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Harvard Nutritional Epidemiologist Gives Ancel Keys Memorial Lecture On Personalized Versus Public Health Nutrition

Over One Million Deaths Averted Since 2000 Because Of Improved Diets

Harvard University’s Frank Hu, Chair of the Department of Nutrition at the Chan School of Public Health, delivered the Ancel Keys Memorial Lecture at the annual meeting of the American Heart Association in Chicago late last year. In his talk, entitled “Personalized versus Public Health Nutrition in Prevention of Cardiometabolic Diseases”, Hu described an improved understanding of the role of fats and carbohydrates in cardiovascular disease risk and the changes which reflect this new understanding in the most recent dietary guidelines.

Shift to Systems Epi

Also, there has been a growing recognition of the importance of overall dietary patterns and diet quality scores in assessing mortality risk even though the role of specific dietary constituents may be unknown. According to Hu, the shift in thinking in nutritional epidemiology has given the field a bigger picture view of diet and health which now emphasizes there is more than one way to eat a healthy diet and that it is never too late to improve diet. Hu described this new thinking as a paradigm shift from a “black box epi” to a “systems epi” approach defined as “the integration of population, laboratory, analytical, and translational approaches.”

Alexa, What Should I Eat?

Speaking of laboratory advances, Hu noted the opportunities afforded by the  omics technologies which have led to the idea of “precision nutrition”. He described its goals as more precise measurements of dietary intakes and diagnostics of nutritional status as well as more accurate prediction of disease risk. The idea is to identify better nutritional intervention targets and to personalize nutritional therapy or optimal diets for each individual based on their genetics and other factors.

Many questions remain as to whether or not this approach will provide any generalizable information and be feasible in clinical practice.  Hu illustrated this uncertainty by raising the question of whether or not someday people would be asking---“Alexa, what should I eat?” Today, posing that question elicits only a suggested recipe and not  personalized dietary  advice .

Population Approach

In contrasting approaches to nutrition, Hu emphasized the health impacts that can be had by taking a more population-based approach to improving the quality of the US national diet. He reminded the audience of the obesogenic environment in much of the US. Diets of Americans score only about 50 out of 110 on a scale of diet quality, Hu reported in a recent JAMA piece cited below.  However, modest but positive changes in national diet quality since the beginning of this century have cumulatively resulted in an estimated 1.1 million fewer deaths and chronic disease cases. He cited the example of regulations that have nearly eliminated trans fats from the food supply in the US and other countries to demonstrate the crucial role nutrition policies play in creating a healthier food environment. Hu emphasized how public health approaches such as education, policy, and regulation should remain the key interventions.

Diet Histories of the Future

In light of recent criticisms targeted at the difficulties of achieving accurate diet exposure histories, Hu noted that repeated measures of food frequency questionnaires or 24-hour recalls improve accuracy. Going forward, future methods will likely require a combination of self-reported measures, biomarkers, smart phones, and sensors to achieve reliable diet exposures.

More Information

Readers interested in learning more about these trends and findings in nutritional epidemiology may read a viewpoint article on these topics by Hu and colleague Walter Willett in a recent JAMA article (Nov 27, 2018) and read a very informative interview Hu gave to Medscape after his Ancel Keys Lecture entitled “Nutrition Research: Restoring Respect to a Field Under Siege.”

https://wb.md/2Tca6RU    ■

 


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