From personalised nutrition to precision medicine: the rise of consumer genomics and digital health

Abstract

Advances in genomics generated the concept that a better understanding of individual characteristics, e.g. genotype, will lead to improved tailoring of pharmaceutical and nutritional therapies. Subsequent developments in proteomics and metabolomics, in addition to wearable technologies for tracking parameters, such as dietary intakes, physical activity, heart rate and blood glucose, have further driven this idea. Alongside these innovations, there has been a rapid rise in companies offering direct-to-consumer genetic and/or microbiome testing, in combination with the marketing of personalised nutrition services. Key scientific questions include how disparate datasets are integrated, how accurate are current predictions and how these may be developed in the future. In this regard, lessons can be learned from systems biology, which aims both to integrate data from different levels of organisation (e.g. genomic, proteomic and metabolomic) and predict the emergent behaviours of biological systems or organisms as a whole. The present paper reviews the origins and recent advancement of ‘big data’ and systems approaches in medicine and nutrition. Conclusions are that systems integration of multiple technologies has generated mechanistic insights and informed the evolution of precision medicine and personalised nutrition. Pertinent ethical issues include who is entitled to access new technologies and how commercial companies are storing, using and/or re-mining consumer data. Questions about efficacy (both long-term behavioural change and health outcomes), cost-benefit and impacts on health inequalities remain to be fully addressed.

Five Crucial Challenges in Digital Health

“…These two factors are, of course, interlinked. Genomics, on one level, essentially provides information regarding “what might happen” to an individual concerning their health ( 52 ). A key factor in improving our understanding of this information is the interpretation of genetic variants identified during testing.…”

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“…Several definitions for personalized nutrition have been proposed ( 10 , 11 ). The International Life Sciences Institute emphasized that personalized nutrition for the generally healthy population should use “individual-specific information, founded in evidence-based science, to promote dietary behavior change that may result in measurable health benefits” ( 2 ).…”

“…The International Life Sciences Institute emphasized that personalized nutrition for the generally healthy population should use “individual-specific information, founded in evidence-based science, to promote dietary behavior change that may result in measurable health benefits” ( 2 ). Others prefer the term precision nutrition that is focused on a systems biology and multiomics approach (i.e., using the tools of genomics, transcriptomics, proteomics, metabolomics, microbiomics, epigenetics) with integration bioinformatics and machine learning to sharpen the scientific certainty needed for specific nutrition recommendations ( 3 , 11 ).…”

“…Personalized and precision nutrition are emerging disciplines that aim to stratify individuals into ever-smaller groups as the science develops and specific nutrition guidance can be conveyed accurately ( 7 , 11 ). There are many challenges to overcome before personalized and precision nutrition becomes an accepted component of nutrition science and professional practice.…”

“…Precision nutrition aims to improve scientific understanding of responders and non-responders to dietary interventions. This process will require a tremendous investment by multiomics-focused investigators and funding agencies, with strong bioinformatics support ( 11 , 13 ). Once metabolic heterogeneity is better understood, the findings must next be translated to accurate dietary advice that is efficacious and health-promoting ( 6 , 11 ).…”