• Philip James.
• London School of Hygiene and Tropical Medicine, United Kingdom. jeanhjames@aol.com
• Nutr. Rev. 2006 May 1; 64 (5 Pt 2): S1-11; discussion S72-91.

AbstractNutrition is now becoming once more of intense interest to biological and medical scientists working on the control of development and human health. It is also now of ever greater public health interest. Few scientists, however, recognize that the same interest for those involved in fundamental science and public health developed a century ago focusing on the way in which nutrition and specific micronutrients, as well as general energy and protein intakes, were crucial to infant growth and appropriate development. The discovery of vitamins was matched by the proposition that stunted children in poor communities in the Western world were suffering from poverty-related poor diets. The critical role of nutrition was established by feeding studies, which then led to major food and agricultural policy changes during the Second World War, when food supplies were scarce throughout Europe. The success of these wartime policies led to a revolution in governmental thinking and a cheap food policy, together with a major boost in national agricultural production as an issue of national security. Nutritionists transferred their scientific interest to the study of childhood malnutrition in the developing world. The promotion of intensive agriculture and the food industry led to a revolution in food supplies, with the intense promotion of meat, milk, butter, and sugar production and consumption. The resulting escalation in cardiovascular disease related to the dietary change slowly altered public health policies, but as cardiovascular deaths decreased in the developed world, obesity and diabetes progressively increased. Now the lower- and middle-income countries (i.e., the developing world) have far more cardiovascular disease as Western diets and cultural habits are imported. The remarkable escalation of diabetes and cardiovascular disease, particularly in populations currently and previously subjected to malnutrition, now reveals unusual susceptibility to these diseases. This susceptibility is increasingly related to the conjunction of fetal malnutrition and later inappropriate diets. The alarming escalation in the health burden suggests that two-thirds of the world's population is super-sensitive to weight gain, diabetes, cardiovascular disease, and perhaps many cancers. New evidence on epigenetics and the structural changes in the fetus in response to inappropriate maternal diets provides mechanisms to explain this. Unfortunately, a vicious intergenerational cycle of maternal and fetal epigenetic change seems to herald markedly increased future burdens of disease. The nutrition field is therefore challenged not only in terms of science, but also in new dimensions of public health of immense economic significance.

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