by Marion Nestle

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Oct 12 2015

Independently funded study by Industry-funded authors finds sugary drinks to increase the risk of hypertension. The score: 70:6.

Do sugar-sweetened beverages increase the risk of high blood pressure?

Yes, says this study, which was conducted by investigators who accept research funding from Coca-Cola and the Calorie Control Council (a trade association for companies that make or use artificial sweeteners).  But the study itself was funded by independent government agencies or health associations in Canada.

I’m counting it in the category of studies with results unfavorable to the food industry sponsors.

This brings the score to 70 industry-funded studies since mid-March with results favorable to the sponsor, to 6 with unfavorable results.

Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohortsViranda H Jayalath, Russell J de Souza, Vanessa Ha, Arash Mirrahimi, Sonia Blanco-Mejia, Marco Di Buono, Alexandra L Jenkins, Lawrence A Leiter, Thomas MS Wolever, Joseph Beyene, Cyril WC Kendall, David JA Jenkins, and John L Sievenpiper.  Am J Clin Nutr 2015; 102:914-921 doi:10.3945/ajcn.115.107243.

  • Conclusions: SSBs were associated with a modest risk of developing hypertension in 6 cohorts. There is a need for high-quality randomized trials to assess the role of SSBs in the development of hypertension and its complications.
  • Funding: “The Canadian Institutes of Health Research…through the Canada-wide Human Nutrition Trialists’ Network and by the Diet, Digestive Tract, and Disease (3D) Centre, which is funded through the Canada Foundation for Innovation.  The Ministry of Research and Innovation’s Ontario Research Fund provided the infrastructure for the conduct of this project.”  Some of the investigators also received funds from Canadian government agencies or health associations.
  • Authors’ funding disclosures: RJdS has received research support from the Calorie Control Council and the Coca-Cola Company…ALJ is a part owner, vice president, and director of research of Glycemic Index Laboratories, Toronto, Canada….JB has received research support from the Calorie Control Council and The Coca-Cola Company…CWCK has received research support from the Calorie Control Council, the Coca-Cola Company (investigator initiated, unrestricted grant), Hain Celestial, Kellogg, Kraft, Loblaw Companies Ltd., Solae, and Unilever…DJAJ has received research grants from Loblaw Companies Ltd., Unilever, the Coca-Cola Company… JLS has received research support from the Calorie Control Council and the Coca-Cola Company…travel funding, speaker fees, or honoraria from the Calorie Control Council, the Canadian Sugar Institute, World Sugar Research Organization, White Wave Foods, Abbott Laboratories, Dairy Farmers of Canada, Dr. Pepper Snapple Group, The Coca-Cola Company, and the Corn Refiners Association….

Comment

This is an exception that proves the rule.  In this study, a group of investigators, some—but not all— of whom typically receive funding from food companies, participated in a study funded by Canadian government and health agencies.

One possible explanation is that when investigators typically funded by soda companies are funded independently,  they design and conduct independent research.

If nothing else, this study is evidence for the need for and value of independent funding of nutrition research.

Oct 7 2015

The bizarre saga of the 2015 Dietary Guidelines: Continued

Two events yesterday:

#1.  USDA and HHS announce that sustainability will not be part of the Dietary Guidelines.

This year, we will release the 2015 edition, and though the guidelines have yet to be finalized, we know they will be similar in many key respects to those of past years. Fruits and vegetables, low-fat dairy, whole grains and lean meats and other proteins, and limited amounts of saturated fats, added sugars and sodium remain the building blocks of a healthy lifestyle.

…In terms of the 2015 Dietary Guidelines for Americans (DGAs), we will remain within the scope of our mandate in the 1990 National Nutrition Monitoring and Related Research Act (NNMRRA), which is to provide “nutritional and dietary information and guidelines”… “based on the preponderance of the scientific and medical knowledge.”  The final 2015 Guidelines are still being drafted, but because this is a matter of scope, we do not believe that the 2015 DGAs are the appropriate vehicle for this important policy conversation about sustainability.

OK, but see Michele Simon’s analysis of the legal issues related to sustainability in the guidelines, and My Plate My Planet’s analysis of the comments filed on the sustainability question.

As my analysis shows, the USDA and HHS would be well within its legal authority to include sustainability. In summary:

    • A plain reading of the statute does not preclude sustainability;
    • The Congressional intent was to further a broad agenda on health;
    • Previous DGA versions included issues beyond “nutrition and diet”.

And also see Kathleen Merrigan et al’s argument in favor of sustainable dietary guidelines in Science Magazine.

So this is about politics, not science.

#2.  A coalition of critics of the Dietary Guidelines is attempting to block their release.

Yesterday’s Hagstrom Report and, later, Politico (both behind paywalls) reported that this group is calling on  USDA and HHS to turn over the guidelines to a committee of the National Academy of Sciences Food and Nutrition Board for reexamination before releasing them to the public.

The issues?  The meat and beverage recommendations.

The group is funded by philanthropists Laura and John D. Arnold, who fund Nina Teicholz’s work.

Teicholz is on the board of the group as is Cheryl Achterberg, dean of the Ohio State University College of Education, and John Billings, who directs the Wagner School’s Health Policy and Management Program at NYU (why they agreed to do this is beyond me).

Hagstrom notes that coordinating support is coming from Beth Johnson, a former undersecretary for food safety at USDA who has her own consulting firm with clients apparently including the National Restaurant Association and the National Cattlemen’s Beef Association.

Other members of the advisory board include several scientists who do research funded by food companies.

The Coalition’s website is here.

This morning’s Politico Pro Agriculture has a long piece on the funding behind the coalition.

In the lead up to congressional hearings on the proposed 2015 dietary guidelines, the Arnolds are spending an initial $200,000 to communicate that critique and to advocate for changes that they say would improve the process. They have funded the new political action group, called The Nutrition Coalition, whose well-placed lobbyists have helped Teicholz score face-to-face meetings with top officials in Congress and the White House to push for an independent review of the guideline process. The team helped persuade lawmakers to insert language in the fiscal 2016 House agriculture spending bill to direct the National Academy of Medicine to conduct such a review.

Really? Eating fruits and vegetables and not overeating calories requires this level of lobbying?

This too is about politics.

The mind boggles.

Addition

The Hagstrom Report is keeping track of the testimony at today’s congressional hearing on the guidelines.

Oct 2 2015

Weekend Reading: Emily Yates-Doerr’s “The Weight of Obesity”

Emily Yates-Doerr.  The Weight of Obesity: Hunger and Global Health in Postwar Guatemala. University of California Press, 2015.

Emily was a student in NYU’s anthropology department and I’ve admired her work for a long time.  Her book is based on her remarkable dissertation work, and I was happy to be asked to blurb it:

Emily Yates-Doerr gives us an anthropologist’s tough analysis of how one resource-poor Guatemalan population responds to an increasingly globalized food supply as it transitions rapidly from widespread hunger and malnutrition to the increasing prevalence of obesity and its health consequences.  The Weight of Obesity views this “nutrition transition” from the unusually revealing perspective of an insider who experienced it personally with eyes wide open.

For me, the most riveting parts of her book are the transcribed conversations between clinic nutritionists and patients newly diagnosed with type 2 diabetes—a case study in the cultural gap between nutrient-based advice (“nutritionism”) and the way people actually eat.  The effects of the rapid influx of “ultra-processed” products on the health of the populations studied here are also painfully clear.  This is an ethnography of the nutrition transition caught just as these cultural and dietary shifts were occurring.

Sep 29 2015

Cocoa flavanols: science or marketing?

Sunday’s New York Times carried this full-page advertisement.

cocoa via

The ad is from Cocoa Via, a company owned by Mars.  It quotes a dietitian stating that cocoa flavanols “support healthy blood flow…which allows oxygen and nutrients to get to your heart more easily.”

The ad directs you to the full story at nytinmes.com/cocoavia (where you see more ads).

I posted the science behind this ad earlier this month in my collection of industry-funded studies with results favorable to the sponsor’s interests.  To repeat:

Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health Study Roberto Sansone, Ana Rodriguez-Mateos , Jan Heuel, David Falk, Dominik Schuler, Rabea Wagstaff, Gunter G. C. Kuhnle, Jeremy P. E. Spencer, Hagen Schroeter, Marc W. Merx, Malte Kelm and Christian Heiss for the Flaviola Consortium, European Union 7th Framework Program.  British Journal of Nutrition, September 9, 2015. doi:10.1017/S0007114515002822.

  • Conclusion: In healthy individuals, regular CF [cocoa flavanol] intake improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects.
  • Funding: Additional funding was provided…through an unrestricted grant by MARS Inc. MARS Inc. also provided the standardised test drinks used in this investigation… H. S. provided test drinks on behalf of Mars Inc… H. S. is employed by MARS Inc., a member of the Flaviola research consortium and a company engaged in flavanol research and flavanol-related commercial activities. [The conflict statement also discloses that MARS employee H.S. shared responsibility for designing the study, writing the paper, and approving the final content].
  • Comment: Lest the “eat more chocolate” message of these studies be missed, Mars sent out a press release: “Cocoa flavanols lower blood pressure and increase blood vessel function in healthy people.”

Now we have a full-page ad in the New York Times.

Here’s what the ad does not say:

  • CocoaVia is owned by MARS, Inc (this appears nowhere in the ad).
  • Flavanols are usually destroyed during normal cocoa processing.
  • Most chocolate contains few flavanols; CocoaVia’s process preserves some of the flavonols in very dark chocolate.
  • Flavonol-rich or not, chocolate candy is not a health food.

Like most conflicted research, this is about marketing—hence, the ad—not science.

Sep 24 2015

Sugar politics: A roundup of items

This week’s post about sugars #4:

Sugar politics is in the news and I’ve been collecting items about it.

  • U.K. consumers say sugar is their #1 food issue, beating out waste and salt.
  • The Florida sugar industry is giving generously to Republican presidential candidates.
  • Australian sugar growers are pushing for greater access to the U.S. sugar market through the Trans Pacific Partnership agreement, and are in part responsible for the impasse in signing it (this is not necessarily a bad thing).
  • U.S. candy makers are not happy about the suspension agreements brought against Mexican sugar imports.  These, they say, have raised the price of sugar.  Ordinarily, under NAFTA, Mexico is allowed to ship as much sugar to the U.S. as it likes, with no tariffs.  But Mexico agreed to new trade caps in return for not having to deal with antidumping investigations (isn’t trade fun?).
  • The Washington Post has a good summary of where we are on putting Added Sugars on food labels.
  • The FDA will take comments specifically on its Nutrition Facts panel studies, including controversial research on how well consumers would understand an added sugars label, the agency announced in a Federal Register notice.  The comment period is extended to October 15.
  • The FDA’s move follows a letter from law firm Olsson Frank Weeda Terman Matz that criticized the agency for not taking comments on its consumer research.
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Sep 17 2015

Another five industry-funded nutrition studies with industry-favorable results. Score: 60:3

Nutrition research studies funded by food companies are pouring in and here’s another set of five with expected results.  The first one is notable for its extensive revelations, a case of TMI (too much information) if I’ve ever seen one.  As usual, if you run across more of these—and especially industry-funded studies that do not favor the sponsor’s interest, please send.  The roundup since mid-March: 60 with favorable results, 3 without.

Effect of Fructose on Established Lipid Targets: A Systematic Review and Meta‐Analysis of Controlled Feeding Trials.  Laura Chiavaroli, Russell J. de Souza, Vanessa Ha, Adrian I. Cozma, Arash Mirrahimi, David D. Wang, Matthew Yu, Amanda J. Carleton, Marco Di Buono, Alexandra L. Jenkins, Lawrence A. Leiter, Thomas M. S. Wolever, Joseph Beyene, Cyril W. C. Kendall, David J. A. Jenkins, and John L. Sievenpiper.  J Am Heart Assoc. 2015;4: originally published September 10, 2015, doi:10.1161/JAHA.114.001700.

  • Conclusion: Pooled analyses showed that fructose only had an adverse effect on established lipid targets when added to existing diets so as to provide excess calories (+21% to 35% energy). When isocalorically exchanged for other carbohydrates, fructose had no adverse effects on blood lipids.
  • Conflicts:  The disclosures cover two full pages in the journal.  These authors report every source of income—honoraria, prizes, travel funds—including those of their spouses.  They apparently work for every food company imaginable, including any number with interests in minimizing a harmful role of fructose in health.
  • Comment:  I do not know why the editors of this journal decided that the conflict-of-interest statement was worth two pages of journal space.  Perhaps they don’t think such statements necessary and were being ironic?  Or perhaps they wanted to make sure that these highly conflicted authors were fully exposed?  Yoni Freedhoff of Weighty Matters consulted an ethicist about this question but did not get a clear answer.  I wrote the journal editor and asked what this was about, but have not received a response.

Beneficial effects of oral chromium picolinate supplementation on glycemic control in patients with type 2 diabetes: A randomized clinical study. Ana N. Paiva, Josivan G. de Lima, Anna C.Q. de Medeiros, Heverton A.O. Figueiredo, Raiana L. de Andrade, Marcela A.G. Ururahye, Adriana A. Rezende, José Brandão-Neto, Maria das G. Almeida.   Journal of Trace Elements in Medicine and Biology 32 (2015) 66–72.

  • Conclusions: CrPic supplementation had a beneficial effect on glycemic control in patients with poorly controlled T2DM, without affecting the lipid profile.
  • Conflict: Manipulation Pharmacy Companhia da Fórmula donated the chromium picolinate supplement.
  • Comment: Without knowing more about this situation, it’s not possible to say whether donation of a supplement is enough to raise concerns.  This study raises questions because most independently funded studies of chromium and diabetes have shown minimal or no benefits (see, for example this one).

Oat consumption reduced intestinal fat deposition and improved health span in Caenorhabditis elegans model. Chenfei Gao, Zhanguo Gao, Frank L. Greenway, Jeffrey H. Burton, William D. Johnson, Michael J. Keenan, Frederick M. Enright, Roy J. Martin, YiFang Chu, Jolene Zheng.  Nutrition Research September 2015 Volume 35, Issue 9, Pages 834–843.

  • Conclusion: Oat consumption may be a beneficial dietary intervention for reducing fat accumulation, augmenting health span, and improving hyperglycemia-impaired lipid metabolism [in nematodes].
  • Conflict: This research was supported by a nonrestricted donation from PepsiCo Inc. Oats used in this study were a gift of PepsiCo Inc. Y. Chu is an employee of PepsiCo, Inc, which manufactures oatmeal products under the brand name Quaker Oats.

A pilot study examining the effects of consuming a high-protein vs normal-protein breakfast on free-living glycemic control in overweight/obese ‘breakfast skipping’ adolescents. L B Bauer, L J Reynolds, S M Douglas, M L Kearney, H A Hoertel, R S Shafer, J P Thyfault and H J Leidy.  International Journal of Obesity (2015) 39, 1421–1424; doi:10.1038/ijo.2015.101; published online 7 July 2015

  • Conclusion: These data suggest that the daily addition of a HP breakfast, containing 35 g of high-quality protein, has better efficacy at improving free-living glycemic control compared with a NP breakfast in overweight/obese, but otherwise healthy, ‘breakfast skipping’ adolescents.
  • Disclosure: The authors declare no conflict of interest, but the study was funded by the Pork Checkoff.

Acute Cocoa Supplementation Increases Postprandial HDL Cholesterol and Insulin in Obese Adults with Type 2 Diabetes after Consumption of a High-Fat Breakfast.  Arpita Basu, Nancy M Betts, Misti J Leyva, Dongxu Fu, Christopher E Aston, and Timothy J Lyons.  J Nutr September 2, 2015, doi: 10.3945/​jn.115.215772

  • Conclusions: Acute cocoa supplementation showed no clear overall benefit in T2D patients after a high-fat fast-food–style meal challenge. Although HDL cholesterol and insulin remained higher throughout the 6-h postprandial period, an overall decrease in large artery elasticity was found after cocoa consumption.
  • Funding: Among other sources, the lead author receiveda grant from The Hershey Company.
  • Comment: This is a negative study (no benefit) with a positive spin (higher HDL, decrease in large artery elasticity).

 

Sep 15 2015

Big Soda vs. Public Health: the US Conference on Mayors

There seems to be no end to such stories, many of which I cover in Soda Politics: Taking on Big Soda (and Winning)officially out October 1 but being shipped right now.

Here’s one I didn’t cover.

2008: The U.S. Conference of Mayors (USCM) passed a resolution supporting “increased resources for cities to help combat obesity and fund obesity prevention, including consideration of revenues from the major leading contributors of the nation’s obesity epidemic, including calorically sweetened beverages, fast food, and high calorie snacks.”  Translation: taxes

2010: USCM posted an article in its online newspaper about mayors considering soda taxes.

2011: The American Beverage Association (ABA) became a member of the USCM’s Business Council, and partnered with the group to start a $3 million childhood obesity prevention program.  Would this aim to reduce intake of sugary beverages?  Nope.

Instead, the program focused on:

  • Promoting physical activity
  • Increasing fruit and vegetable consumption

2015:  The winning projects were:

  • Jacksonville, FL, $150,000 for a youth initiative to make fresh fruits and vegetables available at a cheaper cost, and to promote physical activity.
  • Seattle, WA, $25,000 to increase fruit and vegetable consumption among at-risk kids, through farm-to-table initiatives.

2015: Here’s what Scientific American says about all this (I’m quoted).

There is no mention in the application of decreasing consumption of calorically sweetened beverages, fast food, or high calorie snacks, which are all specifically cited in the 2008 USCM resolution as contributors to the nation’s obesity epidemic…The beverage industry seems to be obsessed with physical activity, as evident from the recent spate of stories about Coca-Cola funding studies that point the blame for obesity at caloric expenditure, rather than caloric intake. The science overwhelmingly does not support this.

Sep 14 2015

Five more industry-funded studies with expected results. The score: 55:3

Here’s the latest collection of 5 studies funded by food companies or trade associations, all with results that favor the sponsor’s interests.  I’ve just reviewed them and found a couple of duplicates, so this is a corrected score.  The correct score is 55 industry-funded studies with positive results vs. 3 with results unfavorable to industry—since mid-March.

I’m particularly interested in the unfavorable category.  If you run across any, please send.

Jejunal Casein Feeding Is Followed by More Rapid Protein Digestion and Amino Acid Absorption When Compared with Gastric Feeding in Healthy Young Men. Joanna Luttikhold, Klaske van Norren, Nikki Buijs, Marjolein Ankersmit, Annemieke C Heijboer, Jeannette Gootjes, Herman Rijna, Paul AM van Leeuwen, and Luc JC van Loon. J. Nutr. 2015; 145:2033-2038 doi:10.3945/jn.115.211615.

  • Conclusions: Jejunal feeding of intact casein is followed by more rapid protein digestion and AA absorption when compared with gastric feeding in healthy young men. The greater postprandial increase in circulating EAA concentrations may allow a more robust increase in muscle protein synthesis rate after jejunal vs. gastric casein feeding.
  • Funding: Supported by Nutricia Research, Utrecht, Netherlands. J Luttikhold was employed by Nutricia Research; K van Norren is a guest employee of Nutricia Research; and LJC van Loon has served as a consultant for Nutricia Research.  [Note: Nutricia Research is a subsidiary of Danone].

Higher Total Protein Intake and Change in Total Protein Intake Affect Body Composition but Not Metabolic Syndrome Indexes in Middle-Aged Overweight and Obese Adults Who Perform Resistance and Aerobic Exercise for 36 Weeks. Wayne W Campbell, Jung Eun Kim, Akua F Amankwaah, Susannah L Gordon, and Eileen M Weinheimer-Haus. J. Nutr. 2015; 145:2076-2083 doi:10.3945/jn.115.213595.

  • Conclusions: In conjunction with exercise training, higher TPro [total protein] promoted positive changes in BC [body composition] but not in MetS [metabolic syndrome] indexes in overweight and obese middle-aged adults. Changes in TPro from before to during the intervention also influenced BC responses and should be considered in future research when different TPro is achieved via diet or supplements.
  • Funding:  Supported by the US Whey Protein Research Consortium (to WWC) among others.  WW Campbell was a member of the National Dairy Council Whey Protein Advisory Panel while the research was being conducted.

Intense Sweeteners, Appetite for the Sweet Taste, and Relationship to Weight ManagementFrance Bellisle.  Current Obesity Reports March 2015, Volume 4, Issue 1, pp 106-110 10.1007/s13679-014-0133-8

  • Conclusion: While many of the existing studies cannot identify any causal links between use of LES [artificial, low-energy sweeteners] and appetite for sweetness, randomized trials in children and adults suggest that use of LES tends to reduce rather than increase the intake of sugar-containing foods and to facilitate, rather than impair, weight loss.
  • Conflict: Parts of [this study] are extracted from a non-published document for which the author received an honorarium from the International Sweeteners Association (ISA).  France Bellisle is a member of the Scientific Advisory Board for General Mills and has received travel reimbursement and honoraria for contributions in scientific congresses from Mondelez, ISA, and General Mills.

Impact of cocoa flavanol intake on age-dependent vascular stiffness in healthy men: a randomized, controlled, double-masked trial.  Christian Heiss & Roberto Sansone & Hakima Karimi & Moritz Krabbe & Dominik Schuler & Ana Rodriguez-Mateos & Thomas Kraemer & Miriam Margherita Cortese-Krott & Gunter G. C. Kuhnle & Jeremy P. E. Spencer & Hagen Schroeter & Marc W. Merx & Malte Kelm & for the FLAVIOLA Consortium, European Union 7th Framework Program.  AGE (2015) 37: 56 DOI 10.1007/s11357-015-9794-9

  • Conclusion: CF [cocoa flavanol] intake reverses age-related burden of cardiovascular risk in healthy elderly, highlighting the potential of dietary flavanols to maintain cardiovascular health.
  • Funding: …Additional funding was provided by an unrestricted grant by MARS, Inc…MARS, Inc. provided the standardized test drinks used in this investigation. HS is employed by MARS, Inc., a member of the FLAVIOLA research consortium and a company engaged in flavanol research and flavanol-related commercial activities.

Cocoa flavanol intake improves endothelial function and Framingham Risk Score in healthy men and women: a randomised, controlled, double-masked trial: the Flaviola Health StudyRoberto Sansone, Ana Rodriguez-Mateos , Jan Heuel, David Falk, Dominik Schuler, Rabea Wagstaff, Gunter G. C. Kuhnle, Jeremy P. E. Spencer, Hagen Schroeter, Marc W. Merx, Malte Kelm and Christian Heiss for the Flaviola Consortium, European Union 7th Framework Program.  British Journal of Nutrition, September 9, 2015. doi:10.1017/S0007114515002822.

  • Conclusion: In healthy individuals, regular CF [cocoa flavanol] intake improved accredited cardiovascular surrogates of cardiovascular risk, demonstrating that dietary flavanols have the potential to maintain cardiovascular health even in low-risk subjects.
  • Funding: Additional funding was provided…through an unrestricted grant by MARS Inc. MARS Inc. also provided the standardised test drinks used in this investigation… H. S. provided test drinks on behalf of Mars Inc… H. S. is employed by MARS Inc., a member of the Flaviola research consortium and a company engaged in flavanol research and flavanol-related commercial activities. [The conflict statement also discloses that MARS employee H.S. shared responsibility for designing the study, writing the paper, and approving the final content].
  • Comment: Lest the implicit (but never stated directly) “eat more chocolate” message of these studies be missed, Mars sent out a press release: “Cocoa flavanols lower blood pressure and increase blood vessel function in healthy people.”