Healthy aging - both genes and lifestyle
To preserve your health into old age and enjoy many years of good health is an ideal for most people. The question is how do I do it. The answer is extremely individual how one should live in order to stay healthy. It’s an interaction between genes and lifestyle.
The EpiHealth venture, run by Uppsala University and Lund University, will study the interaction between lifestyle factors and genes with major endemic diseases. Here in Uppsala, Lars Lind, professor of medicine, leads the project. He confirms what we already know: there is no simple tie between lifestyle and health.
“As a doctor I frequently hear: I had a grandfather who drank like a fish and smoked a hundred cigarettes a day, yet he still lived past a hundred.” The only answer is he must have had some type of genes that made him resistant to neglect while others get lung cancer and die early, even if they only smoke occasionally.
For each lifestyle factor, for example smoking, there are genes that control how susceptible we are and with that how harmful it is to us.
The same applies to “good” lifestyle factors, such as healthy eating and regular exercise. Today doctors give the same advice to everyone. However, there are now tools to bore deeper into genetics - detailed genetic analyses, large-scale protein analysis and so-called “metabolomics”, which measure various metabolic variables such as amino acids, lipids and hormones.
“Ultimately the aim is to be able to provide individualised health advice so that we can say to this grandfather, yes, you can smoke. Yet to the vast majority, we will say that smoking is harmful for you and we can also identify individuals for whom it is extremely dangerous to smoke,” says Lars Lind.
Samples and survey responses are collected within the EpiHealth project from different people at a clinic in Uppsala and one in Malmö. So far data from 10,000 people has been gathered here in Uppsala, but the goal is to collect data from 300,000 individuals, as large amounts of material are needed to work from.
“First of all, there are very many different lifestyle factors, and every human being has 20,000 genes and a number of different things that control genes, so it is complex.”
Within EpiHealth the major endemic diseases are studied, which often come in middle age and beyond, with an emphasis on cancer, cardiovascular disease, dementia, osteoporosis and diabetes. These are diseases that usually cannot be cured and which cost society a great deal of money.
We are getting older, but the diseases remain. “However, the pattern has changed in recent years,” says Lars Lind.
“If you look at it from the perspective of what you die of, statistically, the trend has shifted from people usually dying of cardiovascular disease to one where most often or not people die of cancer.
This has to do with the major advances in the cardiovascular field over the last 10-15 years, which means that fewer die from a heart attack. Firstly, it occurs at a later age and most people live longer after a heart attack. This means they become older and then the risk of getting cancer increases.
“The aim must be to put off diseases as long as possible in life so that you can enjoy as many healthy years as possible. The second objective, once you get a disease, is to treat it as effectively as possible so that you enjoy a reasonable quality of life even after becoming ill,” adds Lars Lind.
What lifestyle factors do you look for?
“The classic ones are smoking, alcohol habits, what you eat and exercise. However, we also look at other factors that are less studied, but of equal interest, such as mental stress, social networks and well-being. We also look at environmental factors, such as how you perceive your work place and whether you are exposed to environmental toxins.
Do they have a link to endemic diseases?
“Yes, but in different ways.” Some lifestyle factors are more important for some diseases than they are for others, and there is more or less a degree of heritability. In principle for all diseases we study - such as heart attack, stroke, cancer and dementia - both lifestyle factors and genetic factors are significant, yet they can vary in significance.
The first interim goal, to collect data from 10,000 people has been achieved and in the autumn we will start to study obesity as a risk factor for major endemic diseases. The initial pilot project is about “healthy obese” - can you be obese without it being harmful?
Reports from other research says that about 20-25 per cent of all those who have a BMI over 30 (which is the definition of obesity), do not suffer from heart disease or diabetes.
“This is something we are going to study in more detail.” Partly which lifestyle factors mean that some people who tend to become fat do not suffer from diabetes and cardiovascular disease, but also the underlying genes. What we will do with this group is to follow these individuals in the future and see who develops diseases.
The increased knowledge can lead to more personalised dietary advice. Research has shown that there is a gene, the APOE gene, which is important for fat metabolism. If you have a specific apoE genotype, it is very important to eat very little saturated fat, while with a different genotype it is of less importance. Which suggests that there is a diet that is “right” for everyone.
Personalisation is also needed for medicines too. For example, in the event of a heart attack several different medicines are prescribed at the hospital, despite the fact that all medicines are probably not needed for all individuals. Today there are a lack of tools to determine who needs which medicines.
“Healthcare has a great deal to gain by personalising lifestyle advice and medication. Both in terms of the efficiency of the individual, but also in terms of health care costs,” says Lars Lind.
In Uppsala there is data on approximately 10,000 individuals. In addition, there is a test centre in Malmö. The aim is for 300,000 individuals, but this will require additional funding.
Those who leave data are randomly selected from the national register. About one quarter of those called attend.
The study consists of three parts:
1. A questionnaire completed via the web, which can be done at home.
2. At the test centre the individual’s height, weight, waist measurement, blood pressure, lung function are measured. An ECG is also taken and the individuals do a brain test. Blood samples give answers regarding blood lipids and blood sugar, and some are frozen in a biobank.
3. Follow-up of the patients using the registers kept by the National Board of Health and Welfare. Once a year, the database is run against the cause of death register, inpatient care records and some other registers.