The characteristics and extent of food industry involvement in peer-reviewed research articles from 10 leading nutrition-related journals in 2018.

INTRODUCTION: There is emerging evidence that food industry involvement in nutrition research may bias research findings and/or research agendas. However, the extent of food industry involvement in nutrition research has not been systematically explored. This study aimed to identify the extent of food industry involvement in peer-reviewed articles from a sample of leading nutrition-related journals, and to examine the extent to which findings from research involving the food industry support industry interests. METHODS: All original research articles published in 2018 in the top 10 most-cited nutrition- and dietetics-related journals were analysed. We evaluated the proportion of articles that disclosed involvement from the food industry, including through author affiliations, funding sources, declarations of interest or other acknowledgments. Principal research findings from articles with food industry involvement, and a random sample of articles without food industry involvement, were categorised according to the extent to which they supported relevant food industry interests. RESULTS: 196/1,461 (13.4%) articles reported food industry involvement. The extent of food industry involvement varied by journal, with The Journal of Nutrition (28.3%) having the highest and Paediatric Obesity (3.8%) having the lowest proportion of industry involvement. Processed food manufacturers were involved in the most articles (77/196, 39.3%). Of articles with food industry involvement, 55.6% reported findings favourable to relevant food industry interests, compared to 9.7% of articles without food industry involvement. CONCLUSION: Food industry involvement in peer-reviewed research in leading nutrition-related journals is commonplace. In line with previous literature, this study has shown that a greater proportion of peer-reviewed studies involving the food industry have results that favour relevant food industry interests than peer-reviewed studies without food industry involvement. Given the potential competing interests of the food industry, it is important to explore mechanisms that can safeguard the integrity and public relevance of nutrition research.

Una nueva perspectiva: aproximación ética-moral al problema de la nutrición / A new perspective: ethical-moral approach to the problem of nutrition

¿Se puede ver el problema de la desnutrición y la alimentación desde el punto de vista ético? Se trata de un dilema o de una contradicción, revisaremos los conceptos de ética, moral y valor. Consideraremos el reto de ser ético al usar las Redes Sociales y la posibilidad de pensar en la Nutrición Virtual(AU)

Can we see the problem of malnutrition and nutrition from an ethical point of view? It is a dilemma or a contradiction, we will review the concepts of ethics, morals and value. We will consider the challenge of being ethical when using Social Networks and the possibility of thinking about Virtual Nutrition.(AU)

Perspective: Consideration of Values When Setting Priorities in Nutrition Research: Guidance for Transparency.

Nutrition research can guide interventions to tackle the burden of diet-related diseases. Setting priorities in nutrition research, however, requires the engagement of various stakeholders with diverse insights. Consideration of what matters most in research from a scientific, social, and ethical perspective is therefore not an automatic process. Systematic ways to explicitly define and consider relevant values are largely lacking. Here, we review existing nutrition research priority-setting exercises, analyze how values are reported, and provide guidance for transparent consideration of values while setting priorities in nutrition research. Of the 27 (n = 22 peer-reviewed manuscripts and 5 grey literature documents) studies reviewed, 40.7% used a combination of different methods, 59.3% described the represented stakeholders, and 49.1% reported on follow-up activities. All priority-setting exercises were led by research groups based in high-income countries. Via an iterative qualitative content analysis, reported values were identified (n = 22 manuscripts). Three clusters of values (i.e., those related to impact, feasibility, and accountability) were identified. These values were organized in a tool to help those involved in setting research priorities systematically consider and report values. The tool was finalized through an online consultation with 7 international stakeholders. The value-oriented tool for priority setting in nutrition research identifies and presents values that are already implicitly and explicitly represented in priority-setting exercises. It provides guidance to enable explicit deliberation on research priorities from an ethical perspective. In addition, it can serve as a reporting tool to document how value-laden choices are made during priority setting and help foster the accountability of stakeholders involved.

Perspective: Reductionist Nutrition Research Has Meaning Only within the Framework of Holistic and Ethical Thinking.

Today, it seems that nutrition is in a state of great confusion, especially for the general public. For decades, some nutrients (e.g., cholesterol, saturated fats, sugars, gluten, salt) and food groups (e.g., dairy, cereals, meats) have been regularly denigrated. In this position paper, we hypothesize that such a state of confusion is mainly the result of the reductionist paradigm applied to nutrition research for more than a century, and by being pushed to its extreme, this perspective has led to accusations about some nutrients and foods. However, the real issue is about foods taken as a whole and therefore about their degree of processing, which affects both the food matrix and composition. Indeed, we eat whole foods, not nutrients. Therefore, the objectives of this article are to emphasize the need for more holistic approaches in nutrition to preserve our health, animal welfare, and planet. We propose to first redefine the food health potential on a holistic basis and then to show that reductionism and holism are interconnected approaches that should coexist. Then, we try to explain how extreme reductionism has been disconnected from reality and ethical considerations and has ultimately led to environmental degradation and loss of biodiversity, notably through very specific crops, and to an increased prevalence of chronic diseases. Furthermore, to address the confusion of the general public and to simplify nutritional messages, we propose 3 holistic golden rules based on scientific evidence to protect human health, animal welfare, and the environment (climate and biodiversity). Finally, we try to show how these 3 rules can be easily applied worldwide while respecting the environment, cultural traditions, and heritage.

The 3Rs in research: a contemporary approach to replacement, reduction and refinement.

First promulgated in 1959, the 3Rs of Replacement, Reduction and Refinement have evolved as fundamental principles underlying the use of animals and alternatives in science throughout the modern world. This review describes a contemporary approach to delivering the 3Rs through acknowledging the contribution of new technologies and emphasising that applying the 3Rs can be beneficial to good science as well as to animal welfare. This science-led approach moves the concept of the 3Rs out of an ethical silo where they were often considered by scientists to be an inconvenient obligation. On the contrary, relevant examples demonstrate the opportunity to practise better science using 3Rs technologies which deliver faster, more reproducible and more cost-effective results. Indeed, methods harnessing Replacement approaches may permit discoveries which are simply not feasible using animals and frequently are more flexible and agile since compliance with regulatory oversight requirements is simplified. Although the necessity for rigorous oversight is well recognised, it is important that the associated bureaucracy is not allowed to become prohibitive, causing scientists to avoid pursuing justifiable and important research involving animals. Public support for research is conditional - animals should not suffer unnecessarily and sufficient potential benefit should accrue from the research. However, society also actively seeks pioneering medical and scientific advances which can only be achieved through research. Therefore, a balance must be struck between safeguarding animal welfare whilst enabling high-quality science. It is this balance which promotes and sustains public confidence that animal based research is acceptable and being appropriately managed.

Challenges in conducting clinical nutrition research.

Clinical nutrition research has played a pivotal role in establishing causality between diet or nutrient intake and health outcome measures and in the determination of dietary requirements and levels of supplementation to achieve specific outcomes. Because the studies are performed with humans, clinical nutrition research can be readily translated into public health messages. However, there are many challenges and considerations unique to the field, such as the baseline nutritional status of study participants, defining appropriate control groups, effective blinding of participants and investigators, the evolving ethics of randomized control trials, and a tension in a priori decisions regarding inclusion of nutritionally vulnerable participants versus representative samples of general populations. Regulatory approvals that place increasing burdens on the ability of investigators to carry out and complete research protocols have grown dramatically in recent years. There is much room for improved efficiency in the approval and reporting processes aimed at protecting volunteers and providing transparency to the public. Decreased redundancy would have a direct benefit to clinical nutrition research and investigators. Despite these challenges, the information to be gained and the rewards of clinical nutrition research remain high.

The problematic messages of nutritional discourse: A case-based critical media analysis.

Nutritional science has assumed a fundamental importance in shaping food meanings and practices in the developed world. This study critically analysed the content of one weekly nutrition column written by a nutritional expert in a popular New Zealand magazine, from a social constructionist perspective, to investigate how nutritional advice constructs food, food practices and eaters. The analysis identified a range of ways in which the nutrition information communicated in the articles was potentially problematic for readers. The articles advocated eating for health with recommendations based on nutritional science, but depicted nutritional information as inconclusive, changeable and open to interpretation. Fear-based messages were used to motivate making 'healthy' food choices, through linking 'unhealthy' food choices with fatness and chronic ill health. Unhealthy foods were portrayed as more enjoyable than healthy foods, social occasions involving food were constructed as problematic, and exercise was defined only as a way to negate food consumption. Healthy eating was portrayed as a matter of personal choice, obscuring the situational factors that impact on food choice and health. We conclude that the nutritional advice analysed in this study constructs a way of understanding food that, if internalised by eaters, may evoke anxiety, confusion and dissatisfaction around food and eating.

Nutrition: ethical issues and challenges.

For nutrition and its associated disciplines, ethical considerations related to research are often complicated by factors that range from the use of experimental research designs that are overly holistic to inextricable links between nutrition research and marketing. As a consequence, there is the need for constant vigilance to assess and deal with apparent conflicts of interest. Also, there are few scientific disciplines that are defined by cultural, religious, or political codifications as is nutrition. Accordingly, examples of historical, cultural, and political events are described that have influenced ethical approaches related to nutrition research. Furthermore, nutrition research questions are often multifaceted and require dealing with complex variables. In this regard, ethical principles and perspectives that have relevance to data acquisition, the publication and translation of nutrition research, and the marketing of nutritional products and concepts are highlighted.

Have the Answers to Common Legal Questions Concerning Nutrition Support Changed Over the Past Decade? 10 Questions for 10 Years.

Clinical nutrition specialists (CNSs) are often confronted with technological, ethical, and legal questions, that is, what can be done technologically, what should be done ethically, and what must be done legally, which conflict at times. The conflict represents a "troubling trichotomy" as discussed in the lead article of this issue of Nutrition in Clinical Practice (NCP). During Clinical Nutrition Week in 2006, a symposium covering these 3 topics was presented, and later that year, an article covering the same topic was published in NCP In this article, we revisit several legal questions/issues that were raised 10 years ago and discuss current answers and approaches. Some of the answers remain unchanged. Other answers have been modified by additional legislation, court decisions, or regulations. In addition, new questions/issues have arisen. Some of the most common questions regarding nutrition support involve the following: liability, informed consent, medical decisional incapacity vs legal competence, advance directive specificity, surrogate decision making, physician orders for life-sustaining treatment and electronic medical orders for life-sustaining treatment, legal definition of death, patient vs family decision making, the noncompliant patient, and elder abuse obligations. In the current healthcare environment, these questions and issues are best addressed via a transdisciplinary team that focuses on function rather than form. The CNS can play a pivotal role in dealing with these challenges by applying the acronym ACT: being Accountable and Communicating with all stakeholders while actively participating as an integral part of the transdisciplinary Team.

The Troubling Trichotomy 10 Years Later: Where Are We Now?

A decade ago, "Nutrition Support and The Troubling Trichotomy: A Call To Action" was published in this journal, identifying existing conflicts among technological, ethical, and legal aspects of nutrition support therapy, particularly in terminal or end-of-life situations. Over the past 10 years, the American Society for Parenteral and Enteral Nutrition and others have responded to the action call. A "state of the trichotomy" reveals that while much has been achieved, differences in all 3 aspects will continue to exist due to their dynamic and ever-changing states. The technology arena has made it possible to increase the delivery of nutrition support in alternative settings with the use of telemedicine and social media. Critical/crucial conversations and earlier declarations of individual wishes for care and treatment while having decision-making capacity have been enhanced with the focus on patient-centered and family-centered care. The definition of death as brain death has been challenged in at least one instance. Conflicts between the state's interests and the individual's interests have added to recent legal controversies. Notwithstanding the progress made over the past 10 years, several challenges remain. The future challenges presented by the Troubling Trichotomy can be best confronted if we ACT-Accountability, Communication, and Teamwork. The focus of teamwork should move from multidisciplinary and interdisciplinary teams to transdisciplinary teams, reflecting the shift to function rather than form presented by the new healthcare environment. The transdisciplinary team will be able address the opportunities of the Troubling Trichotomy in the next decade by incorporating the 12 Cs, as detailed in the article.

Cambios en la adherencia a la dieta mediterránea en estudiantes de los Grados de Enfermería y de Magisterio tras cursar una asignatura de Nutrición / Changes in the adherence to the mediterranean diet in students of Grades of Teaching and Nursing after completing a course on Nutrition

Introducción: El patrón de Dieta Mediterránea es considerado como un modelo a potenciar; sin embargo, se está deteriorando especialmente en jóvenes universitarios. Intentar mejorarlo en la etapa de formación universitaria creemos puede ser de interés y máxime si se trata de futuros profesionales de Enfermería (E) y Magisterio (M). Objetivo: Determinar las variaciones que con la docencia en asignaturas de nutrición-alimentación se pueden conseguir tanto en conocimientos como en la adherencia a la dieta mediterránea (ADM) en una población universitaria de futuros Enfermeros y Maestros y analizar diversos factores que pudieran mejorar su calidad nutricional. Material y métodos: Distribución pre y post docencia de un cuestionario y del test Kidmed a una muestra de 399 universitarios (216, E; y 183, M) con edades medias de 22,4 años (E) y de 33,8 años (M). De cada encuestado se registraban estudios iniciales, edad, peso, talla, conocimientos de DM e índice Kidmed (de 0 a 12) indicando si la ADM era baja (de 0 a 3), media (de 4 a 7) o alta (de 8 a 12). Para la comparación de los datos se ha utilizado el test Chi cuadrado y el programa estadístico SPSS 21. Resultados: Existen en ambos colectivos (E y M), tras la docencia variaciones significativas en conocimientos (p<0,001) sobre DM. Asimismo son significativos los cambios entre los valores medios de ADM, tanto en Enfermería que pasan de 4,76 a 5,33 (p<0,05), como en Magisterio que evoluciona de 6,17 a 8,77 (p<0,001). No obstante lo anterior, son muy deficientes los valores finales de consumo de frutas y verduras en el grupo de Enfermería. La mejor evolución del grupo de Magisterio puede estar condicionada por la edad madura de este grupo. Dentro de las mejoras significativas post docencia conseguidas en los hábitos de ambos grupos sólo son coincidentes las que implican un consumo de menor bollería industrial (p<0,001) y golosinas (p<0,05). Conclusiones: A pesar de los avances conseguidos el 84,3% de los futuros Enfermeros necesitarían mejorar su ADM y sería necesario incrementar hábitos nucleares de la DM como son el consumo diario de frutas y verduras. Ya en menor proporción, un 27% de los estudiantes de Magisterio deberían también mejorar su ADM. Sería conveniente seguir profundizando en campañas educativas nutricionales y máxime teniendo en cuenta la futura función social que estos colectivos pueden desempeñar (AU)

Introduction: The Mediterranean diet pattern is considered as a model to be promoted; however, it is deteriorating especially in universitary students. We believe that trying to improve it on the stage of university education may be of interest and moreover if these are future professionals of Nursing (E) and Teaching (M). Objective: Determining the variations after teaching of subjects in nutrition and food that can be achieved in both, knowledge and Adherence to the Mediterranean Diet (AMD) in a universitary population of futures Nurses and Teachers and analyzing various factors to improve their nutritional quality. Materials and Methods: Distribution Pre and Post Teaching of a questionnaire and Kidmed test to a sample of 399 university students (216 E, and 183 M) with mean enge of 22.4 years old (E) and 33.8 years old (M). Background studies, age, weight, height, knowledge on MD and Kidmed index (0-12) indicating whether the AMD was low (0 to 3), medium (4 to 7) or high (from 8 to 12) are recorded by each respondent. The Chi square test and SPSS 21 statistical program are used for data comparison. Results: Significative differences exist in both groups (E and M) after teaching in knowledge (p <0.001) on MD. Likewise, those changes between the mean values of AMD in both, Nursing, from 4.76 to 5.33 (p <0.05), and Teaching evolving from 6.17 to 8.77 (p <0.001) are significant. Despite of this, values of consumption of fruits and vegetables within the Nursing group, are very poor. The best evolution in the Teaching students may be conditioned by the maturity of this group. Among the significant improvements achieved in post teaching habits are those involving lower consumption of bakery products (p <0.001) and sweets (p <0.05), which only occurs in both groups. Conclusions: Despite the progress achieved, the 84.3% of future nurses would need to improve their AMD and to increase the nuclear DM habits, such as daily consumption of fruits and vegetables. Although in a smaller proportion, 27% of the Teaching students should improve their AMD as well. It would be desirable to get deeper in nutritional education campaigns using subjects such as those already mentioned, and especially considering the future social role that these groups can play (AU)

The role of the institutional review board in the oversight of the ethical aspects of human studies research.

Institutional review boards are charged with overseeing that human studies research is conducted in accordance with federal and state regulations and with their own policies and procedures, with the goal of minimizing risks to participants and maximizing the quality of the research data. Nutrition research often involves vulnerable populations, including children and the cognitively impaired, for whom there are specific regulations. Ethical issues are common in nutrition research, and both the investigative team and the institutional review board should seek input regarding ethical issues that arise.

Nutrition research in rural communities: application of ethical principles.

This narrative review focuses on ethics related to nutrition-specific community-based research, within the framework of science for society, and focusing on the rights and well-being of fieldworkers and research participants. In addition to generally accepted conditions of scientific validity, such as adequate sample size, unbiased measurement outcome and suitable study population, research needs to be appropriate and feasible within the local context. Communities' suspicions about research can be overcome through community participation and clear dialogue. Recruitment of fieldworkers and research participants should be transparent and guided by project-specific selection criteria. Fieldworkers need to be adequately trained, their daily schedules and remuneration must be realistic, and their inputs to the study must be recognized. Fieldworkers may be negatively affected emotionally, financially and physically. Benefits to research participants may include physical and psychological benefits, minimal economic benefit, and health education; while risks may be of a physical, psychological, social, or economic nature. Targeting individuals in high-risk groups may result in social stigmatization. The time burden to the research participant can be minimized by careful attention to study procedures and questionnaire design. Potential benefits to the community, fieldworkers and research participants and anticipated knowledge to be gained should outweigh and justify the potential risks. Researchers should have an exit strategy for study participants. For effective dissemination of results to individual research participants, the host community and nutrition community, the language, format and level of presentation need to be appropriate for the target audience.