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Welcome! To join the audio portion of the event, please dial: 1-800-919-1728 Note: SNA members will automatically earn 1 CEU credit for participating in today’s event. Details will be provided at the conclusion of the webinar. Disclaimer of Endorsement: reference herein to any products, services or expressed ideas does not constitute or imply endorsement or recommendation by the School Nutrition Association. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org High Fructose Corn Syrup (HFCS) and School Wellness: Science-based Facts for Healthful School Nutrition Programs May 7, 2008 Disclaimer of Endorsement: reference herein to any products, services or expressed ideas does not constitute or imply endorsement or recommendation by the School Nutrition Association. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org High Fructose Corn Syrup (HFCS) and School Wellness: Science-based Facts for Healthful School Nutrition Programs Overview and Moderator Susan Borra, RD, President, International Food Information Council Foundation Food Science Perspective of HFCS John White, PhD, President, White Technical Research Health Effects of Foods and Beverages with Added Sugars in Children’s Diets Theresa Nicklas, DrPH, MPH, Professor of Pediatrics, Baylor College of Medicine HFCS in School Nutrition Operations Sandy Voss, RD, LD, District Dietitian/Assistant Food Service Director, Arlington Heights School District 25 Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Consumer perceptions of Sugar/HFCS Susan Borra, RD President, IFIC Foundation Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org International Food Information Council (IFIC) Foundation Mission: To effectively communicate science-based information on health, nutrition, and food safety for the public good. Primarily supported by the broad-based food, beverage and agricultural industries. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Sugars in the 2005 Dietary Guidelines Concern about weight gain, obesity, nutrient dilution Emphasized limiting foods with “added sugars” (“discretionary calories”) Fiber-rich fruits, vegetables, whole grains Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Media Reporting on Sugars and Health – Some Recent Headlines Law Banning Sugary Foods in Schools Passes Rethink that drink; the liquid calories you take in may be packing on more pounds than you realize Sweet Tooth Could Lead to More Fruit, Less Obesity Juices fall from list of best kids’ drinks The SugarSweetened Facts Food companies vow to tighten limits on kids’ ads Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Sugar and Obesity Media Coverage No. of stories 2000 1500 1000 500 Low-carb diet fad 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2002 2003 2004 2005 2006 Note: Lexis-Nexis search in U.S. Newspapers and Newswires on “obesity AND sugar or fructose or high fructose corn syrup or carbs or carbohydrates” Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org 2007 Global Media Coverage of Fructose/High Fructose Corn Syrup and Obesity International US No. of stories 200 150 100 50 0 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2001 2002 2003 2004 2005 2006 Note: Figures retrieved from Lexis-Nexis searches on “Fructose or High Fructose Corn Syrup and Obesity or Obese” in U.S. newspapers, newswires, and Non-U.S. newspapers and newswires Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org 2007 70 60 50 40 F at 30 S ugar 20 C arbohydrates 10 Glycemic Index 07 20 05 20 99 19 97 19 95 19 93 19 91 19 89 19 87 19 85 19 83 0 19 % o f C o n s m ers R ep o rin g C o n c ern Consumers Reporting “Somewhat or Very Concerned” About Nutritional Content, 1983-2007 Copyright © 2008 School Nutrition Association. All Rights Reserved. US Grocery Shopper Trends, FMI 2007 www.schoolnutrition.org Consumer Awareness of Label Terms Related to Dietary Sugars Percent Heard (n=1000) 94% Sugar Glucose 85% HFCS 81% Fructose Lactose Sucrose 79% 79% 2007 69% Food and Health Survey 2007 Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Sugar Consumption Trends Please indicate whether you are trying to consume more or less of the following: Sugar Added sugars HFCS 2007 (n=478) 1% 2007 (n=345) 1% 2007 (n=411) 4% Glucose 2007 (n=440) 1% 67% 39% 2007 (n=364) 1% Significant decrease from ‘06 Food and Health Survey 2007 71% 32% 2007 (n=405) 1% Fructose Sucrose 28% 60% 59% 37% 63% 36% 61% 38% More Neither Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Less Science Says: High Fructose Corn Syrup and sugars have similar effects in humans Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Factors Influencing Consumers Purchasing Decisions How much of an impact do the following have on your decision to buy foods and beverages? Taste Price 2007 53% 35% 2006 54% 31% 37% 2007 2006 35% 35% 2006 58% 32% Great impact Some impact Convenience 2007 65% 40% 26% 63% 28% 25% 85% 72% Healthfulness 2007 2006 88% 23% 32% 19% 30% 55% 49% Significant increase from ‘06 Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org (n=1000) Food Science Perspective of HFCS John S. White, Ph.D. White Technical Research Argenta, Illinois Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org HFCS in perspective Surprising attention • Dietary component for eons • Similar to sucrose • Expert reviews: no concerns Predictable • Obesity solution sought Discovery of honey ~ Piero de Cosimo 1462, Worcester Art Museum • Historical precedent • Distrust of government/agriculture/industry Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org What is HFCS? HFCS = monosaccharides = free sugars Fructose + glucose Sucrose = disaccharide = bound sugars FructoseGlucose Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org HFCS is similar to sugars from natural sources Fructose (% total sugars) Fruit, vegetables, nuts, dairy ≥66 Apples, pears 56-65 Asparagus, raspberries, spinach, watermelon 42-55 Almonds, apricots, bananas, blackberries, blueberries, broccoli, Brussels sprouts, cabbage, cantaloupe, carrots, cashews, cherries, Clementines, sweet corn, cucumbers, currants, dates, figs, filberts, grapefruit, grapes, hazelnuts, honeydew, melon, kiwi fruit, lentils, lettuce, lime juice, macadamias, nectarines, sweet onions, navel oranges, peaches, peanuts, peas pecans, sweet peppers, persimmons, pineapple, pistachios, raisins, summer squash, strawberries, sweet potatoes, tomatoes, walnuts, cooked wild rice 31-41 Artichokes, celery, okra, plums, radishes, turnip greens Source: NutritionData.com. Conde Nast. 2008. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org HFCS is similar to other caloric sweeteners % Total sugars Sweetener Physical form Total fructose Total glucose Crystalline fructose Dry 99.5+ 0.1 max HFCS-42 Syrup 42 58 HFCS-55 Syrup 55 45 Honey Syrup 48 52 Dry 50 50 Medium invert Syrup 50 50 Total invert Syrup 50 50 Grape juice+ conc. Syrup 53 47 Apple juice+ conc. Syrup 65 35 Pear juice+ conc. Syrup 74 26 Agave nectar+ Syrup 74 24 Crystalline sucrose Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org HFCS is similar to other caloric sweeteners • Composition • Sugars ratio • Production unit operations • Functionality (some differences) • Absorption • Metabolism Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Fructose-glucose sweeteners are interchangeable Once absorbed into the bloodstream, they • deliver the same sugars • at the same ratios • to the same tissues • within the same timeframe • to the same metabolic pathways Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org HFCS/fructose is highly functional • Stability in acid • Resistance to crystallization • Ease of handling • Flavor enhancement • Control of freezing • Fermentable sugars • Sugars for browning reactions • Sweetness equivalent to sucrose • Moisture retention Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Sweetness sucrose = HFCS-55 Sweetness Intensity (crystalline)1 Relative Sweetness (10% ds)2 Fructose 180 117 Sucrose 100 100 Sugars HFCS-55 Glucose 99 74-82 65 1Schallenberger 2White & Acree. 1971. Sugar Chemistry. AVI Pub. Co., Westport CT. & Parke. 1989. Cereal Foods World. 34(5):392-398. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org HFCS is a versatile ingredient • Carbonated soft drinks, juices, fruit drinks • Cereals, breakfast drinks • Condiments • Dairy products • Meats • Sauces, dressings, marinades • Snack foods • Syrups, toppings Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org US availability: sucrose = HFCS 80.0 Per capita availability (pounds/yr) 70.0 60.0 Sucrose 50.0 40.0 30.0 HFCS 20.0 10.0 0.0 1970 1975 1980 1985 1990 1995 Year Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org 2000 2005 It’s a sucrose world 160.0 140.0 92% Consumption (million tons, dry basis) 120.0 100.0 HFCS Sucrose 80.0 60.0 40.0 20.0 49% 8% 51% 0.0 USA Source: Fereday et al. Sweetener analysis. LMC International Ltd., 2005. Worldwide Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org We eat more of everything Year 1970 1975 1980 1985 1990 1995 2000 2005 2,800 Added sugars (D = -1%) +24% 2,700 2,600 Flour, cereal products 2,500 Vegetables 2,400 Fruit Dairy 2,300 Total per capita calories (kcal/day) USDA-ERS Nutrient food category Added fats 2,200 Meat, eggs, nuts 2,100 -4 -3 -2 -1 0 1 2 3 4 5 6 Change in percent of total daily per capita calories by category: 1970 to 2005 Source: USDA-ERS 2007 Caloric nutrients data set, loss adjusted Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Perspective is lacking in the HFCS debate • As HFCS , sucrose • We eat more of everything now than 35y ago • HFCS = sucrose in lab tests • HFCS is not uniquely responsible for obesity in the US or abroad • Replacing HFCS with sucrose will not reduce obesity or improve health; they are the same Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Weighing the Evidence Theresa A. Nicklas, DrPH Professor USDA/ARS Children’s Nutrition Research Center Baylor College of Medicine Department of Pediatrics Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Which of the Following is the Strongest Predictor of Obesity? Poor parenting Being a male Using computers and cell phones Drinking too much sweetened beverages Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org What is an Evidence—Based System? A science-based systematic evaluation of the strength of the evidence behind a statement. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org The Philosophy Behind an Evidence-Based System Rules are set “up front” then followed rather than having a preconceived idea, then finding the papers to support the idea. If one follows the rules, any trained scientist should come to the same conclusion. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org ADA Evidence Analysis Library Intake of calorically-sweetened beverages is positively related to adiposity in children (Sept. 2004) — Strength of the available evidence — Grade II (Fair) Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org ADA Evidence Analysis Library Grade II: Fair 1. Strong design 2. Uncertainty attached to the conclusion 3. Doubts about generalizability, bias, research design flaws, or adequacy of sample size Or, alternatively 1. Weak designs 2. Results have been confirmed in separate studies Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Sweetened Beverage Consumption and Weight Status Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org No Relationship Between Sweetened Beverage Consumption and Overweight Status: 13 Studies 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Johnson L, Mander AP, Jones LR, Emmett PM, Jebb SA. Is sugar-sweetened beverage consumption associated with increased fatness in children?. Nutr. 2007; 23:557-563. Sun SZ, Empie MW.Lack of findings for the association between obesity risk and usual sugar-sweetened beverage consumption in adults—A primary analysis of databases of CSFII-1989-1991, CSFII-1994-1998, NHANES III, and combined NHANES 1999-2002. Food Chem Toxicol. 2007; 45:1523-1536. Mundt CA, Baxter-Jones AD, Whiting SJ, Bailey DA, Faulkner RA, Mirwald RL. Relationships of activity and sugar drink intake on fat mass development in youths. Med Sci Sports Exerc. 2006; 38:1245-54. Blum JW, Jacobsen DJ, Donnelly JE. Beverage consumption patterns in elementary school aged children across a two-year period. J Am Coll Nutr. 2005; 24:93-8. Andersen LF, Lillegaard IT, Overby N, Lytle L, Klepp KI, Johansson L. Overweight and obesity among Norwegian schoolchildren: changes from 1993 to 2000. Scand J Public Health. 2005; 33:99-106. Overby NC, Lillegaard IT, Johansson L, Andersen LF. High intake of added sugar among Norwegian children and adolescents. Public Health Nutr. 2004; 7:285-93. Newby PK, Peterson KE, Berkey CS, Leppert J, Willett WC, Colditz GA. Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota. J Am Diet Assoc. 2004; 104:1086-94. Phillips SM, Bandini LG, Naumova EN, Cyr H, Colclough S, Dietz WH, Must A. Energy-dense snack food intake in adolescence: longitudinal relationship to weight and fatness. Obes Res. 2004; 12:461-72. Forshee RA, Anderson PA, Storey ML. The role of beverage consumption, physical activity, sedentary behavior, and demographics on body mass index of adolescents. Int J Food Sci Nutr. 2004; 55:463-478. Forshee RA, Storey ML. Total beverage consumption and beverage among children and adolescents. Int J Food Sci Nutr. 2003; 54:297-307. Giammattei J, Blix G, Marshak HH, Wollitzer AO, Pettitt DJ. Television watching and soft drink consumption: association with obesity in 11- to 13-year-old schoolchildren. Arch Pediatr Adolesc Med. 2003; 157:882-6. Rodríguez-Artalejo F, García EL, Gorgojo L, Garcés C, Royo MA, Martin Moreno JM, Benavente M, Macías A, De Oya M, Investigators of the Four Provinces Study. Consumption of bakery products, sweetened soft drinks and yogurt among children aged 6-7 years: association with nutrient intake and overall diet quality. Br J Nutr. 2003; 89:419-29. Forshee RA, Storey ML. The role of added sugars in the diet quality of children and adolescents. J Am Coll Nutr. 2001; 20:3243. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Some Relationship Between Sweetened Beverage Consumption and Overweight Status: 17 Studies 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. Sanigorski AM, Bell AC, Swinburn BA. Association of key foods and beverages with obesity in Australian schoolchildren. Public Health Nutr. 2007; 10:152-157. Dubois L, Farmer A, Girard M, Peterson K. Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. J Am Diet Assoc. 2007; 107:924-934. Welsh JA, Cogswell ME, Rogers S, Rockett H, Mei Z, Grummer-Strawn LM. Overweight among low-income preschool children associated with the consumption of sweet drinks: Missouri, 1999-2002. Pediatrics. 2005; 115:e223-9. Novotny R, Daida YG, Acharya S, Grove JS, Vogt TM. Dairy intake is associated with lower body fat and soda intake with greater weight in adolescent girls. J Nutri. 2004; 134:1905-9. Schulze MB, Liu S, Rimm EB, Manson JE, Willett WC, Hu FB. Glycemic index, glycemic load, and dietary fiber intake and incidence of type 2 diabetes in younger and middle-aged women. Am J Clin Nutr. 2004; 80:348-56. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004; 292:927-934. Berkey CS, Rockett HR, Field AE, Gillman MW, Colditz GA. Sugar-added beverages and adolescent weight change. Obes Res. 2004; 12:77888. Ariza AJ, Chen EH, Binns HJ, Christoffel KK. Risk factors for overweight in five- to six-year-old Hispanic-American children: a pilot study. J Urban Health. 2004; 81:150-61. James J, Thomas P, Cavan D, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomized controlled trial. Br Med J. 2004; 328:1237. Nicklas TA, Yang S-J, Baranowski T, Zakeri I, Berenson G. Eating patterns and obesity in children: The Bogalusa Heart Study. Am J Prev Med. 2003; 25:9-16. Mrdjenovic G, Levitsky DA. Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children. J Pediatr. 2003; 142:604-10. Giammattei J, Blix G, Marshak HH, Wollitzer AO, Pettitt DJ. Television watching and soft drink consumption: association with obesity in 11- to 13-year-old schoolchildren. Arch Pediatr Adolesc Med. 2003; 157:882-6. Gillis LJ, Bar-Or O. Food away from home, sugar-sweetened drink consumption and juvenile obesity. J Am Coll Nutr. 2003; 22:539-45. Liebman M, Pelican S, Moore SA, Holmes B, Wardlaw MK, Melcher LM, Liddil AC, Paul LC, Dunnagan T, Hayanes GW. Dietary intake, eating behavior, and physical activity-related determinants of high body mass index in rural communities in Wyoming, Montana, and Idaho. Int J Obes Relat Metab Disord. 2003; 27:684-92. Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet. 2001; 357:505-8. French SA, Jeffery RW, Forster JL, McGovern PG, Kelder SH, Baxter JE. Predictors of weight change over two years among a population of working adults: the Healthy Worker Project. Int J Obes Relat Metab Disord. 1994; 18:145-54. Tordoff MG, Alleva AM. Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight. Am J Clin Nutr. 1990; 51:963-9. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Sweetened Beverage Consumption and Weight Status: Where is the Weight of the Evidence? No Relationship Some Relationship Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Evidence for the Relation Between Sweetened Beverage Intake and Overweight Status WEAKNESSES small sample regionally specific sample response bias due to low return rate of beverage diaries single 24-hour recall multi-colinearity in diet Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Regular Carbonated Soft Drinks (NHANES) Regular colas and sodas - times/month Mean frequency is 21.9 servings per month, less than 1/day. 1000 800 600 400 200 Std. Dev = 26.38 Mean = 21.9 87% of adolescents have 30 or fewer servings per month, or less than 1/day. N = 1981.24 0 0.0 40.0 20.0 80.0 60.0 120.0 100.0 160.0 140.0 Regular colas and sodas - times/month 180.0 Smith PA, Forshee RA, Storey ML, Ceres Institute, Center for Food and Nutrition Policy, EB 2001 Source: NHANES, w eighted to reflect US population Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Regular Carbonated Soft Drinks (NHANES) 60 Body mass index 55BMI, 0 Relationship between soft drinks and BMI is not simple. Some who consume no soft drinks have very high BMI, some who consume a lot of soft drinks have low BMI. servings 50 40 30 20 10 -100 0 100 200 18BMI, 182 servings Smith PA, Forshee RA, Storey ML, Ceres Institute, Center for Food and Nutrition Policy, EB 2001 Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org The Association Between Eating-Pattern Variables and Overweight Status by Ethnicity-Gender Groups Eating pattern EA male OR (95% CI) EA female OR (95% CI) AA male OR (95% CI) AA female OR (95% CI) R²=0.08 R²=0.10 R²=0.17 R²=0.13 0.97 (0.85 – 1.10) 1.03 (0.88 – 1.20) 0.98 (0.77 – 1.24) 1.20 (0.86 – 1.67) 1.12 (0.95 – 1.31) 0.89 (0.73 – 1.09) 0.94 (0.76 – 1.18) 1.68 (1.12 – 2.33)* 0.99 (0.89 – 1.09) 1.00 (0.83-1.19) 1.10 (0.92-1.31) 1.09 (0.87-1.36) 0.90 (0.62-1.30) 0.93 (0.78-1.12) 1.08 (0.86-1.35) 0.78 (0.60-1.01) 1.53 (1.05-2.22)* 1.04 (0.94-1.16) 0.93 (0.71-1.22) 0.97 (0.69-1.41) 1.05 (0.74-1.49) 0.62 (0.33-1.16) 1.06 (0.82-1.37) 0.89 (0.65-1.22) 0.79 (0.51-1.23) 1.02 (0.72-1.46) 0.97 (0.76-1.23) Food groups consumption a,b Fats/oils Fruits/fruit juices Vegetables Breads/grains Mixed meats Desserts Candy Sweetened beverages Poultry 1.06 (0.86-1.32) 0.55 (0.38 0.79)* 0.75 (0.51-1.09) 1.03 (0.60-1.79) 0.97 (0.78-1.19) 0.89 (0.66-1.21) 1.00 (0.73-1.35) 0.92 (0.65-1.30) 0.99 (0.84-1.16) * p < 0.05;*p < 0.01 a Food group consumption I: individual food group consumption as eating pattern variables. b Odds ratio = risk of being overweight if increasing mean gram consumption. AA, African American; CI, confidence interval; EA, Euro-American; FJV, fruits/fruit juices and vegetables; meats, mixed meats, poultry, seafood, eggs, pork, and beef; OR, odds ratio; sweets, desserts, candy, and sweetened beverages; dairy, milk and cheese. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Overweight and Eating Patterns 95% Unexplained by Eating Patterns 4% Explained by Other Eating Patterns 1% Explained by Sweetened Beverages Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Variance of Children’s BMI Explained by Regression Model Total Variance Explained Variance Unexplained Variance 91.8% Explained Variance 8.3% Demographics 4.0% Income 1.8% TV 2.0% Diet 0.5% Smith PA, Forshee RA, Storey ML, Ceres Institute, Center for Food and Nutrition Policy, EB 2001 Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Association Between Eating Patterns and Weight Status Mean Difference Normal Weight Overweight Obese Food Groups I (Gram Percent) Fat Fruits/Fruit Juices Vegetables Breads/Grains Mixed Meats Dessert Candy Non-Alcohol Beverage Diet Beverage Sweetened Beverage 1.41 (0.12) 2 6.36 (0.61) a 7.99 (0.58) 10.21 (0.50) 0.99 (0.25) 2.26 (0.27) 1.33 (0.14) 39.75 (1.37) a 2.57 (0.91) a 37.25 (1.54) 1.24 (0.18) 3.60 (0.87) b 7.21 (0.83) 10.36 (0.72) 1.74 (0.36) 2.17 (0.39) 1.25 (0.20) 43.42 (1.97) a,b 5.56 (1.32) a,b 37.94 (2.23) 1.27 (0.21) 4.80 (1.05) a,b 9.05 (1.00) 9.64 (0.86) 1.42 (0.43) 2.30 (0.47) 0.85 (0.24) 46.57 (2.36) b 6.80 (1.58) b 39.84 (2.67) Model adjusted for age, calories intake, ethnicity, gender, and ethnicity x gender. 1 OR (95% CI) 2 Least-square mean (Stderr) a,b Significant mean difference if with different superscripts. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Review Articles Sweetened Beverages and Weight Status Strong Evidence 1, 2 1. 2. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006 Aug 84(2):274-88. Vartainian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007 April 97:667-75. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Review Articles Sweetened Beverages and Weight Status Inconclusive Evidence 3, 4 3. Pereira MA, Jacobs DR. Sugar-sweetened beverages, weight gain and nutritional epidemiological study design. Br J Nutr. 2007 Nov 23;1-2. 4. Bachman CM, Baranowski T, Nicklas TA. Is there an association between sweetened beverages and adiposity? Nutr Rev. 2006 April 64(4):153-74. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Review Articles Sweetened Beverages and Weight Status ????? Inconclusive Evidence Strong Evidence Where is the weight of the evidence? Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Conclusions Based on a Scientific Review of the Literature Strongest evidence was the positive association between sweetened beverage consumption and total energy intake. However…. The evidence regarding sweetened beverage consumption and overweight/obesity was not conclusive and warrants further investigation. 2005 Dietary Guidelines Advisory Committee Report Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org No Simple Answer to the Obesity Epidemic Food Industry Candy Genes Soft Drinks Pouring Contracts Glycemic Index TV Sugar Obesity Epidemic Junk Food Restaurants Fast Food Working Mothers Poverty Decreased PE in Schools Energy Density Decreasing Physical Activity School Feeding Poor Computers Parenting Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org The Energy Balance Equation Dietary Intake – Energy Expenditure = Stores (What you got – What you spent = What’s left) FOOD INTAKE PHYSICAL ACTIVITY Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org “If you eat more of one thing, you eat a lot less of something else. So for every theory saying this disease is caused by an excess in x, you can produce an alternative theory saying it’s a deficiency in y.” ~ Hugh Tunstall Pedoe Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Should we be making policy recommendations based on……. Intuition versus science Inconsistent findings Lack of consensus from systematic reviews Amount of variance explained in BMI is less than 5% for diet Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Newsweek, Dec. 26, 2005/Jan. 2, 2006 Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org High Fructose Corn Syrup Issues in a School Lunch Program Sandra Voss, MS, RD, LDN Arlington Heights, Illinois District 25 Food & Nutrition Services Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Objectives • Background, Trends, & Goals of District 25 Food Service • Parents issues and concerns regarding high fructose corn syrup • SFA response to concerns & strategies for dealing with the parents • SFA perspective of high fructose corn syrup in school food service operations Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Background on District 25 • District of approximately 5000 children in suburban Chicago • Middle to upper class community • Highly educated parents Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Trends in Food Service • • • • Organic and All Natural Offerings Farm to School Programs Foods without Trans Fats Foods not containing HFCS Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Goals of our Department • Meet USDA Nutritional Requirements of the National School Lunch and Breakfast Programs • Provide good quality food at an affordable price • Promote good nutrition by offering a wide variety of fruits, vegetables, and whole grains Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Issues & Concerns with HFCS 2 major areas of concern….. • Parent Perspective • School Food Authority Perspective Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Parent Issues & Concerns All concern rises from media coverage and research done regarding the relationship of HFCS and childhood obesity •Ala Carte offerings containing HFCS •Reimbursable meal components containing HFCS Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Response to Concerns A la carte products: • Some products contain HFCS such as cookies, crackers, flavored sparkling water, and low fat ice cream products • Soda and confectionary products are not served (per NSLP regulations) Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Response to Concerns • Ala carte offerings are optional and fit nutritional guidelines established by the district <35% cal from fat <10% cal from sat fat <35% sugar by weight <200 calories per serving Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Response to Concerns • These items should be consumed in moderation and with a balanced, healthy diet • Parents have control of children’s accounts and have the ability to block ala carte purchases Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Response to Concerns Reimbursable Meal Components: • Majority of foods offered as part of meal do NOT contain HFCS • Whole grain breads, yogurt, and chocolate milk DO contain HFCS • Benefits of children consuming these nutrient dense foods • Served in proper portion sizes Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org School Food Authority Perspective Cost Implications • We will not eliminate foods containing HFCS to meet our customers demand • Current and anticipated increase in bread, milk, and other dairy products effecting the program • Suggest to manufacturers to offer products without HFCS Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Strategies for Dealing with Concerned Parents Educate your parents • About your program • About HFCS • Food and nutrition program requirements • Financial implications of program eliminating HFCS Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Additional Strategies Nutrition Education • Remember that kids only get 18-20% of their calories from school meals and the other 80% are consumed outside of school • Educate students on eating balanced meals and choosing a variety of foods Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Additional Strategies Offer a variety of meal choices at lunch • Allow multiple types of products, most of which do not have HFCS Educate front-line staff on HFCS and the school food service perspective • When parents approach FS staff, they can address some of their concerns Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Additional Strategies Encourage consumption of fruits/veggies, whole grains….go back to the basics! Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Questions & Answers Sue Borra, RD John White, PhD Theresa Nicklas, DrPh Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Sandy Voss, MS, RD, LDN Resources for HFCS Information • International Food Information Council Foundation (IFIC): http://ific.org (use HFCS as search criteria) • The American Dietetic Association: www.eatright.org (see “Position of the ADA: Use of Nutritive and Nonnutritive Sweeteners”) • The Facts about High Fructose Corn Syrup: www.hfcs.com Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Today’s webinar was made possible by: Disclaimer of Endorsement: reference herein to any products, services or expressed ideas does not constitute or imply endorsement or recommendation by the School Nutrition Association. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org Details on Receiving SNA CEU Credits ALL SNA members who registered for and participated in the event will automatically obtain 1 SNA Continuing Education Unit (CEU) for viewing today’s webinar. – Participation will be verified against the event registration log, so if you participated via a shared computer, please email [email protected] to indicate your participation. Please include your SNA member number, full name and contact information, and the name of the person who registered for the event in the body of your email. * Please note: CEU credits are for SNA members only; SNA is unable to provide CEU’s for other organizations. CEU certificates will NOT be issued as SNA will maintain record of your participation in the event. Copyright © 2008 School Nutrition Association. All Rights Reserved. www.schoolnutrition.org