Epigenetics Evidence to Advance Utility of Multifaceted Lifestyle Interventions in Primary Care Practice: The Lessons from a Targeted Review

Background: Epigenetics is a science that deals with the impact of environmental factors and lifestyle on healthful or pathological alterations in epigenetic processes. Primary care providers (PCPs) may need to redefine their roles in health care that requires lifestyle counseling or coaching on healthy lifestyle choices, and prescribing behavioral interventions to tackle lifestyle related chronic diseases. The knowledge of epigenetics can motivate PCPs to incorporate multifaceted lifestyle intervention practices in their clinical encounters with patients to improve their health outcomes. Objectives: The objectives of this study are: 1) to explore the relationship between epigenetics and multiple dimensions of lifestyle and environmental factors; and 2) discuss the implication of epigenetics knowledge driven multifaceted lifestyle interventions in primary care practice. Methods: A targeted search was carried out on articles published in English from MEDLINE over an 11 year period, from January 1st, 2005-December 31st, 2016, with a focus on seven selected categories of lifestyle dimensions (spiritual, intellectual, emotional, physical, social, occupational, and environmental), and the corresponding lifestyle interventions commonly used in patient care. Results: The study identified a large base of literature (11,500 articles) connecting epigenetics to the various components of lifestyle factors. The percentage of articles found on the various lifestyle categories varied significantly - spiritual (1%), intellectual (4%), emotional (40%), physical (24%), social (8%), occupational (5%) and environmental (19%). 927 articles were also investigated for epigenetic effects driven by lifestyle interventions. A causal and effect relationship between lifestyle and epigenetics was highly observed in emotional and physical lifestyle dimensions. Conclusions: Generally, Epigenetics modification occurred in response to the multidimensional lifestyle factors reviewed in this study. This evidence would improve knowledge, attitudes, and approaches PCPs use in their clinical encounters with patients suffering from lifestyle-associated chronic diseases. Integrating epigenetics knowledge may advance the use of a multifaceted lifestyle intervention approach in primary care practice to address chronic diseases.