Inadequate nutrient status and non-communicable diseases: links to personalised nutrition

There is strong science to show that micronutrients may prevent or delay the onset of several NCDs, says Prof. Manfred Eggersdorfer, Nutrition Acience and Advocacy, DSM

Vitamins and minerals play an essential role in helping to sustain and improve human health during every stage of our lives. They can prevent the onset of deficiency diseases such as rickets and illnesses such as the common cold.

However, micronutrients can also play a substantial role in strengthening the immune system and organs to significantly reduce the risk of non-communicable diseases (NCDs), which, according to the World Health Organisation, amounted to 67% of worldwide deaths during 2012.1

This includes conditions such as type 2 diabetes (t2d), which resulted in 1.5 million deaths, and cardiovascular disease (CVD), which caused 17.5 million deaths in the same year.1 NCDs are on the rise and are expected to increase mortality to 52 million by 2030.1 They can develop as a result of certain lifestyle factors, inadequate diets and poor nutrition. Therefore, it is vital that people are aware of those risks and the ways of preventing the early onset of these diseases.

Current approach to micronutrients

There are numerous studies that show that people in Europe and the US do not consume the recommended daily amount of nutrient-rich food groups, such as fruits, vegetables, legumes and whole grains. However, the typical diet consists of an increased intake of fats and sugars instead, which means there is a significant lack of micronutrients supporting general well-being.2 Micronutrients — vitamins and minerals — are required by humans in the smallest amounts. They act together in equilibrium; and, if one or more are not present in the required amount, it may impact long-term health.

This can expose human bodies to the risk of diabetes, cardiovascular disease and even stroke. Currently, micronutrients are rarely recommended to consumers and prescribed to patients by physicians, which results in a lack of knowledge and medical encouragement to take the necessary nutrients for a healthy life and to prevent the onset of NCDs.

Doctors do not tend to advise patients to take micronutrients to lead a healthy life, partly because of limited knowledge about the possible benefits linked to reducing the risk of NCDs, but also because of a lack of understanding. Traditional medical training has a limited focus on nutrition and does not concentrate on how supplement intake could potentially improve health in general.3

Although there is good scientific evidence to support the benefits of micronutrients on human health, they are rarely administered by medical doctors to prevent NCDs. In addition, the benefits of supplementation have been questioned in the past.

Personalised nutrition

Despite shortfalls in nutrient consumption, understanding of the role of micronutrients in human health is improving. To help achieve optimal well-being throughout the life course and decrease the onset of NCDs, researchers have considered including phenotype and even genotype assessment into medical analysis to determine which diseases people are more likely to develop according to their predisposition, medical history and lifestyle. This can be done using biomarkers to measure these conditions.

Biomarkers are indicators of biological or pathogenic states that can be measured in patients, such as the presence of certain matters that indicate the risk of a disease.4,5 Phenotypes are inherited physical or behavioural characteristics, and genotypes are the genetic factors that determine the appearance of the phenotypes.6 New technologies allow micronutrient–gene interactions to be evaluated and connect nutrient status with this genetic data.

These developments are a new way of approaching nutrition science and research, with the potential to provide personal feedback and individualised recommendations to prevent serious conditions. For example, a link has been suggested between oxidative stress, CVD and the antioxidant vitamin E.7

The risk of CVD in t2d patients was five times higher if they had a mutation in a gene for haptoglobin (a protein produced by the liver).8 Increasing vitamin E intake in these individuals would compensate for the lack of antioxidant function of haptoglobin, thus reducing the risk of stroke, myocardial infarction (heart attack caused by a blood clot) and cardiovascular mortality.9

This targeted approach shows that recommending specific micronutrients to people with a high risk of CVD based on their individual phenotype assessment can improve their health and compensate for the lack of various enzymatic functions. There are more and more organisations offering such evaluation, which may lead to future developments in diagnostics to determine how diet can impact human health.

An international project, food4me, has been undertaking significant research into personalised nutrition by examining participants from various European countries. It set out to evaluate how education and personalised nutrition can be established as part of medical and nutritional services when assessing the nutrient status of people and prescribing relevant information and treatments. This research will outline the current scientific knowledge and approach to medical advice concerning personalised nutrition. The outcomes will be shared with leading EU institutions, the food and nutrition industry and other stakeholders.10

Another similar study is being done at the University Medical Center Groningen (UMCG) by the LifeLines cohort and DSM. The project aims to investigate multifactorial, age-related diseases and the interactions between environmental, phenotypic and biological factors during a period of 30 years. Participants span three generations and data collected include anthropometry, blood pressure, lung infection, cognition and urine samples.11 DSM’s research is part of the LifeLines cohort, which will map nutritional status against health outcomes in certain populations to further establish why some people develop chronic illnesses early in life and others remain healthy into old age.

Making changes

There is strong science to show that micronutrients may prevent or delay the onset of several NCDs and that daily multivitamin supplementation is a safe and effective way to address nutritional shortfalls. Changing the current medical approach by mapping the individual status and recommending personalised nutrition could potentially revolutionise preventive medicine and positively change many lives.

Ongoing research, such as the food4me project or the LifeLines cohort, is trying to establish whether people would start taking care of their health from an earlier stage of their lives if they knew about their micronutrient-calorie intake, their personal requirements and if they were predisposed to certain conditions. This would alleviate some of their inadequacies and strengthen their health to prevent or delay the onset of NCDs. Including phenotypes and genotypes into medical analysis would not only benefit the general population and those patients already diagnosed with specific diseases, but also those whose lifestyle might trigger them in the future.

There is still a gap in the knowledge of both medical professionals and consumers, who are reluctant to take micronutrients according to the DRA to maintain their health. DSM has been heavily involved in research and consumer education on the benefits of micronutrients to human health and adequate supplement intake to avoid NCDs whenever possible.

There are numerous studies that show that people in Europe and the US do not consume the recommended daily amount of nutrient-rich food groups, such as fruits, vegetables, legumes and whole grains

Inadequate intake is proven to have an effect on health span and longevity, and this impacts long-term economic productivity and stability, as well as national and global health. For example, the healthcare costs related to osteoporosis-attributed bone fractures among all US women over the age of 55 diagnosed with osteoporosis is expected to be more than $136 billion from 2013 to 2020.

It is estimated that the cost could be reduced by $15 billion if all the women in the at-risk group were to supplement their diet with calcium and vitamin D at the recommended daily intake.12 However, not only women suffer from osteoporosis; the healthcare cost to treat US men over the age of 50 is $4.1 billion. This is estimated to increase to $6.8 billion by 2025.13 There is already evident progress; however, more research needs to be accessible to the public to raise awareness of how increasing micronutrient intake can prevent the onset of NCDs.

In summary, many people have poor diets, as assessed by the calorie to vitamin ratio. There is a significant lack in vitamin and mineral consumption, which may overrule satiety signals. A balanced diet should be vitamin and mineral-dense, low-calorie, high-fibre and fruit-based nutrition. It can be complemented with fortified foods and supplements to markedly improve metabolism in those with less than optimal diets and improve health, vitality and support longevity.

References

1. http://apps.who.int/iris/bitstream/10665/148114/1/9789241564854_eng.pdf.

2. S. Krebs-Smith, et al., J. Nutr. 140(10), 1832–1838 (2010).

3. http://jama.jamanetwork.com/article.aspx?articleid=198139&resultClick=1#RESULTS.

4. www.ncbi.nlm.nih.gov/pmc/articles/PMC3078627/.

5. www.ncbi.nlm.nih.gov/pmc/articles/PMC1884846/.

6. www.bbc.co.uk/bitesize/intermediate2/biology/environmental_and_genetics/phenotype_and_genotype/revision/2/.

7. http://jama.jamanetwork.com/article.aspx?articleid=1028653&resultClick=3.

8. A.P. Levy, et al., 'Haptoglobin Phenotype is an Independent Risk Factor for Cardiovascular Disease in Individuals with Diabetes: The Strong Heart Study,' J. Am. Coll. Cardiol. 40, 1984–1990 (2002).

9. S. Blum, et al., 'Vitamin E Reduces Cardiovascular Disease in Individuals with Diabetes Mellitus and the Haptoglobin 2-2 Genotype,' Pharmacogenomics 11, 675–584 (2010).

10. www.food4me.org.

11. www.lifelines.nl/lifelines-research/study-design.

12. C. Shanahan and R. de Lorimier, Smart Prevention: Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements (Frost & Sullivan, Mountain View, California, USA, 2013), pp 1–125.

13. http://share.iofbonehealth.org/WOD/2014/fact-sheet/WOD_2014-fact_sheet.pdf.

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