Personalised nutrition in patient‐centred care

It has recently been estimated that one in five early deaths worldwide is associated with poor dietary habits 1. Addressing this societal challenge through dietetics practice will require substantial human resource investment. However, according to the World Health Organization, there is currently a substantial shortage of healthcare workers, which is expected to increase over the coming decades 2. Because of this, it is important to develop an understanding of the potential ways that new technologies and digital tools can help to increase the impact of dietetics. This will create value not only for the individual patient, but also as a scalable approach to helping individuals develop improved dietary habits and transition to a service that is based on prevention and self‐care.

Patient‐centred care is a cornerstone of modern dietetics practice 3. A key tenant underlying this approach is the individualisation of guidance based on the patient’s specific needs and, in a broad sense, treating the patient and not the disease 4. In parallel, personalisation has recently developed as a trend in the consumer nutrition and wellness area 5. Numerous apps, programs, platforms and plans are now aimed at delivering a personalised experience for the user based on profiling of an individual’s demographics, genotype, nutritional intake and status, anthropometrics, lifestyle behaviours, and/or preferences 6, 7. Several definitions have been put forth for personalised nutrition, including those that deal primarily with genetic differences, and others that include much broader concepts, including phenotypic, psychosocial and behavioural aspects of individualisation 8-11. In this editorial, we employ a recently proposed definition of personalised nutrition to describe approaches that ‘use individual‐specific information, founded on evidence‐based science, to promote dietary behaviour change that may result in measurable health benefit’ 12. By leveraging a holistic definition, we can consider how different aspects of personalisation can be of greatest benefit and can be most effectively leveraged for the individual patient, which can be appreciated by all dietitians.

The scientific evidence for personalised nutrition is growing. Substantiation continues to emerge that personalised nutrition can provide added value beyond conventional approaches. In the clinical setting, there has been increased recognition of the importance of implementing nutritional screening and intervention 13. For example, individualised nutrition assessments and provision of tailored nutritional support in patients at nutritional risk have been shown to significantly improve clinical outcomes, including patient survival 14. In a broader wellness context, several important gene–diet interactions were found to influence the response to dietary weight‐loss interventions in the landmark DIOGENES trial 15.

More holistic approaches, leveraging personalised information based on both genotypic and phenotypic variation, have also been promising 16. A recent study in older Dutch adults found that the provision of personalised advice, based on dietary intake, genetic and physiological information, resulted in increased resiliency and motivation, and decreased body fat percentage and hip circumference 17. In the future, we expect to see even more research investment in Personalised ‘algorithm‐based’ approaches. For example, clinical trials are currently underway aiming to validate a microbiome‐based personalisation approach for blood sugar management 18, 19. Likewise, an ongoing collaboration between Stanford University and Massachusetts General Hospital recently published a pilot study (PREDICT) and is now conducting a large observational study (PREDICT2) to measure individual metabolic responses to foods, with the aim of developing a commercial platform 20. In the Nutrigenomics, Overweight/Obesity and Weight Management Trial (NOW Trial), the effects of a lifestyle intervention employing personalised genetic testing and behavioural advice will be compared with the same intervention with population‐based advice 21. However, for many commercial platforms, their benefit has yet to be established in randomised controlled trials. Challenges still exist in terms of replicability of results, diversity of population groups included 22, as well as scientific validation and accuracy of products currently available 23. It has become clear however, that behaviour change is the common denominator underpinning successful personalised nutrition approaches for which dietitians are well versed, trained and experienced.

中文翻译：

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个性化营养技术：数字化转型时代饮食实践和培训的新范例。

以患者为中心的个性化营养

最近据估计，全世界五分之一的早期死亡与不良的饮食习惯有关1。通过饮食实践来应对这一社会挑战将需要大量的人力资源投资。但是，根据世界卫生组织的资料，目前医护人员严重短缺，预计在未来几十年中还会增加2。因此，重要的是要了解新技术和数字工具可以帮助增加营养学影响的潜在方式。这不仅将为个体患者创造价值，而且还将作为一种可扩展的方法来帮助个体养成改善的饮食习惯并过渡到基于预防和自我护理的服务。

以患者为中心的护理是现代饮食实践3的基石。该方法的主要承租人是根据患者的具体需求进行个体化指导，并在广义上治疗患者而不是疾病4。同时，个性化近来已发展为消费者营养和保健领域的趋势5。现在，许多应用程序，程序，平台和计划旨在基于对个人的人口统计学，基因型，营养摄入和状况，人体测量学，生活方式和/或偏好6、7的分析，为用户提供个性化的体验。。已经针对个性化营养提出了几种定义，包括那些主要针对遗传差异的定义，而其他定义则包含了更广泛的概念，包括个体化的表型，社会心理和行为方面8-11。在这篇社论中，我们采用了最近提出的个性化营养定义，以描述“利用基于证据的科学的个体特定信息来促进饮食行为改变（可能带来可衡量的健康益处）的方法” 12。通过使用整体定义，我们可以考虑个性化的不同方面如何才能发挥最大的作用，并可以最有效地为每个患者提供帮助，所有营养学家都可以理解。

个性化营养的科学证据正在增长。越来越多的证据表明，个性化营养可以提供超越传统方法的附加值。在临床环境中，人们越来越认识到实施营养筛查和干预的重要性13。例如，已显示有营养风险的患者进行个性化营养评估和提供有针对性的营养支持可以显着改善临床结果，包括患者生存率14。在更广泛的健康背景下，具有里程碑意义的DIOGENES试验15发现了几种重要的基因-饮食相互作用会影响对饮食减肥干预的反应。

利用基于基因型和表型变异的个性化信息的更全面的方法也很有希望16。一项针对荷兰老年人的最新研究发现，根据饮食摄入，遗传和生理信息提供个性化建议，可以提高适应力和动力，并降低体脂百分比和臀围17。将来，我们希望在个性化“基于算法”的方法上看到更多的研究投资。例如，目前正在进行临床试验，旨在验证基于微生物组的血糖管理个性化方法18、19。同样，斯坦福大学和马萨诸塞州总医院之间正在进行的合作最近发布了一项试验研究（PREDICT），目前正在开展一项大型观察性研究（PREDICT2），以测量个体对食物的新陈代谢反应，以开发商业平台20。在营养基因组学，超重/肥胖和体重管理试验（NOW试验）中，将采用个性化基因检测和行为建议的生活方式干预的效果与基于人群的建议进行的干预相比较21。但是，对于许多商业平台，它们的益处尚未在随机对照试验中确定。在结果的可复制性，包括人口群体的多样性方面仍然存在挑战22以及目前可用产品的科学验证和准确性23。然而，很明显，行为改变是成功的个性化营养方法的共同点，营养学家对此精通，训练有素并且经验丰富。