My thoughts on Nutrition in 2017 - hopes, concerns, expectations and things to look out for:
1. The National Academies of Medicine (NAM) - NAM is making moves on laying a framework for addressing chronic diseases within the context of the dietary reference intakes. It'll be interesting to see what directions NAM moves in and how actionable this framework will be. Nutrition has a long history of relying on variable qualities of evidence to achieve its recommendations that's led to a lot of talk about how to make nutrition policy. When it comes to addressing chronic disease, we have very few validated surrogate outcomes (e.g. LDL) to link nutrient intakes to, and major parts of the field of medicine are moving away from these due to their limitations. Nutrition has a really poor history of conducting large randomized controlled trials with meaningful, interpret-able outcomes (e.g. MRFIT, WHI, PREDIMED), especially when brought together in seemingly endless variations of meta-analyses; I'll be curious to see NAM's commentary on this issue. That leaves us with prospective cohort studies, which have caused a lot of drama lately, not only due to their observational nature but also the issues with assessing dietary intake; alas, cohorts are often our only way to assess the relationship between intake and disease outcomes and will likely remain a core component of future guidelines, especially when it comes to qualifying the hazy results of large RCTs with outcomes. NAM has historically focused on nutrient intakes, but they'll also need to start taking into account food form and the food matrix (in addition to nutrients, not instead of!) to achieve meaningful recommendations - the literature is replete with examples where this matters (e.g. liquid vs solid sugar intakes, viscosity of fibers, the impact of butter vs cheese saturated fats on LDL). I'm excited that NAM is addressing this issue, and I'm hoping they can at least set a framework for what the overall field feels is acceptable for addressing outcomes research - how to achieve such a framework is literally a thought that keeps me up late at night.
2. Foods Vs Nutrients; Dietary Patterns - As alluded to above, I'm hoping we see less 'food vs nutrients' talk and more of a focus on 'foods and nutrients'. While dietary guidelines have indeed focused predominantly on nutrients, largely to prevent deficiency diseases, non-nutrient characteristics of food have the potential to impact physiology/disease risk. That, however, doesn't mean we should create false dichotomies and stop focusing on nutrients. Nutrients interact with the food matrix and that's important to consider, in addition to individual nutrient and matrix contributions. There are very complex considerations for the design of trials and analysis of observational data in order to get at the importance of both foods and nutrients - i'll have a blog post on this in the near future hopefully. For now, I'm hoping to see fewer folks, especially in the field, cheering that 'We eat food, not nutrients!'. Simple analyses addressing individual foods and their associations with chronic disease risk are rarely informative. I'll be on the lookout for new dietary patterns data that arises, though this field is still in its infancy - Regan Bailey had a great talk on the science of dietary patterns that i'd highly recommend.
3. Interpreting Evidence and the Media - I'm hoping but mainly just concerned that the press releases (from universities, industry, etc) are going to continue to be blasted across the media and continue to degrade trust in the field of nutrition. At the very least, I'm hoping that limitations of research aren't buried in the last line and we see more honest discussion by journalists and interviewed academics on issues.
On a semi-related note, I'm hoping to see more humble discussions of evidence in the literature, and subsequent media presentations, when findings from an analysis are exploratory/secondary to the primary outcome - I've seen a lot of this as of late. I'm not against these analyses and think they're important for informing the future design of trials and can fit into the context of larger bodies of data, but all too often we see overstated headlines based on subgroup exploratory analyses that run a high risk of being statistical noise. I understand researchers desires to make the most out of their efforts in collecting data, but the tone of conclusions and associated press releases are often too strong.
4. Keep an eye out - There's been some really exciting developments that relate to the broader fields of nutrition and metabolism that I think are worth highlighting and keeping an eye on:
a. Bile Acids - the past couple years have seen a lot of enthusiasm for bile acids, especially in the metabolic adaptations to gastric bypass surgeries. With greater understandings of the molecular roles of their receptors (TGR5 and FXRs) and recent advances in our understanding of the endogenous ligands for LRH-1, I think we'll see some interesting work on bile and metabolic health coming out.
b. FGF 21 - FGF21 has really blown up over the past few years and has been implicated in a whole host of metabolic processes and even eating behavior preferences. We saw more work in humans and non-human primates this past year, and i'm hoping to see some more of the preclinical work tested in clinical settings.
c. Mendelian Randomization - My research alerts for MR have steadily increased over the last year, and it's been fun to see human genetics used to address issues in human nutrition, though I think we're at the very early stages of interpreting this literature base, and there's conflicting evidence. We saw the Best But Oft Forgotten Practices series from AJCN cover MR this year, and I expect that the nutrition community is going to start discussing the relevance of MR and its limitations for the field in 2017. Since MR involves pseudo randomization and can assess lifelong exposures to certain variables, it'll inevitably start to enter our conversations about nutrition and chronic disease, and I think it's important that nutrition researchers and professionals understand its implications and limitations.
d. Metabolomics - As the field attempts to find more objective biomarkers of adherence, markers of regular intake of specific foods/nutrients, and new causal players in disease processes, I'm sure 2017 will be full of metabolomics-based analyses to address these issues. There is a lot of hype about the potential for metabolomics in addressing these issues and I think in 2017 we'll see some of this brought to bear. Keep in mind that these -omics platforms are jumping off points, and can only generate new hypotheses, they're not an end point in and of themselves.
e. Vitamin D - We've seen a number of trials related to vitamin D supplements coming out recently that have examined the impact of supplementation on disease outcomes; we'll likely see some more of these analyses this year. I'm still concerned that the field is just adding more noisy data, as few of the trials are really designed to address the crux of the issue regarding optimal blood levels of vitamin D for disease prevention (e.g. endless debates over 16 vs 20 vs 30 vs 40 ng/mL cut off levels). We saw updates on the VITAL trial in 2016 - curious what 2017 will bring about!
f. Macros - because it's nutrition, I'm sure there will still be endless discussions about fatty acids. With growing interest about the effects of dairy fats and the controversy surrounding them, I'm sure we'll see a lot more discussion. Additionally, we'll likely be seeing more oleic acid research, as crops engineered to be higher in oleic take the forefront in the oil market. Interpretation of this research will inevitably lead to in fighting as we really lack trial evidence with meaningful outcomes in either of these areas. Multiple trials are ongoing of omega 3 fatty acids (ASCEND, DO-HEALTH, VITAL) that are worth looking out for, though they likely won't be published in 2017. Recent diet books touching on sugar and responses from industries and academics will likely heat up this space as sugar takes the 'bad macronutrient' hot seat for another year. Protein seems to be focusing on plants more and more, and it'll be interesting to see attempts from this industry to address concerns over the lower contents of BCAAs in many of these sources, given the enthusiasm for high BCAA protein sources/body composition - I have a feeling pea protein will be talked about more and more. Any enthusiasm for short term outcomes from BCAAs tends to stir up those concerned about long term intake (e.g. aging field, mTOR inhibition enthusiasts), though I doubt this issue will take center stage over fats and sugar.
g. Biofortified Crops - the past few years have seen a lot of interest in biofortification of crops through both 'traditional' breeding and genetic engineering technologies. 2016, in particular, saw more evidence rolling in from different feeding trials of these crops in a number of different settings, and I expect 2017 to be full of hype and discussion about their potential for impact - we saw a Cochrane review protocol for the impact of biofortified crops on health outcomes pop up in late 2016. From a nutrition standpoint, it's pretty cool to see agricultural scientists and nutritionists start to collaborate a lot more, as the outcomes of breeding research have incentive to look beyond yield. Follow the work from HarvestPlus and collaborators if you're into this sort of thing! And who knows what CRISPR will bring..
h. Nutritional Genomics - with much hype over 'Precision Medicine' in the area of oncology, it'll be very interesting to see what 2017 does for 'precision nutrition'. The field is likely a bit far off from recruiting individual genotypes and randomizing them to diets, but there's been a fair number of secondary analyses that have provided hypotheses for important genetic variants in nutrient metabolism. I expect 2017 to add some incremental advances to the field, and see some more aggressive marketing from 'personalized nutrition' genetic testing companies as consumers seek out the 'perfect' diet. We'll also likely see some more research on the effect of nutrition on fetal programming, epigenetic state and the microbiome - hopefully, it'll be more meaningful than some of the more publicized work on diet and the microbiome! Hopefully, we won't see anymore big name retractions in the obesity and microbiome field..
5. Politics - With the change of administration, ongoing passing of soda taxes and data rolling in from current tax efforts, agricultural biotechnology labeling laws and regulations (which desperately need updating), continuing drama with dietary guidelines, and questions about how we fund science/what science we fund, I imagine we're going to see a lot of science and policy interacting over the next year. Data -> policy is rarely a smooth ride and it'll be certainly 'interesting 'to watch.
6. Food/Nutrition Technology and Processing - Food companies are going out of their way to modify foods in ways that they believe will attract new consumers; as always, there's a lot of overmarketed hype and some interesting happenings to be seen. FNCE 2016 highlighted a number of things we can expect to see from the food industry. There's been some cool efforts in cellular agriculture, making meat alternatives that are more like the real thing, using bugs (crickets) as protein sources, and alternative methods for reducing/replacing sugars. 2017 will also see more farmers planting high oleic GE crops, which will inevitably begin population wide-reductions in PUFA intake and increases in MUFA intake, and a serious alternative to instances where trans fats are still used. Some food technologists shared their top 10 trends to look out for here.
I'm sure we'll also be seeing a lot more tech coming out as it relates to nutrition and dietary assessment, both from a practical and research standpoint. 2016 wasn't so great for wearables and weight loss. 2017 might bring about some interesting research and innovations in these area as the wearable industry grows. For another spin on nutrition technology, a recent review from the Mehta Research Group at Cornell might be of interest to those who are interested in smart phone technology and dietary assessment.
What are you excited for in #FoodNutrition2017?
3. Interpreting Evidence and the Media - I'm hoping but mainly just concerned that the press releases (from universities, industry, etc) are going to continue to be blasted across the media and continue to degrade trust in the field of nutrition. At the very least, I'm hoping that limitations of research aren't buried in the last line and we see more honest discussion by journalists and interviewed academics on issues.
On a semi-related note, I'm hoping to see more humble discussions of evidence in the literature, and subsequent media presentations, when findings from an analysis are exploratory/secondary to the primary outcome - I've seen a lot of this as of late. I'm not against these analyses and think they're important for informing the future design of trials and can fit into the context of larger bodies of data, but all too often we see overstated headlines based on subgroup exploratory analyses that run a high risk of being statistical noise. I understand researchers desires to make the most out of their efforts in collecting data, but the tone of conclusions and associated press releases are often too strong.
4. Keep an eye out - There's been some really exciting developments that relate to the broader fields of nutrition and metabolism that I think are worth highlighting and keeping an eye on:
a. Bile Acids - the past couple years have seen a lot of enthusiasm for bile acids, especially in the metabolic adaptations to gastric bypass surgeries. With greater understandings of the molecular roles of their receptors (TGR5 and FXRs) and recent advances in our understanding of the endogenous ligands for LRH-1, I think we'll see some interesting work on bile and metabolic health coming out.
b. FGF 21 - FGF21 has really blown up over the past few years and has been implicated in a whole host of metabolic processes and even eating behavior preferences. We saw more work in humans and non-human primates this past year, and i'm hoping to see some more of the preclinical work tested in clinical settings.
c. Mendelian Randomization - My research alerts for MR have steadily increased over the last year, and it's been fun to see human genetics used to address issues in human nutrition, though I think we're at the very early stages of interpreting this literature base, and there's conflicting evidence. We saw the Best But Oft Forgotten Practices series from AJCN cover MR this year, and I expect that the nutrition community is going to start discussing the relevance of MR and its limitations for the field in 2017. Since MR involves pseudo randomization and can assess lifelong exposures to certain variables, it'll inevitably start to enter our conversations about nutrition and chronic disease, and I think it's important that nutrition researchers and professionals understand its implications and limitations.
d. Metabolomics - As the field attempts to find more objective biomarkers of adherence, markers of regular intake of specific foods/nutrients, and new causal players in disease processes, I'm sure 2017 will be full of metabolomics-based analyses to address these issues. There is a lot of hype about the potential for metabolomics in addressing these issues and I think in 2017 we'll see some of this brought to bear. Keep in mind that these -omics platforms are jumping off points, and can only generate new hypotheses, they're not an end point in and of themselves.
e. Vitamin D - We've seen a number of trials related to vitamin D supplements coming out recently that have examined the impact of supplementation on disease outcomes; we'll likely see some more of these analyses this year. I'm still concerned that the field is just adding more noisy data, as few of the trials are really designed to address the crux of the issue regarding optimal blood levels of vitamin D for disease prevention (e.g. endless debates over 16 vs 20 vs 30 vs 40 ng/mL cut off levels). We saw updates on the VITAL trial in 2016 - curious what 2017 will bring about!
f. Macros - because it's nutrition, I'm sure there will still be endless discussions about fatty acids. With growing interest about the effects of dairy fats and the controversy surrounding them, I'm sure we'll see a lot more discussion. Additionally, we'll likely be seeing more oleic acid research, as crops engineered to be higher in oleic take the forefront in the oil market. Interpretation of this research will inevitably lead to in fighting as we really lack trial evidence with meaningful outcomes in either of these areas. Multiple trials are ongoing of omega 3 fatty acids (ASCEND, DO-HEALTH, VITAL) that are worth looking out for, though they likely won't be published in 2017. Recent diet books touching on sugar and responses from industries and academics will likely heat up this space as sugar takes the 'bad macronutrient' hot seat for another year. Protein seems to be focusing on plants more and more, and it'll be interesting to see attempts from this industry to address concerns over the lower contents of BCAAs in many of these sources, given the enthusiasm for high BCAA protein sources/body composition - I have a feeling pea protein will be talked about more and more. Any enthusiasm for short term outcomes from BCAAs tends to stir up those concerned about long term intake (e.g. aging field, mTOR inhibition enthusiasts), though I doubt this issue will take center stage over fats and sugar.
g. Biofortified Crops - the past few years have seen a lot of interest in biofortification of crops through both 'traditional' breeding and genetic engineering technologies. 2016, in particular, saw more evidence rolling in from different feeding trials of these crops in a number of different settings, and I expect 2017 to be full of hype and discussion about their potential for impact - we saw a Cochrane review protocol for the impact of biofortified crops on health outcomes pop up in late 2016. From a nutrition standpoint, it's pretty cool to see agricultural scientists and nutritionists start to collaborate a lot more, as the outcomes of breeding research have incentive to look beyond yield. Follow the work from HarvestPlus and collaborators if you're into this sort of thing! And who knows what CRISPR will bring..
h. Nutritional Genomics - with much hype over 'Precision Medicine' in the area of oncology, it'll be very interesting to see what 2017 does for 'precision nutrition'. The field is likely a bit far off from recruiting individual genotypes and randomizing them to diets, but there's been a fair number of secondary analyses that have provided hypotheses for important genetic variants in nutrient metabolism. I expect 2017 to add some incremental advances to the field, and see some more aggressive marketing from 'personalized nutrition' genetic testing companies as consumers seek out the 'perfect' diet. We'll also likely see some more research on the effect of nutrition on fetal programming, epigenetic state and the microbiome - hopefully, it'll be more meaningful than some of the more publicized work on diet and the microbiome! Hopefully, we won't see anymore big name retractions in the obesity and microbiome field..
5. Politics - With the change of administration, ongoing passing of soda taxes and data rolling in from current tax efforts, agricultural biotechnology labeling laws and regulations (which desperately need updating), continuing drama with dietary guidelines, and questions about how we fund science/what science we fund, I imagine we're going to see a lot of science and policy interacting over the next year. Data -> policy is rarely a smooth ride and it'll be certainly 'interesting 'to watch.
6. Food/Nutrition Technology and Processing - Food companies are going out of their way to modify foods in ways that they believe will attract new consumers; as always, there's a lot of overmarketed hype and some interesting happenings to be seen. FNCE 2016 highlighted a number of things we can expect to see from the food industry. There's been some cool efforts in cellular agriculture, making meat alternatives that are more like the real thing, using bugs (crickets) as protein sources, and alternative methods for reducing/replacing sugars. 2017 will also see more farmers planting high oleic GE crops, which will inevitably begin population wide-reductions in PUFA intake and increases in MUFA intake, and a serious alternative to instances where trans fats are still used. Some food technologists shared their top 10 trends to look out for here.
I'm sure we'll also be seeing a lot more tech coming out as it relates to nutrition and dietary assessment, both from a practical and research standpoint. 2016 wasn't so great for wearables and weight loss. 2017 might bring about some interesting research and innovations in these area as the wearable industry grows. For another spin on nutrition technology, a recent review from the Mehta Research Group at Cornell might be of interest to those who are interested in smart phone technology and dietary assessment.
What are you excited for in #FoodNutrition2017?
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