• Attitudes toward genetic testing and personalised nutrition in a representative sample of European consumers

      Stewart-Knox, Barbara; Bunting, B.P.; Gilpin, S.; Parr, H.J.; Pinhao, S.; Strain, J.J.; de Almeida, M.D.V.; Gibney, M.J. (2009)
      Negative consumer opinion poses a potential barrier to the application of nutrigenomic intervention. The present study has aimed to determine attitudes toward genetic testing and personalised nutrition among the European public. An omnibus opinion survey of a representative sample aged 14-55+ years (n 5967) took place in France, Italy, Great Britain, Portugal, Poland and Germany during June 2005 as part of the Lipgene project. A majority of respondents (66 %) reported that they would be willing to undergo genetic testing and 27 % to follow a personalised diet. Individuals who indicated a willingness to have a genetic test for the personalising of their diets were more likely to report a history of high blood cholesterol levels, central obesity and/or high levels of stress than those who would have a test only for general interest. Those who indicated that they would not have a genetic test were more likely to be male and less likely to report having central obesity. Individuals with a history of high blood cholesterol were less likely than those who did not to worry if intervention foods contained GM ingredients. Individuals who were aware that they had health problems associated with the metabolic syndrome appeared particularly favourable toward nutrigenomic intervention. These findings are encouraging for the future application of personalised nutrition provided that policies are put in place to address public concern about how genetic information is used and held.
    • Capturing health and eating status through a Nutritional Perception Screening Questionnaire (NPSQ9) in a randomised internet-based personalised nutrition intervention: the Food4Me study

      San-Cristobal, R.; Navas-Carretero, S.; Celis-Morales, C.; Livingstone, K.M.; Stewart-Knox, Barbara; Rankin, A.; Macready, A.L.; Fallaize, R.; O'Donovan, C.B.; Forster, H.; et al. (2017-12)
      Background: National guidelines emphasize healthy eating to promote wellbeing and prevention of non-communicable diseases. The perceived healthiness of food is determined by many factors affecting food intake. A positive perception of healthy eating has been shown to be associated with greater diet quality. Internet-based methodologies allow contact with large populations. Our present study aims to design and a short nutritional perception questionnaire, to be used as a screening tool for assessing nutritional status, and to predict an optimal level of personalisation in nutritional advice delivered via the Internet. Methods: Data from all participants who were screened and then enrolled into the Food4Me proof-of-principle study (n=2369) were used to determine the optimal items for inclusion in a novel screening tool, the Nutritional Perception Screening Questionnaire-9 (NPSQ9). Exploratory and confirmatory factor analyses were performed on anthropometric and biochemical data and on dietary indices acquired from participants who had completed the Food4Me dietary intervention (n=1153). Baseline and intervention data were analysed using linear regression and linear mixed regression, respectively. Results: A final model with 9 NPSQ items was validated against the dietary intervention data. NPSQ9 scores were inversely associated with BMI (β=-0.181, p<0.001) and waist circumference (Β=-0.155, p<0.001), and positively associated with total carotenoids (β=0.198, p<0.001), omega-3 fatty acid index (β=0.155, p<0.001), Healthy Eating Index (HEI) (β=0.299, p<0.001) and Mediterranean Diet Score (MDS) (β=0. 279, p<0.001). Findings from the longitudinal intervention study showed a greater reduction in BMI and improved dietary indices among participants with lower NPSQ9 scores. Conclusions: Healthy eating perceptions and dietary habits captured by the NPSQ9 score, based on 9 questionnaire items, were associated with reduced body weight and improved diet quality. Likewise, participants with a lower score achieved greater health improvements than those with higher scores, in response to personalised advice, suggesting that NPSQ9 may be used for early evaluation of nutritional status and to tailor nutritional advice.
    • Food4Me study: Validity and reliability of Food Choice Questionnaire in 9 European countries

      Markovina, Jerko; Stewart-Knox, Barbara; Rankin, A.; Gibney, M.J.; de Almeida, M.D.V.; Fischer, A.R.H.; Kuznesof, S.; Poinhos, R.; Panzone, L.; Frewer, L.J. (2015)
      This analysis has been conducted to explore the validity and reliability of the Food Choice Questionnaire (FCQ) across 9 European countries. Variation in the factor structure and the perceived importance of food choice motives have been compared cross-nationally. Volunteers (N = 9381) were recruited from an existing panel of a social research agency to take part in the Food4Me survey in Germany, Greece, Ireland, Poland, Portugal, Spain, the Netherlands, the UK and Norway. The survey was administered on-line. Configural, metric and scalar invariance fell within acceptable limits and were consistent across the 9 countries. All reliability parameters were above acceptable levels. Factor analysis confirmed that all items loaded onto the same 9 factors established by Steptoe and Pollard (1995). There was highly significant agreement in the relative importance of food choice factors between countries. Price was ranked as most important food choice factor in five countries (Spain, Greece, Ireland, Portugal and the Netherlands),sensory appeal was ranked first for three countries (Norway, Germany and the UK) while natural content was ranked as the most important factor in Poland. Familiarity and ethical concern were consistently ranked as least important in all countries. These data suggest that the FCQ is a suitable tool for exploring food choice motives across different European populations. Differences in relative importance of factors within countries may need to be taken into account in dietary health intervention and food product development.
    • Making personalised nutrition the easy choice: creating policies to break down the barriers and reap the benefits

      Stewart-Knox, Barbara; Markovina, Jerko; Rankin, A.; Bunting, B.P.; Kuznesof, S.; Fischer, A.R.H.; van der Lans, I.A.; Poinhos, R.; de Almeida, M.D.V.; Panzone, L.; et al. (2016-08)
      Personalised diets based on people’s existing food choices, and/or phenotypic, and/or genetic information hold potential to improve public dietary-related health. The aim of this analysis, therefore, has been to examine the degree to which factors which determine uptake of personalised nutrition vary between EU countries to better target policies to encourage uptake, and optimise the health benefits of personalised nutrition technology. A questionnaire developed from previous qualitative research was used to survey nationally representative samples from 9 EU countries (N = 9381). Perceived barriers to the uptake of personalised nutrition comprised three factors (data protection; the eating context; and, societal acceptance). Trust in sources of information comprised four factors (commerce and media; practitioners; government; family and, friends). Benefits comprised a single factor. Analysis of Variance (ANOVA) was employed to compare differences in responses between the United Kingdom; Ireland; Portugal; Poland; Norway; the Netherlands; Germany; and, Spain. The results indicated that respondents in Greece, Poland, Ireland, Portugal and Spain, rated the benefits of personalised nutrition highest, suggesting a particular readiness in these countries to adopt personalised nutrition interventions. Greek participants were more likely to perceive the social context of eating as a barrier to adoption of personalised nutrition, implying a need for support in negotiating social situations while on a prescribed diet. Those in Spain, Germany, Portugal and Poland scored highest on perceived barriers related to data protection. Government was more trusted than commerce to deliver and provide information on personalised nutrition overall. This was particularly the case in Ireland, Portugal and Greece, indicating an imperative to build trust, particularly in the ability of commercial service providers to deliver personalised dietary regimes effectively in these countries. These findings, obtained from a nationally representative sample of EU citizens, imply that a parallel, integrated, public-private delivery system would capture the needs of most potential consumers.
    • The perceived impact of the National Health Service on personalised nutrition service delivery among the UK public

      Fallaize, R.; Macready, A.L.; Butler, L.T.; Ellis, J.A.; Berezowska, A.; Fischer, A.R.H.; Walsh, M.C.; Gallagher, C.; Stewart-Knox, Barbara; Kuznesof, S.; et al. (2015)
      Personalised nutrition (PN) has the potential to reduce disease risk and optimise health and performance. Although previous research has shown good acceptance of the concept of PN in the UK, preferences regarding the delivery of a PN service (e.g. online v. face-to-face) are not fully understood. It is anticipated that the presence of a free at point of delivery healthcare system, the National Health Service (NHS), in the UK may have an impact on end-user preferences for deliverances. To determine this, supplementary analysis of qualitative data obtained from focus group discussions on PN service delivery, collected as part of the Food4Me project in the UK and Ireland, was undertaken. Irish data provided comparative analysis of a healthcare system that is not provided free of charge at the point of delivery to the entire population. Analyses were conducted using the ‘framework approach’ described by Rabiee (Focus-group interview and data analysis. Proc Nutr Soc 63, 655-660). There was a preference for services to be led by the government and delivered face-to-face, which was perceived to increase trust and transparency, and add value. Both countries associated paying for nutritional advice with increased commitment and motivation to follow guidelines. Contrary to Ireland, however, and despite the perceived benefit of paying, UK discussants still expected PN services to be delivered free of charge by the NHS. Consideration of this unique challenge of free healthcare that is embedded in the NHS culture will be crucial when introducing PN to the UK.