The Food and Nutrition Board’s Impact on Nutrition and Science: Domestic and International Perspectives
The opening session of the symposium was moderated by Sylvia Rowe, President of SR Strategy, LLC, and member of the Food and Nutrition Board (FNB). Rowe introduced the session speakers, Suzanne Murphy, E. Wayne Askew, Dennis Bier, and Janet King. The session began with Murphy, who gave a historical perspective on milestone achievements of the FNB, beginning with the development of the first Recommended Dietary Allowances (RDAs) and the evolution of the Dietary Reference Intakes (DRIs). The second presentation, by Askew, focused on ways that the FNB has had an impact on the nutritional well-being of the military. The third presentation by Bier discussed the influence of the FNB on public health initiatives. In the final presentation, King reviewed the role and impact of the FNB in international nutrition and current efforts to achieve global harmonization of approaches to deriving nutrient intake recommendations. The session ended with a moderated discussion between the speakers and symposium participants.
Murphy, Professor Emerita at the University of Hawaii and former Chair of the FNB, opened the session with a description of the beginning of the FNB’s 80-year history. She then acknowledged those symposium participants in the audience who spoke at the 50th anniversary in 1990.
Murphy began with a discussion of nutrient standards, specifically the RDAs and the DRIs. She noted that between 1940 and 1980, 10 RDA reports were released, and even though they were not without controversy, funding was available for an update every 5 years. She went on to describe the next milestone, the 1986 report Nutrient Adequacy: Assessment Using Food Consumption Surveys (NRC, 1986). She described the impact of that report as “the point at which we realized that a new paradigm was needed.” Murphy showed a graphical model of the paradigm, which included risk of inadequacy and risk of excess. The model shows that as intake increases, risk of inadequacy decreases, but, at some point, risk increases again above the safe upper level of intake (see Figure 4-1). “This became really the heart of the paradigm,” she said.
By the mid-1990s, the DRI paradigm had been defined. The 1986 model was adopted, but with the new DRI terms: the average requirement became the Estimated Average Requirement, the RDA stayed the same, and the safe upper level of intake became the Tolerable Upper Intake Level. Murphy went on to state that the initial DRI reports were published between 1997 and 2005 and included energy, macronutrients, vitamins, minerals, and electrolytes. In the past 10 years, the DRIs have been revised for calcium and vitamin D in 2011 and sodium and potassium in 2019, which included a new DRI for chronic disease risk reduction. Among the challenges that Murphy faced as FNB Chair was to try to increase the visibility of the importance of the DRIs, which led to the development of a graphic that illustrated 10 critical health applications of the DRIs (see Figure 4-2).
Murphy described several other areas where the FNB has had an important impact. In obesity prevention, she noted, the FNB has been a major player with projects that include the Weight of the Nation™, the Roundtable on Obesity Solutions, and a number of publications on childhood obesity prevention, including Food Marketing to Children and Youth (IOM, 2006c), and physical activity, for example, Educating the Student Body: Taking Physical Activity and Physical Education to School (IOM, 2013). In the area of food safety, she noted three impactful reports: Seafood Choices (IOM, 2007), Enhancing Food Safety: The Role of the Food and Drug Administration (IOM and NRC, 2010), and Finding a Path to Safety in Food Allergy (NASEM, 2017). Murphy described several reports about nutrition needs across population groups from a historical perspective. Beginning in 1942 with The Food and Nutrition of Industrial Workers in War Time (Boudreau and Goodhart, 1942) and continuing up to the present, reports on improving food assistance programs for pregnant women, infants, and children; school meals; and adult and child day care have addressed these needs, she said.
In closing, Murphy shared experiences from a committee assignment that was very important to her: revising the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages. It was the first revision since the program was initiated in the early 1970s. After several unsuccessful tries at revising the food packages, the U.S. Department of Agriculture (USDA) turned to the FNB. As Chair of the committee, Murphy described her experience with the study committee and staff as “excellent.” She also remarked that the report WIC Food Packages: Time for a Change (IOM, 2006a) had a major impact on the multi-billion dollar WIC program. For the first time, she noted, the program provided fresh fruits and vegetables to everyone in the program. In addition, subsequent research has shown a positive impact on dietary quality and reducing obesity. Murphy’s final slide was a quote from Jay Hirschman, formerly at USDA’s Food and Nutrition Service. The quote was from an email that Hirschman sent to the committee the night before the new regulations went into effect. It read: “Tomorrow we rise refreshed and renewed, to vibrantly greet the new era of WIC’s service to our nation. Together we are making a difference, a better future.” Murphy asked, “How much more eloquent could we be about describing the work that the Food and Nutrition Board does?”
Askew, Professor Emeritus at The University of Utah, spoke about the work of the Committee on Military Nutrition Research (CMNR), an
activity of the FNB covering a period of about 30 years. The CMNR was initially formed in response to a request from the U.S. Department of Defense (DoD) to advise the military on aspects of feeding service members operating under extreme environmental conditions and when maneuvering in combat and field conditions.
Askew began by highlighting some historical landmarks leading up to formation of the CMNR. He explained that beginning in the 1950s and 1960s, the Army had a number of in-house nutrition research laboratories and a group of “Nutrition Reserve Officers” who were scientists that served in the military for a 2-year period. These officers were stationed at various laboratories around the country, where they worked until the 1980s when the nutrition laboratories were closed. However, in 1981 the DoD requested that the National Academies conduct a review of its feeding program. As an outcome of one of the review panel’s recommendations, the Military Nutrition Research program was re-established at the U.S. Army Research Institute of Environmental Medicine in Natick, Massachusetts. This came at a critical time when there were an increasing number of nutrition issues related to the introduction of a new system of field feeding and ration development, Askew said. He added that in response to a request for advice from the Assistant Surgeon General of the Army, the CMNR was formed.
Askew went on to highlight some of the CMNR reports. He noted a group of three reports that dealt with energy and its importance to performance in the field under extreme environmental stress (IOM, 1996), food depravation (IOM, 1995), high energy expenditure (IOM, 2006b), and loss of sleep (IOM, 2001). He noted that as an outcome of the report recommendations the military was able to adjust feeding regimens for specific training situations, thereby reducing the performance issues. Another set of reports addressed the nutrient needs of service women (IOM, 1998). In response, adjustments were made in allowances for iron, calcium, and vitamin D for female service members undergoing basic training. Askew remarked that another outcome was development of the Performance Readiness Bar, which was fortified with calcium and vitamin D (see Figure 4-3).
Askew described a report on performance-enhancing rations (IOM, 1994b). Among the items produced from the report recommendations was the “Stay Alert” gum designed to improve alertness and decrease choice reaction time. Another product, the “First Strike Ration,” could be consumed without preparation for short-term, high-intensity conflicts. The last report described by Askew was Not Eating Enough: Overcoming Under-consumption of Military Operational Rations (IOM, 1995). The request, said Askew, was direct from General Powell’s office—“Fix the MRE [Meal Ready-to-Eat].” The report resulted in MREs “that the soldiers actually
wanted.” The final CMNR report was on nutrient recommendations to support recovery from traumatic brain injury (IOM, 2011). He remarked that the Army is working on those research recommendations today. He added that the CMNR also contributed to international standardizations of North Atlantic Treaty Organization rations.
Askew concluded by acknowledging two individuals who made significant contributions to the CMNR. First, he acknowledged Colonel David Schnakenberg for his work in getting military nutrition brought back to the Army, and then for assistance in forming the CMNR. Askew then acknowledged Robert Nesheim, who led the first CMNR committee. Askew described Nesheim as “always a strong advocate and supporter of military nutrition and [who] got the committee off to a wonderful start in its first 16 years of operation.”
Bier, Director of the Children’s Nutrition Research Center at the Baylor College of Medicine and former Chair of the FNB, gave his thoughts on issues related to public health nutrition and other issues of current interest in nutrition science. He began by noting two previous celebrations of the FNB, one at 25 years and one at 50 years. His approach would be to look back with pride at previous accomplishments, then contemplate the contemporary scene, and finally look ahead “into regions of poor visibility.” Bier noted several scientists who made significant contributions to the FNB. Lydia Roberts (a member of the first FNB), he said, was charged with coming up with the RDAs overnight. Others included Conrad Elvehjem, who discovered two vitamins; Icie Hoobler, one of the first pediatric nutrition scientists; Charles Glen King, who wrote the opening article in the first volume of The American Journal of Clinical Nutrition, and who published the identity of vitamin C before it was published by Szent-Gyorgyi, who received the Nobel prize for the work; and William Rose, who worked out all of the initial amino acid requirements.
At the 50th anniversary symposium (IOM, 1992), Jean Meyer (former President, Tufts University) looked back to the 25th anniversary summary and noted that the symposium committee thought of nutrition as an agenda-based science. The agenda was to feed all Americans, he said, and noted that this is one of the issues with which nutrition science is still struggling. Some scientists publish in non-nutrition journals, but have provided the foundation for the vast amount of fundamental nutrition science, he said. Bier described the view of the 50th symposium committee as having the same view of nutrition as they have with medicine, activities based on science and directed toward a certain end. “I think that is still true today,” he said. “It was true at the beginning. It is still true 80 years later.” Bier reflected that Meyer, also at the 50th anniversary, noted the lack of data on children 18 months to 18 years of age, which is still true today. The other population groups that are missing data are women, particularly those who are pregnant and lactating, and older adults. Although progress has been made, Bier noted, we still have a long way to go.
With regard to public health nutrition, Bier said, a long list of FNB initiatives, including obesity prevention, food safety, and guidance for feeding infants and children, has become a part of the U.S. Dietary Guidelines for Americans. He added that the list should include planning for a new DRI review and that it should be a priority. Another emerging issue is the area of evidence-based synthesis and relationships with chronic disease. Bier remarked that the big challenge is what we have learned about the exposome and environmental exposure. “Essentially every single variable in our
nutritional environment is connected to 50, 60, 70, or 80 other variables in the same environment,” he said. Traditional nutritional and observational studies have not touched on more than a dozen of those variables.
Bier described the biggest question in nutrition and public health in the next century as how environmental signals are transduced to gene expression. Connecting these environmental signals covers public health, agriculture, sustainability, and ecology, and now zoonoses, he said. In working through the issues, “we have to deal with uncertainty.” He remarked on the RDA process and the uncertainty in identifying a “number” when the public and the government wanted a number. The second part, he said, is what to do with the evidence. Bier described the need to achieve a standard in which there is agreement on the evidence, and then determine what to do with the evidence—an inherently subjective assessment. Bier then summarized his immediate priorities. First is to be able to measure dietary intake. He stated that it is not feasible to measure what people eat, which is a rate-limiting step. It is important to have independent measures of dietary intake. His next priority is to obtain more comprehensive information about food composition databases. There are more than 4,000 chemicals in foods and unless the composition is known, then the focus is on a small fraction of the environment to solve. Bier then reiterated his earlier remarks on the need to more fully probe diet and exposome interdependencies.
His final priority was the need for innovative study designs that allow causal intervention-based experiments to prove hypotheses. He remarked on Arthur Clark’s Second Law—the only way to know the limits of the possible is to go slightly beyond them and look back. “We are at the cusp of trying to learn the limits of what we can do and we have to be able to have really good ethical guidelines and safety guidelines,” he said.
Bier closed his remarks with future challenges. One challenge, he said, is inclusivity, which he described as the inability to include the food industry in solving food problems. He stated that there is a need for an independent broker to find a way to allow legitimately important research questions to be funded by industry, as long as they do not control the conduct of the experiments and the reporting of results. The other challenge, Bier noted, is funding.
The final speaker in the session was King, Professor Emerita at the University of California, Berkeley, and former Chair of the FNB. King spoke about the FNB’s international impact. She noted the several study committees she served on, beginning in 1973. “The FNB,” she stated, “has
made numerous contributions to global recommendations and policies over its 80-year career.” King said that she would focus her remarks on four specific areas: nutrient recommendations; food insecurity, hunger, and obesity worldwide; sustainability in the food supply and diets; and advancing agricultural and food research locally and globally. She began by reviewing the goal of global harmonization of nutrient recommendations. The activity was initiated in 2005 and co-chaired by Bert Garza and herself. She said that they put together a workshop of international experts who met in Florence, Italy, to identify the concepts needed to develop a framework for global nutrient recommendations.
King showed the structure of the harmonization framework, which, she described, included three recommendations similar to the DRIs: the average nutrient requirement (ANR); an individual nutrient level, set at a percentile above the ANR; and the upper nutrient level (see Figure 4-4). She then described the concepts needed to compose the requirements. First was to have
criteria for the requirements that could be evaluated. King added that they would have to extrapolate from data published elsewhere in different populations, and adjusted for different food sources and population standards. She noted that the international expert group also recognized the emerging role of genetic variation, as well as the need to maintain long-term health, the need to deal with methods to assess the adequacy of the diet, and to be able to carry out planning for individuals and populations. With regard to applications for labeling, public health planning, food fortification, and dietary guidance, King remarked, there is similarity between what the international group did for its framework and what is now in place with the DRIs. She added that, among the recommended intake requirements for the DRIs described previously by Murphy, the international group did not promote or use the average intake recommendation.
A full decade passed, King said, between publication of the harmonization framework report and the convening of a committee on nutrient recommendations for global use by the National Academies. That effort began, she noted, with a joint workshop among the FNB, the World Health Organization, and the Food and Agriculture Organization of the United Nations (FAO). She described the geographically unique needs that were brought up in the workshop as the differences in the food supply, the bioavailability of nutrients from that food supply, and the population’s health status. Even though there might be a common framework, individual countries and regions will have to adapt it to their own population and food supply.
King also described the application of the framework in an FNB report on harmonizing the derivation of nutrient reference values for young children and women of reproductive age. The report provided the basis for doing this work, noting that the project sponsor, the Bill & Melinda Gates Foundation, is involved worldwide in providing food and nutrition and evaluating the health of young children and women of reproductive age. King emphasized that the report recommendations included regular updates, and that there should be a clear, transparent process for how the numbers are derived. Another area King noted was the FNB’s work on chronic disease. She told the audience that in 1994 the first DRI committees discussed the need for nutrient recommendations to reduce the risk of chronic disease. However, she said, nothing happened until 2015 when the National Institutes of Health held a workshop and published a report on the scientific basis for establishing the DRIs that considered chronic disease endpoints. Based on that report the FNB carried out a study to develop a set of guiding principles for DRIs with chronic disease endpoints. King noted that Shiriki Kumanyika chaired the study committee and that she (King) was a committee member. “We also need to think how to establish harmonized approaches to reduce chronic disease globally,” she added.
King further stated that the issue of obesity and hunger, which also has global implications, has been addressed by the FNB. King mentioned a number of reports on obesity in children and youth in Mexico as well as the United States, and a collaborative report with the United Kingdom on establishing policies to prevent obesity. She reminded the audience that obesity does not exist in isolation, and, in fact, often exists in populations where there is hunger, the subject of a 2011 report (IOM, 2011). She also mentioned a 2019 report that looked at the status and response to the global obesity pandemic, adding, “We are hopeful that we can proceed forward now with some specific projects to reduce this problem.”
King then spoke about the global implications of maintaining a sustainable diet. She described a 2014 FNB workshop summary, Sustainable Diets: Food for Healthy People and a Healthy Planet (IOM, 2014), which, she said, emphasized the need to explore the effect of food and nutrition policies on the environmental impact on the food system. She described the relationship as a global issue that needs to be addressed not only by the FNB, but also with colleagues at USDA and FAO. King pointed out that a sustainable diet has not been defined; however, nutrition scientists need to know how to merge the criteria for a healthy intake with both domestic and global variations in food production. This means that it is critical to address effects on climate, climate literacy, food, nutrition, and health. In the future, she said, “we are going to have to shift the way we approach this and be thinking about how food and agriculture policies need to be based on air quality and environmental management, and how will that shift affect nutrition and health.” The last report mentioned by King was Science Breakthroughs to Advance Food and Agricultural Research by 2030 (NASEM, 2019), which she described as showing that advances are needed to make the U.S. food and agricultural systems more efficient, resilient, and sustainable.
In closing, King spoke about next steps that the FNB should address moving forward into the next decade. She remarked that global activities that have occurred in the past 10 years demonstrate the need for a renewed interest in food and agriculture. “We need to take steps now to stimulate that interest in our next generation of scientists and to enhance mechanisms for conducting the multidisciplinary research that is needed to bring that about,” she said. She further noted the need to look into the characteristics of a future robust food and agricultural research force, and the need for talented individuals proficient in addressing challenges across the food system with new and innovative approaches.
Finally, King suggested possible topics that might be on the agenda for the FNB’s 100th anniversary. The topics she asked the FNB to consider included a novel method to mediate the effect of climate on the food supply and nutrients and innovative food technologies. Apart from genetic food
modification, there is a need to address plant-based alternatives, she added. King also predicted that the obesity epidemic will continue and thus there is a need to think of new approaches to combating it throughout the life cycle, including in utero and during the early years of life. Finally, she asked that work continue on harmonizing nutrient recommendations that reflect the strong global collaborations in place in food production and development.
Rowe opened the discussion by asking the speakers to give their thoughts on the factors behind the success of the FNB over the past 80 years. “What is the secret sauce that made all of these accomplishments possible?” she asked. Bier said that, to him, the success of any venture depends on who is chosen to carry it out. He noted that the FNB was successful because of the people who were picked for the mission, that is, the health of the American population. He added that, despite their differences in discipline, training, etc., FNB leaders took their mission seriously and that was the main reason for the board’s success. Murphy said that among her interactions with colleagues, one of the best has been the meetings of the FNB. She said that the two in-person yearly meetings were enormously productive, generating new ideas and new paths for the board to take. Askew remarked that he was impressed by the FNB’s ability to come together and focus on important issues. “They have this ability to focus on the problem and how their particular expertise fits into that problem to come up with a solution,” he added. King said that the key success of the FNB is the diversity represented in each of the committees, which enables a full discussion of the topic and a way to consider a variety of different solutions. She added that it was important because the long-term goal for many committees is to come up with recommendations that contribute to public policy.
An audience member who was a doctoral student at American University asked about human capacity, and how that helps advance the goals of the board. She asked to hear about the process for identifying topics and if there will be future reports that look at human capital investment (i.e., ethnic diversity) to advance nutrition and food science; and about how technology is a key driver in translating the reports to consumers. Askew responded that he was thinking about how diversity in the military drove the changes to the food ration system, providing different choices to accommodate diversity and flexibility for soldiers in the field. Bier addressed the question about identifying topics for reports. He said that one way is that people bring the problems to the board. The other way is that boards collaborate in responding to questions. The third way, he said, is what committee members themselves bring up, but that way requires seeking outside funding. He suggested that an endowment or Congress could fund
a base set of new activities. Murphy added that the FNB welcomes outside suggestions. Also, every committee that meets has open sessions, and that is another way for the FNB to hear about new ideas, she said.
The final question came from Karl Friedl, chief physiologist in the Army. He began by noting that “it is sometimes important to be a little bit hungry, because you then have to beat the bushes for money and justify a project’s priority.” He added that, for the military, there are national security issues that, when you solve those for new recruits, there is a dual benefit. He noted that was the case with the Committee on Military Nutrition Research and that was part of the strength of the FNB. Bier responded that the first priority is to convince people of the importance of the project. He noted that the military is a great example, citing that the amount of money that we think is big is really small change in the military. Rowe added that, looking back on the past 80 years, it is clear there has been an enormous return on investment, and perhaps better articulating the potential return for the next 80 years may be one of the future challenges.
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