Will this refined approach to nutrition change clinical care?

Gone are the days of one-size-fits-all patient care. A personalized approach—one specifically tailored to a person’s needs—is the new focus of clinical practice. This is precision medicine, and it has gained traction thanks to better access to genome sequencing and a constant stream of studies demonstrating that gene variants affect disease risk and treatment. Precision nutrition (PN) takes a similar approach, but rather than simply treat disease, aims to prevent it.

The concept of PN is that the interaction between a person’s genotype and their nutrient intake, behavioral lifestyle, and socioeconomic environment together influence overall health. Experts call this intricate interplay a “nutrition phenotype,” and they believe that this refined approach to nutrition will change clinical care.

“There has been increasing recognition that an individual's diet and environment may impact disease susceptibility by affecting the expression of genes involved in critical metabolic pathways,” explain Deepika Laddu, PhD, and Michelle Hauser, MD—authors of a recent review article on nutritional phenotypes, published in Progress in Cardiovascular Diseases.

“The overarching goals of PN are to deliver individualized, actionable dietary therapy based on an individual's nutritional phenotype, created from the integration of genetics, metabolic profile, and environmental factors in order to prevent and treat chronic disease,” they wrote.

What are ‘omics’?

Modern technologies known as “omics” are key to understanding dietary variability and disease susceptibility, noted Dr. Laddu, assistant professor, Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, and Dr. Hauser, postdoctoral research fellow, Cardiovascular Disease Prevention, Stanford University School of Medicine, Stanford, CA. Among these new technologies are nutrigenetics and nutrigenomics—complementary disciplines that experts believe will help unlock the importance of nutrition phenotypes.

An important focus of omics research is obesity. More specifically, investigators are assessing how genetic polymorphisms influence different responses among people who have the same eating patterns. They are also trying to identify genotypes that make people more susceptible to obesity-related diseases.

PN is not necessarily a new concept in clinical care—think gluten-free diets for celiac disease or diets that avoid sugar spikes for diabetes—but translating complex omics data and getting PN to be more mainstream in clinical care has proven difficult.

Barriers include clinicians’ already-limited time with patients, lack of general nutrition training, emphasis on prescribing medications over lifestyle changes, and the overwhelming effort necessary to keep up with current research. In addition, no consensus guidelines exist to help streamline PN into broader practice.

Better training needed

To overcome these hurdles, experts propose better integration of nutrition trends in medical training programs and continuing medical education. They suggest focusing on the many overlapping advantages that diets like the Mediterranean diet and DASH have in various patient types. Once equipped with that knowledge, clinicians can then refer appropriate patients to dieticians specifically trained in PN who understand genetic and metabolic tests to further elucidate a patient’s nutrition phenotype.

According to Drs. Laddu and Hauser, expanding the role of PN in clinical practice can “create opportunities for new specialties within medicine and dietetics as the volume of knowledge needed to stay abreast in this ever-changing and growing field would be substantial.”

PN strategies also present “unprecedented opportunity to refine disease risk stratification and better target prevention efforts,” they added.

With the emergence of precision nutrition, it is clear that the old adage of “proper diet and exercise” is no longer a universal solution. Nor should it be when emerging evidence shows that individualized nutrition and medicine may ultimately afford better care for all.