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For decades, the food pyramid and population-based dietary guidelines have played a fundamental role in educating the public on what — and what not — to eat. But as the world enters a new era in nutrition science, that may no longer be enough.

As rates of obesity, metabolic disease, and other noncommunicable diseases (NCDs) surge across Europe, a growing number of nutrition scientists believe personalized nutrition — an approach that tailors dietary advice to an individual’s genetics, microbiome, metabolic profile, and lifestyle — could transform how we eat. The challenge will be making it work for everyone.

“The metabolic reality of the 21st century is profoundly different from the one in which these models were originally conceived,” Hellas Cena, MD, professor of dietetics and clinical nutrition and head of the Laboratory of Dietetic and Clinical Nutrition at the University of Pavia, Pavia, Italy, told Medscape News Europe.

One Size Doesn’t Fit All

NCDs are the leading cause of death and disability in Europe, with the region facing unprecedented rates of obesity, metabolic diseases, chronic inflammation, and eating disorders across all age groups. Health promotion and disease prevention could reduce the burden of NCDs by as much as 70%.

But as the NCD burden grows, research has found that individuals do not respond identically to the same foods or dietary patterns. That’s because genetics, microbiota composition, metabolic phenotype, hormonal status, lifestyle, sleep, stress, socio-economic conditions, and environmental exposures all influence individual nutritional responses, Cena explained.

“Personalized nutrition has the potential to significantly improve the prevention and management of NCDs by moving beyond ‘one-size-fits-all’ dietary recommendations,” said Itziar Tueros, PhD, head of the Food and Health Department at AZTI, a science and technology center based in Spain, and researcher for the Spanish Association Against Cancer.

“By integrating dietary data, biological markers, and AI-based models, personalized nutrition can provide recommendations that are tailored to each individual’s physiological profile, improving effectiveness compared to generic dietary guidelines,” she told Medscape News Europe.

For Eileen Gibney, PhD, professor of nutrition at University College Dublin and director of the university’s Institute of Food and Health, Dublin, Ireland, the food pyramid and personalized nutrition need to coexist.

“We cannot stop giving population advice, but what we might begin to see is perhaps the food pyramid being personalized for individuals, providing tools for individuals to know where they currently stand in comparison to recommended intakes, and the provision of advice to change,” she told Medscape News Europe.

“This is what is provided when an individual visits a dietician or nutritionist, but more often we see tools which take this approach and provide automated advice and support.”

Gibney’s work in personalized nutrition began almost a decade ago with the Food4Me trial across seven European countries, which focused on developing online tools to capture information about someone’s diet and to provide automated feedback for change. It found that personalized nutrition advice delivered via the internet produced larger and more appropriate changes in dietary behavior than conventional dietary advice.

She’s now involved in PLAN’EAT, a European Commission-funded project in 11 countries with the aim of transforming food systems and food environments towards healthy and sustainable dietary behaviors.

“We are addressing not just what people should change in their diets but how. We’re addressing the different behavioral barriers to change and developing personalized behavioral strategies to support change. Our evidence to date shows that if we address both the what and how to change, we can see really significant change, which is quite exciting.”

The Equity Question

But while the field of personalized nutrition shows promise, experts told Medscape News Europe that it needs to be equitable, accessible, and sustainable.

“A major concern is ensuring that personalized nutrition does not become an elitist model, accessible only to wealthy populations,” Cena said.

Katherine Livingstone, PhD, associate professor from the Deakin Institute for Physical Activity and Nutrition in Melbourne, Australia, who was also involved in the Food4Me pan-European trial, told Medscape News Europe that, ideally, everyone should benefit from dietary advice that is tailored to their needs.

“In reality, often there is a fee-for-service model involved,” she said, stressing that personalized nutrition advice should always be delivered by a qualified professional, such as a general practitioner, dietitian, or genetic counselor.

However, this could change with time, she said. Personalized dietary advice could be delivered at scale by leveraging digital tools, such as machine learning algorithms, to process large amounts of information and create personalized dietary advice at a population level.

“However, this requires investment in time and resources to ensure that the tools are evidence-based, that patient data is handled securely, and that healthcare professionals are involved in helping patients interpret and implement their advice,” she said.

Tueros, the project coordinator of CoDiet, an international research project funded by the European Union that aims to tackle diet-related diseases through innovative diet-monitoring technologies and personalized nutrition, agrees. She believes the most scalable model will likely combine digital tools with clinical and public health systems.

“Reaching large populations is feasible, but it requires scalable, cost-effective technologies. One of the key contributions of projects like CoDiet is precisely to develop methods that can be integrated into real-life settings and eventually linked to national nutrition policies, enabling broader population-level impact,” she said.

One of the key markers of whether personalized nutrition will succeed in tackling NCDs — and the consumption environment — is if people have access to affordable, nutritious, healthy, and seasonal food.

“We know people struggle to follow a healthy diet, so we need to be able to make the healthy choice the easy choice,” Gibney said.

“Quite often, it is the most marginalized groups in society that do not have the luxury of choice that other groups have, and it is important to ensure that we support and provide solutions that address these inequalities.”

A Difficult Narrative to Change

For Cena, this means not placing responsibility exclusively on individuals and recognizing that there are deep-rooted structural and systemic factors at play.

She would like to see food policies supporting healthier food environments, greater regulation of ultra-processed foods, incentives for sustainable food production, and greater integration of nutrition into primary healthcare.

Tueros agrees, adding that policies must ensure personalized nutrition solutions are scalable, affordable, and ethically implemented to avoid widening existing health inequalities.

“Looking ahead, the future of this field will likely involve the convergence of AI, omics technologies, and real-world data collection, enabling more precise, predictive, and preventive approaches to health,” she said.

“At the same time, a critical step will be the translation of scientific knowledge into policy and practice, so that the benefits of personalized nutrition extend beyond individuals and contribute to improving population health at scale.”

That won’t happen overnight. Cena stressed that any changes to long-established dietary paradigms are not only “scientifically complex” but also “institutionally and politically sensitive.”

“Dietary guidelines influence healthcare systems, education, food policies, agricultural systems, and industry practices. As a result, changing the narrative is inevitably difficult and requires robust evidence, interdisciplinary collaboration, and careful communication,” she said.

“Ultimately, I believe the future of nutrition will move from generalized recommendations toward more adaptive, flexible, and context-sensitive models. The challenge will be achieving this without increasing health inequalities.”

Cena reported receiving advisory fees and/or speaker honoraria from companies operating in the fields of nutrition, metabolic health, medical nutrition, and pharmaceuticals, including Abbott, Novo Nordisk, and Lilly. She is also involved in university research collaborations with companies working in the food, medical nutrition, and medical device sectors. Part of her research activity is supported through competitive funding from governmental and public institutions, including the Italian Ministry of University and Research, European Union programs (including NextGenerationEU/National Recovery and Resilience Plan initiatives), and foundations such as Fondazione Cariplo.

Tueros, Gibney, and Livingstone reported no relevant financial relationships.