PMC:7454258 / 178894-193513 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7454258","sourcedb":"PMC","sourceid":"7454258","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7454258","text":"New National Institute of Nutrition\nA new NIH National Institute of Nutrition (NIN) would be additive to the 27 current institutes and centers leading research within NIH (Supplemental Figure 8). NIN would be a crucial new asset for NIH to accomplish its mission “to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability” (321). NIN would be tasked with leading innovative, cross-cutting, and foundational research on nutrition and health, including intramural and extramural programs and training and outreach activities. Under the leadership of the NIN Director, NIN would help guide strategic planning, coordination, and review of nutrition research across NIH and with other federal departments and agencies. This would increase harmonization, collaboration, and leveraging of all nutrition-related research programs across NIH institutes, centers and offices. NIN priority areas and funding should be coordinated with, additive to, and synergistic with existing NIH nutrition research efforts, such as within NIDDK, NHLBI, and NCI, among others, as well as with USDA, CDC, FDA, DoD, VHA, and NASA, among others. Rather than “silo-ing” nutrition research, NIN would help craft strategies and focus areas that span across, support, and/or are not covered by specific interest areas of other federal nutrition research efforts. A new NIH National Advisory Council on Nutrition Research—comprising research experts, health professionals, and community members—would advise the HHS Secretary, NIH Director, and NIN Director on matters related to the NIN's mission.\nTABLE 4 Key strategies within the NIH for strengthening and accelerating national nutrition research1\nOption Description Advantages Disadvantages Paths forward\nNew National Institute of Nutrition (NIN)2 Leads research, coordination, training, outreach on foundational and cross-cutting topics in nutrition and health\nAdditive focus areas and funding to existing NIH and other federal nutrition research efforts\nHarmonizes and leverages other nutrition and related research at NIH and other agencies and departments\nStrong partner to inform, collaborate on, and help address joint research needs of other departments and agencies, e.g., USDA, FDA, CDC, DoD, VA, USAID, and CMS\nPromotes and supports training of a diverse 21st century nutrition research workforce\nGuides and supports training of health care professionals for clinical care and basic and translational science in nutrition\nTranslates and disseminates sound nutrition science findings to the public\nFosters innovative external collaborations and partnerships Strong leadership, robust infrastructure, and investment\nCan better address nutrition science that is cross-cutting rather than disease specific\nIncludes extramural and intramural research, training, and outreach activities\nA long-term structure, leading to unanticipated positive returns, outlasting shorter-term options, and evolving appropriately with changing science and needs of the US population\nMeaningful external advisory mechanism to solicit diverse relevant insights and input\nStrong return on investment, in line with or exceeding other NIH research investments Requires new, additive appropriations to prevent reductions in any ongoing NIH or other federal nutrition research\nCould increase silo-ing of nutrition research\nWould need to navigate potentially entrenched cultures and perspectives around NIN nutrition research\nWithout new appropriations, could increase competition for resources Congress establishes a new NIN by statute, with dedicated appropriations and updating the current cap on the number of NIH institutes and centers\nCongressional inquiry and/or appropriations could explore the current status of federal nutrition research and potential options including an NIN\nNew NIH Office for Nutrition Research Restores the NIDDK Office of Nutrition Research back into the NIH Office of the Director (within the Division of Program Coordination, Planning, and Strategic Initiatives)\nModeled after the NIH Office of Disease Prevention (ODP), Office of Dietary Supplements (ODS), or Office of Behavioral and Social Sciences Research (OBSSR)\nWould lead efforts to build and coordinate new collaborative relationships and synergies within NIH, with other federal agencies and departments, and with external stakeholders including public-private partnerships to drive nutrition research and innovation\nPlan and coordinate trans-NIH nutrition research initiatives\nLead cooperative efforts to identify and stimulate priority areas of science, provide guidance on rigorous methodology, offer trainings, and increase the impact, visibility, and dissemination of findings\nDirector of the NIH Office of Nutrition Research would also serve as the Associate Director of Nutrition Research Legislation is not required\nElevates the leadership, staffing, resources, and capacities of this important area within and outside NIH\nReestablishes close communication and coordination with the NIH Director and the other divisions and offices within the NIH Office of the Director\nIncreases capacity and expertise for dissemination of sound nutrition science\nCan engage strong external advisory mechanisms\nSome dedicated funding to stimulate research across NIH\nNot viewed as serving only one institute\nAbility to transition to an NIH center and/or institute over time Size and resources of such an office remain relatively limited for substantially needed strategic planning, cross-governmental collaboration, public communication, assistance with the DGAs, DRIs, and national monitoring and surveillance, food and nutrition regulatory activities, and external partnerships\nInsufficient independent funding to stimulate major extramural or intramural research\nInadequate authority and resources to support new national training of scientists and health care professionals\nBudgets, staff sizes, and influence can vary widely between offices and fluctuate over time NIH Director has discretion to restore this office into the NIH Office of the Director\nCongress can authorize (ideally with new appropriations) the creation of this office within the NIH Office of the Director\nNew Trans-NIH Initiative(s) in Nutrition Research An initiative across multiple NIH institutes and centers around a specific focused priority research topic\nModeled after several examples such as the BRAIN Initiative, “All of Us” Research Program, or the NIH Human Microbiome Project\nCan be supported by dedicated staff within NIH and other federal working groups\nDedicated funding to support intramural and extramural research, training, and technology development\nCan help create new or enhanced public–private partnerships Legislation is not required\nHelps galvanize NIH around a key topic\nOften preceded by a comprehensive and separately useful review of relevant leadership, staffing, funding, external advisory mechanisms, and collaborative approaches available across NIH\nBrings new strategic planning, workgroups, funding opportunities, training, and technology development\nValuable when combined with other NIH options, above Only covers one focused topic, while needs and opportunities across nutrition research are broad and complex\nUnlikely to provide the sustained leadership, coordination, and resources to grasp the critical science gaps and opportunities\nGenerally time-limited and not sustained Can be established by the NIH Office of the Director with support from the NIH Common Fund\nCan be established by Congressional authorization and appropriations\n1 These strategies include key organizational structures successfully used within NIH (322). Importantly, these different options are not mutually exclusive, but can be implemented in combination to create synergies and leverage complementary strengths. CMS, Centers for Medicare and Medicaid Services; DGAs, Dietary Guidelines for Americans; DoD, Department of Defense; USAID, US Agency for International Development; VA, Department of Veterans Affairs.\n2 A new NIH National Center for Nutrition Research (NCNR) could also be proposed, broadly similar to the proposed NIN but on a smaller scale—for example, modeled after the path of the Office of Research on Minority Health (ORMH) within the NIH Office of the Director (Public Law 103–43) that led to the National Center on Minority Health and Health Disparities (NCMHD) (Public Law 106–525) that led to the National Institute on Minority Health and Health Disparities (NIMHD) (Public Law 111–148) (see Supplemental Text 3). NIN would expand the knowledge base of research on diet-related illnesses and their intersections with other fields through strategic planning, coordination, and evaluation of NIH nutrition research and through conduct and support of research in nutrition science and related areas. Relevant cross-cutting areas of focus could include many priority areas from genetic, molecular, and biological science to clinical, behavioral, and translational research, as well as research on health systems, workforce development, and health equity (Table 2). NIN's efforts would support, expand, and amplify key science relevant to other NIH institutes, centers, and offices, such as on nutrition and diabetes, obesity, cardiovascular disease, cancer, brain health, minority health and disparities, child health, and more. Within NIH, NIN would represent a natural authority and partner to support and coordinate cross-cutting intramural research that complements existing nutrition research portfolios across NIH. NIN would also promote and support the training of a diverse 21st century nutrition science workforce, including in cross-disciplinary priority areas like quantitative methods, personalization, and technology. Given NIH's roles in supporting training of health care professionals, NIN would also guide and support innovative programs to build a cadre of well-trained health professionals for both clinical care and basic and translational science in nutrition (269, 323).\nNIN would provide required leadership, staff, expertise, and resources to build meaningful partnerships on nutrition-related activities and research priorities of other federal departments and agencies, in particular USDA as well as FDA, CDC, DoD, VA, USAID, and CMS, among others. For example, this role could include development of joint requests with USDA for applications investigating the interlinkages between food, nutrition, health, and agricultural practices. NIN would support the efforts of HHS ODPHP in the USDA–HHS partnership to review evidence and, importantly, address new scientific needs for the DGAs. NIN would similarly support collaborative new science to inform the DRIs, FDA food safety and regulatory activities, USDA nutrition assistance programs, CDC surveillance and public health activities, USAID priorities, and DoD and VA research needs for US active-duty forces (including enhanced human performance and military readiness), military families, and veterans. NIN would inform and support CMS and CMMI efforts, such as “Food is Medicine” interventions to reduce diet-related illness and associated health care costs (268, 324, 325). Such joint initiatives will have the greatest impact if nutrition research at these other departments and agencies were simultaneously strengthened with new investments. NIN would also lead and have the required staff capacity to engage meaningfully in public–private partnerships and with nonprofit organizations and international entities such as the WHO and World Bank.\n\nAdvantages\nNIN would add strong authority, infrastructure, investment, and external advisory mechanisms for nutrition research to the nation's largest funder of science. NIN would require a Federal Advisory Committee (Council) and would have a budget and funding authority. NIN would allow NIH to better address nutrition science that is cross-cutting rather than disease-specific, both across institutes, centers, and offices within NIH and with other federal departments and agencies. For example, the NIN would be instrumental in implementing and achieving the goals of the new 2020–2030 Strategic Plan for NIH Nutrition Research (129). As a long-term structure, NIN's activities and benefits would provide both expected and unexpected returns over many decades, outlasting shorter-term options such as cross-agency initiatives and changing priorities of individual administrations, and evolving appropriately with changes in science, food systems, nutritional needs, and disease conditions of the US public. A new institute could help maintain the strength of NIH focus on laboratory and clinical research in nutrition while, at the same time, facilitating expansion to research efforts to other translational priorities across NIH and across other federal departments and agencies. As has been seen with NIH research overall, NIN's coordinated leadership, structure, and capacity would likely provide a strong ROI to the US economy. The combination of NIN plus a new cross-governmental approach (Table 3) would provide a powerful strategy to address the scope and scale of the challenges and opportunities we face as a nation.\n\nDisadvantages\nThe addition of a new institute would require legislative action to increase the current limit of 27 NIH institutes and centers (Public Law 109–482) and provide additive new appropriations to prevent reductions in any ongoing NIH or other federal nutrition research. NIN could increase silo-ing of nutrition research or divestment in nutrition research from other parts of NIH, which has historically been and should remain a component of almost all NIH institutes, offices, and centers. Even with a remit to coordinate and complement existing efforts, a new institute would need to navigate potentially entrenched cultures and perspectives around the “home” of certain areas of research. Congressional appropriations for expanded nutrition research funding within and outside NIH would be needed to prevent increased competition for resources.\n\nPath forward\nCongress can authorize the establishment of NIN, updating the cap (Public Law 109–482) on the total number of NIH institutes and centers and providing new, additive appropriations to NIH. As an intermediary step, Congress could submit an inquiry to appropriate federal departments and agencies, host hearings, as well as appropriate funds, to explore the current status of federal nutrition research and potential options including the 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