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Although consumers, scientists, el1treprel1eurs' arid policymakers want evictence on potential flew relationships Remeet? nutrients and c1`ro'~ic diseases as soots as possible, conclusive evicle'~ce is typically elusive. Gathe'-i'~g sufficient know/edge to ciraw conclusions abor't cause/ relationships, es~vecial/y between a given '?utrie'~t anc' a chronic disease, remains a c/?cz//enge.- Ero/utio'? of Evidence for Se/ectec! Nutrient n'~c! Disease Re/ationships, 2002 F~ Of ot3o I ~~o SArETY A slumber of receipt court cases have cI~allenged the validity of criteria treat underlie U.S. food safety regulations, potentially undermining tire authority of regulatory agencies to enforce tI~ose sta'~darcis. Concerned about tile growing contro- versy, Congress requested tight tire Institute of Medicine and tire National Research Council's Division of Earths and Life Studies (DELS) study else scientific basis for food safety criteria ant! the extent to wl~icl~ they actually protect tire i~ealtl~ of consumers. Scientific Criteria to Ensure Food sc`~fic Criter'~ fO ~~C ~33 ~SdiCti (2003 j *at p(~ videos ~ blueprint for devel open of scienilt~fically based food safely I ry criteria to pro1:~t human health s Safety /~2003), issued by tire lOM's Food and Nutrition Board, provicles a blueprint for development of scientifically baser! food safety regulatory criteria to protect Lyman l~ealtl~. Tire report calls for Congress to require the clevelop~nent of a comprehensive nation- :, z LLJ Z o O ~ Z

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INE(~.~.~(r ']~E F';'r'~ CRI]~AL iSSI1~S IN Hr,4~ al plait to harmonize and integer ate the foocIborne disease surveillance con- ducted lay public I~ealtI~ agencies witty tire efforts of foot! safety regulatory agencies to monitor pathogens across the foot! production and clistribu- tion continuum. Allis integration would nuance it possible to clefine links between foodborne disease and specific foods or food groups and to meas- ure the effectiveness of interventions. Congress also sI~ouic! give regulato- ~y agencies clear authority to clevelop, implement, and enforce foot! safe- ty crite'ia, as well as tire administrative flexibility to update these criteria as needecI. Tire criteria should be clearly fielded to specific public health goals. 1~ developing tire criteria, regulatory agencies should adopt strate- gies based on sound! science amuck that are cleat ifs Blair item. 1~ taxis effort, tile agencies calf draw off a variety of scientific ~netI~ods, such as risI; assessments and statistical process control. Marty everyday foods contain cl~emicals that were added during pro- cluction to achieve a desired result such as entrancing flavor or extending shelf life. Tire Fooc! Chemicals Codex (FCC), produced by the lOM's Food ant! Nutrition Board, is tire accepted compendium of specifications for defining tire quality ant! purity of direct anti some indirect food acIclitives, i~gredi- ents, ant! substances that are used in foocI. FCC specifications, which limit potential toxic contaminants, protect tire I~ealtl~ of consumers and provicle a level playing field! for inclustry. The U.S. Food ant] Drug Administration (FDA) and various national and international food ~e~ulato~v authorities. c~ .~ ~ r ecognizing the scientific basis of FCC specifications, fi e- quently r efe~ OCR for page 49
EN.~)~\C; FO(~D SAM Aloofly PP(~R . ... .... . A. .; . ... ... .. .. . .. . ~ ;1 i, it, t4t l$.~t .~t ~ ~ V tt~ ,. ~ ~ a.: 4,. FAT (~~'l t'' `~} ~ i<~ ~ hi. ~ j\( il1( >~11 t,: i) dI~! V' ~ ~ (~I'l1~) I. ~ ~ ~ b ~ ~ ~ A. A ~ ? ~ ~ ~ :t ~ ~ . ~ ci ~ +~ ~ it , ~ V ~ ~ ~ ', j 't `;,s:~,,'`~,' ~ ~ V`~) <'< ~ c\.jl't1111^~'ll tIs~l,:i ~ .............. . ~ ala:. CHIN,`! ~ let} &'lI)}01]'4,'CIN1'l:~e'' tic:~} Matrix of Scorers Used in Establishing Relative Priority Among Dietary Supplements. SOURCE: Proposed Framework for Evaluating the Safety of Dietary Supplements, 2002, page 9. Consumer use of dietary supplements leas increased significantly over tire past decacle since Co~,ress passed tire Dietary Supplement HealtI, and Education Act in 1994. Basec! on taxis statute, these supplements are pre- su~ned safe, similar to conventional foocIs. Tire U.S. Food and Drug Administration bias no authority to require safety stuclies prior to a prod- uct's co~n~nercial introduction and must prove that a supplement presents an unreasonable risk to I~ealtl~ in order to remove it from the market. In contrast, drugs must be proven safe ant! effective before Clay are market- ed. Tire FDA wants to improve its ability to assess the safety of biotic tradi- tional and new supplements, and tire agency turner! to tire IOM for leap. In a report titled Proposed Framework for Evaluating the Safety of Dietary Supplements (20021, lOM's Food anc! Nutrition Board proposer! a scientifical- ly based approach that would enable tire EDA to assess safety by analyzing information treat alreacly is available. Tire proposer! process consists of three steps: reviewing readily available information to screen for potential- ly hazardous substances; identifying ant! prioritizing tI~ose substances Slat require the most immediate attention; and taken conclucting indiviclual in- depth safety evaluations, which would be based on collecting and review- ing additional data regarding a substance's safety (including data obtained fiom industry). Comments received about tire proposed framework leave beers undergoing, review. Please two of tire study is to review six supple- ments to demonstrate flow tire proposed assessment process would work in practice. A final report will present the completed frameworks along witty tire prototype safety reviews. Although tile U.S. food supply is among else safest in tire world, food- borne diseases still exact a considerable toll, causing some 76 million ill- nesses and 5,000 deatI~s in else country elicit year. In tire face of sucks pub- lic health problems, the U.S. Department of Agriculture (USDA) is formulat- II1~ON

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[3~;~\,!~\r(~ ]~-~E FI1~ ANAL [~'E.S IN <,- Production On-Farm Transport Marketing of live animals Slaughter Preparation Dehiding Grinding Evisceration ~ Transportation Splitting Storage Chilling Distribution Cutting Cooking Consumption Hazard Characterization Dose-response Number ill Severity of illness Mortality Risk Characterization Risk estimates Important variables Research needs Risl<-assessment Structu re for E. cold 01 5 7: H 7 i ~~ Grou nd Beef. SOU RCE: Escherichia cold 0157:H7in Ground6eef: Review of a Draft Risk,~sessment, 2002, page 14. ing risk assessments to identify important foodborne i~azarcts ant! evaluate potential strategies to prevent, r educe, or eliminate tI~ose hazards. One of the initial projects is a risI; assessment of the health impact of a particula'- variety office bacterium EscI~ericI~ia coli, caller! E. cold 0157:H7, that is fre- quently fount! in grounc! beef. Tire USDA asker! tire IOM to review tire pro- ject's first draft of Allis ~ isle assessment. Its report, titled Esc12eric/,ia cold 0157:H7 in Grot'nd Beef: Review of a Draft Assessfne'~t (2002), commends tire USDA on tile magni- tucle of its effort and tile principles underlying the assess- ment. In its recommendations, tire report notes that the assessment as with all risIc assessments will be improved by making tile inner workings of tire analysis more explicit. This will require, making public cletails about assumptions, data sources, and equations used, and lim- itations and uncertainties of the conclusions. Tire report also calls on tire developers of tire riser assessment n~ode! to identify any gaps in tire available data. Charting such deficiencies will help in setting priorities for future research wick in turn may leac! to more informed policy decisions. Dioxide ant! ctioxin-like compounds off DLCs are fount! throughout the environment; they are transported through air and deposit on plants soil and sediment in waterways. People are exposed to tI~ese unintentional environ',~enta] contaminants primarily through the food supply altI,ougI~ at low levels particularly by eating animal fat in meat dairy products anti fists. Wl~ile tire amount of DLCs in tire environment leas cleclinec! since the late 1970s tl~e public continues to be co'~cer~ecl about tire safety of tire food supply and the potential adverse health effects of DLC exposure espe- cially in groups such as developing fetuses and infants who may be more

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k NSt1~lAi,~G ~~) ~5AfT117 AND Park \' ~r1~71~3N sensitive to the toxic effects of these compounds. Numerous healths effects slave been linked to exposure to DLCs including skin damage cancel; non- insulin clependent diabetes in adults neurological and immune system in~pairn~ents in infants acid endocrine system disruption. Many of tI~ese effects were identifier! in inclivicluals who had hi' lo levels of exposures However; information is limited on flow low-level DEC exposure thorough foocis definecl as occurring in everycIay life influences the development of cancer ant! otI~er diseases. To devise strategies for reducing Unman expo- sure to DLCs Tom tile food supply tire National Science and Technology Council s Intel agency Working Go oup on Dioxin witty support frolic tile ITS. Department of Agriculture tire U.S. Department of Healths Alice Humans Services acid oilier agencies acid sponsors r equested the Whelp of the IOM. The resulting study Dioxides and Dioxi'~-like Co~npou'~cis in the Food Supply: Strategies to Decrease Exposure (2003) r ecommellds policy options to reduce exposure to tI~ese contami- nants wirily co'~sicle~ it flow implementing these options could both reduce health risks and affect nutrition particular ly in sensitive ant! higI,ly exposer! groups. The report recommends that a ~mmu',~ system `~,pa't feclerally-sponsorect interagency task group ~ne'~lts in Fits and develop and implement an integrates! risk-n~an- agen~ent strategy ant! action plan to recluce Truman exposure to dioxins in foods and treat government officials collaborate witty tire private sector to identify amuck pursue voluntary interventions to further minimize levels of tI~ese toxic compounds ifs Truman foods and animal feeds However; tire healtI, risks posed by tire levels of clioxins in foods have yet to be ascertained so tile report does not recomme~ci regulatory limits Ott DLCs ilk food or feed. Numerous heallb effects sure to DI.Cs I 6 Y <~n oamage' cancer, non-- insulin dependent diabetes ill adullS neur(-~-iCal and ~ f ~ ~ R o ~ ~ e'~doct'ne system disruption. Currently the IOM ant! DELS are conducting a study to outline science- based approaches to iclentify and assess (or predict) unintencled ejects of genetically engineered foods on Truman health. Taxis study will identify appropriate scientific questions and methods for determining unintended changes in tire levels of nutrients toxicants allergens or Oliver compounds in food frotn genetically engineered plants and animals and outline n~etI~- ods to assess tire potential silent ant! long-term Truman health conse- quences of such changes. Tire stu(ly will compare genetically engineered] foods to foocIs clerived from other genetic modification methods (e.g. cross breeding with respect to the expected frequency of compositional

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~ MA cp~A~ fs~'J,~s IN ~E,4~7W changes respiting From tire modification process and tire potential frequen- cy and severity of tire effects of these cI~anges on consumer hearth. As part of this comparison the likelil~ooc! that elevatec! toxin or allergen levels would occur ilk clon~esticated anin~als or plants treat are notified by differ- ent n~ethocIs will be considered. Based oat taxis analysis tire committee Will discuss whether certain safety issues are specific to genetically engineered foods amuck if so recommence approaches foil addressing these issues. The committee also will separately evaluate potential unintencieci co~npositio~- al cleanses and health effects of foods derived from cloned animals. Taxis evaluation will be presenter! in a short report separate fiord but designed to acco~npa~y the full-lengtI~ report oat foods derived from genetic ~nodifi- cation methods. ENS[~G ADEQUATE NL}TRITI(::~N FOR Tnosr AT RISK The Special Supplemental Nutrition Program for Women Infants and Children commonly caller! the WIC program provicles food anti nutrition eclucation to low-income pregnant or postpartum women infants and children to age 5 years. Applicants must face nutrition risI; in order to receive services. Tire most common cat- egory of risk is dietary risI; treat is routine failure to consume the number of daily servings of various types of foods specifier! by tire U.S. Department of Agricultures Food Guicle PyramicI. But in practice assessing clietary risI; is difficult. Tire USDA asIcec! tire IOM to evaluate var- ious tools for assessing clietary risk ant! to matte recom- mendations on how risk assessment can be used ilk deter- minillg eligibility for tire WIC program. Dietary Risk Assessment i/? the WJC Programed (2002) conclucles that none of tire assessment tools currently available can accurate- ly measure an individual s true dietary risk and fu~-ti~er that developing a useful too! is unlikely. The report reco~nme~ds instead treat all women and children ages 2 to 5 years WI10 meet tire programs general eligibility requirements (based On income alla other social factors) sIlould be pre- sumed to also meet the requirement of dietary risI; since abundant evi- dence shows fiat nearly all of these individuals routinely fad! to meet national nutrition guidelines. By presuming dietary risk the WIC program r etains its potential for prevel~ti~g alla correcting ~~utritiol~-related problems while avoiding misclassification errors bleat could lead to denial ~ . 01 services.

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~f\.~ FO()D SAI~~11 ANI) Pact NAN Dietary Guidelines for Americans AIM FOR FITNESS Aim for a healthy weight. Be physically active each day. BUILD A HEALTHY BASE Let the Pyramid guide your food choices. Choose a variety of grains daily, especially whole grains. Choose a variety of fruits and vegetables clai~y. Keep foods safe to eat. CHOOSE SENSIBLY Choose a diet that is low in saturated [at and cholesterol alla moderate in total fat. Choose beverages and foods to moderate your intake of sugars. Choose and prepare foods with less salt. If you drink alcoholic beverages, do so in moderation. SOURCE: Dietary Risk Assessment in the W/C Program, 2002, page 2. A vast majority of infants in the Uniter! States and other industrialized countries receive infarct formula at some time during tire first year of life. For many of these infants, formula is often tile sole source of nutrition for the first four to six notes of life. Propel nutrition, wirily important throughout life, is particularly important during infancy when growth and clevelopment are most lapin and widen else consequences of inadequate nutrition al e most severe. Because of tire paucity of consistent ~buideli~es for assessing tile safety of ingredients added to infant formula, tire U.S. Food and Drug Administration (FDA) and Healths Canada asleep tire IOM to review mutinous currently used to assess safety of ingredients new to infant formula and identify tools to evaporate the safety of ingredients new to infant formula uniter intended conditions of use in ter m Fats. In tile face of natural disasters or otI~er emergency situations, sucks as the displacement of large numbers of people by political or military con- flicts, providing, tile victims with rapid, sI~ort-term food relief at act early stage is often of paramount importance. The U.S. Agency for International Development (USAlD) arch tire Department of Defense, Elicit distribute most of the emergency foot! aid proviclec' by tile fecleral government, asker! ~,~

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I~F`~rt, --I F~;r~. GAL l\~S IN -Art able IOM for acIvice on cleveloping a product specifically tailored to finis use. An lOM report, titled High-Energy, Nutrie'?t-Dense Emergency Relief Foot! Product (2002), describes tire technical specifications for a product that wouIc' satisfy tire t~utritio~al requirements of all people oIcler titan 6 months and serve as thei' sole source of subsistence foil rip to 15 days. To achieve this, the committee first cletermined tire ~~utritior~al profile of a single product that would meet the nutritional needs of young children as well as olde' aclults. Tire product also needed to be able to be deliver ed by Hitler lane! or air; to be able to be eaten on tire move without p~-epa'-ation, anti; to be acceptable to people from diverse cultural, ethics acid religious Assumptions Used in Developing the Nutrition Composition of the EFP Potable water is provicled as a top priority and is available with the EFP. Inc~iviJua~s will eat to meet their energy requirements. The product is to be consumed by aid age groups, except infants less titan 6 months of age; thus the product is not to be used in lieu of breast feeding, wi1ict~ is encouraged to at least 1 year of age with complementary use of the EFP after 6 months of age. It is not to be used as a therapeutic product and is not appropriate for severely malnourished individuals. It may constitute tire sole source of food for target recipients for up to 1 5 days. Recipients are likely to be at least mildly ma~nourisI~ed and/or suffer from mild to moderate diarrhea and other debilitating diseases brought about by u nsan itary cond itions and exacerbated by stress. The recipient population may have nutrient needs comparable to we~- nourished individuals in spite of smaller body weights due to maintaining muscle and visceral mass at the expense of body fat. ~ The product should provide a nutrient density that will meet or exceed the nutrient recommendations as specified by tire recommended intakes (IOM, 1997, 1998, 2000, 2001; NRC, 1989) which are designed to meet the needs of ain~ost aid individuals in each life stage and gender group (with tire exception of infants) without exceeding Tolerable Upper Stake Levels (IOM, 1 997, 1 998, 2000, 2001 1. Nutrient needs of pregnant and lactating women are Lot included in the calculations, but it is~assumed they will consume mole than the daily ration based on individual needs~for additional energy~beyond the average of 2,100 kcal/day. SO U RCE: High-Energy, N~ltrient-Dense Emergency Relief Food Product, 2 002, page ~ .. ~ a'

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E}~IAS\C! FO(~D SAM A~\rD Palm NIXON bacI mates as reference values for specific uses. TI~ese include the amounts of nutrients Cleat i'~ciividuals neec! to optimize timid health anti prevent disease ant! deficiencies as well as amounts tight are upper intake levels or limits to lamp people avoid potential adverse effects from consuming too much of a nutrient. To date seven reports have been published bv IOM: tire tiptoe most recent resorts Drovide DRls for ener~v . ~ . ~ , - ~a ~ '. . . ~ 1. . r . ~ ~ ~ ~ . ~ r . ~ yielding nutrients such as dietary tats and carbohydrates and tor trace ele- n~ents and important vitamins as well as a report on how DRls should be used in dietary planning. Tire IOM is currently working on two acictitional DRI reports: one will focus on tire intakes of soclium potassium cI~loricle sulfate and water; and another will iclentify general guiding principles for use of DRls in nutrition labeling. 57

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I 'JWE Ike 0~L /.~S IN -AWE Dietary Reference Intakes for Vitamins A Vitamin K Arsenic Boron Chromium Copper iodine Iron Manganese Molybclenum Nickel Silicon Vanc'dium and Zinc (2001~. Taxis report concludes, baser! on national nutri- tion surveys in else United States, that most people cart obtain tire recon~- mencied intakes for tI~ese nutrients Tom their diets, without taking supple- ~ne~ts. One exception is treat pregnant women usually neec! iron supple- ments to meet their increased claily require nets. Among other findings, tl~e report notes that Quits and vegetables yield significantly less vitamin A than previously thought. Taxis means people must make sure tinny eat enough of tire foods that are diciest in vita- min A Such as carrots, sweet potatoes, acid broccoli) ifs order to meet their daily requirement, especially if Riley do not eat animal-derived foods, wl~icI~ serve as addition- al good sources of tile nutrient for most people. The report also identifies several important gaps in pleat is known about Blase micronutrients. Some of the priority areas for research include identifying factors that impair or enhance their absorption ant! metabolism in the body, and exploring more fully tire r ole of arsenic, boron, nick- el, silicon, and vanadium in human health. Dietary Reference l'~takesfor Energy Carbo/?ycirate Fibet; Fat Fatty Acids Cholesterol Protein and Amino Acicis (2002~. This report describes acceptable intake ranges for each ofthese energy sources, baser! on evidence fiat con- sumption above these ranges can lead to cleveloping chronic diseases, including corollary heart clisease, obesity, diabetes, amuck cancel; while coa~- sumption below these ranges can lead to problems causer! by nutrient imbalances or inadequacies. Adults should get 45 percent to 65 percent of their calories from carbohydrates, 20 percent to 35 percent fiom fat, and 10 percent to 35 percent from proteins. Acceptable ranges for cI~ildre~ are similar to tI~ose for adults, except bleat infants and younger cl~ildren need a slightly hippier proportions of fat (prom 25 percent to 40 percent of their caloric intake). Tire report recommenciect ranges for polyunsaturated fats and recommends that saturated fatty acids, bans fatty acids, and choles- tero! be as low as possible in tile diet Simile consuming a nutritionally ade- quate diet. Among otiose finclings, the report suggests that adcled sugars that is, sugars incorporated into foods ant! beverages clearing production shouIc} not exceed a maximal level of 25 percent of total calories con- sumecI, since more people whose (diets are high in actUecl sugars in tire Uniter] States have been found to consume inadequate amounts of essen- tial nutrients. The report also stresses tile importance of balancing cliet ~8

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~~.~1~.~G ~ '0~) ~S~7 Al\'l) PP(~R ~~0At~ witty exercise. To maintai n cardiovascular stealth at a maximal level, aclults and children alike should spenc] at least one flour each day in moclerately i~te~se pl~ysical activity, a total that is double tile daily 'minimum goals set by previous federal recommendations. ~ Dietary Reference Intakes: Applications in Dietary Pla'~ni'~g (20031. Taxis report is else seconc! in a series providing guidance on the use and interpre- tatio~ of DRls in pla~ni~ acid assessing diets. Some of tire activities that can benefit by taking DRls into account include individual clietary planning, institutional and military food planning, planning for food assistance pro- grams, foot! labeling, food fortifications, developing new or modified food products, and assuring foot! safety. Whether for act i~clividual or a group, ciieta~-y planning involves developing a diet that is nutritionally adequate without being excessive. FoocI-basec! education tools, such as tire USDA's Fooc! Guicle L~ ~ , ~ . Pyramid, are fieque~tly used to help act individ- ual plan a 1lealtI~ful diet. For group planning, the ID'e*~ry plann~g t~t be Yclicall activil:v that inv(~S plannjusp j~- mentat:iOn.t OLSSCSSOlODi' report presents a flew approach based on determining tire distril~ution of tire long-term average intakes of indivicluals in the group. This metI~od can serve to maximize tire number of group members wl~ose daily nutritional intakes al e lil~ely to be adequate but not excessive. The report stresses that dietary planing must be a cyclical activity Pleat involves plalllling, imple- mentatioll, assessment, aloud reassessment. Pogrom Tow D'sc~s Tire Department of Healths ant] Human Services estimates treat 64 per- cent of adults are overweight ant! obese, more titan 15 percent of cl~ildren and teens carry excess pOUn]S7 acid a total cost estimated to be $1 17 bil- lion is spent annually on obesity ant! obesity-related healths problems. Research shows that overweight children are at risk for serious health problems, including diabetes and cardiovascular disease. According to one report, about 60 percent of children ages 5 to 10 who are overweight or obese aIreacly leave at least one carcliovascular clisease risk factor; such as elevates] total cholesterol levels or Ogler blood pressure, and 25 percent }rave two or more. The IOM is currently conducting a stucly on the Prevention of Obesity in CI~ilcIret~ acid Youths to assess the factors responsi- ble for the epidemic of obesity in cI~ilciren and to clevelop an action plan (focusing on ,otevention) to clecrease its prevalence. The study will assess the social, environmental, medical, dietaly7 and other factors responsible

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/~IN(t 1~E ~I>~ GAL lSSl 'KS IN HEALS-] for the increasing prevalence of childhood! obesity ant! identify the most promising ~netI~ocIs for preventions, including interventions acid policies for immediate action ant! for the longer term. Research opportunities will be identified. Altl~ougI~ consideration will lee given to flow I~ereciity acid older biologic factors contribute to tire clevelopn~ent of obesity, primary empha- sis will be cli~-ectec} to environmental acid cultural factors, social constructs that encourage appropriate eating patterns, ant! other broacher. enviro~- ',~ental facto' s. In 19937 else lOM's FNB created tire Food Forum to pe~-ioctically bring together leading scientists, acl~inistrators, and policy-~nalcers Mom acade- ~nia' government, industry, and flee public sectors to cliscuss issues related to food, food safety, ant! tire array of regulations fiat affect low food is produced anti consumed. Forum meetings provide a relatively rapic! way to iclentify important issues of common interest and to develop new approaches to solving problems. Recent meetings leave produced wo~k- shop summaries on such topics as Food Safe By Science, Policy, and Risk Assessment: Strengt1~e'?ing the Connection (2001) and Enhancing the Reg''lato~y Decision-Maki'~g Process for Direct Fooc! Ingredient Technologies (1999~. Tire Forum floes clot procluce policy recomn~endations or offer acIvice regarding specific issues. Rather; it brings together interested parties, com- piles authoritative i~formatio~, develops possible options for consiclera- tion, and brings together outsicle experts to present information on tile topic unpiler discussion. Tire unofficial nature of tire deliberations, tire ~~eu- trality of tire setting, ant! tire continuity pi esented by regular Greetings leas pi oved effective ilk stimulating fresco thinking anal pro~noti'~g fat auk exchanges of views. Witty similar motives and means in Extinct, tile FNB also leas created tire International Food and Nutrition Forum. It provides an ongoing mecha- nism for scientists, administrators, and policy-~al~ers fiom tire U.S. gov- ern~nent, nongovernmental organizations, ant! academia to discuss global issues related to food and nutrition. Such issues inclucle food security and nutritional deficiencies treat can cause morbidity and mortality. Where problems exist, tire discussions Allay lead to identification of possible solu- tions, sucks as promoting efforts in research and training. As with tire Food Forum, tire goal is not to develop specific policy recommendations, but to catalyze frank ant! open discussions that will help improve understancling among tire participants of tire topics under consideration. In 1982, following a request by tire Assistant Surgeon General of tile 6~.)

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EN.~IA`~G l-~) SA]~] 11I ,4]YO PP(~LYR NI11~O,\ Army, else National Academies set up a committee to advise the U.S. Department of Defense on tire need for and conduct of nutrition ~esea~-cl~ arid related issues. Taxis became the lOM's Committee on Military Nutrition Research (CMNR). Tire committee's tasks continue to lye (1) to iclentify nutritional factors that may car itically influence the physical and mental per- fo~mance of military personnel uncler all environ~ne~tal extremes; (2) to identify gaps ifs the existing data base concerning the relationship of cliet to performance of military personnel; (3) to recommend ~esea~cl~ trusts to fill significant gaps in the data base; (4) to recommend appropriate -esearcl~ strategies acid metl~odolo ,ies to study tire relatio~sI~ip of diet to pl~ysical anc! mental performance; acid (5) to review and advise on curt 'nutritional guidelines for military feecling systems. AltI,ougl~ tire ~nember- sl~ip of the committee cages periodically, tire disciplines represented leave consistently includes! human nutrition, nutritional biochemistry, per- fo~Mance physiology, food science, and psychology. 1~ 2003, tire CMNR released Weight Management: State of tile Science and Opportunities for Military Programs to aid in developing strategies for tire prevention Alice remediation of overweight in military personnel. Tire report reviews exist- i~g data Ott optional com,vo~e~ts of a weigl~t-~nanage~nent progeny; tire role of age, gentled and etI~nicity in weight management; and assesses cur- r ent DoD activities in weight management. Specifically, tire report provides guidance on tire appropriate degree of stancIardization of programs across tire services, wI~ether specific aids for weight loss (e.g., drugs) should be considered, flow dietary changes would impact successful weight loss, and wI~etI~e~4 resistiveness to weight loss and maintenance aloe genetically co~- trolled to tire extent treat individuals witty genetic predispositions for obe- sity sI~ouic] be iclentifiec] anti automatically excluclecl. Tire CMNR will soon be releasing a study on metabolic monitoring technologies for military felc! applications, which focuses Ott ways to monitor metabolic status ilk tile field in orcler to predict individual health and performance outcomes. This will include an analysis of n~etabolic regulation cluring prolonged, exhaustive efforts (such as combat training of field operations) wipers nutritio~/~yciration and repair ~necI~anisms may be mismatched to intakes and rest, or wiser specific metabolic derangements are present (erg., fol- lowing toxic chemical exposures or psychological tI~reats). OtI~erworI<- sI~ops or symposia conducted by CMNR have dealt with topics such as foot] components to enhance performance; nutritional steeds in blot, cold, amuck I~igh-altitucle environments; body composition ant] physical performance; nutrition and ''l~vsical , ~ . ~ ~ performance; cognitive testing n~ethoclology; fluid replacement ant! heat stress; and antioxiciants and oxiciative stress.

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Selected Recommendations for Public Health Policy Focus on Public Health Infrastructure: The Department of Sleuth and Human : Services should cleve~op a comprehensive investment plan for a strong national gov- ernmenta~ public health infrastructure with ~ timetable, clear performance meas- ures, and regular progress reports to the public. State and local governments should also provide adequate cor~sistent, and sustainable funding for the governmental public healths infrastructure. DHHS should review the regulatory authorities of its health agencies to reduce overlap and inconsistencies and to simplify relationships with state and local public health agencies. A nationals commission is neeciec] to develop a framework and recommendations for state public health law reform. Schools of public health should emphasize the importance and centrality of the eco- logical approach. Further, schools have a primary role in influencing the incorpora- tion of this ecological view of public health, as well as a population focus, into all health professional education and practice. (The Future of the Public's Health in the 21st Century, 2002) . . . . . . . . .. .. .. The Role of Public Health Education: Schools of public health should] enhance fac- ulty involvement in policy development ant] implementation for relevant issues; provide increased academic recognition and reward for policy-re~atec] activities; play a leadership role in public policy discussion about the future of the U.S. health care system, including its relation to population health; enhance dissemination of scientific findings ant] knowledge to broad aucliences; and actively engage with other parts of the academic enterprise that participate in policy activities. The Federal government SilOU~6 provide funding to develop competencies and cur- ricu~un~ ire emerging areas of practice; fund degree-oriented public health fe~ow- ship programs; provide incentives for developing acaclemic/practice partnerships; and support increased participation of public health professionals in tile education and training activities of schools and programs of public Ilealth. (Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, 2002) Reducing Tobacco's Harm: A national comprehensive surveillance system is urgently needed to collect information necessary to understand the population impact of tobacco products and potential reduced-exposure products, including attitucles, beliefs, product characteristics, product distribution and usage patterns, marketing~messages such as harm reduction claims and advertising, the incidence of initiation and quitting, anti non-tobacco risk factors for tobacco- relatecl conditions. Federal regu~ati~on of all modified tobacco products with risk reduction or exposure reduction claims, exp~icit~or implicit, and any other products offered to the public to promote reduction In or cessations of tobacco use should; be strengthened (Clearing the Smoke: Assessing the Science Base for Tobacco Harm Reduction, 2001 )