PREPARED STATEMENT OF M. C. NESHEIM

Good morning, Mr. Chairman, I am pleased to have the opportunity to present some ideas relative to the role of the federal government in nutrition research. I am Director of the Division of Nutritional Sciences at Cornell University, an academic unit which is the largest of its kind in the United States dealing with research, teaching and extension in Human Nutrition.

We have a strong commitment to Human Nutrition Research and through activity of Division faculty we receive about $3,500,000 annually in Federal research funding. These funds come primarily from USDA (21%), NIH (44%) and USAID (23%). Smaller amounts of research funding comes from National Science Foundation and from private industry and foundations. New York State contributes some $680,000 to this research, primarily in the form of faculty salaries. This in practical terms shows that the federal government plays a major role in funding human nutrition research in the United States.

I believe that Human Nutrition as a major component of public health will continue to be a major research and policy issue for at least the remainder of this century in the United States and will deserve continued federal support. Some of the research issues needing attention include:

1. The relationship of dietary practices to health and chronic degenerative disease such as cancer, heart disease, obesity, diabetes, hypertension and other diseases of aging. Understanding these relationships and developing strategies for broad public health solutions will involve a variety of approaches including:

a. Biological approaches to understanding the etiology of chronic disease, including approaches at the molecular level, study of metabolic regulatory processes and the interaction of nutrients with these metabolic processes, particularly as influenced by nutrient deficiency and nutrient excess. Those involved in nutrition must understand and use the latest techniques of modern biology as researach tools.

b. Epidemiological approaches: in addition to the biological and molecular level research, nutrition/chronic disease relationships must also be understood in an epidemiological context. Therefore, the epidemiological studies in nutrition for understanding etiology and dietary relationships will become increasingly important and less emphasis will be put on large scale intervention studies.

c. Public policy research: the studies on etiology, carried out at the biological or epidemiological level raise issues of public policy dealing with intervention strategies, nutrition education, and how food policy and social policy issues impact upon the nutritional practices and nutritional well being of the population.

2. Problems of malnutrition in the developing world. Protein-energy malnutrition is probably the major public health problem in the world today. Other extremely prevalent and important forms of malnutrition include nutritional anemias, vitamin A deficiency (a leading cause of blindness in children), and endemic goiter due to iodine deficiency. The United States, as a major world power, cannot ignore the human cost of malnutrition and has both a moral and economic interest in participation in the alleviation of this major world problem. The research agenda on the international issues include: a. Biological factors related to malnutrition, including relationships to environmental factors such as disease, parasitic infection and nutrient deficiency.

b. Further understanding the relationship of malnutrition to functional outcomes such as infant mortality, learning disabilities, worker productivity, pregnancy outcome, and population social organization.

c. The relationship of malnutrition in the developing world to social, demographic and economic factors, including alleviation of poverty, policy and planning issues, interventions, family planning and program management. d. The trial and evaluation of intervention strategies (including food programs, fortification, nutrition education, control of infections and parasitic diseases, the protection of breast feeding, etc.) designed to improve the nutritional status of communities and populations.

3. The development of improved programs and techniques for planning, implementation, and evaluation of nutrition programs and nutrition policies. We have not done a good job of assessing our nutrition intervention programs in the U.S. in spite of our large federal commitment to them and we must commit a greater research and development effort to improve our abilities to assess program benefits.

Although this discussion of research issues in nutrition in the years ahead, separates major issues of nutrition research into those of developed

countries such as our own and developing countries, a better division might be between people that are poor, and those with adequate resources. We

have just completed a study assessing the growth of children in the U.S. based on data collected in the first and second Health and Nutrition Examination Surveys (HANES). The data from these surveys, carried out in the early and late 1970s, clearly show poverty related growth deficits in children, indicating that the poverty environment even in the United States still prevents full expression of a child's biological potential. Part of this environment is related to adequate nutrition.

The support for the research outlined above, does not come from a single agency of the federal government but is scattered throughout several federal agencies. Organization of nutrition programs and policies within the federal government has been difficult because of the varied nature of the issues facing nutrition and the multidisciplinary expertise needed to carry out appropriate research and to manage research programs. Agency coordination of programs so that there is clear responsibility outlined for various aspects of nutrition research continues to be a problem in the federal system. These problems were outlined in several reports to the Congress in the late 1, 2 1970's and they apparently still exist today. The recent abolishment of the "Joint Subcommittee on Human Nutrition Research" suggests that appropriate coordination mechanisms have still not been found and I hope some new mechanism will be forthcoming to replace the Joint Committee that will insure communication among federal agencies involved with Human Nutrition. In the context of the research agenda I have just outlined I wish to make some comments as to Federal support of nutrition research from my perspective in an academic department involved broadly in many of these areas or research.

The Department of Health and Human Services, primarily through the NIH continues to support nutrition research and remains the major source of support for basic nutrition studies. Support for Nutrition properly

1. General Accounting Office, National Nutrition Issues CED-78-7 Dec. 1977.

2. Office of Technological Assessment, Nutrition Research Alternatives, 1978.

comes from nearly all of the NIH institutes and I am strongly in favor of continuing to look for support for human nutrition research throughout the various NIH programs. Such broad NIH involvement has received strong congressional support in the past and I hope this support will be continued.

The diffuse support for nutrition throughout NIH, however, has made it difficult to maintain support for activities that strengthen the ability of the biomedical research community to carry out nutrition related research. Support for nutrition training, clinical nutrition research units, areas of basic nutrition research not specifically disease related needs continued attention and strengthening. Therefore, I also support suggestions made by many in the nutrition community that a Center for Nutrition be established within one of the existing NIH institutes. Such a Center provided with specific budgetary allocations would insure that the research and training needs in nutrition would receive adequate support and that priorities for training and basic nutrition research would receive specific attention. This focus for nutrition within NIH is even more critical in today's funding climate. While NIH has been able to maintain total numbers of individual research grant awards relatively constant, grant budgets have been cut in the face of rising research costs, and training and center grants have suffered even greater reductions.

I also believe that the NIH could play a much greater role in support of research that is highly relevant to nutrition problems of developing countries. Malnutrition and disease are partners in most of the tropical areas of the world. These two problems together retard development, and make it more difficult for developing countries to properly use economic aid. Much of the developed world, living in temperate climates has reduced support for research in tropical diseases, parasitic infections, and associated nutritional deficiency disease. Much of current support for such research comes from the Agency for International Development, but AID is not specifically charged with support of the basic biological research needed to deal with such problems. The US capability to maintain expertise in areas of tropical disease and nutrition problems of the developing countries of the world

is declining and will continue to do so without greater support for basic biomedical research in these areas.

The role of the USDA in human nutrition research has been expanded in recent years, particularly with the development of several intramural research centers as units administered by the Agricultural Research Service. These centers are a valuable national resource for research in Human Nutrition and I am strongly in favor of their continued support.

USDA support of extramural research in human nutrition has been modest. Considering the role of the Department in food programs, food policy, and Nutrition education, I believe the research underpinnings of these programs is inadequate and must be expanded. Much of the research dealing with nutrition education, program evaluation, nutritional assessment, and nutrient requirements has been the domain of USDA and HHS has not provided much specific support for these research areas. Suppport from USDA for applied nutrition research has substantially declined in the past 2 years, just as appropriate research expertise was being developed in these areas in US universities.

Extramural USDA funding has been primarily through the formula funds granted to agricultural experiment stations. An analysis of such funding, carried out in 1982 by a sub-committee of the Experiment Station Committee on Policy (ESCOP) is attached to this testimony. This report shows that relative to ARS commitments to Human Nutrition research, allocation of State Experiment Station funds to human nutrition research is very modest, only about 3.9% of the total. This is a reflection of local priorities of agricultural experiment stations for limited funds. Competitive grants in human nutrition while only a very modest 2.8 million dollars in 1982 represented about 46% of the total extramural USDA research funding through the Cooperative State Research Service. Clearly, the way for USDA extramural funding for human nutrition research to be increased is by increasing the allocation for competitive grants. I strongly support this along with a broadening of the research areas these grants will suppport to reflect the full range of human nutrition responsibilities of the USDA.

The USDA has a major commitment to human nutrition education through the Cooperative Extension Program. Nearly 25% of the extension service