A massive new precision nutrition study from the National Institutes of Health will give some volunteers controlled meals, like this one, prepared by a nutritionist in the agency’s metabolic research kitchen.

National Institute for Diabetes and Digestive and Kidney Diseases

By Jocelyn KaiserFeb. 1, 2021, 3:20 pm

There is no one-size-fits-all diet. If you want to avoid raising your blood sugar with a snack, a banana might be a better choice than a sugary cookie. In a 2015 study of 800 Israeli volunteers, some people got their highest blood sugar levels from bananas or bread instead of sugary baked goods. And as nutritionist Elizabeth Parks of the University of Missouri, Columbia notes, “We all know people who lose weight easily and others who don’t.”

Now the US National Institutes of Health (NIH) is trying to understand these individual differences. Last week, the agency announced the largest study ever to study “precision nutrition,” a 5-year study worth $ 156 million to look at how 10,000 Americans process food by collecting data ranging from continuous blood sugar levels to microbes in a person’s gut.

The study “has the potential to truly transform the field of nutritional science” and generate new tools, methodologies, and “a wealth of data to advance discovery science for years to come,” said Griffin Rodgers, director of the National Institute for Diabetes and Digestion and Kidney Disease (NIDDK) said at an NIH board meeting last year where he introduced the project. Ultimately, it could enable nutritionists to tailor diets to an individual’s genes and microbiome.

And it’s part of a broader drive at the NIH to boost nutritional science, an area that is sometimes viewed as “fuzzy” because “we’re free range eaters” and our diets are difficult to control, notes Paul Coates, vice president of the American Society for Nutrition who headed the NIH Dietary Supplements Office until he retired in 2018.

In May 2020, NIH Director Francis Collins released the Agency for Nutritional Science’s first 10-year strategic plan recognizing the importance of diet in chronic diseases such as heart disease and diabetes. The plan aims to incorporate fundamental disciplines like neurobiology, study the role of nutrition across the lifespan, consider how food can serve as medicine, and improve precision nutrition. The concept recognizes that the human body’s response to food depends on factors ranging from genetics to sleeping habits, social environment, and gut microbes. For example, the Israeli study, which found individual differences in response to refined sugar versus fruit, showed that the microbiome was largely responsible.

Now comes NIH’s Nutrition for Precision Health, powered by All of Us, the agency’s extensive genomics and health study that fully participated in 272,000 out of a planned 1 million participants, more than 50% from minority groups. “We realized it was a really good fit,” says Holly Nicastro, study coordinator and program director at the NIH’s Nutrition Office, to leverage All of Us’s data and infrastructure.

Around 10,000 All of Us participants taking part in the nutritional study wear various monitors to track physical activity, blood sugar, and more. write down what they eat; and visit a clinic to have a specific meal and undergo clinical tests. A subgroup of up to 1500 will also follow three different diets at home or in the clinic and then do the same tests. And 500 to 1000 volunteers will live in a clinical center for three weeks while eating three strictly controlled diets. Such “feeding” studies are the gold standard in the field, but their high cost usually keeps them small. NIH recently did a few at its clinical center, looking at things like the effects of ultra-processed foods, but only involved 20 people.

By collecting a variety of personal data, from participants’ DNA composition to their zip code, “we remove a lot of the ‘noise’ we’ve had for years and that was caused by factors we didn’t measure before” says Tufts University nutritionist José Ordovás hosted a workshop with Parks last month to discuss the study. Artificial intelligence researchers will then use the collected data to create models that predict the best diet for a person – an effort fueled by the Israeli study that spawned a company that developed an algorithm to calibrate diets adapt for people who are diabetic or trying to lose weight. A second 5-year phase could test these models in clinical studies.

The NIH is now inviting proposals for study components such as a data center, clinical centers, and a microbiome center. The aim is to take on volunteers from January 2023. “The study is so exciting,” says Parks.

You and other nutritionists also welcome other signals of NIH’s new focus on nutrition. The Office of Nutrition Research, once part of the NIH director, was demoted to the NIDDK years ago. Last month, Collins announced that it was being restored. Coates hopes this will mean more staff – the office now has just six employees – and a modest budget to fund studies with NIH institutes. “A lot of [of nutrition science] falls between the cracks, ”he says – gaps that he now hopes will close.