OMICS A Journal of Integrative Biology

Volume 13, Number 1, 2009

© Mary Ann Liebert, Inc.
DOI: 10.1089/omi.2008.0047

Knowledge and Attitudes of Canadian Consumers

and Health Care Professionals Regarding
Nutritional Genomics

Karine Morin

Abstract

With advances in the field of nutrigenomics, commercial laboratories have begun marketing genotyping ser-
vices, nutritional advice, and dietary supplements “tailored” to match individual genetic predispositions. Al-
though primarily offered by American companies, these services are available to Canadian consumers via the
Internet. Qualitative research in the form of focus groups with members of the Canadian public was under-
taken to assess the current level of understanding of and receptivity toward this new genomic application. Ad-
ditionally, focus groups with health care professionals (physicians, pharmacists, dieticians, nutritionists, and
naturopaths) investigated their interest in integrating nutrigenomics into health care delivery, and their ca-
pacity to do so. Gauging knowledge and attitudes early in the introduction of a new technology serves to iden-
tify potential “blind spots” regarding the ethical, legal, and social implications. Preliminary results indicate con-
sumers believe potential benefits of nutrigenomics outweigh risks, while health care professionals express more
skepticism. Both groups agree that more public education about nutrigenomics is needed and that regulatory
oversight should ensure consumer protection.

Introduction the Government Accountability Office forewarned early pi-

oneers of direct-to-consumer nutrigenomic services that they

R ESEARCHERS ARE OPTIMISTIC that nutrigenomics will reveal

valuable understanding regarding individual genetic
risk of diet-modulated diseases and help maintain health,
prevent the onset of disease, and offer therapies (Kaput, 2007;
Kaput and Rodriguez, 2004). Scientific researchers are not
the only ones foreseeing a transformation of nutrition, and
with it, of food consumption. The Institute for the Future in
a series of three reports published earlier this decade antic-
ipated that nutrigenomics could have a significant impact on
consumers’ food purchases (Cain and Schmid, 2003; Mas-
soud et al, 2001; Oliver, 2005). According to their assessment,
even if consumers are not familiar with the term “nutritional
genomics,” they can grasp the idea of personalized nutrition,
and are attracted to its benefits (Oliver, 2005).
Public health authorities and health product regulators are
also noticing these advances. Health Canada has acknowl-
edged that there is a “Growing . . . awareness of the rela-
tionship between food safety and nutritional quality and
chronic disease,” which must be accounted for in the mod-
ernization of regulatory strategies related to nutrition and
food (Health Canada, 2007). In the United States, however,
are under scrutiny as the claims they have made regarding
their services were deemed to “mislead consumers by mak-
ing predictions that are medically unproven and so am-
biguous that they do not provide meaningful information to
consumers” (U.S. Government Accountability Office, 2006).
It is against this background that qualitative research was
undertaken to assess the knowledge and attitudes of Cana-
dian consumers regarding nutritional genomics, as well as
those of health care professionals, particularly regarding the
risks and potential benefits of nutrigenetic tests offered di-
rectly to consumers. The research would help elucidate
whether health care professionals and consumers hold sim-
ilar views regarding this new technology and also help in-
form regulators as to some of the ethical, legal, or social con-
cerns identified by participants.
Method
Between November 22 and 28, 2007, 12 focus groups were
conducted with members of the public in five cities across
Canada. Participants were randomly recruited by telephone

University of Ottawa, Ottawa, Canada.

37
38
by an independent third party and invited to specialized fo-
cus group facilities in Halifax, Montreal, Toronto, Edmon-
ton, and Vancouver. Each session included approximately
eight participants, totaling over 90 adults representing a mix
of gender, income, marital status, and ethnicity. At least half
the participants in each group had children at home, con-
sumed natural health products, and used the Internet to look
for health-related information. Prior to the moderated focus
group discussion, each participant completed a brief ques-
tionnaire. Among other questions, participants were asked
to provide a definition for the terms “nutrigenomics” and
“personalized nutrition.” The moderated, 2-h sessions cov-
ered the following issues: contextual issues (e.g., importance
of food in relation to health, understanding of the role of
genes); awareness and initial perception of nutrigenomics;
reactions to a media article, a mock Web site selling nu-
trigenomic tests and services, and a summary document de-
scribing the current state of nutrigenomics; and communi-
cation issues.
Two focus groups were conducted with physicians and
pharmacists, and two more with dieticians, nutritionists, and
naturopaths in Toronto and Vancouver, each with approxi-
mately six participants, totaling over 20 professionals. Re-
cruited in the same manner as the members of the public,
they were selected to represent various practice settings and
included a mix of participants according to gender and age.
They, too, were asked to complete a brief questionnaire. The
moderated sessions were similar to those with members of
the public.
Sessions were either video or audio recorded; preliminary
analysis reported here are based on notes made by the re-
searchers who acted as observers and a summary document
prepared by the professional moderators hired to lead the
focus groups.
Results
Unlike most quantitative surveys, the focus groups were
not established to be representative of the Canadian pop-
ulation, but they suggest that members of the public, as
well as many health care professionals, have very limited
knowledge of current nutrigenomic practices. Yet, this lack
of knowledge did not prevent many participants from ap-
preciating the potential value of better information about
one’s own genetic profile and the implications in relation
to healthy eating. Some skepticism also was expressed,
particularly toward a model of nutrigenetic testing offered
directly to consumers. In essence, members of the public
and health care professionals shared many of the same at-
titudes and perceptions, although some differences also
transpired, as shown in the preliminary results presented
below.
Nutrition and genetics as health factors
Members of the public generally identified diet and/or
nutrition, along with exercise, as the most important factors
in maintaining good health. They understood that a good
diet and balanced nutrition can help avoid diseases. Many,
although not all participants, indicated that they are inter-
ested in the link between nutrition and health. When “fam-
ily history” or genetics were identified as relevant to health,
they were not among the first factors mentioned.
MORIN
These findings closely matched those of health care pro-
fessionals who similarly claimed that nutrition and/or diet,
along with exercise, were significant factors in maintaining
good health. The dieticians, nutritionists, and naturopaths
also tended to emphasize a “balanced lifestyle.” Health care
professionals eventually considered genetics as a relevant
factor, but it was not first on their mind, as was the case with
members of the public.
Health care professionals were asked about their under-
standing of the relationship between genetics health and
whether they had ever counseled patients on gene-based
health risks. A small number reported they had based nu-
tritional counselling on the patient’s family history, or in a
few instances, on genetic test results. They commented on
the significance of genetic predisposition to certain chronic
conditions, such as cardiovascular diseases, diabetes, obesity
and cancer. Interestingly, physicians and pharmacists em-
phasized the importance of genetic factors to health, while
dieticians, nutritionists, and naturopaths placed more em-
phasis on environmental factors. Both groups conceded that
much remains to be learned about the influence of gene–en-
vironment interactions on health.
Awareness and perceptions of nutrigenomics
With only a few exceptions, members of the public were
unfamiliar with the term “nutrigenomics.” However, in the
questionnaires, some participants were able to provide a sim-
ple definition that linked nutrition, genes, and health.
Among health care professionals, approximately half the di-
eticians, nutritionists, and naturopaths were aware of the
term “nutrigenomics,” but none of the physicians or phar-
macists. Even in answers written in the questionnaires, pro-
fessionals offered simple definitions of nutrigenomics, and
some did not refer to interactions between genes and nutri-
ents and their impact on health. Sample answers provided
in writing or discussed during the moderated sessions are
presented in Table 1.
The term “personalized nutrition” was usually under-
stood to refer to an individually tailored nutritional plan.
Some members of the public offered definitions related to
healthy eating in general; others referred to “individualized”
eating habits without linking it to the idea of optimizing nu-
trition for health purposes. Only a few health care profes-
sionals related it to an individual’s genetic profile.
After the moderator offered a brief explanation of nu-
trigenomics, members of the public were generally optimistic
that a tailored diet could help reduce the risk of disease.
Some expressed concern that nutritional guides, such as
Canada’s Food Guide, would become less meaningful or ir-
relevant. As one participant commented “It [nutrigenomics]
seems to usher out the ‘one size fits all’ approach to nutri-
tion.” Health care professionals generally were more skepti-
cal since, in their view, many factors influence disease risk.
Internet-based nutrigenomics services
All groups were shown a mock Web site, modeled on
those of existing firms, selling nutrigenomics services that
consisted of a test kit and health questionnaire, nutritional
counseling, and supplements. These services and products
ranged in price from $275 to $2400. Some members of the
public commented that companies are likely more interested
KNOWLEDGE AND ATTITUDES OF CANADIANS REGARDING NUTRITIONAL GENOMICS
TABLE 1. DEFINITIONS OF THE
Definitions provided by participants in focus groups
Health care professionals
• The study of the link between nutrition and
genetics
• Using genetics to improve nutrition or using
nutrition to improve one’s genetics
• Choosing foods specific to one’s genetic makeup
• The study of nutrition in humans
• A branch of science focusing mainly on nutrition
and how it affects everyone’s health
• Genetic changes in nutrients
• The study/application of how nutrition affects
genetic expression
• The study of how nutrition/specific nutrients can
have an impact on individuals because of their
unique genetic makeup
• Creation of custom foods not naturally found in
nature
• Genetically modified to alter nutritional content
in financial gain than health promotion, although other in-
dividuals retained a favorable view of companies. There was
general discomfort with purchasing a test online and partic-
ipants expressed a clear preference for in-person testing at a
clinic or laboratory, especially where they could have direct
interaction with a health care professional. Overall, Internet-
based nutrigenomic services raised “buyer beware” instincts.
Health care professionals were skeptical of the informa-
tion and services presented on the mock Web site. Physicians
and pharmacists in particular questioned whether sufficient
scientific evidence supported such tests. Professionals advo-
cated regulatory oversight of direct-to-consumer nutrige-
nomic services, and believed health care professionals
should be involved in counseling patients. Nevertheless,
there also was some recognition that nutrigenomics could
TABLE 2. RISKS AND BENEFITS OF NUTRIGENOMIC TESTING IDENTIFIED
HEALTH CARE PROFESSIONALS AND MEMBERS OF THE PUBLIC
Health care professionals
• Generating wider interest in
nutrition
• Encouraging preventive care
• Knowledge of predisposition as
BENEFITS
trigger to behavioral change
• Targeted treatment for specific
conditions
• Potentially, health care savings
• Validity of tests is not established
• Inaccurate results/misdiagnosis
• Self-treatment/overuse of
supplement
RISKS • Patients fail to consider other
interventions (i.e., tests are
“viewed as magic bullet”)
• Psychological risks
• Potential breach of privacy
39
TERM “NUTRIGENOMICS”
Members of the public
• How certain foods affect our genes
• How nutrition interacts with genetics to affect
health
• How genes influence nutrition
• The study of food and how it affects our body
• Nutrients necessary to health
• Natural foods
• Genetically modified foods
• Nutrition engineering
• Person who deals with nutrition
• Nutrition and economics
yield valuable information, foster more interest in health and
nutrition among patients or clients, and favor preventive in-
terventions. Finally, health care professionals stated that they
should be familiar with nutrigenomics in order to respond
to patient/client inquiries.
Risks and benefits
Although members of the public and health care profes-
sionals spoke of risks and benefits using different terms,
there was considerable concordance of views (Table 2). For
the lay participants, nutrigenomics was viewed as poten-
tially providing tailored advice and removing guess work
from nutrition. It also could lead to early diagnoses or dis-
ease prevention, and generally should encourage healthier
BY
Members of the public
• Tailored approach could take
away nutritional guesswork
• Early diagnosis could lead to
better diet, disease prevention,
and overall healthier habits
• NGx testing could have positive
impact on behavior
• Science not yet robust enough
• Results are unclear
• Not worth the expense
• Individuals fail to consider other
interventions (i.e., nutrigenomics
“should not be seen as magic
bullet.”)
• Cause anxiety
• Potential breach of privacy
concerns
40
habits. Overall, many considered that nutrigenomic testing
could have a positive impact on behavior. For health care
professionals, nutrigenomics could generate wider interest
in nutrition, encourage preventive care, potentially trigger
behavioral change, and help target interventions. Taken to-
gether, they believed these measures could result in health
care savings.
All groups also expressed several concerns. The public
wanted to know if nutrigenomic services are backed by suf-
ficient science and also whether results would be readily
comprehensible. They also expressed some concern that ser-
vices may be overly expensive, and that some companies
could engage in fraudulent practices. Health care profes-
sionals questioned the accuracy and validity of the tests, and
worried about the risks of misdiagnosis, self-treatment, or
overuse of supplement.
Both groups cautioned that nutrigenomics should not be
considered a “magic bullet,” and worried that some indi-
viduals might not seek other medically oriented interven-
tions if they overly relied on nutrigenetic test results and re-
lated lifestyle changes to address health problems. They also
expressed concern about psychological risks (such as anx-
iety), and privacy aspects of turning over biological samples
and personal information to Internet-based companies.
Overall, members of the public generally found that bene-
fits would likely outweigh risks; health care professionals
appeared less favorable.
Delivery of nutrigenomics-related services
Members of the public were interested in nutrigenomics
services. Their favorable views potentially would lead many
participants to get tested, depending on affordability of the
tests. However, they expressed a strong preference for get-
ting tested at a clinic rather than through tests purchased on-
line and mailed back to a commercial entity. Notably, par-
ticipants did not expect their own physicians to be well
informed about nutrigenomics, nor able to provide follow-
up advice regarding results of tests purchased online.
Physicians and pharmacists generally did not believe they
were sufficiently qualified to give advice on nutrigenomic
testing, and would refer patients to a dietician or nutrition-
ist if they wanted follow-up on such results. Other health
care professionals said they would counsel patients after re-
searching information in peer-reviewed publications or
through professional associations, or even by contacting a
nutrigenomic company.
A small number of health care professionals reported ex-
perience assisting patients or clients with nutrigenomic test-
ing: two had previously helped individuals get tested, and
one had helped with the interpretation of results. In one in-
stance, a health care professional had advised a patient
against the need for such tests. Finally, health care profes-
sionals who would refer a patient or client for nutrigenomic
testing would do so as a last resort, in circumstances where
a family history of risk would support genetic testing. These
attitudes appear to conform to the Canadian Guide to Clin-
ical Preventive Health Care, which states:
While there is evidence that nutritional counselling is
effective in changing diet, the role of the physician has
not been adequately evaluated. Based on the effective-
MORIN
ness of dietary advice and the association between poor
diet and disease, it is reasonable to provide general di-
etary advice. For those at increased risk, it is prudent to
consider referral to a clinical nutritionist or other pro-
fessional with specialized nutritional expertise (Cana-
dian Task Force on the Periodic Health Examination,
2008).
Discussion
Although social scientists, legal scholars and bioethicists
have begun turning their attention toward nutrigenomics
(Levesque et al., 2008; Ozdemir and Godard, 2007; Ries, 2008;
Ronteltap, 2008), little empirical work has been conducted to
date. In the United States, as part of the 2006 Behavioral Risk
Factor Surveillance System, Michigan, Oregon, and Utah
measured awareness of direct-to-consumer nutrigenomic
tests. Results ranged between 7.6% in Michigan, where the
question referred to a test whereby one receives a personal
health profile and lifestyle recommendations, to 19.7% and
24.4% in Utah and Oregon, respectively, where the questions
referred more broadly to DNA tests to improve health and
prevent disease (Goddard et al., 2008). A 2007 survey by the
International Food Information Council indicates an even
greater response to a question related to genetic information
that can be used to provide important nutrition and/or diet-
related recommendation. Of 1,000 respondents, 67% claimed
to have heard of this possibility (IFIC, 2007). Awareness of
nutrigenomics, along with other questions such as under-
standing, favorability, and interest also have been measured
as part of broader surveys on genomics or functional foods
(Schmidt et al, 2008). Results from the focus group research
presented in this article generally echo findings from these
other initiatives. Yet, it is important to clarify that this qual-
itative research cannot be generalized to the full Canadian
population nor to all health care professionals across the
country. Nevertheless, it helps identify public and profes-
sional perceptions about and attitudes toward nutrige-
nomics, including potential benefits and risks.
Members of the public and health care professionals both
recognized their limited knowledge about nutrigenomics
and expressed the need for educational material. Among var-
ious potential sources of educational material, they gener-
ally recognized that government agencies play an important
role in educating the public regarding nutrition, through the
Canada Food Guide and Web sites such as HealthyCanadi-
ans.gc.ca. If such channels could inform the public about nu-
trigenomics, it is worth noting that Canadians’ confidence in
various sources promoting healthy eating varies across
provinces and age groups, suggesting that a single educa-
tional strategy would likely be insufficient (Marquis et al.,
2005).
Educating health professionals presents additional chal-
lenges, especially since knowledge of genetics and nutrition
varies widely among professional groups. In recent surveys,
practicing physicians have rated their nutrition knowledge
and skills as inadequate and felt unprepared to counsel pa-
tients about nutrition (Adams et al., 206). Time constraints
present another challenge to providing nutritional counsel-
ing in the primary care office (Eaton et al., 2003). Similar find-
ings have resulted from a systematic review of the literature
regarding primary care providers’ views regarding genetic
KNOWLEDGE AND ATTITUDES OF CANADIANS REGARDING NUTRITIONAL GENOMICS
services in general (Suther and Goodson, 2003): respondents
believed their knowledge was inadequate to provide genetic
information or services, that time was limited to obtain a de-
tailed family history, and that there was a lack of relevant
guidelines. Overall, it appears that general practitioners lack
information about genetic services and options available to
patients, which in turn, decreases their confidence to refer
patients to appropriate testing services. Other professional
groups, such as dieticians, nutritionists, and naturopaths
have expertise in nutrition and would likely be able to re-
ceive complementary targeted training in genetics to im-
prove their capacity to counsel clients on nutrigenomics.
In light of the concerns that were identified regarding nu-
trigenomic tests, particularly services offered directly to con-
sumers via the Internet, focus group participants stated that
nutrigenomic practices should not be left to an unregulated
marketplace; rather, government oversight is needed to en-
sure consumer protection. At present, however, nutrigenetic
tests typically have been outside the purview of regulatory
agencies such as the U.S. Food and Drug Administration or
Health Canada’s Health Products and Food Branch (Ries,
2008).
The findings of this focus group research point to con-
sumers’ general acceptance of nutrigenomics while health
care professionals expressed more reservations. If profes-
sional skepticism persists, uptake of nutrigenomics may re-
main limited. However, additional evidence of the potential
public and personal health benefits of nutrigenomics may
change this situation as the field evolves. Therefore, regula-
tors in collaboration with other experts should undertake to
assess whether potential benefits of this new genomic ap-
plication outweigh its risks, beginning with those discussed
by participants in the focus groups. They also should deter-
mine whether the current consumer protection framework
that governs health products and services is adequate to ad-
dress the ethical, legal, and social issues that may arise from
the expansion of nutrigenomics.
Acknowledgments
This research was made possible through funding support
from the Network of Centres of Excellence for Advanced
Foods & Materials (www.afmnet.ca). The author acknowl-
edges the helpful comments provided by Nola M. Ries and
David Castle, as well as research assistance from Juliana
Aiken, Sarah Scott, and Jennifer Farrell.
Author Disclosure Statement
No competing financial interest exists.
References
Adams, K.M., Lindell, K.C., Kohlmeier, M., and Zeisel, S.H.
(2006). Status of nutrition education in medical schools. Am J
Clin Nutr 83, 941S–944S.
Cain, M., and Schmid, G. (2003). From nutrigenomic science to
personalized nutrition: the market in 2010 (A report of the In-
stitute for the Future, Palo Alto, CA).
Canadian Task Force on the Periodic Health Examination.
(2008). Canadian Guide to Clinical Preventive Health Care, Chap-
ter 49: Nutritional Couneselling for Undesirable Dietary Pat-
terns and Screening for Protein/Calorie Malnutrition Disor-
41
ders in Adults. Available at: http://www.phac-aspc.gc.ca/
publicat/clinic-clinique/index.html. (Accessed June 13, 2008).
Eaton, C.B., McBride, P.E., Gans, K.A., and Underbakke, G.L.
(2003). Teaching nutrition skills to primary care practitioners.
J Nutr 133, 563S–566S.
Goddard, K.A.B., Duquette, D., Zlot, A., Johnson, J., Annis-
Emeott, A., Lee, P.W., et al. (2008). Public awareness and use
of direct-to-consumer genetic tests: Results from three State
Population-Based Surveys, 2006. Am J Public Health.
Health Canada, Health Products and Food Branch. (2007). To-
wards a regulatory modernization strategy for food and
nutrition. Available at: http://www.hc-sc.gc.ca/fn-an/alt_
formats/hpfb-dgpsa/pdf/consultation/rmsfn-smran-
eng.pdf (Accessed June 10, 2008).
IFIC. (2007). Consumer attitudes toward functional foods/foods for
health—Executive summary. (A Report of the International
Food Information Council). Available at: http://www.ific.
org/research/funcfoodsres07.cfm. (Accessed August 6, 2008).
Kaput, J. (2007). Nutrigenomics—2006 update. Clin Chem Lab
Med 45, 279–287.
Kaput, J., and Rodriguez, R.L. (2004). Nutritional genomics: the
next frontier in the postgenomic era. Physiol Genomics 16,
166–177.
Lévesque, L., Ozdemir, V., Gremmen, B., and Godard, B. (2008).
Integrating anticipated nutrigenomics bioscience applications
with ethical aspects. OMICS 12, 1–16.
Marquis, M., Dubeau, C., and Thibault, I. (2005). Canadians’
level of confidence in their sources of nutrition information.
Can J Diet Pract Res 3, 170–175.
Massoud, M., Ragozin, H., Schmid, G., and Spalding, L. (2001).
The future of nutrition: consumers engage with science (A re-
port of the Institute for the Future, Palo Alto, CA).
Oliver, D. (2005). The future of nutrigenomics: from the lab to the
dining room. (A report of the Institute for the Future, Palo Alto,
CA).
Ozdemir, V., and Godard, B. (2007). Evidence based manage-
ment of nutrigenomics expectations and ELSIs. Pharmacoge-
nomics 8, 1051–1062.
Ries, N.M. (2008). Regulating nutrigenetic tests: an international
comparative analysis. Health Law Rev 16, 9–20.
Ronteltap, A, Van Trijp, J.C.M., and Renes, R.J. (2008). Consumer
acceptace of nutrigenomics-based personalised nutrition. Br J
Nutr (Published online by Cambridge University Press 15
May 2008 doi:10.1017/S0007114508992552).
Schmidt, D.B., White, C., Kapsak, W.R, Conway, J., and Baily,
E. (2008). U.S. consumer attitudes toward personalized nutri-
tion. In Personalized Nutrition: Principles and Applications Kok,
F., Bouwman, L., Desiere, F. eds. (CRC Press, Boca Raton, FL),
pp. 205–219.
Suther, S., and Goodson, P. (2003). Barriers to the provision of
genetic services by primary care physicians: a systematic re-
view of the literature. Genet Med 5, 70–76.
U.S. Government Accountability Office. (2006). Nutrigenetic
testing: tests purchased from four Web sites mislead con-
sumers. Washington, DC. Available at: http://www.gao.
gov/new.items/d06977t.pdf. (Accessed June 10, 2008).
Address reprint requests to:
Karine Morin
University of Ottawa
60 University
Ottawa, ON, K1N 6N5, Canada
E-mail: kmorin@uottawa.ca
This article has been cited by:

1. Vural Ozdemir , Arno G. Motulsky , Eugene Kolker , Béatrice Godard . 2009. Genome–Environment Interactions and Prospective
Technology Assessment: Evolution from Pharmacogenomics to Nutrigenomics and EcogenomicsGenome–Environment
Interactions and Prospective Technology Assessment: Evolution from Pharmacogenomics to Nutrigenomics and Ecogenomics.
OMICS: A Journal of Integrative Biology 13:1, 1-6. [Abstract] [PDF] [PDF Plus]