The Future of Nutrition Research at the National Institutes of Health^,,

Abstract

Cuts to the NIH budget decreased funding for nutrition research. It is even more necessary now to understand and elevate the role of nutrition research at the NIH. This symposium shed light on where nutrition research stands today and what the future holds for nutrition research at the NIH. In his introduction, the ASN president shared an overview of nutrition research at the NIH and a description of what the ASN is doing to advance the future of nutrition research. Nutrition program directors from various NIH institutes and offices, including the National Heart, Lung, and Blood Institute, the National Institute of Diabetes and Digestive and Kidney Disease, the National Cancer Institute, and the Office of Dietary Supplements, discussed nutrition research advances supported by past and present federal funding and highlighted nutrition research opportunities through forthcoming funding opportunity announcements of interest to ASN members.

Substantial reductions to the budgets of federal agencies limited funding for nutrition research. The NIH budget remained stagnant over recent years and was subject to substantial budget cuts that were associated with sequestration. Although some of those sequestered funds have since been restored, there is reason to believe that this issue will arise again. The NIH currently supports 2000 fewer research project grants than it did 5 y ago. In fact, today only 1 in 6 grant applications are funded, the lowest rate in NIH history. It is even more necessary now to understand and elevate the role of nutrition research at the NIH. This session focused on where nutrition research stands today and what the future holds for nutrition research at the NIH. Nutrition program directors from various NIH institutes and offices, including the National Heart, Lung, and Blood Institute (NHLBI)⁶, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the National Cancer Institute (NCI), and the Office of Dietary Supplements (ODS), discussed nutrition research advances supported by past and present federal funding and highlighted nutrition research opportunities through forthcoming requests for applications or program announcements that would be of interest to ASN members. They also discussed nuances when applying for grants at their specific institute, such as the importance of multidisciplinary and interdepartmental proposals.

Dr. Gordon Jensen, ASN President, opened the symposium with an overview of nutrition research at the NIH and a description of what the ASN is doing to advance the future of nutrition research. He provided a number of statistics related to nutrition funding: >90% of nutrition-related research and training is funded by the NIH and the USDA, only 8% of the NIH budget is devoted to nutrition and obesity research, and the NIH invested $1.7 billion for 4600 nutrition research projects in fiscal year 2012. More than half of all NIH nutrition-related expenditures each year are provided by the NIDDK, the NHLBI, and the NCI; each of these institutes invests more than $200 million annually in support of nutrition research. Through congressional outreach and testimony, ASN representatives have been very active in advocating for increased nutrition research support. As highlighted by Dr. Jensen, the ASN also developed a list of nutrition research priorities. These include the following: 1) variability in response to diet and food; 2) healthy growth, development, and reproduction; 3) health maintenance; 4) medical management; 5) nutrition-related behavior; and 6) food supply and environment. Cross-cutting tools are essential to advance nutrition research. “Omics” technologies will facilitate research on nutrient interactions with genes, proteins, and metabolites. Bioinformatics will enable researchers to more efficiently manage, analyze, and understand nutrition data. Databases are needed to track and observe trends related to nutrition. Biomarkers are essential to be able to determine and monitor nutrition status. Finally, economic analysis is needed to calculate and compare costs of research. Dr. Jensen finished his presentation by recommending that investigators read the nutrition research priorities (1).

Kathryn McMurry, Nutrition Coordinator at the NHLBI, provided an overview of nutrition research at the NHLBI. The NHLBI supports a broad spectrum of nutrition research related to obesity, cardiovascular diseases, pulmonary diseases, blood diseases, and sleep disorders. The NHLBI funding amount for nutrition research averaged approximately $230 million over the past 6 y; most study applications are initiated by investigators. Research methodologies span from knowledge to use: from basic research and epidemiology, which increases knowledge about biologic and behavioral associations and mechanisms, to clinical trials and feeding studies, which determine the efficacy of interventions under tightly controlled circumstances, to intervention studies in clinical and community settings, which determine the effectiveness of intervention in “real-world” settings, to research that translates and disseminates intervention approaches to clinical and community settings. Moreover, this path is bidirectional.

Recently, at the NHLBI, there has been increased interest in low-cost, pragmatic trials. These trials would be expected to do the following: 1) determine the effectiveness of an intervention in a real-world setting; 2) answer questions that greatly affect patients or healthcare providers; 3) leverage existing clinical practice settings/electronic resources; 4) minimize the use of separate infrastructure; and 5) use low-cost methods to collect, store, and utilize biologic specimens.

The seminal NHLBI-funded study Dietary Approaches to Stop Hypertension (DASH) serves to highlight some of the research questions that can be investigated with T4 (translation to population) translational research. For example, what are effective ways to foster DASH eating patterns within communities, within healthcare settings and by individuals? Moreover, this broad question can be divided into a number of smaller questions. How can we communicate most effectively with providers and consumers? How can we motivate individuals to change their eating habits? How can we monitor adherence to a heart-healthy diet? How can we promote effective counseling/coaching to follow DASH? What tools/resources are most effective? Finally, how can availability/affordability be increased for foods and beverages that are heart healthy?

Dr. Padma Maruvada, Program Director at the NIDDK, focused on nutrition research at the NIDDK. The NIDDK supports and conducts a broad spectrum of research to combat diabetes and other endocrine and metabolic diseases, liver and other digestive diseases, nutritional disorders, obesity, and kidney, urologic, and hematologic diseases. The NIDDK is very committed to the following: 1) basic, translational, and clinical research; 2) research training and career development; and 3) the dissemination of health information to improve the lives of patients, their families, and those at risk for these diseases. The NIDDK supports the largest nutrition research portfolio at the NIH, which includes both traditional nutrition studies and metabolic research, averaging ∼21% of the NIDDK budget (approximately $400 million each year for the past 6 y).

The NIDDK has a number of current funding opportunities that would be of interest to the nutritional community. Dr. Maruvada highlighted 2 of these. The first is Nutrigenetics and Nutrigenomics Approaches for Nutrition Research (research project grant PAR-13-375) (2). The goal of this initiative is to foster collaborative research between nutrition researchers and experts in “omics” technologies and to encourage applications that use application of nutrigenetics and/or ≥1 nutrigenomics approaches to basic, translational, and clinical nutrition research. Gut Microbiota-Derived Factors in the Integrated Physiology and Pathophysiology of Diseases within NIDDK’s Mission (research project grant PAR-13-293) also was emphasized (3). The objective of this initiative is to support investigator-initiated multidisciplinary R01 research projects to define interactions between the host and the gut microbiota that regulate normal physiology and pathophysiology of diseases within the NIDDK mission. The goal of the research projects is to define specific human gut microbiota genes or gene regulatory networks, metabolites, secreted proteins, or other molecular factors that affect or are affected by host physiology (including diet/nutrition), homeostasis, and disease pathophysiology. In addition to discovery of specific microbiota-derived factors, research projects will need to define the specific interactions and pathways by which they affect host processes locally within the gut and/or at distant organ sites.

The NIDDK also has a number of resources related to nutrition research. The Nutrition Obesity Research Centers program supports research infrastructure, including research services, enrichment programs, and collaborative activities, at an academic/medical institution or consortium of institutions, to foster interdisciplinary basic, clinical, and public health research. The Digestive Diseases Research Core Centers program provides a mechanism for funding shared resources (i.e., core facilities). Through these centers, the NIDDK aims to integrate, coordinate, and foster interdisciplinary cooperation between groups of established investigators that conduct high-quality research on digestive diseases. The Mouse Metabolic Phenotyping Centers program provides experimental testing services to scientists studying diabetes, obesity, diabetic complications, and other metabolic diseases in mice.

In the future, the NIDDK will continue to promote state-of-the-art nutrition research, encourage the introduction of novel technologies and concepts in nutrition research to complement current efforts, encourage application of high-throughput “omics” technologies to address diet–host–microbiome interactions, support collaborative and multidisciplinary research, and leverage existing resources and infrastructure developed across federal agencies. The NIDDK will meet the challenge of deploying its precious budgetary resources in the most effective and efficient ways to sustain research momentum and fully capitalize on research achievements.

Dr. Sharon Ross, Program Director at the NCI, discussed nutrition research at the NCI. At the NCI, there are 4 different extramural divisions that support nutrition research: 1) the Division of Cancer Biology; 2) the Division of Cancer Control and Population Sciences; 3) the Division of Cancer Prevention; and 4) the Division of Cancer Treatment and Diagnosis. The Nutritional Sciences Research Group, located in the Division of Cancer Prevention, supported mechanistic preclinical and clinical studies concerning the influence of bioactive food components in cancer prevention with an emphasis on understanding variation in response and biologic processes of cancer development and prevention. Current supported studies continue to focus on these areas and strive to understand the relation between the microbiome, diet, and cancer prevention and understand the link between diet, obesity, and cancer prevention. The NCI encourages applicants to consider the totality of the evidence rather than selective inclusion of evidence when testing a hypothesis and to be mindful of adequately addressing power, sample size, multiple comparisons, and study design issues in both preclinical and clinical studies. In fiscal year 2012, the NCI funded 585 nutrition-related projects at a cost of more than $286 million, which represented 5.7% of the NCI budget (4).

Beginning in 2011, the NCI adopted a new approach to the selection of grant applications for funding. Rather than establish an absolute pay line, individual consideration of a broad range of applications were the hallmark of the NCI selection process for all competing applications. In 2013, most applications with scores up to percentile 9 were funded. Funded applications with higher scores were subject to divisional and Scientific Program Leaders review. The NCI awarded 1095 competing research project grants, resulting in a final success rate of 14% (5).

A number of recent funding opportunities at the NCI also were highlighted (6, 7). Research Answers to NCI’s Provocative Questions—Group A (Cancer Prevention and Risk) is a funding opportunity announcement (FOA) for R01 and R21 applications that challenges investigators to seek answers to specific unsolved problems generally related to the investigation of changes in behavior and various exposure risks, mechanistic links between cancer risk factors and biologic events associated with cancer development, and how we might identify and better understand prevention mechanisms. The NCI omnibus R21 FOA supports the development of new research activities in all areas of cancer research (8). The R21 mechanism is intended to encourage exploratory and developmental research projects by providing support for the early and conceptual stages of these projects. These studies may involve considerable risk but may lead to a breakthrough in a particular area or to the development of novel techniques, agents, methodologies, models, or applications that could have a major affect on a field of cancer research (biomedical, behavioral, or clinical). The NCI omnibus R03 FOA supports small research projects on cancer that can be performed in a short period of time with limited resources (9). The R03 grant mechanism supports different types of projects, including the following: 1) pilot and feasibility studies; 2) secondary analysis of existing data; 3) small, self-contained research projects; 4) development of research methodology; and 5) development of new research technology.

The final speaker was Dr. Cindy Davis, Director of Grants and Extramural Activities at the ODS, who discussed the role of the ODS in nutrition funding. The mission of the ODS is to strengthen knowledge and understanding of dietary supplements by evaluating scientific information, stimulating and supporting research, disseminating research results, and educating the public to foster an enhanced quality of life and health for the U.S. population. Unlike the institutes at the NIH, the ODS is not able to directly fund or take primary responsibility for grants. Instead, the ODS co-funds grants that have already been through NIH peer review and subsequently funded through an NIH institute. ODS accepts applications from the program directors of the NIH institutes and centers 3 times a year and evaluates them on their relevance to the ODS mission and strategic plan, whether they fill gaps in the ODS research portfolio, and quality of the science. The ODS spends ∼60% of its budget co-funding extramural grants. At its peak in 2007, the ODS co-funded 103 awards for $17.4 million compared with 96 awards in 2013 for $13.7 million with 14 different NIH institutes.

Research interests of the ODS are not limited to specific health conditions, organ systems, or population groups. The ODS supports all types of research, including preclinical, clinical, behavioral, and epidemiologic, in which the emphasis is on dietary supplements or their ingredients. However, the ODS will not entertain grants that have disease treatment as a focus. Primary consideration for support is given to proposals that stimulate dietary supplement research when it is lacking, clarify gaps, and focus on the use of supplements in improving or maintaining health and reducing the risk of chronic disease.

Dr. Davis also discussed a new FOA for fiscal year 2015 (10). The ODS will fund up to 30 administrative supplements that are designed to provide supplemental funds to relevant, active, NIH-supported research projects to incorporate dietary supplement research that is within the scope of the parent project.

The symposium ended with a panel discussion that also incorporated the scientific review aspects of nutrition research. Attendees now have a better understanding of how the different NIH institutes, offices, and centers fund nutrition-related research and future funding opportunities within the NIH.