Table 2.

Summary of CPG recommendations.

Key factors	Resulting nutrigenetic CPG recommendations
Main considerations of general guidelines for TG lowering through lifestyle (beyond omega-3 intake)	• Reduce intake of refined sugar/carbohydrates, alcohol and/or trans fats. • Increase physical activity.
Main considerations of general guidelines for omega-3 supplementation or dietary intake	• Do not recommend omega-3s from marine sources in patients with contraindications (e.g., fish allergy). • Monitor for potential adverse effects such as gastrointestinal discomfort or skin abnormalities. • Do not exceed 3.0 g/day EPA+DHA.
APOE rs429358, rs7412, EPA and/or DHA and TG	• Strong level of evidence to recommend 0.7–3.0 g/day EPA and/or DHA in E3/E4 or E4/E4 genotypes for significant TG lowering. Other genotypes are less likely to benefit from 0.7 to 3.0 g/day EPA and/or DHA for TG lowering. EPA and/or DHA may still be recommended to these patients for reasons beyond TG reduction; plasma TG levels should then be monitored accordingly. • HCPs must take location-specific regulatory requirements into consideration when deciding on EPA/DHA dosages for their patient. • Generalizable population: adult males (but not females). • Consider ethical and regulatory considerations when offering this test in a clinical setting.
31-SNP nutri-GRS, EPA+DHA and TG	• Strong level of evidence to recommend 3.0 g/day EPA+DHA for TG lowering in those who have lower nutri-GRSs. On a range of scores from −6 to +10, those with higher nutri-GRSs are less likely to benefit from 3.0 g/day EPA+DHA for TG lowering, and may exhibit increases in plasma TG levels in response. EPA+DHA should not be routinely recommended to patients with higher nutri-GRSs; these patients' plasma TG levels should be monitored accordingly if they are taking EPA+DHA supplementation for reasons beyond TG management. Individuals with nutri-GRS scores closer toward the limits of the range (e.g., −6 and +10) can be more clearly classified as responders vs. non-responders, compared to those closer to the middle of the range. • HCPs must take location-specific regulatory requirements into consideration when deciding on EPA+DHA dosages for their patient. • Generalizable population: adults with overweight/obesity.
Cases of conflicting results for APOE rs429358, rs7412 and 31-SNP nutri-GRS	• Given that the level of evidence is higher for the 31-SNP nutri-GRS compared to APOE rs429358 and rs7412, the nutri-GRS result should be used to guide practice related to TG management in lieu of the APOE result if results are conflicting among patients who fall within the generalizable population stated below. For example, EPA+DHA for TG reduction should be recommended to adult male patients with overweight/obesity who have a low nutri-GRS, even if they are not APOE E4 carriers. • Generalizable population: adult males with overweight/obesity
Other genes, SNPs and lipid/lipoprotein outcomes	• Beyond the abovementioned guidelines related to APOE and the 31-SNP nutri-GRS, do not provide any other nutrigenetically-guided personalized omega-3 recommendations for total cholesterol, HDL-cholesterol, LDL-cholesterol, LDL particle size, TG and/or apolipoproteins.