PubAnnotation

Id	Subject	Object	Predicate	Lexical cue
T1	0-124	Sentence	denotes	Strengthening national nutrition research: rationale and options for a new coordinated federal research effort and authority
T2	126-134	Sentence	denotes	Abstract
T3	135-143	Sentence	denotes	ABSTRACT
T4	145-155	Sentence	denotes	Background
T5	156-210	Sentence	denotes	The US faces remarkable food and nutrition challenges.
T6	211-374	Sentence	denotes	A new federal effort to strengthen and coordinate nutrition research could rapidly generate the evidence base needed to address these multiple national challenges.
T7	375-451	Sentence	denotes	However, the relevant characteristics of such an effort have been uncertain.
T8	453-463	Sentence	denotes	Objectives
T9	464-1139	Sentence	denotes	Our aim was to provide an objective, informative summary of 1) the mounting diet-related health burdens facing our nation and corresponding economic, health equity, national security, and sustainability implications; 2) the current federal nutrition research landscape and existing mechanisms for its coordination; 3) the opportunities for and potential impact of new fundamental, clinical, public health, food and agricultural, and translational scientific discoveries; and 4) the various options for further strengthening and coordinating federal nutrition research, including corresponding advantages, disadvantages, and potential executive and legislative considerations.
T10	1141-1148	Sentence	denotes	Methods
T11	1149-1527	Sentence	denotes	We reviewed government and other published documents on federal nutrition research; held various discussions with expert groups, advocacy organizations, and scientific societies; and held in-person or phone meetings with >50 federal staff in executive and legislative roles, as well as with a variety of other stakeholders in academic, industry, and nongovernment organizations.
T12	1529-1536	Sentence	denotes	Results
T13	1537-1589	Sentence	denotes	Stark national nutrition challenges were identified.
T14	1590-1675	Sentence	denotes	More Americans are sick than are healthy, largely from rising diet-related illnesses.
T15	1676-1847	Sentence	denotes	These conditions create tremendous strains on productivity, health care costs, health disparities, government budgets, US economic competitiveness, and military readiness.
T16	1848-2140	Sentence	denotes	The coronavirus disease 2019 (COVID-19) outbreak has further laid bare these strains, including food insecurity, major diet-related comorbidities for poor outcomes from COVID-19 such as diabetes, hypertension, and obesity, and insufficient surveillance on and coordination of our food system.
T17	2141-2294	Sentence	denotes	More than 10 federal departments and agencies currently invest in critical nutrition research, yet with relatively flat investments over several decades.
T18	2295-2391	Sentence	denotes	Coordination also remains suboptimal, documented by multiple governmental reports over 50 years.
T19	2392-2633	Sentence	denotes	Greater harmonization and expansion of federal investment in nutrition science, not a silo-ing or rearrangement of existing investments, has tremendous potential to generate new discoveries to improve and sustain the health of all Americans.
T20	2634-2696	Sentence	denotes	Two identified key strategies to achieve this were as follows:
T21	2697-2914	Sentence	denotes	1) a new authority for robust cross-governmental coordination of nutrition research and other nutrition-related policy and 2) strengthened authority, investment, and coordination for nutrition research within the NIH.
T22	2915-3061	Sentence	denotes	These strategies were found to be complementary, together catalyzing important new science, partnerships, coordination, and returns on investment.
T23	3062-3164	Sentence	denotes	Additional complementary actions to accelerate federal nutrition research were identified at the USDA.
T24	3166-3177	Sentence	denotes	Conclusions
T25	3178-3488	Sentence	denotes	The need and opportunities for strengthened federal nutrition research are clear, with specific identified options to help create the new leadership, strategic planning, coordination, and investment the nation requires to address the multiple nutrition-related challenges and grasp the opportunities before us.
T26	3490-3507	Sentence	denotes	Executive Summary
T27	3509-3513	Sentence	denotes	Aims
T28	3514-3623	Sentence	denotes	This white paper aims to evaluate key issues relevant to federal nutrition research, including the following:
T29	3624-3759	Sentence	denotes	The mounting diet-related health burdens and corresponding economic, health equity, national security, and sustainability implications;
T30	3760-3862	Sentence	denotes	The current diverse federal nutrition research landscape and existing mechanisms for its coordination;
T31	3863-4025	Sentence	denotes	The opportunities for new nutrition-related discoveries in fundamental, clinical, public health, food and agricultural, and translational scientific research; and
T32	4026-4176	Sentence	denotes	The best strategies to further strengthen and coordinate federal nutrition research, including advantages, disadvantages, and potential paths forward.
T33	4177-4447	Sentence	denotes	This effort, informed by extensive background research and interviews, is intended to invite comment and discussion from all key stakeholders and help lay the foundation for accelerated scientific advances in nutrition to improve and sustain the health of all Americans.
T34	4449-4459	Sentence	denotes	The burden
T35	4460-4531	Sentence	denotes	Diet-related illnesses are the leading source of poor health in the US.
T36	4532-4660	Sentence	denotes	Nearly 3 in 4 American adults are overweight or obese, and 1 in 2 have diabetes or prediabetes—and these rates continue to rise.
T37	4661-4783	Sentence	denotes	Poor nutrition further contributes to cardiovascular diseases, several cancers, poor gut health, and many other disorders.
T38	4784-4955	Sentence	denotes	Beyond effects on health, these diet-related diseases create enormous strains on productivity, health care spending, health disparities, and military readiness (Figure 1).
T39	4956-5062	Sentence	denotes	Our food system also strains our natural resources, a crucial new area of intersecting science and policy.
T40	5063-5205	Sentence	denotes	FIGURE 1 Examples of identified diet-related burdens that could be addressed by more coordinated and strengthened federal nutrition research.
T41	5206-5241	Sentence	denotes	COVID-19, coronavirus disease 2019.
T42	5242-5294	Sentence	denotes	Graphic design support courtesy of Ink&Pixel Agency.
T43	5295-5470	Sentence	denotes	Profound disparities in both diet-related chronic diseases and food insecurity, for example, are experienced by low-income, rural, minority, and other underserved populations.
T44	5471-5590	Sentence	denotes	Nearly 3 in 4 young Americans do not qualify for military service, with obesity being the leading medical disqualifier.
T45	5591-5747	Sentence	denotes	Obesity and other diet-related chronic diseases are endemic among veterans, while obesity and food insecurity coexist in many active-duty military families.
T46	5748-5952	Sentence	denotes	Over just 50 y, federal health care spending has risen from 5% to 28% of the federal budget, while US business (inflation-adjusted) spending on health care has increased from $79 billion to $1180 billion.
T47	5953-6061	Sentence	denotes	Approximately 85% of current health care spending is related to management of diet-related chronic diseases.
T48	6062-6408	Sentence	denotes	Estimated US government expenditures on direct medical care for diabetes alone (∼$160 billion/y) exceeds the annual budgets of many individual federal departments and agencies, including, among others, the Departments of Education (DoE), Homeland Security (DHS), and Justice (DoJ) and the NIH, CDC, Environmental Protection Agency (EPA), and FDA.
T49	6409-6504	Sentence	denotes	These strains have been further exposed and exacerbated by coronavirus disease 2019 (COVID-19).
T50	6505-6794	Sentence	denotes	This includes, for example, challenges related to hunger and food insecurity, major diet-related comorbidities for poor outcomes from COVID-19, insufficient evidence on optimal population resilience through better nutrition, and inadequate surveillance and coordination of our food system.
T51	6795-7003	Sentence	denotes	Addressing each of these issues requires a better understanding of their multilevel, interrelated biological, individual, social, and environmental determinants, and the corresponding translational solutions.
T52	7004-7170	Sentence	denotes	However, the current scope and pace of nutritional knowledge and discovery are insufficient to address the fundamental nutrition-related challenges facing the nation.
T53	7172-7193	Sentence	denotes	The current landscape
T54	7194-7288	Sentence	denotes	More than 10 federal departments and agencies currently invest in critical nutrition research.
T55	7289-7462	Sentence	denotes	Their relative investments in nutrition research have remained flat or declined over several decades—even as diet-related conditions and their societal burdens have climbed.
T56	7463-7613	Sentence	denotes	The NIH is the largest funder, with nutrition research investments estimated at $1.9 billion annually (∼5% of total NIH funding) for fiscal year 2019.
T57	7614-7745	Sentence	denotes	Approximately 25% of this funding (1.3% of total NIH funding) focuses on diet for the prevention or treatment of disease in humans.
T58	7746-7864	Sentence	denotes	This NIH nutrition research is conducted and supported across nearly all of the 27 current NIH institutes and centers.
T59	7865-8010	Sentence	denotes	Coordination of these efforts has been challenged by successively smaller NIH coordinating offices with decreasing stature, staff, and resources.
T60	8011-8185	Sentence	denotes	The USDA is the second-largest funder of US nutrition research, with an estimated annual budget of ∼$0.17 billion for fiscal year 2019 across several institutes and services.
T61	8186-8473	Sentence	denotes	The USDA works to provide Americans with safe, nutritious, and wholesome food and works to ensure the foods and beverages our nation produces optimally benefits human and animal health and to address food insecurity through the administration of 15 federal nutrition assistance programs.
T62	8474-8699	Sentence	denotes	Several structures work to improve research coordination within the USDA, although a recent USDA workshop and Government Accountability Office (GAO) report identified gaps and opportunities in nutrition research coordination.
T63	8700-8982	Sentence	denotes	Multiple other federal departments and agencies invest in nutrition research, including the CDC, FDA, Department of Defense (DoD), US Agency for International Development (USAID), Department of Veterans Affairs (VA), National Aeronautics and Space Administration (NASA), and others.
T64	8983-9131	Sentence	denotes	Consistent with this fragmented infrastructure, multiple major reports over 50 y have called for greater coordination of federal nutrition research.
T65	9132-9564	Sentence	denotes	Current coordination efforts include the Interagency Committee on Human Nutrition Research (ICHNR), which currently meets about twice a year to work on the following activities, among others: food and nutrition monitoring and surveillance, the joint USDA–Department of Health and Human Services (-HHS) activity to produce the Dietary Guidelines for Americans (DGAs) and certain regulatory, communication, and educational activities.
T66	9565-9698	Sentence	denotes	However, no concrete authority has been created to successfully harmonize and leverage the federal investments in nutrition research.
T67	9699-10045	Sentence	denotes	Overall, this white paper and several prior reports found these efforts to be important but insufficient to address current and rising diet-related disease burdens, food insecurity, health disparities, health care costs, challenges to military readiness, and intersections with food and agricultural production, supply chains, and sustainability.
T68	10047-10062	Sentence	denotes	The opportunity
T69	10063-10191	Sentence	denotes	Several specific priority areas in nutrition research have been identified by various federal and nongovernmental organizations.
T70	10192-10241	Sentence	denotes	However, most have not been adequately addressed.
T71	10242-10376	Sentence	denotes	Greater federal coordination and investment in nutrition research could accelerate discoveries across these critical areas (Figure 2).
T72	10377-10469	Sentence	denotes	FIGURE 2 Opportunities for enhanced federal nutrition research coordination and investment.
T73	10470-10741	Sentence	denotes	DGAs, Dietary Guidelines for Americans; DoD, Department of Defense; NASA, National Aeronautics and Space Administration; SNAP-Ed, USDA Supplemental Nutrition Assistance Program Education; USAID, US Agency for International Development; VA, Department of Veterans Affairs.
T74	10742-10794	Sentence	denotes	Graphic design support courtesy of Ink&Pixel Agency.
T75	10795-10923	Sentence	denotes	Several lines of evidence support a strong return on investment (ROI) for an expanded and coordinated nutrition research effort.
T76	10924-11281	Sentence	denotes	As stated by the FDA Commissioner in 2018 at the National Food Policy Conference, “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.”
T77	11283-11294	Sentence	denotes	The options
T78	11295-11487	Sentence	denotes	Any new federal nutrition research investment and coordination structure must leverage, harmonize, and catalyze the existing efforts being led across multiple federal departments and agencies.
T79	11488-11539	Sentence	denotes	Two major complementary strategies were identified:
T80	11540-11757	Sentence	denotes	1) a new authority for robust cross-governmental coordination of nutrition research and other nutrition-related policy and 2) strengthened authority, investment, and coordination for nutrition research within the NIH.
T81	11758-11975	Sentence	denotes	Specific promising options to advance these 2 strategies were identified (Box 1); and for each option, potential advantages and disadvantages, executive and legislative considerations, and paths forward are discussed.
T82	11976-12204	Sentence	denotes	Improved coordination between federal departments and agencies conducting nutrition research was identified as having tremendous potential for accelerating essential basic, clinical, public health, and translational discoveries.
T83	12205-12360	Sentence	denotes	Increased authority, coordination, and funding for nutrition science within NIH was also identified as being essential for accelerating needed discoveries.
T84	12361-12536	Sentence	denotes	Appropriate efforts should leverage and amplify, not replace, compete with, or isolate existing nutrition research efforts across NIH, USDA, or other departments and agencies.
T85	12537-12721	Sentence	denotes	The cross-government strategy and within-NIH strategy were identified as complementary, with benefits accruing independently and further synergies to be gained by joint implementation.
T86	12722-12831	Sentence	denotes	Box 1 Promising cross-governmental and NIH options to strengthen and accelerate national nutrition research1
T87	12832-12918	Sentence	denotes	Cross-governmental A new Office of the National Director of Food and Nutrition (ONDFN)
T88	12919-12970	Sentence	denotes	A new US Global Nutrition Research Program (USGNRP)
T89	12971-13083	Sentence	denotes	A new Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP)
T90	13084-13133	Sentence	denotes	A new US Task Force on Federal Nutrition Research
T91	13134-13188	Sentence	denotes	Within NIH A new National Institute of Nutrition (NIN)
T92	13189-13240	Sentence	denotes	A new National Center for Nutrition Research (NCNR)
T93	13241-13327	Sentence	denotes	A return of the Office of Nutrition Research (ONR) into the NIH Office of the Director
T94	13328-13390	Sentence	denotes	Development of new trans-NIH initiatives in nutrition research
T95	13391-13509	Sentence	denotes	Within USDA Increased investment in nutrition research across the USDA Research, Education, and Economics mission area
T96	13510-13573	Sentence	denotes	Expanded USDA research to improve public guidance and education
T97	13574-13654	Sentence	denotes	Innovative USDA research to strengthen benefits of nutrition assistance programs
T98	13655-13858	Sentence	denotes	1 Additional relevant priorities to strengthen federal nutrition research within other departments and agencies, such as DoD, USAID, and FDA, were recognized and should be the subject of future reports.
T99	13860-13955	Sentence	denotes	Further complementary actions to accelerate federal nutrition research were identified at USDA.
T100	13956-14376	Sentence	denotes	First, to increase investment in nutrition research for the Agricultural Research Service (ARS) including its network of Human Nutrition Research Centers, the National Institute of Food and Agriculture (NIFA) extramural research programs, and the Economic Research Service (ERS) programs, which assesses demographic, social, informational, and economic determinants of dietary consumption and associated health outcomes.
T101	14377-14506	Sentence	denotes	Second, to expand USDA research that evaluates and improves major ongoing efforts for public guidance and education on nutrition.
T102	14507-14689	Sentence	denotes	And third, to build the robust evidence base and collaborations needed to strengthen the positive impacts of the ∼$100 billion/y federal investments in nutrition assistance programs.
T103	14691-14702	Sentence	denotes	Conclusions
T104	14703-14795	Sentence	denotes	This white paper identified many stark and growing national challenges related to nutrition.
T105	14796-14996	Sentence	denotes	Our research further documented a diversity of federal investments in nutrition research across departments and agencies, but with flat or declining funding and with suboptimal coordination authority.
T106	14997-15147	Sentence	denotes	The opportunities to be gained by greater coordination and investment in federal nutrition research are clear, with potential for large and rapid ROI.
T107	15148-15349	Sentence	denotes	This white paper identified and described 2 priority strategies, including 1) a new authority for cross-governmental coordination and 2) strengthened authority, investment, and coordination within NIH.
T108	15350-15411	Sentence	denotes	Additional important strategies were also identified at USDA.
T109	15412-15519	Sentence	denotes	All these strategies were found to be complementary, providing independent as well as synergistic benefits.
T110	15520-15765	Sentence	denotes	The identified specific options would help create the new leadership, strategic planning, coordination, and investment the nation requires to address the multiple nutrition-related challenges before us, and grasp the corresponding opportunities.
T111	15767-15779	Sentence	denotes	Introduction
T112	15780-15834	Sentence	denotes	The US faces remarkable food and nutrition challenges.
T113	15835-16025	Sentence	denotes	More Americans are sick than are healthy, with diet-related illnesses playing a major role including obesity, type 2 diabetes, cardiovascular diseases, cancers, food allergies, and more (1).
T114	16026-16129	Sentence	denotes	The incidence and prevalence of many of these conditions have increased dramatically in recent decades.
T115	16130-16378	Sentence	denotes	In addition to burdens on health and productivity, these diet-related diseases are creating tremendous strains on health care spending, health disparities, government budgets, economic competitiveness of American businesses, and military readiness.
T116	16379-16540	Sentence	denotes	Innovations in food and nutrition should improve human health while also preserving our natural resources, a crucial new area of intersecting science and policy.
T117	16541-16643	Sentence	denotes	Many of these strains in food and nutrition have been further exposed and exacerbated by COVID-19 (2).
T118	16644-17037	Sentence	denotes	This includes, for example, challenges related to hunger and food insecurity; major diet-related comorbidities for hospitalization and death from COVID-19 such as diabetes, obesity, and hypertension; insufficient evidence on optimal population resilience through better nutrition; and the need to further improve the surveillance on and coordination of food production and supply chains (3–9).
T119	17038-17283	Sentence	denotes	While advancing nutrition research has provided evidence to describe the general contours of healthy eating patterns, it has also highlighted many critical new, unanswered questions on food and nutrition and the national challenges we face (10).
T120	17284-17387	Sentence	denotes	Important nutrition research is currently being supported by >10 federal departments and agencies (11).
T121	17388-17528	Sentence	denotes	Yet, as diet-related conditions and their societal burdens have climbed in recent decades, funding for such research has remained flat (12).
T122	17529-17759	Sentence	denotes	In addition, no concrete action has emerged to successfully harmonize and leverage nutrition research across the government, despite consistent recommendations over at least 5 decades for a robust coordinating federal entity (13).
T123	17760-17961	Sentence	denotes	A major, new federal effort to strengthen and coordinate nutrition research could rapidly generate the necessary evidence base to address multiple national challenges, providing major benefits and ROI.
T124	17962-18078	Sentence	denotes	The aim of this white paper is to evaluate key issues relevant to such a scientific effort, including the following:
T125	18079-18236	Sentence	denotes	The mounting diet-related health burdens facing our nation and the corresponding economic, health equity, national security, and sustainability implications;
T126	18237-18410	Sentence	denotes	The current federal nutrition research landscape and existing mechanisms for its coordination among the diverse departments and agencies working to address these challenges;
T127	18411-18588	Sentence	denotes	The opportunities for and potential impact of new fundamental, clinical, public health, food and agricultural, and translational scientific discoveries related to nutrition; and
T128	18589-18794	Sentence	denotes	The best strategies to further strengthen and coordinate federal nutrition research, including relevant advantages, disadvantages, and potential executive and legislative considerations for a path forward.
T129	18795-19148	Sentence	denotes	This white paper is intended to invite comment and discussion from all stakeholders who care about strengthening nutrition research, whether to improve health, lower public and private health care spending, reduce disparities, promote business innovation, reinvigorate rural communities, preserve our national resources, or strengthen national security.
T130	19149-19206	Sentence	denotes	Key audiences for this white paper include the following:
T131	19207-19290	Sentence	denotes	Elected and appointed federal officials in both executive and legislative branches;
T132	19291-19351	Sentence	denotes	Federal science agency leaders and program and policy staff;
T133	19352-19380	Sentence	denotes	Federal military leadership;
T134	19381-19404	Sentence	denotes	The academic community;
T135	19405-19456	Sentence	denotes	Clinical and scientific professional organizations;
T136	19457-19483	Sentence	denotes	Nonprofit advocacy groups;
T137	19484-19525	Sentence	denotes	Allied health professional organizations;
T138	19526-19648	Sentence	denotes	US businesses whose efforts, employees, and competitiveness can be benefited by federally supported nutrition discoveries;
T139	19649-19711	Sentence	denotes	The media, who communicate key nutrition-related messages; and
T140	19712-19864	Sentence	denotes	The public who rely on and desperately need advances in federally supported nutrition research to help improve and sustain their health and communities.
T141	19865-19958	Sentence	denotes	This white paper was informed by extensive background research and stakeholder conversations.
T142	19959-20337	Sentence	denotes	This research included a review of government and other published documents on federal nutrition research; discussions with expert groups, advocacy organizations, and scientific societies; and in-person or phone meetings with >50 federal staff in executive and legislative roles, as well as with a variety of extramural researchers in academic and nongovernmental organizations.
T143	20338-20518	Sentence	denotes	The writing group reached out to all 10 departments and agencies participating in the ICHNR, particularly for assistance in estimating their relevant budget for nutrition research.
T144	20519-20621	Sentence	denotes	The legislative history for the NIH was independently collected by 2 team members with high agreement.
T145	20622-20847	Sentence	denotes	Legal experts at the Center for Health Law and Policy Innovation at Harvard Law School reviewed this white paper with special attention to the section on Options and the corresponding legislative and executive considerations.
T146	20848-21115	Sentence	denotes	We also reviewed feedback received through the American Society for Nutrition (ASN) request for member input regarding the concept of a National Institute of Nutrition and through a related panel session and Q&A at the ASN Nutrition 2019 annual scientific conference.
T147	21116-21674	Sentence	denotes	We also sought input from members of the Nutrition Action Alliance (NAA), a coalition of organizations working to advance federal nutrition research, nutrition education, and nutrition monitoring and surveillance, among other activities, and which includes ASN, Academy of Nutrition and Dietetics, American Society for Parenteral and Enteral Nutrition, Association of Nutrition Departments and Programs, Institute of Food Technologists, National Board of Physician Nutrition Specialists, Society for Nutrition Education and Behavior, and The Obesity Society.
T148	21675-22022	Sentence	denotes	The writing group used these document reviews, one-on-one conversations, stakeholder interviews, and additional discussions to maximize candid, confidential reflections following Chatham House Rules on the past and present state of federal nutrition research, the challenges and opportunities, and the best available strategies for moving forward.
T149	22023-22238	Sentence	denotes	We hope this white paper provides an objective, informative summary of the 1) burdens, 2) current federal nutrition research landscape, 3) opportunities, and 4) options for strengthening national nutrition research.
T150	22239-22424	Sentence	denotes	Ultimately, we hope it helps lay the foundation for accelerated advances in nutrition research to help improve and sustain the health of all children, adults, families, and communities.
T151	22426-22436	Sentence	denotes	The Burden
T152	22437-22671	Sentence	denotes	Poor nutrition is contributing to major increases in diet-related obesity and type 2 diabetes, as well as continuing high rates of other chronic diet-related diseases such as cardiovascular diseases, cancers, and other conditions (1).
T153	22672-22733	Sentence	denotes	Since the 1970s, Americans’ diets have changed significantly.
T154	22734-22860	Sentence	denotes	For example, both portion sizes and frequency of snacking have increased, with each linked to greater calorie intake (14, 15).
T155	22861-23033	Sentence	denotes	Among US children, substantial increases in daily calories since the 1970s are entirely attributable to increased foods eaten outside from home, mostly from fast food (16).
T156	23034-23318	Sentence	denotes	Consistent with prior health messaging to reduce total fat, the percentage of energy from carbohydrates increased from 42% to 48% of calories in men and 45% to 51% in women between 1971 and 2004, primarily due to higher consumption of starches, grains, and caloric beverages (17, 18).
T157	23319-23512	Sentence	denotes	Between 1977 and 1994, intake of processed breakfast cereals increased by 60%, intake of pizza by 115%, and intakes of snack foods like crackers, popcorn, pretzels, and corn chips by 200% (19).
T158	23513-23678	Sentence	denotes	Between 1965 and 2002, the intake of caloric beverages increased from 12% to 21% of all calories, representing an average increase of 222 calories/d per person (20).
T159	23679-23775	Sentence	denotes	This change was due to increased intake of sweetened fruit drinks, alcohol, and especially soda.
T160	23776-23870	Sentence	denotes	Over this time, the average portion size of a sugar-sweetened beverage increased by >50% (21).
T161	23871-24128	Sentence	denotes	In more recent years, with growing public awareness of the critical role of nutrition in overall health, some aspects of US diet quality have modestly improved, such as reductions in soda and small increases in whole grains, fruits, and nuts/seeds (22, 23).
T162	24129-24431	Sentence	denotes	Nevertheless, intakes of these and other healthful components remain far below dietary guidelines, with 45.6% of adults and 56.1% of children continuing to have poor-quality diets overall, and most of the remainder having intermediate-quality diets, with very few Americans having ideal diets (22, 23).
T163	24432-24574	Sentence	denotes	While less well documented by national surveillance data, the levels and types of food processing have substantially changed in the past 50 y.
T164	24575-24660	Sentence	denotes	Ultra-processed foods now contribute ∼60% of all calories in the US food supply (24).
T165	24661-24880	Sentence	denotes	These changes in our nutrition and corresponding diet-related illnesses are associated with rising health care costs, widening diet-related health disparities, and weakened national security and military readiness (25).
T166	24881-25059	Sentence	denotes	Between 1980 and 2018, the percentage of US children with obesity increased from 5.5% to 19.3%, whereas the percentage of adults with obesity increased from 15% to 42.4% (26–30).
T167	25060-25138	Sentence	denotes	Nearly 3 in 4 American adults are now either overweight or obese (26, 31, 32).
T168	25139-25348	Sentence	denotes	Across all preventable risk factors for disease in the US, poor diet is now the leading cause of poor health, associated with more than half a million deaths per year—or more than 40,000 deaths each month (1).
T169	25349-25465	Sentence	denotes	Along with suboptimal diet, adiposity and physical inactivity are shared risk factors for illness and death (33–37).
T170	25466-25650	Sentence	denotes	Over the last 20 y, the number of adults with diabetes has more than doubled (38), and today, >100 million Americans—nearly half of all adults—suffer from diabetes or prediabetes (39).
T171	25651-25748	Sentence	denotes	Cardiovascular disease afflicts ∼122 million Americans and causes ∼840,000 deaths each year (40).
T172	25749-25954	Sentence	denotes	Many of these diseases disproportionately affect older Americans, and as our nation's demographics shift toward an aging population, the burden of diet-related ailments on society will accelerate (41, 42).
T173	25955-26099	Sentence	denotes	In short, more Americans are sick or suffer from major medical conditions than are healthy, and much of this is related to diet-related illness.
T174	26100-26258	Sentence	denotes	Although the general contours of healthy eating patterns have been outlined by important advances in nutrition science, many questions remain unanswered (10).
T175	26259-26488	Sentence	denotes	Modern nutrition science is still evolving, with a rapidly growing but still relatively nascent repertoire of research methods, foundational science, and large-scale interventions to investigate and address diet-related diseases.
T176	26489-26645	Sentence	denotes	For most of the 20th century, the focus of nutrition research was on isolated vitamins and minerals and their role in clinical nutrient deficiency diseases.
T177	26646-27057	Sentence	denotes	This effort led to major accomplishments, such as documenting the role of individual nutrients in diseases such as pellagra (vitamin B-3 deficiency), rickets (vitamin D deficiency), and scurvy (vitamin C deficiency), among others, and then quickly mobilizing innovative technology such as fortification of staple foods, along with well-coordinated policy and programmatic responses, to address these conditions.
T178	27058-27336	Sentence	denotes	In comparison, the shift of nutrition science to focus more meaningfully on diet-related chronic diseases, such as heart disease, strokes, cancer, diabetes, obesity, brain health, and autoimmune and inflammatory diseases, is much more recent, largely begun only since the 1980s.
T179	27337-27395	Sentence	denotes	In this short period, important knowledge has been gained.
T180	27396-27570	Sentence	denotes	Yet, the investment and pace of progress have been insufficient to address the burgeoning rates of diet-related illness and the associated societal and economic consequences.
T181	27571-27860	Sentence	denotes	For example, in detailed reviews of available research by the 2015 Dietary Guidelines Advisory Committee (DGAC), numerous areas were identified as having only moderate, limited, or insufficient (not assignable) scientific evidence for making dietary recommendations (Supplemental Table 1).
T182	27861-28523	Sentence	denotes	These include, for instance, evidence that healthier dietary patterns favorably influence body weight or obesity in adults (moderate evidence) or children or adolescents (limited); reduce the risk of type 2 diabetes in adults (limited) or children (not assignable); or are associated with lower risk of colorectal (moderate), breast (moderate to limited), lung (limited), or prostate (not assignable) cancer; age-related cognitive impairment, dementia, or Alzheimer disease (limited); depression in adults (limited) or children, adolescents, or postpartum mothers (not assignable); or bone health in adults (limited) or children and adolescents (not assignable).
T183	28524-28910	Sentence	denotes	Considering specific individual foods and nutrients, the 2015 DGAC concluded that evidence is only moderate that coffee consumption is associated with reduced risk of type 2 diabetes, cardiovascular disease, or certain cancers and is limited for caffeine intake and lower risk of cognitive decline and Alzheimer disease or increased risk of miscarriage, stillbirth, or low birth weight.
T184	28911-29028	Sentence	denotes	The 2015 DGAC found limited evidence to address additives, such as aspartame and risk of cancers or preterm delivery.
T185	29029-29415	Sentence	denotes	Evidence was considered moderate for any specific sodium target (e.g., 2400 mg/d) for blood pressure control or risk of cardiovascular outcomes; limited or not assignable for potassium intake and these outcomes; moderate or limited for low-calorie sweeteners and body weight or diabetes; and limited for replacing saturated fat with monounsaturated fat for reducing cardiovascular risk.
T186	29416-29506	Sentence	denotes	The 2015 DGAC identified multiple specific areas of research needs (Supplemental Table 2).
T187	29507-30461	Sentence	denotes	Examples include the need to conduct research on 1) the dietary needs and intakes of older adults, whether polypharmacy plays a role in nutritional adequacy, and whether comorbidities, such as poor dentition, musculoskeletal difficulties, arthralgias, vision loss, and other age-related symptoms, affect their ability to establish and maintain proper nutritional status; 2) nutrition transitions from early childhood to adolescence to identify how and why diets change so rapidly during this period, the driving forces behind these changes, and effective programs to maintain positive nutrition habits established in young children; 3) the validity, reliability, and reproducibility of new biomarkers of nutritional status; 4) the effects of fortification strategies and supplement use on consumer behaviors and diets related to calcium, vitamin D, potassium, iron, and fiber; and 5) design approaches to quantify diets in large population-based studies.
T188	30462-30615	Sentence	denotes	Overall, advances in science have identified numerous new opportunities for research and pressing scientific questions that must be addressed (Figure 2).
T189	30616-31038	Sentence	denotes	These topics, discussed further in “The Opportunity” section below, include fundamental questions about foods and diet quality in relation to obesity, insulin resistance, diabetes, cancers, and other conditions; the interactions between diet, physical activity, the microbiome, and immunity and other key health defenses; and the health effects of various forms of food processing, additives, fermentation, and probiotics.
T190	31039-31412	Sentence	denotes	Other topics include personalization of nutrition based on each person's background, habits, genes, microbiome, medications, and existing diseases; how hunger and food security influence wellness and key approaches to address this interaction; the intersections of plant and animal breeding and farming practices with nutrition and sustainability; and many other questions.
T191	31413-31608	Sentence	denotes	Thus, we have learned much, but the present state of science remains far from offering a sufficient understanding of many crucial facets of food and nutrition fundamental to human health (43–47).
T192	31609-31822	Sentence	denotes	Scientific progress is being made, but at the current pace it may take many decades to meaningfully understand and reduce the prevalence and impact of the broad range of diet-related chronic diseases that we face.
T193	31823-31903	Sentence	denotes	The economic costs of nutrition-related diseases are staggering and ever rising.
T194	31904-32057	Sentence	denotes	As a share of our economy, total US health care expenditures have nearly tripled since 1970, from 6.9% to 17.9% of Gross Domestic Product (GDP) (48, 49).
T195	32058-32184	Sentence	denotes	These increases are harming government budgets, competitiveness of US businesses, workers’ wages, and livelihoods of families.
T196	32185-32334	Sentence	denotes	Federal health care spending has increased from 5% of the total federal budget in 1970 to 28% in 2018, reducing available funds for other priorities.
T197	32335-32462	Sentence	denotes	Similarly, average state government spending on health care has increased from 11.3% of state budgets in 1989 to 28.7% in 2016.
T198	32463-32621	Sentence	denotes	For US businesses, health care expenditures have increased 15-fold in 50 y, from $79 billion in 1970 to $1180 billion in 2017 (in constant 2017 dollars) (49).
T199	32622-32762	Sentence	denotes	Over this same period, annual per capita health care spending in the US has increased from $1797 to $10,739 (in constant 2017 dollars) (49).
T200	32763-32874	Sentence	denotes	And, ∼85% of total US health care expenditures are related to management of diet-related chronic diseases (50).
T201	32875-33105	Sentence	denotes	For example, the total direct health care and indirect economic costs of cardiovascular diseases are estimated at $316 billion/y; of diabetes, at $327 billion/y; and of all obesity-related conditions, at $1.72 trillion/y (51, 52).
T202	33106-33460	Sentence	denotes	These economic costs exceed the annual budget appropriations of most federal departments and agencies, such as (for fiscal year 2020) the budgets of the USDA ($150 billion) (53), DoE ($72 billion) (54), DHS ($51 billion) (55), DoJ ($33 billion) (56), NIH ($42 billion) (57), CDC ($12.7 billion) (58), EPA ($9.5 billion) (59), and FDA ($5.9 billion) (59).
T203	33461-33738	Sentence	denotes	Rising health care expenditures are straining government budgets and private business growth; limiting the ability to support other national, state, and business priorities; contributing to stagnating wages; and bankrupting individuals, families, and small businesses (60, 61).
T204	33739-33929	Sentence	denotes	Improving what Americans eat would have a significant impact on reducing diet-related chronic diseases, lowering health care spending, and creating new opportunities for innovation and jobs.
T205	33930-34183	Sentence	denotes	Although advancing science has elucidated the broad outlines of healthy eating patterns for making many general dietary and policy recommendations, numerous critical questions remain unanswered, with corresponding scientific debate and public confusion.
T206	34184-34384	Sentence	denotes	There is a large and growing appetite among American citizens for credible, rigorous nutritional science information, both for general health but also for treating many specific diseases and ailments.
T207	34385-34654	Sentence	denotes	Consumers are inundated with often conflicting information from multiple sources, including the internet, social media, television, marketing, and food and menu labeling, among others, making it difficult to discern trusted information for making informed choices (62).
T208	34655-34826	Sentence	denotes	Many American adults remain unaware of foundational federal guidance on nutrition (63, 64), and use the internet or other sources for seeking guidance on what to eat (65).
T209	34827-34883	Sentence	denotes	Poor nutrition also contributes to profound disparities.
T210	34884-35024	Sentence	denotes	Prior to COVID-19, food insecurity was a significant challenge for 1 in 8 Americans (66, 67), and is expected to more than double this year.
T211	35025-35134	Sentence	denotes	A total of 37 million Americans, including 11 million children, experienced food insecurity in 2018 (68, 69).
T212	35135-35313	Sentence	denotes	The dramatic increase in unemployment with COVID-19 is expected to cause food insecurity for an additional 18 million US children, bringing the total to 40% of all US youth (70).
T213	35314-35475	Sentence	denotes	Americans are also experiencing ever-widening disparities in diet quality and diet-related chronic diseases by race/ethnicity, education, and income (22, 71–75).
T214	35476-35703	Sentence	denotes	While social and economic factors such as lower education, poverty, bias, and reduced opportunities are major contributors to population disparities, they are likewise major barriers to healthy food access and proper nutrition.
T215	35704-35926	Sentence	denotes	Poor diets lead to a harsh cycle of lower academic achievement in school, lost productivity at work, increased chronic disease risk, increased out-of-pocket health costs, and poverty for the most vulnerable Americans (76).
T216	35927-36208	Sentence	denotes	Addressing these profound diet-related disparities experienced by rural, low-income, and minority populations requires a better understanding of their multilevel and interrelated individual, social, and environmental determinants, and corresponding translational solutions (77–80).
T217	36209-36387	Sentence	denotes	As one example, the 2015 DGAC concluded that the current body of evidence on the links between access to retail food outlets and dietary intake was limited and inconsistent (81).
T218	36388-36460	Sentence	denotes	Our national nutrition challenges also diminish military readiness (82).
T219	36461-36570	Sentence	denotes	For much of human history, governments have prioritized nutrition to enable a high-performing, able military.
T220	36571-36843	Sentence	denotes	During World War II, for example, recognition of the national security threat of undernutrition produced strong federal actions, such as creation of the first RDAs by President Franklin D Roosevelt in 1941 and of the National School Lunch Program by Congress in 1945 (83).
T221	36844-36897	Sentence	denotes	Today, we face very different nutritional challenges:
T222	36898-37042	Sentence	denotes	71% of young people between the ages of 17 and 24 do not qualify for military service, with obesity being the leading medical disqualifier (25).
T223	37043-37063	Sentence	denotes	Since 2010, Mission:
T224	37064-37255	Sentence	denotes	Readiness—a group of >750 retired US generals, admirals and other top military leaders—has produced several reports documenting the national security threat of childhood obesity (25, 84, 85).
T225	37256-37447	Sentence	denotes	In addition, obesity and other diet-related chronic diseases are common among veterans, with more than one-third of veterans seen at the Veterans Health Administration (VHA) being obese (86).
T226	37448-37577	Sentence	denotes	Food insecurity is common among veterans seen at the VHA and is associated with suboptimal control of medical conditions (87–89).
T227	37578-37682	Sentence	denotes	Both obesity and food insecurity are common and often coexist in active-duty military families (90, 91).
T228	37683-37810	Sentence	denotes	Overall, diet-related illnesses are harming the readiness of US military forces and the budgets of the DoD and VA (86, 92, 93).
T229	37811-37987	Sentence	denotes	A more robust understanding of nutrition is a top DoD priority to maximize the performance of active-duty forces and their recovery from physical and psychologic injuries (11).
T230	37988-38115	Sentence	denotes	Our food systems are creating challenges to our climate and natural resources with widespread related health consequences (94).
T231	38116-38337	Sentence	denotes	Emerging science is advancing the understanding of how nutrition security—access to affordable, sufficient, safe, and nutritious food—is interrelated with challenges and opportunities in use of natural resources (11, 94).
T232	38338-38535	Sentence	denotes	While federal nutrition research and coordination is the focus of this white paper, we recognize that nutrition research and agricultural and food systems research are mutually interdependent (95).
T233	38536-38712	Sentence	denotes	Ongoing market forces, food production, and consumption patterns, among other factors, are creating not only poor health but large and unsustainable environmental impacts (96).
T234	38713-38848	Sentence	denotes	On a global scale, one-quarter of greenhouse gases, 70% of water use, and 90% of tropical deforestation are related to food production.
T235	38849-38956	Sentence	denotes	Climate change is warming the planet, contributing to lower crop yields and new economic risks for farmers.
T236	38957-39129	Sentence	denotes	These issues and corresponding potential solutions are complex: for example, greenhouse gas emissions have global impact, while water use has more regional impact (97–101).
T237	39130-39271	Sentence	denotes	Food waste worsens resource losses, with at least one-third of food produced in the US wasted during post-harvest, and consumer losses (102).
T238	39272-39439	Sentence	denotes	The future productivity of US agriculture faces additional growing environmental challenges such as resource scarcity, loss of biodiversity, and soil degradation (96).
T239	39440-39685	Sentence	denotes	These sustainability issues have direct relevance for human health, increasing the risk of infectious diseases, respiratory illness, allergies, cardiovascular diseases, food- and waterborne illness, undernutrition, and mental illness (103, 104).
T240	39686-39887	Sentence	denotes	Addressing all of these nutrition-related health, equity, societal, and economic burdens requires advancing science to better understand their biological, individual, social, and environmental drivers.
T241	39888-40030	Sentence	denotes	Current scientific knowledge, however, remains insufficient to address the mechanistic determinants and solutions of these complex challenges.
T242	40032-40080	Sentence	denotes	The Current Federal Nutrition Research Landscape
T243	40081-40298	Sentence	denotes	The federal government is the largest supporter of US nutrition research, with a diverse federal nutrition research infrastructure that generates critically important research and surveillance across a range of areas.
T244	40299-40496	Sentence	denotes	A new federal research investment and coordination structure must leverage, harmonize, and catalyze—not diminish or replace—these efforts being led across multiple federal departments and agencies.
T245	40497-40596	Sentence	denotes	No current or complete accounting of all federal nutrition research funding is available (12, 105).
T246	40597-40779	Sentence	denotes	For this work, we obtained and collated information on the largest departments and agencies focused on nutrition research, and their current estimated spending on nutrition research.
T247	40780-40850	Sentence	denotes	These findings are presented in Table 1, and summarized further below.
T248	40851-40931	Sentence	denotes	The NIH and USDA are by far the 2 largest funders of federal nutrition research.
T249	40932-41112	Sentence	denotes	As recently described (12), NIH and USDA negotiated how to share priorities for nutrition science after the 1978 Congressional report on Nutrition Research Alternatives (106, 107).
T250	41113-41371	Sentence	denotes	The Secretaries of HHS and USDA agreed that NIH would take the lead on research related to the biomedical aspects of nutrition (e.g., diagnosing and treating diseases), while USDA would be responsible for research on healthy diets for the general population.
T251	41372-41518	Sentence	denotes	In addition to NIH and USDA, many other departments and agencies conduct or utilize nutrition research (11), as described in further detail below.
T252	41519-41618	Sentence	denotes	TABLE 1 Current federal nutrition research agencies and departments participating in the US ICHNR1
T253	41619-41773	Sentence	denotes	Department or agency (department) Legislative authorities and appropriations Description Estimated annual expenditures on nutrition research,2 millions
T254	41774-42146	Sentence	denotes	National Institutes of Health (HHS) Labor, Health and Human Services, and Education, and related agencies Supports biomedical research, training, and infrastructure in nutrition to improve health and this work is carried out by investigators in research organizations and settings throughout the country, primarily in universities and biomedical research centers $19003
T255	42147-42713	Sentence	denotes	Agricultural Research Service (USDA) Agriculture, Rural Development, FDA, and related agencies Works to advance human nutrition research in a variety of ways, drawing from a number of its national programs, including the Human Nutrition National Program that works to: (1) link agricultural practices and beneficial health outcomes; (2) monitor food composition and nutrient intake of the nation; (3) determine the scientific basis for dietary guidance; (4) prevent obesity and obesity-related diseases; and (5) understand life-stage nutrition and metabolism $884
T256	42714-43099	Sentence	denotes	National Institute of Food and Agriculture (USDA) Agriculture, Rural Development, FDA, and related agencies Invests in and advances agricultural research, education, and extension and through its food, nutrition, and health programs works to strengthen the nation's capacity to address issues related to diet, health, food safety, food security, and food science and technology $425
T257	43100-43629	Sentence	denotes	Food and Nutrition Service (USDA) Agriculture, Rural Development, FDA, and related agencies Conducts research and makes use of the nutrition research sponsored by other federal agencies to help assess and improve the 15 FNS programs and conducts secondary research such as systematic reviews and policy-related research to develop and disseminate the latest edition of the dietary guidelines every five years, including development of USDA Food Patterns, Healthy Eating Index, USDA Food Plans, and communications research $416
T258	43630-43902	Sentence	denotes	CDC (HHS) Labor, Health and Human Services, and Education, and related Agencies Addresses nutritional issues related to population health through surveillance, intramural and extramural research, the translation of research into practice, and program implementation $97
T259	43903-44592	Sentence	denotes	FDA (HHS) Agriculture, Rural Development, FDA, and related agencies Depends on nutrition research to inform its many regulatory and other activities on food labeling, oversight of food additives and constituents of foods, nutrition education activities, and other nutrition-related work; and conducts its own research activities including consumer studies to support nutrition labeling and claims, assessments of constituents of the food supply, development of methods for analyzing food constituents, surveys on health, analyses of dietary intake, monitoring of adverse events from dietary foods and supplements, and cost/benefit analyses of various nutrition regulatory activities $88
T260	44593-44772	Sentence	denotes	Department of Defense Defense Develops, implements, and evaluates effective nutritional strategies to optimize performance before, during, and after training and operations $59
T261	44773-45235	Sentence	denotes	Agency for International Development State, Foreign Operations, and related programs Adopts, adapts, modifies, and increases the information, evidence, practices, and technologies of US institutions in human nutrition to be applicable to USAID target populations in developing countries to: improve food security and nutrient adequacies; increase access to safe water; and reduce infectious diseases, environmental toxins, poor sanitation, and parasitism $410
T262	45236-45618	Sentence	denotes	Economic Research Service (USDA) Agriculture, Rural Development, FDA, and related agencies Conducts and supports studies examining the actions of and interactions among consumers, food industry, and government as they relate to food supply and access; food choice and its impact on diet quality; and federal nutrition assistance, regulation, and other aspects of food policy NA11
T263	45619-45925	Sentence	denotes	Department of Commerce Commerce, Justice, Science, and related agencies National Institute of Standards and Technology (NIST) provides food-matrix Standard Reference Materials (SRMs) for the determination of trace element content, including both nutrient elements (minerals) and toxic metal contaminants.
T264	45926-46064	Sentence	denotes	National Oceanic and Atmospheric Administration (NOAA) contributes to advancing human nutrition research through its work on seafood NA12
T265	46065-46364	Sentence	denotes	National Aeronautics and Space Administration Commerce, Justice, Science, and related agencies Conducts life sciences research in space flight on the International Space Station (ISS) and in ground-based analogs of space flight (e.g., extended bed rest, Antarctic winters, undersea habitats) NA13
T266	46365-46491	Sentence	denotes	Federal Trade Commission Financial Services Relevant work and interest primarily focuses on food marketing to children NA14
T267	46492-46641	Sentence	denotes	Environmental Protection Agency Interior, Environment, and related agencies Conducts risk assessments regarding dietary exposure of chemicals NA15
T268	46642-47177	Sentence	denotes	Health Resources and Services Administration (HHS) Labor, Health and Human Services, and Education, and related agencies Provides health care to people who are geographically isolated, economically or medically vulnerable, including people living with HIV/AIDS, women who are pregnant, mothers and their families, and those in need of high-quality primary health care, and supports the training of health professionals, the distribution of providers to areas where they are needed most, and improvements in health care delivery NA16
T269	47178-47200	Sentence	denotes	Total, millions $2005
T270	47201-47374	Sentence	denotes	1 HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; NA, not available; USAID, US Agency for International Development.
T271	47375-47584	Sentence	denotes	2 There is no annual budget reporting for federal nutrition research and related activities so the footnotes indicate the activities and, where possible, the fiscal year associated with the estimate provided.
T272	47585-47687	Sentence	denotes	3 The National Institute of Diabetes and Digestive and Kidney Diseases, Office of Nutrition Research.
T273	47688-47722	Sentence	denotes	NIH Nutrition Research Task Force.
T274	47723-47778	Sentence	denotes	Estimated Nutrition Research Funding, Fiscal Year 2019.
T275	47779-47922	Sentence	denotes	Available at https://www.niddk.nih.gov/about-niddk/advisory-coordinating-committees/nih-nutrition-research-task-force (accessed 12 March 2020).
T276	47923-47984	Sentence	denotes	4 The 2019 President's Budget—Agricultural Research Service.
T277	47985-48068	Sentence	denotes	Available at https://www.obpa.usda.gov/18ars2019notes.pdf (accessed 19 March 2020).
T278	48069-48871	Sentence	denotes	5 Specific Agriculture and Food Research Initiative (AFRI) programs include Foundational and Applied Sciences [anticipated amount available for new grants in this fiscal year 2020 for this request for funding applications (RFAs) is ∼ $192.6 million], which includes 6 priority areas including the number 3 area, Food Safety Nutrition and Health, and the Nutrition program area priorities are Diet, Nutrition and the Prevention of Chronic Diseases and Food and Human Health; Sustainable Agricultural Systems (anticipated amount available for new grants in this fiscal year 2020 for this RFA is ∼$90 million); and Education and Workforce Development (anticipated amount available for new grants in fiscal year 2019 for this RFA is ∼$29.166 million and this fiscal year 2020 has not been determined yet).
T279	48872-49234	Sentence	denotes	Selected Higher Education Programs include Distance Education Grants Program for Institutions of Higher Education in Insular Areas (estimated total program funding: $800,000), Higher Education Challenge Grants (estimated total program funding: $4,500,000), and Hispanic-Serving Institutions Education Grants Program (estimated total program funding: $8,800,000).
T280	49235-49438	Sentence	denotes	The 2018 Farm Bill increased mandatory commitments to the Gus Schumacher Nutrition Incentive Program up to $250 million over 5 y and estimated total funding for fiscal year 2019 projects was $41 million.
T281	49439-49574	Sentence	denotes	In addition, the Community Food Projects Competitive Grant Program estimated total program funding in fiscal year 2019 was ∼$4,800,000.
T282	49575-49755	Sentence	denotes	Also relevant, the Women and Minorities in Science, Technology, Engineering, and Mathematics Fields Program (WAMS) estimated total program funding in fiscal year 2019 was $400,000.
T283	49756-50500	Sentence	denotes	There are other RFAs that solicit nutrition-relevant activities including work with the Expanded Food and Nutrition Education Program (EFNEP) (estimated total program funding in fiscal year 2019 was $68,440,680 to support program implementation by land-grant universities) and partnering with the USDA Food and Nutrition Service (FNS) on Supplemental Nutrition Assistance Program Education (SNAP-Ed) by facilitating communication among federal, state, and local partners and providing programmatic leadership to cooperative extension/land-grant university program implementers for effective nutrition education and obesity-prevention interventions through the land-grant system in conjunction with other implementing agencies and organizations.
T284	50501-50669	Sentence	denotes	The USDA National Institute of Food and Agriculture (NIFA) also supports a range of other career development and training programs relevant to human nutrition research.
T285	50670-51151	Sentence	denotes	6 For fiscal year 2020, overall FNS spending on federal nutrition assistance programs: $97.3 billion; estimated FNS spending on nutrition education and promotion: $1.2 billion [mostly Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)]; and estimated FNS spending on nutrition assistance-related research and analysis: $34 million [$14 million SNAP, $15 million Child Nutrition (CN), $5 million WIC].
T286	51152-51385	Sentence	denotes	For the Center for Nutrition Policy and Promotion (CNPP), an estimate of ∼$6.6 million in fiscal year 2020 for nutrition evidence reviews, committee support, and Dietary Guidelines for Americans (DGA)–related educational development.
T287	51386-51540	Sentence	denotes	Congress provided CNPP a one-time allocation of $12.3 million in the fiscal year 2019 appropriations bill to complete the 2020–2025 DGA over the next 3 y.
T288	51541-51775	Sentence	denotes	7 The CDC Division of Nutrition, Physical Activity, and Obesity (DNPAO) funds the Nutrition and Obesity Policy Research Network (NOPREN) at $300,000 each year, which is their only dedicated research project out of the Obesity Branch.
T289	51776-51970	Sentence	denotes	The Obesity Branch has 2 full-time employees (FTEs) dedicated to the epidemiology and surveillance of nutrition/obesity (e.g., fruits and vegetables, added sugars, water, food systems, obesity).
T290	51971-52207	Sentence	denotes	The CDC's Childhood Obesity Research Demonstration (CORD) Project 3.0 (2019–2024) is focused on childhood obesity weight-management program applied research and nutrition is a component but not considered traditional nutrition research.
T291	52208-52270	Sentence	denotes	Five grants were awarded with a total budget of $12.5 million.
T292	52271-52363	Sentence	denotes	The Infant Feeding Practices III (IFPS III) (2019–2026) study cost estimate is $3.4 million.
T293	52364-52421	Sentence	denotes	The Nutrition Branch has 1 FTE dedicated to the IFPS III.
T294	52422-52506	Sentence	denotes	Additional DNPAO funding goes towards other nutrition-relevant surveillance systems.
T295	52507-52703	Sentence	denotes	The CDC Division of Population Health School Health Branch addresses nutrition, physical activity, and chronic health conditions in the school setting through research and programmatic activities.
T296	52704-52784	Sentence	denotes	The following estimates reflect funds for nutrition-related research activities:
T297	52785-53092	Sentence	denotes	1) Contribution to the Youth Risk Behavior Surveillance System (YRBSS) and School Health Profiles, which is administrated by the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Adolescent and School Health: $18,500 per year (this is the portion for nutrition topics).
T298	53093-53225	Sentence	denotes	Also, 1.5 FTEs work on nutrition research including descriptive and analytic projects, research synthesis, and research translation.
T299	53226-53377	Sentence	denotes	The School Health Branch also supports program evaluation relevant to nutrition estimated at 0.5 FTE and $100,000 per year in 1801 evaluation contract.
T300	53378-53732	Sentence	denotes	There are other activities within the CDC's National Center for Chronic Disease Prevention and Health Promotion that are relevant to nutrition and these activities likely account for a 5% estimate of non-DNPAO Divisions’ budgets (see the US Department of Health and Human Services, CDC National Center for Chronic Disease Prevention and Health Promotion.
T301	53733-53839	Sentence	denotes	Available at https://www.cdc.gov/chronicdisease/programs-impact/budget/index.htm (accessed 27 April 2020).
T302	53840-53915	Sentence	denotes	The total costs to conduct the NHANES in fiscal year 2019 was ∼$40 million.
T303	53916-54106	Sentence	denotes	This does not include staff salaries or in-kind contributions for work such as laboratory processing or dietary data coding provided by other parts of the CDC or other agencies such as USDA.
T304	54107-54196	Sentence	denotes	This also does not include nutrition-related support for the NHANES from outside the CDC.
T305	54197-54293	Sentence	denotes	The nutrition-related NHANES activities attributable costs was ∼$8 million for fiscal year 2019.
T306	54294-54343	Sentence	denotes	8 The US Government Accountability Office (GAO).
T307	54344-54379	Sentence	denotes	Report to Congressional Requesters:
T308	54380-54406	Sentence	denotes	Food Safety and Nutrition.
T309	54407-54490	Sentence	denotes	FDA Can Build on Existing Efforts to Measure Progress and Implement Key Activities.
T310	54491-54502	Sentence	denotes	GAO-18–174.
T311	54503-54516	Sentence	denotes	January 2018.
T312	54517-54600	Sentence	denotes	Available at https://www.gao.gov/assets/690/689796.pdf (accessed 26 February 2020).
T313	54601-54756	Sentence	denotes	9 The largest resource for nutrition research is the Army, which received ∼$3.3 million in fiscal year 2020 for its intramural nutrition research program.
T314	54757-54916	Sentence	denotes	The Army nutrition research program also seeks extramural support, which varies from year to year but in fiscal year 2020 is estimated to receive $1.4 million.
T315	54917-55029	Sentence	denotes	The Uniformed Services University of Health Sciences is estimated to receive $750,000 per year for the next 3 y.
T316	55030-55177	Sentence	denotes	Other services, including the Air Force and Navy, conduct nutrition research, although budgets vary and may depend upon extramural funding sources.
T317	55178-55317	Sentence	denotes	10 The US Agency for International Development (USAID) Report to Congress on Health-Related Research and Development for Fiscal Year 2018.
T318	55318-55403	Sentence	denotes	Available at https://www.usaid.gov/open/reports-congress (accessed 27 February 2020).
T319	55404-55972	Sentence	denotes	11 USDA Economic Research Service (ERS) fiscal year 2019 budget was $87 million, which covered research led by 3 research divisions: market and trade economics, resource and rural economics, and food economics. The ERS does not have a more specific number for food, food security, and nutrition-relevant research. The Research Innovation and Development Grants in Economics (RIDGE) program was supported by USDA ERS and FNS; it awarded 8 grants in 2019 and will hold a conference to present findings from those awards in 2020 but has no further funding at this point.
T320	55973-56079	Sentence	denotes	The RIDGE program has funded >285 products at >100 educational and research institutions during 1998–2019.
T321	56080-56332	Sentence	denotes	USDA ERS and FNS have co-sponsored the National Household Food Acquisition and Purchase Survey (FoodAPS-1); research grants for analysis of FoodAPS-1, and methodological research to develop FoodAPS-2, as well as a number of data development activities.
T322	56333-56554	Sentence	denotes	Between 2013 and 2018, USDA FNS funded ∼50 cooperative research agreements and grants between the ERS researchers, university-based centers, and university-based researchers, tallying >$3 million provided through the ERS.
T323	56555-56726	Sentence	denotes	These agreements have covered wide ranging topics including food security, SNAP, WIC, School Meal Programs, promotion of healthier eating, and the food retail environment.
T324	56727-57056	Sentence	denotes	12 There is a specific internal budget for the production of Standard Reference Materials (SRMs), which includes but is not limited to the National Institute of Standards and Technology's (NIST's) food matrix items but there is not an exact estimate at this time for other nutrition research–relevant activities across the NIST.
T325	57057-57171	Sentence	denotes	Relevant program descriptions indicating staff support and activities are available on the NIST website (see NIST.
T326	57172-57229	Sentence	denotes	Measurements and Standards to Support Nutrition Labeling.
T327	57230-57361	Sentence	denotes	Available at https://www.nist.gov/programs-projects/measurements-and-standards-support-nutrition-labeling; accessed 27 April 2020).
T328	57362-57558	Sentence	denotes	There is no current budget estimate for the National Oceanic and Atmospheric Administration's (NOAA's) nutrition research relevant activities while current staff are actively engaged in this area.
T329	57559-57789	Sentence	denotes	13 The National Aeronautics and Space Administration's (NASA's) complete food capability roadmap is still under construction, and unfortunately it is not at liberty to share these budget details, but this is a high priority area.
T330	57790-57898	Sentence	denotes	14 The Federal Trade Commission (FTC) has not engaged in any research related to nutrition in recent years.
T331	57899-58070	Sentence	denotes	Since about 2010, Congress prohibited the FTC from completing the study they were conducting with FDA, CDC, and USDA on nutrition standards for food marketing to children.
T332	58071-58189	Sentence	denotes	15 There is no specific nutrition research budget as this work is mainly in-house analyses utilizing the NHANES data.
T333	58190-58443	Sentence	denotes	Other groups within the Environmental Protection Agency such as the Office of Research and Development and the Office of Air and Radiation also rely on the NHANES, but these data are freely available and NHANES is not contracted with the CDC to collect.
T334	58444-58643	Sentence	denotes	16 Nutrition is generally addressed in the context of larger initiatives, so it is not possible for the Health Resources and Services Administration (HRSA) to break out an accurate funding estimate.
T335	58644-58858	Sentence	denotes	In 2003, the Director of the White House Office of Science and Technology Policy (OSTP) estimated that federal investment for food-related (beyond nutrition alone) research and development was $2.5 billion/y (105).
T336	58859-59053	Sentence	denotes	A 2015 USDA report estimated that overall federal investment in nutrition research was $1.6 billion/y in 2009, increased from ∼$0.8 billion/y in 1985 (in constant 2007 dollars) (Figure 3) (108).
T337	59054-59170	Sentence	denotes	The increase occurred primarily at NIH, while nutrition funding at USDA declined in real dollars during this period.
T338	59171-59279	Sentence	denotes	However, total NIH research funding also doubled between fiscal year 1994 and 2003 (constant dollars) (109).
T339	59280-59507	Sentence	denotes	Thus, as a share of overall research expenditures, federal nutrition research spending remained generally flat, despite the dramatic increase in diet-related illnesses such as obesity and diabetes from 1980 to the present (12).
T340	59508-59667	Sentence	denotes	A limitation of all such estimates is the reliance on keyword searches of grant projects, which may incorporate funding only peripherally related to nutrition.
T341	59668-59830	Sentence	denotes	For example, funding for research identified as related to “obesity” increased nearly 4-fold between 1985 and 2009, and was counted as “nutrition” research (108).
T342	59831-59990	Sentence	denotes	FIGURE 3 Estimated overall federal expenditures for nutrition research, 1985–2009 (top panel) (108); and within NIH for fiscal year 2019 (bottom panel) (110).
T343	59991-60243	Sentence	denotes	The top panel is based on information provided by the DHHS (NIH, FDA, CDC), USDA, VA, USAID, DoD, DoC, NSF, and NASA using data from the NIH Human Nutrition Research Information Management system and the Biomedical Research and Development Price Index.
T344	60244-60428	Sentence	denotes	The bottom panel is based on data from all NIH institutes, centers, and offices (x axis) that provided funding for nutrition research in fiscal year 2019, listed in alphabetical order.
T345	60429-62016	Sentence	denotes	DHHS, Department of Health and Human Services; DoC, Department of Commerce; DoD, Department of Defense; FIC, Fogarty International Center; FY, fiscal year; NASA, National Aeronautics and Space Administration; NCATS, National Center for Advancing Translational Sciences; NCCIH, National Center for Complementary and Integrative Health; NCI, National Cancer Institute; NEI, National Eye Institute; NHGRI, National Human Genome Research Institute; NHLBI, National Heart, Lung, and Blood Institute; NIA, National Institute of Aging; NIAAA, National Institute on Alcohol Abuse and Alcoholism; NIAID, National Institute of Allergy and Infectious Diseases; NIAMS, National Institute of Arthritis and Musculoskeletal and Skin Diseases; NIBIB, National Institute of Biomedical Imaging and Bioengineering; NICHD, Eunice Kennedy Shriver National Institute of Child Health and Human Development; NIDA, National Institute on Drug Abuse; NIDCD, National Institute on Deafness and Other Communication Disorders; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIEHS, National Institute of Environmental Health Sciences; NIGMS, National Institute of General Medical Sciences; NIMH, National Institute of Mental Health; NIMHD, National Institute on Minority Health and Health Disparities; NINDS, National Institute of Neurological Disorders and Stroke; NINR, National Institute of Nursing Research; NLM, National Library of Medicine; NSF, National Science Foundation; OD, Office of the Director; USAID, US Agency for International Development; VA, Department of Veterans Affairs.
T346	62017-62122	Sentence	denotes	Reprinted with permission from the USDA Economic Research Service and NIDDK Office of Nutrition Research.
T347	62124-62127	Sentence	denotes	NIH
T348	62128-62241	Sentence	denotes	The NIH is the largest biomedical research agency in the world and largest funder of US nutrition research (110).
T349	62242-62691	Sentence	denotes	Important intramural and extramural nutrition research occurs across multiple institutes, centers, and offices, in particular the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Heart, Lung, and Blood Institute (NHLBI); National Cancer Institute (NCI); National Institute of Aging (NIA); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); and NIH Office of the Director (110).
T350	62692-62797	Sentence	denotes	These institutes focus on diseases or specific subsets of the population, rather than food and nutrition.
T351	62798-63157	Sentence	denotes	For example, NIDDK research efforts include diabetes and other endocrine and metabolic diseases; liver disease and other digestive diseases and conditions; nutritional disorders, such as inborn errors of metabolism; obesity; kidney diseases, such as polycystic kidney disease and glomerular disease; urologic diseases and conditions; and blood diseases (111).
T352	63158-63549	Sentence	denotes	The NHLBI aims to promote the prevention and treatment of heart, lung, and blood diseases, which includes strategic priorities around dietary assessment methodologies that combine objective dietary measures and biomarkers to help identify dietary patterns and food constituents that contribute to weight maintenance and to inform intervention strategies to lower cardiometabolic risks (112).
T353	63550-63757	Sentence	denotes	The NCI leads, conducts, and supports cancer research to advance scientific knowledge and help all people live longer, healthier lives, which includes efforts to advance dietary assessment methodology (113).
T354	63758-63988	Sentence	denotes	The NIA leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life, including building the understanding of the roles of nutrition, obesity, sleep, and metabolic status (114).
T355	63989-64108	Sentence	denotes	The NICHD aims to investigate human development through the entire life process, including the role of nutrition (115).
T356	64109-64415	Sentence	denotes	Within the NIH Office of the Director, as one example of several offices relevant to nutrition, the NIH Office of Dietary Supplements works to promote the scientific study of the benefits of dietary supplements in maintaining health and preventing chronic disease and other health-related conditions (116).
T357	64416-64643	Sentence	denotes	For fiscal year 2019, total NIH expenditures for nutrition research were estimated at $1.9 billion, supporting a total of ∼4600 active projects across at least 25 of the 27 NIH institutes, centers, and offices (Figure 3) (110).
T358	64644-64872	Sentence	denotes	NIH's investment in nutrition research has been estimated at 5% of total funding, a percentage that “has remained largely flat for at least three decades, and pales in comparison to many other areas of research” (Figure 4) (12).
T359	64873-65155	Sentence	denotes	A separate analysis of NIH-supported research grants and cooperative research projects between 2012 and 2017 found that only 16.7% of projects and 22.6% of funding supported investigations focused on primary prevention or secondary prevention (treatment) of disease in humans (117).
T360	65156-65221	Sentence	denotes	And, among this subset, only 7.8% included a focus on diet (118).
T361	65222-65418	Sentence	denotes	Thus, this careful analysis suggests that only 1.3% of all research projects supported by NIH in recent years focused on the role of diet in the prevention or treatment of disease in humans (119).
T362	65419-65740	Sentence	denotes	Another recent NIH analysis evaluated the leading risk factors and causes of death and disability in the US, compared with NIH funding on these factors, and concluded that large mismatches exist between the top causes of poor health versus research funding to address them, with the largest gap being for nutrition (120).
T363	65741-66141	Sentence	denotes	FIGURE 4 Trends in NIH investments in total nutrition research based on data from the NIH, Hathi Trust, and the Government Publishing Office (12) (top panel) and the 2020 NIH analysis of the percentage of NIH's prevention research projects focused on leading risk factors for death in the US compared with the percentage of deaths caused by these leading risk factors in the US (120) (bottom panel).
T364	66142-66251	Sentence	denotes	Top panel adapted from POLITICO Pro Datapoint (12), with graphic design support courtesy of Ink&Pixel Agency.
T365	66252-66519	Sentence	denotes	Over the years, NIH has aimed to coordinate the diverse nutrition science research being conducted or supported across the agency through a range of initiatives, including recent efforts to help accelerate the science of obesity research (Supplemental Table 3) (121).
T366	66520-66743	Sentence	denotes	In 1975, the NIH Nutrition Coordinating Committee (NCC) was established within the NIH Office of the Director to improve nutrition research coordination and communications within NIH and across the federal government (122).
T367	66744-66962	Sentence	denotes	In 1993, NCC was moved from the Office of the Director, the highest level of leadership within NIH, into one of the institutes, NIDDK, where NIH Division of Nutrition Research Coordination (DNRC) was established (123).
T368	66963-67032	Sentence	denotes	The DNRC comprised ∼10 full-time employees, more than half with PhDs.
T369	67033-67246	Sentence	denotes	In 2015, DNRC was disbanded and transitioned from an NIDDK Division into an NIDDK Office, the Office of Nutrition Research (ONR) (123) [within NIDDK, a lower organizational stature and size than a division (124)].
T370	67247-67319	Sentence	denotes	The ONR now comprises 2 PhD-level scientists and 3 other staffers (125).
T371	67320-67431	Sentence	denotes	The ONR hosts the renamed and slightly restructured NIH Nutrition Research Coordinating Committee (NRCC) (122).
T372	67432-67574	Sentence	denotes	In 2016, one of the main tasks of ONR was to develop the first overall NIH strategic plan to expand mission-specific nutrition research (123).
T373	67575-67771	Sentence	denotes	The NIH Nutrition Research Task Force was established later in 2016 to guide the development and implementation of the first NIH-wide strategic plan for nutrition research for the next 10 y (126).
T374	67772-67903	Sentence	denotes	A draft plan was released for public comment in the Fall of 2018—the original date the final plan was to be made public (127, 128).
T375	67904-67991	Sentence	denotes	The final 2020–2030 Strategic Plan for NIH Nutrition Research was released in May 2020.
T376	67992-68177	Sentence	denotes	Including several themes from the 2016 National Nutrition Research Roadmap (11) (see “ICHNR” section below), this first-of-its-kind NIH plan is organized around 4 strategic goals (129):
T377	68178-68238	Sentence	denotes	Spur discovery and innovation through foundational research:
T378	68239-68280	Sentence	denotes	What do we eat and how does it affect us?
T379	68281-68354	Sentence	denotes	Investigate the role of dietary patterns and behaviors in optimal health:
T380	68355-68383	Sentence	denotes	What and when should we eat?
T381	68384-68433	Sentence	denotes	Define the role of nutrition across the lifespan:
T382	68434-68490	Sentence	denotes	How does what we eat promote health across the lifespan?
T383	68491-68541	Sentence	denotes	Reduce the burden of disease in clinical settings:
T384	68542-68589	Sentence	denotes	How can we improve the use of food as medicine?
T385	68590-68833	Sentence	denotes	The NIH plan includes 5 cross-cutting areas: minority health and health disparities; health of women; rigor and reproducibility; data science, systems science, and artificial intelligence; and training the nutrition scientific workforce (130).
T386	68834-69396	Sentence	denotes	Examples of priority objectives in the 4 strategic areas include to investigate bioinformatic gaps in nutrition-related genes and pathways, diet-host-microbiome interrelationships, new tools for microbiome and precision nutrition research, mechanisms of interindividual variability in responses to food-based dietary patterns, influence of diet on infant developmental and health outcomes, the role of nutrition in older adults to promote healthy aging, and interactions between drugs, diseases, and nutrition to improve clinical care and outcomes, among others.
T387	69397-69555	Sentence	denotes	How new NIH funding streams, leadership, coordination structures, or other implementation strategies may help achieve these important goals were not detailed.
T388	69556-69817	Sentence	denotes	Also in May 2020, the trans-NIH Precision Nutrition Working Group of the NIH Common Fund, in collaboration with the NIH Nutrition Research Task Force, published a request for information on the challenges and opportunities in precision nutrition research (130).
T389	69818-70088	Sentence	denotes	The NIH Common Fund is planning a potential program in Precision Nutrition for fiscal year 2021 (131), potentially similar to other Common Fund–supported endeavors such as the All of US Research Program and the NIH Human Microbiome Project (see “Options” section below).
T390	70090-70094	Sentence	denotes	USDA
T391	70095-70288	Sentence	denotes	Starting in 1895, Dr. Wilbur Atwater's pioneering work at USDA laid much of the groundwork for modern nutrition science in the US as well as many current USDA nutrition research programs (132).
T392	70289-70424	Sentence	denotes	The USDA is the second largest federal funder of nutrition-relevant research, with activities across multiple agencies (Table 1) (133).
T393	70425-70741	Sentence	denotes	The Farm Bill requires the Secretary of USDA to establish and support food and human nutrition research as a distinct mission of the Department, including coordinating nutrition research within the Department and with agencies across the federal government, as well as using formalized mechanisms for external input.
T394	70742-70891	Sentence	denotes	The USDA also has a major focus on implementing federal nutrition programs to segments of the public, which constitute the majority of USDA's budget.
T395	70892-71236	Sentence	denotes	The importance of the nutrition assistance and associated nutrition education programs for improving food security and health and preventing disease in low-income populations creates a particularly important need to integrate and connect nutrition research from within and outside USDA to inform and guide policy development for these programs.
T396	71237-71500	Sentence	denotes	The agencies in USDA's Research, Education, and Economics (REE) mission area work to integrate research, analysis, and education to create a safe, sustainable, competitive US food and agricultural system and strong, healthy communities, families, and youth (134).
T397	71501-71601	Sentence	denotes	REE science agencies include the ARS, NIFA, ERS, and National Agricultural Statistics Service (135).
T398	71602-71881	Sentence	denotes	The ARS’ Human Nutrition Program emphasizes food-based approaches for health, including a core network of 6 internationally recognized Human Nutrition Research Centers with scientists, equipment, and facilities for long-term, multidisciplinary, translational research (136, 137).
T399	71882-72134	Sentence	denotes	NIFA supports postsecondary education at 113 land-grant colleges and universities (Public Law 37–130), as well as 21 historically black colleges and universities (Public Law 51–841) and 37 tribal colleges and universities (Public Law 89–329) (138–141).
T400	72135-72524	Sentence	denotes	While federal funding for these schools initially focused on agricultural research and extension, over time these schools have increasingly focused on human nutrition and food research and extension nutrition education, although the recent growth in research is largely through additional competitive grant mechanisms rather than direct NIFA support to the Agricultural Experiment Station.
T401	72525-72995	Sentence	denotes	NIFA further supports extramural nutrition research, often with a focus on integrating agricultural considerations with promotion of health and decreasing health disparities; this work includes funding projects aiming to identify environmental and behavioral factors that act as barriers to consumption of a high-quality diet, while identifying factors that promote healthy eating behaviors (e.g., increasing home access and availability of fruits and vegetables) (142).
T402	72996-73239	Sentence	denotes	The ERS’ food and nutrition research aims to study demographic, social, economic, and informational determinants of adequacy and healthfulness of the American diet, related health outcomes, and corresponding health care expenditures (11, 143).
T403	73240-73577	Sentence	denotes	This research includes examining interactions among consumers, food industry, and government as they relate to the food supply, markets, and access; food choice and its impact on diet quality; federal regulations and other aspects of food policy; and the USDA's nutrition assistance programs in meeting public policy and nutrition goals.
T404	73578-73693	Sentence	denotes	The Food and Nutrition Service (FNS) is the only agency of the Food, Nutrition, and Consumer Services mission area.
T405	73694-73903	Sentence	denotes	The FNS administers 15 domestic nutrition assistance programs, conducts some limited research, and makes use of nutrition research sponsored by other federal agencies to help assess and improve these programs.
T406	73904-74251	Sentence	denotes	And, as discussed in the cross-governmental section below, the USDA FNS Center for Nutrition Policy and Promotion (CNPP) conducts the evidence analysis for the DGAs, including nutrition evidence systematic reviews, data analysis, and food pattern modeling, and develops the corresponding consumer-facing education tools (e.g., MyPlate) (144, 145).
T407	74252-74390	Sentence	denotes	USDA investments in research and statistics, including nutrition, have fallen below 1980s levels in constant dollars (Figure 3) (12, 146).
T408	74391-74645	Sentence	denotes	Indeed, as a percentage of GDP, public investment in agrifood (agriculture and food combined) research and development (4.2%) and particularly food research and development (1%) was lower in 2018 than pharmaceutical research and development (4.9%) (147).
T409	74646-74764	Sentence	denotes	The US fell behind China in public agricultural research in 2009, and now only invests half the amount as China (148).
T410	74765-74970	Sentence	denotes	US public sector funding for agricultural research and development is also lower than India, Western Europe, and the Asia-Pacific region including Canada, using constant 2011 purchasing-power parity (148).
T411	74971-75083	Sentence	denotes	Yet, growth in productivity in the farm sector has come almost exclusively from science-based innovations (146).
T412	75084-75289	Sentence	denotes	Declines in US public funding for food and agriculture research and development “risks national competitiveness, long-term cutting-edge scientific discovery, and the next generation talent pipeline” (147).
T413	75290-75547	Sentence	denotes	Specific to nutrition, as one example, the ARS budget for human nutrition research and monitoring, including funding for 6 important extramural and intramural Human Nutrition Centers nationally, has been flat since 1980 in constant dollars (Figure 5) (132).
T414	75548-75780	Sentence	denotes	In addition, 2 USDA research and statistical agencies that include nutrition research—ERS and NIFA—were relocated to Kansas City, Missouri, at the start of fiscal year 2020 and lost 50% (ERS) and 71% (NIFA) of their workforce (149).
T415	75781-76119	Sentence	denotes	A recent Congressional Research Service analysis reported the leadership positions at NIFA and ERS have been staffed primarily by acting officials since the relocation and indicated that Congress may be interested in how NIFA and ERS are meeting their responsibilities with reduced workforces and as new staff are potentially hired (150).
T416	76120-76305	Sentence	denotes	These trends demonstrate declining investments in science to advance US food and agriculture to increase health, sustain our natural resources, and stimulate rural economic development.
T417	76306-76596	Sentence	denotes	FIGURE 5 Trends in USDA ARS investments for total nutrition research based on data from the USDA, Hathi Trust, and the Government Publishing Office (12) (top panel) and for human nutrition research and monitoring for fiscal years 1978–2010 based on data from the USDA (132) (bottom panel).
T418	76597-76785	Sentence	denotes	In the bottom panel, shaded bars represent absolute yearly funding (millions of dollars) and open bars represent funding adjusted to 1978 dollars (https://data.bls.gov/cgi-bin/cpicalc.pl).
T419	76786-76838	Sentence	denotes	ARS, Agricultural Research Service; FY, fiscal year.
T420	76839-76948	Sentence	denotes	Top panel adapted from POLITICO Pro Datapoint (12), with graphic design support courtesy of Ink&Pixel Agency.
T421	76949-77087	Sentence	denotes	The USDA has aimed to coordinate nutrition research within and outside the department in many different ways (Supplemental Table 4) (132).
T422	77088-77555	Sentence	denotes	The Food Security Act of 1985 (Public Law 99–198) required the Secretary of Agriculture to submit to Congress “a comprehensive plan for implementing a national nutrition research program, including recommendations relating to research directions, educational activities, and funding levels necessary to carry out such a plan.” This plan was submitted to Congress in 1986, but no new legislative mandates or change in mission resulted from this report (132, 151, 152).
T423	77556-77834	Sentence	denotes	In 1993, USDA revised its human nutrition program coordination structure and developed a Human Nutrition Policy Committee that reported to the Secretary's Policy Coordination Council and a USDA Human Nutrition Coordinating Committee (HNCC) that reported to the Policy Committee.
T424	77835-77913	Sentence	denotes	The Human Nutrition Policy Committee has not been active since the late 1990s.
T425	77914-78084	Sentence	denotes	HNCC is chaired by an ARS representative and vice-chaired by an FNS representative and includes members from a variety of USDA agencies with additional liaisons from HHS.
T426	78085-78143	Sentence	denotes	Over the last 2 decades, HNCC has generally met quarterly.
T427	78144-78293	Sentence	denotes	Each March, HNCC coordinates National Nutrition Month activities at USDA and functions as the steering committee for the website Nutrition.gov (153).
T428	78294-78741	Sentence	denotes	USDA Office of the Chief Scientist (OCS) was established by Congress in 2008 (Public Law 110–234) “to provide strategic coordination of the science that informs USDA's and the federal government's decisions, policies, and regulations that impact all aspects of US food and agriculture and related landscapes and communities.” (154) The OCS advises USDA's Chief Scientist and the Secretary of Agriculture in multiple areas, including the following:
T429	78742-79018	Sentence	denotes	Agricultural Systems and Technology; Animal Health and Production, and Animal Products; Plant Health and Production, and Plant Products; Renewable Energy, Natural Resources, and Environment; Food Safety, Nutrition, and Health; and Agricultural Economics and Rural Communities.
T430	79019-79162	Sentence	denotes	By statute, OCS is primarily staffed by detailed staff from other departments and agencies across the government for potentially up to 3 years.
T431	79163-79345	Sentence	denotes	In 2017, OCS hosted the first-of-its-kind USDA Intra-Departmental Nutrition Workshop Series and identified major gaps and needs to strengthen coordination of USDA nutrition research.
T432	79346-79762	Sentence	denotes	These gaps and needs included the following: assessing existing and potential new means of coordination and collaboration; developing new interdepartmental working groups and interest groups; identifying new and improved ways to enhance coordination with USDA food safety efforts; better utilizing the HNCC; and hosting overviews of USDA nutrition relevant databases and related data science trainings and resources.
T433	79763-79883	Sentence	denotes	The chair of this workshop series was detailed to OCS for 1 y and completed the detail a few months after this workshop.
T434	79884-79994	Sentence	denotes	A 2019 GAO report noted there are currently no plans for another intradepartmental meeting on nutrition (155).
T435	79995-80154	Sentence	denotes	In 2020, USDA put forth a new Science Blueprint for the next 5 y to help promote synergy across the department for prioritized objectives and strategies (156).
T436	80155-80888	Sentence	denotes	This Blueprint includes specific objectives in nutrition and health promotion, such as to develop and update the current evidence base to promote proper macro- and micronutrient intake among critical age groups or life stages, such as women who are pregnant or lactating, infants, children, adolescents, working-age adults, tribal members, and seniors; provide guidance and incentives to promote healthier eating patterns so that the US can reduce incidence of, and morbidity from, obesity and diet-related chronic diseases; promote food systems that reduce the prevalence and severity of food insecurity; and expand understanding about the impacts of USDA nutrition assistance programs on human health, communities, and the economy.
T437	80889-81294	Sentence	denotes	The USDA Science Blueprint has objectives related to infrastructure, innovation, and well-being: to develop and evaluate methods to increase access to low-cost and nutritious food as well as sustain efficient agriculture and bioeconomy systems in rural communities; and to evaluate alternative systems that may improve the quality, resiliency, and sustainability of food, fiber, forest, and fuel supplies.
T438	81295-82337	Sentence	denotes	The USDA also set forth objectives to work toward being a “beacon for science”: to encourage a global conversation and facilitate such discussion within decision-making bodies about literacy in agriculture, food, forestry, health, and science; advocate globally for the development of science-based, international and domestic standards, regulatory approaches, and policies, including those guiding the development of new and emerging technologies; develop an effective and diverse US agriculture workforce that contributes to safer, healthier, vibrant, sustainable, and innovative communities; enhance the capacities of USDA and other institutions in workforce development, with attention towards developing scientists and practitioners familiar with developing technologies and innovative practices; and develop and expand degree, certificate, curriculum, and youth programs that integrate science, technology, engineering, and mathematics (STEM) into instruction, considering real-world challenges relevant to agriculture and food science.
T439	82338-82481	Sentence	denotes	How new federal funding streams, leadership, or coordination structures may help achieve these laudable goals were not addressed in the report.
T440	82482-82721	Sentence	denotes	On 20 February 2020, the Secretary of Agriculture put forth a new Agriculture Innovation Agenda, a department-wide initiative to align resources, programs, and research to position American agriculture to better meet future global demands.
T441	82722-82869	Sentence	denotes	Benchmarks of success included reducing US food loss and waste by 50% by the year 2030 and reducing US nutrient loss in water by 30% by 2050 (157).
T442	82871-82931	Sentence	denotes	Nutrition research in other federal departments and agencies
T443	82932-83045	Sentence	denotes	In addition to NIH and USDA, many other departments and agencies conduct or utilize nutrition research (Table 1).
T444	83046-83252	Sentence	denotes	This section highlights summaries provided by 8 departments and agencies in the Topics of Interest section of the 2016 National Nutrition Research Roadmap, as well as any major developments since then (11).
T445	83253-83514	Sentence	denotes	The Roadmap explained each of the participating ICHNR department and agency's missions, roles and responsibilities, and mechanisms for supporting and/or using nutrition research; many include histories and contemporary overviews of research needs and interests.
T446	83515-83601	Sentence	denotes	The DoD, for example, focuses on nutrition's role in human performance and resilience.
T447	83602-83813	Sentence	denotes	At the US Army Natick Soldier Systems Center, DoD supports scientists and technologists conducting innovative research to develop foods and combat rations that are nutritious, palatable, and nonperishable (158).
T448	83814-84174	Sentence	denotes	In Natick, the Combat Feeding Directorate, a part of the Combat Capabilities Development Command of the US Army Futures Command, provides DoD with a joint-service program responsible for research, development, testing, and integration and engineering for materiel solutions such as combat rations, food service equipment technology, and combat feeding systems.
T449	84175-84443	Sentence	denotes	The Military Nutrition Division (MND) of the US Army Research Institute of Environmental Medicine, a part of the US Army Medical Research and Materiel Development Command, also of the US Army Futures Command is co-located in Natick with the Combat Feeding Directorate.
T450	84444-84808	Sentence	denotes	The MND conducts research that provides the biomedical science basis for warfighter nutritional requirements utilized for the development of rations, menus, policies and programs that enable warfighter health and performance, evaluates warfighter nutritional status, and examines interactions between nutrition, health, performance and the operational environment.
T451	84809-85251	Sentence	denotes	The Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences (DoD's health sciences university) conducts various nutrition-related research on the nutrition environment (Go For Green and the Military Nutrition Environment Assessment Tool) and tests strategies to mitigate the consequences of environmental and/or physiological stressors and sustain physical and cognitive performance.
T452	85252-85393	Sentence	denotes	CHAMP is also extensively involved in dietary supplement research—from beneficial ingredients to those that could compromise force readiness.
T453	85394-85498	Sentence	denotes	Both MND and CHAMP collaborate on projects whenever possible to maximize efficiencies and effectiveness.
T454	85499-85702	Sentence	denotes	NASA conducts nutrition research to understand the dietary requirements of space travelers and the role of nutrition in human adaptation to microgravity, each critical to crew safety and mission success.
T455	85703-85856	Sentence	denotes	The CDC addresses population nutrition through surveillance, intramural and extramural research, and translation of research into program implementation.
T456	85857-85994	Sentence	denotes	The FDA is responsible for protecting the public health by ensuring the safety of our nation's food supply, among other activities (159).
T457	85995-86099	Sentence	denotes	The FDA works to foster an environment to promote healthy and safe food choices through several actions.
T458	86100-86474	Sentence	denotes	This includes providing and supporting accurate and useful nutrition information and education to customers, monitoring and assessing emerging nutrition science and changes in the composition of foods in the marketplace in relation to the health status of Americans, and encouraging and facilitating new products and product reformulation to promote a healthier food supply.
T459	86475-86985	Sentence	denotes	To achieve this mission, FDA depends heavily on federal nutrition research from other departments and agencies and also conducts its own research activities, such as consumer studies to support nutrition labeling and claims, assessments of constituents of the food supply, development of methods for analyzing food constituents, surveys on health, analyses of dietary intake, monitoring of adverse events from dietary foods and supplements, and cost–benefit analyses of various nutrition regulatory activities.
T460	86986-87056	Sentence	denotes	The VA is home to the largest integrated health care system in the US.
T461	87057-87215	Sentence	denotes	Known as the VHA, this system includes ∼150 medical centers and 1400 community-based outpatient clinics, community living centers, Vet Centers, and domiciles.
T462	87216-87466	Sentence	denotes	The VHA Office of Research and Development supports a range of projects that relate to nutrition including The Million Veteran Program, which aims to build one of the largest databases of genetic, military exposure, lifestyle, and health information.
T463	87467-87719	Sentence	denotes	USAID adopts, adapts, modifies, and increases the information, evidence, practices, and technologies of US institutions in human nutrition to be applicable to USAID target populations in developing countries as a key plank of US diplomacy and security.
T464	87720-88068	Sentence	denotes	Demonstrating its increased prioritization of nutrition, USAID recently hired its first Chief Nutritionist, who aims to galvanize support for the December 2020 Nutrition for Growth Summit and secure commitments from partner countries, private sectors, and nongovernmental organizations to accelerate progress on improving nutrition worldwide (160).
T465	88069-88581	Sentence	denotes	There are a variety of other federal departments and agencies that are not a member of ICHNR that engage with and leverage nutrition research, such as, but not limited to, HHS Centers for Medicare and Medicaid Services (CMS), HHS Center for Medicare and Medicaid Innovation (CMMI), HHS Office of the Surgeon General, Federal Emergency Management Agency (FEMA), and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice.
T466	88583-88653	Sentence	denotes	Current Efforts for Cross-Governmental Nutrition Research Coordination
T467	88654-88822	Sentence	denotes	Given the diverse investments in nutrition research across separate federal departments and agencies, several initiatives have aimed to better coordinate these efforts.
T468	88823-88862	Sentence	denotes	Major initiatives are summarized below.
T469	88864-88869	Sentence	denotes	ICHNR
T470	88870-89015	Sentence	denotes	In 1977, Congress recognized the need and called for improved coordination of human nutrition research (Public Law 95–113) (Supplemental Text 1).
T471	89016-89213	Sentence	denotes	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).
T472	89214-89349	Sentence	denotes	This report found that federal nutrition research programs had failed to deal with the changing health problems of the American people.
T473	89350-89577	Sentence	denotes	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).
T474	89578-89885	Sentence	denotes	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).
T475	89886-89981	Sentence	denotes	In 1983, JSHNR completed its review and recommendations, leading to the formation of the ICHNR.
T476	89982-90412	Sentence	denotes	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).
T477	90413-90640	Sentence	denotes	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.
T478	90641-90729	Sentence	denotes	ICHNR includes representatives from multiple federal departments and agencies (Table 1).
T479	90730-90820	Sentence	denotes	After some early collaborative successes, ICHNR had a ≥10-y hiatus (Supplemental Table 5).
T480	90821-90926	Sentence	denotes	Reassembled in 2013, ICHNR recognized the need for a new effort to coordinate federal nutrition research.
T481	90927-91016	Sentence	denotes	This resulted in a new strategic plan, the National Nutrition Research Roadmap 2016–2021:
T482	91017-91081	Sentence	denotes	Advancing Nutrition Research to Improve and Sustain Health (11).
T483	91082-91124	Sentence	denotes	The Roadmap was framed around 3 questions:
T484	91125-91211	Sentence	denotes	How can we better understand and define eating patterns to improve and sustain health?
T485	91212-91275	Sentence	denotes	What can be done to help people choose healthy eating patterns?
T486	91276-91382	Sentence	denotes	How can we develop and engage innovative methods and systems to accelerate discoveries in human nutrition?
T487	91383-91827	Sentence	denotes	Across 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).
T488	91828-92030	Sentence	denotes	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.
T489	92031-92194	Sentence	denotes	Notably, the Roadmap did not include any data, findings, or recommendations on current or new nutrition research investment levels, leadership, or structures (11).
T490	92195-92445	Sentence	denotes	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.
T491	92446-92584	Sentence	denotes	This may be why a 2017 analysis found only early signs of implementation of the Roadmap among ICHNR member departments and agencies (163).
T492	92585-92784	Sentence	denotes	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).
T493	92785-92948	Sentence	denotes	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.
T494	92949-93049	Sentence	denotes	There are few other indicators of current use or monitoring of the Roadmap's aims or progress (164).
T495	93050-93259	Sentence	denotes	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.
T496	93260-93546	Sentence	denotes	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.
T497	93548-93603	Sentence	denotes	National food and nutrition monitoring and surveillance
T498	93604-93692	Sentence	denotes	National monitoring and surveillance are integral to nutrition research and translation.
T499	93693-93909	Sentence	denotes	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).
T500	93910-94218	Sentence	denotes	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).

T1

Sentence

denotes

Strengthening national nutrition research: rationale and options for a new coordinated federal research effort and authority

T2

126-134

Sentence

denotes

Abstract

T3

135-143

Sentence

denotes

ABSTRACT

T4

145-155

Sentence

denotes

Background

T5

156-210

Sentence

denotes

The US faces remarkable food and nutrition challenges.

T6

211-374

Sentence

denotes

A new federal effort to strengthen and coordinate nutrition research could rapidly generate the evidence base needed to address these multiple national challenges.

T7

375-451

Sentence

denotes

However, the relevant characteristics of such an effort have been uncertain.

T8

453-463

Sentence

denotes

Objectives

T9

464-1139

Sentence

denotes

Our aim was to provide an objective, informative summary of 1) the mounting diet-related health burdens facing our nation and corresponding economic, health equity, national security, and sustainability implications; 2) the current federal nutrition research landscape and existing mechanisms for its coordination; 3) the opportunities for and potential impact of new fundamental, clinical, public health, food and agricultural, and translational scientific discoveries; and 4) the various options for further strengthening and coordinating federal nutrition research, including corresponding advantages, disadvantages, and potential executive and legislative considerations.

T10

1141-1148

Sentence

denotes

Methods

T11

1149-1527

Sentence

denotes

We reviewed government and other published documents on federal nutrition research; held various discussions with expert groups, advocacy organizations, and scientific societies; and held in-person or phone meetings with >50 federal staff in executive and legislative roles, as well as with a variety of other stakeholders in academic, industry, and nongovernment organizations.

T12

1529-1536

Sentence

denotes

Results

T13

1537-1589

Sentence

denotes

Stark national nutrition challenges were identified.

T14

1590-1675

Sentence

denotes

More Americans are sick than are healthy, largely from rising diet-related illnesses.

T15

1676-1847

Sentence

denotes

These conditions create tremendous strains on productivity, health care costs, health disparities, government budgets, US economic competitiveness, and military readiness.

T16

1848-2140

Sentence

denotes

The coronavirus disease 2019 (COVID-19) outbreak has further laid bare these strains, including food insecurity, major diet-related comorbidities for poor outcomes from COVID-19 such as diabetes, hypertension, and obesity, and insufficient surveillance on and coordination of our food system.

T17

2141-2294

Sentence

denotes

More than 10 federal departments and agencies currently invest in critical nutrition research, yet with relatively flat investments over several decades.

T18

2295-2391

Sentence

denotes

Coordination also remains suboptimal, documented by multiple governmental reports over 50 years.

T19

2392-2633

Sentence

denotes

Greater harmonization and expansion of federal investment in nutrition science, not a silo-ing or rearrangement of existing investments, has tremendous potential to generate new discoveries to improve and sustain the health of all Americans.

T20

2634-2696

Sentence

denotes

Two identified key strategies to achieve this were as follows:

T21

2697-2914

Sentence

denotes

1) a new authority for robust cross-governmental coordination of nutrition research and other nutrition-related policy and 2) strengthened authority, investment, and coordination for nutrition research within the NIH.

T22

2915-3061

Sentence

denotes

These strategies were found to be complementary, together catalyzing important new science, partnerships, coordination, and returns on investment.

T23

3062-3164

Sentence

denotes

Additional complementary actions to accelerate federal nutrition research were identified at the USDA.

T24

3166-3177

Sentence

denotes

Conclusions

T25

3178-3488

Sentence

denotes

The need and opportunities for strengthened federal nutrition research are clear, with specific identified options to help create the new leadership, strategic planning, coordination, and investment the nation requires to address the multiple nutrition-related challenges and grasp the opportunities before us.

T26

3490-3507

Sentence

denotes

Executive Summary

T27

3509-3513

Sentence

denotes

Aims

T28

3514-3623

Sentence

denotes

This white paper aims to evaluate key issues relevant to federal nutrition research, including the following:

T29

3624-3759

Sentence

denotes

The mounting diet-related health burdens and corresponding economic, health equity, national security, and sustainability implications;

T30

3760-3862

Sentence

denotes

The current diverse federal nutrition research landscape and existing mechanisms for its coordination;

T31

3863-4025

Sentence

denotes

The opportunities for new nutrition-related discoveries in fundamental, clinical, public health, food and agricultural, and translational scientific research; and

T32

4026-4176

Sentence

denotes

The best strategies to further strengthen and coordinate federal nutrition research, including advantages, disadvantages, and potential paths forward.

T33

4177-4447

Sentence

denotes

This effort, informed by extensive background research and interviews, is intended to invite comment and discussion from all key stakeholders and help lay the foundation for accelerated scientific advances in nutrition to improve and sustain the health of all Americans.

T34

4449-4459

Sentence

denotes

The burden

T35

4460-4531

Sentence

denotes

Diet-related illnesses are the leading source of poor health in the US.

T36

4532-4660

Sentence

denotes

Nearly 3 in 4 American adults are overweight or obese, and 1 in 2 have diabetes or prediabetes—and these rates continue to rise.

T37

4661-4783

Sentence

denotes

Poor nutrition further contributes to cardiovascular diseases, several cancers, poor gut health, and many other disorders.

T38

4784-4955

Sentence

denotes

Beyond effects on health, these diet-related diseases create enormous strains on productivity, health care spending, health disparities, and military readiness (Figure 1).

T39

4956-5062

Sentence

denotes

Our food system also strains our natural resources, a crucial new area of intersecting science and policy.

T40

5063-5205

Sentence

denotes

FIGURE 1 Examples of identified diet-related burdens that could be addressed by more coordinated and strengthened federal nutrition research.

T41

5206-5241

Sentence

denotes

COVID-19, coronavirus disease 2019.

T42

5242-5294

Sentence

denotes

Graphic design support courtesy of Ink&Pixel Agency.

T43

5295-5470

Sentence

denotes

Profound disparities in both diet-related chronic diseases and food insecurity, for example, are experienced by low-income, rural, minority, and other underserved populations.

T44

5471-5590

Sentence

denotes

Nearly 3 in 4 young Americans do not qualify for military service, with obesity being the leading medical disqualifier.

T45

5591-5747

Sentence

denotes

Obesity and other diet-related chronic diseases are endemic among veterans, while obesity and food insecurity coexist in many active-duty military families.

T46

5748-5952

Sentence

denotes

Over just 50 y, federal health care spending has risen from 5% to 28% of the federal budget, while US business (inflation-adjusted) spending on health care has increased from $79 billion to $1180 billion.

T47

5953-6061

Sentence

denotes

Approximately 85% of current health care spending is related to management of diet-related chronic diseases.

T48

6062-6408

Sentence

denotes

Estimated US government expenditures on direct medical care for diabetes alone (∼$160 billion/y) exceeds the annual budgets of many individual federal departments and agencies, including, among others, the Departments of Education (DoE), Homeland Security (DHS), and Justice (DoJ) and the NIH, CDC, Environmental Protection Agency (EPA), and FDA.

T49

6409-6504

Sentence

denotes

These strains have been further exposed and exacerbated by coronavirus disease 2019 (COVID-19).

T50

6505-6794

Sentence

denotes

This includes, for example, challenges related to hunger and food insecurity, major diet-related comorbidities for poor outcomes from COVID-19, insufficient evidence on optimal population resilience through better nutrition, and inadequate surveillance and coordination of our food system.

T51

6795-7003

Sentence

denotes

Addressing each of these issues requires a better understanding of their multilevel, interrelated biological, individual, social, and environmental determinants, and the corresponding translational solutions.

T52

7004-7170

Sentence

denotes

However, the current scope and pace of nutritional knowledge and discovery are insufficient to address the fundamental nutrition-related challenges facing the nation.

T53

7172-7193

Sentence

denotes

The current landscape

T54

7194-7288

Sentence

denotes

More than 10 federal departments and agencies currently invest in critical nutrition research.

T55

7289-7462

Sentence

denotes

Their relative investments in nutrition research have remained flat or declined over several decades—even as diet-related conditions and their societal burdens have climbed.

T56

7463-7613

Sentence

denotes

The NIH is the largest funder, with nutrition research investments estimated at $1.9 billion annually (∼5% of total NIH funding) for fiscal year 2019.

T57

7614-7745

Sentence

denotes

Approximately 25% of this funding (1.3% of total NIH funding) focuses on diet for the prevention or treatment of disease in humans.

T58

7746-7864

Sentence

denotes

This NIH nutrition research is conducted and supported across nearly all of the 27 current NIH institutes and centers.

T59

7865-8010

Sentence

denotes

Coordination of these efforts has been challenged by successively smaller NIH coordinating offices with decreasing stature, staff, and resources.

T60

8011-8185

Sentence

denotes

The USDA is the second-largest funder of US nutrition research, with an estimated annual budget of ∼$0.17 billion for fiscal year 2019 across several institutes and services.

T61

8186-8473

Sentence

denotes

The USDA works to provide Americans with safe, nutritious, and wholesome food and works to ensure the foods and beverages our nation produces optimally benefits human and animal health and to address food insecurity through the administration of 15 federal nutrition assistance programs.

T62

8474-8699

Sentence

denotes

Several structures work to improve research coordination within the USDA, although a recent USDA workshop and Government Accountability Office (GAO) report identified gaps and opportunities in nutrition research coordination.

T63

8700-8982

Sentence

denotes

Multiple other federal departments and agencies invest in nutrition research, including the CDC, FDA, Department of Defense (DoD), US Agency for International Development (USAID), Department of Veterans Affairs (VA), National Aeronautics and Space Administration (NASA), and others.

T64

8983-9131

Sentence

denotes

Consistent with this fragmented infrastructure, multiple major reports over 50 y have called for greater coordination of federal nutrition research.

T65

9132-9564

Sentence

denotes

Current coordination efforts include the Interagency Committee on Human Nutrition Research (ICHNR), which currently meets about twice a year to work on the following activities, among others: food and nutrition monitoring and surveillance, the joint USDA–Department of Health and Human Services (-HHS) activity to produce the Dietary Guidelines for Americans (DGAs) and certain regulatory, communication, and educational activities.

T66

9565-9698

Sentence

denotes

However, no concrete authority has been created to successfully harmonize and leverage the federal investments in nutrition research.

T67

9699-10045

Sentence

denotes

Overall, this white paper and several prior reports found these efforts to be important but insufficient to address current and rising diet-related disease burdens, food insecurity, health disparities, health care costs, challenges to military readiness, and intersections with food and agricultural production, supply chains, and sustainability.

T68

10047-10062

Sentence

denotes

The opportunity

T69

10063-10191

Sentence

denotes

Several specific priority areas in nutrition research have been identified by various federal and nongovernmental organizations.

T70

10192-10241

Sentence

denotes

However, most have not been adequately addressed.

T71

10242-10376

Sentence

denotes

Greater federal coordination and investment in nutrition research could accelerate discoveries across these critical areas (Figure 2).

T72

10377-10469

Sentence

denotes

FIGURE 2 Opportunities for enhanced federal nutrition research coordination and investment.

T73

10470-10741

Sentence

denotes

DGAs, Dietary Guidelines for Americans; DoD, Department of Defense; NASA, National Aeronautics and Space Administration; SNAP-Ed, USDA Supplemental Nutrition Assistance Program Education; USAID, US Agency for International Development; VA, Department of Veterans Affairs.

T74

10742-10794

Sentence

denotes

Graphic design support courtesy of Ink&Pixel Agency.

T75

10795-10923

Sentence

denotes

Several lines of evidence support a strong return on investment (ROI) for an expanded and coordinated nutrition research effort.

T76

10924-11281

Sentence

denotes

As stated by the FDA Commissioner in 2018 at the National Food Policy Conference, “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.”

T77

11283-11294

Sentence

denotes

The options

T78

11295-11487

Sentence

denotes

Any new federal nutrition research investment and coordination structure must leverage, harmonize, and catalyze the existing efforts being led across multiple federal departments and agencies.

T79

11488-11539

Sentence

denotes

Two major complementary strategies were identified:

T80

11540-11757

Sentence

denotes

1) a new authority for robust cross-governmental coordination of nutrition research and other nutrition-related policy and 2) strengthened authority, investment, and coordination for nutrition research within the NIH.

T81

11758-11975

Sentence

denotes

Specific promising options to advance these 2 strategies were identified (Box 1); and for each option, potential advantages and disadvantages, executive and legislative considerations, and paths forward are discussed.

T82

11976-12204

Sentence

denotes

Improved coordination between federal departments and agencies conducting nutrition research was identified as having tremendous potential for accelerating essential basic, clinical, public health, and translational discoveries.

T83

12205-12360

Sentence

denotes

Increased authority, coordination, and funding for nutrition science within NIH was also identified as being essential for accelerating needed discoveries.

T84

12361-12536

Sentence

denotes

Appropriate efforts should leverage and amplify, not replace, compete with, or isolate existing nutrition research efforts across NIH, USDA, or other departments and agencies.

T85

12537-12721

Sentence

denotes

The cross-government strategy and within-NIH strategy were identified as complementary, with benefits accruing independently and further synergies to be gained by joint implementation.

T86

12722-12831

Sentence

denotes

Box 1 Promising cross-governmental and NIH options to strengthen and accelerate national nutrition research1

T87

12832-12918

Sentence

denotes

Cross-governmental A new Office of the National Director of Food and Nutrition (ONDFN)

T88

12919-12970

Sentence

denotes

A new US Global Nutrition Research Program (USGNRP)

T89

12971-13083

Sentence

denotes

A new Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP)

T90

13084-13133

Sentence

denotes

A new US Task Force on Federal Nutrition Research

T91

13134-13188

Sentence

denotes

Within NIH A new National Institute of Nutrition (NIN)

T92

13189-13240

Sentence

denotes

A new National Center for Nutrition Research (NCNR)

T93

13241-13327

Sentence

denotes

A return of the Office of Nutrition Research (ONR) into the NIH Office of the Director

T94

13328-13390

Sentence

denotes

Development of new trans-NIH initiatives in nutrition research

T95

13391-13509

Sentence

denotes

Within USDA Increased investment in nutrition research across the USDA Research, Education, and Economics mission area

T96

13510-13573

Sentence

denotes

Expanded USDA research to improve public guidance and education

T97

13574-13654

Sentence

denotes

Innovative USDA research to strengthen benefits of nutrition assistance programs

T98

13655-13858

Sentence

denotes

1 Additional relevant priorities to strengthen federal nutrition research within other departments and agencies, such as DoD, USAID, and FDA, were recognized and should be the subject of future reports.

T99

13860-13955

Sentence

denotes

Further complementary actions to accelerate federal nutrition research were identified at USDA.

T100

13956-14376

Sentence

denotes

First, to increase investment in nutrition research for the Agricultural Research Service (ARS) including its network of Human Nutrition Research Centers, the National Institute of Food and Agriculture (NIFA) extramural research programs, and the Economic Research Service (ERS) programs, which assesses demographic, social, informational, and economic determinants of dietary consumption and associated health outcomes.

T101

14377-14506

Sentence

denotes

Second, to expand USDA research that evaluates and improves major ongoing efforts for public guidance and education on nutrition.

T102

14507-14689

Sentence

denotes

And third, to build the robust evidence base and collaborations needed to strengthen the positive impacts of the ∼$100 billion/y federal investments in nutrition assistance programs.

T103

14691-14702

Sentence

denotes

Conclusions

T104

14703-14795

Sentence

denotes

This white paper identified many stark and growing national challenges related to nutrition.

T105

14796-14996

Sentence

denotes

Our research further documented a diversity of federal investments in nutrition research across departments and agencies, but with flat or declining funding and with suboptimal coordination authority.

T106

14997-15147

Sentence

denotes

The opportunities to be gained by greater coordination and investment in federal nutrition research are clear, with potential for large and rapid ROI.

T107

15148-15349

Sentence

denotes

This white paper identified and described 2 priority strategies, including 1) a new authority for cross-governmental coordination and 2) strengthened authority, investment, and coordination within NIH.

T108

15350-15411

Sentence

denotes

Additional important strategies were also identified at USDA.

T109

15412-15519

Sentence

denotes

All these strategies were found to be complementary, providing independent as well as synergistic benefits.

T110

15520-15765

Sentence

denotes

The identified specific options would help create the new leadership, strategic planning, coordination, and investment the nation requires to address the multiple nutrition-related challenges before us, and grasp the corresponding opportunities.

T111

15767-15779

Sentence

denotes

Introduction

T112

15780-15834

Sentence

denotes

The US faces remarkable food and nutrition challenges.

T113

15835-16025

Sentence

denotes

More Americans are sick than are healthy, with diet-related illnesses playing a major role including obesity, type 2 diabetes, cardiovascular diseases, cancers, food allergies, and more (1).

T114

16026-16129

Sentence

denotes

The incidence and prevalence of many of these conditions have increased dramatically in recent decades.

T115

16130-16378

Sentence

denotes

In addition to burdens on health and productivity, these diet-related diseases are creating tremendous strains on health care spending, health disparities, government budgets, economic competitiveness of American businesses, and military readiness.

T116

16379-16540

Sentence

denotes

Innovations in food and nutrition should improve human health while also preserving our natural resources, a crucial new area of intersecting science and policy.

T117

16541-16643

Sentence

denotes

Many of these strains in food and nutrition have been further exposed and exacerbated by COVID-19 (2).

T118

16644-17037

Sentence

denotes

This includes, for example, challenges related to hunger and food insecurity; major diet-related comorbidities for hospitalization and death from COVID-19 such as diabetes, obesity, and hypertension; insufficient evidence on optimal population resilience through better nutrition; and the need to further improve the surveillance on and coordination of food production and supply chains (3–9).

T119

17038-17283

Sentence

denotes

While advancing nutrition research has provided evidence to describe the general contours of healthy eating patterns, it has also highlighted many critical new, unanswered questions on food and nutrition and the national challenges we face (10).

T120

17284-17387

Sentence

denotes

Important nutrition research is currently being supported by >10 federal departments and agencies (11).

T121

17388-17528

Sentence

denotes

Yet, as diet-related conditions and their societal burdens have climbed in recent decades, funding for such research has remained flat (12).

T122

17529-17759

Sentence

denotes

In addition, no concrete action has emerged to successfully harmonize and leverage nutrition research across the government, despite consistent recommendations over at least 5 decades for a robust coordinating federal entity (13).

T123

17760-17961

Sentence

denotes

A major, new federal effort to strengthen and coordinate nutrition research could rapidly generate the necessary evidence base to address multiple national challenges, providing major benefits and ROI.

T124

17962-18078

Sentence

denotes

The aim of this white paper is to evaluate key issues relevant to such a scientific effort, including the following:

T125

18079-18236

Sentence

denotes

The mounting diet-related health burdens facing our nation and the corresponding economic, health equity, national security, and sustainability implications;

T126

18237-18410

Sentence

denotes

The current federal nutrition research landscape and existing mechanisms for its coordination among the diverse departments and agencies working to address these challenges;

T127

18411-18588

Sentence

denotes

The opportunities for and potential impact of new fundamental, clinical, public health, food and agricultural, and translational scientific discoveries related to nutrition; and

T128

18589-18794

Sentence

denotes

The best strategies to further strengthen and coordinate federal nutrition research, including relevant advantages, disadvantages, and potential executive and legislative considerations for a path forward.

T129

18795-19148

Sentence

denotes

This white paper is intended to invite comment and discussion from all stakeholders who care about strengthening nutrition research, whether to improve health, lower public and private health care spending, reduce disparities, promote business innovation, reinvigorate rural communities, preserve our national resources, or strengthen national security.

T130

19149-19206

Sentence

denotes

Key audiences for this white paper include the following:

T131

19207-19290

Sentence

denotes

Elected and appointed federal officials in both executive and legislative branches;

T132

19291-19351

Sentence

denotes

Federal science agency leaders and program and policy staff;

T133

19352-19380

Sentence

denotes

Federal military leadership;

T134

19381-19404

Sentence

denotes

The academic community;

T135

19405-19456

Sentence

denotes

Clinical and scientific professional organizations;

T136

19457-19483

Sentence

denotes

Nonprofit advocacy groups;

T137

19484-19525

Sentence

denotes

Allied health professional organizations;

T138

19526-19648

Sentence

denotes

US businesses whose efforts, employees, and competitiveness can be benefited by federally supported nutrition discoveries;

T139

19649-19711

Sentence

denotes

The media, who communicate key nutrition-related messages; and

T140

19712-19864

Sentence

denotes

The public who rely on and desperately need advances in federally supported nutrition research to help improve and sustain their health and communities.

T141

19865-19958

Sentence

denotes

This white paper was informed by extensive background research and stakeholder conversations.

T142

19959-20337

Sentence

denotes

This research included a review of government and other published documents on federal nutrition research; discussions with expert groups, advocacy organizations, and scientific societies; and in-person or phone meetings with >50 federal staff in executive and legislative roles, as well as with a variety of extramural researchers in academic and nongovernmental organizations.

T143

20338-20518

Sentence

denotes

The writing group reached out to all 10 departments and agencies participating in the ICHNR, particularly for assistance in estimating their relevant budget for nutrition research.

T144

20519-20621

Sentence

denotes

The legislative history for the NIH was independently collected by 2 team members with high agreement.

T145

20622-20847

Sentence

denotes

Legal experts at the Center for Health Law and Policy Innovation at Harvard Law School reviewed this white paper with special attention to the section on Options and the corresponding legislative and executive considerations.

T146

20848-21115

Sentence

denotes

We also reviewed feedback received through the American Society for Nutrition (ASN) request for member input regarding the concept of a National Institute of Nutrition and through a related panel session and Q&A at the ASN Nutrition 2019 annual scientific conference.

T147

21116-21674

Sentence

denotes

We also sought input from members of the Nutrition Action Alliance (NAA), a coalition of organizations working to advance federal nutrition research, nutrition education, and nutrition monitoring and surveillance, among other activities, and which includes ASN, Academy of Nutrition and Dietetics, American Society for Parenteral and Enteral Nutrition, Association of Nutrition Departments and Programs, Institute of Food Technologists, National Board of Physician Nutrition Specialists, Society for Nutrition Education and Behavior, and The Obesity Society.

T148

21675-22022

Sentence

denotes

The writing group used these document reviews, one-on-one conversations, stakeholder interviews, and additional discussions to maximize candid, confidential reflections following Chatham House Rules on the past and present state of federal nutrition research, the challenges and opportunities, and the best available strategies for moving forward.

T149

22023-22238

Sentence

denotes

We hope this white paper provides an objective, informative summary of the 1) burdens, 2) current federal nutrition research landscape, 3) opportunities, and 4) options for strengthening national nutrition research.

T150

22239-22424

Sentence

denotes

Ultimately, we hope it helps lay the foundation for accelerated advances in nutrition research to help improve and sustain the health of all children, adults, families, and communities.

T151

22426-22436

Sentence

denotes

The Burden

T152

22437-22671

Sentence

denotes

Poor nutrition is contributing to major increases in diet-related obesity and type 2 diabetes, as well as continuing high rates of other chronic diet-related diseases such as cardiovascular diseases, cancers, and other conditions (1).

T153

22672-22733

Sentence

denotes

Since the 1970s, Americans’ diets have changed significantly.

T154

22734-22860

Sentence

denotes

For example, both portion sizes and frequency of snacking have increased, with each linked to greater calorie intake (14, 15).

T155

22861-23033

Sentence

denotes

Among US children, substantial increases in daily calories since the 1970s are entirely attributable to increased foods eaten outside from home, mostly from fast food (16).

T156

23034-23318

Sentence

denotes

Consistent with prior health messaging to reduce total fat, the percentage of energy from carbohydrates increased from 42% to 48% of calories in men and 45% to 51% in women between 1971 and 2004, primarily due to higher consumption of starches, grains, and caloric beverages (17, 18).

T157

23319-23512

Sentence

denotes

Between 1977 and 1994, intake of processed breakfast cereals increased by 60%, intake of pizza by 115%, and intakes of snack foods like crackers, popcorn, pretzels, and corn chips by 200% (19).

T158

23513-23678

Sentence

denotes

Between 1965 and 2002, the intake of caloric beverages increased from 12% to 21% of all calories, representing an average increase of 222 calories/d per person (20).

T159

23679-23775

Sentence

denotes

This change was due to increased intake of sweetened fruit drinks, alcohol, and especially soda.

T160

23776-23870

Sentence

denotes

Over this time, the average portion size of a sugar-sweetened beverage increased by >50% (21).

T161

23871-24128

Sentence

denotes

In more recent years, with growing public awareness of the critical role of nutrition in overall health, some aspects of US diet quality have modestly improved, such as reductions in soda and small increases in whole grains, fruits, and nuts/seeds (22, 23).

T162

24129-24431

Sentence

denotes

Nevertheless, intakes of these and other healthful components remain far below dietary guidelines, with 45.6% of adults and 56.1% of children continuing to have poor-quality diets overall, and most of the remainder having intermediate-quality diets, with very few Americans having ideal diets (22, 23).

T163

24432-24574

Sentence

denotes

While less well documented by national surveillance data, the levels and types of food processing have substantially changed in the past 50 y.

T164

24575-24660

Sentence

denotes

Ultra-processed foods now contribute ∼60% of all calories in the US food supply (24).

T165

24661-24880

Sentence

denotes

These changes in our nutrition and corresponding diet-related illnesses are associated with rising health care costs, widening diet-related health disparities, and weakened national security and military readiness (25).

T166

24881-25059

Sentence

denotes

Between 1980 and 2018, the percentage of US children with obesity increased from 5.5% to 19.3%, whereas the percentage of adults with obesity increased from 15% to 42.4% (26–30).

T167

25060-25138

Sentence

denotes

Nearly 3 in 4 American adults are now either overweight or obese (26, 31, 32).

T168

25139-25348

Sentence

denotes

Across all preventable risk factors for disease in the US, poor diet is now the leading cause of poor health, associated with more than half a million deaths per year—or more than 40,000 deaths each month (1).

T169

25349-25465

Sentence

denotes

Along with suboptimal diet, adiposity and physical inactivity are shared risk factors for illness and death (33–37).

T170

25466-25650

Sentence

denotes

Over the last 20 y, the number of adults with diabetes has more than doubled (38), and today, >100 million Americans—nearly half of all adults—suffer from diabetes or prediabetes (39).

T171

25651-25748

Sentence

denotes

Cardiovascular disease afflicts ∼122 million Americans and causes ∼840,000 deaths each year (40).

T172

25749-25954

Sentence

denotes

Many of these diseases disproportionately affect older Americans, and as our nation's demographics shift toward an aging population, the burden of diet-related ailments on society will accelerate (41, 42).

T173

25955-26099

Sentence

denotes

In short, more Americans are sick or suffer from major medical conditions than are healthy, and much of this is related to diet-related illness.

T174

26100-26258

Sentence

denotes

Although the general contours of healthy eating patterns have been outlined by important advances in nutrition science, many questions remain unanswered (10).

T175

26259-26488

Sentence

denotes

Modern nutrition science is still evolving, with a rapidly growing but still relatively nascent repertoire of research methods, foundational science, and large-scale interventions to investigate and address diet-related diseases.

T176

26489-26645

Sentence

denotes

For most of the 20th century, the focus of nutrition research was on isolated vitamins and minerals and their role in clinical nutrient deficiency diseases.

T177

26646-27057

Sentence

denotes

This effort led to major accomplishments, such as documenting the role of individual nutrients in diseases such as pellagra (vitamin B-3 deficiency), rickets (vitamin D deficiency), and scurvy (vitamin C deficiency), among others, and then quickly mobilizing innovative technology such as fortification of staple foods, along with well-coordinated policy and programmatic responses, to address these conditions.

T178

27058-27336

Sentence

denotes

In comparison, the shift of nutrition science to focus more meaningfully on diet-related chronic diseases, such as heart disease, strokes, cancer, diabetes, obesity, brain health, and autoimmune and inflammatory diseases, is much more recent, largely begun only since the 1980s.

T179

27337-27395

Sentence

denotes

In this short period, important knowledge has been gained.

T180

27396-27570

Sentence

denotes

Yet, the investment and pace of progress have been insufficient to address the burgeoning rates of diet-related illness and the associated societal and economic consequences.

T181

27571-27860

Sentence

denotes

For example, in detailed reviews of available research by the 2015 Dietary Guidelines Advisory Committee (DGAC), numerous areas were identified as having only moderate, limited, or insufficient (not assignable) scientific evidence for making dietary recommendations (Supplemental Table 1).

T182

27861-28523

Sentence

denotes

These include, for instance, evidence that healthier dietary patterns favorably influence body weight or obesity in adults (moderate evidence) or children or adolescents (limited); reduce the risk of type 2 diabetes in adults (limited) or children (not assignable); or are associated with lower risk of colorectal (moderate), breast (moderate to limited), lung (limited), or prostate (not assignable) cancer; age-related cognitive impairment, dementia, or Alzheimer disease (limited); depression in adults (limited) or children, adolescents, or postpartum mothers (not assignable); or bone health in adults (limited) or children and adolescents (not assignable).

T183

28524-28910

Sentence

denotes

Considering specific individual foods and nutrients, the 2015 DGAC concluded that evidence is only moderate that coffee consumption is associated with reduced risk of type 2 diabetes, cardiovascular disease, or certain cancers and is limited for caffeine intake and lower risk of cognitive decline and Alzheimer disease or increased risk of miscarriage, stillbirth, or low birth weight.

T184

28911-29028

Sentence

denotes

The 2015 DGAC found limited evidence to address additives, such as aspartame and risk of cancers or preterm delivery.

T185

29029-29415

Sentence

denotes

Evidence was considered moderate for any specific sodium target (e.g., 2400 mg/d) for blood pressure control or risk of cardiovascular outcomes; limited or not assignable for potassium intake and these outcomes; moderate or limited for low-calorie sweeteners and body weight or diabetes; and limited for replacing saturated fat with monounsaturated fat for reducing cardiovascular risk.

T186

29416-29506

Sentence

denotes

The 2015 DGAC identified multiple specific areas of research needs (Supplemental Table 2).

T187

29507-30461

Sentence

denotes

Examples include the need to conduct research on 1) the dietary needs and intakes of older adults, whether polypharmacy plays a role in nutritional adequacy, and whether comorbidities, such as poor dentition, musculoskeletal difficulties, arthralgias, vision loss, and other age-related symptoms, affect their ability to establish and maintain proper nutritional status; 2) nutrition transitions from early childhood to adolescence to identify how and why diets change so rapidly during this period, the driving forces behind these changes, and effective programs to maintain positive nutrition habits established in young children; 3) the validity, reliability, and reproducibility of new biomarkers of nutritional status; 4) the effects of fortification strategies and supplement use on consumer behaviors and diets related to calcium, vitamin D, potassium, iron, and fiber; and 5) design approaches to quantify diets in large population-based studies.

T188

30462-30615

Sentence

denotes

Overall, advances in science have identified numerous new opportunities for research and pressing scientific questions that must be addressed (Figure 2).

T189

30616-31038

Sentence

denotes

These topics, discussed further in “The Opportunity” section below, include fundamental questions about foods and diet quality in relation to obesity, insulin resistance, diabetes, cancers, and other conditions; the interactions between diet, physical activity, the microbiome, and immunity and other key health defenses; and the health effects of various forms of food processing, additives, fermentation, and probiotics.

T190

31039-31412

Sentence

denotes

Other topics include personalization of nutrition based on each person's background, habits, genes, microbiome, medications, and existing diseases; how hunger and food security influence wellness and key approaches to address this interaction; the intersections of plant and animal breeding and farming practices with nutrition and sustainability; and many other questions.

T191

31413-31608

Sentence

denotes

Thus, we have learned much, but the present state of science remains far from offering a sufficient understanding of many crucial facets of food and nutrition fundamental to human health (43–47).

T192

31609-31822

Sentence

denotes

Scientific progress is being made, but at the current pace it may take many decades to meaningfully understand and reduce the prevalence and impact of the broad range of diet-related chronic diseases that we face.

T193

31823-31903

Sentence

denotes

The economic costs of nutrition-related diseases are staggering and ever rising.

T194

31904-32057

Sentence

denotes

As a share of our economy, total US health care expenditures have nearly tripled since 1970, from 6.9% to 17.9% of Gross Domestic Product (GDP) (48, 49).

T195

32058-32184

Sentence

denotes

These increases are harming government budgets, competitiveness of US businesses, workers’ wages, and livelihoods of families.

T196

32185-32334

Sentence

denotes

Federal health care spending has increased from 5% of the total federal budget in 1970 to 28% in 2018, reducing available funds for other priorities.

T197

32335-32462

Sentence

denotes

Similarly, average state government spending on health care has increased from 11.3% of state budgets in 1989 to 28.7% in 2016.

T198

32463-32621

Sentence

denotes

For US businesses, health care expenditures have increased 15-fold in 50 y, from $79 billion in 1970 to $1180 billion in 2017 (in constant 2017 dollars) (49).

T199

32622-32762

Sentence

denotes

Over this same period, annual per capita health care spending in the US has increased from $1797 to $10,739 (in constant 2017 dollars) (49).

T200

32763-32874

Sentence

denotes

And, ∼85% of total US health care expenditures are related to management of diet-related chronic diseases (50).

T201

32875-33105

Sentence

denotes

For example, the total direct health care and indirect economic costs of cardiovascular diseases are estimated at $316 billion/y; of diabetes, at $327 billion/y; and of all obesity-related conditions, at $1.72 trillion/y (51, 52).

T202

33106-33460

Sentence

denotes

These economic costs exceed the annual budget appropriations of most federal departments and agencies, such as (for fiscal year 2020) the budgets of the USDA ($150 billion) (53), DoE ($72 billion) (54), DHS ($51 billion) (55), DoJ ($33 billion) (56), NIH ($42 billion) (57), CDC ($12.7 billion) (58), EPA ($9.5 billion) (59), and FDA ($5.9 billion) (59).

T203

33461-33738

Sentence

denotes

Rising health care expenditures are straining government budgets and private business growth; limiting the ability to support other national, state, and business priorities; contributing to stagnating wages; and bankrupting individuals, families, and small businesses (60, 61).

T204

33739-33929

Sentence

denotes

Improving what Americans eat would have a significant impact on reducing diet-related chronic diseases, lowering health care spending, and creating new opportunities for innovation and jobs.

T205

33930-34183

Sentence

denotes

Although advancing science has elucidated the broad outlines of healthy eating patterns for making many general dietary and policy recommendations, numerous critical questions remain unanswered, with corresponding scientific debate and public confusion.

T206

34184-34384

Sentence

denotes

There is a large and growing appetite among American citizens for credible, rigorous nutritional science information, both for general health but also for treating many specific diseases and ailments.

T207

34385-34654

Sentence

denotes

Consumers are inundated with often conflicting information from multiple sources, including the internet, social media, television, marketing, and food and menu labeling, among others, making it difficult to discern trusted information for making informed choices (62).

T208

34655-34826

Sentence

denotes

Many American adults remain unaware of foundational federal guidance on nutrition (63, 64), and use the internet or other sources for seeking guidance on what to eat (65).

T209

34827-34883

Sentence

denotes

Poor nutrition also contributes to profound disparities.

T210

34884-35024

Sentence

denotes

Prior to COVID-19, food insecurity was a significant challenge for 1 in 8 Americans (66, 67), and is expected to more than double this year.

T211

35025-35134

Sentence

denotes

A total of 37 million Americans, including 11 million children, experienced food insecurity in 2018 (68, 69).

T212

35135-35313

Sentence

denotes

The dramatic increase in unemployment with COVID-19 is expected to cause food insecurity for an additional 18 million US children, bringing the total to 40% of all US youth (70).

T213

35314-35475

Sentence

denotes

Americans are also experiencing ever-widening disparities in diet quality and diet-related chronic diseases by race/ethnicity, education, and income (22, 71–75).

T214

35476-35703

Sentence

denotes

While social and economic factors such as lower education, poverty, bias, and reduced opportunities are major contributors to population disparities, they are likewise major barriers to healthy food access and proper nutrition.

T215

35704-35926

Sentence

denotes

Poor diets lead to a harsh cycle of lower academic achievement in school, lost productivity at work, increased chronic disease risk, increased out-of-pocket health costs, and poverty for the most vulnerable Americans (76).

T216

35927-36208

Sentence

denotes

Addressing these profound diet-related disparities experienced by rural, low-income, and minority populations requires a better understanding of their multilevel and interrelated individual, social, and environmental determinants, and corresponding translational solutions (77–80).

T217

36209-36387

Sentence

denotes

As one example, the 2015 DGAC concluded that the current body of evidence on the links between access to retail food outlets and dietary intake was limited and inconsistent (81).

T218

36388-36460

Sentence

denotes

Our national nutrition challenges also diminish military readiness (82).

T219

36461-36570

Sentence

denotes

For much of human history, governments have prioritized nutrition to enable a high-performing, able military.

T220

36571-36843

Sentence

denotes

During World War II, for example, recognition of the national security threat of undernutrition produced strong federal actions, such as creation of the first RDAs by President Franklin D Roosevelt in 1941 and of the National School Lunch Program by Congress in 1945 (83).

T221

36844-36897

Sentence

denotes

Today, we face very different nutritional challenges:

T222

36898-37042

Sentence

denotes

71% of young people between the ages of 17 and 24 do not qualify for military service, with obesity being the leading medical disqualifier (25).

T223

37043-37063

Sentence

denotes

Since 2010, Mission:

T224

37064-37255

Sentence

denotes

Readiness—a group of >750 retired US generals, admirals and other top military leaders—has produced several reports documenting the national security threat of childhood obesity (25, 84, 85).

T225

37256-37447

Sentence

denotes

In addition, obesity and other diet-related chronic diseases are common among veterans, with more than one-third of veterans seen at the Veterans Health Administration (VHA) being obese (86).

T226

37448-37577

Sentence

denotes

Food insecurity is common among veterans seen at the VHA and is associated with suboptimal control of medical conditions (87–89).

T227

37578-37682

Sentence

denotes

Both obesity and food insecurity are common and often coexist in active-duty military families (90, 91).

T228

37683-37810

Sentence

denotes

Overall, diet-related illnesses are harming the readiness of US military forces and the budgets of the DoD and VA (86, 92, 93).

T229

37811-37987

Sentence

denotes

A more robust understanding of nutrition is a top DoD priority to maximize the performance of active-duty forces and their recovery from physical and psychologic injuries (11).

T230

37988-38115

Sentence

denotes

Our food systems are creating challenges to our climate and natural resources with widespread related health consequences (94).

T231

38116-38337

Sentence

denotes

Emerging science is advancing the understanding of how nutrition security—access to affordable, sufficient, safe, and nutritious food—is interrelated with challenges and opportunities in use of natural resources (11, 94).

T232

38338-38535

Sentence

denotes

While federal nutrition research and coordination is the focus of this white paper, we recognize that nutrition research and agricultural and food systems research are mutually interdependent (95).

T233

38536-38712

Sentence

denotes

Ongoing market forces, food production, and consumption patterns, among other factors, are creating not only poor health but large and unsustainable environmental impacts (96).

T234

38713-38848

Sentence

denotes

On a global scale, one-quarter of greenhouse gases, 70% of water use, and 90% of tropical deforestation are related to food production.

T235

38849-38956

Sentence

denotes

Climate change is warming the planet, contributing to lower crop yields and new economic risks for farmers.

T236

38957-39129

Sentence

denotes

These issues and corresponding potential solutions are complex: for example, greenhouse gas emissions have global impact, while water use has more regional impact (97–101).

T237

39130-39271

Sentence

denotes

Food waste worsens resource losses, with at least one-third of food produced in the US wasted during post-harvest, and consumer losses (102).

T238

39272-39439

Sentence

denotes

The future productivity of US agriculture faces additional growing environmental challenges such as resource scarcity, loss of biodiversity, and soil degradation (96).

T239

39440-39685

Sentence

denotes

These sustainability issues have direct relevance for human health, increasing the risk of infectious diseases, respiratory illness, allergies, cardiovascular diseases, food- and waterborne illness, undernutrition, and mental illness (103, 104).

T240

39686-39887

Sentence

denotes

Addressing all of these nutrition-related health, equity, societal, and economic burdens requires advancing science to better understand their biological, individual, social, and environmental drivers.

T241

39888-40030

Sentence

denotes

Current scientific knowledge, however, remains insufficient to address the mechanistic determinants and solutions of these complex challenges.

T242

40032-40080

Sentence

denotes

The Current Federal Nutrition Research Landscape

T243

40081-40298

Sentence

denotes

The federal government is the largest supporter of US nutrition research, with a diverse federal nutrition research infrastructure that generates critically important research and surveillance across a range of areas.

T244

40299-40496

Sentence

denotes

A new federal research investment and coordination structure must leverage, harmonize, and catalyze—not diminish or replace—these efforts being led across multiple federal departments and agencies.

T245

40497-40596

Sentence

denotes

No current or complete accounting of all federal nutrition research funding is available (12, 105).

T246

40597-40779

Sentence

denotes

For this work, we obtained and collated information on the largest departments and agencies focused on nutrition research, and their current estimated spending on nutrition research.

T247

40780-40850

Sentence

denotes

These findings are presented in Table 1, and summarized further below.

T248

40851-40931

Sentence

denotes

The NIH and USDA are by far the 2 largest funders of federal nutrition research.

T249

40932-41112

Sentence

denotes

As recently described (12), NIH and USDA negotiated how to share priorities for nutrition science after the 1978 Congressional report on Nutrition Research Alternatives (106, 107).

T250

41113-41371

Sentence

denotes

The Secretaries of HHS and USDA agreed that NIH would take the lead on research related to the biomedical aspects of nutrition (e.g., diagnosing and treating diseases), while USDA would be responsible for research on healthy diets for the general population.

T251

41372-41518

Sentence

denotes

In addition to NIH and USDA, many other departments and agencies conduct or utilize nutrition research (11), as described in further detail below.

T252

41519-41618

Sentence

denotes

TABLE 1 Current federal nutrition research agencies and departments participating in the US ICHNR1

T253

41619-41773

Sentence

denotes

Department or agency (department) Legislative authorities and appropriations Description Estimated annual expenditures on nutrition research,2 millions

T254

41774-42146

Sentence

denotes

National Institutes of Health (HHS) Labor, Health and Human Services, and Education, and related agencies Supports biomedical research, training, and infrastructure in nutrition to improve health and this work is carried out by investigators in research organizations and settings throughout the country, primarily in universities and biomedical research centers $19003

T255

42147-42713

Sentence

denotes

Agricultural Research Service (USDA) Agriculture, Rural Development, FDA, and related agencies Works to advance human nutrition research in a variety of ways, drawing from a number of its national programs, including the Human Nutrition National Program that works to: (1) link agricultural practices and beneficial health outcomes; (2) monitor food composition and nutrient intake of the nation; (3) determine the scientific basis for dietary guidance; (4) prevent obesity and obesity-related diseases; and (5) understand life-stage nutrition and metabolism $884

T256

42714-43099

Sentence

denotes

National Institute of Food and Agriculture (USDA) Agriculture, Rural Development, FDA, and related agencies Invests in and advances agricultural research, education, and extension and through its food, nutrition, and health programs works to strengthen the nation's capacity to address issues related to diet, health, food safety, food security, and food science and technology $425

T257

43100-43629

Sentence

denotes

Food and Nutrition Service (USDA) Agriculture, Rural Development, FDA, and related agencies Conducts research and makes use of the nutrition research sponsored by other federal agencies to help assess and improve the 15 FNS programs and conducts secondary research such as systematic reviews and policy-related research to develop and disseminate the latest edition of the dietary guidelines every five years, including development of USDA Food Patterns, Healthy Eating Index, USDA Food Plans, and communications research $416

T258

43630-43902

Sentence

denotes

CDC (HHS) Labor, Health and Human Services, and Education, and related Agencies Addresses nutritional issues related to population health through surveillance, intramural and extramural research, the translation of research into practice, and program implementation $97

T259

43903-44592

Sentence

denotes

FDA (HHS) Agriculture, Rural Development, FDA, and related agencies Depends on nutrition research to inform its many regulatory and other activities on food labeling, oversight of food additives and constituents of foods, nutrition education activities, and other nutrition-related work; and conducts its own research activities including consumer studies to support nutrition labeling and claims, assessments of constituents of the food supply, development of methods for analyzing food constituents, surveys on health, analyses of dietary intake, monitoring of adverse events from dietary foods and supplements, and cost/benefit analyses of various nutrition regulatory activities $88

T260

44593-44772

Sentence

denotes

Department of Defense Defense Develops, implements, and evaluates effective nutritional strategies to optimize performance before, during, and after training and operations $59

T261

44773-45235

Sentence

denotes

Agency for International Development State, Foreign Operations, and related programs Adopts, adapts, modifies, and increases the information, evidence, practices, and technologies of US institutions in human nutrition to be applicable to USAID target populations in developing countries to: improve food security and nutrient adequacies; increase access to safe water; and reduce infectious diseases, environmental toxins, poor sanitation, and parasitism $410

T262

45236-45618

Sentence

denotes

Economic Research Service (USDA) Agriculture, Rural Development, FDA, and related agencies Conducts and supports studies examining the actions of and interactions among consumers, food industry, and government as they relate to food supply and access; food choice and its impact on diet quality; and federal nutrition assistance, regulation, and other aspects of food policy NA11

T263

45619-45925

Sentence

denotes

Department of Commerce Commerce, Justice, Science, and related agencies National Institute of Standards and Technology (NIST) provides food-matrix Standard Reference Materials (SRMs) for the determination of trace element content, including both nutrient elements (minerals) and toxic metal contaminants.

T264

45926-46064

Sentence

denotes

National Oceanic and Atmospheric Administration (NOAA) contributes to advancing human nutrition research through its work on seafood NA12

T265

46065-46364

Sentence

denotes

National Aeronautics and Space Administration Commerce, Justice, Science, and related agencies Conducts life sciences research in space flight on the International Space Station (ISS) and in ground-based analogs of space flight (e.g., extended bed rest, Antarctic winters, undersea habitats) NA13

T266

46365-46491

Sentence

denotes

Federal Trade Commission Financial Services Relevant work and interest primarily focuses on food marketing to children NA14

T267

46492-46641

Sentence

denotes

Environmental Protection Agency Interior, Environment, and related agencies Conducts risk assessments regarding dietary exposure of chemicals NA15

T268

46642-47177

Sentence

denotes

Health Resources and Services Administration (HHS) Labor, Health and Human Services, and Education, and related agencies Provides health care to people who are geographically isolated, economically or medically vulnerable, including people living with HIV/AIDS, women who are pregnant, mothers and their families, and those in need of high-quality primary health care, and supports the training of health professionals, the distribution of providers to areas where they are needed most, and improvements in health care delivery NA16

T269

47178-47200

Sentence

denotes

Total, millions $2005

T270

47201-47374

Sentence

denotes

1 HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; NA, not available; USAID, US Agency for International Development.

T271

47375-47584

Sentence

denotes

2 There is no annual budget reporting for federal nutrition research and related activities so the footnotes indicate the activities and, where possible, the fiscal year associated with the estimate provided.

T272

47585-47687

Sentence

denotes

3 The National Institute of Diabetes and Digestive and Kidney Diseases, Office of Nutrition Research.

T273

47688-47722

Sentence

denotes

NIH Nutrition Research Task Force.

T274

47723-47778

Sentence

denotes

Estimated Nutrition Research Funding, Fiscal Year 2019.

T275

47779-47922

Sentence

denotes

Available at https://www.niddk.nih.gov/about-niddk/advisory-coordinating-committees/nih-nutrition-research-task-force (accessed 12 March 2020).

T276

47923-47984

Sentence

denotes

4 The 2019 President's Budget—Agricultural Research Service.

T277

47985-48068

Sentence

denotes

Available at https://www.obpa.usda.gov/18ars2019notes.pdf (accessed 19 March 2020).

T278

48069-48871

Sentence

denotes

5 Specific Agriculture and Food Research Initiative (AFRI) programs include Foundational and Applied Sciences [anticipated amount available for new grants in this fiscal year 2020 for this request for funding applications (RFAs) is ∼ $192.6 million], which includes 6 priority areas including the number 3 area, Food Safety Nutrition and Health, and the Nutrition program area priorities are Diet, Nutrition and the Prevention of Chronic Diseases and Food and Human Health; Sustainable Agricultural Systems (anticipated amount available for new grants in this fiscal year 2020 for this RFA is ∼$90 million); and Education and Workforce Development (anticipated amount available for new grants in fiscal year 2019 for this RFA is ∼$29.166 million and this fiscal year 2020 has not been determined yet).

T279

48872-49234

Sentence

denotes

Selected Higher Education Programs include Distance Education Grants Program for Institutions of Higher Education in Insular Areas (estimated total program funding: $800,000), Higher Education Challenge Grants (estimated total program funding: $4,500,000), and Hispanic-Serving Institutions Education Grants Program (estimated total program funding: $8,800,000).

T280

49235-49438

Sentence

denotes

The 2018 Farm Bill increased mandatory commitments to the Gus Schumacher Nutrition Incentive Program up to $250 million over 5 y and estimated total funding for fiscal year 2019 projects was $41 million.

T281

49439-49574

Sentence

denotes

In addition, the Community Food Projects Competitive Grant Program estimated total program funding in fiscal year 2019 was ∼$4,800,000.

T282

49575-49755

Sentence

denotes

Also relevant, the Women and Minorities in Science, Technology, Engineering, and Mathematics Fields Program (WAMS) estimated total program funding in fiscal year 2019 was $400,000.

T283

49756-50500

Sentence

denotes

There are other RFAs that solicit nutrition-relevant activities including work with the Expanded Food and Nutrition Education Program (EFNEP) (estimated total program funding in fiscal year 2019 was $68,440,680 to support program implementation by land-grant universities) and partnering with the USDA Food and Nutrition Service (FNS) on Supplemental Nutrition Assistance Program Education (SNAP-Ed) by facilitating communication among federal, state, and local partners and providing programmatic leadership to cooperative extension/land-grant university program implementers for effective nutrition education and obesity-prevention interventions through the land-grant system in conjunction with other implementing agencies and organizations.

T284

50501-50669

Sentence

denotes

The USDA National Institute of Food and Agriculture (NIFA) also supports a range of other career development and training programs relevant to human nutrition research.

T285

50670-51151

Sentence

denotes

6 For fiscal year 2020, overall FNS spending on federal nutrition assistance programs: $97.3 billion; estimated FNS spending on nutrition education and promotion: $1.2 billion [mostly Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)]; and estimated FNS spending on nutrition assistance-related research and analysis: $34 million [$14 million SNAP, $15 million Child Nutrition (CN), $5 million WIC].

T286

51152-51385

Sentence

denotes

For the Center for Nutrition Policy and Promotion (CNPP), an estimate of ∼$6.6 million in fiscal year 2020 for nutrition evidence reviews, committee support, and Dietary Guidelines for Americans (DGA)–related educational development.

T287

51386-51540

Sentence

denotes

Congress provided CNPP a one-time allocation of $12.3 million in the fiscal year 2019 appropriations bill to complete the 2020–2025 DGA over the next 3 y.

T288

51541-51775

Sentence

denotes

7 The CDC Division of Nutrition, Physical Activity, and Obesity (DNPAO) funds the Nutrition and Obesity Policy Research Network (NOPREN) at $300,000 each year, which is their only dedicated research project out of the Obesity Branch.

T289

51776-51970

Sentence

denotes

The Obesity Branch has 2 full-time employees (FTEs) dedicated to the epidemiology and surveillance of nutrition/obesity (e.g., fruits and vegetables, added sugars, water, food systems, obesity).

T290

51971-52207

Sentence

denotes

The CDC's Childhood Obesity Research Demonstration (CORD) Project 3.0 (2019–2024) is focused on childhood obesity weight-management program applied research and nutrition is a component but not considered traditional nutrition research.

T291

52208-52270

Sentence

denotes

Five grants were awarded with a total budget of $12.5 million.

T292

52271-52363

Sentence

denotes

The Infant Feeding Practices III (IFPS III) (2019–2026) study cost estimate is $3.4 million.

T293

52364-52421

Sentence

denotes

The Nutrition Branch has 1 FTE dedicated to the IFPS III.

T294

52422-52506

Sentence

denotes

Additional DNPAO funding goes towards other nutrition-relevant surveillance systems.

T295

52507-52703

Sentence

denotes

The CDC Division of Population Health School Health Branch addresses nutrition, physical activity, and chronic health conditions in the school setting through research and programmatic activities.

T296

52704-52784

Sentence

denotes

The following estimates reflect funds for nutrition-related research activities:

T297

52785-53092

Sentence

denotes

1) Contribution to the Youth Risk Behavior Surveillance System (YRBSS) and School Health Profiles, which is administrated by the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of Adolescent and School Health: $18,500 per year (this is the portion for nutrition topics).

T298

53093-53225

Sentence

denotes

Also, 1.5 FTEs work on nutrition research including descriptive and analytic projects, research synthesis, and research translation.

T299

53226-53377

Sentence

denotes

The School Health Branch also supports program evaluation relevant to nutrition estimated at 0.5 FTE and $100,000 per year in 1801 evaluation contract.

T300

53378-53732

Sentence

denotes

There are other activities within the CDC's National Center for Chronic Disease Prevention and Health Promotion that are relevant to nutrition and these activities likely account for a 5% estimate of non-DNPAO Divisions’ budgets (see the US Department of Health and Human Services, CDC National Center for Chronic Disease Prevention and Health Promotion.

T301

53733-53839

Sentence

denotes

Available at https://www.cdc.gov/chronicdisease/programs-impact/budget/index.htm (accessed 27 April 2020).

T302

53840-53915

Sentence

denotes

The total costs to conduct the NHANES in fiscal year 2019 was ∼$40 million.

T303

53916-54106

Sentence

denotes

This does not include staff salaries or in-kind contributions for work such as laboratory processing or dietary data coding provided by other parts of the CDC or other agencies such as USDA.

T304

54107-54196

Sentence

denotes

This also does not include nutrition-related support for the NHANES from outside the CDC.

T305

54197-54293

Sentence

denotes

The nutrition-related NHANES activities attributable costs was ∼$8 million for fiscal year 2019.

T306

54294-54343

Sentence

denotes

8 The US Government Accountability Office (GAO).

T307

54344-54379

Sentence

denotes

Report to Congressional Requesters:

T308

54380-54406

Sentence

denotes

Food Safety and Nutrition.

T309

54407-54490

Sentence

denotes

FDA Can Build on Existing Efforts to Measure Progress and Implement Key Activities.

T310

54491-54502

Sentence

denotes

GAO-18–174.

T311

54503-54516

Sentence

denotes

January 2018.

T312

54517-54600

Sentence

denotes

Available at https://www.gao.gov/assets/690/689796.pdf (accessed 26 February 2020).

T313

54601-54756

Sentence

denotes

9 The largest resource for nutrition research is the Army, which received ∼$3.3 million in fiscal year 2020 for its intramural nutrition research program.

T314

54757-54916

Sentence

denotes

The Army nutrition research program also seeks extramural support, which varies from year to year but in fiscal year 2020 is estimated to receive $1.4 million.

T315

54917-55029

Sentence

denotes

The Uniformed Services University of Health Sciences is estimated to receive $750,000 per year for the next 3 y.

T316

55030-55177

Sentence

denotes

Other services, including the Air Force and Navy, conduct nutrition research, although budgets vary and may depend upon extramural funding sources.

T317

55178-55317

Sentence

denotes

10 The US Agency for International Development (USAID) Report to Congress on Health-Related Research and Development for Fiscal Year 2018.

T318

55318-55403

Sentence

denotes

Available at https://www.usaid.gov/open/reports-congress (accessed 27 February 2020).

T319

55404-55972

Sentence

denotes

11 USDA Economic Research Service (ERS) fiscal year 2019 budget was $87 million, which covered research led by 3 research divisions: market and trade economics, resource and rural economics, and food economics. The ERS does not have a more specific number for food, food security, and nutrition-relevant research. The Research Innovation and Development Grants in Economics (RIDGE) program was supported by USDA ERS and FNS; it awarded 8 grants in 2019 and will hold a conference to present findings from those awards in 2020 but has no further funding at this point.

T320

55973-56079

Sentence

denotes

The RIDGE program has funded >285 products at >100 educational and research institutions during 1998–2019.

T321

56080-56332

Sentence

denotes

USDA ERS and FNS have co-sponsored the National Household Food Acquisition and Purchase Survey (FoodAPS-1); research grants for analysis of FoodAPS-1, and methodological research to develop FoodAPS-2, as well as a number of data development activities.

T322

56333-56554

Sentence

denotes

Between 2013 and 2018, USDA FNS funded ∼50 cooperative research agreements and grants between the ERS researchers, university-based centers, and university-based researchers, tallying >$3 million provided through the ERS.

T323

56555-56726

Sentence

denotes

These agreements have covered wide ranging topics including food security, SNAP, WIC, School Meal Programs, promotion of healthier eating, and the food retail environment.

T324

56727-57056

Sentence

denotes

12 There is a specific internal budget for the production of Standard Reference Materials (SRMs), which includes but is not limited to the National Institute of Standards and Technology's (NIST's) food matrix items but there is not an exact estimate at this time for other nutrition research–relevant activities across the NIST.

T325

57057-57171

Sentence

denotes

Relevant program descriptions indicating staff support and activities are available on the NIST website (see NIST.

T326

57172-57229

Sentence

denotes

Measurements and Standards to Support Nutrition Labeling.

T327

57230-57361

Sentence

denotes

Available at https://www.nist.gov/programs-projects/measurements-and-standards-support-nutrition-labeling; accessed 27 April 2020).

T328

57362-57558

Sentence

denotes

There is no current budget estimate for the National Oceanic and Atmospheric Administration's (NOAA's) nutrition research relevant activities while current staff are actively engaged in this area.

T329

57559-57789

Sentence

denotes

13 The National Aeronautics and Space Administration's (NASA's) complete food capability roadmap is still under construction, and unfortunately it is not at liberty to share these budget details, but this is a high priority area.

T330

57790-57898

Sentence

denotes

14 The Federal Trade Commission (FTC) has not engaged in any research related to nutrition in recent years.

T331

57899-58070

Sentence

denotes

Since about 2010, Congress prohibited the FTC from completing the study they were conducting with FDA, CDC, and USDA on nutrition standards for food marketing to children.

T332

58071-58189

Sentence

denotes

15 There is no specific nutrition research budget as this work is mainly in-house analyses utilizing the NHANES data.

T333

58190-58443

Sentence

denotes

Other groups within the Environmental Protection Agency such as the Office of Research and Development and the Office of Air and Radiation also rely on the NHANES, but these data are freely available and NHANES is not contracted with the CDC to collect.

T334

58444-58643

Sentence

denotes

16 Nutrition is generally addressed in the context of larger initiatives, so it is not possible for the Health Resources and Services Administration (HRSA) to break out an accurate funding estimate.

T335

58644-58858

Sentence

denotes

In 2003, the Director of the White House Office of Science and Technology Policy (OSTP) estimated that federal investment for food-related (beyond nutrition alone) research and development was $2.5 billion/y (105).

T336

58859-59053

Sentence

denotes

A 2015 USDA report estimated that overall federal investment in nutrition research was $1.6 billion/y in 2009, increased from ∼$0.8 billion/y in 1985 (in constant 2007 dollars) (Figure 3) (108).

T337

59054-59170

Sentence

denotes

The increase occurred primarily at NIH, while nutrition funding at USDA declined in real dollars during this period.

T338

59171-59279

Sentence

denotes

However, total NIH research funding also doubled between fiscal year 1994 and 2003 (constant dollars) (109).

T339

59280-59507

Sentence

denotes

Thus, as a share of overall research expenditures, federal nutrition research spending remained generally flat, despite the dramatic increase in diet-related illnesses such as obesity and diabetes from 1980 to the present (12).

T340

59508-59667

Sentence

denotes

A limitation of all such estimates is the reliance on keyword searches of grant projects, which may incorporate funding only peripherally related to nutrition.

T341

59668-59830

Sentence

denotes

For example, funding for research identified as related to “obesity” increased nearly 4-fold between 1985 and 2009, and was counted as “nutrition” research (108).

T342

59831-59990

Sentence

denotes

FIGURE 3 Estimated overall federal expenditures for nutrition research, 1985–2009 (top panel) (108); and within NIH for fiscal year 2019 (bottom panel) (110).

T343

59991-60243

Sentence

denotes

The top panel is based on information provided by the DHHS (NIH, FDA, CDC), USDA, VA, USAID, DoD, DoC, NSF, and NASA using data from the NIH Human Nutrition Research Information Management system and the Biomedical Research and Development Price Index.

T344

60244-60428

Sentence

denotes

The bottom panel is based on data from all NIH institutes, centers, and offices (x axis) that provided funding for nutrition research in fiscal year 2019, listed in alphabetical order.

T345

60429-62016

Sentence

denotes

DHHS, Department of Health and Human Services; DoC, Department of Commerce; DoD, Department of Defense; FIC, Fogarty International Center; FY, fiscal year; NASA, National Aeronautics and Space Administration; NCATS, National Center for Advancing Translational Sciences; NCCIH, National Center for Complementary and Integrative Health; NCI, National Cancer Institute; NEI, National Eye Institute; NHGRI, National Human Genome Research Institute; NHLBI, National Heart, Lung, and Blood Institute; NIA, National Institute of Aging; NIAAA, National Institute on Alcohol Abuse and Alcoholism; NIAID, National Institute of Allergy and Infectious Diseases; NIAMS, National Institute of Arthritis and Musculoskeletal and Skin Diseases; NIBIB, National Institute of Biomedical Imaging and Bioengineering; NICHD, Eunice Kennedy Shriver National Institute of Child Health and Human Development; NIDA, National Institute on Drug Abuse; NIDCD, National Institute on Deafness and Other Communication Disorders; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NIEHS, National Institute of Environmental Health Sciences; NIGMS, National Institute of General Medical Sciences; NIMH, National Institute of Mental Health; NIMHD, National Institute on Minority Health and Health Disparities; NINDS, National Institute of Neurological Disorders and Stroke; NINR, National Institute of Nursing Research; NLM, National Library of Medicine; NSF, National Science Foundation; OD, Office of the Director; USAID, US Agency for International Development; VA, Department of Veterans Affairs.

T346

62017-62122

Sentence

denotes

Reprinted with permission from the USDA Economic Research Service and NIDDK Office of Nutrition Research.

T347

62124-62127

Sentence

denotes

NIH

T348

62128-62241

Sentence

denotes

The NIH is the largest biomedical research agency in the world and largest funder of US nutrition research (110).

T349

62242-62691

Sentence

denotes

Important intramural and extramural nutrition research occurs across multiple institutes, centers, and offices, in particular the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Heart, Lung, and Blood Institute (NHLBI); National Cancer Institute (NCI); National Institute of Aging (NIA); Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); and NIH Office of the Director (110).

T350

62692-62797

Sentence

denotes

These institutes focus on diseases or specific subsets of the population, rather than food and nutrition.

T351

62798-63157

Sentence

denotes

For example, NIDDK research efforts include diabetes and other endocrine and metabolic diseases; liver disease and other digestive diseases and conditions; nutritional disorders, such as inborn errors of metabolism; obesity; kidney diseases, such as polycystic kidney disease and glomerular disease; urologic diseases and conditions; and blood diseases (111).

T352

63158-63549

Sentence

denotes

The NHLBI aims to promote the prevention and treatment of heart, lung, and blood diseases, which includes strategic priorities around dietary assessment methodologies that combine objective dietary measures and biomarkers to help identify dietary patterns and food constituents that contribute to weight maintenance and to inform intervention strategies to lower cardiometabolic risks (112).

T353

63550-63757

Sentence

denotes

The NCI leads, conducts, and supports cancer research to advance scientific knowledge and help all people live longer, healthier lives, which includes efforts to advance dietary assessment methodology (113).

T354

63758-63988

Sentence

denotes

The NIA leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life, including building the understanding of the roles of nutrition, obesity, sleep, and metabolic status (114).

T355

63989-64108

Sentence

denotes

The NICHD aims to investigate human development through the entire life process, including the role of nutrition (115).

T356

64109-64415

Sentence

denotes

Within the NIH Office of the Director, as one example of several offices relevant to nutrition, the NIH Office of Dietary Supplements works to promote the scientific study of the benefits of dietary supplements in maintaining health and preventing chronic disease and other health-related conditions (116).

T357

64416-64643

Sentence

denotes

For fiscal year 2019, total NIH expenditures for nutrition research were estimated at $1.9 billion, supporting a total of ∼4600 active projects across at least 25 of the 27 NIH institutes, centers, and offices (Figure 3) (110).

T358

64644-64872

Sentence

denotes

NIH's investment in nutrition research has been estimated at 5% of total funding, a percentage that “has remained largely flat for at least three decades, and pales in comparison to many other areas of research” (Figure 4) (12).

T359

64873-65155

Sentence

denotes

A separate analysis of NIH-supported research grants and cooperative research projects between 2012 and 2017 found that only 16.7% of projects and 22.6% of funding supported investigations focused on primary prevention or secondary prevention (treatment) of disease in humans (117).

T360

65156-65221

Sentence

denotes

And, among this subset, only 7.8% included a focus on diet (118).

T361

65222-65418

Sentence

denotes

Thus, this careful analysis suggests that only 1.3% of all research projects supported by NIH in recent years focused on the role of diet in the prevention or treatment of disease in humans (119).

T362

65419-65740

Sentence

denotes

Another recent NIH analysis evaluated the leading risk factors and causes of death and disability in the US, compared with NIH funding on these factors, and concluded that large mismatches exist between the top causes of poor health versus research funding to address them, with the largest gap being for nutrition (120).

T363

65741-66141

Sentence

denotes

FIGURE 4 Trends in NIH investments in total nutrition research based on data from the NIH, Hathi Trust, and the Government Publishing Office (12) (top panel) and the 2020 NIH analysis of the percentage of NIH's prevention research projects focused on leading risk factors for death in the US compared with the percentage of deaths caused by these leading risk factors in the US (120) (bottom panel).

T364

66142-66251

Sentence

denotes

Top panel adapted from POLITICO Pro Datapoint (12), with graphic design support courtesy of Ink&Pixel Agency.

T365

66252-66519

Sentence

denotes

Over the years, NIH has aimed to coordinate the diverse nutrition science research being conducted or supported across the agency through a range of initiatives, including recent efforts to help accelerate the science of obesity research (Supplemental Table 3) (121).

T366

66520-66743

Sentence

denotes

In 1975, the NIH Nutrition Coordinating Committee (NCC) was established within the NIH Office of the Director to improve nutrition research coordination and communications within NIH and across the federal government (122).

T367

66744-66962

Sentence

denotes

In 1993, NCC was moved from the Office of the Director, the highest level of leadership within NIH, into one of the institutes, NIDDK, where NIH Division of Nutrition Research Coordination (DNRC) was established (123).

T368

66963-67032

Sentence

denotes

The DNRC comprised ∼10 full-time employees, more than half with PhDs.

T369

67033-67246

Sentence

denotes

In 2015, DNRC was disbanded and transitioned from an NIDDK Division into an NIDDK Office, the Office of Nutrition Research (ONR) (123) [within NIDDK, a lower organizational stature and size than a division (124)].

T370

67247-67319

Sentence

denotes

The ONR now comprises 2 PhD-level scientists and 3 other staffers (125).

T371

67320-67431

Sentence

denotes

The ONR hosts the renamed and slightly restructured NIH Nutrition Research Coordinating Committee (NRCC) (122).

T372

67432-67574

Sentence

denotes

In 2016, one of the main tasks of ONR was to develop the first overall NIH strategic plan to expand mission-specific nutrition research (123).

T373

67575-67771

Sentence

denotes

The NIH Nutrition Research Task Force was established later in 2016 to guide the development and implementation of the first NIH-wide strategic plan for nutrition research for the next 10 y (126).

T374

67772-67903

Sentence

denotes

A draft plan was released for public comment in the Fall of 2018—the original date the final plan was to be made public (127, 128).

T375

67904-67991

Sentence

denotes

The final 2020–2030 Strategic Plan for NIH Nutrition Research was released in May 2020.

T376

67992-68177

Sentence

denotes

Including several themes from the 2016 National Nutrition Research Roadmap (11) (see “ICHNR” section below), this first-of-its-kind NIH plan is organized around 4 strategic goals (129):

T377

68178-68238

Sentence

denotes

Spur discovery and innovation through foundational research:

T378

68239-68280

Sentence

denotes

What do we eat and how does it affect us?

T379

68281-68354

Sentence

denotes

Investigate the role of dietary patterns and behaviors in optimal health:

T380

68355-68383

Sentence

denotes

What and when should we eat?

T381

68384-68433

Sentence

denotes

Define the role of nutrition across the lifespan:

T382

68434-68490

Sentence

denotes

How does what we eat promote health across the lifespan?

T383

68491-68541

Sentence

denotes

Reduce the burden of disease in clinical settings:

T384

68542-68589

Sentence

denotes

How can we improve the use of food as medicine?

T385

68590-68833

Sentence

denotes

The NIH plan includes 5 cross-cutting areas: minority health and health disparities; health of women; rigor and reproducibility; data science, systems science, and artificial intelligence; and training the nutrition scientific workforce (130).

T386

68834-69396

Sentence

denotes

Examples of priority objectives in the 4 strategic areas include to investigate bioinformatic gaps in nutrition-related genes and pathways, diet-host-microbiome interrelationships, new tools for microbiome and precision nutrition research, mechanisms of interindividual variability in responses to food-based dietary patterns, influence of diet on infant developmental and health outcomes, the role of nutrition in older adults to promote healthy aging, and interactions between drugs, diseases, and nutrition to improve clinical care and outcomes, among others.

T387

69397-69555

Sentence

denotes

How new NIH funding streams, leadership, coordination structures, or other implementation strategies may help achieve these important goals were not detailed.

T388

69556-69817

Sentence

denotes

Also in May 2020, the trans-NIH Precision Nutrition Working Group of the NIH Common Fund, in collaboration with the NIH Nutrition Research Task Force, published a request for information on the challenges and opportunities in precision nutrition research (130).

T389

69818-70088

Sentence

denotes

The NIH Common Fund is planning a potential program in Precision Nutrition for fiscal year 2021 (131), potentially similar to other Common Fund–supported endeavors such as the All of US Research Program and the NIH Human Microbiome Project (see “Options” section below).

T390

70090-70094

Sentence

denotes

USDA

T391

70095-70288

Sentence

denotes

Starting in 1895, Dr. Wilbur Atwater's pioneering work at USDA laid much of the groundwork for modern nutrition science in the US as well as many current USDA nutrition research programs (132).

T392

70289-70424

Sentence

denotes

The USDA is the second largest federal funder of nutrition-relevant research, with activities across multiple agencies (Table 1) (133).

T393

70425-70741

Sentence

denotes

The Farm Bill requires the Secretary of USDA to establish and support food and human nutrition research as a distinct mission of the Department, including coordinating nutrition research within the Department and with agencies across the federal government, as well as using formalized mechanisms for external input.

T394

70742-70891

Sentence

denotes

The USDA also has a major focus on implementing federal nutrition programs to segments of the public, which constitute the majority of USDA's budget.

T395

70892-71236

Sentence

denotes

The importance of the nutrition assistance and associated nutrition education programs for improving food security and health and preventing disease in low-income populations creates a particularly important need to integrate and connect nutrition research from within and outside USDA to inform and guide policy development for these programs.

T396

71237-71500

Sentence

denotes

The agencies in USDA's Research, Education, and Economics (REE) mission area work to integrate research, analysis, and education to create a safe, sustainable, competitive US food and agricultural system and strong, healthy communities, families, and youth (134).

T397

71501-71601

Sentence

denotes

REE science agencies include the ARS, NIFA, ERS, and National Agricultural Statistics Service (135).

T398

71602-71881

Sentence

denotes

The ARS’ Human Nutrition Program emphasizes food-based approaches for health, including a core network of 6 internationally recognized Human Nutrition Research Centers with scientists, equipment, and facilities for long-term, multidisciplinary, translational research (136, 137).

T399

71882-72134

Sentence

denotes

NIFA supports postsecondary education at 113 land-grant colleges and universities (Public Law 37–130), as well as 21 historically black colleges and universities (Public Law 51–841) and 37 tribal colleges and universities (Public Law 89–329) (138–141).

T400

72135-72524

Sentence

denotes

While federal funding for these schools initially focused on agricultural research and extension, over time these schools have increasingly focused on human nutrition and food research and extension nutrition education, although the recent growth in research is largely through additional competitive grant mechanisms rather than direct NIFA support to the Agricultural Experiment Station.

T401

72525-72995

Sentence

denotes

NIFA further supports extramural nutrition research, often with a focus on integrating agricultural considerations with promotion of health and decreasing health disparities; this work includes funding projects aiming to identify environmental and behavioral factors that act as barriers to consumption of a high-quality diet, while identifying factors that promote healthy eating behaviors (e.g., increasing home access and availability of fruits and vegetables) (142).

T402

72996-73239

Sentence

denotes

The ERS’ food and nutrition research aims to study demographic, social, economic, and informational determinants of adequacy and healthfulness of the American diet, related health outcomes, and corresponding health care expenditures (11, 143).

T403

73240-73577

Sentence

denotes

This research includes examining interactions among consumers, food industry, and government as they relate to the food supply, markets, and access; food choice and its impact on diet quality; federal regulations and other aspects of food policy; and the USDA's nutrition assistance programs in meeting public policy and nutrition goals.

T404

73578-73693

Sentence

denotes

The Food and Nutrition Service (FNS) is the only agency of the Food, Nutrition, and Consumer Services mission area.

T405

73694-73903

Sentence

denotes

The FNS administers 15 domestic nutrition assistance programs, conducts some limited research, and makes use of nutrition research sponsored by other federal agencies to help assess and improve these programs.

T406

73904-74251

Sentence

denotes

And, as discussed in the cross-governmental section below, the USDA FNS Center for Nutrition Policy and Promotion (CNPP) conducts the evidence analysis for the DGAs, including nutrition evidence systematic reviews, data analysis, and food pattern modeling, and develops the corresponding consumer-facing education tools (e.g., MyPlate) (144, 145).

T407

74252-74390

Sentence

denotes

USDA investments in research and statistics, including nutrition, have fallen below 1980s levels in constant dollars (Figure 3) (12, 146).

T408

74391-74645

Sentence

denotes

Indeed, as a percentage of GDP, public investment in agrifood (agriculture and food combined) research and development (4.2%) and particularly food research and development (1%) was lower in 2018 than pharmaceutical research and development (4.9%) (147).

T409

74646-74764

Sentence

denotes

The US fell behind China in public agricultural research in 2009, and now only invests half the amount as China (148).

T410

74765-74970

Sentence

denotes

US public sector funding for agricultural research and development is also lower than India, Western Europe, and the Asia-Pacific region including Canada, using constant 2011 purchasing-power parity (148).

T411

74971-75083

Sentence

denotes

Yet, growth in productivity in the farm sector has come almost exclusively from science-based innovations (146).

T412

75084-75289

Sentence

denotes

Declines in US public funding for food and agriculture research and development “risks national competitiveness, long-term cutting-edge scientific discovery, and the next generation talent pipeline” (147).

T413

75290-75547

Sentence

denotes

Specific to nutrition, as one example, the ARS budget for human nutrition research and monitoring, including funding for 6 important extramural and intramural Human Nutrition Centers nationally, has been flat since 1980 in constant dollars (Figure 5) (132).

T414

75548-75780

Sentence

denotes

In addition, 2 USDA research and statistical agencies that include nutrition research—ERS and NIFA—were relocated to Kansas City, Missouri, at the start of fiscal year 2020 and lost 50% (ERS) and 71% (NIFA) of their workforce (149).

T415

75781-76119

Sentence

denotes

A recent Congressional Research Service analysis reported the leadership positions at NIFA and ERS have been staffed primarily by acting officials since the relocation and indicated that Congress may be interested in how NIFA and ERS are meeting their responsibilities with reduced workforces and as new staff are potentially hired (150).

T416

76120-76305

Sentence

denotes

These trends demonstrate declining investments in science to advance US food and agriculture to increase health, sustain our natural resources, and stimulate rural economic development.

T417

76306-76596

Sentence

denotes

FIGURE 5 Trends in USDA ARS investments for total nutrition research based on data from the USDA, Hathi Trust, and the Government Publishing Office (12) (top panel) and for human nutrition research and monitoring for fiscal years 1978–2010 based on data from the USDA (132) (bottom panel).

T418

76597-76785

Sentence

denotes

In the bottom panel, shaded bars represent absolute yearly funding (millions of dollars) and open bars represent funding adjusted to 1978 dollars (https://data.bls.gov/cgi-bin/cpicalc.pl).

T419

76786-76838

Sentence

denotes

ARS, Agricultural Research Service; FY, fiscal year.

T420

76839-76948

Sentence

denotes

Top panel adapted from POLITICO Pro Datapoint (12), with graphic design support courtesy of Ink&Pixel Agency.

T421

76949-77087

Sentence

denotes

The USDA has aimed to coordinate nutrition research within and outside the department in many different ways (Supplemental Table 4) (132).

T422

77088-77555

Sentence

denotes

The Food Security Act of 1985 (Public Law 99–198) required the Secretary of Agriculture to submit to Congress “a comprehensive plan for implementing a national nutrition research program, including recommendations relating to research directions, educational activities, and funding levels necessary to carry out such a plan.” This plan was submitted to Congress in 1986, but no new legislative mandates or change in mission resulted from this report (132, 151, 152).

T423

77556-77834

Sentence

denotes

In 1993, USDA revised its human nutrition program coordination structure and developed a Human Nutrition Policy Committee that reported to the Secretary's Policy Coordination Council and a USDA Human Nutrition Coordinating Committee (HNCC) that reported to the Policy Committee.

T424

77835-77913

Sentence

denotes

The Human Nutrition Policy Committee has not been active since the late 1990s.

T425

77914-78084

Sentence

denotes

HNCC is chaired by an ARS representative and vice-chaired by an FNS representative and includes members from a variety of USDA agencies with additional liaisons from HHS.

T426

78085-78143

Sentence

denotes

Over the last 2 decades, HNCC has generally met quarterly.

T427

78144-78293

Sentence

denotes

Each March, HNCC coordinates National Nutrition Month activities at USDA and functions as the steering committee for the website Nutrition.gov (153).

T428

78294-78741

Sentence

denotes

USDA Office of the Chief Scientist (OCS) was established by Congress in 2008 (Public Law 110–234) “to provide strategic coordination of the science that informs USDA's and the federal government's decisions, policies, and regulations that impact all aspects of US food and agriculture and related landscapes and communities.” (154) The OCS advises USDA's Chief Scientist and the Secretary of Agriculture in multiple areas, including the following:

T429

78742-79018

Sentence

denotes

Agricultural Systems and Technology; Animal Health and Production, and Animal Products; Plant Health and Production, and Plant Products; Renewable Energy, Natural Resources, and Environment; Food Safety, Nutrition, and Health; and Agricultural Economics and Rural Communities.

T430

79019-79162

Sentence

denotes

By statute, OCS is primarily staffed by detailed staff from other departments and agencies across the government for potentially up to 3 years.

T431

79163-79345

Sentence

denotes

In 2017, OCS hosted the first-of-its-kind USDA Intra-Departmental Nutrition Workshop Series and identified major gaps and needs to strengthen coordination of USDA nutrition research.

T432

79346-79762

Sentence

denotes

These gaps and needs included the following: assessing existing and potential new means of coordination and collaboration; developing new interdepartmental working groups and interest groups; identifying new and improved ways to enhance coordination with USDA food safety efforts; better utilizing the HNCC; and hosting overviews of USDA nutrition relevant databases and related data science trainings and resources.

T433

79763-79883

Sentence

denotes

The chair of this workshop series was detailed to OCS for 1 y and completed the detail a few months after this workshop.

T434

79884-79994

Sentence

denotes

A 2019 GAO report noted there are currently no plans for another intradepartmental meeting on nutrition (155).

T435

79995-80154

Sentence

denotes

In 2020, USDA put forth a new Science Blueprint for the next 5 y to help promote synergy across the department for prioritized objectives and strategies (156).

T436

80155-80888

Sentence

denotes

This Blueprint includes specific objectives in nutrition and health promotion, such as to develop and update the current evidence base to promote proper macro- and micronutrient intake among critical age groups or life stages, such as women who are pregnant or lactating, infants, children, adolescents, working-age adults, tribal members, and seniors; provide guidance and incentives to promote healthier eating patterns so that the US can reduce incidence of, and morbidity from, obesity and diet-related chronic diseases; promote food systems that reduce the prevalence and severity of food insecurity; and expand understanding about the impacts of USDA nutrition assistance programs on human health, communities, and the economy.

T437

80889-81294

Sentence

denotes

The USDA Science Blueprint has objectives related to infrastructure, innovation, and well-being: to develop and evaluate methods to increase access to low-cost and nutritious food as well as sustain efficient agriculture and bioeconomy systems in rural communities; and to evaluate alternative systems that may improve the quality, resiliency, and sustainability of food, fiber, forest, and fuel supplies.

T438

81295-82337

Sentence

denotes

The USDA also set forth objectives to work toward being a “beacon for science”: to encourage a global conversation and facilitate such discussion within decision-making bodies about literacy in agriculture, food, forestry, health, and science; advocate globally for the development of science-based, international and domestic standards, regulatory approaches, and policies, including those guiding the development of new and emerging technologies; develop an effective and diverse US agriculture workforce that contributes to safer, healthier, vibrant, sustainable, and innovative communities; enhance the capacities of USDA and other institutions in workforce development, with attention towards developing scientists and practitioners familiar with developing technologies and innovative practices; and develop and expand degree, certificate, curriculum, and youth programs that integrate science, technology, engineering, and mathematics (STEM) into instruction, considering real-world challenges relevant to agriculture and food science.

T439

82338-82481

Sentence

denotes

How new federal funding streams, leadership, or coordination structures may help achieve these laudable goals were not addressed in the report.

T440

82482-82721

Sentence

denotes

On 20 February 2020, the Secretary of Agriculture put forth a new Agriculture Innovation Agenda, a department-wide initiative to align resources, programs, and research to position American agriculture to better meet future global demands.

T441

82722-82869

Sentence

denotes

Benchmarks of success included reducing US food loss and waste by 50% by the year 2030 and reducing US nutrient loss in water by 30% by 2050 (157).

T442

82871-82931

Sentence

denotes

Nutrition research in other federal departments and agencies

T443

82932-83045

Sentence

denotes

In addition to NIH and USDA, many other departments and agencies conduct or utilize nutrition research (Table 1).

T444

83046-83252

Sentence

denotes

This section highlights summaries provided by 8 departments and agencies in the Topics of Interest section of the 2016 National Nutrition Research Roadmap, as well as any major developments since then (11).

T445

83253-83514

Sentence

denotes

The Roadmap explained each of the participating ICHNR department and agency's missions, roles and responsibilities, and mechanisms for supporting and/or using nutrition research; many include histories and contemporary overviews of research needs and interests.

T446

83515-83601

Sentence

denotes

The DoD, for example, focuses on nutrition's role in human performance and resilience.

T447

83602-83813

Sentence

denotes

At the US Army Natick Soldier Systems Center, DoD supports scientists and technologists conducting innovative research to develop foods and combat rations that are nutritious, palatable, and nonperishable (158).

T448

83814-84174

Sentence

denotes

In Natick, the Combat Feeding Directorate, a part of the Combat Capabilities Development Command of the US Army Futures Command, provides DoD with a joint-service program responsible for research, development, testing, and integration and engineering for materiel solutions such as combat rations, food service equipment technology, and combat feeding systems.

T449

84175-84443

Sentence

denotes

The Military Nutrition Division (MND) of the US Army Research Institute of Environmental Medicine, a part of the US Army Medical Research and Materiel Development Command, also of the US Army Futures Command is co-located in Natick with the Combat Feeding Directorate.

T450

84444-84808

Sentence

denotes

The MND conducts research that provides the biomedical science basis for warfighter nutritional requirements utilized for the development of rations, menus, policies and programs that enable warfighter health and performance, evaluates warfighter nutritional status, and examines interactions between nutrition, health, performance and the operational environment.

T451

84809-85251

Sentence

denotes

The Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences (DoD's health sciences university) conducts various nutrition-related research on the nutrition environment (Go For Green and the Military Nutrition Environment Assessment Tool) and tests strategies to mitigate the consequences of environmental and/or physiological stressors and sustain physical and cognitive performance.

T452

85252-85393

Sentence

denotes

CHAMP is also extensively involved in dietary supplement research—from beneficial ingredients to those that could compromise force readiness.

T453

85394-85498

Sentence

denotes

Both MND and CHAMP collaborate on projects whenever possible to maximize efficiencies and effectiveness.

T454

85499-85702

Sentence

denotes

NASA conducts nutrition research to understand the dietary requirements of space travelers and the role of nutrition in human adaptation to microgravity, each critical to crew safety and mission success.

T455

85703-85856

Sentence

denotes

The CDC addresses population nutrition through surveillance, intramural and extramural research, and translation of research into program implementation.

T456

85857-85994

Sentence

denotes

The FDA is responsible for protecting the public health by ensuring the safety of our nation's food supply, among other activities (159).

T457

85995-86099

Sentence

denotes

The FDA works to foster an environment to promote healthy and safe food choices through several actions.

T458

86100-86474

Sentence

denotes

This includes providing and supporting accurate and useful nutrition information and education to customers, monitoring and assessing emerging nutrition science and changes in the composition of foods in the marketplace in relation to the health status of Americans, and encouraging and facilitating new products and product reformulation to promote a healthier food supply.

T459

86475-86985

Sentence

denotes

To achieve this mission, FDA depends heavily on federal nutrition research from other departments and agencies and also conducts its own research activities, such as consumer studies to support nutrition labeling and claims, assessments of constituents of the food supply, development of methods for analyzing food constituents, surveys on health, analyses of dietary intake, monitoring of adverse events from dietary foods and supplements, and cost–benefit analyses of various nutrition regulatory activities.

T460

86986-87056

Sentence

denotes

The VA is home to the largest integrated health care system in the US.

T461

87057-87215

Sentence

denotes

Known as the VHA, this system includes ∼150 medical centers and 1400 community-based outpatient clinics, community living centers, Vet Centers, and domiciles.

T462

87216-87466

Sentence

denotes

The VHA Office of Research and Development supports a range of projects that relate to nutrition including The Million Veteran Program, which aims to build one of the largest databases of genetic, military exposure, lifestyle, and health information.

T463

87467-87719

Sentence

denotes

USAID adopts, adapts, modifies, and increases the information, evidence, practices, and technologies of US institutions in human nutrition to be applicable to USAID target populations in developing countries as a key plank of US diplomacy and security.

T464

87720-88068

Sentence

denotes

Demonstrating its increased prioritization of nutrition, USAID recently hired its first Chief Nutritionist, who aims to galvanize support for the December 2020 Nutrition for Growth Summit and secure commitments from partner countries, private sectors, and nongovernmental organizations to accelerate progress on improving nutrition worldwide (160).

T465

88069-88581

Sentence

denotes

There are a variety of other federal departments and agencies that are not a member of ICHNR that engage with and leverage nutrition research, such as, but not limited to, HHS Centers for Medicare and Medicaid Services (CMS), HHS Center for Medicare and Medicaid Innovation (CMMI), HHS Office of the Surgeon General, Federal Emergency Management Agency (FEMA), and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice.

T466

88583-88653

Sentence

denotes

Current Efforts for Cross-Governmental Nutrition Research Coordination

T467

88654-88822

Sentence

denotes

Given the diverse investments in nutrition research across separate federal departments and agencies, several initiatives have aimed to better coordinate these efforts.

T468

88823-88862

Sentence

denotes

Major initiatives are summarized below.

T469

88864-88869

Sentence

denotes

ICHNR

T470

88870-89015

Sentence

denotes

In 1977, Congress recognized the need and called for improved coordination of human nutrition research (Public Law 95–113) (Supplemental Text 1).

T471

89016-89213

Sentence

denotes

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).

T472

89214-89349

Sentence

denotes

This report found that federal nutrition research programs had failed to deal with the changing health problems of the American people.

T473

89350-89577

Sentence

denotes

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).

T474

89578-89885

Sentence

denotes

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).

T475

89886-89981

Sentence

denotes

In 1983, JSHNR completed its review and recommendations, leading to the formation of the ICHNR.

T476

89982-90412

Sentence

denotes

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).

T477

90413-90640

Sentence

denotes

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.

T478

90641-90729

Sentence

denotes

ICHNR includes representatives from multiple federal departments and agencies (Table 1).

T479

90730-90820

Sentence

denotes

After some early collaborative successes, ICHNR had a ≥10-y hiatus (Supplemental Table 5).

T480

90821-90926

Sentence

denotes

Reassembled in 2013, ICHNR recognized the need for a new effort to coordinate federal nutrition research.

T481

90927-91016

Sentence

denotes

This resulted in a new strategic plan, the National Nutrition Research Roadmap 2016–2021:

T482

91017-91081

Sentence

denotes

Advancing Nutrition Research to Improve and Sustain Health (11).

T483

91082-91124

Sentence

denotes

The Roadmap was framed around 3 questions:

T484

91125-91211

Sentence

denotes

How can we better understand and define eating patterns to improve and sustain health?

T485

91212-91275

Sentence

denotes

What can be done to help people choose healthy eating patterns?

T486

91276-91382

Sentence

denotes

How can we develop and engage innovative methods and systems to accelerate discoveries in human nutrition?

T487

91383-91827

Sentence

denotes

Across 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).

T488

91828-92030

Sentence

denotes

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.

T489

92031-92194

Sentence

denotes

Notably, the Roadmap did not include any data, findings, or recommendations on current or new nutrition research investment levels, leadership, or structures (11).

T490

92195-92445

Sentence

denotes

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.

T491

92446-92584

Sentence

denotes

This may be why a 2017 analysis found only early signs of implementation of the Roadmap among ICHNR member departments and agencies (163).

T492

92585-92784

Sentence

denotes

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).

T493

92785-92948

Sentence

denotes

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.

T494

92949-93049

Sentence

denotes

There are few other indicators of current use or monitoring of the Roadmap's aims or progress (164).

T495

93050-93259

Sentence

denotes

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.

T496

93260-93546

Sentence

denotes

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.

T497

93548-93603

Sentence

denotes

National food and nutrition monitoring and surveillance

T498

93604-93692

Sentence

denotes

National monitoring and surveillance are integral to nutrition research and translation.

T499

93693-93909

Sentence

denotes

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).

T500

93910-94218

Sentence

denotes

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).

T501

94219-94412

Sentence

denotes

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).

T502

94413-94642

Sentence

denotes

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).

T503

94643-94793

Sentence

denotes

In 1967, this international surveillance program was reorganized in response to Congressional amendments to focus on domestic hunger and malnutrition.

T504

94794-95039

Sentence

denotes

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.

T505

95040-95415

Sentence

denotes

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).

T506

95416-95706

Sentence

denotes

In 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.

T507

95707-95956

Sentence

denotes

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.

T508

95957-96380

Sentence

denotes

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).

T509

96381-96588

Sentence

denotes

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).

T510

96589-96764

Sentence

denotes

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).

T511

96765-96912

Sentence

denotes

When this program ended in 2002, federal nutrition monitoring efforts returned to being decentralized, without explicit coordination (11, 174–176).

T512

96913-97316

Sentence

denotes

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).

T513

97318-97322

Sentence

denotes

DGAs

T514

97323-97482

Sentence

denotes

A key cross-departmental nutrition-related activity is the DGAs, the cornerstone for many federal nutrition programs and policies (Supplemental Table 8) (179).

T515

97483-97641

Sentence

denotes

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.

T516

97642-97832

Sentence

denotes

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).

T517

97833-97985

Sentence

denotes

Regardless of departmental lead, the USDA CNPP conducts the evidence analysis and develops the corresponding consumer-facing education tools (144, 145).

T518

97986-98147

Sentence

denotes

The HHS Office of Disease Prevention and Health Promotion (ODPHP) aims to provide technical expertise and develop DGA-related resources for health professionals.

T519

98148-98244

Sentence

denotes

Both agencies’ efforts are constrained by limited funding and staff dedicated to the DGAs (144).

T520

98245-98544

Sentence

denotes

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.

T521

98545-98774

Sentence

denotes

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.

T522

98775-98914

Sentence

denotes

Successive DGACs from the 1980 edition onwards have documented persistent, major research gaps for setting evidence-based guidelines (181).

T523

98915-99105

Sentence

denotes

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).

T524

99106-99390

Sentence

denotes

In 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).

T525

99391-99509

Sentence

denotes

First, in February 2017, NASEM released “Optimizing the Process for Establishing the Dietary Guidelines for Americans:

T526

99510-99539

Sentence

denotes

The Selection Process” (184).

T527

99540-99735

Sentence

denotes

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.

T528

99736-99880

Sentence

denotes

The second report released in September 2017 was entitled “Redesigning the Process for Establishing the Dietary Guidelines for Americans” (182).

T529

99881-100175

Sentence

denotes

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.

T530

100176-100495

Sentence

denotes

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).

T531

100496-100683

Sentence

denotes

In 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).

T532

100684-100839

Sentence

denotes

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.

T533

100840-101096

Sentence

denotes

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).

T534

101097-101454

Sentence

denotes

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.

T535

101455-101673

Sentence

denotes

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).

T536

101674-101865

Sentence

denotes

In 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).

T537

101866-102065

Sentence

denotes

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).

T538

102066-102178

Sentence

denotes

Thus, the DGAs’ general focus may exclude the specific dietary needs of the great majority of the US population.

T539

102179-102403

Sentence

denotes

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).

T540

102404-102493

Sentence

denotes

These reviews were used by DGACs with input and endorsement from >25 professional groups.

T541

102494-102785

Sentence

denotes

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).

T542

102786-103006

Sentence

denotes

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).

T543

103007-103227

Sentence

denotes

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.

T544

103228-103452

Sentence

denotes

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.

T545

103453-103610

Sentence

denotes

Thus, currently no federal entity takes the lead on the development of evidence reviews or dietary guidance for patients with diet-related health conditions.

T546

103611-104086

Sentence

denotes

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).

T547

104087-104535

Sentence

denotes

In 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).

T548

104536-104988

Sentence

denotes

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.

T549

104990-104994

Sentence

denotes

DRIs

T550

104995-105092

Sentence

denotes

DRIs provide specific targets for intakes of relevant nutrients for the general population (196).

T551

105093-105179

Sentence

denotes

The first DRIs were created by Presidential mandate in 1941 when President Franklin D.

T552

105180-105316

Sentence

denotes

Roosevelt commissioned scientists to generate new minimum dietary requirements for the population to be prepared for World War II (197).

T553

105317-105507

Sentence

denotes

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).

T554

105508-105683

Sentence

denotes

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.

T555

105684-105917

Sentence

denotes

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).

T556

105918-106021

Sentence

denotes

NASEM leads the updating of any DRI when requested by the federal government or instructed by Congress.

T557

106022-106151

Sentence

denotes

Recently, a NASEM Consensus Study Report determined that crucial research gaps for setting DRIs remain largely unaddressed (200).

T558

106152-106369

Sentence

denotes

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).

T559

106370-106630

Sentence

denotes

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.

T560

106632-106672

Sentence

denotes

Food and nutrition regulatory activities

T561

106673-106907

Sentence

denotes

Nutrition 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).

T562

106908-107105

Sentence

denotes

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.

T563

107106-107507

Sentence

denotes

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).

T564

107508-107630

Sentence

denotes

Since that time, USDA and FDA, among other federal departments and agencies, have needed to work together on these topics.

T565

107631-108235

Sentence

denotes

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.

T566

108236-108498

Sentence

denotes

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).

T567

108499-108676

Sentence

denotes

In 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).

T568

108677-108983

Sentence

denotes

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).

T569

108984-109181

Sentence

denotes

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).

T570

109182-109370

Sentence

denotes

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).

T571

109371-109564

Sentence

denotes

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).

T572

109565-109740

Sentence

denotes

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).

T573

109741-109885

Sentence

denotes

The 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).

T574

109886-110174

Sentence

denotes

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).

T575

110175-110363

Sentence

denotes

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.

T576

110365-110406

Sentence

denotes

Federal nutrition education and promotion

T577

110407-110626

Sentence

denotes

Congress 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).

T578

110627-110733

Sentence

denotes

This process is facilitated by a Dietary Guidance Review Committee, co-chaired by USDA CNPP and HHS ODPHP.

T579

110734-110961

Sentence

denotes

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).

T580

110962-111285

Sentence

denotes

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.

T581

111286-111426

Sentence

denotes

Over the years, various efforts have examined the impacts of USDA investments in nutrition education and promotion with mixed success (218).

T582

111427-111681

Sentence

denotes

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).

T583

111682-111970

Sentence

denotes

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.

T584

111972-112008

Sentence

denotes

National nutrition research database

T585

112009-112115

Sentence

denotes

There is no dedicated, consistent funding to identify and track federal investments in nutrition research.

T586

112116-112313

Sentence

denotes

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).

T587

112314-112461

Sentence

denotes

From 1985 to 2015, HNRIM was maintained by NIH and, at its peak, included ≥100,000 records on federal nutrition research and training expenditures.

T588

112462-112625

Sentence

denotes

HNRIM was a staff-curated database, with projects identified and classified by expert staff including the proportion of each project actually addressing nutrition.

T589

112626-112948

Sentence

denotes

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 >200 Congressionally mandated categories (Public Law 109–482).

T590

112949-113044

Sentence

denotes

RCDC uses automated text data mining to match federal research projects to spending categories.

T591

113045-113284

Sentence

denotes

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.

T592

113285-113444

Sentence

denotes

For instance, a single project and its total dollars may be counted as 100% nutrition, obesity, cardiovascular disease, diabetes, and prevention, among others.

T593

113445-113648

Sentence

denotes

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).

T594

113650-113676

Sentence

denotes

Current landscape: summary

T595

113677-113867

Sentence

denotes

Significant efforts are occurring across diverse federal departments and agencies to leverage existing personnel and funding and coordinate existing activities to advance nutrition research.

T596

113868-114236

Sentence

denotes

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.

T597

114237-114297

Sentence

denotes

Many new opportunities exist to be seized, as reviewed next.

T598

114299-114314

Sentence

denotes

The Opportunity

T599

114315-114466

Sentence

denotes

A strengthening of federal nutrition research has significant potential to generate new discoveries to improve and sustain the health of all Americans.

T600

114467-114707

Sentence

denotes

We identified and collated multiple specific priority areas that have been set forth by various federal and nongovernmental organizations (Table 2, Figure 2), and most of these have not been adequately addressed (11, 81, 147, 196, 219–226).

T601

114708-114799

Sentence

denotes

TABLE 2 Opportunities for enhanced federal nutrition research coordination and investment1

T602

114800-114981

Sentence

denotes

Cross-governmental strategic planning and prioritization Develop a national strategic planning process including optimal leadership, coordination, monitoring, and funding structures

T603

114982-115186

Sentence

denotes

Develop criteria for prioritization such as based on population impact, feasibility, emerging scientific opportunities and methodologic advances, and relevance for cross-governmental regulatory priorities

T604

115187-115299

Sentence

denotes

Enhance the scope, interdisciplinary nature, and impact of individual research projects and research initiatives

T605

115300-115322

Sentence

denotes

Accelerate translation

T606

115323-115497

Sentence

denotes

Develop new research mechanisms and transparent private–public partnerships that stimulate and reward science-driven innovations for health, health equity, and sustainability

T607

115498-115610

Sentence

denotes

Develop common guidance and standards on project reviews and scientific rigor, reproducibility, and transparency

T608

115611-115916

Sentence

denotes

Advance the science for dietary recommendations to the public Comparative effects of different popular diet patterns, eating frequency, intermittent fasting, and diet quantity vs. different foods on weight loss and weight maintenance; and heterogeneity in these effects based on a person's characteristics

T609

115917-116105

Sentence

denotes

Optimal dietary recommendations for specific disease conditions, such as hypertension, type 2 diabetes, cardiovascular diseases, specific cancers, infections, autoimmune diseases, and more

T610

116106-116308

Sentence

denotes

Rigorous studies on food groups with unclear or controversial evidence, such as different dairy foods (cheese, yogurt, milk, butter), red meats, tropical oils, organic vs. nonorganic foods, among others

T611

116309-116431

Sentence

denotes

Numerous other critical areas requiring more scientific evidence as identified by the 2015 DGAC (see Supplemental Table 2)

T612

116432-116527

Sentence

denotes

A stronger intergovernmental process and more consistent funding for establishing DGAs and DRIs

T613

116528-116714

Sentence

denotes

Leverage new technologies and data science resources and approaches Interactions between diet, the gut microbiome, immunity, epigenetics, vascular health, and other physiological systems

T614

116715-116864

Sentence

denotes

Personalized or precision nutrition, including based on personal backgrounds, habits, genes, microbiomes, medications, and chronic medical conditions

T615

116865-116923

Sentence

denotes

Interrelationships of nutrition and epigenetics for health

T616

116924-117077

Sentence

denotes

Using innovative technology and data science for diverse fundamental, clinical, environmental, and public health research questions in food and nutrition

T617

117078-117249

Sentence

denotes

Advance foundational and basic science knowledge and discoveries Molecular basis of nutritional needs across the lifespan, physical activity levels, and disease conditions

T618

117250-117347

Sentence

denotes

Pathways of nutritional effects in the first 1000 days of life for programming of lifelong health

T619

117348-117392

Sentence

denotes

Origins of and treatments for food allergies

T620

117393-117428

Sentence

denotes

Optimal nutrition for healthy aging

T621

117429-117547

Sentence

denotes

Nutritional treatments for reducing side effects of and more effectively targeting cancer chemo- and radiation therapy

T622

117548-117750

Sentence

denotes

Comprehensive characterization of and molecular and health effects of trace bioactives and phenolics, such as in extra-virgin olive oil, cocoa, green tea, coffee, red wine, and blueberries, among others

T623

117751-117963

Sentence

denotes

Assessing the molecular and health impacts of additives, gluten, FODMAPS (fermentable oligo-, di-, mono-saccharides and polyols), low-calorie sweeteners, and other food components of public interest and confusion

T624

117964-118063

Sentence

denotes

Assessing the opportunities, controversies and confusion around food processing and processed foods

T625

118064-118221

Sentence

denotes

Understand and address diet-related health disparities Community-based participatory research to understand and address community priorities around nutrition

T626

118222-118397

Sentence

denotes

Influence of the food environment, and intersections with individual and social determinants, of diet-related health disparities, and the corresponding translational solutions

T627

118398-118550

Sentence

denotes

Causal interrelationships between food insecurity and diet-related chronic diseases like obesity, diabetes, cardiovascular diseases, and certain cancers

T628

118551-118693

Sentence

denotes

Influence of education, knowledge, personal choice, sociocultural influences, industry marketing, and diverse food environment characteristics

T629

118694-118835

Sentence

denotes

Roles of past and current discriminatory policies and practices that alter employment opportunities, homeownership, and community development

T630

118836-119008

Sentence

denotes

Support and enhance translational and implementation science Intersections of nutrition with shared risk factors such as low physical activity and tobacco use, among others

T631

119009-119133

Sentence

denotes

Developing effective behavior change strategies and policy, systems, and environmental supports for promoting healthy eating

T632

119134-119221

Sentence

denotes

Understanding characteristics of effective communication channels for diverse audiences

T633

119222-119258

Sentence

denotes

Enhancing nutrition science literacy

T634

119259-119424

Sentence

denotes

Rigorous evaluation of the major federal investments (DGAs, food labeling, health claims, menu labeling, SNAP-Ed, etc.) for informing public choices around nutrition

T635

119425-119535

Sentence

denotes

Nutrition policy and food environment research including efficacy, cost-effectiveness, equity, and feasibility

T636

119536-119598

Sentence

denotes

Coordinated interagency research on food marketing to children

T637

119599-119693

Sentence

denotes

Strengthen medical nutrition therapy for an array of acute and chronic diseases and conditions

T638

119694-119997

Sentence

denotes

Coordinated interagency research on Food is Medicine interventions within health care systems, including medical and other allied health professional education, medically tailored meals with enhanced medical nutrition therapy, produce prescriptions, and other nutrition-focused flexible benefit services

T639

119998-120194

Sentence

denotes

Coordinate key cross-agency research priorities for nutrition-related investments Optimizing nutrition-related investments for diplomacy, development, and defense, such as by USAID ($27 billion/y)

T640

120195-120327

Sentence

denotes

DoD priorities around nutrition for human performance, military readiness, and treatment of musculoskeletal and battlefield injuries

T641

120328-120407

Sentence

denotes

VHA opportunities to reduce high rates of diet-related illnesses among veterans

T642

120408-120566

Sentence

denotes

Understand and define basic nutrient requirements during extended stays in microgravity, among other research and translation needs to support NASA astronauts

T643

120567-120682

Sentence

denotes

Strengthen and leverage the nearly $100 billion/y national investment across ≥15 USDA nutrition assistance programs

T644

120683-120735

Sentence

denotes

Food safety research, relevant to FDA, USDA, and NIH

T645

120736-120957

Sentence

denotes

FDA regulatory issues including Nutrition Facts labeling, front-of-pack labeling, restaurant menu labeling, health claims, food category standards of identity, cellular agriculture, food additives, and dietary supplements

T646

120958-121095

Sentence

denotes

Intersections of nutrition science and food, nutrition, and health regulatory activities coordinated between FDA, USDA, NIH, among others

T647

121096-121277

Sentence

denotes

Intersections with food production, supply chains, and sustainability Interplay of livestock and farming practices on the joint nutritional quality of foods and natural resource use

T648

121278-121477

Sentence

denotes

Nutritional innovations and collaborations for healthier crops and manufactured food products including novel ingredients and biofortification as a means to increase nutrient content and availability

T649

121478-121547

Sentence

denotes

Nutritional implications of novel regenerative agriculture approaches

T650

121548-121652

Sentence

denotes

Impacts of plant-based meat and dairy alternatives and cellular agriculture on health and sustainability

T651

121653-121720

Sentence

denotes

Joint impacts of climate on nutrition, production, and resource use

T652

121721-121815

Sentence

denotes

Monitoring and surveillance Diets and health nationally, by state, and in population subgroups

T653

121816-121917

Sentence

denotes

Food security and diet-related health disparities, including monitoring food access and affordability

T654

121918-121999

Sentence

denotes

Neighborhood food environments, school meals, and retail and restaurant purchases

T655

122000-122060

Sentence

denotes

Nutritional aspects of federal nutrition assistance programs

T656

122061-122153

Sentence

denotes

Structures, strengths, and weaknesses of local, regional, national, and global supply chains

T657

122154-122412

Sentence

denotes

1 These examples were identified and adapted from several governmental and nongovernmental consensus recommendations on current priority areas for new nutrition research along with an assessment of additional research literature (11, 81, 147, 196, 219–226).

T658

122413-122793

Sentence

denotes

DGA, Dietary Guidelines for Americans; DGAC, Dietary Guidelines Advisory Committee; DoD, Department of Defense; FODMAPS, fermentable oligo-, di-, mono-saccharides and polyols; NASA, National Aeronautics and Space Administration; SNAP-Ed, USDA Supplemental Nutrition Assistance Program Education; USAID, US Agency for International Development; VHA, Veterans Health Administration.

T659

122795-122851

Sentence

denotes

Cross-governmental strategic planning and prioritization

T660

122852-122999

Sentence

denotes

An expanded, coordinated federal nutrition research effort could more effectively plan and prioritize scientific discoveries across critical areas.

T661

123000-123170

Sentence

denotes

In addition to existing priorities, such an effort would create capacity to quickly identify and address timely new scientific challenges and opportunities as they arise.

T662

123171-123285

Sentence

denotes

Improved cross-governmental coordination would also facilitate interdisciplinary research and its societal impact.

T663

123286-123665

Sentence

denotes

This would include accelerated translation of scientific findings into practice—for example, relevant for USDA nutrition assistance programs, FDA regulatory activities, CMS health care improvements, CDC public health efforts, DoD and VA priorities for active-duty forces and veterans, USDA agricultural priorities, and additional interests of communities, schools, and worksites.

T664

123666-123782

Sentence

denotes

Cross-governmental coordination would also provide leadership to help develop effective public–private partnerships.

T665

123783-124122

Sentence

denotes

A coordinated federal nutrition research authority would also facilitate appropriate expertise on review panels to identify meritorious projects and multidisciplinary investigative teams to achieve project goals and foster the development and application of high standards for scientific rigor, reproducibility, and transparency (11, 227).

T666

124124-124174

Sentence

denotes

Greater science for dietary guidance to the public

T667

124175-124328

Sentence

denotes

While current science permits broad recommendations on healthy eating patterns, significant scientific debate and public confusion remain on many topics.

T668

124329-124493

Sentence

denotes

As reviewed earlier, the 2015 DGAC identified numerous critical areas for national dietary guidance that require greater scientific evidence (Supplemental Table 2).

T669

124494-124647

Sentence

denotes

A 2020 DGAC member described their continuing inability to draw many conclusions from an inadequate evidence base in 2 words: “It's disheartening” (228).

T670

124648-124746

Sentence

denotes

Similar opportunities exist for greater scientific investments to allow regular DRI updates (200).

T671

124747-125090

Sentence

denotes

Additional areas for accelerated research include major food groups for which health effects are currently poorly understood, and the interrelationships between nutrition and the gut microbiome, immunity, epigenetics, vascular health, food allergies, and other physiological systems—all with tremendous implications for human health (229–232).

T672

125091-125325

Sentence

denotes

The complex effects of nutrition on health, the often provocative messages from the media and other influencers, and the many real unanswered and emerging questions in nutrition science have created significant public confusion (233).

T673

125326-125606

Sentence

denotes

As a result, the public is awash with insufficient and conflicting information on many topics, such as on popular diets for weight loss, the effects of caloric restriction or intermittent fasting, and many other topics, with limited rigorous science to provide confident guidance.

T674

125607-125762

Sentence

denotes

A broadly expanded and coordinated effort to generate and disseminate scientifically sound nutrition research is an essential need for the American people.

T675

125764-125806

Sentence

denotes

Leverage new technologies and data science

T676

125807-125973

Sentence

denotes

Exponential growth has occurred in technology, genomics, proteomics, and metabolomics platforms; personalized and environmental sensors; and other big-data resources.

T677

125974-126073

Sentence

denotes

Yet, the implications of these advances for a new era of nutrition research have not been realized.

T678

126074-126654

Sentence

denotes

Strategic planning across the federal government would help mobilize limited resources for maximizing this high-cost area of research. As one example, while diverse federal departments and agencies [e.g., NIH, USDA, DoD, FDA, National Science Foundation (NSF), VA] have expressed great interest in personalized or precision nutrition (234), inadequate funding and coordination have hampered the nation's ability to fully leverage and harness the potential of the powerful, expensive ’omics platforms and related data science advances to develop personalized recommendations (235).

T679

126655-126879

Sentence

denotes

The untapped potential of new technology and data science approaches extends far beyond precision nutrition, with promise for additional basic, clinical, environmental, and public health research on food and nutrition (236).

T680

126881-126921

Sentence

denotes

Foundational basic science and discovery

T681

126922-127079

Sentence

denotes

Fundamental research in nutrition is essential to accelerate progress but is hampered by the absence of any federal home for its investment and coordination.

T682

127080-127262

Sentence

denotes

For example, little is known about the molecular basis of varying nutritional needs across continua from birth to older age, health to disease, or inactive to active lifestyles (11).

T683

127263-127469

Sentence

denotes

Pathways of nutritional influences during the first 1000 days of life, when critical metabolic programming can alter lifelong and possibly epigenerational disease risk, remain critically understudied (237).

T684

127470-127620

Sentence

denotes

Food allergies have exploded among US children, yet with little understanding of their underlying determinants or effective preventive measures (238).

T685

127621-127874

Sentence

denotes

The molecular and metabolic influences of food on aging—including frailty, suppressed immune responses, brain function, sarcopenia, macular degeneration, renal decline, and functional decline—are essential areas of research for an aging population (11).

T686

127875-128056

Sentence

denotes

Thousands of poorly characterized bioactive compounds in foods, such as flavanols and other phenolics, require basic research to elucidate their biochemical and physiologic effects.

T687

128057-128335

Sentence

denotes

Accelerated basic research is also essential to assess the molecular and health impacts of other factors such as food additives, gluten, FODMAPS (fermentable oligo-, di-, mono-saccharides and polyols), low-calorie sweeteners, and other food components of public health interest.

T688

128337-128368

Sentence

denotes

Diet-related health disparities

T689

128369-128452

Sentence

denotes

Many health disparities are closely linked to nutritional disparities (71–73, 239).

T690

128453-128584

Sentence

denotes

Hunger and food insecurity remain pervasive in the US, with great costs for society and our health care system (76, 218, 240, 241).

T691

128585-128908

Sentence

denotes

Yet, while it is now evident that calories alone are an insufficient solution, scientific understanding remains limited on the causal intersections of food insecurity and risk of diet-related chronic diseases, and on the optimal nutritional and other translational approaches to address these challenges (78, 80, 240, 242).

T692

128909-129163

Sentence

denotes

As noted earlier, nutrition-related health disparities experienced by low-income, rural, and minority populations are influenced by a complex and insufficiently understood intersection of individual, sociocultural, and environmental determinants (77–80).

T693

129164-129314

Sentence

denotes

Community-based participatory research holds promise as an approach to better understand and address community priorities around nutrition (243, 244).

T694

129315-130031

Sentence

denotes

Research priorities for greater investment and cross-agency coordination include the influence of context on food-related decisions and behaviors across diverse retail food environments, including but not limited to the influence of price and marketing, food access and availability, transportation options and use, perceptions of neighborhood and traffic safety, rapidly growing online purchasing including with federal nutrition programs, the short- and long-term impacts of the Public Charge Rule on federal nutrition assistance participation, and the influences of past and current discriminatory policies and practices impacting employment opportunities, homeownership, and community development (218, 245–256).

T695

130033-130073

Sentence

denotes

Translational and implementation science

T696

130074-130206

Sentence

denotes

Major research initiatives are needed to better understand how eating behaviors can be positively influenced in diverse populations.

T697

130207-130485

Sentence

denotes

Translational research must identify optimal strategies to leverage the food environment, including retail settings, schools, worksites, health care systems, nursing homes and assisted-living facilities, and federal nutrition assistance programs for better nutrition (257, 258).

T698

130486-131015

Sentence

denotes

In the 2015 DGAC report, for example, the scientific evidence was considered limited or not assignable for many crucial translational questions, such as whether food insecurity affects body weight; whether acculturation influences diet, body weight, or cardiovascular risk factors; whether menu calorie labels influence food selection or consumption; or whether access to farmers’ markets, supermarkets, grocery stores, or convenience/corner stores influences dietary intakes, diet quality, or body weight (Supplemental Table 1).

T699

131016-131266

Sentence

denotes

Implementation research is also crucial to assess and optimize intended benefits of the numerous federal policies and investments around public communication and education, including the DGAs, food labeling, health claims, menu labeling, and SNAP-Ed.

T700

131267-131618

Sentence

denotes

This should include coordinated research efforts on evidence-based nutrition education and promotion strategies for healthy populations (the current focus of the DGAs), those with specific diet-related illnesses (the majority of the US population, but not included in the DGAs), and those with resource limitations and food insecurity (194, 259, 260).

T701

131619-131818

Sentence

denotes

Understanding how and why effectiveness of communication channels may vary, such as according to print or health literacy, numeracy, culture, income, or neighborhood (e.g., food access), is critical.

T702

131819-131989

Sentence

denotes

Effective approaches to increase nutrition science literacy can be assessed through new and enhanced research collaborations, such as between the DoE, USDA, NIH, and CDC.

T703

131990-132209

Sentence

denotes

As one example, enhanced collaborations with DoE could include efforts to study potential improvements to food-, nutrition-, and health education–related curricula, testing, school environments, and teacher preparation.

T704

132210-132488

Sentence

denotes

In addition, more research is needed across the policy development and dissemination spectrum to advance our understanding of efficacy, cost-effectiveness, equity, and feasibility of policy, systems changes, and environmental supports that promote healthy eating (241, 261–263).

T705

132489-132646

Sentence

denotes

Coordinated interagency research is also needed on the effects and appropriateness of food marketing to children (e.g., between the FTC, CDC, FDA, and USDA).

T706

132647-132872

Sentence

denotes

Together, such research can inform both current and alternative federal approaches for disseminating evidence-based information to inform choice and reduce confusion among a public hungering for scientifically sound guidance.

T707

132873-133019

Sentence

denotes

Translational research is also needed to leverage allied health professionals and the health care infrastructure to reduce diet-related illnesses.

T708

133020-133260

Sentence

denotes

Innovative translational and implementation science research has tremendous potential to strengthen medical nutrition therapy led by registered dietitian nutritionists for an array of acute and chronic diseases and conditions (11, 264–267).

T709

133261-133816

Sentence

denotes

Many other promising strategies warrant significant research, including the following: expanding the integration of food security and diet quality assessments into electronic medical records or Fast Healthcare Interoperability Resources, updating of medical and other health care licensing and certification standards to include nutrition education, assessing health and cost impacts of medically tailored meals and produce prescriptions, and leveraging Medicaid flexible benefit services and Medicare Advantage for better nutrition and health (268, 269).

T710

133817-133954

Sentence

denotes

The rapidly growing private and public interest and investment in such “Food is Medicine” approaches must be informed by robust research.

T711

133955-134229

Sentence

denotes

Strengthened coordination of research priorities and investments across CMS, CMMI, CDC, Health Resources and Service Administration (HRSA), NIH, and USDA, among others, can inform how best to engage in these strategies together with the allied health community in real-time.

T712

134230-134493

Sentence

denotes

In addition, more research is needed across the policy development and dissemination spectrum to advance our understanding of efficacy, cost-effectiveness, equity, and feasibility of policy, systems changes, and environmental supports that promote healthy eating.

T713

134495-134565

Sentence

denotes

Key cross-agency research priorities for nutrition-related investments

T714

134566-134666

Sentence

denotes

Coordinated research is also important to better leverage the many federal investments in nutrition.

T715

134667-134920

Sentence

denotes

This includes the $27 billion annual investment in USAID, 1 of the 3 foundational pillars for promoting and protecting US national security interests abroad, for which expanded research in nutrition and agricultural innovation is central (11, 270, 271).

T716

134921-135075

Sentence

denotes

The DoD also has key nutrition research priorities around human performance and military readiness that would benefit from cross-agency coordination (11).

T717

135076-135263

Sentence

denotes

Increased investment in nutrition research would also benefit many active-duty families who suffer from diet-related chronic illnesses as well as often coexisting food insecurity (87–91).

T718

135264-135409

Sentence

denotes

The majority of veterans receiving care at VHA, the largest integrated health care system in the US, suffer from ≥1 diet-related conditions (86).

T719

135410-135623

Sentence

denotes

NASA conducts some of its own nutrition research but relies heavily on other federal departments and agencies to help define nutrient requirements and healthy eating strategies for extended space exploration (11).

T720

135624-135896

Sentence

denotes

Other cross-governmental opportunities for coordinated nutrition research include how best to strengthen and leverage the nearly $100 billion annual national investment in USDA nutrition assistance programs (241) and research on food safety, a joint FDA and USDA priority.

T721

135897-136010

Sentence

denotes

Many other FDA regulatory actions require robust research findings, yet are often limited by incomplete evidence.

T722

136011-136273

Sentence

denotes

This includes decisions on Nutrition Facts labeling, front-of-pack labels, restaurant menu labeling, health claims, dietary supplements, food additives, standards of identity (e.g., around plant-based dairy and meat alternatives), and cellular agriculture (210).

T723

136274-136497

Sentence

denotes

An expanded federal nutrition research effort to better support regulatory actions could create renewed industry support for nutrition research as well as interest in developing innovative public–private partnerships (272).

T724

136499-136568

Sentence

denotes

Intersections with food production, supply chains, and sustainability

T725

136569-136719

Sentence

denotes

The federal government has many priorities around US farming, rural development, food production, food manufacturing, and supply chains (9, 156, 157).

T726

136720-137176

Sentence

denotes

Nutrition research intersects with each of these, such as on how to increase production of and access to affordable, healthful food; develop technologies and collaborations to produce new high-value products for farmers and food manufacturers; foster public–private partnerships for innovation and adoption of novel technologies; and expand technology development and other entrepreneurship efforts between academic institutions and small businesses (147).

T727

137177-137563

Sentence

denotes

As summarized in earlier sections, fundamental research questions are also emerging on how food production jointly intersects with human and planetary health, including effects of different strategies for plant and animal breeding, livestock and farming practices, regenerative agriculture, production of plant-based meat and dairy alternatives, and cellular agriculture (11, 156, 273).

T728

137565-137592

Sentence

denotes

Monitoring and surveillance

T729

137593-137750

Sentence

denotes

Nutrition-related monitoring and surveillance are critical to inform nutrition research, which then bidirectionally guides surveillance priorities (11, 274).

T730

137751-138107

Sentence

denotes

The COVID-19 crisis has highlighted the fragmented and often incomplete national infra-structure for monitoring food- and nutrition-related questions in real time, including, for example, information on local, regional, and national food insecurity; dietary choices; diet-related health disparities; neighborhood food environments; and supply chains (3–9).

T731

138108-138262

Sentence

denotes

Expanded and modernized monitoring and surveillance are essential components of a strategy to strengthen and better coordinate federal nutrition research.

T732

138264-138284

Sentence

denotes

Return on investment

T733

138285-138363

Sentence

denotes

The ROI for federal research has been documented across several metrics (275).

T734

138364-138506

Sentence

denotes

Considering commercial innovation, ∼1 in 12 NIH grants directly lead to patents, while ∼1 in 3 granted patents cite NIH-funded research (276).

T735

138507-138663

Sentence

denotes

In a 2012 analysis, each $1 increase in NIH funding was estimated to increase the size (output) of the bioscience industry by between $1.70 and $3.20 (277).

T736

138664-138894

Sentence

denotes

A $3.8 billion federal investment in the human genome project plus an additional $8.5 billion in related research and support have been estimated to produce nearly $1 trillion of economic growth, amounting to a 180-fold ROI (278).

T737

138895-139145

Sentence

denotes

In 2014 Senate testimony, NIH Director Francis Collins reported that NIH funding supported >402,000 jobs and $58 billion in economic output nationwide, whereas NIH discoveries contributed $69 billion to GDP and supported 7 million jobs in 2011 (279).

T738

139146-139277

Sentence

denotes

Our review suggests that expanded federal coordination and investment in nutrition research will generate similarly meaningful ROI.

T739

139278-139567

Sentence

denotes

Opportunities include more efficient leveraging of existing nutrition research infrastructure and investments, as well as other current federal investments in nutrition-related programs and policies at USDA (∼$100 billion/y), USAID (∼$27 billion/y), DoD, VA, FDA, CDC, CMS, FEMA, and more.

T740

139568-139696

Sentence

denotes

Such investments could also be crucial to help reduce population diet and health inequities across diverse population subgroups.

T741

139697-139832

Sentence

denotes

One of the most promising areas for ROI would be advancing basic, clinical, and implementation science to reduce diet-related diseases.

T742

139833-139996

Sentence

denotes

As mentioned in earlier sections, a recent NIH prevention research portfolio analysis compared national risk factors for death with NIH research investments (120).

T743

139997-140271

Sentence

denotes

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).

T744

140272-140451

Sentence

denotes

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).

T745

140452-140633

Sentence

denotes

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).

T746

140634-140981

Sentence

denotes

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.

T747

140982-141110

Sentence

denotes

A major effort to expand and harmonize federal nutrition research could have rapid ROI based on reduced health care costs alone.

T748

141111-141371

Sentence

denotes

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).

T749

141372-141625

Sentence

denotes

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.

T750

141626-141949

Sentence

denotes

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).

T751

141950-142178

Sentence

denotes

Greater coordination and investment in federal nutrition research could also catalyze and unlock economic growth through new public–private partnerships and new private capital investment, small businesses, jobs, and inventions.

T752

142179-142406

Sentence

denotes

In addition to potential for lower health care spending, accelerated nutrition research could help foster a healthier and more productive workforce, more active and thriving children, and healthier and more independent seniors.

T753

142407-142603

Sentence

denotes

New research investment and structure should also support the training of a new generation of scientists and health care professionals who can leverage nutrition-related knowledge for public good.

T754

142604-142761

Sentence

denotes

Enhanced nutrition science and cross-governmental authority can also strengthen dietary guidance, reduce public confusion, and improve consumer food choices.

T755

142762-142970

Sentence

denotes

Together with increased investment in food and agricultural research, strengthened multidisciplinary nutrition science could better support the long-term economic vibrancy of US farmers and rural communities.

T756

142971-143092

Sentence

denotes

Past increases in agricultural productivity, for example, have come almost entirely from science-based innovations (146).

T757

143093-143303

Sentence

denotes

Such integrated efforts would also be able to address the critical emerging nexus of health, food, agriculture, climate, and sustainability (147, 286, 287), positioning the US as the global leader in this area.

T758

143304-143411

Sentence

denotes

This would further improve stewardship of US natural resources, including water, soil, forests, and oceans.

T759

143412-143616

Sentence

denotes

In sum, this would strengthen long-term US food security, farmers’ incomes, national and rural economic growth, and resilience of the food and agricultural sector, which accounts for 1 in 9 US jobs (288).

T760

143617-143762

Sentence

denotes

Appropriate federal investment and coordination of nutrition research could improve national resilience against chronic threats and acute crises.

T761

143763-143899

Sentence

denotes

The COVID-19 pandemic highlights the need to have a coordinated, vigorous scientific research infrastructure before crises strike (3–8).

T762

143900-144086

Sentence

denotes

The bidirectional impacts between food and nutrition and COVID-19 have also revealed a vital new area for research and policy that requires significant investment and coordination (289).

T763

144087-144353

Sentence

denotes

In 2019, the Director of National Intelligence reported to Congress that our national disinvestment in science and technology is 1 of 10 global threats because, without the research to produce disruptive US technologies, we weaken our economic competitiveness (290).

T764

144354-144789

Sentence

denotes

A new structure for coordination of existing federal nutrition research, combined with a major new investment—for example, increasing federal nutrition funding by $1–2 billion or more each year—could together provide highly cost-effective approaches to addressing the poor health, rising disparities, spiraling health care costs, declining qualified military recruits, and other pressing food and agricultural challenges facing the US.

T765

144791-144844

Sentence

denotes

Options for Strengthening National Nutrition Research

T766

144845-145024

Sentence

denotes

Based on our review, a strengthened federal nutrition research effort is necessary and should be additive to and synergistic with existing efforts across departments and agencies.

T767

145025-145187

Sentence

denotes

Expanded coordination and investment in nutrition science, rather than a silo-ing of nutrition research or a rearrangement of existing investments, are essential.

T768

145188-145431

Sentence

denotes

Based on the documented burdens, current landscape of research and coordination efforts, and identified opportunities, we first identified 2 priority strategies to strengthen federal nutrition research, which we defined and reviewed in detail.

T769

145432-145454

Sentence

denotes

These were as follows:

T770

145455-145668

Sentence

denotes

1) a new authority for robust cross-governmental coordination of nutrition research and other nutrition-related policy and 2) strengthened authority, investment, and coordination for nutrition research within NIH.

T771

145669-145818

Sentence

denotes

These 2 strategies were identified as complementary, with benefits accruing independently and further synergies to be gained by joint implementation.

T772

145819-146049

Sentence

denotes

A third important, and further complementary, identified strategy was to strengthen authority, investment, and coordination at USDA for human nutrition research, food and agricultural research, education, extension, and economics.

T773

146050-146178

Sentence

denotes

To achieve success, a key identified theme was the need for not just additional investment but also new authority and structure.

T774

146179-146306

Sentence

denotes

Multiple assessments over many decades have identified the fundamental need to strengthen federal nutrition research in the US.

T775

146307-146755

Sentence

denotes

This includes, among others, the 1969 White House Conference; the 1977 Congressional call for improved coordination of human nutrition research; the 1983 creation of ICHNR; the 1994 Institute of Medicine report on nutrition and food sciences; the 1996 joint OSTP and the National Science and Technology Council (NSTC) report on health, safety, and food; the 2000 National Nutrition Summit; and more (Supplemental Table 5 and Supplemental Table 10).

T776

146756-146936

Sentence

denotes

Several within- and cross-agency convenings of federal departments and agencies have further identified critical shared interests and research gaps in nutrition research (Table 2).

T777

146937-147177

Sentence

denotes

Yet, the full intended impacts of these important efforts were mostly not achieved, in large part because they lacked any new federal structure with strong and sustained authority, robust coordination capacity, and dedicated appropriations.

T778

147178-147464

Sentence

denotes

The following sections describe the identified promising options for strengthening nutrition research through 1) increased cross-governmental coordination; 2) increased authority, investment, and coordination within NIH; and 3) increased authority, investment, and coordination at USDA.

T779

147465-147588

Sentence

denotes

The majority of these options are being set forth for the first time and, where possible, we reference comparable examples.

T780

147590-147689

Sentence

denotes

Identified cross-governmental coordination strategies for strengthening national nutrition research

T781

147690-147936

Sentence

denotes

Improved coordination between federal departments and agencies conducting nutrition research has tremendous potential for strengthening our nation's ability to achieve essential fundamental, clinical, public health, and translational discoveries.

T782

147937-148008

Sentence

denotes

Key identified strategies are summarized in Table 3 and reviewed below.

T783

148009-148111

Sentence

denotes

These options were not found to be mutually exclusive and could be even more effective in combination.

T784

148112-148231

Sentence

denotes

TABLE 3 Key cross-governmental coordination strategies for strengthening and accelerating national nutrition research1

T785

148232-148293

Sentence

denotes

Option Description Advantages Disadvantages Paths forward

T786

148294-148553

Sentence

denotes

New Office of the National Director of Food and Nutrition (ONDFN) President-appointed, Senate-confirmed Director, serving as the Principal Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military, and Congress

T787

148554-148619

Sentence

denotes

Modeled after the Office of the Director of National Intelligence

T788

148620-148738

Sentence

denotes

Coordinate and harmonize the work of the ≥10 US departments and agencies that comprise the federal nutrition community

T789

148739-148862

Sentence

denotes

Ensure that timely and objective national nutrition information is provided to key federal leaders Tested, effective model

T790

148863-148903

Sentence

denotes

Dedicated leadership, staff, and funding

T791

148904-149040

Sentence

denotes

Builds on the ICHNR, with much stronger coordination and synergies across departments and agencies and a stronger dissemination platform

T792

149041-149290

Sentence

denotes

Can be mobilized to advise on urgent situations (e.g., COVID-19) which require pre-existing robust leadership and coordination across departments and agencies Focus on multiple nutrition issues could dilute relative focus on research and innovation

T793

149291-149445

Sentence

denotes

May be too high-level to address on-the-ground infrastructure and investment needs of key research agencies Congressional authorization and appropriation

T794

149446-149512

Sentence

denotes

Presidential appointment of the Director, with Senate confirmation

T795

149513-149693

Sentence

denotes

New US Global Nutrition Research Program (USGNRP) Charged with improving coordination and integration of federal research on food and nutrition and the implications for the nation

T796

149694-149745

Sentence

denotes

Modeled after the US Global Change Research Program

T797

149746-149845

Sentence

denotes

Overseen by the Executive Office of the President and facilitated by a National Coordination Office

T798

149846-149973

Sentence

denotes

Funded by a small portion of relevant research budgets from the participating departments and agencies Tested, effective model

T799

149974-150012

Sentence

denotes

Dedicated structure, staff, and budget

T800

150013-150032

Sentence

denotes

Builds on the ICHNR

T801

150033-150274

Sentence

denotes

Renewed and clear mandate for coordination, with explicit requirements for strategic planning, rigorous assessments, and annual reporting Budget dependent on size and commitment of participating departments and agencies to its research area

T802

150275-150461

Sentence

denotes

Staffing dependent on detailed personnel from participating departments and agencies, reducing continuity Presidential Initiative (with or without subsequent Congressional codification)

T803

150462-150543

Sentence

denotes

Congressional authorization, ideally associated with Congressional appropriations

T804

150544-150724

Sentence

denotes

New Associate Director for Nutrition Science in the White House Office of Science and Technology Policy (OSTP) Non–cabinet-level position, President-appointed and Senate-confirmed

T805

150725-150798

Sentence

denotes

Serves as the President's advisor on issues related to nutrition research

T806

150799-150863

Sentence

denotes

Modeled after other Associate Director positions and initiatives

T807

150864-150988

Sentence

denotes

Provides high-level leadership and harmonization to leverage and translate federal and nonfederal nutrition research efforts

T808

150989-151182

Sentence

denotes

Identify and help develop more coordinated and innovative nutrition research initiatives Brings a key leader to the White House for improved coordination, communication, and strategic planning

T809

151183-151268

Sentence

denotes

Elevates work and impact of individual federal departments and agencies and the ICHNR

T810

151269-151350

Sentence

denotes

Can hire advisors, special assistants, and fellows to deepen expertise and impact

T811

151351-151581

Sentence

denotes

Creates collaborations with private sector, state and local governments, academic communities, other countries OSTP positions can vary greatly from one administration to the next, greatly limiting long-term continuity and success

T812

151582-151653

Sentence

denotes

OSTP initiatives may not align with focus or levels of research funding

T813

151654-151717

Sentence

denotes

Staffing often small, transient, and reliant on temporary staff

T814

151718-151842

Sentence

denotes

Success highly dependent on the skills and interests of the hired person Presidential appointment, with Senate confirmation

T815

151843-151973

Sentence

denotes

New US Task Force on Federal Nutrition Research Charged with improving coordination and integration of federal nutrition research

T816

151974-152060

Sentence

denotes

Modeled after the successful US Task Force for Combating Antibiotic-Resistant Bacteria

T817

152061-152195

Sentence

denotes

Co-chaired by the Secretaries of HHS, USDA, DoD, and possibly VA, with additional broad membership from other departments and agencies

T818

152196-152239

Sentence

denotes

Complementary Presidential Advisory Council

T819

152240-152366

Sentence

denotes

Would develop a 5-y National Action Plan with required annual reporting to the President on progress Tested, successful model

T820

152367-152441

Sentence

denotes

Executive Order would elevate federal prioritization of nutrition research

T821

152442-152466

Sentence

denotes

Cabinet-level leadership

T822

152467-152525

Sentence

denotes

Concrete National Action Plan with required annual reports

T823

152526-152573

Sentence

denotes

Advisory Council to leverage external expertise

T824

152574-152761

Sentence

denotes

Strengthen coordination, communication, and budgetary priorities toward the highest-impact shared agenda Presidential Executive Order often does not bring or align with dedicated funding

T825

152762-152852

Sentence

denotes

More transient in nature, with defined scope and time period Presidential Executive Order

T826

152853-152905

Sentence

denotes

Presidential directive to revise the ICHNR structure

T827

152906-152948

Sentence

denotes

Congressional inquiry on the above actions

T828

152949-153011

Sentence

denotes

Legislation to revise the ICHNR charge, structure, and funding

T829

153012-153218

Sentence

denotes

1 COVID-19, coronavirus disease 2019; DoD, Department of Defense; HHS, Department of Health and Human Services; ICHNR, Interagency Committee on Human Nutrition Research; VA, Department of Veterans Affairs.

T830

153220-153277

Sentence

denotes

New Office of the National Director of Food and Nutrition

T831

153278-153642

Sentence

denotes

Modeled after the Office of the Director of National Intelligence (ODNI) (291), but with a smaller budget and staffing scale, an Office of the National Director of Food and Nutrition (ONDFN) would provide essential coordination and harmonization of the work of the ≥10 US departments and agencies comprising the federal nutrition community (Supplemental Figure 3).

T832

153643-153855

Sentence

denotes

ODNI is a crucial office created as part of the Intelligence Reform and Terrorism Prevention Act of 2004 (Public Law 108–458) to lead and integrate the diverse intelligence efforts of 16 departments and agencies.

T833

153856-154041

Sentence

denotes

Working as one team, ODNI helps synchronize intelligence collection, analysis, and counterintelligence, forging a harmonized system to deliver the most insightful intelligence possible.

T834

154042-154327

Sentence

denotes

ODNI prioritizes intelligence-community-wide mission requirements, manages strategic investments to foster innovation and efficiency, evaluates the effectiveness of intelligence programs and spending, and absorbs new missions and develops new capabilities without adding to staff size.

T835

154328-154432

Sentence

denotes

Nearly half (40%) of ODNI staff are on rotation from 1 of the 16 participating departments and agencies.

T836

154433-154606

Sentence

denotes

Of note, the combined budgets of ODNI members ($50 billion/y) are of a similar scale as the overall current nutrition-related programs (including research) of ICHNR members.

T837

154607-154856

Sentence

denotes

ONDFN would be led by a new, cabinet-level Director of National Food and Nutrition, serving as the Principal Food and Nutrition Advisor to the White House, heads of executive branch departments and agencies, senior military commanders, and Congress.

T838

154857-155680

Sentence

denotes

Similar to ODNI, ONDFN functions would include reviewing and coordinating priorities and strategies to maximize nutrition research efforts across various federal investments; establishing objectives and priorities for the collection, analysis, and dissemination of national nutrition monitoring and surveillance; ensuring provision of accurate and timely nutrition information to decision makers; evaluating and improving the effectiveness and synergies of federal nutrition research and policy efforts; overseeing the coordination of external advisory groups and public–private partnerships around nutrition research and policy; developing policies and programs to leverage the distinct efforts of departments and agencies around nutrition; and developing and reporting on performance goals and program milestone criteria.

T839

155682-155692

Sentence

denotes

Advantages

T840

155693-155855

Sentence

denotes

This tested and successful model is on a comparable area of national importance and with a similar size and breadth of relevant involved departments and agencies.

T841

155856-155965

Sentence

denotes

ONDFN would build on ICHNR, but with a much stronger platform to create effective coordination and synergies.

T842

155966-156181

Sentence

denotes

ONDFN would deliver relevant harmonized information to the President, Cabinet, other executive branch leadership, senior military commanders, and Congress for developing policy, programmatic, and budget initiatives.

T843

156182-156452

Sentence

denotes

A clear Congressional mandate would provide cross-agency coordination of strategic planning, programmatic review, annual reporting and quadrennial assessments to the President, Congress, and other key stakeholders, budgetary needs, and external research and cooperation.

T844

156453-156538

Sentence

denotes

There could also be additional Congressional oversight as needed and interests arise.

T845

156539-156733

Sentence

denotes

ONDFN would also provide dedicated leadership and staff in the executive branch cabinet for federal nutrition research and policy, providing a crucial bridge between research and implementation.

T846

156734-157046

Sentence

denotes

These activities and personnel would more efficiently and effectively help identify topics of strategic interest across multiple departments and agencies with significant impact and feasibility, and advance emerging opportunities to accelerate progress across new fundamental and transactional scientific topics.

T847

157047-157265

Sentence

denotes

A broad focus would increase synergies, shared priorities, and effectiveness and efficiency of different departments and agencies engaged in activities related to innovation in nutrition, agriculture, and food systems.

T848

157266-157455

Sentence

denotes

Like ODNI, a meaningful number of staff would be drawn from existing departments and agencies, creating budgetary efficiencies while maximizing cross-fertilization of ideas and innovations.

T849

157456-157795

Sentence

denotes

ONDFN would have the infrastructure and authority necessary for true cross-department/agency coordination—for example, to develop a modernized approach to the nexus between the agriculture-food-health value chain—including research, policy, and practice from farm inputs and food processing/production to consumer behavior to human health.

T850

157796-158337

Sentence

denotes

ONDFN would also advance the coordination for communication of trusted nutrition information to the American public, which occurs across separate departments and agencies including CMS and VHA (health care providers), USDA (DGAs, SNAP-Ed, WIC education, food safety for meat and poultry), FDA (food safety for other foods, Nutrition Facts, health claims, package warning labels, restaurant menu labeling), NIH (scientific studies), DoE (nutrition and STEM curricula), CDC (school, community, and public health nutrition education), and more.

T851

158338-158465

Sentence

denotes

This would help meet the almost explosive growth in public demand for better information on the science of diet-related health.

T852

158466-158730

Sentence

denotes

ONDFN would combine a national food strategy with coordinated new science, considered crucial to better harmonize law and policymaking around food and agriculture, food safety and nutrition research, and establishing, prioritizing, and pursuing common goals (292).

T853

158731-158895

Sentence

denotes

Such a strategic plan would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success across its purview.

T854

158896-159201

Sentence

denotes

A high-level, cross-governmental structure like ONDFN would also be crucial for effective and timely responses on urgent nutrition and food challenges during complex situations like COVID-19, which require immediate and ongoing leadership and coordination at the highest levels of the government (9, 293).

T855

159203-159216

Sentence

denotes

Disadvantages

T856

159217-159321

Sentence

denotes

This new position and office would require Congressional (legislative) authorization and appropriations.

T857

159322-159531

Sentence

denotes

As a cabinet-level office, ONDFN would naturally focus on major federal nutrition issues beyond research (e.g., nutrition assistance programs), which could dilute its relative focus on research and innovation.

T858

159532-159730

Sentence

denotes

ONDFN may also be too politically high-level to directly address ways to strengthen on-the-ground infrastructural and investment needs within key federal nutrition research departments and agencies.

T859

159732-159744

Sentence

denotes

Path forward

T860

159745-159945

Sentence

denotes

Congress can authorize the establishment of ONDFN to advise the President on food and nutrition and lead the coordination of multiple federal departments and agencies, policies, budgets, and programs.

T861

159946-160035

Sentence

denotes

The mandate should include a clear emphasis on strengthening national nutrition research.

T862

160036-160162

Sentence

denotes

Congress would also appropriate funding to establish this Office and then provide annual appropriations directly to the ONDFN.

T863

160163-160346

Sentence

denotes

Congress would also indicate the required frequency of reporting (e.g., annual reporting and quadrennial assessments) and indicate the committees of oversight in the House and Senate.

T864

160347-160424

Sentence

denotes

The President would then appoint the National Director of Food and Nutrition.

T865

160426-160466

Sentence

denotes

New US Global Nutrition Research Program

T866

160467-160679

Sentence

denotes

A new US Global Nutrition Research Program (USGNRP) would be charged with improving coordination and integration of federal research on food and nutrition and implications for the country (Supplemental Figure 4).

T867

160680-160921

Sentence

denotes

The USGNRP would be modeled after the successful US Global Change Research Program (USGCRP), established in 1989 by a Presidential Initiative and codified in Congress through the Global Change Research Act of 1990 (Public Law 101–606) (294).

T868

160922-161108

Sentence

denotes

This Act required a comprehensive and integrated US research program to assist the nation to assess, predict, and respond to human-induced and natural processes of global climate change.

T869

161109-161402

Sentence

denotes

Bringing together 13 departments and agencies, USGCRP is steered by the Subcommittee on Global Change Research under the Committee on Environment, Natural Resources, and Sustainability, overseen by the Executive Office of the President, and facilitated by a National Coordination Office (295).

T870

161403-161537

Sentence

denotes

USGCRP has its own budget that mainly supports the National Coordination Office, staffed with professional coordination support staff.

T871

161538-161689

Sentence

denotes

USGCRP is supported by statute through small apportions of participating departments’ and agencies’ research funding dedicated to climate issues (296).

T872

161690-161901

Sentence

denotes

Guided by a series of multi-stakeholder strategic plans since 1989 (297), the efforts of participating departments and agencies are coordinated through Interagency Working Groups that span interconnected topics.

T873

161902-162390

Sentence

denotes

Annual USGCRP reports and other scientific assessments and resources highlight key program accomplishments, such as observing and understanding changes in climate, the ozone layer, and land cover; identifying impacts of these changes on ecosystems and society; estimating future changes in the physical environment, and associated vulnerabilities and risks; and providing scientific information to enable effective decision making to address corresponding threats and opportunities (297).

T874

162391-162487

Sentence

denotes

Similar to USGCRP, USGNRP leadership would be overseen by the Executive Office of the President.

T875

162488-162749

Sentence

denotes

Likewise, its National Coordination Office would be staffed by dedicated staff and temporary (“detailed”) staff from participating departments and agencies, and funded by small portions of relevant research budgets from each participating department and agency.

T876

162750-163186

Sentence

denotes

In addition to current ICHNR members, USGNRP could include a more contemporary vision of federal stakeholders who engage with and leverage nutrition research, such as CMS, CMMI, HHS Office of the Surgeon General, FEMA, and Departments of Veterans Affairs, Education, Energy, Transportation, Labor, Homeland Security, Housing and Urban Development, Interior, and Justice (e.g., related to optimal nutrition in the federal prison system).

T877

163187-163538

Sentence

denotes

Like USGCRP, functions of USGNRP would include multi-stakeholder–informed strategic planning; Inter-agency Working Groups to identify and coordinate shared priority research and translation; assessment and modernization of nutrition monitoring and surveillance; and creating partnerships with academic, private, and international science stakeholders.

T878

163540-163550

Sentence

denotes

Advantages

T879

163551-163625

Sentence

denotes

This is a tested, successful model on a similarly crucial area of science.

T880

163626-163747

Sentence

denotes

USGNRP could build on ICHNR but with the establishment of a dedicated budget from participating departments and agencies.

T881

163748-163886

Sentence

denotes

Through strategic planning, new and additive budget initiatives could be formulated and implemented through more sustained appropriations.

T882

163887-164227

Sentence

denotes

Compared with ICHNR, USGNRP would have a renewed and clear mandate around improved coordination and harmonization, with explicit requirements for programmatic review, strategic planning, annual reporting, fiscal coordination on new initiatives, quadrennial assessments submitted to the President, and international research and cooperation.

T883

164228-164486

Sentence

denotes

Like ONDFN, USGNRP activities would more efficiently and effectively identify topics that resonate across multiple departments and agencies with significant population impact and feasibility, while advancing emerging scientific opportunities and discoveries.

T884

164487-164656

Sentence

denotes

Also like ONDFN, a strategic planning process would create transparency and accountability, including tasks of identifying and monitoring budgets and metrics of success.

T885

164657-164809

Sentence

denotes

ICHNR subcommittees could be transitioned to Interagency Working Groups to effectively and efficiently foster cross-department and cross-agency actions.

T886

164810-164971

Sentence

denotes

As one example, a new DGA Interagency Working Group would have a stronger charge and dedicated staff to address new research needs identified by the latest DGAC.

T887

164972-165137

Sentence

denotes

Like USGCRP, the participating USGNRP departments and agencies would utilize a National Coordination Office to help produce high-level and informative reports (298).

T888

165138-165405

Sentence

denotes

USGNRP would also intersect with other high-level coordinating structures, such as USGCRP's Interagency Working Group on Climate Change and Health, to enable effective and rapid responses to acute threats such as COVID-19, other pandemics, or other future challenges.

T889

165407-165420

Sentence

denotes

Disadvantages

T890

165421-165739

Sentence

denotes

If based on the USGCRP appropriations model, USGCRP would be funded by a legislative mandate for contributions by participating members (rather than any new appropriations), so its budget would vary with the size and consistency of commitment of participating departments or agencies to its research areas of interest.

T891

165740-165892

Sentence

denotes

Ideally, Congress would also authorize and appropriate some core funding for USGNRP, although no new, dedicated funding has emerged for USGCRP thus far.

T892

165893-166056

Sentence

denotes

Also, significant staffing in the National Coordination Office would be temporary (“detailed”) personnel from participating members, which could reduce continuity.

T893

166058-166070

Sentence

denotes

Path forward

T894

166071-166156

Sentence

denotes

USGNRP could be established by a Presidential Initiative, without legislative action.

T895

166157-166232

Sentence

denotes

For longer-term success, Congress could later codify USGNRP into law (296).

T896

166233-166315

Sentence

denotes

Alternatively, Congress could directly establish USGNRP (e.g., in place of ICHNR).

T897

166316-166411

Sentence

denotes

In any of these cases, separate Congressional appropriations are not needed but would be ideal.

T898

166413-166473

Sentence

denotes

New Associate Director for Nutrition Science within the OSTP

T899

166474-166714

Sentence

denotes

A new OSTP Associate Director for Nutrition Science would be a non–cabinet-level position, President-appointed and Senate-confirmed, who would serve as the President's advisor on issues related to nutrition research (Supplemental Figure 5).

T900

166715-166987

Sentence

denotes

OSTP, established by Congress in 1976, has a broad mandate “to provide, within the Executive Office of the President, advice on the scientific, engineering, and technological aspects of issues that require attention at the highest level of Government” (Public Law 94–282).

T901

166988-167319

Sentence

denotes

OSTP advises the President on science and technology topics related to domestic and international affairs, leads interagency efforts to develop and implement sound science and technology policies and budgets, and works with the private sector, state and local governments, science and academic communities, and other nations (299).

T902

167320-167466

Sentence

denotes

In addition to the Director, Congress provides the President the authority to appoint up to 4 Associate Directors, subject to Senate confirmation.

T903

167467-167599

Sentence

denotes

The statute provides great flexibility to the President with respect to corresponding areas of focus, expertise, and responsibility.

T904

167600-167743

Sentence

denotes

Under President George W Bush, there were 2 Associate Directors—one focused on science and the other on technology—each with a Deputy Director.

T905

167744-167891

Sentence

denotes

The Clinton Administration had 4 Associate Directors, focused on science, technology, environment, and national security and international affairs.

T906

167892-168165

Sentence

denotes

President Obama's 4 Associate Directors focused on similar areas, with additional joint appointments of OSTP staff to the National Economic Council, National Security Council (NSC), Domestic Policy Council (DPC), and White House Office of Management and Budget (OMB) (300).

T907

168166-168437

Sentence

denotes

President Trump's OSTP Director, confirmed in January 2019, has expressed interest in military readiness and national security, communication networks, energy and environmental leadership, health and bioeconomic innovation, and space exploration, among other areas (301).

T908

168438-168578

Sentence

denotes

President Trump has appointed only 1 Associate Director, confirmed in August 2019, who also serves as the US Chief Technology Officer (302).

T909

168579-168697

Sentence

denotes

Prior OSTPs have had advisors on nutrition and, at the highest level, an Assistant Director of Nutrition in 2014–2015.

T910

168698-168769

Sentence

denotes

However, OSTP has never had an Associate Director of Nutrition Science.

T911

168770-169134

Sentence

denotes

Modeled after other Associate Directors, the Associate Director for Nutrition Science would provide high-level leadership to leverage and translate federal and nonfederal nutrition science efforts, identify and help develop more coordinated and innovative nutrition research initiatives, and advise the President on corresponding national and international issues.

T912

169136-169146

Sentence

denotes

Advantages

T913

169147-169325

Sentence

denotes

OSTP has a long history of identifying and elevating science and technology opportunities for the President to help shape policy, programmatic, and resource allocation decisions.

T914

169326-169426

Sentence

denotes

OSTP advises the OMB on research and development programs for annual White House budgetary requests.

T915

169427-169534

Sentence

denotes

For example, OSTP support was instrumental to the doubling of the NIH's budget between 1998 and 2003 (303).

T916

169535-169683

Sentence

denotes

OSTP can lead important coordination activities and reports among different federal departments and agencies as well as external stakeholders (304).

T917

169684-169878

Sentence

denotes

An Associate Director of Nutrition Science provides a key leader to the White House to improve coordination, communication, and strategic planning around key priority areas in nutrition science.

T918

169879-170033

Sentence

denotes

The Associate Director would also work closely with and elevate the communication and impact of individual federal departments and agencies and the ICHNR.

T919

170034-170296

Sentence

denotes

The Associate Director can hire advisors, special assistants, or White House fellows to deepen expertise and impact and can lead efforts to create new collaborations with the private sector, state and local governments, academic communities, and other countries.

T920

170297-170411

Sentence

denotes

Legislative action is not required; the President can simply assign 1 of the 4 allocated Associate Director slots.

T921

170413-170426

Sentence

denotes

Disadvantages

T922

170427-170568

Sentence

denotes

OSTP positions and areas of focus can dramatically change across administrations, greatly diminishing continuity and long-term effectiveness.

T923

170569-170693

Sentence

denotes

OSTP staffing is often small, transient, and reliant on temporary (“detailed”) staff from relevant departments and agencies.

T924

170694-170964

Sentence

denotes

Success of this approach would be highly dependent on the skills and interests of the new Associate Director, rather than any concrete or consistent structure or process for strengthening federal nutrition research through increased coordination, funding, and alignment.

T925

170965-171037

Sentence

denotes

OSTP initiatives may not align with focus or levels of research funding.

T926

171039-171051

Sentence

denotes

Path forward

T927

171052-171146

Sentence

denotes

A President can appoint an Associate Director for Nutrition Science, with Senate confirmation.

T928

171147-171528

Sentence

denotes

Congress can also recommend a specific Associate Director focus, although recent recommendations were not successful [e.g., the 110th Congress recommended an Associate Director for Earth Science and Applications (Senate 1745), and the 111th Congress recommended an Associate Director and Coordinator for Societal Dimensions of Nanotechnology (House of Representatives 5116)] (299).

T929

171530-171577

Sentence

denotes

New US Task Force on Federal Nutrition Research

T930

171578-171955

Sentence

denotes

A new US Task Force on Federal Nutrition Research would be charged with improving coordination and integration of federal nutrition research—for example, modeled after other timely US task forces such as on Combating Antibiotic-Resistant Bacteria (305); on Veteran Wellness, Empowerment, and Suicide Prevention (306); or on Combating Drug Addiction and the Opioid Crisis (307).

T931

171956-172155

Sentence

denotes

As an example, in 2013, CDC, G7, and WHO each released reports or statements on the importance of dedicated prevention and infection-control efforts for antibiotic-resistant bacteria (305, 308, 309).

T932

172156-172316

Sentence

denotes

In 2014, a Presidential Executive Order established combating antibiotic-resistant bacteria as a federal priority and created a new high-level task force (310).

T933

172317-172548

Sentence

denotes

This Task Force for Combating Antibiotic-Resistant Bacteria was co-chaired by the Secretaries of HHS, USDA, and DoD, with representatives from Departments of State, DoJ, VA, and DHS and the EPA, USAID, OMB, DPC, NSC, OSTP, and NSF.

T934

172549-172664

Sentence

denotes

Its functions included developing a 5-y National Action Plan and reporting to the President on the plan's progress.

T935

172665-172941

Sentence

denotes

In addition, a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria composed of up to 30 members, appointed or designated by the co-chairs, was required to help advise the task force, culminating in a report to the President with recommended actions (311).

T936

172942-173224

Sentence

denotes

The resulting National Action Plan, put forward in 2015, continues to guide federal actions toward a coordinated response to this pressing public health issue, directing efforts, personnel, and funding of participating departments and agencies toward a common critical agenda (312).

T937

173225-173516

Sentence

denotes

Modeled on that successful task force, the leadership, members, and general functions of a Task Force on Federal Nutrition Research would develop and report to the President on a major new National Action Plan for accelerating and strengthening nutrition discoveries (Supplemental Figure 6).

T938

173517-173671

Sentence

denotes

Co-chairs could include HHS, USDA, and DoD (and perhaps VA) Secretaries, with additional broad representation from other diverse departments and agencies.

T939

173672-173882

Sentence

denotes

A complementary Presidential Advisory Council on Nutrition Research would include expert members appointed by the co-chairs to advise the task force and provide a report of recommended actions to the President.

T940

173883-173995

Sentence

denotes

This task force could also work well with ONDFN and/or the Associate Director of Nutrition Sciences in the OSTP.

T941

173997-174007

Sentence

denotes

Advantages

T942

174008-174199

Sentence

denotes

This is a tested, successful model on an area of science with some similarities, including multiple relevant federal departments and agencies and a need for international collaboration (313).

T943

174200-174368

Sentence

denotes

The Presidential Executive Order would appropriately elevate the prioritization of nutrition research, create a concrete action plan, and include reporting on progress.

T944

174369-174501

Sentence

denotes

The task force would benefit from cross-governmental cabinet-level leadership and include diverse relevant departments and agencies.

T945

174502-174603

Sentence

denotes

The high-level Advisory Council provides a formal mechanism to leverage external expertise and input.

T946

174604-174748

Sentence

denotes

These elements would together strengthen coordination and communication of existing important research efforts toward the highest impact agenda.

T947

174749-174883

Sentence

denotes

Task force activities and reporting would help inform and amplify research budgets directed to participating departments and agencies.

T948

174884-174927

Sentence

denotes

This approach does not require legislation.

T949

174929-174942

Sentence

denotes

Disadvantages

T950

174943-175072

Sentence

denotes

Despite its successes, no new funding was provided nor has emerged for the Task Force on Combating Antibiotic-Resistant Bacteria.

T951

175073-175155

Sentence

denotes

That task force also has not developed any coordinated budget initiatives to date.

T952

175156-175360

Sentence

denotes

A Presidential Executive Order remains in effect only until revoked, although it can endure across administrations (e.g., the Task Force for Combating Antibiotic-Resistant Bacteria has remained in place).

T953

175361-175502

Sentence

denotes

A task force would likely have a defined scope over a set time period, and not provide sustained leadership and coordination into the future.

T954

175504-175516

Sentence

denotes

Path forward

T955

175517-175663

Sentence

denotes

The President can issue an Executive Order to establish nutrition research as a priority and create a US Task Force on Federal Nutrition Research.

T956

175664-175809

Sentence

denotes

The President can also direct the heads of OSTP, DPC, and NSC to revise ICHNR coordination structure to more closely follow the Task Force model.

T957

175810-176088

Sentence

denotes

Congress could also initiate such a task force by inquiring with the Executive Office of the President or with the relevant department and agency leadership about updating ICHNR or a potential new Presidential Executive Order or directive around nutrition research coordination.

T958

176089-176243

Sentence

denotes

Congress could also revise the charge, structure, and funding of ICHNR via legislation to create appropriate activities consistent with such a task force.

T959

176245-176281

Sentence

denotes

Other new cross-governmental options

T960

176282-176676

Sentence

denotes

At the cabinet level, the Joint Chiefs of Staff could be called upon to focus on necessary nutrition research to address escalating diet-related health burdens on military readiness and national security (25, 86, 92, 314–318), leading coordinated efforts across DoD, other ICHNR members, and the National Collaborative on Childhood Obesity Research (Supplemental Text 2, Supplemental Figure 7).

T961

176677-176914

Sentence

denotes

Congress could amend the National Nutrition Monitoring and Related Research Act of 1990 (Public Law 101–445) to authorize and appropriate a specific funding stream for the DGAs, DRIs, and associated monitoring and surveillance processes.

T962

176915-177233

Sentence

denotes

HHS could mobilize existing or new positions within the Office of the Assistant Secretary of Health (e.g., a new HHS Office of Nutrition, modeled after the HHS Office of Women's Health or Office of Infectious Disease and HIV/AIDS Policy) to coordinate nutrition research needs and opportunities within and outside HHS.

T963

177234-177453

Sentence

denotes

An ongoing GAO evaluation of federal policies and activities in relation to diet-related diseases and their economic burdens (319) may provide additional recommendations for increased coordination of nutrition research.

T964

177454-177733

Sentence

denotes

Congress could authorize and appropriate funds for NASEM to assess the gaps and options to strengthen and coordinate federal nutrition research to address escalating diet-related health burdens and related economic, equity, national security, and sustainability challenges (320).

T965

177734-177898

Sentence

denotes

Congress could appoint a global health coordinator to lead a new interagency council that reaffirms domestic and global health as a core national security interest.

T966

177899-178065

Sentence

denotes

The coordinator and council would be charged with developing strategic plans to detect and prevent acute and chronic health threats, such as new infectious pandemics.

T967

178066-178292

Sentence

denotes

Such a focus should incorporate the critical role of food and nutrition in population health and resilience, including against infectious diseases, and appropriate and coordinate the necessary activities for relevant research.

T968

178294-178365

Sentence

denotes

Identified NIH strategies for strengthening national nutrition research

T969

178366-178540

Sentence

denotes

As the nation's largest funder of research, NIH is one essential (although not exclusive) home for increased authority, coordination, and funding for nutrition science (110).

T970

178541-178820

Sentence

denotes

Any new NIH strategy must leverage and amplify, not replace or compete with, existing extramural and intramural nutrition research efforts across the 27 current NIH institutes, centers, or offices or with existing nutrition research across other federal departments and agencies.

T971

178821-178892

Sentence

denotes

Key identified strategies are summarized in Table 4 and reviewed below.

T972

178894-178929

Sentence

denotes

New National Institute of Nutrition

T973

178930-179089

Sentence

denotes

A new NIH National Institute of Nutrition (NIN) would be additive to the 27 current institutes and centers leading research within NIH (Supplemental Figure 8).

T974

179090-179349

Sentence

denotes

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).

T975

179350-179543

Sentence

denotes

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.

T976

179544-179733

Sentence

denotes

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.

T977

179734-179885

Sentence

denotes

This would increase harmonization, collaboration, and leveraging of all nutrition-related research programs across NIH institutes, centers and offices.

T978

179886-180137

Sentence

denotes

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.

T979

180138-180350

Sentence

denotes

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.

T980

180351-180585

Sentence

denotes

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.

T981

180586-180688

Sentence

denotes

TABLE 4 Key strategies within the NIH for strengthening and accelerating national nutrition research1

T982

180689-180750

Sentence

denotes

Option Description Advantages Disadvantages Paths forward

T983

180751-180908

Sentence

denotes

New National Institute of Nutrition (NIN)2 Leads research, coordination, training, outreach on foundational and cross-cutting topics in nutrition and health

T984

180909-181002

Sentence

denotes

Additive focus areas and funding to existing NIH and other federal nutrition research efforts

T985

181003-181106

Sentence

denotes

Harmonizes and leverages other nutrition and related research at NIH and other agencies and departments

T986

181107-181267

Sentence

denotes

Strong 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

T987

181268-181353

Sentence

denotes

Promotes and supports training of a diverse 21st century nutrition research workforce

T988

181354-181478

Sentence

denotes

Guides and supports training of health care professionals for clinical care and basic and translational science in nutrition

T989

181479-181553

Sentence

denotes

Translates and disseminates sound nutrition science findings to the public

T990

181554-181671

Sentence

denotes

Fosters innovative external collaborations and partnerships Strong leadership, robust infrastructure, and investment

T991

181672-181759

Sentence

denotes

Can better address nutrition science that is cross-cutting rather than disease specific

T992

181760-181838

Sentence

denotes

Includes extramural and intramural research, training, and outreach activities

T993

181839-182017

Sentence

denotes

A long-term structure, leading to unanticipated positive returns, outlasting shorter-term options, and evolving appropriately with changing science and needs of the US population

T994

182018-182103

Sentence

denotes

Meaningful external advisory mechanism to solicit diverse relevant insights and input

T995

182104-182305

Sentence

denotes

Strong 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

T996

182306-182351

Sentence

denotes

Could increase silo-ing of nutrition research

T997

182352-182453

Sentence

denotes

Would need to navigate potentially entrenched cultures and perspectives around NIN nutrition research

T998

182454-182669

Sentence

denotes

Without 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

T999

182670-182815

Sentence

denotes

Congressional inquiry and/or appropriations could explore the current status of federal nutrition research and potential options including an NIN

T1000

182816-183026

Sentence

denotes

New 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)

T1001

183027-183182

Sentence

denotes

Modeled after the NIH Office of Disease Prevention (ODP), Office of Dietary Supplements (ODS), or Office of Behavioral and Social Sciences Research (OBSSR)

T1002

183183-183440

Sentence

denotes

Would 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

T1003

183441-183501

Sentence

denotes

Plan and coordinate trans-NIH nutrition research initiatives

T1004

183502-183705

Sentence

denotes

Lead 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

T1005

183706-183848

Sentence

denotes

Director of the NIH Office of Nutrition Research would also serve as the Associate Director of Nutrition Research Legislation is not required

T1006

183849-183955

Sentence

denotes

Elevates the leadership, staffing, resources, and capacities of this important area within and outside NIH

T1007

183956-184102

Sentence

denotes

Reestablishes close communication and coordination with the NIH Director and the other divisions and offices within the NIH Office of the Director

T1008

184103-184180

Sentence

denotes

Increases capacity and expertise for dissemination of sound nutrition science

T1009

184181-184227

Sentence

denotes

Can engage strong external advisory mechanisms

T1010

184228-184283

Sentence

denotes

Some dedicated funding to stimulate research across NIH

T1011

184284-184324

Sentence

denotes

Not viewed as serving only one institute

T1012

184325-184697

Sentence

denotes

Ability 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

T1013

184698-184783

Sentence

denotes

Insufficient independent funding to stimulate major extramural or intramural research

T1014

184784-184895

Sentence

denotes

Inadequate authority and resources to support new national training of scientists and health care professionals

T1015

184896-185075

Sentence

denotes

Budgets, 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

T1016

185076-185198

Sentence

denotes

Congress can authorize (ideally with new appropriations) the creation of this office within the NIH Office of the Director

T1017

185199-185356

Sentence

denotes

New Trans-NIH Initiative(s) in Nutrition Research An initiative across multiple NIH institutes and centers around a specific focused priority research topic

T1018

185357-185483

Sentence

denotes

Modeled after several examples such as the BRAIN Initiative, “All of Us” Research Program, or the NIH Human Microbiome Project

T1019

185484-185563

Sentence

denotes

Can be supported by dedicated staff within NIH and other federal working groups

T1020

185564-185665

Sentence

denotes

Dedicated funding to support intramural and extramural research, training, and technology development

T1021

185666-185754

Sentence

denotes

Can help create new or enhanced public–private partnerships Legislation is not required

T1022

185755-185793

Sentence

denotes

Helps galvanize NIH around a key topic

T1023

185794-185979

Sentence

denotes

Often preceded by a comprehensive and separately useful review of relevant leadership, staffing, funding, external advisory mechanisms, and collaborative approaches available across NIH

T1024

185980-186082

Sentence

denotes

Brings new strategic planning, workgroups, funding opportunities, training, and technology development

T1025

186083-186245

Sentence

denotes

Valuable when combined with other NIH options, above Only covers one focused topic, while needs and opportunities across nutrition research are broad and complex

T1026

186246-186372

Sentence

denotes

Unlikely to provide the sustained leadership, coordination, and resources to grasp the critical science gaps and opportunities

T1027

186373-186505

Sentence

denotes

Generally time-limited and not sustained Can be established by the NIH Office of the Director with support from the NIH Common Fund

T1028

186506-186574

Sentence

denotes

Can be established by Congressional authorization and appropriations

T1029

186575-186668

Sentence

denotes

1 These strategies include key organizational structures successfully used within NIH (322).

T1030

186669-186829

Sentence

denotes

Importantly, these different options are not mutually exclusive, but can be implemented in combination to create synergies and leverage complementary strengths.

T1031

186830-187030

Sentence

denotes

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.

T1032

187031-187554

Sentence

denotes

2 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).

T1033

187555-187837

Sentence

denotes

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.

T1034

187838-188101

Sentence

denotes

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).

T1035

188102-188365

Sentence

denotes

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.

T1036

188366-188557

Sentence

denotes

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.

T1037

188558-188767

Sentence

denotes

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.

T1038

188768-189029

Sentence

denotes

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).

T1039

189030-189311

Sentence

denotes

NIN 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.

T1040

189312-189498

Sentence

denotes

For example, this role could include development of joint requests with USDA for applications investigating the interlinkages between food, nutrition, health, and agricultural practices.

T1041

189499-189649

Sentence

denotes

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.

T1042

189650-190019

Sentence

denotes

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.

T1043

190020-190192

Sentence

denotes

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).

T1044

190193-190362

Sentence

denotes

Such joint initiatives will have the greatest impact if nutrition research at these other departments and agencies were simultaneously strengthened with new investments.

T1045

190363-190565

Sentence

denotes

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.

T1046

190567-190577

Sentence

denotes

Advantages

T1047

190578-190736

Sentence

denotes

NIN would add strong authority, infrastructure, investment, and external advisory mechanisms for nutrition research to the nation's largest funder of science.

T1048

190737-190840

Sentence

denotes

NIN would require a Federal Advisory Committee (Council) and would have a budget and funding authority.

T1049

190841-191053

Sentence

denotes

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.

T1050

191054-191206

Sentence

denotes

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).

T1051

191207-191578

Sentence

denotes

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.

T1052

191579-191853

Sentence

denotes

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.

T1053

191854-192004

Sentence

denotes

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.

T1054

192005-192198

Sentence

denotes

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.

T1055

192200-192213

Sentence

denotes

Disadvantages

T1056

192214-192480

Sentence

denotes

The 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.

T1057

192481-192701

Sentence

denotes

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.

T1058

192702-192902

Sentence

denotes

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.

T1059

192903-193058

Sentence

denotes

Congressional appropriations for expanded nutrition research funding within and outside NIH would be needed to prevent increased competition for resources.

T1060

193060-193072

Sentence

denotes

Path forward

T1061

193073-193260

Sentence

denotes

Congress 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.

T1062

193261-193513

Sentence

denotes

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 NIN.

T1063

193515-193557

Sentence

denotes

New National Center for Nutrition Research

T1064

193558-193833

Sentence

denotes

As a smaller model than a new institute, a new NIH National Center for Nutrition Research (NCNR) could be created, representing a 28th institute or center at NIH that would be broadly similar to a new NIN, although with less stature, staff, and funding (Supplemental Text 3).

T1065

193834-193919

Sentence

denotes

The NCNR could aim to accomplish many of the same goals as an NIN, on a lesser scale.

T1066

193920-194026

Sentence

denotes

Advantages, disadvantages, and the path forward for NCNR are likewise similar, on a reduced scale, to NIN.

T1067

194027-194127

Sentence

denotes

Long term, the NCNR could further evolve into an institute, as has happened to other centers at NIH.

T1068

194128-194348

Sentence

denotes

However, if a research area is of sufficient national priority that it may transition into an institute within a decade or less, then starting as a center can be inefficient, compared with directly creating an institute.

T1069

194349-194598

Sentence

denotes

For example, both the National Institute of Minority Health and Health Disparities (NIMHD) and National Institute of Nursing Research (NINR) were founded as centers but transitioned into institutes within ≤10 y (Public Laws 111–148, 99–158, 103–43).

T1070

194600-194649

Sentence

denotes

New NIH ONR within the NIH Office of the Director

T1071

194650-194867

Sentence

denotes

This option would return ONR to the NIH Office of the Director (Supplemental Figure 9) (326), the central entity for setting NIH policy and planning and for managing and coordinating NIH programs and activities (327).

T1072

194868-195015

Sentence

denotes

Multiple offices and divisions within the NIH Office of the Director function together to identify opportunities and needs across the agency (328).

T1073

195016-195153

Sentence

denotes

The NIH ONR can be modeled after other Congressionally mandated offices within the NIH Office of the Director (see “Path forward” below).

T1074

195154-195338

Sentence

denotes

Each of these lead and coordinate trans-NIH efforts, guided by an Office director, dedicated expert staff (ranging from 15 to 30 full-time employees), and specific budgetary resources.

T1075

195339-195562

Sentence

denotes

Like the NIH Office of Disease Prevention Director who also serves as the Associate Director for Prevention (Public Law 99–158), the Director of the NIH ONR would also serve as the Associate Director for Nutrition Research.

T1076

195563-195837

Sentence

denotes

The NIH ONR would lead efforts to build and coordinate new collaborative relationships and synergies within the NIH, with other federal departments and agencies, and with external stakeholders including public–private partnerships to drive nutrition research and innovation.

T1077

195838-196060

Sentence

denotes

The NIH ONR would lead 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.

T1078

196061-196384

Sentence

denotes

The new office would plan and coordinate relevant trans-NIH initiatives (see below), such as supported by the NIH Common Fund, a “venture” fund within the NIH Office of the Director, which aims to propel high-risk, high-reward research to speed scientific discovery and translation to improve health at a faster pace (329).

T1079

196385-196517

Sentence

denotes

The new office would develop approaches and resources to support analyses and reporting of nutrition research portfolios across NIH.

T1080

196519-196529

Sentence

denotes

Advantages

T1081

196530-196696

Sentence

denotes

Restoring the ONR into the NIH Office of the Director would elevate the leadership, staffing, resources, and capacities of this important area within and outside NIH.

T1082

196697-196928

Sentence

denotes

This structure would reestablish close communication and coordination with the NIH Director, other divisions and offices within the NIH Office of the Director, and the nutrition activities across all the NIH institutes and centers.

T1083

196929-197099

Sentence

denotes

This is particularly important for identification and prioritization of concrete, timely research focus areas, given the breadth of areas and topics touched by nutrition.

T1084

197100-197379

Sentence

denotes

This office would have some dedicated funds to help stimulate priority research across NIH and encourage NIH institutes, centers, and other offices to direct or pool their funds toward common priority areas and would not be dependent on or viewed as serving any single institute.

T1085

197380-197554

Sentence

denotes

This office could help stimulate new, flexible appropriations for the NIH Office of the Director to focus broadly on nutrition priority areas, outside the Common Fund per se.

T1086

197555-197855

Sentence

denotes

In addition to research strategy and harmonization, the new office director and staff (including communications specialists, present in other similar NIH Office of the Director Offices) would increase capacity and expertise for dissemination of nutrition science to the public and other stakeholders.

T1087

197856-198074

Sentence

denotes

This office could engage strong external advisory mechanisms, strengthening input from other federal departments and agencies, academic institutions, advocacy groups, state and local governments, and community members.

T1088

198075-198385

Sentence

denotes

Based on Congressional prioritization of new national research areas, such an office can transition into a center (e.g., National Center for Complementary and Integrative Health; Public Laws 103–42, 105–277, 113–235) or an institute (e.g., NINR, Public Law 103–43; NIMHD, Public Laws 103–43, 106–525, 111–148).

T1089

198387-198400

Sentence

denotes

Disadvantages

T1090

198401-198864

Sentence

denotes

The size and resources of such an office would remain limited to coordinating and developing nutrition strategy across all NIH institutes, centers, and offices, inform and collaborate with other federal departments and agencies engaged in nutrition-relevant research and programming, assist with communication to the public, work with ODPHP in the USDA–HHS partnership to develop the DGAs, and meaningfully engage in public–private or other external partnerships.

T1091

198865-198985

Sentence

denotes

Such an office does not generally have sufficient independent funding to promote major extramural or intramural science.

T1092

198986-199139

Sentence

denotes

Such an office does not have sufficient authority or resources to support national training of new scientists and health care professionals in nutrition.

T1093

199140-199265

Sentence

denotes

An office's budget, staff size, and influence can vary widely across offices and over time depending on other NIH priorities.

T1094

199267-199279

Sentence

denotes

Path forward

T1095

199280-199371

Sentence

denotes

The NIH Director has discretion to restore this office into the NIH Office of the Director.

T1096

199372-199855

Sentence

denotes

Congress can also pass legislation to create a new Office of Nutrition Research within the NIH Office of the Director, similar to other Congressionally mandated offices such as the NIH Office of AIDS Research (Public Law 103–43), Office of Research on Women's Health (Public Law 103–340), Office of Behavioral and Social Sciences Research (330) (Public Law 103–43), Office of Disease Prevention (331) (Public Law 99–158), and Office of Dietary Supplements (332) (Public Law 103–417).

T1097

199857-199906

Sentence

denotes

New trans-NIH initiative(s) in nutrition research

T1098

199907-200018

Sentence

denotes

Trans-NIH initiatives are efforts to promote collaborative research across NIH in a particular area of science.

T1099

200019-200123

Sentence

denotes

These initiatives can originate from the NIH Director; NIH institutes, centers, or offices; or Congress.

T1100

200124-200229

Sentence

denotes

Some of these initiatives engage with external stakeholders such as businesses and nonprofit foundations.

T1101

200230-200309

Sentence

denotes

The funding, leadership, and structures for trans-NIH initiatives tend to vary.

T1102

200310-200613

Sentence

denotes

Generally, trans-NIH programs utilize the same mechanisms of grant funding that NIH currently offers: research grants (R series), career development awards (K series), research training and fellowships (T & F series), program project/center grants (P series), and resource grants (various series) (333).

T1103

200614-201328

Sentence

denotes

NIH currently supports a variety of broad-reaching programs that are trans-NIH in nature; examples include Biomedical Information Science and Technology Institute (BISTI), NIH Blueprint for Neuroscience Research, Research Supplements to Promote Diversity in Health-Related Research, Administrative Supplements to Existing NIH Grants and Cooperative Agreements, New and Early Stage Investigators Policies, Genome-Wide Association Studies, NIH Common Fund, NIH Basic Behavioral and Social Science Research Opportunity Network (OppNet), Presidential Early Career Award for Scientists and Engineers, Stem Cell Information (PECASE), and the Trans-NIH Countermeasures Against Chemical Threats (CounterACT) program (333).

T1104

201329-201447

Sentence

denotes

The NIH Common Fund has emerged as one approach to support trans-NIH programs and uses the same mechanisms of support.

T1105

201448-201669

Sentence

denotes

The NIH Common Fund is a specific component of the NIH budget and is managed by the Office of Strategic Coordination/Division of Program Coordination, Planning, and Strategic Coordination/Office of the NIH Director (329).

T1106

201670-201958

Sentence

denotes

Common Fund programs are short-term (usually ∼5 y), goal-driven strategic investments that are “intended to change paradigms, develop innovative tools and technologies, and/or provide fundamental foundations for research that can be used by the broad biomedical research community” (329).

T1107

201959-202103

Sentence

denotes

Then, an NIH institute, center, or office or multiple institutes, centers, and offices must continue the support of these time-limited programs.

T1108

202104-202237

Sentence

denotes

As one example, the NIH Human Microbiome Project was a trans-NIH initiative supported by the NIH Common Fund from 2007 to 2016 (334).

T1109

202238-202293

Sentence

denotes

This project aimed to expand science on the microbiome.

T1110

202294-202485

Sentence

denotes

Initially funded as an initiative of the NIH Roadmap for Biomedical Research, the NIH Human Microbiome Project was originally established as a 5-y project with a budget of $150 million (335).

T1111

202486-202637

Sentence

denotes

The project began with a “jumpstart” phase in 2007 and a set of grants was funded in mid-2009 and additional demonstration project grants were awarded.

T1112

202638-202879

Sentence

denotes

These activities were supported by a Data Analysis and Coordination Center and a set of additional grants was awarded for developing new technologies, new software tools, and studying the ethical, legal, and social implications of this work.

T1113

202880-202944

Sentence

denotes

The grantees worked together in a highly cooperative consortium.

T1114

202945-203134

Sentence

denotes

Ultimately, this 10-y $215 million project spanned >20 of the NIH institutes, centers, and offices and resulted in a >40-fold increase in nonproject investment in microbiome research (336).

T1115

203135-203255

Sentence

denotes

That is, individual or multiple institutes, centers, and offices used program announcements or request for applications.

T1116

203256-203443

Sentence

denotes

Some of these funding mechanisms were supported by the Common Fund and others were additional commitments by the participating NIH institutes, centers, and offices from their own budgets.

T1117

203444-203695

Sentence

denotes

The Trans-NIH Microbiome Working Group established in 2012 provided a forum for coordinating NIH extramural research activities related to the human microbiome and continues to coordinate this work after the NIH Human Microbiome Project was completed.

T1118

203696-203872

Sentence

denotes

Notably, the NIH Human Microbiome Project identified several potential priority areas around food and the microbiome, but these topics have not yet been systematically pursued.

T1119

203873-204168

Sentence

denotes

The Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative is an example of a trans-NIH initiative (337), supported by staff within NIH and across federal working groups and providing funding for intramural and extramural research, training, and technology development.

T1120

204169-204383

Sentence

denotes

Between 2013 and 2019, this initiative supported >700 research projects totaling ∼$1.3 billion through support across the NIH, including appropriations through the 21st Century Cures Act (Public Law 114–255) (337).

T1121

204384-204487

Sentence

denotes

The BRAIN initiative is managed by 10 NIH institutes and centers, with coordination at multiple levels.

T1122

204488-204723

Sentence

denotes

Extramural program staff and institute and center directors meet regularly to integrate strategic planning, management, and a BRAIN Multi-Council Working Group and Neuroethics Working Group provide further input on a variety of issues.

T1123

204724-204913

Sentence

denotes

Another trans-NIH example is the All of US Research Program (Public Law 115–31), directly supported through annual appropriations from Congress ($1.5 billion over 10 y) (Public Law 115–31).

T1124

204914-205094

Sentence

denotes

This initiative, supported and overseen by NIH, arose from recommendations by the NIH's Precision Medicine Initiative Working Group of the Advisory Committee to the Director (338).

T1125

205095-205283

Sentence

denotes

The program staff are based in the NIH Office of the Director, with a Trans-NIH Liaisons Coordinating Team made up of scientific leaders from across NIH and has an external advisory panel.

T1126

205284-205545

Sentence

denotes

A potential trans-NIH program in Precision Nutrition is being considered as an NIH Common Fund program for fiscal year 2021 (131, 339), and the NIH Director included Precision Nutrition in the NIH's congressional budget justification for fiscal year 2021 (131).

T1127

205546-205628

Sentence

denotes

A new Program Director in the NIDDK ONR was hired in 2020 to lead this initiative.

T1128

205630-205640

Sentence

denotes

Advantages

T1129

205641-205669

Sentence

denotes

Legislation is not required.

T1130

205670-205820

Sentence

denotes

A trans-NIH initiative can help galvanize NIH to develop a coordinated approach to a specific topic on nutrition and human health (e.g., see Table 2).

T1131

205821-206022

Sentence

denotes

Such an effort would generally be preceded by a careful—and separately useful—review of relevant NIH leadership, staffing, funding, external advisory mechanisms, and collaborative approaches available.

T1132

206023-206153

Sentence

denotes

A trans-NIH initiative brings new strategic planning, working groups, funding opportunities, training, and technology development.

T1133

206154-206282

Sentence

denotes

A trans-NIH initiative is complementary to other NIH and cross-governmental strategies to strengthen federal nutrition research.

T1134

206283-206364

Sentence

denotes

Such initiatives can also help build new or enhanced public–private partnerships.

T1135

206366-206379

Sentence

denotes

Disadvantages

T1136

206380-206557

Sentence

denotes

The needs and opportunities across nutrition research are broad and complex, and a new trans-NIH initiative would cover 1 focused topic, such as, if funded, precision nutrition.

T1137

206558-206838

Sentence

denotes

Addressing the science gaps and opportunities for nutrition—a leading cause of disease in the US—will require greater and more sustained authority, coordination, resources, and collaboration than provided by a single initiative, especially one only limited to precision nutrition.

T1138

206839-206981

Sentence

denotes

Trans-NIH initiatives are generally time-limited, difficult to sustain, and not easily communicated to a broad range of external stakeholders.

T1139

206982-207173

Sentence

denotes

The long-term success of such initiatives can be dependent on a single leading NIH institute, center, and/or office to commit to carry that area of work forward after the initial investments.

T1140

207175-207187

Sentence

denotes

Path forward

T1141

207188-207397

Sentence

denotes

The NIH Director could propose new trans-NIH budget initiatives for Congress to review; as noted earlier, Precision Nutrition is proposed in NIH's congressional budget justification for fiscal year 2021 (131).

T1142

207398-207587

Sentence

denotes

Congress could authorize and appropriate funds for this proposed initiative or put forth support for another or additional trans-NIH initiative(s) focused on ≥1 areas of nutrition research.

T1143

207588-207684

Sentence

denotes

NIH institutes, centers, and offices can develop and collectively support trans-NIH initiatives.

T1144

207685-207806

Sentence

denotes

External support through the private and nongovernment sectors can also be mobilized through public–private partnerships.

T1145

207808-207880

Sentence

denotes

Identified USDA strategies for strengthening national nutrition research

T1146

207881-208010

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denotes

In addition to NIH, the USDA is an important home for increased authority, coordination, and funding for nutrition science (110).

T1147

208011-208221

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As for NIH options, any new USDA strategy must leverage and strengthen, not supplant, existing extramural and intramural nutrition research efforts across USDA as well as other federal departments and agencies.

T1148

208222-208268

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Key identified strategies are discussed below.

T1149

208269-208338

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Each was considered as complementary, rather than mutually exclusive.

T1150

208339-208499

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Comparative advantages and disadvantages, executive and legislative considerations, and paths forward for these options should be the subject of future reports.

T1151

208501-208554

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Increased investment in nutrition research across REE

T1152

208555-208854

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Declining appropriations for nutrition-relevant research and statistics at USDA, compounded by declining public investment in agrifood research and development, is limiting the nation's ability to fully understand and leverage the critical nexus between agriculture, food, and health (12, 146, 147).

T1153

208855-209041

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denotes

An emphasis on agricultural production research has created pressure on the USDA nutrition portfolio to respond to these growing research needs and opportunities with its limited budget.

T1154

209042-209286

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denotes

Strong Congressional appropriations for nutrition research across REE is critical to reestablish the US as the global leader in food and agricultural science and technology, which creates healthy and productive communities, families, and youth.

T1155

209287-209620

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denotes

A renewed commitment to advancing and integrating nutrition into the overall crop, livestock, food manufacturing, food safety, natural resources, and climate research agendas has tremendous potential to improve economic growth, national security, competitiveness, sustainability, climate resilience, food security, and public health.

T1156

209621-209794

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denotes

Such investment would also maximize cross-governmental coordination and public–private partnerships with the greatest potential to accelerate progress in this complex nexus.

T1157

209795-209981

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The USDA also implements major nutrition programs and thus must rely upon an integrated focus that connects nutrition research to policy and practice to improve the health of the public.

T1158

209982-210147

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To accomplish this integrated approach, each of the science mission areas at ARS, ERS, and NIFA must be at full capacity including sufficient staffing and resources.

T1159

210148-210493

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denotes

Nutrition research investment in ARS is essential for food-composition research and development, dietary surveys and food databases instrumental to national surveillance and scientific discovery, and the Human Nutrition Research Center network that pursues long-term, translation research priorities impractical to assess in short-term programs.

T1160

210494-210706

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NIFA complements ARS with competitive extramural funding vital to strengthening our nation's capacity to address opportunities related to diet, health, food safety, food security, and food science and technology.

T1161

210707-210878

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In addition, ERS provides invaluable food supply data, federal nutrition assistance program evaluations, and surveys on food insecurity and food acquisition and purchases.

T1162

210880-210943

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denotes

Expanded USDA research to improve public guidance and education

T1163

210944-211286

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denotes

As detailed in earlier sections, the USDA CNPP plays a major role in the development of the DGAs, with far-reaching implications for many federal and nonfederal policies and programs such as the suite of 15 federal nutrition assistance programs, FDA regulatory policies, and clinical guidance for individuals from allied health professionals.

T1164

211287-211425

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Yet, the CNPP 2020 budget is only $6.6 million for nutrition evidence reviews, committee support, and DGA-related educational development.

T1165

211426-211713

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Further work is needed to provide consistent funding and staff to maintain and protect the scientific integrity for nutrition evidence systematic reviews; fundamental nutrition research, monitoring, and surveillance processes; and to develop, translate, and disseminate dietary guidance.

T1166

211714-211816

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Other USDA investments in public guidance include SNAP-Ed, with $441 million in funding in 2020 (340).

T1167

211817-212238

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The benefits of this major effort could be further amplified by the creation of a robust SNAP-Ed infrastructure [e.g., similar to the USDA NIFA Gus Schumacher Nutrition Incentive Program (GusNIP) or SNAP Employment and Training] to support evaluation of novel educational interventions, including policy and systems changes, online purchasing strategies, and other environmental supports, using SNAP pilot authority (13).

T1168

212239-212632

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denotes

Similarly, expanded research on WIC Nutrition Education should address approaches to further strengthen this valuable program, such as new strategies for education on breastfeeding practices, food and beverage choices, sleep, and screen time, as well as novel information systems and technology including online, mobile, and telehealth options to deploy this guidance to WIC participants (13).

T1169

212633-213314

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Greater research on the USDA's State Nutrition Action Committee (SNAC) program—which helps states coordinate USDA food-assistance programs, Affordable Care Act community benefits, wellness, and other food and nutrition programs—and the USDA Farm to School Grant Program—which funds school districts, state and local agencies, Indian tribal organizations, agricultural producers, and nonprofit organizations to increase local foods served through child nutrition programs, teach children about food and agriculture through garden and classroom education, and develop schools’ and farmers’ capacities to participate in farm to school—would amplify benefits of these investments (13).

T1170

213316-213396

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denotes

Innovative USDA research to strengthen benefits of nutrition assistance programs

T1171

213397-213625

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denotes

New research efforts supported by USDA, as well as NIH, are critical to develop the evidence base and collaborations to further augment the positive impacts of large federal investments in nutrition assistance (∼$100 billion/y).

T1172

213626-213823

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denotes

Such research must, for example, delineate and address the tremendous increases in food insecurity, associated economic disruptions, and nutrition-related health disparities stemming from COVID-19.

T1173

213824-213986

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denotes

Now is the time to expand our understanding of the best approaches to increase the public health impacts of our suite of 15 federal nutrition assistance programs.

T1174

213987-214264

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denotes

This approach can include, for instance, new USDA-supported pilots and waivers to evaluate innovations that better support healthier eating in SNAP (e.g., healthy retail approaches, healthy food incentives combined with disincentives, online purchasing technologies) (13, 341).

T1175

214265-214508

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denotes

Further critical research needs include how USDA's nutrition assistance programs can be better integrated and coordinated with other federal and state programs, in particular Medicaid and Medicare, to improve diet-related health outcomes (13).

T1176

214509-214713

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denotes

These translational research investments will help address the varying geographic, contextual, and cultural needs of Americans and ensure the most effective outcomes from these essential federal programs.

T1177

214715-214738

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denotes

Summary and Conclusions

T1178

214739-215131

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This report identified stark national challenges in nutrition: diet-related illnesses, food insecurity, diet-related health disparities, health care costs for public and private payers, workforce productivity, military readiness, tremendous scientific debate and public confusion on a variety of critical topics, sustainability, and food system and population resilience to unexpected crises.

T1179

215132-215264

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denotes

Multiple federal departments and agencies are currently involved and investing in nutrition research and nutrition-related programs.

T1180

215265-215546

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denotes

However, as a share of total federal research expenditures, investments in nutrition research have been generally flat over the past 4 decades, despite the dramatic increase in diet-related illnesses such as obesity and type 2 diabetes and other identified diet-related challenges.

T1181

215547-215728

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denotes

Several current federal initiatives and collaborations aim to increase coordination of specific aspects of nutrition research and related activities across departments and agencies.

T1182

215729-215917

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denotes

Yet, the full potential of these efforts has not been realized, as documented by multiple governmental and other assessments since at least 1969, due to insufficient authority and funding.

T1183

215918-216068

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denotes

The opportunities to be gained by greater coordination and investment in federal nutrition research are clear, with potential for large and rapid ROI.

T1184

216069-216169

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denotes

This report identified and described 2 priority strategies to strengthen federal nutrition research:

T1185

216170-216377

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1) a new authority for cross-governmental coordination of nutrition research and other nutrition-relevant policy and 2) strengthened authority, investment, and coordination for nutrition research within NIH.

T1186

216378-216521

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These 2 strategies were found to be complementary and synergistic, each providing benefits that would be largest and most effective in concert.

T1187

216522-216661

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denotes

These options could potentially be a part of a multiyear strategy, initiated in part or whole (in some cases) by Congress or the President.

T1188

216662-216768

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denotes

Optimally, these options would garner full bipartisan support from the executive and legislative branches.

T1189

216769-216889

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denotes

Additional relevant priorities to strengthen federal nutrition research, particularly within USDA, were also recognized.

T1190

216890-217105

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Each of the identified options in this report would help create the new leadership, strategic planning, coordination, and investment the nation requires to address the challenges and grasp the opportunities we face.

T1191

217107-217129

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denotes

Supplementary Material

T1192

217130-217193

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nqaa179_Supplemental_File Click here for additional data file.

T1193

217195-217210

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Acknowledgments

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217211-217416

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We are indebted to a variety of federal agency staff and other stakeholders for their candid reflections of the past and present, as well as thorough assessments of potential strategies for moving forward.

T1195

217417-217642

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denotes

We are grateful to Dr. Sally Rockey and Dr. Yvonne Maddox for critical advisory comments and input and for input from Emily Broad Leib and Sarah Downer at the Center for Health Law and Policy Innovation at Harvard Law School.

T1196

217643-218202

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We are grateful for input from members of the Nutrition Action Alliance (NAA), a coalition of organizations working to advance federal nutrition research, nutrition education, and nutrition monitoring and surveillance, among other activities, which includes ASN, Academy of Nutrition and Dietetics, American Society for Parenteral and Enteral Nutrition, Association of Nutrition Departments and Programs, Institute of Food Technologists, National Board of Physician Nutrition Specialists, Society for Nutrition Education and Behavior, and The Obesity Society.

T1197

218203-218403

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denotes

This opportunity to review and provide feedback did not imply that the NAA nor any individual member organization has taken a specific policy position on every strategy option referenced in the paper.

T1198

218404-218466

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denotes

We thank Sylara Marie Cruz for outstanding management support.

T1199

218467-218769

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denotes

The authors’ responsibilities were as follows—SEF, CEW, PMC, VSH, and DM: were on the lead writing group of this paper; the remaining authors regularly reviewed drafts and provided substantive feedback during regular calls and rounds of reviews; and all authors: read and approved the final manuscript.

T1200

218770-218997

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denotes

PMC reports paid consultancies with the Indiana University School of Public Health at Bloomington, Purdue University Department of Nutrition Sciences, and the Friedman School of Nutrition Science and Policy at Tufts University.

T1201

218998-219215

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SEF reports paid consultancies with the Friedman School of Nutrition Science and Policy at Tufts University and various paid work with Healthy Eating Research, a national program of the Robert Wood Johnson Foundation.

T1202

219216-219390

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VSH reports paid consultancies with the Indiana University School of Public Health at Bloomington and the Friedman School of Nutrition Science and Policy at Tufts University.

T1203

219391-219939

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denotes

DM reports research funding from the NIH and the Gates Foundation; personal fees from GOED, Bunge, Indigo Agriculture, Motif FoodWorks, Amarin, Acasti Pharma, Cleveland Clinic Foundation, America's Test Kitchen, and Danone; participating on scientific advisory boards of start-up companies focused on innovations for health including Brightseed, DayTwo, Elysium Health, Filtricine, Foodome, HumanCo, and Tiny Organics; and chapter royalties from UpToDate, all outside the submitted work; as well as research funding from The Rockefeller Foundation.

T1204

219940-220251

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denotes

PJS reports grant/research support from the NIH; participating on scientific advisory and/or membership boards of Marabou Foundation, the National Academy of Sciences, Engineering, and Medicine, the ASN, and International Council on Amino Acid Science; and holding stock in TIAA, all outside the submitted work.

T1205

220252-220510

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denotes

CEW reports a paid consultancy with the World Wildlife Fund for their research on sustainable food systems under a grant from The Rockefeller Foundation, outside the submitted work with the Friedman School of Nutrition Science and Policy at Tufts University.

T1206

220511-220561

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The other authors report no conflicts of interest.

T1207

220563-220568

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Notes

T1208

220569-220623

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Supported by the Rockefeller Foundation (award number:

T1209

220624-220638

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denotes

2019 FOD 011).

T1210

220639-220740

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The views expressed herein do not necessarily represent the views of the funders or Tufts University.

T1211

220741-220890

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The views and opinions expressed in this article are those of the authors, and do not necessarily reflect the official policy or position of the ASN.

T1212

220891-221037

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denotes

This article did not undergo review by the editors of The American Journal of Clinical Nutrition but did undergo review by several members of ASN.

T1213

221038-221291

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denotes

Supplemental Figures 1–9, Supplemental Tables 1–10, and Supplemental Text 1–3 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/ajcn/.

T1214

221292-224524

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denotes

Abbreviations used: AHRQ, Agency for Healthcare Research and Quality; ARS, USDA Agricultural Research Service; BRAIN, NIH Brain Research through Advancing Innovative Neurotechnologies; CHAMP, Consortium for Health and Military Performance; CMMI, HHS Center for Medicare and Medicaid Innovation; CMS, HHS Centers for Medicare and Medicaid Services; CNPP, USDA Center for Nutrition Policy and Promotion; COVID-19, coronavirus disease 2019; DGA, Dietary Guidelines for Americans; DGAC, Dietary Guidelines Advisory Committee; DHS, Department of Homeland Security; DNRC, NIH Division of Nutrition Research Coordination; DoC, Department of Commerce; DoD, Department of Defense; DoE, Department of Education; DoJ, Department of Justice; DPC, Domestic Policy Council; DPCPSI, NIH Division of Program Coordination, Planning, and Strategic Initiatives; EPA, Environmental Protection Agency; ERS, USDA Economic Research Service; FEMA, Federal Emergency Management Agency; FNS, USDA Food and Nutrition Service; FTC, Federal Trade Commission; GAO, Government Accountability Office; GDP, Gross Domestic Product; HHS, Department of Health and Human Services; HNCC, USDA Human Nutrition Coordinating Committee; HNRIM, Human Nutrition Research and Information Management; IBNMRR, Interagency Board for Nutrition Monitoring and Related Research; ICHNR, Interagency Committee on Human Nutrition Research; JSHNR, Joint Subcommittee on Human Nutrition Research; MND, Military Nutrition Division; NASA, National Aeronautics and Space Administration; NASEM, National Academies of Sciences, Engineering, and Medicine; NCC, NIH Nutrition Coordinating Committee; NCI, National Cancer Institute; NCNR, proposed NIH National Center for Nutrition Research; NHLBI, NIH National Heart, Lung, and Blood Institute; NIDDK, NIH National Institute of Diabetes and Digestive and Kidney Diseases; NIFA, USDA National Institute of Food and Agriculture; NIMHD, NIH National Institute of Minority Health and Health Disparities; NINR, NIH National Institute of Nursing Research; NIN, NIH new National Institute of Nutrition; NNMRRP, National Nutrition Monitoring and Related Research Program; NSC, National Security Council; NSF, National Science Foundation; OCS, USDA Office of the Chief Scientist; ODNI, Office of the Director of National Intelligence; ODPHP, HHS Office of Disease Prevention and Health Promotion; OMB, White House Office of Management and Budget; ONDFN, New Office of the National Director of Food and Nutrition; ONR, NIDDK Office of Nutrition Research; OSTP, White House Office of Science and Technology Policy; RCDC, Research, Condition, and Disease Categorization; REE, USDA Research, Economics, and Education mission area; RePORTER, NIH Research Portfolio Online Reporting Tools Expenditures and Results; ROI, return on investment; SNAP, USDA Supplemental Nutrition Assistance Program; SNAP-Ed, USDA Supplemental Nutrition Assistance Program Education; USAID, US Agency for International Development; USGCRP, US Global Climate Research Program; USGNRP, New US Global Nutrition Research Program; VA, Department of Veterans Affairs; VHA, Veterans Health Administration; WIC, USDA Special Supplemental Nutrition Program for Women, Infants, and Children.

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