13/11/2019 COPE WEBINAR SERIES FOR HEALTH PROFESSIONALS FINDING SLIDES FOR TODAY’S WEBINAR November 13, 2019 Using g e ne tic informa tion to pre dic t a nd tre a t obe sity: www.villanova.edu/COPE Click on Loos Ar e we r e ady for pr e c ision me dic ine ? webinar description page Moderator: Lisa Diewald, MS, RD, LDN Program Manager MacDonald Center for Obesity Prevention and Education M. Louise Fitzpatrick College of Nursing Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 1 2 DID YOU USE YOUR PHONE TO ACCESS THE WEBINAR? OBJECTIVES • Discuss genetic testing directly-to-consumers (DTC) If you are calling in today rather than services, advertised as providing genetically matched using your computer to log on, and need diets based on genotype data. CE credit, please email cope@villanova.edu and provide your • Explain the basic principles of prediction and the name so we can send your certificate. limitations of using genetic information in personalizing diet and exercise prescriptions. • Identify other opportunities for personalizing health related behaviors. Nursing Education Continuing Education Programming Research Nursing Education Continuing Education Programming Research 3 4 NUTRITION FUTURE FORWARD: CE DETAILS ARE WE READY FOR OUT OF THE BOX THINKING? March 6, 2020 Villanova University College of Nursing is accredited as a 9 AM-4 PM provider of continuing nursing education by the American Driscoll Hall Auditorium Nurses Credentialing Center Commission on Villanova University Accreditation Villanova University College of Nursing Continuing Education/COPE is a Continuing Professional Education RNs: 6 contact hours (CPE) Accredited Provider with the Commission on RD/ RDN/ DTR: 6 CPEUs Dietetic Registration Villanova.edu/cope Nursing Education Continuing Education Programming Research 5 6 1
13/11/2019 Using genetic information to predict and treat CE CREDITS obesity: Are we ready for precision medicine? • This webinar awards 1 contact hour for nurses and 1 CPEU for dietitians Ruth Loos, PhD. Charles Bronfman Professor in Personalized Medicine • Suggested CDR Learning Need Codes: 2000, Icahn School of Medicine 2050, 5370, and 9020 Wednesday, November 13, 2019 12-1 PM EST • Level 2 • CDR Performance Indicators: 6.2.5, 8.3.6, 8.3.7 Nursing Education Continuing Education Programming Research 7 8 DISCLOSURE The planners and presenter of this program have no conflicts of Using g e ne tic informa tion to pre dic t a nd tre a t obe sity: interest to disclose. Ar e we r e ady for pr e c ision me dic ine ? Accredited status does not imply endorsement by Villanova University, COPE or the American Nurses Credentialing Center of any commercial products or medical/nutrition advice displayed in conjunction with an activity. Ruth L oos Charle s Bro nfman Pro fe sso r in Pe rso nalize d Me dic ine Cha rle s Bro nfma n Institute fo r Pe rso na lize d Me dic ine Mindic h Child He a lth a nd De ve lo pme nt Institute Ic a hn Sc ho o l o f Me dic ine a t Mo unt Sina i Ne w Yo rk ruth.lo o s@ mssm.e du Vi l l anova COPE Webi nar , November 13 t h 2019 9 10 NCD Risk F ac to r Co llab o ratio n L anc e t 2017 Ove rwe ig ht/ obe sity pre va le nc e in USA sinc e 1980’s Obe sity “runs” in fa milie s Ca na da F itne ss Surve y N = 15,245, a g e d 7 – 69 yrs, fro m 6,377 fa milie s Wo me n Me n Girls Bo ys Ge ne s Sha re d e nviro nme nt Sha re d e nviro nme nt Katzmarzyk e t al. AJE , 1999 11 12 2
13/11/2019 Both g e ne s a nd e nvironme nt c ontribute to obe sity risk Obe sity is he rita ble , more tha n 1,000 loc i ha ve be e n ide ntifie d T win studie s F amily studie s 1000 Childhood Obesity and BMI MZ Extreme and early onset Obesity Overweight and obesity 800 BMI (African) Cumulative number of loci identified BMI (Asian) BMI (predominantly European) DZ 600 400 Bo rje so n Ac ta Pae d Sc and 1976 200 h 2 = 40- 70% 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 13 14 Why study g e ne tic s of obe sity ? Using g e ne tic informa tion throug hout the life -c ourse Ge ne - disc ove ry Pre dic t & pre ve nt dise a se Dia g nose & tre a t dise a se Biolog y & me c ha nisms Pre dic tion & Dia g nostic s Speliotes et al. Nature Genetics 2010 Siljee et al. Nature Genetics 2018 Khera et al. Nature Genetics 2018 15 16 Pr e c ision me dic ine a nd c ommon obe sity Monoge nic for ms of obe sity Common obe sity Pre c ision me dic ine to tre a t obe sity, MC4R L E P ma inta in he a lthy we ig ht POMC L E PR F a ro o q i e t a l. NE JM 2003 F a ro o q i e t a l. NE JM 1999 K rud e e t a l. Na t Ge n 1998 Sa e e d e t a l. Ob e sity 2014 • mutation in o ne g e ne tha t affe c ts a • Many ge ne tic var iants in many g e ne s tha t One spe c ific pathway a nd ha ve a lar ge e ffe c t . a c t thro ug h multiple pathways tha t ha ve • L ife style a nd e nviro nme nt ha ve mino re ffe c t. small e ffe c ts . • L ife style a nd e nviro nme nt a re impo rta nt. • He rita b ility 40-70% L P muta tions Re c ombinant human le ptin E muta tions in POMC , L ,… MC4R a g onists E PR 17 18 3
13/11/2019 Pr e c ision me dic ine in the g e nome e r a – ta ilor e d tr e a tme nt T he Blood-T ype die t • • e vo lve d a fte r the sta rt o f the b e ne fits a nd into le ra nc e s o f High fibe r die t type s A a nd B a g ra ria n so c ie ty • b e st o ff a s ve g e ta ria n L ow satur ate d fat die t Ae robic e xe rc ise L ow glyc e mic die t • e me rg e d a s huma ns • ne e d to e a t me a t virtua lly mig ra te d to wa rd e ve ry da y to sa tisfy yo ur High- fat die t a nc ie nt hunte r-g a the re r g e ne s c o lde r c lima te s • a vo id o a ts, whe a t, a nd mo st • the mo st va rie d die t, g ra ins inc luding me a t Sc re e ning T re atme nt base d • E xpo so me on profile • do e s we ll with da iry (life style , pro duc ts e nviro nme nt) • Ge no me • T ra nsc ripto me , … So urc e : MD Ande rso n 19 20 Dir e c t- to- c onsume r c ompa nie s ma ke bold c la ims 21 22 A c a se study – he a lthy woma n se e ks a dvic e A c a se study – the e vide nc e • 48 ye a r o ld wo ma n • • No da ta o n we ig ht g a in No da ta o n we ig ht g a in • • One va ria nt – wha t a b o ut o the r One va ria nt – wha t a b o ut o the r va ria nts ? va ria nts ? • Ge ne ra lly he a lthy, physic a lly a c tive , • • Wha t is the a d vic e fo r T Wha t is the a d vic e fo r T -a lle le -a lle le c a rrie rs ? c a rrie rs ? • • Sig nific a nt inte ra c tio n <> Sig nific a nt inte ra c tio n <> he a lthy die t, do e s no t smo ke ,… pre d ic tive pre d ic tive F r amingha m Offspr ing Pue r to Ric a n Ce nte r s on PHHD Pue r to Ric a n Ce nte r s on PHHD • Wa nts a dvic e fo r he a lthy a g ing study study DT C te st tha t inc lud e s te sts o n we llne ss Ruth L o o s 23 24 4
13/11/2019 A c a se study – the e vide nc e Cha lle ng e s for pre c ision me dic ine in c ommon obe sity • Sma ll (inte ra c tio n) e ffe c ts b ig g e r e ffe c ts that disc riminate b e twe e n g e no type s • One SNP a t a time , o ne e xpo sure (d ie t, phys a c t, …) a t a time • Ho w muc h “pre c isio n” do e s this • Ho w muc h “pre c isio n” do e s this “F ull pic ture ” (”b ig data”) is ne e de d info rma tio n a dd in the c o nte xt o f info rma tio n a dd in the c o nte xt o f pre c isio n me dic ine ? pre c isio n me dic ine ? • F e w studie s tha t e xa mine “c ha ng e ” in re spo nse to a n e xpo sure L o ng itudinal studie s o n we ig ht c hang e , inte rve ntio ns (L o o k AHE AD, DPP, POUNDS L OST , …) 25 26 Pre c ision me dic ine to pre dic t obe sity 27 28 Polyg e nic risk sc ore s SNPs – Sing le Nuc le otide Polymorphisms One SNP- a ssoc ia tion Gly Ala Gly Arg Ser Ile Ser Trp Ala Trp Trp Ala Cys Val GGC GCC GGA CGC TCC ATC TCC TGG GCC TGG TGG GCA TGT GTG T T/T GGC GCC GGA CGC TCC ATC TCC TGG GCC TGG TGG GCA TGT GTG T 29 PRS 7 8 4 12 7 8 Gly Ala Gly Arg Thr Ile Ser Trp Ala Trp Trp Ala Cys Val GGC GCC GGA CGC ACC ATC TCC TGG GCC TGG TGG GCA TGT GTG A A/T 28 SNP 1 0 0 1 2 0 2 GGC GCC GGA CGC TCC ATC TCC TGG GCC TGG TGG GCA TGT GTG T 27.9 BMI (kg / m 2 ) SNP 2 1 2 2 2 1 0 27 SNP 3 2 0 1 0 2 2 GGC GCC GGA CGC TCC ATC TCC TGG GCC TGG TGG GCA TGT GTG T 26.6 T/T GGC GCC GGA CGC TCC ATC TCC TGG GCC TGG TGG GCA TGT GTG T 26 SNP 4 … SNP 5 … GGC GCC GGA CGC ACC ATC TCC TGG GCC TGG TGG GCA TGT GTG A 25 25.2 A/A GGC GCC GGA CGC ACC ATC TCC TGG GCC TGG TGG GCA TGT GTG A SNP 6 … 24 SNP 7 … 0 1 2 T / T A/ T A/ A GGC GCC GGA CGC TCC ATC TCC TGG GCC TGG TGG GCA TGT GTG T A/T SNP 8 … GGC GCC GGA CGC ACC ATC TCC TGG GCC TGG TGG GCA TGT GTG A SNP - Ge notype SNP … … SNP Single Nucleotide Polymorphism SNP … … So urc e : RGA 29 30 5
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