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Wiersma M, Kerridge IH, Lipworth W. Perspectives on non-financial conflicts of interest in health-related journals: A scoping review. Account Res 2024:1-37. [PMID: 38602335 DOI: 10.1080/08989621.2024.2337046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Abstract
The objective of this scoping review was to systematically review the literature on how non-financial conflicts of interest (nfCOI) are defined and evaluated, and the strategies suggested for their management in health-related and biomedical journals. PubMed, Embase, Scopus and Web of Science were searched for peer reviewed studies published in English between 1970 and December 2023 that addressed at least one of the following: the definition, evaluation, or management of non-financial conflicts of interest. From 658 studies, 190 studies were included in the review. nfCOI were discussed most commonly in empirical (22%; 42/190), theoretical (15%; 29/190) and "other" studies (18%; 34/190) - including commentary, perspective, and opinion articles. nfCOI were addressed frequently in the research domain (36%; 68/190), publication domain (29%; 55/190) and clinical practice domain (17%; 32/190). Attitudes toward nfCOI and their management were divided into two distinct groups. The first larger group claimed that nfCOI were problematic and required some form of management, whereas the second group argued that nfCOI were not problematic, and therefore, did not require management. Despite ongoing debates about the nature, definition, and management of nfCOI, many articles included in this review agreed that serious consideration needs to be given to the prevalence, impact and optimal mitigation of non-financial COI.
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Affiliation(s)
- Miriam Wiersma
- Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Ian H Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, Australia
| | - Wendy Lipworth
- Philosophy Department, Ethics and Agency Research Centre, Macquarie University, Sydney, Australia
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2
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Nikolaidis MG, Margaritelis NV. Free radicals and antioxidants: appealing to magic. Trends Endocrinol Metab 2023; 34:503-504. [PMID: 37365057 DOI: 10.1016/j.tem.2023.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/28/2023]
Abstract
In biology, there are no good or evil molecules. There is limited or no evidence to support the consumption of antioxidants or (super)foods rich in antioxidants, for the intended purpose of an antioxidant effect, because there is risk of interfering with free radicals and deoptimizing the regulation of fundamental processes.
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Affiliation(s)
- Michalis G Nikolaidis
- Department of Physical Education and Sports Science - Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Nikos V Margaritelis
- Department of Physical Education and Sports Science - Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
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3
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Sigurdson MK, Sainani KL, Ioannidis JPA. Homeopathy can offer empirical insights on treatment effects in a null field. J Clin Epidemiol 2023; 155:64-72. [PMID: 36736709 DOI: 10.1016/j.jclinepi.2023.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES A "null field" is a scientific field where there is nothing to discover and where observed associations are thus expected to simply reflect the magnitude of bias. We aimed to characterize a null field using a known example, homeopathy (a pseudoscientific medical approach based on using highly diluted substances), as a prototype. STUDY DESIGN AND SETTING We identified 50 randomized placebo-controlled trials of homeopathy interventions from highly cited meta-analyses. The primary outcome variable was the observed effect size in the studies. Variables related to study quality or impact were also extracted. RESULTS The mean effect size for homeopathy was 0.36 standard deviations (Hedges' g; 95% confidence interval: 0.21, 0.51) better than placebo, which corresponds to an odds ratio of 1.94 (95% CI: 1.69, 2.23) in favor of homeopathy. 80% of studies had positive effect sizes (favoring homeopathy). Effect size was significantly correlated with citation counts from journals in the directory of open-access journals and CiteWatch. We identified common statistical errors in 25 studies. CONCLUSION A null field like homeopathy can exhibit large effect sizes, high rates of favorable results, and high citation impact in the published scientific literature. Null fields may represent a useful negative control for the scientific process.
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Affiliation(s)
- Matthew K Sigurdson
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Kristin L Sainani
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - John P A Ioannidis
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Department of Medicine, Stanford University, Stanford, CA, USA; Department of Biomedical Data Science, Stanford University, Stanford, CA, USA; Department of Statistics, Stanford University, Stanford, CA, USA.
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4
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Kirvalidze M, Hodkinson A, Storman D, Fairchild TJ, Bała M, Beridze G, Zuriaga A, Brudasc NI, Brini S. The role of glucose on cognition, risk of dementia, and related biomarkers in individuals without type 2 diabetes mellitus or the metabolic syndrome: a systematic review of observational studies. Neurosci Biobehav Rev 2022; 135:104551. [DOI: 10.1016/j.neubiorev.2022.104551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 01/14/2023]
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5
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Chusyd DE, Austad SN, Brown AW, Chen X, Dickinson SL, Ejima K, Fluharty D, Golzarri-Arroyo L, Holden R, Jamshidi-Naeini Y, Landsittel D, Lartey S, Mannix E, Vorland CJ, Allison DB. From Model Organisms to Humans, the Opportunity for More Rigor in Methodologic and Statistical Analysis, Design, and Interpretation of Aging and Senescence Research. J Gerontol A Biol Sci Med Sci 2021; 77:2155-2164. [PMID: 34950945 PMCID: PMC9678201 DOI: 10.1093/gerona/glab382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Indexed: 12/26/2022] Open
Abstract
This review identifies frequent design and analysis errors in aging and senescence research and discusses best practices in study design, statistical methods, analyses, and interpretation. Recommendations are offered for how to avoid these problems. The following issues are addressed: (a) errors in randomization, (b) errors related to testing within-group instead of between-group differences, (c) failing to account for clustering, (d) failing to consider interference effects, (e) standardizing metrics of effect size, (f) maximum life-span testing, (g) testing for effects beyond the mean, (h) tests for power and sample size, (i) compression of morbidity versus survival curve squaring, and (j) other hot topics, including modeling high-dimensional data and complex relationships and assessing model assumptions and biases. We hope that bringing increased awareness of these topics to the scientific community will emphasize the importance of employing sound statistical practices in all aspects of aging and senescence research.
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Affiliation(s)
- Daniella E Chusyd
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Steven N Austad
- Department of Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA,Nathan Shock Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andrew W Brown
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Stephanie L Dickinson
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - David Fluharty
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA,Departments of Mathematics and Economics, Ivy Tech Community College, Columbus, Indiana, USA
| | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Richard Holden
- Department of Health and Wellness Design, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Yasaman Jamshidi-Naeini
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Doug Landsittel
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Stella Lartey
- Department of Epidemiology and Biostatistics, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Edward Mannix
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Colby J Vorland
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, Indiana, USA
| | - David B Allison
- Address correspondence to: David B. Allison, PhD, Department of Epidemiology and Biostatistics, Indiana University Bloomington, 1025 E. 7th St., PH 111, Bloomington, IN 47405, USA. E-mail:
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6
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Nutrition Literacy and Healthy Diet: Findings from the Validation of a Short Seniors-Oriented Screening Tool, the Spanish Myths-NL. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212107. [PMID: 34831865 PMCID: PMC8624156 DOI: 10.3390/ijerph182212107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/23/2022]
Abstract
A good level of nutrition literacy (NL) is proposed as a determinant factor for following a healthy diet. Improving seniors’ NL might be particularly pertinent to enhance the quality of their diets. This study aimed to systematically design and validate a short seniors-oriented questionnaire as a screening tool to evaluate NL. We developed the Myths-NL questionnaire, composed of 10 widespread nutrition myths, and checked for its content and face validity. An observational cross-sectional study was conducted to explore the validity and the test–retest reliability, involving a community-dwelling group of 316 individuals aged 65 years and over. Construct validity was proved by establishing both discriminant and convergent validity. Cronbach α = 0.61 and Spearman r = 0.79 (p = 0.02) demonstrated internal consistency and test–retest reliability. Participants who had secondary/university studies scored significantly higher compared with those with primary (p < 0.001), and a significant linear relationship (R2 = 0.044, p = 0.001) with a positive slope (β = 0.209) between Mediterranean Diet Adherence Screener (MEDAS) and Myths-NL scores was observed, proving construct validity. In conclusion, the Myths-NL questionnaire is a valid and reliable tool to screen NL in Spanish seniors and it might be useful as an assessment NL tool for designing and implementing lifestyle interventions to promote healthy eating.
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BROWN ANDREWW, ASLIBEKYAN STELLA, BIER DENNIS, DA SILVA RAFAELFERREIRA, HOOVER ADAM, KLURFELD DAVIDM, LOKEN ERIC, MAYO-WILSON EVAN, MENACHEMI NIR, PAVELA GREG, QUINN PATRICKD, SCHOELLER DALE, TEKWE CARMEN, VALDEZ DANNY, VORLAND COLBYJ, WHIGHAM LEAHD, ALLISON DAVIDB. Toward more rigorous and informative nutritional epidemiology: The rational space between dismissal and defense of the status quo. Crit Rev Food Sci Nutr 2021; 63:3150-3167. [PMID: 34678079 PMCID: PMC9023609 DOI: 10.1080/10408398.2021.1985427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
To date, nutritional epidemiology has relied heavily on relatively weak methods including simple observational designs and substandard measurements. Despite low internal validity and other sources of bias, claims of causality are made commonly in this literature. Nutritional epidemiology investigations can be improved through greater scientific rigor and adherence to scientific reporting commensurate with research methods used. Some commentators advocate jettisoning nutritional epidemiology entirely, perhaps believing improvements are impossible. Still others support only normative refinements. But neither abolition nor minor tweaks are appropriate. Nutritional epidemiology, in its present state, offers utility, yet also needs marked, reformational renovation. Changing the status quo will require ongoing, unflinching scrutiny of research questions, practices, and reporting-and a willingness to admit that "good enough" is no longer good enough. As such, a workshop entitled "Toward more rigorous and informative nutritional epidemiology: the rational space between dismissal and defense of the status quo" was held from July 15 to August 14, 2020. This virtual symposium focused on: (1) Stronger Designs, (2) Stronger Measurement, (3) Stronger Analyses, and (4) Stronger Execution and Reporting. Participants from several leading academic institutions explored existing, evolving, and new better practices, tools, and techniques to collaboratively advance specific recommendations for strengthening nutritional epidemiology.
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Affiliation(s)
- ANDREW W. BROWN
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | | | - DENNIS BIER
- Baylor College of Medicine, Houston, Texas, USA
| | | | - ADAM HOOVER
- Clemson University, Clemson, South Carolina, USA
| | - DAVID M. KLURFELD
- United States Department of Agriculture, Agricultural Research Service, Beltsville, Maryland, USA
| | - ERIC LOKEN
- University of Connecticut, Storrs, Connecticut, USA
| | - EVAN MAYO-WILSON
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - NIR MENACHEMI
- Indiana University Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana, USA
| | - GREG PAVELA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - PATRICK D. QUINN
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - DALE SCHOELLER
- University of Wisconsin-Madison Biotechnology Center, Madison, Wisconsin, USA
| | - CARMEN TEKWE
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - DANNY VALDEZ
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - COLBY J. VORLAND
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - LEAH D. WHIGHAM
- University of Texas Health Science Center School of Public Health, El Paso, Texas, USA
| | - DAVID B. ALLISON
- Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
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8
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Zeraatkar D, Bhasin A, Morassut RE, Churchill I, Gupta A, Lawson DO, Miroshnychenko A, Sirotich E, Aryal K, Mikhail D, Khan TA, Ha V, Sievenpiper JL, Hanna SE, Beyene J, de Souza RJ. Characteristics and quality of systematic reviews and meta-analyses of observational nutritional epidemiology: a cross-sectional study. Am J Clin Nutr 2021; 113:1578-1592. [PMID: 33740039 PMCID: PMC8243916 DOI: 10.1093/ajcn/nqab002] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Dietary recommendations and policies should be guided by rigorous systematic reviews. Reviews that are of poor methodological quality may be ineffective or misleading. Most of the evidence in nutrition comes from nonrandomized studies of nutritional exposures (usually referred to as nutritional epidemiology studies), but to date methodological evaluations of the quality of systematic reviews of such studies have been sparse and inconsistent. OBJECTIVES We aimed to investigate the quality of recently published systematic reviews and meta-analyses of nutritional epidemiology studies and to propose guidance addressing major limitations. METHODS We searched MEDLINE (January 2018-August 2019), EMBASE (January 2018-August 2019), and the Cochrane Database of Systematic Reviews (January 2018-February 2019) for systematic reviews of nutritional epidemiology studies. We included a random sample of 150 reviews. RESULTS Most reviews were published by authors from Asia (n = 49; 32.7%) or Europe (n = 43; 28.7%) and investigated foods or beverages (n = 60; 40.0%) and cancer morbidity and mortality (n = 54; 36%). Reviews often had important limitations: less than one-quarter (n = 30; 20.0%) reported preregistration of a protocol and almost one-third (n = 42; 28.0%) did not report a replicable search strategy. Suboptimal practices and errors in the synthesis of results were common: one-quarter of meta-analyses (n = 30; 26.1%) selected the meta-analytic model based on statistical indicators of heterogeneity and almost half of meta-analyses (n = 50; 43.5%) did not consider dose-response associations even when it was appropriate to do so. Only 16 (10.7%) reviews used an established system to evaluate the certainty of evidence. CONCLUSIONS Systematic reviews of nutritional epidemiology studies often have serious limitations. Authors can improve future reviews by involving statisticians, methodologists, and researchers with substantive knowledge in the specific area of nutrition being studied and using a rigorous and transparent system to evaluate the certainty of evidence.
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Affiliation(s)
- Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada,Department of Biomedical Informatics, Harvard Medical
School, Boston, MA, USA
| | - Arrti Bhasin
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western
University, London, Ontario, Canada
| | - Isabella Churchill
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa,
Ottawa, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - David Mikhail
- Faculty of Science, McMaster University,
Hamilton, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Department of Medicine,
Temerty Faculty of Medicine, University of Toronto,
Toronto, Ontario, Canada,3D Knowledge Synthesis and Clinical Trials Unit, Clinical
Nutrition and Risk Factor Modification Centre, Division of Endocrinology
& Metabolism, St. Michael's Hospital,
Toronto, Ontario, Canada
| | - Vanessa Ha
- School of Medicine, Queen's University,
Kingston, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Department of Medicine,
Temerty Faculty of Medicine, University of Toronto,
Toronto, Ontario, Canada,3D Knowledge Synthesis and Clinical Trials Unit, Clinical
Nutrition and Risk Factor Modification Centre, Division of Endocrinology
& Metabolism, St. Michael's Hospital,
Toronto, Ontario, Canada
| | - Steven E Hanna
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact,
McMaster University, Hamilton, Ontario, Canada
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9
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Kroeger CM, Ejima K, Hannon BA, Halliday TM, McComb B, Teran-Garcia M, Dawson JA, King DB, Brown AW, Allison DB. Persistent confusion in nutrition and obesity research about the validity of classic nonparametric tests in the presence of heteroscedasticity: evidence of the problem and valid alternatives. Am J Clin Nutr 2021; 113:517-524. [PMID: 33515017 PMCID: PMC7948897 DOI: 10.1093/ajcn/nqaa357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/06/2020] [Indexed: 12/22/2022] Open
Abstract
The use of classic nonparametric tests (cNPTs), such as the Kruskal-Wallis and Mann-Whitney U tests, in the presence of unequal variance for between-group comparisons of means and medians may lead to marked increases in the rate of falsely rejecting null hypotheses and decreases in statistical power. Yet, this practice remains prevalent in the scientific literature, including nutrition and obesity literature. Some nutrition and obesity studies use a cNPT in the presence of unequal variance (i.e., heteroscedasticity), sometimes because of the mistaken rationale that the test corrects for heteroscedasticity. Herein, we discuss misconceptions of using cNPTs in the presence of heteroscedasticity. We then discuss assumptions, purposes, and limitations of 3 common tests used to test for mean differences between multiple groups, including 2 parametric tests: Fisher's ANOVA and Welch's ANOVA; and 1 cNPT: the Kruskal-Wallis test. To document the impact of heteroscedasticity on the validity of these tests under conditions similar to those used in nutrition and obesity research, we conducted simple simulations and assessed type I error rates (i.e., false positives, defined as incorrectly rejecting the null hypothesis). We demonstrate that type I error rates for Fisher's ANOVA, which does not account for heteroscedasticity, and Kruskal-Wallis, which tests for differences in distributions rather than means, deviated from the expected significance level. Greater deviation from the expected type I error rate was observed as the heterogeneity increased, especially in the presence of an imbalanced sample size. We provide brief tutorial guidance for authors, editors, and reviewers to identify appropriate statistical tests when test assumptions are violated, with a particular focus on cNPTs.
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Affiliation(s)
- Cynthia M Kroeger
- Charles Perkins Centre, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Keisuke Ejima
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Bridget A Hannon
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | - Tanya M Halliday
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, UT, USA
| | - Bryan McComb
- Division of Biostatistics, New York University School of Medicine, New York, NY, USA
| | - Margarita Teran-Garcia
- Division of Nutritional Sciences, University of Illinois, Urbana-Champaign, Urbana, IL, USA
| | - John A Dawson
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - David B King
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - Andrew W Brown
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, IN, USA
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10
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Kaiser M, Goldson S, Buklijas T, Gluckman P, Allen K, Bardsley A, Lam ME. Towards Post-Pandemic Sustainable and Ethical Food Systems. FOOD ETHICS 2021; 6:4. [PMID: 33521245 PMCID: PMC7826152 DOI: 10.1007/s41055-020-00084-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 02/03/2023]
Abstract
The current global COVID-19 pandemic has led to a deep and multidimensional crisis across all sectors of society. As countries contemplate their mobility and social-distancing policy restrictions, we have a unique opportunity to re-imagine the deliberative frameworks and value priorities in our food systems. Pre-pandemic food systems at global, national, regional and local scales already needed revision to chart a common vision for sustainable and ethical food futures. Re-orientation is also needed by the relevant sciences, traditionally siloed in their disciplines and without adequate attention paid to how the food system problem is variously framed by diverse stakeholders according to their values. From the transdisciplinary perspective of food ethics, we argue that a post-pandemic scheme focused on bottom-up, regional, cross-sectoral and non-partisan deliberation may provide the re-orientation and benchmarks needed for not only more sustainable, but also more ethical food futures.
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Affiliation(s)
- Matthias Kaiser
- Centre for the Study of the Sciences and Humanities, University of Bergen, Bergen, Norway
| | - Stephen Goldson
- Koi Tū Centre for Informed Futures, University of Auckland, Auckland, New Zealand
| | - Tatjana Buklijas
- Koi Tū Centre for Informed Futures, University of Auckland, Auckland, New Zealand
| | - Peter Gluckman
- Koi Tū Centre for Informed Futures, University of Auckland, Auckland, New Zealand
| | - Kristiann Allen
- Koi Tū Centre for Informed Futures, University of Auckland, Auckland, New Zealand
| | - Anne Bardsley
- Koi Tū Centre for Informed Futures, University of Auckland, Auckland, New Zealand
| | - Mimi E. Lam
- Centre for the Study of the Sciences and Humanities, University of Bergen, Bergen, Norway
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11
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Jones JM, García CG, Braun HJ. Perspective: Whole and Refined Grains and Health-Evidence Supporting "Make Half Your Grains Whole". Adv Nutr 2020; 11:492-506. [PMID: 31682258 PMCID: PMC7231599 DOI: 10.1093/advances/nmz114] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/11/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Research-based dietary guidelines suggest that consumers "make half their grains whole." Yet some advocate ingesting only whole-grain foods (WGFs) and avoiding all refined-grain foods (RGFs). Some even recommend avoiding all grain-based foods (GBFs). This article will provide arguments to counter negative deductions about GBFs and RGFs, especially staple ones, and to support dietary guidance recommending a balance of GBFs-achieved through the right mix, type, and quantity of WGFs and RGFs. Studies looking at early mortality, body weight, and glucose tolerance and diabetes will be used as examples to characterize the literature about GBFs. The following issues are highlighted: 1) inconsistent findings between epidemiological and interventional studies and impacts of GBFs on health outcomes, and the underreporting of findings showing RGFs neither raise nor lower health risks; 2) multiple confounding and potential interactions make adequate statistical adjustment difficult; 3) nonuniform WGF definitions among studies make comparison of results challenging, especially because some WGFs may contain 49-74% refined grain (RG); 4) binary categorization of GBFs creates bias because nearly all categories of WGFs are recommended, but nearly half the RGF categories are not; 5) ingestion of >5 (30-g) servings RGFs/d and <1 serving WFGs/d creates dietary imbalance; 6) pattern names (e.g., "white bread") may impugn RGFs, when names such as "unbalanced" or "few fruits and vegetables" may more fairly characterize the dietary imbalance; 7) avoidance of all enriched RGs may not only impair status of folate and other B vitamins and certain minerals such as iron and zinc but also decrease acceptability of WGFs; 8) extrapolation beyond median documented intakes in high-WGF consumers (∼48 g whole grain/d) in most cohorts is speculative; 9) recommended dietary patterns such as the Mediterranean diet demonstrate that the right mix of WGFs and RGFs contributes to positive health outcomes.
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Affiliation(s)
| | - Carlos Guzmán García
- Department of Genetics, Advanced Technical College of Agricultural Engineering and Forestry, University of Córdoba, Córdoba, Spain
| | - Hans J Braun
- Global Wheat Program, Centro Internacional de Mejoramiento de Maiz y Trigo, El Batan, near Texcoco, Mexico
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12
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Mela DJ, McLaughlin J, Rogers PJ. Perspective: Standards for Research and Reporting on Low-Energy ("Artificial") Sweeteners. Adv Nutr 2020; 11:484-491. [PMID: 31925418 PMCID: PMC7231577 DOI: 10.1093/advances/nmz137] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/20/2019] [Accepted: 12/31/2019] [Indexed: 12/15/2022] Open
Abstract
Widely differing views exist among experts, policy makers, and the general public with regard to the potential risks and benefits of reduced- or low-energy sweeteners (LES) in the diet. These views are informed and influenced by different types of research in LES, with differing hypotheses, designs, interpretation, and communication. Given the high level of interest in LES, and the public health relevance of the research evidence base, it is important that all aspects of the research process are framed and reported in an appropriate and balanced manner. In this Perspective, we identify and give examples of a number of issues relating to research and reviews on LES, which may contribute toward apparent inconsistencies in the content and understanding of the totality of evidence. We conclude with a set of recommendations for authors, reviewers and journal editors, as general guidance to improve and better standardize the quality of LES research design, interpretation, and reporting. These focus on clarity of underlying hypotheses, characterization of exposures, and the placement and weighting of new research within the wider context of related prior work.
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Affiliation(s)
| | - John McLaughlin
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Peter J Rogers
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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13
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Brown AW, Altman DG, Baranowski T, Bland JM, Dawson JA, Dhurandhar NV, Dowla S, Fontaine KR, Gelman A, Heymsfield SB, Jayawardene W, Keith SW, Kyle TK, Loken E, Oakes JM, Stevens J, Thomas DM, Allison DB. Childhood obesity intervention studies: A narrative review and guide for investigators, authors, editors, reviewers, journalists, and readers to guard against exaggerated effectiveness claims. Obes Rev 2019; 20:1523-1541. [PMID: 31426126 PMCID: PMC7436851 DOI: 10.1111/obr.12923] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 07/13/2019] [Accepted: 07/14/2019] [Indexed: 12/16/2022]
Abstract
Being able to draw accurate conclusions from childhood obesity trials is important to make advances in reversing the obesity epidemic. However, obesity research sometimes is not conducted or reported to appropriate scientific standards. To constructively draw attention to this issue, we present 10 errors that are commonly committed, illustrate each error with examples from the childhood obesity literature, and follow with suggestions on how to avoid these errors. These errors are as follows: using self-reported outcomes and teaching to the test; foregoing control groups and risking regression to the mean creating differences over time; changing the goal posts; ignoring clustering in studies that randomize groups of children; following the forking paths, subsetting, p-hacking, and data dredging; basing conclusions on tests for significant differences from baseline; equating "no statistically significant difference" with "equally effective"; ignoring intervention study results in favor of observational analyses; using one-sided testing for statistical significance; and stating that effects are clinically significant even though they are not statistically significant. We hope that compiling these errors in one article will serve as the beginning of a checklist to support fidelity in conducting, analyzing, and reporting childhood obesity research.
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Affiliation(s)
- Andrew W Brown
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Tom Baranowski
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, Texas
| | - J Martin Bland
- Department of Health Sciences, University of York, York, UK
| | - John A Dawson
- Department of Nutritional Sciences, Texas Tech University, Lubbock, Texas
| | | | - Shima Dowla
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kevin R Fontaine
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew Gelman
- Department of Statistics and Department of Political Science, Columbia University, New York, New York
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Wasantha Jayawardene
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, Indiana
| | - Scott W Keith
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Eric Loken
- Neag School of Education, University of Connecticut, Storrs, Connecticut
| | - J Michael Oakes
- Department of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - June Stevens
- Departments of Nutrition and Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Diana M Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, New York
| | - David B Allison
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana
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14
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Bohan Brown MM. Digging into breakfast: serving up a better understanding of the effects on health of the "most important meal of the day". Am J Clin Nutr 2019; 110:4-5. [PMID: 31095278 DOI: 10.1093/ajcn/nqz068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/28/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Michelle M Bohan Brown
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN
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15
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Baranowski T, Ryan C, Hoyos-Cespedes A, Lu AS. Nutrition Education and Dietary Behavior Change Games: A Scoping Review. Games Health J 2019; 8:153-176. [PMID: 30339086 PMCID: PMC6909754 DOI: 10.1089/g4h.2018.0070] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Games provide an attractive venue for engaging participants and increasing nutrition-related knowledge and dietary behavior change, but no review has appeared devoted to this literature. A scoping review of nutrition education and dietary behavior change videogames or interactive games was conducted. A systematic search was made of PubMed, Agricola, and Google Scholar. Information was abstracted from 22 publications. To be included, the publication had to include a videogame or interactive experience involving games (a videogame alone, minigames inserted into a larger multimedia experience, or game as part of a human-delivered intervention); game's design objective was to influence dietary behavior, a psychosocial determinant of a dietary behavior, or nutrition knowledge (hereinafter referred to as diet-related); must have been reported in English and must have appeared in a professional publication, including some report of outcomes or results (thereby passing some peer review). This review was restricted to the diet-related information in the selected games. Diversity in targeted dietary knowledge and intake behaviors, targeted populations/audiences, game mechanics, behavioral theories, research designs, and findings was revealed. The diversity and quality of the research in general was poor, precluding a meta-analysis or systematic review. All but one of the studies reported some positive outcome from playing the game(s). One reported that a web-based education program resulted in more change than the game-based intervention. Studies of games may have been missed; a number of dietary/nutrition games are known for which no evaluation is known; and the data presented on the games and research were limited and inconsistent. Conclusions and Implications: A firmer research base is needed to establish the efficacy and effectiveness of nutrition education and dietary behavior change games.
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Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Courtney Ryan
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | | | - Amy Shirong Lu
- Health Technology Lab, Department of Communication Studies, College of Arts, Media & Design, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
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16
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Trinquart L, Erlinger AL, Petersen JM, Fox M, Galea S. Applying the E Value to Assess the Robustness of Epidemiologic Fields of Inquiry to Unmeasured Confounding. Am J Epidemiol 2019; 188:1174-1180. [PMID: 30874728 DOI: 10.1093/aje/kwz063] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/27/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
We explored the use of the E value to gauge the robustness of fields of epidemiologic inquiry to unmeasured confounding. We surveyed nutritional and air pollution studies that found statistically significant associations between exposures and incident outcomes. For 100 studies in each field, we extracted adjusted relative effect estimates and associated confidence intervals. We inverted estimates where necessary so that all effects were greater than 1. We calculated E values for both the effect estimate and the lower limit of the 95% confidence interval. Nutritional studies were smaller than air pollution studies (median participants per study, 40,652 vs. 72,460). More than 90% of nutritional studies categorized the exposure, whereas 89% of air pollution studies analyzed the exposure as a continuous variable. The median relative effect was 1.33 in nutrition and 1.16 in air pollution. The corresponding median E values for the estimates were 2.00 and 1.59, respectively. E values for the 95% confidence intervals had median values of 1.39 and 1.26, respectively. Little to moderate unmeasured confounding could explain away most observed associations. The E value is necessarily larger for smaller studies that reach statistical significance, making cross-field comparison difficult. The E value for the 95% confidence interval might be a more useful measure in reports of epidemiologic observational studies.
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Affiliation(s)
- Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Adrienne L Erlinger
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Matthew Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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17
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Abstract
We discuss efforts in improving the value of nutrition research. We organised the paper in five research stages: Stage 1: research priority setting; Stage 2: research design, conduct and analysis; Stage 3: research regulation and management; Stage 4: research accessibility and Stage 5: research reporting and publishing. Along the stages of the research cycle, varied initiatives exist to improve the quality and added value of nutrition research. However, efforts are focused on single stages of the research cycle without vision of the research system as a whole. Although research on nutrition research has been limited, it has potential to improve the quality of nutrition research and develop new tools and instruments for this purpose. A comprehensive assessment of the magnitude of research waste in nutrition and consensus on priority actions is needed. The nutrition research community at large needs to have open discussions on the usefulness of these tools and lead suitable efforts to enhance nutrition research across the stages of the research cycle. Capacity building is essential and considerations of nutrition research quality are vital to be integrated in training efforts of nutrition researchers.
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18
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Garza C, Stover PJ, Ohlhorst SD, Field MS, Steinbrook R, Rowe S, Woteki C, Campbell E. Best practices in nutrition science to earn and keep the public's trust. Am J Clin Nutr 2019; 109:225-243. [PMID: 30657846 PMCID: PMC6900562 DOI: 10.1093/ajcn/nqy337] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022] Open
Abstract
Public trust in nutrition science is the foundation on which nutrition and health progress is based, including sound public health. An ASN-commissioned, independent Advisory Committee comprehensively reviewed the literature and available public surveys about the public's trust in nutrition science and the factors that influence it and conducted stakeholder outreach regarding publicly available information. The Committee selected 7 overlapping domains projected to significantly influence public trust: 1) conflict of interest and objectivity; 2) public benefit; 3) standards of scientific rigor and reproducibility; 4) transparency; 5) equity; 6) information dissemination (education, communication, and marketing); and 7) accountability. The literature review comprehensively explored current practices and threats to public trust in nutrition science, including gaps that erode trust. Unfortunately, there is a paucity of peer-reviewed material specifically focused on nutrition science. Available material was examined, and its analysis informed the development of priority best practices. The Committee proposed best practices to support public trust, appropriate to ASN and other food and nutrition organizations motivated by the conviction that public trust remains key to the realization of the benefits of past, present, and future scientific advances. The adoption of the best practices by food and nutrition organizations, such as ASN, other stakeholder organizations, researchers, food and nutrition professionals, companies, government officials, and individuals working in the food and nutrition space would strengthen and help ensure earning and keeping the public's continued trust in nutrition science.
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Affiliation(s)
- Cutberto Garza
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Patrick J Stover
- College of Agriculture and Life Sciences, Texas A&M University, College Station, TX
| | | | - Martha S Field
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Robert Steinbrook
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Catherine Woteki
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA
| | - Eric Campbell
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, CO
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19
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Mohorko N, Černelič-Bizjak M, Poklar-Vatovec T, Grom G, Kenig S, Petelin A, Jenko-Pražnikar Z. Weight loss, improved physical performance, cognitive function, eating behavior, and metabolic profile in a 12-week ketogenic diet in obese adults. Nutr Res 2018; 62:64-77. [PMID: 30803508 DOI: 10.1016/j.nutres.2018.11.007] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/18/2018] [Accepted: 11/09/2018] [Indexed: 12/21/2022]
Abstract
The ketogenic diet (KD) is being increasingly promoted as a strategy to fight obesity. Although the KD is effective for weight loss and weight control, comprehensive determination of its relationship with biochemical, physiological and psychological changes is still largely unexplored. We hypothesized that a 12-week KD (12KD) would significantly affect body weight, physical performance, cognitive function, eating behaviors, the metabolic and hormonal profile in obese adults, although differently in men and women. In an uncontrolled intervention, 35 sedentary obese adults (13 men, 25 women), aged 37 ± 7 years with a BMI 36.1 ± 5.6 kg/m2 underwent a 12KD between March 2017 and June 2017 at the University of Primorska. The 12KD resulted in decreased appetite, significant weight loss of participants (-18 ± 9 kg men vs. -11 ± 3 kg women; P < .001), decreased emotional and external eating (P < .001 for both), increased body image satisfaction (P < .001) and improved physical performance (P < .001). Biochemically, a significant drop in glucose (P = .026), and a significant increase in LDL-cholesterol (P = .031), CRP (P = .007), and BDNF (P = .035) were observed in the first 2 weeks; then, all listed parameters returned to baseline. On the other hand, a significant reduction in insulin (P < .001) and leptin levels (P < .001), and a significant increase in adiponectin (P = .008) and NPY (P = .009) were detected throughout the duration of the 12KD. Our results show the efficacy of the 12KD on weight loss, physical performance, cognitive function, eating behaviors and metabolic profile. However, the long-term effects of a KD on these outcomes needs to be further studied before general recommendations can be made.
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Affiliation(s)
- Nina Mohorko
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola.
| | | | | | - Gašper Grom
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola.
| | - Saša Kenig
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola.
| | - Ana Petelin
- University of Primorska, Faculty of Health Sciences, Polje 42, SI-6310 Izola.
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20
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Tarone RE. Conflicts of interest, bias, and the IARC Monographs Program. Regul Toxicol Pharmacol 2018; 98:A1-A4. [PMID: 30194952 DOI: 10.1016/j.yrtph.2018.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/22/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
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21
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Trepanowski JF, Ioannidis JPA. Perspective: Limiting Dependence on Nonrandomized Studies and Improving Randomized Trials in Human Nutrition Research: Why and How. Adv Nutr 2018; 9:367-377. [PMID: 30032218 PMCID: PMC6054237 DOI: 10.1093/advances/nmy014] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A large majority of human nutrition research uses nonrandomized observational designs, but this has led to little reliable progress. This is mostly due to many epistemologic problems, the most important of which are as follows: difficulty detecting small (or even tiny) effect sizes reliably for nutritional risk factors and nutrition-related interventions; difficulty properly accounting for massive confounding among many nutrients, clinical outcomes, and other variables; difficulty measuring diet accurately; and suboptimal research reporting. Tiny effect sizes and massive confounding are largely unfixable problems that narrowly confine the scenarios in which nonrandomized observational research is useful. Although nonrandomized studies and randomized trials have different priorities (assessment of long-term causality compared with assessment of treatment effects), the odds for obtaining reliable information with the former are limited. Randomized study designs should therefore largely replace nonrandomized studies in human nutrition research going forward. To achieve this, many of the limitations that have traditionally plagued most randomized trials in nutrition, such as small sample size, short length of follow-up, high cost, and selective reporting, among others, must be overcome. Pivotal megatrials with tens of thousands of participants and lifelong follow-up are possible in nutrition science with proper streamlining of operational costs. Fixable problems that have undermined observational research, such as dietary measurement error and selective reporting, need to be addressed in randomized trials. For focused questions in which dietary adherence is important to maximize, trials with direct observation of participants in experimental in-house settings may offer clean answers on short-term metabolic outcomes. Other study designs of randomized trials to consider in nutrition include registry-based designs and "N-of-1" designs. Mendelian randomization designs may also offer some more reliable leads for testing interventions in trials. Collectively, an improved randomized agenda may clarify many things in nutrition science that might never be answered credibly with nonrandomized observational designs.
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Affiliation(s)
| | - John P A Ioannidis
- Stanford Prevention Research Center
- Meta-Research Innovation Center at Stanford (METRICS)
- Departments of Medicine, Stanford University, Stanford, CA
- Departments of Health Research and Policy, Stanford University, Stanford, CA
- Departments of Biomedical Data Science, Stanford University, Stanford, CA
- Departments of Statistics, Stanford University, Stanford, CA
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22
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Abstract
PURPOSE OF REVIEW To review how the media frames obesity and the effect it has upon on public perceptions. RECENT FINDINGS The scientific and public health understanding of obesity increasingly points away from individual behaviors and toward medical and community factors, but diffusion of this knowledge is slow. Growing awareness of the importance of body positivity is driving attention to the harms of weight bias and fat shaming. Health science reporting related to obesity, nutrition, and physical activity tends to perpetuate myths and misunderstandings. Moving forward, greater attention to accurate messages about obesity and evidence-based interventions will be essential for progress to reduce suffering and the impact on public health from this chronic disease.
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Affiliation(s)
- Fatima Cody Stanford
- Harvard Medical School (HMS), Boston, MA, 02115, USA
- Massachusetts General Hospital (MGH) Weight Center, Boston, MA, 02114, USA
- MGH Internal Medicine-Gastroenterology and Pediatrics Endocrinology, Boston, MA, 02114, USA
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23
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Brown AW, Kaiser KA, Allison DB. Issues with data and analyses: Errors, underlying themes, and potential solutions. Proc Natl Acad Sci U S A 2018; 115:2563-2570. [PMID: 29531079 PMCID: PMC5856502 DOI: 10.1073/pnas.1708279115] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Some aspects of science, taken at the broadest level, are universal in empirical research. These include collecting, analyzing, and reporting data. In each of these aspects, errors can and do occur. In this work, we first discuss the importance of focusing on statistical and data errors to continually improve the practice of science. We then describe underlying themes of the types of errors and postulate contributing factors. To do so, we describe a case series of relatively severe data and statistical errors coupled with surveys of some types of errors to better characterize the magnitude, frequency, and trends. Having examined these errors, we then discuss the consequences of specific errors or classes of errors. Finally, given the extracted themes, we discuss methodological, cultural, and system-level approaches to reducing the frequency of commonly observed errors. These approaches will plausibly contribute to the self-critical, self-correcting, ever-evolving practice of science, and ultimately to furthering knowledge.
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Affiliation(s)
- Andrew W Brown
- Office of Energetics and Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Kathryn A Kaiser
- Office of Energetics and Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
| | - David B Allison
- Office of Energetics and Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
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24
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Tarone RE. On the International Agency for Research on Cancer classification of glyphosate as a probable human carcinogen. Eur J Cancer Prev 2018; 27:82-87. [PMID: 27552246 DOI: 10.1097/cej.0000000000000289] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The recent classification by International Agency for Research on Cancer (IARC) of the herbicide glyphosate as a probable human carcinogen has generated considerable discussion. The classification is at variance with evaluations of the carcinogenic potential of glyphosate by several national and international regulatory bodies. The basis for the IARC classification is examined under the assumptions that the IARC criteria are reasonable and that the body of scientific studies determined by IARC staff to be relevant to the evaluation of glyphosate by the Monograph Working Group is sufficiently complete. It is shown that the classification of glyphosate as a probable human carcinogen was the result of a flawed and incomplete summary of the experimental evidence evaluated by the Working Group. Rational and effective cancer prevention activities depend on scientifically sound and unbiased assessments of the carcinogenic potential of suspected agents. Implications of the erroneous classification of glyphosate with respect to the IARC Monograph Working Group deliberative process are discussed.
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Affiliation(s)
- Robert E Tarone
- Robert Tarone retired in 2016 after 28 years as Mathematical Statistician at the US National Cancer Institute and 14 years as Biostatistics Director at the International Epidemiology Institute. Rockville, Maryland, USA
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25
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Abstract
Nearly 50 years ago, I set out to investigate the clinical problem of hypoglycemia in children with illnesses that limited their food intake. My goal was to gather accurate and precise measurable data. At the time, I wasn't interested in nutrition as a discipline defined in its more general or popular sense. To address the specific problem that interested me required development of entirely new methods based on stable, nonradioactive tracers that satisfied the conditions of accuracy and precision. At the time, I had no inclination of the various theoretical and practical problems that would have to be solved to achieve this goal. Some are briefly described here. Nor did I have the slightest idea that developing the field would result in a fundamental change in how human clinical investigation was conducted, with the eventual replacement of radiotracers with stable isotopically labeled ones, even for adult clinical investigation. Additionally, I had no inclination that the original questions would open avenues to much broader questions of practical nutritional relevance. Moreover, only much later as the editor of The American Journal of Clinical Nutrition did I appreciate the policy implications of how nutritional data are presented in the scientific literature. At least in part, less accurate and precise measurements and less than full transparency in reporting nutritional data have resulted in widespread debate about the public policy recommendations and guidelines that are the intended result of collecting the data in the first place. This article provides a personal recollection (with all the known faults of self-reporting and retrospective memory) of the journey that starts with measurement certainty and ends with policy uncertainty.
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Affiliation(s)
- Dennis M Bier
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030;
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26
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Magni P, Bier DM, Pecorelli S, Agostoni C, Astrup A, Brighenti F, Cook R, Folco E, Fontana L, Gibson RA, Guerra R, Guyatt GH, Ioannidis JPA, Jackson AS, Klurfeld DM, Makrides M, Mathioudakis B, Monaco A, Patel CJ, Racagni G, Schünemann HJ, Shamir R, Zmora N, Peracino A. Perspective: Improving Nutritional Guidelines for Sustainable Health Policies: Current Status and Perspectives. Adv Nutr 2017; 8:532-545. [PMID: 28710141 PMCID: PMC5502870 DOI: 10.3945/an.116.014738] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A large body of evidence supports the notion that incorrect or insufficient nutrition contributes to disease development. A pivotal goal is thus to understand what exactly is appropriate and what is inappropriate in food ingestion and the consequent nutritional status and health. The effective application of these concepts requires the translation of scientific information into practical approaches that have a tangible and measurable impact at both individual and population levels. The agenda for the future is expected to support available methodology in nutrition research to personalize guideline recommendations, properly grading the quality of the available evidence, promoting adherence to the well-established evidence hierarchy in nutrition, and enhancing strategies for appropriate vetting and transparent reporting that will solidify the recommendations for health promotion. The final goal is to build a constructive coalition among scientists, policy makers, and communication professionals for sustainable health and nutritional policies. Currently, a strong rationale and available data support a personalized dietary approach according to personal variables, including sex and age, circulating metabolic biomarkers, food quality and intake frequency, lifestyle variables such as physical activity, and environmental variables including one's microbiome profile. There is a strong and urgent need to develop a successful commitment among all the stakeholders to define novel and sustainable approaches toward the management of the health value of nutrition at individual and population levels. Moving forward requires adherence to well-established principles of evidence evaluation as well as identification of effective tools to obtain better quality evidence. Much remains to be done in the near future.
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Affiliation(s)
- Paolo Magni
- Department of Pharmacological and Biomolecular Sciences, and
| | - Dennis M Bier
- Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | | | - Carlo Agostoni
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, DISCCO, Università degli Studi di Milano, Milan, Italy
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Furio Brighenti
- Department of Food Sciences, University of Parma, Parma, Italy
| | - Robert Cook
- Bazian, Economist Intelligence Unit Healthcare, London, United Kingdom
| | - Emanuela Folco
- Giovanni Lorenzini Medical Science Foundation, Milan, Italy
| | - Luigi Fontana
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy;,Department of Medicine, Washington University, St. Louis, MO
| | - Robert A Gibson
- School of Agriculture, Food and Wine, FOODplus Research Centre, University of Adelaide, Adelaide, Australia
| | - Ranieri Guerra
- Department of Preventive Health, Ministry of Health, Rome, Italy
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - John PA Ioannidis
- Department of Health Policy and Research, Stanford University, Stanford, CA
| | - Ann S Jackson
- Giovanni Lorenzini Medical Science Foundation, Houston, TX
| | - David M Klurfeld
- Human Nutrition Program, USDA Agricultural Research Service, Beltsville, MD
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | | | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA
| | - Giorgio Racagni
- Department of Pharmacological and Biomolecular Sciences, and
| | - Holger J Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, University of Tel Aviv, Tel Aviv, Israel; and
| | - Niv Zmora
- Department of Immunology, Weizmann Institute of Science, Rehovot, Israel
| | - Andrea Peracino
- Giovanni Lorenzini Medical Science Foundation, Milan, Italy;
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27
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Affiliation(s)
- Tanis R Fenton
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TRF, e-mail: ; CJF)
| | - Carol J Fenton
- From the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (TRF, e-mail: ; CJF)
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George BJ, Beasley TM, Brown AW, Dawson J, Dimova R, Divers J, Goldsby TU, Heo M, Kaiser KA, Keith S, Kim MY, Li P, Mehta T, Oakes JM, Skinner A, Stuart E, Allison DB. Common scientific and statistical errors in obesity research. Obesity (Silver Spring) 2016; 24:781-90. [PMID: 27028280 PMCID: PMC4817356 DOI: 10.1002/oby.21449] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 01/13/2023]
Abstract
This review identifies 10 common errors and problems in the statistical analysis, design, interpretation, and reporting of obesity research and discuss how they can be avoided. The 10 topics are: 1) misinterpretation of statistical significance, 2) inappropriate testing against baseline values, 3) excessive and undisclosed multiple testing and "P-value hacking," 4) mishandling of clustering in cluster randomized trials, 5) misconceptions about nonparametric tests, 6) mishandling of missing data, 7) miscalculation of effect sizes, 8) ignoring regression to the mean, 9) ignoring confirmation bias, and 10) insufficient statistical reporting. It is hoped that discussion of these errors can improve the quality of obesity research by helping researchers to implement proper statistical practice and to know when to seek the help of a statistician.
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Affiliation(s)
- Brandon J. George
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294
| | - T. Mark Beasley
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Andrew W. Brown
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
| | - John Dawson
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409
| | - Rositsa Dimova
- Department of Biostatistics, University at Buffalo, Buffalo, NY 14260
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - TaShauna U. Goldsby
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Moonseong Heo
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10467
| | - Kathryn A. Kaiser
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Scott Keith
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Thomas Jefferson University, Philadelphia, PA 19107
| | - Mimi Y. Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10467
| | - Peng Li
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Tapan Mehta
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL 35294
| | - J. Michael Oakes
- Department of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN 55454
| | - Asheley Skinner
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599
| | - Elizabeth Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
| | - David B. Allison
- Office of Energetics, University of Alabama at Birmingham, Birmingham, AL 35294
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294
- Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, AL 35294
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Trinquart L, Johns DM, Galea S. Why do we think we know what we know? A metaknowledge analysis of the salt controversy. Int J Epidemiol 2016; 45:251-60. [PMID: 26888870 DOI: 10.1093/ije/dyv184] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although several public health organizations have recommended population-wide reduction in salt intake, the evidence on the population benefits remains unclear. We conducted a metaknowledge analysis of the literature on salt intake and health outcomes. METHODS We identified reports--primary studies, systematic reviews, guidelines and comments, letters or reviews--addressing the effect of sodium intake on cerebro-cardiovascular disease or mortality. We classified reports as supportive or contradictory of the hypothesis that salt reduction leads to population benefits, and constructed a network of citations connecting these reports. We tested for citation bias using an exponential random graph model. We also assessed the inclusion of primary studies in systematic reviews on the topic. RESULTS We identified 269 reports (25% primary studies, 5% systematic reviews, 4% guidelines and 66% comments, letters, or reviews) from between 1978 and 2014. Of these, 54% were supportive of the hypothesis, 33% were contradictory and 13% were inconclusive. Reports were 1.51 [95% confidence interval (CI) 1.38 to 1.65] times more likely to cite reports that drew a similar conclusion, than to cite reports drawing a different conclusion. In all, 48 primary studies were selected for inclusion across 10 systematic reviews. If any given primary study was selected by a review, the probability that a further review would also have selected it was 27.0% (95% CI 20.3% to 33.7%). CONCLUSIONS We documented a strong polarization of scientific reports on the link between sodium intake and health outcomes, and a pattern of uncertainty in systematic reviews about what should count as evidence.
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Affiliation(s)
| | - David Merritt Johns
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Dwyer JT. Trailblazer Lecture: Why Are Processed Foods So Controversial? J Acad Nutr Diet 2016; 115:1871-6. [PMID: 26514721 DOI: 10.1016/j.jand.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 11/28/2022]
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31
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Brown AW, Sievenpiper JL, Kyle TA, Kaiser KA. Communication of randomized controlled trial results must match the study focus. J Nutr 2015; 145:1027-9. [PMID: 25934665 PMCID: PMC4408739 DOI: 10.3945/jn.114.207282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew W Brown
- From the University of Alabama at Birmingham, Birmingham, AL (AWB, e-mail: ; KAK); St. Michael's Hospital, Toronto, Canada (JLS); and ConscienHealth, Pittsburgh, PA (TAK)
| | - John L Sievenpiper
- From the University of Alabama at Birmingham, Birmingham, AL (AWB, e-mail: ; KAK); St. Michael's Hospital, Toronto, Canada (JLS); and ConscienHealth, Pittsburgh, PA (TAK)
| | - Theodore A Kyle
- From the University of Alabama at Birmingham, Birmingham, AL (AWB, e-mail: ; KAK); St. Michael's Hospital, Toronto, Canada (JLS); and ConscienHealth, Pittsburgh, PA (TAK)
| | - Kathryn A Kaiser
- From the University of Alabama at Birmingham, Birmingham, AL (AWB, e-mail: ; KAK); St. Michael's Hospital, Toronto, Canada (JLS); and ConscienHealth, Pittsburgh, PA (TAK)
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