Good Morning, American Society for Nutrition

June 8^th: My suitcase wheels leave parallel trails of sand across the granite floor of the Boston Sheraton Hotel. The Smiling Coast of Africa sits 3,858 miles behind me. The inaugural ASN meeting awaits. I consume a lemon twist muffin in two bites. Good Morning, America.

Carrying spinach quiche and chocolate croissants, Nutrition 2018 attendees flock from corner cafes, hotel buffets, and caffeine collectives.  Someone probably enjoys a carb-less commute. We unite in the name of science. I open my Nutrition 2018 app: ‘Emotion Trumps Science. Why Science-based Facts are No Longer Enough to Educate the Public Effectively.’ I adjust my badge and gulp the last swig of cream-filled coffee. My blood sugar soars with glee. I steer towards the 3^rd floor escalator.

As the world’s premiere nutrition society, Nutrition 2018 delivered an extensive nutrition experience. The greatest minds in nutrition science surrendered novel findings, shared the latest technologies, and strengthened existing partnerships. The exhaustive list of research themes made it impossible for patrons to attend every event. Here, I proffer one personal, fragmented, undeniably biased account of the proceedings:

The Hynes Convention Center fills with the familiar buzz of old friends, new members, and seasoned colleagues.  We navigate the sea of posters, search for friendly faces, and scurry up and down the stairs searching for the next symposium. While waiting outside the overflowing microbiome theater room, I overhear colleagues’ questions:

Do we promote muscadine grape extract, curcumin shots, supplement with flavonol-rich cocoa—or all three? We must finally decide on low calorie sweeteners. What is the best way to measure infant cognitive performance? How much longer must the nefarious GMO lurk in antipathy? What are the constraints and challenges in vegetable production (and distribution)? We discuss the success stories of various sectors.

Eating Behavior and Brain Function

June 9^th: Cascades of cheese beckoned from the second floor corridor. I had traveled across the sea from a small West African village called Keneba, where I was incidentally engaged in a two-week fasting experiment. The Ramadan fast is a month-long, annual ritual involving prayer, empathy, abstaining from smoking and gossiping, curbing negative thoughts and anger, etc. How quickly I pile my plate with pita bread and drizzle the salad with a symphony of sauces.

It all goes back to an elementary principle my instructor wisely professed: everything in moderation. Easier said than done.

We continue to detect and characterize eating behavior, but numerous factors guide food and beverage choices. Somehow, we must muster some magic and change the way humans think. How in the world can we alter the behavior of such irrational creatures?

If repeated behaviors alter brain function, how long does it take to subsequently rewire those circuits? (The answer is certainly more than a two-week, well-intentioned Ramadan fast.) A recent study investigated whether prolonged fasting or weight loss influenced neural activity in obese participants and found that an 8-week weight loss intervention (but not a 48-hour fast), decreased activity in brain areas involved in feeding behavior and reward processing (1).

Nutrition and Nutrition Programs for School-Age Children

June 10^th: At the front of the lunch line I peer across the ticket counter. Finished? “ASN is out of small sandwiches,” I whisper dismally.

Some of us know all too well the effects of a lackluster lunch. Many advocate for SNAP and other strategies within the United States. Around the world, stunting and childhood growth issues continue to puzzle scientists. How can we help children at risk for stunting grow taller? Wide gaps in the evidence for program effectiveness remain. Exposure to a comprehensive nutrition program among infants under 2 years old in Malawi led to a small but sustained increase in weight but not linear growth during the preschool-age period (2). Perhaps we will see intergenerational benefits of India’s national mid-day meal program— now in its third decade of implementation—but what is our next move (3)? Providing calories and vitamins alone probably won’t do.

Perhaps our programs are too late. What must an expectant mother eat to ensure her future child’s epigenome stays error-free? So far, little evidence indicates that the initiation of a comprehensive nutrition supplement during the preconception period prompts superior birth outcomes over initiation at the 1^st and 2^nd trimesters (4). However, maternal choline supplementation during pregnancy recently showed improvements in executive functioning in children at age 7 (5).

While global health experts consider blanket Vitamin-A supplementation and the prevalence of seasonal orange-palmed Zambian children (6), others discuss food matrix complexities, enteropathy, and protein needs. Much effort in international research is directed towards ending acute malnutrition and stunting (7). Understanding which ingredients might bolster resistance against infection, fight cancer, and curb HIV is still a great challenge.

Personalized Nutrition

June 11^th: 3,500 scientists, clinicians, policy experts, 2018 Fellows, enamored students, emerging leaders, and placid professors unite as equals, once again, in the quest for finger foods.

To end the ASN Nutrition 2018 conference, we renew our commitment to food. Food remains timeless. The early fetus, picky adolescent, pregnant woman, professional athlete, and spindly senior must partake. However, one size does not fit all. We are moving fast towards diet profiling, setting the table for personally prescribed food provisions. Matching macronutrient composition and fiber content to an individual’s specific glucose metabolism and microbial makeup may improve weight loss outcomes and help some achieve optimum health (8).

Still, the evidence for fruit and vegetable consumption prevails. Dietary intakes of total flavonols and its more common subclasses might slow cognitive decline in aging adults (9). New links are being made between flavonoids, endothelial function, and vascular health (10). Other aspects of health are difficult to pick apart. The role of fruits and vegetables in psychological well-being is evident (11), but we must isolate it from other confounding factors. May the awe-inspiring intricacies of phytonutrients be realized forevermore?

“Good” and “Bad” Food Choices and Timely Interventions

June 12^th: I promptly visit Trader Joe’s to pack my carry-on bag with exclusive, superior plane snacks. Armed with tomatillo salsa and olive tapenade, I lug my suitcase through Newark International Airport. Just thirty minutes after takeoff, the temptation is too great. My inability to refuse salty airplane pretzels must be related to a genetic polymorphism.

SNP or no SNP, I am a trained nutrition expert. Like so many Americans, I know what’s “good” and “bad,” yet I continue to make “bad” choices. Solve that scientific mystery!

If we begin at the earliest life stages, the American Heart Association recommends that children under 2-years avoid added sugar. A recent analysis of NHANES data showed that more than 80% of 6- to 23-month-olds consumed on average 4.2 teaspoons of added sugar (12). Timely interventions seem worthwhile. Repeated exposure can increase infants’ acceptance of initially disliked foods (e.g., dark leafy greens), but caregivers report lacking the persistence that is necessary to achieve acceptance (13).

Some innovative programs targeting adolescents have made great progress: cooking experience and family involvement was found to alter BMI in 4th graders (14); but can knowledge alone safeguard the child who ogles delicious discount chocolate bars at the checkout counter every afternoon?

Becoming Conscious Consumers

To test my metabolic flexibility, consumption continues in the Frankfurt airport terminal. I walk past ice cream cones and duty free Toblerone, but stop to savor the seed-covered, crusty, thick brick of dark brown bread. My subcortical neural networks (involved in homeostatic cognitive control and reward processing) jump for joy.

Americans are ravenous for the wrong things. Instead of being world-renowned for childhood obesity and portion sizes, let us strive to be known for our transformative innovations that precipitate a radical shift in our population’s health and happiness.

The war on sugar-sweetened beverages (SSBs) is being waged worldwide. High SSB consumption at 5-years is associated with higher BMI and risk of being overweight. However, if we are to modify our sugary beverage consumption, we must present alternative drinks as well as quantified directives (15). This is just one facet of the potbellied problem.

We need both blanket and tailored interventions to help us make better choices. Interventions focused on reducing bites, reducing eating rate, and taking more steps may be practical for those who are more prone to eating in response to external cues that are independent of internal hunger and satiety (16).

We shall not become supplement fairies and place omega-3’s under children’s pillows at night. We shall not wait for the blueberry crumble miracle pill, devoid of caloric content and formulated for our metabolic needs. We must engage the public and empower people to act. Somehow, we will start listening to what our bodies truly need, becoming more conscious and respectful consumers.

Dietary Behavior Tools, Systems, and Prevention Strategies

I board again in Brussels, Belgium. Surely, I do not have to explain irrational excitement over airplane food to you, nutrition scientist, or the pure thrill of peeling back the foil to reveal… surprisingly nice marinara raviolis, questionable coleslaw, and the obligatory bread roll. I am sandwiched between two tall Senegalese men still stifling Ramadan hunger pangs; they neatly pack away their lunches.

There is no feedback pathway that tells the body to absorb less when it consumes too much (the changes must come from deep within!). Online dietary behavior change tools can only reduce gestational weight gain if the pregnant population uses them (17). Whether it’s a food revolution or a shift in focus, we must (wince) make America healthy again.

What are the consequences if we don’t?

Digital imaging innovations promise to measure consumption, household purchases, and even food environments with increased accuracy (18, 19). Mobile and electronic-supported health care (eHealth and mHealth) will surely play a role in weight and eating interventions (20). Will insurance packages soon include dietetic nutrition counseling?

We must think about systems. We must share prevention strategies. We must reach more people—in school lunchrooms, household pantries, drive-through windows, and picnic baskets.

Inevitably, someone must also translate this science for every person who eats. We have orthorexia, anorexia, anemia, aflatoxin exposure, unauthorized cardiac events, and unwarranted childhood obesity. Our solutions must reflect the inequalities that exist.

American Society for Nutrition’s Role in Improving Health Through Nutrition

June 14^th: Gambian sand resettles between my toes. The coastal air seeps into my skin. Piles of freshly fallen mangos greet me on the ground. I peel back the green membrane and sink my teeth into juicy, orange flesh. Good morning, Gambia.

However, I have also returned to a crisis of the worst kind. The Fula bakers are on strike. Breadmakers demand 7 dalasis (15 cents) for tapalapa (thick, delicious baguette made of unfortified white flour), but buyers refuse to pay more than the customary 6.

I buy breakfast beneath the baobab tree for 5 dalasis (10 cents), thicken it with milk powder, add peanut paste, and swirl in honey for a rich, energy-dense and delicious breakfast. Though this meal will likely improve my appetite, satiety levels, and snacking behaviors throughout the day, not many in the village would dare pay such a price for a protein punch.

At six o’clock, I mount my bicycle for the routine ride to Manduar. “Water is coming!” a Gambian boy exclaims as I quickly pedal past his field. Farmers look nervously and expectantly into the sky. Rural villages lack the abundance of markets, restaurants, and imported packaged foods available at the coast. The brief annual rains must yield enough groundnuts and maize to provide food for families until the following harvest.

Improvements in nutrition and agriculture will plot a different development trajectory for all countries. Global food insecurity remains a growing problem. Diet diversity is grim, both in America and worldwide. Americans value convenience: we stock our freezers full of microwave meals. Gambians enjoy meals largely limited to rice, heavily laden with oil and virtually void of vegetables.

We are the American Society for Nutrition. America is guilty of self-destructive food behaviors—learned, practiced, and engrained cultural habits that we must amend. This transformation has already begun. In 2028 we will celebrate our centenary; the ASN vision is due to expand. America maintains the ability to lead other countries, to stir momentum for a global movement of improved health through good nutrition. Unfinished business identified, we can position our society to serve the public and the world at large. As a society—embracing our role, responsibilities, and reach—we must continue to examine and explore these issues one bite at a time.

References

1. A.van Opstal, Wijngaarden, Marjolein, Pijl, Hanno, van der Grond, Jeroen, Changes in brain activity after weight loss in obesity, Sunday June 10, American Society for Nutrition 2018.

 

2. K. Hurley, Exposure to comprehensive nutrition program among children 6-23m of age in Malawi led to sustained increase in weight but not linear growth during the preschool-age period, Sunday June 10, American Society for Nutrition 2018.

 

3. S. Scott, Intergenerational Benefits of India’s National School Feeding Program: Identifying a Path to Reduced Child Stunting in the Next Generation, Sunday June 10, American Society for Nutrition 2018.

 

4. N. Krebs, Impact of a preconception maternal nutrition intervention on birth length in 4 low middle income countries: the “Women First” trial, Sunday June 10, American Society for Nutrition 2018.

 

5. C. Bahnfleth, Enduring benefits of prenatal choline supplementation in 7-year olds: enhanced attention task performance, Sunday June 10, American Society for Nutrition 2018.

 

6. S. Tanumihardjo, Children: Biofortification of food and possiblevitaminA toxicity, Friday June 8, American Society for Nutrition 2018.

 

7. L. Larson, Meta-analysis of the Effects of Various Types of Early Life Interventions on Linear Growth vs. Neurodevelopment, Sunday June 10, American Society for Nutrition 2018.

 

8. A. Astrup, Personalized dietary management of obesity based on simple biomarkers, Sunday June 10, American Society for Nutrition 2018.

 

 

9. T. Holland, Dietary Intake of Flavonols May Slow Decline in Multiple Cognitive Abilities, Sunday June 10, American Society for Nutrition 2018.

 

10. S. Johnson, Flavonoid-rich Foods for Attenuating VascularEndothelial Dysfunction and Cardiovascular Risk with Aging, Saturday June 9, American Society for Nutrition 2018.

 

11. L. Jahns, The Role of Vegetables and Fruits in Psychological Well-Being, Monday June 11, American Society for Nutrition 2018.

 

12. K. Herrick, Consumption of added sugars among U.S. infants aged 6-23 months, 2011-2014, Sunday June 10, American Society for Nutrition 2018.

 

13. K. Moding, The Good Tastes Study: exploring caregiver feeding persistence and the roles of perceived infant liking, child temperament, and caregiver food neophobia, Sunday June 10, American Society for Nutrition 2018.

 

14. B. Lohse, Cooking experience and family involvement key to BMI change in a 4th grade school-based intervention, Sunday June 10, American Society for Nutrition 2018.
15. V. Malik, Principles for Establishing a Guidance System forBeverage Consumption, Saturday June 9, American Society for Nutrition 2018.

 

16. J. Beatty, Examining Weight-Related Eating Behaviors within an 8-Week Weight Loss Intervention, Saturday, June 9, American Society for Nutrition 2018.

 

17. C. Olson, Use of an online dietary behavior change tool: associations with reduced risk of excessive gestational weight gain, Sunday June 10, American Society for Nutrition 2018.

 

18. E. Shonkoff, Reliability and validity of digital images to assess plate waste in a restaurant setting, Sunday June 10, American Society for Nutrition 2018.

 

19. D. Brassard, Examining the Value of Using Multiple Web-Based Dietary Assessment Instruments to Measure Population Dietary Intake – The PREDISE Study, Sunday June 10, American Society for Nutrition 2018.

 

20. J. G. Thomas, The Role of Technology in the Delivery of Behavioral Interventions, Saturday June 9, American Society for Nutrition 2018.