Nowadays, the rapid development of science and technology is felt in various sectors, including nutrition and health. The concept of a medical paradigm through a predictive, preventive, personal, and participatory approach can manage and support a specific health status for individuals. Personalized nutrition is a basic concept that shows everyone has a different metabolism, genetics, biochemistry, and microbiota that contribute to the body’s response to nutritional intake. Therefore, the concept of personalized nutrition applies multidisciplinary, such as nutrition, medicine, biology, epigenetics, and genomics to demonstrate the relationship of individual variation to a disease risk.

Nutrigenetics and nutrigenomics play an important role in genetically based nutrition recommendations or personalized nutrition. Individuals have different genetic variations that can affect the body’s response to nutrients. Nutrigenetics describes the interaction of genetic variation with the environment, including the nutrients contained in food. While nutrigenomics consider the impact of nutrient intake (macronutrients, micronutrients, and bioactives) on gene expression, where nutrients can activate or silence certain genes. Thus, nutrigenetics plays a role in providing an overview of the individual’s response to the environment and nutrigenomics will provide appropriate dietary recommendations.

One example of the application of nutrigenetic to describe the interaction of genes and nutrients is the activity of methylene-tetra-hydro folate reductase (MTHFR) enzyme. MTHFR enzyme involved in folic acid metabolism and maintenance of homocysteine ​​levels. A particular MTHFR gene SNP (C677T and A 1298C) were associated with an increase in blood homocysteine ​​levels, especially in conditions of deficiency folic acid intake. In addition, individuals with low MTHFR enzyme activity are usually accompanied by elevated homocysteine ​​levels, which have been associated with inflammation and heart disease, difficulty conceiving, birth defects, and potentially impaired detoxification abilities. For this reason, intake of micronutrients including folic acid, vitamin B6, and B12 is very important to maintain homocysteine ​​levels.

Based on nutrigenomics, an example of nutritional intake that affects gene expression can be known through phenylketonuria disease. Phenylketonuria or PKU is an inherited metabolic disorder caused by mutations in a single gene, thus patients should avoid foods containing the amino acid phenylalanine. High levels of phenylalanine in the body can interfere with brain function, mental retardation, and seizures.

Currently, research in nutrigenetics and nutrigenomics related to the prevention and treatment of diseases is increasing, including chronic diseases such as obesity, type 2 diabetes mellitus, cancer, and cardiovascular disease. Personalized nutrition is certainly useful for a nutritionist or dietitian in providing appropriate nutritional recommendations according to the genetic characteristics of individuals. By knowing the role of nutrigenetics and nutrigenomics in personalizing nutrition, hoped this knowledge will develop as the basic concept to provide nutritional recommendations.

Archibald, A. and Joffe, Y., 2021. The Role of Nutrigenetics and Nutrigenomics in Clinical Nutrition Practice. ADCES in Practice, 9(2), pp.34-40. 

Bush, C.L., Blumberg, J.B., El-Sohemy, A., Minich, D.M., Ordovás, J.M., Reed, D.G. and Behm, V.A.Y., 2020. Toward the definition of personalized nutrition: a proposal by the American Nutrition Association. Journal of the American College of Nutrition, 39(1), pp.5-15.

Di Renzo, L., Gualtieri, P., Romano, L., Marrone, G., Noce, A., Pujia, A., Perrone, M.A., Aiello, V., Colica, C. and De Lorenzo, A., 2019. Role of personalized nutrition in chronic-degenerative diseases. Nutrients, 11(8), p.1707. 

Marcum, J.A., 2020. Nutrigenetics/nutrigenomics, personalized nutrition, and precision healthcare. Current nutrition reports, 9(4), pp.338-345.

Sharma, P. and Dwivedi, S., 2017. Nutrigenomics and nutrigenetics: new insight in disease prevention and cure. Indian Journal of Clinical Biochemistry, 32(4), pp.371-373.

Uthpala, T.G.G., Fernando, H.N., Thibbotuwawa, A. and Jayasinghe, M., 2020. Importance of nutrigenomics and nutrigenetics in food Science. MOJ Food Processing & Technology, 8(3), pp.114-119.

Recently people are familiar and connected with the science and technology development especially in the health area. In health area, technology has been widely used in such areas as communication, education, and health management. Besides that, technology has also been widely used for diet management, food nutrition database, and anthropometrics measurements. Technological applications in the field of nutrition have now entered a “genomic era” that relates to the development of nutrigenetic. Nutrigenetic is science that studies the interaction between the genetic impact and nutrition in specific individuals. The relationship between genes and individual nutrition intake is specifically known by the term personalized nutrition. The term has broken the old approach called “one size fit all” which means the nutritional needs are united for everyone.

Based on the concept of the personalized nutrition, each individual has a unique gene in its own to adapt to nutrition intake, environment, and risk of illness. The genetic factors of each individual are also linked to physical activity, health status, and eating habits. Today, the personalized nutrition is thriving because it has the benefit of predicting the prevention of certain infectious diseases or malnutrition through a genetic approach. The personalized nutrition can also contribute to the continuation of dietary plans. Application of genetic examination of nutrition can be performed in both vulnerable individuals (such as the elderly and pregnant mothers) as well as in healthy groups of individuals who wish to prevent disease and promote health status. The samples used for genetic screening can be biological samples such as blood and saliva.

One example of a widely studied personalized nutrition application is at the risk of obesity. According to some studies, single nucleotide polymorphism (SNPS) represents a genetic variant commonly used to predict diet interactions related to obesity. The study included a personalized nutrition application for the prevention of non-communicable diseases. The interaction of SNPS and diet can be seen at table 1.

Table 1. SNPS and diet interactions

Source: Ramos-lopez and martinez (2020)

Despite its many benefits, the utilization of nutrigenetic for the personalized nutrition in Indonesia is still quite expensive today. Additionally, it requires much further research on the scale of laboratories, clinical trials, and populations. However, it is not expected that this does not hinder the potential for development and utilization of the long-term development of health-care technology in Indonesia.

References

Aji, A. S. 2020. Personalized Functional Foods: Masa Depan Penerapan Personalized Nutrition Advice. Prosiding Seminar Nasional Online: Peran Pangan Fungsional dan Nutraseutikal dalam Meningkatkan Sistem Imun Mencegah Covid – 19, Juni 2020, Bogor, pp. 303 – 310.

Caradonna, F. et al. 2020. Science and Healthy Meals in the World: Nutritional Epigenomics and Nutrigenetics of the Mediterranean Diet. Nutrients. Multidisciplinary Digital Publishing Institute, 12(6), pp. 1–23.

Freitag L. M., H. 2021. Mengenal Konsep Personalized Nutrition [Internet]. Tersedia dalam: <https://gizigama.com/2021/12/13/mengenal-konsep-personalized-nutrition/> [Diakses 6 Maret 2022]

Jayasinghe, M. 2020. Importance of Nutrigenomics and Nutrigenetics in Food Science. MOJ Food Process Technols, 8(3), pp. 114–119.

Ordovas, J. M. et al. 2018. Personalized  Nutrition and Health. BMJ (Online). BMJ Publishing Group, 361, pp. 1–7.

Prasanti, D. dan Fuady, I. 2018. Pemanfaatan Media Komunikasi Dalam Penyebaran Informasi Kesehatan Kepada Masyarakat. Reformasi, 8(1), pp. 8–14.

Ramos-lopez, O. and Martinez, J. A. 2020. Nutrigenetic Approaches in Obesity and Weight loss in Precision Medicine for Investigators, Practitioners and Providers. Elsevier Inc., pp. 409–415.

Rankin, A. et al. 2018. Food Choice Motives, Attitude Towards and Intention to Adopt Personalized  Nutrition. Public Health Nutrition. Cambridge University Press, 21(14), pp. 2606–2616.

Sugar-sweetened beverages (SSB) are any type of drinks that are sweetened with added sugars, such as brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, lactose, malt syrup, maltose, raw sugar, and sucrose (1,6). This includes, but are not limited to, regular soda, fruit drinks, sports drinks, energy drinks, sweetened waters, also coffee and tea beverages with added sugars (1). SSB usually contains high calories but it will not make you feel as full as if you had eaten the same calories from solid food. There is a research (2) that explained about sugar content of SSB per serving of product in Indonesia by sampling 91 SSB products from a popular convenience store. On an average, the amount of sugar per serving was 22.8 g or 86.3 g/1000 ml. Sugar in sports drinks had the highest contribution to energy of products (93.33%).

Many researches have explained consuming SSB frequently is associated with weight gain or obesity, type 2 diabetes, heart disease, kidney diseases, non-alcoholic liver disease, tooth decay, cavities, and gout (3,4,5,7). People who consume sugary drinks regularly—1 to 2 cans a day or more—have a 26% greater risk of developing type 2 diabetes than people who rarely have such drinks (3). A study that tracked the health of nearly 90,000 women over two decades, found that women who drank more than two servings of sugary beverage each day had 40% higher risk of heart attacks or death from heart disease than women who rarely drank sugary beverages (5). A study of 33,097 individuals showed that among people with a genetic predisposition for obesity, those who drank sugary drinks were more likely to be obese than those who did not (4). This study is important because it suggests genetic risk for obesity does not need to become a reality if healthy habits, like avoiding sugary drinks, are followed.

Indonesian Health Ministry recommends that daily sugar intake does not exceed 50 grams or 4 tablespoons. In fact, based on previous research mentioned (2), the content of sugar alone in carbonated beverages per serving has reached 33.6 grams or 67.2% of the daily intake. It means that only 32.8% of sugar could be obtained from other foods. Another example is that ice cream contains 22 g sugar per serving or 44% of daily intake. Therefore, it is necessary for consumer to read nutrition label before purchasing the product.

 Knowing the bad effects of consuming SSB, plain water is always the best option to choose or beverages with few or no calories. If you are willing to contribute to society, asking schools or workplaces to provide filtered water or water fountain is a good move. You can also help yourself by not stocking soda, fruit punch, or other sugary drinks in the house and making them an occasional treat rather than a daily beverage.

1. CDC (2021). Get the Facts: Sugar-Sweetened Beverages and Consumption. [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html [Accessed 26 Feb. 2022].
2. Haning, Mohamad Thahir & Arundhana, Andi Imam & Muqni, Asry. (2016). The government policy related to sugar-sweetened beverages in Indonesia. Indian Journal of Community Health. 28. 222-227.
3. Malik VS, Hu FB. Sugar-sweetened beverages and cardiometabolic health: An update of the evidence. Nutrients. 2019;11(8):1840.
4. Qi Q, Chu AY, Kang JH, Jensen MK, Curhan GC, Pasquale LR, Ridker PM, Hunter DJ, Willett WC, Rimm EB, Chasman DI. Sugar-sweetened beverages and genetic risk of obesity. New England Journal of Medicine. 2012 Oct 11;367(15):1387-96.
5. Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, Hu FB. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA. 2004 Aug 25;292(8):927-34.
6. The Nutrition Source. (2013). Sugary Drinks. [online] Available at: https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-drinks/ [Accessed 26 Feb. 2022].
7. Valenzuela MJ, Waterhouse B, Aggarwal VR, Bloor K, Doran T. Effect of sugar-sweetened beverages on oral health: a systematic review and meta-analysis. Eur J Public Health. 2020.

The case of the Omicron variant of COVID-19 is still the main case in Indonesia. On February 19, 2022, known daily cases reached 59.384, higher than last year’s peak of Delta’s daily cases of 56.757. However, the Ministry of Health stated that there was a decrease in daily confirmed cases of 10.900 on February 20 from the previous day, and active cases slowed slightly with the addition of 15.448 per day. Nevertheless, the government continues to make efforts to prevent the COVID-19 pandemic by increasing the complete vaccination program and booster doses. If someone has received the second dose within a minimum period of six months, it is strongly recommended to get a booster vaccination (Kemenkes, 2022). Several studies have shown that booster vaccines are considered to be more effective in preventing transmission of the Omicron variant of COVID-19 than the Delta variant (Omer and Malani, 2022).

In an attempt to increase the body’s immunity and prevent the current transmission of COVID-19, supplementation of vitamins A, C, E, and B complex is very important. Vitamin A has a role in protecting the body against infection by maintaining healthy tissue and skin surfaces in the mouth, stomach, intestines, and respiratory system. Adequate intake of vitamin A can be obtained from the consumption of carrots, broccoli, spinach, cassava leaves, sweet potatoes and several other foods fortified with vitamin A (Kemenkes, 2020).

Vitamin C is a nutrient that cannot be synthesized by the body, so vitamin C intake is very necessary. Vitamin C can act as an anti-inflammatory that can prevent oxidative stress so that it can boost the immune system (Shakoor et al., 2021). In supporting the immune system, vitamins also play a role in increasing the chemotaxis and phagocytic ability of neutrophils, increasing macrophage activity, and supporting the proliferation of neutrophils, monocytes, and phagocytes (Febriana, 2021). Consumption of vitamin C supplements in a day is recommended at a dose of 500-1000 mg in 1-2 times, considering the upper limit of tolerance for vitamin C intake should not exceed 2000 mg per day (Ahmed et al., 2022). While in foods rich in vitamin C, it can be found in fruits such as guava, papaya, oranges, tomatoes, strawberries, and kiwi.

Vitamin E has an immunomodulatory effect on cells of innate and adaptive immunity. Vitamin E is able to increase T cell production, increase NK cell activity, increase IL-2 cytokine secretion, increase lymphocyte response, and reduce the risk of infection (Shakoor et al., 2021). Based on several existing literature sources, vitamin E supplementation can improve the immune system and reduce the risk of infection due to some viruses and bacteria. Food sources that contain vitamin E include green vegetables and beans.

Vitamin B1 or thiamin can reduce mortality in sepsis patients in COVID-19 patients. Inadequate intake of vitamin B1 can induce an inflammatory response that can result in nerve cell death. Vitamins B2 and B3 may play a role in reducing proinflammatory cytokines. Vitamins B6, B9, and B12 are able to support the activation of cytotoxic T cells and NK cells to support immune function (Febriana, 2021). Vitamin B6 in the diet can be found in cereals, fish, chicken, meat, beans, and green leafy vegetables.

Most natural sources of vitamins are found in a variety of foods. Therefore, consuming a balanced diet as recommended by the Ministry of Health with the “Isi Piringku” principle can help meet vitamin intake. Fulfillment of sufficient vitamins during the COVID-19 pandemic is very important to prevent disease transmission.

1. Ahmed, A. et al. (2022) The Combination of Quercetin and Bromelain with Zinc, EGCG, Retinoic Acid, Vitamin C and Vitamin D for the potential Symptom Reducer, Prevention, and Treatment for Coronavirus Disease 2019 (COVID-19).
2. Febriana, L. (2021) ‘Potensi Suplemen dalam Tatalaksana COVID-19’, Continuing Medical Education, 48(2), pp. 93–96.
3. Kemenkes (2020) ‘Panduan Gizi Seimbang pada Masa Pandemi COVID-19’. Kementerian Kesehatan RI.
4. Kemenkes (2022) Kasus Konfirmasi COVID-19 Menurun Signifikan, Pemerintah Terus Mengimbau Disiplin Prokes dan Vaksinasi, Kementerian Kesehatan RI. Available at: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20220220/2839361/kasus-konfirmasi-covid-19-menurun-signifikan-pemerintah-terus-mengimbau-disiplin-prokes-dan-vaksinasi/ (Accessed: 20 February 2022).
5. Omer, S. B. and Malani, P. N. (2022) ‘Booster Vaccination to Prevent COVID-19 in the Era of Omicron’, Journal of The American Medical Association, 327(7), pp. 628–629.
6. Shakoor, H. et al. (2021) ‘Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19?’, Maturitas, 143, pp. 1–9.

COVID-19 daily cases in Indonesia will continue to climb due to the omicron variant’s transmission, approaching the delta variant’s peak in mid-2021. The daily adding positive confirmation of 55,209 cases on February 13, 2022. According to WHO (2022), the omicron variant has higher infection rates but a mortality rate lower than a delta variant. The Director of Infectious Disease Prevention and Control of The Health Ministry Indonesia predicted the peak of the COVID-19 variant omicron case in early March 2022. Therefore, communities need to increase preventive measures in the COVID -19 infection by guarding medical protocol, performing booster vaccinations, and increasing body immunity.

Efforts to increase the body’s immunity are among the primary protections to prevent the transmission of COVID-19. To boost immunity, communities can apply the four pillars of balanced nutrition guidelines or “Pedoman Gizi Seimbang” (PGS). The first principle is to eat a varied and balanced diet. Eating a variety of foods aims to meet all the nutritional needs needed by the body to ensure growth and maintain health. The ministry of health Indonesia has guided in filling nutrients improperly with “Isi Piringku”. The portion of food should consist of carbohydrates as a source of energy, side dishes as a source of protein, fruits and vegetables as a source of vitamins and minerals. Daily consumption recommended in “Isi Piringku” consists of 3-4 servings of carbohydrate, 2-3 servings of side dishes, 3-4 servings of vegetables, and 2-3 servings of fruits. Meeting the consumption of various vegetables and fruits may provide a source of vitamins (A, C, E, and B) and minerals (Se, Fe, and Zn) that act as antioxidants and increase body immunity. On the other hand, people are also encouraged to limit consumption of sugar (4 tbsp), salt (1 tsp), and oil (5 tbsp) in one day.

The third concept was to engage in physical activity and exercise regularly. Physical activity is defined as any skeletal muscle movement that needs energy expenditure. Physical activity includes activities performed at work, leisure time, and everyday life. Exercise is a type of physical exercise that is calculated, regulated, and done to maintain fitness. The ministry of health Indonesia recommends that physical activity be carried out at least 150 minutes a week or 30 minutes a day with a moderate intensity of three to five times a week. A moderate-intensity (about 30 minutes) regularly benefits the body’s immune defenses, especially in adults (Simpson, et al., 2020). This is appropriate with the third principle of PGS to maintaining ideal body weight. Normal weight is one indicator of the achieving balance of the body’s nutrients for adults. Routine or no weight can be seen from the body mass index (BMI). Maintaining an ideal body weight can prevent disease and improve quality of life.

The last principle is to apply clean and healthy living behavior to avoid infectious diseases. Clean and healthy living behavior is carried out because of personal awareness, which includes taking care of the body, maintaining a clean environment, washing hands, and maintaining health. The application of this principle is in line with efforts to tighten health protocols. Therefore, to prevent the transmission of COVID-19, it is necessary to apply 3M (using the mask, maintaining distance, and washing hands with soap).

References:

1. Kementrian Kesehatan RI. 2022. Pasien Positif COVID-19. Tersedia pada: https://kemkes.go.id/. Diakses pada: 14 Februari 2022
2. Kementrian Kesehatan 2014. Pedoman Gizi Seimbang. Jakarta : Direktur Jenderal Bina Gizi dan KIA Kemenkes RI.
3. Simpson RJ, Campbell JP, Gleeson M, Krüger K, Nieman DC, Pyne DB, Turner JE, Walsh NP. Can exercise affect immune function to increase susceptibility to infection? Exerc Immunol Rev. 2020;26:8-22. PMID: 32139352.
4. World Health Organization. Jan 2022. Update on COVID-19: Omicron wave threatening to overcome health workforce. Available at: https://www.euro.who.int/en/media-centre/sections/statements/2022/statement-update-on-covid-19-omicron-wave-threatening-to-overcome-health-workforce. Diakses pada: 14 Februari 2022.