Nutrition at the extremes of life

The Rank Prize lecture yesterday afternoon was a very interesting romp through the world of public health nutrition with Professor Ricardo Uauy. A difficult name to pronounce for many of us non-Spanish speakers (he’s originally from Chile), but a clear message at least.

Nutritionists need a common vision, a common mission to work towards. Together.

Uauy devoted his forty minutes of the Nutrition Society’s Summer Meeting in Nottingham to exploring the improvement that can be achieved at the extremes, the stunted growth, the obesity, the cardiovascular diseases, the stroke, the cognitive decline and even (believe-it-or-not) the climate change that result from getting the world’s nutrition wrong.

Jeffrey Friedman had already explored the biology of obesity earlier in his Boyd Orr lecture. But Uauy used it as just one example of the attitude of ‘global citizenship’ that nutritionists around the world need to adopt: integrating our efforts in the prevention and control of diseases that result when nutrition goes wrong.

Importantly, he stressed that, in the fight against malnutrition in infants, we should remember to address the stunting it can cause and measure height in infants rather than weight (which can lead to the use of high energy, low nutrient density rations, which, ironically can cause some of the same disease problems that obesity can). Worryingly, 60% of child deaths from non-communicable diseases (excluding accidents) could be prevented by ‘doing things that we know how to do, but we’re not getting it done’. One out of three deaths in children can be prevented by appropriate nutrition. At the other end of the malnutrition scale in childhood, Uauy explored the consequences of early rapid growth, which the epigeneticists tell us, is associated with obesity in later life. We need, he said to redefine ‘adequate food’. ‘Not just adequate in terms of quantity, but also in terms of quality.’ And this isn’t just because it’s nice to save lives. Improving child survival rates has a dramatic effect on economic improvement, too, a concept explored by Fogel in 2003 using the economic development of Europe during the 20th Century. In developing countries, tragically, we are looking at the opposite scenario. Uauy thinks we may just have got our measurement wrong again. ‘If we were to look at improving the height of children, rather than the weight, we might be able to improve this situation’.

Having discussed children of extreme sizes, Uauy turned his attention to the other end of life – what to do with the aging population? Old age is full of degenerative diseases, but does it have to be like this? Are nutritionists and nutrition policymakers getting it wrong here too? Presenting the findings of other studies, Uauy thinks that something as simple as oily fish might prevent and even attenuate cognitive decline, for instance, a form of healthy longevity most of us would welcome (though if we maintain selective memory loss, I for one would applaud). Data from the Framingham study indicate a 60% reduction in the risk of dementia as a result of our old friend docosahexaenoic acid. But, he warned, ‘you have to act early’. Even though it is possible to attenuate dementia using fish oils, ‘when you have signs of dementia, you already have 20% decreased brain mass’.

Hey, we can even do our bit for global warning by better nutrition, while addressing the problems of over- under- and poor nutrition. Uauy suggests that what we need to do is work on reducing the per capita consumption of meat in high income countries while increasing it in developing ones. He proposes that a lower ‘maximum’ consumption ‘ceiling would help reduce greenhouse gases from livestock production and help save the planet, too.

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