Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studiesBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5644 (Published 10 January 2018) Cite this as: BMJ 2018;360:j5644
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Wang et al1 investigated whether improving adherence to healthy dietary patterns interacts with the genetic predisposition to obesity in relation to long term changes in body mass index and body weight from a prospective cohort study - the Nurses' Health Study and Health Professionals Follow-up Study - during a 20 year follow-up. They observed that improving adherence to healthy dietary patterns could attenuate the genetic association with weight gain. Moreover, the beneficial effect of improved diet quality on weight management was particularly pronounced in people at high genetic risk for obesity.
Improving adherence to healthy dietary patterns, as assessed by various diet scores, has been associated with weight loss in several studies. However, no study has assessed the interactions between changes in these diet quality scores and genetic predisposition to obesity in relation to long term changes in body mass index and body weight. In this point, the current study clearly underlines the importance of improving adherence to healthy dietary patterns in the prevention of weight gain, especially in people with greater genetic predisposition to obesity.
Systematic review and meta-analysis of randomised controlled trials using random effects and estimating risk ratios and mean differences, observed that weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.2
Cardiometabolic syndrome consisting of obesity, dyslipidemia of high triglycerides or low high-density lipoprotein cholesterol, pre-hypertension, and pre-diabetes showing fasting glucose >100 mg/dl are major risk factor for cardiovascular diseases such as hypertension, diabetes mellitus, coronary heart disease, and heart failure, as well as cancer, congenital malformations, and dementia. Obesity is the most important factor among others and also can be controlled by diet and exercise.3-5 Indeed, exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.6
Although it is clear that there is a strong link between obesity and the incidence of various clinical outcomes, whether reducing weight gain should be the primary target at the clinical level is still debatable. It has rather been suggested that targeting key behaviors such as improving nutritional quality, usually low in fat and saturated fat, and improving cardiorespiratory fitness through regular physical activity would be legitimate approaches contributing to generate “healthy weight loss modalities”.3-5,7
Funding: None, Disclosures: None
1. Wang T, Heianza Y, Sun D, Huang T, Ma W, Rimm EB, Manson JE, Hu FB, Willett WC, Qi L. Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies. BMJ. 2018;360:j5644.
2. Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ. 2017;359:j4849.
3. Koh KK. To take or not to take drugs? That is the question. BMJ 2013, Published 30 December 2013, http://www.bmj.com/content/347/bmj.f5577/rr/679697
4. Koh KK. Reconfirm to follow guidelines to prevent cardiovascular diseases.
BMJ 2016, Published on 5 March 2016, http://www.bmj.com/content/352/bmj.i721/rr-0.
5. Kim SH, Després JP, Koh KK. Obesity and cardiovascular disease: friend or foe?
Eur Heart J. 2016;37:3560-3568.
6. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug
interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577
7. Koh KK. Letter by Koh Regarding Article, “Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project (Prediction for ASCVD Risk in China)” and “Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population”
(What is the best risk prediction tool in the primary and secondary prevention?) Circulation. 2017;135:e818-e819.
Competing interests: No competing interests
Re: Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies
It's good to read research article on obesity, a prospective cohort study on health professionals (1).
It's true that genetic predisposition to obesity is not a barrier to weight management.
The prevalence of obesity has increased all over the world due to faulty dietary habits & life style and it's in parallel with increasing fast food chain, packed and stored food (2).
Weight loss is just an indicator of compliance in a weight management program, but it does not indicate the health of obese patients. Obesity is a threat to life and predisposes to the development of many diseases. Obesity is the result of the "interaction of multicausal and multidimensional factors". The advice of Hippocrates that "Walking is man’s best medicine" is golden advice in the present time.
Good dietary habits and adoption of positive life style may modify the genetic association with obesity.
Physical activity is inversely associated, and sedentary behaviour is independently & positively associated with an increased risk of cancer. Obesity is one of the significant contributory factors associated with cancer risk. The inclusion of wholegrain, fibre, fruits, and vegetables in the diets is associated with a reduced risk of cancer (3).
Obesity management remains a very big challenge globally (4).
Competing interests: No competing interests