Public health nutrition and genetics: implications for nutrition policy and promotion

Abstract

The unravelling of the human genome has the potential to radically extend many of the strategies used in public health nutrition to improve health and to increase food availability, accessibility and utilization. The present paper divides nutrigenomics into two broad but differing areas in asking about possible public health applications: (1) the increasing mismatch between population growth and global food security, on top of the already approximately 800 million of the world population who are food insecure; (2) possible responses to the rising prevalence of non-communicable diseases as the Western diet becomes increasingly inappropriate to the needs of those consuming it. It is clear that complex interactions of multiple polymorphisms play a role in how individuals and sub-populations respond to dietary interventions. All these applications present public health and ethical challenges, particularly in ensuring that any benefits that do come from nutrigenomics are not restricted to the wealthy minority of only the affluent nations. The present paper concludes that the public health applications of nutrigenomics are probably at least a decade away, especially for developing countries. Clinical applications are likely to be more immediate, probably resulting in ‘designer diets’ for individuals with particular polymorphisms, but unless governments take on the role of ensuring some extent of equity in access, any benefits are most likely to go to those who can afford the screening, tests and treatment. At the same time, greatly increased international efforts are needed towards the continuing, and in some cases worsening, global malnutrition, as genetic manipulation of crops is unlikely to provide more than part of the solution.

The challenges for molecular nutrition research 1: linking genotype to healthy nutrition

“…Opportunities were heralded for the food industry in functional foods and products tailored to specific genotypes [21] which could fit alongside the development of appropriate business models. The population-based ''one diet fits all'' approach to public health began to be questioned [10] but the potential ethical, legal and social impact of individualised nutrition [2,20] also attracted criticism [31]. Alongside this growing interest, many findings from the early intervention and association studies began to demonstrate the full complexity of this gene-environment interaction science and the extensive research, and research funding, which would be needed to resolve the underlying science.…”

Zinc–gene interaction related to inflammatory/immune response in ageing

“…By the other side, it is also commonly accepted that the complex interactions of multiple polymorphisms play a key role in how individuals may respond to dietary interventions [38]. For each nutrient, there is a window of intake between the Recommended Dietary Allowance (RDA), (which is defined as the dietary intake sufficient to meet the requirement of 97% of healthy individuals in a particular stage of life and sex group), and the tolerable upper limit (UL), which is the highest nutrient intake that can be achieved without incurring risk of adverse health effects for most individuals in the general population [140].…”

Pharmacogenomics and nutrigenomics: synergies and differences

“…This approach is unlikely to be costeffective (Section 9.10) and is driven by a desire to achieve the maximum growth for companies (food manufacturers and pharmaceutical and biotech companies), not the maximum benefit to public health. In developing countries -where increases in chronic diseases are the most rapid -the idea of genotyping most individuals and offering 'tailored diets' has rightly been described as an 744 'impossible dream'.…”