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The Path to Policy: ODS Interview

Student Blogger
Interview with NIH Office of Dietary Supplements Director Dr. Paul Coates
By: R. Alex Coots

Academia is changing.

Today's universities increasingly rely on adjunct faculty to teach courses and reserve the coveted full-time academic position for the science superstars.  This phenomenon, coupled with decreasing paylines from funding agencies, makes a science career especially challenging to pursue. And that's not even considering the project difficulties!

The problem has become so pressing that even the NIH has realized it. New initiatives, such as the BEST Innovation Award, aim to ensure that graduate students and post-docs have increased opportunities to expand their skill sets for a future outside of academia.  

Policy is one of the many areas that nutrition experts can serve. The current Director of the Office of Dietary Supplements (ODS), Dr. Paul Coates, successfully made the transition from bench research as a geneticist to a career in science policy. He spoke with me about his career and transition to ODS.

What motivated your interest into policy?
I was curious. For all these years, I had been funded to do research by the NIH and other organizations, but what I concentrated most on was my own research. I was pretty naïve when I came to the NIH, not knowing what life was like for people who worked on the government side. There were plenty of them like me, PhD's in one setting or another, who had come to the NIH to work as extramural program directors.

What are the important skills or knowledge that someone should have when moving into policy?
One of the things I understood was the importance of making connections. My first job at the NIH was focusing on diabetes research efforts. I learned how to work with other people within an institute, and then gradually in other institutes and beyond to achieve common goals. I think the art of science policy is knowing who else works in this field that you can benefit from, and flip it around and ask “How can I help other people benefit from working together with them?” Recognize the talent that's out there in other organizations.

What advice would you give to students?
You need to pay your dues as a scientist first. You need to understand the scientific method. You don't have to spend an eternity in science, but you must have spent some time doing it. Author publications and write grants. My observation is that the people best prepared for this kind of experience “get it” about what a scientist does. They must be prepared to critically analyze data and know what to look for in the literature to inform policy.

What types of projects do the AAAS and Milner fellows work on?
The AAAS Science and Technology Policy Fellowship is beautifully designed to encourage people at different levels of experience in science to work closely with federal agencies to learn about the science-to-policy transition. In ODS, we're recent partners in that program. Fellows are engaged in projects that my office works on. We have a very active role in translating science into policy, but also in identifying research needs.

The Milner fellowship has a different side to it. Jointly funded by ODS and the Beltsville Human Nutrition Research Center, the Milner fellowship brings in one or two people per year for a two-year stint that will allow them to conduct research in one of the labs at Beltsville. At the same time, they participate at ODS in work on science policy.

How do you see ODS changing in the future?
ODS is getting a little older. A fairly urgent challenge is identifying people who can come up behind us and continue to identify opportunities for research—particularly those that have public health implications— and be committed to help tackle them.


ASN Focused on Collaboration to Solve Nutrition’s Complex Problems

John Courtney
By John E. Courtney, PhD

As a society, ASN highlights the very best scientific research that promotes healthy people and communities; we recognize that nutrition research is conducted within and across the public, private and government sectors of our society. ASN members understand that the nutrition challenges facing the world are multi-faceted and require research-based solutions. The Society also understands that public confidence in scientific research and integrity is essential to translate scientific evidence into improved dietary practices by consumers.

ASN's professional activities allow members to come together and share information and research findings that accelerates discoveries that allow us to better understand the connections among diets and health. As a broad member-based organization, we are transparent about the fact that industry, government, trade groups and other scientific organizations contribute funding to help our society support the research enterprise for all of our members.  ASN is committed to openness, objective science, and disclosure of potential conflicts. The Society's Conflict of Interest attestation and “guiding principles for working with external groups and addressing COI” can be found on our website. All of the Editors for ASN's three journals have publicly-available conflict of interest statements, which is not a required process and is an example of our commitment to transparency.
 
ASN promotes rigorous research that highlights the very best dietary practices, policies and guidance. Because issues of nutrition impact virtually every aspect of the food supply chain, involvement of all informed stakeholders in the scientific enterprise is essential. Furthermore, in today's extremely competitive research environment, industry support helps progress research that might otherwise be impossible due to limited federal funding.  ASN, like all scientific societies, remains vigilant in safeguarding the integrity of the scientific process from the biases and influences that can be associated with research funding from all sources. Without scientific integrity, there can be no public trust. 

ASN does not have small goals, and therefore we cannot work in a vacuum. We believe that scientists in academia, government, and industry can partner to solve the world's nutrition challenges. Our members work with moms and dads, children, the elderly, the sick, the under- and over- nourished, foundations, companies, governments, and media. We look forward to continuing to work with all stakeholders who are passionate about nutrition and committed to the highest ethical standards for research that advances the public health to achieve a healthier world.

ASN welcomes all to the table to learn from one other and to make progress on continuing to solve today's complex nutrition challenges. These challenges include improving mechanisms and processes to fund, conduct and review nutrition research that improves global health.

Dietary Guidelines Committee Focuses on the Diet-Health-Environment Trilemma

Student Blogger
By Banaz Al-khalidi

First released in 1980, the Dietary Guidelines for Americans are updated and jointly published by the U.S. Department of Agriculture (USDA) and the U.S. Department of Health and Human Services (HHS) every 5 years. These guidelines provide recommendations on nutrition and physical activity for Americans aged 2 and older, and are the driving force behind Federal nutrition policies, nutrition education and food procurement programs. As such, these guidelines are used by both the public and industry, and by a wide variety of audiences including educators, health professionals and government agencies.

Earlier the 2015 Dietary Guidelines Advisory Committee (DGAC) released a Scientific Report based on the latest evidence, which will shape the finalized guidelines later this year. The committee's work was influenced by two fundamental connections between nutrition and lifestyle-related health issues facing the U.S population:

1) Chronic diseases, overweight and obesity: about half of all American adults (~117 million) have one or more preventable chronic diseases such as type 2 diabetes, cardiovascular diseases, hypertension, and diet related cancers, and about two-thirds of adults and one-third of children are overweight or obese due to poor dietary habits and physical inactivity.  
2) Food environment and settings: diet and lifestyle behaviors are strongly influenced by personal, social, organizational, and environmental context and systems. As such, the DGAC developed their recommendations based on a conceptual model of socio-ecological framework to provide recommendations at the individual, social, organizational, and environmental level.

What does the DGAC's report say about the latest research on diet and lifestyle-related health outcomes?

The DGAC found that the current average American diet is low in vegetables, fruits, and whole grains and too high in refined grains, added sugars, saturated fat, and sodium. Furthermore, inadequate consumption of vitamin D, calcium, fiber, and potassium were categorized as nutrients of public health concern for the majority of the U.S population. Lifestyle-related health problems in the U.S. have persisted for more than 2 decades and the DGAC's report calls for urgent preventative actions at the national, state, and local community levels. The DGAC recommended a shift in focus to a more environmentally friendly, sustainable plant-based diet that focuses on whole foods rather than specific nutrients. The overall body of evidence examined by the committee is summarized below:

“A diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet.”

This is not to say that any food groups need to be eliminated completely to improve health and sustainability outcomes. In fact, the DGAC recommended three dietary patterns to provide options that can be adopted by the U.S. population and are also aligned with lower environmental impacts. These dietary patterns include the Healthy U.S. style Pattern, the Healthy Mediterranean style Pattern, and the Healthy Vegetarian Pattern.  Furthermore, the 2015 DGAC left out cholesterol restrictions where previously, the 2010 DGAs recommended that cholesterol intake be limited to no more than 300 mg/day. The up-to-date evidence on cholesterol showed no substantial relationship between dietary consumption of cholesterol and blood cholesterol. Thus, the 2015 DGAC concluded, “Cholesterol is not a nutrient of concern for overconsumption.”

The message is clear—the 2015 DGAC recommends the U.S population consume dietary patterns that are rich in vegetables, fruits, whole grains, seafood, legumes, and nuts; moderate in low- and non-fat dairy products and alcohol; lower in red and processed meat; and low in saturated fat (less than 10% of total calories consumed per day), added sugars (maximum of 10% of total calories consumed per day), and sodium (2,300 mg per day or age-appropriate Dietary Reference Intake amount). Whether the USDA and the HHS will choose to adopt or ignore these recommendations put forth by the 2015 DGAC remains uncertain at this point. Meanwhile, dozens of health and environmental groups support the committee's recommendations regarding sustainability, as viewed in the open letter found at My Plate My Planet, Food for a Sustainable Nation.  

The advisory recommendations put forth by the 2015 DGAC are also closely aligned with recent research highlighting the urgency of shifting global diets, where healthy dietary patterns (i.e. Vegetarian, Pescetarian, and Mediterranean diets) are found to be associated with more favorable health as well as environmental outcomes. Thus, the available data strongly suggest that diets that are higher in plant-based foods will not only improve personal and public health, but also boost our planet's health via “weight” reduction in greenhouse gases mainly due to reduction in livestock production.


Food for Health

Suzanne Price
By Sarah Ohlhorst, MS, RD and John Courtney, PhD

While nutrition scientists in academia and industry seek to increase research and inquiry with respect to the potential value and role of foods and nutrition-based products in improving health, the current regulatory framework appears to limit research on the health benefits of foods. Is it not time for a renewed discussion of the role of food in health? It appears to be necessary, especially related to risk reduction for noncommunicable diseases, given research that consistently shows the role of food in reducing risk of or managing a range of acute and chronic conditions.  Read the full guest blog posted at the Altarum Health Policy Forum.

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.

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