A study protocol for a pilot randomized controlled trial to evaluate the effectiveness of a gene-based nutrition and lifestyle recommendation for weight management among adults: the MyGeneMyDiet® study

Introduction

Managing nutrition and lifestyle practices, nutrition phenotypes, and the genome forms the foundation of precision nutrition. Precision nutrition focuses on metabolic variability among individuals, and one approach to achieving its goals is to integrate gene-based nutrition and lifestyle recommendations in nutrition practice. However, scientific evidence proving the effectiveness of such recommendations is limited. This study will examine whether providing nutrition and lifestyle recommendations based on individual genotype can lead to better weight loss, along with reduction in body mass index (BMI), waist circumference, and body fat percentage among overweight and obese adults.

Methods and analysis

A parallel group, single-blind, randomized controlled trial will be conducted. Sixty-two overweight/obese individuals aged 19-59 years old will be recruited. Participants will be randomly allocated to either the intervention (n = 31) or the control arm (n = 31). Participants in the intervention group will receive the MyGeneMyDiet® Recommendation for Weight Management, a gene-based nutrition and lifestyle recommendation that was developed based on existing evidence of the effects of FTO rs9939609 on body weight, BMI, and physical activity; UCP1 rs1800592 on calorie intake; and TCF7L2 rs7903146 on dietary fat intake. Participants in the control group will receive the standard recommendations for weight management. The primary outcomes will be the differences in weight, BMI, waist circumference, and body fat percentage between arms in both the active phase (6 months) and inactive phase (last 6 months) of the trial. Participants in both arms will be evaluated at baseline and in months 3, 6, 9, and 12.

Discussion

To the best of our knowledge, this will be the first gene-based intervention that will adopt a phase of intensive nutrition counseling, followed by a simulation of a free-living state to determine adherence to a gene-based recommendation. This study will contribute to the future implementation of precision nutrition interventions by providing evidence on the effectiveness of a gene-based nutrition and lifestyle recommendation for weight loss.

Clinical trial registration

clinicaltrials.gov, identifier [NCT05098899].

Nutritional and genetic determinants of essential hypertension among adult respondents of the 2013 national nutrition survey, Philippines: a preliminary observational study

Preventive strategies for hypertension and its sequelae require an understanding of their predisposing conditions and recognition of at-risk individuals. Several factors, both genetic and nongenetic, are influential, and likely vary in their effects across ethnicities. This study aimed to identify dietary, lifestyle-related differences and genetic variants associated with hypertension in Filipinos. The study included 147 adult Filipino respondents of the 2013 Philippine National Nutrition Survey living in the National Capital Region. Data on the socio-demographic profile and selected lifestyle factors were obtained via face-to-face interviews. Blood pressure, anthropometric and biochemical indicators of health were determined using standard procedures. Hypertension incidence was determined following American College of Cardiology/American Heart Association guideline. Genotyping utilized the customized Illumina Golden Gate genotyping array, with subsequent allele and genotypic association analytics. Genetic variant effects were adjusted to clinical parameters via logistic regression. Between those with and without hypertension, there was relatively higher intake of dietary protein, fat but not carbohydrates in the latter (P<.05). Of note, other established risk factors for hypertension, such as high lipid levels and fasting blood sugar, were consistently frequently seen among hypertensive respondents. Of the gene markers, 3 SNPs (rs10492602 of APOC [3' UTR], rs12721054 of CYP2C19 [exon] and rs4244285 [intergenic between PCDH17-DIAPH3 locus]) remained significant after multivariable logistic regression. The study highlights that both nutrition and genetic information may contribute to hypertension among Filipinos. This could guide public health initiatives to identify Filipinos susceptible to hypertension and recommend control strategies in lowering its morbidity rate.

"Right diet for the right person": a focus group study of nutritionist-dietitians' perspectives on nutritional genomics and gene-based nutrition advice

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.

Diet supplemented with MCT oil in the management of childhood diarrhea

This study was undertaken to determine the effect of medium-chain triglyceride (MCT) oil supplementation on the duration and episodes of diarrhea attacks, and specifically its effect on the clinical manifestations of patients. Seventeen children aged 6 months to 47 months old with a mean age of 19.6 months, suffering from acute diarrhea at the Pediatric Ward of the Philippine General Hospital Medical Center and other neighboring health centers were studied. A double-blind randomized design was employed. Physical and clinical assessment was performed by a physician prior to enrolment in the study. Dietary, anthropometric, and biochemical assessment were undertaken by clinical investigators before and after the supplementation. The subjects were randomly assigned to either the MCT oil- supplemented diet or the non-MCT oil diet. Daily monitoring of food intake and the frequency or episodes of diarrhea attacks was done. Subjects were closely monitored for any possible adverse reactions. The baseline characteristics of the subjects were not significantly different for any of age, height, weight, cholesterol or triglyceride concentrations between the two groups. Nutrient intakes at baseline and during intervention were also not significantly different. There were no differences in cholesterol and triglyceride between the two groups after supplementation. Stool frequencies of the MCT group and the non-MCT group at baseline, after the 6th hr, and at 12th hour, were not different. No subject developed fat malabsorption during the intervention, as assessed with Sudan Black stain. There was statistical significant difference in the rate of weight gain among subjects in the MCT group compared to subjects in the non-MCT group , but a trend in this direction (0.22 + 0.22 kg/day vs -.048 + .26 kg/day), (p=.042). MCT oil may promote weight gain (although what this constitutes in body compositional terms is uncertain) and shows a trend towards shorter duration of intervention among children with acute diarrhea. Limited sample size precludes conclusions on these possibilities. MCT oil did not cause vomiting, dehydration, or fat intolerance. MCT oil did not cause an elevation in cholesterol and triglyceride levels. More studies, with larger sample size, and longer duration will be worthwhile to assess the effect of MCT oil on childhood diarrhea.

Enteral feeding in stable chronic obstructive pulmonary disease patients

OBJECTIVE

The study aimed to compare the effectiveness of a defined formula diet with a blenderized diet on nutritional and respiratory function parameters and to determine the bacteriological load of the two formulations.

METHODOLOGY

Seventeen patients, aged 50-75 years, admitted to the University of the Philippines-Philippine General Hospital for chronic bronchitis and/or emphysema, were studied. They were divided into two groups according to dietary regimens. Each group of patients received either the standardized commercial formula or the blenderized formula for 2 weeks. Evaluation of dietary intake, anthropometric measurements, laboratory examinations and lung function were assessed. Subjective evaluation (patient's and physician's assessment) was also sought. Microbiological examinations were performed on the prepared enteral formulas.

RESULTS

There was a slight increase in weight and in pulmonary function in both groups but these results did not differ significantly. Possible formula contamination was confirmed. Furthermore, in the overall assessment, the physician and patients rated both formulas as comparable.

Relationship of conjunctival impression cytology with clinical and biochemical assessment of vitamin A status of preschoolers

Comparison of conjunctival impression cytology (CIC) with ocular signs and vitamin A levels was done based upon a national nutrition survey involving 427 randomly selected subjects aged 6 months to 6 years. Medical nutritionists looked for ocular signs and performed conjunctival impressions. Imprints were submitted to the Institute of Ophthalmology, University of the Philippines-Philippines General Hospital, for analysis. Fixing, staining and reading of all imprints was performed in accordance with the procedures of the International Centre for Epidemiologic and Preventive Ophthalmology (ICEPO). Comparison of the biochemical determination of serum vitamin A (SVA) with CIC results revealed that irrespective of SVA levels, more than 50% of the subjects were noted to have abnormal CIC results. The highest proportion of abnormal imprints was seen among those with low SVA. The relationship, however, was found not to be significant. Of the 247 subjects examined, 95% had a normal clinical and biochemical assessment of vitamin A; of these, 50.2% had abnormal cytology imprints while 45.3% had normal imprints. Using sensitivity and specificity analyses, CIC was compared with SVA levels. The computed sensitivity, specificity and positive predictive value (PPV) were 60.5, 45.2 and 60.0%, respectively. The lack of significant difference in mean serum retinol levels between normal and abnormal CIC groups may partly explain the low sensitivity and PPV of the CIC. In this study population, CIC failed to identify children with subclinical vitamin A deficiency as established by biochemical examination.

Interactions among micronutrient deficiencies and undernutrition in the Philippines

Data gathered from the 1987 National Nutrition Survey in the Philippines provided the opportunity to study the interactions among micronutrient deficiencies and undernutrition in different age groups as basis for program targeting. A randomly selected set of 50% of the households (3,200) covered by the national survey served as source of subjects. Results showed that there was a greater proportion of anemia among the undernourished (as judged by weight for age in children and weight for height in adults) (66.0%) than among the adequately nourished (54.6%) (P < 0.01). However, the observed differences in the proportion of serum vitamin A deficiency and of goiter among the undernourished compared to the adequately nourished were not significant. Also not significant were the observed higher prevalence of anemia among subjects with acceptable serum vitamin A levels for both adequately nourished and undernourished, and the higher prevalence of vitamin A deficiency among the non-anemics. Again there were no significant differences in the prevalence of anemia among goitrous and non-goitrous subjects, as well as the prevalence of goiter among anemic and non-anemic subjects. Neither were there significant differences in the prevalence of vitamin A deficiency among goitrous and non-goitrous subjects, but there were significant differences in the prevalence of goiter among vitamin A deficient and non-vitamin A deficient subjects among the 7-14 years old and among pregnant and lactating women. The study concludes that at the national level, there is apparently an interaction between anemia and protein-energy undernutrition and possibly also between goiter and vitamin A deficiency in the high-risk age groups, but between anemia on the one hand and goiter and vitamin A deficiency in the other, perhaps because of clustering in the latter conditions not found in anemia and general undernutrition. These findings may be useful in targeting communities with high prevalence of micronutrient deficiencies by using prevalence of underweight and goiter as indicators for high prevalence of anemia and vitamin A deficiency, respectively.

Interactions among micronutrient deficiencies and undernutrition in the Philippines

Data gathered from the 1987 National Nutrition Survey in the Philippines provided the opportunity to study the interactions among micronutrient deficiencies and undernutrition in different age groups as a basis for program targeting. A randomly selected subset of 50% of the households (3,200) covered by the national survey served as source of subjects. Results showed that there was a greater proportion of anaemia among the undernourished (as judged by weight -for-age in children and weight-for-height in adults (66.0%) than among the adequately nourished (54.6%) alpha=0.01). However, the observed differences in the proportion of serum vitamin A deficiency and of goitre among the undernourished compared to the adequately nourished were not significant. Also not significant were the observed higher- prevalence of anaemia among subjects with acceptable serum vitamin A levels for both adequately nourished and undernourished, and the higher prevalence of vitamin A deficiency among the non-anaemic. Again there were no significant difference in the prevalence of anaemia among goitrous and non-goitrous subjects, as well as the prevalence of goitre among anaemic and non-anaemic subjects. Neither were there significant differences in the prevalence of vitamin A deficiency among goitrous and non goitrous subjects, but there were significant differences in the prevalence of goitre among vitamin A deficient and non-vitamin A deficient subjects among the 7-14 year olds and among pregnant and lactating women. The study concludes that at the national level there is apparently an interaction between anaemia and protein-energy undernutrition and possibly also between goitre and vitamin A deficiency in the high risk age groups, but not between anaemia on the one hand and goitre and vitamin A deficiency in another, perhaps because of clustering in the latter conditions not found in anaemia and general undernutrition. These findings may be useful in targeting communities with high prevalence of micronutrient deficiencies by using prevalence of underweight and goitre as indicators for high prevalence of anaemia and vitamin A deficiency, respectively.

Prenatal hormone treatment with thyrotropin releasing hormone and with thyrotropin releasing hormone plus dexamethasone delays antioxidant enzyme maturation but does not inhibit a protective antioxidant enzyme response to hyperoxia in newborn rat lung

Whereas glucocorticoid administration to pregnant rats produces parallel acceleration of lung surfactant and antioxidant enzyme system maturation in late gestation, prenatal thyroid hormone treatment results in acceleration of surfactant maturation, with a paradoxical decrease in antioxidant enzyme (AOE) development. In these studies, we tested whether prenatal thyroid releasing hormone (TRH) treatment would act like prenatal thyroid hormone on pulmonary surfactant and AOE system maturation and whether combined prenatal treatment with TRH plus dexamethasone (DEX) would alter these effects. Secondly, we tested whether prenatal TRH and prenatal TRH plus DEX would inhibit the ability of newborn rats to respond to hyperoxia with protective increases in AOE activities. Results of the developmental studies revealed significantly increased fetal lung disaturated phosphatidylcholine content with significantly decreased pulmonary AOE activities as a result of prenatal TRH treatment that was not reversed with the addition of DEX. Combined TRH plus DEX treatment resulted in statistically significant decreases in body weight, lung weight, and lung weight to body weight ratios at both 21 and 22 d of gestation; growth effects were not seen with TRH alone. In terms of hyperoxic AOE response, despite being born with lower baseline AOE levels, the newborn animals prenatally treated with TRH or TRH plus DEX were able to induce a normal pulmonary AOE response to high O2 exposure. Although requiring further investigation, this reassuring finding suggests that clinical prenatal therapy with TRH or the combination of TRH plus DEX is not contraindicated for those infants delivered prematurely who go on to require intensive hyperoxic therapy.

Percutaneous transluminal angioplasty of the hepatic veins for treatment of Budd-Chiari syndrome

The authors report a case of Budd-Chiari syndrome caused by occlusion of all of the hepatic veins which was treated by percutaneous transluminal angioplasty. There were two recurrences requiring redilatation. Two years later, the patient was asymptomatic and off medication.