Digital Resilience Biomarkers for Personalized Health Maintenance and Disease Prevention

Abstract

Health maintenance and disease prevention strategies become increasingly prioritized with increasing health and economic burden of chronic, lifestyle-related diseases. A key element in these strategies is the empowerment of individuals to control their health. Self-measurement plays an essential role in achieving such empowerment. Digital measurements have the advantage of being measured non-invasively, passively, continuously, and in a real-world context. An important question is whether such measurement can sensitively measure subtle disbalances in the progression toward disease, as well as the subtle effects of, for example, nutritional improvement. The concept of resilience biomarkers, defined as the dynamic evaluation of the biological response to an external challenge, has been identified as a viable strategy to measure these subtle effects. In this review, we explore the potential of integrating this concept with digital physiological measurements to come to digital resilience biomarkers. Additionally, we discuss the potential of wearable, non-invasive, and continuous measurement of molecular biomarkers. These types of innovative measurements may, in the future, also serve as a digital resilience biomarker to provide even more insight into the personal biological dynamics of an individual. Altogether, digital resilience biomarkers are envisioned to allow for the measurement of subtle effects of health maintenance and disease prevention strategies in a real-world context and thereby give personalized feedback to improve health.

Keywords: digital biomarker; lifestyle intervention; optical sensing; prevention; resilience; wearable sensors.

Figure 1

Conceptualization of digital resilience biomarkers. (A) The multilayer model of health with complex interactions across hierarchical layers of biological organization. (B) Digital sensors can be connected to molecules or biological processes of, e.g., glucose regulation, lipid regulation, vascular regulation, microbiome dynamics, stress regulation, and low-grade inflammation to come to a digital resilience biomarker. (C) Resilience markers are more sensitive to early and subtle derailments of biological system before disease manifests.

Figure 2

Measures of resilience with (A) the increased response of glucose to a high caloric milkshake with age and disease [data from studies described by Wopereis et al. (21) and van den Broek et al. (22)] and (B) the decrease of heart rate variability with age and disease [reprinted with permission from Sturmberg et al. (23)].