Currently browsing posts about: Conflicts-of-interest

You might not think that avocados need any special sales efforts, but the Haas Avocado marketers are particularly aggressive in funding research to demonstrate the health benefits of this food.

I’ve written about Haas-funded avocado research previously (most recently, here and here) but here’s yet another, this time initiated by a tweet:

I think avocados are fine foods, love them, but wish their marketers would not do this.  Here’s the Good News Network headline: “An Avocado a Day May Keep Your Gut Microbes Happy, Study Shows.”  As always, the operative word is “may.”  The headline would be equally correct saying “may not.”

The study: Avocado Consumption Alters Gastrointestinal Bacteria Abundance and Microbial Metabolite Concentrations among Adults with Overweight or Obesity: A Randomized Controlled Trial. Sharon V Thompson, Melisa A Bailey, Andrew M Taylor, Jennifer L Kaczmarek, Annemarie R Mysonhimer, Caitlyn G Edwards, Ginger E Reeser, Nicholas A Burd, Naiman A Khan, Hannah D Holscher.  The Journal of Nutrition, Volume 151, Issue 4, April 2021, Pages 753–762.

Conclusions: “Daily avocado consumption resulted in lower fecal bile acid concentrations, greater fecal fatty acid and SCFAs, and greater relative abundances of bacteria capable of fiber fermentation, providing evidence that this nutrient-dense food affects digestive physiology, as well as the composition and metabolic functions of the intestinal microbiota.”

Funding: Support for this research was provided by the Hass Avocado Board and the USDA National Institute of Food and Agriculture, Hatch project 1009249.

Author disclosures: NAB, NAK, and HDH received grant funding from the Hass Avocado Board.

Comment: All fruits and vegetables provide nutritional value and the best way to get the nutrients you need is by eating a variety of them.  If you like avocados, include them in that variety.  If not, don’t.

The Haas marketers want you to think that avocados are a superfood.  Alas, there is no such thing.  All fruits and vegetables provide nutritional value.  By that criterion, all fruits and vegetables are superfoods.

Here’s an example of how Haas advertises:

Did you know fresh avocados can be part of the MyPlate food guide?

• Make half your plate fruits and vegetables.

Avocados are a nutrient-dense fruit with naturally good fats and are easily incorporated into various meals and snacks. One serving (50g or one-third of a medium avocado) has only 80 calories and contributes nearly 20 vitamins, minerals, and phytonutrients along with dietary fiber.

The same could be said for most other fruits and vegetables, although most will be lower in calories.

Nutritional Viewpoints on Eggs and Cholesterol. by Michihiro Sugano and Ryosuke Matsuoka.  Foods 2021, 10(3), 494; https://doi.org/10.3390/foods10030494

Opinion:  This review says that although Japanese people eat more eggs than Americans, they may be protected against higher cholesterol levels due to the differences in everything else they eat (more seafood, for example?).

Conclusion: “Although randomized controlled trials with long-term follow-up are required to evaluate the association between consumption of eggs and human health, available information, at least from the nutritional viewpoint, suggests that egg is a healthy and cost-efficient food worldwide.”

Conflicts of interest: “M.S. declares no conflicts of interest, and R.M. is an employee of Kewpie Corporation. There are no other patents, products in development, or marketed products to declare. Kewpie Corporation has no conflicts of interest with this research.”

Comment: Really?  No conflicts of interest?  But Kewpie is Japan’s #1 mayonaise company.  Kewpie says that it “uses about four billion eggs a year. Recognizing that eggs contain all the necessary ingredients for creating life, we continually study ways of effectively utilizing such ingredients and manufacture fine chemicals for use in a broad range of food, cosmetic, and pharmaceutical applications.”

One of those ways, apparently, is to get its employees to write opinion pieces like this.

With that said, concerns about eggs and cholesterol have diminished in recent years.  The 2020 Dietary Guidelines for Americans says not a word about eggs and cholesterol; it just recommends eggs as a source of protein.  A study in the American Heart Association Journal finds no association between eggs and heart disease mortality.

The American Heart Association notes that eggs are the leading source of dietary cholesterol but their negative effects may be confounded by the fact that they are so often eaten with bacon and sausage.  The AHA egg recommendations:

• Vegetarians (lacto-ovo) who do not consume meat-based cholesterol-containing foods may include more dairy and eggs in their diets within the context of moderation discussed herein.
• Patients with dyslipidemia, particularly those with diabetes mellitus or at risk for heart failure, should be cautious in consuming foods rich in cholesterol.
• For older normocholesterolemic patients, given the nutritional benefits and convenience of eggs, consumption of up to 2 eggs per day is acceptable within the context of a heart-healthy dietary pattern.

And even with that said, the authors should have disclosed Kewpie’s evident conflicted interests.

Dietary Patterns and Nutritional Status in Relation to Consumption of Chickpeas and Hummus in the U.S. Population.  by  Cara L. Frankenfeld and Taylor C. Wallace.   Appl. Sci. 2020, 10(20), 7341; https://doi.org/10.3390/app10207341

Conclusion: ” Adults who consumed chickpeas and hummus were 48% and 62% less likely to have metabolic syndrome, respectively. Consuming chickpeas or hummus may be a practical means of improving diet quality and nutritional status. ”

Funding:  This research was funded by an investigator-initiated, unrestricted educational grant from Sabra Dipping Co., LLC.

Comment: That’s what they all say about the sponsor’s role, despite substantial evidence to the contrary (in many other cases).  Sabra is owned by PepsiCo.

Hat tip: To Daniel Bowmn Simon for sending me this one.

The Study:  Maaike J. Bruins and Ulla Létinois. Adequate Vitamin D Intake Cannot Be Achieved within Carbon Emission Limits Unless Food Is Fortified: A Simulation Study.  Nutrients 2021, 13(2), 592; https://doi.org/10.3390/nu13020592

Conclusion: The present study shows that adequate intakes for vitamin D cannot be achieved with the current diet alone within realistic calorie and carbon emission limits, and additional vitamin D sources are needed to overcome the shortfalls. Universal fortification along with small dietary shifts represents an approach to improve the vitamin D status of the general population, at a high acceptability without affecting the carbon footprint.

Conflicts of Interest: M.J.B. and U.L. are employed by DSM Nutritional Products, a manufacturer of nutritional ingredients.

Comment: Study after study shows that vitamin D supplements do not make healthy people healthier, but the idea persists and supplement companies take advantage of faith in these products.  Well, there isn’t much evidence for harm either, but sunshine on skin is a better source by far.

OK.  I know there’s a big controversy about this.

Here’s a study that shows benefits for patients with COVID; supplements were associated with keeping people out of intensive care.  One of its authors has financial ties to supplement companies, but the study has been criticized on other grounds as has a member of the British Parliament who thinks it provides evidence for supplementing everyone.

And here’s an independently funded study in JAMA shows that vitamin D to have no effect on patients hospitalized with Covid-19.

This one, comes with an editorial.

Given the lack of highly effective therapies against COVID-19, except perhaps for corticosteroids, it is important to remain open-minded to emerging results from rigorously conducted studies of vitamin D (despite smaller sample sizes and important limitations of some studies). However, taken together with existing randomized clinical trials of vitamin D administration in hospitalized patients with respiratory infection and critical illness, the results reported by Murai et al¹² do not support routine administration of vitamin D in hospitalized patients with moderate to severe COVID-19.

Fortunately, vitamin D supplements are unlikely to be harmful unless taken in very large doses.

Sunshine, anyone?

As a general rule, industry-funded studies produce results favorable to the sponsor’s interests.  But what have we here?

The study: A Systematic Review and Meta-Analysis of Randomized Controlled Trials on the Effects of Oats and Oat Processing on Postprandial Blood Glucose and Insulin Responses.  Kathy Musa-Veloso, Daniel Noori, Carolina Venditti, Theresa Poon, Jodee Johnson, Laura S Harkness, Marianne O’Shea, YiFang Chu.  The Journal of Nutrition, Volume 151, Issue 2, February 2021, Pages 341–351.

Results: the consumption of thick—but not thin—oat flakes was associated with significant reductions in postprandial blood glucose and insulin responses.

Conclusion: “Relative to a refined grain control food with the same amount of available carbohydrate, the postprandial glycemic and insulin responses elicited by intact oat kernels and thick oats were significantly reduced. The postprandial glycemic and insulin responses with thin/instant/quick oats were not significantly different from those elicited by the refined grain control.”

Funding: The systematic review and meta-analysis, as well as the writing of the manuscript, were funded by PepsiCo, Inc.

Author disclosures: “KM-V, DN, CV, and TP are employees of Intertek Health Sciences Inc., which has provided consulting services to PepsiCo, Inc. JJ, MO, and YC are employees of PepsiCo, Inc., which manufactures oatmeal products under the brand name Quaker Oats and which funded this systematic review and meta-analysis. LSH is a former employee of PepsiCo, Inc.  The views expressed in this article are those of the authors and do not necessarily reflect the opinion or policies of Intertek Health Sciences Inc. or PepsiCo, Inc.”

Comment:  This is a PepsiCo study paid for by the company and conducted by employees or contractors.  PepsiCo owns Quaker Oats instant oatmeal.  In the late 1980s, oat bran was a craze.  Everyone I knew was sprinkling oat bran on everything they ate as a means to reduce their blood cholesterol levels.  Even then, there were real questions about whether oats had any special effects on blood cholesterol levels.   But the idea has persisted.  This study demonstrates that oats might have metabolic benefits, but only if they are thick, whole-grain, and minimally processed.  Instant oatmeal is not in that category.  I wonder what the company’s reaction is to this study, whether it intends to fund more like it, and whether it will us thicker oats in its Quaker products.

I’ve been collecting items about meat.  This is a good week to post them, starting with this.

The study:  Effects of Total Red Meat Intake on Glycemic Control and Inflammatory Biomarkers: A Meta-Analysis of Randomized Controlled Trials. Lauren E O’Connor, Jung Eun Kim, Caroline M Clark, Wenbin Zhu, and Wayne W Campbell. . Adv Nutr 2021;12:115–127.

Conclusion:  “Total red meat consumption, for up to 16 weeks, does not affect changes in biomarkers of glycemic control or inflammation for adults free of, but at risk for, cardiometabolic disease.”

Funder (my emphasis): “This study was funded by The Pork Checkoff and Purdue University’s Bilsland Dissertation Fellowship (LEO). The funder had no role in the design or conduct of the study or the analysis or interpretation of data.

Author disclosures: LEO received honoraria and travel to present related research as a graduate student from the National Cattlemen’s Beef Association. During the time this research was conducted, WWC received funding for research grants, travel, or honoraria for scientific presentations or consulting services from the following organizations: National Cattlemen’s Beef Association, National Pork Board, National Dairy Council, North Dakota Beef Commission, Foundation for Meat and Poultry Research and Education, Barilla Group, New York Beef Council, and North American Meat Institute. All the other authors report no conflicts of interest.

Comment:  Red meat is under attack for its strong association with health problems, cancer in particular.  In the 24 studies this group looked at, selected out of nearly 1200, they found no bad effects.  This is a typical result for an industry-funded study conducted by investigators with industry ties.  It would be more reassuring if found by independent investigators.

The study: Effects of Unsweetened Preloads and Preloads Sweetened with Caloric or Low-/No-Calorie [LNCS] Sweeteners on Subsequent Energy Intakes: A Systematic Review and Meta-Analysis of Controlled Human Intervention Studies.  Han Youl Lee, Maia Jack, Theresa Poon, Daniel Noori, Carolina Venditti, Samer Hamamji, Kathy Musa-Veloso.  Advances in Nutrition, nmaa157, https://doi.org/10.1093/advances/nmaa157

Conclusions:  “These findings suggest that LNCS-sweetened foods and beverages are viable alternatives to CS-sweetened foods and beverages to manage short-term energy intake.

Funder: The American Beverage Association provided funding for the work presented herein.

Author disclosures: MJ is a paid employee of the American Beverage Association. Intertek Health Sciences, Inc.(HYL, TP, DN, CV, SH, KMV), works for the American Beverage Association as paid scientific and regulatory consultants.

Comment: This is a study paid for by the American Beverage Association, a trade association for the makers of soft drinks, sweetened with sugars or artificial sweeteners, conducted in-house.  Its purpose is to demonstrate that artificial and low-calorie sweeteners will help you lose weight, something that independently funded studies often do not.  I’d classsify this as marketing research.  I don’t think it belongs in professional journals published by the American Society for Nutrition.  We need a new journal for this, as Corinna Hawkes of City University London once suggested, “The Journal of Industry-Funded Research.”

Selenium, antioxidants, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis of randomized controlled trials. David JA Jenkins, David Kitts, Edward L Giovannucci, Sandhya Sahye-Pudaruth, Melanie Paquette, Sonia Blanco Mejia, Darshna Patel, Meaghan Kavanagh, Tom Tsirakis, Cyril WC Kendall, Sathish C Pichika, and John L Sievenpiper.  The American Journal of Clinical Nutrition, Volume 112, Issue 6, December 2020, Pages 1642–1652

Background: “Antioxidants have been promoted for cardiovascular disease (CVD) risk reduction and for the prevention of cancer. Our preliminary analysis suggested that only when selenium was present were antioxidant mixtures associated with reduced all-cause mortality.”

Results: No association of selenium alone or antioxidants was seen with CVD and all-cause mortality. However, a decreased risk with antioxidant mixtures was seen for CVD and all-cause mortality when selenium was part of the mix.

Conclusion: The addition of selenium should be considered for supplements containing antioxidant mixtures if they are to be associated with CVD and all-cause mortality risk reduction.

Comment: The results are statistically significant, but not by much (RR: 0.90; 95% CI: 0.82, 0.98; P = 0.02); the Confidence Interval reaches 0.98, which is very close to 1.00, which would show no difference.  But that’s not the real reason for my interest in this one.  The real reason in this astounding conflicts-of-interest statement and the disclaimer that follows it.

Conflicts of interest

DJAJ has received research grants from Loblaw Companies Ltd, the Almond Board of California, Soy Nutrition Institute (SNI), and the Canadian Institutes of Health Research (CIHR). He has received in-kind supplies for trials as a research support from the Almond Board of California, Walnut Council of California, American Peanut Council, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, and WhiteWave Foods. He has been on the speakers’ panel, served on the scientific advisory board, and/or received travel support and/or honoraria from the Loblaw Companies Ltd, Diet Quality Photo Navigation (DQPN), Better Therapeutics (FareWell), Verywell, True Health Initiative (THI), Heali AI Corp, Institute of Food Technologists (IFT), Soy Nutrition Institure (SNI), Herbalife Nutrition Institute (HNI), Herbalife International, Pacific Health Laboratories, Nutritional Fundamentals for Health (NFH), the Soy Foods Association of North America, the Nutrition Foundation of Italy (NFI), the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society (CNS), and the American Society of Nutrition (ASN). He received an honorarium from the USDA to present the 2013 W. O. Atwater Memorial Lecture. He is a member of the International Carbohydrate Quality Consortium (ICQC). His wife, Alexandra L Jenkins, is a director and partner of INQUIS Clinical Research for the Food Industry; his 2 daughters, Wendy Jenkins and Amy Jenkins, have published a vegetarian book that promotes the use of the plant foods advocated here, The Portfolio Diet for Cardiovascular Risk Reduction; and his sister, Caroline Brydson, received funding through a grant from the St. Michael’s Hospital Foundation to develop a cookbook for one of his studies. CWCK has received grants or research support from the Advanced Food Materials Network, Agriculture and Agri-Foods Canada (AAFC), Almond Board of California, American Peanut Council, Barilla, Canadian Institutes of Health Research (CIHR), Canola Council of Canada, International Nut and Dried Fruit Council, International Tree Nut Council Research and Education Foundation, Loblaw Brands Ltd, Pulse Canada, and Unilever. He has received in-kind research support from the Almond Board of California, American Peanut Council, Barilla, California Walnut Commission, Kellogg Canada, Loblaw Companies, Quaker (PepsiCo), Primo, Unico, Unilever, and WhiteWave Foods/Danone. He has received travel support and/or honoraria from the American Peanut Council, Barilla, California Walnut Commission, Canola Council of Canada, General Mills, International Nut and Dried Fruit Council, International Pasta Organization, Loblaw Brands Ltd, Nutrition Foundation of Italy, Oldways Preservation Trust, Paramount Farms, Peanut Institute, Pulse Canada, Sun-Maid, Tate & Lyle, Unilever, and White Wave Foods/Danone. He has served on the scientific advisory board for the International Tree Nut Council, International Pasta Organization, McCormick Science Institute, and Oldways Preservation Trust. He is a member of the International Carbohydrate Quality Consortium (ICQC), is Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD and a director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of Health Research (CIHR), Diabetes Canada, PSI Foundation, Banting and Best Diabetes Centre (BBDC), American Society for Nutrition (ASN), INC International Nut and Dried Fruit Council Foundation, National Dried Fruit Trade Association, The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), and the Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council). He has received in-kind food donations to support a randomized controlled trial from the Almond Board of California, California Walnut Commission, American Peanut Council, Barilla, Unilever, Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, WhiteWave Foods, and Nutrartis. He has received travel support, speaker fees, and/or honoraria from Diabetes Canada, Dairy Farmers of Canada, FoodMinds LLC, International Sweeteners Association, Nestlé, Pulse Canada, Canadian Society for Endocrinology and Metabolism (CSEM), GI Foundation, Abbott, Biofortis, ASN, Northern Ontario School of Medicine, INC Nutrition Research & Education Foundation, European Food Safety Authority (EFSA), Comité Européen des Fabricants de Sucre (CEFS), and Physicians Committee for Responsible Medicine. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, Wirtschaftliche Vereinigung Zucker e.V., and Inquis Clinical Research. He is a member of the European Fruit Juice Association Scientific Expert Panel and Soy Nutrition Institute (SNI) Scientific Advisory Committee. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the Study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Obesity Canada. He serves or has served as an unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and the Technical Committee on Carbohydrates of the International Life Science Institute (ILSI) North America. He is a member of the International Carbohydrate Quality Consortium (ICQC), executive board member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His wife is an employee of AB InBev. DK, ELG, SS-P, MP, SBM, DP, MK, TT, and SCP have no conflicts of interest to declare.

Disclaimer: The authors have no relevant conflicts of interest over the past 4 y. DJAJ has received funds for dietary studies from Loblaws, which, during the course of his funding, acquired Shopper’s Drugmart, which is a pharmaceutical company that also sells supplements.

Comment: Here’s one reason why I am not a fan of dietary supplements.  Most independently funded studies show no significant benefit when they are given to healthy people.  The industry needs studies like these for marketing purposes.  I’m not, but if you are worried about selenium, try food.