Snacks, Smiles and Taste Preferences

Sponsor

Temple University (Other)

Overall Status

Active, not recruiting

CT.gov ID

NCT03631992

Collaborator

Monell Chemical Senses Center (Other), National Institute on Deafness and Other Communication Disorders (NIDCD) (NIH)

120

Enrollment

Locations

Arms

37.7

Anticipated Duration (Months)

Patients Per Site

1.6

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The research study is designed is to determine whether children's acceptance of low sugar snacks, most preferred level of sweet and salty taste, and dietary intake of added sugars changes after repeated exposure to snacks lower in sweetness when compared to the control group.

Condition or Disease	Intervention/Treatment	Phase
Development, Child	Behavioral: Low Sweet Behavioral: Regular Sweet	N/A

Detailed Description

This is a longitudinal, randomized, within- and between- subject study of children and their mothers to determine whether children's repeated exposure to snacks lower in sweetness and mothers' educational lessons about dental health and nutrition (intervention group) affects children's acceptance of low sugar snacks, most preferred level of sweet and salty taste, and dietary intake of added sugars when compared to the control group.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

120 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

The intervention group will receive snacks lower in added sugar and sweetness (children) and educational lessons on dental care, food labels, added sugar, and portion size (mothers) whereas the control group will receive typical snacks (children) and educational lessons on portion size, sleep, screen time, and physical activity (mothers). Control group will receive the educational lessons of the intervention group at the end of the trial.The intervention group will receive snacks lower in added sugar and sweetness (children) and educational lessons on dental care, food labels, added sugar, and portion size (mothers) whereas the control group will receive typical snacks (children) and educational lessons on portion size, sleep, screen time, and physical activity (mothers). Control group will receive the educational lessons of the intervention group at the end of the trial.

Masking:

Triple (Participant, Investigator, Outcomes Assessor)

Masking Description:

Participants and outcome assessors will be blind to hypotheses and group assignment. Investigators will be blind to the group assignment during statistical analyses.

Primary Purpose:

Basic Science

Official Title:

Downshifting Sweet Preference and Added Sugar Intake During Snacking

Actual Study Start Date :

Oct 9, 2018

Anticipated Primary Completion Date :

Nov 30, 2021

Anticipated Study Completion Date :

Nov 30, 2021

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Low Sweet Children in intervention group will be provided with daily snacks lower in added sugar and sweetness and their mothers will receive educational lessons on dental care, reading food labels, and nutrition that support the goals of reducing "sweet" exposure and added sugar intake.	Behavioral: Low Sweet Children in the experimental group get repeated exposure to lower sweet snacks and mothers get education lessons on dental care, reading food labels, portion size, and nutrition.
Sham Comparator: Regular Sweet Children in the regular sweet control group will be provided with common snacks fed to children of this age and mothers will be given education lessons on portion size, physical activity, sleep, screen time and, at the end of the trial, dental care.	Behavioral: Regular Sweet Children in sham comparator get typical snacks and mothers get education lessons on portion size, physical activity, sleep, and screen time.

Arm

Intervention/Treatment

Experimental: Low Sweet

Children in intervention group will be provided with daily snacks lower in added sugar and sweetness and their mothers will receive educational lessons on dental care, reading food labels, and nutrition that support the goals of reducing "sweet" exposure and added sugar intake.

Behavioral: Low Sweet

Children in the experimental group get repeated exposure to lower sweet snacks and mothers get education lessons on dental care, reading food labels, portion size, and nutrition.

Sham Comparator: Regular Sweet

Children in the regular sweet control group will be provided with common snacks fed to children of this age and mothers will be given education lessons on portion size, physical activity, sleep, screen time and, at the end of the trial, dental care.

Behavioral: Regular Sweet

Children in sham comparator get typical snacks and mothers get education lessons on portion size, physical activity, sleep, and screen time.

Outcome Measures

Primary Outcome Measures

Change is being assessed in the children's level of taste preferences [From timepoint 0 (baseline Monell visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month=end of intervention) and T5 (5 month which is 1 month post-intervention delay)]
Level of tastant (sucrose, salt) most preferred as determined by Monell forced choice tracking method [range: 0.09 to 1.05 M] measured at baseline, 2 months, 4 months (end of intervention), 1 month postintervention
Change is being assessed in the children's liking of snacks low in sweetness [From timepoint 0 (baseline Temple visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month, end of intervention) and T5 (5 month, which is 1 month post-intervention delay)]
Children's grouping of the taste of novel snacks as liked or disliked as determined by lab-based forced-choice testing procedures; following grouping of snacks into liked and disliked, snacks will be ranked for most liked to most disliked [range: 4-6].
Change is being assessed in the children's intake of snacks low in sweetness [From timepoint 0 (baseline Temple visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month= end of intervention) and T5 (5 month which is 1 month, post-intervention delay)]
Children's intake of novel snacks in grams, as determined by lab-based testing feeding procedures which are digitally recorded and later analyzed for behavioral responses during feeding; higher intake and/or less facial expressions of distaste, greater acceptance

Secondary Outcome Measures

Change is being assessed in levels of hair biomarker for added sugar intake [From timepoint 0 (baseline Temple visit at start of intervention) to T4 (4 month visit=end of intervention)]
Estimates of added sugar intake will be determined via stable isotope ratio mass spectrometry methods on hair samples collected at the start (T0) and end of 4-month intervention (T4)
Concordance of hair biomarker for added sugar intake among mother-child dyads [Relationship between hair biomarker levels at timepoint 0 (baseline Temple visit at start of intervention) and at T4 (4 month visit=end of intervention)]
Estimates of added sugar intake will be determined via stable isotope ratio mass spectrometry methods on hair samples collected from mother and child at the start (T0) and end of 4-month intervention (T4) end of the 4-month intervention period (T4) to determine concordance among mother-child dyads
Change is being assessed in dietary intake of energy from added sugar and other sources [From timepoint 0 (baseline Temple visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month, end of intervention) and T5 (5 month, which is 1 month post-intervention delay)]
Dietary intake (g/day) will be determined from Automated Self-Administered Recall System (ASA24) and Diet History Questionnaire III completed by mothers for her child and herself, and adjusted for body weight of the individual (child, mother)
Change is being assessed in liking-based dietary intake survey [From timepoint 0 (baseline Temple visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month, end of intervention) and T5 (5 month, which is 1 month post-intervention delay)]
Dietary intake of foods as determined by measurements of the degree of dislike or like for a variety of foods and beverages (e.g., sweet/fat, fruit, vegetables) as well as experiences and activities; range: -100 (maximal dislike) to 100 (maximal like)]. The items in a given category (e.g., fruits; sweets/fats; healthy foods) are combined and averaged [range: -100 to 100; higher numbers reflect greater liking and intake]. The preschool adapted liking survey (PALS) is used for children and the adult liking survey (ALS) is used for mothers
Monitoring of individual differences in parenting feeding styles [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month, end of intervention) and T5 (5 month, which is 1 month post-intervention delay)]
Mothers will complete the 19-item Child Feeding Styles and Practices Questionnaire [CFSQ]. Each item is scored from 1 (never) to 5 (always). Scores are averaged and categorized into one of four feeding styles: authoritative, authoritarian, indulgent and uninvolved; higher scores represent more of the feeding style
Monitoring of individual differences in children's appetitive drive [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month, end of intervention) and T5 (5 month, which is 1 month post-intervention delay)]
Mothers will complete the 26-item Children's Eating Behavior Questionnaire [CEBQ]. Each item is scored from 1 (never) to 5 (always) and are averaged and categorized into aspects of child eating (e.g., enjoyment of food, food responsiveness, satiety responsiveness, emotional overeating; emotional undereating, food fussiness); higher numbers reflect more of the behavior
Monitoring of individual differences in children's palatable eating motivation [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month, end of intervention) and T5 (5 month, which is 1 month post-intervention delay)]
Mothers will complete the 19-item Kids Palatable Eating Motive Scales (KPEMS) questionnaire; each item is scored from 1 (child almost never/never exhibits behavior) to 5 (child almost always/always exhibits behavior). Scores are averaged and categorized to reflect motives for intake of palatable foods (e.g., to socialize, cope, fit in or conform, for reward enhancement); higher numbers reflect more of the motivation
Monitoring of individual differences in mothers' palatable eating motivation [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month, end of intervention) and T5 (5 month, which is 1 month post-intervention delay)]
Mothers will complete the 19-item Palatable Eating Motive Scales (PEMS) questionnaire; each item is scored from 1 (almost never/never exhibits behavior) to 5 (almost always/always exhibits behavior). Scores are averaged and categorized to reflect motives for intake of palatable foods (e.g., to socialize, cope, fit in or conform, for reward enhancement); higher numbers reflect more of the motivation
Monitoring of weight [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month= end of intervention) and T5 (5 month which is 1 month, post-intervention delay)]
Children's weight will be measured in kg; these measures will be converted to weight for age Z scores which provide measures of anthropometry adjusted age and sex.
Monitoring of height [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month= end of intervention) and T5 (5 month which is 1 month, post-intervention delay)]
Children's height will be measured in cm; these measures will be converted to height for age Z scores which provide measures of anthropometry adjusted age and sex.
Monitoring of body mass index [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month= end of intervention) and T5 (5 month which is 1 month, post-intervention delay)]
Children's height will be measured in cm and weight in kg; these measures will be combined to determine BMI (kg/m2) and then converted to BMI Z scores which provide measures of anthropometry adjusted age and sex.
Monitoring of waist and hip measurements [From timepoint 0 (baseline visit at start of intervention) to T1 (1 month), T2 (2 month), T3 (3 month), T4 (4 month= end of intervention) and T5 (5 month which is 1 month, post-intervention delay)]
Children's waist and hip circumference will be measured in cm; measurements will be combined to calculate waist-to-hip ratio
Taste receptor genotype [At timepoint 0 (baseline Monell visit at start of intervention)]
Saliva with DNA will be collected for determination of allellic variants of known taste receptor genes to conduct exploratory analysis of genomic influence on sweet taste preference and response to intervention

Eligibility Criteria

Criteria

Ages Eligible for Study:

3 Years to 6 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Yes

Inclusion Criteria:

English speaking mother 18 years or older
Mother has primary responsibility for the eligible child's care
Mother has primary responsibility for feeding the eligible child
Mother is responsible for purchasing food for the family
Mother must be willing to refrain from eating food and beverages high in added sugars in the eligible child's presence for the duration of the study

Exclusion Criteria:

Child is in full-day daycare or school
Child is currently on a special diet (e.g. weight management programs)
Child has severe food allergies (e.g. gluten, peanuts)
Child has medical conditions know to affect growth or eating (e.g. diabetes, cystic fibrosis)
Mother is a current smoker