Currently browsing posts about: Conflicts-of-interest

The study: Impact of low-fat and full-fat dairy foods on fasting lipid profile and blood pressure: exploratory endpoints of a randomized controlled trial.  Kelsey A Schmidt, et al. The American Journal of Clinical Nutrition, nqab131, https://doi.org/10.1093/ajcn/nqab131.  Published: 13 July 2021

Background: “Dietary guidelines traditionally recommend low-fat dairy because dairy’s high saturated fat content is thought to promote cardiovascular disease (CVD). However, emerging evidence indicates that dairy fat may not negatively impact CVD risk factors when consumed in foods with a complex matrix.”

Method: “Participants were then randomly assigned to 1 of 3 diets, either continuing the limited-dairy diet or switching to a diet containing 3.3 servings/d of either low-fat or full-fat milk, yogurt, and cheese for 12 wk.”

Conclusions: “In men and women with metabolic syndrome, a diet rich in full-fat dairy had no effects on fasting lipid profile or blood pressure compared with diets limited in dairy or rich in low-fat dairy. Therefore, dairy fat, when consumed as part of complex whole foods, does not adversely impact these classic CVD risk factors.”

Funding: “National Dairy Council, Dairy Farmers of Canada, Dutch Dairy Association (Nederlandse Zuivel Organisatie), Dairy Australia, and the French Dairy Interbranch Organization (CNIEL),” and NIH and others.

Conflict of interest: “This study was initiated by the principal investigator (MK). The dairy-related funding organizations suggested changes to details of the study design prior to the conduct of the study, some of which were implemented. Otherwise, the funding organizations had no impact on the design or conduct of the trial or the analysis and interpretation of study data.”

Comment: Let’s give these investigators high marks for disclosing that the dairy funders influenced the design of the study, which, as we know from the data of Lisa Bero and her colleagues, is the place where biases caused by industry funding most typically show up.  Food companies that fund research are looking for benefits; they won’t risk study designs that might yield inconvenient results.

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.

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. 

Thanks to Frank Lindner for sending this study.  He is a campaigner for foodwatch Nederland, which among other campaigns, runs Stop the sale of science for better transparency in science.

He says this Tweet made him curious:

He followed up and found the study: The place of animal products in a sustainable diet.  Authors: Stephen Peters, Jolande Valkenburg, Thom Huppertz, Luuk Blom, Lionel van Est. Norwegian Journal of Nutrition, Nr. 2 – June 2021.

The study begins with this premise:

Replacing animal-based foods with plant-based foods does not necessarily lower the diets [sic] carbon footprint.

Why?

In an average Dutch person’s diet, animal products are an important source of protein, minerals and vitamins…Animal products contribute significantly to the intake of important nutrients, such as high-quality protein, vitamins A, B2 and B12, calcium, magnesium, zinc and (in the case of meat) heme iron. These nutrients are not naturally, or often, found in plant products. Omitting animal products from the diet therefore can have major consequences for nutrient intake.

Lindner wrote that “I read the article and my jaw fell wide open at the very end….”

Funding: The research has been sponsored by the Dutch Dairy Association.

Conflicts of interest: Dr. Peters is a employed by the Dutch Dairy Association as manager of dairy health and sustainability. Dr. Huppertz is employed by FrieslandCampina, The Netherlands and is a professor of Dairy Science at Wageningen University and Research, The Netherlands, Distinguished Visiting Professor at Victoria University, Australia and Editor-in-Chief of International Dairy Journal. Dr. Bloom and Dr. van Est are the founders of Nutrisoft. A (commercial) company that combines the knowledge of nutrition and ICT.

Comment: FrieslandCampina is a large dairy cooperative operating in 38 countries and employing nearly 24,000 people.   It sponsors research at Wageningen University.

Milk and dairy may be at the heart of what we do, but at FrieslandCampina, we make more than just cheese and yogurt. We also produce dairy nutrition for specific groups of consumers, such as toddlers or adults with specific requirements.

Lindner was surprised by the disclosures and said “At least they are open and honest about it (they don’t even bother to hide it).”  He should not be surprised.  Industry-funded studies almost always produce results favorable to the sponsors’ interests.  That is one reason why journals require authors to disclose financial relationships with sponsors.

Here, the interests are obvious.  It is very much in the economic interests of dairy companies to demonstrate the nutritional superiority of dairy products over plant-based alternatives.

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.

So many readers have asked me to comment on the recent study comparing the nutrient content of meat versus plant-based alternatives that I thought I better get to it.

For example, Andrew Wilder of eatingrules.com writes:

They conclude that there are nutritional differences…My first thought was “Duh!”… so I started wondering why they would even do this study…Surprise surprise, two of the authors have connections to the beef industry.  I also thought it was interesting that in the Abstract, they say “This has raised questions of whether plant‑based meat alternatives represent proper nutritional replacements to animal meat.” So they’re framing everything with the baseline that animal meat is “proper nutrition” which seems like a pretty obvious bias right out of the gate…

Indeed it does.  But the study is a bit more complicated than that, and definitely worth a look.

The study: A metabolomics comparison of plant‑based meat and grass‑fed meat indicates large nutritional differences despite comparable Nutrition Facts panels. Stephan van Vliet, James R. Bain Michael J. Muehlbauer, Frederick D. Provenza, Scott L. Kronberg, Carl F. Pieper & Kim M. Huffman. Nature Scientific Reports (2021) 11:13828.

The research question: Do plant‑based meat alternatives represent proper nutritional replacements to animal meat?

The method: The study compared 190 metabolites (chemical compounds capable of being used by the body) in meat and plant-based alternatives.

Result: Big differences.

Conclusion:  “In conclusion, metabolomics revealed that abundance of 171 out of 190 profiled metabolites differed between beef and a commercially-available plant-based meat alternative, despite comparable Nutrition Facts panels. Amongst identified metabolites were various nutrients (amino acids, phenols, vitamins, unsaturated fatty acids, and dipeptides) with potentially important physiological, anti-inflammatory, and/or immunomodulatory roles—many of which remained absent in the plant-based meat alternative when compared to beef and vice versa. Our data indicates that these products should not be viewed as nutritionally interchangeable, but could be viewed as complementary in terms of provided nutrients. It cannot be determined from our data if either source is healthier to consume [my emphasis].”

Competing interests: “S.V.V. reports a grant from the North Dakota Beef Association to study the impact of diet quality on the relationship between red meat and human health. S.V.V reports additional grant support from USDA-NIFA-SARE (LS21-357), the Turner Institute of Ecoagriculture, and the Dixon Foundation for projects that link agricultural production systems to the nutritional/metabolite composition of foods and human health. S.V.V also reports having received honoria [sic] for talks linking food production systems to human health, which was used to support scientific research. F.D.P. reports receiving honoraria for his talks about behavior-based management of livestock. J.R.B., M.J.M., S.L.K., C.F.P., and K.M.H report no conflicts. S.V.V., J.R.B., M.J.M., F.D.P., S.L.K., and C.F.P. consume omnivorous diets; K.M.H. consumes a vegetarian diet.”

Comment: To the question of nutritional differences, duh, indeed.  Why would anyone not expect nutritional differences?  From the abstract and conclusion, the study appears to suggest that meat is nutritionally better.

But then, the authors throw in those hedge-betting comments.

Really?   If they can’t figure out which is better, why do this study?

Andrew Wilder’s analysis and mine too: the underlying purpose of this study is to demonstrate the nutritional superiority of meat and the lack of equivalence of plant-based substitutes.

As for the conflicted interests: My first reaction to seeing this study was to ask: “Who paid for this?”

But the reported conflicts are somewhat confusing.  The lead author has meat-industry funding to do studies of this type.  But most of the other authors report no conflicts, and one is a vegetarian.

Maybe the vegetarian was responsible for the hedging comments?

Yesterday, I posted information about the forthcoming UN Summit on Food Systems (UNFSS) and its Pre-Summit.  The Summit has been heavily criticized on the grounds that it:

• Sets agenda themes determined by corporate entities such as The World Economic Forum and the Gates Foundation.
• Favors corporate technological solutions to food system problems.
• Ignores agroecology, organic farming, and indigenous knowledge.
• Excludes meaningful representation from people most affected by food system transformation.
• Promotes corporate control of food systems.
• Ignores the conflicted interests of its organizers.
• Is fundamentally undemocratic.

These criticisms are so severe that The Civil Society and Indigenous Peoples’ Mechanism for Relations with the UN (CSM) is organizing counter events July 25 to July 27.

• Download and share this call to action
• Learn more about CSM’s position as regards the UN Food Systems Summit

Much has been written to document such concerns.

Civil Society and Indigenous Peoples Mechanism, North America: UN Food System Summit “Dialogue” events spark renewed concerns of corporate capture in North American food system and rural economies globally

In March 2020, 550 civil society organizations sent an open letter to the United Nations (UN) Secretary-General condemning the involvement of the World Economic Forum in the UNFSS, the appointment of Ms. Agnes Kalibata as UNFSS Special Envoy due to her links to corporate agribusiness, the failure of the UNFSS to elevate the primacy and indivisibility of human rights frameworks as foundational to the governance of food systems, and the necessity of civil society organizations to have an autonomous, self-organized, and equal ‘seat at the table.’ These concerns have not been addressed despite numerous CSM interactions with UNFSS organizers.

The International Panel of Experts on Sustainable Food Systems (IPES): An IPCC [Intergovernmental Panel on Climate Change] for Food?”  How the UN Food Systems Summit is being used to advance a problematic new science-policy agenda.

Behind what sounds like a technocratic question is in fact a high-stakes battle over different visions of what constitutes legitimate science and relevant knowledge for food systems. This, in turn, is part of a broader battle over what food systems should look like and who should govern them.

Matthew Canfield, Molly D. Anderson and Philip McMichael.  UN Food Systems Summit 2021: Dismantling Democracy and Resetting Corporate Control of Food Systems.  Front. Sustain. Food Syst., 13 April 2021. [Note: this paper has an especially useful historical account of attempts to establish global food system governance]

Although few people will dispute that global food systems need transformation, it has become clear that the Summit is instead an effort by a powerful alliance of multinational corporations, philanthropies, and export-oriented countries to subvert multilateral institutions of food governance and capture the global narrative of “food systems transformation”…It elaborates how the current structure and forms of participant recruitment and public engagement lack basic transparency and accountability, fail to address significant conflicts of interest, and ignore human rights.

Independent scientists:  Open letter to policy makers: No new science-policy interface for food systems.

We call on governments and policymakers to…Support participatory processes that actively and meaningfully include plural perspectives and voices in food system governance. Farmers and other citizens need inclusive, participatory, and safe spaces within the CFS-HLPE process to co-create the knowledge necessary to govern food systems at global, national and local levels.

Maywa Montenegro, Matthew Canfield, and Alastair Iles.  Weaponizing Science in Global Food Policy.

Nobody disputes the need for urgent action to transform the food system. But the UNFSS has been criticized by human rights experts for its top-down and non-transparent organization. Indigenous peoples, peasants, and civil society groups around the world know their hard-won rights are under attack. Many are protesting the summit’s legitimacy and organizing counter-mobilizations.

Scientists are also contesting a summit because of its selective embrace of science, as seen in a boycott letter signed by nearly 300 academics, from Brazil to Italy to Japan.

Through the Summit, “science” has been weaponized by powerful actors not only to promote a technology-driven approach to food systems, but also to fragment global food security governance and create institutions more amenable to the demands of agribusiness.

Scientists: An open letter from scientists calling for a boycott of the 2021 Food Systems Summit.

Some critics of the UNFSS have suggested ways that the process could become less problematic: (1) it could incorporate a human rights framing into all of its “action tracks”; (2) it could create an action track led by the CSM on the corporate capture of food systems; and (3) it could designate the UN Committee on World Food Security as the institutional home to implement recommendations coming out of the summit.

Nisbett N, et al.  Equity and expertise in the UN Food Systems Summit.  BMJ Global Health. 2021;6:e006569.

…time is not late to take action in rebalancing powers and enabling a greater diversity of knowledge, not simply among a multiplicity of voices in multiple public forums, but explicitly engaged at the summit’s top table of expertise and summit leadership. It is also not late to adopt mechanisms that limit the engagement of those actors whose primary interests have driven our food systems to
become unhealthy, unsustainable and inequitable, so the voices of the people can be clearly heard..

An alternative: The Global People’s Summit on Food Systems

The People’s Summit is composed primarily of movements of landless peasants, agricultural workers, fisherfolk, indigenous people, rural women, and youth—or small food producers who produce 70% of the world’s food, yet remain among the world’s poorest and food insecure.  “The issue of landlessness and land grabbing is not on the agenda of the UNFSS.  Nowhere in its so-called Action Tracks do discussions highlight critical trends such as on land concentration and reconcentration in the hands of big agribusiness firms and their network of local landlords and compradors, nor on the massive displacement of rural communities to give way to big private investments and large development projects,” said Chennaiah Poguri, chairperson of the Asian Peasant Coalition (APC).

Additions

• Video explaining “multistakeholderism”
• Links (ongoing) to papers on the UN Food System Summit

By this time, a great many research studies have associated eating nuts—of any kind—with good health.  Nuts have fats and, therefore, calories (150-200 per ounce).

The nut industry would like to minimize concerns about fats and calories.  It funds research to demonstrate that nut fats are healthy (which they are) and that you don’t have to worry about the calories (which you do, depending on what else you eat).  Hence:

The study: Almond Bioaccessibility in a Randomized Crossover Trial: Is a Calorie a Calorie?  Nishi SK, et al.  Mayo Clinic Proceedings, 2021;nn(n):1-12, Published April 11, 2021.

Methods: This is a clinical trial in which subjects with hyperlipidemia consumed about 1 or 2 ounces a day of almonds versus muffins with equivalent calories.

Results: “Almond-related energy bioaccessibility was 78.5%±3.1%, with an average energy loss of 21.2%±3.1% (40.6 kcal/d in the full-dose almond phase).”

Conclusion:  “Energy content of almonds may not be as bioaccessible in individuals with hyperlipidemia as predicted by Atwater factors, as suggested by the increased fat excretion with almond intake compared with the control.”

Comment #1: The authors went to a lot of expensive trouble to demonstrate what has been known for a long time: almonds as typically consumed have only about 80% of the calories listed in standard tables.  This is because some of the fat is excreted rather than absorbed.  Chewing is not as efficient as machine grinding in separating fat from fiber.  When nuts are machine ground, their fats are more fully released and their calories similar to values obtained in calorimeters.

So guess who paid for this?

Grant Support: …the Almond Board of California…[and several other sources].

Potential competing interests: Where to begin?  The list takes three full columns of printed page.  Several of the authors report grants or consulting arrangements with entities such as the Almond Board of California, American Peanut Council, International Nut & Dried Fruit Council (INC), International Tree Nut Council Research and Education Foundation, California Walnut Commission, Peanut Institute, and the International Tree Nut Council.  But authors also report funding relationships that seem irrelevant to this study, such as the Dairy Farmers of Canada, Ocean Spray, the Saskatchewan & Alberta Pulse Growers Associations, and Beyer Consumer Care.  Even odder are reports of an honorarium from the USDA for a lecture; travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association (CDA); and, most unnecessarily, a book about vegetarian diets published by the daughters of one of the authors.

Comment #2:  I think disclosure statements like these are disrespectful of the disclosure requirement.  In this case, because several of the authors have so many financial relationships with food and drug companies, a listing of the nut-industry connections would have sufficed.  These alone would make it clear that these authors have conflicted interests that might deserve consideration in interpreting the study results.

The review:  Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting .  Yanni Papanikolaou, Joanne L Slavin, Roger Clemens, J Thomas Brenna, Dayle Hayes, Glenn A Gaesser, Victor L Fulgoni, III.  Current Developments in Nutrition, Volume 4, Issue 10, October 2020, nzaa125.

Method: “A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes.

Results: 

1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns,

2) whole and refined grain foods contribute nutrient density,

3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet,

4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and

5) gaps exist in the scientific literature with regard to grain foods and health.“

Supported by the Grain Foods Foundation.  The sponsors (Grain Foods Foundation) had no role in the design of the study or in the collection, analyses, or interpretation of the data.

Author disclosures: YP, as President of Nutritional Strategies, provides food, nutrition, and regulatory affairs consulting services for food and beverage companies and food-related associations and collaborates with VLF on NHANES analyses. VLF, as Senior Vice President of Nutrition Impact, provides food and nutrition consulting services for food and beverage companies. VLF also conducts analyses of NHANES data for members of the food industry. JLS, RC, JTB, DH, and GAG all received an honorarium and travel expenses in the current scientific collaboration.

Comment: The Grain Foods Foundation commissioned the panel and paid the panel participants for their service and travel.  For the authors, this was a paid gig.  The Foundation got what it paid for.  About results #1, 2, and 5, there can be no argument.  #1 and #2 are obvious and did not require a scientific panel to come to those conclusions: even refined grains have nutritional value, not least because they are fortified with several key nutrients.   That’s why these authors consider fortification and enrichment to be “vital.”

What this really is about is to demonstrat that refined grains are healthy and do no harm (#4).  But refined grains are major components of ultra-processed foods, which cause people who eat them to take in more calories than they recognize or need (see Hall et al, 2019) and are strongly associated with higher levels of obesity, chronic disease, and mortality.  Despite dozens of studies consistently linking ultra-processed foods to these conditions, this industry-sponsored panel says the evidence is inconclusive.

The underlying purpose of this study, therefore, is to cast doubt on the connection between refined grains, ultra-processed foods, and weight gain.

With independently funded research, even by biased researchers, the underlying purpose is usually explicit.

–Thanks to Lisa Young for alerting me to this one.

Conclusion: “Addition of mushrooms to USDA Food Patterns increased several micronutrients including shortfall nutrients (such as potassium, vitamin D and choline), and had a minimal or no impact on overall calories, sodium or saturated fat.”