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

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.

A critique of the objective function utilized in calculating the Thrifty Food Plan.

The Thrifty Food Plan (TFP) is the basis of benefit allocations within the USDA's Supplemental Nutrition Assistance Program (SNAP), which administers nearly $70 billion in benefits to over 42 million people annually. To produce the allocation of food within the TFP, the USDA uses a mathematical optimization model that solves for the daily apportionment across various food groups. The model is constrained by nutritional and consumption requirements to produce an "optimal" allocation. Despite the importance of the TFP, the computational solution developed by the USDA has received insufficient attention, with only a handful of articles written on the TFP optimization model. Here, we run three alternative objective functions that are simpler than the one used by USDA. Our first alternative objective function minimizes the sum of squared errors between the consumed market basket of goods and an allocated market basket of goods, the second alternative objective function minimizes the sum of the absolute value of the difference between the consumed market basket of goods and an allocated market basket of goods, and the third alternative objective function minimizes the weighted absolute deviation of allocations and actual consumption expressed as a proportion of observed consumption. A clear theoretical advantage of either of our methods is that they eliminate the need to arbitrarily set allocated consumption to nonzero values, as is the case for the logarithmic objective function used by USDA. In an operational sense, we find that our model formulations produce an allocation that fits actual consumption better than the objective function employed by the USDA.

Insights in public health: The Special Supplemental Nutrition Program for Women, Infants and Children: strengthening families for 40 years.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a proven, cost-effective investment in strengthening families. As part of the United States Department of Agriculture's (USDA) 15 federal nutrition assistance programs for the past 40 years, WIC has grown to be the nation's leading public health nutrition program. WIC serves as an important first access point to health care and social service systems for many limited resource families, serving approximately half the births in the nation as well as locally. By providing nutrition education, breastfeeding promotion and foods in addition to referrals, WIC plays a crucial role in promoting lifetime health for women, infants and children. WIC helps achieve national public health goals such as reducing premature births and infant mortality, increasing breastfeeding, and reducing maternal and childhood overweight. Though individuals and families can self-refer into WIC, physicians and allied health professionals have the opportunity and are encouraged to promote awareness of WIC and refer families in their care.

Prioritizing health and community food security through the farm bill.

Food security and health are complex interrelated issues. Individual characteristics exist within the physical and built environments. Title IV of the Food, Conservation, and Energy Act of 2008 is analyzed in terms of how it addresses systemic food insecurity and the opportunities the policy has for improving public health by increasing support for the availability of affordable local produce to low-income households. Structural changes need to occur for programs to be equitable, efficient, and effective. Interdisciplinary leadership within government agencies, school systems, social service agencies, health care agencies, and nonprofit networks is necessary to ensure food security and health for all Americans. Social work and public health practitioners have the opportunity to change the status quo, encourage community-level interventions, advocate for producers and consumers, and encourage more equitable distribution of food to create a healthier low-income population.

The role of pediatricians as innovators in pediatric nutrition.

Innovation is about making changes. When it comes to health care, innovations, though they may be something 'new', may not be beneficial if not demonstrated to be an improvement over what is current practice. Innovations in pediatric nutrition sometimes fall into this category. The establishment of safe water and milk supplies at the end of the 19th and beginning of the 20th centuries is viewed as one of the greatest advances in preventative medicine and truly was an 'innovation', with its dramatic impact on infant mortality. Other innovations in pediatric nutrition included the development of the caloric method of infant feeding which led to the large-scale adoption of a single infant formula. This required cooperation with industry and ultimately led to the development of life-saving specialty formulas for various disease states including inborn errors of metabolism. Over the last 50 years there have been further modifications of term infant formula that have included taurine, carnitine, nucleotides, whey proteins, PUFAs including decosahexenoic acid (DHA) and arachidonic acid, probiotics, and prebiotics. Many of these additions are of questionable benefit and are questioned as true innovations. Though the addition of novel nutrients to infant formula has been an area of great interest, more basic research (including randomized controlled trial) is needed to determine many pediatric nutrient requirements including the lower and upper limits of nutrients added to infant formula. Such research could be facilitated by institutions such as the US National Institute of Child Health whose establishment in 1962 was a significant 'innovation' as it led to advances in pediatric nutritional research. Much more research is needed to determine basic pediatric nutritional requirements and pediatricians should strive for such true innovations.