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Roman S, Campos-Medina L, Leal-Mercado L. Personalized nutrition: the end of the one-diet-fits-all era. Front Nutr 2024; 11:1370595. [PMID: 38854164 PMCID: PMC11157041 DOI: 10.3389/fnut.2024.1370595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
Personalized Nutrition emerged as a new trend for providing nutritional and food advice based on the individual's genetic composition, a field driven by the advancements in the multi-omic sciences throughout the last century. It intends not only to tailor the recommended daily allowances of nutrients and functional foods that a person may need but also to maintain the principles of sustainability and eco-friendliness. This principle implies the implementation of strategies within the healthcare system to advocate for the ending of the one-diet-fits-all paradigm by considering a personalized diet as an ally to prevent diet-related chronic diseases. In this Perspective, we highlight the potential benefits of such a paradigm within the region of Latin America, particularly Mexico, where the genetic admixture of the population, food biodiversity, and food culture provide unique opportunities to establish personalized nutrigenetic strategies. These strategies could play a crucial role in preventing chronic diseases and addressing the challenges confronted in the region.
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Affiliation(s)
- Sonia Roman
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Liliana Campos-Medina
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
- Doctoral Program in Molecular Biology in Medicine, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Leonardo Leal-Mercado
- Department of Genomic Medicine in Hepatology, Civil Hospital of Guadalajara, Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
- Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
- Doctoral Program in Molecular Biology in Medicine, Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico
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Mayes C, Meloni M. Forgetting how we ate: personalised nutrition and the strategic uses of history. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2024; 46:14. [PMID: 38453802 PMCID: PMC10920492 DOI: 10.1007/s40656-024-00613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
Personalised nutrition (PN) has emerged over the past twenty years as a promising area of research in the postgenomic era and has been popularized as the new big thing out of molecular biology. Advocates of PN claim that previous approaches to nutrition sought general and universal guidance that applied to all people. In contrast, they contend that PN operates with the principle that "one size does not fit all" when it comes to dietary guidance. While the molecular mechanisms studied within PN are new, the notion of a personal dietary regime guided by medical advice has a much longer history that can be traced back to Galen's "On Food and Diet" or Ibn Sina's (westernized as Avicenna) "Canon of Medicine". Yet this history is either wholly ignored or misleadingly appropriated by PN proponents. This (mis)use of history, we argue helps to sustain the hype of the novelty of the proposed field and potential commodification of molecular advice that undermines longer histories of food management in premodern and non-Western cultures. Moreover, it elides how the longer history of nutritional advice always happened in a heavily moralized, gendered, and racialized context deeply entwined with collective technologies of power, not just individual advice. This article aims at offering a wider appreciation of this longer history to nuance the hype and exceptionalism surrounding contemporary claims.
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Affiliation(s)
- Christopher Mayes
- School of Humanities and Social Sciences, Deakin University, Geelong, Australia.
| | - Maurizio Meloni
- School of Humanities and Social Sciences, Deakin University, Geelong, Australia
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Duarte MKRN, Leite-Lais L, Agnez-Lima LF, Maciel BLL, Morais AHDA. Obesity and Nutrigenetics Testing: New Insights. Nutrients 2024; 16:607. [PMID: 38474735 DOI: 10.3390/nu16050607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Obesity results from interactions between environmental factors, lifestyle, and genetics. In this scenario, nutritional genomics and nutrigenetic tests stand out, with the promise of helping patients avoid or treat obesity. This narrative review investigates whether nutrigenetic tests may help to prevent or treat obesity. Scientific studies in PubMed Science Direct were reviewed, focusing on using nutrigenetic tests in obesity. The work showed that few studies address the use of tools in obesity. However, most of the studies listed reported their beneficial effects in weight loss. Ethical conflicts were also discussed, as in most countries, there are no regulations to standardize these tools, and there needs to be more scientific knowledge for health professionals who interpret them. International Societies, such as the Academy of Nutrition and Dietetics and the Brazilian Association for the Study of Obesity and Metabolic Syndrome, do not recommend nutrigenetic tests to prevent or treat obesity, especially in isolation. Advancing nutrigenetics depends on strengthening three pillars: regulation between countries, scientific evidence with clinical validity, and professional training.
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Affiliation(s)
| | - Lúcia Leite-Lais
- Department of Cell Biology and Genetics, Biosciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Lucymara Fassarella Agnez-Lima
- Biochemistry and Molecular Biology Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Department of Cell Biology and Genetics, Biosciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Bruna Leal Lima Maciel
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Postgraduate Program in Nutrition, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
| | - Ana Heloneida de Araújo Morais
- Biochemistry and Molecular Biology Postgraduate Program, Biosciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Department of Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
- Postgraduate Program in Nutrition, Health Sciences Center, Federal University of Rio Grande do Norte, Natal 59078-970, RN, Brazil
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Cratsenberg DM, Jackson MK, Hanson CK, Zimmerman HH. Integrating nutrition and genetic counseling: A case study approach to interprofessional learning. J Genet Couns 2024; 33:244-249. [PMID: 38225907 DOI: 10.1002/jgc4.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 08/03/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Abstract
Interprofessional collaboration is an increasingly important skillset for practicing healthcare professionals including genetic counselors and registered dietitian nutritionists. A multi-part interactive case study activity was created to develop interprofessional skills for graduate students within genetic counseling and medical nutrition training programs at an academic medical center. Feedback from learners who participated in this activity highlights its effect on their post-graduation clinical practice. Additionally, since the implementation of this activity, collaboration between students and faculty members of each program has occurred in other scholarly pursuits, fostering longstanding interprofessional relationships. Similar approaches to interprofessional education could be considered with other healthcare professions or at other institutions as another tool to strengthen practice upon graduation.
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Affiliation(s)
- Drew M Cratsenberg
- Genetic Counseling Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mariah K Jackson
- Medical Nutrition Education Division, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Corrine K Hanson
- Medical Nutrition Education Division, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Holly H Zimmerman
- Genetic Counseling Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Nasti A, Okumura M, Takeshita Y, Ho TTB, Sakai Y, Sato TA, Nomura C, Goto H, Nakano Y, Urabe T, Nakamura S, Tamura T, Matsubara K, Takamura T, Kaneko S. The declining insulinogenic index correlates with inflammation and metabolic dysregulation in non-obese individuals assessed by blood gene expression. Diabetes Res Clin Pract 2024; 208:111090. [PMID: 38216088 DOI: 10.1016/j.diabres.2024.111090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
AIMS Diabetes onset is difficult to predict. Since decreased insulinogenic index (IGI) is observed in prediabetes, and blood gene expression correlates with insulin secretion, candidate biomarkers can be identified. METHODS We collected blood from 96 participants (54 males, 42 females) in 2008 (age: 52.5 years) and 2016 for clinical and gene expression analyses. IGI was derived from values of insulin and glucose at fasting and at 30 min post-OGTT. Two subgroups were identified based on IGI variation: "Minor change in IGI" group with absolute value variation between -0.05 and +0.05, and "Decrease in IGI" group with a variation between -20 and -0.05. RESULTS Following the comparison of "Minor change in IGI" and "Decrease in IGI" groups at time 0 (2008), we identified 77 genes correlating with declining IGI, related to response to lipid, carbohydrate, and hormone metabolism, response to stress and DNA metabolic processes. Over the eight years, genes correlating to declining IGI were related to inflammation, metabolic and hormonal dysregulation. Individuals with minor change in IGI, instead, featured homeostatic and regenerative responses. CONCLUSIONS By blood gene expression analysis of non-obese individuals, we identified potential gene biomarkers correlating to declining IGI, associated to a pathophysiology of inflammation and metabolic dysregulation.
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Affiliation(s)
- Alessandro Nasti
- Information-Based Medicine Development, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Miki Okumura
- Department of Endocrinology and Metabolism, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Yumie Takeshita
- Department of Endocrinology and Metabolism, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Tuyen Thuy Bich Ho
- Information-Based Medicine Development, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
| | - Yoshio Sakai
- Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan; Sakai Internal Medicine Clinic, Nonoichi, Ishikawa 921-8825, Japan
| | | | - Chiaki Nomura
- Department of Endocrinology and Metabolism, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Hisanori Goto
- Department of Endocrinology and Metabolism, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Yujiro Nakano
- Department of Endocrinology and Metabolism, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Takeshi Urabe
- Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, 3-8 Kuramitsu, Hakusan, Ishikawa 924-8588, Japan
| | | | - Takuro Tamura
- Research and Development Center for Precision Medicine, University of Tsukuba, Tsukuba 305-8550, Japan
| | | | - Toshinari Takamura
- Department of Endocrinology and Metabolism, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - Shuichi Kaneko
- Information-Based Medicine Development, Kanazawa University, Graduate School of Medical Sciences, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan; Department of Gastroenterology, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
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Brown JE, Pham T, Burden H, Braakhuis AJ. Specific Genotypes Associated with Differences in Fasting Insulin Levels and Body Mass Index in Healthy Young Males: Implications for Gene-Nutrient Interactions-an Exploratory Study. Curr Dev Nutr 2023; 7:102018. [PMID: 38026570 PMCID: PMC10663744 DOI: 10.1016/j.cdnut.2023.102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background Genetic variation may significantly impact an individual's susceptibility to diseases, particularly when combined with specific nutrients. Additionally, genetic variations can lead to interindividual differences in metabolic responses. Objective The present study explores the association between gene variants and observed interindividual differences in metabolic responses. Methods The study included 30 healthy males (aged 20-34) who underwent a fasting period and subsequently consumed a standardized meal. Blood samples were collected both before and after the meal to assess metabolic changes. BMI served as an indirect measure for assessing physiological responses associated with body composition. Appetite changes were assessed using an online Visual Analog 100-point Scale. Buccal swabs were collected to analyze genetic variants in single nucleotide polymorphisms (SNPs). Results The data underwent multiple regression analysis, revealing significant associations with 3 SNPs and their metabolic status: the insulin-receptor substrate 1 (IRS1) gene variant rs2943641, genotypes CT and CC, with elevated fasting insulin levels (R2 = 0.639, P = < 0.0001); the mitochondrial uncoupling protein 1 (UCP1) gene variant rs1800592, genotypes GG and GA, with increased BMI (R2 = 0.261, P = 0.007); and the peroxisome proliferator-activated receptor γ2 (PPARγ2) gene variant rs1801282, genotypes GG and GC, with increased BMI (R2 = 0.200, P = 0.024). Conclusions Therefore, our study established significant associations between these 3 SNPs and differences in fasting insulin levels and BMI within our cohort.
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Affiliation(s)
- Julie E. Brown
- The Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Toan Pham
- The Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Hannah Burden
- The Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrea J. Braakhuis
- The Discipline of Nutrition, School of Medical Sciences, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Batheja S, Schopp EM, Pappas S, Ravuri S, Persky S. Characterizing Precision Nutrition Discourse on Twitter: Quantitative Content Analysis. J Med Internet Res 2023; 25:e43701. [PMID: 37824190 PMCID: PMC10603558 DOI: 10.2196/43701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND It is possible that tailoring dietary approaches to an individual's genomic profile could provide optimal dietary inputs for biological functioning and support adherence to dietary management protocols. The science required for such nutrigenetic and nutrigenomic profiling is not yet considered ready for broad application by the scientific and medical communities; however, many personalized nutrition products are available in the marketplace, creating the potential for hype and misleading information on social media. Twitter provides a unique big data source that provides real-time information. Therefore, it has the potential to disseminate evidence-based health information, as well as misinformation. OBJECTIVE We sought to characterize the landscape of precision nutrition content on Twitter, with a specific focus on nutrigenetics and nutrigenomics. We focused on tweet authors, types of content, and presence of misinformation. METHODS Twitter Archiver was used to capture tweets from September 1, 2020, to December 1, 2020, using keywords related to nutrition and genetics. A random sample of tweets was coded using quantitative content analysis by 4 trained coders. Codebook-driven, quantified information about tweet authors, content details, information quality, and engagement metrics were compiled and analyzed. RESULTS The most common categories of tweets were precision nutrition products and nutrigenomic concepts. About a quarter (132/504, 26.2%) of tweet authors presented themselves as science experts, medicine experts, or both. Nutrigenetics concepts most frequently came from authors with science and medicine expertise, and tweets about the influence of genes on weight were more likely to come from authors with neither type of expertise. A total of 14.9% (75/504) of the tweets were noted to contain untrue information; these were most likely to occur in the nutrigenomics concepts topic category. CONCLUSIONS By evaluating social media discourse on precision nutrition on Twitter, we made several observations about the content available in the information environment through which individuals can learn about related concepts and products. Tweet content was consistent with the indicators of medical hype, and the inclusion of potentially misleading and untrue information was common. We identified a contingent of users with scientific and medical expertise who were active in discussing nutrigenomics concepts and products and who may be encouraged to share credible expert advice on precision nutrition and tackle false information as this technology develops.
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Affiliation(s)
- Sapna Batheja
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States
| | - Emma M Schopp
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
| | - Samantha Pappas
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States
| | - Siri Ravuri
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
| | - Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
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de la Garza AL, Zonenszain-Laiter Y. Análisis bioético del uso de la biotecnología genómica en la nutrición traslacional. PERSONA Y BIOÉTICA 2023. [DOI: 10.5294/pebi.2022.26.2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Los avances de la biotecnología y las fascinantes perspectivas de la genómica nutricional en el escenario de la práctica clínica conducen a la consideración de distintos aspectos que impactan en el beneficio integral del ser humano. En ese sentido, la integración de la nutrición personalizada en la atención clínica requiere de un análisis bioético centrado en la unidad de la persona que, con base en su perfil nutrigenético único, contribuya al cuidado de la salud por medio del tratamiento nutricional individualizado. El análisis bioético contempla los principios de totalidad terapéutica, libertad e integridad. Además, el uso de las pruebas nutrigenéticas destaca no solo la confidencialidad de datos, que se presupone, sino que lleva a considerar el derecho a la intimidad.
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Thomas D, Wu M, Nakauchi Y, Zheng M, Thompson-Peach CA, Lim K, Landberg N, Köhnke T, Robinson N, Kaur S, Kutyna M, Stafford M, Hiwase D, Reinisch A, Peltz G, Majeti R. Dysregulated Lipid Synthesis by Oncogenic IDH1 Mutation Is a Targetable Synthetic Lethal Vulnerability. Cancer Discov 2023; 13:496-515. [PMID: 36355448 PMCID: PMC9900324 DOI: 10.1158/2159-8290.cd-21-0218] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/18/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022]
Abstract
Isocitrate dehydrogenase 1 and 2 (IDH) are mutated in multiple cancers and drive production of (R)-2-hydroxyglutarate (2HG). We identified a lipid synthesis enzyme [acetyl CoA carboxylase 1 (ACC1)] as a synthetic lethal target in mutant IDH1 (mIDH1), but not mIDH2, cancers. Here, we analyzed the metabolome of primary acute myeloid leukemia (AML) blasts and identified an mIDH1-specific reduction in fatty acids. mIDH1 also induced a switch to b-oxidation indicating reprogramming of metabolism toward a reliance on fatty acids. Compared with mIDH2, mIDH1 AML displayed depletion of NADPH with defective reductive carboxylation that was not rescued by the mIDH1-specific inhibitor ivosidenib. In xenograft models, a lipid-free diet markedly slowed the growth of mIDH1 AML, but not healthy CD34+ hematopoietic stem/progenitor cells or mIDH2 AML. Genetic and pharmacologic targeting of ACC1 resulted in the growth inhibition of mIDH1 cancers not reversible by ivosidenib. Critically, the pharmacologic targeting of ACC1 improved the sensitivity of mIDH1 AML to venetoclax. SIGNIFICANCE Oncogenic mutations in both IDH1 and IDH2 produce 2-hydroxyglutarate and are generally considered equivalent in terms of pathogenesis and targeting. Using comprehensive metabolomic analysis, we demonstrate unexpected metabolic differences in fatty acid metabolism between mutant IDH1 and IDH2 in patient samples with targetable metabolic interventions. See related commentary by Robinson and Levine, p. 266. This article is highlighted in the In This Issue feature, p. 247.
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Affiliation(s)
- Daniel Thomas
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
- Adelaide Medical School, University of Adelaide, South Australia and Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Manhong Wu
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Yusuke Nakauchi
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ming Zheng
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Chloe A.L. Thompson-Peach
- Adelaide Medical School, University of Adelaide, South Australia and Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kelly Lim
- Adelaide Medical School, University of Adelaide, South Australia and Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Niklas Landberg
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Thomas Köhnke
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Nirmal Robinson
- Centre for Cancer Biology, University of South Australia, South Australia, Australia
| | - Satinder Kaur
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Monika Kutyna
- Adelaide Medical School, University of Adelaide, South Australia and Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Melissa Stafford
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Devendra Hiwase
- Adelaide Medical School, University of Adelaide, South Australia and Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Andreas Reinisch
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
- Division of Hematology and Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Gary Peltz
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Ravindra Majeti
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Palo Alto, California
- Corresponding Author: Ravindra Majeti, Department of Medicine, Division of Hematology, Stanford Institute for Stem Cell Biology and Regenerative Medicine, Lokey Stem Cell Building, 265 Campus Drive, Stanford, CA 94305. Phone: 650-721-6376; Fax: 650-736-2961; E-mail:
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Vasconcellos C, Ferreira O, Lopes MF, Ribeiro AF, Vasques J, Guerreiro CS. Nutritional Genomics in Nonalcoholic Fatty Liver Disease. Biomedicines 2023; 11:biomedicines11020319. [PMID: 36830856 PMCID: PMC9953045 DOI: 10.3390/biomedicines11020319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common chronic condition associated with genetic and environmental factors in which fat abnormally accumulates in the liver. NAFLD is epidemiologically associated with obesity, type 2 diabetes, and dyslipidemia. Environmental factors, such as physical inactivity and an unbalanced diet, interact with genetic factors, such as epigenetic mechanisms and polymorphisms for the genesis and development of the condition. Different genetic polymorphisms seem to be involved in this context, including variants in PNPLA3, TM6SF2, PEMT, and CHDH genes, playing a role in the disease's susceptibility, development, and severity. From carbohydrate intake and weight loss to omega-3 supplementation and caloric restriction, different dietary and nutritional factors appear to be involved in controlling the onset and progression of NAFLD conditions influencing metabolism, gene, and protein expression. The polygenic risk score represents a sum of trait-associated alleles carried by an individual and seems to be associated with NAFLD outcomes depending on the dietary context. Understanding the exact extent to which lifestyle interventions and genetic predispositions can play a role in the prevention and management of NAFLD can be crucial for the establishment of a personalized and integrative approach to patients.
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Affiliation(s)
- Carolina Vasconcellos
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Oureana Ferreira
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Marta Filipa Lopes
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - André Filipe Ribeiro
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - João Vasques
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, 1649-028 Lisboa, Portugal
| | - Catarina Sousa Guerreiro
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Correspondence:
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Roosan D, Wu Y, Tran M, Huang Y, Baskys A, Roosan MR. Opportunities to integrate nutrigenomics into clinical practice and patient counseling. Eur J Clin Nutr 2023; 77:36-44. [PMID: 35444269 DOI: 10.1038/s41430-022-01146-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little progress has been made in translating nutrigenomics knowledge into clinical counseling in the past decade. Currently, clinicians are overwhelmed by nutrigenomics information without the proper scientific guidelines on patient counseling. METHODS In this study, we conducted a scoping review of the primary literature to assess the current evidence of nutrigenomics counseling. A literature search using PRISMA guidelines identified the current challenges and opportunities facing nutrigenomics counseling in clinical practice. RESULTS We identified four main themes: inadequate training, lack of awareness, underdeveloped nutrigenomics counseling skills, and unreliable evidence-based practice information. Many clinicians did not have the necessary knowledge to perform nutrigenomic counseling and were unaware of the available scientific information source. Moreover, there are no guidelines in the scientific community to counsel patients on nutrigenomics testing. CONCLUSION Opportunities exist for government and non-government entities to create an evidence-based information platform using clinical guidelines to integrate nutrigenomics knowledge from bench to bedside successfully.
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Affiliation(s)
- Don Roosan
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
| | - Yanting Wu
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Michael Tran
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Ying Huang
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA
| | - Andrius Baskys
- Graduate College of Biomedical Sciences, Western University of Health Sciences, Pomona, CA, USA
| | - Moom R Roosan
- School of Pharmacy, Chapman University, Irvine, CA, USA
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12
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Olive Oil in the Mediterranean Diet and Its Biochemical and Molecular Effects on Cardiovascular Health through an Analysis of Genetics and Epigenetics. Int J Mol Sci 2022; 23:ijms232416002. [PMID: 36555645 PMCID: PMC9782563 DOI: 10.3390/ijms232416002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/27/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Human nutrition is a relatively new science based on biochemistry and the effects of food constituents. Ancient medicine considered many foods as remedies for physical performance or the treatment of diseases and, since ancient times, especially Greek, Asian and pre-Christian cultures similarly thought that they had beneficial effects on health, while others believed some foods were capable of causing illness. Hippocrates described the food as a form of medicine and stated that a balanced diet could help individuals stay healthy. Understanding molecular nutrition, the interaction between nutrients and DNA, and obtaining specific biomarkers could help formulate a diet in which food is not only a food but also a drug. Therefore, this study aims to analyze the role of the Mediterranean diet and olive oil on cardiovascular risk and to identify their influence from the genetic and epigenetic point of view to understand their possible protective effects.
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13
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Greyvensteyn D, Walsh CM, Nel M, Jordaan EM. Nutrigenomics: Perceptions of South African Dietitians and General Practitioners. Lifestyle Genom 2022; 16:11-20. [PMID: 36349789 DOI: 10.1159/000526898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/28/2022] [Indexed: 12/22/2023] Open
Abstract
INTRODUCTION Although investigations into the emerging field of nutrigenomics are relatively limited and more research in this field is required, experts agree that there is potential for it to be incorporated into health care practice. If health care professionals can promote healthy dietary behavior based on nutrigenomic testing, it can assist in addressing the health consequences of poor diet and lightning the strain on the South African health care system. METHODS Registered dietitians (RDs) and general practitioners (GPs) registered with the Health Professions Council of South Africa (HPCSA) who obtained their qualification in South Africa (SA) were eligible to participate in this cross-sectional study. Participants were identified using convenience and snowball sampling. A self-administered electronic survey using EvaSys Software® was completed by those that agreed to participate. RESULTS Nearly all RDs (97.3%), but less than a third of GPs (30.4%), had heard of the term nutrigenomics. Approximately three-quarters of RDs (74.7%) and GPs (73.9%) had or would personally consider undergoing genetic testing. More than 40% (43.5%) of RDs ranked direct-to-consumer genetic testing companies as the most equipped, while 31.8% of GPs ranked RDs as the most equipped to provide patients with nutrigenomic services. Both RDs and GPs ranked similar reasons as "strongly agree" for why consumers were motivated to make use of nutrigenomic services, which included "motivated by a desire to prevent or manage disease" (56.7%), "prevent a disease based on family history" (65.9%), "control health outcomes based on family history" (54.9%), and "improve overall health-related quality of life" (48.6%). Cost concerns were reported as the greatest barrier to implementing nutrigenomic services (75.7%). Other barriers included confidentiality issues (47.8%) and moral concerns (37.3%). Greater individualization of diet prescription (66.5%), stronger foundations for nutrition recommendations (62.4%), and dietary prescriptions that would manage or prevent certain diseases more effectively (59.0%) were all perceived as benefits of including nutrigenomics in practice. CONCLUSION This study identified perceived consumer motivators and barriers that might affect the willingness to seek nutrigenomic services in SA. In addition, the need for more nutrigenomic training opportunities, including the planning of personalized diets based on genetic testing results and interpretation of results, was confirmed. However, both RDs and GPs felt that the emerging field of nutrigenomics needs further development before it can be applied effectively in routine private and public health care in SA.
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Affiliation(s)
- Desiré Greyvensteyn
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Corinna May Walsh
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Mariette Nel
- Department of Biostatistics, School of Biomedical Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Elizabeth Margaretha Jordaan
- Department of Nutrition and Dietetics, School of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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14
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Iłowiecka K, Glibowski P, Libera J, Koch W. Changes in Novel Anthropometric Indices of Abdominal Obesity during Weight Loss with Selected Obesity-Associated Single-Nucleotide Polymorphisms: A Small One-Year Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11837. [PMID: 36142109 PMCID: PMC9517315 DOI: 10.3390/ijerph191811837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/13/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
Whether BMI and the competing waist circumference (WC)-based anthropometric indices are associated with obesity-related single-nucleotide polymorphisms (SNPs) is as yet unknown. The current study aimed to evaluate the anthropometric indices (fat mass index, body shape index, visceral adiposity index, relative fat mass, body roundness index, and conicity index) during a weight loss intervention in 36 obese individuals. Blood biochemical parameters (total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides) and three SNPs (FTO rs9939609, TFAP2B rs987237, and PLIN1 rs894160) were assessed in 22 women and 14 men (35.58 ± 9.85 years, BMI 35.04 ± 3.80 kg/m2) who completed a 12-month balanced energy-restricted diet weight loss program. Body composition was assessed via bioelectrical impedance (SECA mBCA515). At the end of the weight loss intervention, all anthropometric indices were significantly reduced (p < 0.05). For the SNP FTO rs9939609, the higher risk allele (A) was characteristic of 88.9% of the study group, in which 10 participants (27.8%) were homozygous. We found a similar distribution of alleles in TFAP2B and PLIN1. Heterozygous genotypes in FTO rs9939609 and TFAP2B rs987237 were predisposed to significant reductions in WC-based novel anthropometric indices during weight loss. The influence of PLIN1 rs894160 polymorphisms on the changes in the analyzed indices during weight loss has not been documented in the present study.
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Affiliation(s)
- Katarzyna Iłowiecka
- Department of Food and Nutrition, Medical University of Lublin, 4a Chodźki Str., 20-093 Lublin, Poland
| | - Paweł Glibowski
- Department of Biotechnology, Microbiology and Human Nutrition, University of Life Science in Lublin, 8 Skromna Str., 20-704 Lublin, Poland
| | - Justyna Libera
- Division of Engineering and Cereals Technology, Department of Plant Food Technology and Gastronomy, University of Life Sciences, 8 Skromna Str., 20-704 Lublin, Poland
| | - Wojciech Koch
- Department of Food and Nutrition, Medical University of Lublin, 4a Chodźki Str., 20-093 Lublin, Poland
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15
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dos Santos K, Rosado EL, da Fonseca ACP, Belfort GP, da Silva LBG, Ribeiro-Alves M, Zembrzuski VM, Martínez JA, Saunders C. FTO and ADRB2 Genetic Polymorphisms Are Risk Factors for Earlier Excessive Gestational Weight Gain in Pregnant Women with Pregestational Diabetes Mellitus: Results of a Randomized Nutrigenetic Trial. Nutrients 2022; 14:1050. [PMID: 35268025 PMCID: PMC8912276 DOI: 10.3390/nu14051050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/16/2022] Open
Abstract
Excessive gestational weight gain (GWG) is associated with increased risk of maternal and neonatal complications. We investigated obesity-related polymorphisms in the FTO gene (rs9939609, rs17817449) and ADRB2 (rs1042713, rs1042714) as candidate risk factors concerning excessive GWG in pregnant women with pregestational diabetes. This nutrigenetic trial, conducted in Brazil, randomly assigned 70 pregnant women to one of the groups: traditional diet (n = 41) or DASH diet (n = 29). Excessive GWG was the total weight gain above the upper limit of the recommendation, according to the Institute of Medicine guidelines. Genotyping was performed using real-time PCR. Time-to-event analysis was performed to investigate risk factors for progression to excessive GWG. Regardless the type of diet, AT carriers of rs9939609 (FTO) and AA carriers of rs1042713 (ADRB2) had higher risk of earlier exceeding GWG compared to TT (aHR 2.44; CI 95% 1.03-5.78; p = 0.04) and GG (aHR 3.91; CI 95% 1.12-13.70; p = 0.03) genotypes, respectively, as the AG carriers for FTO haplotype rs9939609:rs17817449 compared to TT carriers (aHR 1.79; CI 95% 1.04-3.06; p = 0.02).
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Affiliation(s)
- Karina dos Santos
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil; (K.d.S.); (E.L.R.); (G.P.B.); (L.B.G.d.S.)
| | - Eliane Lopes Rosado
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil; (K.d.S.); (E.L.R.); (G.P.B.); (L.B.G.d.S.)
| | - Ana Carolina Proença da Fonseca
- Laboratório de Genética Humana, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Pavilhão Leônidas Deane, Avenida Brasil 4365, Rio de Janeiro 21040-360, Brazil; (A.C.P.d.F.); (V.M.Z.)
| | - Gabriella Pinto Belfort
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil; (K.d.S.); (E.L.R.); (G.P.B.); (L.B.G.d.S.)
| | - Letícia Barbosa Gabriel da Silva
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil; (K.d.S.); (E.L.R.); (G.P.B.); (L.B.G.d.S.)
| | - Marcelo Ribeiro-Alves
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil 4365, Rio de Janeiro 21040-360, Brazil;
| | - Verônica Marques Zembrzuski
- Laboratório de Genética Humana, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Pavilhão Leônidas Deane, Avenida Brasil 4365, Rio de Janeiro 21040-360, Brazil; (A.C.P.d.F.); (V.M.Z.)
| | - J. Alfredo Martínez
- Precision Nutrition and Cardiometabolic Health Program, IMDEA Food Institute, Crta. de Canto Blanco, n 8, E-28049 Madrid, Spain;
| | - Cláudia Saunders
- Programa de Pós-Graduação em Nutrição, Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Avenida Carlos Chagas Filho, 373-Bloco J 2° andar, Cidade Universitária, Rio de Janeiro 21941-902, Brazil; (K.d.S.); (E.L.R.); (G.P.B.); (L.B.G.d.S.)
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16
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Nacis JS, Galang MR, Labrador JPH, Gonzales MS, Dablo AMFD, Domalanta-Ronquillo DGA, Alfonso VFJ, Glorioso IG, Rodriguez MP. "Right diet for the right person": a focus group study of nutritionist-dietitians' perspectives on nutritional genomics and gene-based nutrition advice. J Community Genet 2022; 13:49-57. [PMID: 34705214 PMCID: PMC8799789 DOI: 10.1007/s12687-021-00560-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022] Open
Abstract
Advances in nutritional genomics are intended to revolutionize nutrition practice. A basic understanding of nutritional genomics among nutritionist-dietitians is critical for such advancements to occur. As a precedent to the development and integration of gene-based nutrition advice, this study aimed to assess hospital-based nutritionist-dietitians' perceptions of nutritional genomics. A total of ten focus group discussions (FGDs) with sixty-one registered nutritionist-dietitians (RNDs) from hospitals in the National Capital Region (NCR), Philippines, were conducted from October to November 2019. Data were collected using a pretested semistructured discussion guide, and thematic analysis was subsequently performed. Diverging perceptions about nutritional genomics were noted among the FGD participants. Five themes emerged relating to the enablers and barriers of gene-based nutrition advice: training and capacity building, the extent of information to be disclosed, cost, ethical considerations, and government support. Themes related to the desired features of the gene-based nutrition advice included being consent-driven, cost-effective, technology-oriented, and guided by standards. The results of this study suggest that training and continued learning will equip RNDs to provide nutrition advice based on genetic information. However, other factors, such as cost and ethical considerations, are critical dimensions that need to be acknowledged and addressed before integrating gene-based advice into nutrition practice.
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Affiliation(s)
- Jacus S Nacis
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines.
- Nutrition and Food Research and Development Division, Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), General Santos Avenue, Bicutan, 1631, Taguig City, Metro Manila, Philippines.
| | - Marilou R Galang
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines
| | - Jason Paolo H Labrador
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines
| | - Milflor S Gonzales
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines
| | - Aurora Maria Francesca D Dablo
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines
| | | | - Victor Franco J Alfonso
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines
| | - Idelia G Glorioso
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines
| | - Marietta P Rodriguez
- Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI), 1631, Taguig City, Metro Manila, Philippines
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17
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Wiechert M, Holzapfel C. Nutrition Concepts for the Treatment of Obesity in Adults. Nutrients 2021; 14:169. [PMID: 35011045 PMCID: PMC8747374 DOI: 10.3390/nu14010169] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity caused by a positive energy balance is a serious health burden. Studies have shown that obesity is the major risk factor for many diseases like type 2 diabetes mellitus, coronary heart diseases, or various types of cancer. Therefore, the prevention and treatment of increased body weight are key. Different evidence-based treatment approaches considering weight history, body mass index (BMI) category, and co-morbidities are available: lifestyle intervention, formula diet, drugs, and bariatric surgery. For all treatment approaches, behaviour change techniques, reduction in energy intake, and increasing energy expenditure are required. Self-monitoring of diet and physical activity provides an effective behaviour change technique for weight management. Digital tools increase engagement rates for self-monitoring and have the potential to improve weight management. The objective of this narrative review is to summarize current available treatment approaches for obesity, to provide a selective overview of nutrition trends, and to give a scientific viewpoint for various nutrition concepts for weight loss.
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Affiliation(s)
| | - Christina Holzapfel
- Institute for Nutritional Medicine, School of Medicine, Technical University of Munich, 80992 Munich, Germany;
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18
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The Role of miR-155 in Nutrition: Modulating Cancer-Associated Inflammation. Nutrients 2021; 13:nu13072245. [PMID: 34210046 PMCID: PMC8308226 DOI: 10.3390/nu13072245] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023] Open
Abstract
Nutrition plays an important role in overall human health. Although there is no direct evidence supporting the direct involvement of nutrition in curing disease, for some diseases, good nutrition contributes to disease prevention and our overall well-being, including energy level, optimum internal function, and strength of the immune system. Lately, other major, but more silent players are reported to participate in the body’s response to ingested nutrients, as they are involved in different physiological and pathological processes. Furthermore, the genetic profile of an individual is highly critical in regulating these processes and their interactions. In particular, miR-155, a non-coding microRNA, is reported to be highly correlated with such nutritional processes. In fact, miR-155 is involved in the orchestration of various biological processes such as cellular signaling, immune regulation, metabolism, nutritional responses, inflammation, and carcinogenesis. Thus, this review aims to highlight those critical aspects of the influence of dietary components on gene expression, primarily on miR-155 and its role in modulating cancer-associated processes.
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19
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Karamanoglu I, Nielsen DE. Healthcare Professional Clinical Actions following Nutrigenomics Testing in Practice. Public Health Genomics 2020; 23:237-245. [DOI: 10.1159/000511785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Clinical demand for nutrigenomics testing (NGT) is increasing, underscoring the importance of assessing healthcare professional (HCP) competence and clinical actions with NGT in practice. While previous studies have explored HCP perceptions of NGT, no study has examined real HCP experiences with NGT in practice. <b><i>Objective:</i></b> The objective of this study was to evaluate the clinical experience of providing NGT among early adopter HCPs who have used NGT in their practice. We hypothesized that HCP clinical actions after NGT would differ according to HCP personal experience undergoing genetic testing (GT) as well as years in practice. <b><i>Design:</i></b> An online survey questionnaire was administered to HCPs (<i>n</i> = 70) who have provided NGT in practice. χ<sup>2</sup> tests, tests for trend, and logistic regression were used to compare HCP characteristics with post-NGT outcomes. <b><i>Results:</i></b> HCPs with fewest years in practice (<5 years) comprised the lowest proportion of respondents (16%). Most HCPs reported good understanding of NGT results and 92% made genetic-based dietary recommendations to patients following NGT. HCP personal use of GT increased significantly with increasing years in practice (<5 years: 36%, 5–10 years: 53%, 11–20 years: 70%, and >20 years: 85%, <i>p</i> trend = 0.003). Requesting patient bloodwork because of NGT results increased significantly with HCP years in practice when HCPs with <5 years in practice were not considered (5–10 years: 19%, 11–20 years: 28%, and >20 years: 60%, <i>p</i> trend = 0.010). A near significant difference was observed where a greater proportion of HCPs who had personally undergone GT reported requesting patient bloodwork (personal use: 46% vs. no personal use: 23%, <i>p</i>-χ<sup>2</sup> = 0.066). <b><i>Conclusion:</i></b> Early HCP adopters of NGT utilize the test results to provide genetic-based dietary recommendations to patients. Clinical action after NGT currently appears to be driven by HCP years in practice, but HCP personal use of GT may also be a factor.
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20
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Knowledge, opinions and expectations of adults concerning personalised genotype-based dietary recommendations: a German survey. Public Health Nutr 2020; 24:1916-1926. [PMID: 33070793 PMCID: PMC8094433 DOI: 10.1017/s1368980020004152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective: To assess the knowledge, opinions and expectations of persons with and without obesity concerning personalised genotype-based nutrition. Design: Questions about nutrition, weight management and personalised genotype-based dietary recommendations were asked via standardised telephone-based interviews. Sociodemographic and anthropometric data were collected. The data were statistically weighted by age, gender, education, domicile and BMI. Setting: Germany. Participants: Representative sample of the German population (n 1003) randomly sampled via a scientific Random Digit dial method plus 354 adults with a BMI ≥ 30·0 kg/m2 to enlarge the sample. Results: Data of 1357 participants were analysed (51·1 % female, age: 50·5 ± 18·5 years, 15·9 % adults with a BMI ≥ 30·0 kg/m2). About 42 % or 19 % of the survey participants stated to know the terms personalised dietary recommendation or genotype-based dietary recommendation, respectively. Of those, 15·8 % indicated to have an experience with a personalised or genotype-based dietary recommendation. Almost 70 % of the survey participants believed that a genotype-based dietary recommendation is a reasonable measure for weight management. About 55 % of the survey participants pointed out that a genotype-based dietary recommendation is an effective concept in general. One-third of the survey participants (34·6 %) indicated to conceive the usage of a genotype-based dietary recommendation. Conclusion: Most of the survey participants did not know the term personalised or genotype-based dietary recommendation. One-third of the study participants are interested to use a genotype-based dietary recommendation. Therefore, more education of the public is necessary to properly help people making informed and serious decisions and assessing commercially available direct-to-consumer genetic tests.
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21
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Mullins VA, Bresette W, Johnstone L, Hallmark B, Chilton FH. Genomics in Personalized Nutrition: Can You "Eat for Your Genes"? Nutrients 2020; 12:E3118. [PMID: 33065985 PMCID: PMC7599709 DOI: 10.3390/nu12103118] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
Genome-wide single nucleotide polymorphism (SNP) data are now quickly and inexpensively acquired, raising the prospect of creating personalized dietary recommendations based on an individual's genetic variability at multiple SNPs. However, relatively little is known about most specific gene-diet interactions, and many molecular and clinical phenotypes of interest (e.g., body mass index [BMI]) involve multiple genes. In this review, we discuss direct to consumer genetic testing (DTC-GT) and the current potential for precision nutrition based on an individual's genetic data. We review important issues such as dietary exposure and genetic architecture addressing the concepts of penetrance, pleiotropy, epistasis, polygenicity, and epigenetics. More specifically, we discuss how they complicate using genotypic data to predict phenotypes as well as response to dietary interventions. Then, several examples (including caffeine sensitivity, alcohol dependence, non-alcoholic fatty liver disease, obesity/appetite, cardiovascular, Alzheimer's disease, folate metabolism, long-chain fatty acid biosynthesis, and vitamin D metabolism) are provided illustrating how genotypic information could be used to inform nutritional recommendations. We conclude by examining ethical considerations and practical applications for using genetic information to inform dietary choices and the future role genetics may play in adopting changes beyond population-wide healthy eating guidelines.
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Affiliation(s)
- Veronica A. Mullins
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85719, USA; (V.A.M.); (W.B.)
| | - William Bresette
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85719, USA; (V.A.M.); (W.B.)
| | - Laurel Johnstone
- The BIO5 Institute, University of Arizona, Tucson, AZ 85719, USA; (L.J.); (B.H.)
| | - Brian Hallmark
- The BIO5 Institute, University of Arizona, Tucson, AZ 85719, USA; (L.J.); (B.H.)
| | - Floyd H. Chilton
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85719, USA; (V.A.M.); (W.B.)
- The BIO5 Institute, University of Arizona, Tucson, AZ 85719, USA; (L.J.); (B.H.)
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22
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Fischer ML, Cini RDA, Zanata AA, Nohama N, Hashimoto MS, Da Rocha VB, Rosaneli CF. Panorama da nutrigenômica no Brasil sob a perspectiva da Bioética. REVISTA LATINOAMERICANA DE BIOÉTICA 2020. [DOI: 10.18359/rlbi.3475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A nutrigenômica tem configurado, no meio científico e popular, como alternativa para prevenir doenças, cuja predisposição determinada geneticamente pode ser evitada ou estimulada, de- pendendo do ambiente no qual o indivíduo se insere. Este estudo questionou o potencial da nutrigenômica em mitigar ou gerar vulnerabilidades. Objetivou-se traçar o panorama da nutrigenômica no Brasil sob a perspectiva da Bioética. O estudo consistiu em um mapeamento quantitativo do panora- ma da nutrigenômica no cenário científico e popular do Brasil, e em uma análise bibliográfica exploratória com o intuito de identificar os agentes e pacientes morais, bem como as vulnerabilidades com vistas a promover uma reflexão à luz da Bioética. O cenário da nutrigenômica no Brasil, elaborado a partir de 18 textos científicos e de 600 conteúdos populares, indicou a prematuridade da área no contexto científico em confronto com uma ampla incorporação pelo meio popular. A incorporação da Bioética na questão foi analisada em 44 artigos científicos, a partir dos quais foram identificados como aspectos condicionantes de decisões do agente moral os contextos filosófico, biológico, cultural, legal e sanitário nos quais se insere. Foram elencadas as vulnerabilidades e mudanças de paradigmas necessárias para sua implementação no Brasil, a fim de diminuir o potencial de geração de vulnerabilidades. A Bioética pode e deve ter uma atuação mais ampla e efetiva nas questões da nutrigenômica ao normatizar, balizar e orientar o desenvolvimento dessa área promissora. Assim, deve visar às mudanças de paradigmas da ciência, dos profissionais, do mercado, do paciente e do consumidor para serem suprimidos os aspectos potenciais de geração das vulnerabilidades identificadas e contribuir para a qualidade de vida de todos os seres vivos desta e de futuras gerações.
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Integrative Nutrition CARE in the Community-Starting with Pharmacists. PHARMACY 2020; 8:pharmacy8030170. [PMID: 32933158 PMCID: PMC7557542 DOI: 10.3390/pharmacy8030170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Dietary supplementation is increasingly sought after by consumers looking to meet the demands of a modern lifestyle. Effective supplementation requires knowledge of the purpose and proper use of nutritional supplements. Unverified or inadequate guidance on supplementation can propagate misconceptions and increase undue fears of side effects. Community pharmacists are best placed to guide consumers on nutritional supplement use. In this review, a panel comprised of community pharmacists, pharmacy academia, and dietitians (n = 6) convened to provide an experience- and evidence-based guidance on rational drug use, patient education, and integrated and personalized nutrition care in both community and hospital pharmacy settings. A novel framework to guide community pharmacist-led consultations on supplementation is proposed. The four-step CARE (Categorize, Assess, Recommend, Empower) guide was developed to facilitate and optimize outcomes of pharmacist-led nutritional supplement consultation. Telehealth advancements in the form of digital health applications and personalized nutrigenomic DNA testing support Integrative Nutrition Care, and will further promote appropriate supplementation use to improve overall well-being in the community. Practical implementation of the CARE guide is necessary to ascertain its applicability for optimizing outcomes of pharmacist-led consultation and the recommendation of nutritional supplements.
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Braakhuis A, Monnard CR, Ellis A, Rozga M. Consensus Report of the Academy of Nutrition and Dietetics: Incorporating Genetic Testing into Nutrition Care. J Acad Nutr Diet 2020; 121:545-552. [PMID: 32624395 DOI: 10.1016/j.jand.2020.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Indexed: 12/15/2022]
Abstract
Personalization of nutrition advice is a process already familiar to registered dietitian nutritionists, but it is not yet clear whether incorporating genetic results as an added layer of precision improves nutrition-related outcomes. Therefore, an independent workgroup of experts, supported by the Academy's Evidence Analysis Center staff, conducted a systematic review to examine the level of evidence measuring the effect of incorporating genetic testing results into nutrition counseling and care, compared to an alternative intervention or control group, on nutrition-related outcomes. This systematic review revealed that only weak quality evidence is available in the scientific literature and observed that this field is still maturing. Therefore, at present, there is insufficient scientific evidence to determine whether there are effects of incorporating genetic testing into nutrition practice. The workgroup prepared this Consensus Report based on this systematic review to provide considerations for the practical application of incorporating genetic testing into the nutrition care process.
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Affiliation(s)
- Andrea Braakhuis
- Faculty of Medical and Health Science, Discipline of Nutrition, The University of Auckland, Grafton, Auckland, New Zealand
| | | | - Amy Ellis
- University of Alabama, Tuscaloosa, AL
| | - Mary Rozga
- Academy of Nutrition and Dietetics Evidence Analysis Center, Chicago, IL.
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Robinson K, Rozga M, Braakhuis A, Ellis A, Monnard CR, Sinley R, Wanner A, Vargas AJ. Effect of Incorporating Genetic Testing Results into Nutrition Counseling and Care on Dietary Intake: An Evidence Analysis Center Systematic Review-Part I. J Acad Nutr Diet 2020; 121:553-581.e3. [PMID: 32624394 DOI: 10.1016/j.jand.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Indexed: 12/15/2022]
Abstract
Consumer interest in personalized nutrition based on nutrigenetic testing is growing. Recently, multiple, randomized controlled trials have sought to understand whether incorporating genetic information into dietary counseling alters dietary outcomes. The objective of this systematic review was to examine how incorporating genetic information into nutrition counseling and care, compared to an alternative intervention or control group, impacts dietary outcomes. This is the first of a 2-part systematic review series. Part II reports anthropometric, biochemical, and disease-specific outcomes. Peer-reviewed randomized controlled trials were identified through a systematic literature search of multiple databases, screened for eligibility, and critically reviewed and synthesized. Conclusion statements were graded to determine quality of evidence for each dietary outcome reported. Reported outcomes include intake of total energy and macronutrients, micronutrients, foods, food groups, food components (added sugar, caffeine, and alcohol), and composite diet scores. Ten articles representing 8 unique randomized controlled trials met inclusion criteria. Of 15 conclusion statements (evidence grades: Weak to Moderate), 13 concluded there was no significant effect of incorporating genetic information into nutrition counseling/care on dietary outcomes. Limited data suggested that carriers of higher-risk gene variants were more likely than carriers of low-risk gene variants to significantly reduce intake of sodium and alcohol in response to nutrition counseling that incorporated genetic results. Included studies differed in quality, selected genetic variants, timing and intensity of intervention, sample size, dietary assessment tools, and population characteristics. Therefore, strong conclusions could not be drawn. Collaboration between the Academy of Nutrition and Dietetics and professional nutrigenetic societies would likely prove valuable in prioritizing which genetic variants and targeted nutrition messages have the most potential to alter dietary outcomes in a given patient subpopulation and, thus, should be the targets of future research.
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Affiliation(s)
- Katie Robinson
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, OH
| | - Mary Rozga
- Academy of Nutrition and Dietetics, Evidence Analysis Center, Chicago, IL.
| | - Andrea Braakhuis
- Faculty of Medical and Health Science, Discipline of Nutrition, The University of Auckland, Grafton, Auckland, New Zealand
| | - Amy Ellis
- University of Alabama, Tuscaloosa, AL
| | | | | | | | - Ashley J Vargas
- National Institutes of Health, Office of Disease Prevention, Rockville, MD
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Chowanadisai W, Hart MD, Strong MD, Graham DM, Rucker RB, Smith BJ, Keen CL, Messerli MA. Genetic and Genomic Advances in Developmental Models: Applications for Nutrition Research. Adv Nutr 2020; 11:971-978. [PMID: 32135011 PMCID: PMC7360451 DOI: 10.1093/advances/nmaa022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/22/2019] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
There is increasing appreciation that dietary components influence and interact with genes important to metabolism. How such influences impact developmental regulation and programming or risks of chronic diseases remains unclear. Nutrition is recognized to affect development and chronic diseases, but our understanding about how genes essential to nutrient metabolism regulate development and impact risks of these diseases remains unclear. Historically, mammalian models, especially rodents such as rats and mice, have been the primary models used for nutrition and developmental nutrition science, although their complexity and relatively slow rate of development often compromise rapid progress in resolving fundamental, genetic-related questions. Accordingly, the objective of this review is to highlight the opportunities for developmental models in the context of uncovering the function of gene products that are relevant to human nutrition and provide the scientific bases for these opportunities. We present recent studies in zebrafish related to obesity as applications of developmental models in nutritional science. Although the control of external factors and dependent variables, such as nutrition, can be a challenge, suggestions for standardizations related to diet are made to improve consistency in findings between laboratories. The review also highlights the need for standardized diets across different developmental models, which could improve consistency in findings across laboratories. Alternative and developmental animal models have advantages and largely untapped potential for the advancement of nutrigenomics and nutritionally relevant research areas.
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Affiliation(s)
- Winyoo Chowanadisai
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Matthew D Hart
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Morgan D Strong
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - David M Graham
- Department of Biology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Robert B Rucker
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Brenda J Smith
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA
| | - Carl L Keen
- Department of Nutrition, University of California, Davis, Davis, CA, USA
| | - Mark A Messerli
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD, USA
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Rogers PC, Barr RD. The relevance of nutrition to pediatric oncology: A cancer control perspective. Pediatr Blood Cancer 2020; 67 Suppl 3:e28213. [PMID: 32096351 DOI: 10.1002/pbc.28213] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 02/06/2023]
Abstract
It is indisputable that adequate and appropriate nutrition is fundamental to the health, growth, and development of infants, children, and adolescents, including those with cancer. Nutrition has a role in most of the accepted components of the cancer control spectrum, from prevention through to palliation. The science of nutrigenomics, nutrigenetics, and bioactive foods (phytochemicals), and how nutrition affects cancer biology and cancer treatment, is growing. Nutritional epigenetics is giving us an understanding that there are possible primary prevention strategies for pediatric cancers, especially during conception and pregnancy, which need to be studied. Primary prevention of cancer in adults, such as colorectal cancer, should commence early in childhood, given the long gestation of nutritionally related cancers. Obesity avoidance is definitely a target for both pediatric and adult cancer prevention, commencing in childhood. There is now compelling evidence that the nutritional status of children with cancer, both overweight and underweight, does affect cancer outcomes. This is a potentially modifiable prognostic factor. Consistent longitudinal nutritional assessment of patients from diagnosis through treatment and long-term follow-up is required so that interventions can be implemented and evaluated. While improving, there remains a dearth of basic and clinical nutritional research in pediatric oncology. The perspective of evaluating nutrition as a cancer control factor is discussed in this article.
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Affiliation(s)
- Paul C Rogers
- British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada
| | - Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Canada
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Ramalho R, Rao M, Zhang C, Agrati C, Ippolito G, Wang FS, Zumla A, Maeurer M. Immunometabolism: new insights and lessons from antigen-directed cellular immune responses. Semin Immunopathol 2020; 42:279-313. [PMID: 32519148 PMCID: PMC7282544 DOI: 10.1007/s00281-020-00798-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023]
Abstract
Modulation of immune responses by nutrients is an important area of study in cellular biology and clinical sciences in the context of cancer therapies and anti-pathogen-directed immune responses in health and disease. We review metabolic pathways that influence immune cell function and cellular persistence in chronic infections. We also highlight the role of nutrients in altering the tissue microenvironment with lessons from the tumor microenvironment that shapes the quality and quantity of cellular immune responses. Multiple layers of biological networks, including the nature of nutritional supplements, the genetic background, previous exposures, and gut microbiota status have impact on cellular performance and immune competence against molecularly defined targets. We discuss how immune metabolism determines the differentiation pathway of antigen-specific immune cells and how these insights can be explored to devise better strategies to strengthen anti-pathogen-directed immune responses, while curbing unwanted, non-productive inflammation.
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Affiliation(s)
- Renata Ramalho
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, U4585 FCT), Applied Nutrition Studies Group G.E.N.A.-IUEM), Instituto Universitário Egas Moniz, Egas Moniz Higher Education School, Monte de Caparica, Portugal
| | - Martin Rao
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Chao Zhang
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | | | | | - Fu-Sheng Wang
- Treatment and Research Center for Infectious Diseases, The Fifth Medical Center of PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - Markus Maeurer
- ImmunoSurgery Unit, Champalimaud Centre for the Unknown, Lisbon, Portugal.
- I Medizinische Klinik, Johannes Gutenberg University Mainz, Mainz, Germany.
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29
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Corrêa TAF, Quintanilha BJ, Norde MM, Pinhel MADS, Nonino CB, Rogero MM. Nutritional genomics, inflammation and obesity. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2020; 64:205-222. [PMID: 32555987 PMCID: PMC10522224 DOI: 10.20945/2359-3997000000255] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/13/2020] [Indexed: 11/23/2022]
Abstract
The Human Genome Project has significantly broadened our understanding of the molecular aspects regulating the homeostasis and the pathophysiology of different clinical conditions. Consequently, the field of nutrition has been strongly influenced by such improvements in knowledge - especially for determining how nutrients act at the molecular level in different conditions, such as obesity, type 2 diabetes, cardiovascular disease, and cancer. In this manner, characterizing how the genome influences the diet and vice-versa provides insights about the molecular mechanisms involved in chronic inflammation-related diseases. Therefore, the present review aims to discuss the potential application of Nutritional Genomics to modulate obesity-related inflammatory responses. Arch Endocrinol Metab. 2020;64(3):205-22.
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Affiliation(s)
- Telma Angelina Faraldo Corrêa
- Departamento de Alimentos e Nutrição ExperimentalFaculdade de Ciências FarmacêuticasUniversidade de São PauloSão PauloSPBrasil Departamento de Alimentos e Nutrição Experimental , Faculdade de Ciências Farmacêuticas , Universidade de São Paulo (USP), São Paulo , SP , Brasil
- Centro de Pesquisa em AlimentosCentros de Pesquisa, Inovação e DifusãoFundação de Amparo à Pesquisa do Estado de São PauloSão PauloSPBrasil Centro de Pesquisa em Alimentos (FoRC), Centros de Pesquisa, Inovação e Difusão (Cepid), Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp), São Paulo , SP , Brasil
| | - Bruna Jardim Quintanilha
- Centro de Pesquisa em AlimentosCentros de Pesquisa, Inovação e DifusãoFundação de Amparo à Pesquisa do Estado de São PauloSão PauloSPBrasil Centro de Pesquisa em Alimentos (FoRC), Centros de Pesquisa, Inovação e Difusão (Cepid), Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp), São Paulo , SP , Brasil
- Departamento de NutriçãoFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasil Laboratório de Genômica Nutricional e Inflamação, Departamento de Nutrição , Faculdade de Saúde Pública , Universidade de São Paulo (USP), São Paulo , SP , Brasil
| | - Marina Maintinguer Norde
- Departamento de NutriçãoFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasil Laboratório de Genômica Nutricional e Inflamação, Departamento de Nutrição , Faculdade de Saúde Pública , Universidade de São Paulo (USP), São Paulo , SP , Brasil
| | - Marcela Augusta de Souza Pinhel
- Departamento de Medicina InternaFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Departamento de Medicina Interna , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo (USP), Ribeirão Preto , SP , Brasil
- Departamento de Ciências da SaúdeFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Departamento de Ciências da Saúde , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo (USP), Ribeirão Preto , SP , Brasil
| | - Carla Barbosa Nonino
- Departamento de Medicina InternaFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Departamento de Medicina Interna , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo (USP), Ribeirão Preto , SP , Brasil
- Departamento de Ciências da SaúdeFaculdade de Medicina de Ribeirão PretoUniversidade de São PauloRibeirão PretoSPBrasil Departamento de Ciências da Saúde , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo (USP), Ribeirão Preto , SP , Brasil
| | - Marcelo Macedo Rogero
- Centro de Pesquisa em AlimentosCentros de Pesquisa, Inovação e DifusãoFundação de Amparo à Pesquisa do Estado de São PauloSão PauloSPBrasil Centro de Pesquisa em Alimentos (FoRC), Centros de Pesquisa, Inovação e Difusão (Cepid), Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp), São Paulo , SP , Brasil
- Departamento de NutriçãoFaculdade de Saúde PúblicaUniversidade de São PauloSão PauloSPBrasil Laboratório de Genômica Nutricional e Inflamação, Departamento de Nutrição , Faculdade de Saúde Pública , Universidade de São Paulo (USP), São Paulo , SP , Brasil
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Tweedie J, Palermo C, Wright HH, Pelly FE. Using document analysis to identify core concepts for dietetics: The first step in promoting conceptual learning. Nurs Health Sci 2020; 22:675-684. [PMID: 32166858 DOI: 10.1111/nhs.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/03/2020] [Accepted: 03/09/2020] [Indexed: 11/30/2022]
Abstract
Concept-based approaches to curriculum design have been proposed in nursing and health sciences education to address the issue of content overload in curricula but have not been described in dietetics. This study aimed to identify core concepts for the dietetics discipline in Australia and investigate the commonality and differences in these concepts across different dietetic organizations across the world. This study used document analysis of a purposive sample of international dietetics competency or proficiency standards identified from English-speaking dietetic organizations worldwide. Content analysis was applied to the performance criteria or equivalent from 10 documents (nine organizations) to identify the most common elements. A total of 1,007 statements were analyzed. Fifty-six concepts were developed. The four most frequent concepts coded across all statements were "critical thinking," "communication," "nutrition and dietetic service," and "quality assurance and improvement." There were 55 concepts common to all standards. The concept of "food security" was not present in one of the standards from the United States. The concepts that emerged from this study were common across different English-speaking dietetic organizations across the world. Small differences on the emphasis of concepts, between different competency standards may reflect the health needs; health, political, economic, and social systems; and the cultural context of a country. Identifying core concepts in dietetics is the first step to help to inform curriculum design, which may address overcrowded curricular and promote conceptual learning.
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Affiliation(s)
- Judith Tweedie
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Claire Palermo
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia.,Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Hattie H Wright
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Fiona E Pelly
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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31
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Kaufman-Shriqui V, Salem H, Boaz M, Birk R. Knowledge and Attitudes Towards Nutrigenetics: Findings from the 2018 Unified Forces Preventive Nutrition Conference (UFPN). Nutrients 2020; 12:nu12020335. [PMID: 32012749 PMCID: PMC7071140 DOI: 10.3390/nu12020335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Nutrigenetics indicates that individual genetic variability results in altered health outcomes necessitating personalized nutrition adaptation. Registered dietitians are recognized as the clinical nutrition experts, but their knowledge and attitudes regarding nutrigenetics has not been delineated. Methods: This cross sectional online survey was conducted in a convenience sample of 169 national nutrition conference attendees. The survey queried demographics, knowledge, and attitudes towards nutrigenetics and information on training in nutrigenetics. Results: The majority of participants were registered dietitians and female, 45% of whom held advanced degrees. Personalized nutrition was perceived by 93.5% of participants as highly important or important; however, 94% of respondents indicated they are not sufficiently knowledgeable in personalized nutrition and only 9.5% had received training in nutrigenetics. The mean nutrigenetics knowledge score was 6.89 ± 1.67 (out of a possible 12). A multivariate regression model of knowledge score identified education as the only independent predictor of this outcome. Conclusion: Personalized nutrition is a rapidly developing field that incorporates genetic data into clinical practice. Dietitians recognize the importance of advanced studies to acquire knowledge in nutrigenetics. Only by acquiring the necessary knowledge can dietitians accurately translate this nutrigenetics into clinical practice.
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Affiliation(s)
| | | | | | - Ruth Birk
- Correspondence: ; Tel.: +972-3-976-5704; Fax: +972-3-542-3553
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Iglesias MS, Grzelczak M. Using gold nanoparticles to detect single-nucleotide polymorphisms: toward liquid biopsy. BEILSTEIN JOURNAL OF NANOTECHNOLOGY 2020; 11:263-284. [PMID: 32082965 PMCID: PMC7006498 DOI: 10.3762/bjnano.11.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/21/2020] [Indexed: 05/02/2023]
Abstract
The possibility of detecting genetic mutations rapidly in physiological media through liquid biopsy has attracted the attention within the materials science community. The physical properties of nanoparticles combined with robust transduction methods ensure an improved sensitivity and specificity of a given assay and its implementation into point-of-care devices for common use. Covering the last twenty years, this review gives an overview of the state-of-the-art of the research on the use of gold nanoparticles in the development of colorimetric biosensors for the detection of single-nucleotide polymorphism as cancer biomarker. We discuss the main mechanisms of the assays that either are assisted by DNA-based molecular machines or by enzymatic reactions, summarize their performance and provide an outlook towards future developments.
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Affiliation(s)
- María Sanromán Iglesias
- Centro de Física de Materiales CSIC-UPV/EHU and Donostia International Physics Center (DIPC), Paseo Manuel de Lardizabal 5, 20018 Donostia-Sebastián, Spain
| | - Marek Grzelczak
- Ikerbasque, Basque Foundation for Science, 48013 Bilbao, Spain
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Brandhorst S, Longo VD. Dietary Restrictions and Nutrition in the Prevention and Treatment of Cardiovascular Disease. Circ Res 2019; 124:952-965. [PMID: 30870119 DOI: 10.1161/circresaha.118.313352] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in many developed countries and remains one of the major diseases strongly affected by the diet. Nutrition can affect CVD directly by contributing to the accumulation of vascular plaques and also indirectly by regulating the rate of aging. This review summarizes research on nutrition and CVD incidence based on a multipillar system that includes basic research focused on aging, epidemiological studies, clinical studies, and studies of centenarians. The relevant research linking nutrition and CVD with focus on macronutrients and aging will be highlighted. We will review some of the most relevant studies on nutrition and CVD treatment, also focusing on interventions known to delay aging. We will discuss both everyday dietary compositions, as well as intermittent and periodic fasting interventions with the potential to prevent and treat CVD.
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Affiliation(s)
- Sebastian Brandhorst
- From the Longevity Institute, Davis School of Gerontology, University of Southern California, Los Angeles (S.B., V.D.L.)
| | - Valter D Longo
- From the Longevity Institute, Davis School of Gerontology, University of Southern California, Los Angeles (S.B., V.D.L.).,Institute of Molecular Oncology, Italian Foundation for Cancer Research, Milan (V.D.L.)
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Position of the Academy of Nutrition and Dietetics: Micronutrient Supplementation. J Acad Nutr Diet 2019; 118:2162-2173. [PMID: 30366569 DOI: 10.1016/j.jand.2018.07.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022]
Abstract
It is the position of the Academy of Nutrition and Dietetics that micronutrient supplements are warranted when requirements are not being met through the diet alone. Those with increased requirements secondary to growth, chronic disease, medication use, malabsorption, pregnancy and lactation, and aging may be at particular risk for inadequate dietary intakes. However, the routine and indiscriminate use of micronutrient supplements for the prevention of chronic disease is not recommended, given the lack of available scientific evidence. A few specific age and disease states that may benefit from micronutrient supplementation are discussed. The most common dietary supplements used by both children and adults in the United States contain micronutrients. Consumers may not be well informed about the safety and use of these products, and some may have difficulty interpreting product labels. Thus, the expertise of registered dietitian nutritionists and nutrition and dietetic technicians, registered, is needed to guide the safe and appropriate selection and use of micronutrient supplements. To accomplish this, registered dietitian nutritionists and nutrition and dietetic technicians, registered, must keep up to date on efficacy, safety, and the regulatory issues influencing the use of these products. This position paper aims to increase awareness of current issues relevant to micronutrient supplementation and of the resources available to assist registered dietitian nutritionists and nutrition and dietetic technicians, registered, in evaluating their potential benefits and adverse outcomes.
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Hansen J, Stadler D. Nutritional Genomics: Exploration of Personal Genetic Testing in the Classroom. J Acad Nutr Diet 2019; 119:1613-1617. [DOI: 10.1016/j.jand.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Indexed: 01/08/2023]
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Limon-Miro AT, Lopez-Teros V, Astiazaran-Garcia H. Dynamic Macronutrient Meal-Equivalent Menu Method: Towards Individual Nutrition Intervention Programs. Methods Protoc 2019; 2:E78. [PMID: 31491882 PMCID: PMC6789454 DOI: 10.3390/mps2030078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/24/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022] Open
Abstract
Nutrition interventions should reflect the state of the art in science and dietetics to meet each patient's requirements. Incorporating new knowledge into individualized food-based nutrition interventions is a major challenge, and health care professionals constantly search for novel approaches through specific and standardized methods. The dynamic macronutrient meal-equivalent menu method involves individuals making informed food choices that match their requirements, schedule, and food availability and affinity, helping them maintain a sense of control and motivation to adhere to a nutrition intervention program. This protocol includes the steps required to prepare a nutrition plan containing equivalent meal options consistent with the patient's needs and preferences. Standard food servings are planned according to population specific dietary guidelines and individual characteristics. Servings are distributed at required mealtimes, and are all equivalent in energy and macronutrient content, providing every patient with interchangeable choices within each mealtime. This empowers individuals to select foods in a guided format whilst adhering to a dietary plan. Acceptable variations for calculated energy and macronutrient content are as follows: protein ±1 g/day, fat ±1 g/day, carbohydrate ±2 g/day, and energy ±15 kcal/day. Following this method, health care professionals can develop individualized nutrition intervention programs that may improve patients' adherence, nutritional status, and health.
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Affiliation(s)
- Ana Teresa Limon-Miro
- Department of Nutrition, Centro de Investigacion en Alimentacion y Desarrollo A.C. (CIAD), Carretera Gustavo Enrique Astiazaran Rosas 46, Hermosillo 83304, Sonora, Mexico
| | - Veronica Lopez-Teros
- Department of Chemical and Biological Sciences, Universidad de Sonora, Hermosillo 83000, Sonora, Mexico
| | - Humberto Astiazaran-Garcia
- Department of Nutrition, Centro de Investigacion en Alimentacion y Desarrollo A.C. (CIAD), Carretera Gustavo Enrique Astiazaran Rosas 46, Hermosillo 83304, Sonora, Mexico.
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Noland D, Raj S. Academy of Nutrition and Dietetics: Revised 2019 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Nutrition in Integrative and Functional Medicine. J Acad Nutr Diet 2019; 119:1019-1036.e47. [DOI: 10.1016/j.jand.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Indexed: 02/07/2023]
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Andreescu N, Puiu M, Niculescu M. Effects of Dietary Nutrients on Epigenetic Changes in Cancer. Methods Mol Biol 2019; 1856:121-139. [PMID: 30178249 DOI: 10.1007/978-1-4939-8751-1_7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gene-nutrient interactions are important contributors to health management and disease prevention. Nutrition can alter gene expression, as well as the susceptibility to disease, including cancer, through epigenetic changes. Nutrients can influence the epigenetic status through several mechanisms, such as DNA methylation, histone modifications, and miRNA-dependent gene silencing. These alterations were associated with either increased or decreased risk for cancer development. There is convincing evidence indicating that several foods have protective roles in cancer prevention, by inhibiting tumor progression directly or through modifying tumor's microenvironment that leads to hostile conditions favorable to tumor initiation or growth. While nutritional intakes from foods cannot be adequately controlled for dosage, the role of nutrients in the epigenetics of cancer has led to more research aimed at developing nutriceuticals and drugs as cancer therapies. Clinical studies are needed to evaluate the optimum doses of dietary compounds, the safety profile of dosages, to establish the most efficient way of administration, and bioavailability, in order to maximize the beneficial effects already discovered, and to ensure replicability. Thus, nutrition represents a promising tool to be used not only in cancer prevention, but hopefully also in cancer treatment.
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Affiliation(s)
- Nicoleta Andreescu
- Medical Genetics Discipline, Center of Genomic Medicine, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
| | - Maria Puiu
- Medical Genetics Discipline, Center of Genomic Medicine, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Mihai Niculescu
- Medical Genetics Discipline, Center of Genomic Medicine, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
- Advanced Nutrigenomics, Hillsborough, NC, USA
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Vallée Marcotte B, Cormier H, Garneau V, Robitaille J, Desroches S, Vohl MC. Nutrigenetic Testing for Personalized Nutrition: An Evaluation of Public Perceptions, Attitudes, and Concerns in a Population of French Canadians. Lifestyle Genom 2019; 11:155-162. [DOI: 10.1159/000499626] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/12/2019] [Indexed: 11/19/2022] Open
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VanBuren C, Imrhan V, Vijayagopal P, Solis-Pérez E, López-Cabanillas Lomelí M, Gonzalez-Garza R, Gutiérrez-López M, González-Martinez BE, Boonme K, Juma S, Prasad C. "Omics" Education in Dietetic Curricula: A Comparison between Two Institutions in the USA and Mexico. Lifestyle Genom 2019; 11:136-146. [PMID: 31067544 DOI: 10.1159/000499202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The completion of sequencing of the human genome and a better understanding of epigenomic regulation of gene expression have opened the possibility of personalized nutrition in the near future. This has also created an immediate need for trained personnel qualified to administer personalized nutrition education. Of all the allied healthcare personnel, dietitians are the most likely to undertake this role. However, dietitians and dietetic students are still deficient in their knowledge of nutrigenomics and other "omics" technologies. Therefore, with the eventual goal of dietetic curriculum reorganization, the International Society of Nutrigenetics/Nutrigenomics (ISNN) has set out to evaluate nutrigenomic knowledge among dietetic students from different countries. In this study, we compared nutrition and dietetic students from Texas Woman's University (TWU) and the Universidad Autónoma de Nuevo León (UANL) for their perceived need for, interest in, and knowledge of different topics within nutritional genomics. METHODS Students from both universities were sent an e-mail link to the survey which was located at psychdata.com. One hundred twenty-seven students completed the survey. The survey assessed the students' knowledge of, perceived need for, and interest in different omics technologies, as well as their basic knowledge of basic nutrition and genetic topics. Differences were assessed using the χ2 test for homogeneity and Fisher's exact test. RESULTS Students from TWU and UANL exhibited differences in their knowledge, desire to learn more, and perceived need for omics science in some but not all categories. CONCLUSIONS Undergraduate nutrition students from both the USA and Mexico lack a high level of knowledge in different omics topics but recognize the role that omics will play in their future as dietitians. There were differences between the 2 universities in terms of the desire to learn more about different omics technologies and to take more classes covering different topics with nutritional genomic components. In order to make personalized nutrition a reality, future dietitians will need to become fluent in different omics technologies.
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Affiliation(s)
- Christine VanBuren
- Department ofNutrition and Food Sciences, Texas Woman's University, Denton, Texas, USA
| | - Victorine Imrhan
- Department ofNutrition and Food Sciences, Texas Woman's University, Denton, Texas, USA
| | - Parakat Vijayagopal
- Department ofNutrition and Food Sciences, Texas Woman's University, Denton, Texas, USA
| | - Elizabeth Solis-Pérez
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Raquel Gonzalez-Garza
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Myriam Gutiérrez-López
- Facultad de Salud Pública y Nutrición, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Kittipong Boonme
- College of Business, Texas Woman's University, Denton, Texas, USA
| | - Shanil Juma
- Department ofNutrition and Food Sciences, Texas Woman's University, Denton, Texas, USA
| | - Chandan Prasad
- Department ofNutrition and Food Sciences, Texas Woman's University, Denton, Texas, USA, .,Section of Endocrinology, Department of Medicine, LSU Health Sciences Center, New Orleans, Louisiana, USA,
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Tebani A, Bekri S. Paving the Way to Precision Nutrition Through Metabolomics. Front Nutr 2019; 6:41. [PMID: 31024923 PMCID: PMC6465639 DOI: 10.3389/fnut.2019.00041] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/21/2019] [Indexed: 12/11/2022] Open
Abstract
Nutrition is an interdisciplinary science that studies the interactions of nutrients with the body in relation to maintenance of health and well-being. Nutrition is highly complex due to the underlying various internal and external factors that could model it. Thus, hacking this complexity requires more holistic and network-based strategies that could unveil these dynamic system interactions at both time and space scales. The ongoing omics era with its high-throughput molecular data generation is paving the way to embrace this complexity and is deeply reshaping the whole field of nutrition. Understanding the future paths of nutrition science is of importance from both translational and clinical perspectives. Basic nutrients which might include metabolites are important in nutrition science. Moreover, metabolites are key biological communication channels and represent an appealing functional readout at the interface of different major influential factors that define health and disease. Metabolomics is the technology that enables holistic and systematic analyses of metabolites in a biological system. Hence, given its intrinsic functionality, its tight connection to metabolism and its high clinical actionability potential, metabolomics is a very appealing technology for nutrition science. The ultimate goal is to deliver a tailored and clinically relevant nutritional recommendations and interventions to achieve precision nutrition. This work intends to present an update on the applications of metabolomics to personalize nutrition in translational and clinical settings. It also discusses the current conceptual shifts that are remodeling clinical nutrition practices in this Precision Medicine era. Finally, perspectives of clinical nutrition in the ever-growing, data-driven healthcare landscape are presented.
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Affiliation(s)
- Abdellah Tebani
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen, France
| | - Soumeya Bekri
- Department of Metabolic Biochemistry, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, CHU Rouen, INSERM U1245, Rouen, France
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A Scientific Perspective of Personalised Gene-Based Dietary Recommendations for Weight Management. Nutrients 2019; 11:nu11030617. [PMID: 30875721 PMCID: PMC6471589 DOI: 10.3390/nu11030617] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 01/06/2023] Open
Abstract
Various studies showed that a "one size fits all" dietary recommendation for weight management is questionable. For this reason, the focus increasingly falls on personalised nutrition. Although there is no precise and uniform definition of personalised nutrition, the inclusion of genetic variants for personalised dietary recommendations is more and more favoured, whereas scientific evidence for gene-based dietary recommendations is rather limited. The purpose of this article is to provide a science-based viewpoint on gene-based personalised nutrition and weight management. Most of the studies showed no clinical evidence for gene-based personalised nutrition. The Food4Me study, e.g., investigated four different groups of personalised dietary recommendations based on dietary guidelines, and physiological, clinical, or genetic parameters, and resulted in no difference in weight loss between the levels of personalisation. Furthermore, genetic direct-to-consumer (DTC) tests are widely spread by companies. Scientific organisations clearly point out that, to date, genetic DTC tests are without scientific evidence. To date, gene-based personalised nutrition is not yet applicable for the treatment of obesity. Nevertheless, personalised dietary recommendations on the genetic landscape of a person are an innovative and promising approach for the prevention and treatment of obesity. In the future, human intervention studies are necessary to prove the clinical evidence of gene-based dietary recommendations.
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Nutritional Genomics in Precision Nutrition: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2019; 119:507-515.e7. [DOI: 10.1016/j.jand.2018.05.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 02/03/2023]
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Tutty E, Hickerton C, Adamski MM, Metcalfe SA. Personal genomic testing for nutrition and wellness in Australia: A content analysis of online information. Nutr Diet 2019; 76:263-270. [PMID: 30693631 DOI: 10.1111/1747-0080.12516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/04/2018] [Accepted: 12/09/2018] [Indexed: 12/16/2022]
Abstract
AIM Personal genomic testing for nutrition and wellness (PGT-NG) offers a new service delivery model to nutritionists and dietitians. However, research indicates that this type of testing currently lacks sufficient clinical validity and utility to be commercially available. Despite Australian guidelines to the contrary, healthcare professionals are currently offering testing to clients, and promoting these services online. Thus, it is important to understand how PGT-NG is currently framed online to the public. METHODS A mixed methods content analysis was conducted to assess the content, quality and marketing approaches of websites offering PGT-NG to Australians. Websites were identified using popular search engines to mimic the behaviour of a consumer. A novel framework was developed for the purposes of the analysis. RESULTS Thirty-nine websites were analysed, comprising four nutritional genomic testing company websites and 35 healthcare provider websites. Healthcare providers relied on information from the testing companies. The content was emotive, and little attention was given to the scientific and ethical aspects of personal genomic testing. Websites appealed to consumer empowerment and framed testing as an essential and superior tool for optimising health. CONCLUSIONS Websites lacked the transparency necessary for informed consent. A basic checklist of key information was developed to aid healthcare providers when informing potential clients of PGT-NG online.
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Affiliation(s)
- Erin Tutty
- Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Chriselle Hickerton
- Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Melissa M Adamski
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Sylvia A Metcalfe
- Murdoch Children's Research Institute, Royal Children's Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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Molster CM, Bowman FL, Bilkey GA, Cho AS, Burns BL, Nowak KJ, Dawkins HJS. The Evolution of Public Health Genomics: Exploring Its Past, Present, and Future. Front Public Health 2018; 6:247. [PMID: 30234091 PMCID: PMC6131666 DOI: 10.3389/fpubh.2018.00247] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022] Open
Abstract
Public health genomics has evolved to responsibly integrate advancements in genomics into the fields of personalized medicine and public health. Appropriate, effective and sustainable integration of genomics into healthcare requires an organized approach. This paper outlines the history that led to the emergence of public health genomics as a distinguishable field. In addition, a range of activities are described that illustrate how genomics can be incorporated into public health practice. Finally, it presents the evolution of public health genomics into the new era of "precision public health."
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Affiliation(s)
- Caron M. Molster
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
| | - Faye L. Bowman
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
| | - Gemma A. Bilkey
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
- Office of the Chief Health Officer, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
| | - Angela S. Cho
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
| | - Belinda L. Burns
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
| | - Kristen J. Nowak
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, Australia
- Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, WA, Australia
| | - Hugh J. S. Dawkins
- Office of Population Health Genomics, Public and Aboriginal Health Division, Western Australian Department of Health, East Perth, WA, Australia
- School of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, Australia
- Sir Walter Murdoch School of Policy and International Affairs, Murdoch University, Murdoch, WA, Australia
- School of Public Health, Curtin University of Technology, Bentley, WA, Australia
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Abstract
Jose Ordovas and colleagues consider that nutrition interventions tailored to individual characteristics and behaviours have promise but more work is needed before they can deliver
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Affiliation(s)
- Jose M Ordovas
- JM-USDA-HNRCA at Tufts University, Boston, MA, USA
- Centro Nacional Investigaciones Cardiovasculares, Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Lynnette R Ferguson
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | | | - John C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
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Grimaldi KA, van Ommen B, Ordovas JM, Parnell LD, Mathers JC, Bendik I, Brennan L, Celis-Morales C, Cirillo E, Daniel H, de Kok B, El-Sohemy A, Fairweather-Tait SJ, Fallaize R, Fenech M, Ferguson LR, Gibney ER, Gibney M, Gjelstad IMF, Kaput J, Karlsen AS, Kolossa S, Lovegrove J, Macready AL, Marsaux CFM, Alfredo Martinez J, Milagro F, Navas-Carretero S, Roche HM, Saris WHM, Traczyk I, van Kranen H, Verschuren L, Virgili F, Weber P, Bouwman J. Proposed guidelines to evaluate scientific validity and evidence for genotype-based dietary advice. GENES & NUTRITION 2017; 12:35. [PMID: 29270237 PMCID: PMC5732517 DOI: 10.1186/s12263-017-0584-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022]
Abstract
Nutrigenetic research examines the effects of inter-individual differences in genotype on responses to nutrients and other food components, in the context of health and of nutrient requirements. A practical application of nutrigenetics is the use of personal genetic information to guide recommendations for dietary choices that are more efficacious at the individual or genetic subgroup level relative to generic dietary advice. Nutrigenetics is unregulated, with no defined standards, beyond some commercially adopted codes of practice. Only a few official nutrition-related professional bodies have embraced the subject, and, consequently, there is a lack of educational resources or guidance for implementation of the outcomes of nutrigenetic research. To avoid misuse and to protect the public, personalised nutrigenetic advice and information should be based on clear evidence of validity grounded in a careful and defensible interpretation of outcomes from nutrigenetic research studies. Evidence requirements are clearly stated and assessed within the context of state-of-the-art 'evidence-based nutrition'. We have developed and present here a draft framework that can be used to assess the strength of the evidence for scientific validity of nutrigenetic knowledge and whether 'actionable'. In addition, we propose that this framework be used as the basis for developing transparent and scientifically sound advice to the public based on nutrigenetic tests. We feel that although this area is still in its infancy, minimal guidelines are required. Though these guidelines are based on semi-quantitative data, they should stimulate debate on their utility. This framework will be revised biennially, as knowledge on the subject increases.
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Affiliation(s)
| | | | - Jose M. Ordovas
- JMUSDA-Human Nutrition Research Center on Aging at Tufts University, Boston, USA
- IMDEA Alimentacion, Madrid, Spain
| | - Laurence D. Parnell
- Agriculture Research Service, USDA, Human Nutrition Research Center on Aging, Boston, MA 02111 USA
| | - John C. Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL UK
| | - Igor Bendik
- DSM Nutritional Products, Kaiseraugst, Switzerland
| | - Lorraine Brennan
- UCD Institute of Food and Health, UCD School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Carlos Celis-Morales
- Human Nutrition Research Centre, Institute of Cellular Medicine, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL UK
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, G12 8TA UK
| | | | - Hannelore Daniel
- Nutritional Physiology, Technische Universität München, 85350 Freising, Germany
| | | | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, 150 College Street, 3rd Floor, Toronto, ON M5S 3E2 Canada
| | | | - Rosalind Fallaize
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, Berkshire RG6 6AP UK
| | - Michael Fenech
- CSIRO Health and Biosecurity, Gate 13, Kintore Avenue, Adelaide, SA 5000 Australia
| | - Lynnette R. Ferguson
- ACSRC and Discipline of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1184 New Zealand
| | - Eileen R. Gibney
- UCD Institute of Food and Health, UCD School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Mike Gibney
- UCD Institute of Food and Health, UCD School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Ingrid M. F. Gjelstad
- Department of Nutrition, Universitetet i Oslo, PO Box 1046, Blindern, N-0316 Oslo, Norway
| | - Jim Kaput
- Vydiant Inc, 2330 Gold Meadow Way, Gold River, 95670 CA USA
| | - Anette S. Karlsen
- Department of Nutrition, Universitetet i Oslo, PO Box 1046, Blindern, N-0316 Oslo, Norway
| | - Silvia Kolossa
- Nutritional Physiology, Technische Universität München, 85350 Freising, Germany
| | - Julie Lovegrove
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, Berkshire RG6 6AP UK
| | - Anna L. Macready
- Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, Berkshire RG6 6AP UK
| | - Cyril F. M. Marsaux
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
| | - J. Alfredo Martinez
- IMDEA Alimentacion, Madrid, Spain
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBERobn, Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Fermin Milagro
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBERobn, Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Santiago Navas-Carretero
- Department of Nutrition, Food Science and Physiology, Centre for Nutrition Research, University of Navarra, Pamplona, Spain
- CIBERobn, Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Helen M. Roche
- Nutrigenomics Research Group, UCD Institute of Food and Health/UCD Conway Institute, University College Dublin, Dublin, Ireland
| | - Wim H. M. Saris
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
| | - Iwona Traczyk
- Department of Human Nutrition, Faculty on Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Henk van Kranen
- Institute for Public Health Genomics (IPHG), Department of Genetics and Cell Biology, Faculty of Health, Medicine & Life Sciences, University of Maastricht, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | | | - Fabio Virgili
- Council for Agricultural Research and Economics, Food and Nutrition Research Centre, (CREA - AN), via Ardeatina 546, 00178 Rome, Italy
| | - Peter Weber
- DSM Nutritional Products, Kaiseraugst, Switzerland
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Beckett EL, Jones PR, Veysey M, Lucock M. Nutrigenetics—Personalized Nutrition in the Genetic Age. EXPLORATORY RESEARCH AND HYPOTHESIS IN MEDICINE 2017; 2:1-8. [DOI: 10.14218/erhm.2017.00027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hurlimann T, Peña-Rosas JP, Saxena A, Zamora G, Godard B. Ethical issues in the development and implementation of nutrition-related public health policies and interventions: A scoping review. PLoS One 2017; 12:e0186897. [PMID: 29073186 PMCID: PMC5658098 DOI: 10.1371/journal.pone.0186897] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022] Open
Abstract
Background The limited integration of ethics in nutrition-related public health policies and interventions is one major concern for those who have the task of implementing them. Ethical challenges that are overlooked during the development of such interventions could raise serious ethical issues during their implementation and even after. As a result, these decision makers need technical support and ethical guidance for adaptation of interventions to local (cultural, social, economic, etc.) contexts. Aim The goal of this scoping review is to delineate and “map” the range of ethical issues in nutrition-related public health interventions, as well as the range of the various fields in which they may arise. Methods A scoping review of empirical research and conceptual literature was conducted following the framework of Arksey and O’Malley. Searches using PubMed with Medical Subject Headings (MeSH) categories and Advanced Search Builder as well as in the Global Health Library were performed. The final sample consists of 169 publications. Results The ethics of public health prevention or treatment of obesity and non-communicable diseases is the most explicitly and frequently discussed subject. In comparison, ethical issues raised by public health interventions in the fields of undernutrition, breastfeeding, vitamin/mineral supplementation and food fortification, food security, food sustainability and food safety are addressed in a lower proportion of the sample. The results illustrate the various natures, types, and scopes of existing public health nutrition-related interventions, and the various ethical issues that may be raised by these interventions, in addition to the numerous and different contexts in which they may be implemented. Discussion The ethical issues faced in the development and implementation of nutrition-related public health interventions are varied and cannot be equated with, nor generalized about, when dealing with specific activities in this field. More importantly, these ethical issues cannot be managed without a careful consideration for the complexity of contexts in which nutrition-related interventions are expected to be implemented. These interventions engage a variety of actors with diverse perspectives and interests. We discuss these challenges and also comment on the importance of considering ethical impacts in the monitoring and evaluation of such interventions. Conclusion General ethical frameworks or recommendations–although useful–cannot be expected to provide policy makers, implementators and other public health personnel with sufficient practical ethical guidance as they cannot consider and anticipate the particularities of all specific nutrition-related public health interventions and the complexity of the contexts in which they are implemented. Further research is needed in order to develop more targeted ethical frameworks.
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Affiliation(s)
- Thierry Hurlimann
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Abha Saxena
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Gerardo Zamora
- Evidence and Programme Guidance, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Béatrice Godard
- Public Health Research Institute of the University of Montreal (IRSPUM), Montreal, Canada
- * E-mail:
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Theodoratou E, Timofeeva M, Li X, Meng X, Ioannidis JPA. Nature, Nurture, and Cancer Risks: Genetic and Nutritional Contributions to Cancer. Annu Rev Nutr 2017; 37:293-320. [PMID: 28826375 DOI: 10.1146/annurev-nutr-071715-051004] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
It is speculated that genetic variants are associated with differential responses to nutrients (known as gene-diet interactions) and that these variations may be linked to different cancer risks. In this review, we critically evaluate the evidence across 314 meta-analyses of observational studies and randomized controlled trials of dietary risk factors and the five most common cancers (breast, lung, prostate, colorectal, and stomach). We also critically evaluate the evidence across 13 meta-analyses of observational studies of gene-diet interactions for the same cancers. Convincing evidence for association was found only for the intake of alcohol and whole grains in relation to colorectal cancer risk. Three nutrient associations had highly suggestive evidence and another 15 associations had suggestive evidence. Among the examined gene-diet interactions, only one had moderately strong evidence.
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Affiliation(s)
- Evropi Theodoratou
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh EH8 9AG, United Kingdom.,Colon Cancer Genetics Group, Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics & Molecular Medicine, Western General Hospital, The University of Edinburgh, Edinburgh EH4 2XU, United Kingdom
| | - Maria Timofeeva
- Colon Cancer Genetics Group, Medical Research Council Human Genetics Unit, Medical Research Council Institute of Genetics & Molecular Medicine, Western General Hospital, The University of Edinburgh, Edinburgh EH4 2XU, United Kingdom
| | - Xue Li
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh EH8 9AG, United Kingdom
| | - Xiangrui Meng
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh EH8 9AG, United Kingdom
| | - John P A Ioannidis
- Stanford Prevention Research Center, Departments of Medicine and Health Research and Policy, Stanford University School of Medicine, Stanford, California 94305-5411; .,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California 94305-5411
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