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Rethinking the problem of long-term weight management

Student Blogger
By Banaz Al-khalidi

Losing weight is hard enough. Keeping it off is even harder. Despite decades of scientific advancement in our understanding of energy intake and energy expenditure, weight regain after weight loss remains a major issue in obesity treatment. What could we be missing in this energy balance equation? Rethinking this problem, I think it is worth asking ourselves whether we live to eat or eat to live. There is a huge difference. Given the abundance of food in our environment, the majority of us will live to eat. But what drives this motivation or simply put, what are the determinants of healthy versus unhealthy behaviors?  

Generally, healthy lifestyle interventions including diet, exercise, and behavioral strategies, such as keeping a food log, have proven to be effective for weight loss in the short term. However, participants' lack of adherence to the intervention coupled with subsistence of unhealthy behaviors result in weight regain in the long term. According to a research on cardiovascular health behaviors and health factor changes in the US population from 1988 to 2008, healthy diet scores changed minimally (from 0.3% to 1.4% between 1999 and 2008), and physical inactivity levels decreased by only 7-10% from 1999 to 2006. Furthermore, by 2020, it is estimated that 43% of American men and 42% of American women will have a BMI of ≥ 30 kg/m2 (i.e., obese category). Despite the established risks and benefits associated with diet and physical activity, it seems that health behaviors tend to be incredibly resistant to change.
 
A recent report from a panel of obesity experts convened at the National Institutes of Health discussed the issue of weight regain after weight loss. The authors highlighted the problem of behavioral fatigue, in which patients grow weary of strict lifestyle regimens, especially when weight loss declines after the first 6 months. Specifically, the authors mentioned that “Initially, the positive consequences of weight loss (e.g., sense of accomplishment, better fit of clothes) outweigh the cognitive and the physical effort needed to lose the weight. Later, when the goal is to maintain lost weight, the positive feedback is less compared to the effort required to keep adhering to the same regimen. Thus, the benefits no longer seem to justify the costs”. In other words, the costs of adherence to these interventions exceed the benefits as time progresses, and patients seem to justify their behavior by re-thinking about the cost/benefit ratio in the long run. How can we then increase the long-term benefits while decrease the costs associated with weight maintenance?

There is a need to understand what factors allow people to successfully maintain a behavior over a long period of time. In recent years, obesity and behavioral scientists have started to explore strategies that involve incorporating ‘mindfulness' to promote the sustainability of healthy behaviors. Mindfulness is defined as: awareness of the present moment, and paying attention to one's moment-to-moment experiences non-judgmentally. This attention leads to a clear awareness of one's own thoughts as well as one's environment in that one observes what is happening, but instead of reacting, the mind views these thoughts as inconsequential. This does not mean disconnection from life; rather, the mind is actively engaged and flexible. Mindfulness is not a technique but it is a way of being.

You might ask, what does this have to do with obesity and health behaviors? They're all related. Mindfulness-based interventions (MBIs) have recently become a focus for the treatment of obesity-related eating behaviors. A recent review paper examined the effectiveness of MBIs for changing obesity-related eating behaviors. Of the 21 studies included in the review, 18 studies reported positive results for obesity related eating behavior outcomes. Specifically, mindfulness enhanced self-awareness and self-regulation (i.e. long lasting self-motivation) by improving awareness of emotional and sensory cues, which may be effective for sustaining a behavior in the long term. It's about acceptance of the moment we're in and feeling whatever we feel (accepting both positive and negative emotions) without trying to resist, change or control it. Under emotional stress, most of us will try to comfort ourselves by putting something into our mouths, but being aware of the negative emotions, and having greater self-control skills may help us resist the urge to eat large quantities of food or unhealthy food. Thus, greater awareness and self-control skills may help an individual to better monitor and regulate their dietary intake as well as their engagement in physical activity.

When we live to eat, we tend to engage in the act of mindless eating because we tend to see food as a source of reward or entertainment, and we shovel food into our mouths without paying attention to what we're eating and whether we feel full. However, when we're more mindful or self-aware (i.e. eating to live), we become more conscious of what goes into our bodies by focusing fully on the act of eating and eating related decisions. The bottom line is mindfulness may help patients identify internal and external eating cues, manage food cravings, and enhance self-regulation and resilience- all factors important to counteract the behavioral fatigue that tends to occur in lifestyle interventions over time. Perhaps, when we're more mindful, we'll tune into our bodies instead of our thoughts (i.e., thinking about the costs/benefits), and will start to look at food as nourishment rather than as emotional comfort blanket. It is important to note that research in this area is still preliminary but exploring and understanding the relationship between mindfulness and health behaviors may hold promise for long-term weight management.


New Focus on Reducing Anemia in Adolescent Girls

Student Blogger
By Marion Roche, PhD

The target set out by the World Health Assembly is to reduce the anemia in all women of reproductive age by 50% by 2025. Women make up about 3.5 billion in population on our planet. In order to reach this World Health Assembly target, it will be essential to address anemia in the 600 million adolescent girls in the world and recently their nutrition has been getting more attention.

The global birth rate has declined over the past decade, except when analyzing the rate for adolescent girls, with 17-20 million adolescent pregnancies per year. Eleven percent of all pregnancies are to adolescents and 95% of these adolescent pregnancies are occurring in developing countries. 

Complications from pregnancy and child birth are the second greatest contributor to mortality for girls 15-19 years of age. Young maternal age increases the risk for anemia during pregnancy, yet adolescent women are less likely to be covered by health services, including micronutrient supplementation, than older women. Compared with older mothers, pregnancy during adolescence is associated with a 50% increased risk of stillbirths and neonatal deaths, and greater risk of preterm birth, low birth weight and small for gestational age (SGA) (Bhutta et al, 2013; Kozuki et al, 2013; Gibbs et al, 2012).

Reducing anemia in adolescents is often motivated by efforts to improve maternal and newborn health outcomes for pregnant adolescents; however, benefits for improving adolescent school performance and productivity at work and in their personal lives should also be valued.

Globally, iron deficiency anaemia is the third most important cause of lost disability adjusted life years (DALYs) in adolescents worldwide at 3%, behind alcohol and unsafe sex (Sawyer et al, 2012).

Adolescents have among the highest energy needs in their diets, yet in developing countries many of them struggle to meet their micronutrient needs. The World Health Organization recommends intermittent or weekly Iron Folic Acid Supplements for non-pregnant women of reproductive age, including adolescent girls. IFA supplementation programs have often been designed to be delivered through the existing health systems, without specific strategies for reaching adolescent girls.

I have heard adolescence referred to as “the awkward years” when individuals explore self-expression and autonomy, but it is also definitely an awkward period for public health services in terms of delivering nutrition, as we often fail to reach this age group. 

There have been examples of programs going beyond the health system to reach adolescent girls, such as through schools, peer outreach, factory settings where adolescents work in some countries and even sales in private pharmacies to target middle and upper income adolescent girls.
The Micronutrient Initiative implemented a pilot project with promising results in Chhattisgarh, India where teachers distributed the IFA supplements to 66,709 female students once per week during the school year over a 2 year pilot. 

It was new for the schools to become involved in distribution of health commodities, but engaged teachers proved to be effective advocates. There were also efforts to reach the even more vulnerable out of school girls through the integrated child development centers, yet this proved to be a more challenging group of adolescents to reach. Peer to peer outreach by the school girls offered a potential strategy. The current project is being scaled up to reach over 3.5 million school girls.

Adolescent girls have much to offer to their friends, families and communities beyond being potential future mothers. It is time to get them the nutrients they need to thrive in school, work and life.


Revisiting Fiber and Colorectal Cancer

Student Blogger
By Kevin Klatt

Colorectal cancers are the third most common worldwide, and represent one of the major areas of prevention research. Rates of these cancers increase with industrialization, and are uncommon in Africa and much of Asia. A number of potential nutritional targets have been posited, based on preclinical and epidemiological data; however, these remain controversial. The American Institute of Cancer Research's 2011 report (1) on Colorectal Cancer states that there is convincing evidence that foods high in fiber decrease risk and red and processed meats increase risk of colon cancer. However, there are few controlled feeding studies in humans have corroborated these associations; indeed, a large body of literature (2-7) focusing on dietary fiber supplementation back in the late 90's and early 2000's did not show any support for any positive effects of high fiber/low-fat diets on recurrent adenomas . However, these studies can/have been criticized for: 1. not being long enough 2. fail to capture of a window of true prevention (as subjects already had adenomas) 3. The dose/type of fiber. Since these trials, considerable experimental data (8,9) has been generated to suggest that the type of fiber, its dose, and the type/amount of short chain fatty acid fermentation products likely add some complexity to the inconsistent epidemiological associations between fiber intake and colorectal cancer risk.

A recent study published in Nature Communications (10) provides a novel perspective on this contentious topic of high-fiber diets and colon. The study employed a food-based dietary intervention in 2 populations: African Americans and rural South Africans (a sensible population to study given Burkitt's original observations that rural Africans are nearly free of large bowel diseases). Twenty healthy, middle-aged African Americans and 20 rural Africans were first examine in their home environments for 2 weeks, to examine their normal food intake, before being housed in their respective research facilities for the 2 weeks of the dietary intervention (to ensure compliance). African Americans were given the ‘African style' diet that was low in fat (16% kcals) and high in fiber (55g/day). Participants from Africa were given a western style diet that was higher in fat (52% kcals) and lower in fiber (12g/day). Notably, the high fiber diet was achieved using HiMaize, a purified resistant starch product. The authors look at outcomes related to mucosal epithelial cell proliferation (Ki67 staining) and markers of inflammation (CD3+ intraepithelial lymphocyte and CD68+ lamina propria macrophage staining), to examine the effect of diet on predicted neoplastic change and increased risk of colon cancer. They further look at alterations in microbial composition, highlighting changes in microbes with the baiCD gene, responsible for the deconjugation of bile acids and production of their carcinogenic, secondary metabolites. Their results quite nicely show that the high fiber intervention alters biomarkers in directions that suggest a protective effect against colorectal cancer, while also finding some interesting nuances related to amino acid and choline metabolism.

While providing encouraging results for the role of nutrition in colorectal cancer development, the study leaves us with more hypotheses to test, and a renewed interest in the way in which fiber and its fermentative products might act to buffer against colorectal cancer. Without hard clinical outcomes, it's difficult to get too excited about the results in light of the multiple fiber interventions that have failed in the past. The biomarkers chosen are not without their scrutiny, as it has been noted that decreases in apoptosis rather than increased cell proliferation better predict tumorigenesis in animal models of colorectal cancer (11). Regardless of one's enthusiasm about biomarker changes over 2 weeks, it does force us to critically think about previous study designs that have cast doubt on fiber's role in colon cancer. The authors in this current study employ highly butyrogenic starches, at doses not tested in the trials that have failed before. There is consistent molecular evidence that butyrate works in a paradoxical manner, both stimulating cell proliferation at low concentrations and inhibiting it at high (12), leaving open the possibility that the previous doses of fiber were too low to see a beneficial effect.

Given the Western diets low concentrations of dietary fiber, particularly resistant starches (13), as well as the increased enthusiasm to fortify the food supply with added fibers, further research examining the role of particular fibers, their appropriate doses, and their relationship to clinical outcomes appear warranted. The type 2 resistant starch utilized in this study is uncommon in the food supply, coming largely from raw potatoes, unripe bananas, and some legumes and represents a potential area for food technologists to significantly alter the food supply for better health (14).

References
1.    http://www.aicr.org/continuous-update-project/colorectal-cancer.html
2.    http://www.ncbi.nlm.nih.gov/pubmed/11073017
3.    http://www.ncbi.nlm.nih.gov/pubmed/10770979
4.    http://www.ncbi.nlm.nih.gov/pubmed/10770980
5.    http://www.ncbi.nlm.nih.gov/pubmed/7730878
6.    http://www.ncbi.nlm.nih.gov/pubmed/7473832
7.    http://www.nejm.org/doi/pdf/10.1056/NEJM199901213400301
8.    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926973/
9.    http://www.ncbi.nlm.nih.gov/pubmed/20937167
10.    http://www.nature.com/ncomms/2015/150428/ncomms7342/full/ncomms7342.html
11.    http://carcin.oxfordjournals.org/content/18/4/721.abstract
12.    http://jn.nutrition.org/content/134/2/479.full
13.    http://linkinghub.elsevier.com/retrieve/pii/S0002-8223(07)01932-3
14.    http://advances.nutrition.org/content/4/3/351S.full

Is Nutrition Influencing Puberty in Teen Girls?

Student Blogger
By Meghan Anderson Thomas

The age of menarche has decreased significantly in the past century, from an average age of 16-17 years old to younger than 13 years of age (Buttke, Sircar, & Martin, 2012). There are several different theories as to why this may be occurring.  Some believe that environmental toxins or exposure to estrogen-disrupting compounds (EDC) may play a role. EDCs are found in household plastics, cleaners, deodorizers and personal care products.  Other theories include increased body mass index in children and adolescents. Increased hormones found in obese children maybe responsible for the earlier onset of puberty.  Finally, nutritional implications such as breast versus bottle-feeding and increased dairy and meat intake in adolescence may also play a role in puberty at younger ages.

EDCs include benzophenones, dichlorophenols, parabens, triclosan, which are compounds that effect estrogen signaling by binding to the receptor and have downstream effects (Buttke, Sircar, & Martin, 2012). These compounds are becoming increasingly common in everyday and household use.  This type of exposure may be implicated as one of the causes of decreased age of menarche.  In a study by Buttke et al, the level of urinary EDCs was analyzed in females between the ages of 6-11 and 12-19 (2012).  Females with urinary EDCs above the 75th percentile have significantly lower age of menarche (Buttke, Sircar, & Martin, 2012). These results are worrisome, because pollutants in our environment are influencing the development of adolescents. This is a larger public health concern than previously believed.  Further investigations are underway to better understand which products are the most dangerous culprits.  

Obesity has become a major epidemic, whereas two-thirds of the Americans are overweight or obese and one-third of children are overweight or obese.  While obesity in adulthood can lead to a plethora of health concerns, it was previously thought that childhood obesity might have reversible effects.  However, obesity in young females has been shown to have an influence on early-onset puberty. Obesity causes an increase in certain hormonal levels including leptin, insulin, IGF-1, certain binding proteins, and androgens (Marcovecchio & Chiarelli, 2013).  Early signs of puberty are not the only effects seen by the hormonal changes associated with obesity, hyperandrogenism may be present as well (Marcovecchio & Chiarelli, 2013).  Hyperandrogenism involves increased body and facial hair, alopecia, acne, and increased libido.  Both hyperandrogenism and earlier development in females may have extreme social effects in adolescent females.

Nutrition in newborns is predominately breast-feeding at approximately 75%, however, after just one-week postpartum breast feeding incidence drops to 16.2%. Approximately 20% of formula-fed infants are given soy-based formula (Andres, Moore, Linam, Casey, Cleves, & Badger , 2015).  Isoflavones are organic compounds that act as phytoestrogens in mammals and are found in soy-based products and may be feared to cause estrogenic effects such as early-onset puberty (Andres, Moore, Linam, Casey, Cleves, & Badger , 2015). Currently, the most recent study on hormonal additives was done in 1988 by the FAO/WHO Committee on Food Additives Joint with the Federal Drug Administration (FDA) which showed no concern for human consumption of hormonal additives (Larrea & Chirinos, 2007).  Later, Larrea and Chirinos show that the study may be concerning due to the inadequate scientific elements that were used (Larrea & Chirinos, 2007).  Furthermore, previous studies on the effects of hormonal additives on early onset of puberty are inconclusive and current studies are still underway (Andres, Moore, Linam, Casey, Cleves, & Badger , 2015).  The conclusions of the current longitudinal studies will be a vital factor in not only post-partum nutrition but child and adolescent nutrition as well.

The significance of all of the theories behind early menarche is due to the psychosocial effects of early maturity of young girls and the unwanted attention they may receive.  Early onset of puberty also causes women to have longer exposure to estrogen, which may be associated with several types of cancers, including breast and endometrial cancer.   Estrogen exposure also increases risks for cardiovascular disease and high cholesterol.  These health-related side effects were significantly lower when women were experiencing menarche at older ages. Clearly, more research needs to be done in order to investigate the multifactorial causes of early menarche in adolescents; however, current studies seem to implicate both environmental and nutritional exposures.
    
References
Andres, A., Moore, M., Linam, L., Casey, P., Cleves, M., & Badger , T. (2015, March). Compared with feeding infants breast milk or cow-milk formulas, soy formula feeding does not affect subsequent reproductive organ size at 5 years of age. The Journal of Nutrition , .
Buttke, D., Sircar, K., & Martin, C. (2012). Exposure to endocrine-disrupting chemicals and age of menarche in adolescent girls in NHANES. Environmental Health Prospective , 120 (11), 2003-2008.
Larrea, F., & Chirinos, M. (2007). Impact on human health of hormonal additives used in animal production. Rev Invest Clin , 59 (3), 206-211.
Marcovecchio, M., & Chiarelli, F. (2013). Obesity and growth during childhood and puberty. World Review of Nutrition and Dietetics , 106, 135-141.
NIH. (2009-2010). Overweight and Obesity Statistics. Retrieved 2015, from National Institute of Diabetes and Digestive and Kidney Diseases: niddk.nih.gov

YPIG EB 2015 Session Guides Early Career Professionals

Suzanne Price
Becoming an Expert: Easy as 1, 2, 3 (Almost)
By Debbie Fetter

As part of ASN's Scientific Sessions, the ASN Young Professional Interest Group (YPIG) organized a session called, “Establishing Yourself as an Expert.” I (virtually) sat down with the co-chairs, Eric D. Ciappio, PhD, RD and Mary N. Lesser, PhD, RD, to get more insight into the presentations.

Q.    What was the purpose of the session?

A.    The purpose of this session was to provide some guidance to early career professionals looking to establish themselves as experts in their specific corners of nutrition science. We heard from four respected experts in different areas of nutrition who helped young scientists understand best practices for communication and interacting with colleagues.
 
Q.    What did it address?
 
A.    While technical knowledge is important, another large part of being an expert in nutrition is being viewed as one by your peers in the field. This session addressed this latter point and aimed to help young professionals develop their communication skills to help them become viewed as experts in the field. We split this topic into two main themes, which we referred to as “internal communication” and “external communication.” The "external communication" bucket focused on communicating with the broader field of nutrition via academic publications and social media – both of which are demonstrated essentials for early career professionals in the modern age. The “internal communication” bucket addressed methods to improve in-person interactions with your colleagues, both in one-on-one settings as well as finding ways to guide a group of strong scientific minds to a consensus opinion.
 
Q.    What were the main takeaways for the attendees?
 
A.    We believe the largest takeaway was that effective communication is the most important career skill that we never think about. As scientists, we can often become so focused on increasing our technical knowledge and expertise that we forget about the human element of the profession. Nurturing working relationships with colleagues is an essential skill early career professionals need to develop to enhance and to continue to advance in their careers.
 
Q.    What are your personal do's and don'ts for advancing your career? Or which were your favorites from the session?
 
A.    EC: I think taking time to establish personal connections with your colleagues is the best thing you can do for your career. Your professional network is probably the most valuable piece of portable currency you have, and growing that network benefits both your organization (regardless of whether you are in academia, industry, government, etc.) and your own career.
 
A.    ML: Definitely taking the time to establish meaningful, personal connections with your colleagues, no matter what capacity (mentor, mentee, faculty, staff, student, etc.) is key. These are the individuals whom you will be working alongside and will be your resources or source of support in a variety of settings. Also, never underestimate the value of a good “thank you” and paying it forward.
 
Q.    How does it seem social media will change science communications?
 
A.    Social media offers an opportunity to be a part of the conversation on nutrition. While academic publications are a mainstay of scientific discourse among scientists, the public discussion of science – particularly nutrition science – takes place much more rapidly than the traditional academic publication model allows. Social media also engages the public in a way that traditional publications never have. With so much public interest in nutrition there is incredible value in being a credible and accurate source of information that can effectively engage the public to help educate them about the relationship between diet and health. Effectively utilizing social media offers a platform for nutrition scientists (early or more advanced in their careers) to do just that.
 
Q.    What are some key ways to work together as a group? Is it always possible to come to a group consensus? 
 
A.    Once again, effective communication is the key. In her session, Dr. King stressed the importance of clearly outlining the goals of the group and taking time to understand each person's stance on the issues up for discussion. Finding a way that pleases all parties with conflicting opinions may not always be possible, but respectful communication and compromise can help guide the group to remain productive and conclude with a census or working census outcome.
 
Q.    Why is it important to have good working relationships with your colleagues? How do you manage a good working relationship with someone who has conflicting opinions from you?
 
A.    Having strong working relationships with your colleagues is not only a way to accomplish your daily professional goals, but also the best way to move your career forward. We learn about so many opportunities – potential jobs, speaking engagements, serving on committees – from our colleagues. And while having a solid relationship with someone may not always be enough to land you that opportunity, more often than not, having a poor relationship with a colleague in a position to help you is almost certain to be a hindrance. If you have a colleague who you just cannot see eye to eye with on a work issue, do your best to keep your emotions in control and take the time to try and understand what your colleague's goals and motivations are. Do not be afraid to seek the guidance of a mentor who can act as a sounding board to ensure that you are not overreacting to the issue and provide guidance on how to proceed forward in interacting with this particular colleague.
 
Q.    What does being an "expert" mean to you?

A.    EC: Being an expert is a combination of having both a strong technical knowledge base and an ability to engage your colleagues and community. You need to be a source of accurate information and good ideas, but putting your thoughts into action requires working with your colleagues effectively.
 
A.    ML: Being an expert to me means having a strong knowledge base in your area of research, education, etc. but also being able to contribute to conversations/collaborations with your colleagues and the community as a whole. To echo Eric's above comment, you do need to be a source of accurate information and ideas, but effectively communicating your knowledge and ideas into action requires working with your colleagues.

Thank you both for a wonderful recap of this session. Now we are all ready to go out in the world and establish ourselves as experts!

Thanks to DuPont Nutrition & Health and PepsiCo for educational grants in support of this session.

Crisis in Nepal: What about nutrition?

Student Blogger
By Sheela Sinharoy

As the tragedy of the earthquake in Nepal continues to unfold, we see images of disaster response teams at work. How does assistance reach those who need it, especially in terms of meeting the food security and nutrition needs of the affected population?

In general, humanitarian response is led by the United Nations (UN) Office for the Coordination of Humanitarian Affairs (OCHA). OCHA uses a cluster approach; in Nepal, the nutrition cluster is jointly led by the Ministry of Health and Population (MoHP) and UNICEF. Other UN agencies (e.g., World Food Programme), bilateral organizations (e.g., United States Agency for International Development or USAID), and non-governmental organizations (e.g., CARE) are all members of the cluster. In many countries, the cluster has regular meetings so that coordination and communication mechanisms are already in place before a disaster strikes.

Each cluster follows the guidance in The Sphere Handbook, which outlines minimum standards in the areas of water supply, sanitation and hygiene promotion; food security and nutrition; shelter, settlement and non-food items; and health. This handbook represents the contributions of many humanitarian agencies and is meant to have universal application to any humanitarian response. It particularly emphasizes affected populations' right to dignity, protection, and assistance and promotes their active participation as a way to ensure the appropriateness and quality of the response.

The food security and nutrition section of the handbook includes standards for the protection of safe and optimal infant and young child feeding, management of acute malnutrition and micronutrient deficiencies, and food security. It states that food rations should meet the following nutrition requirements: 2,100 kcals per person per day, 10% of total energy provided by protein, 17% of total energy provided by fat, and adequate micronutrient intake. If the affected population has access to some food, then the ration should aim to fill the gap between what people can access and the nutrition requirements. There are many other considerations outlined in the handbook, including the cultural acceptability of the food ration and the ability of the affected population to store and prepare the foods.

According to the May 1, 2015 Nepal situation report issued by OCHA, more than 3 million people require food assistance.  In line with The Sphere Handbook, the nutrition cluster has decided to standardize food assistance to include 400g rice, 60g lentils, 25g oil, and 7.5g iodized salt per person per day. Some of the food comes from in-country supplies, and some is brought in from other countries in the region. WFP, as lead of the logistics cluster in Nepal, manages this and has dispatched trucks and, in some cases, helicopters to carry food and other supplies to priority areas.

Disasters such as the earthquake in Nepal require an immediate expert response. OCHA and the nutrition cluster, by following The Sphere Handbook, are working to protect the nutrition of the affected populations in the most effective way possible.

Interview with Christopher Ryland, Eskind Biomedical Library

Suzanne Price
Ever wondered where ASN stores some of its historical treasures? ASN's Society Archives have been housed at Vanderbilt's Eskind Biomedical Library since 1980, and the founding days of the Society, as well as the emergence of the nutrition science field, are archived at EBL via many early records, photographs, and memorabilia. Chris Ryland is Associate Director for Special Collections at the Eskind Biomedical Library (EBL) at Vanderbilt University Medical Center and he spoke with us about the value of archives.

Nutrition Notes Daily: Wrap up issue

Suzanne Price
Read the final issue of Nutrition Notes Daily for coverage of sessions you may have missed, photos, and more. We hope you enjoyed the conference newspaper in Boston.

wrap up 2015.jpg

ASN's Dr. John Courtney Outlines Growth, Future Plans

Suzanne Price
A Conversation with ASN Executive Officer John E. Courtney, PhD
By Teresa L. Johnson, MSPH, RD

The smile on Dr. John Courtney's face says it all: ASN's Scientific Sessions and Annual Meeting at EB 2015 is the place to be. Courtney, who is in his ninth year as ASN's Executive Officer, sat down with me on a sunny afternoon in Boston and chatted about the meeting and ASN's current and future status.  

TJ: What's your favorite thing about ASN's Annual Meeting?
JC: It's so great for bringing together the wide, diverse audience of ASN in one central convening area. We have members in basic, clinical, and translational nutrition, and they're housed in academia, medicine, practice, and industry. So it's exciting to give people an opportunity to develop and build partnerships and work together, not only to advance the science but their personal careers too.

TJ: Tell me about the changes ASN members can expect to see in 2018.
JC: ASN will convene a nutrition-focused Scientific Sessions and Annual Meeting for three years beginning in 2018. EB has been a great forum for people to work within, but we think that having a nutrition-focused meeting brings together members of the nutrition science community where they can all meet and convene. It will be a smaller meeting so it will be more open to networking, less confusing, and have less competition for scheduling to allow productive connections. I envision us having a lot more flexibility in how we structure our meeting. We'll probably do it outside the academic year, and we'll do it in a cool place!

TJ: What are you hearing from the members regarding this change?
JC: There's been great support from our members, and a lot of excitement. Of course, our current president, Dr. Simin Nikbin Meydani (pictured below with Dr. Courtney) of Jean Mayer USDA HNRCA at Tufts University, is a fantastic leader with great skills in consensus-building. If you make changes, you really have to go the extra mile in seeking input and cultivating agreement, and she's done that.

 John and Simin small.jpg

TJ: How will ASN maintain the same level of quality in its meeting?
JC: A lot of questions have been raised about how we can do it the best way. Some people are concerned because they like the EB model—they like the “cross-fertilization” of scientific disciplines—so one of the things we're hearing loud and clear is that we need to keep that cross-fertilization. So we'll offer programming that meets all the segments of ASN's needs.

TJ: What will be unique about ASN's meeting?
JC: I see us having a lot of different types of activities. We can take a look at how to offer sessions that reach out to the public. Right now we reach the researchers and the practitioners, but we want to take that next leap and start to engage the public.

We're also planning sessions that are unrelated to nutrition. Maybe we'll hear about the newest, hottest thing in the future of information technology or the potential role that robotics can play in personalized health!

Perhaps we'll have an inspirational session that brings in that spectacular leader or renowned speaker who says, “This is what the world is going to look like in 2050,” and asks, “How can people working in nutrition prepare for the challenges and the opportunities that will be taking place then?”

TJ: How is ASN poised to address the next five years?
JC: We have a strategic map that focuses on positioning ASN as the global authoritative leader in nutrition science. We have an actionable dashboard that identifies what our key problematic areas are and we've developed strategies that fit and help us meet those challenges.

For example, one of the exciting strategies that our incoming president Dr. Patrick Stover, Cornell University, wants to focus on is positioning ASN for 2028—the 100th anniversary for the Society. So, rather than looking at what we want to be in five years, we're asking what we want to do and be in 2028; then we're breaking it into chunks that will get us there. We're looking at an endpoint to best add the most value.

TJ: What kinds of initiatives do you anticipate ASN will launch here in the US and abroad?
JC: I expect we'll have a lot more topical meetings throughout the world. We have meetings now in the Middle East, Central and South America, and Asia, but I see us really taking off so that ASN will have a presence in every major continent in the next five years. Although we have that presence now with members, we don't offer a lot of programming outside of the States so that's what we want to do—develop programs that meet those members' needs and grow even more.

TJ: Will ASN still be called “American Society for Nutrition”?
JC: That's a great question! We've dialogued about that and had a lot of good feedback about it. I don't envision us changing ASN—I really don't—but we're a volunteer organization, and if our volunteers should wish to change it, perhaps we'll simply refer to ourselves as “ASN.” When we say our name, we each have some vision of what that means, but what we really are is a global organization. We have over 5,200 members in 72 different countries, and approximately 28% of the meeting attendees are from outside the United States. Clearly we're drawing a global audience.

TJ: What keeps ASN relevant?
JC: ASN really is the global leader in nutrition science. Our members, our authors, and our speakers are the preeminent leaders in nutrition. They're the ones researching today's problems, disseminating that research through our publications and our meeting-related activities, and then taking it and translating that to dietitians, medical practitioners, and public health advocates.
 
ASN is really on the move. We've more than doubled our membership, outreach, staffing and budget in the last 10 years. In the next 10 years I think we'll see equivalent growth in terms of our revenue and our member service activities, so we'll have more interaction on a grander scale.

For a first-person take on Dr. Courtney's management style, watch his video interview with CEO Update here.

Immunometabolism: The Role of Iron in an Emerging Field

Student Blogger
By Ann Liu, PhD

Historically, immunology and metabolism have been distinct disciplines. However in recent decades we have learned that metabolic diseases such as obesity and type 2 diabetes result in major changes in inflammation and the immune response. Conversely, it has also become clear that certain behaviors and properties of lymphocytes are regulated by internal metabolic processes. Thus the new field of immunometabolism has emerged to examine the crosstalk between immune and metabolic processes. Speakers at the symposium “Diet and Immunometabolism,” co-sponsored by the Nutritional Immunology and Obesity RIS, highlighted the role of nutrients and metabolites in inflammatory processes on March 31.

While we may traditionally think of iron's role in anemia and fetal development, it is also required for proper immune function and adipogenesis. Elevated serum ferritin levels are associated with type 2 diabetes, gestational diabetes, and metabolic syndrome. Excess iron also induces lipolysis and insulin resistance. Dr. Alyssa Hasty from Vanderbilt University School of Medicine presented data from mouse models indicating that iron homeostasis is disrupted during obesity. Iron is traditionally stored in the liver, however during obesity it appears that iron levels decrease in the liver and increase in adipocytes.

These changes may be related to changes in macrophage populations, which are important mediators of adipose tissue inflammation. Hasty identified two distinct macrophage populations based on their iron content.  Some macrophages have high iron content which allows them to be isolated using a magnet while others have low iron content. Lean animals have both types of macrophages. However obese animals have increased levels of macrophages with low iron content.

This indicates that iron levels are changing in both adipocyte and macrophage populations during obesity and suggests that the ability of macrophages to sequester iron may be impaired. Further study is needed to identify the mechanisms of crosstalk between macrophages and adipocytes and examine potential functional consequences.