Issue 2 | December 7, 2013

NutritionNotesDaily

Advances and Controversies in Clinical Nutrition 2013

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There have been U.S. dietary guidelines for grains since 1916, said Joanne L. Slavin, PhD, RD, during the Friday

morning session “Whole Grains and Health: Does the Evidence Support Current Guide-lines?” In 2005, the guidelines began specifi-cally mentioning whole grains, but there are still issues with defining and labeling exactly what constitutes a whole grain.

Although whole grains and dietary fiber have historically been linked, they’re not the same, Slavin said. Fiber includes legumes, fruits, vegetables and foods with added fiber, along with whole grains.

A whole grain includes the bran, or outer shell, endosperm and germ. The bran provides fiber, B vitamins, trace minerals and phyto-chemicals; the endosperm includes carbohy-drates, protein and some B vitamins; and the germ provides B vitamins, vitamin E, trace minerals, phytochemicals, antioxidants and

lipids. Most Americans are deficient in both whole

grains and fiber, Slavin said. The average American only eats about half the daily recom-mended fiber intake, and most people consume one serving of whole grains instead of three.

Americans’ main source of fiber is white flour and potatoes, Slavin said. Even among whole grains, dietary fiber varies—for instance, brown rice is not a good source, she said.

The 2010 Dietary Guidelines for Americans state that three or more servings of whole grains a day reduces the risk of coronary heart disease and helps with weight maintenance. Slavin citied studies as far back as 1963 back-ing up this statement, including the Nurses’ Health Study, which found that women who consumed more whole grains weighed less than women who consumed fewer whole grains.

However, Slavin pointed out, “we’re never going to have randomized, controlled, double-

blind studies.” The 2010 report of the Dietary Guidelines

advisory committee stated that there’s a moder-ate body of evidence from large prospective cohort studies showing that whole grain intake, which includes cereal fiber, protects against car-diovascular disease and is associated with lower body weight. There’s limited evidence showing that whole grain consumption lowers the risk of type 2 diabetes.

Since then, Slavin said a meta-analysis published in The Journal of the American Medical Association analyzed 26 studies, with 2,060 participants, and found that whole grain intake didn’t affect body weight, but there was a small effect on percentage of body fat.

A 2012 meta-analysis of 13 epidemiological studies and five intervention studies published in Nutrition Reviews found that in the epidemio-logical studies there was an association between

Session Sifts Through the Kernels of Whole Grain Science

There’s been intriguing evidence that in terms of weight gain, not all calories are created equal. But in order to find

out for sure, researchers need to conduct randomized trials, said David B. Allison, PhD, during the Friday afternoon session “Are Some Foods More Fattening Than Others? What Does This Mean and How Do We Test It?”

Allison said a general model of conceivable effects shows how foods can be differentially

Fattening Foods: When is a Calorie Not a Calorie? fattening. Consumption of food goes to causal pathways, such as how tasty a food is, whether it suppresses intake of subsequent foods and if it decreases physical activity. These pathways in turn lead to body energy stores and then body fat stores. Another causal pathway leads to nutrient partitioning, which then leads to body energy stores and body fat stores.

Studying this can be problematic, however. Self-reporting food intake creates measure-

ment difficulties, Allison said, and even con-trolled interventions have issues. He cited the 1930 Lanarkshire Milk Experiment in which 5,000 children drank raw milk and 5,000 drank pasteurized milk for four months. There were 10,000 controls. A serious flaw in the study— it wasn’t randomized, so teachers tended to assign the poorer, skinnier students to the milk group—led to the conclusion that drinking milk had no effect on the children’s growth.

Observational, epidemiological studies that eliminate “usual suspects” like measure-ment error, genetic variation, smoking and socioeconomic status as cofounders have still been found to be faulty, Allison said. Other problems include:

• Confusion about calories—whether they’re digestible energy or other types of energy

• Studies that are insufficient length • Complexities in testing foods: “Is a large

portion of steak and a small portion of pasta a low-carbohydrate diet, a high-chewing diet or a

Continued on page 4Robert Russell, MD

ASN Past President Rob Russell, MD, sat down with

Nutrition Notes Daily during ACCN 2013 to discuss two important new initia-tives the Society is under-taking: the ASN Nutrition Research Priorities and the ASN Foundation.

Q: The Nutrition

Russell Outlines New InitiativesResearch Priorities were announced this fall. How did they come about?

A: As funding for research in general has dwindled, ASN feels that it’s very important to show the public, stakeholders and the govern-ment the value of nutrition research, both in terms of health and actually making our society more productive by contributing to the economy. The healthier the society, the more productive the population and the more com-

2 Nutrition Notes Daily December 7, 2013

About Nutrition Notes Daily: Nutrition Notes Daily is the conference version of ASN’s quarterly member newsletter, Nutrition Notes. This publication may be printed during ASN’s Annual Meeting, Advances & Controversies in Clinical Nutrition and/or various other activities which the Society organizes and hosts. ASN accepts advertisements, recruitment listings and classifieds for publication in Nutrition Notes Daily; all advertisements are subject to review. Please email meetings@nutrition.org to offer feedback on the Nutrition Notes Daily, or to share suggestions to improve other aspects of ACCN 2013. Executive Officer: John Courtney; Editorial Staff: Paula Eichenbrenner, Suzanne Price; Publisher: CustomNEWS; Science Writer: Vicky Uhland; Design and Photography: John Carter

Fortified foods are not a new concept. Af-ter World War I, the British government added vitamins A and D to margarine in

order to eliminate rickets, and in the U.S., white flour has been fortified since the 1930s. Today’s diet may call for even more modifications, including personalized nutrition, said David Heber, MD, PhD, during the Friday morning session “Fortified Foods, Supplements and All Else Missing From the Dietary Guidelines for Americans.”

Heber said most Americans don’t meet three major goals of the 2010 DGAs:

• Balance calories with physical activity to manage weight

• Consume more fruits, vegetables, whole grains, seafood, and fat-free and low-fat dairy products

• Consume fewer foods with sodium, satu-rated fats, trans fats, cholesterol, added sugars and refined grains

Noting that the human body is designed to be able to look for food for long periods of time, Heber said “it takes a lot of exercise to make up for a little dietary indiscretion.”

Twenty-seven percent of Americans have zero leisure-time physical activity. “When the urge to exercise comes over them, they wait until it goes away,” Heber joked.

Adequate vegetable and fruit consumption is

Fortified Foods and Supplements Offer Personalized Nutritionanother problem, Heber said. “In America today, people eat three servings of vegetables a day, and they’re iceberg lettuce, French fries and ketchup.”

Even if people do know about proper nutri-tion, that doesn’t necessarily modify nutrition behavior, Heber said. “It’s very hard for the public to translate isolated nutrients into ‘What do I eat for lunch?’”

Boldly, he said, “we need to try to design foods that are healthier, and not be shy about that.” Fortified foods and supplements can help people balance energy intake and expenditure to reduce abdominal fat, increase omega-3s and decrease omega-6s, increase good fructose

and limit refined sugar, boost antioxidant and phytochemical levels, and increase fiber intake, Heber said.

New genetic research can create personalized nutrition, with multivitamin/multimineral, cal-cium and vitamin D-targeted supplements. Per-sonalized nutrition solutions should also address protein, which Heber said needs to be eaten at every meal because the body doesn’t store it.

Heber closed this thought-provoking lecture by saying, “A different approach beyond an evidence-based approach is needed to move from populations to individuals by using a tai-lored personal approach.”

Gordon L. Jensen, MD, PhD, ASN president (seated, second from right), paused during the ACCN confer-ence with fellow Board members Friday to send holiday greetings to meeting attendees and the wider world of nutrition researchers.

a diet high in whole grains and lower C-reactive protein concentrations. However, the interven-tion studies didn’t report the same finding.

Currently, there is no universal standard of what constitutes a whole-grain food, Slavin said. The Food and Drug Administration-approved whole grain health claim defines a whole grain as containing all portions of the

grain kernel; being at least 51 percent whole grain by weight; and meeting fat, saturated fat and cholesterol restrictions. But that definition really only works for cereals, Slavin said.

The American Association of Cereal Chem-ists International has recommended that any food labeled “whole grain” contain 8 grams or more of whole grain per 30 gram serving. The Whole Grains Council also has a stamp program labeling good to excellent sources of whole grain, Slavin said.

Continued from page 1Whole Grains

“The Advances & Controversies in Clinical Nutrition conference is a tremendous success! Meeting members of the broader clinical community has been informa-tive and engaging, and the fantastic program has led to record-breaking attendance. It’s truly an honor and a privilege to work with ASN’s volunteer leaders and the phenomenal staff of such an innovative society. We look forward to continuing to advance global health through nutrition science.” —Dr. John Courtney

December 7, 2013 Nutrition Notes Daily 3

Officers Jorge Price and Christopher Dion explain the work of the U.S. Army Healthcare Command to Oluyemisi Folasire, University of Ibadan, in the exhibit hall Friday.

high-macho diet?” Allison asked.Blinding is possible in some studies, Allison

said, citing an Army trial that studied calorie deprivation on soldiers over two days.

“There are many different meanings to the question of whether one food is more fatten-ing that another,” Allison concluded. “Opera-tionalizing one’s independent variable is vital to interpretation of any observed effect, and use of unblended foods creates challenges.

Expectancy, placebo and other non-specific affects need to be controlled.”

Continued from page 1Calories

Making Connections in the Exhibit Hall

ASN’s international review journal, Advances in Nutrition, was a Finalist for the ALPSP Best New Journal Award 2013. The November 2013 issue fea-tures several reviews (including “Recent Developments in Multivitamin/Mineral Research”), analysis of a CDC Report on Fruits & Vegetables and Summaries and Reviews of Scientific Symposia from EB 2013. Contact new Editor-in-Chief Dr. Katy Tucker with suggestions for future Advances content: katherine_tucker@uml.edu.

4 Nutrition Notes Daily December 7, 2013

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Louis Ndife, Pharmavite, learns about the re-search conducted by Joyce Maalouf of the Centers for Disease Control and Prevention on the poster floor Friday afternoon.

Continued from page 1Russell

petitive it is with regard to other countries. (To learn more about the Research Priorities, visit http://www.nutrition.org/researchagenda

Q: How have the Research Priorities been received?

A: During a Congressional briefing Wednesday, we presented the priorities to about 70 congressional staffers, plus represen-tatives and senators. There are a lot of people in Congress that already believe in the impact of federally funded research and support it, but there are a lot of people that want to make government as tiny as possible, and the only way you can really get them to care is to get their constituents to care. So we’re looking at publicizing the priorities on our website, via infographics and through articles in various publications. We also held a Capitol Hill Day on Thursday where Board members visited their legislators.

Q: Tell us about the ASN Foundation.A: There has traditionally been no way to

advance the Society in areas like global out-reach, public education, providing scholarships and funding research. The Foundation is being set up to allow a place for donation dollars to

come in that can then be used in these altruis-tic ways. We want to change the culture to be more than a professional society that publishes great journals and puts on a good annual meet-ing—we also want to become a global entity that does a lot more.

Q: How was the Foundation established?A: The notion of creating a foundation

started several years ago when Jim Hill was ASN president; the legal process and getting people on board took time. Now we’re at the stage that beginning early next year, we’ll be soliciting funds on behalf of the ASN Founda-tion. We already have many members anxious to support these efforts; nearly 220 donors have already contributed to ASN in 2013. While both entities (ASN and ASNF) can now receive charitable gifts, the vast majority of do-nors will be supporting ASNF starting in 2014.

Q: What is the Foundation’s focus for the coming year?

A: We have several focuses that are long range: to advance understanding of contro-versial issues in nutrition science, facilitate exploration of the future of nutrition science, address grand challenges, drive interest in nutrition science careers, create resources for undergraduate students, develop scholarships materials and engage mentors.