Expert Review Team Report for Institute of Nutrition, Metabolism and Diabetes

Submitted by: Dr. Garret FitzGerald
Chair, Expert Review Team
February 2011

Table of contents


This is a summary of the main topics that emerged from our discussions. We felt it more constructive to pursue in some depth issues that arose in consideration of the Institute and CIHR generally with stakeholders than be restrained by a restrictive, pre-ordained format. However, commentary within the pre-specified bounds is also provided.

Human capital

Areas of focus

Governance and structure

Section 1 – Institute mandate

The Institute of Nutrition, Metabolism and Diabetes (INMD) is mandated to support research that enhances health in relation to diet, digestion, excretion and metabolism for a wide range of conditions and problems associated with hormone, digestive system, kidney and liver function.

CIHR Institute of Nutrition, Metabolism and Diabetes – Internal Assessment for 2011 International Review, pg 1

Section 2 - Status of this area of research in Canada

Initial exclusive focus on obesity has been broadened after consultation with representatives of stakeholders. However, obesity remains a central focus of the interest.

Although there are some who felt left out, the general impression is of a more inclusive strategy and an overall understanding to have some general areas of emphasis. Both renal and GI constituencies reflected this feeling of improvement.

Still a perception of neglect of mechanistic investigators remains, especially physician scientists, who operate in or across pillars 1 and 2.

Recognized impact on the magnitude of the network of obesity researchers in Canada.

Overall impression of the Canadian research landscape in this area

Need to address the deficiency in human capital in the domain of pillars 1 and 2, particularly physician scientists.

Need to look beyond conventional metrics of short-term success and to link this to intermediate and long-term metrics that relate to health outcomes.

This will require strategic interaction with other agencies which this Institute is well positioned to lead.

Section 3 - Transformative Impacts of the Institute

Certainly, an improvement in perception of this Institute in the past several years.

Has had an impact in presenting a focus for obesity research and, in that sense, has had a transformative impact on the community.

Has begun to forge partnerships with other entities such as Health Canada and Statistics Canada.

Overall impression – to what extent has this Institute been transformative?

Needs to take the lead in catalyzing interaction between the many stakeholders who collect data relevant to assessing the impact of enhanced obesity research capacity on medium term (e.g. incidence of childhood obesity, prevalence of adult obesity and diabetes metrics) and long term (e.g. cardiovascular deaths- indices of health).

Could also play a catalytic role in bringing agencies and agribusiness together to consider making food science an interdisciplinary translational priority for Canada.

Could catalyze discussion around creating translational infrastructure in Canada as exemplified by Clinical and Translational Science Awards in the US. Perhaps there should be some form of a "translational mandate" in many of the grants.

Could catalyze discussion around industry / academia interface as summarized above.

Section 4 - Outcomes

Has created the Canada Obesity Network and contributed to enhanced training (e.g. the Obesity Boot Camp; the Canadian Child Health Clinician Scientist Program).

Has leveraged resources from hospitals, provincial governments and charities – although no figures were provided.

Has provided more bridge funding - which helps asymmetrically, young investigators – than all the other CIHR institutes.

Strategic interactions with provincial governments could begin with a few « bright lights » to obtain initial proof of principal.

Overall impression – to what extent has this Institute been successful in achieving outcomes?

Good start, but needs to act as the catalyst for much more connectivity amongst organizations scattered across the food science spectrum to develop a strategic approach to the opportunity and the challenge. Besides obesity, this can embrace other areas – such as salt reduction – that include other domains of the Institute's constituency of researchers – in this latter case, renal physicians and scientists.

Such interactions will clarify major initiatives such as biobanking where programmatic and infrastructural contributions from discrete funding bodies are defined at initiation of the project, but it is unclear who pays for sustainability. Here, interaction with initiatives such as the Biobanking and Biomolecular Resources Research Infrastructure in Europe which has experience with such issues would be helpful.

Section 5 - Achieving the Institute mandate

The broad community feels better served by the Institute in recent years. However, the focus on obesity highlighted interactions across all 4 pillars of Institute-funded research.

Traditional academic metrics speak to the success of the Institute in addressing its mandate.

Broadly, CIHR may have to « do fewer things and do them better » and this is also true of this Institute. Besides focus, this means leveraging interactions with other quasi non-governmental organisations, medical charities, provincial governments and industry.

The CIHR and this Institute could catalyze interactions between these bodies to clarify strategic opportunities for those that formulate policy without « tainting its scientific mission ». CIHR has already done something like this in multiple sclerosis research.

Identifying cross cutting interdisciplinary themes within INMD would help address the issue of heterogeneity of this Institute. As an example, the committee suggested that focussing on areas like inflammation allow for participation from all traditional constituencies on an open call basis and may diminish feelings of structural disenfranchisement.

Could educate the public and politicians on (i) how long it takes to develop a successful drug or diagnostic and how (ii) both efforts contribute to the health and wealth of the nation. This builds the case for incremental investment in basic and clinical research. The Institute budget is very limited, given its mandate.

Overall impression – to what extent has this Institute achieved its mandate?

The Institute has been very successful in addressing the mandate within the narrow terms of obesity research.

The committee felt it should build on this achievement to take a more expansive view of its potential.

The Institute might clarify its expectations around knowledge transfer – to whom and in what form? Develop a strategy to engage non-governmental organisations and advocacy groups. Build on the Partnerships for Health System Improvement programs.

It might exploit a focus on industry/academia interactions to bring guidance on some complex ethical issues such as conflict of interest.

Section 6 - ERT Observations & Recommendations

These are summarized in detail in the prelude.

Overall impression of the performance of this Institute

The efforts of the Institute to build a community of obesity researchers of international visibility have been successful.

The loosening of focus under the current leadership has been broadly appreciated.

The Institute could exploit further its capacity to leverage its influence and promote a more strategic approach to solving Canada's health challenges in this domain and exploiting commercial potential.


Address aggressively the limited human capital with expertise to span the T1 translational divide with a particular emphasis on physician scientists.

Foster investment in translational infrastructure, linking programmatic and infrastructural strategies with a particular emphasis on sustainability – from research careers through to biobanks.

Play a more strategic and catalytic role with the objective of harnessing the capabilities and objectives of multiple agencies to deliver a politically tractable message that influences policy. French governmental use of the Institut national de la santé et de la recherche médicale to gather data on obesity is a good model.

Move beyond traditional short-term academic metrics to link these to real clinical outcomes, thus demonstrating the value of investment in research.

Appendix 1 - Expert Review Team

Chair - Dr. Garret A. FitzGerald
Chair, Department of Pharmacology
Director, Institute for Translational Medicine and Therapeutics
University of Pennsylvania, USA

Expert Reviewer – Professor W. Philip T. James
President, International Association for the Study of Obesity
Honorary Professor of Nutrition, London School of Hygiene and Tropical Medicine, UK

International Review Panel – Professor Christian Bréchot
Vice-President - Medical and Scientific Affairs
Institut-Mérieux, France

Appendix 2 - Key Informants

Session 1 – Review of Institute

  1. Dr. Philip Sherman, INMD Scientific Director
  2. Dr. Stephanie Atkinson, Chair – Institute Advisory Board
    Professor and Associate Chair (Research), Pediatrics
    McMaster University
  3. Dr. Denis Richard
    Director, Centre for Research on Energy Metabolism
    Université Laval
  4. Dr. Stephen Collins
    Associate Dean, Research, Faculty of Health Sciences
    Professor, Department of Medicine
    McMaster University

Session 2 – Consultation with researchers

  1. Dr. John Wallace
    Professor, Division of Gastroenterology, Department of Medicine
    McMaster University
  2. Dr. Lise Gauvin
    Professor, Department of Social and Preventive Medicine
    University of Montreal
  3. Dr. Kevin Burns
    Senior Scientist, Chronic Diseases, Ottawa Hospital Research Institute
    Professor, Division of Nephrology, University of Ottawa and Ottawa Hospital

Session 3 – Roundtable with stakeholders

  1. Mr. Paul Shay
    National Executive Director
    Kidney Foundation of Canada
  2. Dr. Steve Vanner
    VP Research Affairs
    Canadian Association of Gastroenterology
  3. Ms. Kimberly Elmslie
    Director General, Centre for Chronic Disease Prevention and Control
    Public Health Agency of Canada
Date modified: