The Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study is one of the country’s largest and most in-depth focusing on how pregnancy and early childhood factors influence children’s health and development in later life.
The study has been covering over 1,200 pregnant women across the three major ethnic groups in Singapore since its inception, and has been observing and collecting data on the children since they were in utero until their current adolescence (14 to 15 years of age).
According to Singapore Institute for Clinical Sciences Senior Research Fellow and GUSTO researcher Dr Jun Shi Lai, one of the main dietary observations made by the study has been a tendency for children to stick to unhealthy diets especially if started early on in life.
“One of the observations we made when tracking the dietary patterns of these children until the age of seven was that if an ‘unhealthy’ dietary pattern (usually high in salt, sugar, etc.) was established by or at the age of 18 months, this would continue to be maintained all the way until seven-years-old,” she told the floor at our recent Growth Asia Summit 2024.
“Conversely, when it comes to ‘healthy’ diets, adherence tends to decline with age and there is a need for intervention by the parents/guardians at a certain point, usually at the age of seven or eight – and this is crucial as they are still growing and need a certain concentration of good nutrients in their bodies.
“The issue is that we have also seen that at the age of nine months, some 60% of GUSTO infants were already being fed sugar-sweetened beverages (SSBs) as part of the weaning process, and the proportion only increased as they got older i.e. over 70% by the age of one-year, and around 100% by the age of five-years.
“This increase was not only in terms of the proportion of kids drinking SSBs, but also the volumes of SSBs drank, and the alarm bells here are that a higher SSBs intake at five years of age was associated with higher BMI and risk of overweight/obesity the following year – we estimate a 15% increase in risk for every 100ml consumed.”
These concerns were further compounded by findings showing that these children are also not consuming enough healthy foods such as fruits and vegetables, evidenced by a further GUSTO study examining their diet quality.
“We developed a Diet Quality Index which basically looked at how well the kids were meeting their recommended daily servings of different foods daily across their growth,” Dr Lai said.
“The analysis at 18 months showed that just 28% were meeting their recommended fruit intake, and an even lower 9.8% were meeting their recommended vegetables intake, whereas the highest adherence was whole grains with 67%.
“At five-years-old, these numbers increased to 36% meeting fruit intake recommendations and 13% meeting vegetable intake recommendations – but whole grain intake dropped significantly to just 18% meeting the recommendations for these.
“So it is obvious that there is a whole lot of room for improvement in the dietary intakes of our Singaporean children, especially if we want them to grow up healthy.”
Brain development
In addition to metabolic health risks, Dr Lai highlighted the potential positive impacts that nutrients such as vitamin B12 and omega fatty acids can have on cognitive development.
“We measured the children’s blood plasma for vitamin B12 levels, tested their executive function abilities such as inhibition control, multitasking and problem-solving, and did MRI brain scans,” she said.
“What we found was that those with higher B12 levels demonstrated better cognition at 8.5 years of age, and better working memory at 10.5 years of age.
“We also measured their levels of omega fatty acids and tested their academic and learning abilities such as numerical operations, reading and spelling. Here, we found that DHA in particular was really beneficial for these operations but also that the balance of omega fatty acids is very important as a higher ratio of omega-6 to omega-3 was found to show poorer performance.”
The next phase of the GUSTO study will continue to follow this cohort, focusing on adolescent nutrition.
