Currently browsing posts about: Conflicts-of-interest

By this time, a great many research studies have associated eating nuts—of any kind—with good health.  Nuts have fats and, therefore, calories (150-200 per ounce).

The nut industry would like to minimize concerns about fats and calories.  It funds research to demonstrate that nut fats are healthy (which they are) and that you don’t have to worry about the calories (which you do, depending on what else you eat).  Hence:

The study: Almond Bioaccessibility in a Randomized Crossover Trial: Is a Calorie a Calorie?  Nishi SK, et al.  Mayo Clinic Proceedings, 2021;nn(n):1-12, Published April 11, 2021.

Methods: This is a clinical trial in which subjects with hyperlipidemia consumed about 1 or 2 ounces a day of almonds versus muffins with equivalent calories.

Results: “Almond-related energy bioaccessibility was 78.5%±3.1%, with an average energy loss of 21.2%±3.1% (40.6 kcal/d in the full-dose almond phase).”

Conclusion:  “Energy content of almonds may not be as bioaccessible in individuals with hyperlipidemia as predicted by Atwater factors, as suggested by the increased fat excretion with almond intake compared with the control.”

Comment #1: The authors went to a lot of expensive trouble to demonstrate what has been known for a long time: almonds as typically consumed have only about 80% of the calories listed in standard tables.  This is because some of the fat is excreted rather than absorbed.  Chewing is not as efficient as machine grinding in separating fat from fiber.  When nuts are machine ground, their fats are more fully released and their calories similar to values obtained in calorimeters.

So guess who paid for this?

Grant Support: …the Almond Board of California…[and several other sources].

Potential competing interests: Where to begin?  The list takes three full columns of printed page.  Several of the authors report grants or consulting arrangements with entities such as the Almond Board of California, American Peanut Council, International Nut & Dried Fruit Council (INC), International Tree Nut Council Research and Education Foundation, California Walnut Commission, Peanut Institute, and the International Tree Nut Council.  But authors also report funding relationships that seem irrelevant to this study, such as the Dairy Farmers of Canada, Ocean Spray, the Saskatchewan & Alberta Pulse Growers Associations, and Beyer Consumer Care.  Even odder are reports of an honorarium from the USDA for a lecture; travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association (CDA); and, most unnecessarily, a book about vegetarian diets published by the daughters of one of the authors.

Comment #2:  I think disclosure statements like these are disrespectful of the disclosure requirement.  In this case, because several of the authors have so many financial relationships with food and drug companies, a listing of the nut-industry connections would have sufficed.  These alone would make it clear that these authors have conflicted interests that might deserve consideration in interpreting the study results.

The review:  Do Refined Grains Have a Place in a Healthy Dietary Pattern: Perspectives from an Expert Panel Consensus Meeting .  Yanni Papanikolaou, Joanne L Slavin, Roger Clemens, J Thomas Brenna, Dayle Hayes, Glenn A Gaesser, Victor L Fulgoni, III.  Current Developments in Nutrition, Volume 4, Issue 10, October 2020, nzaa125.

Method: “A scientific expert panel was convened to review published data since the release of 2015 dietary guidance in defined areas of grain research, which included nutrient intakes, diet quality, enrichment/fortification, and associations with weight-related outcomes.

Results: 

1) whole grains and refined grains can make meaningful nutrient contributions to dietary patterns,

2) whole and refined grain foods contribute nutrient density,

3) fortification and enrichment of grains remain vital in delivering nutrient adequacy in the American diet,

4) there is inconclusive scientific evidence that refined grain foods are linked to overweight and obesity, and

5) gaps exist in the scientific literature with regard to grain foods and health.“

Supported by the Grain Foods Foundation.  The sponsors (Grain Foods Foundation) had no role in the design of the study or in the collection, analyses, or interpretation of the data.

Author disclosures: YP, as President of Nutritional Strategies, provides food, nutrition, and regulatory affairs consulting services for food and beverage companies and food-related associations and collaborates with VLF on NHANES analyses. VLF, as Senior Vice President of Nutrition Impact, provides food and nutrition consulting services for food and beverage companies. VLF also conducts analyses of NHANES data for members of the food industry. JLS, RC, JTB, DH, and GAG all received an honorarium and travel expenses in the current scientific collaboration.

Comment: The Grain Foods Foundation commissioned the panel and paid the panel participants for their service and travel.  For the authors, this was a paid gig.  The Foundation got what it paid for.  About results #1, 2, and 5, there can be no argument.  #1 and #2 are obvious and did not require a scientific panel to come to those conclusions: even refined grains have nutritional value, not least because they are fortified with several key nutrients.   That’s why these authors consider fortification and enrichment to be “vital.”

What this really is about is to demonstrat that refined grains are healthy and do no harm (#4).  But refined grains are major components of ultra-processed foods, which cause people who eat them to take in more calories than they recognize or need (see Hall et al, 2019) and are strongly associated with higher levels of obesity, chronic disease, and mortality.  Despite dozens of studies consistently linking ultra-processed foods to these conditions, this industry-sponsored panel says the evidence is inconclusive.

The underlying purpose of this study, therefore, is to cast doubt on the connection between refined grains, ultra-processed foods, and weight gain.

With independently funded research, even by biased researchers, the underlying purpose is usually explicit.

–Thanks to Lisa Young for alerting me to this one.

Conclusion: “Addition of mushrooms to USDA Food Patterns increased several micronutrients including shortfall nutrients (such as potassium, vitamin D and choline), and had a minimal or no impact on overall calories, sodium or saturated fat.”

US and UK Consumer Adoption of Cultivated Meat: A Segmentation Study.  Keri Szejda, Christopher J. Bryant, Tessa Urbanovich.  Foods 2021, 10(5), 1050.

Background: “Despite growing evidence of the environmental and public health threats posed by today’s intensive animal production, consumers in the west remain largely attached to meat. Cultivated meat offers a way to grow meat directly from cells, circumventing these issues as well as the use of animals altogether.”

Purpose: “The aim of this study was to assess the overall consumer markets and a range of preferences around cultivated meat in the US and the UK relating to nomenclature, genetic modification, health enhancements, and other features.”

Conclusion: “there are solid consumer markets for cultivated meat in the UK and the US, despite an overall lack of familiarity with the product. Younger generations are the most open to trying cultivated meat, and government seals of approval are considered important. Consumers tend to prefer non-GM cultivated meat, and while nutritional enhancements do not add much to consumer appeal overall, they may be an effective way to provide tangible benefits to more skeptical consumers.”

Funding: “This work was supported by Aleph Farms. Aleph Farms participated in the study design, but not other aspects of the project.”

Conflicts of interest: “The authors report no conflicts of interest.”

Comment: Aleph Farms produces cell-based meat substitutes: “We’re paving a new way forward in the field of cultivated meat, growing delicious, real beef steaks from the cells of cows, eliminating the need for slaughtering animals or harming the environment.”

The company paid for consumer research to find out how to sell its product.   The authors perceive no conflicted interests in this kind of paid research.  The biases induced by paid research are often unconscious and unrecognized.  The result of this study is an implied suggestion to add nutrients to cell-based meat products as a means to convince people to buy them.

This is marketing research.

Thanks to Michele Simon for sending a query about this paper.

I recently received an email from the Soyfoods Council: “If You’re Confused About Endocrine Disruptors, Here’s Why Soy Isn’t One.”

The email explained that “the Soyfoods Council is a non-profit organization, created and funded by Iowa soybean farmers, providing a complete resource to increase awareness of soyfoods, educate and inform media, healthcare professionals, consumers and the retail and foodservice markets about the many benefits of soyfoods.  Iowa is the country’s number one grower of soybeans and is the Soyfoods Capital of the world.”

The email referred to a just-published paper

The Study: Neither soyfoods nor isoflavones warrant classification as endocrine disruptors: a technical review of the observational and clinical data, by Mark Messina,Sonia Blanco Mejia,Aedin Cassidy,Alison Duncan,Mindy Kurzer,Chisato Nagato, et al.  Critical Reviews in Food Science and Nutrition, published online: 27 Mar 2021.

Conclusion: After extensive [my emphasis] review, the evidence does not support classifying isoflavones as endocrine disruptors.

Funding: “Funds were provided by the Soy Nutrition Institute and the European Plant-based Food Association to MM and the Toronto 3D Knowledge Synthesis & Clinical Trials Foundation for work related to the development and writing of this paper.”

Disclosures: Mark John Messina receives funding from the Soy Nutrition Institute as its Executive Director. Both Mindy Kurzer and John Sievenpiper are on the advisory board of the Soy Nutrition Institute. Ian Rowland is on the advisory board of the European Plant-based Foods Association. I have disclosed those interests fully to Taylor & Francis, and have in place an approved plan for managing any potential conflicts arising from these positions.

Comment: “Extensive” is an understatement; the paper has 688 references.  This may be overkill, but its purpose is to put to rest any concerns that soybeans might act as endocrine disrupters and, therefore, should be avoided.  The Soy Foods Council, obviously, wants you to stop worrying about this and paid for this review for that purpose.

I’m not particularly worried about soybeans.  As I wrote in What to Eat, I view soy as neither poison nor panacea.  But there is plenty of evidence on both sides.  That’s why paid reviews are not helpful.

You might not think that avocados need any special sales efforts, but the Haas Avocado marketers are particularly aggressive in funding research to demonstrate the health benefits of this food.

I’ve written about Haas-funded avocado research previously (most recently, here and here) but here’s yet another, this time initiated by a tweet:

I think avocados are fine foods, love them, but wish their marketers would not do this.  Here’s the Good News Network headline: “An Avocado a Day May Keep Your Gut Microbes Happy, Study Shows.”  As always, the operative word is “may.”  The headline would be equally correct saying “may not.”

The study: Avocado Consumption Alters Gastrointestinal Bacteria Abundance and Microbial Metabolite Concentrations among Adults with Overweight or Obesity: A Randomized Controlled Trial. Sharon V Thompson, Melisa A Bailey, Andrew M Taylor, Jennifer L Kaczmarek, Annemarie R Mysonhimer, Caitlyn G Edwards, Ginger E Reeser, Nicholas A Burd, Naiman A Khan, Hannah D Holscher.  The Journal of Nutrition, Volume 151, Issue 4, April 2021, Pages 753–762.

Conclusions: “Daily avocado consumption resulted in lower fecal bile acid concentrations, greater fecal fatty acid and SCFAs, and greater relative abundances of bacteria capable of fiber fermentation, providing evidence that this nutrient-dense food affects digestive physiology, as well as the composition and metabolic functions of the intestinal microbiota.”

Funding: Support for this research was provided by the Hass Avocado Board and the USDA National Institute of Food and Agriculture, Hatch project 1009249.

Author disclosures: NAB, NAK, and HDH received grant funding from the Hass Avocado Board.

Comment: All fruits and vegetables provide nutritional value and the best way to get the nutrients you need is by eating a variety of them.  If you like avocados, include them in that variety.  If not, don’t.

The Haas marketers want you to think that avocados are a superfood.  Alas, there is no such thing.  All fruits and vegetables provide nutritional value.  By that criterion, all fruits and vegetables are superfoods.

Here’s an example of how Haas advertises:

Did you know fresh avocados can be part of the MyPlate food guide?

• Make half your plate fruits and vegetables.

Avocados are a nutrient-dense fruit with naturally good fats and are easily incorporated into various meals and snacks. One serving (50g or one-third of a medium avocado) has only 80 calories and contributes nearly 20 vitamins, minerals, and phytonutrients along with dietary fiber.

The same could be said for most other fruits and vegetables, although most will be lower in calories.

Nutritional Viewpoints on Eggs and Cholesterol. by Michihiro Sugano and Ryosuke Matsuoka.  Foods 2021, 10(3), 494; https://doi.org/10.3390/foods10030494

Opinion:  This review says that although Japanese people eat more eggs than Americans, they may be protected against higher cholesterol levels due to the differences in everything else they eat (more seafood, for example?).

Conclusion: “Although randomized controlled trials with long-term follow-up are required to evaluate the association between consumption of eggs and human health, available information, at least from the nutritional viewpoint, suggests that egg is a healthy and cost-efficient food worldwide.”

Conflicts of interest: “M.S. declares no conflicts of interest, and R.M. is an employee of Kewpie Corporation. There are no other patents, products in development, or marketed products to declare. Kewpie Corporation has no conflicts of interest with this research.”

Comment: Really?  No conflicts of interest?  But Kewpie is Japan’s #1 mayonaise company.  Kewpie says that it “uses about four billion eggs a year. Recognizing that eggs contain all the necessary ingredients for creating life, we continually study ways of effectively utilizing such ingredients and manufacture fine chemicals for use in a broad range of food, cosmetic, and pharmaceutical applications.”

One of those ways, apparently, is to get its employees to write opinion pieces like this.

With that said, concerns about eggs and cholesterol have diminished in recent years.  The 2020 Dietary Guidelines for Americans says not a word about eggs and cholesterol; it just recommends eggs as a source of protein.  A study in the American Heart Association Journal finds no association between eggs and heart disease mortality.

The American Heart Association notes that eggs are the leading source of dietary cholesterol but their negative effects may be confounded by the fact that they are so often eaten with bacon and sausage.  The AHA egg recommendations:

• Vegetarians (lacto-ovo) who do not consume meat-based cholesterol-containing foods may include more dairy and eggs in their diets within the context of moderation discussed herein.
• Patients with dyslipidemia, particularly those with diabetes mellitus or at risk for heart failure, should be cautious in consuming foods rich in cholesterol.
• For older normocholesterolemic patients, given the nutritional benefits and convenience of eggs, consumption of up to 2 eggs per day is acceptable within the context of a heart-healthy dietary pattern.

And even with that said, the authors should have disclosed Kewpie’s evident conflicted interests.

Dietary Patterns and Nutritional Status in Relation to Consumption of Chickpeas and Hummus in the U.S. Population.  by  Cara L. Frankenfeld and Taylor C. Wallace.   Appl. Sci. 2020, 10(20), 7341; https://doi.org/10.3390/app10207341

Conclusion: ” Adults who consumed chickpeas and hummus were 48% and 62% less likely to have metabolic syndrome, respectively. Consuming chickpeas or hummus may be a practical means of improving diet quality and nutritional status. ”

Funding:  This research was funded by an investigator-initiated, unrestricted educational grant from Sabra Dipping Co., LLC.

Comment: That’s what they all say about the sponsor’s role, despite substantial evidence to the contrary (in many other cases).  Sabra is owned by PepsiCo.

Hat tip: To Daniel Bowmn Simon for sending me this one.