FSHN 492, Spring 2016

Sugar Administration in Infancy: Neurological Effects and Taste Preference Shaping Dr. Leslie Cunningham-Sabo &
Brooke Duncan, Andrea Johnson, Emma Kett Colleen Burke

Abstract The Physiology of Dopamine in Response to Sugar Reducing Unnecessary Sugar

Early exposure to sugar may predispose infants to . Alternative Soothing Methods: Alternatives to sugar solution
prefer sweet flavors later in life. These preferences may be administration generally involve distracting or comforting the
due to neurological changes that alter the expression of infant in a manner that directs the infants attention away from
Figure 3: Dopamine's neurological response to sugar in the gustatory pathway Frequent intermittent the procedure.5
biological components responsible for pleasure.1 Repeated
consumption of sugar
exposure to sugar solutions or sweetened foods may further
enhance these neurological changes, ultimately leading to
Dopamine Table: Alternative Soothing Methods4,5
increased preference for and consumption of sugary Method Description
Nucleus D

food/beverages.2 Early exposure occurs when infants are Accumbens Dopamine in the Swaddling -Wrapped in a blanket
administered sugar solutions for pain management, an Nucleus Accumbens
binds to receptors Facilitated tucking -Arms placed inside and next the body
accepted medical practice.3,4,5 Additional exposure through D2 Receptor
Neurological Rocking/Holding -Gently holding while gently swaying
the diet may further amplify this effect.6,7 Other methods of pleasure response
pain management and lower sugar foods are available and Sucking: Nutritive or -Breast feeding, bottle, or pacifier use
Dopamine Nonnutritive
considered safe.5,4 A growing body of evidence Tegmental Area Expression of
Vagus (X) Nerve
demonstrating the potential for adverse neurological and rate limiting Skin-to-Skin care or -Skin contact between mother and infant
Facial (VII) Nerve D
enzyme of Kangaroo Care with placement on the mother's chest
metabolic impacts makes this an area of concern for Dopamine is released in dopamine
healthcare and public health professionals.2,3,4,7,8 Glossopharyngeal (IX) the VTA (Ventral D
synthesis:
Sensorial stimulation/ -A combination of feeding and talking to
Nerve Tegmental Area) Tyrosine distraction the infant while looking at it, massaging
Objectives Hydroxylase its back, and face stroking
-Numbing an area with a cream or gel
Expression of Topical Anesthetics
Explore pathways that shape taste preferences Dopamine
sucrose receptor D2
Examine how infants are exposed to sugar consumption to
Examine how early exposure to sugar and changes in taste compensate for Reduction of Sugar in the Diet: Many baby foods and
preference can affect health later in life decrease in
neurological formulas have more sugar in them than parents or
Provide ways to reduce sugar administration pleasure professionals expect.8 A few simple ways to reduce infant and
Tongue recognition. child sugar consumption are:
Introduction and Background Taste buds are comprised of 50-100 sensory cells, which have T1R2 Increased DA within the NAC has been seen with the consumption of
Breastfeeding for as long as possible
Reading nutrition labels for sugar content and purchasing
Children's ability to taste sweet substances begins in and T1R3 surface receptors.6, 9 These receptors converge as a heterodimer palatable food, as well as with illicit drug use. When DA release is
the lower sugar option
utero, by their 17th week of gestation sweet substance taste activating a G-coupled protein pathway resulting in increased intracellular stimulated excessively or repeatedly in the tegmental area it may result in
Making baby food from scratch
receptors are mature and functional. Though evolutionary calcium levels that activate a transient receptor channel (M5). M5 is the blunting of DA release.1,2 In fact, a single exposure to a palatable food
Reducing juice intake
development has provided infants with an innate preference responsible for the release of the neurotransmitters that activate the three has been shown to decrease the amount of DA released into the NAC. 2 It is
for sweet substances new evidence indicates dietary primary cranial nerves associated with taste (Figure 3). These cranial believed that this blunting may be due to reduced expression of tyrosine
consumption may also play a role.6 nerves stimulate the tegmental area, ultimately activating dopamine (DA) hydroxylase (the rate limiting enzyme for DA synthesis), as well as Implications & Conclusions
One mechanism leading to increased sugar consumption synthesis and release, resulting in increased DA levels within the nucleus decreased expression of the D2 receptor found in the NAC.1,2,10
accumbens (NAC).9 Early sugar may strongly affect neurological
among children is a learned taste preference for sweet
pathways, ultimately increasing a childs taste
substances that may begin in infancy.6 One exposure route is
the oral administration of sugar solutions to infants for pain Relative Nutrition Explanation & Connection with Baby Food preference and consumption of sweet substances.2,3,6,7
With this in mind, sugar consumption in infancy and
management. Administration of sugar solutions has become
childhood should be a primary public health concern.
an accepted practice for pain management in infants; however,
administration of sugar solutions and measures of
Figure 4: Food Sources Within the First 2 Years of Life11 The most common sugars infants are exposed to in their first year are The fact that infants and children are exposed to sugar in
fructose and sucrose. Fructose and sucrose are also the sweetest of all both food and routine medical practices may contribute
effectiveness lack legitimacy.4,7 A second dietary exposure
19 -24 sugars: they are approximately 4 times sweeter than lactose (the main to undesired health outcomes, including obesity.11,14
route is the amount of fructose/glucose in readily consumed Baby Foods/Beverages
sugar in breastmilk).12 Infant sugar exposure is common in pain Though the evidence for sugars negative neurological
foods provided to infants/children. 15 -18 Baby Cereals
Months of Age

Figure 1: Baby receiving sucrose
management settings and is in many of the foods that are fed to infants and impacts has primarily been examined in mice models,
Formula
12 -14
Breastmilk children (baby formulas, yogurts, cereals, and baby foods).8 One study the potential negative influence on humans should not
9 - 11 shows that by 12 months old 78.8% of infants consume some type of be ignored, especially when its exposure in food is
sweet food or beverage. Continuous exposure to sweet flavors may unnecessary and its use in medical procedures is
7-8
increase sweet taste preferences.13 In modern society, sweet foods are inconclusive.
4-6 often energy dense with low nutrient value. This early exposure to sugar
Acknowledgements:
0% 50% 100% may ultimately lead to future obesity through preferential consumption of
We would like to thank Sarah Hibbs-Shipp for all of her
Percent of Infants and Toddlers Consuming Each Food Item energy dense sweet foods, thereby promoting adiposity and weight gain.14 expertise and advice as our poster adviser and James Peth for his
assistance with graphics.
Figure 2: Feeding baby ice cream

1. Gugusheff JR, Muhlhausler BS. The early origins of food preferences: targeting the critical windows of development. Fasab J. 2015; 6. Lipchock S, Reed D, Mennella J. Gustatory and olfactory systems during infancy: Implications for development of feeding behaviors in 11. Gidding SS, Dennison BA, Birch LL, et al. Dietary Recommendations for Children and Adolescents: A guide for practitioners. Circulation. Photo Attributions:
25(2): 365-73. doi: 10.1096/fj.14-255976. the high risk neonate. Clin Perinatol. 2011; 38(4) 627-641. doi: 10.1016/j.clp.2011.08.008. 2005; 112: 2061-2075. doi: 10.1161/circulationaha.105.169251. Figure 1: P1030972- http://col.st/eu1eg. by Dan Hatton CC-BY-NC-ND.
2. Rada P, Avena NM, Hoebel BG. Daily bingeing on sugar repeatedly releases dopamine in the accumbens shell. Neuroscience. 2005; 134: 7. Park S, Pan L, Sherry B, Li R. Association of sugar-sweetened beverage intake during infancy with sugar sweetened beverage intake at 6 12. Relative Sweetness of Sugar. Canadian Institute of Sugar Website. http://sugar.ca/Nutrition-Information-Service/Consumers/Cooking-with- Figure 2: Day 246 First ice cream http://col.st/2yKw9. Sean Freese- CC- BY.

References 737-744. doi: 10.1016/j.neuroscience.2005.04.043.

3. Holsti L, Grunau RE. Considerations for using sucrose to reduce procedural pain in preterm infants. Pediatrics. 2010; 125(5): 1042-1047.
doi: 10.1542/peds.2009-2445.
4. Hall RW. Anand K. Pain management in newborns. Clin Perinatol. 2014; 41(4): 895-924. doi: 10.1016/j.clp.2014.08.010.
5. AAP Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. Prevention and Management of Procedural
Pain in the Neonate: An Update. Pediatrics. 2016;137(2):e20154271. doi: 10.1542/peds.2015-4271.
years of age. Pediatrics. 2014; 134(1):S56-S62. doi: 10.1542/peds.2014-0646J.
8. Walker RW, Goran MI. Laboratory determined sugar content and composition of commercial infant formulas, baby foods and common
grocery items targeted to children. J Nutr. 2015; 7: 5850-5867. doi: 10.3390/nu7075254.
9. Timofeeva E, Mitra A. The Effects of Sucrose on Neuronal Activity. In: Magazu S, ed. Sucrose: Properties, Biosynthesis and Health
Sugar/Sweetness-of-Sugar.aspx. Published 2016. Accessed March 5, 2016.
13. Fox MK, Pac S, Devaney B, Jankowski L. Feeding infants and toddlers: what foods are infants and toddlers eating? J Acad Nutr Diet. 2004;
104(1): 22-30. doi: 10.1016/j.jada.2003.10.026.
14. Pan L, Li R, Park S, Galuska DA, Sherry B, Freedman DS. A longitudinal analysis of sugar sweetened beverage intake in infancy and
Figure 3: Cubed Sugar Photo: Public Domain-No attribution required: Pixabay.com. http://col.st/B1Gt6.
Figure 3: Baby Illustration: Public Domain- No attribution required: Pixabay.com. http://col.st/2LQss.
Figure 3: Gustatory Pathway: Tortora GJ, Derrickson BH. Principles of Anatomy and Physiology 13th Edition. Hoboken, NJ: John Wiley &
Sons, Inc; 2012. Page 677, modified figure. Midbrain: AXON: Spinothalamic Pathway (Pain & Temperature) From Foot (1 of 9)-
Implications. New York, NY: Nova Science Publishers, Inc; 2013: 74-114. obesity at 6 years. Pediatrics. 2014; 134(1): 1-9. doi: 10.1542/peds.2014-0646F. Duration: 2 minutes, 21 seconds. UCD Medicine YouTube Website. http://col.st/uFg3D.Published September 28, 2012. Accessed
10. Hajnal A, Smith GP, Norgren R. Oral sucrose stimulation increases accumbens dopamine in the rat. Am J Psychol. January 2004; 286(1): April 12, 2016.
31-37. doi: 10.1152/ajpregu.00282.2003. Figure 4: Food Sources Within the First Two Years of Life. Created by Andrea Johnson. April 11, 2016. Microsoft Excel Program.