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Personalised, population considers an individual′s genomic growth of nutrition and person- BMJNPH: first published as 10.1136/bmjnph-2021-000235 on 2 June 2021. Downloaded from
and planetary nutrition background and nutrient- gene inter- alised endeavours and methodolo-
for precision health actions but also a thorough pheno- gies, where important achievements,
typing evaluation, including family recommendations and challenges are
and personal clinical features, peri- expected for combining public and
natal feeding programming and personal health benefits including
Nutrition is a global science that orig- expectantly a wide spectrum of bioin- ethical issues.9
inally was envisaged to biologically formatic data concerning metabolic
analyse and integrate the processes pathways. This last aspect involves PRECISION POPULATION NUTRITION
related to food transformation into omics strategies and high- throughput A number of policies and public
energy and nutritious components technologies such as metabolomics, efforts are being currently devoted
for cell functions and homeostasis.1 proteomics, (epi) genomics or metag- to generate evidence for health
Noteworthy, it is now evident that enomics related to macronutrients promotion and disease risk reduc-
such physical, chemical and metabolic and micronutrients metabolic utilisa- tion supported by food- based dietary
reactions participate in human devel- 6 guidelines (FBDG) in order to instruct
opment to ensure life expectancy and tion. Indeed, the conceptual frame- populations about healthy dietary
well- being, with a growing and insepa- work describing precision nutrition is 10
based on evaluating the interpersonal habits. These messages are better
rable relevance for personal, popula- diversity caused by genetic/epigen- interpreted than nutrient intakes
2
tion and planetary health. Nowadays, etic differences, the environmental only and easier to make recommen-
nutritional challenges and nutri- and lifestyle exposome heterogeneity, dations on primary prevention of
tionist’s interests are being focused metagenomic variations in micro- noncommunicable diseases (NCDs)
on health and wellness involving biota and objective behavioural/ when they are based on Mediterra-
physical, emotional, intellectual, nean dietary components and other
cognitive, spiritual, environmental psychological features with evident regional foods from Oriental, Latin
3 consequences for conjoint personal
and occupational facets. Moreover, and population public health-related American and Indian diets with spices
according to the newer emerging 11 12
challenges and applications. Conse- rich in bioactive compounds. Of
health scenarios, food intake should quently, precision nutrition should equal importance are the traditional
be assessed in relationship with social, contemplate the implementation African foods and diets which have
satisfaction, satiety, security, safety of an efficient individualised nutri- not received global dimensions even
and sustainable dimensions. In this tional status and assessment of strat- though these are rich in their diverse
context, two apparently alternative egies based on validated indices and nutrient quality such as nutrients
approaches, one derived from a provided insect foods.
global public health perspective and metrics for metabolic care in every In any case, nutritional advices http://nutrition.bmj.com/
another derived from a precision- person, being not only restricted to in different continents and regions
personalised nutrition paradigm, patients suffering chronic diseases seem to be comprehensively similar
7
should be harmonised and deliber- but also to healthy subjects. Thus, it across countries such as to consume
ated since they are complementary to is a good mandate to recognise indi- a variety of foods in balanced propor-
each other and as such, personalised, vidual′s differences and to develop tions including fruits and vegetables,
participative, preventive and predic- new genetic and transcriptomic indi- whole grains, cereals, legumes and
tive strategies are all needed in order cators, inclusive of proteomic, lipid- moderate animal- source products
to maintain a healthy status as well as omic and metabolomic approaches and limit high energy yielding sugary on January 6, 2023 by guest. Protected by copyright.
4 and nutrigenomic and metagenomic
to prevent and manage diseases. tools related to nutrient metabolism.8 and fatty foods. The adverse impact
of ultraprocessed foods and discre-
PRECISION PERSONALISED NUTRITION Nevertheless, personalised clinical tionary food consumption involving
The evolving notion about preci- and phenotypical features including red and processed meats, added
sion nutrition concerns personalised one’s own psychological/personality sugars, confectionery and other detri-
nutrition guidelines and tailor- patterns, specific food allergies and mental food ingredients need to be
made dietary prescriptions for the intolerances, differential cultural, explicitly disclosed on the packaged
prevention and treatment of obesity, social and environmental back- food labels and scores following
diabetes, cardiovascular events and grounds, drug side effects, personal 13
the dietary guidelines. On the
other chronic diseases. The manage- dietary preferences as well as singular contrary, some myths on fats, oils and
ment of metabolic impairments, lifestyle and environmental factors nuts need to be dispelled, given the
inflammatory/haematological distur- such as cold weather or warm, and very strong available scientific evidence of
warm climates need to be addressed
bances or neoplasia/tumorous their cardiovascular benefits and the
diseases with nutritional approaches for a robust precision nutrition and dangers of overconsumption beyond
are needed for health maintenance medical approaches. Regulatory
a level without proper exercise to
5 issues are needed to be developed
as well as in clinical practice. In this metabolise them adequately in the
context, precision nutrition not only and implemented for a smooth 14
body.
Martínez- González MA, et al. bmjnph Month 2021 Vol 0 No 0 1
BMJ Nutrition, Prevention & Health
Information sourced from the BMJNPH: first published as 10.1136/bmjnph-2021-000235 on 2 June 2021. Downloaded from
FBDG repository of the FAO or artic-
ulated by WHO reveals that FBDG
are currently available for about 100
countries or regions, where the incor-
poration of bioactive compounds
occurring on foods and the analysis of
environmental sustainability informa-
tion, climate change data and consid-
erations to sociocultural factors and
swiftly varying dietary tendencies
15
are fairly documented. It is not the
intent of this article to serve as advise
to different countries, but to high-
light the parameters to be considered
in nutrition and health of the popu-
lation depending on the climate and
the nature of agricultural nutritious
products that they are growing and
which are used within traditional food
practices over thousands of years.
Furthermore, epidemiological
investigations concerning the impacts Figure 1 Schematic representation of global precision nutrition and its role in
of Japanese, Nordic, Latin American health from the perspective of linkages of nutrition to personal, population and
and Mediterranean diets or African, planetary health respectively (based on IUNS task force).
Indian and Oriental plant-based
18
nutritional patterns on NCDs have countries and regions. Outstanding against the aetiological roots and
positioned evidences with remarkable research and maintenance of large hazardous consequences on health
benefits in health outcomes and life and long- term high- quality cohorts concerning the double burden of
expectancy compared with western- such as The European Prospective malnutrition, which involves not
ised food intake habits of high fatty Investigation into Cancer and Nutri- only undernutrition, stunting,
16 tion, Framingham, The Supplemen- underweight and wasting, including
food and meat- rich diets. Further-
more, some well- conducted trials tation en Vitamines et Mineraux hidden deficiencies of micronutri- http://nutrition.bmj.com/
such as PREDIMED or DASH and Antioxydants, Nurses and Health ents, but also excessive body weight
Diabetes Prevention Programs imple- Professionals and UK Biobank are and obesity, which are associated to
mented in USA, Europe, China, India important tools to develop/design a high impactful of NCDs across the
20
or Japan have confirmed the role policies and healthy messages for the globe. These endeavours should be
of lifestyle and dietary practices on people. These interventions need based on concepts of sustainability,
health maintenance or prevention/ to be replicated with local modi- food security and environmental and
management of obesity, diabetes and fications and food availability for climate change monitoring, which
cardiovascular events.17 sustainable nutrition agenda. New are receiving support and resources on January 6, 2023 by guest. Protected by copyright.
Additionally, specific population- food frequency questionnaires and from important organisations and
the implementation of appropriate institutions such a UN agencies,
oriented public health-nutrition
communication should reflect the biomarkers of food intake and surro- UNICEF, FAO, WHO- OMS, World
specific physiological needs across gates of metabolic utilisation shall Bank, FMI and IUNS. Such attempts
the life cycle, including infancy and continue to improve our knowledge are also through integrated or inde-
19
pregnancy or lactation status, which in a dynamic fashion. pendent initiatives such as GAIN,
require tailored nutritional supplies Scaling Up Nutrition, IUNS Task
to balance particular nutrient require- PRECISION PLANETARY NUTRITION Forces and specifically via the WHO’s
ments and to account for cultural and As stated in International Union Sustainable Development Goals.
socioeconomic differences among for Nutritional Sciences (IUNS) International embracing of a global
areas, countries and regions. Of vision declaration, to live a life nutrition agenda should address food
course, education, practical training without undernutrition is a funda- and nutrition problems in developing
and professional development for mental human right, while nutri- countries as well as training/capacity
sustainable food systems and dietary tion improvement anywhere in the building for nutritionists. The same
practices need to consider differen- world is a societal, household and is the situation with high- income
tial personal and population profiles individual concern. Indeed, a major countries and NCDs and the obesity
in the low- income and high- income focus of planetary nutrition is to fight pandemic.
2 Martínez- González MA, et al. bmjnph Month 2021 Vol 0 No 0
BMJ Nutrition, Prevention & Health
Current planetary challenges in aided by capacity building and online Funding The authors have not declared a specific
nutrition include enhanced agri- learning strategies accompanying grant for this research from any funding agency in the BMJNPH: first published as 10.1136/bmjnph-2021-000235 on 2 June 2021. Downloaded from
cultural production for sustain- a strong public health nutrition public, commercial or not- for- profit sectors.
able human development in order 25 Competing interests None declared.
workforce. IUNS is making such
to match the planetary needs for attempts in this direction to reach out Patient consent for publication Not required.
21 Provenance and peer review Not commissioned;
nutrient intake. Socioeconomic such knowledge networking spread
and political issues controlling food globally, where phenotypical traits externally peer reviewed.
distribution, food system transfor- and the genetic makeup should be
mation, food reformulations or 26
considered.
discretionary taxes application to
unhealthy dietary products, trade Precision nutrition conclusions
regulations concerning staple foods, Indeed, precision nutrition should
the adoption of national/regional deem all factors involved in global Open access This is an open access article distributed
FBDG concerning healthy meal quality of life and metabolic well- in accordance with the Creative Commons Attribution
consumption such as vegetables, being depending not only on the Non Commercial (CC BY-NC 4.0) license, which permits
grains, legumes, cereals, seafood others to distribute, remix, adapt, build upon this
protein sources to fill in the nutri- genotype but also on the dietary work non- commercially, and license their derivative
22 intake and associated healthy lifestyles works on different terms, provided the original work is
tional gaps. The research of innova- in order to be worldwide developed properly cited, appropriate credit is given, any changes
tive and efficient dietary biomarkers and implemented in personalised, made indicated, and the use is non- commercial.
and research metrics for nutritional See: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
surveillance are needed urgently and population and planetary settings for © Author(s) (or their employer(s)) 2021. Re- use
be complemented with sustainability individual’s, public and sustainable permitted under CC BY- NC. No commercial re- use. See
factors on land and water use, climate global health considering genetic rights and permissions. Published by BMJ.
change management and reduction and nongenetic- related phenotypes
as well as environmental factors.
in human- generated greenhouse
gas emissions. It is only then when a 1,2 To cite Martínez- González MA, Kim H- S, Prakash V,
Miguel A Martínez- González, et al. Personalised, population and planetary nutrition
friendly environment for mankind 3 4
Hyun- Sook Kim, Vish Prakash, for precision health. BMJ Nutrition, Prevention & Health
5 6
well- being with health and sustain- Omar Ramos- Lopez, Francis Zotor, 2021;0
7,8
ability perspectives concerning global J Alfredo Martinez
23 1
food consumption will emerge. Department of Preventive Medicine and Public Health, Received 13 January 2021
In this context, precision, person- University of Navarra, Pamplona, Spain Accepted 18 May 2021
2
alised, population and planetary Department of Nutrition, Harvard T H Chan School of
nutrition for public health imple- Public Health, Boston, MA, USA bmjnph 2021;0. http://nutrition.bmj.com/
3
mentation must concentrate on Department of Food and Nutrition, Sookmyung doi:10.1136/bmjnph-2021-000235
promoting advancement in nutri- Women's University, Yongsan- gu, Seoul, The Republic
of Korea
tional sciences, research and devel- 4
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