Search results: american journal of clinical nutrition

Happy Anniversary Food Politics.

The Tenth Anniversary Edition is out with a new Foreword by Michael Pollan.  It also has new Preface and a new Afterword, in which I bring food politics up to date.

Order from your local independent bookstore or Amazon or UC Press or Barnes & Noble

Summary

We all witness, in advertising and on supermarket shelves, the fierce competition for our food dollars. In this engrossing exposé, Marion Nestle goes behind the scenes to reveal how the competition really works and how it affects our health. The abundance of food in the United States—enough calories to meet the needs of every man, woman, and child twice over—has a downside. Our overefficient food industry must do everything possible to persuade people to eat more—more food, more often, and in larger portions—no matter what it does to waistlines or well-being.

Like manufacturing cigarettes or building weapons, making food is very big business. Food companies in 2000 generated nearly $900 billion in sales. They have stakeholders to please, shareholders to satisfy, and government regulations to deal with. It is nevertheless shocking to learn precisely how food companies lobby officials, co-opt experts, and expand sales by marketing to children, members of minority groups, and people in developing countries. We learn that the food industry plays politics as well as or better than other industries, not least because so much of its activity takes place outside the public view.

Editor of the 1988 Surgeon General’s Report on Nutrition and Health, Nestle is uniquely qualified to lead us through the maze of food industry interests and influences. She vividly illustrates food politics in action: watered-down government dietary advice, schools pushing soft drinks, diet supplements promoted as if they were First Amendment rights.When it comes to the mass production and consumption of food, strategic decisions are driven by economics—not science, not common sense, and certainly not health.

No wonder most of us are thoroughly confused about what to eat to stay healthy. An accessible and balanced account, Food Politics will forever change the way we respond to food industry marketing practices. By explaining how much the food industry influences government nutrition policies and how cleverly it links its interests to those of nutrition experts, this pathbreaking book helps us understand more clearly than ever.

Blurbs

“In this fascinating book we learn how powerful, intrusive, influential, and invasive big industry is and how alert we must constantly be to prevent it from influencing not only our own personal nutritional choices, but those of our government agencies. Marion Nestle has presented us with a courageous and masterful exposé.” — Julia Child

“This remarkable book is essential reading for anyone who wishes to understand how it has come to be that the richest nation in the world is eating itself to death. . . . Straight reporting about the shaping of food policy, as this volume makes clear, is certain to offend some very powerful players.” — Joan Dye Gussow, author of This Organic Life

“Food politics underlie all politics in the United States. There is no industry more important to Americans, more fundamentally linked to our well-being and the future well-being of our children. Nestle reveals how corporate control of the nation’s food system limits our choices and threatens our health. If you eat, you should read this book.” — Eric Schlosser, author of Fast Food Nation

“‘Blockbuster’ is one of the best ways that I could describe this book. . . . A major contribution to understanding the interaction of politics and science, especially the science of nutrition, it is of extreme value to virtually all policy makers and to everyone concerned with the American diet.” — Sheldon Margen, editor of the Berkeley Wellness Letter

“A devastating analysis of how the naked self-interest of America’s largest industry influences and compromises nutrition policy and government regulation of food safety. . . . A clear translation of often obscure studies and cases, the writing is accessible and lively.” — Warren Belasco, author of Appetite for Change

Reviews and Commentary

• Food Politics: Worse Than You Thought Durham Independent 5/21/03
• Resource Review – Food Politics Dietitians of Canada Members Online Newsletter 5/03
• Marketing, Not Health Townsend Letter for Doctors and Patients 5/03
• Book Review Journal of the American Dietetic Association 4/03
• Have Fat, Will Sue Financial Times 12/12/03
• Book Review The American Journal of Clinical Nutrition 12/02
• Expert Blames Obesity on Food-Industry Marketing The Seattle Times 11/6/02
• The Hunger for Profit World Watch 9/02 – 10/02
• The Soft Sell: How the Food Industry Shapes Our Diets Nutrition Action Health Letter 9/02
• Schools Teach 3 C’s: Candy, Cookies and Chips The New York Times 9/24/02
• Barbecue of the Vanities The Guardian 8/19/02
• The Food Pushers Science 7/12/02
• Digesting the Message International Association for the Study of Obesity Newsletter 2002
• Book Review The New England Journal of Medicine 6/20/02
• Exposé from a Food Policy Insider Veg Source 6/5/02
• Weighing Our Health: Epidemic of Obesity San Francisco Chronicle 5/26/02
• Food Politics Blames Industry for Obesity Epidemic Food Chemical News 5/20/02
• Food in the USA: Something to Chew Over The Lancet 5/18/02
• Food Industry Tempts us to Overeat, Professor Says Columbia Daily Tribune 5/15/02
• Book Draws Protests from Food Leaders Elsevier Food International 5/15/02
• One Woman’s Showdown with the Food Industry The New York Times 5/15/02
• Heavy Duty The New Republic 5/13/02
• Lean on Me The Economist 5/11/02
• Big Food’s Real Appetites The Nation 5/6/02
• She’s a ‘Nag’ for Detailing Big Food’s Deviousness The Philadelphia Inquirer 4/17/02
• The Campaign Against Big Food townhall.com 4/2/02
• Feeding Frenzy The Village Voice 3/26/02
• Big Fat San Francisco Bay Guardian 3/8/02
• Obesity: Should Food Industry Be Blamed? CNSNews.com 2/26/02
• Sugar-Coating the Facts (Lesson Plan) The New York Times 2/19/02
• Food for Thought for a Fat Nation USA Today 2/19/02

This is an example of what the late and much missed Sheldon Krimsky called “the funding effect,” the strong tendency for industry-funded studies to produce results favorable to the commercial interests of the sponsor.

The study: Industry study sponsorship and conflicts of interest on the effect of unprocessed red meat on cardiovascular disease risk: a systematic review of clinical trials. Miguel López-Moreno, Ujué Fresán, Carlos Marchena-Giráldez, Gabriele Bertotti, Alberto Roldán-Ruiz.  The American Journal of Clinical Nutrition, 2025, https://doi.org/10.1016/j.ajcnut.2025.02.030.

The findings:  

• Of 44 studies of meat and cardiovascular risks, 66% had links to the meat industry.
• All independently funded studies reported unfavorable (73.3%) or neutral (26.7%) results.
• All studies with funding ties to the meat industry reported favorable (20.7%) or neutral (79.3 %) results.
• Studies with conflicts of interest were nearly 4 times more likely to report favorable/neutral outcomes.

Conclusion: 

• Studies funded by the meat industry “may underestimate the cardiovascular benefits of reducing red meat intake.”

Comment

This study confirms an enormous body of research on this topic: industry funding influences research outcome.  How?  Usually by influencing how the research question is framed or in how the results are interpreted (unfavorable results reported as neutral, for example).  I’ve seen criticisms of this study arguing that ideology (favoring plant-based diets, for example) also influences research outcome.  It does, but all investigators have belief systems that influence their work.  These can go in any direction.  That’s why research needs repeating by other investigators with other biases.  Financial ties are different; they invariably skew results in the same direction—toward the commercial interests of the sponsor.

A Canadian reader, Michel Lucas, sent this one (merci).

The report: Benoît Lamarche, Arne Astrup, Robert H Eckel, Emma Feeney, Ian Givens, Ronald M Krauss, Philippe Legrand, Renata Micha, Marie-Caroline Michalski, Sabita Soedamah-Muthu, Qi Sun, Frans J Kok.  Regular-fat and low-fat dairy foods and cardiovascular diseases: perspectives for future dietary recommendations.  The American Journal of Clinical Nutrition, Volume 121, Issue 5, 2025, Pages 956-964,  ISSN 0002-9165, https://doi.org/10.1016/j.ajcnut.2025.03.009.

The workshop: Saturated Fat in Dairy and Cardiovascular Diseases, Amsterdam, 15–16 April, 2024.

Findings: “The most recent evidence indicates that overall, consumption of milk, yogurt and cheese, irrespective of fat content, is neutrally associated with CVD risk. There is also no evidence yet from randomized controlled trials that consumption of regular-fat milk, yogurt, and cheese has different effects on a broad array of cardiometabolic risk factors when compared with consumption of low-fat milk, yogurt, and cheese.”

Conclusion: “Thus, the body of evidence does not support differentiation between regular-fat and low-fat dairy foods in dietary guidelines for both adults and children.”

Implication: “Strategies focusing primarily on reduction of energy-dense, nutrient-poor foods, the main source of SFAs in Western diets, rather than on the fat content of dairy foods, are more likely to benefit the population’s cardiovascular health.”

Funding: The workshop “was supported by an unrestricted grant from the Dutch Dairy Association.”

Comment: Foods from animal sources—meat and dairy—are by far the main sources of saturated fatty acids in US diets (all food fats, no exceptions, are mixtures of saturated, unsaturated, and polyunsaturated fatty acids; it’s just the proportions that differ).

Cows eat grass; grass has fatty acids but they are mostly unsaturated; bacteria in the cows’ rumens saturate the fatty acids.

Pretty much everyone agrees that when saturated fatty acids are substituted for unsaturated or polyunsaturated fatty acids, they raise blood cholesterol and the risk for heart disease.  The disagreements are over by how much and whether clinically meaningful.

The dairy industry would like everyone to believe that the saturated fatty acids in dairy foods are benign.  Hence this workshop.

Conflict of interest: The disclosure statement begins with “The Dutch Dairy Association had no role in the discussions held at the high-level closed workshop and did not participate or provide comments during the development and writing of this manuscript.”  It didn’t have to.

Here’s the rest of the statement (I’ve emphasized dairy connections):

AA is a member of the Journal’s Editorial Board and is also an Associate Editor on The American Journal of Clinical Nutrition and played no role in the journal’s evaluation of the manuscript, reports a relationship with Rééducation Nutritionnelle et Psycho-Comportementale Scientific Committee and American Journal of Clinical Nutrition that includes board membership; and a relationship with Ferrero that includes funding grants. QS reports travel provided by Dutch Dairy Association. AA, RHE, IG, EF, RMK, PL, RM, M-CM, SS-M, and FJK reports financial support and travel provided by Dutch Dairy Association. BL reports writing assistance provided by Chill Pill Media Ltd and relationship with Health Canada that includes funding grants. EF reports a relationship with Food for Heath Ireland and Teagasc Food Research Ireland that includes funding grants; relationship with Irish section of the Nutrition Society and British Journal of Nutrition that includes board membership; relationship with National Dairy Council Ireland that includes consulting or advisory and travel reimbursement. IG reports a relationship with Global Dairy Platform, Dairy Australia, Barham Benevolent Foundation, UK Research and Innovation, Medical Research Council that includes funding grants; relationship with European Milk Federation, French National Interprofessional Centre for Dairy Economics, and Dairy Council Northern Ireland that includes speaking and lecture fees and travel reimbursement; relationship with ELSEVIER INC that includes consulting or advisory. RMK reports a relationship with Dairy Management Inc that includes funding grants. RM reports a relationship with National Institutes of Health and Gates Foundation that includes funding grants. M-CM reports a relationship with French Dairy Interbranch Organization, Sodiaal-Candia and Danone that includes funding grants; relationship with Sodiaal-Candia that includes consulting or advisory; relationship with International Milk Genomics Consortium that includes speaking and lecture fees and travel reimbursement; relationship with Danone Nutricia Research and French Dairy Interbranch Organization that includes travel reimbursement. SS-M reports a relationship with Dutch Dairy Association and Danish Dairy Research Foundation that includes funding grants.

 

 

The Study: Whole cranberry fruit powder supplement reduces the incidence of culture-confirmed urinary tract infections in females with a history of recurrent urinary tract infection: A 6-month multicenter, randomized, double-blind, placebo-controlled trial.Stonehouse, Welma et al. The American Journal of Clinical Nutrition, Volume 121, Issue 4, 932 – 941

Methods: “This multicenter, 6-mo, randomized, placebo-controlled, double-blind study enrolled 150 healthy females [18–65 y, body mass index (BMI) >17.5 and <35 kg/m²] with rUTI defined as ≥3 UTIs in the last year or ≤2 UTIs in the last 6 mo, excluding those with >5 UTIs in the last 6 mo. Participants consumed either 1 capsule of 500 mg/d of whole cranberry powder (Pacran) or placebo.”

Results: “Whole cranberry powder capsules reduced culture-confirmed UTI risk compared with placebo by 52%…reduced Escherichia coli UTIs…reduced incidence of UTI with urinary frequency and urgency symptomatology; delayed time to first UTI episode…and reduced the mean total number of UTIs per participant.”

Conclusion: “This study shows that whole cranberry powder capsules do not impact safety markers and reduce the incidence of culture-confirmed UTI and several other UTI-related outcomes in healthy females with rUTI history.”

Conflict of interest: “Financial sponsorship for the study was provided by Swisse Wellness Pty Ltd to the Commonwealth Scientific Industrial Research Organisation. All authors report no conflicts of interest.”

Funding: “Swisse Wellness Pty Ltd was the trial sponsor and Givaudan Flavors Corp was the raw material supplier.”

Disclaimers: “The funding source and the raw material supplier, in collaboration with the research scientists, designed the trial and monitored its implementation, but had no influence over the analyses, reporting, interpretation of the data and preparation of the manuscript. The manuscript was reviewed by the sponsor and the raw material supplier before the submission to the journal, but they had no influence over the manuscript content.”

Comment: You should not be surprised to learn that the funder, Swisse Wellness Pty Ltd, makes “supplements for everyday lifestyle.” among them cranberry supplements.  The raw material supplier, Givaudan, sells cransberry oil.  The disclaimer reveals that both companies  designed the trial, were involved throughout, and reviewed the manuscript.  The authors consider all this to constitute “no influence,” in quotes because it is impossible to avoid influence under these circumstances.  At the very least, the companies would make sure the study design had little chance of coming up with the wrong result.  This is an industry-funded study with predictable results that will help them sell cranberry powder.  I hope it works.

I.  Darius Mozaffarian, a nutrition professor at Tufts University, has an editorial in the American Journal of Clinical Nutrition:“The Dietary Guidelines for Americans—is the evidence bar too low or too high?”

He writes about an analysis of the systematic literature reviews SRs) that form the basis of science-based decisions in the guidelines.  His comments gives an insight into the Dietary Guidelines process worth seeing.

For the 2025–2030 DGAC, I served as a peer reviewer for the SR on UPFs…I felt that the SR’s question, design, and planned methods were appropriate, but that its implementation and conclusions were weakened by important deviations from these standards. For example, contradicting its stated eligibility criteria, the SR included numerous studies that did not appropriately or adequately define or assess UPF. Following inclusion of such heterogeneous studies, the SR concluded that the scientific evidence on UPF was limited due to many studies having serious concerns around exposure misclassification as well as evaluating dietary patterns not directly varying in amounts of UPF. This demonstrated a circular and dismaying reasoning: the SR included studies it should not have that had heterogeneous and poorly characterized assessments of UPF, and then concluded that heterogeneous and poorly characterized assessments of UPF limited the strength of the evidence.

He observes:

Most importantly, the DGA and SR requirements make clear that guiding Americans toward a healthier diet is an unfair fight from the start. The food industry can do almost anything it wishes to our food, combining diverse ingredients, additives, and processing methods with virtually no oversight or required evidence for long-term safety  In contrast, the DGAs and other federal agencies can only make recommendations to avoid certain foods or limit certain manufacturing methods when there is extensive, robust, and consistent evidence for harm. In this severely imbalanced playing field, industry wins again and again.

II.  Senator Bernie Sanders posted on Facebook Sanders Statement on How to Make America Healthy Again.  Among other issues, he’s taking on the food industry.

Reform the food industry. Large food corporations should not make record-breaking profits addicting children to the processed foods which make them overweight and prone to diabetes and other diseases. As a start, we must ban junk food ads targeted to kids and put strong warning labels on products high in sugar, salt and saturated fat. Longer term, we can rebuild rural America with family farms that are producing healthy, nutritious food.

III.  California Governor Gavin Newsom “issues executive order to crack down on ultra-processed foods and further investigate food dyes.”

The food we eat shouldn’t make us sick with disease or lead to lifelong consequences. California has been a leader for years in creating healthy and delicious school meals, and removing harmful ingredients and chemicals from food. We’re going to work with the industry, consumers and experts to crack down on ultra-processed foods, and create a healthier future for every Californian.

Comment

Mozaffarian offers these opinions despite disclosing financial ties to food companies.  Sanders is a welcome addition to the handful of legislators concerned about food issues.  Newsom is making it easier for other states to take similar steps.

Maybe there’s a glimmer of hope for coalition building among advocates for healthier food systems.  Maybe this really is a movement!

How’s that for a cheery thought for 2025.  Happy new year everyone!

Plant-Based Meat Analogs and Their Effects on Cardiometabolic Health: An 8-Week Randomized Controlled Trial Comparing Plant-Based Meat Analogs With Their Corresponding Animal-Based Foods. Toh DWK, Fu AS, Mehta KA, Lam NYL, Haldar S, Henry CJ. Am J Clin Nutr. 2024 Jun;119(6):1405-1416. doi: 10.1016/j.ajcnut.2024.04.006. Epub 2024 Apr 8.

Erratum in: Am J Clin Nutr. 2024 Aug;120(2):459. doi: 10.1016/j.ajcnut.2024.06.012.

This study compared effects on cardiometabolic health among people eating meat or plan-based alternatives for 8 weeks.

Conclusion: An 8-wk PBMA (plant-based) diet did not show widespread cardiometabolic health benefits compared with a corresponding meat based diet.

Funding: This study was supported by Pinduoduo Incorporated (HongKong Walnut Street Limited). Pinduoduo Incorporated had no role in study design, study conduct, laboratory analyses, data collection, management and interpretation or the writing, reviewing and approval of the manuscript.

Comment

This study was sent to me by a reader, who viewed it as a rare example of an industry-funded study with results unfavorable to the sponsor’s interests.  He thought the “Walnut” in the company’s name indicated a plant-based bias.

I wasn’t so sure and wondered what Pinduoduo did, exactly.

According to Wikipedia, “Pinduoduo Inc. (Chinese: 拼多多; Pinyin: Pīn duōduō) is a Chinese online retailer with a focus on the traditional agriculture industry. The business is the largest product of PDD Holdings, which also owns the online marketplace Temu.”

But it gets even better.  The American Journal of Clinical Nutrition published a correction to the paper:

The original funding statement was insufficiently elaborated and has been revised for greater clarity: Christiani Jeyakumar Henry [the senior investigator on this study] reports partial financial support provided by Pinduoduo Incorporated (HongKong Walnut Street Limited) which is an agricultural research firm.

This, then, is a standard example of an industry-funded—and conducted—study producing just the results wanted.  Another example of marketing research, alas.

The study: Mixed nut consumption improves brain insulin sensitivity: a randomized, single-blinded, controlled, crossover trial in older adults with overweight or obesity.  American Journal of Clinical Nutrition.  https://doi.org/10.1016/j.ajcnut.2023.12.010

Objective: “This study aimed to investigate longer-term effects of mixed nuts on brain insulin sensitivity in older individuals with overweight/obesity.”

Methods: “In a randomized, single-blinded, controlled, crossover trial, twenty-eight healthy adults (mean±SD; 65±3 years; BMI: 27.9±2.3 kg/m²) received either daily 60 g mixed nuts (15 g of walnuts, pistachio, cashew, and hazelnuts) or no nuts (control) for 16 weeks, separated by an 8-week washout period.”

Results: “Compared with control, mixed nut consumption improved regional brain insulin action in five clusters located in the left…and right occipital lobe.

Conclusions: “Longer-term mixed nut consumption affected insulin action in brain regions involved in the modulation of metabolic and cognitive processes in older adults with overweight/obesity.”

Funding: “This study was supported by a grant obtained from the International Nuts and Dried Fruit Council (INC). The INC had no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript.”

Comment: Does this study have any clinical significance?  Body weight and composition did not change. I’m all for nut-eating—love them—but for this reason?  Hardly.  Despite what this study implies, nuts have calories and they most definitely count.

As I pretty much demonstrate every Monday, industry-funded studies almost invariably produce results favoring the sponsor’s interests.

But here we have a rare exception to the rule:

• The study: Effect of cocoa extract supplementation on cognitive function: results from the clinic subcohort of the COSMOS trial.  The American Journal of Clinical Nutrition,Volume 119, Issue 1, January 2024, Pages 39-48.
• Objective: “To test whether daily supplementation with CE, compared with placebo, produces better cognitive change over 2 y.”
• Conclusions: “Among 573 older adults who underwent repeat in-person, detailed neuropsychological assessments over 2 y, daily CE supplementation, compared with placebo, showed no overall benefits for global or domain-specific cognitive function. Possible cognitive benefits of CE among those with poorer diet quality warrant further study.”
• Funding: The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) is supported by an investigator-initiated grant from Mars Edge, a segment of Mars dedicated to nutrition research and products, which included infrastructure support and the donation of study pills and packaging. Pfizer Consumer Healthcare (now Haleon) provided support through the partial provision of study pills and packaging.

Comment: Why anyone would think that cocoa extract would have any efffect at all on cognitive function is beyond me, but I, in sharp contrast to Mars, am not trying to sell cocoa extract or convince anyone that M&Ms are a health food.  But, as seems invariably the case, the investigators did give Mars a small break in favorably finding “possible” cognitive benefits of cocoa extract for people eating terrible diets.  My prediction: further studies will not find benefits of cocoa extract—or M&Ms—on cognitive function even though eating M&Ms can be lots of fun.