FAHRE
- Food and Health Research in Europe -
Analysis of gaps and overlaps for existing
food and health research needs in Europe
Thematic Expert Report Template
- July 2010 -
Deadline (draft): 20th October
WORK PACKAGE
LEADS
AUTHOR
Disease and nutrition
WP2. Research needs assessement
Mark Mccarthy (UCL) Lilia Ahrné (SIK)
Acknowledgement
This report forms part of the deliverables from a project called "FAHRE" which has
received funding from the European Community's Seventh Framework Programme
FP7/2007-2013 under grant agreement n° 244459. The Community is not responsible
for any use that might be made of the content of this publication.
FAHRE aims to investigate how to improve the coordination of food and health
research in Europe. The project runs from January 2010 to December 2011, it
involves seven partners and is coordinated by Sociedade Portuguesa de Inovação
(SPI). More information on the project can be found at http://www.spi.pt/fahre or
by contacting the project manager Rachel Newton (rachelnewton@spi.pt).
This document has been developed by the partners for recording expert information
only. It is not an official publication from the project.
Disease and nutrition
Foreword: some definitions for ‘food and health research’
‘Food and health research’ for this report refers to research about the production,
marketing, choice, regulation and policy for food as it affects health, and the
mechanisms and control of diet-related diseases, nutrition and obesity. It covers
positive and negative impacts of food on health as well as issues related to under and
over consumption of food (undernutrition and obesity). It draws on a wide range of
disciplines including psychological, social, management and political sciences,
laboratory sciences, clinical medicine, environment and epidemiology, and is
undertaken by public, independent and industry organisations.
Programmes for food and health may be structured in different ways. In developing
the 'thematic experts' side of FAHRE, we have identified 8 areas for experts, four
broad 'fields' of research, and compared these with three issues in Joint Programming
Initiative 'Healthy Food for a Health Life' Interim Report (March 2010). However, they
form a continuum, with overlaps. They are set out in the table below.
The analysis of the gaps and overlaps for the research fields in each area should
consider all the aspects relevant to supporting research in the area. It should examine
how the needs of the field can be met with regard to research commissioning, major
equipment or technical facilities, available technology tools, and expertise with
particular attention to improving the functioning of the field as a European Research
Area. Thus it will analyse organisations undertaking research or commissioning
research, networks, training programmes, databases, technical facilities and comment
on their effectiveness in moving towards the ERA goals, in particular for greater
mobility, joint research infrastructures, knowledge-sharing, Joint Programming and
International Science & Technology Cooperation.
FAHRE
Research
thematic
areas
FAHRE Country Report
Programme research
fields
JPI interim report
Food production Production field: design of
and products
food (components…), its
preparation (processes…),
Food safety
its manufacturing and also
home cooking matters
linked to health and
disease, interface between
industry and the scientific
sector.
Diet and food production:
Establish reliable data on consumer
food preferences and acceptance in
order to develop new food products and
to redesign how foods are produced.
Enable redesign and optimisation of
food processing and packaging.
Foods must always be safe and should
be produced in a sustainable way.
Regulation,
claims, and
food policy for
health
Lifestyle: Consumer behaviour and food
choice
understanding of consumer behaviour
with regard to food and also to raise
Policy field: regulation
(labeling, salt, sugar and
fat contents, claims…) and
consumers, which will have
3
Consumer
behaviour and
what influences
it
an impact on diet and
therefore on health. It
could also focus on
programmes more
economically oriented,
linked to marketing,
participation, public
expression and access.
consumer understanding of healthy
foods and food consumption patterns.
Measuring food purchase and
consumption behaviour taking into
account cultural differences, and
subsequently, developing reliable
models of consumer choice processes.
Effective communication strategies with
consumers need to be developed to
induce behavioural change directed to
improving consumer health and social
responsibility.
Population
Population field: at human Horizontal issues:
surveys causes and population level,
and control
epidemiologic approaches
(including biological, social
Health policy
and psychological
for food,
determinants) and
nutrition, diet
observational and
and obesity
interventional research on
behaviours that can explain
eating disorders leading to
chronic diseases.
Food causing
disease –
excess,
imbalance,
sensitivity
Biomedical field: nutrition
and dietary research
relating to molecular and
clinical aspects, in the
pathways and causes of
disease, and the
Nutrition micro- mechanisms at different
elements,
periods of the life course.
malnutrition,
gene
It could also include food
interactions,
safety, both toxicology and
biological.
Chronic diseases: preventing foodrelated, chronic diseases and increasing
the quality of life:
1) understanding of brain function in
relation to diet; 2) the effects of dietgut interaction on intestinal and
immune functions;
3) the link between diet and metabolic
function (obesity and associated
metabolic disorders).
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Content
5
Introduction to the Expert´s Area........................................................................................................ 7
1 Methodology: .................................................................................................................................... 8
2 Research at European level in your area of expertise ....................................................................... 8
2.1 Main programmes and projects and groups ............................................................................... 9
2.2 Infrastructures & equipment ...................................................................................................... 9
2.3 Major researcher groups........................................................................................................... 10
2.4 Networks .................................................................................................................................. 10
2.5 Current Training Programmes ................................................................................................. 10
Cochrane database......................................................................................................................... 13
2.6 Congresses .............................................................................................................................. 13
3 Comparison of country reports: ..................................................................................................... 14
3.1 Countries (see methods above) ................................................................................................ 14
3.2 Overview .................................................................................................................................. 14
4 Towards 2020: assessing needs....................................................................................................... 16
4.1 Knowledge needs .................................................................................................................... 16
4.2 Significant research questions .................................................................................................. 17
4.3 Ways to organise research: priorities, developing agendas ..................................................... 17
4.4 Interaction between public research and industry ................................................................... 18
5 Gaps and Overlaps for further research .......................................................................................... 20
5.1 Structures ................................................................................................................................. 20
5.2 Infrastructures .......................................................................................................................... 20
5.3 Ways to organise research...................................................................................................... 20
...................................................................................................................................................... 20
6 Conclusions and Proposals ............................................................................................................. 21
6.1 Research fields ......................................................................................................................... 21
6.2 Research organisation, structures and infrastructures .............................................................. 21
6
Introduction to the Expert´s Area
Improving nutrition in Europe is thought to be the single most important contributor
to reducing the burden of disease in the European Region. (WHO p.9) In Europe
today, five out of the seven most important risk factors for premature death relate to
how we eat and drink.
Non-communicable diseases are responsible for most of the disease burden.
Cardiovascular diseases (CVD) and cancer dominate as causes of premature death in
Europe and about one third of CVD cases are related to poor diet (WHO p.22)
although there are regional variations that have been linked to changing economic
circumstances. For example, Eastern European countries have experienced economic
shifts that have resulted in rapid increases in chronic disease rates.
The dietary contributions to CVD, cancer, type 2 diabetes mellitus and obesity have
many common components. Important components of diet that have been directly
related to these diseases include: cholesterol, trans-fatty acids; fruit and vegetable
(low consumption of); salt; red meat; tobacco; alcohol. Vitamins and minerals appear
to confer some health benefits but the evidence is weaker particularly when they are
ingested as supplements rather than as components of food. Nutritional deficiencies,
autoimmune conditions, dental disease, neuropsychiatric diseases and birth defects
also represent an important burden of disease and illustrate the breadth of the impact
of food on health (a brief description of these is included in the appendix).
This report will focus on the area of clinical trials research on food related disease
groups mentioned above. Food in this context will exclude tobacco and alcohol but
include supplements. Clinical research will comprise aetiological or causal research,
diagnostics, and interventions although there is overlap between these. Interventions
include 1) supplementation/pharmaceutical, 2) behavioural and 3) policy type
interventions where clinical research staff are involved.
It is becoming increasingly apparent that there needs to be a shift from curative to
preventive health care models in addressing chronic diseases in Europe (FroidmontGortz 2009). While most of our knowledge of the link between food and health comes
from epidemiological evidence, and the recommendations for many of food-related
diseases contain similar advice, there is a growing interest in personalised forms of
medicine. The latter relies on emerging research disciplines coming under the
umbrella of nutrigenomics – which aims to understand the interactions between our
genetic make up and diet. This research spans biochemistry, physiology, psychology
and nutrition, and can require highly specialised equipment and is arguably promising
– it is linked to the field of functional foods (health promoting or disease preventing
foods). Presently, there is little that can be translated into effective clinical
interventions. However, it presents new opportunities in personalised nutrition
and collaboration between industry and the public sector.
http://www.toadhillreviews.com/nutrigenomics-market-research/
There has also been a growing interest in the role of prebiotics or the prebiotic effect
('The selective stimulation of growth and/or activity(ies) of one or a limited number of
microbial genus(era)/species in the gut microbiota that confer(s) health benefits to
the host.') – However, again, there is little evidence at present to translate into
clinical practice. The only Cochrane review available has shown no effect of prebiotics
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in preventing bacterial vaginosis, or of the addition of probiotics to infant feeds in
preventing allergic disease or food hypersensitivity. Remarkably, probiotics,
prebiotics, and synbiotics aimed at improving intestinal health currently represent the
largest segment of the functional foods market in Europe, Japan and Australia.
(Roberfroid et al Prebiotic effects: metabolic and health benefits.)
There is insufficient evidence to recommend.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006475/frame.html
This report will aim to produce a European wide view of food and health clinical
research and make some suggestions on how a coherent clinical research agenda
might be formulated.

Methodology:
The information collated in this report is based on a number of sources of information.
In addition to the experts own expertise in the area, a semi-systematic methodology
was employed to capture as much information as possible focusing on publicly
available information online
Qualitative analysis: literature review & country report
 Pubmed and the Cochrane
o See bibliometry section for search terms
 Google
o Scoping searches were conducted for information on programmes,
networks, civil society organisations, infrastructures, and congresses
 Country reports
Data on clinical programmes was extracted manually from the supplied tables. The
rest of the report was systematically searched for information on ‘clinical’ or
‘intervention’ programmes using word search. The rest of the report was examined
subjectively for general information relevant to understanding the EU research
landscape including opportunities and barriers for joint research. Food safety research
was not included.
o
Statistical model
To aid analysis in this report, a number of publicly available indicators were collated
for all 31 European countries to examine the relationship between research publication
and other country level factors. A simple model based on linear regression was
constructed using forward selection.

Research at European level in your area of expertise
While the World Health Organization has put forward a strategic approach to health
policy implementation in relation to food and disease, it does not have a research
programme. (WHO food and health strategy report) There are a number of large
funding bodies supporting international research such as the Wellcome Trust but the
focus is not specifically on developing European research and so do not tap into the
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‘European added value’.
http://ec.europa.eu/research/fp7/understanding/fp7inbrief/what-is_en.html
The European Community funds research in Europe through its framework Programmes
for research and technological development (FP). The Framework Programmes aim to
develop research capabilities, to promote innovation and competitiveness, and to
provide evidence to inform policies in priority areas for Europe. Current European
level projects are funded from FP5, FP6 and FP7. FP7 represents a significant increase
in budget (50billion to be spent between 2007 and 2013) of 63% at current prices
relative to FP6
(http://ec.europa.eu/research/fp7/understanding/fp7inbrief/what-is_en.html).
Health related research represents 19% of this funding ‘Food, Agriculture & Fisheries,
and Biotechnology’ (FAFB) represents 6%.
(http://en.wikipedia.org/wiki/Seventh_Framework_Programme)

Main programmes and projects and groups
Specific European level research programmes related to food and health given as
examples on the FP7 website, the Danone institute website and the European
Technology Platform Food for Life database (see appendix C).
http://ec.europa.eu/research/health/medical-research/clinicaltrials/projectsfp7_en.html)
http://www.danoneinstitute.org/nutrition_portal/eu_research_programs.php

Infrastructures & equipment
Research units focusing on diet and disease would be located either within health care
services with an academic capacity, in universities or specialised units. The key
components for clinical research on food and nutrition are:
1. Subjects: humans (patients/members of the public); animals.
2. Clinical facilities: laboratory equipment; clinical equipment
3. Staff: clinically trained and research trained
4. Framework: institutions which can support research methodology; ethical and
regulatory standards
5. Geography: accessible for delivery of equipment (including cold chain);
subjects; and inspection.
The implementation of personalised research requires large numbers of subjects
within the general population. This requires collaboration from communities as well as
the infrastructure for holding large databases of confidential data. It also requires
harmonisation of study designs to allow for comparable data analyses. A practical
example of the implementation of future food and health research is the use of
community based participatory research. (McCabe-Sellers, Personalizing Nutrigenomics
Research through Community Based Participatory Research and Omics)
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Thinking forward, the infrastructure needs of a coherent and integrated research
agenda for food and health would require facilitation of public/private sector
collaboration. These would be in the form of new research facilities with shared
equipment and resources; or use of public infrastructure. Both of these options should
operate within a strong governance framework to ensure the interest of the public is
maintained even if private monies are used. This also requires that industry be
present and operating under fair competitive conditions as an incentive to industrial
partners. Additional incentives in the form of a time limited patent system similar to
that used by pharmaceutical companies may help. Advice on intellectual property
matter would be required.

Major researcher groups
In addition to groups involved in the research programmes mentioned above. Other
researcher groups are listed under the European Research Council – see appendix D.
Of note, although not clinical in nature, EPIC represents a major research group
providing epidemiological evidence on the link between diet and disease at European
level.

Networks
A list of mostly clinically driven networks that incorporate research on nutrition and
disease is included in appendix E.
EuroFIR (European Food Information Resource) was a five-year Network of Excellence
funded by the European Commission's Research Directorate General under the "Food
Quality and Safety Priority" of the Sixth Framework Programme for Research and
Technological Development. The network involved 49 partners from universities,
research institutes and small-to-medium sized enterprises from 27 European
countries.The EuroFIR project officially ended on 30th June 2010.
http://www.eurofir.net/
Other civil society networks and groups can be found at
http://www.ezilon.com/health/nutrition/index.shtml

Current Training Programmes
Clinical research training is first introduced to potential researchers through core
training. Advanced skills including leadership as principal investigators are acquired
through further leading to further academic qualifications. In recent years, one major
skill has been the ability to manage ethics applications for studies that involve
humans, animals and other biological materials.
Some countries have integrated medical training and PhDs such as the MD-PhD
programmes pioneered in the UK by a handful of universities e.g. UCL, Cambridge and
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Oxford. At the European level, FP5 had supported Marie-Curie fellowships to develop
research capacity among researchers under 35 years. Specifically, there is a European
Master’s programme in public health nutrition. However, the syllabus does not appear
to incorporate any training in conducting clinical research or in the emerging
disciplines in food science.
(http://ec.europa.eu/health/ph_projects/2001/promotion/fp_promotion_2001_frep_0
4_en.pdf/)
In 1998, the Eurodiet project aimed to establish training for health professionals in
the skills and knowledge to develop and implement locally relevant interventions.
Follow up is not yet publically available. Since 1994, a one week European Nutrition
Leadership programme recruiting under 35s from the research field and food industry
has been held. Emphasis is placed on understanding the qualities and skills of
leadership, team building, communication and the role of nutrition and science in
society. http://www.enlp.eu.com/en/index.html
A survey or higher training in nutrition was conducted in 1989 showed that very few
students completed PhDs in nutrition. (Oshaug 1992)
http://heapro.oxfordjournals.org/content/7/4/265.full.pdf
There are few institutes specialising in clinical trial methodology only, one notable
example being the Clinical Trial Service Unit & Epidemiological Studies Unit in Oxford,
UK.
Examples of industry led training programmes can be found in appendix F.
Monitoring
There is currently no database collecting information on trials being conducted in
Europe. CORDIS of the EU provides some information on past, present and future
research calls put out through the Thematic Frameworks. A new interactive platform
on European health research has been set up but was not accessible :
www.healthcompetence.eu. It lists “all projects related to life science and health
supported by the European Commission since 2004. It aims to give visibility to
organisations and scientists involved in these projects, together with interactive
search devices and facilitates the identification of potential collaboration partners and
setting up of partnerships between academia and industry in health research.”
In the 2003-2008 period, the EU Commission with the Health Information Strand of
the Public Health Programme aimed to develop indicators to monitor Public Health
Nutrition in Europe. The proposed indicators related to risk factors for poor nutrition
and relevant co-risk factors such as physical activity levels.
In terms of genomic research, large databases produced through collaborative
research among consortia of individuals and institutions will be required.
Publications and congresses
2.6 Publications
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A basic bibliometric analysis using free search terms was conducted using Pubmed
and the Cochrane databases.
For the Pubmed search, three categories of research and of interventions were
defined. The searches were conducted in a mutually exclusive manner (see appendix
I). Search terms were restricted to the last five years and last ten years for
comparison. All research publications and clinical trial publications were examined for
comparison. Filters were not refined for precision for this basic bibliometry. Results
are shown below.
Publications in the field of food and disease by type of research
area, 2000-2010 (Pubmed)
70
% of publications
60
%of all
publications
50
40
% of clinical
trial
publications
30
20
10
0
Aetiology/cause
Diagnosis
Intervention or
treatment
Research area
Publications in the field of food and disease by type of
intervention, 2000-2010 (Pubm ed)
60
% of publications
50
40
30
%of all
publications
20
% of all
clinical trials
10
0
Policy
Behavioural
Pharmaceutical
Area of nutrition research
*There was no difference in the distribution between the two periods of 2000-2004
and 2005-2010 so only the total period results are shown.
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The key observations are the small percentage of aetiological research and of policy
research relative to the other categories of research. This can be explained by the fact
that policy research does not lend itself well to clinical trial methodology. However,
even when all research is taken into account there is still a relatively small percentage
of policy type research within the medical literature available on Pubmed. In terms of
interventions, pharmaceutical interventions represent half of all clinical trials (50%).
Cochrane database
A simple analysis of all listed Cochrane reviews under the search term ‘food’ reveals
some insights into clinical research on food. Most studies listed have been conducted
in the last two years. All reviews (140) that reviewed the effect of food or diet or
nutritional manipulation on a health outcome relevant to the developed world (malaria
for instance was excluded as an outcome) were examined for conclusions. Two broad
categories emerged:
 reviews of single nutrient or type of nutrient (e.g. probiotics) interventions –
these represented the majority of the reviews
 more general dietary interventions
Level of evidence
% of total publications (n)
Single nutrient
Good
Some
None or little
12% (4)
15%(5)
74%(25)
Whole diet
0%
63.6%(7)
27.3%(3)
There was little evidence for single nutrient approaches. Although the sample sizes
are very small, for whole dietary approaches appear to yield more positive evidence.
The long term sustainability of these interventions and their generalisability outside
the study remain a problem for clinical research methodology.
An independent review of pubmed and Cochrane publications on dietary supplements
http://www.informationisbeautiful.net/visualizations/snake-oil-supplements/ examined the
scientific evidence of around 100 supplements.
In conclusion, most clinical research appears to focus on single nutrient interventions
at present. This indicates that clinical research is the natural medium for testing
future functional food candidates and that clinicians have an important role in
facilitating this. However, very little has been yielded so far in terms of effective single
nutrient interventions. In addition, the translation of these findings into practice is not
always meaningful in the context of complex diets and interacting nutritional factors.
This suggests that functional foods are a long way off and that new research
methodology such as systems biology approaches may be required to design effective
dietary clinical interventions

Congresses
Today, it is hard to find a conference programmes of disease or clinical specialty areas
which does not include presentations on the role of food or diet. The networks listed
above will themselves hold many meetings which are not listed here. There are many
cross-disciplinary, food-related conferences as well. A non-exhaustive list of
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congresses that have taken place around the theme of food and disease in the last
seven years is shown in appendix h.
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

Comparison of country reports:
Countries (see methods above)
The list of programmes related to clinical or intervention research for each country are
shown in the table in appendix J.

Overview
In many countries universities dominate the food and health research landscape. In
some countries, it appears industry has a strong presence as well e.g. Belgium.
Countries with comprehensive research programmes included France, Germany, the
UK, Sweden, Finland, Denmark, Ireland. Many emerging economy countries reported
a research with an emphasis on food safety. Few countries cited collaborative projects
other than in some reports where European Union funded projects were cited. There
are evident areas of overlap in the research programmes although it was difficult to
identify specific projects that overlapped. Both Malta and Ireland have programmes
dedicated to investigating marine sources of nutrients. Mediterranean countries such
as Italy had a focus on the effects of the Mediterranean diets on health.
A model predicting factors that would foster increased research output at European
level was constructed from a set of country level indicators. Outcomes examined
included: 1) number of clinical publications on food and health research (extracted
from pubmed); 2) number of total technical publications (World Bank indicator); 3)
number of citations (International science database); 4) research quality (H index
from an international science database); and 5) number of patents (OECD data).
The table of indicators and results are shown in a table in appendix K. The main
findings are that the number of research articles published (world bank indicator) was
associated with two key factors: the size of the population and the democracy score
used. For every 100,000 people an extra 3 publications were produced; and for every
1 point on the democracy score scale (0-10) 167 extra publications were produced
(p≤0.01 for both results). GNP per capita and the number of universities in each
country were not significant in effect. Other variables that did not have an effect
were: R&D investment; % of the population with a graduate degree; and food related
disease burden measured by DALYs (WHO data). This association was consistent
when other outcome measures were examined (using indicators from different
databases): population size and democracy score were similarly associated with: a)
the number of citations, 2) the quality of research published and 3) the number of
research publications listed in Pubmed extracted through a search for “food OR diet
OR nutrition” by country. There were no factors predicting the number of patents
(total patents or biotechnology patents), although there was a small association
between country wealth (GNP per capita) and the number of patents with foreign coinvestors.
This simple analysis suggests that over and above country wealth, level of population
education and the number of universities in each country, a critical mass of people
and conditions of information flow must be present to facilitate research (including
good quality research) and its dissemination. This may be due to a network
generating effect.
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These results support the pursuit of a European wide research agenda that would
facilitate links between different countries and sectors. A European framework would
support the development of joint programmes which would increase the critical mass
of individuals involved in any one area as well as promote information exchange by
setting up appropriate research frameworks and networks of exchange.
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
Towards 2020: assessing needs
Country level research indicates an absence of a single research agenda and only a
few countries mentioned EU funded projects. There is some convergence in aims:
addressing the growing burden of food related diseases such as diabetes and obesity
but also a move towards personalised dietary approaches coming under the
‘nutrigenomics’ umbrella and aiming to develop functional foods. Few countries
mentioned research on appetite regulation, or on the relationship between food and
(gut) absorption, although the latter two represent key aspects of a research agenda
addressing the need to develop healthier foods for the future. Functional foods have
an easier commercial applicability and represent an area of interest for industry.
However, the interests of industry do not always align with the long term interest of
the public and the EU could help address this so as to foster a positive and fruitful
collaboration between different public and private sectors to improve the European
population’s health.

Knowledge needs
One of the most urgent needs in Europe is to implement interventions to reverse the
tide of obesity and related diseases. At the clinical level, there is little that can
realistically be done in relation to lifestyles. It is difficult for clinicians to bring about
behavioural change in a clinical setting and there are essentially no pharmaceutical
interventions available. Bariatric surgery represents one effective option for treatment
but is not viable as a prevention option due to cost and ethical implications.
The knowledge needs of clinical research in Europe can be divided in to two simple
categories:
1) Which foods or diets are effective as functional foods?
2) Which interventions are feasible within a clinical setting of health care to
address food related diseases?
Addressing the first question requires robust clinical trial methodology but also new
forms of research (see below). Important forms of intervention in clinical settings
attracting attention from governments are the use of incentives for behavioural
change; and motivational interviewing. The latter is a technique for counselling
patients on dietary behaviour by clarifying motives. It has been investigated in
relation to childhood obesity for instance but is time-consuming and subject to
operator bias. The patient-doctor relationship is a key medium through which
behavioural change could in theory be brought about. Doctors and other clinical
professionals are trained to take personal histories from their patients and so are well
positioned to give personalised advice in the light of both family history (a correlate of
genetic make up) and social history (occupation, living conditions, family
circumstances, etc). The patient-doctor interaction could be re-explored as a tool for
bringing about change in social norms.
Today, new clinical technologies are required to not only treat diseases but also to
prevent them. The rise of personalised medicine means that new diagnostic and risk
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assessment tools based on molecular and genetic markers are relevant (and
potentially commercially viable incentives). DG Health ran a workshop to identify state
of the art systems for medical applications.
(ftp://ftp.cordis.europa.eu/pub/fp7/health/docs/final-report-systems-medicineworkshop_en.pdf) It identified systems biology as a new tool to further clinical
research to guide clinical trial design by shortening times and costs. Other aims
identified to improve clinical research which are relevant to food based diseases
included:
 Re-definition of clinical phenotypes based on molecular and dynamic
parameters
 Discovery of effective biomarkers of multiple nature for disease progression
(clinically useful for risk, prognosis, diagnosis)
 Combinatorial therapy (this approach would be useful to find out a combination
and lower doses of effective drugs, in particular in the case of co-morbidity,
where more than one disease is affecting the patient)
 Improvement of drug development (optimized drug efficacy, safety and
delivery, timing and dosage of therapy)
 The healthy individual to be addressed in the long term

Significant research questions
A short list of specific research questions around diseases of deficiency and excess is
included in appendix L. This is based on reviews of the literature.
The complexity of the food and disease landscape is illustrated by contradictions in
health advice. For instance, it is thought that reductions in salt consumption resulting
from health advice make it difficult to address the widespread iodine deficiency that is
still believed to exist in Europe.
The most important research questions should therefore address the need for whole
diet approaches, including the effects of diet on health throughout life, epigenetic
effects, and complex dietary exposures. Personalised diets may be an answer but the
need to address health concerns is urgent. Research examining food as an addiction
may also be important - Rudd Center.
http://www.yaleruddcenter.org/what_we_do.aspx?id=262. Research that
addresses policy coherence, including at macro level e.g. food policy, is probably more
effective at present in achieving large scale impact on the health of Europeans. This
requires political will and organisational advances to make gains, as gains will be very
limited in the short term within clinical settings.

Ways to organise research: priorities, developing agendas
An important finding from the country reports is that most of the research output is
concentrated in Northern and Western Europe. These countries have comprehensive
research agendas and resources to match so they can lead the way to novel clinical
interventions. Southern and Eastern Europe still have a need to address food safety as
well as raise public awareness of healthy lifestyles to address large NCD burdens.
There was also mention of a lack of cooperation between universities and a lack of
competitive research bids (funding is directly allocated); as well as focus on medicine
rather than medicine and food in clinical research settings in S&E Europe. However,
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Southern and Eastern Europe also present advantages in research collaborations.
Southern Europe has a strong Mediterranean diet culture that presents a medium of
investigation for functional foods. Eastern European populations are ‘research naive’
and present cost-effective clinical trial locations. ‘Policy technology’ that has improved
health in N&W Europe could be shared with S&E Europe.
The EU could help with setting up databases, biobanks, and research platforms. And
guarantee shared results, knowledge and ownership by overseeing ethical and quality
frameworks. One country suggested integrating a ‘farm-to-fork’ research agenda with
a ‘food-to-health’ research agenda to create a ‘earth-to-health’ agenda. This requires
long term vision and integration to attain a critical mass for meaningful strategic
research. The EU could facilitate collaboration between ministries of agriculture,
biotechnology, and of health to develop joint research agendas. FP7 health and food
themes should lead the way by encouraging joint calls from these two research
sectors.

Interaction between public research and industry
There are evident advantages to collaboration between these two sectors such as
pooling of resources, sharing of know-how and rapid availability of successful
products to the public. There are countries where this is well developed e.g.
Finland describes itself as the ‘Silicon valley of functional foods’. An example of a
successful collaborations are the product VITANEA (Bulgaria) and the use of costsavings as an incentive for industry participation in research.
Personalised diets present an evolving area for fruitful collaboration. The
development of screening tools to identify high risk individuals and advise them on
the best diet for their health may potentially have a large scale impact. A number
of private companies now sell genetic profiling tests for example. Other areas of
collaboration, include the creation of foods that are nutrient rich and adequate in
energy intake for sedentary lifestyles and creating palatable foods that are healthy.
A significant barrier remains the lack of transparency required for industry
research to be competitive on the market (ultimately linked to intellectual property
issues). A number of countries expressed a desire from industry to collaborate with
the public or academic sector. One of the problems mentioned was Intellectual
Property law – companies are unable to file for patents as this is against university
regulations in one country for example. These issues should be addressed within a
legal framework to incentivise public-private collaborations supported at European
level.
Ultimately, successful areas of collaborations are those where the interests of the
public’s health and of the private sector meet. Functional foods is an obvious area.
Research in this area will require the screening and extraction of large numbers of
components, similar to the screening process applied in discovering new
pharmaceutical products, followed by clinical trials to determine the health effect,
then translation research to understand how these foods interact in a complex
biological system. Industry can contribute at any of these stages.
1
9
However, where evidence points in a particular direction, this should be taken into
account and commercial interests in pursuing that particular direction curbed. The
Finnish Allergy programme for example has emphasised the importance of
environmental interventions (time in nature, allergen exposure, and consumption
of farm milk) can reduce the costs and morbidity of asthma. In contrast research
(Cochrane review) has shown that administering prebiotics to infants is not
effective in reducing allergy. The EU could insist that industry cater to a health
agenda that is evidence-based, sustainable and public health orientated.
In Switzerland, agronomic research focused very early on the improvement of the
trans-fatty acid content of rapeseeds. The FOPH then collaborated with other
research institutes to gain significant results which could be implemented within
two years in cooperation with private industries. This comparatively low priced
intervention prevented Switzerland from problems related to trans-fatty acids.
In summary, public-private collaboration around food and health research of a
clinical nature should be supported by strong legal and ethical frameworks to both
incentivise private corporations and protect the interests of the public from being
overwhelmed by commercial interests where public monies are spent. Industry
should see collaboration as part of its corporate social responsibility with potential
commercial gains as a secondary gain. This will require strong political leadership
from the EU and clear academic and ethical governance frameworks.
2
0

Gaps and Overlaps for further research
While there are overlaps in research between countries, the more striking feature of
the European research system is the gap between food related research and clinical
research, although N&W Europe have made some progress towards integration. This
is reflected in funding streams – even at European level. While it is not possible to
subsume all food and health research within one discipline, it is important to develop a
coherent research agenda linking the various sectors including agriculture,
biotechnology and health. This could begin by defining a set of promising nutrients or
foods that are to be investigated from ‘earthto-to-fork’.
It is imperative therefore, to invest in creating infrastructures that promote
interdisciplinary research including change management and public economics in
combination with the emerging and clinical sciences. This is essential in underpinning
the intersectoral action required to promote a living environment and personal
opportunities that promote healthful decision making.
In terms of understanding mechanisms of disease the origin of inflammatory bowel
disease and other autoimmune diseases, and the dietary risk factors behind dementia
are important question. These require large multicentre collaborations to generate
sufficient sample sizes and would therefore benefit from European-wide
collaborations.

Structures
As described above, there is a need to integrate funding streams to underpin a
common research agenda. A sustainable research agenda requires an approach
integrating the climate change research agenda with the health agenda.

Infrastructures
This has been described above as a need for 1) database management frameworks;
2) clinical trial governance frameworks for outsourcing clinical trials to other
countries; 3) legal and ethical frameworks for public-private collaborations.
Concentrating equipment for research within a single location may be too early at this
stage, when there is no actual research agenda and therefore non-specific needs.
In Belgium, WagrALIM is assessing list of equipment needs for food and health
research which may make some useful recommendations.
5.3 Ways to organise research
Described under section 4.3
2
1


Conclusions and Proposals
Research fields
Described in section 4.2

Research organisation, structures and infrastructures
Described under sections 4.4, 5.1 and 5.2
In addition, for clinicians to successfully contribute to the endeavour, they will require
adequate training in how to engage with industry and other disciplines in the food
sector developing candidates for functional foods. They will also require training in
how to distinguish between successful candidates from a health point of view as
opposed to a commercially successful point of view – a difficult task due to the
merging of the roles of patients and consumers. Clinicians have an important role in
safeguarding the ethical conduct of clinical trials, and advocating for all patients (not
just those who have the purchasing power or the ‘worried well’). These goals can be
achieved through strong scientific training, development of a professional identity and
an understanding of business processes. These principles could be enshrined in a
European wide oath of practice for clinicians and clinical researchers.
APPENDIX
Appendix A: Food related diseases other than cardiovascular, metabolic and
cancer diseases.
Nutritional deficiency diseases persist to a smaller extent in Europe, for instance
iodine deficiency in some geographical areas, and vitamin D deficiency among some
Asian women. Malnutrition is found among older people, and alcoholics. There are
also rare genetic disorders of metabolism.
Autoimmune conditions are also less common than the above NCDs and are a
poorly understood set of diseases. Research in these areas provides insight into
mechanisms of disease. These include food allergies and diseases of gastrointestinal
malabsorption and inflammation such as Coeliac’s disease and Crohn’s disease
respectively.
Other diet related conditions which represent an important burden of disease but are
less easy to classify include dental diseases, neuropsychiatric diseases (e.g.
dementia), birth defects (e.g. spina bifida) and constipation.
2
2
Appendix B: Sixth and seventh framework Programmes for research and
technological development (FP6 and FP7) in relation to food and health
research
FP6 called for proposals from universities, business and SMEs, etc to investigate
priority areas and allocated 2.5 billion Euros to the Thematic Priority ‘Life Sciences,
genomics and biotechnology for health’ (1.2bn euros for ‘advanced genomics and its
applications for health’; and 1.3bn euros for ‘combating major diseases’). The
Thematic Priority ‘Food quality and safety’ was allocated 0.7billion Euros and includes
the areas of ‘epidemiology of food-related diseases and allergies’ and ‘impact of food
on health’.
The seventh Framework Programme (FP7) runs from January 2007 to December
2013, providing funding of 55 billion euros for European research.
Most of the funds in FP7 go to collaborative research under ten priority themes,
including one on ‘Food, Agriculture & Fisheries, and Biotechnology’ (FAFB), with a
budget of 1.9 billion euros and another on ‘Health’.
This FAFB theme is based on three activity areas:
 Sustainable production and management of biological resources
 Fork to farm: food, health and well-being
 Life sciences and biotechnology for sustainable non-food products and
processes
The Health research theme includes clinical research. It promotes translational
research, the ‘from bench-to-bedside’ approach, that leads from laboratory
experiments through clinical research to applications in the clinic that have practical
benefits and improve the quality of life. This can help assess the relative safety and
efficacy of various treatments and promote the translation of research into clinical
practice. The calls for Health research are for clinically driven proposals around 8
broad themes and include:
Topics targeting SMEs:
 Developing tools and technologies for high-throughput research
 Genome-based biomarkers for patient stratification and pharmacogenomic
strategies
 Tools, technologies & devices for application in regenerative medicine
 Development and production of new, high-affinity protein scaffolds for
therapeutic use
 Development of multi-analyte diagnostic tests
 Development of tools to control microbial biofilms with relevance to clinical drug
resistance
 Evaluation and validation studies of clinically useful biomarkers in prevention
and
 management of cardiovascular disease
 New methodologies for clinical trials in personalised medicine
Topics for investigator-driven clinical trials:
 Regenerative medicine
 Childhood-onset neurodegenerative diseases
 Therapeutic interventions in the elderly populations
 Off-patent antibiotics
 Rare cancers
2
3



The management of cardiovascular diseases
Reducing diabetes complications
On off-patent medicines for children
(REF - ftp://ftp.cordis.europa.eu/pub/fp7/health/docs/fp7-health-2011-mainfeaturescalls_en.pdf)
Appendix C: European level collaborative research programmes around food
and health
7th FRAMEWORK PROGRAMME(2007-2013)

DALI (Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus
Prevention).

EUROCHIP (European Obesity Consortium studying the Hypothalamus and its
Interaction with Peripheral organs).
The Infant Nutrition Cluster
The Infant Nutrition Cluster is the collective name that is given to three EU supported
research projects in the area of “metabolic programming” - the process by which
nutrition during the prenatal and foetal stage triggers metabolic changes that can
mark the human being for life. The three projects which make up this program are
studying these ‘programmed’ relations in terms of pathologies of foetal growth, infant
obesity
and
insulin-dependent
diabetes.
The
Programs
are:

PERILIP: Influence of dietary fatty acids on the pathophysiology of
intrauterine foetal growth and neonatal development.</u>
Objectives The overall objective of PERILIP is to define the role of fatty acids
in foetal growth and neonatal development, with particular reference to intrauterine growth restriction. The ultimate goal is to improve dietary guidelines for
human pregnancies.
Contact: Dr Peter Dodds, Imperial College at Wye, UK.

DIABETES PREVENTION: Nutritional primary prevention of type 1
diabetes.
Objectives The overall objective of the project is to determine whether
weaning to a casein hydrolysate (Nutramigen TM) during at least the first 6
months of life reduces the incidence of Type 1 diabetes in genetically
susceptible children. An important study question is, whether casein
hydrolysate effects are due to the avoidance of complex weaning diets such as
cow's milk based formula. This question will be addressed by correlating cow's
milk immune responses with autoimmune markers and with diabetes.
For more information: http://trigr.epi.usf.edu
Contact: Prof. Dr Hans Aakerblom University of Helsinki, Finland.
EARNEST
2
4
The EARNEST project is a large collaborative investigation into the long-term consequences of
early nutrition by metabolic programming. It brings together a multi-disciplinary team of scientists
from 38 institutions in 16 European countries. The project will run from 2005 to 2010 and is being
coordinated by Professor Koletzko of the Children's Hospital, University of Munich.
6th FRAMEWORK PROGRAMME(2002-2006)

DIABESITY

DIOGENES
Diet, Obesity and Genes

EUGENE2
European Network on Functional Genomics of Type 2 Diabetes

EXGENESIS
health benefits of EXercise: identification of GENEs and SIgnalling pathways
involved in the effects of exercise on insulin resistance, obesity and metabolic
Syndrome

HELENA
Healthy Lifestyle in Europe by Nutrition in Adolescence

TONECA
Coordination action on the aetiology, pathology and prediction of type 1
diabetes in Europe

5th FRAMEWORK PROGRAMME( 1998-2002)

ACTION LADA
Prevalence characterisation and prevention of latent autoimmune
diabetes in adults (LADA) in Europe

DIABETES PREVENTION
Nutritional primary prevention of type 1 diabetes

DIET and OBESITY
Dietary and genetic influences on susceptibility or resitance to weight
gain on a high fat diet

EURAGEDIC
European rational approach for the genetics of diabetes complications

EUROSTARCH
Stable isotope applications to monitor starch digestion and fermentation
for the development of functional foods
2
5

NUGENOB
Nutrient-gene interactions in human obesity: implications for dietary
guidelines

OB-AGE
Obesity and disease in ageing
Effects of dietary fat modification on insulin sensitivity and on other risk factors of the metabolic
syndrome-LIPGENE: a European randomized dietary intervention study.
Tierney AC, McMonagle J, Shaw DI, Gulseth HL, Helal O, Saris WH, Paniagua JA, GołąbekLeszczyñska I, Defoort C, Williams CM, Karsltröm B, Vessby B, Dembinska-Kiec A, LópezMiranda J, Blaak EE, Drevon CA, Gibney MJ, Lovegrove JA, Roche HM.
The European Prospective Investigation into Cancer and Nutrition (EPIC) is also a key
source of evidence for the link between diet and disease and is described in a sister
report to this one (epidemiology of nutrition and disease by V. Hirani)
Some of the European programmes collected in the European Technology Platform
Food for Life database include:









Influence of the dietary history in the prevention of coeliac disease: possibilities
of induction of tolerance for gluten in genetic predisposed children
EaRly Nutrition programming- long term Efficacy and Safety Trials and
integrated epidemiological, genetic, animal, consumer and economic research.
Global allergy and asthma european network
Collaborative European action into environmental, nutritional and genetic
factors in non-Hodgkin's lymphoma aetiology
Relationship between insulin sensitivity and cardiovascular disease risk
Global view of food allergy: opportunities to study the influence of microbial
exposure
European platform for research on prevention and treatment of Coeliac disease:
Improving the quality of life of elderly people by co-ordinating research into
malnutrition of the frail elderly
Public health impact of long-term, low-level mixed element exposure in
susceptible population strata
Appendix D: European level projects
Projects listed under the European Research Council website include:
http://europa.eu/rapid/pressReleasesAction.do?reference=MEMO/04/277&type
=HTML&aged=0&language=EN&guiLanguage=en
Project – Cell growth control by nutrients. Institut National de la Sante et de la
Recherche Medical (INSERM).
LIPIDIET (multicountry). Preventing Alzheimer’s disease through the diet. Project
coordinator – Dr Tobias Hartman; Centre for Molecular Biology Heidelberg, Germany.
2
6
Other countries involved: the Czech Republic, Finland, Germany, Hungary, Israel, The
Netherlands and Switzerland.
EU funding: €2.2 million
OPTIFORD: Can fortified foods or supplements have an impact on bone health? Project
coordinator: Rikke Andersen, M.Sc., Department of Nutrition, Danish Institute of Food
and Veterinary Research, Söborg, Denmark. Other countries involved: Denmark (two
partners), Finland, Ireland, Poland and Spain.
EU funding: €1.75 million
HELENA (Health Lifestyle in Europe by Nutrition in Adolescence): multicountry study
including piloting community intervention multi-centre studies. Addresses link
between adolescence, nutrition and later chronic diseases.
http://www.helenastudy.com/
The Nutrigenomics Organisation (European Network of Excellence)
The Early Nutrition Programming Project – University of Munich (EU funded) multicountry
http://www.metabolic-programming.org/consortium.htm
META-PHOR – a metabolomics research initiative.
http://www.metabolic-programming.org/consortium.htm
Appendix E: European networks incorporating clinical research on food and
health
 Alzheimer Europe
 European Federation of Asthma and Allergiy
 The European Academy of Allergology and Clinical Immunology Organisation
 The European Association for Communication in Healthcare
 The European Association for the Study of Diabetes
 The European Association for the Study of Obesity
 The European Association for the Study of the Liver
 The European Atherosclerosis Society
 The European Cancer Organization
 The European Dental Association
 The European Food Information Council
 The European Medical Association
 The European Nutrigenomics Organisation (EU Network of Excellence)
 The European Nutrition for Health Alliance
 The European Nutrition Leadership Programme
 The European Society for Clinical Cell Analysis
 The European Society for Clinical Investigation
 The European Society for Clinical Nutrition
 The European Society for Clinical Nutrition and Metabolism
 The European Society for Medical Oncology
 The European Society for Paediatric Endocrinology
 The European Society of Cardiology
 The European Society of Endocrinology
 The European Society of Gastroenterology and Endoscopy
2
7












The European Society of Hypertension
The European Society of Medical Oncology Pharmacy
The European Society of Neurogastroenterology and Motility
The European Society of Paediatric Gastroenterology, Hepatology and Nutrition
The European Stroke Network
The European Stroke Organization
The Federation of European Nutrition Societies
The Functional Foods Network (see website for partners involved)
http://www.functionalfoodnet.eu/asp/default.asp?p=9
The International Osteoporosis Foundation
The International Scientific Association for Probiotics and Prebiotics
The Standing Committee of European Doctors
United European Gastroenterology Federation
Appendix F: Examples of industry led training programmes in food and health
research
http://www.foodfrenz.com/bckgrd.htm

Two joint EU-NZ workshops aimed at identifying best practice for achieving
effective cross-sectoral collaborations between industry, universities and
research institutions and involving foresight in consumer needs to direct food
research;

Twenty fellowships awarded to EU researchers involved in industry or researchbased organisations, to undertake study visits to NZ; and

A joint EU-NZ conference to disseminate outcomes from the workshops and
study visits.
The aim of FOOD-FRENZ (EC is one of the partners) is to jointly stimulate focused
collaboration between EU and NZ food researchers as a means of achieving
complementary consumer driven and industry goals and more effectively address
some increasingly global issues such as safety, traceability, animal husbandry and
sustainability.
Appendix H:
Conference title
8th Meeting of the International Scientific Association for Probiotics and Prebiotics
ADIT 2010 Advances in Diabetes and Insulin Therapy
The First World Congress on Controversies in Gastroenterology and Liver Diseases
2nd EFFL Summer Academy on Global Food Law & Policy
III European conference The Academy of Breastfeeding Medicine for physicians
Gastro-intestinal Models for the Study of Probiotics and Prebiotics – Scientific Symposium
2nd SteviaWorld Europe
Natural Food Finder Annual Conference: Natural Food & Nutrition 2010
3rd National Conference: Addiction and The Liver
4th International Food and Feed Law Conference: Challenges of Consumer Information
4th Annual European Nutrition and Lifestyle Conference
Year
2010
2010
2010
2010
2010
2010
2010
2010
2010
2010
2010
1st World Congress on Controversies in Metabolism and Nutrition in the Acute and the Chronic Disease
(CoMET)
2010
3rd International Congress on Prediabetes and the Metabolic Syndrome
Vitamins, Nutrition, Diagnostics
2009
2009
2
8
Conference title
Year
14th European Meeting on Fat Soluble Vitamins
2009
2nd International Conference on Advanced Technologies & Treatments for Diabetes (ATTD)
5th International Symposium on Diabetes and Pregnancy - DIP
International Scientific Conference on Nutraceuticals and Functional Foods
The Nutritional Needs of Mankind
2009
2009
2009
2009
Food Allergy: a global perspective
2009
Fifth National Conference on Obesity and Health
2nd International Conference on Hypertension, Lipids, Diabetes & Stroke Prevention
Food & Drink. The Innovation Summit from BME Global.
Second International Conference on Health and Biodiversity
VII Barcelona International Congress on the Mediterranean Diet
77th European Atherosclerosis Society Congress
5th London Anti-Ageing Conference
Molecular Targets for Cancer Prevention Diagnosis and Treatment
7th International Conference VITAMINS - Nutrition and Diagnostics
2009
2008
2008
2008
2008
2008
2008
2007
2007
3rd International Conference on Traditional Mediterranean Diet: Past, Present and Future - Focusing on
Wine
2007
6th Annual World Food Technology and Innovation Forum 2007
Sustainable Agri-Food: Use of Ozone & Related Oxidants
The Future of Nutraceuticals, Trends and Opportunities in Marketing, Challenges in Regulations
3rd Istanbul Anti Aging - Medical Aesthetics Congress & Exhibition
2007
2007
2007
2007
Nutrition and Nurture in Infancy and Childhood: Bio-Cultural Perspectives
2007
The 8th London International Eating Disorders Conference - Eating Disorders 2007
Obesity Drug Development World
2007
2007
Food, Nutrition, Phycial Activity and the Prevention of Cancer: A Global Perspective - A Launch Conference
2007
Combating Obesity - A Healthy Eating Strategy for Europe
To Your Health: Prevention, Wellness and Nutrition Intervention Across the Lifespan
Strategies for Combating Obesity in Europe
Obesity in Europe Conference
Nutrition, immune functions and health
2006
2006
2005
2005
2005
Traditional Mediterranean Diet: Past, Present and Future - Focusing on Olive Oil and Traditional Food
Products
2005
4th NIZO Dairy Conference
Current Issues in Food and Nutrition: Functional Foods, Claims and Policy
2005
2005
8th International Congress ACTUAL PROBLEMS OF CREATION OF NEW MEDICINAL PREPARATIONS OF
NATURAL ORIGIN
2004
Traditional Mediterranean Diets: Past, Present and Future
BioProducts for Food
New Functional Ingredients and Foods
Poverty, Food and Health in Welfare: current issues, future perspectives
Nutrition and health conference
Functional Foods
2004
2004
2003
2003
2003
2002
2
9
Appendix I: Bibliometric methodology
PUBMED search term definitions
Definition
Research type
Aetiology/cause ((diet OR food OR nutrition) AND
(health OR disease)) AND ((aetiology
OR cause) NOT (intervention OR
treatment OR diagnosis))
Diagnosis ((diet OR food OR nutrition) AND
(health OR disease)) AND ((diagnosis)
NOT
(aetiology
OR
cause
OR
intervention OR treatment))
Intervention/treatment ((diet OR food OR nutrition) AND
(health
OR
disease))
AND
((intervention OR treatment) NOT
(aetiology OR cause OR diagnosis))
Intervention type
Definition
Policy ((diet OR food OR nutrition) AND
(health OR disease)) AND ((policy OR
community)
NOT
(behaviour
OR
supplements OR supplementation OR
drugs))
Behavioural ((diet OR food OR nutrition) AND
(health OR disease)) AND ((behaviour)
NOT
(policy
OR
community
OR
supplements OR supplementation OR
drugs))
Pharmaceutical ((diet OR food OR nutrition) AND
(health
OR
disease))
AND
((supplements OR supplementation OR
drugs) NOT (behaviour OR policy OR
community))
3
0
Appendix J:
country
Austria
National
coordinated
research agenda
on food and
nutrition?
No
Belgium
Yes (not
involved in JPI
Health food etc)
Yes. Not
involved in JPI
Bulgaria
Croatia
No
Cyprus
No
Czech
Republic
Yes (through health
for all programme)
Two strands c.f. fP7
of research
Institutions
1. Department of Paediatrics and
Adolescent Medicine, Medical University
of Vienna
2. Department of Nutritional Sciences of
the University of Vienna
3. Fund Healthy Austria
4. GEN-AU
DG06 Waleo 3 programme
IWT
1. Medical Universities (Sofia, Plovdiv,
Varna,Pleven, Trakia University
Medil (foundation of a life sciences institute in
2005)
University dominated research
1. Social, Economic and Humanitarian
Sciences: Society
1. Ministry of Health Research
Development Programme (20072011)
2. Ministry of Education, Youth &
Sports
3. FP7 funded projects
Programmes/projects
1.
2.
3.
4.
Obesity
Nutrigenomics
Cardiovascular diseases
Genomics
Experimental research
Applied biomedical research
1. Diagnostics and
treatments, obesity; food
supplements; Functional
foods
Build research infrastructure and
support scientific excellence in
biomedicine.
1. Psychology, Psychological
Health, Addiction,
Dependency
MoH
o Nutrients: folates,
o Risk factors (diet and exercise)
o Nutrigenomics
o Dietary assessment and
interventions
3
1
MoEYP
o Charles University, Prevention,
diagnostics and therapy of
diabetes mellitus, metabolic and
endocrine damage of organism;
The use of experimental and
clinical models of metabolic
processes, nutrition and
pharmacotherapy for the
advancement of knowledge,
clinical practice and quality of life
improvement
FP7
o RICHE a platform and inventory
for child health research in Europe
o Integrated genomics, clinical
research and care in hypertension
Denmark
Estonia
1. Interdisciplinary research programme on
the relationship between food, nutrition and
health
2. Food Research Programme 2006
1. National Health Research and
Development Programme
2. Bio-Competence of Healthy Dairy
Products
1:
a. Interactions between lifestyle and
genes, including diet and
microbiological resistance
b. Interaction between nutrition,
health perceptions and food
consumption, including food
related diseases
c. Interaction between food and life
quality
2: Diet and genes including
nutrigenomics
1. Programme document not
available yet
2. Enhance industry’s
competitiveness through
innovative solutions including
use of clinical trials
3
2
Finland
France
1. University of eastern Finland Unit of
Clinical Nutrition (including the Food &
Health Research Centre)
2. ELVIRA
3. SKIDI-KIDS
4. Responding to public health challenges
(SALVE)
Yes
Very well developed
research
programme
1.
2.
3.
4.
5.
6.
French foundation for food and health
IRD
ALIA
R&D INRA
PNRA (public research centres)
CNRS/ANR/INSERM
1. Controlled dietary
interventions inc
nutrigenomics, metabolobmis
and systems biology
2. Nutrition, genetic factors and
metabolism
3. Environments of childhood
growth
4. Dietary studies.
1. Intervention studies
2. Nutripass: clinical and policy
intervention evaluation
3. Impact of Obesity on the
Digestive functions and Enteric
Nervous System.
4. Effects of food and nutrients
on main physiological
functions of human beings
5. Nature of dietary lipids and
early development of adipose
tissue., High protein neonatal
nutrition: effects on intestinal
maturation, kidney and
hypothalamus in the newborn
and long-term
consequences; Vascular,
cognitive and neurological
dysfunction in the elderly: the
influence of
hyperhomocysteinemia on the
epigenetic regulation of
candidates gene.
6. projects are in the field of the
Circulation, metabolism,
nutrition INSERM’s institute
3
3
Germany
Yes
1. German Institute of Human Nutrition)
2. National Genome Research Network
3. BMBF/Universities
1:

Experimental
Diabetology
 Clinical Nutrition
Food dependent development of
cancer and the metabolic syndrom
(molecular genetics, pharmacology,
experimental
diabetology,
clinical
nutrition, epidemiology, nutritional
toxicology,
gastrointestinal
microbiology,
biochemistry
of
nutrients) characterization of these
genes
2: Identification of genes influencing
body weight and subsequent clinical,
epidemiological and functional
3: Health Reserach Programme –
interventional research on behaviour;
Focal
Point
of
Support
(food
research);
Disease
related
competence network; Development
and
evaluation
of
prevention
measures
and
programmes,
in
particular for young people
Greece
Harokopio University, Department of Dietetics
and Nutritional Science
Health aspects of food, including
systematic clinical trials
Hungary
Italy
National institute for food and nutrition science
Italian National institute of Health
University of Pavia
Human Nutrition Unit (University of Parma) &
San Raffaele Hospital
University of Pavia, National Cancer Institute,
Gluten introduction on the
development of celiac disease
Supplement NOPE & EGF RCT
Intervention study using low
antioxidant diets and beta-carotene
3
4
University of Parma.
Ireland
Latvia
Lithuania
Diet and infertility
1. JINGO – national nutrition phenotype
database
2. Food for health Ireland
3. Marine Functional Foods Initiative
1. Record genes with gene-diet
interactions
2. Development of new functional
food ingredients; GI health
Dietar intervention studies on
characterised marine bioactives
1. Agency for International Science and
Technology Development
2. Lithuanian Science and Studies
Foundation
3. Research Council of Lithuania
1. Bioactive food components,
mitochondrial functions and
health
2. Fruit Plants as Producents of
Natural Anthocyanins
-
Luxembou
rg
FNR
Malta
Netherlan
ds
1. Wageningen University – division of
nutrition
2. Vrije Universiteit Amsterdam – Section
Nutrition and Health
3. University of Rotterdam
4. TNO
5. VLAG
3. Interaction of genes and diet
in assessing risk of
dyslipidaemias and obesity in
Lithuanian population
Mobile Expert and networking system
for systematic analysis of nutritionbased allergies; living in the grand
duchy of Luxembourg after a stroke –
impact on patients, their families their
quality fo life, equality of access to
care and social resources.
1. Controlled dietary
interventions
2. Intervention studies on
diabetes, obesity, metabolic
syndrome, diet
3. Dietary interventions
4. Reducing food intake by
satiety stimulation, hunger
inhibition
5. Nutrients and physiology,
3
5
Portugal
1. Nutrition and Metabolism Unit, IMM
(Institute for Molecular Medicine),
Faculty of Medicine
2. Universities e.g. Faculty of Medicine, of
the University of Oporto (FMUP)
3. FCT projectos de I&D
4. Adipofc
Poland
Romania
Spain
Slovakia
Slovenia
National Centre for Research Development
National authority for scientific research, the
national plan for research development and
innovation
1. Institute of Dairy Products
2. National Programme for Applied
Research Projects
3. Universities e.g. university of Granada
Institute of Nutrition and Food
Technology
CINDI – countrywide integrated noncommunicable disease programme
University of Maribor faculty of agriculture and
life sciences and faculty of medicine
determinants of intake
1. Clinical and translational
biomedical/nutritional research
including nutrition and dietary
related diseases (e.g.obesity,
malnutrition, diabetes)
2. Chemical biopathology and
pharmacological Centrecapture of nutrients, obesity,
functional drinks
3. Phytooestrogenc dugring the
menopause; dietary
polyphenols and intestinal
inflammation;peripheral body
fat, lifestyles and adipokines;
food intake,
hyperhomcysteinaemia & CVD
in DM2
4. Functional foods
5th line: agriculture foodsafety and
security – functional foods
1. Probiotics, prebiotics and gut
(inc human intervention
studies)
2. Highly nutritional products,
functional foods
3. Childhood metabolism; Food
and Health topics
Societal interventions on common
risk factors
Food and health
3
6
Sweden
1. Universities eg Gothenberg &
Uppsala
2. VINNOVA
3. Formas
Switzerlan
d
1. Universities e.g. Geneva
2. Haute Ecole de Santé de Genève
3. University of Fribourg, project funded by
the German Research Foundation
4. Swiss institute of allergy and asthma
research; EFRAIM
5. FP7 projects
1.
2.
3.
4.
5.
Turkey
UK (
Yes
1. The support programme for scientific
and technological research projects
1. DRINC
2. NIHR Biomedical Research Unit for
Nutrition
3. Medical Research Council
4. Diabetes Clinical Research Network
1.
1.
2.
1. Clinical research e.g.
on appetite regulation;
malabsorption in
elderly
2. Food design; functional
food science; fruits and
probiotics;investigation
of children’s eating
habits
3. allergy and
fish/nutrients; food,
genetics, and risk of
CHD and obesity;
hospital-based dietary
interventions
Clinical nutrition
Dietary behaviours and
nutritional disorders;
evaluation of inpatient
nutritional needs using
calorimetry
Binge eating disorders in
childhood
Allergy work
TORNADO – diet and intestinal
microflora/immune system
lifecourse; FLAVIOLA –
flavanol metabolism
;ETHERPATHS – development
of systems biology tools
Maternal iron supplementation
effect on newborns
8 projects and 10 studentships
to develop healthy foods
Southampton University and
Hospitals partnership
supporting research on diet
3
7
5. Universities with a clinical or
intervention study programme on
nutrition: Aberdeen; Southampton;
University College London; Leeds;
Reading; King’s College London; London
School of Hygiene & Tropical Medicine;
Imperial College London
and lifestyle diseases
3. Centre for Obesity and Related
Metabolic Disease (Cambridge;
Collaborative Centre for
Human Nutrition Research
(Cambridge); International
nutrition Group (London
School of Hygiene & Tropical
Medicine)
4. Clinical studies
Appendix K: Results of country comparative model of research output
Number of universities
R&D investment ($103)
Food related disease burden (DALYs 103)
% of the population >25yrs with a graduate degree
Population (106)
Democracy score
GNP/capita ($103)
Number of additional
clinical publications for
each unit increase in the
predictor
p-value
1
-17
14
5
3
167
-4
0.09
0.66
0.45
0.11
0.01
<0.01
0.09
3
8
Appendix L: Significant research questions in key disease areas
1) Diseases of deficiency
There has been increasing evidence of the importance of vitamin D to many aspects of
health. Areas of uncertainty in relation to deficiency include standards of assay testing
and cut-offs, optimal regimens and routes of delivery for both mothers and children.
There is a lack of research investment in these possibly because of the few
commercial opportunities since vitamin D is a generic compound.
Osteoporosis:
 Which models of care are most effective at detecting the elderly at risk?
 Ways of improving adherence to therapy?
 New forms of treatment (monoclonal antibodies, cytokines, cathepsin K, etc)
Iodine deficiency:
 How to improve detection in pregnancy and newborns and infants
 What is the role of reduced consumption of table salt?
Iron deficiency anaemia:
 What is the impact of fortification of flour?
 What is the optimal regiment in pregnancy?
2) Cancer, circulatory diseases, and metabolic diseases
Cancer:
 What are the roles of carotenoids, vitamin C & E, folic acid and vitamin b6 in
prevention?
 Which components of red meat are harmful (fat, protein, iron or processing)?
 What is the role of genetic and metabolic factors?
Circulatory and metabolic diseases
 How do fruit and vegetables protect? Which components?
 Are the effects of the Mediterranean diet transferrable?
 How to deliver PH messages and bring about behavioural change?
 The role of phytooestrogens, flavonoids; linoleic acid
3
9
Conferences
For same intervention (only latest trial. Only interventions relevant to Europe (i.e. not malaria, etc). Diseases related to food or a food
component
Intervention
Condition/age group
Author
Year
Single dietary component intervention
Multinutrient fortification of breast milk
Enteral nutrition
Fortified human milk
Folic acid
Nutritional supp
Zinc
Whole grain foods
Whole grain cereals
Omega-3 Fas
Carnitine sup
Vit D
Tyrosine
Triglyceride (long chain vs medium chain) content of forumla
milk
Formula milk
Probiotics
Probiotics
Calcium sup
Antioxidants and other pharmaceuticals
Garlic
Roselle (a tropical plant)
Vit D
Oral calorie supplements
S-adenosylmethionine
Hydrolysed protein
Fibre supplements
Laetrile treatment
Preterm infants
Crohn's dissease
Infant growth
NTDs
Hip fracture aftercare in elderly
Otitis Media
Prevention of DM2
CHD
intermittent claudications
Inborn errors of metab
Health children/deficient childre
2010
2009
2009
2010
2010
2010
2009
2009
2008
2010
2010
Phenylketonuria
McCormick et al
Akobeng et al
Kuschel & Harding
De-Regil et al
Avenell & handoll
Abba et al
Priebe et al
Kelly et al
Sommerfield et al
Nasser et al
Winzenberg et al
Webster &
Wildgoose
Preterm infants
Preterm infants
Allergy & food hypersensitivity
Eczema
Bone mineral density in children
Friedreich's ataxia
Pre-eclampsia
Hypertension
Chronic pain adults
cystic fibrosis
Ostheoarthritis of knee/hip
Allergy and food intolerance
Constipation in pregnancy
Cancer
Nehra et al
Henderson et al
Osborn & Sinn
Boyle et al
Winzenberg et al
Kearney et al
Meher & Duley
Ngamjarus et al
Staube et al
Smyth et al
Rutjes et al
Osborn & Sinn
Jewell & Young
Milazzo & al
2008
2008
2009
2008
2010
2010
2010
2010
2010
2009
2009
2009
2009
2009
2010
4
0
Marine oil
Multiple RF interv
Phytoestrogens
Vitamin B6 supplementation
Soy formula
Zinc supplementation
Enteral nutrition
Protein substitute
Prebiotics
Whole dietary intervention
Dietary treatment
Dietary advice
Multiple risk factor intervention
Advice to reduce dietary salt
Dietary exclusions
Low sodium diet
Diet and exercise interventions
Dietary advice
Dietary advice
School feeding
Dietary interventions
Pregnancy
CHD
Menopause
Pregnancy
Allergy and food intolerance
Prevention of DM2
Crohn's dissease
Phenylketonuria
Allergy & food hypersensitivity
Makrides et al
Ebrahim et al
Lethaby et al
Thaver et al
Osborn & Sinn
Beletate et al
Zachos et al
Yi & Singh
Osborn & Sinn
2009
2009
2009
2009
2009
2009
2008
2009
2009
Familial hypercholesterolaemia
Pregnancy
CHD
Prevention of CVD
Eczema
BP
Obesity
Gestational dm
Illness related malnutrition
wellbeing among disadvantaged
children
Rheumatoid arthritis
Singh et al
Kramer & Kakuma
Ebrahim et al
Hooper et al
Bath-Hextall et al
Jurgens & Graudal
Summerbell et al
Tieu et al
Baldwin & Weekes
2010
2010
2009
2009
2008
2008
2009
2009
2009
Kristhansson et al
Hagen et al
2009
2009
4
1
4
2