Representational image / Freepik
It’s hard to escape the fruit snacks-juice box culture many parents and children live in. But a growing body of research supports limiting children’s sugar intake for the first 1,000 days of life - starting at conception - or until age 2.
A study released last year based on World War II-era data highlights the importance of eating well, particularly during pregnancy, says Robert Siegel, a pediatrician and pediatric obesity specialist at Cincinnati Children’s Hospital and Medical Center.
Siegel, who was not involved in the study, is also the director of the hospital’s Center for Better Health and Nutrition.
"You are not only what you eat, you are what your mom eats,” Siegel says. "In utero and afterward, you’re definitely developing these food preferences.”
Diabetes risk
Published in Science last year, the World War II-based research points to an increased risk of some chronic diseases, including Type 2 diabetes and hypertension, for pregnant women and young children who consume higher levels of sugar.
"With today’s children, including toddlers, consuming excessive sugar, concerns are naturally growing about its long-term impact,” says Tadeja Gracner, a senior economist at the Center for Economic and Social Research at the University of Southern California and the study’s lead author.
She says health data collected during and after World War II-era sugar rationing in Britain offers unique insights. It allowed her team to compare long-term health trends among those who had extremely limited access to sugar in their early years with those who had more traditional sugar intake.
Using data from the UK Biobank, the researchers examined records of more than 60,000 people born between October 1951 and March 1956 (ages 51-66 at the time of the survey). Britain rationed sugar and other foods from January 1940, early in World War II, until the mid-1950s, years after the war’s end.
Early-life sugar rationing was associated with reduced Type 2 diabetes by 35 percent and delayed disease onset by four years, and a 20 percent lower hypertension rate and delayed disease onset by two years, the study found.
"We find that the end of rationing increased the adult prevalence of chronic inflammation, an important marker of chronic disease. We also find increases in poor metabolic health; particularly diabetes, cholesterol and arthritis,” Gracner and her co-author, Paul Gertler, wrote in a working paper accompanying the study.
In an interview, Gracner says more research is needed on the underlying reasons for this, but "our findings suggest that early-life sugar restrictions set individuals on a healthier trajectory.” One possible reason, she says, "is a reduced preference for sweetness - a hypothesis supported by our working paper and other studies showing that taste preferences form early and persist into adulthood.”
Researchers are investigating the role epigenetics - changes in gene expression that can be inherited - and metabolism play during pregnancy, and want to learn more about just how much sugar is "okay” during critical periods of fetal development, Gracner says.
"It means that we need to continue to work on the ideal nutritional intake from the moment of conception onward,” adds Mark R. Corkins, chair of the American Academy of Pediatrics’ Committee on Nutrition and division chief of pediatric gastroenterology at the University of Tennessee Health Science Center.
Guidelines for parents
The American Academy of Pediatrics (AAP) says maternal prenatal nutrition and the first two years of life (starting with conception) may "program” childhood and adult health risks.
The Mayo Clinic recommends avoiding "added sugars.” These are the sugars added to food products, including pasta sauces, crackers and drinks. Typically, they’re processed and not naturally occurring; they include corn syrup, fructose, sucrose and glucose.
The AAP says sugar makes up 17 percent of kids’ diets, and half of that comes from sugary drinks. Among the AAP’s recommendations:
• Children under 2 years should consume no added sugar.
• Children 2 and older should take in less than 25 grams (about 6 teaspoons) of added sugar per day. For reference, 1 cup of Honey Nut Cheerios has 12 grams of added sugar.
• The National Dietary Guidelines for Americans recommend minimizing added sugar intake at any age, limiting it to less than 10 percent of calories per day.
Steven Abelowitz, medical director and pediatrician at Ocean Pediatrics in Orange County, California, says parents don’t need to strive for perfection but for reducing sugar as much as possible.
"Today, in almost all food products, there’s a breakdown of all ingredients including sugar,” Abelowitz says. "When there’s an option, choose the product that is lower in sugar.”
For parents who need a starting place or goal, he recommends a concept called "95210,” developed by Pittsburgh-based pediatrician Alicia Hartung:
• 9 hours of sleep
• 5 servings of fruits and vegetables per day
• 2 hours or less of screens
• 1 hour of movement
• 0 sugary drinks
Abelowitz says there are lower-sugar swaps that can help during pregnancy. "Looking at and being aware of the total carbohydrates and total sugar contents in products will help make a positive impact for both the mother and baby,” he says.
Gracner says manufacturers should also play a role. "While improving nutritional literacy is important, food companies also need to be part of the solution - whether through reformulating healthier options or reconsidering how sugary foods are marketed and priced.”
She adds that the study "isn’t about banning sugar - a birthday cake, candy or cookies in moderation are treats we can all enjoy from time to time.”
