**11. Ethic**

Although an increased understanding of how these and other genes influence response to nutrients should facilitate the progression of personalized nutrition, the ethical issues surrounding its routine use need careful consideration (Lovegrove & Gitau., 2008).

The study of nutrigenetics is in its infancy. Many studies published in this area have only considered one SNP in a single gene, with little consideration being given to multiple nutrient–gene–environmental interactions. Although this is scientifically valid, and invaluable for the elucidation of causative mechanisms in disease, multiple gene–nutrient– environment–gender interactions will be required for developing specific personalized nutritional advice. The collation of data in haplotype databases and biobanks is expensive and difficult to establish, but is a necessity if nutrigenetic research is to progress (Lovegrove & Gitau., 2008).

Standardized protocols in nutrigenetics are not yet established, the comparison of studies is challenging and conclusions are often difficult to draw. As discussed previously, studies are often retrospective in design and thus of insufficient power to detect nutrient–gene associations. Prospective genotyping increases the power to resolve these associations and should be used whenever possible. With any research, publication bias results in positive associations being reported more often than negative associations. This has applied to nutrigentic studies and created a false impression of the level of significance of many nutrient–gene interactions (Lovegrove & Gitau., 2008).

There are numerous ethical issues and unavoidable assumptions that need to be considered before personalized nutritional can become routine practice. First, it is important to consider

Future studies will have to be large in order to assess the effects of multiple polymorphisms, and will have to control for many factors other than diet. At present, it is premature to recommend the use of genotyping in the design of therapeutic diets. However, such studies may be useful in identifying the mechanisms by which dietary components influence lipid

However, current knowledge is still very limited and so is the potential benefit of its application to clinical practice. Thinking needs to evolve from simple scenarios (e. g., one single dietary component, a single nucleotide polymorphism and risk factor) to more realistic situations involving multiple interactions. One of the first situations where personalized nutrition is likely to be beneficial is in patients with dyslipidemia who require special intervention with dietary treatment. This process could be more efficient if the recommendations were carried out based on genetic and molecular knowledge. Moreover, adherence to dietary advice may increase when it is supported with information based on nutritional genomics, and a patient believes the advice is personalized. However, a number of important changes in the provision of health care are needed to achieve the potential

approach with greater integration among physicians, food and nutrition professionals, and

The ultimate goal of nutritional genomics is to provide sufficient knowledge to allow diagnosis and nutritional treatment recommendations based on an individual's genotype. Defining the interaction effects of nutrients and genes on complex phenotypes will be the challenge of this field of nutrition research for some time to come (Fisler & Warden, 2005;

Although an increased understanding of how these and other genes influence response to nutrients should facilitate the progression of personalized nutrition, the ethical issues

The study of nutrigenetics is in its infancy. Many studies published in this area have only considered one SNP in a single gene, with little consideration being given to multiple nutrient–gene–environmental interactions. Although this is scientifically valid, and invaluable for the elucidation of causative mechanisms in disease, multiple gene–nutrient– environment–gender interactions will be required for developing specific personalized nutritional advice. The collation of data in haplotype databases and biobanks is expensive and difficult to establish, but is a necessity if nutrigenetic research is to progress (Lovegrove

Standardized protocols in nutrigenetics are not yet established, the comparison of studies is challenging and conclusions are often difficult to draw. As discussed previously, studies are often retrospective in design and thus of insufficient power to detect nutrient–gene associations. Prospective genotyping increases the power to resolve these associations and should be used whenever possible. With any research, publication bias results in positive associations being reported more often than negative associations. This has applied to nutrigentic studies and created a false impression of the level of significance of many

There are numerous ethical issues and unavoidable assumptions that need to be considered before personalized nutritional can become routine practice. First, it is important to consider

surrounding its routine use need careful consideration (Lovegrove & Gitau., 2008).

levels (Masson & McNeill., 2005).

genetic counselors (Ordovas., 2006).

**11. Ethic** 

& Gitau., 2008).

Gregori et al, 2011; Ordovas & Corella., 2004).

nutrient–gene interactions (Lovegrove & Gitau., 2008).

benefits associated with this concept, including a teamwork

whether the genetic tests and personalized food products would be affordable, cost-effective and socially acceptable. It is also of concern that only the well educated and affluent would benefit. The open accessibility of genetic information to third parties has major implications for the availability of health insurance and increased premiums (Lovegrove, Gitau, 2008).

Moreover, it is still unknown whether people will want to undertake genetic tests or even understand the concept of such technology. A survey was conducted by Cogent Research in 2003 on 1000 Americans in which 62% of respondents reported they had never heard of 'nutrigenomics'. However, if specific products did arise from nutrigenomic research, those interviewed did express interest in an in-depth well-being assessment and also a strong interest in vitamins, fortified foods and natural foods. More research is required to determine whether individuals would want to undergo such tests, and for understanding the value to the individual of an increased awareness of personalized nutrition regimens. There is already a large gap between the existing dietary guidelines and what people actually eat. Knowledge of being at higher than average risk of CVD may motivate people to actually make positive changes to their diets. However, genetic testing could undermine current healthy eating messages, by implying that only those with the 'risky gene' need to eat a healthy diet. These are important unanswered questions that must be addressed if personalized nutritional advice is ever to become part of mainstream disease prevention and treatment. It may be that the interactions between genotype–phenotype and the environment are just too complex to be properly understood from human dietary intervention studies (Lovegrove, Gitau, 2008).

There is resistance to the use and perceived effectiveness of personalized nutrition that is based on genomics, and whether this can offer a solution to diseases caused by a diet that is inappropriate for health (Canon & Leitzmann, 2005). It has been suggested that it may be more beneficial to use current risk factors as a basis for population screening and the management of CVD (McCluskey et al., 2007). There has also been dialogue on the social, economic and environmental causes of CVD, shifting the emphasis away from dietary intake to food manufacturing as being more effective in disease management (Canon & Leitzmann, 2005; Lovegrove & Gitau., 2008).

Progression of knowledge in the fields of nutrient–gene interactions promises a future revolution in preventative health care. However, although there is increasing evidence for interactions between diets/nutrients, genes and environmental factors, there are inconsistencies in the evidence that will limit the application of nutrigenetics in diet-related disease in the immediate future. In addition to the need for adequately powered intervention studies, greater attention should be given to ethical issues, such as the public's acceptance of genetic testing and the economics of this relatively new science (Lovegrove & Gitau., 2008).

Ethical issues fall into a number of categories: (1) why nutrigenomics? Will it have important public health benefits? (2) questions about research, e. g. concerning the acquisition of information about individual genetic variation; (3) questions about who has access to this information, and its possible misuse; (4) the applications of this information in terms of public health policy, and the negotiation of the potential tension between the interests of the individual in relation to, for example, prevention of conditions such as obesity and allergy; (5) the appropriate ethical approach to the issues, e. g. the moral difference, if any, between therapy and enhancement in relation to individualised diets; whether the 'technological fix' is always appropriate, especially in the wider context of the

Nutrigenetics and Dyslipidemia 69

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**4** 

*Iran* 

**Impact of Climate Change and** 

Roya Kelishadi1 and Parinaz Poursafa2

*Isfahan University of Medical Sciences, Isfahan,* 

*Isfahan University of Medical Sciences, Isfahan,* 

*2Environment Research Center,* 

**Air Pollution on Dyslipidemia and** 

*1Faculty of Medicine & Child Health Promotion Research Center,* 

**the Components of Metabolic Syndrome** 

Environmental factors, notably climate change and air pollution influence health before conception, and continue during pregnancy, childhood, and adolescence. Experts have suggested that such health hazards may represent the greatest public health challenge humanity has faced. The accumulation of greenhouse gases such as carbon dioxide, primarily from burning fossil fuels results in warming, which has an impact on air pollution, particularly on levels of ozone and particulates. Heat-related health effects include increased rates of pregnancy complications, pre-eclampsia, eclampsia, low birth weight, renal effects, vector-borne diseases as malaria and dengue; increased diarrheal and respiratory disease, food insecurity, decreased quality of foods (notably grains), malnutrition, water scarcity, exposures to toxic chemicals, worsened poverty, natural disasters, and population displacement. Air pollution has many adverse health effects, which would have long-term impact on the components of the metabolic syndrome. In addition to short-term effects as premature labor, intrauterine growth retardation, neonatal and infant mortality rate, malignancies (notably leukemia and Hodgkin lymphoma), respiratory diseases, allergic disorders and anemia, exposure to criteria air pollutants from early life might be associated with dyslipidemia, increase in stress oxidative, inflammation and endothelial dysfunction which in turn might have long-term effects on chronic non-

Air pollution is a mixture of solid particles and gases in the air. The six common and hazardous air pollutants consist of particulate matter, ground-level ozone, carbon monoxide, sulfur oxides, nitrogen oxides, and lead; of which, particle pollution and groundlevel ozone are the most widespread health hazards (Samet & Krewski, 2007; Chen & Kan,

**2. Environmental factors: Climate change and air pollution** 

**1. Introduction** 

communicable diseases.

**2.1 Air pollutants** 

2008).

