New Paradigm of Evidence-Based Nutrition

A Commentary on the Nutrient-Chronic Disease Relationship and the New Paradigm of Evidence-Based Nutrition

A discussion regarding the relationship between predisposition to many chronic diseases and the diet, nutritional status, and lifestyle of an individual.

Abstract

Understanding the role of nutrition in the prevention of long-latency chronic disease is one of the greatest challenges facing the health sciences field today.

The scientific community lacks consensus around how to appropriately generate and/or evaluate the available nutrition data to inform treatment recommendations and public policy decisions.

Evidence-based medicine (EBM) is a well-established research paradigm for the evaluation of drug effects. Currently, EBM is arguably being misapplied in order to establish the relationship between nutrients and human health. Nutrients and other bioactive food components are not drugs, and several distinguishing characteristics are overlooked in the design and/or interpretation of nutrition research. Unlike drugs, nutrients work in complex networks, are homeostatically controlled, and cannot be contrasted to a true placebo group. The beneficial effects of nutrients are small and can take decades to manifest. A new paradigm of evidence-based nutrition (EBN) needs to be established that sets criteria and guidelines for how to best study the effects of nutrients in humans. EBN must consider the complex nuances of nutrients and bioactive food components to better inform the design and interpretation of nutrition research. Practitioners, researchers, and policy makers will be better served by a nutrition-centered framework suited to assess the totality of the available evidence and inform treatment and policy decisions. Several recommendations for guidelines and criteria that could help define the EBN research paradigm are discussed.

Introduction

There is general agreement within the nutrition science and practitioner communities that one’s diet, nutritional status, and lifestyle can substantially predispose one to (or protect against) many chronic diseases and other conditions, including heart disease, diabetes, and cardiovascular disease.

For decades, the US government has invested, and continues to invest, enormous resources to support programs such as the Dietary Guidelines for Americans1 and the Institute of Medicine’s (IOM) Dietary Reference Intakes2 to develop recommendations for diet and nutrient intake levels that will, among other things, reduce chronic disease risk within the population.

The nutrient-chronic disease relationship is also addressed by the Food and Drug Administration (FDA) when it reviews Health Claim and Qualified Health Claim petitions,3 both of which are viewed as broad public health statements. But many questions unique to nutrition still remain when it comes to evaluating the evidence on which these and other recommendations are based. Although a research paradigm for the evaluation of drug effects—evidence-based medicine (EBM)—has been established for years,1 the amount, level, and scope of scientific evidence, and the interpretation needed to support nutrition recommendations, continue to be of intense debate.4–6 Obtaining this evidence has proved to be challenging due to resource and feasibility limitations. Consensus does not yet exist about how to appropriately generate and/or evaluate the available data to inform clinical and/or public policy decision making. These and other important issues are currently being debated by scientists from government (FDA, NIH, USDA), academia, and industry, as well as among practitioners.

Continued Tomorrow

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http://www.depsyl.com/

http://back2basicnutrition.com/

http://bionutritionalresearch.olhblogspace.com