We are pursuing an NIH STTR R41 grant to study whether genomic nutrition guidance moves clinical outcomes in Alaska Native and urban Native American adults with Type 2 diabetes and NAFLD.
USDA MyPlate and ADA nutrition guidelines are population-average recommendations. They don't account for the genomic variants that change how nutrients are absorbed, converted, and metabolized — variants that vary significantly across ancestral populations.
Alaska Native adults develop Type 2 diabetes at 3× the national average. Non-alcoholic fatty liver disease (NAFLD) rates are similarly elevated. Both conditions are driven primarily by nutrition and metabolic dysfunction — yet the nutritional interventions deployed by IHS and ANTHC are generic, not personalized to the individual's biochemistry.
MTHFR variants reduce folate metabolism by 30–65%. FADS1 variants impair omega-3 conversion from plant sources. TCF7L2 elevates T2DM risk and changes carbohydrate response. PNPLA3 rs738409 is the strongest single genetic predictor of NAFLD and liver fibrosis. Standard guidelines ignore all of this.
Omeprazole (PPI) depletes B12, magnesium, and calcium. Metformin depletes B12. SSRIs affect sodium and folate. When a patient carries both a genomic variant and a medication that impair the same nutrient pathway, the clinical effect is compounded — and no existing tool flags this intersection.
Standalone DTC genomic tools (23andMe, Helix) exist, but none are embedded in the clinical workflow or cross-referenced with the patient's active medication list and live lab values. CareShield closes that gap by running inside the provider's existing EHR via SMART on FHIR.
A randomized feasibility study comparing CareShield genomic nutrition guidance to standard dietary counseling in Alaska Native and urban Native American adults with T2DM or NAFLD.
| Outcome | Measure | Timepoint | Type |
|---|---|---|---|
| Glycemic control | Hemoglobin A1C (%) | Baseline, 3mo, 6mo, 12mo | Primary |
| Liver health | ALT, AST (U/L) | Baseline, 6mo, 12mo | Primary |
| Metabolic markers | BMI, waist circumference, lipid panel | Baseline, 6mo, 12mo | Secondary |
| Dietary adherence | Patient-reported 24hr recall + food frequency questionnaire | Baseline, 3mo, 6mo, 12mo | Secondary |
| Provider adoption | CareShield MPage utilization rate per encounter | Throughout | Secondary |
STTR requires ≥30% of funded work at a research institution. We are actively establishing the institutional partner network ahead of the September 8, 2026 deadline.
Primary research institution partner. Must be an IHS-affiliated or tribally operated facility in Alaska with existing liver disease or metabolic health programs and IRB capacity.
Secondary site with an urban Native American patient population. Expands the study from Alaska Native to pan-tribal generalizability. Prior NIH research activity preferred.
The STTR mechanism funds collaborative research between a small business and a research institution. Phase 1 establishes feasibility and proof-of-concept.
NHGRI · Genomics, Health Disparities, Precision Medicine
An institutional PI at ≥30% FTE from a qualifying research institution with IHS or tribal health system affiliation. This is the single blocking item between the current state and a complete application. If you are a researcher in Native health disparities, genomics, clinical informatics, or hepatology — we want to talk.
If you are a faculty member or staff researcher at an IHS-affiliated institution, tribal health consortium, or university with Native health research capacity — and this study aligns with your work — we want to talk before September 2026.