Looking into the future of foods and health.

ABSTRACT

The health of the population is compromised by poor dietary choices. Resolving this situation will require a substantial investment at many levels of science, agriculture and food industrialisation. If such investments are undertaken they will provide the opportunity to change the food marketplace from a product centric, to a consumer centric, strategy competing to deliver health benefits to individuals.

Keywords: food; health; assessment; personalising; metabolomics food reformulation

THE NEED: HEALTH VARIATION IN THE POPULATION

The food industry has a unifying goal to deliver to the marketplace safe, convenient, affordable and delicious food products that provide consumers the means to assemble the diets that maintain and improve their health. Scientific research has built considerable basic knowledge that has been instrumental in achieving this goal. Examples of prior success abound, from the scientific discoveries of the essential nutrients to the engineering of unit operations that ensure the reliable and controlled lethality of potential food borne pathogens in food processing lines. This knowledge ensured that the population consumed foods that provided all of the essential nutrients within a normal diet and was protected from the broad range of food borne microbial pathogens in the environment. The overall success of the industrial translation of this science is illustrated by the observation that most of the Western population is now unaware of, that is, has never seen the phenotypes of diseases caused by classic deficiency diseases, iodine--goitre, vitamin C--scurvy, vitamin A--blindness, and rarely experiences food borne illness from the consumption of industrialised foods.

Consistent and sustained efforts by various health organisations at the local, federal and international levels, working with the food industry and regulatory agencies are addressing the diseases that are caused by overt, frank deficiencies of essential nutrients in the developing world (Chakravarty and Sinha 2002). Even in the developed world there remain instances whereby unusual lifestyles lead to dietary patterns that produce inadequacies of particular nutrients (Smotkin-Tangorra et al 2007; Aung et al 2006). Nonetheless, these are rare and usually recognised quickly for what they are, conspicuously unusual and inappropriate food choices. Again, by the nature of essential nutrients such deficiencies even if caused by unusual diets can be resolved simply by fortifying with appropriate vitamins and minerals (Cannell et al 2008).

Over the past several decades, as food choices and the food marketplace continued to change in response to convenience, affordability, and of course delight, food intakes began to reflect more and more these food choices based purely on preference (Moskowitz et al 2005). Consumers reacted very positively to the wide variety of choices and the diversity of apparent choices increased. Food products and the food marketplace in general have experienced a prolonged expansion of diversity. Consumers genuinely have the luxury of choice of different food products and they embrace this luxury in choosing the foods that they prefer. Dietary intakes needless to say, have become increasingly dominated by the composition of those foods that appeal to convenience, affordability and taste and flavour preference (Sebastian et al 2008).

Through the past three decades, although nutrient deficiencies have not increased, diet-related diseases have (Alberti 2001). These new health problems though related to diet are not due to deficiencies but to imbalances in overall macronutrient contents relative to the lifestyles of those consuming them. Disturbingly, imbalanced diets have apparently become widespread across the world leading to diseases including atherosclerosis, obesity, diabetes, hypertension and osteoporosis (Lopez et al 2006). Furthermore, several diseases such as cancer, inflammatory disorders, neurodegenerative diseases and autoimmunities that while not believed to be explicitly caused by diet are either accelerated or delayed depending on dietary choices implying that diet could significantly improve the global burden of these problems (Locke et al 2005).

HUMAN HEALTH STATUS

Food and nutrition research thus have a new challenge for the 21st century that parallels in many ways the challenges at the beginning of the 20th century. The devastating and widespread diseases that were epidemic in the 19th century and were caused by nutrient deficiencies were resolved during the 20th century by a massive global scientific and industrial effort extending across the entire agricultural enterprise (Backstrand 2002). The solutions for health problems caused by imbalanced diets will require a similar investment in science partnered by all aspects of agriculture and food (Daar et al 2007). A combination of research knowledge and food applications must continue to provide consumers with diets that maintain the value systems of safety, quality, stability, convenience and cost. These values are not sufficient. While we do not yet know what the solutions to the problems of poor diets and the metabolic diseases that they produce, nonetheless certain elements of the solution are already clear. Whereas the great successes of essential nutrients were achieved by viewing humans as a relatively homogeneous population, this will not be true for the next generation of diet-related diseases. Diets must also ensure that each consumer as an individual maintains optimal health within the lifestyle that they choose to pursue. This is the great challenge of diet and health, not to provide a standardised food that fits the mean of the population, but to provide the means for individuals in the population to achieve their aspirations for their own personal health. To reach this goal, science will first have to build and technologies bring to practice an actionable understanding of human health including its diversity.

Assessing human health

The biological truth is that individual humans differ in their health in many of its aspects as a result of genetics, life state, life history and all of the external influences that make up an individual's environment (Fay and German 2008). Therefore any attempt to successfully guide individuals towards a health status that supports the lifestyle that they choose for themselves and prevents the development of diseases associated with that lifestyle will require supporting diets, lifestyle, even clothing, designed to recognise and address those differences in health.

First and perhaps foremost, health itself is highly complex and cannot be defined in simple terms linked solely to disease (Lange et al 2006). For example the complexity of the interactions between diet and health are being revealed due in no small part to the catastrophic failures in metabolic regulation and health millions of people are experiencing around the world (Popkin 2006). Metabolic health can be loosely defined as the successful management of energy requirements of a particular lifestyle with appropriate energy (calorie) intakes, storage and effective mobilisation; energy efficiency, fuel partitioning and prioritisation. When successful, individuals consume precisely the calories that their lifestyle requires, store a suitable storage buffer and mobilise this storage according to acute needs. What would seem simple is clearly not. We are now experiencing a literal global pandemic of disorders due to failures of 'simple' metabolism. However, while metabolic imbalance is the central theme, ie excess caloric intake, the expression of this imbalance varies widely across the population. Some experience obesity caused by excessive intake of energy substrates (fats, carbohydrates or potentially even protein or alcohol) (Popkin 2006), others suffer type 2 diabetes apparently caused by inappropriate clearance and storage of energetic intermediates (lipids, carbohydrates) (Wang et al 2008; Schulze et al 2005), some experience premature atherosclerosis caused by a failure in the transport of energy intermediates (complex lipids) (Ordovas 2003). Hence, no intervention in metabolic health, either pharmacological or nutritional can be foreseen to be the same for all consumers.

If individuals should consume diets based on their personal health, how will they know what their health is? It will be necessary to build technologies based on measuring assessors/diagnostics that reflect each individual's health with sufficient accuracy to be actionable. This fundamental truth is already a well established fact in therapeutics in which sophisticated technologies have evolved to diagnose individuals for diseases that are a departure from normal or healthy and to design drugs to treat their specifically diagnosed diseased state. It will be necessary to develop comparable assessment approaches to diet dependent health. While this may sound overwhelming, it is not. Scientists are developing the knowledge, technologies and bioinformatic tools that will be needed (German et al 2005a; Gibney et al 2007; Schoenhagen and Nissen 2006; Lemay et al 2007; Sajda 2006).

Will consumers accept a more personal view of diet and health if it requires a more invasive assessment system? Humans are for the most part reconciled to routine diagnostics and this loss of privacy and personal control is accepted because of the fear of undiagnosed and untreated disease, by demands of medical insurance mandate and the comfort of cradle to grave familiarity with the process. However, in order for food to succeed with a science based wellness strategy, customers must first subject themselves to assessment of their basic health status. There is no obvious precedent for this in the food industry, yet there are abundant examples from other consumer sectors. Customers are prepared to accommodate to assessment for other aspects of wellness/quality of life. Examples of such assessment strategies are size measurements for apparel, weight measurements for safety devices, ability measures for athletic equipment, skin and hair assessment for cosmetics and optical calibration for eye glasses etc It is now time to take an aggressive approach to define precisely what is necessary to make individualised health a reality, and then to make it so. Also as in any other aspect of the consumer marketplace, sophisticated decisions require educated consumers. Hence education will be a central element to the development of more personalised health and the success of various solutions as consumer products.

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