We all hear about the risks and high rates of cardiovascular disease, diabetes and stroke in the Emirates – but what can be done about it?
The UAE Healthy Future Study aims to determine how genetics, environment and living patterns of Emiratis contribute to chronic diseases. Since 2016 researchers have built a cohort of 14,294 participants, formed almost two dozen partnerships with local entities from Tamkeen to G42 to Abu Dhabi Police, created a Public Health Research Center at NYUAD, built a national data resource to foster future research and a lab and, published 47 research papers.
This work is of a scope that has never been attempted in the Middle East, let alone the UAE. According to a 2020 study published in the journal Genome Medicine, less than one percent of research into genetic variation comes from the region. Within a few years, the team hopes for the first time to have significantly boosted that number, creating a meaningful body of region-specific evidence to work with instead of relying on European data, which is often dramatically different from the local population.
Moving forward they will be looking for causation, examining everything from DNA, diet to smoking patterns to unearth how genetics interacts with the mechanisms of disease. The team is primed to have flexibility to accommodate emerging areas of research, new tools and new findings – such as whether cholesterol levels are the best biomarkers, using MRI and AI in assessment and diagnostics, and how the health of the oral and gut microbiomes contributes to disease.
Livehealthy sat down with the two directors of the Public Health Research Center to find out more about the study so far – and where it is headed next.
Dr Youssef Idaghdour is co-principal investigator in the UAE Healthy Future Study, an associate professor of biology and Global Network Associate Professor of Biology, Faculty of Arts and Science, NYU.
Dr Raghib Ali is founder and principle investigator of the UAE Healthy Future Study and a clinical epidemiologist. He has been made an OBE (Officer of the Order of the British Empire) for his services to Britain’s National Health Service and the COVID-19 response.
What is unique about this study?
Dr Youssef Idaghour: It’s a prospective cohort. Which means, we recruit study participants, we generate data through physical measurements, lab tests, genomics, microbiome, and then we follow them over time. Now, this is extremely important, as a design, because to really understand onset of disease on the long run, we need this type of design where you collect baseline data, you follow participants, and then some of them will develop disease, some will not.
And then you can go back the actual baseline data. This has a lot of potential, not just to understand mechanisms of disease, but to actually predict onset of disease.
Where does a prospective cohort study sit in the realm of clinical research?
Dr Youssef Idaghour: Public health is more about the population, less about the individual. In the clinic or in medicine, usually it’s about the patient, it’s about the individual. But we know that they’re very, very well connected. A lot of knowledge that we get from the population can actually serve the individual patient.
But the opposite is less true. So, public health can inform medicine and the clinic more than the opposite. Now just a specific point about that. The one aspect is again this idea of preventive health. Or preventive medicine. So, as opposed to disease cohorts, where we’re going to recruit patients who have cancer, or patients who have diabetes. This is a completely different design. It’s a general population cohort. To really get insights you would never be able to get by studying just diseased individuals. For example, prevalence. You want to know if you want to study prevalence for a disease, you need a representative sample of the population to be able to come up with accurate numbers. And our study kind of contributes to that.
We used to believe if you had a genetic predisposition for disease, that was your future. How is this changing?
Dr Youssef Idaghour: I have to be careful with that statement because with rare diseases, genetics is extremely important. We mean what we call monogenic or Mendelian diseases, those are 100 percent defined by our genes. Sickle cell disease is an example. If an individual has a mutation, they have the disease. Now the environment is not going to change that, but it’s going to change the manifestation of the disease. Symptoms, severity of the disease, so the cause of the disease could be genetic, but the manifestation and severity of symptoms could be driven by the environment lifestyle.
Now that’s for monogenic diseases. The biggest problem are common complex diseases like diabetes, cardiovascular cancer, asthma, depression. Those are not defined by one gene, those are defined by so many genes. Now that’s where the environment can play a major role in modifying the risk that what we call the genetic risk.
So think about genetics as something like it predisposes individuals, but then you need lifestyle or the environment to act on the risk so that the disease takes place. If we can’t classify individuals based on the risk, then we can do something about it. That’s really the power of genetic data: we can obtain it at birth, and my prediction is that it will become part of our medical records going forward. So each one of us will have a file sitting in a computer with all of our genetic data. That will have a lot of use in terms of clinicians can look at it and can use it either for diagnostics, but more importantly for preventive care purposes, because again, the idea is to classify individuals based on risk.
This feeds into personalized and precision medicine…
Dr Youssef Idaghour: Exactly. And to give a very specific example, we’re given the same drugs, you know, we’re very different genetically, our lifestyle is different, but we’re given exactly the same drugs. Now the field of pharmacogenomics? It’s exactly about tailoring therapies to our own genetic makeup. If I know this patient will, let’s say, metabolize a drug in a specific way, then I can adjust based on that. This is already applied for things like breast cancer. Based on the genetic profile of the breast cancer patient, we can tailor the most efficient treatment. This can save a lot of resources and money as well as life, because you can obtain that genetic risk early enough to actually act on it as opposed to just therapies when it’s already often too late.
What have you uncovered so far?
Dr Raghib Ali: So the first set of papers are based on what we call the baseline characteristics of the cohort. These 14,200 people, they’ve filled in questionnaires, had physical measurements taken, blood tests taken, and then we look at the measurements and the data from all of that collection, and then we look at cross sectional data; tells us about prevalence of certain risk factors, for example, hypertension, high blood pressure, high cholesterol, diabetes, etc.
It also tells us about the characteristics in terms of age, gender, demographics, socioeconomic factors, etc., diet, physical activity, and from the blood test we can measure various things as well. That’s helpful because it’s important to know the baseline of your cohort, but the true value, and that’s what the publication has been based on so far.
So either talking about the prevalence of these risk factors, or there’s been a particular couple of studies, for example, on the microbiome, looking at the bacteria and other organisms in the mouth. That’s a relatively new area of research. But the true value of this study is really the follow up. So it’s by following people who are essentially disease-free at baseline, and seeing who develops disease, and then comparing them to those who don’t develop disease, and that’s how we understand what the main risk factors are for these common chronic diseases.
What has been the big challenge working in the Emirates vs the UK?
Dr Raghib Ali: The hardest thing was certainly getting started in the first place. To do anything for the first time, of course, is difficult, but particularly a study that involves looking at the genetics of a population, asking people for very personal information about themselves and their health, and linking to their health records, that had never been done before. And so it did take us a very long time to get those approvals in place, to build a trust among the regulators and the population, and then to persuade, you know, over 14,000 people to take part. That’s not easy. I mean, in countries like the UK and the US that have been doing these studies for decades, it’s much easier.
When do you expect the first information to come out?
Dr Raghib Ali: We’re starting to follow up now; that means bringing people back for further measurements and also link ]this to their medical records. That data will analyzed over the coming two to three years.
Within the next five years, we expect to have the first key findings, particularly in relation to incidence of diabetes.
In the meantime, what should people do?
Dr Raghib Ali: Most of what we know from previous studies, will be applicable here. There are four key risk factors for most common chronic diseases, which is unhealthy diet, lack of physical activity, tobacco and alcohol. Be very careful about their diet, physical activity, and not to smoke, and to minimize their alcohol intake.
The big challenge actually is to how to change people’s behavior. Because most of us know these risk factors, but it’s not easy to change their behavior.
• These interviews have been edited for clarity and brevity. To listen to them in full, check out the Livehealthy podcast on Wednesday, November 8, 2023.