Personalized Therapy, Personalized Nutrition, and Chronic Disease

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Epidemiology".

Deadline for manuscript submissions: closed (10 November 2021) | Viewed by 46132

Special Issue Editors


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Guest Editor
Department of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, Medical Center, Utrecht University, Utrecht, The Netherlands
Interests: cholesterol; single nucleotide polymorphism; genetics; risk factors; cardiovascular risk; diabetes; epidemiology; heart failure; cardiology; cardiovascular

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Guest Editor
Department of Epidemiology, Julius Center Research Program Cardiovascular Epidemiology, Medical Center, Utrecht University, Utrecht, The Netherlands
Interests: diabetes; hypertension; imaging; blood pressure; atherosclerosis; lipids; lipoproteins; heart failure; nutrition; physical activity

Special Issue Information

Dear Colleagues,

Background: Non-communicable diseases are responsible for the majority of global mortality and disability-adjusted life years. The majority of premature deaths and debilitating morbidities caused by non-communicable diseases (NCDs) are linked to common risk factors, such as the use of tobacco, physical inactivity, air pollution, harmful use of alcohol, and unhealthy diets, and are, therefore, largely preventable. Due to the growing and aging of the population, our healthcare systems will break if we are unsuccessful in the prevention of disease occurrence and disease progression. Healthy diets are a very important component of primary and secondary prevention of NCDs.

Aim and Scope: Epidemiologic research, interdisciplinary health research, nutrition research, and human research.

History: Particularly, in disease treatment, the focus has been on drug treatment, while lifestyle and diet are equally important. Measuring dietary intake is difficult and error-prone. The study of diet and health is also difficult, because randomized trials, the panacea for causal research, are often not feasible, and observational research is sensitive to bias. Dietary advice needs to become more personalized to improve its implementation.

What kind of paper we are looking for: We are looking for contributions from cutting-edge research that move the research and thinking about nutrition and health to the next level, using emerging technology and big data solutions.

Prof. Dr. Yvonne T. van der Schouw
Prof. Dr. Diederick E. Grobbee
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diet
  • nutrition
  • health
  • personalized
  • methodology

Published Papers (10 papers)

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Research

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18 pages, 1349 KiB  
Article
Personalized Lifestyle Intervention and Functional Evaluation Health Outcomes SurvEy: Presentation of the LIFEHOUSE Study Using N-of-One Tent–Umbrella–Bucket Design
by Joseph J. Lamb, Michael Stone, Christopher R. D’Adamo, Andrey Volkov, Dina Metti, Lucia Aronica, Deanna Minich, Michelle Leary, Monique Class, Malisa Carullo, Jennifer J. Ryan, Ilona A. Larson, Erik Lundquist, Nikhat Contractor, Brent Eck, Jose M. Ordovas and Jeffrey S. Bland
J. Pers. Med. 2022, 12(1), 115; https://doi.org/10.3390/jpm12010115 - 15 Jan 2022
Cited by 7 | Viewed by 4489
Abstract
The working definition of health is often the simple absence of diagnosed disease. This common standard is limiting given that changes in functional health status represent early warning signs of impending health declines. Longitudinal assessment of functional health status may foster prevention of [...] Read more.
The working definition of health is often the simple absence of diagnosed disease. This common standard is limiting given that changes in functional health status represent early warning signs of impending health declines. Longitudinal assessment of functional health status may foster prevention of disease occurrence and modify disease progression. The LIFEHOUSE (Lifestyle Intervention and Functional Evaluation-Health Outcomes SurvEy) longitudinal research project explores the impact of personalized lifestyle medicine approaches on functional health determinants. Utilizing an adaptive tent–umbrella–bucket design, the LIFEHOUSE study follows the functional health outcomes of adult participants recruited from a self-insured employee population. Participants were each allocated to the tent of an all-inclusive N-of-one case series. After assessing medical history, nutritional physical exam, baseline functional status (utilizing validated tools to measure metabolic, physical, cognitive, emotional and behavioral functional capacity), serum biomarkers, and genomic and microbiome markers, participants were assigned to applicable umbrellas and buckets. Personalized health programs were developed and implemented using systems biology formalism and functional medicine clinical approaches. The comprehensive database (currently 369 analyzable participants) will yield novel interdisciplinary big-health data and facilitate topological analyses focusing on the interactome among each participant’s genomics, microbiome, diet, lifestyle and environment. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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13 pages, 1442 KiB  
Article
Weight Loss at First Month and Development of Tolerance as Possible Predictors of 30 mg Phentermine Efficacy at 6 Months
by Héctor Isaac Rocha-González, Lidia Elizabeth De la Cruz-Álvarez, Ashuin Kammar-García, Samuel Canizales-Quinteros, Juan Carlos Huerta-Cruz, Lina Marcela Barranco-Garduño and Juan Gerardo Reyes-García
J. Pers. Med. 2021, 11(12), 1354; https://doi.org/10.3390/jpm11121354 - 12 Dec 2021
Cited by 4 | Viewed by 4479
Abstract
The efficacy of anti-obesity drugs usually does not consider the high degree of interindividual variability in responses to the drug which could affect the decision to withdraw the drug early due to ineffectiveness or to continue therapy according to specific expectations of success. [...] Read more.
The efficacy of anti-obesity drugs usually does not consider the high degree of interindividual variability in responses to the drug which could affect the decision to withdraw the drug early due to ineffectiveness or to continue therapy according to specific expectations of success. The aim of this study was to analyze body weight loss in kilograms during the first month (1 mo-BWLkg) of treatment with 30 mg phentermine and development of tolerance to phentermine, on its 6-month efficacy. One hundred sixty-six subjects with obesity were individually or jointly analyzed in the study. Subjects with 1 mo-BWLkg of <1 kg, 1–3 kg, 3–5 kg, and ≥5 kg reached 6-month mean percentage body weight reductions (BWR%) of approximately 3%, 5%, 10%, and 15%, respectively. Development of late tolerance (4–6 months) to phentermine had a lower impact than early tolerance (2–3 months). Subjects with 1 mo-BWLkg < 3 kg who developed early tolerance did not achieve relevant BWR% (≥5%) at month 6, while the rest of the subgroups achieved increasing and progressive BWR%, according to their 1 mo-BWLkg range and time of onset of tolerance. The 1 mo-BWLkg and development of tolerance to phentermine could be useful to predict the expected 6-month efficacy trends in obese patients treated with 30 mg phentermine. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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9 pages, 677 KiB  
Article
Value of SERCA2a as a Biomarker for the Identification of Patients with Heart Failure Requiring Circulatory Support
by Meryem Ezzitouny, Esther Roselló-Lletí, Manuel Portolés, Ignacio Sánchez-Lázaro, Miguel Ángel Arnau-Vives, Estefanía Tarazón, Carolina Gil-Cayuela, Silvia Lozano-Edo, Raquel López-Vilella, Luis Almenar-Bonet and Luis Martínez-Dolz
J. Pers. Med. 2021, 11(11), 1122; https://doi.org/10.3390/jpm11111122 - 31 Oct 2021
Cited by 3 | Viewed by 1349
Abstract
Background: Heart failure (HF) alters the nucleo-cytoplasmic transport of cardiomyocytes and reduces SERCA2a levels, essential for intracellular calcium homeostasis. We consider in this study whether the molecules involved in these processes can differentiate those patients with advanced HF and the need for mechanical [...] Read more.
Background: Heart failure (HF) alters the nucleo-cytoplasmic transport of cardiomyocytes and reduces SERCA2a levels, essential for intracellular calcium homeostasis. We consider in this study whether the molecules involved in these processes can differentiate those patients with advanced HF and the need for mechanical circulatory support (MCS) as a bridge to recovery or urgent heart transplantation from those who are clinically stable and who are transplanted in an elective code. Material and method: Blood samples from 29 patients with advanced HF were analysed by ELISA, and the plasma levels of Importin5, Nucleoporin153 kDa, RanGTPase-Activating Protein 1 and sarcoplasmic reticulum Ca2+ ATPase were compared between patients requiring MCS and those patients without a MCS need prior to heart transplantation. Results: SERCA2a showed significantly lower levels in patients who had MCS compared to those who did not require it (0.501 ± 0.530 ng/mL vs. 1.123 ± 0.661 ng/mL; p = 0.01). A SERCA2a cut-off point of 0.84 ng/mL (AUC 0.812 ± 0.085, 95% CI: 0.646–0.979; p = 0.004) provided a 92% sensitivity, 62% specificity, 91% negative predictive value and 67% positive predictive value. Conclusions: In this cohort, patients with advanced HF and a need for MCS have shown significantly lower levels of SERCA2a as compared to stable patients without a need for MCS prior to heart transplantation. This is a small study with preliminary findings, and larger-powered dedicated studies are required to confirm and validate these results. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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22 pages, 478 KiB  
Article
“My Patients Asked Me If I Owned a Fruit Stand in Town or Something.” Barriers and Facilitators of Personalized Dietary Advice Implemented in a Primary Care Setting
by Heather L. Rogers, Silvia Núñez Fernández, Susana Pablo Hernando, Alvaro Sanchez, Carlos Martos, Maribel Moreno and Gonzalo Grandes
J. Pers. Med. 2021, 11(8), 747; https://doi.org/10.3390/jpm11080747 - 29 Jul 2021
Cited by 4 | Viewed by 1705
Abstract
Primary care is especially well positioned to address prevention of non-communicable diseases. However, implementation of health promotion activities such as personalized dietary advice is challenging. The study aim was to understand barriers and facilitators of the personalized dietary advice component of a lifestyle [...] Read more.
Primary care is especially well positioned to address prevention of non-communicable diseases. However, implementation of health promotion activities such as personalized dietary advice is challenging. The study aim was to understand barriers and facilitators of the personalized dietary advice component of a lifestyle intervention in primary care, as perceived by health center professionals and program participants. Thirteen focus groups were conducted with 49 professionals and 47 participants. Audio recordings were transcribed. Professional group text was coded using the Consolidated Framework for Implementation Research (CFIR). Participant group text was coded via an inductive approach with thematic analysis. Across most CFIR domains, both barriers and facilitators were equally present, except for ‘characteristics of individuals’, which were primarily facilitators. Intervention characteristics was the most important domain, with barriers in design and packaging (e.g., the ICT tool) and complexity. Facilitators included high evidence strength and quality, adaptability, and relative advantage. Participants described the importance of more personalized advice, the value of follow-up with feedback, and the need to see outcomes. Both professionals and patients stated that primary care was the place for personalized dietary advice intervention, but that lack of time, workload, and training were barriers to effective implementation. Implementation strategies targeting these modifiable barriers could potentially increase intervention adoption and intervention effectiveness. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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15 pages, 5081 KiB  
Article
Customization of Diet May Promote Exercise and Improve Mental Wellbeing in Mature Adults: The Role of Exercise as a Mediator
by Lina Begdache and Cara M. Patrissy
J. Pers. Med. 2021, 11(5), 435; https://doi.org/10.3390/jpm11050435 - 19 May 2021
Cited by 7 | Viewed by 12779
Abstract
Diet, dietary practices and exercise are modifiable risk factors for individuals living with mental distress. However, these relationships are intricate and multilayered in such a way that individual factors may influence mental health differently when combined within a pattern. Additionally, two important factors [...] Read more.
Diet, dietary practices and exercise are modifiable risk factors for individuals living with mental distress. However, these relationships are intricate and multilayered in such a way that individual factors may influence mental health differently when combined within a pattern. Additionally, two important factors that need to be considered are gender and level of brain maturity. Therefore, it is essential to assess these modifiable risk factors based on gender and age group. The purpose of the study was to explore the combined and individual relationships between food groups, dietary practices and exercise to appreciate their association with mental distress in mature men and women. Adults 30 years and older were invited to complete the food–mood questionnaire. The anonymous questionnaire link was circulated on several social media platforms. A multi-analyses approach was used. A combination of data mining techniques, namely, a mediation regression analysis, the K-means clustering and principal component analysis as well as Spearman’s rank–order correlation were used to explore these research questions. The results suggest that women’s mental health has a higher association with dietary factors than men. Mental distress and exercise frequency were associated with different dietary and lifestyle patterns, which support the concept of customizing diet and lifestyle factors to improve mental wellbeing. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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10 pages, 250 KiB  
Article
CLOCK Gene Variation Is Associated with the Incidence of Metabolic Syndrome Modulated by Monounsaturated Fatty Acids
by Dayeon Shin and Kyung-Won Lee
J. Pers. Med. 2021, 11(5), 412; https://doi.org/10.3390/jpm11050412 - 14 May 2021
Cited by 5 | Viewed by 1927
Abstract
The circadian locomotor output cycles kaput (CLOCK) gene plays a crucial role in regulating circadian rhythms through its transcription factor gene product. The objective of this study was to investigate the association between CLOCK rs1801260 and the incidence of metabolic syndrome [...] Read more.
The circadian locomotor output cycles kaput (CLOCK) gene plays a crucial role in regulating circadian rhythms through its transcription factor gene product. The objective of this study was to investigate the association between CLOCK rs1801260 and the incidence of metabolic syndrome modulated by dietary monounsaturated fatty acid (MUFA) intake in Korean adults. Using a dataset from the Ansan-Ansung Cohort Study of the Korean Genome and Epidemiology Study, 3608 Korean adults were included after an average of nine years of follow-up. Men who were minor allele carriers (G allele) of CLOCK rs1801260 had a 18% higher incidence of metabolic syndrome than non-carriers [hazard ratio (HR), 1.18; 95% confidence interval (CI), 1.00–1.40; p Value = 0.047]. By dichotomizing dietary MUFA intake, we observed that men who were minor allele carriers (G allele) of CLOCK rs1801260 had a 42% increased incidence of metabolic syndrome when dietary MUFA intake was ≤3.5% (HR: 1.42, 95% CI 1.23–1.81; p Value = 0.004). No significant association was found between CLOCK rs1801260 and the incidence of metabolic syndrome modulated by dietary MUFA intake in women. CLOCK polymorphisms affected metabolic syndrome, modulated by dietary MUFA intake in men. These results suggest the significance of CLOCK genes in the pathogenesis of metabolic syndrome and the modulating role of dietary MUFA intake and provide new insights into the underlying mechanisms connecting the circadian system, dietary factors, and metabolic syndrome. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
15 pages, 305 KiB  
Article
The Epidemiology and Genetics of Hyperuricemia and Gout across Major Racial Groups: A Literature Review and Population Genetics Secondary Database Analysis
by Faven Butler, Ali Alghubayshi and Youssef Roman
J. Pers. Med. 2021, 11(3), 231; https://doi.org/10.3390/jpm11030231 - 22 Mar 2021
Cited by 55 | Viewed by 11102
Abstract
Gout is an inflammatory condition caused by elevated serum urate (SU), a condition known as hyperuricemia (HU). Genetic variations, including single nucleotide polymorphisms (SNPs), can alter the function of urate transporters, leading to differential HU and gout prevalence across different populations. In the [...] Read more.
Gout is an inflammatory condition caused by elevated serum urate (SU), a condition known as hyperuricemia (HU). Genetic variations, including single nucleotide polymorphisms (SNPs), can alter the function of urate transporters, leading to differential HU and gout prevalence across different populations. In the United States (U.S.), gout prevalence differentially affects certain racial groups. The objective of this proposed analysis is to compare the frequency of urate-related genetic risk alleles between Europeans (EUR) and the following major racial groups: Africans in Southwest U.S. (ASW), Han-Chinese (CHS), Japanese (JPT), and Mexican (MXL) from the 1000 Genomes Project. The Ensembl genome browser of the 1000 Genomes Project was used to conduct cross-population allele frequency comparisons of 11 SNPs across 11 genes, physiologically involved and significantly associated with SU levels and gout risk. Gene/SNP pairs included: ABCG2 (rs2231142), SLC2A9 (rs734553), SLC17A1 (rs1183201), SLC16A9 (rs1171614), GCKR (rs1260326), SLC22A11 (rs2078267), SLC22A12 (rs505802), INHBC (rs3741414), RREB1 (rs675209), PDZK1 (rs12129861), and NRXN2 (rs478607). Allele frequencies were compared to EUR using Chi-Square or Fisher’s Exact test, when appropriate. Bonferroni correction for multiple comparisons was used, with p < 0.0045 for statistical significance. Risk alleles were defined as the allele that is associated with baseline or higher HU and gout risks. The cumulative HU or gout risk allele index of the 11 SNPs was estimated for each population. The prevalence of HU and gout in U.S. and non-US populations was evaluated using published epidemiological data and literature review. Compared with EUR, the SNP frequencies of 7/11 in ASW, 9/11 in MXL, 9/11 JPT, and 11/11 CHS were significantly different. HU or gout risk allele indices were 5, 6, 9, and 11 in ASW, MXL, CHS, and JPT, respectively. Out of the 11 SNPs, the percentage of risk alleles in CHS and JPT was 100%. Compared to non-US populations, the prevalence of HU and gout appear to be higher in western world countries. Compared with EUR, CHS and JPT populations had the highest HU or gout risk allele frequencies, followed by MXL and ASW. These results suggest that individuals of Asian descent are at higher HU and gout risk, which may partly explain the nearly three-fold higher gout prevalence among Asians versus Caucasians in ambulatory care settings. Furthermore, gout remains a disease of developed countries with a marked global rising. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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16 pages, 983 KiB  
Article
Associations of Polygenetic Variants at the 11q23 Locus and Their Interactions with Macronutrient Intake for the Risk of 3GO, a Combination of Hypertension, Hyperglycemia, and Dyslipidemia
by Jun-Yu Zhou and Sunmin Park
J. Pers. Med. 2021, 11(3), 207; https://doi.org/10.3390/jpm11030207 - 15 Mar 2021
Cited by 6 | Viewed by 2089
Abstract
3GO is a condition in which hypertension, hyperglycemia, and dyslipidemia co-occur, and these conditions are related to each other and genetic and environmental factors. We hypothesized that common genetic variants and their interactions with lifestyles influenced 3GO risk. We aimed to explore common [...] Read more.
3GO is a condition in which hypertension, hyperglycemia, and dyslipidemia co-occur, and these conditions are related to each other and genetic and environmental factors. We hypothesized that common genetic variants and their interactions with lifestyles influenced 3GO risk. We aimed to explore common genetic variants to affect 3GO risk and their haplotype interaction with lifestyles in a city hospital-based cohort in 58,701 Koreans > 40 years. 3GO was defined as SBP ≥ 140 mmHg and DBP ≥ 90 mmHg for hypertension, fasting blood glucose ≥ 126 mg/dL for hyperglycemia, and LDL ≥ 160 mg/dL or HDL ≤ 40 mg/dL, or triglyceride ≥ 200 mg/dL for dyslipidemia. Haplotypes were generated by genetic variants selected from genome-wide association study ((GWAS) an observational study of the genetic variation of the whole genome in different individuals, used to see if any variation is related to traits) after adjusting for age, sex, area of residence, and body mass index (BMI). Nutrient intakes were assessed using food frequency questionnaires. Interactions between haplotype and lifestyles and 3GO risk were investigated. Parameters related to metabolic syndrome were significantly different in the 0GO, 1–2GO, and 3GO groups, that is, groups of individuals with none, one to two, or all three of the components of 3GO. At the 11q23 locus, KCNQ1_rs2237892, ZPR1_rs2075291, APOA5_rs662799, APOA1_rs5072, and SIK3_rs151139277, influenced 3GO risk, and the minor alleles of their haplotype had a 3GO risk 3.23 times higher than the major alleles. For subjects with a high energy intake, the 3GO risk of the minor alleles was significantly higher than that of the major alleles (OR = 3.230, 95% confidence interval (CI) = 2.062~5.061, p < 0.001). BMI, HbA1c, SBP, and serum concentrations of glucose, HDL, and triglyceride were significantly higher for the minor allele than the major alleles (p < 0.001). The haplotype interacted with the intakes of protein (p = 0.033), digestible carbohydrate (p = 0.012), fat (p = 0.008), and undigestible carbohydrates (p = 0.015) to increase 3GO risk. An interaction was also observed between smoking and the haplotype (p = 0.007). The minor allele effects on 3GO incidence were higher in the high digestible carbohydrate intake and smoking groups. By contrast, the minor allele impacts on 3GO frequencies were much higher in the low intake of undigestible carbohydrates, protein, and fat. In conclusion, people who carry a minor allele of the 11q23 locus haplotype should avoid smoking and replace digestible carbohydrate intake with consuming high-quality protein, healthy fat, and undigestible carbohydrates. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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Review

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10 pages, 376 KiB  
Review
Personalized Nutrition in Patients with Type 2 Diabetes and Chronic Kidney Disease: The Two-Edged Sword of Dietary Protein Intake
by Milou M. Oosterwijk, Gerjan Navis, Stephan J. L. Bakker and Gozewijn D. Laverman
J. Pers. Med. 2022, 12(2), 300; https://doi.org/10.3390/jpm12020300 - 17 Feb 2022
Cited by 4 | Viewed by 2217
Abstract
In type 2 diabetes (T2D), there is a general and strong focus on carbohydrate restriction. However, this may have unwarranted consequences for those with concomitant chronic kidney disease (CKD) since decreasing intake of carbohydrates implies a higher proportion of dietary protein, which is [...] Read more.
In type 2 diabetes (T2D), there is a general and strong focus on carbohydrate restriction. However, this may have unwarranted consequences for those with concomitant chronic kidney disease (CKD) since decreasing intake of carbohydrates implies a higher proportion of dietary protein, which is of critical debate in patients with CKD due to its ambiguous implications in maintaining either kidney function or nutritional status. We evaluated adherence to the protein recommendations, taking into account the nutritional status of patients with T2D with or without CKD. Patients were divided in three groups according to their estimated Glomerular Filtration Rate (eGFR): mild to no CKD (eGFR > 60 mL/min/1.73 m2), moderate CKD (eGFR 30–60 mL/min/1.73 m2), or advanced CKD (eGFR < 30 mL/min/1.73 m2). Regarding adherence to the protein recommendations, 17% of the patients without advanced CKD consumed < 0.8 g/kg/day, 29% of the patients with moderate CKD consumed > 1.3 g/kg/day, and 60% of the patients with advanced CKD consumed > 1.0 g/kg/day. In addition, patients with moderate- or advanced CKD tend to have a lower muscle mass, normalized by height, compared to patients with mild to no CKD (p < 0.001), while body mass index was not significantly different between patients with or without CKD (p = 0.44). We found that although dietary protein restriction has not been indicated in either of the CKD stages, approximately 10% had a dietary protein intake < 0.8 g/kg/day, with accompanying risks of malnourishment and sarcopenia. Our main advice is to maintain a dietary protein intake of at least 0.8 g/kg/day in order to prevent patients from becoming malnourished and sarcopenic. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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11 pages, 241 KiB  
Review
Towards a Responsible Transition to Learning Healthcare Systems in Precision Medicine: Ethical Points to Consider
by Roel H. P. Wouters, Rieke van der Graaf, Tessel Rigter, Eline M. Bunnik, M. Corrette Ploem, Guido M. W. R. de Wert, Wybo J. Dondorp, Martina C. Cornel and Annelien L. Bredenoord
J. Pers. Med. 2021, 11(6), 539; https://doi.org/10.3390/jpm11060539 - 10 Jun 2021
Cited by 5 | Viewed by 2494
Abstract
Learning healthcare systems have recently emerged as a strategy to continuously use experiences and outcomes of clinical care for research purposes in precision medicine. Although it is known that learning healthcare transitions in general raise important ethical challenges, the ethical ramifications of such [...] Read more.
Learning healthcare systems have recently emerged as a strategy to continuously use experiences and outcomes of clinical care for research purposes in precision medicine. Although it is known that learning healthcare transitions in general raise important ethical challenges, the ethical ramifications of such transitions in the specific context of precision medicine have not extensively been discussed. Here, we describe three levers that institutions can pull to advance learning healthcare systems in precision medicine: (1) changing testing of individual variability (such as genes); (2) changing prescription of treatments on the basis of (genomic) test results; and/or (3) changing the handling of data that link variability and treatment to clinical outcomes. Subsequently, we evaluate how patients can be affected if one of these levers are pulled: (1) patients are tested for different or more factors than before the transformation, (2) patients receive different treatments than before the transformation and/or (3) patients’ data obtained through clinical care are used, or used more extensively, for research purposes. Based on an analysis of the aforementioned mechanisms and how these potentially affect patients, we analyze why learning healthcare systems in precision medicine need a different ethical approach and discuss crucial points to consider regarding this approach. Full article
(This article belongs to the Special Issue Personalized Therapy, Personalized Nutrition, and Chronic Disease)
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