One of the most promising areas for ROI would be advancing basic, clinical, and implementation science to reduce diet-related diseases. As mentioned in earlier sections, a recent NIH prevention research portfolio analysis compared national risk factors for death with NIH research investments (120). The largest gap was for nutrition, which was the top cause of attributable deaths (estimated to cause 19.1% of all deaths) but represented only 6.7% of all NIH prevention research funding (∼$0.43 billion based on the 2019 NIH budget, or ∼1.1% of all NIH funding) (117, 120). In comparison, estimated government spending on direct health care for diabetes alone was ∼$160 billion/y in 2017, with an expected growth rate of 5% (∼$8 billion) per year (280). Medical care for people with diagnosed diabetes accounts for ∼1 in 4 health care dollars in the US, with more than half of these costs being directly attributable to diabetes (280). And, while mounting evidence suggests that severity, complications, and costs of type 2 diabetes can be rapidly reduced through better lifestyle including dietary changes (281–284), the optimal dietary priorities, behavior change strategies, microbiome implications, and personalization needs to most effectively improve diabetes remain uncertain. A major effort to expand and harmonize federal nutrition research could have rapid ROI based on reduced health care costs alone. For instance, a new, additive $1–2 billion annual investment in nutrition research could potentially generate a several-fold ROI if this helped flatten the anticipated ∼$8 billion/y annual increase in government expenditures on medical care for diabetes (280). Estimates of potential ROI of expanded federal nutrition research can be considered against health care and other societal costs of other diet-sensitive conditions, such as hypertension, food allergies, coronary heart disease, certain cancers, and more. As stated by the FDA Commissioner in 2018, “Improvements in diet and nutrition offer us one of our greatest opportunities to have a profound and generational impact on human health … The public health gains of such efforts would almost certainly dwarf any single medical innovation or intervention we could discover” (285).