Alaska Native Children Do Not Prefer Sugar-Sweetened Fruit Drinks to Sugar-Free Fruit Drinks

Published:April 13, 2019DOI:https://doi.org/10.1016/j.jand.2019.02.007

      Abstract

      Background

      Alaska Native children, including children of Yup’ik descent, consume large volumes of sugar-sweetened fruit drinks, which contain added sugars that contribute to obesity, diabetes, and dental caries. To date, taste preference evaluations have not been conducted on commercially available sugar-free fruit drinks.

      Objective

      The study tested the hypothesis that children would have equal preference for sugar-free and sugar-sweetened fruit drinks.

      Design

      This was an experimental two-alternative forced-choice paired preference test.

      Participants/setting

      The study focused on a convenience sample of Yup’ik children, aged 7 to 10 years, recruited and enrolled from the Yukon-Kuskokwim Health Corporation dental clinic in Bethel, AK (N=89).

      Intervention

      Children evaluated four different commercially available sugar-free fruit drinks paired with the sugar-sweetened versions of each flavor. Order of flavor pair presentation was alternated across children, and order of presentation within each of the four pairs was randomized across pairs.

      Main outcome measures

      The outcome was taste preference for the sugar-free versus the sugar-sweetened version of a fruit drink.

      Statistical analyses performed

      A test of equivalence was run across all four flavors and separately for each flavor using two one-sided tests.

      Results

      The data failed to demonstrate equivalence of the sugar-free and sugar-sweetened fruit drinks across all four flavors (P=0.51) or separately for each flavor. However, this was not because of a preference for sugar-sweetened drinks. The preference for sugar-free drinks overall and for each flavor was >50%. Although the lower bounds of the 90% CIs were within the range of equivalence (40% to 60%), the upper bounds were outside the range of equivalence (>60%). According to post hoc analyses, similar preferences were observed for Yup’ik and non-Yup’ik children, boys and girls, and children of different ages.

      Conclusions

      Taste preference findings suggest that sugar-free fruit drinks may be a well-tolerated alternative to sugar-sweetened fruit drinks for Yup’ik children in Alaska Native communities.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Malik V.S.
        • Pan A.
        • Willett W.C.
        • Hu F.B.
        Sugar-sweetened beverages and weight gain in children and adults: A systematic review and meta-analysis.
        Am J Clin Nutr. 2013; 98: 1084-1102
        • Choo V.L.
        • Viguiliouk E.
        • Blanco Mejia S.
        • et al.
        Food sources of fructose-containing sugars and glycaemic control: Systematic review and meta-analysis of controlled intervention studies.
        BMJ. 2018; 363: k4644
        • Moynihan P.J.
        • Kelly S.A.
        Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines.
        J Dent Res. 2014; 93: 8-18
        • Mesirow M.S.
        • Welsh J.A.
        Changing beverage consumption patterns have resulted in fewer liquid calories in the diets of US children: National Health and Nutrition Examination Survey 2001-2010.
        J Acad Nutr Diet. 2015; 115: 559-566
        • Bailey R.L.
        • Fulgoni V.L.
        • Cowan A.E.
        • Gaine P.C.
        Sources of added sugars in young children, adolescents, and adults with low and high intakes of added sugars.
        Nutrients. 2018; 10: E102
        • Munsell C.R.
        • Harris J.L.
        • Sarda V.
        • Schwartz M.B.
        Parents' beliefs about the healthfulness of sugary drink options: Opportunities to address misperceptions.
        Public Health Nutr. 2016; 19: 46-54
        • Elwan D.
        • de Schweinitz P.
        • Wojcicki J.M.
        Beverage consumption in an Alaska Native village: A mixed-methods study of behaviour, attitudes and access.
        Int J Circumpolar Health. 2016; 75: 29905
        • Kolahdooz F.
        • Simeon D.
        • Ferguson G.
        • Sharma S.
        Development of a quantitative food frequency questionnaire for use among the Yup'ik people of Western Alaska.
        PLoS One. 2014; 9: e100412
        • Chi D.L.
        • Hopkins S.
        • O'Brien D.
        • Mancl L.
        • Orr E.
        • Lenaker D.
        Association between added sugar intake and dental caries in Yup'ik children using a novel hair biomarker.
        BMC Oral Health. 2015; 15: 121
        • Chi D.L.
        • Scott J.M.
        Added sugar and dental caries in children: A scientific update and future steps.
        Dent Clin North Am. 2019; 63: 17-33
        • Avery A.
        • Bostock L.
        • McCullough F.
        A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness.
        J Human Nutr Diet. 2015; 28: 52-64
        • Ebbeling C.B.
        • Feldman H.A.
        • Chomitz V.R.
        • et al.
        A randomized trial of sugar-sweetened beverages and adolescent body weight.
        N Engl J Med. 2012; 367: 1407-1416
        • Maupomé G.
        • Karanja N.
        • Ritenbaugh C.
        • Lutz T.
        • Aickin M.
        • Becker T.
        Dental caries in American Indian toddlers after a community-based beverage intervention.
        Ethn Dis. 2010; 20: 444-450
        • Petter L.P.
        • Hourihane J.O.
        • Rolles C.J.
        Is water out of vogue? A survey of the drinking habits of 2-7 year olds.
        Arch Dis Child. 1995; 72: 137-140
        • de Ruyter J.C.
        • Katan M.B.
        • Kuijper L.D.
        • Liem D.G.
        • Olthof M.R.
        The effect of sugar-free versus sugar-sweetened beverages on satiety, liking and wanting: An 18 month randomized double-blind trial in children.
        PLoS One. 2013; 8: e78039
        • de Ruyter J.C.
        • Olthof M.R.
        • Seidell J.C.
        • Katan M.B.
        A trial of sugar-free or sugar-sweetened beverages and body weight in children.
        New Engl J Med. 2012; 367: 1397-1406
        • US Department of Health and Human Services and US Department of Agriculture
        2015–2020 Dietary Guidelines for Americans. 8th Edition.
        (Updated in December 2015. Accessed November 26, 2018)
      1. American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Quality of Care and Outcomes Research; and Stroke Council. Low-calorie sweetened beverages and cardiometabolic health: A science advisory from the American Heart Association.
        Circulation. 2018; 138: e126-e140
        • Fitch C.
        • Keim K.S.
        Position of the Academy of Nutrition and Dietetics: Use of nutritive and nonnutritive sweeteners.
        J Acad Nutr Diet. 2012; 112: 739-758
        • American Academy of Pediatrics
        Sweeteners and sugar substitutes: Can I give my children foods sweetened with no- and low-calories sweeteners?.
        (Updated in 2011. Accessed October 17, 2017)
        • American Academy of Pediatric Dentistry
        Policy on Dietary Recommendations for Infants, Children, and Adolescents.
        Pediatr Dent. 2016; 38: 57-59
        • Panel on Macronutrients
        Panel on the Definition of Dietary Fiber, Subcommittee on Upper Reference Levels of Nutrients, Subcommittee on Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, & Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.
        Institute of Medicine, Washington, DC2005
        • Magnuson B.A.
        • Roberts A.
        • Nestmann E.R.
        Critical review of the current literature on the safety of sucralose.
        Food Chem Toxicol. 2017; 106: 324-355
        • Loewen R.
        • Pliner P.
        The Food Situations Questionnaire: A measure of children’s willingness to try novel foods in stimulating and non-stimulating situations.
        Appetite. 2000; 35: 239-250
        • Mennella J.A.
        • Lukasewycz L.D.
        • Griffith J.W.
        • Beauchamp G.K.
        Evaluation of the Monell forced-choice paired-comparison tracking procedure for determining sweet taste preferences across the lifespan.
        Chem Senses. 2011; 36: 345-355
        • Chow S.C.
        • Shao J.
        • Wang H.
        Sample Size Calculation in Clinical Research.
        Marcel Dekker, New York, NY2003
        • Zhang E.
        • Wu V.Q.
        • Chow S.C.
        • Zhang H.G.
        TrialSize: R functions in Chapter 3,4,6,7,9,10,11,12,14,15. R package version 1.3.
        (Updated June 3, 2013. Accessed on November 26, 2018)
        • Sailer M.O.
        crossdes: Construction of Crossover Designs. R package version 1.1-1.
        (Updated March 18, 2013. Accessed on November 26, 2018)
        • Wakeling I.N.
        • MacFie H.J.H.
        Designing consumer trials balanced for first and higher orders of carry-over effect when only a subset of k samples from t may be tested.
        Food Qual Pref. 1995; 6: 299-308
        • Hardin J.W.
        • Hible J.M.
        Generalized Estimating Equations.
        Chapman & Hall/CRC, New York, NY2003
        • Hills A.P.
        • Andersen L.B.
        • Byrne N.M.
        Physical activity and obesity in children.
        Br J Sports Med. 2011; 45: 866-870
        • Walsh T.
        • Worthington H.V.
        • Glenny A.M.
        • Appelbe P.
        • Marinho V.C.
        • Shi X.
        Fluoride toothpastes of different concentrations for preventing dental caries in children and adolescents.
        Cochrane Database Syst Rev. 2010; 1: CD007868

      Biography

      D. L. Chi is an associate professor, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle.

      Biography

      S. E. Coldwell is a professor, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle.

      Biography

      L. Mancl is a research associate professor, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle.

      Biography

      K. Senturia is a research study coordinator, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle.

      Biography

      C. L. Randall is a postdoctoral fellow, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle.

      Biography

      S. Cruz is a graduate research assistant, Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle.

      Biography

      S. Hopkins is an instructor and research nurse, Department of Obstetrics and Gynecology, School of Medicine, Oregon Health Sciences University, Portland.

      Biography

      E. Orr is a research professional, Center for Alaska Native Health Research, University of Alaska Fairbanks.