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class="section-jump-link head-1" link-destination="406623716"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623716">Abstract</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623718"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623718">Lay Summary</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623722"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623722">INTRODUCTION</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623729"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623729">OPPORTUNITY 1. ADVANCE CONSIDERATION OF IMPLEMENTATION AND DISSEMINATION EARLY IN THE DESIGN OF INTERVENTIONS TO FACILITATE OPPORTUNITIES FOR EQUITABLE SCALE-UP AND SUSTAINABILITY OF EBIs</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623733"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623733">OPPORTUNITY 2. DEVELOP AND TEST STRATEGIES FOR EQUITABLE IMPLEMENTATION OF NUTRITION AND DIET EBIs IN HEALTH CARE AND COMMUNITY SETTINGS</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623739"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623739">OPPORTUNITY 3. BUILD AND STRENGTHEN THE INFRASTRUCTURE, CAPACITY, AND EXPERTISE NEEDED TO INCREASE USE OF IS IN CLINICAL AND COMMUNITY NUTRITION RESEARCH TO SWIFTLY MOVE THE RESEARCH INTO PRACTICE</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623743"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623743">CONCLUSION</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623745"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623745">Funding</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623747"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623747">Acknowledgments</a> </div> </li> <li class="section-jump-link head-1" link-destination="406623749"> <div class="section-jump-link__link-wrap"> <a class="js-jumplink scrollTo" href="#406623749">Compliance with Ethical Standards</a> </div> </li> <li 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class="navbar-search-advanced"><a href="/tbm/advanced-search" class="advanced-search js-advanced-search">Advanced Search</a></div> </div> <div class="navbar-search-collapsed"><a href="javascript:;" class="icon-menu_search js_expand-navsearch"><span class="screenreader-text">Search Menu</span></a></div> </div> </div> <input id="routename" name="RouteName" type="hidden" value="tbm" /> </div> </div> </div> </div> <div id="ContentTab" class="content active"> <div class="widget widget-ArticleFulltext widget-instance-OUP_Article_FullText_Widget"> <div class="module-widget"> <div class="widget-items" data-widgetname="ArticleFulltext"> <h2 scrollto-destination=406623716 id="406623716" class="abstract-title js-splitscreen-abstract-title" >Abstract</h2> <section class="abstract"><p class="chapter-para">Despite population-wide recommendations by the U.S. <em>Dietary Guidelines for Americans</em> and others to encourage health-promoting dietary patterns, the proportion of Americans following dietary recommendations remains low. The gaps in the adoption and integration of evidence-based dietary interventions, practices, programs, and policies (EBIs) into community and clinical settings signal the need to strengthen efforts in implementation science (IS) in nutrition research to understand and alleviate barriers to adopting and sustaining healthy dietary behaviors and practices. Equally important is the translation of this research into practice in a variety of settings and across the diversity of populations. Recognizing this need, the U.S. National Institutes of Health (NIH) 2020–2030 Strategic Plan for NIH Nutrition Research calls for the expansion of IS as a key opportunity to advancing nutrition research. This commentary highlights three scientific opportunities to stimulate IS in nutrition research and provides examples for each opportunity. These include: (a) Advance consideration of implementation and dissemination early in the design of interventions to facilitate opportunities for equitable scale-up and sustainability of EBIs, (b) Develop and test strategies for equitable implementation of nutrition and diet EBIs in health care and community settings, and (c) Build and strengthen the infrastructure, capacity, and expertise needed to increase use of IS in clinical and community nutrition research to swiftly move the research into practice. By advancing the three opportunities identified in this commentary, the scientific community has the potential to advance the field of nutrition research and IS with the ultimate goal of improving public health.</p></section> <div class="article-metadata-panel clearfix at-ArticleMetadata"></div> <div class="lay-summary"> <h2 scrollto-destination=406623718 id="406623718" class="abstract-title js-splitscreen-abstract-title" >Lay Summary</h2> <section class="abstract"><p class="chapter-para">While dietary guidelines have proven effective in clinical studies, most Americans do not follow these tested guidelines. More work is needed to bring research into practice so that all populations can benefit from the research. The U.S. National Institutes of Health recognizes this need and highlights it as a key opportunity in its 2020–2030 Strategic Plan for NIH Nutrition Research. This commentary describes three scientific opportunities that can help to stimulate the research needed to move research into practice, toward the ultimate goal of improving public health.</p></section> </div> <div id="B1" class="boxed-text boxed-matter"><div class="caption caption-id-"><div class="title">Implications</div></div><div class="clearfix"></div><p class="chapter-para"><strong>Practice:</strong> To swiftly move research into practice, it will be necessary to build and strengthen the infrastructure, capacity, and expertise needed to increase the use and understanding of implementation science in clinical and community nutrition.</p><p class="chapter-para"><strong>Policy:</strong> Implementation science can help advance the movement of diet and nutrition research to practice and policy.</p><p class="chapter-para"><strong>Research:</strong> Future research should consider implementation early in the design of interventions and could develop and test strategies for equitable implementation of nutrition and diet evidence-based interventions in health care and community settings.</p></div> <h2 scrollto-destination=406623722 id="406623722" class="section-title js-splitscreen-section-title" data-legacy-id=s1>INTRODUCTION</h2> <p class="chapter-para">Significant gaps exist between discovery and broad adoption of healthy dietary approaches. For example, over the past 20 years, numerous studies have revealed the health benefits of increasing the consumption of fruits and vegetables [<span class="xrefLink" id="jumplink-CIT0001 CIT0002 CIT0003 CIT0004"></span><a href="javascript:;" reveal-id="CIT0001 CIT0002 CIT0003 CIT0004" data-open="CIT0001 CIT0002 CIT0003 CIT0004" class="link link-ref link-reveal xref-bibr">1–4</a>]; however, population-wide intakes of fruits and vegetables in the USA are still far lower than the 2 cups of fruit and 2.5 cups of vegetables recommended by the <em>Dietary Guidelines for Americans</em> (2,000 calorie diet) [<span class="xrefLink" id="jumplink-CIT0005"></span><a href="javascript:;" reveal-id="CIT0005" data-open="CIT0005" class="link link-ref link-reveal xref-bibr">5</a>]. Despite dietary interventions proven to improve health and reduce disease risk through rigorous trials (e.g., Dietary Approaches to Stop Hypertension trial [<span class="xrefLink" id="jumplink-CIT0006"></span><a href="javascript:;" reveal-id="CIT0006" data-open="CIT0006" class="link link-ref link-reveal xref-bibr">6</a>], Prevención con Dieta Mediterránea (PREDIMED) [<span class="xrefLink" id="jumplink-CIT0007"></span><a href="javascript:;" reveal-id="CIT0007" data-open="CIT0007" class="link link-ref link-reveal xref-bibr">7</a>]), these diets have not been widely adopted or implemented in clinical and community practice in a way that can impact population health. To advance equitable uptake of evidence-based interventions, practices, programs, and policies (EBIs) that promote sustainable dietary behavior changes, considerations for scaling up and implementation must occur throughout the intervention development and testing process as well as in the delivery of interventions in clinical and community practice, as described in published frameworks and systematic reviews [<span class="xrefLink" id="jumplink-CIT0008 CIT0009 CIT0010 CIT0011"></span><a href="javascript:;" reveal-id="CIT0008 CIT0009 CIT0010 CIT0011" data-open="CIT0008 CIT0009 CIT0010 CIT0011" class="link link-ref link-reveal xref-bibr">8–11</a>].</p><p class="chapter-para">This goal for population health can be potentially achieved through efforts in implementation science (IS), the study of methods to promote the adoption and integration of EBIs into routine health care and public health settings to improve the impact on population health [<span class="xrefLink" id="jumplink-CIT0012"></span><a href="javascript:;" reveal-id="CIT0012" data-open="CIT0012" class="link link-ref link-reveal xref-bibr">12</a>]. With support from the U.S. National Institutes of Health (NIH), the IS field, particularly regarding cancer, mental health, HIV, and cardiometabolic diseases, has made significant advances in recent years through research and capacity building funding opportunities, conferences including the Annual Conference on the Science of Dissemination and Implementation in Health, trainings, textbooks, and publications [<span class="xrefLink" id="jumplink-CIT0013 CIT0014 CIT0015 CIT0016"></span><a href="javascript:;" reveal-id="CIT0013 CIT0014 CIT0015 CIT0016" data-open="CIT0013 CIT0014 CIT0015 CIT0016" class="link link-ref link-reveal xref-bibr">13–16</a>]. Across public health research, for example, IS has been employed to identify barriers and facilitators to improving antibiotic use [<span class="xrefLink" id="jumplink-CIT0017"></span><a href="javascript:;" reveal-id="CIT0017" data-open="CIT0017" class="link link-ref link-reveal xref-bibr">17</a>], appropriate strategies for implementing smoking cessation interventions [<span class="xrefLink" id="jumplink-CIT0018"></span><a href="javascript:;" reveal-id="CIT0018" data-open="CIT0018" class="link link-ref link-reveal xref-bibr">18</a>], and factors that influence the implementation of recovery-oriented mental health services [<span class="xrefLink" id="jumplink-CIT0019"></span><a href="javascript:;" reveal-id="CIT0019" data-open="CIT0019" class="link link-ref link-reveal xref-bibr">19</a>]. For nutrition research, IS can improve our understanding of barriers and opportunities for development of strategies for implementing EBIs, such as breastfeeding and the provision of fruits and vegetables in schools [<span class="xrefLink" id="jumplink-CIT0020"></span><a href="javascript:;" reveal-id="CIT0020" data-open="CIT0020" class="link link-ref link-reveal xref-bibr">20</a>, <span class="xrefLink" id="jumplink-CIT0021"></span><a href="javascript:;" reveal-id="CIT0021" data-open="CIT0021" class="link link-ref link-reveal xref-bibr">21</a>], to promote healthy dietary behaviors, practices, and policies. Equally important is the translation of this research into practice so that health care providers, patients, families, caregivers, and communities are equipped with tools to adapt and sustain successful nutrition practices.</p><p class="chapter-para">Recognizing this need, the 2020–2030 Strategic Plan for NIH Nutrition Research (SPNR) calls for expanding IS as a key opportunity to advance nutrition research [<span class="xrefLink" id="jumplink-CIT0022"></span><a href="javascript:;" reveal-id="CIT0022" data-open="CIT0022" class="link link-ref link-reveal xref-bibr">22</a>]. The first NIH-wide strategic plan for nutrition research was developed with extensive input from the nutrition science community, practitioners, the public, and others, and identifies cross-cutting and innovative opportunities to advance the field. The plan is organized around four Strategic Goals, with specific objectives tied to each goal that represent gaps and opportunities for nutrition scientists. Each objective identifies extensive and interdisciplinary areas of research that are unlikely to be addressed by one research group or project alone.</p><p class="chapter-para">The SPNR emphasizes a multifaceted approach that spans basic science to clinical discovery and seeks to promote innovative research approaches to ensure equitable distribution in the benefits of research findings across diverse populations and settings. Consequently, IS in diet and nutrition research has a set of models and approaches that can be leveraged to realize the goals and objectives across the SPNR (<span class="xrefLink" id="jumplink-F1"></span><a href="javascript:;" data-modal-source-id="F1" class="link xref-fig">Fig. 1</a>). Precision nutrition, the unifying theme of the SPNR, is dynamic, requiring translation and delivery of nutrition science into meaningful, clinically relevant solutions for individuals and population subgroups.</p> <a id="406623727" scrollto-destination="406623727"></a> <div data-id="f1" data-content-id="f1" class="fig fig-section js-fig-section" swap-content-for-modal="true"><div class="graphic-wrap"><img class="content-image" src="https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/tbm/13/1/10.1093_tbm_ibac066/4/m_ibac066_fig1.jpeg?Expires=1735766945&Signature=hIdn-6EIpr4x0Zn4qpsBwostLRj2PCbUY5c6OW~0APPVTJOLzqA2cwKuQf9-qfXyi~gR9JR4EdwlVXugNRypwBAToeAxbCopcSs91VqHqYJGntC4OfUJjCfXhOo5gByXGPaN2J3b16OP9r-MNZ6wl3L14WunXAbWy4XMcmSlb~4xpvHzxmRTGyudM0XCjjvd8Q1~EzKaauPBpJUp8KgOkwvAW6I8U0JWAE53-LBGGzRHggS6lCHGDLbv3JAwJJmTvVtGpJvfe~crDkqkxn8Mjc9VJDJ1UsU2Wv8ROl~HlUV2mt2Tm8TCxJPn3wtPBffGY2S49i10AoFWSoq-k4ivgQ__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA" alt="Unifying vision, goals, and cross-cutting research areas emphasized in the 2020–2030 Strategic Plan for NIH Nutrition Research (SPNR) (previously published in [22]). Discoveries in all areas of the SPNR’s four goals (large circles), five cross-cutting themes (small dots), and unifying vision of precision nutrition will require an IS approach to bring them into practice and to ensure equitable distribution in the benefits of research findings across diverse populations and settings." data-path-from-xml="ibac066_fig1.jpg" /><div class="graphic-bottom"><div class="label fig-label" id="label-406623727">Fig 1</div><div class="caption fig-caption"><p class="chapter-para">Unifying vision, goals, and cross-cutting research areas emphasized in the 2020–2030 Strategic Plan for NIH Nutrition Research (SPNR) (previously published in [<span class="xrefLink" id="jumplink-CIT0022"></span><a href="javascript:;" reveal-id="CIT0022" data-open="CIT0022" class="link link-ref link-reveal xref-bibr">22</a>]). Discoveries in all areas of the SPNR’s four goals (large circles), five cross-cutting themes (small dots), and unifying vision of precision nutrition will require an IS approach to bring them into practice and to ensure equitable distribution in the benefits of research findings across diverse populations and settings.</p></div><div class="ajax-articleAbstract-exclude-regex fig-orig original-slide figure-button-wrap"><a class="fig-view-orig js-view-large at-figureViewLarge openInAnotherWindow" role="button" aria-describedby="label-406623727" href="/view-large/figure/406623727/ibac066_fig1.jpg" data-path-from-xml="ibac066_fig1.jpg" target="_blank">Open in new tab</a><a class="download-slide" role="button" aria-describedby="label-406623727" data-section="406623727" href="/DownloadFile/DownloadImage.aspx?image=https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/tbm/13/1/10.1093_tbm_ibac066/4/ibac066_fig1.jpeg?Expires=1735766945&Signature=NP89b7n4Dk2lYq8o8AkDTs3KeZUxYJYdrKuVOgOZRw6jzQfuoTbmiHUF4yFJdGgQ30xImZ7ezBRyos5dcV1M10qax8FniLeLWR-TMJzcu3Z8XGgwHeYKiGym97U076U3OBG3aFMIHSwj7t5lSDkPx9Klg6AoQBenXvc2aaHv~A8dOhuYZDkFApUCpngE3YDSkhFUgHSPT2jfMS3C4anbON7zidQqLK5r~0fDInkxZ8mq1fp2NReppksUBIdrHbyLaYlfjqtNxl6-zuzJCZ3bcO1sCJ3MrIBaRIaZK8ZxruCTi-kF9cRCSCUr9dJAifPePprhzd4FYgKw-IHDtjE0NA__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA&sec=406623727&ar=6825356&xsltPath=~/UI/app/XSLT&imagename=&siteId=6132" data-path-from-xml="ibac066_fig1.jpg">Download slide</a></div></div></div></div><p class="chapter-para">This commentary highlights three scientific opportunities related to IS that, if realized, would serve to advance nutrition research and implement the priorities of the SPNR. These opportunities and examples were developed by the NIH SPNR Implementation of Nutrition-related Programs, Practices, and Behaviors Implementation Working Group [<span class="xrefLink" id="jumplink-CIT0023"></span><a href="javascript:;" reveal-id="CIT0023" data-open="CIT0023" class="link link-ref link-reveal xref-bibr">23</a>] which was established to assist the NIH Office of Nutrition Research in implementing the SPNR. The Working Group developed these opportunities using information provided in the SPNR and from the processes that informed SPNR development, including reviews of the recent literature, online crowdsourcing, coordination and discussion with other federal agencies, and NIH-sponsored meetings [<span class="xrefLink" id="jumplink-CIT0017"></span><a href="javascript:;" reveal-id="CIT0017" data-open="CIT0017" class="link link-ref link-reveal xref-bibr">17</a>]. Opportunity 1 outlines the need to plan for implementation and dissemination as nutrition interventions are developed and tested. Opportunity 2 identifies how IS strategies can promote equitable implementation of nutrition- and diet-related EBIs. Opportunity 3 emphasizes the need to build capacity and infrastructure to support transdisciplinary or multidisciplinary approaches to using IS in nutrition research. All three opportunities touch on the need for multilevel and multicomponent approaches that acknowledge the real-world settings, lived experiences of communities, and their impacts on implementation of nutrition-related and diet and behavior change EBIs. These diverse influences include, but are not limited to, health systems and policies including food outlet availability, marketing strategies and social media messaging, school and workplace policies, practices, and norms, the social and physical environment, and the role of culture, history, and community-level influences [<span class="xrefLink" id="jumplink-CIT0024 CIT0025 CIT0026 CIT0027"></span><a href="javascript:;" reveal-id="CIT0024 CIT0025 CIT0026 CIT0027" data-open="CIT0024 CIT0025 CIT0026 CIT0027" class="link link-ref link-reveal xref-bibr">24–27</a>].</p> <h2 scrollto-destination=406623729 id="406623729" class="section-title js-splitscreen-section-title" data-legacy-id=s2>OPPORTUNITY 1. ADVANCE CONSIDERATION OF IMPLEMENTATION AND DISSEMINATION EARLY IN THE DESIGN OF INTERVENTIONS TO FACILITATE OPPORTUNITIES FOR EQUITABLE SCALE-UP AND SUSTAINABILITY OF EBIs</h2> <p class="chapter-para">Evidence-based recommendations for a healthy diet are available in multiple forms, including the <em>Dietary Guidelines for Americans</em> [<span class="xrefLink" id="jumplink-CIT0005"></span><a href="javascript:;" reveal-id="CIT0005" data-open="CIT0005" class="link link-ref link-reveal xref-bibr">5</a>], the Dietary Approaches to Stop Hypertension eating plan [<span class="xrefLink" id="jumplink-CIT0006"></span><a href="javascript:;" reveal-id="CIT0006" data-open="CIT0006" class="link link-ref link-reveal xref-bibr">6</a>], Mediterranean dietary patterns [<span class="xrefLink" id="jumplink-CIT0007"></span><a href="javascript:;" reveal-id="CIT0007" data-open="CIT0007" class="link link-ref link-reveal xref-bibr">7</a>], and others [<span class="xrefLink" id="jumplink-CIT0028"></span><a href="javascript:;" reveal-id="CIT0028" data-open="CIT0028" class="link link-ref link-reveal xref-bibr">28</a>, <span class="xrefLink" id="jumplink-CIT0029"></span><a href="javascript:;" reveal-id="CIT0029" data-open="CIT0029" class="link link-ref link-reveal xref-bibr">29</a>]. Consideration of implementation as interventions are designed and tested can further advance understanding of how best to enhance the reach, adoption, adaptation, and sustainability of these and other evidence-based recommendations, ultimately contributing to the achievement of goals in the SPNR [<span class="xrefLink" id="jumplink-CIT0030"></span><a href="javascript:;" reveal-id="CIT0030" data-open="CIT0030" class="link link-ref link-reveal xref-bibr">30</a>]. A recent review of diet and nutrition interventions in school settings found that effect sizes of strategies to improve implementation were highly variable across studies, highlighting the need for identify the best mix of strategies for implementation in a given context [<span class="xrefLink" id="jumplink-CIT0031"></span><a href="javascript:;" reveal-id="CIT0031" data-open="CIT0031" class="link link-ref link-reveal xref-bibr">31</a>]. Identifying opportunities for pragmatic research [<span class="xrefLink" id="jumplink-CIT0032"></span><a href="javascript:;" reveal-id="CIT0032" data-open="CIT0032" class="link link-ref link-reveal xref-bibr">32</a>, <span class="xrefLink" id="jumplink-CIT0033"></span><a href="javascript:;" reveal-id="CIT0033" data-open="CIT0033" class="link link-ref link-reveal xref-bibr">33</a>], identifying and addressing barriers and facilitators to implementation, conducting community engagement, considering implementation within multicomponent and multilevel interventions, and conducting iterative trials can contribute to development and testing of future implementation strategies that have the greatest potential to foster healthy eating across populations who have diverse lived experiences and environments.</p><p class="chapter-para">Examples of future research activities related to this opportunity include, but are not limited to, the following:</p><ul class="bullet"><li><p class="chapter-para">Consider implementation earlier in the translational research continuum (e.g., efficacy and effectiveness studies), for example, by applying the principles of designing for dissemination and sustainability [<span class="xrefLink" id="jumplink-CIT0030"></span><a href="javascript:;" reveal-id="CIT0030" data-open="CIT0030" class="link link-ref link-reveal xref-bibr">30</a>] during food environment intervention development and testing to improve use in real-world contexts.</p></li><li><p class="chapter-para">Advance multilevel nutrition and dietary behavior change interventions that include outer context or setting variables to contribute to the knowledge base on potential feasibility and acceptability for future implementation.</p></li><li><p class="chapter-para">Promote intervention research that partners with communities to identify the role of culture, familial norms, social relationships, cost, household food security (and other social barriers to behavior change) that would influence the uptake, acceptability, and feasibility of nutrition-related EBIs across individual, family, organizational, and community levels.</p></li><li><p class="chapter-para">Examine the role of structural environmental influences (e.g., food outlet availability, marketing strategies and social media messaging, school and workplace policies and norms, and environmental interventions) on adherence to dietary recommendations.</p></li><li><p class="chapter-para">Examine the influence of food, nutrition, and other public health policies, processes, and practices on EBI sustainability [<span class="xrefLink" id="jumplink-CIT0034"></span><a href="javascript:;" reveal-id="CIT0034" data-open="CIT0034" class="link link-ref link-reveal xref-bibr">34</a>].</p></li><li><p class="chapter-para">Examine the effectiveness of large-scale nutrition policies and programs (e.g., financial incentives and disincentives, such as taxes, on purchasing behaviors) across multiple contexts and diverse populations that could help improve diet quality at the population level or identify any differential effects across groups to help inform future policy IS research.</p></li></ul> <h2 scrollto-destination=406623733 id="406623733" class="section-title js-splitscreen-section-title" data-legacy-id=s3>OPPORTUNITY 2. DEVELOP AND TEST STRATEGIES FOR EQUITABLE IMPLEMENTATION OF NUTRITION AND DIET EBIs IN HEALTH CARE AND COMMUNITY SETTINGS</h2> <p class="chapter-para">Multilevel and multicomponent implementation strategies are needed for effective and sustained delivery of dietary EBIs across various settings, including health care, public health, and community-based organizations. Implementation strategies are the specific methods or techniques used to enhance the adoption, implementation, and sustainability of a public health program or practice [<span class="xrefLink" id="jumplink-CIT0035"></span><a href="javascript:;" reveal-id="CIT0035" data-open="CIT0035" class="link link-ref link-reveal xref-bibr">35</a>]. Multilevel approaches allow researchers to consider the varied influences on health, beyond individual genetics, biology, and behaviors. This multilevel emphasis highlights the role of settings and environments beyond where implementation occurs and how these external influences intersect with characteristics and processes of the implementation setting. Additionally, multicomponent approaches—the implementation of a set of interventions, whether within or across levels of influence—are important strategies to target a combination of factors related to diet and health.</p><p class="chapter-para">To expand the reach of our investments so that the benefit of EBIs can be gained across all populations and reduce inequalities, multilevel and multicomponent approaches to develop and test implementation strategies may consider social determinants of health such as structural racism, neighborhood food environment, food- and nutrition-related policies, neighborhood or community socioeconomic status, culture, transportation, and other social and structural factors that place barriers to equitable implementation [<span class="xrefLink" id="jumplink-CIT0026"></span><a href="javascript:;" reveal-id="CIT0026" data-open="CIT0026" class="link link-ref link-reveal xref-bibr">26</a>, <span class="xrefLink" id="jumplink-CIT0036"></span><a href="javascript:;" reveal-id="CIT0036" data-open="CIT0036" class="link link-ref link-reveal xref-bibr">36</a>]. Identifying implementation strategies that intervene, remedy, or respond to the influence of structural and social context have the potential to enhance adoption, fidelity, adaptation, or sustainability, particularly in populations experiencing health disparities in diet- and nutrition-related behaviors and other health outcomes [<span class="xrefLink" id="jumplink-CIT0036"></span><a href="javascript:;" reveal-id="CIT0036" data-open="CIT0036" class="link link-ref link-reveal xref-bibr">36</a>, <span class="xrefLink" id="jumplink-CIT0037"></span><a href="javascript:;" reveal-id="CIT0037" data-open="CIT0037" class="link link-ref link-reveal xref-bibr">37</a>]. In these ways, IS can improve the equitable reach and translation of nutrition research into practice [<span class="xrefLink" id="jumplink-CIT0011"></span><a href="javascript:;" reveal-id="CIT0011" data-open="CIT0011" class="link link-ref link-reveal xref-bibr">11</a>].</p><p class="chapter-para">Emphasis on multilevel and multicomponent influences are recognized at NIH as instrumental in addressing and advancing health equity and eliminating health inequalities. They are woven throughout several programs, including the NIH Minority Health and Health Disparities Research Framework [<span class="xrefLink" id="jumplink-CIT0038"></span><a href="javascript:;" reveal-id="CIT0038" data-open="CIT0038" class="link link-ref link-reveal xref-bibr">38</a>], the Nutrition Health Disparities Research Framework [<span class="xrefLink" id="jumplink-CIT0039"></span><a href="javascript:;" reveal-id="CIT0039" data-open="CIT0039" class="link link-ref link-reveal xref-bibr">39</a>], the Pathways to Prevention Program [<span class="xrefLink" id="jumplink-CIT0040"></span><a href="javascript:;" reveal-id="CIT0040" data-open="CIT0040" class="link link-ref link-reveal xref-bibr">40</a>, <span class="xrefLink" id="jumplink-CIT0041"></span><a href="javascript:;" reveal-id="CIT0041" data-open="CIT0041" class="link link-ref link-reveal xref-bibr">41</a>], RADx Underserved Populations (RADx-UP) [<span class="xrefLink" id="jumplink-CIT0042"></span><a href="javascript:;" reveal-id="CIT0042" data-open="CIT0042" class="link link-ref link-reveal xref-bibr">42</a>], and the Common Fund programs “Transformative Research to Address Health Disparities and Advance Health Equity” [<span class="xrefLink" id="jumplink-CIT0043"></span><a href="javascript:;" reveal-id="CIT0043" data-open="CIT0043" class="link link-ref link-reveal xref-bibr">43</a>] and “Nutrition for Precision Health, powered by the <em>All of Us</em> Research Program” [<span class="xrefLink" id="jumplink-CIT0044"></span><a href="javascript:;" reveal-id="CIT0044" data-open="CIT0044" class="link link-ref link-reveal xref-bibr">44</a>].</p><p class="chapter-para">Examples of future research activities related to this opportunity include, but are not limited to, the following:</p><ul class="bullet"><li><p class="chapter-para">Use systems science approaches and other innovative methods (e.g., sequential multiple assignment randomized trials and hybrid designs) to develop implementation strategies and improve the implementation of nutrition-related programs and policies within local, state, tribal, or federal contexts.</p></li><li><p class="chapter-para">Further explore the potential impact of using digital health technology at multiple levels to implement, extend reach, and disseminate nutrition interventions.</p></li><li><p class="chapter-para">Promote community engagement in developing and testing implementation strategies and explore iterative methods to adapt and disseminate diet and nutrition EBIs for specific populations (e.g., based on age, race or ethnicity, acculturation, gender, and/or geography).</p></li><li><p class="chapter-para">Leverage multilevel natural experiments from the USA and globally to study implementation of evidence-based policy, systems, and environmental change initiatives aimed at improving nutrition (e.g., examine the effects of the FDA changes in voluntary sodium reduction goals on population blood pressures or related cardiovascular disease).</p></li><li><p class="chapter-para">Consider the influences of the food supply, industry practices, advertising, and the retail food environment when developing and testing implementation strategies across organizational, family, and individual levels.</p></li><li><p class="chapter-para">Explore the influence of social determinants of diet and health (e.g., neighborhood food access and resources, socioeconomic status, educational access, literacy, housing, structural racism, etc.) on the effectiveness of multilevel and multicomponent implementation strategies [<span class="xrefLink" id="jumplink-CIT0036"></span><a href="javascript:;" reveal-id="CIT0036" data-open="CIT0036" class="link link-ref link-reveal xref-bibr">36</a>].</p></li><li><p class="chapter-para">Promote research on adaptation, scale-up, and sustainability strategies to achieve nutrition intervention population health impact, particularly in low resource and community settings.</p></li></ul> <h2 scrollto-destination=406623739 id="406623739" class="section-title js-splitscreen-section-title" data-legacy-id=s4>OPPORTUNITY 3. BUILD AND STRENGTHEN THE INFRASTRUCTURE, CAPACITY, AND EXPERTISE NEEDED TO INCREASE USE OF IS IN CLINICAL AND COMMUNITY NUTRITION RESEARCH TO SWIFTLY MOVE THE RESEARCH INTO PRACTICE</h2> <p class="chapter-para">The nutrition field is a complex system including community partners across clinical, community, neighborhood, school, faith-based, and family settings. Building capacity for implementation has the potential to resolve common challenges that go beyond study design, such as leadership decision-making, buy-in, and organizational change [<span class="xrefLink" id="jumplink-CIT0009"></span><a href="javascript:;" reveal-id="CIT0009" data-open="CIT0009" class="link link-ref link-reveal xref-bibr">9</a>, <span class="xrefLink" id="jumplink-CIT0045 CIT0046 CIT0047 CIT0048"></span><a href="javascript:;" reveal-id="CIT0045 CIT0046 CIT0047 CIT0048" data-open="CIT0045 CIT0046 CIT0047 CIT0048" class="link link-ref link-reveal xref-bibr">45–48</a>]. Successful IS efforts require infrastructure, capacity, oversight, adaptive approaches, and expertise to be responsive to and commensurate with the needs of a research project across its lifecycle [<span class="xrefLink" id="jumplink-CIT0049"></span><a href="javascript:;" reveal-id="CIT0049" data-open="CIT0049" class="link link-ref link-reveal xref-bibr">49</a>]. Interdisciplinary approaches, multisite collaboration, research in real-world settings, and meaningful community engagement are some of the keys to success and sustainability [<span class="xrefLink" id="jumplink-CIT0050"></span><a href="javascript:;" reveal-id="CIT0050" data-open="CIT0050" class="link link-ref link-reveal xref-bibr">50</a>, <span class="xrefLink" id="jumplink-CIT0051"></span><a href="javascript:;" reveal-id="CIT0051" data-open="CIT0051" class="link link-ref link-reveal xref-bibr">51</a>]. The successful involvement of diverse community partners with different vantage points and needs requires ongoing assessment, thoughtful deliberation, foresight, and planning to adequately address issues and opportunities that may arise [<span class="xrefLink" id="jumplink-CIT0052"></span><a href="javascript:;" reveal-id="CIT0052" data-open="CIT0052" class="link link-ref link-reveal xref-bibr">52</a>]. A team-based approach to nutrition science, where there is equity across partners in input and decision-making, can help meet these objectives.</p><p class="chapter-para">Examples of future research activities related to this opportunity include, but are not limited to, the following:</p><ul class="bullet"><li><p class="chapter-para">Explore opportunities to integrate nutrition-specific study aims into research projects with focuses beyond nutrition to cultivate new partnerships, engage in transdisciplinary collaboration, add translational approaches, and leverage limited resources.</p></li><li><p class="chapter-para">Advance cross-sector partnerships with government agencies, private entities, food systems, and local communities for high-impact research, dissemination, and implementation. Anticipate and plan for data sharing or data integration with appropriate partners and collaborators (e.g., other investigators, public health officials) and systems (e.g., data repositories, electronic health records, surveillance systems) in a lawful and ethical manner to build a sustainable and fertile data ecosystem in the field of nutrition.</p></li><li><p class="chapter-para">Facilitate collaborative academic and field opportunities for registered dietitian nutritionists, clinicians, health and wellness service providers, public health professionals, and community-based organizations to receive training in and gain familiarity with IS and translational research related to nutrition.</p></li><li><p class="chapter-para">Address barriers to ensuring meaningful and sustained involvement of academic disciplines, professions, organizational settings, and demographic characteristics currently underrepresented in nutrition research and practice teams.</p></li><li><p class="chapter-para">Support infrastructure development, capacity building, and adoption of diet/nutrition EBIs including with minority-serving and low-resource institutions, providers in underserved communities, and health disparity populations to broaden the distribution of benefits arising from nutrition research.</p></li><li><p class="chapter-para">Document and share best practices for successful multisite IS diet and nutrition studies, including obtaining and sustaining support and meaningful engagement across partners and within the community, establishing contingency plans for unanticipated events, and monitoring and addressing implementation issues, potential pitfalls, or ethical concerns.</p></li><li><p class="chapter-para">Promote interdisciplinary participation that recognizes the relationship between IS and nutrition with other relevant areas of research (e.g., physical activity/sedentary behavior, sleep, epigenetics).</p></li></ul> <h2 scrollto-destination=406623743 id="406623743" class="section-title js-splitscreen-section-title" data-legacy-id=s5>CONCLUSION</h2> <p class="chapter-para">In 2021, NIH invested over $2 billion in nutrition research, an annual amount that has been increasing steadily over time [<span class="xrefLink" id="jumplink-CIT0053"></span><a href="javascript:;" reveal-id="CIT0053" data-open="CIT0053" class="link link-ref link-reveal xref-bibr">53</a>]. IS offers the opportunity to expand the reach, sustainability, and scale of nutrition scientific discovery and may be a unique tool to address nutrition-related disparities and advance health equity. IS holds promise for understanding the barriers to changing dietary behaviors and environments, the means of sustaining adherence to those changes over time, and the strategies to implementing scalable interventions. Overall, the NIH SPNR Implementation of Nutrition-related Programs, Practices, and Behaviors Implementation Working Group is seeking to advance IS research approaches to develop and deliver successful EBIs for broad impact on population health.</p> <h2 scrollto-destination=406623745 id="406623745" class="backsection-title js-splitscreen-backsection-title" data-legacy-id=s6>Funding</h2> <p class="chapter-para">No funding sources to disclose.</p> <h2 scrollto-destination=406623747 id="406623747" class="backacknowledgements-title js-splitscreen-backacknowledgements-title" data-legacy-id=a1>Acknowledgments</h2> <p class="chapter-para">The content is solely the responsibility of the authors and does not necessarily represent the official views of the Office of Nutrition Research, Fogarty International Center, National Human Genome Research Institute, National Cancer Institute, National Heart Lung and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, or the U.S. Department of Health and Human Services and the National Institutes of Health.</p> <h2 scrollto-destination=406623749 id="406623749" class="backsection-title js-splitscreen-backsection-title" data-legacy-id=s7>Compliance with Ethical Standards</h2> <p class="chapter-para"><strong>Conflict of Interest:</strong> No conflicts of interest to disclose.</p><p class="chapter-para"><strong>Ethical Approval:</strong> This article does not contain any studies with human participants performed by any of the authors.</p><p class="chapter-para"><strong>Informed Consent:</strong> This study does not involve human participants and informed consent was therefore not required.</p><p class="chapter-para"><strong>Welfare of Animals:</strong> This article does not contain any studies with animals performed by any of the authors.</p> <h2 scrollto-destination=406623754 id="406623754" class="backreferences-title js-splitscreen-backreferences-title" data-legacy-id=r1>REFERENCES</h2> <div class="ref-list 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