NUTRITION ACADEMIC AWARD Release Date: February 19, 1999 RFA: HL-98-016 P.T. National Heart, Lung, and Blood Institute National Institute of Diabetes and Digestive and Kidney Diseases Letter of Intent Receipt Date: March 18, 1999 Application Receipt Date: June 11, 1999 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), obesity, diabetes, and other chronic diseases. 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). It also may also be found at: http://www.crisny.org/health/us/health7.html. 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 clinical nutrition, emphasizing cardiovascular disease prevention, obesity, and diabetes, 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 (K07) 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 $50,360 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 (indirect costs) may not exceed 8 percent. It is anticipated that support for this program will begin April 1, 2000. 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. If the possibility of an award exists following the initial review, the Budget, Other Support, and Checklist information will be requested by NHLBI staff. FUNDS AVAILABLE It is anticipated that in fiscal year 2000, support will be available for total costs of approximately $1,050,000 and that approximately seven grants will be awarded under this program. The actual number of awards each year will depend upon the merit and scope of the applications received and the availability of funds. Because the nature and scope of the research proposed may vary, it is anticipated that the size of each award will also vary. Although the financial plans of the IC(s) provide support for this program, awards pursuant to this RFA are contingent upon the availability of funds and the receipt of a sufficient number of applications of outstanding scientific and technical merit. RESEARCH 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 diseases, obesity, diabetes, 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; National Heart, Lung, and Blood Institute, 1998). 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, obesity, diabetes, and other chronic diseases 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 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, obesity, diabetes, and other chronic disease 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 chronic diseases. 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 chronic disease 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, obesity, and diabetes 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). 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. INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS It is the policy of NIH that children (i.e., individuals under the age of 21) must be included in all human subjects research, conducted or supported by the NIH, unless there are scientific and ethical reasons not to include them. This policy applies to all initial (Type 1) applications submitted for receipt dates after October 1, 1998. All investigators proposing research involving human subjects should read the "NIH Policy and Guidelines" on the Inclusion of Children as Participants in Research Involving Human Subjects that was published in the NIH Guide for Grants and Contracts, March 6, 1998, and is available at the following URL address: http://grants.nih.gov/grants/guide/notice-files/not98-024.html Although the Nutrition Academic Award is not primarily a mechanism to support research, medical students and residents are likely to 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 March 18, 1999, 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 and NIDDK 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. C. James Scheirer at the address listed under INQUIRIES. APPLICATION PROCEDURES Applications are to be submitted on the grant application form PHS 398 (rev. 4/98). These forms are available at most institutional offices of sponsored research and from the Division of Extramural Outreach and Information Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892-7910, telephone (301) 710-0267, Email: GrantsInfo@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 HL-98-016." Sample budgets and justification page will be provided upon request or following the submission of a letter of intent. The instructions described in the Career Award Section of the PHS 398 (rev. 4/98) must be followed when preparing an application in response to this RFA. Applications that do not conform to the instructions in the Career Award section of the PHS 398 (rev 4/98) will be considered unresponsive to this RFA and will be returned without further review. 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. Submit a signed, typewritten original of the application and three signed, photocopies, in one package to: CENTER FOR SCIENTIFIC REVIEW 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. James Scheirer, at the address listed under INQUIRIES. Applications must be received by June 11, 1999. If an application is received after this date, it will be returned to the applicant without review. CSR 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 CSR 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 $125,900 plus fringe benefits (a maximum of $50,360 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, exercise scientists, behavioral 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, NHLBI, and NIDDK 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 or the National Institute of Diabetes and Digestive and Kidney Diseases 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 CSR and responsiveness to this RFA by NHLBI and NIDDK. 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 NIDDK 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, obesity, diabetes, and other chronic 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. Schedule Letter of Intent Receipt Date: March 18, 1999 Application Receipt Date: June 11, 1999 Review by NHLBI Council: February 10, 2000 Anticipated Award Date: April 1, 2000 AWARD CRITERIA The anticipated date of award is April 1, 2000. 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 and NIDDK 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 Judith M. Podskalny, Ph.D. Division of Digestive Diseases and Nutrition National Institute of Diabetes and Digestive and Kidney Diseases 45 Center Drive, Room 6AN-12E, MSC 6600 Bethesda, MD 20892-6600 Telephone: (301) 594-8876 FAX: (301) 480-8300 Email: jp53s@nih.gov Direct inquiries regarding review matters, address the letter of intent and mail two copies of the completed application to: C. James Scheirer, Ph.D. Division of Extramural Affairs National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 7220, MSC 7924 Bethesda, MD 20892-7924 Telephone: (301) 435-0266 FAX: (301) 480-3541 Email: js110@nih.gov Direct inquiries regarding fiscal matters to: Marie A. Willett Grants Operation Branch National Heart, Lung, and Blood Institute 6701 Rockledge Drive, Room 7156, MSC 7926 Bethesda, MD 20892-7926 Telephone: (301) 435-0144 FAX: (301) 480-3310 Email: Marie_Willett@nih.gov Nancy Dixon Grants Management Branch National Institute of Diabetes and Digestive and Kidney Diseases 45 Center Drive, MSC 6600 Bethesda, MD 20892-6600 Telephone: (301) 594-8854 FAX: (301) 480-3504 Email: dixonn@extra.niddk.nih.gov AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance No. 93.837. 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 Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults the evidence report. Obes Res 1998;6:51S-210S. 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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