Nutrition in Medicine PDF

The n e w e ng l a n d j o u r na l of m e dic i n e Review Article Nutrition in Medicine C. Corey Hardin, M.D., Ph.D., Editor Guidance on Energy and Macronutrients across the Li...

The n e w e ng l a n d j o u r na l of m e dic i n e Review Article Nutrition in Medicine C. Corey Hardin, M.D., Ph.D., Editor Guidance on Energy and Macronutrients across the Life Span Steven B. Heymsfield, M.D., and Sue A. Shapses, Ph.D., R.D.N.​​ P oor nutrition is a major risk factor for and a leading prevent- From the Pennington Biomedical Re- able cause of chronic disease in the United States.1 Suboptimal diets contrib- search Center, Louisiana State University System, Baton Rouge (S.B.H.); and the ute to one in five deaths worldwide.2 “Food is medicine” interventions are Department of Nutritional Sciences and being increasingly studied as a means of preventing and treating multiple chronic the New Jersey Institute for Food, Nutri- diseases.3,4 Unlike traditionally approved medicines for which molecular targets tion, and Health, Rutgers University, and the Department of Medicine, Rutgers– are well established, dietary intake comprises a large variety of food ingredients, Robert Wood Johnson School of Medi- and their functions are spread out over a lifetime. Providing recommendations to cine — both in New Brunswick (S.A.S.). patients, specifically those with chronic diseases, on what and how much to eat is Dr. Heymsfield can be contacted at ­steven​.­heymsfield@​­pbrc​.­edu or at Pen- thus more complex than most health recommendations. Here we present an over- nington Biomedical Research Center, view of contemporary nutritional concepts, with a specific focus on energy and 6400 Perkins Rd., Baton Rouge, LA 70808. macronutrients. N Engl J Med 2024;390:1299-310. DOI: 10.1056/NEJMra2214275 Copyright © 2024 Massachusetts Medical Society. His t or ic a l De v el opmen t Evolution of Nutrition Science More than 2000 years ago, Greek philosophers and physicians recognized that food was needed to replace inexorable losses of body material, that those require- ments varied during the stages of life, and that food, along with air, was needed to fuel “innate” body heat.5 During the chemical revolution, which began at the end of the 18th century,5 Antoine Lavoisier and his collaborators laid the founda- tions for the modern understanding of metabolism by showing that body heat results from an oxygen-requiring combustive process (Fig. 1).6 In the first half of the 19th century, Gerardus Johannes Mulder and Jöns Jacob Berzelius identified and named protein,5 Michel Eugène Chevreul and others consolidated concepts related to lipids and fat,7 and multiple scientists identified sugars and starch as carbohydrates.5 Today we recognize that proteins, fats, and carbohydrates are the major macronutrients serving as metabolic fuels and that they participate in many other vital functions. By the early 20th century, it was clear that food components beyond macronu- trients were required for maintaining optimum health. The 13 currently recognized water- and fat-soluble vitamins were identified between 1912 and 1948.8,9 There are also 21 essential minerals, classified as macrominerals (e.g., calcium; daily requirement, ≥100 mg) and microminerals (e.g., iodine; daily requirement,