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2
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.
3
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 Childrens 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

4
Consumer perceptions of Sugar/HFCS

• Susan Borra, RD
• President, IFIC Foundation

5
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.
6
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

7
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
The Sugar-Sweetened Facts
Juices fall from list of best kids drinks
Food companies vow to tighten limits on kids ads
8
Sugar and Obesity Media Coverage
Low-carb diet fad
2003
2004
2002
2005
2006
2007
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
9
Global Media Coverage of Fructose/High Fructose
Corn Syrup and Obesity
2001
2002
2004
2003
2005
2006
2007
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
10
Consumers Reporting Somewhat or Very Concerned
About Nutritional Content, 1983-2007
US Grocery Shopper Trends, FMI 2007
11
Consumer Awareness of Label Terms Related to
Dietary Sugars
Percent Heard (n1000)
Food and Health Survey 2007
12
Sugar Consumption Trends
Please indicate whether you are trying to consume
more or less of the following
Sugar
Added sugars
HFCS
Fructose
Glucose
?
Sucrose
? Significant decrease from 06
Food and Health Survey 2007
13
Science Says
High Fructose Corn Syrup and sugars have similar
effects in humans
14
Factors InfluencingConsumers Purchasing Decisions
How much of an impact do the following have on
your decision to buy foods and beverages?
88
2007
53
35
Taste
2006
85
54
31
?
Price
2007
72
37
35
2006
63
?
35
28
Healthfulness
?
65
2007
25
40
2006
58
?
26
32
Great impact
Some impact
Convenience
?
2007
55
23
32
2006
49
19
30
(n1000)
? Significant increase from 06
15
Food Science Perspectiveof HFCS

• John S. White, Ph.D.
• White Technical Research
• Argenta, Illinois

16
HFCS in perspective

• Surprising attention
• Dietary component for eons
• Similar to sucrose
• Expert reviews no concerns

• Predictable
• Obesity solution sought
• Historical precedent
• Distrust of government/agriculture/industry

Discovery of honey Piero de Cosimo1462,
Worcester Art Museum
17
What is HFCS?

• HFCS monosaccharides free sugars
• Fructose glucose
• Sucrose disaccharide bound sugars
• Fructose?Glucose

18
HFCS is similar to sugars from natural sources
Source NutritionData.com. Conde Nast. 2008.
19
HFCS is similar to other caloric sweeteners
20
HFCS is similar to othercaloric sweeteners

• Composition
• Sugars ratio
• Production unit operations
• Functionality (some differences)
• Absorption
• Metabolism

21
Fructose-glucose sweetenersare 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

22
HFCS/fructose is highly functional

• Stability in acid
• Ease of handling
• Flavor enhancement
• Control of freezing
• Fermentable sugars
• Moisture retention

• Resistance to crystallization
• Sugars for browning reactions
• Sweetness equivalent to sucrose

23
Sweetnesssucrose HFCS-55
1Schallenberger Acree. 1971. Sugar Chemistry.
AVI Pub. Co., Westport CT.2White Parke. 1989.
Cereal Foods World. 34(5)392-398.
24
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

25
US availability sucrose HFCS
26
Its a sucrose world
Source Fereday et al. Sweetener analysis. LMC
International Ltd., 2005.
27
We eat more of everything
Source USDA-ERS 2007 Caloric nutrients data set,
loss adjusted
28
Perspective is lacking inthe 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

29
Weighing the Evidence

• Theresa A. Nicklas, DrPH
• Professor
• USDA/ARS Childrens Nutrition Research Center
• Baylor College of Medicine
• Department of Pediatrics

30
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

31
What is anEvidenceBased System?

• A science-based systematic evaluation of the
  strength of the evidence behind a statement.

32
The Philosophy Behind anEvidence-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.

33
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)

34
ADA Evidence Analysis Library

• Grade II Fair
• Strong design
• Uncertainty attached to the conclusion
• Doubts about generalizability, bias, research
  design flaws, or adequacy of sample size
• Or, alternatively
• Weak designs
• Results have been confirmed in separate studies

35
Sweetened Beverage Consumption and Weight Status
36
No Relationship Between Sweetened Beverage
Consumption and Overweight Status 13 Studies

• Johnson L, Mander AP, Jones LR, Emmett PM, Jebb
  SA. Is sugar-sweetened beverage consumption
  associated with increased fatness in children?.
  Nutr. 2007 23557-563.
• Sun SZ, Empie MW.Lack of findings for the
  association between obesity risk and usual
  sugar-sweetened beverage consumption in adultsA
  primary analysis of databases of CSFII-1989-1991,
  CSFII-1994-1998, NHANES III, and combined NHANES
  1999-2002. Food Chem Toxicol. 2007 451523-1536.
• 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 381245-54.
• Blum JW, Jacobsen DJ, Donnelly JE. Beverage
  consumption patterns in elementary school aged
  children across a two-year period. J Am Coll
  Nutr. 2005 2493-8.
• 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
  3399-106.
• Overby NC, Lillegaard IT, Johansson L, Andersen
  LF. High intake of added sugar among Norwegian
  children and adolescents. Public Health Nutr.
  2004 7285-93.
• 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 1041086-94.
• 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 12461-72.
• 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
  55463-478.
• Forshee RA, Storey ML. Total beverage consumption
  and beverage among children and adolescents. Int
  J Food Sci Nutr. 2003 54297-307.
• 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 157882-6.
• 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 89419-29.
• Forshee RA, Storey ML. The role of added sugars
  in the diet quality of children and adolescents.
  J Am Coll Nutr. 2001 2032-43.

37
Some Relationship Between Sweetened Beverage
Consumption and Overweight Status 17 Studies

• Sanigorski AM, Bell AC, Swinburn BA. Association
  of key foods and beverages with obesity in
  Australian schoolchildren. Public Health Nutr.
  2007 10152-157.
• 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
  107924-934.
• 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 115e223-9.
• 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 1341905-9.
• 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 80348-56.
• 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 292927-934.
• Berkey CS, Rockett HR, Field AE, Gillman MW,
  Colditz GA. Sugar-added beverages and adolescent
  weight change. Obes Res. 2004 12778-88.
• 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 81150-61.
• 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 3281237.
• 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 259-16.
• Mrdjenovic G, Levitsky DA. Nutritional and
  energetic consequences of sweetened drink
  consumption in 6- to 13-year-old children. J
  Pediatr. 2003 142604-10.
• 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 157882-6.
• Gillis LJ, Bar-Or O. Food away from home,
  sugar-sweetened drink consumption and juvenile
  obesity. J Am Coll Nutr. 2003 22539-45.
• 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 27684-92.
• Ludwig DS, Peterson KE, Gortmaker SL. Relation
  between consumption of sugar-sweetened drinks and
  childhood obesity a prospective, observational
  analysis. Lancet. 2001 357505-8.
• 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 18145-54.
• 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 51963-9.

38
Sweetened Beverage Consumption and Weight Status
Where is the Weight of the Evidence?





39
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

40
Regular Carbonated Soft Drinks(NHANES)

• Mean frequency is 21.9 servings per month, less
  than 1/day.
• 87 of adolescents have 30 or fewer servings per
  month, or less than 1/day.

Smith PA, Forshee RA, Storey ML, Ceres Institute,
Center for Food and Nutrition Policy, EB 2001
41
(No Transcript)
42
The Association Between Eating-PatternVariables
and Overweight Status byEthnicity-Gender Groups

• Eating pattern EA male EA female AA male AA
  female
• OR (95 CI) OR (95 CI) OR (95 CI) OR (95
  CI)
• Food groups consumption a,b R²0.08 R²0.10 R²
  0.17 R²0.13
• Fats/oils 0.97 (0.85 1.10) 1.00
  (0.83-1.19) 0.93 (0.71-1.22) 1.06 (0.86-1.32)
• Fruits/fruit juices 1.03 (0.88 1.20) 1.10
  (0.92-1.31) 0.97 (0.69-1.41) 0.55 (0.38 0.79)
• Vegetables 0.98 (0.77 1.24) 1.09
  (0.87-1.36) 1.05 (0.74-1.49) 0.75 (0.51-1.09)
• Breads/grains 1.20 (0.86 1.67) 0.90
  (0.62-1.30) 0.62 (0.33-1.16) 1.03 (0.60-1.79)
• Mixed meats 1.12 (0.95 1.31) 0.93
  (0.78-1.12) 1.06 (0.82-1.37) 0.97 (0.78-1.19)
• Desserts 0.89 (0.73 1.09) 1.08
  (0.86-1.35) 0.89 (0.65-1.22) 0.89 (0.66-1.21)
• Candy 0.94 (0.76 1.18) 0.78 (0.60-1.01) 0.79
  (0.51-1.23) 1.00 (0.73-1.35)
• Sweetened beverages 1.68 (1.12 2.33) 1.53
  (1.05-2.22) 1.02 (0.72-1.46) 0.92 (0.65-1.30)
• Poultry 0.99 (0.89 1.09) 1.04
  (0.94-1.16) 0.97 (0.76-1.23) 0.99 (0.84-1.16)
• p lt 0.05p lt 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.

43
Overweight and Eating Patterns
4 Explained by Other Eating Patterns
95 Unexplainedby Eating Patterns




1 Explained by Sweetened Beverages
44
Variance of Childrens BMI Explained by
Regression Model





Smith PA, Forshee RA, Storey ML, Ceres Institute,
Center for Food and Nutrition Policy, EB 2001
45
Association Between Eating Patterns and Weight
Status





46
Review ArticlesSweetened Beverages and Weight
Status
Strong Evidence 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 97667-75.

47
Review ArticlesSweetened Beverages and Weight
Status
Inconclusive Evidence 3, 4

• Pereira MA, Jacobs DR. Sugar-sweetened
  beverages, weight gain and nutritional
  epidemiological study design. Br J Nutr. 2007
  Nov 231-2.
• Bachman CM, Baranowski T, Nicklas TA. Is there
  an association between sweetened beverages and
  adiposity? Nutr Rev. 2006 April 64(4)153-74.

48
Review ArticlesSweetened Beverages and Weight
Status
?????




Inconclusive Evidence
Strong Evidence
Where is the weight of the evidence?
49
Conclusions Based on a ScientificReview 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
50
No Simple Answer to theObesity Epidemic




51
The Energy Balance Equation
Dietary Intake Energy Expenditure
Stores (What you got What you spent Whats
left)





PHYSICAL ACTIVITY
FOOD INTAKE
52
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 its a
deficiency in y. Hugh Tunstall Pedoe





53
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

54





Newsweek, Dec. 26, 2005/Jan. 2, 2006
55

• High Fructose Corn Syrup Issues in a School Lunch
  Program

Sandra Voss, MS, RD, LDN Arlington Heights,
Illinois District 25 Food Nutrition Services
56
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

57
Background on District 25

• District of approximately 5000 children in
  suburban Chicago
• Middle to upper class community
• Highly educated parents

58
Trends in Food Service

• Organic and All Natural Offerings
• Farm to School Programs
• Foods without Trans Fats
• Foods not containing HFCS

59
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

60
Issues Concerns with HFCS

• 2 major areas of concern..
• Parent Perspective
• School Food Authority Perspective

61
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

62
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)

63
Response to Concerns

• Ala carte offerings are optional and fit
  nutritional guidelines established by the
  district
• lt35 cal from fat
• lt10 cal from sat fat
• lt35 sugar by weight
• lt200 calories per serving

64
Response to Concerns

• These items should be consumed in moderation and
  with a balanced, healthy diet
• Parents have control of childrens accounts and
  have the ability to block ala carte purchases

65
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

66
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

67
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

68
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

69
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

70
Additional Strategies

• Encourage consumption of fruits/veggies, whole
  grains.go back to the basics!

71
Questions Answers
Sue Borra, RD
John White, PhD
Theresa Nicklas, DrPh
Sandy Voss, MS, RD, LDN
72
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

73
Todays 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.
74
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