by Marion Nestle

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Apr 11 2016

The strange story of my accepted but yet-to-be published commentary on a Disney-sponsored study gets stranger

Last week, StatNews.com revealed that the Walt Disney company tried to withdraw a research study it had funded because its University of Colorado authors, Jim Hill and John Peters, were behind the Global Energy Balance Network, the group funded by Coca-Cola to minimize the role of sugary drinks in obesity.

The headline: “Disney, fearing a scandal, tried to press journal to withdraw research paper.”

StatNews.com based the story on e-mails obtained from the University of Colorado by Gary Ruskin of US Right to Know through open records requests.

An e-mail from John Peters to a Disney representative says “could I ask you to look this [draft press release] over and edit as you see fit.”

But the authors’ conflict-of-interest disclosure statement says:

This work was supported by the Walt Disney Company and by the National Institutes of Health (grant no. DK48520). The Walt Disney Company and the National Institutes of Health had no role in the design, analysis, or writing of this article.

This may be strictly true, but the authors were asking Disney to approve their press release, which is not exactly “no role.”

Readers: does any of this sound familiar?  In February, I wrote a blog post about precisely this article for which I wrote an invited Commentary, accepted by the journal but not published.  I said:

The paper turned out to be by a group of authors, among them John Peters and Jim Hill, both members of the ill-fated Global Energy Balance Network, the subject of an investigation by the New York Times last August…I thought Disney’s sponsorship of this research and its withholding of critical baseline and sales data on kids’ meals that the company considered proprietary did indeed deserve comment, and wrote my piece accordingly.  Brian Wansink [the journal editor] soon accepted it for publication but to my surprise, gave it to Peters et al. for rebuttal.  They filed a lengthy response.  I was then given the opportunity to respond, and did so, briefly.

My Commentary—and the back-and-forth—were omitted (although they are online and will be published in a later issue, apparently).

Brian Wansink wrote colleagues who are editing the next issue of the journal that the back-and-forth debate over the article “was heated, and it also dragged on (because of Disney approvals) and – as we feared – it missed the deadline of our issue.”

This suggests that Disney had even more of an involvement, but when I asked Wansink if Disney approvals were responsible for his having dropped my Commentary, he said no, they just ran out of room.

We now know that Disney was more involved than disclosed.  How involved?  We dont know but perhaps other e-mails will surface to answer that question.

In their Rebuttal to my Commentary, Hill and Peters said

We were disappointed by Dr. Nestle’s assertion that Disney’s decision to not allow publication of kid’s park attendance numbers or raw kid’s meal sales numbers (because of their proprietary nature in the competitive business of theme parks) and the fact that Disney funded the study raises “red flags” about the veracity of the data presented…While we believe caution and transparency are always key ingredients when working with industry we also believe that solving the obesity problem will require finding a productive model for working together that can channel everyone’s energy toward finding solutions.  The Disney study is a good example of why partnering with industry can help move the field forward.

I am sorry I disappointed them, but I disagree.

The e-mails demonstrate even more forcefully that the Disney study is a good example of why partnering with industry should raise acres of red flags.

To repeat my response:

The response from Peters and Hill still fails to acknowledge the severity of the problems posed by Disney’s sponsorship of their research—the company’s failure to produce data essential for proper interpretation of study results, and the level to which sponsorship by food companies biases such interpretations.  At one point, Disney boasted of the results of this research, confirming its benefit to marketing goals.  The threat of industry sponsorship to research credibility has received considerable press attention in recent months, as must surely be known to these authors. [References one and two]. 

Because of Disney’s funding, the company must have thought it had the right to determine whether and how its funded study would be published.  And, as these e-mails reveal, therein lies the problem.

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Apr 7 2016

Sponsored research: raspberries this time

This morning, I received a query from a scientist:

I have been following your documentation of industry-funded research on health benefits. I’ve been thinking about this issue from the perspective of fruits and vegetables. We know that they are good in general, but how does one fund research to demonstrate that clinically? In particular, how does one get specific about the form and amount that his helpful for specific health benefits?  You may be interested in this press release from the raspberry industry telling about the papers at the Society for Experimental Biology meetings that are relevant to the health benefits of eating raspberries. This seems to be approaching what a good model might look like. I’m interested in your perspective. Furthermore, are the results relevant to nutritionists?

Here’s how I answered it:

Thanks for sending.  I guess my question would be something along the lines of why getting specific about form and amount of specific fruits and vegetables is important for public health.  People don’t eat just raspberries.  They put them in cereal or on desserts.  Raspberries are expensive.  Wealthy, educated and, therefore, healthy people are likely to consume them.  So this looks like marketing research to me—selling raspberries as a superfood.  If you think there is a special benefit to raspberries and that it would be good to quantify it, the best strategy would be to get the research funded by an independent agency.  Otherwise, it’s clearly marketing research (hence the press release).   At least that’s how I see it.

This, of course, gets us back to the question of sponsored research which, as my collection of sponsored studies has shown, almost inevitably produce results favorable to the sponsor.  I love raspberries and don’t doubt for a minute that they are healthy, but a superfood?  I don’t think so.

I’m still working on the descriptive analysis of the year’s collection of sponsored studies.  I will also be giving more thought to such questions, so send them along.

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Apr 4 2016

The Guardian: my thoughts on food companies’ taking out the negatives

Here’s my piece from The Guardian, April 2, 2016.

No amount of ‘free from’ labelling will make processed food good for you
Campbell’s is phasing BPA out of its cans. That, and GMO-labelling initiatives, are all great, but canned foods still aren’t fresh, local or sustainable

Americans these days don’t want artificial and unsustainably produced ingredients in the food they buy and eat. For the makers of highly processed foods – ultraprocessed in today’s terminology – there isn’t a lot that they can do to make the products appear fresh and natural.

But Campbell’s is certainly trying. A few months after announcing that it will phase out genetically modified organisms (GMOs), the iconic soup company said on Friday that it will remove Bisphenol-A (BPA) from its cans by next year.

BPA, you will recall, is a chemical typically used in polycarbonate plastic containers and in the epoxy linings of food cans. It’s also an endocrine disrupter, which means it can interfere with the work our hormones are doing. Some research finds BPA to have effects on childhood development and reproduction.

Although the FDA doesn’t believe evidence of potential harm is sufficient to ban BPA from the food supply, the agency discourages use of BPA-polycarbonate or epoxy resins in baby bottles, sippy cups or packaging for infant formulas. For the past year or so, other retailers have been working hard to phase out BPA and to reassure customers that their cans and packages are safe.

All of these companies sell highly processed foods in an era when the public is demanding – and voting with their dollars – for fresh, natural, organic, locally grown and sustainably produced ingredients.

They can’t provide those things, but they can tout the bad, or unpopular, things that aren’t part of their product, the “no’s”: no unnatural additives, no artificial colors or flavors, no high fructose corn syrup, no trans fat, no gluten and, yes, no GMOs or BPA.

Let me add something about companies labeling their products GMO-free. In my view, the food biotechnology industry created this market – and greatly promoted the market for organics, which do not allow GMOs – by refusing to label which of its products contain GMOs and getting the FDA to go along with that decision. Whether or not GMOs are harmful, transparency in food marketing is hugely important to increasing segments of the public. People don’t trust the food industry to act in the public interest; transparency increases trust.

Vermont voted last year to mandate GMO labeling in the state – the US Senate rejected a bill in mid-March attempting to undermine it – and food conglomerates such as Campbell’s, General Mills, ConAgra, Kellogg and Mars have committed to labeling their products as containing GMO.

In addition to removing BPA from packaging and GMO from products, at least 11 other companies have announced recently that say they are phasing out as many artificial additives as possible, as quickly as they can.

Taco Bell, for example, will get rid of Yellow Dye #6, high fructose corn syrup, palm oil and artificial preservatives, and replace them with “natural” ingredients. Huge food companies such as Kraft, Nestlé (no relation) and General Mills are heading in the same direction.

All this may well benefit consumers to an extent. It also makes perfect sense from a business perspective: the “no’s” sell. But what everyone needs to remember is that foods labeled “free from” still have calories and may well contain excessive salt and sugars. The healthiest diets contain vegetables and lots of other relatively unprocessed foods. No amount of subtraction from highly processed foods is going to change that.

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Mar 31 2016

What do Americans eat? It’s hard to say.

I’ve just received a new report from USDA’s Economic Research Service, U.S. Food Commodity Consumption Broken Down by Demographics.  This looks at trends in per capita food availability—the amounts of specific foods available in the food supply, obtained from data on production and imports, from 1994 to 2008, corrected for waste, per person in the United States.

Food availability data, especially when corrected for waste, suggest trends in per capita consumption patterns (otherwise why would USDA bother to collect them?), but they are not consumption data.  They are about supply, not use.

With that said, the trends seem odd to me.  They demonstrate a decline in the availability of:

  • Fruit (mainly oranges)
  • Vegetables
  • Dairy (mainly milk)
  • Beef
  • Pork
  • Potatoes
  • Sugars

The supply of yogurt and cheese, however, has increased (but their per capita availability is relatively low).

The supply of apple juice also has increased:

Capture

Food availability data corrected for waste are supposed to come close to what people actually eat.  But if people are eating less of practically all foods, how come so many of us are still gaining weight?  Surely it’s not because of apple juice.

These data are an important source of information on U.S. dietary patterns.

But what do they mean?  The authors do not say, so it’s left to us to figure that out.

As I keep saying, finding out what people eat is the single most intellectually challenging problem in the field of nutrition.

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Mar 25 2016

Weekend reading: Concentration and Power in the Food System

Philip H. Howard. Concentration and Power in the Food System: Who Controls What We Eat?  Bloomsbury, 2016.

I don’t know Philip Howard personally but I have long appreciated his graphic visualizations of the extent of concentration—only a few companies owning fast percentages of the market—in various industries:

This brief book summarizes his work in developing these graphics and makes it clear why he thinks industrial concentration is a problem for American democracy.   Without competition, these companies get away with doing whatever they want.  He gives a few examples:

Walmart, which controls 33 percent of US grocery retailing, is challenged for exploiting its suppliers, taking advantage of taxpayer subsidies, and paying extremely low worker wages…Monsanto, which controls 26 percent of the global commercial seed market, is denounced for its influence on government polocies, spying on farmers it suspects of saving and replanting seeds, and the environmental impacts of herbicides tied to these seeds.  These impacts tend to disproportionately affect the disadvantaged—such as women, young children, recent immigrants, members of minority ethnic groups, and those of lower socioeconomic status—and as a result, reinforce existing inequalities…Like ownership relations, the full extent of these consequences may be hidden from public view.

Howard’s solution?  The food movement!

Joining these movements and supporting the alternatives created by others could therefore be essential to maintaining our ability to feed ourselves in the future.

The book is fun to read (“seed-industrial complex”) and, obviously, well illustrated.  If you want to know how current-day food markets really work, this is the place to start.

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Mar 24 2016

Beverage Daily’s Special Edition: Calorie-Cutting Initiatiatives

One of the newsletters I subscribe to, BeverageDaily.com, has a special edition—a collection of its articles—on what the industry is doing to address its biggest problem: reducing sugar.

What is the beverage industry doing to cut calories?

Health and wellness is at the forefront of consumers’ minds, and sugar gets plenty of bad press. Obesity is as big a concern as ever, and soft drinks are in the firing line.

What is the beverage industry doing to reduce calories? How are market leaders reformulating and revamping their portfolios; and what healthier brands are appearing?

From alternative sweeteners to packaging sizes, we look at what the industry is doing to cut calories – and how well these initiatives are working.

From reformulation to nutritional labeling, the non-alcoholic beverage industry has adopted a variety of strategies to reduce the calorie content of drinks. We look at how different strategies from around the world are being implemented. .. Read

You can see why the industry has a problem.  Sugar tastes good.  These other things not so much.

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Mar 18 2016

Six industry-funded studies. The score for the year: 156/12

Since March 16, 2015, I’ve been collecting research studies funded by industry or conducted by investigators with food industry connections.  These are studies that I’ve either run across in the course of my reading or that were sent to me by readers (thanks especially to Cole Adams).

It has now been a year since I started doing this.  If I have counted correctly, this somewhat haphazard collection comes to a grand total of 168 funded studies, 156 of them with results favorable to the sponsor’s interests, but only 12 industry-funded studies with unfavorable results.

That’s more than enough to make this point: it’s a lot easier to find industry-funded studies with results favorable to the sponsor’s interest than against it.

I will do a more accurate count and see what other conclusions, if any, can be drawn from this collection as soon as I can get to its analysis.

In the meantime, I’m stopping the collection.  From now on, I will only post sponsored studies that raise particular issues or that I find particularly amusing.

Here’s the last bunch:

Missing Lunch Is Associated with Lower Intakes of Micronutrients from Foods and Beverages among Children and Adolescents in the United States.  Kevin C. Mathias, PhD, Emma Jacquier, MMedSci, Alison L. Eldridge, PhD, RD.  DOI: http://dx.doi.org/10.1016/j.jand.2015.12.021.

  • Conclusions: This study identifies potential concerns for children missing lunch with respect to micronutrient intakes and shows that the lunches consumed by children in the United States are an important source of essential nutrients, but also less healthful dietary components.
  • Disclosures: All authors are employed by the Nestlé Research Center, Lausanne Switzerland (Nestec Ltd). Funding was provided by Nestec Ltd (Vevey, Switzerland) 

Higher-protein diets improve indexes of sleep in energy-restricted overweight and obese adults: results from 2 randomized controlled trials.  Jing Zhou, Jung Eun Kim, Cheryl LH Armstrong, Ningning Chen, and Wayne W Campbell.   Am J Clin Nutr March 2016;vol. 103 no. 3 766-774. doi: 10.3945/​ajcn.115.124669.

  • Conclusion: The consumption of a greater proportion of energy from protein while dieting may improve sleep in overweight and obese adults.
  • Disclosures: WWC was a member of the National Dairy Council Whey Protein Advisory Panel while the research was being conducted. The other authors reported no conflicts of interest related to the study.

A randomized trial of high-dairy-protein, variable-carbohydrate diets and exercise on body composition in adults with obesity.  Evelyn B. Parr, Vernon G. Coffey, Louise E. Cato, Stuart M. Phillips, Louise M. Burke andJohn A. Hawley. Obesity.  Article first published online: 2 MAR 2016.  DOI: 10.1002/oby.21451

  • Conclusions: Compared to a healthy control diet, energy-restricted high-protein diets containing different proportions of fat and CHO confer no advantage to weight loss or change in body composition in the presence of an appropriate exercise stimulus.
  • Funding agencies: Supported by a grant from the Dairy Health and Nutrition Consortium, Dairy Innovation Australia Ltd…to JAH, VGC, SMP, and LMB).  Disclosure: The authors declared no conflict of interest.

Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial.  Betsy Foxman, PhD; Anna E. W. Cronenwett, BA; Cathie Spino, DSc; Mitchell B. Berger, MD, PhD; Daniel M. Morgan, MD.  Am J Obstet Gynecol 2015;213:194.e1-8.

  • Conclusion: Among women undergoing elective benign gynecological surgery involving urinary catheterization, the use of cranberry extract capsules during the postoperative period reduced the rate of UTI by half.
  • Disclosure: The authors report no conflicts of interest… We also thank Theralogix, LLC (Rockville, MD) for providing cranberry juice capsules and placebo for use in this study.
  • Comment: With respect to herbal medications, JAMA says “Only the use of cranberry for prevention of recurrent urinary tract infections in women is supported by some scientific evidence.”  It does not say whether that evidence was obtained by cranberry or cranberry supplement producers.

Coffee Consumption Increases the Antioxidant Capacity of Plasma and Has No Effect on the Lipid Profile or Vascular Function in Healthy Adults in a Randomized Controlled Trial. Gloria M Agudelo-Ochoa, Isabel C Pulgar´ın-Zapata, Claudia M Velasquez-Rodriguez, ´  Mauricio Duque-Ramirez, Mauricio Naranjo-Cano, Monica M Quintero-Ortiz, Oscar J Lara-Guzman, and Katalina Munoz-Durango.  J Nutr 2016;146:524–31.

  • Conclusions: Both coffees, which contained CGAs [chlorogenic acids] and were low in diterpenes and caffeine, provided bioavailable CGAs and had a positive acute effect on the plasma AC [antioxidant capacity] in healthy adults and no effect on blood lipids or vascular function. The group that did not drink coffee showed no improvement in serum lipid profile, FMD [flow-mediated dilatation], BP [blood pressure], or NO [nitrous oxide] plasma metabolites.
  • Funding: Supported by Vidarium, Nutrition, Health and Wellness Research Center, Nutresa Business Group; CES University; and the University of Antioquia.
  • Author disclosures: GM Agudelo-Ochoa, IC Pulgarın-Zapata, OJ Lara-Guzman, ´ and K Munoz-Durango are researchers at Vidarium, Nutrition, Health and Wellness Research Center, Nutresa Business Group. M Naranjo-Cano and M Quintero-Ortiz are researchers at the Colcafe Research Coffee Group, Colcafe S.A.S. CM Velasquez-Rodrıguez and M Duque-Ramırez, no conflicts of interest.

Consumption of Fish Oil Providing Amounts of Eicosapentaenoic Acid and Docosahexaenoic Acid That Can Be Obtained from the Diet Reduces Blood Pressure in Adults with Systolic Hypertension: A Retrospective Analysis. Anne M Minihane, Christopher K Armah, Elizabeth A Miles, Jacqueline M Madden, Allan B Clark, Muriel J Caslake, Chris J Packard, Bettina M Kofler, Georg Lietz, Peter J Curtis, John C Mathers, Christine M Williams, and Philip C Calder.  J. Nutr. March 1, 2016 vol. 146 no. 3 516-523

  • Conclusions: These findings indicate that in adults with isolated systolic hypertension, daily doses of EPA+DHA as low as 0.7 g show clinically meaningful BP reductions, which, at a population level, could be associated with lower cardiovascular disease risk. Confirmation of findings in an RCT in which participants are prospectively recruited on the basis of BP status is required to draw definite conclusions.
  • Author disclosures: CK Armah, EA Miles, JM Madden, AB Clark, MJ Caslake, CJ Packard, BM Kofler, G Lietz, PJ Curtis, JC Mathers, and CM Williams, no conflicts of interest. AM Minihane is academic advisor for International Life Sciences Institute (ILSI) Europe Obesity and Diabetes Task Force and receives funding from Abbott Nutrition, USA. PC Calder serves on advisory boards of Pronova BioPharma, Aker Biomarine, Danone/Nutricia, Smartfish, Sancilio, DSM, Solutex, and ILSI Europe.
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Mar 15 2016

Five more industry-positive studies. The score: 150/12

Higher compared with lower dietary protein during an energy deficit combined with intense exercise promotes greater lean mass gain and fat mass loss: a randomized trial.  Thomas M Longland, Sara Y Oikawa, Cameron J Mitchell, Michaela C Devries, and Stuart M Phillips.  Am J Clin Nutr  March 2016  vol. 103 no. 3 738-746. doi: 10.3945/​ajcn.115.119339

  • Conclusion: Our results showed that, during a marked energy deficit, consumption of a diet containing 2.4 g protein · kg−1 · d−1 was more effective than consumption of a diet containing 1.2 g protein · kg−1 · d−1 in promoting increases in LBM [lean body mass] and losses of fat mass when combined with a high volume of resistance and anaerobic exercise.
  • Conflicts of interest: SMP has received research funding, travel allowances, and honoraria from the US National Dairy Council and Dairy Farmers of Canada. None of the other authors reported a conflict of interest related to the study.
  • Comment: Dairy, of course, is a source of protein.

Consumption of dairy foods and diabetes incidence: a dose-response meta-analysis of observational studies. Gijsbers L, Ding EL, Malik VS, de Goede J, Geleijnse JM, Soedamah-Muthu SS. Am J Clin Nutr. 2016 Feb 24. pii: ajcn123216. [Epub ahead of print]

  • Conclusion: This dose-response meta-analysis of observational studies suggests a possible role for dairy foods, particularly yogurt, in the prevention of T2D. Results should be considered in the context of the observed heterogeneity.
  • Funding: This meta-analysis project on dairy products and incident diabetes was funded by Wageningen University.  SSS-M previously received funding from Global Dairy Platform, Dairy Research Institute, and Dairy Australia for projects related to dairy effects on lipoproteins and mortality; JMG previously received funding from the Global Dairy Platform and Dutch Dairy Association for projects related to dairy and cardiovascular diseases; and ELD previously consulted for the Dairy Research Institute. LG, VSM, and JdG reported no conflicts of interest related to the study. Any prior sponsors had no role in the design and conduct of the study, data collection and analysis, interpretation of the data, decision to publish, or preparation of this manuscript. The current funder had no role in design and conduct of the study, data collection and analysis, interpretation of the data, or decision to publish.
  • Comment: The conclusions put a positive spin on results that can also be considered equivocal.

Plenary Lecture 2: Milk and dairy produce and CVD: new perspectives on dairy and cardiovascular health. Julie A. Lovegrove* and Ditte A. Hobbs.  Proceedings of the Nutrition Society, Page 1 of 12 doi:10.1017/S002966511600001X.

  • Conclusion: These apparent benefits of milk and dairy foods have been attributed to their unique nutritional composition, and suggest that the elimination of milk and dairy may not be the optimum strategy for CVD risk reduction.
  • Conflicts of Interest: The authors have previously received funding for research from AHDB Dairy. J. A. L. has acted as an advisor to the Dairy Council. J. A. L. has received funding for research from Volac for BBSRC case studentship and ‘in kind’ foods from Arla for an MRC funded study.

Multivitamin/mineral supplements: rationale and safety – A systematic review. Hans K. Biesalski, Jana Tinz.  Nutrition, in press 2016.  doi:10.1016/j.nut.2016.02.013

  • Conclusion: Taken together, these findings indicate that MVM can be safe for long-term use (more than 10 years).
  • Funding: Editorial support was provided by Peloton Advantage and funded by Pfizer.

The challenges of vitamin and mineral supplementation in children with inherited metabolic disorders: a prospective trial.  A. Daly, S. Evans, S. Chahal, I. Surplice, S. Vijay, S. Santra and A. MacDonald.  J Human Nutrition and Dietetics.  Article first published online: 18 JAN 2016. DOI: 10.1111/jhn.12354 (thanks to Cole Adams for sending).

  • Conclusions: Despite improvements in some nutritional markers, overall use of the vitamin and mineral supplement was less than prescribed. New methods are needed to guarantee delivery of micronutrients in children at risk of deficiencies as a result of an essential manipulation of diet in inborn disorders of metabolism.
  • Funding: Anita MacDonald has received research funding from Merck Serono, Vitaflo Ltd and Nutricia. She is on Advisory Boards for Arla, Merck Serono and Nutricia. Anne Daly and Sharon Evans have received research funding from Vitaflo Ltd, and Nutricia. Research funding was obtained from Vitaflo International for the funding of this project.
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