The phrase "life starts all over again when it gets crisp in the fall" is from F. Scott Fitzgerald's novel The Great Gatsby. Yes, September is here, and the hot, humid days of summer are transitioning to the cool, clear days of autumn. It’s a time for change and transition; new starts; maybe a time for reflection; and – for many – a time for going back to school. Indeed, this time of year marks a new beginning for many children, adolescents, and young adults as they either start or continue their academic journey. And as my 12-year-old daughter reminds me every year, it seems to come too quickly!
Traditionally, autumn also marks the end of the growing season and the ensuing harvest – a time of abundance. Regrettably, for too many, the reality is that abundance is not always shared. Food and nutrition insecurity remain a daunting challenge in America and worldwide. So, it’s important for us to be aware that school-age individuals of all ages and in all stages – from pre-K to middle school to college – don’t always have enough to eat or adequate nutrition. This is sobering, especially given its significant impacts on physical and cognitive development, academic performance, and overall health.
When school doors were closed across the globe during the COVID-19 pandemic, ~400 million children worldwide lost access to school meals – often the only nutritious meal of their day. This, coupled with shocks and stresses to global food and nutrition programs, prompted several important questions, including: (i) how can we restore the school meal/nutrition support enterprise; (ii) as part of that effort, how can we improve the precision of determining both the need and impact of school meal/nutrition support programs on child health and development; and (iii) in so doing, how can we improve health while also avoiding any unintended consequences?
As almost every pediatrician has said at some point in their career, “children are not little adults;” but children and adolescents – like adults – are complex biological systems that are impacted by internal (biological, genetic, nutritional) factors and external (social/behavioral/economic/political, home, community, physical) environments. This ecological framework may sound familiar as I’ve written about the “nutritional ecology” before. School-aged children also represent a range of critical stages in terms of physical and neurological development, each of which is nutritionally sensitive and thus necessitates food and nutrition security that ensures access to a high-quality diet to meet nutritional requirements. The “Biomarkers of Nutrition for Development: Knowledge Indicating Dietary Sufficiency (BOND-KIDS)” Project – led by current members of the Office of Nutrition Research (ONR) – was initiated to develop a multidisciplinary approach to address this ecology and help inform the range of communities involved in providing nutritional support to school-aged children in the United States and globally. Importantly, the outputs from the BOND-KIDS Project have informed the World Food Programme, the School Meals Coalition, and others.
Indeed, food and nutrition security, coupled with optimal nutrition, are important for everyone. And malnutrition is not restricted to children. Rather, it affects individuals of all ages and malnutrition in all of its forms – ranging from hunger and undernutrition (including wasting and stunting) to micronutrient deficiencies (often termed the “hidden hunger”) to overweight and obesity – is now the leading cause of morbidity and mortality in the world today. It is estimated that one in three individuals on this planet suffers from some form of malnutrition; many suffer from multiple forms – all at the same time. And the consequences of malnutrition are enormous.
As alluded to above, malnutrition affects an individual’s ability to learn, perform, and grow to his or her full potential, creating a lifelong malady that has repercussions throughout the entire life cycle and that reverberates through future generations. Importantly, malnutrition also presents at every point of contact between patients and the health care systems they interact with and has implications with respect to disease susceptibility, care, and treatment. Fundamentally, we need to be able to answer a core question when someone enters the health care system: “are you sick because you are malnourished, or are you malnourished because you’re sick?” Our ability to answer this question will enhance our ability to more precisely care for patients irrespective of setting.
Given the enormity of the issue, and as noted in an earlier post this month, ONR is launching the “Assessing the Determinants of Malnutrition – Implications for Treatment (ADMIT)” Project, which aims to better understand the nutritional ecology of individuals across the lifespan and health care continuum. The goal of ADMIT is to address the nutritional needs and assessment of individuals presenting for and during nutrition care and to develop an etiology-based approach to interventions. I am excited to see this project move forward and will of course keep you updated on its progress.
Addressing malnutrition requires a multifaceted approach, including an expanded appreciation of the biology of nutrition, its assessment, and more precise interpretation of clinical data. In addition, ensuring food security and access to a diverse, nutrient-rich diet is fundamental. Research is needed to provide the evidence base to support the programs, policies, and practices developed to ameliorate the scourge of malnutrition. This is a call to action for all of us – scientists, policymakers, providers, and community members – to keep striving for solutions, and ONR is primed and ready to work alongside our partners to drive the solutions forward.
Furthermore, the fight against malnutrition is not just about food; it is about creating environments that support healthy choices and lifestyles. By prioritizing nutrition in our programs, policies, and practices, we can improve health outcomes, enhance quality and length of life, and promote sustainable development. It is a challenge that demands our collective effort, but the benefits of overcoming it are immeasurable. Together, we can turn the tide on malnutrition and build a healthier world for ourselves and future generations.
As always, I welcome comments, feedback, and suggested new directions for nutrition science research. If you’re on LinkedIn, feel free to share your favorite healthy snack or recipe with me – I’m always looking to expand my cookbook! Until next time, please visit the ONR website to get office-related information, and consider signing up for ONR Updates to receive monthly emails (including the Drew’s Views blog and the ONR Director’s Updates newsletter).
Nutrition Is Who We Are!
Drew Bremer
September 23, 2025