The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum-A Conceptual and Systems Approach

The domestic and global diet, nutrition, and health context is becoming increasingly complex. Our ability to effectively address the daunting challenges presented by malnutrition in all its forms-both clinically and from a public health perspective-is constrained by a number of issues that coalesce around our understanding of nutrition and the what, why, and how of its assessment. This complexity is further enhanced when screening, assessment, diagnosis, and care are often performed in different settings (hospital compared with school compared with home), across populations, and with a limited care team (e.g. certain care teams may only have a nurse or dietitian within a school district). In this perspective, we make the case that our ability to improve the precision of assessment, diagnosis, and intervention demands a view of nutrition as a biological variable: a complex system resulting from the interactions between our internal (biology, health status, developmental stage, genetics, etc.) and external (social determinants of health, home, community, physical) environments, i.e. a nutritional ecology. We offer both 1) a conceptual framework for more effectively integrating nutrition in medical assessment and etiology-based care; and 2) suggest solutions to overcome some of the systematic challenges in the clinical care continuum. Leveraging the concept of nutrition as a biological variable that emphasizes the integration of both internal and external variables into an assessment within the Nutrition Care Process model allows for both the identification of the nutrition problem and also the root cause (etiology) of the problem. Suggestions are offered for how to integrate this approach from both a clinical and public health perspective.