Heggie, Lisa; (2024) Measuring Free Sugar and Non-Nutritive Sweetener in Early Life Diets: Patterns of Intake and Prospective Associations with Sweet Food Preferences and Body Mass Index Trajectories. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Diet significantly shapes health in early life. Free sugar (FS) and non-nutritive sweetener (NNS) sweeten diets. Burgeoning evidence links FS and NNS intakes with health in adults, but data in early childhood are limited. This thesis examines FS and NNS intakes and their prospective associations with early food preferences and body mass index (BMI) trajectories, using data with repeated measures sampled from a large British childhood cohort (Gemini). First, findings from prospective cohort and intervention studies on FS/NNS intakes, sweet taste preferences and adiposity in childhood were systematically reviewed. Findings were inconsistent. Neither FS nor NNS were examined directly. Study 1 developed a novel method for estimating NNS intake from daily dietary data to enhance epidemiological investigations. Study 2 characterised FS and NNS intake in toddlerhood and middlechildhood, revealing children consistently exceeded dietary FS recommendations, and beverages were their primary NNS source. Children of lower SES were more likely to exceed FS guidelines and be NNS consumers. Study 3 found no evidence of links between FS nor NNS and later liking of sugar-sweetened food between toddlerhood and early childhood, showing young children’s liking for these foods is high with little variation. Finally, Study 4 used multilevel growth models to examine associations between toddlerhood intakes and BMI trajectories into adolescence. Both FS and NNS intakes were associated with steeper growth trajectories. For NNS, toddlers who were high NNS consumers had on average higher estimated BMI at 14-year follow up. This thesis adds to growing research on FS and NNS in the context of public health, and underscores the importance of populationlevel interventions to reduce FS intake in early life. NNS intake in toddlerhood should be approached with caution. Public health policies should focus on an overall ‘de-sweetening’ of the diet until more epidemiological evidence adds clarity to this research area.

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