Is There a Role for Precision Nutrition in the Management of Type 2 Diabetes?
Despite the promising preliminary data, precision nutrition is still novel, and at this point it is unlikely to be widely used in clinical and public health settings.
According to 2015 estimates, diabetes affects more than 30.3 million people in the United States, including 1.25 million individuals with type 1 diabetes.1 Another 84.1 million US adults were reported to have prediabetes in 2015; 1.5 million Americans are diagnosed with diabetes each year.1
It is well-established that a high-quality diet is a key component in the prevention and management of type 2 diabetes (T2D). However, current dietary guidelines, such as those recommended by the American Diabetes Association, are "based on population averages and often do not take into account individual variability in response to nutritional components," as stated in a recent review published in the Lancet Diabetes & Endocrinology.2
In contrast, an approach called precision nutrition (also referred to as personalized nutrition) "adapts nutrition interventions and recommendations on the basis of individual characteristics to prevent and manage chronic diseases such as [T2D]," the authors of the review wrote.2 Noting the increasing interest in precision nutrition among scientists, as well as the general public, they explored the available evidence regarding its potential role in preventing and managing T2D. For example, genomics research has identified numerous loci associated with the heritability of the disease, whereas metabolomics studies have pinpointed T2D-associated metabolites that may be modifiable via dietary changes.3-5
Endocrinology Advisor interviewed 2 experts about the findings discussed in the review and the current state of precision nutrition for T2D: Rashmi S. Mullur, MD, assistant clinical professor in the Division of Endocrinology, Diabetes, and Metabolism at the David Geffen School of Medicine at the University of California, Los Angeles, and associate chief of integrative medicine at the VA Greater Los Angeles Healthcare System; and Linda E. Sartor, RD, LDN, CDE, a diabetes nutrition specialist in the Penn Rodebaugh Diabetes Center at Penn Medicine, Philadelphia.
Endocrinology Advisor: What does the available evidence suggest thus far about the potential role of precision nutrition in the prevention and management of T2D?
Rashmi S. Mullur, MD: Authors Wang and Hu reviewed the currently available literature that evaluated the use of precision medicine techniques applied to the field of nutrition and endocrinology.2 The concept of precision medicine, a research initiative launched by the Obama administration, is one that combines large-scale biologic databases such as the human genome sequence; new scientific methods for characterizing individuals, such as proteomics, metabolomics, and genomics; and the computational tools required to analyze these large sets of data.
Although the short-term goals of precision medicine were initially focused on treatment of cancer, longer-term goals are targeted to overall health and prevention of chronic diseases including obesity, T2D, and heart disease.
The authors provide a compelling argument supporting the science and theory behind precision nutrition. In an ideal world, precision nutrition would allow us to achieve a more reliable assessment of dietary intake, identify newer molecular targets for lifestyle and pharmacologic interventions, provide personalized lifestyle interventions, and ultimately, allow us to understand the underlying mechanisms that cause individuals to respond differently to nutritional interventions.
Linda E. Sartor, RD, LDN, CDE: These findings suggest an exciting and emerging role for the evidence-based practice of precision nutrition in the current treatment and prevention of T2D. Advances in genomics, metabolomics, and gut microbiome analysis, along with mobile apps and wearable devices, offer more accurate integration of nutritional data and other lifestyle parameters (exercise, sleep, stress management) with the development of personalized health strategies.
Still, challenges remain, including a lack of long-term, reproducible results and the high cost of testing currently, which limits accessibility to the general population, and thus limits its use in public health.