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Camp KM, Trujillo E. Position of the Academy of Nutrition and Dietetics: nutritional genomics. J Acad Nutr Diet 2014; 114:299-312. [PMID: 24439821 DOI: 10.1016/j.jand.2013.12.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Indexed: 01/28/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that nutritional genomics provides insight into how diet and genotype interactions affect phenotype. The practical application of nutritional genomics for complex chronic disease is an emerging science and the use of nutrigenetic testing to provide dietary advice is not ready for routine dietetics practice. Registered dietitian nutritionists need basic competency in genetics as a foundation for understanding nutritional genomics; proficiency requires advanced knowledge and skills. Unlike single-gene defects in which a mutation in a single gene results in a specific disorder, most chronic diseases, such as cardiovascular disease, diabetes, and cancer are multigenetic and multifactorial and therefore genetic mutations are only partially predictive of disease risk. Family history, biochemical parameters, and the presence of risk factors in individuals are relevant tools for personalizing dietary interventions. Direct-to-consumer genetic testing is not closely regulated in the United States and may not be accompanied by access to health care practitioners. Applying nutritional genomics in clinical practice through the use of genetic testing requires that registered dietitian nutritionists understand, interpret, and communicate complex test results in which the actual risk of developing a disease may not be known. The practical application of nutritional genomics in dietetics practice will require an evidence-based approach to validate that personalized recommendations result in health benefits to individuals and do not cause harm.
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Camp KM, Lloyd-Puryear MA, Yao L, Groft SC, Parisi MA, Mulberg A, Gopal-Srivastava R, Cederbaum S, Enns GM, Ershow AG, Frazier DM, Gohagan J, Harding C, Howell RR, Regan K, Stacpoole PW, Venditti C, Vockley J, Watson M, Coates PM. Expanding research to provide an evidence base for nutritional interventions for the management of inborn errors of metabolism. Mol Genet Metab 2013; 109:319-28. [PMID: 23806236 PMCID: PMC4131198 DOI: 10.1016/j.ymgme.2013.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 11/27/2022]
Abstract
A trans-National Institutes of Health initiative, Nutrition and Dietary Supplement Interventions for Inborn Errors of Metabolism (NDSI-IEM), was launched in 2010 to identify gaps in knowledge regarding the safety and utility of nutritional interventions for the management of inborn errors of metabolism (IEM) that need to be filled with evidence-based research. IEM include inherited biochemical disorders in which specific enzyme defects interfere with the normal metabolism of exogenous (dietary) or endogenous protein, carbohydrate, or fat. For some of these IEM, effective management depends primarily on nutritional interventions. Further research is needed to demonstrate the impact of nutritional interventions on individual health outcomes and on the psychosocial issues identified by patients and their families. A series of meetings and discussions were convened to explore the current United States' funding and regulatory infrastructure and the challenges to the conduct of research for nutritional interventions for the management of IEM. Although the research and regulatory infrastructure are well-established, a collaborative pathway that includes the professional and advocacy rare disease community and federal regulatory and research agencies will be needed to overcome current barriers.
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Affiliation(s)
- Kathryn M. Camp
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Lynne Yao
- U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Stephen C. Groft
- Office of Rare Diseases Research, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | - Melissa A. Parisi
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Andrew Mulberg
- U.S. Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Rashmi Gopal-Srivastava
- Office of Rare Diseases Research, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Gregory M. Enns
- Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Abby G. Ershow
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Dianne M. Frazier
- University of North Carolina Chapel Hill, Chapel Hill, NC 27599, USA
| | - John Gohagan
- Office of Disease Prevention, National Institutes of Health, Bethesda, MD 20892, USA
| | - Cary Harding
- Oregon Health and Science University, Portland, OR 97239, USA
| | | | - Karen Regan
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA
- Division of Nutrition Research Coordination, National Institutes of Health, Bethesda, MD 20892, USA
| | | | - Charles Venditti
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jerry Vockley
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Michael Watson
- American College of Medical Genetics and Genomics, Bethesda, MD 20814, USA
| | - Paul M. Coates
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD 20892, USA
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Rhea M, Bettles C. Future Changes Driving Dietetics Workforce Supply and Demand: Future Scan 2012-2022. J Acad Nutr Diet 2012; 112:S10-24. [DOI: 10.1016/j.jand.2011.12.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Indexed: 12/01/2022]
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