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or recommendation by the School Nutrition Association.
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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
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Consumer perceptions of
Sugar/HFCS
Susan Borra, RD
President, IFIC Foundation
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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
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Less

Science Says:
High Fructose Corn Syrup
and sugars have similar
effects in humans
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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.
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(n=1000)
Food Science Perspective
of HFCS
John S. White, Ph.D.
White Technical Research
Argenta, Illinois
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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.
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What is HFCS?
HFCS = monosaccharides = free sugars
Fructose + glucose
Sucrose = disaccharide = bound sugars
FructoseGlucose
Copyright © 2008 School Nutrition Association. All Rights Reserved.
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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.
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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.
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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.
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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
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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
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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.
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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
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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
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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
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Sweetened Beverage Consumption and
Weight Status: Where is the Weight of the
Evidence?
No Relationship
Some Relationship
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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
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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.
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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
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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.
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Overweight and Eating Patterns
95% Unexplained
by Eating Patterns
4% Explained by
Other Eating
Patterns
1% Explained by
Sweetened Beverages
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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
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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.
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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.
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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.
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Review Articles
Sweetened Beverages and Weight Status
?????
Inconclusive
Evidence
Strong
Evidence
Where is the weight of the evidence?
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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
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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
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The Energy Balance Equation
Dietary Intake – Energy Expenditure = Stores
(What you got – What you spent = What’s left)
FOOD INTAKE
PHYSICAL ACTIVITY
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“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
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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
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Newsweek, Dec. 26, 2005/Jan. 2, 2006
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High Fructose Corn Syrup Issues in a
School Lunch Program
Sandra Voss, MS, RD, LDN
Arlington Heights, Illinois
District 25
Food & Nutrition Services
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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
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Background on District 25
• District of approximately
5000 children in
suburban Chicago
• Middle to upper class
community
• Highly educated parents
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Trends in Food Service
•
•
•
•
Organic and All Natural Offerings
Farm to School Programs
Foods without Trans Fats
Foods not containing HFCS
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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
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Issues & Concerns with HFCS
2 major areas of
concern…..
• Parent Perspective
• School Food Authority
Perspective
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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
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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)
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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
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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
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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
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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
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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
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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
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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
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Additional Strategies
Encourage consumption of fruits/veggies, whole
grains….go back to the basics!
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Questions & Answers
Sue Borra, RD
John White,
PhD
Theresa Nicklas,
DrPh
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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
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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.
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