The traditional approach with nutritional supplements is “one size fits all,” which has its limitations due to a lack of consideration of individual variations, including genetic background, health condition, lifestyle, and dietary intake. Depending on individual characteristics, the exact same nutritional supplementation could be beneficial, have no effect, or even be harmful. Precision nutrition has emerged as a new horizon, with the aim of carefully assessing individual nutritional and health needs and designing individually tailored diet and nutritional supplements. Engineering may play a significant role in each step of precision nutrition research and translation, including big data collection and management, nutritional and environmental assessment, data analyses, prediction, biomedical engineering, and nutritional engineering. The integration of precision nutrition and engineering could enhance our ability to best serve all people’s nutritional and health needs.
1. The evolving concept of precision nutrition
Balanced nutrition plays a crucial role in growth, development, health maintenance, longevity, and overall wellbeing across an individual’s lifespan. Suboptimal nutritional status—be it deficiency, excess, or imbalance—can lead to a range of subclinical and clinical problems, including many chronic diseases such as stroke, cardiovascular disease, cancer, and premature death. Compared to pharmaceutical agents, foods and vitamin supplementation are safe, inexpensive, and scalable. As early as in 1941, recommended dietary allowances (RDAs) were established by the US National Academy of Science and served as dietary guidelines for healthy populations according to individual age and sex. Since then, RDAs have been periodically updated, with the latest release occurring in 2020 by the US Departments of Agriculture (USDA) and Health and Human Services (HHS) [
1].
Despite the established RDAs, suboptimal nutritional status is widespread among the world’s general populations, particularly in patients with various chronic diseases. According to a systematic analysis of 195 dietary studies from around the world, dietary risk factors contribute to cardiovascular diseases, type 2 diabetes, and cancer [
2]. With increasing public awareness of the importance of and need for balanced nutrition, nutritional supplements have been pouring the market. For example, as of 2018, there were about 90 000 dietary supplements available over the counter in the United States [
3]. The proportion of people taking dietary supplements is at least 21% and can be as high as 80%, depending on the region of the world [
4]. The most common supplements are vitamin C, vitamin D, multivitamins, probiotics, omega-3, zinc, and complex B vitamins [
4]. However, the wide availability and use of dietary supplements has not benefited everyone and can sometimes lead to harm. According to the US Preventive Service Task Force’s (USPSTF) systematic review of 84 studies (739 803 adults involved in total) on vitamin or mineral supplementation in healthy adults [
5], beta-carotene supplementation can increase the risk of lung cancer and cardiovascular death, while vitamin D and vitamin E have no significant correlation with all-cause mortality, cardiovascular events, or cancer [
6]. In a meta-analysis of 179 randomized clinical trials (RCTs) on the prevention and treatment of cardiovascular disease with vitamin and mineral supplements, supplementation with multivitamins, calcium, vitamin C, and vitamin D had no effect on reducing the risk of cardiovascular disease [
7]. Folate is well-known for its role in preventing fetal neural tube defects [
8]. The efficacy of folic acid supplementation in stroke prevention depends on individual folate nutritional status and genetic background. In populations with low folate intake, high frequency of
MTHFR C677T mutation and without mandatory folic acid grain fortification, folic acid supplementation was found to significantly reduce the risk of stroke by 21% (Hazard ratio (HR) = 0.79, 95% confidence interval (CI): 0.68-0.93) [
9]. In contrast, in populations with higher level of folate (e.g., those residing in countries with mandatory folic acid fortification), the benefit of folic acid supplementation in stroke prevention was modest [
7].
For a long time, dietary nutritional supplementation was limited to “one size fits all,” an approach that lacks consideration of individual characteristics and actual health and nutritional needs, leading to under, over, or imbalanced nutritional supplementation [
10]. As a result, depending on individual scenarios, the exact same nutritional supplementation could be beneficial, have no effect, or even be harmful. This is why the available literature often shows conflicts in findings across studies, causing confusion among healthcare providers and consumers. Recently, the US National Institute of Health launched the Precision Nutrition Initiative [
11]. The overarching goals of precision nutrition are to assess individual nutritional and health needs and to design individually tailored diet and nutritional supplements in order to improve nutritional and health status and prevent chronic diseases. This represents a significant step forward in the field of nutrition and health.
2. The challenges and opportunities of precision nutrition
The biggest challenge in advancing precision nutrition is to generate solid and unbiased scientific evidence to inform clinical and public health practice and dietary recommendations. As illustrated in
Fig. 1, individual nutritional needs can be affected by each of the multidimensional factors from cell to society and by each of the life stages from
in utero to adulthood. Traditionally, the study of nutrition has focused on single nutrients without considering co-exposures. The future approach must shift from a single-nutrient focus to considering individual multitude factors at the molecular, personal, family, neighborhood, and societal levels. As such, advancing precision nutrition hinges on longitudinal and multidimensional data collection. A good example is the US “All of Us” research program, which is an American longitudinal cohort comprising one million individuals, with multidimensional data collection [
12].
We are entering an era of unprecedented opportunities to advance precision nutrition [
13]. In addition to the clinical and epidemiological data and biospecimen collection, rapid advancement in biomedical sciences and high-throughput, affordable biotechnologies such as genomics, transcriptomics, metabolomics, proteomics, and microbiomics offer powerful tools to advance our understanding of the effects of nutrition on human health at the individual molecular level. Such individual molecular-level data complements traditional clinical, epidemiological data; moreover, when appropriately integrated, it will create unprecedented opportunities for scientific discoveries and translations. In the meantime, advances in statistical methods, high-performance computing, machine learning, and artificial intelligence have greatly increased our ability to harness large and complex data. Above all, there is growing transdisciplinary collaboration, which is the key to accelerating the pipelines from scientific discoveries to the translation into clinical and public health guidelines, tools, and consumer products.
3. Envisioning the intersectionality and synergy of precision nutrition and engineering
As illustrated in
Fig. 2, the integration of engineering with precision nutrition would be highly synergistic and might play a significant role in each step of precision nutrition research and translation, as highlighted below.
• Big data acquisition and management: Engineering may facilitate the carrying out of large-scale nutritional trials or cohort studies; the retrieval and management of electronic health records, census data, and vital statistics data; and the storage and management of biospecimens and multiomics data.
• Nutritional and environmental assessment: Engineering may help improve the quality and efficiency of dietary and environmental exposure assessments.
• Data analyses and prediction: Engineering may help to develop analytical algorithms and pipelines and to harness biomarkers, machine learning, and artificial intelligence in order to enhance our capacity to advance precision nutrition, allow us to gain new insight into molecular mechanisms, and enable us to make more accurate prediction and nutrition recommendations tailored to individual needs.
• Precision interventions: Biomedical engineering and nutritional engineering may help people adhere to a healthy lifestyle, including dietary intake, physical activity, and sleep, while reducing adverse environmental exposure.
In short, the goal of precision nutrition is to advance the nutrition sciences and benefit all people in terms of health, longevity, and quality of life. The integration of precision nutrition and engineering could enhance our ability to best serve all people’s nutritional and health needs and to ensure that nutritional supplementation is effective, safe, feasible, and convenient.
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