Randomized Controlled Trial to Investigate the Effects of Repeated Exposure to Low Added Sugar Snacks Among Children: Choice of Experimental Food Stimuli

OBJECTIVES: What we eat during childhood programs food preferences, yet from the age of two years, added sugar intake exceeds recommended levels. We are conducting a trial in which mother-child dyads are randomized to one of two groups that differ in the sweetness and added sugar content of afternoon snacks provided to toddlers and type of educational lessons given to their mothers. The present study describes the methods used to determine the types of snacks proffered to the control and intervention groups during the 4-month exposure period. METHODS: We established a priori that snacks for either group would differ in added sugar and sweetness without the inclusion of candy, low calorie sweeteners, or sugar sweetened beverages and would provide similar energy (300 kcal) at each snack occasion. We developed two menus. In the first menu, every snack occasion contained at least one food or beverage item, often made by the same manufacturer, for which there was a regular sugar version for control group and low-sugar version for the intervention group. In the second menu, we put less emphasis on matching the types of snacks for the two groups. Rather, we focused on the added sugar and salt content of the snacks and we provided additional snack occasions (∼4/month) of fresh fruit for the intervention group. A sensory panel evaluated the sweetness of the snacks using the general labelled magnitude scale. RESULTS: While both menus yielded snacks that differed in sweetness (p < 0.001) and sugar content (p < 0.001), the intervention snacks in the first menu contained twice the amount of sodium than the control snacks in the first menu (p < 0.001). Adding fruit and focusing on the sugar and sodium content per se resulted in the intervention snacks in the second menu containing significantly less sodium than those in the first menu (p < 0.001). Although there was only a one-fold difference between the intervention and control snacks in the second menu, the difference was significant, due in part to more savory snacks for the intervention group (p < 0.001). CONCLUSIONS: Providing low-sugar snacks to children requires attention to its salt content, another preferred taste of children. With increasing evidence suggesting the importance of early life experiences on long-term health, this trial will inform future prevention efforts for children. FUNDING SOURCES: Supported by NIH Grant R01DC016616.