Strengthening the Reporting of Nutritional Genomics Research to Inform Knowledge Translation in Personalized Nutrition.

The ultimate goal of researching nutrigenetic interactions is to be able to provide individuals with genetically-tailored nutrition advice (when evidence is sufficient) in an effort to optimize health outcomes. Accordingly, original research often discusses the potential for the results to inform genetically-tailored nutrition advice. Despite this, many studies do not report their methods, results, and discussion in a manner that is conducive to knowledge translation. With several consumer nutritional genomics companies now offering genetic testing for personalized nutrition, proper reporting of nutritional genomics research for knowledge translation is of vital importance. Common reporting errors relate to SNP and genotype reporting, results lacking detail, consideration of linkage disequilibrium, mechanisms of action/functional SNPs, details of dietary intake, and sample reporting. Because of this, knowledge translation professionals may be unable or challenged in their attempt to use the findings from such research to inform clinical practice in nutritional genomics and personalized nutrition. The present article provides an overview of the issues at hand. It further pre-sents a checklist as well as table and figure templates for researchers to use when reporting the results of original research in nutritional genomics to inform knowledge translation.

The Ontario Public Does Not Understand the Difference Between Registered Dietitians and Unregulated "Nutritionists": Results from a Cross-Sectional Mixed Methods Study.

BACKGROUND: Current Ontario healthcare policy permits anyone to use the title "nutritionist" and practice as a clinician regardless of education and training. The title "dietitian," on the other hand, is protected under the Dietetics Act (1991) for use exclusively by individuals who undergo rigorous education and training in evidence-based nutrition. OBJECTIVES: The objectives of this study were to: identify whether the Ontario general public understands the difference between a registered dietitian (RD) and an unregulated "nutritionist;" understand experiences with RDs and "nutritionists;" and determine if the current nutrition landscape arising from gaps in healthcare policy has the potential to harm the public. METHODS: A cross-sectional mixed methods survey study was carried out using inductive content analysis, descriptive statistics and chi-square tests. RESULTS: Respondents (n = 402) did not understand the difference between RDs and "nutritionists." Overall, public experiences have been significantly more positive when nutrition information/advice stemmed from an RD. IMPLICATIONS: This study provides justification for proposed legislative amendments to the Dietetics Act (1991) and the Regulated Health Professions Act (1991). These proposed amendments have been detailed in the full-text manuscript.

Exploring Attitudes, Subjective Norms and Perceived Behavioural Control in a Genetic-Based and a Population-Based Weight Management Intervention: A One-Year Randomized Controlled Trial.

BACKGROUND: Several studies demonstrate that the provision of personalized lifestyle advice, based on genetics, can help motivate individuals to engage in greater nutrition and physical activity changes compared to the provision of population-based advice. The theoretical mechanism behind this phenomenon is poorly understood. The objective of this study was to determine the impact of providing genetically tailored and population-based lifestyle advice on key constructs of the Theory of Planned Behaviour (TPB). MATERIALS AND METHODS: A pragmatic, cluster randomized controlled trial (n = 140) took place at the East Elgin Family Health Team, in Aylmer, Ontario, Canada. Participants were primarily Caucasian females enrolled in a weight management program (BMI ≥ 25.0 kg/m2). Weight management program groups were randomized (1:1) to receive a population-based lifestyle intervention for weight management (Group Lifestyle Balance™ (GLB)) or a lifestyle genomics (LGx)-based lifestyle intervention for weight management (GLB+LGx). Attitudes, subjective norms and perceived behavioural control were measured at baseline, immediately after receiving a report of population-based or genetic-based recommendations and after 3-, 6- and 12-month follow-ups. Linear mixed models were conducted, controlling for measures of actual behavioural control. All analyses were intention-to-treat by originally assigned groups. RESULTS: Significant changes (p < 0.05) in attitudes, subjective norms, and perceived behavioural control tended to be short-term in the GLB group and long-term for the GLB+LGx group. Short-term and long-term between-group differences in measures of subjective norms were discovered, favouring the GLB+LGx group. CONCLUSIONS: The TPB can help provide a theoretical explanation for studies demonstrating enhanced behaviour change with genetic-based lifestyle interventions. CLINICAL TRIAL REGISTRATION: NCT03015012.

Can a Lifestyle Genomics Intervention Motivate Patients to Engage in Greater Physical Activity than a Population-Based Intervention? Results from the NOW Randomized Controlled Trial.

BACKGROUND: Lifestyle genomics (LGx) is a science that explores interactions between genetic variation, lifestyle components such as physical activity (PA), and subsequent health- and performance-related outcomes. The objective of this study was to determine whether an LGx intervention could motivate enhanced engagement in PA to a greater extent than a population-based intervention. METHODS: In this pragmatic randomized controlled trial, participants received either the standard, population-based Group Lifestyle BalanceTM (GLB) program intervention or the GLB program in addition to the provision of LGx information and advice (GLB + LGx). Participants (n = 140) completed a 7-day PA recall at baseline, 3, 6, and 12 months. Data from the PA recalls were used to calculate metabolic equivalents (METs), a measure of energy expenditure. Statistical analyses included split plot analyses of covariance and binary logistic regression (generalized linear models). Differences in leisure time PA weekly METs, weekly minutes of moderate + high-intensity PA, and adherence to PA guidelines were compared between groups (GLB and GLB + LGx) across the 4 time points. RESULTS: Weekly METs were significantly higher in the GLB + LGx group (1,114.7 ± 141.9; 95% CI 831.5-1,397.8) compared to the standard GLB group (621.6 ± 141.9 MET/week; 95% CI 338.4-904.8) at the 6-month follow-up (p = 0.01). All other results were non-significant. CONCLUSIONS: The provision of an LGx intervention resulted in a greater weekly leisure time PA energy expenditure after the 6-month follow-up. Future research should determine how this could be sustained over the long-term. CLINICAL TRIAL REGISTRATION: NCT03015012.

Change in Weight, BMI, and Body Composition in a Population-Based Intervention Versus Genetic-Based Intervention: The NOW Trial.

OBJECTIVE: The aim of this study was to compare changes in body fat percentage (BFP), weight, and BMI between a standard intervention and a nutrigenomics intervention. METHODS: The Nutrigenomics, Overweight/Obesity and Weight Management (NOW) trial is a parallel-group, pragmatic, randomized controlled clinical trial incorporated into the Group Lifestyle BalanceTM (GLB) Program. Statistical analyses included two-way ANOVA and split-plot ANOVA. Inclusion criteria consisted of: BMI ≥ 25.0 kg/m2 , ≥18 years of age, English speaking, willing to undergo genetic testing, having internet access, and not seeing another health care provider for weight-loss advice outside of the study. Pregnancy and lactation were exclusion criteria. GLB groups were randomly assigned 1 to 1 (N = 140) so that participants received either the standard 12-month GLB program or a modified 12-month program (GLB plus nutrigenomics), which included the provision of nutrigenomics information and advice for weight management. The primary outcome was percent change in BFP. Secondary outcomes were change in weight and BMI. RESULTS: The GLB plus nutrigenomics group experienced significantly (P < 0.05) greater reductions in percent and absolute BFP at the 3-month follow-up and percent BFP at the 6-month follow-up compared with the standard GLB group. CONCLUSIONS: The nutrigenomics intervention used in the NOW trial can optimize change in body composition up to 6 months.

Assessing the Validity of the Past-Month, Online Canadian Diet History Questionnaire II Pre and Post Nutrition Intervention.

Dietary intake tools are used in epidemiological and interventional studies to estimate nutritional intake. The past-month Canadian Diet History Questionnaire II (CDHQII) has not yet been validated. This study aimed to assess the validity of the CDHQII in adults by comparing dietary results from the CDHQII to the same participants' 24-h recalls consisting of two weekdays and one weekend day. The recalls were collected using the validated multiple-pass method. Participants were asked to complete both tools at baseline, and again at 3-month follow-up. The study further aimed to determine which dietary intake tool was preferred by study participants by comparing completion rates. Data collection occurred at baseline (pre-intervention) and 3-month follow-up (post-intervention). Paired sample t-tests were conducted to compare means for the following nutrients (grams and %kcal): calories, protein, carbohydrates, total fat, saturated fat, unsaturated fat and sodium. Intraclass correlation coefficients of agreement and coefficients of variation were further calculated. Chi-square tests were used to determine the dietary assessment method with the greatest participant completion rate. At baseline (n = 104), there were no significant differences between the results of the CDHQII and three 24-h recalls (averaged), with overall moderate correlation coefficients. At 3-months (n = 53), there were significant differences (p < 0.05) between dietary intake collection methods for all nutrients assessed in this study, except for saturated fat (%kcal), unsaturated fat (%kcal), protein (%kcal) and sodium (mg). Correlation coefficients were moderate. A significantly greater proportion of participants completed the three 24-h recalls compared to the CDHQII after 3 months (completion rates of 67.2% vs. 50.8% of the sample, respectively). The CDHQII provided estimates of mean nutritional intake (calories, macronutrients and sodium) that were comparable to mean intake established from three 24-h recalls, at baseline and was validated in a sample of primarily middle-aged, college-educated, Caucasian female adults with overweight and obesity for mean baseline or cross-sectional measurement only but not for assessing individual/patient dietary intake in clinical practice (r = 0.30-0.68). This tool was not validated at 3-month follow-up. Additionally, participants preferred the three 24-h recalls to the online, past-month CDHQII.

Biological plausibility for interactions between dietary fat, resveratrol, ACE2, and SARS-CoV illness severity.

The angiotensin converting enzyme-2 (ACE2) cellular receptor is responsible for the pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), thus impacting the entrance and clearance of the virus. Studies demonstrate that upregulation of ACE2 has a protective effect on SARS-CoV-2 illness severity. Moreover, animal studies demonstrate that dietary intake can modulate ACE2 gene expression and function. A high intake of resveratrol may have a protective role, upregulating ACE2, whereas a high intake of dietary fat may have a detrimental role, downregulating ACE2. As such, we postulate on the biological plausibility of interactions between dietary fat and/or resveratrol and ACE2 gene variations in the modulation of SARS-CoV-2 illness severity. We call to action the research community to test this plausible interaction in a sample of human subjects.