Research for a Healthy Life RESEARCH

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1 Research into Prevention and Nutrition - Action Plan Research for a Healthy Life RESEARCH

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3 Research into Prevention and Nutrition - Action Plan Research for a Healthy Life RESEARCH

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5 Contents 1 Contents summary opportunities and Challenges Societal questions Research policy answers need for Research and Measures Linking Biomedicine and Epidemiology: Identifying risk factors and explaining their effects Strengthening Prevention Research: Developing prevention and health promotion strategies on the basis of scientific findings Expand Competences in Nutrition Research: New strategies for improving dietary habits and food choice... 8

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7 summary 3 Summary everyone hopes to be able to live a healthy, active and self-determined life well into old age. this is becoming increasingly possible thanks to medical progress and improved living conditions. at the same time, however, major chronic diseases such as cardiovascular diseases, musculoskeletal diseases, cancer, dementia and diabetes mellitus are becoming more widespread. It is therefore extremely important to prevent their occurrence. The funding of competence clusters in nutrition research will produce an efficient research system that is geared towards developing solutions for today s health problems that are related to diet. It will develop targeted strategies to lastingly improve the population s dietary habits and food choice in the long term. These measures are anchored in a European strategy process in the field of nutrition and health, the Joint Programming Initiative A Healthy Diet for a Healthy Life. Germany is playing an active role in this process. This action plan describes the Federal Government s strategic research funding in the field of prevention and health promotion. The planned funding measures address projects along the entire innovation chain, from basic to application-oriented research. The Federal Ministry of Education and Research (BMBF) provides up to 125 million available for research and development projects during the period 2013 to The action plan combines relevant research approaches in an interdisciplinary manner ranging from biomedicine to epidemiology, prevention research and nutrition research. The funding of biomedical basic research is geared towards establishing systems medicine in Germany. This field uses system-oriented methods in research and clinical health care in order to understand complex physiological and pathological processes and create the basis for developing innovative therapies and preventive approaches. Improving links between the life and information sciences is a key factor in this context. Funding in the field of epidemiology will enable the creation of the largest ever population cohort in Germany, the National Cohort, thus establishing the preconditions for identifying risk factors at an early stage. At the same time, steps will be taken to strengthen epidemiological research at universities. The aim of the proposed funding for prevention research is to improve the scientific basis of prevention and health promotion, enabling the development of solutions for specific target groups, that can be implemented in everyday life.

8 4 Opportunities and Challenges 1 Opportunities and Challenges 1.1 societal questions over the last hundred years, progress in medical care and improved living conditions have caused life expectancy to increase by almost thirty years. this success is not least due to science and research. However, the fact that people are living longer and their living and dietary patterns have changed considerably also means that there is a marked increase in the number of people suffering from chronic diseases such as cardiovascular diseases, musculoskeletal diseases, cancer, dementia and diabetes mellitus. At the same time, multimorbidity is becoming more common. This situation does not only present each individual with new challenges but also the German health system and society as a whole. Chronic diseases usually have a number of causes. Individual genetic disposition and genetic as well as physiological processes are just as decisive as individual lifestyles and environmental influences. Diet and physical activity as well as tobacco and alcohol consumption are among the most important individual lifestyle factors. External environmental factors, for example, include infectious pathogens, allergens, noise, particulate matter and toxic substances as well as psychosocial stress. A person s living environment is also an important external factor not to be neglected. For example, our social environment, work situation and eating out habits all have a considerable influence on our health and well-being. A good way to combat chronic diseases is to prevent them from occurring in the first place. Targeted prevention and health promotion can play a significant role in fostering people s health and well-being and thus enhancing the quality of those extra years of life. Prevention and Health Promotion The WHO (World Health Organization) 1 considers health promotion to include all measures and activities on different societal levels that serve to strengthen people s health resources and potential, their health and healthy living conditions. Health is defined from an holistic point of view as physical, psychological and social well-being. Prevention, on the other hand, aims at introducing targeted activities to prevent, reduce the probability of, or delay health impairment or disease. A differentiation is made between primary, secondary and tertiary prevention depending on the stage at which a prevention measure is introduced. Primary prevention is intended to maintain health and prevent the occurrence of disease as far as possible. Examples of primary prevention are vaccinations or measures to encourage a healthy diet, physical activity, stress management and addiction prevention. secondary prevention aims at the early diagnosis of diseases. This is intended to limit disease progression and to prevent it from becoming chronic (e.g. tests to detect cancer at an early stage). tertiary prevention serves primarily to prevent relapses and follow-up damage after acute treatment or in the case of clinical disease that has already manifested itself. Rehabilitation measures are an important component of tertiary prevention. 1.2 Research policy answers Successful prevention and health promotion measures depend on assured knowledge. What influences diseases and their occurrence? What factors are involved and how do they interact? There is still a need for biomedical and epidemiological research into this area. New prevention measures that are based on the findings of biomedical and epidemiological research and tailored to the needs of the respective target groups will have to be developed and applied. On the one hand, these measures will help people to live more healthily in the long term. On the other hand, they will contribute towards creating healthier living environments; that is to say, the places where people live, eat, work and spend their leisure time. Diverse influences such as social, cultural, economic and psychological factors play an important role in this context. Why do people prefer certain behavioural and dietary patterns although they 1 World Health Organization, Ottawa Charter, 1986

9 Opportunities and Challenges 5 are aware of their adverse effects on health? Why do people not make use of prevention measures or comply with dietary recommendations? What influences a long-term change in behaviour? Answers to these questions will help us to develop improved prevention concepts that are comprehensible for the individual and meet with a high level of acceptance. In particular, the rise in obesity in our society results in an increase of multiple chronic diseases that are influenced by people s dietary and physical activity patterns. Prevention therefore has a special focus on promoting a healthy lifestyle and a living environment which encourages a healthy and balanced diet as well as healthy levels of physical activity. Prospective research funding thus aims to strengthen prevention and health promotion in all areas of society. The Federal Ministry of Education and Research (BMBF) is focusing on developing new approaches to the challenges described above through interdisciplinary research and innovation activities. It was against this background that end of 2010 the Federal Government introduced Research into Prevention and Nutrition as one of six fields of action in its Health Research Framework Programme. The current action plan presents the framework for the BMBF s future research funding. The action plan covers all the research approaches that are relevant for the development of successful prevention measures ranging from epigenetics and epidemiology to prevention research and nutrition research. It takes into account the entire innovation chain from basic to application-oriented research. The action plan reflects the outstanding importance of nutrition in the context of individual lifestyle factors. and tertiary prevention (cf. definition Prevention and Health Promotion ). Project funding of up to 125 million will be provided to implement the action plan in the period 2013 to The main objectives can be summed up as follows: short-term objectives (1-5 years) Strengthening and linking biomedical and epidemiological research as basis for identifying and evaluating the relevant influencing factors Improving evidence for prevention and health promotion measures by expanding and strengthening interdisciplinary prevention research Harmonizing the methods and instruments in prevention research Establishing an efficient, interdisciplinary and internationally competitive nutrition research sector Long-term objectives (6-10 years) Obtaining assured findings on influencing factors and their effects as well as their relevance for the occurrence of diseases as a starting point for successful prevention measures Gaining more knowledge about the long-term effects and health-economical impact of prevention measures Developing effective prevention measures and dietary recommendations Devising new recipes for processed foods based on the latest scientific findings New funding measures will be introduced and strategically linked up with existing funding activities in order to achieve the aims described above. Project funding within the framework of the Research into Prevention and Nutrition action plan focuses on disease-overarching primary prevention and health promotion. It complements the German Centres for Health Research and other disease-related funding measures implemented by the BMBF which attach considerable importance to disease-related secondary

10 6 Need for Research and Measures 2 Need for Research and Measures 2.1 Linking Biomedicine and epidemiology: Identifying risk factors and explaining their effects Current research questions Biomedicine and epidemiology help us to understand the interactions between the human organism and the environment. Biomedicine has achieved considerable breakthroughs in recent years. Today, we are able to better understand how the environment and the human body interact at molecular level. For example, we now know that environmental factors alter our genetic substance permanently. This can lead to longterm changes in metabolic functions. This metabolic programming is also of direct clinical relevance for the occurrence of obesity and diabetes mellitus. Furthermore, there is increasing evidence that it can have a lasting influence on future generations. The analysis of interactions between genes and the environment is the starting point for the epigenetics field, which has opened up a variety of perspectives and opportunities for prevention in recent years. For example, studies show that a mother s diet during pregnancy has longterm effects on the growth and health of her newborn baby. Influences such as overnutrition in pregnancy can programme the foetus s cells epigenetically and alter their functions permanently. The focus of current research is shifting increasingly away from individual factors towards their complex interactions, which ultimately determine the occurrence and progress of diseases. We still do not understand many of these complex processes and their interactions with the genome. Determining these relationships is therefore one of the most pressing issues of biomedical research. Epidemiological research also provides a significant (data-) base for the development of successful prevention and health promotion strategies. Population-related, prospective cohort studies can be used to observe links between genes, human behaviour, lifestyle factors and the environment and to analyse their significance for disease onset. Long-term studies with follow-up surveys over periods of up to several decades are of key importance in this context. Funding objective In order to develop successful preventive approaches, we need sound knowledge about the interrelationships between the human organism and the environment and about their relevance for the occurrence of diseases. This requires a close networking of biomedical and epidemiological research. The planned funding measures therefore aim to strengthen research in both areas and in particular to intensify their cooperation. This will involve integrating new findings in basic research (for example, in epigenetics and epigenome research) and new biomedical technologies in population-related and interventional epidemiological studies. Funding measures German national Cohort One prominent funding measure in the field of epidemiology is the establishment of a long-term, population-based cohort: the German National Cohort (GNC). It will provide an excellent basis for various future national and international health research projects. The GNC is a joint interdisciplinary endeavour of scientists from the Helmholtz Association, Leibniz Association, universities and Ressortforschung. Its aims are to identify risk factors for major diseases such as cardiovascular diseases, musculoskeletal diseases, cancer, diabetes mellitus, dementia and infectious diseases, to discover ways of effective prevention and to recognize opportunities for the early diagnosis of diseases. In total 200,000 men and women aged between 20 and 69 will undergo a medical examination and answer questions regarding their lifestyles (e.g. physical activity, diet, smoking, alcohol consumption, profession) and their social environment. Furthermore, blood samples will be taken from all the participants for use in subsequent research projects dealing for example with genetic and epigenetic questions. All the participants will be invited back to the study centres for a follow-up examination and a second interview after five years. During the follow-up period of 10 to 20 years, some people will develop certain diseases, which can then be related to the

11 Need for Research and Measures 7 data collected. The study thus allows a large number of scientific surveys which link epidemiological and (epi-)genetic questions. It will help us to understand how genetic factors, environmental conditions, the social environment and lifestyle interact in the development of diseases. Health-related epidemiological research at universities The aim of this structural measure is to expand research and teaching capacities in epidemiology at German universities and ensure that Germany meets international research standards in the long term. The funding scheme includes two elements: the formation of junior research groups in epidemiology and the provision of start-up funding for the establishment of professorships in epidemiology. The BMBF is funding concrete research projects dealing with current and relevant issues in clinical population-related and/or care-related epidemiology. These projects will make significant contributions to a better understanding of the complex interaction between the many influencing factors and trends that play an important role in the occurrence and the course of diseases. This will provide a basis for devising individual medical care and disease prevention measures. e:med research and funding concept: Paving the way for systems medicine The funding measures under the e:med research and funding concept refer to application-oriented basic research in the life sciences. e:med is a research and funding concept that promotes the systems-oriented study of diseases by linking the life sciences and the information sciences. This so-called systems medicine provides a better understanding of the complex causes of diseases. To be successful it requires not only diverse and comprehensive, but also suitably processed data material ranging from genetic information to clinical data, e.g. a blood count or X-ray. It is easy to obtain genetic, cell biological, physiological and visual data sets relatively cheaply nowadays. What is important now is their electronic processing; that is to say, the computer-aided archiving, analysis and integration of data. Apart from having significant implications for research into prevention and nutrition, future results particularly in epigenome research are also essential for progress in the prevention, diagnosis and treatment of major diseases and for the increasing individualization of medicine. Clinical trials Clinical trials need to be conducted to transfer research findings into health care. Population-based clincal trials testing new strategies from basic biomedical and epidemiological research will become more important in the future. Funding of such trials with a preventive approach and a high relevance for health care will be accounted for in the further development of the BMBF funding measure Clinical trials. 2.2 strengthening Prevention Research: Developing prevention and health promotion strategies on the basis of scientific findings Current research questions It is the task of prevention research to develop, test and evaluate target-group-specific measures in primary prevention and health promotion. These approaches may aim at both effecting a change in behaviour by increasing health-awareness (behavioural prevention) and providing health-promoting conditions in everyday life (setting-based prevention). A large number of prevention and health promotion measures are available. However, their effectiveness and benefits are often not sufficiently proven. In particular, their long-term effects and health economic benefits are largely unknown. This calls for comprehensive scientific studies to look into the effects of prevention and health promotion. Studies should take into account the social, cultural and economic environment as well as gender-specific aspects as these are factors which influence the disease risk. For example, there is a correlation between a person s level of educational attainment, on the one hand, and their exercise and smoking habits, on the other.

12 8 Need for Research and Measures People are still not sufficiently employing prevention and health promotion measures with proven positive effects in their everyday lives. Furthermore, people with a low social status are far less likely to take part in behavioural prevention measures than people with a medium or high social status. Intensive research efforts are needed in order to reach all population groups in an appropriate manner and convince them of the benefits of prevention and health promotion measures. Funding objective The aim of research funding is to establish the scientific basis for developing and evaluating new strategies for primary prevention and health promotion. German prevention research will be strengthened for this purpose. Particular importance will be attached to research into the long-term effects of prevention and health promotion. Funding measures Research consortia on primary prevention and health promotion Effective prevention research must focus on inter- and intra-disciplinary cooperation and use the synergies between the different research players. Germany s university and non-university institutions lack strong, internationally visible research in prevention and health promotion. Despite certain improvements in recent years, there is still a shortage of research structures to support the networking of scientists and everyday practice. Based on the BMBF s Prevention Research priority programme, which has been funding individual projects since 2003, the tried and tested instrument of research consortia will therefore be applied here. In this interdisciplinary research consortia which are preferably organized on a regional basis, all the expertise and resources that are needed for the respective research objective are pooled. The consortia are intended to improve the scientific basis for primary prevention and health promotion measures and accelerate their transfer to everyday life. Furthermore, they will develop specific methods of prevention research and will promote junior scientists. The research consortia should concentrate on topics of overarching importance. What do people eat? Do they get sufficient exercise? Why do they smoke or drink alcohol? How should prevention and health promotion measures be designed and how do they reach specific target groups? Furthermore, funding will be provided for Regional Health and Service Clusters which will be established to develop and test regional solutions in health promotion and primary prevention. evaluation studies on the long-term effects of primary prevention and health promotion With this funding measure the BMBF supports evaluation studies on the long-term effects of primary prevention and health promotion interventions to clarify, whether and how prevention measures work. Funding is provided for follow-up studies of evaluations that have already been completed with the aim of examining the long-term effects of primary prevention and health promotion under everyday circumstances. Apart from investigating individual effects (behavioural changes), the studies also consider structural developments (conditional changes). They also focus, for example, on changes in people s quality of life and performance. Furthermore, they examine the societal benefits of disease prevention in relation to the costs involved. 2.3 expand Competences in nutrition Research: new strategies for improving dietary habits and food choice Current research questions The supply of food in Germany is sufficiently good and varied to satisfy the needs of most people. Nevertheless, diseases associated with nutrition such as overweight, Type 2 diabetes, various types of cancer or allergies are on the increase. Nutrition research is therefore particularly important for improving people s health and preventing diseases that are associated with nutrition.

13 Need for Research and Measures 9 One pressing but still unsolved question is why people do not adhere to dietary recommendations regularly and sufficiently in their everyday lives. Contributions to address this problem can be expected from the cultural sciences as well as from the field of psychology and behavioural economics. Among other things, it is important to find out: What effects do people s societal, cultural and socio-economic environment have on their dietary habits? How can consumers be persuaded to follow dietary recommendations in their everyday routine and to eat more healthily? And what is the role of the increasing variety of modified (reformulated) foods? Biomedical and nutritional physiology questions are another priority for future research. There is still very little information available about how foods and their constituents interact with the human body, how they work at the molecular level and what role is played by the individual s genetic disposition. Furthermore, there is still a lack of scientific knowledge about how diet and disease go hand in hand. What factors determine the occurrence and the course of nutrition-related diseases? Funding objective Funding will be provided for the development of target-group-specific dietary recommendations and prevention strategies. In addition, measures will be taken to support health-related improvements in the production of food with a particular focus on consumer acceptance of these products. This calls for the establishment of an interdisciplinary and internationally competitive nutrition research sector in Germany. Funding measures Competence clusters in nutrition research to improve the health status in Germany Academic nutrition research in Germany is extremely diversified: There is a large number of disciplines and sites at universities and other institutions of higher education. In many cases, however, there is not sufficient critical mass for scientific excellence and training that is suited to meet the demand. There is no sufficiently established transfer of knowledge and technology between science and industry particularly involving small and medium-sized enterprises (SMEs). The result is that it takes too long for new scientific findings to be translated into the production of healthy foods. Under its funding measure Competence Clusters in Nutrition Research, the BMBF intends to establish regional, theme-focused competence clusters in nutrition research which pool the nutritional competences of universities, non-university research institutions, Ressortforschung and industry. These clusters will develop targeted strategies to combat diseases that are associated with nutrition. Furthermore, the international visibility and scientific excellence of German nutrition research will be enhanced. In general, the funding measure aims to orient German nutrition research towards a more interdisciplinary approach and increase its relevance for practical applications. Independent junior research groups support young scientists in the early stages of their careers and open up new career options within the competence clusters. SMEs receive academic support for application-oriented research and development work. The access to scientific expertise is intended to enhance their willingness and ability to produce healthier food products. It is envisioned for each competence cluster to set up an innovation office to facilitate the prompt transfer of results and technology from science to nutritional practice. Funding of a european Knowledge Hub under the Joint Programming Initiative (JPI) a Healthy Diet for a Healthy Life The BMBF and the Federal Ministry of Food, Agriculture and Consumer Protection (BMELV) are involved in the European Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life that was launched in In this initiative Germany is working with 20 European states to align national funding strategies to a common strategic research agenda and expand international cooperation. As a first step, a European network for communication and cooperation between excellent inter-

14 10 Need for Research and Measures disciplinary research groups (knowledge hub) is being set up. This network will contribute to a better understanding of how biological, psychological and socio-economic factors influence consumers decision-making with regard to diet and physical activity. The comparison of different conditions in the European Member States can provide new insights into factors that influence nutrition and physical activity. Furthermore, researchers will also study the effects of genetic and epigenetic differences in the European population. Another initiative within JPI will develop and validate biomarkers for assessment of the health status as well as the influence of specific dietary patterns and food constituents. This information will be merged in a joint database. The biomarkers are intended to accelerate the harmonization of the methods used in nutrition research, substantiate and enable the comparison of research results and finally contribute towards a better competence in determining the individual s risk of chronic disease.

15 Imprint Published by the Federal Ministry of Education and Research (BMBF), Germany Health Research Division Berlin Orders in writing to Publikationsversand der Bundesregierung Postfach Rostock Internet: or by Phone: Fax: (14 cents/min. from German landlines, up to 42 cents/min. from mobile network) Last updated: Februar 2013 Printing BMBF Layout W. Bertelsmann Verlag, Bielefeld, Christiane Zay, Potsdam Photo credits Cover: Getty Images, AE Pictures Inc. Edited by PT-DLR Project Management Agency, Health Research This publication is distributed free of charge by the German Federal Ministry of Education and Research as part of its public relations work. It is not intended for commercial sale. It may not be used by political parties, candidates or electoral assistants for advertising purposes during an election campaign. This applies to federal, Länder and local elections as well as to elections to the European Parliament. In particular, the distribution of this publication at election events and at the information stands of political parties as well as the insertion, printing or affixing of party-relevant information or advertising material are regarded as improper use. The distribution of this publication to third parties for the purpose of campaign publicity is also prohibited. Regardless of how recipients came into possession of this publication and how many copies of it they may have, it may not be used in a manner that could be construed as showing partisanship on the part of the Federal Government in favour of individual political groups, even if not within the context of an upcoming election.

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