Health Professionals

Continuing Education for

numedix.com Continuing education. Anytime. Anywhere.TM

The Omics of Nutrition 2 CPEU or CE hour numedix.com 2009 Page 1 of 7

Our professional approvals

The Omics of Nutrition 2 CPEU or CE hour numedix.com 2009 Page 2 of 7

For dietetic professionals CPE level: 3. Suggested Commission on Dietetic Registration Learning Need Codes: It is the sole responsibility of the dietetic professional to determine the learning need code met by a course. numedix.com provides the following "suggested" codes, but the professional can deviate from them if they feel another need is met. 2050 Genetics 2100 Nutritional biochemistry 3090 Screening parameters, methodology, and surveillance 4010 Community intervention, monitoring, and evaluation 4040 Disease prevention 4050 Epidemiology 5150 Cancer 5160 Cardiovascular disease Your educational objectives Understand the metabolic, psychological and cultural influences that challenge weight loss in women. Identify bad habits that sabotage weight loss and healthy eating. Implement checklists, menu plans and snacking tips that facilitate healthy weight loss. Instructions Refer to the reading below to answer the continuing education exam questions. For your convenience, an answer form is provided on the last page of this packet. Choose Your Parents Wisely Heres an age-old question: nature or nurture? Experience and intuition tells us that certain traits tend to naturally run in families. Characteristics range from the innocuous--for instance--idiosyncratic mannerisms, to the life altering--such as cardiovascular disease, cancer, obesity and aging. The genetic-health relationship is widely accepted by an astounding 96% of Americans, however as with many health behaviors, the putting it into practice chasm is significant. In fact, only one-third of Americans have attempted to document their family health history. June 2000 marked the completion of the 10-year Human Genome Project (HGP), a major undertaking to identify and map the approximately 20,00025,000 genes of the human genome from both a physical and functional standpoint. Although interpretation of genome data is still in its initial stages, detailed knowledge of the human genome has created new paradigms in nutrition, medicine and biotechnology. Simply put, characterizing usual genetic landmarks along the DNA genome, for instance, scientists could also began to identify unusual variations/variants. Genomics, metabolomics and related researchaffectionately regarded as, the -omics sciences---is a 30-year old metamorphosis that has emerged as the new face of nutrition and health. Nutrigenomics refers to the role of nutrients in gene expression. On the other hand, nutrigenetics takes a more systemic approach, describing an individuals response to diet due to genetic variants or polymorphisms. Despite their directional differences, both nutrigenetics and nutrigenomics evaluate nutrient effects using molecular biology technologies.

Nutrigenomics The role of nutrients in gene expression. Nutrigenetics An indidvuals specific response to diet due to genetic variants or polymorphisms.

Did you know the term nutrigenetics was first used by Dr. R.O. Brennan in 1975, in his book Nutrigenetics: New Concepts for Relieving Hypoglycemia.

Nutrition science is moving towards nutrigenomics and nutrigenetics to understand the relationship among dietary components, genetic polymorphism, and cellular metabolism. Goals of nutrigenomics are: Utilize genomic information to uncover how genetic variations affect nutrients and dietary factors; and Understand the bodys response to nutrients and dietary factors through the use of -omics research.

The Omics of Nutrition 2 CPEU or CE hour numedix.com 2009 Page 3 of 7

Keep in mind that the diet-gene interaction is bidirectional ; that is, diet influences gene expression and gene expression alters responses to the diet. Comprehending the interaction between diet and genes will identify individuals who are more or less likely to respond to dietary prevention and treatment. Pragmatically speaking, this knowledge will influence the mechanics of disease prevention, screening and Polymorphism treatment, with an emphasis upon personalized, and therefore more The genetic variation within a population. efficacious therapy. In fact, adherence to dietary advice may increase when it is supported with information based on nutritional genomics, and the patient believes the advice is personalized. Conceptually, the philosophies sound simple enough. Logistically, however, -omics research is a complex and complicated matter. Variables of interest are numerous, examine varying degrees of specificity in the gene expression process, and include: Genomics. Gene analysis determines whether a given gene exists. Epigenomics. If the gene is present, is it expressed? Specifically, techniques involve research involving gene methylation and histone modification, features that influence gene expression. Transcriptomics. If the gene exists, does it transcribe to produce transcription RNA (tRNA) and then ultimately messenger RNA (mRNA)? Also referred to as the study of gene expression at the RNA level. Proteomics. What are the protein products of the gene? Are they altered or bioactivated differently? Metabolomics. How do protein products affect the cellular constituents? This examines the holistic result of gene expression and its influence upon cellular metabolism and metabolic products.

Implications for Disease Public heath prevention has been based largely upon epidemiological studies, with the presumption that statistical analyses applies to the population at large. Indeed, this is a correct and appropriate application of biostatistics; however, there are many anecdotal and experimental data to illustrate that population-based recommendations have Allele limited benefit for some individuals. This intrapopulation variability might be One member of a pair or series of genes that explained due to interactions among the following genetic variants, nutrient occupy a specific position on a specific chromosome. intake and biomarkers of disease risk. Cardiovascular disease Specifically, genetic variants in ApoE influence dietary response to a hearthealthy diet. Variant ApoE4, for instance, identifies individuals who are likely to respond positively to a risk-reducing diet. Allele variants in ApoA, specifically ApoAI also predict a positive relationship between polyunsaturated fat intake and HDL-cholesterol. Further supporting this finding is that homozygote carriers of ApoAI are even better responders than heterozygote carriers.

Homozygous Having two identical alleles of a particular gene. Heterozygous Having two different alleles of a particular gene.

Several genes appear to affect postprandial lipemia, a metabolic period of interest because of its atherogenic potential. Postprandial lipid response can be modified by polymorhpisms within the genes for apo A-I, A-IV, A-V, E, B, C-I and C-III, lipoprotein lipase, hepatic lipase, fatty acid binding and transport proteins, microsomal triglyceride transfer protein and scavenger receptor class B type I. The influence each of these variants can exert upon postprandial metabolism, and their interaction among each other is a vast and essential territory to charter. Initially, the role of folate in reducing artery-damaging homocysteine was well received. Since its initial conception, there have data to cast doubt upon whether this relationship exists, and this may be due to newly discovered polymorphisms in the folate metabolizing genes. The Human Genome Project has helped scientists identify numerous genetic variants within the population. This has helped define the relationships between folate and CVD, and folate and colorectal carcinogenesis. Implications of these findings suggest that certain individuals may benefit from higher or lower intakes of folate, relative to their folate metabolizing genes.

The Omics of Nutrition 2 CPEU or CE hour numedix.com 2009 Page 4 of 7

Did you know The Oncotype DX genetic test can predict the chemotherapy risk-benefit for breast cancer survivors? Genetic screening can identify women who are fast, intermediate and slow metabolizers of hormone therapy drug, Tamoxifen?

Breast Cancer Breast cancer genes (BCRA 1 and 2, or BReast Cancer 1 and 2) are two tumor suppressor genes that, when functioning normally, help repair DNA damage. In 1994, researchers discovered that women who carry mutations of BRCA1 or BRCA2 are at higher risk of developing both breast and ovarian cancer. Presently, there are over 2000 genetic mutations associated with BRCA1 and BRCA2 genes , and not all BRCA mutations carry the same risk of cancer. Women who test positive for BRCA defects will not necessarily develop breast cancer; they are merely at higher risk for the diseasea point in which diet and lifestyle preventive measures may need to be more aggressive.

Mediterranean Diet, Inflammation & Genetics The Mediterranean Diet the anti-inflammation and CVD risk reduction superstar, has shown a surprisingly inconsistent effects, depending upon the subjects European cultural origin (i.e., Italy, Germany, and Spain). To minimize genetic variation among subjects, researchers at Emory University designed a study to examine the effects of the Mediterranean Diet upon inflammation biomarkers in monozygotic/identical and dizygotic/fraternal twins. Given the increasing recognition of fundamental genetic influences, it is essential that polymorphism be a considered variable. Aging The telomere theory of aging states describes small capstelomeres which appear on the ends of chromosomes. Each time the cell divides, the telomere shortens, and in some cells, it can be rebuilt by telomerase; however, when a telomere is not replenished because of the absence of telomerase or simply reaching the cells reproduction limit, the cell can no longer reproduce and eventually dies. The amount of cellular telomerase is genetic, thus testifying to the idea that longevity runs in families. The good news is that telomerase can be enhanced by stress reduction through means such as meditation.

Did you know Telomeres are 50 percent shorter in the cells of people who are stressed. Using telomere length as an estimate of biological age, scientists predict that stress shortens telomeres and life expectancy by 9 to 17 years?

You Choose Genes have the ability to express themselves in various ways, and numerous gene-activating factors are under ones control, if you choose to exercise it. In other words, we are not passive victims to our genes, but rather we can shift the balance of power in ones favor by being more prudent in diet and other lifestyle choices. The presence and interactions of gene variants and its complex interactions leads to the need for an enhanced interdisciplinary approach with integration among physicians, dietetic professionals, and genetic counselors. Too Much Information? Several companies are offering genetic tests that can show predisposition to a variety of illnesses. Sampling is accessible and noninvasiveurine, blood and saliva may be usedmaking genetic biomarker identification increasingly accessible, affordable and ubiquitous. But are consumers ready for this information, or is it too much information? For instance, a major reason women do not conduct monthly manual breast exams, is because of the fear of actually locating a suspicious area. How does one cope with negative information? Ideally, this type of information would prompt positive nutrition and lifestyle changes. The Surgeon Generals Family Health Portrait Tool Family health history is a powerful screening toolso significant that the Surgeon General has launched a national public health campaign, the Surgeon General's Family History Initiative. This initiative is designed to prompt Americans to document, examine and share their family health history with their health provider. Designed to help establish a family health history through a complete series of interview questions and survey (www.hhs.gov/familyhistory), the information can be presented to ones health provider, making the patient a true partner in a customized health strategy for screening, Conclusion Although the concept of nutrigenetics was introduced 35 years ago, it entry into mainstream medicine and practice is relatively young. This new paradigm in nutrition eliminates the one size fits all approach, replacing it with a customized, specified and personalized prevention and intervention.

The Omics of Nutrition 2 CPEU or CE hour numedix.com 2009 Page 5 of 7

Survey First, help us serve you better! Please answer the following questions, marking your answer form: How did you first hear about numedix.com? List subjects you would like to see as continuing education courses. Continuing education exam 1. The genetic-health relationship is accepted by of Americans. A. 50 B. 63 C. 79 D. 96 2. percent

A. B. C. D.

Epigenomics Transcriptomics Proteomics Metabolomics responders than

6. Homozygote ApoAI carriers are heterozygote carriers. A. better B. smaller

7. The presence of BCRA 1 and 2 identify women who will develop breast cancer during their lifetime. A. True B. False percent shorter in the cells of 8. Telomeres are people who are stressed. A. 10 B. 20 C. 40 D. 50 9. A. B. C. D. What samples may be used for genetic testing? Urine Blood Saliva Any of the above

The Human Genome Project maps approximately genes. A. 10,000 to 15,000 B. 20,000 to 25,000 C. 30,000 to 50,000 D. 1,000,000 3. Which term describes the role of nutrients in gene expression? A. Nutrigenomics B. Nutrigenetics when the individual 4. Patient compliance believes the advice is personalized. A. decreases B. increases 5. Which term is the stud of gene expression at the RNA level?

10. The Surgeon Generals Family History Initiative is designed to prompt Americans to document, examine and share their family health history with their health providers. A. True B. False

References Bull C., Fenech M.. Genome-health nutrigenomics and nutrigenetics: nutritional requirements or 'nutriomes' for chromosomal stability and telomere maintenance at the individual level. The Proceedings of the Nutrition Society. 2008;67:146-56. Cancer Therapy; National Institutes of Health describes research in cancer therapy. Clinical Oncology Week. March 2008;790. Dai J. Adherence to the Mediterranean Diet Is Inversely Associated With Circulating Interleukin-6 Among Middle-Aged Men. Circulation. 2008;117:169-175 Davis CD, Hord NG. Nutritional "Omics" Technologies for Elucidating the Role(s) of Bioactive Food Components in Colon Cancer Prevention1. The Journal of Nutrition . 2005;135:2694-7. Diet & Nutrition; Combination of nutrigenomics and nutrigenetics will progress nutrition research. Genomics & Genetics Weekly. December 2005;85. Diet & Nutrition; Nutrigenomics may result in biomarker discovery in nutrition and health. Life Science Weekly. October 2006;560. Diet and Nutrition; Research on diet and nutrition reported by scientists at University of Tokyo. Health & Medicine Week . June 2008;1795. Genetics & Genomics; Nutrigenetics assessments sold direct to consumers available in some pharmacies. Heart Disease Weekly . September 2005;117. Genetics & Genomics; Studies from University of Reading have provided new information about genetics & genomics. Genomics & Genetics Weekly . June 2008;140. Gillies PJ. Nutrigenomics: The Rubicon of molecular nutrition. American Dietetic Association. Journal of the American Dietetic Association. 2 . 2003;103:S50-5.
The Omics of Nutrition 2 CPEU or CE hour numedix.com 2009 Page 6 of 7

Ioannis Arkadianos, Ana M Valdes, Efstathios Marinos, Anna Florou, Rosalynn D Gill, Keith A Grimaldi. Improved weight management using genetic information to personalize a calorie controlled diet. Nutrition Journal . 2007;6:29. Lairon D., Defoort C., Martin J., Amiot-Carlin M., Gastaldi M., Planells R.. Nutrigenetics: links between genetic background and response to Mediterranean-type diets. Public Health Nutrition . 2009;12:1601-6. Lopez-Miranda J., Williams C., Lairon D.. Dietary, physiological, genetic and pathological influences on postprandial lipid metabolism. The British Journal of Nutrition . 2007;98:458-73. Lovegrove J., Gitau R.. Nutrigenetics and CVD: what does the future hold? The Proceedings of the Nutrition Society. 2008;67:206-213. Nutrigenetics and nutrigenomics. Scitech Book News. March 2005;29. Ordovas JM. Nutrigenetics, Plasma Lipids, and Cardiovascular Risk. American Dietetic Association. Journal of the American Dietetic Association . 2006;106:1074-1081. Rimbach G., Minihane A.. Nutrigenetics and personalised nutrition: how far have we progressed and are we likely to get there? The Proceedings of the Nutrition Society . 2009;68:162-72. Roizen MF and Oz MC. You Staying Young. Simon & Schuster. New York. 2007. Scripps Research Institute, La Jolla; Combination of nutrigenomics and nutrigenetics will progress nutrition research. Biotech Week. December 2005;911. Ulrich CM. Nutrigenetics in Cancer Research-Folate Metabolism and Colorectal Cancer1,2. I2005;135:2698-702.

Congratulations! You have completed your exam!

Submit your answer form to numedix.com
Online: www.numedix.com/Exam.html | Fax: 1.800.973.2129 | Email: custserv@numedix.com

Receive your continuing education certificate.

When you earn a minimum score of 70%, numedix.com will indicate that you earned continuing education on the date of your submission. (If you do not achieve a minimal passing score of 70%, another exam will be sent to you for complimentary re-test.) Within 3 business days of receiving your submission, youll receive a CE certificate via email and USPS mail.

Thank you for using numedix.com as your continuing education resource!

Visit us often for special discounts, free courses & updated topics to keep you successful!

The Omics of Nutrition Individual information (please complete) Name: Profession & registration no.: Address: Email:

Survey
1. 2. 3. 4. 5. Fill in blank: Fill in blank: A A A A A B B B B B C C C C C D D D D D 6. 7. 8. 9. 10. A A A A A B B B B B C C C C C D D D D D
The Omics of Nutrition 2 CPEU or CE hour numedix.com 2009 Page 7 of 7