RESEARCH Commentary Diet-Related Disease, Nutritional Genomics, and Food and Nutrition Professionals RUTH DEBUSK, PhD, RD W e are facing a global pandemic of diet-related chronic disease, preventable disorders that in- clude vascular disease, diabetes, cancers, osteopo- rosis, and myriad inflammatory disorders. Chronic dis- eases are the leading cause of the global health burden (1). Virtually all of these disorders are diet-related and, not surprisingly, have not responded well to the pharma- ceutical model that characterizes today’s health care par- adigm. We are in need of an etiology-based model that identifies the underlying molecular basis of a patient/ client’s dysfunction and targets that basis with therapeu- tic and preventive strategies that take into account the biochemical individuality of each person. With the com- pletion of the Human Genome Project, a genetic predis- position model of health and disease is emerging that embodies etiology-based care and that will almost cer- tainly supplant the current evidence-based pharmaceuti- cal model. The concept of genetic predisposition has arisen from the discovery that genes are not necessarily destiny. That is, health and disease outcomes are not necessarily pre- determined based on one’s genes. Particularly with re- spect to diet-related disease, genetic outcomes are typi- cally modifiable as a result of the dynamic interaction of specific genetic variations with environmental factors, which include nutrients and other bioactive components in food. This concept of genetic susceptibility, as opposed to genetic determinism, and of being able to change one’s health trajectory through the judicious use of diet and lifestyle is a marked departure from the current medical model. This seismic shift in health care has profound implica- tions for the food and nutrition profession. Diet-related disease will assume a prominence never before experi- enced, which will position the profession as a major force in health care. The profession will face commensurate expectations to provide insight into how genes and envi- ronmental factors interact and to translate that insight into clinical applications that improve health outcomes. The profession will be further challenged to equip those health professionals who are able to successfully inte- grate the science into effective approaches to diet-related disease and effect the wide scale adoption of these ap- proaches by consumers. The emerging discipline of nutri- tional genomics offers many promising solutions to these challenges. Nutritional genomics focuses on the molecular basis for health and disease and the translation of this knowledge into practical applications to improve health for individ- uals and populations. Nutritional genomics is a corner- stone of the molecular approach to health care and prom- ises to contribute significantly to reducing the incidence of diet-related disease through improved management of disease and, ultimately, its prevention. The principles and tools of nutritional genomics will provide the basis for the detection of genetic variations that increase the risk of developing diet-related disease, allowing for earlier and more targeted interventions than currently exist. Clearly, this discipline holds significance for the dietetics profession and is squarely within the purview of the food and nutrition professional, particularly the clinical dieti- tian. RAISING AWARENESS OF THE VALUE OF NUTRITIONAL GENOMICS The Journal of the American Dietetic Association has been the leader in introducing food and nutrition profes- sionals to the depth and breadth of nutritional genomics and its central role in dietetics, publishing a series of articles on nutritional genomics beginning in 2005. I am honored to have served as the member of the Board of Editors overseeing this introductory series and to have had the opportunity to work with many of the foremost global authorities on nutritional genomics. These contrib- utors introduced readers to a variety of topics, ranging from the implications of the genomics era to the role of functional foods and their bioactive components in ad- dressing genetic susceptibility to disease (2-13). Not sur- prisingly, the key role of molecular nutrition and bio- chemical individuality figured prominently throughout the series. The first article and accompanying commen- tary raised awareness of the coming genomics era and its effect on nutrition practice (2,3). It was followed by three articles that introduced readers to nutritional genomics, transcriptomics, proteomics, metabolomics, epigenomics, and systems biology, and explored their anticipated con- tributions to understanding the molecular basis of ge- R. DeBusk is a geneticist and clinical dietitian in pri- vate practice in Tallahassee, FL, and an adjunct associ- ate professor of nutrition, Graduate Programs in Clini- cal Nutrition, Department of Nutritional Sciences, University of Medicine & Dentistry of New Jersey, Newark. Address correspondence to: Ruth DeBusk, PhD, RD, PO Box 180279, Tallahassee, FL 32318. E-mail: RuthDeBusk@comcast.net Manuscript accepted: November 24, 2008. Copyright © 2009 by the American Dietetic Association. 0002-8223/09/10903-0005$36.00/0 doi: 10.1016/j.jada.2008.11.037 410 Journal of the AMERICAN DIETETIC ASSOCIATION © 2009 by the American Dietetic Association