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“There is a worldwide advance”
Andreas Hiemisch; ©LIFE-Project
To be able to implement research of diseases of civilization such as diabetes and obesity, you also need a large interdisciplinary crew of scientists. This is the only way to unlock widespread diseases, which are not just increasing in their frequency but also in their intensity.
The LIFE-Project in Leipzig, Germany, has made this research their business. The goal of the more than 300 scientists is to significantly advance the research of lifestyle diseases. Andreas Hiemisch, scientific project coordinator of LIFE CHILD HEALTH and OBESITY at the University Hospital for Children and Adolescents in Leipzig, talked to MEDICA.de about the challenge of this major research project.
MEDICA.de: By now numerous diseases can be classified under the term civilization diseases. On which core research areas does the LIFE project that started at the end of 2010 focus on?
Andreas Hiemisch: We devote ourselves to the most common diseases of our society during childhood and adolescence and in a second research focus also during adulthood. Apart from methodical differences in the implementation of such studies, there are also different disease areas that necessitate a separation of these periods of life. Children are frequently affected by adiposity (obesity) and its secondary complications such as diabetes and high blood pressure. However, allergies, sleep disturbances and anomalies in physical and mental development are also our focus. Especially the latter is a subject that increasingly gains in importance.
We are assuming an incidence of mental disorders in the population of 20 to 30 percent at this point. In addition we are looking at impacts that are being evoked by environmental pollutants. One example to mention would be softening agents in plastics, which very often can be found in toys but also in objects of daily use. In later adulthood dementia and tumor diseases also play an essential role. Overall we are dealing with an extensive and comprehensive field of research.
MEDICA.de: How did this project come to be?
Hiemisch: In children as well as adults we see a strong trend in the increase of civilization diseases. Despite numerous preventative measures and treatment options there is a worldwide progression. We also noticed that not just the frequency is increasing, but also the intensity of these diseases. Presently, children are more overweight than in previous years. The shortcomings of today’s knowledge inspired the idea to more comprehensively research the underlying mechanisms than was previously done. The unique aspect of our research project is that children and young adults of the entire age spectrum are being phenotypically and genotypically characterized – from zero to 18 years of age. The research already starts in the 24th week of gestation. We accompany the children and young adults over another ten years. In addition we study adults between the ages of 20 and 80. In doing so, we want to create a basic and comprehensive image of civilization diseases.
MEDICA.de: Who initiated this research?
Hiemisch: The idea for this originated with leading scientists of the Medical Faculty at the University of Leipzig. We then turned to the European Union with our developed concept to be able to financially implement the project with the necessary scope.
MEDICA.de: How many researchers in total are collaborating on the major research project “civilization diseases“?
Hiemisch: Currently over 300 scientists are working on the overall LIFE project. Among them are also research teams from other universities in Germany and all over Europe. We emphasize interdisciplinarity. The individual LIFE project teams include physicians, psychologists, sports scientists, sociologists, nutritionists but also mathematicians and IT specialists. Alongside there are advisory committees on ethical questions. At the moment around 130 employees are employed and financed in the project. This number will still increase to about 200 associates. We are therefore also an important element for the region in terms of economic aspects.
10,000 children and young adults between the ages of 0 and 18 years shall be included in this cohort;© LIFE-Project Leipzig
MEDICA.de: Early preliminary studies of the LIFE project have already been concluded. What were you able to already determine?
Hiemisch: The preliminary studies were conducted to test the feasibility of certain inquiries. Some are used in childhood for the first time and have to be modified accordingly. In addition we have a strong interest in checking how children and young adults approve of different inquires. An adult thinks about his/her own motivation for this project ahead of time. This kind of interest does not automatically exist in children. This is why it is important for us to make the testing as suitable for children and exciting as possible, so the little participants also enjoy themselves and like to come back and visit us again.
The first studies showed which type of testing we will conduct in the future and which ones we won’t do. We had to realize during a test on fat absorption that our test persons would have to fast for four to eight hours to be able for us to get valid results. In our opinion this is not acceptable for children. We were able to optimize other testing to where it is very well accepted by children.
We also gained experience on how we can conduct the study with a high degree of comparability. One of the main objectives of the preliminary studies was therefore to come up with solutions to logically set up the process and to design it economically, as well as conduct it in a highly standardized fashion.
MEDICA.de: How can you create research in a way that’s well suited for children?
Hiemisch: We created a sort of treasure map for the research course. Each test has a special story that we created for the little participants. For example, if the children come to have their basal metabolic rate measured, they have a kind of bonnet put on their head which looks like a space-helmet. At the same time they can gaze at the stars on the ceiling of the room and get the impression of being on a little space travel adventure. This is very important for the smaller children.
For most children taking a blood sample is the most critical point. We are trying to make this as comfortable as possible through the surroundings and by using soothing adhesive tape. Young adults on the other hand would rather get the facts to understand why a certain test is being done. For instance they have their cardiovascular ultrasound check projected onto the wall and are able to follow everything very closely.
MEDICA.de: How many tests do the younger test persons have to undergo and how much time do the parents need to take?
Hiemisch: This is graduated by age. We have infants who already come to us in their third month of life. In this instance we keep the amount of testing down as much as possible. The babies receive a physical check-up, one ultrasonic testing of the brain, one blood draw and a test on their physical and mental developmental stage. The entire process lasts about 45 to 60 minutes. For young adults on the other hand we can choose from a wide test spectrum, depending on the problem. Oftentimes this means between 10 and 15 tests which from experience overall last about four to five hours.
MEDICA.de: How do you recruit the young study participants in particular?
Hiemisch: For children we have three individual groups that we characterize in more detail. On the one hand, we examine healthy children and young people or to say it differently, children without any pathological findings. Overall we would like to include 10,000 children and young adults between the ages of 0 and 18 years in this cohort. We recruit them from the population pool in Leipzig and the surrounding areas. Many times this is not quite so easy, since children and young adults initially don’t have much interest in participating in a scientific study.
That’s why the children and their parents are being approached during Kindergarten, their school enrollment or first day of school with the help of the public health department of Leipzig. We also work together with the Education Agency of Saxony, which helps us to address schools and school classes directly. Statistical probability then decides which school class in Leipzig or the surrounding areas we will specifically select. Recruiting entire school classes also gives us the advantage to be able to picture the social structures within the school class and the peer group, respectively.
The second part of the recruitment encompasses already diseased children. There are two disease-cohorts that are being researched specifically and in increased depth: On the one hand are the overweight and obese children and on the other hand children with mental abnormalities and problems, respectively. During a second exam day we conduct special, continuative tests with these children. Overweight children for instance will be examined with the help of whole-body MRTs to determine their fat and muscle distribution. In addition there are measurements of the basal metabolic rate and physical activity over a period of a week. There also is an extended assessment for children with mental abnormalities, which includes EEG tests, clinical interviews and a social stress test. The children disease-cohorts are preferentially recruited through care facilities. Another portion is included from the random sample of the population via special screening methods.