Currently browsing posts about: Conflicts-of-interest

A reader, Bart Peuchot, writes:

I would be very interested to have your view on this new publication for Nature.

As you taught me, I checked the competing interests and it seems to be a perfect industry-funded publication.

And then ,I ran across this Tweet (X) from @Stuart Gillespie:

New paper concluding “more research needed”
…brought to you by Nutrition Foundation of Italy…
…which in turn is brought to you by
…..@Nestle @McDonalds @CocaCola Ferrero, Barilla, Danone et al…

Well.  What  is this about?

I went right to the paper: Visioli, F., Del Rio, D., Fogliano, V. et al. Ultra-processed foods and health: are we correctly interpreting the available evidence?. Eur J Clin Nutr (2024). https://doi.org/10.1038/s41430-024-01515-8

Aha! Another attack on the concept of ultra-processed foods.  The article concludes

the available evidence on how different UPFs have been associated with health, as well as the results of studies examining specific food additives, call into question the possibility that ultra-processing per se is the real culprit. It is possible that other unaccounted for confounding factors play an important role. Future, urgently needed studies will clarify this issue.

The Italian food industry has been especially active in opposing NutriScore labels and anything else that might discourage sales of foods high in sugar, salt, and saturated fat.

But it is not alone in pushing back against the concept of  ultra-processed foods—an existential threat to junk food manufacturers.

Here, for example, is Hank Cardello,  the Executive Director of Leadership Solutions for Health + Prosperity at Georgetown’s Business School writing in Forbes:: New Report Highlights The Sweet Side Of Ultra-Processed Foods.

With ultra-processed foods (UPFs) replacing “junk food” as the new bogeyman for public health advocates, a new study published by  the Georgetown University Business for Impact Center (full disclosure: I am one of the authors) reveals that all UPFs are not created equal. The report spotlighted that candy in particular was the exception, since that category contributes only 6.4% of added sugars and less than 2% of our calories. The most surprising discovery is that the “healthiest of the healthiest” consumer cohort in the study purchased candy 26% more frequently than the general population.

The report: New Consumer Insights on Ultra-Processed Indulgent Foods: How Confectionery Products Are Different.

Candy behaves differently from other ultraprocessed indulgent products. New NMI and NHANES data re-confirm that candy is different and should not be lumped together with other indulgent products. Consumers do not overconsume  chocolate and candy, so targeting these foods will not impact obesity. An approach that focuses on product categories that consumers with the highest BMIs eat and drink the most will be more effective.

OK, readers: Take a guess at who paid for this.

Funding for this paper was provided by the National Confectioners Association.

As I keep saying, you can’t make this stuff up.

Here’s how I learned about this one: Unilever, Nestlé and Coca-Cola villainised for government scientist ties.  Mondelēz International, Tate & Lyle, Pepsico and a host of other global food and drink manufacturing majors face fresh scrutiny over their links to government-advising scientists…. Read more

Villainized?  Isn’t this just business as usual?

Not exactly.  An analysis in the BMJ (formerly British Medical Journal) says UK government’s nutrition advisers are paid by world’s largest food companies(see BMJ 2024;386:q1909).

The authors examined declared links between members of SACN (The UK Government’s Scientific Advisory Committee on Nutrition) and the food and drinks industry.

:

The study found

More than half of the experts on the UK government’s advisory panel on nutrition have links to the food industry…Campaigners say that these conflicts of interests at the heart of policy making are detrimental to public health. Others say that they reflect the lack of funding for nutrition research and that removing experts with industry links from SACN would “diminish” its expertise..

Six members of SACN are members of the American Society for Nutrition, which is funded by Mars, Mondelez, Nestlé, PepsiCo, and the Sugar Association, among others…SACN’s current work includes reviewing the evidence over ultraprocessed foods, artificial sweeteners, and plant based food and drink…Experts including van Tulleken and Percival say that SACN did not do enough to present the case for tougher regulation on ultraprocessed foods.

Two readers, Tara Kenny and Martin Caraher, sent this one:  Plant-based diets–impacts of consumption of little or no animal-source foods on human health.  by Alice V. Stanton  ^{Front. Nutr., 17 September 2024. Volume 11 – 2024 | https://doi.org/10.3389/fnut.2024.1423925}

The paper argues for the benefits of meat-based diets:

The protections provided by plant-based diets against NCDs [non-communicable diseases] appear to be more strongly associated with reduced intakes of calories and salt, and increased intakes of fruit, vegetables, nuts and whole grains, rather than with reduced intakes of ASFs [animal-source foods]. Any possible absolute adverse effects of red and processed meat consumption on NCDs are very small and uncertain…dietary guidelines should advise moderating excessive consumption, rather than substantially limiting or excluding ASFs from the human diet.

The author’s conflict-of-interest statement:

Alice Stanton was a part-time employee of Devenish Nutrition (2017–2023); and currently owns stock in Devenish Nutrition, an agri-technology company specializing in sustainable food solutions.

Comment

My readers point out that the author’s financial conflicts of interest are understated.  Devinish Nutrition is, in fact, a family business.  The company states it is “an innovator in animal nutrition by providing a wide range of products and services.”  It was acquired this year by EASY BIO a South Korean animal nutrition company.

Both readers also point out that Alice Stanton has pro-meat ideological conflicts of interest, but these concern me much less.  Everyone who does research has beliefs and hypotheses they want to test.  But not everyone stands to benefit financially from the outcome of their research or opinion, which is why full disclosure is so necessary.

Nutrients, a journal that requires authors to pay CHF 2900 ($3400) for their articles, does publish the most amazing studies, ostensibly peer-reviewed (I’ve heard mixed things about its process).  This journal is a source for many of my Monday posts, each more creative than the next.

This is a good one. 

Sourdough Bread with Different Fermentation Times: A Randomized Clinical Trial in Subjects with Metabolic Syndrome. Pérez-Vega KA, Sanllorente A, Zomeño M-D, Quindós A, Muñoz-Martínez J, Malcampo M, Aldea-Perona A, Hernáez Á, Lluansí A, Llirós M, et al.. Nutrients. 2024; 16(15):2380. https://doi.org/10.3390/nu16152380

Rationale: The Mediterranean diet, featuring sourdough bread, shows promise in managing metabolic syndrome.

Method: In a double-blind clinical trial, participants randomized to consume either Elias Boulanger^® long-fermentation (48 h) sourdough bread (EBLong) or Elias Boulanger^® short-fermentation (2 h) sourdough bread (EBShort) over a two-month period.

Results. EBShort bread was effective in reducing some inflammation markers.

Conclusion.  The consumption of sourdough bread may offer potential benefits in reducing inflammation markers in individuals with metabolic syndrome; however, longer fermentation times did not show additional benefits.

Conflicts of interest: “I.E. and N.EM. were employees of Elias–Boulanger and received funding from RTC-2017-6467-2 program. They had no role in the collection, analyses, and interpretation of data or in the decision to publish the results. The rest of the authors declare no conflicts of interest.”

Comment: I’ll bet they didn’t.  Sourdough bread is responsible for the benefits of the Mediterranean diet?  That’s news to me.  The bread is healthier if its fermented for a shorter time?  Also news.

The paper does not describe the taste or texture of the bread.

• Ingredients EBLong: whole-grain flour, water, yeast, salt [in other words, real bread].
• Ingredients EBShort: refined wheat flour, water, yeast, salt, wheat gluten, xanthan gum, emulsifier E471, antioxidant E-300 [this is ultra-processed bread].

Thus, the underlying purpose of this study must be to give Elias-Boulanger an excuse to cut down on fermentation time and claim the cheaper, ultra-processed bread is healthier. Count me as dubious, on taste grounds alone.

But isn’t this a great example of marketing research in action?  You can’t make this stuff up.

ADDITION

A reader points out that Nutrients is not alone in requiring Article Processing Charges (APCs) for open-access publication.  Prestigious journals charge much more.

• Nature:  $12,290

• BMJ: £5408 / €6154 / $7159 $7,159 

• Lancet:  $6,000 – $7,000:+

I saw this announcement in Food Navigator: Study: Nutrient dense formula could improve cognition and behaviour in infants.

My immediate question: Who paid for this?

I went right to it.

The study: Schneider N, Hartweg M, O’Regan J, Beauchemin J, Redman L, Hsia DS, Steiner P, Carmichael O, D’Sa V, Deoni S. Impact of a Nutrient Formulation on Longitudinal Myelination, Cognition, and Behavior from Birth to 2 Years: A Randomized Clinical Trial. Nutrients. 2023; 15(20):4439. https://doi.org/10.3390/nu15204439

Conclusions: The results suggest that brain development may be modifiable with brain- and age-relevant nutritional approaches in healthy infants and young children, which may be foundational for later learning outcomes.

Funding: This study received funding from the Société des Produits Nestlé S.A.

Conflicts of Interest: This study received funding from the Société des Produits Nestlé S.A. The funder had the following involvement with the study: study design, study monitoring and oversight, data collection and analysis, decision to publish, and preparation of the manuscript.

Comment: Some of the authors of this study are employed by Nestlé (no relation).  Their disclosure statement is unusually candid: the funder was totally involved in every aspect of the research.  It’s refreshing to see that dislosed.  But the underlying issue still holds: industry-funded reseach all too often produces results favorable to the commercial interests of the funder.

The concern here is that promoting infant formula as better than breast milk is a marketing strategy, as described in reports from the World Health Organization.  And see my previous post on this.

This one was sent to me by a reader: 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 study: “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” by Gavin Connolly, Joshua L. Hudson, Robert E. Bergia, Eric M. Davis, Austin S. Hartman, Wenbin Zhu, Chad C. Carroll and Wayne W. Campbell, 25 June 2023, Nutrients. DOI: 10.3390/nu15132870

Oh.  It’s in Nutrients, a journal that might as well be called “The Journal of Industry-Funded Research” (authors have to pay for publication of their articles in this journal–2900 Swiss Francs).

The study was designed to demonstrate that protein from animal sources is better than protein from plant sources, immediately raising the question: Who sponsored this study?

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.

Do the authors report conflicts of interest?  Yes, they do:

Conflicts of Interets: 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.

I’m not going to bother going through the methods, results, or other details.  The point here is that industry-funded research has a high probability of producing results favorable to the sponsors’ interests, as happened in this instance.  The statement that the sponsors had no role may or may not be true; it’s hard to know without further investigation, but research on this question demonstrates that the statement is not always accurate.  Funding exerts influence, whether recognized by researchers or not.

A reader who wishes to remain anonymous forwarded this email she received from Kristen Hicks-Roof PhD, RDN, LDN, FAND , Director of Human Nutrition·National Pork Board.

Growing Strong: Animal-Source Foods’ Role in Childhood Development and Sustainable Food Systems

Childhood and adolescence are critically important periods for growth and development. These periods are also key for establishing healthy dietary patterns that can influence eating behaviors and health into adulthood.

During these stages, animal-source foods provide critical nutrients — such as high-quality protein, iron, zinc, choline, and B vitamins — that are not easily replaced from other sources.

In this webinar, Dr. Adegbola Adesogan will:

– Present evidence on the role of animal-source foods in childhood development and impact on future health outcomes

– Review how animal-source foods are a source of key nutrients that support health in children and adolescents

The CPE activity application for this webinar is pending review by the Commission on Dietetic Registration (CDR) and approval for 1.0 CPEU.

Comment

Presumably, the CDR will approve this for continuing education credits required for dietetic licensing.  Also presumably, participants will not learn about the polluting effects of Pork CAFOs or the community lawsuits against them for obnoxious odors and other offenses.  Or the way the pork industry fights back against such complaints.  Or the welfare issues about farrowing crates.  Or complaints about Pork Checkoff programs.

As I’ve noted previously, dietitians are able to fulfill all requirements for continuing education credits from industry-funded courses like this one.

Conflict of interest, anyone?

The title of this article triggered my usual question: Who paid for this?  I cannot think of any reason other than marketing this supplement for doing a study like this.

Multi-nutrient supplementation of astaxanthin, vitamin E and grape juice improves episodic memory, cognitive performance – RCT:  A study has found that 12 weeks of multi-nutrient supplementation, comprising astaxanthin, vitamin E and grape juice extract, resulted in improved episodic memory and several biomarkers associated with cognitive health…. Read more

The study: Lopresti AL, Smith SJ, Riggs ML, Major RA, Gibb TG, Wood SM, Hester SN, Knaggs HE. An Examination into the Effects of a Nutraceutical Supplement on Cognition, Stress, Eye Health, and Skin Satisfaction in Adults with Self-Reported Cognitive Complaints: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2024; 16(11):1770. https://doi.org/10.3390/nu16111770

Method: adults aged 40 to 70 years with subjective memory complaints were randomized to take a supplement containing vitamin E, astaxanthin, and grape juice extract daily for 12 weeks or a matching placebo.

Outcomes:  Changes in cognitive tasks assessing episodic memory, working memory, and verbal memory., speed of information processing, attention, and self-report measures of memory, stress, and eye and skin health.

Results: “Compared to the placebo, nutritional supplementation was associated with larger improvements in one primary outcome measure comprising episodic memory (p = 0.037), but not for working memory (p = 0.418) or verbal learning (p = 0.841). Findings from secondary and exploratory outcomes demonstrated that the nutraceutical intake was associated with larger improvements in the Everyday Memory Questionnaire (p = 0.022), increased plasma brain-derived neurotrophic factor (p = 0.030), decreased plasma malondialdehyde (p = 0.040), and increased skin carotenoid concentrations (p = 0.006). However, there were no group differences in changes in the remaining outcome measures.”

Conclusions: “The results from this 12-week study provide some support for the cognitive-enhancing effects of a nutraceutical containing astaxanthin, vitamin E, and grape juice extract in adults with self-reported memory complaints. This was demonstrated by improvements in one primary outcome measure (episodic memory) but not working memory or verbal learning.”