The goal of precision nutrition is to provide individuals with nutritional advice that will optimize their health. This approach shows promise for the prevention and treatment of diabetes.
The goal of precision nutrition is for everyone to have information about what, when, why, and how to eat to stay healthy. This information would be unique to each person and based on a person’s body, lifestyle, and circumstances. The science of precision nutrition is still in its early stages, explains Holly Nicastro, PhD, MPH, but it promises to map people to the most appropriate eating habits for them.
Q: What is the link between eating habits and the risk of chronic diseases, especially type 2 diabetes?
A: Eating foods and beverages with high amounts of added sugar, sodium, and saturated fat, or eating too much food that leads to weight gain, can increase your risk of type 2 diabetes or other chronic diseases. But the good news is that positive eating habits like eating whole grains, fruits and vegetables, foods high in fiber, and micronutrient-rich foods, and avoiding sugar, sodium, and saturated fats can reduce your risk.
Q: Does eating healthy or unhealthy have the same effect on everyone?
A: No. The nation offers nutritional guidelines, the Nutritional Guidelines for Americans 2020-2025, but these are broad. While the guidelines provide population-based recommendations, a general nutritional approach is not always sufficient, as we find a degree of individual variability in response to a particular diet in virtually every nutritional study. For example, if people at risk for type 2 diabetes are advised to follow the lifestyle change program of the diabetes prevention program, we expect results to improve. However, the weight loss or change in glucose response varies from patient to patient.
Q: What are the various factors that could be contributing to this variability?
A: Age, gender, genetics, meal times and the composition of your own microbiome or gut bacteria can all contribute to this. This also applies to pregnancy, breastfeeding or menopause. These are just a few of the variables we know. There are other factors that we need to discover, and better investigate, that could also contribute, such as the environment or life experiences such as stress. And we need to examine all of these factors holistically, rather than just testing one or more factors at a time.
Q: How can precision nutrition help people find the nutritional pattern that best supports their health?
A: When NIH uses the term “precision nutrition,” we’re talking about the goal of individualized and actionable dietary recommendations that help people choose what, when, why, and how to eat in order to optimize their health or quality of life. For example, for a person with type 2 diabetes, eating well may mean following a diet that minimizes blood sugar spikes and dropouts. But at this point in time, we don’t have a test that can help a person find out exactly how to eat to optimize their health.
Q: How is precision nutrition used in clinical practice today?
A: With regard to individual and actionable dietary recommendations, we are constantly adapting advice and recommendations. As an example, the Dietary Guidelines for Americans rank the recommendations based on age and gender. Pregnant and breastfeeding women have additional recommendations for minerals and nutrients such as iron and choline; Older adults also have different dietary recommendations.
We also adjust dietary recommendations based on disease status. Think of celiac disease, where a person cannot tolerate gluten; we would not give them the same dietary recommendations as someone else of the same age, weight, or gender. We tailor dietary recommendations to patients with diabetes when we advise them to limit added sugar and stick to a consistent meal time. So we’re doing precision nutrition all the time, but the future of precision nutrition would be to tailor dietary recommendations based on a broader list of factors than we are currently using, such as age, gender, or disease status.
Health professionals today also take a precise approach to how they educate their patients and how they recommend changes that patients can make in their lives. You can take into account the patient’s socio-economic status, family situation, and other factors.
At the moment, the gold standard for nutrition education – what has been studied, what is covered by Medicare – is group counseling combined with individual counseling. But instead of just saying, “Okay, follow the standardized program,” we may be able to use some of the person’s factors to decide how to make this recommendation or any other recommendation. I will use myself as an example. I’m in my thirties with two children and a husband at home. You can’t just tell me to follow a certain diet without considering the needs of my entire family. So maybe a better approach would be to provide me with recipes that will feed a whole family or that are kid-friendly.
Q: What improvements does precision nutrition bring to diabetes care?
A: In the case of diabetes, I can imagine precisely predicting individual blood sugar reactions to different foods, nutritional patterns or nutritional strategies. This would involve several steps: identifying the most important factors; Predicting individual responses to different foods, food groups, and nutritional patterns; Development of the bespoke plan for one person; and find the most effective way to train that person to follow the recommendations.
This bespoke approach could be implemented in people with prediabetes or high risk of diabetes. Precision medicine could potentially also help in the longer-term management of diabetes or possibly in reversing type 2 diabetes. I hope that this approach can be further explored in depth and applied more widely over the next few years.
Q: What needs to be done to refine the nutritional advice and tailor it to the patient?
A: We need to identify the main ones of hundreds of thousands of potential predictors: genes, microbiome signatures, metabolic flows over time, subjective measurements of a person’s experience, and other complexities. This requires very, very, very large data sets from a larger study than before, which includes a very large number of people and ensures diversity among the people examined.
With artificial intelligence (AI), we could integrate multimodal data to create the algorithms that determine how an individual would react to a particular food or diet. Another benefit of an AI approach is that it could help identify predictive factors for healthy or unhealthy outcomes that, on their own, may have less of an impact, but, when combined with other factors, could contribute to variability. So maybe there is a specific gene that by itself does not predict response to treatment, but when you see this genetic signature in women over the age of 50 who also have a specific microbiome signature, you may get a bigger signal.
Q: How is the NIH All of Us research project helping build knowledge about precision nutrition?
A: The All of Us Research Program is a national precision medicine initiative. We are building the largest and most diverse database of health information of its kind. This resource will be available to all researchers and we aim to enroll a million or more participants.
Q: You are the coordinator of an NIH initiative that we are all driving forward called Nutrition for Precision Health. What is it?
A: Nutrition for Precision Health will be the first large additional study for All of Us with around 10,000 participants. Its goal is to develop algorithms to predict individual responses to food and nutritional patterns, and it will use the participant cohort and infrastructure to expand the data collection and advance new discoveries.
Nutrition for Precision Health will be awarding research grants in early 2022 and will focus on three exciting opportunities. The first option is to identify and strengthen the evidence base for predictive variables, for example in the genome or microbiome, or in relation to behavior and social determinants of health. The second possibility is to use artificial intelligence and machine learning to predict individual reactions to different foods, diet patterns or dietary recommendations and to continuously improve the accuracy of these predictions.
A third exciting option is implementation science – studying methods to encourage adoption of bespoke or personalized approaches. We are not there yet because we must first build the evidence base for predictive factors and responses. However, I think there will be some unique ways that we can get people to better adhere to dietary recommendations if we use precision approaches.
Q: How can health professionals support this research?
A: Healthcare professionals can recommend their patients for participation in the All of Us Research Program. People can now enroll through funded organizations or health care providers register online. (Nutrition for Precision Health will begin registration in a few years.)
All of our participants provide information through surveys and links to their electronic health records. Some physical measurements are taken in person, and patients send a blood sample for genomic information. The privacy of participant data is one of the core values of the All of Us Research Program, and tremendous efforts are made to gain and maintain the trust of participants. Participation in the All-of-Us research program can be a very motivating and exciting way for patients with diabetes to focus on their own health while helping to build the knowledge base for a precise nutritional approach to diabetes care.
How are you currently applying the concept of precision nutrition to working with patients with diabetes? Tell us in the comments below.