J Nutrigenet Nutrigenomics 2014;7:161–174 DOI: 10.1159/000371743 Received: June 10, 2014 Accepted: December 23, 2014 Published online: February 20, 2015
© 2015 S. Karger AG, Basel 1661–6499/15/0073–0161$39.50/0 www.karger.com/jnn
Original Paper
An Intervention Study of Individual, apoE Genotype-Based Dietary and Physical-Activity Advice: Impact on Health Behavior Hanna-Leena Hietaranta-Luoma a Hannu Puolijoki c Anu Hopia a
Raija Tahvonen b
Terhi Iso-Touru b
a Functional
Foods Forum, University of Turku, Turku, b Biotechnology and Food Research, MTT Agrifood Research Finland, Jokioinen, and c Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
Key Words Nutrigenomics · apoE · Intervention · Health information · Dietary advice · Health · Taste attitudes
Hanna-Leena Hietaranta-Luoma University Consortium of Seinäjoki Kampusranta 9 C FI–60320 Seinäjoki (Finland) E-Mail hlhieta @ utu.fi
Downloaded by: University of Tokyo 157.82.153.40 - 5/14/2015 7:57:04 PM
Abstract Aim: To assess the behavioral effects of receiving personal genetic information, using apoE genotypes as a tool for promoting lifestyle changes. apoE was chosen because it has a significant impact on lipid metabolism and cholesterol absorption, both factors in cardiovascular disease. Methods: This study was a 1-year intervention study of healthy adults aged 20–67 years (n = 107). Their behavioral changes were measured by diet (e.g., fat quality, as well as consumption of vegetables, berries, fruits, and fatty and sugary foods), alcohol consumption, and exercise. Health and taste attitudes were assessed with the Health and Taste Attitude Scales (HTAS). The measurements were performed 4 times: at baseline (T0), as well as 10 weeks (T1), 6 months (T2), and 12 months after baseline (T3). These behavioral effects were assessed for three groups: a high-risk (Ɛ4+; n = 16), a low-risk (Ɛ4–; n = 35), and a control group (n = 56). Results: Personal genetic information affected health behavior. Dietary fat quality improved more in the Ɛ4+ group than in the Ɛ4– and control groups after personal, genotype-based health advice. This change differed significantly between the Ɛ4+ and the control group (p < 0.05), but only for a short time. Conclusion: Personal genetic information, based on apoE, may affect dietary fat quality. More research is required to determine how to utilize genotype-based health information and how to efficiently achieve long-term changes © 2015 S. Karger AG, Basel in the prevention of lifestyle-related diseases.
162
J Nutrigenet Nutrigenomics 2014;7:161–174 DOI: 10.1159/000371743
© 2015 S. Karger AG, Basel www.karger.com/jnn
Hietaranta-Luoma et al.: An Intervention Study of Individual, apoE Genotype-Based Dietary and Physical-Activity Advice: Impact on Health Behavior
Population-based health recommendations have limited efficacy in promoting health behavioral changes [1–3]. This may be due to individual differences in responding to dietary changes because of nutrient-gene interactions [2]. Personal genetic information, combined with genotype-tailored dietary advice, is a new tool for health professionals to encourage individuals to adopt improved health behaviors [4]. Genetic screening, together with personalized health recommendations, can act as a motivator if a person already has a risk factor for a disease (e.g., high cholesterol and overweight) and they want to change their health behavior in a relatively easy way [5, 6]. However, genetic testing could undermine current dietary advice by implying that only those with a risk gene need to implement a healthy diet [2]. The use of genotype-based nutrition and health information (e.g., nutrigenetics) that aims to affect health behavior and lower the risk for lifestyle-related diseases [e.g., obesity, diabetes, and cardiovascular disease (CVD)] is a relatively new approach in health education [7]. Although genetic variation is known to cause individual differences in response to dietary factors, this effect is commonly ignored [8]. Research in this field is challenging because several (e.g., biological, learned, sociocultural, and material-economic) factors affect the onset of lifestyle-related diseases. In their review article, Marteau et al. [9] found that genetic information may have some favorable effects on diet and lifestyle. Among a high-risk group, favorable effects were found by Chao et al. [10], who reported that apoE gene testing in the context of Alzheimer’s disease prevention increased exercise and vitamin intake and improved diet. Furthermore, Marteau et al. [11] found that the genetic testing of familial hypercholesterolemia did not have an impact on smoking, diet, exercise, and medication adherence in three groups (mutation, no mutation, and no genetic diagnosis) 6 months after the diagnostic assessment. This study also found that cholesterol medication was considered more effective in lowering the cholesterol level than diet among the mutation group. In genotype-based personalized health information, the challenge is to target the tailored health message correctly. Individuals’ response to dietary fat varies [12], and the most convincing evidence for this heterogeneity is related to the apoE gene [2]. apoE affects cholesterol absorption and has a function in lipid and vitamin E metabolism [13]. apoE has three major alleles: ε2, ε3, and ε4. Those who have the apoE ε4 allele have a higher blood cholesterol content and an increased risk for CVD than the carriers of other alleles [12]. Carriers of the apoE ԑ4 allele may even have a 42% higher risk for CVD than carriers of the apoE 3/3 genotype [14]. It is also known that a low vitamin D serum level is a risk factor for CVD [15]. The reported relation between apoE genotype and serum vitamin D content may be due to the better absorption of dietary fats among apoE ε4 carriers [15]. Several studies have shown that apoE ε4 carriers respond better to dietary changes (in fat quality) and exercise than apoE ε3 or ε2 carriers [12, 16]. However, controversial results have also been found, for example, after fish oil and flavonoid supplementation [17, 18]. CVD is one of the major causes of mortality and morbidity in developed countries [19], and this worldwide problem has led to a continuous search for new tools for motivating individuals to adopt a healthy lifestyle. Health behavioral interventions could be developed for groups of individuals with specific genotypes [6], and biomarker-based personalized nutritional intervention has been proposed as a new tool for managing the prevention of metabolic diseases [8]. The purpose of this study was to examine (1) how people respond to information on their own genetic risk and (2) whether personalized health information, based on genetic risk, promotes a change for a healthier lifestyle and modifies CVD risk factors. The genetic risk and health information focused on the apoE gene and its effects on CVD risk. Health information based on the participants’ genetic risk was emphasized for the participants in each intervention group, using personally tailored messages. In this paper, we report both short-term
Downloaded by: University of Tokyo 157.82.153.40 - 5/14/2015 7:57:04 PM
Introduction
163
J Nutrigenet Nutrigenomics 2014;7:161–174 DOI: 10.1159/000371743
© 2015 S. Karger AG, Basel www.karger.com/jnn
Hietaranta-Luoma et al.: An Intervention Study of Individual, apoE Genotype-Based Dietary and Physical-Activity Advice: Impact on Health Behavior
(10 weeks after baseline; 2 weeks after receiving the gene results) and long-term (6 and 12 months after baseline) behavioral effects (changes in dietary fat quality, in the consumption of vegetables, berries, fruits, alcohol, and fatty and sugary foods, and in exercise) in the context of heritable apoE genotype and CVD. The effect of genetic information on health and taste attitude was also monitored [with the Health and Taste Attitude Scales (HTAS)]. The intervention included both an active communication period (the first 6 months) and a follow-up period (the last 6 months), during which the participants received no health communication from the research group. We planned this intervention to hypothesize that personalized health information, based on an individual’s genetic risk (apoE 3/4 or 4/4 genotypes), motivates people to change their health behavior in order to prevent CVD more than does general information on lifestyle and CVD risk. To our knowledge, no controlled studies have previously been conducted that would use personalized health information based on the apoE genotype with an aim to promote a healthy lifestyle and lower CVD risk. Subjects and Methods
Health Information (Message) The health information (message) was based on the analyzed apoE genotype and was provided using the Extended Parallel Process Model (EPPM) [20]. The specific risk communicated to the participants in the study was CVD, and the effect of apoE genotype on CVD risk was emphasized for each participant in the inter-
Downloaded by: University of Tokyo 157.82.153.40 - 5/14/2015 7:57:04 PM
Study Design and Participants Altogether, 122 adults aged 20–67 years participated in this 1-year, single-blinded intervention study. The participants included in the study were healthy, had no long-term medication (e.g., diabetes, cholesterol, blood pressure, or psychiatric medication) or chronic conditions (e.g., diabetes or mental disorders). Other inclusion criteria were: blood pressure 120 g/l, and proper kidney, liver, and thyroid function [fP-Cr
© 2015 S. Karger AG, Basel 1661–6499/15/0073–0161$39.50/0 www.karger.com/jnn
Original Paper
An Intervention Study of Individual, apoE Genotype-Based Dietary and Physical-Activity Advice: Impact on Health Behavior Hanna-Leena Hietaranta-Luoma a Hannu Puolijoki c Anu Hopia a
Raija Tahvonen b
Terhi Iso-Touru b
a Functional
Foods Forum, University of Turku, Turku, b Biotechnology and Food Research, MTT Agrifood Research Finland, Jokioinen, and c Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
Key Words Nutrigenomics · apoE · Intervention · Health information · Dietary advice · Health · Taste attitudes
Hanna-Leena Hietaranta-Luoma University Consortium of Seinäjoki Kampusranta 9 C FI–60320 Seinäjoki (Finland) E-Mail hlhieta @ utu.fi
Downloaded by: University of Tokyo 157.82.153.40 - 5/14/2015 7:57:04 PM
Abstract Aim: To assess the behavioral effects of receiving personal genetic information, using apoE genotypes as a tool for promoting lifestyle changes. apoE was chosen because it has a significant impact on lipid metabolism and cholesterol absorption, both factors in cardiovascular disease. Methods: This study was a 1-year intervention study of healthy adults aged 20–67 years (n = 107). Their behavioral changes were measured by diet (e.g., fat quality, as well as consumption of vegetables, berries, fruits, and fatty and sugary foods), alcohol consumption, and exercise. Health and taste attitudes were assessed with the Health and Taste Attitude Scales (HTAS). The measurements were performed 4 times: at baseline (T0), as well as 10 weeks (T1), 6 months (T2), and 12 months after baseline (T3). These behavioral effects were assessed for three groups: a high-risk (Ɛ4+; n = 16), a low-risk (Ɛ4–; n = 35), and a control group (n = 56). Results: Personal genetic information affected health behavior. Dietary fat quality improved more in the Ɛ4+ group than in the Ɛ4– and control groups after personal, genotype-based health advice. This change differed significantly between the Ɛ4+ and the control group (p < 0.05), but only for a short time. Conclusion: Personal genetic information, based on apoE, may affect dietary fat quality. More research is required to determine how to utilize genotype-based health information and how to efficiently achieve long-term changes © 2015 S. Karger AG, Basel in the prevention of lifestyle-related diseases.
162
J Nutrigenet Nutrigenomics 2014;7:161–174 DOI: 10.1159/000371743
© 2015 S. Karger AG, Basel www.karger.com/jnn
Hietaranta-Luoma et al.: An Intervention Study of Individual, apoE Genotype-Based Dietary and Physical-Activity Advice: Impact on Health Behavior
Population-based health recommendations have limited efficacy in promoting health behavioral changes [1–3]. This may be due to individual differences in responding to dietary changes because of nutrient-gene interactions [2]. Personal genetic information, combined with genotype-tailored dietary advice, is a new tool for health professionals to encourage individuals to adopt improved health behaviors [4]. Genetic screening, together with personalized health recommendations, can act as a motivator if a person already has a risk factor for a disease (e.g., high cholesterol and overweight) and they want to change their health behavior in a relatively easy way [5, 6]. However, genetic testing could undermine current dietary advice by implying that only those with a risk gene need to implement a healthy diet [2]. The use of genotype-based nutrition and health information (e.g., nutrigenetics) that aims to affect health behavior and lower the risk for lifestyle-related diseases [e.g., obesity, diabetes, and cardiovascular disease (CVD)] is a relatively new approach in health education [7]. Although genetic variation is known to cause individual differences in response to dietary factors, this effect is commonly ignored [8]. Research in this field is challenging because several (e.g., biological, learned, sociocultural, and material-economic) factors affect the onset of lifestyle-related diseases. In their review article, Marteau et al. [9] found that genetic information may have some favorable effects on diet and lifestyle. Among a high-risk group, favorable effects were found by Chao et al. [10], who reported that apoE gene testing in the context of Alzheimer’s disease prevention increased exercise and vitamin intake and improved diet. Furthermore, Marteau et al. [11] found that the genetic testing of familial hypercholesterolemia did not have an impact on smoking, diet, exercise, and medication adherence in three groups (mutation, no mutation, and no genetic diagnosis) 6 months after the diagnostic assessment. This study also found that cholesterol medication was considered more effective in lowering the cholesterol level than diet among the mutation group. In genotype-based personalized health information, the challenge is to target the tailored health message correctly. Individuals’ response to dietary fat varies [12], and the most convincing evidence for this heterogeneity is related to the apoE gene [2]. apoE affects cholesterol absorption and has a function in lipid and vitamin E metabolism [13]. apoE has three major alleles: ε2, ε3, and ε4. Those who have the apoE ε4 allele have a higher blood cholesterol content and an increased risk for CVD than the carriers of other alleles [12]. Carriers of the apoE ԑ4 allele may even have a 42% higher risk for CVD than carriers of the apoE 3/3 genotype [14]. It is also known that a low vitamin D serum level is a risk factor for CVD [15]. The reported relation between apoE genotype and serum vitamin D content may be due to the better absorption of dietary fats among apoE ε4 carriers [15]. Several studies have shown that apoE ε4 carriers respond better to dietary changes (in fat quality) and exercise than apoE ε3 or ε2 carriers [12, 16]. However, controversial results have also been found, for example, after fish oil and flavonoid supplementation [17, 18]. CVD is one of the major causes of mortality and morbidity in developed countries [19], and this worldwide problem has led to a continuous search for new tools for motivating individuals to adopt a healthy lifestyle. Health behavioral interventions could be developed for groups of individuals with specific genotypes [6], and biomarker-based personalized nutritional intervention has been proposed as a new tool for managing the prevention of metabolic diseases [8]. The purpose of this study was to examine (1) how people respond to information on their own genetic risk and (2) whether personalized health information, based on genetic risk, promotes a change for a healthier lifestyle and modifies CVD risk factors. The genetic risk and health information focused on the apoE gene and its effects on CVD risk. Health information based on the participants’ genetic risk was emphasized for the participants in each intervention group, using personally tailored messages. In this paper, we report both short-term
Downloaded by: University of Tokyo 157.82.153.40 - 5/14/2015 7:57:04 PM
Introduction
163
J Nutrigenet Nutrigenomics 2014;7:161–174 DOI: 10.1159/000371743
© 2015 S. Karger AG, Basel www.karger.com/jnn
Hietaranta-Luoma et al.: An Intervention Study of Individual, apoE Genotype-Based Dietary and Physical-Activity Advice: Impact on Health Behavior
(10 weeks after baseline; 2 weeks after receiving the gene results) and long-term (6 and 12 months after baseline) behavioral effects (changes in dietary fat quality, in the consumption of vegetables, berries, fruits, alcohol, and fatty and sugary foods, and in exercise) in the context of heritable apoE genotype and CVD. The effect of genetic information on health and taste attitude was also monitored [with the Health and Taste Attitude Scales (HTAS)]. The intervention included both an active communication period (the first 6 months) and a follow-up period (the last 6 months), during which the participants received no health communication from the research group. We planned this intervention to hypothesize that personalized health information, based on an individual’s genetic risk (apoE 3/4 or 4/4 genotypes), motivates people to change their health behavior in order to prevent CVD more than does general information on lifestyle and CVD risk. To our knowledge, no controlled studies have previously been conducted that would use personalized health information based on the apoE genotype with an aim to promote a healthy lifestyle and lower CVD risk. Subjects and Methods
Health Information (Message) The health information (message) was based on the analyzed apoE genotype and was provided using the Extended Parallel Process Model (EPPM) [20]. The specific risk communicated to the participants in the study was CVD, and the effect of apoE genotype on CVD risk was emphasized for each participant in the inter-
Downloaded by: University of Tokyo 157.82.153.40 - 5/14/2015 7:57:04 PM
Study Design and Participants Altogether, 122 adults aged 20–67 years participated in this 1-year, single-blinded intervention study. The participants included in the study were healthy, had no long-term medication (e.g., diabetes, cholesterol, blood pressure, or psychiatric medication) or chronic conditions (e.g., diabetes or mental disorders). Other inclusion criteria were: blood pressure 120 g/l, and proper kidney, liver, and thyroid function [fP-Cr
