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Precision nutrition in low- and middle-income settings

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This is a summary of the following paper: Sight and Life (2022) Precision Nutrition for Low- and Middle-Income Countries: Hype or Hope? https://sightandlife.org/resource-hub/magazine/precision-nutrition-for-low-and-middle-income-countries-hype-or-hope

Precision nutrition (Box 1) is an emerging area of research that falls under the umbrella of precision medicine – an approach that has yielded big wins in developed countries across areas such as targeted cancer therapy or microbiome sequencing, following the introduction of Big Data into healthcare. Physicians have known for decades that individuals respond individually to different treatment regimens, yet only now do they have the tools at their disposal to delve into the reasons behind this. While targeted treatments may therefore yield the greatest benefit on an individual level, precision medicine creates a dilemma for public health professionals who deal with healthcare at the population level. This is especially pertinent for lower-income countries, where resources are often constrained to the point that even basic healthcare remains a challenge. Is a move towards precision nutrition therefore irrelevant, or do these very challenges increase the need for more precise, efficient approaches?

Box 1. What is precision nutrition?

Precision nutrition evaluates an individual’s unique DNA, race, gender, health history, lifestyle habits, microbiome and metabolic response to specific foods or dietary patterns to determine the most effective eating plan to prevent or treat disease. It aims to provide safer and more effective ways to prevent and treat disease by providing more accurate and targeted strategies. Precision nutrition assumes that each person may have a different response to specific foods and nutrients, so that the best diet for one individual may look very different from the best diet for another.

The authors of the report highlight the importance of targeting the most vulnerable groups with a precision nutrition approach. Using the example of pregnant women with anaemia – which affects between 33% and 75% of pregnant women in developing countries (Abdallah et al, 2022) – such a strategy could deliver cost-effectiveness, given that interventions could be distributed in smaller amounts rather than through costly blanket supplementation. Anaemia reduction can boost productivity by providing additional economic benefits for this group, and increasing nutrient status in mothers can reduce the subsequent burden of disease in their children, reducing healthcare costs further down the line. This represents a more strategic application of resources rather than the blanket approach that national health systems employ today.

The report also highlights a pyramid infographic that outlines the accessibility of different approaches (p. 14) and methods (p. 15). It notes that demographic surveys, which make up the bulk of many nutrition research projects, are at the base of the pyramid – accessible and not constrained by resources, yet imprecise and limited – with lifestyle data collection presenting the next step in personalisation. Such data (diet, physical activity, dietary diversity, etc.) are commonplace, but not routinely measured in all settings. At the tip of the pyramid, and currently too costly for many low- and middle-income countries (yet becoming more accessible), are genetic and omics methods. These are not yet routine in high-income settings, but are currently available through many private healthcare systems. The spectrum of phenotype measurements (anthropometry and clinical biomarkers) at the accessible end of the pyramid, and of metabolic indicators (wearable devices, oral glucose tolerance tests, gut microbiota analysis, etc.) at the other end, are also represented here.

Although this road map for the future may be exciting, representing a shift from generic guidelines such as the Food Pyramid towards targeted, personalised and ultimately precision nutrition (p. 77), the field remains in its infancy, and scale-up of such technology remains unfeasible within many poorer health systems.

Precision nutrition is in its early stages and too soon to introduce as a treatment for chronic diseases in the general population. Research is being conducted on the application of precision nutrition for obesity, metabolic syndrome, certain cancers, and type 2 diabetes” (Harvard T.H. Chan School of Public Health, 2023).

A detailed breakdown of this report is beyond the scope of this summary, but readers are encouraged to explore this topic further by accessing the full report. It also provides a useful glossary of precision nutrition terminology (p. 6), helping readers make sense of a complex topic where nutrition, biochemistry, genomics and the computer sciences intersect.

References

Abdallah F, John S, Hancy A et al (2022) Prevalence and factors associated with anaemia among pregnant women attending reproductive and child health clinics in Mbeya region, Tanzania. PLOS Global Public Health, 2, 10. https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000280#:~:text=In%20industrialized-%20countries%2C%20the%20prevalence,higher%20%5B2%2C%205%5D

Harvard T.H. Chan School of Public Health (2023) The Nutrition Source: Precision Nutrition. https://www.hsph.harvard.edu/nutritionsource/precision-nutrition/

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Precision nutrition in low- and middle-income settings. Field Exchange 69, May 2023. p49. www.ennonline.net/fex/69/precision-nutrition-in-low-and-middle-income-settings

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