THE PRACTICE OF CLINICAL NUTRITION IN DEVELOPING-NATION

Recently the academic community has been charged with nutrition malpra ctice for allegedly spending billions of dollars in international nutr ition research and failing to make a difference. Looking at this issue from a field perspective one would conclude that notable progress has been made and is being made on a daily basis. The analysis presented is based on my experience as a clinical nutritionist in Chile, a devel oping country in transition. It points out the issues and some of the answers by using selected examples of what can be accomplished by inte grated health, nutrition, and educational interventions. The results h ave been a dramatic decline in infant and childhood malnutrition and m ortality rates and the emergence of a pattern of mortality that closel y resembles that of developed countries. The specific nutritional prob lems of hospitalized patients are discussed and the benefits of entera l nutritional support are presented. Preventive strategies are emphasi zed; they require wide coverage of basic human needs and community par ticipation. Nutritional improvement is a prerequisite for economic dev elopment and is only possible if individuals and institutions ace comm itted to making this happen. Critical dilemmas facing clinical nutriti onists in developing countries are addressed.