Nutrition Science – Exploring Every Aspect of Nutrition in a New Article Series

The following article appeared in the leading international medical and scientific journal NEJM on 11 April 2024 under the title "Nutrition in Medicine — A New Review Article Series".

Approximately 11 million deaths worldwide each year are associated with inadequate and unhealthy diets, including diets high in sodium and low in whole grains and fruit.

Inadequate or unhealthy nutrition contributes to serious health problems, including obesity resulting from excessive energy intake, hypertension, heart disease, stroke, type 2 diabetes, and particularly stomach and colorectal cancers.

For these reasons, nearly one in every 4 people in Western societies now follows a particular dietary pattern. However, the relationship between dietary intake and health is complex and not fully understood.

Nutrition Education Is Overlooked

The latest data reveal that nutrition curricula worldwide are inadequate, with only 1% of medical school examination questions addressing nutrition. This is hardly surprising, as many medical students and doctors turn to alternative sources to fill gaps in their nutritional knowledge. They also express uncertainty about nutritional assessment and basic dietary strategies. This highlights serious gaps in nutrition education for health professionals.

The Complex Dynamics of Nutrition

Adding to this complexity, causes of malnutrition beyond the traditional factors are increasingly being recognized, including low socioeconomic status, dietary restrictions, and chronic diseases.

The growing popularity of treatments such as bariatric surgery and weight-loss medications requires careful monitoring of the potential risks of inadequate or unhealthy nutrition in patients receiving these treatments. Malnutrition in older adults is becoming particularly urgent, given projections that by 2060 a quarter of the population in many Western societies will be over 65. Nutritional assessment in older adults is complicated by factors such as common coexisting health conditions, use of multiple medications, and end-of-life decisions; these situations therefore require a sensitive and careful approach.

Many professional societies are calling for more comprehensive nutrition education for both current and future doctors. Proposed core competencies include appropriate nutrition at different life stages, essential nutrients, evidence-based diets, malnutrition (inadequate or unhealthy nutrition), and nutritional management of disease.

Food Is Medicine

Countries are now emphasizing the "food is medicine" approach in their nutrition strategies, highlighting the need for more nutrition education for clinical specialists.

• Precision nutrition,
• Food additives,
• Genetically modified foods,
• Metabolomics and proteomics,
• Climate change and food scarcity,
• Telenutrition,
• Culinary medicine, and
• New nutritional biomarkers

Ongoing research in these areas continues to expand our knowledge in this exciting field, where further investigation is needed.

Exploring Nutrition Science in Depth Through a New Article Series

To address these knowledge gaps, NEJM  has announced a new review article series covering:

• The basic "pharmacodynamics" of food,
• Interactions between the gut and the immune system,
• And the role of the gut microbiome in health and disease—a varied range of topics explored in the newly launched review article series.

We recognize the critical importance of key components of appropriate and adequate nutrition, particularly patient-centered dietary counseling and multidisciplinary care, which are difficult to address in printed materials. This series aims to deepen our understanding of nutrition science and make valuable contributions to our practical work.

These reviews aim to explore in depth how foods are selected, consumed, digested, and metabolized. With this knowledge, we hope to help doctors personalize their approaches to preventing and treating a range of common diseases. 

Let us move beyond "food for thought" and embrace "food in practice" to improve our patients' health worldwide. This shift emphasizes that food should be actively incorporated into health care rather than merely considered.