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To show that nutrition science, with its application to food and nutrition policy, now needs a new conceptual framework. This will incorporate nutrition in its current definition as principally a biological science, now including nutritional aspects of genomics. It will also create new governing and guiding principles; specify a new definition; and add social and environmental dimensions and domains.
A narrative review of nutrition science, its successes and achievements, and its dilemmas, paradoxes, shortcomings, dissonances and challenges. Reference is made to 16 associated papers. Equal use is made of continuous text and of boxed texts that extend the review and give salient examples.
Recent and current interrelated electronic and genomic discoveries and linked sequential demographic, nutritional and epidemiological shifts, in the context of associated and interlinked global social, cultural, environmental, economic, political and other developments, altogether amount to a world in revolution, requiring all disciplines including that of nutrition science to make comparably radical responses.
Nutrition in principle and practice should be a biological and also an environmental and social science. This new broad integrated structure brings much recent and current progressive work into the centre of nutrition science, and in some ways is a renewal of the period when nutrition science had its greatest impact. It amounts to a map charting well-known and also new worlds. The new nutrition science is concerned with personal and population health, and also with planetary health – the welfare and future of the whole physical and living world of which humans are a part. In this way the discipline will make a greater contribution to the preservation, maintenance, development and sustenance of life on Earth, appropriate for the twenty-first century.
To specify the principles, definition and dimensions of the new nutrition science.
To identify nutrition, with its application in food and nutrition policy, as a science with great width and breadth of vision and scope, in order that it can fully contribute to the preservation, maintenance, development and sustenance of life on Earth.
A brief overview shows that current conventional nutrition is defined as a biological science, although its governing and guiding principles are implicit only, and no generally agreed definition is evident. Following are agreements on the principles, definition and dimensions of the new nutrition science, made by the authors as participants at a workshop on this theme held on 5–8 April 2005 at the Schloss Rauischholzhausen, Justus-Liebig University, Giessen, Germany.
Nutrition science as here specified will retain its current [classical] identity as a biological science, within a broader and integrated conceptual framework, and will also be confirmed as a social and environmental science. As such it will be concerned with personal and population health, and with planetary health – the welfare and future of the whole physical and living world of which humans are a part.
To outline the history of dietetics since its beginnings in recorded history, and of nutrition science in its first phase beginning in the mid-nineteenth century and then its second phase in the second half of the twentieth century.
Three narrative overviews: of dietetics from its beginnings until after the end of the mediaeval and then Renaissance periods in Europe; of nutrition science in its first phase from its beginnings in the mid-nineteenth century until the middle of the twentieth century, with reasons for its rise; and of nutrition science in its second phase in the second half of the twentieth century, with reasons for its decline.
In its third phase in the twenty-first century, the new nutrition science should regain much of the vision and scope of its preceding disciplines.
To show that current rates of global population growth, production and consumption of food, and use of living and physical resources, are evidently not sustainable. To consider ways in which nutrition and allied sciences can respond to this great challenge of the twenty-first century.
Past, current and future projected trends in production and consumption patterns are examined. These show that overall present and projected patterns cannot be sustained; and also show increasing unacceptable inequity between and within rich and poor regions and countries.
Nutrition science classically focuses on nutrients in relation to human physiology, metabolism, growth, health and disease. The social and environmental conditions of the modern, interconnected, market-oriented world, and the consequences for food production and consumption, are extending the research and policy agenda with which nutrition science must now urgently engage. Historically, much attention has been paid to eliminating nutritional deficiency states, and this remains an important task. In modern urban populations ‘malnutrition’ encompasses new forms of dietary imbalance, especially excesses of certain nutrients. These contribute to various non-communicable diseases and, particularly, to overweight/obesity and its attendant metabolic derangements and disease risks. As a mass phenomenon the current surge in obesity has no historical precedent. The escalating impact of humankind on the natural environment, with its ramifications for present and future food production, is also unprecedented.
The essential challenge for nutrition science is to develop new understanding and strategies to enable a balance between promoting, equitably, the health of humans while sustaining the long-term health of the biosphere. Extension of nutrition science and food policy to meet those goals will be aided by understanding better how dietary conditions shaped the biological evolution of humankind. The fundamental long-term task is to integrate human health with the health of the biosphere.
Agriculture designed to make best use of landscape and to be maximally sustainable would also provide food of the highest nutritional and gastronomic standards, and would inevitably employ a great many people. Thus it would solve the world's food problems, and its principal social problem, at a stroke. But agriculture in practice is designed for a quite different purpose – to generate wealth, in the cause of ‘economic growth’. The pressing need is not for more science and technology, but to recognise the true cause of the problems and to re-think priorities.
We could all be well fed. Indeed, everyone in the world who is ever likely to be born could be fed to the highest standards of gastronomy as well as of nutrition until humanity itself comes to an end. We already have most of the necessary technique – perhaps all that is needed. We could always do with more excellent science but we need not depend, as we are often told from on high, on the next technological fix. The methods that can provide excellent food would also create a beautiful environment, with plenty of scope for other creatures, and agreeable and stable agrarian economies with satisfying jobs for all.
In reality, in absolute contrast, we have created a world in which almost a billion are chronically undernourished; another billion are horribly overnourished, so that obesity and diabetes are epidemic, and rising; a billion live on less than two dollars a day; and a billion live in urban slums – a figure set to increase and probably at least to double over the next half century; while other species are disappearing so fast that biologists speak of mass extinction.
To focus on factors that play a major role in our rapid, global nutritional changes.
A range of studies are summarised: these show how an understanding of social, economic and technological change at the global, national and community levels affects diet, activity, and body composition patterns and trends. These studies are used to demonstrate the value of the key global, national, community, household and individual factors that should define the field of nutrition.
The focus is global.
Large shifts have occurred in diet and in physical activity patterns – particularly in the last one or two decades of the twentieth century. These changes are reflected in nutritional outcomes such as changes in average stature, body composition and morbidity. Understanding the rapidity of these changes and the underlying factors at the global, national and community levels is critical for creating a science of nutrition that can prevent disease and sustain the health and integrity of humans.
The vision of the nutrition field is one where scholars who work on many levels will intersect; equal weight in the nutrition profession will be provided to all dimensions as they are welcomed into the field of nutrition – particularly those that will directly or indirectly affect dietary patterns, physical activity patterns, and energetics. This vision of the nutrition field is one where scholars from a range of disciplines and perspectives meet to work together with the goal being a focus on improving nutritional status and the human condition.
To explore the terms on which nutrition should engage with the global challenges ahead.
Analysis of current orientation of nutrition and policy.
Nutrition faces four conceptual problems. The first is that nutrition has fissured into two broad but divergent directions. One is biologically reductionist, now to the genome; the other sees nutrition as located in social processes, now also requiring an understanding of the physical environment. As a result, nutrition means different things to different people. The second problem is a misunderstanding of the relationship between evidence, policy and practice, assuming that policy is informed by evidence, when there is much evidence to the contrary. The third problem is that nutrition is generally blind to the environment despite the geo-spatial crisis over food supply, which will determine who eats what, when and how. How can we ask people to eat fish when fish stocks are collapsing, or to eat wisely if water shortage dominates or climate change weakens food security? The fourth problem is that, in today's consumerist and supermarketised world, excess choice plus information overload may be nutrition's problem, not solution.
Nutrition science needs to re-engage with society and the environment. The alternative is, at best, to produce an individualised approach to public health or, at worst, to produce brilliant science but be policy-irrelevant.
To explain how the philosophy of nutrition is part of the philosophy of health. To show that this link allows practical solutions for equity and sustainability.
An analysis of the historical philosophies concerned with nutrition and health. A comparison of the definitions in the history of mind from antiquity to the beginning of the twenty-first century.
We are not individually healthy, but we are so in togetherness, even with animals and plants. Comprehensive nutrition science has physical, social and environmental attributes. It follows that nutrition is good for the enhancement of good company with human beings as well as with the connatural world. We recognise that we owe to others what we are and this constitutes the equity of being.
To promote the new field of ‘public nutrition’ as a means to address, in a more efficient, sustainable and ethical manner, the world-wide epidemic of malnutrition – undernutrition and specific nutrient deficiencies, and also obesity and other nutrition-related chronic diseases.
Grounded in the health promotion model, public nutrition applies the population health strategy to the resolution of nutrition problems. It encompasses ‘public health nutrition’, ‘community nutrition’ and ‘international nutrition’ and extends beyond them. It fits within the conceptual framework of ‘the new nutrition science’ and is an expression of this reformulated science in practice. Its fundamental goal is to fulfil the human right to adequate food and nutrition. It is in the interest of the public, it involves the participation of the public and it calls for partnerships with other relevant sectors beyond health. Public nutrition takes a broader view of nutritional health, addressing the three interrelated determinant categories of food systems and food security; food and health practices; and health systems. It assesses and analyses how these influence the immediate determinants that are dietary intake and health status so as to direct action towards effective progress. To further enhance the relevance and effectiveness of action, public nutrition advocates improved linkages between policies and programmes, research and training. A renewed breed of professionals for dietetics and nutrition, trained along those lines, is suggested.
There is a critical need to develop new knowledge, approaches and skills to meet the pressing nutrition challenges of our times.
To emphasise the importance of defining a new nutrition science and food policy that includes social and environmental dimensions.
Nutrition science and food policy is put in the context of sustainable development. Examples are presented to show that a number of factors including exploitation of resources, disrespect for land and food insecurity contribute to the decline of a culture. The fate of cultures that lack implemented sustainable development strategies is discussed.
Pressure from low-income and economically challenged countries combined with the efforts of not-for-profit private institutions is proposed. The goal is to produce and provide science-based evidence and guidelines to be used as a tool to encourage institutions and organisations to redefine their policies to deal effectively with global issues.
To show that the practice of wholesome nutrition meets the demands of the concept of the new nutrition science, at present and in the future.
To define ‘wholesome nutrition’, to describe its origin and to discuss its recommendations; and to cite practical examples showing that wholesome nutrition includes the dimensions and domains that are the basis of the concept of the new nutrition science.
The recommendations of wholesome nutrition are an effective implementation of the concept of the new nutrition science.
To describe an integrated, holistic conceptual framework and research paradigm for a better understanding of the nutrition transition in middle- and low-income countries.
Current inability effectively to prevent the increasing burden related to changes in food consumption patterns and other health behaviours of populations in transition motivates a new approach for nutrition research and practice. In this proposed approach, broader and integrated dimensions of science and practice may be applied for a better understanding of this complex phenomenon.
Examples from our own studies are given and quoted to illustrate how results from transdisciplinary studies were used to design an integrated, holistic programme to improve quality of life of people infected with HIV.
Based on these experiences it is argued that the more holistic and integrated approach should and could lead to more effective and sustainable interventions to prevent the adverse health consequences of the nutrition transition. At the same time such an approach will contribute to efforts to conserve the environment and also human, living and natural resources.
To show that nutrition science is anchored in food systems and is influenced by the social, through the environmental to the cosmological, life's connections and rhythms. To indicate that an integrative approach is now becoming possible with advances in food technology, in the understanding of food choice and of human behaviour, and in a preparedness to recognise nutritional inputs in the full sweep of life-long well-being and health outcomes.
An analysis of the much broader understanding of nutritionally related diseases from an ecological perspective, with attention to economic development, beginning with poverty alleviation. Recognition that the biological dimension of nutrition science is undergoing a profound reappraisal; that technologies will allow us to change the course of nutritionally related diseases for the better; and that nutrition science will find partners in information technology and telecommunications, food technology and energy technology.
A new generation of nutrition scientists can help build a new economy that supports development amongst communities, whether close or distant from each other. The opportunities for this kind of development to be realised between Asia, Latin America and Africa are considerable. At all times, however, nutrition scientists must uphold the paramount importance of good governance, conflict resolution and maternal literacy if their work is to achieve its growing potential.
To examine the present methods used to define nutritional needs, and to analyse the intrinsic limitations of the reductionist chemical, biological and medical approaches to assess requirements. To establish the necessity to incorporate the complexities emerging from a broader understanding of the biological sciences as well as to include environmental and social dimensions in addressing nutritional needs.
Examples of the limitations of current approaches and the implications of these in defining potential solutions and policy options to address present nutritional problems are presented and discussed.
The chemical and biological sciences have provided a strong base for nutrition and have been essential in establishing nutrition as a science with public health relevance. However, these approaches are clearly insufficient to address the main challenges that confront nutrition science now in the twenty-first century. There is a pressing need to include the social, economic and human rights aspects in order to define future policies that will secure the right to safe and nutritious food for all.