Despite enormous advances in nutrition science and a deepening understanding of the role of nutrition as a disease trigger, a global epidemic of lifestyle diseases rages around us. Why do we have this knowing-doing gap in the translation of nutrition science to the control of lifestyle diseases? asks Swaminathan Subramaniam.
Nutrition science has evolved tremendously over the last few decades to throw light on the role of nutrition as a trigger for lifestyle diseases. However, despite the 10-fold increase in publications on the topic of nutrition over the last four decades, there has been a concurrent three-fold rise in lifestyle diseases like obesity and type 2 diabetes. Nutraceutical interventions have had a negligible impact on the epidemic rise of these diseases. Why do we have this knowing-doing gap in the translation of nutrition science to the control of lifestyle diseases?
“Nutraceutical interventions have had a negligible impact on the epidemic rise of these diseases. Why do we have this knowing-doing gap in the translation of nutrition science to the control of lifestyle diseases?”
The science that drives nutrition recommendations is mostly based on observational studies. Subsequent prospective randomised controlled studies have more often than not contradicted the results of the original observational study. As a result, the use of observational studies to base nutritional recommendations has been questioned. Even a prospective study like the large PREDIMED study of the Mediterranean diet has suffered retraction due to improper randomisation procedures. Clinical nutrition studies experience a minefield of problems due to their complex methodology, making execution difficult if not impossible. Even if the execution is successful, the methodological peculiarities bear no resemblance to the context or practice of nutrition in real life.
Given these challenges, it is unlikely that the shifting sands of evidence in nutrition science will stabilise any time soon. The pendulum in nutrition science has swung from the extreme of untrammelled hubris to pessimistic nihilism. The prevailing nihilism is disappointing for consumers who have been conditioned by advertising to expect miracles from nutrition products. Is there a way out of this funk?
Several alternatives exist to the current model by which nutrition science is developed and applied to the development of nutrition products. One method is to treat nutrition within the context of the environment within which it is presented to the consumer – the nutrition ecology approach. Nutrition ecology is an integrative approach encompassing the entire food chain and its related elements. It has great explanatory power when applied to the nutrition of animals living in their native habitats. Application to human nutrition, either in generating new hypotheses or producing new answers has been limited and difficult.
The “beneficence” of phytochemicals inherent in our diets can be explained by the fact that they have co- evolved with our genome over thousands of years. The “beneficence” is not manifested as a clinical benefit in days, weeks or even months. It is expressed after decades of consumption of a particular diet. One way to detect these effects in the short-term is to use biomarkers of disease process (processes that are ongoing every day, such as tissue inflammation) rather than disease outcome (e.g. myocardial infarction). Validated biomarkers of disease process are robustly associated with disease outcome. Once this link is established, the biomarker can be used as a screening tool to discover disease-modifying nutraceuticals with potential clinical benefit following long-term consumption. Such biomarker technologies will allow us to run shorter prospective trials with the biomarker acting as a near-term surrogate for the desired long-term outcome. Using the biomarker as an inclusion criterion in these trials would also allow targeting nutraceutical interventions to the relevant population. These tools may help us avoid the Scylla and Charybdis of the small, impotent observational study and the long-term and impossible to do prospective study. The development and validation of disease process biomarkers should be high on the agenda for the global nutrition science community.
Listen to talk
- Supporting mental and physical wellbeing
- Despite advances in nutrition science, there is a vast knowing-doing gap, as attested to by the epidemic of obesity ravaging most societies
- Difficulties in translating nutrition science into marketplace innovation is a result of failures at multiple levels – from the research laboratory to the end-consumer
- Discussing key elements that contribute to this failure and offering a fresh perspective on how the translational gap in nutrition innovation can be bridged