Goal 2: Reduce Human Disease

The missing ingredient in diet and cardiovascular disease prevention research

Determining the dietary patterns and dietary constituents that are most effective in preventing cardiovascular disease events.

 

In addition to the obvious challenge of limited resources, the challenge is overcoming the tension between desire for comparable data produced from low-cost tools and need for higher quality data. Many studies continue using low-cost self-reported diet assessment instruments that produce data comparable with that collected over past decades and must tolerate high degree of misclassification error. In addition the cost of doubly-labeled water continues to be a challenge for diet assessment methods development since use of this gold standard recovery biomarker dramatically increases expense of validation studies.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Addressing the challenge of a dietary assessment method that harnesses recent technological advances in novel biomarker assessments and in metabolomics and microbiome research with best practices in self-reported assessment instruments would enable a giant leap forward in nutrition and cardiovascular disease prevention research. Self-reported instruments require repeated measurements which are expensive or are instruments hampered by measurement error that attenuates estimates of the diet-disease association. Progress on this critical challenge would enable research questions to be addressed using more accurate methods, including questions that ask about best overall diet pattern to prevent cardiovascular disease as well as questions targeted to specific nutrients or diet constituents. Overcoming this obstacle would enable research to move forward in population science research where knowledge of the diet of free-living individuals or community populations is needed as well as among patients in clinical research (other than expensive feeding trials where exact diet is known). There is great potential in stored specimens from epidemiology cohorts and clinical trials to be used with new biomarker assessments to associate earlier diet with hard outcomes accrued in these studies.

Feasibility and challenges of addressing this CQ or CC

Advances in microbiome research and metabolomics technologies illustrate that progress in the field of biomarker assessments of dietary status is not only feasible but may sharpen our understanding of the relationship of dietary constituents with HLB disease pathologies. In the field of energy balance measurement there are calls for movement away from self-reported diet measures and for researchers and sponsors to focus development on objective measures (http://www.nature.com/ijo/journal/vaop/naam/abs/ijo2014199a.html ). Leadership from NHLBI in this area can move the field forward in validating tools and making them more cost effective.
“You are what you eat” is a familiar aphorism, but research progress on what dietary patterns and dietary constituents are most effective in preventing cardiovascular disease events is impeded by inadequate dietary assessment tools. This critical challenge calls for a major effort, in collaboration with other ICs, to develop methods and innovations in measures using blood, urine, feces, saliva, or other bodily fluids or tissues. These tools eventually need to be cost effective, valid, and reproducible.

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Idea No. 336