Table 1c.

Genetic testing of variants for evaluating plasma lipid/lipoprotein/apolipoprotein* responses to dietary/supplemental omega-3 other than omega-3/TG responsiveness and APOE (rs429358 and rs7412) or the Vallée Marcotte et al. 31-SNP nutri-GRS.

Decision domain	Judgment	Reason for judgment	Subdomains influencing judgment
Quality of evidence • Is there high or moderate quality evidence?	Yes □ No ⊠	The evidence is generally weak (low or very low quality) for SNPs influencing plasma lipid/lipoprotein/apolipoprotein* responses to dietary/supplemental omega-3 other than APOE (rs429358 and rs7412) and the Vallée Marcotte et al. 31-SNP nutri-GRS further detailed in Tables 1a,b. There is moderate quality evidence to demonstrate a lack of effect for APOE (rs rs429358 and rs7412), omega-3 and total cholesterol in females (16–24, 55) as well as PPARg2 (rs1801282), omega-3 and LDL cholesterol (56–60).	While several observational and interventional studies have demonstrated evidence of various SNPs influencing plasma lipid/lipoprotein/apolipoprotein* responses to dietary/supplemental omega-3, most have not yet been replicated (5). In those that have been replicated, reasons for downgrading the evidence include risk of bias, inconsistency, indirectness, and imprecision. However, many nutrigenetic associations had evidence of a mechanism of action (5).
Balance of desirable and undesirable outcomes • Given the best estimate of typical values and preferences, are you confident that the benefits outweigh the harms and burden or vice versa?	Yes □ No ⊠	Given the lack of scientific evidence, there are minimal to no desirable consequences. It is undesirable to provide nutrition advice that is not evidence-based.	A lack of scientific evidence would lead to the public receiving dubious nutrition advice, that is unlikely to lead to health benefits above and beyond population-based advice.
Values and preferences • Are you confident about the typical values and preferences and are they similar across the target population?	Yes ⊠ No □	If a patient wishes to undergo this nutrigenetic test and consents to genotyping, they should have the option to do so. However, the test offered to the patient should be evidence-based and ethically incorporated into practice (see quality of evidence and resource use sections).	In general, the public expresses an interest in genetic testing for personalized nutrition (45–49), especially if this testing leads to lifestyle recommendations (48, 50) and is offered by a registered dietitian or other HCP (45, 50). Moreover, there is substantial demand for genetic testing among consumers (patients) (53). However, the choice to undergo this type of genetic testing will vary from person to person and some individuals have expressed concerns (50). Despite consumer interest in nutrigenetics, the CPG panel is confident that patients would not wish to receive dubious (scientifically invalid) nutrition information and advice.
Resource use • Are the resources worth the expected net benefit from following the recommendation?	Yes ⊠ No □	Resources are required for the implementation of nutrigenetic testing into practice, but several nutrigenetic testing companies exist and many HCPs are already offering this type of testing in their practice.	Nutrigenetic testing has been integrated into clinical practice for many years (53). The CPG recommendations presented herein would help to strengthen existing tests available on the market and evidence-based practice among healthcare professionals.
Overall strength of recommendation	Strong	The panel strongly recommends not to provide personalized omega-3 recommendations for lipids, lipoproteins and apolipoproteins* based on genetic variation of any SNPs beyond the nutri-GRS developed by Vallée Marcotte et al. (25, 26), or APOE (rs429358 and rs7412) genotype = based on the evidence currently available.
Evidence to recommendation synthesis	The quality of the evidence is generally weak, with some nutrigenetic associations demonstrating moderate-quality evidence for lack of association. Potential risks outweighed potential benefits and patients would not wish to receive dubious (scientifically invalid) nutrition information and advice. As such, the panel has made a strong recommendation against testing certain genetic variations.

*Includes total cholesterol, HDL-cholesterol, LDL-cholesterol, LDL particle size, TG and/or apolipoproteins.