1. Presenter: Andrew W. Brown, PhD Nutrition & Obesity Research Center - Office of Energetics University of Alabama at Birmingham awbrown@uab.edu awbrown@uab.edu Moderator: James M. Rippe, MD – Leading cardiologist, Founder and Director, Rippe Lifestyle Institute Approved for 1 CPE (Level 2) by the Commission on Dietetic Registration, credentialing agency for the Academy of Nutrition and Dietetics. NUTRI-BITES ® Webinar Series In the Eye of the Beholder: Critical Evaluation of Nutrition Research Original recording of the March 12, 2015 webinar and PDF download of presentation available at: www.ConAgraFoodsScienceInstitute.com March 12, 2015

2. Based on this webinar the participant should be able to:  State potential influences of biases in nutrition research  Discuss the importance of critically evaluating new research (i.e. whether it confirms or refutes standard clinical practice or commonly held beliefs)  Describe steps to minimize misinterpretation of research  Identify strategies health professionals can use to objectively translate scientific knowledge to clinical practice NUTRI-BITES ® Webinar Series Critical Evaluation of Nutrition Research

3. How do we know about nutrition? Critically evaluating research to minimize misinterpretation What exactly was studied? How exactly was it studied? How does that compare to how it was communicated? Translating science to clinic or policy Outline

4. Nutrition Quadrilateral Research How do we ‘know’ things in Nutrition Science? Reason TraditionExperience The quadrilateral requires of a [nutrition scientist] no more than what he or she might reasonably be held accountable for: which is to say, a familiarity with [scientific literature] that is both critical and faithful; plus, an acquaintance with the wisdom of [nutrition science history]; plus, a taste for logical analysis as something more than a debater’s weapon… adapted from Outler. Wesleyan Theological Journal. 1985;20:1,p17

5. How Researchers Define Snacks and Meals By time: 8-10AM, 12-2PM, and 6- 8PM = meals; Other times = snacks By food composition/type: Based on ‘taxonomy’ of food, or calories in eating occasion (Gregori et al, 2011; Gregori, & Maffeis, 2007) How Individuals Define Snacks and Meals Meal Related-PerceptionsSnack Related-Perceptions Eating with familyvs.Eating alone Cloth napkinvs.Paper napkin Sitting while eatingvs.Standing while eating Expensivevs.Inexpensive Prepared foodvs.Packaged food ‘Healthy’ foodvs.‘Unhealthy’ food (Adapted from Wansink et al, 2010. Appetite. 54(1), 214-16) Abstract concepts

6. or The Tale of Two Cheese Sandwiches What exactly are we comparing? “Whole” FoodProcessed Food BreadMulti-grain bread with whole sunflower seeds and whole- grain kernels White bread CheeseCheddar cheeseProcessed cheese product Fat17.5 g14.5 g Protein20 g15 g Carbohydrates40 g49.5 g Sandwich2 slices of bread 2 slices of cheese 3 slices of bread 2.28 slices of cheese

7. “We … offer the contrary view that [self-report measures of EI] are so poor as measures of actual EI … that they no longer have a justifiable place in scientific research aimed at understanding actual EI...” – N.V. Dhurandhar et al., Int J Obes (Lond). 2014 Nov 13 “It appears, therefore, that, unless special precautions are applied to the study of the fourth of the adult population which is overweight, any data collected on the caloric intake of populations by the record method is likely to be an underestimate.” Are the methods good enough? JADA, January 1953

8. Spin perpetuates throughout the reporting Spin: specific reporting strategies, intentional or unintentional, emphasizing the beneficial effect of the experimental treatment Bias Presented to the Public

9. Abstracts were categorized based on results and conclusions about breakfast and obesity Breakfast was more likely to be mentioned in conclusions if results were pro-breakfast (p=0.0492) Biasing Interpretations of Own Results Brown A W et al. Am J Clin Nutr 2013;98:1298-1308 Selective Reporting Mentioned in Conclusions Not mentioned in conclusions

10. CONCLUSIONS: “These schoolchildren are exposed to an obesogenic environment, and it is not surprising that in this situation, many of these children are already overweight and will likely become obese as adults.” RESULTS: “Based on our observations, it appears that those who have higher BMIs are less likely to consume fast food as often.” Conclusions not matching results PMID:22721691

11. Adapted from: Brown A W et al. Am J Clin Nutr 2013;98:1298-1308 Being cognizant of our own humanity Food X is Bad! Mere Exposure Effect Food X is Bad! Food X is BAD! Food X is OKAY Cognitive Dissonance Confirmation Bias Discarded information

12. Often impossible to tell if something ‘worked’ for an individual (e.g., responders vs non-responders) Improvements could have been spontaneous Improvements may have been better with another option Impairments may have been mitigated Scientific investigation tells us whether, on average, a group does better under one condition than another RCTs in particular tell us whether a change in exposure causes a change in outcome The plural of anecdote is not ‘data’ Anecdote vs Data