Jared and Matthew are identical twins who grew up together but have lived apart since college. Jared lives in New York City and is a certified public accountant in a high-profile accounting firm, working long hours in a stressful environment. Matthew attended college in California, where he studied nutrition and exercise physiology and now manages the wellness program at a large fitness center. At age 30 the two brothers are noticeably different in weight and body shape. Jared has a body mass index of 29 compared with Matthew’s 23. Jared has developed central obesity, hypertension, and problems with blood sugar regulation, all signs of a tendency toward developing type 2 diabetes. In contrast, Matthew is lean and has normal blood pressure and normal blood sugar levels.
Nutrition Diagnostic Statement
Overweight related to possible genetic susceptibility, limited physical activity, overeating with snacks and consumption of large meals as evidenced by diet history, central obesity, and body mass index
Nutrition Care Questions
1. Because they are identical twins, would you have expected the two brothers to have similar health profiles?
2. How would you expect their diets to be different?
3. What is going on? Does Matthew not have the same genetic susceptibilities that Jared has? If not, why not? If so, why doesn’t Matthew exhibit the same phenotype as Jared? This question is complex: think about the twins’ deoxyribonucleic acid but also their environmental influences and their epigenetic markings.
4. How could you confirm your suspicion that Jared is genetically predisposed to type 2 diabetes?
5. What would you advise Jared to do to decrease his genetic susceptibility to diabetes?
6. As part of the nutrition assessment, Jared is found to be homozygous for IL1 -511C.T and heterozygous for IL6 -174G.C. These genes code for the proinflammatory cytokines interleukin-1 and interleukin-6 and these particular single nucleotide polymorphisms have been strongly associated with chronic inflammation. What would you discuss with Jared about the implications of these genotype findings and his susceptibility to chronic disease?