Downshifting Sweet Preference and Added Sugar Intake During Snacking Among Young Children: A Randomized Controlled Trial

项目摘要和摘要 世界卫生组织呼吁所有国家减少儿童的糖摄入量，因为 有确凿证据表明，限制摄入游离(添加)糖可降低肥胖、龋齿及以后患病的风险 心脏病。在美国，学龄前儿童正在消费，通常是在零食的背景下， 每天大约13茶匙的添加糖，是美国心脏协会的两倍多 推荐儿童使用。以证据为基础的策略，有效减少添加糖的摄入并促进 喜欢添加糖较少的饮料和食品显然是公众健康的优先事项。 我们建议的随机对照试验建立在我们之前由NIH赞助的研究的基础上，该研究证明 早期生活喜好的可塑性以及反复接触对生活的影响 不断变化的偏好。我们已经证实，孩子天生就对甜味有更高的偏好， 母亲们提供含糖零食通常是出于非营养素的原因，而在 对奖励的敏感性和食欲可能会使一些儿童更容易受到饮食过量的影响 零食中的糖。这项拟议的研究将是第一个确定 4个月的日常零食是否会降低学龄前儿童的甜食偏好 与年龄相近的人相比，含有更少添加糖和甜味的(干预组) 对照组每天的零食总糖分增加两倍多，添加的零食增加五倍 糖(具体目标1)。我们还将确定干预的影响是否推广到其他 在实验室里，人们更喜欢和更多地摄入新奇的低糖零食，而更低的游离 通过甘蔗和玉米糖的生物标记物验证了添加糖的活体摄入量，这两种主要添加糖 美国食品供应中的糖(特定目标2)。我们将进一步研究是否存在个体间的差异 味觉基因、食欲调节特征和奖赏敏感性决定了某些儿童是否 在改变偏好方面不如其他人成功(具体目标3)。次要目标将探索 通过检查母亲的甜食偏好程度，研究干预措施对母亲的涓滴效应 给孩子喂食含糖量和甜度较低的零食会对他们造成影响。 为了实现我们的目标，我们组建了一个多机构、跨学科的调查团队， 他们中的每一个人都带来了人类味觉和遗传学方面独特而必要的专业知识， 食欲调节、生物标记物、儿科牙科和统计学方法。研究结果将提供新的见解 以家庭为基础的个性化方法，提高幼儿对低附加值食物的喜好 糖和甜味。这项研究将服务于建立循证证据的长期目标 减少儿童添加糖摄入量和促进健康零食行为的策略。

PROJECT SUMMARY AND ABSTRACT The World Health Organization calls on all countries to reduce sugar intake among children because of the solid evidence that limiting intake of free (added) sugars reduces the risks of obesity, tooth decay, and later heart disease. In the United States, preschoolers are consuming, often in the context of snacking, approximately 13 teaspoons of added sugars daily, more than double what the American Heart Association recommends for children. Evidence-based strategies to effectively reduce added sugar intake and promote the liking of beverages and foods containing less added sugar are a clear public health priority. Our proposed randomized controlled trial builds upon our prior NIH-sponsored research that demonstrates the plasticity of preferences during early life and the fundamental role that repeated exposure has on shifting preferences. We have established that children have inborn, elevated preferences for sweet taste, that sugary snacks are often offered for nonnutritive reasons by mothers, and that personal variation in the reward sensitivity and appetitive tastes may make some children more susceptible to dietary excess of sugars from snacks. This proposed research will be the first randomized controlled trial to determine whether sweet preferences can be downshifted in preschoolers by a 4-month exposure to daily snacks containing reduced levels of added sugars and sweetness (intervention group) compared to a similarly aged control group whose daily snacks will be more than twofold higher in total sugar and fivefold higher in added sugar (Specific Aim 1). We will also determine whether the impact of the intervention generalizes to other foods as reflected by greater liking and intake of novel low-sugar snacks in the laboratory and by lower free- living intake of added sugars, validated by biomarkers of cane and corn sugar, the two predominant added sugars in the US food supply (Specific Aim 2). We will further examine whether inter-individual variation in taste genotype, appetitive regulation traits, and reward sensitivity determines whether certain children are less successful in shifting preference than others (Specific Aim 3). The Secondary Aim will explore the trickle-down effects of the intervention on mothers by examining the extent to which their sweet preferences are affected by feeding their children snacks with lower levels of sugar and sweetness. To accomplish our goals, we have assembled a multi-institutional, interdisciplinary team of investigators, each of whom brings unique and necessary expertise in human taste perception and genetics, child appetite regulation, biomarkers, pediatric dentistry, and statistical methods. Findings will provide new insight on family-based, personalized approaches for increasing young children’s liking of foods lower in added sugar and sweetness. This research will serve the long-term goals of establishing evidenced-based strategies to reduce children’s consumption of added sugar and promoting healthy snacking behaviors.