Evidence-based nutrition (EBN) has gained currency as part of the growing role of evidence-based medicine (EBM) to increase the validity, utility and cost-effectiveness of both clinical practice and, increasingly, public health endeavours. Nutritionally-related disorders and diseases (NRD) account for a relatively large proportion of the burden of ill-health, disease and mortality, especially as the nexus between them and both infectious disease and so-called chronic disease is understood. As resource allocation is increasingly dependent on the evidence for preventive or therapeutic effect, the case for nutrition interventions also needs to be underpinned by evidence. However, feeding studies are not as amenable to the designs familiar to clinical trialists and dietary interventions in public health may be complex in their conduct and interpretation, making other approaches like cohort studies more attractive even if costly and long in the execution. With a number of food system changes in rapid progress or imminent, especially in the populous Asia Pacific region, along with changing demographics, changing disease patterns and concern about present and future food security, a stock-take and scenario analysis of EBN was undertaken by a panel of nutrition scientists, population scientists, agriculturalists, clinicians and policy makers together with consumer and indigenous stake-holders in Taiwan in 2007. They found that clinical practice guidelines and proposals for health and nutrition policies required greater emphasis and expertise in EBN.
Asia Pacific Health and Nutrition Centre, Monash Asia Institute, 8th Floor Menzies Buliding, Monash University, Wellington Road, Clayton, Melbourne, Victoria 3800, Australia. firstname.lastname@example.org
Food culture is most influenced by the locality of its origin, which will have been one of food acquisition and processing by various means. It is generally agreed, and is the basis of much United Nations, especially Food and Agriculture Organisation strategic development policy, that successful agriculture, horticulture and aquaculture along with fishing, underpin economically viable and healthy communities with their various food cultures. We also know that this must be in tandem with maternal literacy and operational health care systems. These elements are best represented on a regional basis. There is a growing consumer interest in knowing where one's food comes from as a measure of "food integrity". However, food production alone can be a precarious business and relate to a lesser or greater extent to local food culture and to trade, which may be complementary or at-odds with each other. Likewise, the local food culture may have its strengths and weaknesses as far as its ability to meet nutritional and health needs is concerned. Local food production may be restricted because of geographical or socio-economic conditions which preclude food diversity, although this may be compensated for by trade. Where food adequacy and diversity is compromised, and soils poor, various macronutrient, micronutrient (from animals and plants) and phytonutrient (nutritionally-advantageous food component from plants) deficiencies may be in evidence. These food system problems may be intertwined with food culture--for example, "rice-based and water-soluble vitamin poor"; "few animal-derived foods like meat, fish, eggs and milk with associated low calcium, vitamin D, Vitamin B12 and long chain n-3 fatty acid intakes"; "low fruit and vegetable intake with limited carotenoids and other phytonutrients". Geo-satellite surveillance and mapping as identifying such "hot spots": for regional food problems, as well as hot spots where most of the world's biodiversity is found (1.4 % of land on earth). On the other hand, regional food culture can confer considerable advantage for health and economic development, but does not necessarily do so. The challenge is to respect and retain traditional food knowledge and sustainable food systems, with good governance for food security. There has been a recent awakening of interest and concern about the lack of documentation of traditional and indigenous food cultures which are important not only for their own sake, but for the legacy of food knowledge which they can confer on future generations, provided they are not lost. Hence, the value of a special focus on African food cultures (www.healthyeatingclub.org/Africa), including Rift and Nile Valleys and North West African foods, which are the cradles of human food systems and habits. This is the case too with indigenous foods and food cultures (whether hunter-gatherer or subsistence agriculture); with relatively long-living food cultures in North East Asia, with food cultural distinction and fusion (FHILL and SENECA studies) and with migratory Food Habits. By and large, there is a remarkable resilience and ingenuity of people and their food systems, but monoculture and lack of diversity encourage food system failure.