How 10.000 Danes can help us tailor health care to each individual

Half of all adult Danes live with obesity, type 2 diabetes or cardiovascular disease. These common diseases affect our daily lives. 

Chances are, you – or someone you love – are suffering from one or more of these diseases. 

These interconnected metabolic disorders are the leading cause of death globally and represent a major hurdle to our healthcare system. 

It's not exactly the most uplifting information to start with – but don't worry, there is a positive side to this story. 

In our research center, CBMR at Copenhagen University, we try to generate scientific evidence that can improve our future healthcare system. How? By improving our ability to predict, diagnose, prevent and treat cardiometabolic diseases. 

We have recently launched Denmark’s largest population screening project of its kind, led by professor Ruth Loos, gathering incredibly detailed information from thousands of individuals. 

A project where you – regardless of whether you are suffering from cardiometabolic disease or not – can contribute to generating the scientific evidence that will change our current understanding of health and disease.

This change can translate to meaningful improvements in our healthcare system and society. 

It is now possible to sign up (see box later in the text). But first, let us tell you more about the project and the research gap we are aiming to fill.

Different people need different healthcare approaches and treatments 

Obesity, type 2 diabetes and cardiovascular diseases are common diseases, but how the disease presents itself, develops and what the related consequences are vary from one person to another. 

After many years of research, scientists are now starting to better understand what causes these diseases and how they progress. And one thing we have learned is that not all populations are the same. 

This means that instead of viewing a population as ‘single-coloured’, precision health acknowledges that a population consists of ‘blue’, ‘green’, ‘yellow’ and ‘purple’ groups of individuals, that need different treatments even though they have the same disease. 

Take type 2 diabetes as an example; We know that not all people living with type 2 diabetes are similar. There are groups of people with type 2 diabetes who are more likely to develop certain complications or respond differently to specific medications.

Adapting interventions (for prevention or treatment) to fit different ‘color’ groups represents a more proactive and personalized healthcare and is at the core of precision health.

Which leads us to the research gap: How do we categorize people into different colors?

Genetics not enough 

When researchers first started to investigate precision medicine, genetics was assumed to be a key factor to categorize people and assign colours. 

For example, metformin is the most commonly used medication to treat type 2 diabetes. However, some patients carry a genetic variation that causes metformin to not work as effectively as it does in people who do not carry that variant. 

If doctors know the patient’s genotype, they can better predict the effect of the medication and possibly offer a different dose or a different treatment altogether.

However, research has shown that genetics alone is not sufficiently precise to ‘color’ categorize individuals. 

While genetic information can be the anker in precision health, we need more information about a person’s health, at different times in their life, from a large number of people. 

This detailed information will help determine what aspects of a person’s health contribute the most to future disease.

Data beyond age, sex, diet and exercise

To address this research gap, we have launched the Danish Precision Health Initiative (DELPHI). 

The purpose of DELPHI is to collect information about people’s health to an unprecedented detail for the next 25 years. 

We will do ultrasound of their arteries, scan their liver health and bone strength, measure their sleep and capture their lung function – among others (more to follow). 

This new knowledge will be used to assess what aspects of their health are the most important contributors to the diagnosis, prediction, prevention, prognosis and treatment of cardiometabolic diseases. 

With this new data, we aim to move beyond the traditional factors such as age, sex, diet and exercise to provide more precise insights for personalized health.

DELPHI will recruit 10,000 individuals aged 20-65 years. Participants will be invited to two clinical visits for detailed measurements related to their health. 

During the 14 days in between the two clinical visits, participants will wear a glucose monitor, a physical activity monitor, a smartwatch and other wearables to capture their health in daily life.

What we are measuring

At the clinic visits, we examine the current health status of the participants by measuring:

• Body composition via Dexa scan 

• Cardiovascular health via ultrasound of arteries and retina scan of the eye

• Liver health via Fibroscan

• Lung function

• Strength and fitness level tests.

Just to mention a few.

During the 14-day health profiling, we also collect data on d

The DELPHI is a Danish cohort study that collects health information in unparalleled detail.

DELPHI stands on the shoulders of other excellent Danish cohort studies that have been conducted in Denmark over the past five decades, e.g. Glostrup-undersøgelsen (Inter 99), Herlev/Østerbro-undersøgelsen (Copenhagen General Population Study) and ‘Kræft, Kost og Helbred’ (DCH) to mention a few. 

What makes DELPHI special is the combination of large sample size, detailed phenotyping and a frequent follow-up regime. 

Together this establishes the DELPHI as the first precision health cohort in Denmark.

The DELPHI is a Danish cohort study that collects health information in unparalleled detail.

DELPHI stands on the shoulders of other excellent Danish cohort studies that have been conducted in Denmark over the past five decades, e.g. Glostrup-undersøgelsen (Inter 99), Herlev/Østerbro-undersøgelsen (Copenhagen General Population Study) and ‘Kræft, Kost og Helbred’ (DCH) to mention a few. 

What makes DELPHI special is the combination of large sample size, detailed phenotyping and a frequent follow-up regime. 

Together this establishes the DELPHI as the first precision health cohort in Denmark.

iet, physical activity, sleep, blood pressure, exposure to pollutants and chemicals, blood sugar profile and individual response to food. 

Together, this provides us with a 360-degree overview of the health of the participants and the external factors for cardiometabolic diseases. 

Participants contribute with data that will improve the healthcare system of the future and at the same time enable them to follow their own health through a personal health report.

… and 25 years later, we can better diagnose and predict disease

Over the next 25 years, we will ask participants to answer questionnaires every year. 

Participants will be re-invited for in-clinic visits and continuous health profiling; every two years (if aged 40 years or older) or every five years (if younger than 40 years). 

This design allows us to collect unprecedented multi-dimensional data on biology, environment and behavior and study the trajectory from healthy to disease state across the life course. 

With this data, it is our goal to:

• Improve diagnosis of obesity, diabetes and cardiovascular disease by identifying different group of ‘colors’ in the population, i.e. who’s at risk and who’s not.

• Improve the prediction of the future risk of cardiometabolic diseases and the prognosis of disease progression based on the ‘color’ of the individual 

• Identify key factors for the prevention of obesity, diabetes and cardiovascular disease.

In other words, this study will strengthen the five pillars of precision medicine: Precision diagnosis, precision prevention, precision treatment, precision prognosis and precision prediction.

We will use a discovery science approach. This means a process, where we identify new patterns, get insight in the underlying biology and form new hypotheses by analyzing a large amount of phenotypic data.

A unique look into your own health 

A discovery science approach relies on different mathematical and computational methods to describe data, predict endpoints, explain interconnections and relationships within the data. 

It doesn’t stop there though. The methods also help us evaluate and test various changes in environmental and personal components. Or to identify key drivers and thresholds at which outcomes (i.e., development of obesity or glucose deterioration) may change. 

Participants in the study will be able to follow their personal health development on bone health and fat mass, strength and fitness level, liver and cardiovascular health, blood pressure and markers of health in the blood, composition of diet and daily physical activity level.

At the same time, their data will provide us with new knowledge about cardiometabolic diseases, ultimately enabling our healthcare system to offer more tailored advice and treatment in the future. 

Equally important, we aim to make our data into a resource for scientists across Denmark to use for their research.

For the past three years, we have been working on developing the study design, the technical solutions needed for the study and the renovation of a 300 m2 phenotyping clinic. 

That’s a long time preparing the study, but with a follow-up time of 25 years its only reasonable that we think twice and test carefully before we start. 

Now we're just looking forward to bringing the project to life!

You can become part of the DELPHI-project here. 

The project is funded by University of Copenhagens NNF Center for Basic Metabolic Research, Danmarks Grundforskningsfond og Novo Nordisk Fondens Laureate Forskningspris.