Exposure to a Slightly Sweet Lipid-Based Nutrient Supplement During Early Life Does Not Increase the Preference for or Consumption of Sweet Foods and Beverages by 4-6-y-Old Ghanaian Preschool Children: Follow-up of a Randomized Controlled Trial

Abstract

Background: Whether consuming sweet foods early in life affects sweet food preferences and consumption later in childhood is unknown.

Objective: We tested the hypothesis that exposure to a slightly sweet lipid-based nutrient supplement (LNS) early in life would not increase preference for or consumption of sweet items at preschool age.

Methods: We followed up children who had participated in a randomized trial in Ghana in which LNS was provided to 1 group of women during pregnancy and 6 mo postpartum and to their infants from ages 6-18 mo (LNS group). The control group (non-LNS group) received iron and folic acid during pregnancy or multiple micronutrients during pregnancy and 6 mo postpartum, with no infant supplementation. At 4-6 y, we obtained data from caregivers on children's food and beverage preferences and consumption (n = 985). For a randomly selected subsample (n = 624), we assessed preference for sweet items using a photo game (range in potential scores, 0-15). For the photo game and reported consumption of sweet items, we examined group differences using predetermined noninferiority margins equivalent to an effect size of 0.2.

Results: Median (quartile 1, quartile 3) reported consumption of sweet items (times in previous week) was 14 (8, 23) in the LNS group and 16 (9, 22) in the non-LNS group; in the photo game, the number of sweet items selected was 15 (11, 15) and 15 (11, 15), respectively. The upper level of the 95% CI of the mean difference between LNS and non-LNS groups did not exceed the noninferiority margins for these outcomes. Caregiver-reported preferences for sweet items also did not differ between groups (P = 0.9).

Conclusion: In this setting, where child consumption of sweet foods was common, exposure to a slightly sweet LNS early in life did not increase preference for or consumption of sweet foods and beverages at preschool age. This trial was registered at clinicaltrials.gov as NCT00970866.

Keywords: Ghana; children; consumption; lipid-based nutrient supplements; preference; sugar-sweetened beverage; sweet food.

FIGURE 1

Study profile. IFA, iron and folic acid; LNS, lipid-based nutrient supplement; MMN, multiple micronutrients. LNS group, women received 20 g LNS daily during pregnancy and for 6 mo postpartum. Infants received 20 g LNS daily from 6–18 mo of age; Non-LNS group, women received either IFA during pregnancy and placebo for 6 mo postpartum or MMN capsules during pregnancy and for 6 mo postpartum. Infants did not receive any supplement. *Details reported in (29).

FIGURE 2

Noninferiority graphs. All outcome values have been re-scaled to SD units. Error bars indicate 95% CIs. The noninferiority margin is denoted by the dotted line. (A) Difference in children's preference for sweet foods and beverages (defined as the number of sweet items chosen by child from among 30 food and beverage items included in a photo game) between the LNS (n = 301) and non-LNS groups (n = 323). The 95% CIs lie to the left of the noninferiority margin (0.2 SD), indicating noninferiority (i.e., the preference for sweet foods and beverages by the LNS group was not higher than that preferred by the non-LNS group). Analysis adjusted for household assets and distance to weekly market. (B) Difference in children's consumption of sweet foods and sugar-sweetened beverages (as reported by caregiver) between LNS (n = 345) and non-LNS groups (n = 640). The 95% CIs lie to the left of the noninferiority margin (0.2 SD), indicating noninferiority (i.e., the preference for sweet foods and beverages by the LNS group was not higher than that preferred by the non-LNS group). Analysis adjusted for prepregnancy BMI, maternal age, maternal education, nulliparity, and household assets. (C) Difference in children's consumption of sugar-sweetened beverages (as reported by caregiver) between LNS (n = 345) and non-LNS groups (n = 640). The 95% CIs lie to the left of the noninferiority margin (0.2 SD), indicating noninferiority (i.e., the consumption of sweet foods and beverages by the LNS group was not higher than that consumed by the non-LNS group). Adjusted for prepregnancy BMI, maternal education, nulliparity, and household assets. LNS, lipid-based nutrient supplement; non-LNS, no exposure to lipid-based nutrient supplement (control group).