Balancing Lifestyle and Genomics Research for Disease Prevention in Later Life
Walter C. Willett
Harvard School of Public Health
Both genetic and environmental factors, including diet and lifestyle,
contribute to cardiovascular diseases, cancers, and other major causes
of mortality, but various lines of evidence indicate that environmental
factors are most important. This evidence includes observations that
rates of these diseases differ dramatically among countries, that
migrants from low to high risk countries almost always achieve the
disease rates of their new environment, and that studies of twins
within countries indicate a greater contribution to risk than genetic
factors. Much of the genetic contribution seen in twin studies may be
spread across hundreds of polymorphisms, each with a minor contribution
that has little practical importance. Overly enthusiastic expectations
regarding the benefits of genetic research for disease prevention have
the potential to distort research priorities and spending for health.
However, integration of new genetic information into epidemiologic
studies can help to clarify causal relationships between both lifestyle
and genetic risk factors and risks of disease. Thus, a balanced
approach should provide the best data to make informed choices about
the most effective means to prevent disease.
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