The study: Co-Occurrence and Clustering of Sedentary Behaviors, Diet, Sugar-Sweetened Beverages, and Alcohol Intake among Adolescents and Adults: The Latin American Nutrition and Health Study (ELANS)

Abstract: Poor diet, sedentary behaviors, sugar-sweetened beverages (SSB) and alcohol intake seem to co-exist in complex ways that are not well understood. The aim of this study was to provide an understanding of the extent to which unhealthy behaviors cluster in eight Latin America countries. A secondary aim was to identify socio-demographic characteristics associated with these behaviors by country…. Among 9218 individuals, the most prevalent behaviors were transportation and occupation–sedentary time, SSB and alcohol intake.

Conclusions:  EBRB, particularly excessive time spent on sedentary-activities and SSB intake, commonly co-occurred in a representative sample of LA adolescents and adults. While unhealthy behavior varied across LA countries, nearly half of sampled subjects in Argentina and Colombia presented at least two risk factor behaviors.

Recommendation: Public health policies and behavioral-change strategies should target SB domains (screen-time, occupational, and transportation), diet intake, and SSB and alcoholic intake in combination [my emphasis].

Funding: The ELANS data collection was originally supported by the scientific grant from the Coca-Cola Company (Atlanta, GA, USA) and by grants/supports from the ILSI Latin America branches (Argentina, Brazil, Sur-Andino, Nor-Andino, and Meso-America), Sabará Children’s Hospital, PENSI Institute, University of Costa Rica, Pontifical Catholic University from Chile, Pontifical Catholic University Javeriana, Colombia, Central University of Venezuela/Foundation Bengoa, University of San Francisco, Quito, and Nutritional Institute of Investigation, Peru. The funders had no role in study design, data collection, analysis, the decision to publish, or the preparation of this manuscript.

Conflicts of Interest: The authors 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: This is the first study I have seen funded by Coca-Cola since the scandal over its funding of  the Global Energy Balance Network (see my last post on it) and its announcement that it would no longer pay more than half the cost of a study (see policy statement).  This study is co-funded by ILSI (also industry) and universities (independent).  Coca-Cola is still funding lots of studies.  See here and here.

Why would Coca-Cola want to fund a study like this?  The answer lies in the recommendation.  My translation: Do not target sugar-sweetened beverages with tax or warning label policies alone.  If you want to improve unhealthy behavior, you have to target all of those behaviors—screen time, jobs, transportation, dietary intake, and alcohol—at the same time.

Everybody wants to get into CBD edibles.  They have the potential to make lots of money for lots of people.

Here are a few recent items.

CBD ice cream:  Way back in 2019, Ben and Jerry’s, always on the cutting edge, promised to move right in.  I haven’t seen any yet, but can’t wait.

CBD pet food: Martha Stewart, also ever ahead of the curve, is doing a new line of products.

CBD alcohol: Product names or descriptors such as ‘CBD gin’ or ‘rum infused with CBD’ could prove problematic in the UK, says the Portman Group, as it sets out guidance on marketing CBD…. Read more

CBD supplements: Rugby warriors tackle cannabinoid concerns with CBD startup:  Two professional rugby players have created a startup selling third-party tested CBD supplements that give elite athletes and everyday consumers peace of mind over cannabinoid content.. Read

CBD edible hazards: Four children needed hospital treatment in England after eating sweets thought to have contained cannabis. A 12-year-old boy was discharged on May 1 and the other three were expected to be released from hospital in Surrey after being kept in overnight for monitoring and observation.  Continue Reading

CBD hazard regulation (or lack thereof): CBD experts recommend THC limit for finished products.  CBD industry experts have put together a detailed safety review of THC recommending clear policy recommendations to cut market confusion… Read

Regulations are sure to come, and the sooner the better—for reasons of public safety, but also to give startups some guidelines.

Thanks to Habib Benzian for telling me about this study.

Price information influences the subjective experience of wine: A framed field experiment.  Christoph Patrick Werner, et al.  Food Quality and Preference; 2021;92:104223

Highlights

• First study manipulating wine prices using a framed field experiment.
• Blind intensity ratings differ for 3 wines of different price and expert rating.
• Blind pleasantness ratings do not differ for the same three wines.
• Pleasantness of the budget wine increased when presented with a fake higher price.

The study: The authors got 140 people to taste wines of three different price ranges with open, deceptive, or no price information, and rate them for taste.

The main result: When price information was accurate, participants’ ratings were parallel to cost.  When price information was missing or deceptive, pleasantness ratings did not differ.

Wine A is inexpensive; Wine B is more expensive and rated as medium quality; wine C is expensive and rated outstanding

This report documents how government policies—in the U.S. and internationally—promote and protect makers of booze, wine, and beer, despite the demonstrably harmful effects of those products on health and society.

How do governments do this?

• Development assistance
• Tax breaks
• Tax rebates
• Marketing deductions
• Production subsidies
• Trade agreements

Why do they do this?  Lobbying and tax revenues.

If you want to understand why the USDA and HHS “found no evidence” for reducing the alcohol recommendation in the 2020 Dietary Guidelines, read this report.

Stefano Castriota (Translated from the Italian by Judith Turnbull).  Wine Economics.  MIT Press, 2020.  

Wine isn’t something that I pay a lot of attention to academically, so I had no idea there was a field of economics devoted to these products until MIT Press sent me this book.  It reviews the literature on lots of issues I’ve never thought about:

• Why you pay more for some wines than others even when the cost of producction is the same.
• The role of expertise: can they really tell the difference between one wine and another, and how does expertise affect price.
• What market forces affect wine consumption.
• The external costs of wine production and consumption.

This is a serious but well written review of the academic literature and a convenient way to dig into these topics all at once.  The book is full of charts, impenetrable (to me) economic diagrams, and figures.  Here’s one I copied (badly).  It’s per capita consumption of alcohol by type in the U.S. from 1934 (post-Prohibition) to 2014.  Wine is the dotted line at the bottom.  This is why this industry is pushing you to drink more wine.

The pushing is one reason why I am interested in the economic externalities of wine production and consumption.

Castriota is convinced by his reading of the literature that moderate wine consumption is associated with improved health.  I’d say the jury is still out on this one, but in any case positive health externalities depend on what’s meant by “moderate.”

But there are definitely other positive externalities: gorgeous countryside, land preservation, wine tourism, conviviality, cultural value.

The negative externalities of excessive alcohol consumption are well known: poor physical and mental health, accidents, violence, fetal damage.  These add up to enormous costs to society.  How much of that is due to wine consumption?  Hard to say.

This industry wants to sell more wine.  To do so, Castriota suggests:

• Make wines of better quality.
• Change the tax system to promote quality.
• Clarify the classification system.
• Support small wineries.
• Keep prices competitive.
• Promote wine culture among consumers.

Even after writing Unsavory Truth: How the Food Industry Skews the Science of What We Eat I could hardly believe this particular example.

The Study: Exploring the Influence of Alcohol Industry Funding in Observational Studies on Moderate Alcohol Consumption and Health.   Moniek Vos, Annick P M van Soest, Tim van Wingerden, Marion L Janse, Rick M Dijk, Rutger J Brouwer, Iris de Koning, Edith J M Feskens, Aafje Sierksma.  Advances in Nutrition, Volume 11, Issue 5, September 2020, Pages 1384–1391.

Methods:  This is a meta-analysis of meta-analyses of studies examining the health effects of alcohol consumption that are used as the basis of international guidelines for alcohol consumption.

Results and conclusions: “only a small proportion of observational studies in meta-analyses …are funded by the alcohol industry. Based on this selection of observational studies the association between moderate alcohol consumption and different health outcomes does not seem to be related to funding source.

Funding: “The authors reported no funding received for this study.”

Author disclosures: “MV, APMvS, TvW, MLJ, RMD, RJB, IdK, and AS were employed by the Dutch Beer Institute during the study and writing of the manuscript. This Institute is funded by Dutch Brewers, which is the trade organization of the 14 largest beer brewers in the Netherlands. EJMF reports no conflicts of interest.”

Comment: This one defies credulity: an industry-funded study—most authors work for the beer industry—of whether industry funding affects research outcome.

Guess what?  It didn’t find any effect.

For years, the alcohol industry has been working hard to convince regulators and the public that moderate drinking, especially of wine and beer, is not only harmless but actually improves health.  This study is an example of how this industry attempts to accomplish that goal.

For another egregious example, see this post.

The Trump Administration has poured billions of dollars into supporting Midwest producers of industrial corn, but to date is not doing anything in particular to help producers of corn-based ethanol.  Because Americans are not traveling as much, demand for gasoline is down and so is demand for fuel ethanol (required by law to comprise 10% of automobile fuel).

The ethanol industry is unhappy about this situation, and is accusing the Trump Administration of reneging on its promises.

This secret list of promises, the vast majority of which have not been fulfilled, was first reported by Reuters today and offers powerful evidence of the Trump administration’s failure to support ethanol, despite his rhetoric. This secret list also highlights how Senator Ernst and Grassley have failed to follow through on their own promises to fight for Iowa farmers with this administration, despite their rhetoric. Just last week, Senator Ernst touted herself as a “tireless advocate” for the ethanol industry yet by never releasing the list of White House ethanol promises she has avoided having to call out the President for the full extent of his failures.

What’s all this about?  Money, of course.

But I don’t have much sympathy for ethanol producers.

I don’t think corn—a food mainly for animals but also for people—should be used as fuel for cars.

For one thing, it takes almost as much energy to produce a gallon of ethanol as it does to produce gasoline.  The best that can be said is this:

Energy is required to turn any raw feedstock into ethanol. Ethanol produced from corn demonstrates a positive energy balance, meaning that the process of producing ethanol fuel does not require more energy than the amount of energy contained in the fuel itself.

If you want details, see the USDA’s report on ethanol energy balance.

An astonishing 40% or so of US corn is grown to produce ethanol.

I’m not the only one who thinks growing food to fuel cars is ridiculous, or—more politely—needs rethinking.

As a crop, corn is highly productive, flexible and successful. It has been a pillar of American agriculture for decades, and there is no doubt that it will be a crucial part of American agriculture in the future. However, many are beginning to question corn as a system: how it dominates American agriculture compared with other farming systems; how in America it is used primarily for ethanol, animal feed and high-fructose corn syrup; how it consumes natural resources; and how it receives preferential treatment from our government.

Another reason, as the USDA puts it: “Strong demand for ethanol production has resulted in higher corn prices and has provided incentives for farmers to increase corn acreage.”

Neither of those is good for the health of people or the planet.

Growing corn for ethanol makes no sense to me.  It’s too bad that the companies that invested in ethanol plants are hurting, but hey: that’s how capitalism works

The report of the 2020 Dietary Guidelines Advisory Committee is now available in online preprint.

It sets a record at 835 pages.

Its conclusions are highly consistent with those of previous Dietary Guidelines.

It recommends eating more of these foods:

Common characteristics of dietary patterns associated with positive health outcomes include higher intake of vegetables, fruits, legumes, whole grains, low- or nonfat dairy, lean meat and poultry, seafood, nuts, and unsaturated vegetable oils.

It recommends eating less of these foods:

The Committee found that negative (detrimental) health outcomes were associated with dietary patterns characterized by higher intake of red and processed meats, sugar-sweetened foods and beverages, and refined grains.

It retained the recommendation: Eat less red and processed meats

It retained the recommendation to eat less saturated fat (replace with polyunsaturated or monounsaturated)

Thus, the Committee recommends that dietary cholesterol and saturated fat intake be as low as possible within a healthy dietary pattern, and that saturated fat intake be limited to less than of 10 percent of total energy intake, as recommended by the 2015-2020 Dietary Guidelines for Americans. This recommendation applies to adults and children ages 2 years and older.

It tightened up restrictions on alcoholic beverages from 2 drinks a day for men to 1 drink:

The Committee concluded that no evidence exists to relax current Dietary Guidelines for Americans recommendations, and there is evidence to tighten them for men such that recommended limits for both men and women who drink would be 1 drink per day on days when alcohol is consumed.

It tightened up restrictions on added sugars, from 10% of calories to 6%:

After considering the scientific evidence for the potential health impacts of added sugars intake, along with findings from model-based estimations of energy available in the dietary pattern after meeting nutrient requirements, the Committee suggests that less than 6 percent of energy from added sugars is more consistent with a dietary pattern that is nutritionally adequate while avoiding excess energy intake from added sugars than is a pattern with less than 10 percent energy from added sugars.

What’s missing?

• Salt: The report says remarkably little about sodium beyond that it is overconsumed and people should “reduce sodium intake.”  It’s possible that I missed it, but I could not find suggestions for quantitative limits.
• Ultraprocessed: The word does not appear in the report except in the references.  A large body of evidence supports an association of ultraprocessed foods to poor health.  If the committee considered this evidence, it did not spell it out explicitly.
• Sustainability: This was off the table from the beginning but this committee recommends that it be considered next time in the context of a food systems approach to the Dietary Guidelines (p.771).

Comment

This is an impressive, solid, conservative review of the existing science highly consistent with previous Dietary Guidelines but with mostly stronger recommendations.

This committee was up against:

• A tight time frame
• A first-time mandate to review literature on infancy, pregnancy, and lactation in addition to that for adults
• A first-time process in which the agencies set the research agenda, not the committee
• The Coronavirus pandemic

At the outset, I was concerned that the committee members might be heavily biased in favor of food industry interests.  If they were, such biases do not show up in the final report.  I think this committee deserves much praise for producing a report of this quality under these circumstances.

Want to weigh in on it? 

The agencies are taking public comments until August 13.  On August 11, there will be an online public meeting for even more comments.

What’s next?

This report is advisory, only.  USDA and HHS must boil this down to the actual 2020 Dietary Guidelines.  Whereas the committee process was transparent, the boiling down process is highly secretive, or was in 2015.  It will be interesting to see what the agencies do, especially given the heavy lobbying by proponents of meat, saturated fat, and low-carbohydrate diets.