Hollands Gareth J, French David P, Griffin Simon J, Prevost A Toby, Sutton Stephen, King Sarah, Marteau Theresa M
Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK.
School of Psychological Sciences, University of Manchester, Manchester, UK.
BMJ. 2016 Mar 15;352:i1102. doi: 10.1136/bmj.i1102.
To assess the impact of communicating DNA based disease risk estimates on risk-reducing health behaviours and motivation to engage in such behaviours.
Systematic review with meta-analysis, using Cochrane methods.
Medline, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials up to 25 February 2015. Backward and forward citation searches were also conducted.
Randomised and quasi-randomised controlled trials involving adults in which one group received personalised DNA based estimates of disease risk for conditions where risk could be reduced by behaviour change. Eligible studies included a measure of risk-reducing behaviour.
We examined 10,515 abstracts and included 18 studies that reported on seven behavioural outcomes, including smoking cessation (six studies; n=2663), diet (seven studies; n=1784), and physical activity (six studies; n=1704). Meta-analysis revealed no significant effects of communicating DNA based risk estimates on smoking cessation (odds ratio 0.92, 95% confidence interval 0.63 to 1.35, P=0.67), diet (standardised mean difference 0.12, 95% confidence interval -0.00 to 0.24, P=0.05), or physical activity (standardised mean difference -0.03, 95% confidence interval -0.13 to 0.08, P=0.62). There were also no effects on any other behaviours (alcohol use, medication use, sun protection behaviours, and attendance at screening or behavioural support programmes) or on motivation to change behaviour, and no adverse effects, such as depression and anxiety. Subgroup analyses provided no clear evidence that communication of a risk-conferring genotype affected behaviour more than communication of the absence of such a genotype. However, studies were predominantly at high or unclear risk of bias, and evidence was typically of low quality.
Expectations that communicating DNA based risk estimates changes behaviour is not supported by existing evidence. These results do not support use of genetic testing or the search for risk-conferring gene variants for common complex diseases on the basis that they motivate risk-reducing behaviour.
This is a revised and updated version of a Cochrane review from 2010, adding 11 studies to the seven previously identified.
评估告知基于DNA的疾病风险估计对降低风险的健康行为及参与此类行为的动机的影响。
采用Cochrane方法进行的系统评价与荟萃分析。
截至2015年2月25日的Medline、Embase、PsycINFO、CINAHL以及Cochrane对照试验中央注册库。还进行了前后向引文检索。
涉及成年人的随机和半随机对照试验，其中一组接受基于个性化DNA的疾病风险估计，这些疾病的风险可通过行为改变降低。符合条件的研究包括一项降低风险行为的测量。
我们审查了10515篇摘要，纳入了18项研究，这些研究报告了7种行为结果，包括戒烟（6项研究；n = 2663）、饮食（7项研究；n = 1784）和体育活动（6项研究；n = 1704）。荟萃分析显示，告知基于DNA的风险估计对戒烟（优势比0.92，95%置信区间0.63至1.35，P = 0.67）、饮食（标准化均数差0.12，95%置信区间 -0.00至0.24，P = 0.05）或体育活动（标准化均数差 -0.03，95%置信区间 -0.13至0.08，P = 0.62）均无显著影响。对任何其他行为（饮酒、用药、防晒行为以及参加筛查或行为支持项目）或改变行为的动机也无影响，且无不良影响，如抑郁和焦虑。亚组分析未提供明确证据表明携带风险基因型的信息比未携带此类基因型的信息对行为的影响更大。然而，研究主要存在高偏倚风险或偏倚风险不明确，且证据质量通常较低。
现有证据不支持认为告知基于DNA的风险估计会改变行为的预期。这些结果不支持基于激发降低风险行为的目的而使用基因检测或寻找常见复杂疾病的风险赋予基因变异。
这是2010年Cochrane综述的修订和更新版本，在之前确定的7项研究基础上增加了11项研究。
