Currently browsing posts about: Conflicts-of-interest

Thanks again to Jim Krieger of Healthy Food America for sending this one.

The study: Sievenpiper JL, Purkayastha S, Grotz VL, Mora M, Zhou J, Hennings K, Goody CM, Germana K. Dietary Guidance, Sensory, Health and Safety Considerations When Choosing Low and No-Calorie Sweeteners [LNCSs]. Nutrients. 2025 Feb 25;17(5):793. doi: 10.3390/nu17050793.

The greater sweetness intensity of LNCSs compared to sucrose allows for the use of lesser amounts to achieve a similar level of sweetness, facilitating a reduction in an individual’s caloric and sugar consumption. Furthermore, the substitution of LNCSs for sugar supports individual and public health outcomes by addressing issues related to obesity, diabetes, and chronic illnesses…Lastly, emerging evidence from in vitro and a randomized controlled trial have investigated food intake and satiety management and suggests that natural LNCSs may be beneficial…The diverse range of LNCSs available in global food and beverage choices, coupled with their varying sweetness intensities, offers enjoyment and pleasure to consumers on their respective health and wellness journeys.

Conflict of interest statement: The following authors are employed at Ingredion, Inc.: Margaux Mora, Jing Zhou, Katie Hennings, and Kristen Germana. The following authors received an honorarium from Ingredion, Inc. for professional services provided: John L. Sievenpiper, Sidd Purkayastha, V. Lee Grotz and Cynthia Goody. Dr. John L Sievenpiper 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), National Honey Board (U.S. Department of Agriculture [USDA] honey “Checkoff” program), Institute for the Advancement of Food and Nutrition Sciences (IAFNS), Pulse Canada, Quaker Oats Center of Excellence, INC International Nut and Dried Fruit Council Foundation, The United Soybean Board (USDA soy “Checkoff” program), Protein Industries Canada (a Government of Canada Global Innovation Cluster), Almond Board of California, European Fruit Juice Association, 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 which has received contributions from IFF among other donors), The Plant Milk Fund at the University of Toronto (a fund established by the Karuna Foundation through Vegan Grants), and The Nutrition Trialists Network Fund at the University of Toronto (a fund established by donations from the Calorie Control Council, Physicians Committee for Responsible Medicine, and Login5 Foundation). He has received food donations to support randomized controlled trials from the Almond Board of California, California Walnut Commission, Danone, Nutrartis, Soylent, and Dairy Farmers of Canada. He has received travel support, speaker fees and/or honoraria from FoodMinds LLC, Nestlé, Abbott, General Mills, Nutrition Communications, International Food Information Council (IFIC), Arab Beverage Association, International Sweeteners Association, Calorie Control Council, and Phynova. He has or has had ad hoc consulting arrangements with Almond Board of California, Perkins Coie LLP, Tate and Lyle, Ingredion, and Brightseed. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study of Diabetes (EASD), Canadian Cardiovascular Society (CCS), and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons. He serves as an unpaid member of the Board of Trustees of IAFNS. He is a Director at Large of the Canadian Nutrition Society (CNS), founding member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His spouse is a former employee of Nestle Health Science and AB InBev.

If you have any doubts about the value of the concept of ultra-processed, the breadth and extent of industry pushback against the idea is excellent evidence.  The concept is an existential threat to the processed food industry, and it is fighting back.  The Italian food industry is especially concerned because it also has the Nutri-Score front-of-pack labeling system to contend with; the letter grades on ultra-processed products tend to be C’s, D’s, and E’s—as bad as they come.

Here’s an example of the pushback.

The opinion piece: Visioli, F., Del Rio, D., Fogliano, V., Marangoni F, Ricci C, Poli A.  Ultra-processed foods and health: are we correctly interpreting the available evidence?. Eur J Clin Nutr 79, 177–180 (2025). https://doi.org/10.1038/s41430-024-01515-8

Competing interests: AP and FM are the Chairman and Scientific Director, respectively, of NFI—Nutrition Foundation of Italy, a non-profit organisation partially supported by Italian and non-Italian Food Companies. All other authors declare no conflict of interest associated with this publication.

Comment: The senior (last) author and one other run the Italian Nutrition Foundation, an organization sponsored by food companies, Italan and international.  This makes the Foundation an industry front group, pretending to be independent, but not.  Its job is to further the commercial interests of its corporate sponsors, which is what it is doing here.  It is using the tobacco industry playbook: cast doubt on the research, suggest alternatives, argue against regulation.  The foundation’s authors are joined by academic and government authors, who have their own, not necessarily commercial, reasons for unhappiness with the UPF concept, which focuses on degree of processing, not nutrient content.  Yes, nutrients matter, but there are better ways of getting them than through UPFs.

A dietitian member of the Academy of Nutrition and Dietetics, who wishes to remain anonymous, emailed me about PepsiCo’s guide to research interpretation.

PepsiCo sent dietitians this webinar and handout for communicating nutrition science and evaluating studies. I took a look at the handout, which gives a “high quality research” distinction to any studies in which authors have clearly disclosed conflict of interest. So … As long as it’s disclosed, it can be high quality research?  Ok.

The handout: How to Communicate Nutrition Science Effectively.

As a credentialed healthcare professional, you have the power to inspire trust and deepen the general public’s understanding of nutrition through credible scientific communication. Let this guide help you to better understand scientific publications and to improve your effectiveness as a nutrition communicator.

Here’s what got the attention of my reader:

According to PepsiCo, high-quality science requires publication in a reputable, peer-reviewed journal, results based on the totality of evidence, conflicts of interest disclosed, and ethical questions, societal implications, limitations discussed.

This is good advice.

But as noted by my reader, disclosure of conflicts of interest should not be sufficient to determine research quality.

Disclosure is essential, but not enough to resolve the problems of conflict of interest.

As I endlessly repeat in these Monday posts, the recipients of industry funding rarely recognize the risk of undue influence; they did not intend to be influenced, and they believe themselves to be immune from the influence—despite the fact that tons of research shows otherwise.

Food companies fund research for reasons that have everything to do with marketing and little to do with science.  They do not fund research if they think it might show harm from their products.

Yes, this is a complicated issue.  But consider the benefit to PepsiCo from engaging dietitians in this endeavor.

The study: Amone F, Spina A, Perri A, Lofaro D, Zaccaria V, Insolia V, Lirangi C, Puoci F, Nobile V. Standardized Grape (Vitis vinifera L.) Extract Improves Short- and Long-Term Cognitive Performances in Healthy Older Adults: A Randomized, Double-Blind, and Placebo-Controlled Trial. Foods. 2024; 13(18):2999. https://doi.org/10.3390/foods13182999

The headline:  “Just 2 handfuls of pistachios daily could help protect your eyesight.”

Really?  Let’s take a look.

The Study: Pistachio Consumption Increases Macular Pigment Optical Density in Healthy Adults: A Randomized Controlled Trial.  Scott, Tammy M et al.  The Journal of Nutrition, Volume 155, Issue 1, 168 – 174. 2024 Oct 18:S0022-3166(24)01099-X.   doi: 10.1016/j.tjnut.2024.10.022.

Background: Pistachios are a bioavailable source of the xanthophyll lutein. Along with zeaxanthin, these plant pigments are major components of macular pigment (MP) in the human retina. MP can be non-invasively measured and is referred to as MP optical density (MPOD). MPOD is modifiable with dietary interventions that include lutein and zeaxanthin (L/Z). Higher MPOD protects the eye from light damage and is positively associated with eye health.

Objectives: This dietary intervention study aimed to evaluate the effect of pistachio consumption on MPOD.

Method: This single-blinded, randomized controlled trial compared a 12-week pistachio intervention (2 oz/d) with usual diet (UD) on MPOD and serum L/Z in middle-aged to older healthy adults (n = 36) in a 1:1 randomization scheme.

Conclusions: The results of our study demonstrate that a dietary intervention with pistachios is efficacious in increasing MPOD in healthy adults selected for habitually low intake of L/Z and low baseline MPOD. This suggests that pistachio consumption could be an effective dietary strategy for preserving eye health. Future studies need to evaluate the generalizability of our findings to other populations.

Funding: This project was supported by the American Pistachio Growers, who had no role in the final design, conduct, or interpretation of this study. The project described was also supported by the National Center for Advancing Translational Sciences, National Institutes of Health, Award Number UM1TR004398. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflict of interest: Tammy M Scott reports financial support provided by American Pistachio Growers. The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Comment: When I saw the title, I wanted to know immediately, “Who paid for this?”  If you eat foods containing lutein and zeaxanthin, the levels of those factors will increase.  No surprise.  Are pistachios the only or best way to do this?  That’s not what this study aimed to find out.  This, as is true of much (most) industry-funded studies, this one is more about marketing than science.

Charles Platkin sent me this  article from Food Manufacturing: “Eating pork linked with better handgrip strength, industry group says.”

I quickly found the The Pork Board’s press release.

And went right to the source.

The study: Jung A-J, Sharma A, Chung M, Wallace TC, Lee H-J. he Relationship of Pork Meat Consumption with Nutrient Intakes, Diet Quality, and Biomarkers of Health Status in Korean Older Adults.  Nutrients. 2024; 16(23):4188. https://doi.org/10.3390/nu16234188

Objectives: We evaluated the association between pork meat consumption and nutrient intake, diet quality, and biomarkers of health among older adults (age ≥ 65 years) in Korea.

Methods: Our analyses utilized dietary and health examination data from the 2016–2020 Korean National Health and Nutrition Examination Survey (n = 2068).

Results: Pork consumption was associated with  a higher intake of energy and [some] nutrients…Diet quality was modestly higher among…pork consumers. Differences in biomarkers were clinically irrelevant…Handgrip strength was slightly higher.

Conclusions: In Korean older adults, pork consumption may contribute to a higher intake of energy and most nutrients, improved diet quality scores, higher vegetable intake, and small improvements in health biomarkers.

Funding: Funding for this research was provided through an investigator-initiated educational grant from the National Pork Board (#22-056) to Think Healthy Group, LLC. The sponsor had no role in the design, analysis, interpretation, or presentation of the data or results. The authors and sponsor strictly adhered to the American Society for Nutrition’s guiding principles for private funding for food science and nutrition research. M.C. did not receive salary support or consulting fee from this grant.

Conflicts of interest”: T.C.W. has received scientific consulting fees as a current member of the Science Advisory Board for the National Pork Board. He has also received other investigator-initiated educational research grants from the National Pork Board. All other authors have no conflicts of interest to declare.

Comment: Applause to Food Manufacturing for noting the industry  source in its headline: “industry group says”.  Note the effect size: “small improvements in health biomarkers.”  Nevertheless, the Pork Board thought it was worth a press release—it had paid for the study, after all.  The Pork Board runs a USDA-sponsored checkoff program; it collects fees from pork producers and uses them for purposes like these.  Worth it?  A lot of pork producers don’t think so, but the USDA insists and manages it through its Agricultural Market Service.  I wonder if the new administration will take interest in such programs…?

A reader, Maria Birman, alerted me to this new report in Lancet Diabetes & Endocrinology from the 56-member Commission on the Definition and Diagnosis of Clinical Obesity.  The commission recommended shifting the definition and diagnostic criteria for obesity away from the BMI and instead defining obesity in two categories based on health status.

• Clinical obesity: signs and symptoms of organ or other dysfunctions; a disease requiring effective health care treatment
• Pre-clinical obesity: high levels of body fat but no signs of dysfunction but higher risk for chronic disease, requiring support for risk reduction.

Maria writes:

I’m astonished by the full two-page “declaration of interests” (no conflict there, of course not!). Naturally Eli Lilly and Novo Nordisk are very much interested in obesity being considered a disease, and a treatable one at that. And doctors and scientists paid by these companies authored this paper which is posed to be very influential.

I took a look at the conflict-of-interest statement.  It is indeed astonishing as it goes on and on for nearly two pages in four columns.

Maria saved me from having to go through the analysis.  Here are her counts.

• Of the 56 authors, 47 declared conflicts of interest; only 9 did not.
• All 8 authors on the steering committee declare financial ties to drug companies.
• Novo Nordisk (Ozempic, Wegovy) is mentioned 60 times by 38 authors.
• Eli Lilly (Zepbound) is mentioned 39 times by 27 authors.
• Authors report financial ties to other pharmaceutical companies: AstraZeneca, Pfizer, Merck, Johnson & Johnson, Eurodrug Laboratories, Sanofi., and others.
• Authors report consulting fees, fees for educational purposes, research grants, speaker fees, co-authorship of manuscripts, medical writing assistance, and personal honoraria as a consultant and speaker, among others.
• Authors report financial ties to food companies such as Nestlé, which makes the Vital Pursuit line marketed to people on Ozempic.

Comment

No question, the BMI is an imperfect measure of the health risks of obesity, although it works pretty well as a first step.  Defining obesity as a disease may well help get treatment for people who need it.

I wish we had a health care system that could help people with obesity find out whether they have the clinical or pre-clinical form.  In the absence of  a functional health care system, we have drugs—effective and without deleterious side effects for some people, but for the great majority, highly expensive and hard to get.

This commission appears as an arm of the pharmaceutical industry.  Its findings require careful scrutiny.

In its scientific report, the 2025-2030 Dietary Guidelines Advisory Committee recommends substituting plant proteins for animal proteins.

The Committee recommends that the proposed Eat Healthy Your Way Dietary Pattern emphasizes dietary intakes of beans, peas, and lentils while reducing intakes of red and processed meats….The Committee also proposes reorganizing the order of the Protein Foods Group to list Beans, Peas, and Lentils first, followed by Nuts, Seeds, and Soy products, then Seafood, and finally Meats, Poultry, and Eggs.

It did not take long for the meat industry to respond: Animal vs. Plant Protein: New Research Suggests That These Protein Sources Are Not Nutritionally Equivalent.

As is my habit, I went right to the study.

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

Conclusions: “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: Amino acids, the building blocks of protein, are the same whether they come from plants or animals (or us).  Food animals are closer to us evolutionarily than are plants; the animo acid composition of their proteins is more like ours than the amino acid composition of food plants.  That is why protein complementarity matters; mix and match the plants you eat and their amino acid compositions will complement each other and fill in the gaps.  This doesn’t even have to be done at every meal.  Overall, it’s easier to get the needed amino acids from animal foods but it’s not all that hard to get them from plants as long as they are varied and you eat enough of them.  So the study isn’t wrong; it’s just not telling the whole story.

Thanks to Kevin Mitchell for sending this one.