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NUTRITIION CONTROVERSIES: Tackling tough topics with facts, not emotion

NUTRITIION CONTROVERSIES: Tackling tough topics with facts, not emotion. Keith-Thomas Ayoob, EdD , RD, FADA, CDN Associate Clinical Professor of Pediatrics Albert Einstein College of Medicine New Jersey School Nutrition Association August 16, 2012. 3 examples of “risky” topics.

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NUTRITIION CONTROVERSIES: Tackling tough topics with facts, not emotion

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  1. NUTRITIION CONTROVERSIES:Tackling tough topics with facts, not emotion Keith-Thomas Ayoob, EdD, RD, FADA, CDN Associate Clinical Professor of Pediatrics Albert Einstein College of Medicine New Jersey School Nutrition Association August 16, 2012

  2. 3 examples of “risky” topics • Artificial colors • Sugar • Flavored milk

  3. Common thoughts… • Sugar is making kids • Hyperactive/diabetic/high • “Artificial colors make them hyperactive”

  4. A R T I F I C I A L COLORS

  5. What ARE they? • Regulated by FDA • 2 kinds of colors in food: • Certified color additives • Colors exempt from certification

  6. 9 Certified colors • Blue #1 • Blue #2 • Green #3 • Red #2 • Red #3 • Red #40 • Orange B • Yellow #5 • Yellow #6

  7. Exempt colors • Naturally derived but are still color additives, must comply with regulations • More expensive • May impart flavors

  8. What are they doing in our food? • Compensate for color losses • Maintain uniformity when colors naturally vary • Enhance naturally occurring colors

  9. THE BIG QUESTION: DO COLORS IN FOOD CAUSE HYPERACTIVITY?

  10. HISTORY • Started with Feingold in the 1970s • Hyperactivity caused by: • Salicylates • Artificial flavors • Artificial colors Feingold, BF Delaware Med J 1977

  11. McCann et al (2007) • General population • Double-blind, placebo-controlled • Global hyperactivity aggregate scores

  12. McCann et al (2007) • Comparing Mix A against placebo, Mix B against placebo: • 3 y.o.: in both cases, Mix showed significantly greater hyperactivity scores • 8/9 y.o.: in both cases, Mix showed significantly greater hyperactivity scores …but….

  13. McCann et al (2007) • When adjusted for: • Week during trial • Sex • Maternal education • SES • GHA in baseline week • Pretrial diet………

  14. McCann et al (2007) • Effect in 8/9 y.o., was significant only at highest dose (Mix B) • Effect in 3 y.o. was significant only at the lower dose (Mix A).

  15. McCann et al (2007) Among authors’ conclusions: “…substantial individual differences in the response of children to the additives.”

  16. Conclusions of EFSA panel • “…the study provides limited evidence that the two mixtures had a small and statistically significant effect on activity and attention.” • They also concluded that the McCann study did not provide an acceptable basis for altering the ADI for colors. EFSA Journal, 2008

  17. Guidance • Perceived or real, some subset of children may be especially sensitive or high-responders to ACs • Look at quantity/frequency • 4 oz. of candy for a 3-year-old and • 8 oz. of candy for an 8-y.o. is EXCESSIVE • Smaller amounts may matter little or none • Assess context, setting, situation

  18. SUGAR SUGAR SUGAR

  19. The buzz • Sugar gets kids hyperactive • Sugar makes kids overweight • HFCS: The new trans fat. It gives you diabetes, metabolic syndrome, etc. • Fructose causes high blood pressure.

  20. How much sugar do we eat? • Total added sugars eaten, per capita1: • 1999: 107.7 lb. • 2007: 97.0 lb. (=120 gm/day) 1 - ers.usda.gov, accessed 9/21/09

  21. Mean calories from added sugars by age and sex CDC/NCHS -- March 2012

  22. Percent of total calories by sex and age CDC/NCHS March 2012

  23. Percent of calories from added sugars by type of food & location CDC/NCHC March 2012

  24. Sources of All Simple Sugars Present in Children’s’ Diets (15.4%) RTE cereals,5.1% Fruits, 13.3% Sugars and sweetsincluding candy, 11.9%% Vegetables, 2.1% Carbonated softdrinks, 16.8% Milk, milk products,22.2% (49.5%) (29.1%) Meat, poultry, fish andmixtures, 1.4% Fruitades and other beverages,12.6% All other grain products,5.5% Source: Bell Institute for Health & Nutrition Cakes, cookies, piesand pastries, 8.2% Misc. = 0.9 NHANES 2001-02

  25. HFCS: the evil of the moment • 2 basic kinds: • HFCS 42: 42% fructose • HFCS 55: 55% fructose • Cane sugar (sucrose): • 50% fructose • Take-away message: HFCS is really not high in fructose

  26. What IS high in fructose: • Apple juice: • 65% fructose, 35% glucose • Pear juice: • 74% fructose, 26% glucose

  27. Sugar, HFCS, and obesity? • Evidence suggests otherwise • IOM report (2002): • Higher intakes of sugar are associated with lower rates of obesity • “No clear and consistent association between increased intake of added sugars and BMI.”

  28. Sugar & HFCS and obesity -- NOT • Inverse relationship found between sugar intake and bodyweight or BMI: • Saris (2003) • Hill & Prentice (1995) • Inverse relationship between total sugar intake and total fat intake: • Gibson (1996)

  29. Sucrose and weight loss, satiety • 42 women – two groups • All on low-fat, low calorie diets • 1 group consumed 43% of energy as sugar • Result: • No differences in weight loss, mood, hunger, stress level • Equal decreases in BP, %BF, plasma lipids Surwit, AJCN 1997

  30. Sugar & hyperactivity: How the rumors started • Case study of 1 child by Crook (1974) • Sugar was removed, behavior improved • Controlled studies unable to replicate results

  31. Sugar and behavior • Negative associations generally dismissed by the scientific community1 • Perception of sugar by parents and consumers continues to defy years of sound science and logic. • Some evidence that behavior is positively affected by sugar. 1 – IOM, Dietary carb, 2002

  32. Meta-analysis by Wolraich, et al (1995) • 23 studies • Double blinded, placebo-controlled • Known quantity of sugar • Reported statistics useful for computing dependent measures

  33. Meta-analysis by Wolraich, et al (1995) • Conclusion: • “Sugar does not affect the behavior or cognitive performance of children. The strong belief of parents may be due to expectancy and common association.” In fact…….

  34. Sugar can even IMPROVE behavior and performance • Decrease in activity after sucrose1 or glucose2 • Sugar-containing snack can enhance ability to stay on task3 • Glucose enhances long-term verbal and spatial memory4 1 – Behar et al (1994); 2- Saravis et al (1990) 3 – Busch et al (2002); 4- Sunram-Lea et al (2001) But….

  35. THE DUMBESTFIGHT IN SCHOOL: CHOCOLATE MILK

  36. Based on Consumer Self-report Data, Americans Under-consume Dairy Pyramid Servings of Dairy (Milk, Cheese, Yogurt) in Average Day Source: NPD Nutrient Intake Database (Self-reported consumption); Years ending February

  37. Suburban Connecticut • Sept/Oct/Nov: 2007 vs. 2008 • 2007: FF and LF milk, white & chocolate • 2008: FF and LF milk, white only • RESULT: • Declines in milk consumption, 35-62% JADA, 2009

  38. WHEN FLAVORED MILK “DROPS-OUT”… • 58 elementary & middle schools • 7 school districts across the country • Flavored milk was eliminated • Also studied: • # of cartons chosen • Amount of milk consumed 2010, Milk PEP

  39. …KIDS SPEAK WITH THEIR HANDS Cartons chosen Actual consumption 2010, Milk PEP

  40. “They’ll just adapt” --NOT! • They adapt to NOT having milk • They ALSO miss on: • 8 gm protein • 1/3 daily calcium • 8-oz. fluid Change in consumption 2010, Milk PEP

  41. Wansink & Just • Two cafeteria lines: • Typical meals • “healthy express” • Add low-fat chocolate milk to healthy express line: • 18% increase in better-for-you foods • 28% decrease in low-nutrient foods

  42. Harvard: “Kids’ll drink what’s there” • 4 schools, suburban Boston • 2 schools: regular menu, white & flavored milk • 2 schools, “chef assisted”, white milk, with flavored milk 2 days/week • Measures: milk intake during two days, after 2 years

  43. Devil’s details • Intake measured over 2 days • Chef-assisted schools offered flavored milk on ONE of the two days • Intake not broken down by day, so no info on consumption difference on flavored milk vs. white milk days.

  44. Emotion: “40 cal/day of sugar = 11 lb/yr” • Are the 35% of kids who skip milk losing weight? • So….. 80 FEWER cals/day = 22 lb LOSS/year?

  45. Flavored milk: FACT • 2763 children 6-11 years 1125 teens, 12-17 years • 3 groups: • Non-consumers of flavored milk • 0-240 g • >240 g Johnson, R et al, 2002, JADA

  46. Flavored milk drinkers had: • More calcium ~100-150 mg/day • No additional intake in added sugars • Lower intake of soft drinks/fruit drinks Johnson, R et al, 2002, JADA

  47. Sugary drinks How much are they getting? Where’s it coming from?

  48. Daily calories from sugar drinks NCHS Data Brief #71 August 31, 2011

  49. Where are kids getting their sugary drinks? NCHS Data Brief #71, August 31, 2011

  50. Discretionary calories: How much is too much? Ref: 2005 US Dietary Guidelines for Americans

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