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In a country where leading a healthy lifestyle can sometimes seem like a national obsession, it's not surprising that this quest has been turned into a science - literally.
For half a century now, Sweden has been at the vanguard of medical research into a family of metabolic disorders known to cause a wide range of 'lifestyle' diseases.
These metabolic disorders - which include obesity, high blood pressure, cholesterol imbalances and insulin resistance - all individually increase the risk of developing diabetes, heart attacks and strokes. When they occur together, however, the risks are multiplied - leading to a condition called metabolic syndrome.
A person's susceptibility to metabolic syndrome is partly determined by genetic factors, but an unhealthy lifestyle will trigger its onset. In the developed world, unhealthy lifestyles are on the rise: Swedish obesity rates have doubled over the past 20 years, to just under 10 per cent of the population. One recent study estimates 40 per cent of Americans over 40 now have metabolic syndrome.
Sweden is home to some of the world's most advanced research into lifestyle diseases, with no fewer than four internationally recognised centres of excellence - at the universities of Lund and Göteborg in the south of the country, and at Uppsala and Karolinska Institutet around Stockholm.
The origins of Swedish expertise: The trigger for this concentration of Swedish expertise was the work of two remarkable researchers, working separately - Nobel Laureate Sune Bergström in Lund and at Karolinska, and Per Björntorp in Göteborg. Their cumulative effort between 1950 and 1980 launched an entirely new field of study.
"Sune Bergström was a truly creative and brilliant scientist who opened up many areas of research," says Professor Jan-Åke Gustafsson, Head of Medical Nutrition at Karolinska, and himself winner of the 2004 Bristol-Myers Squibb Award in nutrition research. "Most of the successful research teams in Sweden in metabolic diseases can be traced back to him and his associates."
What Bergström did to win the Nobel prize was discover the structure of prostaglandins, which are hormone-like chemicals found almost everywhere in the body. Different prostaglandins regulate different metabolic processes, such as blood pressure, body temperature, and even contractions of the uterus during labour. They are a fundamental regulator of the body's metabolism - when they malfunction, so do we.
Björntorp, in turn, identified metabolic syndrome as a distinct condition, and developed experimental methods for measuring the risk factors that contribute to its occurrence. He is considered to be one of the great pioneers in obesity research.
Leaving a legacy: Both researchers left a legacy of collaborators and protégés that today drives Swedish research in the field. In Göteborg, noted researcher and onetime Björntorp collaborator Lars Sjöström now heads the Department of Body Composition and Metabolism, which has been conducting a major long-term study of obesity - the Swedish Obese Subjects (SOS) Intervention Study.
Lund University's medical faculty has a noted diabetes programme, while at Uppsala a team headed by Olle Korsgren is researching tissue transplantation options for diabetes patients. Korsgren's team's successes have led to major funding from the US National Institutes of Health (NIH).
Factors promoting Swedish expertise: Swedish research benefits from a well-educated population and generously funded universities. But additional factors promote the quality of the research itself. According to Hans-Olov Adami, Head of Karolinska's Department of Medical Epidemiology and Biostatistics, Sweden is a "paradise" for medical statisticians because the quality of the medical data they get to work with is unrivalled.
That's because Sweden has centralised healthcare, a unique personal identification number for each resident and a long history of record-keeping by hospitals, even for outpatient visits. According to Adami, this means that from a medical perspective "we can literally follow any single individual throughout their lives." Not surprising, then, that Sweden's database of twins is the world's largest, with 140,000 participants out of a population of nine million.
But Adami has far bigger plans. In February 2005, he and his colleagues at Karolinska unveiled an ambitious proposal for tracking relationships between lifestyle, genes and health from a global perspective. Called "LifeGene," it would be the largest medical project since the mapping of the human genome - the DNA that contains genes.
The idea is to gather data directly from participants using unobtrusive technologies such as text messaging, interactive TV, or even electronic pencils. "We would be able to pick up diseases that are transient, that are mild, that often do not lead that person to seek medical advice," says Adami. These diseases "account for an enormous fraction of the short-term sicknesses in the working population, but which have never been studied before," he says.
Scientists know very little about the risk factors that determine why some people get the flu while others do not, for example. LifeGene, a Swedish initiative, might well solve that riddle.
This article was originally published on Sweden.se - the Official Gateway to Sweden.
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