Position of the Academy of Nutrition and Dietetics: Nutrition Informatics

It is the position of the Academy of Nutrition and Dietetics that nutrition informatics is a rapidly evolving area of practice for registered dietitian nutritionists and nutrition and dietetic technicians, registered; and that the knowledge and skills inherent to nutrition informatics permeate all areas of the dietetics profession. Further, nutrition and dietetics practitioners must continually learn and update their informatics knowledge and skills to remain at the forefront of nutrition practice. Nutrition informatics is the intersection of information, nutrition, and technology. However, informatics is not just using technology to do work. The essence of nutrition informatics is to manage nutrition data in combination with standards, processes, and technology to improve knowledge and practice that ultimately lead to improved quality of health care and work efficiency. Registered dietitian nutritionists and nutrition and dietetic technicians, registered, are already experts in using evidence to practice in all areas of nutrition and dietetics. To remain at the forefront of technological innovation, the profession must actively participate in the development of standards, processes, and technologies for providing nutrition care.     

Exploring Culture in the World of International Nutrition and Nutrition Sciences

This symposium was organized to bring insights from the social sciences into the awareness of nutrition scientists committed to developing and implementing effective nutrition interventions internationally. The symposium explored three different areas in the field where a more precise analysis of culture could enhance the effectiveness of nutrition science: 1) in the implementation of nutrition science research in the field; 2) in the collaboration of multiple stakeholders working to enhance nutrition in a national setting; and 3) in the language and discussions used to frame proposed changes in large scale food and nutrition security policy transnationally. Three social scientists, Monique Centrone Stefani, Lucy Jarosz, and David Pelletier were invited to share insights from their respective disciplines and respondents from within the field of nutrition provided initial reflections to better understand such perspectives. The symposium’s interdisciplinary nature was designed to illustrate the challenge of multiple perspectives and methodologies and to advance understanding that could derive from such an exchange for those in the field of international nutrition seeking to decrease global hunger and malnutrition.Culture is an integral component of food habits, affecting what, when, and how we eat. Although there is a general tendency to understand culture as applying only to nations and ethnicities, social scientists see culture in every sphere of life. Social scientists define culture as the values, beliefs and ideas, objects and technologies, norms of behavior and related expectations, as well as the identities and unspoken rules that orient peoples’ activity in the world. Examined in this way, culture infuses national-level perceptions of malnutrition, informs professional approaches to characterizing and addressing malnutrition, and is embedded in the very science of nutrition itself. Culture comprises the language and symbolic elements that characterize the life of groups and serves to orient both group members and nonmembers to the norms of the group. For example, ethnic traditions are a strong factor in determining people’s food choices. Within the field of nutritional sciences, the professional culture is a reflection of beliefs shared by nutrition scientists about appropriate topics and methods of a nutrition research program.This symposium was organized to bring insights from the social sciences into the awareness of nutrition scientists committed to developing and implementing effective nutrition interventions. The symposium explored 3 different arenas where an understanding of cultural thinking could enhance the effectiveness of nutrition science: first, in the implementation of nutrition science research in the field; second, in the collaboration of multiple stakeholders working to enhance nutrition in a national setting; and third, in the language and discussions that are used to frame proposed changes in large-scale food and nutrition security policy transnationally. Three social scientists were invited to share insights from their respective disciplines and respondents from within the field of nutrition provided initial reflections to better understand the perspectives. The symposium’s interdisciplinary nature was designed to illustrate the challenge of multiple perspectives and methodologies and the potential for advancing the understanding of those in the field of international nutrition seeking to decrease global hunger and malnutrition.Dr. Monique Centrone Stefani described the work of creating boundaries around a scientific discipline, nutrition science, and the process of defining what knowledge is inside the scientific domain and what is outside. The creation of scientific or generalizable knowledge about nutrition, such as the role of multiple anthropometric deficits in child mortality risks (1), is the domain of nutritional science. This can be seen in contrast to local or situated knowledge, for instance, in the consumption of culturally accepted nonfood items in Zanzibar, Tanzania (2). During the development of nutrition interventions, situated knowledge becomes critical for effectiveness. Yet the boundary between scientific and situated knowledge closely corresponds to the 2 branches within the field of nutrition, one focused on research, teaching, and training and the other focused on operations, programming, and planning (OPP) as characterized by Berg et al. (3). The former branch has historically been considered science, whereas the latter has not (4), yet these 2 structural directions delineate and reinforce a distinction between 2 different kinds of knowledge that are both crucial for the creation of effective interventions. The work of OPP is increasingly recognized as key for successful programming and this calls for a redrawing of scientific boundaries. In particular, OPP enters the domain of science by incorporating it into the emerging field of implementation science, which Dr. Pelletier et al. (5) have referred to as “Mode 2 research.” Dr. Centrone Stefani’s presentation outlined and illustrated how the tension between these 2 approaches plays out in creating the knowledge base for the field of nutrition science. She also explored how situated knowledge is legitimated by defining it in terms of implementation science. Dr. Anna Herforth, responding to Dr. Centrone Stefani’s presentation, spoke from her own experience of the ways in which micro-level knowledge of specific vegetables and rules for eating were crucial for developing effective interventions.Dr. David Pelletier’s and Dr. Gretel Pelto’s paper used a cultural approach to address the “challenge of managing and promoting effective agreements and alignments among and across agencies and disciplines that are engaged in the development of policies and programs to ameliorate undernutrition.” They provided an outline of the concept of organizational culture and applied the concept to a country-level case study to illuminate the challenges of creating a nationally owned intervention that included national government, donors and international non-governmental organizations (INGO), as is common in large-scale interventions. Drs. Pelletier and Pelto used a case study from their experience of working with a country during a period of 24 mo as a broad coalition sought to develop a national, multi-sectoral, nutrition strategy. After an extended period of time building relationships and developing a shared vision of a multidisciplinary approach, the leader of one organization was able to dramatically shift the discussions and agenda despite the previous agreement, although the government eventually reasserted the multi-sectoral vision. Dr. Pelletier’s presentation strongly suggested that national networks of collaboration in nutrition intervention need to articulate and make part of the process of developing nutrition interventions the collaboration itself, through explicit efforts to develop not only a shared culture but also shared interests. Despite recognition of a common vision to enhance nutrition, challenges remain in how organizations communicate, identify priorities, and direct an intervention agenda. The challenges are often based on underlying interests that derive from funding sources, history, and the culture of the sector: academia, civil society, or national level governments. The effect of the underlying interests on implementation of interventions remains less well studied. Dr. Uauy’s response on the politics of interventions he has witnessed and led in previous years affirmed and added another layer of complexity by illustrating how local-level interests complicate national-level approaches.Dr. Jarosz used discourse analysis to examine how language is used in 2 competing global policy discussions, food security and food sovereignty, each of which proposes to address the roots of malnutrition. Food security sees the roots in reliable access and food supply, and food sovereignty sees the roots in access to productive agricultural land and resources. This analysis illustrated how the discourses play out in 2 arenas, urban agriculture and land grabbing, and matched the practices and policies on the global, national, and community scale promoted by the proponents of food sovereignty and food security. In the analysis, Dr. Jarosz demonstrated how “practices aligned with food security and sovereignty discourses may enable food access and enable individuals and households to control the production and quality of some of the foods they consume, but may involve little or no transformation of governance and the larger political economies of food and agrarian development evidenced at the national and international levels.”Dr. Jarosz’s presentation suggested attention to 2 crucial issues for nutrition science: first, how the examination of language, in conjunction with the long-term historical problem of hunger and malnutrition, reveals important underlying structural dynamics of power and disenfranchisement for the individuals suffering the worst nutrition; and second, how language becomes a simplified lens through which actors concerned with nutrition in the global community reduce and polarize competitors where there are actually points of agreement. Dr. Jarosz’s work highlighted the range of groups that consider themselves stakeholders in global policy conversations foundational to nutrition, such as access to land that is used for food production. Her work reveals the complexity of interested stakeholder groups that are widely differentiated in terms of political and economic power on the global scale. A key implication of her work for the nutrition community would be to more carefully consider the labels behind which important global policy discussions and processes that affect nutrition occur.In comparing the work of Dr. Jarosz and Dr. Pelletier, Dr. Jarosz used a methodology, critical discourse analysis, described by Dr. Pelletier in his earlier presentation as underused yet essential to developing new paths in the reduction of hunger and malnutrition. The nutrition community would benefit from incorporating methodologies that look deeper into the alignment between, on the one hand, how stakeholders in nutrition policy describe nutrition problems and, on the other hand, their actual goals and practices and the underlying structural realities. In the case of food sovereignty compared with food security discourse, accepting the simple assumption that the 2 discourses actually represented opposing practices was shown to not always be the case, allowing a potential way forward. In contrast, Dr. Pelletier and Dr. Pelto’s research showed that discursive commitments that are taken as a baseline in reducing malnutrition may actually hide varied interests and agendas that become adversarial in the course of large-scale interventions. The concept of boundary making elaborated in Dr. Centrone Stefani’s work adds to a more nuanced understanding of intervention by showing how the formation of groups, in this case nutrition science itself, builds in assumptions about what are legitimate domains of study and how these domains are being consciously reconfigured to open a path forward.There is increasing attention given to the importance of culture in designing appropriate interventions (6), particularly in an era of cultural competency. However, the symposium sought to reverse the focus from the culture of those we are trying to help to our own culture within the field of nutrition. In line with previous authors from within the field, the symposium sought to provide additional tools for examining how we approach international nutrition and nutrition interventions in a way that might enhance effectiveness (3). The goal of this session was to explore the connections between the culture of the discipline in terms of underlying beliefs and values and how these interact with the different cultures within which nutrition scientists work. Adding new ways of thinking about important problems such as undernutrition will not provide a magic bullet. It will take collaboration and the international nutrition community’s re-envisioning many current processes and organizational arrangements in the governance of nutrition problems; it may even require an articulation and re-imagining of what nutrition science is itself. How the nutrition community takes on this challenge of interdisciplinarity illustrates the same issues Dr. Pelletier describes in his own work on multisectorality. Articulating and understanding these cultural spaces is integral to successful interventions and therefore to those who are the intended beneficiaries of nutrition research and intervention.     

Nutrition and the skin

The skin is influenced by the whole body and any disease affecting the body also affects the skin to a greater or less extent. Although the state of nutrition of the individual therefore is reflected in the skin, owing to the great variations of individual reaction to given stimuli, it is very difficult to enumerate specific skin changes resulting from dietetic causes. This has been discussed with special reference to vitamin deficiencies and abnormalities of food absorption.     

Nutrition for the lads

Throughout their lives, men's health compares badly to that of women. This article looks at healthy eating for men, whose energy and nutritional requirements differ from women's. It outlines the changes in food and alcohol intake that some males need to make in order to reduce their risk of ill-health and disease. A healthy diet in adolescence is also important as this is the period of rapid growth when much of the body's bone mass is laid down. Since men attend health centres and visit their general practitioners less often than women, health professionals should consider raising nutritional issues opportunistically.