From Rations to Reactions: A Narrative Review of Precision Nutrigenomics in Emergency, Disaster, and Critical Care Medicine
Abstract
Background: Traditional nutritional support in emergency and disaster medicine operates on a one-size-fits-all paradigm, often delayed until the hospital phase of care. This approach fails to address the profound metabolic heterogeneity of critically ill or traumatized individuals, potentially compromising recovery.
Aim: This narrative review aims to synthesize current evidence and propose an integrated framework for implementing precision nutrigenomics across the continuum of crisis care, from pre-hospital settings through to rehabilitation.
Methods: A systematic search of PubMed, Scopus, Web of Science, and CINAHL was conducted for literature published between 2010 and 2024.
Results: The review identifies a viable pathway for personalized nutrition in crisis response, reliant on: 1) Point-of-Injury Metabolic Phenotyping via portable lab devices; 2) Genetically-Informed Formulary Development for enteral/parenteral nutrition; 3) Informatics-Enabled Dietary Data Integration into emergency protocols; and 4) Logistical Frameworks for delivering precision diets in austere or high-security environments. Key barriers include the validation of field-deployable biomarkers, cost, data interoperability, and the need for cross-disciplinary training.
Conclusion: Precision nutrigenomics represents a transformative frontier in crisis medicine, with the potential to modulate immune response, reduce complications, and improve survival. Its realization requires dismantling silos between emergency responders, laboratory scientists, dietitians, and hospital logisticians to create a seamless, data-driven nutritional care pathway that begins at the moment of crisis intervention.
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References
Ahmed, Z., Mohamed, K., Zeeshan, S., & Dong, X. (2020). Artificial intelligence with multi-functional machine learning platform development for better healthcare and precision medicine. Database, 2020, baaa010. https://doi.org/10.1093/database/baaa010
Alipanah-Lechner, N., Neyton, L., Mick, E., Willmore, A., Leligdowicz, A., Contrepois, K., ... & Calfee, C. S. (2023). Plasma metabolic profiling implicates dysregulated lipid metabolism and glycolytic shift in hyperinflammatory ARDS. American Journal of Physiology-Lung Cellular and Molecular Physiology, 324(3), L297-L306. https://doi.org/10.1152/ajplung.00278.2022
Anderson, C., Carmichael, J., Hicks, A. J., Burke, R., & Ponsford, J. (2023). Interaction between APOE ɛ4 and age is associated with emotional distress one year after moderate-severe traumatic brain injury. Journal of Neurotrauma, 40(3-4), 326-336. https://doi.org/10.1089/neu.2022.0226
Bates, D. W., Saria, S., Ohno-Machado, L., Shah, A., & Escobar, G. (2014). Big data in health care: using analytics to identify and manage high-risk and high-cost patients. Health affairs, 33(7), 1123-1131. https://doi.org/10.1377/hlthaff.2014.0041
Bayer, R., & Galea, S. (2015). Public health in the precision-medicine era. N Engl J Med, 373(6), 499-501. DOI: 10.1056/NEJMp1504077
Braverman, G., Shapiro, Z. E., & Bernstein, J. A. (2018). Ethical issues in contemporary clinical genetics. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 2(2), 81-90. https://doi.org/10.1016/j.mayocpiqo.2018.03.005
Carr, A. C., & Rowe, S. (2020). The emerging role of vitamin C in the prevention and treatment of COVID-19. Nutrients, 12(11), 3286. https://doi.org/10.3390/nu12113286
Casaer, M. P., & Van den Berghe, G. (2014). Nutrition in the acute phase of critical illness. New England Journal of Medicine, 370(13), 1227-1236. DOI: 10.1056/NEJMra1304623
Chen, J., Gorman, M., O'Reilly, B., & Chen, Y. (2016). Analytical evaluation of the epoc® point-of-care blood analysis system in cardiopulmonary bypass patients. Clinical Biochemistry, 49(9), 708-712. https://doi.org/10.1016/j.clinbiochem.2015.12.015
Ciaraglia, A., Brigmon, E., Braverman, M., Kidd, E., Winckler, C. J., Epley, E., ... & Jenkins, D. (2022). Use of whole blood deployment programs for mass casualty incidents: South Texas experience in regional response and preparedness. Journal of Trauma and Acute Care Surgery, 93(6), e182-e184. DOI: 10.1097/TA.0000000000003762
Cruzat, V., Macedo Rogero, M., Noel Keane, K., Curi, R., & Newsholme, P. (2018). Glutamine: metabolism and immune function, supplementation and clinical translation. Nutrients, 10(11), 1564. https://doi.org/10.3390/nu10111564
Dragasevic, S., Stankovic, B., Kotur, N., Milutinovic, A. S., Milovanovic, T., Stojkovic Lalosevic, M., ... & Popovic, D. (2022). Genetic Aspects of Micronutrients Important for Inflammatory Bowel Disease. Life, 12(10), 1623. https://doi.org/10.3390/life12101623
Eveleens, R. D., Witjes, B. C., Casaer, M. P., Vanhorebeek, I., Guerra, G. G., Veldscholte, K., ... & Joosten, K. F. (2021). Supplementation of vitamins, trace elements and electrolytes in the PEPaNIC Randomised Controlled Trial: composition and preparation of the prescription. Clinical nutrition ESPEN, 42, 244-251. https://doi.org/10.1016/j.clnesp.2021.01.028
Ferguson, L. R., De Caterina, R., Görman, U., Allayee, H., Kohlmeier, M., Prasad, C., ... & Martinez, J. A. (2016). Guide and position of the international society of nutrigenetics/nutrigenomics on personalised nutrition: part 1-fields of precision nutrition. Lifestyle Genomics, 9(1), 12-27. https://doi.org/10.1159/000445350
Heyland, D. K., Dhaliwal, R., Wang, M., & Day, A. G. (2015). The prevalence of iatrogenic underfeeding in the nutritionally ‘at-risk’critically ill patient: Results of an international, multicenter, prospective study. Clinical Nutrition, 34(4), 659-666. https://doi.org/10.1016/j.clnu.2014.07.008
Horn, D. L., Bettcher, L. F., Navarro, S. L., Pascua, V., Neto, F. C., Cuschieri, J., ... & O’Keefe, G. E. (2021). Persistent metabolomic alterations characterize chronic critical illness after severe trauma. Journal of Trauma and Acute Care Surgery, 90(1), 35-45. DOI: 10.1097/TA.0000000000002952
Jin, J., Mulesa, L., & Carrilero Rouillet, M. (2017). Trace elements in parenteral nutrition: considerations for the prescribing clinician. Nutrients, 9(5), 440. https://doi.org/10.3390/nu9050440
Kassem, N. M., Abdelmegid, Y. A., El-Sayed, M. K., Sayed, R. S., Abdel-Aalla, M. H., & Kassem, H. A. (2023). Nutrigenomics and microbiome shaping the future of personalized medicine: a review article. Journal of Genetic Engineering and Biotechnology, 21(1), 134. https://doi.org/10.1186/s43141-023-00599-2
Khorram-Manesh, A., Carlström, E., Burkle, F. M., Goniewicz, K., Gray, L., Ratnayake, A., ... & Magnusson, C. (2023). The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards. Scandinavian journal of trauma, resuscitation and emergency medicine, 31(1), 88. https://doi.org/10.1186/s13049-023-01128-3
Kotwal, R. S., Montgomery, H. R., Miles, E. A., Conklin, C. C., Hall, M. T., & McChrystal, S. A. (2017). Leadership and a casualty response system for eliminating preventable death. Journal of trauma and acute care surgery, 82(6S), S9-S15. DOI: 10.1097/TA.0000000000001428
Lambell, K. J., Tatucu-Babet, O. A., Chapple, L. A., Gantner, D., & Ridley, E. J. (2020). Nutrition therapy in critical illness: a review of the literature for clinicians. Critical Care, 24(1), 35. https://doi.org/10.1186/s13054-020-2739-4
Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: a standards-based, interoperable apps platform for electronic health records. Journal of the American Medical Informatics Association, 23(5), 899-908. https://doi.org/10.1093/jamia/ocv189
Mathers, J. C. (2017). Nutrigenomics in the modern era. Proceedings of the Nutrition Society, 76(3), 265-275. doi:10.1017/S002966511600080X
Mehta, N., Pokharna, P., & Shetty, S. R. (2023). Unwinding the potentials of vitamin C in COVID-19 and other diseases: An updated review. Nutrition and Health, 29(3), 415-433. https://doi.org/10.1177/02601060221139628
Moisey, L. L., Merriweather, J. L., & Drover, J. W. (2022). The role of nutrition rehabilitation in the recovery of survivors of critical illness: underrecognized and underappreciated. Critical Care, 26(1), 270. https://doi.org/10.1186/s13054-022-04143-5
Molloy, A. M. (2011). Genetic aspects of folate metabolism. Water Soluble Vitamins: Clinical Research and Future Application, 105-130. https://doi.org/10.1007/978-94-007-2199-9_7
Olivecrona, M., Wildemyr, Z., & Koskinen, L. O. D. (2010). The apolipoprotein E ε4 allele and outcome in severe traumatic brain injury treated by an intracranial pressure–targeted therapy. Journal of neurosurgery, 112(5), 1113-1119. https://doi.org/10.3171/2009.8.JNS09636
Paula, R. F., Távora, P. F., Gomes, M. M., Neto, J. D., Leonel, T. C., Santos, L. I., & Midrigal, A. D. (2023). A-387 Evaluation of the Analytical and Clinical Performance of epoc Point of Care Equipment Compared to Standard Blood Gas in Patients with Nephropathy. Clinical Chemistry, 69(Supplement_1), hvad097-343. https://doi.org/10.1093/clinchem/hvad097.343
Pirmohamed, M. (2011). Pharmacogenetics: past, present and future. Drug discovery today, 16(19-20), 852-861. https://doi.org/10.1016/j.drudis.2011.08.006
Prudovsky, I., Kacer, D., Zucco, V. V., Palmeri, M., Falank, C., Kramer, R., ... & Rappold, J. (2022). Tranexamic acid: beyond antifibrinolysis. Transfusion, 62, S301-S312. https://doi.org/10.1111/trf.16976
Rindal, D. B., Pasumarthi, D. P., Thirumalai, V., Truitt, A. R., Asche, S. E., Worley, D. C., ... & Mitchell, S. G. (2023). Clinical decision support to reduce opioid prescriptions for dental extractions using SMART on FHIR: implementation report. JMIR Medical Informatics, 11(1), e45636. https://doi.org/10.2196/45636
Roberts, I., Shakur-Still, H., Aeron-Thomas, A., Beaumont, D., Belli, A., Brenner, A., ... & Williams, J. (2021). Tranexamic acid to reduce head injury death in people with traumatic brain injury: the CRASH-3 international RCT. Health Technology Assessment (Winchester, England), 25(26), 1. https://doi.org/10.3310/hta25260
Sharma, A., Malviya, R., & Gupta, R. (2022). Big data analytics in healthcare. Cognitive Intelligence and Big Data in Healthcare, 257-301. https://doi.org/10.1002/9781119771982.ch10
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., ... & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition in the intensive care unit. Clinical nutrition, 38(1), 48-79. https://doi.org/10.1016/j.clnu.2018.08.037
Tatucu-Babet, O. A., & Ridley, E. J. (2022). How much underfeeding can the critically ill adult patient tolerate?. Journal of Intensive Medicine, 2(02), 69-77. https://doi.org/10.1016/j.jointm.2022.01.002
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., ... & Society of Critical Care Medicine. (2016). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Critical care medicine, 44(2), 390-438. DOI: 10.1097/CCM.0000000000001525
Vankrunkelsven, W., Gunst, J., Amrein, K., Bear, D. E., Berger, M. M., Christopher, K. B., ... & Casaer, M. P. (2021). Monitoring and parenteral administration of micronutrients, phosphate and magnesium in critically ill patients: the VITA-TRACE survey. Clinical nutrition, 40(2), 590-599. https://doi.org/10.1016/j.clnu.2020.06.005
Wischmeyer, P. E., Bear, D. E., Berger, M. M., De Waele, E., Gunst, J., McClave, S. A., ... & van Zanten, A. R. (2023). Personalized nutrition therapy in critical care: 10 expert recommendations. Critical Care, 27(1), 261. https://doi.org/10.1186/s13054-023-04539-x
Wong, A., Otles, E., Donnelly, J. P., Krumm, A., McCullough, J., DeTroyer-Cooley, O., ... & Singh, K. (2021). External validation of a widely implemented proprietary sepsis prediction model in hospitalized patients. JAMA internal medicine, 181(8), 1065-1070. doi:10.1001/jamainternmed.2021.2626
Zhang, C., Li, G., Lu, T., Liu, L., Sui, Y., Bai, R., ... & Sun, B. (2023). The interaction of microbiome and pancreas in acute pancreatitis. Biomolecules, 14(1), 59. https://doi.org/10.3390/biom14010059
Zhou, X., Jin, S., Pan, J., Lin, Q., Yang, S., Lu, Y., ... & Hong, W. (2023). Relationship between cholesterol-related lipids and severe acute pancreatitis: from bench to bedside. Journal of Clinical Medicine, 12(5), 1729. https://doi.org/10.3390/jcm12051729
Authors
Copyright (c) 2024 Mohammed Mujahid Ateeq Alkuwaykibi, Abdullah Marran Aldhfeeri, Oudah Salem Owaid Alsharari, Mazen Khulaif Buthul Alruwaili, Bader Gaed Alanazi, Salem Gaed Alanazi, Aadel Mohammad Gh Alrasheedi, Nouf Saeed Alghamdi, Kefaya Ayedh Nahar Alrashidy, Nadiah Aeid N Alrashidy, Fahad Ali Nageef Alqhtani, Mohammed Ayed Al-Rumayh
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