Candy: What is Moderate Consumption?

Laura Shumow, MHS Director of Scientific and Regulatory Affairs

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National Confectioners Association

• Major association representing the U.S. confectionery industry – small and large companies since 1884

• Education and leadership in manufacturing, technical research, public relations, retailing practices, government relations, and statistical analyses

• Committed to science-based evidence and educational resources to convey role of candy as a treat in a healthy lifestyle

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• Earliest confections date back to antiquity

• Cocoa used by Mayans >2000 years ago

• Celebratory food often given as a gift and part of holidays/traditions

Candy in History & Culture

What is the impact of candy on health

and wellness?

Cross-Sectional Analyses of Candy Consumption and Health

O'Neil CE, Fulgoni VL, Nicklas TA. Association of Candy Consumption with Body Weight Measures, Risk Factors for Cardiovascular Disease, and Diet Quality in U.S. Adults: NHANES 1999-2004. Nutrition Research, 2011. 31(2):122-130.

O'Neil CE, Fulgoni VL, Nicklas TA. Association of Candy Consumption with Body Weight Measures, Other Health Risk Factors for Cardiovascular Disease and Diet Quality in U.S. Children and Adolescents: NHANES 1999-2004. Food Nutr Res. 2011;55. doi: 10.3402/fnr.v55i0.5794

Studies of more than 15,000 U.S. adults and 11,000 children and adolescents from NHANES data showed no association between candy intake with:– increased weight/body mass index – risk factors for heart disease (blood pressure, blood lipids, etc)– Risk factors for diabetes/metabolic syndrome (glucose levels,

CRP, etc)

Cross-Sectional Analyses of Candy Consumption Frequency and Health

Golomb et al. Association between More Frequent Chocolate Consumption and Lower Body Mass Index. Arch Intern Med. 2012;172(6):519-521

Murphy et al. Body weight status and cardiovascular risk factors in adults by frequency of candy consumption. Nutr J. 2013; 12 (1): 53.

• A 2012 study of >1,000 healthy people published in Archives of Internal Medicine showed men and women who ate chocolate more frequently had a lower BMI than those who ate chocolate less often.

• In 2013, a Nutrition Journal publication showed that frequency of total candy consumed by adults was not associated with risk of obesity/overweight, blood pressure, blood cholesterol levels or markers of insulin resistance

Candy consumption in childhood is not predictive of cardiovascular risk factors in young adults: The

Bogalusa Heart Study

O’Neil CE, Nicklas TA, Liu Y, Berenson GS. Candy consumption in childhood is not predictive of weight, adiposity measures, or cardiovascular risk factors in young adults: The Bogalusa Heart Study. Journal of Human Nutrition and Dietetics. 2013. (E-pub before print).

The objective of this study was to determine whether candy consumption in childhood was predictive of the

presence of adverse levels of CVRF, including weight/adiposity measures, in young adulthood.

Study Methodology

Candy (g/d) consumption at baseline and from the first follow-up survey was obtained from one day 24-hr dietary recall

Candy consumption from the second follow-up was obtained via a food frequency questionnaire.

Separate linear mixed models were used to detect relationships between candy at baseline and health biomarkers at follow-up.

Effect of candy consumption on cardiovascular risk factors (n=355)

CVRF at Follow-upCandy Baseline Candy Follow-up

β±SE std β P-value β±SE std β P-valueBMI (kg/m2)* 0.005±0.006 0.04 0.329 -0.004±0.009 -0.02 0.608Weight (kg)* 0.013±0.016 0.03 0.410 -0.020±0.025 -0.03 0.413Systolic BP (mm Hg)** 0.005±0.012 0.02 0.674 -0.006±0.020 -0.01 0.776Diastolic BP (mm Hg)** -0.018±0.011 -0.09 0.108 0.006±0.018 0.02 0.732Total Cholesterol (mg/dL)** 0.062±0.039 0.08 0.116 -0.067±0.063 -0.05 0.288LDL-C (mg/dL) ** 0.025±0.036 0.04 0.495 -0.005±0.058 0.00 0.935

HDL-C (mg/dL)** 0.017± 0.015 0.06 0.262 0.000±0.024 0.00 0.993Triglycerides (mg/dL)** 0.133±0.082 0.10 0.106 -0.245±0.133 -0.10 0.066Glucose (mg/dL)** 0.025±0.019 0.11 0.191 0.034±0.039 0.07 0.382

Insulin (µU/mL) ** 0.047±0.026 0.18 0.081 0.031±0.058 0.05 0.591

*Adjusted for, baseline DV, age, gender, race, gender * race, total energy, candy consumed at follow-up, smoking status, and alcohol, and length of follow-up. **Adjusted for baseline DV, age, gender, race, gender*race, total energy, BMI, smoking status, and alcohol, and length of follow-up.Abbreviations: β = beta coefficient; SE = Standard Error

Conclusions & Implications

• Levels of candy consumption reported by this study population were not predictive of CVRF.

• Consumption of nutrient dense foods consistent with dietary recommendations are important, but foods like candy can be added to the diet, in modest amounts, without potential adverse long term health consequences.

• More studies are need to confirm these results.

Why No Link Between Candy

and Weight?

Percent consumers of candy and per capita intake of candy among Americans ages 2 years and older Population Group

Parameter 2+ y 2-18 y 19+ yCandy consumers, % Candy containing chocolate 15.0 13.2 15.6 Candy not containing chocolate 12.6 21.3 9.8 Total candy 22.8 29.6 20.6Per capita candy intake, g Candy containing chocolate 5.7 4.7 6.1 Candy not containing chocolate 4.3 7.2 3.4 Total candy 10.0 11.9 9.4Source: What We Eat in America, National Health and Nutrition Examination Survey 2007-2010, day 1 dietary recalls. n=17,571 individuals ages 2 years and older, n=6,090 individuals ages 2-18 years, and n=11,481 individuals ages 19 years and older; breastfeeding children were excluded from the sample. Candy categories (candy containing chocolate, candy not containing chocolate) correspond to the What We Eat in America food categories; chewing gum was excluded from this analysis.

Per capita contributions of candy to total energy, fat and sugar intakes Population Group

Parameter 2+ y 2-18 y 19+ yTotal energy intake, kcal 2075 1907 2128 Energy intake from candy, kcal 45.2 51.6 43.2 % of energy intake from candy 2.2 2.7 2.0Total fat intake, g 77.6 69.9 80.0 Fat intake from candy, g 1.6 1.5 1.7 % of fat intake from candy 2.1 2.1 2.1Total saturated fat intake, g 25.9 24.5 26.4 Saturated fat intake from candy, g 0.8 0.8 0.8 % of saturated fat intake from candy 3.2 3.2 3.2Total sugars intake, g 120 127 117 Sugars intake from candy, g 5.7 6.7 5.3 % of sugars intake from candy 4.7 5.3 4.5Total added sugars intake, tsp 18.5 19.1 18.3 Added sugars intake from candy, tsp 1.2 1.3 1.1 % of added sugars intake from candy 6.4 7.0 6.3Source: What We Eat in America, National Health and Nutrition Examination Survey 2007-2010, day 1 dietary recalls. n=17,571 individuals ages 2 years and older, n=6,090 individuals ages 2-18 years, and n=11,481 individuals ages 19 years and older; breastfeeding children were excluded from the sample. Estimates reflect intake from all candy other than chewing gum; candy as defined by the candy categories in the What We Eat in America food categories (i.e., candy containing chocolate and candy not containing chocolate).

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Moderation vs Deprivation

• Research suggests that forbidding certain foods may be counterproductive

• Dieting and restrained eating may lead to overeating and poor body weight control in children and adults

• It is more productive to promote moderation rather than restriction

Ongoing Research on Candy Restriction

• Penn State study evaluating the effects of parental practices regarding candy– Preliminary results show that parental restriction of

candy is associated with children’s lower self-regulatory control

– Studying strategies to promote consumption of candy in moderation

• Trial on the impact of chocolate restriction on consumption at Purdue in adults

Identifying Strategies to Promote Moderate Consumption

• Individual tactics - mindfulness, distraction techniques

• Package size, food environment• Parental tactics – “limit setting” as opposed to

restriction

Proposed definition of candy in moderation: 50-100 calories/day

Educational Tools toPromote Moderation

www.candyusa.com/treatright

Industry Responsibility Efforts

QUESTIONSLaura.Shumow@CandyUSA.com