Conflicts of interest in food and nutrition

The existence of conflicts of interest in the field of food and nutrition is not new, but has intensified and has been better documented during the past decade, in terms of both knowledge production and dissemination, and of policy formulation and management. Since the 1970s, more than eight thousand articles about conflicts of interest were published in health sciences reference databases (MEDLINE and LILACS). In contrast, only a few dozen food and/or nutrition-related articles were published during the past 20 years, three fourths of which in the last decade alone. The recent increase in documenting food and nutrition-related conflicts of interest is proportionally higher than what was observed for the overall publications in the same databases. This indicates that the conflicts intensified or that the recognition of conflicts as such expanded, and/or there was stronger motivation to make them visible. Both in knowledge production and dissemination and in the formulation of food and nutrition policies, the growth, intensification and increased visibility of the conflicts of interest, and lack of compliance with them are partially based on the increase of flaws in food systems, which prevent them from fulfilling their purpose of ensuring suitable, healthy food to the population. Therefore, in order to move forward in facing conflicts of interest in this field, it is necessary to recognize nutritional problems as expressions of flaws in the food system 1,2. It is thus possible to identify common, structural causes that account for different problems, such as obesity, micronutrient deficiencies, and other forms of malnutrition, therefore avoiding ineffective or palliative solutions. Moreover, it is necessary to identify and characterize the responsible for such flaws. There is broadly documented evidence that these dramatic changes in the food systems and in the feeding of populations have been imposed globally by large transnational corporations 1,2,3. Such changes affect the way food is produced, supplied, prepared and eaten, with the ultimate goal of generating wealth for these corporations and increasing their market share in a concentrated way (Table 1). Therefore, in addition to the nutritional problems they trigger, these corporations also cause an important negative effect on inequity, starting from the corporate environment itself. A study conducted in 2013 revealed that an employee of the McDonald’s Corporation in the United States needs to work 1,196 hours to receive the equivalent of one hour’s work of the company’s CEO 4. The socioeconomic, environmental and cultural impact 5,6 of this model imposed by such corporations also favors an increase in the recognition of conflicts that previously were not acknowledged as such. Therefore, the intensifi-

The existence of conflicts of interest in the field of food and nutrition is not new, but has intensified and has been better documented during the past decade, in terms of both knowledge production and dissemination, and of policy formulation and management.Since the 1970s, more than eight thousand articles about conflicts of interest were published in health sciences reference databases (MEDLINE and LILACS).In contrast, only a few dozen food and/or nutrition-related articles were published during the past 20 years, three fourths of which in the last decade alone.
The recent increase in documenting food and nutrition-related conflicts of interest is proportionally higher than what was observed for the overall publications in the same databases.This indicates that the conflicts intensified or that the recognition of conflicts as such expanded, and/or there was stronger motivation to make them visible.
Both in knowledge production and dissemination and in the formulation of food and nutrition policies, the growth, intensification and increased visibility of the conflicts of interest, and lack of compliance with them are partially based on the increase of flaws in food systems, which prevent them from fulfilling their purpose of ensuring suitable, healthy food to the population.Therefore, in order to move forward in facing conflicts of interest in this field, it is necessary to recognize nutritional problems as expressions of flaws in the food system 1,2 .It is thus possible to identify common, structural causes that account for different problems, such as obesity, micronutrient deficiencies, and other forms of malnutrition, therefore avoiding ineffective or palliative solutions.Moreover, it is necessary to identify and characterize the responsible for such flaws.
There is broadly documented evidence that these dramatic changes in the food systems and in the feeding of populations have been imposed globally by large transnational corporations 1,2,3 .Such changes affect the way food is produced, supplied, prepared and eaten, with the ultimate goal of generating wealth for these corporations and increasing their market share in a concentrated way (Table 1).Therefore, in addition to the nutritional problems they trigger, these corporations also cause an important negative effect on inequity, starting from the corporate environment itself.A study conducted in 2013 revealed that an employee of the McDonald's Corporation in the United States needs to work 1,196 hours to receive the equivalent of one hour's work of the company's CEO 4 .
The socioeconomic, environmental and cultural impact 5,6 of this model imposed by such corporations also favors an increase in the recognition of conflicts that previously were not acknowledged as such.Therefore, the intensifi- cation of conflicts of interest in the field of food and nutrition also results from advances in social recognition of food and nutritional problems by sectors other than those directly related to the matter.The United Nations General Assembly held in 2011 is a milestone that formalizes the broad recognition of the matter, since, for the first time in history it was on the agenda of the Member States represented by Heads of State, and not food, nutrition and health authorities only.This broader recognition of malnutrition as a problem for societies signals an intensification of the search for solutions.The solutions should tackle the causes and repercussions of the previously mentioned wealth accumulation and market concentration.As a result, the business sector begin to work even more aggressively in preventing and delaying solutions focused on structural causes that are sustained and enhanced by transnational corporations.Instead of only defending itself or avoiding regulation, the sector openly (e.g., on behalf of a particular company) or covertly (e.g., by means of foundations, or professional, research, or non-for-profit organizations that defend the interests of companies that founded, fund or control them) interfere in the policy-formulation process.
Since the 2011 United Nations General Assembly, the interferences towards supranational organizations, such as the World Health Organization (WHO), have been intensified, but they also reach the countries.Recently, the WHO launched a public consultation on its draft principles and policies of engagement with non-States actors, which has at the core of discussion the distinction between actors in the public and in the commercial interest, and the avoidance, prevention anf management of conflicts of interests.The public consultation has been closed, but the document is still under discussion, and at the center of the dispute, is the interaction of private commerical actors with WHO, as well as their role in the formulation of policies.
In addition to the direct pressure the WHO to interfere with policies, transnational corporations also lobby within Member States in order to influence their position before WHO 7 .As an example, it was recently exposed Italy's position against the new (more restrictive) recommendations of WHO on sugar intake 8 .The isolated opposing position of that country surprised all other 33 Member States of the WHO Executive Board.Later, the Italian Observatory on Global Health revealed that a former advisor of the Ferrero group, an Italian manufacturer of confectionary products, was a member of Italy's Foreign Relations delegation 9 .
Despite the growing visibility of conflicts of interest situations, there are still cases where the interaction between individual or collective parties is not clearly recognized as conflictual.Moreover, with the political power highly sensitive to economic pressures, United Nations' agencies and governments are more and more encouraged to take a favorable position in regards to the involvement of the private sector in the formulation and development of food and nutrition policies, adopting an indiscriminate and quite reductionist perspective, commonly stated as: "we must engage the private sector".In addition, transnational corporations make huge investments to make conflicts of interest in food and nutrition seem natural and/or invisible, and reinforce a cynical denial about them.
On the other hand, there is a growing mobilization of initiatives to protect health public policies from the interference of commercial interests.In 2011, a coalition of 160 national, regional and international networks and organizations endorsed a statement demanding from the United Nations a clear distinction between public-interest and business-interest organizations (Conflicts of Interest Coalition; http:// coicoalition.blogspot.com/).In Brazil, dozens of individuals and civil society entities, research institutions and other organizations established, in 2013, the Front for the Regulation of Public-Pri-vate Relationship in Food and Nutrition (http:// regulacaopublicoprivado.blogspot.com),with one of its goals being the articulation of collective actions to tackle and regualte conflicts of interest.
Notwithstanding, there are still a number of situations in which individuals, organizations or institutions that act in favor of the public interest have difficulties in breaking conflicting interactions with sectors of opposing interests.For this reason, some elements that may contribute to make such interactions be perceived as conflictual and justify their discontinuance will be provided here.
In the case of food and nutrition, in order to materialize or characterize the interests so as to identify those that oppose healthy and sustainable diets, one should go beyond the analysis of the products manufactured by the companies, and also take into consideration their practices and policies (including mission, goals, aims, principles, vision) 10 .In addition to companies, organizations and initiatives in which they take part should also be considered, as presented in Table 1 and Figure 1.
It is noteworthy that, just by the products, the non-interaction of a food and nutrition organization, for instance, with a manufacturer of products that are not recommended for healthy and sustainanble diets would already be justified.However, there is often the argument that the company manufactures other products that are not contraindicated, and the discussions get lost in defining what a healthy or non-healthy product is, and do not advance.For this reason, it is essential to gather information on the corporate practices and policies that will reveal, undoubtedly, the interest of the company and related organizations.
Table 1 presents examples of products, practices and policies of the ten largest transnational corporations that are members of the International Food & Beverage Alliance (https://ifbal liance.org/about/members/) to illustrate the application of the criteria presented on Figure 1.These companies manufacture products and promote practices that are not recommended for healthy and sustainable diets, and adopt policies that reinforce the expansion of such products and practices.Moreover, they hold significant shares of these products' global market (Table 1).Table 1 also serves as a basis to support the discontinuance of conflictual interactions of organizations and professionals that do not recommend or endorse the products, practices and/ or policies of the referred companies with these and others companies that manufacture such products, promote such practices and/or adopt such policies.Other companies not listed on Table 1 may be similarly analyzed by the same criteria (Figure 1) in order to identify those that oppose the public interest in regards to improving population's diet and health.The information about products, practices and policies of companies and related organizations may be easily obtained in product sales points, websites of the companies and of their products, and/or annual reports of the companies and related organizations.
The problems associated with the operation of transnational corporations, such as those mentioned here, are evident.However, most proposed or attempted solutions avoid this issue, and those that face the issue are strongly opposed.For this reason, corporations and related organizations responsible for that opposition should be vigorously exposed and recognized as mainly the ones maintaining and disseminating the problem and its causes.It could then be possible to achieve robust solutions that tackle the structures and actors responsible for the faults in food systems that prevent the adequate nourishment of populations.

Figura 1 Criteria
Figura 1Criteria for the identification of actors in the commercial sector that should not be engaged * in policy formulation processes, knowledge production and dissemination, or capacity building in food and nutrition **.

Table 1
Characterization of the ten largest transnational corporations that are members of the International Food & Beverage Alliance (IFBA) according to their products, practices, policies and market share.