Abstract
Background: Children consume more added sugar than recommended, with snacks a major source.
Objectives: To determine the effects of repeated exposure to lower-sugar snacks, combined with caregiver education, on children’s added sugar intake, acceptance of lower-sweetness foods, and sweet preferences.
Methods: In a 4-month randomized trial with 1-month follow-up, 70 preschooler-caregiver dyads were assigned to a control group receiving daily snacks typical for children and general health lessons for caregivers or an intervention group receiving lower-sugar, lower-sweetness snacks and caregiver lessons on nutrition and dental health, including guidance to limit sugary foods and remove sugar-sweetened beverages (SSBs) from the home. Primary outcomes were changes in children’s added sugar and SSB intakes, acceptance of low-sweetness snacks, and taste preferences.
Results: At 4 months, intervention children ingested less added sugar [–10.1 tsp/d; 95% confidence interval) CI: −14.0, −6.2; P < 0.001] and SSB (−103.3 kcal/d; 95% CI: −159.2, −47.5; P < 0.001) than controls; decreases were evident by mid-trial. The intervention did not alter their liking or intake of 4 selected lower-sugar snacks or shift their most preferred sucrose concentration. However, there was significant group × time interaction for salt preferences (P = 0.045); intervention children most preferred higher salt concentrations (0.52 ± 0.04 Molarity [M]) than did controls (0.32 ± 0.04 M; P = 0.002). By mid-trial, intervention caregivers also consumed less added sugar (–17.6 tsp/d; 95% CI: –24.5, –10.7; P < 0.001) and SSBs (–255 kcal/d; 95% CI: –329, –122; P = 0.01) than controls.
Conclusions: Providing lower-sugar snacks daily and caregiver education for 4 months effectively reduced daily added sugar and SSB intakes among children and their caregivers without shifting the most preferred level of sweetness. Although sodium intake was unchanged, increased salt preference among intervention children suggests a potential trade-off between added sugar and sodium content of children’s snacks that warrants further investigation.
Summary: This 4-month RCT involving 70 caregiver-child dyads investigated whether repeated exposure to lower sugar snacks alongside caregiver education could reduce added sugar intake or change taste preferences in preschoolers, compared with a control group receiving typical snacks.
Results showed that children in the intervention group significantly reduced their added sugar intake and SSB consumption compared with the control group. Similar reductions were observed among caregivers.
Of particular interest, while overall exposure to sweetness was reduced, children’s preferred level of sweetness did not change over the course of the study. In contrast, intervention children showed a significant increase in preference for higher salt concentrations, suggesting a possible sensory “trade-off”, where children deprived of their high-sugar snacks may have sought out more intense salty taste. However, these findings on taste preferences were exploratory.