by Marion Nestle

Currently browsing posts about: Conflicts-of-interest

Jun 8 2023

New report on conflicts of interest in health research

Sponsor Influences on the Quality and Independence of Health Research: Proceedings of a Workshop
This report summarizes the proceedings of a workshop on the effects of industry funding in biasing health—and, therefore, food and nutrition—research.

The workshop covered the ways that funding sources (especially corporate funders) influence research quality and outcomes (precisely the topic of my book, Unsavory Truth: How Food Companies Skew the Science of What We Eat.

The report is a succinct yet thorough summary of the research on the effects of funding on research design, outcome, and interpretation.

Some of the speakers:

This report is a great place to begin if the topic is new to you.

And so is this, of course.

Jun 5 2023

Conflicted interest of the week: multivitamins and memory

Here’s another one that several readers have asked me about: Multivitamin Supplementation Improves Memory in Older Adults: A Randomized Clinical Trial.  Authors: American Journal of Clinical Nutrition. DOI:https://doi.org/10.1016/j.ajcnut.2023.05.011

The study: “Participants were randomly assigned to a daily multivitamin supplement (Centrum Silver) or placebo and evaluated annually with an Internet-based battery of neuropsychological tests for 3 y.”  Primary outcome measure: change in episodic memory (immediate recall performance on the ModRey test, after 1 y of intervention).  Secondary outcome measures: changes in episodic memory over 3 y of follow-up,  and in performance on neuropsychological tasks of novel object recognition and executive function over 3 y.

Results: “Compared with placebo, participants randomly assigned to multivitamin supplementation had significantly better ModRey immediate recall at 1 y, the primary endpoint (t(5889) = 2.25, P = 0.025), as well as across the 3 y of follow-up on average (t(5889) = 2.54, P = 0.011). Multivitamin supplementation had no significant effects on secondary outcomes…we estimated that the effect of the multivitamin intervention improved memory performance above placebo by the equivalent of 3.1 y of age-related memory change.”

Conlusion: “Daily multivitamin supplementation, compared with placebo, improves memory in older adults.”

Conflict of interest: HDS, JEM, and AMB received investigator-initiated grant support to their institutions from Mars Edge. Pfizer Consumer Healthcare (now Haleon) provided support through the partial provision of study pills and packaging. HDS received investigator-initiated grants from Pure Encapsulations and Pfizer Inc and honoraria and/or travel for lectures from the Council for Responsible Nutrition, BASF, NIH, and the
American Society of Nutrition during the conduct of the study. No funding sources had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Funding: This work was supported by an investigator-initiated grant from Mars Edge, a segment of Mars Inc dedicated to nutrition research. Pfizer Consumer Healthcare (now Haleon) provided support through the
partial provision of study pills and packaging.

Comment:  This study continues to surprise me.  As I’ve written before, it is part of the COSMOS trial, which is also supported by grants from NIH and a private foundation.  In my previous post on it, I noted that despite being funded by Pfizer (which makes Centrum Silver multivitamin supplements), the study did not show benefits of the supplement for prevention of cardiovascular disease or cancer—a rare exception to the rule that industry-funded studies tend to favor the sponsor’s interests.  But here we go again, this time with an equally surprising result but for a different reason: most multivitamin studies have shown no benefits whereas this one says if you take Centrum Silver, it will give you another three years of no loss in memory.  Wow!  I’ll be Pfizer is thrilled.

Here’s what the NIH National Center for Complementary and Integrative Health says about multivitamins:

Multivitamins/multiminerals (MVMs) are the most frequently used dietary supplements, with close to half of American adults taking them. MVMs cannot take the place of eating a variety of foods that are important to a healthy diet. Foods provide more than vitamins and minerals. Many foods also have fiber and other substances that can provide health benefits. However, some people who don’t get enough vitamins and minerals from food alone, or who have certain medical conditions, might benefit from taking one or more of these nutrients found in single-nutrient supplements or in MVMs. However, evidence to support their use for overall health or disease prevention in the general population remains limited.

Some of its conclusions:

  • Most individuals can get all of the necessary vitamins and minerals through a healthy eating pattern of nutrient-dense foods.
  • Taking an MVM increases overall nutrient intake and helps some people get the recommended amounts of vitamins and minerals when they can’t or don’t get them from food alone.
  • There’s no standard or regulatory definition for MVMs, or any dietary supplement, as to what nutrients they must contain or at what levels. .
  • People with healthier diets and lifestyles are more likely to take dietary supplements, making it hard to identify any benefits from their use. There’s no convincing evidence that MVMs help prevent chronic disease.

We will see whether this study causes the Center to change any of this.

May 29 2023

Industry-funded study of the week: kiwi fruit this time

Thanks to Bradley Flansbaum for sending this one from a journal not on my usual reading list: “In persons with constipation or IBS-C, kiwifruit vs. psyllium increased spontaneous bowel movements.”

I like the way this press release gets right to the point.

An industry-funded randomized trial assessed the effect of daily consumption of kiwifruit versus psyllium on GI function and comfort in 184 adults who were healthy, had functional constipation (FC), or met Rome III diagnostic criteria for constipation-predominant irritable bowel syndrome (IBS-C).

The study: Consumption of 2 Green Kiwifruits Daily Improves Constipation and Abdominal Comfort—Results of an International Multicenter Randomized Controlled TrialThe American Journal of Gastroenterology ():10.14309/ajg.0000000000002124, January 9, 2023. | DOI: 10.14309/ajg.0000000000002124.

Authors: Gearry, Richard MD, PhD; Fukudo, Shin MD, PhD; Barbara, Giovanni MD; Kuhn-Sherlock, Barbara PhD; Ansell, Juliet PhD; Blatchford, Paul PhD; Eady, Sarah MSc; Wallace, Alison PhD; Butts, Christine PhD; Cremon, Cesare MD; Barbaro, Maria Raffaella PhD; Pagano, Isabella MD; Okawa, Yohei PhD; Muratubaki, Tomohiko PhD; Okamoto, Tomoko PhD; Fuda, Mikiko MS; Endo, Yuka MD; Kano, Michiko MD, PhD; Kanazawa, Motoyori MD, PhD; Nakaya, Naoki PhD; Nakaya, Kumi PhD; Drummond, Lynley BTech (Hons)

Summary of the study

Methods: Participants included healthy controls (n = 63), patients with functional constipation (FC, n = 60), and patients with constipation-predominant irritable bowel syndrome (IBS-C, n = 61) randomly assigned to consume 2 green kiwifruits or psyllium (7.5 g) per day for 4 weeks, followed by a 4-week washout, and then the other treatment for 4 weeks. The primary outcome was the number of complete spontaneous bowel movements (CSBM) per week.

Results: Consumption of green kiwifruit was associated with a clinically relevant increase of ≥ 1.5 CSBM per week (FC; 1.53, P < 0.0001, IBS-C; 1.73, P = 0.0003) and significantly improved measures of GI comfort (GI symptom rating scale total score) in constipated participants (FC, P < 0.0001; IBS-C, P < 0.0001).

Conclusion: This study provides original evidence that the consumption of a fresh whole fruit has demonstrated clinically relevant increases in CSBM and improved measures of GI comfort in constipated populations. Green kiwifruits are a suitable dietary treatment for relief of constipation and associated GI comfort.

Financial support: Zespri International Ltd. was the principal sponsor and reviewed, approved, and funded the study design. The New Zealand study center trial was jointly funded by a grant from the New Zealand government (Contract C11X1312) and the sponsor company, Zespri International Ltd. In Italy and Japan, Zespri International Ltd. was the sole funder for each study center trial. The funder did not contribute to the study design or data analysis.

Potential competing interests: J.A. and P.B. are employed by Zespri International who part-funded the study. R.G. and L.D. sit on the Science Advisory Board, have received travel and research grants from Zespri International. SF and GB have received research travel grants from Zespri International.

Comment:  Can you guess what Zespri International sells?  Go on.  Take a wild guess.  I’ll admit it.  I’d go for kiwi over psyllium every time.  But we are talking here about an average improvement of 1.5 bowel movements a week, which may or may not be clinically meaningful..  I do give the authors credit for claiming a benefit for “fresh whole fruit,” not specifically kiwifruit.  The study didn’t compare kiwi to other fruits (and why would it, given the kiwi fruit sponsor).  But overall, this is yet another study done for marketing far more than scientific purposes.

May 22 2023

Industry-funded study of the week: Exercise!

My thanks to Arun Gupta for sending this one from a newspaper in India.

The clipping refers to this article.

  • The study: Ostendorf, D.M., Schmiege, S.J., Conroy, D.E. et al.Motivational profiles and change in physical activity during a weight loss intervention: a secondary data analysis.Int J Behav Nutr Phys Act18, 158 (2021). https://doi.org/10.1186/s12966-021-01225-5.
  • First sentence : “High levels of moderate-to-vigorous physical activity (MVPA) are strongly associated with sustained weight loss [12], and current guidelines recommend high levels of PA for weight management .”
  • Methods: Participants were asked to follow a weight-loss diet and to do 300 minutes per week of exercise.  The investigators lstudies participants’ motivation levels.
  • Conclusion: once exercise supervision and support was removed, adults in the high autonomous motivational profile were protected against the standard attenuation in MVPA following removal of support/supervision.
  • Competing interests: “The results of this study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. DC reports consulting income from Gelesis, Inc., a company that has developed a weight loss device.  SP has a grant from WW International [formerly, Weight Watchers] unrelated to this work.”

Comment: As far as I can tell, the paper says nothing about exercise being more important than diet.  The study didn’t find any differences in weight among people with different levels of motivation.  We can’t blame the authors for the press account.    But anything that minimizes the need for dietary changes gets pounced on.  Alas.

May 16 2023

Dietary Guidelines Advisory Committee: conflict of interest disclosed, sort of

In a strange partnership, the Nutrition Coalition and the Center for Science in the Public Interest (CSPI) are jointly complaining about the way the USDA and HHS have “disclosed” conflicts of interest among members of the 2025-2030 Dietary Guidelines Advisory Committee.

Why strange?  Because the Nutrition Coalition has long urged relaxations on advice about dietary fat, whereas CSPI has long urged restrictions.

Why “disclosed” in quotes?  Because the agencies’ disclosure statement lists the combined conflicts for the entire group, not for individual members of the committee.

Here’s the committee, courtesy of a tweet from Christopher Gardner.

Here is a small part of what the disclosure list looks like.

 

 

 

 

 

 

 

 

Because these are all jumbled together, you have to look hard to pull out the genuine conflicts—-relationships of committee members with food companies with vested interests in the outcome of the guidelines.

The Nutrition Coalition points out that USDA and HHS are failing to:

  • Comply with a National Academies of Science report calling for publicly posting financial and nonfinancial biases and conflicts of interest of committee members.
  • Fully adopt the National Academies’ 11 recommendations.
  • Recognize the significance of the first-ever systematic review of a DGAC’s financial ties. This review found 95% of the 2020 DGAC members had at least one tie with a food or pharmaceutical company and half had 30 such ties or more.

In its statement, CSPI says that it, the Coalition, and 13 other groups are calling on the federal government to disclose potential financial conflicts of interest, including sources of research funding, speakers’ fees, and other relationships.

Press coverage, the statement says, “has already uncovered one 2025 Dietary Guidelines Advisory Committee member with a conflict of interest that seems relevant to their role.”

Comment:  I agree that the credibility of the committee and the guidelines depends on transparency, but it’s hard to know how much of a problem this is.

I wanted to compare the disclosure list to the research questions set by the agencies for the committee, but I can no longer find them online.

This reminds me that’s it’s hard to know how much influence the committee will have, in any case, now that the agencies set the research questions and write the actual guidelines.

The advisory committee is just that, advisory.  The agencies do not have to take its advice.

I will be following this closely.  Stay tuned.

Additions, May 17 (thanks to Jerry Mande)

 

May 14 2023

Industry-funded study of the week: cereals!

Thanks to reader Maira Bes-Rastrollo at the University of Navarra in Spain (and whose work I greatly admire) for this one.

The Relationship of Ready-to-eat Cereal Intake and Body Weight in Adults: A Systematic Review of Observational Studies and Controlled Trials.   Lisa M Sanders, Mary R. Dicklin, Yong Zhu, Kevin C. Maki.  Advances in Nutrition https://doi.org/10.1016/j.advnut.2023.05.001

Objective: to evaluate the effect of RTEC [Ready to eat cereals] intake on body weight outcomes in observational studies and RCTs [randomized clinical trials] in adults.

Methods: A search of PubMed and CENTRAL databases yielded 28 relevant studies, including 14 observational studies and 14 RCTs.

Results: Results from observational studies demonstrate that frequent RTEC consumers (usually ≥4 servings/week) have lower BMI, lower prevalence of overweight/obesity, less weight gain over time, and less anthropometric evidence of abdominal adiposity compared to non-consumers, or less frequent consumers.

Conclusion: RTEC intake is associated with favorable body weight outcomes in adults in observational studies. RTEC does not hinder weight loss when used as a meal or snack replacement within a hypocaloric diet.

Support: This research was supported by Bell Institute of Health and Nutrition, General Mills, Inc. The funding sponsor provided comments on early aspects of the study design, reviewed the final data, and provided input to the manuscript.

Conflicts of Interest: LMS is a consulting scientist and MRD and KCM are employees of Midwest Biomedical Research which has received research funding from General Mills, Inc. and Kellogg Company. LMS has received funding from Kellogg Company. YZ is an employee of General Mills, Inc.
Comment:  This is an industry-sponsored, designed, influenced, if not conducted, and written study with one goal: to make you believe that eating breakfast cereal is better than any other breakfast choice.  If a Journal of Industry-Funded Marketing Studies existed, this paper belongs right there.  I don’t often see examples as straightforward as this one, and didn’t want you to miss it.
May 8 2023

Industry-funded study of the week: Pasta!

Thanks to reader Thijs van Rens for sending this one, and apologies for the delay in getting to it.

This one comes from The Conversation back in January: Stop hating on pasta – it actually has a healthy ratio of carbs, protein and fat.

Its author writes about the benefits of pasta.

The ratio of carbs to protein in pasta is 38g to 7.7g, which equates to roughly a 5:1 ratio, well within the acceptable macronutrient distribution range. Meaning pasta actually has enough protein to balance with the carbohydrates…But pasta…also has micronutrients.

One cup of cooked pasta has about a quarter of our daily recommended intakes of vitamins B1 and B9, half the recommended intake of selenium, and 10% of our iron needs.

The news for pasta gets even better when we eat it as leftovers. When pasta is cooked and cooled, some of the carbohydrates convert to resistant starch. This starch gets its name from being resistant to digestion, so it contributes less energy and is better for blood sugar levels.

Funding: The author reports having “received funding for research or consulting from Mars Foods, Nutrition Research Australia, NHMRC, ARC, AMP Foundation, Kellogg, and the University of Newcastle.

Her article refers to: A systematic review on the relations between pasta consumption and cardio-metabolic risk factors.

Conclusion: Pasta meals have significantly lower postprandial glucose response than bread or potato meals,

Funding: American Heart Association, National Institute of Health, Barilla [the pasta maker!].

Comment

I love pasta, in moderation of course and with something this caloric, moderation is useful.  What’s going on here is a defense against rapidly absorbable carbohydrates which quickly convert to sugars.  I don’t necessarily disagree with the facts here; it’s the industry-funded distraction from calories that troubles.  It’s good that the authors disclosed their industry connections.

May 1 2023

American Society for Nutrition commissions highly conflicted meta-analysis

I was surprised to see a press release from the American Society for Nutrition (ASN—of which I am a member) announcing publication of a research paper the Society had commissioned and published on sugars and body weight: Important food sources of fructose-containing sugars and adiposity: a systematic review and meta-analysis of controlled feeding trials.

The paper, the press release said, “Illustrate[s] The Need for Nuance in Public Health Guidance Related to Consumption of Sugars: Findings call into question recommendations that imply all sources of fructose-containing sugars carry the same risk.

The press release notes that “this comprehensive review is timely as the 2025 Dietary Guidelines Advisory Committee currently assesses the latest science to inform updated evidence-based recommendations,” and it quotes the lead author: “There is an opportunity for more food-based guidance around sugars to help ensure Americans don’t inadvertently eat less health-promoting foods containing fructose – especially at a time when most people don’t eat enough of all forms of fruit, which offer significant health benefits.”

Uh oh.  This is an easily misinterpreted message.

My immediate question:  Who wrote the paper ?

No surprise.: authors with extensive conflicts of interest.

I’ve written about some of these authors’ conflicts of interest disclosures previously.  See, for example. this, this, and this.

Just for fun, I’ll post this particular statement of the conflicted interests at the end of this post.

Basically, these authors do not understand the difference between a conflict of interest (financial ties, which are discretionary) and non-discretionary viewpoints (all researchers have them).  In this case, consulting for a sugar company is a conflict; being a vegan or avoiding sugar-sweetened beverages is not.

My second question: Why did ASN commission this paper, and from these particular authors no less?

I contacted John Courtney, the long-time executive director of the ASN.  He said this was a leftover from an initiative started ten years ago.  Since then, the ASN has decided not to commission papers on controversial topics and this will not happen again.

Good.  It shouldn’t.  Commissioning papers like these make the ASN look like an arm of the food industry.  The ASN should avoid even teh appearance of conflicts of interest as much as it possibly can.

You don’t believe this is a problem?  Take a look at this conflict of interest statement.  Enjoy!

Conflict of Interest

JLS is a member of the Journal’s Editorial Board and played no role in the Journal’s evaluation of the manuscript.

LC was a Mitacs-Elevate postdoctoral fellow jointly funded by the Government of Canada and the Canadian Sugar Institute (September 2019–August 2021). She was previously (2010–2018) employed as a casual clinical coordinator at INQUIS Clinical Research, Ltd. (formerly Glycemic Index Laboratories, Inc.), a contract research organization.

AC and AA have received funding from a Toronto 3D MSc Scholarship award.

SA-C was funded by a Canadian Institutes of Health Research (CIHR) Canadian Graduate Scholarships Master’s Award, the Loblaw Food as Medicine Graduate Award, the Ontario Graduate Scholarship, and the CIHR Canadian Graduate Scholarship Doctoral Award. She avoids consuming NSBs and SSBs and has received an honorarium from the international food information council (IFIC) for a talk on artificial sweeteners, the gut microbiome, and the risk for diabetes.

NM was a former employee of Loblaw Companies Limited and current employee of Enhanced Medical Nutrition. She has completed consulting work for contract research organizations, restaurants, start-ups, the International Food Information Council, and the American Beverage Association, all of which occurred outside of the submitted work.

TAK has received research support from the Canadian Institutes of Health Research (CIHR), the International Life Science Institute (ILSI), and the National Honey Board. He has taken honorarium for lectures from International Food Information Council (IFIC) and Institute for the Advancement of Food and Nutrition Sciences (IAFNS; formerly ILSI North America).

FA-Y is a part-time Research Assistant at INQUIS Clinical Research, Ltd., a contract research organization.

DL reports receiving a stipend from the University of Toronto Department of Nutritional Sciences Graduate Student Fellowship, University of Toronto Fellowship in Nutritional Sciences, University of Toronto Supervisor’s Research Grant—Early Researcher Awards, and Dairy Farmers of Canada Graduate Student Fellowships; a scholarship from St. Michael’s Hospital Research Training Centre, and a University of Toronto School of Graduate Studies Conference Grant.

AZ is a part-time Research Associate at INQUIS Clinical Research, Ltd., a contract research organization, and has received funding from a BBDC Postdoctoral Fellowship. She has received consulting fees from the GI found.

RJdS has served as an external resource person to the World Health Organization’s Nutrition Guidelines Advisory Group on transfats, saturated fats, and polyunsaturated fats. The WHO paid for his travel and accommodation to attend meetings from 2012–2017 to present and discuss this work. He has also performed contract research for the CIHR’s Institute of Nutrition, Metabolism, and Diabetes, Health Canada, and the World Health Organization for which he received remuneration. He has received speaker’s fees from the University of Toronto and McMaster Children’s Hospital. He has held grants from the Canadian Foundation for Dietetic Research, Population Health Research Institute, and Hamilton Health Sciences Corporation as a principal investigator and is a co-investigator on several funded team grants from the CIHR. He has served as an independent director of the Helderleigh Foundation (Canada). He serves as a member of the Nutrition Science Advisory Committee to Health Canada (Government of Canada) and is a co-opted member of the Scientific Advisory Committee on Nutrition Subgroup on the Framework for the Evaluation of Evidence (Public Health England).

TMSW was previously a part owner and now is an employee of INQUIS and received an honorarium from Springer/Nature for being an Associate Editor of the European Journal of Clinical Nutrition.

CWCK has received grants or research support from the Advanced Food Materials Network, Agriculture and Agri-Foods Canada, Almond Board of California, Barilla, CIHR, Canola Council of Canada, International Nut and Dried Fruit Council, International Tree Nut Council Research and Education Foundation, Loblaw Brands Ltd, the Peanut Institute, Pulse Canada, and Unilever. He has received in-kind research support from the Almond Board of California, Barilla, California Walnut Commission, Kellogg Canada, Loblaw Companies, Nutrartis, Quaker (PepsiCo), the Peanut Institute, Primo, Unico, Unilever, and WhiteWave Foods/Danone. He has received travel support and/or honoraria from the Barilla, California Walnut Commission, Canola Council of Canada, General Mills, International Nut and Dried Fruit Council, International Pasta Organization, Lantmannen, Loblaw Brands, Ltd., the Nutrition Foundation of Italy, Oldways Preservation Trust, Paramount Farms, the Peanut Institute, Pulse Canada, Sun-Maid, Tate & Lyle, Unilever, and White Wave Foods/Danone. He has served on the scientific advisory board for the International Tree Nut Council, the International Pasta Organization, McCormick Science Institute, and Oldways Preservation Trust. He is a founding member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD and is a Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation.

DJAJ has received research grants from Saskatchewan & Alberta Pulse Growers Associations, the Agricultural Bioproducts Innovation Program through the Pulse Research Network, the Advanced Foods and Material Network, Loblaw Companies, Ltd., Unilever Canada and Netherlands, Barilla, the Almond Board of California, Agriculture and Agri-food Canada, Pulse Canada, Kellogg’s Company, Canada, Quaker Oats, Canada, Procter & Gamble Technical Centre, Ltd., Bayer Consumer Care, Pepsi/Quaker, International Nut & Dried Fruit Council, Soy Foods Association of North America, the Coca-Cola Company (investigator initiated, unrestricted grant), Solae, Haine Celestial, the Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Soy Nutrition Institute (SNI), the Canola and Flax Councils of Canada, the Calorie Control Council, the CIHR, the Canada Foundation for Innovation and the Ontario Research Fund. He has received in-kind supplies for trials as a research support from the Almond Board of California, Walnut Council of California, the Peanut Institute, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, and WhiteWave Foods. He has been on the speaker’s panel, served on the scientific advisory board and/or received travel support and/or honoraria from Nutritional Fundamentals for Health (NFH)-Nutramedica, Saint Barnabas Medical Center, The University of Chicago, 2020 China Glycemic Index International Conference, Atlantic Pain Conference, Academy of Life Long Learning, the Almond Board of California, Canadian Agriculture Policy Institute, Loblaw Companies, Ltd., the Griffin Hospital (for the development of the NuVal scoring system), the Coca-Cola Company, Epicure, Danone, Diet Quality Photo Navigation, Better Therapeutics (FareWell), Verywell, True Health Initiative, Heali AI Corp, Institute of Food Technologists, SNI, Herbalife Nutrition Institute, Saskatchewan & Alberta Pulse Growers Associations, Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Herbalife International, Pacific Health Laboratories, Barilla, Metagenics, Bayer Consumer Care, Unilever Canada and Netherlands, Solae, Kellogg, Quaker Oats, Procter & Gamble, Abbott Laboratories, Dean Foods, the California Strawberry Commission, Haine Celestial, PepsiCo, the Alpro Foundation, Pioneer Hi-Bred International, DuPont Nutrition and Health, Spherix Consulting and WhiteWave Foods, the Advanced Foods and Material Network, the Canola and Flax Councils of Canada, Agri-Culture and Agri-Food Canada, the Canadian Agri-Food Policy Institute, Pulse Canada, the Soy Foods Association of North America, the Nutrition Foundation of Italy, Nutra-Source Diagnostics, the McDougall Program, the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society, the American Society of Nutrition, Arizona State University, Paolo Sorbini Foundation, and the Institute of Nutrition, Metabolism and Diabetes. He received an honorarium from the United States Department of Agriculture to present the 2013 W.O. Atwater Memorial Lecture. He received the 2013 Award for Excellence in Research from the International Nut and Dried Fruit Council. He received funding and travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association. He is a member of the ICQC. His wife, Alexandra L Jenkins, is a director and partner of INQUIS Clinical Research for the Food Industry. His 2 daughters, Wendy Jenkins and Amy Jenkins, have published a vegetarian book that promotes the use of the foods described in this study, The Portfolio Diet for Cardiovascular Risk Reduction (Academic Press/Elsevier 2020 ISBN:978-0-12-810510-8). His sister, Caroline Brydson, received funding through a grant from St. Michael’s Hospital Foundation to develop a cookbook for 1 of his studies. He is also a vegan. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of health Research (CIHR), Diabetes Canada, American Society for Nutrition (ASN), International Nut and Dried Fruit Council (INC) Foundation, National Honey Board [the US Department of Agriculture (USDA) honey “Checkoff” program], Institute for the Advancement of Food and Nutrition Sciences (IAFNS), Pulse Canada, Quaker Oats Center of Excellence, The United Soybean Board (the USDA soy “Checkoff” program), The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), The Plant Protein Fund at the University of Toronto (a fund that has received contributions from IFF), and The Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council). He has received food donations to support randomized controlled trials from the Almond Board of California, California Walnut Commission, Peanut Institute, Barilla, Unilever/Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, WhiteWave Foods/Danone, Nutrartis, Soylent, and Dairy Farmers of Canada. He has received travel support, speaker fees, and/or honoraria from ASN, Danone, Dairy Farmers of Canada, FoodMinds LLC, Nestlé, Abbott, General Mills, Comité Européen des Fabricants de Sucre, Nutrition Communications, International Food Information Council, Calorie Control Council, the International Sweeteners Association, the International Glutamate Technical Committee, Phynova, and Brightseed. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, Phynova, and INQUIS Clinical Research. He is a former member of the European Fruit Juice Association Scientific Expert Panel and a former member of the Soy Nutrition Institute (SNI) Scientific Advisory Committee. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study of Diabetes, Canadian Cardiovascular Society, and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons. He serves or has served as an unpaid member of the Board of Trustees and an unpaid scientific advisor for the Carbohydrates Committee of IAFNS. He is a member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His spouse is an employee of AB InBev.

XYQ, SB, NM, VH, EL, SBM, VLC, and LAL declare no competing interests.

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