Using Individual, ApoE Genotype-Based Dietary and Physical Activity Advice to Promote Healthy Lifestyles in Finland—Impacts on Cardiovascular Risk Markers


Aim: There is increasing demand for individualized health advice. The aim of this study was to assess the effects on cardiovascular risk markers of receiving personal genetic health information, using apoE genotypes as a tool for promoting lifestyle changes. ApoE was chosen because it had a significant impact on lipid metabolism and cholesterol absorption, all factors for CVD. Methods: This study was a one-year explanatory intervention study for healthy adults, aged between 20 - 67 years old (n = 106). Their clinical markers (serum lipids, blood glucose, blood pressure, Body Mass Index, body fat percentage and waist circumference) were measured three times during the intervention. The clinical effects were assessed for three groups: a high risk group (ε 4+, n = 16); a low-risk group (ε 4-, n = 35); and a control group (n = 55). Results: The triglyceride values and waist circumference lowered more in ε 4+ compared with the control group (p < 0.05; alpha value 0.005) during the intervention. Conclusion: The personal genetic information, based on apoE, may have positive effects on cardiovascular risk markers (e.g., improvement in triglyceride values). The individual health information, based on genotyping could be a potential option in the prevention of CVD. More research is required on how to utilize genotype-based health information in the prevention of lifestyle-related diseases.

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Hietaranta-Luoma, H. , Åkerman, K. , Tahvonen, R. , Puolijoki, H. and Hopia, A. (2015) Using Individual, ApoE Genotype-Based Dietary and Physical Activity Advice to Promote Healthy Lifestyles in Finland—Impacts on Cardiovascular Risk Markers. Open Journal of Preventive Medicine, 5, 206-217. doi: 10.4236/ojpm.2015.55024.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Bloss, C.S., Schork, N.J. and Topol, E.J. (2011) Effect of Direct-to-Consumer Genomewide Profiling to Assess Disease Risk. The New England Journal of Medicine, 364, 524-534.
[2] Voils, C.I., Coffman, C.J., Edelman, D., Maciejewski, M.L., Grubber, J.M., Sadeghpour, A., et al. (2012) Examining the Impact of Genetic Testing for Type 2 Diabetes on Health Behaviors: Study Protocol for a Randomized Controlled Trial. Trials, 13, 121.
[3] Juma, S., Imrhan, V., Vijayagopal, P. and Prasad, C. (2014) Prescribing Personalized Nutrition for Cardiovascula Health: Are We Ready? Journal of Nutrigenetics and Nutrigenomics, 7, 153-160.
[4] Smith, T.W., Orleans, C.T. and Jenkins, C.D. (2004) Prevention and Health Promotion: Decades of Progress, New Challenges, and an Emerging Agenda. Health Psychology?: Official Journal of the Division of Health Psychology, American Psychological Association, 23, 126-131.
[5] Gramling, R., Nash, J., Siren, K. and Culpepper, L. (2003) Predictive Genetics in Primary Care: Expectations for the Motivational Impact of Genetic Testing Affects the Importance Family Physicians Place on Screening for Familial Cancer Risk. Genetics in Medicine?: Official Journal of the American College of Medical Genetics, 5, 172-175.
[6] Nielsen, D.E. and El-Sohemy, A. (2012) A Randomized Trial of Genetic Information for Personalized Nutrition. Genes and Nutrition, 7, 559-566.
[7] Nielsen, D., Shih, S. and El-Sohemy, A. (2014) Perceptions of Genetic Testing for Personalized Nutrition: A Randomized Trial of DNA-Based Dietary Advice. Journal of Nutrigenetics and Nutrigenomics, 7, 94-104.
[8] Taloustutkimus, Oy.F. (2013) The Finnish Innovation Fund S: Genomitieto, Asenneselvitys-Lääkärit. Physicians: Genetic Testing Is Becoming More and More Common, So Where Are the Guidelines? Helsinki.
[9] Mountcastle-Shah, E. and Holtzman, N.A. (2000) Primary Care Physicians’ Perceptions of Barriers to Genetic Testing and Their Willingness to Participate in Research. American Journal of Medical Genetics, 94, 409-416.
[10] Ordovás, J.M. and Smith, C.E. (2010) Epigenetics and Cardiovascular Disease. Nature Reviews Cardiology, 7, 510-519.
[11] Vartiainen, E., Laatikainen, T., Peltonen, M., Juolevi, A., Männistö, S., Sundvall, J., et al. (2010) Thirty-Five-Year Trends in Cardiovascular Risk Factors in Finland. International Journal of Epidemiology, 39, 504-518.
[12] Lusis, A.J. (2000) Atherosclerosis. Nature, 407, 233-241.
[13] Cho, S.-W., Kang, J.-Y., Park, Y.-K., Paek, Y.-M. and Choi, T.-I. (2009) A 12-Week Worksite Health Promotion Program Reduces Cardiovascular Risk Factors in Male Workers with the Apolipoprotein E2 and Apolipoprotein E3 Genotypes, but Not in Apolipoprotein E4 Genotype. Nutrition Research, 29, 542-550.
[14] Masson, L.F., McNeill, G. and Avenell, A. (2003) Genetic Variation and the Lipid Response to Dietary Intervention: A Systematic Review. The American Journal of Clinical Nutrition, 77, 1098-1111.
[15] Song, Y., Stampfer, M.J. and Liu, S. (2004) Meta-Analysis: Apolipoprotein E Genotypes and Risk for Coronary Heart Disease. Annals of Internal Medicine, 141, 137-147.
[16] Minihane, A.M. (2013) The Genetic Contribution to Disease Risk and Variability in Response to Diet: Where Is the Hidden Heritability? The Proceedings of the Nutrition Society, 72, 40-47.
[17] Huebbe, P., Lodge, J.K. and Rimbach, G. (2010) Implications of Apolipoprotein E Genotype on Inflammation and Vitamin E Status. Molecular Nutrition & Food Research, 54, 623-630.
[18] Minihane, A.M., Jofre-Monseny, L., Olano-Martin, E. and Rimbach, G. (2007) ApoE Genotype, Cardiovascular Risk and Responsiveness to Dietary Fat Manipulation. The Proceedings of the Nutrition Society, 66, 183-197.
[19] Ordovas, J.M., Kaput, J. and Corella, D. (2007) Nutrition in the Genomics Era: Cardiovascular Disease Risk and the Mediterranean Diet. Molecular Nutrition & Food Research, 51, 1293-1299.
[20] Minihane, A.M., Khan, S., Leigh-Firbank, E.C., Talmud, P., Wright, J.W., Murphy, M.C., et al. (2000) ApoE Polymorphism and Fish Oil Supplementation in Subjects with an Atherogenic Lipoprotein Phenotype. Arteriosclerosis, Thrombosis, and Vascular Biology, 20, 1990-1997.
[21] Egert, S., Boesch-Saadatmandi, C., Wolffram, S., Rimbach, G. and Müller, M.J. (2010) Serum Lipid and Blood Pressure Responses to Quercetin Vary in Overweight Patients by Apolipoprotein E Genotype. The Journal of Nutrition, 140, 278-284.
[22] Marteau, T.M., French, D.P., Griffin, S.J., Prevost, A.T., Sutton, S., Watkinson, C., et al. (2010) Effects of Communicating DNA-Based Disease Risk Estimates on Risk-Reducing Behaviours. Cochrane Database of Systematic Reviews, Online, Article ID: CD007275.
[23] Marteau, T., Senior, V., Humphries, S.E., Bobrow, M., Cranston, T., Crook, M.A., et al. (2004) Psychological Impact of Genetic Testing for Familial Hypercholesterolemia within a Previously Aware Population: A Randomized Controlled Trial. American Journal of Medical Genetics Part A, 128A, 285-293.
[24] Harvey-Berino, J., Gold, E.C., West, D.S., Shuldiner, A.R., Walston, J., Starling, R.D., et al. (2001) Does Genetic Testing for Obesity Influence Confidence in the Ability to Lose Weight? A Pilot Investigation. Journal of the American Dietetic Association, 101, 1351-1353.
[25] Arkadianos, I., Valdes, A.M., Marinos, E., Florou, A., Gill, R.D. and Grimaldi, K.A. (2007) Improved Weight Management Using Genetic Information to Personalize a Calorie Controlled Diet. Nutrition Journal, 6, 29.
[26] Hietaranta-Luoma, H.-L., Hopia, A., Luomala, H., Puolijoki, H. and Hopia, A. (2014) Using ApoE Genotyping to Promote Healthy Lifestyles in Finland—Psychological Impacts: Randomized Controlled Trial. Journal of Genetic Counseling, 1-39.
[27] Hietaranta-Luoma, H.-L., Tahvonen, R., Iso-Touru, T., Puolijoki, H. and Hopia, A. (2015) An Intervention Study of Individual, ApoE Genotype-Based Dietary and Physical-Activity Advice: Impact on Health Behavior. Journal of Nutrigenetics and Nutrigenomics, 161-174.
[28] Alberti, K.G.M.M., Zimmet, P. and Shaw, J. (2005) The Metabolic Syndrome—A New Worldwide Definition. The Lancet, 366, 1059-1062.
[29] Faul, F., Erdfelder, E., Lang, A.-G. and Buchner, A. (2007) G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences. Behavior Research Methods, 39, 175-191.
[30] The Finnish Medical Society Duodecim: Current Care Guidelines: Dyslipidemias.
[31] Helldán, A., Helakorpi, S., Virtanen, S. and Uutela, A. (2013) Suomalaisen aikuisväestön terveyskäyttäytyminen ja terveys, kevät 2012 (Health Behaviour and Health among the Finnish Adult Population, Spring 2012). Helsinki, Finland, 2013.
[32] Vähäsarja, K., Salmela, S., Villberg, J., Rintala, P., Vanhala, M., Saaristo, T., et al. (2012) Perceived Need to Increase Physical Activity Levels among Adults at High Risk of Type 2 Diabetes: A Cross-Sectional Analysis within a Community-Based Diabetes Prevention Project FIN-D2D. BMC Public Health, 12, 514.
[33] Marteau, T.M. and Weinman, J. (2006) Self-Regulation and the Behavioural Response to DNA Risk Information: A Theoretical Analysis and Framework for Future Research. Social Science Medicine, 62, 1360-1368.
[34] Nexoe, J., Halvorsen, P.A. and Kristiansen, I.S. (2007) Critiques of the Risk Concept—Valid or Not? Scandinavian Journal of Public Health, 35, 648-654.
[35] Lovegrove, J.A. and Gitau, R. (2008) Personalized Nutrition for the Prevention of Cardiovascular Disease: A Future Perspective. Journal of Human Nutrition and Dietetics: The Official Journal of the British Dietetic Association, 21, 306-316.
[36] Carvalho-Wells, A.L., Jackson, K.G., Lockyer, S., Lovegrove, J.A. and Minihane, A.M. (2012) ApoE Genotype Influences Triglyceride and C-Reactive Protein Responses to Altered Dietary Fat Intake in UK Adults. American Journal of Clinical Nutrition, 96, 1447-1453.
[37] Wood, P.D., Haskell, W.L., Blair, S.N., Williams, P.T., Krauss, R.M., Lindgren, F.T., et al. (1983) Increased Exercise Level and Plasma Lipoprotein Concentrations: A One-Year, Randomized, Controlled Study in Sedentary, Middle-Aged Men. Metabolism, 32, 31-39.
[38] Anderson, J.W. (1985) Physiological and Metabolic Effects of Dietary Fiber. Federation Proceedings, 44, 2902-2906.
[39] Brown, L., Rosner, B., Willett, W.W. and Sacks, F.M. (1999) Cholesterol-Lowering Effects of Dietary Fiber: A Meta-Analysis. The American Journal of Clinical Nutrition, 69, 30-42.
[40] Maxwell, T.J., Ballantyne, C.M., Cheverud, J.M., Guild, C.S., Ndumele, C.E. and Boerwinkle, E. (2013) APOE Modulates the Correlation between Triglycerides, Cholesterol, and CHD through Pleiotropy, and Gene-by-Gene Interactions. Genetics, 195, 1397-1405.
[41] Downer, B., Estus, S., Katsumata, Y. and Fardo, D. (2014) Longitudinal Trajectories of Cholesterol from Midlife through Late Life According to Apolipoprotein E Allele Status. International Journal of Environmental Research and Public Health, 11, 10663-10693.
[42] Saito, M., Eto, M., Nitta, H., Kanda, Y., Shigeto, M., Nakayama, K., et al. (2004) Effect of Apolipoprotein E4 Allele on Plasma LDL Cholesterol Response to Diet Therapy in Type 2 Diabetic Patients. Diabetes Care, 27, 1276-1280.
[43] Helkala, E.L., Lakka, T., Vanhanen, M., Tuomainen, T.P., Ehnholm, C., Kaplan, G.A., et al. (2001) Associations between Apolipoprotein E Phenotype, Glucose Metabolism and Cognitive Function in Men. An Explorative Study in a Population Sample. Diabetic Medicine: A Journal of the British Diabetic Association, 18, 991-997.
[44] Rantala, M., Savolainen, M.J., Kervinen, K. and Kesäniemi, Y.A. (1997) Apolipoprotein E Phenotype and Diet-Induced Alteration in Blood Pressure. The American Journal of Clinical Nutrition, 65, 543-550.
[45] Carvalho-Wells, A.L., Jackson, K.G., Gill, R., Olano-Martin, E., Lovegrove, J.A., Williams, C.M., et al. (2010) Interactions between Age and ApoE Genotype on Fasting and Postprandial Triglycerides Levels. Atherosclerosis, 212, 481-487.
[46] Couderc, R., Mahieux, F., Bailleul, S., Fenelon, G., Mary, R. and Fermanian, J. (1993) Prevalence of Apolipoprotein E Phenotypes in Ischemic Cerebrovascular Disease: A Case-Control Study. Stroke: A Journal of Cerebral Circulation, 24, 661-664.
[47] Yoon, U., Kwok, L.L. and Magkidis, A. (2013) Efficacy of Lifestyle Interventions in Reducing Diabetes Incidence in Patients with Impaired Glucose Tolerance: A Systematic Review of Randomized Controlled Trials. Metabolism: Clinical and Experimental, 62, 303-314.
[48] Koenigsberg, M.R., Bartlett, D. and Cramer, J.S. (2004) Facilitating Treatment Adherence with Lifestyle Changes in Diabetes. American Family Physician, 69, 309-316.
[49] Wallace, L.M., Brown, K.E. and Hilton, S. (2014) Planning for, Implementing and Assessing the Impact of Health Promotion and Behaviour Change Interventions: A Way Forward for Health Psychologists. Health Psychology Review, 8, 8-33.
[50] Maderuelo-Fernandez, J.A., Recio-Rodríguez, J.I., Patino-Alonso, M.C., Pérez-Arechaederra, D., Rodriguez-Sanchez, E., Gomez-Marcos, M.A., et al. (2014) Effectiveness of Interventions Applicable to Primary Health Care Settings to Promote Mediterranean Diet or Healthy Eating Adherence in Adults: A Systematic Review. Preventive Medicine.

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