History of modern nutrition science—implications for current research, dietary guidelines, and food policy

1910s to 1950s: era of vitamin discovery
1950s to 1970s: fat versus sugar and the protein gap
1970s to 1990s: diet related chronic diseases and supplementation
1990s to the present: evidence debates, diet patterns, the double burden
Building on the evidence for multifaceted effects of different foods, processing methods, and diet patterns,3233 new priorities for research are emerging in nutrition science. These include optimal dietary composition to reduce weight gain and obesity; interactions between prebiotics and probiotics, fermented foods, and gut microbiota; effects of specific fatty acids, flavonoids, and other bioactives; personalised nutrition, especially for non-genetic lifestyle, sociocultural, and microbiome factors; and the powerful influences of place and social status on nutritional and disease disparities.
Conversely, growing evidence suggests that, over longer periods, diet composition may be a more relevant focus than calories because of the varied influences of different foods on overlapping pathways for weight control such as satiety, brain reward, glycaemic responses, the microbiome, and liver function.
Recognition of complexity is a key lesson of the past. This is common in scientific progress whether in nutrition, clinical medicine, physics, political science, or economics: initial observations lead to reasonable, simplified theories that achieve certain practical benefits, which are then inevitably advanced by new knowledge and recognition of ever-increasing complexity.
Like nutrition science, policy needs to move from simplistic reductionist strategies to multifaceted approaches.
Although reductionist policies may have some value to reduce specific additives—eg, trans fats, sodium, added sugar—whole food based policies will be crucial to fully address diet related illnesses. Most policy innovation has focused on sugar sweetened drinks, following the model of the WHO Framework Convention on Tobacco Control: tax, restrict places of sale, restrict marketing, use warning labels. This construct breaks down for incentivising consumption of healthy foods. Integrated policy, investment, and cultural strategies are needed to create change in food production and manufacturing, worksites, schools, healthcare systems, quality standards and labelling, food assistance programmes, research and innovation, and public-private partnerships.
Key messages

Modern nutrition science is young: It is less than one century since the first vitamin was isolated in 1926

The first half of the 20th century focused on the discovery, isolation, and synthesis of essential micronutrients and their role in deficiency diseases

●This created strong precedent for reductionist, nutrient focused approaches for dietary research, guidelines, and policy to address malnutrition

This reductionist approach was extended to address the rise in diet related non-communicable diseases—eg, focusing on total fat, saturated fat, or sugar rather than overall diet quality

Recent advances in nutrition science have shown that foods and diet patterns, rather than nutrient focused metrics, explain many effects of diet on non-communicable disease

●Lower income countries are recognising a growing “double burden” (combined undernutrition and non-communicable disease)

Nutrition policy should prioritise food based dietary targets, public communication of trusted science, and integrated policy, investment, and cultural strategies to create systems level change across multiple organisations and environments