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Nutrigenomics: Do our genes determine what we should eat? Dr. Ahmed El-Sohemy Canada Research Chair in Nutrigenomics Chief Scientific Officer Department of Nutritional Sciences University of Toronto Nutrigenomix Inc. Toronto – Sydney Santiago – São Paulo Disclosure A. E-S. holds shares in Nutrigenomix Inc. The Science of Nutrigenomics Using genomic information and genetic technologies to investigate how nutrients interact with our genome to impact our health and performance. Diet Genes Food preferences Why bother with genetics/genomics? Health Outcome Nutrition Genotype A Genes Genotype B Genotype C One size does not fit all Increase No Effect Decrease Is Coffee associated with CVD? CVD Coffee Genotype A Genes Genotype B Genotype C Increase No Effect Decrease Bioactives in Coffee aliphatic acids magnesium potassium caffeine melanoidins diterpenoids polyphenols Caffeine (1,3,7-trimethylxanthine) “The Legal Alternative” Caffeine CYP1A2 Paraxanthine 1,7-dimethyluric acid 5-acetylamino-61-methylxanthine formylamino-3methyluracil 1-methyluric acid Genetic Variation in CYP1A2 -163 AC 300 fast % Inducibility 250 200 150 slow 100 50 0 AA AC CC CYP1A2 Genotype Costa Rica Heart Study • 2013 cases (myocardial infarction) • 2013 population-based controls - matched (age, sex, area of residence) • Data collection: - food frequency questionnaire - health and lifestyle questionnaire - fasting blood sample (DNA) Coffee Intake and Risk of Myocardial Infarction Odds Ratio 2.0 1.5 <1 cup/d 1 cup/d 2-3 cups/d 4 cups/d * 1.0 0.5 Total Population * P<0.05 Cornelis et al., JAMA 295: 1135-41, 2006 Coffee Intake and Risk of Myocardial Infarction Odds Ratio 2.0 1.5 <1 cup/d 1 cup/d 2-3 cups/d 4 cups/d * * 1.0 0.5 AA AC + CC CYP1A2 Genotype * P<0.05 Cornelis et al., JAMA 295: 1135-41, 2006 Coffee Intake and Risk of Myocardial Infarction Subjects <50 Years of Age Odds Ratio 4 3 * <1 cup/d 1 cup/d 2-3 cups/d 4 cups/d * 2 1 * * 0 AA AC + CC CYP1A2 Genotype * P<0.05 Cornelis et al., JAMA 295: 1135-41, 2006 Coffee Intake and Risk of Hypertension Hazard Ratio 4 3 Abstainers 1-3 cups/day 4 cups/day * * 2 1 * 0 AA AC + CC CYP1A2 Genotype * P<0.05 Palatini et al., J Hypertens 27: 1594-1601, 2009 Coffee Intake and Risk of Impaired Fasting Glucose 3 Abstainers * Hazard Ratio 1-3 cups/d 2 ≥ 4 cups/d 1 0 AA AC + CC CYP1A2 Genotype * P<0.05 Palatini et al. Eur J Epidemiol. 2015;30:209-217. GST-T Genotype and Serum Ascorbic Acid Deficiency Caucasians East Asians Vitamin C Intake <RDA Meets RDA 20% null 30 20 10 40 Serum Ascorbic Acid (mol/L) Serum Ascorbic Acid (mol/L) 40 50% null 30 20 10 0 0 Null Functional GST-T genotype P=0.001 for diet-gene interaction Null Functional GST-T Genotype P=0.02 for diet-gene interaction Cahill et al, Am J Clin Nutr, 2009 First Clinical Trial of Vitamin C James Lind, 1772 Vitamin C Deficiency in Canadian Adults Cahill et al Am J Epidemiol, 170: 464-471, 2009 Serum Ascorbic Acid and Biomarkers of Disease Cahill et al Am J Epidemiol, 170: 464-471, 2009 Personalized Dietary Advice vs Public Health Recommendations Consumer Genetic Tests USA, 2006 UK/USA, 2000 - 2009 USA, 2007-2012 Iceland, 2007-2012 USA, 2007-?? Canada, 2011 USA, 2007 USA, 2009 Canada, 2009-2012 USA, 2001 USA, 2000 UK, 2010 Australia, 2008-2013 Consumer Genetic Tests Does genetic information influence behaviour? I have the gene, so I eat healthily. I have the gene, so what can I do? Disease Risk Genes vs Metabolic/Modifier Genes DNA-based dietary advice resulted in: greater understanding of recommendations greater interest in learning more greater motivation to change eating habits Improved dietary outcomes DNA-based dietary advice is superior to the one-size-fits-all general recommendations Why go through a HCP? Explains benefits and limitations of the test. Addresses concerns of a genetic test. Accountability to HCP. Ancillary testing options. Better understanding of instructions. Partners How Nutrigenomix® Works Personalized report reviewed by healthcare practitioner Gluten Test 7-Gene Test 45-Gene Test **New 45-Gene Test Covering these 7 aspects of health: Sample Report Sample Report Loss of fat mass (%) after 2 years of low or high protein diet by FTO genotype * Significantly greater weight loss (fat mass) in response to a moderate-to-high protein diet only in individuals with the AA genotype. Adapted from Zhang et al. Diab. 2012;61:3005-3011. Is DNA-based Dietary Advice Ready for Prime Time? • Scientific evidence is robust (studies replicated) • Increasing consumer awareness and demand • Information is actionable and “personalized” • Focus on wellness/prevention, not disease treatment • Improved compliance (evidence from RCT) • Within the scope of practice for healthcare professionals ~1/3 of consumers will focus on personalized nutrition “…making day-to-day decisions about what to eat based on their particular genetic makeup.” Genotype “Positive health requires a knowledge of man’s primary constitution and of the powers of various foods, both those natural to them and those resulting from human skill.” Personalized Nutrition - Hippocrates (480 BC)
