Currently browsing posts about: Conflicts-of-interest

This is another example of my seeing the title of a paper and wondering right away who paid for it.  The paper is displayed as a research article, but reads more like an analytical opinion piece.

The paper: Nutritionism in a food policy context: the case of ‘animal protein’.  Frédéric Leroy, Ty Beal, Pablo Gregorini, Graham A. McAuliffe, and Stephan van Vliet. Animal Production Science –   Published online: 21 February 2022

The rationale: Reductionist approaches to food focus on isolated nutritional criteria, ignoring the broader physiological and societal benefits and trade-offs involved…Among our present-day array of issues is the disproportionate stigmatisation of animal-source foods as harmful for human and planetary health.

The problem: “…animal-source foods (reduced to the notion of ‘animal protein’) are represented as an intrinsically harmful food category that needs to be minimised, thereby falsely assuming that ‘proteins’ are nutritionally interchangeable.

The solution: “…we suggest referring to said foods as ‘protein-rich foods’, while acknowledging the expanded pool of non-protein nutrients that they provide and their unique capabilities to support a much broader range of bodily functions. Several essential or otherwise beneficial nutrients are generally more bioavailable in animal-source foods than in plant-source foods.

The overall solution: “A more appropriate way forward would consist of combining and integrating the best of animal and plant solutions to reconnect with wholesome and nourishing diets that are rooted in undervalued benefits such as conviviality and shared traditions, thus steering away from a nutrient-centric dogma.”

Funding: FL acknowledges financial support of the Research Council of the Vrije Universiteit Brussel, including the SRP7 and IOF3017 projects, and in particular the Interdisciplinary Research Program ‘Tradition and naturalness of animal products within a societal context of change’ (IRP11). GM is funded by Soil to Nutrition (S2N), Rothamsted Research’s Institute Strategic Programme supported by UK Research and Innovation (UKRI) and Biotechnology and Biological Sciences Research Council (BBSRC) (BBS/E/C/000I0320). SvV grant support by SvV reports grant support from USDA-NIFA-SARE (2020-38640-31521; 2021-67034-35118), the North Dakota beef commission, the Turner Institute of Ecoagriculture, the Dixon Foundation, and the Greenacres Foundation for projects that link agricultural production systems (including livestock and crops) to the nutritional/metabolite composition of foods and human health. PG and FL acknowledge financial support of the project ‘Grazing for environmental and human health’ funded by the New Zealand Royal Society’s Catalyst Seeding Fund.

Conflicts of interest: FL is a non-remunerated board member of various academic non-profit organisations including the Belgian Association for Meat Science and Technology (President), the Belgian Society for Food Microbiology (Secretary), and the Belgian Nutrition Society. On a non-remunerated basis, he also has a seat in the scientific committee of the Institute Danone Belgium, the Scientific Board of the World Farmers’ Organization, and the Advisory Commission for the ‘Protection of Geographical Denominations and Guaranteed Traditional Specialties for Agricultural Products and Foods’ of the Ministry of the Brussels Capital Region. PG is an Associate Editor of Animal Production Science but was blinded from the peer-review process for this paper. SvV reports financial renumeration for academic talks, but does not accept honoraria, consulting fees, or other personal income from food industry groups/companies. All authors consume omnivorous diets.

Comment: I too am an omnivore, do not disagree with much of it, and could have written a lot of this myself, particularly the concerns about nutritionism (the use of nutrients to stand for the foods that contain them) and the concluding sentence in the Abstract: “Humans do not consume isolated nutrients, they consume foods, and they do so as part of culturally complex dietary patterns that, despite their complexity, need to be carefully considered in food policy making.”

But the purpose of this piece is to defend meat as a nutritious source of protein.

Why feel the need to take this on?

That’s what made me wonder who paid for it and whether authors had ties to the meat industry, which of course they do.

Reference: For research on why and how industry sponsorship can influence opinions and study outcomes, see Unsavory Truth: How Food Companies Skew the Science of What We Eat.

I was sent an email with this message:

Calling your attention to this newly released review article, Animal source foods in healthy, sustainable, and ethical diets – An argument against drastic limitation of livestock in the food system. It was published in the March 2022 edition of Animal and is well worth a read, as it makes a strong case for the role of animal source foods in healthy, environmentally sustainable and ethical diets. See below for “highlights” taken directly from the paper, with the full review attached.

–Animal source foods are seen by some as unhealthy, unsustainable, and unethical.

–Outcomes depend on practical specificities, not on the fact that animals are involved.

–As for any food, the challenge is to promote best practices and limit harm.

     –Well-managed animals contribute to food security, ecological function and livelihoods.

     –Heavy reduction of livestock may lead to a fragile food system and societal damage.

I happen to agree that food animals are essential components of regenerative agriculture systems but there was something about this that triggered my “who paid for this?” question.  Bingo!

Here is the paper’s financial support statement:

FL acknowledges financial support of the Research Council of the Vrije Universiteit Brussel, including the SRP7 and IOF342 projects, and in particular, the Interdisciplinary Research Program “Tradition and naturalness of animal products within a societal context of change” (IRP11). PM acknowledges financial support of the Helsinki Institute of Sustainability (HELSUS) through the project “Understanding pastoralism sustainability through an interdisciplinary lens”. PG and FL acknowledge financial support of the project “Grazing for environmental and human health” funded by the New Zealand Royal Society’s Catalyst Seeding Fund. SvV acknowledges grant support from the North Dakota Beef Association to study the health effects of red meat in relation to diet quality. SvV reports additional grant support from USDA-NIFA-SARE (2020-38640-31521; 2021-67034-35118), the Turner Institute of Ecoagriculture, the DixonFoundation, and the Greenacres Foundation for projects that link agricultural production systems (including livestock and crops) to the nutritional/metabolite composition of foods and human health.

Here are the authors’ conflict of interest declarations:

All authors follow omnivorous diets. FL is a non-remunerated board member of various academic non-profit organisations including the Belgian Association for Meat Science and Technology (president), the Belgian Society for Food Microbiology (secretary), and the Belgian Nutrition Society. On a non-remunerated basis, he also has a seat in the scientific committee of the Institute Danone Belgium, the World’s Farmers Organization, and the Advisory Commission for the “Protection of Geographical Denominations and Guaranteed Traditional Specialties for Agricultural Products and Foods” of the Ministry of the Brussels Capital Region. PM is a non-remunerated member of the Spanish Platform for Extensive Livestock and Pastoralism. SvV reports financial renumeration for academic talks, but does not accept honoraria, consulting fees, or other personal income from food industry groups/companies.

Comment: The authors say much more than is usual about their potential conflicts of interest, either via their personal diets or their professional financial links to the meat industry.  Still, those links exist, as I could predict from the paper’s title.  The role of food animals in health and sustainability is heavily disputed.  Because of its funding and the ties of some of the authors to the meat industry, this study appears less convincing than it might if funded independently and carried out by independed researchers.

Reference: For research on why and how industry sponsorship can influence study outcome, see Unsavory Truth: How Food Companies Skew the Science of What We Eat.

I learned about this one from an article—no, it’s an ad really—in NutraIngredients.com.

Its headline: “Large new study validates krill oil’s heart health benefits.”

Heading the page is this note:

CONTENT PROVIDED BY AKER BIOMARINE SUPERBAKrill Learn More

I clicked on Learn More and got a disclaimer, the first time I have seen something like this:

The following content is provided by an advertiser or created on behalf of an advertiser. It is not written by the NutraIngredients.com editorial team, nor does it necessarily reflect the opinions of NutraIngredients.com.

OK.  Now we know that the entire article is an ad paid for by the maker of the product under discussion.

What about the research?

The study: Effectiveness of a Novel ω-3 Krill Oil Agent in Patients With Severe HypertriglyceridemiaA Randomized Clinical Trial.  Dariush Mozaffarian, MD, DrPH¹; Kevin C. Maki, PhD^2,3; Harold E. Bays, MD⁴; et alFernando Aguilera, MD⁵; Glenn Gould, MD⁶; Robert A. Hegele, MD⁷; Patrick M. Moriarty, MD⁸; Jennifer G. Robinson, MD, MPH⁹; Peilin Shi, PhD¹; Josefina F. Tur, MD¹⁰; Jean-François Lapointe, PhD¹¹; Sarya Aziz, PhD¹¹; Pierre Lemieux, PhD¹¹; for the TRILOGY (Study of CaPre in Lowering Very High Triglycerides) investigators.  JAMA Netw Open. 2022;5(1):e2141898. doi:10.1001/jamanetworkopen.2021.41898

Method: The investigators pooled data from two previous trials of people given Krill oil or a cornstarch placebo for 26 weeks.

Results: “This study found that ω-3 –PL/FFA, a novel krill oil–derived ω-3 formulation, reduced TG levels and was safe and well tolerated in patients with severe hypertriglyceridemia.”

Funding/Support:The study was sponsored by Acasti Pharma Inc. [Acasti partners with Aker to make Krill oil]

Role of the Funder/Sponsor: The sponsor collaborated with the academic principal investigator (Dr Mozaffarian) in the design and conduct of the study, interpretation of the data, and review and suggestions for editing of the manuscript. The sponsor collaborated with the academic principal investigator and an independent contract research organization (IQVIA) in study implementation, data collection, and management. The sponsor had no role in the analysis of the data or the decision to submit the manuscript for publication.

Conflict of Interest Disclosures: Dr Mozaffarian reported serving as a consultant for Acasti Pharma Inc as principal investigator of this trial; receiving research funding from the National Institutes of Health, the Gates Foundation, and the Rockefeller Foundation; personal fees from Barilla, Cleveland Clinic Foundation, Danone SA, and Motif FoodWorks; chapter royalties from UpToDate; serving on the scientific advisory board of Beren Therapeutics PBC, Brightseed, Calibrate, DayTwo (ended June 2020), Elysium Health, Filtricine Inc, Foodome Inc, HumanCo, January, Perfect Day Inc, Season, and Tiny Organics; and holding stock ownership in Calibrate and HumanCo outside the submitted work. Dr Maki reported receiving research grants from and consulting for Acasti Pharma Inc and Matinas BioPharma Holdings Inc, and receiving research funding from Indiana University Foundation, Pharmavite, Novo Nordisk A/S, General Mills Inc, The Kellogg Company, and PepsiCo Inc, and consulting for 89bio Inc, and NewAmsterdam Pharma outside the submitted work. Dr Bays reported receiving research grants from Acasti Pharma Inc. Dr Aguilera reported receiving research grants from Acasti Pharma Inc. Dr Gould reported receiving research grants from Acasti Pharma Inc. Dr Hegele reported receiving research grants from Acasti Pharma Inc and personal fees from Akcea-Ionis, Amgen Inc, Arrowhead Pharmaceuticals, HLS Therapeutics Inc, Novartis International AG, and Pfizer Inc outside the submitted work. Dr Moriarty reported receiving research grants from Acasti Pharma Inc. Dr Robinson reported receiving research grants to the institution from Acasti Pharma Inc, Amarin Corporation, Amgen Inc, Astra-Zeneca, Eli Lilly & Co, Esperion Therapeutics Inc, The Medicines Company, Merck & Co Inc, Novartis International AG, Novo Nordisk A/S, and Regeneron Pharmaceuticals Inc, and consulting fees from COR2ED, Getz Pharma Limited, The Medicines Company, and Novartis International AG. Dr Shi reported consulting for Acasti Pharma Inc for performing statistical analyses on this trial. Dr Tur reported receiving research grants from Acasti Pharma Inc. Dr Lapointe reported owning stock or stock options in Acasti Pharma Inc. Dr Aziz reported owning stock or stock options in Acasti Pharma Inc. Dr Lemieux reported serving chief operating officer/chief strategy officer of Acasti Pharma Inc during the conduct of the study and outside the submitted work and holding a patent for CaPre. No other disclosures were reported. [My emphasis]

Comment: You can’t make this stuff up.

Reference: For research on why and how industry sponsorship can influence study outcome, see Unsavory Truth: How Food Companies Skew the Science of What We Eat.

Tara Kenny, a postdoctoral researcher in Ireland sent me this one.

The paper: Perspective Nutrition research challenges and processed food and health. Michael J. Gibney and Ciarán Forde. Nature Food, 2022.

Purpose: “If public health nutrition is to consider the degree of food processing as an important element of the link between food and health, certain gaps in research must be acknowledged.”

Method: The paper compares and critiques differing classification systems for processed foods, emphasizes the physical and sensory aspects of food products as reasons for consumption, and suggests areas for further research.

Conclusion: “The NOVA recommendation that HPFs be avoided poses a considerable challenge, given that a wide body of evidence across the globe shows that almost two-thirds of all energy comes from HPFs…Finally, notwithstanding the opposition of NOVA to the reformulation of HPFs, the value of this approach is internationally recognized.”

Competing interests: “M.J.G. has engaged in paid and non-paid consultancy for a wide range of food companies that manufacture processed foods. He has provided online presentations on ultraprocessed foods to the staff of Unilever and Mondelez. C.G.F. is currently a paid member of the Kerry Health and Nutrition Institute.”

Comment: The paper is a critique of the term ultra-processed (the authors prefer Highly Processed Foods or HPF), of the NOVA classification system for levels of food processing, and of the idea that ultra-processed foods continue to remain in the category of ultra-processed even when reformulated.

Dr. Kenny provided a deeper analysis of the conflicts of interest inherent in this paper; she read the references to several statements in the paragraph that follows the subtitle, “First, do no harm”.

• Ample evidence exists to show that there are no differences in postprandial glucose or insulin response following the ingestion of breads, varying from wholegrain to white and to those with and without additives (Breen et al & Gibney, MRC Human Nutrition Research, Government Agency)
• Similarly, studies show that the nutrient intakes of infants fed on home-prepared infant and toddler foods are not materially different to those of infants fed on industrially prepared products with the exception of sodium, which was higher in the infants fed with home-prepared foods (Reidy et al, 2018 – lead author is head of Nutrition Science for Baby Food, Nestlé Infant Nutrition, Global R&D and leads the Feeding Infants and Toddlers Studies globally. Three additional authors are also Nestle employees).
• Breakfast cereals, normally served with milk, make a very important contribution to micronutrient intake (Gibney et al, 2018 – funded by Cereal Partners Worldwide and General Mills Inc.)
• The advent of low-fat spreads optimized for fatty-acid profile have contributed to a substantial reduction in the intake of saturated fatty acids (Li et al & Gibney).
• Beverages sweetened with artificial sweeteners help reduce the intake of added sugars. These filters should also include foods that are generally regarded as ‘treats’ that have a negligible population impact on nutrient intake (for example, ice cream and chocolate). For example, a study of chocolate intake in 11 European countries showed that the contribution of chocolate to added sugar intake averaged 5% (Azaïs-Braesco et al, funded by Danone Nutricia Research)…”.

She also provided a link to a much more detailed conflict-of-interest statement filed as a correction to another paper co-authored by Mike Gibney.

I’ve written frequently about ultra-processed foods and why I think the NOVA classification is so useful.  See, for example, this post (the classification system) and this one (Kevin Hall’s study).

Despite the opinions expressed in the Nature Food paper, reducing intake of ultra-processed foods seems like a really good idea.

Larissa Zimberoff, the author of Technically Food (which I blurbed and reviewed), forwarded  this press release from the University of California Berkeley:  Global elimination of meat production could save the planet.  

A new study of the climate impacts of raising animals for food concludes that phasing out all animal agriculture has the potential to substantially alter the trajectory of global warming.  The work is a collaboration between Michael Eisen, professor of molecular and cell biology at the University of California, Berkeley, and Patrick Brown, professor emeritus of biochemistry at Stanford University and the CEO of Impossible Foods Inc., a company that sells plant-based meat substitutes.

The study: Rapid global phaseout of animal agriculture has the potential to stabilize greenhouse gas levels for 30 years and offset 68 percent of CO₂ emissions this century.  Michael B. Eisen, Patrick O. Brown.   PLoS Climate. 2022;1(2).  https://doi.org/10.1371/journal.pclm.0000010 

Method: The authors modeled the combined, long-term effects of emission reductions and biomass recovery that would be unlocked by a phaseout of animal agriculture.

Findings:  A phaseout of livestock production would provide half of the net emission reductions necessary to limit warming to 2°C

Conclusion: The magnitude and rapidity of these potential effects should place the reduction or elimination of animal agriculture at the forefront of strategies for averting disastrous climate change.

Funding:  There was no formal funding of this work. Michael Eisen is an Investigator with the Howard Hughes Medical Institute which funds all work in his lab. Patrick Brown is CEO of Impossible Foods, Inc.

Thanks to Daniel Bowman Simon for pointing me to this one.

The study: Effect of Standardized Grape Powder Consumption on the Gut Microbiome of Healthy Subjects: A Pilot Study.  Jieping Yang, et al.  Nutrients. 2021 Nov; 13(11): 3965. doi: 10.3390/nu13113965

Methods: Study subjects had to eat 46 grams a day of grape powder (the equivalent of two daily grape servings) for 4 weeks.  Their microbiomes and serum cholesterol levels were compared to those observed during a baseline 4-week period.

Conclusions: “In conclusion, grape powder consumption significantly modified the gut microbiome and cholesterol/bile acid metabolism.”

Funding: This research was funded by California Table Grape Commission.

Conflicts of Interest: No potential conflict of interest was reported by the authors.

Comment: The authors see no conflicts of interest but they accepted funding from the Grape Commission for the study.  California grape producers issue requests for research proposals to demonstrate the health benefits of grapes using grape powder, so I’m guessing the authors applied for this funding.  As I explain in my book, Unsavory Truth, industry influence on research outcome is well documented, but often unrecognized by recipients.  Funders typically get what they pay for.  Does grape powder duplicate the nutritional benefits of grapes?  Hard to say.  Are any of these results clinically important?  Ditto.

To continue the thene of yesterday’s post, check out this report from the Global Health Advocacy Incubator (an international organization that supports advocacy).

The report documents the food industry’s strategies to defeat warning labels on ultra-processed food products (UPP).

1. Protect the UPP industry’s reputation and brands through corporate washing;
2. Influence policies through multilateral bodies to delay implementation and threaten countries with legal and economic concerns;
3. Divert attention from its corporate responsibility on the damage to environmental and human health to blame individuals for their behaviors;
4. Imply that their products contribute to health, the environment, and society while blocking the development and implementation of healthy food policies; and
5. Seek loopholes in regulations to continue promoting ultraprocessed products.

For example, here is how strategy #5 was implemented in Mexico:

Here, also for example, is image #27:

What should civil society organizations be doing to counter industry tactics?

• Monitor and unmask industry practices
• Use legal strategies
• Avoid loopholes, gaps, and ambiguities when developing labeling  policies
• Demand transparency and no conflicts of interest

This report is exceptionally well documented, covers an enormous range of countries, and gives a quick but compelling overview of how the food industry operates internationally to product product sales.

• Full report click here.
• Executive Summary
• Report’s microsite:  advocacy examples recommendetions.
• Webinar: English, Spanish, Portuguese

Let’s start 2022 off with a review sent to me by a reader who wishes to remain anonymous.

The review: Implementing the 2020–2025 Dietary Guidelines for Americans: Recommendations for a path forward. Sanders, L. M., Allen, J. C., Blankenship, J., Decker, E. A., Christ-Erwin, M., Hentges, E. J., Jones, J. M., Mohamedshah, F. Y., Ohlhorst, S. D., Ruff, J., &Wegner, J. (2021). J Food Sci. 86:5087–5099.  https://doi.org/10.1111/1750-3841.15969

Method: Based on a workshop aimed at developing strategies to promote adoption of dietary guideline recommendations.

Workshop funding: a grant from USDA with contributions from the Institute of Food Technologists.

Conflicts of interest: Mary Christ-Erwin is President and Owner of MCE Food and Agriculture Consulting and received an honorarium from the grant for moderating the meeting and panel and roundtable discussions. Julie M. Jones is a Scientific Advisor to USA Rice, Grain Foods Foundation, and the Quality Carbohydrate Coalition. John Ruff is an Investment Committee Member for Sathguru Catalyser Advisors Private Limited, the Asset Management Company of Innovation in Food and Agriculture Fund (IFA Fund) that invests in innovation-driven growth enterprises in the Food and Agriculture sectors, based in India. He is reimbursed for meeting fees and expenses related to attending committee meetings but has no investments in the fund. Lisa M. Sanders [Note: First author who wrote original draft] is the owner of Cornerstone Nutrition, LLC, a consultancy which has received funding from Kellogg Company, PepsiCo, and The Coca-Cola Company. Dr Sanders receivedwriting fees fromthe grant for development of this manuscript. JillWegner is an employee of Nestle. Jonathan C. Allen, Jeanne Blankenship, Eric A. Decker, Eric J.Hentges, Farida Y. Mohamedshah, and Sarah D. Ohlhorst have no conflicts to declare.

Comment: This workshop reflects a food industry perspective on the dietary guidelines.  Some of its reocmmendations make sense.  Others raise eyebrows, or should.

• The first recommendation: “Emphasize health benefits…gained through cooking at home.
• My favorite recommendation: “Leverage the current interest in science to debunk myths about food processing by demonstrating the similarity of techniques used to make foods at home and at scale in food industry, to show how food processing can contribute to the solution.”

This review is an excellent example of why the food industry needs to firmly excluded from nutrition policy discussions (for details on why, see my book, Unsavory Truth).

My strongest criticism of the 2020 dietary guidelines is that they fail to say anything about the health benefits of reducing consumption of ultra-processed foods (the junk food category strongly associated with excessive calorie intake, weight gain, and poor health).

Yet here we have a published review in a food science journal arguing for debunking “myths” about food processing.

They are not myths.  Evidence is abundant.

See, for example:

• Monteiro CA, Cannon G, Levy RB, et al.  Ultra-processed foods: what they are and how to identify them.  Public Health Nutr; 2019;22(5):936–941.
• Lawrence MA, Baker PI.  Ultra-processed food and adverse health outcomes.  BMJ. 2019 May 29;365:l2289.  doi: 10.1136/bmj.l2289.
• Hall KD, Ayuketah A, Brychta R, et al. Ultra-processed diets cause excess calorie intake and weight gain: an inpatient randomized controlled trial of ad libitum food intake [errata in Cell Metab. 2019;30(1):226 and Cell Metab. 2020;32(4):690]. Cell Metab. 2019;30(1):67–77.e3. doi: 10.1016/j.cmet.2019.05.008.