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OPPORTUNITIES IN THE HUTLITIOF flHD or - Ire crlrn<~t llesearch Challenges and the Next Generation of Investigators Committee on Opportunities in the Nutrition and Food Sciences Food and Nutrition Board INSTITUTE OF MEDICINE Paul R. Thomas and Robert Earl, Editors NATIONAL ACADEMY PRESS Washington, D.C. 1994

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diagonal Academy Press e ZIO1 Conshtut10n Avenue, \.~. ~ Washington, D.C. 20418 NOTICE: The project tbut ~ the subject of tab report was approved by the Caverning Board of the Nabona1 Research CouncO, verbose members are drawn Tom the councils of the Nabona1 Academy of Sciences, the \adona1 Academy of Engineering, and the Institute of Medicine. The members of the committee responsible far the report mere chosen far their special competences and with regard far appropriate balance. This report teas been reviewed by ~ group other than the outbox according to proce- dures approved by ~ Report Review Committee consisting of members of the Nubon~1 Academy of Sciences, the Nabonn1 Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the Nabona1 Academy of Sciences to enlist d~tinguisbed members of the appropriate professions in the examination of policy maters pertaining to the bet of the public. In thin the Institute acts under bow the Acudemy's 1863 congressiona1 courter responsibility to be an adviser to the faders govern- ment and Us own inibutive in identifying issues of medical care, research, and education. ~r Kenneth L Shine ~ president of the Institute of Medicine. This Rudy was supported by Reference Log No. S9-0130G-000 Mom the Few Cb~tuble Trusts; Contract No. N01-DK-1-2270 Tom Me National Institutes of Herb, U.S. ~epart- ment of Heabb and Human Services; the Kellogg Foundabon; Contract No. 59-32U4-0-35 Tom the U S. Department of Agriculture; and CeneraI M]1~ Inc. Library of Congress Catalog1ng-In-Pub11~ation Data Institute of Medicine (U.S.). Committee on Opportunities in the Nut~bon and Food Sciences Opportunibes in the nutrition Ad Nod sciences: research chaHenges and the Dext generation of iovesUgators / Committee on Opportunities in the Nutdtion and Food Sciences, Food and Nuthtion Board, Institute of Medicine; Paul R. Tbom~s and Robert Earls Eaton P cm. Includes bibbogr~bica1 references Ed index. ISEN 0-309-Q4S84-2 1. Nutrition Research. 2. Food Research. I. Tbomas, Paul Rag 1953- . IL EaH, Dobert O. IIL Title. QP143456 1994 613.2'072 dc20 Copyright 1994 by the N~dona1 Academy of Sciences. All rights resewed. Pruned ~ Me Unhed States of America 93-41970 CIP The serpent has been ~ symbol of long Em, beahng, and knowledge among almost aH cub tares and reDgions since the beginning of recorded hector. The image adopted as ~ logotype by the Institute of Medicine ~ based on ~ relief coming Lom ancient Creece, now beld by the Sta~Uchemuseen in BerLn.

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D Indication This report is dedicated to Debut S. Goodman, .. {1930-1991), who sewed as the ori~nu1 chaLmun of this committee. Dr. Coodman was ~ renowned nutrition researcher and educator as well as ~ developer and great supporter of this study. His untimely death is ~ tragic loss to the biomedicu1 community. We believe that this report reRects ha desire to enhance research and training in the nutrition and Mod sciences. . . . zzz

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COMMITTEE ON OPPORTUNITIES IN THE NUTRITION AND FOOD SCIENCES RICHARD l. HANSEL (Chair),~! Cardiovascular Research Institute, School of Medicine, University of California, San Francisco, California JOHN W. ERDMAN, JR. (Vice Chair), Division of Nutritional Sciences, University of Illinois, Urbana, Illinois CUTBERTO GARZA (Vice Chair), Division of Nutritional Sciences, Cornell University, Ithaca, New York ALAN G. GOODRIDGE (Vice Chair), Department of Biochemistry, University of Iowa, Iowa City, Iowa [ANET C. KING (Vice Chair), Department of Nutritional Sciences, University of California, Berkeley, California FERGUS M. CLYDESDALE, Department of Food Science, University of Massachusetts, Amherst, Massachusetts ROBERT ). COUSINS, Center for Nutritional Sciences, University of Florida, Gainesville, Florida ADAM DREWNOWSKI, Human Nutrition Program, School of Public Health, University of Michigan, Ann Arbor, Michigan SUSAN K. HARLANDER, Dairy Foods Research, Technology, and Engineering, Land O'Lakes, Inc., Minneapolis, Minnesota LAURENCE N. KOLONEL, Cancer Research Center of Hawaii University of Hawaii, Honolulu, Hawaii GILBERT A. LENIEILLE, Research and Technical Services, Nabisco Foods Group, East Hanover, New Jersey MARTHA CONSTANTINE-PATON, Department of Biology, Yale University, New Haven, Connecticut F. XAVIER PI-SUNYER, Division of Endocrinology, Diabetes, and Nutrition, St. Luke's/Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York SARA A. QUANDT, Department of Anthropology, University of Kentucky, Lexington, Kentucky SYED S.H. RIZVI, Department of Food Science, Cornell University, Ithaca, New York IRWIN H. ROSENBERG, USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts A. CATHARINE ROSS, Division of Nutrition, Department of Biochemistry, Medical College of Pennsylvania, Philadelphia, Pennsylvania Member, National Academy of Sciences M ember, Institute of M edicine v

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SACEIIKO T. ST. JEOR, Nutrition Education and Research Program, University of Nevada School of Medicine, Reno, Nevada ALBERT l. STUNKARD,f Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania DAVID VALLE, Departments of Pediatrics, Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, Maryland WALTER C. WILLETT, School of Public Health, IIarvard University, Boston, Massachusetts M.R.C. GREENWOOD (Food and Nutrition Board Liaison),l Office of Graduate Studies, University of California, Davis, California Staff PAUL R. THOMAS, Project Director ROBERT EARL, Program Officer CONNIE ROSEMONT, Research Associate (through June 1992) SHEILA A. MOATS, Research Associate (from August 1993) JANIE B. MARSHALL, Project Assistant (through April 1993) SUSAN M. KNASIAK, Project Assistant (from November 1993) Al

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FOOD AND NUTRITION BOARD M.R.C. GREENWOOD (C7~air),i Office of Graduate Studies, University of California, Davis, California EDWIN L. BIERMAN (Vice Chair),! Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, Washington OJ ~ PERRY L. ADKISSON,~ Department of Entomology, Texas A&M University, College Station, Texas LINDSAY lI. ALLEN, Department of Nutrition, University of California, Davis, California DENNIS M. BIER, Children's Nutrition Research Center, Houston, Texas EJECTOR F. DeLUCA, Department of Biochemistry, University of Wisconsin, Madison, Wisconsin MICHAEL P. DOYLE, Department of Food Science and Technology, Georgia Experiment Station, University of Georgia, Griffin, Georgia JOEIANNA T. DWYER, Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts JOHN W. ERDMAN, ;iR., Division of Nutritional Sciences, University of Illinois, Urbana, Illinois CUTBERTO GARZA, Division of Nutritional Sciences, Cornell University, Ithaca, New York K. MICHAEL HAMBIDGE, Department of Pediatrics, University of Colorado Medical Center, Denver, Colorado JANET C. KING, Department of Nutritional Sciences, University of California, Berkeley, California JOEIN E. KINSELLA (cleceased), School of Agriculture and Environmental Sciences, University of California, Davis, California LAURENCE N. KOLONEL, Cancer Research Center of EIawaii, University of EIawaii, EIonoluTu, Hawaii SANFORD A. MILLER, School of Biomectical Sciences, University of Texas, San Antonio, Texas ALFRED SOMMER,! School of Hygiene and Public EIealth, Johns Hopkins University, Baltimore, Maryland VERNON R. YOUNG, Department of Nutritional Biochemistry, Massachusetts Institute of Technology, Boston, Massachusetts Member, National Academy of Sciences Member, Institute of Medicine . . V11

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STEVE L. TAYLOR (Ex Officio), Department of Food Science and Technology, University of Nebraska, Lincoln, Nebraska ARTEIUR EI. RUBENSTEIN (IOM Council LiaisonJ,f Department of Medicine, University of Chicago, Chicago, Illinois Staff CATEIERINE E. WOTEKI, Director MARCIA S. LEWIS, Administrative Assistant S U S AN M . WYATT, Financial As s ociate . . . vale

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Foreword Food is fundamental to life and health. Observations over millennia and scientific research have demonstrated that what and how much we eat can affect profoundly how we grow, develop, and age and our ability to enjoy life to its fullest. Dietary patterns are linked to risks of developing a variety of chronic diseases that are disabling and terminate life prema- turely. Fundamental scientific inquiry is essential to advances in the nutri- tion and food sciences or to any of the biomedical, social, and physical sciences. Especially noteworthy is the promise of the biological and ge- netic revolutions in biomedicine and agriculture. With disease prevention becoming more important in this time of health care reform, continued research and advances in the nutrition and food sciences provide great opportunities to improve the lives of millions of Americans. The United States' preeminent role as a feeder of the world is a stunning example of how advances in science and technology have led to improved food pro- duction and processing practices. As a result, citizens in this country and in much of the world are assured an adequate amount of nutritious and safe foods at reasonable prices. To 1 1 1 1 . 1 1 Public health researchers and practitioners face many challenges in facilitating the adoption of healthy eating patterns by the majority of the public. These include developing improved measures to assess the nutri- tional status and health of individuals and groups, as well as developing individualized dietary recommendations that are based on individual sus i

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x FOREWORD ceptibilities to disease. The range of problems is broad from dietary excesses contributing to chronic disease, to inadequate food contributing to hunger and their solutions will require changes in both individual behaviors and public policies. This report identifies research that will link the nutrition and food sciences even more closely with agriculture, eco- nomics, and the social and behavioral sciences in order to develop re- search-based programs and policies to improve public health. Given the vital importance of the nutrition and food sciences to the wealth of nations and the health of their citizens, it is unfortunate that nutritionists and food scientists have reasons to be concerned about the future and long-term vitality of their disciplines. As described in this report, research in the nutrition and food sciences appears to be inad- equately funded in relation to its Potential contribution to society. These fields face an identity crisis given their interdisciplinary nature and the diversity of institutional settings in which research and training occur. How to recruit and train students to address the interdisciplinary research opportunities of the future is a critical challenge. Such opportunities highlight the need for collaborative efforts among nutritionists, food sci- entists, and their colleagues in disciplines ranging from basic biology and chemistry to the social and engineering sciences. The members of the Committee on Opportunities in the Nutrition and Food Sciences have produced a timely and important report. Special thanks are due to Richard Havel, a member of the National Academy of Sciences and Institute of Medicine, who agreed to chair this committee following the untimely death of DeWitt Goodman, another Institute of Medicine member. The report reflects the dedication of the committee members, who gave large amounts of their time and energy over several years. It should be an important reference work that will spark needed discussion about shaping the future directions of the nutrition and food sciences into the twenty-first century. Bruce M. Alberts President National Acaclemy of Sciences .~ ,~ Kenneth I. Shine President Institute of Medicine

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Preface The Institute of Medicine's (IOM) Food and Nutrition Board (FNB) has Tong wished to examine needs and opportunities in the nutrition and food sciences, as others have done under the auspices of the National Academy of Sciences for the fields of chemistry, biology, hydrology, as- tronomy and astrophysics, and several others. We were able to initiate this stucly with the generous support of the Pew Charitable Trusts, the Na- tional Institutes of Health, the U.S. Department of Agriculture, and Na- tionaT Research Council funds from the Kellogg Foundation. The objec- tives of this 2.5-year study were: . to identify the most promising opportunities in research in the nutrition and food sciences and the means of enhancing research, and to examine the organizational structure and quality of education and training in nutrition and the foot! sciences ant! to propose recommen- cdations for improving them. The Committee on Opportunities in the Nutrition and Food Sciences, whose members wrote this report, consists of 21 scientists who are recog- nized leaders in research and who were recommended by one or more scientific or professional associations. These individuals work in a wide variety of settings, incTucling lancI-grant colleges, public and private uni- versities, medical schools, and industry. They are familiar with education and training issues and, as a group, with the work of practitioners in nonacademic settings, including various institutions, hospitals, and public health agencies, as well as field settings and the food industry. Xl

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Ma PREFACE Because no committee of manageable size could adequately cover the range of topics within the purview of the nutrition and food sciences, we requested the help of many outside experts. First, we contacted more than 100 professional scientists and practitioners, asking them for infor- mation, ideas, or contributions on specific topics. In addition, we orga- nized public sessions at the 1992 annual meetings of the Federation of American Societies for Experimental Biology and the Institute of Food Technologists. Furthermore, we encouraged contributions by publishing a O ' O ~ 1 0 .. r . .. . r . ~ . stucly summary anct a 11st ot SIX questions In numerous professional Jour- nals and newsletters, including American Institute of Nutrition Notes, Food Technology The tournal of the American Dietetic Association Tournal of ~ ~ , ., ~ , ., ~ Nutrition Education, and the newsletter ot the American (college ot Nu- trition. The questions were: 1. What do you consider to be the top three research findings in your own area; 2. What do you see as the three most important new frontiers and opportunities for research in the nutrition and food sciences that should be adctressecI? 3. What new technologies are required or need to be developed to meet these challenges? 4. What do you regard as the essential elements of training needed to meet the future research opportunities that you listed above? 5. What changes in current institutional and organizational struc- tures would enhance research and training and thereby lead to progress in the nutrition and food sciences? 6. If you could hire a new faculty member or employee, what exper- tise would you seek? We evaluated all contributions and incorporated many of them in this report. With our sincere thanks for their help, we list these contributors by name and affiliation in Appendix B. The full committee met five times during the course of this study. We established four working groups to develop drafts of Chapters 3 through 6, which identify needs and exciting opportunities for research related to nutrition in the basic biological sciences, food science and technology, clinical sciences, and public health. Working groups held innumerable special meetings and conference calls to prepare their papers and coordi- nate the contributions of outside experts. Our draft report was formally reviewed under the auspices of the National Academy of Sciences' Report Review Committee by a panel of experts whose identities remain un- known to the committee. We have incorporated many of their thoughtful and constructive suggestions. This report describes a wide range of interesting and exciting needs and opportunities for research in the nutrition and food sciences. EIow

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PREFACE ever, by necessity in such diverse anc3 applied disciplines, we were selec- tive rather than encyclopedic in our coverage. We examined recommen- dations for research made in a variety of reports by the FNB, government, and other sources. We established three criteria to help us decide which areas of research to highlight. First, the research must be likely to en- hance individual and public health substantially, by preventing ancl treat- ing nutrition-related diseases and improving the quality, safety, and avail- ability of our food supply. Second, the research must provide important opportunities and challenges for investigators. Thircl, the research was seen as important by one or more of the outside experts who contributed to this report. Our selections were made difficult by friendly differences of opinion and the fact that the nutrition and food sciences are expanding as new techniques and ideas are developed in the basic sciences on which these disciplines depend. With few exceptions, the research accomplishments and opportunities we have identified are of domestic interest. The constraints that led to this limitation precluded a discussion of the exciting challenges faced by the nutrition and food sciences in improving global health. The nature of immigrant populations worldwide and common health problems faced by them and by many rural and urban communities in this country present special challenges that we were unable to review. We hope that the op- portunities highlighted in this report succeed in capturing the imagination of new professionals ant! encourage them to tackle problems of domestic and international significance. In addition to identifying research opportunities and needs to en- hance the education and training of the next generation of investigators, this report also speaks to the need for facilitating the application of avail- able knowledge in the nutrition and food sciences to clinical and public health programs and policies. However, this latter topic one of vital im- portance to the future of the nutrition and food sciences deserves a separate study of its own. Most nutritionists and food scientists are practi- tioners who translate and apply the research results of investigators into programs and initiatives to improve dietary patterns in this country, treat diet-related diseases, or improve the nutritional value and safety of our food supply. 1~7 1 vve nave prepared this report for a large audience, from nonscientist policymakers to well-trained nutrition researchers. We hope to reach de- cision makers in Congress, academic institutions, founclations, and gov- erning boards of accrediting programs, who are in positions to support the growth and well-being of the nutrition and food sciences. We also direct our report to students who are contemplating careers in science, as we hope to convey the excitement and challenge of careers in these disci- plines. Our goal is to provide all readers with some understanding of and appreciation for the diversity of problems and opportunities that chal

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xIv PREFACE lenge nutrition and food scientists. Realization of these opportunities will provide us in some cases with a better understanding of the basic biologi- cal mechanisms that may improve health in the future and in others with immediate improvements in our lives through medicine, agriculture, and our choices in the supermarket. ORGANIZATION OF THIS REPORT This volume begins with a summary of the report that sets forth our conclusions and recommendations for research, education, and training priorities to ensure adequate support for the nutrition and food sciences. In Chapter 1, we present what we believe to be some of the most promis- ing directions for research, organized into five themes and illustrated with two examples. Chapter 2 describes several important accomplishments that are based upon modern concepts of biology and available technolo- gies. Our examples show how the nutrition and food sciences have enor- mously improved human health around the world and suggest how further research promises even greater health benefits. Chapters 3 through 6 make up the bulk of this report. They describe numerous current and future opportunities for exciting, challenging re- search to advance the nutrition and food sciences and to improve human health and the healthfulness of the food supply. Research opportunities in the basic biological sciences and the food sciences are presented, followed by opportunities in clinical nutrition research and public health nutrition. While these are necessarily the most technical chapters in the report, their main points are presented in nontechnical fashion in the summary and conclusions. The future health of the nutrition and food sciences depends almost entirely on a continued supply of outstanding researchers in these areas, as well as adequate financial support. In Chapter 7, we address the educa- tion and training of nutrition and food scientists. While our primary focus is on the training of competent researchers at the graduate and postdoctoral levels, we do not neglect undergraduate education. Chapter 8 reviews the various sources of financial support for the nutrition and food sciences and trends in that support over time. Our list of references is intentionally short; we have listed review articles and particularly important research studies to steer the interested reader to more detailed information on the topics we address. The report concludes with three appendixes: a list of acronyms, acknowledgment of contributors to this report, and brief biog- raphies of the committee members and staff. This report, while ostensibly a product of this committee, incorpo- rates the contributions of hundreds of individuals, many of whom are -1 ~1-r ~----r

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PREFACE XV recognized leaders in the nutrition and food sciences. We have benefited greatly from their ideas and suggestions and hope that, as a result, this report represents somewhat of a consensus of expert opinion on how to shape the directions of the nutrition and food sciences into the twenty- first century. Richard l. Havel, Chair Committee on Opportunities in the Nutrition and Food Sciences

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Acknowlec3 gments This committee acknowledges the important contributions of Paul Thomas, Project Director of this report, as well as Catherine Woteki, FNB Direc- tor, and Robert Earl, Program Officer. Their attention, skill, and dedica- tion to all aspects of the production of this report and their service to the committee have been invaluable. We also appreciate the assistance provided by Research Associates Connie Rosemont and Sheila Moats en c! Project Assistant Janie Marshall. Mike Edington of IOM's Reports and Information Office helped to pre- pare the final manuscript for publication, and Blair Burns Potter served ably as copy editor. The staff of the National Academy Press, particularly Sally Stanfield in publishing this report and Barbara Kline in marketing it, were professional and helpful, as always. Special thanks are also due to Kenneth Shine, IOM President, Enriqueta Bond, IOM Executive Officer, and the members of the FNB for their support, advice, and encourage- ment. xv Richard J. lIavel, Chair Committee on Opportunities in the Nutrition and Food Sciences

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Contents SUMMARY AND CONCLUSIONS 1 I NTROD UCTION ACCOMPLISHMENTS IN THE NUTRITION AND FOOD SCIENCES UNDERSTANDING GENETIC, MOLECULAR, CELLULAR, AND PHYSIOLOGICAL PROCESSES 4 E NHANCING THE FOOD SUPPLY UNDERSTANDING DIET, HEALTH, AND DISEASE RELATIONSHIPS IMPROVING THE DIET AND HEALTH OF INDIVIDUALS AND POPULATIONS 7 EDUCATION AND TRAINING IN THE NUTRITION AND FOOD SCIENCES SUPPORT OF THE NUTRITION AND FOOD SCIENCES . . XV11 tar 15 27 47 98 143 180 209 237

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xviii SOURCES AND SUGGESTED READING APPENDIXES A ACRONYM S B CONTRIBUTORS TO THE REPORT C BIOGRAPHIES OF COMMITTEE MEMBERS AND STAFF INDEX CONTENTS 269 281 286 292 301