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RECENT TRENDS AND FUTURE DIRECTIONS
Maiden C. Neshelm
A biochemist, a human geneticist, a food- scientist, an
epidemiologist, a physician/endocrinologist, a human
biologist, a public health physician, and a sociologist
have discussed aspects of the future of nutritional
sciences in this volume. Perhaps it is not surprising,
then, that educational institutions are in some confusion
as to what to do about nutrition, a field that does not
seem to have a neat and tidy academic niche. In this
paper I discuss some observations relating to the
challenges in nutrition that face educational
institutions and raise issues for discussion.
Since the great age of discovery of essential dietary
factors has been left behind, one could argue that the
nutritional sciences have reached a high point in their
history, particularly in the United States.
The number of individuals in this country who consider
themselves to be professionally associated with the field
approaches more than 70,000. The memberships of the
major professional societies in the United States with a
primary interest in nutrition are given in Table 1. The
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TABLE 1 Major Professional Nutrition Societies in
the United States
Society
Founded
Current
Membership
American Dietetic Association
American Public Health
Association Food and
Nutrition Section
American Institute of Nutrition
American Board of Nutrition
American College of Nutrition
American Society for Clinical
Nutrition
Society for Nutrition Education
American Society for Parenteral
and Enteral Nutrition
Institute of Food Technologists,
Nutrition Division
American Association of Cereal
Chemists, Nutrition Division
Total
1917
1917
1928
1948
1959
1960
1968
1975
1975
1981
56,300
1,085
2,400
400
980
600
3,700
4,450
1,600
300
71,815
largest group, with more than 56,000 members, is the
American Dietetic Association (ADA), an association made
up primarily of nutrition practitioners. Other
individuals associated with various aspects of nutrition
research or nutrition and medicine number in the many of
thousands, and there have been six major nutrition
societies founded in the United States since 1959. The
growth of the ADA has been especially striking, with very
rapid growth since about 1970 (Figure 1~.
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60000
-
~-
2X
1~
f
-
-
-
a
l9l0 1920 1930 t9 ~lffO 1950 1970 t980 1~0
Year
FIGURE 1 Membership of the American Dietetic
Association, 1917 to Present.
i
There has also been a major increase in the number of
nutrition science-related journals published both in the
United States and worldwide. The number of titles in
print began to grow significantly in about 1940, and this
growth appears to have accelerated since 1970 (Figure 2~.
Journals published outside the United States seem to have
increased at a greater rate than those published in the
United States.
This increase seems to have closely paralleled the rise
in funding for nutrition research (Nesheim, 1986~. Prior
to 1950, the principal support for human nutrition
research was through federal formula funding to state
agricultural experimental stations and through industry.
173
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so -
~ :
o
40 ~
20
a'
Combined LiLles r
tf orsign ULlce
of ~u.s ~5185
,~
1890 1910 1930 1950 1970 1990
Year
FIGURE 2 Major Nutrition-related Journals, U.S. and
Foreign Titles in Print, 1890 to Present. SOURCE:
Compiled from information in Ulrich's International
Periodicals Directory (1987-1988~.
The Nutrition Foundation played an important role from
1942 to 1963, providing about $6 million in grants for
nutrition research over that period. The National
Institutes of Health (NIH) has now become the major
source of support, with over $200 million in extramural
research related to nutrition. The U.S. Department of
Agriculture (USDA) has over $50 million of expenditures
in human nutrition research, although these funds are
expended largely in support of five major human nutrition
research centers. These centers represent a major
commitment by the federal government to human nutrition
research. The National Cancer Institute (NCI) has
recently announced plans to open an intramural nutrition
research laboratory to support research relative to diet,
nutrition, and cancer.
All of these activities--the growth in the number of
scientists and practitioners, the level of research
funding, and the development of major government research
centers--seem to indicate that nutrition science is a
growing and robust component of the U.S. scientific
community.
The growth of the nutrition sciences has also been
accompanied by major changes that have affected U.S.
educational institutions. Until about 1960, the
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principal focus of nutrition research was on the
discovery, isolation, and identification of functions of
the dietary essentials that are recognized today. It was
an extremely exciting period and was clearly the domain
of biochemists and physiologists. The practitioners of
the nutrition sciences were primarily in the field of
home economics, where the emphasis and application of
nutrition principals were on the home and family.
Today, the research agenda is very different from that
of 30 years ago. Nutrition scientists study aspects of
metabolic regulation by modern techniques of molecular
and cell biology. They are concerned with chronic
diseases such as heart disease and cancer, and there are
new and rather sophisticated applications of nutrition
principles in aspects of clinical medicine. Also,
individuals involved in intervention strategies often are
concerned with a variety of population-based
interventions. The organization of society has made the
traditional, family-based approach to nutrition
interventions less effective.
Thus, in view of the many
institutional changes in the field, it is not surprising
that we are in a time of uncertainty for nutrition
programs at many U.S. universities.
Over the years, there has been a waxing and waning of
the contributions of various universities to the field of
nutrition. Many early researchers traced their lineage
to the laboratory of Osborne and Mendel at Yale and that
of McCollum at Johns Hopkins. Strong and large programs
in nutrition existed for many years at Harvard and the
Massachusetts Institute of Technology, and it is fair to
say that the nature of those institutions' commitment to
nutrition has changed a great deal over the past several
years.
Much of the institutional difficulties associated with
nutrition today involve the nature of research and where
it is done. For example, much of the research on
nutrition and cancer, or nutrition and heart
disease--which has dominated much of our research in the
past several years--began in medical schools or in units
outside of the traditional nutrition science
organizations at universities. Thus, there are
universities in which individuals or small laboratories
are scattered throughout the institution and in which
many research programs significantly related to nutrition
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have no institutional connection to units identified with
the field. This problem is at the core of the
institutional crises that have developed in U.S.
universities in terms of nutrition organizations.
Perhaps a good illustration of where nutritionists work
today can be obtained from examining the sources of
papers published in the Journal of Nutrition and the
American Journal of Clinical Nutrition (AJCN). The data
TABLE 2 Origin of Papers Published in the American
Journal of Clinical Nutrition, Vols. 43 and 44, 1986
Origin of Papers
No. of
Papers
Medical schools or hospitals
Medical schools and other units (university
departments of nutrition, biochemistry, other)
Government or private research laboratories
University departments of nutrition, food
science, or food and nutrition
Schools of public health
University departments of biochemistry,
biophysics, or biomedical sciences
Other
92
44
27
25
13
9
5
in Table 2 show that in 1986, for the AJCN, most of the
papers came from investigators based in medical schools
with a much smaller number coming from traditional
nutrition departments. Many came from private or
governmental research laboratories and from a large
number of other academic centers. Similarly, for the
Journal of Nutrition in 1986 (Table 3) researchers based
in medical schools represented a major group of
contributors, although the more traditional nutrition
groups contributed more to this journal than to AJCN.
There are papers in both journals from a broad range of
176
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TABLE 3 Origin of Papers Published in the Journal of
Nutrition, Vol. 116, 1986
No. of
Papers
Origin of Papers
University departments of nutrition, food
science, or food and nutrition
Medical schools or hospitals
Animal science and veterinary medicine
Government or private research laboratories
University departments of biochemistry,
biophysics, biomedical sciences, and
agricultural biochemistry
Medical schools and other units (university 19
departments of nutrition, biochemistry, other)
Schools of public health
Other
76
50
35
31
22
2
organizational entities. The concentration of medical
school-based papers is of interest in view of the general
lack of identity of nutrition units in many medical
schools. Nutrition scientists publish in many other
journals; however, the two journals discussed above,
which are clearly identified as nutrition journals,
probably reflect publications of individuals who wish
their work to be clearly identified as nutrition related.
It is precisely the lack of focus, definition, and
visibility of nutrition research and teaching programs in
universities today that led to the development of the Pew
National Nutrition Program. This program, funded by the
Pew Memorial Trust of Philadelphia, has attempted to help
a limited number of institutions develop new strategies
for their nutrition programs over the next few years, in
light of the modern agenda of the field.
When the program was announced in 1986, institutions
interested in being considered for an institutional grant
of up to $1 million were asked to submit a letter of
intent outlining the ideas they wished to develop. Over
70 institutions in the United States responded. The
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distribution of these letters of intent was very
interesting and provides a useful profile of the
distribution of nutrition programs in universities
throughout the United States. Some data relative to the
letters of intent are given in Table 4.
TABLE 4 Nature of Applications to the Pew National
Nutrition Program
Academic Unit of Principal
Investigator
No. of
Institutions
l
Medicine
Combined medicine and other unites)
Public health
Human ecology or home economics
Agriculture
Other
Total
29
11
s
11
12
2
70
. .
Forty of the applications were submitted by principal
investigators based in medical schools. Of those 40, 11
were submitted jointly, that is, by one principal
investigator in a medical school and a second principal
investigator associated with another organization on
campus, most commonly a department of nutrition based in
a college of agriculture or home economics (eight
applications) or a school of public health or allied
health (three applications). Of the medical schools that
applied, 23 submitted applications for programs based
essentially entirely within the school of medicine. The
remaining 17 were collaborative programs between the
school of medicine and many other units within the
institution, including those related to allied health,
agriculture, nursing, dentistry, pharmacy, home economics
(human ecology), and even the liberal arts.
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Five applications whose principal investigators were
within schools of public health were received. The
programs proposed in all but one of those applications
were collaborative efforts with the school of medicine
and in two cases, several other departments ranging from
nursing, dentistry, pharmacology, arts and sciences, and
education were also involved.
.
Eleven of the letters-of intent were submitted by
schools or colleges of home economics or human ecology.
Of these, 10 proposed a collaboration with a large number
of other units within the institution. There were 12
applications whose principal investigators were based in
a college of agriculture and associated with a variety of
departments such as animal science, poultry science, food
science, nutritional science, or agricultural chemistry.
All of the agriculture-based applications proposed
collaborations with multiple departments, ranging, it
appeared, across the university. Two of the applications
came from university units that did not fall in any of
these categories: one was based within a particular
department, and the other was a multidepartmental
collaboration.
Although the original announcement of the Pew National
Nutrition Program may have encouraged this
multidepartmental approach, it was clear that the
applicants were responding to the complex organizational
arrangements in which individuals contributing to and
interested in nutrition find themselves.
proposal outlined a coordination mechanism that would be
developed to bring together individuals interested in
nutrition, but almost none of the proposals involved
substantial -institutional reorganization. In many cases,
multiple groups with previous concerns for nutrition were
present on the same campus, presumably competing for
institutional resources that were allocated to support
the subject.
Almost every
The advisory committee for the Pew National Nutrition
Program was somewhat disappointed by the institutional
responses, and it is clear that the incentive that would
be required to stimulate major organizational changes
within institutions is far greater than the funds that
were available through the Pew program. Five
institutions were identified whose proposals were
considered to be innovative and exciting, and the Pew
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program intends to work with these institutions over the
next 5 years as they attempt to develop aspects of their
nutrition programs that will accomplish the objectives of
the Pew grants. In response to the general
disappointment with the applications, however, some of
the funds originally allocated to the program by the Pew
Memorial Trust are being redirected into fellowship
programs intended to develop skills and leadership in
individuals within the nutrition community, as opposed to
attempting to promote institutional change.
One could respond to the above discussion of the
institutional organization of nutrition with the
following question: "What difference does it make if the
research in nutrition sciences is now scattered
throughout institutions and if the focus and identity of
nutrition as a subject is becoming lost?" This may be a
desirable evolution of subject matter within
universities, and there are a number of other areas that
have lost identity over the years. As long as the
particular research problems important to the field as a
whole are being considered with sufficient expertise,
perhaps there is no need for strong institutional
identities and organizations for the subject within
colleges and universities.
In contrast to many other fields that have gone in this
direction, however, there are some unique factors
affecting the field of nutrition that are important for
universities to face. Several thousand individuals who
are majoring in some aspect of nutrition are graduating
from U.S. colleges and universities every year. They are
becoming the grass roots nutrition practitioners
throughout the United States. In U.S. land-grant
colleges, there exists a national network of nutrition
educators associated with the cooperative extension
system in the United States. This represents one of the
principal resources for nutrition education of the public
at large. The dissociation of the units or departments
that carry out this undergraduate training and nutrition
education from the major researchers and research themes
now occupying the field represents a long-term problem
for the nutritional sciences that should be addressed at
the institutional level.
Although researchers in human nutrition more often seem
to be associated with medical schools, no strong
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organizational units associated with nutrition have ~
appeared in many medical schools. Perhaps this is why it
has been so difficult to increase the attention given to
the teaching of nutrition in medical schools (National
Research Council, 19851.
Some universities have been coming to grips with this
problem and have been making changes in institutional
arrangements or in faculty expertise that reflect the
changing research agenda of the field. Progress has been
rather slow, however, and institutions need to ensure
that undergraduates are in contact with the subject
matter most important and relevant to nutrition practice
today. Care must be taken that professional
organizations--which have been so concerned with
developing the professionalism that would ensure a niche
for practitioners in the field within the health
system--do not unintentionally create barriers for
institutions that make it difficult to respond to changes
that are occurring within the field of nutrition.
I have no prescription that can be universally applied
for the organization of nutrition in academic
institutions. However, universities whose resources in
nutrition are scattered throughout several areas of the
institution are missing an opportunity to do many
interesting and exciting things. Because of the breadth
and depth of the subject matter currently making up
nutrition, substantial resources are required that are
managed in such a way that research, teaching, and public
education can be dealt with logically and in concert.
This is a challenge that those in the field of nutrition
must meet if they are to provide the traditional
association between high-quality research, training of
graduate students, appropriate undergraduate instruction,
and professional education of future nutrition
practitioners.
REFERENCES
National Research Council. 1985. Nutrition Education in
U.S. Medical Schools. Committee on Nutrition in
Medical Education, Food and Nutrition Board, National
Research Council. National Academy Press, Washington,
D.C.
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Nesheim, M.C. 1986. Human nutrition--changing
directions and priorities. Pp. 21-25 in Human
Resources Research, 1887-1987, Proceedings. College of
Home Economics, Iowa State University, Ames.
182
Representative terms from entire chapter:
nutrition research
