It is rare, in modern times, for a university to launch an entirely new department. However, that was how Human Nutrition became established - the only independent clinical academic Department of Human Nutrition in Scotland.
Nutrition is obviously fundamental to all growth, development and response to injury, but first hit the headlines with the discovery of vitamins in the early 20th century - small molecules with dramatic effects for health, but required only in minute quantities from common foods. That work led directly to the establishment of the UK Medical Research Council (MRC) and modern biochemistry. No more vitamins were discovered, and the Joint ARC/MRC Neuberger Report of 1974 declared that the scientific problems in nutrition had been solved.
The MRC decided that any remaining issues could be dealt with by its Dunn Human Nutrition Unit in Cambridge, with its particular focus on developing countries.
As UK academic resources in Human Nutrition started to decline, others disagreed. The MRC Dunn Nutrition Unit shifted some of its focus towards Clinical Nutrition (i.e. nutrition support) and the modern problems of over-nutrition, obesity and chronic diseases. Soon after, the Rank Prize Funds decided to fund three new academic departments of Human Nutrition to promote nutritional science, and to fill the worrying lack of nutrition education within medical training. Together with Southampton and St Bartholomew’s Hospital, the University of Glasgow submitted a successful bid, led by Professors John Durnin (Physiology) and Forester Cockburn (Child Health), to build on Glasgow’s illustrious history of nutrition research by Cathcart, Paton, Boyd-Orr, Cuthbertson and others. The initial proposal was for two senior clinical academics, one to deal primarily with nutrition in childhood at Yorkhill Hospital (Royal Hospital for Sick Children (RHSC), and the other primarily with nutrition in adults at the Royal Infirmary.
Brian Wharton was Professor of Human Nutrition (1988-1992) at Yorkhill Hospital. He helped establish nutrition as a key area in Paediatrics and led the incorporation of nutrition teaching into the undergraduate medical curriculum. His research included the impact of nutrients in milk (human and formula) during the first year of life on the gut microbiota. This included study of iron and lactoferrin, whey and casein, as well as nucleotides. After leaving the University, he was director of the British Nutrition Foundation until 1997; and is currently Honorary Professor at the Childhood Nutrition Research Centre, University College London Institute of Child Health.
He was succeeded as Professor by Mike Lean (1992-current), who had been appointed at the Royal Infirmary as clinical Senior Lecturer in 1990.
The Department of Human Nutrition
The Department of Human Nutrition, officially opened by the Princess Royal, Princess Anne in October 1990, commenced with just three rooms at the Royal Infirmary, initially housing the clinical senior lecturer, his secretary, and a bicycle.
Nutrition research progressed through collaborations with other groups in the university which saw value from adopting the principles of human nutrition research. External funding came from a variety of sources including research councils (ESRC in collaboration with the MRC Medical Sociology Unit) and Chief Scientist’s Office, charities (both local and national, notably Diabetes UK) and from commercial contracts, particularly to conduct clinical trials with novel agents for obesity and diabetes. Research staff on external funding were soon located in rooms borrowed from diverse departments at the Royal Infirmary and Yorkhill, and across the University in Pathological Biochemistry, Botany, Economics, MRC Medical Sociology.
Several members of junior medical staff in other GRI departments undertook MD or other research projects within Human Nutrition, and progressed to senior positions in Glasgow, with continued collaboration: Naveed Sattar (Pathological Biochemistry), Stewart Campbell and Aidan Cahill (Gastroenterology), Douglas Grieve (Respiratory) are examples. The department was one of the first within the University of Glasgow and nationally to enhance its impact by developing its own ‘corporate identity’, complete with an independent website, logo and coordinated fonts and colour scheme for presentations and communications.
When the initial 10-years funding from the Rank Prize Funds ended in 1999, the success of the Department was recognised by its adoption by the university as an established academic unit, with the permanent university-funded academic staff contingent increased from four to eight.
Three of these academic staff were based at the Royal Infirmary: Professor Lean, the only medical member; Dr Catherine Hankey representing clinical dietetics, who became a non-clinical senior lecturer, and Dr Jane Scott with interests in breast-feeding and public health (now professor at Curtin University, Australia).
External funding continued to support high-impact research on body composition, obesity and weight management, and on unravelling the metabolic pathways for metabolism of potentially bio-active plant products. In a highly productive partnership, a Plant Products and Human Nutrition Laboratory was set up with Professor Alan Crozier (Botany) who joined Human Nutrition after his formal retirement, later moving to continue his work at the University of California Davis.
The staff at Yorkhill established research on the colonisation and function of the infant gut microbiota (leading two EU framework projects; Professor Christine Edwards) and energy expenditure and body composition in children, with John Reilly (now Professor at the University of Strathclyde) establishing some of the earliest data on how the obesity epidemic was also affecting children. Following their retirements, Professor John Durnin and Dr Matthew Dunnigan both joined Human Nutrition at GRI for several years, contributing their international reputations to teaching and to research into body composition and energy balance in pregnancy, and into bone health, respectively.
In line with the original aims of the department, its impact on nutrition education has been highly significant. Nutrition is now firmly embedded across the undergraduate medical curriculum in Glasgow. The staff of the Glasgow team took leading roles, together with Southampton, in establishing nutrition education as a new priority for medical training in the GMC document ‘Tomorrow’s Doctors’, and in formulating the national learning outcomes for nutrition in medical education. These became part of the ‘Training Tomorrows Doctors’ policy document from the Intercollegiate Group on Nutrition of the Academy of Royal Medical Colleges.
The department was also heavily involved in designing and delivering short postgraduate courses for trainee and consultant-level doctors from all specialty fields. The Human Nutrition Outpatient Clinic at the Royal Infirmary, with an increasing focus on medically complicated obesity, has contributed to postgraduate medical training; and in 2016, through the efforts of Human Nutrition, Glasgow became the first Scottish city to be awarded the status ‘Centre for Obesity Management’ by the European Association for the Study of Obesity.
With the primary initial aim of identifying high-quality PhD students, an MSc course in Human Nutrition was established, with four specialisation courses (Clinical Nutrition, Public Health Nutrition, Sports and Exercise Nutrition, and Obesity and Weight Management). This MSc course has become one of the most successful in Europe, under the management of Professor Christine Edwards, expanding to take over 40 students every year from countries across the world.
Human Nutrition staff (Professor Lean and Dr Emilie Combet) have authored standard textbooks, based on this course, which are now used world-wide. Together with the forthcoming (2018) Specialist Textbook on Obesity (Dr Catherine Hankey) and the ABC of Nutrition (Professor Lean, Drs Hankey and Wilma Leslie), these books are key English language texts for the nutrition student and health professional.
The office space allocated to Human Nutrition at the Royal Infirmary gradually increased to accommodate successful projects, and in 2014, it was rehoused in the New Lister Building, along with relocation of staff from Yorkhill. Expanded and upgraded laboratory and teaching space has allowed greater integration of clinical and research activities and expansion of PhD and MD training facilities.
The clinical and academic activities of Human Nutrition at GRI hinge on the integrative role of food and nutrition in underpinning all biological functions (and malfunctions), in every organ system, throughout the life course Thus the scientific principles of human nutrition are relevant, to some degree, to every medical subspecialty and to every year of medical undergraduate teaching. PhD and MD students have come from a wide range of interested medical subspecialties, including cardiovascular and respiratory medicine, gastroenterology, dermatology, microbiology, anaesthetics/intensive care, public health, neonatology and paediatrics as well as many non-clinical sciences.
Human Nutrition staff have secured roles within the British Dietetic Association nationally, and offer guidance, training and expertise at local and national levels for dietetic services and research, both for chronic disease and acute nutritional care.
Within clinical services, at an early stage Professor Lean addressed the very major problems which had arisen around line infections with parenteral nutrition among post-surgical patients. After writing new protocols and guidelines, and securing Health Board funding for an all-important specialist Nutrition Support Nurse, routine coordination of the Nutrition Support Team was handed on to NHS colleagues, particularly to Dr Ruth McKee. Research activity around malnutrition has continued with well-cited papers on hospital malnutrition, on inflammatory bowel disease (Professor Christine Edwards and Dr Kostas Gerasimidis) and on specific nutrient deficiencies.
A new Weight Management Service for the Health Board was designed by adapting the model developed for the national Counterweight Programme, and this was handed over to NHS staff for routine treatment of the very large numbers of people with obesity in Glasgow. One measure of its success, and of the Counterweight Programme which has slowly been implemented in primary care across Scotland, has been a reduction in the waiting time for the Human Nutrition Outpatient Clinic from almost 3 years to about 3 weeks. This programme has been adopted for the Diabetes Remission Clinical Trial, the largest research initiative ever funded by Diabetes UK, based at the Royal Infirmary. Human Nutrition staff have contributed to many SIGN and NICE clinical guidelines for obesity, diabetes and heart disease (Professor Lean, Catherine Hankey, John Reilly, Charlotte Wright).
Beyond the clinical field, Human Nutrition at Glasgow has contributed nationally to several Public Health activities, including government initiatives for health promotion and public health. Professor Lean was Chair of the Nutrition Subcommittee of Diabetes UK (1993-2002), a non-executive director of the Health Education Board for Scotland for two terms (1995-2003), and chaired the Advisory Committee on Research for the London-based Food Standards Agency, also for two terms (2002-2007).
External recognition of work in Human Nutrition at GRI includes awards from the British Nutrition Foundation in 2003 for developing the Counterweight Weight Management Programme, and nomination of 3 staff (Lean, Crozier, Mullen) out of only 19 from all academic disciplines in Scotland, in the 2015 Thomson-Reuters ‘Highly Cited Researchers’ listing of those in the top 1% world-wide. Professor Jaap Seidel (Wageningen and Amsterdam) held a visiting professorship from 1995-1997.
Outputs with particularly notable international impact have included important publications on:
- Body composition and health, and waist circumference cut-offs adopted by WHO and elsewhere as the key reversible diagnostic feature of Metabolic Syndrome and preferred alternative to Body Mass Index. (Lean MEJ, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995;311:158)
- Criteria for malnutrition screening in childhood. (Gerasimidis, K, Keane, O, Macleod, I, Flynn, D, & Wright, C. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr, 2010;104(5):751)
- Establishing the metabolic pathways for a range of plant-derived bioactive phenolic compounds. (Crozier A, Jaganath IB, Clifford MN. Dietary phenolics: chemistry, bioavailability and effects on health. Natural Product Reports, 2009;26:1001)
- Description of a framework for Translational Research in Chronic Disease (Lean MEJ, Mann JI, Hoek JA, Elliot RM, Schofield G. (2008) Translational research: from evidence based medicine to sustainable solutions for public health problems. BMJ,2008;337:a863)
- Questionnaire for identifying low dietary iodine status. (Combet E, Lean MEJ. Validation of a short food frequency questionnaire specific for iodine in UK females of childbearing age. J Hum Nutr Diet, 2014;27:599-605)
- As an example of ‘Health by Stealth’, the development of a reformulated nutritionally balanced pizza (containing all essential micronutrients and macronutrients in proportions recommended for optimal health) now being served to schoolchildren across UK. (Combet E, Jarlot A, Aidoo K, Lean MEJ. Development of a nutritionally balanced pizza, as a functional meal designed to meet dietary guidelines. Publ Health Nutr 2013;17:113-126)
For a small department, and research group, Human Nutrition has thus generated very substantial impact on practice and policy, on teaching and training, and among the wider community, over its 27 years existence. It is now an important component of the University of Glasgow School of Medicine, Dentistry and Nursing, and it has become the first port of call in Scotland for government agencies, charities and commercial companies seeking evidence based advocacy on matters relating to food and nutrition, as well as for clinical colleagues from many subspecialties.
Professor Mike Lean, Professor Christine Edwards, Dr Catherine Hankey and Maureen McNee (2018)
Vitamins image provided by Shutterstock