精准营养与工程学的交叉融合及协同创新展望

工程（英文） ›› 2024, Vol. 42 ›› Issue (11) : 15 -17. DOI: 10.1016/j.eng.2024.04.021

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宋昀 ^a ,
张昊 ^a ,
郭慧媛 ^a ,
王晓斌 ^b

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Envisioning the Intersectionality and Synergy of Precision Nutrition and Engineering

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传统营养补充剂的应用通常采用“一刀切”的方式，但由于缺乏对个体差异（如遗传背景、健康状况、生活方式及饮食摄入等因素）的考量，存在一定局限性。由于个体差异，完全相同的营养补充方案可能会对身体产生益处，也可能完全没有效果甚至对身体有害。精准营养学应运而生，该学科旨在通过精准评估个体的营养与健康需求，制定个性化膳食及营养补充方案。工程学可在精准营养学研究和转化的各环节发挥关键作用，包括大数据采集与管理、营养与环境评估、数据分析、预测、生物医学工程及营养工程等方面。二者的深度融合将提升我们服务全人类营养健康需求的能力。

1 不断发展的精准营养概念

均衡营养在个体的生长发育、健康维持、寿命延长以及全生命周期的整体健康中发挥着关键作用。无论是营养不足、过剩还是失衡，营养状况欠佳均可能引发一系列亚临床和临床问题，包括卒中、心血管疾病、癌症等慢性病及过早死亡。与药物相比，食物和维生素补充剂具有安全性高、成本低廉且可规模化应用的优势。早在1941年，美国国家科学院便制定了推荐膳食供给量（RDA），根据年龄与性别为健康人群提供膳食指导。此后，RDA持续更新，最新版本由美国农业部（USDA）与卫生及公共服务部（HHS）于2020年发布[1]。

尽管已经制定了RDA，但营养状况欠佳仍在全球普通人群中广泛存在，慢性病患者群体尤为突出。一项针对全球195项膳食研究的系统性分析表明，饮食风险因素是心血管疾病、2型糖尿病及癌症的重要诱因[2]。随着公众对均衡营养的重要性与必要性的认知不断提升，营养补充剂已大量涌入市场。例如，截至2018年，美国市场在售的非处方类膳食补充剂已达约9万种[3]。全球范围内膳食补充剂使用者的比例至少为21%，部分地区最高可达80% [4]。维生素C、维生素D、复合维生素、益生菌、Omega-3脂肪酸、锌及B族维生素复合剂是最常见的补充剂类型[4]。但是，膳食补充剂的广泛供应和使用并未惠及所有人群，有时甚至会造成健康损害。美国预防服务工作组（USPSTF）针对健康成人维生素或矿物质补充剂使用的84项研究（共纳入739 803名成人）开展系统性综述[5]发现：β-胡萝卜素补充剂可能增加肺癌及心血管疾病死亡风险，而维生素D和维生素E则与全因死亡率、心血管事件或癌症发生率无显著相关性[6]。对179项关于维生素与矿物质补充剂防治心血管疾病的随机对照试验进行荟萃分析发现，复合维生素、钙、维生素C及维生素D的补充对降低心血管疾病风险无显著效果[7]。众所周知，叶酸可预防胎儿神经管缺陷[8]。但叶酸在预防卒中方面的效果则取决于个体叶酸营养状态及遗传背景。在叶酸摄入量低、MTHFR C677T突变频率高且未实施叶酸强化政策的群体中，补充叶酸可使卒中风险显著降低21%（风险比= 0.79，95%置信区间：0.68~0.93）[9]。相比之下，在叶酸水平较高的人群（如强制叶酸强化国家的居民）中，补充叶酸对预防卒中的益处则较为有限[7]。

长期以来，膳食营养补充始终局限于“一刀切”模式，这种模式缺乏对个体特征及实际健康与营养需求方面的考量，会导致营养补充不足、过量或失衡[10]。正因如此，完全相同的营养补充方案可能会对身体产生益处，也可能完全没有效果甚至会对身体有害。现有文献常出现研究结论相互矛盾的情况，使医疗从业者与消费者困惑重重，根源即在于此。近期，美国国立卫生研究院发起了“精准营养倡议”[11]，其核心目标在于精准评估个体营养与健康需求，设计个性化膳食与营养补充方案，从而改善营养健康状况并预防慢性疾病。这标志着营养健康领域的重大突破。

2 精准营养的挑战和机遇

推进精准营养的最大挑战在于生成坚实且公正的科学证据，为临床实践、公共卫生政策及膳食建议提供指导。如图1所示，个体营养需求既受“细胞至社会”多维因素影响，又随“胎儿期至成年期”各生命阶段动态变化。传统营养学研究侧重于单一营养素，忽视复合暴露。未来研究需从单一营养素视角转向分子、个人、家庭、社区及社会层面的多维度因素整合。因此，精准营养的突破有赖于纵向追踪与多维度数据采集。典型范例之一是美国全民健康研究计划（All of Us），该计划纳入百万人口，是实施多维度数据采集的全国性纵向队列研究[12]。

我们正迈入推动精准营养发展的空前机遇时代[13]。除了临床和流行病学数据及生物样本采集外，生物医学领域的快速进步以及基因组学、转录组学、代谢组学、蛋白质组学、微生物组学等高通量且经济实用的生物技术的发展，为在个体分子层面理解营养对人类健康的影响提供了强大工具。此类分子层面的个体化数据与传统临床及流行病学数据形成互补；更重要的是，经有效整合后，其将为科学发现与转化创造前所未有的机遇。同时，统计方法、高性能计算、机器学习及人工智能的突破，大大增强了我们驾驭复杂海量数据的能力。尤为重要的是，日益深化的跨学科协作正成为加速从科学发现向临床公共卫生指南、工具及消费产品转化的关键引擎。

3 精准营养与工程学的交叉融合及协同创新展望

如图2所示，工程学与精准营养学的深度融合将产生高度协同效应，且或可在精准营养学研究与转化的各环节发挥关键作用，具体如下。

· 大数据获取和管理：工程学可以促进大规模营养试验或队列研究的开展；电子健康记录、人口普查数据和人口动态统计数据的检索与管理；以及生物样本和多组学数据的存储和管理。

· 营养与环境评估：工程学或可有助于提升膳食和环境暴露评估的质量与效率。

· 数据分析和预测：工程学可助力开发分析算法及流程，并利用生物标志物、机器学习和人工智能技术，增强推进精准营养的能力，帮助我们获取分子机制的新洞见，并实现更准确的预测及基于个体需求的营养建议。

· 精准干预：生物医学工程和营养工程可帮助人们坚持健康的生活方式（包括饮食摄入、身体活动与睡眠），同时减少不良环境暴露。

简而言之，精准营养的目标是推进营养科学的发展，在健康、长寿与生活质量方面惠及全人类。精准营养与工程学相结合能够增强我们最大限度满足所有人营养与健康需求的能力，并确保营养补充方案有效、安全、可行且便捷。

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