Article

Proposing a Definition of Candy in Moderation

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Abstract

Advice to practice “moderation” in eating conveys that reasonable amounts of specific foods or beverages can fit into healthful meal patterns. However, interpretation of moderation varies widely between both health professionals and consumers. Evidence suggests that candy can have a place in an overall lifestyle that supports health, wellness, and happiness. Recognizing the importance of managing calories, a proposed definition for consuming candy in moderation offers realistic and practical advice for individuals wishing to include confections within the context of a healthful diet and lifestyle. Quantifying candy in moderation is proposed as a range of up to 50 to 100 calories per day depending on energy needs. This amount falls within dietary guidance from leading health authorities for calories from added sugars and fats. The purpose of this article was to summarize current intakes of candy, examine the potential role of candy in health and well-being, and provide support for a proposed definition of “candy in moderation” for those who choose to consume confections, including chocolates, hard and chewy candy, and chewing gum.

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... In the United States, Candy plays an important role in national and cultural traditions and celebrations for thousands of years and it continues to be enjoyed by most people as an occasional treat (Duyff, et al., 2015). Statistics show that 97% of Americans report candy consumption at least once per year (Hornick, et al., 2014). Among the total consumers, 62.8% eat hard candy or breath mints each month, 20% are considered heavy buyers, eating at least six rolls of candy per month, while half of the hard candy and breath-mint consumers eat between two and five rolls of it in a month's time (Chief Marketer Staff, 2000). ...
... Children aged 2 -6 years old eat more frequently than any other age group in the study and female more than male are candy eaters. The prevalence of candy eaters is consistent with Hornick, et al. (2014) who found that 97% of American candy eat candy at least once a year. Also, with the reports published in the United Kingdom by the Statistical Research Department (2015) where there was 87% prevalence of candy eating at least once a week. ...
Experiment Findings
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Candy is eaten by people of all ages and all genders. Candy eating behavior can be that, with conscious efforts to lick it to finish, the eater may repeatedly crush it instead. This study examined what could be responsible for candy crushing despite the desire to lick it. A survey design is employed to understand this through questionnaire administered via WhatsApp and Facebook targeting anyone aged two and older across the globe. There were 212 respondents. The data was analyzed using simple descriptive statistics. Results show the prevalence of 89.6% of candy eating across age groups. Majority of the candy eaters put the whole candy in the mouth at once and start by licking and uncontrollably end up crushing it. About a quarter of the candy eaters indicated powerlessness over crushing candy. And the candy crushing can be hypothesized to be due to brain chemical 'dopamine' stimulated by sugar hijacking the decision-making/willpower part of the brain in the frontal lobe. It is recommended that neurological study be conducted to investigate what overrides willpower to not crush candy. This may shed more lights to understanding why people are addicted to certain substance.
... Children did not, however, mention portion size as it relates to candy consumption. This provides insight for avenues on future obesity prevention efforts in that intervention messaging should emphasize that while candy is not required in the diet, consuming candy "in moderation", that is, portion-controlled amounts eaten on occasion, may be more effective for developing healthy eating behaviors than complete restriction (Hornick, Duyff, Murphy, & Shumow, 2014). The enjoyment of candy in moderation using strategies such as mindfulness and attention control may promote children's self-regulation of these foods, rather than restriction of candy, which often leads to later overconsumption. ...
... MyPlate tips from the 2010 Dietary Guidelines for Americans acknowledge both the frequency of eating occasions and portion size in their recommendation that small portions of treats such as candy may be eaten on occasion rather than eliminated completely from the diet (USDA., 2011). What constitutes "small", or "candy in moderation," has been defined as 50e100 calories per day for adults (Hornick et al., 2014). However, a child-specific definition is warranted given children's differing daily energy needs. ...
... Candy has played an important role in cultural traditions and celebrations for thousands of years and continues to be enjoyed by most people as an occasional treat. Frequency data indicate that 97% of Americans report candy consumption at least once per year (1). Behavioral nutrition research strategies provide insight into how individuals can enjoy treats, such as candy, in moderation in the context of an overall healthful eating plan. ...
... Evidence suggests that moderation through portion control may be more effective than elimination or restriction of a highly palatable food in relation to weight management and improved dietary health (2)(3)(4)(5)(6). A definition of moderation proposed for candy intake is an amount equivalent of up to an average of 50-100 kcal/d for adults, to fit within a range of energy needs when nutrient-dense foods are chosen first (1). This amount of candy is equivalent to 20-30% of the maximum daily allowance for solid fats and added sugars in diets, ranging from 1800 to 3000 kcal/d. ...
Article
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Nearly all Americans (97%) report eating candy at least once per year; yet, on a given day, only approximately one-fourth of the US population aged ≥2 y consumes candy. Among all Americans, candy contributes a relatively small proportion of calories, added sugars, and saturated fat to the total diet, and recent research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Providing guidance for the consumption of candy in moderation requires an understanding of various behavioral health-related factors that influence candy consumption. A roundtable of behavioral nutrition experts, researchers, and nutrition educators met to discuss recent data on intakes of candy, health outcomes associated with usual candy intake, and the impact of behavioral strategies, including restriction, education, and environmental awareness, on modifying eating behaviors to achieve moderate intakes of candy. Restricting access to palatable foods, whether self-imposed or by parental control, may have potentially negative consequences. Techniques and insight into how to adopt "moderation" in candy consumption, from effective parental practices to environmental strategies that facilitate behavior change without a high degree of effort, were identified as important next steps toward sustainable dietary guidance related to the role of candy and other treats in a healthy lifestyle. © 2015 American Society for Nutrition.
... However, excessive consumption of sugary foods is not recommended given the health consequences (Freeman et al., 2018). Yet, it has been reported that people consume candy about two to three times a week (Duyff et al., 2015;Hornick, Duyff, Murphy, & Shumow, 2014). When eaten in moderation though (50-100 calories per session), candy can be part of a healthy lifestyle. ...
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Eating candy is pleasurable. Yet, eating candy in large quantities is not recommended. Manufacturers have consistently produced small portion sizes of a variety of candy. While consuming small versus large portion sizes is healthier, do people experience the same amount of pleasure from eating a small portion and does it matter how it is eaten? In a pre-registered study, we examined how candy portion size and mindful eating affected eating-related pleasure. Participants (N = 301) were randomly assigned to eat a small (113 calories) or large (210 calories) portion of a popular candy, Reese's Peanut Butter Cups. They were also randomly assigned to eat the candy in a regular or mindful manner. We examined eating-related pleasure after consumption. We found that eating pleasure did not differ between portion sizes in the regular eating condition, but in the mindful eating condition, participants experienced more pleasure when eating the small versus large portion. Furthermore, participants experienced more guilt after eating the large versus small portion in the regular eating condition, but portion size did not affect feelings of guilt in the mindful eating condition. An awareness of such effects could encourage people to reduce the portion sizes of the candy they consume.
... Sweets have played an important role in cultural traditions and celebrations for 1000 years and continue to be enjoyed by most people as an occasional treat. [1] Consuming a modest amount of some types of candy, such as cocoa, dark chocolate, and chewing gum, has been associated with positive effects on weight and cardiovascular health. [2] One pilot study investigated the potential effects of candy consumption on health risk factors in children and adults including body weight and markers of disease risk such as blood cholesterol, blood pressure, and blood glucose. ...
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Introduction: Human desire for sweet taste spans all ages, races, and cultures. Throughout evolution, sweetness has had a role in human nutrition, helping to orient feeding behavior toward foods providing both energy and essential nutrients. Infants and young children, in particular, base many of their food choices on familiarity and sweet taste. Materials and Methods: In this study, an online survey was conducted. For the survey to be conducted, a questionnaire which contains 20 questions including the child's name, age, and gender was prepared. The questionnaire was put in an online survey website and was sent to the parents of children <6 years of age in urban area. Results were tabulated and analyzed. Results: About 13.3% of children consume sweets once a month and 22.9% of children consume sweets many times in a week. 18.1% of parents think sweet consumption is good for their child. 57.1% of parents think otherwise. 24.8% of parents think that sweet consumption may be good for their child. 21.9% of children have candies as their preferred sweet, 57.1% prefer chocolates, 16.2% prefer traditional sweets, and 4.8% prefer other sweets. 41.9% of children brush their teeth only once. 44.8% of children brush their teeth twice. 9.5% brush more than two times and 3.8% of children never brush. Conclusion: In this study, it was found that there was increased consumption of sweets among children. This increased consumption of sweets increases the risk of dental caries, obesity, and early onset of diabetes.
... Murphy, Bi, & Bodor, 2012). This amount is equivalent to one-half of a fun size bar (Hornick, Duyff, Murphy, & Shumow, 2014). Chocolate is a popular candy not only in the US but consumed around the world. ...
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... Children did not, 332 however, mention portion size as it relates to candy consumption. This provides insight for 333 avenues on future obesity prevention efforts in that intervention messaging should emphasize 334 that while candy is not required in the diet, consuming candy " in moderation " , that is, portion335 controlled amounts eaten on occasion, may be more effective for developing healthy eating 336 behaviors than complete restriction (Hornick, Duyff, Murphy, & Shumow, 2014). The enjoyment 337 of candy in moderation using strategies such as mindfulness and attention control may promote 338 children's self-regulation of these foods, rather than restriction of candy, which often leads to 339 later overconsumption. ...
Article
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... People in the U.S. are estimated to consume candy once every 2 to 3 days on average (Hornick, Duyff, Murphy, & Shumow, 2014). Consumption is higher in other areas of the world (Forbes, 2015). ...
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Parents have some responsibility for children's dietary habits and they are often the focus of public health interventions designed to improve children's diets and thereby reduce the prevalence of childhood obesity. The current UK interventions promote awareness of healthy food choices, but offer little guidance for parents on child-feeding behaviours. A review of recent literature regarding child-feeding behaviours and child weight. Parents report using a wide range of child-feeding behaviours, including monitoring, pressure to eat and restriction. Restriction of children's eating has most frequently and consistently been associated with child weight gain. Furthermore, there is substantial evidence for a causal relationship between parental restriction and childhood overweight. Parents may inadvertently promote excess weight gain in childhood by using inappropriate child-feeding behaviours. We recommend the development of interventions to increase awareness of the possible consequences of inappropriate child-feeding behaviours. Parents who are concerned about their child's weight will also require guidance and support in order to adopt more appropriate child-feeding behaviours.
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Regular intake of cocoa-containing foods is linked to lower cardiovascular mortality in observational studies. Short-term interventions of at most 2 weeks indicate that high doses of cocoa can improve endothelial function and reduce blood pressure (BP) due to the action of the cocoa polyphenols, but the clinical effect of low habitual cocoa intake on BP and the underlying BP-lowering mechanisms are unclear. To determine effects of low doses of polyphenol-rich dark chocolate on BP. Randomized, controlled, investigator-blinded, parallel-group trial involving 44 adults aged 56 through 73 years (24 women, 20 men) with untreated upper-range prehypertension or stage 1 hypertension without concomitant risk factors. The trial was conducted at a primary care clinic in Germany between January 2005 and December 2006. Participants were randomly assigned to receive for 18 weeks either 6.3 g (30 kcal) per day of dark chocolate containing 30 mg of polyphenols or matching polyphenol-free white chocolate. Primary outcome measure was the change in BP after 18 weeks. Secondary outcome measures were changes in plasma markers of vasodilative nitric oxide (S-nitrosoglutathione) and oxidative stress (8-isoprostane), and bioavailability of cocoa polyphenols. From baseline to 18 weeks, dark chocolate intake reduced mean (SD) systolic BP by -2.9 (1.6) mm Hg (P < .001) and diastolic BP by -1.9 (1.0) mm Hg (P < .001) without changes in body weight, plasma levels of lipids, glucose, and 8-isoprostane. Hypertension prevalence declined from 86% to 68%. The BP decrease was accompanied by a sustained increase of S-nitrosoglutathione by 0.23 (0.12) nmol/L (P < .001), and a dark chocolate dose resulted in the appearance of cocoa phenols in plasma. White chocolate intake caused no changes in BP or plasma biomarkers. Data in this relatively small sample of otherwise healthy individuals with above-optimal BP indicate that inclusion of small amounts of polyphenol-rich dark chocolate as part of a usual diet efficiently reduced BP and improved formation of vasodilative nitric oxide. clinicaltrials.gov Identifier: NCT00421499.
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Hetherington and Boyland (2007) have reported that gum chewing in the afternoon after lunch produced a significant reduction in subsequent snack intake, compared to the control condition. The objective of the present study was to verify this observation and to assess specific macronutrient intake and total caloric intake after having chewed gum as compared with intake in the control, no‐gum condition. After consuming a standard lunch, subjects chewed gum for 15 minutes hourly for 3 hours and then were tested in a modified version of our Macronutrient Self‐Selection Paradigm (MSSP). The MSSP consisted of 12 snack foods in which macronutrient content was varied significantly and systematically in a 2 (Fat factor: High Fat and Low Fat) X 2 (Carbohydrate Factor: High Sugar and High Complex Carbohydrate) design. Results showed that, in the gum condition, subjects specifically decreased their caloric intake of high‐sugar, snack foods in comparison with their intake in the no‐gum condition. Intake of the other foods presented in the MSSP did not differ between the two conditions. These results suggest that chewing gum may be effective in the control of intake of sweet snacks and thereby would be useful in weight management. Funding provided by a research grant from the Wrigley Science Institute.
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It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.
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Flavanol consumption is favorably associated with cognitive function. We tested the hypothesis that dietary flavanols might improve cognitive function in subjects with mild cognitive impairment. We conducted a double-blind, parallel arm study in 90 elderly individuals with mild cognitive impairment randomized to consume once daily for 8 weeks a drink containing ≈990 mg (high flavanols), ≈520 mg (intermediate flavanols), or ≈45 mg (low flavanols) of cocoa flavanols per day. Cognitive function was assessed by Mini Mental State Examination, Trail Making Test A and B, and verbal fluency test. At the end of the follow-up period, Mini Mental State Examination was similar in the 3 treatment groups (P=0.13). The time required to complete Trail Making Test A and Trail Making Test B was significantly (P<0.05) lower in subjects assigned to high flavanols (38.10±10.94 and 104.10±28.73 seconds, respectively) and intermediate flavanols (40.20±11.35 and 115.97±28.35 seconds, respectively) in comparison with those assigned to low flavanols (52.60±17.97 and 139.23±43.02 seconds, respectively). Similarly, verbal fluency test score was significantly (P<0.05) better in subjects assigned to high flavanols in comparison with those assigned to low flavanols (27.50±6.75 versus 22.30±8.09 words per 60 seconds). Insulin resistance, blood pressure, and lipid peroxidation also decreased among subjects in the high-flavanol and intermediate-flavanol groups. Changes of insulin resistance explained ≈40% of composite z score variability through the study period (partial r(2)=0.4013; P<0.0001). To the best of our knowledge, this is the first dietary intervention study demonstrating that the regular consumption of cocoa flavanols might be effective in improving cognitive function in elderly subjects with mild cognitive impairment. This effect appears mediated in part by an improvement in insulin sensitivity.
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It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.
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A growing body of evidence suggests that the consumption of foods rich in polyphenolic compounds, particularly cocoa, may have cardioprotective effects. No review, however, has yet examined the effect of flavonoid-rich cocoa (FRC) on all major cardiovascular risk factors or has examined potential dose-response relationships for these effects. A systematic review and meta-analysis of randomized, controlled trials was performed to evaluate the effect of FRC on cardiovascular risk factors and to assess a dose-response relationship. Inclusion and exclusion criteria as well as dependent and independent variables were determined a priori. Data were collected for: blood pressure, pulse, total cholesterol, HDL cholesterol, LDL cholesterol, TG, BMI, C-reactive protein, flow-mediated vascular dilation (FMD), fasting glucose, fasting insulin, serum isoprostane, and insulin sensitivity/resistance indices. Twenty-four papers, with 1106 participants, met the criteria for final analysis. In response to FRC consumption, systolic blood pressure decreased by 1.63 mm Hg (P = 0.033), LDL cholesterol decreased by 0.077 mmol/L (P = 0.038), and HDL cholesterol increased by 0.046 mmol/L (P = 0.037), whereas total cholesterol, TG, and C-reactive protein remained the same. Moreover, insulin resistance decreased (HOMA-IR: -0.94 points; P < 0.001), whereas FMD increased (1.53%; P < 0.001). A nonlinear dose-response relationship was found between FRC and FMD (P = 0.004), with maximum effect observed at a flavonoid dose of 500 mg/d; a similar relationship may exist with HDL cholesterol levels (P = 0.06). FRC consumption significantly improves blood pressure, insulin resistance, lipid profiles, and FMD. These short-term benefits warrant larger long-term investigations into the cardioprotective role of FRC.
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Reduced-calorie diets are difficult to follow because they often require elimination of certain foods, leading to poor compliance and limited success. However, a low-calorie, nutrient-dense diet has the potential to accommodate a daily snack without exceeding energy requirements, even during weight loss. This pilot study evaluated the effects of a reduced-calorie diet including either a daily dark chocolate snack or a non-chocolate snack on anthropometric and body composition measurements. In a randomized clinical trial, 26 overweight and obese (body mass index ≥25 to ≤43) premenopausal women were assigned to a reduced-calorie diet that included either a daily dark chocolate snack or non-chocolate snack (n=13 per group) for 18 weeks. At baseline and end of study, body weight and waist and hip circumferences were measured along with fat mass, lean mass, and body fat percentage by dual-energy x-ray absorptiometry. Energy and macronutrient intakes were estimated from 4-day food records. Within- and between-group changes from baseline were analyzed using paired t tests and independent t tests, respectively. Women in both snack groups reduced estimated daily energy intake (P<0.001). Women in both the dark chocolate snack and non-chocolate snack groups, respectively, experienced decreases (P<0.001) in body weight (-5.1 vs -5.1 kg), hip circumference (-5.8 vs -5.4 cm), waist circumference (-5.7 vs -3.5 cm), fat mass (-3.9 vs -3.6 kg), and body fat percentage (-3.4% vs -3.1%), with no change in lean mass. Improvements in anthropometric and body composition measurements among overweight and obese premenopausal women can be achieved with a reduced-calorie diet including either a daily dark chocolate snack or non-chocolate snack.
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Orosensory stimulation is an important contributing factor to the development of satiation. Providing orosensory stimulation with few calories may satisfy appetite and help to suppress cravings for high energy snacks. This may be a useful strategy for those motivated to lose or maintain weight. The present study tested the hypothesis that chewing sweetened gum will reduce subjective appetite and subsequent snack intake in moderately restrained eaters. Within-subjects, repeated measures study, sixty healthy participants (53 women; body mass index, in kg/m(2): 26.2±4.5) came to the laboratory 4 times for a standard lunch. Immediately after this meal, participants rated hunger, appetite and cravings for sweet and salty snacks every hour until they returned to the laboratory 3 h later for snack. On two occasions during this 3 h period participants chewed gum for at least 15 min at hourly intervals (45 min) and on two occasions no gum was chewed. On two occasions salty snacks were offered and on two occasions sweet snacks were provided. A small but significant reduction in snack intake was observed, chewing gum reduced weight of snack consumed by 10% compared to no gum (p<0.05). Overall, chewing gum for at least 45 min significantly suppressed rated hunger, appetite and cravings for snacks and promoted fullness (p<0.05). This study demonstrated some benefit of chewing gum which could be of utility to those seeking an aid to appetite control.
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Unlabelled: Gum chewing has been shown to improve cognitive performance in adults; however, gum chewing has not been evaluated in children. This study examined the effects of gum chewing on standardized test scores and class grades of eighth grade math students. Math classes were randomized to a gum chewing (GC) condition that provided students with gum during class and testing, or a control condition with no gum (NGC). Participants included 108 students. The math sections of the Texas Assessment of Knowledge and Skills (TAKS) and the Woodcock Johnson III Tests of Achievement (WJ-III), and math class grades were used to assess academic performance. Students in the gum chewing condition improved standardized test scores and maintained higher grades in math class compared to those in the no-gum chewing condition. These results are encouraging as gum chewing may be a cost-effective and easily implemented method to increase student performance. Trial registration: NCT00792116.
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There is limited research examining the relationship of candy consumption by adults on diet and health. The purpose of this study was to determine total, chocolate, or sugar candy consumption and their effect on energy, saturated fatty acid and added sugar intake, weight, risk factors for cardiovascular disease, metabolic syndrome (MetS), and diet quality in adults 19 years and older (n = 15,023) participating in the 1999-2004 National Health and Nutrition Examination Survey. Twenty-four-hour dietary recalls were used to determine intake. Covariate-adjusted means ± SE and prevalence rates were determined for candy consumption groups. Odds ratios were used to determine the likelihood of cardiovascular risk factors and MetS. A total of 21.8%, 12.9%, and 10.9% of adults consumed total, chocolate, and sugar candy, respectively. Mean daily per capita intake of total, chocolate, and sugar candy was 9.0 ± 0.3, 5.7 ± 0.2, and 3.3 ± 0.2 g, respectively; intake in consumers was 38.3 ± 1.0, 39.9 ± 1.1, and 28.9 ± 1.3 g, respectively. Energy (9973 ± 92 vs 9027 ± 50 kJ; P < .0001), saturated fatty acid (27.9 ± 0.26 vs 26.9 ± 0.18 g; P = .0058), and added sugar (25.7 ± 0.42 vs 21.1 ± 0.41 g; P < .0001) intake were higher in candy consumers than nonconsumers. Body mass index (27.7 ± 0.15 vs 28.2 ± 0.12 kg/m(2); P = .0092), waist circumference (92.3 ± 0.34 vs 96.5 ± 0.29 cm; P = .0051), and C-reactive protein (0.40 ± 0.01 vs 0.43 ± 0.01 mg/dL; P = .0487) levels were lower in candy consumers than nonconsumers. Candy consumers had a 14% decreased risk of elevated diastolic blood pressure (P = .0466); chocolate consumers had a 19% decreased risk of lower high-density lipoprotein cholesterol (P = .0364) and a 15% reduced risk of MetS (P = .0453). Results suggest that the current level of candy consumption was not associated with health risks.
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A 2-day forum was convened to (1) discuss ways to translate the 2009 American Heart Association added sugars recommendations into actions in areas such as regulation, food labeling, nutrient content claims, and practical application in the American diet; (2) review surveillance methodology and metrics for tracking and understanding the impact of reducing added sugars in the diet; and (3) initiate the development of a framework for future collaboration to help Americans implement science-based guidance relative to added sugars. More than 100 multinational participants representing scientists from academia and government and stakeholders engaged in food production, development, and processing, food manufacturing and servicing, food and nutrition policy, and nutrition recommendations for the public attended the conference. Presentations included definitions and examples of added sugars, current US and international added sugars perspectives, added sugars in diets of individuals and in the food supply, food technology behind added sugars, added sugars and health, food manufacturer perspectives, added sugars food-labeling considerations, and examples of positive approaches to improve eating behaviors and the food environment. Facilitated breakout sessions were conducted after the plenary sessions to allow participants to contribute their expertise and thoughts. The American Heart Association Added Sugars Conference is the first step in an important process that facilitates collaboration across science, public health, and industry to foster innovation, partnerships, policy, and implementation of new products and services for the benefit of the health and well-being of the American public. Science has advanced in the area of added sugars and health, creating mounting pressure to use better methods for translation and dissemination of the science for consumer education and for food companies to respond by producing foods and beverages with fewer added sugars. The new science also reinforces the importance of preventing, rather than simply treating diseases, especially overweight and obesity, diabetes mellitus, high blood pressure, heart disease, and stroke. Reducing added sugars consumption is a good target for addressing obesity, along with other sources of excess calories. However, the potential unintended consequences of substituting added sugars with ingredients that may not reduce calories and of increasing other macronutrients or food groups that may not result in a net health gain must be considered. Although there are many challenges to incorporating added sugars to the food label as was discussed during the conference, disclosure of added sugars content on food and beverage labels is an essential element in consumer education and can provide the information and motivation for making healthier food choices. This conference demonstrated the value of interactive dialogue among multiple sectors and disciplines. More disciplines should be at the table to bring expertise to discuss cross-cutting issues related to public policies and offer diverse insights to finding a solution.
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Randomized clinical trials have shown that chocolate intake reduces systolic and diastolic blood pressure, and observational studies have found an inverse association between chocolate intake and cardiovascular disease. The aim of this study was to investigate the association between chocolate intake and incidence of heart failure (HF). We conducted a prospective cohort study of 31,823 women aged 48 to 83 years without baseline diabetes or a history of HF or myocardial infarction who were participants in the Swedish Mammography Cohort. In addition to answering health and lifestyle questions, participants completed a food-frequency questionnaire. Women were followed from January 1, 1998, through December 31, 2006, for HF hospitalization or death through the Swedish inpatient and cause-of-death registers. Over 9 years of follow-up, 419 women were hospitalized for incident HF (n=379) or died of HF (n=40). Compared with no regular chocolate intake, the multivariable-adjusted rate ratio of HF was 0.74 (95% CI, 0.58 to 0.95) for women consuming 1 to 3 servings of chocolate per month, 0.68 (95% CI, 0.50 to 0.93) for those consuming 1 to 2 servings per week, 1.09 (95% CI, 0.74 to 1.62) for those consuming 3 to 6 servings per week, and 1.23 (95% CI, 0.73 to 2.08) for those consuming ≥1 servings per day (P=0.0005 for quadratic trend). In this population, moderate habitual chocolate intake was associated with a lower rate of HF hospitalization or death, but the protective association was not observed with intake of ≥1 servings per day.
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While a diet rich in anti-oxidant has been favorably associated with coronary disease and hypertension, limited data have evaluated the influence of such diet on subclinical disease. Thus, we sought to examine whether chocolate consumption is associated with calcified atherosclerotic plaque in the coronary arteries (CAC). In a cross-sectional design, we studied 2217 participants of the NHLBI Family Heart Study. Chocolate consumption was assessed by a semi-quantitative food frequency questionnaire and CAC was measured by cardiac CT. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. There was an inverse association between frequency of chocolate consumption and prevalent CAC. Odds ratios (95% CI) for CAC were 1.0 (reference), 0.94 (0.66-1.35), 0.78 (0.53-1.13), and 0.68 (0.48-0.97) for chocolate consumption of 0, 1-3 times per month, once per week, and 2+ times per week, respectively (p for trend 0.022), adjusting for age, sex, energy intake, waist-hip ratio, education, smoking, alcohol consumption, ratio of total-to-HDL-cholesterol, non-chocolate candy, and diabetes mellitus. Controlling for additional confounders did not alter the findings. Exclusion of subjects with coronary heart disease or diabetes mellitus did not materially change the odds ratio estimates but did modestly decrease the overall significance (p = 0.07). These data suggest that chocolate consumption might be inversely associated with prevalent CAC.
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High intakes of dietary sugars in the setting of a worldwide pandemic of obesity and cardiovascular disease have heightened concerns about the adverse effects of excessive consumption of sugars. In 2001 to 2004, the usual intake of added sugars for Americans was 22.2 teaspoons per day (355 calories per day). Between 1970 and 2005, average annual availability of sugars/added sugars increased by 19%, which added 76 calories to Americans' average daily energy intake. Soft drinks and other sugar-sweetened beverages are the primary source of added sugars in Americans' diets. Excessive consumption of sugars has been linked with several metabolic abnormalities and adverse health conditions, as well as shortfalls of essential nutrients. Although trial data are limited, evidence from observational studies indicates that a higher intake of soft drinks is associated with greater energy intake, higher body weight, and lower intake of essential nutrients. National survey data also indicate that excessive consumption of added sugars is contributing to overconsumption of discretionary calories by Americans. On the basis of the 2005 US Dietary Guidelines, intake of added sugars greatly exceeds discretionary calorie allowances, regardless of energy needs. In view of these considerations, the American Heart Association recommends reductions in the intake of added sugars. A prudent upper limit of intake is half of the discretionary calorie allowance, which for most American women is no more than 100 calories per day and for most American men is no more than 150 calories per day from added sugars.
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A priority for research is to identify individuals early in development who are particularly susceptible to weight gain in the current, obesogenic environment. This longitudinal study investigated whether early individual differences in inhibitory control, an aspect of temperament, predicted weight outcomes and whether parents' restrictive feeding practices moderated this relation. Participants included 197 non-Hispanic white girls and their parents; families were assessed when girls were 5, 7, 9, 11, 13, and 15 years old. Measures included mothers' reports of girls' inhibitory control levels, girls' reports of parental restriction in feeding, girls' body mass indexes (BMIs), and parents' BMIs, education, and income. Girls with lower inhibitory control at age 7 had higher concurrent BMIs, greater weight gain, higher BMIs at all subsequent time points, and were 1.95 times more likely to be overweight at age 15. Girls who perceived higher parental restriction exhibited the strongest inverse relation between inhibitory control and weight status. Variability in inhibitory control could help identify individuals who are predisposed to obesity risk; the current findings also highlight the importance of parenting practices as potentially modifiable factors that exacerbate or attenuate this risk.
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We propose a self-control analysis of the role of availability in valuation. We explored the hypothesis that, when temptation becomes available, counteractive self-control processes render it less valuable. We found evidence for devaluation of available temptation among gym users before they choose to forgo an unhealthy snack rather than after they make their choice (Study 1), and among students evaluating leisure activities when their decision to enroll in an uninteresting class is reversible rather than irreversible (Study 2).
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The authors conducted a systematic review of original studies that was designed to assess the impact of polyol-containing chewing gum on dental caries compared with the effect with no chewing gum. The authors searched MEDLINE, The Cochrane Library and Google Scholar up to May 2008 to identify peer-reviewed articles that compared polyol-containing chewing gum with no chewing gum. The authors extracted study characteristics, data on incremental dental caries and quality by consensus. Data on prevented fraction (PF) were pooled across studies. The results of 19 articles with data from 14 study populations showed that the use of xylitol, xylitol-sorbitol blend and sorbitol were associated with mean PF (95 percent confidence interval) of 58.66 percent (35.42-81.90), 52.82 percent (39.64-66.00) and 20.01 percent (12.74-27.27), respectively. For the sorbitol-mannitol blend, it was 10.71 percent (-20.50-41.93), which was not statistically significant. Sensitivity analyses confirmed the robustness of the findings. Although research gaps exist, particularly on optimal dosing and relative polyol efficacy, research evidence supports using polyol-containing chewing gum as part of normal oral hygiene to prevent dental caries.
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Dark chocolate (DC) is one of the richest sources of flavonoids. Since DC has been demonstrated to have beneficial effects on the cardiovascular system, our study examined its effect on platelet reactivity, inflammation, and lipid levels in healthy subjects. In 28 healthy volunteers, we analyzed the effect of one week of DC (providing 700 mg of flavonoids/day). The primary outcome was to determine the effects of DC consumption on platelet activity measured by flow cytometry (adenosine diphosphate [ADP]- and arachidonic acid [AA]-induced total and activated glycoprotein (GP) IIb/IIIa as well as P-selectin expression). In addition to this, we measured the effect of DC on high-sensitivity C-reactive protein (hsCRP), high-density lipid cholesterol (HDL) and low-density lipid cholesterol (LDL) levels. Following seven days of regular DC ingestion, LDL fell by 6% (120 +/- 38 vs 112 +/- 37 mg/dL, P < 0.018) and HDL rose by 9% (66 +/- 23 vs 72 +/- 26 mg/dL, P < 0.0019). ADP- and AA-induced activated GPIIb/IIIa expression was reduced by DC [27.3 +/- 27.8 vs 17.4 +/- 20.5 mean fluorescence intensity (MFI), P < 0.006; and 9.2 +/- 6.5 vs. 6.1 +/- 2.2 MFI, P < 0.005, respectively]. DC reduced hsCRP levels in women (1.8 +/- 2.1 vs. 1.4 +/- 1.7 mg/dL, P < 0.04). One week of DC ingestion improved lipid profiles and decreased platelet reactivity within the total group while reducing inflammation only in women. Regular dark chocolate ingestion may have cardioprotective properties. Further long-term research is warranted to evaluate the effect of flavonoids on cardiovascular health and to determine whether DC's beneficial effects are related to flavonoids or some yet unknown component. This research is based on a larger study which was presented at the American Heart Association Scientific Sessions 2007.
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It is the position of the American Dietetic Association that all foods can fit into a healthful eating style. The ADA strives to communicate healthful eating messages to the public that emphasize the total diet, or overall pattern of food eaten, rather than any one food or meal. If consumed in moderation with appropriate portion size and combined with regular physical activity, all foods can fit into a healthful diet. Public policies that support the total diet approach include Reference Dietary Intakes, Food Guide Pyramid, Dietary Guidelines for Americans, Nutrition Labeling and Healthy People 2010. The value of a food should be determined within the context of the total diet because classifying foods as "good" or "bad" may foster unhealthy eating behaviors. Eating practices are influenced by taste and food preferences, concerns about nutrition and weight control, physiology, lifestyle, environment, and food product safety. To increase the effectiveness of nutrition education in promoting sensible food choices, dietetics professionals plan communications and educational programs that utilize theories and models related to human behavior. Communication campaigns/programs should implement an active, behaviorally focused approach within the larger context of food choices. Nutrition confusion can be reduced by emphasizing moderation, appropriate portion size, balance and adequacy of the total diet over time, the importance of obtaining nutrients from foods, and physical activity.
Article
Consumption of flavanol-rich dark chocolate (DC) has been shown to decrease blood pressure (BP) and insulin resistance in healthy subjects, suggesting similar benefits in patients with essential hypertension (EH). Therefore, we tested the effect of DC on 24-hour ambulatory BP, flow-mediated dilation (FMD), and oral glucose tolerance tests (OGTTs) in patients with EH. After a 7-day chocolate-free run-in phase, 20 never-treated, grade I patients with EH (10 males; 43.7+/-7.8 years) were randomized to receive either 100 g per day DC (containing 88 mg flavanols) or 90 g per day flavanol-free white chocolate (WC) in an isocaloric manner for 15 days. After a second 7-day chocolate-free period, patients were crossed over to the other treatment. Noninvasive 24-hour ambulatory BP, FMD, OGTT, serum cholesterol, and markers of vascular inflammation were evaluated at the end of each treatment. The homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and insulin sensitivity index (ISI) were calculated from OGTT values. Ambulatory BP decreased after DC (24-hour systolic BP -11.9+/-7.7 mm Hg, P<0.0001; 24-hour diastolic BP -8.5+/-5.0 mm Hg, P<0.0001) but not WC. DC but not WC decreased HOMA-IR (P<0.0001), but it improved QUICKI, ISI, and FMD. DC also decreased serum LDL cholesterol (from 3.4+/-0.5 to 3.0+/-0.6 mmol/L; P<0.05). In summary, DC decreased BP and serum LDL cholesterol, improved FMD, and ameliorated insulin sensitivity in hypertensives. These results suggest that, while balancing total calorie intake, flavanols from cocoa products may provide some cardiovascular benefit if included as part of a healthy diet for patients with EH.
Article
The relation between being deprived of a food and intake and craving for that food was investigated in restrained and unrestrained eaters. For 1 week, 103 female undergraduate students were assigned to be chocolate deprived, vanilla deprived, or nondeprived. Only chocolate deprivation was expected to elicit cravings, as chocolate is not easily substituted, whereas vanilla is. The main effect of chocolate deprivation on consumption was qualified by an interaction with restraint. Chocolate-deprived restrained eaters consumed more chocolate food than did any other group. Restrained eaters experienced more food cravings than did unrestrained eaters and were more likely to eat the craved food. Moreover, restrained eaters deprived of chocolate spent the least time doing an anagram task before a "taste-rating task" in which they expected that chocolate foods might be available. Converging measures of craving indicate that deprivation causes craving and overeating, but primarily in restrained eaters.
Article
There is growing interest in possible beneficial effects of specific dietary components on cardiovascular health. Platelets and leukocytes contribute to arterial thrombosis and to inflammatory processes. Previous studies performed in vitro have demonstrated inhibition of platelet function by (-)-epicatechin and (+)-catechin, flavan-3-ols (flavanols) that are present in several foods including some cocoas. Also, some modest inhibition of platelet function has been observed ex vivo after the consumption of flavanol-containing cocoa products by healthy adults. So far there are no reports of effects of cocoa flavanols on leukocytes. This paper summarizes 2 recent investigations. The first was a study of the effects of cocoa flavanols on platelet and leukocyte function in vitro. The second was a study of the effects of consumption of a flavanol-rich cocoa beverage by healthy adults on platelet and leukocyte function ex vivo. Measurements were made of platelet aggregation, platelet-monocyte conjugate formation (P/M), platelet-neutrophil conjugate formation (P/N), platelet activation (CD62P on monocytes and neutrophils), and leukocyte activation (CD11b on monocytes and neutrophils) in response to collagen and/or arachidonic acid. In the in vitro study several cocoa flavanols and their metabolites were shown to inhibit platelet aggregation, P/M, P/N, and platelet activation. Their effects were similar to those of aspirin and the effects of a cocoa flavanol and aspirin did not seem to be additive. There was also inhibition of monocyte and neutrophil activation by flavanols, but this was not replicated by aspirin. 4'-O-methyl-epicatechin, 1 of the known metabolites of the cocoa flavanol (-)-epicatechin, was consistently effective as an inhibitor of platelet and leukocyte activation. The consumption of a flavanol-rich cocoa beverage also resulted in significant inhibition of platelet aggregation, P/M and P/N, and platelet activation induced by collagen. The inhibitory effects were related to their flavanol content. There was also inhibition of monocyte and neutrophil activation, but here it was concluded that cocoa constituents other than flavanols may contribute to the inhibition that was observed. It can be concluded that cocoa flavanols, their metabolites and possibly other cocoa constituents can modulate the activity of platelets and leukocytes in vitro and ex vivo. The research suggests that the consumption of certain cocoa products may provide a dietary approach to maintaining or improving cardiovascular health.
Article
Consumers report that chewing gum can reduce cravings and the likelihood of snacking. The present study set out to examine the effects of chewing gum on subjective appetite and snack energy intake (EI) in 60 participants (40 females, 20 males, 21.7+/-4 years; BMI=22.7+/-3.4) who came to the laboratory four times for lunch and then returned 3 h later for a snack. Participants consumed salty or sweet snacks after chewing gum (sugar-free or regular) for 15 min hourly after lunch or had no-gum. Hunger, desire to eat and fullness were rated immediately after lunch (T0) and hourly post-lunch (T1 and T2) until just before snack (T3). Chewing gum reduced EI by 36 cal (401.8+/-22 kcal) compared to no-gum (437.7+/-23 kcal; p=0.04). Rated hunger increased from T0 to T3 (p<0.001); however, this was less after gum compared to no-gum (p<0.01). Desire to consume salty and sweet snacks also increased. However, desire to eat sweet snacks (but not salty) increased less after gum compared to no-gum (p=0.004). Therefore, chewing gum suppressed appetite, specifically desire for sweets and reduced snack intake. This supports anecdotal reports by consumers and could inform weight control strategies.
Article
A single-dose ingestion of flavanol-rich cocoa acutely reverses endothelial dysfunction. To investigate the time course of endothelial function during daily consumption of high-flavanol cocoa, we determined flow-mediated dilation (FMD) acutely (for up to 6 hours after single-dose ingestion) and chronically (administration for 7 days). The study population represented individuals with smoking-related endothelial dysfunction; in addition to FMD, plasma nitrite and nitrate were measured. The daily consumption of a flavanol-rich cocoa drink (3 x 306 mg flavanols/d) over 7 days (n=6) resulted in continual FMD increases at baseline (after overnight fast and before flavanol ingestion) and in sustained FMD augmentation at 2 hours after ingestion. Fasted FMD responses increased from 3.7 +/- 0.4% on day 1 to 5.2 +/- 0.6%, 6.1 +/- 0.6%, and 6.6 +/- 0.5% (each P < 0.05) on days 3, 5, and 8, respectively. FMD returned to 3.3 +/- 0.3% after a washout week of cocoa-free diet (day 15). Increases observed in circulating nitrite, but not in circulating nitrate, paralleled the observed FMD augmentations. The acute, single-dose consumption of cocoa drinks with 28 to 918 mg of flavanols led to dose-dependent increases in FMD and nitrite, with a maximal FMD at 2 hours after consumption. The dose to achieve a half-maximal FMD response was 616 mg (n=6). Generally applied biomarkers for oxidative stress (plasma, MDA, TEAC) and antioxidant status (plasma ascorbate, urate) remained unaffected by cocoa flavanol ingestion. The daily consumption of flavanol-rich cocoa has the potential to reverse endothelial dysfunction in a sustained and dose-dependent manner.
Article
We hypothesized that chocolate preference would be related to health and psychological well-being in old men. We have followed up a socio-economically homogenous group of men, born in 1919-1934, since the 1960s. In 2002-2003, a mailed questionnaire was used to assess the health and well-being (including questions related to positive life orientation, visual analogue scales and the Zung depression score) of survivors. In addition, candy preference was inquired. Those men who reported no candy consumption (n=108) were excluded from the analyses. Psychological well-being in old age. The response rate was 69% (1367 of 1991). Of the respondents, 860 and 399 preferred chocolate and other type of candy, respectively. The average age in both candy groups was 76 years. Of the respondents, 99% were home-dwelling, 96% were retired and 87% were presently married, without differences between the candy groups. Men preferring chocolate had lower body mass index and waist circumference, and they also reported more exercise and better subjective health (P=0.008) than other candy consumers. Variables related to psychological well-being were consistently better in those preferring chocolate. The differences were statistically significant in feeling of loneliness (P=0.01), feeling of happiness (P=0.01), having plans for the future (P=0.0002) and the Zung depression score (P=0.02). In this socioeconomically homogenous male cohort, chocolate preference in old age was associated with better health, optimism and better psychological well-being. The Academy of Finland, the Päivikki and Sakari Sohlberg Foundation, the Helsinki University Central Hospital and the Finnish Foundation for Cardiovascular Research.
Article
Perceived deprivation describes a feeling of not eating what or as much as one would like, despite being in energy balance. This construct was previously found to correlate with the Restraint Scale in obese binge eaters and current dieters [Timmerman, G. M., & Gregg, E. K. (2003). Dieting, perceived deprivation, and preoccupation with food. Western Journal of Nursing Research, 25(4), 405-418]. The current study examined perceived deprivation and restraint in 66 normal weight college females with no history of eating disorders. Perceived deprivation was significantly correlated with restraint generally and with dietary concern in particular; this relationship was due to perceived limits on what, rather than how much, food was eaten. This relationship may have important implications for understanding the motivation underlying restrained eaters' aberrant eating behaviors and the nature of their susceptibility to weight gain.
The impact of polyol-containing chewing gums on dental caries: a systematic review of original randomized controlled trials and observational studies.
  • Deshpande