title: Confectionery consumption and overweight, obesity, and related outcomes in children and adolescents: a systematic review and meta-analysis.
abstract: BACKGROUND
  Many calorie-rich dietary components contribute to obesity. However, the contribution of confectionery to obesity in children and adolescents has not been well established.
  
  
  OBJECTIVE
  In this systematic review and meta-analysis, we hypothesized that higher total, chocolate, and nonchocolate confectionery consumption would be associated with higher odds of overweight, obesity, and other obesity-related outcomes [body mass index (BMI), BMI z score, body composition, waist circumference, and percentage body fat] in children and adolescents.
  
  
  METHODS
  We searched Scopus, PubMed, and reference lists of pertinent reviews, supplemented by expert contact, for randomized controlled trials (RCTs) and observational studies published between 1990 and 31 March 2015, and we conducted separate meta-analyses for categorical and continuous ORs and for total, chocolate, and nonchocolate confectioneries with the use of a random-effects model.
  
  
  RESULTS
  A total of 19 studies were included in the systematic review, and the cross-sectional results of 11 studies (∼177,260 participants) were included in the meta-analysis. In the meta-analysis, which examined the combined outcome of overweight and obesity, the odds of overweight or obesity were 18% lower (OR: 0.82; 95% CI: 0.69, 0.97) for subjects in the highest category of consumption than for a reference category of consumption. Thus, a 1-time/wk or a 1-U increase in consumption was associated with a 13% (OR: 0.87; 95% CI: 0.85, 0.88) decrease in the odds of overweight or obesity. Associations were similarly inverse for chocolate and nonchocolate confectioneries. In the longitudinal studies and the RCT included in the review, no associations were observed between confectionery consumption and overweight, obesity, or obesity-related outcomes.
  
  
  CONCLUSIONS
  Instead of overweight and obese children and adolescents having higher confectionery intakes, this review shows the reverse effect. This result might reflect a true inverse association, reverse causality, or differential underreporting in heavier individuals. Interventions may need to focus on dietary elements other than confectionery to tackle obesity.
authors.affiliation: The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; and constantine.gasser@mcri.edu.au.
authors.forename: Constantine E
authors.identifier: http://orcid.org/0000-0002-7826-5717
authors.initials: CE
authors.lastname: Gasser
authors.affiliation: The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; and The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Fiona K
authors.initials: FK
authors.lastname: Mensah
authors.affiliation: The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; and.
authors.forename: Melissa
authors.initials: M
authors.lastname: Russell
authors.affiliation: The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; and.
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Dunn
authors.affiliation: The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia; and The Royal Children's Hospital, Melbourne, Australia.
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
mesh_terms: D000293:Adolescent; D001823:Body Composition; D015992:Body Mass Index; D002182:Candy / Q000009:adverse effects*; D002648:Child; D002149:Energy Intake; D006801:Humans; D064887:Observational Studies as Topic; D050177:Overweight / Q000453:epidemiology*; D063766:Pediatric Obesity / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D055105:Waist Circumference
keywords: adolescent; candy; child; obesity; overweight