by Marion Nestle

Search results: children's nutrition

Mar 26 2019

Pediatric Academy and Heart Association endorse soda taxes!

The American Academy of Pediatrics (AAP)) and the American Heart Association (AHA) have issued a joint statement endorsing soda taxes along with other policies aimed at reducing risks for childhood obesity (the full statement is published in Pediatrics).

The AAP and AHA recommend:

  • Local, state and national policymakers should consider raising the price of sugary drinks, such as via an excise tax, along with an accompanying educational campaign. Tax revenues should go in part toward reducing health and socioeconomic disparities.
  • Federal and state governments should support efforts to decrease sugary drink marketing to children and teens.
  • Healthy drinks such as water and milk should be the default beverages on children’s menus and in vending machines, and federal nutrition assistance programs should ensure access to healthy food and beverages and discourage consumption of sugary drinks.
  • Children, adolescents, and their families should have ready access to credible nutrition information, including on nutrition labels, restaurant menus, and advertisements.
  • Hospitals should serve as a model and establish policies to limit or discourage purchase of sugary drinks.

Comment:  This action of the AAP is truly remarkable.  In 2015, this Academy was heavily criticized for taking funding from Coca-Cola and, surely not coincidentally, saying little about the need for children to reduce consumption of sugary drinks.  Once exposed, the AAP said it could no longer accept that funding. I did, however, hear an alternative story.  Coca-Cola officials told me that as a result of their transparency initiative, the company would no longer fund the Pediatric, Dietetic, and Family Practice Academies.  It is also hardly a coincidence that now that the AAP no longer takes money from Coke, it is free to promote soda taxes as a useful public health strategy.

Jan 9 2017

FoodNavigator-USA’s Special Edition on Snack Foods

I always like to share FoodNaviagator-USA’s special editions—collections of articles on one theme, in this case, what’s happening with snacks from the industry’s perspective.

Special Edition: Snacking trends 

What’s hot in snacks? Sprouted grains? Posh jerky? Chickpeas? Gourmet marshmallows? What’s the difference between a meal and a snack, or are the lines becoming increasingly blurred? What’s a suitable portion-size? This FoodNavigator-USA special edition explores the hottest new trends and brands in the market.

Jul 19 2016

Check out who funded this study of kids’ lunches in Brazil

Brazilian researchers have published a study clearly aimed at countering Brazil’s dietary guidelines, which the authors say, include advice to “avoid fast food.”

The study, which looked at the nutritional quality of children’s lunches, comes to three conclusions:

  1. The nutrition quality of lunch in fast food restaurants is similar to a typical Brazilian meal [Really?  Who paid for this?].
  2. The restaurant meals could fit into a balanced diet from time to time [Of course.  Anything can].
  3. Every meal observed here could be improved with regard to sodium and fiber to promote children’s health in adulthood [Ditto].

Did you guess?

The authors acknowledge Equilibrium Consultancy which led this study. Funding by McDonald’s Corporation for the project was primarily to Equilibrium.

This is yet another industry-funded study with results favorable to the sponsor’s interests.  These especially require scrutiny of hypotheses, methods, and interpretation and repetition by independently funded investigators.

Mar 28 2016

From research to policy: making school food healthier and more effective

Why anyone would be opposed to giving healthy food to kids in schools is beyond me, but school food is a flash point for political fights.

Sometimes research helps.  Two recent studies produce results that can be used to counter criticisms of government school meal programs.

Kids are eating more healthfully than they used to, according to a research study funded by the Department of Health and Human Services and the Robert Wood Johnson Foundation.  The study concludes:

Food policy in the form of improved nutrition standards was associated with the selection of foods that are higher in nutrients that are of importance in adolescence and lower in energy density. Implementation of the new meal standards was not associated with a negative effect on student meal participation. In this district, meal standards effectively changed the quality of foods selected by children.

This is excellent news for proponents of better school food.  USDA Secretary Tom Vilsack issued a statement:

This study is the latest in a long list of evidence which shows that stronger school meal standards are leading to healthier habits in schools. Children are eating more fruits and vegetables and consuming more nutrients, making them better prepared to learn and succeed in the classroom. After decades of a growing obesity epidemic that harmed the health and future of our children and cost our country billions, we are starting to see progress in preventing this disease. Now is not the time to take as step backwards in our efforts to do what is right for our children’s health. I urge Congress to reauthorize the child nutrition programs as soon as possible and to maintain the high standards set by the Healthy, Hunger-Free Kids Act.

Kids who eat breakfast in school are healthier.  Even if they have already had breakfast at home, kids who eat school breakfasts are less likely to be overweight or obese than those who don’t, finds a study from groups at U. Connecticut and Yale.

The press release explains:

The findings of the study…add to an ongoing debate over policy efforts to increase daily school breakfast consumption. Previous research has shown that, for students, eating breakfast is associated with improved academic performance, better health, and healthy body weight. But there have been concerns that a second breakfast at school following breakfast at home could increase the risk of unhealthy weight gain.

So now we know: they do not.

Research like this is unlikely to settle the matter but it ought to help school personnel who are working hard to make sure that kids get something decent to eat and to move ahead on school food initiatives.

Feb 2 2016

Food-Navigator’s Special Edition: Food for kids!

I greatly enjoy Food-Navigator’s collections of articles on specific topics.  Here’s one on marketing foods to kids.

While there is some evidence that the tide may now be turning on childhood obesity, 8.4% of US 2-5 year-olds; 17.7% of 6-11 year-olds and 20.5% of 12-19-year-olds are still obese, and many are lacking in essential nutrients from potassium, dietary fiber and calcium, to vitamin D. So how can the food industry respond to these concerns and develop more nutritious, but appealing snacks, meals and beverages for kids?

Addition, February 3: A reader reminds me that Food-Navigator published a guide to creating successful children’s brands a couple of months ago.

Aug 26 2015

Five more industry-funded studies with expected results. Score: 47 to 1

The Inadmissibility of What We Eat in America and NHANES Dietary Data in Nutrition and Obesity Research and the Scientific Formulation of National Dietary Guidelines. Archer EPavela GLavie CJ. Mayo Clin Proc. 2015 Jul;90(7):911-26. doi: 10.1016/j.mayocp.2015.04.009. Epub 2015 Jun 9.

  • Conclusion: we conclude that M-BM [memory-based dietary assessment methods] data cannot be used to inform national dietary guidelines and that the continued funding of M-BMs constitutes an unscientific and major misuse of research resources.
  • Funding: National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.
  • Potential Competing Interests: Dr Archer has received honoraria from the International Life Sciences Institute and The Coca Cola Company. Dr Lavie reports receiving consulting fees and speaking fees from The Coca-Cola Company….
  • Comment: This is part of what appears to be a concerted effort by Coca-Cola to discredit NHANES, the national survey of dietary intake and disease risk that consistently associates soda intake to poor health.

A high-protein breakfast prevents body fat gain, through reductions in daily intake and hunger, in “Breakfast skipping” adolescents.  Heather J. Leidy, Heather A. Hoertel, Steve M. Douglas, Kelly A. Higgins and Rebecca S. Shafer.  Obesity.  Article first published online: 4 AUG 2015.  DOI: 10.1002/oby.21185

  • Conclusions: The daily addition of a HP [high-protein] breakfast improved indices of weight management as illustrated by the prevention of body fat gain, voluntary reductions in daily intake, and reductions in daily hunger in breakfast skipping adolescents with overweight/obesity.
  • Funding: The Pork Checkoff supplied the funds to complete the study.
  • Disclosure: The authors declared no conflict of interest.
  • Comment: Industry-funded investigators typically state that funding does not introduce conflicts of interest.

Breakfasts Higher in Protein Increase Postprandial Energy Expenditure, Increase Fat Oxidation, and Reduce Hunger in Overweight Children from 8 to 12 Years of Age.  Jamie I Baum, Michelle Gray, and Ashley Binns.  J. Nutrition.  First published August 12, 2015, doi: 10.3945/jn.115.214551  J. Nutr. jn214551

  • Conclusion: This study indicates that breakfast macronutrient composition affects postprandial responses in both NW [normal weight] and OW [overweight] children. A PRO [protein-rich breakfast] increases postprandial EE [energy expendititure] and fat oxidation, reduces hunger, and increases satiety when compared with a carbohydrate-based breakfast.
  • Funding: Supported by a grant from the Egg Nutrition Center/American Egg Board, Chicago, IL. The Egg Nutrition Center/American Egg Board was not involved in the design, implementation, analysis, or interpretation of the data.
  • Author disclosures: JI Baum, M Gray, and A Binns, no conflicts of interest.
  • Comment: These industry-funded investigators also deny that funding introduces conflicts of interest.

The Effect of Breakfast vs. No Breakfast on Brain Activity in Adolescents when Performing Cognitive Tasks, as Assessed by fMRI [functional magnetic resonance imaging].  Jonathan Fulford1, Joanna L Varley2 and Craig A Williams.   Nutritional Neuroscience 2015 epub ahead of print.

  • Conclusion: Although no statistically significant (P > 0.05) improvement in task performance was determined, significantly higher activation was recorded in the frontal, premotor, and primary visual cortex areas in the breakfast trial relative to the fasting condition…Such a finding may have important implications in the examination of the role of diet, and specifically breakfast, in determining children’s performance within the school environment.
  • Funding: A grant was received of £18,678.08 from Kellogg Marketing & Sales Company (UK) Ltd to cover MRI scanning costs. Otherwise the research was conducted with the support of internal institutional funds and the authors received no other direct or indirect support, with no further competing interests.
  • Comment: Ordinarily I’m not concerned about food companies’ donating products to be tested but £18,678.08 seems noteworthy, especially since the only point of this study is to demonstrate that breakfast-eaters do better (higher brain activation even though no significant gain in task performance).

Suboptimal Serum α-Tocopherol Concentrations Observed among Younger Adults and Those Depending Exclusively upon Food Sources, NHANES 2003-2006. McBurney MI, Yu EA, Ciappio ED, Bird JK, Eggersdorfer M, Mehta S (2015). PLoS ONE 10(8): e0135510. doi:10.1371/journal.pone.0135510

  • Conclusion: The prevalence of inadequate vitamin E levels is significantly higher among non-users of dietary supplements…Our findings provide evidence that most Americans have serum α-tocopherol levels below 30 μmol/L. The EAR [Estimated Average Requirement], epidemiological and randomized controlled studies all indicate that maintaining a serum α-tocopherol concentration of 30 μmol/L may have beneficial effects on mortality, cognitive function and reproduction [Note: “may” indicates that what follows is speculative].
  • Funding: This statistical analysis of data collected by the Centers for Disease Control (CDC)…was supported by DSM Nutritional Products, a manufacturer of vitamin E. MM, EC, JB and ME are employees of DSM Nutritional Products. DSM Nutritional Products provided support in the form of salaries for authors MM, EC, JB, and ME and as an unencumbered gift to Cornell University that was used to support EY as a graduate research assistant.
  • Competing interests: This study was supported by DSM Nutritional Products, a manufacturer of vitamins, including vitamin E, for food, dietary supplement, and pharmaceutical use. MM, EC, JB, and ME are employees of DSM Nutritional Products.
  • Comment: Inadequate vitamin E in this study is defined as a serum level below a certain cut-point with uncertain clinical significance.  According to the Dietary Reference Intakes, clinical signs of vitamin E deficiency have not been observed in healthy populations.

Note: Since mid-March, I have posted 47 industry-funded studies with results favorable to food companies or trade associations, vs. 1 study with unfavorable results.

If you see industry-funded studies with results that must have made the sponsor unhappy, please send.

Mar 12 2015

New Scientist: Cigarettes get plain packets – will junk food be next?

Here is the online version of my commentary in New Scientist, March 14, 2015:24-25.

I submitted an illustration with it, which the editors did not use.  It’s from the Ontario Medical Association.

OMA

Cigarettes get plain packets – will junk food be next?

The tobacco industry is fighting moves to sell cigarettes in plain packs by claiming food manufacturers will be hit next. Will they?

ANTI-SMOKING advocates will be delighted. MPs have today voted in favour of introducing uniform packaging for cigarettes in the UK. That plain wrappers will undoubtedly further reduce smoking, especially among young people, is best confirmed by the tobacco industry’s vast opposition to this government measure and positive evidence from Australia, the first country to adopt it.

Along with lobbying and appeals to the World Trade Organization, the tobacco industry, when under attack, inevitably wheels out well-worn arguments about the nanny state, personal freedom, lack of scientific substantiation, and losses in jobs and tax revenues.

So to perk up its tired and thoroughly discredited campaign, the tobacco folks have added a new argument. Requiring plain wrappers on cigarettes, they say, is a slippery slope: next will be alcohol, sugary drinks and fast food. This argument immediately raises questions. Is it serious or just a red herring? Should the public health community lobby for plain wrappers to promote healthier food choices, or just dismiss it as another tobacco industry scare tactic?

Let me state from the outset that foods cannot be subject to the same level of regulatory intervention as cigarettes. The public health objective for tobacco is to end its use. So for cigarettes the rationale for plain wrappers is well established. Company logos, attractive images, descriptive statements, package colours and key words all promote purchases. Plain wrappers discourage buying, especially along with other measures such as bans on advertising, smoke-free policies, taxes and health warnings.

Australia’s pioneering law specified precise details of pack design, warning images and statements. The result: cigarette brands all look much alike. Most reports say plain packaging boosts negative perceptions of cigarettes among smokers and increases their desire to quit. Australia expects plain packaging to further reduce its smoking rate, which, at 12.8 per cent, is already among the world’s lowest. Along with the UK, New Zealand and Ireland are well on the way to adding plain packaging to their anti-smoking arsenal. More nations are considering it.

Which is all bad news for the tobacco industry. So it ramps up the slippery slope argument, hoping the food industry will support its fight against plain wrappers. It cites examples such as the regulation of infant formula in South Africa, where pictures of babies on labels are forbidden; that’s a big problem for the Gerber food brand – Gerber’s company logo is a smiling baby.

But those peddling the slippery slope idea ignore the fact that the health message for tobacco is simple: stop smoking. But beyond tobacco, it is more complex. For alcohol it is a little more nuanced: drink moderately, if at all. For food it is much more nuanced. Food is not optional; we must eat to live. Nutritional quality varies widely. Foods are spread across a spectrum from unhealthy to healthy, from soft drinks (no nutrients) to carrots or fish (many nutrients). Most fall somewhere in between. What’s more, an occasional soft drink is fine; daily guzzling is not. So the advice is to choose the healthy and avoid or eat less junk, both in the context of calorie intake and expenditure.

Is there any evidence that plain packaging for unhealthy foods would reduce demand? Research has focused on marketing’s effect on children’s food preferences, demands and consumption. Brands and packages sell foods and drinks, and even very young children recognise and desire popular brands. When researchers compare the responses of children to the same foods wrapped in plain paper or in wrappers with company logos, bright colours or cartoon characters, kids invariably prefer the more exciting packaging.

But the problem is deciding which foods and beverages might call for plain wrappers. For anything but soft drinks and confectionery, the decisions look too vexing. Rather than having to deal with such difficulties, health advocates prefer to focus on interventions that are easier to justify – scientifically and politically.

We know that some regulations and market interventions –analogous to, if not the same as those aimed at smoking cessation – are essential for reducing the damage from harmful products. If not plain packaging, then what? Studies suggest small benefits from a long list of interventions such as taxes, caps on portion size, front-of-package traffic-light labels, nutrition standards for school meals, advertising restrictions, and elimination of toys from fast food meals and cartoons from packaging. Rather than dealing with the impossible politics of plain wrappers on foods, health advocates increasingly favour warning labels.

These first appeared on cigarette packs in the 1960s and have been considered for food products since the early 1990s. Heart disease researchers suggested that foods high in calories and fat should display labels such as: “The fat content of this food may contribute to heart disease.” More recently, health advocates in California and New York proposed warning labels on sugary drinks. The Ontario Medical Association takes a similar view: “To stop the obesity crisis, governments must apply the lessons learned from successful anti-tobacco campaigns.” It has mocked up examples of warnings on foods.

Although no warning label law has passed so far, such messages are the logical next step in promoting healthy food choices, in the same way that plain wrappers are the next logical step for all cigarette packages. Health advocates should recognise the slippery slope argument for the typical tobacco ploy that it is.

 

 

Jun 30 2014

The FDA’s fish advisory for pregnant women: some additional thoughts

When the FDA advisory came out a week or so ago, I started getting questions about whether it meant that women must eat fish during pregnancy and, if so, how much.

As I said in my previous post on the topic, if you like fish, of course eat it, otherwise I can’t think of any compelling reason why anyone has to eat fish.

I view the data on the dilemma caused by omega-3 fatty acids in fish (good) versus the content of methylmercury (bad) as still rather uncertain.  Dr. Malden Nesheim and I discussed this point in an editorial we wrote for the American Journal of Clinical Nutrition [reference 1 below].

Here’s what the FDA advisory says:

Eat 8 to 12 ounces of a variety of fish each week from choices that are lower in mercury. The nutritional value of fish is important during growth and development before birth, in early infancy for breastfed infants, and in childhood… Fish contains important nutrients for developing fetuses, infants who are breastfed, and young children. Fish provides health benefits for the general public. Many people do not currently eat the recommended amount of fish.

This is a prescriptive statement telling pregnant women that they should eat fish.

I would argue that the data on which FDA based this prescription are limited, especially because the results of its scientific assessment are based mostly on theoretical models rather than empirical studies.

Here’s what makes me think some skepticism is warranted:

  1. The effects of even low-level methylmercury exposure may be greater than discussed in the assessment [see reference 2], as the latest analysis from the Environmental Working Group explains.
  2. The increase in young children’s IQ associated with fish-eating during pregnancy is low—-0.7 to a maximum of 3 IQ points.

As the FDA’s assessment report says:

On a population basis, average neurodevelopment in this country is estimated to benefit by nearly 0.7 of an IQ point (95% C.I. of 0.39 – 1.37 IQ points) from maternal consumption of commercial fish. For comparison purposes, the average population-level benefit for early age verbal development is equivalent in size to 1.02 of an IQ point (95% C.I. of 0.44 – 2.01 IQ size equivalence). For a sensitive endpoint as estimated by tests of later age verbal development, the average population-level benefit from fish consumption is estimated to be 1.41 verbal IQ points (0.91, 2.00). The assessment also estimates that a mean maximum improvement of about three IQ points is possible from fish consumption, depending on the types and amounts of fish consumed.

How significant is this?  And does the small benefit in childhood persist into adolescence or adulthood?

  1. The economic question.  Fish are expensive.
  2. The ecological questions.  Advice to increase fish consumption comes up against environmental realities—-overfishing, fish farming—-that make the recommendation impossibly unsustainable [reference 3].
  • The levels of long-chain omega-3s in farmed fish depend on feeding them wild fish, an ecological problem on its own.
  • Guidance about fish can’t be just nutritional; it has to take the economic and ecological impact of fish choices into consideration [reference 4].
  • Current per capita fish consumption is about half the FDA recommended level, and half of that is shrimp.  Fortunately, shrimp don’t have much mercury (although the ones from Asia may have other contaminants), but they also don’t have much omega-3).

All of this suggests grounds for skepticism.  I think a better recommendation would leave more wiggle room to account for uncertainties.  Here’s how I would edit the FDA’s statement:

Pregnant women may eat up to 8 to 12 ounces of a variety of fish each week from choices that are lower in mercury.  Fish are useful sources of nutrients that may have value for growth and development before birth, in early infancy for breastfed infants, and in childhood, and may provide health benefits for the general public.  Other food sources also provide such benefits.

References

[1] Nesheim MC, Nestle M. Advice for fish consumption: challenging dilemmas. American Journal of Clinical Nutrition. 2014;99:973-974.

[2] Karagas MR, Choi AL, Oken E, Horvat M, Schoeny R, Kamai E, Cowell W, Grandjean P, Korrick S. Evidence on the human health effects of low-level methymercury  exposure. Environ Health Perspect. 2012; 120:799-806.

[3] Jenkins D, Sievenpiper JL, Pauli D, Sumaila UR, Kendall CWC  Are dietary recommendations for use of fish oils sustainable? Canadian Medical Association Journal 2009;180: 633-637.

[4] Oken E, Choi AL Karagas MR, Marien K, Rheinberger CM, Schoeny R, Sunderland E, Korrick S  Which fish should I eat? Perspectives influencing fish consumption choices. Environmental Health Perspectives 2012;120:790-798.

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