Correction: February 24.  A reader points out that one of the studies posted here had already been posted on January 27  as an industry-negative.  Apologies.  Consider it deleted and change the count.

Yesterday’s post was about a study funded by Disney.  It brought the number of studies funded by companies with results favorable to the company to 125 since last March.  I’ve only found 12 with unfavorable results.  Today’s five raise the count to 130/12.

The association between dietary saturated fatty acids and ischemic heart disease depends on the type and source of fatty acid in the European Prospective Investigation into Cancer and Nutrition–Netherlands cohort.  Jaike Praagman, Joline WJ Beulens, Marjan Alssema, Peter L Zock, Anne J Wanders, Ivonne Sluijs, and Yvonne T van der Schouw. Am J Clin Nutr 2016; 103:356-365 doi:10.3945/ajcn.115.122671.  I posted this study as industry-negative on January 27; it is listed here in error.  

Dietary plant stanol ester consumption improves immune function in asthma patients: results of a randomized, double-blind clinical trial.  Florence Brüll, Els De Smet, Ronald P Mensink, Anita Vreugdenhil, Anja Kerksiek, Dieter Lütjohann, Geertjan Wesseling, and Jogchum Plat. Am J Clin Nutr 2016; 103:444-453 doi:10.3945/ajcn.115.117531

• Conclusion: To the best of our knowledge, we are among the first authors to show that plant stanol ester consumption improves the immune function in vivo in asthma patients
• Supported by RAISIO Nutrition LTD. Test products for the study were provided by RAISIO Nutrition LTD…RAISIO Nutrition LTD is a Finnish food company that is involved in life sciences and sells, among other products, the Benecol brand. RAISIO Nutrition LTD had no influence in the setup of the study or the interpretation of the results. None of the authors reported a conflict of interest related to the study.

Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults.  Sigrid A. Gibson, GrahamW. Horgan, Lucy E. Francis, Amelia A. Gibson and Alison M. Stephen.  Nutrients 2016, 8(1), 9; doi:10.3390/nu8010009

• Conclusion: Results indicate that NC and LCB consumers tend to have higher quality diets compared with SSB or BB consumers and do not compensate for sugar or energy deficits by consuming more sugary foods.
• Conflicts of Interest: S.G. is director of Sig-Nurture Ltd, an independent consultancy, which has received research funding from food and beverage and ingredient companies, not-for-profit organisations and trade bodies. None of the other authors had a conflict of interest. The sponsors had no role in the design, analysis or interpretation of the study, or in the preparation of the manuscript

Dietary Milk-Fat-Globule Membrane Affects Resistance to Diarrheagenic Escherichia coli in Healthy Adults in a Randomized, Placebo-Controlled, Double-Blind Study.  Sandra J Ten Bruggencate3,*, Pernille D Frederiksen4, Simon M Pedersen5, Esther G Floris-Vollenbroek3, Elly Lucas-van de Bos3, Els van Hoffen3, and Peter L Wejse5.  J. Nutr. February 1, 2016  vol. 146 no. 2 249-255

• Conclusion: The present diarrheagenic E. coli challenge trial conducted in healthy adults indicates that a milk concentrate rich in natural, bioactive phospho- and sphingolipids from the MFGM may improve in vivo resistance to diarrheagenic E. coli.
• Author disclosures: SJ Ten Bruggencate, EG Floris-Vollenbroek, E Lucas-van de Bos, and E van Hoffen, no conflicts of interest. PD Frederiksen is an employee of Arla Foods Ingredients Group P/S (AFI, Denmark), which produces and markets Lacprodan MFGM-10, Lacprodan PL-20, and Capolac MM 0525 BG. SM Pedersen and PL Wejse are employees of Arla Foods amba (Denmark). The sponsor was involved in the writing of the manuscript.
• Comment:  This is the first time I’ve seen a disclosure of the sponsor’s involvement in the writing of a manuscript.  High marks to the Journal of Nutrition for insisting on this.

A 9-mo randomized clinical trial comparing fat-substituted and fat-reduced diets in healthy obese men: the Ole Study.  George A Bray, Jennifer C Lovejoy, Marlene Most-Windhauser, Steven R Smith, Julia Volaufova, Yvonne Denkins, Lilian de Jonge, Jennifer Rood, Michael Lefevre, Alison L Eldridge, and John C Peters.   Am J Clin Nutr 2002;76: 928–34.

• Conclusion: Replacement of dietary fat with olestra reduces body weight and total body fat when compared with a 25%-fat diet or a control diet containing 33% fat.
• Supported in part by…the USDA and by the Procter & Gamble Co, Cincinnati.

Last summer, Brian Wansink, a friend and Cornell colleague and the editor of the new Journal of the Association for Consumer Research, asked me to write a commentary on a paper to be published in its inaugural issue.

The paper turned out to be by a group of authors, among them John Peters and Jim Hill, both members of the ill-fated Global Energy Balance Network, the subject of an investigation by the New York Times last August.

Titled “Using Healthy Defaults in Walt Disney World Restaurants to Improve Nutritional Choices,” the paper described the benefits of improving the composition of kids’ meals at Disney World.

The healthy defaults reduced calories (21.4%), fat (43.9%) and sodium (43.4%) for kid’s meal sides and beverages sold in the park. These results suggest that healthy defaults can effectively shift food and beverage selection patterns toward healthier options.

The authors explain:

This work was supported by the Walt Disney Company and by the National Institutes of Health…The Walt Disney Company and the National Institutes of Health had no role in the design, analysis, or writing of this article. Full disclosure: JH is a consultant for the Walt Disney Company and for McDonalds; KA is a consultant for the Walt Disney Company.”

I thought Disney’s sponsorship of this research and its withholding of critical baseline and sales data on kids’ meals that the company considered proprietary did indeed deserve comment, and wrote my piece accordingly.  Brian Wansink soon accepted it for publication but to my surprise, gave it to Peters et al. for rebuttal.  They filed a lengthy response.  I was then given the opportunity to respond, and did so, briefly.

The paper by Peters, et al. did was published in the journal’s first issue.   This issue also includes several commentaries on other papers (none of which are accompanied by rebuttals).

My commentary—and the back-and-forth—however, were omitted.

After some discussion, the journal published my commentary online.  You have to scroll down to find it.  The site provides no links to it in the table of contents or in the article by Peters et al.

Is it possible that Disney or the authors’ contractual relationships with Disney could have had anything to do with the omission of my accepted-for-publication commentary?  Brian Wansink says no, they just ran out of room (despite room for others).

Whatever.

Here’s what I wrote:

Dietary nudges for obesity prevention: They work, but additional policies are also needed

In 2006, the Walt Disney Company announced a new initiative to improve the nutritional quality of meals served to children at its theme parks. The company would be changing the default kids’ meals—the components that come without having to be ordered separately–to include low-fat milk, juice, or water rather than soft drinks, and sides such as apple sauce or carrots rather than French fries. Parents who wanted sodas or fries for their children would have to ask for them, something many might not bother to do. Health groups had long advocated for this policy change (Wootan 2012).

As I commented to a reporter at the time, “going to Disney World is an excuse for eating junk food…Disney or its advisers must be feeling they have some responsibility” (Horovitz and Petrecca 2006). Indeed, the healthier defaults were part of a larger effort by Disney to deal with its contribution to obesity in America. After ticket prices, food is the second greatest source of revenue at Disney World. Although reducing the amount of food consumed at the parks might help create a less “obesogenic” food environment, revenues might fall. But the default change might be revenue neutral. By 2008, Disney could report that two-thirds of U.S. customers ordering kids’ meals had accepted the default, with no loss in sales. In Hong Kong Disney parks, nearly all customers accepted the default. The report, however, did not include data on the numbers or proportions of customers ordering kids’ meals (Walt Disney Company 2008).

Disney’s more recent summary of its child health initiatives states that it is funding investigators at the University of Colorado to conduct a more formal evaluation of use of the default options (Walt Disney Company 2015). The paper by Peters et al. (2016) in this issue of the Journal presents the results of that research. Their work confirms the ongoing effectiveness of the strategy. Nearly half the customers ordering kids’ meals accepted the healthy default side dishes and two-thirds accepted the healthier beverages. These choices resulted in significant reductions in the calories, fat, and sodium in purchased kids’ meals, but not sugar (Peters et al 2016).

The authors argue that gentle nudges changes like these are preferable to more coercive policies that smack of nanny statism. Such reductions help, but are they enough to make a real difference? To answer this question, it would help to know what else the children were eating along with the drink and side dishes. Although the authors were given raw sales data, Disney did not permit them to use this information as part of the overall analysis. The company also refused to provide information about the number of children who visited the park or the number of kids’ meals sold.

These missing pieces raise red flags because this is a Disney-funded study that produced results that Disney can use to advertise itself as a company that cares about kids’ health, and to deflect attention from Disney World’s’ reputation as a junk-food paradise. Corporate funding of research introduces conflicts of interest and reduces the credibility of the results, not least because the biases inherent in such research are largely unconscious, unintentional, and unrecognized (Moore et al 2005) The results of this study merit especially careful scrutiny. Taking them at face value, the default strategy worked well for the drink, but the sides are still a problem, and so are the sugars. They do not reveal much about what kids eat in a day at Walt Disney World

Nudges like this default are an important part of strategies to counter childhood obesity. But are they enough to deal with the public health problem? To make a real difference, they need to be accompanied and supported by a range of policy approaches. Current thinking about such approaches recommends combining insights from behavioral research, economics, and public health to establish a food environment far more conducive to making the healthy choice not only easy choice, but also the preferred choice. Doing so is likely to require multiple actions—for example, regulation of nutrient content and marketing; incentives such as subsidies of healthier foods; disincentives such as taxes, warning labels, and nutritional rating systems for unhealthier foods; and education of adults and children (Hawkes et al 2015). Disney’s voluntary default is a small step in the direction of such policies, but many more are needed if we are to make real progress in reducing the prevalence of childhood obesity.

• Margo G. Wootan. Children’s meals in restaurants: families need more help to make healthy choices.   Childhood Obesity 2012;8(1):31-33.
• Bruce Horovitz and Laura Petrecca.  Disney to make food healthier for kids.  USA Today, October 17, 2006.
• Walt Disney Company. Walt Disney Company—2008 Corporate Responsibility Report. 2008.
• Walt Disney Company.  Magic of Healthy Living brochure.  2015. https://thewaltdisneycompany.com/sites/default/files/MOHL_Brochure.pdf.
• John C. Peters, Jimikaye Beck, Jan Lande, Zhaoxing Pan, Michelle Cardel, Keith Ayoob, and James Hill. Using healthy defaults in Walt Disney World restaurants to improve nutritional choices.  J Assoc Consumer Res., 2016;1:1.
• Don A. Moore, Daylian M. Cain, George Loewenstein, and Max H. Bazerman, editors.  Conflicts of Interest: Challenges and Solutions in Business, Law, Medicine, and Public Policy.  Cambridge University Press, 2005.
• Corinna Hawkes, Trenton G Smith, Jo Jewell, Jane Wardle, Ross A Hammond, Sharon Friel, Anne Marie Thow, Juliana Kain.  Smart food policies for obesity prevention. The Lancet 2015;385:2410–2421.

And here’s my response to the rebuttal by Peters et al.

The response from Peters and Hill still fails to acknowledge the severity of the problems posed by Disney’s sponsorship of their research—the company’s failure to produce data essential for proper interpretation of study results, and the level to which sponsorship by food companies biases such interpretations.  At one point, Disney boasted of the results of this research, confirming its benefit to marketing goals.  The threat of industry sponsorship to research credibility has received considerable press attention in recent months, as must surely be known to these authors.^1,2 

1  Anahad O’Connor.  Coca-Cola funds scientists who shift blame for obesity away from bad diets.  New York Times, August 9, 2015. http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/

2  Candice Choi.  AP Newsbreak: Emails reveal Coke’s role in anti-obesity group.  US News, November 24, 2015.  http://www.usnews.com/news/business/articles/2015/11/24/apnewsbreak-emails-reveal-cokes-role-in-anti-obesity-group

Thanks to Sinead Boylan for sending me this photo about Woolworths’ attempt to encourage kids to eat fruit.

Wouldn’t you think everyone would be thrilled at the idea of giving free fruit to kids?  No such luck.

Sinaed asks: Is W00lies (which is what they call it) trying to pull the wool over our eyes?

The Australian press worries about foodborne illness.

I think it’s a great idea.  I hope it works.

Thanks to my friend Jocelyn Harris of Dunedin, New Zealand for forwarding this editorial from the Otago Daily Times of January 16.

The editorial notes that a recent report finding no linkage between alcohol consumption and violence among Australians and New Zealanders was sponsored by Lion, a leading supplier of alcoholic beverages.

The report is Understanding Behavior in the Australian and New Zealand Night-Time Economies: An Anthropological Study.  Its author, anthropologist Anne Fox, lists these key findings:

• Alcohol-related violence is just one aspect of a culture of violence.
• There is no direct relationship between per capita levels of consumption and rates of violence.
• A drinking culture is both a part of and a reflection of the culture as a whole.
• Efforts at alcohol control will be ineffective if not related to changes in the macho culture of violence.
• Scapegoating alcohol as the sole cause of violence merely diverts attention from violent men and the maladaptive cultural norms that allow their behaviour to develop and proliferate.

Her recommendations focus on the behavior of individuals behavior.  They largely dismiss the value of approaches such as limitations on alcohol marketing, the times alcoholic beverages can be sold, or the ways beverage companies create local cultures of drinking.

In a nutshell, the central point of this whitepaper is: it is the wider culture that determines the drinking behaviour, not the drinking. You can’t change a culture by simply changing drinking. It is, of course, justifiable to explore the effectiveness of small measures such as advertising restrictions, increases or decreases in price, relaxation or restriction of hours, but such things tinker at the margins of culture and it is doubtful that they will alter the culture of violence and anti-social behaviour in any meaningful way.

The report explains:

We could become totalitarian and try to stop public festive drinking completely, but it would most likely just move into homes. Or we can live with it and try to determine what the worst outcomes are (police overtime, all night transport cost, lost work hours and productivity, accidents and injuries, street clean-up, etc.,), and work to minimise and deal with them sensibly. We would do better to work cooperatively with all stakeholders to engineer conditions for festive drinking that are the least conducive to violence and anti-social behaviour.

In other words, societies should fix the problem at the level of “festive” drinking, but should not bother to try to prevent it at an earlier stage in the chain of causation of alcohol abuse.

The Otago Daily Times editorial concludes:

It is vital we keep debating the issues, examining the causes and hearing all the voices in the debate.

But that debate must be fair and honest.

It is a real shame, therefore, that Dr Fox has effectively silenced herself by aligning herself with an alcohol industry giant when her findings could have made a valuable contribution had they been genuinely independent.

Presumably, Lion got the report it paid for.  But it left itself—and the author’s work—vulnerable to charges of bias, an inevitable hazard of industry-sponsored research.

A shame indeed.

My daily walk to the Charles Perkins Centre at Sydney Uni takes me past Ground Up—the campus community garden.

It has a greenhouse.  And vegetables.

It’s summer here!

Dale Finley Slongwhite.  Fed Up: The High Costs of Cheap Food.  University Press of Florida, 2014.

Yes, there’s a movie called Fed Up (in which I make a very brief appearance) but this book covers a quite different topic.  It takes a tough look at the impact of widespread pesticide use on farmworkers in the area around Lake Apopka in Central Florida.  Slongwhite tells the individual stories of these workers through oral histories, thereby putting a human face on callous disregard for people and the environment.

I’m having a hard time keeping up with these, but here are five more industry-funded studies with results favorable to the sponsor, bringing the total of industry-positives to 124 since last March, versus just 12 with unfavorable results.  This percentage is lower than that found in more systematic studies.  If you know of such studies, please send.

In the meantime, here’s the next set.

A randomized controlled trial to determine the efficacy of a high carbohydrate and high protein ready-to-eat food product for weight loss.  N. R. Fuller, M. Fong, J. Gerofi, L. Leung, C. Leung, G. Denyer andI. D. Caterson.  Clinical Obesity. Article first published online: 19 JAN 2016. DOI: 10.1111/cob.12137

• Conclusion: There was no significant difference in percentage weight loss from screening to 6 weeks between the two groups…Both diets were nutritionally matched and well-accepted over the 6-week period. This study shows that the inclusion of a ready-to-eat food product can be included as part of a dietary programme to achieve a clinically significant weight loss over a short period.
• Funding: This study was supported by a research grant from Arnotts Biscuits Ltd. The funder had no role in the protocol design, the conduct of the study, the analysis of the data, nor the writing of the manuscript.
• Comment: The idea of this study was to get participants to include Vita-Weat biscuits in their diets.  The control group was simply advised about healthy eating.  Both groups lost weight.  Arnotts Biscuits makes Vita-Weat.

Obesity, Fitness, Hypertension, and Prognosis: Is Physical Activity the Common Denominator?  Carl J. Lavie, MD, Parham Parto, MD; Edward Archer, PhD. JAMA Intern Med. 2016;176(2):217-218. doi:10.1001/jamainternmed.2015.7571.

• Conclusions: Although excess caloric load has been suggested as a major contributor to obesity, we believe that marked declines during the past 5 decades in leisure time and occupational physical activity explain the notable increase in BMI over time… Therefore, substantial efforts are needed, beginning in children and adolescents and extending into adulthood, to increase levels of physical activity across all ages and in both sexes, which would have substantial effects on preventing obesity and improving levels of CRF [cardiorespiriatory fitness].
• Conflict of Interest Disclosures: Dr Lavie reported being the author of the book The Obesity Paradox and serving as a lecturer for the Coca Cola Company (on physical activity, exercise, fitness, and the obesity paradox and not on their products). Dr Archer reported received speaking fees from industry and nonprofit organizations.
• Comment: Coca-Cola has been especially active in funding investigators who promote the idea that physical activity is more important that diet in determining health status.  This paper is a commentary on a study demonstrating that “high BMI and low aerobic capacity in late adolescence were associated with higher risk of hypertension in adulthood…interventions to prevent hypertension should begin early in life and include not only weight control but aerobic fitness, even among persons with normal BMI.”

Dietary anthocyanin intake and age-related decline in lung function: longitudinal findings from the VA Normative Aging Study.  Amar J Mehta,, Aedín Cassidy, Augusto A Litonjua, David Sparrow, Pantel Vokonas, and Joel Schwartz.  Am J Clin Nutr February 2016 vol. 103 no. 2 542-550

• Conclusions: An attenuation of age-related lung function decline was associated with higher dietary anthocyanin intake in this longitudinal sample of predominantly elderly men. Further prospective studies are needed to confirm these novel associations.
• Conflicts: AC has a grant, unrelated to this project, to conduct observational and experimental studies of blueberries and cardiovascular health outcomes from the US Highbush Blueberry Council. None of the other authors had competing interests to declare.
• Comment:  This paper is about blueberry anthocyanins.  The authors report “Blueberry intake was associated with the slowest rate of annual decline in lung function; compared with no or very low intake.”

The effects of lutein on cardiometabolic health across the life course: a systematic review and meta-analysis.  Elisabeth TM Leermakers, Sirwan KL Darweesh, Cristina P Baena, Eduardo M Moreira, Debora Melo van Lent, Myrte J Tielemans, Taulant Muka, Anna Vitezova, Rajiv Chowdhury, Wichor M Bramer, Jessica C Kiefte-de Jong, Janine F Felix, and Oscar H Franco.  Am J Clin Nutr February 2016 vol. 103 no. 2 481-494

• Conclusions: Our findings suggest that higher dietary intake and higher blood concentrations of lutein are generally associated with better cardiometabolic health. However, evidence mainly comes from observational studies in adults, whereas large-scale intervention studies and studies of lutein during pregnancy and childhood are scarce.
• Funding: ETML, DMvL, MJT, JCK-dJ, and OHF are employees at ErasmusAGE, a center for aging research across the life course funded by Nestlé Nutrition (Nestec Ltd.), Metagenics Inc., and AXA. Nestlé Nutrition (Nestec Ltd.), Metagenics Inc., and AXA had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript. None of the authors reported a conflict of interest related to the study.

Dietary protein intake is associated with body mass index and weight up to 5 y of age in a prospective cohort of twins.  Laura Pimpin, Susan Jebb, Laura Johnson, Jane Wardle, and Gina L Ambrosini.  First published December 30, 2015, doi: 10.3945/​ajcn.115.118612.  Am J Clin Nutr February 2016 vol. 103 no. 2 389-397

• Conclusion: A higher proportion of energy from protein during the complementary feeding stage is associated with greater increases in weight and BMI in early childhood in this large cohort of United Kingdom children.
• Conflicts: JW: was principal investigator of the Gemini study with responsibility for data collection; and all authors: advised on the analyses or interpretation of data and contributed to manuscript preparation. JW received grants from Cancer Research UK and from Danone Baby Nutrition during the conduct of the study. LJ received institutional consultancy fees from Danone Baby Nutrition during the conduct of the study. All other authors declared no conflicts of interest.

Short-term studies of DHA ( docosahexaenoic acid, a long-chain omega-3 fatty acid) have suggested that DHA supplements promote the visual acuity of infants born prematurely.  This study, for which supplement and formula companies donated products, and in which some of the investigators had connections to those and other companies with a vested interest in the results, could not find measurable benefits of DHA supplementation by the time children reached school age.

This is a rare example of a study supported by food companies with results that must have caused much disappointment.

How rare?  Since last March, I’ve unsystematically collected 119 industry-supported studies with results that favor the sponsor’s interest (industry-positive) but have only run across or been sent 12 that do not.

Long-term effect of high-dose supplementation with DHA on visual function at school age in children born at 33 wk gestational age: results from a follow up of a randomized controlled trial. Carly S Molloy, Sacha Stokes, Maria Makrides, Carmel T Collins, Peter J Anderson, and Lex W Doyle.  Am J Clin Nutr 2016; 103:268-275 doi:10.3945/ajcn.115.114710.

• Conclusion: Supplementing human milk with DHA at a dose of ~1% of total fatty acids given in the first months of life to very preterm infants does not appear to confer any long-term benefit for visual processing at school age.
• Funding: Treatment and placebo capsules for the original trial were donated by Clover Corporation, and infant formula was donated by Mead Johnson Nutrition and Nutricia Australasia.
• Authors’ disclosures: CTC and MM have received nonfinancial support from Clover Corporation and Nestlé Nutrition for research outside that of the submitted work. MM serves on scientific advisory boards for Nestlé, Fonterra, and Nutricia. Associated honoraria for MM are paid to her institutions to support conference travel and continuing education for postgraduate students and early-career researchers. MM, through the Women’s and Children’s Health Research Institute, has a patent pending “Methods and compositions for promoting the neurological development of an infant.” None of the other authors declared a conflict of interest.