APOE Genotype Disclosure and Lifestyle Advice in a Randomized Intervention Study with Finnish Participants

Background: The APOE epsilon 4 allele is associated with higher risks of cardiovascular diseases and Alzheimer disease than epsilon 3 and epsilon 2. Objectives: We studied the effectiveness of dietary and lifestyle guidance and personal genetic risk information [epsilon 4 carrier (s4+); epsilon 4 noncarrier (epsilon 4-)] as motivators for a healthier lifestyle. Methods: A total of 188 healthy Finnish volunteers (82.4% women; mean +/- SD age: 51.0 +/- 5.6 y; BMI: 26.0 +/- 3.6 kg/m2; total cholesterol: 5.2 +/- 0.9 mmol/L) participated in our randomized intervention study. The participants were genotyped for APOE and divided into intervention (INT; INT epsilon 4+, n = 33; INT epsilon 4-, n = 57) and control groups (CTRL; CTRL epsilon 4+, n = 36; CTRL epsilon 4-, n = 62). Blood samples, measured observations, and questionnaire data were obtained at baseline and at 1 and 1.5 y. INT participants received their s4 carrier status at baseline. Monthly Internet-based guidance based on the Finnish Dietary guidelines was provided for all. Results: The proportion of SFAs in plasma over time fluctuated less in INT epsilon 4+ than in the other groups (P-interaction < 0.05; primary outcome). The lifestyle guidance increased vegetable consumption from 3.5 to 3.6 portions/d, improved the dietary fat quality score by 5.3%, increased the plasma n-3 (omega-3) FA proportion by 7.3%, and decreased the consumption of high-fat/high-sugar foods from 7.3 to 6.5 portions/wk and totaland LDL-cholesterol concentrations by 4.3% and 6.1%, respectively, in the entire participant population (P < 0.05; secondary outcome). Compared with the epsilon 4- participants, epsilon 4+ participants had 2.4% higher plasma n-6 (omega-6) FA, lower C-peptide (3.9 compared with 4.2 nmol/L x h) and sensitive C-reactive protein values, and decreased plasma malondialdehyde concentrations over time (P < 0.05; secondary outcome). Conclusions: Lifestyle guidance given to healthy Finnish participants yielded small but beneficial changes. The INT epsilon 4+ group did not seem markedly more responsive to the guidance than the other groups. This trial was registered at clinicaltrials.gov as NCT03794141.

Automated summary

The study aimed to investigate the impact of APOE epsilon 4 genotype on lifestyle intervention, finding that lifestyle guidance led to improvements in vegetable consumption, dietary fat quality, and cholesterol levels, with no significant differences observed between epsilon 4 carriers and non-carriers in response to the intervention.