Depending on the outcome measure, detectable effects may take weeks or months for the intervention. Only a limited number of studies exist assessing the impact of nut or berry intake on the incidence or severity of diseases or metabolic dysfunction, which require durations of months or years. Moving Forward: Precision Nutrition, Multi-omics, and Biomonitoring Precision nutrition evaluates an individual’s unique biological characteristics such as genotype and phenotype, including DNA expression, influences of the gut microbiome, and metabolic response to specific foods or dietary patterns, as well as dietary habits and external factors influencing outcomes such as social determinants of health, to determine the most effective dietary strategies to improve health and prevent disease. Understanding the sources of interindividual variability that contribute to metabolic heterogeneity and applying mathematical modeling and computational algorithms will be essential to refining dietary recommendations. Several recent publications comprehensively review research gaps and study design considerations in the field of precision nutrition and specifically concerning phenolic-rich plant foods. Precision nutrition will lead to important discoveries pertaining to interindividual responsiveness to the intake of nuts and berries. Ultimately, this information can be applied via targeted recommendations to individuals and groups for achievable and sustainable dietary intake of nuts and berries to promote optimal health. The incorporation of bio-monitoring technologies into study designs may also be used for precision nutrition. Current and emerging mobile devices can provide continuous data collection in free-living populations with minimal participant burden. The study of nuts and berries would be enhanced with the use of devices that can capture real-time physiological outputs at home that reflect normal living conditions.
Further collaborative efforts in the fields of bioengineering and artificial intelligence hold promise for advancing the understanding of benefits from nuts or berries. An emerging personal bio-monitoring technology is the Precision Health Toilet,square pot which collects and evaluates human urine and stool, which are then analyzed using artificial intelligence to determine flow rate and volume of urine, as well as fecal analysis via the Bristol Stool Scale. A second type of toilet seat, the Heart Seat, has recently been approved by the US Food and Drug Administration for home use to monitor heart rate and oxygen saturation, with future plans to add sensors that monitor systolic and diastolic blood pressure. Assessment of metabolites in the excreta seems like a feasible goal for future development, which may be useful, for example in the detection of urinary and fecal metabolites that can reflect the metabolism of ellagic acid to urolithins and of -epicatechin to γ-valerolactone. A third example is an ingestible capsule containing a biological photosensor that can detect gut inflammation. Bioluminescence can be monitored from bacteria that have been engineered to illuminate when they come into contact with a molecule for which they have been coded, such as urolithins from berries or lipid-sensitive metabolites from nuts. Finally, another type of ingestible capsule has recently been detailed that collects samples from multiple regions of the human intestinal tract during normal digestion. This device has been used to explore the role of the gut microbiome in physiology and disease, with novel findings that intestinal and stool metabolomes differ dramatically. The ability of nut or berry intake to alter such metabolomes, and their association with changes in physiological function and health outcomes, would be an interesting area for future research. Although these technologies are still in their infancy, they have promise to further precision nutrition research efforts on nuts and berries. Research addressing the issue of “responders” compared with “nonresponders” is important in understanding the metabolic discrepancies in many studies on nuts and berries. For example, platelet aggregation phenotypes can vary significantly by individual responsiveness to oxylipins, bio-active lipid mediators derived from polyunsaturated fatty acids present in nuts as well as in extra virgin olive oil.
Variations in circulating metabolites and microvascular function following the intake of freeze-dried strawberry powder have been reported. Those individuals producing increased nitrate and nitrite levels showed favorable changes in function whereas those showing no change in nitrate or nitrite levels did not. Another example is illustrated by a recent letter in response to a systematic review of almond intake and inflammatory biomarkers. The letter notes that while the review included amounts of almonds ranging from 10 to 113 g/d, favorable responses only occurred at intake of <60 g/d. Further, the authors note that although the review reports beneficial effects of almond intake on reduction in C-reactive protein and interleukin-6, subgroup analyses showed that the effects on these 2 outcomes were not significant among those with obesity or who were rated as unhealthy prior to the intervention. Characterizing participants according to precision nutrition, including the use of genetic phenotyping to identify target genes that may result in “responders” and “nonresponders” prior to enrollment may be helpful for clinical trials but does not reflect responses in a free-living population. Furthermore, in addition to physiological variations, sociobehavioral differences among individuals that may modulate responses to berries and nuts must also considered. Nonetheless, innovative precision nutrition models that can identify inter individual differences would be useful in defining mechanisms of action and potentially who would benefit the most from regular nut or berry consumption. Plasma and serum concentrations are useful to identify the bio-availability and bioefficacy of key nutrients and phytochemicals found in nuts and berries. Some compounds, such as small molecular weight polyphenols, are first absorbed in their native state in the small intestine. Other polyphenols can be biotransformed via the host microbiota to a second set of compounds that are subsequently absorbed and confer additional bio-activity beyond that obtained from the parent molecules. Monitoring both host and microbial metabolites in the blood and urine, and those that may accumulate in tissues of interest such as the liver and gastrointestinal epithelium, among other tissues, would be useful in understanding the dynamics of nut and berry bio-activity and specific association with site of actions.
Broader application of orthogonal approaches that combine untargeted with targeted metabolomic platforms and combined with the use of advanced informatics will support new understanding about the absorption, distribution, metabolism, and excretion of compounds found in nuts and berries. For example, the UC Davis West Coast Metabolomics Center conducts both targeted and untargeted assays that assess plasma microbial metabolites using a bio-genic amine panel that identifies and quantifies acylcarnitines, trimethylamine N-oxide, cholines, betaines, nucleotides and nucleosides, methylated and acetylated amines, di- and oligo-peptides, and a number of microbially modified food-derived metabolites. Some inter individual differences in response to nut or berry intake have been attributed to the composition of the gut microbiome. For example, ellagitannins are polyphenolic compounds present in strawberries, raspberries, and walnuts that are metabolized by gut bacteria into an array of urolithins . The production of urolithins relies on the capacity of specific microbes, Gordonibacter pamelaeae and Gordonibacterurolithinfaciens. Urolithins may decrease symptoms of chronic metabolic diseases, including inflammation and dyslipidemia. Following a single intake of red raspberries, individuals with prediabetes and insulin resistance had lower concentrations of circulating urolithins compared to levels found in those who were metabolically healthy, a result related to gut microbiome composition. In the same population, consuming red raspberries for 4 wk improved hepatic insulin resistance and total and LDL cholesterol in the prediabetes group, and the effects were related to decreased R. gnavus and increased E. eligins. Overall, including a practical amount of red raspberry in the diet regularly is a low-calorie dietary strategy that improves gut microbiota composition and function in individuals with prediabetes and insulin resistance resulting in improvements in metabolic health. With a sustained emphasis on the role of gut microbiota in nutrition research, advances in our understanding of food-gut dynamics will provide new insights about the role of nuts and berries in human health and performance. Although research on a specific nut or berry provides insight into bio-activity and potential mechanisms of action,square plastic planter such focus also creates the potential for fragmentation because the search for overall dietary patterns is not addressed. The composition of fruits and nuts differ at the molecular level, and a broader view assessing similarities in chemistry and health benefits is critical for translational research as well as for messaging purposes. For example, blueberries, strawberries, pomegranate, walnuts, and grapes all have reported benefits for cardiovascular health, driven largely by the presence of similar polyphenols, which are present at varying quantities in each of these foods. Although health professionals and consumers often hear messaging on a single berry or nut, the potential benefits of increasing consumption of the broader category may be obscured or lost. This challenges the ability to maintain consistent messaging and align better with translatable dietary guidance. Future interventions that combine nuts and berries with one or more other foods within a food matrix at dietary achievable doses and in more diverse populations are warranted. To date, multi-omics technologies have provided valuable insights into exposure-disease relationships.
Coupled with artificial intelligence, predictive modeling and continuous, personalized monitoring, these data-intensive outcomes can provide further insights about the health benefits associated with regular intake of nuts or berries. Use of highly personalized data collection devices will require secure data repositories. One of the challenges of similar foods being studied in differing formats and by various research groups is the utility of the data as a combined set. Differences in test materials and experimental designs make integration of data difficult. The proper curation of combined data, whether physiologic, metabolomic, or genomic, is critical to ensure that combined datasets provide synergy, statistical power, and enhanced usefulness.The cardiometabolic benefits from regular consumption of nuts or berries are widely reported and include improved vascular function, reduction of cardiovascular disease risk factors, improved insulin sensitivity, and reduced risk of type 2 diabetes mellitus. Antioxidant and anti-inflammatory capacity and activity have also been noted. Metabolic outcomes may be context-specific and related to the physiologic state of the individual and host microbiome composition, among other factors. Examples include findings of ellagitannin and ellagic acid rich foods resulting in differential responses in healthy individuals compared to those with prediabetes, who are dependent on gut microbial-derived metabolite profiles. Many factors contribute to inter individual variability in response to diet that can extend to context-specific aspects influencing the magnitude of health benefits and reinforces the importance for further research aimed at advancing discoveries in precision nutrition. Additional health outcomes related to nut or berry intake are outlined below.Adding nuts or berries to the daily diet may be advantageous for weight management for several physiological reasons. One is that these foods produce feelings of satiety, helping to reduce the desire to consume calorie-rich snacks that are low in vitamins, minerals, and fibers, ultimately improving body composition over time. A second possibility is due to urolithins, secondary metabolites produced from ellagitannins in nuts and berries. Urolithins increase the activation of the adenosine monophosphate-activated protein kinase pathway, resulting in anti-obesogenic properties in vitro and in animal models. AMPK increases fatty acid oxidation and decreases triglyceride accumulation. Phosphorylation of AMPK may also decrease cholesterol synthesis and lipogenesis by down regulating 3-hydroxy-3-methylglutaryl coenzyme A reductase activity and sterol regulatory-element binding protein expression. In clinical studies exploring the relationship between food and body composition, the incorporation of nuts and berries into the diet was associated with weight loss or maintenance.Regular consumption of nuts or berries has been reported to support brain health and cognitive function, motor control, mood, and executive function at physiologically relevant intakes. Middle-aged and older adults experienced improvements in balance, gait, and memory, and children experienced higher executive function and positive affect after acute and regular intake of both strawberries and blueberries. These beneficial effects may be the result of direct effects on brain signaling or indirect effects through oxidant defense and anti-inflammatory properties of polyphenols and other bio-active compounds in nuts and berry foods. The gut-brain axis is an emerging area of research. Most studies are preclinical in nature using animal models but are suggestive of a significant role of gut microbial-derived ellagitannin metabolites on brain health and neuroprotection.Regular intake of almonds, a good source of fatty acids and polyphenols, has been associated with a significant decrease in facial hyperpigmentation and wrinkle severity.