Diets, nutrients, genes and the microbiome: recent advances in personalised nutrition.

As individuals seek increasingly individualised nutrition and lifestyle guidance, numerous apps and nutrition programmes have emerged. However, complex individual variations in dietary behaviours, genotypes, gene expression and composition of the microbiome are increasingly recognised. Advances in digital tools and artificial intelligence can help individuals more easily track nutrient intakes and identify nutritional gaps. However, the influence of these nutrients on health outcomes can vary widely among individuals depending upon life stage, genetics and microbial composition. For example, folate may elicit favourable epigenetic effects on brain development during a critical developmental time window of pregnancy. Genes affecting vitamin B12 metabolism may lead to cardiometabolic traits that play an essential role in the context of obesity. Finally, an individual's gut microbial composition can determine their response to dietary fibre interventions during weight loss. These recent advances in understanding can lead to a more complete and integrated approach to promoting optimal health through personalised nutrition, in clinical practice settings and for individuals in their daily lives. The purpose of this review is to summarise presentations made during the DSM Science and Technology Award Symposium at the 13th European Nutrition Conference, which focused on personalised nutrition and novel technologies for health in the modern world.

Public health relevance of drug-nutrition interactions.

The public health relevance of drug-nutrition interactions is currently highly undervalued and overlooked. This is particularly the case for elderly persons where multi-morbidity and consequently polypharmacy is very common. Vitamins and other micronutrients have central functions in metabolism, and their interactions with drugs may result in clinically relevant physiological impairments but possibly also in positive effects. On 12 April 2016, the University Medical Center Groningen (The Netherlands), as part of its Healthy Ageing program, organized a workshop on the public health relevance of drug-nutrient interactions. In this meeting, experts in the field presented results from recent studies on interactions between pharmaceuticals and nutrients, and discussed the role of nutrition for elderly, focusing on those persons receiving pharmaceutical treatment. This paper summarizes the proceedings of the symposium and provides an outlook for future research needs and public health measures. Since food, pharma and health are closely interconnected domains, awareness is needed in the medical community about the potential relevance of drug-nutrition interactions. Experts and stakeholders should advocate for the integration of drug-nutrition evaluations in the drug development process. Strategies for the individual patients should be developed, by installing drug review protocols, screening for malnutrition and integrating this topic into the general medical advice.

A Systematic Review of Global Alpha-Tocopherol Status as Assessed by Nutritional Intake Levels and Blood Serum Concentrations.

The purpose of this study is to systematically review the published literature reporting vitamin E intake levels and serum concentrations in order to obtain a global overview of α-tocopherol status. Articles published between 2000 and 2012 were considered; 176 articles referring to 132 single studies were included. Applying an RDA (recommended daily allowance) of 15 mg/day and EAR (estimated average requirement) of 12 mg/day to all populations with a minimum age of 14 years, 82 and 61 % of mean and median data points were below the RDA and the EAR, respectively. Regarding serum concentrations, globally 13 % of the included data points were below the functional deficiency threshold concentration of 12 µmol/L, mostly for newborns and children. Several prospective observational studies suggest that a serum α-tocopherol concentration of ≥30 µmol/L has beneficial effects on human health. Of the reported study populations and subpopulations, only 21 % reached this threshold globally. This systematic review suggests that the α-tocopherol status is inadequate in a substantial part of the studied populations.

The challenge of setting appropriate intake recommendations for vitamin E: considerations on status and functionality to define nutrient requirements.

The main function of vitamin E is to protect against scavenging of reactive oxygen species; it is the primary protective agent against lipid peroxidation. Overt vitamin E deficiency is present only in patients with severe malnutrition and certain chronic diseases. The latest Recommended Dietary Allowance for vitamin E is based on the correlation between hydrogen peroxide-induced erythrocyte lysis and plasma α-tocopherol concentrations (Institute of Medicine, United States), or the prevention of lipid peroxidation (National Nutrition Societies of Germany, Austria and Switzerland, D-A-CH). According to the current recommendations, the reference plasma concentration for vitamin E is 12 - 46 µmol/L (daily intake of 15 - 30 mg α-tocopherol equivalents). Epidemiological studies suggest a beneficial effect of vitamin E on cardiovascular health at a plasma concentration of 30 µmol/L (a daily intake of ~ 50 IU). Vitamin E is also an important micronutrient for maintaining the immune system, especially in the elderly. A workshop was organized with the main objective to propose a concept for developing markers of status, functionality, and health in the field of nutritional research, in order to define desirable vitamin E requirements in healthy individuals.

Cardiometabolic health improvements upon dietary intervention are driven by tissue-specific insulin resistance phenotype: A precision nutrition trial.

Precision nutrition based on metabolic phenotype may increase the effectiveness of interventions. In this proof-of-concept study, we investigated the effect of modulating dietary macronutrient composition according to muscle insulin-resistant (MIR) or liver insulin-resistant (LIR) phenotypes on cardiometabolic health. Women and men with MIR or LIR (n = 242, body mass index [BMI] 25-40 kg/m2, 40-75 years) were randomized to phenotype diet (PhenoDiet) group A or B and followed a 12-week high-monounsaturated fatty acid (HMUFA) diet or low-fat, high-protein, and high-fiber diet (LFHP) (PhenoDiet group A, MIR/HMUFA and LIR/LFHP; PhenoDiet group B, MIR/LFHP and LIR/HMUFA). PhenoDiet group B showed no significant improvements in the primary outcome disposition index, but greater improvements in insulin sensitivity, glucose homeostasis, serum triacylglycerol, and C-reactive protein compared with PhenoDiet group A were observed. We demonstrate that modulating macronutrient composition within the dietary guidelines based on tissue-specific insulin resistance (IR) phenotype enhances cardiometabolic health improvements. Clinicaltrials.gov registration: NCT03708419, CCMO registration NL63768.068.17.

Prevalence of underweight, overweight and obesity on the basis of body mass index and body fat percentage in Hungarian schoolchildren: representative survey in metropolitan elementary schools.

BACKGROUNDS/AIMS: The incidence of obesity is increasing dramatically not only among adults, but also in children. The purpose of the survey was to assess the age- and gender-specific anthropometric data of children between the ages of 7 and 14 years who attended elementary schools in Budapest. METHODS: A cross-sectional study was performed in 2005. Altogether 1,928 students (1,002 boys and 926 girls) were recruited from the schools. The representative sampling sites were selected randomly. Height and waist circumference were measured, other data were analyzed by an 8-polar bioelectrical impedance procedure. Statistical analysis was carried out using SPSS 11 for windows. RESULTS: On the basis of body mass index (BMI), prevalence of underweight, overweight and obesity were 5.1, 18.1 and 7.4% for boys and 6.8, 19.6 and 6.3% for girls, respectively. On the basis of body fat percentage (%BF), prevalence of obesity was 17.9% for boys and 12.8% for girls. Forty nine percent of boys and 28% of girls categorized as overweight by BMI were obese according to their %BF. The difference in waist circumference between individuals categorized by BMI as normal and obese was 24.7 cm for boys and 20.5 cm for girls. Between those categorized as non-obese and obese by %BF, the difference was 17.3 cm for boys and 16.4 cm for girls. Normal and overweight boys and girls with high %BF had significantly higher waist circumferences than their counterparts with normal %BF. This means that many obese children may escape detection as obese, if classified as overweight on the basis of BMI alone. CONCLUSION: Results appear to underline that in addition to BMI, the determination of the %BF and waist circumference is important in epidemiological studies to identify obese subjects.

Lifestyle of Hungarian adolescents--observations among metropolitan secondary school students.

BACKGROUND/AIMS: Obesity among adolescents is a significant and global disease which requires early prevention. The development of overweight and obesity depends not only on genetic components but also on lifestyle. The objective of the survey was to study the lifestyle of 15- to 19-year-old secondary school students in Budapest. METHODS: Students (n = 1,273, 670 boys, 603 girls) were asked to complete questionnaires about their leisure activities, physical exercise, eating habits and knowledge of nutrition. The response rate was 45.2%. RESULTS: Three-quarters of the secondary school students lived a sedentary life and more than half were dissatisfied with their body weight. More than 40% of the girls had been on a slimming diet at least once. Half of the students regularly consumed vitamin and/or mineral supplements. Nearly 25% of the adolescents did not have breakfast and nearly 60% of the school-leavers smoked regularly. CONCLUSIONS: Coordinated cooperation is necessary among stakeholders to support the aim of changing nutritional and exercise behavior of adolescents.

[Association between birth weight and childhood obesity in a Budapest metropolitan survey]. / A születési testtömeg és a gyermekkori elhízás kapcsolata egy fôvárosi felmérés alapján.

INTRODUCTION: According to epidemiological investigations, association between birth weight and overweight and obesity in childhood/adolescence is ambiguous. AIM: The purpose of the study was to investigate the association between birth weight and overweight and obesity in childhood and adolescence. METHODS: Birth and actual anthropometric data of school children and secondary school students from metropolitan schools were analyzed. Overweight/obesity were established by standardized (sex, age) body mass index, and obesity also by body fat percent. RESULTS: Data of 1,334, 7- to 19-year-old children and adolescents (725 boys and 609 girls) were evaluated. Prevalence of overweight/obesity was similar in the case of persons with low (19.36%) and normal birth weight (18.96%), while in the case of persons with high birth weight this rate was 25.98%. Based on body fat percent, the prevalence of obesity in the latter group was also higher than in groups with low and normal birth weight (18.11% vs. 12.89% and 12.66%). CONCLUSIONS: Among macrosomic babies the rate of overweight and obesity is higher than among normal or low-birth-weight babies, particularly in childhood.

[Methods for the assessment of adolescent obesity in epidemiological studies]. / Az epidemiológiai vizsgálatokban alkalmazható néhány méromódszer a serdülokori elhízás megítélésére.

INTRODUCTION: The incidence of obesity is increasing dramatically not only among adults, but also in the child population. OBJECTIVE: Comparison of different anthropological methods. METHODS: The authors evaluated the data of 654 boys and 584 girls (age 15-19 years). Body height and waist circumference were measured, body composition was determined using InBody3.0 bioimpedance instrument. Body mass index and body fat percentage were calculated by the instrument. RESULTS: On the basis of age and gender specific diagnostic criteria for body mass index, incidence of leanness, overweight and obesity in the boys' group were 6.7, 15.9 and 4.1%, respectively. In the girls' group the respective figures were 7.2, 7.9 and 1.9%. On the basis of body fat percentage, 5.1% of boys and 16.2% of girls were obese, whereas on the basis of data for waist circumference, visceral obesity occurred in 10.5% of boys and 7.9% of girls. In the overweight groups 10.5% of boys and 77.0% of girls were obese on the basis of body fat percentage, whereas taking into consideration the values of waist circumference, 38% of boys and 55% of girls could be regarded as obese. CONCLUSIONS: The determination of body composition is of utmost importance in obesity screening and in the follow-up slimming diets. In addition to this, simple and inexpensive waist circumference measurements should be performed in each instance.

[Is there a unique measuring method to assess obesity?]. / Van kitüntetett méromódszer az elhízás megállapítására?

UNLABELLED: In the literature there is not available a uniformly accepted method for assessing the degree of obesity. AIM: To determine how far insulin resistance, serum levels of leptin and resistin are altered in persons categorized on the basis of body-mass index (BMI), body fat percentage, and abdominal circumference. METHODS: 101 volunteer boys and 115 girls participated in the studies. Body height was measured, body mass, abdominal circumference, and body composition were determined by InBody3 bioimpedance instrument. Body mass index and body fat percentage were calculated by the instrument. Concentrations of serum glucose, insulin, leptin, and resistin were determined. Insulin resistance was calculated using the homeostasis model: HOMA IR . RESULTS: Body fat percentage, serum levels of leptin and resistin were significantly higher in girls than in boys. Increases in BMI, body fat percentage, and abdominal circumference were associated with the significant elevation of both HOMA IR and serum leptin concentrations. In overweight boys categorized by body fat percentage as obese the serum leptin concentrations were significantly higher than in their non-obese counterparts. CONCLUSION: Determination of body composition would be important concerning the follow-up of biochemical changes occurring in the body during the course of both epidemiological studies and nutritional interventions.

[Effects of oligofructose containing diet in obese persons]. / Az oligofruktóz hatásának vizsgálata elhízottakban.

UNLABELLED: In the treatment of obesity the introduction of a low-calorie diet is a fundamental requirement. The enhancement of the fiber content of food causing satiety may contribute to the observation of dietary prescriptions. Oligofructoses belong to the group of dietary fibers. AIM: To study the effects of the consumption of a low-energy diet (2,000 kcal/day) completed with Jerusalem artichoke concentrate in obese adolescents and adults. METHODS: 12 obese students (6 boys and 6 girls) and 6 obese women were put on a low-calorie regimen for 12 weeks, whereas 16 obese students (10 boys and 6 girls) and 17 obese women consumed the same low-calorie diet completed with Jerusalem artichoke concentrate containing 14 g/day oligofructose. Sensation of fullness was estimated. In addition to anthropometric parameters serum biomarkers of lipid and carbohydrate metabolism and adipokines were determined. RESULTS: The consumption of the low-calorie diet completed with Jerusalem artichoke concentrate resulted in a diminished sensation of hunger. Body mass index and body fat percentage decreased significantly. In girls and women, the serum levels of triglycerides were also significantly reduced and the rate of insulin resistance estimated on the basis of homeostasis model assessment was also improved. CONCLUSIONS: The results of this pilot study appear to demonstrate that the Jerusalem artichoke concentrate produced by a new technology can be a promising component of future diet therapy.

Dietary habits of school children: representative survey in metropolitan elementary schools. Part two.

BACKGROUND/AIMS: The aim of this study was to investigate the eating habits and the nutrient intake of 11- to 14-year-old school children as part of a representative nutrition and health survey in primary schools in Budapest. METHODS: A food frequency questionnaire of 875 school children, aged from 11 to 14 (449 boys and 426 girls), was recorded and evaluated. Energy and nutrient intake of 235 children (124 boys and 111 girls) was calculated in parallel by 3-day dietary record. RESULTS: The average energy intake (MJ) was appropriate (boys: 10.40 +/- 1.89; girls: 9.18 +/- 1.50); protein and fat intake was somewhat higher than the Hungarian recommended dietary allowances. Sodium intake was alarmingly high. The intake of calcium and vitamin D was inadequate. The intakes of zinc, chromium, retinol, folate for both genders, and iron in the case of girls were insufficient. The daily consumption of milk and dairy products was deficient, that of vegetables and fresh fruits was rather low, while the frequency of consumption of sugar-sweetened beverages, chips, sticks and fast foods was high. CONCLUSIONS: Nutrition intervention programs should be launched among Hungarian school children.

Lifestyle of school children: representative survey in metropolitan elementary schools. Part one.

BACKGROUND/AIMS: The prevalence of overweight and obesity among school children is increasing dramatically. Obesity is multifactorial and depends on lifestyle as well as genetic components. The purpose of the survey was to investigate the lifestyle of 7- to 14-year-old children attending elementary schools in Budapest. METHODS: The research was questionnaire-based. Children were asked to answer questions about their leisure activities, physical exercise, nutritional, eating, and smoking habits. RESULTS: Many children live a sedentary life and are dissatisfied with their body weight. One in 5 boys and 1 in 3 girls have been on a slimming diet at least once. About two-thirds of the children regularly consumed vitamin and/or mineral supplements and at the same time just over half of them knew how much fruit should be eaten daily. School children in the upper classes did not eat 5 times a day. More than 5% of the 11- to 14-year-old boys and more than 10% of the girls smoked regularly. CONCLUSIONS: According to our results, the unfavorable lifestyle of the great majority of Hungarian school children may have implications for their health during adulthood.

Conventional foods, followed by dietary supplements and fortified foods, are the key sources of vitamin D, vitamin B6, and selenium intake in Dutch participants of the NU-AGE study.

With aging, energy needs decrease, necessitating a more nutrient-dense diet to meet nutritional needs. To bridge this gap, the use of nutrient-dense foods, fortified foods, and dietary supplements can be important. This observational study aims to describe current micronutrient intakes of Dutch elderly and to identify the contribution of nutrient-dense foods, fortified foods, and dietary supplements to the intake of micronutrients that are often inadequately consumed in Dutch elderly. Data of 245 Dutch volunteers from the NU-AGE study aged 65 to 80 years were used. Dietary intake was assessed by means of 7-day food records, and dietary supplement use was recorded with an additional questionnaire. Information on fortified foods was obtained from the Dutch Food Composition Table 2011. Nutrient density of foods was evaluated using the Nutrient Rich Food 9.3 score. The percentages of participants not meeting their average requirement were high for vitamin D (99%), selenium (41%), and vitamin B6 (54%) based on conventional foods and also when taking into account fortified foods (98%, 41%, and 27%, respectively) and vitamin and mineral supplements (87%, 36%, and 20%, respectively). Conventional foods were the main source of vitamin D, vitamin B6, and selenium intake (42%, 45%, and 82%, respectively), followed by vitamin and mineral supplements (41%, 44%, and 18%) and fortified foods (17%, 11%, and 1%). Foods with the highest nutrient density contributed most to total vitamin B6 intake only. To optimize nutrient intakes of elderly, combinations of natural food sources, fortified foods, and dietary supplements should be considered.

Nutrient Status Assessment in Individuals and Populations for Healthy Aging-Statement from an Expert Workshop.

A workshop organized by the University Medical Center Groningen addressed various current issues regarding nutrient status of individuals and populations, tools and strategies for its assessment, and opportunities to intervene. The importance of nutrient deficiencies and information on nutrient status for health has been illustrated, in particular for elderly and specific patient groups. The nutrient profile of individuals can be connected to phenotypes, like hypertension or obesity, as well as to socio-economic data. This approach provides information on the relationship between nutrition (nutrient intake and status) and health outcomes and, for instance, allows us to use the findings to communicate and advocate a healthy lifestyle. Nutrition is complex: a broader profile of nutrients should be considered rather than focusing solely on a single nutrient. Evaluating food patterns instead of intake of individual nutrients provides better insight into relationships between nutrition and health and disease. This approach would allow us to provide feedback to individuals about their status and ways to improve their nutritional habits. In addition, it would provide tools for scientists and health authorities to update and develop public health recommendations.

Nutritional Solutions to Reduce Risks of Negative Health Impacts of Air Pollution.

Air pollution worldwide has been associated with cardiovascular and respiratory morbidity and mortality, particularly in urban settings with elevated concentrations of primary pollutants. Air pollution is a very complex mixture of primary and secondary gases and particles, and its potential to cause harm can depend on multiple factors-including physical and chemical characteristics of pollutants, which varies with fine-scale location (e.g., by proximity to local emission sources)-as well as local meteorology, topography, and population susceptibility. It has been hypothesized that the intake of anti-oxidant and anti-inflammatory nutrients may ameliorate various respiratory and cardiovascular effects of air pollution through reductions in oxidative stress and inflammation. To date, several studies have suggested that some harmful effects of air pollution may be modified by intake of essential micronutrients (such as B vitamins, and vitamins C, D, and E) and long-chain polyunsaturated fatty acids. Here, we review the existing literature related to the potential for nutrition to modify the health impacts of air pollution, and offer a framework for examining these interactions.

Selected nutrients and their implications for health and disease across the lifespan: a roadmap.

Worldwide approximately two billion people have a diet insufficient in micronutrients. Even in the developed world, an increasing number of people consume nutrient-poor food on a regular basis. Recent surveys in Western countries consistently indicate inadequate intake of nutrients such as vitamins and minerals, compared to recommendations. The International Osteoporosis Foundation's (IOF) latest figures show that globally about 88% of the population does not have an optimal vitamin D status. The Lancet's "Global Burden of Disease Study 2010" demonstrates a continued growth in life expectancy for populations around the world; however, the last decade of life is often disabled by the burden of partly preventable health issues. Compelling evidence suggests that improving nutrition protects health, prevents disability, boosts economic productivity and saves lives. Investments to improve nutrition make a positive contribution to long-term national and global health, economic productivity and stability, and societal resilience.

Blood glutathione and subclinical atherosclerosis in African men: the SABPA Study.

BACKGROUND: Sub-Saharan Africans face an increasing burden of hypertension and related cardiac and cerebrovascular morbidity and mortality, making the identification of factors leading to early vascular abnormalities imperative. METHODS: We investigated the possible influence of the antioxidant glutathione (GSH) on early subclinical atherosclerosis in 63 hypertensive (aged 45.2 years) and 34 normotensive (aged 38.9 years; P < 0.001) nondiabetic African men. We measured ambulatory daytime systolic and diastolic blood pressure (SBP, DBP) as well as daytime mean arterial pressure (MAP), carotid intima-media thickness (CIMT), and calculated the cross-sectional wall area. We determined the reduced form of GSH in whole blood and blood glucose in serum. RESULTS: Blood glucose (110 vs. 92 mg/dl; P < 0.001) and CIMT (0.75 vs. 0.61 mm; P < 0.001) were higher in hypertensives compared to normotensives. No significant difference existed for GSH. Associations in normotensives suggested the hypotensive effect of GSH after single (SBP: r = -0.35, P < or = 0.05; DBP: r = -0.37, P < or = 0.05; MAP: r = -0.38, P < or = 0.05) and multiple (SBP: B = -0.015, P < 0.05; DBP: B = -0.011, P < 0.05; MAP: B = -0.012, P < 0.05) regression analyses. In hypertensives, CIMT (B = -0.00027, P < 0.01) and cross-sectional wall area (CSWA) (B = -0.0066, P < 0.05) correlated negatively with GSH. These findings were consistent after excluding 10 human immunodeficiency virus (HIV)-positive hypertensive subjects. CONCLUSIONS: In hypertensive African men, CIMT is negatively associated with GSH, suggesting a possible contributory role of attenuated GSH levels in the development of subclinical atherosclerosis.

Von Willebrand factor as marker of vascular function in South African women: the POWIRS Study.

BACKGROUND: The increasing prevalence of hypertension and vascular-related morbidity and mortality among Africans emphasizes the need to identify markers for the early detection of vascular disease. Caucasian-based studies demonstrate that the von Willebrand factor (vWf) is a useful marker of vascular dysfunction. We investigated whether associations between this marker and markers of cardiovascular function in Caucasian women are comparable with African women. METHODS: The study consisted of apparently healthy African (n = 99) and Caucasian (n = 114) women (mean age, 31.0 years), individually matched for age and body mass index. We measured blood pressure and arterial compliance noninvasively, and vWf in serum. We assessed univariate and multivariate-adjusted associations of blood pressure and arterial compliance with vWf. RESULTS: Although no ethnic difference existed for mean vWf levels, Caucasian and African women showed opposite associations of blood pressure and arterial compliance with vWf after single, partial, and multiple regression analyses. In Caucasians, after full adjustment, systolic (beta = +0.179; P < 0.05) and diastolic (beta = +0.190; P < 0.05) blood pressure correlated positively and arterial compliance negatively (beta = -0.197; P < 0.01) with vWf. Conversely, in Africans, systolic blood pressure correlated weakly, but negatively (beta = -0.168; P = 0.059) with vWf. However, this opposite tendency seemed due to the confounding influence of the depot medroxyprogesterone acetate (DMPA) contraceptive injection and, although >99% power existed, significance disappeared after excluding these subjects (beta = -0.071; P = 0.46). CONCLUSIONS: Associations of vWf with blood pressure and arterial compliance were not comparable between Caucasian and African women, suggesting that the vWf may not be a useful marker of vascular alterations in African women.