Behavior, nutrition and lifestyle in a comprehensive health and disease paradigm: skills and knowledge for a predictive, preventive and personalized medicine

Health and disease of individuals and of populations are the result of three groups of factors: genetics, environment and behavior. Only the last is mostly dependent by the chooses of the single person, but assessment, interventions and tailored changes are possible.Medical genetics and genetic variation studies relate to human health and disease: knowledge and skills in DNA sequencing and genomics make possible to study the molecular sequences associated with many human diseases, to predict and council accordingly, to prevent and/or treat several conditions. Nutrigenomics is the study of the effects of foods and food constituents on gene expression, and has been associated with the idea of personalized nutrition based on genotype. Nonetheless the actual determinants of human diet are economic, climatic, geographic, historical, with a strong psychological and sociological basis. This is the reason that data on habits, attractiveness of diet, quality of food and alimentation are the more consistent source of knowledge explored by epidemiological tools.A cultural framework of competences and skills by which Medical Doctors can personally manage the need of prediction (early diagnosis), prevention (intervention on healthy persons) and tailored therapy and follow-up for patients is the premise for reasonable guidelines aimed at more effective clinical practice and favorable cost-benefit balance. Despite the current perception of the usefulness of interventions, also at the clinical individual level, on lifestyles, nutrition and physical activity, and the bulk of studies available, an effective translational practice from the EBM of the epidemiology to the EBM of therapeutic interventions is limited if not totally lacking. Nutritional knowledge and skills teaching and training are a neglected subject of the Curricula of all Schools of Medicine and of allied Health professions. Moreover, we are far from the implementation of skills for enhancing healthy lifestyles, includ