PMC:7454258 / 88583-114297 JSON TXT

Annnotations TAB JSON ListView MergeView

LitCovid-PD-FMA-UBERON

LitCovid-PD-UBERON

{"project":"LitCovid-PD-UBERON","denotations":[{"id":"T34","span":{"begin":8393,"end":8397},"obj":"Body_part"},{"id":"T35","span":{"begin":13309,"end":13314},"obj":"Body_part"},{"id":"T36","span":{"begin":13413,"end":13418},"obj":"Body_part"},{"id":"T37","span":{"begin":13441,"end":13446},"obj":"Body_part"},{"id":"T38","span":{"begin":13752,"end":13757},"obj":"Body_part"},{"id":"T39","span":{"begin":13777,"end":13782},"obj":"Body_part"},{"id":"T40","span":{"begin":19511,"end":19522},"obj":"Body_part"},{"id":"T41","span":{"begin":19518,"end":19522},"obj":"Body_part"}],"attributes":[{"id":"A34","pred":"uberon_id","subj":"T34","obj":"http://purl.obolibrary.org/obo/UBERON_0001456"},{"id":"A35","pred":"uberon_id","subj":"T35","obj":"http://purl.obolibrary.org/obo/UBERON_0002542"},{"id":"A36","pred":"uberon_id","subj":"T36","obj":"http://purl.obolibrary.org/obo/UBERON_0000178"},{"id":"A37","pred":"uberon_id","subj":"T37","obj":"http://purl.obolibrary.org/obo/UBERON_0000178"},{"id":"A38","pred":"uberon_id","subj":"T38","obj":"http://purl.obolibrary.org/obo/UBERON_0000178"},{"id":"A39","pred":"uberon_id","subj":"T39","obj":"http://purl.obolibrary.org/obo/UBERON_0000178"},{"id":"A40","pred":"uberon_id","subj":"T40","obj":"http://purl.obolibrary.org/obo/UBERON_0001049"},{"id":"A41","pred":"uberon_id","subj":"T41","obj":"http://purl.obolibrary.org/obo/UBERON_0000025"}],"text":"Current Efforts for Cross-Governmental Nutrition Research Coordination\nGiven the diverse investments in nutrition research across separate federal departments and agencies, several initiatives have aimed to better coordinate these efforts. Major initiatives are summarized below.\n\nICHNR\nIn 1977, Congress recognized the need and called for improved coordination of human nutrition research (Public Law 95–113) (Supplemental Text 1). Congress further requested its Office of Technology Assessment to review existing federal human nutrition research, with findings published in the 1978 report Nutrition Research Alternatives (106). This report found that federal nutrition research programs had failed to deal with the changing health problems of the American people. In response, Congress chartered the Joint Subcommittee on Human Nutrition Research (JSHNR), under the aegis of OSTP, who, in a 1980 report, recommended an improved planning system to coordinate federal nutrition research (161). In 1982, the GAO was also asked to review federal nutrition research and concluded that the government had no overall federal nutrition plan with specific goals or unified and coordinated strategies, while acknowledging the ongoing work of USDA, HHS, and OSTP to develop a coordinated planning system (162).\nIn 1983, JSHNR completed its review and recommendations, leading to the formation of the ICHNR. The aim of ICHNR was to fill the identified gaps of insufficient planning and coordination and achieve “the pursuit of new knowledge to improve the understanding of nutrition as it relates to human health and disease … in 5 major areas: biomedical and behavioral sciences, food sciences, nutrition monitoring and surveillance, nutrition education, and impact on nutrition of intervention programs and socioeconomic factors” (161). ICHNR co-chairs are the HHS Assistant Secretary for Health and USDA Undersecretary for Research, Education, and Economics (who is also USDA Chief Scientist)—positions filled by Presidential appointment with Senate confirmation. ICHNR includes representatives from multiple federal departments and agencies (Table 1).\nAfter some early collaborative successes, ICHNR had a ≥10-y hiatus (Supplemental Table 5). Reassembled in 2013, ICHNR recognized the need for a new effort to coordinate federal nutrition research. This resulted in a new strategic plan, the National Nutrition Research Roadmap 2016–2021: Advancing Nutrition Research to Improve and Sustain Health (11). The Roadmap was framed around 3 questions:\nHow can we better understand and define eating patterns to improve and sustain health?\nWhat can be done to help people choose healthy eating patterns?\nHow can we develop and engage innovative methods and systems to accelerate discoveries in human nutrition?\nAcross these 3 questions, 11 topical areas were identified based on population impact, feasibility given current technological capacities, and emerging scientific opportunities (Supplemental Figure 1) within which 120 short- and long-term research and resource initiatives were defined. Each of the participating ICHNR departments or agencies also briefly described their own interests in the Roadmap's 11 topical areas (Supplemental Figure 2). The Roadmap also identified gaps in the US nutrition research workforce and put forth recommendations for developing a diverse, interdisciplinary workforce able to advance nutritional sciences research.\nNotably, the Roadmap did not include any data, findings, or recommendations on current or new nutrition research investment levels, leadership, or structures (11). Thus, the Roadmap lacked any prioritization between the 120 identified initiatives, due to variable and nonharmonized funding criteria, priorities, and capacities across federal, nonprofit, and private-sector research agencies in the US and globally. This may be why a 2017 analysis found only early signs of implementation of the Roadmap among ICHNR member departments and agencies (163). ICHNR recognized that further engagement with the extramural scientific community and leveraging existing or new public–private partnerships would be important to achieving the Roadmap's goals (163). Currently, ICHNR has a narrower focus, meeting about twice per year to discuss the DGAs, DRIs, and a potential new federal database of nutrition research projects. There are few other indicators of current use or monitoring of the Roadmap's aims or progress (164). Although ICHNR is the current major entity charged with improving coordination among federal departments and agencies engaged in nutrition research (164), several structural challenges have limited its impact. These include lack of any strong or consistent connection to the White House, no specific budget appropriations, no mechanism for reporting to Congress, and absence of any well-supported infrastructure for external advisory input on cross-governmental strategies for nutrition research.\n\nNational food and nutrition monitoring and surveillance\nNational monitoring and surveillance are integral to nutrition research and translation. Several CDC and other federal collaborations (Supplemental Table 6) and USDA efforts (Supplemental Table 4) focus on food and nutrition monitoring and surveillance surveys and related research (Supplemental Table 7). These federal efforts began with an international focus to lend expertise and capacity to developing nations to help them develop nutritional assessment and data-informed food and nutrition policy and programmatic responses, such as food fortification and research and training in nutritional sciences (165). For example, in 1955, the Interdepartmental Committee on Nutrition for National Defense was formed after malnutrition was identified to be common among the troops of Korea and China (166, 167). After initial emphasis on surveillance of nutrition programs among military personnel, this Committee expanded focus to civilians in countries of “special interest,” ultimately conducting surveys in 33 developing countries (165). In 1967, this international surveillance program was reorganized in response to Congressional amendments to focus on domestic hunger and malnutrition. In 1968, the Ten State Nutrition Survey identified severe malnutrition in several low-income US states (168), stimulating Congressional hearings regarding hunger and the formation of the US Senate Select Committee on Nutrition and Related Needs. In 1969, President Nixon commissioned the first and still only White House Conference on Food, Nutrition, and Health, which put numerous concrete recommendations that led to expansion and standardization of school lunch and Food Stamps, and the creation of school breakfast and the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (13, 169).\nIn 1990, Congress (Public Law 101–445) created the National Nutrition Monitoring and Related Research Program (NNMRRP), with aims to produce a comprehensive, coordinated program for nutrition monitoring and related research to improve assessment of the US population's health and nutrition. Congress required this program to achieve coordination of federal monitoring efforts within 10 y, guided by a new Interagency Board for Nutrition Monitoring and Related Research (IBNMRR) and a 9-member National Nutrition Monitoring Advisory Council. The IBNMRR convened between 1991 and 2002, co-chaired by HHS Assistant Secretary for Health and USDA Undersecretary for Research, Education, and Economics, and was charged with designing and implementing a 10-y comprehensive plan for planning and coordinating the activities of 22 federal agencies that conduct nutrition monitoring and surveillance or related research or are major users of nutrition monitoring data (170). The IBNMRR published its 10-y plan in 1993, and summarized ongoing federal nutrition monitoring in its Directory of Federal and State Nutrition Monitoring Activities in 1989, 1992, 1998, and 2000 (171, 172). The impact of this plan is difficult to quantify, although in its first 5 y, 97 proposed and final regulations citing NNMRRP data were published in the Federal Register (173). When this program ended in 2002, federal nutrition monitoring efforts returned to being decentralized, without explicit coordination (11, 174–176). Current national nutrition monitoring and surveillance systems face fiscal, infrastructure, and coordination challenges that limit their capacity to respond to evolving data needs, technological advances, and demographic shifts (e.g., barriers to provide sufficient national data for the Congressional mandate in the 2020–2025 DGAs to include infants and women who are pregnant or lactating) (177, 178).\n\nDGAs\nA key cross-departmental nutrition-related activity is the DGAs, the cornerstone for many federal nutrition programs and policies (Supplemental Table 8) (179). The National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) requires the DGAs be reviewed by the Secretaries of both USDA and HHS. Since 1995, a memorandum of understanding between the 2 departments provides a framework for this joint USDA–HHS endeavor, with each department alternating in leading each 5-y edition (180). Regardless of departmental lead, the USDA CNPP conducts the evidence analysis and develops the corresponding consumer-facing education tools (144, 145). The HHS Office of Disease Prevention and Health Promotion (ODPHP) aims to provide technical expertise and develop DGA-related resources for health professionals.\nBoth agencies’ efforts are constrained by limited funding and staff dedicated to the DGAs (144). In mandating the DGAs, Congress (Public Law 101–445) did not authorize or appropriate any regular funding for the DGA process nor, importantly, for the fundamental research, monitoring, and surveillance processes necessary for developing and translating dietary guidance, among other national needs. For example, there is no consistent funding source to develop the nation's DRIs, which are foundational to the DGAs, nor to ensure sufficient research to develop the necessary evidence base for updates of either the DGAs or DRIs. Successive DGACs from the 1980 edition onwards have documented persistent, major research gaps for setting evidence-based guidelines (181). Consistent funding also does not exist to review the impact of the DGAs on the public's understanding of nutrition, food choices, or health, or on the impact on other stakeholders (181–183).\nIn response to concerns that the DGA process may require updated processes and coordination, in 2016 Congress instructed the National Academies of Sciences, Engineering, and Medicine (NASEM) to review and make recommendations to the process for updating the DGAs (Public Law 114–113). First, in February 2017, NASEM released “Optimizing the Process for Establishing the Dietary Guidelines for Americans: The Selection Process” (184). This report provided recommendations for how the advisory committee process can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints. The second report released in September 2017 was entitled “Redesigning the Process for Establishing the Dietary Guidelines for Americans” (182). This report identified the following specific opportunities for improvement in the DGA process: more consistent interpretation of purpose and target audiences of the DGA, greater transparency of the overall process, and more rigorous methodological approaches to the evaluation of the evidence. The USDA-HHS responded to NASEM recommendations in September 2018 indicating changes they will be making in the development of the 2020–2025 DGAs, such as asking for public comments on the topics and scientific questions to be examined in the review of the evidence supporting the development of the next edition (185).\nIn part to respond to these recommendations, the FY2019 appropriations bill provided a one-time allocation of $12.3 million to CNPP, divided over 3 y, to support the 2020–2025 DGAs (186). These one-time funds are supporting a limited set of systematic reviews of published evidence, but not any new research to address critical knowledge gaps. As previously noted, only ∼1.3% of NIH-supported research focuses on diet for the prevention or treatment of disease in humans, and furthermore, among these, only about half of the projects relate to key research gaps identified by the 2015 DGAC (117–119). In addition, while the 2014 Farm Bill (Public Law 113–79) mandated that the DGAs include, for the first time, food-based nutrition guidance for infants and toddlers aged 0–24 mo and women who are pregnant or lactating (prior DGAs did not include or consider these critical populations), no funding was authorized or appropriated to support this new mandate. Given the first-ever focus of the 2020–2025 DGAs on these important populations, it is expected that the 2020 DGAC will identify even more knowledge gaps for setting national dietary guidance than prior editions (187).\nIn 1990, Congress specified that the DGAs focus on the general public, not on specific nutritional recommendations for individuals suffering from diet-related conditions (Public Law 101–445). However, highlighting the scale and scope of diet-related illness, only 12% of US adults are metabolically healthy (as defined by blood glucose, cholesterol, blood pressure, and waist circumference). Thus, the DGAs’ general focus may exclude the specific dietary needs of the great majority of the US population. Until 2014, the NIH supported the development of evidence reviews and dietary guidance for patients with health issues such as overweight and obesity, high blood pressure, and high blood cholesterol, among others (188, 189). These reviews were used by DGACs with input and endorsement from \u003e25 professional groups. The NIH ceased these reports in 2014, in part because the CDC's mandate deals with disease prevention activities and the mandate of the HHS Agency for Healthcare Research and Quality (AHRQ) includes development of systematic evidence reviews to inform clinical practice guidelines (189–191). Certain nongovernmental professional and clinical organizations provide nutrition guidance for populations with or at risk for various chronic conditions, but these various recommendations are not coordinated (192, 193). The current 2020 DGAC process excludes—for the first time—the use of existing high-quality nongovernmental systematic reviews and meta-analyses conducted by peer-reviewed researchers and major professional organizations. Little work has been done to understand the short- or long-term implications of NIH's shift in 2014 away from dietary guidance for populations with disease conditions, or whether CDC and AHRQ efforts are addressing this gap. Thus, currently no federal entity takes the lead on the development of evidence reviews or dietary guidance for patients with diet-related health conditions. Several organizations, including AND, the National Association for the Advancement of Colored People, and the National Hispanic Medical Association, recently formed the Food4Health Alliance to advocate for additional federal nutrition guidelines tailored to the needs of tens of millions of Americans who have diet-related diseases such as hypertension, obesity, and type 2 diabetes—conditions that also disproportionately affect minorities and underserved communities (194).\nIn addition to the lack of consistent funding and staff for the evidence reviews, fundamental research, monitoring, and surveillance processes needed to develop and translate dietary guidance, concerns have been raised that the process of updating the DGAs every 5 y is not protected from political or external influences (e.g., political appointees, Congress, food and beverage industries, agribusiness interests, advocacy groups) (182, 184, 195). A coordinated federal approach and authority for nutrition research could help strengthen the process for objective and independent development, review, and dissemination of the best science evidence to the American public in the DGAs for both healthy individuals and those with major diet-related illnesses, as well as for the evaluation of corresponding intended and unintended impacts of these guidelines and needed changes to improve these impacts.\n\nDRIs\nDRIs provide specific targets for intakes of relevant nutrients for the general population (196). The first DRIs were created by Presidential mandate in 1941 when President Franklin D. Roosevelt commissioned scientists to generate new minimum dietary requirements for the population to be prepared for World War II (197). In 1943, the first RDAs (a type of DRI) were published, providing science-based guidelines for target intakes of total calories, protein, calcium, phosphorus, iron, and a few vitamins (198). Although DRIs are foundational to DGAs, the Nutrition Facts label, and other federal policies, there is no dedicated funding stream or statutory requirement for updating DRIs. Since the 1940s, DRIs have been updated sporadically dependent on available funding support provided by Congress to federal agencies (e.g., NIH and CDC) and, since the 1990s, additional contributions by the Canadian government (199). NASEM leads the updating of any DRI when requested by the federal government or instructed by Congress. Recently, a NASEM Consensus Study Report determined that crucial research gaps for setting DRIs remain largely unaddressed (200). Another challenge is there is no generally accepted process for deriving dietary reference values, which has led to several-fold differences in international recommendations and decreases their credibility (201, 202). The ICHNR DRI Subcommittee recommended that $2 million annually be placed and held in an agency's budget (e.g., ARS, CDC, and/or NIH) to establish a consistent funding stream for setting and updating of DRIs (203); this recommendation has not been implemented.\n\nFood and nutrition regulatory activities\nNutrition research is foundational for diverse federal, tribal, state, and local food and nutrition regulatory activities including labeling, health claims, food marketing, and oversight of food additives and other constituents (204). For example, Congress in 1990 (Public Law 101–535) authorized the Secretary of HHS to provide consumers with accurate nutrition information on food labels, giving rise to the Nutrition Facts panel. In 1994, the GAO recommended that USDA and FDA work together to perform laboratory analyses to independently verify the accuracy of nutrition labels; review labels for compliance with formatting requirements, nutrient content claims, and health claims; work with companies to correct identified inaccuracies; and where appropriate, pursue legal action against products with inappropriate labels (205). Since that time, USDA and FDA, among other federal departments and agencies, have needed to work together on these topics. Examples include the determination that partially hydrogenated oils (high in industrial trans fat) were no longer Generally Recognized As Safe (GRAS), for which NIH- and USDA-funded research, CDC surveillance data, and HHS regulatory reviews supported the FDA determination (206); and FDA's amendment of the food additive regulations to change the standard of identity of enriched flour and corn masa flour (207) to allow folic acid fortification to help prevent neural tube defects in developing infants, which required similar inputs from diverse federal research, surveillance, and regulatory efforts. Another example is the 2016 Nutrition Facts updates (e.g., requiring labeling of added sugar) based on new scientific research, updated DGAs, consensus reports, and national survey data, along with input obtained through proposed rulemaking processes (208, 209).\nIn 2018, FDA announced their Nutrition Innovation Strategy that outlined key activities to take a “fresh look” at what can be done to reduce diet-related chronic diseases (210). Key elements included the following: modernizing claims such as “healthy,” modernizing ingredient labels and standards of identity, implementing the Nutrition Facts Label and Menu Labeling, reducing sodium, and expanding nutrition education (e.g., launching a new Nutrition Facts label education campaign). For example, FDA agreed with a petition that its definition of “healthy,” central for marketing regulations, was scientifically outdated and inconsistent with the DGAs and advancing research (211). Insufficient scientific evidence on dietary supplement contents, health effects, and potential risks limits the FDA's ability to provide oversight for this $40 billon/y industry (212–214). As another example, there is no DRI or listing on Nutrition Facts for many compounds that appear relevant for health such as omega-3 fatty acids, phenolics, and other phytonutrients (212, 215). Further, many processing methods and additives banned in the European Union are permitted in the US, based on insufficient science for a definitive determination by FDA (216).\nThe Federal Trade Commission (FTC) has not been able to engage in any research on the impacts of food marketing to children in nearly 10 y (11). Congress prohibited FTC from completing their joint study with FDA, CDC, and USDA on nutrition standards for food marketing to children, even though this Interagency Working Group on Food Marketed to Children was established by the 2009 Omnibus Appropriations Act (Public Law 111–8) (11). Taken together, these FDA and FTC examples, among others, illustrate the crucial role of robust and coordinated federal nutrition research for numerous regulatory decisions and activities.\n\nFederal nutrition education and promotion\nCongress requires federal departments and agencies to coordinate review processes to ensure that nutrition education materials produced by the federal government are consistent with the latest DGAs (Public Law 101–445). This process is facilitated by a Dietary Guidance Review Committee, co-chaired by USDA CNPP and HHS ODPHP. More recently, DoD worked with USDA and HHS to integrate DGAs into their Go for Green® joint-service performance-nutrition initiative that aims to improve the food environment where military service members live and work (217). There is no direct, consistent Congressional investment in nutrition education for the general public, except for limited support of CNPP's dietary guidance translation activities and of USDA Food and Nutrition Service's nutrition education and promotion materials associated with the federal nutrition assistance programs. Over the years, various efforts have examined the impacts of USDA investments in nutrition education and promotion with mixed success (218). A 2019 GAO evaluation found that USDA administers 5 key programs that provide nutrition education but does not have formal coordination mechanisms for its nutrition education efforts and does not fully leverage the department's nutrition expertise (155). The GAO recommended that USDA develop a formal mechanism for coordinating nutrition education, improve the information it gathers on Supplemental Nutrition Assistance Program Education (SNAP-Ed), and take steps to fully leverage the department's expertise for nutrition education efforts.\n\nNational nutrition research database\nThere is no dedicated, consistent funding to identify and track federal investments in nutrition research. In 1981, Congress authorized the Human Nutrition Research and Information Management (HNRIM) system to track funding of nutrition research projects across the federal government (Public Law 97–98). From 1985 to 2015, HNRIM was maintained by NIH and, at its peak, included ≥100,000 records on federal nutrition research and training expenditures. HNRIM was a staff-curated database, with projects identified and classified by expert staff including the proportion of each project actually addressing nutrition. NIH shifted to the more automated NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) system, which is based on NIH's Research, Condition, and Disease Categorization (RCDC) system to define and categorize research projects across \u003e200 Congressionally mandated categories (Public Law 109–482). RCDC uses automated text data mining to match federal research projects to spending categories. The RePORTER system then assigns the total dollar amount of any research project that may be related to nutrition to the category of “nutrition research.” Most research projects meet criteria for and are counted across multiple categories. For instance, a single project and its total dollars may be counted as 100% nutrition, obesity, cardiovascular disease, diabetes, and prevention, among others. Besides NIH systems, a variety of other websites and databases aim to capture federal investments in human nutrition research, each using different methods with uncertain accuracy (Supplemental Table 9).\n\nCurrent landscape: summary\nSignificant efforts are occurring across diverse federal departments and agencies to leverage existing personnel and funding and coordinate existing activities to advance nutrition research. However, these efforts are not sufficiently coordinated or expansive enough to address the current and future diet-related disease burdens, or the corresponding health care spending, food insecurity and health disparities; strains on government budgets and American businesses; challenges to military readiness; and intersections with supply chains and sustainability. Many new opportunities exist to be seized, as reviewed next."}

LitCovid-PD-MONDO

LitCovid-PD-CLO

LitCovid-PD-CHEBI

LitCovid-PD-GO-BP

{"project":"LitCovid-PD-GO-BP","denotations":[{"id":"T47","span":{"begin":1375,"end":1384},"obj":"http://purl.obolibrary.org/obo/GO_0009058"},{"id":"T48","span":{"begin":2582,"end":2588},"obj":"http://purl.obolibrary.org/obo/GO_0007631"},{"id":"T49","span":{"begin":2676,"end":2682},"obj":"http://purl.obolibrary.org/obo/GO_0007631"},{"id":"T50","span":{"begin":5097,"end":5108},"obj":"http://purl.obolibrary.org/obo/GO_0006412"},{"id":"T51","span":{"begin":6381,"end":6390},"obj":"http://purl.obolibrary.org/obo/GO_0009058"},{"id":"T52","span":{"begin":8105,"end":8116},"obj":"http://purl.obolibrary.org/obo/GO_0065007"},{"id":"T29074","span":{"begin":19370,"end":19381},"obj":"http://purl.obolibrary.org/obo/GO_0065007"},{"id":"T64080","span":{"begin":20497,"end":20508},"obj":"http://purl.obolibrary.org/obo/GO_0065007"},{"id":"T82298","span":{"begin":22536,"end":22547},"obj":"http://purl.obolibrary.org/obo/GO_0006412"}],"text":"Current Efforts for Cross-Governmental Nutrition Research Coordination\nGiven the diverse investments in nutrition research across separate federal departments and agencies, several initiatives have aimed to better coordinate these efforts. Major initiatives are summarized below.\n\nICHNR\nIn 1977, Congress recognized the need and called for improved coordination of human nutrition research (Public Law 95–113) (Supplemental Text 1). Congress further requested its Office of Technology Assessment to review existing federal human nutrition research, with findings published in the 1978 report Nutrition Research Alternatives (106). This report found that federal nutrition research programs had failed to deal with the changing health problems of the American people. In response, Congress chartered the Joint Subcommittee on Human Nutrition Research (JSHNR), under the aegis of OSTP, who, in a 1980 report, recommended an improved planning system to coordinate federal nutrition research (161). In 1982, the GAO was also asked to review federal nutrition research and concluded that the government had no overall federal nutrition plan with specific goals or unified and coordinated strategies, while acknowledging the ongoing work of USDA, HHS, and OSTP to develop a coordinated planning system (162).\nIn 1983, JSHNR completed its review and recommendations, leading to the formation of the ICHNR. The aim of ICHNR was to fill the identified gaps of insufficient planning and coordination and achieve “the pursuit of new knowledge to improve the understanding of nutrition as it relates to human health and disease … in 5 major areas: biomedical and behavioral sciences, food sciences, nutrition monitoring and surveillance, nutrition education, and impact on nutrition of intervention programs and socioeconomic factors” (161). ICHNR co-chairs are the HHS Assistant Secretary for Health and USDA Undersecretary for Research, Education, and Economics (who is also USDA Chief Scientist)—positions filled by Presidential appointment with Senate confirmation. ICHNR includes representatives from multiple federal departments and agencies (Table 1).\nAfter some early collaborative successes, ICHNR had a ≥10-y hiatus (Supplemental Table 5). Reassembled in 2013, ICHNR recognized the need for a new effort to coordinate federal nutrition research. This resulted in a new strategic plan, the National Nutrition Research Roadmap 2016–2021: Advancing Nutrition Research to Improve and Sustain Health (11). The Roadmap was framed around 3 questions:\nHow can we better understand and define eating patterns to improve and sustain health?\nWhat can be done to help people choose healthy eating patterns?\nHow can we develop and engage innovative methods and systems to accelerate discoveries in human nutrition?\nAcross these 3 questions, 11 topical areas were identified based on population impact, feasibility given current technological capacities, and emerging scientific opportunities (Supplemental Figure 1) within which 120 short- and long-term research and resource initiatives were defined. Each of the participating ICHNR departments or agencies also briefly described their own interests in the Roadmap's 11 topical areas (Supplemental Figure 2). The Roadmap also identified gaps in the US nutrition research workforce and put forth recommendations for developing a diverse, interdisciplinary workforce able to advance nutritional sciences research.\nNotably, the Roadmap did not include any data, findings, or recommendations on current or new nutrition research investment levels, leadership, or structures (11). Thus, the Roadmap lacked any prioritization between the 120 identified initiatives, due to variable and nonharmonized funding criteria, priorities, and capacities across federal, nonprofit, and private-sector research agencies in the US and globally. This may be why a 2017 analysis found only early signs of implementation of the Roadmap among ICHNR member departments and agencies (163). ICHNR recognized that further engagement with the extramural scientific community and leveraging existing or new public–private partnerships would be important to achieving the Roadmap's goals (163). Currently, ICHNR has a narrower focus, meeting about twice per year to discuss the DGAs, DRIs, and a potential new federal database of nutrition research projects. There are few other indicators of current use or monitoring of the Roadmap's aims or progress (164). Although ICHNR is the current major entity charged with improving coordination among federal departments and agencies engaged in nutrition research (164), several structural challenges have limited its impact. These include lack of any strong or consistent connection to the White House, no specific budget appropriations, no mechanism for reporting to Congress, and absence of any well-supported infrastructure for external advisory input on cross-governmental strategies for nutrition research.\n\nNational food and nutrition monitoring and surveillance\nNational monitoring and surveillance are integral to nutrition research and translation. Several CDC and other federal collaborations (Supplemental Table 6) and USDA efforts (Supplemental Table 4) focus on food and nutrition monitoring and surveillance surveys and related research (Supplemental Table 7). These federal efforts began with an international focus to lend expertise and capacity to developing nations to help them develop nutritional assessment and data-informed food and nutrition policy and programmatic responses, such as food fortification and research and training in nutritional sciences (165). For example, in 1955, the Interdepartmental Committee on Nutrition for National Defense was formed after malnutrition was identified to be common among the troops of Korea and China (166, 167). After initial emphasis on surveillance of nutrition programs among military personnel, this Committee expanded focus to civilians in countries of “special interest,” ultimately conducting surveys in 33 developing countries (165). In 1967, this international surveillance program was reorganized in response to Congressional amendments to focus on domestic hunger and malnutrition. In 1968, the Ten State Nutrition Survey identified severe malnutrition in several low-income US states (168), stimulating Congressional hearings regarding hunger and the formation of the US Senate Select Committee on Nutrition and Related Needs. In 1969, President Nixon commissioned the first and still only White House Conference on Food, Nutrition, and Health, which put numerous concrete recommendations that led to expansion and standardization of school lunch and Food Stamps, and the creation of school breakfast and the USDA Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (13, 169).\nIn 1990, Congress (Public Law 101–445) created the National Nutrition Monitoring and Related Research Program (NNMRRP), with aims to produce a comprehensive, coordinated program for nutrition monitoring and related research to improve assessment of the US population's health and nutrition. Congress required this program to achieve coordination of federal monitoring efforts within 10 y, guided by a new Interagency Board for Nutrition Monitoring and Related Research (IBNMRR) and a 9-member National Nutrition Monitoring Advisory Council. The IBNMRR convened between 1991 and 2002, co-chaired by HHS Assistant Secretary for Health and USDA Undersecretary for Research, Education, and Economics, and was charged with designing and implementing a 10-y comprehensive plan for planning and coordinating the activities of 22 federal agencies that conduct nutrition monitoring and surveillance or related research or are major users of nutrition monitoring data (170). The IBNMRR published its 10-y plan in 1993, and summarized ongoing federal nutrition monitoring in its Directory of Federal and State Nutrition Monitoring Activities in 1989, 1992, 1998, and 2000 (171, 172). The impact of this plan is difficult to quantify, although in its first 5 y, 97 proposed and final regulations citing NNMRRP data were published in the Federal Register (173). When this program ended in 2002, federal nutrition monitoring efforts returned to being decentralized, without explicit coordination (11, 174–176). Current national nutrition monitoring and surveillance systems face fiscal, infrastructure, and coordination challenges that limit their capacity to respond to evolving data needs, technological advances, and demographic shifts (e.g., barriers to provide sufficient national data for the Congressional mandate in the 2020–2025 DGAs to include infants and women who are pregnant or lactating) (177, 178).\n\nDGAs\nA key cross-departmental nutrition-related activity is the DGAs, the cornerstone for many federal nutrition programs and policies (Supplemental Table 8) (179). The National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) requires the DGAs be reviewed by the Secretaries of both USDA and HHS. Since 1995, a memorandum of understanding between the 2 departments provides a framework for this joint USDA–HHS endeavor, with each department alternating in leading each 5-y edition (180). Regardless of departmental lead, the USDA CNPP conducts the evidence analysis and develops the corresponding consumer-facing education tools (144, 145). The HHS Office of Disease Prevention and Health Promotion (ODPHP) aims to provide technical expertise and develop DGA-related resources for health professionals.\nBoth agencies’ efforts are constrained by limited funding and staff dedicated to the DGAs (144). In mandating the DGAs, Congress (Public Law 101–445) did not authorize or appropriate any regular funding for the DGA process nor, importantly, for the fundamental research, monitoring, and surveillance processes necessary for developing and translating dietary guidance, among other national needs. For example, there is no consistent funding source to develop the nation's DRIs, which are foundational to the DGAs, nor to ensure sufficient research to develop the necessary evidence base for updates of either the DGAs or DRIs. Successive DGACs from the 1980 edition onwards have documented persistent, major research gaps for setting evidence-based guidelines (181). Consistent funding also does not exist to review the impact of the DGAs on the public's understanding of nutrition, food choices, or health, or on the impact on other stakeholders (181–183).\nIn response to concerns that the DGA process may require updated processes and coordination, in 2016 Congress instructed the National Academies of Sciences, Engineering, and Medicine (NASEM) to review and make recommendations to the process for updating the DGAs (Public Law 114–113). First, in February 2017, NASEM released “Optimizing the Process for Establishing the Dietary Guidelines for Americans: The Selection Process” (184). This report provided recommendations for how the advisory committee process can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints. The second report released in September 2017 was entitled “Redesigning the Process for Establishing the Dietary Guidelines for Americans” (182). This report identified the following specific opportunities for improvement in the DGA process: more consistent interpretation of purpose and target audiences of the DGA, greater transparency of the overall process, and more rigorous methodological approaches to the evaluation of the evidence. The USDA-HHS responded to NASEM recommendations in September 2018 indicating changes they will be making in the development of the 2020–2025 DGAs, such as asking for public comments on the topics and scientific questions to be examined in the review of the evidence supporting the development of the next edition (185).\nIn part to respond to these recommendations, the FY2019 appropriations bill provided a one-time allocation of $12.3 million to CNPP, divided over 3 y, to support the 2020–2025 DGAs (186). These one-time funds are supporting a limited set of systematic reviews of published evidence, but not any new research to address critical knowledge gaps. As previously noted, only ∼1.3% of NIH-supported research focuses on diet for the prevention or treatment of disease in humans, and furthermore, among these, only about half of the projects relate to key research gaps identified by the 2015 DGAC (117–119). In addition, while the 2014 Farm Bill (Public Law 113–79) mandated that the DGAs include, for the first time, food-based nutrition guidance for infants and toddlers aged 0–24 mo and women who are pregnant or lactating (prior DGAs did not include or consider these critical populations), no funding was authorized or appropriated to support this new mandate. Given the first-ever focus of the 2020–2025 DGAs on these important populations, it is expected that the 2020 DGAC will identify even more knowledge gaps for setting national dietary guidance than prior editions (187).\nIn 1990, Congress specified that the DGAs focus on the general public, not on specific nutritional recommendations for individuals suffering from diet-related conditions (Public Law 101–445). However, highlighting the scale and scope of diet-related illness, only 12% of US adults are metabolically healthy (as defined by blood glucose, cholesterol, blood pressure, and waist circumference). Thus, the DGAs’ general focus may exclude the specific dietary needs of the great majority of the US population. Until 2014, the NIH supported the development of evidence reviews and dietary guidance for patients with health issues such as overweight and obesity, high blood pressure, and high blood cholesterol, among others (188, 189). These reviews were used by DGACs with input and endorsement from \u003e25 professional groups. The NIH ceased these reports in 2014, in part because the CDC's mandate deals with disease prevention activities and the mandate of the HHS Agency for Healthcare Research and Quality (AHRQ) includes development of systematic evidence reviews to inform clinical practice guidelines (189–191). Certain nongovernmental professional and clinical organizations provide nutrition guidance for populations with or at risk for various chronic conditions, but these various recommendations are not coordinated (192, 193). The current 2020 DGAC process excludes—for the first time—the use of existing high-quality nongovernmental systematic reviews and meta-analyses conducted by peer-reviewed researchers and major professional organizations. Little work has been done to understand the short- or long-term implications of NIH's shift in 2014 away from dietary guidance for populations with disease conditions, or whether CDC and AHRQ efforts are addressing this gap. Thus, currently no federal entity takes the lead on the development of evidence reviews or dietary guidance for patients with diet-related health conditions. Several organizations, including AND, the National Association for the Advancement of Colored People, and the National Hispanic Medical Association, recently formed the Food4Health Alliance to advocate for additional federal nutrition guidelines tailored to the needs of tens of millions of Americans who have diet-related diseases such as hypertension, obesity, and type 2 diabetes—conditions that also disproportionately affect minorities and underserved communities (194).\nIn addition to the lack of consistent funding and staff for the evidence reviews, fundamental research, monitoring, and surveillance processes needed to develop and translate dietary guidance, concerns have been raised that the process of updating the DGAs every 5 y is not protected from political or external influences (e.g., political appointees, Congress, food and beverage industries, agribusiness interests, advocacy groups) (182, 184, 195). A coordinated federal approach and authority for nutrition research could help strengthen the process for objective and independent development, review, and dissemination of the best science evidence to the American public in the DGAs for both healthy individuals and those with major diet-related illnesses, as well as for the evaluation of corresponding intended and unintended impacts of these guidelines and needed changes to improve these impacts.\n\nDRIs\nDRIs provide specific targets for intakes of relevant nutrients for the general population (196). The first DRIs were created by Presidential mandate in 1941 when President Franklin D. Roosevelt commissioned scientists to generate new minimum dietary requirements for the population to be prepared for World War II (197). In 1943, the first RDAs (a type of DRI) were published, providing science-based guidelines for target intakes of total calories, protein, calcium, phosphorus, iron, and a few vitamins (198). Although DRIs are foundational to DGAs, the Nutrition Facts label, and other federal policies, there is no dedicated funding stream or statutory requirement for updating DRIs. Since the 1940s, DRIs have been updated sporadically dependent on available funding support provided by Congress to federal agencies (e.g., NIH and CDC) and, since the 1990s, additional contributions by the Canadian government (199). NASEM leads the updating of any DRI when requested by the federal government or instructed by Congress. Recently, a NASEM Consensus Study Report determined that crucial research gaps for setting DRIs remain largely unaddressed (200). Another challenge is there is no generally accepted process for deriving dietary reference values, which has led to several-fold differences in international recommendations and decreases their credibility (201, 202). The ICHNR DRI Subcommittee recommended that $2 million annually be placed and held in an agency's budget (e.g., ARS, CDC, and/or NIH) to establish a consistent funding stream for setting and updating of DRIs (203); this recommendation has not been implemented.\n\nFood and nutrition regulatory activities\nNutrition research is foundational for diverse federal, tribal, state, and local food and nutrition regulatory activities including labeling, health claims, food marketing, and oversight of food additives and other constituents (204). For example, Congress in 1990 (Public Law 101–535) authorized the Secretary of HHS to provide consumers with accurate nutrition information on food labels, giving rise to the Nutrition Facts panel. In 1994, the GAO recommended that USDA and FDA work together to perform laboratory analyses to independently verify the accuracy of nutrition labels; review labels for compliance with formatting requirements, nutrient content claims, and health claims; work with companies to correct identified inaccuracies; and where appropriate, pursue legal action against products with inappropriate labels (205). Since that time, USDA and FDA, among other federal departments and agencies, have needed to work together on these topics. Examples include the determination that partially hydrogenated oils (high in industrial trans fat) were no longer Generally Recognized As Safe (GRAS), for which NIH- and USDA-funded research, CDC surveillance data, and HHS regulatory reviews supported the FDA determination (206); and FDA's amendment of the food additive regulations to change the standard of identity of enriched flour and corn masa flour (207) to allow folic acid fortification to help prevent neural tube defects in developing infants, which required similar inputs from diverse federal research, surveillance, and regulatory efforts. Another example is the 2016 Nutrition Facts updates (e.g., requiring labeling of added sugar) based on new scientific research, updated DGAs, consensus reports, and national survey data, along with input obtained through proposed rulemaking processes (208, 209).\nIn 2018, FDA announced their Nutrition Innovation Strategy that outlined key activities to take a “fresh look” at what can be done to reduce diet-related chronic diseases (210). Key elements included the following: modernizing claims such as “healthy,” modernizing ingredient labels and standards of identity, implementing the Nutrition Facts Label and Menu Labeling, reducing sodium, and expanding nutrition education (e.g., launching a new Nutrition Facts label education campaign). For example, FDA agreed with a petition that its definition of “healthy,” central for marketing regulations, was scientifically outdated and inconsistent with the DGAs and advancing research (211). Insufficient scientific evidence on dietary supplement contents, health effects, and potential risks limits the FDA's ability to provide oversight for this $40 billon/y industry (212–214). As another example, there is no DRI or listing on Nutrition Facts for many compounds that appear relevant for health such as omega-3 fatty acids, phenolics, and other phytonutrients (212, 215). Further, many processing methods and additives banned in the European Union are permitted in the US, based on insufficient science for a definitive determination by FDA (216).\nThe Federal Trade Commission (FTC) has not been able to engage in any research on the impacts of food marketing to children in nearly 10 y (11). Congress prohibited FTC from completing their joint study with FDA, CDC, and USDA on nutrition standards for food marketing to children, even though this Interagency Working Group on Food Marketed to Children was established by the 2009 Omnibus Appropriations Act (Public Law 111–8) (11). Taken together, these FDA and FTC examples, among others, illustrate the crucial role of robust and coordinated federal nutrition research for numerous regulatory decisions and activities.\n\nFederal nutrition education and promotion\nCongress requires federal departments and agencies to coordinate review processes to ensure that nutrition education materials produced by the federal government are consistent with the latest DGAs (Public Law 101–445). This process is facilitated by a Dietary Guidance Review Committee, co-chaired by USDA CNPP and HHS ODPHP. More recently, DoD worked with USDA and HHS to integrate DGAs into their Go for Green® joint-service performance-nutrition initiative that aims to improve the food environment where military service members live and work (217). There is no direct, consistent Congressional investment in nutrition education for the general public, except for limited support of CNPP's dietary guidance translation activities and of USDA Food and Nutrition Service's nutrition education and promotion materials associated with the federal nutrition assistance programs. Over the years, various efforts have examined the impacts of USDA investments in nutrition education and promotion with mixed success (218). A 2019 GAO evaluation found that USDA administers 5 key programs that provide nutrition education but does not have formal coordination mechanisms for its nutrition education efforts and does not fully leverage the department's nutrition expertise (155). The GAO recommended that USDA develop a formal mechanism for coordinating nutrition education, improve the information it gathers on Supplemental Nutrition Assistance Program Education (SNAP-Ed), and take steps to fully leverage the department's expertise for nutrition education efforts.\n\nNational nutrition research database\nThere is no dedicated, consistent funding to identify and track federal investments in nutrition research. In 1981, Congress authorized the Human Nutrition Research and Information Management (HNRIM) system to track funding of nutrition research projects across the federal government (Public Law 97–98). From 1985 to 2015, HNRIM was maintained by NIH and, at its peak, included ≥100,000 records on federal nutrition research and training expenditures. HNRIM was a staff-curated database, with projects identified and classified by expert staff including the proportion of each project actually addressing nutrition. NIH shifted to the more automated NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) system, which is based on NIH's Research, Condition, and Disease Categorization (RCDC) system to define and categorize research projects across \u003e200 Congressionally mandated categories (Public Law 109–482). RCDC uses automated text data mining to match federal research projects to spending categories. The RePORTER system then assigns the total dollar amount of any research project that may be related to nutrition to the category of “nutrition research.” Most research projects meet criteria for and are counted across multiple categories. For instance, a single project and its total dollars may be counted as 100% nutrition, obesity, cardiovascular disease, diabetes, and prevention, among others. Besides NIH systems, a variety of other websites and databases aim to capture federal investments in human nutrition research, each using different methods with uncertain accuracy (Supplemental Table 9).\n\nCurrent landscape: summary\nSignificant efforts are occurring across diverse federal departments and agencies to leverage existing personnel and funding and coordinate existing activities to advance nutrition research. However, these efforts are not sufficiently coordinated or expansive enough to address the current and future diet-related disease burdens, or the corresponding health care spending, food insecurity and health disparities; strains on government budgets and American businesses; challenges to military readiness; and intersections with supply chains and sustainability. Many new opportunities exist to be seized, as reviewed next."}

LitCovid-PubTator

LitCovid-sentences

LitCovid-PD-HP

2_test

PMC:7454258 / 88583-114297 JSONTXT

Annnotations TAB JSON ListView MergeView

PMC:7454258 / 88583-114297 JSON TXT