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Nutritional Epidemiology

Although observations on relationships between diet and health have always been recognized, the systematic science of nutritional epidemiology in populations is relatively recent. Important observations propelling the field of nutrition forward were numerous in the 18th and 19th centuries, as it was recognized that deficiencies in certain classes of foods led to important diseases such as scurvy, rickets, pellagra, and beriberi. This was followed by the rapid sequential discovery of the vitamins in the early 20th century. Since then, the focus of diet and health has shifted to include the problems of obesity and the role of diet on chronic disease risk. Just as the parent field of epidemiology is defined as the investigation of the frequency, distribution, and risk factors influencing disease in populations, nutritional epidemiology may be defined as the frequency and distribution of nutrition-related diseases as well as the relation of nutritional intake and status to disease outcomes.

Nutrition Monitoring and Surveillance

The systematic quantification of nutritional status with population surveys has been done only relatively recently. Early surveys in the United States, such as the Ten-State Nutrition Survey released by the U.S. Centers for Disease Control in 1971, identified stunted growth associated with insufficient food in lowincome groups. Such results led President Johnson to declare a ‘War on Hunger’ in the United States in 1966. In the relatively short time since then, food availability has changed rapidly with associated changes in nutritional risk, such that we have gone from substantial undernutrition to a current epidemic of obesity in all income categories. At the same time, heart disease and cancer have escalated as the major diseases contributing to mortality as we have made progress against deficiency and infectious disease. Fortunately, these changes have been well documented at the national level with the representative U.S. Department of Agriculture Continuous Survey of Food Intake of Individuals and the U.S. Department of Health and Human Services National Health and Nutrition Examination Surveys (NHANES) that have been conducted periodically since 1970. These have now been combined into the Continuous NHANES, which is released for public use in 2-year cycles.

With the encouragement of the World Health Organization, nutritional surveillance activities are now also implemented in many developing countries. These include organized community weighing programs, school entry height measurements, and the addition of nutrition modules to existing national surveys to provide data that document trends in nutritional status and support policy decisions to target and improve identified nutrition problems.

Diet and Health

A central focus of nutritional epidemiology is to inform dietary recommendations by clarifying the role of food and nutrient intake to the risk of health outcomes. Early work in this area began from ecological observations that there were large differences in the prevalence of differing chronic diseases across countries with differing food patterns. For example, death rates from heart disease or colon cancer have been shown to be positively associated with higher-than-average fat intakes across countries. However, such an association does not necessarily imply a causal relationship—particularly in such ecologic observations, as numerous other exposures differ across countries. Migration studies, documenting change in risk associated with the movement of groups from their native country to a new environment, provide further evidence of the importance of environmental exposures, as opposed to genetic variation, in disease risk. Central among these are changes in diets, adding more evidence for several diet and health relationships.

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