Nutrition and dietetics conferences are important platforms for the dissemination of scientific evidence and the gathering of professionals. Information presented in these events could be used in the practice of nutritionists, dietitians and other health professionals, as well as in advocacy, and could contribute to the development of public health policy(Reference Simon1). It is, therefore, important that information presented in these events is independent and unbiased. However, there are growing concerns that food industry actors are involved in and use these events to promote their products and disseminate biased information. The food industry was, for example, present in the past editions of the International Congress of Nutrition (organised by the International Union of Nutritional Sciences)(Reference Oshaug2–Reference Gomes4). A recent study found that a majority of exhibitors in the Congress promoted ultra-processed food products(Reference Piaggio and Solans3), usually energy-dense and high in fats, sugars and Na, which consumption is associated with an increased risk of developing various non-communicable diseases(Reference Monteiro, Cannon and Moubarac5). This was also the case in national nutrition and dietetics conferences in the USA(Reference Simon1). Speakers in nutrition and dietetics conferences sometimes have ties with the food industry, some of them being food industry employees or consultants for large transnationals, without necessarily being transparent about these ties when presenting their work(Reference Simon1,Reference Gomes4) . In an annual meeting of the American Society for Nutrition, PepsiCo sponsored six of the thirty-four scientific sessions(Reference Simon6). The sponsorship of scientific events and the distribution and promotion of products have been highlighted in Australia(Reference Simon7), Brazil(Reference Canella, Martins and Silva8), Mexico(9) and South Africa(9).
The involvement of food industry actors in nutrition and dietetics conferences, particularly those producing and selling unhealthy products, risks tarnishing these events’ reputation and the credibility of professional associations organising them(Reference Simon1,Reference Oshaug2) . Health professionals may also be less likely to criticise these corporations(Reference Gomes4,Reference Canella, Martins and Silva8) . Corporate sponsorship could result in negative publicity for nutrition societies, for the nutrition and dietetics profession, and the personal credibility of nutrition professionals(Reference Reitshamer, Schrier and Herbold10). Moreover, conflicts of interest arise when nutrition and dietetics professionals undertake activities for or engage with food industry actors, which may compromise their loyalty or independent judgement(Reference Rodwin11).
Nonetheless, information on the extent of industry participation in scientific events in nutrition and dietetics, on a larger scale, is scarce, except for the cases mentioned above. The present study was developed to start addressing that gap, with the aim to identify and characterise the involvement of the food industry in nutrition and dietetics national and regional events in Latin America and the Caribbean in 2018–2019.
Methods
This was a qualitative study consisting of desk-based searches for all national, regional and international nutrition and dietetics events held in the thirty-three sovereign states from Latin America and the Caribbean. Each individual from our team selected between one and thirteen of these countries, all listed in supplementary material 1, where they identified relevant events in nutrition and dietetics, from their work in these countries, as professionals of these disciplines, and additional Google searches using the key words: ‘nutrition’ or ‘dietetics’ and the name of country (in English, Portuguese or Spanish, as relevant). The first author collected and analysed data for regional and international events organised in the region. She consulted the webpages of the Latin American Federation of Nutritional Therapy, Clinical Nutrition, and Metabolism (FELANPE), based in Panama and which has a membership of seventeen societies, associations and professional associations in nutrition from the region(12), to identify events that could have been missed by the research team (n 4) and collected and analysed data for them.
While we included events focusing on clinical nutrition, we excluded events that covered only a specific aspect of nutrition, such as breast-feeding, parenteral, enteral, paediatrics, sport or oncological nutrition. We excluded events organised by hospitals and other institutions that were not national in scale.
For each of these events, the official websites and/or social media accounts (Twitter and Facebook only) were identified and searched by each author collecting data for each country. Only the most recent national event(s) held in the past 2 years (period January 2018–December 2019) was included, due to time constraints. If the most recent event happened before that period, it was excluded. When there were two occurrences of an event during the period of data collection (for annual events), we only collected information about the most recent occurrence of the event, in a conservative approach, to avoid the duplication of information. The absence of a national event, or the absence of an official website or of another source of information when an event existed, was also noted. We only collected publicly available information freely accessible online that did not require a password.
For the present study, we defined the term ‘food industry’ as including manufacturers of food and beverage products (including breastmilk substitutes and dietary supplements, but excluding drugs), wholesalers, retailers, distributors, foodservice providers, as well as producers of raw material. We also included institutions supported by these actors, such as trade associations, public relations firms, ‘philanthropic’ organisations and research institutions. The classification of sponsors was undertaken by the first author, cross-checked by the second author and discussed with the research team in case of disagreement or need for clarification. When there was doubt about the nature of a sponsor, the first and second authors conducted searches on Google for their official webpage or social media accounts. If we could not find that information, the sponsor was excluded from our analysis. While we noted the existence of sponsorship and other forms of support from companies selling drugs, medical devices, and health insurance, and from the alcohol industry, these data were not collected, as it was beyond the scope of the present study.
All data were collected and analysed between February and April 2020. We included data published in Spanish, Portuguese and English.
The first author developed a data collection matrix in Microsoft Excel 2010 based on existing knowledge of the food industry’s political practices globally(Reference Mialon, Swinburn and Sacks13–Reference Mialon and Mialon15). The matrix was discussed with the second author and refined during data collection and analysis.
On each of the websites identified above, we searched information about:
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Sponsorship of the conference by the food industry;
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Sessions sponsored by the food industry or/and with speakers from the food industry, including the name of the sponsor, the nature of sponsorship and the affiliation of speakers from the industry (when available and applicable);
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Scholarships, fellowship, grants, awards and other prizes from the food industry;
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Exhibitor space/booths for the food industry;
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Other forms of involvement.
The first author revised all data for all countries, by visiting the websites of all events and searching for relevant information, as described above. The second author revised a random sample of 10 % of the data, by visiting the websites of the events, verifying the categorisation of information and verifying the information included. Any disagreement during data collection and data analysis was discussed amongst the research team.
Results
For thirteen of the thirty-three countries included in our analysis (Antigua y Barbuda; Bahamas; Belize; Dominica; Grenada; Guyana; Haiti; Nicaragua; St Kitts and Nevis; St Lucia; St Vincent and the Grenadines; Suriname; and Trinidad and Tobago), we found no scientific event in nutrition or dietetics in the past 2 years, so these were excluded from the analysis. For the other twenty countries, we found a total of thirty-six different events, including regional/international events (some of these were held twice, in the case of annual events). Mexico and Peru were the countries that hosted the highest number of different scientific events in nutrition and dietetics in the past couple of years (n 5 and 4, respectively). Twenty-six of these events focused on the broad disciplines of nutrition and/or dietetics. The remaining ten events centred on clinical nutrition. For five of the thirty-six events identified, we found no public presence online at the time of data collection, which excluded another two countries (Bolivia and Venezuela) from our analysis. Therefore, we collected information for thirty-one different events from eighteen countries in the region (see online supplementary material, Supplemental Table 2).
Table 1 is a summary of the results regarding the involvement of the food industry in the thirty-one events in nutrition and dietetics held in Latin America and the Caribbean in 2018–2019.
Table 1 Involvement of the food industry in the thirty-one events in nutrition and dietetics held in Latin America and the Caribbean in 2018–2019
Figure 1 is an illustration of the geographical extent of the involvement of food industry actors in nutrition conferences in Latin America and the Caribbean in 2018–2019.
Fig. 1 Map of Latin American and Caribbean countries with nutrition and dietetics events where food industry actors were involved in 2018–2019. Country which is not a sovereign state, or with no scientific event, or where scientific event(s) had no public presence online (white); country with one event where the food industry was involved (light grey); country with two events where the food industry was involved (dark grey), country with three or more events where the food industry was involved (black)
We noticed, for most events, a lack of information available online regarding the involvement or not of food industry actors. Overall, 45 % of events had no stated information on their sponsorship, while more than half had no information about the sponsorship of sessions or the presence of speakers from the industry. Likewise, for 87 % of the events, finding information regarding the sponsorship of scholarships or other prizes was not possible. Finally, in 68 % of the events, there was no stated information on the exhibitor space and booths.
When we found information on sponsorship, we noted that food industry actors sponsored almost all these events (n 15 out of the 17 events, or 88 %, for which we found information). We found ninety-two different food industry sponsors for these events, all listed in Supplementary Material 2. Abbott and Nestlé were the most frequent sponsors of nutrition and dietetics events in the region, supporting ten (59 %) and eight (47 %) of the seventeen events for which we had information on sponsorship, respectively. Other sponsors included transnational and national food manufacturers (Yakult, Danone, Gloria, Monte Azul, etc.), trade associations and other industry-funded organisations (such as the International Life Science Institute – ILSI). One conference, the VIII Internacional Nestlé Nutrition Congress, was entirely organised by the food manufacturer Nestlé, in Peru, and included the awarding of a Henri Nestlé prize.
Prizes and scholarships from the food industry were also awarded at the XVIII Colombian Congress of Nutrition and Dietetics (one from Boydorr and one from ILSI) and the Congress of the Latin American Society of Nutrition (SLAN) held in Mexico in 2018 (from Vitanui and Yakult).
The only event where we found no form of involvement on the part of the food industry was the 2018 Brazilian Congress on Nutrition. Also, amongst the different partners of the Caribbean Nutrition Conference 2019, held in Barbados, there was no sponsorship from the food industry, but there was a speaker from Abbott.
Abbott, Nestlé and Danone were also the most frequent sponsors of specific sessions in nutrition and dietetics events in the region. Abbott sponsored a session on the ‘Role of the health professional as a guide in managing growth and child immunity’ at the XVII Latin American and Caribbean Confederation of Nutritionists and Dietitians in Peru. The companies also organised several sessions on clinical nutrition and hospitalisation. Nestlé organised a workshop on ‘The health professional as a vehicle for healthy nutrition and systemic welfare in the industry’ at the XXXIV Congress of the Mexican Association of Nutrition Faculties and Schools Members, as well as sessions on ‘Anemia-related micronutrient deficiency during the first 1000 days’ and ‘Success story of anemia eradication in Chile’ in its own Nestlé conference in Peru. In the same way, Danone sponsored a workshop entitled ‘Sustainable Cooking?’ in the Argentine Congress of Graduates in Nutrition and a session on ‘Microbiota and cancer’ in the Brazilian Ganepão 2019 event.
In addition, where we find information, Nestlé had booths or exhibitor space in half of the events for which we had information (n 4 out of 8 events). Finally, refreshments were provided by food industry actors in some events, for example, from Gatorade at the XVIII Colombian Congress of Nutrition and Dietetics, or a bottled water company, Bonafont, and café producers, at the SLAN Congress in Mexico.
Discussion
We found that there was limited information available on the involvement or not of industry actors in nutrition and dietetics events in Latin America and the Caribbean. When we had access to that information, we found that ninety-two different food industry actors sponsored 82 % of the events (n 14 out of 17 events), with Abbott and Nestlé being the most frequent sponsors. Other sponsors included large transnationals from the food industry, national food manufacturers and trade associations, amongst others. We found evidence that ILSI, a group founded and funded by transnationals in the food industry, sponsored and distributed a prize at one of these events, in Colombia, and sponsored some of its scientific sessions. Representatives from ILSI were also speakers in events in Brazil and Ecuador. ILSI is a group founded and funded by transnationals in the food industry and has been criticised for promoting the agenda of these corporations rather than that of public health(Reference Steele, Ruskin and Sarcevic16–18).
The presence of the food industry (and others, perhaps, like the pharmaceutical industry) in nutrition and dietetics events exposes professionals to the brands and marketing of certain products, including ultra-processed foods(Reference Monteiro, Cannon and Moubarac5). If academics lack knowledge on food industry influence and conflicts of interest, nutrition and dietetics events may also become a platform through which commercial enterprises get access to and could hire researchers(Reference Marks19). The involvement of the industry in these scientific events also represents a risk for scientific independence, integrity, trust and credibility(Reference Marks19). There is evidence that the food industry’s involvement in nutrition research more broadly, through its funding to studies, leads to biased results towards the products manufactured by these companies(Reference Lundh, Lexchin and Mintzes20,Reference Bes-Rastrollo, Schulze and Ruiz-Canela21) . Moreover, the involvement of the food industry in science is shaping the research agenda in ways that are favourable to market-driven solutions(Reference Fabbri, Holland and Bero22,Reference Fabbri, Lai and Grundy23) .
Nutrition conferences are only one aspect through which industry actors influence food systems in Latin America and the Caribbean. The food industry penetrates food markets in the region with ultra-processed foods, often promoted through aggressive marketing practices, thus profoundly reshaping the way food is produced, supplied, prepared and consumed(Reference Monteiro, Gomes and Cannon24,Reference Monteiro and Cannon25) , which is ultimately leading to ill health for the Latin American and Caribbean populations(Reference Monteiro, Cannon and Moubarac5). In countries that have adopted the WHO Code of Marketing of Breastmilk Substitutes, the involvement in nutrition and dietetics events of companies selling breastmilk substitutes, such as Nestlé or Abbott, needs to be carefully considered, in case this involvement risks violating national laws(26).
This is the first study, to our knowledge, on the extent of the involvement of the food industry in nutrition and dietetics events at the regional level(27). Our results are consistent with existing literature on the sponsorship of specific nutrition and dietetics events. In Latin America and the Caribbean, food industry actors sponsored sessions and had exhibitor space and booths where they could promote their products, as was the case in the USA and international conferences(Reference Simon1,Reference Piaggio and Solans3,Reference Gomes4,Reference Canella, Levy and Martins28) .
There is a need for greater transparency from the conference organisers, on the involvement of corporations(Reference Simon1,Reference Oshaug2,Reference Gomes4) , including through the clear identification of participants from the industry, and the publication of the financial reports of the events(Reference Gomes4). The management of the engagement with corporations is also needed, which could be facilitated through the development of policies on sponsorship and conflict of interest in these events, and professionals codes of ethics(Reference Simon1,Reference Oshaug2,Reference Gomes4) . Searching these policies was beyond the scope of our study, as we only focused on their annual events, not the organisation itself, but offers an opportunity to conduct more work in that space. However, and as detailed in Supplemental Table 2, we noted that the Brazilian Association of Nutrition (ASBRAN) and the Institute of Nutrition of Central America and Panama (INCAP) in Guatemala have guidelines for addressing and managing conflicts of interest in their scientific events. There was also a discussion on conflicts of interest in an event in Argentina, but we were not able to retrieve more details about that specific session. The implementation of these policies is as much important as their development, and sanctions could be considered in cases of non-compliance.
There is also, perhaps, a need for input from members of the professional organisations and discussion on the industry’s involvement in nutrition and dietetics events and the risks this pose to their profession(Reference Simon1). Some suggested that it is essential not only to reject corporate-sponsored education(Reference Simon1) but also to ensure the independence of the organising and scientific committees for these conferences(Reference Gomes4). When questioned, a majority of the members of the American Academy of Nutrition and Dietetics were, for example, willing to pay a higher amount for their membership if it meant having fewer corporate sponsors(Reference Reitshamer, Schrier and Herbold10). SLAN created guidelines for addressing and managing conflicts of interest and industry influence in its scientific events and other activities it coordinates(Reference Barquera, García-Chávez and Navarro-Rosenblatt29). Recently, these guidelines were endorsed by Mexican nutrition professionals who developed the ‘Nutricia Code’ (‘Code on Nutrition and Conflict of Interest in Academia’)(Reference Barquera, Balderas and Rodríguez30). Importantly, more research is needed to assess whether or not such solutions can address the issue of industry involvement and influence on science, as emerging evidence noted that transparency might be counterproductive in some circumstances(Reference Goldberg31). Interestingly, the Colombian Association of Dietitians and Nutritionists (ACODIN) stated on its website (see online supplementary material, Supplemental Table 2) that it did not have a conflict of interest even if several industry actors were present in its scientific event. The Association also declared that it ‘does not exclude’ but rather ‘listens to all the positions’, where the food industry is to be found somewhere amongst ‘institutional, non-institutional, academic and civil actors’ (see online supplementary material, Supplemental Table 2). This type of declarations may legitimise the involvement of commercial enterprises in nutrition and dietetics events and may create a platform for influence on professionals(Reference Goldberg31).
Our study has limitations. First, we did not search for all speakers’ affiliations in the absence of a declaration online. For ILSI and similar groups, these affiliations would not be apparent, as academics would not declare their affiliation with the institute in scientific events, as they usually primarily work for academic institutions. Funding to attend nutrition and dietetics events could also be sponsored by the industry, through the support of travel expenses, for example, but retrieving such information was beyond the scope of the study.
In addition, we were not able to identify the amount of money involved in the sponsorship of these events, as this was not declared online. We imagine that the more the company invests in a conference, the higher its presence is in the event (through its branding of the event, for example)(Reference Lo and Grady32).
Another limitation is that our analysis was based on publicly available information, mainly information that was still available online after the events occurred. We made no contact with the events’ organisers and did not collect information from printed programmes or other printed documents. Visiting the events and their exhibition spaces in person was outside the scope of the present study, given our absence of resources for conducting the study. We also noted, when visiting ILSI’s webpages, the existence of an ILSI-SBAN prize to four individuals at the SBAN annual event in 2019, information that was not reported on the website of the scientific event, and therefore not included in our analysis(27). It is likely that, by only analysing the official webpages of nutrition and dietetics events in the region, we missed information that might have been published elsewhere. Therefore, we may have underestimated the extent of the food industry involvement in these events.
In addition, we included all actors from the food industry in our analysis, which covered those that produce unprocessed or minimally processed foods, for a limited part of their activities (like Nestlé or Danone) or as a central part of their work (like vegetable oils or almond producers). We made no distinction between these actors, but those who sponsor most events were belonging to the former category, thus potentially primarily promoting ultra-processed products.
In light of these findings, it is crucial to ask for more transparency about the food industry’s involvement in nutrition and scientific events, including from third parties that have ties with this industry. It is also important to monitor and manage this involvement. Educating professionals about the risks associated with such involvement is also crucial(Reference Mialon, Vandevijvere and Carriedo-Lutzenkirchen33). Finally, it is perhaps necessary to address and prevent such involvement when the products or practices of commercial enterprises or trade associations are not aligned with public health goals. This may include rethinking the way these events are organised, often in prestigious venues and locations, which could be replaced by more simple options like university buildings, or, as the current COVID-19 pandemic has forced us to do, hold events online, where professionals working in remote areas or with limited funding could now, perhaps, join the discussions. We, however, noted that corporate actors could still be heavily involved in online conferences. This was recently the case for the annual event of the American Society of Nutrition(34–36).
Conclusion
Our main finding is that information on the food industry involvement in nutrition and dietetics events in Latin America and the Caribbean is mostly unreported. However, where we found such information, we found that ninety-two different food industry actors sponsored 82 % of the events. Therefore, there is a likely extensive involvement of the food industry in scientific events in the region. Conference organisers need to be more transparent about these relationships with the industry, and there is a need for continuous monitoring of this involvement of the industry in science (by civil society or/and academia), more education on these issues, to ensure the independence and integrity of researchers and nutrition professionals, and, more importantly, the prevention and management of undue influence from the food industry in scientific events in nutrition and dietetics.
Acknowledgements
Acknowledgements: The authors would like to thanks the coordinating committee of the Latin-American Workshops on Nutrition Leadership, Ricardo Uauy, Juan Ángel Rivera Dommarco; Carlos Monteiro; Daniel López de Romaña and the VIII Latin-American Workshop on Nutrition Leadership facilitators, Mónica Mazariegos, Juan Ángel Rivera Dommarco, Humberto Vásquez, Jesús Manuel García, Teresa Téllez, Sonia rodríguez, Dinorah González and Daniel López de Romaña. Financial support: F.R. received a Fellowship from the São Paulo Research Foundation (FAPESP), Brazil (grant number 2016/14302-7). A.J. was funded by a PhD fellowship from the National Commission for Scientific and Technological Research, Chile (CONICYT-PCHA/Doctorado Nacional, grant number 2014-63140222). F.L.B. received a postgraduate student grant for her PhD at the Universidad Nacional Autónoma de México and a graduate student scholarship from the Consejo Nacional de Ciencia y Tecnología, Mexico (grant number CVU 547092). S.L.A. was supported by the National Fund for Scientific and Technological Development, Chile (FONDECYT) (grant number 11190931) and the third call for research projects of the Chilean Society of Nutrition (SOCHINUT)-Henry Nestlé. The funders had no role in the design, analysis or writing of this article. The authors are solely responsible for the opinions, hypotheses and conclusions or recommendations expressed in this publication. Conflict of interest: S.L.A. was supported by the third call for research projects of the Chilean Society of Nutrition (SOCHINUT)-Henry Nestlé. Y.G.G. received funding from Bonafont to present in a congress of pediatrics in 2016 and funding from a company contracted by Abbott to write two books chapters in 2020. The VIII Latin-American Workshop on Nutrition Leadership was funded by Sight & Life; the Institute of Nutrition for Central America and Panama (INCAP); the World Food Programme (WFP); Bloomberg Philanthropies; UNICEF and the Global Alliance for Improved Nutrition (GAIN). Some of these organisations receive funding or support from food industry actors. Authorship: The first and second authors formulated the research question. The first author led the design of the study with the support of the second author. All authors were involved in the collection of data, supervised by the first author and coordinated by the second author. The first author led the data analysis and the writing of the article. The second author supported the data analysis and contributed to the writing of the article. All authors critically revised the article. Ethics of human subject participation: Not applicable as our study did not involve human participants.
Supplementary material
For supplementary material accompanying this paper visit https://doi.org/10.1017/S1368980020003870
