International Society for the Study of Fatty Acids and Lipids (ISSFAL) 

Congress Report 

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ISSFAL

The International Society for the Study of Fatty Acids and Lipids (ISSFAL) was established in 1991, with the main objective of providing a better understanding of the role of dietary fatty acids and lipids in health and disease through research and education. The 13th congress of ISSFAL was held at the MGM grand hotel and casino in Las Vegas, Nevada, USA. This congress provided a very unique opportunity for me to learn from the seasoned researchers and experts in my area of interest. Approximately 500 scientists, health professionals, administrators and educators with an interest in the health effects of dietary fats attended the congress. 

The ISSFAL program was well organised and comprised different satellite symposia, plenary and parallel break-out sessions. ISSFAL hosted two satellite symposia on Sunday, May 27. On this day, the registration desk was open and accessible through out the whole day. I attended the satellite symposium on arachidonic acid (AA) and docosahexaenoic acid (DHA) in infant and development. An international panel of thought leaders in this area were assembled specifically for these presentations and the symposium highlighted the biological functions of AA and DHA in early human and animal development.

In the evening, there was an opening reception at the Tropicana Hotel where the congress chair Hee-yong Kim from National Institutes of Health welcomed the attendees to Las Vegas and the congress. Kim encouraged all young investigators and junior scientists to take advantage of the many events within the program to interact with the seasoned researchers and experts in the field of fatty acids and lipids and foster interaction among all participants. These included the ‘meet the Professors breakfast’ and ‘young investigator social’ providing networking opportunities with people from different parts of the world. At that moment I realized that there is more to research than collecting data and writing articles, it’s all about being part of something, socializing with people who share similar interests and coming together to help improve the world we live in. 

The program for the congress covered three major topics: Biochemistry and Metabolism of Fatty Acids; Lipids in Health and Disease; and Lipids in Nutrition. These major themes encompassed all other aspects of lipids including but not limited to lipidomics and metabolomics, which are all important for understanding human physiology and pathophysiology. The actual scientific congress started on Monday, May 28 and ended on Thursday, May 31. Each day began with one plenary session in the morning, followed by three parallel break-out sessions, another plenary session soon after the lunch break and three parallel break-out sessions after the afternoon coffee break. All in all, there were six plenary sessions and 24 parallel break-out sessions. Presentations ranged from translational research to clinical studies. Most presentations provided evidence about the impact of lipids in different clinical diseases and a clear understanding of the role that dietary lipids play at all ages in preventing diseases related to lifestyle. 

Below are a few key learnings from my experience at ISSFAL:

Maternal and Infant Nutrition 

– Results from a randomized controlled trial showed that enteral DHA supplementation with 60mg per kilogram of DHA resulted in a greater risk of lung inflammation in very preterm infants. Therefore, these results did not support supplementing very preterm infants with DHA above levels currently available in breast milk and recommended in infant formula. 

– Other analyses highlighted the importance of controlling for environmental factors when evaluating nutritional interventions. Furthermore, differences in brain function and behavior were observed in children more than 5 years after in utero DHA supplementation. However, boys may be more vulnerable and tend to benefit more from early supplementation.

– The importance of long chain polyunsaturated fatty acids (LCPUFAs) in infant formula is still evolving. Polymorphisms add an entirely new dimension, particularly, the FADS status of the mother and infant should be considered when designing future studies. In addition, fortified infant formula milk should contain both DHA and AA, because there is insufficient clinical trial evidence for the safe removal of AA in infant formula milk containing DHA. 

Clinical Trial Methodology 

–  It is important to optimize the differences between the treatment and control groups to ensure that effects are detected, if any. The interpretation of results solely depends on the background diet, dose of fatty acid intervention and use of appropriate control diets or supplements. Research is important for assessing different trial outcomes, therefore, it is important to have realistic expectations and outcomes. 

– At the beginning of a trial, it is important to consider the design of tools to enable effective organisation of the study protocol with the aim of improving compliance. Of importance is a communication plan, study timeline, data management and monitoring plan as well as the establishment of appropriate committees. The full lifespan of the project must be examined, giving special attention to defining roles, training a skilled research team and creating a comprehensive manual of standard operating procedures. 

– Also critical is further refining relationships with institutional support sectors including institutional review boards, research institutes, and clinical stake holders. When conducting clinical trials, it is important to be vigilant and focus on the goal as well as to keep contact on the ground on the project’s routine needs thus allowing your team to not only keep momentum but also to anticipate a variety of road blocks at any stage of the trial. 

Dietary Fatty Acid Intake 

– In Canada, healthy toddlers are not meeting the recommended dietary intakes of DHA and AA. 

– Moreover, in the United States of America, the current recommendation of 2 servings of fish per week in adults is unlikely to result in a desirable omega 3 index. Thus, at least 3 servings of fish per week plus an EPA+DHA supplement appears to be necessary to achieve this target level. 

I also attended the Alexander Leaf award ceremony and had the privilege to listen to Maria Makrides’ (South Australian Health and Medical Research Institute & School of Medicine, University of Adelaide, Australia) lecture titled, “Standing on the shoulders on giants: Great women role models of my career”. From this speech I learnt that: 

– It is important to keep your eye on the horizon. Be clear about your destination and how you want to get there. Keep trying out new things, adjust and modify your journey accordingly. Sometimes you want to think that your career will be linear, always a step forward, but along the way you will find a lot of sharp turns. Even then, do not cut too many corners in the process because the value of the outcomes is strongly linked to the quality of the research process. 

– It’s all about creating opportunities and preparation. Learn from as many people as you can along the way. Be open to new possibilities and by so doing you will always have a runway for continuing to explore new areas of research and stretching yourself beyond limits. Also, remember to be kind to yourself and to others. Have fun and enjoy the journey. 

Congress report, DHA
Linda P. Siziba standing by her poster at the ISSFAL congress

Poster presentations were done every day during lunch and coffee breaks. I had the privilege of presenting my poster entitled “Associations of plasma total phospholipid fatty acid patterns with feeding practices, growth and psychomotor development in six-month old South African infants.”

Furthermore, some activities were organised to enable everyone to meet and socialize with other delegates at the congress. In addition to the welcome reception, I also had the privilege to attend the ‘DSM 1000 days award breakfast’, DSM Science and Technology Award reception, young investigator social and ‘meet the Professors breakfast’. Wednesday, May 30 was an ‘off-day’ and this was an opportunity for everyone to explore Las Vegas and surrounding areas. There was a variety of tours and activities to choose from which included but were not limited to a helicopter ride or a drive to the Grand Canyon. The congress officially ended on Thursday, May 31 with a gala dinner, where we had an amazing ‘German’ experience, while in Las Vegas, at the Hofbräuhaus. 

I would like to express my utmost gratitude to Sight and Life, DSM, Centre of Excellence for Nutrition and my promoters (Prof Marius Smuts and Prof Jeannine Baumgartner) for generously contributing towards making my ISSFAL congress attendance possible. It was indeed a unique opportunity for me as a budding researcher for personal branding, networking and learning even more about fatty acids from leading scientists in the field. 

Correspondence: Linda P. Siziba, PhD student at Centre of Excellence for Nutrition, North West University, South Africa. Email: sizibalinda@gmail.com

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Uncovering Nutritional Solutions in Haiti

A researcher's viewpoint

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Adrienne Clermont is a research associate at the Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, and the author of ‘Market-Based Sales of Nutritional Products in Low-Income Settings: Acceptability and feasibility from consumer focus groups in Haiti’. The article is based on research from her thesis project for her Master of Science in Public Health (MSPH) in Human Nutrition and is published in the Sight and Life magazine, Focus on Food Culture edition.

The feature examines the distribution of lipid-based nutrient supplements (LNS), which, it says, have grown in popularity in recent years in low-income contexts and are currently distributed primarily through humanitarian assistance programs, the scope and duration of which are limited by the availability of donor funding. It considers the case of Haiti, a country with intensely high levels of poverty and food insecurity, asking if market-based sales of LNS could prove viable in this country; if so, they could provide a new and sustainable revenue stream for local LNS producers in addition to an affordable source of high-quality nutrition for low-income Haitians.

Clermont told Sight and Life that her experience in Haiti provided outcomes that were not only unexpected but on occasion heartbreaking, challenging, and inspiring.

Sight and Life magazine (SAL): Why did you choose this topic?

Adrienne Clermont (AC): Edesia, a US-based producer of ready-to-use foods (RUFs), nutritional products that combat malnutrition in low-income countries, had a grant to work with several partner organizations, including Meds & Foods for Kids (MFK), the RUF producer in Haiti, to look at whether it would be possible to sell RUFs on the market in Haiti. Up until now, MFK has produced RUFs for sale to non-governmental organisations (NGOs), schools, hospitals, and other organizations. It has never sold directly to consumers, however, which could allow these nutritional products to reach more people and have more of a positive impact. If sold at a price that covered all manufacturing and distribution costs, they could help subsidize MFK’s work with more underprivileged populations.

A whole team of Haiti-based researchers was involved in the project and used several research methods, including a quantitative survey and key informant interviews. I was asked to lead the qualitative research component, carrying out focus groups with low- and middle-income consumers to find out more about their food-purchasing habits, and their potential interest in an RUF product.

 

SAL: How did you collect your data?

AC: We conducted 19 focus groups in four cities across Haiti. These included (in separate groups) pregnant and lactating women, primary-school-age kids, and male and female caregivers of young children. I speak French fluently, but very limited Haitian Creole, so I sat in the back and listened while a Haitian colleague led the discussions. I was able to follow a bit, and being there gave a lot of context for when we translated the focus groups into English later on. It was fascinating to see the group dynamics, as well as get a glimpse into the lives of lower-middle class Haitians in a variety of circumstances. In each location, we spent some time traveling around the neighborhood to see the context, and to see what foods were for sale nearby (part of our objective was to understand the food landscape and competitor products that the RUF would face). Some of the focus groups were at schools, and others were at a health clinic in a slum, so we saw a lot of interesting places.

SAL: Are there any key moments you would like to share?

AC: One of the most interesting and fun parts of the focus groups were the taste tests. I brought hundreds of sample sachets of peanut-based RUF with me from Edesia’s factory in the US to Haiti, and during each focus group we were able to give each participant a sachet and get their feedback.

RUF is like thick, sugary peanut butter, so most people – especially kids – love it. Pretty much every single kid in our focus groups finished their sachet, tore the packaging apart, and licked it until every last speck of peanut paste was gone. It was heartbreaking to watch, because it gave an idea of how hungry most of these kids are most of the time.

Among the adults, most people liked the product, but there were some varied opinions. First, peanut butter is a hugely popular local product in Haiti, so everyone was comparing the RUF to mamba, which is Haitian peanut butter. They claimed they could taste that it was not made from Haitian peanuts, that the taste was ‘too weak,’ but I think that was mostly because RUF is mixed with a number of other ingredients (sugar, soy, dairy, oil, vitamin premix), so it does taste quite different from pure peanut butter. Some local peanut butter in Haiti is made with chili powder, so they recommended we make a ‘spicy’-flavored RUF to appeal to adults! Second, some pregnant women found the RUF off-putting because of their food sensitivities. In Haiti, people say that a woman’s food cravings in pregnancy are based on what the baby in the womb wants, so I guess some of those babies did not want peanut butter! 

SAL: And any unexpected outcomes?

AC: I didn’t go into the study with any expectations about whether market-based sales of RUF would be feasible or not, so the ultimate conclusions of the study were a surprise to me. Essentially, what we found is that, although there is a huge need for healthy, nutritious snack foods in Haiti (most current snack foods are highly processed cookies and crackers with basically no nutritional value), and there is an existing system of small street vendors who could sell such a product to our target consumer groups, it would be practically impossible to produce the RUF at the price point that most Haitians would be able to pay.

Existing snack foods are incredibly cheap, and RUFs must be produced to international standards – things like vitamin premix, peanuts that are inspected for aflatoxin, and plastic packaging that is shelf-stable (even in Haiti’s tropical climate) for up to two years are expensive. And the sad reality is that most Haitians do not have the information to distinguish between ‘healthy’ and ‘unhealthy’ snack foods and, at the end of the day, need to prioritize putting food in their bellies over paying more for the most nutritious option. I believe Edesia and MFK are looking into production options that might allow RUFs to be produced at that price point in the future, but at the moment it’s not feasible. 

SAL: Did your research help Edesia move forward with LNS products in Haiti?

AC: Edesia and, more importantly, MFK both continue to innovate in terms of new LNS products for Haiti. However, for the time being, they continue to focus on sales to humanitarian groups only, rather than market-based sales (the topic of my research). 

SAL: What findings would you like to highlight?

AC: We spent quite a bit of time in the focus groups talking about women’s nutritional needs in pregnancy – what typical diets are, cultural beliefs about what should and shouldn’t be consumed during pregnancy pregnancy, and so on.

One interesting finding was that many women actually fear getting ‘too much’ nutrition in pregnancy, in the sense that they worry a very large baby will lead to a difficult, painful, or even life-threatening delivery. There is some foundation to this, in that women who are stunted (due to poor nutrition earlier in life) may have trouble delivering a large baby due to the smaller size of their pelvis. However, these women took this idea too far – several of our focus group participants reported refusing to take prenatal supplements (such as iron pills) because they didn’t want the baby to get too big. In fact, they believed the iron pills were actually a ‘scam’ carried out by doctors to make more money – that the doctor would give women pills to make the baby grow big, so the baby would have to be delivered by Cesarean section, an expensive procedure that the doctor could then charge for.

This is a sad commentary on the level of trust in the Haitian medical system! I have since seen this same fear of big babies resulting in Cesarean sections or dangerous childbirth in other qualitative research I’ve done in West Africa, which is interesting. It’s an area where better messaging (addressing this fear during antenatal care visits when iron pills are distributed) could really help to alleviate a problem, and encourage more women to take nutritional supplements in pregnancy. 

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