The new paradigm of public health nutrition.

Poor food habits that result in nutritional deficiencies and excesses along with smoking infections and toxic environmental factors are the major determinants of the health and longevity of individuals. Fetal malnutrition reflects the nutritional status and health of the mother. Iodine deficiency marasmus kwashiorkor and lesser degrees of protein-energy deficiency can also have lasting functional consequences. Stunting associated with clinical malnutrition also exerts a lasting effect on learning and behavior. Nutritional supplementation of young children beneficially affects cognitive development and performance. Two well-designed studies in the late 1960s in Guatemala and Mexico demonstrated that supplementary feeding up to 2 years of age benefited rural breast-fed children who were taller had fewer infections and performed better on cognitive tests. In Guatemala over 2000 of these children performed better on comprehensive achievement tests and had completed more years of schooling when reexamined as adolescents and young adults. In a study of infants born between 1935 and 1943 blood pressure of adult men and women was strongly predicted by high placental weight combined with birth weight. Increased insulin tolerance and adult onset diabetes are also more common among individuals 45 to 54 years old with low weight at birth and at 1 year of age. Iron deficiency anemia in developing countries amounts to 26% for men and nearly 50% for women and children. The adverse consequences of anemia include weakness decreased physical capacity and impaired cognitive performance and growth of children. Osteoporosis is strongly influenced by diets low in calcium at an early age. Cancers are greatly influenced by environmental factors including diet. The 1989 US National Research Council Report on diet and health estimated the 35% to 40% of cancers in the United States were diet related. In summary fulfillment of the genetic potential of individuals is impaired by malnutrition and other environmental factors throughout life.