Worldwide, 11 million deaths per year are attributed to suboptimal diets, including those with high sodium, low whole-grain, and low fruit content.¹ Dietary factors contribute to hypertension, obesity, heart disease, stroke, type 2 diabetes mellitus, and cancers, especially gastric and colorectal cancers.^2-4 Up to one in four Americans are dieting at any given time.⁵ However, the relation between dietary intake and health is complex and incompletely understood. Recent data show that nutrition curricula worldwide are inadequate,^6,7 and fewer than 1% of questions on medical licensing exams are related to topics in nutrition.⁸ Unsurprisingly, many medical students and physicians seek nutrition education elsewhere⁹ and express uncertainty around nutritional assessment and basic dietary strategies.^10,11

Complicating matters, emerging causes of malnutrition beyond traditional ones are becoming increasingly recognized — causes such as low socioeconomic status, dietary restrictions, and chronic illness. The increasing popularity of bariatric surgery and weight loss medications requires careful attention to and monitoring for potential posttreatment malnutrition in patients who receive such therapies. Malnutrition in older adults will become an increasingly pressing issue as a projected 1 in 4 Americans will be over 65 years of age by 2060.¹² Nutritional assessment in older adults is often complicated by coexisting conditions, polypharmacy, and end-of-life decisions and, thus, requires a nuanced approach.

Multiple professional societies have called for more nutrition education for current and future physicians.¹³ Suggested core competencies in nutrition include the basic principles of food composition, nutrition across different life stages, essential nutrients, evidence-based diets, malnutrition, and nutrition in disease.^14-16 President Joe Biden’s 2022 National Strategy on Hunger, Nutrition, and Health emphasizes a “food is medicine” approach and echoes the need for more nutrition training for clinicians.¹⁷ Ongoing research related to precision nutrition, food additives and genetically modified foods, metabolomics and proteomics, climate change and food scarcity, telenutrition, culinary medicine, and novel nutritional biomarkers is exciting and continues to inform us in a field where more research is needed.

To help approach these knowledge gaps, the Journal announces the launch, in this issue, of a new review article series centered on fundamental and emerging concepts in nutrition, ranging from the basic “pharmacodynamics” of food to evolving topics such as the relation between the gut and immunity and the role of the gut microbiome in health and disease. We welcome ongoing feedback and the submission of rigorous original research related to nutrition, while acknowledging that equally important components of nutrition competency are patient-centered dietary counseling and multidisciplinary care that are difficult to capture in print.

We hope that these reviews will highlight how food is selected, ingested, digested, and metabolized, allowing clinicians to tailor it as prevention and intervention for many common diseases. Let us move toward abandoning “food for thought” and adopting “food as practice” to improve the health of our patients worldwide.