Early exposure to added sugars via infant formula may explain high intakes of added sugars during complementary feeding beyond maternal modeling

Adrianne K Griebel-Thompson; Tera L Fazzino; Emily Cramer; Rocco A Paluch; Katherine S Morris; Kai Ling Kong

doi:10.3389/fnut.2023.1188852

Early exposure to added sugars via infant formula may explain high intakes of added sugars during complementary feeding beyond maternal modeling

Front Nutr. 2023 Sep 7:10:1188852. doi: 10.3389/fnut.2023.1188852. eCollection 2023.

Authors

Adrianne K Griebel-Thompson¹, Tera L Fazzino^{2

3}, Emily Cramer^{4

5}, Rocco A Paluch⁶, Katherine S Morris⁷, Kai Ling Kong^{1

5

8}

Affiliations

¹ Baby Health Behavior Lab, Division of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, United States.
² Department of Psychology, University of Kansas, Lawrence, KS, United States.
³ Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, KS, United States.
⁴ Biostatistics and Epidemiology Core, Division of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, United States.
⁵ Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States.
⁶ Division of Behavioral Medicine, Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States.
⁷ FeedMore WNY, Buffalo, NY, United States.
⁸ Center for Children's Healthy Lifestyles and Nutrition, University of Kansas Medical Center, Kansas City, KS, United States.

Abstract

Background: Research has shown that early exposure to added sugars from table food is related to increased intake of added sugars in later childhood. The earliest window of exposure to added sugars may be in infancy via infant formula. However, beyond the well-established factors of maternal lifestyle and modeling, there is a lack of research examining how exposure to added sugars from infant formula influences infant/toddler added sugar intakes from table foods and sugar sweetened beverages (SSB).

Objective: While accounting factors previously associated with infant/toddler added sugar intakes and maternal SSB consumption (proximal measure of maternal modeling), this study aims to examine if there is an association between added sugars in infant formula and added sugar intakes from table foods and SSB during the complementary feeding period.

Methods: This is a secondary, cross-sectional analysis using three-day caregiver-reported 24-h dietary recalls in a cohort of infant/toddlers (n = 95), ages 9- < 16 mos., enrolled in a music intervention trial. Hierarchical stepwise regression was used to estimate the association between exposure to added sugars from infant formula and (1) intake of added sugars from table food and (2) SSB consumption. Infant/toddler SSB consumption was transformed to account for distributional properties. We performed incremental F-tests to determine whether the addition of each step improved model fit (R²).

Results: Early exposure to added sugars via infant formula was associated with infant/toddler SSB (ΔR² = 0.044, Finc (1, 87) =6.009, p = 0.016) beyond sociodemographic and maternal SSB consumption, but not with infant/toddler added sugar intakes from table foods (ΔR² = 0.02, Finc (1, 87) =3.308, p = 0.072).

Conclusion: While past studies have identified circumstantial (i.e., sociodemographic), or indirect (i.e., maternal lifestyle and modeling), mechanisms contributing to higher infant/toddler added sugar intakes, this study identifies exposure to added sugars from infant formula as a possible direct mechanism explaining why some infants/toddlers consume more added sugars.

Keywords: 24-h dietary recall; added sugar intakes; infant dietary intake; infant formula; parental modeling.