PerspectivePhysiology

Challenges of human nutrition research

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Science  20 Mar 2020:
Vol. 367, Issue 6484, pp. 1298-1300
DOI: 10.1126/science.aba3807

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  • RE: Challenges to human nutrition research: shall we learn from history?
    • Milind Watve, Scientist, Deenanath Mangeshkar Hospital and Research Center

    In response to Kevin Hall’s critical introspection of nutrition research1, I am tempted to ask a very naïve question. What is the evidence that ‘unhealthy diet’ is the main cause of NCDs such as CVD or type 2 diabetes? At present hardly anyone doubts the role of diet, but consensus cannot be equated to evidence.
    In the history of vitamin deficiency disorders2 we see a close parallel. Germ theory of disease was an established paradigm much before the concept of vitamin deficiencies. For diseases like pellagra and beriberi, for quite a few decades microbiologists kept on isolating different germs with a consensus that some or the other germ must be causal. Fortunately, for germ theory, Koch’s postulates were already there as a sound framework for causal inference. In the field of diet such a framework is also absent. Hall’s insistence on domiciled feeding studies may be an important step to improve, but simultaneously we need to consider the other lesson from history. The real cause of beriberi and pellagra ultimately did not turn out to be germs. Similarly we need to be open to the possibility that diet is NOT causal to NCDs at all and a new paradigm may be awaited. This is very likely because evidence across diet-NCD studies is not consistent, often contradictory and weak. Even in studies where statistical significance is high, variance explained is typically poor.
    Just as the microbiologists hunting for causal agent of beriberi and pellagra did not even drea...

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    Competing Interests: None declared.

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