Ways to combat impostor syndrome and advance your professional skill set were brought to life during the ASN Student Interest Group and Early Career Nutrition Interest Group symposium on “Thriving, Not Just Surviving: Skills Essential to Leveraging Your Scientific Career” during ASN’s Scientific Sessions and Annual Meeting.

Phyllis Rippey, University of Ottawa, opened the session with her talk on impostor syndrome. Surprisingly, she talked about an upside to impostor syndrome: those who experience it are less likely to cheat on exams. However, the cons outweigh the benefits since the persistent feeling that one’s successes are undeserved can be detrimental to self-confidence and taking career risks.

“I was just in the right place at the right time.”

“If I can do it, anyone can do it.”

These seemingly harmless remarks appear all too frequently, but they represent a pattern of explaining away accomplishments. Rippey wanted us to know that we’re not alone when we feel this way. Reaching out to others and getting help is a good thing. She says, “Confidence isn’t about knowing everything, it’s about knowing how to use the resources to get the job done.” Rippey talked about how focusing on learning and improvement instead of knowing everything and being perfect helped overcome pressure in her career. The room was silent and attentive when she announced, “The goal should be to be good enough most of the time.” She recommended keeping an accomplishment inventory, so we can remember our successes, even in times when it feels impossible.

The next speaker was Ellen Fung, UCSF Benioff Children’s Hospital, who spoke about the secrets to getting great mentorship. She taught us that mentorship has four basic topic areas: 1) professional development; 2) scientific method/project input development; 3) emotional support/community/accountability; and 4) networking. Fung recommended seeking out a mentor, who is not only knowledgeable and passionate about the specific field you’re interested in, but also interested in being a mentor. Most importantly, a mentor should be someone who you are able to communicate well with, since the mentor/mentee relationship thrives off of mutual respect and trust. Mentees drive this relationship, so it’s important to know yourself and your goals before approaching a new mentor. Fung also warned us of common ways mentees damage this mentorship relationship, such as by not providing the mentor with a plan, disrespect, disregarding all advice, and not using your mentor’s time wisely. She concluded her talk by sharing, “You will have a variety of mentors, some good, some bad, and you will learn something from them all.”

Michelle Braun, DuPont Nutrition and Health, took the podium next to share tips for successful networking. She revealed that most people perceive networking as an event with barriers. However, she recommends on planning to be uncomfortable, preparing for the worst, not automatically saying “no,” and giving yourself time to recover after the event (i.e. unwind with a hot cup of tea and a good book). Networking is an exchange of information, where you learn about the other person and share about yourself. Her simple steps to make networking an enjoyable experience are:

  • Find meeting places and networking events
  • Have an opening line ready that encourages a share
  • Be ready with your elevator pitch (30 second introduction and ending with a question about the other person)
  • Identify who you want to meet
  • Pace yourself and make choices
  • Collect business cards
  • Follow-up: LinkedIn, email, social media platforms; give yourself a deadline so time doesn’t get away from you

Braun shared her secret tips for meeting someone new: simply sit somewhere new, make eye contact with others, and be open to interactions. The room almost became a giant game of musical chairs, as attendees smiled and looked around the room. We were then given a break to practice networking and the room was filled with chatter, laughter, and positive energy.

Christina Sherry, Abbott Nutrition, was the next speaker and spoke about the transition from mentee to mentor. She recommends taking the time to listen to your colleagues about challenges they may face and sharing your own experiences if you have been in similar circumstances. Your colleagues may pinpoint you as a problem solver. However, it’s important to respect confidentiality in this circumstance. You can also tell a relatable story about what you did that may or may not have worked. Sherry recommends sticking to a neutral tone to come across as more objective, rather than preachy. She suggests getting involved in organizational activities to help develop your skills and meet others. Sherry voiced that we are moving into a more collaborative scientific world, so don’t let titles hold you back since we can all learn from each other. Sherry has found that being transparent and vulnerable helped open doors for better communication.

Barbara Schneeman, University of California, Davis, then talked about team management and leadership. She revealed that the difference between the two roles comes down to a shift in perspective. As a team participant, you focus on what resources are available to support you and whether you have access to mentors. As a team leader, you focus on balancing the competing demands on time and achieving success for each team member, as well as the team as a whole. As a leader, you have to motivate and communicate with each team member amidst differing personalities. Schneeman pinpoints that responsiveness is important to a team. Leaders must know how to assess a situation, problem solve, and respond, while also motivating and inspiring team members to problem solve on their own. She recommends strategic planning, such as conducting a SWOT analysis or planning framework. Schneeman revealed five competencies associated with leadership that she recommends working on: 1) dealing with ambiguity; 2) active listening; 3) negotiating; 4) being politically savvy; and 5) priority setting. She ended with a quote from Peter Drucker, “Management is doing things right; leadership is doing the right things.”

The last speaker was Shelly McGuire, Washington State University, who spoke about a topic near and dear to graduate students and those in the workforce alike: prioritizing your time and learning to say “no.” In fact, McGuire turned it around and told us that learning to say “yes” is way more important than learning to say “no.” McGuire shared the wisdom she learned over the years from being a career woman and raising a family: you have to put in energy (i.e. effort) to avoid the crazy. She revealed that successful people put the time and energy into the values and roles that are important to them, rather than the things that they don’t value or roles with no meaning. Oftentimes when you don’t feel happy, it’s because you’re not honoring your values. She encouraged us to think about our core values. Once we identify these, we can then put a plan in place to uphold our values. McGuire then turned the conversation to effectiveness versus efficiency. Effectiveness is the degree to which your objectives are achieved, whereas efficiency is doing something well with the least amount of effort/time–these are not the same thing! She prompted us to consider the following the next time we are asked to do something:

  1. Does this task fit with my values? If not, walk away.
  2. Does it nurture or advance one of my main roles? Does it contribute to your effectiveness?
  3. Do you actually have the time to do it? If not, can you shift your time or commitments to accommodate it?

The wisdom and advice shared throughout the symposium appeared to motivate the audience to go out there, put away the impostor syndrome, and be successful.

With the rise in technology, information is at our fingertips–literally. Concurrent with the technology boom, more and more people are paying attention to their health and food. This combination has led to mass food movements, changes in food policy, and more. But, who exactly is driving this push for change? What role can nutrition experts play in food movements? This is what the International Food Information Council (IFIC) addressed during their session “Restoring Relevancy of Nutrition Expertise in the Current Food Movement,” which was hosted by the ASN Nutrition Translation RIS and supported by Tate and Lyle.

Kris Sollid, RD, Senior Director of Nutrition Communications at IFIC, began by presenting findings about food trends and the key drivers of consumer’s food and beverage choices from IFIC’s annual Food and Health Survey. One main finding was that consumers want more transparency. However, recent data from Pew Research Center found that many Americans turn to social media for their news. This means many look to social media platforms when seeking information about food. Intuitively, the nutrition experts should be the ones driving the ship when it comes to key food issues. Alarmingly, according to an ASN member survey, many nutrition experts and researchers felt it was actually the media and television personalities driving the food conversation. This opening set the stage for the session, which focused on encouraging us, as nutrition experts, to get out in the field and use our expertise to steer the food movement using evidence-based research.

Melissa Kinch, Partner and Director, Ketchum West, took the stage next to use her expertise in public relations to teach us how to reach the public. As scientists, we’re taught to gather the data and facts, build a case, and share the findings. In today’s age, we should work on drawing people in with a “hot start” and then use analogies and visuals to make it relatable. Then, wrap up with sharing the data and facts as support. Kinch says, “Digestible science simplifies without talking down.” Her key recommendations were to avoid using jargon and technical terms, listen and embrace, and to show empathy to consumers. Then, work to find common ground, include visuals, analogies, metaphors, and examples, share personal stories, and show your passion. Kinch voices that we need science and technology to drive the future of food to solve our problems, but there’s a growing narrative of fearing science and food that we have to work to overcome.

Mark Haub, PhD, Professor and Department Head at Kansas State University, and Kavin Senapathy, freelance science writer and public speaker, were brought to the stage to share their experiences with science and the media and then partake in a panel discussion. Haub was the subject of a class project gone wrong when the media approached him after they got wind of his “junk food diet.” Haub followed his “junk food diet” for 10 weeks and lost weight due to the calorie deficit. However, the media twisted the story and he became known as the “twinkie doctor” and headlines appeared touting that you can eat junk and still lose weight. He wanted us to learn from his experience with the media and offered invaluable advice for how to effectively work with the media. Haub encouraged us to think about the media’s goal (click bait) and our goal (to educate) and told us “If you want to drive your message, you have to be the leader, otherwise people will take it for you.”

Kavin Senapthy shared her extensive expertise with bridging the information gap between the science and public, working with the press, and using social media. Senapthy urged us to integrate information within the context of social content and values to resonate with the public. Misinformation is often shared across social media, and usually it’s from people with good intentions. She reiterated that when you see something inflammatory on social media, it’s important to keep the middle ground in mind. People are so used to arguing with “trolls” on the Internet that it’s easy to forget there’s reasonable people simply observing the social interaction, which they may then use to base their decision-making process. She told us, “It’s important to be aware of context, your overall message, and who you’re communicating with.”

Megan Meyer, PhD, Director of Science Communications at IFIC, concluded the session by talking about ways to communicate science effectively. She expressed, “Values and social networks play a key role in influencing behavior change.” This is why credentialed experts need to become the trusted and influential source. IFIC has been working on projects to disseminate credible science to the public. One recent project was a compilation of memes that are “thank you notes to food science” that coincided with the March for Science. IFIC also maintains a “Fast Take” blog series where current studies getting a lot of media attention are written in a consumer-friendly way while staying true to the science. Their “Sound Science” blog series provides information about new, credible studies that may not have gotten as much media attention. We are living in the cornerstone for the intersection between technology and scientific communication and there is much more to come.

Key Takeaways:

  • Take advantage of media training opportunities
  • Harness your elevator pitch
  • Get on social media (including ASN Nutrilink!) and interact with others; follow others with differing opinions
  • Pay attention to pop culture and food trends
  • Have a content focus
  • Don’t be afraid to make mistakes, everything will be okay
  • Have as many conversations as you can with people that aren’t science-based
  • Practice!

Sunday morning at ASN’s 2017 Scientific Sessions and Annual Meeting began with the “Nutrigenomics and Personalized Nutrition” session hosted by the ASN Nutrient-Gene Interactions RIS. The presentations that followed addressed aspects of the question: how do genes and nutrition interact?

Silvia Berciano, Tufts University, opened the session with her presentation on “Behavior related genes, dietary preferences and anthropometric traits.” She explored how genes involved in behavioral and psychological traits influence dietary habits, which then subsequently affect physical traits. Data was used from the Genetics and Lipid Lowering Drugs and Diet Network (GOLDN) Study to investigate how behavioral candidate genes, food preferences, and anthropometric traits interacted. Her study found multiple genes were associated with various dietary components, such as chocolate intake was linked to a variation at the OXTR locus, which was associated with waist circumference. Her results support that mapping genes could lead to a better understanding of how to personalize nutrition.

Krittikan Chanpaisaeng, Purdue University, next presented on “Femoral and L5 Spine Trabecular Bone Are Differentially Influenced by Dietary Calcium Restriction and Genetics in Growing Mice.” Her study explored site-specific effects of dietary calcium intake on the trabecular bone mass in the right femur and L5 vertebrae using genetically distinct mouse lines randomized to receive adequate or low-calcium intake. She found the low-calcium intake had a negative effect on trabecular bone mass, but this was especially seen on the structural integrity of the femoral, as compared to L5 vertebrae. This suggests the low-calcium intake has a differential effect on trabecular bone mass. Further, there was large phenotypic diversity among the mouse population for all femur and spine parameters, which shows genetics may be a major regulator of trabecular bone mass. These findings demonstrate that genetic mapping can help classify sites that could be more susceptible to bone loss. This information could be used to identify those that may then be more vulnerable to osteoporosis.

From the same research group, James Fleet, (below image) Purdue University, shared his talk, “Multi-Trait Genetic Mapping Reveals Novel Loci Responsible for Genetic and Genetic-by-Diet Interactions Affecting Bone, Vitamin D, and Calcium Metabolism.” Fleet used multi-trait analysis to examine interactions between bone mass, calcium, and vitamin D phenotypes. He used Principle Components Analysis to look for patterns and relationships between phenotypes. This approach found loci not identifiable on a single-trait map, which can be employed to establish a framework for understanding how genetic variation can interact with calcium intake to affect the development for components of bone mass.

Maxwell Barffour, (below image) University of California Davis, then presented his findings on “Hemoglobinopathies and Child Feeding Practices as Predictors of Anemia in Rural Laotian Children: Evidence from the Lao Zinc Study.” Anemia tends to peak around complementary feeding due to inadequate feeding practices. He examined how Hemoglobin E-trait (HbE), a common structural hemoglobin variant in Southeast Asia, was associated with risk for anemia. Children, aged 6-23 months from the Lao Zinc randomized controlled trial, were genetically mapped to see if they had the normal trait (HbAA), were heterozygote (HbEA), or homozygote (HbEE). Feeding practices were assessed using a 24-hr dietary recall administered to the parents. His study found homozygotes had more than triple the risk for anemia and heterozygotes had a 40% greater risk for anemia. His findings support that among breastfed children, consumption of iron-rich foods and especially food diversification, may reduce anemia risk in this population.

Riva Sorkin, University of Toronto, examined how salivary amylase may influence consumption of a high starch diet in her presentation, “Genetic variation in the AMY1 gene is associated with dietary carbohydrate and starch intake in a young adult population.” Salivary amylase is encoded by the AMY1 gene, which has high copy number variation, meaning that large regions of the genome are duplicated or deleted on chromosomes. Single nucleotide polymorphisms by the amylase genes have been shown to be associated with AMY1 copy number. Sorkin used data from an ethno-culturally diverse population from the Toronto Nutrigenomics and Health Study and genotyped the participants for AMY1 single nucleotide polymorphisms. Participants also completed questionnaires about their health, lifestyle, and physical activity. She found that polymorphisms in the AMY1 gene were linked to dietary intake patterns, such as carriers for the minor allele in rs1999478 in East Asians had significantly higher total energy and sugar intakes. Her study suggests there are unknown mechanisms, including genetic polymorphisms, that affect satiety and appetite regulation that should continue to be explored.

M. Elizabeth Tejero, INMEGEN, discussed how response to a fish oil supplementation trial in Mexicans (aged 18-40 years) was influenced by genetics during her talk on “Differences in the transcriptome of responders and non-responders on glucose metabolism markers after fish oil supplementation.” Participants were given fish oil pills (DHA and EPA) for 6 weeks. Participants with the largest reduction or increase in fasting insulin were then pair-matched by age, sex, change in omega-3 index, and BMI. Between these two groups, there was no difference in gene expression before the study. However, after the trial there were changes in genes related to inflammatory response and glucose metabolism. Participants with the largest reduction in fasting insulin exhibited more changes in these genes, as compared to participants with the largest increase in fasting insulin. Her findings support that dietary intake can influence gene expression.

Next, Tolunay Aydemir, (below image) University of Florida, presented her talk, “Zip14-Mediated Zinc Transport Contributes to Regulation of Glucose Homeostasis in Intestine, Pancreas and Liver.” Her study used a ZIP14 knockout mouse model to support findings that ZIP14 is vital for regulating signaling events for glucose homeostasis and inflammation. The knockout mice were found to have impaired zinc-dependent insulin degrading proteases, insulin degrading enzyme, and cathepsin D, which increased the activity of the insulin receptor. These mice also displayed greater hepatic glycogen synthesis and impaired gluconeogenesis and glycolysis linked to reduced cytosolic zinc levels. Her study showed that ZIP14-mediated zinc transport is related to intestinal barrier function, biosynthesis and secretion of insulin, insulin receptor activity, and glucose homeostasis in the liver. This suggests ZIP14 could be a new target for treating diabetes and other glucose-related disorders.

Qiaozhu Su, (below image) University of Nebraska-Lincoln, ended the session with her presentation on “MicroRNAs in the Pathogenesis of Lipogenic Diet Induced Hyperlipidemia and Insulin Resistance.” Her study investigated how micro RNAs could regulate the development of hyperlipidemia and insulin resistance induced by a high-fructose diet. Illumina small RNA sequencing was used to identify micro RNAs that were altered in response to a high-fructose diet in mouse livers. Su found that genetic depletion of one type of micro RNA protected the mice from fructose-induced insulin resistance, while overexpression of another type of micro RNA led to inflammatory stress in the liver. These findings suggest there may be potential to manipulate these micro RNAs to prevent the development of high-fructose diet induced hyperlipidemia and insulin resistance.

Walking into the “Developing Healthy Eating and Physical Activity Behaviors through Education, Extension or Technology” session sponsored by the ASN Nutrition Education and Behavioral Sciences RIS, you could feel the energy in the room as everyone waited in anticipation for the oral sessions to begin.

The session began with a presentation by Gabriella McLoughlin, University of Illinois at Urbana Champaign, on “School Lunch and Physical Activity During Recess: Interactive Effects of Health Behaviors in the School Setting.” Her presentation focused on how the timing of lunch affects food intake during lunch and physical activity during recess for 4th– and 5th-grade students. Her study found that students who ate lunch before recess were more physically active during recess and consumed more vegetables. Further, engaging in moderate-to-vigorous physical activity was inversely associated with lower intakes of carbohydrate, fat, sugar, and overall calories. However, students who ate lunch after recess ate more and had greater intakes of carbohydrate and fat.

Laura Adam, University of Alberta, followed with her presentation on “Sense of Weight Control Prior to Pregnancy Could Help Predict Women at Risk for Excessive Gestational Weight Gain.” Her analysis sought to understand if differing amounts of lifestyle support provided by a Registered Dietitian (RD) during pregnancy could help women achieve appropriate gestational weight gain. Participants were randomized into the control or intervention group. The intervention group received two visits from an RD during pregnancy, while the control group did not. No difference was found for total gestational weight gain, rate of weight gain, and adherence to the gestational weight guidelines between the groups. However, she found that more women with BMIs in the obese and overweight category exceeded the recommended gestational weight gain, as compared to women with a normal BMI. Further, women who felt more in control of their weight before pregnancy were more likely to adhere to the gestational weight gain guidelines.

James Roemmich, Grand Forks Human Nutrition Research Center, next shared a unique perspective for how to motivate people to be active during his talk on “Increasing Discomfort Tolerance Predicts Incentive Sensitization of Exercise Reinforcement: Preliminary Results from a Randomized Controlled Intervention to Increase the Reinforcing Value of Exercise in Adults.” His work uses the Incentive Sensitization Theory, which is usually used to describe how people become addicted to drugs. This theory postulates that neuroadaptations in the brain increase craving of a behavior causing the object to become more motivating, so the individual wants to consume the stimulus. Roemmich applies this theory to physical activity to determine if tolerance for exercise discomfort is related to relative reinforcing value of exercise. He conducted a 3-arm, randomized, controlled trial over the course of 6 weeks with two exercise arms (expending 150 or 300 kcals during cardio-type exercise 3 days/wk) and a control group. He found that those who exercised more intensely increased their tolerance to exercise and those with more tolerance had greater relative reinforcing value of exercise. He recommends the focus be on guidelines to increase motivation for exercise, so it becomes a habit.

Jacqueline Vernarelli, Fairfield University, explored the relationship between energy density and enjoyment of physical activity for her presentation on “Early development of healthy habits: Children who enjoy physical activity have healthier diets than children who do not.” She used data from NHANES: 2012 National Youth Fitness Survey (NYFS) with a sample of 1,640 children between 3-15 years old. Children were asked if they liked recess using a 5-point likert scale. She found that children who strongly liked recess had lower energy dense diets. Vernarelli recommends focusing on future strategies to examine ways to increase enjoyment of physical activity to encourage children and adolescents to be active.

Sofia Segura-Pérez, Hispanic Health Council, examined a novel way to reach a Latino audience during her talk on “Development and Validation of a Culturally Appropriate Heart Disease Prevention Fotonovela among Spanish Speaking Low-income Latinos.” She employed Community Based Participatory Research to develop a fotonovela (a form of sequential storytelling that uses photographs in the form of photo comics) about heart disease prevention. Through a series of focus groups, she identified common barriers to eating healthy, exercising, and smoking cessation and was able to create messages to encourage healthier behaviors. After her final focus group, she found participants increased knowledge following reading the fotonovela and wanted to be more active, eat better, and stop smoking. Her research shows that fotonovelas are culturally and literacy appropriate educational instruments to use for Latinos.

Sarah Stotz, University of Georgia, took the podium next to share how she developed an eLearning nutrition program to encourage Supplemental Nutrition Assistance Program Education (SNAP-Ed) eligible participants to make healthier choices during her talk on “Expectations and Recommendations from Low-Income Adults Regarding an eLearning Nutrition Education Program Prior to Program Use.” With increased access to the Internet, online learning can be used to address the barrier to attending nutrition education sessions in-person. Further, online learning is self-directed, which capitalizes on adult learning principles. Stotz developed the Food eTalk eLearning Program, which was adapted from the validated nutrition education program, Food Talk. To gauge how her intended audience would respond to the program, she conducted a focus group series (n = 45) and individual interviews (n = 19) to see what participants wanted in an online education program. She uncovered three common themes: 1) Participants used their phones a lot; 2) Participants had low expectations for an online program; and 3) Even though they were unprompted, participants wanted to share that they know they should eat healthier, but “it’s just hard.” Based on this information, Stotz learned to make the eLearning program mobile-friendly, create short learning modules (~10 minutes), identify specific learning topics, and make the lessons entertaining and video-based.

Sharon Kirkpatrick, University of Waterloo, discussed her findings from using a web-based dietary assessment tool during her presentation on “Evaluation of the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) for use with children: An observational feeding study.” ASA24 is an online, self-administered dietary recall tool that follows a format based on the Automated Multiple-Pass Method used in the National Health and Nutrition Examination Survey (NHANES). Dietary assessment, particularly among children, is a challenge since it’s subjected to many biases. Kirkpatrick conducted a study to determine how precise ASA24 was with children in 5th-8th grade. She provided each child with lunch that was weighed before and after consumption. The next day, the children were given time to complete ASA24 during class independently. She found most children reported the main lunch item well, but recall was lower for side dishes and the lowest for condiments, such as dip. Kirkpatrick also found that the younger children had more difficulty completing ASA24. Overall, she found that ASA24 performed relatively well, but younger children need more time and help to complete the recall. She suggests accompanying ASA24 and similar technologies with a training, tailored help, and/or supplementary sources of information, such as including menus.

The session concluded with a presentation by Soghra Jarvandi, University of Tennessee Extension, on “Goal Setting, Past Performance and Behavioral Outcomes in a Worksite Wellness Program.” Jarvandi used the Walk Across Tennessee program, a team-based walking program, as a platform for using goal setting as a strategy for facilitating behavior change. Before the study, participants completed the International Physical Activity Questionnaire – short form (IPAQ-short) to assess their initial physical activity level. Participants also self-selected a walking goal and during the study received weekly feedback through a visual graph depicting how much they walked compared to their initial goal. Jarvandi used the IPAQ-short questionnaire to divide the participants into high activity (compliers) and low activity (non-compliers) to see if they had differences in their activity and goal setting during the study. After the study concluded, she found no difference between compliers and non-compliers in terms of their activity habits and goal setting. However, she suggests participants with low levels of physical activity may benefit from behavioral strategies that improve motivation.

How much evidence should be demonstrated before enacting obesity-targeted health policy? This difficult question was debated between two speakers Sunday at ASN’s Scientific Sessions and Annual Meeting, as part of the Obesity Research Interest Section Forum, chaired by Andrew Brown, PhD.

The first speaker, Laura Schmidt, PhD, defended the need to set such policies early on. According to Schmidt, one reason we cannot afford to wait for perfect evidence is because the National Nutrition Research Roadmap indicated that the average amount of time that it takes for research to go from bench to bedside/community is 17 years. Dr. Schmidt noted that how research is translated to policy needs to be strategic and carefully considered, the evidence must be robust and systematically reviewed, but that science can only inform, not drive policy decisions. Often it is not possible to enact policy at exactly the specifications that research suggests. For example, a 20% tax on sugar sweetened beverages was indicated to show an effect on sales, but San Francisco couldn’t get a bill passed into law until the tax was reduced below 20%. Standards for evidence are often higher in the scientific community, she said: they utilize systematic reviews, expert panel summaries, and formal guidelines by federal and global agencies. When the results of a large number of different types of studies that use different measures and outcomes point in the same direction (i.e. observational, clinical trials, and mechanistic), we can be confident in the strength of the evidence. Schmidt gave an example of some issues she perceives haven’t reached a body of research big enough to act on yet: taxing 100% juice or diet sodas, even though there is emerging concern on each from the literature. Finally, Dr. Schmidt noted that we need to be concerned with industry funded research as some evidence suggests it may bias conclusions on a topic. To summarize: we should acknowledge the need to translate research in ways that can inform policy and that best practices and standards for evidence-to-policy are shaping up, but that challenges remain, including scientific bias due to conflicts of interest.

As a contrasting perspective, Michael Marlow, PhD, outlined his concerns with setting policies without a very high level of confidence that they will succeed. In other words, caution must be exercised because researchers don’t yet know optimal policies. He outlined his concerns as follows: 1) There are good intentioned hunches over scientific exploration. Confirmation bias and common narratives may lead to policies that don’t reflect reality. 2) Many research methods promote type-I errors, such as P-hacking, often a consequence of tenure and grant requirements and journal editor demands. 3) The quality of dietary data is poor. Dr. Marlow pointed to a study that found that for 95% of a study sample, fast food, soft drinks, and candy had no association with BMI. There are a number of possible interpretations to this: the data sources (diet recalls) may be so seriously flawed that it is ok to advocate laws that only affect 5% of the population. Should we enact policy or wait until data collection is improved? And, 4) There is naive modeling of interventions that goes into estimating policy efficacy. Linear relationships are often assumed between availability of nutrition information and behavioral changes, for instance. Because of what is overlooked, Marlow’s simulations of policy success range from 6.25% with optimistic probabilities of effects to 0.01% with less optimistic assumptions. To summarize: policy proposals need solid theoretical and empirical support, data quality needs more attention and acknowledgement, measures for policy success need major rethinking, uncertainty and unintended effects need acknowledgment, and we need to resist ill-advised albeit good-intentioned policies from citizen pressure.

There is no easy answer to how long we should wait before enacting health policies that target obesity. Translating research to policy is difficult and policy as a natural experiment can help us understand if we can impact obesity. A common thread of agreement is the need to ensure that we have high quality research methods and to reduce bias wherever possible. Perhaps then the question would be easier to answer.

multivitamins

Are multivitamin/mineral supplements beneficial? How do they relate to personalized nutrition? What even is a multivitamin? These questions were discussed at the “Multivitamin/Mineral Supplements in the Age of Personalized Nutrition” session Sunday during ASN’s Scientific Sessions and Annual Meeting. The chair of the session, Jeffrey Blumberg, PhD, introduced the session by noting that we don’t have a good consensus definition of either multivitamins or personalized nutrition. Multivitamins currently market for health claims such as bone health, vision, achieving nutrient recommendations etc… are these personalization or just marketing segmentation?

Regan Bailey, PhD, MPH, RD, was the first speaker who brought her expertise in epidemiology for an overview of multivitamin research, particularly from the National Health and Nutrition Examination Survey (NHANES) data. She discussed the various ways the definition of a “multi” can be operationalized: multivitamin to multivitamin/multimineral, and that there is no standard or regulatory definition. This has led to different ways of assessing multi use in NHANES research; for instance > 3 vitamins, > 30 vitamins & > 1 mineral, > 10 vitamins, etc. Depending on how you define, it you could change the estimate of how many people use these products in the U.S. by a couple million people. This also makes it difficult to monitor trends over time. Survey data tells us that the #1 reason why people use multis is to improve health, and associations with health behaviors suggests that these are people who are looking to take an active role in their health. In addition, multis are the #1 recommended product by physicians, although the use of multis is usually not disclosed to physicians. Other findings from NHANES tell us that adult users of multi products tend to have higher vitamin and mineral intakes from foods than non-users, that supplements help users meet recommendations for all micronutrients except potassium, but also that supplements increase the potential for intakes above Tolerable Upper Intake Levels for some nutrients. There are concerns with the level of nutrients on labels versus the actual amounts.This can vary by quite a bit in certain products, as well as bioavailability, nutrient and drug interactions, and keeping databases up to date. To solve some of these issues, more funding is needed. Dr. Bailey provided perspective that if annual supplement sales represent a $100 bill, the amount of funding that the entire National Institutes of Health (NIH) receives is only $1.

Cornelia Ulrich, PhD, spoke to the relationship between micronutrients and nutrigenomics/epigenetics, focusing on folate as an example of the bigger picture. An issue, she says, is that adults with cancer or cancer survivors frequently use vitamin and mineral supplements. This may put folic acid intakes well over the requirement, combined with folic acid fortification of foods. Antifolates are used in cancer therapy, and some research suggests an increased risk for certain cancers such as prostate with folate supplementation. In silico modeling of folate metabolism based on known kinetics and biochemical properties also suggests that high folic acid can impact cancer biomarkers, particularly in those with a genetic predisposition (i.e. MTHFR polymorphisms). Biological changes with high folate include a reduction leukocyte global DNA methylation, and a reduction in natural killer cell cytotoxicity, which may explain some of the relationships with cancers. Folate appears to modify associations between DNA methylation and outcomes such as fasting glucose, and its effects may be passed on in uterine development. Dr. Ulrich concluded with a summary that folate may have potential dual roles dependent on dose and context that warrants caution with supplementation or fortification, and that genetic make-up can affect these associations which will no doubt be a consideration going forward toward nutrition personalization.

Lastly, Howard Sesso, SCD, MPH, discussed the evidence from randomized controlled trials of multivitamin interventions. The U.S. Preventive Services Task Force (USPSTF)’s latest recommendations concluded that there is insufficient evidence regarding the long-term chronic disease effects of multivitamins on chronic disease risk. A big issue stemming from the lack of a standardized definition of a multivitamin is that it makes the meta-analyses on the topic more difficult to interpret. In recent years several large randomized trials have explored the effects of multis on primary and secondary disease prevention. With regard to cancer, the SU.VI.MAX study suggested a possible benefit on cancer incidence and mortality in men but not women. A trial in Linxian, China indicated a reduction in total and cancer mortality and stomach cancer, and the Physicians’ Health Study II also found a reduction in total cancer. For cardiovascular outcomes, multis reduced blood pressure and C-reactive protein, TACT showed no effect on cardiovascular events, and the Linxian Dysplasia Nutrition Intervention showed no effect on overall mortality. The Physicians’ Health Study II also indicated a reduction in cataracts. This overview led to their trial currently in progress: the COcoa Supplement and Multivitamin Outcomes Study (COSMOS). It will consist of 18,000 participants who undergo a 4 year treatment and follow-up, due to be completed around 2020. Ancillary studies will look at cognition, eye disease, and other chronic diseases like diabetes, cancer, etc. Sesso concluded by reiterating the need for multivitamin trials given their high prevalence of use and recommendation by clinicians, that more short-term mechanistic trials are needed, but that we need to improve the designs of larger, longer prevention trials as well.

Multivitamins are used by a large percentage of the population, yet despite large trials we are still unclear of their efficacy on many health outcomes. It is important to standardize definitions and databases so further trials can be adequately designed to answer such questions. More short-term trials should explore the plausibility by which multivitamins could be acting to reduce disease risk in various populations, including genetic subgroups to explore those who may benefit most from a move toward personalization.

how nutrition science should mature

Dennis Bier, MD, was this year’s W.O. Atwater Memorial Award Winner and Lecturer at ASN’s Scientific Sessions and Annual Meeting on Tuesday, sponsored by USDA-ARS and ASN. His talk, titled “Traveling the Road From Precision to Imprecision- Have I Gone in the Wrong Direction?” was a broad critique on the state of nutrition science, contrasting his long research career using isotopics for precise kinetic measurements in humans to some of the more imprecise techniques being used in nutrition. Human nutrition today remains an immature science, says Dr. Bier, because it is so difficult to accurately measure what people eat.

Among his critique along this line, he noted that individual nutrient intake measurement methods are “validated” against other imprecise methods, and even these correlations are generally weak within the 0.2 to 0.5 range. Further, it generally takes between 5-15 24-hour diet recalls, sometimes many more, to achieve an adequate estimation of nutrient intakes in overweight and obese participants, which is never done in practice. Another problem is the seasonal variability of nutrients in foods, using vitamin C as an example, or variation from changes during processing and cooking. If such variation is considered in epidemiological studies associating foods with disease outcomes, it greatly reduces the power to detect a statistically significant result, or can change a result from a positive association to a neutral one.

Should we think about nutrition as a science in the same manner as other disciplines like physics? Bier thinks we should. The differences are obvious now. It is extremely difficult to do long-term experiments in people for many reasons of practicality and cost. But if we concede to this difficulty, our confidence in certain areas of nutrition science will remain stagnant. There are some examples where observational data seems to have led us astray, for example with vitamin E and a follow-up negative trial, and similarly with homocysteine reduction with folic acid and a follow-up negative trial. Dr. Bier noted that more than 15 randomized controlled trials have failed to support nutrient hypotheses generated from observational studies of food intake. There may be many reasons for this: differences in subjects, inclusion criteria, dose or duration, therapeutic window, etc., but we also must consider that the observational data may lead us astray. There are underappreciated interdependencies in observational variables that cannot all be statistically accounted for. Bier’s cautions on such data should be uncontroversial. Associations uncovered in observational studies are hypothesis, they cannot infer causality, and drawing conclusions from them are fine as long as their uncertainty is acknowledged where they are used. In practice, however, these rules are often not followed.

Bier concluded by talking about the many issues that plague science in general that make the literature less reliable. For instance, 95% of the biomedical literature contains a significant result, suggesting a severe publication bias in favor of positive results. Other issues arise with a large researcher degrees of freedom; that is, the number of choices the researcher makes when designing a study or analyzing the results. Asking a lot of questions, changing the primary endpoints, focusing on positive endpoints and discounting negative ones. In reporting of results, implying causality from associations is often done inappropriately, or inflating the effect of the finding by only reporting relative risk instead of absolute risk.

“Transparent science, like transparent government, means releasing your tax returns.” Dr. Bier wants the field to think more about reporting. Among a long list of ways that scientific integrity can be improved: require a priori registration of all studies and a data analysis plan, report all primary endpoints together, require perspective in reporting of the results (e.g. effect sizes, confidence intervals, absolute risks, NNT, etc.), mandatory use of reporting guidelines, report alternative analyses (e.g. alternative models that fit the data with equivalent statistical confidence), making the original data available for scrutiny, and improving the disclosure of conflicts of interest. Everyone has some form of conflicts, for example, money, grants, fame, etc., and Bier thinks that allegiance biases are at least as common as financial ones, so we need to come up with a universal conflict of interest system to make this standardized and fair.

While Dr. Bier’s views may be too idealistic for some, he promotes a necessary conversation about how we improve nutrition science and reduce our uncertainties. To that end, the field should continuously strive to enforce policies and practices that better our measurement techniques and limit bias.

ASN Scientific Sessions

How does predictive modeling influence nutrition research, clinical interventions, and public health? This question was pondered in a session co-chaired by David Allison, PhD, and Kevin Hall, PhD, on Saturday morning at Experimental Biology. Dr. Allison introduced the session by giving an overview of some uses of predictive modeling related to nutrition research: modeling the social contagion of obesity, obesity propagation over generations, projecting policy implications, and agent-based modeling.

Kevin Hall, PhD, shared his influential work that started with developing predictive models and now uses them within clinical studies. Using previous highly controlled studies in metabolic chambers, he was able to form a mathematical model to predict metabolic adaptations in response to changes in energy intake. Recently, he and colleagues have used these models to design and predict what occurs in response to reducing the level of carbohydrate in the diet. The carbohydrate-insulin hypothesis, which postulates that carbohydrates cause body fat gain through the increase of insulin, has recently gained prominence from those filling in research gaps with their own speculations. To address this gap, he tested the predictions of his mathematical model against this hypothesis in a metabolic ward study by providing isocaloric diets restricted in either carbohydrates or fat. Though the low carbohydrate diet group did exhibit reduced insulin, both groups lost body fat, and in fact, the reduced fat group had a greater fat loss,because energy expenditure was decreased by the reduced carb group. In response to this study, Dr. Hall noted that they were criticized by some low carb advocates that their study wasn’t “true low-carb”, and that they didn’t wait long enough to observe a rebound in energy expenditure on a low-carb diet. However, in 2016 they published a second study on a ketogenic diet. The small, but not clinically significant increase in energy expenditure on the ketogenic diet was predicted by the model. Such successful application of mathematical modeling demonstrates that the models can be used to make testable predictions for experiments, and data can be continuously integrated to evolve the model.

Corby Martin, PhD, talked about the application of predictive modeling into the clinical setting. Combining such modeling into technology can theoretically improve adherence to a weight loss intervention, in part by allowing feedback between the clinician and the patient. Dr. Martin emphasized however that the presence of a device does little itself to change behavior over the long-term; it must be used in combination with a behavior change theory and the goals of the patient. He and his colleagues have been developing mobile health interventions to bring the rigor a clinic-based weight loss intervention to larger scale. For example, their SmartLoss app allows tracking of objective data such as weight that can be be fed into a predictive model to quantify diet adherence, and feedback can be sent to the patient in near real-time. Such data can be useful to individualize recommendations; for instance patterns may arise if patients don’t come often enough for clinic visits, or if certain methods of calorie restriction like portion control work better than others. Further, it can make it easy to visually show the plateau effect of even small intermittent non-adherence. Their initial trial demonstrated a 9.4% weight loss using the app versus 0.6% in those only receiving health tips by smartphone.

Next, Ben van Ommen, PhD, discussed the concept of “personalized nutrition” – that health is defined by “the ability to adapt”, and that we all have variability within certain oxidative, inflammatory, and metabolic processes in response to dietary challenges. In other words, we have a phenotypic flexibility in the ability to adapt to inflammation, or different amounts of nutrients in the diet (e.g. fats vs. carbs). This may be indicated by Blanco-Rojo et al 2015, who found that a low-fat versus Mediterranean diet may result in improved insulin sensitivity depending on whether participants have liver or muscle insulin resistance. Dr. van Ommen also discussed the issue of data ownership, something that they’ve put a lot of thought into in Europe that will become a bigger issue as we move toward personalization of nutrition.

Lastly, Emily Dhurandhar, PhD, talked about the usefulness of predictive modeling for public health obesity policies. Two issues with public health policies is that they often don’t account for energy balance being a dynamic, adaptable system, because the models are built in clinical settings, and they often focus on one food or habit instead of achieving a substantial shift in overall energy balance. For instance, Dr. Hall and colleagues showed that using the simple 3500 kcal per pound fat gain rule greatly overestimates how much weight will be lost over time in response to calorie reductions because it fails to account for metabolic adaptations in energy expenditure. In addition, behavioral compensation is not considered in health policies. Dhurandhar and colleagues showed that such compensation in exercise interventions to increase energy expenditure may be 55-64% less than expected because of such compensation like increased appetite. From this data they built an “E-EBALANCE” calculator that corrects for behavioral compensation. Dr. Hall’s group also revealed the underappreciated role of appetite in slowing weight loss compared to energy expenditure. If models that inform public health policies don’t take both metabolic and behavioral adaptations into account, the effectiveness of public health recommendations will be overestimated.

Diana Thomas summarized the session by concluding that predictive modeling can be used to ask “what if” questions, and these results can form the basis for targeted experimental design, which lends more rigor to the experiment. It can be used to determine deviations from expectation during weight loss interventions, and closely assess patient adherence, while guiding behavior change. We are slowly uncovering evidence of individual metabolic responses to dietary challenges, and predictive modeling will have a role in the future of personalized nutrition. Modeling needs to be incorporated into assessing the potential impacts of public policy, and tracking unintended changes and long-term national trends. It is clear that modeling will play an important role in nutrition research, the clinic, and public policy going forward.