Journal of Human Nutrition and Dietetics

PERSONALISED NUTRITION
Personalised nutrition technologies: a new paradigm for
dietetic practice and training in a digital transformation era
M. Abrahams1,2 & N. V. Matusheski3
1
Faculty of Management, Law & Social Sciences, University of Bradford, Bradford, UK
2
Qina Ltd, Olhao, Portugal
3
Nutrition Science and Advocacy, DSM Nutritional Products, Parsippany, NJ, USA

Keywords
behaviour change, digital health, digital literacy,
mHealth, personalised nutrition, technology.

Correspondence
M. Abrahams, Qina Ltd, Olhao 8700, Portugal.
Tel.: +351 9644 50622
E-mail: info@qina.tech

Received 2 December 2019; revised 12 February

2020; accepted 13 February 2020.

How to cite this article

Abrahams M.& Matusheski N.V. (2020)
Personalised nutrition technologies: a new
paradigm for dietetic practice and training in a
digital transformation era. J Hum Nutr Diet. 33,
295–298
https://doi.org/10.1111/jhn.12746

This is an open access article under the terms of

the Creative Commons Attribution License, which
permits use, distribution and reproduction in any
medium, provided the original work is properly
cited.

Patient-centred care is a cornerstone of modern dietet-

Personalised nutrition in patient-centred care
ics practice (3). A key tenant underlying this approach is
It has recently been estimated that one in five early deaths the individualisation of guidance based on the patient’s
worldwide is associated with poor dietary habits (1). specific needs and, in a broad sense, treating the patient
Addressing this societal challenge through dietetics prac- and not the disease (4). In parallel, personalisation has
tice will require substantial human resource investment. recently developed as a trend in the consumer nutrition
However, according to the World Health Organization, and wellness area (5). Numerous apps, programs, plat-
there is currently a substantial shortage of healthcare forms and plans are now aimed at delivering a person-
workers, which is expected to increase over the coming alised experience for the user based on profiling of an
decades (2). Because of this, it is important to develop an individual’s demographics, genotype, nutritional intake
understanding of the potential ways that new technologies and status, anthropometrics, lifestyle behaviours, and/or
and digital tools can help to increase the impact of dietet- preferences (6,7). Several definitions have been put forth
ics. This will create value not only for the individual for personalised nutrition, including those that deal pri-
patient, but also as a scalable approach to helping indi- marily with genetic differences, and others that include
viduals develop improved dietary habits and transition to much broader concepts, including phenotypic, psychoso-
a service that is based on prevention and self-care. cial and behavioural aspects of individualisation (8,9,10,11).

ª 2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd 295
on behalf of British Dietetic Association.
 Personalised nutrition technologies M. Abrahams and N. V. Matusheski

In this editorial, we employ a recently proposed definition

A practical personalised nutrition framework
of personalised nutrition to describe approaches that ‘use
individual-specific information, founded on evidence- Considering the high level of consumer interest in person-
based science, to promote dietary behaviour change that alised nutrition, it is not surprising that many commercial
may result in measurable health benefit’ (12). By leverag- personalised nutrition programs have arisen. However,
ing a holistic definition, we can consider how different each approach varies regarding the information that it col-
aspects of personalisation can be of greatest benefit and lects about an individual, and which recommendations
can be most effectively leveraged for the individual arise. Because of this, it is important to develop a frame-
patient, which can be appreciated by all dietitians. work for assessing whether a given personalised nutrition
The scientific evidence for personalised nutrition is platform can offer real benefits, or whether some alterna-
growing. Substantiation continues to emerge that person- tive should be recommended. An interdisciplinary expert
alised nutrition can provide added value beyond conven- group (12) recently developed a set of 10 ‘guiding princi-
tional approaches. In the clinical setting, there has been ples’ for personalised nutrition that can support such an
increased recognition of the importance of implementing assessment (Box 1). These principles can be of equal value
nutritional screening and intervention (13). For example, for those developing and for those using or implementing
individualised nutrition assessments and provision of tai- a technology-enabled personalised nutrition program.
lored nutritional support in patients at nutritional risk Using such a framework can help determine whether a
have been shown to significantly improve clinical out- personalised nutrition approach is credible and would be
comes, including patient survival (14). In a broader well- expected to deliver results for an individual.
ness context, several important gene–diet interactions Despite a rapid rise in availability, the integration of
were found to influence the response to dietary weight- digital tools into daily dietetic practice remains low
loss interventions in the landmark DIOGENES trial (15). amongst dietitians. In a survey of dietitians in Canada,
More holistic approaches, leveraging personalised infor- Australia and the UK, 63% of respondents reported using
mation based on both genotypic and phenotypic variation, a mobile health app in their practice, primarily for infor-
have also been promising (16). A recent study in older mational and patient self-monitoring purposes (24), yet
Dutch adults found that the provision of personalised very few are used for behaviour change (25,26). Another
advice, based on dietary intake, genetic and physiological study in Australia demonstrated poor eHealth readiness
information, resulted in increased resiliency and motiva- in terms of advocacy, although there was an improvement
tion, and decreased body fat percentage and hip circumfer- with respect to attitudinal, aptitude and access to eHealth
ence (17). In the future, we expect to see even more research readiness (27). A recent multi-national survey showed that
investment in Personalised ‘algorithm-based’ approaches. dietitians who had adopted personalised nutrition innova-
For example, clinical trials are currently underway aiming tions demonstrated higher levels of self-efficacy, lower per-
to validate a microbiome-based personalisation approach ceptions of risk and higher usefulness, and also assigned a
for blood sugar management (18,19). Likewise, an ongoing higher importance of technology to dietetic practice, com-
collaboration between Stanford University and Mas- pared to those who had not (28). Interestingly, dietitians
sachusetts General Hospital recently published a pilot study who had integrated personalised nutrition technologies
(PREDICT) and is now conducting a large observational perceived themselves to be entrepreneurs, bringing
study (PREDICT2) to measure individual metabolic
responses to foods, with the aim of developing a commer-
cial platform (20). In the Nutrigenomics, Overweight/Obe- Box 1. Guiding principles for personalised nutrition.
sity and Weight Management Trial (NOW Trial), the 1 Define potential users and beneficiaries
effects of a lifestyle intervention employing personalised 2 Use validated diagnostic methods and measures
3 Maintain data quality and relevance
genetic testing and behavioural advice will be compared
4 Derive data-driven recommendations from validated models
with the same intervention with population-based advice and algorithms
(21)
. However, for many commercial platforms, their bene- 5 Design personalised nutrition studies around validated individ-
fit has yet to be established in randomised controlled trials. ual health or function needs and outcomes
Challenges still exist in terms of replicability of results, 6 Provide rigorous scientific evidence for an effect on health or
diversity of population groups included (22), as well as sci- function
entific validation and accuracy of products currently avail- 7 Deliver user-friendly tools
8 For healthy individuals, align with population-based recommen-
able (23). It has become clear however, that behaviour
dations
change is the common denominator underpinning success- 9 Communicate transparently about potential effects
ful personalised nutrition approaches for which dietitians 10 Protect individual data privacy and act responsibly
are well versed, trained and experienced.

296 ª 2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd
on behalf of British Dietetic Association.
 M. Abrahams and N. V. Matusheski Personalised nutrition technologies

another dimension to how we may need to address digital inclusive leadership, developing an entrepreneurial mind-
transformation and organisational change in a modern set (28,32), data management and digital literacy (30). At
data-driven healthcare service (29). As a result of these present, the area of tech-enabled personalised nutrition
advances in both science and technology, it is important receives little attention in the dietetic curriculum (33). To
for the practising dietitian to increase their awareness, our knowledge, with the exception of genomics, new
knowledge, digital literacy (in terms of artificial intelli- technologies such as AI, machine learning and neural net-
gence and genomics) (30), professional skills and comfort works are not currently covered in the dietetic curricu-
level with respect to the digital solutions that power these lum. This is concerning, considering that the recent
personalised recommendations through big data analytics, survey cited above demonstrated that most Registered
machine learning and artificial intelligence (AI). Dietitians (RDs) did not consider technology to play an
important role in dietetic practice (28). However, we know
that students are interested (33), which highlights that
The growing role and need for the next
there is indeed a gap between consumer demand and cur-
generation of dietitians
rent dietetic awareness.
Although the guiding principles are an excellent reference
point for those aiming to develop personalised nutrition
Conclusions
solutions, the growing role for the next generation of dieti-
tians is clear. Digital solutions will not replace dietitians The time is right for dietitians to take the lead in the dig-
because of the crucial value that we bring in terms of per- ital transformation of healthcare services, with nutrition
sonal relationship building and behaviour change (31). and lifestyle playing a vital role in the prevention of non-
However, dietitians who do not adopt or sufficiently communicable diseases. New personalised nutrition tech-
understand new technologies may run the risk of being nologies that are based on science, and are inclusive and
replaced. As a profession, we need to address this new real- accessible, provide new ways of delivering care and reach-
ity at all levels of personalisation. Dietitians can play an ing key groups to support them in lasting behaviour
important role in new initiatives and product development change. Dietitians have a unique opportunity to be a
to ensure that digital products are scientifically valid, inclu- guiding voice, a reality check and a key resource for the
sive, equitable, accessible, explainable and representative. creation and delivery of new solutions and healthcare
The opportunities for dietitians as we move into the models. To become the reference professionals for a data-
fourth industrial revolution are limitless and include driven future that is already here, we need to address
those outlined in Box 2. where we are as a profession in terms of our inclusive
leadership, and ensure that our digital and entrepreneur-
ial literacy skills are truly at the forefront of change.
Strategic considerations for digital transformation
in dietetic practice
References
In a modern healthcare system, which is transitioning to
one that is participatory and personalised, we need to 1. Afshin A, Sur PJ, Fay KA et al. (2019) Health effects of
ensure that we are equipped with the right skills, knowl- dietary risks in 195 countries, 1990–2017: a systematic
edge and mindsets for this shift. These skills include analysis for the Global Burden of Disease Study 2017.
Lancet 393, 1958–1972.
2. Global Health Workforce Alliance and World Health
Box 2. Opportunities for dietitians in the fourth industrial Organization. A universal truth: no health without a
revolution. workforce. Available at: https://www.who.int/workforceallia
1 Acquiring new skills in bias validation, algorithm develop- nce/knowledge/resources/hrhreport2013/en/ (accessed
ment, data management and analytics, as well as workflow, and October 2019).
unlocking new business models. 3. Sladdin I, Ball L, Bull C et al. (2017) Patient-centred care
2 Identifying new career opportunities that can uniquely to improve dietetic practice: an integrative review. J Hum
combine the best of humanity, society, sustainability and technol- Nutr Diet 30, 453–470.
ogy to impact health outcomes for all 4. Harding E, Wait S & Scrutton J. The state of play in
3 Creating a new value proposition for dietitians as we
person-centred care: a pragmatic review of how
leverage our nutrition domain expertise with digital literacy and a
person-centred care is defined, applied and measured,
focus on prevention
4 Learning a new language in terms of digital technologies
featuring selected key contributors and case studies
and regulation that transcends borders as technology increases across the field. Available at: http://www.healthpolicypa
our reach rtnership.com/person-centred-care (accessed October
2019).

ª 2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd 297
on behalf of British Dietetic Association.
 Personalised nutrition technologies M. Abrahams and N. V. Matusheski

5. Collins J, Ryan L & Truby H (2014) A systematic review 20. Spector T, Berry S, Valdes A et al. (2019) Integrating
of the factors associated with interest in predictive genetic metagenomic information into personalized nutrition
testing for obesity, type II diabetes and heart disease. J tools: the PREDICT I study (P20–005-19). Curr Dev Nutr
Hum Nutr Diet 27, 479–488. 3, 1763.
6. Kanter M & Desrosiers A (2019) Personalized wellness past 21. Horne J, Gilliland J, O’Connor C et al. (2019) Study
and future: will the science and technology coevolve? Nutr protocol of a pragmatic randomized controlled trial
Today 54, 174–181. incorporated into the Group Lifestyle BalanceTM program:
7. Martin CK, Nicklas T, Gunturk B et al. (2014) Measuring the nutrigenomics, overweight/obesity and weight
food intake with digital photography. J Hum Nutr Diet 27, management trial (the NOW trial). BMC Public Health 19,
72–81. 310.
8. Betts JA & Gonzalez JT (2016) Personalised nutrition: 22. Morales J, Welter D, Bowler EH et al. (2018) A
what makes you so special? Nutr Bull 41, 353–359. standardized framework for representation of ancestry data
9. Ferguson LR, Caterina RD, G€ orman U et al. (2016) Guide in genomics studies, with application to the NHGRI-EBI
and position of the international society of nutrigenetics/ GWAS Catalog. Genome Biol 19, 21.
nutrigenomics on personalised nutrition: part 1 - fields of 23. Chen J, Cade JE & Allman-Farinelli M (2015) The most
precision nutrition. J Nutrigenet Nutrigenomics 9, 12–27. popular smartphone apps for weight loss: a quality
10. Ordovas JM, Ferguson LR, Tai ES et al. (2018) assessment. JMIR mHealth uHealth 3, e104.
Personalised nutrition and health. Br Med J 361, 24. Chen J, Lieffers J, Bauman A et al. (2017) The use of
bmj.k2173. smartphone health apps and other mobile health
11. Gibney MJ & Walsh MC (2013) The future direction of (mHealth) technologies in dietetic practice: a three
personalised nutrition: my diet, my phenotype, my genes. country study. J Hum Nutr Diet 30, 439–452.
Proc Nutr Soc 72, 219–225. 25. Conroy DE, Yang C-H & Maher JP (2014) Behavior
12. Adams SH, Anthony JC, Carvajal R et al. (2019) change techniques in top-ranked mobile apps for physical
Perspective: guiding principles for the implementation of activity. Am J Prev Med 46, 649–652.
personalized nutrition approaches that benefit health and 26. Hoppe CD, Cade JE & Carter M (2017) An evaluation of
function. Adv Nutr 11, 25–34. diabetes targeted apps for Android smartphone in relation
13. Merker M, Gomes F, Stanga Z et al. (2019) Evidence- to behaviour change techniques. J Hum Nutr Diet 30, 326–
based nutrition for the malnourished, hospitalised patient: 338.
one bite at a time. Swiss Med Wkly 149, w20112. 27. Maunder K, Walton K, Williams P et al. (2018) eHealth
14. Schuetz P, Fehr R, Baechli V et al. (2019) Individualised readiness of dietitians. J Hum Nutr Diet 31, 573–583.
nutritional support in medical inpatients at nutritional 28. Abrahams M, Frewer LJ, Bryant E et al. (2019)
risk: a randomised clinical trial. Lancet 393, 2312–2321. Personalised nutrition technologies and innovations: a
15. Larsen LH, Ängquist L, Vimaleswaran KS et al. (2012) cross-national survey of registered dietitians. Public Health
Analyses of single nucleotide polymorphisms in selected Genomics 22, 119–131.
nutrient-sensitive genes in weight-regain prevention: the 29. Zhao J, Freeman B & Li M (2016) Can mobile phone apps
DIOGENES study. Am J Clin Nutr 95, 1254–1260. influence people’s health behavior change? An evidence
16. Celis-Morales C, Livingstone KM, Marsaux CF et al. review. J Med Internet Res 18, e287.
(2017) Effect of personalized nutrition on health-related 30. Topol E. The Topol review: preparing the healthcare
behaviour change: evidence from the Food4Me European workforce to deliver the digital future. Available at:
randomized controlled trial. Int J Epidemiol 46, 578–588. https://topol.hee.nhs.uk/ (accessed October 2019).
17. Doets EL, de Hoogh IM, Holthuysen N et al. (2019) 31. O’Donovan CB, Walsh MC, Nugent AP et al. (2015) Use
Beneficial effect of personalized lifestyle advice compared of metabotyping for the delivery of personalised nutrition.
to generic advice on wellbeing among Dutch seniors – an Mol Nutr Food Res 59, 377–385.
explorative study. Physiol Behav 210, 112642. 32. Abrahams M, Frewer LJ, Bryant E et al. (2018)
18. Mendes-Soares H, Raveh-Sadka T, Azulay S et al. (2019) Perceptions and experiences of early-adopting registered
Assessment of a personalized approach to predicting dietitians in integrating nutrigenomics into practice. Br
postprandial glycemic responses to food among individuals Food J 20, 763–776.
without diabetes. JAMA Netw Open 2, e188102. 33. VanBuren C, Imrhan V, Vijayagopal P et al. (2018)
19. Personalized nutrition for diabetes type 2. Available at: “Omics” education in dietetic curricula: a comparison
https://clinicaltrials.gov/ct2/show/NCT03662217 (accessed between two institutions in the USA and Mexico. Lifestyle
October 2019). Genom 11, 136–146.

298 ª 2020 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd
on behalf of British Dietetic Association.