Currently browsing posts about: Sponsored-research

The study: Recent Research on the Health Benefits of Blueberries and Their Anthocyanins.   Wilhelmina Kalt, Aedin Cassidy, Luke R Howard, Robert Krikorian, April J Stull, Francois Tremblay,Raul Zamora-Ros.   Advances in Nutrition, nmz065, https://doi.org/10.1093/advances/nmz065

Abstract conclusion: More evidence, and particularly human clinical evidence, is needed to better understand the potential for anthocyanin-rich blueberries to benefit public health. However, it is widely agreed that the regular consumption of tasty, ripe blueberries can be unconditionally recommended.

Overall conclusion:  It can be safely stated that daily moderate intake (50 mg anthocyanins, one-third cup of blueberries) can mitigate the risk of diseases and conditions of major socioeconomic importance in the Western world.

Funding: The United States Highbush Blueberry Council (USHBC) offered support for this article by providing an honorarium to each author but had no role in the design and conduct of the review.  Author disclosures: AC, LRH, RZ-R, no conflicts of interest. AC acts as an advisor to the USHBC grant committee and has received research support from the USHBC. RK, WK, AJS, and FT have received research funding from the USHBC and have no conflict of interest.

Comment:  This is a literature review.  The USHBC paid the authors to write it.  That makes this article a paid advertisement for blueberries.  Why the authors think they have no conflict of interest in taking the money to write this is beyond me.  We can ask why the USHBC thinks this kind of “study” is needed.  Of course blueberries are recommended.  They are a fruit and all fruits are recommended.  The USHBC wants you to think that blueberries are especially beneficial, but that can be said of any fruit.  Not all fruits have sponsors paying for articles, however.

JOURNALS OF GERONTOLOGY: SPECIAL SECTION: AGING AND BLUEBERRIES (thanks to Bradley Flansbaum for sending)

The papers in this series were supported in one way or another by one or another blueberry trade associations.

• Blue Versus Gray: Potential Health Benefits of Blueberries for Successful Aging.  Donald K Ingram, PhD.  The Journals of Gerontology: Series A, Volume 74, Issue 7, July 2019, Pages 965–966. Sponsored by the Wild Blueberry Association of North America.
• Circulating Anthocyanin Metabolites Mediate Vascular Benefits of Blueberries: Insights From Randomized Controlled Trials, Metabolomics, and Nutrigenomics :  Ana Rodriguez-Mateos, et al.  The Journals of Gerontology: Series A, Volume 74, Issue 7, July 2019, Pages 967–976. This work was supported by the Medical Research Committee of the University of Düsseldorf (9772574) and by an unrestricted grant from the Wild Blueberry Association of North America. ARM and CH have received unrestricted research grants from the Wild Blueberry Association of North America. The other authors declare no conflicts of interests.
• Blueberries Improve Neuroinflammation and Cognition differentially Depending on Individual Cognitive baseline Status.  Barbara Shukitt-Hale, et al. The Journals of Gerontology: Series A, Volume 74, Issue 7, July 2019, Pages 977–983.  This research was supported by USDA Intramural funds. The blueberry powder used in this study was provided at no cost under a Material Transfer Agreement between the USDA and the U.S. Highbush Blueberry Council (USHBC). 
• Systematic Review of the Effects of Blueberry on Cognitive Performance as We Age .  Sabine Hein, et al. The Journals of Gerontology: Series A, Volume 74, Issue 7, July 2019, Pages 984–995.This work was supported by an unrestricted grant from the Wild Blueberry Association of North America.
• Polyphenols From Grape and Blueberry Improve Episodic Memory in Healthy Elderly with Lower Level of Memory Performance: A Bicentric Double-Blind, Randomized, Placebo-Controlled Clinical Study  Julien Bensalem, et al. The Journals of Gerontology: Series A, Volume 74, Issue 7, July 2019, Pages 996–1007.  This work is part of the Neurophenols project. The specific aims of the program are to characterize and formulate fruit extracts from grape and blueberry and to evaluate their safety and efficacy in pre-clinical and clinical trials. Neurophenols Industry partners, some of which sell ingredients derived from grapes and blueberries, are listed here.

Comment: The introductory paper in this series explains what it is about: “The epidemiological evidence is strong and convincing regarding the health benefits of a diet rich in fruits and vegetables to ward off age-related diseases. However, what about individual foods?”  What about them?  I love blueberries but are they really better for older adults than raspberries, strawberries, or peaches, for that matter?  Variety is still a basic principle of nutrition.  Enjoy your fruit bowl.

A low-fat spread with added plant sterols and fish omega-3 fatty acids lowers serum triglyceride and LDL-cholesterol concentrations in individuals with modest hypercholesterolaemia and hypertriglyceridaemia.  Blom AM, et al.  European Journal of Nutrition.  2019;58(4):1615–1624.

Purpose: “to investigate the triglyceride (TG) and LDL-cholesterol (LDL-C) lowering effects of a spread [i.e., margarine] with added plant sterols (PS) and fish oil as compared to a placebo spread.”

Conclusions: “Four-week consumption of the intervention spread led to significant and clinically relevant decreases in serum TG, LDL-C and other blood lipid concentrations.”

Funder: The study was funded by Unilever BCS Research and Development Vlaardingen, the Netherlands.

Conflicts of interest: of the authors, four are employed by Unilever.

Comment: Unilever makes margarines with plant sterols and fish oils.  You might buy them if they control blood lipid risk factors for heart disease.  This is in-house company research aimed at proving the benefits of a Unilever product, which is what so many other companies do.

But Unilever was one of the few Big Food companies that sponsored basic research (and maybe it still does?).  As I describe in my book, Unsavory Truth, Unilever was the sponsor of the basic research that demonstrated the harmful effects of trans-fat on disease risk.

I spotted some tweets about this study from Washington Post writer Tamar Haspel, who has a sharp eye for this sort of thing.  Her first tweet said:

Her second tweet explained the problem:

So of course I had to look up the study.  It’s not one I would ordinarily have noticed because its title does not use the word “probiotic,” which typically refers to the live bacteria (in yogurt, for example).  The evidence for benefits of probiotics is iffy, so this study raises lots of questions.

Let’s take a look at it:

The Study:  Supplementation with Akkermansia muciniphila in overweight and obese human volunteers: a proof-of-concept exploratory study. Depommier C, et al.  Nature Medicine (2019) Letter | Published: 01 July 2019.

Conclusion: I’ve left out the statistics to make this easier to read:  “Compared to placebo, pasteurized A. muciniphila improved insulin sensitivity…, and reduced insulinemia…and plasma total cholesterol…. Pasteurized A. muciniphila supplementation slightly decreased body weight…compared to the placebo group, and fat mass…and hip circumference…compared to baseline….In conclusion, this proof-of-concept study…shows that the intervention was safe and well tolerated and that supplementation with A. muciniphila improves several metabolic parameters.”

Competing interests:  Five of the authors “are inventors of patent applications…filed with [patent offices in at least 12 countries]…dealing with the use of A. muciniphila and its components in the context of obesity and related disorders.” Two of the authors are cofounders of A-Mansia Biotech S.A., a Belgian company that sells A. muciniphila supplements, presumably as weight-loss supplements.

Comment: As Haspel points out, the subjects in this study were given either (a) live bacteria, (b) Pasteurized (and, therefore, mostly dead) bacteria, or (c) a placebo.  The Pasteurized ones were associated with metabolic benefits and weight loss.  Pasteurization is what gets done to milk to kill most—not all—of the living bacteria it contains.  In this study, Pasteurized bacteria had the same effect on the microbiome as the unpasteurized.  The point of the study was to show that the Pasteurized supplement would induce weight loss; the observed loss, however, was not statistically significant.   Nature Medicine‘s editors should know better.  So should the New York Times’ editors.  Haspel points out that the New York Times account of the study accepted its conclusion uncritically, headlining it “A Probiotic for Obesity?”  At least the headline included a question mark.  The article did not mention the authors’ patents or conflicts of interest; it should have.

Bottom line: If you want to keep your microbiome healthy, eat a healthy diet.

The study: Using the Avocado to Test the Satiety Effects of a Fat-Fiber Combination in Place of Carbohydrate Energy in a Breakfast Meal in Overweight and Obese Men and Women: A Randomized Clinical Trial.  Zhu L, et al.  Nutrients 2019, 11, 952; doi:10.3390/nu11050952.

Conclusions: Replacing carbohydrates in a high-carbohydrate meal with avocado-derived fat-fiber combination increased feelings of satiety mediated primarily by PYY [peptide YY] vs. insulin. These findings may have important implications for addressing appetite management and metabolic concerns.

Funding: This research was supported by the Hass Avocado Board, Irvine, CA, USA.

Comment: Why does the Hass Avocado Board fund studies like this?  Because it generates headlines like this one: “Study finds avocados curb appetite and help with weight loss.”

Oops.  This is not what the study actually found.  As I learned from Obesity and Energetics Offerings (an exceptionally useful weekly compendium of articles having to do with energy balance), the discrepancy between what the study’s findings and what got reported merited its inclusion in OEO’s “Headline vs. Study” category.

• Headline: Study finds avocados curb appetite and help with weight loss.
• Study: This was a 6-hour RCT [randomized clinical trial] demonstrating effects on short-term reports of hunger – neither effects on actual food intake nor on body weight were studied.

Sponsored research is often about headlines, not science.

It’s also about advertising.  Here’s an ad that the Hass Avocado people sent out to all members of the Academy of Nutrition and Dietetics.  Although the Academy noted this was an advertisement, here’s what it looked like (thanks to my colleague Lisa Sasson for sending):

I love avocados but wish the Hass people would stick with how delicious they are and fund research on something more useful, like resistance to pests or climate change, maybe.

No such luck.  Here’s the request for proposals I just received:

Replacing Saturated Fat With Walnuts or Vegetable Oils Improves Central Blood Pressure and Serum Lipids in Adults at Risk for Cardiovascular Disease: A Randomized Controlled‐Feeding Trial.  Alyssa M. Tindall, et al. Journal of the American Heart Association. 2019;8:May 7, 2019.

Conclusions: “Replacing saturated fatty acids (FAs) with 57 to 99 g/d of walnuts for 6 weeks reduced central diastolic blood pressure compared with a diet similarly low in saturated FAs but with lower α‐linolenic acid content…This study represents a feasible food‐based approach for replacing saturated FAs with unsaturated FAs (including α‐linolenic acid) from walnuts and vegetable oils, demonstrating that relatively small dietary changes can reduce cardiovascular risk.

Funding: This study was funded by the California Walnut Commission…The California Walnut Commission provided funds for the research conducted. The commission’s staff was not involved with any aspects of conducting the study, analyzing the data, or interpreting the results reported in this article.

Comment: Walnuts, like pretty much all other nuts and seeds, contain healthy fats and other nutrients.  When substituted for unhealthier foods, they would be expected to demonstrate improvements.  This study contributes no new information and there is only one reason to do it: marketing (as I discuss in Unsavory Truth).  The California Walnut Commission wants you to eat more walnuts.  Trade associations or producers of pecans, macadamia nuts. pistachios, almonds, peanuts, hazelnuts, and any other nut you can think of have the same goal.  Do they all have to do this kind of research?  Apparently so.

Mixed nuts, anyone?

You may think, as I do, that everyone would be better off eating less sugar, but that’s not how The Sugar Association sees it.  This trade association for sugar producers funds research to demonstrate that eating sugar is a good thing and not harmful.

Here’s what The Sugar Association says:

The Sugar Association is committed to transparent engagement with researchers, external partners and consumers to address knowledge gaps and support independent, peer-reviewed science. Recent literature suggests this framework, rooted in transparency and communication and reflected in our Operating Principles, leads to increased public confidence in industry-funded research,* a goal the organization is working to achieve.

The asterisk refers to Achieving a transparent, actionable framework for public-private partnerships for food and nutrition research, a consensus report written by, among others, representatives of the International Life Sciences Institute, a well known front group for the food industry, and other organizations with ties to food companies.

The Sugar Association lists some of its recent publications [you can’t make this stuff up]:

• Bakke AJ, Stubbs CA, McDowell EH, Moding KJ, Johnson SL, Hayes JE. Mary Poppins was right: Adding small amounts of sugar or salt reduces the bitterness of vegetables. Appetite. 2018. doi: 10.1016/j.appet.2018.03.015. [Mary Poppins was talking about medicine, not vegetables: “Just a spoonful of sugar helps the medicine go down, In a most delightful way.”]
• Bailey RL, Fulgoni VL, Cowan AE, Gaine PC. Sources of Added Sugars in Young Children, Adolescents, and Adults with Low and High Intakes of Added Sugars. Nutrients. 2018;10(1):102.

Nutrition Today Supplement: Sweet Taste Perception and Feeding Toddlers. March/April 2017 – Volume 52 [The Sugar Association funded the conference that resulted in this supplement, which it also funded].

• Dwyer JT. Good Nutrition in Toddlers. Nutrition Today. 2017;52(2):S1-S2.5.
• Bailey RL, Barr SI. Introduction: Sweet Taste Perception and Feeding Toddlers. Nutrition Today. 2017;52(2):S3-S5.
• Achterberg C. A Perspective: Toddler Feeding, Science, and Nutrition Policy. Nutrition Today. 2017;52(2):S6-S13.
• Kleinman RE, Greer F, Cowart BJ, et al. Roundtable Proceedings: The Role of Innate Sweet Taste Perception in Supporting a Nutrient-Dense Diet for Toddlers, 12 to 24 Months Old. Nutrition Today. 2017;52(2):S14-S24. [Kleinman is co-chair of the 2020 Dietary Guidelines Advisory Committee]
• Murray RD. Influences on the Initial Dietary Pattern Among Children From Birth to 24 Months. Nutrition Today. 2017;52(2):S25-S29.Johnson SL, Hayes JE. Developmental Readiness, Caregiver and Child Feeding Behaviors, and Sensory Science as a Framework for Feeding Young Children. Nutrition Today. 2017;52(2):S30-S40.
• Hayes JE, Johnson SL. Sensory Aspects of Bitter and Sweet Tastes During Early Childhood.Nutrition Today. 2017;52(2):S41-S51.
• Moshfegh AJ, Rhodes DG, Goldman JD, Clemens JC. Characterizing the Dietary Landscape of Children, 12 to 35 Months Old. Nutrition Today. 2017;52(2):S52-S59.
• Welsh JA, Figueroa J. Intake of Added Sugars During the Early Toddler Period. Nutrition Today. 2017;52(2):S60-68.
• Palmer CA. Oral and Dental Health Considerations in Feeding Toddlers. Nutrition Today. 2017;52(2):S69-S75.

Ray Goldberg, Harvard Business School Professor of Agribusiness, Emeritus, but still running a seminar that I have attended annually for about 25 years, often challenges me to think more constructively about how food businesses should respond to pressures from public health advocates. His 2018 book, Food Citizenship (for which I was interviewed and videotaped) illustrates some of the back-and-forth we have had over the years.

Recently, in response to my “industry-funded study of the week” posts, he sent me several thought-provoking questions, which I respond to here with his permission.

RG: How can the private sector support nutrition research without being accused of a conflict of interest?

MN: With great difficulty. Industry-sponsored research is inherently conflicted when research questions are designed for marketing purposes, which much—if not most—industry-sponsored research now is. Such research almost invariably produces results that favor the sponsor’s interests. As I explain in Unsavory Truth, I get letters all the time from trade associations requesting proposals for research projects to demonstrate the benefits of the products they represent. There is a big difference between designing a study to demonstrate benefits (a marketing question) and one asking an open-ended what-happens question (basic research). If companies want to fund basic research, they could contribute to a common pool administered by an independent third party such as the NIH. But food companies don’t want to take the risk of paying for research that might come out with inconvenient results. In my book, I suggest taxing food companies to create a research fund that would be administered independently. That’s the only way I can think of that would work.

RG: How does the consumer end up having confidence in the statements of those in the food system who really do have integrity and who really care about their customers and society and the environment? I trust the Wegmans because I know them personally. How does the Food System build back trust?

MN: It’s interesting that you mention Wegmans (I often shop in the one in Ithaca). It is a family-owned business, not publicly traded. I recall hearing Danny Wegman explain the advantage of family ownership at one of your seminars. It’s not that family members don’t want to make money; it’s that they don’t have to be greedy .  They can do things for their customers that publicly traded supermarkets cannot. As long as Wall Street expects food companies to make a profit and to grow their profits every 90 days, companies must respond by pushing their most highly profitable products every way they can, regardless of whether poor health is collateral damage. If companies want the public to trust them, they have to be trustworthy.  But investors don’t reward integrity; they reward profits.

RG: The food system needs people who care about the health of people, plants, animals and our environment but who is providing the leadership that you and others want in that system?

MN: If they want to sell products, large food product companies (Big Food) has to appeal to public demands for health and sustainability.  They are trying to move the Titanic as quickly as they can and still maintain the same profit margins. Big Ag is way behind. I’m seeing a worldwide consensus that we need food system approaches to solve world food problems.  These firmly link agricultural policy to health and environmental policy so as to address hunger, obesity, and climate change. at the same time.  A largely, but not necessarily exclusively, plant-based diet does that and it’s what all food policies should promote.  At the moment, American agriculture and dietary guidelines are outliers in ignoring those linkages. We badly need to catch up.  I see international leadership on this issue, but not here.  Is Harvard training food business leaders to address these needs?  You tell me where the American leadership is. I don’t see it coming from the top.  It has to be bottom up.  Fortunately, lots of young people are interested in food issues and the leadership is going to have to come from them.

Seafood intake and the development of obesity, insulin resistance and type 2 diabetes.  Bjorn Liaset, Jannike Øyen, Hélène Jacques, Karsten Kristiansen and Lise Madsen. Nutrition Research Reviews (2019), 32, 146–167.

Conclusion: Evidence from intervention trials and animal studies suggests that frequent intake of lean seafood, as compared with intake of terrestrial meats, reduces energy intake by 4–9%, sufficient to prevent a positive energy balance and obesity. At equal energy intake, lean seafood reduces fasting and postprandial risk markers of insulin resistance, and improves insulin sensitivity in insulin-resistant adults… More studies are needed to confirm the dietary effects on energy intake, obesity and insulin resistance.”

Funding: The present review was financially supported by The Norwegian Seafood Research Fund…The authors declare that they have no competing interests.

Comment:  It is understandable that the Norwegian seafood industry would support research to promote seafood consumption.  Seafood is a demonstrably good source of animal protein but how good, how essential, and how environmentally sustainable are highly debatable.  To the authors’ credit, they acknowledge the debate when they admit that “more studies are needed….”  Industry-funded studies tend to put a positive spin on equivocal research, as this one does [I provide evidence for these views in Unsavory Truth].