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Integrative Research Infrastructure for Food'
Agriculture' and Health
During the first panel presentation and discussion session, representatives of
institutions with experience in integrative research programs spoke. The panel
members were from three universities, a food manufacturer, and a private
foundation, and they discussed a variety of programs in their institutions that
successfully integrate research and education in traditionally independent fields,
such as agriculture, food, and health. They also described recent scientific
breakthroughs that have opened up new opportunities in their work, and funding
and policy obstacles that hinder progress.
MODEL UNIVERSITY PROGRAMS IN FOOD-HEALTH
INTEGRATION
Programs at the three universities represented on the panel the University of
Minnesota, Cornell University, and the University of Maryland modeled some
of the ideals espoused throughout the workshop: close collaboration among
agricultural, medical, and ecology schools at a land-grant university; a graduate
nutrition program that draws on the expertise of 35 faculty in 22 fields at a
23
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24
EXPLORING A VISION
private university; and a medical school that makes nutrition education a key
component of its curriculum.
Role of the Public University
It is the role of public universities to provide students with integrated studies on
nutrition and health and to collaborate with outside institutions, government
agencies, and industry to advance such research, argued Charles Muscoplat,
Vice President of Agricultural Policy and Dean of the College of Agricultural,
Food, and Environmental Sciences at the University of Minnesota. "The
constituents and genes in our food have an intimate relationship with the
constituents and genes in our bodies. Similarly, the research in agriculture and
food must be integrated with our research on nutrition, treatment, and disease
prevention and health," he said, making the case for integrated research and
collaboration.
Muscoplat added that the University of Minnesota is one of the few land grant
research universities that in a single metropolitan location integrates the research
strengths of its College of Agricultural, Food, and Environmental Sciences;
College of Human Ecology; and the seven colleges within its Academic Health
Center, and has a host of programs including partnerships with government
and industry that integrate agriculture, nutrition, and health research to
promote better public health. Those programs include a research center
dedicated to microbial and plant genomics; a biotechnology research alliance
with the Mayo Clinic and the state of Minnesota; a carcinogenesis prevention
program focused on discovery of naturally occurring and synthetic
chemopreventive agents; an obesity center; a center for studying how plants and
plant products may be used to improve human health and nutrition; the Hormel
Institute, which is recognized worldwide as a center for lipid research; the
Center for Spirituality and Healing, which integrates medical and spiritual
aspects of care; a partnership with six tribal colleges in Minnesota, North
Dakota, and Wisconsin to create culture-specific nutrition-education programs
in conjunction with Native American colleges; and collaborative ventures with
major food manufacturers and retailers, such as General Mills and Super Value.
Colleges of agriculture and affiliated colleges and medical schools should come
together to use nutrition as a focal point to enhance curriculum and preparation
of students, Muscoplat suggested. They could increase the number of graduates
who educate the public in nutrition as a vehicle for the prevention of disease and
who work in nutrition therapy, enhance the engagement with underserved
constituents, enhance education and nutrition of current students and health-care
professionals, and address nutrition issues that affect selected populations, such
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INTEGRATIVE RESEARCH INFRASTRUCTURE
25
as the elderly, Native Americans, new immigrants, and children. Emphasis
should be on outreach to the K-12 grade systems, social-service providers, and
government leaders, he added, pointing out that there are opportunities for
adjusting disease prevention through policies related to school-lunch programs
and food-stamp programs, for example.
Mullidisciplinary Mode} for Nutrition Education
Cornell University has established a multidisciplinary model of studies related to
nutrition, according to Cutberto Garza, a Professor in Cornell University's
Division of Nutritional Sciences and Director of the United Nations University's
Food and Nutrition Program. Cornell has found that the core of nutrition
knowledge comes at the interface of several basic disciplines, such as
biochemistry, physiology, immunology, genetics, bioinformatics, and cell
biology. He stressed that the problem-based rather than discipline-based nature
of nutrition requires integration if nutrition is to realize its potential in improving
the health of the American public (see Figure 5~.
Cornell achieves such integration by bringing together about 35 faculty
members in the various disciplines into one academic unit the Division of
Nutritional Sciences. Its faculty members belong to more than 20 other fields of
graduate study across the university. Students receive training in the core
subject of their interest and become well versed in at least two other minor
subjects of study (see Figure 3-1~. In the 60 years that the integrative model
represented by the Division of Nutritional Sciences and its predecessor, the
Graduate School of Nutrition, has been in place at Cornell, it has proved to be
successful in achieving integration of the biologic, physical, and social sciences.
Garza said that research at the university is similarly integrated, thus attracting
funding from diverse sources, including USDA, NIH, and the private sector. He
added that research would be further facilitated if USDA truly embraced a much
more balanced approach that recognizes food and nutrition in addition to
agriculture and if NIH embraced a greater health-promotion agenda, rather than
focusing on combating disease.
Nutrition Education for Physicians: One Approach
The typical student entering medical school has had very little exposure to
agriculture, nutrition science, and many of the health-related struggles
confronting their future patients. The burden on universities to fill those gaps in
their education, said David Mallott, Associate Dean for Medical
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EXPLORING A VISION
Education at the University of Maryland School of Medicine. Mallott gave
several reasons for the gaps. Medical students, like much of American youth,
are overwhelmingly suburban and have never been to a farm, except perhaps a
pick-your-own facility. Starting in high school, many students gravitate to high-
technology, subcellular scientific fields, such as genetics, with little appreciation
of the larger ecologic picture into which one might put nutrition and nutrition
science. This trend is compounded by the lack of nutrition in the undergraduate
curriculum of the average premedical student. Medical students have little
awareness of nutrition science, and medical schools begin teaching nutrition
often too late to have a significant impact. Moreover, medical students and
physicians are generally healthy and have access to good health care and health
information, which can make it difficult for them to empathize with patients
who do not, he said. It is essential to break down those barriers, Mallott stated.
The University of Maryland School of Medicine's approach to nutrition
education starts in the first month. As part of the introduction to clinical
practice, there are a series of life-cycle-based lectures, supplemented by a series
of activities to engage the students, Mallott explained. The curriculum includes
a practicum in the first year, in which where each student is given an imaginary
budget and asked to go food-shopping for an impoverished inner-city mother
and her children. Students later receive "heart-smart cooking classes" and an
assignment to spend time at a rural health-education center, where they study the
eating habits of patients and their families. The purpose is to get them to see
why individual people eat what they do. Noting that the supreme commodity in
medical education, and in the medical field itself, is time, Mallott asked the
workshop participants to be mindful that whatever integrative function is needed
has to be packaged for easy digestion by the medical world.
FOOD-HEALTH INTEGRATION IN A PRIVATE
ENTERPRISE
Eric Gugger, Technical Manager of the Nutrition Science Group at the General
Mills' Bell Institute of Health and Nutrition, provided an industry perspective on
the types of nutrition-related research sponsored and funded by food companies,
sometimes in partnership with universities and other entities. He also explained
how consumer interest has led the food manufacturer to use health claims to
help market its products.
General Mills, one of the largest U.S. food companies, with brands that include
Cheerios, Pillsbury, Betty Crocker, and Yoplait, recently has been able to make
health an economic driver. Gugger noted that the company uses product
packaging to convey messages to consumers about products' potential health
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[NTEGRATIVE RESEARCH INFRASTRUCTURE
29
benefits. The messages are most evident on boxes of cereals like Total and
Cheerios, which tout benefits such as lower cholesterol, reduced risk of heart
disease, and weight loss benefits that are supported by decades of research and
are well understood by consumers, he said. The company also uses press
releases and commercials, which give it more flexibility to discuss the results of
diet-related studies, as well as handouts, dispensed through dietitians and nurses,
with information on how a cereal like Cheerios would fit into the American
Heart Association guidelines (see Box 3-1~.
General Mills marketing research has determined that consumers respond best to
familiar foods or products that are identified as having a recognizable and
familiar health benefit. They do not want to pay more for health benefits,
however, and are not interested in products targeted specifically to health
benefits or that contain additional ingredients that produce health benefits.
"Scientific research is the foundation of our health messages," Gugger said,
noting that the company relies on published studies in addition to company-
funded research. General Mills tends to fund product- or platform-specific
research rather than basic research, which is funded when an issue or food
product is of particular importance or has an advantage in the marketplace. It
also funds clinical trials at universities and through contract research
organizations, in-house dietary-intake research, and epidemiologic research,
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27 The Bell Institute of Health and Nutrition. 2003. Available at
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OCR for page 30
30
EXPLORING A VISION
when related to product or platform. Gugger said General Mills is seeking more
research on diet and diet patterns versus specific compounds, on whole foods,
and on health outcomes for the consumer that can be conveyed in a positive
manner.
A MODEL FOR INTEGRATING TWO DISCIPLINES
John Linehan, Vice President for Biomedical Engineering Programs at the
Whitaker Foundation, described how the private, nonprofit foundation served as
a catalyst for the development of a new interdisciplinary field of study
biomedical engineering that has since become a major discipline in many
colleges and universities and has led to important breakthroughs in the study of
genetics. The foundation efforts to promote biomedical engineering served as a
springboard for discussion of the integration of such fields as agriculture and
public health, and some participants later cited the foundation's achievements
and methods as a possible model.
The foundation decided in the late 1980s to close down, and therefore began to
invest all its funds into the development of the newly emerging field of
bioengineering, which incorporated physics, chemistry, mathematics, and
biology. The foundation started in 1975 by awarding seed grants to young
investigators for initial research to generate preliminary data to be used in
developing more traditionally funded research programs through NSF and NIH.
Although successful, it was slow in producing results, so the foundation later
decided to offer larger competitive development and leadership awards to
universities, which had to compete for the funds. Specifically, the universities
were asked to propose programs to further biomedical-engineering education.
The funding program was set up with the following elements:
The foundation required matching funds, but it placed no cap on how
much it would invest.
It was flexible it avoided prescribing whether the funds had to go
toward startup costs, new buildings, or hiring of new faculty.
If a proposal included a new building, the foundation would not be the
major investor, but would be willing to be the first investor.
Universities were required form departments to qualify for some of the
major awards. This policy was put in place with the recognition that
formalized infrastructure was needed to ensure the sustainability of the
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According to Linehan, universities viewed the program as a great opportunity,
because "this was at the time of the molecular revolution and the computer
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[NTEGRATIVE RESEARCH INFRASTRUCTURE
31
revolution. He imagined them saying, "if we are ever going to do something in
an accelerated way, this is the opportunity to do it." Eighty programs applied
for the grants, submitting very detailed plans; 15 were involved in extensive
follow-up site visits by foundation staff.
Bioengineering education and interdisciplinary research and education have
flourished as a result of the program, Linehan said. Departments were formed in
colleges of engineering, as bridge departments between medical and engineering
schools, or with faculty who had joint primary appointments or funding. One
example is the 1998 creation of a new biomedical engineering department that
bridges Georgia Institute of Technology's College of Engineering and Emory
University's School of Medicine; it now has over 20 active faculty members.
Linehan emphasized the catalytic role of new technologies that are driving
bioengineering, in such fields as cell signaling, functional genomics, and high-
throughput phenotyping. He noted that "when the educational programs exist,
the young men and women will come, and if they come in sufficient numbers
and are of sufficient quality, then the field will be secure in the future."
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28 The Whitaker Foundation. 2003. Biomedical Engineering Educational Summit Meeting.
Available at ~ [September 2003].
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EXPLORING A VISION
OPPORTUNITIES AND OBSTACLES
Responding to audience questions, the panelists discussed current and future
trends in food and health research, as well as obstacles to progress. Recent
breakthroughs in genomics are opening up a new avenue of diet-health
research—one that is shifting the focus of health care from intervention to
prevention. Muscoplat noted that changes are needed in food and health funding
structures to clear the way for interdisciplinary studies and in agricultural policy
to support a new paradigm based on benefits to citizens and consumers.
Genomics and the Diel-Health Nexus
The public-health focus on nutrition and health is expected to increase steadily
in the next decades, Garza said. He attributes the likelihood of this increasing
emphasis in large part to recent advances in genomics. Public health will move
steadily from crisis-driven interventions to increasing emphasis on preventive
medicine as scientists understand better how nutrition and other environmental
factors affect human health and use that knowledge to target treatment to
individuals and groups, Garza said. Preventive therapies that include nutrition
strategies will be used increasingly as scientists gain further insight into single-
nucleotide polymorphisms, haplotypes, and other epigenetic changes that will
help us understand individual and population risks of diet-related diseases.
Agricultural Production Policies
Agricultural policies have inadvertently resulted in some adverse consequences
for the United States, on public health, the ecosystem, world trade, and rural
communities. Muscoplat said it is time for the United States to shift to a new
agricultural paradigm one based on what is both good for consumers and
profitable for farmers. In the future, the "from farm to table" paradigm will be
shifted to "from table to farm" what we should eat to be healthy will drive
what is produced, instead of production driving consumption.
Public Education
As a growing field, food and health knowledge is ever-changing, and it is a
challenge to keep educators, clinicians, and the public up to date on the latest
nutrition and health recommendations. Mallott suggested that educators need to
focus more on the process of continuous learning, to understand better how to
gather, incorporate, refine, and evaluate knowledge from formal and informal
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[NTEGRATIVE RESEARCH INFRASTRUCTURE
33
sources. Without such knowledge, consumers will not drive the production and
development of healthful foods, and physicians will not be able to advise their
patients accurately on healthy choices.
Muscoplat pointed out that modifying human behavior with regard to diet and
health has proved far more challenging than expected taste, convenience,
abundance, and price all complicate lifestyle choices. He reminded listeners that
low-fat diet recommendations intended to reduce heart disease and other diet-
related major diseases were put out 30 years ago, and that rates of obesity have
since increased significantly. He questioned whether the cause of that trend is
the practices and products of the current food-production system whether
science, the marketplace, consumer behavior, and agricultural policy interact to
produce unintended, unhealthful consequences. He recommended a global,
multidisciplinary, geopolitical perspective to solve this complicated problem.
Preventive Medicine
Edward P. Richards, Director of the Louisiana State University Law Center
Program in Law, Science, and Public Health, reminded panelists of the impact
of legal, economic, and insurance issues on American health and its health-care
system. As examples, he specifically identified the short-term contractual nature
of insurance policies as shaping short-sighted, responsive health-care practices,
and the pharmaceutical industry's interest in genomics based on commercial
uses rather than therapeutics. Panelists reiterated the importance of those
concerns, which perpetuate a curative rather than preventive perspective, and
monetize problems and outcomes that should be looked at in terms of
sustainability and social benefit. Mallott, speaking as a psychiatrist, included
nonrational dietary and lifestyle choices made on non-rational bases and the
youth-oriented culture as also playing important roles in a disease-oriented
rather than wellness-oriented system.
Food Safety
One participant felt that foodborne disease presented a key opportunity to focus
on preventive measures. The food supply in the United States is one of the
safest in the world, but the CDC estimates that each year 5,000 Americans die
from foodborne illness, 76 million get sick, and more than 300,000 are
hospitalized, some with long-term health consequences.29 Some populations,
such as children and the elderly, are especially vulnerable, and discussants felt
29 For more information on food safety, see: http://www.cdc.gov/foodsafety/
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EXPLORING A VISION
that science has the ability to help lift the burden of food safety from the
consumer to the elimination of hazards early in the food system.
Disease surveillance and other food-safety efforts have increased as a secondary
result of counterterrorism efforts since the 2001 bioterrorism events, but there
are still improvements to be made, Mallott felt, in that cases of foodborne
disease were still going unrecognized and uncounted. The opportunity to take a
broader view of the food system and its vulnerabilities and to strengthen the
whole system should not be lost, Garza added.
Institutional Coordination
Panelists encouraged funding agencies to engage with each other and to
designate specific grant opportunities for interdisciplinary research in food and
health and suggested that grant review include evaluative criteria for
determining the extent of crosscutting science. Cited as an example was the
successful experience of the NIH Bioengineering Consortium (BECoN),30
which consists of senior-level representatives of all the NIH institutes, centers,
and divisions plus representatives of other federal agencies concerned with
biomedical research and development. Linehan directed attendees to a
symposium on promoting team research that BECON recently organized.3i
Some audience members and panelists suggested that the National Academies
had the opportunity to set examples of better integration of agriculture and
nutrition. The National Academies' newly launched partnership with the Reck
Foundation to push the frontiers of science through a joint program of focused
symposia and seed grants may be a useful platform for advancing
interdisciplinary food and health research, some participants offered.
30 For more information on BECON, see:http://www.becon.nih.gov/becon.htm
3} The Symposium on Catalyzing Team Science was held on June 23-24, 2003 at the NIH Natcher
Conference Center. Its goal was to examine the forces encouraging and discouraging team
approaches to biomedical research and to explore how NIH, academe, and others can stimulate and
reward team efforts. About 350 attendees participated in the plenary presentations, topical breakout
sessions, and case studies of effective team science. A draft summary of the symposium is available
at: http://www.becon.nih.gov/symposium2003.htm
Representative terms from entire chapter:
nutrition science
