Science and Politics of Nutrition

Personalised nutrition and health

BMJ: first published as 10.1136/bmj.k2173 on 13 June 2018. Downloaded from http://www.bmj.com/ on 29 October 2024 by guest. Protected by copyright.
Jose Ordovas and colleagues consider that nutrition interventions tailored to individual

D
characteristics and behaviours have promise but more work is needed before they can deliver
ietary factors are well recog- related terms such as precision nutrition, Personalised nutrition can be applied
nised contributors to common nutrigenomics, nutrigenetics, nutritional in two broad areas: firstly, for the dietary
diseases, including heart dis- genomics, etc (box 1). management of people with specific
ease, stroke, type 2 diabetes The overall goal of personalised nutrition diseases or who need special nutritional
and cancer. 1-3 Despite the is to preserve or increase health using support—for example, in pregnancy or old
known link between dietary patterns and genetic, phenotypic, medical, nutritional, age, and, secondly, for the development of
disease, interventions to alter dietary habits and other relevant information about more effective interventions for improving
and to improve public health and wellbeing individuals to deliver more specific public health. It has traditionally focused
have had limited impact. Personalisation healthy eating guidance and other on maximising the benefits and reducing
of interventions may be more effective in nutritional products and services (table 1). the adverse effects of dietary changes for
changing behaviour4 that will affect health Personalised nutrition is equally applicable the individual. However, this focus on
outcomes.5 In this article we consider the to patients and to healthy people who the individual may have limited impact
evidence for personalised nutrition. may or may not have enhanced genetic on populations. To have a wider impact,
susceptibilities to specific diseases. it must be deployed at a scale and in a
What is personalised nutrition and what is it
used for?
There is no agreed definition of person- Box 1: Descriptors and definitions
alised nutrition. For the purposes of this In common with other scientific fields in their early development, multiple concepts and
review, we define it as an approach that descriptors are used in personalised nutrition, sometimes without rigorous definition.
uses information on individual character- In addition to the term personalised nutrition, many other terms are used—for example,
istics to develop targeted nutritional advice, precision nutrition, stratified nutrition, tailored nutrition, and individually tailored
products, or services. Gibney et al6 describe nutrition. We have attempted to group the descriptors as follows:
it as an approach that “assists individuals • Stratified and tailored nutrition are similar (if not synonymous). These approaches
in achieving a lasting dietary behaviour attempt to group individuals with shared characteristics and to deliver nutritional
change that is beneficial for health.” Per- intervention/advice that is suited to each group
sonalised nutrition partially overlaps with • Personalised nutrition and individually tailored nutrition mean similar things and
go a step further by attempting to deliver nutritional intervention/advice suited to
each individual
Key messages • Precision nutrition is the most ambitious of the descriptors. It suggests that it is pos-
sible to have sufficient quantitative understanding about the complex relationships
• Personalised nutrition uses informa-
tion on individual characteristics to between an individual, his/her food consumption, and his/her phenotype (including
develop targeted nutritional advice, health) to offer nutritional intervention/advice, which is known to be individually
products, or services to assist people beneficial. The degree of scientific certainty required for precision nutrition is much
to achieve a lasting dietary change in greater than that required for the other approaches
behaviour that is beneficial for health • Nutrigenetics is an aspect of personalised nutrition that studies the different phe-
notypic responses (ie, weight, blood pressure, plasma cholesterol, or glucose levels)
• Personalised nutrition is based on the
to a specific diet (ie, low fat or Mediterranean diets), depending on the genotype of
concept that individualised nutritional
the individual
advice, products, or services will be
more effective than more traditional
• Nutrigenomics involves the characterisation of all gene products affected by nutrients
and their metabolic consequences
generic approaches
• Exposome is the collection of environmental factors, such as stress, physical activity
• This personalisation may be based and diet, to which an individual is exposed and which may affect health
on biological evidence of differential As one moves from stratified to personalised to precision nutrition, it becomes necessary
responses to foods/nutrients depend- to apply more and more dimensions or characteristics to achieve the desired goal. For
ent on genotypic or phenotypic char- example, stratification could be undertaken using one, or a few, dimensions such as
acteristics, and/or based on current age, gender, or health status. In contrast, given the complexity of relationships between
behaviour, preferences, barriers and individual diet and phenotype, deployment of a wide range of dimensions/characteris-
objectives tics, perhaps including “big data” approaches, would be necessary to achieve the goal
• Most of the available evidence in of precision nutrition. An exception to this broad generalisation is the management of
support of personalised nutrition has inborn errors of metabolism such as phenylketonuria, where “precision nutrition” can
come from observational studies with be achieved using information on a single characteristic—that is, genotype.
risk factors as outcomes, rather than • Epigenomics is a branch of genomics concerned with the epigenetic changes (meth-
from randomised controlled trials ylation, histone modification, microRNAs) that modify the expression and function
using clinical end points of the genetic material of an organism
• The overall consensus is that much • Metabolomics is the scientific study and analysis of the metabolites (usually restricted
research and regulation is required to small molecules, ie, <900 daltons) produced by a cell, tissue, or organism
before personalised nutrition can • Microbiomics is the study of the microbiome, the totality of microbes in specific envi-
deliver the expected benefits ronments (ie, the human gut)

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Science and Politics of Nutrition

way that reduces (rather than increases) It is a classic example of an attempt to glucose concentrations in 800 people
health disparities. Individuals may also characterise the response of an individual continuously for 1 week. They then used
wish to use personalised nutrition to to a dietary intervention based on genetic the variability in glycaemic response to
achieve personal goals/ambitions that factors. To a large extent, this is based on identical test meals to devise a machine-

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are less directly related to health—for accumulating evidence of the phenotypic learning algorithm that integrated
example, to deal with preferences for, and consequences of interactions between blood par ameters, dietary habits,
dislikes of, specific foods, to attempt to interindividual differences in genetic anthropometrics, physical activity, and
achieve a desired body size or shape, or for make up and nutrition.12 Nutrigenetics gut microbiota to predict an individual’s
competitive sports.7 has evolved from using a unique single postprandial glycaemic response to
nucleotide polymorphism at a candidate real meals. The predictive algorithm
What are the conceptual bases for gene locus to examine interaction with was validated in an independent cohort
personalised nutrition? a specific nutrient (eg, saturated fat) to (n=100). These investigators conducted
Personalised nutrition is based on the idea a more comprehensive whole genome a small randomised controlled dietary
that individualising nutritional advice, approach analysing interactions with intervention study that suggested that
products, or services will be more effective dietary patterns.13 personalised diets may successfully modify
than more generic approaches. More recently, new technology has raised postprandial blood glucose.
Personalisation can be based on: enabled multiple endogenous and The potential role of microbiome based
• Biological evidence of differential exogenous factors to be studied at the same information in developing personalised
responses to foods/nutrients depend- time and used to predict the response to nutrition has been emphasised in more
ent on genotypic or phenotypic charac- intervention. These include epigenomics, recent work from the same group. They
teristics metabolomics, microbiomics (box 1), and used a small intervention study to show
• Analysis of current behaviour, prefer- the individual’s environment,14 also known that an individual’s glycaemic response
ences, barriers, and objectives and sub- as the exposome.15 The ability to measure to a test meal can be predicted from
sequent delivery of interventions, which “everything that matters” is becoming microbiome data before the intervention.22
motivate and enable each person to make a reality with the increasing availability These results highlight the importance of
appropriate changes to his or her eating of fitness trackers, mobile apps, and information about individual people in
pattern. other devices. These enable individuals understanding the effects of dietary factors
to monitor continuously multiple health on metabolism and health. The results
Personalisation based on biological related factors, such as physical activity, suggest that interindividual differences
characteristics of the individual sleep, and vital signs—for example, blood in responses to dietary challenges may
Differences in the response of people pressure, heart rate, and stress levels. be particularly informative, but we need
to dietary components have been well The usefulness of these devices remains evidence from larger scale studies to know
documented for almost a century.8-10 This controversial. 16 17 However, in theory, whether such personalised interventions
provides the basis, and motivation, for such information could be used to develop based on a “challenge test” offer significant
developing personalised nutrition strate- algorithms that, in combination with advantages.
gies. The trend towards personalisation is genetic and other biological information, This approach was illustrated more
the result of: firstly, nutrition research that may provide a sound basis for personalised recently by Price et al.23 They collected
provides a better understanding of how diet recommendations. personal data, including whole
affects health; secondly, new technology Potentially just as important is the genome sequences, clinical tests, blood
that enables better and continuous measure- belief that easy access to indices of health metabolome and proteome, physical
ments of markers of individual health and provided frequently, and in real time, will activity, and fecal microbiome, on three
fitness; and thirdly, new analytical tools that be a driver for beneficial, and sustained occasions over 9 months from 108
interpret this flow of data and transform it behaviour change. Thus, an individual people. They used these data to generate
into user friendly practical information. will acquire data on his/her genotype correlation networks that disclosed
Moreover, personal nutrition integrates with and multiple phenotypic characteristics communities of related analytes associated
the change in bioscience and public health on which the personalised nutrition with physiology and disease. They also
programmes towards preventing rather is based. Periodic physiological and used some of the personal data (genotype
than mitigating existing disease. Response biochemical analyses and microbiome and clinical markers) to implement
to food is variable and has multiple forms. tests will enable tracking of their health behavioural coaching to help participants
These include differential responses in metrics in response to dietary, and other to improve biomarkers of health. This study
plasma cholesterol concentration to dietary personalised, behavioural changes in real showed, firstly, that some highly motivated
saturated fat intake, food allergies or intol- time. Relatively little has been published people are willing to collect personal data
erances (eg, lactose intolerance or gluten on the development and validation of the over extended periods; secondly, that more
sensitivity), or more severe forms such as algorithms for personalised nutrition. The information can help to confirm existing
phenylketonuria and other inborn errors of Food4Me Study published algorithms to knowledge about the connectedness of
metabolism. Moreover, personalised nutri- integrate information based on current human physiology and to expose new
tional advice may be appropriate for some diet, phenotypic characteristics, and connections; and, thirdly, with intense
key factors, such as age (teenager, elderly, genotypic characteristics. 18 However, measurement in highly motivated people,
child, adult), stage of life (pregnant, lactat- other approaches—for example, “personalised coaching” may help to
ing, etc), sex, BMI, disease or health status, using machine-learning 19 or artificial change behaviour. However, it is not clear
ethnicity, and cultural or religious back- intelligence, 20 might offer additional how much of the detailed measurement
grounds that dictate particular diets advantages. undertaken in the study was essential in
Nutrigenetics has been defined as For example, Zeevi et al 21 used the developing the “personalised coaching.”
“the discipline that studies the different connection between a raised concentration As the participants were self-selected, it is
phenotypic response to diet depending of postprandial blood glucose and the risk unclear whether this approach would be
on the genotype of each individual.” 11 of type 2 diabetes risk. They monitored acceptable to larger populations.

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 Science and Politics of Nutrition

Personalisation based on analysis of current was a randomised controlled trial (RCT) is needed before personalised nutrition can
behaviour, preferences, barriers, and involving >1600 participants from seven deliver the expected benefits.36
objectives European countries, which showed that Gaps in the evidence base—Firstly, most
Most researchers, and other stakeholders personalised nutrition was more effective studies, many of which are nutrigenetic,

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in personalised nutrition, have focused than a conventional one-size-fits-all have used retrospective or observational
on the capture of genotypic or phenotypic approach as control (box 2).27 A limitation approaches. Those studies that have
characteristics. The implicit assumption is of the study is that no information is used interventions are small and have
that, the more we can measure, the more available on outcomes beyond 6 months. focused on intermediate biomarkers.
effective will be the outcomes of person- However, findings from an earlier Only a few reports have studied gene-diet
alisation.24 There is increasing realisa- systematic review and meta-analysis interactions in large, randomised, long
tion that, unlike with medication, dietary suggest that, if changes are apparent at 6 term dietary intervention studies with
changes require individuals to make daily, months, they are likely to be sustained for clinical events as endpoints.39 40 Stronger
sometimes hourly, choices. The adoption at least a year.28 evidence for causality may come from well
of these lifestyle changes (including but No n e t h e l e s s, m a ny q u e s t i o n s designed dietary RCTs that use prospective
not limited to changes in dietary patterns) remain, and the conceptual framework genotyping when randomising participants
is highly dependent on effective collabora- underpinning this type of personalisation to treatments, as in the FINGEN Study41
tion with participants who are being helped is poorly defined. (box 3). The latter study investigated the
to take responsibility for their behaviour, effects of supplementation with fish oil on
and, ultimately, health. Increasing technol- Implementation challenges cardiovascular risk markers. For the design
ogy is available that can motivate healthy Personalised nutrition has raised expec- and implementation of an RCT, such an
eating. However, such applications usually tations similar to the excitement that has approach is much less complex than trials
adopt a “one-size-fits-all” approach that is surrounded other scientific developments involving whole foods or which attempt
biased towards specific cultures or popula- in their early stages. Scientists working in to change eating patterns. Randomised
tion subgroups. Evidence suggests that it is this area have expressed concerns about controlled trials are essential to providing
possible to facilitate a change in behaviour overpromising,29 30 individually31 32 as well proof of concept and to giving scientific
using genetic testing or personalised advice as through institutional guidelines and credibility to the concept of personalised
as the catalysts. 25 26 More emphasis is statements.33-38 Highest expectations arise nutrition. We envisage that ethical
needed to develop behavioural approaches from the suggestion that genetic informa- providers will build delivery systems in
that will best motivate particular individual tion might be used to define personalised which elements of the system are evidence
and cultural groups. dietary recommendations. For example, the based but for which it would be difficult or
There may be benefits in moving from Academy of Nutrition and Dietetics states impossible to test the whole system with
a decision framework based on health that “nutritional genomics provides insight an RCT.
professionals’ perspectives of effectiveness into how diet and genotype interactions Applying evidence for populations
to one of shared decision making. An affect phenotype. The practical application to individuals— Most of our evidence
intervention based on shared decision of nutritional genomics for complex chronic in populations is probabilistic. The
making between the provider and the disease is an emerging science and the use personalised nutrition approach wants to
recipient becomes personalised and may of nutrigenetic testing to provide dietary use this evidence for individuals. To take
increase acceptance and adherence. In this advice is not ready for routine dietetics prac- a simple example, there is evidence that
regard, the Food4Me Study stands out. It tice.” The consensus is that much research an interaction between a variant in APOA2
and intake of saturated fatty acids has an
effect on obesity and, by extrapolation,
Box 2: Food4Me Study
on the risk of cardiovascular disease.42 43
The Food4Me Study27 is the largest randomised controlled trial to have investigated the Lowering saturated fatty acid intake
efficacy of personalised nutrition. in those carrying this variant would be
The study asked two key questions: expected to lower obesity and thus the risk
• Is personalised nutrition more effective in changing diet than a conventional one- of cardiovascular disease in populations.
size-fits-all approach? However, for individuals, there is no
• Does the basis used for personalisation matter? (With particular interest in the benefit guarantee of any benefit. This is because,
of personalisation based on phenotypic and genotypic characteristics) in common with most health outcomes,
After 6 months, the answer was clear. Personalisation of dietary advice assisted and/ the risk of cardiovascular disease is
or motivated consumers to eat a healthier diet and follow a healthier lifestyle (in com- multifactorial and includes the effects
parison with “impersonal” (conventional) dietary advice). The Healthy Eating Index of stochastic factors. Available evidence
was used as the global measure of “healthfulness” of eating patterns and change was allows us to predict mean outcomes from
measured after 3 and 6 months. a given intervention and genotype, but it is
Personalisation based on analysis of current diet was more effective in assisting impossible to predict health outcomes for
and/or motivating study participants to make, and to sustain, appropriate healthy individuals. Thus, the current interest is in
changes to their usual (habitual) diet and lifestyle. However, there was no evidence studies that measure multiple parameters
of any additional benefit from using more sophisticated, and expensive, bases for at the same time. Alternatively, others
personalisation, such as phenotypic and genotypic information. have advocated single subject studies in
The Food4Me Study was implemented as an internet based intervention to emulate personalised nutrition.44 Single subject,
commercial personalised nutrition aids. The intervention was delivered to >1600 or n-of-1, trials can potentially assess the
adults in seven European countries and used several new approaches to collection and usefulness of personalised interventions
validation of data and biological samples.47-58 This study provides a model for the use of by integrating emerging technology and
the internet in delivering personalised interventions. It demonstrates the opportunities biomarkers. 45 Analytical approaches
to scale up and to make potentially significant cost effective improvements in public to n-of-1 studies are being developed
health. in related fields—for example, health

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Science and Politics of Nutrition

Box 3: Personalised nutrition Personalised nutrition in the marketplace

The potential market for personalised nutri-
Strengths
tion is huge. Firstly: as indicated above, it
• Interindividual variability in response to dietary factors is a real phenomenon
applies to both diseased and healthy peo-

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• Some studies have shown that personalisation results in greater improvements in
ple; secondly, eating is a daily activity, and
diet than universal approaches
thus opportunities for personalisation are
• Personalisation may foster sustained change in behaviour
continuous; thirdly, through personalisa-
• The personalised nutrition approach mirrors the rise in personalised, or precision,
tion a person may feel able to enhance or
medicine, which is likely to drive scientific developments beneficial for personalised
maintain health. Most commercial person-
nutrition, and, therefore, public health
alised nutrition interventions are provided
Weaknesses
directly to the consumer through the inter-
• Scientific evidence for personalised nutrition is mostly based on observational studies
net. The reliability of the evidence used
with a low level of reproducibility
by such companies is uncertain.52 53 The
• The theoretical basis for personalised nutrition is underdeveloped
business has developed without regulatory
• The factors responsible for interindividual differences in response to dietary fac-
oversight, defined standards, and consumer
tors, their persistence over time within the same individual, and their heritability
protection.54 Moreover, there are no educa-
are mostly unknown59
tional resources or guidelines for how the
• There are few well-designed randomised controlled trial that demonstrate the efficacy
outcomes of research into personalised
and safety of personalised nutrition
nutrition should be implemented. To pro-
• Most commercial offerings in the personalised nutrition area are based on direct to
tect the public, advice should be based on
consumer tests that are unregulated and have limited published evidence of benefit
robust scientific evidence. A framework for
testing evidence for the scientific validity
of nutrigenetic knowledge has been pub-
psychology, and may be suitable for use in greater, more appropriate and sustained lished.38 It is intended to be used for devel-
personalised nutrition.46 changes in behaviour than conventional oping transparent and scientifically sound
Effect on health disparities—The use approaches? Secondly, do these changes advice to the public founded on nutrige-
of most new technology (such as n-of-1 result in better health and wellbeing? netic tests. This is based on the assumption
trials) for predicting and measuring the We have limited information that the that scientifically valid, properly regulated
response to specific dietary changes may answer to the first of these questions information delivered through the internet
be prohibitively expensive if deployed at is yes. 27 49 However, evidence for the will be less expensive and more pervasive
scale.5 This may increase health disparities. usefulness of communicating genetic risks and may help to reduce health inequalities.
The challenge for research will be to define of a disease itself on risk-reducing health
the minimum set of measurements/ behaviour is weak.50 A recent systematic Suggestions for the future
biomarkers that predicts individual review studied genetic testing and lifestyle Advancement of personalised nutrition
response to personalised nutrition. behaviour change. It concluded that will be facilitated by a number of factors.
Encouraging shared decision making— behaviour change can be facilitated using Firstly, the development of a strong theo-
Face-to-face consultations with a health genetic testing as the catalyst. The authors retical basis, including identification of the
professional or lifestyle coach might argued that to promote such change the most important individual characteristics
enable shared decision making, but is theory of planned behaviour should be on which to base personalisation. Sec-
relatively expensive. In the Food4Me deployed when communicating the results ondly, the evidence for efficacy and cost
Study, personalisation was implemented of genetic testing.26 effectiveness from well designed interven-
by nutrition researchers52 7 47 using decision The second question remains tion studies. Thirdly, the introduction of a
trees. This guided the personalised advice unanswered. No personalised nutrition regulatory framework designed to protect
and ensured that it was standardised across study has been carried out at a large the public and to give confidence to health
study sites. This process could be used to scale, in an appropriate population group professionals and policy makers. This will
build algorithms that “tailor” the advice/ and over a sufficiently long time. For this require a substantial increase in the scien-
support offered to an individual, based on reason, and because of the importance of tific evidence. This implies:
preferences, barriers, ambitions, etc. Such lifestyle change for large sections of the • More robust study designs ranging from
algorithms can also incorporate techniques population, other investigators advocate a RCTs enrolling participants based on pre-
for behaviour change to help maximise the universal, rather than targeted, approach to selected genotypes, to n-of-1 trials and
(health) benefit.48 These algorithms could lifestyle intervention for disease prevention aggregated n-of-1 trials. Such research will
be automated and could operate in “real and treatment.51 The logistical complexity, benefit from multidisciplinary research
time” using the internet. They provide an practical challenges, and financial costs of teams, comprising, for example, behav-
opportunity for large scale, cost effective nutrition intervention studies with disease ioural psychologists, computer scientists,
shared decision making that may minimise risk as outcomes are large and likely to biomedical scientists, and nutritionists.
possible increases in health disparities. be increased in personalised nutrition • Integration of other “omics” to provide
interventions. Thus further testing will greater mechanistic interpretation of the
Is personalised nutrition more effective than probably use outcomes such as changes in evidence. This is likely to include empha-
alternative approaches? diet, adiposity, or established biomarkers sis on epigenomics, metabolomics, and
Despite studies supporting personalised of disease such as blood pressure, HbA1c, microbiomics. In this respect, proof of
nutrition, most evidence has come from or cognitive function. In addition, there are principle of the role of the microbiome
observational studies with risk factors as major opportunities to test the usefulness in shaping interindividual variability in
outcomes, rather than from RCTs using of personalised nutrition in the response to response to diet has been established.
clinical end points. disease management and treatment. This A first step in developing guidelines for
There are two key related questions. would be cost effective and logistically using genotype based advice in personal-
Firstly, can personalised nutrition produce feasible. ised nutrition has been proposed by the

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 Science and Politics of Nutrition

Table 1 | Different levels of recommendation for women (not pregnant or lactating)

Global Personalised dietitian recommendation based on an individual’s history Personalised recommendation based on individual history, preferences,
recommendation and preferences and genetic information

BMJ: first published as 10.1136/bmj.k2173 on 13 June 2018. Downloaded from http://www.bmj.com/ on 29 October 2024 by guest. Protected by copyright.
Zn (8 mg/day): Recommendations vary according to age, sex, pregnancy and lactation (2-13 SLC30A8: Carriers of the A allele at the rs11558471 SLC30A8 (zinc transporter)
Consume a wide variety mg). Personalisation will account for these individual characteristics. In addition, variant need supplements containing zinc in addition to a healthy diet to
of foods containing zinc. consideration should be given to: maintain proper glucose homoeostasis.55 Knowledge of this genetic information
Red meat and poultry • People who have had gastrointestinal surgery, such as weight loss surgery, or will trigger a recommendation for Zn supplementation
provide the majority of who have digestive disorders, such as ulcerative colitis or Crohn’s disease. Both
zinc in the American these conditions can decrease the amount of zinc that the body absorbs and
diet. Other good food increase the amount lost in the urine
sources include beans, • Vegetarians, because they do not eat meat, which is a good source of zinc.
nuts, certain types of Also, the beans and grains they typically eat contain compounds that prevent
seafood, whole grains, complete absorption of zinc by the body. For this reason, vegetarians might
fortified breakfast need to eat as much as 50% more zinc than the recommended amounts
cereals, and dairy • Older infants who are breastfed because breast milk contains insufficient zinc
products for infants aged >6 months. Infants taking formula receive sufficient zinc. Older
infants who do not take formula should be given foods that contain zinc, such
as pureed meats
• Alcoholics, because alcoholic beverages decrease the amount of zinc absorbed
by the body and increase the amount lost in the urine. Also, many alcoholics eat
a limited amount and variety of food, so they may not get enough zinc
• People with sickle cell disease, because they might need more zinc
Dietary fat and Use fats and oils sparingly. TCF7L2: For carriers of the T allele at the TCF7L2-rs7903146 polymorphism a
cholesterol: Choose a Use the nutrition facts label to help you choose foods lower in fat, saturated fat, Mediterranean diet reduces its adverse effect on cardiovascular risk factors and
diet low in fat, saturated and cholesterol incidence of stroke, but not so a low fat diet. Therefore carriers of the T allele will
fat, and cholesterol Eat plenty of grain products, vegetables, and fruits be recommended to:
Choose low fat milk products, lean meats, fish, poultry, beans, and peas to • Eat primarily plant based foods, such as fruits and vegetables, whole grains,
get essential nutrients without substantially increasing calories and intake of legumes, and nuts
saturated fat • Replace butter with healthy fats such as extra virgin olive oil
• Use herbs and spices instead of salt to flavour foods
• Limit red meat to a few times a month
• Eat fish and poultry at least twice a week
• Drink red wine in moderation (optional)39
Vitamin B2 Recommendations vary according to age, sex, pregnancy, and lactation (0.3-1.6 MTHFR: Carriers of the TT genotype at the MTHFR C677T polymorphism are at
(riboflavin): Consume mg/day) Personalisation will take account of these individual characteristics. In higher risk of hypertension, which may not reach targets (systolic blood pressure
the appropriate addition, consideration should be given to: <120 mmHg) with medication. However, they particularly benefit from riboflavin
recommended dietary • Vegetarian athletes, as exercise produces stress in the metabolic pathways that supplementation (~1.6 mg/day)56
allowance (RDA) from a use riboflavin SLC52A3: Brown-Vialetto-Van Laere syndrome is caused by mutations in the
variety of foods People who are vegan or consume little milk, or both, are also at risk of riboflavin SLC52A3 gene, which encodes the intestinal riboflavin transporter. As a result,
inadequacy these patients have riboflavin deficiency. Riboflavin supplementation can be life
saving in this population57

Food4Me consortium.38 It will be impor- Jose M Ordovas, professor1 2 3 5 Celis-Morales C, Lara J, Mathers JC. Personalising
nutritional guidance for more effective behaviour
tant for research and regulatory communi- Lynnette R Ferguson, professor4
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3
approaches to personalised nutrition, it is IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain 7 Pickering C, Kiely J. Are the current guidelines on
likely to be difficult to agree on the prin-
4
Faculty of Medical and Health Sciences, The caffeine use in sport optimal for everyone? Inter-
University of Auckland, Auckland, New Zealand individual variation in caffeine ergogenicity, and a move
ciples for such generic guidelines. Expe- 5 towards personalised sports nutrition. Sports Med
National University of Singapore, Singapore
rience shows that commercial providers 6
2018;48:7-16. doi:10.1007/s40279-017-0776-1
Human Nutrition Research Centre, Institute of Cellular
are keen to proceed before the scientific Medicine, Newcastle University, Newcastle Upon Tyne,
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NS, Christian JC, Grim CE. Blood pressure response
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