DOCSLIB.ORG

Food, Health, and Complexity: Towards a Conceptual Understanding to Guide Collaborative Public Health Action Shannon E

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Majowicz et al. BMC Public Health (2016) 16:487 DOI 10.1186/s12889-016-3142-6 RESEARCH ARTICLE Open Access Food, health, and complexity: towards a conceptual understanding to guide collaborative public health action Shannon E. Majowicz1*, Samantha B. Meyer1, Sharon I. Kirkpatrick1, Julianne L. Graham1, Arshi Shaikh2, Susan J. Elliott1,3, Leia M. Minaker4, Steffanie Scott3 and Brian Laird1 Abstract Background: What we eat simultaneously impacts our exposure to pathogens, allergens, and contaminants, our nutritional status and body composition, our risks for and the progression of chronic diseases, and other outcomes. Furthermore, what we eat is influenced by a complex web of drivers, including culture, politics, economics, and our built and natural environments. To date, public health initiatives aimed at improving food-related population health outcomes have primarily been developed within ‘practice silos’, and the potential for complex interactions among such initiatives is not well understood. Therefore, our objective was to develop a conceptual model depicting how infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy can be linked via shared drivers, to illustrate potential complex interactions and support future collaboration across public health practice silos. Methods: We developed the conceptual model by first conducting a systematic literature search to identify review articles containing schematics that depicted relationships between drivers and the issues of interest. Next, we synthesized drivers into a common model using a modified thematic synthesis approach that combined an inductive thematic analysis and mapping to synthesize findings. Results: The literature search yielded 83 relevant references containing 101 schematics. The conceptual model contained 49 shared drivers and 227 interconnections. Each of the five issues was connected to all others. Obesity and food insecurity shared the most drivers (n = 28). Obesity shared several drivers with food allergy (n = 11), infectious foodborne illness (n = 7), and dietary contamination (n = 6). Food insecurity shared several drivers with infectious foodborne illness (n = 9) and dietary contamination (n = 9). Infectious foodborne illness shared drivers with dietary contamination (n = 8). Fewer drivers were shared between food allergy and: food insecurity (n = 4); infectious foodborne illness (n = 2); and dietary contamination (n = 1). Conclusions: Our model explicates potential interrelationships between five population health issues for which public health interventions have historically been siloed, suggesting that interventions targeted towards these issues have the potential to interact and produce unexpected consequences. Public health practitioners working in infectious foodborne illness, food insecurity, dietary contaminants, obesity, and food allergy should actively consider how their seemingly targeted public health actions may produce unintended positive or negative population health impacts. Keywords: Public health, Public policy, Health policy, Population-based planning, Foodborne diseases, Food allergy, Food insecurity, Dietary contamination, Obesity * Correspondence: [email protected] 1School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo N2L 3G1, ON, Canada Full list of author information is available at the end of the article © 2016 Majowicz et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Majowicz et al. BMC Public Health (2016) 16:487 Page 2 of 13 Background there are no conceptual models that support thinking sys- Food and health are intimately intertwined: what we eat temically about multiple food-related population health is- simultaneously impacts our exposure to foodborne path- sues in concert, to provide a roadmap for considering how ogens [1–4], allergens [5–9], and environmental contam- targeted public health initiatives may interact in unex- inants [10, 11], our nutritional status [12, 13], body pected ways or have unintended consequences. Therefore, composition [14–16], mental health [17–19], risks for the objective of this study was to develop a conceptual and the progression of chronic diseases [20–22], and model depicting how multiple food-related population other outcomes. Furthermore, what we eat is influenced health issues can be linked via shared drivers, illustrating by a complex web of drivers, such as socioeconomic sta- the potential for complex interactions, with the ultimate tus [23–25], food security [26, 27], preferences [28–30], goal of supporting collaboration across public health culture [31–34], politics [35–37], economics [38–40], practice silos to guide informed interventions. trade [41, 42], industry [43–45], legislation [46, 47], and our built [48–50] and natural [51–53] environments. Methods To date, public health initiatives aimed at improving We applied a complex adaptive systems (CAS) lens to food-related population health outcomes have primarily the concept of population health as related to food and been developed within ‘practice silos’ (e.g., chronic dis- diet. A CAS lens suggests that a given population health ease prevention efforts typically developed independently outcome or issue is an emergent property of an under- from food safety activities), and their potential to inter- lying system of inter-related drivers including political, act or have unintended consequences has been largely environmental, social, biological, and other factors [71]. ignored. As is the case in any system, ‘solutions’ to one We developed a conceptual model depicting the shared issue may create new problems for another [54]. With drivers of five population health issues related to food respect to food and health, for example, food safety mea- (hereafter called ‘issues’): infectious foodborne illness, sures to limit microbial growth, such as the addition of food insecurity, dietary contaminants, obesity, and food salt [55, 56], can pose chronic disease risks [57, 58], and allergy. We selected these because (a) they are important the development of urban gardens to improve food public health issues for which there is significant invest- security [59–61] can increase exposure to a variety of ment in prevention and improvement, and (b) we hy- contaminants [62–65]. Therefore, understanding the po- pothesized that they had shared drivers, and we tential for complex interactions among public health ini- assembled our research team to provide expert know- tiatives aimed at improving specific aspects of population ledge in these areas. We defined ‘drivers’ broadly, as fac- health (here, as related to food) is imperative to under- tors with the potential to impact one or more issues, standing how such efforts may influence one another, or and included drivers across scales (from individual to so- influence seemingly unrelated population health out- cietal) and types of associations (e.g., direct causes, comes, in unexpected ways. higher-level proxies for more complex pathways). The Systems thinking offers public health practitioners a conceptual model was developed by identifying drivers paradigm for framing issues that explicates complexity from the peer-reviewed literature and synthesizing and interrelationships among parts of a whole, and shared drivers into a common model, using a modified facilitates identification of less obvious influences and thematic synthesis approach [72] that combined a sys- consequences [66, 67]. Systems-informed public health tematic search process, inductive thematic analysis [73], initiatives exist in the realm of food and health; perhaps and mapping to synthesize findings. the most well-known is the Foresight Obesity System In March 2015, we searched the peer-reviewed litera- Map [68], an in-depth exploration of the complex web ture in MEDLINE (via PubMed) for English-language re- of social, economic, biological, psychological, and other views published in the last five years, using the search drivers of a single food-related population health issue, terms shown (Table 1). We selected only review articles obesity. In addition to exploring the myriad of drivers for inclusion because initial topic-specific searches for one issue, the bilateral connectivity between issues returned between 800 and 54,000 articles per topic. We has been explored, for example between obesity and designed the search to identify recent, evidence-based food security [69]. Such bilateral explorations of food- descriptions of a range of drivers of the five chosen is- health issues have also been expanded to involve system sues; the search was not intended to produce a compre- actors (i.e., those whose actions influence the parts hensive nor exhaustive list of drivers, but rather to within the system) from non-health sectors. For example, identify a range of drivers, including possible shared one local public health agency integrated the economic drivers. Additional articles were identified via citation
Recommended publications
  • Proquest Administrator Module User Guide Table of Contents

    Proquest Administrator Module User Guide Table of Contents

    ProQuest Administrator Module User Guide Table of Contents 1. Getting Started 1.1. Getting Started .............................................................................................................................. 3 2. User Interface 2.1. User Interface Main Page .............................................................................................................. 5 2.2. Interface Settings............................................................................................................................ 5 2.3. Branding.......................................................................................................................................... 8 2.4. Create a ProQuest Login URL ...................................................................................................... 8 2.5. Customize Subject Areas/Customize Industries ............................................................................ 9 3. Usage Reports 3.1. Usage Reports Introduction ........................................................................................................ 10 3.2. Request Usage Reports................................................................................................................ 10 3.3. Scheduled Usage Reports .......................................................................................................... 11 4. Linking In/Out 4.1. Linking In/Out Introduction .......................................................................................................... 12 4.2.
  • 'Why Calories Count' Weighs in on Food and Politics 24 April 2012, by Susan Kelley

    'Why Calories Count' Weighs in on Food and Politics 24 April 2012, by Susan Kelley

    'Why Calories Count' weighs in on food and politics 24 April 2012, By Susan Kelley The authors not only explain how scientists count calories in food and measure how bodies use them but also why we need calories for survival, warmth and work, covering metabolism and how the body uses calories. They also discuss calorie needs, the difficulties of estimating calorie intake and the body's complex weight management system. In exploring issues related to too few calories, they discuss starvation, global hunger and whether restricting calories could prolong human life. Their section on too many calories covers obesity, the complex relationship between calories and weight gain, whether all calories are created equal and whether some kinds of diets work better than others. A calorie is simply a measurement of energy. But it's also the source of confusion and worry for Having armed readers with the necessary many people trying to lose weight. At the same information to interpret food labels, evaluate diet time, calories -- too few or too many -- are causing claims and understand evidence as presented in health problems resulting from malnutrition and popular media, Nesheim and Nestle elucidate the obesity that affect billions of people around the political stakes and show how federal and world. corporate policies have come together to create an "eat more" environment. Finally, the authors offer A new 304-page book, "Why Calories Count: From some candid advice: Get organized. Eat less. Eat Science to Politics" (University of California Press), better. Move more. Get political. aims to clear up the confusion. It explains in accessible language what calories are and how "Ultimately, the calorie is political: marketing affects they work, biologically and politically.
  • Food) Politics Is Local: Increasing Food Access Through Local Government Action

    Food) Politics Is Local: Increasing Food Access Through Local Government Action

    All (Food) Politics is Local: Increasing Food Access through Local Government Action The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Emily M. Broad Leib, All (Food) Politics is Local: Increasing Food Access through Local Government Action, 7 Harv. L. & Pol'y Rev. 321 (2013). Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:11189975 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Open Access Policy Articles, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#OAP \\jciprod01\productn\H\HLP\7-2\HLP202.txt unknown Seq: 1 9-AUG-13 9:27 All (Food) Politics is Local: Increasing Food Access Through Local Government Action Emily M. Broad Leib* I. INTRODUCTION Our national and international food system1 has implications for a wide range of issues that are important across the political spectrum and include improving health outcomes,2 reducing environmental impacts,3 increasing social justice,4 fostering economic development,5 and even improving home- land security.6 This article focuses on healthy-food access, one of the most urgent food policy issues because of its social and economic effects, as well as its public health impacts. In 2010, thirty-six percent of Americans were obese and another thirty-three percent were overweight,7 while eight percent of Americans were diabetic and thirty-five percent suffered from pre-diabe- tes.8 Though food access is not perfectly correlated with public health out- * Director of the Harvard Law School Food Law and Policy Clinic.
  • The Global Politics of Food: a Critical Overview Nancy Ehrenreich

    The Global Politics of Food: a Critical Overview Nancy Ehrenreich

    University of Miami Law School Institutional Repository University of Miami Inter-American Law Review 10-1-2011 The Global Politics of Food: A Critical Overview Nancy Ehrenreich Beth Lyon Follow this and additional works at: http://repository.law.miami.edu/umialr Part of the Comparative and Foreign Law Commons, and the International Law Commons Recommended Citation Nancy Ehrenreich and Beth Lyon, The Global Politics of Food: A Critical Overview, 43 U. Miami Inter-Am. L. Rev. 1 (2011) Available at: http://repository.law.miami.edu/umialr/vol43/iss1/3 This Foreword is brought to you for free and open access by Institutional Repository. It has been accepted for inclusion in University of Miami Inter- American Law Review by an authorized administrator of Institutional Repository. For more information, please contact [email protected]. 1 LatCrit South-North Exchange The Global Politics of Food: Sustainability and Subordination The Global Politics of Food: A Critical Overview @Nancy Ehrenreich & Beth Lyon* Like many other arenas of life, the world of food is a world of politics and power. Inequalities of power and privilege across the globe affect who has access to food and who does not, who controls its production and who is harmed by that production, how con- sumptive choices are constructed and constrained, and whether * Professor of Law and William M. Beaney Memorial Research Chair, Denver University Sturm College of Law and Professor of Law, Villlanova University School of Law. We thank Shawn Hogue, Anthony Hearn, and the entire editorial board of the Inter-American Law Review for their hard work on our article and this Symposium.
  • Fire in the Mountains| Campesino and Natural Resource Manager Perspectives on Agro-Pastoral Burning and Forest Fires in Honduras

    Fire in the Mountains| Campesino and Natural Resource Manager Perspectives on Agro-Pastoral Burning and Forest Fires in Honduras

    University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 2002 Fire in the mountains| Campesino and natural resource manager perspectives on agro-pastoral burning and forest fires in Honduras Dale Gregory Woitas The University of Montana Follow this and additional works at: https://scholarworks.umt.edu/etd Let us know how access to this document benefits ou.y Recommended Citation Woitas, Dale Gregory, "Fire in the mountains| Campesino and natural resource manager perspectives on agro-pastoral burning and forest fires in Honduras" (2002). Graduate Student Theses, Dissertations, & Professional Papers. 2354. https://scholarworks.umt.edu/etd/2354 This Thesis is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. Maureen and Mike MANSFIELD LIBRARY The University of Montana Permission is granted by the author to reproduce this material in its entirety, provided that this material is used for scholarly purposes and is properly cited in published works and reports. **Please check "Yes" or "No" and provide signature Yes, I grant permission J No, I do not grant permission Author's Signature: Date: Z3 200Z Any copying for commercial purposes or financial gain may be undertaken only with the author's explicit consent. MSThesissMansneid Library Permission Fire in the Mountains: Campesino and natural resource manager perspectives on agro-pastoral burning and forest fires in Honduras by Dale Gregory Woitas B.S.
  • Introduction the Global Environmental Politics of Food • Jennifer Clapp and Caitlin Scott*

    Introduction the Global Environmental Politics of Food • Jennifer Clapp and Caitlin Scott*

    Introduction The Global Environmental Politics of Food • Jennifer Clapp and Caitlin Scott* This special issue seeks to expand our understanding of the complex inter- linkages between the politics and governance of the global environment, on one hand, and the global food system on the other. The articles in this issue explore insights that the field of global environmental politics can bring to questions of food system sustainability, while at the same time considering what the relationship between food systems and the environment reveals about the nature of global environmental politics. The authors examine how issues at the intersection of environment and food are framed in international political settings; the articles explore the political and economic dynamics surrounding different actors—including states, corporations, civil society organizations, and marginalized populations—in shaping debates around how best to govern these issues. This focus on the global environmental politics of food is, in our view, much needed. In the decade since the 2007–08 global food crisis, people have become increasingly more aware of the linkages between food systems and envi- ronmental systems. The industrial production, distribution, storage, and market- ing systems that provide much of the world’s food utilize large amounts of water and fossil energy and contribute significantly to deforestation, biodiversity loss, soil erosion, chemical exposure, depletion of fisheries, and climate change. The extent of the ecological crisis associated with the global food and agriculture system is widely understood in the scientific community and backed by growing volumes of empirical data that have enormous policy significance (e.g., Foley et al.
  • From Chaos to Stability: U.S. Policies and Interests in Honduras Cristian Arntson

    From Chaos to Stability: U.S. Policies and Interests in Honduras Cristian Arntson

    University of Portland Pilot Scholars History Undergraduate Publications and History Presentations 12-2017 From Chaos to Stability: U.S. Policies and Interests in Honduras Cristian Arntson Follow this and additional works at: https://pilotscholars.up.edu/hst_studpubs Part of the Latin American History Commons, and the Political History Commons Citation: Pilot Scholars Version (Modified MLA Style) Arntson, Cristian, "From Chaos to Stability: U.S. Policies and Interests in Honduras" (2017). History Undergraduate Publications and Presentations. 1. https://pilotscholars.up.edu/hst_studpubs/1 This Thesis is brought to you for free and open access by the History at Pilot Scholars. It has been accepted for inclusion in History Undergraduate Publications and Presentations by an authorized administrator of Pilot Scholars. For more information, please contact [email protected]. Arntson 1 From Chaos to Stability: U.S. Policies and Interests in Honduras By Cristian Arntson Submitted in partial fulfillment of the requirements for the degree of Bachelor of Arts in History University of Portland December 2017 Arntson 2 December 23, 2004, a bus passes through the rough and rugged road on the way back to the suburbs of San Pedro Sula before Christmas. The bus carried 60 passengers, many of which were young children with their mothers who were carrying Christmas gifts they had bought in the city, and others were workers in the maquilas, or textile factories, who were heading home after a long day’s work. As they were traveling, the driver, Guillermo Salgado Pineda, noticed two cars stopped ahead of him, and as the bus went along one of the cars cut off the bus and stopped in front of it while the other boxed it in from behind.
  • A Select Survey of Criminal Justice Administration and Criminology Resources for Research, Reference, and Collection Development

    A Select Survey of Criminal Justice Administration and Criminology Resources for Research, Reference, and Collection Development

    the alert collector Neal Wyatt, Editor A Select Survey of Criminal Justice Administration and Criminology Resources for Research, Reference, and Collection Development Richard A. Stoddart, Brett This column illustrates the best of outcomes when colleagues Spencer, and Adrienne R. assist one another in developing subject expertise and in McPhaul, Guest Columnists building collections. As all of us in the collection develop- ment world know, crafting well-developed collections in subject-specific areas is a constant challenge. Taking up this Correspondence concerning this challenge in a subject specialty you do not know well is, column should be addressed to to put it lightly, a daunting prospect. When Rick Stoddart Neal Wyatt, The Alert Collector, c/o found himself in that position, he turned to Brett Spencer and RUSA, 50 E. Huron, Chicago, IL 60611; Adrienne McPhaul for assistance. Spencer and McPhaul have [email protected]. Wyatt is almost ten years of criminal justice collection liaison experi- a collection development and readers’ ence between them, and both agreed to help Stoddart get up advisory librarian from Virginia. She to speed on critical materials for his collection. The result of wrote The Readers’ Advisory Guide their collaboration was a list of core resources as well as sev- to Nonfiction (ALA Editions, 2007) eral tables of comparisons between resources that can be used and is an editor of Library Journal’s not only to build collections but also to quickly see the scope “Reader’s Shelf” column and compiles and capabilities of each relevant database and resource. As we LJ’s weekly “Wyatt’s World Lists.” are called upon to work more frequently in areas we do not know well, it can only be hoped that we will follow the model Richard A.
  • MARION NESTLE, Ph.D., M.P.H. May 2021 EDUCATION 1954-59 U

    MARION NESTLE, Ph.D., M.P.H. May 2021 EDUCATION 1954-59 U

    Department of Nutrition & Food Studies New York University Marion Nestle 411 Lafayette Street, 5th Floor Paulette Goddard Professor of Nutrition, Food Studies, and Public Health, Emerita New York, NY 10003-7035 P: 212 998 5595 [email protected] www.foodpolitics.com @marionnestle MARION NESTLE, Ph.D., M.P.H. May 2021 EDUCATION 1954-59 U. California Berkeley, Bacteriology, Phi Beta Kappa BA 1963-68 U. California Berkeley, Molecular Biology PhD 1985-86 U. California Berkeley, Public Health Nutrition MPH HONORARY DEGREES 2016 Doctor of Humane Letters, Macaulay Honors College, City University of New York 2012 Doctor of Science Honoris Causa, Transylvania University, Kentucky LICENSE New York State Certification in Nutrition and Dietetics, License #000007 PRIMARY APPOINTMENTS 1988- New York University, Department of Nutrition and Food Studies, Steinhardt School 2017- Paulette Goddard Professor, Emerita 2014- College of Global Public Health (Affiliated) 2006- Department of Sociology, Professor (Affiliated) 2004- Paulette Goddard Professor 2003-04 Professor and Director of Public Health Initiatives 1988-03 Professor and Chair 2006- Cornell University, College of Agriculture, Division of Nutritional Sciences (Affiliated) VISITING APPOINTMENTS 2019 University of California, Berkeley, Graduate School of Journalism (Spring) 2018 University of Gastronomic Sciences, Pollenzo, Italy (Spring) 2017 Instituto Nacional de Salud Publica, Cuernavaca, Mexico, Fulbright Specialist (Spring) 2016 University of Sydney, Charles Perkins Centre, Distinguished
  • Ex Libris Joins Proquest FAQ

    Ex Libris Joins Proquest FAQ

    Ex Libris Joins ProQuest FAQ General Information About Ex Libris Ex Libris is a leading global provider of cloud-based solutions for higher education and for research, public, and national libraries. The company offers SaaS solutions for the management and discovery of the full spectrum of library materials, as well as mobile campus services for driving student engagement and success. Ex Libris serves over 5,600 customers in 90 countries, with solutions deployed at 43 of the top 50 universities worldwide and more than 40 national libraries. In close collaboration with its customers, Ex Libris develops innovative solutions that greatly enhance the user experience and enable libraries and academic institutions to maximize productivity and efficiency. About ProQuest ProQuest connects people with vetted, reliable information. Key to serious research, the company’s products are a gateway to the world’s knowledge, including dissertations, governmental and cultural archives, news, historical collections, and ebooks. ProQuest technologies serve users across the critical points in research, helping them discover, access, share, create, and manage information. The company’s cloud-based technologies offer flexible solutions for librarians, students, and researchers through the ProQuest®, Bowker®, Coutts® information services; Dialog®, ebrary®, EBL™, and SIPX® businesses; and notable research tools such as the Summon® discovery service, the RefWorks® citation and reference management platform, the MyiLibrary® ebook platform, the Pivot® research development tool, and the Intota™ library services Ex Libris Joins ProQuest FAQ Page 1 platform. The company is headquartered in Ann Arbor, Michigan, with offices around the world. What is the rationale for the Ex Libris and ProQuest agreement? Libraries worldwide strive to increase their value to their users and the institutions that the libraries serve.
  • Dietary Change and Debate About Food Allergy in the United States

    Dietary Change and Debate About Food Allergy in the United States

    39 3 Allergic to Innovation? Dietary Change and Debate about Food Allergy in the United States Matthew Smith Introduction Th e expert on nutrition is not the nutrition expert, but the man who has studied nutrition by the ultimate method of research, the struggle for survival. Th e Eskimo, living on the ice fl oes of the North Pole, the Red Indian travelling hard and far over wild lands in hunting or war, the trapper in the Canadian forests, the game hunters in Africa – these men must fi nd food that gives the greatest nutritive value in the smallest bulk [. .] All these men have found that a diet of meat and animal fat alone, with no carbohydrates, with no fruit or vegetables, with no vitamins other than those they get in meat, not merely provides them with all the energy they need, but keeps them in perfect health for months at a time. Seal meat and blubber for the Eskimo, pemmican for the Indian and the trapper, biltong for the hunter, have proved to be the perfect diet. 1 In the search for the ideal diet, is it best to innovate? Or is it better to look to the past, perhaps even the distant past? 2 In his foreword to the bestselling Eat Fat and Grow Slim (1958), a diet book written by British psychiatrist Richard Mackarness (1916–1996), Sir Heneage Ogilvie (1887–1971) opted for the latter. Both argued that the protein- and fat-rich diets of early humans, which still endured in existing hunter/gatherer communities, were clearly superior to anything that had been developed since.
  • Food Industry Funding of Nutrition Research: the Relevance of History for Current Debates

    Food Industry Funding of Nutrition Research: the Relevance of History for Current Debates

    Food Industry Funding of Nutrition Research Invited Commentary Invited Commentary HEALTH CARE POLICY AND LAW Food Industry Funding of Nutrition Research The Relevance of History for Current Debates Marion Nestle, PhD, MPH Industry-sponsored nutrition research, like that of research Figure. Close Epidemiological Correlations Between Sugar and Saturated sponsored by the tobacco, chemical, and pharmaceutical in- Fat “Consumption” and Mortality in 14 Countries dustries, almost invariably produces results that confirm the benefits or lack of harm of the sponsor’s products, even when Sugar Consumption, lb/y 0 20 40 60 80 100 120 140 160 independently sponsored re- 900 search comes to opposite Sugar Saturated fat Author Audio Interview 1 conclusions. Although con- 800 USA siderable evidence demon- Australia Related article strates that those industries 700 deliberately influenced the Canada 2 design, results, and interpretation of the studies they paid for, 600 much less is known about the influence of food-company spon- Finland New Zealand sorship on nutrition research. Typically, the disclosure state- 500 ments of sponsored nutrition studies state that the funder United Kingdom had no role in their design, conduct, interpretation, writing, 400 or publication. Without a “smoking gun” it is difficult to prove Denmark Mortality per 100 000 otherwise. 300 Sweden In this issue of JAMA Internal Medicine, Kearns and Norway Switzerland colleagues3 report on having found a smoking gun. From a deep 200 dive into archival documents from the 1950s and 1960s, they W Germany Italy have produced compelling evidence that a sugar trade asso- 100 Japan France ciation not only paid for but also initiated and influenced re- search expressly to exonerate sugar as a major risk factor for 0 0 5 10 15 20 25 30 35 40 coronary heart disease (CHD).