Accessible Requires Authentication Published by De Gruyter February 15, 2019

A pilot study to improve sugar and water consumption in Maltese school children

C. Copperstone ORCID logo, G. McNeill, L. Aucott and D.M. Jackson



Excessive sugar consumption remains implicated as one of the key dietary factors that has been linked to overweight and obesity in children. Schools have been identified as an important setting for health promotion interventions in children and can be successful in bringing about dietary behavioral change when well designed.


The main aim of the study was to conduct a pilot intervention study and assess the possible effects of educational and environmental methodological components on sugar intake and water consumption in Maltese school children.

Subjects and methods

Face-to-face educational sessions for children and parents were supported by written materials and provision of free drinking water for children for a 12 week period in the school setting. Two main dietary outcomes were measured: non-milk extrinsic sugars(NMES) intake (measured as g/day) and water consumption (measured as servings/day), measured in the pre- and post-intervention periods. The dietary outcomes were measured at school using the novel online dietary assessment tool, REALITYMALTA™.


55 children, aged 10-11 years, were recruited, and 48 provided diet data at baseline and end. A reduction in mean energy intakes was noted from 7733 kJ/day (SD 2046) to 6809 (SD 2224) kJ/day (p = 0.03), with water servings intake increased and NMES intake decreased but results not statistically significant. Parent attendance at the educational sessions was low.


A larger scale study, including multi-level analysis is recommended. Modifying the content of the intervention and finding ways to increase parent engagement should be considered in future.


The authors would like to thank Professor Liberato Camilleri for statistical guidance, the staff from the RINH who performed the dietary analysis and the ‘Change 4 Life Campaign™’ for use of the educational materials design. Thanks are extended to all the teachers, children and parents who were involved in the study.

  1. Conflict of interest: The authors declare no conflict of interest.

  2. Authors’ contributions: CC carried out the study, drafted the manuscript and carried out the statistical analysis. GMcN, LA and DMJ conceived the project, contributed to the design of the study and helped draft the manuscript. LA helped in the statistical analysis and choice of statistical tools. All authors read and approved the final manuscript.

  3. Funding source: This study was part of a PhD project with the University of Aberdeen, for which CC received a PhD scholarship from the University of Malta. GMcN and DMJ were supported by the Scottish Government Rural and Environment Research and Analysis Services (RERAS).


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Received: 2018-06-26
Accepted: 2018-09-06
Published Online: 2019-02-15

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