by Marion Nestle

Search results: dietary guidelines

Dec 7 2023

No, Virginia, correlation does not necessarily signify causation

On Thursdays I like posting things I want everyone to enjoy.

This one, I stole from Tamar Haspel, who writes about food for the Washington Post.

I follow her on X (the site formerly known as Twitter), where she recently posted:

This could be my all-time favorite BMI correlation!

In China and post-Soviet states, BMI correlates with corruption. The fatter, the crookeder.

The correlation she cites is from an article in the Economist, Are Overweight Politicians Less Trustworthy?

 

 

 

 

 

 

 

 

 

I agree.  This is a fabulous example of how correlation does NOT mean causation—a basic tenet of epidemiology often forgotten.

But here’s my personal favorite example.  I laugh every time I see it.

Image

No, the Dietary Guidelines did not cause the prevalence of obesity to rise.

This is correlation, NOT causation.

For causes, please consider food overproduction, pressures on food companies to sell food when there is so much of it, and the shareholder value movement, which demands not only profits, but  continual growth in profits.  All of these forced food companies to find new ways to get everyone to eat more food (by creating an “eat more” food environment.  I discuss all this in Food Politics and my other books).

Correlation is lots of fun but causation requires much deeper analyses.

Sorry about that.

Thanks Tamar.

Nov 20 2023

Nutrition professional organizations should not partner with food companies

Just because all of the major nutrition professional organizations partner with food companies, does not make it a good idea.  If nothing else, partnerships with food companies raise reputational risks.  They give the appearance of conflicted interests, as David Ludwig and I warned in 2008.  I have also written about the hazards of food industry sponsorship of professional organizations in Food Politics, Soda Politics, and Unsavory Truth.  Here’s what they are doing now.

Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association)  OOPS.  My error.  This should be the American Diabetes Association (even worse).  Abject apologies.  This is what I get for not reading more carefully.  Apologies again.

If I seem to be picking on AND, it’s because it is bigger and gets into more trouble than other nutrition professional societies.

The latest example: According to Reuters, a former AND officer, Elizabeth Hanna, has sued the organzation for “firing her for objecting to what she called a “pay to play” scheme to promote the no-calorie sweetener Splenda.

In its 2022 annual report, the ADA said Splenda was one of a group of “elite” supporters that had given more than $1 million, along with Bayer Healthcare, Blue Cross Blue Shield of Illinois, Helmsley Charitable Trust and others.

On its website, Splenda publishes “diabetes-friendly recipes,” endorsed by the ADA. Hanna, a registered dietitian nutritionist, said she refused to approve the endorsement of several of these recipes in July.

…The U.S. Centers for Disease Control and Prevention states on its website that some studies have found possible health risks associated with the sweeteners, but that more research is needed.

American Society for Nutrition (ASN)

I am a member of this society and raise objections every time I get something like this in my e-mail.

Sponsored Webinar: Oral Health and Nutrition: Imperative for Healthy People 2030 and US Dietary Guidelines   Sponsored By: Mars Wrigley and the Oral Health Alliance.  The 2020-2025 Dietary Guidelines (DGA) identified dental caries as a major diet-related chronic disease of public health concern….

Doing this sort of thing risks reputation.

Evidence:  In a video on ultra-processed foods, the Financial Times identifies the ASN as “food industry advocacy group.”

The ASN’s executive director assures me they will ask for a correction.

Society for Nutrition Education and Behavior

Et tu?

It just announced a webinar, “Latinos love affair with Mangos: Maintaining Generational Food Traditions to Improve Health Outcomes.”

This is “a webinar sponsored by the National Mango Board, SNEB Organizational Member.”

The mango is…one of the world’s most popular fruits, and a staple food across Spanish speaking countries of North America, South America, and the Caribbean. Beyond its culinary popularity, an expanding body of research shows associations with mangos and risk reductions for inflammation and metabolically- based chronic disease, many of which disproportionately impact Hispanic American populations.

Mangos as opposed to any other fruit?

I am also a member of this society.

Overall comment

Are the reputational risks—and the loss of integrity—worth the money?  I don’t think so.

Nov 14 2023

The food industry’s role in dietetic education

I frequently get sent copies of e-mailed messages sent to members of the Academy of Nutrition and Dietetics, the professional organization for people holding credentials as Registered Dietitian Nutritionists (RDN).

Disclosure: I do not hold this credential; long after I had a doctorate while I was doing a later master’s in public health, I fulfilled all of the graduate and clinical requirements but was still short one undergraduate course.

Holders of the RDN must complete 75 credits of continuing education courses every five years to maintain the credential.  Usually, dietitians must pay for courses to meet those credits.

But as my correspondents make clear, food complanies offer courses for credit—at no cost.

It is not at all difficult to fully meet credit requirements through industry-sponsored courses.

Here are some examples:

  • International STEVIA Council.  Stevia: The Science Beehind the Sweet: a complimentary webinar that will review the most recent scientific evidence supporting the use of stevia to help reduce the risk of chronic diseases and improve quality of life.  https://www.todaysdietitian.com/marketing/webinars/2023/ISC/index.html
  • This…Free CPEUs: Webinar on Dietary Diversity: Join PepsiCo Health & Nutrition Sciences on Thursday, December 7th for the latest research on incorporating more diverse foods, such as whole grains, legumes and other under-consumed food groups, in dietary patterns. This webinar will also feature a fun culinary demo! Earn 1.25 free CPEUs. Register now.
  • The Latest on Low- and No-Calorie Sweeteners: What You Need to Know. This activity is accredited by Heartland Food Products Group. 1.0 CPEU FREE
  • Looking for more free CPE opportunities?  IFIC has 20+ hours of CPEUs available here  [NOTE: IFIC, the International Food Information Council, is a food industry trade association focused on education].

Comment: One can only imagine what those sessions will say.  Do not expect anything critical about the sponsor’s products.

But here’s an even easier way to pick up a bunch of credits.

Free CPE Opportunities are Now Available for Reading the Dietary Guidelines for Americans!  A Special Treat for Professionals: Free CPE Units Available Now for Reading the Dietary Guidelines for Americans.

You can now earn 2.0 free continuing professional education (CPE) credits for reading the Introduction and Chapter 1 of the Dietary Guidelines for Americans, 2020-2025! Credits are provided by the Commission on Dietetic Registration (CDR), the credentialing body for Registered Dietitians and Dietetic Technicians, Registered.

The self-study module will equip professionals with knowledge of the scientific underpinnings that makes the Dietary Guidelines relevant across all life stages. Participants will also learn science-based advice on what to eat and drink to build a healthy diet that can promote health, help prevent diet-related chronic disease, and meet nutrient needs.

Visit CPE Opportunities | Dietary Guidelines for Americans to start earning credits and stay updated on the release of future modules.

Comment:  Let’s hope that dietitians have already read the Dietary Guidelines at some point.  Or maybe it takes free credits to get anyone to slog through its 150 pages.

In any case, AND should not be allowing food companies to “educate” dietitians.

Just to be fair: the society to which I belong, the American Society of Nutrition, is doing this.  It too should not.

 

Oct 27 2023

Weekend reading: School food in Mexico

José Tenorio.  School Food Politics in Mexico: The Corporatization of Obesity and Healthy Eating Policies.  Routledge, 2023.  

I was asked for a blurb for this one:

From first-hand observations and deep research, José Tenorio makes it clear that school food in Mexico is about much more than feeding hungry kids; it’s about how food corporations have taken advantage of social inequalities to replace native food traditions with less healthful but profitable products.  School food politics, indeed!

This book may seem specialized, but it is a useful case study in the politics of school food—not confined to the United States, apparently.

Mexico leads the way in efforts to promote healthier diets.  It has  excellent dietary guidelines.   It also has warning labels on food products (see my post on these), soda taxes, a ban on trans fats, and other measures.

Mexico’s schools do not provide meals for kids in schools.  They sell foods at canteens.

The country set nutrition standards for foods sold in schools in 2011, but compliance is not great.

Public health and food advocacy groups support laws to ban unhealthy foods and drinks from schools.  Despite formidible industry opposition, this may actually happen.

This book provides evidence for why it should.

Oct 23 2023

Industry funded study of the week: the Pork Checkoff and Egg Board in action

Thanks to a reader, Kevin Mitchell, for sending this news item: Animal vs. Plant Protein: New Research Suggests That These Protein Sources Are Not Nutritionally Equivalent.

Scientists found that two-ounce-equivalents (oz-eq) of animal-based protein foods provide greater essential amino acids (EAA) bioavailability than the same quantity of plant-based protein foods. The study challenges the Dietary Guidelines for Americans (DGAs) which suggest these protein sources are nutritionally equivalent.

I went right to the source.

  • The study: Connolly G, Hudson JL, Bergia RE, Davis EM, Hartman AS, Zhu W, Carroll CC, Campbell WW. Effects of Consuming Ounce-Equivalent Portions of Animal- vs. Plant-Based Protein Foods, as Defined by the Dietary Guidelines for Americans on Essential Amino Acids Bioavailability in Young and Older Adults: Two Cross-Over Randomized Controlled Trials. Nutrients. 2023; 15(13):2870. https://doi.org/10.3390/nu15132870
  • Objectives: We assessed the effects of consuming two oz-eq portions of pork, eggs, black beans, and almonds on postprandial EAA bioavailability in young and older adults.
  • Methods: We conducted two investigator-blinded, randomized crossover trials in young (n = 30; mean age ± SD: 26.0 ± 4.9 y) and older adults (n = 25; mean age ± SD: 64.2 ± 6.6 y). Participants completed four testing sessions where they consumed a standardized meal with two oz-eq of either unprocessed lean pork, whole eggs, black beans, or sliced almonds.
  • Conclusions: Pork resulted in greater EAA bioavailability than eggs in young adults (p < 0.0001), older adults (p = 0.0007), and combined (p < 0.0001)… The same “oz-eq” portions of animal- and plant-based protein foods do not provide equivalent EAA content and postprandial bioavailability for protein anabolism in young and older adults.
  •  Funding: This research was funded by the Pork Checkoff and the American Egg Board—Egg Nutrition Center. The supporting sources had no role in study design; collection, analysis, and interpretation of data; writing of the report; or submission of the report for publication.
  • Conflicts of Interest: When this research was conducted, W.W.C. received research funding from the following organizations: American Egg Board’s Egg Nutrition Center, Beef Checkoff, Pork Checkoff, North Dakota Beef Commission, Barilla Group, Mushroom Council, and the National Chicken Council. C.C.C. received funding from the Beef Checkoff. R.E.B. is currently employed by Archer-Daniels-Midland (ADM); the research presented in this article was conducted in a former role and has no connection with ADM. G.C., J.L.H., E.M.D., A.S.H. and W.Z. declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Comment: It is very much in the interest of the Pork Checkoff and the Egg Board t,o demonstrate that animal-source food protein is better for you than proteins from plant sources—and to cast doubt on any evidence to the contrary.  Proteins, whether from animal or plant sources, contain precisely the same 20 amino acids, although in different proportions.  Animal proteins are closer in amino acid composition than are plant proteins but if you eat a variety of plant foods you will get the amino acids you need.   People who eat largely plant-based diets are generally healthier than people who eat a lot of animal-based foods.  The conclusion of this study does not change that overall conclusion.  This, then, is another industry-funded study with predictable results.

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

Jul 20 2023

Ultra-processed pushback #4: a debate

The British journal, Public Health Nutrition, published a debate about ultra-processed foods this month.

Invited commentaries

CON:  Michael Gibney.  Ultra-processed foods in public health nutrition: the unanswered questions,

Several definitions of the degree of processing have been proposed. However, when each of these is used on a common database of nutritional, clinical and anthropometric variables, the observed effect of high intakes of highly processed food, varies considerably.. Moreover, assigning a given food by nutritional experts, to its appropriate level of processing, has been shown to be variable. Thus, the subjective definitions of the degree of food processing and the coding of foods according to these classifications is prone to error…Another issue that need[s] resolution is the relative importance of the degree of food processing and the formulation of a processed food. Although correlational studies linking processed food and obesity abound, there is a need for more investigative studies.

PRO: Mark Lawrence.  Ultra-processed foods: a fit-for-purpose concept for nutrition policy activities to tackle unhealthy and unsustainable diets.  Also an addendum: Ultra-processed foods: a fit-for-purpose concept for nutrition policy activities to tackle unhealthy and unsustainable diets.

This commentary describes the UPF concept as being fit-for-purpose in providing guidance to inform policy activities to tackle unhealthy and unsustainable diets. There is now a substantial body of evidence linking UPF exposure with adverse population and planetary health outcomes. The UPF concept is increasingly being used in the development of food-based dietary guidelines and nutrition policy actions. It challenges many conventional nutrition research and policy activities as well as the political economy of the industrial food system. Inevitably, there are politicised debates associated with UPF and it is apparent a disproportionate number of articles claiming the concept is controversial originate from a small number of researchers with declared associations with UPF manufacturers.

Letters to the editor

CON: Mark J Messina, John L Sievenpiper, Patricia Williamson, Jessica Kiel, John W Erdman.  Ultra-processed foods: a concept in need of revision to avoid targeting healthful and sustainable plant-based foods

we take issue with his perspective on our recently published article in which we make two fundamental points. First, the common criticisms of ultra-processed foods (UPF) do not apply to soya-based meat and dairy alternatives more so than they do to their animal-based counterparts, meat and cows’ milk, despite the former being classified as UPF and the latter as unprocessed/minimally processed foods. Second, NOVA is overly simplistic and does not adequately evaluate the nutritional attributes of meat and dairy alternatives based on soya….We therefore stand by our opinion that NOVA does a disservice to the public by suggesting that because soya burgers and soyamilk are NOVA-classified as UPF, they should be avoided. These foods can aid in the transition to and maintenance of plant-based diets.

PRO:  Mark Lawrence. The need for particular scrutiny of claims made by researchers associated with ultra-processed food manufacturers.

In this Commentary, I referred to challenges the UPF concept presents to researchers with declared associations with UPF manufacturers. The interplay between nutrition research and commercial interests is a widely recognised phenomenon in the commercial determinants of health literature…UPF-related research has become highly politicised and the integrity of the claims presented by researchers associated with UPF manufacturers demands close scrutiny.

Comment

In his letter, Mark Lawrence noted my having included the paper by Messina et al as one of my “industry-funded studies of the week” on this website.  In it, I reproduced the unusually long conflict of interest declaration of the authors, many of them disclosing ties to companies making ultra-processed foods.  Again, the ultra-processed concept is backed up by an extraordinary amount of research far beyond the point where it can be ignored or dismissed out of hand.

Professor Lawrence explains why there is so much pushback: “It [the UPF concept] challenges many conventional nutrition research and policy activities as well as the political economy of the industrial food system.”

Jul 17 2023

Industry-influenced study of the week: Ultra-processed foods are good for you!

I am devoting this week to the pushback against advice to reduce consumption of ultra-processed foods.  It is coming from the food industry, of course, government agencies with ties to the food industry, and nutritionists who focus on  the benefits of nutrients, without contextualizing the foods and diets they come from (“nutritionism”).

For the record, ultra-processed foods are :

  • Industrially produced
  • Bear little resemblance to the foods they were derived from
  • Typically contain additives for color, flavor, and texture
  • Cannot be made in home kitchens,
  • Are formulated to be irresistable,
  • Are associated with excessive calorie intake and poor health
  • Are extremely profitable to their makers
  • Cannot be made in home kitchens (a brief operating definition)

Ultra-processed food pushback #1: A study from the USDA and authors with conflicted interests

The USDA’s Agricultural Research Service is so proud of this study that it sent out a press release.

Scientists at the USDA Agricultural Research Service’s (ARS) Grand Forks Human Nutrition Research Center led a study that demonstrates it is possible to build a healthy diet with 91 percent of the calories coming from ultra-processed foods (as classified using the NOVA scale) while still following the recommendations from the 2020-2025 Dietary Guidelines for Americans (DGA). The study highlights the versatility of using DGA recommendations in constructing healthy menus.

The Study: Dietary Guidelines Meet NOVA: Developing a Menu for A Healthy Dietary Pattern Using Ultra-Processed Foods.  Julie M. Hess, Madeline E. Comeau, Shanon Casperson, Joanne L. Slavin, Guy H. Johnson, Mark Messina, Susan Raatz, Angela J. Scheett, Anne Bodensteiner, Daniel G. Palmer.  The Journal of Nutrition, 2023.  https://doi.org/10.1016/j.tjnut.2023.06.028.

Purpose: “The purpose of this proof-of-concept study was to determine the feasibility of building a menu that aligns with recommendations for a healthy dietary pattern from the 2020 DGA and includes ≥80% kcal from UPF as defined by NOVA.”

Method: “we first developed a list of foods that fit NOVA criteria for UPF, fit within dietary patterns in the 2020 DGA, and are commonly consumed by Americans. We then used these foods to develop a 7-d, 2000 kcal menu modeled on MyPyramid sample menus and assessed this menu for nutrient content as well as for diet quality using the Healthy Eating Index-2015 (HEI-2015).”

Results: “In the ultra-processed DGA menu that was created, 91% of kcal were from UPF, or NOVA category 4. The HEI-2015 score was 86 out of a possible 100 points.”

Conclusions: “Healthy dietary patterns can include most of their energy from UPF, still receive a high diet quality score, and contain adequate amounts of most macro- and micronutrients.”

 Conflicts of Interest: “MM serves as the Director of Nutrition Science and Research for the Soy Nutrition Institute (SNI) Global. The SNI Global receives funding from soybean farmers via the soybean national checkoff program and via membership dues from companies involved in manufacturing and/or selling soy ingredients and/or soyfoods. GHJ serves as Senior Advisor to the McCormick Science Institute. JLS serves on advisory/consultant boards for Simply Good Foods, Quality Carbohydrates Coalition, and the Sustainable Nutrition Scientific Board and has received funding from the National Institutes of Health, Taiyo, Barilla Foods, and the USDA in the past 12 mo. The other authors report no conflicts of interest.”

Funding: This work was supported by USDA Agricultural Research Service project grant #3062-51000-057-00D.

Comment:  I can think of only one reason for doing a study like this: to cast doubt on the concept of ultra-processed foods (UPF) and all the research showing that UPF diets induce people to eat more calories (see the study by Kevin Hall et al) and are strongly associated in hundreds of studies with poor health, evidence that by this time is overwhelming and incontrovertible.  Why now?  Because the 2025-2030 Dietary Guidelines Advisory Committee has been charged with examining the relationship of UPF to heart disease risk.

The first rule of the ‘Playbook” is to cast doubt on the research, which is what we are seeing here.  The message to reduce consumption of ultra-processed foods makes good sense for health reasons.  But such advice is very bad for the profits of food companies making junk foods.

The USDA’s Agricultural Research Service is a marketing arm of the food industry,.  It is heavily conflicted.

For one thing, the Healthy Eating Index is not useful for this purpose; it is strictly nutrient-based, which is not the issue here.  And the Dietary Guidelines are careful to leave plenty of room for eating junk foods and to say not one word about UPF.

I think the UPF concept is so solidly backed up by evidence that it is here to stay.  But it is so threatening to food companies making UPF products, and the USDA is so captured by the food industry (checkoff programs, anyone?) that it is understandable why they are so eager to cast doubt.

Thanks to the half dozen or so readers who sent this one to me, to Ted Kyle for calling it “oxymoronic healthy eating,” and  Kevin Hall for pointing out that the healthfulness of this diet is assumed, not tested: