Setting a New Standard

Nutrition is everyone’s business. Not only because everyone eats, but because food weaves a thread through the very fabric of human culture, history, family, and memory. Nutrition is also a major thread at every NIH Institute, Center, and Office. Nutrition connects food to health; it touches every cell and every system in our bodies at every age and every stage.

Amid the excitement and support to recognize nutrition as a central and multidimensional driver of health, there is a lot of science to do! Nutrition is integral to all human biology, but humans are complex systems. Our lives reflect internal factors (biology, genetics, health status, and developmental age) as well as external impacts from our social, behavioral, home, community, and physical environments. Our science needs to respect this complexity by viewing nutrition in an ecological framework.

Accomplishing this goal means defining nutritional status as a key variable and fundamental driver of health. Doing so will set a new standard toward increasing the rigor and reproducibility of scientific discovery and enhancing equity.

Nutrition is one of many variables that shape health. We know, for example, that “children are not little adults,” a seemingly obvious truth noted by Swiss developmental psychologist Jean Piaget nearly a century ago. As a pediatrician and internist, this is common sense to me. Research questions and methods need to be specifically geared to age and development since health determinants and outcomes vary dramatically across all stages of life, from infancy to adolescence to midlife to older age.

Another fundamental health driver is sex. We know from recent NIH-funded research, for example, that females are more likely than males to have health problems like autoimmune diseases. How and why these sex differences occur is the subject of active research toward improving health for everyone regardless of their sex.

All people should inherently have access to a high-quality diet. Precise nutritional assessment will help us figure out how and why one person’s individual nutritional needs differ from someone else’s, and how each individual’s nutritional status can be optimized. That knowledge will also broaden nutritional status beyond just food and nutrition security.

Take obesity as an example. Many people think of obesity as excess weight, so it may be counterintuitive to consider that people with obesity can also experience malnutrition. But they do, frequently. They may have micronutrient deficiencies or changes in physiology that make it hard to accurately measure their nutritional status.

Going forward, we need methodologies that are measurable and accurate, not only subjective views based on a person’s outward characteristics or on self-reported data about diet and exercise. Improving the precision of nutritional assessment is paramount to emerging concepts such as “food is medicine,” “precision nutrition,” and other efforts to understand how nutrition interacts with climate/environmental change, food systems, and health more broadly.

Currently, the nutrition science community does not yet have enough tools to precisely assess and measure nutritional status or its drivers. This reality presents a challenge but also an opportunity, deserving an all-hands-on-deck response. We need to come together around what is certainly a fundamental issue for all of us. And I know we can do it!

So, how do we get there? A first step is to develop truly objective ways to measure the nature and behavior of people, their foods, and their physical, biological, and social environments. Acknowledging nutrition as part of a dynamic ecosystem means that nutrition studies must consider each of these influences in unbiased ways. The NIH-funded Nutrition for Precision Health study, which is now enrolling research participants, aims to predict individual responses to foods and dietary patterns in order to optimize an individual’s health. The results of this research could lead to tailored diets based on all the characteristics of a person (including their culture and environment), not just how old they are, their sex/gender, or how much they weigh.

Rigorous research grounded by considering nutritional status as a foundational variable that is both an input and an outcome of health and disease is good stewardship, invoking the highest level of rigor for biomedical research supported by the American public. Going forward, nutrition science guided by this paradigm will yield results that we can trust and be trusted – results that can be used by researchers, clinicians, and people who make daily decisions that affect their health and the health of others. As we develop objective, precise tools to measure nutritional status, we will be able to identify and treat nutrition-related problems by addressing their root causes. What an incredible step forward that would be!

Our Office is committed to rigorous science that addresses priority issues in public health and nutrition across the lifespan. Now is the time to spark a sea change in the way we do nutrition science. It’s an incredibly exciting time to join this pursuit of knowledge that will benefit from many perspectives new to nutrition science: omics, anthropology, sociology, data science, and many others. We can do this, together, by recognizing the centrality of nutritional status to optimize health.

During this National Nutrition Month™, let’s remember that nutrition isn’t something that deserves recognition only in March, but rather as a daily acknowledgment throughout our lives. As always, I welcome comments, feedback, and suggested new directions any time (check out the “Request a Session” button for NutRitioNaLS – NIH Research on Nutrition Listening Sessions, located on the ONR Website). Until then, thanks for reading, and please subscribe to receive ONR email updates.

Nutrition Is Who We Are!

Drew Bremer

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