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Doctor David B. Allison is the current dean, distinguished professor, and provost professor at the Indiana University School of Public Health-Bloomington. Prior to Indiana University, Allison was a distinguished professor, Quetelet Endowed Professor, and director of the NIH-funded Nutrition Obesity Research Center (NORC) at the University of Alabama at Birmingham (UAB). Allison was appointed director of the NORC in 2003 and served until 2017. Allison has published more than 500 scientific papers with research interests including obesity and nutrition, quantitative genetics, clinical trials, statistical and research methodology, and research rigor and integrity.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NORCs are “intended to integrate, coordinate, and foster interdisciplinary basic, clinical, translational, and public health research by a group of established investigators actively conducting programs of important, high-quality research that is related to research specific to NIDDK’s mission.”

There are currently twelve university-based NORCs across the United States from New York to Washington State. These centers are funded by P30 Center Core Grants from the NIDDK to bring together investigators who are conducting research in nutrition and obesity and improve the quality of research by promoting multidisciplinary work and sharing access to specialized technical resources and expertise. These centers allow for cost-effective collaboration between groups of investigators at the same institution. The NORC at UAB currently has 159 investigators from 58 different academic units – a manifestation of the center’s multidisciplinary approach.

Allison’s 14-year appointment as director of UAB’s NORC makes him an ideal individual to speak with about the successes of the initiative since its inception in 1999. Allison was gracious enough to answer several questions about his tenure as director and about NORCs more broadly.

What role do you see NORCs playing on university campuses?

NORCs are enormously helpful, and it is valuable to consider them in a historical context. The first NORC – before they were even called NORCs – was the New York Obesity Research Center at Columbia University and, at the time, Rockefeller University. It was the first and for many years only federally funded obesity research center in the United States. The NIDDK subsequently decided to call all the clinical nutrition research units and obesity nutrition research centers “NORCs,” and there are now twelve under this designation.

The New York center is where I started my career as an obesity researcher during my second postdoc. It was a lot of fun there. The NY Obesity Research Center was the mecca of obesity research. If you were an obesity researcher, and if you wanted to get trained, you knew where the mecca was. If you wanted to make a pilgrimage, you could see what the great leaders of the field were doing. You could go there and meet esteemed individuals such as Ted VanItallie, Xavier Pi-Sunyer, and Steven Heymsfield.

You sort of knew where the leadership was – where the intelligentsia and cognoscenti were. There were certainly other places in the world that were powerhouses in obesity, but in the United States, the NY Obesity Research Center served as a galvanizing force. It also served as a great training ground at the time – and NORCs still do. It is one of the things that makes NORCs special: they are multidisciplinary, and they are focused on a topic.

What you sometimes see in the field of obesity, which is probably true in other fields as well, is that there are a lot of instances of people making mistakes that I refer to as “errors in interdisciplinarity.” This is an error which one makes because one is completely unaware of something that would be basic and fundamental to someone in another discipline – but you as a member of a different discipline aren’t aware of it.

A simple example would be if you are a social scientist and you know that physical activity matters for obesity, and you make an assessment that some program will have an important effect, but you don’t know anything about body mass or energetics. You then project the amount of weight change that could occur because of the physical activity intervention without understanding the physics, the mechanics, or the energetics. This is an error of interdisciplinarity.  We see these things regularly.

When I was “growing up” in the NY Obesity Research Center, these kinds of things would become the fodder of your education as a young person. So if you piped up and raised your hand in a seminar and said, “What about this?” it may reveal that you didn’t understand a basic concept in statistics, psychology, physiology, or anatomy. Then the more senior people around, who were experts in those things, would say to you, “Come on over here, kid, let’s explain to you that’s not how that works.” You got it drilled into your head, an emphasis of interdisciplinarity – the idea of real expertise – and avoiding these simplistic mistakes that you still see so often now in people who are focused on obesity research. That is one very valuable part of it: bringing together an interdisciplinary cadre of experts on the topic who then educate young people to be an expert in a topic, and not just get caught up in their own discipline.

The second thing that is extremely valuable is the idea of the NORC as provocateurs of people’s interests. The total amount of money in the NORCs per se is not much – around $750k/year in direct costs – not much bigger than one or two R01s. What is important is not the total cash value, but the way the value is delivered through a leader on campus, who then uses the funds as a lever, at the right points to provoke activity, and provoke interests.

Years ago, early in the NORC’s history at UAB, it became clear to me that using more invertebrate models for obesity was important, that genomics was upon us, and that we should have people working with Drosophila and C. elegans. I was able to use different pieces of the NORC to provoke that. For example, I would bring in speakers through our seminar series who worked on those topics. We had funding for pilot grants that could be used on that research. There were extra discretionary funds from institutional matching, so I could use those funds to recruit some younger people to work on these topics. All those things came together so that people were writing and getting R01s to do research involving those organisms.

There are other things that are important for the NORC in terms of sense of identity.  People are excited to be at an NORC because they feel that they are at one of “the” places. The dollar amount of the NORC isn’t that great, but the prestige value is high. It serves to create an identity to get people excited – to pull them together to work together on things. Those are some of the big values of the NORCs today.

You were director of the NORC at the University of Alabama at Birmingham for nearly 15 years. How have you seen the effect of NORCs change over that time?

I think we have seen a couple of changes. In general, science has changed, and the NORC science has changed with it. Science has become more molecular, more genetic, and the NORCs keep up with the trends of general science. Other things I have seen in NORCs is this idea of leveraging the amount of money. Not only is the amount of money provided by the direct costs of the NORC not large, especially compared to diabetes centers, cancer centers, and other NIH centers that receive much more than NORCs, but it’s been flatlined for over 20 years. If you compared the NORC funds in real dollars to the dollars from 20 years ago, the current funds are much smaller.

NORCs have become these engines – at their best – where creative leaders use the P30 grants as the nucleating site around which to build other stuff. You go to your institution and get a match in funds, and then you get some T32 grants. You say, “Isn’t this great we have an NORC, so we can do great training. Please give us a postdoctoral and predoctoral T32 in obesity, and then why don’t you give us an R5 to do a national short course in obesity?” … You keep adding those things on. We at UAB were very strong on that. Many other institutions are as well, and that is one way you have seen the NORCs change. They have become these multi-infrastructure grant organizations.

When speaking with other NORC directors and center administrators, what are some of the advances and successes that have stood out to you?

I think probably more than anything, the successes and advances that I hear the NORC directors take the greatest pride in is the young people who they help get started, and that is especially true for those NORCs that go on to get T32s, which many have. How I got my own start was on a T32 while in New York. That is also how I learned to write T32s, by being thrown into it by my old boss at the NORC. He said, “Here’s my old folder. I’m going on a trip out of the country. I will be back after this thing is due. Good luck,” and I said “…okay,” and so I learned how to write a T32 grant.

I think when people are successful in getting those T32 grants, as well as in getting young people involved, however they do it, bringing new people into the field, and helping those new people achieve, it is a great success. You can look at many of us and say that we are products of the NORC systems themselves. Myself, Doctors Dympna Gallagher, Tim Nagy, Barbara Gower, Michael Goran, and many others, are all the products of these centers, brought in as postdocs at the beginning of a center. Many who are NORC directors now got their start there.

How do NORCs help cultivate the future generation of nutrition and obesity researchers?

To reiterate, the interdisciplinarity: training people so they are not just a public health person that says, “Yeah I get it, people, they eat too much and exercise too little, what else do I need to know about obesity. Now I just need to talk about the policies that will make people eat less and exercise more.” Well, maybe it would be good to know a little more than that. NORCs bring up people with a more robust knowledge of this. The NORCs also draw people into the field, give them a sense of identity and belonging and an enthusiasm for being in the field.

You have been critical of the rigor at which obesity and nutrition research is performed. Do you think that NORCs have been able to increase the quality of research in the field?

I think that NORCs do increase the quality of research in the field, and they lead by example. I am critical of the rigor and quality of the research everywhere, including in my own research. That is important for us to do as scientists – to be critical of the rigor and the quality of research – and to make it better. I think there are particular concerns raised in the field of obesity, and some of those concerns in my mind came out in the mid-90s when obesity began to be seen as a public health crisis.

Instead of obesity research being driven to a greater extent by people who were fully involved in it for a long time, and involved with others in getting this interdisciplinary background, it became more that anybody felt that they can jump in. Any economist, any public health official, jumped in with zealous passion, which much of the time wasn’t matched with rigorous background knowledge. This has led to some of the more questionable research we have seen. It’s not everything, but just one factor. NORCs are helping by providing training for people, by putting out good research, and by leading by example.

What are some fond memories from your time at UABs NORC

Well, pulling together on things in general. Part of what makes a great center great is people working together as a center. In fact, one of the things that attracted me to come down to UAB was in fact its centeredness. I had other offers before heading to UAB, and some were at institutions that were more attractive in some ways, but what I liked about UAB and the NORC was the feeling that this was a group of people that worked together, and only a slight exaggeration, but it was a sense of a family. I really liked that. To me, a lot of my fondest memories were pulling together with Tim Nagy, Barbara Gower, José Fernández, Tim Garvey, the late Roland Weinsier, Stephen Barnes, Steve Austad, Kevin Fontaine, Julie Locher, Gary Hunter, and I am sure I’ve missed many important people, but the ability to pull together through tough challenges, working hard, overcoming obstacles – doing things together which none of us could have done alone.

 

This is part two of a two-part interview with Dr. David Allison.

Doctor David B. Allison is the current dean, distinguished professor, and provost professor at the Indiana University School of Public Health-Bloomington. Prior to Indiana University, Allison was a distinguished professor, Quetelet Endowed Professor, and director of the NIH-funded Nutrition Obesity Research Center (NORC) at the University of Alabama at Birmingham (UAB). Allison was appointed director of the NORC in 2003 and served until 2017. Allison has published more than 500 scientific papers with research interests including obesity and nutrition, quantitative genetics, clinical trials, statistical and research methodology, and research rigor and integrity.

In addition to his primary appointments, Allison is a co-director for two NIH-funded “Short Courses” on obesity research held in Birmingham, Ala., during the summer. Dr. Allison’s “Short Course on Mathematical Sciences in Obesity Research” is going on its fifth consecutive year, while the “Short Course on Strengthening Causal Inference in Behavioral Obesity Research” is coming up on its fourth consecutive year. These interdisciplinary courses convene a cadre of expert faculty members who teach on various aspects of obesity research, covering economics, epidemiology, statistics, genetics, and much more. These courses are oriented toward investigators who want to increase the rigor in their approach to obesity research, and they bridge various disciplines in which obesity research is performed. Allison took the time to answer a few questions regarding the ability to better approach obesity and nutrition research.

You have noted that the rigor of obesity research has been lacking. Has there been a shift in recent years?

I don’t have unequivocal data as to whether there has been a shift in recent years in obesity research or research overall. I have a hypothesis though, which is when you look within any one journal, research is getting ever more rigorous, whereas when you look across all journals, it may be getting less rigorous because of the influx of new journals.

If you take a journal like the American Journal of Clinical Nutrition, they keep getting more rigorous. That is in part because the editor-in-chief, Dr. Dennis Bier, has a very strong commitment to that, and he has built an associate editorial board who shares the commitment. Meanwhile, other journals keep springing up that are not as rigorous. So for the overall quality of the literature, I am not sure if it is going up or down, since you have these competing factors.

One of the things my colleagues and I are writing a paper on now is the childhood obesity intervention literature, which seems to be particularly susceptible to distortion. We hypothesize that this has to do with feelings of zealousness – the idea that childhood obesity is such a problem and it must be addressed. To come out after an expensive and effortful intervention and say, “Guess what, I did an intervention and it just didn’t work, so let’s move on.” People just don’t want to say that. They want to instead say, “But it must work, we can’t tell people not to do this, especially if we don’t have something better, so let’s twist and bend and ‘find a pony in there’.” We see a lot of “spin” in these things, and that is an area where things seem to have become worse.

What are your suggestions to researchers in the field to increase conscientiousness in limiting and being transparent about shortcomings in the quality of the research produced?

I think there are different aspects to it. Some aspects to it, and perhaps related to what I was saying about the childhood obesity literature, is that people, often again with good intentions, are bending the truth. I think that we need to continually remind ourselves that we are scientists and reflect on why we all got into science in the first place. To be a scientist means to pursue truth through the scientific method. We have to affirm that speaking the unvarnished truth is an uncompromisable imperative. Commitment to one’s identity as a scientist is something to be held dear.

Then, I think there are some things that are more skill-level. Many errors I see – and partially because this is my expertise, so I see what I understand and know about – are statistical errors. One of the challenges is that the norm for many years was, and still is, that many scientists should be able to conduct their own statistical analyses. Physicians are generally not trained with this mentality, because they get very little training in statistics. They accept that they will need to go to a statistician – most at least. Whereas if you are trained in a field like nutrition, psychology, physiology, or biology, you get a PhD in that, and you get one or two statistics courses as you earn your PhD, often taught by that same department. The person who teaches that course tends to not be a professional statistician, but rather a physiologist, biologist, or nutritionist who knows a little statistics. What you are getting is kind of an intelligent amateur who is running the statistics for professional research.

If you think about that – it’s the equivalent of me saying that I need to get a kidney surgery and I say, “Well, I have an anatomy book. I know approximately where my kidneys are. I have a bottle of hand sanitizer. I can get some rubber gloves and a pocket knife, and I can do it myself.” Well, no. Just because you have an anatomy book and you know where the kidneys are and you understand the idea of surgery doesn’t mean you are a professional surgeon, and we wouldn’t have you do it. Why take a different view about statistics? Part of what we are currently exploring, since statisticians are in limited supply, is how we can get more professional statisticians to be involved with more papers, and how can we create a culture and an economic situation that would permit that.

Is there an overreliance on observational research in nutrition/obesity studies? If so, why is this the case?

I think there is sometimes a reliance on observational studies for situations in which they are not what I would call “probative.” For example, you can think, “Well, maybe Pokémon GO is going to reduce obesity levels.” No-one has ever looked at it, so sure, go ahead and do an observational study. Do people who start using Pokémon GO lose weight or gain less weight? And that is fine, there is nothing wrong with that. You might even want to replicate it once or twice. But if you say, “Well, now we’ve done that, so let’s do 20 more of those,” then you need to wonder why you need the next 20. Maybe you need one more to confirm it, but not 20 more. What you see is people not shifting out of the observational and into the experimental when it is called for. For example, breakfast consumption, fruit and vegetable consumption, things like that – when people continue to grind on the observational literature long after it is really useful.

You have noted that you see many errors in obesity and nutrition related meta-analyses. How would you caution investigators in interpreting these papers?

I would say, interpret with a grain of salt, particularly if there isn’t a professional statistician on there. The issue is that there is software out there, where it is seemingly easy. You plug in a few numbers, and it spits out a meta-analysis for you. The problem is, you need to know what numbers to plug in. That is where the problem, the challenge, and the mistakes often occur. Particularly, these mistakes seem to occur around variances. I would caution anybody who is going to do a meta-analysis who thinks, “Oh, meta-analyses are easy. I can just get a grad student to grab some papers, write the numbers down, and plug them in some public software.” I would caution people not to do that, but to have a professional statistician involved.

You have published articles criticizing the statistics and assumptions of various academic papers, resulting in their retractions. Can you theorize why these papers are being published in the first place? What are some mistakes that you see most often?

Why they get published in part is because we don’t really have a good system for vetting papers. Many people seem to think that peer review is that system, but I don’t think it was ever realistic to expect that peer review can be the true gatekeeper of papers and can eliminate all mistakes – or even most mistakes. I think peer review just checks if a paper belongs, and then you receive advice. But the peer reviewers don’t have the time and the ability to go through everything the author and investigator did to see if it is correct. That must fall on the investigators themselves. I think many investigators let a lot slip through – some intentional and some unintentional. I think we need to work on both of those things.

What would you recommend to young researchers in the field of obesity and nutrition who would like to improve their ability to identify poor methods and conclusions?

I would say to take our short courses. Read very widely, including interdisciplinary work. Read some work on the physiology of obesity, the genetics of obesity, engineering approaches, computational approaches, nutritional, psychology, medical, and economic approaches, so that you have a broad base to compare things to. I would say to talk broadly and question everything. Question yourself. Question your own ideas. Those are all important things to do.

 

This is part two of a two-part interview with Dr. David Allison.

One of the best feelings is when you get a good night’s sleep and feel refreshed to take on the day. Unfortunately, many of us (especially us graduate students) stay up too late and wake up too early, which leads to not enough sleep and/or poor sleep quality. However, getting enough sleep may be an important health habit to prioritize since research has suggested there is a link between sleep and nutrition.

Recently, a study that found a negative correlation between sleep and sugar consumption has been getting a lot of media attention. In this study, researchers from King’s College London recruited 42 healthy participants who reported frequently sleeping less than 7 hours of sleep per night. At baseline, participants were given a wrist actigraph to objectively measure sleep and were asked to record their sleep and wake times in 7-day sleep diaries, along with their food intake.

After baseline assessments, participants were randomly assigned with stratification to the sleep extension group (n = 21) or the control group (n = 21). Participants in the sleep extension group were given a personalized sleep consultation session with the purpose of encouraging participants to increase time in bed by about 1-1.5 hours each night. The control maintained their usual habits.

After one month, researchers found that the sleep extension group increased their time in bed by 55 minutes, sleep period by 47 minutes, and sleep duration by 21 minutes, on average. These increases led the sleep extension group to meet a weekly average sleep duration of the recommended 7-9 hours. These increases in sleep were not observed in the control group. However, participants in the sleep extension group reported a decline in sleep quality. The researchers speculated this might have been due to the adjustment period of spending more time in bed. Participants in the sleep extension group also self-reported lower sugar consumption, which was significantly different from the control group. There was a trend towards a decrease in carbohydrate and fat intake in the sleep extension group as compared to the control group, but this was not significantly different. The researchers found no difference in cardiometabolic risk factors or appetite hormones between the groups from pre- to post-.

These results demonstrate that sleeping longer could be associated with consuming less sugar. However, this study had several limitations, such as using a small sample of predominantly white females and relying on self-reported food records. More research needs to be done in this area using larger randomized controlled trials over a longer duration. For now, the current sleep recommendations are to aim for 7-9 hours of sleep a night.

 

Reference:

  1. Al-Khatib HK, Hall WL, Creedon A, et al. Sleep extension is a feasible lifestyle intervention in free-living adults who are habitually short sleepers: a potential strategy for decreasing intake of free sugars? A randomized controlled pilot study. Am J Clin Nutr. 2018;0:1–11. doi:1093/ajcn/nqx030

April 2017 Member Highlight Interview for ASN Nutrition Notes eNewsletter:

Interview with Robert Bertolo, Professor, Department of Biochemistry, Memorial University of Newfoundland, Vice Chair of ASN Publications Management Committee, and Immediate Past President of the Canadian Nutrition Society

Dr. Bertolo has been with the Memorial University of Newfoundland since 2002. He trained at the Universities of Guelph and Alberta studying nutrition and metabolism during development with a focus on amino acid and protein nutrition. As a Professor of Nutrition and Metabolism and Canada Research Chair in Human Nutrition, his current research involves the neonatal use of amino acids for growth and non-growth requirements.

1. How did you first get involved in biochemistry and nutrition? What made you interested in the field?

My undergraduate degree was in liberal arts with a minor in biochemistry and when it came time to choose my honours thesis topic, a course in nutritional biochemistry by Stephanie Atkinson piqued my interest. The work in the lab was exciting and that environment felt like home. So I started my MSc at Guelph in nutrition shortly thereafter and never looked back. What I really enjoyed about studying nutrition and metabolism is the combination of mechanisms with real world applicability. Anyone who eats is a self-declared expert in nutrition so the field is uniquely influenced by the public and is very dynamic. There’s always so much to learn, and even more to teach.

2. When and why did you first join ASN? What convinced you to join the organization?

As with most of us, I first joined ASN as a graduate student to get connected with the network of researchers and to present our data. It’s a testament to ASN’s support of trainees that we all join so early. My first EB was an unforgettable experience of excitement, nerves, intellectual stimulation and fun. Presenting to the names on your reference list is quite the experience, but also realizing they’re all just regular folks made it so rewarding. After that first conference, ASN became the home base for networking with international experts and learning about many other disciplines within nutrition.

3. What aspects of ASN membership have you found most useful, professionally? What other aspects of your membership do you find useful as your career has progressed?

Probably the most important asset to membership is the networking opportunities with nutritionists from around the world. ASN is the gathering place for nutritionists from around the world and it allows you to learn about peripheral topics in nutrition so you don’t get consumed by your own little niche. A key part of this networking is getting involved in ASN activities including RIS events, committees, judging, etc. That’s really where you meet wonderful people of all career levels and from various disciplines. Many collaborations (and friendships) are started in the hallway between sessions or at a poster or at a break during the committee meetings. The world of research today is all about team effort, so these connections are key to research success.

4. How do you see ASN’s role in the nutrition community?

I was president of Canadian Nutrition Society shortly after it too was formed from the merger of nutritional sciences and clinical nutrition societies. ASN was a model we used to build a community of nutritionists with different goals and priorities. We admired ASN’s ability to grow and be strong, while at the same time taking risks and constantly looking for opportunities. It was because of our similar goals that we established a joint membership opportunity and we continue to collaborate. And beyond Canada, ASN has made it a point to link with many nutrition societies internationally which is a testament to their role as global leaders.

5. Can you tell us more about your current position and the research in which you are involved?

I am full professor at Memorial University of Newfoundland, which is on the eastern edge of North America. It is a mid-size university in a beautiful location with a great collaborative atmosphere. For research, I am interested in amino acid metabolism and how it affects requirements in different situations. Currently, I am trying to determine how neonatal nutrition and methyl metabolism affect programming of risk for developing obesity and hypertension. From a nutritional perspective, my question is how much methionine is needed to maintain growth and methylation demands and which pathways take priority when nutrition is inadequate. We have some exciting data on the non-protein pathways of methionine and are able to quantify these fluxes using tracer kinetics. I also have other research on amino acid requirements during intestinal stress, such as in parenteral feeding and short bowel syndrome. Overall, I try to conduct all of my research by building a team of experts to enhance the research questions and outcomes. I feel this is the key to research success.

6. What do you feel are the biggest challenges facing nutrition researchers today? Are there any areas where you would like to see more research?

The funding climate has become very difficult, especially for young researchers. There is a short-sighted emphasis to funnel more money to the top researchers which starves the more modest base. I think the key for young nutrition researchers is collaboration and to lead team approaches to big ideas. Don’t be afraid to have someone take you out of your comfort zone; we’re to learn after all. In terms of areas of future research, I think we need more understanding of nutrition behaviours and food environments. We have known for a long time what we should eat to be healthy, but we can’t seem to convince the public to do it. I am also concerned about food insecurity in North America and more work at the policy level is needed resolve this issue. And all of this relates back to the obesity epidemic, which is a very modern issue that has eluded effective solutions.

7. Is there anything else you’d like to tell ASN members, especially students and postdocs?

I think the key message for trainees is to get involved. There are many opportunities out there that could lead to something great. Almost none of us foresaw our current path as students and so trying to plan a specific outcome is just not realistic. Get involved in ASN and other societies and meet people. Most of us are where we are after a chance meeting with someone at the right time and that happens by getting out there. So get involved!

Editor’s Note: Under Dr. Bertolo’s leadership, ASN and CNS began offering joint memberships in 2015.

By Seth Morrison

My name is Seth Morrison, a final year medical student at the Medical School for International Health in Israel. I would like to share with you a taste of my experiences in the ASN’s unique Clinical Nutrition Internship.

Clinical nutrition was never really on my radar as something I might become interested in until halfway through medical school. It was then that I attended the International Congress of Nutrition held in Granada, Spain, where I met some members of the ASN. Like most medical students, the nutrition content in my courses was only enough to whet my appetite. I never had a chance to really delve into nutrition in-depth so that I would feel comfortable counselling patients or speaking intelligently about it with colleagues. The ICN conference opened my eyes to the many different research branches of the nutrition sciences as well as public health nutrition. The global trends in the “double burden” of malnutrition (undernutrition and overnutrition) in developing countries began to worry me, and I started learning about the many efforts that are underway to intervene. All of this made me want to find an opportunity to supplement my nascent interest in nutrition, and see which career avenues exist. I would like to incorporate nutrition into my medical practice and possibly conduct public health nutrition interventions in resource-limited settings worldwide. That is when I discovered this clinical nutrition internship.

I think my internship was an unparalleled opportunity for a medical student to get an insider’s look into the fascinating world of clinical nutrition and nutrition science. The variety of opportunities I had at the University of Colorado and Children’s Hospital Colorado working with Dr. Nancy Krebs as my mentor gave me the ability to look at the role of nutrition in health from many different angles. I saw how important clinical nutrition is in the weekly outpatient clinics at Children’s Hospital. There were two separate clinics for kids with either growth faltering or obesity. These clinics are where I spent a great deal of my time. Throughout that time, I gradually gleaned the beauty in which skilled nutrition practitioners were able to make a real difference in outcomes as a team. Other physicians in these clinics, along with the amazing nutritionists, nurses, and a clinical psychologist, each contributed to my education in unique ways. They taught me the decision-making process of how to decipher clues to the causes of very different clinical nutrition problems (i.e. overweight vs. underweight), whether they be organic, lifestyle-related, or sometimes, in the case of young children, family food-related behaviors. This created the immensely enjoyable opportunity to decipher solutions to these myriad problems with clinical judgement and a creativity that respects the patient’s/family’s abilities and interests. I like to say today that in order to provide effective dietary counselling to patients, each doctor should have a little bit of a nutritionist inside them. This skill is one of the greatest gifts that the internship provided me for my own toolbox of clinical skills.

A sampling of the other components of my internship that made it very well-rounded were a research project, visits to WIC clinics, family eating well classes, several journal clubs and special nutrition lectures every week, and even a few nutrition-related Grand Rounds on Friday afternoons. I also completed a research project, which was a small metabolomics study on the relative serum levels of acylcarnitines and branched-chain amino acids in lean vs. obese groups of pregnant Guatemalan women.

This research component of the internship added an essential ingredient to the overall experience. Not only did I get to work with a fantastic and knowledgeable basic science researcher on a project in a burgeoning field of nutrition science (metabolomics), I also gained new skills and refined others that are needed in any research project I may become involved with in the future. This academic component reinforced the ever-present need for an army of researchers to inform the nutritional counsel given to patients in clinical medicine.

Inpatient care in the University of Colorado Hospital especially gave me the chance to see how crucial proper nutrition is for pre- and post-operative patients, burn unit patients, and of course in critical care. The nutrition support physician and the knowledgeable dietitians there broadened my knowledge of TPN and other topics in critical care nutrition research. In doing so, the truth was ingrained in me that nutrition is dynamic and can, in different circumstances, be prevention, treatment, or even both. Whether a patient is acutely ill or on a path of long term lifestyle change to reach a healthy weight, nutrition is likely to play an important role in their success!

The ASN Clinical Nutrition Internship satiated a special hunger for this nutrition niche in my medical education. I could not be more grateful and proud to have been awarded this unique opportunity, and the memories from it will linger with me for the rest of my career. As a soon-to-be physician, I’ve now learned that nutrition is a bit like music. It’s nice to listen to, but to really appreciate it, you must also learn to play some of your own notes.

 

By John E. Courtney, PhD

As a society, ASN highlights the very best scientific research that promotes healthy people and communities; we recognize that nutrition research is conducted within and across the public, private and government sectors of our society. ASN members understand that the nutrition challenges facing the world are multi-faceted and require research-based solutions. The Society also understands that public confidence in scientific research and integrity is essential to translate scientific evidence into improved dietary practices by consumers.

ASN’s professional activities allow members to come together and share information and research findings that accelerates discoveries that allow us to better understand the connections among diets and health. As a broad member-based organization, we are transparent about the fact that industry, government, trade groups and other scientific organizations contribute funding to help our society support the research enterprise for all of our members. ASN is committed to openness, objective science, and disclosure of potential conflicts. The Society’s Conflict of Interest attestation and “guiding principles for working with external groups and addressing COI” can be found on our website. All of the Editors for ASN’s three journals have publicly-available conflict of interest statements, which is not a required process and is an example of our commitment to transparency.

ASN promotes rigorous research that highlights the very best dietary practices, policies and guidance. Because issues of nutrition impact virtually every aspect of the food supply chain, involvement of all informed stakeholders in the scientific enterprise is essential. Furthermore, in today’s extremely competitive research environment, industry support helps progress research that might otherwise be impossible due to limited federal funding. ASN, like all scientific societies, remains vigilant in safeguarding the integrity of the scientific process from the biases and influences that can be associated with research funding from all sources. Without scientific integrity, there can be no public trust.

ASN does not have small goals, and therefore we cannot work in a vacuum. We believe that scientists in academia, government, and industry can partner to solve the world’s nutrition challenges. Our members work with moms and dads, children, the elderly, the sick, the under- and over- nourished, foundations, companies, governments, and media. We look forward to continuing to work with all stakeholders who are passionate about nutrition and committed to the highest ethical standards for research that advances the public health to achieve a healthier world.

ASN welcomes all to the table to learn from one other and to make progress on continuing to solve today’s complex nutrition challenges. These challenges include improving mechanisms and processes to fund, conduct and review nutrition research that improves global health.

By Banaz Al-khalidi

First released in 1980, the Dietary Guidelines for Americans are updated and jointly published by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) every 5 years. These guidelines provide recommendations on nutrition and physical activity for Americans aged 2 and older, and are the driving force behind Federal nutrition policies, nutrition education and food procurement programs. As such, these guidelines are used by both the public and industry, and by a wide variety of audiences including educators, health professionals and government agencies.

Earlier the 2015 Dietary Guidelines Advisory Committee (DGAC) released a Scientific Report based on the latest evidence, which will shape the finalized guidelines later this year. The committee’s work was influenced by two fundamental connections between nutrition and lifestyle-related health issues facing the U.S population:

1) Chronic diseases, overweight and obesity: about half of all American adults (~117 million) have one or more preventable chronic diseases such as type 2 diabetes, cardiovascular diseases, hypertension, and diet related cancers, and about two-thirds of adults and one-third of children are overweight or obese due to poor dietary habits and physical inactivity.
2) Food environment and settings: diet and lifestyle behaviors are strongly influenced by personal, social, organizational, and environmental context and systems. As such, the DGAC developed their recommendations based on a conceptual model of socio-ecological framework to provide recommendations at the individual, social, organizational, and environmental level.

What does the DGAC’s report say about the latest research on diet and lifestyle-related health outcomes?

The DGAC found that the current average American diet is low in vegetables, fruits, and whole grains and too high in refined grains, added sugars, saturated fat, and sodium. Furthermore, inadequate consumption of vitamin D, calcium, fiber, and potassium were categorized as nutrients of public health concern for the majority of the U.S population. Lifestyle-related health problems in the U.S. have persisted for more than 2 decades and the DGAC’s report calls for urgent preventative actions at the national, state, and local community levels. The DGAC recommended a shift in focus to a more environmentally friendly, sustainable plant-based diet that focuses on whole foods rather than specific nutrients. The overall body of evidence examined by the committee is summarized below:

“A diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet.”

This is not to say that any food groups need to be eliminated completely to improve health and sustainability outcomes. In fact, the DGAC recommended three dietary patterns to provide options that can be adopted by the U.S. population and are also aligned with lower environmental impacts. These dietary patterns include the Healthy U.S. style Pattern, the Healthy Mediterranean style Pattern, and the Healthy Vegetarian Pattern. Furthermore, the 2015 DGAC left out cholesterol restrictions where previously, the 2010 DGAs recommended that cholesterol intake be limited to no more than 300 mg/day. The up-to-date evidence on cholesterol showed no substantial relationship between dietary consumption of cholesterol and blood cholesterol. Thus, the 2015 DGAC concluded, “Cholesterol is not a nutrient of concern for overconsumption.”

The message is clear—the 2015 DGAC recommends the U.S population consume dietary patterns that are rich in vegetables, fruits, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol; lower in red and processed meat; and low in saturated fat (less than 10% of total calories consumed per day), added sugars (maximum of 10% of total calories consumed per day), and sodium (2,300 mg per day or age-appropriate Dietary Reference Intake amount). Whether the USDA and the HHS will choose to adopt or ignore these recommendations put forth by the 2015 DGAC remains uncertain at this point. Meanwhile, dozens of health and environmental groups support the committee’s recommendations regarding sustainability, as viewed in the open letter found at My Plate My Planet, Food for a Sustainable Nation.

The advisory recommendations put forth by the 2015 DGAC are also closely aligned with recent research highlighting the urgency of shifting global diets, where healthy dietary patterns (i.e. Vegetarian, Pescetarian, and Mediterranean diets) are found to be associated with more favorable health as well as environmental outcomes. Thus, the available data strongly suggest that diets that are higher in plant-based foods will not only improve personal and public health, but also boost our planet’s health via “weight” reduction in greenhouse gases mainly due to reduction in livestock production.

By Brett Loman

Now more than ever before, the world of academic science is a competitive place. However, does the current environment promote good research? Could the current system from pipette to publication create an environment that incubates bad science? The pressure is on to produce high quality, impactful data in order to climb the academic pyramid, but why is this becoming the rule rather than the exception?

The obvious first place to point fingers is at the evaporating pool of funding. The NIH, a principal funding source for many of us in the life sciences, experienced a budget cut of 5% equaling $1.55 billion below the previous fiscal year. Concurrently, grant success rates dropped to a historic low of 16.8%. Approximately 10% of all submissions to journals are accepted, with top tier publishing groups such as Nature maintaining rates under 8%. Quality control (a very important part of the publication process) can be attributed to a large chunk of these rejections. However, like all businesses, profit and competition rule and questionable research still makes it through the overloaded and poorly regulated peer review process.

Under a publish or perish credo where deans and provosts often value quantity over quality, how likely is it for researchers to overexaggerate and tweak results? Given human nature, it doesn’t seem likely that an Olympic-sized group of inflated egos is going to play nicely in the kiddy pool. Should we then be pointing the fingers at ourselves and taking a good look in the mirror? Are these pressures leading to bad practice, and in turn, potentially misleading publications? In a world where the goal line is productivity and that line keeps inching forward, salami slicing, HARKing, positive result bias, cherry picking, and a whole tidal wave of biases are threatening to wipe out the credibility of science and the people who conduct it. What happened to the pursuit of knowledge being noble and objective? Who is to blame and how do we plug up the leak before it becomes a flood?

Certainly the competition isn’t going away anytime soon as the number of investigators continues to grow annually. Personally, it seems like a vicious cycle where every faction needs to take responsibility to amend the issues and hold themselves to higher standards. Passing higher values and standards on to the next generation of budding scientists is crucial.

The ASN symposium at Experimental Biology 2014 in April titled “Unscientific Beliefs about Scientific Topics in Nutrition” brought to light these higher values. It was reassuring to hear Drs. Andrew Brown (UAB) and Mark Cope (Solae) point out that these biases and poor practices were not going unnoticed. More importantly, they offered potential solutions. Dr. Brown discussed the importance of honestly reporting the results of other studies. Even if we dutifully report our results, we can only hope that other scientists do not misconstrue these outcomes or condemn us for them. Dr. Cope echoed a common theme raised throughout the session that accessible study registries and approval databases could help curb some of these unethical practices. The missing component in these talks was the role of current culture in publishing groups, which is why I have mentioned it here. Watch the recorded lectures from this session that struck a chord with me. I invite your personal comments and insights below!

By Colby Vorland

Southwest Airlines is consistently rated as serving good food on their flights, yet they don’t serve food at all. Can we trust diet data if people don’t know if they even ate? This amusing anecdote was offered by Dr. David Allison at the following session during ASN’s Scientific Sessions in San Diego in April: “Not Everything That Counts Can be Counted and Not Everything That Can Be Counted Counts: How Should We Collect Dietary Data for Research?” chaired by Drs. Regan Bailey and Claire Zizza. The session was organized by ASN’s Nutritional Epidemiology, Aging/Chronic Disease, and Community/Public Health RISs. The panel took a critical perspective but also emphasized the value in using self-reported diet intake data.

Dr. Allison was the first presenter, taking a hard position on self-reported energy intake in nutritional research: it just isn’t good enough. Not only that, it often flat-out misleads obesity research. Allison highlighted a recent paper by Archer and colleagues that looked at energy intake of respondents in NHANES from 1971-2012, finding that 67.3% of women and 58.7% of men were not physiologically plausible – i.e. the number of calories is “incompatible with life.” Correlations with the IOM’s gold standard equation for estimating total energy expenditure were 0.163 for women and 0.225 for men, effectively yielding no meaningful relationship. This “doesn’t seem like science anymore,” Allison stated. This problem has been known for a long time: in 1991, Goldberg and others looked at 37 studies across 10 countries and found that over 65% of the mean ratio between reported energy intake and basal metabolic rate measures were implausible. Forrestal also published a review in 2010 of 28 papers looking specifically at children and adolescents, finding that about half misreport energy intake.

It is time to abandon self-reported energy intakes in favor of less misleading paths in obesity research, Allison said. It is not worthy of scientific use because the measurement errors are not random and modest, estimates are often not in the correct direction, and errors will not lead to the detection of false effects under plausible circumstances. He told a story of how originally, self-report intake data suggested that the overweight consumed less energy than they expended, but using more rigorous methods proved exactly the opposite to be true (here is a 1990 review by Schoeller). Allison said that we currently have no economic and social incentive to make a complete transition to incorporating doubly labeled water, as the cost has been flat since the 1980s. It will be painful initially, but clearly we need to make the transition.

Dr. Amy Subar argued that energy intake is not the only important aspect of diet data, and improvements are being made to collection methods, and therefore we shouldn’t throw the baby out with the bathwater. Even if total energy intake isn’t accurate, we still can track food patterns, diet quality, nutrient intakes, and social and physical environments. Subar emphasized the utility of self-reported data- it can yield more comprehensive data with much less of an investigator burden compared to biomarkers or observation, but there is the issue with error. Within-person variation and memory are 2 potential errors, but adjustments are possible. New technologies, such as keeping food records with mobile phones or wearable sensors to reduce reactivity to monitoring and burden, are being developed to improve self-report data. In addition, Subar has been involved in the development of self-administered 24-hour recalls – ASA24 – to be able to gather a lot more data from participants without investigator burden. They have validated the accuracy of this method against interviewer-administered recalls. Dr. Subar noted that food frequency questionnaires have more bias than short-term methods but combining multiple recalls with food frequency questionnaires could reduce this.

Dr. Elizabeth Yetley expanded on how self-reported diet data is currently relied on in national policy. For example, fortification strategies would not be possible without such data. Many considerations go into fortification, and modeling specific foods and evaluating the outcomes of such programs are important. The IOM uses diet data to track added sugars and salt disappearance. Nutrient safety can also be tracked. For example, data from the Total Diet Study in 1981 was able to quickly identify unexpected iodine sources in the food supply that were resulting in extremely high intakes. Diet data is also used for food additive/GRAS reviewing, to examine what has been added vs naturally occurring. Yetley states that there would be a significant adverse effect on policy if intake data wasn’t available. However, intake data can fail to accurately predict nutrient status, as Pfeiffer et al. (2012) have demonstrated. In 1988, Lewis and colleagues showed that cola intake could be underestimated by about 50%, though Yetley notes that surveys have been improved since then. Iron fortified cereals also virtually always underestimate the actual intake when using the amount listed on the label. Self-reported intake using label data is therefore not accurate. Infrequently consumed foods such as alcohol beverages also cause problems in nutritional epidemiology. However, Dr. Yetley reiterated that it is still crucial for many uses and we can work to improve precision while using caution when interpreting.

Finally, Dr. Laurence Freedman discussed some studies that are being done to improve self-reported intake measurement. Freedman began by emphasizing that we can do validation for some nutrients by comparing to recovery of biological products; for example, using doubly-labeled water for energy expenditure, nitrogen for protein, potassium and sodium for themselves. The error is indicative of true intake. However, for many we don’t have accurate recovery products. Freedman described a project he is involved in – the Validation Studies Pooling Project – that aims to better understand measurement errors of food frequency questionnaires and 24-hour recalls using recovery biomarkers. For example, in the AMPM study, energy intake is underreported on 24-hour recalls by about 10%, but underreporting of intake differs by nutrient. Measurement error effects diet-health outcomes by attenuating relative risks and statistical power. This attenuation is expressed as an “attenuation factor” – the ratio of attenuation to the actual value. Preliminary data shows that attenuation factors are more extreme for energy intake compared to protein, and protein density is less so than both. Adjusting datasets from energy intake alleviates attenuation factors somewhat but does not solve it, and increasing samples size does not itself solve it because of unknown confounding. Freedman went into more detail about the ASA24 (multiple 24-hour recalls) – emphasizing that they have a high response and low attrition. With 3 or more recalls, the attenuation factor for protein improves. Relative risks increase with additional recalls compared to 1 food frequency questionnaire, and combining both methods yields even better data according to Carroll and colleagues (2012). Combining biomarkers with self-report data improves statistical power because measurement error is reduced, as Freedman and others (2011) have shown. Dr. Freedman reiterated that self-report data is extremely useful for surveillance, education, dietary guidance apart from the difficulties of using it to measure energy intake.

It is clear that self-reported diet data has many important uses, but caution must be accepted when interpreting it. Hopefully improvements that are currently being validated will be adopted quickly, and for some measures such as energy intake, it seems necessary that current methods be abandoned because we know they are unacceptable.