DIETARY SUPPLEMENT DISEASE PREVENTION RESEARCH: INITIAL FOCUS ON SUBGROUPS

DIETARY SUPPLEMENT DISEASE PREVENTION RESEARCH: INITIAL FOCUS ON SUBGROUPS is recommended by a group of disease prevention and public health experts before supplements can be used in the general population. At an Oct. 6 workshop on the effects of nutrition on aging and chronic disease held at the National Institutes of Health, the group, headed by American Health Foundation President Ernst Wynder, MD, suggested that further vitamin and nutritional supplement research should start with members of "the subpopulation, such as the elderly . . . and in general, individuals of low income," Wynder summed up. The group concluded that widespread use of dietary supplements in the general population is not advisable until benefits can be firmly established. "At this time, recommendations cannot be made for nutritional supplements for the general population," Wynder said. Not recommending dietary supplements for the general population, however, also may pose problems, asserted Oliver Alabaster, MD, George Washington University. Alabaster speculated, for example, that "if there is little harm from taking antioxidant vitamins . . . [and] if you're approaching a sort of anarchistic situation where the public decides for themselves, or the pharmaceutical industry presses huge amounts of vitamins on people for all sorts of things, there may be an advantage in the scientific community saying, on the basis [of known evidence], as an intermediate sort of presentation of data or state of knowledge, certain vitamins, possibly certain minerals, at certain dose levels, may have beneficial effects." In general, research should proceed along narrowly defined lines consistent with specific scientific goals, the workshop members recommended. For example, Wynder proposed that NIH "conduct research into the indication for nutritional supplementation, especially for vitamins and minerals and many nutrients across the age span that have possible preventive measure against certain types of cancer." Workshop participants also discussed the potential use of higher doses of nutritional supplements as drug therapies. Commenting on vitamin A, for instance, Alfred Sommer, MD, Johns Hopkins University, noted that "we're talking about a totally different order of magnitude now, using naturally occurring dietary foods not as parts of the diet, but, in fact, as pharmaceuticals." Especially with the introduction of free radical scavengers, he said, "we're talking about pharmacologic doses." For example, in the case of measles, there is evidence that doses of vitamin A could be an effective treatment, Sommer explained. Citing U.S. studies that show low levels of vitamin A in children severely ill with the disease, Sommer informed the workshop that "both the American Academy of Pediatrics and UNICEF are now suggesting the recommendation that it doesn't matter where you are: [if] you get measles, you get vitamin A." In a brief presentation at the workshop, Robert Wallace, MD, University of Iowa, argued that the Recommended Dietary Allowances should be abandoned. "I think we ought to pitch RDAS," he advised, because "they really have no meaning for older people." Each individual has different metabolic and nutritional needs depending on his life situation, such as age, state of health, or sex, Wallace emphasized. Wallace cited several factors that dictate dietary and nutritional needs for the elderly, such as cognitive and sensory changes, and altered food absorption, metabolism, body composition and caloric demand. Furthermore, within each designated age group there are even more differentials, so that "we're probably going to need separate prevention studies and separate recommendations for different epochs of life," Wallace maintained. The nutrition and aging/chronic disease workshop was one of nine held during the Oct. 6-8 NIH conference on disease prevention research. Most of the workshops concluded that NIH should develop a comprehensive research agenda for nutritional supplements. Other suggestions included that NIH design studies that are characterized by more interdisciplinary cooperation and that there be greater inclusion of behavioral science in nutritional studies. At an Oct. 7 workshop on the involvement of Public Health Service agencies and professional societies in disease prevention research, participants recommended that more requests for applications (RFAS) on prevention research, specifically research initiatives outlined in the PHS publication "Healthy People 2000," should be issued by NIH. "Healthy People 2000" is PHS' list of health promotion and disease prevention goals for the year 2000. Workshop Chairman John Kalberer, PhD, NIH Office of Disease Prevention, suggested that "NIH and the ICDs [institutes, centers and divisions should] give greater consideration to issuing more RFAS." However, he pointed out that it probably would not happen "on the part of the ICDs unless there are additional funds." Kalberer noted that there is a possibility under President Clinton's health reform plan that NIH could receive an additional $ 1 bil. According to a Sept. 7 draft of the Clinton plan, the NIH associate director for prevention would "develop an ongoing plan for prevention research activities conducted by NIH." Workshop participant Raymond Seltser, MD, Agency for Health Care, Policy and Research, asserted that "if there is going to be a windfall to NIH," the funds "should not be allowed to be put into the same pot and handled in exactly the same way" and that there should be "some specific recommendations which indicate you want to do prevention research." Kalberer concurred, emphasizing that if NIH gets "this windfall . . . [one] might even go as far to say that those monies should be . . . identified with prevention efforts and maybe we should do more targeting" of research. In a separate Oct. 7 workshop on the involvement of the private sector in prevention research, Johnson & Johnson representative Jonathan Fielding stressed that it would be important for NIH to "sit down with associations and business leaders and call a meeting [to say] here are opportunities for collaboration" for the next decade. In closing the conference, Acting NIH Director Ruth Kirschstein, MD, noted that recommendations made during the workshops will be compiled in a report to be presented to the NIH director. The report is expected to be available in late 1993 or early 1994. Kirschstein also emphasized that NIH "will make sure that the Office of Disease Prevention follows up on this meeting to the degree that it is appropriate" and provide "an implementation plan" for the recommendations put forth. The recommendations also will be included in an upcoming issue of Preventive Medicine, expected to be published in March.