First steps towards transforming nutrition and health research in the UK

“Unfulfilled potential”, “fragmented, spread thinly and lacking in critical mass”, “overall lack of capacity”, “perceived poor career progression” and “lack of leadership and high-level strategy at a national level”. These were some of the issues identified by the field Review of Nutrition and Health Research in the UK carried out by the Medical Research Council (MRC) and National Institute for Health Research (NIHR) on behalf of the Office for Strategic Coordination of Health Research (OSCHR) and published in 2017 (MRC & NIHR, 2017; Figure 1). The Review also identified weaknesses in the quality and rigour of some nutrition research carried out in humans and was concerned that much nutrition research was not embedded in human health and disease research or sufficiently well connected to related and underpinning sciences. It highlighted that the field was approaching a critical point where senior researchers were moving towards retirement and too few junior researchers were entering the field. The Review recognised that high quality, multidisciplinary nutrition research and effective collaborations are key to improving global health but concluded that transformative thinking and action would be needed to ensure that this nutrition research remains innovative and forward-looking. To achieve those goals, the Review made several recommendations that were aimed to reinvigorate and strengthen the field whilst capitalising on existing strengths. The MRC and NIHR established the UK Human Nutrition Research Partnership (NRP) that included experts from academia, health research and industry who were tasked with developing and realising an implementation plan for the review recommendations. To date this has resulted in two significant actions. Firstly, the NRP launched a Call to establish multidisciplinary pump-priming Collaborative Awards on Human Health and Nutrition that aimed to identify important challenges and opportunities related to nutrition in human health and disease and, by working in a cross-disciplinary manner, begin to make a significant step-change in scientific progress. This led to the establishment of two multi-disciplinary consortia: (1) The Nutriom (Nutrition targeting inflammation and microbiota) partnership is led by Professor Philip Calder (University of Southampton) and includes the Universities of Birmingham, Nottingham and Newcastle and the Quadram Institute Bioscience. Nutriom links research in nutrition, immunity and the microbiota and aims to establish a virtual research centre in nutritional immunology to provide evidence-based guidance and expert leadership to enhance national research capabilities so that researchers can better identify and robustly test key nutritional strategies to support and promote healthy ageing. (2) The NuBrain consortium aims to advance understanding of the complex interactions between nutrition and brain health during ageing, and to develop and test interventions to achieve positive behaviour change that facilitates healthy brain ageing (Stevenson et al., 2020). Led by Professor Emma Stevenson (Newcastle University), the multidisciplinary NuBrain consortium also includes researchers from the Universities of East Anglia, Edinburgh and Manchester. The work undertaken via NuBrain is intended to inform funding bids for future pragmatic and scalable nutritional interventions to test potential dietary interventions to maintain good brain health during ageing. The second action is the focus of this Virtual Issue of the Nutrition Bulletin. The NRP launched a Call for Nutrition Hot Topic Workshops that would accelerate progress by encouraging new thinking on important challenges in the nutrition field. Funding was made available to support focused workshops that addressed specific nutrition ‘hot topics’ needing urgent attention in an agile and timely manner. The Call was structured to support new linkages between different disciplines and to build research capacity by encouraging the formation of new multidisciplinary research teams able to address these challenges. The longer-term aim was to build a strong pipeline of ideas and collaborative projects that could be competitive for response mode funding in the near future. An important, and unusual, feature of the competition was the requirement to have co-leadership of each workshop with one of the leaders being an early career researcher. In addition, these Hot Topic Workshops were intended to bring together a new community of researchers and stakeholders/users with a range of research expertise, and from relevant non-academic sectors. Significantly, it was anticipated that some participants would have no track record or previous association with nutrition research. When the Call was launched, it was envisaged that the workshops would be held before 31 July 2020. However, the COVID-19 pandemic, subsequent lockdowns and additional restrictions on travel and meetings meant that in-person workshops were not possible so the successful applicants had to be flexible and innovative in designing workshops that could be delivered through digital platforms. That had some advantages since it reduced costs for travel and accommodation and more individuals could participate in the virtual workshops than would have been possible normally. Obesity continues to be one of the commonest adverse consequences of poor diet and inadequate physical activity. Disturbingly, the prevalence of obesity, especially among children, increased during the COVID-19 pandemic (Dyer, 2021). Recognising that over-eating is influenced by the individual's food environment, Johnstone and Brown (2021) designed their Hot Topic Workshop to explore how the food environment might be re-shaped by applying interdisciplinary perspectives in appetite research. In addition to set piece lectures and open discussions in breakout rooms (greatly facilitated by the now familiar online platforms), this workshop innovated by including a pre-recorded debate on the topic ‘Does Precision Nutrition offer a future for individualised appetite control?’. Lanham-New et al. (2022) set out to elucidate the role of vitamin D in human health and to discuss potential strategies to improve vitamin D status in the UK population. Benefitting from the virtual format, their Workshop included participants from elsewhere in Europe and from Canada as well as from the UK and attracted not only academics but also colleagues from Public Health England and the Ministry of Defence. The workshop concluded that multiple approaches would be needed to prevent/treat vitamin D insufficiency in the UK and that future research would likely need to take a personalised approach and to address individual preferences, cultural differences and issues around health status. The INPACT (Improving our understanding of the metabolic interplay between nutrition and physical activity) Workshop brought together world-leading nutritional and exercise scientists with experts in metabolism to bridge the disciplinary gaps, to work collaboratively to advance mechanistic research on metabolism and to define a research agenda (Wallis & Chambers, 2021). The Workshop had a strong emphasis on supporting early career researchers who had an opportunity to showcase their work. Priority areas for research identified by the Workshop included: (i) Nutrient-activity timing/chronobiology; (ii) Nutrition, physical activity and weight management; and (iii) Mechanisms of nutrient-inactivity interactions in metabolic dysfunction. A group of over 40 experts from a range of disciplines led by Professor Ann-Marie Minihane (University of East Anglia) contributed to planning for a potential UK-wide nutrition primary prevention randomised controlled trial with incident disease as the study endpoint: the UK Nutrition and Healthy Life Expectancy (NuLifE) trial (Carter et al., 2021). This included two Workshops, a series of online discussions and a systematic evidence synthesis. The outcome was a three-stage plan with the ambitious aim of establishing a multi-disciplinary and multi-agency intervention, that embedded effective eating behaviour change strategies, to address the growing inequalities in the UK and to contribute to reduced risk of prevalent diet-related chronic disease and increased healthy life expectancy. The prevalence of frailty (defined as an increased vulnerability to stressors across multiple bodily systems) is increasing globally and is associated with poor health outcomes. In addition, recent research has shown that frailty is an independent predictor of mortality among those with COVID-19 (Zhang et al., 2021). The Workshop on Nutrition and Frailty aimed to promote dialogue between more junior and more experienced researchers, to forge links between non-clinical and clinical disciplines, and to bring researchers with common interests in nutrition and frailty together for the first time to address the potential of diet to prevent and treat frailty (Ni Lochlainn & Robinson, 2021). Although the idea that nutritional status is a modifiable risk factor for frailty is gaining traction, much of the current evidence comes from observational studies and there is limited evidence for causality. Future studies should address this issue and aim to identify nutritional and dietary factors that are causal for the development and progression of frailty. Starting from the evidence that increased energy intake due to greater consumption of energy-dense food or non-alcoholic beverages high in fat, saturated fat, sugar or salt (‘HFSS food’) is the main explanation for weight gain at the population level, Gokani et al. (2021) hosted a Workshop that focused on the relationship between health, nutrition and the sponsorship of sport and related marketing by ‘HFSS food businesses’. It also considered the implications for obesity prevention strategies, especially among children. The Workshop brought together experts from diverse disciplines (including psychology, law and human rights, finance and accountancy, nutrition and epidemiology, sports marketing and sports management, media studies and health policy) with healthcare practitioners, representatives from government and sports organisations and, importantly, children's organisations including a member of the BiteBack youth board. Underpinning all this, improvements in methodology are critical to continued advances in all areas of scientific research and nutrition is no exception. Indeed, the development of standardised and validated objective measures of human dietary intake was identified as a priority by the MRC/NIHR Review Group. This was addressed across two virtual Workshops led by Professor Gary Frost that included about 50 participants from a wide range of academic disciplines, including speakers from the US, and representatives from the MRC and the Biotechnology & Biological Sciences Research Council (BBSRC; de la Hunty et al., 2021). In the panel discussions, speakers were challenged to envisage what the field of dietary assessment would look like in 10 years’ time and how to achieve those goals of more robust, and less expensive, measurement. The reports in this Virtual Issue provide a window into, and record of, a series of exciting Hot Topic Workshops that have engaged large numbers of individuals from academia and beyond, and from the wide range of disciplines that will be necessary to develop nutrition research capacity over the next decades and to contribute to improving global health. These Workshops have identified several important, and tractable, ‘big questions’ in nutrition research and have succeeded in drawing in the talented early career researchers whose innovative ideas, enthusiasm and expertise will be pivotal in achieving the ambitions of the MRC/NIHR Review of Nutrition and Health Research. Academia has delivered and we await the MRC’s response to these Hot Topic Workshops. Since the NRP appears to be in limbo, it is unclear whether, or how, the outcomes of these workshops will be evaluated. Clearly, the investment will have been successful if the conversations and ideas engendered by these events lead to a surge in applications for collaborative projects in nutrition and health research that prove to be competitive for response mode funding from the MRC, other UKRI funders and the NIHR. At the time of writing, no new funding streams for nutrition research have been announced by the MRC or NIHR. However, the BBSRC has just announced (9 March 2022) their new Diet & Health Open Innovation Research Club (OIRC), an £11 million investment which, in addition to an annual funding competition, will support five innovation hubs over 5 years. These innovation hubs are intended to catalyse collaboration to address key challenges within the diet, health and nutrition sector. This new investment follows from the BBSRC’s highly successful Diet & Health Research Industry Club (DRINC; see the Nutrition Bulletin for reports from some of those projects) and is likely to stimulate new, and to strengthen existing, academic-industry research partnerships and to tackle key challenges in the diet, nutrition and health area. However, substantially more research funding, sustained over many years, will be necessary if we are to achieve the revitalised nutrition research community that was envisioned by the MRC/NIHR Review. That sustained investment will be essential to capitalise on the immense potential of the expertise and resources (both public and private) in the UK, to reduce not only the total burden of, but also the shocking inequalities in, diet-related ill health nationally and globally that have been highlighted, and exacerbated, by the COVID-19 pandemic. The author was a member of the Review Group that undertook the Review of Nutrition and Human Health Research on behalf of OSCHR. In addition, he served on the Expert Review Panel of the UK NRP Collaborative Awards and contributed to, or attended, four of the Hot Topic Workshops described in this editorial.

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