John C Mathers and Carlos Celis-Morales
Good dietary patterns are associated with improved health and well-being but many people find it difficult to change their eating habits. In this study we tested the idea that a “personalised nutrition” approach would be better in helping people improve their diets.
Why diet matters
Poor dietary patterns lead to poor health and increased risk of obesity and a wide range of common diseases including cardiovascular disease, several cancers and type 2 diabetes. Despite knowing that we should improve our diets by eating more vegetables and fruit, cutting down on fatty foods and going easy on sugary drinks and confectionary, many people find it difficult to make sustained improvements in their dietary choices. Knowing what we should do is not enough. We need interventions which help us to make, and to keep on making, appropriate changes in what we eat.
The “personalised nutrition” approach
The “personalised nutrition” approach is based on the idea that by “individualising” advice and support, each of us will be enabled and motivated to make the dietary changes which each of us as individuals need to make. So instead of providing generic advice such as “eat at least 5 portions of fruits and vegetables daily” or “eat two portions of fish, one of which is oily fish, per week”, a personalised nutrition approach uses information about each individual to derive advice and support relevant for that individual. Unless we are an identical twin, each of us is genetically unique. We know that our genotype interacts with diet to influence health so maybe we could use genotypic information to tailor dietary advice.
The Food4Me study
The Food4Me study was an EU-funded, pan-European intervention study in which we tested the idea that a personalised nutrition approach would produce bigger improvements in eating patterns than a conventional “one size fits all” approach. We recruited adults across 7 countries and randomised them to one of 4 treatment groups. In addition to a Control group (conventional dietary advice), we tested 3 different bases for personalisation i.e.
- personalised nutrition based on analysis of current diet
- personalised nutrition based on diet and phenotype (adiposity and blood markers)
- personalised nutrition based on diet, phenotype and genotype
For the latter we considered 5 genes for which there was strong evidence of diet-gene interactions and opportunity to tailor dietary advice based on genotype.
The Food4Me study was innovative in that we recruited participants via the web. Participants provided dietary and other data via the web and participants collected their own biological samples at home using kits that we provided. The intervention study was popular. More than 5000 people went to the Food4Me website (www.food4me.org) and registered to join the study. We recruited the first 1607 who met our inclusion criteria and 80% of these completed the study successfully. After 6 months, we discovered that those randomised to the personalised nutrition treatment groups had significantly bigger improvements in their eating patterns than those randomised to the Control group. Perhaps surprisingly, there was no evidence that the different bases for personalisation made any difference to the outcome.
Towards improvements in public health
Given the dominant role of lifestyle (including diet and physical activity) as a determinant of health and well-being throughout the life-course, finding effective, acceptable and cost-effective interventions to improve lifestyle has a very high priority. However, most conventional lifestyle-based interventions produce relatively small effects, are not easily scalable and are difficult and expensive to sustain. The Food4Me intervention provides proof of principle that a personalised nutrition approach can produce bigger benefits than the conventional “one size fits all” approach. The successful delivery of the intervention via the internet to a relatively large number of people across 7 European countries suggests that the approach is scalable and attractive to participants. In addition, internet delivered interventions such as Food4Me may have greater reach than conventional approaches and may help to reduce health inequalities.
Celis-Morales C, Livingstone KM et al. Effect of personalised nutrition on health-related behaviour change. Evidence from the Food4Me European randomised controlled trial. International Journal of Epidemiology. 2016, doi: 10.1093/ije/dyw186. [Free to access until 18 November 2016]
Celis-Morales C, Lara J, Mathers JC. Personalising nutritional guidance for more effective behaviour change. Proc Nutr Soc. 2015 May;74(2):130-8. doi: 10.1017/S0029665114001633.
Celis-Morales C, Livingstone KM, Mathers JC, et al. Design and baseline characteristics of the Food4Me study: a web-based randomised controlled trial of personalised nutrition in seven European countries. Genes Nutr. 2015 Jan;10(1):450. doi: 10.1007/s12263-014-0450-2.
Livingstone KM, Celis-Morales C et al. Profile of European adults interested in internet-based personalised nutrition: the Food4Me study. Eur J Nutr. 2016 Mar;55(2):759-69. doi: 10.1007/s00394-015-0897-y
John Mathers is Professor of Human Nutrition and Director of the Human Nutrition Research Centre at Newcastle University UK. He investigates links between nutrition and health across the life-course including research on mechanisms and the development and implementation of lifestyle-based interventions.
Carlos Celis-Morales is a research associate at the Human Nutrition Research Centre at Newcastle University, UK. His research focuses on the effect of personalised nutrition on improving health-related behaviour.