Perspective: nutritional status as a biological variable (NABV): integrating nutrition science into basic and clinical research and care
Open accessAbstract
The field of nutrition has evolved from one focused primarily on discovery of the identities, metabolic functions, and requirements for essential nutrients to one focused on the application of that knowledge to the development and implementation of dietary recommendations to promote health and prevent disease. This evolution has produced a deeper appreciation of not only the roles of nutrients, but also factors affecting their functions in increasingly complex global health contexts. The intersection of nutrition with an increasingly more complex global health context necessitates a view of nutritional status as a biological variable (NABV), the study of which includes an appreciation that nutritional status is: 1) not limited to dietary exposure; 2) intimately and inextricably involved in all aspects of human health promotion, disease prevention, and treatment; and 3) both an input and an outcome of health and disease. This expanded view of nutrition will inform future research by facilitating considerations of the contexts and variability associated with the many interacting factors affecting and affected by nutritional status. It will also demand new tools to study multifactorial relations to the end of increasing precision and the development of evidence-based, safe, and effective standards of health care, dietary interventions, and public health programs.
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Nutritional assessment should be viewed as involving more than just one nutrient; rather, it should be viewed as the result of myriad interactions of multiple nutrients within biological systems of interest.
“Conceivably, from both a clinical and public health perspective, nutritional assessment should be viewed as involving more than just one nutrient; rather, it should be viewed as the result of myriad interactions of multiple nutrients within biological systems of interest [9].”
From The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum—A Conceptual and Systems Approach (2025) · cites this paper as [9]
Improving the precision of nutritional assessment, diagnosis, and intervention requires viewing nutrition as a biological variable-a complex system resulting from interactions between internal (biology, health status, developmental stage, genetics) and external (social determinants of health, home, community, physical) environments (a nutritional ecology).
“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.”
From The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum—A Conceptual and Systems Approach (2025) · cites this paper as [9]
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“The presumption by many is that anemia is synonymous with nutritional iron deficiency (NID).”
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Improving Anemia Assessment in Clinical and Public Health Settings
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Bell, K., Matthews, L. G., Cherkerzian, S., Prohl, A. K., Warfield, S. K., Inder, T. E., Onishi, S., & Belfort, M. B. (2022) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2021-321653 · Cited by 26 · see citing works
Jimenez, E. Y., Lamers-Johnson, E., Long, J. M., McCabe, G., Ma, X., Woodcock, L., Bliss, C., Abram, J. K., & Steiber, A. L. (2024) · The American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2023.12.012 · Cited by 25 · see citing works
Self-citationPongcharoen, T., Rojroongwasinkul, N., Tuntipopipat, S., Winichagoon, P., Vongvimetee, N., Phanyotha, T., Sukboon, P., Muangnoi, C., Praengam, K., & Khouw, I. M. S. L. (2024) · Public Health Nutrition · doi:10.1017/s1368980024000053 · Cited by 21 · see citing works
“Dietary assessment tends to be a useful index of the exposure stage of the nutrients as consumed through foods, but it does not necessarily reflect nutritional status such as those of biomarkers or biochemical measures based on metabolism or physiological processes (59,60) .”
Raiten, D. J., Steiber, A. L., Dary, O., & Bremer, A. A. (2024) · Nutrients · doi:10.3390/nu16030421 · Cited by 13 · see citing works
Self-citationExploring the Anemia Ecology: A New Approach to an Old Problem
Raiten, D. J., Moorthy, D., Hackl, L., & Dary, O. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.07.016 · Cited by 12 · see citing works
“These facts should inform our efforts to develop more precise assessment methodologies and study designs [19].”
BackgroundSelf-citationDonovan, S. M., Abrams, S. A., Azad, M. B., Belfort, M. B., Bode, L., Carlson, S. E., Dallas, D. C., Hettinga, K. A., Järvinen, K. M., Kim, J. H., et al. (2022) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2022.11.027 · Cited by 12 · see citing works
Raiten, D. J., Steiber, A. L., & Bremer, A. A. (2025) · Advances in Nutrition · doi:10.1016/j.advnut.2025.100385 · Cited by 10 · see citing works
“…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 [9,10].”
Self-citationBremer, A. A., & Raiten, D. J. (2023) · Nutrients · doi:10.3390/nu15132824 · Cited by 10 · see citing works
“, social, behavioral, cultural, and physical) environments [1].”
InfluentialSelf-citationFujita, M., Wander, K., Tran, T. T., & Brindle, E. (2022) · American Journal of Biological Anthropology · doi:10.1002/ajpa.24603 · Cited by 9 · see citing works
“Investigation of interactions in the mother-infant dyad are a necessary step toward better understanding of the impact of context on nutrition interventions (Raiten et al., 2021).”
BackgroundAn Ecological Approach for Advancing the Understanding of Nutrition and Health
Raiten, D. J., & Bremer, A. A. (2023) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2023.1613 · Cited by 7 · see citing works
Self-citationAdvancements in precision nutrition: Targeted strategies for personalized health
Zheng, H., Zhang, X., Su, W., Zaky, A. A., EL-Aty, A. M. A., Xu, E., Liu, D., & Tan, M. (2026) · The Innovation Life · doi:10.59717/j.xinn-life.2026.100191 · Cited by 6 · see citing works
Bremer, A. A., Zenk, S. N., Pasiakos, S. M., & Langevin, H. M. (2024) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2024.12.008 · Cited by 5 · see citing works
“Nutrition itself is a complex biological system with internal and external inputs and outputs that relate to both human biology and the world around us [1].”
InfluentialSelf-citationDiet–Oral Microbiota Interactions and Salivary Biomarkers of Nutritional Health: A Narrative Review
Anchidin-Norocel, L., Lobiuc, A., & Covașă, M. (2026) · Nutrients · doi:10.3390/nu18030396 · Cited by 4 · see citing works
“Nutritional status reflects an individual’s health condition as determined by the intake, absorption, and utilization of nutrients [98].”
Raiten, D. J., Steiber, A. L., Rozga, M., Moloney, L. M., Papoutsakis, C., Handu, D., & Bremer, A. A. (2026) · Advances in Nutrition · doi:10.1016/j.advnut.2026.100608 · Cited by 4 · see citing works
“To advance a more comprehensive appreciation of the nexus of CEC, dietary patterns, nutritional status, and health, it is important to recognize the role of nutrition as a biological variable that is both an input and an outcome of health and disease [16].”
Self-citationMehta, S., Allen, L. H., Bailey, R. L., Boushey, C. J., Duggan, C., Crouter, S. E., Engle‐Stone, R., Fahim, S. M., Gibbs, K., Hernández, E., et al. (2025) · Journal of Nutrition · doi:10.1016/j.tjnut.2025.10.030 · Cited by 7 · see citing works
Self-citationPrioritizing Nutrition in Medical Education—the Time Has Come
Bremer, A. A. (2024) · Advances in Nutrition · doi:10.1016/j.advnut.2024.100231 · Cited by 4 · see citing works
“” However, despite advances in myriad areas of medicine and public health, signi fi cant gaps remain in our understanding of why and how food and nutrition affect health [1].”
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The value of an ecological approach to address micronutrient malnutrition
Raiten, D. J., Saavedra, J. M., Combs, G. F., Dary, O., Levin, E., & Bremer, A. A. (2025) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2025.07.006 · Cited by 3 · see citing works
“Nutritional assessment should address multiple nutrients and their interactions in biological systems [46].”
Self-citationAssociation between phase angle and all-cause mortality in adults aged 18–49 years: NHANES 1999–2004
Xia, X.-X., Li, C.-X., Xue, X.-X., Chen, Y., He, F., & Guo, H. (2025) · Scientific Reports · doi:10.1038/s41598-025-86825-y · Cited by 3 · see citing works
Why Should Nutrition Research and Innovation Be Integrated with Environmental Science?
Bremer, A. A. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101516 · Cited by 2 · see citing works
Self-citationMoloney, L. M., Chacón, V., Devarakonda, S. L. S., Scollard, T., Jones, S., Rozga, M., & Handu, D. (2025) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2025.03.005 · Cited by 3 · see citing works
Nugroho, R. F., & Wardani, E. M. (2025) · Journal of Current Health Sciences · doi:10.47679/jchs.2025132 · Cited by 1 · see citing works
Nutritional Cognitive Neuroscience: The Science of Mind, Brain, and Nutrition
Barbey, A. K. (2025) · Journal of Nutrition · doi:10.1016/j.tjnut.2025.11.026 · Cited by 1 · see citing works
Raiten, D. J., Bundy, D. A. P., DeBernardo, D., Steiber, A. L., Papoutsakis, C., Jimenez, E. Y., Proaño, G. V., Rozga, M., & Bremer, A. A. (2026) · Journal of Nutrition · doi:10.1016/j.tjnut.2026.101614 · Cited by 1 · see citing works
Self-citationLee, Y.-J., Kim, J., Go, H., Kim, E., & Choi, Y. (2025) · 대한구강보건학회지 · doi:10.11149/jkaoh.2025.49.2.98
Genetic susceptibility shaped by biological state: beyond gene-environment interaction
Qu, H., & Hakonarson, H. H. (2026) · Frontiers in Genetics · doi:10.3389/fgene.2026.1877629
“A dietary variable may record reported intake without capturing absorption, metabolism, or nutritional status (Raiten et al., 2021).”
Bremer, A. A. (2026) · Journal of Food Science · doi:10.1111/1750-3841.71248
Self-citationNourishing collaboration: interdisciplinary nutrition education for health care professionals
Bremer, A. A., Nicastro, H. L., Levin, E., & Kleinstreuer, N. (2026) · American Journal of Clinical Nutrition · doi:10.1016/j.ajcnut.2026.101428
Self-citationErector spinae density as a predictor of early cardiac complications in patients with stroke
Ding, K., Lin, Y., Zhu, Q., Liu, X., Cao, P., Liang, L.-L., Cui, M., & Ni, J.-W. (2026) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2026.1878270
Ashar, H., Rahfiludin, M. Z., Nugraheni, S. A., Tjandrarini, D. H., Yunitawati, D., Kusumawardani, H. D., & Supadmi, S. (2026) · ЗДОРОВЬЕ НАСЕЛЕНИЯ И СРЕДА ОБИТАНИЯ - ЗНиСО / PUBLIC HEALTH AND LIFE ENVIRONMENT · doi:10.35627/2219-5238/2026-34-7-18-23
张, 汗. (2026) · Advances in Clinical Medicine · doi:10.12677/acm.2026.16103372
Bremer, A. A., Krans, A., & Raiten, D. J. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1976376
Self-citation
- Authors
- Raiten, D. J., Combs, G. F., Steiber, A. L., & Bremer, A. A.
- Affiliations
- National Institutes of Health (US)
- Tufts University (US)
- Academy of Nutrition and Dietetics (US)
- Corresponding author
- Raiten, Daniel J
- Venue
- Advances in Nutrition
- Publisher
- Elsevier BV
- Published
- 2021-09
- Volume
- 12
- Issue
- 5
- Pages
- 1599-1609
- ISSN
- 2156-5376 (ISSN-L)
- 2161-8313
- PMC
- PMC8483963
- OpenAlex
- W3162066803
- Cited by
- 33
- References
- 64
- Citations by year
- 2026: 12 · 2025: 8 · 2024: 6 · 2023: 4 · 2022: 3
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Advances in Nutrition (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Nutrition, Health, and Society Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Nutrition, Genetics, and Disease
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- nutritional status, essential nutrients, dietary recommendations, disease prevention, health promotion, global health, personalized nutrition, dietary intervention, public health programs
- MeSH terms
- Diet, Health Promotion, Humans, Nutritional Status, Global Health, Nutritional Sciences
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