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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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Vimaleswaran KS, Reddy GB. Comment on "Guiding Global Best Practice in Personalized Nutrition Based on Genetics: The Development of a Nutrigenomics Care Map". J Acad Nutr Diet 2021; 121:1215-1216. [PMID: 34172268 DOI: 10.1016/j.jand.2021.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - G Bhanuprakash Reddy
- Department of Biochemistry, ICMR-National Institute of Nutrition, Hyderabad, India
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Horne JR, Nielsen DE, Madill J, Robitaille J, Vohl MC, Mutch DM. Guiding Global Best Practice in Personalized Nutrition Based on Genetics: The Development of a Nutrigenomics Care Map. J Acad Nutr Diet 2021; 122:259-269. [PMID: 33744236 DOI: 10.1016/j.jand.2021.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
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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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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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Joffe Y, Herholdt H. What Will It Take to Build an Expert Group of Nutrigenomic Practitioners? Lifestyle Genom 2020; 13:122-128. [DOI: 10.1159/000507252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/06/2020] [Indexed: 11/19/2022] Open
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Abrahams M, Frewer L, Bryant E, Stewart-Knox B. Personalised Nutrition Technologies and Innovations: A Cross-National Survey of Registered Dietitians. Public Health Genomics 2019; 22:119-131. [DOI: 10.1159/000502915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/25/2019] [Indexed: 11/19/2022] Open
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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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Harding B, Webber C, Rühland L, Dalgarno N, Armour C, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips SP, MacKenzie JJ. Bridging the gap in genetics: a progressive model for primary to specialist care. BMC MEDICAL EDUCATION 2019; 19:195. [PMID: 31185964 PMCID: PMC6558677 DOI: 10.1186/s12909-019-1622-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 05/22/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND The rapid expansion of genetic knowledge, and the implications for healthcare has resulted in an increased role for Primary Care Providers (PCPs) to incorporate genetics into their daily practice. The objective of this study was to explore the self-identified needs, including educational needs, of both urban and rural Primary Care Providers (PCPs) in order to provide genetic care to their patients. METHODS Using a qualitative grounded theory approach, ten key informant interviews, and one urban and two rural PCP focus groups (FGs) (n = 19) were conducted. All PCPs practiced in Southeastern Ontario. Data was analyzed using a constant comparative method and thematic design. The data reported here represent a subset of a larger study. RESULTS Participants reported that PCPs have a responsibility to ensure patients receive genetic care. However, specific roles and responsibilities for that care were poorly defined. PCPs identified a need for further education and resources to enable them to provide care for individuals with genetic conditions. Based on the findings, a progressive stepped model that bridges primary and specialty genetic care was developed; the model ranged from PCPs identifying patients with genetic conditions that they could manage alone, to patients who they could manage with informal or electronic consultation to those who clearly required specialist referral. CONCLUSIONS PCPs identified a need to integrate genetics into primary care practice but they perceived barriers including a lack of knowledge and confidence, access to timely formal and informal consultation and clearly defined roles for themselves and specialists. To address gaps in PCP confidence in providing genetic care, interventions that are directed at accessible just-in-time support and consultation have the potential to empower PCPs to manage patients' genetic conditions. Specific attention to content, timing, and accessibility of educational interventions is critical to address the needs of both urban and rural PCPs. A progressive framework for bridging primary to specialty care through a 'stepped' model for providing continuing medical education, and genetic care can was developed and can be used to guide future design and delivery of educational interventions and resources.
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Affiliation(s)
- Brittany Harding
- Department of Pediatrics, McMaster University, Hamilton, Ontario Canada
| | - Colleen Webber
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Lucia Rühland
- Queen’s University, 99 University Avenue, Kingston, Ontario K7L 3N6 Canada
| | - Nancy Dalgarno
- Botterell Hall, Queen’s University, 18 Stuart Street, Kingston, Ontario K7L 3N6 Canada
| | - Christine Armour
- Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8L1 Canada
| | | | - Glenn Brown
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - June C. Carroll
- Department of Family and Community Medicine, Granovsky Gluskin Family Medicine Centre, Mount Sinai Hospital, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario M5T 3L9 Canada
| | - Michael Flavin
- Department of Pediatrics, Faculty of Health Sciences, Queen’s University, Kingston, Ontario Canada
| | - Susan P. Phillips
- Centre for Studies in Primary Care, Queen’s University, 220 Bagot Street, P.O.#8888, Kingston, Ontario K7L 5E9 Canada
| | - Jennifer J. MacKenzie
- Department of Pediatrics, McMaster Children’s Hospital, 1280, Main St. West, 3N11-G, Hamilton, Ontario L8S 4K1 Canada
- Department of Medicine, Queen’s University, Kingston, Ontario Canada
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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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Ogunrin O, Taiwo F, Frith L. Genomic Literacy and Awareness of Ethical Guidance for Genomic Research in Sub-Saharan Africa: How Prepared Are Biomedical Researchers? J Empir Res Hum Res Ethics 2018; 14:78-87. [PMID: 30358478 DOI: 10.1177/1556264618805194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Achieving the objectives of rolling out genomic research programs in sub-Saharan Africa depends on how prepared indigenous biomedical researchers are for this type of research. We explored the level of preparedness of biomedical researchers in a sub-Saharan African country using in-depth interviews to obtain data on their understanding of genomics and genomic research and assess their awareness of the scope of the country's code of health research ethics. Thirty biomedical researchers were interviewed. Only eight were familiar with concepts of genomics, a form of "genomic health literacy." The majority were not aware of the country's code of research ethics. This study showed that generally biomedical researchers were not genomic health literate, unaware of the code and its limitations as a source of ethical guidance for the conduct of genomic research. These findings underscore the need for educational training in genomics and creating awareness of ethical oversight for genomic research in sub-Saharan Africa.
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Harding B, Webber C, Ruhland L, Dalgarno N, Armour CM, Birtwhistle R, Brown G, Carroll JC, Flavin M, Phillips S, MacKenzie JJ. Primary care providers' lived experiences of genetics in practice. J Community Genet 2018; 10:85-93. [PMID: 29700759 PMCID: PMC6325046 DOI: 10.1007/s12687-018-0364-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/12/2018] [Indexed: 12/28/2022] Open
Abstract
To effectively translate genetic advances into practice, engagement of primary care providers (PCPs) is essential. Using a qualitative, phenomenological methodology, we analyzed key informant interviews and focus groups designed to explore perspectives of urban and rural PCPs. PCPs endorsed a responsibility to integrate genetics into their practices and expected advances in genetic medicine to expand. However, PCPs reported limited knowledge and difficulties accessing resources, experts, and continuing education. Rural practitioners’ additional concerns included cost, distance, and poor patient engagement. PCPs’ perspectives are crucial to develop relevant educational and systems-based interventions to further expand genetic medicine in primary care.
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Affiliation(s)
- Brittany Harding
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, Kingston, Ontario, K7L 2N6, Canada
| | - Colleen Webber
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Lucia Ruhland
- Queen's University, 99 University Avenue, Kingston, Ontario, K7L 3N6, Canada
| | - Nancy Dalgarno
- Office of Health Sciences Education, Queen's University, Botterell Hall, Room 217, 18 Stuart Street, Kingston, Ontario, K7L 3N6, Canada
| | - Christine M Armour
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Richard Birtwhistle
- Centre for Studies in Primary Care, Queen's University, 220 Bagot Street, P.O.#8888, Kingston, Ontario, K7L 5E9, Canada
| | - Glenn Brown
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - June C Carroll
- Department of Family & Community Medicine, Mount Sinai Hospital, Granovsky Gluskin Family Medicine Centre, University of Toronto, 60 Murray St., 4th Floor, Box 25, Toronto, Ontario, M5T 3L9, Canada
| | - Michael Flavin
- Kingston General Hospital, 76 Stuart Street, Kingston, Ontario, K7L 2V7, Canada
| | - Susan Phillips
- Department of Family Medicine, 220 Bagot Street, Kingston, Ontario, K7L 5E9, Canada
| | - Jennifer J MacKenzie
- Department of Pediatrics, McMaster Children's Hospital, 1280 Main St. West, 3N11-G, Hamilton, ON, L8S 4K1, Canada.
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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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15
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Factors determining the integration of nutritional genomics into clinical practice by registered dietitians. Trends Food Sci Technol 2017. [DOI: 10.1016/j.tifs.2016.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hurlimann T, Robitaille J, Vohl MC, Godard B. Ethical considerations in the implementation of nutrigenetics/nutrigenomics. Per Med 2016; 14:75-83. [PMID: 29749825 DOI: 10.2217/pme-2016-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Awareness of ethical issues that may be raised by the implementation of nutrigenetic/nutrigenomic (NGx) testing and personalized nutrition, at an individual or a public health level, is crucial to ensure the latter's sound and effective implementation. NGx tests that are currently offered or developed have different natures and scopes. We provide an example of NGx testing on the MTHFR gene to illustrate the current challenges when it comes to grasp the meaning of the results of such testing. In addition, NGx testing is developed within an evolving landscape of new genomic technologies and occurs at a time when public health policies mainly focus on preventive and predictive healthcare, with an emphasis on increased individual responsibility. The ethical issues raised by such a context and the genetic nature of NGx testing both should be carefully evaluated.
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Affiliation(s)
- Thierry Hurlimann
- Public Health Research Institute - University of Montreal (IRSPUM), PO Box 6128, Station Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Julie Robitaille
- Institute of Nutrition & Functional Foods (INAF) & School of Nutrition, Université Laval, 2440 Hochelaga Blvd, Room 2729-N, Quebec City, QC, Canada
| | - Marie-Claude Vohl
- Institute of Nutrition & Functional Foods (INAF) & School of Nutrition, Université Laval, 2440 Hochelaga Blvd, Room 2729-N, Quebec City, QC, Canada
| | - Béatrice Godard
- Public Health Research Institute - University of Montreal (IRSPUM), PO Box 6128, Station Centre-ville, Montreal, QC, H3C 3J7, Canada
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Riboflavin status, MTHFR genotype and blood pressure: current evidence and implications for personalised nutrition. Proc Nutr Soc 2016; 75:405-14. [PMID: 27170501 DOI: 10.1017/s0029665116000197] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Clinical deficiency of the B-vitamin riboflavin (vitamin B2) is largely confined to developing countries; however accumulating evidence indicates that suboptimal riboflavin status is a widespread problem across the developed world. Few international data are available on riboflavin status as measured by the functional biomarker, erythrocyte glutathione reductase activation coefficient, considered to be the gold standard index. One important role of riboflavin in the form of flavin dinucleotide is as a co-factor for the folate-metabolising enzyme methylenetetrahydrofolate reductase (MTHFR). Homozygosity for the common C677T polymorphism in MTHFR, affecting over 10 % of the UK and Irish populations and up to 32 % of other populations worldwide, has been associated with an increased risk of CVD, and more recently with hypertension. This review will explore available studies reporting riboflavin status worldwide, the interaction of riboflavin with the MTHFR C677T polymorphism and the potential role of riboflavin in personalised nutrition. Evidence is accumulating for a novel role of riboflavin as an important modulator of blood pressure (BP) specifically in individuals with the MTHFR 677TT genotype, with results from a number of recent randomised controlled trials demonstrating that riboflavin supplementation can significantly reduce systolic BP by 5-13 mmHg in these genetically at risk adults. Studies are however required to investigate the BP-lowering effect of riboflavin in different populations and in response to doses higher than 1·6 mg/d. Furthermore, work focusing on the translation of this research to health professionals and patients is also required.
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Covolo L, Rubinelli S, Ceretti E, Gelatti U. Internet-Based Direct-to-Consumer Genetic Testing: A Systematic Review. J Med Internet Res 2015; 17:e279. [PMID: 26677835 PMCID: PMC4704942 DOI: 10.2196/jmir.4378] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/12/2015] [Accepted: 10/16/2015] [Indexed: 12/26/2022] Open
Abstract
Background Direct-to-consumer genetic tests (DTC-GT) are easily purchased through the Internet, independent of a physician referral or approval for testing, allowing the retrieval of genetic information outside the clinical context. There is a broad debate about the testing validity, their impact on individuals, and what people know and perceive about them. Objective The aim of this review was to collect evidence on DTC-GT from a comprehensive perspective that unravels the complexity of the phenomenon. Methods A systematic search was carried out through PubMed, Web of Knowledge, and Embase, in addition to Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist with the key term “Direct-to-consumer genetic test.” Results In the final sample, 118 articles were identified. Articles were summarized in five categories according to their focus on (1) knowledge of, attitude toward use of, and perception of DTC-GT (n=37), (2) the impact of genetic risk information on users (n=37), (3) the opinion of health professionals (n=20), (4) the content of websites selling DTC-GT (n=16), and (5) the scientific evidence and clinical utility of the tests (n=14). Most of the articles analyzed the attitude, knowledge, and perception of DTC-GT, highlighting an interest in using DTC-GT, along with the need for a health care professional to help interpret the results. The articles investigating the content analysis of the websites selling these tests are in agreement that the information provided by the companies about genetic testing is not completely comprehensive for the consumer. Given that risk information can modify consumers’ health behavior, there are surprisingly few studies carried out on actual consumers and they do not confirm the overall concerns on the possible impact of DTC-GT. Data from studies that investigate the quality of the tests offered confirm that they are not informative, have little predictive power, and do not measure genetic risk appropriately. Conclusions The impact of DTC-GT on consumers’ health perceptions and behaviors is an emerging concern. However, negative effects on consumers or health benefits have yet to be observed. Nevertheless, since the online market of DTC-GT is expected to grow, it is important to remain aware of a possible impact.
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Affiliation(s)
- Loredana Covolo
- Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy, Brescia, Italy.
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Cormier H, Tremblay BL, Paradis AM, Garneau V, Desroches S, Robitaille J, Vohl MC. Nutrigenomics - perspectives from registered dietitians: a report from the Quebec-wide e-consultation on nutrigenomics among registered dietitians. J Hum Nutr Diet 2014; 27:391-400. [DOI: 10.1111/jhn.12194] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. Cormier
- Institute of Nutrition and Functional Foods (INAF); Laval University; Quebec City QC Canada
- Department of Food Sciences and Nutrition; Faculty of Agriculture and Food Sciences; Laval University; Quebec City QC Canada
| | - B. L. Tremblay
- Institute of Nutrition and Functional Foods (INAF); Laval University; Quebec City QC Canada
- Department of Food Sciences and Nutrition; Faculty of Agriculture and Food Sciences; Laval University; Quebec City QC Canada
| | - A.-M. Paradis
- Department of Food Sciences and Nutrition; Faculty of Agriculture and Food Sciences; Laval University; Quebec City QC Canada
| | - V. Garneau
- Institute of Nutrition and Functional Foods (INAF); Laval University; Quebec City QC Canada
- Department of Food Sciences and Nutrition; Faculty of Agriculture and Food Sciences; Laval University; Quebec City QC Canada
| | - S. Desroches
- Institute of Nutrition and Functional Foods (INAF); Laval University; Quebec City QC Canada
- Department of Food Sciences and Nutrition; Faculty of Agriculture and Food Sciences; Laval University; Quebec City QC Canada
| | - J. Robitaille
- Institute of Nutrition and Functional Foods (INAF); Laval University; Quebec City QC Canada
- Department of Food Sciences and Nutrition; Faculty of Agriculture and Food Sciences; Laval University; Quebec City QC Canada
| | - M.-C. Vohl
- Institute of Nutrition and Functional Foods (INAF); Laval University; Quebec City QC Canada
- Department of Food Sciences and Nutrition; Faculty of Agriculture and Food Sciences; Laval University; Quebec City QC Canada
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Nielsen DE, Shih S, El-Sohemy A. Perceptions of Genetic Testing for Personalized Nutrition: A Randomized Trial of DNA-Based Dietary Advice. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2014; 7:94-104. [DOI: 10.1159/000365508] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Wright ORL. Systematic review of knowledge, confidence and education in nutritional genomics for students and professionals in nutrition and dietetics. J Hum Nutr Diet 2013; 27:298-307. [DOI: 10.1111/jhn.12132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- O. R. L. Wright
- Centre for Dietetics Research (C-DIET-R); School of Human Movement Studies; The University of Queensland; Brisbane QLD Australia
- Metabolic Medicine; Mater Medical Research Institute; Brisbane QLD Australia
- Translational Research Institute; Brisbane QLD Australia
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Abstract
It is predicted that non-communicable diseases will account for over 73 % of global mortality in 2020. Given that the majority of these deaths occur in developed countries such as the UK, and that up to 80 % of chronic disease could be prevented through improvements in diet and lifestyle, it is imperative that dietary guidelines and disease prevention strategies are reviewed in order to improve their efficacy. Since the completion of the human genome project our understanding of complex interactions between environmental factors such as diet and genes has progressed considerably, as has the potential to individualise diets using dietary, phenotypic and genotypic data. Thus, there is an ambition for dietary interventions to move away from population-based guidance towards 'personalised nutrition'. The present paper reviews current evidence for the public acceptance of genetic testing and personalised nutrition in disease prevention. Health and clear consumer benefits have been identified as key motivators in the uptake of genetic testing, with individuals reporting personal experience of disease, such as those with specific symptoms, being more willing to undergo genetic testing for the purpose of personalised nutrition. This greater perceived susceptibility to disease may also improve motivation to change behaviour which is a key barrier in the success of any nutrition intervention. Several consumer concerns have been identified in the literature which should be addressed before the introduction of a nutrigenomic-based personalised nutrition service. Future research should focus on the efficacy and implementation of nutrigenomic-based personalised nutrition.
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Nielsen DE, El-Sohemy A. A randomized trial of genetic information for personalized nutrition. GENES & NUTRITION 2012; 7:559-66. [PMID: 22407352 PMCID: PMC3448037 DOI: 10.1007/s12263-012-0290-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 02/21/2012] [Indexed: 02/01/2023]
Abstract
Personal genetic information has become increasingly accessible to the public as a result of direct-to-consumer (DTC) genetic tests; however, concerns have been raised over their value and potential risks. We compared the effects of providing genotype-based dietary advice with general recommendations on behavioral outcomes using a randomized controlled study. Participants were men and women from the Toronto Nutrigenomics and Health Study between the ages of 20-35 years (n = 149) who completed a survey to assess their awareness of DTC genetic tests and nutrigenomics, as well as potential motivations for undergoing genetic testing. Participants were then randomized into an intervention (I) or control (C) group and were given either genotype-based personalized dietary advice or general dietary advice, respectively. A second survey was administered to assess the participants' opinions of the dietary reports they received. A greater proportion of participants in the intervention group agreed that they understood the dietary advice they were given (93% (I) vs. 78% (C); p = 0.009). Participants in the intervention group were more likely to agree that the dietary recommendations they received would be useful when considering their diet (88% (I) vs. 72% (C); p = 0.02) and wanted to know more about the recommendations (95% (I) vs. 76% (C); p < 0.0001). Only 9% of participants in the intervention group reported feeling uneasy about learning their genetic information. These findings suggest that individuals find dietary recommendations based on genetics more understandable and more useful than general dietary advice. Very few feel uneasy about receiving their genetic information that relates to personalized nutrition.
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Affiliation(s)
- Daiva E. Nielsen
- Department of Nutritional Sciences, Room 350, University of Toronto, 150 College St, Toronto, ON M5S 3E2 Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Room 350, University of Toronto, 150 College St, Toronto, ON M5S 3E2 Canada
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Pavlidis C, Karamitri A, Barakou A, Cooper DN, Poulas K, Topouzis S, Patrinos GP. Ascertainment and critical assessment of the views of the general public and healthcare professionals on nutrigenomics in Greece. Per Med 2012; 9:201-210. [PMID: 29758826 DOI: 10.2217/pme.12.3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIM The aim of this study was to understand the general public's and healthcare professionals' views on nutrigenomics. PATIENTS & METHODS We designed a cross-sectional survey of healthcare professionals (n = 87) and the general public (n = 1504) in the three largest cities in Greece (Athens, Thessaloniki and Patras). RESULTS Our data revealed that only 11.5% of respondents from the general public had been advised to take a genetic test in order to explore the relationship between their genes and their nutritional status. Although 80.5% of healthcare professionals would have been willing to recommend their patients/clients to undergo nutrigenomic analysis to correlate their genetic profile with their diet, only 17.2% of respondents had actually done so. In general, the general public was opposed to direct-access nutrigenomics testing. CONCLUSION The application of genomic information in the context of nutritional choice requires the continuing education of healthcare professionals and the dissemination of accurate and reliable information to the general public.
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Affiliation(s)
- Cristiana Pavlidis
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-26504, Patras, Greece
| | - Angeliki Karamitri
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-26504, Patras, Greece
| | - Aglaia Barakou
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-26504, Patras, Greece
| | - David N Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Konstantinos Poulas
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-26504, Patras, Greece
| | - Stavros Topouzis
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-26504, Patras, Greece
| | - George P Patrinos
- University of Patras, School of Health Sciences, Department of Pharmacy, University Campus, Rion, GR-26504, Patras, Greece.
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Bergmann MM, Mathers JC. Ethical challenges in human nutrigenomics research. Maturitas 2011; 68:297-8. [DOI: 10.1016/j.maturitas.2010.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
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