Using research on the obesity pandemic as a guide to a unified vision of nutrition

Association of Maternal Education With Nutritional Outcomes of Poor Children With Stunting in Indonesia

The consequences of poverty and food insecurity can indirectly contribute to obesity. Long-term effect of stunting children may be the risk factor for overweight and obesity in the poor in Indonesia. The role of parental education is also associated with overweight and obesity in children. This study aimed to observe the risk of stunted children becoming overweight and obese based on maternal education among poor people in Indonesia. This study involved three cohorts design. Cohort 1 is a 14-year cohort, and two 7-year cohorts for cohorts 2 and 3. We used secondary longitudinal data from Indonesian Family Life Survey (IFLS) 3 (2000), IFLS 4 (2007), and IFLS 5 (2014). After stratification by high maternal education and economic status of the family, there is an increased risk of stunting children becoming overweight and obese, with a risk ratio of 2 in cohort 1 and 1.69 in cohort 2. These results showed that stunted children with high-education mothers and lived in the low-income families have a 1.69 to 2 times higher risk of becoming overweight and obese. Thus, the importance of primary education and health education for women to increase children's health in the future.

Obesity and Urban Environments

Obesity is a major public health issue, affecting both developed and developing societies. Obesity increases the risk for heart disease, stroke, some cancers, and type II diabetes. While individual behaviours are important risk factors, impacts on obesity and overweight of the urban physical and social environment have figured large in the recent epidemiological literature, though evidence is incomplete and from a limited range of countries. Prominent among identified environmental influences are urban layout and sprawl, healthy food access, exercise access, and the neighbourhood social environment. This paper reviews the literature and highlights the special issue contributions within that literature.

GORDURA, DISCRIMINACIÓN Y CLASISMO: UN ESTUDIO EN JÓVENES DE SANTIAGO DE CHILE

Resumen El estudio de la obesidad desde la psicología social se ha realizado principalmente desde una aproximación cognitivo conductual omitiendo los contextos sociales en que se realizan juicios discriminadores. Con el objetivo de comprender los significados con que se construye la gordura y su interacción con otras formas de exclusión social, hemos realizado un estudio cualitativo de jóvenes de Santiago de Chile. Trabajamos con tres grupos de discusión, que analizamos siguiendo las directrices de la teoría fundada. Presentamos los resultados relativos a la construcción de la gordura y su vinculación con las clases sociales. La gordura se constituye como una condición que define a la persona como ansioso/a, perezoso/a y deforme, lo que justifica la acción de discriminación. Los atributos por los que son excluidos las personas gordas coinciden con los utilizados históricamente para discriminar a los/as pobres, de ahí que concluimos que se constituye como una nueva forma de clasismo.

Variations in Obesity Rates between US Counties: Impacts of Activity Access, Food Environments, and Settlement Patterns

There is much ongoing research about the effect of the urban environment as compared with individual behaviour on growing obesity levels, including food environment, settlement patterns (e.g., sprawl, walkability, commuting patterns), and activity access. This paper considers obesity variations between US counties, and delineates the main dimensions of geographic variation in obesity between counties: by urban-rural status, by region, by area poverty status, and by majority ethnic group. Available measures of activity access, food environment, and settlement patterns are then assessed in terms of how far they can account for geographic variation. A county level regression analysis uses a Bayesian methodology that controls for spatial correlation in unmeasured area risk factors. It is found that environmental measures do play a significant role in explaining geographic contrasts in obesity.

Mind-Body Practice and Body Weight Status in a Large Population-Based Sample of Adults

INTRODUCTION

In industrialized countries characterized by a high prevalence of obesity and chronic stress, mind-body practices such as yoga or meditation may facilitate body weight control. However, virtually no data are available to ascertain whether practicing mind-body techniques is associated with weight status. The purpose of this study is to examine the relationship between the practice of mind-body techniques and weight status in a large population-based sample of adults.

METHODS

A total of 61,704 individuals aged ≥18 years participating in the NutriNet-Santé study (2009-2014) were included in this cross-sectional analysis conducted in 2014. Data on mind-body practices were collected, as well as self-reported weight and height. The association between the practice of mind-body techniques and weight status was assessed using multiple linear and multinomial logistic regression models adjusted for sociodemographic, lifestyle, and dietary factors.

RESULTS

After adjusting for sociodemographic and lifestyle factors, regular users of mind-body techniques were less likely to be overweight (OR=0.68, 95% CI=0.63, 0.74) or obese (OR=0.55, 95% CI=0.50, 0.61) than never users. In addition, regular users had a lower BMI than never users (-3.19%, 95% CI=-3.71, -2.68).

CONCLUSIONS

These data provide novel information about an inverse relationship between mind-body practice and weight status. If causal links were demonstrated in further prospective studies, such practice could be fostered in obesity prevention and treatment.

Tryptophan depletion in context of the inflammatory and general nutritional status of a low-income South African HIV-infected population

BACKGROUND

The essential amino acid tryptophan cannot be synthesised in the body and must be acquired through dietary intake. Oxidation of tryptophan, due to immune induction of the enzyme indoleamine 2,3-dioxygenase (IDO), is considered to be the main cause of tryptophan depletion in HIV infection and AIDS. We examined plasma tryptophan levels in a low-income sub-Saharan HIV-infected population and compared it to that of developed countries. Tryptophan levels were further examined in context of the general nutritional and inflammatory status.

METHODS

This cross-sectional study included 105 HIV-positive patients recruited from the Kalafong Hospital in Pretoria, South Africa, and 60 HIV-negative controls.

RESULTS

Patient tryptophan levels were in general markedly lower than those reported for developed countries. In contrast to reports from developed countries that showed tryptophan levels on average to be 18.8 % lower than their control values, tryptophan levels in our study were 44.1 % lower than our controls (24.4 ± 4.1 vs. 43.6 ± 11.9 μmol/l; p < 0.001). Tryptophan levels correlated with both CD4 counts (r = 0.341; p = 0.004) and with pro-inflammatory activity as indicated by neopterin levels (r = -0.399; p = 0.0001). Nutritional indicators such as albumin and haemoglobin correlated positively with tryptophan and negatively with the pro-inflammatory indicators neopterin, interleukin 6 and C-reactive protein. The most probable causes of the lower tryptophan levels seen in our population are food insecurity and higher levels of inflammatory activity.

CONCLUSIONS

We contend that inflammation-induced tryptophan depletion forms part of a much wider effect of pro-inflammatory activity on the nutritional profile of HIV-infected patients.

Prevalence of abnormal birth weight and related factors in Northern region, Ghana

BACKGROUND

Birth weight is a crucial determinant of the development potential of the newborn. Abnormal newborn weights are associated with negative effects on the health and survival of the baby and the mother. Therefore, this study was designed to determine the prevalence of abnormal birth weight and related factors in Northern region, Ghana.

METHODS

The study was a facility-based cross-sectional survey in five hospitals in Northern region, Ghana. These hospitals were selected based on the different socio-economic backgrounds of their clients. The data on birth weight and other factors were derived from hospital records.

RESULTS

It was observed that low birth weight is still highly prevalent (29.6%), while macrosomia (10.5%) is also increasingly becoming important. There were marginal differences in low birth weight observed across public hospitals but marked difference in low birth weight was observed in Cienfuegos Suglo Specialist Hospital (Private hospital) as compared to the public hospitals. The private hospital also had the highest prevalence of macrosomia (20.1%). Parity (0-1) (p < 0.001), female gender (p < 0.001) and location (rural) (p < 0.001) were significantly associated with decreased risk of macrosomic births. On the other hand, female infant sex (p < 0.001), residential status (rural) (p < 0.001) and parity (0-1) (p < 0.001) were significantly associated with increased risk of low birth weigh.

CONCLUSIONS

Our findings show that under nutrition (low birth weight) and over nutrition (macrosomia) coexist among infants at birth in Northern region reflecting the double burden of malnutrition phenomenon, which is currently being experienced by developing and transition counties. Both low birth weight and macrosomia are risk factors, which could contribute considerably to the current and future burden of diseases. This may overstretch the already fragile health system in Ghana. Therefore, it is prudent to recommend that policies aiming at reducing diet related diseases should focus on addressing malnutrition during pregnancy and early life.

Maternal Determinants of Birth Weight in Northern Ghana

OBJECTIVES

Weight at birth is usually considered as an indicator of the health status of a given society. As a result this study was designed to investigate the association between birth weight and maternal factors such as gestational weight gain, pre-pregnancy BMI and socio-economic status in Northern Ghana.

METHODS

The study was a facility-based cross-sectional survey conducted in two districts in the Northern region of Ghana. These districts were purposively sampled to represent a mix of urban, peri-urban and rural population. The current study included 419 mother-infant pairs who delivered at term (37-42 weeks). Mother's height, pre-pregnancy weight and weight changes were generated from the antenatal records. Questionnaires were administered to establish socio-economic and demographic information of respondents. Maternal factors associated with birth weight were examined using multiple and univariate regressions.

RESULTS

The mothers were generally well nourished before conception (Underweight 3.82%, Normal 57.76%, Overweight 25.06% and Obesity 13.37%) but approximately half of them could not gain adequate weight according to Institute of Medicine recommendations (Low weight gain 49.64%, Adequate weight gain 42.96% and Excessive weight gain 7.40%). Infants whose mothers had excess weight gain were 431g (95% CI 18-444) heavier compared to those whose mothers gained normal weight, while those whose mothers gained less were 479g (95% CI -682- (-276) lighter. Infants of mothers who were overweight and obese before conception were 246g (95% CI 87-405) and 595g (95% CI 375-815) respectively heavier than those of normal mothers, whereas those whose mothers were underweight were 305g (95% CI -565 -(-44) lighter. The mean birth weight observed was 2.98 ± 0.68 kg.

CONCLUSION

Our findings show that pre-pregnancy body mass index and weight gain during pregnancy influence birth weight. Therefore, emphasis should be placed on counseling and assisting pregnant women to stay within the recommended weight gain ranges.

The Obesity Epidemic: The United States as a Cautionary Tale for the Rest of the World

Obesity is a global epidemic and its prevalence continues to increase in many developed and developing countries. This brief review provides an update on the prevalence of obesity in the United States (US) and globally, reviews the underlying mechanism of several comorbidities associated with obesity, and discusses the economic burden of obesity. Although the overall prevalence of obesity in the US is not increasing, racial and ethnic minorities continue to struggle with rising obesity rates. Globally, the largest increases are being observed in developing continues. Given the comorbidities associated with obesity and its immense economic burden, nearly every country will soon struggle with the financial and healthcare implications of the epidemic.

A weight loss program in a chiropractic practice: a retrospective analysis

CONTEXT

Obesity is a global problem and places individuals at risk for developing chronic metabolic disorders. The need for investigating simple, effective and sustaining approaches to weight loss cannot be overstated.

METHODS

We performed a retrospective file analysis of patient files attending a 13-week weight loss program. Inclusion for analysis were files of adults (i.e., >18 years) completing the program consisting of chiropractic adjustments/spinal manipulative therapy augmented with diet/nutritional intervention, exercise and one-on-one counseling.

RESULTS

Sixteen of 30 people (i.e., 53.33%) completed the program. Statistically and clinically significant changes were noted in weight and BMI measures based on pre-treatment (average weight = 190.46 lbs. and BMI = 30.94 kg/m(2)) and comparative measurements (average weight = 174.94 lbs. and BMI = 28.50 kg/m(2)).

CONCLUSION

A cohort of patients under enrolled in a weight loss program was described. This provides supporting evidence on the effectiveness of a multi-modal approach to weight loss implemented in a chiropractic clinic.

Sustainability and Food & Nutrition Security

Recurrent food crises and climate change, along with habitat loss and micronutrient deficiencies, are global issues of critical importance that have pushed food security and environmental sustainability to the top of the political agenda. Analyses of the dynamic linkages between food consumption patterns and environmental concerns have recently received considerable attention from the international and scientific community. Using the lens of a broad sustainability approach, this conceptual article aims at developing a multidimensional framework to evaluate the sustainability of food systems and diets, applicable to countries of the Mediterranean region. Derived from natural disaster and sustainability sciences, a vulnerability approach, enhanced by inputs from the resilience literature, has been adapted to analyze the main issues related to food and nutrition security. Through causal factor analysis, the resulting conceptual framework improves the design of information systems or metrics assessing the interrelated environmental, economic, social, and health dynamics of food systems.

Energy balance and obesity: a UK perspective on the gluttonyv.sloth debate

Obesity in the UK was assumed to have developed against a population decline in physical activity, with health messages focused on diet and exercise prevention strategies. Doubly-labelled water (DLW) studies of energy expenditure have indicated the alternative scenario that the increased obesity prevalence reflects excessive food energy intake with physical activity levels unchanged. This analysis is questionable, deriving in part from a weakness of the DLW methodology in identifying changing physical activity levels within populations of increasing body weight. This has resulted in an underestimation of the reduction in physical activity in the overweight and obese, as revealed by direct studies of such behaviour. Furthermore, a close examination of food energy supply, household food purchases and individual food energy consumption since 1955, in relation to likely estimates of current intakes indicated by simple modelling of predicted energy expenditure, identifies: (a) food energy supply as markedly overestimating energy intakes; (b) individual food energy consumption as markedly underestimating energy intakes; and (c) household food purchase data as the closest match to predicted current food energy intakes. Energy intakes indicated by this latter method have fallen by between 20 to 30 %, suggesting comparable falls in physical activity. Although unequivocal evidence for a matching UK trend in falling physical activity is limited, as is evidence that obesity follows reductions in physical activity, such a link has been recently suggested in a large prospective study in adolescents. Thus, for the UK, obesity has developed within a ‘move less–eat somewhat less but still too much’ scenario. A focus on both diet and exercise should remain the appropriate public health policy.

A comparative study on nutritional status and body composition of urban and rural schoolchildren from Brandsen district (Argentina)

The purpose of this study was to analyze whether nutritional status and body composition varies according to the environment of residence (urban or rural) of children in the Brandsen district (Argentina). Weight, height, arm circumference and tricipital and subscapular skinfolds were performed in 1368 schoolchildren aged 3 to 14. NHANES III reference was used to estimate nutritional status -underweight, stunting, wasting, overweight, and obesity- and to evaluate body composition -deficit and excess of adipose (DA, EA) and muscular (DM, EM) tissues of the arm-. Central fat distribution (CFD) was estimated using the subscapular-tricipital index. A structured questionnaire was implemented to evaluate socio-environmental characteristics. Nutritional categories based on body size and body composition were compared between urban and rural areas of residence using Chi-squared tests (χ2). The results indicated for the total sample: 1.1% underweight, 6.9% stunting, 0.4% wasting, 12.1% overweight, 9.7% obesity, 22.0% DM, 2.5% EM, 0.1% DA, 17.6% EA, and 8.5% CFD. Significant differences between urban and rural areas were found only for CFD. The socio-environmental analysis showed that while access to public services and housing quality was significantly better in the urban area, a considerable number of city households lived under deficient conditions, lacked health insurance and had low socioeconomic level. Fifty-three percent of the undernourished children had DM without urban-rural significant differences, and none of them showed DA. In the overweight plus obesity group, 62.8% presented EA, 6.4% EM, 4.7% DM, and 22.8% CFD. The highest percentages of DM and CFD were recorded in rural areas (p = 0.00). We conclude that the child population shows the “double burden” of malnutrition. The environment of residence does not promote any differentiation in the nutritional status. Nevertheless, the increment of central adiposity and, in some cases of muscle deficit in rural children, suggests a consumption of unbalanced diet.

Obesity in Asia--is it different from rest of the world

An epidemic of obesity and obesity related diseases such as diabetes and cardio vascular disease (CVD) is prevalent in many Asian countries. Migration from rural to urban areas, and rapid socio-economic transition are associated with the lifestyle changes resulting in decreased levels of physical activity and increased intake of energy dense diet.

Hunter-gatherer energetics and human obesity

Western lifestyles differ markedly from those of our hunter-gatherer ancestors, and these differences in diet and activity level are often implicated in the global obesity pandemic. However, few physiological data for hunter-gatherer populations are available to test these models of obesity. In this study, we used the doubly-labeled water method to measure total daily energy expenditure (kCal/day) in Hadza hunter-gatherers to test whether foragers expend more energy each day than their Western counterparts. As expected, physical activity level, PAL, was greater among Hadza foragers than among Westerners. Nonetheless, average daily energy expenditure of traditional Hadza foragers was no different than that of Westerners after controlling for body size. The metabolic cost of walking (kcal kg(-1) m(-1)) and resting (kcal kg(-1) s(-1)) were also similar among Hadza and Western groups. The similarity in metabolic rates across a broad range of cultures challenges current models of obesity suggesting that Western lifestyles lead to decreased energy expenditure. We hypothesize that human daily energy expenditure may be an evolved physiological trait largely independent of cultural differences.

Energy expenditure in adults living in developing compared with industrialized countries: a meta-analysis of doubly labeled water studies

BACKGROUND

There is an assumption that people in developing countries have a higher total energy expenditure (TEE) and physical activity level (PAL) than do people in developed nations, but few objective data for this assertion exist.

OBJECTIVE

We conducted a meta-analysis of TEE and PAL by using data from countries that have a low or middle human development index (HDI) compared with those with a high HDI to better understand how energy-expenditure variables are associated with development status and population differences in body size.

DESIGN

We performed a literature search for studies in which energy expenditure was measured by using doubly labeled water. Mean data on age, weight, body mass index (BMI; in kg/m(2)), TEE, and PAL were extracted, and HDI status was assessed. Pooled estimates of the mean effect by sex were obtained, and the extent to which age, weight, HDI status, and year of publication explained heterogeneity was assessed.

RESULTS

A total of 98 studies (14 studies from low- or middle-HDI countries) that represented 183 cohorts and 4972 individuals were included. Mean (±SE) BMI was lower in countries with a low or middle HDI than in those with a high HDI for both men and women (22.7 ± 1.0 compared with 26.0 ± 0.7, respectively, in men and 24.3 ± 0.7 compared with 26.6 ± 0.4, respectively, in women). In meta-regression models, there was an inverse association of age (P < 0.001) and a positive association of weight (P < 0.001) with TEE for both sexes; there was an association of age only in men with PAL (P < 0.001). There was no association of HDI status with either TEE or PAL.

CONCLUSION

TEE adjusted for weight and age or PAL did not differ significantly between developing and industrialized countries, which calls into question the role of energy expenditure in the cause of obesity at the population level.

Prevalence of overweight and obesity in Italy (2001-2008): is there a rising obesity epidemic?

PURPOSE

To provide national, population-based estimates of the prevalence of overweight and obesity in the Italian population.

METHODS

Prevalence estimates of overweight and obesity were calculated in seven waves (2001-2008) of the cross-sectional Multipurpose Household Survey organized by the Italian National Institute of Statistics, which are representative of the general adult Italian population. Sampling weights were used to estimate prevalence figures as well as their standard errors. Mean-difference plot was used to evaluate changes in the distribution of body mass index across sex and age categories.

RESULTS

Almost half of Italian men and about 1 of 3 Italian women are overweight or obese. Between 2001 and 2008 the age-standardized prevalence of overweight (obesity) increased 1.4% (1.9%) in men and 0.4% (0.5%) in women. Mean-difference plots showed an upward shift for body mass index distribution with an increasing skewness.

CONCLUSIONS

The obesity epidemic is one of the major issues in United States and other developed countries. However, if for "epidemic" we mean that in Italy obesity is steadily increasing, then our data give little support to this interpretation. In fact, trends observed between 1983 and 2008 suggest that the rates of changes in the prevalence of overweight and/or obesity are not increasing.

Food prices and fruit and vegetable consumption among young American adults

Multivariate negative binomial count models were estimated to examine associations between young adults' fruit and vegetable (FV) consumption and the prices of FV, other food at home grocery items, and fast food and the availability of restaurants and food stores. This study used the 2002 wave of data collected from US young adults aged 18-23 years in the 1997 National Longitudinal Survey of Youth merged by geocode identifiers with food prices and restaurant and food store availability. The results showed that higher levels of FV consumption were associated with lower FV prices (price elasticity of -0.32) and that this own-price effect was robust to the inclusion of other food prices and food outlet availability. Lower income and lower educated young adults and those with lower educated mothers and middle-income parents were found to be most price sensitive. No statistically significant cross-price effects on FV consumption were found with other grocery food (meat, dairy and bread) prices or fast food prices. Fiscal policy instruments such as FV subsidies may help to increase FV intake, particularly among young adults of lower socioeconomic status.

Non-communicable diseases and global health governance: enhancing global processes to improve health development

This paper assesses progress in the development of a global framework for responding to non-communicable diseases, as reflected in the policies and initiatives of the World Health Organization (WHO), World Bank and the UN: the institutions most capable of shaping a coherent global policy. Responding to the global burden of chronic disease requires a strategic assessment of the global processes that are likely to be most effective in generating commitment to policy change at country level, and in influencing industry behaviour. WHO has adopted a legal process with tobacco (the WHO Framework Convention on Tobacco Control), but a non-legal, advocacy-based approach with diet and physical activity (the Global Strategy on Diet, Physical Activity and Health). The paper assesses the merits of the Millennium Development Goals (MDGs) and the FCTC as distinct global processes for advancing health development, before considering what lessons might be learned for enhancing the implementation of the Global Strategy on Diet. While global partnerships, economic incentives, and international legal instruments could each contribute to a more effective global response to chronic diseases, the paper makes a special case for the development of international legal standards in select areas of diet and nutrition, as a strategy for ensuring that the health of future generations does not become dependent on corporate charity and voluntary commitments. A broader frame of reference for lifestyle-related chronic diseases is needed: one that draws together WHO's work in tobacco, nutrition and physical activity, and that envisages selective use of international legal obligations, non-binding recommendations, advocacy and policy advice as tools of choice for promoting different elements of the strategy.

Fatigue performance of composite analogue femur constructs under high activity loading

Synthetic mechanical analogue bone models are valuable tools for consistent analysis of implant performance in both equilibrium and fatigue biomechanical testing. Use of these models has previously been limited by the poor fatigue performance when tested under realistic service loads. An objective was to determine whether a new analogue bone model (Fourth-Generation) using enhanced analogue cortical bone provides significantly improved resistance to high load fracture and fatigue as compared to the current (Third-Generation) bone models in clinically relevant in situ type testing of total hip implants. Six Third-Generation and six Fourth-Generation mechanical analogue proximal femur models were implanted with a cemented mock hip arthroplasty. Each specimen was loaded at 5 Hz in simulated one-legged stance under load control with a maximum compressive load of 2670 N and load ratio of 0.1. Average complete structural failure in Third-Generation femurs occurred at 3.16 million cycles; all specimens exhibited substantial displacement and crazing at well below 3 million cycles. In contrast, all Fourth-Generation femurs sustained 10 million cycles without complete structural failure and showed little change in actuator deflection. The Fourth-Generation femur model performance was sufficient to allow the model to be used in biomechanically relevant load bearing levels with an intramedullary device without model compromise that would affect test results.

Effectiveness of monetary incentives in modifying dietary behavior:a review of randomized, controlled trials

To review research evidence on the effectiveness of monetary incentives in modifying dietary behavior, we conducted a systematic review of randomized, controlled trials (RCTs) identified from electronic bibliographic databases and reference lists of retrieved relevant articles. Studies eligible for inclusion met the following criteria: RCT comparing a form of monetary incentive with a comparative intervention or control; incentives were a central component of the study intervention and their effect was able to be disaggregated from other intervention components; study participants were community-based; and outcome variables included anthropometric or dietary assessment measures. Data were extracted on study populations, setting, interventions, outcome variables, trial duration, and follow-up. Appraisal of trial methodological quality was undertaken based on comparability of baseline characteristics, randomization method, allocation concealment, blinding, follow-up, and use of intention-to-treat analysis. Four RCTs were identified as meeting the inclusion criteria. All four trials demonstrated a positive effect of monetary incentives on food purchases, food consumption, or weight loss. However, the trials had some methodological limitations including small sample sizes and short durations. In addition, no studies to date have assessed effects according to socioeconomic or ethnic group or measured the cost-effectiveness of such schemes. Monetary incentives are a promising strategy to modify dietary behavior, but more research is needed to address the gaps in evidence. In particular, larger, long-term RCTs are needed with population groups at high risk of nutrition-related diseases.

The new nutrition science project

Objective

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.

Method

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.

Results

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.

Conclusion

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.

Dimensions, domains and principles of the new nutrition science

OBJECTIVE

Following the agreed principles, definition and dimensions of the new nutrition science, to elaborate its overall guiding principles, to propose some domains of its biological, social and environmental dimensions, and to propose a series of principles to govern and guide these dimensions and domains. This paper, part of The New Nutrition Science project, is initial work in progress towards a comprehensive typology of the science, and is designed to stimulate further work.

METHOD

A review that takes into account the discussions of the Giessen workshop on the new nutrition science, and in particular the workshop agreement as expressed in The Giessen Declaration. Three outlines of the evolutionary, historical and ecological general principles to guide the new nutrition science are given in boxed texts. The suggested specific principles, taken mostly from 14 associated papers and workshop discussion, are an informal supplement to the Declaration. They are presented as further work in progress, to be developed, revised and agreed at future meetings designed to develop the new nutrition science.

CONCLUSION

An essential aspect of the theory and the practice of the new nutrition science--in common with any scientific discipline and indeed any ordered human activity--is a specification of its dimensions and their domains, with definitions; and also considered and agreed principles to govern and guide its work.

The principles, definition and dimensions of the new nutrition science

Objective

To specify the principles, definition and dimensions of the new nutrition science.

Purpose

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.

Method

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.

Result

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.

The emerging epidemic of obesity in developing countries

Thirty years ago international nutritionists were focussing on childhood malnutrition, the 'protein gap' and how to feed the world's burgeoning population, and medical services in the developing world were concentrated on the fight against infectious diseases. Today the World Health Organization (WHO) finds itself needing to deal with the new pandemic of obesity and its accompanying non-communicable diseases (NCDs) while the challenge of childhood malnutrition has far from disappeared, TB and malaria rates are escalating, and the scourge of AIDS has emerged. This has created a 'double burden' of disease that threatens to overwhelm the health services of many resource-poor countries. WHO warns that the greater future burden of obesity and diabetes will affect developing countries, and the projected numbers of new cases of diabetes run into the hundreds of millions within the next 2 decades. The obesity pandemic originated in the US and crossed to Europe and the world's other rich nations before, remarkably, it penetrated even the world's poorest countries especially in their urban areas. The pandemic is transmitted through the vectors of subsidized agriculture and multinational companies providing cheap, highly refined fats, oils, and carbohydrates, labour-saving mechanized devices, affordable motorized transport, and the seductions of sedentary pastimes such as television. This paper briefly reviews these macro-environmental trends as well as considering some of the socio-behavioural influences on weight gain in traditional societies. It concludes, pessimistically, that the pandemic will continue to spread for the foreseeable future, and that, apart from educational campaigns, the governments and health services of poor countries will have few effective public health levers with which they can try to arrest the trend.