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Vol 23, No. 11, November 2019   |   Issue PDF view/purchase
Clinical research studies pave the way for better healthcare
Studies provide insight to metabolic disease in Singapore through deep phenotyping and medical imaging.
by Deborah Seah

GUSTO and S-PRESTO may sound like Italian expressions however they refer to something more profound that could bring great impact to the future of healthcare in Singapore.

GUSTO (Growing Up in Singapore Towards Health Outcomes) was the largest and cohort study in Singapore which started out in 2007, collecting information from 1,358 volunteered Singaporean women on their pregnancies and post-birth. The researchers hoped to gain insights from the findings for disease prevention and management.

The S-PRESTO (Singapore PREconception Study of long-Term maternal and child Outcomes) study was the first large-scale healthcare study that recruited local Singaporean couples who are planning to conceive. With the aim of investigating how lifestyle and environmental factors in the preconception period such as nutrition and mental health can affect health outcomes of both mother and baby.

Both studies were collaborative research efforts by National University Singapore (NUS), Singapore Institute for Clinical Sciences (SICS), National University Hospital (NUH), and Kandang Kerbau Women’s and Children’s Hospital (KKH).

Professor Johan G Eriksson explains that the collaboration was essential as “Research in the world today is always a collaborative effort and requires teamwork. We need partners from different disciplines in order to be successful in deep phenotyping, recruitment of study subjects as well as share and discuss research findings.” He quotes from Helen Keller “Alone we can do so little, together we can do so much.”

Such nation-wide medical research studies are beneficial in understanding the needs required for managing metabolic disease. The analysis of the data collected as well as imaging studies will provide pathophysiological mechanisms and comprehension of disease insights for several common non-communicable disease such as diabetes that is specific to the Singaporean population.

“Most previous data have been based upon studies performed in Caucasian populations and we know that the Asian metabolic phenotype is different from the Caucasian.” Prof. Johan G Eriksson. These studies will allow more specialized recommendations catered to the local population.

Researchers also collected imaging data through ultrasound for pregnant women. Other imaging methods included DEXA (dual-energy X-ray absorptiometry), which measures fat mass, lean mass (body weight minus fat mass) and bone mineral density. Percentage body fat in neonates was measured through the PEA POD which uses an air displacement plethysmography system that complements the imaging performed with MRI.

“Imaging methods have been carefully selected for appropriate use for the cohorts with either none or low radiation. Most of the body composition imaging studies are performed by MRI (Magnetic Resonance Imaging) with no radiation.” Dr. S. Sendhil Velan

Through the GUSTO study, a number of publications were produced from the data collected. These will provide essential associations and reveal potential points for targeted disease management. Based on the findings from the GUSTO study recommendations were made to the Ministry of Health in Singapore to update guidelines in relation to gestational diabetes (GDM). This was reflected in the white paper by the College of Obstetricians and Gynaecologists, Singapore where universal screening for GDM was implemented in local hospitals. Another recommendation was made to set up a registry to assist follow-up of women with a history of GDM and their children. Another recommendation as also made in relation to maternal mental health. Integrating screening for anxiety and depression into routine prenatal and postnatal care to identify women who need professional support.

“The deep phenotyping performed in GUSTO and S-PRESTO will undoubtedly lead us into the field of personalized medicine. The approach towards most NCDs (non-communicable diseases) has been too simple – we know that we need to consider a vast number of factors including the microbiome, metabolome, genome, and epigenome to get a better understanding of the disease process. This will lead into individualized treatment strategies as well as individualized preventive measures.” Said Prof. Johan G Eriksson.

Professor Johan G Eriksson is professor at the Yong Loo Lin School of Medicine, Department of Obstetrics and Gynecology, National University of Singapore (NUS) and Director (Human Development) at the Singapore Institute for Clinical Sciences (SICS). His research focuses primarily on metabolism in relation to obesity, gestational diabetes and Type 2 diabetes and related metabolic disorders.

Dr. S. Sendhil Velan is the head of metabolic imaging group at Singapore Bioimaging Consortium (SBIC) and also a principal investigator at the Singapore Institute for Clinical Sciences (SICS). He is also an adjunct associate professor at the Yong Loo Lin School of Medicine and Department of Physiology at the National University of Singapore (NUS). His research is focused on translational imaging of metabolic diseases where the knowledge gained through pre-clinical imaging is being translated to clinical practice.

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