Broadly these can be divided into resources for health professionals and resources for the lay public. This chapter focuses mainly on the former. At the same time, it is important to note that one of the more interesting aspects of the Internet is its democratization of information, which allows lay users to have much the same access to health professional resources as do health professionals.
E-Mail-Based Nutrition Applications
Private Communication
Many biomedical journals now publish the e-mail address ofthe lead or contact author of their articles, thus facilitating private communication between readers and authors. This includes such prominent journals as the British Medical Journal. Unfortunately, this practice is not particularly common among nutrition journals as yet. For example, the American Journal of Clinical Nutrition used to publish author e-mail addresses, but currently does not do so.
Mailing Lists and Newsgroups
There are a considerable number of nutrition-related mailing lists and newsgroups, allowing discussion among small to large numbers of like-minded individuals. These include lay or patient mailing lists for people suffering from or interested in such nutrition issues as weight problems, eating disorders, diabetes, vegetarianism, and so forth. Topics of discussion can vary from patient support to the latest news on treatment, to alternative therapies, to philosophical debates. The easiest way to find such resources is through a web site dedicated to cataloging mailing lists.
Mailing lists for nutrition professionals are also in plentiful supply. There is a certain level of turnover with new lists starting up, whereas other lists die a natural death through lack of interest; Table 1 highlights some of the most important and enduring of these.
Newsletters
There are some useful, free, one-way nutrition e-mail communications that mirror the traditional function of the printed newsletter. For the nonprofessional reader, Nutrition News Focus is a daily newsletter providing lay interpretation on current nutrition news as provided by a well-known US-based professor of nutrition. For the nutrition or other health professional, the Arbor Clinical Nutrition Update is the Internet's most widely read nutrition communication. It contains weekly summaries of the latest clinical nutrition research together with informatlon on the best nutrition resources available on the Internet. Readership at the end of 1999 totaled more than 15,000 health professionals based in 150 countries.
Web-Based Nutrition Applications
There are an enormous number of web sites concerned with nutrition. Entering "nutrition" as the search term into the general search engine Alta Vista returns over 1.3 million listings (using the term "food" adds another 8.5 million!). It is impossible to say how many of these web sites are commercial (although it is clear from casual inspection that many are), how many represent the private musings of nonprofessional individuals, how many are targeted at a noncommercial lay audience, and how many are intended for nutrition professionals. In the following sections, we examine some of the more useful categories of nutrition web sites from the health professional perspective. They can conveniently be broken down into portal sites, guides and search engines, institutional home pages, nutrition science (including research), dietetics, healthy diet, clinical nutrition, and food science.
Portal Site, Guides, and Search Engines
One of the greatest problems in approaching the Internet is knowing where to find things.
For this reason, some of the most popular web sites are those that tell the user what is available and present in such an organized manner that the desired information source can be found quickly. Such sites may operate as directories, search engines, or both. They are often the first port of call en route to finding the resource one actually wants, and are therefore often referred to as portal sites. Provided they are updated regularly, portal sites can be an invaluable resource for the novice and experienced user alike. Because of the rapidly changing nature of the subject, no printed publication will ever replace portal sites in providing current information on what is available on the Internet.
The reader is advised to consult such portal sites for current and more detailed information to accompany the content of this chapter. The Arbor Nutrition Guide is the largest portal site specifically focused on resources for health professionals. It has over 3000 listings and covers the broad range of categories referred to before. It includes descriptions of the web sites listed and a search engine, and is updated regularly. Perhaps the best of all the portal sites aimed at the lay public is the Nutrition Navigator site. Produced by staff from the nutrition department at Tufts University, it has fewer listings than the Arbor site but provides an independent rating score for each of them, based on measures including how often the listings are updated.
It also has a search engine, and has found widespread acceptance as a portal site. Other portal sites have a more food and food science approach. For the lay audience, this includes the Martindale "Virtual" Nutrition Center, whereas for nutrition professionals there are two useful web sites from Australia and the US National Agricultural Library.
Institutional Home Pages
A home page refers to a web site focused on providing information about its owner. A large number of institutions relevant to nutrition professionals now have home pages on the Internet. This includes government organizations, universities, NGOs, book publishers, and many commercial bodies. The usefulness of these institutional home pages varies enormously. In some cases, they have little more than descriptions of what the organization does and the names of personnel.
In other cases, they carry information of more general nutrition interest, which can range from Extension (educational) newsletters to the actual content of courses as well as reports and lay education resources. A few of the more interesting such institutional web sites with rich nutrition content include US Department of Agriculture (USDA), Health Canada, United Nations Committee on Nutrition, International Life Sciences Institute (lLSI), and US National Academy of Science. There are several web sites that provide reasonably comprehensive lists of the home pages of university nutrition and food science departments, both internationally and within North America. These inform the user of those universities that have accredited nutrition science graduate or dietetic training programs.
Nutrition Science (Including Research)
The Internet has significantly enhanced access for those who wish to keep up with the latest in nutrition knowledge, including published research. Improvements have come about in both the ability to access this kind of information much more quickly after it is published, and the ability to filter and sort the vast amount of such information for what is relevant to the individual. In this respect, nutrition science has benefited from developments in biomedical science generally. Various journal abstract services are now available on-line, many without charge. These include Cancerlit, a collection from the National Cancer Institute, andMedline, the journal abstract service of the National Library of Medicine, which provides references and abstracts from 4300 biomedical journals.
A wide variety of third-party providers has made Medline access freely available to Internet users in many guises, and it is possible to tailor the service to specific needs. For example, lnfotrieve allows the user to register a specific Medline search and receive weekly e-mail updates of all new Medline entries matching that search. Pubmed, which is the National Library of Medicine's own Internet Medline service, allows full Boolean queries of the complete range of Medline fields and can produce very large results going back many years.
A simplified version from the same source is Grateful Med, which also incorporates preMedline for rapid access to literature not yet incorporated into the main Medline index. Biomednet has a literature search service that provides "intelligent Medline," combining the results of a normal Medline search with other resources some of which have been evaluated by independent assessors. "On-searching" is provided, which is the ability to search for articles similar to a selected article (based on MESH headings) or for articles by the same author. In some cases, these sites allow the user to order full-text articles, as well as viewing the abstracts, but this is normally a commercially charged add-on feature.
At the same time, individual journals have been making use of the Internet to expand the reach and scope of the printed journals. One of the best examples of this is the British Medical Journal with its eBMJ web site. As each new issue of the journal is posted to eBMJ, at the same time if not a little before the printed version is available, on-line visitors have immediate access to the latest content. A number of articles are available to all visitors in full text, whereas most of the rest appears in abstract form with full text for subscribers. References cited within an eBMJ article are linked to the relevant original abstract within Medline. Many biomedical journals now allow e-mailed letters to the editor, but in eBMJ you can read all the letters pertaining to a particular topic and participate in a forum on the topic. The site also has a Customised @ lerts feature, which sends e-mailed tables of contents on request for each new issue. This feature can be further customized by selecting from one or more of the 100 plus clinical categories into which journal content has been arranged.
A search engine allows ready access to archived material, which is also grouped within "clinical collections" corresponding to the same clinical categories as the e-mail alerts. As Nutrition is one of those collections, it is a simple matter to track nutrition-related content on what is one of the world's leading medical journals. Although the British Medical Journal is perhaps the best implementation of an electronic biomedical journal site, a substantial number of nutrition journals have provided on-line sites that provide some combination of these features. More than 50 nutrition and 30 food science journals currently offer at least free on-line tables of contents. A comprehensive list of these is maintained on the Arbor Nutrition Guide. The American Journal of Clinical Nutrition web site is a well-implemented example, providing abstracts of the current issues with archives back to 1996, as well as a search engine and e-mail table of contents. The Journal of Nutrition offers an interesting twist to e-mail updates, offering alerts whenever another journal article cites the paper in question. Exciting as these developments are, they are only the beginning. A recent trend is the pre publishing of research articles on the Internet prior to acceptance by the printed journal. This not only cuts down enormously on the time lag between submission of a paper and its availability to the health professional community, but it also allows the democratization of the peer review process. The Medical Journal of Australia was the first major medical journal to experiment with this concept, allowing any qualified viewer to submit peer review comments on articles that have been accepted in principle.
The comments and the authors' responses to those comments are all publicly posted. In this way, it is hoped that the peer review process will become a more open and transparent one. Two web sites initiated toward the end of 1999, Clinical Medicine Net Prints and Biomedcentral, offer anyone who wishes the ability to put up a paper, whether or not it has been accepted by any particular journal. Both have excellent academic credentials, one being sponsored by the British Medical Journal and Stanford University Libraries. Like eBMJ, it allows browsing by medical specialty, of which nutrition is one area. The ultimate conclusion of Internet publishing may be journals that exist only on the Internet.
However, although there are a scattering of such e-journals already, current trends suggest that Internet publishing is going to enhance rather than take over from the traditional hard copy journals. From the lay perspective, there are many ways to keep up with recent developments in nutrition science in a less formal way. Commercial news agencies such as Reuters and CNN have health news web sites, both of which allow the user to specify a food and nutrition focus. For health professionals, several of the web sites established specifically for physicians run regular nutrition articles and case reviews, for example Doctors Guide.
Dietetics, Healthy Diet
There are a very large number of web sites containing information on healthy diet, dietary guidelines, recommended dietary intakes, and the like. The Food and Nutrition Information Center of the US Department of Agriculture has one of the better collections on its web site, including, for example, both the text and graphics of the US dietary guidelines, along with the report of the committee that produced them, and the Recommended Dietary Allowances as produced by the National Academy of Sciences. For lay information sheets, a good starting point is the American Dietetic Association web site, which has a large range of "Nutrition Fact Sheets".
The International Food Information Council has a good collection of lay information, with material on food safety and on the general healthy diet. Dietitians have not been slow to
ake advantage of the Internet, both to promote their services commercially and to communicate among themselves. The American Dietetic Association web site has a good deal of material about the dietetic profession, position statements, and a database of dietitians, which can be searched by location and specialty interest. Dietitians of Canada also has a well thought-out web site with professional and lay resources. It is host to the home page of the International Committee of Dietetic Associations, within which can be found a list of dietitians' associations around the world. Surprisingly few have web sites as of the date of writing. Dietitians have also organized informal groupings to communicate via the Internet. Dietetics Online is the web site of "a worldwide networking organization of nutrition and dietetic professionals". First developed to provide information on and archives from a long-standing dietitians' bulletin board on the proprietary America Online service, it has grown to include recipes, marketplace information on dietetic-related products, job information, and a reference point for state dietetic associations and several dietitian special interest groups. There are numerous sites belonging to individual dietitians, which generally feature some lay nutrition information along with advertisements for the owner's dietetic services. Cyberdiet is a particularly good example of a web site originally set up by an individual dietitian, which has now become part of a larger Internet health network. Ask the Dietitian is another of the best dietitian-authored web sites, with a particularly good Q&A section for the lay visitor.
Clinical Nutrition
There are many Internet resources of relevance to clinical nutritionists, but they are scattered amongst many web sites, including university medical school curricularn and course notes, medical CME sites, and organizational home pages. Once again, a good portal site can help to locate what the user is seeking. The American Society for Parenteral and Enteral _Vutrition web site is one of the better examples, providing news, clinical updates, and lay information on nutrition support. The Arbor Nutrition Guide has a series of articles tailored for family physicians.
Nutrition elements of specific diseases are often best covered by medical organizations concerned with those diseases. For example, useful nutrition resources are available at the
American Diabetes Association, American Heart Association, National Heart, Lung, and Blood Institute, International Association of Physicians in AIDS Care, and Canadian Pediatric Society. The American Association of Clinical Endocrinologists web site has quite a bit of nutrition material related to osteoporosis and growth disorders, whereas the Heinz Institute of Nutritional Sciences (HINS) web site has health professional material on pediatrics.
Food and Food Science
The interactive nature of the Internet is particularly suited to accessing food tables and other forms of nutrition software. The USDA Nutrient Database food composition data can be accessed through a simple search engine, in which users can specify food and food quantity in several ways. Cyberdiet offers food label food composition data; it is particularly suited to lay users. This site will also calculate a person's recommended dietary intake based on age, gender, anthropometric measures, and activity level. More specialized food composition sites include: Drive Thru Diet from Wake Forest University, which provides nutritional information on foods from the seven largest fast-food chains in the United States, and You Are What You Eat, an imaginative site originally designed by nutrition students offering nutrient and food label information, food counter and planner, and the ability to report intake data in relation to an individualized nutrient profile. Other types of interactive nutrition calculators are available on-line, particularly for calculating body mass index, energy requirements, compliance with dietary pyramid recommendations (66), and intake of various specific nutrients such as calcium. The food industry is well covered by web sites: generic, industry-wide, and those dealing with individual companies. The range and number of such sites is, however, larger than can be accommodated in this chapter; this is even more the case in relation to sites devoted to food and cooking. Once again, reference to a good nutrition portal site is recommended.
