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OCR for page 49
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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Representative terms from entire chapter:
food safety
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~
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
[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
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
~ 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.
~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!
~,~
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'
E}~IAS\C! FO(~D SAM A~\rD Palm NIXON
bacI
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
~~.~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
/~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~.)
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.
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 )
