This document provides an overview of the Friedman School of Nutrition Science & Policy at Tufts University. It discusses the school's academic programs and research focuses, which include areas like global food security, public health and nutrition, and biochemical and molecular nutrition. The document also outlines the school's research centers and facilities, including the Jean Mayer USDA Human Nutrition Research Center on Aging. It notes the school is ranked #1 for nutrition research and has field-based research programs around the world. The dean discusses opportunities for future growth in areas like climate change and sustainability, food systems policy, and community intervention science.

1. Dariush Mozaffarian, MD DrPH
Dean, Friedman School of Nutrition Science & Policy
Jean Mayer Chair in Nutrition
San Francisco, California
September 17, 2015
This is Nutrition’s Time
A Conversation with the Dean

2. Friedman School of Nutrition Science & Policy
• Friedman School of Nutrition Science & Policy: www.nutrition.tufts.edu
• Academic Programs: Agriculture, Food, & Environment; Biochemical & Molecular
Nutrition; Food Policy & Applied Nutrition; Humanitarian Assistance; Nutrition
Communication & Behavior Change; Nutritional Epi; MS Dietetics Internship.
• Hybrid/Online Programs: MNSP Blended Learning; Online Graduate Certificates –
nutrition for health professionals, communications, community interventions, international
delivery science, sustainable food systems.
Outreach and Public Impact:
• Child Obesity 180: www.childobesity180.org
• Feinstein International Center: fic.tufts.edu
• Global Nutrition and Policy Consortium: www.globaldietarydatabase.org
• New Entry Sustainable Farming Project: www.nesfp.org
• Nutrition Innovation Lab: www.nutritioninnovationlab.org
• Tufts Health & Nutrition Letter: www.nutritionletter.tufts.edu
• Tufts Nutrition Magazine: www.nutrition.tufts.edu/publications/magazine

3. Tufts-USDA Research Center on Aging
• Jean Mayer USDA Human Nutrition Research Center on Aging www.hnrca.tufts.edu
Research Programs:
• Antioxidants
• Body Composition
• Bone Metabolism
• Cardiovascular Nutrition
• Energy Metabolism
• Neuroscience and Aging
• Nutrition & Cancer Biology
• Nutritional Epidemiology
• Nutrition, Exercise, Phys. & Sarcopenia
• Nutritional Genomics
• Nutritional Immunology
• Nutrition & Vision
• Obesity Metabolism
• Vascular Biology
• Vitamins & Carcinogenesis
• Vitamin K
• Vitamin Metabolism
Core Units:
• Biostatistics
• Comparative Biology
• Dietary Assessment
• Mass Spectrometry
• Metabolic Research
• Nutrition Evaluation
Four research clusters: hnrca.tufts.edu/research/research-clusters
Boston Claude D. Pepper Older Americans Independence Center: bostonpettppercenter.org
Boston Nutrition Obesity Research Center: bnorc.org
Outreach and Public Impact:
International Obesity Consortium: www. hnrca.tufts.edu/iocabout
Fit4Life Program: www. tufts.edu/fit-4-life-program
Talk and Taste: www. tufts.edu/events/talk-and-taste
MyPlate for Older Adults: www.my-plate-for-older-adults/

4. The Friedman School – Fast Facts
• 81 primary faculty, 89 associated faculty/adjuncts
• 354 graduate students, 1600+ alumni
• 8 academic programs, 6 combined degree programs
• 6 online programs: 1 MS, 5 certificate programs
• Field-based research in the US and around the world, e.g. Afghanistan,
Bangladesh, Bolivia, Burkina Faso, Cambodia, Egypt, Ethiopia, Haiti, Honduras,
India, Kenya, Malawi, Mozambique, Nepal, Niger, Somalia, Sudan, Turkey,
Uganda, Zambia etc.
• Ranked #1 overall and #1 for research activity among 45 major US
nutrition PhD programs by the National Research Council, National
Academies

5. Areas of Academic Strength
• Agriculture and food systems
• Global food security
• Public health and community nutrition
• Media and communications
• Biochemical and molecular nutrition
• Healthy aging
• Humanitarian crises and livelihoods
• Nutrition policy and economics
• Global chronic diseases

6. Areas for Future Academic Growth
• Climate change, agricultural systems, sustainability
• Water and security
• Food systems, policy analysis, regulations, legislation
• Computational methods, modelling, ‘big data’
• Global chronic diseases
• Community intervention, behavior change,
implementation science.
• Food industry, big business, marketing
• Microbiome, bioactives

7. Nutrition and Health
US Burden of Disease
Collaborators, JAMA 2013

8. Nutrition and the Environment
http://rainforests.mongabay.com/0803.htm

9. Nutrition and the Economy
Source: World Economic Forum, 2011

10. Nutrition: Passion and Confusion
Source: Google images

11. Diet & Obesity/Diabetes: Conventional Wisdom
Energy In
(Intake)
Obesity
Total Fat
Energy Density
Energy Out
(Expenditure)
“Calories In,
Calories Out"
Type 2 Diabetes
Added Sugars

12. Calorie/Fat Focus Dominates Current Policy
• Dietary Guidelines: Extensive focus on “portion sizes”,
“calorie control,” “low-fat”, “lean” choices.
• Affordable Care Act (Obamacare): Mandated total calorie
labeling on restaurants menus nationwide.
• UK Front-of-Pack: Total calories, total fat are first two items.
• US FDA: Proposed emphasis on total calories in Nutrition
Facts; violations to nut-rich “Kind” bars for being “high-fat.”
• National School-Lunch Program: Banned whole milk, allows
sugar-sweetened skim milk.
• NIH Dietary Guidelines For Kids: Recommend fat-free salad
dressing, diet soda, trimmed beef; caution for eggs, vegetables
with added fat, whole milk, nuts, tuna in oil.

13. Explosion of Nutrition Science
Source: Pubmed/Medline
NumberofScientific
Publications

14. Diet & Obesity/Diabetes: Modern Science
Energy In
(Intake)
Obesity
Energy Out
(Expenditure)
Type 2 Diabetes
Foods / Diet Quality :
Carbohydrate Quality
Nuts, Fruits, Vegetables, Yogurt, Cheese
Meats, Specific Fats and Oils
Overall Diet Patterns

15. Diet & Health: Modern Science
Blood Pressure
Glucose-Insulin Homeostasis
Liver Fat Synthesis
Blood Lipids, Apolipoproteins
Endothelial Function
Systemic Inflammation
Brain Reward, Craving
Gut Microbiome
Satiety, Hunger, Obesity
Adipocyte Function
Cardiac Function
Thrombosis, Coagulation
Vascular Adhesion
Refined Grains, Starches, Sugars
Fruits, Vegetables, Nuts
Whole grains, Beans
Yogurt, Cheese, Milk
Fish, Shellfish
Processed Meats, Red Meats
Vegetable Oils, Specific Fatty Acids
Coffee, Tea, Alcohol
Sugary Drinks, Juice
Minerals, Antioxidants, Phenolics,
Phytochemicals
Food-Based Dietary Patterns
Food Processing, Preparation
Methods
Mozaffarian D, in preparation

16. • Hunger, fullness
• Glucose, insulin, other hormonal responses
• Liver de novo fat synthesis (conversion of
starch and sugar to fat)
• Brain reward, craving
• Gut microbiome (bacteria) responses
• Body’s metabolic rate (energy out)
Foods and Obesity: Complex Influences
e.g., Browning AJCN 2011; Ebbeling JAMA 2012;
Poutahidis Plos ONE 2013; Lennerz AJCN 2013; Ludwig JAMA 2014
All Calories
are Not
Created Equal

17. Average Sources of Calories in the US Diet
Sat fat
Mono fat
Poly fat
Trans fatProtein
Other carbs
Potatoes
Whole grain
Refined grain
Added sugar

18. Mozaffarian D. Curr Athero Reports 2005
► Whole grain content
► Fiber content
► Glycemic response
► Food structure
Carbohydrate Quality: How To Define Simply?

19. • Different recommendations:
– Industry-sponsored “whole grain stamp”
– Three USDA definitions, each using the
ingredients list
– Ratio of total carb to fiber per serving (AHA)
• Best : Ratio of total carb to fiber
> 10:1 = Avoid
< 10:1 = A good choice (many options)
< 5:1 = A great choice (fewer options)
Choosing Carbs: Best Rule of Thumb ?
Mozaffarian RS et al, Public Health Nutr 2013

20. Grains and Sugars: What's The Healthy Choice ?

21. Benefit
Harm
Fruits, Nuts, Fish
Vegetables, Vegetable Oils
Processed Meats, High Sodium Foods
Cheese
Industrial Trans Fat
Refined Grains, Starches, Sugars
Whole Grains, Beans, Yogurt
Eggs, Poultry, Milk
Unprocessed Red Meat
Mozaffarian D,
In preparation
Dietary Priorities: Healthy Food Patterns

22. And what about … ?
• Gluten-free
• Organic
• Local
• Paleo
• Low-carb
• Vegetarian, vegan
• Mediterranean

23. Preventing Chronic Diseases: Food Patterns

24. Why Our Infatuation with Single Nutrients?
• In 1753, James Lind tested whether eating citrus fruits prevented scurvy.
• In 1932, Vitamin C isolated, confirmed as the active protective nutrient.
One nutrient → one disease!
• Soon: Thiamine (beriberi), niacin (pellagra), iron (anemia),
iodine (goiter), vitamin A (night blindness), vitamin D (rickets).
• Early 20th century dietary guidelines thus focused on preventing nutrient deficiency
diseases. Great Depression and World War II food shortages → further emphasis.
• The League of Nations, British Medical Association, and USDA formed panels to
create new minimum requirements for calories, protein, calcium, phosphorus, iron, and
various vitamins → First RDAs in 1941.
• Modern dietary guidelines were developed to meet these new RDAs. Set precedent
to start with nutrient targets and then translate these into food recommendations.
Mozaffarian & Ludwig. JAMA 2010

25. Nutrient Focus: Recipe for Confusion
www.nhlbi.nih.gov/health/public/heart/obesity/wecan/downloads/go-slow-whoa.pdf

26. Nutrient Focus: Recipe for Manipulation
• Low calorie = “Less weight
gain”
• Fat free = “Healthy"
• Low saturated fat = "Healthy"

27. Calories, Fat, Single Nutrients: Misleading

28. Nutrition: Passion and Confusion
Source: Google images

29. Barriers and Opportunities for Healthy Eating
Afshin A et al, The Handbook for Global Health Policy, 2014

30. Brain craving/reward is plastic
Deckersbach et al. Nutr Diabetes 2014
• 6-month randomized trial
• Training to reduce hunger;
devalue associations between
unhealthy food and brain reward;
& reinforce associations between
healthy food and brain reward.
Healthy
Food
Unhealthy
Food
Healthy -
Unhealthy

31. Dietary Policy Priorities
• National tax and subsidy framework to reflect the real costs of
food.
• Strong health-aligned incentives in all food assistance programs.
• Industry incentives (and discentives) to develop and market
healthier foods.
• Comprehensive school and workplace wellness programs.
• Quality standards on salt and trans fat; marketing to children.
• Long-term agricultural policies for production, storage,
transport, and sales of healthier foods.
• Modernize dietary guidelines to match the science.
AHA Scientific Statement: Population Approaches to Improve Diet, Physical
Activity, and Smoking Habits. Mozaffarian et al., Circulation 2012

32. The Real Cost of Food – Dietary Taxes
and Subsidies to Improve Public Health
Mozaffarian, Rogoff, & Ludwig, JAMA 2014
Packaged and supermarket
foods
Restaurant and other food
service establishments
Simple Flat Tax
(10 to 30%)
Most packaged foods (e.g.,
nearly all foods with a label).
Most chain restaurants, large
cafeteria vendors, and other
similar food service
establishments.
Subsidy
(from tax revenue)
Minimally processed healthful
foods, such as fruits, nuts,
vegetables, beans, seafood,
plain yogurt, vegetable oils,
and minimally processed
whole grains.
School lunch and afterschool
programs.

33. Penalvo et al., Spring AHA 2015 (abstract)
Percent Reduction in US Cardiometabolic Deaths
Attributable to a 10% Subsidy or Tax
• 10% price change in 7 foods would reduce cardiometabolic mortality by 4.95%.
• 30% price change would prevent 86,000 cardiometabolic deaths, 14.2% of such deaths.
Also 10% tax on
processed meats,
red meats

34. Lessons From Past Public Health Successes
US Centers for Disease Control and Prevention, MMWR Morb Mortal Wkly Rep, 1999

35. Lessons From Past Public Health Successes
Adapted from Mozaffarian, Hemenway, & Ludwig, JAMA 2013

36. John Snow, London Cholera Epidemic, 1854
Snow, J. On the Mode of Communication of Cholera, C.F. Cheffins, London 1855

37. Dariush.Mozaffarian@Tufts.edu
Twitter: @DMozaffarian
www.nutritionletter.tufts.edu