A 3‐D approach to personalised nutrition

Abstract

Food Science and TechnologyVolume 36, Issue 2 p. 34-37 FeaturesFree Access A 3-D approach to personalised nutrition First published: 09 June 2022 https://doi.org/10.1002/fsat.3602_8.xAboutSectionsPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Nate Matusheski and Chloe Giraldi of Hologram Sciences introduce the concept of personalised nutrition and explain why science and technology are key to promoting dietary behaviour for improved health benefits. The concept of personalised nutrition has been growing in popularity over the past several years, as evidenced by numerous acquisitions by major players in the food and nutrition industry. Commercial approaches in this area have taken many forms, ranging from simple questionnaire-driven supplement sachets to holistic dietary and lifestyle subscription programmes. Such approaches range from customised vitamins and supplements that assure nutritional adequacy to programmes that address dietary and lifestyle behaviours affecting chronic disease. Here we provide a perspective on the definition, evolution and recent trends that are driving commercial personalised nutrition approaches, along with key considerations for delivering high-quality personalised nutrition programmes to consumers. Optimal nutrient intakes and improved health outcomes Today's nutrient intake recommendations are almost exclusively based on population averages, an approach dating back to the 1960s. In most countries, dietary reference values (DRVs) are the basis for everything from public health recommendations to food labelling and are designed to account for the variation that exists in the general population. However, while they account for differences in nutrient needs by age and gender, these recommendations are grounded on average requirements, with a simple ‘margin of safety’ to assure population coverage. But, of course, there is no such thing as an ‘average’ person. Individual nutritional requirements vary widely due to numerous factors including individual genetics, phenotypic differences, such as body weight or muscle mass, physical activity levels and other lifestyle and health factors1. As the field of personalised nutrition has emerged, various terminologies have been used and several definitions have been proposed. The term ‘precision nutrition’ is typically used in the area of disease intervention, whereas ‘personalised nutrition’ tends to be more widely used for health and wellness. One relevant definition has been proposed by a cross-disciplinary group of experts and echoed by the Academy of Nutrition and Dietetics in the US2: ‘Personalised nutrition uses individual-specific information, founded in evidence-based science, to promote dietary behaviour change that may result in measurable health benefits’. New developments in sensor technology are creating opportunities for lower cost and less invasive measurement of nutritional status and other health factors. This definition can be interpreted using a 3 dimension approach across what we characterise as the ‘3Ds’ of personalised nutrition (Figure 1). The first is diagnostic, which reflects the collection and tracking of individual-specific information. This can include any questionnaire, lab test, or passively-collected information, for example from a wearable device. The second is digital, where digital technology is leveraged to create science-based protocols, algorithms and connections with experts to promote dietary behaviour change. The final D is delivery, where the user is provided with either dietary or lifestyle advice, or better yet a physical nutritional or other consumer product. Ultimately, those individual-specific recommendations and products should result in a measurable and sustained health benefit. Figure 1Open in figure viewerPowerPoint The three ‘Ds’ of personalised nutrition Evolution of personalised nutrition In one sense, the concept of personalised nutrition has been practised for many years on a one-to-one basis by professional dietitians and is, by definition, the essence of patient-centred care3. The challenge has been how to scale this to broaden the accessibility. With recent advances in the aforementioned realms of diagnostics, digital and delivery, the field of personalised nutrition has been undergoing some revolutionary changes, both in the scientific and commercial sectors. On the scientific side, advances continue to be made in understanding the relevance of genotype and phenotype, epigenetics, microbiome and behavioural factors for individual health4. Artificial intelligence and machine learning approaches have been employed to interpret complex data sets. New developments in sensor technology are creating opportunities for lower cost and less invasive measurement of nutritional status and other health factors5. In the commercial sector, advances in digital technology have resulted in greater consumer expectations for customised products and services that are tailored to individual needs and preferences. Today's consumers experience personalisation cutting across everything from footwear to jewellery to confections. In the nutrition domain, the personalised supplement sachet subscription model has rapidly gained popularity, with recommendations driven by individual responses to in-depth health questionnaires. Impact of the pandemic on personalised approaches Telemedicine was increasing in popularity, even before the COVID-19 pandemic. The growth of web-based video conferencing services and structured approaches to telemedicine services had contributed to this trend. However, the pandemic added fuel to the fire, igniting exponential growth. A 2021 report from the US Department of Health and Human Services found a 63- fold increase in the utilisation of telehealth services during the pandemic6. The UK was recently reported to be the most established market for telehealth among several European countries. Aside from the necessity of telemedicine during the height of the pandemic, these approaches have been favourably received by patients and physicians alike7. The trend in telemedicine has now set the stage for individuals to expect more at-home services in the nutrition and wellness area, and also creates an expectation for consumers that they should be able to access credentialed experts like dietitians or other health coaches from the comfort of home. Similarly, at-home lab testing has also been experiencing rapid growth and even more so over the course of the pandemic. Individuals have become all too familiar with the concept of taking a nasal swab or saliva sample and applying it to a device for a rapid at-home COVID test. Major US testing firm Quest Diagnostics recently estimated the at-home testing market could be worth $2bn USD by 2025. The CEO of US-based testing firm Everlywell reported a 100% growth in 2021 vs. 2020. These trends point to the ‘normalisation’ of consumer-initiated at-home testing, again setting the stage for more widespread consumer acceptance of at-home tests in the wellness area. These changes in the healthcare space most likely will have important implications for increased interest in, and adoption of, personalised nutrition concepts in the consumer marketplace. Assuring the quality of commercial personalised nutrition concepts As personalised nutrition is an evolving field, consumer scepticism exists and is sometimes well-founded. Early approaches related to nutritional genetic testing became popular in the early 2000s, but were critiqued in some academic circles and eventually lost commercial momentum. On the other hand, much more holistic and generalised approaches to personalised nutrition and wellness, such as those offered by Habit and Arivale, were more highly regarded, but in the end, became cost-prohibitive to deliver and either merged with other platforms or shut down completely. As an increasing number of personalised approaches continue to enter the market, it is important to ensure that these programmes are not only commercially viable but also built upon a strong foundation of scientific evidence, so that consumer trust will be maintained. To this aim, a set of guiding principles has been established that can be useful in the development of high-quality personalised nutrition approaches, or in the assessment of such approaches by practising clinicians or consumers themselves (Table 1)2. In addition, personalised nutrition programmes have begun to be categorised and rated by independent organisations, such as Qina.tech, which publishes a database of personalised nutrition approaches and rates them regarding current industry best practices. In the future, such rating systems are also likely to gain in popularity with practising clinicians as they guide their patients toward appropriate programmes. Table 1. Guiding principles for personalised nutrition2 GUIDING PRINCIPLES FOR PERSONALISED NUTRITION 1 Define potential users and beneficiaries. 2 Use validated diagnostic methods and measures. 3 Maintain data quality and relevance. 4 Derive data-driven recommendations from validated models and algorithms. 5 Design personalised nutrition studies around validated individual health or function needs and outcomes. 6 Provide rigorous scientific evidence for an effect on health or function. 7 Deliver user-friendly tools. 8 For healthy individuals, align with population-based recommendations. 9 Communicate transparently about potential effects. 10 Protect individual data privacy and act responsibly. The collection of individual-specific information is a cornerstone of personalisation. The identification of affordable and minimally-invasive biomarkers for health or nutritional status is a priority to assure the accessibility of such approaches for the general population. As we assess new testing approaches that can inform a personalised nutrition programme, we can utilise a three-part construct (Figure 2). First, the test itself should measure a biomarker that is important for health, and when modified can contribute to a meaningful health outcome. Second, the biomarker should be one that can be reliably influenced by nutrition or lifestyle factors. Finally, evidence should exist that the nutrition or lifestyle intervention itself can be habituated by an individual and modify the health outcome by way of the measured biomarker. This construct can be utilised whether the biomarker is one of nutritional status, such as circulating vitamin D concentration, or an intermediate health biomarker, such as an inflammatory mediator. Figure 2Open in figure viewerPowerPoint A construct for a successful at-home testing approach A recent case study illustrates several of the above points. A new-to-market vitamin D supplement was launched in the US by Hologram Sciences under the d.velop™ brand name as part of a personalised solution for immunity. Because the product contains calcifediol, a more effective dietary form of vitamin D3, it was important to demonstrate to consumers that this new supplement was effective at raising their vitamin D levels. An at-home vitamin D test was integrated into the offering and new subscription customers have been offered the ability to ‘opt-in’ to receive a free two-pack at-home vitamin D test. Providing the test for free creates credibility for the efficacy of the supplement, even for those who decline the test. Of those who have taken both tests, vitamin D levels were found to increase in 97% of users who started with sub-optimal vitamin D levels. Vitamin D test results are provided directly in the d.velopTM app, which also provides users with an ‘immune health score’ that factors in diet, exercise, sun exposure and other lifestyle factors like smoking and alcohol use. A registered dietitian coach contacts individuals to review their test results and offer dietary and lifestyle guidance related to immune system health. d.velop at-home vitamin D test kit Role of live coaching and behaviour change science One important but often overlooked aspect of creating a high-quality personalised nutrition approach is a focus on behaviour change science, to ensure that any nutrition or lifestyle guidance is truly embraced by participants and habituated into their daily lives. From a business standpoint, habituation and retention of consumers onto a personalised nutrition programme is also paramount to commercial success. One important but often overlooked aspect of creating a high-quality personalised nutrition approach is a focus on behaviour change science, to ensure that any nutrition or lifestyle guidance is truly embraced by participants. Most successful dietary or lifestyle interventions leverage one or more scientifically-validated behaviour change techniques. However, most mobile health apps do not adequately leverage such approaches, so there is a gap between commercially-available apps and best practices8. In order to address this, Hologram Sciences worked with the expert behaviour change consulting firm Younger Lives to create a set of nine guiding principles for behaviour change. These are applied in digital app and programme development to ensure the best possible user retention and an improved probability for users to achieve their personal health goals. The guiding principles help providers, product developers and designers better understand which strategies to use when creating programmes and experiences to better engage the user and offer a superior end-to-end personalised experience. Live coaching is key to providing in-the-moment support, recommendations and advice – also known as ‘ecological momentary intervention’. This allows behaviour change to continue beyond just a single interaction for an exchange in habit building strategies that can incorporate information available in a digital platform – such as from a wearable device, an assessment etc. When designing for behaviour changes within personalised nutrition experiences, stakeholders can use similar principles to rationalise the inclusion and placement of live coaching. Each person has unique goals and psychosocial factors should be considered when delivering a personalised nutrition approach. With live coaching, a person-centred approach known as ‘motivational interviewing’ is another strategy that can be used to elicit behaviour change by taking into consideration personal motivations and changing lifestyle dynamics9. Motivational interviewing is commonly used by registered dietitians when working with clients on new nutrition and wellness behaviours, focusing on using open-ended questions, understanding readiness to change, reflecting back on acquired knowledge, and planning specific actions related to the user's goals. Once a live coach better understands where a user falls on the spectrum for desired change, a cohesive personalised plan can be developed. The importance of human support alongside artificial intelligence (AI) and other technologies has recently been highlighted10. Live coaching models within personalised nutrition can offer an innovative take on telehealth by pairing real-life professionals with advanced digital platforms. Digital approaches can automate many of the usual, time-consuming tasks in a nutrition counselling session. This allows each live coach to interact with more users on the mobile platform, providing more opportunities for behaviour change to occur throughout the user's journey. When properly and regularly evaluated, the role of technology, live coaching and behaviour change in personalised nutrition provides a strong delivery model for evidence-based public health. It may also improve the delivery and accessibility of sound information and clinical efficiency – allowing clinicians to target larger demographics and produce cost savings. Technology and science will drive adoption There can be no doubt that the technology and science behind personalised nutrition will continue to evolve and that consumer demand for high-quality, accessible, ‘one-stop-shop’ health and nutrition solutions is likely to grow. Commercial providers of personalised nutrition programmes should ensure that ease-of-use is matched to evidence-based practices and that continuous development allows for these methods to evolve along with consumer desires. This includes being able to integrate a variety of solutions including wearable devices, smart health monitoring solutions, personalised nutritional products, at-home testing, and more. Future personalised nutrition approaches may also stretch far beyond the individual consumer and could play a pivotal role within our food system in how we make food and nutrition choices based on not only health but also environmental or ethical ideals. Cross-industry collaborations between digital tech companies, supplement/ingredient manufacturers, scientists, clinicians, food service providers, community stakeholders and others will be key to accelerating innovation in personalised nutrition. Nate Matusheski PhD, Chief Science Officer and Chloe Giraldi, MS, RD, LDN, VP Nutrition Science, Hologram Sciences, Inc., Boston, MA, USA Hologram Sciences, Inc. is a direct-to-consumer personalised nutrition company backed by Royal DSM, N.V. email nate@hologramsciences. com web hologramsciences.com References 1Ordovas, J.M., Ferguson, L.R., Tai, E.S., Mathers, J.C. 2018. Personalised nutrition and health. BMJ 361: bmj.k2173. Available from: https://doi.org/10.1136/bmj.k2173Google Scholar 2Adams, S.H., Anthony, J.C., Carvajal, R. et al. 2020. Perspective: guiding principles for the implementation of personalized nutrition approaches that benefit health and function. Advances in Nutrition 11: 25-34. Available from: https://doi.org/10.1093/advances/nmz086Google Scholar 3Abrahams, M., Matusheski, N.V. 2020. Personalised nutrition technologies: a new paradigm for dietetic practice and training in a digital transformation era. Journal of Human Nutrition and Dietetics 33: 295-298. 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