Currently browsing posts about: Conflicts-of-interest

Just because all of the major nutrition professional organizations partner with food companies, does not make it a good idea.  If nothing else, partnerships with food companies raise reputational risks.  They give the appearance of conflicted interests, as David Ludwig and I warned in 2008.  I have also written about the hazards of food industry sponsorship of professional organizations in Food Politics, Soda Politics, and Unsavory Truth.  Here’s what they are doing now.

Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association)  OOPS.  My error.  This should be the American Diabetes Association (even worse).  Abject apologies.  This is what I get for not reading more carefully.  Apologies again.

If I seem to be picking on AND, it’s because it is bigger and gets into more trouble than other nutrition professional societies.

The latest example: According to Reuters, a former AND officer, Elizabeth Hanna, has sued the organzation for “firing her for objecting to what she called a “pay to play” scheme to promote the no-calorie sweetener Splenda.

In its 2022 annual report, the ADA said Splenda was one of a group of “elite” supporters that had given more than $1 million, along with Bayer Healthcare, Blue Cross Blue Shield of Illinois, Helmsley Charitable Trust and others.

On its website, Splenda publishes “diabetes-friendly recipes,” endorsed by the ADA. Hanna, a registered dietitian nutritionist, said she refused to approve the endorsement of several of these recipes in July.

…The U.S. Centers for Disease Control and Prevention states on its website that some studies have found possible health risks associated with the sweeteners, but that more research is needed.

American Society for Nutrition (ASN)

I am a member of this society and raise objections every time I get something like this in my e-mail.

Sponsored Webinar: Oral Health and Nutrition: Imperative for Healthy People 2030 and US Dietary Guidelines   Sponsored By: Mars Wrigley and the Oral Health Alliance.  The 2020-2025 Dietary Guidelines (DGA) identified dental caries as a major diet-related chronic disease of public health concern….

Doing this sort of thing risks reputation.

Evidence:  In a video on ultra-processed foods, the Financial Times identifies the ASN as “food industry advocacy group.”

The ASN’s executive director assures me they will ask for a correction.

Society for Nutrition Education and Behavior

Et tu?

It just announced a webinar, “Latinos love affair with Mangos: Maintaining Generational Food Traditions to Improve Health Outcomes.”

This is “a webinar sponsored by the National Mango Board, SNEB Organizational Member.”

The mango is…one of the world’s most popular fruits, and a staple food across Spanish speaking countries of North America, South America, and the Caribbean. Beyond its culinary popularity, an expanding body of research shows associations with mangos and risk reductions for inflammation and metabolically- based chronic disease, many of which disproportionately impact Hispanic American populations.

Mangos as opposed to any other fruit?

I am also a member of this society.

Overall comment

Are the reputational risks—and the loss of integrity—worth the money?  I don’t think so.

Several readers wrote suggesting I take a look at the conflicts of interest statement on this paper.

It comes from the Harvard TH Chan School of Public Health, which issued a press release: Harvard study: ‘Portfolio diet’ may decrease risk of heart disease, stroke.

The portfolio diet—a plant-based diet designed to lower unhealthy cholesterol, emphasizing plant proteins (legumes), phytosterols (nuts and seeds), viscous fiber (oats, barley, berries, apples), and plant-based monounsaturated fatty acids (avocado)—may lower the risk of heart disease and stroke, according to a new study co-authored by researchers at Harvard T.H. Chan School of Public Health.

The study was published in Circulation, which also sent out a press release: Ever heard of the portfolio diet? It may lower risk for heart disease and stroke.

The study itself, Portfolio Diet Score and Risk of Cardiovascular Disease: Findings From 3 Prospective Cohort Studies, produced results that should be expected from eating healthier diets.

Background: The plant-based Portfolio dietary pattern includes recognized cholesterol-lowering foods (ie, plant protein, nuts, viscous fiber, phytosterols, and plant monounsaturated fats) shown to improve several cardiovascular disease (CVD) risk factors in randomized controlled trials.

Objective: to examine the relationship between the Portfolio Diet Score (PDS) and the risk of total CVD, coronary heart disease (CHD), and stroke.

Methods: We prospectively followed 73924 women in the Nurses’ Health Study (1984–2016), 92346 women in the Nurses’ Health Study II (1991–2017), and 43970 men in the Health Professionals Follow-up Study (1986–2016) without CVD or cancer at baseline. Diet was assessed using validated food frequency questionnaires at baseline and every 4 years using a PDS that positively ranks plant protein (legumes), nuts and seeds, viscous fiber sources, phytosterols (mg/day), and plant monounsaturated fat sources, and negatively ranks foods high in saturated fat and cholesterol.

Conclusions: The PDS was associated with a lower risk of CVD, including CHD and stroke, and a more favorable blood lipid and inflammatory profile, in 3 large prospective cohorts.

This report was funded by Canadian and U.S. government research agencies.

Comment: The reason readers sent this to me had to do with the authors’ reported conflicts of interest.  These take up the equivalent of an entire page in the journal and refer to a curious mixture of financial support or connections, paid and unpaid, with government agencies and foundations, authors’ and sometimes their spouses’—in addition to long lists of financial ties to food trade associations for one or another plant food included in the Portfolio diet.

Muddying up disclosure statements like this is inappropriate.  Many connections listed do not in any way imply conflicted interests.  Mixing them up with those that do takes the focus away from financial ties that could have influenced the design or interpretation of the study.

Financial connections to food companies raise questions of credibility in nutrition research.  At the very least, they give the appearance of industry influence.

Disclosure lists like these either reflect ignorance of the significance and harm causes by conflicts of interest or deliberate disdain for its meanings.  If Circulation is requiring this mix of disclosures, it should reevaluate its policy.

Just because these disclosures come in a study from Harvard does not make them OK.

Thanks to a reader, Kevin Mitchell, for sending this news item: 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 source.

• The study: Connolly G, Hudson JL, Bergia RE, Davis EM, Hartman AS, Zhu W, Carroll CC, Campbell WW. 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. Nutrients. 2023; 15(13):2870. https://doi.org/10.3390/nu15132870
• Objectives: We assessed the effects of consuming two oz-eq portions of pork, eggs, black beans, and almonds on postprandial EAA bioavailability in young and older adults.
• Methods: We conducted two investigator-blinded, randomized crossover trials in young (n = 30; mean age ± SD: 26.0 ± 4.9 y) and older adults (n = 25; mean age ± SD: 64.2 ± 6.6 y). Participants completed four testing sessions where they consumed a standardized meal with two oz-eq of either unprocessed lean pork, whole eggs, black beans, or sliced almonds.
• Conclusions: Pork resulted in greater EAA bioavailability than eggs in young adults (p < 0.0001), older adults (p = 0.0007), and combined (p < 0.0001)… The same “oz-eq” portions of animal- and plant-based protein foods do not provide equivalent EAA content and postprandial bioavailability for protein anabolism in young and older adults.
•  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.
• Conflicts of Interest: 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.

Comment: It is very much in the interest of the Pork Checkoff and the Egg Board t,o demonstrate that animal-source food protein is better for you than proteins from plant sources—and to cast doubt on any evidence to the contrary.  Proteins, whether from animal or plant sources, contain precisely the same 20 amino acids, although in different proportions.  Animal proteins are closer in amino acid composition than are plant proteins but if you eat a variety of plant foods you will get the amino acids you need.   People who eat largely plant-based diets are generally healthier than people who eat a lot of animal-based foods.  The conclusion of this study does not change that overall conclusion.  This, then, is another industry-funded study with predictable results.

It was hard to miss this headline in Dairy Reporter: “Cheese intake could lower risk of dementia, study suggests.”

No kidding?  I wonder who paid for this?

To its credit, the article did full disclosure:

The study was conducted as part of broader research commissioned by Japanese dairy major Meiji Co., Ltd. and part-funded by the company.

I went right to it.

The study: Kim H, Osuka Y, Kojima N, Sasai H, Nakamura K, Oba C, Sasaki M, Suzuki T. Inverse Association between Cheese Consumption and Lower Cognitive Function in Japanese Community-Dwelling Older Adults Based on a Cross-Sectional Study. Nutrients. 2023; 15(14):3181. https://doi.org/10.3390/nu15143181

Purpose: “We investigated whether cheese intake is associated with lower cognitive function (LCF) in community-dwelling older adults.”

Method: “This cross-sectional study included 1503 adults aged over 65 years. The analyzed data were obtained through face-to-face interviews and functional ability measurement.”

Results: Cheese intake, along with usual walking speed and calf circumference to be significant factors associated with LCF.

Conclusions: Cheese intake is inversely associated with lower cognitive function.

Funding: This study was funded by the Japan Agency for Medical Research and Development , the National Center for Geriatrics and Gerontology, and Meiji Co., Ltd.

Conflicts of Interest: “This study was conducted as a part of the ‘Epidemiology study of the relationship between dairy products intake and cognitive function’ commissioned by Meiji Co., Ltd. T.S. holds the position of Commissioned Research Chair, and H.K. is a member of the Commissioned Research group. K.N., C.O., and M.S. are employees of Meiji Co., Ltd. The other authors declare no conflict of interest. The funding sponsors had no role in the execution, analysis, or interpretation of the data or the writing of the manuscript.

Comment: Meiji Holdings Co Ltd (Meiji) 

is a manufacturer and distributor of dairy products, confectionery, and nutritional products. The company’s product portfolio comprises milk, yogurt, cheese, ice cream, chocolates, and gummy candies. The company also provides beauty supplements, protein products, nutritional products, vaccines, antibacterial agents, and generic drugs. The company markets its products under Meiji, Essel, Oishii Gyunyu, DepromeL, Reflex, Kaju Gummy, Kinoko no Yama, Galbo, Amino Collagen, Savas, Sycrest, Streptomycin, Kanamycin, Depromel, and Metact brand names…Meiji is headquartered in Chuo-Ku, Tokyo, Japan.

Five of the authors work for the company.

Does eating cheese reduce the risk of dementia?  You read the paper and decide.  I think you can’t make this stuff up.

I was not going to bother to say anything about this letter addressed to the Washington Post from the President of the Academy of Nutrition and Dietetics (AND), Laurie Wright, which she sent to all members.  But at least five recipients sent it to me for comment, so here goes.

From: Commission on Dietetic Registration <cdr@eatright.org>
Date: September 29, 2023 at 3:19:42 PM EDT
To: [REDACTED]
Subject: Letter to the Editor of the Washington Post from Academy President Lauri Wright

The September 13 article “The food industry pays ‘influencer’ dietitians to shape your eating habits” does a disservice to the nation’s hundred thousand plus registered dietitian nutritionists by painting broad-stroke misrepresentations about the dietetics profession and its association, the Academy of Nutrition and Dietetics.

Using examples of only seven individuals, the authors imply it is common practice for RDNs to have undisclosed affiliations with food companies and sponsors. This could not be further from the truth. More than 90 percent of registered dietitian nutritionists work in clinical health care, such as hospitals, medical centers and long-term care facilities, as well as in private practice, public and community health, school nutrition and other foodservice operations.

A growing number of practitioners do share their knowledge and expert opinions through social platforms, engaging with online communities and correcting health misinformation (much of which comes from potentially harmful fads promoted by infinitely larger numbers of uncredentialed influencers with much larger followings). The Academy of Nutrition and Dietetics has a strict Code of Ethics — which includes adhering to disclosure rules and guidelines established by the Federal Trade Commission — and has published many articles over the years about the importance of disclosure.

The authors further implied that the Academy is funded by the food and beverage industry, citing a long-since debunked “investigation” conducted by a small group of activists that disbanded six years ago. The truth lies in the facts: The Academy uses an independent advisor to manage our financial investments in all sectors of the S&P 500, and less than 3 percent of the Academy’s and its Foundation’s investments are in the food sector. Further, only 7 percent of the Academy’s revenue comes from sponsorships. This information has always been fully transparent to the public through our annual reports.

All this information was provided to the Post reporters in advance of the story, but unfortunately the writers elected to mislead their readers with a false narrative implying that non-disclosure of sponsorships is rampant in our profession. Speaking for Academy members who abide by our Code of Ethics, we expected the Post to abide by a higher journalistic standard as well.

Oh dear.  The cozy relationship between AND members and food companies is something I’ve written about extensively in my books, Food Politics and, more recently, Unsavory Truth.  

I’ve also written about the Academy’s conflicted interests on this site, most recently here.

And then there is Michele Simon’s deep dive into the Academy’s relationships with sponsors from a decade ago.

Here’s what President Wright’s defensive letter does not say:

• We apologize for the unethical behavior of some of our members and will immediately take steps to make sure no member does this again.
• Non-disclosure of sponsorship is grounds for dismissal from the Academy.
• We will strengthen our policies to make clear that the Academy will not tolerate such non-disclosure.
• We will insist not only of disclosure of paid posts, but also disclosure of the name of the sponsor.
• To make sure members fully understand what is at stake, we are providing guidelines for ethical disclosure and illustrations of what and what is not appropriate.

For your amusement, one reader sent me an Instagram example of full disclosure from Gwyneth Paltrow (who is not, to my knowledge, an AND member)—clearly labeled as a paid partnership with Copperfit.  You have to be logged in to Instagram to open the link.

When I saw this article—Study: Orange and pomegranate extract impacts major marker for healthy ageing—my first thought was “Who paid for this?”  Bingo.

The study: Ahles, S., Cuijpers, I., Hartgens, F. et al. The Effect of a Citrus and Pomegranate Complex on Physical Fitness and Mental Well-Being in Healthy Elderly: A Randomized Placebo-Controlled Trial. J Nutr Health Aging 26, 839–846 (2022). https://doi.org/10.1007/s12603-022-1834-4

• Objectives: This study investigates whether a citrus and pomegranate complex (CPC) improves physical fitness, mental well-being, and blood biomarkers for oxidative stress and endothelial function in healthy elderly.
• Design: A randomized placebo-controlled cross-over trial.
• Participants: The study included 36 healthy elderly aged 60–75 years old.
• Intervention and Measurements: Participants received four weeks of CPC supplementation and performed the handgrip strength and senior fitness test. Quality of life (QOL) was assessed and blood samples were analyzed for oxidative stress and endothelial function markers.
• Results: After four weeks of CPC supplementation, handgrip strength significantly improved (p=0.019), compared to placebo. Moreover, the thinking, memory, learning, and concentration facets were improved (p=0.042), compared to placebo, and plasma malondialdehyde decreased, compared to placebo (p=0.033). The intervention did not affect senior fitness and the other QOL domains and blood parameters.
• Conclusion: Four weeks of daily CPC supplementation significantly improves handgrip strength and self-evaluated measures of psychological function in healthy older adults. Further research should focus on mechanisms associated with physical performance.
• Funding: Funding: Authors IC and FT are supported by the Province of Limburg, The Netherlands [grant number HEFI-2]. This research project was supported by BioActor B.V.
• Ethics declarations: Conflict of interest: S.A. is an employee of BioActor BV. F.H. is a sports medicine consultant and owner of Sports Medicine Center Maastricht*Parkstad. All other authors declare no conflict of interest. The funders had no role in the design of the study, in the preparation of the manuscript, or in the decision to publish the results.

Comment: This is a classic example of a study nobody but the product maker would ever do.  The statement that the funders had nothing to do with the study design or anything else may or may not be true—there have been too many examples of its not being true to take any such statement seriously without much further discussion.  Even with that assurance, researchers who accept industry funding rarely recognize industry influence—it seems to occur at some unconscious level.

The Examination, a brand-new news outlet, and the Washington Post jointly published a jaw-dropping article last week about dietitians paid by food and supplement companies to defend and promote their products on Instagram and TikTok.

Why jaw-dropping?  Two reasons: the media—videos, posts—embedded in the article (these are amazing to see), and the non-disclosure of payment.

As the World Health Organization raised questions this summer about the risks of a popular artificial sweetener, a new hashtag began spreading on the social media accounts of health professionals: #safetyofaspartame….What these dietitians didn’t make clear was that they were paid to post the videos by American Beverage, a trade and lobbying group representing Coca-Cola, PepsiCo and other companies….The food, beverage, and dietary supplement industries are paying dozens of registered dietitians that collectively have millions of social media followers to help sell products and deliver industry-friendly messages on Instagram and TikTok, according to an analysis by The Examination and The Washington Post.

Here’s just one example:

Registered dietitian Lindsay Pleskot, of Vancouver, British Columbia, has posted videos of herself eating ice cream and peanut butter cups while telling people that denying themselves sugary food will only make cravings worse….These and other posts were paid for by the Canadian Sugar Institute.

A reader, Emma Calvert, a Senior Food Policy Officerfor the European Union in Brussels, sent me “this article.  She also pointed me to the article Food Navigator wrote about it: “Review hails health benefits of beer-gut alliance.”

Eager to find out what the “beer-gut alliance” might be, I went right to it.

The study: Beer-gut microbiome alliance: a discussion of beer-mediated immunomodulation via the gut microbiome.” Silu Zhang, Shuo Jin, Cui Zhang, Shumin Hu, Huajun Li.  Front. Nutr., 25 July 2023.  Volume 10. https://doi.org/10.3389/fnut.2023.1186927

Background: “As a long-established fermented beverage, beer is rich in many essential amino acids, vitamins, trace elements, and bioactive substances that are involved in the regulation of many human physiological functions.  The polyphenols in the malt and hops of beer are also important active compounds that interact in both directions with the gut microbiome.”

Methods: “This review summarizes the mechanisms by which polyphenols, fiber, and other beneficial components of beer are fermentatively broken down by the intestinal microbiome to initiate the mucosal immune barrier and thus participate in immune regulation.”

Conclusion: “Beer degradation products have anti-inflammatory, anticoagulant, antioxidant, and glucolipid metabolism-modulating potential. ..The positive effects of bioactive substances in beer in cancer prevention, reduction of cardiovascular events, and modulation of metabolic syndrome make it one of the candidates for microecological modulators.”

Funding: “This study was supported by the Open Research Fund of State Key Laboratory of Biological Fermentation Engineering of Beer, under grant no. K202101.”

Conflict of interest: “CZ and SH were employed by Tsingtao Brewery Co. Ltd.  The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.”

Comment: This seems like a lot to claim for beer.  Vested interest?  Yes.  The State Key Beer Lab is part of the Tsingtao Brewery Co. Ltd, Qingdao, 266100, China and two of the authors work for the company.  Why do this study?  To distract attention from the harmful effects of alcohol consumption (where do I begin?) and from its calories, and instead give beer a health aura.

Beer, alas, is not a health food, best consumed in moderation if at all.

Sorry.