Why Was "Custom a Second Nature" in Early Modern Medicine?

"Custom is a second nature" is a saying that circulated long before the early modern period and in many different cultural settings. But the maxim had special salience, reference, and force in dietetic medicine from the late medieval period through the eighteenth century. What did that saying mean in the early modern medical setting? What presumptions about the body, about habitual ways of life, and about the authority of medical knowledge were inscribed within it? And what was the historical career of the saying as views of the body, its transactions with the environment, and the hereditary process changed through the nineteenth and twentieth centuries?

The history and development of registered dietitian accreditation systems in China and other comparable countries.

A dietitian has qualifications in nutrition and dietetics and applies the science of food and nutrition to improve the health of individuals, groups, and communities. The Registered Dietitian (RD) credential has gained recognition over the years for its expertise. The accreditation systems were developed and have been used to ensure quality of this profession. Accreditation systems set standards for academic and professional training in nutrition and dietetics and reflect current research-based information. The purpose of this paper is to review a few countries that have a RD accreditation system including China and several other countries, e.g. the United States, Japan, and the United Kingdom. The aims are to introduce the newly established RD system in China and to compare the differences among the countries' systems.

Was Luigi Cornaro a Dietary Expert?

Luigi Cornaro (d. 1566) was a Venetian nobleman whose book De Vita Sobria (On the Temperate Life) was an instant success and has proved to be one of the most long-lasting and influential works of practical medical advice, counseling readers how to live long and healthily. Yet Cornaro was not a physician and his account raises a series of questions about the nature and location of medical expertise. Who can have that expertise? Can you, and should you, be your own physician, and, if so, on what grounds? I situate Cornaro's claims to expertise within a historically specific culture of medical dietetics in which personal experience counted for much. How did certain dietary practices "agree with" individuals? How did personal experience figure in constituting expertise? Was a healthy regime compatible with ordinary civic life and, if not, did it matter? What was the role of precise quantitative measure in prescribing the regime making for health and longevity? I address these questions with respect to Cornaro's historical setting and also in relation to pervasive commentary on his text over the centuries that followed.

Five Decades: From Challenge to Acclaim.

What can make your work as a dietitian so meaningful that you begin each day with enthusiasm, and if you so choose, retain that joy in your work for 5 decades or more? Three themes are: (i) doing work that profoundly makes sense to you, (ii) inspiring others (and yourself) to make healthful choices, and (iii) moving through challenges to success. Initially it can be challenging to make a living through work that is most deeply meaningful or closest to your heart. Yet it is well worth finding the balance between practicality and movement in the desired direction. Other challenges faced by dietitians involve helping others to adopt new, more healthful lifestyle choices. As health professionals, our attitudes towards plant-based diets have changed dramatically during these past decades. This article examines our evolving perspectives of plant-based diets, and uses this as an example of movement through challenges to success and acclaim. Vegetarian and vegan diets that were considered entirely inappropriate for many stages of the life cycle in the 1970s are now seen to confer health benefits. This applies to well-designed plant-based diets, thus offering a significant role for dietitians as creative leaders in this field.

Valoración del estado nutricional en Geriatría: declaración de consenso del Grupo de Nutrición de la Sociedad Española de Geriatría y Gerontología / Nutritional status assessment in Geriatrics: Consensus declaration by the Spanish Society of Geriatrics and Gerontology Nutrition Work Group

El progresivo envejecimiento de la población es uno de los factores que influyen en el aumento de la prevalencia de desnutrición, ya que los ancianos son un colectivo de riesgo por sus características biológicas, psicológicas y sociales. A pesar de su alta prevalencia, la desnutrición está infradiagnosticada en geriatría. Por este motivo, el objetivo del presente documento de consenso es elaborar un protocolo de valoración nutricional geriátrica. En el marco de la SEGG se ha creado un equipo multidisciplinar con el objetivo de darle la debida importancia a la desnutrición y el riesgo de la misma para que sean diagnosticadas y tratadas de forma adecuada. Entre los muchos métodos validados para el cribado nutricional, el MNA-SF representa una herramienta práctica. Tras evidenciar la sospecha o la presencia de desnutrición la valoración completa prevé la realización de una historia nutricional exhaustiva. Las historias clínico-nutricional y dietética pretenden evidenciar los posibles factores de riesgo sobre la base del cuadro de desnutrición. Entonces la valoración antropométrica, asociada a los datos de laboratorio, pretende objetivar las modificaciones físicas y metabólicas asociadas a la desnutrición. Hoy en día cada vez más se tiende a profundizar en la valoración nutricional utilizando técnicas no invasivas de estudio de la composición corporal asociadas al estudio funcional. Esta última representa un índice indirecto del estado nutricional de gran interés para la geriatría. En conclusión, un correcto cribado nutricional es la base fundamental para un temprano diagnóstico de desnutrición y poder valorar la indicación al tratamiento nutricional. Para esto es fundamental fomentar la investigación en el campo de la nutrición geriátrica para aumentar el conocimiento y poder hacer cada vez más una geriatría basada en la evidencia (AU)

Ongoing population ageing is one of the factors influencing the increase in the prevalence of undernutrition, as elderly people are a vulnerable group due to their biological, psychological and social characteristics. Despite its high prevalence, undernutrition is underdiagnosed in the geriatric sphere. For this reason, the aim of this consensus document is to devise a protocol for geriatric nutritional assessment. A multidisciplinary team has been set up within the Spanish Society of Geriatrics and Gerontology (in Spanish Sociedad Española de Geriatría y Gerontología [SEGG]) in order to address undernutrition and risk of undernutrition so that they can be diagnosed and treated in an effective manner. The MNA-SF is a practical tool amongst the many validated methods for nutritional screening. Following suspicion of undernutrition, or after establishing the presence of undernutrition, a full assessment will include a detailed nutritional history of the patient. The compilation of clinical-nutritional and dietetic histories is intended to help in identifying the possible risk factors at the root of a patient's undernutrition. Following this, an anthropometric assessment, combined with laboratory data, will describe the patient's physical and metabolic changes associated to undernutrition. Currently, the tendency is for further nutritional assessment through the use of non-invasive techniques to study body composition in association with functional status. The latter is an indirect index for nutritional status, which is very interesting from a geriatrician's point of view. To conclude, correct nutritional screening is the fundamental basis for an early undernutrition diagnosis and to assess the need for nutritional treatment. In order to achieve this, it is fundamental to foster research in the field of nutritional geriatrics, in order to expand our knowledge base and to increasingly practice evidence-based geriatrics (AU)

What is clinical nutrition? Understanding the epistemological foundations of a new discipline.

BACKGROUND: Although the therapeutic and economic efficacy of nutrition has been proven, optimal nutritional care is still scarce among hospital and ambulatory patients. Thus malnutrition is still highly prevalent. We identify as an underlying cause the absence of a common understanding of clinical nutrition as a discipline. The aim of this paper is to establish the epistemological foundations of clinical nutrition and to characterize it as a science. METHODS AND RESULTS: From the standpoint of historical epistemology, we examine the historical conditions that determine i) the main object of knowledge, ii) the nature and iii) domain of this science. Our hypothesis is that clinical nutrition as a science was formed in the second half of the twentieth century as an outcome of the integration of medicine and nutrition and underpinned by a primary transformation of the "nutrient" concept. We identify malnutrition as the primary practical and research domain of knowledge. CONCLUSION: Clinical nutrition is an autonomous empirical science that can be characterized as a basic and applied science. Its wide multi-disciplinarity guarantees its future.