Porto. Just before the Porto
congress, as an update of our
September website, we previewed what
we thought might be the hot
sessions. In some cases we were
right. In other cases, boy, were we
wrong. What follows now, is reviews
of some of the Porto sessions
attended by members of the editorial
team. In the case of previewed
sessions, the preview remarks are
retained and the review follows.
When we did not preview a session,
what’s here is just the review.
These
reviews are all in red.
They are selective in a number of
ways. First they obviously are the
opinion of the reviewer, although
they also reflect gossips in and out
of sessions and during meals and
feasts.
Readers with different views –
including the presenters of the
sessions reviewed! – are encouraged
to use the response facility at the
end of this story. Second, between
them our editorial team missed a
substantial number of sessions, and
we can only say sorry. Third, only
sessions presented in English are
reviewed.
The reviews are all structured
schematically, Reviewers were asked
to rate ‘their’ sessions using a
star system. This is in terms of:
(a) overall judgement of session,
(b) importance of topic, (c)
relevance to public health
nutrition, (d) quality of session.
They were then asked to write a review. The
star system is
***** Hot
**** Excellent
***
Good
**
Patchy
*
Bad
■
Flop
__________________________________________________________________
Thursday 23 September
_________________________________________________________________
0800-0900
Tribute to
Jose Maria Bengoa
Not previewed
Review
*** Overall
**** Importance
**** Relevance
*** Quality
Congress
president Maria Daniel Vaz de
Almeida, a member of the Association
council, began the congress by
announcing 1053 participants from 70
countries. During the day people
wondered where all these
participants were – Porto has no
beaches. True, it has many excellent
wine bars, so maybe they were
plotting. But it seemed that the
total number of people within the
beautifully and elegantly converted
old customs house could not have
been more than around 600-700. Maybe
this was merely because the congress
was being held in a capacious
building. .
One thing learned here is that in
the Mediterranean region, at a time
when it is not fully light at 7.30,
people are accustomed to the
discipline in colder climes of
starting the day at 8. Attendance at
this opening plenary session was
pitiful – maybe 75 people.
It is a pity that these series of
tributes to the founding father of
public nutrition were delivered only
after Dr Bengoa’s death in his
mid-90s earlier in the year. He
would have been gratified to have
heard them. In his address, Irv
Rosenberg reminded us that Dr Bengoa,
in his work beginning as a physician
on the republican side in the
Spanish Civil War, then from 1938 as
a country doctor in an impoverished
rural area in Venezuela, and then
worldwide, including a 15 year
period as head of the Cavendes
Foundation, amounts to the
‘intellectual and cultural basis of
the science of public health
nutrition’. Always, Dr Bengoa, as he
was always known, emphasised the
social and environmental aspects of
nutrition. Maria Nieves Garcia Casal
and Association founder member Nevin
Scrimshaw also gave moving tributes.
A fine scene-setter – as said
though, alas that it was not a
feature of the 2006 Barcelona
congress, which was attended by Dr
Bengoa.
_________________________________________________________________
10.00-12.00
Hydration,
beverages and health: hydration,
beverages, satiety and health (1)
Symposium
Preview
*****
Sponsored by Danone, so watch out
for conflicted industry-friendly
vibrations. These will not come from
Association founder members Barry
Popkin and Walter Willett, whose
presentations are a must, and whose
take on the effect of sugary soft
drinks (‘soda’ as Barry and Walter
call them) is ferocious. The UK
speaker Susan Jebb should be good,
too.
Review
*** Overall
**** Importance
**** Relevance
*** Quality
This session,
parallel with seven others, was well
attended – about 140 people were
present. Curiously unsatisfying
though, rather like fizzy sugary
drinks themselves. The star system
being used here does not work well
for sessions like this, whose
quality varied greatly from speaker
to speaker.
Barry Popkin insisted that this
session was all about the science
supporting the need for a public
health approach to water, soft
drinks, and other non-alcoholic
drinks. Hm. Taken together the
presentations were somewhat
incoherent. They covered a lot of
ground, without altogether coming to
a conclusion, except that more
research is needed.
Barry’s own presentation was as
always, vehement, skilled and
energetic – indeed, fizzy. But he
persisted in identifying fruit
drinks as fruit juices, whereas most
such drinks have sugar added. His
howler here was to identify
‘squashes’, so-called in the UK, as
fruit juices. These contain no fruit
at all. You can’t get the science
right until you get the facts
straight.
Susan Jebb said: ‘None of us
considers that we suffer from any
lack of choice’. Really? She
congratulated Pepsi-Co for its
public-spirited approach to the
marketing of its cola and other
sugary drinks in the UK. Really?
After her muffled presentation, that
by Walter Willett was clear and
unequivocal. Sugared soft drinks,
consumed in the quantities they
typically are in the USA, do indeed
cause overweight and obesity,
probably by evading the body’s
normal satiety mechanisms, and also
do cause diabetes. Alone of the
speakers Walter, while pointing out
that much of the science is fairly
new, made clear that public health
action is needed now.
__________________________________________________________________
12.00-13.30. D Luis room
There are
good reasons for phasing out the
worldwide vitamin A capsule
programme
Debate
Preview
*****
This is the first of the
excellently conceived Porto
controversy sessions. Speaker for
the motion is Association member
Michael Latham (see his May WN
commentary), and the speaker against
is Keith West (his commentary is in
the WN October issue). Sparks should
fly. Let’s hope this and all the
other debates are well-organised,
allow major interventions, and end
with a vote.
Review
***** Overall
***** Importance
***** Relevance
**** Quality
Congratulations are due to Noel
Solomons, congress scientific joint
president, who masterminded the
series of debates at Porto, of which
this was the first of ten.
This session was the high spot of
the Porto first day. It was
electrically exciting. With five
other sessions running in parallel,
it was not well attended – about 90
people turned up. It began with a
‘pre-vote’, a show of hands on the
motion. Most people were shy, but
about 10 were ‘ayes’ and around 15
were ‘noes’ – a clear victory for
the Johns Hopkins position
represented by Keith West.
Session co-moderator Irv Rosenberg
did an excellent job, keeping
speakers on their toes and to time.
Michael Latham started badly by
saying the slides that prove his
point were being presented at a
session the next day. But he then
made a rhetorically powerful spoken
address. He summarised the key
points in
his WN
commentary He quoted extensively
from the communications and letters
in WN supporting his position or
food-based approaches, including
from Association member
Urban Jonsson, former head of
nutrition at UNICEF, and from
FAO. One point that came across
very clearly, is that results of
vitamin A capsule interventions
evidently showed remarkable
improvements in mortality but not in
morbidity. How can this be? Before
they die, children suffer. This
point resonated in the room.
In response, Keith West said that he
would speak not about politics but
about science. He would leave ‘the
data to speak for itself’, he said.
His presentation ably summarised the
main points made in his strong
commentary, co-authored with Rolf
Klemm and Al Sommer, being published
in the October issue of WN – a few
days after Porto. Results of the
intervention trials are not
completely consistent, but it shows
a strong protective effect, which
extrapolated adds up to the saving
of hundreds of thousands of lives a
year. He said that world-wide, the
best estimates are that 190 million
young children, and 50-70 per cent
in India, are deficient in vitamin
A, judged in terms of serum retinol
levels below a defined cut-off
point. He claimed that the capsule
programme does not act as a ‘policy
blockade’, impeding food-based
approaches. He said that ‘the data
are not there for food-based
strategies’. This was not
convincing, as a number of speakers
from the floor confirmed, from their
own experience.
Summing up, Michael Latham revealed
that interventions using massive
doses of vitamin A are judged
unethical in the USA and are not
allowed. Elsewhere in the world,
‘children have no option but to open
their mouths and swallow the stuff’,
he said. .
And the final vote? A dramatic
turn-round. Having heard the cases
for and against, the rather depleted
final vote was around 25 for the
motion, and 3 against, with about
another 35 people abstaining
(choosing not to vote). It does
indeed look as if the time has come
to replace the current worldwide
capsule programme. Altogether, this
session was a magnificent
vindication of and advertisement for
the debate technique, used to
ventilate important and genuinely
controversial issues.
__________________________________________________________________
13.30-15.00 D Luis room
Meet the
editors
Not previewed
Review
**
Overall
**** Importance
**** Relevance
**
Quality
This turned
out to be a good idea, thanks above
all to Irv Rosenberg of Food and
Nutrition Bulletin. He felt, and
it was generally agreed, that
journal editors have a common
interest in getting together, and
taking a joint view on important
issues, such as what actually is the
impact of journals, the implications
of publishing on-line, and indeed
exploring what ‘nutrition’ actually
is. The rating here is tentative,
because the value of this session
will be evident only if there is
follow-up. Enthusiasms in
conferences tend to be like Chinese
meals – filling at the time, but not
for long.
__________________________________________________________________
14.00-17.00. Porto room
Building
capacity for action
Workshop
Preview
****
Association event. Starring
Association founder members Roger
Hughes, Roger Shrimpton and Chizuru
Nishida. It also stars John Mason,
once secretary of the UNSCN, now at
Tulane University, Big Easy.
Review
**
Overall
**** Importance
**** Relevance
*
Quality
Poorly
attended – no more than 50 people in
this session parallel with seven
others. It was attended only briefly
by this reviewer and so the ratings
are tentative. It followed a
pre-congress workshop. What
presentations were heard, felt
rather tired.
__________________________________________________________________
15.00-17.00. Infante room
Hydration,
beverages and health: government and
regulatory actions across the globe
(2)
Symposium
Preview
****
Barry Popkin and Walter Willett
again, together with Benjamin
Caballero, and Association founder
members Mark Lawrence and Juan
Rivera, whose tales of the
hanky-panky of the soft drinks
industry in Australia and Mexico are
a must.
Review
**
Overall
**** Importance
**** Relevance
■
Quality
Four hours on
this topic on the first day, with
more to come, was too much. Much too
much. The session was well attended
by about 180 people. But given the
total length of time, and given the
power of the evidence that sugary
soft drinks are as close as we will
ever get to cigarettes, in terms of
the case for fiscal and other legal
control, overall the presentations
were rather academic in the bad
sense, and somewhat of a flop.
They were interesting, as would be
expected from a panel of eminent
investigators, but somehow rather
limp. Description of the appalling
epidemic of overweight and obesity
notably in children, and the clear
indictment of sugary soft drinks,
and above all Coca-Cola and
Peps-Cola, is not enough. The view
of this reviewer is that it’s over
time to move from scholarship to
public health action. Maybe this
isn’t a task for ‘scholars’. Maybe
the lesson to learn here, is that
what’s needed is a nutrition
equivalent of Greenpeace, as already
effectively operates in the case of
baby formula.
__________________________________________________________________
18.00-19.00. D Luis room
Environmental nutrition
Lecture
Preview
Joan Sabaté of Loma Linda University
was a member of the Giessen workshop
that produced The
Giessen Declaration on nutrition
as multi-dimensional. This will be a
thoughtful and valuable
presentation.
Review
**** Overall
***** Importance
***** Relevance
***
Quality
This should
have been the outstanding
presentation of the first day, and
it was indeed superb, but it fell
short. It was a session about which
some of the people present had
strong and essentially sympathetic
feelings. First, given the quality,
novelty and importance of Joan
Sabaté’s work at Loma Linda
University, this should have been a
morning keynote plenary
presentation. Placing it at the end
of a long day as a parallel session
with here others, starting 10 hours
after the opening session, when most
participants had had enough, and
were drifting away to have a shower
and dinner, or to hang around for
the welcome reception, was the first
major blunder made by the
organisers. The session was poorly
attended, by maybe 70 people. And
why has Porto featured no set-piece
plenaries at all? Odd.
Second, Joan Sabaté’s case for
admitting the environmental
dimension of nutrition was – is –
awesome. Building on the work of
Tony McMichael and others, in one
focused and concentrated session he
proved – proves – that the
industrialised production of meat
and animal products is a
catastrophe, and that environmental
impact is as important – more
important – to the human race, as
calories and nutrients. There was
inevitably some muttering after the
session that a researchers from the
US Seventh-day Adventist university,
on the topic of meat, would say
that, wouldn’t he.
The bigger but, was that he made no
allowance for the positioning of the
session, and exhausted the audience
by running over 60 minutes, abetted
by session co-chair Lluis
Serra-Majem in languid mode. Lack of
presentation discipline is a
besetting sin within nutrition
congresses.
During flurried Q&A, which should
have been at least 20 minutes of
discussion, Association founder
members
Michael Krawinkel and
Geoffrey Cannon (a member of
this editorial team) made
effectively the same point.
Positioning this topic as
‘environmental nutrition’ is highly
troublesome. In fact, it is
nutrition in its environmental
dimension – an entirely different
conceptual frame.
Michael Krawinkel, in a powerful
intervention, said that systems
approaches are now essential, to
frame and gauge nutrition in this
era. Joan Sabaté seemed not to get
the point, possibly because he wants
to protect his patch, but probably
more likely simply because time had,
unfortunately and wrongly, over-run.
To insist on environmental aspects
of nutrition is clearly vital. But
to devise a new speciality called
‘environmental nutrition’ is a
blunder. The value of this in terms
of new journals and fresh sources of
research funding, is clear enough.
But making more divisions within
nutrition is clearly troublesome.
That’s the problem with all the
alternative versions such as
‘eco-nutrition’, ‘ecological
nutrition’ ‘wholesome nutrition’,
‘holistic nutrition’, and so forth.
__________________________________________________________________
19.30-21.30 Electric Car Museum (a
walk away)
Welcome
reception
Preview
*****
No need to encourage you all to
mingle, plot and gossip!
Review
**** Overall
**** Food
**** Drink
**** Company
They do things
like this very well in the
Mediterranean region. Lovely
building n the side of the River
Duoro, excellent service, the wine
kept flowing, the buffet nibbles
were toothsome. No extra speeches of
welcome, phew, no bands, hooray.
Between and behind the classic
beautifully restored trams, people
had a good two hours to gossip, plot
and mingle – with lots of jokes
also. The groups from Mexico
gathered round Juan Rivera were on
good form. It seemed that what with
the big contingent from Brazil,
about half those present were
speaking Poruguese. Walter Willett
and Jaap Seidell joshed one another
about their debate earlier in the
day.
Lluis Serra-Majem presided in
majesty. Excellent, otimo.
__________________________________________________________________
Friday 24 September
__________________________________________________________________
10.00-12.00. Infante room
Science, policy, action to
prevent cancer, other chronic
diseases.
Symposium
Preview
****
Latest progress with the giant World
Cancer Research Fund/ American
Institute for Cancer Research
initiative. Speakers include
Association members Ricardo Uauy and
Geoffrey Cannon (a member of this
editorial team), and Martin Wiseman.
The latest news about spreading the
word and making things happen, in
Latin America, comes from
Association member Fabio Gomes (yes,
he who contributes a column to this
website every month and is also an
editorial team member).
Review
**** Overall
**** Importance
**** Relevance
**** Quality
Well attended
session – about 120 people in the
room. The work of the World Cancer
Research Fund/ American Institute
for Cancer Research was brought up
to date by Martin Wiseman and
Geoffrey Cannon, and in particular
by Fabio Gomes of the Brazilian
National Cancer Institute (INCA) the
partner with WCRF/AICR in Brazil.
The fourth and final presentation by
Ricardo Uauy was a humdinger. What’s
needed now, he said, is action-based
evidence, not evidence-based action.
Reforms in Chile (his own country)
have been supported by the former
president Michelle Bachelet. ‘We
cannot just be knowledgeable. We
must be activists’. If we were to be
serious, we need legislators in our
meetings. We need to educate the
politicians’. He introduced the head
of the Chilean senate health
committee, invited opportunistically
to Porto, who made an electrically
dramatic intervention, saying the
legislation is crucial to protect
public health. As an example of a
product on the market in Chile that
is plainly harmful to health, he
produced a packet of Nestlé’s
Chocapix, whose sugar content really
make it not so much a breakfast
cereal, ac confectionery. The
senator said that he could not
understand why at conferences like
Porto, all the participants are
nutritionists. He repeated Ricardo’s
point. If the intention is to change
or improve public policy, then
public policy-makers – politicians
and others in government – should be
present.
This, it seems very likely, is a
recommendation that will be followed
through at the Association’s
conference, Rio 2012.
__________________________________________________________________
12.00-13.30. Infante room
The use of ready to eat foods
should be scaled up immediately
Debate
Preview
*****
The title is wrong – this is
actually about RUTFs (ready to use
therapeutic foods). Mark Manary for
the motion. If David Sanders, billed
as being against the motion,
actually is coming to Porto, this
will be a must-attend-and-engage
sizzler, and is five-starred on that
basis: David is a brilliant,
learned, committed, mordant speaker.
Again, let’s hope that these debate
sessions are properly organised,
with contributions from the
participants and a vote.
Review
** Overall
***** Importance
***** Relevance
*** Quality
This
well-attended session , with about
115 people in the room, was
co-convened by Ken Brown of the
University of California (Davis). Dr
Brown is a colleague of Mark Manary,
the motion’s proposer.
It was made clear that the topic for
debate was ready to use therapeutic
foods (RUTFs), used quasi-medically
to treat children with severe acute
malnutrition, which is not also and
controversially being used to treat
mild chronic malnutrition, and even
to prevent malnutrition. RUTFs are
typically packaged patented peanut
paste with added oil, vitamins and
minerals.
Dr Manary explained that he is
‘very, very passionate’ about
ready-to-use therapeutic foods (RUTFs),
which are now a central part of his
life’s work, especially in Africa.
As a long-standing colleague of WHO
RUTF champion André Briend, he was
proud of the astounding results
achieved by the RUTF Plumpy’Nut, in
enabling acutely and severely
malnourished children to survive and
thrive. The RUTF project began in
2001, and ‘worked like a dream’.
Recovery rates are dramatic. This
and other products are, he said,
safe and very palatable, and they
work. By contrast, he said,
plant-based diets cannot provide the
full range of nutrients children
need. Yes, RUTFs are expensive, but
are a better investment than
immunisation or vitamin A
supplements. Why the resistance to
RUTFs in India? ‘Some people want to
ideologise about this’, he said. ‘To
fix malnutrition we going to have to
engage many sectors’. RUTFs? ‘We
need to go for it’.
Yes, David Sanders was present at
Porto. Hunger, he said, is a
political issue. He stormed through
more than 50 slides, taking a much
broader public health view. In 2009
15,000 tonnes of RUTFs had been
distributed mainly by UNICEF, MSF
and the Clinton Foundation. They are
a commercialisation of nutrition. Of
course they have a vital role in
medical contexts, but if up-scaled
would have a disastrous effect on
breastfeeding, indigenous and
established foods, local food
systems and economies, and community
integrity. Their justification is
only in a precise, narrow context.
He quoted the attack by famed
economist Jeffrey Sachs, on
expansionist plans for RUTFs. How
come the patent on Plumpy’Nut is so
fiercely protected? The real issues
include the fact that poverty in
impoverished countries is being
created and increased by unfair
terms of trade. ‘The
commercialisation of “magic
solution” is part of the problem.
This was another outstanding example
of a crucial topic for debate. The
long series of interventions were
all sympathetic with David Sanders’s
opposition to scaling up of the use
of RUTFs, or else supported him
explicitly, some strongly. John
Mason of Tulane University, a former
technical secretary of the UNSCN,
who became a member of the
Association at Porto (as did David
Sanders) cogently opposed the
motion. He said that children got
hooked on Plumpy’Nut – once they eat
it they won’t eat anything else.
The vote? Ken Brown ruled that the
motion was unclear, and that there
would be no vote.
__________________________________________________________________
18.00-19.00 Infante room
It is best
to be small
Debate
Preview
****
Association member Geoffrey
Cannon for the motion; David
Pelletier of Cornell University
against. Geoffrey is braced for an
onslaught from the paediatric
nutrition science community leaders
present at Porto. We can promise
that this session will be
excellently organised and moderated
by Juan Rivera, and Aryeh Stein of
Emory University.
Geoffrey
declares an interest, as a member of
this reviewing team.
Review
***** Overall
***** Importance
***** Relevance
**** Quality
This debate
was indeed immaculately organised by
Aryeh Stein and Juan Rivera, who
called the assembly to order and,
first, explained the rules of
engagement, only loosely followed in
the other debates reviewed here.
First, the motion was more tightly
defined: ‘Small refers to human
populations. It means height and
weight throughout the lifespan that
is substantially shorter and lighter
than high-income populations, and
that is now generally recommended’.
This explained, a ‘pre-vote’ is
taken, to establish the base-line.
The proposer of the motion speaks
first, followed by the opposing
speaker. Each has 20 minutes, will
be given a 5 and 1 minute warning,
and if unfinished, will be cut off.
This is then followed by statements
and questions from participants in
the room. After this, the speaker
against the motion has five minutes
to respond and make concluding
remarks, followed by the motion’s
proposer. Then a final vote is
taken, as the conclusion and as
comparison with the baseline.
At the end of a sunny day, to be
seen outside the building and to be
enjoyed by the banks of the Douro,
it was gratifying that anybody other
than the co-convenors and speakers
turned up! The session started with
about 40 people in the room, Most
were shy to respond to the call for
a re-vote, which resulted in 0
(zero) for the motion, and 10
against.
Geoffrey Cannon, in proposing the
motion, made his case mainly for
environmental reasons: the bigger
people are, the more they consume.
He began by showing what he was
recommending: two volunteers
present, Sueli Couto (head of the
nutrition unit at the Brazilian
National Cancer Institute) and the
congress’s official photographer,
who strutted their stature on stage,
and sat down to great good-humoured
applause. He calculated that short
light populations could be
physically active and still turn
over 10 per cent less energy than
the current specified norm.
Construed in terms of cattle, on a
global basis this would add up to
150 million fewer cows, or
alternatively 50,000 billion fewer
hamburgers, and therefore 2-5% less
greenhouse gas, 1% less consumption
of oil (70 times the Deepwater
Horizon spill), and 8% less water.
He flicked through a series of
distinguished ‘short-arses’,
including Voltaire, Kant, Stalin,
Benito Juarez, Queen Victoria,
Gandhi, and Charlie Chaplin. Maybe
being tall protects against heart
disease, but it increases the risk
of cancer. He quoted John Waterlow
as sharing his views and as saying
that the ‘height explosion’
consequent on low-income populations
becoming as tall as high-income
populations are now, would have as
catastrophic effect as the
population explosion. From the
evolutionary and environmental point
of view, he said, the argument for
relatively small populations was
unassailable.
In responding, David Pelletier
relied mainly on the evidently
impregnable data showing that
infants and young children so short
and light as to be defined as
‘stunted’ and ‘wasted’ are more
likely to die as children, and are
at a disadvantage all their lives. A
speculation such as that made by
Geoffrey failed the test of ‘first,
do no harm’. Geoffrey seemed to be
suggesting a manipulation of human
populations that surely was
unwarranted, and also gave no real
idea of how this could be done. The
motion failed all elementary
standards taught in school. He
himself had a BMI marginally over
25. Should he be worried? No! Juan
Rivera turned out to be an
immaculate session chair: each
speaker completed in 20 minutes on
the button.
The room by then contained around 80
people, felt to be really good for
the time of day, and with the gala
dinner imminent. People in the room
included Association president
Barrie Margetts, and Association
members
Esté Vorster, Walter Willett,
Carlos Monteiro, and Michael Latham.
Most contributions were still
somewhat incredulous about the
motion. In wrapping up, both David
and Geoffrey clicked through their
slides and showed a few more –
clever stuff! Geoffrey displayed his
new world height, weight and energy
turnover charts.
And the final vote? As in other
debate sessions, most people in the
room did not commit themselves. The
shows of hands were 13 for the
motion, 14 against. The raw result
therefore was a success for Team
Cornell. But judged against the 0-7
baseline vote, it was a triumph for
Team Maverick. People walked out of
the room in a mood of buzzy
enjoyment. Walter Willett, in
conversation at the dinner reception
(below) reckoned that the theme of
human height alone has many
dimensions. A new book? A whole new
university department of Nutrition
and Stature? Indeed!
__________________________________________________________________
19.30-21.30.Palácio de Bolsa (a walk
away)
Gala dinner
Preview
*****
More scope for networking. The food
and drink will for sure be
excellent.
Review
**** Overall
**** Importance
***** Relevance
**** Quality
The old
Counting House Palace, exquisitely
restored, was the venue for
gratified participants at the end of
the second day. The sense of the
Portuguese world empire, at its
first heights half a millennium ago,
was palpable. The reception before
we all sat down, in what are indeed
palatial corridors, gave us plenty
of time to meet and mingle. Then we
were all ushered into what may be
the most splendid room in Porto, for
wine and the feast, everybody in a
good mood.
The layout of the space, with plenty
of room between the tables each set
for eight, was also perfect for
recognising and greeting colleagues
at the other side of the room.
Criticism? Only one: the band was
too loud and the music rather
discordant and inelegant. Overall
though, this was the kind of
occasion that a billionaire would
gladly spend a fortune to create.
Maria Daniel Vaz de Almeida and her
colleagues from SPNCA (the
Portuguese Society for the
Nutritional Sciences) have achieved
a fine accomplishment
__________________________________________________________________
Saturday 25 September
__________________________________________________________________
10.00-12.00. D Maria room
The combating of malnutrition in
all its forms
Symposium
Preview
****
With such a sprawling title this
could fly or flop. Moderators
Association founder member Ricardo
Uauy, and David Pelletier, will need
to focus proceedings. The sequence
is obesity, stunting, wasting, and
bringing it all together.
Review
*** Overall
***** Importance
***** Relevance
*** Quality
The small room
was more or less full, with about 80
people. Another session which was
difficult to rate overall, because
of the variable quality of the
various presentations. Moderator
Ricardo Uauy said that he would
insist on reserving over half an
hour after the presentations, for
questions and contributions from the
floor, and so he did. Full marks,
for this unusual discipline.
In a superb presentation, Ben
Caballero proposed that
undernutrition and overnutrition are
not separate public health crises,
but are connected. One consequence
of ‘pushing calories into children’
identified as stunted, was to
increase their body fat.
On wasting, Mark Manary said ‘We
wanna fix the problem’. He showed
ways in this could be done, with
USAID fortified blended flours (FBFs),
and corn-soy blends (CSBs). Over 400
million tonnes of these products
have been distributed. Médicins
San Frontières (MSF) made a
blanket distribution of ready to use
therapeutic foods (RUTFs) in Niger
in 2007 to prevent malnutrition,
with great success.
On stunting, Marilyn Scott, who is a
parasitologist, described a study in
Panama showing that in a rural area
60 per cent of all the children were
stunted, and 80 per cent were
infested with the Ascaris parasitic
worm. Responding to this, Michael
Latham said that the need de-worming
was so often overlooked – children
free from parasitic infection
recover weight.
Seeking an integrated approach,
David Pelletier said that nutrition
policy is indeed ‘top-down’ and that
science does indeed ‘split nutrition
into very small pieces’, and that
‘scientists tend to advocate their
own research’. Commenting, Geoffrey
Cannon said
that these surely were all parts of
the problem. So many interventions
have proved not to work or, as in
the case of ‘pushing calories into
children’ to catch up their growth
with inflated velocity curves, have
made more problems. He recommended
that everybody read and mark
Leonardo Mata’s classic book
The Children of Santa Maria Cauqué,
which shows that with support – and
with de-worming – impoverished
communities are best left to restore
and maintain the health and
well-being, from the bottom up.
__________________________________________________________________
12.00-13.30 Infante room
Ultra-processed foods are adverse
to human health
Debate
Preview
*****
Yes, another ***** given to a debate
session. Carlos Monteiro for the
motion. John Lupien of the industry
organisation the European Food
Information Council (EUFIC) against.
Carlos’s thesis will be the WN
commentary this November. Much
depends on the quality of the
presentations as given.
Review
*** Overall
***** Importance
***** Relevance
*** Quality
About 100 people were in the room at
or soon after the start. The
convenors introduced the session
without mentioning a vote and, when
asked about this, said that the
motion was felt to be obscure and
that no vote would be taken. After
vigorous protest from the floor
along the lines of ‘let the people
decide!’, they changed their minds
and said OK OK a vote would be
taken. It turned out that before the
session started John Lupien had said
to the convenors that the motion was
obscure and that a vote would not be
helpful.
Both presentations were a lot longer than
the specified 20 minutes.
Association founder member Carlos Monteiro said he
needed to explain what is meant by
‘minimally processed foods’ and, by
contrast, ‘ultra-processed foods’.
His thesis in effect is that the
issue with nutrition and health is
not so much food, or nutrients, as
what is done to food before it is
consumed. Ultra-processed foods –
and drinks – are characteristically
made from refined ingredients whose
nutritional quality is grossly
degraded, made palatable by
sophisticated use of cosmetic
additives. Household expenditure
surveys in Brazil show, over time, a
gradual replacement of ‘type 1 food’
(minimally processed), and ‘type 2
food’ (ingredients used in the
preparation of meals at home), with
‘type 3 food’ (ultra-processed,
manufactured to be very palatable,
can be consumed immediately,
therefore ‘fast’ or ‘convenience’
food). Comparing type 1 and type 2
foods taken together with type 3
foods, these ultra-processed foods
are higher in sugar, saturated fat
and salt, and lower in dietary
fibre.
John Lupien also spoke for over
half-an-hour, in his case without
slides. He said we need to live in
the real world. The main issue is
the 1 billion people in the world
who are undernourished. ‘Food and
nutrition education is the real
basis of what needs to be done’,
with help from the medical
community, and parents. ‘We all need
to work together’, he said. During
his speech people steadily left the
room and at the end there were about
55 left.
Then discussion. Lluis Serra-Majem
popped into the room, said that
bread is a feature of the
Mediterranen diet, and popped out
again. Nicole Darmon wondered why
Carlos Monteiro had not incorporated
nutrient profiling. In response,
Carlos said that an attempt to make
profiling work in Mexico has been
wrecked by industry.
The vote was taken: 30 for the
motion, 0 against.
__________________________________________________________________
17.00-18.00 Infante room
Special session
Tribute to Igor de Gorine and to Nevin Scrimshaw
Preview
Nevin tells us, without irony, that
conferences have been paying tribute
to him for decades now. But the
speakers are three of his ‘young
men’. Ricardo Uauy, Benjamin
Caballero and Noel Solomons, so it
should be good value. Association
Council members will miss this
session, alas – see above.
Review
** Overall
*** Importance
**** Relevance
** Quality
After the
tributes to Jose Maria Bengoa on the
first day, and to Rainer Gross
immediately before (not reviewed
here), some people present felt
somewhat tributed out. Also, any
tribute to anybody orchestrated by
Noel Solomons tends to feel like a
tribute by and to Noel Solomons –
which can be fun, if distracting.
__________________________________________________________________
18.00-onwards. Arquivo room.
Music, dancing, refreshments
Preview
****
Good idea this, it will encourage
people to stay to the end. It’ll be
interesting to see who are the
sponsors of this fun event. Those
worried about this could bring their
own bottle – of wine, that is.
Review
*
Overall
**** Food,
drink
** Entertainment
*** Company
Beautiful
room, where the congress began –
what seems a long time ago, now.
Lots of space for the 200 or so
stalwarts to mingle – this is
crucial. Fine views of the river
Excellent snacks, good wine – of
course. As before, the band was
raucous. Congratulations to Maria
Daniel, embraces, até proxima vez –
until next time, which is Rio 2012.
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That’s all folks
For
Porto 2010
Your reviewing team
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