Certainly a preschooler who eats a lot of sugary food and drinks many sugary beverages is eating poorly. But how they eat may make as much difference to their health as what they eat.
A recent study found that preschoolers' eating habits appear linked to their risk for heart-related conditions later on.
If they ate in unhealthy ways, their cholesterol levels tended to be higher.
Higher cholesterol indicates a higher risk later on for heart-related conditions.
Unhealthy eating habits include eating while watching TV or eating when they are not actually hungry.
The study, led by Navindra Persaud, MD, of the Department of Family and Community Medicine at St. Michael's Hospital and the University of Toronto, Canada, aimed to find out whether preschoolers' eating habits might be related to cardiovascular disease risk later on.
The researchers assessed 1,076 children, aged 3 to 5, who were part of seven primary care clinics in Toronto.
Information was gathered on their diet, eating behaviors and their blood levels of non-HDL cholesterol (HDL is the "good" cholesterol) and their LDL cholesterol (the "bad" cholesterol).
A person's blood levels of non-HDL cholesterol is considered a way to find out their cardiovascular risk.
The children's eating behaviors were assessed with a tool called the Nutritional Screening Tool for Every Preschooler (NutriSTEP).
One part of this tool includes a subscale where higher scores mean greater nutritional risk (unhealthier behaviors) in their eating habits.
Some of these unhealthy behaviors related to whether they were allowed to decide how much they ate, whether they ate while watching TV, how many meals they ate each day, whether they gagged or had trouble swallowing while eating and whether they were not hungry at meal times because of drinking beverages.
The researchers found that each unit of increase in the NutriSTEP score was related to an increase of 0.02 mmol/L of their non-HDL cholesterol.
They also found that poorer eating habits as measured by the NutriSTEP were also linked to higher LDL cholesterol ("bad" cholesterol) levels.
These findings were after the researchers adjusted their analysis to account for the children's diet, their parents' concerns about their eating, their screen time and their use of supplements like vitamins.
They also accounted for age, sex, birth weight, current body weight, the parents' current body weight, whether the mother had gestational diabetes during pregnancy and the parents' ethnicities.
No link was found between preschoolers' actual diet and their non-HDL cholesterol.
Therefore, the important aspect of their possible cardiovascular risk later in life had to do with their eating behaviors moreso than what they ate.
"Eating behaviors in preschool-aged children are important potentially modifiable determinants of cardiovascular risk and should be a focus for future studies of screening and behavioral interventions," the authors wrote.
"Evidence suggests promoting responsive feeding, where adults provide appropriate access to healthy foods and children use internal cues (not parent-directed cues or cues from the television) to determine the timing, pace and amount they consume," the authors wrote.
Eve Pearson, a licensed and registered dietitian at Nutriworks CNC in Dallas-Fort Worth, and dailyRx expert, explained the importance of eating behaviors.
"For the parents of preschoolers, think about times you've gone on a diet to lose weight," Pearson said. "Now, think about how you gained that weight back."
She said that most people who go on a diet to lose weight later gain it back again.
"You didn't keep the weight off because you didn't change your behaviors regarding food and eating," Pearson said. "This study shows that it's similarly important to teach kids important healthy habits around their eating behaviors."
The study was published June 17 in the Canadian Medical Association Journal. The research was funded by the Canadian Institutes of Health Research Institute of Human Development, Child and Youth Health.
It also received funding support from the Institute of Nutrition Metabolism and Diabetes, the St. Michael's Hospital Foundation and The Hospital for Sick Children Foundation.
One author is a board member for the Danone Institute of Canada and a consultant for Dietitians of Canada. She also receives royalties for NutriSTEP licenses.
Another author is a board member for Medpace, has consulted for Eli Lilly, Merck and Bristol-Myers-Squibb and has received grant funds from AstraZeneca.
One author is an associate editor for CMAJ but had no part in the study's selection to be published by CMAJ. No other potential conflicts of interest were reported.