From Treating Childhood Malnutrition to Public Health Nutrition

Abstract

Background: This analysis sets out an overview of an IUNS presentation of a European clinician’s assessment of the challenges of coping with immediate critical clinical problems and how to use metabolic and a mechanistic understanding of disease when developing nutritional policies. Summary: Critically ill malnourished children prove very sensitive to both mineral and general nutritional overload, but after careful metabolic control they can cope with a high-quality, energy-rich diet provided their initial lactase deficiency and intestinal atrophy are taken into account. Detailed intestinal perfusion studies also showed that gastroenteritis can be combatted by multiple frequent glucose/saline feeds, which has saved millions of lives. However, persisting pancreatic islet cell damage may explain our findings of pandemic rates of adult diabetes in Asia, the Middle East and Mexico and perhaps elsewhere including Africa and Latin America. These handicaps together with the magnitude of epigenetic changes emphasized the importance of a whole life course approach to nutritional policy making. Whole body calorimetric analyses of energy requirements allowed a complete revision of estimates for world food needs and detailed clinical experience showed the value of redefining stunting and wasting in childhood and the value of BMI for classifying appropriate adult weights, underweight and obesity. Lithium tracer studies of dietary salt sources should also dictate priorities in population salt-reduction strategies. Metabolic and clinical studies combined with meticulous measures of population dietary intakes now suggest the need for far more radical steps to lower the dietary goals for both free sugars and total dietary fat unencumbered by flawed cohort studies that neglect not only dietary errors but also the intrinsic inter-individual differences in metabolic responses to most nutrients. Key Messages: Detailed clinical and metabolic analyses of physiological responses combined with rigorous dietary and preferably biomarker of mechanistic pathways should underpin a new approach not only to clinical care but also to the development of more radical nutritional policies.

A Dissenter's Journey

“…We thought we were in paradise! My immediate research was on albumin metabolism (28) and then the extensive analyses of intestinal function, which involved constructing a five-lumen tube to assess both motility and absorption and then relating these to mucosal enzyme activities (20,21). Motility was secondary to malabsorption in the malnourished, but in gastroenteritis there was a secretory process, and inducing net absorption required both glucose and sodium in appropriate proportions (24).…”

“…Our whirlwind of research with both animal and human studies is summarized elsewhere (20,21). This was a fast-moving subject, and we found ourselves catapulted into the international spotlight by participation in a British Broadcasting Corporation (BBC) Horizon program on new science called Fat in the Fire, highlighting the new research on brown adipose tissue: Our team was the only one working with patients.…”

“…Having accepted the challenge of writing this autobiography, I began to wonder whether this was sensible, given that I had already produced a couple of overviews of my work (20,21). However, given the sudden turns in my career, I realized I could set out how key developments were often unexpected and achievements sometimes serendipitous.…”

Hunger and Obesity as Symptoms of Non-Sustainable Food Systems and Malnutrition

“…Malnutrition has been linked to both under-as well as overweight [1][2][3][4] and is considered the single most important threat to global public health [5][6][7], with data from the World Health Organization (WHO) suggesting that malnutrition accounts for the largest proportion of child mortality worldwide [8][9][10]. Undoubtedly, a population's nutrition, health status and wellbeing are closely linked with each other and together they can have far-reaching social, ecological and economic impact.…”

Food security in rural sub-Saharan Africa : a household level assessment of crop-livestock systems

“…These deficiencies increasingly co-exist with instances of obesity within the same communities -forming a triple burden on human health and society (May, 2018). Malnutrition is now the greatest risk factor driving a rising global noncommunicable disease burden (GBD 2016Risk Factors Collaborators, 2017, having direct implications for child growth failure, neonatal disorders, immune function, cognitive function, diabetes, heart disease and cancer (James, 2018;Prentice, 2018;de Pee et al, 2017;Pisa et al, 2017;Akombi et al, 2017;Micha et al, 2015). These burdens will only intensify as rural and urban populations grow, diets change and wealth is further concentrated (FAO et al, 2018;Popkin, 2014).…”