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Sugar intake of children in the "Childhood Obesity Project" trial
Sugar intake of children in the "Childhood Obesity Project" trial
Introduction: High sugar intake has been suggested to be involved in the development of overweight and obesity and several associated NCDs such as diabetes and CVD. The aim of this doctoral thesis is to investigate whether a higher sugar intake in children is associated with two different risk factors of NCDs, i.e. overweight and obesity, and unfavorable blood markers of lipid and glucose metabolism. Methods: Data was drawn from the CHOP trial, a randomized controlled nutritional intervention trial in the first year of life with long- term follow-up. Infants from five European countries (Belgium, Germany, Italy, Poland, Spain) were randomized to feeding with a higher or lower protein content formula, and an additional breastfed reference group was recruited. Nutrition was assessed yearly from 2 to 6 years of age and again at age 8 years using 3-day-weighed food protocols. Anthropometric measurements were taken from 2 to 8 years of age, at the same time as nutrition assessments. A longitudinal analysis was performed to investigate the influence of sugar intake on age and gender standardized body mass index (BMI) and fat mass index (FMI) over time. A cross-sectional analysis at 8 years of age examined the association of sugar intake with several blood markers of lipid and glucose metabolism. Results: While increasing TS intake in an ad libitum diet was positively associated with BMI and FMI z-score, a negative association was observed on an energy-equivalent basis (zBMI: -0.033; 95% CI: -0.061, -0.005, zFMI: - 0.050; 95% CI: - 0.089, - 0.011 at an increase of 100 kcal from TS). Looking at blood markers, an increased consumption of 100 kcal from TS was significantly associated with a HDL-C z-score decrease (-0.14; 95% CI: -0.01, - 0.27). Increase of TS intake from SSBs showed the strongest association with a decrease in HDL-C z-score (-1.67; 95% CI: -0.42, -2.91). For none of the other investigated markers of lipid or glucose metabolism a significant association with TS increase or TS increase of major food groups was observed. Conclusions: Results indicate that increasing TS intake in childhood does not affect overweight or obesity on an energy-equivalent basis. Additionally, on an energy-equivalent basis only HDL-C was unfavorably influenced by increasing TS intake and this association was very weak. The analysis of the current thesis suggests that increasing TS on an energy-equivalent basis in childhood have little impact on the investigated risk factors of NCDs. Therefore, for prevention of NCD risk factors in early childhood the reduction of TEI should be rather focused on. Nevertheless, a diet with a high sugar intake is generally not recommended, since dietary products with high sugar intake, especially with free sugars, are often accompanied by a low nutritional density and add unnecessary and dispensable energy.
Sugar intake, BMI, blood lipids, blood sugars, children
Aumüller, Nicole
2021
English
Universitätsbibliothek der Ludwig-Maximilians-Universität München
Aumüller, Nicole (2021): Sugar intake of children in the "Childhood Obesity Project" trial. Dissertation, LMU München: Faculty of Medicine
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Abstract

Introduction: High sugar intake has been suggested to be involved in the development of overweight and obesity and several associated NCDs such as diabetes and CVD. The aim of this doctoral thesis is to investigate whether a higher sugar intake in children is associated with two different risk factors of NCDs, i.e. overweight and obesity, and unfavorable blood markers of lipid and glucose metabolism. Methods: Data was drawn from the CHOP trial, a randomized controlled nutritional intervention trial in the first year of life with long- term follow-up. Infants from five European countries (Belgium, Germany, Italy, Poland, Spain) were randomized to feeding with a higher or lower protein content formula, and an additional breastfed reference group was recruited. Nutrition was assessed yearly from 2 to 6 years of age and again at age 8 years using 3-day-weighed food protocols. Anthropometric measurements were taken from 2 to 8 years of age, at the same time as nutrition assessments. A longitudinal analysis was performed to investigate the influence of sugar intake on age and gender standardized body mass index (BMI) and fat mass index (FMI) over time. A cross-sectional analysis at 8 years of age examined the association of sugar intake with several blood markers of lipid and glucose metabolism. Results: While increasing TS intake in an ad libitum diet was positively associated with BMI and FMI z-score, a negative association was observed on an energy-equivalent basis (zBMI: -0.033; 95% CI: -0.061, -0.005, zFMI: - 0.050; 95% CI: - 0.089, - 0.011 at an increase of 100 kcal from TS). Looking at blood markers, an increased consumption of 100 kcal from TS was significantly associated with a HDL-C z-score decrease (-0.14; 95% CI: -0.01, - 0.27). Increase of TS intake from SSBs showed the strongest association with a decrease in HDL-C z-score (-1.67; 95% CI: -0.42, -2.91). For none of the other investigated markers of lipid or glucose metabolism a significant association with TS increase or TS increase of major food groups was observed. Conclusions: Results indicate that increasing TS intake in childhood does not affect overweight or obesity on an energy-equivalent basis. Additionally, on an energy-equivalent basis only HDL-C was unfavorably influenced by increasing TS intake and this association was very weak. The analysis of the current thesis suggests that increasing TS on an energy-equivalent basis in childhood have little impact on the investigated risk factors of NCDs. Therefore, for prevention of NCD risk factors in early childhood the reduction of TEI should be rather focused on. Nevertheless, a diet with a high sugar intake is generally not recommended, since dietary products with high sugar intake, especially with free sugars, are often accompanied by a low nutritional density and add unnecessary and dispensable energy.