nutrition research alternatives

Nutrition Research Alternatives

September 1978

NTIS order #PB-289825

Library of Congress Catalog Card Number 78-600116

For sale by the Superintendent of Documents, U.S. Government Printing OfficeWashington, D.C. 20402 Stock No. 052-003 -00596-4

FOREWORD

This assessment is an analysis of nutr i t ion research al ternat ives—alternative goals and priorities, alternative definitions and funding, and alter-native research personnel requirements. Its principal finding is that Federalhuman nutrition research programs have failed to deal with the changing healthproblems of the American people. Possibly the most productive and importantarea of nutrition research will be the identification of specific dietary links tochronic diseases, leading to methods for prevention.

The late Senator Hubert H. Humphrey, member of the Technology Assess-ment Board, requested the assessment to provide guidance to Congress in over-sight of the executive agencies conducting human nutrition research.

The study was conducted by the staff of the OTA food program with theassistance of the OTA Food Advisory Committee and the Advisory Panel onHuman Nutrition Research. The resulting report is a synthesis and does notnecessarily reflect the position of any individual.

RUSSELL W. PETERSONDirectorOffice of Technology Assessment

. . .111

OTA Food Program Staff

J.B. Cordaro, Food Program Manager

Catherine E. Woteki, Nutrition Cluster Leader

Phyllis Balan, Administrative Secretary

Reita Crossen, Secretary

Ann Woodbridge, Administrative Assistant

OTA Publishing Staff

John C. Holmes, Publishing Officer

Kathie S. Boss Joanne Heming

OTA Food Advisory Committee

Martin E. Abel, ChairmanSenior Vice President, Schnittker Associates

Johama Dwyer, Vice ChairmanFrances Stern Nutrition Center, New England Medical Center

David CallDirector of Cooperative

ExtensionCornell University

Cy CarpenterPresidentMinnesota Farmers Union

Eliot ColemanDirector, Coolidge Center for the

Study of Agriculture

Almeta Edwards FlemingSocial Program CoordinatorFlorence County, S.C.

Lorne GreeneChairman of the BoardAmerican Freedom From

Hunger Foundation

Richard L. HallVice President, Science and

TechnologyMcCormick & Company, Inc.

Laura HeuserMember, Board of DirectorsAgricultural Council of America

Arnold MayerLegislative RepresentativeAmalgamated Meat Cutters and

Butcher Workmen of NorthAmerica

Max MilnerAssociate DirectorInternational Nutrition Planning

ProgramMassachusetts Institute of

Technology

Robert O. NesheimVice President, Science and

TechnologyThe Quaker Oats Company

Kathleen O’ReillyDirectorConsumer Federation of America

R, Demis RouseDean, School of AgricultureAuburn University

Lauren SethAgricultural Consultant

Thomas SporlederProfessor of Agricultural

EconomicsTexas A&M University

Sylvan WittwerDirector and Assistant DeanCollege of Agriculture and

Natural ResourcesMichigan State University

OTA Steering Panel onHuman Nutrition Research

Johanna Dwyer, ChairmanFrances Stern Nutrition Center, New England Medical Center

Howard Bauman Robert Harkins Margaret McConnellScience and Technology Grocery Manufacturers of Society for Nutrition EducationThe Pillsbury Company America, Inc.

Mark Hegsted Maiden C. NesheimEllen Haas School of Public Health Division of Nutritional SciencesCommunity Nutrition Institute Harvard University Cornell University

vi

Sol ChafkinOffice of Social DevelopmentFord Foundation

Joan GussowProgram in NutritionTeachers CollegeColumbia University

Alice LiechtensteinDepartment of NutritionHarvard University

Manuscript Review Panel

Hamish MunroDepartment of Nutrition and

Food ScienceMassachusetts Institute of

Technology

Consultants

Patricia KearneyFrances Stern Nutrition CenterNew England Medical Center

Bernard SchweigertDepartment of Food Science

and TechnologyUniversity of California at

Davis

Samuel IkerIker Associates. Inc.

vii

Workshop Participants

Dale F. Anderson*Quality ControlGeneral Mills

Jane Armstrong*Consumer AffairsJewell Companies, Inc.

James Carroll*Department of Public

AdministrationSyracuse University

Gerald Cassidy* **Schlossberg-Cassidy Associates

Samuel J. Fomon**Pediatrics DepartmentUniversity of Iowa

James D. Grant**Research and DevelopmentCPC International Inc.

Harry L. Greene**Pediatrics, Biochemistry,

and NutritionVanderbilt Medical CenterVanderbilt University

Helen Guthrie**Nutrition DepartmentPennsylvania State University

Richard Hall*McCormick & Company, Inc.

James Halpin**Southern RegionAgricultural Experiment StationClemson University

Gaurth Hansen**Biochemistry & NutritionUtah State University

LaVell Henderson**Department of BiochemistryUniversity of Minnesota

Ruth Hueneman*Public Health NutritionUniversity of California at

Berkeley

Jacob Jacoby* **Psychological SciencesPurdue University

Norge Jerome**Community HealthUniversity of Kansas Medical

Center

Ogden C. Johnson**Hershey Foods

Paul Lachance* **Food Science DepartmentRutgers University

Alex Malaspina*External Technical AffairsThe Coca-Cola Company

Josephine Martin**School Food & Nutrition SectionGeorgia District of

Education

Robert J, McEwen, S.J. **Economics DepartmentBoston College

Max Milner*International Nutrition Planning

ProgramMassachusetts Institute of

Technology

Robert Nesheim*Science and TechnologyThe Quaker Oats Company

S. J. Ritchey**Virginia Polytechnic Institute

and State University

Arthur J. Salisbury**National Foundation

March of Dimes

Arnold Schaefer**Swanson Center for

Nutrition, Inc.

Kenneth Schlossberg**Schlossberg-Cassidy Associates

Kathleene D. Sheekey*Consumer Federation of America

Sheila Sidles*Iowa Consumers League

Bruce Shillings**Corporate Research

ActivitiesNabisco, Inc.

Albert Stunkard**Department of PsychiatryUniversity of Pemsylvania

Medical School

Janet Tenney* **Office of Consumer AffairsGiant Food, Inc.

Reinhardt Thiessen, Jr, *NutritionGeneral Foods

Ed Traisman*McDonald’s, Inc.

James Turner, Esq. *Swankin & Turner

Stanley Wilson*Alabama Agricultural

Experiment Station

Beverly Winikoff*Rockefeller Foundation

*Newport News Workshop, Nov. 28-29, 1977**Boston Workshop, Sept. 28-30, 1977

.,.VIM

Agency Personnel

Myrtle BrownFood and Nutrition BoardNational Academy of Sciences

John E. CanhamLet term an Army Institute of

Researchoffice of the Surgeon General

Elizabeth DavisCooperative Stat e Research

ServiceU.S. Department of Agriculture

T,M. AdministerAgricultural Research ServiceU.S. Department of Agriculture

Lfary EganHealth Services AdministrationDepartment of Health, Education,

and Welfare

AlIan ForbesFood and Drug AdministrationDepartment of Health. Education,

and Welfare

Garol Foreman[J. S. Department of Agriculture

Martin FormanBureau of Technical AssistanceAgency for International

DevelopmentDepartment of StateThomas GrumblyFood and Drug AdiministrationDepartment of Health, Education,

and Welfare

Linda HaverbergBureau for Latin AmericaAgency for International

DevelopmentDepartment of State

Irwin Horn steinBureau of Technical AssistanceAgency for International

I)evelopmentDepartment of State

Robert H. HermanLetterman Arm\ Institute of

Researchoffice of the Surgeon

General

Col. HickmanU.S. Army Medical Research and

DevelopmentCommand office of the Surgeon

General

Responding to Questionnairesor Interviewed by OTA Staff

James H. IaconoAgricultural Research ServiceU.S. Department of Agriculture

Evelyn JohnsonExtension ServiceU.S. Department of Agriculture

Samuel KahnBureau of Technical

AssistanceAgency for International


Nancy LeidenfrostExtension ServiceU.S. Department of Agriculture

Robert LeytonNledical Research ServiceVeterans Administration

Charles U. LowePublic Health ServiceDepartment of Health, Education,

and Welfare

Ralph McCrackenAgricultural Research ServiceU.S. Department of Agriculture

James NielsonResearch and EducationU.S. Department of Agriculture

Patti Okura-LeibergFood and Agriculture

organization

Grace OstensoFood and Nutrition ServiceU.S. Department of

Agriculture

Llichael J. PallanschAgricultural Research ServiceU.S. Department of

AgricultureAlbert A. PawlowskiAlcohol, Drug Abuse, and Mental

Health AdrninistrationDepartment of Health,

Education, and Welfare

Seymour PerryNational Institutes of HealthDepartment of Health.


Dan C. PopmaBio-Environmental SstemsNational Aeronautics and

Space Administration

Dorothy PringleCooperative State Research

ServiceU.S. Department of

Agriculture

Miloslave RechciglBureau for Technical

AssistanceAgency for International


Howerde E. SauberlichLetterman Army Institute of

ResearchOffice of the Surgeon General

Neil SchallerExtension ServiceU.S. Department of

Agriculture

Ruth SchultzMedical Research ServiceVeterans Administration

Fred ShankFood and Nutrition ServiceU.S. Department of

Agriculture

Daniel ShaughnessyOffice of Food for PeaceAgency for International


Artemis SirnopoulosNational Institutes of HealthDepartment of Health,


Evelyn SpindlerExtension ServiceU.S. Department of

Agriculture

Paul E, TylerMedical Research and

DevelopmentU.S. Navy

Fred WrelzBureau for Latin AmericaAgency for International


ix

.i 1-4 I “ ( I - 75 - 2

Workshop Observers

Thelma ArnoldWalter ReedUniversity of Health ScienceU.S. Army

Beverly CullenNutrition DepartmentBoston University

Elizabeth DavisCooperative State Research


Agriculture

Yolan L. HarsanyFood and Drug AdministrationDepartment of Health,


James HicksCenter for Disease ControlDepartment of Health,


Robert LeytonField Operations DivisionMedical Research ServiceVeterans Administration

Marshall MatzSubcommittee on NutritionSenate Committee on

Agriculture, Nutrition,and Forestry

Arthur McDowellNational Cancer for Health

StatisticsDepartment of Health,


Robert McGandyMedical CenterTufts University

Lucille McLaughlinNutrition DepartmentBoston University

Max MilnerInternational Nutrition

Planning ProgramMassachusetts Institute of

Technology

George ParmanTrade and Development

Corporation

Isabelle PattersonDepartment of Health,


Dorothy PringleCooperative Stat e Research


Agriculture

Arlette RasmussenFood Science and Nutrition

DepartmentUniversity of Delaware

Artemis SimopoulosNational Institutes of HealthDepartment of Health,


Evelyn SpindlerCooperate Extension ServiceU.S. Department of

Agriculture

Geraldine ThornpkinsOffice of Health Information

and Health PromotionDepartment of Health,


Edith WeirNational Agricultural LibraryU.S. Department of

Agriculture

-..

Contents

Chapter PageEXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Congressional Options. .. .. .. .. O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

I OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

What Research Cannot Do To Solve Nutrition Problems . . . . . . . . . . . . . . . . . . . . . . 11

II. KEY ISSUES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......15

Issue I—Goals and Priorities of Human Nutrition Research. . . . . . . . . . . . .......15Issue 2—Definition and Funding of HumanNutrition Research. . . . . . . . . . . . . . . . 17Issue 3—Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . .......22

III NUTRITION RESEARCH STRATEGIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......27

The Status Quo: Nutrition Research in the Federal Government . . . . . . . . .......27Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....27Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30

New Directions in Federally Supported Human NutritionResearch: The OSTP Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30

Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......32Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......32

Federal Human Nutrition Research Needs a CoordinatedApproach To Advance Nutrition Knowledge: The GAO Report. . . . . . . . .......32

Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....32Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......33Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......33

A Comprehensive Nutrition Research Strategy . . . . . . . . . . . . . . . . . . . . . . .......34Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....34Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......36Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......37

IV. CONGRESSIONAL OPTIONS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......41

Option l: Congress Could Choose To Maintain the Overall Status Quo. . . . .......410ption2: Congress Could Choose To Pursue a Human Nutrition

Research Strategy Different From That of the Status Quo. . . . . . .......42

APPENDIX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......47

xi

LIST OF TABLES

Table No. Page1. Alternative Human Nutrition Research Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52. Death Rates Per 100,000 Population for Leading Causes, by Sex

and Age: 1974 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103. Federal Government Agencies Active in Food and Nutrition Programs

and Their Nutrition Research Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184. Federal Expenditures for Human Nutrition Research. . . . . . . . . . . . . . . . ., . .......215. A Seven-Point Nutrition Research Strategy. . . . . . . . . . . . . . . . . . . . . . . . . . . .......356. Criteria Used for Assessing Research Priorities . . . . . . . . . . . . . . . . . . . . . . . .......48

xii

EXECUTIVE SUMMARY

During this century, particularly since World War 11, Americans havemarkedly altered their eating habits and lifestyles. Simultaneously there has beenan equally significant change in the major causes of death.

Fifty to seventy-five years ago illnesses during infancy and infectiousdiseases, such as tuberculosis and pneumonia, dominated the mortality tables,Nutrient deficiency diseases, such as rickets and pellagra, were also signifi-cant public health concerns.

Today we find that most Americans die from degenerative illnesses such asheart disease and cancer. At the same time few Americans show any overt evi-dence of nutritional deficiency,

Unlike the infectious diseases, degenerative illness appears to result fromthe complex interaction of multiple factors. Although diet is one of the factors in-volved, to date there has been relatively little research into the direct relationshipof diet to chronic disease. However, epidemiological studies indicate that overcon-sumption of food, especially certain kinds of foods, contributes to the incidence ofand mortality from degenerative diseases such as heart disease, some cancers,stroke, hypertension, and diabetes.

The united States has gradually shifted its nutrition research focus awayfrom domestic nutrient deficiency questions, and toward biochemical functions ofnutrients and undernutrition in developing countries. This shift has left a vacuumin domestic human nutrition research. Today we need to know the answers toseveral key questions, such as: What specific elements in the American diet con-tribute to the physiological or biochemical changes which lead to the developmentof degenerative illnesses? By reorienting Federal nutrition research efforts, thelinks between diet and these diseases may soon be discovered. obtaining betterknowledge, and conveying it to the public, could reduce or delay the incidence of anumber of major ailments.

Research on the links between diet and heart disease has brought widelypublicized recommendtions to reduce consumption of cholesterol andsaturated animal fats. These recommendations have changed the eating habitsof many Americans. We are eating more polyunsaturated fats and lesssaturated fat and cholesterol. In the last 10 years, the mortality rate from cor-onary heart disease has gone down over 20 percent, although heart diseasestill remains the leading cause of death. No conclusive cause and effect havebeen established, but diet, along with exercise and improved medical care, isconsidered a factor in this decline.

Most human nutrition research in the United States is conducted or spon-sored by the Federal Government, primarily through the Department of Agri-culture [USDA), the State agriculture experiment stations, and the Departrmentof Health, Education, and Welfare (HEW). Alternatives for redefining andrefocusing Government nutrition research have been put forward in recentlegislation and several studies. This report assesses these alternatives, alongwith the state of Federal nutrition research.

3

The principal finding of this OTA assessment report is that the FederalGovernment has failed to adjust the emphasis of its human nutrition researchactivities to deal with the changing health problems of the people of theUnited States. The consequences of continuing to pursue the present preoc-cupation with nutritional deficiency diseases will seriously affect the quality oflife of present and future generations into the 21st century.

OTA”S assessment explores several optional paths that the U.S. Congressmight consider to deal with this finding. Each of these options are discussedfrom the perspective of the three issue areas critical to the assessment’s prin-cipal finding. These are:

1) Goals and priorities of human nutrition research,

2) Definition and funding of human nutrition research, and

3) Personnel resource requirements.

CONGRESSIONAL OPTIONS

Congress can elect to maintain the status quo with or without minor shiftsor choose among the strategies and options offered by OTA, the General Ac-counting Office (GAO), and the Office of Science & Technology Policy (OSTP),These alternatives are outlined in table 1. Either alternative has economic, in-stitutional, and health implications.

Congress could choose to maintain the overall status quo by refrainingfrom any action, awaiting the recommendations of the President’s Reorganiza-tion Project,

Congress could also choose to make small alterations to the existingsystem without changing its overall priorities and structure, This could beaccomplished by amending the Food and Agriculture Act of 1977 to clarify thedesignation of lead agency for human nutrition research, by developing nutri-tion research goals and priorities for HEW that complement the goals and pri-orities outlined for USDA in the Food and Agriculture Act of 1977, by enactinglegislation establishing a coordinating mechanism for Federal human nutritionresearch activities, or by considering legislation to improve data storage andretrieval systems currently in use,

If Congress chooses to change the emphasis of federally funded nutritionresearch, such change could be based on the strategies and options put for-ward by OSTP, GAO, or OTA. Before any path is chosen, however, more in-formation is required on Federal expenditures and nutrition research person-nel. This could be gained through a GAO audit of Federal expenditures forhuman nutrition research and a census of research personnel. Based on thesefindings, Congress could consider increased training grants and fellowships tofill any existing gaps in research personnel,

——

Table 1 .—Alternative Human Nutrition Research Strategies

Components of Office of Technologystrategy Assessment

Researcnpriorities

• Role of diet in prevention ofchronic disease and obesity

● Role of nutrition in treat-ment of disease and sup-port of therapy

. Requirements for essentialnutrients

. Nutrition education andconsumer informatlon

• Nutritional aspects of foodscience and food safety

. Monitoring nutritionalstatus

. Nutrition policy andmanagement

Definitionand funding

Personnelrequirements

Researchorganization

Definition should recognizedegree of relationship tostated goals. Before Congressconsiders appropriationsfor nutrition research, anaudit of Federal expendituresshould be performed using aconstant definition.

No reliable figures areavaiIable for numbers of nutri -tion research scientists in thelaboratory or in training.Before a comprehensiveresearch program IS estab-I I shed, must consider abilityof the field to implement andsustain a program.

● Maintain pluralistic ap-proach with well-definedagency responsiblIities

. Initiate an interagencycommittee with rotatingchairmanship

. Implement a uniform datastorage and retrievalsystem

• Improve congressionaloversight through joint planning and hearings

General Accounting office of Science andOffice Technology Policy

Research gaps:. Knowledge of dietary

nutrients required to pro-mote or maintain growth orwell-being at various stagesand conditions of Iife

. Information on the com-position of the currentU.S. food supply and theextent that nutrients arebiologically available

. Evaluation of long-termhealth consequences of themodern diet

. Assessment of the Nation’scurrent nutritional status i nterms of dietary excessesand imbalances, as well asdeficiencies

Research needs:. Long-term studies of

human subjects across thefull range of both healthand disease

. Comparative studies ofpopulations of differinggeographic, cultural, andgenetic backgrounds

● Basic Investigations of thefunctions and interactionsof dietary components

. Updated and expandedfood composition data

. Improved techniques forassessing long-term tox-icological risks

Does not define nutritionresearch. Instability of fed-eralIy funded extramural re-search is a barrier toprogress. Endorses develop-ment of federally fundedregional research centers i nconjunction with universities.

There is a shortage of nutri-tion research scientists.

. Effects of nutrition onhuman health and per-formance

. Food sciences● Nutrition education research. Diet and nutritional status

surveillance

Definition includes basicphysiological and biochemicalresearch. Establishes FY 1977research spending at $116.6million, Recommends no in-creases i n funding with real lo-cation of resources to thehigher priority areas.

Not considered.

● Assign each area to a leadFederal agency

● Eliminate unnecessary re-search

. Promote Government-wideresearch planning, coor-dination, and reporting

• Coordinate agency activitiesthrough the Federal Coordi-nating CounciI on ScienceEngineering, & Technology

● Conduct external reviews ofintramural programs

● Improve intra-agency coor-dination

. Establish an ad hoc inter-agency nutrition educationresearch committee

5

Chapter I

OVERVIEW

fats

proteins

Chapter I

OVERVIEW

Modern nutrition science dates from the turn of the century when vita-mins were first discovered. Since that time, nearly all elements in foodsessential for health have been identified—vitamins, amino acids, minerals,and fatty acids. Indeed, a patient can be maintained for a long period by in-travenous feeding with a purified diet that contains the known necessarynutrients. This indicates that few essential nutrients remain to be found.

Early nutrition research was spurred by the finding that many severediseases such as rickets, pellagra, beriberi, and scurvy were caused byvitamin deficiencies. These nutrition deficiency diseases were practicallyeliminated in the United States by the 1940’s as a result of better nutritionalknowledge, food enrichment, agricultural advances, and socioeconomicchanges. Consequently, a belief spread among scientists that little of prac-tical importance for the United States would result from further research inhuman nutrition. Attent ion was instead shif ted increasingly to thebiochemical functions of essentialmalnutrition in developing nations.

nutrients and infant and childhood

Over the past 50 years, the basic goal ofnutrition strategy in the United States hasbeen to ensure an adequate intake of allessential nutrients for the population. Nutri-tional advice to the public has consistentlystressed a balanced diet that provides nec-essary protein, minerals, and vitamins. Thisstrategy has been largely successful. How-ever, it was developed and carried out withlittle understanding of the long-term effectsof the abundant diet currently consumed bythe majority of Americans.

Studies during the past decade have in-dicated that overconsumption of food andrelative overconsumption of certain kinds offood are important contributing factors inheart disease, stroke, hypertension, cancer,diabetes, osteoporosis, and dental disease.Increased research into the role of diet incausing and preventing such major chronicdiseases may lead to findings which couldreduce their incidence or delay their onset.

These diet-related diseases take a heavytoll in the United States. For example, car-diovascular disease, diabetes, and hyperten-

sion share the common risk factor of obes-ity, which is caused by overeating and lackof exercise. About 30 percent of men and40 percent of women in the United Statesbetween the ages of 40 and 49 are over-we igh t . Many a re t echn ica l ly “obese” -more than 20 pe rcen t above des i r ab leweight. This fact is reflected in diseasestatistics. Some 23 million Americans sufferfrom hypertension and 10 million from dia-betes. Diabetics are twice as prone to heartdisease and stroke. Every year, 850,000Americans suffer fatal heart attacks.

Five of the leading causes of death arebelieved to be diet-related. These are heartdisease, cancer, stroke, diabetes, and cir-rhosis of the liver, The mortality statisticsfor these diseases are shown in table 2. Theimpact of chronic diseases extends beyondthe obvious mortality figures. Chronic dis-eases account for many days of work lost,major hospitalization costs, and personalsuffering because of activity limitation.

The links between diet and these diseasesare based on epidemiological studies, and

9

Table 2.—Death Rates Per 100,000 Population for Leading Causes, by Sex and Age: 1974(Excludes deaths of nonresidents of the United States)

Sex and age Heart Cirrhosis Emphy-group (in years) disease Cancer Stroke Accidents Pneumonia a Homicide Suicide Diabetes of Iiver sema

Male. . . . . . . . . . 40015-24 . . . . . . . 325-44 . . . . . . . 4445-64 . . . . . . . 59165 and over .. 3,081

Female . . . . . . . . 30115-24 . . . . . . . 225-44 . . . . . . . 1545-64 . . . . . . . 19565 and over .. 2,159

1918

29338

1,293

1515

35261723

87.81,57.7

73,1810.7

107.91.3

7.956.2

791.8

71.199.169.671.0

144.229.023.917.424.994.6

28.91.94.8

24.9233.7

23.01.53.1

12.5150.7

16.322.129.516.98.9

4.46.37.03.73.2

18.117.123.128.236.7

6.54.69.5

11.87.3

alncludes influenza.Source. U.S. National Center for Health Statistics, V/ta/ .Skit/stms of the Urr/ted .Sfafes, annual

direct cause-and-effect relationships havenot been established. It is therefore impossi-ble to estimate the economic benefits to bederived from funding research in this area.This does not imply that attention shouldnot be directed to this research. Clearly,reducing the incidence and severity of thesediseases or preventing the early expressionof them would reap large economic andsocial benefits.

There is evidence that nutrition researchcan make an impact on chronic diseases. In-tensive studies on the relationship of diet toheart disease, the greatest cause of death inthe United States, have yielded results. Asthe connections have become clearer, atleast 16 national and international groupshave developed similar dietary recommen-dations to combat cardiovascular disease.With varying degrees of emphasis, theserecommendations have urged reduced in-take of cholesterol and fats , especiallysaturated animal fats . In addition, theyhave stressed weight control, more physicalactivity, and a halt to smoking.

These recommendations, w i d e l y a n drepeatedly publicized, have had an impacton Americans. Recent reports indicate thatwhile the age adjusted mortality rate fromcoronary heart disease rose 19 percent be-tween 1950 and 1963, the rate has declinedmore than 20 pe rcen t du r ing the pas t

14.70.53.2

20.8110,420.5

0.62.7

20.3130.1

21.20.5

13.760.961.9

10.60.37.4

28.822.7

15.30.10.5

18.4131.8

3.800.25.7

21.4

decade. The causes of this favorable trendare not conclusively known, but better nutri-tion education, changes in formulation ofprocessed food, and changing eating habitsappear to have played an important role.The statistics are consistent with reportedper capita reductions in the consumption ofsaturated animal fats and cholesterol, in-creases in the consumption of vegetable oils,alterations of the ratio of polyunsaturatedto saturated fats in the diet, a decrease insmoking, and the attention of many Ameri-cans to exercise. These shif ts bel ie thewidespread assumption that it is impossibleto change American habits, including eatinghabits, for the better. They also indicatethat a major chronic disease can be com-bated by modifying dietary behavior.

These findings are significant to futurenu t r i t i on r e sea rch in l igh t o f g rowingepidemiological evidence linking diet toother chronic and degenerative diseasessuch as cancer, diabetes, hypertension, andosteoporosis. There has been little directresearch, however, into the dietary factorsinvolved in these diseases. Specific aspectsof diet that contribute to physical or bio-chemical changes leading to the onset ofsuch diseases are still unknown. Currentknowledge is now at the point where knowl-edge of diet and heart disease was in thelate 1950’s, when intense research began toestablish the relationship. Possibly the most

10

productive and important area of nutritionresea rch wi l l be the iden t i f i ca t ion o fspecific dietary links to other chronic dis-eases. Such research will inevitably requirethe development of new techniques and ap-proaches.

There are other areas where more nutri-tion research is needed. While severe mal-nutrition is now relatively rare in the UnitedStates, moderate degrees of iron deficiency,folic acid deficiency, and possibly otherdeficiencies remain relatively common. Fora variety o f social, economic, or physiologi-cal reasons, some groups in the populationare particularly prone to nutritional defi-ciencies. These groups include the poor, theelderly, pregnant women, alcoholics, and

patients with chronic diseases or specialmetabolic problems of genetic origin.

The identification of all or nearly all ofthe essential nutrients has opened up newareas of clinical patient care. The develop-ment of purified diets allows complete nutri-tion by intravenous feeding. Diets can now”

be tailored. to meet the needs of a widevariety of patients. It is clear that manyp a t i e n t s — t h o s e w i t h c h r o n i c d i s e a s e ,trauma, genetic defects, and others—havenot received adequate nutrition in the past,Since developments in this field are still intheir infancy, further research support willbe needed to ensure continued improve-ments in patient care.

WHAT RESEARCH CANNOT DOTO SOLVE NUTRITION PROBLEMS

Increased nutr i t ion research can helpsolve some of the nutrition problems ofAmerican society, Research, however, can-not solve all such problems. Some of ourmost pressing needs involve the applicationof existing knowledge ra the r than thesearch for new knowledge. If it is unclearhow to make use of existing knowledge, re-search indeed can help. If both the knowl-edge and means are available but are not

utilized, the failure may lie in the inadeq-uate design and administration of publicnutrition education and food programs. Peo-ple may fail to respond to existing pro-grams. They may be confused by the profu-sion of sometimes contradictory recommen-dations and urgings from various expertsand authorities. It is the Government’s chal-lenge to remedy such problems and reachpeople with needed nutrition services,

11

Chapter II

KEY ISSUES

vitamins

fats

minerals

carbohydrates

proteins

—

Chapter II

KEY ISSUES

An appreciation of three key issues that underlie the basic findings ofthis assessment can aid Congress in better judging appropriate options.These issues are:

1) Goals and priorities of human nutrition research,

2) Definition and funding of human nutrition research, and

3) Personnel resource requirements.

ISSUE 1—Goals and Priorities of Human Nutrition Research

The problems of setting goals and prioritiesfor Federal human nutrition research are in-separable from the organizational structureof current research efforts. Such efforts arenow fragmented. Fourteen Federal agencies(under seven departments) are involved inhuman nutrition research. Each departmenthas independently established its own nutri-tion research goals and priorities—in linewith how it interprets its own particularlegislative mandates. The result is a piece-meal approach to nutrition research.

Although most nutrition experts agree thatthe main goals of nutrition research includethe promotion of optimum health and per-formance, and the treatment of diseasethrough diet therapy and support of othermedical therapies, the Federal Government’sactivities lack such specific unifying goals.They are st i l l guided by the tradit ionalnutrient deficiency disease approach. Thisfails to meet the changing needs of the Ameri-can people.

Indeed, nutrition research activities in Fed-eral agencies are generally without focus.This confusion was pointed out by the Na-tional Institutes of Health (NIH) Director Dr.Donald Fredrickson’s March 15, 1977 testi-mony before the Senate Committee on Appro-priations: “, , research on nutrition is as yet,at NIH and elsewhere, a vast, diverse, andessentially unstructured set of activities.

This lack of overall focus is reflected in thepoor coordination of research efforts amongFederal agencies involved in such activities.Past attempts at coordination between theDepartments of Agriculture (USDA) andHealth, Education, and Welfare (HEW), thetwo principal funders of nutrition research,have usually been of short duration and littleimpact. International nutrition research, sup-ported primarily through the Agency forInternational Development (AID), is essential-l y i n d e p e n d e n t o f d o m e s t i c n u t r i t i o nresearch.

The result of this absence of coordinationis duplication— not only in the missions ofsome Government agencies but also in theirresearch and other activities. For example,both NIH and USDA’s Science Education Ad-ministration have similar research programson protein, carbohydrates, lipids, vitamins,and minerals.

The Office of Technology Assessment alsofound a need in Federal nutrition researchprograms for better integration of data stor-age and retrieval. Collecting such data is nec-essary at all levels of nutrition research sothat findings can be better utilized. However,various agencies now use different types ofindexing, data storage, and retrieval systems.Thus they find it difficult to report results ofresearch projects. Moreover, no agency hasan efficient system of evaluating and col-

15

lating research findings. Because of a generallack of accessibility, it is often extremely dif-ficult for agencies to communicate researchinformation to the public or Congress.

Of course, some overlap in interests is in-evitable in similar areas of research, andduplication of research results is a necessarypart of scientific research. But unnecessaryduplication should be avoided. Minimizingduplication by developing more efficientmeans of sharing information on planned, on-going, and completed research is an achiev-able goal.

In the same sense that some duplication isa necessary part of scientif ic research,healthy competition among agencies maystimulate greater effort and ultimately bene-fit the public. But the proprietary stancetaken by some agencies is wasteful and in-hibits joint planning. Internecine struggles athigher levels of Government apparently fos-ter such attitudes. However, career civil serv-ants and the public, as well as the overallFederal research effort, suffer as a result.The turf battles that lead agencies to work atcross purposes should be eliminated. Agen-cies involved in nutrition research shoulddemonstrate a commitment to coordinationand the avoidance of unnecessary duplica-tion. This commitment needs to be built in, notonly at the “political” level of the higherechelons of Government but also in the careercivil service.

The establishment at USDA of the HumanNutrition Center and the Human NutritionPolicy Committee and at HEW of the NutritionCoordinating Committee are two positivesteps toward intra-agency coordination. Theynot only indicate a commitment to nutritionresearch but also can serve as mechanismsfor interagency coordination and informationexchange.

The Food and Agriculture Act of 1977specifies that the Secretary of Agricultureshall “periodically consult with the adminis-trators of other Federal departments andagencies that have responsibility for coor-dinating Federal nutrition research activ-ities. ” However without the support and in-volvement of the Secretary of HEW, unilat-eral USDA efforts to coordinate researchmay not be effective. Likewise, it should be

noted that this language is ambiguous. It doesnot specify “lead,” and it leaves cooperationto the goodwill of HEW.

The need for improved coordination innutrition research extends beyond the execu-tive agencies to Congress. At present 14 con-gressional committees and 20 subcommitteesare concerned with nutrition matters. Theprincipals include the Senate Committees onAgriculture, Nutrition, and Forestry (Sub-committee on Nutri t ion); Appropriat ions(Subcommittees on Labor-Health, Educationand Welfare, and Agriculture); the HouseAgriculture Committee (Subcommittee onDomestic Marketing, Consumer Relations,and Nutrition); the House AppropriationsCommittee (Subcommittees on Agricultureand Labor-Health, Education, and Welfare);House Interstate and Foreign CommerceCommittee (Subcommittees on Oversight andInvestigations, and Health and Environment);and the House Science and Technology Com-mittee (Subcommittee on Domestic and Inter-national Scientific Planning, Analysis, andCooperation, and the Subcommittee on Sci-ence, Research, and Technology). Since someduplication of interest exists, joint sessions ofrelevant congressional subcommittees to con-sider plans and hearings for oversight pur-poses should be considered.

There is a strong relationship betweenhuman nutrition research conducted abroadand research needs in the United States. Theresearch goals identified in this report can bebest achieved if international and domesticresearch activities are tuned together.

Nutrition research in other countries mayhelp in solving domestic nutrition problems.For example, epidemiological investigationsof certain chronic diseases require good in-formation about disease incidence. This maybe obtained from studies of societies withlifestyles and food habits very different fromour own. The high incidence of malnutritionin some developing nations also provides anopportunity to investigate relationships be-tween the nutritional status and functionalperformance of individuals in a way thatwould be impossible in the United States. Itmay be possible to extrapolate the results ofstudies of severe malnutrition abroad tomarginal nutritional areas in this country.

16

The study of worldwide populations andfood patterns is essential to the better under-standing of some of the priority researchareas of nutrition. Thus any effort to increaseinternational nutrition research capabilities

will have a dual reward—assistance to mal-nourished peoples abroad and increasedknowledge of human nutr ient needs andhealth status under changing environmentalconditions.

ISSUE 2—Definition and Funding of Human Nutrition Research

If one accepts that the goals of humannutrition research are twofold—(l) the pro-motion of optimum health and performance,and (2) the treatment of diseases through diettherapy and the support of other medicaltherapies—then definition of human nutritionresearch flows from these stated goals, If allthe research areas involving nutrition arelisted, from basic studies on the metabolismof nutrients to genetic studies on the develop-ment of foods with specific nutrient charac-teris t ics , i t is clear that some areas ofresearch are more closely related to thesestated goals than others. Accordingly, thedefinition of human nutrition research musttake into account these relat ionships tostated goals.

In terms of this assessment, nutr i t ionresearch falls into three broad categories.Most closely related to the stated goals isresearch into the biochemical and physiologi-cal effects of food on the body in health anddisease. This category includes research onnutritional management of disease, nutrientneeds and interactions, and research whichpromotes optimum health and disease pre-vention through diet.

Research on food and nutrition qualitydeterminants is also related to the statedgoals, but less directly so than the previouscategory. Under this heading would be re-search into food composition, especially thenutritive components and changes in nutrientcomposition that occur from point of origin topoint of consumption; food safety; social, cul-tural, and economic aspects of food habits;feeding programs; nutrition education; con-sumer information; and nutrition surveillanceand monitoring.

The third category of research involvesbasic research on sources of human food andbasic biochemistry. Research into animal

genetics, animal nutrition, plant nutrition,and plant genetics comes under this classi-fication. While there is need to integrate suchagricultural research with human nutritionconcerns, these areas should not be consid-ered human nutrition research. Similarly,basic research on metabolism of nutrients, ifnot directly applicable to people, should notbe considered human nutr i t ion research.Basic research on metabolism should be con-sidered as basic research underlying all ofthe biomedical and life sciences. Humannutrition research builds upon this knowl-edge base, but the apparent commitment toand budget for human nutrition researchshould not be inflated by its inclusion.

Throughout this assessment, a recurrentproblem has been that of definition of humannutrition research. Agencies report as humannutrition research studies that appear tohave little to do with human nutrition. Ex-amples are “Catalytic Functions and Metab-olism of Vitamin B6 in Bacteria and Fungi, ”“Nutritional Imbalance and Metabolic Alter-ations in Fungi, ” or “Hepatoma Incidence inTrout on Dietary Aflatoxin and PCB. ” Suchstudies are worthwhile and contribute to ourunderstanding of basic biochemistry but arenot directly applicable to humans.

The almost unanimous consensus of theparticipants in the OTA study was that at-tribution of these Federal expenditures to“human nutrition research” was improper.

Fourteen different Federal agencies areengaged in some sort of nutrition research.Each agency has developed its own definitionof human nutrition research and set prioritieson the basis of how it interprets its legislationmandate. The agencies and their prioritiesare shown in table 3.

Federal expenditures for human nutritionresearch in FY 1977 (shown in table 4) were

171 /

Table 3.— Federal Government Agencies Active in Food and Nutrition Programsand Their Nutrition Research Priorities

Food andnutrition

Department Agency programs Research priorities

Health, Edu- National National Institute of Arthritis, Metabolism, and Digestive Diseasescation, & Institutes (N/AMDD), Basic physiological studies of nutrients; basic metabolismWelfare of Health studies; obesity; trace elements nutrition support of patients; fiber;

anemias.

National Institute of Child Health and Human Development (NICHHD).Nutrition and fetal development; metabolic capacities of normal, low-birthweight, and premature infants; diet modification for low-birth-weight and premature infants; optimum nutrition in developmentalyears; nutrition and reproductive potential; genetic variability —nutri-tional interaction; prevention—metabolic antecedents of adult disease.

National Cancer Institute (NC/). Nutrition support of cancer patient; nu-trition in cancer etiology; host-tumor interactions and competition fornutrients; prevention strategies based on nutrition; diet and nutrition inthe rehabilitation of cancer patients.

National Heart, Lung, and Blood Institute (NHLBI). Nutrition in etiologyof arteriosclerosis and hypertension; achieving and maintaining dietarychange; development of food composition tables; methodology —col-Iecting, recording, and evaluating dietary data.

National Institute of General Medical Sciences (NIGMS). Trauma-tized/burned patients and nutrition.

National Institute of Environmental Health Sciences (NIEHS). Neuro-toxicity; mutagenesis; teratology; environmental contaminants in food.

National Institute of Neurological and Communicative Disorders andStroke (N/NCDS). Protein-calorie malnutrition, B-vitamin deficienciesand the nervous system; genetic disorders and the nervous system;specific nutritional problems in the central nervous system; stroke.

National Institute of Dental Research (NIDR). Sucrose and caries; poornutrition and periodontal disease; poor nutrition and oral mucus mem-branes; nutrition in craniofacial malformations and oral-facial struc-tures; nutrition and salivary gland development.

National Institute of Allergy and Infectious Disease (NIAID). Interrelatedfactors hearing on malnutrition, infection, and the immune system.

National Eye Institute (NE/). Vitamins A, B-12, and other nutrients invisual processes; diseases of visual system, e.g., keratomalacia; metab-0lism of visual celIs; protein changes in the lens.

National Institute on Aging (N/A). Nutritional status of the elderly;aspects of increase in life span including dietary manipulations; vitaminsupplementation in elderly; nutrient intake as a consequence of econ-omic status in elderly; relationship among nutrition, cellular structure,and function in elderly.

Division of Research Resources (DRR). Nutrient requirements forgrowth, gestation, lactation in primates and laboratory rodents; stand-ard diets for specific objectives; interaction of various nutrients onphysiological function in laboratory animals; differences in nutrient re-quirements among strains of animals within a species.

— —.Food & Regulatory activities Nutrient efficacy and safety; nutrient interrelationships as concernedDrug related to: nutrition with disease prevention; nutrient bioavailabiiity for food fortificationAdmin- Iabeling, ingredient purposes; nutrient quality assessment of processed foods; medicalistration labeling, food for food assessment; food composition and nutrient analysis as related to

special dietary use, FDA mission; and consumer studies of perceptions about food valuesfood advertising, nutri- and nutritional quality and educational models to help correcttion quality of foods misconceptions about them.

Health Re- Health and Nutrition Assessment of the nutritional status of the American people.sources Examination SurveyAdmin-istration

18

———— —————

Table 3—continued

Department Agency

Center forDiseaseCentrol

HealthServicesAdmin-i s t r a t i o n

Alcohol,DrugAbuse, &MentalHealthAdmin-istration

Agriculture Agricul-tural Re-searchService ●

Food andnutritionprograms Research priorities

Epldemlological surveil lance studies in cooperation with Stateagencies assistance to Al D i n SimiIar international areas.

Collaborateive research and screening program for phenylketonurla,

Effects of alcohol consumption on ‘nutrient metabolism and nutritionaldeficiencies; study of food additive consumption and hyperactivityin chiIdren.

Human -Reqirements for Nutrient<Determine the requirements for lipid intake and identification of theforms of these nutrients in foods that may be useful in meetingthese requirements.

Determine the requirements for mineral intake by humans and identi-fication of the forms of these nutrients in foods that may be useful inmeeting these requirements.

Determine the requirements for vitamin intake by humans and identi-fication of the forms of these nutrients in foods that may be useful inmeeting these requirements.

Determine the requirements for protein and amino acid intake byhumans and identification of the forms of these nutrients in foodsthat may be useful in meeting these requirements.

Determine the requirements for carbohydrate and energy intake byhumans and identification of the forms of these nutrients in foodsthat may be useful in meeting these requirements.

Food Composition and ImprovementTo provide accurate, up-to-date, and comprehensive information in areadily usable form on the composition of all important foods forthose nutrients required by and biologically useful to man.

To provide the technology for the nutritional improvement of foodswhen enhanced levels of certain nutrients in the diet are needed tocorrect possible dietary faults.

Food Consumption and UseTo provide accurate, up-to-date, and comprehensive Information In areadiIy usable form on food consumption and dietary levels.

To provide consultative assistance on food and nutrition problemsand provide sound guidance materials on nutrition for the consumerand for nutrition educators, program leaders, and food program man-agers; to Identify techniques which will assist people in selecting nu-tritionally adequate diets within different budget Iimitatlons, to iden-tify means to modify undesirable food habits; to strengthen nutri -tionalIy desirable food choice.

To identify and develop suitable and safe procedures for food man-agement and preparation for home and institutional consumers, forbest retention of both nutritional and eating qualities and to avoidfood-borne iIlness.

Coopera- Nutrient requirements; nutritional status of special population groupstive State including children, low income, and aging; metabolic function ofResearch nutrients in the diet and their Interact Ions: nutrient content of foods;Service ● ● effects of processing on nutrients: food delivery systems; food habits

and use); dietary patterns.

19

Table 3—continued—.

Food and-—

nutritionDepartment Agency programs Research priorities

Economic Economic and social research relating to domestic food programs;Research nutrition policy in LDCS; food choices (demand); nutritional programsService* ● ● for the elderly,

Defense Determination of nutritional and dietary standards for Armed Forcespersonnel subsisted under normal and special operating conditions;evaluation of nutritional adequacy of food as consumed; evaluation ofthe nutritional status of Armed Forces personnel; establishment ofsanitary and food hygiene standards for all food program activities;food aspects of preventive medicine,

—National Nutritional control of neurotransmitters; role of dietary protein andAeronautics specific amino acids i n optimizing human performance under stress.& Space Ad-ministration

—. . -- —VeteransAdminis-tration

Depart-ment ofMedicine& Surgery

State Agencyfor lnter-nationalDevelop-ment

Research in disease and diet: nutrition and disease or clinical nutrition,dietary therapy; effect of disease on nutrition; environmental toxicants,alcohol, and nutrition; nutrition and cancer; nutrition and vision re-search; nutrition-related therapy.

Metabolic effects: Investigations on or related to malabsorption syn-dromes, inborn errors of metabolism, and familial or inherited nutri-tional defects.

Nutrition requirements: Studies of nutrient metabolism, malnutrition,neuroendocrine nutrient interactions, fundamental Intermediary metab-olism involving the role of one or more nutrients.

—Development of new low-cost nutritious foods; development anddissemination of new appropriate technologies; understandingnutritional needs and requirements; testing and evaluation of nutritionprogram alternatives; research on methodologies for improving nationalnutrition planning and programing.

National Basic research in the behavioral, education, and social sciences inScience areas applicable to foods and nutrition.Foundation

“Under USDA’S recent reorganlzatlon, ARS IS now called Federal Research, and IS housed within the Science and Educatton Admlnlstration“” Under USDA’S recent reorganlzatlon, CRS IS called Cooperative Research and IS housed wlthln the Science and Educat{on Admlmstration

“”” Under USDA’s recent reorganlzatlon, ERS IS called Economics and IS housed wlthln the Economics, Statistics, and Cooperatives Servtce“”” Under USDA’s recent reorganlzatlon, ES IS called Extension and IS housed w(thtn the Science and Education Admtnlstratlon

estimated at between $50 million and $117million, depending on how “nutrition re-search” was defined. If for example, the NIHdefinition is used, NIH appears to be spend-ing $80 million for human nutrition research.This broad definition takes in studies of basicbiochemistry, studies which are not focusedon nutrition but have a nutrition aspect, aswell as studies of primary nutrition. If a nar-row definition is used, one encompassing onlythose studies of direct clinical applicationsand disease prevention, the NIH nutritionresearch funding falls in the annual range of$20 million. Even the higher $80 millionfigure, incidentally, amounts to less than 3percent of the NIH research budget.

HEW and USDA are responsible for themajority of federally supported human nutri-

20

tion research. Seventy-five percent of Federalnutrition research is conducted outside of thetwo departments through competitive grantsand contracts. Using the more realistic fund-ing figure of $50 million for FY 1977, NIH atHEW funded 44 percent of the total, and theScience and Education Administration (SEA)at USDA funded 43 percent of the total. TheScience and Education Administration en-compasses what were formerly known as theAgricultural Research Service and the Coop-e ra t ive S ta te Research Serv ice . UnderUSDA’s new reorganization, most human nu-trition research will be coordinated by SEA’sHuman Nutrition Center.

The Science and Education AdministrationCooperative Research (SEA-CR) of USDA isunique among Federal agencies in that it links

Table 4.– Federal Expenditures for Human Nutrition ResearchAn Approxlmatlon of FY ’77 Expenditures (millions of dollars)

Office of Science & Office of ManagementAgency Technology Policy’ & Budgetb

Department of Health, Education, & Welfare. . . . . . . . . . . . . . . . . . . $ 88.6 $22.0

National Institutes of Health . . . . . . . . ... . 80.4’ 22.odFood and Drug Administration . . . . . . . . . . . . . . . . . . . . 3.9National Center for Health Statistics . ... 2.4Alcohol, Drug Abuse, and Mental Health Administration, . 1.1 ●

Health Services Administration . . . . . . . . . . . . . ... 0.5’Center for Disease Control . . . . . . . . . . . 0.3’

Department of Agriculture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.0 21.8Agricultural Research Service. ., . 14.0 13.2Cooperative State Research Service . . . . . . . . . . . . . . . . . . . . . 7.5 8.1Economic Research Service . . . . . . . . . . . . 0.5 0.5

Agency for International Development. . . . . . . . . . . . . . . . . . . . . . . . 2.9 0Department of Defense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3* 2.2

Veterans Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.5’ 4.1

National Science Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3” oGrand total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $116.6 - - $50.2 --

aOfflce of Sc[ence and Technology Pol I cy, New D/reef/ons In Federa//y Supported Human Nutr/t/on Rese;rch, December 1977~Offlce of Management and Budget Spec/a/ Ana/yses —Budget Of the u S. Government ~ Y 7979.CTh[s ftg u re Inc Iudes stud Ies designed to assess the mechanisms and the consequences of food or nutrient Intake I n the Intact

organ Ism, particularly man, Invest lgatlons lnvolvlng nutrient variables at the cellular or subcell ular level, includlng metabol icst udles I n an Imals and man, research deslg ned to elucidate the metabollc role or function of an essential nutr[ent In both animalmodels and man, as appropriate, al I stud les concerned wlt h genetic- nutrient-environmental Interact Ions, dietary stud Ies ex-pected to produce changes I n health status, Inc Iudlng the maintenance of health and the treatment of disease I n man.

‘~Th Is f(g ure Includes blochemlcal, physlologlcal, and clln Ical studies of nutritional needs for normal g rowth, development , andhealth, n utrlt Ional needs of pat tents wlt h speclflc common diseases; and experimental assessments of feeding programs

“ Est(mates of FY 1976 expenditures prowded by draft Government Accounting Off Ice report, H u m a n Nutr/t/on Research—Need for a Coordinated Approach to Advance Our Knowledge, 1977

Federal and State research efforts. SEA-CRadministers funds that Congress appropri-ates to the States for agricultural research,This work is conducted at the State agricul-tural experiment stations, land-grant collegesand universities, approved schools of for-estry, colleges of 1890, and Tuskegee In-stitute. In FY 1977, the States used $7.5million of the Federal money available tothem for human nutri t ion research. TheStates themselves provided $11.7 million forhuman nutrition research in 1976. Most ofthe Federal money came from funds author-ized by the Hatch Act, as amended, and P.L,89-106 (an act to amend the Agriculture Actof 1954). The funds are accounted for underthe Hatch Act research program called Peo-ple, Communities. and Institutions, whichcomprised 12 percent of total Hatch Actresearch funds in 1977.

Federal human nutrition research may befinancially undernourished. However, noana1ysis of the adequacy of present funding

levels could be made since current estimatesof Federal spending for human nutritionresearch are questionable, Estimates for FY1977 range from $50 million to $117 million(table 4). The lower figure, based on agencyresponses to a standard questionnaire, wasdeveloped by the Office of Management andBudget (OMB) for the FY 1979 budget, Thehigher figure came from an OSTP workinggroup and appeared in the December 1977report “New Directions in Human NutritionResearch. ”

Neither is reliable. The $50 million, for ex-ample, fai ls to include certain nutr i t ionresearch activities within HEW, AID, and theNational Science Foundation. The $117 mil-lion, on the other hand, includes $80.4 millionof NIH spending—much of it of tenuous c.on-nection to human nutrition research. In testi-mony before the Senate Select Committee onNutrition and Human Needs on October 17,1977, NIH Director Dr. Donald Fredricksonconceded that, based on a strict definition,

21,4 -

his agency devoted only around $20 million tohuman nutrition research in FY 1977 (a fig-ure reported to OMB).

Another statistic which raised questionscame from the Veterans Administration (VA).GAO put the VA’s FY 1976 nutrition researchspending at $0.5 million. In FY 1977, the VAreported sharply increased expenditures of$4.1 million, even though nutrition researchwas not recognized as a high priority by theagency.

In some cases, it was difficult to determinehow much (if any) money was being spent forcertain types of important nutrition research.For instance, the Federal Government is nowannually spending about $70 million on nutri-t ion educa t ion p rograms . I t i s unc lea r

whether any of these funds are devoted toresearch on which methods are most effec-tive for reaching people.

OTA concluded that most estimates ofhuman nutrition research funding were ques-tionable and that total funding fell con-siderably short of the reported $117 millionlevel. Regardless of which overall figure ismore nearly accurate, certain areas iden-tified by OTA are not now receiving sufficientFederal support, the result of a lack ofrecognition of their importance and zero oralmost no funds. Those areas most in need ofincreased funding are the role of diet in theprevention of chronic disease and obesity,nutrition education and consumer informa-tion, monitoring nutritional status, and nutri-tion policy and management.

ISSUE 3—Personnel Resource Requirements

Estimates of the number of scientistsengaged in human nutrition research alsoproved elusive.

In an attempt to determine the currentnumber of scientists engaged in human-nutri-tion research and the numbers of researchscientists being trained, OTA contacted fiveprofessional societies and six Governmentagencies. Of the professional societies, theAmerican Public Health Association, Insti-tute of Food Technologists, and AmericanChemical Society make no attempt to distin-guish between members engaged in researchversus other career orientations andtherefore could not supply information on theproportion of their membership engaged inhuman nutrition research or training of nutri-tion research scientists. Membership in theAmerican Institute of Nutrition (AIN) islimited to those who have made significantcontributions to the field of nutrition re-search. By definition, all of AIN’s 1,730 mem-bers are nutrition research scientists. Thisnumber seriously underestimates the totalnumber of scientists in the field, since juniorpeople are not eligible for membership andvery few behavior and education researchersare included. AIN does not keep any figureson training. Of the American Dietetic Asso-ciation’s 21,751 members in 1977, 764 state

they are engaged in research activities. Thisdoes not indicate the degree of involvementand, of course, neglects those outside ofdietetics engaged in nutrition research.

The two Government agencies that fundthe largest portion of nutrition research,HEW and USDA, do maintain figures on sci-entist-years devoted to nutrition researchand 5-year projections of personnel needs, AtUSDA in FY 1976, 193,5 scientist years weredevoted to human nutrition research as de-fined by the agency, The 5-year projection ofneed for nutri t ion research scientists atUSDA is for 260.7 scientist years, a 20-per-cent increase.

In a written response to an OTA question-naire, NIH informed OTA that 70 scientistswere employed in human nutrition researchin 1977. But NIH Director Fredrickson submitted a written statement to the SenateSelect Committee on Nutrition and HumanNeeds that during that same time period 180intramural investigators in NIH were directlyinvolved in human nutrition research. Of thatnumber, 20 were defined as “classical nutri-tionists” when nutrition research was de-fined as “the study of food and nutrients, ” InFY 1977, 20 lead scientists, those holdingM. D., Ph. D., or D.V.M. degrees, and 50 juniorscientists were conducting nutrition research

22

at Letterman Army Institutethe Department of Defense.

of Research of

Before a comprehensive nutrition researchprogram is established, consideration mustbe given to the ability of the field to sustainsuch a program. No accurate figures exist onhow many scientists are currently engaged inhuman nutrition research. Furthermore, fewreports on nutrition research mention thisaspect of planning.

Implementation of the research priorityareas identified in this report may requirechanges of emphasis in existing graduate and

professional nutrition training programs aswell as increased training support. For grad-uate students in nutrition and food science,such changes might include greater stress onnutritional pharmacology, food science prin-ciples, nutrition education, nutritional statusevaluation, and nutrition-related diseases.Training would be further strengthened bypostdoctoral research work with either hu-mans or experimental animals. Greater em-phasis on nutritional biochemistry and clini-cal nutrition in undergraduate medical edu-cation may help attract physicians to thefield.

23

Chapter III

NUTRITION RESEARCHSTRATEGIES

fats

minerals

Chapter III

NUTRITION RESEARCHSTRATEGIES

Accumulating the fragmented research activities of the 14 Federal agen-cies supporting human nutrition research does not, as a whole, constitute acoherent strategy for the solution of current diet-related health problems. Agood understanding of the status quo can be gained by analysis of the Foodand Agriculture Act of 1977 which established research goals and prioritiesfor the Department of Agriculture (USDA). The picture of the present situationcan be completed by reviewing the research goals and priorities at the Na-tional Institutes of Health (NIH). Alternatives to the status quo can be foundin the recently published reports of the Office of Science and TechnologyPolicy (OSTP) and the General Accounting Office (GAO). These two alter-natives, plus an alternative developed by OTA, are examined here and provideCongress with several alternative strategies that may be pursued. Each of thealternatives are examined from three perspectives: Do the stated goals andpriorities adequately address current U.S. health problems? Is nutritionresearch defined clearly to permit realistic estimation of Federal expend-itures? Is consideration given to the personnel requirements to fulfill pro-posed research priorities?

THE STATUS QUO: NUTRITION RESEARCHIN THE FEDERAL GOVERNMENT

Goals and Priorities

The Food and Agriculture Act of 1977 rec-ognized the relationship between diet and thegeneral health of the population. The legis-lation states “that there is increasing evi-dence of a relationship between diet andmany of the leading causes of death in theUnited States; that improved nutrition is anintegral component of preventive health care;that there is a serious need for research onthe chronic effects of diet on degenerativediseases and related disorders; that nutritionand health considerations are important toU.S. agricultural policy; that there is insuffi-cient knowledge concerning precise humannutritional requirements, the interaction ofthe various nutritional constituents of food,and differences in nutritional requirementsamong different population groups such as in-

fants, children, adolescents, elderly men andwomen, and pregnant women; and that thereis a critical need for objective data concern-ing food safety, the potential of food enrich-ment, and means to encourage better nutri-tional practices. ”

The legislation declares that the Secretaryof Agriculture shall develop and implement anational food and human nutrition researchprogram that shall include, but not be limitedto, five areas:

1. Research on human nutritional require-ments.

2. Research on nutrient composition offoods and the effects of agricultural

27

practices, handling, food processing,and cooking on the nutrients they con-tain.

3. Surveillance of the nutritional benefitsprovided to participants in the food pro-grams administered by USDA,

4. Research on the factors affecting foodpreference and habits,

5. The development of techniques andequipment to assist consumers in thehome or in institutions in selecting foodthat supplies a nutritionally adequatediet.

Although the legislation points up the rela-tionship between diet and leading causes ofdeath in the United States, the research pri-ority areas spelled out do not pursue this lineof inquiry. Since the legislation pertainsalmost exclusively to USDA, it lays out whatcould be considered a partial strategy tosolve the problems of diet and chronic de-generative diseases—research on nutrientneeds, on the composition of the food supply,on ways to help consumers select a healthfuldiet, and surveillance of the population. Fur-thermore, funding proposed in the FY 1979budget does not match the ambitious wordingof the legislation.

The Food and Agriculture Act of 1977designated the Secretary of Agriculture to“establish joint ly with the Secretary ofHealth, Education, and Welfare proceduresfor coordination with respect to nutritionresearch in areas of mutual interest. ” Sec-tion 1406 amends the National Science andTechnology Policy, Organization, and Priori-ties Act of 1976 (90 Stat. 471; 42 U.S.C. 6651(h)), by creating a standing subcommittee tobe known as the Subcommittee on Food andRenewable Resources.

The legislation also established a NationalAgricultural Research and Extension UsersAdvisory Board composed of 21 members rep-resenting a wide variety of agricultural pro-ducer, consumer, marketing, and environ-mental interests. Two members must be en-gaged in human nutrition work. The AdvisoryBoard has the responsibilities for:

●

●

●

●

●

●

“Reviewing the policies, plans, and goalsof programs within USDA involving thefood and agricultural sciences, andrelated programs in other Federal andState departments and agencies and inthe colleges and universities developedby the Secretary under this title;

Reviewing and assessing the extent ofagricultural research and extension be-ing conducted by private foundationsand businesses, and the relationships ofsuch research and extension to federallysupported agricultural research and ex-tension;

Reviewing and providing consultation tothe Secretary on national policies, prior-ities, and strategies for agriculturalresearch and extension for both theshort and long term;

Assessing the overall adequacy of, andmaking recommendations to the Secre-tary with regard to, the distribution ofresources and the allocation of funds au-thorized by this title;

Preparing and submi t t i ng to theSecretary, not later than October 31 ofeach year, a statement of recommenda-tions as to allocations of responsibilitiesand levels of funding among federallysupported agricultural research and ex-tension programs; and

Not later than March 1 of each year sub-mitting a report on its appraisal of thePresident’s proposed budget for the foodand agricultural sciences for the fiscalyear beginning in such year and therecommendations of the Secretary con-tained in the annual report. ”

As indicated earlier, the Food and Agricul-ture Act of 1977 does not clearly give USDAthe lead responsibility for human nutritionresearch. Section 1405 declares “the Depart-ment of Agriculture is designated as the leadagency of the Federal Government for agri-cultural research (except with respect to thebiomedical aspects of human nutrition con-cerned with diagnosis or treatment of dis-ease). . . .“ Human nutrition is one of theareas included in the definition of “food and

28

agricultural sciences” (section 1404). ButSection 1409 states that “It is the intent ofCongress in enacting this title to augment,coordinate, and supplement the planning, ini-tiation, and conduct of agricultural researchprograms existing prior to the enactment ofthis title, except that it is not the intent ofCongress in enacting this title to limit theauthority of the Secretary of Health, Educa-tion, and Welfare under any Act which theSecretary of Health, Education, and Welfareadmin i s t e r s . Thus a clear mandate is notgiven to USDA to be the lead agency forhuman nutrition research.

Section 1423 (b) requires the Secretary ofAgriculture to “periodically consult with theadministrators of the other Federal depart-ments and agencies. ” As discussed earlier,this uni lateral approach to coordinat ionrelies on the goodwill of other agencies tocooperate with USDA in the goal of researchcoordination.

Research priorities at NIH are summarizedin table 3. A wide range of basic and appliedresearch are embodied in these priorities.The major emphasis is on basic and curative-oriented disease research rather than dis-ease prevention. This becomes more clear asallocations of funds to the different areas arestudied, The Nutrition Study Section at NIHreviewed a total of 181 grant proposals in FY1977, and approved 119, totaling $4.7 million.Only four other study sections recommendedfor approval grants totaling less than $4.7million in this period of time. Two of thesesections have been disbanded, their work be-ing referred to other study sections. Sinceresearch in nutrition involves many differentdisciplines and crosses traditional discipli-nary lines, NIH maintains that many grantapplications with nutrition components arereferred to other study sections. It can there-fore be assumed that $4.7 million is what NIHclearly defined as human nutrition research,and the remainder of the $80.4 million ofnutrition research funded by NIH if FY 1977was basic and disease-oriented researchwith nutrition components of varying degreesof relevance.

The Agency for International Development(AID) is the Federal agency primarily respon-sible for international nutrition research.

. , , the long-range goals of the AID nutri-tion program are: to have developing coun-tries incorporate nutrition considerations in-to their social and economic developmentplans; to create the methodologies for assess-ing needs, determining causes, and selectinginterventions; and to have available the mostcost-effective interventions with informationon when they are most appropriate to apply,the cost and other requirements for imple-menting them, the best methods for imple-menting them, and information on expectedresults.

The AID nutrition research program isdesigned to provide new knowledge that willhelp implement programs to attain thesegoals, The AID nutrition research programattempts to assess the functional signifi-cance of improvements in nutrition; it seeksto establish whether nutritional needs can besatisfied with locally available foods; itevaluates the effectiveness of nutrition in-tervention; and it seeks to inform govern-ments about the potential impact of policiesin food and nutrition. ]

It is therefore apparent that the AID nutri-tion research program is not and should notbe designed to address the research needsoutlined in this report. The AID program isdesigned to meet the needs of host countries.Should a research project yield results ap-plicable to problems discussed in this report,it is serendipitous. There is a clear need to en-courage international research, much ofwhich would be epidemiological, to identifyand explore dietary and lifestyle factors con-tributing to the major chronic diseases,

In theory, AID’s nutrition research ac-tivities undergo peer review. Research fundsare publicized through the distribution of abrochure, and information on AID’s researchneeds are circulated among professionalgroups and announced at professional meet-ings. “Projects that are awarded on the basisof predominant capability are very carefullyreviewed before approval. Fewer and fewerprojects follow this latter route, “z

In practice, the system seems to have func-tioned somewhat differently, Human nutr~-

‘Irwin Hornstein, Deputy Director, Office of Nutri-tion, Agency for International Development, June 8,1978.

‘Ibid.

29

tion research received an estimated $2.7 mil-lion from AID in FY 1977. Most of this re-search was conceived by agency staff whothen had a scientific research group developstudy proposals . T h e p r o p o s a l s w e r escreened by AID staff members before beingsubmitted to the Research Advisory Commit-tee for technical feasibility evaluation. Theagency does not widely advertise requests forproposals, and few unsolicited proposals arereceived. Some panel participants felt thatthis system reduces the scientific base of ex-pertise on which the agency can draw andleads to an inbreeding of research ideas.

human nutrition research is made in the Act.

In response to these requirements, USDArequested $43 million for human nutritionresearch in its FY 1979 budget proposal. Thisis a 95-percent increase over its FY 1977spending of $22 million.

At NIH, nutrition research support has re-mained relatively constant over the last sev-eral years, constituting less than 3 percent ofthe total research budget, Estimates of actualdollar outlays for human nutrition researchvary from $20 million to $80 million for FY1977.

Definition and FundingPersonnel Resource Requirements

The Food and Agriculture Act of 1977 doesnot explicitly define the term “nutrition” northe scope of “nutrition research. ” It impliesthat “nutrition research” includes researchon diet and disease, certain aspects of agri-cultural policy, nutritional requirements,food composition and nutrient interactions,food safety, food enrichment, and means ofencouraging bet ter nutritional practices.There is no reference in the legislation to in-ternational nutrition research.

Section 1423 (a) of the Food andAgriculture Act of 1977 states that the Secre-tary of Agriculture “shall increase supportfor such research [research into food andhuman nutrition] to a level that providesresources adequate to meet the policy of thissub t i t l e . No specif ic authorizat ion for

Both the USDA and HEW support under-graduate, predoctoral, and postdoctoralstudents through a variety of tuition grants,loans, fellowships, and training grants. TheFood and Agriculture Act establishes grantsand fellowships for food and agriculturalsciences education at the undergraduatethrough postdoctoral levels, The program isauthorized in FY 1978 for $25 million, ex-panding to $50 million by FY 1982. The pro-portion of this money to be devoted to trainingnutrition researchers is not specified.

The Department of Health, Education, andWelfare has traditionally supported trainingof research scientists through training grantsand fellowships. In FY 1977 these totaled$2.8 million for human nutrition research,

NEW DIRECTIONS IN FEDERALLY SUPPORTEDHUMAN NUTRITION RESEARCH: THE OSTP REPORT


In December 1977, OSTP published a re-port on Government nutrition research. Thereport defined the scope of human nutritionresearch, described existing Federal pro-grams, identified research areas that needmore attention, and suggested means for en-hancing the coordination and quality of Fed-

eral nutrition research activities. Althoughthe report focused only on domestic research,it encouraged various Federal agencies in-volved in such activities to assess the poten-tial international benefits from current andplanned projects.

The working groups of the OSTP inter-agency senior nutrition research staff recom-mended four priority research activities:

30

10

2.

3.

4.

Effects of nutrition on human health andperformance in pregnancy, infancy andearly childhood, old age, obesity, irondeficiency, nutrient toxicity, and in-teractions;Food sciences (methodology for analyz-ing food composition, nutrient bio-avail-ab i l i t y in foods , upda t ing na t iona lnutrient data bank, expanding food com-position measurements);Nutrition education research (factorsdetermining dietary practices, identifi-cation of good nutritional practices, adhoc educational research committee);andDiet and nutritional status surveillance(food composition, survey methodology,measurements of nutr i t ional s tatus,analysis of the Health and Nutrition Ex-amination Survey (HANES) data, epi-demiological studies),

The criteria used by the working group inselecting research areas for greater attentionwere impact, substantial existing knowledgegap, and researchability. The priority areaschosen reflect the narrowness of these cri-teria. The priorities tend toward short-termprojects that lack long-term commitmentsneeded to identify the nutrition elements ofmajor health problems facing adult Ameri-cans—the chronic degenerative diseases andobesity.

In the OSTP report several recommenda-tions are made for coordination within andamong the departments conducting nutritionresearch, First of all, the participants in thestudy requested OSTP “to continue to take alead role in coordinating and monitoringnutrition research activities. ” OSTP couldserve as a focal point for interagency plan-ning through the Federal Coordinating Coun-cil on Science, Engineering, and Technology(FCCSET), chaired by the Director of OSTP.Secondly, external reviews of the intramuralgrants process in both NIH and USDA withjoint participation of Federal agencies indeveloping requests for proposals and inreviewing research in progress.

To improve coordination and communica-tion within HEW and USDA, the report rec-ommends:

InDrug

HEW, the programs ofAdministration (FDA],

the Food andthe National

Center for Health Statistics [NCHS], theCenter for Disease Control (CDC), and NIHmust be coordinated in the high-priority ac-tivities identified, . . . At NIH, it is essentialfor the NIH Director and for the NutritionCoordinating Committee under his directionto have the authority to prioritize nutritionresearch needs, The Director of NIH, has arelationship to the several Institutes whichpermits allocation of funds for nutritionresearch in the absence of specific statutory

authorities for reprogramming between In-stitute appropriations.

In USDA, it is essential that the nutritionresearch activities of the Agricultural Re-search Service (ARS), the Cooperative StateResearch Service (CSRS), the Food and Nutri-tion Service (FNS), and the Economic Re-search Service (ERS) be coordinated throughthe Secretary of Agriculture. ”

Finally, the establishment of an ad hoc in-teragency nutrition education research com-mittee is recommended, This committeewould: identify and summarize research find-ings related to nutrition education researchand summarize pertinent findings from otherareas of education research, establish priori-ties, and develop a plan for conducting nutri-tion education research.

It is doubtful that OSTP through FCCSETwould be able to adequately oversee coordi-nation of nutrition research activities, Thestaff of the Office is small, and their respon-sibilities large. With a budget of $50 millionto $117 million per year, nutrition research isa very small component of the FY 1977 $3.6billion research budget for health and agri-culture.

External reviews by teams of nonagencyscientists may improve the quality of intra-mural human nutrition research activities,but they camot be expected to improve re-search coordination. This recommendationcalls for the external reviews to be conductedwithin 12 months of the report’s publicationby an unspecified number of multidiscipli-nary teams. Scientists from agencies con-ducting nutrition research would also par-ticipate. The report suggests that this wouldbe expected to increase communication andunderstanding of Federal programs, Sincethe review would only be conducted once and

31

no provisions are made for improving badsituations if they are found, it is doubtful thatit would be of any lasting use in improving in-teragency communication or the quality of in-tramural research.

The proposal that Federal agencies jointlyparticipate in developing requests for re-search proposals and in reviewing researchin progress has merit, as does the proposalfor an ad hoc interagency nutrition educationresearch committee. The ideas could be fur-ther explored by USDA and HEW and pro-posals for implementation developed.

Definition and Funding

The scope of human nutrition research, asdefined by the OSTP study, included in-vestigation of:

●

●

●

Basic physiological and biochemicalmechanisms for the digestion, absorp-tion, metabolism, and transport of nutri-ents; the role of food ingredients inhuman health and performance and inthe prevention and treatment of disease;

Nutrient composition of foods; the ef-fects of storage, processing, and packag-ing; and the biological availability of nu-trients in the foods at the time of con-sumption;

Determinants of dietary practices andmethods for educating the public aboutdietary practices; and

● Food consumption patterns and nutri-tional status of the general populationand of special high-risk subgroups with-in the population; evaluation of the nutri-tional impacts of various interventionstrategies and public policies.

The OSTP report established Federal ex-penditures for nutrition research for FY 1977at $116,6 million. The report stated that nospecific funding levels would be recommend-ed, but that the report’s objectives could bemet “at least in part by real locat ion ofresources from exist ing programs to thehigher priority areas identified. ” It is highlyunlikely that this could be accomplishedwithout outside intervention, It is also ques-tionable whether such a strategy makes goodsense, since the amount of human nutritionresearch conducted in this country is so smallin comparison to our $3.6 billion in health andagriculture research expenditures and our$160.6 billion in health costs. Furthermore, atleast $60 million of the $117 million is basicresearch on metabolism which underliesmany of the biological and health sciences. Acut in this funding would severely constrainprogress in basic research.

Personnel Resource Requirements

The OSTP report does not consider the per-sonnel resources needed to fulfill the re-search priorities contained in the report.

FEDERAL HUMAN NUTRITION RESEARCHNEEDS A COORDINATED APPROACH TO ADVANCE

Goals and Priorities ●

The General Accounting Office was askedto identify research gaps and needs in thefield of human nutrition. The scope of the ●

report was restricted to the domestic situa-tion. Gaps identified by GAO included:

Knowledge of dietary nutrients requiredto promote or maintain growth or well-being at various stages and conditions oflife;

Information on the composition of thecurrent U.S. food supply and the extentthat nutrients are biologically available;

32

• Evaluation of long-term health conse-quences of the modern diet; and

• Assessment of the Nation’s currentnutritional status in terms of dietary ex-cesses and imbalances, as well as defi-ciencies.

GAO recommended research along thefollowing lines to overcome these researchgaps:

Long-term studies of human subjectsacross the full range of both health anddisease;

Comparative studies of populations ofd i f fe r ing geograph ic , cu l tu ra l , andgenetic backgrounds;

Basic investigations of the functions andinteractions of dietary components;

Updated and expanded food compositiondata; and

Improved techniques for assessing long-term toxicological risks.

The priorities set out in the GAO report in-volve the types of research that will probablyprovide the most information on the role ofdiet in disease. However, work is also neededon how best to convey the research findingsto the public so they can be translated intodaily life.

The GAO report cites “lack of centralfocus and coordination” and “shortage of nu-trition scientists” as two of the three prin-cipal barriers to progress in human nutritionresearch. To remedy the first of these, the re-port recommends that the Director of OSTP“work with the Federal agencies to furtherdefine the subject areas comprising humannutrition research and make recommenda-tions to the Director of OMB to:

• Assign where practicable, each area toa lead Federal agency.

• Eliminate unnecessary research thatmay exist among Federal agencies.

. Promote Government-wide human nutri-tion research planning, coordination,and reporting. ”

These recommendations are not suffi-ciently specific to be considered a strateg y

for organizing nutrition research. Further-more, in an early draft of their report, OSTPassigned lead and support agency respon-sibi l i t ies for specif ic nutr i t ion researchareas. This approach was abandoned in thefinal report because of agency objections, Ageneral goal of improved research planning,coordination, and reporting is commendable,but without specifics probably will not be at-tained.


GAO identifies the third barrier to prog-ress in nutrition research as “instability offederally funded extramural research. ” Thereport does not make specific recommenda-tions as to how to improve this situation.However, it endorses the development of fed-erally funded regional research centers inconjunction with universities and colleges.

GAO estimates U.S. Government expend-itures for human nutrition research at $73million to $117 million annually. It makes noattempt to define nutrition research or toanalyze agency reports on nutrition researchexpenditures,


The GAO report highlights the concern ofthe scientific community that there is a short-age of nutrition research scientists. If thissituation exists, it holds significant implica-tions for the ability of the research commun-ity to absorb research funds should large in-creases be made in the future. Since no accu-rate information exists on the numbers andexpertise of nutrition research scientists out-side Government laboratories, analysis of re-search capabilities is impossible.

33

A COMPREHENSIVE NUTRITION RESEARCH STRATEGY


The focus now lacking in Federal nutritionresearch could be achieved by defining thescope of human nutrition research, defininggeneral goals for Federal agencies that con-duct such research, and specifying researchpriority areas that are in line with the gen-eral goals. A reorientation of Federal nutri-tion research efforts should recognize thechanging nature of four food supply by placinggreater emphasis on the role of diet inpreventing chronic diseases. At the sametime, Government programs must continuestriving to eliminate hunger and malnutritionthrough intervention programs and research.

Such a reoriented research strategy re-quires an increased focus on today’s complexfood supply, especially on the effects of proc-essed food, food additives and contaminants,and similar problems that concern consum-ers, food producers, and health profession-als. Research in the food sciences wouldenable us to evaluate the adequacy of thefood supply and to develop recommendationsfor needed changes. Such changes might in-clude new processing techniques, fortifica-tion, reformulation, or selection of alternativefood items by consumers.

Broader information and intervention ef-forts outside of the health care system arealso necessary. The public should know whatthe scientific community has learned aboutthe relationships among lifestyles, food con-sumption, and health. Developing improvedways of conveying such knowledge would en-courage the public to adopt better eatinghabits and other health-promoting behavior.

OTA working group participants felt thatneither the existing legislation nor the priori-ties suggested in the OSTP and GAO reportsprovided the holistic, integrated researchstrategy needed to meet current and pro-jected diet-related problems in the UnitedStates. Seven elements of a comprehensiveresearch strategy to define the role of nutri-tionin the prevention of chronic disease andto improve management of current nutrition-related problems were discussed. The seven

34

points are outlined in table 5. The rationalefor the selection of each is contained in theappendix.

Several mechanisms for coordinating Fed-eral nutrition research activities have beensuggested. These include assigning respon-sibilities for research areas to various agen-cies, making one agency the lead agency,placing coordination responsibility under athird party, assigning coordination respon-sibility to the assistant secretary level, andconcentrating all nutrition research activitiesin either USDA or HEW.

The first alternative (assigning respon-sibilities for research areas to various agen-cies) would make USDA and HEW the twolead agencies in human nutrition research,This approach is similar to the one taken inthe Food and Agriculture Act of 1977 inwhich the legitimate roles of both agencies innutri t ion research are recognized. Undersuch a system of joint responsibility, the con-cerns of each agency would have to be de-fined to minimize duplication of effort, An ef-fective system of intra-agency cooperationwould also be necessary. However, since itmay not be possible to clearly separate theconcerns of nutrition and disease from thoseof “normal nutrition,” some overlap wouldprobably beinevitable.

The second alternative assigns one agencymain responsibility for nutrition research.Since USDA and HEW fund 87 percent ofFederal human nutrition research, they arethe most likely candidates for the lead agencyrole. There are arguments both for andagainst giving such responsibility to one orthe other agency.

Currently USDA plays the major role incarrying out food intervention programs inthe United States. By giving it primary re-sponsibility for funding and coordinatingnutrition research efforts, the Government’sresearch and food intervention activitiesmight be better coordinated. At the samet ime , Federa l r e sea rch ac t iv i t i e s migh tbecome more responsive to consumer viewsand needs because of USDA’s major involve-ment in food and nutrition education pro-grams.

Table 5.—A Seven-Point Nutrition Research Strategy

The role of diet in the prevention - of chronic disease and obesityMajor health problems and diet-related risk factorsDiet, aging, and diseaseMethods for preventing obesityNutrition and mental development

The role of nutrition in the treatment of disease and support of therapyNutritional support of patients with severe disease and injuryOther disease statesTechnology for delivery of nutrients to patientsBehavioral and emotional problems

Nutrition education and consumer informationFactors affecting lifetime eating habits and identification of critical points for educationDevelopment and evaluation of nutrition education and communication methodsMethods for simplifying consumer information utilization

Requirements for essential nutrientsMethods for determining nutrient needsInteractions among nutrient requirements based on functional criteriaPharmacologic and toxicologic effects of on nutritionsBioavaiability of nutrients in foods

Nutritional aspects of food science and food safetyFood compositionNew food processing and handling procedures to maintain nutrient contentBetter methods of assuring food safety

Monitoring nutritional statusMethods for improving integration of food consumption and nutritional status surveillanceEvaluation of the effects of food and nutrition education programs

Nutrition policy and managementFood-related interventionsOther Interventions

—

USDA now coordinates research in thearea of food production with the State agri-culture experiment stations and other coop-erating institutions. Some link between thenutritional concerns of consumers and thefood production system seems to be essential,But USDA has traditionally had little respon-sibility or expertise in the area of humanhealth and disease. One of the major needs inFederal nutrition research activities is areorientation of priorities to stress the role ofnutrition in the prevention of disease, Thusseparating health-related nutrition researchfrom the overall direction of health researchmay not be wise, If health-related nutritionresearch fell exclusively under USDA, poten-tial conflicts might arise. The research mightproduce recommendations for substantialshifts in food practices. Such findings andrecommendations could conflict with thetraditional interests of producer groups.

Many of the research priorities identifiedby OTA as well as other groups involve therelationship of human health to nutritionalpractices. Therefore, there are strong argu-

ments for giving HEW, the agency concernedwith health, the lead responsibility for direct-ing nutrition research, However, such re-search has not been a main HEW concern inthe past. Disease-prevention research hasgenerally received much less support thanspecific disease-oriented or curative-orientedresearch. Moreover, HEW has not been con-cerned with the nutrient requirements ofhealthy people, food consumption patterns, orfood composition. In addition, HEW has nonationwide programs of nutrition and healtheducation comparable to those developed byUSDA.

The report by OSTP recommended that thelead role in nutrition research be given to athird party which would formulate policy andcoordinate and monitor programs. Under thisarrangement, various agencies would retaintheir exist ing nutr i t ion research respon-sibilities, but their activities would be over-seen by the third party. The concept offerssome positive features, It would focus atten-tion on nutrition while retaining the healthy

35

competition among agencies involved in nutri-tion research.

However, such a third-party concept alsoraises several problems. It involves anotherlayer of Federal bureaucracy. A third-partyoversight body might have no real power toinfluence budgets and allocate resourceswithin and among agencies, especially sinceit would lack a political constituency. Thesepotential deficiencies would be further mag-nified by inadequate staff and expertise. Inthe end, such a coordinating mechanismwould probably only serve as a means to ex-change information, much as the nutritioncoordinating committee does within NIH andthe Current Research Information System(CRIS) does for USDA,

Another alternative would give assistantsecretaries in HEW and USDA responsibilityfor coordinating nutrition research policywithin and between their respective agen-cies. Lack of high-level commitment to nutri-tion research has been a problem in the past.Placing responsibility for nutrition at theassistant secretary level might create thevisibility and commitment needed to effec-tively coordinate nutrition research efforts,Such an arrangement would require adminis-trative changes within both agencies. At pre-sent, it is unclear if the USDA reorganizationtha t c rea ted a Human Nut r i t ion Cen te rwithin SEA will accomplish this goal.

A final option would consolidate nutritionprograms in one agency, either USDA orHEW. These activities would include re-search, education, regulation, training, serv-ice delivery, monitoring and surveillance, andfood and other intervention programs. BothUSDA and HEW have recently shown interestin this concept in papers entitled USDA’SCommitment to Food and Nutrition Policy andThe Role of HEW in Human Nutrition: FutureDirections. However, the wisdom of such aconsolidation is debatable, Although bothagencies currently have a number of nutri-tion programs, the expertise involved is quitespecialized. Whether this approach wouldsolve coordination prob lems p robab lydepends on the agency’s commitment to thefield of nutrition.

A pluralistic approach to human nutritionresearch, with well-defined agency respon-sibilities for HEW and USDA, appears to bethe best means of coordinating Federalresearch efforts. Such an approach couldproduce the kind of creative competition thatwould l ike ly enhance human n u t r i t i o nresea rch . I t wou ld a l so r e su l t in someoverlapping of efforts , which should beminimized by the coordinating process.

The coordinating function might best becarried out by an interagency committee witha rotating chairmanship. This arrangementwould be consistent with a pluralistic ap-proach to research. At the same time, itwould help ensure against any one agencybuilding a “most-favored” relationship withthe coordinating committee.

Coordination of Federal nutrition activitiesextends beyond specif ic mechanisms forintra- and inter-agency coordination, It alsoincludes information storage, retrieval, andintegration. No uniform system presently ex-ists among the various agencies involved innutrition research. Computerized systemsthat permit information integration and re-trieval need to be explored. At the very least,relevant branches of HEW and USDA shouldhave a common indexing and data retrievalsystem for this type of information, Sincefederally supported research accounts forthe major share of research in the nutritionand health maintenance areas, integrationamong these agencies is essential. Integrationof nutrition research data is also desirableamong the public, private, and voluntary sec-tors.


As outlined under issue 2, OTA could notperform an analysis of the present Federalhuman nutrition research budget, since pres-ent expenditure estimates are so disparate.

Federal spending on human nutr i t ionresearch should be precisely determined. Byeliminating the present confusion, Congresswill be better able to judge appropriate levelsof funding for nutrition research. Congresscould request GAO to audit the human nutri-

36

tion research expenditures of Federal agen-cies. The GAO audit, based on a constantdefinition, should determine total Federalspending for human nutrition research, thenumber of scientis t years involved, andFederal expenditures in the seven priorityareas setout in this report.

On the basis of such information, Congresswould have several options. The first wouldbe to maintain the status quo in nutritionresearch funding, with possible reallocationof some funds to areas not now receiving sup-port. As a second option, Congress could ap-propriate additional funds to specific nutri-t ion research areas that are not get t ingenough support. Finally, Congress could ear-mark a percentage of Hatch funds for humannutrition research. Such an audit, togetherwith a uniform system for reporting humannutr i t ion research spending, could also

facil i tate future congressional oversighthearings,


If Congress were to choose to implementthe OTA comprehensive nutrition researchstrategy, there is a clear need to establishhow many scientists are both presentl y i n -volved in, or training for, nutrition research.This census would include a breakdown interms of various research areas, such asGovernment facilities, universities, medicalfacilities, private institutes, and industry,This kind of census would identify where nu-trition research personnel gaps exist andwhere greater support is necessary. To fillsuch gaps, expanded Federal support shouldbe considered.

37

Chapter IV


fats

minerals

——— ——

Chapter IV


OTA found that three key issues underlie the basic finding that the Fed-eral Government has failed to adjust the emphasis of its human nutritionresearch activities to meet the changing health problems of the Americanpeople. Alternative approaches of dealing with these issues have been ex-plored. Congress can elect to maintain the status quo, with or without minorshifts, or choose among the strategies and options offered by OTA, theGeneral Accounting Office (GAO), and the Office of Science and TechnologyPolicy (OSTP), (see chapter I Ii). Either alternative has economic, institutional,and health implications.

Option 1: Congress Could Choose To Maintain the Overall Status Quo

Maintaining the status quo could meanrefraining from any action. In a broadersense, i t a lso could involve minor im-provements in the present system—withoutmaking substantial changes.

A. Congress could refrain from any action,awaiting the recommendations of thePresident’s Reorganization Project.

In Augus t o f 1977 , P res iden t Car te rdirected the Reorganization Project staff atthe Office of Management and Budget to thor-oughly review the organization and structureof Federal food and nutrition programs. Foodand nutrition research is one of the seven ma-jor areas under review. A final report to thePresident, expected in January of 1979, willinclude recommendations that may signifi-cantly alter the organization, and thus thecourse, of nutrition research activities.

Since significant strides have been made innutrition research, there is no reason to ex-pect a decline in research productivity if cur-rent funding levels are maintained. However,since several important areas of nutritionresearch receive little support at present,progress in these areas would be slow, Theseareas include the role of nutrition in the pre-vention of disease, nutrition education, mon-

itoring nutrition status, and nutrition policyand management.

If Congress chooses to refrain from any ac-tion to await the recommendations of thePresident’s Reorganization Project, no ad-verse effects would be expected.

B. Congress could amend the Food and Agri-culture Act of 1977 to clarify the desig-nation of lead agency for human nutritionresearch.

At the present time, the Department ofAgriculture (USDA) interprets the Food andAgriculture Act of 1977 to mean that USDA isthe lead agency for human nutrition re-search, an interpretation not shared by theDepartment of Health, Education, and Wel-fare (HEW). If Congress intended USDA tohave primary responsibility for this researcharea, the Act will require amendment.

c.

r

Congress could develop nutrition researchgoals and priorities for HEW that comple-ment the goals and priorities outlined forUSDA in the Food and Agriculture Act of1977.

The legislation contains strong language onthe relationship of diet to many of the leading

41

causes of death in the United States, the im-portance of proper nutrition in disease pre-vention, and the need for more knowledge inseveral areas of nutrition research. The re-search priorities spelled out in the bill do notfully reflect these thoughts,

Since the legislation pertains almost exclu-sively to USDA, it lays out what could be con-sidered a partial strategy to solve the prob-lems of diet and chronic degenerative dis-eases.

Congress could develop legislation contain-ing research goals and priorities for HEWthat complement those already legislated forUSDA. These goals and priorities could bebased on either the GAO, OSTP, or OTAstrategies,

D. Congress could enact legislation establish-ing a coordinating mechanism for Federalhuman nutrition research activities.

Numerous recommendations for coordi-nat ing Federal human nutr i t ion researchhave been made since the 1969 White HouseConference on Food, Nutrition, and Health.

The fact that the issue remains al ive in-dicates the need for improvement.

E. Congress could consider legislation to im-prove data storage and retrieval, and tolink the systems currently in use.

Coordination of Federal nutrition activitiesextends beyond specif ic mechanisms forintra- and inter-agency coordination. It alsoincludes information storage, retrieval, andintegration, No uniform system presently ex-ists among the various agencies involved innutrition research, Computerized systemsthat permit information integration and re-trieval need to be explored. At the very least,relevant branches of HEW and USDA shouldhave a common indexing and data retrievalsystem for this type of information. Sincefederally supported research accounts forthe major share of research in the nutritionand health maintenance areas, integrationamong these agencies is essential. Integrationof nutrition research data is also desirableamong the public, private, and voluntary sec-tors,

Option 2: Congress Could Choose To Pursue a Human NutritionResearch Strategy Different From That of the Status Quo

Since this assessment found that the pres-ent nutri t ion research establishment hasfailed to respond to the changing health needsof Americans, Congress could move to changethe emphasis of federally funded nutritionresearch. Such change could be based on thestrategies and options put forward by OSTP,GAO, and OTA (reviewed and analyzed,chapter III). If Congress decides to follow thispath, more information is required on currentexpenditures and existing expertise. Basedon the results of needed studies, Congresscould then determine which strategies andoptions would be most productive.

A. Congress could request GAO to conductan audit of Federal expenditures forhuman nutrition research,

To eliminate the present confusion overhow much Government agencies are spending

42

on human nutrition research, Congress couldask the GAO to audit such Federal expend-itures, using the definition of human nutritionresearch developed in this report. On comple-tion of the audit, Congress would be in a bet-ter position to determine which areas ofnutrition research are receiving inadequatesupport. At that point, Congress might con-sider reallocating some funds or appropri-ating additional funds to specific areas ofnutrition research identified as poorly sup-ported, or earmarking a percentage of Hatchfunds for human nutrition research.

B. Congress could request the lead agencyfor human nutrition research to conduct acensus of research personnel.

There is a clear need to establish howmany scientists are both presently involved inand training for nutrition research. This cen-

sus would include a breakdown in terms ofvarious research areas. such as Governmentfacilities, universities, medical facilities,private institutes, and industry. This kind ofcensus would identify where nutrition re-sea rch pe r sonne l gaps ex i s t and wheregreater support is necessary. To fill suchgaps, expanded Federal support should beconsidered.

C. Congress could increase training grantsand fellowships, and consider establish-ing midcareer training for scientists.

If a need is established for more researchpersonnel, this could be met through a com-

bination of two routes: increasing training ofyoung scientists and providing midcareertraining for established scientists. By makingfellowship and training grants available, can-didates would be attracted to those fields inwhich more research is needed (particularlythe newer fields), Congress might also con-sider alternative means to facilitate trainingsuch as loans, work/study funds, pay-backscholarships, and income tax rebates forstudents.

For establ ished scient is ts wishing tobroaden the scope of their research intereststo encompass nutrition research priorities,midcareer training or continuing educationcould be considered.

43

APPENDIX

— ——

APPENDIX

SUPPORTING MATERIALS

BACKGROUND FOR OTA

In the preparation of this report, OTAfound that Federal nutrition research lacksfocus and direction. This is demonstrated bythe lack of general consensus on overallgoals and priorities. The picture is furthercomplicated by the large number of Federalagencies involved—7 departments encom-passing 14 separate agencies. Without aconcerted, continuous effort to integratetheir efforts, the agencies have been unableto share information on planned, ongoing, orcompleted research. Furthermore, the in-ability to develop an agreed upon definitionof what const i tutes “nutr i t ion research”has led to widely divergent reports on Fed-eral spending.

In view of public concern over the foodwe eat, how we live, and their relationshipto how we die, human nutrition research re-ceives l i t t le Federal at tention. Researchalong the lines in the comprehensive nutri-tion research plan developed by OTA willhelp determine if causal relationships canbe established between the American dietand the American way of death. Implemen-tation of the results of this research couldhopefully improve the health status of manyAmericans.

A technical analysis and rationale for theproposed research strategy are presentedbelow.

Criteria for Evaluation

The establishment of research prioritiesand the development of appropriate budgets

RESEARCH STRATEGY

involve various kinds of judgments. Only afew of the documents reviewed attempted toset priorities for nutrition research, andcriteria used differed from one reportanother (see table 6). For the purposethis assessment, the criteria used inother reports were found wanting in a nuber of respects.

hetoofhem-

First, some of the criteria were ill-defined,difficult to interpret in a uniform manner, orwere not mutually exclusive. Second, the cri-eria for types of technology necessary toachieve results were unclear. For example,the criterion for researchability was definedin one document as being either an area inwhich effort was 1ikely to advance knowledgeor one in which the knowledge base, person-nel , and basic research techniques wereavailable. From the standpoint of technologyassessment, the two are quite different. Useof the same term to describe these two dif-ferent characteristics confuses rather thansimplifies decisionmaking. Third, costs orrelative dollar requirements were not i n -cluded in the criteria. Fourth, because mostof the documents which used criteria forselecting priorities were written by researchscientists or Government officials, estimatesof need and potential impacts were viewedfrom their vantage point rather than fromthat of the users or ultimate beneficiaries ofresearch—the American public, In contrast,the OTA advisory panel represented a widerange, including not only the producers andadministrators of research but also users out-side of the Federal Government and con-sumer representatives. Finally, the criteriaselected for reports suggesting domestic nu-

47

Table 6.—Criteria Used for Assessing Research Priorities

Office of Science & ‘ -

Technology Policy ●

1. Irnpact: Research findings areexpected to have major infIuenceon human health or dietary practices.

1. Substantial existjng knowledgegap: There is insufficient knowledgein a specific area either because Iittlerelevant research has been carriedout or because the research has notyielded conclusive results.

3. Researchability: An adequatecapability— knowledge base, skilledpersonnel, and research tech-niques —exists to address theproblem so that research is likelyto result in a significant break-through in knowledge. This criteriondepends on scientific judgmentabout the met hods available to oper-ationalize research questions.

—

National Academy of Sciences’ ● General Accounting Office ● ● ●

1. What advances in knowledge will 1. Knowledge gaps at present.specific areas of research produce,and what is the scientific ortechnological significance of theseadvances?

2. If research does produce results,what effect wouId they Iikely have onreducing global hunger andmalnutrition over the next severaldecades?

3.What supportive action Will berequired to conduct research foraccelerated activity recommended(e.g., more resources, policy changes,organizational changes)?

“Office of Science and Technology Policy, New Directions in Federally Supporled Nurnan Nutrition Research, December 1977“ “ NAS, World Food and Nufrition Study, 1977‘” “GAO, federal Human Nutrition Research–Need for a Coordinated Approach To Advance Our Knowledge, 1978

trition research priorities tended by defini-tion to favor short-term gains. By developinga separate criterion for the immediacy of ap-plication, this bias was reconciled. The cri-teria used by OTA in evaluating research pri-orities were need, current state of knowl-edge, capability, cost, and immediacy.

Importance of the Problem

There are two different viewpoints on howto assess the importance of the problem orthe need for a solution. Health professionalsmight advocate an approach based upon epi-demiological considerations. Since estimatesof the prevalence, incidence, duration, andmortality rates of various diseases generallyreflect their effects upon human health, theyare useful.

Economists use more general considera-tions in defining needs. They concentrateupon the economic impacts of the expectedsolutions.

Also important are the more subjectivehuman dimensions of suffering and inconve-nience, which are conveyed only imperfectlyby the epidemiological data, and the benefits

projected by the estimates of economic im-pact. For example, heart attacks kill threetimes as many people in this country ascancer, but most people fear cancer morethan they do heart disease. Overnutrition isassociated with much more illness in theUnited States than undernutrition. Yet thereis a widespread belief that it is worse to behungry than to be overfed and that theGovernment has a special obligation to helpthose who might otherwise go hungry.

While the factors mentioned above involveexpert judgment to some extent, need is dif-ficult to assess because of the many subjec-tive factors involved. Congress and the publichave as much ability as anyone else to eval-uate their relative importance, Since publicmonies are to be spent, a wide spectrum ofopinions likely to be representative of thepublic is therefore useful. Indeed, all thesevarious types of expertise will be helpful inmaking judgments.

Current State of Knowledge orRelative Potential of the Area

Here the emphasis shifts to the state ofknowledge in the field and how likely it is that

48

expected resultsand knowledge

or answers will be foundadvanced. Estimating the

relative potential of research efforts is anarea in which expert judgment is particularlyuseful, since knowledge of the present stateof the art and current research ideas ishelpful. One difficulty often encountered hereis that science must take into account what ispractical and possible rather than solelywhat is deemed to be important.

Capability

This criterion involves estimates of thepresent capacity for performing researchfrom the standpoint of personnel, technology,and the availability of basic research tech-niques to deal with the problem. Special ex-pertise is helpful in making these estimates.

cost

This factor involves the relative amounts ofmoney required by the proposed research inthe immediate future.

Immediacy

This criterion evaluates whether yields arelikely to be seen over the short, medium, orlong term, Specific target dates in terms ofapplication are very difficult to predict. Ingeneral, short term was used to describe proj-ects in which usable results could be ex-pected in under 5 years; medium term, 5 to 10years; and long term, 10 to 20 years. Expertjudgment was helpful in making these deci-sions, but even so they represent guesses andnot certainties.

Other Criteria Which Were Considered

While the major criteria used for assessingthe various possibilities for emphasis arementioned above, other points were also con-sidered in arriving at overall judgments,These included the following:

Potential for achieving multiplier effects bydeveloping closer links between research andtraining. Lists of research priorities tend tobe specific. Yet the best researchers arethose with broad experience and trainingwho can solve problems requiring variouskinds of technical expertise. Research topics

which a re amenab le to such b road ap-proaches are therefore particularly suitablefor exposing research personnel in training tothe very collaborative endeavors that may bethe most fruitful.

Maintenance of research potential. Thesetting in which research is carried out af-fects the ability to maintain nutrition re-search potential. In some settings such as uni-versities, particular emphasis is placed uponthe transmission of knowledge by trainingyoung investigators, while in others the focusis restricted to the production of new knowl-edge, Since there is no solid evidence avail-able to indicate that research by contract orby private or Government organizations ismore efficient in producing results, partic-ular emphasis was given by the OTA advisorypanel to topics or funding mechanisms thatwould have secondary gains, in that theywould also produce scientists.

Approaches which maximized the benefitsto be gained by focusing research prioritiesand minimized the undesirable effects. Ef-forts to direct research toward useful solu-tions by establishing priorities and fundingare helpful in several ways. They encouragedialogue among scientists, funding agencies,and the ultimate users of research efforts,thus helping to achieve consensus, summa-rize our current state of knowledge, andstrengthen the public understanding of sci-ence. They may permit public monies to bebetter spent for achieving desired objectivesand speed up the process of application offundamental research f indings to humanproblems,

However, undesirable effects also stemfrom efforts to direct research, These includeplacing greater power and control in thehands of bureaucrats who may be limited intheir ability to judge quality. Scientific judg-ment may be weakened . Per func to ry r e-search which follows bureaucratic guidelinesbut involves little intellectual effort may befavored. More productive areas of researchmay be disregarded in favor of “popular”areas of interest in which a paucity of newresearch ideas exists.

49

THE ROLE OF DIET IN THE PREVENTION OFCHRONIC DISEASE AND OBESITY

The role of nutrition must be given greaterpriority in the prevention and improved man-agement of today’s major health problems.Nutritional factors deserve particular atten-tion for two reasons. First, it is possible tochange diets while some of the other factorsthat influence disease development cannot bealtered. Second, nutrition is basic to healthand deserves attention as one of many factorsthat influence health and disease,

Just if i cat ion

Major Health Problems andDiet-Related Risk Factors

The major health problems of Americansinclude cardiovascular disease, cancer, dia-betes, hypertension, osteoporosis, obesity,drug and alchohol abuse, mental illness, anddental disease. All of these diseases have acomplex etiology of which nutrition is a part.Thus, research must aim at identifying the in-terrelat ionships between diet , exercise,stress, other environmental and genetic fac-tors, and general health. More attention mustbe paid to nutrition as a variable in ongoingstudies of disease which are mentionedbelow. This kind of research will be long term(10 to 20 years), but some payoff can be ex-pected relatively soon (such as the reductionin coronary heart diseases in the past 10years and recent reports linking high dietarysodium levels with hypertension).

Cardiovascular disease. Although moreresearch effort has been directed to athero-sclerotic heart disease than to other chronicdiseases, it remains a major health problem.Each year 850,000 cardiovascular deaths arecaused by arteriosclerosis, 25 percent ofthese occurring before the age of 65.

The role of diet in the development of heartdisease is generally accepted but still notunderstood. Further definition of the relativeimportance of specific dietary components—such as type and amounts of fat, dietary cho-lesterol, type of carbohydrates, dietary fiber,and alcohol—is required. The positive ornegative effects they produce are particular-ly germane to the clinical and public healthapplication of findings. Both specific risks

50

produced by individual components and thecombined risks of different dietary patternsneed exploration.

The relationship between atheroscleroticdisease and other conditions such as obesity,hypertension, and diabetes needs more care-ful study, The exciting new observations onthe role of high-density lipoproteins, whichtransport blood fats, in retarding the develop-ment of atherosclerosis provide a possiblebasis for approaches involving the manipula-tion of selected food constituents or other fac-tors which may increase high-density lipopro-teins,

More research is also needed on the waysin which various dietary factors—such astype and amount of fat, alcohol, and energybalance—affect the disease process. Whyand how these factors affect the developmentof cardiovascular disease are more difficultto uncover than discovering if they have posi-tive or negative influences,

Cancer. Three quarters of the cancers thatoccur in this country are believed to berelated to environmental factors, which in-clude foods and their constituents, Epidemio-logic data and findings from animal studiesrelate cancer of the esophagus, stomach, co-lon, breast, and liver to diet. A variety of fac-tors in food has been implicated.

A primary effort must be directed towardidentifying the dietary patterns and dietaryconstituents which are associated with highrisk in populations. Food factors—such asnutrients and other substances naturally oc-curring in food, food contaminants, food ad-ditives, or total dietary patterns—may all in-fluence the development of cancer. There aremany types of cancer which affect many dif-ferent tissues and organs, and no single‘‘cause’ of cancer can be expected to beidentified. Until basic research efforts havebetter explained the causes of cancer, it willbe difficult to achieve a breakthrough in theapplied area. Thus a renewed emphasis onbasic research funding will be necessary.

Diabetes mellitus, Diabetes correlates withcardiovascular disease and certain kinds of

cancer and is itself a major cause of deathand disability. Projections of current rates ofincrease suggest that 20 percent of all Ameri-cans may develop diabetes unless methods ofprevention are found. Maturity-onset diabe-tes is clearly related to obesity. Diabetics areknown to be part icularly susceptible toarteriosclerotic heart disease. These inter-relationships suggest common causal factorsthat need clarification.

Study of the interrelationships among theamount and kind of various carbohydratesand fats and the total energy intake in thecausation and control of diabetes mellitusshould be particularly useful,

Fiypertension. Hypertension is epidemic inthe U.S. population. Nearly 23 million Ameri-cans are affected. Epidemiologic data, aswell as animal feeding studies, link hyperten-sion to sodium intake, and low-sodium dietshave been useful in the control of hyperten-sion. Hypertension is also linked to obesityand, as with most chronic diseases, there isprobably a strong genetic component. Therole that sodium intake may play within theAmerican population is not clear, nor havethe possible effects of sodium restriction inpreventing hypertension been adequately ex-plored. The interrelationships between thegenetic component and diet, particularly saltintake, must be thoroughly studied. The roleof diet coupled with other preventive meas-ures also needs more exploration than it hasas yet received.

0steoporosis. M o s t a d u l t s l o s e b o n esubstance as they age. Morbidity associatedwith osteoporosis has been estimated to af-fect probably 20 percent of the populationover 50 years of age. Adequate epidemiologicdata are not yet available. A nutritional com-ponent in the development of osteoporosis islikely. Excessive intakes of protein and phos-phate and relative deficiencies of calcium,fluoride, and vitamin D have been implicated.Research in this field has been minisculerelative to the importance of the problem.

A broad attack ranging from the collectionof satisfactory epidemiologic data within andbetween countries, the development of ap-propriate animal models, and appropriateclinical studies aimed at exploring the rela-

tionships among nutrition, endocrinology, andgenetics will be required to develop solutions.

Chronic digestive disorders. Ulcer disease,inflammatory bowel disease, and diverticulardisease of the colon may have nutrition-related causes. These need exploration.

Dental disease. Dental caries and periodon-tal disease are a serious and expensivehealth problem. Dental caries afflict 95 per-cent of the population under 17 and signifi-cantly increase health-care costs. Nearly 45percent of the total population has periodon-tal disease, which is the primary cause oftooth loss after age 35. Fermentable carbohy-drate is the primary factor causing toothdecay. Fluoride has a protective effect whenconsumed during the period of enamel devel-opment or when applied topically. But otherdiet-related factors are also involved. At-tempts to identify other dietary factors hav-ing cariogenic or cariostatic effects are cur-rently focused on the effects of trace ele-ments upon the oral microflora and enamelvolubility and on the role of nutrition in thedevelopment and activity of the salivaryglands. Recent studies have clarified the roleof food consistency in gingival health, andcurrent research is focusing on the role ofnutrition in the maintenance of gingivalhealth and the resistance to periodontaldisease.

But our knowledge of the role of nutritionin the causation of periodontal disease isminimal. The importance of specific dietarycomponents and their interrelationships withdental hygiene, heredity, the oral microflora,eating patterns, and other factors in thesediseases must be defined, Research shouldshow the major causes and provide guidanceon practical means of preventing dentalcaries and periodontal disease.

Diet, Aging, and Disease

The diseases which have been discussedconstitute major health problems which areprevalent among the aged, although they arenot necessarily restricted to the aged or di-rectly correlated with aging. A major andgrowing segment of our population is elderly,yet we know very little about how to deal withthe combination of aging and these disease

51

problems. A great deal of data are now avail-able to demonstrate that the aging process inanimals can be delayed by appropriate dietsand particularly by limiting food intake.

The implications of these studies on humannutrition are profound, yet very little isknown abou t how d ie t a ry modi f i ca t ionachieves these effects, what might be the roleof specific food components, or how they canbe applied in human nutrition. The impor-tance of research in this area is self-evidentas various diseases (particularly the infec-tious diseases) come under increasing controland the number of elderly people increases.Fundamental research in this area mustreceive attention.

Research is also needed on the relationshipbetween food intake in the early years of lifeand the later development of cardiovascularand other diseases.

Methods for Preventing Obesity

Obesity is a condition of excessive fatnessrather than a disease itself. It is related toseveral of the major health problems men-tioned above. Specific causes and factors in-volved in obesity—such as heredity, nutritionin early life, emotional factors, the nature ofthe food supply, and physical inactivity—must be studied to develop better methods forcontrolling the condition,

The role of obesity in the development ofchronic disease needs attention so we candefine associated disease problems and act toprevent or control them. Obesity may bedetrimental to the health of some peoplewhile not to others. Study of the interactionsof obesity with other risk factors may help tounravel the interrelationships of obesity withchronic diseases.

Present preventive and curative programshave only limited success. Carefully con-ducted clinical trials which would allow cost-effectiveness comparisons between differentapproaches are not available, but are sorelyneeded, and may prove helpful in developingnew and better preventive techniques.

Nutrition and Mental Development

Nutrition plays a positive role in mental aswell as physical health. Although malnutri-tion in the prenatal and early postnatal per-iods has been linked to retarded mental devel-opment, the specific role of nutrition and itsrelationship to other factors which affectmental development remains obscure. Con-tinued effort is required to clarify these rela-tionships and also to develop methods whichwill assure that each child’s potential formental and physical development is fulfilled,Studies concentrating on clarification of therelationships between nutrition, mental de-velopment, and behavior are particularly ger-mane to the problems in developing countrieswhere diets may be severely limited. Theymay also benefi t certain disadvantagedgroups in our own country, such as handi-capped children, with better methods forfeeding. Techniques for speeding the rehabili-tation of abused children who have been nu-tritionally deprived might also be developed.

Analysis

Need

The severity, irreversibility, and toll inhuman suffering of these common diseaseswith nutritional components make this anurgent area of concern. The economic im-pacts of preventing or delaying the onset ofthese diseases would be enormous.

Current State of Knowledge

There is a long-standing belief, backed bysubstantial evidence, that proper choices ofdiets and lifestyles can do much to enhanceand maintain good health. The specific role ofdiet in the development of these major chron-ic diseases is not certain. But several—inclu-ding heart disease, cancer, diabetes, andhypertension —are so common and seriousthat every effort must be made to diminishtheir impact.

The potential for advances in this area ishigh, but the returns for a specific project arenever known in terms of what the practicalapplication will be or whether they will be ap-

52

plicable to human nutrition problems. Interms of the improvement of human health,however, many great breakthroughs have re-sulted in the past from the identification ofgeneral principles which underlie biologicalphenomena, whether these have arisen fromserendipity, general studies, or mission-ori-ented research concerned with a particularproblem.

Capability

The lack of appropriate basic researchtechniques and appropriately trained person-nel are major limitations in this area. Never-theless, presently available techniques needto be applied more broadly. The extent andnature must be known of the correlationsamong dietary composition, other causativefactors, and the incidence of major diseasesin order to do this. Extensive animal feedingtrials in appropriate species, biochemicalstudies, and some experimentation with hu-man subjects are also directly relevant.

cost

Costs of research in the role of diet in theprevention of chronic diseases and obesitywill be high, but not in comparison to thehealth costs these diseases generate. A greatdeal remains to be done, and significant in-creases are likely to be necessary.

Immediacy

Research on disease prevention has a rela-tively long leadtime before it reaps results, al-

though some advances can be expected in afew years. Since this type of research has re-ceived little attention from the nutrition per-spective over the past few decades, it is par-ticularly important to begin to catch up, Ouraim should be to build a research programthat deals with the problems of today as wellas one that will be ready to meet those of thefuture. Since this type of research furnishesthe foundation upon which applied researchis based, it is fundamental to all practicalprograms. Yet a number of recent reports—including t h e P r e s i d e n t ’ s B i o m e d i c a lResearch Panel, the World Food and Nutri-tion Study, and the recent OTA assessmenton basic research needs in agriculture—allagree that much important fundamental in-formation of this type is not being developedand that our storehouse of knowledge forbuilding applied programs based on these ad-vances i s r a p i d l y becoming depleted.Therefore it is absolutely essential that im-mediate attention be paid to this problem.

Other Criteria

The opportunities for achieving multipliereffects with funds spent to develop close linksbetween research and training are high. Thedevelopment of this area is essential formaintaining research potential and keepingnutrition viable and in the mainstream of ad-vances in biomedical research. The prioritiesare general enough to encourage creativity.

THE ROLE OF NUTRITION IN THE TREATMENTOF DISEASE AND SUPPORT OF THERAPY

Just i f icat ion care, genetic abnormalities, gastrointestinaldisease, allergies, and behavioral disorders,

There is increasing recognition today that has aroused increased interest in recent

nutrition plays a significant role in the man- years.

agement of many disease states. Its applica-tion to the management of a wide variety of The results of research on nutrition in thediseases, including postoperative and chronic management of disease can help health care

53

providers integrate nutri t ional concernsmore fully into the health-care system. By ap-plying these results and by improving thequality of information provided to patients,the nutritional status of those under medicalcare can be improved and the chances forsuccess of treatments for their specific condi-tions improved.

Nutritional Support of Patients WithSevere Disease and Injury

The treatment of severe disease and injuryaccounts for the major costs involved in hos-pital care and represents the greatest oppor-tunity for trained physicians and other healthprofessionals to use new knowledge in thecare of patients.

Severe systemic and infectious diseases.Patients with severe illnesses resulting in per-manent and prolonged disability may requiremajor qualitative and quantitative modifica-tions of their intakes with respect to energy,amino acids, minerals, and vitamins. Othersmay require special routes for feeding, Majorareas for research include:

1.

2.3.4.5.6.

Gastrointestinal diseases, including re-gional ileitis, ulcerative colitis, shortbowel syndrome, primary bowel disor-ders;Infection;Liver disease;Renal disease:Cancer; andDiabetes mellitus.

Severe injury. Severe injury involves burns,severe trauma (such as that sustained fromdamage to vital structures through accidentor gunshot or stab wounds), compression-de-compression injury, irradiation, and majorsurgical procedures. It is well known thatnutrient requirements and metabolism arealtered in these states. Moreover, the pos-sible methods of feeding and nutrient mix-tures may need to be modified in those specia-lized states (e.g., intravenous feedings, con-tinuous infusions, alterations in hormone re-lease and responsiveness). Therefore, thesetopics are important research priorities.

Inborn errors of metabolism. The numberof people with inborn errors of metabolism is

54

not large. These diseases include the inbornerrors of amino-acid metabolism and thelipid-storage diseases such as Tay-Sachsdisease. These disorders have profound ef-fects in terms of early death and permanentphysical and/or mental disability. Furtherresearch on the nutritional management ofthese diseases may yield benefits similar tothose achieved in the treatment of phenylke-tonuria (PKU), Infants born with PKU, whenraised on a special diet, develop normally andavoid the mental retardation that occurs inuntreated PKU,

Other Disease States

Other less severe conditions need to be ex-amined as to the role of nutrition in their man-agement. While they are not causes for hos-pitalization, they are inconvenient and tempo-rarily disabling. Therefore, clinic time, losttime to the patient, and cost of prescribed orover-the-counter drugs are considerable. Thepotential role of nutrition in providing care orprevention of these conditions has not yetbeen clarified and awaits future develop-ments in the area of basic research. Thoseareas of importance include:

Acute gastrointestinal disease in adults, in-jants, and children. Acute gastrointestinal in-fections may lead to secondary malnutritionfrom malabsorption if they are treated incor-rectly. Research is needed to identify theseconditions and correct treatment.

Food intolerances, Food intolerances suchas celiac disease, sensitivity to various milkproteins, other sensitivities, and intolerances.

i m m u n e a n d au to immune d i seases .Preliminary findings suggest a relationshipbetween diet and the development of some im-mune and autoimmune diseases.

Technology for Deliveryof Nutrients to Patients

We are concerned here with a variety ofvery practical problems aimed at improvingthe nutritional status of severely ill patients.These involve:

Improvement of dietary formulas. Improve-ment of dietary formulas for those withspecial feeding problems such as patients

who m u s tperiods by

be maintained for substantialparenteral nutrition alone, those

with genetic defects who require chemicallydefined diets, those in whom certain foods ornutrients must be severely limited as may bedesirable in chronic renal disease, institu-tionalized patients with special feeding prob-lemsas in mental hospitals and homes for theaged. Palatability is a particular issue of im-portance to patients when oral feeding routesare used and must not be forgotten in thequest for more effective formulas from themetabolic standpoint.

Improvement in the delivery of such for-mulas. Better techniques for delivery of par-enteral solutions, intragastric feeding and in-travenous feeding outside the hospital (oftencalled home total parenteral nutrition (TPN)),and the feeding of patients who cannot feedthemselves are also needed. Substantial op-portunit ies for lowering the cost of themanagement of such patients by these techni-ques as well as improving their nutritionalstatus will result from such efforts.

Behavioral and Emotional problems

The number of patients who come to healthpersonnel with psychological and psychoso-matic stress-related problems that theysuspect are diet-associated is on the increase.

Effects of dietary constituents on behavior,Certain dietary constituents such as mono-amine oxidase inhibitors, monosodium gluta-mate, and certain food colors and flavorshave been implicated as having effects on be-havior. The whole question of hyperactivitydue to foods or food constituents is still anopen one, yet results from two large studies todate indicate that the results of attempting toassociate or disassociate foods and hyperki-nesis have been equivocal, Recent findings inother areas suggest that diet-drug interac-tions affecting behavior may be more commonthan was previously thought. Research ex-ploring the possible effects of these food con-stituents and interactions on behavior isneeded to make satisfactory medical recom-mendations as well as to provide regulatoryagencies with information which may behelpful in decisionmaking on the use of cer-tain food additives. Methodologies for precise

and sensitive measurement of different be-havioral indices are urgently needed; the lackof such indices limits progress on the effectsof dietary constituents on behavior.

Effects of various patterns of moderatealcohol use on behavior and performance.Dose, pattern of alcohol consumption, thepurposes for which it is used, and the socialcontext of consumption are all associatedwith its potential for misuse, Forms of alcoholconsumption that pose the least risks of harmneed to be identified.

Other related studies. Research on the ef-fects of diet on human behavior must involvestudies of specific dietary constituents aswell as studies on food consumption. Threeresearch areas are therefore apparent: theeffects of kind of food, amount of food, andfeeding interval on behavior; the effects ofspecific nutrient deficiencies and marginaldeficiencies on behavior; and the pharmaco-logical effects of food constituents, food ad-ditives, and accidental food contaminants onbehavior.

Analysis

Need

Recent studies have uncovered a shockingdegree of overt undernutrition among hospit-alized patients. The sources of this malnutri-tion may be undernourishment in the elderlyand ill before they enter the hospital, recogni-tion of a problem that has always been withus, or failure to provide nutritional support,

Research advances in the nutritional man-agement of disease can be expected to short-en hospital confinement, prevent complica-tions, and hasten convalescence. It is impor-tant to evaluate the impact of new methods ofnutritional support and treatment on suchvariables as patient response to treatmentand changes in number of hospitalizatio n

days. If significant positive changes areachieved, inclusion in patient care may large-ly pay for itself by tradeoffs in other areas.

Finally, the impact upon quality of life ofthis research is likely to be high. The chronicdiseases include many which cause seriousincapacitation and pain, as well as those

55

which collectively account for the vast ma-jority of urgent demands for health-care ser-vices. Improvements in management maytherefore improve quality of life.


Recent advances in the applied scienceshave opened up a whole new field involvingreversal or management of disease by provi-sion of supportive nutritional therapy. Herepotential for breakthrough is high, particular-ly if it is possible to train physicians and otherhealth providers who presently lack thisknowledge.

A good deal of basic science background isalready available in some areas so that fun-damental “ b r e a k t h r o u g h s ” t o a c h i e v etransfer of findings from research to applica-tion at the clinical level can be expectedrelatively quickly.

Applied research efforts in this field canbe expected to yield results which requirelarge-scale testing and refinement to demon-strate effectiveness. Such clinical trials areexceedingly expensive and must therefore beundertaken only after careful planning andexperimental design.

Capability

While the technologies and personnel areavailable at present, they are in short supplyand highly specialized. Only small-scale re-search studies are being done. Better integra-tion of research with clinical training mayhelp in making this type of expertise morewidely available.

The development of clinical nutrition re-search must be primarily a medically relatedactivity. However, it should have a close rela-tionship to other nutrition and food scienceresearch activities and personnel whose inte-rests are broader than nutrition in the treat-ment of disease so that their specializedknowledge may be transferred as rapidly aspossible.

cost

Current levels of funding are inadequate todevelop technology transfer to the wide-scalepractice of procedures which have already

been demonstrated useful . Resources re-quired are essentially financial.

This research can be expected to have eco-nomic implications over the long term interms of lessened disability, fewer complica-tions, and shorter total hospital stays.

Most research on improvement of dietaryformulas and techniques for delivery of for-mulas is supported by private industry. Fed-eral research costs in this area are thereforeexpected to be low.

Immediacy

The time span involved to solve these prob-lems varies a good deal and depends upon thedisease state under consideration as well ason the availability of basic science and tech-nology. Where these are sufficiently devel-oped, a mission-oriented approach would bemost appropriate for speeding up practicalapplications. However , pas t exper ienceshows that applied studies must rest upon rel-evant data generated at the basic sciencelevel. In many of the areas mentioned, long-term studies will be needed before clinicalapplication of findings can be considered.

Other Considerations

The potential for linking this type of re-search with training is high. Such an ap-proach would also help to maintain researchpotential. This research, conducted in clini-cal settings, would be a stimulus to health-care providers and encourage them to inte-grate nutritional concerns more fully into thehealth-care system. The research which hasalready been done has had a positive effect inthat it has generated increased interest inclinical nutrition and preventive medicineamong some sections of the medical commun-ity and particular among medical students,

The necessity for assuring that adequatetraining in newer aspects of clinical nutritionapplication is provided to students in medicaland other health professions is closely associ-ated with this priority. Over the long run, pro-vision of such training funds would allowmore rapid application of existing researchfundings and technologies to patient careproblems, thus achieving greater impacts perresearch dollar expended.

56

NUTRITION EDUCATION AND CONSUMER INFORMATION

Just if i cat ion

Present knowledge as to how nutritioncontributes to the maintenance of positivehealth as well as to the prevention or treat-ment of chronic diseases is considerable. Torealize the potential benefits from this re-search and from future research, findingsmust be translated into practice. Individualsmust have the opportunity to incorporatethem into their own eating practices and life-style. We know very little about how to sup-port the maintenance of nutritionally desir-able behavior to help individuals adjust theirdietary practices. Nutritional behavior in thiscontext includes such practices as food con-sumption, food selection and purchase, foodpreparation and storage, physical activity,and lifestyle.

The Federal Government supports severaldifferent types of nutritional intervention pro-grams. These include nutrition education,food fortification, food regulation and inspec-tion, food price support, and various feedingprograms, including Food Stamps, programsfor the elderly, women, infants, and children.For many nutrition practices, consumer nutri-tion education alone or in combination with afeeding program may be the most feasiblemechanism for influencing food choices. Italso possesses the advantage of leaving deci-sions in the hands of the public rather thanexpanding the role of Government.

While there is a common core of researchquestions that must be explored in order todevelop a basic understanding of the dynam-ics of food choices, it must be rememberedthat different agencies with different legisla-tive mandates have unique concerns whichmust be served by nutrition education re-search, Therefore, different research em-phases of individual agencies must be con-sidered,

In FY 1976, the Departments of Agricul-ture and Health, Education, and Welfare sup-ported roughly $70 million of nutrition educa-tion activities. Very little of this money is ac-

tually allocated to research, and the vast ma-jority goes to programs.

The primary emphasis of Federal nutritioneducation programs until now has been theobtaining of an adequate diet. Since this isnot the major nutritional problem in theUnited States today, the public deserves to beinformed about nutrition and other measuresthat promise to help in health maintenanceand the prevention of disease. Knowledge isoften incomplete to move forward with firmrecommendations of demonstrated utility. Butthe public’s need for information on the prosand cons of the measures is still present.Such information would allow them to under-stand the changing nature of scientific knowl-edge and to play a more active role in adopt-ing healthful food consumption practices intheir own lives if they wish to do so. It wouldalso help them to make more rational use ofthe enormous amount of health-related in-formation they constantly encounter.

Since little research on nutrition behaviorand education is currently conducted by theFederal Government, research in these areasshould accomplish four goals:

1.

2.

3.

Definition of the focus of nutritional be-havior and education research. Thespecific issues, concerns, or contentmost urgently in need of study or atten-tion in light of national interests need tobe defined. The panel’s recommenda-tions on these areas are described in thefollowing section.

Guidance for Federal food and nutritionpolicies and programs. In view of the rel-atively large amounts of Federal moneyspent each year on nutrition educationprograms and the lack of evidence of ef-fectiveness of these programs, this areais probably one of the greatest congres-sional concerns.

Development of a theoretical frameworkfor nutritional behavior. Little or notheory has been developed to explain orallow prediction of nutritional behavioror to indicate which nutrition education

57

approaches are likely to be most effec-tive in different situations.

4. Development of methodologies for study-ing nutritional behavior, testing nutri-tion communications, and evaluating nu-trition education effectiveness. Therehave been few systematic attempts tocatalog the methodologies available andapplicable to such studies.

Factors Affecting Lifetime Eating Habitsand Identification of Critical Pointsfor Education

Successful nutrition education must takeinto account all of the various factors thatmotivate consumer food choices. Current nu-trition information and education programsfunded at the Federal, State, and local levelshave a weak research base. A modest expen-diture of funds in the following areas shouldyield high returns in improving the effective-ness of existing programs:

Sociocultural and other lifestyle factorsthat influence American dietary patterns. Im-proved public health through better nutritionfor groups that run particularly high risk ofproblems depends on better approaches be-ing developed in this area. A great deal isknown about clinical implications of certaindietary lifestyle habits, but we know very lit-tle about the factors that influence the adop-tion of these eating patterns or how they canbest be influenced. One step in the right di-rection is to identify the various characteris-tics of groups within our diverse population.

Times of life which are particularly ripe foreducation intervention. We need to knowwhen particular types of consumers are mostresponsive in terms of their lifestyles andfood habit formation to receiving differenttypes of nutrition and health-related informa-tion.

Food advertising and its effects. The influ-ence of food advertising on eating habitsneeds more careful study. The food industryspends between $1 billion and $5 billion an-nually on advertising. The degree to whichsuch advertising influences food choices andaffects or competes with consumer compre-

hension of nutrition information from othermore objective sources needs study.

Development and Evaluationof Nutrition Education andCommunication Methods

Since the goal of nutrition research is to im-prove the health of people, it is important thatcurrent research knowledge be communi-cated to the public in daily living. Means forcommunicating useful research findings tothe public so they can be acted upon in dailylife need testing. The message communicatedmust optimize the ability to make food choicesthat will promote health, taking into accountlifestyle constraints.

More effective methods for evaluating theeffects of teaching efforts in schools areneeded. Since public education is the respon-sibility of the States, intergovernmental col-laboration between Federal and State agen-cies will be necessary in order to achieve this.

Evaluation of nutrition education programsrequires clear cri teria for achievement.Research efforts in this area include investi-gations of effective program design and de-velopment of criteria for success, Methodsfor nutritional status and risk factor evalua-tion may be relevant and need incorporation.Significant research findings which can beput into practice should be available within arelatively short term. However, pilot pro-grams, carried out over a period of 5 to 10years, will also be needed to assess the utilityand long-term effects of such improvements,

The development and testing of models forscreening and evaluating educational mater-iak is also needed. Such systems can be usedto examine the appropriateness and effec-tiveness of materials currently being used inrelation to functional literacy, nutritionalproblems, and communication modes of thevarious populations towards which they aredirected.

This research focuses on finding the mostuseful ways of fostering healthful food con-sumption practices by educational means.Useful areas of research here include:

Identifying current sources of informationand locations or settings in which specific

58

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types of nutrition information are most effec-tively delivered and the most appropriatemeans to do this (e. g., family support systems,community organizations, the health caresystem, work sites, the school system, media,Government, private sector, etc.).

Measuring the effectiveness of communica-ting objective information on controversialtopics and information with respect to dietand health risks. People need to have infor-mation on the pros and cons of differentchoices with respect to diet so that they canmake their own decisions and choose dietarypractices which are appropriate to theirstyles of both life and health. Enough evi-dence exists at present to suggest broadguidelines with respect to prudent measuresfor health, price, and other aspects of diet.There is no expectation that a single optimaldietary pattern can or should be generated.

Research must be directed toward develop-ing a series of dietary recommendations fordifferent income, ethnic, age, and sex groupswithin the population, taking into accountvariations in their total environment, habits,economics, and their own estimates of risk,Some recommendations can appropriately bemade today, but a good deal remains to bedone in finding the most effective ways tocommunicate such changes. Research is alsoneeded to determine the most effective meansfor researching different target groups.

Many risk factors associated with the laterdevelopment of chronic diseases are alreadypresent by the time children leave grammarschool. Some of these, such as obesity anddental caries, are nutrition-related. People ofall ages have enormous difficulties in compre-hending low risks or judging low-probabilityevents, Issues that currently fall into this cat-egory include the advisability of various nu-tritional patterns for health maintenance andthe nutritional value and safety of the foodsupply as well as the association of diet withdisease.

The proper response of Government whenfaced with the dissemination of new findingswith respect to risk factors is an importantquestion that must be clarified by publicdebate.

There is virtual unanimity that Govern-ment does have an obligation to provide infor-mation that promotes health-related behav-ior; however, as attested to by recent con-gressional investigations and Federal legislat-ion and appropriations in the area, researchis needed on the best ways to do this.

Research on Methods for SimplifyingConsumer Information Utilization

Consumers are likely to benefit most direct-ly from information which reaches them intheir daily lives. Food labeling for nutrients,ingredients, and unit prices are examples ofhow consumers can acquire information di-rectly. Many foods are not adequately la-beled today, and the present form of nutritionlabeling may be difficult for some consumersto understand, The value of graphic forms oflabeling; extension of the number and type offoods labeled to include meats, fruits, vegeta-bles, and other commodities; and the expan-sion of the information provided to includesuch food constituents as sodium, potassium,type of fat, cholesterol, refined carbohy-drates, and dietary fiber should also be ex-plored.

Analysis

NeedThe public’s need for information, par-

ticularly with respect to chronic diseases,obesity, and wise food choices, is high. Inview of the fact that changes in the majorfood programs (such as replacing food stampswith income subsidies) are now being con-sidered, information and education on wisefood choice may be even more important inthe future. The impact of improved methodsfor helping the public to adopt healthfuleating practices was assessed to be high.


The major difficulty identified here is thatthe basic knowledge base is weak, Behavioraland social scientists have given only super-ficial attention to nutrition education re-search. It has been a scientific backwaterwhich has failed to attract the attention itdeserves from applied scientists in many dif-

59

ferent disciplines. Programs designed to pro-vide information on nutrition and to changeeating practices are presently funded by avariety of Federal, State, and local govern-ment bodies. But information provision is notsynonymous with information that attractsattention, is being at tended to, compre-hended, accepted, and used in daily life.Much of what is already known in the field ofnutrition can benefit people if it is readilyavailable in useful and appealing forms.Research addressing the question of how bestto communicate nutri t ion information isneeded to do this.

The final difficulty is our diversity. We area heterogeneous people with diverse needsand preferences. There is no single, simple,cheap, easy answer as to how to go aboutdeveloping approaches that reach all of thesediverse groups. We also require reasonablelimits for our expectations of what can be ac-complished by education.

Capability

Research in food and nutrition educationshould involve a variety of disciplines, par-ticularly nutrition scientists, food scientists,social and behavioral scientists, and educa-tors. Collaborative research efforts involvinginterdisciplinary groups including such spe-cialists as social and consumer psychologists,educators, home economists, human ecolo-gists, anthropologists, economists, epidemi-ologists, health care evaluators, sociologists,communications researchers, and consumerrepresentatives are needed to develop the re-search strategies. There is a need to developappropriate psychological and behavioraltesting procedures. The resources that arethe most sophisticated with respect to thistype of research are in other fields. The Fed-eral Government has until now had almost noinvolvement in developing methods of edu-cating the public with respect to nutrition.

In recent years no Federal expenditureshave been specifically earmarked for nutri-tion education research. Thus while vastsums are being spent by the food industry tofind ways to influence people’s purchase be-havior and many Government agencies ad-minister consumer nutrition education and in-formation programs, virtually none of this

money is devoted to finding out how to pro-vide this material in a manner that would fa-cilitate consumer comprehension and usage.Even modest amounts of funds expended onsuch research can be expected to yield highreturns per research dollar spent.

cost

While a great deal of research must bedone, great benefits can be reaped from thetransfer of already developed technologiesfrom the industr ial and communicationsfields; thus development costs are reduced.Moreover, economies may be effected by thedevelopment of more efficient program ef-forts. Federal programs now spend over $ 7 0million on nutrition education, yet researchefforts financed by Federal efforts amount tovery little. The food industry has been muchmore active in investigating factors that in-fluence our food choices. A vast amount ofmoney (estimates range from $1 billion to $5billion) is spent annually on food advertisingin an effort to influence consumers’ foodchoices, and careful research underlies theirefforts to influence brand choice. But little ofthis research is devoted directly to the issueof choosing diets that promote good health bypreventing chronic as well as deficiencydiseases and obesity. Federal expendituresare needed to broaden the research base onwhich to build nutrition education programsdealing with these issues.

Immediacy

While some benefits can be expected overthe short term, as in developing improvedlabeling and nutrition information programson risk factors, most of the outcomes willreach the stage of practical application in 5to 10 years.

Other Factors

The potential for links between researchand training was judged to be excellent.Maintenance of research potential is alsohigh if such endeavors are carried out in set-tings in which new professionals are trained.The priority areas are broad and are not suchthat creativity is likely to be hampered by thistype of mission-oriented research.

60

REQUIREMENTS FOR ESSENTIAL NUTRIENTS

Just i f icat ion

Better understanding of nutrient needs andinterrelationships increases the store of fun-damental knowledge and makes practical ad-vances possible. The amounts of certain nu-trients required by individuals of differentage, sex, and occupational groups are stillunknown. These nutrients deserve particula~attention. Little-explored interactions bet-ween nutrients and toxic materials also needmore study.

Methods for Determining Nutrient Needs

Estimation of requirements for nutrientsabout which little is known. Our knowledge ofneeds is deep for some of the 50-odd nutrientshuman beings require and is shallow forothers. For a number of nutrients, estimatesof requirements have reached a point wherefurther refinements can be expected to yieldrather t r ivial gains in improving humanhealth. A great deal of work remains to bedone in developing better methods for esti-mating requirements for nutrients aboutwhich little is known. These nutrients includemost of the trace minerals and certain of thevitamins. In some instances the gaps inknowledge are so great that even the method-ology to determine their requirements doesnot yet exist,

Nutrient needs for population subgroups,such as low-birthweight infants, adolescents,women using oral contraceptives, pregnantand lactating women, and the elderly. Weknow very little about nutrient needs for spe-cial times and events in life, We do know thatcertain vulnerable groups in the populationhave a higher risk of nutrition problemsbecause of changing needs. These groups in-clude low-birthweight infants (especiallythose having weights under 1,300 grams),adolescents (especial ly pregnant adoles-cents), women who are using oral contracep-tives, pregnant women (and their fetus), lac-tating women, and the elderly (with particu-lar attention to the effects of aging on nutri-ent need in chronic disease), The range of re-quirements for various groups of people and

the interactions between ranges of require-ments may be important.

Nut r i t ion resea rch d i rec ted toward ahealthy survival of low-birthweight infantsshould produce massive payoffs in terms ofreducing the prevalence of mental retarda-tion, learning disabilities, and perhaps neuro-muscular disorders. All of these are mostcommon in children and adults who sufferedintrauterine growth retardation and or shortgestation. Approximately 8 percent of new-borns fall into these groups. If they can behelped to a healthy survival, they could have70 to 80 years of productive living.

Nutrient Requirements Basedon Functional Criteria

The needs for many nutrients have beenset on the basis of rather arbitrary criteria.For example, the requirements for iron is setby determining what is considered to be a sat-isfactory concentration of hemoglobin in theblood or biochemical measures that reflectiron stores. More meaningful measures fromthe standpoint of s ignif icance to humanhealth and well-being might be resistance toinfection, levels associated with the bestl ea rn ing ab i l i ty , o r exe rc i se to le rance .Numerous examples exist of other nutrientsfor which relatively arbitrary criteria arepresently used, Attention must be devoted tostudies on functional cr i ter ia related toreproductive function, work capacity or pro-ductivity, and mental function.

Nutrient Interactions

Food is the most complex mixture of chemi-cals the population comes in contact with on aregular basis, The topic of chemical-drug-nutrient interactions has not yet been ap-proached except in a peripheral way, yet itcould yield significant information from thestandpoint of human well-being and welfare,Interactions among nutrients, foods, foodcomponents, d r u g s , a n d environmentalagents need careful study.

Efforts to keep knowledge of nutrient needscurrent and applicable are very important,

61

Because of the complexity of this task, it willbe increasingly necessary to develop new ap-proaches to understanding what constitutesan appropriate diet.

Requirements for some nutrients vary de-pending on the level of other nutrients in thediet. Studies on interactions among nutrientsare therefore needed. In some instancesother food components, drugs, or environmen-tal agents to which people are exposed alsoact to modify nutrient requirements or theavailability of nutrients in foods that areeaten. Our food supply consists increasinglyof processed foods. Constant effort is neces-sary to keep knowledge of nutrient needsabreast of and applicable to this changingworld.

Pharmacologic and Toxicologic Effectson Nutrition

Safety and effects of high doses of nutri-ents. The public is exposed to a great deal ofmaterial concerning the merits and liabilitiesof large doses of nutrients and dietary fiber,although little satisfactory evidence existsabout their effects. Clarification of the poten-tial for damage or benefit is needed. This typeof research should be conducted with concur-rent investigations on how these substancesexert their effects.

Nutrient needs of patients suffering fromchronic diseases that involve constant medi-cation. It is likely that some of the chronicdiseases have specific effects upon require-ments for nutrients or other substances infood. As the American population continuesto live longer each year, the proportion of thepopulation suffering from various types ofchronic disease is on the increase. Thespecial requirements of these persons needattention,

Effects of alcohol on nutritional status.Alcohol is a food as well as a drug and is con-sumed by a high proportion of the adult popu-lation, Alcohol abuse is a major problem inthis country, affecting both performance andnutritional status at some levels of intake.Studies of the effects of alcohol on nutritionstatus deserve attention because of its wide-spread abuse,

1. Effects of alcohol intake during pregnan-cy on the fetus and its subsequent devel-opment. Alcoholism has been clearlylinked with poor outcomes of pregnancy.The effects of more moderate alcoholuse also needs to be explored since theremay be serious effects on the develop-ment of the fetus. Such research canprovide guidance about acceptable lev-els of alcohol intake during pregnancy.

2. Effects of alcohol consumption on nutri-tional status and nutrient utilization.Alcohol consumption is the norm ratherthan the exception in American life to-day. The nutritional effects of alcoholconsumption need to be better delin-eated. Information amassed will help todefine the physical and social conse-quences of various levels of alcohol con-sumption and provide the basis for thedevelopment of practical recommend-ations on the controlled use of thissubstance,

3. Interactions among diet, alcohol, andother addictions. Although studies on theinterrelationships between alcohol con-sumption and nutritional status havebeen done, practically no such studiesare available with other addictive drugs,Many addictions obviously result indietary neglect and malnutr i t ion, sotheir nutritional implications deserve at-tention.

Bioavailabilit y of Nutrients in Foods

Because of the form in which they occurand the food’s composition or processing,some nutrients may not, in fact, be availableto the body even though they are eaten in thefood. One example is certain forms of iron,but there are many others. Other nutrientspresent in the raw state may be altered byprocessing to become either more or lessavailable. The effects on nutritional status ofthese factors need more careful investigation.

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Analysis

Need

The prevalence of undernutrition inUnited States is fortunately very muchthan it was even a few generations

thelessago.

However, for some nutrients, techniques formeasuring needs have not been available,and therefore we cannot yet ascertain ifproblems exist, In other cases, the importantquestions of interrelationships between nutri-ents and special needs for nutrients by high-risk groups within the population cannot beanswered until more studies are successfullycompleted. The health impact of developingbetter knowledge of the needs of prematureinfants, p r e g n a n t w o m e n (particularlyteenagers), and other high-risk groups may beconsiderable.


The relative potential of this area is limitedin areas such as interrelationships betweennutrients because basic science informationis not yet adequate. For some nutrients thereare also methodological or ethical limitationsthat make it difficult to measure needs. Fun-

damental advances in methodology are re-quired.

Capability

The fields of nutritional pharmacology andtoxicology are presently underdeveloped, anda reorientation in training of research per-sonnel will be necessary to fill these gaps.

cost

Payoffs in this area are most likely to resultfrom steady research over many years. Thislong-term process therefore requires steadyfunding over many years rather than largesums for short periods of time.

Immediacy

Steady research over many years is neces-sary to develop this type of information.


The potential for achieving multiplier ef-fects by developing close interrelationshipsbetween research and training is high in thisarea, as is that for the maintenance ofresearch potential. A mission-oriented ap-proach is probably most suitable in theseareas.

NUTRITIONAL ASPECTS OF FOOD SCIENCEAND FOOD SAFETY

Just if i cat ion

Food composition, processing, and safetyare related to the development of better un-derstanding of current nutrition and foodissues. First, there is the problem of discover-ing more about the chemical composition ofboth processed and unprocessed foods. Sur-prisingly little is known about this. For exam-ple, it is extremely difficult to obtain informa-tion on nutrients such as zinc, folic acid, andtrace elements; data for other food constitu-

ents such as dietary fiber or sugar are lack-ing for almost all foods. Second, more needsto be known about changes in chemical com-position that occur in food production and inprocessing and storage before food reachesthe consumer. Also, what consumers do infood handling and preparation after they buythe food must be considered, since this too in-fluences nutrient and food composition. Final-ly, it is important to learn more about howfood composition and processing may in-teract. Such interactions also may affect nu-trient content and food safety,

63

Food Composition

New and improved methods of analysis offood composition. A complete food analysismust include not only complete nutrient con-tent but other food components of signifi-cance as well, such as fiber, additives, andtoxic materials. For several substances of in-terest, such as various forms of fiber andtypes of carbohydrates, such methods (oranalysis) are sorely needed.

Composition of foods currently on the mar-ket and new foods as they become available(or new varieties in the case of fruits and veg-etables). The composition of many foods onthe market today is not known, whether withrespect to the nutrients or to other food com-ponents.

How the composition of foods may be al-tered through processing, handling, and hold-ing prior to use and in institutional or homepreparation, Changes in nutrients and othersubstances occur during food storage andprocessing. The changes include possiblecompleting with other food components, de-composition, or formation of toxic chemicals.Those that are likely to impact adverselyupon health are of top priority.

New Food Processing and HandlingProcedures to Maintain Nutrient Content

New methods for maximizing use of foodand minimizing spoilage, waste, and other de-terioration that lead to nutrient losses areneeded in the entire food chain from pro-ducer through the marketing system to theultimate consumer.

Better Methods of Assuring Food Safety

Better methods are urgently needed forassessing, monitoring, and minimizing toxi-cants (both natural and environmental) infoods and food systems. Since all substancesare toxic at some high exposure level, suchmethods must distinguish between risks ofvery different magnitudes. Appropriate pri-orities are critically important. Research di-rected at risk reduction must concentratefirst on those toxicants that are largest ormore easily and significantly reduced. Thedevelopment of new handling and processingtechniques should emphasize maximization of

safety rather than concentrating upon mini-mum standards. Research in this area must:

ldentify food constituents, both microbio-logical and chemical, that bear on food safetyand ultimately on health, The isolation andidentification of food constituents of possiblehazard is a considerable analytical task thatcurrently must precede effective toxicolog-ical evaluation.

Develop quick and reliable methods for as-sessing the toxicity of food constituents andadditives. Toxins of bacterial and fungalorigin pose hazards which, with the nutri-tional hazards, far outweigh all other foodrisks. Appropriate preservation and sanita-tion can prevent most microbiological prob-lems. For chemical hazards, conventional tox-icological approaches rely on expensive, long-term, error-prone feeding of single, identifiedsubstances to test animals. New short-termmethods, or preferably a battery of suchtests, may replace these for screening pur-poses. Before such short- term tests areemployed for decisionmaking purposes, theymust be rigorously validated by extensive col-laborative study on a sufficient variety ofsubstances in food and in an environment tocreate a background of interpret ive ex-perience. By such validated tests on crudelyseparated food fractions, the elaborate andexpensive conventional, analytical, and toxi-cological methods may perhaps be largelyavoided and focused only where they aremost needed.

Mechanisms for the improvement and co-ordination of surveillance and monitoring ofthese various substances in the food supplymust also be developed. These are discussedin the next section, “Monitoring NutritionalStatus. ” At present, USDA and FDA eachhave independent surveillance systems formonitoring toxic substances in foods, andthese need better coordination.

Analysis

Need

The monitoring and surveillance of thesafety of the food supply and consumptionpatterns is presently hindered because food

64

composition information is not complete. Thecomposition of a food includes all of the chem-icals contained in the food. These includenaturally occurring compounds as well as ad-ditives classified as nutrients, colors, flavors,texturizers, preservatives, and so on, Somesubstances in food that may be important tohuman health are indirect additives or unin-tentional contaminants; others are direct ad-ditives. In addition, there is a large andunquantified number of chemical-reactionproducts induced by processing or associatedwith formulation, fabrication, and cooking.Some of these constituents of food have phy-siological effects to a lesser or a greater ex-tent. Their significance upon human healthcan be ascertained only by careful research.The economic impact of eliminating harmfulsubstances from the food supply may be con-siderable, But research is also necessary inthis area to assure that changes are based onfacts rather than opinion, since the negativeeconomic impact of unwarranted changes inthe food supply is also considerable.


Basic knowledge necessary for reapingpractical benefits is available for achievingthe goals of learning more about food com-position and the effects of processing andhandling procedures upon nutrients. Bettermethods of assuring food safety await ad-vances in basic knowledge. However, reorien-tation in focus may be helpful.

Capability

The resources are available to achievemost of the goals in this section. Methodol-ogies for some types of food safety testing re-quire refinement and validation and the ex-pertise of food toxicologists.

cost

Since laboratories equipped to performthis type of research are already available,

particularly at larger universities, major de-velopment costs can be avoided.

Immediacy

The results of this research will have im-mediate and long-term practical application,Some results can be expected very soon andothers within 5 to 10 years, However, theirultimate practical utility is great. Amongother things, they should help us to:

Evaluate the nutrient value of food con-sumed and develop recommendations forchanges where required. Changes recom-mended might include new processing tech-niques adopted by the manufacturer, fortifi-cation, reformulation, or selection of alter-native food items by consumers.

Provide means to evaluate potentialchanges in the nutrient supply related to in-troduction and use of new foods, new varie-ties, or formulated or fabricated foods, and tofurnish the basis for factual recommenda-tions and appropriate action when needed.

Prevent the introduction of unsafe foodsresulting from interactions during processingof various components or selection of vari-eties with potential adverse properties,

Expand the availabdity of nutritionally ade-quate processed foods and maximize agricul-tural production.


The potential for achieving multiplier ef-fects by linking research and training arepresent if the research is carried out at in-stitutions with graduate programs, The abil-it y to maintain research potential will dependupon whether the settings in which the re -search is carried out provide for training.

65

MONITORING NUTRITIONAL STATUS

Just if i cat ion

If the national objective of assuring thebest possible nutritional status for everycitizen is to be acheived, accurate, up-to-datenutritional profiles of the population andways of measuring the impacts of various en-vironmental changes upon this status is re-quired. Particular attention is necessary forgroups likely to be at high risk of malnutri-tion. Such information is also fundamentalfor sound policymaking for food and healthprograms designed to enhance nutritionalstatus as well as for monitoring changes inthe food supply.

Certain groups— such as members of theArmed Forces, patients in Federal hospitals,American Indians, and Aleu t s—are thewards of the Federal Government, and thustheir heal th is i ts direct responsibi l i ty .Research on better means to provide formonitoring and improving their nutritionalhealth is also of particular importance.

Methods for Improving Integrationof Food Consumption and NutritionalStatus Information

Adequate methods are sorely needed forcontinually obtaining information on f o o dconsumption patterns and nutritional statuswhich can be correlated. Existing systemsneither are sufficiently integrated nor is theiroverall capacity sufficient to do this job. Datacurrently available from the Department ofAgriculture Food Consumption Survey, theHEW Health and Nutrition Examination Sur-vey (HANES), and the Center for Disease Con-trol furnish useful information on the overallnutritional status of the population. But theywere not planned in coordination nor de-signed to concentrate on high-risk groups.Subgroups within the population that aresuspected to have particularly high nutri-tional risks are not represented in sufficientnumbers, nor are data complete enough topermit detailed evaluation of their most likelyproblems, Thus the facts needed for launch-

ing useful interventions are not available.Neither survey is appropriate for surveil-lance or assessing the results of interventionprograms; nor does either provide the sophis-ticated information on food practices, at-titudes, and related habits that are necessaryif more effective intervention and informationprograms are to be mounted. The Food andDrug Administration has recently launchedyet another separate type of monitoring effortwhich may provide some of this type of in-formation; this is another independent effortthat is poorly linked to existing systems. Evenfrom this brief review, the fractionation,gaps, and potential for duplication in monitor-ing and surveillance efforts are all too evi-dent.

It has been suggested that there should beefforts to integrate monitoring and surveil-lance with local and regional systems. Localefforts would presumably be more effectivein identifying problem areas and in evalu-ating the effects of intervention programsand thus would be useful in program develop-ment. They might utilize information fromsuch already existing systems as market re-search organizations, sales of food outlets,school health examinations, hospitals, in-surance companies, and unions as well asadditional information which it may be neces-sary to collect, Research on how best to linkthe various levels of information into a na-tional survey system is needed.

Evaluation of the Effect of Foodand Nutrition Education Programs

Evaluation methodology for improving theeffectiveness of current programs. Bettermethods for evaluating programs designed toimprove nutr i t ional s tatus are urgentlyneeded . P resen t food p rograms inc ludeschool breakfast and lunch and the Supple-mentary Food Programs, as well as specialmilk programs for summer and severalschemes for provision of surplus commoditiesto nonprofit institutions at low cost. Edu-cating and informing the public on food andnutrition is accomplished through 12 dif-

66

— —..

ferent Federal agencies engaged in educa-tional programs as well as by food labelingand food advertising efforts. Finally, the safe-ty of the food supply is governed by regula-tions enforced by FDA and USDA. Researchmust continue on present programs with theobjective of improving program efficiencyand effectiveness, developing informationwhich may be needed for mounting betterprograms, and integrating these with otherhea l th and educa t iona l e f fo r t s d i r ec tedtoward the same recipients,

It is sometimes contended that the food pro-grams are essentially a politically palatableform of welfare with few or no advantagesover direct-income supplements with respectto improvement of nutritional status. Beforethis hypothesis is accepted, i t deservescareful test ing involving large-scale ex-periments that include survey research onknowledge, at t i tudes, and pract ices withrespect to nutrition, nutritional status, unex-pected but likely effects on employment, etc.,and consumer acceptance among recipients.The cost is small relative to the critical needfor objective data in making decisions aboutsuch multibillion- dollar programs.

Improved monitoring of food consumptionand nutrition status in Federal facilities. TheFederal Government is the Nation’s largestfood purchaser. In federally operated facili-ties such as defense installations, veterans’hospitals, Public Health Service hospitals,and Government offices and installations, theFederal Government is responsible for thewhole food delivery system. Such institutionsprovide an opportunity for applied researchin how best to monitor food consumption andnutritional status. The medical facilities offeradditional opportunities for research on waysto monitor nutritional status in hospitals. Asyet their potential has hardly been realized.

extent of problems related to nutrition andthe impact achieved by intervention efforts,they are extremely important. The need for abetter system of monitoring the nutritionalstatus of Americans is great,


The current state of knowledge is poorregarding the nutritional status of our popu-lation, particularly that of groups which aremost likely to be malnourished. There aremany methodological limitations that maybest be overcome by the development of bet-ter techniques for measuring nutri t ionalstatus.

Capability

Technological innovations permitting morerap id da ta co l l ec t ion and ana lys i s a re

necessary.

cost

Cost for an integrated system for monitor-ing nutritional status would be high, It is un-certain whether it is possible to either devel-op or implement an ideal system. Therefore,research and field trials are needed,

Of prime concern in the area of monitoring

nutritional status is the stabilization of fund-ing. Assuring a research budget over the opcrating costs of the present system would en-courage research on methodolog y and inte-gration of survey efforts between USDA andHEW.

Other ConsiderationsAnalysis

The opportunities for maintaining research

Need potential are high since most of the researchis conducted in Government facilities, Most

Since these studies furnish the basic in- links with this type of research are low atformation directly necessary to estimate the present.

67

NUTRITION POLICY AND MANAGEMENT

Just if i cation

Shifts in policy in the areas of economics,labor, energy, or food may result in altera-tions in nutritional status. Their effects arenot widely appreciated, and only recentlyhave attempts been made to measure them.The distinguishing characteristic of nutrition-policy research is its concern with nutritionaleffects. Food policy in the past has beenbased largely upon economic, political, andagricultural considerations, while healthpolicy has been largely oriented towardscurative medicine. Many changes of either aplanned or unplanned nature or changes insocietal institutions and systems may haveprofound and unforeseen effects on nutritionstatus. These changes include income sup-plements, agricultural price supports, level ofemployment, farm size, cost, availability ofenergy, and others.

Analysis

Need

The need for assessing the impacts ofvarious policies is high and may be helpful inassessing the relative merits of existing pro-grams.


Each discipline tends to believe that itholds the keys to unlocking problems in otherareas; yet there is no way of validating thesesuppositions. There is also the dangeroustendency in policy-oriented research toequate politically expedient solutions withtruth.

Capability

The problems addressed in food and nutri-tion policy cannot be well handled in a single

agency of the Federal Government. These aremost logically attacked by joint efforts on across-agency basis with a number of problem-solving groups. The bottom line, however,must be a primary concern for solving nutri-tion-related problems or evaluating solutionson a nutritional basis, and the nutrition andfood researchers should have a major inputinto each group.

Joint efforts involving persons from manydifferent disciplines must be mounted, withthe “mix” of such persons depending uponthe problem, The underlying concern, how-ever, must remain constant: solving nutrition-related problems or evaluating solutions withnutritional criteria in mind. Nutrition andfood scientists should have major inputs ineach of these groups. Since nutrition policystudies are concerned with the relationshipsbetween nutrition and such diverse factors ashealth, supply and demand, experts in otherdisciplines must be represented,

cost

Costs for policy research should be low.

Immediacy

Some immediate benefits could be ex-pected from interdisciplinary and interagen-cy collaboration in discussing policy ques-tions and in performing needed research.


Since most policy decisions and researchare done in settings in which training does notoccur simultaneously, the potential for linkingthis type of research with training efforts islow. Maintenance of research potential isalso likely to be poor because of the location.For these reasons, extramural research con-ducted at universities should be implemented.

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—

RELATIONSHIP OF DOMESTIC ANDINTERNATIONAL RESEARCH

There should be a strong relationship be-tween human nutrition research carried outin an international context and domestic re-search needs in the United States. The prior-ity research goals identified in this report canbest be achieved if research is carried out in-ternationally and domestically relative to cer-tain areas. The conduct of research interna-tionally has a basic relationship to the U.S.nutrition research policy, In many cases,research carried out in areas of the worldoutside the United States may be the best wayto solve problems that have cons ide rab ledomestic relevance,

For example, epidemiological investigationof certain chronic diseases states requiresgood information about disease incidence andfood patterns of societies with lifestyles andfood habits different from our own. The highincidence of extreme cases of malnutrition insome developing countries also provides a nopportunity to investigate the relationshipsbetween nutritional status and functionalperformance of individuals in a way t h a tcould not be done in the United States. Studyof the clear effects in extreme cases maymake it possible to extrapolate the results t omarginal nutritional states.

To be able to investigate some of the priori-ty research areas of nutrition, the study o fpopulations and food patterns worldwide isessential. Thus any effort to increase interna-t ional research capabil i ty in the U n i t e dStates and abroad will have a dual reward:improved nutritional status of malnourishedpeople and increased knowledge of h u m a nnu t r i en t needs and hea l th s t a tus unde rchanging environmental conditions,

Other international research may have sig-nificance principally for problems of malnu-trition in the developing world, Identifying thesocial, political, and economic determinantsof malnutrition may be the major researchthat must be carried out to design interven-tion programs to alleviate the widespreadmalnutrition in certain areas of the wor ld .The policy research that needs to be carriedout may be quite specific to the political,

social, and economic situations of the coun-tries involved.

The 1977 National Academy of Sciencesreport, The World Food and Nutrition Study,recommended four priority areas for nutri-tion research:

1.

2*

3.

4.

Nutrition-performance relations. Th isresearch should determine the damagecaused by various levels of malnutritionand the effects of diet patterns on levelsof human functioning.

Role of dietary components. This re-search would determine specific foodsthat best meet nutritional needs underdiffering circumstances and the effectsof individual nutrient levels, as con-sumed, on nutritional status.

Policies affection nutrition. This re-search would improve the effects of thefull range of Government policies fromthe perspective of their effects on nutri-tional policies and practices.

Nutrition intervention programs. This re-search would improve the effects of di-rect intervention programs and evaluatethe effect iveness of al ternative programs to reach nutritional goals.

These provide opportunities to examine awide range of intervention strategies in manyparts of the world that may have relevance tosolving nutrition problems in the U n i t e dStates. The effectiveness of agricultural poli-cies, food fortification policies, and interven-tions to alleviate malnutrition in certainvulnerable population groups may be estab-lished by programs carried out in other coun-tries.

Therefore, U.S. involvement in interna-tional nutrition research should be viewed asan integral part of the domestic research ef-fort and not as a separate effort, The coor -dination of domestic and international re -search efforts is currently poor and reflectsthe current divisions of authority. SeparateFederal agencies have responsibility for fund-

69

ing domestic and international research, withthe Agency for International Developmentsupport ing the majori ty of internationalhuman nutrition research.

The NAS report suggests that AID shouldcontinue to play the leading role in interna-tional human nutrition research, The recom-mendations propose substantial increases i nthe scale of and improvements in the sub-stance of the act ivi t ies of AID to helpestablish research and development of inter-national research centers and programs andsupport U.S. groups that wish to undertakefood and nutrition research in the developingcountries.

However, AID has suffered a serious deter-iorat ion of professional s taff capabil i ty.Resources outside of AID, whether universit-ies or others, cannot be effectively mobilized,nor can accountability be assured, unlessAID develops a significant cadre of nutritionand related specialists. This need must bemet if Congress implements the NAS recom-mendations that AID triple, from $30 millionto $90 million by 1980, its efforts in nutrition,

AID must do much more before a specificagenda for human nutrition research activi-ties should be funded. Several checkpointsneed to be assessed before Congress makesdecisions about whether to provide additionalfunds for international nutrition or to reallo-cate existing funds to this area. These are:

● Demonstration of commitment by theAgency for International Development tothe development of human nutrition re-search. This would be accomplished byupgrading and increasing the in-housetechnical capability of the Agency.

● Completion of a research plan to imple-ment the recommendations of the NASWorld Food and Nutrition Study.

● Submission of evidence of accomplish-ment of the above two tasks at oversighthearings held during FY 1979.

The alternatives to coordination of interna-tional nutrition research through AID in-clude:

1. Earmarking a percentage of U.S. moneyto international centers for nutrition.

This ensures that money goes to nutri-tion and also provides ties to productionand other aspects of agricultural re-search. However, it removes nutritionresearch from the health complex whichis strong in many developing countries.Since these centers are regional, the re-search may be too general to be useful inspecific countries,

2. Developing U.S.-developing country in-stitutional relationships. This is a provenmechanism that has worked in agricul-tural research and offers opportunitiesfor the formation of consortia among anumber of U.S. and developing countryinstitutions. Title XII of the ForeignAssistance Act of 1975 declared that theUnited States should provide “increasedand longer term support to the applica-tion of science to solving food and nutri-tion problems of the developing coun-tries. ” This has served as the basis forland-grant and other eligible universitiesentering into cooperative research pro-grams with counterparts in developingcountries. Critics of this type ofcooperative arrangement point out thatpolitical agents tend to undermine long-term development, that too much moneyis spent within the United States, andthat this country does not have the capa-bility to solve the problems of other coun-tries.

3. Provision of funds to international or-ganizations. The funding of nutrition re-search through internat ional organi-zations would strengthen internationalcooperation, depoliticize U.S. involve-ment, and strengthen United Nationscapabilities. However, there has been alack of coordination within the UnitedNations research complex, and the typeof research required for the solution ofnutr i t ional problems traversing bothhealth and agricultural concerns hassuffered. Funding of internationalresearch through international organi-zations also removes accountability ofh o w p r i o r i t i e s a r e s e t , r e s e a r c hmonitored, and money spent.

70

4. Provision of funds directly to developing mechanism for research funding wouldcountry institutions. This mechanism have little direct U.S. payoff and wouldputs money where the problems are, re- decrease the amount of technical assis-duces U.S. overhead and administrative tance that could be offered. There is alsocosts, helps to build individual national a loss of accountability of how prioritiescapabilities, a n d m a y i n c r e a s e t h e are set, research monitored, and moneyrelevance of the research done. Such a spent.

DEVELOPMENT OF RESEARCH PERSONNEL

Better coordination between projectionsfor research needs and the training of re-search personnel is needed. This section ad-dresses this priority. Increased emphasis onfederal ly funded research requires somechanges in existing programs to encourageapplication of what is known to better humanhealth as well as an increase in training ofcertain types of research scientists.

Links Between Research and Training

Research requires trained personnel. Suchpersons, at every level, are produced only byuniversities. Although this expertise can befurther developed in a variety of settings byparticipation in actual research efforts, it isdebatable whether the recent emphasis on re-search by contract or by private and govern-mental organizations has in fact been moreefficient. It is likely that university-relatedresearch efforts, which also produce scien-tists, have been impoverished as a result. Thefruits of such shortsightedness in the past arepresently evident in the fields of nutrition andfood science, where there is a shortage of ap-propriately oriented research personnel .There was a widespread perception in the1950’s and 1960’s that the field was unimpor-tant. Funding was minimal, research effortswere limited, few research personnel weretrained, and positions available for themwere few. These effects are still felt todaybecause a field of effort cannot be “turnedon” or “turned off” readily as problems areperceived to be more or less important. A“leadtime” of 10 to 20 years is required toproduce a research effort of the magnitudethat can be felt at the national level. Morecareful planning is needed in this area. Since

a number of fields of research that receivedmajor emphasis during the 1960’s apparentlyproduce excessive numbers of personnel,more precise methods are needed so thatsimilar types of overflow do not develop innew fields.

Types of Personnel Available

Doctorates in nutritional sciences and re-lated disciplines such as public health nutri-tion, veterinary medicine, and food science.Although the availability of training grants inthe nutritional sciences has declined becauseof phasing out of this program at HEW, nutri-tion departments continue to attract gradu-ate students. Lack of student support is aliability for attracting top-quality studentswho have the option of going into otherbiological and health research areas.

Many outstanding graduate programs al-ready exist where a major part of the basicnutritional research of that unit is conductedby graduate students as part of their doctoraltheses. Yet some changes in emphasis withinthese programs might be helpful. Greaterstress on human diseases with a nutritionalcomponent, nutritional pharmacology, foodscience principles, and evaluation of nutri-tional status are but a few examples of thedirection these changes might take in nutri-tion sciences training.

Public health nutrition research also needsreorientation and increased emphasis on theimportance of related fields such as epidemi-ology, behavioral sciences, health servicesadministration, community organization, andnutrition policy, without losing their strongbasic core in nutritional sciences.

71

It is generally agreed that training for a re-search career must incorporate research ex-perience over an extended time. These sci-entists can best meet the health-related nutri-tion research needs of the Nation by extend-ing their training as postdoctoral trainees ina clinical or community setting, which will ex-pose them to the nutritional problems ofhealthy or diseased persons.

Veterinarians are particularly well pre-pared to do experimental animal research,but very few receive training in nutrition ordevelop research capabilities. They are in aparticularly favorable position to correlateclinical disease with its underlying nutri-tional bases, using multidisciplinary ap-proaches involving nutritional biochemistry,toxicology, and pathology. Postdoctoral train-ing of veterinarians in nutrition research isneeded to attract these people and make themfully productive in the area.

The complex chemical nature of food re-quires a thorough foundation in the chemicaland biological aspects of food as well as anunderstanding of food processing principles.Not all State universities or agricultural ex-periment stations and a very limited numberof private universities have food sciencegraduate programs. A small but increasingnumber of universities have combined foodscience and nutrition programs. Only a fewuniversities have capability in food safety,toxicology, and pathology.

Training of physicians and dentists forresearch in clinical nutrition. The physicianor dentist who is interested in a researchcareer in clinical or experimental nutritionwill profit from postdoctoral experience in ast imulat ing research team working withei ther humans or experimental animals,where he or she can become familiar with thechemical and physical methods which under-lie nutritional investigations, Greater empha-sis in undergraduate medical education onexposure to the facts of nutritional biochem-istry and clinical nutrition in the broadestsense will help to attract physicians to thefield and assure transfer of knowledgeresulting from research to the patient.

The Nutrition Cluster Report of the Presi-dent’s Biomedical Research Panel suggested

that 25 to 40 postdoctoral fellowships peryear could reduce the timelag in having anadequate supply of instructors for our med-ical and dental schools. To further stimulatethe initiation and expansion of such training,this same report recommended that 10 to 15faculty positions in medical schools becreated with Federal funds with the stipula-tion that after a limited period, support wouldbe assumed by the medical school, Such posi-tions would be regular faculty appointmentsin traditional academic departments such aspediatrics, internal medicine, or surgery; thesubspecialty would be clinical nutrition. Suchfaculty might have a double affiliation in aclinical or community medicine departmentand some appropriate basic science depart-ment. These recommendations would providea means of hastening the introduction ofclinical nutrition and public health nutritioninto the mainstream of academic medicine.

Research is also necessary in how best tointegrate food- and nutrition-related con-cerns into the health care system, Profes-sionals who are experts in one area may haveunsound information in other areas that areequally important in cl inical and publichealth nutrition.

Training of dietitians and allied health per-sonne l i n nutrition research methods.Research efforts in the health sciences re-quire the part icipat ion of heal th profes-sionals in various fields. Dietitians, phar-macists, and other allied health professionalstrained and experienced in research methodswould be needed to complete the multidiscip-linary teams of scientists engaged in clinicalnutrition research.

Training of nutrition educators. Nutritioneducators are persons trained in any of thefields mentioned in this section who havespecial expertise in the dissemination of ac-curate information on the sciences of nutri-tion to others as well as training in nutritionsciences. They often lack the specialized ex-pertise necessary to interpret technical re-search articles to laymen and suffer from thefailures of the scientific community to mounteffective efforts aimed at information trans-fer. However, given appropriate informationthey are able to further package and shape it

72

in a form most appropriate to the audience inquestion. The i r t r a in ing needs inc ludestronger preparation in basic sciences andgreater attention to information transfer—more specifically, learning theory, instruc-tional media, methodology, art, and graphics.

Associate- and bachelor-level training. Aswidespread nutrition and monitoring and in-tervention programs develop, the need for ex-tensive numbers of persons for routine workin laboratories or in the field will become ap-parent. In many cases, these jobs can be doneby technicians with bachelor or associatedegrees. In the fields of chemistry, engineer-ing, and medical technology, these personshave tradi t ional ly been trained throughwork/study programs to supplement more for-mal training at the educational institution.Similar programs could be developed fortechnicians in nutrition,

Present Estimates of Personnel Available

In an attempt to determine the currentnumber of scientists engaged in human nutri-tion research and the numbers of researchscientists being trained, OTA contacted fiveprofessional societies and six Governmentagencies. Of the professional societies, theAmerican Public Health Association, the In-stitute of Food Technologists, and the Ameri-can Chemical Society make no attempt to dis-tinguish between members engaged in re-search versus other career orientations andtherefore could not supply information on theproportion of their membership engaged inhuman nutrition research or training of nutri-tion research scientists. Membership in theAmerican Institute of Nutrition is limited tothose who have made significant contribu-tions to the field of nutrition research. Bydefinition, all of AIN’s 1,730 members are nu-trition-research scientists. This number seri-ously underestimates the total number of sci-entists in the field, since junior people are noteligible for membership and very few behav-ior and education researchers are included,AIN does not keep any figures on training. Of

the American Dietetic Association’s 21,751members in 1977, 764 state they are engagedin research activities. This does not indicatethe degree of involvement and, of course, neg-lects those outside of dietetics engaged innutrition research.

The two Government agencies that fundthe largest portion of nutrition research,HEW and USDA, do maintain figures on sci-entist-years devoted to nutrition researchand USDA also makes 5-year projections ofpersonnel needs. At USDA* in FY 1976, 193.5scientist-years were devoted to human nutri-tion research as defined by the Agency. The5-year projection of need for nutrition re-search scientists at USDA is for 260.7 scien-tist-years, a 20-percent increase. At NIH inFY 1977, the intramural manpower figurewas 70 scientist-years devoted to human nu-trition research as defined by the Agency.However, in testimony before the SenateSelect Committee on Nutrition and HumanNeeds in October 1977, Dr. Donald Fredrick-son stated that ‘‘180 intramural investigatorsdirectly involved in nutrition research” wereemployed at NIH but that only 20 intramuralinvestigators could be considered “classicalnutritionists. ” In FY 1977, 20 lead scientists,those holding MD, PhD, or DVM degrees, and50 junior scientists were conducting nutritionresearch at Letterman Army Institute of Re-search of the Department of Defense.

There is therefore a clear need to identifythe number of scientists engaged in nutritionresearch and the numbers of those in trainingwith a breakdown by research interest (gene-ral categories such as nutrition education,clinical nutrition, etc. ) and site of research(Government facility, university, industry,private research institutes).

In order to finance preparation of those re-search careers to fill gaps which are obvious,the extension of expanded Federal supportmust be considered, Candidates for trainingin these areas, particularly the newer fields,wil l be at t racted by the avai labi l i ty offellowship and training grants at institutionswhere outstanding research is done,

*USDA scientist-~’e~rs in~lucie nutrition research scientists at State Agrimlture Experiment Stations.

73

REVIEW OF REPORTS ONHUMAN NUTRITION

In preparation for this assessment, OTAreviewed numerous journal articles, Govern-ment documents, and activities. The 1969White House Conference on Food, Nutrition,and Health was chosen as a starting point foranalysis, since it marked the beginning of thegrowth of public and congressional interest innutrition. Twelve reports were identified thatcontained specific recommendations on nutri-tion research priorities and on organizationof the Government to improve coordination ofnutrition research act ivi t ies . These 12reports were:

1969—

1 9 7 4 —1 9 7 5 —

1 9 7 5 —

1975—

1 9 7 6 —

1 9 7 6 —

1 9 7 6 —

1 9 7 7 —

1 9 7 7 —

1 9 7 7 —

1978—

White House Conference on Food,Nutrition, and HealthWorld Food ConferenceSenate Select Committee on Nutri-tion and Human Needs, Towards a

National Nutrition PolicyAgricultural Research Policy Ad-visory Committee (ARPAC), State-

ment on Agricultural Research andDevelopmentDepartment of Health, Education,and Welfare, Forward Plan for

Health 1977-81Congressional Research Service,The Role of the Federal Govern-ment in Human Nutrition ResearchJoint FAO/WHO Expert Committeeon Nutrition, Food and Nutrition

Strategies in National DevelopmentReport of the President’s Biomedi-cal Research PanelNational Academy of Sciences,World Food and Nutrition StudyCongressional Research Service,The Role of the Federal Govern-ment in Nutrition EducationOffice of Science and TechnologyPolicy, New Directions in Federal-

ly Supported Human Nutrition Re-searchGeneral Accounting Office, Feder-al Human Nutri t ion Research—Need for a Coordinated Approachto Advance our Knowledge

RESEARCH 1969-77

Few of these deal with nutrition researchexclusively. The specific objectives of thereports must be recognized, The White HouseConference on Food, Nutrition, and Healthdid not deal specif ical ly with nutr i t ionresearch, However, selecting from specificsessions (such as Surveillance and Evaluationof the State of Nutrition of American People;Establishing Guidelines for the Nutrition ofVulnerable Groups; Adults in an Affluent So-ciety; the Aging; the Sick; the Provision ofFood as It Affects the Consumer; and Nutri-tion Teaching and Nutrition Education) someconclusions can be reached about recommen-dations on research priorities. In general,there is “something for everyone” in thisreport, and no attempt was made to realisti-cally appraise the recommendations in lightof the relative need for the research, the feas-ibility of the research, and the technical,physical, and monetary resources available.

The Senate Select Committee’s Toward aNational Nutrition Policy stressed research inareas related to the policy and organizationalrecommendations made in that report, Sinceone of the major policy recommendations wasto develop and implement a national nutritionplan containing an improved system of nutri-tional surveillance, priority was given to thedevelopment of better, cheaper, and morereliable methods for measuring nutritionalstatus. The main areas identified were:

●

●

●

●

Increased understanding of nutritionalrequirements, especial ly the dietaryneeds of preschool children, teenagers,and the elderly.

Better information on the effects ofmalnu t r i t ion on men ta l a s we l l a sphysical development.

Research into the impact of changingpatterns of food consumption.

Basic research on nutrient-nutrient in-teraction, nutrient-additive interaction,and long-term accumulation of mineralsin the body, if significant progress isever to be made on diseases associatedwith the aging process.

74

Agricultural practice, use of processedfood, and changing lifestyles.

Food consumption habits or the long-term effects of food additives, pesti-cides, and other aspects of food qualityand safety.

Better methods of nutritional surveil-lances, especially the development ofnutritional indicators that are sensitive,reliable, and inexpensive to collect andevaluate.

Better understanding of basic metab-

— .— —

aspects of nutrition and research priorities.The emphasis was on biomedical research toincrease knowledge of human nutritional re-quirements and to improve understanding ofthe individual and complementary action ofthe essential nutrients. Special mention wasmade of eight areas:

1. nutrient requirements,2. complementary action of nutrients,3. prevention and treatment of disease,4. maternal and child health,5. aging,6. behavioral research,

olism.

The recommendations relating to nutritioneducation and nutrition education researchwere:

Intensify national efforts to providenutrition education to teachers in col-leges and universities.

Support in-service and continuingeducation after graduation.

Support a series of summer institutes innutrition and food modeled on the Na-tional Science Foundation programs ofscience teaching institutes,

Utilize modern multimedia materials andtechniques to instruct teachers.

Favor resource and development train-ing centers at select universities and col-leges.

Urge the National Science Foundation toplay a more active role in exchanging in-formation among nutri t ion researchgroups.

Field testing of nutrient fortification pro-posals, intervention or novel use ofnutrients on human subjects, Measure-ment of the impact of field tests shouldbe a focus o f na t iona l nu t r i t i ona lsurveillance.

Support for the training of nutritionresearch specialists should be steppedup.

The HEW Forward Plan for Health 1977-81contained a policy statement on the health

7. nutritional assessment, and8. health service delivery.

The report of the President’s BiomedicalResearch Panel concentrated on assessingthe state of the science and identifying areasof greatest promise in nutritional science. Inthe latter, the approach taken was to catalogthe areas along the classical lines:

●

●

●

●

●

●

●

●

Vitamins. Metabolism and mechanismsof action, genetic diseases methodology,transport of vitamins, relationship ofvitamins to central nervous system func-tion, interrelationship of vitamin nutri-tion and drug action, factors that modifyvitamin requirements, turnover, biosyn-thesis, and degradation of the vitamins.

Minerals. Trace minerals, other mineralelements.

Lipids.

Carbohydrates and energy-yieldingnutrients.

Protein and aminomechanisms, proteintional requirements.

Absorption.

acids. Basic cellmetabolism, nutri-

Nutrition-endorcine interrelationships.

Aspects of food quality, supplements,and regulations.

The OSTP report, New Directions in Feder-ally Supported Human Nutrition Research,identified four priority areas:

1 . S tud ies o f human nu t r i en t needs .Pregnancy, infancy, the elderly, obesity,

75

2,

3.

4.

iron deficiency, and nutrient toxicity andnutrient interactions.

Food sciences. Methods for food com-position analysis , bioavai labi l i ty ofnutrients in foods as consumed, up-dating National Nutrient Data Bank, andexpansion of Federal food compositionmeasurement capabilities.

Nutrition education research. Identifica-tion of factors influencing consumerd ie ta ry p rac t i ces , i den t i f i ca t ion o f“good” nutritional practices.

Monitoring diet and nutrition-relatedhealth status. Food consumption survey,cl inical and laboratory methods formeasuring changes in nutritional status,analysis of HANES data, and nutrition-related epidemiology studies.

The GAO report, Federal Human NutritionResearch—Need for Coordinated Approachto Advance Our Knowledge, identified fourareas in which major gaps in nutrition knowl-edge exist:

1.

2.

3.

4.

76

Human nutritional requirements. Usesand limitations of current quantitativenutrition standards; pregnancy, infancy,and lactation; childhood and adoles-cence, women, elderly, disease andstress, drug and vitamin usage, need forlong-term studies and comparative cul-ture studies, need for studies definingfunctions and interactions of dietarycomponents.

Food composition and nutrient biologicalavailability. Need for more current andcomprehensive food composition data,need for improved methods of determin-ing composition and biological availabili-ty.

Diet, disease causation, and food safety.Diet in obesity, diet in heart disease andstroke, diet in cancer, dietary fiber indisease prevention, and need to developimproved techniques of assessing toxichazards in foods.

Food consumption and nutritional status.N e e d f o r a s u r v e i l l a n c e p r o g r a mmonitoring nutrition status, need to im-prove methods of nutritional assessment

and identify determinants of nutritionalstatus, need to define the role of diet inthe aging process.

Lastly, the Food and Agriculture Act of1977 iden t i f i ed f ive nu t r i t i on r e sea rchpriorities for USDA. The areas were:

1.

2,

3.

4.

54

Human nutritional requirements.

Nutrient composition of foods and the ef-fects of agricultural practices, handling,food processing, and cooking on thenutrients they contain.

Surveillance of the nutritional benefitsprovided to participants in the food pro-grams administered by USDA.

Factors affecting food preference andhabits.

Development of techniques and equip-ment to assist consumers in the home orin institutions in selecting food that sup-plies a nutritionally adequate diet,

The agencies have fulfilled the stipulationthat within 90 days after enactment, theSecretary of Agriculture and the Secretary ofHealth, Education, and Welfare shall submitto Congress a proposal for a comprehensivenutrition status monitoring system.

In reviewing all the above studies, severaltrends can be seen. The White House Confer-ence on Food, Nutrition, and Health emergesas a significant milestone, even though it wasnever designed to be a serious assessment ofresearch needs. Probably because of the sig-nificant public participation, several areaswere identified that have only now emergedas areas of high research priority. Theseareas are food safety, consumer information,and nutrition education research, and the em-phasis on translation of research findings in-to applications in daily life. Those reports ondomestic research needs since 1969 have allcontained as areas of high-priority food com-position, food consumption surveys, nutri-tional surveillance methodology, and nutrientrequirements of specific populations (espec-ially pregnant and nursing women and the ag-ing). In 1975, the policy statement containedin the HEW Forward Plan for Health specifi-cally emphasized the prevention and treat-ment of disease through nutrition. This has

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since been followed through in subsequentHEW plans, as well as in the OSTP report andthe GAO report. Food safety emerged as apriority research area in the White HouseConference report, but not until the 1976Report of the President’s Biomedical Re-search Panel and subsequently in the OSTPand GAO reports was food safety seen as anutrition research priority. More recently,NAS, OSTP, and GAO named the bioavailabil-ity of nutrients and the role of nutrition inperformance as areas of high priority.

An analysis of the recommendations con-tained in the reviewed reports on organiza-tion to improve coordination is more difficultto do than for research priorities since therecommendations on organization and coor-dination have usually been vague. The WhiteHouse Conference on Food, Nutrition, andHealth recommended one system to adminis-ter all food and nutrition activities within theFederal Government. An Office of Nutrition

was recommended to be established withinHEW to administer all food programs, devel-op policy, and coordinate activities. The con-cept of consolidating all food programs andnutrition activities into one agency was aban-doned by 1975 when Toward a National Nu-trition Policy recommended the establishmentof an independent agency to formulate policyand coordinate and monitor programs; whilethe existing pluralism would be maintained,budget and line responsibilities would rest inthe agencies with nutrition programs. Thisconcept of a coordinating body independentof the agencies involved, but housed withinthe executive branch, is retained in the OSTPreport. All the reports reviewed since 1975recognize the need for better coordination ofFederal nutrition research activities, whilealso admitting the benefits to be derived frommaintaining the current division of responsi-bilities or some permutation thereof. They dif-fer in the specifics of where the coordinatingresponsibilities should lie.

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