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Looking back over the history of the accomplishments of the Canadian Paediatric Society (CPS)’s Nutrition Committee, I am struck by the significant role that the committee has played in determining nutrition policy for Canadian infants and children, both directly and indirectly. Direct contributions have come via the publication of advice to health professionals on the prevention of nutritionally related diseases. Guidelines written on such diverse nutritional issues as breastfeeding, nutritional support for the developmentally handicapped child, feeding the preterm infant and prevention of iron deficiency anemia are good examples of the committee’s attempt to influence public health nutrition practice in Canada.
Indirectly, the committee has also had what I believe to be a significant impact on the nutritional health of Canadian infants and children. The Nutrition Committee has developed true partnerships with Health Canada through the Health Promotion and Programs Branch and the Health Protection Branch and the Dietitians of Canada. The Nutrition for Healthy Term Infants guidline has been a joint project of Health Canada, the Dietitians of Canada and the Nutrition Committee. (A summary of the recommendations can be found on pages 107–116). This combined effort allows for important input on and ownership of the final product and a distribution system that encompasses all players in the field of nutrition for children. The relationship between the Nutrition Committee and Health Canada has resulted in numerous consultations between the two organizations, giving the CPS input into most, if not all, federal nutritional issues pertaining to the paediatric age group. This, I believe, is an ideal role for the CPS.
With the strong links among the Dietitians of Canada, Health Canada and the committee, the future looks bright for the Nutrition Committee. However, to remain credible, the way we do business must change. The new Nutrition for Healthy Term Infants guideline is a first attempt to use an ‘evidence-based’ approach in the formulation of guidelines. As a first attempt it was not bad, but there still is a long way to go. Canada, originally through the efforts of David Sackett of McMaster University, has been the leader in the development of evidence-based clinical practice. At a time when the academic medical community is arguing that clinical medicine should be evidence-based, is it not reasonable to suggest that this same rigour should also be applied to nutrition policy and promotion. Dr David Naylor from the Institute for Clinical Evaluative Sciences in Toronto has recently noted that if physicians are expected to base their decisions on the findings of research, surely those responsible for writing nutrition policy should do the same. Although individual patients may be at less risk from uninformed policymaking than from medicine that ignores available evidence, the dangers to the community as a whole are substantial. The impact of public health guidelines that are poorly designed and untested have the potential to be both unsafe in the short term and disastrous in the long term. As such, the case for evidence-based policymaking and evaluated experience is difficult to refute.
Despite this argument for evidence-based policymaking, the CPS, to my knowledge, does not routinely demand this practice of their committees. Infrastructure support for evidence-based policymaking should becomes a priority for the CPS in the years to come.