Personalized Nutrition Principles and Applications - 1st

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Chapter 10 Taste as the Gatekeeper of Personalized Nutrition .........................115

Toshiko Tanaka, Danielle R. Reed, and Jose M. Ordovas

Chapter 11 Personalized Nutrition and Public Health .......................................133

Pieter van’t Veer, Edith J.M. Feskens, and Ellen Kampman

Section II
Personalized Nutrition and Stakeholders in Society........................................149

Chapter 12 Imminent Applications of Nutrigenomics:

A Stakeholder Analysis....................................................................151
J.T. Winkler

Chapter 13 The Personal Factor in Nutrition Communication ..........................169

Laura I. Bouwman, Maria A. Koelen, and Gerrit J. Hiddink

Chapter 14 A Marketing and Consumer Behavior Perspective

on Personalized Nutrition ................................................................185
Hans C.M. van Trijp and Amber Ronteltap

Chapter 15 U.S. Consumer Attitudes toward Personalized Nutrition................205

David B. Schmidt, Christy White, Wendy Reinhardt Kapsak, Josh Conway,
and Elizabeth Baily

Chapter 16 Ethics of Personalized Nutrition......................................................221

Michiel Korthals

Section III
The Future of Personalized Nutrition ...............................................................235

Chapter 17 International Efforts on Nutrigenomic Health

for Individuals in the Global Community .......................................237
Jim Kaput

Chapter 18 The Future of Foods ........................................................................261

Heribert J. Watzke and J. Bruce German

Index ......................................................................................................................279
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Foreword
PERSONALIZED NUTRITION: HISTORY
AND PROMISES?
Personalized nutrition is an emerging but controversial new discipline among nutri-
tion scientists. Due to its possible genetic component, it has become an attractive
topic for the media. So far, the “science fiction” stories of a lady doing food shopping,
guided by a PDA containing her genome information are not taken very seriously.
Of course, in the developed world, personalized food choice is taken for granted.
Did you realize that while ordering Italian three-taste gelato, you can choose from
over a million combinations and variations, if you consider tastes, sizes, toppings,
and packaging? The same is true for coffee or take-away pizzas.
In the context of this book, personalized nutrition is related to a differentiated
health effect, with the key questions targeted at the possible scientific basis for this
phenomenon. In order to put this in the right perspective, let us have a look at the
historical development of the diet and health relationship. Until the early twentieth
century, nutritional sciences dealt with hygiene and processing. This was followed
by the incorporation of biochemistry and (molecular) physiology: the vitamins were
described, energy metabolism was understood, etc. During the second half of the
twentieth century, knowledge of cellular and molecular biological processes allowed
for further optimizing of our diet toward a balanced macro- and micronutrient
composition. This contributed to a prolongation of life span and produced a com-
mercial wave of supplements.
Gradually, nutrition scientists indicated the involvement of diet in a large number
of diseases and disorders (e.g., colon cancer, cardiovascular disorders, type 2 diabetes
mellitus, a number of inflammation-related health problems, and many more. During
the 1990s, this development triggered the introduction of functional foods, dietary
components with “added health value.” So far, these functional foods, apart from
the aforementioned supplements (vitamins, cofactors, minerals, and so forth, which
I do not consider to be real functional foods), have resulted in only a limited number
of successful products (cholesterol-lowering stanols, probiotics, a number of specific
fatty acids). Except for the cholesterol-lowering products, where an established
biomarker (the relationship between CVD and HDL/LDL cholesterol) was estab-
lished by the biomedical research community, it was very difficult to obtain scientific
proof of efficacy for most other functional foods. In many cases, the advertisement
and PR efforts by far outreached the scientific efforts accompanying the market
introduction.
Why does nutrition science have such a hard job in providing evidence for health
claims related to a dietary component? In pharmacological and biomedical research,
bioactive compounds are developed to treat a well-characterized disease. In contrast,
nutrition deals with prevention of disease and optimizing health. Here, biomarkers
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quantifying the health status are essentially missing, and much of the nutrition
research (the large observational and intervention cohorts) rely on disease endpoints
instead of health endpoints. Also in the “gold standard” of diet and health research,
the (cross-over) dietary intervention trial, the quantification of the effect is a major
issue. Usually, the observed effects are small, and great efforts have to be made to
unravel the intervention effect from potential confounding variables. In other words,
the confounding parameters have a larger impact than the intervention effects. The
recent omics-related observations in human intervention studies, using very accurate
biomarkers, confirm that intraindividual variation is much smaller than interindividual
variation. Differences between study subjects may be much larger than differences
affected by the dietary treatment.
The keys for personalized nutrition actually are these “confounders” that make
the life of nutrition scientists so difficult. Age, gender, lifestyle (e.g., exercise),
phenotype (e.g., body mass index), genetic makeup, and epi-genomic imprinting —
all possibly determine our nutritional needs, the way we respond to nutrition, and
thus our “personal diet-and-health relationship.” Infant nutrition clearly differs from
a sports diet. Now, a triad of questions arise:

1. To what extent is this personal diet-and-health relationship practically

valid?
2. How can nutrition science demonstrate this?
3. What is the proposition of stakeholders in society, including the con-
sumer?

This book at least attempts to answer these questions. My personal opinion is that
indeed this relationship exists to a much greater extent than assumed until now, and
that nutrition science will need to do a much better job in accurately identifying and
quantifying the subtle differences in health status related to dietary treatment. A
complete merger of nutrition with a number of fundamental scientific disciplines
(molecular biology, biochemistry, bioinformatics, statistics, etc.) will be essential to
reach the goal.
Now, what about this specific and overemphasized part of personalized nutrition,
the impact of genetic differences? Of course, we know the examples of cholesterol
and folate, where genetic predisposition partly determines plasma concentration and
related health effects. In the case of cholesterol, a phenotypic assessment of LDL
and HDL provides a solid phenotypic biomarker, which makes genetic testing (at
least partly) unnecessary. In fact, this phenotypic readout is the gross result of at
least 20 genetic different makeups. The HDL/LDL relationship partly determines
biomedical intervention and the consumer’s food choice. In the case of folate, the
occurrence of a genetic polymorphism in one of the enzymes involved in folate
biotransformation results in a relatively low plasma folate concentration. In extreme
cases, this leads to embryonic deformation (spina bifida) due to impaired DNA
synthesis. Folate is essential for DNA synthesis as it provides the methyl group for
nucleotide synthesis. Folate is cheap, and some countries have turned to folate
supplementation to the general population (e.g., by fortification of bread). In other
words, a genetically based differential dietary advice is overruled by mass treatment.
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Possible negative consequences in persons efficiently dealing with folate (high folate
levels have been shown to overmethylate DNA and are thus potentially mutagenic
and carcinogenic) were considered nonrelevant. Time will tell whether a personalized
approach would be better.
A number of disorders related to nutrition are packed with genetic variation, but
the effect of nutritional modulation of the phenotypic outcome of these variations
is difficult to assess as yet. Nutrition is the worst-case scenario for this approach in
science as multiple minor genetic differences can occur, possibly modulated by
multiple food bioactives, usually with low receptor affinity, and resulting in multiple
minor changes in gene expression and resulting phenotypic expression.
Eventually, nutrition science may very likely determine a large number of per-
sonalized nutrition and health relationships. However, this is only a small part of
the equation. Food consumption nowadays is only partially driven by health con-
cerns. It is still much more driven by convenience and price. “Food is pleasure”
rightfully is a universally held credo, and science will have a hard job in promoting
healthy diet if this aspect is compromised. Therefore, a personalized diet needs to
be both optimized toward personal health and also for personal convenience, plea-
sure, and affordability. What a challenge!

Ben van Ommen

Senior Research Fellow, Nutritional Systems Biology
Director, European Nutrigenomics Organisation (NuGO)/TNO Quality of Life
Zeist, The Netherlands
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Preface
The primary role of diet is to provide an individual with optimal levels of nutrients
to meet metabolic requirements, and to give the consumer a feeling of satisfaction
and well being through the pleasure of eating. In addition, particular diets, foods
and food components can provide additional physiological, cognitive and psycho-
logical benefits, and result in biological activities beyond their widely accepted
nutritional effects. Moreover, diet not only helps to achieve and maintain optimal
health and development but can also play an important role in reducing the risk of
specific diseases and disorders.
However, a diet that serves the health of one individual does not necessarily
work for all individuals due to differences in (genetic) predisposition, and environ-
mental and lifestyle factors. Hence, diagnostic tools that reflect both the overall
health status and (genetic) predisposition of a particular person at a given time need
to be developed. The knowledge obtained thereby will facilitate appropriate nutri-
tional advice to individuals according to their immediate and long-term health needs
and, ultimately, we can foresee the time when nutritional products will be tailored
for individual consumers.
The success of the introduction of personalized nutrition in society depends on many
factors. The scientific background for this must be established, the regulatory system
must be in place, ethical issues need to be addressed, services and products with clear
health benefits must be available, and the accompanying communication must be clear.
This textbook has the aim of defining the area of personalized nutrition both
from a biomedical and social science perspective. A selected group of leading
scientists in the field will comprehensively address the molecular, physiological,
epidemiologic, and public health aspects of personalized nutrition, highlighted with
examples from major diseases. Another group of well-known social scientists will
discuss the behavioral, ethical, and consumer perspectives that will influence a
legitimate successful introduction of personalized nutrition.
We expect our book will be useful for the education of students in several
disciplines, for example, nutrition, behavioral and communication science. More-
over, stakeholders involved in personalized nutrition in government, health care, and
business may use the book as a reference guide.
Our book is divided in three sections: (1) Scientific Principles of Personalized
Nutrition, (2) Personalized Nutrition: Consumer and Society, and (3) Future Per-
spectives on Personalized Nutrition.
In the first section, Scientific Principles of Personalized Nutrition, the state of
the art of nutrigenomics technologies, including transcriptomics, proteomics, and
metabolomics, are discussed. Subsequently, the use of genomics technology for a
better understanding of the molecular mechanisms involved in major diet-related
chronic disorders — i.e., chronic inflammation, cardiovascular disease, type 2
diabetes, cancer, and obesity — is addressed.
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Next, the consequences of metabolic programming during pregnancy and the

potential of new molecular biomarkers, as well as the gatekeeper role of taste in
personalized nutrition, are covered. In the last chapter in this section, the epidemi-
ologic aspects of genomic testing and the health benefits for the individual vs. the
population are described.
Besides providing the most recent knowledge, all authors discuss opportunities
and pitfalls of nutrigenomics in the development of personalized nutrition.
The second section, Personalized Nutrition: Consumer and Society, starts with
a stakeholder analysis in which five interest groups (scientists, food companies,
consumers, competitive athletes, and health-care providers) are compared regarding
their practices and opinions of personalized nutrition. Based on behavioral change
strategies, the next chapter is focusing on whether and how personalized nutrition
will contribute to a healthier dietary pattern.
Two chapters specifically target the consumer perspective. The first reviews the
marketing potential of personalized nutrition; in the second, consumer attitudes are
discussed. The section is completed with a contribution on ethical issues related to
personalized advice on diet and health and the customization of food products.
In the final section, Future Perspectives on Personalized Nutrition, the challenges
of nutrigenomics research and its applications are presented in two chapters. One
chapter focuses on the need to address the humanitarian issues related to developing
countries and issues a call for international efforts to develop best practices, fostering
international collaborations and sharing data sets. The final chapter provides an
outlook of personalized nutrition in the context of ongoing innovations in food
technology, nutrigenomics, and food delivery systems.
We sincerely hope that you enjoy reading this guide to a scientific underpinning
of personalized nutrition.

Frans J. Kok
Laura Bouwman
Frank Desiere
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The Editors
Frans J. Kok PhD, is full professor of nutrition and health and head of the Division
of Human Nutrition at Wageningen University, The Netherlands. Moreover, as dean of
Wageningen Graduate Schools, he is responsible for securing the quality of academic
research and training at the university.
Dr. Kok was trained in human nutrition at Wageningen University and in epi-
demiology at Harvard University, Cambridge, Massachusetts. His scientific expertise
covers topics such as energy balance and body composition, diet in disease preven-
tion, and sensory science. He has authored more than 250 original scientific publi-
cations and is a member of the Dutch Health Council and the Academic Board of
Wageningen University. As a faculty member, he has lectured in many courses on
nutrition and health, including the European Nutrition Leadership Program, as well
as in courses in the U.S., Africa, and Asia.

Laura Bouwman is a PhD researcher in the department of communication science at

Wageningen University. Her research is focused on whether and how innovations in
personalized nutrition can be used for the development of more effective nutrition inter-
ventions. Two topics are central: 1) how stakeholders in science, healthcare, health
education, government, and industry perceive their roles and responsibilities in the inno-
vation process, and 2) the representation of personal factors in food choice, with emphasis
on the representation of genetic background. Laura is involved in the development of
communication activities for diverse stakeholder-groups regarding personalized nutrition
in the European Nutrigenomics Organisation. Before her current PhD research, Laura
worked for six years at a communication bureau for the oils and fats industry.

Frank Desiere, PhD, MBA, started his scientific career in the earlier days of biotech-
nology doing research in fermentation technology, microbiology, and biological conver-
sion of xenobiotics, and later joined the Nestlé Research Center in Lausanne, Switzerland,
to work on the ecology and evolution of bacteriophages in milk fermentation. Later, he
initiated a bioinformatics effort at Nestlé and worked on microbial genomics, transcrip-
tomics, and proteomics. Dr. Desiere also initiated Peptideatlas (www.peptideatlas.org)
for the integration of proteomics data with human and other genomes. He was then
responsible for a project involving personalized nutrition at Nestlé that initiated consumer
and patient applications of personalized nutrition concepts in the marketplace. As a result
of this initiative, his interests evolved into the commercial application of scientific con-
cepts in science and nutrition, management of innovation and new business ideas. After
having completed an MBA at IMD Lausanne, Dr. Desiere now works as business
development manager at Roche Diagnostics in Basel, Switzerland. His scientific activities
have resulted in more than 30 peer-reviewed publications and numerous presentations
at international scientific conferences.
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Contributors
Lydia A. Afman Hannelore Daniel
Nutrition, Metabolism, and Genomics Molecular Nutrition Unit
Division of Human Nutrition Center of Life and Food Sciences
Wageningen University Technical University of Munich
Wageningen Freising-Weihenstephan
The Netherlands Germany

Elizabeth Baily Aldona Dembinska-Kieć

International Food Information Council Department of Clinical Biochemistry
Washington, D.C. Jagiellonian University
Medical College
Laura I. Bouwman Krakow
Wageningen University Poland
Sub-Department of Communication
Science, Communication
Management Group Lynnette R. Ferguson
Wageningen Discipline of Nutrition
The Netherlands University of Auckland
Grafton, Auckland
New Zealand
Lorraine Brennan
UCD School of Biomolecular
and Biomedical Science Edith J.M. Feskens
UCD Conway Institute Division of Human Nutrition
University College Wageningen University
Dublin Wageningen
Ireland The Netherlands

Josh Conway
Cogent Research, LLC J. Bruce German
Cambridge, Massachusetts University of California–Davis
Davis, California
Dolores Corella
Department of Preventive Medicine Michael J. Gibney
University of Valencia UCD Agriculture and Food Science
Genetic and Molecular Epidemiology Centre
Unit University College
Valencia Dublin
Spain Ireland
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Gerrit J. Hiddink Simon C. Langley-Evans

Wageningen University University of Nottingham
Sub-Department of Communication School of Biosciences
Science, Communication Sutton Bonington, Loughborough
Management Group United Kingdom
Wageningen
The Netherlands John C. Mathers
Human Nutrition Research Centre,
School of Clinical Medical Sciences
Hans-Georg Joost University of Newcastle
German Institute of Human Nutrition Newcastle-on-Tyne
Potsdam-Rehbruecke United Kingdom
Nuthetal
Germany Michael Müller
Nutrition, Metabolism, and Genomics
Division of Human Nutrition
Ellen Kampman
Wageningen University
Division of Human Nutrition
Wageningen
Wageningen University
The Netherlands
Wageningen
The Netherlands Jose M. Ordovas
Nutrition and Genomics Laboratory
Wendy Reinhardt Kapsak Jean Meyer USDA Human Nutrition
International Food Information Council Research Center on Aging
Washington, D.C. Tufts University
Boston, Massachusetts

Jim Kaput Martin Philpott

Laboratory of Nutrigenomic Medicine Discipline of Nutrition
Department of Surgery University of Auckland
University of Illinois Chicago Grafton, Auckland
Chicago, Illinois New Zealand

Danielle R. Reed
Maria A. Koelen Monell Chemical Senses Center
Wageningen University Philadelphia, Pennsylvania
Sub-Department of Communication
Science, Communication Manuela Rist
and Innovation Group Molecular Nutrition Unit
Wageningen Technical University of Munich
The Netherlands Freising-Weihenstephan
Germany
Michiel Korthals Amber Ronteltap
Applied Philosophy Marketing and Consumer Behavior
Social Sciences Group
Wageningen University Wageningen University
Wageningen Wageningen
The Netherlands The Netherlands
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David B. Schmidt Marianne Walsh

International Food Information Council UCD Agriculture and Food Science
Washington, D.C. Centre
University College
Toshiko Tanaka Dublin
Nutrition and Genomics Laboratory Ireland
Jean Mayer USDA Human Nutrition
Research Center on Aging
Tufts University Heribert J. Watzke
Boston, Massachusetts Nestlé Research Centre
Lausanne
Hans C.M. van Trijp Switzerland
Marketing and Consumer Behavior
Group
Wageningen University Christy White
Wageningen Cogent Research, LLC
The Netherlands Cambridge, Massachusetts

Pieter van’t Veer

Division of Human Nutrition J. T. Winkler
Wageningen University London Metropolitan University
Wageningen London
The Netherlands United Kingdom
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