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1 Introduction America's abundant food supply has been both a blessing and a curse to the nation's health throughout its history. The hard physical labor that was required to found and forge the nation was fueled by the plentiful, safe, and diverse offerings of American agriculture, providing energy and nutrients for growth and health. Science over the centuries has served to increase the quantity, quality, and variety of the food supply. New technologies have allowed us to determine that chemical compounds found in some foods, such as antioxidants, can promote good health and combat disease. Agricultural biotechnology has allowed the extension of traditional crop-improvement practices to the molecular level, and further increased the nutrient quality and overall productivity of food plants and animals. Advances in food processing and storage techniques have reduced the incidence of foodborne illness. Economically, national and global market unification has introduced new foods and new cuisines into the American diet, and seasonal foods, such as fresh vegetables and fruits, have become available year-round. While these changes have allowed malnutrition and hunger to be a concern of the past for most Americans and the average caloric intake has been increasing (see Figure 1-1), the nation has become increasingly sedentary. The very abundance of food and traditional eating habits that were so beneficial now 1

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[NTRODUCTION 3 contribute to an epidemic of overweight and obesity. Rates of overweights in adults in the United States increased from 33 to 37 percent and the rate of obesity3 increased from almost 12 to over 22 percents (see Table 1-1 for U.S. Obesity trends in 1991-2001~. Diet and overweight have been linked to secondary health consequences, including heart disease, stroke, diabetes, and some cancers of the colon and rectum, breast, endometrium, prostate, esophagus, and kidney.5 The medical cost of overweight and obesity has been estimated at $92.6 billion in 2002 dollars, and annual medical spending attributable to overweight and obesity now rivals that attributable to smoking.6 Although data indicate that American diets are becoming healthier and Americans are becoming more active (see Figure 1-2), the average diet still fails to meet the U. S. Department of Agriculture (USDA) recommendations for daily alcohol, fruit and vegetable, and fat consumption. Activity and diet remain the personal choice of consumers, but programs to expand and disseminate knowledge for better health fall in the public and private sector. Whether we see food as medicine or as the cause of disease, medical and agricultural research have the potential to come together in innovative ways to help consumers and producers understand and face the challenges of following a healthful diet. Government, universities, foundations, and industry can support such efforts through the research infrastructure they provide and the priorities they set. Research is needed on foods (both beneficial and detrimental to health) on consumer knowledge and behavior, and its motivation, and on the economics of food- and health-related activities, including food pricing, health-care costs, and agricultural support programs. Agricultural research has traditionally focused on improving production quantities and quality, usually of single crops or animal species. USDA, with its mission to support American agriculture and a safe and affordable food supply Defined as a Body Mass Index (BMI) between 25.0 and 29.9 in adults 18 and older. BMI is defined as weight in kilograms divided by height in meters squared (w/h**2). 3 Defined as a Body Mass Index (BMI) of 30.0 or more in adults 18 years old and older. 4 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. (n. d.). Behavioral Risk Factor Surveillance System, Trends Data Nationwide. Available on-line at i, ~ [January 2004]. 5 World Cancer Research Fund in association with American Institute for Cancer Research. 1997. Food, nutrition and the prevention of cancer: a global perspective. Washington, DC: American Institute for Cancer Research. Available on-line at ~L~ [January 2004] 6 Finkelstein, E. A., Fiebelkorn, I. C., and G. Wang. 2003. National medical spending attributable to overweight and obesity: how much, and who's paying? Health Affairs Web Exclusive, May 14, 2003. Available on-line at ~df [January 2004].

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4 EXPLORING A VISION Table 1-1. Percentages of adults in the United States who are obese, by gender, age, race, education, and smoking status, based on Behavioral Risk Factor Surveillance System data (Obesity defined as a Body Mass Index (BMI = Kg/m2) greater than or equal to 30.~. 738393~0 Characteristics Fraction Obese, NO (BMI, kg/m) 1991 1995 1998 1999 2000 2001 12.0 15.3 17.9 18.9 19.8 20.9 Total Gender Men Women Age groups, years 18-29 30-39 40-49 50-59 60-69 >70 Race ethnicity White, non-Hispanic Black, non-Hispanic Hispanic Other Educational level Less than high school High-school degree Some college College or above Smoking status Never smoked Ex-smoker Current smoker 11.7 15.6 12.2 15.0 7.1 10.1 11.3 14.4 15.8 17.9 16.1 21.6 14.7 19.4 11.4 12.1 11.3 14.5 19.3 22.6 11.6 16.8 7.3 9.6 16.5 13.3 10.7 8.0 17.7 18.1 12.1 12.1 16.9 18.6 21.2 22.4 23.8 21.3 14.6 16.6 26.9 20.8 11.9 20.1 24.1 16.7 19.4 15.1 17.8 11.0 13.1 12.0 15.2 17.9 14.0 17.9 20.9 9.9 12.3 14.8 19.1 20.2 18.6 19.4 13.5 24.2 22.3 16.1 15.5 17.7 18.5 27.3 29.3 21.5 23.4 12.4 12.0 26.1 21.7 19.5 25.3 20.6 18.1 14.3 15.2 21.0 20.8 14.0 20.2 20.5 22.9 24.7 25.6 26.1 22.9 25.3 17.1 19.6 31.1 23.7 15.7 27.4 23.2 21.0 15.7 19.0 19.9 20.9 21.5 22.7 23.9 15.7 16.3 17.8 19.9 22.7 7 Mokdad AH, Serdula M, Dietz W. et al. 1999. The spread of the obesity epidemic in the United States, 1991-1998. Journal ofthe American Medical Association 282:1519-1522. Modkad AH, Serdula M, Dietz W. et al. 2000. The continuing obesity epidemic in the United States. Journal ofthe American Medical Association 284:1650-1651. 9 Mokdad AH, Bowman BA, Ford ES, et al. 2001. The continuing epidemics of obesity and diabetes in the United States. Journal of the American Medical Association 286(10): 1195-1200. A Mokdad AH, Bowman BA, Ford ES, et al. 2003. Prevalence of obesity, diabetes, and obesity related health risk factors, 2001. Journal of the American Medical Association 289:76-79.

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INTRODUCTION Figure 1-2. Trends in diet and activity levels in the United Statesmen Percent of Adults (Ages 18+) Reporting NO Physical Activity in Their Leisure Time 1 9gO-1998 Per apita Alcohol Consumption (Ages 14+) 1990-1 998 1 999 Average Daily Servings of Fruits and \/dgetables (Ages 2+) 1989-1991 to 1994-1996 1~ a cot i= qua o it= 1 0 :~: 3 : ~ ah in 1 - O - ~o l~ 30' .~ o c' t Q ~3 ; ffl ~3 Nan @] ATOM ~ '' ~ MOffOU~UT~tO~ Fatty ^Ci6$ i. ~ S:atur~ed Lady Acres ~ Po;lyur~a)ur~ted Fogy Aclds i l [lends in Fort Intakes as a Percentage of total Calories 1989-1991 to 1994-1996 990 1 ~~a 1 9~ 1~ gag 1 9gO l 99~ mat mar 1996 1999 National Cancer Institute. 2001. 2001 Cancer Progress Report. Available on-line at [January 2004]. 5

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6 EXPLORING A VISION for the American public, is a primary sponsor of agricultural research, both intramural through the USDA Agricultural Research Service, and extramural through the National Research Initiative (NRI). The NRI focuses on research that bridges the basic and applied sciences, including nutrition, food safety, and health; it has begun to encourage multidisciplinary and interagency efforts in recognition of the added value of interdisciplinary science. Competition for NRI support is open to scientists at all academic institutions, federal research agencies, and private and industrial organizations. In FY 2001, the NRI awarded a total of $99 million to the top 597 proposals submitted. The average grant award for new standard research projects was $188,116 for 2.4 years. USDA expects that about $120-150 million will be available for new awards for the FY 2004 award cycled (see Table 1-2~. The National Institutes of Health (NIH) is the primary sponsor of biomedical research in the United States, and has traditionally operated with a disease- combating paradigm, rather than a health-promotion one. This has resulted in exploration of individual diseases and treatments, not of possibly shared etiologies. Obesity, with a role in many serious chronic illnesses, received only about $274 million of the FY 2000 NIH research budget of over $27 billion. In contrast, heart disease and diabetes, known outcomes of overweight and obesity, each received over $1 billion.~4 The National Academies brought together representatives of USDA and NIH, along with the other public and private funding institutions, in the hope of sparking exploration of a more efficient and effective system for conducting food and health research geared to improving, maintaining, and promoting health. A discussion of new structures, policies, programs, and roles may encourage research and education into these novel, interdisciplinary avenues. STRUCTURE OF THE MEETING To address the need for a better understanding of the linkages between food and health, the National Academies invited leaders in agriculture and public health to gather at a workshop in Washington, DC, on June 9, 2003. In her |2 U.S. Department of Agriculture, Cooperative State Research, Education, and Extension Service. n.d. NRI Annual Report: Fiscal Year 2001, National Research Initiative Competitive Grants Program. Available on-line at tiff [January 2004]. |3U.S. Department of Agriculture, Cooperative State Research, Education, and Extension Service. n.d. National Research Initiative Competitive Grants Program. Available on-line at [January 2004]. |4 NIH Computer Retrieval of Information on Scientific Projects (CRISP) System n.d. Available on-line at ~ r~ [January 2004].

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INTRODUCTION 7 Table 1-2. NRI Funding Allocationsa, FY 200115 Research Area/Program Number Total Dollars of Grants Awardedb Natural resources and environment Plant responses to the environment 18 $3,090,000 Watershed processes and water resources 18 4,124,049 Soils and Soil Biology 23 4,380,600 Total 59 $11,594,649 Nutrition, food safety, and health Improving human nutrition for optimal health 22 4,774,458 Food safetyc 31 5,976,378 Epidemiological approaches to food safetyc 6 5,486,155 Total 59 $16,236,991 Animals Animal reproduction 22 3,888,726 Animal health and well-beingd 55 10,988,912 Animal genome and genetic mechanisms 15 2,700,000 Animal growth, development, and nutrient utilizatione 26 3,928,146 Total 118 $21,505,784 Biology and management of pest and beneficial organisms Entomology and nematologyf 33 5,593,143 Biology of plant-microbe associationsg 26 5,349,010 Biologically based pest managementh 17 2,494,593 Biology of weedy and invasive plants 11 2,630,000 Total 87 $16,066,746 Plants Plant genetic mechanismsi 34 4,833,571 Plant growth and developmentj 28 3,646,000 Agricultural plant biochemistryk 34 3,914,847 Total 96 $12,394,418 Markets, trade, & rural development Markets and tradel 21 1,984,000 Rural developmentm 14 1,483,333 Total 35 $3,467,333 (continues) 15U.S. Department of Agriculture, Cooperative State Research, Education, and Extension Service. n.d. NRI Annual Report: Fiscal Year 2001, National Research Initiative Competitive Grants Program. Available on-line at http://www.reeusda.gov/nri/pubs/annreport/2001.pdf [January 2004].

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8 EXPLORING A VISION Table 1-2. (continued) Research Area/Program Number Total Dollars of Grants Awardedb Enhancing value and use of agricultural and forest products Food characterization/process/product research 21 3,367,883 Non-food characterization/process/product research 16 2,453,217 Improved utilization of wood and wood fibern 16 2,025,166 Total 53 $7,846,266 Other Agricultural systems 11 2,535,289 Strengthening programso 75 3,514,458 Metabolic engineering program interagencyp 2 250,000 U.S. rice genome project interagency 2 2,000,000 Total 90 $8,299,747 Awards to be determinedq $1,620,267 Grand total 597 $99,032,201 aThe content of this table varies slightly from tables provided in documents supporting the President's budget to Congress each year in the following ways: 1) while the documents supporting the President's budget include data only for funds from the 2001 appropriation, this table includes data on all awards from proposals submitted to the 2001 proposal cycle, regardless of the year the funds were appropriated (as noted in the table) and 2) awards are arranged in this table under program area (to which proposals are submitted and reviewed) as opposed to relationship to appropriated budgetary lines. bIncludes awards still in process. cIncludes $304,672 in funds from the FY 2000 appropriation. dIncludes $13,239 in funds from the FY 1996 appropriation, $6,759 in funds from the FY 1997 appropriation, and $2 in funds from the FY 1999 appropriation. eIncludes $1,000 in funds from the FY 1996 appropriation and $5,000 in funds from the FY 2000 appropriation. fIncludes $2,132 in funds from the FY 1996 appropriation, $21,981 in funds from the FY 1997 appropriation, and $4,030 in funds from the FY 1998 appropriation. gIncludes $30,000 in funds from the FY 1997 appropriation and $479,010 in funds from the FY 2000 appropriation. hIncludes $3,974 in funds from the FY 1997 appropriation. iIncludes $10,864 in funds from the FY 1996 appropriation, $498 in funds from the FY 1997 appropriation, $2,638 from the 1998 appropriation, and $114,571 in funds from the FY 2000 appropriation. jIncludes $5,000 in funds from the 1997 appropriation. kIncludes $2,298 in funds from the 1997 appropriation and $549 in funds from the FY 1998 appropriation. lIncludes $2,293 in funds from the 1996 appropriation, $5,596 in funds from the FY 1997 appropriation, $1 in funds from the FY 1998 appropriation, and $2,110 in funds from the FY 1999 appropriation. mIncludes $12,666 in funds from the FY 1996 appropriation, $47 in funds from the FY 1997 appropriation, $21 in funds from the FY 1998 appropriation and $2,646 in funds from the FY 1999 appropriation. nIncludes $4,308 in funds from the FY 1996 appropriation and $37,666 in funds from the FY 1998 appropriation. oIncludes $88,187 in funds from the FY 1996 appropriation, $41,133 in funds from the FY 1997 appropriation, $54,702 from the FY 1998 appropriation, and $6 from the FY 1999 appropriation. pIncludes $100,000 in funds from the FY 2000 appropriation. qAs of December 17, 2001.

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INTRODUCTION 9 introductory remarks to the participants, Moderator Barbara Glenn, a member of the National Academies Board on Agriculture and Natural Resources, tasked the roughly 100 decision-makers in agricultural and health research, education policy, and industry to meet this challenge. Their mission was to share and build upon their scientific and organizational backgrounds, with the goal of developing innovative means of improving the integration of the nation's food system with its health system to promote better health. Meeting participants drew on their past experiences with other integration attempts and their future needs in research and education fields where food and the food supply intersect with health, such as food biotechnology, nutrition, cancer, obesity, diabetes, food safety, food-animal health, and zoonotic diseases. These contributions served as a springboard for a broader examination of the education and research infrastructure in agricultural colleges, medical schools, and funding institutions. To provide background for an exploration of these challenges, the opening keynote address was followed by plenary presentations by key government scientists. Two panels were then introduced to begin the discussions; the presentations of the first focused on academic, industrial, and philanthropic infrastructure for food and health research, and those of the second on the experience of researchers at the nexus of these topics. Each presentation session was interspersed with audience questions. In the final session of the workshop, participants were divided into groups and asked to discuss five questions related to food and health integration. The discussion format provided an opportunity for participants to respond to earlier presentations and to offer their own ideas and recommendations on the subject. A rapporteur in each group took notes and presented a summary of the group's discussion to the entire gathering. The five questions for discussion were: Are food and health research and education currently conducted and managed to maximize scientific progress, incentives for collaboration, and benefits to the public health? What activities, programs, or initiatives currently exist in your institution, organization, or agency to address the challenges of improved integration of agriculture and health sciences? What gaps remain? What potential national initiatives could be implemented to address the challenges of improved integration of agriculture and health sciences? How can education and outreach contribute to improved research integration? Which technical research fields would be most amenable or of high importance to initial integration efforts?

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10 EXPLORING A VISION WORKSHOP SUMMARY This workshop summary extracts the key technical issues from the presentations and discussions. Many issues were touched upon repeatedly by several speakers in different sessions, and this format is intended to allow readers who did not attend the workshop to gain an understanding of the discussions in the context of the entire workshop. The workshop was intended to illuminate issues, not to resolve them. By its nature, any workshop is necessarily incomplete, and a workshop summary can report only on what was said. All the information reported here emerged from presentations and discussions during the workshop. This summary is intended to reflect the variety of opinions expressed by the speakers. The contributors have reviewed it and affirmed that it accurately reflects the events and discussions at the workshop.