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

Abstract

Background: The US faces remarkable food and nutrition challenges. A new federal effort to strengthen and coordinate nutrition research could rapidly generate the evidence base needed to address these multiple national challenges. However, the relevant characteristics of such an effort have been uncertain.

Objectives: 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.

Methods: 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.

Results: Stark national nutrition challenges were identified. More Americans are sick than are healthy, largely from rising diet-related illnesses. These conditions create tremendous strains on productivity, health care costs, health disparities, government budgets, US economic competitiveness, and military readiness. 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. More than 10 federal departments and agencies currently invest in critical nutrition research, yet with relatively flat investments over several decades. Coordination also remains suboptimal, documented by multiple governmental reports over 50 years. 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. Two identified key strategies to achieve this were as follows: 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. These strategies were found to be complementary, together catalyzing important new science, partnerships, coordination, and returns on investment. Additional complementary actions to accelerate federal nutrition research were identified at the USDA.

Conclusions: 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.

Keywords: Dietary Guidelines for Americans; Dietary Reference Intakes; diet; federal nutrition research; nutrition; policy; prevention; research.

FIGURE 1

Examples of identified diet-related burdens that could be addressed by more coordinated and strengthened federal nutrition research. COVID-19, coronavirus disease 2019. Graphic design support courtesy of Ink&Pixel Agency.

FIGURE 2

Opportunities for enhanced federal nutrition research coordination and investment. 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. Graphic design support courtesy of Ink&Pixel Agency.

FIGURE 3

Estimated overall federal expenditures for nutrition research, 1985–2009 (top panel) (108); and within NIH for fiscal year 2019 (bottom panel) (110). 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. 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. 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. Reprinted with permission from the USDA Economic Research Service and NIDDK Office of Nutrition Research.

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

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). 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). ARS, Agricultural Research Service; FY, fiscal year. Top panel adapted from POLITICO Pro Datapoint (12), with graphic design support courtesy of Ink&Pixel Agency.