Analyzing the challenge of translating nutrition research into clinical practice

Nutrition is a unique field of study and practice. Much of medical research guiding clinical interventions to prevent, treat, or cure diseases and their complications follows a one-dimensional, linear translational spectrum from phases I-IV clinical trials. In contrast, the spectrum of nutrition research is two-dimensional because dietary variables consist of connected levels of exposures ranging from dietary factors in food that drive diet-disease relationships (basic level) to whole dietary patterns that combine the effects of numerous dietary factors (diet level). Dietary interventions in clinical practice are generally tailored to the patient between these two levels in the form of strategies targeting food groups and sub-groups (practice level). Dietary interventions are rarely informed by phases I-IV clinical trials of these practice-level strategies, but are instead translated from nutrition research in the basic and diet levels. This review examines the multi-level spectrum of nutrition research to explore key sources of uncertainty, variability, and error forming the gaps between nutrition research and practice. It identifies the translation between the levels of dietary exposures, particularly the nutrition translation from basic level to the practice level, as an unmet opportunity for promoting the delivery of standardized, evidence-based diet therapy in practice. To address this challenge, clinical practice guidelines are encouraged to move beyond recommendations at the basic and diet levels to focus on practice-level dietary guidance.