‘Gepersonaliseerd voedingsadvies
leidt tot effectievere gedragsverandering’ (vervolg)
Abstract
Background: Optimal nutritional choices are linked with better health, but many current interventions to improve diet have limited effect. We tested the hypothesis that providing personalized nutrition (PN) advice based on information on individual diet and lifestyle, phenotype and/or genotype would promote larger, more appropriate, and sustained changes in dietary behaviour.
Methods: Adults from seven European countries were recruited to an internet-delivered intervention (Food4Me) and randomized to: (i) conventional dietary advice (control) or to PN advice based on: (ii) individual baseline diet; (iii) individual baseline diet plus phenotype (anthropometry and blood biomarkers); or (iv) individual baseline diet plus phenotype plus genotype (five diet-responsive genetic variants). Outcomes were dietary intake, anthropometry and blood biomarkers measured at baseline and after 3 and 6 months’ intervention.
Results: At baseline, mean age of participants was 39.8 years (range 18–79), 59% of participants were female and mean body mass index (BMI) was 25.5 kg/m2. From the enrolled participants, 1269 completed the study. Following a 6-month intervention, participants randomized to PN consumed less red meat [-5.48 g, (95% confidence interval:-10.8,-0.09), P = 0.046], salt [-0.65 g, (−1.1,-0.25), P = 0.002] and saturated fat [-1.14 % of energy, (−1.6,-0.67), P < 0.0001], increased folate [29.6 µg, (0.21,59.0), P = 0.048] intake and had higher Healthy Eating Index scores [1.27, (0.30, 2.25), P = 0.010) than those randomized to the control arm. There was no evidence that including phenotypic and phenotypic plus genotypic information enhanced the effectiveness of the PN advice.
Conclusions: Among European adults, PN advice via internet-delivered intervention produced larger and more appropriate changes in dietary behaviour than a conventional approach.
Introduction
Poor diet and lack of physical activity (PA) are major risk factors for non-communicable diseases (NCDs) including type 2 diabetes (T2D), cardiovascular diseases (CVDs) and many cancers.1,2 Up to 80% of major CVDs, and over one-third of cancers, could be prevented by eliminating shared risk factors, including tobacco use, unhealthy diet, physical inactivity and excess alcohol consumption.3 This emphasizes the importance of changing lifestyle in public health initiatives.
Most population strategies to reduce NCD burden have used ‘one size fits all’ public health recommendations, e.g. ‘eat at least five portions of fruit and vegetables daily’.4 However, the global burden of NCD continues to rise, underlining the need for more effective prevention.5 Advances in the cost and time efficiency of genome sequencing and enhanced ability to extract information of interest, e.g. disease risk, have fuelled interest in the use of personal genetics.6,7 However, the effectiveness of genetic-based information in facilitating behaviour change is unclear. A systematic review recommended that more, and larger, randomized controlled trials (RCTs) are needed to determine whether DNA-based dietary advice motivates people to make appropriate behavioural changes.8
Personalized dietary interventions are designed according to key characteristics of the individual participants. The more tailored the intervention, the more sophisticated and potentially expensive it will be to acquire, analyse and act upon those participant characteristics. With conventional face-to-face interventions, the resource implications of the necessary information collection and processing could mean that such personalized nutrition (PN) interventions would be limited to the more affluent. Given that the prevalence and risk of death from NCDs are strongly socioeconomically patterned,9 it is important that interventions reach all social groups. Use of the internet is rising rapidly in Europe.5,10 Current data show that 76.5% of the population of the European Union use the internet and, increasingly, national governments and others use the internet to deliver a wide range of social, financial and health services.5,10 Thus, digital-based technologies for delivering interventions may offer advantages including convenience, scalability, personalization/stratification, sustainability and cost effectiveness. Therefore, the aims of the Food4Me Study were to conduct a multi-centre, internet-based RCT of PN to determine whether providing more personalized dietary advice leads to larger and more appropriate changes in dietary behaviour than standard ‘one size fits all’ population advice.
Methods
Study design
The Food4Me ‘Proof of Principle’ study was a 6-month, four-arm RCT conducted across seven European countries to compare the effects of three levels of PN with standard population advice (control) on health-related outcomes.