by Marion Nestle
Oct 14 2013

Annals of Nutrition Science: Coca-Cola 1; NHANES 0

I got called by a couple of reporters asking for comment on a paper just published in PLoS One, an online, open-access—and highly respected (at least until now)—medical journal.

The paper examines the validity of calorie-intake estimations obtained from the National Health and Nutrition Examination Survey (NHANES) from 1971 to 2010 (click on Download to see the entire paper).

Its “shocking” conclusion: people underreport calorie intake on surveys.

My first comment to reporters: duh.

The authors present—-as if it were a bombshell—-something that has been known for years: people underreport food intake, usually by a third or more, and obese respondents underreport even more.   The study quantifies the degree of underreporting and comes to conclusions no different from those reported for decades.

Question #1: Why would anyone do a study like this?  Answer:  Look who sponsored it: Coca-Cola!

Question #2: Why would Coca-Cola want to fund a study to cast doubt on information derived from NHANES:  See the Abstract:

The confluence of these results and other methodological limitations suggest that the ability to estimate population trends in caloric intake and generate empirically supported public policy relevant to diet-health relationships from U.S. nutritional surveillance is extremely limited.

And see the paper’s conclusion:

As such, there are no valid population-level data to support speculations regarding trends in caloric consumption and the etiology of the obesity epidemic.

Got that?  If data from NHANES are not valid, then studies showing a correlation between sodas and obesity are not valid, and recommendations to drink less soda are unjustified.

This study, then, is a classic example of why food industry sponsorship of nutrition research is so pernicious.  Coca-Cola is systematically recruiting sympathetic nutrition researchers to cast doubt on science linking soda consumption to health problems.

Question #3: Why would a prestigious journal like PLoS One publish something like this?  The science in this article passed peer review.  Evidently nobody considered that politics might have something to do with the design of the study and its conclusions.

I’m guessing that PLoS One editors have become complacent.  The journal just came up smelling like roses in a Science Magazine sting operation examining the quality of peer review in open-access scientific journals.  The author sent an evidently false paper to hundreds of such journals.  Of 106 that said they did peer review, 70% accepted the paper.  But PLoS One turned it down for the right reasons.

If you think that science has nothing to do with politics, Coca-Cola vs. NHANES is a good reason to reconsider.


    Its not a surprise Marion, that when something goes against complete logic and common sense that if you follow the trail, you will find big money at the end. If Coca Cola lived in a vacuum where no one would drink it, then it would be correct in saying that it doesnt contribute to obesity. But they don’t live in a vacuum and people do drink it.

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  • Leoluca Criscione

    I fully agree: that it is “Science” that creates and feeds the confusion” (this is also a chapter in our book: Eating healthy and dying obese”).

    Regarding the key issue of people “underreporting food intake”, I would like to make you aware of the experience we have made in our Nutritional Practice in Basel. Our approach (as described in our book) is the classical energy balance one, but based on a MEASURED Resting Metabolic Rate (mRMR) to assess INDIVIDUAL Total Daily Energy Expenditure (TDEE).

    At the the last ECO2013 (European Congress on Obesity), we presented data from lean, overweight and obese participants with this approach, named Calogenetic Balance** (see a copy of the poster with this link).

    The most relevant part of this experience, in relation to “inderreporting”, is the fact that “underreporting” disappears, once a given person is made aware of the importance of individual mRMR for assesing the own personal TDEE (as described in the book)!

    As stated in the conclusions of our poster, all participants were of the opinion that the familiarity with the own real metabolic capacity (mRMR) gives security, removes confusion and promotes motivation and adherence…and let me add: It makes “unterreporting” almost impossible!!!

    I would appreciate your comment

    Kind regards

    ** We named the approach “Calogenetic Balance”, just to indicate that all factors influencing the energy balance (including the “bad” and “good ” genes) and finally the TDEE, have to influence the mRMR


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  • Jean-Claude Moubarac

    Great article; that was my instinct reaction when I read the paper…….thank you very much!

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  • Was hoping you’d comment on the even more important question here, which is how we should interpret the various studies based on NHANES data–an ongoing collection effort despite its methodological flaws!– given this finding which takes a well-recognized truth about self-reported consumption and applies it specifically to NHANES.

    I too saw the Coke funding, had no difficulty connecting the dots between their interest and the study’s outcome – but that doesn’t change the facts regarding NHANES data problems. I keep hoping some of our health policy thought leaders will comment on this broader issue but haven’t seen much beyond pokes at Coke’s sponsorship and the “duh” nature of the finding.

  • MrPete

    As noted in the study, while funding came from conflicted sources, “The sponsor of the study had no role in the study design, data
    collection, data analysis, data interpretation, or writing of the
    report, and does not alter the authors’ adherence to all the PLOS ONE
    policies on sharing data and materials.”

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