Centre for Nutrition Education and Lifestyle Management, Wokingham, Berkshire, United Kingdom.
School of Health and Education, Middlesex University, Hendon, London, United Kingdom.
Nutr Rev. 2020 Dec 1;78(12):1046-1051. doi: 10.1093/nutrit/nuaa012.
The strengths and limitations of current approaches to clinical nutrition practice and their underpinning research are explored in this article. It describes how a personalized nutrition practice approach supported by evidence-based pathophysiological reasoning could direct additional research, which could then transform practice and support food industry developments. Current use of the term "personalized nutrition" is reviewed and a definition is provided. Also explored are current approaches to personalized nutrition practice and evidence-based practice in clinical nutrition. Patient-centered practice, which involves individuals in their healthcare decisions, is currently being provided under the name "personalized." An evidence-based personalized practice approach should include the use of robust, standardized, and validated tools that gather a patient's signs and symptoms, health history, family history, genetics, environment, lifestyle, social life, diet, behavior and other factors that have an impact on physiological processes. It should also gather anthropometric measures as well as functional, diagnostic, and prognostic biomarkers for pathophysiological mechanisms. Such tools would pool n = 1 data into a case-by-case evidence base that uses computational network modelling to predict the efficacy of personalized nutrition interventions. Prediction of the efficacy of interventions should also be validated using, when possible, blinded, randomized, controlled, stratified intervention studies. This model would provide practitioners with data that support evidence-based pathophysiological reasoning. It would enable clinicians to prioritize interventions on the basis of the mechanisms of action of interventions and to ameliorate the mechanisms of pathophysiology, which are a priority for the individual. Interventions then may be applied using a patient-centered practice approach. This would transform evidence-based nutrition practice into a P4 medicine approach that is personalized, preventive, predictive, and participatory. Developing pathophysiological mechanistic understanding also provides new opportunities for stakeholders, including the food industry, researchers, healthcare practitioners, and consumers.
本文探讨了当前临床营养实践方法的优缺点及其基础研究。它描述了如何通过基于证据的病理生理学推理支持的个性化营养实践方法来指导额外的研究，然后这些研究可以改变实践并支持食品行业的发展。本文回顾了当前“个性化营养”的使用情况并提供了定义。还探讨了当前个性化营养实践方法和临床营养中的循证实践。以个体为中心的实践，即让个人参与他们的医疗保健决策，目前是以“个性化”的名义提供的。循证个性化实践方法应包括使用强大、标准化和经过验证的工具，收集患者的症状、健康史、家族史、遗传学、环境、生活方式、社会生活、饮食、行为和其他影响生理过程的因素。它还应收集人体测量学指标以及用于病理生理机制的功能、诊断和预后生物标志物。这些工具将 n = 1 的数据汇集到一个基于案例的证据基础中，该基础使用计算网络建模来预测个性化营养干预措施的疗效。干预措施的疗效预测也应使用尽可能盲法、随机、对照、分层的干预研究进行验证。该模型将为从业者提供支持基于证据的病理生理学推理的数据。它使临床医生能够根据干预措施的作用机制对干预措施进行优先级排序，并改善病理生理学机制，这是个人的首要任务。然后可以使用以患者为中心的实践方法应用干预措施。这将把循证营养实践转变为个性化、预防性、预测性和参与性的 P4 医学方法。发展病理生理学机制理解也为利益相关者提供了新的机会，包括食品行业、研究人员、医疗保健从业者和消费者。
