Abstracts / Journal of Nutrition & Intermediary Metabolism 8 (2017) 60e121
failings may be overcome in future by using electronic measuring, inter-
preting and action-controlling devices.
In both examples given, a small proportion of the relevant cohort of
managers adopted the procedure. Considerable time was spent on one-to-
one coaching, which makes wide penetration across an industry difficult. A
great deal has been written on factors that influence adoption of agricul-
tural practices.2,3 Common themes emerge including: awareness of an
opportunity; compatibility with current practice; negative association
with age; price incentive through commodity price or subsidies; avail-
ability of capital; land tenure-owners greater adopters than renters;
importance of one-to-one information exchange; encouragement from
other farmers, family or friends; and personal goals, for example profit or
leisure.
Several experiences from animal science are relevant to translating
nutritional knowledge for use by humans. Adoption will not occur without
awareness. Adoption is stimulated by price advantage, but decreased by
low finance availability. One-on-one information exchange from experts,
family or peers greatly stimulates adoption. Complex knowledge must be
integrated, but delivered in a simple form. There are examples of these
principles being important for the purchase of healthier foods in the hu-
man nutrition literature. Vogel et al4 showed awareness and purchase of
healthier foods, from supermarkets with lower quality foods, was associ-
ated with higher educational attainment. Price of foods also influences
choices. Supermarkets generally place discount prices on less healthy
foods, which increases their purchase,4,5 whereas lowering prices of fruit
and vegetables by 20% increased the purchase of fruit by 35% and vege-
tables by 15%.5 Complex nutritional information can be simplified and
spread widely across peers, families, friends and the community via
smartphone Apps to influence food choices.
References
1. Black JL (2014) Brief history and future of animal simulation models for
science and application. Anim Prod Sci. 54:1883-1895.
2. Baumgart-Getz A, et al. (2012) Why farmers adopt best management
practice in the United States: A meta-analysis of the adoption literature.
J Environ Manage. 96:17-25.
3. Black AW (2000) Extension theory and practice: A review. Aust J Expt
Agric. 40:493-502.
4. Vogel C, et al (2016) Education and the relationship between super-
market environment and diet. Am J Prev Med. [Epub ahead of print]. doi:
http://dx.doi.org/10.1016/j.amepre.2016.02.030
5. Ball K, et al (2015) Influence of price discounts and skill-building on
purchase and consumption of healthy foods and beverages: super-
market healthy eating for life randomized controlled trial. Am J Clin
Nutr. 101:1055-64
TRANSLATING NUTRITION AND LIFESTYLE EVIDENCE INTO PRACTICE -
LESSONS FROM CANCER PREVENTION AND MANAGEMENT
A.S. Anderson. Centre for Public Health Nutrition Research, Ninewells
Medical School, University of Dundee, UK
E-mail address: a.s.anderson@dundee.ac.uk
It is estimated that around one third of the most common cancers are
preventable through appropriate dietary intake, maintaining a healthy
weight and regular physical activity. However, little action has been taken
to promote and implement dietary (quantitative and qualatitive) change
for cancer prevention and management. This finding is in contrast to to-
bacco control where there is a clear understanding about cancer risk which
has been widely communicated and acted upon at both individual practice
level and in public health policy. Like smoking, randomised control trials of
diet and obesity interventions with cancer end points are not feasible.
However, unlike tobacco, observational data on diet and cancer is often
viewed with doubt due to personal observations, scepticism, failure to
understand practical considerations and lack of commitment for pro-
moting behaviour change from health professionals working in cancer
settings. Intervention research has demonstrated that cancer settings
provide “teachable moments” for engaging with behaviour change pro-
grammes but this concept has still to be fully explored.
Drawing on the model of tobacco control it is clear that translating dietary
63
evidence into practice requires consistent messages (from trusted sources)
on agreed objectives. The complexity of diet (e.g. everyone must eat food),
the dream of discovering miracle chemopreventive agents and persistent
concerns over undernutrition in cancer care increase translational chal-
lenges. Major changes in eating habits and weight management can only
be achieved through a blend of programmes with environmental change
and strong leadership from multi stakeholder collaborations. Within the
nutrition research community there is a need to move beyond academic
dissemination to championing the benefits of diet and weight manage-
ment within user communities.
Funding source: University of Dundee
Dairy Australia lecture
LACTOSE INTOLERANCE: PERCEPTIONS, SCIENTIFIC REALITIES AND
MANAGEMENT
D.A. Savaiano. Department of Nutrition Science, Purdue University, West
Lafayette, IN, USA
E-mail address: savaiano@purdue.edu
Approximately 3/4 of the world population maldigests lactose, due to a
genetically controlled loss of intestinal lactase activity post weaning.
Among this population of maldigesters, dairy food consumption is often
limited due to perceived and real symptoms resulting from intake. Mul-
tiple factors influence lactose digestion and tolerance including lactose
load, gastric and intestinal transit, the use of lactose digestive aids, colon
fermentation of lactose and the consumption of fermented dairy foods and
lactic acid bacteria. Major findings related to dietary management of
lactose maldigestion include: The identification of a microbial lactase in
yogurts that assists lactose digestion in the intestinal tract following the
consumption of yogurt.1 The characterization of the amount of lactose
required to cause symptoms in lactose maldigesters, being 12g or more of
lactose (one cup of milk).2 The finding that lactose consumed with a meal
is tolerated 3 times better than lactose consumed in a fasted state.3
Identifying the colonic flora as key in determining tolerance to lactose.4
The colonic flora readily adapts to lactose in the diet of maldigesters. Thus,
maldigesters who routinely consume lactose have less symptoms due to
more efficient metabolism of lactose by the colon microflora. The identi-
fication of a population of digesters and maldigesters who believe that
they are extremely intolerant to lactose, but who tolerate lactose quite well
in double-blinded clinical trials.5 The characterization of the ability of
lactic acid bacteria including acidophilus and bifidus to improve lactose
digestion in vivo in the gastro-intestinal system. The Results of these
studies indicate that almost all maldigesters can consume significant
amounts of dairy foods without experiencing symptoms of intolerance.
Yet, a substantial group of maldigesters continue to believe that dairy
foods, consumed in even small amounts, will result in gastrointestinal
distress. We are interested in Methods of intervention that will allow
“lactose intolerant” individuals to learn that they can consume dairy foods
without experiencing gastrointestinal symptoms.6 Finally, we are working
with the dairy and pharmaceutical industries to attempt to develop food
products that are well tolerated by the lactose maldigesters.7
References
1. Savaiano DA (2014) Lactose digestion from yogurt: mechanism and
relevance. Am J Clin Nutr.99:6:1251S-5S.
2. Hertzler SR, Huynh, Bao-Chau L, Savaiano DA (1996) How much lactose
is low lactose? J Am Diet Assoc 96:243-246.
3. Martini MC, Kukielka D, Savaiano DA (1991) Lactose digestion from
yogurt: Influence of a meal and additional lactose. Am J Clin Nutr
53:1253-1258.
4. Hertzler S, Savaiano DA (1996) Colonic adaptation to daily lactose
feeding in lactose maldigesters reduces lactose intolerance. Am J Clin
Nutr 64:232-36.
5. Suarez FL, Savaiano DA, Levitt MD (1995) A comparison of symptoms
after the consumption of milk or lactose-hydrolyzed milk by people
with self-reported severe lactose intolerance. New Engl J Med 333:1:1-4.
6. O’Connor L, Eaton TK, Savaiano DA (2015) Milk Aversion can be reversed
in both lactose digesters and maldigesters. J Nutr Educ Behav
47:4:325e330.e1.
64 Abstracts / Journal of Nutrition & Intermediary Metabolism 8 (2017) 60e121
7. Savaiano DA, Ritter AJ, Klaenhammer TR, Gareth J, Longcore AT, Chan-
dler JR, Walker WA, Foyt HL (2013) Improving lactose digestion and
symptoms of lactose intolerance with a novel galacto-oligosaccharide
(RP-G28): a randomized, double-blind clinical trial. Nutr J 12:160.
Plenary 3: Evolution of nutrition sciences
THE INTERFACE BETWEEN FOOD SCIENCE AND HUMAN NUTRITION e
AN ADVANCING FRONT
P. Moughan. Riddet Institute, Massey University, Palmerston North, New
Zealand
E-mail address: p.j.moughan@massey.ac.nz
Traditionally, nutrition investigations have taken a reductionist approach,
reducing a food down to its constituent nutrients, then investigating the
effects of different levels and combinations of nutrients on growth,
development and well-being. The effects of nutrients and other food
components, however, are not always additive, and can be synergistic. It
has been suggested that a more fundamental unit in nutrition is food.
Traditionally food science and food engineering have been based on a ‘unit
process’ approach, and have placed a greater emphasis on holistic food
morphometry, molecular structures and their interactions, in addition to
chemical properties and along with physical properties such as particle
size, particle density, porosity, surface area, rheology, coaguability etc.
Recently, food scientists have taken a greater interest in the “unit pro-
cesses” of digestion and nutrient uptake, and in this space nutrition and
food science intersect. Case-studies will be discussed whereby the dual
application of both philosophical approaches, can provide new insights.
THE NEXUS BETWEEN ANIMAL AND HUMAN NUTRITION
F.R. Dunshea. Faculty of Veterinary and Agricultural Sciences, The University
of Melbourne, Parkville, VIC, Australia
E-mail address: fdunshea@unimelb.edu.au
The nutritional sciences have made substantial advances over the past
century, with many of the initial advances in human nutrition being gained
from studies conducted in farm and laboratory animals. While animal
studies still underpin much of our progress in human nutrition, more
recently there has been a flow of information from human studies to an-
imal nutrition. Some of the examples of this cross-fertilization will be
discussed in this paper.
For example, beriberi had been described as a condition of humans on
restricted diets for the millennia but it was the landmark studies in
chickens in the late 1800’s that replicated the disease in chickens
consuming a diet of solely white rice that led to the discovery of Thiamine.
This was then confirmed in humans consuming white but not brown rice.
The discovery of many other vitamin deficiencies in animals and humans
followed. It was the ruminant nutritionist Eric Underwood who first
identified the trace elements such as selenium and since then many other
mineral deficiencies and toxicities have been characterised in animals
confirmed to occur in humans.
More recently, there have been some excellent learnings for animal nu-
tritionists from research conducted in human nutrition. Epidemiological
studies, such as the study of the Dutch Famine, clearly identified the effects
of prenatal nutrition on lifetime health outcomes of the progeny of
mothers undernourished for key periods during gestation leading to the
concept of foetal programming and epigenetics. Later research clearly
identified lifetime consequence of over-nutrition during pregnancy as well
and these concepts are now being manipulated in animal nutrition to
improve performance and carcass quality. Another very active area in
human and animal nutrition research is in the area of carbohydrate
digestion where the apparent disparate needs of domesticated mono-
gastrics and humans have resulted in advances in both branches of
nutrition. Further areas of complementary progress include pro- and pre-
biotics to improve gut health in humans and reduce antibiotic usage in
animal agriculture, understanding the effect of the microbiota on health
and the effect of nutrition on insulin resistance.
In conclusion, there have been enormous advances in nutrition with many
of these discoveries being applicable in both human and animal nutrition.
It behoves all nutritionists to follow all of the literature if we are to make
best use of all the information that exists.
EVOLUTION OF NUTRITION SCIENCE REPORTING
D. Bier 1, 2. 1 Children’s Nutrition Research Center, Baylor College of Medicine,
USA; 2 The American Journal of Clinical Nutrition, USA
E-mail address: dbier@bcm.edu
Historically, there has been a fundamental problem with the reporting of
clinical research findings. On the order of 90% of published papers report
statistically significant findings, an unrealistically high percentage given
that most scientists are just not that good at guessing “right” the vast
majority of the time. The reporting of clinical nutrition research is not
exempt from this issue and the problem is no trivial one. The predomi-
nance of perceived “positive” studies in clinical nutrition seriously skews
the apparent preponderance of evidence that forms the basis for nutri-
tional guidelines and recommendations. The underlying causes have been
realized for some time and include a wide variety of significance-chasing
biases, allegiance biases and other “investigator degrees of freedom” that
lead to distortion of Results as they are presented in the literature. These
will be discussed. To rectify the problems, new requirements for trans-
parency in research reporting have evolved and are gradually making
their way into journal policies worldwide. Their use ensures that reports
contain the essential elements crucial for proper interpretation. More-
over, the remedial efforts also include requirements for registration of all
clinical studies, including observational ones, a priori declaration of
explicit primary and secondary endpoints, detailed exposition of the
planned analytical approach, open availability of the data for independent
confirmation and alternative analysis and declaration of potential non-
financial as well as financial conflicts of interest. Unfortunately, as will be
discussed, these declarations do not eliminate a wide variety of remaining
biases.
Plenary 4: Mechanisms of disease progression
INTERACTION BETWEEN DIET AND EVOLUTION OF DIGESTIVE
MECHANISMS
J.B. Furness. School of Biomedical Sciences, University of Melbourne, VIC,
Australia
E-mail address: j.furness@unimelb.edu.au
Neither the modern human diet nor the size and proportions of the
human gut resemble those of any other primate. The human digestive
system has both evolved and diverged as different food types and food
preparation techniques have been introduced. For example, the persis-
tence of lactase activity into adulthood occurred after herding of cattle
and dairying began about 8000 years ago and is common in some human
populations and rare in others. The presence of multiple copies of the
amylase gene was also influenced by changed diet, in this case the
presence of dietary starches through the development of Methods to
make these available by milling grain and cooking. Humans have pre-
pared foods by cooking and other means for at least 300-400000 years,
and divergence in genes through dietary influences can be traced back
about 30000 years. Cooking and food preservation expands the range of
food that can be eaten, extends seasonal availability and enhances di-
gestibility. The modern human digestive system is suited to a cooked diet
because of its smaller volume, notably smaller colonic volume, relative to
the intestines of other species, and because of differences from other
primates in dentition and masticatory muscles that Results in lower bite
strength.
Adaptations in human digestive physiology that involve genetic selection
have occurred over thousands of years. However, transmissible diet-
induced epigenetic changes occur in a single generation. These have been
best documented for epigenetic changes related to obesity, and are in
some cases maladaptive. Modern diets have changed dramatically in the