Interview | Dariush Mozaffarian, MD, FACC, began his term in July 2014 as dean of the Friedman School of Nutrition Science and Policy at Tufts University, whose mission is to improve nutrition worldwide through policies and medical practices that benefit humanity. As a cardiologist and epidemiologist, Mozaffarian will lead the school in its missions for education, research and implementation of nutrition policy that will change the future of diet-related illness including heart disease. Prior to joining Tufts, Mozaffarian was an associate professor in the division of cardiovascular medicine at Brigham and Women’s Hospital and Harvard Medical School, associate professor in the department of epidemiology at the Harvard School of Public Health, and co-founder and co-director of the Harvard program in cardiovascular epidemiology.

What drew you to the Friedman School of Nutrition Science and Policy at Tufts University?

One of Friedman’s most attractive qualities is the drive and expertise of our students, faculty and alumni to not only deepen our understanding of crucial scientific questions, but also study and influence policies to achieve lasting change. Friedman’s breadth is also remarkable: investigation of nutrition and chronic diseases; intersections of food, agriculture and the environment; community interventions and public health nutrition; hunger and food insecurity; and nutrition policy and economics. This is nutrition’s time, and the Friedman School, in combination with all of the University’s nutrition efforts, makes Tufts a powerful place to study and influence both nutrition and policy and achieve real and lasting impact.

How do you expect your visions for nutrition and cardiology will impact the Friedman School?

I see our core missions to be education, research and impact. As the only graduate school of nutrition in North America, our alumni are renowned for their achievements in academics, public health, advocacy, industry and government. We will continue to expand our training of outstanding masters and doctoral students in nutrition science, public health nutrition, agriculture and the environment, food security and nutrition policy and economics. With strong support of Tufts’ President Anthony Monaco, we will also grow our research mission to most effectively tackle the crucial nutrition science and policy questions of the 21st century, including a major focus on reducing the global pandemic of cardiometabolic diseases. We will also develop a coordinated multi-component strategy for achieving policy impact in the U.S. and globally.

In addition to my leadership responsibilities as dean, I have brought my core research team and projects with me. My group’s efforts focus on clarifying the key dietary priorities for cardiometabolic diseases, the impact of suboptimal diet on chronic diseases worldwide and the most effective and cost-effective policies to improve diet quality. We are excited to integrate our work into the diverse and complementary portfolios for innovation that already exist at Friedman and across Tufts.

How do you hope nutrition policy will change in the coming years?

First, it is crucial that our dietary targets be solidly evidence-based. Just as clinical medicine and other scientific disciplines have advanced, nutrition science has advanced remarkably, especially in the last decade. We now know that to reduce chronic disease and improve health across the lifespan, our nutrition policy should be focused on food-based diet patterns and diet quality, rather than isolated nutrient targets or total calories. Current U.S. and international nutrition targets represent a mixture of new and old science, a jumble of accurate and outdated diet priorities. We must have the courage to break from outdated paradigms and embrace the new science in our quest to improve the public’s health.

Just as critically, our dietary policies must be selected based on sound evidence. U.S. nutrition policy has traditionally relied heavily on education and information, placing responsibility squarely on the shoulders of the individual to find, purchase, prepare and eat healthy foods. The complexities of the modern food environment demand a new multi-component policy approach, with coordinated strategies including not only education and labelling but also school and workplace approaches, economic incentives, agricultural policy, direct mandates and health care system innovations to support healthier behaviors.

It is essential to continue to deepen the integration of nutrition science and policy: science without policy is stale knowledge, and policy without science is dangerous.

Why is nutrition “the greatest global priority”?

How we eat is the leading cause of poor health, and how we produce our food is the leading cause of environmental injury, on the planet. Suboptimal nutrition is now the leading cause of death and disability in the U.S. and across the globe, while our food production entails greater water use, land use, deforestation and greenhouse gas emissions than any other human activity. There is rapidly increasing recognition of these enormous impacts. Creating enough healthy, sustainable and equitably distributed food is now more important than ever. With climbing rates of obesity, diabetes and other diet-related illnesses, continued hunger and food insecurity, and the associated economic impacts, we are at a crossroads. This is truly nutrition’s time.

How do you connect that priority to cardiology?

During my clinical training, it became clear that poor diet was among the most important factors contributing to poor health in my patients. Yet, I found diet and nutrition to be virtually ignored in both medical education and clinical health care. How many clinical notes or electronic medical records (EMRs) include relevant details on dietary habits? The gap between the importance of the problem, and the attention paid, is perhaps larger for nutrition than for any other factor in our health system. Yet, everywhere I have trained, worked and interacted with patients, providers and the public, everyone is hungry – starving – for accurate, evidence-based information on diet and nutrition. Cardiologists should be the leading advocates for healthy food-based diet patterns for our patients, workplaces and communities.

What would you consider is the next step nationally and globally toward better nutrition and cardiovascular health?

We must emphasize evidence-based dietary targets and policies. First, we need to move away from isolated nutrient and calorie targets and toward food-based priorities, emphasizing increased intakes of fruits, nuts, vegetables, vegetable oils, fish, yogurt and whole grains, and decreased intakes of refined grains, sugars, potatoes, processed meats and sugary beverages. Two additives – salt and trans fat – should also be targeted. We must also recognize that obesity is only one symptom of poor diet quality, and that diet influences cardiovascular and metabolic health through multiple other independent pathways.

Second, we must deploy the full range of available policies to create healthier food environments – some of the most effective and cost-effective options include direct mandates to reduce sodium and trans fat and a framework for comprehensive dietary taxes and subsidies.

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References

1. Mozaffarian D, Rogoff KS, Ludwig DS. The Real Cost of Food: Can Taxes and Subsidies Improve Public Health?. JAMA. 2014; 312(9):889-890.

Keywords: Cardiology Magazine, ACC Publications

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