Precision health: Not a one-size-fits-all approach
Researchers are leveraging technology, bioinformatics and omics data to understand how lifestyle interventions can be tailored to individual patients
By Kate Hunger
The conventional advice patients at risk for cardiovascular and other chronic diseases often receive sounds straightforward enough: Eat well and exercise. But researchers at the School of Nursing know that patients are individuals — and that to be effective, interventions are not one-size-fits-all.
Enter precision health. Nurse scientists at the school are seeking ways to create effective lifestyle interventions to improve outcomes for patients with chronic health conditions, such as high blood pressure and Type 2 diabetes. And they are taking both a micro and macro view of factors in patients’ genomic and metabolomic data, as well as qualitative data — including the availability of community support and human interaction.
Optimizing omics to improve outcomes
PhD, RN, Expertise in self-management of chronic diseases and nutrition.
Assistant Professor Jisook Ko, PhD, RN, has conducted several research projects using a precision nutrition framework to examine the effectiveness of self-management of dietary interventions designed for patients with high blood pressure or Type 2 diabetes. “I just want to help them to make it easier to manage their chronic conditions,” she said.
Ko has focused her research on examining the effect of a low-sodium diet intervention on metabolites in participants with high blood pressure, including identifying and studying participants who are genetically salt sensitive. And as principal investigator of a pilot study, Ko is investigating how personalized nutritional advice and intervention affects metabolites in participants with Type 2 diabetes.
In both studies, participants used a mobile dietary tracking app to log what they ate and digital fitness tracking devices to monitor their physical activity. Ko is comparing the metabolomics taken by blood or urine samples, depending on the study, and comparing that data to what participants logged.
“Looking at the metabolomics profiling, I can see that even though we are eating the same amount of sodium or same amount of sugar, our bodies are responding so differently, according to age, sex, ethnicity and other factors,” Ko said.
The ability to share what is happening in their cells with a patient is powerful information, Ko added. “Looking at the comprehensive assessment in terms of responses to dietary or lifestyle modifications is really helping to convince my patients,” she said. “From there, I can provide more personalized and more individualized advice based on their current profiling.”
Recommending special diets and asking study subjects to log their progress is not enough, Ko said. “That doesn’t work,” she said. “But if we just look at their data, their profiling, then they can understand why [they are] here and why [their] current status is looking like this.”
Considering lifestyle factors
PhD, MPH, RN, Research focuses on improving chronic disease management and patient independence.
Early in her career, School of Nursing Assistant Professor Yan Du, PhD, MPH, RN, worked as a bedside nurse in an intensive care unit.
“I saw a lot of people with severe, chronic health conditions, like multiple organ failures and very severe conditions in the ICU,” she said. “I realized that a lot of the severe conditions can be prevented if they can manage their chronic conditions well at their home or in the community.”
Du studies the effect of biological and psychosocial factors on an individual’s lifestyle behaviors and, ultimately, their health outcomes. One of her research projects, a collaboration with Kumar Sharma, MD, FAHA, FASN, chief of the Division of Nephrology and director of the Center for Precision Medicine in the Joe R. and Teresa Lozano Long School of Medicine, examines the effect of a technology-assisted ketogenic diet on cardio-renal-metabolic health.
In that study, the 60 participants were either overweight or obese, and some had either Type 2 diabetes or early-stage chronic kidney disease. Half of the study group was put on a ketogenic diet, while the other half was given a low-fat diet. All participants received digital fitness trackers and were asked to monitor and log their daily physical activity and food intake and record their weight. Participants with Type 2 diabetes were asked to monitor their blood glucose.
In order to check compliance with the ketogenic diet, researchers confirmed subjects achieved ketosis by measuring ketones in their blood, said Christiane Meireles, PhD, RDN, a clinical associate professor in the School of Nursing who designed the ketogenic diet used in the study and served as a co-investigator.
“In terms of nutrition, health technology can help people increase their awareness of food choices to support lifestyle change because you have real-time feedback when self-monitoring food intake, for example. You have the response right there in front of you at any time,” Meireles said.
Study participants also received individualized, interactive, self-paced digital health lessons. Researchers then imported the data into a platform at the School of Nursing’s Center on Smart and Connected Health Technologies to give the participants personalized feedback on their progress.
“From a precision lifestyle intervention perspective, the magic word is there is no one-fits-all treatment or intervention,” Du said. “We found for both [diet] groups there were some health outcomes improved, and there were some health outcomes not improved in both groups as well.”
Du and her interdisciplinary team of research colleagues has been assessing the microbiome and metabolite responses to the lifestyle intervention, aiming to develop innovative and effective lifestyle interventions individualized to each person. They also added another layer to their research: using patients’ self-monitoring behaviors to predict health outcomes.
“We found that maybe based on their self-monitoring behavior at the beginning of the intervention, we can actually assess who might get the benefit of the intervention and who might not, at the very early stage. We can intervene [with] who needs extra intervention.”
Measuring social impacts
The ketogenic study also revealed the importance of a patient’s lived experience in the success of a lifestyle intervention, Du said. She is conducting another study that aims to take the lifestyle intervention directly to the community, where people live. In that study, researchers will provide digital lessons facilitated by community health workers at a senior day activity center to infuse human connection into the learning piece. The study will consider the social support, cultural adaptation and access to organizational and community resources needed to meet the needs and preferences of the study participants.
“We are trying to see how we can make the lifestyle intervention personalized,” Du said, “not only to their genetics or their current health conditions or behaviors, but also to their environment — not only their physical environment, but also their social environment.”
Center on Smart and Connected Health Technologies
The School of Nursing’s Center on Smart and Connected Health Technologies reopened in 2024 with renovated space and a sharpened mission to serve as a hub that integrates innovative technology with human-factor principles in research, education and clinical practice.
The center is designed to help faculty, students and members of the scientific community conduct research, analyze data and collaborate on projects. The center facilitates academic-industry collaboration on usability and clinical testing and provides consultation on design, development, testing and deployment of mobile health, connected health and telehealth solutions. Rigorous data collection, curation and interdisciplinary collaboration are cornerstones of the center’s success.
The center’s director, School of Nursing Vice Dean of Research and Scholarship Lixin Song, PhD, RN, FAAN, emphasized the center’s focus on human-centered design and responsible use of technologies including artificial intelligence and sensors.
“No matter how much technology evolves and improves, in the end we need to serve the people,” she said. “We need to serve the patient, family caregiver and community.”
In addition to wearable technologies and fitness trackers and a user study room, the center features new technologies, including smart mirrors that can be used to help patients practice new self-care procedures such as ostomy care in the hospital and at home, a screen-based eye tracker and eye-tracking glasses, and a robot “dog” called Sona (School of Nursing Assistant) that can be programmed to monitor health indicators, assist in therapy and more.
“Our center is committed to exploring innovative solutions to improve patient care and support caregivers, alleviating burdens on health care professionals facing burnout and time constraints,” Song said, adding that the center is focused on decreasing health disparities.
“Technology should be helping people instead of being a barrier,” she said.
For more information about the center and its services, email smartcenter@uthscsa.edu.
