What is clinical nutrition? Understanding the epistemological foundations of a new discipline.

BACKGROUND: Although the therapeutic and economic efficacy of nutrition has been proven, optimal nutritional care is still scarce among hospital and ambulatory patients. Thus malnutrition is still highly prevalent. We identify as an underlying cause the absence of a common understanding of clinical nutrition as a discipline. The aim of this paper is to establish the epistemological foundations of clinical nutrition and to characterize it as a science. METHODS AND RESULTS: From the standpoint of historical epistemology, we examine the historical conditions that determine i) the main object of knowledge, ii) the nature and iii) domain of this science. Our hypothesis is that clinical nutrition as a science was formed in the second half of the twentieth century as an outcome of the integration of medicine and nutrition and underpinned by a primary transformation of the "nutrient" concept. We identify malnutrition as the primary practical and research domain of knowledge. CONCLUSION: Clinical nutrition is an autonomous empirical science that can be characterized as a basic and applied science. Its wide multi-disciplinarity guarantees its future.

Historia de la nutrición clínica española (1): Nutrición artificial y su incorporación al ámbito clínico español / The development of clinical nutrition in Spain (1): integrating artificial nutrition into the Spanish clinical setting

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Historia de la Nutrición Clínica Española (2): La contribución de SENPE y de la revista Nutrición Hospitalaria / The development of clinical nutrition in Spain (2): the contribution of SENPE and «Nutrición Hospitalaria» journal

Se aborda la aportación que ha realizado la Sociedad Española de Nutrición Parenteral y Enteral (SENPE) a la nutrición clínica, a través del análisis de los principales elementos que han configurado su proyecto de asociacionismo científico: los inicios y el contexto científico y asistencial que determinó su puesta en marcha, las características y la evolución de los socios y de las juntas directivas, los congresos y las reuniones científicas organizadas, la importancia que ha adquirido la revista Nutrición Hospitalaria como referente para la comunicación científica en el ámbito de las ciencias de la nutrición y las actividades encaminadas a promover la investigación y la formación continuada (grupos de trabajo, publicaciones, etc.) (AU)

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What's next? Nutrition care and science in the 21st century.

The purpose of this review is 2-fold. First, it speculates on future scientific work that will have the greatest effect on clinical practice of nutrition care. Second, it discusses the current and future state of the healthcare system, paying special attention to demographic trends and the future of healthcare reform as it will affect nutrition practice.

INCAP Oriente longitudinal study: 40 years of history and legacy.

Our purpose in this article is to describe the objectives, design, overall coverage, and main domains of data collection of the Institute of Nutrition of Central America and Panama Oriente Longitudinal Study and subsequent follow-up studies. This supplementary feeding trial targeted to pregnant and lactating women and children from birth to 7 y of age, conducted in 4 rural Guatemalan villages (1969-77) with a series of follow-up studies (1988-2007), is one of the richest sources of information on the effects of nutrition, growth, development, and human capital in the developing world, with outstanding data from gestation to adult age and 40 y of follow-up. Its results have influenced nutrition knowledge and policy with over 300 scientific publications. We present brief descriptions of preliminary studies that were critical for the success of the trial and the design and methods used during the trial and in the follow-up studies, in chronological order.

History and early development of INCAP.

Nevin Scrimshaw was the founding Director of the Institute of Nutrition of Central America and Panama (INCAP), serving as Director from 1949 to 1961. In this article, he reviews the history of the founding of INCAP, including the role of the Rockefeller and Kellogg Foundations, the Central American governments, and the Pan American Health Organization. The objectives pursued by INCAP in its early years were to assess the nutrition and related health problems of Central America, to carry out research to find practical solutions to these problems, and to provide technical assistance to its member countries to implement solutions. INCAP pursued a strategy of selecting promising Central Americans for advanced education and training in the US who assumed positions of leadership on their return. After this early phase, talented non-Central Americans of diverse origins were brought to INCAP, as well as additional researchers from the region. Growth of INCAP, as reflected in its annual budget and in the physical plant, was rapid and this was accompanied by high scientific productivity. Several field studies were launched that contributed impetus and design elements for the Oriente Longitudinal Study, which is the focus of this supplement.

What went right? The story of US Medicare Medical Nutrition Therapy.

When President Lyndon Johnson signed the Medicare and Medicaid bill into law in 1965, it ended the 46-year campaign to enact a healthcare program for senior citizens and started what is now a 42-year effort by the American Dietetic Association (ADA) and its members to expand its coverage to 'nutrition services' for all appropriate diseases, disorders and conditions. In December 2000, Congress passed a Medicare Part B Medical Nutrition Therapy (MNT) provision, limited to patients with diabetes and/or renal disease, effective January 2002. In December 2003, the Medicare Modernization Act expanded access to MNT benefit and ADA continues to focus on the role of the registered dietician in MNT. Successful expansion of MNT benefits will require that ADA continues to demonstrate the cost-effectiveness and efficacy of nutrition counseling, as performed by the registered dietitian.

Malnutrition in emergencies: the framing of nutrition concerns in the humanitarian appeals process, 1992 to 2009.

This paper examines how nutrition has been used to raise humanitarian relief resources through the United Nations appeals process, from 1992 to early 2009. Recent calls for "nutrition safety nets" as a response to the world food price crisis reflect a growing recognition of nutrition as a key element in crisis management, not simply as a metric of how bad things have become. The evolution in thinking about the role of nutrition in emergency programming is reflected in changes in how nutrition has been conceptualized and presented in the consolidated appeals process. Based on a desk review, supported by key informant interviews, the paper highlights important changes that include an increasing distinction that separates nutrition from food, water, and health; the importance of synergies across sectors; increased emphasis on "essential packages" of inputs and services versus stand-alone activities; the importance of technical rigor in food and nutrition assessment and surveys; the need for technical competency and capacity in the design and management of nutrition interventions; and the importance of planning for long-term change even in delivering a short-term response. There has also been growing emphasis on specificity in objectives--a trend linked to demand for more accountability across the humanitarian system. Enhanced emergency preparedness will require further capacity building and improved systems for surveillance and data management. Without more systematic, targeted attention to pre-crisis malnutrition, the resources needed to tackle nutrition problems during emergencies will continue to grow.