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Knowledge and Perception of Nutritional Genomics Among Registered Dietitian Nutritionists

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Knowledge and Perception of Nutritional Genomics Among Registered Dietitian Nutritionists KNOWLEDGE AND PERCEPTION OF NUTRITIONAL GENOMICS AMONG REGISTERED DIETITIAN NUTRITIONISTS. A thesis submitted to the college of Kent State University College of Education, Health, and Human Services in partial fulfillment of the requirements for the degree of Master of Science By Amy S Shiyab August 2019 Copyright, 2019 by Amy S Shiyab All Rights Reserved ii Thesis written by Amy S Shiyab B.S., United Arab Emirates University, 2012 M.S., Kent State University, 2019 Approved by _________________________, Director, Master’s Thesis Committee Eun-Jeong Ha _________________________, Member, Master’s Thesis committee Natalie Caine-Bish _________________________, Member, Master’s Thesis committee Jamie Matthews Accepted by _________________________, Director, School of Health Sciences Ellen L. Glickman _________________________, Dean, College of Education, Health and Human Services James Hannon iii SHIYAB, AMY S M.S., AUGUST 2019 Nutrition and Dietetics KNOWLEDGE AND PERCEPTION OF NUTRITIONAL GENOMICS AMONG REGISTERED DIETITIAN NUTRITIONISTS (170 pp.) Co-Director of Thesis: Eun-Jeong Ha Non-communicable diseases (NCD) are projected to cause 2.4 million deaths by 2025 unless urgent action is taken (World Health Organization, 2018). In an effort to decrease diet related NCD prevalence, nutrition interventions have been widely accepted as a resource for the prevention of long-term health conditions. Nutritional genomics is the study of how food affects a person’s genes, and how a person’s genes affects the way the body responds to food at a molecular level. The field aims to understand how a healthy, but also personalized diet can be used to prevent, mitigate, or cure NCDs (Tarantola, 2018). However, previous studies have shown low level of knowledge and perception among health care professionals on genetic testing. With RDNs considered to be the best qualified healthcare providers when it comes to nutritional genomics (Cormier et al, 2014), the current study aimed to examine the knowledge and perception of registered dietitian nutritionists (RDNs) on nutritional genomics. The participants of the study were registered dietician nutritionists actively registered with the Commission on Dietetic Registration. One sample t-test was used to compute average mean knowledge scores and perceptions levels. Genetic knowledge scores were computer as percent mean and perception levels were scaled to a five-point Likert scale where 1 indicated strong disagreement with perception statements, and 5 indicated strong agreement with perception statements. Our findings revealed an overall low genetic knowledge score at 46%, yet a slightly positive perception level towards nutritional genomics (3.66). ACKNOWLEDGEMENT First, I would like to thank my advisor, Dr. Eun-Jeong Ha, for her guidance and patience with me throughout this entire process. She contributed incredible knowledge and offered tremendous support, which allowed me to create quality work. I would also like to thank Dr. Natalie Caine-Bish and Jamie Matthews for their support and insight concerning my thesis. I would also like to extend my gratitude to my parents, who without them, this entire journey would not have been possible. My mother, Tamara Shiyab, for her undeniable positive attitude and support, and my father, Dr. Said Shiyab, who has been my rock and inspiration my entire academic journey, and has continued to support me despite many setbacks, and for that, I will forever be indebted to him. iv TABLE OF CONTENTS ACKNOWLEDGEMENTS……………………………………………………................iv LIST OF FIGURES……………………………………………………………..............viii LIST OF TABLES.……………………………………………………….........................x CHAPTER I. INTRODUCTION……………………………............................................................1 Problem Statement…………………………………………………………………...4 Purpose Statement………………………………………............................................5 Hypotheses…………………………………………………………………………...5 Operational Definitions ……………………………………………………………...6 II. REVIEW OF LITERATURE………………………………………………………...7 History of Genetics…………………………………………………………………...7 Gene versus Genome…………………………………………………………………8 What is a Gene……………………………………………………………..........8 Gene expression…………………………………………………………..11 Gene transcription……………………………......….…...…….11 Gene translation……………………………………….….……12 Histones…………………………………………………...…...12 Gene regulation…………………………………………………………..13 DNA Methylation…………………………………………………………………...14 DNA Modification via Methylation………………............................................14 DNA Modification via Acetylation....……………………………………........15 Polymorphisms……………………………………………………………………...15 Single Nucleotide Polymorphisms….………………………………………….16 Other Polymorphisms………………………………………………………….18 What is the Genome…………………………………...............................................19 Genetics versus Genomics……………………………………………………..19 Genetics…………………………………………………………………...19 Genomics……………………………………………………….................20 Nutritional genomics…………………………...................................21 Nutrigenetics…………………………………………………...21 Nutrigenomics………………………………………………….23 Diseases Related to Nutritional Genomics………………………………………….25 Diseases Related to Nutrigenetics……………………………………………...25 Methyltetrahydrofolate reductase deficiency…..…………………………25 Homocystinuria…………………………………………………...............29 v Irritable bowel disease.…………………………………………………...30 Phenylketonuria…………………………………………………………..33 Celiac disease….………………………………………………………….35 Diseases Related to Nutrigenomics…………………………………................41 Obesity………………………………………………………….................41 Diabetes mellitus …………………………………………………………46 Cancer……………………………………………………………………..50 Coronary heart disease.…………………………………………………...55 Current Genetic Practices…………………………………………………………...62 Ethical Considerations ……………………………………………………………...67 III. METHODOLOGY………………………………………………………………...70 Research Design…………………………………………………………………...70 Research Sample and Recruitment………………………………………………...70 Procedure………………………………………………………………..................71 Instrument of Measure…………………………………………………..................71 Qualtrics…………………………………………………………………..…....71 Data Analysis………………………………………………………………………72 IV. JOURNAL ARTICLE……………………………………………………………..75 Introduction……………………………………………………………………….75 Methodology……………………………………………………………………...77 Questionnaire……………………………………………………………………...78 Data Analysis……………………………………………………………………..79 Results…………………………………………………………………………….80 Demographics………………………………………………………………….80 Genetic Knowledge…………………………………………………………….83 Nutritional Genomic Perception……………………………………………….87 Previous Genetic Education on Knowledge and Perception Scores…………...92 Previous Genetic Training on Knowledge and Perception Scores…………….93 Discussion………………………………………………………………………...95 Current Practices of Nutritional Genomics in the Health Care Field………….96 Genetic Knowledge among Registered Dietitian Nutritionists………………...96 Perception on Nutritional Genomics among Registered Dietitians Nutritionists…………………………………………………………………..101 Effect of Previous Genetic Education on Knowledge and Perception on Nutritional Genomics…………………………………………………………105 Genetic Knowledge Scores and Perception based on Practice Setting…….…105 Effect of Genetic Knowledge on Perception Scores…………………….……106 Limitations……………………………………………………………………….107 Implications……………………………………………………………………...109 Conclusion……………………………………………………………………….110 vi APPENDICES………………………………………………………………………….112 APPENDIX A…………………………………………………………………...113 APPENDIX B……………………………………………………………………115 REFERENCES…………………………………………………………………………128 vii LIST OF FIGURES Figure Page 1. Breakdown of protein coding genes and non-protein coding genes. LTR; long terminal repeats, DNA; deoxyribonucleic acid, SNE; short interspersed nucleotide elements, LINE; long interspersed nucleotide elements………………………...…………………………………………10 2. Genes are made up of DNA. Each chromosome contains many genes….……………..10 3. Humans have 22 chromosome pairs and two sex chromosomes. Females have two X chromosomes; males have an X chromosome and a Y chromosome……………...……...…………………………………………..11 4. Example of mRNA’s three nucleotides matching up with its corresponding amino acid. Met; methionine, Ile; isoleucine, Ser; Serine…….....…………………………………………………...12 5. SNP variation in three different DNA sequences. SNP; single nucleotide Polymorphism………………………………………………………………………...18 6. An overview of the four major "omics" fields, from genomics to metabolomics………………...……………………………..……….…..21 7. Conversion of 5,10- MTHF to 5-MTHF via MTHF reductase enzyme, DNA methylation and interconversion of methionine and homocysteine. DHF; dihydrofolate, THF; tetrahydrofolate, MTHFR; Methyltetrahydrofolate reductase, MS; methionine synthase, MTRR; 5-methyltetrahydrofolate-homocysteine methyltransferase reductase, MAT; methionine adenosyltransfer, BHMT; betaine homocysteine s-methyltransferase, DNMT; DNA methyltransferase…………….….............................................................................27 8. Folate cycle, methionine cycle, re-methylation pathway and trans-sulfuration pathway by Lamberton (n.d.). THF; tetrahydrofolate, MTHFR; Methyltetrahydrofolate reductase, MS; methionine synthase, MTRR; 5-methyltetrahydrofolate-homocysteine methyltransferase viii reductase, MAT; methionine adenosyltransfer, BHMT; betaine homocysteine s-methyltransferase, DNMT; DNA methyltransferase…...……………………………………………………...………..28 9. Phenylalanine hydroxylase reactions……………………………………….………...35 10. Human Leukocyte Antigen Major Histocompatibility Complex (HLA-MHC Complex). The HLA Complex is a gene complex on chromosome 6 that includes three
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