1. Candy: What is Moderate Consumption?
Laura Shumow, MHS
Director of Scientific and Regulatory Affairs

2. 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

3. Candy in History & Culture
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 has long been a part of celebrations of happy moments – as a special treat, a follow up to “trick” at Halloween, and a momentary indulgence.
There is a place for “little pleasures” such as candy in an overall lifestyle that supports health, wellness and happiness.
Candy certainly should not replace nutrient-dense foods in the diet; but it is important to help the public understand how to incorporate these little pleasures in moderation to support an overall healthy diet that balances caloric intake and physical activity.

4. What is the impact of candy on health and wellness?

5. Cross-Sectional Analyses of Candy Consumption and Health
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)
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 Nutrition Research, (2):
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 Food Nutr Res. 2011;55. doi: /fnr.v55i0.5794 

6. Cross-Sectional Analyses of Candy Consumption Frequency and Health
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
Golomb et al. Association between More Frequent Chocolate Consumption and Lower Body Mass Index. Arch Intern Med. 2012;172(6):
Murphy et al. Body weight status and cardiovascular risk factors in adults by frequency of candy consumption. Nutr J. 2013; 12 (1): 53.

7. Candy consumption in childhood is not predictive of cardiovascular risk factors in young adults: The Bogalusa Heart Study
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.
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 (E-pub before print).

8. Study Methodology
Candy was defined as chocolate bars or packets (e.g. Hershey bars or M&Ms), other chocolate candy bars (e.g. Snickers), or sugar candy (e.g. Lifesavers).
Separate linear mixed models were used to detect relationships between candy at baseline and health biomarkers at follow-up.
Models were adjusted for baseline values, BMI, age, gender, race/ethnicity, total energy, lifestyle variables (i.e. smoking status & alcohol use), and total energy intake.
Because age and candy intake varied at follow-up, they were also included as covariates in each model.
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.

9. Effect of candy consumption on cardiovascular risk factors (n=355)
 CVRF at Follow-up
Candy Baseline
Candy Follow-up
β±SE
std β
P-value
BMI (kg/m2)*
0.005±0.006
0.04
0.329
-0.004±0.009
-0.02
0.608
Weight (kg)*
0.013±0.016
0.03
0.410
-0.020±0.025
-0.03
0.413
Systolic BP (mm Hg)**
0.005±0.012
0.02
0.674
-0.006±0.020
-0.01
0.776
Diastolic BP (mm Hg)**
-0.018±0.011
-0.09
0.108
0.006±0.018
0.732
Total Cholesterol (mg/dL)**
0.062±0.039
0.08
0.116
-0.067±0.063
-0.05
0.288
LDL-C (mg/dL) **
0.025±0.036
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
0.993
Triglycerides (mg/dL)**
0.133±0.082
0.10
0.106
-0.245±0.133
-0.10
0.066
Glucose (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

10. 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.

11. Why No Link Between Candy and Weight?

12. Candy containing chocolate 15.0 13.2 15.6
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+ y
Candy 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
20.6
Per capita candy intake, g
5.7
4.7
6.1
4.3
7.2
3.4
10.0
11.9
9.4
Source: What We Eat in America, National Health and Nutrition Examination Survey , 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.

13. Total energy intake, kcal 2075 1907 2128
Per capita contributions of candy to total energy, fat and sugar intakes
Population Group
Parameter
2+ y
2-18 y
19+ y
Total 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
2.0
Total 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
Total saturated fat intake, g
25.9
24.5
26.4
Saturated fat intake from candy, g
0.8
% of saturated fat intake from candy
3.2
Total sugars intake, g
120
127
117
Sugars intake from candy, g
5.7
6.7
5.3
% of sugars intake from candy
4.7
4.5
Total 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
6.3
Source: What We Eat in America, National Health and Nutrition Examination Survey , 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).

15. 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

16. 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

17. Identifying Strategies to Promote Moderate Consumption
Individual tactics - mindfulness, distraction techniques
Package size, food environment
Parental tactics – “limit setting” as opposed to restriction

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

20. Educational Tools to Promote Moderation

21. Industry Responsibility Efforts
In 2013 The member of the National Confectionery Industry announced their voluntary commitment to pursue a key strategy geared to help your shoppers cut through the confusion of ‘what’s in the confectionery products’ by putting calories on the front of the pack. Under the voluntary “Treat Right” program, manufacturers of confections will begin putting calories on the front of packages which will accompany more detailed ingredient summaries already on the back of packages. Exempt from this program will be gift box items

22. QUESTIONS Laura.Shumow@CandyUSA.com