Background/Objectives: Ultra-processed foods (UPFs) consumption is increasing among infants and young children below three years of age, but to what extent is unclear. Understanding ingredient profiles in commercially produced complementary foods is critical given emerging evidence linking UPF consumption in early life with adverse health trajectories. The objective of this study was to assess the degree of processing and characterize the types of ingredients and additives used in commercial complementary foods available in major US grocery stores. Methods: This was a cross-sectional analysis of 651 infant and toddler food products sold by the top 10 largest US grocery stores in 2023. Data were collected from 8 of the 10 stores in Raleigh, North Carolina, and from 2 of the 10 stores online. Ingredients were classified into types and subtypes using Codex Alimentarius and US FDA taxonomies. UPFs were identified using the Nova classification system. The number of UPF ingredients per product and the proportion of products that were considered UPFs were calculated. Mean nutrient levels were compared between UPFs and non-UPFs. Results were examined by category and packaging type. Results: 71% of products were classified as UPFs. In addition, additives were present in 71% of products, with flavor enhancers (36%), thickeners (29%), emulsifiers (19%), and colors (19%) being the most common UPF-marker additives used. Ingredient counts varied widely (range 1–56), with snacks containing the most ingredients. Processed fruit and vegetable ingredients were common, while dairy, meat, and legume ingredients were uncommon. UPF products contained higher mean levels of total sugar, added sugar, sodium, and energy density than non-UPF products. Added sugars were present exclusively in UPF products. Conclusions: Most US commercial complementary foods are ultra-processed and contain multiple additives. These findings highlight the need for improved labeling and regulatory standards for identifying UPF ingredients and additives to ensure the availability of appropriate and healthy products targeting the youngest consumers.
It is now widely understood that consumption of packaged ultra-processed foods and beverages (UPFs) is increasing both in the United States (US) and globally. A defining feature of UPFs is the presence of cosmetic additives, such as flavor enhancers, colors, and emulsifiers. Recent research showed that the proportion of commercially produced complementary products–foods marketed for children up to 36 months of age-purchased by the US population that contain cosmetic additives such as colors and flavors has increased substantially since the early 2000s, and represented the largest growth in purchases containing additives across all food and beverage categories.
In recent years, there has been a huge increase in the availability and variety of commercial complementary foods on the market in the US. This trend has occurred in tandem with increased research demonstrating that the consumption of UPFs containing multiple ingredients and specific additive classes poses health risks not only for adults, but also for young children. In adults, UPF consumption is linked with overweight, obesity and cardio-metabolic risks; cancer, type 2 diabetes and cardiovascular diseases; irritable bowel syndrome, depression and frailty conditions; as well as premature all-cause mortality. In children, research has demonstrated a clear link between UPF consumption and cardio-metabolic conditions. In addition to this, taste preferences and dietary habits formed during early childhood can persist into adulthood, with longitudinal studies clearly demonstrating a positive association between the consumption of UPFs and obesity in young children. Little doubt exists that children in the US are being increasingly exposed to these foods, with substantial expansion in the types and quantities sold.
Complementary feeding, the introduction of family foods and beverages alongside continued breastfeeding, is a critical phase for child growth and development. During this time, what young children eat contributes not only to nutrient intake but also to the development of eating behaviors and food preferences that can persist later in life. Evidence suggests that early exposure to flavors and textures influences acceptance of foods, including preferences for sweet and salty tastes. The growing presence of foods that are classified as UPFs under the Nova framework has raised concerns, as these products are frequently formulated with added sugars, sodium, and cosmetic additives intended to enhance sensory appeal. Consumption of UPFs during complementary feeding may therefore have implications beyond nutrient composition, potentially shaping taste preferences and dietary patterns in ways that favor UPFs high in sugar and sodium.
In response to this, there has been a call to better understand the degree of processing and presence of UPF additive markers in commercial products aimed at infants and young children below 36 months of age. Despite research suggesting a negative association between some food additives and adverse health effects in young children, there is currently no research examining the extent to which food additives are used in the manufacturing of commercially produced complementary foods in the US. Although prior research has assessed the degree of processing among commercially produced complementary foods available in the European market and South East Asian market, comparable data from the US are lacking. Given the explosion of UPF availability and consumption in the US, coupled with the understanding that UPFs can have detrimental effects on infants and young children, the objective of this study was to examine the extent to which commercially produced complementary foods available in US grocery stores are UPFs, with an in-depth look into the types of additives and other ingredients used in these products.
The dataset for analysis comprised n = 651 commercial infant and toddler food products collected in the US in 2023. Data collection methodology has been described previously, but in brief, researchers visited one location for eight of the top 10 grocery store chains in the US (Walmart, Kroger, Costco, Ahold Delhaize, Publix, Sam’s Club, Target, and Aldi) in Raleigh, North Carolina, between March and May 2023. Two of the top ten grocery store retailer locations were not located in North Carolina (H-E-B and Safeway), so data were collected from websites for these retailers. Photos of all available products in the “baby” aisle (in-store) or under the “baby” tab (online) were collected. The George Institute’s FoodSwitch content management system was used to enter data captured from product photos. The information extracted from FoodSwitch for analysis included manufacturer name, brand name, product description, ingredients, packaging type and nutrient information per 100 g (energy, protein, total fat, saturated fat, total sugars, added sugars, sodium). For products with data collected from online sources, information for these products was added to the FoodSwitch data extract to ensure the same information was captured.
Products were categorized using the World Health Organization’s Nutrient and Promotion Profile Model taxonomy, with each product placed in one of eight broad food categories: (1) Dry cereals and starches; (2) Dairy foods; (3) Fruit and vegetable purées/smoothies and fruit desserts; (4) Savory meals/meal components: combinations of starches, vegetables, dairy, and/or traditional proteins; (5) Snacks and finger foods; (6) Ingredients; (7) Confectionery; and (8) Drinks. Further subcategory levels can be seen in Table 1. Products were also placed into one of four packaging type categories (Full-size package; Snack-size package; RTE jar/tub/container; Pouch) based on previous research.
Ingredients were disaggregated using delimiters and compound ingredient information was extracted when present. Compound ingredients are ingredients that contain two or more sub-ingredients (for example, cheese [pasteurized milk, cultures]). For ingredients with a variety of common names, a master ingredient name was identified (fruit juice concentrate became concentrated fruit juice; Table S1). When a term relating to an agricultural technique was identified (e.g., organic) it was removed. All final classifications were manually checked by the research team.
The United States Department of Agriculture (USDA) ingredient category thesaurus was used as a first step to assign each ingredient to a high-level “ingredient type”. Each ingredient was then assigned an ingredient subtype. For additive classifications, these subtypes were based the FDA’s Substances Added to Food inventory, previously known as Everything Added to Foods in the United States. These additive subtypes were then linked to Codex food additive functional classes to facilitate UPF identification (due to differences in Codex and FDA additive class definitions), with this mapping displayed in Table S2. When a specific additive had multiple functions, it was classified under each function. For all remaining categories, taxonomy developed by Gaines et al. was used to enable a deeper look into specific ingredient types. Ten ingredients fell under multiple ingredient type categories. In these cases each product was examined individually to determine the use of the ingredient in each case. All ingredients and their type/subtype allocations can be seen in Table S1.
The Nova classification system was used to identify products that were considered ultra-processed. The list of substances never or rarely used in the kitchen (see Figure 1) and the 12 Codex additive classes specified to be UPF markers under Nova (antifoaming agents, bulking agents, carbonating agents, colors, emulsifiers, emulsifying salts, foaming agents, flavors/flavor enhancers, gelling agents, glazing agents, sweeteners, thickeners) were used to identify UPFs. If none of these substances or additives were found in t
