by Marion Nestle

Search results: sugar policy

Nov 17 2023

Weekend reading: externalized costs of the global food system

I received an e-mailed news release from the UN Food and Agriculture Organization (FAO) about its latest report.

The press release headline: Hidden costs of global agrifood systems worth at least $10 trillion.  154-country study makes case for true cost accounting to guide policy.

Our current agrifood systems impose huge hidden costs on our health, the environment and society, equivalent to at least $10 trillion a year, according to a ground-breaking analysis by the Food and Agriculture Organization of the United Nations (FAO), covering 154 countries. This represents almost 10 percent of global GDP.

According to the 2023 edition of The State of Food and Agriculture (SOFA), the biggest hidden costs (more than 70 percent) are driven by unhealthy diets, high in ultra-processed foods, fats and sugars, leading to obesity and non-communicable diseases, and causing labour productivity losses. Such losses are particularly high in high- and upper-middle-income countries.

This report, FAO says, presents initial cost estimates.  A report next year will focus on ways to mitigate these costs.  Governments, it says, “can pull different levers to adjust agrifood systems and drive better outcomes overall. Taxes, subsidies, legislation and regulation are among them.”

The FAO director says: “the future of our agrifood systems hinges on our willingness to appreciate all food producers, big or small, to acknowledge these true costs, and understand how we all contribute to them, and what actions we need to take. ”

The report urges governments to use true cost accounting to address the climate crisis, poverty, inequality and food security.

True cost accounting (TCA), according to the report is:

A holistic and systemic approach to measuring and valuing the environmental, social, health and economic costs and benefits generated by agrifood systems to facilitate improved decisions by policymakers, businesses, farmers, investors and consumers.43

Translated, this means trying to assign numbers to the externalized and hidden costs of food production and consumption, meaning not just what you pay at the cash register but also the costs you pay in other ways for health care, animal welfare, biodiversity, polluted water and soil, and climate change.

These, says this report, add up to about $12.7 trillion a year.

The idea is to get food producers to pay their fair share of these costs—issues of accounting and accountability (according to the Scientific Group of the UN Food Systems Summit). 

The report comes with a big collection of resources:

Read the background papers:

That should be plenty to keep us all busy for quite a while.  Enjoy and ponder.

Sep 5 2023

British Nutrition Foundation vs. concept of Ultra-Processed Food

I’m always surprised when the nutrition community opposes evidence for the association of ultra-processed foods with poor health outcomes.

I read an article about such opposition from the British Nutrition Foundation.

Bridget Benelam, a BNF spokesperson, explained: For many of us when we get home after a busy day, foods like baked beans, wholemeal toast, fish fingers or ready-made pasta sauces are an affordable way to get a balanced meal on the table quickly. These may be classed as ultra-processed but can still be part of a healthy diet.

I looked up the position statement of the British Nutrition Foundation.

At present, the British Nutrition Foundation believes that due to the lack of agreed definition, the need for better understanding of mechanisms involved and concern about its usefulness as a tool to identify healthier products, the concept of UPF does not warrant inclusion within policy (e.g. national dietary guidelines).

I also looked up its “Why trust us?” statement.

Our funding comes from: membership subscriptions; donations and project grants from food producers and manufacturers, retailers and food service companies; contracts with government departments; conferences, publications and training; overseas projects; funding from grant providing bodies, trusts and other charities.  Our corporate members and committee membership are listed on our website and in our annual reports.

With some diligent searching, I did indeed manage to find the list of corporate members.

Front group anyone?  Take a look.

Current members
AHDB (Agricultural and Horticulture Development Board) www.ahdb.org.uk

Aldi Stores Ltd https://www.aldi.co.uk/corporate-responsibility

Associated British Foods www.abf.co.uk

Arla www.arlafoods.co.uk

ASDA Stores Ltd www.asda.com

British Sugar plc www.britishsugar.co.uk

Cargill Inc www.cargill.com/

Coca Cola www.coca-cola.co.uk

Costa Coffee www.costa.co.uk

Danone Ltd www.danone.com/en

Ferrero www.ferrero.co.uk

General Mills www.generalmills.co.uk

Greggs plc www.greggs.co.uk

Innocent Drinks Ltd http://www.innocentdrinks.co.uk/

International Flavors & Fragrances Inc. www.iff.com

J Sainsbury Plc www.sainsburys.co.uk

Kellogg Europe Trading Ltd www.kelloggs.co.uk

Kerry Taste & Nutrition www.kerrygroup.com

KP Snacks Limited www.kpsnacks.com

Lidl GB www.lidl.co.uk

LoSalt www.losalt.com/uk

Marks and Spencer plc www.marksandspencer.com

Mars UK Ltd www.mars.com

McDonald’s Restaurants Ltd www.mcdonalds.co.uk

Mitchells & Butlers www.mbplc.com

Mondelez International www.mondelezinternational.com

National Farmers’ Union Trust Company Ltd www.nfuonline.com/home

Nestlé UK Ltd www.nestle.co.uk

Nestlé Nutrition www.smahcp.co.uk

Nomad Foods Europe www.iglo.com

PepsiCo UK Ltd  www.pepsico.co.uk

Pladis www.pladisglobal.com

Premier Foods www.premierfoods.co.uk

Quorn www.quorn.com

Slimming World www.slimmingworld.co.uk

Sodexo https://uk.sodexo.com

Starbucks www.starbucks.co.uk

Subway UK & Ireland https://www.subway.com/en-GB

Tata Global Beverages Ltd www.tataglobalbeverages.com

Tate & Lyle www.tate&lyle.com

Tesco Plc www.tesco.com

The Co-operative Group Ltd www.co-operative.coop

Uber Eats www.ubereats.com/gb

UK Flour Millers www.ukflourmillers.org

Waitrose & Partners www.waitrose.com

Weetabix www.weetabix.co.uk

Whitbread www.whitbread.co.uk

Wm Morrisons Supermarkets plc www.morrisons.co.uk

Yakult www.yakult.co.uk 

 

Sustaining Members

Agriculture and Horticulture Development Board www.ahdb.org.uk

ASDA Stores Ltd www.asda.com

Associated British Foods www.abf.co.uk

Coca-Cola Great Britain and Ireland www.coke.com

Danone UK Ltd www.danone.co.uk www.h4hinitiative.com

International Flavors & Fragrances Inc. www.iff.com

J Sainsbury plc www.sainsburys.co.uk

Kellogg Europe www.kelloggs.co.uk

Marks and Spencer plc www.marksandspencer.com

Mondelez International www.mondelezinternational.com

Nestlé UK Ltd www.nestle.com

PepsiCo UK Ltd www.pepsico.com www.walkers.co.uk www.quakeroats.co.uk www.tropicana.co.uk

Tate & Lyle www.tateandlyle.co.uk

Tesco www.tesco.com

Sustaining members agree to provide a donation to the British Nutrition Foundation for at least three years to support our wider charitable work focussing on consumer education, and engagement with the media, government, schools and health professionals. 

Help us improve

Aug 9 2023

On Netflix now: Poisoned

Poisoned, the food safety film featuring the lawyer, Bill Marler,  is now available to watch on Netflix.

I wrote about earlier when I saw it at the Tribeca Film Festival.

It’s totally worth watching, and not only because I have a cameo in it.

Bill Marler explains why.  I reproduce his post with permission.

Over two months ago, while watching the premiere of the documentary, “Poisoned,” at the Tribeca Film Festival in NYC, I got thinking again about how little in the past 30 years I feel I have moved the needle on food safety – pathogens and certainly, human nutrition.  Now that “Poisoned” is up on the Netflix platform, it has become the most watched documentary in the world – at least for the last few days.

The real issues to me is how do we engage the food industry, policy makers, academics and most importantly consumers, to focus on driving the numbers down on the pathogens that kill us quickly and the products that kill us over time?

I will focus on pathogens as I have for the last 30 plus years. I will leave it to some very smart people who are rightly concerned about the millions of us who become sick and die due to inadequate nutrition – especially the millions of illnesses and deaths due to heart disease, diabetes and obesity caused by ultra-processed foods, salt, sugar, and fat.

There is so much to do, and the list is long. So, what would I do with a Food Safety Magic Wand on day one?

  1. Vaccinate. The first thing I would do is mandate that all food service workers be vaccinated against hepatitis A.  Perhaps to some, not the most pressing food safety issue, but it is forefront of my mind.  In the past few months, I finished up litigation around a hepatitis A outbreak involving one ill food service work who infected nearly 50 people, hospitalizing most, killing four and causing two liver transplants.  With regret, I forced a family-owned restaurant chain to file for bankruptcy.  All of this could have been prevented by a safe vaccine that has been around for decades.  It is time for the restaurant industry and the CDC to step up.
  • Investigate. Invest in public health surveillance over human pathogens, like, ListeriaE. coli and Salmonella, etc.  A dirty truth is that most culture-confirmed illnesses are never attributable to a food source, so people never know what sickened or killed them. Not because the source was not food, but because we fail to invest adequate resources in the epidemiologists that investigate illnesses and track those illnesses to the cause. Tracking illnesses to the cause gets tainted product off the market and helps us all understand what products and producers to avoid.  We need to continue to invest in the science of whole genome sequencing, so we know with certainty which pathogens are causing which illnesses. Foodborne illness epidemiology helps us understand the root cause of an outbreak and helps prevent the next one from happening at all.
  • Relegate. Allow public health officials access, especially during an outbreak investigation, to all areas around farms that grow fruits and vegetables.  It is long past time to allow investigators access to neighboring cattle, dairy, chicken, or hog operations that spill billions of deadly pathogens into the environment, via air or water.  We need to think of our growing regions as an integrated system and that all sectors responsible need to play a role.  Access allows investigators to understand the likely cause of an outbreak, and again, what can be done to prevent the next one.
  • Advocate. Make all pathogens that can sicken or kill us adulterants.  In 1994 Mike Taylor making E. coliO157:H7 and adulterant has saved countless lives and has saved the beef industry from my lawsuits. We can do the same for all food producers, especially chicken, turkey, and pork.  Remember, in the 1990’s nearly all the lawsuits I filed were E. coli cases linked to ground beef.  Today that is zero.  Think about it.
  • Educate. Give everyone a thermometer and provide better education to middle and high school teachers and students around food safety and human nutrition policy, not in a dry, technical way, but by sharing engaging history, microbiology, patient stories, and case studies. We need to teach how and why our food can be unsafe and what consumers can do about it.
  • Consolidate. Finally, make a single federal agency out of USDA/FSIS, FDA, and the food safety parts of CDC, NOAA, and EPA, to oversee food safety and human nutrition. Making food safety and human nutrition its own agency would help increase governmental accountability,  close regulatory loopholes, facilitate the collection and sharing of information and facilitate critical change.  I might have a suggestion for someone to run it.

With the CDC estimating 48,000,000 are sickened each year, 125,000 hospitalized, and 3,000 die from food, preventing pathogenic foodborne illness is no simple matter.  And, if you consider the millions that are impacted by the lack of adequate and safe nutrition, we have a lot to do.  However, it can be done, and the six ideas above are a small start.

“Doing anything is better than doing nothing,” my Marine drill sergeant father used to say.  He used to require my brother and I to make our beds every morning and bounce quarters on them.  For the longest time I thought this was punishment.  But it was not punishment, it was accomplishment, that you could build on for the rest of the day.  Doing “little” things, like the six things above, are accomplishments. Doing them starts a process that will continue to make all our lives just a little bit safer.

Jul 21 2023

Why ultra-processed foods matter: the state of world hunger

The Food and Agriculture Organization of the U.N. released its annual State of Food Security and Nutrition in the World report last week.  Its conclusions are sobering.

Global hunger is still far above pre-pandemic levels. It is estimated that between 690 and 783 million people in the world faced hunger in 2022. This is 122 million more people than before the COVID-19 pandemic. Nonetheless, the increase in global hunger observed in the last two years has stalled and, in 2022, there were about 3.8 million fewer people suffering from hunger than in 2021. The economic recovery from the pandemic has contributed to this, but there is no doubt that the modest progress has been undermined by rising food and energy prices magnified by the war inUkraine. There is no room for complacency, though, as hunger is still on the rise throughout Africa, Western Asia and the Caribbean.

Ultra-processed foods are a critical part of this story.  The word “processed” comes up 264 times in this report; “highly processed” comes up 99 times .  Some examples:

  • Healthy diets are essential for achieving food security goals and improving nutritional outcomes. A healthy diet…is based on a wide range of unprocessed or minimally processed foods, balanced across food groups, while it restricts the consumption of highly processed foods and drink products…Eating a healthy diet throughout the life cycle is critical for preventing all forms of malnutrition, including child stunting and wasting, micronutrient deficiencies and overweight or obesity. It also helps reduce the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes and certain types of cancer.
  • The unfinished agendas to reduce stunting, wasting and micronutrient deficiency, along with rising overweight and obesity, represent the current challenge to address multiple forms of malnutrition. Malnutrition in all its forms is related to poor diets, the rise of low-cost
    nutrient-poor foods and the increasing availability of highly processed foods in rural areas.
  • Supply-side factors, including globalized technology in food production, transportation and marketing, coupled with an increase in demand for readily available foods, have contributed to a substantial expansion of supermarkets, hypermarkets, food deliveries and other convenience retailers. However, these are also associated with increased supply and spread of energy-dense and highly processed foods.
  • However, urbanization has also contributed to the spread and consumption of processed and highly processed foods, which are increasingly cheap, readily available and marketed, with private sector small and medium enterprises (SMEs) and larger companies often setting the nutrition landscape. Cost comparisons of individual food items and/or food groups from existing studies indicate that the cost of nutritious foods – such as fruits, vegetables and animal source foods – is typically higher than the cost of energy-dense foods high in fats, sugars and/or salt, and of staple foods, oils and sugars.
  • The dynamics of supply and demand for processed foods, however, are complex. There has been a surge on the supply side, with small and medium enterprises and large private companies alike making massive aggregate investments in all types of processed foods (from minimally to highly processed) in response to demand. At the same time, aggressive marketing and relatively low pricing – and even interference in policies to curb consumption of highly processed foods and sugar-sweetened beverages – are driving up consumption.

The report emphasizes the importance of food processing in contributing to poor diets and health.

What is to be done?  From the Brief summary:

Leveraging connectivity across the rural–urban continuum will require adequate governance mechanisms and institutions to coordinate coherent investment beyond sectoral and administrative boundaries. To this end, subnational governments can play a key role in designing and implementing policies beyond the traditional top-down approach. Approaches to agrifood systems governance should ensure policy coherence among local, regional and national settings through the engagement of relevant agrifood systems stakeholders at all levels.

I read this as saying what’s need is community-based, bottom up approaches at the local level.  That’s a great place to start.  Go for it.

Resources

 

Jul 18 2023

Ultra-processed pushback #2: The UK’s Scientific Advisory Committee

The U.K.’s Scientific Advisory Committee on Nutrition (SACN) has released its statement on ultra-processed foods.

It dealt with the NOVA classification system (the one I used in yesterday’s post to define ultra-processed foods).  The committee does not like it much.

Assessment beyond the initial screen identified that the literature is currently dominated by NOVA, raising the risk that any limitations or biases present within the NOVA classification system may be replicated throughout the research literature.
While NOVA also met criterion 2 on a clear, usable definition and criterion 4 on the availability of data on inter-assessor agreement, assessment beyond the initial screen dentified less certainty on the clarity, reliability and feasibility of the system.

The SACN’s conclusions:

The SRs identified have consistently reported that increased consumption of (ultra-) processed foods was associated with increased risks of adverse health outcomes. However, there are uncertainties around the quality of evidence available. Studies are almost exclusively observational and confounding factors or key variables such as energy intake, body mass index, smoking and socioeconomic status may not be adequately accounted for.

…In particular, the classification of some foods is discordant with nutritional and other food-based classifications. Consumption of (ultra-) processed foods may be an indicator of other unhealthy dietary patterns and lifestyle behaviours. Diets high in (ultra-) processed foods are often energy dense, high in saturated fat, salt or free sugars, high in processed meat, and/or low in fruit and vegetables and fibre.

…The observed associations between higher consumption of (ultra-) processed foods and adverse health outcomes are concerning – however, the limitations in the NOVA classification system, the potential for confounding, and the possibility that the observed adverse associations with (ultra-) processed foods are covered by existing UK dietary recommendations mean that the evidence to date needs to be treated with caution.

Comment: Kevin Hall  et al’s well controlled clinical trial of ultra-processed versus merely processed diets is neither discussed nor cited in this statement.  Once again, I have no personal knowledge of how this statement was developed, but the U.K.s Soil Association has published a statement with the provocative title, Sticky fingers of food industry on government ultra-processed food review.

While we’re pleased that SACN has prioritised this review, and has acknowledged that ultra-processed foods are of “concern”, we’re disturbed that the committee’s conclusions may have been skewed by industry ties, conflicted financial interests, and a narrow framing of the science.

…But the committee is also guilty of losing the wood for the trees, failing even to raise concern about how ultra-processed foods have overtaken their own nutritional advice….Most people in the UK are failing to eat such a [healthy] diet, precisely because these foods have been displaced by ultra-processed products. The average child’s diet is more than 60% ultra-processed, and rates of obesity and ill health are rising sharply in turn. …SACN is oddly silent on case for re-balancing the diet and addressing the corporate capture of children’s food.

These omissions should prompt us to look more closely at the composition of the committee. SACN has sixteen members. One is a paid consultant working for Cargill, Tate & Lyle, and CBC Israel (a manufacturer and marketer of fizzy drinks such as Coca-Cola and Sprite); two are in receipt of funding from the meat and dairy industry; one is a shareholder in Sainsbury’s; and five are members of the American Society of Nutrition, which is funded by Mars, Nestlé, and Mondelez. Among SACN’s members is the Chair of International Life Sciences Institute (ILSI) Europe, a body that receives funding from some of the world’s largest food companies, such as Barilla, Cargill, Danone, General Mills, Mondelez, and PepsiCo; and two individuals with financial relationships with the British Nutrition Foundation, an organisation funded by British Sugar, Cargill, Coca Cola, Danone, Greggs, Kellogg, KP Snacks, Mars, McDonald’s, Mondelez, Nestlé, PepsiCo, Tate & Lyle, and Tesco. Two SACN members have been funded by Danone, one of the largest ultra-processed food companies in the world; one sits on the council of the Nestlé Foundation; and another is a former employee of Unilever, with current shares in the company worth “more than £5000”.

These declared interests do not imply corruption or bias on the part of SACN members, but they illustrate how pervasive are industry ties at the interface of science and policy.

Jul 13 2023

WHO recommends policies to restrict food marketing to kids

The World Health Organization has just come out with a new report on protecting children from the harms of marketing unhealthy food to kids.

Some conclusions from research on the effects of marketing unhealthy foods to kids:

  • Across studies, the most frequently marketed food categories were fast food, sugar-sweetened beverages, chocolate and confectionery, salty and savoury snacks, sweet bakery items and snacks, breakfast cereals, and desserts.
  • Reductions in children’s exposure to food marketing were more often found with: mandatory policies; policies designed to restrict food marketing to children, including those older than 12 years; and policies that used a government-led nutrient profile model to determine the foods for which marketing was to be restricted.
  • Reductions in the power of food marketing were more often found with: mandatory policies; and policies designed to restrict food marketing to children, including those older than 12 years.
  • Policies to protect children from the harmful impacts of food marketing would be highly cost-effective or cost-saving.
  • Policies to protect children from the harmful impacts of food marketing can be expected to reduce health inequities.
  • In HICs [high-income countries], policies to protect children from the harmful impact of food marketing are largely acceptable to
    the public, but industry has generally opposed government-led restrictions.
  • Some countries have successfully implemented policies, demonstrating that policies are acceptable to government and policy-makers and feasible to implement.

Therefore, WHO recommends that policies:

  • Be mandatory
  • Protect children of all ages
  • Use a government-led nutrient profile model to classify foods to be restricted from marketing;
  • Be sufficiently comprehensive to minimize the risk of migration of marketing to other media, to other spaces within the same medium or to other age groups
  • Restrict the power of food marketing to persuade.

Yes!

WHO has just given governments a mandate to take action.  Go for it!

May 3 2023

The 2025-2030 Dietary Guidelines: an update

Personally, I can’t believe we are going through this again since the result will certainly not differ much from previous versions, except in details (see my previous post on this).
But here we are, so let’s get to it.

ODPHP must be in charge this round (leadership passes back and forth between ODPHP and USDA’s nutrition policy office).  It says:

You can get involved by:

  • Attending virtual meetings: View the recording of the first meeting held in February 2023, and register to view the livestream of the second meeting on May 10th on DietaryGuidelines.gov.
  • Providing public comments: Comments may be submitted online.
  • Subscribing to email updates: Stay informed on each step of the process by registering for updates.

More details on the Dietary Guidelines development process can be found at DietaryGuidelines.gov.

What to expect?

  • Investigative reports on conflicts of interest among members of the Dietary Guidelines Advisory Committee (members must report conflicted interests but the agencies do not make the reports public)
  • Nothing about sustainability (Off the table; the agencies said there will be a separate report on that.  When?)
  • Nothing about meat (Off the table)
  • Debates about the significance of ultra-processed foods (but only with respect to heart disease)
  • Other issues, surely

My prediction: after an enormous amount of work, the guidelines will say, as they mostly do:

  • Balance calorie intake with expenditure
  • Eat more plant foods (foods)
  • Don’t eat too much salt, sugar, saturated fat (nutrients)
  • And, if we are lucky, minimize or avoid ultra-processed foods

Stay tuned.

*******

For 30% off, go to www.ucpress.edu/9780520384156.  Use code 21W2240 at checkout.

 

May 1 2023

American Society for Nutrition commissions highly conflicted meta-analysis

I was surprised to see a press release from the American Society for Nutrition (ASN—of which I am a member) announcing publication of a research paper the Society had commissioned and published on sugars and body weight: Important food sources of fructose-containing sugars and adiposity: a systematic review and meta-analysis of controlled feeding trials.

The paper, the press release said, “Illustrate[s] The Need for Nuance in Public Health Guidance Related to Consumption of Sugars: Findings call into question recommendations that imply all sources of fructose-containing sugars carry the same risk.

The press release notes that “this comprehensive review is timely as the 2025 Dietary Guidelines Advisory Committee currently assesses the latest science to inform updated evidence-based recommendations,” and it quotes the lead author: “There is an opportunity for more food-based guidance around sugars to help ensure Americans don’t inadvertently eat less health-promoting foods containing fructose – especially at a time when most people don’t eat enough of all forms of fruit, which offer significant health benefits.”

Uh oh.  This is an easily misinterpreted message.

My immediate question:  Who wrote the paper ?

No surprise.: authors with extensive conflicts of interest.

I’ve written about some of these authors’ conflicts of interest disclosures previously.  See, for example. this, this, and this.

Just for fun, I’ll post this particular statement of the conflicted interests at the end of this post.

Basically, these authors do not understand the difference between a conflict of interest (financial ties, which are discretionary) and non-discretionary viewpoints (all researchers have them).  In this case, consulting for a sugar company is a conflict; being a vegan or avoiding sugar-sweetened beverages is not.

My second question: Why did ASN commission this paper, and from these particular authors no less?

I contacted John Courtney, the long-time executive director of the ASN.  He said this was a leftover from an initiative started ten years ago.  Since then, the ASN has decided not to commission papers on controversial topics and this will not happen again.

Good.  It shouldn’t.  Commissioning papers like these make the ASN look like an arm of the food industry.  The ASN should avoid even teh appearance of conflicts of interest as much as it possibly can.

You don’t believe this is a problem?  Take a look at this conflict of interest statement.  Enjoy!

Conflict of Interest

JLS is a member of the Journal’s Editorial Board and played no role in the Journal’s evaluation of the manuscript.

LC was a Mitacs-Elevate postdoctoral fellow jointly funded by the Government of Canada and the Canadian Sugar Institute (September 2019–August 2021). She was previously (2010–2018) employed as a casual clinical coordinator at INQUIS Clinical Research, Ltd. (formerly Glycemic Index Laboratories, Inc.), a contract research organization.

AC and AA have received funding from a Toronto 3D MSc Scholarship award.

SA-C was funded by a Canadian Institutes of Health Research (CIHR) Canadian Graduate Scholarships Master’s Award, the Loblaw Food as Medicine Graduate Award, the Ontario Graduate Scholarship, and the CIHR Canadian Graduate Scholarship Doctoral Award. She avoids consuming NSBs and SSBs and has received an honorarium from the international food information council (IFIC) for a talk on artificial sweeteners, the gut microbiome, and the risk for diabetes.

NM was a former employee of Loblaw Companies Limited and current employee of Enhanced Medical Nutrition. She has completed consulting work for contract research organizations, restaurants, start-ups, the International Food Information Council, and the American Beverage Association, all of which occurred outside of the submitted work.

TAK has received research support from the Canadian Institutes of Health Research (CIHR), the International Life Science Institute (ILSI), and the National Honey Board. He has taken honorarium for lectures from International Food Information Council (IFIC) and Institute for the Advancement of Food and Nutrition Sciences (IAFNS; formerly ILSI North America).

FA-Y is a part-time Research Assistant at INQUIS Clinical Research, Ltd., a contract research organization.

DL reports receiving a stipend from the University of Toronto Department of Nutritional Sciences Graduate Student Fellowship, University of Toronto Fellowship in Nutritional Sciences, University of Toronto Supervisor’s Research Grant—Early Researcher Awards, and Dairy Farmers of Canada Graduate Student Fellowships; a scholarship from St. Michael’s Hospital Research Training Centre, and a University of Toronto School of Graduate Studies Conference Grant.

AZ is a part-time Research Associate at INQUIS Clinical Research, Ltd., a contract research organization, and has received funding from a BBDC Postdoctoral Fellowship. She has received consulting fees from the GI found.

RJdS has served as an external resource person to the World Health Organization’s Nutrition Guidelines Advisory Group on transfats, saturated fats, and polyunsaturated fats. The WHO paid for his travel and accommodation to attend meetings from 2012–2017 to present and discuss this work. He has also performed contract research for the CIHR’s Institute of Nutrition, Metabolism, and Diabetes, Health Canada, and the World Health Organization for which he received remuneration. He has received speaker’s fees from the University of Toronto and McMaster Children’s Hospital. He has held grants from the Canadian Foundation for Dietetic Research, Population Health Research Institute, and Hamilton Health Sciences Corporation as a principal investigator and is a co-investigator on several funded team grants from the CIHR. He has served as an independent director of the Helderleigh Foundation (Canada). He serves as a member of the Nutrition Science Advisory Committee to Health Canada (Government of Canada) and is a co-opted member of the Scientific Advisory Committee on Nutrition Subgroup on the Framework for the Evaluation of Evidence (Public Health England).

TMSW was previously a part owner and now is an employee of INQUIS and received an honorarium from Springer/Nature for being an Associate Editor of the European Journal of Clinical Nutrition.

CWCK has received grants or research support from the Advanced Food Materials Network, Agriculture and Agri-Foods Canada, Almond Board of California, Barilla, CIHR, Canola Council of Canada, International Nut and Dried Fruit Council, International Tree Nut Council Research and Education Foundation, Loblaw Brands Ltd, the Peanut Institute, Pulse Canada, and Unilever. He has received in-kind research support from the Almond Board of California, Barilla, California Walnut Commission, Kellogg Canada, Loblaw Companies, Nutrartis, Quaker (PepsiCo), the Peanut Institute, Primo, Unico, Unilever, and WhiteWave Foods/Danone. He has received travel support and/or honoraria from the Barilla, California Walnut Commission, Canola Council of Canada, General Mills, International Nut and Dried Fruit Council, International Pasta Organization, Lantmannen, Loblaw Brands, Ltd., the Nutrition Foundation of Italy, Oldways Preservation Trust, Paramount Farms, the 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, the International Pasta Organization, McCormick Science Institute, and Oldways Preservation Trust. He is a founding member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD and is a Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation.

DJAJ has received research grants from Saskatchewan & Alberta Pulse Growers Associations, the Agricultural Bioproducts Innovation Program through the Pulse Research Network, the Advanced Foods and Material Network, Loblaw Companies, Ltd., Unilever Canada and Netherlands, Barilla, the Almond Board of California, Agriculture and Agri-food Canada, Pulse Canada, Kellogg’s Company, Canada, Quaker Oats, Canada, Procter & Gamble Technical Centre, Ltd., Bayer Consumer Care, Pepsi/Quaker, International Nut & Dried Fruit Council, Soy Foods Association of North America, the Coca-Cola Company (investigator initiated, unrestricted grant), Solae, Haine Celestial, the Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Soy Nutrition Institute (SNI), the Canola and Flax Councils of Canada, the Calorie Control Council, the CIHR, the Canada Foundation for Innovation and the Ontario Research Fund. He has received in-kind supplies for trials as a research support from the Almond Board of California, Walnut Council of California, the Peanut Institute, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, and WhiteWave Foods. He has been on the speaker’s panel, served on the scientific advisory board and/or received travel support and/or honoraria from Nutritional Fundamentals for Health (NFH)-Nutramedica, Saint Barnabas Medical Center, The University of Chicago, 2020 China Glycemic Index International Conference, Atlantic Pain Conference, Academy of Life Long Learning, the Almond Board of California, Canadian Agriculture Policy Institute, Loblaw Companies, Ltd., the Griffin Hospital (for the development of the NuVal scoring system), the Coca-Cola Company, Epicure, Danone, Diet Quality Photo Navigation, Better Therapeutics (FareWell), Verywell, True Health Initiative, Heali AI Corp, Institute of Food Technologists, SNI, Herbalife Nutrition Institute, Saskatchewan & Alberta Pulse Growers Associations, Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Herbalife International, Pacific Health Laboratories, Barilla, Metagenics, Bayer Consumer Care, Unilever Canada and Netherlands, Solae, Kellogg, Quaker Oats, Procter & Gamble, Abbott Laboratories, Dean Foods, the California Strawberry Commission, Haine Celestial, PepsiCo, the Alpro Foundation, Pioneer Hi-Bred International, DuPont Nutrition and Health, Spherix Consulting and WhiteWave Foods, the Advanced Foods and Material Network, the Canola and Flax Councils of Canada, Agri-Culture and Agri-Food Canada, the Canadian Agri-Food Policy Institute, Pulse Canada, the Soy Foods Association of North America, the Nutrition Foundation of Italy, Nutra-Source Diagnostics, the McDougall Program, the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society, the American Society of Nutrition, Arizona State University, Paolo Sorbini Foundation, and the Institute of Nutrition, Metabolism and Diabetes. He received an honorarium from the United States Department of Agriculture to present the 2013 W.O. Atwater Memorial Lecture. He received the 2013 Award for Excellence in Research from the International Nut and Dried Fruit Council. He received funding and travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association. He is a member of the 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 foods described in this study, The Portfolio Diet for Cardiovascular Risk Reduction (Academic Press/Elsevier 2020 ISBN:978-0-12-810510-8). His sister, Caroline Brydson, received funding through a grant from St. Michael’s Hospital Foundation to develop a cookbook for 1 of his studies. He is also a vegan. 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, American Society for Nutrition (ASN), International Nut and Dried Fruit Council (INC) Foundation, National Honey Board [the US Department of Agriculture (USDA) honey “Checkoff” program], Institute for the Advancement of Food and Nutrition Sciences (IAFNS), Pulse Canada, Quaker Oats Center of Excellence, The United Soybean Board (the USDA soy “Checkoff” program), 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), The Plant Protein Fund at the University of Toronto (a fund that has received contributions from IFF), 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 food donations to support randomized controlled trials from the Almond Board of California, California Walnut Commission, Peanut Institute, Barilla, Unilever/Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, WhiteWave Foods/Danone, Nutrartis, Soylent, and Dairy Farmers of Canada. He has received travel support, speaker fees, and/or honoraria from ASN, Danone, Dairy Farmers of Canada, FoodMinds LLC, Nestlé, Abbott, General Mills, Comité Européen des Fabricants de Sucre, Nutrition Communications, International Food Information Council, Calorie Control Council, the International Sweeteners Association, the International Glutamate Technical Committee, Phynova, and Brightseed. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, Phynova, and INQUIS Clinical Research. He is a former member of the European Fruit Juice Association Scientific Expert Panel and a former member of the 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, Canadian Cardiovascular Society, and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons. He serves or has served as an unpaid member of the Board of Trustees and an unpaid scientific advisor for the Carbohydrates Committee of IAFNS. He is a member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His spouse is an employee of AB InBev.

XYQ, SB, NM, VH, EL, SBM, VLC, and LAL declare no competing interests.

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