Relationship between Funding Source and Conclusion among Nutrition-Related Scientific Articles

BACKGROUND: Industrial support of biomedical research may bias scientific conclusions, as demonstrated by recent analyses of pharmaceutical studies. However, this issue has not been systematically examined in the area of nutrition research. The purpose of this study is to characterize financial sponsorship of scientific articles addressing the health effects of three commonly consumed beverages, and to determine how sponsorship affects published conclusions. METHODS AND FINDINGS: Medline searches of worldwide literature were used to identify three article types (interventional studies, observational studies, and scientific reviews) about soft drinks, juice, and milk published between 1 January, 1999 and 31 December, 2003. Financial sponsorship and article conclusions were classified by independent groups of coinvestigators. The relationship between sponsorship and conclusions was explored by exact tests and regression analyses, controlling for covariates. 206 articles were included in the study, of which 111 declared financial sponsorship. Of these, 22% had all industry funding, 47% had no industry funding, and 32% had mixed funding. Funding source was significantly related to conclusions when considering all article types (p = 0.037). For interventional studies, the proportion with unfavorable conclusions was 0% for all industry funding versus 37% for no industry funding (p = 0.009). The odds ratio of a favorable versus unfavorable conclusion was 7.61 (95% confidence interval 1.27 to 45.73), comparing articles with all industry funding to no industry funding. CONCLUSIONS: Industry funding of nutrition-related scientific articles may bias conclusions in favor of sponsors' products, with potentially significant implications for public health

Improving the Delivery of Preventive Services to Medicare Beneficiaries

Central to US Congressional and Administration efforts to reform health care is a renewed focus on \u93investment in prevention and wellness.\u941 Translating that commitment to investing in preventive care into improved health will require a strategy for separating effective prevention from that which is ineffective or even harmful, and aligning payment strategies with practices supported by the best evidence. However, existing federal and private insurance coverage does not adequately support the delivery of clinical preventive services associated with improved quality of life and reduced premature mortality. Medicare is both the largest US payer for adult health services and the standard by which many other payers model their coverage. It is thus a logical place to effect optimal coverage for preventive services. In this Commentary, we propose 3 steps by which Medicare could expand preventive care: by expanding preventive coverage, adopting payment reform to pay for the coordination of preventive ..

Change in Glycemic Control for Patients Enrolled in a Membership-Based Primary Care Program: Longitudinal Observational Study

BackgroundBoth primary care practices based on the chronic care model (CCM) and digital therapeutics have been shown to improve the care of patients with diabetes. ObjectiveThe aim of this observational study was to examine the change in diabetes control for patients enrolled in a membership-based primary care service that is based on the CCM. MethodsUsing a diabetes registry, we analyzed the change in glycated hemoglobin (HbA1c) for patients with uncontrolled diabetes mellitus (initial HbA1c≥9%). All patients had access to a technology-enhanced primary care practice built on the CCM. ResultsThe registry included 621 patients diagnosed with uncontrolled diabetes. All patients had at least two HbA1c measurements, with the average time between the first and last measurement of 1.2 years (SD 0.4). The average starting value of HbA1c was 10.7, which decreased to 8.7, corresponding to a reduction of 2.03 (P<.001). Secondary analyses showed statistically significant reductions in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. ConclusionsPatients with initially uncontrolled diabetes who undergo care in a technology-enhanced primary care practice based on the CCM have long-term clinically meaningful reductions in HbA1c

Outdoor advertising, obesity, and soda consumption: a cross-sectional study

Abstract Background: Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, it is unknown whether outdoor advertising is related to obesity. Methods: To test the association between outdoor food advertising and obesity, we analyzed telephone survey data on adults, aged 18-98, collected from 220 census tracts in Los Angeles and Louisiana. We linked self-reported information on BMI and soda consumption with a database of directly observed outdoor advertisements. Results: The higher the percentage of outdoor advertisements promoting food or non-alcoholic beverages within a census tract, the greater the odds of obesity among its residents, controlling for age, race and educational status. For every 10% increase in food advertising, there was a 1.05 (95% CI 1.003 -1.093, p&lt;0.03) greater odds of being overweight or obese, controlling for other factors. Given these predictions, compared to an individual living in an area with no food ads, those living in areas in which 30% of ads were for food would have a 2.6% increase in the probability of being obese. Conclusions: There is a relationship between the percentage of outdoor food advertising and overweight/obesity

Outdoor advertising, obesity, and soda consumption: a cross-sectional study

Abstract Background Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, it is unknown whether outdoor advertising is related to obesity. Methods To test the association between outdoor food advertising and obesity, we analyzed telephone survey data on adults, aged 18–98, collected from 220 census tracts in Los Angeles and Louisiana. We linked self-reported information on BMI and soda consumption with a database of directly observed outdoor advertisements. Results The higher the percentage of outdoor advertisements promoting food or non-alcoholic beverages within a census tract, the greater the odds of obesity among its residents, controlling for age, race and educational status. For every 10% increase in food advertising, there was a 1.05 (95% CI 1.003 - 1.093, p Conclusions There is a relationship between the percentage of outdoor food advertising and overweight/obesity.</p

Association Between Monetary Deposits and Weight Loss in Online Commitment Contracts

PurposeTo examine the characteristics of voluntary online commitment contracts that may be associated with greater weight loss.DesignRetrospective analysis of weight loss commitment contracts derived from a company that provides web-based support for personal commitment contracts. Using regression, we analyzed whether percentage weight loss differed between participants who incentivized their contract using monetary deposits and those who did not.SettingOnline.ParticipantsUsers (N = 3857) who voluntarily signed up online in 2013 for a weight loss contract.InterventionParticipants specified their own weight loss goal, time period, and self-reported weekly weight. Deposits were available in the following 3 categories: charity, anticharity (a nonprofit one does not like), or donations made to a friend.MeasuresPercentage weight loss per week.AnalysisMultivariable linear regressions.ResultsControlling for several participant and contract characteristics, contracts with anticharity, charity, and friend deposits had greater reported weight loss than nonincentivized contracts. Weight change per week relative to those without deposits was -0.33%, -0.28%, and -0.25% for anti-charity, charity, and friend, respectively ( P &lt; 0.001). Contracts without a weight verification method claimed more weight loss than those with verification.ConclusionVoluntary use of commitment contracts may be an effective tool to assist weight loss. Those who choose to use monetary incentives report more weight loss. It is not clear whether this is due to the incentives or higher motivation

Outdoor advertising, obesity, and soda consumption: a cross-sectional study

Abstract Background Recent research has shown that neighborhood characteristics are associated with obesity prevalence. While food advertising in periodicals and television has been linked to overweight and obesity, it is unknown whether outdoor advertising is related to obesity. Methods To test the association between outdoor food advertising and obesity, we analyzed telephone survey data on adults, aged 18–98, collected from 220 census tracts in Los Angeles and Louisiana. We linked self-reported information on BMI and soda consumption with a database of directly observed outdoor advertisements. Results The higher the percentage of outdoor advertisements promoting food or non-alcoholic beverages within a census tract, the greater the odds of obesity among its residents, controlling for age, race and educational status. For every 10% increase in food advertising, there was a 1.05 (95% CI 1.003 - 1.093, p&lt;0.03) greater odds of being overweight or obese, controlling for other factors. Given these predictions, compared to an individual living in an area with no food ads, those living in areas in which 30% of ads were for food would have a 2.6% increase in the probability of being obese. Conclusions There is a relationship between the percentage of outdoor food advertising and overweight/obesity

Evaluating the healthiness of chain-restaurant menu items using crowdsourcing: a new method

ObjectiveTo develop a technology-based method for evaluating the nutritional quality of chain-restaurant menus to increase the efficiency and lower the cost of large-scale data analysis of food items.DesignUsing a Modified Nutrient Profiling Index (MNPI), we assessed chain-restaurant items from the MenuStat database with a process involving three steps: (i) testing 'extreme' scores; (ii) crowdsourcing to analyse fruit, nut and vegetable (FNV) amounts; and (iii) analysis of the ambiguous items by a registered dietitian.ResultsIn applying the approach to assess 22 422 foods, only 3566 could not be scored automatically based on MenuStat data and required further evaluation to determine healthiness. Items for which there was low agreement between trusted crowd workers, or where the FNV amount was estimated to be &gt;40 %, were sent to a registered dietitian. Crowdsourcing was able to evaluate 3199, leaving only 367 to be reviewed by the registered dietitian. Overall, 7 % of items were categorized as healthy. The healthiest category was soups (26 % healthy), while desserts were the least healthy (2 % healthy).ConclusionsAn algorithm incorporating crowdsourcing and a dietitian can quickly and efficiently analyse restaurant menus, allowing public health researchers to analyse the healthiness of menu items