Personalised nutrition PDF

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Personalised nutrition What is personalised nutrition? -

Personalised nutrition is an emerging concept, it has been developed based on the progressive understanding of the interactions between diet, phenotype and genes on our health. Personalised nutrition aims to provide advice on individual/group basis that is tailored to specific needs based on the knowledge of their current diet and phenotypic and or genetic information.

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Personalised is in its infancy – still emerging still growing

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Personalised nutrition is progressing

ILSI definition of personalised nutrition -

Personalised nutrition uses individual specific information that is founded on evidence-based science to promote dietary behaviour change that may result in measurable health benefits.

Differentiate between the concepts nutrigenetics and nutrigenomics. Support your answer with the use of appropriate examples (at least 2) for each concept. (10 marks) Discuss the potential future role of personalised nutrition in replacing population level foodbased dietary guidelines. In your answer, briefly mention any ethical, legal and social issues that may arise from the use of genetic profiles in nutritional advice

Or Discuss briefly the potential challenges of personalised nutrition. Use the following headings to guide your answer: 1) consumer acceptance and compliance, 2) consumer protection 3) commercialisation and 4) social issues Q1

Nutrigenetics and Nutrigenomics are important concepts in the evolving science of Personalised Nutrition.

a) Define the term personalised nutrition.

(5 marks)

b) Differentiate between the concepts nutrigenetics and nutrigenomics. Support your answer with the use of appropriate examples (at least 2) for each concept. (10 marks)

c) Discuss the potential future role of personalised nutrition in replacing population level food-based dietary guidelines. In your answer, briefly mention any ethical, legal and social issues that may arise from the use of genetic profiles in nutritional advice. (10 marks)

Personalised nutrition – where might it go?

No direct question on nutrigenetics and nutrigenomics (could be part of a larger question)

Understand the evolution of PN

Q – How personalised nutrition is developing & give examples -

Metabolomics are a group of tools that can be used in PN for several reasons

Order

1. Read guide and position of the international society of nutrigenetics and nutrigenomics part 1 2. This would like to the video from Mike Gibney (Included n PPT presentation) and info in PPT presentation to 3. The guide and position of the international society of nutrigenetics and nutrigenomics part 2 which discusses the ethical, social challenges etc 4. ILSI paper brings it up to date with focus on practical uses and principles and guidelines

The consumption of food -

Food is consumed for a variety of reasons other than for physiological or nutritional needs

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The key drivers for the consumption of food are hunger and satiety however food choice is not determined solely by these physiological or nutritional needs

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Food choice, like any complex human behaviour, is influenced by many interrelated factors. The key driver for eating is of course hunger and satiety, but what we choose to eat is not determined solely by physiological or nutritional needs. Other factors that influence our food choice are: o The sensory properties of foods, such as taste, smell, or appearance. o Social, emotional, and cognitive factors, such as likes and dislikes, knowledge and attitudes related to diet and health, habit or social context when eating condition our choice. Personal values, life experiences such as marital/cohabitation status, or skills (e.g., cooking), a person's beliefs (e.g., about issues like organic and GM), and perceptions, such as perceived barriers to eating a healthy diet, may be particularly important for certain individuals. o Cultural, religious, and economic factors also constrain our choice. Education, ethnicity and availability, visibility or prices of products play a major role in our food choice. o This multitude of factors illustrates that “healthy eating”, which is the goal of public health campaigns, is only one of many considerations relevant to food choice.

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Many factors affect food choices such as o Social needs o Social network of family & friends o Food customers & culture o Food cost o Education, occupation & income o Routines and habits o Lifestyle o Health and nutrition concerns, knowledge, and beliefs

o Food marketing o Food availability o Food flavour, texture, and appearance preferences o Psychological needs

ILSI paper ‘Perspective: Guiding Principles for the Implementation of Personalised Nutrition Approaches that benefit Health and Function’ (2019)

Informing PN approaches -

Age

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Sex

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Demographic o Apps such as MyFitnessPal input age, sex etc o Fitness watches/accessories o Specific apps developed for life stage such as pregnancy, lactation, older adults

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Phenotype information

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Standard Biochemical markers o Blood pressure o Cholesterol

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Biomarkers of nutrient status o Folate o B12 o Fatty acids in blood

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Lifestyle information such as goals

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Preferences such as culture (can mean availability as well)

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Choice o Allergens o Dietary choice, vegan/vegetarian o Don’t like certain foods

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Dietary intake assessments such as Nutritics

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Genomics based information is less accessible to the average individual

o Microbiome o Proteomics o Metabolomics o Xenometabolim 

Xenobiotic which is relating to or denoting a substance that typically is a synthetic chemical that is foreign to the body or to an ecological system

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Box 1 right hand side – future and less accessible

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Meta-type

Page 27 – diagram – ILSI North America paper figure 1

1. who uses it, who is the information for? Is it for the user or someone else? Is it for your boss/insurance company? 2. Credible 3. Only quality relevant data – what are you trying to find? What is the question – desired answer a. What are you trying to gather and why? b. Who is the data for? c. What are you trying to measure and why? d. How

can

you

use

the

information? 4. EFSA guidelines – use validated recommendations 5. More individualised, design studies around a specific group a. Phrase questions differently depending on the group 6. Endpoint 7. Libro app – difficult to use, give up 8. Important point – individualise info but keep in line with government guidelines a. Example – asked to give a talk to primary school children. Check HSE guidelines on primary school children to ensure information provided doesn’t conflict with previous knowledge to strengthen understanding rather than giving new/different information leading to confusing and overwhelming individuals. 9. – 10. GDPR

Look at paragraphs in paper

Page 32 of ILSI paper

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PN offers opportunity to help users increase compliance with dietary guidelines, shifting the paradigm of nutrition recommendations and delivery from populationbased to individualized. •

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Can close gap between population and personalised

Goal-to arrive at principles that are generally accepted by authorities that evaluate nutrition science and develop recommendations.

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The collective principles can also serve as a guide for companies or organizations that target PN delivery to individuals or populations.

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Apps

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Smart technology

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Spots/patients and population

New PN tools have the potential (PN is in its infancy) to increase access to highquality nutrition advice, enabling adherence to dietary and lifestyle goals and thus reducing disease risk and long-term health care costs. •

Conflicting advice on nutrition

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Need to know goal

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As the field matures, these guiding principles will be developed and adapted to ensure the validity and reliability of interventions. Biological systems are dynamic and integrative.

Important vocab for saying PN is emerging -

It’s in its infancy

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As the field matures

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Potential

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Can serve as a guide

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Opportunity

Summary Science-based PN—coupled to an innovative policy/regulatory environment plus greater consumer awareness—promises a new frontier in nutrition that could optimize health and function across the entire population.

Won’t ask nutrigenetics question, more likely to ask a question on -

How is personalised nutrition promising? i.e. what is its future

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Evidence to show its promising and its challenging

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Definition

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Where it’s going

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Its challenges

Order

5. Read guide and position of the international society of nutrigenetics and nutrigenomics part 1 6. This would like to the video from Mike Gibney (Included n PPT presentation) and info in PPT presentation to 7. The guide and position of the international society of nutrigenetics and nutrigenomics part 2 which discusses the ethical, social challenges etc 8. ILSI paper brings it up to date with focus on practical uses and principles and guidelines

Mike’s video is very important for understanding where we are with PN– v good examples of how PN is valuable in certain aspects 1. Dietary advice 2. Phenotype 3. Genotype

Ethics (genetic information – Challenge) Nutrigenomics paper – challenges about collection of genetic data & its risks

Privacy of information ◦

Insurance companies

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Employers

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Schools

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Athletic teams

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Risk of discrimination, despite recommendation that genetic profile should be kept confidential

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What about other family members? ◦

Siblings, parents-child

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Example BRCA1 gene – breast cancer – most people would get tested for a disease like cancer which could be cured

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FRH1 gene

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FTO gene

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Early detection is better

Individual completes a genetic test and discovers that they are more likely to suffer from early onset dementia ◦

Only a risk – nothing you could do about it regardless

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Unneeded stress

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Certain individuals may modify their lifestyle

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If a family member discovers that their genetics can predispose them for a genetic disorder, they may share this info with their family they have the same genetics – is that fair? Family may not have wanted to know

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Can we misinterpret the results?

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Unwanted results, anxiety

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What about opportunistic screening?

Individuals are aware certain behaviours can increase their risk of developing noncommunicable disease, but this does not cause a change in behaviour, why would a genetic test cause a behaviour change? o High BMI – more likely to development of non-communicable disease yet there is an obesity pandemic

If the gene can be manipulated- recoded -

Would you consider it?

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Gene therapy – certain cancers

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Designer babies o Baby eye colour o Nose size o Genetically modified babies o Embryo level

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Done at medicinal level

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Just because something can be done, should you, do it?

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Ammonised genetic data – you know that an individual has a higher risk of X but can no longer tell them

Genetic test completed and found out info on health based on genetic makeup, what are your reservations? -

This info could lead to a better diet but who can access the info? o Who is entitled to the information? o If the information exists could their insurance company or employer access it o If an individual is identified that they have a higher risk of developing cardiovascular issues (e.g., heart attack) and their employer had access to this information could they discriminate against the employee? o Some companies do a medical for a job o Identify that a potential candidate is at a higher disposition of X, Y and Z and therefore the company does not hire them

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Risk of discrimination despite the recommendation that a genetic profile should be confidently whether its employers, athletics team, insurance company etc

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People may not care about the info

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Could highlight a heredity disease

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Could cause fear in some individuals leading to obsessive behaviours

Guidelines and Legal regulations (Challenge) Aim: to protect individuals ◦

Analytical guidelines

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Clinical validity

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Clinical utility

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Any country or national regulatory agency can establish legislation for clinical genetics

Irish National Adult Nutrition Survey (2008-2010) Part of JINGO (Joint Irish Nutrigenomic Organisation) Separate consent for genetic research

Guidelines -

2002, EU published paper on the regulation of genetic tests that address patient’s rights (right to information, confidentiality, privacy, and informed consent)

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2010 UK Human Genetics Commission (HGC)-principals relating to genetic tests including transparency, accessibility, and ease of information

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Food4me concluded that neither the EU nor its member states have legal instruments specifically dealing with personalised nutrition

Personalised nutrition is moving forward and advancing from a genetic standpoint however regarding commercialisation, personalised nutrition is in its infancy. The current market cannot support PN.

Commercialisation (Challenge) -

DTC (direct to consumer) genetic testing- controversial o DTC is controversial as it can mislead consumers

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Far-reaching promises but contrasting disclaimers

o Not regulated in terms of marketing but disclaimer can say ‘it can only do X, Y and Z’ o Individual takes own swab of genetic material such as saliva or blood, what is the issue with this? o Data protection o Individuals may accept T&C’s without reading them, unaware of how their data is processed as they just want what they think, and they want it now o Reading the terms and conditions are usual long/wordy/small print o T&C’s should be short and to the point, clear and concise – only inform them of what they ned to know in an accessible manner (i.e., in their language) -

23and me-company o Formerly sold a DTC genetic test o online platforms 254 specific diseases and conditions

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o No health professional involvement -

What do you expect when the sample is sent to the company? o Explanation of results from the company about the data o Expect results & advice o Who does the person want advice from? – a health professional/expert o What if it’s bad news? – a letter in the post in complex language may cause the individual to become stressed o If it’s bad news individual may want advice how to reduce the risk – or any solutions? o Are online commercial companies likely to do this? o No o Why does a company set up? – profit

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2013-FDA ordered discontinuation of the product

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The company’s response - still sold tests but no longer offered personal dietary advice!!

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Moving on to 2015: New test Personal genome test (PGS)

Personal genome service (PGS)

PGS’s disclaimer

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Not intended to diagnose any health conditions. You should consult a healthcare professional before making any major lifestyle changes

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Carrier status tests can’t determine if someone has two copies of a genetic variant

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Each test more relevant for people of certain ethnicities

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Tests not intended to tell clients anything about the health of their foetus or their newborn child’s risk of developing a particular disease later in life.

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Many more online companies closed or limited their services

Services mentioned above can continue with expects behind them e.g. if you went to a doctor and it was ‘bad news’ they would not send a letter to relay the information, it would be done face-to-face/phone call etc – more personable approach

Socialisation (Challenge)

‘Could we not get all our nutrients at once?’ – critical care, hospital – tube feeding, it is possible - But this is not what we do and we don’t just consume food for its nutrients People don’t eat to live (generally) -

In context of personalised nutrition –food-tool for good health

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Remember –consumption of food slides

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Every day: social aspects of eating o Cultural o Emotional o Ethical o Sensual

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Understanding of food

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Needs to reach beyond recommendations for single nutrients

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Meals, recipes

More geared towards personalised health where nutrition is an aspect of it

PN exists to some extent - Diabetes

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Disease states CVD etc

Concerns Personalised nutrition-may trigger unhealthy quests for health such as healthism and medicalisation of diet

Current achievements & progress -

P37-p41

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Kohlmeier et al 2016 (on Canvas)

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Guide and Position of the International Society of Nutrigenetics/Nutrigenomics on Personalized Nutrition: Part 2 - Ethics, Challenges and Endeavours of Precision Nutrition

Wrapping it up -

Personalised nutrition is still Emerging, it is promising but it does suffer from limitations.

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Promising

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Limitations

Nutrigenomics is a method for modelling biological systems. This approach assesses the impact of nutrition on the full scale of metabolism, from the level of the gene (genomics) through to the messenger RNA (transcriptomics), proteins (proteomics) and finally metabolites (metabolomics).

Research -

Genome wide association study (GWAS)

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Food4me – global study looking at personalised nutrition

Concepts (Mike’s example) -

Nutrigenetics

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Nutrigenomics

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‘Omics’ technologies o Metabolomics

o Proteomics o Transcriptomics o Epigenetics o Lipidomic o Food-omics etc -

These are tools which will help in PN future

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Don’t need to know Omics in detail

How...