Genetic Testing for Personalized Nutrition

Overview The Science of Nutrigenomics About Nutrigenomix® How Nutrigenomix® Works The Genetic Test Results Report

The Science of Nutrigenomics Genes encode proteins, which have many functions Some proteins interact with dietary components Genes are composed of sequences of nucleotides (A, C, G and T) Differences in nucleotides within a gene produce genetic variants Single Nucleotide Polymorphism = “SNP” Example: a “C” replacing an “A” Insertion/deletion = deleted segments ( “del”) or additional inserted segments ( “ins”) We inherit two copies of most genes, one from each parent Each gene has two different forms (e.g. A and C, or ins and del) Three possible variants (or “genotypes”): Example: AA, CA, or CC

The Science of Nutrigenomics Health Outcome Nutrition Genes Genotype A Genotype C Genotype B Increase Decrease No Effect

About Nutrigenomix® Test developed for exclusive use by dietitians Why only dietitians? Most qualified experts to offer nutritional advice Best at providing personalized nutrition plans Not considered a controlled act No referral required

About Nutrigenomix® University of Toronto start-up company Launched in Canada, June 2012 Available in >300 clinics 8 languages in 15 countries Panel of 7 genetic tests

Nutrigenomix® Launch Dietitians of Canada Conference Toronto, June 2012 International Congress of Dietetics Sydney, Sept. 2012 Food & Nutrition Conference and Expo (USA) Philadelphia, Oct 2012

Science behind Nutrigenomix® Nutrigenomix is based on studies published in: American Journal of Clinical Nutrition Archives of Internal Medicine Atherosclerosis Genes and Nutrition Journal of Hypertension Journal of the American Medical Association Journal of Nutrition Backed by an expert Science Advisory Board

DNA-based dietary advice resulted in: greater understanding of recommendations greater interest in learning more greater motivation to change eating habits improved dietary outcomes (to be published)

International Science Advisory Board Ahmed El-Sohemy, PhD (Chair) Canada Research Chair in Nutrigenomics University of Toronto David Jenkins, MD, PhD Canada Research Chair in Nutrition and Metabolism University of Toronto David Castle, PhD Chair of Innovation in the Life Sciences University of Edinburgh Ben van Ommen, PhD Director of the Nutrigenomics Organisation TNO Quality of Life Lynnette R Ferguson, D.Phil., DSc Program Leader of Nutrigenomics New Zealand University of Auckland Bénédicte Fontaine-Bisson, RD, PhD Assistant Professor in Nutrition Sciences University of Ottawa J. Bruce German, PhD Director of Foods for Health Institute University of California, Davis Jose Ordovas, PhD Director of Nutritional Genomics Tufts University

How Nutrigenomix® Works Test performed with dietitian Test sent to lab Results uploaded Report generated Results interpreted by dietitian Five-Step Process

How Nutrigenomix® Works 1. Test performed with dietitian – saliva sample provided Saliva collected into vial: Quick, non-invasive procedure

How Nutrigenomix® Works 2. Saliva sample sent to lab for genetic analysis

How Nutrigenomix® Works 3. Results uploaded to secure server

How Nutrigenomix® Works 4. Personalized report generated and sent to dietitian

How Nutrigenomix® Works 5. Meet with dietitian to discuss results and develop personalized nutritional plan based on genotype

The Genetic Test Results Report Test panel consists of seven genetic tests:

Sample Report

Vitamin C Low levels of vitamin C linked to increased risk of heart disease, type 2 diabetes and cancer Some utilize vitamin C more efficiently than others Dependent on a variant of the GSTT1 gene Results: Based on individual’s genotype for GSTT1, recommend target vitamin C intake Cahill et al. Am. J. Clin. Nutr. 2009;90:1411-1417.  

Frequency of serum ascorbic acid deficiency by GSTT1 genotype and vitamin C adequacy. * Relative risk of deficiency for those with the “deletion” (Del) variant who do not meet the RDA for vitamin C compared to those who meet the RDA Cahill et al. Am. J. Clin. Nutr. 2009;90:1411-1417.

Sample Results

Sample Results

Folate Low folate linked to increased risk of heart disease Some utilize folate more efficiently than others Dependent on a variant of the MTHFR gene Results: Based on individual’s genotype for MTHFR, recommend target folate intake Guinotte et al. J. Nutr. 2003;133:1272-1280.

Frequency (%) of subjects who had low serum folate after repletion with 400 mcg/day of daily folate equivalents, by MTHFR genotype * Relative risk of low serum folate for those with the risk variant (CT or TT genotype) compared to those with the CC genotype. Guinotte et al. J. Nutr. 2003;133:1272-1280.

Sample Results

Sample Results

Whole Grains Whole grains may help reduce the risk of developing type 2 diabetes Some benefit from increasing whole grain consumption more than others Dependent on a variant of the TCF7L2 gene Results: Based on individual’s genotype for TCF7L2, recommend target whole grain intake Cornelis et al. Am. J. Clin. Nutr. 2009;89:1256-1262.

Risk of diabetes based on TCF7L2 genotype and glycemic load (GL) of the diet. * Percent risk calculated from odds ratios for GT or TT group compared to GG group when the glycemic load of the diet is high. Cornelis et al. Am. J. Clin. Nutr. 2009;89:1256-1262.

Sample Results

Sample Results

Omega-3 Fat Omega-3 fats may help reduce risk of heart disease by lowering triglyceride levels Omega-3 fats help reduce triglycerides in some people, while others see little benefit Dependent on a variant of the NOS3 gene Results: Based on individual’s genotype for NOS3, recommend target omega-3 fat intake Ferguson et al. Atherosclerosis. 2010;211:539-544.

Circulating levels of triglycerides based on circulating levels of omega-3 fats (low vs. high) and NOS3 genotype * Subjects with the GT or TT genotype who had low circulating omega-3 fats (≤3.68% of total lipids as omega-3 polyunsaturated fatty acids) had a 25% greater circulating triglyceride level than those with high circulating omega-3 fats (>3.68% of total lipids as omega-3 polyunsaturated fatty acids). Ferguson et al. Atherosclerosis. 2010;211:539-544.

Sample Results

Sample Results

Saturated Fat Saturated fat is associated with heart disease, type 2 diabetes and obesity Some people are more prone to obesity when consuming a diet high in saturated fat Dependent on a variant of the APOA2 gene Results: Based on individual’s genotype for APOA2, recommend target saturated fat intake Corella et al. Arch. Intern. Med. 2009;169(20):1897-906.

Combined data showing overall frequency of prevalent obesity by APOA2 genotype and saturated fat intake * Relative risk of obesity for those with the CC variant who consume <22 grams saturated fat/day compared to those who consume ≥22 grams of saturated fat/day. Corella et al. Arch. Intern. Med. 2009;169(20):1897-906.

Sample Results

Sample Results

Sodium Sodium intake is linked to blood pressure Some have a greater increase in blood pressure than others in response to excess sodium intake Dependent on a variant of the ACE gene Results: Based on individual’s genotype for ACE, recommend target sodium intake Poch et al. Hypertension. 2001;38:1204-1209.

Prevalence of salt-sensitive hypertension by ACE genotype * Relative risk of salt-sensitive hypertension with the GA or AA genotype compared to the GG genotype. Poch et al. Hypertension. 2001;38:1204-1209.

Sample Results

Sample Results

Caffeine Caffeinated coffee can influence heart health Some people have increased risk of high blood pressure and heart attack if they consume ≥2 cups/d of coffee, while others do not have this risk Dependent on a variant of the CYP1A2 gene Results: Based on individual’s genotype for CYP1A2, recommend target caffeine intake  Cornelis et al. JAMA. 2006;295:1135-41.

Risk of myocardial infarction (MI) associated with coffee consumption by CYP1A2 genotype * Significantly increased risk of MI compared to <1 cup/day. 1,2 Risk = relative risk of MI for subjects with the GA and AA genotype who consume (1) ≥4 cups of coffee/day or (2) 2-3 cups of coffee/day compared to those consuming <1 cup of coffee/day.  Cornelis et al. JAMA. 2006;295:1135-41.

Sample Results

Sample Results

Learn more about Nutrigenomix: Website: www.Nutrigenomix.com Email: info@nutrigenomix.com Or Contact: Lisa Cianfrini, MSc, RD (click below to watch video) Manager, Dietitian Services Nutrigenomix Inc. Lisa.cianfrini@nutrigenomix.com 416-323-7599

Starter Package for Dietitians Register at www.nutrigenomix.com College registration number must be provided