Professor Ellen Blaak, Maastricht University, the Netherlands, will be one of the plenary speakers at the 13th European Nutrition Conference (FENS 2019) this coming October. Professor Blaak will be speaking on day three of the conference, 17 October, on ‘Current metabolomic perspectives on malnutrition in obesity.’ Professor Blaak discusses more about her research, thoughts on malnutrition and obesity interventions, and her lecture topic.

1. As a physiologist, what first led you to focus your research on nutritional science?

Already during secondary school, I was fascinated by the impact of diet and nutrition on metabolism, and that interest developed further during my studies in Human Nutrition in Wageningen. During my period of practical work in Cambridge, UK, I participated in a study on ‘in vivo’ muscle metabolism in humans with obesity during prolonged fasting. During that time, I saw an advertisement for a PhD position in Maastricht on a topic covering precisely this nutritional focus. I applied and acquired that position, so after the work in Cambridge I immediately moved to Maastricht to do my PhD in the field of nutrition and metabolism.

2. With such extensive clinical research experience, how have you seen discourse around the aetiology and treatment of metabolic diseases and obesity change and develop over time?

Insight into the fact that it is not adipose tissue mass, per se, but rather a disturbed functionality of adipose tissue that is of major importance in the aetiology of insulin resistance, has became more prominent. Thus, adipose tissue was no longer seen as an inert storage depot, but instead as a metabolically active organ with a role in the dynamics of fatty acid metabolism and as an endocrine and inflammatory organ linking obesity to chronic metabolic diseases. Since the early 1990s, there has been enormous interest in the concept of impaired adipose tissue function and lipid storage capacity leading to ectopic fat accumulation, which may play an important role in the aetiology of chronic metabolic diseases.

In obesity treatment, it has become evident that not only weight loss is important, but that the crucial factor is the prevention of weight regain after weight loss and weight maintenance. With respect to metabolic health a smaller weight loss obtained through a balanced lifestyle intervention, maintained over time, may be preferred to extreme weight loss strategies. Also, insight has increased into understanding that obesity is not only the problem of the individual, but that interventions to modulate our obesogenic environment also require attention.

Lifestyle interventions may be effective in the prevention of diabetes and reduction of cardiometabolic risk. There is increasing insight that we have to study intervention effects taking factors like the metabolic phenotype and the environment into account. For instance, mechanisms responsible for lipid-induced insulin resistance may depend on dietary fat quality. People with very pronounced liver insulin resistance may benefit from another diet composition, or pharmacological intervention, compared to individuals with peripheral insulin resistance. We really need prospective studies addressing the response to interventions based on a more personalised approach to optimise the prevention and treatment of chronic metabolic diseases.

3. Why do you think it is important to consider malnutrition in an obese world?

Because malnutrition is a very important component in the etiology of obesity, and includes an excessive intake of some nutrients, as well as a deficiency of other nutrients like micronutrients (driven by inadequate intake and altered metabolism). Also, nowadays undernutrition and obesity may co-exist. Furthermore, malnutrition can also be defined as not having optimal nutrition which may touch upon the field of personalised nutrition. All aspects need attention and research  in order to develop targeted prevention and intervention strategies to reverse the obesity epidemic

4. Some of your recent research has explored the role of the gut microbiome in the aetiology and treatment of metabolic disease. What further research in the field would you like to see in order for microbiome related markers and knowledge to be more widely used in interventions?

I think in the field of microbiome research, there is a need for controlled human intervention studies combining state-of-the art methodologies for analyzing microbial composition and functionality, as well as detailed human phenotyping. In these studies, different metabolic phenotypes should be studied in relatively healthy individuals through to obese prediabetic individuals, since it is evident that the effectiveness of interventions may depend on this: it is evident that one size does not fit all. In particular, the interaction between diet and the microbiome may be of particular interest and requires much more research. We have recently demonstrated that the site of fermentation of indigestible carbohydrates may be an important determinant for the effects on metabolic health. For instance, fibre mixtures which are fermented in the distal colon may have a very pronounced effect on our metabolism. Those aspects have to be studied in more detail.

5. Finally, some of your work involves precompetitive research and public-private partnerships. What do you think the role of the food industry should be with regards to nutrition and health?

Indeed, we are involved in several public-private partnerships with several academic partners and industries. I am enthusiastic about these consortia since we have the opportunity and finances to combine scientific excellence with industrial relevance. These partnerships very much increase the ability and potential for research on nutrition and metabolism. Evidently, before starting these consortia, all conditions with respect to publication and Intellectual property rights etc are very well arranged in consortium agreements undersigned by all partners.