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Emeritus Director and Professor of Pediatrics, Baylor College of Medicine, Houston, TX 77030-2600
* To whom correspondence should be addressed. E-mail: bnichols{at}bcm.edu.
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ABSTRACT |
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 TOP ABSTRACT IntroductionLITERATURE CITED |
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"By mutual confidence and mutual aid,Great deeds are done, and great discoveries made;
The wise new prudence from the wise acquire,
And one brave hero fans another's fire."
Alexander Pope, The Iliad of Homer, Book X, 1715–1720.
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Introduction |
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TOPABSTRACTIntroductionLITERATURE CITED |
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Founding of the Children's Nutrition Research Center
The legal authorization for establishing the Children's Nutrition Research Center (CNRC) was Senate Report 35, which was published on September 12, 1963. This report prepared by the USDA Agriculture Research Service (ARS) was entitled "Proposed Plan for Expanded Research in Food and Nutrition." It reviewed the previous 70 y of human nutrition research in the USDA and recommended expansion of human nutrition research by construction and funding of 3 regional laboratories. Senate Report 35 was brought to my attention by Dr. Harold Sandstead in 1973, and as a consequence; a proposal was prepared and submitted to the Agriculture Rural Development and Related Agencies Subcommittee of the House Appropriations Committee in 1974. The application, sponsored by Rep. Bob Casey (D-TX), was based on the proposition that the scientific support for nutritional recommendations for infants and children needed to be strengthened and expanded. The focus was on normal children from conception to adolescence and mothers during pregnancy and lactation. Noninvasive approaches were envisioned, which included body composition, calorimetry, and stable isotope measurements. This initial application was unsuccessful.
We began another cycle of application, sponsored by Rep. Bob Gammage (D-TX), in 1976, which was administratively supported by Dean Joseph Merrill at BCM and Board Member George Bellows at Texas Children's Hospital. This time, the House Agriculture and Related Agencies Subcommittee of the Appropriations Committee, chaired by Jamie Whitten (D-MS), requested a feasibility study. Dr. Jack Iacono, from the ARS National Program Staff, organized a site visit by ARS and external nutritional scientists, including Dr. Harold Sandstead, which was held on January 27, 1977. The site visit report was submitted to the House Agriculture and Related Agencies Subcommittee. On March 16, 1977, I had a telephone call from Dr. Jean Mayer, President of Tufts University, informing me that Tufts was seeking to establish a Human Nutrition Laboratory on Aging and that appropriate enabling language had been added to the 1977 Farm Bill. In 1977 the House marked up appropriations for both BCM and Tufts centers, but the Senate Agriculture Subcommittee only included Tufts. This turn of events lead to a rallying of support by the full Texas Congressional Delegation in the House and Senate in 1978. In the House, leadership was from Rep. Jack Hightower (D-TX) and Rep. Bill Archer (R-TX). Leadership was from Senator Lloyd Bentsen (D-TX) in the Senate. On February 21, 1978, I appeared before the McGovern Senate Select Committee on Nutrition, where I reported on the legal authorizations for our request and our proposed program objectives. I was introduced by Rep. Bob Gammage. In 1978 the House Agriculture Subcommittee again marked up funds for the Tufts and BCM Centers, but the Senate did not. I was present on September 15, 1978, when the House/Senate Agriculture Appropriations Conference Committee met and accepted the House recommendations. The Dean of the Texas Delegation, Chairman of House Appropriations George Mahon (D-TX), walked over to the gallery and reported "Well Doc, you got your center." The conferees directed that the centers maintain close cooperation with NIH. Creation of the USDA/ARS CNRC at BCM and Texas Children's Hospital was announced on November 2, 1978, by Senator Lloyd Bentsen. Dr. Jack Iacono from ARS attended and reported that the House Agriculture Subcommittee had referred >40 competing requests to establish human nutrition centers at other institutions for his review. The CNRC programs began in temporary facilities. Increased 1979 appropriations allowed establishment of a Stable Isotope Laboratory.
On July 27, 1984, in response to leadership by Rep. Jack Hightower and Rep. Bill Archer with Speaker Jim Wright (D-TX), the House Agriculture Rural Development and Related Agencies Subcommittee marked up funds for the construction of a facility for the CNRC. The facility was to be used for research on the nutrient needs and nutritional status of mothers, infants, and children. The Committee justified this appropriation "based upon proximity to Baylor College of Medicine and Texas Children's Hospital," noting that "these institutions had conducted nutrition research for the past 20 y and will provide ready access to newborn and maternity care and to pregnant and lactating women and their unborn and newly born children." The Agriculture Appropriations Conference Committee approved this recommendation in Public Law 98–396 on August 22, 1984. On April 13, 1985, ground breaking occurred on a 1-acre site adjacent to Texas Children's Hospital. The Assistant Secretary of Science and Education of USDA, Orville G. Bentley, announced the $49 million appropriation for constructing and equipping of the CNRC building. He reported that the CNRC
is already employing some of the most advanced research methods of their kind in the world, with emphasis on determining protein and energy requirements of women for pregnancy and lactation and of infants and children for growth and development. Safe, non-radioactive isotopes are being used as tracers of individual nutrients to determine their absorption and utilization.
The completed facility for the CNRC, which was clad in Texas granite to recognize the universal endorsement of the Texas Congressional Delegation, was dedicated October 7, 1988. Chairman of the House Agriculture Committee, "Kika" de la Garza (D-TX), was the keynote speaker. He envisioned "the impact of the important research contributions of the CNRC to USDA programs for child nutrition" and expanded his view of the Center's remit to include "all children of the world."
A Cooperative Agreement between BCM and ARS that formalized the CNRC management system was signed on October 1, 1985. This stated that the mission of the CNRC is "to conduct research that will lead to a definition of the nutritional requirements needed to assure health in children from conception through adolescence, and in pregnant and lactating women." The agreement 58–7MN1–6-100 has been renewed every 5 y maintaining the same mission statement.
In contrast to the investigator-initiated research management system of NIH and National Science Foundation, ARS research is oriented toward solution of problems of importance to U.S. agriculture, nutrition, and health policies. The USDA/ARS Human Nutrition (NP107) Action Plan 2009–2013 Goals for nutrition are described below along with key CNRC performance measures (1).
To visualize progress toward ARS goals, performance measures have been established as follows (1).
Performance Measure 5.2.1.
Monitor food consumption/intake patterns of Americans, including those of different ages, ethnicity, regions, and income levels, and measure nutrients and other beneficial components in the food supply. Provide the information in databases to enable ARS customers to evaluate the healthfulness of the American food supply and the nutrient content of the American diet.
CNRC scientists have focused on the dietary intakes of infants, children, and mothers as highlighted above and as described below.
Performance Measure 5.2.2.
Define the role of nutrients, foods, and dietary patterns in growth, maintenance of health, and prevention of obesity and other chronic diseases. Assess bioavailability and health benefits of food components. Conduct research that forms the basis for and evaluates nutrition standards and Federal dietary recommendations.
CNRC scientists have focused on the role of food intakes of infants, children, and mothers on growth and health as highlighted above and as described below.
The following specific performance measures have made a profound impact on U.S. and international nutrition policies and recommendations for food intake of children. Parallel accomplishments in increased understanding of food needs of pregnant and lactating mothers have been omitted because of space.
Normal child bone growth and food calcium needs
The CNRC has established the norms for bone growth in healthy children. An example of this for girls is shown in Figure 1. Bone mineral content was determined by a minimally invasive procedure to measure bone dimension and density. Similar data for boys are available at the web site. In addition, CNRC scientists, using stable isotope technology, have determined the bioavailability and retention of calcium from foods during childhood (2–15). These studies have been incorporated into the Institute of Medicine (IOM) Recommended Dietary Intakes (RDI) for Children (16).
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The CNRC scientists have established the reference values for growth of lean (nonfat) tissues in the normal child (17–20). This was accomplished by measuring the total body potassium, located mostly in lean tissues, with a noninvasive technique. Estimates of rates of potassium deposition for infants from 9 mo through 3 y of age (18) and total body potassium content from 4 through 18 y of age (20) were utilized to estimate rates of lean-body growth and protein deposition: protein deposition = total potassium accumulated (mmol/d) ÷ 2.15 (mmol potassium/g nitrogen: 6.25). The 40K analyses that formed the basis for the computed protein depositions are given in Figure 2.
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25% in the 2002 IOM RDI (21) and have been adopted as international standards by FAO and WHO (22). Normal child energy expenditures and food energy needs
The CNRC scientists have undertaken the direct measurement of total energy expenditure (TEE) by the doubly labeled water technique perfected in the Stable Isotope Laboratory (23–26). The method represented a distinct advantage over previous TEE evaluations that had to rely on a factorial approach and/or on food intake data, both of which have limited reliability. CNRC investigators submitted almost all of the individual infant and child TEE and ancillary data including age, gender, height, weight, basal energy expenditure, and descriptors for each individual in the data set. The measurements were obtained from infants and children whose ages, body weight, height, and physical activities varied over wide ranges, so they provide an appropriate base to estimate energy expenditures and requirements at different life stages in relation to gender, body weight, height, age, and for different activity estimations. These data were used to estimate the current energy recommendations and also have been used to refine WHO childhood energy intake recommendations. The consequences of these normative CNRC data are shown in Figure 3, where child energy intake is reduced by 20% in the 2002 IOM RDI (21) and have been adopted internationally by FAO/WHO/ UN University (UNU) Committees (22). It is anticipated that this reduction of recommended energy intake can play a role in the prevention of childhood obesity.
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ARS Performance Measure 5.2.3 reads:
Publish research findings not encompassed under the other performance measures for this objective likely to significantly advance the knowledge of human nutrition, extensively influence other researchers in the same or related field, or yield important new directions for research citation rates.
The scientists of CNRC published >3000 peer-reviewed articles and invited reviews from 1978 through 2007. Led by Dr. Dennis Bier since July 1, 1993, CNRC presently has 42 scientists in 8 research clusters: 5 groups on normal development or prevention of obesity; 1 on mineral absorption; 1 on nutrient-gene interactions; and 1 on phytonutrient biochemistry. Under Dr. Bier, CNRC scientists have successfully implemented the 1978 Congressional Mandate to integrate with NIH by matching the ARS research budget with NIH-funded nutrition research programs. Working to provide better scientific information about body growth and food needs, CNRC scientists have made progress in fulfilling the vision of Chairman of House Agriculture Committee de la Garza on October 2, 1988, when he predicted "the impact of the research contributions of the CNRC on food guidelines for USDA programs for child nutrition" and "all children of the world."
Other articles in this supplement include references (28–32).
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FOOTNOTES |
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2 Funded by USDA/ARS through a series of cooperative agreements with BCM.
3 Author disclosure: B. L. Nichols, no conflicts of interest.
4 Abbreviations used: ARS, Agriculture Research Service; BCM, Baylor College of Medicine; CNRC, Children's Nutrition Research Center; IOM, Institute of Medicine; RDI, recommended dietary intakes; TEE, total energy expenditure; UNU, United Nations University.
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LITERATURE CITED |
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TOPABSTRACTIntroductionLITERATURE CITED |
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1. ARS Strategic Plan for 2006–2011. Objective 5.2: Promote Healthier Eating Habits and Lifestyles. Beltsville, MD: USDA/ARS.
2. Abrams SA, Stuff JE. Calcium metabolism in girls: Current dietary intakes lead to low rates of calcium absorption and retention during puberty. Am J Clin Nutr. 1994;60:739–43.
3. Abrams SA, Sidbury JB, Muenzer J, Esteban NV, Vieira NE, Yergey AL. Stable isotopic measurement of endogenous fecal calcium excretion in children. J Pediatr Gastroenterol Nutr. 1991;12:469–73.[Medline]
4. Abrams SA, Esteban NV, Vieira NE, Sidbury JB, Specker BL, Yergey AL. Developmental changes in calcium kinetics in children assessed using stable isotopes. J Bone Miner Res. 1992;7:287–93.[Medline]
5. Abrams SA, Silber TJ, Esteban NV, Vieira NE, Stuff JE, Meyers R, Majd M, Yergey AL. Mineral balance and bone turnover in adolescents with anorexia nervosa. J Pediatr. 1993;123:326–31.[Medline]
6. Abrams SA, O'Brien KO, Stuff JE. Changes in calcium kinetics associated with menarche. J Clin Endocrinol Metab. 1996;81:2017–20.[Abstract]
7. Abrams SA, O'Brien KO, Wen J, Liang LK, Stuff JE. Absorption by 1-year-old children of an iron supplement given with cow's milk or juice. Pediatr Res. 1996;39:171–5.[Medline]
8. Abrams SA, Wen J, Stuff JE. Absorption of calcium, zinc and iron from breast milk by 5- to 7-month-old infants. Pediatr Res. 1997;41:384–90.[Medline]
9. Ellis KJ, Shypailo RJ, Hardin DS, Perez MD, Motil KJ, Wong WW, Abrams SA. Z score prediction model for assessment of bone mineral content in pediatric diseases. J Bone Miner Res. 2001;16:1658–64.[Medline]
10. Ellis KJ, Shypailo RJ, Wong WW, Abrams SA. Prediction models for bone mineral content in school-aged children. Ann N Y Acad Sci. 2000;904:428–32.[Medline]
11. Treuth MS, Butte NF, Ellis KJ, Martin LJ, Comuzzie AG. Familial resemblance of body composition in prepubertal girls and their biological parents. Am J Clin Nutr. 2001;74:529–33.
12. Treuth MS, Butte NF, Wong WW, Ellis KJ. Body composition in prepubertal girls: comparison of six methods. Int J Obes Relat Metab Disord. 2001;25:1352–9.[Medline]
13. Abrams SA, Copeland KC, Gunn SK, Gundberg CM, Klein KO, Ellis KJ. Calcium absorption, bone mass accumulation, and kinetics increase during early pubertal development in girls. J Clin Endocrinol Metab. 2000;85:1805–9.
14. Abrams SA, Grusak MA, Stuff J, O'Brien KO. Calcium and magnesium balance in 9- to 14-year-old children. Am J Clin Nutr. 1997b;66:1172–7.
15. Ellis KJ, Shypailo RJ, Hergenroeder A, Perez M, Abrams S. Total body calcium and bone mineral content: Comparison of dual-energy x-ray absorptiometry (DXA) with neutron activation analysis (NAA). J Bone Miner Res. 1996;11:843–8.[Medline]
16. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1997.
17. Ellis KJ, Shypailo RJ, Abrams SA, Wong WW. The reference child and adolescent models of body composition. A contemporary comparison. Ann N Y Acad Sci. 2000;904:374–82.[Medline]
18. Ellis KJ. Human body composition: in vivo methods. Physiol Rev. 2000;80:649–80.
19. Butte NF, Hopkinson JM, Wong WW, Smith EO, Ellis KJ. Body composition during the first 2 years of life: An updated reference. Pediatr Res. 2000;47:578–85.[Medline]
20. Ellis KJ, Abrams SA, Wong WW. Body composition of a young, multiethnic female population. Am J Clin Nutr. 1997;65:724–31.
21. Panel on Macronutrients, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients). Washington, DC: National Academies Press; 2005.
22. Garlick PJ. Protein requirements of infants and children. Nestle Nutr Workshop Ser Pediatr Program. 2006;58:39–47; discussion 47–50.[Medline]
23. Butte NF, Wong WW, Garza C. Energy cost of growth during infancy. Proc Nutr Soc. 1989;48:303–12.[Medline]
24. Butte NF, Wong WW, Ferlic L, Smith EO, Klein PD, Garza C. Energy expenditure and deposition of breast-fed and formula-fed infants during early infancy. Pediatr Res. 1990;28:631–40.[Medline]
25. Butte NF, Wong WW, Hopkinson JM, Heinz CJ, Mehta NR, Smith EO. Energy requirements derived from total energy expenditure and energy deposition during the first 2 y of life. Am J Clin Nutr. 2000;72:1558–69.
26. Butte NF. Energy requirements of infants and children. Nestle Nutr Workshop Ser Pediatr Program. 2006;58:19–32; discussion 33–7.[Medline]
27. CNRC reference bone mineral content [database on the Internet]. Available from: www.bcm.edu/bodycomplab/Applications/zscrmainpage.htm.
28. Dupont JL. Research in the Agricultural Research Service/USDA: introduction and early history. J Nutr. 2008;139:171–2.[Medline]
29. Sandstead HH, Nielsen FH. The origin and evolution of the Grand Forks Human Nutrition Research Center, 1970–90. J Nutr. 2008;139:173–7.[Medline]
30. Beecher GR, Stewart KK, Holden JM, Harnly JM, Wolf WR. Legacy of Wilbur O. Atwater: Human nutrition research expansion at the USDA–interagency development of food composition research. J Nutr. 2008;139:178–84.[Medline]
31. Combs GF, Sr. USDA Human Nutrition Center, 1978–82, and coordination of human nutrition research agencies. J Nutr. 2008;139:185–7.[Medline]
32. Rosenberg IH. History of the USDA Human Nutrition Research Center on Aging at Tufts University. J Nutr. 2008;139:192–3.[Medline]
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