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Cuparencu C, Bulmuş-Tüccar T, Stanstrup J, La Barbera G, Roager HM, Dragsted LO. Towards nutrition with precision: unlocking biomarkers as dietary assessment tools. Nat Metab 2024:10.1038/s42255-024-01067-y. [PMID: 38956322 DOI: 10.1038/s42255-024-01067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/20/2024] [Indexed: 07/04/2024]
Abstract
Precision nutrition requires precise tools to monitor dietary habits. Yet current dietary assessment instruments are subjective, limiting our understanding of the causal relationships between diet and health. Biomarkers of food intake (BFIs) hold promise to increase the objectivity and accuracy of dietary assessment, enabling adjustment for compliance and misreporting. Here, we update current concepts and provide a comprehensive overview of BFIs measured in urine and blood. We rank BFIs based on a four-level utility scale to guide selection and identify combinations of BFIs that specifically reflect complex food intakes, making them applicable as dietary instruments. We discuss the main challenges in biomarker development and illustrate key solutions for the application of BFIs in human studies, highlighting different strategies for selecting and combining BFIs to support specific study designs. Finally, we present a roadmap for BFI development and implementation to leverage current knowledge and enable precision in nutrition research.
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Affiliation(s)
- Cătălina Cuparencu
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
| | - Tuğçe Bulmuş-Tüccar
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
- Department of Nutrition and Dietetics, Yüksek İhtisas University, Ankara, Turkey
| | - Jan Stanstrup
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Giorgia La Barbera
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Henrik M Roager
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
| | - Lars O Dragsted
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark
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Krukowski RA, Denton AH, König LM. Impact of feedback generation and presentation on self-monitoring behaviors, dietary intake, physical activity, and weight: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2024; 21:3. [PMID: 38178230 PMCID: PMC10765525 DOI: 10.1186/s12966-023-01555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
Self-monitoring of dietary intake, physical activity, and weight is a key strategy in behavioral interventions, and some interventions provide self-monitoring feedback to facilitate goal setting and promote engagement. This systematic review aimed to evaluate whether feedback increases intervention effectiveness, and which forms of feedback presentation (e.g., personalized vs. not personalized) and generation (i.e., human vs. algorithm-generated) are most effective. To achieve this aim, 5 electronic databases (PubMed/MEDLINE, Web of Science, CINAHL, PsycINFO, and Google Scholar) were searched in April 2022 and yielded 694 unique records, out of which 24 articles reporting on 19 studies were included (with a total of 3261 participants). Two reviewers independently screened titles and abstracts and then full texts and categorized articles as eligible or excluded according to the pre-registered criteria (i.e., availability of full text, peer reviewed manuscript in English; adult participants in a randomized controlled trial that included both self-monitoring and feedback; comparisons of different forms of feedback or comparisons of feedback vs. no feedback; primary outcomes of diet, physical activity, self-monitoring behavior, and/or weight). All included studies were assessed for methodological quality independently by two reviewers using the revised Cochrane risk-of-bias tool for randomized studies (version 2). Ten studies compared feedback to no feedback, 5 compared human- vs. algorithm-generated feedback, and the remaining 4 studies compared formats of feedback presentation (e.g., frequency, richness). A random effects meta-analysis indicated that physical activity interventions with feedback provision were more effective than physical activity interventions without feedback (d = 0.73, 95% CI [0.09;1.37]). No meta-analysis could be conducted for other comparisons due to heterogeneity of study designs and outcomes. There were mixed results regarding which form of feedback generation and presentation is superior. Limitations of the evidence included in this review were: lack of details about feedback provided, the brevity of most interventions, the exclusion of studies that did not isolate feedback when testing intervention packages, and the high risk of bias in many studies. This systematic review underlines the importance of including feedback in behavioral interventions; however, more research is needed to identify most effective forms of feedback generation and presentation to maximize intervention effectiveness.Trial registration (PROSPERO)CRD42022316206.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, PO Box 800765, Charlottesville, VA, 22908-0765, USA.
| | - Andrea H Denton
- University of Virginia, Claude Moore Health Sciences Library, Charlottesville, VA, USA
| | - Laura M König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Kulmbach, Germany
- Faculty of Psychology, University of Vienna, Vienna, Austria
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Antwi J. Precision Nutrition to Improve Risk Factors of Obesity and Type 2 Diabetes. Curr Nutr Rep 2023; 12:679-694. [PMID: 37610590 PMCID: PMC10766837 DOI: 10.1007/s13668-023-00491-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF REVIEW Existing dietary and lifestyle interventions and recommendations, to improve the risk factors of obesity and type 2 diabetes with the target to mitigate this double global epidemic, have produced inconsistent results due to interpersonal variabilities in response to these conventional approaches, and inaccuracies in dietary assessment methods. Precision nutrition, an emerging strategy, tailors an individual's key characteristics such as diet, phenotype, genotype, metabolic biomarkers, and gut microbiome for personalized dietary recommendations to optimize dietary response and health. Precision nutrition is suggested to be an alternative and potentially more effective strategy to improve dietary intake and prevention of obesity and chronic diseases. The purpose of this narrative review is to synthesize the current research and examine the state of the science regarding the effect of precision nutrition in improving the risk factors of obesity and type 2 diabetes. RECENT FINDINGS The results of the research review indicate to a large extent significant evidence supporting the effectiveness of precision nutrition in improving the risk factors of obesity and type 2 diabetes. Deeper insights and further rigorous research into the diet-phenotype-genotype and interactions of other components of precision nutrition may enable this innovative approach to be adapted in health care and public health to the special needs of individuals. Precision nutrition provides the strategy to make individualized dietary recommendations by integrating genetic, phenotypic, nutritional, lifestyle, medical, social, and other pertinent characteristics about individuals, as a means to address the challenges of generalized dietary recommendations. The evidence presented in this review shows that precision nutrition markedly improves risk factors of obesity and type 2 diabetes, particularly behavior change.
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Affiliation(s)
- Janet Antwi
- Department of Agriculture, Nutrition and Human Ecology, Prairie View A&M University, Prairie View, USA.
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Tam R, Gifford JA, Beck KL. Recent Developments in the Assessment of Nutrition Knowledge in Athletes. Curr Nutr Rep 2022; 11:241-252. [PMID: 35174474 PMCID: PMC9174104 DOI: 10.1007/s13668-022-00397-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE OF REVIEW Adequate nutrition knowledge may influence dietary behaviour, and the performance and health of athletes. Assessment of the nutrition knowledge of athletes can inform practice and provide a quantitative way to evaluate education interventions. This article aims to review nutrition knowledge questionnaires published in the last 5 years to identify advances, possible improvements in questionnaire development and design, and challenges that remain. RECENT FINDINGS Twelve new or modified questionnaires were identified. All had undergone validity and reliability testing. Advancements included quantitative measures of content validity and Rasch analysis. Online questionnaires were common, with at least seven using this format. Advances included use of images (n = 2), automated scored feedback (n = 1), and use of applied questions. While advancements have been made in validation and reliability testing and electronic delivery, new questionnaires would benefit from interactive and attractive features including images, provision of electronic feedback, and applied questions.
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Affiliation(s)
- Ryan Tam
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, 22 Main St, Blacktown, NSW, 2148, Australia.
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown NSW 2006, Sydney, Australia.
| | - Janelle A Gifford
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Building, Camperdown NSW 2006, Sydney, Australia
| | - Kathryn L Beck
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Palmerston North, New Zealand
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Lamers CR, van Erp LW, Slotegraaf AI, Groenen MJM, de Roos NM, Wahab PJ, Witteman BJM. Web-based dietary assessment and advice helps inflammatory bowel disease patients to improve their diet quality. Br J Nutr 2022; 129:1-26. [PMID: 35373727 PMCID: PMC9870719 DOI: 10.1017/s0007114522001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 02/03/2023]
Abstract
Time to evaluate diet quality and give dietary advice is limited in clinical IBD practice. The Eetscore is a web-based tool that assesses diet quality according to the Dutch dietary guidelines and provides personalised dietary advice. We aimed to assess diet quality of IBD patients using the Eetscore and to study changes in diet quality, health-related quality of life (HRQoL) and clinical disease activity over time. A prospective cohort study was performed in 195 adult IBD patients. Participants were invited to fill out questionnaires (Eetscore-FFQ, short IBDQ and p-HBI/p-SCCAI) at baseline and after 1 and 4 months. The Eetscore calculates diet quality based on 16 food components (10 points per component, total score 0-160; the higher the better) and provides dietary advice per component based on the assessment. At baseline, mean diet quality was 98±19. Diet quality was positively associated with age, female gender and level of education. Component scores were highest for red meat, wholegrain products, and sweetened beverages, and lowest for legumes, nuts, and processed meat. Over time, diet quality increased to 107±21 at 4 months (p<0.001). Each 10-point improvement in diet quality was associated with an increase in HRQoL (β=0.4 (95%CI 0.02; 0.7), p=0.04). Clinical disease activity did not change. In conclusion, diet quality of IBD patients significantly improved following personalised dietary advice of the Eetscore. Improvement of diet quality was associated with a slight improvement in HRQoL. The Eetscore is a practical and useful tool to monitor and support a healthy diet in IBD patients.
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Affiliation(s)
- Carlijn R. Lamers
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands
| | - Liselot W. van Erp
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Anne I. Slotegraaf
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands
- Nutrition & Healthcare Alliance, Ede, The Netherlands
| | - Marcel J. M. Groenen
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Nicole M. de Roos
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands
| | - Peter J. Wahab
- Crohn & Colitis Centre, Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
- Nutrition & Healthcare Alliance, Ede, The Netherlands
| | - Ben J. M. Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Ede, The Netherlands
- Division of Human Nutrition and Health, Wageningen University & Research (WUR), Wageningen, The Netherlands
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de Hoogh IM, Reinders MJ, Doets EL, Hoevenaars FPM, Top JL. Design issues in personalized nutrition advice systems (Preprint). J Med Internet Res 2022; 25:e37667. [PMID: 36989039 PMCID: PMC10131983 DOI: 10.2196/37667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 12/21/2022] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
The current health status of the general public can substantially benefit from a healthy diet. Using a personalized approach to initiate healthy dietary behavior seems to be a promising strategy, as individuals differ in terms of health status, subsequent dietary needs, and their desired behavior change support. However, providing personalized advice to a wide audience over a long period is very labor-intensive. This bottleneck can possibly be overcome by digitalizing the process of creating and providing personalized advice. An increasing number of personalized advice systems for different purposes is becoming available in the market, ranging from systems providing advice about just a single parameter to very complex systems that include many variables characterizing each individual situation. Scientific background is often lacking in these systems. In designing a personalized nutrition advice system, many design questions need to be answered, ranging from the required input parameters and accurate measurement methods (sense), type of modeling techniques to be used (reason), and modality in which the personalized advice is provided (act). We have addressed these topics in this viewpoint paper, and we have demonstrated the feasibility of setting up an infrastructure for providing personalized dietary advice based on the experience of 2 practical applications in a real-life setting.
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Affiliation(s)
- Iris M de Hoogh
- Research Group Microbiology & Systems Biology, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
- Department of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Machiel J Reinders
- Wageningen Economic Research, Wageningen University & Research, Den Haag, Netherlands
| | - Esmée L Doets
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
| | - Femke P M Hoevenaars
- Research Group Microbiology & Systems Biology, Netherlands Organization for Applied Scientific Research, Leiden, Netherlands
| | - Jan L Top
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
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