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sils which may promote the use of breast milk substitutes or bottle feeding. It is stated that the presentation of products must clearly express the superiority of breast feeding and that no pictures or text may be used that idealize the use of infant formula. The Code obliges the member states of the World Health Assembly to take appropriate measures to promote and implement these principles. Countries around the world have implemented measures to promote the principles and practices laid down in the Code [9] . Also the Global Infant Formula Standard of the Codex Alimentarius indicates that the recommendations made in the Code should be taken into account [10] . With regard to Europe, all of the member states of the European Union at the World Health Assembly voted in favor of adoption of the Code [11] . Consequently, the European Directive on infant formulae and follow-on formulae established that ‘the rules of labeling and advertising for these products should be in conformity with the principles and the aims of the International Code of Marketing of Breast Milk Substitutes adopted by the 34th World Health Assembly’ in an effort to provide better protection for the health of infants [12] . However, the current practice in Europe in this regard is far from satisfactory and not in agreement with the European legislation. Three decades ago the ‘International Code of Marketing of Breast Milk Substitutes’ (the Code) was adopted by the 33rd World Health Assembly, the decision-making body of the World Health Organization [1] . The Code aims to protect and promote breast feeding and to ensure ethical approaches to marketing of infant formulae and other foods that are presented as a partial or total replacement for breast milk. These goals are as timely today as ever before given the much increased evidence on the importance of infant feeding for growth, development, and long-term health well into adulthood [2] . Breast feeding is widely recognized as the ideal form of infant feeding, providing multiple benefits for child health, affecting not only immediate health outcomes such as prevention of infectious gastroenteritis but also important long-term outcomes such as a reduced risk of obesity and atopic eczema, and enhanced cognitive development [3–8] . Thus, breast feeding should be actively promoted, protected, and supported. The Code supports the protection of breastfeeding and stipulates that there should be no advertising or other form of promotion of breast milk substitutes to the general public and that manufacturers and distributors should not provide to families, directly or indirectly, samples of such products or other gifts of utenPublished online: December 2, 2011

annals of nutrition and metabolism

Marketing of Dietetic Products for Infants and Young Children in Europe Three Decades after Adoption of the International Code of Marketing of Breast Milk Substitutes