Consensus Report of the Academy of Nutrition and Dietetics: Incorporating Genetic Testing into Nutrition Care.

Personalization of nutrition advice is a process already familiar to registered dietitian nutritionists, but it is not yet clear whether incorporating genetic results as an added layer of precision improves nutrition-related outcomes. Therefore, an independent workgroup of experts, supported by the Academy's Evidence Analysis Center staff, conducted a systematic review to examine the level of evidence measuring the effect of incorporating genetic testing results into nutrition counseling and care, compared to an alternative intervention or control group, on nutrition-related outcomes. This systematic review revealed that only weak quality evidence is available in the scientific literature and observed that this field is still maturing. Therefore, at present, there is insufficient scientific evidence to determine whether there are effects of incorporating genetic testing into nutrition practice. The workgroup prepared this Consensus Report based on this systematic review to provide considerations for the practical application of incorporating genetic testing into the nutrition care process.

What Will It Take to Build an Expert Group of Nutrigenomic Practitioners?

BACKGROUND: The past two decades have seen exponential growth in the number of genetic testing companies, but only a small percentage of these tests are being sold through health care professionals (HCPs). As each new genetic testing company appears, it is becoming more difficult for the practitioner and consumer to evaluate the credibility of the claims being made and the value of the tests being offered. SUMMARY: HCPs appear to have minimal nutrigenomics knowledge and little confidence in choosing and interpreting nutrigenetic tests. To remedy this, HCPs need access to credible education, professional support, networking, career development, mentorship, and a regulated testing environment. This will enable them to evaluate the credibility of genetic tests and testing companies, provide genetic results in context, and apply appropriate clinical translation. Key Message: In order to establish an expert group of nutrigenomic practitioners, collaboration is required between educational institutions, professional organizations, and genetic testing companies. This will provide the necessary support, skills, and knowledge to ensure that the best value is extracted from nutrigenetic tests in an ethical and responsible manner.

A low-cost, in silico nutritional genomics course-based undergraduate research experience applicable to multiple disciplines.

This article describes the development and assessment of a Nutritional Genomics course, designed to be held in a regular classroom during normal class periods, with few extra costs to the students or the department. The course was run as an upper-level undergraduate and lower-level graduate student course. Student taking the course spent 11 weeks learning and then 4 weeks using various in silico methods to independently characterize genes of interest in the field. During the last 4 weeks of the course, students combined their methods to test a hypothesis they generated about a gene they have not yet studied and completed a final report in the form of a journal article. Two students have published or are in the process of publishing work from their final project. Validated surveys of genetic knowledge given at least 6 months following the course indicated a very high level of genetic knowledge retainment, and favorable attitudes toward genetics testing and medical use of genetics. Finally, self-perceived critical thinking skills were high, and students indicated that they perceived these skills to be gained by their participation in the course. Materials and syllabus provided in the manuscript makes this CURE easily transferrable to other disciplines.

Should 'Omics' education be a part of allied health profession curricula?

Sequencing of human genome followed by monumental progress in omics sciences within last two decades has made personalized nutrition for better health is a reality for near future. The complexity of underlying science in making personalized nutrition recommendation has led to the need for training of health care providers. The International Society of Nutrigenetics/Nutrigenomics (ISNN) has mission to increase the understanding among both professionals and the general public of the role of genetic variation and nutrients in gene expression. To bring this mission to fruition, we need trained healthcare professionals ready to educate public. With this in mind, we have surveyed allied health students for their omics knowledge, desire to learn more and their perception of the need of omics education. The results show a need for training in omics in all allied health disciplines and desire of the students to learn more.

The State of Nutrigenomic Education in Poland.

BACKGROUND: In Poland, 45 higher education institutions offer degrees in dietetics. However, only 20 of these offer nutrigenomics or nutrigenetics courses. OBJECTIVES: The purpose of this study was to assess the current state of nutri-genomic education in Poland and to evaluate the level of nutrigenomic knowledge held by dieticians. METHODS: A cross-sectional survey was performed to examine the self-reported attitudes of 193 dietetics students and dietetics professionals who graduated from 33 Polish higher-level institutions. RESULTS: The great majority of respondents were familiar with nutrigenomics and had a positive attitude to it, and this attitude was independent of whether they participated in nutrigenomics courses. Sixty-six percent of the respondents had received training in nutrigenomics, but nutrigenomic education did not meet the expectations of 57% of dieticians. Dieticians possess low levels of self-reported knowledge of nutrigenomics, and only about 15% of respondents know how to effectively communicate information on genetic risk to patients and understand the effect of nutrients on molecular mechanisms. Despite this lack of knowledge, 59% of respondents had a positive attitude to nutri-genomics, and 63% of them had a great interest in broadening their knowledge. Subjects who had participated in nutrigenomics courses exhibited a better understanding of several areas of nutrigenomics. They were especially interested in practical aspects of nutrigenomics, such as the essence of personalized diets and the practical application of nutrigenomics. CONCLUSIONS: In conclusion, Polish dieticians have a positive attitude to nutrigenomics but do not perceive themselves as well educated in this field, which is partly due to systemic problems. The study shows the need for improvements in nutrigenomic education in Poland.

Opportunities for training for nutritional professionals in nutritional genomics: What is out there?

AIM: To identify and profile training courses available to dietitians and nutritionists in the area of nutritional genomics. Genetic technology is progressing quickly, leading to increased public interest and requests from the public for personalised nutrition advice based on genetic background. Tertiary courses often lack specific curriculum in nutritional genomics, preventing graduates from discussing confidently with their clients the relationships between genetics, nutrition and health. This has increased the demand for professional development in this field. METHODS: The search strategy was intended to replicate real-life practice. Google and snowball searches were conducted using terms related to education and nutritional genomics. Results included online or face-to-face courses in any country providing content on nutritional genomics. One-off courses and those courses no longer accessible were excluded. A descriptive analysis of characteristics of courses was undertaken, reporting on mode of delivery, cost, duration, content, qualification awarded, target audience and affiliations. RESULTS: In total, 37 courses varying in duration, content and cost were identified: 4 postgraduate university degrees, 5 university course units, 4 recurring face-to-face workshops, 15 online short courses, 8 pre-recorded presentations and 1 service offering regular live webinars. Affiliations with food and pharmaceutical industry (e.g. genetic testing companies), professional organisations and research/education institutes were observed. CONCLUSIONS: Training courses identified were predominantly delivered online, enabling nutrition professionals worldwide to upskill in nutritional genomics and personalised nutrition. Additional courses exist. Those seeking training should scrutinise and compare cost, duration, mode, content and affiliations of course providers to ensure learning needs are met.

Amount of Genetics Education is Low Among Didactic Programs in Dietetics.

Nutritional genomics is a growing area of research. Research has shown registered dietitian nutritionists (RDNs) have limited knowledge of genetics. Limited research is available regarding how didactic programs in dietetics (DPDs) meet the genetics knowledge requirement of the Accreditation Council for Education in Nutrition and Dietetics (ACEND®). The purpose of this study was to determine the extent to which the study of nutritional genomics is incorporated into undergraduate DPDs in response to the Academy of Nutrition and Dietetics position statement on nutritional genomics. The sample included 62 DPD directors in the U.S. Most programs (63.9%) reported the ACEND genetics knowledge requirement was being met by integrating genetic information into the current curriculum. However, 88.7% of programs reported devoting only 1-10 clock hours to genetics education. While 60.3% of directors surveyed reported they were confident in their program's ability to teach information related to genetics, only 6 directors reported having specialized training in genetics. The overall amount of clock hours devoted to genetics education is low. DPD directors, faculty, and instructors are not adequately trained to provide this education to students enrolled in DPDs. Therefore, the primary recommendation of this study is the development of a standardized curriculum for genetics education in DPDs.

Proceedings of the 11th Congress of the International Society of Nutrigenetics and Nutrigenomics (ISNN 2017).

The International Society of Nutrigenetics and Nutrigenomics (ISNN) held its 11th annual Congress in Los Angeles, California, between September 16 and 19, 2017. In addition to 2 keynote lectures, 4 plenary sessions included presentations by internationally renowned speakers on cutting-edge areas of research and new discoveries in genetics/genomics, the microbiome, and nutrition. Scientific topics included multi-omics approaches; diet and the microbiome; cancer, longevity, and metabolism; moving the field forward; and translational/educational aspects and the future of medicine. There was also an accepted oral abstracts session designed specifically to provide young investigators and trainees with the opportunity to present their work, as well as a session focused on industry-academic partnerships, which included a roundtable discussion afterwards. Overall, the 11th ISNN Congress was an exciting and intellectually stimulating meeting focused on understanding the impact of biological interactions between genes and nutrients on health and disease. These efforts continued the decade-long tradition of the annual ISNN Congress to provide an interdisciplinary platform for scientists from various disciplines to discuss research ideas and advance the fields of nutrigenetics and nutrigenomics.

Systematic review of knowledge, confidence and education in nutritional genomics for students and professionals in nutrition and dietetics.

BACKGROUND: This review examines knowledge and confidence of nutrition and dietetics professionals in nutritional genomics and evaluates the teaching strategies in this field within nutrition and dietetics university programmes and professional development courses internationally. METHODS: A systematic search of 10 literature databases was conducted from January 2000 to December 2012 to identify original research. Any studies of either nutrition and/or dietetics students or dietitians/nutritionists investigating current levels of knowledge or confidence in nutritional genomics, or strategies to improve learning and/or confidence in this area, were eligible. RESULTS: Eighteen articles (15 separate studies) met the inclusion criteria. Three articles were assessed as negative, eight as neutral and seven as positive according to the American Dietetics Association Quality Criteria Checklist. The overall ranking of evidence was low. Dietitians have low involvement, knowledge and confidence in nutritional genomics, and evidence for educational strategies is limited and methodologically weak. CONCLUSIONS: There is a need to develop training pathways and material to up-skill nutrition and/or dietetics students and nutrition and/or dietetics professionals in nutritional genomics through multidisciplinary collaboration with content area experts. There is a paucity of high quality evidence on optimum teaching strategies; however, methods promoting repetitive exposure to nutritional genomics material, problem-solving, collaborative and case-based learning are most promising for university and professional development programmes.

Learning from the past and looking to the future.

BACKGROUND/AIMS: Leaders in the fields of nutrigenomics/genetics can benefit from studying the ethical and social issues raised by comparable biomedical developments in the recent past and their consequences for science and society. METHODS: Experience with recombinant DNA research, beginning in the early 1970s, and its commercial application, and with pharamacogenetics/genomics, beginning two decades later, is analyzed. RESULTS: Particular lessons are drawn from both experiences. As to the first, the conclusions are to encourage open discussion among scientists of the possible negative or risky consequences of their research; not to conduct such discussions behind closed doors, so as to involve rather than to surprise the public; and to keep in mind the international characteristics of science but the domestic nature of the manner in which it is regulated. As to the second, the lessons are to beware of hype, avoid genetic determinism, take account of the problems raised by similarities to traditional genetic screening/testing, overcome the medical system's lack of preparation to use the new information, and recognize that differences in access may exacerbate inequities in health and health care. CONCLUSION: Awareness of these problems, which are likely to recur, can at least prepare those working in the field.

Future perspectives of nutrigenomics foods: benefits vs. risks.

Nutrigenomics, defined as the application of high-throughput genomics tools in nutrition research is now past its incubation phase. The poorly understood associations of diet and disease prevention in particular will likely be the single most important catalyst to its accelerated and continued growth. Whether the goal of matching foods to individual genotypes to improve the health of those individuals can be attained, and personalised nutrigenomic foods enter the world's food markets, depends on numerous hurdles being overcome: some scientific in nature, some' technical and others related to consumer, market or ethical issues. Public adoption of new technologies is an important determinant for their success. Many of the drivers behind the trend in personalisation of food are now known, particularly ethical, legal, and social issues (ELSI) are the major drivers. Future development in the field of nutrigenomics undoubtedly will place its seemingly huge potential in better perspective. From the scientific responsibility point of view, one hopes that the new perspectives to be gained and progress to be made in this field will be so managed as to take the public at large on board, if we are to avoid another nutrition education disaster of the genetically modified organism type and dimension.

Public awareness and use of direct-to-consumer genetic tests: results from 3 state population-based surveys, 2006.

We conducted population-based surveys on direct-to-consumer nutrigenomic testing in Michigan, Oregon, and Utah as part of the 2006 Behavioral Risk Factor Surveillance System. Awareness of the tests was highest in Oregon (24.4%) and lowest in Michigan (7.6%). Predictors of awareness were more education, higher income, and increasing age, except among those 65 years or older. Less than 1% had used a health-related direct-to-consumer genetic test. Public health systems should increase consumer and provider education and continue surveillance on direct-to-consumer genetic tests.

Factors associated with knowledge of genetics and nutritional genomics among dietitians.

INTRODUCTION: Knowledge of genetics and nutritional genomics is important for dietitians in the prevention and management of disease. The present study aimed to analyse data from a nationwide postal questionnaire survey in order to investigate the factors associated with knowledge of genetics and nutritional genomics among dietitians in the UK. METHODS: A nationwide postal questionnaire survey was conducted in a random sample of 600 dietitians in the UK. The questionnaire measured dietitians' knowledge using 12 multiple choice questions relating to genetics and nutritional genomics. Factors that may impact upon such knowledge were also recorded. Knowledge scores were calculated and compared between dietitians using comparative statistics and univariate analysis of variance. RESULTS: A total of 389 (64.8%) usable questionnaires were returned. Overall, the mean +/- SD total knowledge score was low at 41 +/- 19%. Highest qualification (F(2,372) = 9.1, P < 0.001), the genetics content of university education (F(2,372) = 7.1, P = 0.001) and reading literature or attending a conference relating to genetics or nutritional genomics within the last year (F(1,372) = 11.9, P = 0.001) were all associated with higher total knowledge scores. CONCLUSION: Knowledge of genetics and nutritional genomics among dietitians is currently low, and better knowledge is associated with exposure to these in university education and continuing professional development.

Understanding the nutrigenomic definitions and concepts at the food-genome junction.

The marked differences in individual response to dietary factors have led to major controversies in nutrition and puzzled nutrition scientists over the last century. The emerging field of nutrigenomics helps us to understand the basis for some of these differences and also promises us the ability to tailor diet based on individual genetic makeup. Great advances in Human Genome Project, documentation of single nucleotide polymorphisms (SNPs) in candidate genes and their association with metabolic imbalances have gradually added new tests to the nutrigenomic panel. Studies based on ethnopharmacology and phytotherapy concepts showed that nutrients and botanicals can interact with the genome causing marked changes in gene expression. This has led to the commercial development of nutraceuticals and functional foods that can modify negative health effects of individual genetic profile bringing the field to the "food/genome" junction. Despite the promise of nutrigenomics to personalize diet, there is skepticism whether it can truly bring about meaningful modification of the risk factors connected to chronic diseases, due to the lack of large scale nutrition intervention studies. Several intervention studies currently underway in the United States and abroad (Israel, Spain, and France) will further help validate nutrigenomic concepts. France has already introduced a National Nutrition and Health Program to assess nutritional status and risk of major metabolic diseases. As the field(s) related to nutritional genomics advance in their scope, it is essential that: (a) strict guidelines be followed in the nomenclature and definition of the subdisciplines; and (b) the state/federal regulatory guidelines be updated for diagnostic laboratories, especially for those offering tests directly to the public (without a physician's request) to help protect the consumer.

Genetics and diet--gene interactions: involvement, confidence and knowledge of dietitians.

Diet-gene interactions have become the focus of much research in recent years. However, little is known about UK dietitians' involvement, confidence and knowledge in genetics and diet-gene interactions. A validated postal questionnaire sent to a randomly selected sample of 600 dietitians in the UK resulted in 390 responses (65 %). Most dietitians had no involvement in eleven activities relating to genetics and diet-gene interactions and lacked confidence in undertaking such activities. However, a significant positive association was found between involvement and confidence for all activities tested (P < 0.0001). A mean knowledge score of 41 % (sd 19) indicated generally low levels of knowledge in genetics and diet-gene interactions. Knowledge scores were higher for those who reported discussing the genetic basis of disease or discussing how diet-gene interactions affected risk (P < 0.05). For the majority of activities, dietitians who reported higher confidence had higher knowledge scores. Given the importance of interactions between genetics and nutrition in preventing and managing disease, this study identifies a need to increase the involvement, confidence and knowledge in genetics and diet-gene interactions of dietitians in the UK.