Large variability exists in people’s responses to foods. However, the efficacy of personalized dietary advice for health remains understudied. We compared a personalized dietary program (PDP) versus general advice (control) on cardiometabolic health using a randomized clinical trial. The PDP used food characteristics, individual postprandial glucose and triglyceride (TG) responses to foods, microbiomes and health history, to produce personalized food scores in an 18-week app-based program. The control group received standard care dietary advice (US Department of Agriculture Guidelines for Americans, 2020–2025) using online resources, check-ins, video lessons and a leaflet. Primary outcomes were serum low-density lipoprotein cholesterol and TG concentrations at baseline and at 18 weeks. Participants (n = 347), aged 41–70 years and generally representative of the average US population, were randomized to the PDP (n = 177) or control (n = 170). Intention-to-treat analysis (n = 347) between groups showed significant reduction in TGs (mean difference = −0.13 mmol l⁻¹; log-transformed 95% confidence interval = −0.07 to −0.01, P = 0.016). Changes in low-density lipoprotein cholesterol were not significant. There were improvements in secondary outcomes, including body weight, waist circumference, HbA1c, diet quality and microbiome (beta-diversity) (P < 0.05), particularly in highly adherent PDP participants. However, blood pressure, insulin, glucose, C-peptide, apolipoprotein A1 and B, and postprandial TGs did not differ between groups. No serious intervention-related adverse events were reported. Following a personalized diet led to some improvements in cardiometabolic health compared to standard dietary advice. ClinicalTrials.gov registration: NCT05273268.

人们对食物的反应存在很大差异。然而，个性化饮食建议对健康的功效仍未得到充分研究。我们使用随机临床试验比较了个性化饮食计划 (PDP) 与关于心脏代谢健康的一般建议（对照）。 PDP 利用食物特征、个体餐后血糖和甘油三酯 (TG) 对食物的反应、微生物组和健康史，在一项为期 18 周的基于应用程序的项目中生成个性化食物评分。对照组使用在线资源、签到、视频课程和传单接受标准护理饮食建议（美国农业部美国人指南，2020-2025）。主要结局是基线和 18 周时的血清低密度脂蛋白胆固醇和 TG 浓度。参与者 ( n  = 347) 年龄在 41-70 岁，一般代表美国平均人口，被随机分配到 PDP ( n  = 177) 或对照组 ( n  = 170)。组间意向治疗分析 ( n  = 347) 显示 TG 显着降低（平均差 = -0.13 mmol l ^-1；对数转换 95% 置信区间 = -0.07 至 -0.01，P  = 0.016）。低密度脂蛋白胆固醇的变化不显着。次要结果有所改善，包括体重、腰围、HbA1c、饮食质量和微生物组（β 多样性）（P  < 0.05），特别是在高度依从性的 PDP 参与者中。然而，血压、胰岛素、血糖、C 肽、载脂蛋白 A1 和 B 以及餐后 TG 在各组之间没有差异。没有报告严重的干预相关不良事件。与标准饮食建议相比，遵循个性化饮食可以改善心脏代谢健康。 ClinicalTrials.gov 注册：NCT05273268。