Research highlights importance of dietary education to combat rising childhood obesity rates

By Hugo Francisco de Souza Reviewed by Lily Ramsey, LLM Jul 18 2024

In a recent study published in Nutrients, researchers aimed to investigate the artificial sweetener content of children's commonly consumed food products (syrups, juices, and soft drinks) and to ascertain their parents' knowledge about the declarations of these products.

Study:  Intake of Artificial Sweeteners through Soft Drinks in the Preschool- and School-Aged Population . Image Credit: WS-Studio/Shutterstock.com Introduction

The study findings indicate that more than half (54%) of the products consumed by children aged one to 14 years contain artificial sweeteners.

Most parents (51%) remain unaware of this fact because they do not peruse the nutritional information or content declarations of the products they purchase.

These findings highlight a need for consumer education outreach programs tailored to educate parents about the potentially harmful effects of artificial sweeteners and other dietary choices on young children. Background

An alarming and persistent public health concern is that of the growing number of overweight and obese individuals globally.

Recent reports suggest that more than half of European adults (53%) and almost one-third of children (29%; age group – 6 to 9) are overweight (body mass index [BMI] exceeding 25) with the World Health Organization (WHO) estimating that 37 million children under the age of five are overweight as of 2022.

Abnormally high BMI has been previously linked to a heightened risk of chronic non-communicable diseases, including diabetes, cancers, and cardiovascular diseases (CVDs), making addressing this trend is a crucial goal.

Poor dietary choices, in combination with patterns of reduced physical activity, have been highlighted as the main cause of obesity worldwide, with the WHO recognizing the role of excessive sugar consumption in these outcomes and recommending that sugar forms not more than 10% of individuals' total daily calorific intake.

A recent trend among food manufacturers and 'health conscious' consumers has been substituting sugar-based sweeteners with artificial sweeteners.

Despite being marketed as healthier alternatives to sugar, research on the physiological impacts of sugar substitutes remains inconsistent. As a result, the WHO recommends abstaining from their consumption.

"…several studies point to their possible harmful effects in increasing the risk of type 2 diabetes, cardiovascular diseases, premature mortality and changes in the gastrointestinal tract." About the study

Although Croatian cuisine follows the principles of the Mediterranean diet, known as the 'gold standard' for healthy eating, the country has one of the world's highest proportions of overweight children. Related StoriesNew brain targets for GLP1-based obesity drugs may reduce weight without nauseaStudy links circadian rhythm disruption to obesity and diabetesWhat happens to narcissism as we age? Research shows declining trends

Previous research has suggested that soft drinks may be the main culprit in these observations. Still, no studies have evaluated the percentage of children who consume these products or their parents' aptitudes of their potentially harmful effects.

The present study aims to address these knowledge gaps through a cross-sectional, questionnaire-based survey of two large preschools in Split, Croatia.

Randomly selected parents of children studying in these institutions were presented with a custom-designed questionnaire containing items regarding their children's dietary habits and their aptitudes about the contents of the food products they purchase.

Furthermore, parents' attitudes towards obesity and artificial sweeteners were recorded using a 5-point Likert scale.

Common items identified through these questionaries were grouped into one of six types (soft drinks, juices/nectars, syrups, instant beverages, protein drinks, or chewing gums) and subjected to high-performance liquid chromatography (HPLC) to elucidate their chemical composition.

Statistical analyses comprised descriptive statistics for survey items and Chi-squared or Mann-Whitey U tests for between-group evaluations. The Kolmogorov-Smirnov test was used for normality evaluations. Study findings

Three hundred twenty-three parents participated in the survey (89% women; median age 37), comprising parents of preschoolers (children aged 1 to 7; n = 250) and school children (aged 7-14; n = 73).

Parents provided information on their wards' dietary habits and demographic information (age, sex, BMI, parents' educational qualifications, and physical activity).

Common item identification identified 90 food items comprising 35 soft drinks, 33 juices, three syrups, five instant drinks, two protein drinks, and 12 chewing gums.

BMI evaluations revealed that most included children were below the WHO-recommended ideal BMI (83%; mean = 15.4 kg/m2). Physical activity assessments elucidated that 33.2% of included children did not participate in any form of physical activity.

HPLC evaluations revealed that 54% of the included 90 items contained artificial sweeteners (75% of chewing gums, 21.2% of juices, 59% of soft drinks, and 21.2% of nectars). Encouragingly, all but one of these food items highlighted the identified sweeteners in its nutritional description.

Unfortunately, more than half (51%) of parents reported that they did not read food product labels when making purchasing decisions and were therefore unaware of the sweetener contents of these items.

Correlations between the questionnaires and HPLC results reveal that 40% of surveyed children consume artificial sweetener-containing products daily.

Additional data analysis showed a correlation between the frequency of soft drink or syrup consumption and increased BMIs in surveyed children. Conclusions

The present study found that most soft drinks and other Croatian beverages contain varying concentrations of artificial sweeteners.

Despite almost all of them listing the presence of these sweeteners on their labels, most parents fail to read product descriptions, making them oblivious to the potentially adverse chemical composition of their children's diets.

Approximately 40% of surveyed children were noted to consume sweetener-containing products daily, and evaluations of their BMI indicated a correlation between increasing BMI and the frequency of beverage consumption.

These findings highlight a need for education campaigns targeting parents to change present dietary habits. Age groups 1-14 represent a critical age for children's growth and development, and suboptimal diets during these vital years may manifest as chronic diseases during adulthood.

"It is very important, especially for young children, to change the perception of food acceptance and become used to the consumption of normal, not overly sweetened food, whether the sweetness comes from sugar or artificial sweeteners." Journal reference:

Jurcevic Zidar, B.; Luetic, S.; Jurcic, K.; Knezovic, Z.; Sutlovic, D. (2024) Intake of Artificial Sweeteners through Soft Drinks in the Preschool- and School-Aged Population. Nutrients. doi:10.3390/nu16142278. https://www.mdpi.com/2072-6643/16/14/2278