Fly Health, LLC and Georgetown University Law Center, Washington, DC, USA.
University of Virginia Biocomplexity Institute and Initiative, Arlington, VA, USA.
Am J Clin Nutr. 2020 Sep 1;112(3):721-769. doi: 10.1093/ajcn/nqaa179.
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.
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.
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.
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.
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.
美国面临着显著的食品和营养挑战。美国联邦政府若采取新措施来加强和协调营养研究，就有可能迅速为解决这些多重国家挑战提供所需的证据基础。然而，此类措施的相关特征尚不确定。
我们旨在提供一份客观、详实的总结报告，内容涉及：1）我国面临的与饮食相关的健康负担日益加重，以及由此带来的经济、健康公平、国家安全和可持续性方面的影响；2）当前联邦营养研究现状和现有协调机制；3）新的基础、临床、公共卫生、食品和农业以及转化科学发现的机会和潜在影响；4）进一步加强和协调联邦营养研究的各种选择，包括相应的优势、劣势以及可能的行政和立法考虑因素。
我们查阅了有关联邦营养研究的政府和其他已发表的文件；与专家组、倡导组织和科学学会进行了各种讨论；并与 50 多名在行政和立法部门任职的联邦工作人员以及学术界、工业界和非政府组织的各种其他利益攸关方举行了现场或电话会议。
确定了严峻的国家营养挑战。越来越多的美国人患病，而不是健康，主要是由于与饮食相关的疾病增加所致。这些情况给生产力、医疗保健成本、健康差距、政府预算、美国经济竞争力和军事准备造成了巨大压力。2019 年冠状病毒病（COVID-19）的爆发进一步暴露了这些压力，包括粮食不安全、糖尿病、高血压和肥胖等与 COVID-19 不良结局相关的主要饮食相关合并症，以及对我们的食品系统缺乏监测和协调。目前有 10 多个联邦部门和机构投资于重要的营养研究，但几十年来投资相对持平。50 多年来，政府的多份报告都记录了协调工作仍不尽人意。更协调、更广泛地扩大联邦在营养科学方面的投资，而不是将现有投资单独或重新安排，有巨大的潜力可以产生新的发现，从而改善和维持所有美国人的健康。为了实现这一目标，确定了两项关键战略：1）为营养研究以及其他营养相关政策提供强有力的跨政府协调建立新的权威；2）加强 NIH 内部的营养研究的权威、投资和协调。事实证明，这两种策略是相辅相成的，它们共同促进了重要的新科学、伙伴关系、协调和投资回报。还在 USDA 确定了加快联邦营养研究的其他补充行动。
加强联邦营养研究的必要性和机会是明确的，并且有具体的选择可以帮助创造新的领导力、战略规划、协调和投资，这是美国解决多种营养相关挑战和把握当前机遇所需要的。
