Complete financial disclosure for improved transparency in nutrition communication

Andrew N Reynolds^1*Sabita S Soedamah-Muthu^2,3*

• ¹University of Otago, Dunedin, New Zealand
• ²Tilburg University Center of Research on Psychological and Somatic disorders, Tilburg, Netherlands
• ³University of Reading, Reading, United Kingdom

Globally, what foods we eat and their nutrients are primary drivers of morbidity and mortality (1), making nutrition communication an essential tool to improve health outcomes and reduce healthcare costs. Not all nutrition communication is delivered based solely on health interests, however. Given the power of nutrition communication in driving self-perception and behavioural change (2), the accurate disclosure of financial support is fundamentally important to identify an individual's or research group's positionality and vested interest. This is seen as particularly key in nutrition science, as competing interests are high (3)(4)(5), and consumer confidence in nutrition science is low (6).Relevant financial support is important to disclose to understand risk of bias in nutrition communication, such as by the commercial determinants of health. The World Health Organization defines the commercial determinants of health as direct and indirect strategies or approaches used by the private sector to promote products and choices that positively or negatively a^ect health (7). Nutrition science and its communication are areas where health interests and commercial interests interact (8,9). Given the relevance of this topic, several previous publications have discussed aspects of increasing scientific rigor and appropriate disclosing of competing interests (10,11), often with mixed or conflicting views (12)(13)(14). Guidelines on recognising competing interests to protect scientific integrity and credibility have been proposed with general phrasing such as "parties shall require, in publications and conference presentations, full signed disclosure of all financial interests" (10). However, it has been recognised (15) that specific structural guidance on how to disclose competing interests in nutrition communication is lacking (16).While virtually all scientific journals uphold their guidance on disclosing financial support, our experience is that such guidance does not distinguish between disclosure (potential for bias) and acknowledgement. Furthermore, nutrition conferences provide less guidance and do not typically uphold the requirement to list disclosures for all speakers. Here, we have defined useful terminology, identified di^erent types of topicrelated financial support, distinguished between what should be disclosed and what should be acknowledged, and propose a guide to do so. We do this to increase transparency and consistency among researchers and aid nutrition communicators be upfront and transparent when disclosing financial support. Scientific integrity and trustworthiness are key to guarantee credibility in nutrition science and ensure accurate health promotion in oral presentations and written work (nutrition communication). Scientific integrity is defined as the commitment to uphold ethical principles, professional standards, and honest practices in the conduct, managing, use of results, and communication of science and science activities (17).Trustworthiness is defined as the perceived reliability, trust or credibility of the individual by others (18). Transparent disclosure of financial support which could influence nutrition communication is essential to maintain both scientific integrity and trustworthiness.Throughout this writing, specific terms will be used to mean specific things. Di^erences in terminology and the use of non-specific terms can be misleading, making a shared terminology when disclosing financial support important. Specific terms to use are defined in Table 1, which we adopted or adapted from the current literature. Our use of terms starts with the understanding that the nutrition communicator discloses their financial support, and it is the audience who determines any competing interests. It cannot be the role of the nutrition communicator to state their competing interests, as this is a judgement statement for which they might be biased. The focus of this writing is disclosing financial support in any way relevant to the nutrition communication.Financial support can be divided into income, or financial support managed through a host institution (University). In-kind support is included within financial support, because if the goods/services weren't directly provided then they would have been purchased. Relevant patents (awarded or pending) are also included when disclosing financial support, even if they represent only a potential future gain. Relevant financial disclosures should be listed for both the nutrition communicator and the research team behind the work.Finally, disclosing will di^er between restricted project funding and unrestricted project funding. Project funding is only unrestricted when the funder has no role in the study conceptualisation, design, data collection, analysis, the decision to publish, or communication of results such as presentations or publications. These categories where a funder may influence or bias nutrition science are those indicated in the Nature Portfolio's Competing Interests Policy (19). In contrast, unrestricted project funding provides the freedom to conduct and present research without influence from that funder. It is important to acknowledge that there are various forms of competing interests that could influence nutrition science and communication (20), with the scope of this article focussed on disclosing an individual's or research team's financial support. Nonfinancial competing interests may be equally important (21,22), but these should be reported separately and distinctly from financial ones. Mixing financial and nonfinancial competing interests will likely dilute the visibility of financial disclosures. Furthermore, listing funding and positions not related to the topic of the nutrition communication or where no competing interest can exist will also (intentionally or not) dilute the visibility of financial disclosures. Listing credible funding sources from unrelated projects is another way the visibility of relevant financial disclosures may (intentionally or not) be diluted.Understanding the relevant types of financial support is crucial when disclosing this information. Financial disclosures should relate to both income and money or goods/services passed through an institution (University) relating to the topic. Topicrelevance is broader than project-relevance when disclosing, and removes much of the need to specify a time frame within which disclosures should be stated. Instead, any topic-relevant funding received in the past should be disclosed. Income is money (or goods) received personally in exchange for work or activities undertaken or committed to. Income includes both base salary and additional sources paid to an individual and should be the first disclosure stated when relevant to the topic of communication. All sources of income/salary relevant to the topic should be disclosed e.g. salary, royalties, honorarium, directorship, trust and/or dividend pay outs. This includes anticipated or committed future income not yet paid. If an individual receives multiple sources of relevant income, it is useful to order them by amount (without the need to state amounts). It is also useful to indicate the source of the income (e.g. University, government, other (topic-unrelated), or other (topic-related)) when disclosing. Nutrition communicators should focus on topic relevance and disclose all sources rather than reporting only if above an arbitrary amount, as has previously been considered (23). After income, relevant financial support passed through or managed by an institution such as a University should be disclosed next. Such financial support includes: project grants, conference attendance support, and can include honorarium, speakers' fees, director or board fees that are not paid as income.The first of these to disclose is topic-relevant restricted project funding, where the funder was involved in any aspect of study conceptualisation, design, data collection, analysis, the decision to publish, or communication of results. Relevant restricted project funds must always be disclosed, as this seems a common pathway to introducing bias into analyses and interpretation (4,5,24). Like income, source of restricted project funds should also be categorised (University, government, other (topic-unrelated), or other (topic-related)). Following income and restricted project funding, certain other topic-relevant financial support passed through or managed by an institution can then be listed (e.g. conference attendance support, honorarium/ director fees/ board fees/ speakers' fees, shares/trusts/dividends/ royalties, and in-kind support) followed by patents. Finally, if the nutrition communicator has family members receiving topic-related financial support, including nutrition science related trusts/ foundations or employment positions, these should be disclosed.This writing assumes all financial relationships are disclosable. However, it is possible some nutrition communicators may have non-disclosure agreements or confidentiality agreements in place. In these situations where certain disclosures cannot be itemised, and in line with guidance of the Nature publishing group, authors should state: "The authors declare that they are bound by confidentiality agreements that prevent them from disclosing their competing interests in this work". There is no possible guidance where nutrition communications are prevented by confidentiality agreements from disclosing both competing interests and the presence of a confidentiality agreement, however it is possible for such agreements to be in place. When excess or unnecessary information is disclosed, it can dilute or obscure the disclosure of important information to the audience. For this reason it is important for nutrition communicators to understand what must be disclosed and what might instead be acknowledged. Principally, unrestricted project funds irrespective of source should not be included with disclosures. Given that truly unrestricted project funding provides the freedom to conduct and present research without any influence from that funder, there is no competing interest to ascertain. Likewise, it is recommended not to list disclosures for financial support passed through or managed by an institution such as a University that come from University, government, other (topic-unrelated) funders when competing interests cannot exist. Instead of disclosing, these types of financial support could be acknowledged on a separate slide or publication section alongside the relevant grant number or identifier.A guide to disclosure and acknowledgement of financial support is shown in Figure 1 For those interested in this area of scientific rigour, this online list of relevant articles is useful(25) alongside more recently published resources (22). Concepts like social/cultural/strong lifestyle preferences might also introduce competing interests with nutrition communication, as has been raised previously (21,22). While not a focus of this writing, individuals should seek advice from relevant conference or journals for their guidance on whether non-financial interests should be disclosed, but after and separately to financial support. Nutrition science and its communication are areas where health interests and commercial interest interact, with clear potential for detrimental impacts on human health. The appropriate disclosure of financial support in nutrition communication is one area where specific structural guidance is lacking. We have provided terminology and a structure to support the systematic and clear reporting on financial support. The purpose of this work is to add transparency in disclosing financial support, to increase scientific integrity and trustworthiness in nutrition communication. However, the onus remains on the nutrition communicator to be accurate, truthful, and open in disclosing their funding sources. Deleted: