Abstract
Background
Evidence for diet and nutrition’s role in the cancer continuum is inconsistent and requires further study. Although more investigation is needed, the National Cancer Institute (NCI) funding for nutrition has decreased.
Methods
To examine nutrition research funding at the NCI, a portfolio analysis was undertaken for fiscal year (FY) 2018. Nutrition and other cancer-related terms were searched using the National Institutes of Health Query View and Report grants management dashboard. Grants were categorized by mechanism, funding status, applicant characteristics, funding opportunity announcement type, award type, and study characteristics.
Results
A total of 18 233 NCI grant applications were submitted in FY 2018; 12% were funded. Of the 653 nutrition-related grant applications received, 69 (11%) were funded. Funding status of nutrition grants did not differ statistically based on the type of funding opportunity announcement and were higher for applications classified as investigator initiated. Early stage investigators’ nutrition applications were funded less than other investigators. Only 4% and 6% of overall and funded nutrition grant applications were submitted by registered dietitian nutritionist primary investigators, respectively. Average FY 2018 award amounts for funded nutrition and overall grant applications were approximately US $399 000 and approximately US $703 000, respectively. Although the percentage of NCI nutrition grants funded was similar to other grant funding at NCI in FY 2018, between FY 2012 and FY 2018, NCI decreased overall nutrition funding by 44%.
Conclusions
Average grant award amounts for nutrition were less compared with overall NCI-funded grant applications and other topics. Our analysis highlights potential opportunities for greater investment in nutrition research at the NCI.
Despite evidence from epidemiological, clinical, and laboratory research that has resulted in guidelines for nutrition and physical activity for the prevention of cancer (1,2), once cancer is present, relatively less is known about how diet influences tumor progression and whether certain diets affect outcomes and survival (3).
There is robust competition for federal funding of nutrition research. Nutrition research funding amounts at the National Institutes of Health (NIH) have been slowly and steadily increasing, however, as a percentage of total NIH research funding, nutrition research funding has remained flat at approximately 5% for more than 20 years (4). Along with the National Cancer Institute (NCI), the other institutes and centers (ICs) that are the major funders of nutrition research at the NIH are the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); the National Heart, Lung, and Blood Institute (NHLBI); and the National Institute on Aging (NIA) (4).
The purpose of this grant analysis was to examine nutrition research funding at the NCI and to share the details with the nutrition and cancer research community. By examining nutrition funding at the NCI in a snapshot of time, key similarities and differences among funded and unfunded NCI nutrition grant applications are described. For broader context, nutrition funding trends at the NCI from 2012 to 2018 were compared with overall nutrition funding trends at the NIH. Additionally, an exploratory analysis of the involvement of registered dietitian nutritionist (RDN) professionals in nutrition and cancer research was performed to understand their contribution and how their involvement in research might be promoted.
Methods
Grant Search and Inclusion Criteria
The NIH’s Research, Condition, and Disease Categorization (RCDC) system definition of nutrition research was used to search an internal database with the NIH Query View and Report grants management dashboard for total NCI nutrition-related grant applications for fiscal year (FY) 2018. RCDC uses sophisticated text data mining in conjunction with NIH-wide definitions to create a “fingerprint,” which matches projects to research spending categories. Projects are often matched to multiple categories. The same process also was used to search for NCI grant applications in the following spending categories: cancer genomics, complementary and alternative medicine, digestive diseases, genetics, immunotherapy, mental health, microbiome, pain and chronic pain, palliative care, physical activity, prevention, obesity, and radiation oncology.
There is no objective way to assign a percent effort based on the RCDC fingerprints, so the dollars for all identified nutrition-related projects are counted as 100% nutrition. The same projects may also be categorized as 100% in other overlapping categories (ie, physical activity, obesity).
Grant applications for which NCI was the primary administrator and funded grant applications in which NCI had a primary, dual, or secondary assignment to the project were included. This study focused on type 1 (new) and type 2 (renewal) competing research grant applications. Noncompeting grants, intramural projects and grant awards supporting training and fellowships, conferences and meetings, and center infrastructure awards were excluded.
Data Extraction
The following variables were extracted from the Query View and Report system: funding opportunity announcement source and type; study section; applying institution and location; NCI division; principal investigator’s characteristics including status (established, new investigator, early stage investigator); award type; funding status (funded, unfunded); award amount; and study characteristics including sample type (human, animal, and clinical trial).
Three coders (BT, CH, and BA) used a standard codebook and classified abstracts of the nutrition-related grants by cancer continuum, including survivors, treatment, or prevention, and focus areas, including epigenetics, genetics, immunity, inflammation, insulin, microbiome, obesity, physical activity, and weight loss. The reviewers tested and refined the codebook on a subset of the grants before coding the entire sample. The focus areas were predetermined by all authors before coding and were chosen based on the authors’ opinions that those topic areas were current and emerging areas of interest in the cancer and nutrition arena.
The NIH’s next-generation portfolio analysis platform iSearch was employed to perform visualizations to identify and search interactive topic clusters of the funded FY 2018 NCI nutrition grant applications from the title, abstract, and specific aims of each grant application. The displayed clusters are scaled to the number of grant documents.
A retrospective review of research grant applications collected by the major NIH nutrition funding institutes was also conducted over a period of FY 2012 to FY 2018 and NCI throughout FY 2018.
A manual search was conducted for each primary investigator to determine RDN status. A Google (https://www.google.com) search was followed by university or institute websites to find individuals’ bio sketches or faculty profiles or education and training. The information obtained was cross-referenced with other sites, such as LinkedIn (https://www.linkedin.com) or other university or institution webpages. If education and training or credentials specifically stated registered dietician or RDN, the primary investigator was considered an RDN.
Statistical Analysis
Basic frequencies and descriptive statistics were calculated and cross tabs were created to compare grant applications across different characteristics and funding status. χ2 or Fisher exact tests were conducted based on the data’s parameters to compare data across categories. All data cleaning and analysis was completed in SPSS 28.
Results
Characteristics of NCI Grants in FY 2018
A total of 18 223 (17 277 new, 946 renewal) NCI grant applications were submitted in FY 2018 of which 3% (653) were nutrition related. Of the 653 applications, 69 (62 new applications and 7 renewals) were funded. Funding rates, average award amounts of funded grant applications, and the types of grant applications (new or renewal) for nutrition as compared with the total NCI as well as various cancer topic applications is presented in Table 1.
Table 1.
National Cancer Institute funding, average award amounts, and types of grant applications among various cancer topics in fiscal year 2018
| Cancer research areas | Unfunded No. (%) | Funded No. (%) | Average award amount, US $ | New funded No. (%) | Renewal funded No. (%) |
|---|---|---|---|---|---|
| Total (N = 18 223) | 15 977 (88) | 2246 (12) | $702 553 | 1969 (88) | 277 (12) |
| Nutrition (n = 653) | 584 (89) | 69 (11) | $398 666 | 62 (90) | 7 (10) |
| Palliative care (n = 182) | 157 (86) | 25 (14) | $1 208 970 | 25 (100) | 0 (0) |
| Pain and chronic pain (n = 152) | 138 (91) | 14 (9) | $930 232 | 13 (93) | 1 (7) |
| Microbiome (n = 201) | 178 (89) | 23 (11) | $870 104 | 21 (91) | 2 (9) |
| Mental health (n = 210) | 189 (90) | 21 (10) | $785 949 | 19 (90) | 2 (10) |
| Cancer genomics (n = 2115) | 1799 (85) | 316 (15) | $646 124 | 283 (90) | 33 (10) |
| Immunotherapy (n = 2200) | 1936 (88) | 264 (12) | $573 083 | 228 (86) | 36 (14) |
| Genetics (n = 5496) | 4788 (87) | 708 (13) | $539 862 | 616 (87) | 92 (13) |
| Prevention (n = 3632) | 3210 (88) | 422 (12) | $521 743 | 376 (89) | 46 (11) |
| Digestive diseases (n = 2537) | 225 (87) | 332 (13) | $477 841 | 302 (91) | 30 (9) |
| Physical activity (n = 240) | 213 (89) | 27 (11) | $440 567 | 26 (96) | 1 (4) |
| Radiation oncology (n = 934) | 835 (89) | 99 (11) | $421 655 | 86 (87) | 13 (13) |
| Complementary and alternative medicine (n = 315) | 292 (93) | 23 (7) | $394 943 | 22 (96) | 1 (4) |
| Obesity (n = 328) | 300 (91) | 28 (9) | $367 159 | 25 (89) | 3 (11) |
Funding rates were similar for total NCI and nutrition-related grant applications. Of the NCI grants, 12% (2246) were funded, totaling US $1 577 933 813, and 11% (69) of NCI nutrition grant applications were funded, totaling US $27 507 974. However, the average award amounts for funded nutrition grant applications were considerably less, approximately US $399 000, than the average award amount for overall NCI-funded grant applications, approximately US $703 000. The average award amount for nutrition grant applications was below that for other cancer research areas, including genetics, palliative care, pain and chronic pain, microbiome, and mental health.
Funding rates were similar for R series grant applications for nutrition submissions and NCI overall submissions. Nutrition submissions and NCI overall submissions were funded at 9% and 10%, respectively, for R01s and 10% and 11%, respectively, for R03s. R21s were funded at a lower rate of 7% for nutrition submissions and 8% for NCI overall submissions.
The award amounts for nutrition were a minimum of US $23 635, median of US $369 875, and maximum of US $2 423 825; the maximum amount was the one outlier. For comparison, genetics had a minimum of US $8000, median of US $386 104, and maximum of US $14 488 060, and outliers ranged from US $978 294 to the maximum. The distribution of award amounts is displayed in Figure 1.
Figure 1.
Box plot of award amounts by cancer topics in fiscal year 2018. The lower bar represents the calculated minimum, and the upper bar represents the calculated maximum award amounts. The first quartile, median, and third quartile are represented within the box, and the dots represent the outliers.
Characteristics of FY 2018 NCI Nutrition Grants
Funding status of nutrition grants in FY 2018 did not differ statistically based on the type of funding opportunity announcement. Success rates were higher for applications classified as investigator-initiated grant applications. These are applications submitted to broad funding opportunity announcements, usually program announcements, for cancer research topics determined by principal investigators.
Primary Investigator Success Rates for FY 2018 NCI Nutrition Grants
As shown in Figure 2, early stage investigators were less successful in receiving funding than other investigators, which includes established and new investigators, for both NCI overall and nutrition. Early stage investigators’ nutrition applications, however, were funded less (n = 2 [3%]) than other NCI overall early stage investigators (n = 84 [7%]); 13% (n = 2162) and 11% (n = 67) of NCI overall and nutrition investigators other than early stage were funded, respectively.
Figure 2.
Comparison of investigator stage and funding status for overall National Cancer Institute (NCI) submissions and nutrition submissions in fiscal year 2018. The total number of applications and the percentage of each are represented for each of the 4 categories. Other investigators were classified as all investigators, including new investigators, other than early stage investigators. Early stage investigator is a new investigator (not previously competed successfully for a substantial National Institutes of Health independent research award) who has completed his or her terminal research degree or medical residency within the past 10 years. All early stage investigators applied for new (type 1) grant awards.
Only 4% (23 of 653) of nutrition grant applications were submitted by primary investigators who were identified as RDNs, and 6% (4 of 69) were funded. Internet searches were performed to confirm the RDN status of primary investigators.
Study Section Review of FY 2018 NCI Nutrition Grants
There were 166 study sections that reviewed the 653 nutrition grant applications. Ad hoc study sections that were developed for targeted funding opportunities (also known as special emphasis panels) reviewed 268 (41%) grant applications; the remaining 385 (59%) applications were reviewed by standing study sections. The percentage of grant applications reviewed by standing study sections in other cancer areas was similar to nutrition.
Characteristics by Topic of FY 2018 NCI Nutrition Grants
Only 109 nutrition grant applications were clinical trials, and of those, 6% were funded; the majority (456) were nonclinical trials, and 46 (10%) were funded. Grant applications that involved humans or animals were funded equally at 10%. There were 293 human-only and 244 animal-only applications. Applications that included both humans and animals totaled 83, and 6 (7%) of those were funded.
There were more applications categorized as cancer prevention (n = 333) than treatment (n = 263), followed by survivorship (n = 57). Funding rates among the 3 areas were 12% (n = 39, US $413 282 average awarded) for prevention, 8% (n = 22, US $393 857 average awarded) for treatment, and 14% (n = 8, US $340 640 average awarded) for survivorship.
Nutrition grant submissions were categorized by study focus areas (Figure 3). Of these focus areas, obesity (n = 235) and genetics (n = 181) received the most grant applications followed by inflammation (n = 140), epigenetics (n = 137), physical activity (n = 89), immunity (n = 89), microbiome (n = 68), and weight loss (n = 53). Insulin (n = 48) had the fewest applications, yet had the highest percent funding (17%).
Figure 3.
Funding status in fiscal year 2018 of nutrition grant applications categorized by select study focus area. Focus areas are not mutually exclusive and overlap exists. Insulin was included as a focus area to represent areas of diabetes and associated metabolism. Other common focus areas not represented included health disparities and reducing treatment side effects.
Using the iSearch tool, prominent topic areas from the 69 funded nutrition grant applications emerged. Figure 4 is a visual representation of the emerged topic areas.
Figure 4.
Foam tree visualization of prominent research topics of the 69 funded fiscal year 2018 National Cancer Institute nutrition grant applications. Source: Downloaded from iSearch (December 2020). The iSearch tool applied a clustering algorithm that used words and phrases from the title, abstract and specific aims of the 69 fiscal year 2018 National Cancer Institute nutrition grant applications. AA = African American; PDAC = pancreatic ductal adenocarcinoma.
Characteristics of the NIH Award Trends From FY 2012 to FY 2018
During FY 2012-2018, the NIH provided more than US $1 billion in financial support for nutrition research and training each year. From 2012 to 2018, National Institute of Allergy and Infectious Diseases (NIAID) had the largest percent increase (109%) in nutrition research funding. Other institutes with increases in nutrition research funding were the National Institute of General Medical Sciences (79%), NIA (59%), NIDDK (14%), and National Institute of Mental Health (13%). Of the institutes that showed decreased funding for that same period, the NCI had the largest decrease of 44%, followed by the National Center for Complementary and Integrative Health (21%), National Institute of Environmental Health Sciences (17%), National Institute of Child Health and Human Development (13%), National Institute on Alcohol Abuse and Alcoholism (7%), and NHLBI (2%). Figure 5 depicts nutrition research funding from 2012 to 2018 in dollars from the 5 ICs with the largest nutrition research funding (5).
Figure 5.
Nutrition funding by National Institutes of Health Institutes from 2012 to 2018. Although the National Cancer Institute (NCI), the National Heart Lung and Blood Institute (NHLBI), the National Institute of Child Health and Human Development (NICHD), and the National Institute on Aging (NIA) appear to be funding at similar rates, NCI had an appreciably larger budget than the other institutes. Over this time period, NCI’s total funding obligations averaged US $5.2 billion per year with an average 3.6% devoted to nutrition funding. Over the same time period, the average total obligations and nutrition funding for the other institutes were as follows: US $3.1 billion and 7.2% for NHLBI; US $1.8 billion and 30% for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); US $1.5 billion and 6.5% for NIA; and US $1.3 billion and 8% for NICHD.
Although NCI funding for nutrition research steadily decreased, total NCI research funding consistently increased over this time period: US $4.79 billion in 2013; US $4.93 billion in 2014; US $4.95 billion in 2015; US $5.21 billion in 2016; US $5.64 billion in 2017; and US $5.95 billion in 2018 for an overall increase of 19% (6).
Discussion
The funded percentage of nutrition awards at the NCI in FY 2018 was comparable with other cancer areas. However, grant award amounts for nutrition were less than other cancer topics. In fact, other than obesity and complementary and alternative medicine, nutrition had the lowest average award amount compared with other areas of research that were examined.
The NIH nutrition research funding has been stable at 5% of total NIH research funding for many years, and NIDDK, NCI, and NHLBI consistently had the highest NIH nutrition spending. Despite NCI being a top nutrition funder throughout this period, NCI was the only IC to show a consistent downward trend in nutrition funding. Although total NCI research funding increased, there was an overall 44% decrease in nutrition funding, which may be due to the “no-benefit” results from past large NCI- and NIH-funded nutrition clinical trials, including the Selenium and Vitamin E Cancer Prevention Trial and the Beta-Carotene and Retinol Efficacy Trial (7). Capturing how the complex interactions of nutrients and cancer pathways result in changes on cancer development is challenging and possibly highlights the need for better surrogate biomarkers of cancer outcomes. Additionally, the skepticism due to the overuse and misuse of epidemiology in diet and cancer research and the complexity with dietary measurement methodology (8) may have contributed to NCI’s decreased nutrition funding trend.
In our analysis, obesity and cancer prevention predominated as major interests of research in cancer and nutrition, which is consistent with approximately half of the NIH nutrition-related projects in recent years being related to disease prevention and/or obesity (4). Research on food and diet quality in relation to obesity, insulin resistance, diabetes, and cancer is fundamental, and researchers in our analysis were focused in these areas. Physical activity and the gut microbiome emerged as aspects of nutrition cancer research in our analysis. Fatty acids also were a predominant topic area, which is consistent with developments of altered fatty acid metabolism and the potential for new therapeutic strategies targeting lipid metabolism applied to antitumor therapy (9,10).
In FY 2018, many funded investigators studied disparity issues, predominantly African American individuals in relation to colon cancer, physical activity, body fat and composition, risk prediction, vitamin D, and metabolic syndrome. African American individuals have a higher cancer burden, highest death rate, and shortest survival of any racial or ethnic group for most cancers in the United States. As the recognition of cancer health disparities has grown so have research efforts to understand the underlying biological, genetic, and socioeconomic differences that may contribute to cancer health disparities, potentially producing more tailored approaches to prevention, diagnosis, and treatment (11).
Our results suggest that nutrition cancer researchers are more successful with investigator-initiated grant applications compared with solicited mechanisms (eg, Request for Application, Program Announcement with special receipt, referral, and/or review considerations, or topic-specific Program Announcement). The NCI nutrition funding rates for FY 2018, however, were slightly higher for ad hoc study sections than for standing study sections.
Early stage investigators submitting nutrition applications were funded 3 to 4 times less than other investigators submitting nutrition applications and 2 times less compared with overall NCI early stage investigators.
Most of NCI nutrition grant applications were nonclinical trials, which is likely related to the decline in the total number of clinical trials funded by the NIH. Between 2005 and 2015, the number of clinical trials funded by the NIH declined by approximately 40%. Phase I trials have shown little change, but the larger phase II, III, and IV trials have fallen steadily (12).
Low levels of research involvement among RDNs in the United States have been reported (13). Although 50% of RDNs hold a master degree, only 3% hold a doctoral degree (14). Our analysis was consistent with these reports and found that only 4% and 6% of overall and funded research grant applicants in FY 2018, respectively, were submitted by primary investigators who were PhD and RDNs.
Advanced oncology training grants that particularly focused on PhDs/RDNs could provide strong mentorship, leadership, and professional development training, as well as nutrition-specific translational oncology research to inform clinical recommendations, measure impact, and disseminate results (15). Similar efforts to the Medical Scientist Training Program for MDs and PhDs, which began in the 1960s and for which there are now more than 90 active MD/PhD programs in the United States (16), are needed to enhance training scientist nutritionists.
The first NIH-wide strategic plan for nutrition research was released in 2020 and emphasizes cross-cutting, innovative opportunities to advance research across a wide range of areas, from basic science to experimental design to research training (4). Further, the NIH Common Fund’s Nutrition for Precision Health, powered by the All of Us Research Program builds on recent advances in biomedical science including artificial intelligence and microbiome research to develop algorithms that predict individual responses to food and dietary patterns (17).
Our analysis highlights potential opportunities for greater investment in nutrition research at the NCI. More funding for new investigators and an increase in award amounts could potentially lead to improved discovery and innovation and energize nutrition research for the next decade. New research investment and structure should support the training of a new generation of scientists and health-care professionals who can leverage nutrition-related knowledge for public good (18).
At the time we began this analysis, data for FY 2019 grant applications were not complete, and hence, we chose to use data from FY 2018. A shortcoming of the computerized RCDC system is that there is no objective way to assign a percent effort for nutrition in an overall grant based on the nutrition fingerprint.
The temporal comparison of NCI-funded research was not exhaustive. There may have been a broader range of comparison if different areas of research were chosen.
There could have been additional classifications of nutrition topics if topical areas were not preselected. Because in iSearch, words are clustered based on how often they occur together in the same document, words can appear in more than 1 cluster, and titles are given more weight. Additionally, the generation of topic clustering could have been slightly different if we focused only on the title or abstract or specific aims vs looking at all 3 components.
The procedure for determining RDN status could have underestimated RDNs who were primary investigators.
Funding
No funding was used for this analysis.
Notes
Role of the funder: Not applicable.
Disclosures: The authors do not have any disclosures or conflicts of interest to report.
Author contributions: EBT: conceptualization, data analysis, writing (original draft), writing (reviewing and editing). CH: data analysis, coding. KR: data analysis, writing (reviewing and editing). SR: conceptualization, writing (reviewing and editing). HS: conceptualization, writing (reviewing and editing).
Acknowledgements: The authors would like to thank Blair Altman (BA) and Bethany Tennent (BT) for coding abstracts. We thank Martina Taylor for helpful comments on an earlier version of the manuscript and Lori Minasian for assistance in reviewing the manuscript.
Contributor Information
Elaine B Trujillo, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Cameron Hays, College of Health and Human Services, Western Michigan University, Kalamazoo, MI, USA.
Karen Regan, Office of Dietary Supplements, Office of the Director, National Institutes of Health, Bethesda, MD, USA.
Sharon Ross, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Harold Seifried, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
Data Availability
The data set is not available for review due to confidentiality of National Institutes of Health grant applications that are not funded.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data set is not available for review due to confidentiality of National Institutes of Health grant applications that are not funded.