by Marion Nestle

Search results: public health strategies

Aug 23 2021

Industry-funded studies of the week: One Potato, Two Potato

One Potato

Thanks to David Ludwig for alerting me to an e-mail from the Alliance for Potato Research & Education (APRE), a trade association “dedicated to advancing the scientific understanding of the role potatoes play in promoting the health of all people.”

A new APRE-funded study published in Nutrients investigated the effect of increased dietary potassium from a whole food source – baked/boiled potatoes and baked French fries – or a potassium supplement on blood pressure and other cardiovascular disease risk factors compared to a ‘typical American’ control diet (lower potassium intake) among 30 pre-hypertensive-to-hypertensive men and women.

Results showed that baked/boiled potato consumption had the greatest benefit on reducing sodium retention, even more than the supplement, and resulted in a greater reduction in systolic blood pressure (SBP) compared to the control diet.

Further, despite commonly held misbeliefs about French fries and their role in heart-healthy lifestyles, the authors observed that a 330-calorie serving of baked French fries, when eaten as part of a ‘typical American’ diet, had no adverse effect on blood pressure or blood vessel function.

The study concludes:

This was the first controlled feeding study of potassium from food and supplements on BP and CVD outcomes in an unhealthy population…Of public health relevance is our observation that French fries in amounts typical of a large serving in a fast food restaurant has no adverse effect on blood pressure or endothelial function.

It discloses the funding source: “This research was funded by Alliance for Potato Research and Education.”

Comment: Because some (but not all) observational studies have linked potatoes, and especially French fries, to poor health outcomes, the potato industry wants research to give these foods a healthier image.  This study says that potatoes are high in potassium and a high potassium-to-sodium ratio is good for blood pressure and heart disease.  I could have told them that on the basis of food composition data alone: 100 grams of French fries contains 435 mg potassium versus 295 of sodium.  Does that make French fries a health food?  No, alas, it does not.

Once more for the record: industry-funded research is about marketing, not public health.

Two Potato

Last week, I received an emailed notification from APRE, the Alliance for Potato Research & Education announcing a new study.

For decades, people have often associated higher intakes of carbohydrate-containing foods with less healthy lifestyles. Yet, evidence suggests this view is overly simplistic, and it is instead the type and quality of carbohydrate foods that matter most for supporting health…In a newly published perspective in Nutrients, a group of nutrition researchers, who collectively make up the Quality Carbohydrate Coalition-Scientific Advisory Council (QCC-SAC), outline the opportunity for a stronger, more evidence-based approach to defining quality carbohydrate foods to support overall health and provide clearer dietary guidance.

The study: Toward an Evidence-Based Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report.  Kevin B. Comerford, Yanni Papanikolaou,  Julie Miller Jones, Judith Rodriguez. Joanne Slavin,  Siddhartha Angadi.  and Adam Drewnowski.  Nutrients2021, 13(8), 2667.

Conclusion: The identification of higher quality carbohydrate foods could improve evidence-based public health policies and programming—such as the 2025–2030 Dietary Guidelines for Americans. 

Funding:  This work was supported by the Quality Carbohydrate Coalition (QCC), which is funded by Potatoes USA. The QCC was not involved in the expert panel discussions, manuscript preparation, or the decision to submit the manuscript for publication.Conflicts of Interest: All authors are invited members of the Quality Carbohydrate Coalition’s Scientific Advisory Council (QCC-SAC). A.D. is the developer of the Nutrient Rich Food (NRF) index, a nutrient profiling model, and has received grants, contracts, and honoraria from entities, both public and private, with an interest in nutrient density of foods, complex meals, and the total diet. Y.P. is the president of Nutritional Strategies, collaborates on NHANES analyses and provides food, nutrition, and regulatory affairs consulting services for food/beverage companies and food-related associations. S.A. and J.M.J. advise the Grain Foods Foundation. J.S. has current grants from Taiyo and Barilla in the area of dietary fiber, and also serves on the Scientific Advisory Boards for Tate and Lyle and Atkins Nutritionals. J.R. has no conflicts of interest. K.B.C. is employed by FoodMinds, which provides science communications consulting services to various food and nutrition entities, including Potatoes USA and the Alliance for Potato Research and Education (APRE).
Comment: This is a successful effort by the potato industry to engage academics in support of the value of potatoes in healthful diets.  The role of potatoes in health is a contentious issue in the nutrition research community (see, for example, this FrontLine interview with Walter Willett).  The potato industry is fighting back by funding research (see above and also a previous post) and now engaging sympathetic academics.  I think potatoes are fine, in moderation.  But I wish academics would stay out of conflicted situations like this one.Reference: For a summary of research on the “funding effect”—the observations that research sponsored by food companies almost invariably produces results favorable to the sponsor’s interests and that recipients of industry funding typically did not intend to be influenced and do not recognize the influence—see my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

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Aug 13 2021

Weekend reading: A call to the UN Food Systems Summit: Ultra-processed foods

I am a co-author on a paper published recently by BMJ Global Health 2021;6:e006885.  The need to reshape global food processing: a call to the United Nations Food Systems Summit.  Authors: Carlos Augusto Monteiro, Mark Lawrence, Christopher Millett, Marion Nestle, Barry M Popkin, Gyorgy Scrinis, Boyd Swinburn.

Because this paper is open access, I reproduce its text below.  The link is to the pdf.

Summary box

  • In the modern, globalised food system, useful types of industrial food processing that preserve foods, enhance their sensory properties and make their culinary preparation easier and more diverse, have been and are being replaced by food ultra-processing.

  • The main purpose of food ultra-processing is to increase profits by creating hyperpalatable and convenient food products that are grossly inferior imitations of minimally processed foods and freshly prepared dishes and meals.

  • In the last decades, obesity, type 2 diabetes and related diseases have become global epidemics, leading the health systems of many countries to or beyond breaking point.

  • Taken together, the totality of evidence summarised here shows beyond reasonable doubt that increased consumption of ultra-processed foods is a major contributor to the pandemic of obesity, type 2 diabetes and related diseases.

  • The 2021 UN Food System has a unique opportunity to urge countries to implement policy interventions required to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable.

Introduction

The UN Food Systems Summit is taking place later this year at a crucial time. Food systems are manifestly failing to enhance human health, social equity or environmental protection. One symptom is the pandemic of obesity and related non-communicable diseases with their vast consequences. As we show here, one of the main drivers of this pandemic is the transformation in food processing. In the modern, globalised food system, useful types of food processing that preserve foods, enhance their sensory properties and make their culinary preparation easier and more diverse, have been and are being replaced by deleterious types of processing whose main purpose is to increase profits by creating hyperpalatable and convenient products that are grossly inferior imitations of minimally processed foods and freshly prepared dishes and meals. The Summit has a unique opportunity to confront this calamitous change, and to recommend effective policies and actions to UN agencies and member states.

Processing and industry

The key issue here is the nature, purpose and extent of food processing. It is not processing as such. General criticism of food processing is too unspecific to be helpful. Most foods are processed in some way, and culinary preparations of fresh foods are usually made using processed ingredients. Some types of food processing contribute to healthful diets, but others do the opposite.1

At one extreme are minimal processes which mostly preserve or enhance whole foods, such as drying grains, pulses and nuts, grinding grains into flour and pasta, chilling or freezing fruits and vegetables, pasteurising milk and fermenting milk into yoghurt.

At the other extreme are industrial processes that convert food commodities such as wheat, soy, corn, oils and sugar, into chemically or physically transformed food substances, formulated with various classes of additives into generally cheap to make, long duration substitutes to minimally processed foods and freshly prepared dishes and meals. The result is brand-named sugary, fatty and/or salty food and drink products which typically contain little or no whole food, are designed to be ready-to-consume anytime, anywhere and are highly attractive to the senses or even quasi-addictive. These products, including sweet and flavoured drinks, sweet or savoury snacks, reconstituted meat products and shelf-stable or frozen ready meals and desserts, are identified as ultra-processed foods.2

Criticisms of the food industry as a whole are also a mistake. Most of the very many millions of food farming, growing, rearing, making, distributing, selling and catering businesses throughout the world, notably in Asia, Africa and Latin America, deal solely or largely in fresh and minimally processed foods. These businesses and the foods they produce need to be encouraged, defended and supported.

By contrast, ultra-processed foods are mostly enabled, produced and sold by a small number of transnational corporations, some of whose turnovers exceed the revenues of many countries and make annual profits of US$ billions.3 These corporations use their power to formulate, mass manufacture, distribute and aggressively market their products worldwide.4

These corporations shape scientific findings by funding in-house and university-based research, so as to defend and promote ultra-processed foods.5 They also exercise political power by intensive lobbying, donations and sponsorships, and until now have dissuaded most governments from adequately regulating their products and practices.6

Time-series food sales data indicate the explosive growth in manufacturing and consumption of ultra-processed foods worldwide.7 National dietary surveys show that ultra-processed foods already make up 50% or more of total dietary energy intake8 in high-income countries, with even higher consumption among children and adolescents.9 In middle-income countries, they now represent between 15% and 30% of total energy intake8 but sales of ultra-processed foods are increasing fastest in these countries.10

The pandemic of obesity and related diseases and its link with ultra-processing

According to WHO, worldwide prevalence of obesity has nearly tripled since the mid-1970s, and now over 650 million adults are obese, and 1.9 billion adults and over 370 million children and adolescents are overweight or obese (https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight). No country has yet reversed these increases. Closely driven by the increase in obesity is a doubling of worldwide type 2 diabetes prevalence since 1980, now affecting about 420 million people (https://www.who.int/news-room/fact-sheets/detail/diabetes). Obesity, type 2 diabetes and related non-communicable diseases, including cardiovascular diseases and some common cancers, have become pandemics. Pre-COVID-19, health systems in most countries did not have the capacity to effectively treat diet-influenced diseases. Now, many health systems are at or beyond breaking point struggling with COVID-19, the severity of which is significantly higher in people with obesity and related diseases.

Evidence of the general healthfulness of dietary patterns based on fresh and minimally processed foods and culinary preparations, and their protection against all forms of malnutrition, ‘is noteworthy for its breadth, depth, diversity of methods, and consistency of findings’.11

But only in the last decade, with the advent of the NOVA food classification system that distinguishes ultra-processed foods from minimally processed or processed foods,1 has the link between changes in types of food processing and the pandemic of obesity and related diseases been revealed. Evidence here includes:

  • Three meta-analyses of findings from epidemiological studies, including large, long-duration, carefully conducted cohort studies, show dose-response associations between consumption of ultra-processed foods and obesity, abdominal obesity, type 2 diabetes, dyslipidaemias, metabolic syndrome, depression, cardio and cerebrovascular diseases and all-cause mortality.12–14

  • Analysis of national dietary or food purchase surveys in middle-income or high-income countries shows that the higher the dietary share of ultra-processed foods, the higher the obesogenic dietary nutrient profiles. These are characterised by higher energy density, free sugars, unhealthy fats and sodium, and lower protein and dietary fibre.8

  • Epidemiological and experimental studies indicate that ultra-processed foods may increase risks for obesity and related diseases in other ways beyond their nutritional composition. These include structural and physical properties that blunt satiety signalling, organoleptic characteristics associated with higher energy intake rate, neo-formed substances and migrated packaging materials that are endocrine disruptors, additives that promote pro-inflammatory microbiome, and reduced thermic effect that decreases total energy expenditures.12–14

  • A randomised controlled cross-over trial shows that consuming a high ultra-processed diet causes a highly significant increase in ad libitum calorie intake and consequent weight gain. Over a 2-week period, 20 young adults following a diet with 83% of energy from ultra-processed foods consumed approximately 500 more kcal per day than when they followed a diet with no ultra-processed foods. Participants gained 0.9 kg at the end of the 2 weeks with the ultra-processed diet and lost 0.9 kg at the end of the non ultra-processed diet, mostly of body fat.15

  • A longitudinal ecological study of 80 countries from 2002 to 2016 shows a direct association between changes in annual per capita volume sales of ultra-processed foods and corresponding changes in population adult body mass index.16

Taken together, the totality of evidence summarised here shows beyond reasonable doubt that increased consumption of ultra-processed foods is a major contributor to the pandemic of obesity and related diseases. There is also mounting evidence of the harmful effects of the ultra-processed food industry on the planet, through its global demand for cheap ingredients that destroy forests and savannah, its displacement of sustainable farming, and its resource-intensive manufacturing and packaging.17

Policy responses

To begin with, the UN Food Systems Summit should urge international and national health and food and nutrition authorities to review their dietary guidelines to emphasise preference for fresh or minimally processed foods and avoidance of ultra-processed foods, in line with guidelines developed, for example, by the WHO/Pan American Health Organization,18 and issued in several Latino-American countries, and now also in France, Belgium, and Israel.

At the same time, national governments should be urged to use fiscal measures, marketing regulations, bold mandatory front-of-pack labelling schemes and food procurement policies, all designed to promote the production, accessibility and consumption of a rich variety of fresh or minimally processed foods, and to discourage the production, distribution and consumption of ultra-processed foods, as now done in several countries.19

Current food and nutrition policies are mostly intended to encourage food manufacturers to reformulate their products by reducing the use of salt, sugar or unhealthy fats. There is a role for strong regulations that effectively limit the levels of these components, but reformulation alone will not turn ultra-processed products into healthy foods,20 as in effect recently acknowledged in one internal document from one leading ultra-processed food corporation – “some of our categories and products will never be ‘healthy’ no matter how much we renovate” (https://www.ft.com/content/4c98d410-38b1-4be8-95b2-d029e054f492). Policies should instead stimulate the entire manufacturing industry to maintain, develop or improve processing methods that prolong the duration of whole foods, enhance their sensory properties and make their culinary preparation easier and more diverse. Ultra-processed foods should be replaced by processed foods with limited levels or absence of added salt, sugar or unhealthy fats or, preferably, by minimally processed foods.20

Conclusions

Food systems are failing. This is most clearly shown by what are now the pandemics of obesity and type 2 diabetes, of which ultra-processed food is a main contributor. The UN Food Systems Summit should urge member states to implement multiple policy interventions to reduce ultra-processed food production, distribution and consumption, while simultaneously making fresh or minimally processed foods more available, accessible and affordable.

Data availability statement

All data relevant to the study are included in the article.

Ethics statements

Acknowledgments

This paper expands a one-page submission made by the authors to the UN Food Systems Summit within Solution Cluster 2.2.1 (food environment).

References

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Footnotes

  • Twitter @CMonteiro_USP

  • Contributors All authors contributed to the ideas presented in the manuscript. CAM wrote the manuscript. All authors contributed to redrafting and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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Aug 2 2021

Unethical food marketing ad of the week: infant formula, organic no less

When my partner, Mal Nesheim, showed me this ad in Sunday’s New York Times, I had two immediate questions.

Question #1: Who paid for this?

The answer: Bobbie’s Infant Formula “inspired by a mom’s choice.”

When I went to the website, I learned that Bobbie’s infant formula is organic.  I am greatly in favor of organics, but just as organic junk food is still junk food, organic infant formula is still infant formula.

Breast feeding isn’t easy in today’s society and yes, some mothers (and fathers, of course) can’t do it.

But breast feeding is unquestionably best for babies.  Mothers who can breast feed need all the help and encouragement they can get.

That’s why this week has been designated World Breastfeeding Week.

Breastfeeding mothers do not need to be undermined by infant formula marketing.

If Nestlé (no relation) or the other leading infant formula manufacturers put an ad like this in the paper, the result would be worldwide outrage.  This leads to my second question.

Question #2: Doesn’t this ad appear to violate the World Health Organization’s International Code of Marketing of Breast-milk Substitutes?

OK, so the ad does not display infant formula products or even say that Bobbie’s is an infant formula company, let alone an organic one.  But it doesn’t take much to figure both out.

Recall the Nestlé boycott of  the 1980s, a worldwide boycott of the company because of the way it marketed infant formula to women in low-resource countries without clean water supplies.  The women were unable to use the products safely; contaminated or improperly diluted infant formula sickened and killed babies.

Opposition to Nestlé’s marketing strategies led to development of Marketing Code, now ratified by all WHO member nations (the United States and South Africa were the two holdouts, but both eventually agreed).

The boycott was so damaging to Nestlé’s sales and reputation that the company discusses it and defends its current marketing practices on its website.

If you have any concerns about our breast milk substitutes marketing practices, we encourage you to raise them with us so that we can continue to improve.

I’d say this Bobbie ad is morally and ethically wrong on four counts:

  • It undermines breast feeding
  • It directly undermines the intent of World Breastfeeding Week.
  • It violates the spirit if not the letter of the International Marketing Code.
  • It organic washes—it implies that because its products are organic, this company is above the Code.

This is the kind of marketing that gives organics a bad name.

Bobbie’s should not be doing this.

Time for another boycott?

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Jul 12 2021

Conflicted interests? Drugs vs supplements for obesity

Lots of people take supplements in the hope that they will help with body weight.  This is a big market.  Drug companies want in on it.  Most drugs don’t work, or have deal-breaking side effects.  In June,  The FDA approved Novo Nordisk’s Semaglutide for obesity management.

I subscribe to the Obesity and Energetics newsletter, which sends out weekly lists of research, articles, and commentary on those topics—a great way to stay up on current literature.

On July 2, it featured:

This referred to: Perspective: Dietary supplements and alternative therapies for obesity: A Perspective from The Obesity Society’s Clinical Committee.  Srividya Kidambi, John A. Batsis, William T. Donahoo, Ania M. Jastreboff, Scott Kahan, Katherine H. Saunders, Steven B. Heymsfield.  Obesity 23 June 2021.

Our recommendation to clinicians is to consider the lack of evidence for non-FDA-approved dietary supplements and therapies and guide their patients toward tested weight management approaches…we call on regulatory authorities to critically examine the dietary supplement industry, including their role in promoting misleading claims and marketing products that have the potential to harm patients.

I am with the Obesity Society on this one, but what caught my interest was that several of the authors report financial tied to drug companies with interests in pharmacologic approaches to obesity treatment.

Conflicts of interest: SK serves as Medical Editor for TOPS Magazine (TOPS Inc. nonprofit weight loss club) and as Director for the TOPS Center for Metabolic Research at the Medical College of Wisconsin supported by TOPS Inc. JAB’s research reported in this publication was supported in part by the National Institute on Aging of the National Institutes of Health (NIH) under Award Number K23AG051681. JAB reports equity in SynchroHealth LLC. AMJ’s research is supported by the NIH/NIDDK, the American Diabetes Association, Novo Nordisk, and Eli Lilly; she serves as a consultant for Novo Nordisk, Eli Lilly, and Boehringer Ingelheim. SKa has served as a consultant for Novo Nordisk, Vivus, Gelesis, and Pfizer. KHS reports an ownership interest in Intellihealth. SBH reports his position on the Medical Advisory Board of Medifast Corp.

The newsletter also featured the article referred to in the Perspective.

When I clicked on this link, it took me to the page where I could download the pdf.  I got the paper at this site.   But before I could read it, I had to see an ad for Novo Nordisk’s drug, Semaglutide.  Then I scrolled down to get the study:  A Systematic Review of Dietary Supplements and Alternative Therapies for Weight Loss.  John A. Batsis, John W. Apolzan, Pamela J. Bagley, Heather B. Blunt, Vidita Divan, Sonia Gill, Angela Golden, Shalini Gundumraj, Steven B. Heymsfield, Scott Kahan, Katherine Kopatsis … Obesity (2021) 29, 1102-1113

Study conclusion: “There is weak evidence for the efficacy of dietary supplements and alternative therapies.”

Authors’ disclosure: JAB reports equity in SynchroHealth LLC. AG reports consulting with Novo Nordisk and Unjury. SH reports personal fees from Medifast. SKa reports personal fees from Novo Nordisk, Pfizer, Vivus, and Gelesis. DR reports consulting and speaking fees for Novo Nordisk and Astra Zeneca. KHS has a relationship with Intellihealth Inc. SK is the medical director for TOPS Center for Metabolic Health at the Medical College of Wisconsin, which is supported by TOPS Inc. SBH reports his position on the Medical Advisory Board of Medifast Corp.

I much prefer dietary approaches to weight management and policy strategies to make healthy diets the easy choice.

I am almost never in favor of supplements.  The evidence that they do much beyond placebo effects is usually pretty weak.

The ad gives the side effects for Semiglutide; it has to.

My point: all of this seems to be about marketing Semiglutide.

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Jul 9 2021

Classifying ultra-processed foods: PAHO tool

The Pan-American Health Organization (PAHO) has developed a Nutrient Profile Model, which it describes as “a tool to classify processed and ultra-processed food and drink products that are in excess of critical nutrients such as sugars, sodium, total fat, saturated fat and trans-fatty acids.”

To understand how it works, go to the website.  Watch the video.

Its purpose, as explained in the print publication is to help governments to identify unhealthy products and use public policies to discourage the consumption of those products.

The Expert Consultation Group described in this report was commissioned to develop a Nutrient Profile Model for the Pan American Health Organization – the PAHO NP Model – to be used as a tool in
the design and implementation of various regulatory strategies related to the prevention and control of obesity/overweight, including the following:
• Restriction in the marketing of unhealthy food and beverages to children
• Regulation of school food environments (feeding programs and food and beverages sold in schools)
• Use of front-of-package (FOP) warning labels
• Definition of taxation policies to limit consumption of unhealthy food
• Assessment of agricultural subsidies
• Identification of foods to be provided by social programs to vulnerable groups.

The criteria for ultra-processed foods to be avoided or eaten in small amounts:

It’s a start.

PAHO produces its  Nutrient Profile Tool in Spanish, of course: Perfil de Nutrientes – OPS/OMS | Organización Panamericana de la Salud (paho.org)a

It also has a report listing ultra-processed foods in Latin America, and many other useful documents.

As for me, I rather like the broader definition of ultra-processed foods described by the Brazilian public health academics who defined the term:

A practical way to identify an ultra-processed product is to check to see if its list of ingredients contain…either food substances never or rarely used in kitchens (such as high-fructose corn syrup, hydrogenated or interesterified oils, and hydrolysed proteins), or classes of additives designed to make the final product palatable or more appealing (such as flavours, flavour enhancers, colours, emulsifiers, emulsifying salts, sweeteners, thickeners, and anti-foaming, bulking, carbonating, foaming, gelling and glazing agents).

All of these are great resources for food policy in Latin America.

Let’s hope governments respond.

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Jun 25 2021

Weekend reading: Big Food, Big Tech, and Global Democracy

The Center for Digital Democracy has issued a report, Big Tech and Big Food.

The coronavirus pandemic triggered a dramatic increase in online use. Children and teens whose schools have closed relied on YouTube for educational videos, attending virtual classes on Zoom and Google Classroom, and flocking to TikTok, Snapchat, and Instagram for entertainment and social interaction. This constant immersion in digital culture has exposed them to a steady flow of marketing for fast foods, soft drinks, and other unhealthy products, much of it under the radar of parents and teachers. Food and beverage companies have made digital media ground zero for their youth promotion efforts, employing a growing spectrum of new strategies and high-tech tools to penetrate every aspect of young peoples’ lives.

The full report is divided into five parts (annoyingly, there is no table of contents and page numbers are almost invisible):

1.  The data-driven media and marketing complex (starts on page 8).

Today’s youth are at the epicenter of an exploding digital media and marketing landscape. Their deep connection to technology and their influence on purchasing are fueling the growth of new platforms, programs, and services, and generating a multiplicity of marketing opportunities. Google has created a global business offering videos and channels that target children and other young people who are attracted by its entertainment and educational content.

2.  This describes how Big Food targets kids using digital media (page 17)

3.   This part talks about threats to kids’ health, privacy, and autonomy (page 38)

4.  The growing momentum for regulation (is it ever needed) (page 42)

5.  This section lays out a framework for creating a healthier digital environment for kids (page 47)

The report is chilling.  It makes cartoons on breakfast cereals look so last century.  I could not believe the sophistication of these digital marketing efforts, all aimed at getting kids to demand junk foods.

Some congressional leaders are on this.  They deserve support.

You don’t think this is an urgent issue?  Read the report.

Here are a few news stories about this report.

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Jun 14 2021

Industry-funded study of the week: Coca-Cola

The study: Co-Occurrence and Clustering of Sedentary Behaviors, Diet, Sugar-Sweetened Beverages, and Alcohol Intake among Adolescents and Adults: The Latin American Nutrition and Health Study (ELANS)

Abstract: Poor diet, sedentary behaviors, sugar-sweetened beverages (SSB) and alcohol intake seem to co-exist in complex ways that are not well understood. The aim of this study was to provide an understanding of the extent to which unhealthy behaviors cluster in eight Latin America countries. A secondary aim was to identify socio-demographic characteristics associated with these behaviors by country…. Among 9218 individuals, the most prevalent behaviors were transportation and occupation–sedentary time, SSB and alcohol intake.

Conclusions:  EBRB, particularly excessive time spent on sedentary-activities and SSB intake, commonly co-occurred in a representative sample of LA adolescents and adults. While unhealthy behavior varied across LA countries, nearly half of sampled subjects in Argentina and Colombia presented at least two risk factor behaviors.

Recommendation: Public health policies and behavioral-change strategies should target SB domains (screen-time, occupational, and transportation), diet intake, and SSB and alcoholic intake in combination [my emphasis].

Funding: The ELANS data collection was originally supported by the scientific grant from the Coca-Cola Company (Atlanta, GA, USA) and by grants/supports from the ILSI Latin America branches (Argentina, Brazil, Sur-Andino, Nor-Andino, and Meso-America), Sabará Children’s Hospital, PENSI Institute, University of Costa Rica, Pontifical Catholic University from Chile, Pontifical Catholic University Javeriana, Colombia, Central University of Venezuela/Foundation Bengoa, University of San Francisco, Quito, and Nutritional Institute of Investigation, Peru. The funders had no role in study design, data collection, analysis, the decision to publish, or the preparation of this manuscript.

Conflicts of Interest: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Comment: This is the first study I have seen funded by Coca-Cola since the scandal over its funding of  the Global Energy Balance Network (see my last post on it) and its announcement that it would no longer pay more than half the cost of a study (see policy statement).  This study is co-funded by ILSI (also industry) and universities (independent).  Coca-Cola is still funding lots of studies.  See here and here.

Why would Coca-Cola want to fund a study like this?  The answer lies in the recommendation.  My translation: Do not target sugar-sweetened beverages with tax or warning label policies alone.  If you want to improve unhealthy behavior, you have to target all of those behaviors—screen time, jobs, transportation, dietary intake, and alcohol—at the same time.

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Apr 28 2021

FDA issues warnings to leafy green growers and their cattle raising neighbors

Leafy greens contaminated with toxic E. coli make eaters very sick (this is an understatement).

Toxic E. coli are excreted by cattle raised in the vicinity of lettuce and spinach fields.

But leafy green safety is overseen by FDA whereas everything having to do with food animals is overseen by USDA.

This is why the latest moves by FDA about leafy green safety are so noteworthy.

  • The FDA is warning leafy green growers that they must take better precautions to prevent E. coli contamination.
  • It also is warning cattle growers that they must prevent wastes from contaminating leafy green fields.

The Big Question: Will—can—the FDA force cattle ranchers and leafy green growers to adhere to food safety precautionary measures?

Let’s hope.

Here are the relevant documents:

FDA statement on release of a report on a 2020 outbreak

The findings of foodborne illness outbreak investigations since 2013 suggest that a likely contributing factor for contamination of leafy greens has been the proximity of cattle. Cattle have been repeatedly demonstrated to be a persistent source of pathogenic E. coli, including E. coli O157:H7.

Considering this, we recommend that all growers be aware of and consider adjacent land use practices, especially as it relates to the presence of livestock, and the interface between farmland, rangeland and other agricultural areas, and conduct appropriate risk assessments and implement risk mitigation strategies, where appropriate.

Report on the 2020 outbreak investigation

The analysis has confirmed a positive match to the outbreak strain in a sample of cattle feces, which was collected during follow-up investigations on a roadside, uphill from where leafy greens or other food identified in the traceback investigation were grown. While the finding does not provide definitive information on how E. coli may have contaminated product during the growing and harvesting season, it does confirm the presence of a strain of E. coli O157:H7 that causes recurring outbreaks in a more narrowly defined growing region and a potential, continued source of contamination.

Leafy Green STEC Action Plan

As outbreaks have continued to occur, despite significant efforts in recent years, greater emphasis will be needed around such complex issues as adjacent land use, agricultural water, and understanding likely routes by which human pathogens may contaminate leafy greens.

Former FDA food safety official Michael Taylor’s comment on these documents

FDA declared the recurring strain implicated in the 2020 outbreak to be a “reasonably foreseeable hazard,” which FDA attributed to the presence of cattle on land adjacent to growing fields.  This finding seems obvious and shouldn’t be surprising. The surprise, however, is that FDA used regulatory language to express its finding and spelled out the implications: farms covered by the FSMA produce safety rule “are required to implement science and risk-based preventive measures” to minimize the risk of serious illness or death from the E. coli hazard…I do not anticipate FDA taking judicial action to enforce its April 6 finding, absent egregious practices or clear negligence in a particular leafy green growing situation. I do see, however, a heightened sense of urgency at FDA and frustration that efforts to date have not solved the leafy greens safety problem. I share that frustration.    

Food safety lawyer Bill Marler’s comment

The FDA took specific aim at California growers as the cause of repeated and ongoing outbreaks, putting the responsibility of combating the outbreaks squarely on the growers.

FDA’s investigations into foodborne illness outbreaks are available from its outbreak page.  These are the ones from 2020.

 

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