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 Office

Washington, D.C. 20402 Stock No. 052-003 -00596-4
FOREWORD

This assessment is an analysis of nutrition research alternatives—

alternative goals and priorities, alternative definitions and funding, and alternative research personnel requirements. Its principal finding is that Federal

human nutrition research programs have failed to deal with the changing health

problems of the American people. Possibly the most productive and important

area of nutrition research will be the identification of specific dietary links to

chronic diseases, leading to methods for prevention.

The late Senator Hubert H. Humphrey, member of the Technology Assessment Board, requested the assessment to provide guidance to Congress in oversight of the executive agencies conducting human nutrition research.

The study was conducted by the staff of the OTA food program with the

assistance of the OTA Food Advisory Committee and the Advisory Panel on

Human Nutrition Research. The resulting report is a synthesis and does not

necessarily reflect the position of any individual.

RUSSELL W. PETERSON

Director

Office 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, Chairman

Senior Vice President, Schnittker Associates

Johama Dwyer, Vice Chairman

Frances Stern Nutrition Center, New England Medical Center

David Call

Director of Cooperative

Extension

Cornell University

Cy Carpenter

President

Minnesota Farmers Union

Eliot Coleman

Director, Coolidge Center for the

Study of Agriculture

Almeta Edwards Fleming

Social Program Coordinator

Florence County, S.C.

Lorne Greene

Chairman of the Board

American Freedom From

Hunger Foundation

Richard L. Hall

Vice President, Science and

Technology

McCormick & Company, Inc.

Laura Heuser

Member, Board of Directors

Agricultural Council of America

Arnold Mayer

Legislative Representative

Amalgamated Meat Cutters and

Butcher Workmen of North

America

Max Milner

Associate Director

International Nutrition Planning

Program

Massachusetts Institute of

Technology

Robert O. Nesheim

Vice President, Science and

Technology

The Quaker Oats Company

Kathleen O’Reilly

Director

Consumer Federation of America

R, Demis Rouse

Dean, School of Agriculture

Auburn University

Lauren Seth

Agricultural Consultant

Thomas Sporleder

Professor of Agricultural

Economics

Texas A&M University

Sylvan Wittwer

Director and Assistant Dean

College of Agriculture and

Natural Resources

Michigan State University

OTA Steering Panel on

Human Nutrition Research

Johanna Dwyer, Chairman

Frances Stern Nutrition Center, New England Medical Center

Howard Bauman Robert Harkins Margaret McConnell

Science and Technology Grocery Manufacturers of Society for Nutrition Education

The Pillsbury Company America, Inc.

Mark Hegsted Maiden C. Nesheim

Ellen Haas School of Public Health Division of Nutritional Sciences

Community Nutrition Institute Harvard University Cornell University

vi
Sol Chafkin

Office of Social Development

Ford Foundation

Joan Gussow

Program in Nutrition

Teachers College

Columbia University

Alice Liechtenstein

Department of Nutrition

Harvard University

Manuscript Review Panel

Hamish Munro

Department of Nutrition and

Food Science

Massachusetts Institute of

Technology

Consultants

Patricia Kearney

Frances Stern Nutrition Center

New England Medical Center

Bernard Schweigert

Department of Food Science

and Technology

University of California at

Davis

Samuel Iker

Iker Associates. Inc.

vii
Workshop Participants

Dale F. Anderson*

Quality Control

General Mills

Jane Armstrong*

Consumer Affairs

Jewell Companies, Inc.

James Carroll*

Department of Public

Administration

Syracuse University

Gerald Cassidy* **

Schlossberg-Cassidy Associates

Samuel J. Fomon**

Pediatrics Department

University of Iowa

James D. Grant**

Research and Development

CPC International Inc.

Harry L. Greene**

Pediatrics, Biochemistry,

and Nutrition

Vanderbilt Medical Center

Vanderbilt University

Helen Guthrie**

Nutrition Department

Pennsylvania State University

Richard Hall*

McCormick & Company, Inc.

James Halpin**

Southern Region

Agricultural Experiment Station

Clemson University

Gaurth Hansen**

Biochemistry & Nutrition

Utah State University

LaVell Henderson**

Department of Biochemistry

University of Minnesota

Ruth Hueneman*

Public Health Nutrition

University of California at

Berkeley

Jacob Jacoby* **

Psychological Sciences

Purdue University

Norge Jerome**

Community Health

University of Kansas Medical

Center

Ogden C. Johnson**

Hershey Foods

Paul Lachance* **

Food Science Department

Rutgers University

Alex Malaspina*

External Technical Affairs

The Coca-Cola Company

Josephine Martin**

School Food & Nutrition Section

Georgia District of

Education

Robert J, McEwen, S.J. **

Economics Department

Boston College

Max Milner*

International Nutrition Planning

Program

Massachusetts Institute of

Technology

Robert Nesheim*

Science and Technology

The 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

Activities

Nabisco, Inc.

Albert Stunkard**

Department of Psychiatry

University of Pemsylvania

Medical School

Janet Tenney* **

Office of Consumer Affairs

Giant Food, Inc.

Reinhardt Thiessen, Jr, *

Nutrition

General 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 Brown

Food and Nutrition Board

National Academy of Sciences

John E. Canham

Let term an Army Institute of

Research

office of the Surgeon General

Elizabeth Davis

Cooperative Stat e Research

Service

U.S. Department of Agriculture

T,M. Administer

Agricultural Research Service

U.S. Department of Agriculture

Lfary Egan

Health Services Administration

Department of Health, Education,

and Welfare

AlIan Forbes

Food and Drug Administration

Department of Health. Education,

and Welfare

Garol Foreman

[J. S. Department of Agriculture

Martin Forman

Bureau of Technical Assistance

Agency for International

Development

Department of State

Thomas Grumbly

Food and Drug Adiministration

Department of Health, Education,

and Welfare

Linda Haverberg

Bureau for Latin America

Agency for International

Development

Department of State

Irwin Horn stein

Bureau of Technical Assistance

Agency for International

I)evelopment

Department of State

Robert H. Herman

Letterman Arm\ Institute of

Research

office of the Surgeon

General

Col. Hickman

U.S. Army Medical Research and

Development

Command office of the Surgeon

General

Responding to Questionnaires

or Interviewed by OTA Staff

James H. Iacono

Agricultural Research Service

U.S. Department of Agriculture

Evelyn Johnson

Extension Service

U.S. Department of Agriculture

Samuel Kahn

Bureau of Technical

Assistance

Agency for International

Development

Department of State

Nancy Leidenfrost

Extension Service

U.S. Department of Agriculture

Robert Leyton

Nledical Research Service

Veterans Administration

Charles U. Lowe

Public Health Service

Department of Health, Education,

and Welfare

Ralph McCracken

Agricultural Research Service

U.S. Department of Agriculture

James Nielson

Research and Education

U.S. Department of Agriculture

Patti Okura-Leiberg

Food and Agriculture

organization

Grace Ostenso

Food and Nutrition Service

U.S. Department of

Agriculture

Llichael J. Pallansch

Agricultural Research Service

U.S. Department of

Agriculture

Albert A. Pawlowski

Alcohol, Drug Abuse, and Mental

Health Adrninistration

Department of Health,

Education, and Welfare

Seymour Perry

National Institutes of Health

Department of Health.

Education, and Welfare

Dan C. Popma

Bio-Environmental Sstems

National Aeronautics and

Space Administration

Dorothy Pringle

Cooperative State Research

Service

U.S. Department of

Agriculture

Miloslave Rechcigl

Bureau for Technical

Assistance

Agency for International

Development

Department of State

Howerde E. Sauberlich

Letterman Army Institute of

Research

Office of the Surgeon General

Neil Schaller

Extension Service

U.S. Department of

Agriculture

Ruth Schultz

Medical Research Service

Veterans Administration

Fred Shank

Food and Nutrition Service

U.S. Department of

Agriculture

Daniel Shaughnessy

Office of Food for Peace

Agency for International

Development

Department of State

Artemis Sirnopoulos

National Institutes of Health

Department of Health,

Education, and Welfare

Evelyn Spindler

Extension Service

U.S. Department of

Agriculture

Paul E, Tyler

Medical Research and

Development

U.S. Navy

Fred Wrelz

Bureau for Latin America

Agency for International

Development

Department of State

ix

.i 1-4 I “ ( I - 75 - 2
Workshop Observers

Thelma Arnold

Walter Reed

University of Health Science

U.S. Army

Beverly Cullen

Nutrition Department

Boston University

Elizabeth Davis

Cooperative State Research

Service

U.S. Department of

Agriculture

Yolan L. Harsany

Food and Drug Administration

Department of Health,

Education, and Welfare

James Hicks

Center for Disease Control

Department of Health,

Education, and Welfare

Robert Leyton

Field Operations Division

Medical Research Service

Veterans Administration

Marshall Matz

Subcommittee on Nutrition

Senate Committee on

Agriculture, Nutrition,

and Forestry

Arthur McDowell

National Cancer for Health

Statistics

Department of Health,

Education, and Welfare

Robert McGandy

Medical Center

Tufts University

Lucille McLaughlin

Nutrition Department

Boston University

Max Milner

International Nutrition

Planning Program

Massachusetts Institute of

Technology

George Parman

Trade and Development

Corporation

Isabelle Patterson

Department of Health,

Education, and Welfare

Dorothy Pringle

Cooperative Stat e Research

Service

U.S. Department of

Agriculture

Arlette Rasmussen

Food Science and Nutrition

Department

University of Delaware

Artemis Simopoulos

National Institutes of Health

Department of Health,

Education, and Welfare

Evelyn Spindler

Cooperate Extension Service

U.S. Department of

Agriculture

Geraldine Thornpkins

Office of Health Information

and Health Promotion

Department of Health,

Education, and Welfare

Edith Weir

National Agricultural Library

U.S. Department of

Agriculture
Contents

Chapter Page

EXECUTIVE 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. . . . . . . . . . . . .......15

Issue 2—Definition and Funding of HumanNutrition Research. . . . . . . . . . . . . . . . 17

Issue 3—Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . .......22

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

The Status Quo: Nutrition Research in the Federal Government . . . . . . . . .......27

Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....27

Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30

Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30

New Directions in Federally Supported Human Nutrition

Research: The OSTP Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30

Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......30

Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......32

Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......32

Federal Human Nutrition Research Needs a Coordinated

Approach To Advance Nutrition Knowledge: The GAO Report. . . . . . . . .......32

Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .....32

Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......33

Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......33

A Comprehensive Nutrition Research Strategy . . . . . . . . . . . . . . . . . . . . . . .......34

Goals and Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....34

Definition and Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......36

Personnel Resource Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......37

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

Option l: Congress Could Choose To Maintain the Overall Status Quo. . . . .......41

0ption2: 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. Page

1. Alternative Human Nutrition Research Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

2. Death Rates Per 100,000 Population for Leading Causes, by Sex

and Age: 1974 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

3. Federal Government Agencies Active in Food and Nutrition Programs

and Their Nutrition Research Priorities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

4. Federal Expenditures for Human Nutrition Research. . . . . . . . . . . . . . . . ., . .......21

5. A Seven-Point Nutrition Research Strategy. . . . . . . . . . . . . . . . . . . . . . . . . . . .......35

6. Criteria Used for Assessing Research Priorities . . . . . . . . . . . . . . . . . . . . . . . .......48

xii
EXECUTIVE SUMMARY
During this century, particularly since World War 11, Americans have

markedly altered their eating habits and lifestyles. Simultaneously there has been

an equally significant change in the major causes of death.

Fifty to seventy-five years ago illnesses during infancy and infectious

diseases, such as tuberculosis and pneumonia, dominated the mortality tables,

Nutrient deficiency diseases, such as rickets and pellagra, were also significant public health concerns.

Today we find that most Americans die from degenerative illnesses such as

heart disease and cancer. At the same time few Americans show any overt evidence of nutritional deficiency,

Unlike the infectious diseases, degenerative illness appears to result from

the complex interaction of multiple factors. Although diet is one of the factors involved, to date there has been relatively little research into the direct relationship

of diet to chronic disease. However, epidemiological studies indicate that overconsumption of food, especially certain kinds of foods, contributes to the incidence of

and mortality from degenerative diseases such as heart disease, some cancers,

stroke, hypertension, and diabetes.

The united States has gradually shifted its nutrition research focus away

from domestic nutrient deficiency questions, and toward biochemical functions of

nutrients and undernutrition in developing countries. This shift has left a vacuum

in domestic human nutrition research. Today we need to know the answers to

several key questions, such as: What specific elements in the American diet contribute to the physiological or biochemical changes which lead to the development

of degenerative illnesses? By reorienting Federal nutrition research efforts, the

links between diet and these diseases may soon be discovered. obtaining better

knowledge, and conveying it to the public, could reduce or delay the incidence of a

number of major ailments.

Research on the links between diet and heart disease has brought widely

publicized recommendtions to reduce consumption of cholesterol and

saturated animal fats. These recommendations have changed the eating habits

of many Americans. We are eating more polyunsaturated fats and less

saturated fat and cholesterol. In the last 10 years, the mortality rate from coronary heart disease has gone down over 20 percent, although heart disease

still remains the leading cause of death. No conclusive cause and effect have

been established, but diet, along with exercise and improved medical care, is

considered a factor in this decline.

Most human nutrition research in the United States is conducted or sponsored by the Federal Government, primarily through the Department of Agriculture [USDA), the State agriculture experiment stations, and the Departrment

of Health, Education, and Welfare (HEW). Alternatives for redefining and

refocusing Government nutrition research have been put forward in recent

legislation and several studies. This report assesses these alternatives, along

with the state of Federal nutrition research.

3
The principal finding of this OTA assessment report is that the Federal

Government has failed to adjust the emphasis of its human nutrition research

activities to deal with the changing health problems of the people of the

United States. The consequences of continuing to pursue the present preoccupation with nutritional deficiency diseases will seriously affect the quality of

life of present and future generations into the 21st century.

OTA”S assessment explores several optional paths that the U.S. Congress

might consider to deal with this finding. Each of these options are discussed

from the perspective of the three issue areas critical to the assessment’s principal 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 shifts

or choose among the strategies and options offered by OTA, the General Accounting Office (GAO), and the Office of Science & Technology Policy (OSTP),

These alternatives are outlined in table 1. Either alternative has economic, institutional, and health implications.

Congress could choose to maintain the overall status quo by refraining

from any action, awaiting the recommendations of the President’s Reorganization Project,

Congress could also choose to make small alterations to the existing

system without changing its overall priorities and structure, This could be

accomplished by amending the Food and Agriculture Act of 1977 to clarify the

designation of lead agency for human nutrition research, by developing nutrition research goals and priorities for HEW that complement the goals and priorities outlined for USDA in the Food and Agriculture Act of 1977, by enacting

legislation establishing a coordinating mechanism for Federal human nutrition

research activities, or by considering legislation to improve data storage and

retrieval systems currently in use,

If Congress chooses to change the emphasis of federally funded nutrition

research, such change could be based on the strategies and options put forward by OSTP, GAO, or OTA. Before any path is chosen, however, more information is required on Federal expenditures and nutrition research personnel. This could be gained through a GAO audit of Federal expenditures for

human nutrition research and a census of research personnel. Based on these

findings, Congress could consider increased training grants and fellowships to

fill any existing gaps in research personnel,
Table 1 .—Alternative Human Nutrition Research Strategies

Components of Office of Technology

strategy Assessment

Researcn

priorities

• Role of diet in prevention of

chronic disease and obesity

● Role of nutrition in treatment of disease and support of therapy

. Requirements for essential

nutrients

. Nutrition education and

consumer informatlon

• Nutritional aspects of food

science and food safety

. Monitoring nutritional

status

. Nutrition policy and

management

Definition

and funding

Personnel

requirements

Research

organization

Definition should recognize

degree of relationship to

stated goals. Before Congress

considers appropriations

for nutrition research, an

audit of Federal expenditures

should be performed using a

constant definition.

No reliable figures are

avaiIable for numbers of nutri -

tion research scientists in the

laboratory or in training.

Before a comprehensive

research program IS estabI I shed, must consider ability

of the field to implement and

sustain a program.

● Maintain pluralistic approach with well-defined

agency responsiblIities

. Initiate an interagency

committee with rotating

chairmanship

. Implement a uniform data

storage and retrieval

system

• Improve congressional

oversight through joint

planning and hearings

General Accounting office of Science and

Office Technology Policy

Research gaps:

. Knowledge of dietary

nutrients required to promote or maintain growth or

well-being at various stages

and conditions of Iife

. Information on the composition of the current

U.S. food supply and the

extent that nutrients are

biologically available

. Evaluation of long-term

health consequences of the

modern diet

. Assessment of the Nation’s

current nutritional status i n

terms of dietary excesses

and imbalances, as well as

deficiencies

Research needs:

. Long-term studies of

human subjects across the

full range of both health

and disease

. Comparative studies of

populations of differing

geographic, cultural, and

genetic backgrounds

● Basic Investigations of the

functions and interactions

of dietary components

. Updated and expanded

food composition data

. Improved techniques for

assessing long-term toxicological risks

Does not define nutrition

research. Instability of federalIy funded extramural research is a barrier to

progress. Endorses development of federally funded

regional research centers i n

conjunction with universities.

There is a shortage of nutrition research scientists.

. Effects of nutrition on

human health and performance

. Food sciences

● Nutrition education research

. Diet and nutritional status

surveillance

Definition includes basic

physiological and biochemical

research. Establishes FY 1977

research spending at $116.6

million, Recommends no increases i n funding with real location of resources to the

higher priority areas.

Not considered.

● Assign each area to a lead

Federal agency

● Eliminate unnecessary research

. Promote Government-wide

research planning, coordination, and reporting

• Coordinate agency activities

through the Federal Coordinating CounciI on Science

Engineering, & Technology

● Conduct external reviews of

intramural programs

● Improve intra-agency coordination

. Establish an ad hoc interagency nutrition education

research committee

5
Chapter I

OVERVIEW

fats

proteins
Chapter I

OVERVIEW

Modern nutrition science dates from the turn of the century when vitamins were first discovered. Since that time, nearly all elements in foods

essential for health have been identified—vitamins, amino acids, minerals,

and fatty acids. Indeed, a patient can be maintained for a long period by intravenous feeding with a purified diet that contains the known necessary

nutrients. This indicates that few essential nutrients remain to be found.

Early nutrition research was spurred by the finding that many severe

diseases such as rickets, pellagra, beriberi, and scurvy were caused by

vitamin deficiencies. These nutrition deficiency diseases were practically

eliminated in the United States by the 1940’s as a result of better nutritional

knowledge, food enrichment, agricultural advances, and socioeconomic

changes. Consequently, a belief spread among scientists that little of practical importance for the United States would result from further research in

human nutrition. Attention was instead shifted increasingly to the

biochemical functions of essential

malnutrition in developing nations.

nutrients and infant and childhood

Over the past 50 years, the basic goal of

nutrition strategy in the United States has

been to ensure an adequate intake of all

essential nutrients for the population. Nutritional advice to the public has consistently

stressed a balanced diet that provides necessary protein, minerals, and vitamins. This

strategy has been largely successful. However, it was developed and carried out with

little understanding of the long-term effects

of the abundant diet currently consumed by

the majority of Americans.

Studies during the past decade have indicated that overconsumption of food and

relative overconsumption of certain kinds of

food are important contributing factors in

heart disease, stroke, hypertension, cancer,

diabetes, osteoporosis, and dental disease.

Increased research into the role of diet in

causing and preventing such major chronic

diseases may lead to findings which could

reduce their incidence or delay their onset.

These diet-related diseases take a heavy

toll in the United States. For example, cardiovascular disease, diabetes, and hypertension share the common risk factor of obesity, which is caused by overeating and lack

of exercise. About 30 percent of men and

40 percent of women in the United States

between the ages of 40 and 49 are overweight. Many are technically “obese” -

more than 20 percent above desirabl e

weight. This fact is reflected in disease

statistics. Some 23 million Americans suffer

from hypertension and 10 million from diabetes. Diabetics are twice as prone to heart

disease and stroke. Every year, 850,000

Americans suffer fatal heart attacks.

Five of the leading causes of death are

believed to be diet-related. These are heart

disease, cancer, stroke, diabetes, and cirrhosis of the liver, The mortality statistics

for these diseases are shown in table 2. The

impact of chronic diseases extends beyond

the obvious mortality figures. Chronic diseases account for many days of work lost,

major hospitalization costs, and personal

suffering because of activity limitation.

The links between diet and these diseases

are 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 Emphygroup (in years) disease Cancer Stroke Accidents Pneumoniaa Homicide Suicide Diabetes of Iiver sema

Male. . . . . . . . . . 400

15-24 . . . . . . . 3

25-44 . . . . . . . 44

45-64 . . . . . . . 591

65 and over .. 3,081

Female . . . . . . . . 301

15-24 . . . . . . . 2

25-44 . . . . . . . 15

45-64 . . . . . . . 195

65 and over .. 2,159

191

8

29

338

1,293

151

5

35

261

723

87.8

1,5

7.7

73,1

810.7

107.9

1.3

7.9

56.2

791.8

71.1

99.1

69.6

71.0

144.2

29.0

23.9

17.4

24.9

94.6

28.9

1.9

4.8

24.9

233.7

23.0

1.5

3.1

12.5

150.7

16.3

22.1

29.5

16.9

8.9

4.4

6.3

7.0

3.7

3.2

18.1

17.1

23.1

28.2

36.7

6.5

4.6

9.5

11.8

7.3

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 have

not been established. It is therefore impossible to estimate the economic benefits to be

derived from funding research in this area.

This does not imply that attention should

not be directed to this research. Clearly,

reducing the incidence and severity of these

diseases or preventing the early expression

of them would reap large economic and

social benefits.

There is evidence that nutrition research

can make an impact on chronic diseases. Intensive studies on the relationship of diet to

heart disease, the greatest cause of death in

the United States, have yielded results. As

the connections have become clearer, at

least 16 national and international groups

have developed similar dietary recommendations to combat cardiovascular disease.

With varying degrees of emphasis, these

recommendations have urged reduced intake of cholesterol and fats, especially

saturated animal fats. In addition, they

have stressed weight control, more physical

activity, and a halt to smoking.

These recommendations, widely an d

repeatedly publicized, have had an impact

on Americans. Recent reports indicate that

while the age adjusted mortality rate from

coronary heart disease rose 19 percent between 1950 and 1963, the rate has declined

more than 20 percent during the past

14.7

0.5

3.2

20.8

110,4

20.5

0.6

2.7

20.3

130.1

21.2

0.5

13.7

60.9

61.9

10.6

0.3

7.4

28.8

22.7

15.3

0.1

0.5

18.4

131.8

3.8

0

0.2

5.7

21.4

decade. The causes of this favorable trend

are not conclusively known, but better nutrition education, changes in formulation of

processed food, and changing eating habits

appear to have played an important role.

The statistics are consistent with reported

per capita reductions in the consumption of

saturated animal fats and cholesterol, increases in the consumption of vegetable oils,

alterations of the ratio of polyunsaturated

to saturated fats in the diet, a decrease in

smoking, and the attention of many Americans to exercise. These shifts belie the

widespread assumption that it is impossible

to change American habits, including eating

habits, for the better. They also indicate

that a major chronic disease can be combated by modifying dietary behavior.

These findings are significant to future

nutrition research in light of growing

epidemiological evidence linking diet to

other chronic and degenerative diseases

such as cancer, diabetes, hypertension, and

osteoporosis. There has been little direct

research, however, into the dietary factors

involved in these diseases. Specific aspects

of diet that contribute to physical or biochemical changes leading to the onset of

such diseases are still unknown. Current

knowledge is now at the point where knowledge of diet and heart disease was in the

late 1950’s, when intense research began to

establish the relationship. Possibly the most

10
productive and important area of nutrition

research will be the identification of

specific dietary links to other chronic diseases. Such research will inevitably require

the development of new techniques and approaches.

There are other areas where more nutrition research is needed. While severe malnutrition is now relatively rare in the United

States, moderate degrees of iron deficiency,

folic acid deficiency, and possibly other

deficiencies remain relatively common. For

a variety o f social, economic, or physiological reasons, some groups in the population

are particularly prone to nutritional deficiencies. These groups include the poor, the

elderly, pregnant women, alcoholics, and

patients with chronic diseases or special

metabolic problems of genetic origin.

The identification of all or nearly all of

the essential nutrients has opened up new

areas of clinical patient care. The development of purified diets allows complete nutrition by intravenous feeding. Diets can now”

be tailored. to meet the needs of a wide

variety of patients. It is clear that many

patients—those with chronic disease ,

trauma, genetic defects, and others—have

not received adequate nutrition in the past,

Since developments in this field are still in

their infancy, further research support will

be needed to ensure continued improvements in patient care.

WHAT RESEARCH CANNOT DO

TO SOLVE NUTRITION PROBLEMS

Increased nutrition research can help

solve some of the nutrition problems of

American society, Research, however, cannot solve all such problems. Some of our

most pressing needs involve the application

of existing knowledge rather than the

search for new knowledge. If it is unclear

how to make use of existing knowledge, research indeed can help. If both the knowledge and means are available but are not

utilized, the failure may lie in the inadequate design and administration of public

nutrition education and food programs. People may fail to respond to existing programs. They may be confused by the profusion of sometimes contradictory recommendations and urgings from various experts

and authorities. It is the Government’s challenge to remedy such problems and reach

people 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 of

this 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 priorities

for Federal human nutrition research are inseparable from the organizational structure

of current research efforts. Such efforts are

now fragmented. Fourteen Federal agencies

(under seven departments) are involved in

human nutrition research. Each department

has independently established its own nutrition research goals and priorities—in line

with how it interprets its own particular

legislative mandates. The result is a piecemeal approach to nutrition research.

Although most nutrition experts agree that

the main goals of nutrition research include

the promotion of optimum health and performance, and the treatment of disease

through diet therapy and support of other

medical therapies, the Federal Government’s

activities lack such specific unifying goals.

They are still guided by the traditional

nutrient deficiency disease approach. This

fails to meet the changing needs of the American people.

Indeed, nutrition research activities in Federal agencies are generally without focus.

This confusion was pointed out by the National Institutes of Health (NIH) Director Dr.

Donald Fredrickson’s March 15, 1977 testimony before the Senate Committee on Appropriations: “, , research on nutrition is as yet,

at NIH and elsewhere, a vast, diverse, and

essentially unstructured set of activities.

This lack of overall focus is reflected in the

poor coordination of research efforts among

Federal agencies involved in such activities.

Past attempts at coordination between the

Departments of Agriculture (USDA) and

Health, Education, and Welfare (HEW), the

two principal funders of nutrition research,

have usually been of short duration and little

impact. International nutrition research, supported primarily through the Agency for

International Development (AID), is essentially independent of domestic nutritio n

research.

The result of this absence of coordination

is duplication—not only in the missions of

some Government agencies but also in their

research and other activities. For example,

both NIH and USDA’s Science Education Administration have similar research programs

on protein, carbohydrates, lipids, vitamins,

and minerals.

The Office of Technology Assessment also

found a need in Federal nutrition research

programs for better integration of data storage and retrieval. Collecting such data is necessary at all levels of nutrition research so

that findings can be better utilized. However,

various agencies now use different types of

indexing, data storage, and retrieval systems.

Thus they find it difficult to report results of

research projects. Moreover, no agency has

an efficient system of evaluating and col15
lating research findings. Because of a general

lack of accessibility, it is often extremely difficult for agencies to communicate research

information to the public or Congress.

Of course, some overlap in interests is inevitable in similar areas of research, and

duplication of research results is a necessary

part of scientific research. But unnecessary

duplication should be avoided. Minimizing

duplication by developing more efficient

means of sharing information on planned, ongoing, and completed research is an achievable goal.

In the same sense that some duplication is

a necessary part of scientific research,

healthy competition among agencies may

stimulate greater effort and ultimately benefit the public. But the proprietary stance

taken by some agencies is wasteful and inhibits joint planning. Internecine struggles at

higher levels of Government apparently foster such attitudes. However, career civil servants and the public, as well as the overall

Federal research effort, suffer as a result.

The turf battles that lead agencies to work at

cross purposes should be eliminated. Agencies involved in nutrition research should

demonstrate a commitment to coordination

and the avoidance of unnecessary duplication. This commitment needs to be built in, not

only at the “political” level of the higher

echelons of Government but also in the career

civil service.

The establishment at USDA of the Human

Nutrition Center and the Human Nutrition

Policy Committee and at HEW of the Nutrition

Coordinating Committee are two positive

steps toward intra-agency coordination. They

not only indicate a commitment to nutrition

research but also can serve as mechanisms

for interagency coordination and information

exchange.

The Food and Agriculture Act of 1977

specifies that the Secretary of Agriculture

shall “periodically consult with the administrators of other Federal departments and

agencies that have responsibility for coordinating Federal nutrition research activities. ” However without the support and involvement of the Secretary of HEW, unilateral USDA efforts to coordinate research

may not be effective. Likewise, it should be

noted that this language is ambiguous. It does

not specify “lead,” and it leaves cooperation

to the goodwill of HEW.

The need for improved coordination in

nutrition research extends beyond the executive agencies to Congress. At present 14 congressional committees and 20 subcommittees

are concerned with nutrition matters. The

principals include the Senate Committees on

Agriculture, Nutrition, and Forestry (Subcommittee on Nutrition); Appropriations

(Subcommittees on Labor-Health, Education

and Welfare, and Agriculture); the House

Agriculture Committee (Subcommittee on

Domestic Marketing, Consumer Relations,

and Nutrition); the House Appropriations

Committee (Subcommittees on Agriculture

and Labor-Health, Education, and Welfare);

House Interstate and Foreign Commerce

Committee (Subcommittees on Oversight and

Investigations, and Health and Environment);

and the House Science and Technology Committee (Subcommittee on Domestic and International Scientific Planning, Analysis, and

Cooperation, and the Subcommittee on Science, Research, and Technology). Since some

duplication of interest exists, joint sessions of

relevant congressional subcommittees to consider plans and hearings for oversight purposes should be considered.

There is a strong relationship between

human nutrition research conducted abroad

and research needs in the United States. The

research goals identified in this report can be

best achieved if international and domestic

research activities are tuned together.

Nutrition research in other countries may

help in solving domestic nutrition problems.

For example, epidemiological investigations

of certain chronic diseases require good information about disease incidence. This may

be obtained from studies of societies with

lifestyles and food habits very different from

our own. The high incidence of malnutrition

in some developing nations also provides an

opportunity to investigate relationships between the nutritional status and functional

performance of individuals in a way that

would be impossible in the United States. It

may be possible to extrapolate the results of

studies of severe malnutrition abroad to

marginal nutritional areas in this country.

16
The study of worldwide populations and

food patterns is essential to the better understanding of some of the priority research

areas of nutrition. Thus any effort to increase

international nutrition research capabilities

will have a dual reward—assistance to malnourished peoples abroad and increased

knowledge of human nutrient needs and

health status under changing environmental

conditions.

ISSUE 2—Definition and Funding of Human Nutrition Research

If one accepts that the goals of human

nutrition research are twofold—(l) the promotion of optimum health and performance,

and (2) the treatment of diseases through diet

therapy and the support of other medical

therapies—then definition of human nutrition

research flows from these stated goals, If all

the research areas involving nutrition are

listed, from basic studies on the metabolism

of nutrients to genetic studies on the development of foods with specific nutrient characteristics, it is clear that some areas of

research are more closely related to these

stated goals than others. Accordingly, the

definition of human nutrition research must

take into account these relationships to

stated goals.

In terms of this assessment, nutrition

research falls into three broad categories.

Most closely related to the stated goals is

research into the biochemical and physiological effects of food on the body in health and

disease. This category includes research on

nutritional management of disease, nutrient

needs and interactions, and research which

promotes optimum health and disease prevention through diet.

Research on food and nutrition quality

determinants is also related to the stated

goals, but less directly so than the previous

category. Under this heading would be research into food composition, especially the

nutritive components and changes in nutrient

composition that occur from point of origin to

point of consumption; food safety; social, cultural, and economic aspects of food habits;

feeding programs; nutrition education; consumer information; and nutrition surveillance

and monitoring.

The third category of research involves

basic research on sources of human food and

basic biochemistry. Research into animal

genetics, animal nutrition, plant nutrition,

and plant genetics comes under this classification. While there is need to integrate such

agricultural research with human nutrition

concerns, these areas should not be considered human nutrition research. Similarly,

basic research on metabolism of nutrients, if

not directly applicable to people, should not

be considered human nutrition research.

Basic research on metabolism should be considered as basic research underlying all of

the biomedical and life sciences. Human

nutrition research builds upon this knowledge base, but the apparent commitment to

and budget for human nutrition research

should not be inflated by its inclusion.

Throughout this assessment, a recurrent

problem has been that of definition of human

nutrition research. Agencies report as human

nutrition research studies that appear to

have little to do with human nutrition. Examples are “Catalytic Functions and Metabolism of Vitamin B6 in Bacteria and Fungi, ”

“Nutritional Imbalance and Metabolic Alterations in Fungi, ” or “Hepatoma Incidence in

Trout on Dietary Aflatoxin and PCB. ” Such

studies are worthwhile and contribute to our

understanding of basic biochemistry but are

not directly applicable to humans.

The almost unanimous consensus of the

participants in the OTA study was that attribution of these Federal expenditures to

“human nutrition research” was improper.

Fourteen different Federal agencies are

engaged in some sort of nutrition research.

Each agency has developed its own definition

of human nutrition research and set priorities

on the basis of how it interprets its legislation

mandate. The agencies and their priorities

are shown in table 3.

Federal expenditures for human nutrition

research in FY 1977 (shown in table 4) were

17

1 /
Table 3.— Federal Government Agencies Active in Food and Nutrition Programs

and Their Nutrition Research Priorities

Food and

nutrition

Department Agency programs Research priorities

Health, Edu- National National Institute of Arthritis, Metabolism, and Digestive Diseases

cation, & Institutes (N/AMDD), Basic physiological studies of nutrients; basic metabolism

Welfare 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, lowbirthweight, and premature infants; diet modification for low-birthweight and premature infants; optimum nutrition in developmental

years; nutrition and reproductive potential; genetic variability —nutritional interaction; prevention—metabolic antecedents of adult disease.

National Cancer Institute (NC/). Nutrition support of cancer patient; nutrition in cancer etiology; host-tumor interactions and competition for

nutrients; prevention strategies based on nutrition; diet and nutrition in

the rehabilitation of cancer patients.

National Heart, Lung, and Blood Institute (NHLBI). Nutrition in etiology

of arteriosclerosis and hypertension; achieving and maintaining dietary

change; development of food composition tables; methodology —colIecting, recording, and evaluating dietary data.

National Institute of General Medical Sciences (NIGMS). Traumatized/burned patients and nutrition.

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

National Institute of Neurological and Communicative Disorders and

Stroke (N/NCDS). Protein-calorie malnutrition, B-vitamin deficiencies

and 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; poor

nutrition and periodontal disease; poor nutrition and oral mucus membranes; nutrition in craniofacial malformations and oral-facial structures; nutrition and salivary gland development.

National Institute of Allergy and Infectious Disease (NIAID). Interrelated

factors hearing on malnutrition, infection, and the immune system.

National Eye Institute (NE/). Vitamins A, B-12, and other nutrients in

visual processes; diseases of visual system, e.g., keratomalacia; metab0lism 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; vitamin

supplementation in elderly; nutrient intake as a consequence of economic status in elderly; relationship among nutrition, cellular structure,

and function in elderly.

Division of Research Resources (DRR). Nutrient requirements for

growth, gestation, lactation in primates and laboratory rodents; standard diets for specific objectives; interaction of various nutrients on

physiological function in laboratory animals; differences in nutrient requirements among strains of animals within a species.

— —.

Food & Regulatory activities Nutrient efficacy and safety; nutrient interrelationships as concerned

Drug related to: nutrition with disease prevention; nutrient bioavailabiiity for food fortification

Admin- Iabeling, ingredient purposes; nutrient quality assessment of processed foods; medical

istration 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 values

food advertising, nutri- and nutritional quality and educational models to help correct

tion quality of foods misconceptions about them.

Health Re- Health and Nutrition Assessment of the nutritional status of the American people.

sources Examination Survey

Administration

18
Table 3—continued

Department Agency

Center for

Disease

Centrol

Health

Services

Administratio n

Alcohol,

Drug

Abuse, &

Mental

Health

Administration

Agriculture Agricultural Research

Service ●

Food and

nutrition

programs Research priorities

Epldemlological surveillance studies in cooperation with State

agencies assistance to Al D i n SimiIar international areas.

Collaborateive research and screening program for phenylketonurla,

Effects of alcohol consumption on ‘nutrient metabolism and nutritional

deficiencies; study of food additive consumption and hyperactivity

in chiIdren.

Human -Reqirements for Nutrient<

Determine the requirements for lipid intake and identification of the

forms of these nutrients in foods that may be useful in meeting

these requirements.

Determine the requirements for mineral intake by humans and identification of the forms of these nutrients in foods that may be useful in

meeting these requirements.

Determine the requirements for vitamin intake by humans and identification of the forms of these nutrients in foods that may be useful in

meeting these requirements.

Determine the requirements for protein and amino acid intake by

humans and identification of the forms of these nutrients in foods

that may be useful in meeting these requirements.

Determine the requirements for carbohydrate and energy intake by

humans and identification of the forms of these nutrients in foods

that may be useful in meeting these requirements.

Food Composition and Improvement

To provide accurate, up-to-date, and comprehensive information in a

readily usable form on the composition of all important foods for

those nutrients required by and biologically useful to man.

To provide the technology for the nutritional improvement of foods

when enhanced levels of certain nutrients in the diet are needed to

correct possible dietary faults.

Food Consumption and Use

To provide accurate, up-to-date, and comprehensive Information In a

readiIy usable form on food consumption and dietary levels.

To provide consultative assistance on food and nutrition problems

and provide sound guidance materials on nutrition for the consumer

and for nutrition educators, program leaders, and food program managers; to Identify techniques which will assist people in selecting nutritionally adequate diets within different budget Iimitatlons, to identify means to modify undesirable food habits; to strengthen nutri -

tionalIy desirable food choice.

To identify and develop suitable and safe procedures for food management and preparation for home and institutional consumers, for

best retention of both nutritional and eating qualities and to avoid

food-borne iIlness.

Coopera- Nutrient requirements; nutritional status of special population groups

tive State including children, low income, and aging; metabolic function of

Research 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

-—

nutrition

Department Agency programs Research priorities

Economic Economic and social research relating to domestic food programs;

Research nutrition policy in LDCS; food choices (demand); nutritional programs

Service* ● ● for the elderly,

Defense Determination of nutritional and dietary standards for Armed Forces

personnel subsisted under normal and special operating conditions;

evaluation of nutritional adequacy of food as consumed; evaluation of

the nutritional status of Armed Forces personnel; establishment of

sanitary and food hygiene standards for all food program activities;

food aspects of preventive medicine,

—

National Nutritional control of neurotransmitters; role of dietary protein and

Aeronautics specific amino acids i n optimizing human performance under stress.

& Space Administration —. . -- —

Veterans

Administration

Department of

Medicine

& Surgery

State Agency

for lnternational

Development

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 research; nutrition-related therapy.

Metabolic effects: Investigations on or related to malabsorption syndromes, inborn errors of metabolism, and familial or inherited nutritional defects.

Nutrition requirements: Studies of nutrient metabolism, malnutrition,

neuroendocrine nutrient interactions, fundamental Intermediary metabolism involving the role of one or more nutrients.

—

Development of new low-cost nutritious foods; development and

dissemination of new appropriate technologies; understanding

nutritional needs and requirements; testing and evaluation of nutrition

program alternatives; research on methodologies for improving national

nutrition planning and programing.

National Basic research in the behavioral, education, and social sciences in

Science 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 $117

million, depending on how “nutrition research” was defined. If for example, the NIH

definition is used, NIH appears to be spending $80 million for human nutrition research.

This broad definition takes in studies of basic

biochemistry, studies which are not focused

on nutrition but have a nutrition aspect, as

well as studies of primary nutrition. If a narrow definition is used, one encompassing only

those studies of direct clinical applications

and disease prevention, the NIH nutrition

research funding falls in the annual range of

$20 million. Even the higher $80 million

figure, incidentally, amounts to less than 3

percent of the NIH research budget.

HEW and USDA are responsible for the

majority of federally supported human nutri20

tion research. Seventy-five percent of Federal

nutrition research is conducted outside of the

two departments through competitive grants

and contracts. Using the more realistic funding figure of $50 million for FY 1977, NIH at

HEW funded 44 percent of the total, and the

Science and Education Administration (SEA)

at USDA funded 43 percent of the total. The

Science and Education Administration encompasses what were formerly known as the

Agricultural Research Service and the Cooperative State Research Service. Unde r

USDA’s new reorganization, most human nutrition research will be coordinated by SEA’s

Human Nutrition Center.

The Science and Education Administration

Cooperative Research (SEA-CR) of USDA is

unique among Federal agencies in that it links
Table 4.– Federal Expenditures for Human Nutrition Research

An Approxlmatlon of FY ’77 Expenditures (millions of dollars)

Office of Science & Office of Management

Agency Technology Policy’ & Budgetb

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

National Institutes of Health . . . . . . . . ... . 80.4’ 22.od

Food and Drug Administration . . . . . . . . . . . . . . . . . . . . 3.9

National Center for Health Statistics . ... 2.4

Alcohol, Drug Abuse, and Mental Health Administration, . 1.1 ●

Health Services Administration . . . . . . . . . . . . . ... 0.5’

Center for Disease Control . . . . . . . . . . . 0.3’

Department of Agriculture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.0 21.8

Agricultural Research Service. ., . 14.0 13.2

Cooperative State Research Service . . . . . . . . . . . . . . . . . . . . . 7.5 8.1

Economic Research Service . . . . . . . . . . . . 0.5 0.5

Agency for International Development. . . . . . . . . . . . . . . . . . . . . . . . 2.9 0

Department of Defense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3* 2.2

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

National Science Foundation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0.3” o

Grand 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 metabolic

st udles I n an Imals and man, research deslg ned to elucidate the metabollc role or function of an essential nutr[ent In both animal

models and man, as appropriate, al I stud les concerned wlt h genetic- nutrient-environmental Interact Ions, dietary stud Ies expected 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, and

health, 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, Human Nutr/t/on Research—

Need for a Coordinated Approach to Advance Our Knowledge, 1977

Federal and State research efforts. SEA-CR

administers funds that Congress appropriates to the States for agricultural research,

This work is conducted at the State agricultural experiment stations, land-grant colleges

and universities, approved schools of forestry, colleges of 1890, and Tuskegee Institute. In FY 1977, the States used $7.5

million of the Federal money available to

them for human nutrition research. The

States themselves provided $11.7 million for

human nutrition research in 1976. Most of

the Federal money came from funds authorized by the Hatch Act, as amended, and P.L,

89-106 (an act to amend the Agriculture Act

of 1954). The funds are accounted for under

the Hatch Act research program called People, Communities. and Institutions, which

comprised 12 percent of total Hatch Act

research funds in 1977.

Federal human nutrition research may be

financially undernourished. However, no

ana1ysis of the adequacy of present funding

levels could be made since current estimates

of Federal spending for human nutrition

research are questionable, Estimates for FY

1977 range from $50 million to $117 million

(table 4). The lower figure, based on agency

responses to a standard questionnaire, was

developed by the Office of Management and

Budget (OMB) for the FY 1979 budget, The

higher figure came from an OSTP working

group and appeared in the December 1977

report “New Directions in Human Nutrition

Research. ”

Neither is reliable. The $50 million, for example, fails to include certain nutrition

research activities within HEW, AID, and the

National Science Foundation. The $117 million, on the other hand, includes $80.4 million

of NIH spending—much of it of tenuous c.onnection to human nutrition research. In testimony before the Senate Select Committee on

Nutrition and Human Needs on October 17,

1977, NIH Director Dr. Donald Fredrickson

conceded that, based on a strict definition,

21

,4 -
his agency devoted only around $20 million to

human nutrition research in FY 1977 (a figure reported to OMB).

Another statistic which raised questions

came from the Veterans Administration (VA).

GAO put the VA’s FY 1976 nutrition research

spending at $0.5 million. In FY 1977, the VA

reported sharply increased expenditures of

$4.1 million, even though nutrition research

was not recognized as a high priority by the

agency.

In some cases, it was difficult to determine

how much (if any) money was being spent for

certain types of important nutrition research.

For instance, the Federal Government is now

annually spending about $70 million on nutrition education programs. It is unclea r

whether any of these funds are devoted to

research on which methods are most effective for reaching people.

OTA concluded that most estimates of

human nutrition research funding were questionable and that total funding fell considerably short of the reported $117 million

level. Regardless of which overall figure is

more nearly accurate, certain areas identified by OTA are not now receiving sufficient

Federal support, the result of a lack of

recognition of their importance and zero or

almost no funds. Those areas most in need of

increased funding are the role of diet in the

prevention of chronic disease and obesity,

nutrition education and consumer information, monitoring nutritional status, and nutrition policy and management.

ISSUE 3—Personnel Resource Requirements

Estimates of the number of scientists

engaged in human nutrition research also

proved elusive.

In an attempt to determine the current

number of scientists engaged in human-nutrition research and the numbers of research

scientists being trained, OTA contacted five

professional societies and six Government

agencies. Of the professional societies, the

American Public Health Association, Institute of Food Technologists, and American

Chemical Society make no attempt to distinguish between members engaged in research

versus other caree r orientations and

therefore could not supply information on the

proportion of their membership engaged in

human nutrition research or training of nutrition research scientists. Membership in the

American Institute of Nutrition (AIN) is

limited to those who have made significant

contributions to the field of nutrition research. By definition, all of AIN’s 1,730 members are nutrition research scientists. This

number seriously underestimates the total

number of scientists in the field, since junior

people are not eligible for membership and

very few behavior and education researchers

are included. AIN does not keep any figures

on training. Of the American Dietetic Association’s 21,751 members in 1977, 764 state

they are engaged in research activities. This

does not indicate the degree of involvement

and, of course, neglects those outside of

dietetics engaged in nutrition research.

The two Government agencies that fund

the largest portion of nutrition research,

HEW and USDA, do maintain figures on scientist-years devoted to nutrition research

and 5-year projections of personnel needs, At

USDA in FY 1976, 193,5 scientist years were

devoted to human nutrition research as defined by the agency, The 5-year projection of

need for nutrition research scientists at

USDA is for 260.7 scientist years, a 20-percent increase.

In a written response to an OTA questionnaire, NIH informed OTA that 70 scientists

were employed in human nutrition research

in 1977. But NIH Director Fredrickson sub

mitted a written statement to the Senate

Select Committee on Nutrition and Human

Needs that during that same time period 180

intramural investigators in NIH were directly

involved in human nutrition research. Of that

number, 20 were defined as “classical nutritionists” when nutrition research was defined as “the study of food and nutrients, ” In

FY 1977, 20 lead scientists, those holding

M. D., Ph. D., or D.V.M. degrees, and 50 junior

scientists were conducting nutrition research

22
at Letterman Army Institute

the Department of Defense.

of Research of

Before a comprehensive nutrition research

program is established, consideration must

be given to the ability of the field to sustain

such a program. No accurate figures exist on

how many scientists are currently engaged in

human nutrition research. Furthermore, few

reports on nutrition research mention this

aspect of planning.

Implementation of the research priority

areas identified in this report may require

changes of emphasis in existing graduate and

professional nutrition training programs as

well as increased training support. For graduate students in nutrition and food science,

such changes might include greater stress on

nutritional pharmacology, food science principles, nutrition education, nutritional status

evaluation, and nutrition-related diseases.

Training would be further strengthened by

postdoctoral research work with either humans or experimental animals. Greater emphasis on nutritional biochemistry and clinical nutrition in undergraduate medical education may help attract physicians to the

field.

23
Chapter III

NUTRITION RESEARCH

STRATEGIES

fats

minerals
Chapter III

NUTRITION RESEARCH

STRATEGIES

Accumulating the fragmented research activities of the 14 Federal agencies supporting human nutrition research does not, as a whole, constitute a

coherent strategy for the solution of current diet-related health problems. A

good understanding of the status quo can be gained by analysis of the Food

and Agriculture Act of 1977 which established research goals and priorities

for the Department of Agriculture (USDA). The picture of the present situation

can be completed by reviewing the research goals and priorities at the National Institutes of Health (NIH). Alternatives to the status quo can be found

in the recently published reports of the Office of Science and Technology

Policy (OSTP) and the General Accounting Office (GAO). These two alternatives, plus an alternative developed by OTA, are examined here and provide

Congress with several alternative strategies that may be pursued. Each of the

alternatives are examined from three perspectives: Do the stated goals and

priorities adequately address current U.S. health problems? Is nutrition

research defined clearly to permit realistic estimation of Federal expenditures? Is consideration given to the personnel requirements to fulfill proposed research priorities?

THE STATUS QUO: NUTRITION RESEARCH

IN THE FEDERAL GOVERNMENT

Goals and Priorities

The Food and Agriculture Act of 1977 recognized the relationship between diet and the

general health of the population. The legislation states “that there is increasing evidence of a relationship between diet and

many of the leading causes of death in the

United States; that improved nutrition is an

integral component of preventive health care;

that there is a serious need for research on

the chronic effects of diet on degenerative

diseases and related disorders; that nutrition

and health considerations are important to

U.S. agricultural policy; that there is insufficient knowledge concerning precise human

nutritional requirements, the interaction of

the various nutritional constituents of food,

and differences in nutritional requirements

among different population groups such as infants, children, adolescents, elderly men and

women, and pregnant women; and that there

is a critical need for objective data concerning food safety, the potential of food enrichment, and means to encourage better nutritional practices. ”

The legislation declares that the Secretary

of Agriculture shall develop and implement a

national food and human nutrition research

program that shall include, but not be limited

to, five areas:

1. Research on human nutritional requirements.

2. Research on nutrient composition of

foods and the effects of agricultural

27
practices, handling, food processing,

and cooking on the nutrients they contain.

3. Surveillance of the nutritional benefits

provided to participants in the food programs administered by USDA,

4. Research on the factors affecting food

preference and habits,

5. The development of techniques and

equipment to assist consumers in the

home or in institutions in selecting food

that supplies a nutritionally adequate

diet.

Although the legislation points up the relationship between diet and leading causes of

death in the United States, the research priority areas spelled out do not pursue this line

of inquiry. Since the legislation pertains

almost exclusively to USDA, it lays out what

could be considered a partial strategy to

solve the problems of diet and chronic degenerative diseases—research on nutrient

needs, on the composition of the food supply,

on ways to help consumers select a healthful

diet, and surveillance of the population. Furthermore, funding proposed in the FY 1979

budget does not match the ambitious wording

of the legislation.

The Food and Agriculture Act of 1977

designated the Secretary of Agriculture to

“establish jointly with the Secretary of

Health, Education, and Welfare procedures

for coordination with respect to nutrition

research in areas of mutual interest. ” Section 1406 amends the National Science and

Technology Policy, Organization, and Priorities Act of 1976 (90 Stat. 471; 42 U.S.C. 6651

(h)), by creating a standing subcommittee to

be known as the Subcommittee on Food and

Renewable Resources.

The legislation also established a National

Agricultural Research and Extension Users

Advisory Board composed of 21 members representing a wide variety of agricultural producer, consumer, marketing, and environmental interests. Two members must be engaged in human nutrition work. The Advisory

Board has the responsibilities for:

●

●

●

●

●

●

“Reviewing the policies, plans, and goals

of programs within USDA involving the

food and agricultural sciences, and

related programs in other Federal and

State departments and agencies and in

the colleges and universities developed

by the Secretary under this title;

Reviewing and assessing the extent of

agricultural research and extension being conducted by private foundations

and businesses, and the relationships of

such research and extension to federally

supported agricultural research and extension;

Reviewing and providing consultation to

the Secretary on national policies, priorities, and strategies for agricultural

research and extension for both the

short and long term;

Assessing the overall adequacy of, and

making recommendations to the Secretary with regard to, the distribution of

resources and the allocation of funds authorized by this title;

Preparing and submitting to the

Secretary, not later than October 31 of

each year, a statement of recommendations as to allocations of responsibilities

and levels of funding among federally

supported agricultural research and extension programs; and

Not later than March 1 of each year submitting a report on its appraisal of the

President’s proposed budget for the food

and agricultural sciences for the fiscal

year beginning in such year and the

recommendations of the Secretary contained in the annual report. ”

As indicated earlier, the Food and Agriculture Act of 1977 does not clearly give USDA

the lead responsibility for human nutrition

research. Section 1405 declares “the Department of Agriculture is designated as the lead

agency of the Federal Government for agricultural research (except with respect to the

biomedical aspects of human nutrition concerned with diagnosis or treatment of disease). . . .“ Human nutrition is one of the

areas included in the definition of “food and

28
agricultural sciences” (section 1404). But

Section 1409 states that “It is the intent of

Congress in enacting this title to augment,

coordinate, and supplement the planning, initiation, and conduct of agricultural research

programs existing prior to the enactment of

this title, except that it is not the intent of

Congress in enacting this title to limit the

authority of the Secretary of Health, Education, and Welfare under any Act which the

Secretary of Health, Education, and Welfare

administers. Thus a clear mandate is not

given to USDA to be the lead agency for

human nutrition research.

Section 1423 (b) requires the Secretary of

Agriculture to “periodically consult with the

administrators of the other Federal departments and agencies. ” As discussed earlier,

this unilateral approach to coordination

relies on the goodwill of other agencies to

cooperate with USDA in the goal of research

coordination.

Research priorities at NIH are summarized

in table 3. A wide range of basic and applied

research are embodied in these priorities.

The major emphasis is on basic and curativeoriented disease research rather than disease prevention. This becomes more clear as

allocations of funds to the different areas are

studied, The Nutrition Study Section at NIH

reviewed a total of 181 grant proposals in FY

1977, and approved 119, totaling $4.7 million.

Only four other study sections recommended

for approval grants totaling less than $4.7

million in this period of time. Two of these

sections have been disbanded, their work being referred to other study sections. Since

research in nutrition involves many different

disciplines and crosses traditional disciplinary lines, NIH maintains that many grant

applications with nutrition components are

referred to other study sections. It can therefore be assumed that $4.7 million is what NIH

clearly defined as human nutrition research,

and the remainder of the $80.4 million of

nutrition research funded by NIH if FY 1977

was basic and disease-oriented research

with nutrition components of varying degrees

of relevance.

The Agency for International Development

(AID) is the Federal agency primarily responsible for international nutrition research.

. ,,the long-range goals of the AID nutrition program are: to have developing countries incorporate nutrition considerations into their social and economic development

plans; to create the methodologies for assessing needs, determining causes, and selecting

interventions; and to have available the most

cost-effective interventions with information

on when they are most appropriate to apply,

the cost and other requirements for implementing them, the best methods for implementing them, and information on expected

results.

The AID nutrition research program is

designed to provide new knowledge that will

help implement programs to attain these

goals, The AID nutrition research program

attempts to assess the functional significance of improvements in nutrition; it seeks

to establish whether nutritional needs can be

satisfied with locally available foods; it

evaluates the effectiveness of nutrition intervention; and it seeks to inform governments about the potential impact of policies

in food and nutrition. ]

It is therefore apparent that the AID nutrition research program is not and should not

be designed to address the research needs

outlined in this report. The AID program is

designed to meet the needs of host countries.

Should a research project yield results applicable to problems discussed in this report,

it is serendipitous. There is a clear need to encourage international research, much of

which would be epidemiological, to identify

and explore dietary and lifestyle factors contributing to the major chronic diseases,

In theory, AID’s nutrition research activities undergo peer review. Research funds

are publicized through the distribution of a

brochure, and information on AID’s research

needs are circulated among professional

groups and announced at professional meetings. “Projects that are awarded on the basis

of predominant capability are very carefully

reviewed before approval. Fewer and fewer

projects follow this latter route, “z

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

‘Irwin Hornstein, Deputy Director, Office of Nutrition, Agency for International Development, June 8,

1978.

‘Ibid.

29
tion research received an estimated $2.7 million from AID in FY 1977. Most of this research was conceived by agency staff who

then had a scientific research group develop

study proposals. The proposals wer e

screened by AID staff members before being

submitted to the Research Advisory Committee for technical feasibility evaluation. The

agency does not widely advertise requests for

proposals, and few unsolicited proposals are

received. Some panel participants felt that

this system reduces the scientific base of expertise on which the agency can draw and

leads to an inbreeding of research ideas.

human nutrition research is made in the Act.

In response to these requirements, USDA

requested $43 million for human nutrition

research in its FY 1979 budget proposal. This

is a 95-percent increase over its FY 1977

spending of $22 million.

At NIH, nutrition research support has remained relatively constant over the last several years, constituting less than 3 percent of

the total research budget, Estimates of actual

dollar outlays for human nutrition research

vary from $20 million to $80 million for FY

1977.

Definition and Funding

Personnel Resource Requirements

The Food and Agriculture Act of 1977 does

not explicitly define the term “nutrition” nor

the scope of “nutrition research. ” It implies

that “nutrition research” includes research

on diet and disease, certain aspects of agricultural policy, nutritional requirements,

food composition and nutrient interactions,

food safety, food enrichment, and means of

encouraging better nutritional practices.

There is no reference in the legislation to international nutrition research.

Section 1423 (a) of the Food and

Agriculture Act of 1977 states that the Secretary of Agriculture “shall increase support

for such research [research into food and

human nutrition] to a level that provides

resources adequate to meet the policy of this

subtitle . No specific authorization for

Both the USDA and HEW support undergraduate, predoctoral, and postdoctoral

students through a variety of tuition grants,

loans, fellowships, and training grants. The

Food and Agriculture Act establishes grants

and fellowships for food and agricultural

sciences education at the undergraduate

through postdoctoral levels, The program is

authorized in FY 1978 for $25 million, expanding to $50 million by FY 1982. The proportion of this money to be devoted to training

nutrition researchers is not specified.

The Department of Health, Education, and

Welfare has traditionally supported training

of research scientists through training grants

and fellowships. In FY 1977 these totaled

$2.8 million for human nutrition research,

NEW DIRECTIONS IN FEDERALLY SUPPORTED

HUMAN NUTRITION RESEARCH: THE OSTP REPORT

Goals and Priorities

In December 1977, OSTP published a report on Government nutrition research. The

report defined the scope of human nutrition

research, described existing Federal programs, identified research areas that need

more attention, and suggested means for enhancing the coordination and quality of Federal nutrition research activities. Although

the report focused only on domestic research,

it encouraged various Federal agencies involved in such activities to assess the potential international benefits from current and

planned projects.

The working groups of the OSTP interagency senior nutrition research staff recommended four priority research activities:

30
10

2.

3.

4.

Effects of nutrition on human health and

performance in pregnancy, infancy and

early childhood, old age, obesity, iron

deficiency, nutrient toxicity, and interactions;

Food sciences (methodology for analyzing food composition, nutrient bio-availability in foods, updating nationa l

nutrient data bank, expanding food composition measurements);

Nutrition education research (factors

determining dietary practices, identification of good nutritional practices, ad

hoc educational research committee);

and

Diet and nutritional status surveillance

(food composition, survey methodology,

measurements of nutritional status,

analysis of the Health and Nutrition Examination Survey (HANES) data, epidemiological studies),

The criteria used by the working group in

selecting research areas for greater attention

were impact, substantial existing knowledge

gap, and researchability. The priority areas

chosen reflect the narrowness of these criteria. The priorities tend toward short-term

projects that lack long-term commitments

needed to identify the nutrition elements of

major health problems facing adult Americans—the chronic degenerative diseases and

obesity.

In the OSTP report several recommendations are made for coordination within and

among the departments conducting nutrition

research, First of all, the participants in the

study requested OSTP “to continue to take a

lead role in coordinating and monitoring

nutrition research activities. ” OSTP could

serve as a focal point for interagency planning through the Federal Coordinating Council on Science, Engineering, and Technology

(FCCSET), chaired by the Director of OSTP.

Secondly, external reviews of the intramural

grants process in both NIH and USDA with

joint participation of Federal agencies in

developing requests for proposals and in

reviewing research in progress.

To improve coordination and communication within HEW and USDA, the report recommends:

In

Drug

HEW, the programs of

Administration (FDA],

the Food and

the National

Center for Health Statistics [NCHS], the

Center for Disease Control (CDC), and NIH

must be coordinated in the high-priority activities identified, . . . At NIH, it is essential

for the NIH Director and for the Nutrition

Coordinating Committee under his direction

to have the authority to prioritize nutrition

research needs, The Director of NIH, has a

relationship to the several Institutes which

permits allocation of funds for nutrition

research in the absence of specific statutory

authorities for reprogramming between Institute appropriations.

In USDA, it is essential that the nutrition

research activities of the Agricultural Research Service (ARS), the Cooperative State

Research Service (CSRS), the Food and Nutrition Service (FNS), and the Economic Research Service (ERS) be coordinated through

the Secretary of Agriculture. ”

Finally, the establishment of an ad hoc interagency nutrition education research committee is recommended, This committee

would: identify and summarize research findings related to nutrition education research

and summarize pertinent findings from other

areas of education research, establish priorities, and develop a plan for conducting nutrition education research.

It is doubtful that OSTP through FCCSET

would be able to adequately oversee coordination of nutrition research activities, The

staff of the Office is small, and their responsibilities large. With a budget of $50 million

to $117 million per year, nutrition research is

a very small component of the FY 1977 $3.6

billion research budget for health and agriculture.

External reviews by teams of nonagency

scientists may improve the quality of intramural human nutrition research activities,

but they camot be expected to improve research coordination. This recommendation

calls for the external reviews to be conducted

within 12 months of the report’s publication

by an unspecified number of multidisciplinary teams. Scientists from agencies conducting nutrition research would also participate. The report suggests that this would

be expected to increase communication and

understanding of Federal programs, Since

the review would only be conducted once and

31
no provisions are made for improving bad

situations if they are found, it is doubtful that

it would be of any lasting use in improving interagency communication or the quality of intramural research.

The proposal that Federal agencies jointly

participate in developing requests for research proposals and in reviewing research

in progress has merit, as does the proposal

for an ad hoc interagency nutrition education

research committee. The ideas could be further explored by USDA and HEW and proposals for implementation developed.

Definition and Funding

The scope of human nutrition research, as

defined by the OSTP study, included investigation of:

●

●

●

Basic physiological and biochemical

mechanisms for the digestion, absorption, metabolism, and transport of nutrients; the role of food ingredients in

human health and performance and in

the prevention and treatment of disease;

Nutrient composition of foods; the effects of storage, processing, and packaging; and the biological availability of nutrients in the foods at the time of consumption;

Determinants of dietary practices and

methods for educating the public about

dietary practices; and

● Food consumption patterns and nutritional status of the general population

and of special high-risk subgroups within the population; evaluation of the nutritional impacts of various intervention

strategies and public policies.

The OSTP report established Federal expenditures for nutrition research for FY 1977

at $116,6 million. The report stated that no

specific funding levels would be recommended, but that the report’s objectives could be

met “at least in part by reallocation of

resources from existing programs to the

higher priority areas identified. ” It is highly

unlikely that this could be accomplished

without outside intervention, It is also questionable whether such a strategy makes good

sense, since the amount of human nutrition

research conducted in this country is so small

in comparison to our $3.6 billion in health and

agriculture research expenditures and our

$160.6 billion in health costs. Furthermore, at

least $60 million of the $117 million is basic

research on metabolism which underlies

many of the biological and health sciences. A

cut in this funding would severely constrain

progress in basic research.

Personnel Resource Requirements

The OSTP report does not consider the personnel resources needed to fulfill the research priorities contained in the report.

FEDERAL HUMAN NUTRITION RESEARCH

NEEDS A COORDINATED APPROACH TO ADVANCE

Goals and Priorities ●

The General Accounting Office was asked

to identify research gaps and needs in the

field of human nutrition. The scope of the ●

report was restricted to the domestic situation. Gaps identified by GAO included:

Knowledge of dietary nutrients required

to promote or maintain growth or wellbeing at various stages and conditions of

life;

Information on the composition of the

current U.S. food supply and the extent

that nutrients are biologically available;

32
• Evaluation of long-term health consequences of the modern diet; and

• Assessment of the Nation’s current

nutritional status in terms of dietary excesses and imbalances, as well as deficiencies.

GAO recommended research along the

following lines to overcome these research

gaps:

Long-term studies of human subjects

across the full range of both health and

disease;

Comparative studies of populations of

differing geographic, cultural, and

genetic backgrounds;

Basic investigations of the functions and

interactions of dietary components;

Updated and expanded food composition

data; and

Improved techniques for assessing longterm toxicological risks.

The priorities set out in the GAO report involve the types of research that will probably

provide the most information on the role of

diet in disease. However, work is also needed

on how best to convey the research findings

to the public so they can be translated into

daily life.

The GAO report cites “lack of central

focus and coordination” and “shortage of nutrition scientists” as two of the three principal barriers to progress in human nutrition

research. To remedy the first of these, the report recommends that the Director of OSTP

“work with the Federal agencies to further

define the subject areas comprising human

nutrition research and make recommendations to the Director of OMB to:

• Assign where practicable, each area to

a lead Federal agency.

• Eliminate unnecessary research that

may exist among Federal agencies.

. Promote Government-wide human nutrition research planning, coordination,

and reporting. ”

These recommendations are not sufficiently specific to be considered a strategy

for organizing nutrition research. Furthermore, in an early draft of their report, OSTP

assigned lead and support agency responsibilities for specific nutrition research

areas. This approach was abandoned in the

final report because of agency objections, A

general goal of improved research planning,

coordination, and reporting is commendable,

but without specifics probably will not be attained.

Definition and Funding

GAO identifies the third barrier to progress in nutrition research as “instability of

federally funded extramural research. ” The

report does not make specific recommendations as to how to improve this situation.

However, it endorses the development of federally funded regional research centers in

conjunction with universities and colleges.

GAO estimates U.S. Government expenditures for human nutrition research at $73

million to $117 million annually. It makes no

attempt to define nutrition research or to

analyze agency reports on nutrition research

expenditures,

Personnel Resource Requirements

The GAO report highlights the concern of

the scientific community that there is a shortage of nutrition research scientists. If this

situation exists, it holds significant implications for the ability of the research community to absorb research funds should large increases be made in the future. Since no accurate information exists on the numbers and

expertise of nutrition research scientists outside Government laboratories, analysis of research capabilities is impossible.

33
A COMPREHENSIVE NUTRITION RESEARCH STRATEGY

Goals and Priorities

The focus now lacking in Federal nutrition

research could be achieved by defining the

scope of human nutrition research, defining

general goals for Federal agencies that conduct such research, and specifying research

priority areas that are in line with the general goals. A reorientation of Federal nutrition research efforts should recognize the

changing nature of four food supply by placing

greater emphasis on the role of diet in

preventing chronic diseases. At the same

time, Government programs must continue

striving to eliminate hunger and malnutrition

through intervention programs and research.

Such a reoriented research strategy requires an increased focus on today’s complex

food supply, especially on the effects of processed food, food additives and contaminants,

and similar problems that concern consumers, food producers, and health professionals. Research in the food sciences would

enable us to evaluate the adequacy of the

food supply and to develop recommendations

for needed changes. Such changes might include new processing techniques, fortification, reformulation, or selection of alternative

food items by consumers.

Broader information and intervention efforts outside of the health care system are

also necessary. The public should know what

the scientific community has learned about

the relationships among lifestyles, food consumption, and health. Developing improved

ways of conveying such knowledge would encourage the public to adopt better eating

habits and other health-promoting behavior.

OTA working group participants felt that

neither the existing legislation nor the priorities suggested in the OSTP and GAO reports

provided the holistic, integrated research

strategy needed to meet current and projected diet-related problems in the United

States. Seven elements of a comprehensive

research strategy to define the role of nutritionin the prevention of chronic disease and

to improve management of current nutritionrelated problems were discussed. The seven

34

points are outlined in table 5. The rationale

for the selection of each is contained in the

appendix.

Several mechanisms for coordinating Federal nutrition research activities have been

suggested. These include assigning responsibilities for research areas to various agencies, making one agency the lead agency,

placing coordination responsibility under a

third party, assigning coordination responsibility to the assistant secretary level, and

concentrating all nutrition research activities

in either USDA or HEW.

The first alternative (assigning responsibilities for research areas to various agencies) would make USDA and HEW the two

lead agencies in human nutrition research,

This approach is similar to the one taken in

the Food and Agriculture Act of 1977 in

which the legitimate roles of both agencies in

nutrition research are recognized. Under

such a system of joint responsibility, the concerns of each agency would have to be defined to minimize duplication of effort, An effective system of intra-agency cooperation

would also be necessary. However, since it

may not be possible to clearly separate the

concerns of nutrition and disease from those

of “normal nutrition,” some overlap would

probably beinevitable.

The second alternative assigns one agency

main responsibility for nutrition research.

Since USDA and HEW fund 87 percent of

Federal human nutrition research, they are

the most likely candidates for the lead agency

role. There are arguments both for and

against giving such responsibility to one or

the other agency.

Currently USDA plays the major role in

carrying out food intervention programs in

the United States. By giving it primary responsibility for funding and coordinating

nutrition research efforts, the Government’s

research and food intervention activities

might be better coordinated. At the same

time, Federal research activities might

become more responsive to consumer views

and needs because of USDA’s major involvement in food and nutrition education programs.
Table 5.—A Seven-Point Nutrition Research Strategy

The role of diet in the prevention- of chronic disease and obesity

Major health problems and diet-related risk factors

Diet, aging, and disease

Methods for preventing obesity

Nutrition and mental development

The role of nutrition in the treatment of disease and support of therapy

Nutritional support of patients with severe disease and injury

Other disease states

Technology for delivery of nutrients to patients

Behavioral and emotional problems

Nutrition education and consumer information

Factors affecting lifetime eating habits and identification of critical points for education

Development and evaluation of nutrition education and communication methods

Methods for simplifying consumer information utilization

Requirements for essential nutrients

Methods for determining nutrient needs

Interactions among nutrient requirements based on functional criteria

Pharmacologic and toxicologic effects of on nutritions

Bioavaiability of nutrients in foods

Nutritional aspects of food science and food safety

Food composition

New food processing and handling procedures to maintain nutrient content

Better methods of assuring food safety

Monitoring nutritional status

Methods for improving integration of food consumption and nutritional status surveillance

Evaluation of the effects of food and nutrition education programs

Nutrition policy and management

Food-related interventions

Other Interventions

—

USDA now coordinates research in the

area of food production with the State agriculture experiment stations and other cooperating institutions. Some link between the

nutritional concerns of consumers and the

food production system seems to be essential,

But USDA has traditionally had little responsibility or expertise in the area of human

health and disease. One of the major needs in

Federal nutrition research activities is a

reorientation of priorities to stress the role of

nutrition in the prevention of disease, Thus

separating health-related nutrition research

from the overall direction of health research

may not be wise, If health-related nutrition

research fell exclusively under USDA, potential conflicts might arise. The research might

produce recommendations for substantial

shifts in food practices. Such findings and

recommendations could conflict with the

traditional interests of producer groups.

Many of the research priorities identified

by OTA as well as other groups involve the

relationship of human health to nutritional

practices. Therefore, there are strong arguments for giving HEW, the agency concerned

with health, the lead responsibility for directing nutrition research, However, such research has not been a main HEW concern in

the past. Disease-prevention research has

generally received much less support than

specific disease-oriented or curative-oriented

research. Moreover, HEW has not been concerned with the nutrient requirements of

healthy people, food consumption patterns, or

food composition. In addition, HEW has no

nationwide programs of nutrition and health

education comparable to those developed by

USDA.

The report by OSTP recommended that the

lead role in nutrition research be given to a

third party which would formulate policy and

coordinate and monitor programs. Under this

arrangement, various agencies would retain

their existing nutrition research responsibilities, but their activities would be overseen by the third party. The concept offers

some positive features, It would focus attention on nutrition while retaining the healthy

35
competition among agencies involved in nutrition research.

However, such a third-party concept also

raises several problems. It involves another

layer of Federal bureaucracy. A third-party

oversight body might have no real power to

influence budgets and allocate resources

within and among agencies, especially since

it would lack a political constituency. These

potential deficiencies would be further magnified by inadequate staff and expertise. In

the end, such a coordinating mechanism

would probably only serve as a means to exchange information, much as the nutrition

coordinating committee does within NIH and

the Current Research Information System

(CRIS) does for USDA,

Another alternative would give assistant

secretaries in HEW and USDA responsibility

for coordinating nutrition research policy

within and between their respective agencies. Lack of high-level commitment to nutrition research has been a problem in the past.

Placing responsibility for nutrition at the

assistant secretary level might create the

visibility and commitment needed to effectively coordinate nutrition research efforts,

Such an arrangement would require administrative changes within both agencies. At present, it is unclear if the USDA reorganization

that created a Human Nutrition Cente r

within SEA will accomplish this goal.

A final option would consolidate nutrition

programs in one agency, either USDA or

HEW. These activities would include research, education, regulation, training, service delivery, monitoring and surveillance, and

food and other intervention programs. Both

USDA and HEW have recently shown interest

in this concept in papers entitled USDA’S

Commitment to Food and Nutrition Policy and

The Role of HEW in Human Nutrition: Future

Directions. However, the wisdom of such a

consolidation is debatable, Although both

agencies currently have a number of nutrition programs, the expertise involved is quite

specialized. Whether this approach would

solve coordination problems probably

depends on the agency’s commitment to the

field of nutrition.

A pluralistic approach to human nutrition

research, with well-defined agency responsibilities for HEW and USDA, appears to be

the best means of coordinating Federal

research efforts. Such an approach could

produce the kind of creative competition that

would likely enhance human nutritio n

research. It would also result in some

overlapping of efforts, which should be

minimized by the coordinating process.

The coordinating function might best be

carried out by an interagency committee with

a rotating chairmanship. This arrangement

would be consistent with a pluralistic approach to research. At the same time, it

would help ensure against any one agency

building a “most-favored” relationship with

the coordinating committee.

Coordination of Federal nutrition activities

extends beyond specific mechanisms for

intra- and inter-agency coordination, It also

includes information storage, retrieval, and

integration. No uniform system presently exists among the various agencies involved in

nutrition research. Computerized systems

that permit information integration and retrieval need to be explored. At the very least,

relevant branches of HEW and USDA should

have a common indexing and data retrieval

system for this type of information, Since

federally supported research accounts for

the major share of research in the nutrition

and health maintenance areas, integration

among these agencies is essential. Integration

of nutrition research data is also desirable

among the public, private, and voluntary sectors.

Definition and Funding

As outlined under issue 2, OTA could not

perform an analysis of the present Federal

human nutrition research budget, since present expenditure estimates are so disparate.

Federal spending on human nutrition

research should be precisely determined. By

eliminating the present confusion, Congress

will be better able to judge appropriate levels

of funding for nutrition research. Congress

could request GAO to audit the human nutri36
tion research expenditures of Federal agencies. The GAO audit, based on a constant

definition, should determine total Federal

spending for human nutrition research, the

number of scientist years involved, and

Federal expenditures in the seven priority

areas setout in this report.

On the basis of such information, Congress

would have several options. The first would

be to maintain the status quo in nutrition

research funding, with possible reallocation

of some funds to areas not now receiving support. As a second option, Congress could appropriate additional funds to specific nutrition research areas that are not getting

enough support. Finally, Congress could earmark a percentage of Hatch funds for human

nutrition research. Such an audit, together

with a uniform system for reporting human

nutrition research spending, could also

facilitate future congressional oversight

hearings,

Personnel Resource Requirements

If Congress were to choose to implement

the OTA comprehensive nutrition research

strategy, there is a clear need to establish

how many scientists are both presentl y 

i n -

volved in, or training for, nutrition research.

This census would include a breakdown in

terms of various research areas, such as

Government facilities, universities, medical

facilities, private institutes, and industry,

This kind of census would identify where nutrition research personnel gaps exist and

where greater support is necessary. To fill

such gaps, expanded Federal support should

be considered.

37
Chapter IV

CONGRESSIONAL OPTIONS

fats

minerals
Chapter IV

CONGRESSIONAL OPTIONS

OTA found that three key issues underlie the basic finding that the Federal Government has failed to adjust the emphasis of its human nutrition

research activities to meet the changing health problems of the American

people. Alternative approaches of dealing with these issues have been explored. Congress can elect to maintain the status quo, with or without minor

shifts, or choose among the strategies and options offered by OTA, the

General Accounting Office (GAO), and the Office of Science and Technology

Policy (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 mean

refraining from any action. In a broader

sense, it also could involve minor improvements in the present system—without

making substantial changes.

A. Congress could refrain from any action,

awaiting the recommendations of the

President’s Reorganization Project.

In August of 1977, President Carte r

directed the Reorganization Project staff at

the Office of Management and Budget to thoroughly review the organization and structure

of Federal food and nutrition programs. Food

and nutrition research is one of the seven major areas under review. A final report to the

President, expected in January of 1979, will

include recommendations that may significantly alter the organization, and thus the

course, of nutrition research activities.

Since significant strides have been made in

nutrition research, there is no reason to expect a decline in research productivity if current funding levels are maintained. However,

since several important areas of nutrition

research receive little support at present,

progress in these areas would be slow, These

areas include the role of nutrition in the prevention of disease, nutrition education, monitoring nutrition status, and nutrition policy

and management.

If Congress chooses to refrain from any action to await the recommendations of the

President’s Reorganization Project, no adverse effects would be expected.

B. Congress could amend the Food and Agriculture Act of 1977 to clarify the designation of lead agency for human nutrition

research.

At the present time, the Department of

Agriculture (USDA) interprets the Food and

Agriculture Act of 1977 to mean that USDA is

the lead agency for human nutrition research, an interpretation not shared by the

Department of Health, Education, and Welfare (HEW). If Congress intended USDA to

have primary responsibility for this research

area, the Act will require amendment.

c.

r

Congress could develop nutrition research

goals and priorities for HEW that complement the goals and priorities outlined for

USDA in the Food and Agriculture Act of

1977.

The legislation contains strong language on

the relationship of diet to many of the leading

41
causes of death in the United States, the importance of proper nutrition in disease prevention, and the need for more knowledge in

several areas of nutrition research. The research priorities spelled out in the bill do not

fully reflect these thoughts,

Since the legislation pertains almost exclusively to USDA, it lays out what could be considered a partial strategy to solve the problems of diet and chronic degenerative diseases.

Congress could develop legislation containing research goals and priorities for HEW

that complement those already legislated for

USDA. These goals and priorities could be

based on either the GAO, OSTP, or OTA

strategies,

D. Congress could enact legislation establishing a coordinating mechanism for Federal

human nutrition research activities.

Numerous recommendations for coordinating Federal human nutrition research

have been made since the 1969 White House

Conference on Food, Nutrition, and Health.

The fact that the issue remains alive indicates the need for improvement.

E. Congress could consider legislation to improve data storage and retrieval, and to

link the systems currently in use.

Coordination of Federal nutrition activities

extends beyond specific mechanisms for

intra- and inter-agency coordination. It also

includes information storage, retrieval, and

integration, No uniform system presently exists among the various agencies involved in

nutrition research, Computerized systems

that permit information integration and retrieval need to be explored. At the very least,

relevant branches of HEW and USDA should

have a common indexing and data retrieval

system for this type of information. Since

federally supported research accounts for

the major share of research in the nutrition

and health maintenance areas, integration

among these agencies is essential. Integration

of nutrition research data is also desirable

among the public, private, and voluntary sectors,

Option 2: Congress Could Choose To Pursue a Human Nutrition

Research Strategy Different From That of the Status Quo

Since this assessment found that the present nutrition research establishment has

failed to respond to the changing health needs

of Americans, Congress could move to change

the emphasis of federally funded nutrition

research. Such change could be based on the

strategies and options put forward by OSTP,

GAO, and OTA (reviewed and analyzed,

chapter III). If Congress decides to follow this

path, more information is required on current

expenditures and existing expertise. Based

on the results of needed studies, Congress

could then determine which strategies and

options would be most productive.

A. Congress could request GAO to conduct

an audit of Federal expenditures for

human nutrition research,

To eliminate the present confusion over

how much Government agencies are spending

42

on human nutrition research, Congress could

ask the GAO to audit such Federal expenditures, using the definition of human nutrition

research developed in this report. On completion of the audit, Congress would be in a better position to determine which areas of

nutrition research are receiving inadequate

support. At that point, Congress might consider reallocating some funds or appropriating additional funds to specific areas of

nutrition research identified as poorly supported, or earmarking a percentage of Hatch

funds for human nutrition research.

B. Congress could request the lead agency

for human nutrition research to conduct a

census of research personnel.

There is a clear need to establish how

many scientists are both presently involved in

and training for nutrition research. This cen-
sus would include a breakdown in terms of

various research areas. such as Government

facilities, universities, medical facilities,

private institutes, and industry. This kind of

census would identify where nutrition research personnel gaps exist and wher e

greater support is necessary. To fill such

gaps, expanded Federal support should be

considered.

C. Congress could increase training grants

and fellowships, and consider establishing midcareer training for scientists.

If a need is established for more research

personnel, this could be met through a combination of two routes: increasing training of

young scientists and providing midcareer

training for established scientists. By making

fellowship and training grants available, candidates would be attracted to those fields in

which more research is needed (particularly

the newer fields), Congress might also consider alternative means to facilitate training

such as loans, work/study funds, pay-back

scholarships, and income tax rebates for

students.

For established scientists wishing to

broaden the scope of their research interests

to encompass nutrition research priorities,

midcareer training or continuing education

could be considered.

43
APPENDIX
APPENDIX

SUPPORTING MATERIALS

BACKGROUND FOR OTA

In the preparation of this report, OTA

found that Federal nutrition research lacks

focus and direction. This is demonstrated by

the lack of general consensus on overall

goals and priorities. The picture is further

complicated by the large number of Federal

agencies involved—7 departments encompassing 14 separate agencies. Without a

concerted, continuous effort to integrate

their efforts, the agencies have been unable

to share information on planned, ongoing, or

completed research. Furthermore, the inability to develop an agreed upon definition

of what constitutes “nutrition research”

has led to widely divergent reports on Federal spending.

In view of public concern over the food

we eat, how we live, and their relationship

to how we die, human nutrition research receives little Federal attention. Research

along the lines in the comprehensive nutrition research plan developed by OTA will

help determine if causal relationships can

be established between the American diet

and the American way of death. Implementation of the results of this research could

hopefully improve the health status of many

Americans.

A technical analysis and rationale for the

proposed research strategy are presented

below.

Criteria for Evaluation

The establishment of research priorities

and the development of appropriate budgets

RESEARCH STRATEGY

involve various kinds of judgments. Only a

few of the documents reviewed attempted to

set priorities for nutrition research, and

criteria used differed from one report

another (see table 6). For the purpose

this assessment, the criteria used in

other reports were found wanting in a nu

ber of respects.

he

to

of

he

mFirst, some of the criteria were ill-defined,

difficult to interpret in a uniform manner, or

were not mutually exclusive. Second, the crieria for types of technology necessary to

achieve results were unclear. For example,

the criterion for researchability was defined

in one document as being either an area in

which effort was 1ikely to advance knowledge

or one in which the knowledge base, personnel, and basic research techniques were

available. From the standpoint of technology

assessment, the two are quite different. Use

of the same term to describe these two different characteristics confuses rather than

simplifies decisionmaking. Third, costs or

relative dollar requirements were not i n -

cluded in the criteria. Fourth, because most

of the documents which used criteria for

selecting priorities were written by research

scientists or Government officials, estimates

of need and potential impacts were viewed

from their vantage point rather than from

that of the users or ultimate beneficiaries of

research—the American public, In contrast,

the OTA advisory panel represented a wide

range, including not only the producers and

administrators of research but also users outside of the Federal Government and consumer representatives. Finally, the criteria

selected for reports suggesting domestic nu47
Table 6.—Criteria Used for Assessing Research Priorities

Office of Science & ‘-

Technology Policy ●

1. Irnpact: Research findings are

expected to have major infIuence

on human health or dietary practices.

1. Substantial existjng knowledge

gap: There is insufficient knowledge

in a specific area either because Iittle

relevant research has been carried

out or because the research has not

yielded conclusive results.

3. Researchability: An adequate

capability— knowledge base, skilled

personnel, and research techniques —exists to address the

problem so that research is likely

to result in a significant breakthrough in knowledge. This criterion

depends on scientific judgment

about the met hods available to operationalize 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 or

technological significance of these

advances?

2. If research does produce results,

what effect wouId they Iikely have on

reducing global hunger and

malnutrition over the next several

decades?

3.What supportive action Will be

required to conduct research for

accelerated 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 definition to favor short-term gains. By developing

a separate criterion for the immediacy of application, this bias was reconciled. The criteria used by OTA in evaluating research priorities were need, current state of knowledge, capability, cost, and immediacy.

Importance of the Problem

There are two different viewpoints on how

to assess the importance of the problem or

the need for a solution. Health professionals

might advocate an approach based upon epidemiological considerations. Since estimates

of the prevalence, incidence, duration, and

mortality rates of various diseases generally

reflect their effects upon human health, they

are useful.

Economists use more general considerations in defining needs. They concentrate

upon the economic impacts of the expected

solutions.

Also important are the more subjective

human dimensions of suffering and inconvenience, which are conveyed only imperfectly

by the epidemiological data, and the benefits

projected by the estimates of economic impact. For example, heart attacks kill three

times as many people in this country as

cancer, but most people fear cancer more

than they do heart disease. Overnutrition is

associated with much more illness in the

United States than undernutrition. Yet there

is a widespread belief that it is worse to be

hungry than to be overfed and that the

Government has a special obligation to help

those who might otherwise go hungry.

While the factors mentioned above involve

expert judgment to some extent, need is difficult to assess because of the many subjective factors involved. Congress and the public

have as much ability as anyone else to evaluate their relative importance, Since public

monies are to be spent, a wide spectrum of

opinions likely to be representative of the

public is therefore useful. Indeed, all these

various types of expertise will be helpful in

making judgments.

Current State of Knowledge or

Relative Potential of the Area

Here the emphasis shifts to the state of

knowledge in the field and how likely it is that

48
expected results

and knowledge

or answers will be found

advanced. Estimating the

relative potential of research efforts is an

area in which expert judgment is particularly

useful, since knowledge of the present state

of the art and current research ideas is

helpful. One difficulty often encountered here

is that science must take into account what is

practical and possible rather than solely

what is deemed to be important.

Capability

This criterion involves estimates of the

present capacity for performing research

from the standpoint of personnel, technology,

and the availability of basic research techniques to deal with the problem. Special expertise is helpful in making these estimates.

cost

This factor involves the relative amounts of

money required by the proposed research in

the immediate future.

Immediacy

This criterion evaluates whether yields are

likely to be seen over the short, medium, or

long term, Specific target dates in terms of

application are very difficult to predict. In

general, short term was used to describe projects in which usable results could be expected in under 5 years; medium term, 5 to 10

years; and long term, 10 to 20 years. Expert

judgment was helpful in making these decisions, but even so they represent guesses and

not certainties.

Other Criteria Which Were Considered

While the major criteria used for assessing

the various possibilities for emphasis are

mentioned above, other points were also considered in arriving at overall judgments,

These included the following:

Potential for achieving multiplier effects by

developing closer links between research and

training. Lists of research priorities tend to

be specific. Yet the best researchers are

those with broad experience and training

who can solve problems requiring various

kinds of technical expertise. Research topics

which are amenable to such broad approaches are therefore particularly suitable

for exposing research personnel in training to

the very collaborative endeavors that may be

the most fruitful.

Maintenance of research potential. The

setting in which research is carried out affects the ability to maintain nutrition research potential. In some settings such as universities, particular emphasis is placed upon

the transmission of knowledge by training

young investigators, while in others the focus

is restricted to the production of new knowledge, Since there is no solid evidence available to indicate that research by contract or

by private or Government organizations is

more efficient in producing results, particular emphasis was given by the OTA advisory

panel to topics or funding mechanisms that

would have secondary gains, in that they

would also produce scientists.

Approaches which maximized the benefits

to be gained by focusing research priorities

and minimized the undesirable effects. Efforts to direct research toward useful solutions by establishing priorities and funding

are helpful in several ways. They encourage

dialogue among scientists, funding agencies,

and the ultimate users of research efforts,

thus helping to achieve consensus, summarize our current state of knowledge, and

strengthen the public understanding of science. They may permit public monies to be

better spent for achieving desired objectives

and speed up the process of application of

fundamental research findings to human

problems,

However, undesirable effects also stem

from efforts to direct research, These include

placing greater power and control in the

hands of bureaucrats who may be limited in

their ability to judge quality. Scientific judgment may be weakened. Perfunctory 

r e-

search which follows bureaucratic guidelines

but involves little intellectual effort may be

favored. More productive areas of research

may be disregarded in favor of “popular”

areas of interest in which a paucity of new

research ideas exists.

49
THE ROLE OF DIET IN THE PREVENTION OF

CHRONIC DISEASE AND OBESITY

The role of nutrition must be given greater

priority in the prevention and improved management of today’s major health problems.

Nutritional factors deserve particular attention for two reasons. First, it is possible to

change diets while some of the other factors

that influence disease development cannot be

altered. Second, nutrition is basic to health

and deserves attention as one of many factors

that influence health and disease,

Just if i cat ion

Major Health Problems and

Diet-Related Risk Factors

The major health problems of Americans

include cardiovascular disease, cancer, diabetes, hypertension, osteoporosis, obesity,

drug and alchohol abuse, mental illness, and

dental disease. All of these diseases have a

complex etiology of which nutrition is a part.

Thus, research must aim at identifying the interrelationships between diet, exercise,

stress, other environmental and genetic factors, and general health. More attention must

be paid to nutrition as a variable in ongoing

studies of disease which are mentioned

below. This kind of research will be long term

(10 to 20 years), but some payoff can be expected relatively soon (such as the reduction

in coronary heart diseases in the past 10

years and recent reports linking high dietary

sodium levels with hypertension).

Cardiovascular disease. Although more

research effort has been directed to atherosclerotic heart disease than to other chronic

diseases, it remains a major health problem.

Each year 850,000 cardiovascular deaths are

caused by arteriosclerosis, 25 percent of

these occurring before the age of 65.

The role of diet in the development of heart

disease is generally accepted but still not

understood. Further definition of the relative

importance of specific dietary components—

such as type and amounts of fat, dietary cholesterol, type of carbohydrates, dietary fiber,

and alcohol—is required. The positive or

negative effects they produce are particularly germane to the clinical and public health

application of findings. Both specific risks

50

produced by individual components and the

combined risks of different dietary patterns

need exploration.

The relationship between atherosclerotic

disease and other conditions such as obesity,

hypertension, and diabetes needs more careful study, The exciting new observations on

the role of high-density lipoproteins, which

transport blood fats, in retarding the development of atherosclerosis provide a possible

basis for approaches involving the manipulation of selected food constituents or other factors which may increase high-density lipoproteins,

More research is also needed on the ways

in which various dietary factors—such as

type and amount of fat, alcohol, and energy

balance—affect the disease process. Why

and how these factors affect the development

of cardiovascular disease are more difficult

to uncover than discovering if they have positive or negative influences,

Cancer. Three quarters of the cancers that

occur in this country are believed to be

related to environmental factors, which include foods and their constituents, Epidemiologic data and findings from animal studies

relate cancer of the esophagus, stomach, colon, breast, and liver to diet. A variety of factors in food has been implicated.

A primary effort must be directed toward

identifying the dietary patterns and dietary

constituents which are associated with high

risk in populations. Food factors—such as

nutrients and other substances naturally occurring in food, food contaminants, food additives, or total dietary patterns—may all influence the development of cancer. There are

many types of cancer which affect many different tissues and organs, and no single

‘‘cause’ of cancer can be expected to be

identified. Until basic research efforts have

better explained the causes of cancer, it will

be difficult to achieve a breakthrough in the

applied area. Thus a renewed emphasis on

basic research funding will be necessary.

Diabetes mellitus, Diabetes correlates with

cardiovascular disease and certain kinds of
cancer and is itself a major cause of death

and disability. Projections of current rates of

increase suggest that 20 percent of all Americans may develop diabetes unless methods of

prevention are found. Maturity-onset diabetes is clearly related to obesity. Diabetics are

known to be particularly susceptible to

arteriosclerotic heart disease. These interrelationships suggest common causal factors

that need clarification.

Study of the interrelationships among the

amount and kind of various carbohydrates

and fats and the total energy intake in the

causation and control of diabetes mellitus

should be particularly useful,

Fiypertension. Hypertension is epidemic in

the U.S. population. Nearly 23 million Americans are affected. Epidemiologic data, as

well as animal feeding studies, link hypertension to sodium intake, and low-sodium diets

have been useful in the control of hypertension. Hypertension is also linked to obesity

and, as with most chronic diseases, there is

probably a strong genetic component. The

role that sodium intake may play within the

American population is not clear, nor have

the possible effects of sodium restriction in

preventing hypertension been adequately explored. The interrelationships between the

genetic component and diet, particularly salt

intake, must be thoroughly studied. The role

of diet coupled with other preventive measures also needs more exploration than it has

as yet received.

0steoporosis. Most adults lose bon e

substance as they age. Morbidity associated

with osteoporosis has been estimated to affect probably 20 percent of the population

over 50 years of age. Adequate epidemiologic

data are not yet available. A nutritional component in the development of osteoporosis is

likely. Excessive intakes of protein and phosphate and relative deficiencies of calcium,

fluoride, and vitamin D have been implicated.

Research in this field has been miniscule

relative to the importance of the problem.

A broad attack ranging from the collection

of satisfactory epidemiologic data within and

between countries, the development of appropriate animal models, and appropriate

clinical studies aimed at exploring the relationships among nutrition, endocrinology, and

genetics will be required to develop solutions.

Chronic digestive disorders. Ulcer disease,

inflammatory bowel disease, and diverticular

disease of the colon may have nutritionrelated causes. These need exploration.

Dental disease. Dental caries and periodontal disease are a serious and expensive

health problem. Dental caries afflict 95 percent of the population under 17 and significantly increase health-care costs. Nearly 45

percent of the total population has periodontal disease, which is the primary cause of

tooth loss after age 35. Fermentable carbohydrate is the primary factor causing tooth

decay. Fluoride has a protective effect when

consumed during the period of enamel development or when applied topically. But other

diet-related factors are also involved. Attempts to identify other dietary factors having cariogenic or cariostatic effects are currently focused on the effects of trace elements upon the oral microflora and enamel

volubility and on the role of nutrition in the

development and activity of the salivary

glands. Recent studies have clarified the role

of food consistency in gingival health, and

current research is focusing on the role of

nutrition in the maintenance of gingival

health and the resistance to periodontal

disease.

But our knowledge of the role of nutrition

in the causation of periodontal disease is

minimal. The importance of specific dietary

components and their interrelationships with

dental hygiene, heredity, the oral microflora,

eating patterns, and other factors in these

diseases must be defined, Research should

show the major causes and provide guidance

on practical means of preventing dental

caries and periodontal disease.

Diet, Aging, and Disease

The diseases which have been discussed

constitute major health problems which are

prevalent among the aged, although they are

not necessarily restricted to the aged or directly correlated with aging. A major and

growing segment of our population is elderly,

yet we know very little about how to deal with

the combination of aging and these disease

51
problems. A great deal of data are now available to demonstrate that the aging process in

animals can be delayed by appropriate diets

and particularly by limiting food intake.

The implications of these studies on human

nutrition are profound, yet very little is

known about how dietary modification

achieves these effects, what might be the role

of specific food components, or how they can

be applied in human nutrition. The importance of research in this area is self-evident

as various diseases (particularly the infectious diseases) come under increasing control

and the number of elderly people increases.

Fundamental research in this area must

receive attention.

Research is also needed on the relationship

between food intake in the early years of life

and the later development of cardiovascular

and other diseases.

Methods for Preventing Obesity

Obesity is a condition of excessive fatness

rather than a disease itself. It is related to

several of the major health problems mentioned above. Specific causes and factors involved in obesity—such as heredity, nutrition

in early life, emotional factors, the nature of

the food supply, and physical inactivity—

must be studied to develop better methods for

controlling the condition,

The role of obesity in the development of

chronic disease needs attention so we can

define associated disease problems and act to

prevent or control them. Obesity may be

detrimental to the health of some people

while not to others. Study of the interactions

of obesity with other risk factors may help to

unravel the interrelationships of obesity with

chronic diseases.

Present preventive and curative programs

have only limited success. Carefully conducted clinical trials which would allow costeffectiveness comparisons between different

approaches are not available, but are sorely

needed, and may prove helpful in developing

new and better preventive techniques.

Nutrition and Mental Development

Nutrition plays a positive role in mental as

well as physical health. Although malnutrition in the prenatal and early postnatal periods has been linked to retarded mental development, the specific role of nutrition and its

relationship to other factors which affect

mental development remains obscure. Continued effort is required to clarify these relationships and also to develop methods which

will assure that each child’s potential for

mental and physical development is fulfilled,

Studies concentrating on clarification of the

relationships between nutrition, mental development, and behavior are particularly germane to the problems in developing countries

where diets may be severely limited. They

may also benefit certain disadvantaged

groups in our own country, such as handicapped children, with better methods for

feeding. Techniques for speeding the rehabilitation of abused children who have been nutritionally deprived might also be developed.

Analysis

Need

The severity, irreversibility, and toll in

human suffering of these common diseases

with nutritional components make this an

urgent area of concern. The economic impacts of preventing or delaying the onset of

these diseases would be enormous.

Current State of Knowledge

There is a long-standing belief, backed by

substantial evidence, that proper choices of

diets and lifestyles can do much to enhance

and maintain good health. The specific role of

diet in the development of these major chronic diseases is not certain. But several—including heart disease, cancer, diabetes, and

hypertension —are so common and serious

that every effort must be made to diminish

their impact.

The potential for advances in this area is

high, but the returns for a specific project are

never known in terms of what the practical

application will be or whether they will be ap52
plicable to human nutrition problems. In

terms of the improvement of human health,

however, many great breakthroughs have resulted in the past from the identification of

general principles which underlie biological

phenomena, whether these have arisen from

serendipity, general studies, or mission-oriented research concerned with a particular

problem.

Capability

The lack of appropriate basic research

techniques and appropriately trained personnel are major limitations in this area. Nevertheless, presently available techniques need

to be applied more broadly. The extent and

nature must be known of the correlations

among dietary composition, other causative

factors, and the incidence of major diseases

in order to do this. Extensive animal feeding

trials in appropriate species, biochemical

studies, and some experimentation with human subjects are also directly relevant.

cost

Costs of research in the role of diet in the

prevention of chronic diseases and obesity

will be high, but not in comparison to the

health costs these diseases generate. A great

deal remains to be done, and significant increases are likely to be necessary.

Immediacy

Research on disease prevention has a relatively long leadtime before it reaps results, although some advances can be expected in a

few years. Since this type of research has received little attention from the nutrition perspective over the past few decades, it is particularly important to begin to catch up, Our

aim should be to build a research program

that deals with the problems of today as well

as one that will be ready to meet those of the

future. Since this type of research furnishes

the foundation upon which applied research

is based, it is fundamental to all practical

programs. Yet a number of recent reports—

including the President’s Biomedica l

Research Panel, the World Food and Nutrition Study, and the recent OTA assessment

on basic research needs in agriculture—all

agree that much important fundamental information of this type is not being developed

and that our storehouse of knowledge for

building applied programs based on these advances is rapidl y becoming depleted.

Therefore it is absolutely essential that immediate attention be paid to this problem.

Other Criteria

The opportunities for achieving multiplier

effects with funds spent to develop close links

between research and training are high. The

development of this area is essential for

maintaining research potential and keeping

nutrition viable and in the mainstream of advances in biomedical research. The priorities

are general enough to encourage creativity.

THE ROLE OF NUTRITION IN THE TREATMENT

OF DISEASE AND SUPPORT OF THERAPY

Justification care, genetic abnormalities, gastrointestinal

disease, 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 application to the management of a wide variety of The results of research on nutrition in the

diseases, including postoperative and chronic management of disease can help health care

53
providers integrate nutritional concerns

more fully into the health-care system. By applying these results and by improving the

quality of information provided to patients,

the nutritional status of those under medical

care can be improved and the chances for

success of treatments for their specific conditions improved.

Nutritional Support of Patients With

Severe Disease and Injury

The treatment of severe disease and injury

accounts for the major costs involved in hospital care and represents the greatest opportunity for trained physicians and other health

professionals to use new knowledge in the

care of patients.

Severe systemic and infectious diseases.

Patients with severe illnesses resulting in permanent and prolonged disability may require

major qualitative and quantitative modifications of their intakes with respect to energy,

amino acids, minerals, and vitamins. Others

may require special routes for feeding, Major

areas for research include:

1.

2.

3.

4.

5.

6.

Gastrointestinal diseases, including regional ileitis, ulcerative colitis, short

bowel syndrome, primary bowel disorders;

Infection;

Liver disease;

Renal disease:

Cancer; and

Diabetes mellitus.

Severe injury. Severe injury involves burns,

severe trauma (such as that sustained from

damage to vital structures through accident

or gunshot or stab wounds), compression-decompression injury, irradiation, and major

surgical procedures. It is well known that

nutrient requirements and metabolism are

altered in these states. Moreover, the possible methods of feeding and nutrient mixtures may need to be modified in those specialized states (e.g., intravenous feedings, continuous infusions, alterations in hormone release and responsiveness). Therefore, these

topics are important research priorities.

Inborn errors of metabolism. The number

of people with inborn errors of metabolism is

54

not large. These diseases include the inborn

errors of amino-acid metabolism and the

lipid-storage diseases such as Tay-Sachs

disease. These disorders have profound effects in terms of early death and permanent

physical and/or mental disability. Further

research on the nutritional management of

these diseases may yield benefits similar to

those achieved in the treatment of phenylketonuria (PKU), Infants born with PKU, when

raised on a special diet, develop normally and

avoid the mental retardation that occurs in

untreated PKU,

Other Disease States

Other less severe conditions need to be examined as to the role of nutrition in their management. While they are not causes for hospitalization, they are inconvenient and temporarily disabling. Therefore, clinic time, lost

time to the patient, and cost of prescribed or

over-the-counter drugs are considerable. The

potential role of nutrition in providing care or

prevention of these conditions has not yet

been clarified and awaits future developments in the area of basic research. Those

areas of importance include:

Acute gastrointestinal disease in adults, injants, and children. Acute gastrointestinal infections may lead to secondary malnutrition

from malabsorption if they are treated incorrectly. Research is needed to identify these

conditions and correct treatment.

Food intolerances, Food intolerances such

as celiac disease, sensitivity to various milk

proteins, other sensitivities, and intolerances.

immune an d autoimmune diseases.

Preliminary findings suggest a relationship

between diet and the development of some immune and autoimmune diseases.

Technology for Delivery

of Nutrients to Patients

We are concerned here with a variety of

very practical problems aimed at improving

the nutritional status of severely ill patients.

These involve:

Improvement of dietary formulas. Improvement of dietary formulas for those with

special feeding problems such as patients
who must

periods by

be maintained for substantial

parenteral nutrition alone, those

with genetic defects who require chemically

defined diets, those in whom certain foods or

nutrients must be severely limited as may be

desirable in chronic renal disease, institutionalized patients with special feeding problemsas in mental hospitals and homes for the

aged. Palatability is a particular issue of importance to patients when oral feeding routes

are used and must not be forgotten in the

quest for more effective formulas from the

metabolic standpoint.

Improvement in the delivery of such formulas. Better techniques for delivery of parenteral solutions, intragastric feeding and intravenous feeding outside the hospital (often

called home total parenteral nutrition (TPN)),

and the feeding of patients who cannot feed

themselves are also needed. Substantial opportunities for lowering the cost of the

management of such patients by these techniques as well as improving their nutritional

status will result from such efforts.

Behavioral and Emotional problems

The number of patients who come to health

personnel with psychological and psychosomatic stress-related problems that they

suspect are diet-associated is on the increase.

Effects of dietary constituents on behavior,

Certain dietary constituents such as monoamine oxidase inhibitors, monosodium glutamate, and certain food colors and flavors

have been implicated as having effects on behavior. The whole question of hyperactivity

due to foods or food constituents is still an

open one, yet results from two large studies to

date indicate that the results of attempting to

associate or disassociate foods and hyperkinesis have been equivocal, Recent findings in

other areas suggest that diet-drug interactions affecting behavior may be more common

than was previously thought. Research exploring the possible effects of these food constituents and interactions on behavior is

needed to make satisfactory medical recommendations as well as to provide regulatory

agencies with information which may be

helpful in decisionmaking on the use of certain food additives. Methodologies for precise

and sensitive measurement of different behavioral indices are urgently needed; the lack

of such indices limits progress on the effects

of dietary constituents on behavior.

Effects of various patterns of moderate

alcohol use on behavior and performance.

Dose, pattern of alcohol consumption, the

purposes for which it is used, and the social

context of consumption are all associated

with its potential for misuse, Forms of alcohol

consumption that pose the least risks of harm

need to be identified.

Other related studies. Research on the effects of diet on human behavior must involve

studies of specific dietary constituents as

well as studies on food consumption. Three

research areas are therefore apparent: the

effects of kind of food, amount of food, and

feeding interval on behavior; the effects of

specific nutrient deficiencies and marginal

deficiencies on behavior; and the pharmacological effects of food constituents, food additives, and accidental food contaminants on

behavior.

Analysis

Need

Recent studies have uncovered a shocking

degree of overt undernutrition among hospitalized patients. The sources of this malnutrition may be undernourishment in the elderly

and ill before they enter the hospital, recognition of a problem that has always been with

us, or failure to provide nutritional support,

Research advances in the nutritional management of disease can be expected to shorten hospital confinement, prevent complications, and hasten convalescence. It is important to evaluate the impact of new methods of

nutritional support and treatment on such

variables as patient response to treatment

and changes in number of hospitalizatio n

days. If significant positive changes are

achieved, inclusion in patient care may largely pay for itself by tradeoffs in other areas.

Finally, the impact upon quality of life of

this research is likely to be high. The chronic

diseases include many which cause serious

incapacitation and pain, as well as those

55
which collectively account for the vast majority of urgent demands for health-care services. Improvements in management may

therefore improve quality of life.

Current State of Knowledge

Recent advances in the applied sciences

have opened up a whole new field involving

reversal or management of disease by provision of supportive nutritional therapy. Here

potential for breakthrough is high, particularly if it is possible to train physicians and other

health providers who presently lack this

knowledge.

A good deal of basic science background is

already available in some areas so that fundamental “breakthroughs” to achiev e

transfer of findings from research to application at the clinical level can be expected

relatively quickly.

Applied research efforts in this field can

be expected to yield results which require

large-scale testing and refinement to demonstrate effectiveness. Such clinical trials are

exceedingly expensive and must therefore be

undertaken only after careful planning and

experimental design.

Capability

While the technologies and personnel are

available at present, they are in short supply

and highly specialized. Only small-scale research studies are being done. Better integration of research with clinical training may

help in making this type of expertise more

widely available.

The development of clinical nutrition research must be primarily a medically related

activity. However, it should have a close relationship to other nutrition and food science

research activities and personnel whose interests are broader than nutrition in the treatment of disease so that their specialized

knowledge may be transferred as rapidly as

possible.

cost

Current levels of funding are inadequate to

develop technology transfer to the wide-scale

practice of procedures which have already

been demonstrated useful. Resources required are essentially financial.

This research can be expected to have economic implications over the long term in

terms of lessened disability, fewer complications, and shorter total hospital stays.

Most research on improvement of dietary

formulas and techniques for delivery of formulas is supported by private industry. Federal research costs in this area are therefore

expected to be low.

Immediacy

The time span involved to solve these problems varies a good deal and depends upon the

disease state under consideration as well as

on the availability of basic science and technology. Where these are sufficiently developed, a mission-oriented approach would be

most appropriate for speeding up practical

applications. However, past experienc e

shows that applied studies must rest upon relevant data generated at the basic science

level. In many of the areas mentioned, longterm studies will be needed before clinical

application of findings can be considered.

Other Considerations

The potential for linking this type of research with training is high. Such an approach would also help to maintain research

potential. This research, conducted in clinical settings, would be a stimulus to healthcare providers and encourage them to integrate nutritional concerns more fully into the

health-care system. The research which has

already been done has had a positive effect in

that it has generated increased interest in

clinical nutrition and preventive medicine

among some sections of the medical community and particular among medical students,

The necessity for assuring that adequate

training in newer aspects of clinical nutrition

application is provided to students in medical

and other health professions is closely associated with this priority. Over the long run, provision of such training funds would allow

more rapid application of existing research

fundings and technologies to patient care

problems, thus achieving greater impacts per

research dollar expended.

56
NUTRITION EDUCATION AND CONSUMER INFORMATION

Just if i cat ion

Present knowledge as to how nutrition

contributes to the maintenance of positive

health as well as to the prevention or treatment of chronic diseases is considerable. To

realize the potential benefits from this research and from future research, findings

must be translated into practice. Individuals

must have the opportunity to incorporate

them into their own eating practices and lifestyle. We know very little about how to support the maintenance of nutritionally desirable behavior to help individuals adjust their

dietary practices. Nutritional behavior in this

context includes such practices as food consumption, food selection and purchase, food

preparation and storage, physical activity,

and lifestyle.

The Federal Government supports several

different types of nutritional intervention programs. These include nutrition education,

food fortification, food regulation and inspection, food price support, and various feeding

programs, including Food Stamps, programs

for the elderly, women, infants, and children.

For many nutrition practices, consumer nutrition education alone or in combination with a

feeding program may be the most feasible

mechanism for influencing food choices. It

also possesses the advantage of leaving decisions in the hands of the public rather than

expanding the role of Government.

While there is a common core of research

questions that must be explored in order to

develop a basic understanding of the dynamics of food choices, it must be remembered

that different agencies with different legislative mandates have unique concerns which

must be served by nutrition education research, Therefore, different research emphases of individual agencies must be considered,

In FY 1976, the Departments of Agriculture and Health, Education, and Welfare supported roughly $70 million of nutrition education activities. Very little of this money is actually allocated to research, and the vast majority goes to programs.

The primary emphasis of Federal nutrition

education programs until now has been the

obtaining of an adequate diet. Since this is

not the major nutritional problem in the

United States today, the public deserves to be

informed about nutrition and other measures

that promise to help in health maintenance

and the prevention of disease. Knowledge is

often incomplete to move forward with firm

recommendations of demonstrated utility. But

the public’s need for information on the pros

and cons of the measures is still present.

Such information would allow them to understand the changing nature of scientific knowledge and to play a more active role in adopting healthful food consumption practices in

their own lives if they wish to do so. It would

also help them to make more rational use of

the enormous amount of health-related information they constantly encounter.

Since little research on nutrition behavior

and education is currently conducted by the

Federal Government, research in these areas

should accomplish four goals:

1.

2.

3.

Definition of the focus of nutritional behavior and education research. The

specific issues, concerns, or content

most urgently in need of study or attention in light of national interests need to

be defined. The panel’s recommendations on these areas are described in the

following section.

Guidance for Federal food and nutrition

policies and programs. In view of the relatively large amounts of Federal money

spent each year on nutrition education

programs and the lack of evidence of effectiveness of these programs, this area

is probably one of the greatest congressional concerns.

Development of a theoretical framework

for nutritional behavior. Little or no

theory has been developed to explain or

allow prediction of nutritional behavior

or to indicate which nutrition education

57
approaches are likely to be most effective in different situations.

4. Development of methodologies for studying nutritional behavior, testing nutrition communications, and evaluating nutrition education effectiveness. There

have been few systematic attempts to

catalog the methodologies available and

applicable to such studies.

Factors Affecting Lifetime Eating Habits

and Identification of Critical Points

for Education

Successful nutrition education must take

into account all of the various factors that

motivate consumer food choices. Current nutrition information and education programs

funded at the Federal, State, and local levels

have a weak research base. A modest expenditure of funds in the following areas should

yield high returns in improving the effectiveness of existing programs:

Sociocultural and other lifestyle factors

that influence American dietary patterns. Improved public health through better nutrition

for groups that run particularly high risk of

problems depends on better approaches being developed in this area. A great deal is

known about clinical implications of certain

dietary lifestyle habits, but we know very little about the factors that influence the adoption of these eating patterns or how they can

best be influenced. One step in the right direction is to identify the various characteristics of groups within our diverse population.

Times of life which are particularly ripe for

education intervention. We need to know

when particular types of consumers are most

responsive in terms of their lifestyles and

food habit formation to receiving different

types of nutrition and health-related information.

Food advertising and its effects. The influence of food advertising on eating habits

needs more careful study. The food industry

spends between $1 billion and $5 billion annually on advertising. The degree to which

such advertising influences food choices and

affects or competes with consumer comprehension of nutrition information from other

more objective sources needs study.

Development and Evaluation

of Nutrition Education and

Communication Methods

Since the goal of nutrition research is to improve the health of people, it is important that

current research knowledge be communicated to the public in daily living. Means for

communicating useful research findings to

the public so they can be acted upon in daily

life need testing. The message communicated

must optimize the ability to make food choices

that will promote health, taking into account

lifestyle constraints.

More effective methods for evaluating the

effects of teaching efforts in schools are

needed. Since public education is the responsibility of the States, intergovernmental collaboration between Federal and State agencies will be necessary in order to achieve this.

Evaluation of nutrition education programs

requires clear criteria for achievement.

Research efforts in this area include investigations of effective program design and development of criteria for success, Methods

for nutritional status and risk factor evaluation may be relevant and need incorporation.

Significant research findings which can be

put into practice should be available within a

relatively short term. However, pilot programs, carried out over a period of 5 to 10

years, will also be needed to assess the utility

and long-term effects of such improvements,

The development and testing of models for

screening and evaluating educational materiak is also needed. Such systems can be used

to examine the appropriateness and effectiveness of materials currently being used in

relation to functional literacy, nutritional

problems, and communication modes of the

various populations towards which they are

directed.

This research focuses on finding the most

useful ways of fostering healthful food consumption practices by educational means.

Useful areas of research here include:

Identifying current sources of information

and locations or settings in which specific

58
types of nutrition information are most effectively delivered and the most appropriate

means to do this (e. g., family support systems,

community organizations, the health care

system, work sites, the school system, media,

Government, private sector, etc.).

Measuring the effectiveness of communicating objective information on controversial

topics and information with respect to diet

and health risks. People need to have information on the pros and cons of different

choices with respect to diet so that they can

make their own decisions and choose dietary

practices which are appropriate to their

styles of both life and health. Enough evidence exists at present to suggest broad

guidelines with respect to prudent measures

for health, price, and other aspects of diet.

There is no expectation that a single optimal

dietary pattern can or should be generated.

Research must be directed toward developing a series of dietary recommendations for

different income, ethnic, age, and sex groups

within the population, taking into account

variations in their total environment, habits,

economics, and their own estimates of risk,

Some recommendations can appropriately be

made today, but a good deal remains to be

done in finding the most effective ways to

communicate such changes. Research is also

needed to determine the most effective means

for researching different target groups.

Many risk factors associated with the later

development of chronic diseases are already

present by the time children leave grammar

school. Some of these, such as obesity and

dental caries, are nutrition-related. People of

all ages have enormous difficulties in comprehending low risks or judging low-probability

events, Issues that currently fall into this category include the advisability of various nutritional patterns for health maintenance and

the nutritional value and safety of the food

supply as well as the association of diet with

disease.

The proper response of Government when

faced with the dissemination of new findings

with respect to risk factors is an important

question that must be clarified by public

debate.

There is virtual unanimity that Government does have an obligation to provide information that promotes health-related behavior; however, as attested to by recent congressional investigations and Federal legislation and appropriations in the area, research

is needed on the best ways to do this.

Research on Methods for Simplifying

Consumer Information Utilization

Consumers are likely to benefit most directly from information which reaches them in

their daily lives. Food labeling for nutrients,

ingredients, and unit prices are examples of

how consumers can acquire information directly. Many foods are not adequately labeled today, and the present form of nutrition

labeling may be difficult for some consumers

to understand, The value of graphic forms of

labeling; extension of the number and type of

foods labeled to include meats, fruits, vegetables, and other commodities; and the expansion of the information provided to include

such food constituents as sodium, potassium,

type of fat, cholesterol, refined carbohydrates, and dietary fiber should also be explored.

Analysis

Need

The public’s need for information, particularly with respect to chronic diseases,

obesity, and wise food choices, is high. In

view of the fact that changes in the major

food programs (such as replacing food stamps

with income subsidies) are now being considered, information and education on wise

food choice may be even more important in

the future. The impact of improved methods

for helping the public to adopt healthful

eating practices was assessed to be high.

Current State of Knowledge

The major difficulty identified here is that

the basic knowledge base is weak, Behavioral

and social scientists have given only superficial attention to nutrition education research. It has been a scientific backwater

which has failed to attract the attention it

deserves from applied scientists in many dif59
ferent disciplines. Programs designed to provide information on nutrition and to change

eating practices are presently funded by a

variety of Federal, State, and local government bodies. But information provision is not

synonymous with information that attracts

attention, is being attended to, comprehended, accepted, and used in daily life.

Much of what is already known in the field of

nutrition can benefit people if it is readily

available in useful and appealing forms.

Research addressing the question of how best

to communicate nutrition information is

needed to do this.

The final difficulty is our diversity. We are

a heterogeneous people with diverse needs

and preferences. There is no single, simple,

cheap, easy answer as to how to go about

developing approaches that reach all of these

diverse groups. We also require reasonable

limits for our expectations of what can be accomplished by education.

Capability

Research in food and nutrition education

should involve a variety of disciplines, particularly nutrition scientists, food scientists,

social and behavioral scientists, and educators. Collaborative research efforts involving

interdisciplinary groups including such specialists as social and consumer psychologists,

educators, home economists, human ecologists, anthropologists, economists, epidemiologists, health care evaluators, sociologists,

communications researchers, and consumer

representatives are needed to develop the research strategies. There is a need to develop

appropriate psychological and behavioral

testing procedures. The resources that are

the most sophisticated with respect to this

type of research are in other fields. The Federal Government has until now had almost no

involvement in developing methods of educating the public with respect to nutrition.

In recent years no Federal expenditures

have been specifically earmarked for nutrition education research. Thus while vast

sums are being spent by the food industry to

find ways to influence people’s purchase behavior and many Government agencies administer consumer nutrition education and information programs, virtually none of this

money is devoted to finding out how to provide this material in a manner that would facilitate consumer comprehension and usage.

Even modest amounts of funds expended on

such research can be expected to yield high

returns per research dollar spent.

cost

While a great deal of research must be

done, great benefits can be reaped from the

transfer of already developed technologies

from the industrial and communications

fields; thus development costs are reduced.

Moreover, economies may be effected by the

development of more efficient program efforts. Federal programs now spend over $ 7 0

million on nutrition education, yet research

efforts financed by Federal efforts amount to

very little. The food industry has been much

more active in investigating factors that influence our food choices. A vast amount of

money (estimates range from $1 billion to $5

billion) is spent annually on food advertising

in an effort to influence consumers’ food

choices, and careful research underlies their

efforts to influence brand choice. But little of

this research is devoted directly to the issue

of choosing diets that promote good health by

preventing chronic as well as deficiency

diseases and obesity. Federal expenditures

are needed to broaden the research base on

which to build nutrition education programs

dealing with these issues.

Immediacy

While some benefits can be expected over

the short term, as in developing improved

labeling and nutrition information programs

on risk factors, most of the outcomes will

reach the stage of practical application in 5

to 10 years.

Other Factors

The potential for links between research

and training was judged to be excellent.

Maintenance of research potential is also

high if such endeavors are carried out in settings in which new professionals are trained.

The priority areas are broad and are not such

that creativity is likely to be hampered by this

type of mission-oriented research.

60
REQUIREMENTS FOR ESSENTIAL NUTRIENTS

Justification

Better understanding of nutrient needs and

interrelationships increases the store of fundamental knowledge and makes practical advances possible. The amounts of certain nutrients required by individuals of different

age, sex, and occupational groups are still

unknown. These nutrients deserve particula~

attention. Little-explored interactions between nutrients and toxic materials also need

more study.

Methods for Determining Nutrient Needs

Estimation of requirements for nutrients

about which little is known. Our knowledge of

needs is deep for some of the 50-odd nutrients

human beings require and is shallow for

others. For a number of nutrients, estimates

of requirements have reached a point where

further refinements can be expected to yield

rather trivial gains in improving human

health. A great deal of work remains to be

done in developing better methods for estimating requirements for nutrients about

which little is known. These nutrients include

most of the trace minerals and certain of the

vitamins. In some instances the gaps in

knowledge are so great that even the methodology to determine their requirements does

not yet exist,

Nutrient needs for population subgroups,

such as low-birthweight infants, adolescents,

women using oral contraceptives, pregnant

and lactating women, and the elderly. We

know very little about nutrient needs for special times and events in life, We do know that

certain vulnerable groups in the population

have a higher risk of nutrition problems

because of changing needs. These groups include low-birthweight infants (especially

those having weights under 1,300 grams),

adolescents (especially pregnant adolescents), women who are using oral contraceptives, pregnant women (and their fetus), lactating women, and the elderly (with particular attention to the effects of aging on nutrient need in chronic disease), The range of requirements for various groups of people and

the interactions between ranges of requirements may be important.

Nutrition research directed toward a

healthy survival of low-birthweight infants

should produce massive payoffs in terms of

reducing the prevalence of mental retardation, learning disabilities, and perhaps neuromuscular disorders. All of these are most

common in children and adults who suffered

intrauterine growth retardation and or short

gestation. Approximately 8 percent of newborns fall into these groups. If they can be

helped to a healthy survival, they could have

70 to 80 years of productive living.

Nutrient Requirements Based

on Functional Criteria

The needs for many nutrients have been

set on the basis of rather arbitrary criteria.

For example, the requirements for iron is set

by determining what is considered to be a satisfactory concentration of hemoglobin in the

blood or biochemical measures that reflect

iron stores. More meaningful measures from

the standpoint of significance to human

health and well-being might be resistance to

infection, levels associated with the best

learning ability, or exercise tolerance .

Numerous examples exist of other nutrients

for which relatively arbitrary criteria are

presently used, Attention must be devoted to

studies on functional criteria related to

reproductive function, work capacity or productivity, and mental function.

Nutrient Interactions

Food is the most complex mixture of chemicals the population comes in contact with on a

regular basis, The topic of chemical-drugnutrient interactions has not yet been approached except in a peripheral way, yet it

could yield significant information from the

standpoint of human well-being and welfare,

Interactions among nutrients, foods, food

components, drugs, an d environmental

agents need careful study.

Efforts to keep knowledge of nutrient needs

current and applicable are very important,

61
Because of the complexity of this task, it will

be increasingly necessary to develop new approaches to understanding what constitutes

an appropriate diet.

Requirements for some nutrients vary depending on the level of other nutrients in the

diet. Studies on interactions among nutrients

are therefore needed. In some instances

other food components, drugs, or environmental agents to which people are exposed also

act to modify nutrient requirements or the

availability of nutrients in foods that are

eaten. Our food supply consists increasingly

of processed foods. Constant effort is necessary to keep knowledge of nutrient needs

abreast of and applicable to this changing

world.

Pharmacologic and Toxicologic Effects

on Nutrition

Safety and effects of high doses of nutrients. The public is exposed to a great deal of

material concerning the merits and liabilities

of large doses of nutrients and dietary fiber,

although little satisfactory evidence exists

about their effects. Clarification of the potential for damage or benefit is needed. This type

of research should be conducted with concurrent investigations on how these substances

exert their effects.

Nutrient needs of patients suffering from

chronic diseases that involve constant medication. It is likely that some of the chronic

diseases have specific effects upon requirements for nutrients or other substances in

food. As the American population continues

to live longer each year, the proportion of the

population suffering from various types of

chronic disease is on the increase. The

special requirements of these persons need

attention,

Effects of alcohol on nutritional status.

Alcohol is a food as well as a drug and is consumed by a high proportion of the adult population, Alcohol abuse is a major problem in

this country, affecting both performance and

nutritional status at some levels of intake.

Studies of the effects of alcohol on nutrition

status deserve attention because of its widespread abuse,

1. Effects of alcohol intake during pregnancy on the fetus and its subsequent development. Alcoholism has been clearly

linked with poor outcomes of pregnancy.

The effects of more moderate alcohol

use also needs to be explored since there

may be serious effects on the development of the fetus. Such research can

provide guidance about acceptable levels of alcohol intake during pregnancy.

2. Effects of alcohol consumption on nutritional status and nutrient utilization.

Alcohol consumption is the norm rather

than the exception in American life today. The nutritional effects of alcohol

consumption need to be better delineated. Information amassed will help to

define the physical and social consequences of various levels of alcohol consumption and provide the basis for the

development of practical recommendations on the controlled use of this

substance,

3. Interactions among diet, alcohol, and

other addictions. Although studies on the

interrelationships between alcohol consumption and nutritional status have

been done, practically no such studies

are available with other addictive drugs,

Many addictions obviously result in

dietary neglect and malnutrition, so

their nutritional implications deserve attention.

Bioavailabilit y of Nutrients in Foods

Because of the form in which they occur

and the food’s composition or processing,

some nutrients may not, in fact, be available

to the body even though they are eaten in the

food. One example is certain forms of iron,

but there are many others. Other nutrients

present in the raw state may be altered by

processing to become either more or less

available. The effects on nutritional status of

these factors need more careful investigation.

62
Analysis

Need

The prevalence of undernutrition in

United States is fortunately very much

than it was even a few generations

the

less

ago.

However, for some nutrients, techniques for

measuring needs have not been available,

and therefore we cannot yet ascertain if

problems exist, In other cases, the important

questions of interrelationships between nutrients and special needs for nutrients by highrisk groups within the population cannot be

answered until more studies are successfully

completed. The health impact of developing

better knowledge of the needs of premature

infants, pregnant wome n (particularly

teenagers), and other high-risk groups may be

considerable.

Current State of Knowledge

The relative potential of this area is limited

in areas such as interrelationships between

nutrients because basic science information

is not yet adequate. For some nutrients there

are also methodological or ethical limitations

that make it difficult to measure needs. Fundamental advances in methodology are required.

Capability

The fields of nutritional pharmacology and

toxicology are presently underdeveloped, and

a reorientation in training of research personnel will be necessary to fill these gaps.

cost

Payoffs in this area are most likely to result

from steady research over many years. This

long-term process therefore requires steady

funding over many years rather than large

sums for short periods of time.

Immediacy

Steady research over many years is necessary to develop this type of information.

Other Considerations

The potential for achieving multiplier effects by developing close interrelationships

between research and training is high in this

area, as is that for the maintenance of

research potential. A mission-oriented approach is probably most suitable in these

areas.

NUTRITIONAL ASPECTS OF FOOD SCIENCE

AND FOOD SAFETY

Just if i cat ion

Food composition, processing, and safety

are related to the development of better understanding of current nutrition and food

issues. First, there is the problem of discovering more about the chemical composition of

both processed and unprocessed foods. Surprisingly little is known about this. For example, it is extremely difficult to obtain information on nutrients such as zinc, folic acid, and

trace elements; data for other food constituents such as dietary fiber or sugar are lacking for almost all foods. Second, more needs

to be known about changes in chemical composition that occur in food production and in

processing and storage before food reaches

the consumer. Also, what consumers do in

food handling and preparation after they buy

the food must be considered, since this too influences nutrient and food composition. Finally, it is important to learn more about how

food composition and processing may interact. Such interactions also may affect nutrient content and food safety,

63
Food Composition

New and improved methods of analysis of

food composition. A complete food analysis

must include not only complete nutrient content but other food components of significance as well, such as fiber, additives, and

toxic materials. For several substances of interest, such as various forms of fiber and

types of carbohydrates, such methods (or

analysis) are sorely needed.

Composition of foods currently on the market and new foods as they become available

(or new varieties in the case of fruits and vegetables). The composition of many foods on

the market today is not known, whether with

respect to the nutrients or to other food components.

How the composition of foods may be altered through processing, handling, and holding prior to use and in institutional or home

preparation, Changes in nutrients and other

substances occur during food storage and

processing. The changes include possible

completing with other food components, decomposition, or formation of toxic chemicals.

Those that are likely to impact adversely

upon health are of top priority.

New Food Processing and Handling

Procedures to Maintain Nutrient Content

New methods for maximizing use of food

and minimizing spoilage, waste, and other deterioration that lead to nutrient losses are

needed in the entire food chain from producer through the marketing system to the

ultimate consumer.

Better Methods of Assuring Food Safety

Better methods are urgently needed for

assessing, monitoring, and minimizing toxicants (both natural and environmental) in

foods and food systems. Since all substances

are toxic at some high exposure level, such

methods must distinguish between risks of

very different magnitudes. Appropriate priorities are critically important. Research directed at risk reduction must concentrate

first on those toxicants that are largest or

more easily and significantly reduced. The

development of new handling and processing

techniques should emphasize maximization of

safety rather than concentrating upon minimum standards. Research in this area must:

ldentify food constituents, both microbiological and chemical, that bear on food safety

and ultimately on health, The isolation and

identification of food constituents of possible

hazard is a considerable analytical task that

currently must precede effective toxicological evaluation.

Develop quick and reliable methods for assessing the toxicity of food constituents and

additives. Toxins of bacterial and fungal

origin pose hazards which, with the nutritional hazards, far outweigh all other food

risks. Appropriate preservation and sanitation can prevent most microbiological problems. For chemical hazards, conventional toxicological approaches rely on expensive, longterm, error-prone feeding of single, identified

substances to test animals. New short-term

methods, or preferably a battery of such

tests, may replace these for screening purposes. Before such short-term tests are

employed for decisionmaking purposes, they

must be rigorously validated by extensive collaborative study on a sufficient variety of

substances in food and in an environment to

create a background of interpretive experience. By such validated tests on crudely

separated food fractions, the elaborate and

expensive conventional, analytical, and toxicological methods may perhaps be largely

avoided and focused only where they are

most needed.

Mechanisms for the improvement and coordination of surveillance and monitoring of

these various substances in the food supply

must also be developed. These are discussed

in the next section, “Monitoring Nutritional

Status. ” At present, USDA and FDA each

have independent surveillance systems for

monitoring toxic substances in foods, and

these need better coordination.

Analysis

Need

The monitoring and surveillance of the

safety of the food supply and consumption

patterns is presently hindered because food

64
composition information is not complete. The

composition of a food includes all of the chemicals contained in the food. These include

naturally occurring compounds as well as additives classified as nutrients, colors, flavors,

texturizers, preservatives, and so on, Some

substances in food that may be important to

human health are indirect additives or unintentional contaminants; others are direct additives. In addition, there is a large and

unquantified number of chemical-reaction

products induced by processing or associated

with formulation, fabrication, and cooking.

Some of these constituents of food have physiological effects to a lesser or a greater extent. Their significance upon human health

can be ascertained only by careful research.

The economic impact of eliminating harmful

substances from the food supply may be considerable, But research is also necessary in

this area to assure that changes are based on

facts rather than opinion, since the negative

economic impact of unwarranted changes in

the food supply is also considerable.

Current State of Knowledge

Basic knowledge necessary for reaping

practical benefits is available for achieving

the goals of learning more about food composition and the effects of processing and

handling procedures upon nutrients. Better

methods of assuring food safety await advances in basic knowledge. However, reorientation in focus may be helpful.

Capability

The resources are available to achieve

most of the goals in this section. Methodologies for some types of food safety testing require refinement and validation and the expertise of food toxicologists.

cos t

Since laboratories equipped to perform

this type of research are already available,

particularly at larger universities, major development costs can be avoided.

Immediacy

The results of this research will have immediate and long-term practical application,

Some results can be expected very soon and

others within 5 to 10 years, However, their

ultimate practical utility is great. Among

other things, they should help us to:

Evaluate the nutrient value of food consumed and develop recommendations for

changes where required. Changes recommended might include new processing techniques adopted by the manufacturer, fortification, reformulation, or selection of alternative food items by consumers.

Provide means to evaluate potential

changes in the nutrient supply related to introduction and use of new foods, new varieties, or formulated or fabricated foods, and to

furnish the basis for factual recommendations and appropriate action when needed.

Prevent the introduction of unsafe foods

resulting from interactions during processing

of various components or selection of varieties with potential adverse properties,

Expand the availabdity of nutritionally adequate processed foods and maximize agricultural production.

Other Considerations

The potential for achieving multiplier effects by linking research and training are

present if the research is carried out at institutions with graduate programs, The abilit y to maintain research potential will depend

upon 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 the

best possible nutritional status for every

citizen is to be acheived, accurate, up-to-date

nutritional profiles of the population and

ways of measuring the impacts of various environmental changes upon this status is required. Particular attention is necessary for

groups likely to be at high risk of malnutrition. Such information is also fundamental

for sound policymaking for food and health

programs designed to enhance nutritional

status as well as for monitoring changes in

the food supply.

Certain groups— such as members of the

Armed Forces, patients in Federal hospitals,

American Indians, and Aleuts—are the

wards of the Federal Government, and thus

their health is its direct responsibility.

Research on better means to provide for

monitoring and improving their nutritional

health is also of particular importance.

Methods for Improving Integration

of Food Consumption and Nutritional

Status Information

Adequate methods are sorely needed for

continually obtaining information on foo d

consumption patterns and nutritional status

which can be correlated. Existing systems

neither are sufficiently integrated nor is their

overall capacity sufficient to do this job. Data

currently available from the Department of

Agriculture Food Consumption Survey, the

HEW Health and Nutrition Examination Survey (HANES), and the Center for Disease Control furnish useful information on the overall

nutritional status of the population. But they

were not planned in coordination nor designed to concentrate on high-risk groups.

Subgroups within the population that are

suspected to have particularly high nutritional risks are not represented in sufficient

numbers, nor are data complete enough to

permit detailed evaluation of their most likely

problems, Thus the facts needed for launching useful interventions are not available.

Neither survey is appropriate for surveillance or assessing the results of intervention

programs; nor does either provide the sophisticated information on food practices, attitudes, and related habits that are necessary

if more effective intervention and information

programs are to be mounted. The Food and

Drug Administration has recently launched

yet another separate type of monitoring effort

which may provide some of this type of information; this is another independent effort

that is poorly linked to existing systems. Even

from this brief review, the fractionation,

gaps, and potential for duplication in monitoring and surveillance efforts are all too evident.

It has been suggested that there should be

efforts to integrate monitoring and surveillance with local and regional systems. Local

efforts would presumably be more effective

in identifying problem areas and in evaluating the effects of intervention programs

and thus would be useful in program development. They might utilize information from

such already existing systems as market research organizations, sales of food outlets,

school health examinations, hospitals, insurance companies, and unions as well as

additional information which it may be necessary to collect, Research on how best to link

the various levels of information into a national survey system is needed.

Evaluation of the Effect of Food

and Nutrition Education Programs

Evaluation methodology for improving the

effectiveness of current programs. Better

methods for evaluating programs designed to

improve nutritional status are urgently

needed. Present food programs include

school breakfast and lunch and the Supplementary Food Programs, as well as special

milk programs for summer and several

schemes for provision of surplus commodities

to nonprofit institutions at low cost. Educating and informing the public on food and

nutrition is accomplished through 12 dif66
ferent Federal agencies engaged in educational programs as well as by food labeling

and food advertising efforts. Finally, the safety of the food supply is governed by regulations enforced by FDA and USDA. Research

must continue on present programs with the

objective of improving program efficiency

and effectiveness, developing information

which may be needed for mounting better

programs, and integrating these with other

health and educational efforts directed

toward the same recipients,

It is sometimes contended that the food programs are essentially a politically palatable

form of welfare with few or no advantages

over direct-income supplements with respect

to improvement of nutritional status. Before

this hypothesis is accepted, it deserves

careful testing involving large-scale experiments that include survey research on

knowledge, attitudes, and practices with

respect to nutrition, nutritional status, unexpected but likely effects on employment, etc.,

and consumer acceptance among recipients.

The cost is small relative to the critical need

for objective data in making decisions about

such multibillion- dollar programs.

Improved monitoring of food consumption

and nutrition status in Federal facilities. The

Federal Government is the Nation’s largest

food purchaser. In federally operated facilities such as defense installations, veterans’

hospitals, Public Health Service hospitals,

and Government offices and installations, the

Federal Government is responsible for the

whole food delivery system. Such institutions

provide an opportunity for applied research

in how best to monitor food consumption and

nutritional status. The medical facilities offer

additional opportunities for research on ways

to monitor nutritional status in hospitals. As

yet their potential has hardly been realized.

extent of problems related to nutrition and

the impact achieved by intervention efforts,

they are extremely important. The need for a

better system of monitoring the nutritional

status of Americans is great,

Current State of Knowledge

The current state of knowledge is poor

regarding the nutritional status of our population, particularly that of groups which are

most likely to be malnourished. There are

many methodological limitations that may

best be overcome by the development of better techniques for measuring nutritional

status.

Capability

Technological innovations permitting more

rapid data collection and analysis a re

necessary.

cost

Cost for an integrated system for monitoring nutritional status would be high, It is uncertain whether it is possible to either develop 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 funding. Assuring a research budget over the op

crating costs of the present system would encourage research on methodology and integration of survey efforts between USDA and

HEW.

Other Considerations

Analysis

The opportunities for maintaining research

Need

potential are high since most of the research

is conducted in Government facilities, Most

Since these studies furnish the basic in- links with this type of research are low at

formation 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 alterations in nutritional status. Their effects are

not widely appreciated, and only recently

have attempts been made to measure them.

The distinguishing characteristic of nutritionpolicy research is its concern with nutritional

effects. Food policy in the past has been

based largely upon economic, political, and

agricultural considerations, while health

policy has been largely oriented towards

curative medicine. Many changes of either a

planned or unplanned nature or changes in

societal institutions and systems may have

profound and unforeseen effects on nutrition

status. These changes include income supplements, agricultural price supports, level of

employment, farm size, cost, availability of

energy, and others.

Analysis

Need

The need for assessing the impacts of

various policies is high and may be helpful in

assessing the relative merits of existing programs.

Current State of Knowledge

Each discipline tends to believe that it

holds the keys to unlocking problems in other

areas; yet there is no way of validating these

suppositions. There is also the dangerous

tendency in policy-oriented research to

equate politically expedient solutions with

truth.

Capability

The problems addressed in food and nutrition policy cannot be well handled in a single

agency of the Federal Government. These are

most logically attacked by joint efforts on a

cross-agency basis with a number of problemsolving groups. The bottom line, however,

must be a primary concern for solving nutrition-related problems or evaluating solutions

on a nutritional basis, and the nutrition and

food researchers should have a major input

into each group.

Joint efforts involving persons from many

different disciplines must be mounted, with

the “mix” of such persons depending upon

the problem, The underlying concern, however, must remain constant: solving nutritionrelated problems or evaluating solutions with

nutritional criteria in mind. Nutrition and

food scientists should have major inputs in

each of these groups. Since nutrition policy

studies are concerned with the relationships

between nutrition and such diverse factors as

health, supply and demand, experts in other

disciplines must be represented,

cost

Costs for policy research should be low.

Immediacy

Some immediate benefits could be expected from interdisciplinary and interagency collaboration in discussing policy questions and in performing needed research.

Other Considerations

Since most policy decisions and research

are done in settings in which training does not

occur simultaneously, the potential for linking

this type of research with training efforts is

low. Maintenance of research potential is

also likely to be poor because of the location.

For these reasons, extramural research conducted at universities should be implemented.

68
RELATIONSHIP OF DOMESTIC AND

INTERNATIONAL RESEARCH

There should be a strong relationship between human nutrition research carried out

in an international context and domestic research needs in the United States. The priority research goals identified in this report can

best be achieved if research is carried out internationally and domestically relative to certain areas. The conduct of research internationally has a basic relationship to the U.S.

nutrition research policy, In many cases,

research carried out in areas of the world

outside the United States may be the best way

to solve problems that have considerabl e

domestic relevance,

For example, epidemiological investigation

of certain chronic diseases states requires

good information about disease incidence and

food patterns of societies with lifestyles and

food habits different from our own. The high

incidence of extreme cases of malnutrition in

some developing countries also provides a n

opportunity to investigate the relationships

between nutritional status and functional

performance of individuals in a way tha t

could not be done in the United States. Study

of the clear effects in extreme cases may

make it possible to extrapolate the results to

marginal nutritional states.

To be able to investigate some of the priority research areas of nutrition, the study o f

populations and food patterns worldwide is

essential. Thus any effort to increase international research capability in the Unite d

States and abroad will have a dual reward:

improved nutritional status of malnourished

people and increased knowledge of huma n

nutrient needs and health status unde r

changing environmental conditions,

Other international research may have significance principally for problems of malnutrition in the developing world, Identifying the

social, political, and economic determinants

of malnutrition may be the major research

that must be carried out to design intervention programs to alleviate the widespread

malnutrition in certain areas of the world.

The policy research that needs to be carried

out may be quite specific to the political,

social, and economic situations of the countries involved.

The 1977 National Academy of Sciences

report, The World Food and Nutrition Study,

recommended four priority areas for nutrition research:

1.

2*

3.

4.

Nutrition-performance relations. This

research should determine the damage

caused by various levels of malnutrition

and the effects of diet patterns on levels

of human functioning.

Role of dietary components. This research would determine specific foods

that best meet nutritional needs under

differing circumstances and the effects

of individual nutrient levels, as consumed, on nutritional status.

Policies affection nutrition. This research would improve the effects of the

full range of Government policies from

the perspective of their effects on nutritional policies and practices.

Nutrition intervention programs. This research would improve the effects of direct intervention programs and evaluate

the effectiveness of alternative pro

grams to reach nutritional goals.

These provide opportunities to examine a

wide range of intervention strategies in many

parts of the world that may have relevance to

solving nutrition problems in the Unite d

States. The effectiveness of agricultural policies, food fortification policies, and interventions to alleviate malnutrition in certain

vulnerable population groups may be established by programs carried out in other countries.

Therefore, U.S. involvement in international nutrition research should be viewed as

an integral part of the domestic research effort and not as a separate effort, The coordination of domestic and international re -

search efforts is currently poor and reflects

the current divisions of authority. Separate

Federal agencies have responsibility for fund69
ing domestic and international research, with

the Agency for International Development

supporting the majority of international

human nutrition research.

The NAS report suggests that AID should

continue to play the leading role in international human nutrition research, The recommendations propose substantial increases i n

the scale of and improvements in the substance of the activities of AID to help

establish research and development of international research centers and programs and

support U.S. groups that wish to undertake

food and nutrition research in the developing

countries.

However, AID has suffered a serious deterioration of professional staff capability.

Resources outside of AID, whether universities or others, cannot be effectively mobilized,

nor can accountability be assured, unless

AID develops a significant cadre of nutrition

and related specialists. This need must be

met if Congress implements the NAS recommendations that AID triple, from $30 million

to $90 million by 1980, its efforts in nutrition,

AID must do much more before a specific

agenda for human nutrition research activities should be funded. Several checkpoints

need to be assessed before Congress makes

decisions about whether to provide additional

funds for international nutrition or to reallocate existing funds to this area. These are:

● Demonstration of commitment by the

Agency for International Development to

the development of human nutrition research. This would be accomplished by

upgrading and increasing the in-house

technical capability of the Agency.

● Completion of a research plan to implement the recommendations of the NAS

World Food and Nutrition Study.

● Submission of evidence of accomplishment of the above two tasks at oversight

hearings held during FY 1979.

The alternatives to coordination of international nutrition research through AID include:

1. Earmarking a percentage of U.S. money

to international centers for nutrition.

This ensures that money goes to nutrition and also provides ties to production

and other aspects of agricultural research. However, it removes nutrition

research from the health complex which

is strong in many developing countries.

Since these centers are regional, the research may be too general to be useful in

specific countries,

2. Developing U.S.-developing country institutional relationships. This is a proven

mechanism that has worked in agricultural research and offers opportunities

for the formation of consortia among a

number of U.S. and developing country

institutions. Title XII of the Foreign

Assistance Act of 1975 declared that the

United States should provide “increased

and longer term support to the application of science to solving food and nutrition problems of the developing countries. ” This has served as the basis for

land-grant and other eligible universities

entering into cooperative research programs with counterparts in developing

countries. Critics of this type of

cooperative arrangement point out that

political agents tend to undermine longterm development, that too much money

is spent within the United States, and

that this country does not have the capability to solve the problems of other countries.

3. Provision of funds to international organizations. The funding of nutrition research through international organizations would strengthen international

cooperation, depoliticize U.S. involvement, and strengthen United Nations

capabilities. However, there has been a

lack of coordination within the United

Nations research complex, and the type

of research required for the solution of

nutritional problems traversing both

health and agricultural concerns has

suffered. Funding of international

research through international organizations also removes accountability of

how priorities are set, researc h

monitored, and money spent.

70
4. Provision of funds directly to developing mechanism for research funding would

country institutions. This mechanism have little direct U.S. payoff and would

puts money where the problems are, re- decrease the amount of technical assisduces U.S. overhead and administrative tance that could be offered. There is also

costs, helps to build individual national a loss of accountability of how priorities

capabilities, and may increase th e are set, research monitored, and money

relevance of the research done. Such a spent.

DEVELOPMENT OF RESEARCH PERSONNEL

Better coordination between projections

for research needs and the training of research personnel is needed. This section addresses this priority. Increased emphasis on

federally funded research requires some

changes in existing programs to encourage

application of what is known to better human

health as well as an increase in training of

certain types of research scientists.

Links Between Research and Training

Research requires trained personnel. Such

persons, at every level, are produced only by

universities. Although this expertise can be

further developed in a variety of settings by

participation in actual research efforts, it is

debatable whether the recent emphasis on research by contract or by private and governmental organizations has in fact been more

efficient. It is likely that university-related

research efforts, which also produce scientists, have been impoverished as a result. The

fruits of such shortsightedness in the past are

presently evident in the fields of nutrition and

food science, where there is a shortage of appropriately oriented research personnel.

There was a widespread perception in the

1950’s and 1960’s that the field was unimportant. Funding was minimal, research efforts

were limited, few research personnel were

trained, and positions available for them

were few. These effects are still felt today

because a field of effort cannot be “turned

on” or “turned off” readily as problems are

perceived to be more or less important. A

“leadtime” of 10 to 20 years is required to

produce a research effort of the magnitude

that can be felt at the national level. More

careful planning is needed in this area. Since

a number of fields of research that received

major emphasis during the 1960’s apparently

produce excessive numbers of personnel,

more precise methods are needed so that

similar types of overflow do not develop in

new fields.

Types of Personnel Available

Doctorates in nutritional sciences and related disciplines such as public health nutrition, veterinary medicine, and food science.

Although the availability of training grants in

the nutritional sciences has declined because

of phasing out of this program at HEW, nutrition departments continue to attract graduate students. Lack of student support is a

liability for attracting top-quality students

who have the option of going into other

biological and health research areas.

Many outstanding graduate programs already exist where a major part of the basic

nutritional research of that unit is conducted

by graduate students as part of their doctoral

theses. Yet some changes in emphasis within

these programs might be helpful. Greater

stress on human diseases with a nutritional

component, nutritional pharmacology, food

science principles, and evaluation of nutritional status are but a few examples of the

direction these changes might take in nutrition sciences training.

Public health nutrition research also needs

reorientation and increased emphasis on the

importance of related fields such as epidemiology, behavioral sciences, health services

administration, community organization, and

nutrition policy, without losing their strong

basic core in nutritional sciences.

71
It is generally agreed that training for a research career must incorporate research experience over an extended time. These scientists can best meet the health-related nutrition research needs of the Nation by extending their training as postdoctoral trainees in

a clinical or community setting, which will expose them to the nutritional problems of

healthy or diseased persons.

Veterinarians are particularly well prepared to do experimental animal research,

but very few receive training in nutrition or

develop research capabilities. They are in a

particularly favorable position to correlate

clinical disease with its underlying nutritional bases, using multidisciplinary approaches involving nutritional biochemistry,

toxicology, and pathology. Postdoctoral training of veterinarians in nutrition research is

needed to attract these people and make them

fully productive in the area.

The complex chemical nature of food requires a thorough foundation in the chemical

and biological aspects of food as well as an

understanding of food processing principles.

Not all State universities or agricultural experiment stations and a very limited number

of private universities have food science

graduate programs. A small but increasing

number of universities have combined food

science and nutrition programs. Only a few

universities have capability in food safety,

toxicology, and pathology.

Training of physicians and dentists for

research in clinical nutrition. The physician

or dentist who is interested in a research

career in clinical or experimental nutrition

will profit from postdoctoral experience in a

stimulating research team working with

either humans or experimental animals,

where he or she can become familiar with the

chemical and physical methods which underlie nutritional investigations, Greater emphasis in undergraduate medical education on

exposure to the facts of nutritional biochemistry and clinical nutrition in the broadest

sense will help to attract physicians to the

field and assure transfer of knowledge

resulting from research to the patient.

The Nutrition Cluster Report of the President’s Biomedical Research Panel suggested

that 25 to 40 postdoctoral fellowships per

year could reduce the timelag in having an

adequate supply of instructors for our medical and dental schools. To further stimulate

the initiation and expansion of such training,

this same report recommended that 10 to 15

faculty positions in medical schools be

created with Federal funds with the stipulation that after a limited period, support would

be assumed by the medical school, Such positions would be regular faculty appointments

in traditional academic departments such as

pediatrics, internal medicine, or surgery; the

subspecialty would be clinical nutrition. Such

faculty might have a double affiliation in a

clinical or community medicine department

and some appropriate basic science department. These recommendations would provide

a means of hastening the introduction of

clinical nutrition and public health nutrition

into the mainstream of academic medicine.

Research is also necessary in how best to

integrate food- and nutrition-related concerns into the health care system, Professionals who are experts in one area may have

unsound information in other areas that are

equally important in clinical and public

health nutrition.

Training of dietitians and allied health personnel in nutrition research methods.

Research efforts in the health sciences require the participation of health professionals in various fields. Dietitians, pharmacists, and other allied health professionals

trained and experienced in research methods

would be needed to complete the multidisciplinary teams of scientists engaged in clinical

nutrition research.

Training of nutrition educators. Nutrition

educators are persons trained in any of the

fields mentioned in this section who have

special expertise in the dissemination of accurate information on the sciences of nutrition to others as well as training in nutrition

sciences. They often lack the specialized expertise necessary to interpret technical research articles to laymen and suffer from the

failures of the scientific community to mount

effective efforts aimed at information transfer. However, given appropriate information

they are able to further package and shape it

72
in a form most appropriate to the audience in

question. Their training needs include

stronger preparation in basic sciences and

greater attention to information transfer—

more specifically, learning theory, instructional media, methodology, art, and graphics.

Associate- and bachelor-level training. As

widespread nutrition and monitoring and intervention programs develop, the need for extensive numbers of persons for routine work

in laboratories or in the field will become apparent. In many cases, these jobs can be done

by technicians with bachelor or associate

degrees. In the fields of chemistry, engineering, and medical technology, these persons

have traditionally been trained through

work/study programs to supplement more formal training at the educational institution.

Similar programs could be developed for

technicians in nutrition,

Present Estimates of Personnel Available

In an attempt to determine the current

number of scientists engaged in human nutrition research and the numbers of research

scientists being trained, OTA contacted five

professional societies and six Government

agencies. Of the professional societies, the

American Public Health Association, the Institute of Food Technologists, and the American Chemical Society make no attempt to distinguish between members engaged in research versus other career orientations and

therefore could not supply information on the

proportion of their membership engaged in

human nutrition research or training of nutrition research scientists. Membership in the

American Institute of Nutrition is limited to

those who have made significant contributions to the field of nutrition research. By

definition, all of AIN’s 1,730 members are nutrition-research scientists. This number seriously underestimates the total number of scientists in the field, since junior people are not

eligible for membership and very few behavior and education researchers are included,

AIN does not keep any figures on training. Of

the American Dietetic Association’s 21,751

members in 1977, 764 state they are engaged

in research activities. This does not indicate

the degree of involvement and, of course, neglects those outside of dietetics engaged in

nutrition research.

The two Government agencies that fund

the largest portion of nutrition research,

HEW and USDA, do maintain figures on scientist-years devoted to nutrition research

and USDA also makes 5-year projections of

personnel needs. At USDA* in FY 1976, 193.5

scientist-years were devoted to human nutrition research as defined by the Agency. The

5-year projection of need for nutrition research scientists at USDA is for 260.7 scientist-years, a 20-percent increase. At NIH in

FY 1977, the intramural manpower figure

was 70 scientist-years devoted to human nutrition research as defined by the Agency.

However, in testimony before the Senate

Select Committee on Nutrition and Human

Needs in October 1977, Dr. Donald Fredrickson stated that ‘‘180 intramural investigators

directly involved in nutrition research” were

employed at NIH but that only 20 intramural

investigators could be considered “classical

nutritionists. ” In FY 1977, 20 lead scientists,

those holding MD, PhD, or DVM degrees, and

50 junior scientists were conducting nutrition

research at Letterman Army Institute of Research of the Department of Defense.

There is therefore a clear need to identify

the number of scientists engaged in nutrition

research and the numbers of those in training

with a breakdown by research interest (general 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 research careers to fill gaps which are obvious,

the extension of expanded Federal support

must be considered, Candidates for training

in these areas, particularly the newer fields,

will be attracted by the availability of

fellowship and training grants at institutions

where outstanding research is done,

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

73
REVIEW OF REPORTS ON

HUMAN NUTRITION

In preparation for this assessment, OTA

reviewed numerous journal articles, Government documents, and activities. The 1969

White House Conference on Food, Nutrition,

and Health was chosen as a starting point for

analysis, since it marked the beginning of the

growth of public and congressional interest in

nutrition. Twelve reports were identified that

contained specific recommendations on nutrition research priorities and on organization

of the Government to improve coordination of

nutrition research activities. These 12

reports were:

1969—

1974—

1975—

1975—

1975—

1976—

1976—

1976—

1977—

1977—

1977—

1978—

White House Conference on Food,

Nutrition, and Health

World Food Conference

Senate Select Committee on Nutrition and Human Needs, Towards a

National Nutrition Policy

Agricultural Research Policy Advisory Committee (ARPAC), Statement on Agricultural Research and

Development

Department of Health, Education,

and Welfare, Forward Plan for

Health 1977-81

Congressional Research Service,

The Role of the Federal Government in Human Nutrition Research

Joint FAO/WHO Expert Committee

on Nutrition, Food and Nutrition

Strategies in National Development

Report of the President’s Biomedical Research Panel

National Academy of Sciences,

World Food and Nutrition Study

Congressional Research Service,

The Role of the Federal Government in Nutrition Education

Office of Science and Technology

Policy, New Directions in Federally Supported Human Nutrition Research

General Accounting Office, Federal Human Nutrition Research—

Need for a Coordinated Approach

to Advance our Knowledge

RESEARCH 1969-77

Few of these deal with nutrition research

exclusively. The specific objectives of the

reports must be recognized, The White House

Conference on Food, Nutrition, and Health

did not deal specifically with nutrition

research, However, selecting from specific

sessions (such as Surveillance and Evaluation

of the State of Nutrition of American People;

Establishing Guidelines for the Nutrition of

Vulnerable Groups; Adults in an Affluent Society; the Aging; the Sick; the Provision of

Food as It Affects the Consumer; and Nutrition Teaching and Nutrition Education) some

conclusions can be reached about recommendations on research priorities. In general,

there is “something for everyone” in this

report, and no attempt was made to realistically appraise the recommendations in light

of the relative need for the research, the feasibility of the research, and the technical,

physical, and monetary resources available.

The Senate Select Committee’s Toward a

National Nutrition Policy stressed research in

areas related to the policy and organizational

recommendations made in that report, Since

one of the major policy recommendations was

to develop and implement a national nutrition

plan containing an improved system of nutritional surveillance, priority was given to the

development of better, cheaper, and more

reliable methods for measuring nutritional

status. The main areas identified were:

●

●

●

●

Increased understanding of nutritional

requirements, especially the dietary

needs of preschool children, teenagers,

and the elderly.

Better information on the effects of

malnutrition on mental as well a s

physical development.

Research into the impact of changing

patterns of food consumption.

Basic research on nutrient-nutrient interaction, nutrient-additive interaction,

and long-term accumulation of minerals

in the body, if significant progress is

ever to be made on diseases associated

with the aging process.

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Agricultural practice, use of processed

food, and changing lifestyles.

Food consumption habits or the longterm effects of food additives, pesticides, and other aspects of food quality

and safety.

Better methods of nutritional surveillances, especially the development of

nutritional indicators that are sensitive,

reliable, and inexpensive to collect and

evaluate.

Better understanding of basic metab-

aspects of nutrition and research priorities.

The emphasis was on biomedical research to

increase knowledge of human nutritional requirements and to improve understanding of

the individual and complementary action of

the essential nutrients. Special mention was

made 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 nutrition

education and nutrition education research

were:

Intensify national efforts to provide

nutrition education to teachers in colleges and universities.

Support in-service and continuing

education after graduation.

Support a series of summer institutes in

nutrition and food modeled on the National Science Foundation programs of

science teaching institutes,

Utilize modern multimedia materials and

techniques to instruct teachers.

Favor resource and development training centers at select universities and colleges.

Urge the National Science Foundation to

play a more active role in exchanging information among nutrition research

groups.

Field testing of nutrient fortification proposals, intervention or novel use of

nutrients on human subjects, Measurement of the impact of field tests should

be a focus of national nutritiona l

surveillance.

Support for the training of nutrition

research specialists should be stepped

up.

The HEW Forward Plan for Health 1977-81

contained a policy statement on the health

7. nutritional assessment, and

8. health service delivery.

The report of the President’s Biomedical

Research Panel concentrated on assessing

the state of the science and identifying areas

of greatest promise in nutritional science. In

the latter, the approach taken was to catalog

the areas along the classical lines:

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●

●

●

●

●

●

●

Vitamins. Metabolism and mechanisms

of action, genetic diseases methodology,

transport of vitamins, relationship of

vitamins to central nervous system function, interrelationship of vitamin nutrition and drug action, factors that modify

vitamin requirements, turnover, biosynthesis, and degradation of the vitamins.

Minerals. Trace minerals, other mineral

elements.

Lipids.

Carbohydrates and energy-yielding

nutrients.

Protein and amino

mechanisms, protein

tional requirements.

Absorption.

acids. Basic cell

metabolism, nutriNutrition-endorcine interrelationships.

Aspects of food quality, supplements,

and regulations.

The OSTP report, New Directions in Federally Supported Human Nutrition Research,

identified four priority areas:

1. Studies of human nutrient needs.

Pregnancy, infancy, the elderly, obesity,

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2,

3.

4.

iron deficiency, and nutrient toxicity and

nutrient interactions.

Food sciences. Methods for food composition analysis, bioavailability of

nutrients in foods as consumed, updating National Nutrient Data Bank, and

expansion of Federal food composition

measurement capabilities.

Nutrition education research. Identification of factors influencing consumer

dietary practices, identification of

“good” nutritional practices.

Monitoring diet and nutrition-related

health status. Food consumption survey,

clinical and laboratory methods for

measuring changes in nutritional status,

analysis of HANES data, and nutritionrelated epidemiology studies.

The GAO report, Federal Human Nutrition

Research—Need for Coordinated Approach

to Advance Our Knowledge, identified four

areas in which major gaps in nutrition knowledge exist:

1.

2.

3.

4.

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Human nutritional requirements. Uses

and limitations of current quantitative

nutrition standards; pregnancy, infancy,

and lactation; childhood and adolescence, women, elderly, disease and

stress, drug and vitamin usage, need for

long-term studies and comparative culture studies, need for studies defining

functions and interactions of dietary

components.

Food composition and nutrient biological

availability. Need for more current and

comprehensive food composition data,

need for improved methods of determining composition and biological availability.

Diet, disease causation, and food safety.

Diet in obesity, diet in heart disease and

stroke, diet in cancer, dietary fiber in

disease prevention, and need to develop

improved techniques of assessing toxic

hazards in foods.

Food consumption and nutritional status.

Need for a surveillance program

monitoring nutrition status, need to improve methods of nutritional assessment

and identify determinants of nutritional

status, need to define the role of diet in

the aging process.

Lastly, the Food and Agriculture Act of

1977 identified five nutrition research

priorities for USDA. The areas were:

1.

2,

3.

4.

54

Human nutritional requirements.

Nutrient composition of foods and the effects of agricultural practices, handling,

food processing, and cooking on the

nutrients they contain.

Surveillance of the nutritional benefits

provided to participants in the food programs administered by USDA.

Factors affecting food preference and

habits.

Development of techniques and equipment to assist consumers in the home or

in institutions in selecting food that supplies a nutritionally adequate diet,

The agencies have fulfilled the stipulation

that within 90 days after enactment, the

Secretary of Agriculture and the Secretary of

Health, Education, and Welfare shall submit

to Congress a proposal for a comprehensive

nutrition status monitoring system.

In reviewing all the above studies, several

trends can be seen. The White House Conference on Food, Nutrition, and Health emerges

as a significant milestone, even though it was

never designed to be a serious assessment of

research needs. Probably because of the significant public participation, several areas

were identified that have only now emerged

as areas of high research priority. These

areas are food safety, consumer information,

and nutrition education research, and the emphasis on translation of research findings into applications in daily life. Those reports on

domestic research needs since 1969 have all

contained as areas of high-priority food composition, food consumption surveys, nutritional surveillance methodology, and nutrient

requirements of specific populations (especially pregnant and nursing women and the aging). In 1975, the policy statement contained

in the HEW Forward Plan for Health specifically emphasized the prevention and treatment of disease through nutrition. This has
since been followed through in subsequent

HEW plans, as well as in the OSTP report and

the GAO report. Food safety emerged as a

priority research area in the White House

Conference report, but not until the 1976

Report of the President’s Biomedical Research Panel and subsequently in the OSTP

and GAO reports was food safety seen as a

nutrition research priority. More recently,

NAS, OSTP, and GAO named the bioavailability of nutrients and the role of nutrition in

performance as areas of high priority.

An analysis of the recommendations contained in the reviewed reports on organization to improve coordination is more difficult

to do than for research priorities since the

recommendations on organization and coordination have usually been vague. The White

House Conference on Food, Nutrition, and

Health recommended one system to administer all food and nutrition activities within the

Federal Government. An Office of Nutrition

was recommended to be established within

HEW to administer all food programs, develop policy, and coordinate activities. The concept of consolidating all food programs and

nutrition activities into one agency was abandoned by 1975 when Toward a National Nutrition Policy recommended the establishment

of an independent agency to formulate policy

and coordinate and monitor programs; while

the existing pluralism would be maintained,

budget and line responsibilities would rest in

the agencies with nutrition programs. This

concept of a coordinating body independent

of the agencies involved, but housed within

the executive branch, is retained in the OSTP

report. All the reports reviewed since 1975

recognize the need for better coordination of

Federal nutrition research activities, while

also admitting the benefits to be derived from

maintaining the current division of responsibilities or some permutation thereof. They differ in the specifics of where the coordinating

responsibilities should lie.

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