Professor Annamaria Colao, coordinator of Spoke 5 of the OnFoods project and holder of the UNESCO Chair on the Mediterranean Diet, discusses the challenge of transforming scientific knowledge on nutrition into public awareness, through a multidisciplinary approach tailored to the needs of various social and cultural contexts.

At the heart of the OnFoods project, the team of Spoke 5, led by Professor Annamaria Colao, tackles a crucial theme: nutrition across the lifespan. Through studies on chrononutrition, new strategies for healthy eating, and adaptations of Mediterranean guidelines to local contexts, the research conducted by this group is paving innovative paths to make nutritional health accessible and personalized. 

In this interview, Colao explains how OnFoods promotes an integrated, multidisciplinary approach focused on citizens' needs, combining research and outreach in a shared commitment to building a food culture that can truly impact people’s quality of life.

Professor Colao, let’s start by clarifying the overarching vision with which your team joined the OnFoods project. You named your group, Spoke 5, “Nutrition Across the Lifespan,” with the slogan “Healthy Eating for All.” The idea is clear: investing in research for accessible, adequate, and sustainable nutrition also means empowering individuals, societies, and communities, promoting resilience, development, and prosperity. With one year left until the completion of the OnFoods project, what is the vision that you, as coordinator, would still like to keep alive among all Spoke 5 collaborators? In other words, what is the “hill” you would stand by until the last day of the project and beyond?

The main goal of my work and that of my entire research team is to progressively increase citizens' awareness of how essential nutrition is for overall health. This is the true core of the project, both within OnFoods and beyond. There remains a significant gap in this awareness between experts and the general public: we know well that food is one of the foremost mediators of health, but this is not widely understood among the broader population. This gap needs to be closed, but not by imposing knowledge from above; rather, through genuine listening and knowledge exchange. The real challenge lies in the disconnect between intentions and everyday behavior, as healthy and sustainable food is still far too inaccessible for too many people. This is the hill I would stand by with ever-growing conviction, because as a physician, I know that most deadly chronic degenerative diseases arise from a poor approach to nutrition.

Furthermore, it has long been known in the field of Human Nutrition that a one size fits all approach is ineffective. While nutritional recommendations already consider specific needs based on age and gender, healthy and proper nutrition must also be personalized by accounting for other determinants of food choices, such as individual preferences and knowledge about nutrition, as well as sociodemographic and psychosocial factors. From this perspective, consumer choices can be more effectively guided by addressing the specific needs of each individual, thereby promoting not only a more conscious but also a more sustainable diet.

This approach, shared by all Spoke 5 partners, aligns with a holistic OneHealth vision that considers not only nutritional factors but also all health determinants arising from the individual-environment interaction.

Finally, as we know, policies lie between science and citizens. This is why we must all go beyond the academic sphere, engaging in outreach, explaining, and implementing activities that serve as true cultural and food diplomacy. OnFoods provides us with a platform to do just that, in addition to, of course, conducting extensive research.

Four working sub-groups, each focused on an increasingly specific line, make up the framework of Spoke 5. Could you clarify their particular areas of focus and the broader research picture these four major themes contribute to?

The structure of Spoke 5 was designed to gather all relevant information and achieve the objectives set by the OnFoods project. Specifically, it begins with mapping the entire national territory to identify critical issues and gaps that will serve as targets for implementation strategies. This information then guides subsequent activities to identify effective, population-specific strategies (especially for vulnerable populations) based on innovative dietary models inspired by the principles of the Mediterranean Diet.

Finally, it is essential to standardize methodologies for identifying biomarkers specific to the consumption of these nutritional patterns, in order to monitor their effects on nutritional status and health outcomes in both the short and long term. This detailed project planning is made possible by continuous multidisciplinary synergies among partners and highly specialized consultations that contribute to various project activities.

A globally recognized nutritional model and UNESCO intangible heritage, for which you hold the Chair. From the Seven Countries Study to today, research has evolved from purely observational analyses to a much more complex and multidisciplinary approach. What remains of Keys' legacy, and what has changed fundamentally in today’s research?

The Mediterranean Diet, as formulated by Ancel Keys' pioneering studies, remains one of the cornerstones of preventive nutrition against chronic non-communicable diseases. However, the original studies were conducted in a very different context from today’s, one marked by an obesogenic and globalized environment. This has made it necessary to update the model to adapt it to modern lifestyles, while still respecting biodiversity, culinary traditions, and sustainability.

In the context of the OnFoods project, Spoke 5 developed the Planeterranea project, a concrete response to the need for a "glocal" dietary model: a system that, while retaining the benefits of the Mediterranean Diet, adapts its principles to the specificities of different local realities. The Planeterranea project was born during the pandemic, when, analyzing the health conditions of obese patients, it was observed that those adhering to the principles of the Mediterranean Diet showed greater resistance to COVID compared to those with less healthy eating habits. This observation piqued the interest of a Brazilian colleague, who, facing similar challenges, wondered how to adapt these principles to the reality of the Amazon rainforest, with its specific food resources.

Thus, the idea of a Planeterranean diet was born—a model that goes beyond the concept of a "universal" diet, aiming instead for one that respects local food availability, cultural traditions, and regional specificities. While Keys paved the way by correlating nutrition with the prevention of life-threatening diseases, over time, this guiding principle has somewhat been lost in favor of commercial approaches that prioritize ultra-processed products low in fats, carbohydrates, or sugars. Instead, it is essential to return to the basics by relearning how to prepare our meals in a simple and healthy way. However, this requires dedicating "life time" to food preparation, a commitment that, despite its simplicity, can ensure both economic savings and an overall improvement in well-being.

Regarding life-threatening diseases, oncological ones certainly require very targeted nutritional approaches. In the UK, they are introducing mandatory prehabilitation protocols for oncological patients, which include nutritional, psychological, and physical rehabilitation before pharmacological and surgical treatments. As you have mentioned, a patient’s resilience is built through an adequate diet to maintain or quickly restore proper nutritional status, especially in the presence of illness. In Italy, many oncological care pathways have achieved a good level of interdisciplinarity, but proper and timely nutritional assessments are still lacking, as well as the activation of shared protocols, even from the early diagnostic stages. From your perspective, what needs to be done in this regard?

Our research group is extensively involved in oncological aspects, with a specific focus on endocrine tumors and undifferentiated neoplasms. We work closely with oncologists to manage and study these cases, benefiting from the significant advances made in oncology regarding molecular fingerprinting, which allows for the identification of specific tumor characteristics and the development of personalized therapeutic protocols. However, while this approach is strongly tumor-centered—“tumor-driven”—as endocrinologists, we aim to provide a patient-centered perspective, “patient-driven.”

In Italy, as well as internationally, it is evident that better integration of nutritionists into oncological care pathways is necessary. The nutritional approach should not be limited to critical phases, such as when a patient can no longer eat independently. It is crucial that nutritional interventions and shared protocols be implemented from the earliest stages, close to diagnosis, so that nutrition becomes a continuous support, complementing the therapies.

Unfortunately, there is still a lack of widespread understanding that nutrition is an integral part of treatment. For this reason, I firmly believe it is essential to include specific training in nutritional competence in medical degree programs, as nutrition is not just support, but a true form of therapy.

If we follow this principle, we cannot ignore that the lifespan of healthy nutrition begins at conception. The first 1,000 days of life are recognized as a unique window of opportunity for a healthier start and long-term benefits. The Lancet series on "Maternal and Child Undernutrition" has emphasized since 2008 the importance of "early life nutrition" for growth and development. Yet, recent studies by UNICEF, WHO, and the World Bank estimate that, in 2020, 45 million children under five suffered from wasting, the most lethal form of malnutrition. How does Spoke 5 address this issue?

Spoke 5 includes several projects focused on nutrition during the first 1,000 days, but also looking at the intrauterine life by studying the eating habits of pregnant women. This data is crucial for developing personalized nutritional recommendations, where we aim to integrate predictive algorithms to estimate the metabolic effects of diet. However, we also want to promote the awareness that education in healthy and sustainable eating is important for school-age children and adolescents as well. After all, they will be the future promoters of a healthy lifestyle in their families, schools, and environments, with significant implications for the well-being of the community.

Research on biomarkers of food intake has made significant progress in recent years, with the goal of developing biological indicators that can provide an objective assessment of an individual’s eating habits. Genomics, proteomics, and metabolomics are increasingly used to measure the body’s response to different dietary challenges, as responses to dietary changes can vary significantly between individuals. How are you working on this in Spoke 5?

The search for biomarkers using omics techniques (such as genomics, proteomics, and metabolomics) is crucial for understanding and monitoring the effects of diet, both daily and following specific nutritional interventions, on health in the short and long term. Thanks to funding from the PNRR, the sector has made significant progress, equipping itself with advanced instruments that allow for increasingly detailed and precise analyses.

Within Spoke 5, the partners are developing standardized and shared procedures for the storage and analysis of biomarker data. This standardization is essential to ensure the comparability of results across different experimental studies and contributes to a significant expansion of knowledge in the field of nutritional research. In this way, a solid and shared knowledge base is created, facilitating the identification of the real and objective effects of dietary patterns on health.

With about a year left until the end of the OnFoods project in 2025, it’s not yet time to wrap things up, but you likely already have a sense of what the key outcomes of Spoke 5’s research will be and the scientific legacy you aim to leave. And beyond 2025, how would you like to make the most of these three years of extraordinary research opportunity?

One of the most interesting aspects is multidisciplinarity, which is truly a valuable resource. As researchers, we are used to working in a very specialized and vertical way within our field. However, OnFoods offers us a space where it is necessary to bring together expertise from different disciplines. This greatly enriches our work. For example, my research group has conducted a study on chrononutrition, a topic very closely related to the themes explored in Planeterranea. We combined clinical expertise – that is, the analysis of the final effects on the body – with biological knowledge, which allowed us to assess the physiological changes at the root.

In our study, which is currently being published, we demonstrated how nutrition can influence hormone levels and bodily responses, which vary depending on the time of day when food is consumed. For instance, our metabolism responds differently to food eaten in the morning versus the evening, inducing varying metabolic responses. At this point, we wondered whether physical exercise might have a different impact depending on the time of day it’s performed. Indeed, we discovered that muscles respond differently depending on when they are activated. We observed that the body is able to "burn" more energy during the day, while at night, the mitochondria – the "energy factories" of our cells – operate more efficiently but at a lower energy level, making it easier to store excess energy in the form of fat.

In other words, eating more in the evening can lead to weight gain, as the body is less inclined to burn that energy and more predisposed to store it. This correlation was already known clinically, but now we can also scientifically prove it thanks to the collaborative framework that OnFoods has provided us.