Bioética e medicina personalizada no envelhecimento: explorando complexidades / Bioethics and concierge medicine in aging: exploring complexities / Bioética y medicina personalizada en el envejecimiento: explorar las complejidades

Resumo A medicina personalizada surgiu como uma abordagem promissora para fornecer tratamentos exclusivos e personalizados para doenças usando ferramentas genômicas. No campo dos estudos do envelhecimento, a medicina personalizada tem grande potencial para transformar o tratamento e a prevenção de doenças associadas à idade e relacionadas à nutrigenômica e à farmacogenômica. No entanto, o uso de dados genômicos na medicina personalizada levanta preocupações bioéticas significativas, incluindo questões como privacidade, consentimento, equidade e potencial uso indevido de dados genômicos para fins discriminatórios. Portanto, é crucial considerar cuidadosamente os aspectos biomédicos, sociais e éticos da medicina personalizada no contexto de condições relacionadas à idade. Esta revisão tem o objetivo de explorar os principais aspectos da medicina personalizada concernentes a doenças relacionadas à idade nos dados farmacogenômicos e nutrigenômicos, abordando as preocupações bioéticas envolvidas no uso desses dados.

Abstract Concierge medicine emerged as a promising approach to offer exclusive and personalized treatments using genomic tools. In aging studies, concierge medicine has the potential to transform the treatment and prevention of age-associated and related diseases through pharmacogenetics and nutrigenomics; however, its use of genomic data raises important bioethical concerns, including privacy, consent, equity issues and potential misuse of these data for discriminatory purposes. Hence, careful consideration should be given to the biomedical, social, and ethical aspects of concierge medicine in aging contexts. Our review explores the main aspects of age-related pharmacogenetics and nutrigenomics data in concierge medicine, discussing the bioethical concerns involved in its use.

Resumen La medicina personalizada surgió como un enfoque prometedor con el fin de proporcionar tratamientos únicos y personalizados a enfermedades utilizando herramientas genómicas. En los estudios de envejecimiento, la medicina personalizada puede transformar el tratamiento y la prevención de enfermedades asociadas a la edad y relacionadas con la nutrigenómica y la farmacogenómica. Sin embargo, el uso de datos genómicos en medicina personalizada plantea importantes preocupaciones bioéticas, incluidos temas como la privacidad, el consentimiento, la equidad y el posible uso indebido de los datos genómicos con fines discriminatorios. Así, es fundamental ponderar cuidadosamente los aspectos biomédicos, sociales y éticos de la medicina personalizada en el contexto de las afecciones relacionadas con la edad. Esta revisión pretende explorar los principales aspectos de la medicina personalizada sobre las enfermedades relacionadas con la edad en los datos farmacogenómicos y nutrigenómicos al abordar las preocupaciones bioéticas involucradas en el uso de estos datos.

Concept of Ayurgenomics in Context to Nutrigenomics

Nutrigenomics is an emerging branch of science that creates foundation of the relationship between nutrients from diets and their effects on expression of genomes. It also encompasses the heterogenous response of gene to different nutrients, dietary components and developing nutraceuticals under the heading of nutrigenetics. Exploring the aspects of nutrigenomics has been conceptualised to develop the approaches for the determination of the etiology of different physiological conditions, pathological conditions alongside the management of different morbidities by application of the dietics and also prevention of certain possible gene expression causing morbid conditions. All these facts that diet plays in determination of health or disease have already been mentioned in the ancient times by the scholars of Ayurveda. Ayurgenomics in other side includes of classical facts that has been mentioned in the Ayurvedic classic texts which clearly mentions that the Aahar determines the state of health and diseased conditions in an individual. It determines the individuality in the requirement of the nutritional sources in all different individual is different and unique. When the nutrition for the individual is personalised determining the Prakriti (constitution) of the individual, this will ensure maintaining the health and resolving the diseases in the subject. Also different forms of incompatible combinations of Aahar have also been mentioned in Ayurveda and their different levels of effects in different individual have been described under the topic of Virruddhaahar. Analytical study of these subjects together could be manifested in the management of different pathological conditions or even for the prevention of the disease condition in the field of disease management

Influência da nutrição na expressão de genes relacionados à obesidade / Influence of nutrition on the expression of genes related to obesity

A obesidade possui vários prejuízos para a saúde e está associada à inúmeras patologias e baixa expectativa de vida. O desequilíbrio alimentar é um fator que necessita de atenção especial, pois é capaz de alterar as interações entre nutrientes e genes. O objetivo deste trabalho foi verificar as principais linhas de pesquisa associadas à nutrigenômica, e evidenciar a relação da influência da nutrição na expressão de genes relacionados à obesidade. Realizou-se o levantamento bibliográfico e a análise cienciométrica por meio do banco de dados publicados na Biblioteca Virtual em Saúde (BVS) e do Centro Latino-Americano de Informação em Ciências da Saúde (BIREME). Identificou-se 118 artigos originais, os quais foram agrupados em cinco classes: restrição calórica, expressão gênica, alimentos, intervenção dietética e diversos. Os resultados evidenciaram que a restrição calórica possui relação direta da expressão gênica com o controle das células cancerígenas e a diminuição do excesso de tecido adiposo. Além disso, a análise cienciométrica relacionou a importância das fibras alimentares na redução do colesterol e sensibilidade à insulina, bem como a ação do jejum na regulação negativa de genes que contribuem para o crescimento do tecido adiposo. Dessa forma, este artigo fornece princípios ideológicos para auxiliar especialistas na aplicabilidade de estratégias para atingir a redução de peso sustentável por meio da expressão gênica.

Obesity has several health risks and is associated with numerous pathologies and low life expectancy. Food imbalance is a factor that needs special attention, as it is able to change the interactions between nutrients and genes. This study aimed at verifying the main lines of research associated with nutrigenomics, and at showing the relationship of the influence of nutrition on the expression of genes related to obesity. The bibliographic survey and scientometric analysis were carried out through the database published in the Biblioteca Virtual em Saúde (BVS) and the Centro Latino-Americano de Informação em Ciências da Saúde (BIREME). A total of 118 articles of original research were identified, and were grouped into five categories: caloric restriction; gene expression; food; dietary intervention; and miscellaneous. The results showed that caloric restriction has a direct relationship between gene expression and the control of cancer cells and the reduction of excess adipose tissue. Furthermore, the scientometric analysis related the importance of dietary fibers in reducing cholesterol and insulin sensitivity as well as the action of fasting in the negative regulation of genes that contribute to the growth of adipose tissue. Thus, this paper provides ideological principles to assist specialists in the applicability of strategies to achieve sustainable weight reduction through gene expression.

Odontología y nutrigenómica / Dentistry and nutrigenomics

La salud bucal está relacionada con varios factores que son considerados dañinos o protectores para poder estar en un equilibrio de la salud, desde el punto de vista preventivo debemos de enfocarnos cada vez más a aquellos factores protectores, como lo es la nutrición, ya que el alimentarnos adecuadamente nos ayuda a estar sanos, no solamente de la cavidad bucal sino de todo nuestro cuerpo. Una de las ciencias que ha tenido un creciente avance para el entendimiento de este fenómeno es la nutrigenómica, ya que nos ayuda a entender como los alimentos y sus contenidos desde el punto de vista genético colaboran a tener una mejor salud (AU)

Oral health is related to several factors that are considered harmful or protective to be in a balance of health, from the preventive point of view we must focus increasingly on those protective factors, such as nutrition, since to feed ourselves properly helps us to be healthy, not only of the oral cavity but of our whole body. One of the sciences that has had a growing advance for the understanding of this phenomenon is the nutriogenomic, since it helps us to understand how foods and their contents from the genetic point of view collaborate to have a better health (AU)

Nutrigenômica como ferramenta preventiva de doenças crônicas não transmissíveis / Nutrigenomics as a preventive tool for chronic non-communicable diseases / NUTRIGENOMICS AS A PREVENTIVE TOOL FOR CHRONIC NON-COMMUNICABLE DISEASES

A nutrigenômica representa uma ciência emergente que estuda a relação entre os nutrientes e os genes humanos. Dessa forma, as necessidades de alimentos, compostos bioativos e nutrientes variam entre os indivíduos, por conta dos polimorfismos gênicos, principalmente os de nucleotídeo único, podendo resultar no desenvolvimento de diversas doenças crônicas não transmissíveis (DCNTs). Este artigo objetiva conhecer as mais recentes informações sobre a nutrigenômica e os principais polimorfismos genéticos relacionados às DCNTs, bem como o impacto dos nutrientes na modulação da expressão gênica e prevenção destas patologias. Para o levantamento bibliográfico, optou-se pela busca de artigos nas bases de dados PubMed e SciELO, nos idiomas Português e Inglês. Aplicou-se a combinação dos seguintes descritores: "nutrigenômica e necessidades nutricionais", "nutrigenômica e obesidade", "nutrigenômica e diabetes mellitus tipo 2", "nutrigenômica e câncer" e "nutrigenômica e doença inflamatória intestinal". Evidências indicam que diversos tipos de polimorfismos estão associados à incidência, progressão e gravidade de doenças como a obesidade, diabetes mellitus tipo 2 (DM2), câncer e doenças inflamatórias intestinais (DIIs). Os principais polimorfismos encontrados que se relacionam com as DCNTs são: rs9939609 do fat mass and obesity associated (FTO), rs174547 do Fatty acid desaturase 1 (FADS1), Gln27Glu do receptor ß-adrenérgico 2 (ADRB2), Lys656Asn do receptor de leptina (LEPR), -174C/G da interleucina 6 (IL-6), Pro12Ala do receptor ativado por proliferador de peroxissoma gama 2 (PPAR-gama2), rs4315495 da lipina 1 (LPIN1), rs266729 no gene da adiponectina, rs10920533 em adiponectina receptor 1 (AdipoR1), Pro12Ala do receptor ativado por proliferador de peroxissoma γ (PPARγ), rs1440581 da Protein phosphatase, Mg2+/Mn2+ dependent 1K (PPM1K), alelo G para o polimorfismo -11377C>G, alelo A para o polimorfismo 11391 G>A, Cdx2 do receptor de vitamina D (RVD), genes de selenoproteínas sob baixas concentrações de selênio (DIO1, DIO2, GPX-1, GPX-3, SEPHS1, SEPSECS e TXNRD2) e alelo G do rs12212067 do Forkhead box O3 (FOXO3). É fundamental entender as interações gene-nutriente nestas doenças e as diferentes respostas metabólicas envolvidas, para que assim se possa orientar a alimentação de cada indivíduo conforme a sua herança genética. Enfim, os estudos não são conclusivos sobre o papel de cada fator na alteração dos genes, e a nutrigenômica é um fator importante e complexo que precisa avançar com a ciência nutricional.

Nutrigenomics represents an emerging science that studies the relation between nutrients and the human genes. Thus, the need for food, bioactive composts and nutrients vary from person to person due to genic polymorphisms, mainly single nucleotide polymorphism, which can result in the developing of many Chronic Non-Communicable Diseases (NCDs). This article aims at making a scientific literature review regarding the most recent information on nutrigenomics and the main polymorphisms related to the NCDs, as well as the impact of nutrients on the modulation of the genic expression and prevention of those pathologies. For the literature survey, a search was performed in PubMed and SciELO databases, in Portuguese and English using the combination of the following descriptors: "nutrigenomics and nutritional requirements", "nutrigenomics and obesity", "nutrigenomics and diabetes mellitus, type 2", "nutrigenomics and cancer", and "nutrigenomics and inflammatory bowel disease". Evidence has shown that many types of polymorphisms are associated with the incidence, progression and severity of diseases such as obesity, type 2 diabetes mellitus (T2DM), cancer, and inflammatory bowel diseases (IBD). The main polymorphisms found to be related to NCDs are: rs9939609 of the fat mass and obesity associated (FTO), rs174547 of the fatty acid desaturase 1 (FADS1), Gln27Glu of the ß-adrenergic receptor 2 (ADRB2), Lys656Asn of the leptin receptor (LEPR), -174 G/C of the interleukin-6 (IL-6), Pro12Ala of the peroxisome proliferator-activated receptor gamma 2 (PPAR-gama2), rs4315495 of lipin 1 (LPIN1), rs266729 in the adiponectin gene, rs10920533 in adiponectin receptor 1 (AdipoR1), Pro12Ala of Peroxisome proliferator-activated receptor γ (PPARγ), rs1440581 of Protein phosphatase, Mg2+/Mn2+ dependent 1K (PPM1K), G allele of the -11377C>G polymorphism, allele A of the 11391 G>A polymorphism, Cdx2 of the vitamin D receptor (VDR), selenoprotein genes under low selenium concentrations (DIO1, DIO2, GPX-1, GPx-3, SEPHS1, SEPSECS and TXNRD2), and G allele of the Forkhead box O3 (FOXO3) rs12212067. It is fundamental to understand the interaction between gene-nutrients in these diseases and the different metabolic answers involved to guide the eating habits of each person according to their genetic heritage. Finally, the studies are not conclusive on the role of each factor in the alteration of the genes, and nutrigenomics is an important and complex factor that needs to advance with nutritional science.

Nutrigenomics: Opportunities & challenges for public health nutrition

The hierarchical information flow through DNA-RNA-protein-metabolite collectively referred to as 'molecular fingerprint' defines both health and disease. Environment and food (quality and quantity) are the key factors known to affect the health of an individual. The fundamental concepts are that the transition from a healthy condition to a disease phenotype must occur by concurrent alterations in the genome expression or by differences in protein synthesis, function and metabolites. In other words, the dietary components directly or indirectly modulate the molecular fingerprint and understanding of which is dealt with nutrigenomics. Although the fundamental principles of nutrigenomics remain similar to that of traditional research, a collection of comprehensive targeted/untargeted data sets in the context of nutrition offers the unique advantage of understanding complex metabolic networks to provide a mechanistic understanding of data from epidemiological and intervention studies. In this review the challenges and opportunities of nutrigenomic tools in addressing the nutritional problems of public health importance are discussed. The application of nutrigenomic tools provided numerous leads on biomarkers of nutrient intake, undernutrition, metabolic syndrome and its complications. Importantly, nutrigenomic studies also led to the discovery of the association of multiple genetic polymorphisms in relation to the variability of micronutrient absorption and metabolism, providing a potential opportunity for further research toward setting personalized dietary recommendations for individuals and population subgroups.

Ácidos grasos poliinsaturados en la reproducción de peces: algunos Aspectos fisiológicos y endocrinológicos / Polyunsaturated fatty acids in fish reproduction: some Physiological and endocrinological aspects / Os ácidos graxos poliinsaturados em reprodução de peixes: alguns aspectos fisiológicos e endocrinológicos

Resumen La FAO, 2012 y 2014 plantea la importancia de la reproducción en la piscicultura. El incremento de la producción mundial de peces se debe a la intensificación de los sistemas de cultivo, lo que significa producir grandes cantidades de alevinos para crecimiento y ceba (Orozco, 2012). En la última década, se ha investigado la influencia de la nutrición en la reproducción, muchos autores plantean que, nutrientes como los ácidos grasos poliinsaturados (AGPI), afectan la reproducción (Tocher, 2010, Turchini et al., 2011). Varios estudios se han centrado en el establecimiento de los requerimientos nutricionales para el éxito reproductivo, sin embargo, sobre AGPI, es poco lo que se ha logrado determinar (Pohlenz et al., 2014). Lo anterior, ha obligado a realizar estudios con herramientas ómicas (Rodrígues et al., 2012), que integren la información ambiental y la genética en el cerebro de los peces para la transducción en señales neuronales a través de mecanismos bioquímicos y fisiológicos, capaces de modular la secreción hormonal implicada en el proceso reproductivo de los peces (Wing-Keong y Wang, 2011; Norambuena et al., 2012). Estos procesos bioquímicos en peces requieren ser dilucidados para mejorar los sistemas de cultivo, aumentar los niveles de producción, satisfacer la demanda y lograr avances impactantes en el campo del conocimiento científico.

Abstract FAO, 2012 and 2014, raises the importance of reproduction in fish farming. The increase in world fish production is due to the intensification of farming systems, which means producing large numbers of fingerlings for growth and fattening (Orozco, 2012). In the last decade, the influence of nutrition on reproduction has been investigated, many authors suggest that nutrients such as polyunsaturated fatty acids (PUFA) affect reproduction (Tocher, 2010, Turchini et al., 2011). Several studies have focused on the establishment of nutritional requirements for reproductive success, however, few determinations on PUFA, have been made (Pohlenz et al., 2014). Consequently, several studies have used omics tools (Rodrígues et al., 2012), to integrate environmental and genetic information in the fish brain for transduction into neuronal signals through biochemical and physiological mechanisms, capable of modulating the hormonal secretion involved in fish reproduction (Wing-Keong and Wang, 2011, Norambuena et al., 2012). These biochemical processes in fish need to be elucidated to improve farming systems, increase production levels, meet demand and achieve impressive advances in the field of scientific knowledge.

Resumo A FAO, 2012 e 2014, destaca a importância da reprodução na piscicultura. O aumento da produção mundial de peixes deve-se à intensificação dos sistemas de criação, o que significa produzir um grande número de alevinos para crescimento e engorda (Orozco, 2012). Na última década, tem-se pesquisado sobre a influência da nutrição na reprodução. Muitos autores sugerem que nutrientes, como os ácidos graxos poliinsaturados (PUFAs), afetam a reprodução (Tocher, 2010, Turchini et al., 2011). Alguns estudos têm focado seus esforços no estabelecimento de exigências nutricionais para o sucesso reprodutivo. Contudo, são escassos os estudos avaliando os efeitos dos PUFAs sobre aspectos reprodutivos (Pohlenz et al., 2014). Assim, estudos com ferramentas ómicas são relevantes (Rodrigues et al., 2012), ao integrar informação genética e ambiental no cérebro do peixe para a transdução de sinais neuronais através de mecanismos bioquímicos e fisiológicos, modulando a secreção hormonal envolvida no processo reprodutivo dos peixes (Wing-Keong e Wang, 2011, Norambuena et al., 2012). Esses processos bioquímicos nos peixes precisam ser elucidados para melhorar os sistemas de criação, aumentar os níveis de produção, atender à demanda e alcançar avanços científicos significativos.

Brazilian Society for Food and Nutrition position statement: nutrigenetic tests

Position statement: The Brazilian Society for Food and Nutrition (SBAN) bases the following position statement on acritical analysis of the literature on nutritional genomics and nutrigenetic tests: (1) Nutrigenetic tests are predictive and not diagnostic, should not replace other evaluations required to treatment, and should only be used as an additional tool to nutritional prescription; (2) Nutritionists/registered dietitians and other health professionals must be able to interpret the nutrigenetic tests and properly guide their patients, as well as build their professional practice ongeneral ethical principles and those established by regulatory authorities; (3) It is extremely important to highlight that them is interpretation of nutrigenetic tests can cause psychological and health problems to the patient; (4) Currently, there is insufficient scientific evidence for the recommendation of dietary planning and nutritional supplementation based only on nutrigenetic tests. This position statement has been externally reviewed and approved by the board of SBAN and has not gone through the journal's standard peer review process.

Factors Affecting Dieticians in the Provision of Advice Relating to Personalized Nutrition (Nutritional Genomics).

A great amount of research has focused on nutritional genomics in order to personalize dietary interventions based upon genetic premises. The aim of nutritional genomics research is to use this information as a preventive tool in primary care, through personalized dietary advice to populations or to individuals. Increasing the understanding of genetic traits on the part of dieticians and other healthcare professionals can complement the data that is required to create personalized recommendations for dietary intervention. A literature review was conducted by the author using PubMed journals from 2000 to the present day with regard to nutritional genomics studies in order to address the factors affecting dieticians in the provision of advice related to personalized nutrition. Inclusion criteria included research limited to human studies, in the English language and published after 2000. This review concludes that there is a huge demand for an increase in the knowledge and skills of dieticians in order to transform the genetic results and nutrigenomics message into common language as part of their clinical practice. This could be achieved by participation in specific training courses on diet and gene interaction, and by attending conferences and seminars to exchange their perspectives on nutritional genomics. In addition, there is a need to establish a healthcare system that supports and rewards these approaches and promotes their application.

Effect of A One-Week Balanced Diet on Expression of Genes Related to Zinc Metabolism and Inflammation in Type 2 Diabetic Patients

To evaluate the effect of diet on metabolic control and zinc metabolism in patients with type 2 diabetes mellitus (T2DM). One-week balanced diet was provided to 10 Brazilians patients with T2DM. Nutritional assessment, laboratorial parameters and expression of zinc transporter and inflammatory genes in peripheral blood mononuclear cells (PBMC) were performed. Healthy non-diabetic subjects of the same demographic were recruited to provide baseline data. Diabetic patients had higher body mass index and greater fasting plasma glucose, plasma tumor necrosis factor alpha (TNFalpha) and plasma interleukin 6 (IL6) levels compared with healthy subjects. In addition, the expression of transporters 4 (ZnT4) mRNA was lower and IL6 mRNA was higher in PBMC of these diabetic patients than in healthy subject. One week after a balanced diet was provided, fasting plasma glucose decreased significantly as did TNFalpha, IL6 and Metallothionein 1 (MT1) mRNAs. No change was observed in zinc transporter expression in PBMC after the dietary intervention. A healthy eating pattern maintained for one week was able to improve metabolic control of diabetic patients by lowering fasting plasma glucose. This metabolic control may be related to down-regulation of zinc-related transcripts from PBMCs, as TNFalpha, IL6 and MT1 mRNA.

Application of Nutrigenomics in Diabetes / 임상당뇨병

Diabetes mellitus (DM) is considered a global pandemic and its incidence continues to grow worldwide. The most common treatments for controlling diabetes focus on glucose control as a means to reduce long-term complications. Major changes in diet have taken place over the past 10,000 years since the beginning of the Agricultural Revolution: however, human genes have not changed. We now live in a nutritional environment that differs from that for which our genetic constitution was selected. Nutrients and dietary patterns are central issues in the prevention, development and treatment of DM. Nutritional genomics studies generally focus on dietary patterns according to genetic variations, the role of gene-nutrient interactions, gene-diet-phenotype interactions and epigenetic modifications caused by nutrients; these studies facilitate an understanding of the early molecular events that occur in DM and contribute to the identification of better biomarkers and diagnostic tools for the disease. In particular, this approach will help develop tailored diets that maximize the use of nutrients and other functional ingredients present in food, which will aid in the prevention and delay of DM and its complications. Here, we provide an understanding of the role of gene variants and nutrient interactions, and discuss the importance of nutrients and dietary patterns on gene expression.

Importance of nutrition in pediatric oncology.

A nutritional perspective within pediatric oncology is usually just related to the supportive care aspect during the management of the underlying malignancy. However, nutrition has a far more fundamental importance with respect to a growing, developing child who has cancer as well as viewing cancer from a nutritional cancer control perspective. Nutrition is relevant to all components of cancer control including prevention, epidemiology, biology, treatment, supportive care, rehabilitation, and survivorship. This article briefly describes this perspective of nutrition within a cancer control context and is a summary of the presentation at the “1st International SIOP‑PODC Workshop on Nutrition in Children with Cancer” held in Mumbai.

Genómica Nutricional como control de la enfermedad cardiovascular en el futuro próximo / Nutritional Genomics as cardiovascular disease control in the near future / Genômica Nutricional como controle da doença cardiovascular no futuro próximo

Las enfermedades cardiovasculares (ECV) ocupan los primeros lugares entre las causas de morbilidad y mortalidad a nivel mundial. Su desarrollo se inicia por la relación de procesos multifactoriales que incluyen factores genéticos y factores de riesgo potencialmente modificables, como la dieta. Las recomendaciones nutricionales actuales están centradas en reducir los factores de riesgo modificables, destacando el control de las concentraciones elevadas del colesterol plasmático. Sin embargo, esta variable es sólo una dentro de los múltiples factores de riesgo asociados a las ECV. Con el objetivo de identificar las interacciones nutrigenómicas y nutrigenéticas relacionadas con las ECV, se realizó una revisión sistemática de bibliografía en las bases de datos de PUBMED, ELSEVIER y SciELO, encontrándose que la interacción nutricional con algunos genes como la lipasa hepática, los alelos e2, e3, e4 y e5 de la apolipoproteína E modulan las concentraciones plasmáticas de lípidos. Esto potencia el riesgo de desarrollar una enfermedad cardiovascular, sin dejar de lado los efectos de la ingesta rica en ácidos grasos saturados. A pesar de esto se observa que no todos los individuos responden igual al consumo de grasas y no todos desarrollan dicha enfermedad. Este concepto es aplicable en el contexto de la nutrición personalizada como prevención y tratamiento de las enfermedades cardiovasculares. Se concluye que el tratamiento de la enfermedad cardiovascular depende de las variantes genéticas que influyen sobre la respuesta a la dieta y sobre la forma en cómo determinados nutrientes influyen sobre el genoma.

Cardiovascular Diseases (CVDs) rank first among the causes of morbidity and mortality worldwide. Their development started by the ratio of multifactorial factors including genetic factors and potentially modifiable risk factors, such as diet. The current nutritional recommendations focus on reducing modifiable risk factors, highlighting control of elevated plasma cholesterol. However, this variable is only within the multiple risk factors associated with CVD. With the objective of identifying the interactions related to nutrigenetics, nutrigenomics and CVD, a systematic review of the literature in PUBMED, ELSEVIER and SciELO databases, made it possible to find that the nutritional interaction with some genes such as, hepatic lipase, e2, e3, e4 and e5 alleles of apolipoprotein E modulate plasma lipid levels, increasing the risk of developing cardiovascular disease, without neglecting the effects of a diet rich in saturated fatty acids. However, this shows that not all individuals respond equally to fat and not all develop the disease. This concept is applicable in the context of personalized nutrition as prevention and treatment of cardiovascular diseases. In conclusion, the treatment of cardiovascular disease depends on the genetic variants that influence the response to a diet and the way how certain nutrients influence the genome.

As doenças cardiovasculares (DCV) ocupam o primeiro lugar entre as causas de morbidade e mortalidade em todo o mundo. Seu desenvolvimento começou pela relação entre multifatorial, incluindo fatores genéticos e fatores de risco potencialmente modificáveis, como dieta. As recomendações nutricionais atuais concentrar em reduzir fatores de risco modificáveis , com destaque para o controle do colesterol plasmático elevado. No entanto, esta variável é somente dentro dos múltiplos fatores de risco associados a doenças cardiovasculares. A fim de identificar as interações relacionadas nutrigenômica nutrigenéticas e CVD, foi realizada uma revisão sistemática da literatura em bases de dados PUBMED, ELSEVIER e SciELO, constatação de que a interação nutricional com alguns genes como lipase hepática alelos e2, e3, e4 e e5 da apolipoproteína E modulam as concentrações de lipídios plasmáticos, o que aumenta o risco de desenvolver doença cardiovascular, sem descurar os efeitos de uma dieta rica em ácidos gordos saturados. Apesar disso, foi observado que nem todos os indivíduos reagiram igualmente gordura e não todo o desenvolvimento da doença. Este conceito é aplicado no contexto de nutrição personalizada como a prevenção e tratamento de doenças cardiovasculares. Em conclusão, o tratamento da doença cardiovascular em função das variantes genéticas que influenciam a resposta à dieta e na maneira como certos nutrientes influenciar o genoma.

Nutrigenomics and Nutrigenetics: Concepts and Applications in Nutrition Research and Practice.

Nutrigenomics refers to the application of genomic principles in nutritional research, enables us to formulate associations between specific nutrients and genetic factors, e.g. the way in which food or food ingredients influence gene expression. It aims to identify the genes that influence the risk of diet-related diseases and also helpful to solve the mechanisms that underlie these genetic predispositions. In contrast, nutrigenetics reveals the coordination of genetic makeup of individuals with their responses to various dietary nutrients. It clarifies different responses to same nutrient by different individuals. Interaction of genetic background and diet with regard to development of chronic conditions as obesity, cardiovascular disease, hypertension and cancer are discussed in present review. These two branches of nutrition resemble with two sides of a coin, facing towards opposite sides but simultaneously, they are intimately attached with each other. Collective efforts by the scientific community are needed to strictly follow guidelines put forth regarding experimental designs, analysis, and data storage for nutritional research. This strategy will be helpful to generate a sound database useful for clinicians and dietetic practitioners.

Efectos de los nutrientes y compuestos bioactivos de los alimentos en tejidos y células de cáncer humano: aproximación nutrigenómica / Effects of nutrients and bioactive compounds of foods in tissues and cells of human cancer: nutrigenomics approach

Resumen El cáncer es una condición de programación genética anormal en la cual cambios en la secuencia genómica alteran la estructura, función y expresión de proteínas que controlan procesos celulares esenciales como el crecimiento, la proliferación, la diferenciación y la apoptosis. Investigaciones en nutrición y cáncer han analizado los efectos de determinados nutrientes y compuestos bioactivos de los alimentos en el desarrollo y evolución de diversos tipos de cáncer. El objetivo de esta investigación fue revisar, en la información científica reciente, los efectos o interacciones de los nutrientes y compuestos bioactivos de los alimentos en tejidos y/o células de cáncer humano bajo una aproximación nutrigenómica. Se realizó una búsqueda de los artículos, publicados entre enero de 2011 y octubre de 2012, en la base de datos Pubmed, utilizando términos MeSH y "Text Word" relevantes para el objetivo de investigación. De esta búsqueda se obtuvo un total de 250 publicaciones de los cuales se seleccionaron 33. En general, los efectos e interacciones de los nutrientes y compuestos bioactivos selectivamente inducen la muerte e inhiben el crecimiento y proliferación de las células cancerígenas; sin embargo, bajo ciertas condiciones, dichos efectos e interacciones pueden promover la carcinogénesis.

Summary Cancer is a genetic programming abnormal condition in which the change in genomic sequence may alter the structure, function and expression of proteins that control essential cellular processes such as growth, proliferation, differentiation and apoptosis. Nutrition and cancer research have analyzed the effects of certain nutrients and bioactive food compounds in the development and progression of various cancers. The aim of this research was to review, in the recent scientific information, the effects or interactions of nutrients and bioactive food compounds in tissue and cells of human cancer under a nutrigenomics approach. We did a search of articles published between January 2011 and October 2012 in the Pubmed database, using MeSH terms and "Text Word" relevant to the research objective. This search yielded 250 publications which 33 were selected. In general, the effects and interactions of the nutrients and bioactive compounds selectively induce death and inhibit the growth and proliferation of cancer cells, however, under certain conditions, such effects and interactions may promote carcinogenesis.

Perspectiva genética del tratamiento nutricional en la enfermedad cardiovascular / Nutritional management of cardiovascular disease in the near future

Introducción: las enfermedades cardiovasculares son la relación de procesos multifactoriales que incluyen factores genéticos y factores de riesgo potencialmente modificables, como la dieta. Las recomendaciones nutricionales actuales están centradas en reducir los factores de riesgo modificables, como por ejemplo el control de las concentraciones elevadas de colesterol plasmático. Sin embargo, esta variable es sólo una dentro de los múltiples factores de riesgo asociados a la enfermedades cardiovasculares. Objetivo: identificar las interacciones nutrigenómicas y nutrigenéticas relacionadas con la enfermedades cardiovasculares. Metodología: revisión sistemática de bibliografía en las bases de datos de PubMed, ELSEIVER y Scielo. Resultados: la interacción nutricional con algunos genes como, la lipasa hepática, apolipoproteína A-1, A-4, A-5 y apolipoproteína E modulan las concentraciones plasmáticas de lípidos, esto potencia el riesgo de desarrollar una enfermedad cardiovascular, sin dejar de lado los efectos de la ingesta rica en ácidos grasos saturados. A pesar de esto se observa que no todos los individuos responden igual al consumo de grasas y no todos desarrollan dicha enfermedad. Este concepto es aplicable en el contexto de la nutrición personalizada como prevención y tratamiento de las enfermedades cardiovasculares. Conclusiones: el tratamiento de la enfermedad cardiovascular depende de las variantes genéticas que influyen sobre la respuesta a la dieta y sobre la forma en cómo determinados nutrientes influyen sobre el genoma...

Introduction: the cardiovascular disease is multifactorial relationship processes including genetic factors and potentially modifiable risk factors, such as diet. The current nutritional recommendations focus on reducing modifiable risk factors, the highlighting the control of elevated plasma cholesterol eg. However, this variable is only within the multiple risk factors associated with cardiovascular disease. Objective: know to interactions related nutrigenétics nutrigenomics and cardiovascular disease. Methodology: systematic review of literature in the databases PubMed, and Sciel o ELSEIVER. Results: the nutritional interaction as some genes, hepatic lipase, apolipoprotein A1, A-4, A5 and apolipoprotein E modulate plasma lipid levels, this increases the risk of developing cardiovascular disease, without neglecting the effects of diet rich in saturated fatty acids. Although this shows that not all individuals respond equally to fat and not all develop the disease. This concept is applicable in the context of the personalized nutrition as prevention and treatment of cardiovascular diseases. Conclusions: the treatment of cardiovascular disease depends on the genetic variants that influence the response to diet and the way how certain nutrients influence the genome...

La medicina genómica: un cambio de paradigma de la medicina moderna retos para la bioética y el derecho / Genomic medicine; a paradigm shift in modern medicine challenges for bioethics an the law / A medicina genômica: uma mudança de paradigma da medicina moderna desafios para a bioética e para o direito

La medicina genómica y sus diferentes formas de aplicación medicinas personalizada o individualizada, de la que hacen parte la farmacogenómica, toxicogenómica y nutrigenómica; y la medicina predictiva, regenerativa o de reemplazo, molecular y reproductiva), sin lugar a dudas han transformado a la medicina moderna y se constituyen en un nuevo paradigma. Este artículo pretende hacer una revisión de las distintas formas de la medicina genómica, desde sus beneficios para la salud humana y cambios sustanciales en el abordaje del proceso salud-enfermedad, así como de las problemáticas y paradojas asociadas que deben ser abordadas desde la Bioética y el Derecho...

Genomic medicine and its different application forms, such as personalized (to which pharmacogenomics, toxicogenomics, nutrigenomics and predictive medicine belong), regenerative, molecular and reproductive medicines, have undoubtedly transformed modern medicine, becoming a new paradigm. The present study aims at reviewing the different forms of genomic medicine, from its benefits to human health, up to the problems and paradoxes that must be approached from bioethics and law...

A medicina genômica e suas diferentes formas de aplicação (medicinas personalizada ou individualizada, da qual fazem parte a farmacogenômica, a toxicogenômica e a nutrigenômica; e a medicina preditiva, regenerativa ou de substituição, molecular e reprodutiva) sem dúvidas têm transformado a medicina moderna e constituem um novo paradigma. Este artigo pretende fazer uma revisão das distintas formas da medicina genômica, desde seus benefícios para a saúde humana e mudanças substanciais na abordagem do processo saúde-doença, bem como das problemáticas e paradoxos associados que devem ser abordados a partir da Bioética e do Direito...

A ciência da nutrição em trânsito: da nutrição e dietética à nutrigenômica / The science of nutrition in transit: from nutrition and dietetics to nutrigenomics

No cenário mundial, a emergência do campo da Nutrição foi um fenômeno característico do início do século XX. No Brasil, a emergência da Nutrição localizou-se na área das Ciências da Saúde (ou Ciências da Vida), caracterizando-se, à primeira vista, como uma ciência de natureza biológica. Este artigo tem por objetivo analisar a trajetória do processo de produção do conhecimento científico que garantiu especificidade ao campo da Nutrição no Brasil, da emergência aos dias atuais. Os pressupostos teóricos que norteiam o artigo são: o conceito de campo científico, desenvolvido por Pierre Bourdieu e os conceitos de paradigma e comunidade científica, introduzidos por Thomas Samuel Kuhn. A análise histórica evidencia que desde o seu nascimento, além da natureza biológica, a Nutrição brasileira assumiu dimensões sociais e ambientais, caracterizando-se como um campo de conhecimento multidisciplinar, constituído a partir da integração de Ciências Biológicas, Ciências Sociais e Ciências dos Alimentos e Nutrição. Nas últimas décadas, com o intenso desenvolvimento da comunicação e informática, da genética e das teorias sobre a sustentabilidade ecológica do planeta Terra, importantes mudanças paradigmáticas têm ocorrido no campo da Nutrição. Portanto, pode-se afirmar que a Nutrição estaria vivenciando a era pós-genômica, constituindo-se uma ciência multidisciplinar, caracterizada pela integração das dimensões biológica, social e ambiental.

In the world scenario, the emergence of nutrition science was a phenomenon characteristic of the early Twentieth Century. In Brazil, its emergence occurred in the health sciences area (or life sciences) and was characterized, at first, as a science of biological nature. This article aims to analyze the trajectory of the process of producing scientific knowledge which ensured specificity to the field of nutrition in Brazil, from its emergence to the present. The theoretical assumptions that guide the article are: the concept of scientific field, developed by Pierre Bourdieu, and the concepts of paradigm and scientific community, introduced by Thomas Samuel Kuhn. Historical analysis shows that, from birth and in addition to its biological nature, Brazilian nutrition assumed social and environmental dimensions, being characterized as a multidisciplinary field of knowledge formed from the integration of the biological sciences, social sciences and food and nutrition sciences. In the last decades, with the intensive development of communication and information technology, genetics and sustainability theories, major paradigmatic changes have occurred in the field of nutrition. Therefore, one can say that nutrition is experiencing a post-genomic era and becoming a multidisciplinary science, characterized by the integration of the biological, social and environmental dimensions.

Nutrigenômica e nutrigenética: importantes conceitos para a ciência da nutrição / Nutrigenomics and nutrigenetics: important concepts for the nutrition science

The genetic map accomplished in the Human Genome Project was crucialto supply the tools and information about genetic aspects. The knowledge about the communication between genes and food compounds, such as nutrients and bioactive compounds, enabled the emergence of two new sciences, named nutrigenomics and nutrigenetics. Nutrigenomics refers to the study of how these compounds can act in the genetic expression modulation, while nutrigenetics studies the effect of genetic variation in the diet and disease interaction, with the identification of genes responsible for different responses to diet. Given the importance of understanding thein teraction between diet and gene, whereas the substances found in food can modify phenotype, the purpose of the present work is to search andgather literature data about the main advances in nutrigenomics and nutrigenetics, thus contributing to the updated education of students and health professionals. In order to achieve it, an extensive bibliographic research was done into the main scientific electronic database Pubmed and Medline, using the descriptors Nutrigenomics, Nutritional Genomics, Nutrigenetics. Data observed in literature state that environmental factors, mainly the diet, can initiate different responses among individuals due togenetic variability or polymorphisms. The current technology allows the identification of more than 500 thousand polymorphisms per person. However, only some of them seem to have functional effect. In epigeneticevents, polymorphisms are responsible for modifying the phenotype and even for the function of genes, resulting in metabolic changes such as increase or decrease in dietary intake requirements. So, the challenge isto understand how this interaction works on the balance between healthand disease. This knowledge will allow an effective nutritional interventionby the professional, based on the client's genetic map.

El mapa genético realizado en el Proyecto Genoma Humano fue crucial para suministrar herramientase informaciones sobre los aspectos genéticos. El conocimiento de la comunicación entre los genes y los componentes de los alimentos como los nutrientes y los compuestos bioactivos posibilitó el surgimiento de dos nuevas ciencias llamadas nutrigenómica y nutrigenética. La nutrigenómica se refiere al estudio de cómo tales compuestos actúan en la modulación de la expresión genética, mientras que la nutrigenética estudia el efecto de la variación genética en la interacción entre dieta y enfermedad, con la identificación de los genes responsables por diferentes respuestas a la dieta. Dada la importancia de conocer la interacción gen-nutriente, y a que las sustancias presentes en los alimentos pueden modular la expresión génica y cambiar el fenotipo, el presente trabajo pretende pesquisar y compilar los datos de la literatura sobre los principales avancesen nutrigenómica y nutrigenética. Para ello, fue realizada una extensa investigación bibliográfica en los principales banco de datos electrónico scientíficos Pubmed y Medline, por medio de los descriptores Nutrigenomic, Nutritional Genomics y Nutrigenetic. En la literatura, los datos observados afirman que factores ambientales, principalmente la dieta, pueden desencadenar diferentes respuestas entre los individuos en función de variabilidad genética o polimorfismos. La tecnología actual permite la identificación de más de 500 mil polimorfismos por persona, sin embargo, sólo algunos de ellos tienen efecto funcional. En casos epigenéticos,los polimorfi smos son responsables por la alteración del fenotipo e inclusive por las funciones de los genes que pueden resultar en alteraciones metabólicas tales como el aumento o reducción de la necesidadde ingestión de nutrientes. El desafío es entender como esa interacción influye en el equilibrio entre salud y enfermedad. Tal conocimiento permitirá al profesional de nutrición una i...

O mapeamento genético realizado no Projeto Genoma Humano foi crucial no fornecimento de ferramentas e informações acerca dos aspectos genéticos. O conhecimento da comunicação entre os genes e os compostos dos alimentos, como os nutrientes e os compostos biotativos possibilitou o surgimento de duas novas ciências, denominadas nutrigenômica e nutrigenética. A nutrigenômica se refere ao estudo de como tais compostos atuam na modulação da expressão gênica, enquanto a nutrigenética estuda o efeito da variação genética na interação entre dieta e doença, com a identificação dos genes responsáveis por diferentes respostas para com a dieta. Visto a importância em se compreender a interação genenutriente, já que as substâncias presentes nos alimentos podem modular a expressão gênica, modificando o fenótipo. O presente trabalho visa pesquisar e compilar os dados da literatura sobre os principais avanços na nutrigenômica e nutrigenética, contribuindo com a formação atualizada de estudantes e profissionais da saúde. Para tanto, foi realizada extensa pesquisa bibliográfica nos bancos de dados eletrônicos científicos Pubmed e Medline, por meio dos descritores Nutrigenomic, Nutritional Genomics e Nutrigenetic. Na literatura, os dados observados afirmam que fatores ambientais, principalmente a dieta, podem desencadear diferentes respostas entre os indivíduos em função da variabilidade genética ou polimorfismos. A tecnologia atual permite a identificação de mais de 500 mil polimorfismos por pessoa, porém, somente alguns deles têm efeito funcional. Em eventos epigenéticos, os polimorfismos são responsáveis pela alteração do fenótipo e até mesmo pelas funções dos genes, podendo resultar em alterações metabólicas como no aumento ou redução da necessidade de ingestão dos nutrientes. O desafio é entender como essa interação atua no balanço entre a saúde e a doença. Tal conhecimento poderá possibilitar ao profissional de nutrição uma eficaz intervenção nutricional, uma vez que o mes...

La enfermedad de Alzheimer y los polimorfismos del gen metilenotetrahidrofolato reductasa: una potencial aproximación nutrigenómica en México / Alzheimer's disease and methylenetetrahydrofolate reductase gene polymorphisms: a potential nutrigenomic approach for Mexico

El establecimiento de la medicina genómica en México oferta la posibilidad de una mirada más integral de los factores etiológicos de las enfermedades, incorporando en una visión global la interacción del genoma con el ambiente. La nutrición es reconocida como determinante para algunas enfermedades, pero su interacción con polimorfismos, y en general con el genoma, ha sido poco estudiada. En México se informa alta prevalencia de polimorfismos en el gen metilenotetrahidrofolato reductasa, y tanto estudios clínicos como básicos la han relacionado con aumento de susceptibilidad para el desarrollo de enfermedad de Alzheimer. Esto ofrece una potencial aproximación nutrigenómica en el país.

The establishment of medical genomics in Mexico offers the possibility to study in a more comprehensive manner the etiological factors of different diseases, providing a global view of the interaction between the genome and the environment. Nutrition is recognized as a significant determinant in several diseases, yet its interaction with polymorphisms, and in general with the genome, has not been properly addressed Mexico has a high prevalence of polymorphisms of the methylenetetrahydrofolate reductase gene, and in both clinical and basic studies this has been associated with an increased susceptibility of developing Alzheimer's disease. We propose a potential nutrigenomic approach for the study of Alzheimer disease in Mexico.