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Keathley J, Garneau V, Marcil V, Mutch DM, Robitaille J, Rudkowska I, Sofian GM, Desroches S, Vohl MC. Nutrigenetics, omega-3 and plasma lipids/lipoproteins/apolipoproteins with evidence evaluation using the GRADE approach: a systematic review. BMJ Open 2022; 12:e054417. [PMID: 35193914 PMCID: PMC8867311 DOI: 10.1136/bmjopen-2021-054417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Despite the uptake of nutrigenetic testing through direct-to-consumer services and healthcare professionals, systematic reviews determining scientific validity are limited in this field. The objective of this review was to: retrieve, synthesise and assess the quality of evidence (confidence) for nutrigenetic approaches related to the effect of genetic variation on plasma lipid, lipoprotein and apolipoprotein responsiveness to omega-3 fatty acid intake. DESIGN A systematic review was conducted using three search engines (Embase, Web of Science and Medline) for articles published up until 1 August 2020. We aimed to systematically search, identify (select) and provide a narrative synthesis of all studies that assessed nutrigenetic associations/interactions for genetic variants (comparators) influencing the plasma lipid, lipoprotein and/or apolipoprotein response (outcomes) to omega-3 fatty acid intake (intervention/exposure) in humans-both paediatric and adult populations (population). We further aimed to assess the overall quality of evidence for specific priority nutrigenetic associations/interactions based on the following inclusion criteria: nutrigenetic associations/interactions reported for the same genetic variants (comparators) influencing the same plasma lipid, lipoprotein and/or apolipoprotein response (outcomes) to omega-3 fatty acid intake (intervention/exposure) in humans-both paediatric and adult populations (population) in at least two independent studies, irrespective of the findings. Risk of bias was assessed in individual studies. Evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach with a modification to further consider biological plausibility. RESULTS Out of 1830 articles screened, 65 met the inclusion criteria for the narrative synthesis (n=23 observational, n=42 interventional); of these, 25 met the inclusion criteria for GRADE evidence evaluation. Overall, current evidence is insufficient for gene-diet associations related to omega-3 fatty acid intake on plasma apolipoproteins, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein (LDL)-cholesterol and LDL particle size. However, there is strong (GRADE rating: moderate quality) evidence to suggest that male APOE-E4 carriers (rs429358, rs7412) exhibit significant triglyceride reductions in response to omega-3-rich fish oil with a dose-response effect. Moreover, strong (GRADE rating: high quality) evidence suggests that a 31-SNP nutrigenetic risk score can predict plasma triglyceride responsiveness to omega-3-rich fish oil in adults with overweight/obesity from various ethnicities. CONCLUSIONS Most evidence in this area is weak, but two specific nutrigenetic interactions exhibited strong evidence, with generalisability limited to specific populations. PROSPERO REGISTRATION NUMBER CRD42020185087.
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Affiliation(s)
- Justine Keathley
- Université Laval, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF) Quebec, Quebec City, Quebec, Canada
- Universite Laval, School of Nutrition, Quebec City, Quebec, Canada
| | - Véronique Garneau
- Université Laval, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF) Quebec, Quebec City, Quebec, Canada
- Universite Laval, School of Nutrition, Quebec City, Quebec, Canada
| | - Valérie Marcil
- Department of Nutrition, University of Montréal, Montréal, Quebec, Canada
- Research Centre, Sainte-Justine University Health Centre, Montréal, Quebec, Canada
| | - David M Mutch
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Julie Robitaille
- Université Laval, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF) Quebec, Quebec City, Quebec, Canada
- Universite Laval, School of Nutrition, Quebec City, Quebec, Canada
| | - Iwona Rudkowska
- Department of Kinesiology, Université Laval, Quebec City, Quebec, Canada
- Endocrinology and Nephrology Unit, CHU de Québec - Université Laval Research Center, Quebec City, Quebec, Canada
| | | | - Sophie Desroches
- Université Laval, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF) Quebec, Quebec City, Quebec, Canada
- Universite Laval, School of Nutrition, Quebec City, Quebec, Canada
| | - Marie-Claude Vohl
- Université Laval, Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF) Quebec, Quebec City, Quebec, Canada
- Universite Laval, School of Nutrition, Quebec City, Quebec, Canada
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Keathley J, Garneau V, Marcil V, Mutch DM, Robitaille J, Rudkowska I, Sofian G, Desroches S, Vohl MC. Clinical Practice Guidelines Using GRADE and AGREE II for the Impact of Genetic Variants on Plasma Lipid/Lipoprotein/Apolipoprotein Responsiveness to Omega-3 Fatty Acids. Front Nutr 2022; 8:768474. [PMID: 35237638 PMCID: PMC8883048 DOI: 10.3389/fnut.2021.768474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background A recent systematic review, which used the GRADE methodology, concluded that there is strong evidence for two gene-diet associations related to omega-3 and plasma triglyceride (TG) responses. Systematic reviews can be used to inform the development of clinical practice guidelines (CPGs). Objective To provide guidance for clinical practice related to genetic testing for evaluating responsiveness to dietary/supplemental omega-3s and their impact on plasma lipids/lipoproteins/apolipoproteins. Design Using the results of the abovementioned systematic review, the first CPGs in nutrigenetics were developed using the established GRADE methodology and AGREE II approach. Results Three clinical practice recommendations were developed. Most gene-diet associations identified in the literature lack adequate scientific and clinical validity to warrant consideration for implementing in a practice setting. However, two gene-diet associations with strong evidence (GRADE quality: moderate and high) can be considered for implementation into clinical practice in certain cases: male APOE-E4 carriers (rs429358, rs7412) and TG changes in response to the omega-3 fatty acids eicosapentaenoic acid (EPA) and/or docosahexaenoic acid (DHA) as well as a 31-SNP nutrigenetic risk score and TG changes in response to EPA+DHA among adults with overweight/obesity. Ethical and regulatory implications must be considered when providing APOE nutrigenetic tests given the well-established link between APOE genetic variation and Alzheimer's Disease. Conclusion Most of the evidence in this area is not ready for implementation into clinical practice primarily due to low scientific validity (low quality of evidence). However, the first CPGs in nutrigenetics have been developed for two nutrigenetic associations with strong scientific validity, related to dietary/supplemental omega-3 and TG responses.
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Affiliation(s)
- Justine Keathley
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
| | - Véronique Garneau
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
| | - Valérie Marcil
- Research Centre, Sainte-Justine University Health Centre, Montréal, QC, Canada
- Department of Nutrition, Université de Montréal, Montréal, QC, Canada
| | - David M. Mutch
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada
| | - Julie Robitaille
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
| | - Iwona Rudkowska
- Endocrinology and Nephrology Unit, Centre Hospitalier Universitaire de Québec-Université Laval Research Center, Québec City, QC, Canada
- Department of Kinesiology, Université Laval, Québec City, QC, Canada
| | | | - Sophie Desroches
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
| | - Marie-Claude Vohl
- Centre Nutrition, Santé et Société (NUTRISS), Institut sur la Nutrition et les Aliments Fonctionnels (INAF), Université Laval, Québec City, QC, Canada
- School of Nutrition, Université Laval, Québec City, QC, Canada
- *Correspondence: Marie-Claude Vohl
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Leskinen H, Tringham M, Karjalainen H, Iso-Touru T, Hietaranta-Luoma HL, Marnila P, Pihlava JM, Hurme T, Puolijoki H, Åkerman K, Mäkinen S, Sandell M, Vähäkangas K, Tahvonen R, Rokka S, Hopia A. APOE genotypes, lipid profiles and associated clinical markers in a Finnish population with cardiovascular disease risk factors. Lifestyle Genom 2021; 15:45-54. [PMID: 34942620 DOI: 10.1159/000520864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION APOE ɛ4 allele predisposes to high cholesterol and increases the risk for lifestyle-related diseases such as Alzheimer's disease (AD) and cardiovascular diseases (CVD). The aim of this study was to analyse interrelationships of APOE genotypes with lipid metabolism and lifestyle factors in middle-aged Finns among whom the CVD risk factors are common. METHODS Participants (n=211) were analysed for APOE ε genotypes, physiological parameters and health- and diet-related plasma markers. Lifestyle choices were determined by a questionnaire. RESULTS APOE genotypes ε3/ε4 and ε4/ε4 (ε4 group) represented 34.1% of the participants. Genotype ε3/ε3 (ε3 group) frequency was 54.5%. Carriers of ε2 (ε2 group; ε2/ε2, ε2/ε3 and ε2/ε4) represented 11.4%; 1.9 % were of the genotype ε2/ε4. The LDL and total cholesterol levels were lower (P<0.05) in the ε2 carriers than in the ε3 or ε4 groups, while the ε3 and ε4 groups did not differ. Proportions of plasma saturated fatty acids were higher (P<0.01) and omega-6 fatty acids lower (P=0.01) in the ε2 carriers compared with the ε4 group. The ε2 carriers had a higher (P<0.05) percentage of 22:4n-6 and 22:5n-6 and a lower (P<0.05) percentage of 24:5n-3 and 24:6n-3 than individuals without the ε2 allele. CONCLUSIONS The plasma fatty acid profiles in the ε2 group were characterised by higher SFA and lower omega-6 fatty acid proportions. Their lower cholesterol values indicated a lower risk for CVD compared with the ε4 group. A novel finding was that the ε2 carriers had different proportions of 22:4n-6, 22:5n-6, 24:5n-3 and 24:6n-3 than individuals without the ε2 allele. The significance of the differences in fatty acid composition remains to be studied.
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Affiliation(s)
- Heidi Leskinen
- Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Maaria Tringham
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Heli Karjalainen
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Terhi Iso-Touru
- Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | | | - Pertti Marnila
- Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | | | - Timo Hurme
- Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Hannu Puolijoki
- The Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Kari Åkerman
- The Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Sari Mäkinen
- Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Mari Sandell
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Kirsi Vähäkangas
- School of Pharmacy/Toxicology, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Raija Tahvonen
- Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Susanna Rokka
- Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Anu Hopia
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
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Leskinen HM, Tringham M, Karjalainen H, Iso-Touru TK, Hietaranta-Luoma HL, Marnila PJ, Pihlava JM, Hurme T, Kankaanpää SJ, Puolijoki H, Åkerman K, Tanner L, Sandell M, Vähäkangas K, Hopia A, Tahvonen R, Rokka LS. APOE Genotype Disclosure and Lifestyle Advice in a Randomized Intervention Study with Finnish Participants. J Nutr 2021; 151:85-97. [PMID: 33188400 DOI: 10.1093/jn/nxaa316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/20/2020] [Accepted: 09/22/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The APOE ε4 allele is associated with higher risks of cardiovascular diseases and Alzheimer disease than ε3 and ε2. OBJECTIVES We studied the effectiveness of dietary and lifestyle guidance and personal genetic risk information [ε4 carrier (ε4+); ε4 noncarrier (ε4-)] as motivators for a healthier lifestyle. METHODS A total of 188 healthy Finnish volunteers (82.4% women; mean ± SD age: 51.0 ± 5.6 y; BMI: 26.0 ± 3.6 kg/m2; total cholesterol: 5.2 ± 0.9 mmol/L) participated in our randomized intervention study. The participants were genotyped for APOE and divided into intervention (INT; INTε4+, n = 33; INTε4-, n = 57) and control groups (CTRL; CTRLε4+, n = 36; CTRLε4-, n = 62). Blood samples, measured observations, and questionnaire data were obtained at baseline and at 1 and 1.5 y. INT participants received their ε4 carrier status at baseline. Monthly Internet-based guidance based on the Finnish Dietary guidelines was provided for all. RESULTS The proportion of SFAs in plasma over time fluctuated less in INTε4+ than in the other groups (P-interaction < 0.05; primary outcome). The lifestyle guidance increased vegetable consumption from 3.5 to 3.6 portions/d, improved the dietary fat quality score by 5.3%, increased the plasma n-3 (ω-3) FA proportion by 7.3%, and decreased the consumption of high-fat/high-sugar foods from 7.3 to 6.5 portions/wk and total- and LDL-cholesterol concentrations by 4.3% and 6.1%, respectively, in the entire participant population (P < 0.05; secondary outcome). Compared with the ε4- participants, ε4+ participants had 2.4% higher plasma n-6 (ω-6) FA, lower C-peptide (3.9 compared with 4.2 nmol/L × h) and sensitive C-reactive protein values, and decreased plasma malondialdehyde concentrations over time (P < 0.05; secondary outcome). CONCLUSIONS Lifestyle guidance given to healthy Finnish participants yielded small but beneficial changes. The INTε4+ group did not seem markedly more responsive to the guidance than the other groups.This trial was registered at clinicaltrials.gov as NCT03794141.
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Affiliation(s)
- Heidi M Leskinen
- Production Systems, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Maaria Tringham
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Heli Karjalainen
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Terhi K Iso-Touru
- Production Systems, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | | | - Pertti J Marnila
- Production Systems, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Juha-Matti Pihlava
- Production Systems, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Timo Hurme
- Natural Resources, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Santeri J Kankaanpää
- Production Systems, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - Hannu Puolijoki
- The Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Kari Åkerman
- The Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Laura Tanner
- Department of Clinical Genetics, Helsinki University Hospital, Helsinki, Finland
| | - Mari Sandell
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland.,Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Kirsi Vähäkangas
- School of Pharmacy/Toxicology, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anu Hopia
- Functional Foods Forum, Faculty of Medicine, University of Turku, Turku, Finland
| | - Raija Tahvonen
- Production Systems, Natural Resources Institute Finland (Luke), Jokioinen, Finland
| | - L Susanna Rokka
- Production Systems, Natural Resources Institute Finland (Luke), Jokioinen, Finland
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Neuroinflammation in Autism: Plausible Role of Maternal Inflammation, Dietary Omega 3, and Microbiota. Neural Plast 2016; 2016:3597209. [PMID: 27840741 PMCID: PMC5093279 DOI: 10.1155/2016/3597209] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/24/2016] [Accepted: 09/27/2016] [Indexed: 02/06/2023] Open
Abstract
Several genetic causes of autism spectrum disorder (ASD) have been identified. However, more recent work has highlighted that certain environmental exposures early in life may also account for some cases of autism. Environmental insults during pregnancy, such as infection or malnutrition, seem to dramatically impact brain development. Maternal viral or bacterial infections have been characterized as disruptors of brain shaping, even if their underlying mechanisms are not yet fully understood. Poor nutritional diversity, as well as nutrient deficiency, is strongly associated with neurodevelopmental disorders in children. For instance, imbalanced levels of essential fatty acids, and especially polyunsaturated fatty acids (PUFAs), are observed in patients with ASD and other neurodevelopmental disorders (e.g., attention deficit hyperactivity disorder (ADHD) and schizophrenia). Interestingly, PUFAs, and specifically n-3 PUFAs, are powerful immunomodulators that exert anti-inflammatory properties. These prenatal dietary and immunologic factors not only impact the fetal brain, but also affect the microbiota. Recent work suggests that the microbiota could be the missing link between environmental insults in prenatal life and future neurodevelopmental disorders. As both nutrition and inflammation can massively affect the microbiota, we discuss here how understanding the crosstalk between these three actors could provide a promising framework to better elucidate ASD etiology.
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Heras-Sandoval D, Pedraza-Chaverri J, Pérez-Rojas JM. Role of docosahexaenoic acid in the modulation of glial cells in Alzheimer's disease. J Neuroinflammation 2016; 13:61. [PMID: 26965310 PMCID: PMC4787218 DOI: 10.1186/s12974-016-0525-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 03/03/2016] [Indexed: 01/25/2023] Open
Abstract
Docosahexaenoic acid (DHA) is an omega-3 (ω-3) long-chain polyunsaturated fatty acid (LCPUFA) relevant for brain function. It has largely been explored as a potential candidate to treat Alzheimer’s disease (AD). Clinical evidence favors a role for DHA in the improvement of cognition in very early stages of the AD. In response to stress or damage, DHA generates oxygenated derivatives called docosanoids that can activate the peroxisome proliferator-activated receptor γ (PPARγ). In conjunction with activated retinoid X receptors (RXR), PPARγ modulates inflammation, cell survival, and lipid metabolism. As an early event in AD, inflammation is associated with an excess of amyloid β peptide (Aβ) that contributes to neural insult. Glial cells are recognized to be actively involved during AD, and their dysfunction is associated with the early appearance of this pathology. These cells give support to neurons, remove amyloid β peptides from the brain, and modulate inflammation. Since DHA can modulate glial cell activity, the present work reviews the evidence about this modulation as well as the effect of docosanoids on neuroinflammation and in some AD models. The evidence supports PPARγ as a preferred target for gene modulation. The effective use of DHA and/or its derivatives in a subgroup of people at risk of developing AD is discussed.
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Affiliation(s)
- David Heras-Sandoval
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, 04510, México, DF, México.,Laboratorio de Farmacología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Tlalpan 14080, Apartado Postal 22026, México, DF, México
| | - José Pedraza-Chaverri
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Ciudad Universitaria, 04510, México, DF, México
| | - Jazmin M Pérez-Rojas
- Laboratorio de Farmacología, Subdirección de Investigación Básica, Instituto Nacional de Cancerología (INCan), Av. San Fernando #22, Tlalpan 14080, Apartado Postal 22026, México, DF, México.
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