Full Text HL-97-011
 
NUTRITION ACADEMIC AWARD
 
NIH GUIDE, Volume 26, Number 31, September 19, 1997
 
RFA:  HL-97-011
 
P.T.


Keywords: 

 
National Heart, Lung, and Blood Institute
 
Letter of Intent Receipt Date: December 1, 1997
Application Receipt Date: February 18, 1998
 
THIS RFA USES "JUST-IN-TIME" PROCEDURES.  THIS RFA INCLUDES DETAILED
MODIFICATIONS TO STANDARD APPLICATION INSTRUCTIONS THAT MUST BE
FOLLOWED WHEN PREPARING AN APPLICATION IN RESPONSE TO THIS RFA.
 
PURPOSE
 
The primary objective of this initiative is to encourage the
development or enhancement of medical school curricula to increase
opportunities for students, house staff, faculty, and practicing
physicians to learn nutrition principles and clinical practice skills
with an emphasis on preventing cardiovascular diseases (CVD).  A
second objective is to provide training modules for dissemination to
other medical schools as well as other health care professional
schools.
 
HEALTHY PEOPLE 2000
 
The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This RFA,
Nutrition Academic Award, is related to the priority areas of
nutrition, heart disease and stroke, obesity, physical activity,
diabetes, chronic disabling conditions, and clinical prevention
services.  Potential  applicants may obtain a copy of "Healthy People
2000" (Full Report:  Stock No. 017-001-00474-0 or Summary Report:
Stock No. 017-001-00473-1) through the Superintendent of Documents,
Government  Printing Office, Washington, DC 20402-9325 (telephone
202-512-1800).
 
ELIGIBILITY REQUIREMENTS
 
Institution
 
An application may be submitted by any domestic institution with a
school of  medicine.  Eligible institutions may submit only one
application in each competition and receive only one award.
 
Principal Investigator
 
A Principal Investigator for the Nutrition Academic Award must have
the following credentials:
 
o  doctoral degree
 
o  sufficient graduate or post graduate training and experience in
nutrition research, medical or nutrition clinical practice, and/or
medical education to develop and implement a high quality medical
curriculum in nutrition, emphasizing cardiovascular disease
prevention, and to provide leadership for a multidisciplinary team;
 
o  knowledge and skills and a demonstrated commitment to medical
education for students, house staff, physicians and other health care
professionals;
 
o  permanent appointment (not adjunct) at the rank of Associate or
Full Professor on the faculty of an accredited school of medicine in
the United States, its territories, or its possessions;
 
o  demonstrated support from the Dean and educational leadership of
the institution and;
 
o  be a citizen or non-citizen national of the United States or have
been lawfully admitted for permanent residence at the time of
application.
 
Individuals who have or have had another NIH career development award
(K series) or a regular research grant (R01) are eligible for this
award if the individual meets the requirements of the Nutrition
Academic Award program.  Applications from women and individuals from
diverse racial/ethnic backgrounds are encouraged.
 
MECHANISM OF SUPPORT
 
This RFA is part of the Academic Award Program (KO7) of the National
Heart, Lung, and Blood Institute.  Responsibility for the planning,
direction, and execution of the proposed project will be solely that
of the applicant.  The total project period may not exceed five years
and is non-renewable.  Awards will be limited to a maximum of $50,000
for the salary of the Principal Investigator, plus applicable fringe
benefits, and a maximum of $150,000 for the total cost of the award
for the first year (including indirect costs).  A three percent
escalation is allowed per year in subsequent years.  The salary cap
may not be exceeded in any year. Facilities and Administrative costs
may not exceed 8 percent.
 
It is anticipated that support for this program will begin September
30, 1998.
 
Application instructions have been modified to reflect "just-in-time"
streamlining efforts at the NIH.  The just-in-time concept requires
applicants to submit certain materials only when there is the
possibility of an award.  It is anticipated that these changes will
reduce the administrative burden for the applicants, reviewers, and
NHLBI staff.  For this RFA, only limited budgetary information is
required in the application.  However, the anticipated level of
effort in all years and a brief description of responsibilities for
the Principal Investigator and key personnel must be included in the
research plan.  Instructions for completing the Biographical Sketch
have been modified.  In addition, the Other Support information and
application  "Checklist" page are not required as part of the initial
application.  If the possibility of an award exists following the
initial review, the Budget, Other Support, and Checklist information
will be requested by NHLBI staff. The APPLICATION PROCEDURES section
of this RFA provides specific details of these modifications to the
standard PHS 398 application kit.
 
FUNDS AVAILABLE
 
It is anticipated that in fiscal year 1998, support will be available
for total costs of approximately $750,000 and that approximately five
grants will be awarded under this program.  An additional competition
will be held in fiscal years 1999 and 2000.  The actual number of
awards each year will depend upon the merit and scope of the
applications received and the availability of funds.
 
OBJECTIVES
 
Background
 
Diet has been associated with eight of the ten leading causes of
death in the United States (USDHHS, 1988).  A number of national
committees, panels, and agencies have made recommendations for the
nation to modify and improve dietary intake as a major step toward
preventing premature morbidity and mortality from cardiovascular and
other chronic diseases (National Research Council, 1989; USDHHS,
1991; Expert Panel on Detection, Evaluation, and Treatment of High
Blood Cholesterol in Adults, 1993; National High Blood Pressure
Education Program, 1993; US Department of Agriculture, 1995; Krauss
et al, 1996).
 
Currently, health care providers and health care organizations are
paying increasing attention on risk factor management as a key part
of optimal care of patients to prevent CVD, and emphasis is being
placed on strategies to prevent nutrition-related diseases (Pearson
et al, 1996).  More recognition is being given to the importance of
nutrition training for health care providers from several
disciplines, since they play a key role in meeting this need with
patients and the general public.  Over the years, physician and
patient surveys have shown repeatedly a need to increase physicians'
skills and efforts in nutrition.  For example, Schucker et al (1991)
in a survey on cholesterol awareness showed only 9% of the public
reported that their physicians gave them advice to follow
cholesterol-lowering diets, although one in four reported a diagnosis
of elevated cholesterol.
 
For over 30 years, inclusion of nutrition in medical school curricula
has been advocated by nutrition societies and expert committees
(Zimmermann et al, 1993; USDHHS 1991; NHLBI, 1994; US Preventive
Services, 1996).  The Committee on Nutrition in Medical Education
(1985) recommended that nutrition be a required course in medical
schools, a minimum of 25 hours be provided to teach the basic
material, nutrition questions be included in medical licensing
examinations, and a separate nutrition department be instituted in
medical schools.  At the time of the 1985 report, only 25% of medical
schools had required nutrition courses, only a few medical schools
provided 25 hours or more of nutrition content, fewer than 3% of
questions on the National Boards related to nutrition, and only one
or two medical schools had a separate nutrition department (Winick,
1993).  Nearly a decade later there was little, if any, improvement
in this situation (Winick, 1993).  In 1997, Hark et al reported that
medical licensing examinations contained 11% to 12% nutrition
content, as identified by nutrition professionals.  Many of the items
were related to vitamin deficiencies, and little coverage was given
to nutrition-related screening and preventive counseling (Hark et al,
1997).  A national consensus on the essentials of nutrition education
in medical schools has recently been developed (American Medical
Student Association, 1996).  Thus, although numerous reports contain
major recommendations for the inclusion of nutrition in medical
education and physician training, implementation has been limited
(USDHHS, 1991; Pearson et al, 1996; Tobin, 1997).
 
Prevention of CVD through nutrition cuts across several medical and
other health care specialties (e.g., cardiology, internal medicine,
preventive medicine, family practice, pediatrics, obstetrics and
gynecology, geriatrics, nursing, dietetics, physician assistants),
and a multidisciplinary approach is required to integrate nutrition
training in these specialties.  In addition to training in nutrition
principles and counseling techniques, physicians need training on how
to set up an office practice system that is supportive of a team
approach to CVD prevention.  Training mechanisms for faculty in
medical schools with strong backgrounds in nutrition science,
research, and prevention to expand nutrition training of physicians
as well as other health professionals could help meet some of these
needs (Bruer et al, 1994; Hunt et al, 1995; Pearson et al, 1996;
Ockene et al, 1996; Morrison et al, 1996).
 
The aim of this academic award program is to stimulate the
development and enhancement of medical school education programs so
that physicians may learn nutrition principles and clinical practice
skills for the prevention of CVD risks and improved nutritional
management of their patients.  A second aim is to provide training
modules for dissemination to other medical and other health
professional schools.
 
Awardees should propose objectives and plans for incorporating
nutrition into medical school programs.  Preference will be given to
applicants who also include training opportunities for other health
care providers.  The plans should include mechanisms to:
 
o  Encourage the development of high quality curricula in schools of
medicine that will significantly increase the knowledge and skills of
students, house staff, and others, including faculty and practicing
physicians, to apply state-of-the-art nutrition principles, practice,
and counseling with an emphasis on prevention of CVD.
 
o  Evaluate the impact of the proposed program.
 
o  Promote professional development of the awardee so he/she can
serve as a focal point for multidisciplinary interactions promoting
effectiveness in teaching, research, and clinical care in the field
of nutrition, including training of other health care professionals.
 
o  Develop or enhance an infrastructure at the Institution to
continue educational and training programs in nutrition and CVD
prevention when the award is concluded.
 
o  Promote communication among specialists in primary care and other
specialties to ensure coordinated nutritional prevention and
treatment strategies.
 
o  Develop coordinated clinical and educational approaches to address
nutritional needs of patients of various ages and ethnic groups, and
populations with special needs.
 
o  Engage in an interchange of teaching modules and strategies among
other awardees and their institutions.
 
o  Develop curricula and training modules in collaboration with other
awardees that can be adapted and used by other academic training
units and institutions.
 
o  Promote research studies in nutrition and CVD prevention at the
Institution, funded by other support.
 
SPECIAL REQUIREMENTS
 
Applicants should develop a comprehensive program that effectively
addresses their needs related to the objectives of this RFA.  The
primary focus must be on plans to improve the quality of nutrition
medical school education for students and physicians.  Plans and
educational materials for curricular improvements must be of a design
that facilitates dissemination and adoption at other institutions.
All applications must include plans to evaluate the outcome of the
educational initiatives.  The responsibilities of the Principal
Investigator and key personnel must be described in the budget
justification section.  The minority and gender composition of
students to be trained should be described.
 
INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN
SUBJECTS
 
It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This policy results from
the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations), which
have been in effect since 1990.  The policy contains some provisions
that are substantially different from the 1990 policies.  All
investigators proposing research involving human subjects should read
the "NIH Guidelines for Inclusion of Women and Minorities as Subjects
in Clinical Research," which have been published in the Federal
Register of March 28, 1994, (FR 59 14508-14513), and reprinted in the
NIH GUIDE FOR GRANTS AND CONTRACTS of March 18, 1994, Volume 23,
Number 11.
 
Investigators may obtain copies of the policy from these sources or
from the program staff listed under INQUIRIES.  Program staff may
also provide additional relevant information concerning
the policy.
 
Although the Nutrition Academic Award is not primarily a mechanism to
support research, medical students and residents are considered human
subjects and it is likely that human subjects will be involved.
Therefore, protection of human subjects must be addressed, and the
approximate percent of women and each minority group that you expect
in the total population must be included.
 
LETTER OF INTENT
 
Prospective applicants are asked to submit, by December 1, 1997, a
letter of intent, the name, address, and telephone number of the
Principal Investigator, the identities of other key personnel,
participating institutions, and the number and title of the RFA in
response to which the application may be submitted.  Although a
letter of intent is not required, is not binding, and does not enter
into the review of subsequent applications, the information that it
contains allows NHLBI staff to estimate the potential review workload
and to avoid conflict of interest in the review.  The letter of
intent is to be faxed or sent to Dr. Louise Corman, at the address
listed under INQUIRIES.
 
APPLICATION PROCEDURES
 
Applications are to be submitted on the grant application form PHS
398 (rev. 5/95).  These forms are available at most institutional
offices of sponsored research and from the Grants Information Office,
Office of Extramural Outreach and Information Resources,  National
Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD
20892-7910, telephone (301) 435-0714, Email:
asknih@odrockm1.od.nih.gov.
 
The RFA label available in the PHS 398 application form must be
affixed to the bottom of the face page of the application.  Failure
to use this label could result in delayed processing of the
application such that it may not reach the review committee in time
for review.  In addition, to identify the application as a response
to this RFA, check "YES" in item 2 of application page 1 and enter
the title "Nutrition Academic Award  NIH HL-97-011".
 
Use the following modifications in completing the standard PHS 398
application instructions:
 
o  BUDGET INFORMATION - No current/future year budgets or
justifications (form pages 4 and 5) are required in the application.
However, the anticipated level of effort in all years and a brief
description of responsibilities for the Principal Investigator and
all key personnel must be specifically stated at the beginning of the
research plan.  Necessary budget information will be requested by
NHLBI staff if there is a possibility for an award.
 
o  BIOGRAPHICAL SKETCH - In addition to the standard information
requested on Form Page 6, the applicant should provide the title and
source of any sponsored support relevant to the proposed workscope.
 
o  OTHER SUPPORT - No other support information is required on the
"Other Support" page (Form Page 7).  Selected other support
information relevant to the proposed application may be included in
the Biographical Sketch as indicated above.  Complete other support
information will be requested by NHLBI staff if there is a
possibility for an award.
 
o  CHECKLIST - No "Checklist" page is required as part of the initial
application.  A completed Checklist will be requested by NHLBI staff
if there is a possibility for an award.
 
o  FACE PAGE - Currently, the Division of Research Grants requires
that requested costs be reflected on the face page for computer
system tracking purposes.  Because no budgetary information is
required as part of the "streamlined" application, we are requesting
that the following amounts be entered on the face page: 7a. Direct
Costs for Initial Budget Period - $139,000; 7b. Total Costs for
Initial Budget Period - $150,000; 8a. Direct Costs for Proposed
Period of Support - $695,000 and; 8b. Total Costs for Proposed Period
of Support - $750,000. IT IS UNDERSTOOD THAT THESE LEVELS ARE
STRICTLY FOR ADMINISTRATIVE PURPOSES AND THAT ACTUAL AWARD LEVELS ARE
SUBJECT TO NEGOTIATION, PRIOR TO AWARD.
 
The applicant should provide the name and phone number of the
individual to contact concerning fiscal and administrative issues if
additional information is necessary following the initial review.
 
APPLICATIONS NOT CONFORMING TO THESE GUIDELINES WILL BE CONSIDERED
UNRESPONSIVE TO THIS RFA AND WILL BE RETURNED WITHOUT FURTHER REVIEW.
 
Submit a signed, typewritten original of the application and three
signed, photocopies, in one package to:
 
DIVISION OF RESEARCH GRANTS
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express courier service)
 
At the time of submission, two additional copies of the application
must be sent to Dr. Louise Corman, at the address listed under
INQUIRIES.
 
Applications must be received by February 18, 1998.  If an
application is received after this date, it will be returned to the
applicant without review.  The Division of Research Grants (DRG) will
not accept any application in response to this RFA that is
essentially the same as one currently pending initial review, unless
the applicant withdraws the pending application.  The DRG will also
not accept any application that is essentially the same as one
already reviewed.  This does not preclude the submission of
substantial revisions of applications already reviewed, but such
applications must include an introduction addressing the previous
critique.
 
If  an application is determined to be unresponsive to the RFA, the
principal investigator will be notified and the application returned.
 
The following sections are specific cost guidelines that will apply
to those applications selected for award consideration.
 
1. Principal Investigator's Salary
 
The salary for the Principal Investigator (or any other investigator
on the team) must not exceed the actual institutional salary rates
for the effort being devoted to the Academic Award.  In addition,
salary rates must not exceed an annual salary level of $125,000 plus
fringe benefits (a maximum of $50,000 plus fringe benefits for 40
percent effort).  A candidate must devote at least 20 percent effort
and no greater than 40 percent effort to this award.
 
The combined efforts of any individual, Principal Investigator or key
personnel, on the Nutrition Academic Award with any other non-NIH or
NIH-supported grant(s) or contract(s) must not exceed 100 percent.
 
2. Program Support
 
o the applicant should include some percentage of effort for a
multidisciplinary team with sufficient training and experience in
medical education and nutrition needed to develop, implement, and
evaluate high quality curricula.  The team might include health
professionals such as physicians, nutritionists, behavioral
scientists, exercise scientists, or nurses.  The mix of expertise
will be determined by the applicant;
 
o  consumable supplies essential to the proposed program and
education materials are allowable. Office equipment or furniture
costs are not allowable;
 
o  funds for the Principal Investigator to travel and meet with other
investigators and NHLBI staff to exchange ideas and to develop
collaborative projects must be included.  Investigators may be
requested to meet as a group up to three times a year; $1,000 per
trip should be budgeted for this purpose.  One other member of the
team also may be budgeted to attend the meeting if needed;
 
o  funds for educational development to enable the awardee to develop
relevant skills can be included;
 
3.  Facilities and Administrative Costs
 
Awards will be provided for the reimbursement of actual Facilities
and Administrative costs at eight percent of the total direct costs
of each award.
 
4. Conditions of the Award
 
Institutions must provide documentation that the applicant would have
the necessary time and resources to implement the proposed plan.  In
some cases, it may be necessary for the applicant to be relieved of
some responsibilities for the five years of the grant award in order
to implement the proposed plan.
 
An institution is expected to apply on behalf of a named individual
meeting the Principal Investigator criteria for this award.  Only one
application may be submitted from each eligible institution in each
competition. Awards will be limited to one from each eligible school
over the life of the award.  After the first year, grants will be
renewed for a maximum of four years on a noncompetitive basis
depending upon progress in meeting the program's objectives.  An
annual report that summarizes curriculum development at the
institution and other elements of the program plan, and outlines
future plans will be required.  This report will serve as the basis
for renewal of the grant.
 
Awards may not be transferred from one institution to another.  If a
Principal Investigator moves to another institution, the award will
continue at the original institution only upon acceptance by the
National Heart, Lung and Blood Institute of a suitable replacement
proposed by the grantee institution.  Such a replacement will not
lengthen the overall term of the award.
 
REVIEW CONSIDERATIONS
 
Upon receipt, applications will be reviewed for completeness by the
DRG and responsiveness to this RFA by NHLBI.  Incomplete and/or non-
responsive applications will be returned to the applicant without
further consideration.  Applications will be evaluated for scientific
and technical merit by an appropriate peer review group convened by
the Division of Extramural Affairs, NHLBI.
 
As part of the initial merit review, all applications will receive a
written critique and undergo a review in which only those
applications deemed to have the highest scientific merit of the
applications under review (usually two to three times the number of
applications that the NHLBI and participating Institutes anticipate
funding under the program) will be discussed, assigned a priority
score, and receive a second level review by the National Heart, Lung,
and Blood Advisory Council.
 
Review Criteria
 
Applications for this Nutrition Academic Award will be evaluated in
terms of the following criteria:
 
o  qualifications and experience of the Principal Investigator
candidate who must hold an academic position in a medical school at
the Associate or Full Professor rank and key personnel, including
pertinent experience in teaching, curriculum development, program
evaluation, clinical practice, administration, and conducting
research studies;
 
o  plans to develop, improve, and integrate an interdepartmental
curriculum in nutrition with existing institutional training programs
for medical students, graduates, and post-graduates at the
institution and which also could be used at other appropriate health
professional schools;
 
o  plans to evaluate the proposed educational components and overall
program;
 
o  plans for communication and interdepartmental collaboration
between medical specialists in appropriate disciplines to ensure the
development, implementation, and evaluation of optimal educational
programs;
 
o  plans and ability to work cooperatively with other Awardees to
develop innovative and portable curricular materials and modules in
nutrition for adoption at other medical schools and other interested
health professional schools;
 
o  description of the need for this program including the potential
impact of the program on nutrition medical training at the
institution and on medical education in general with a focus on
preventing cardiovascular diseases;
 
o  the magnitude of current programs, curricula and nutrition related
research that exist at the applicant's Institution.  This award is
designed to enhance Institutions that have a base of research and
training in nutrition as well as develop such activities in
Institutions that do not have existing nutrition education programs.
Each applicant should provide a description or table of what
currently exists in curricular activities, nutrition research,
interdepartmental collaborative efforts, and mechanisms to provide
training to other health care professionals;
 
o  institutional commitment to implement the proposed curricular
activities and infrastructure to maintain a program in nutrition
education after the termination of the award.
 
AWARD CRITERIA
 
The anticipated date of award is September 30, 1998.  Factors that
will be taken into consideration in making awards include the
scientific merit of the proposed program, as evidenced by the
priority score, and the availability of funds.  Subject to the
availability of necessary funds and consistent with the objectives of
the Nutrition Academic Award, the NHLBI will provide funds for a
project period up to five years.
 
INQUIRIES
 
Inquiries concerning this RFA are encouraged.  The opportunity to
clarify issues or answer questions from potential applicants is
welcomed.
 
Direct inquiries regarding programmatic issues to:
 
Elaine J. Stone, Ph.D., M.P.H.
Division of Epidemiology and Clinical Applications
National Heart, Lung, Blood Institute
6701 Rockledge Drive, Room 8134, MSC-7936
Bethesda, MD  20892-7936
Telephone:  (301) 435-0382
FAX:  (301) 480-1669
Email: Stonee@gwgate.nhlbi.nih.gov
 
Eva Obarzanek, Ph.D., M.P.H., R.D.
Division of Epidemiology and Clinical Applications
National Heart, Lung, Blood Institute
6701 Rockledge Drive, Room 8136, MSC-7936
Bethesda, MD  20892-7936
Telephone:  (301) 435-0383
FAX:  (301) 480-1669
Email: ObarzanE@gwgate.nhlbi.nih.gov
 
Direct inquiries regarding review matters to:
 
Louise Corman, Ph.D.
Division of Extramural Affairs
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Room 7180, MSC 7924
Bethesda, MD  20892-7924
Telephone:  (301) 435-0270
FAX:  (301) 480-3541
Email: CormanL@gwgate.nhlbi.nih.gov
 
Direct inquiries regarding fiscal matters to:
 
William W. Darby
Chief, Heart and Vascular Diseases
Grants Management Section
National Heart, Lung, and Blood Institute
6701 Rockledge Drive, Room 7140, MSC 7926
Bethesda, MD  20892-7926
Telephone:  (301) 435-0177
FAX:  (301) 480-3310
Email: DarbyW@gwgate.nhlbi.nih.gov
 
AUTHORITY AND REGULATIONS
 
This program is described in the Catalog of Federal Domestic
Assistance No. 93.838.  Grants are made under the authorization of
the Public Health Service Act, Title III, Section 301 (Public Law
78-410, as amended by Public Law 99-158, 42 US 241 and 285) and
administered under PHS grants policies and Federal Regulations 42 CFR
52 and 45 CFR Part 74.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or to
a review by a Health Systems Agency.
 
The PHS strongly encourages all grant recipients to provide a smoke-
free workplace and promote the non-use of all tobacco products.  In
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits
smoking in certain facilities (or in some cases, any portion of a
facility) in which regular or routine education, library, day care,
health care or early childhood development services are provided to
children.  This is consistent with the PHS mission to protect and
advance the physical and mental health of the American people.
 
REFERENCES
 
American Medical Student Association, Nutrition Curriculum Project.
Essentials of nutrition education in medical schools: a national
consensus.  Acad Med 1996;71(9):969-971.
 
Bruer RA, Schmidt RE, David H.  Commentary: nutrition counseling--
Should physicians guide their patients?  Am J Prev Med
1994;10(5):308-311.
 
Committee on Nutrition in Medical Education, National Research
Council.  Nutrition education in U.S. medical schools.  Washington,
DC: National Academy Press, 1985.
 
Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults. Summary of the Second Report of the National
Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
Treatment Panel II).  JAMA 1993;269:3015-3023.
 
Hark LA, Iwamoto C, Melnick DE, Young EA, Morgan SL, Kushner R,
Hensrud DD.  Nutrition coverage on medical licensing examinations in
the United States.  Am J Clin Nutr 1997;65:568-571.
 
Hunt JR, Kristal AR, White E, Lynch JC, Fries E.  Physician
recommendations for dietary change: their prevalence and impact in a
population-based sample.  Am J Public Health 1995;85:722-726.
 
Krauss RM, Deckelbaum RJ, Ernst N, Fisher E, Howard BV, Knopp RH,
Kotchen T, Lichtenstein AH, McGill HC, Pearson TA, Prewitt TE, Stone
NJ, Van Horn L, Weinberg R. Dietary guidelines for healthy American
adults.  A statement for health professionals from the Nutrition
Committee, American Heart Association.  Circulation
1996;94:1795-1800.
 
Morrison G, Hark L.  Medical Nutrition and Disease.  Blackwell
Science: Philadelphia 1996.
 
National Heart, Lung, and Blood Institute.  Report of the Task Force
on Research in Epidemiology and Prevention of Cardiovascular
Diseases.  Washington, DC: USDHHS, NIH, NHLBI 1994.
 
National High Blood Pressure Education Program.  Working Group Report
on Primary Prevention of Hypertension.  National Heart, Lung, and
Blood Institute, National Institutes of Health.  USDHHS, NIH
Publication No. 93-2669, 1993.
 
National Research Council.  Diet and Health: Implications for
Reducing Chronic Disease Risk, National Academy Press: Washington,
DC, 1989.
 
Ockene IS, Herbert JR, Ockene JK, Merriam PA, Hurley TG, Gordon MS.
Effect of training and a structured office practice on physician-
delivered nutrition counseling: The Worcester-Area Trial for
Counseling in Hyperlipidemia (WATCH).  Am J Prev Med
1996;12(4):252-258.
 
Pearson TA, McBride PE, Miller NH, Smith SC.  Organization of
preventive cardiology services: Task Force 8 Bethesda Conference
Report.  JACC 1996;27(5):1039-1047.
 
Schucker B, Wittes JT, Santanello NC, Weber SJ, McGoldrick D, Donato
K, Levy A, Rifkind BM.  Change in cholesterol awareness and action.
Results from national physician and public surveys.  Arch Intern Med
1991;151:666-673.
 
Tobin BW.  Nutrition in the basic medical sciences curriculum.
Nutrition Today 1997;32(2):54-62.
 
US Department of Health and Human Services.  Surgeon General's Report
on Nutrition and Health.  USDHHS, Public Health Service, DHHS (PHS)
Publication No. 88-50210, Washington, DC, 1988, p. 4.
 
US Department of Agriculture and US Department of Health and Human
Services.  Nutrition and Your Health: Dietary Guidelines for
Americans.  Home and Garden Bulletin No. 232, 1995.
 
US Department of Health and Human Services.  Healthy People 2000:
National health promotion and disease prevention objectives.
Washington, DC: US GPO, DHHS Pub. No. 93-1332, 1991.
 
US Preventive Services Task Force.  Guide to clinical preventive
services, 2nd ed.  Baltimore: Williams and Wilkins, 1996.
 
Winick M.  Nutrition education in medical schools.  Am J Clin Nutr
1993;58:825-827.
 
Zimmermann M, Kretchmer N.  Isn't it time to teach nutrition to
medical students?  Am J Clin Nutr 1993;58:828-829.
 
.

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