Chronic disease prevention: A life-cycle approach which takes account of the environmental impact and opportunities of food, nutrition and public health policies - the rationale for an eco-nutritional disease nomenclature

Increasing efforts are being made to address, in public health policy (PHP), both the persistence of nutritional deprivation in economically disadvantaged communities, and the increase in so-called 'chronic disease' (abdominal obesity, diabetes, cardiovascular disease, certain cancers, osteoporosis, arthritides, and inflammatory disease) in communities at all stages of economic development. The problems in the 'chronic disease' descriptor are that its origins may be as early as conception, rather than during the postnatal lifespan, or even in previous generations; it may appear abruptly or slowly; and it may be amenable to environmental and behavioural intervention well into its course and in older age groups. It is also not necessarily 'non-communicable', a qualifier often used for 'chronic disease' (chronic non-communicable disease or CNCD) and often has inflammatory features, for example the inflammatory marker C-reactive protein is a predictor of macrovascular disease and ischaemic events and can, in part, be prevented in the affected by influenzal vaccination. The nexus between immuno-deficiency, inflammatory processes and nutritional status which is characteristic of 'infective' and food-borne illness, is also more and more evident in 'chronic disease'. It may be more helpful to consider chronic disease as 'eco-disease' with its environmental and behavioural contributors, and to regard that which is clearly nutritionally dependent as 'eco-nutritional disease'.