What is clinical nutrition? Understanding the epistemological foundations of a new discipline

Background: Although the therapeutic and economic efficacy of nutrition has been proven, optimal nutritional care is still scarce among hospital and ambulatory patients. Thus malnutrition is still highly prevalent. We identify as an underlying cause the absence of a common understanding of clinical nutrition as a discipline. The aim of this paper is to establish the epistemological foundations of clinical nutrition and to characterize it as a science. Methods and results: From the standpoint of historical epistemology, we examine the historical conditions that determine i) the main object of knowledge, ii) the nature and iii) domain of this science. Our hypothesis is that clinical nutrition as a science was formed in the second half of the twentieth century as an outcome of the integration of medicine and nutrition and underpinned by a primary transformation of the ``nutrient'' concept. We identify malnutrition as the primary practical and research domain of knowledge. Conclusion: Clinical nutrition is an autonomous empirical science that can be characterized as a basic and applied science. Its wide multi-disciplinarity guarantees its future. (c) 2015 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.