Ethical Considerations in the Implementation of Nutrigenetics/Nutrigenomics

Abstract

Awareness of ethical issues that may be raised by the implementation of nutrigenetic/nutrigenomic (NGx) testing and personalized nutrition, at an individual or a public health level, is crucial to ensure the latter's sound and effective implementation. NGx tests that are currently offered or developed have different natures and scopes. We provide an example of NGx testing on the MTHFR gene to illustrate the current challenges when it comes to grasp the meaning of the results of such testing. In addition, NGx testing is developed within an evolving landscape of new genomic technologies and occurs at a time when public health policies mainly focus on preventive and predictive healthcare, with an emphasis on increased individual responsibility. The ethical issues raised by such a context and the genetic nature of NGx testing both should be carefully evaluated.

Personal genomic testing for nutrition and wellness in Australia: A content analysis of online information

“…produced pre‐ and post‐test counselling recommendations that should be addressed by HPs facilitating PGT‐NG. The authors reinforce that pre‐ and post‐test counselling, along with HP training, is essential to ensure consumers make informed choices to pursue PGT‐NG …”

“…Given the potential that nutritional genomics offers the field of nutrition and dietetics, it is essential that the workforce is adequately supported to provide clients with high quality care and advice . One place to start is neutral, evidence‐based information available to consumers online.…”

“…Australian guidelines recommend that healthcare providers should only offer PGT based on nutritional genomics if the test, and related dietary interventions, are sufficiently evidence‐based . To date, however, many gene–nutrition relationships lack clinical validity . Furthermore, the genetic markers used to determine disease‐risk, and the evidence used to provide dietary recommendations, often differ between PGT‐NG companies, meaning consumers may receive different test results, and possibly advice, based on the test they take .…”

“…Internationally, health‐related PGT are often sold online, direct‐to‐consumer (DTC), negating the need to involve a healthcare provider (HP). This also eliminates the possibility for pre‐ and post‐test counselling and, given that online information may be inadequate to ensure informed consent, consumers may be at risk of distress, false hope or ‘buyer‐regret’ . In an attempt to minimise this risk, several PGT‐NG companies have developed a direct‐to‐provider model, whereby a healthcare provider is trained by the company to facilitate testing for their clients.…”

“…4 To date, however, many gene-nutrition relationships lack clinical validity. [5][6][7] Furthermore, the genetic markers used to determine disease-risk, and the evidence used to provide dietary recommendations, often differ between PGT-NG companies, meaning consumers may receive different test results, and possibly advice, based on the test they take. 5,8 Many PGT-NG also do not take into consideration the polygenic nature of many noncommunicable diseases, nor non-genetic factors contributing to poor health.…”