Non-Communicable Diseases Group
The Non-Communicable Diseases Group was created in late 2018 following a long-recognised need to strengthen ITM’s expertise in understanding and addressing the spreading NCD (such as obesity, diabetes, cardiovascular diseases, and cancers) epidemics in low-resource settings, areas traditionally burdened with infectious diseases. The overall motivation of the group is to understand the socioeconomical, behavioral and metabolic risks driving the onset of cardiometabolic diseases and cancer, and therefore our focus is on prevention. The group uses epidemiological methods and advanced modelling to address these research questions, and aims to enable evidence-based, population-specific public health strategies that are efficient and sustainable.
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NCDs remain the main cause of premature death and disability globally. However, while NCD-related death rates are declining in most HIC, the mortality due to NCDs in LMIC is increasing at an alarming rate, especially among the youngest and poorest strata. Rapid globalisation, population aging, unplanned urbanisation, and widespread unhealthy lifestyles are the root causes of NCDs in LMIC, that in addition to traditional infectious disease challenges, constitute a double burden of disease that requires complementary approaches. Though there is evidence on the most effective strategies to tackle NCDs in HICs, more research is needed to characterise the differential drivers of NCDs in LMIC. This includes the contextualisation of NCD prevention and care in already burdened systems, inequities in daily life conditions and underlying socioeconomic, political, environmental and cultural factors. In alignment with WHO’s prioritized actions for NCDs, we will investigate the best approaches to achieve the reduction of modifiable risk factors (malnutrition in all forms, physical inactivity, alcohol, tobacco, and obesity), as well as the control and management of conditions such as diabetes and hypertension to curb the burden (morbidity, mortality, trends, and costs) of NCDs in the context of LMIC. The NCDs group will integrate a multi-disciplinary team of researchers aiming to identify effective and equitable public health strategies that can reduce the burden of NCD specifically in LMIC as well as among vulnerable populations in HIC. Our research overarches all levels of prevention and, initially using available observational data and surveillance analysis and modelling, will focus on four specific objectives:
- Specific objective 1: Burden of NCDs: characterize and quantify burden of individual NCDs in specific population strata and assess individual, socio-economic, environmental, and geographical determinants and assess risks, and synergies with infectious diseases.
- Specific objective 2: Early prevention: identify, evaluate and implement population-based interventions with maximal cost-effective potential to reduce NCDs in specific, vulnerable populations.
- Specific objective 3: Secondary prevention and control: identify, evaluate, and implement population-based strategies to reduce progression of diagnosed NCDs; including adherence to treatment, and behavioral interventions to prevent or delay progression.
- Specific objective 4: Healthy aging: identify drivers of healthy aging and develop programs that strengthen prevention, increase early detection, and ensure sustainable care of chronic NCDs.
Research projects on the burden of disease
Title: Development and validation of a novel life course microsimulation model linking diet to noncommunicable diseases
Sponsor: FWO Senior Fundamental Research, G0C2520N [PI: José L. Peñalvo]
Duration: 2020 - 2024
In collaboration with researchers from Sciensano (Belgium), the team will develop a novel microsimulation model linking diet to the onset of NCDs (obesity, diabetes, cardiovascular disease, and cancer) using a life-course approach. Previous models have focused on individual NCDs and only among adults, not considering the accumulation of risks throughout the lifetime, and the impact of the early onset of obesity and diabetes, and their interplay, with cardiovascular or cancer outcomes. That is why, we will develop a structured and comprehensive microsimulation methodology to accurately quantify the impact that overall diet, as a continuum, has in the accumulation of multiple risks over the life course. This work will be pioneering in Belgium and Europe and will establish the framework for the extension of this research to specific populations across Europe (vulnerable strata in high-income countries) and in LMIC where addressing the rising NCDs burden is a public health priority. Bringing additional inputs to the model (e.g. efficacy for food policies, and associated costs), the team will be able to perform comparative-effectiveness of food policies on overall NCD risk and related costs, as well as determining whether the effectiveness varies for different intervention strategies, dietary factors, population subgroups, or geographic locations. The model will also be able to assess the cumulative effect of the simultaneous implementation of food policies, providing key insights for policy design elements that could alter the effectiveness, feasibility, costs, reach, sustainability or effects on health disparities of a given policy. Identifying (cost-)effective, and feasible interventions to improve health will be crucial to allow sensible use of resources, prevent NCDs, and provide insight on benefits beyond health, including economic gains from increased productivity, and reduced healthcare utilization.
Title: Unravelling Data for Rapid Evidence-Based Response to COVID-19
Sponsor: H2020 SC1-PHE-CORONAVIRUS-2020-2E, CSA 101016216 [PI: José L. Peñalvo]
Duration: 2020 - 2022
unCoVer is a functional network of 29 research institutions in 18 countries collecting data derived from the provision of care to COVID-19 patients by health systems across Europe and internationally. These real-world data allow for studies into patient’s characteristics, risk factors, safety and effectiveness of treatments and potential strategies against COVID-19 in real settings and complement findings from efficacy/safety clinical trials where vulnerable groups, and patients with comorbidities are often excluded. The network will facilitate access to otherwise scattered datasets and build computational and analytical platforms to streamline studies on risk characterisation, and prediction modelling using standardised pooled data derived from real life practices. It will fill data gaps, unify current initiatives and create downstream exploitation opportunities for researchers and public health strategies to optimise COVID-19 strategies and minimise the impacts of future outbreaks.
Title: Using real-world data to understand and mitigate the increased fatality of COVID-19 among chronic patients
Sponsor: ITM’s Pump Priming [PI: José L. Peñalvo]
In collaboration with Sciensano, this project aims at answering the question whether the use of ACE2 enhancing agents is associated with an increased risk of severe disease or death due to COVID-19 in addition to having certain NCDs. Results of the analyses will inform healthcare workers on whether ACEI/ARB are safe options to use in hospitalized chronic patients with COVID-19 infection, which will have a major impact on disease management.
Title: European Burden of Disease Network
Sponsor: H2020 COST CA18218 [PI: Brecht Devleesschauwer]
Duration: 2019 - 2023
Driven by the impact of the Global Burden of Disease study, several researchers and national and international health institutes have adopted the burden of disease approach to address public health questions.The complexity of the burden of disease approach however resulted in major disparities in research capacity across Europe. Furthermore, the current burden of disease landscape remains scattered, and researchers struggle to translate their findings to decision makers. The burden-eu COST Action will address these challenges by acting as a technical platform for integrating and strengthening capacity in burden of disease assessment across Europe and beyond. To achieve this mission, the Action is cooperating with the European Burden of Disease Network of the WHO Regional Office for Europe (EBoDN).
Research projects on preventive interventions
Title: The extent and nature of food advertising targeted to children and adolescents (5-18 years) in Uganda
Sponsor: Makerere University, MAKRIF/DVCFA/026/20 [PI: Gloria Kimuli Seruwagi]
Duration: 2020 - 2021
Food environments are defined as the physical, economic, political and socio-cultural surroundings, opportunities and conditions that influence people’s food choices. Healthy food environments protect children from obesity, reducing their risk of developing non-communicable diseases (NCDs) such diabetes and cardiovascular diseases. Research done in Uganda shows an increasing risk to NCDs among children below five years, adolescents and the general population. In partnership with Ipsos, a leading media monitoring company in Uganda, FACe-U analyses real advertisement data from national and regional television, radio and print media to determine the magnitude and trends of the types of food and non-alcoholic beverages advertised to children and adolescents in Uganda. Findings will inform government policy actions to creating healthy food environments that prevent childhood obesity and achieve the draft Uganda Nutrition Action Plan II (2020-2025) goals.
Title: Prevention of type 2 diabetes and gestational diabetes among women of reproductive age in Kisantu, DRC
Sponsor: City of Antwerp [PI: José L. Peñalvo]
Duration: 2020 - 2023
Kis-Antwerp is a project sponsored by the City of Antwerp and managed by the Institute of Tropical Medicine Antwerp (ITM) and Memisa Belgium. The overall objective of this project is to establish a long-term program for the prevention of type 2 diabetes mellitus (T2DM) and gestational diabetes mellitus (GDM) among at-risk women of reproductive age in Kisantu, Democratic Republic of Congo (DRC). To achieve this overall aim, the Kis-Antwerp will focus on developing effective strategies 1) to reduce the prevalence of overweight/obesity among women of reproductive age; 2) to consolidate strategies for a healthy weight gain during pregnancy. The intervention strategies will focus on counselling provided at the health care center by peer educators and tailored to the study participants characteristics and needs. It will emphasize the prevention of T2DM and GDM through the promotion of optimal diet, and physical activity. Moreover, we will investigate if the health care counselling can be complemented outreaching to the women’s household and communities through peer-support activities, and motivational approaches. At the same time, other purposes are also envisioned, such as improving the usability of data capturing systems for participant’s follow up and strategy adaptation based on data analysis, expanding knowledge among health care providers on effective strategies for diabetes prevention, and the improving women’s attendance to antenatal care and therefore have an impact on maternal and neonatal health.
Title: Worksite Wellness Programs: A systematic review and meta-analysis
Sponsor: ITM’s NCDs [PI: José L. Peñalvo]
This systematic review and meta-analysis aims to quantify the impact of multicomponent worksite wellness programs (WWPs) interventions on dietary habits and cardiometabolic risk indicators and identify the most relevant WWP intervention components. This ongoing research integrates scientific evidence accumulated during the last 30 years. Up to date, this project has shown a modest but significant effect of WWPs on several risk factors such as unhealthy diets, weight-related risks, and metabolic risks.
Title: Scale-up integrated care for diabetes and hypertension in vulnerable populations
Sponsor: H2020-SC1-2018-Single-Stage-RTD 825432 [PI: Josefien Van Olmen]
Duration: 2019 - 2023
Scale-up of an integrated care package with five components: identification of people with hypertension and/or type 2 diabetes and subsequent; treatment in primary care services; health education; self-management support to patients and caregivers, and collaboration between caregivers. Special attention is given to vulnerable patients and their caregivers’ involvement.
The NCDs group participates in teaching across the ITM’s academic offering. Also, the team runs the ITM’s short course (3-weeks) on NCDs, as part the MPH and as a stand-alone course. The course is divided in 3 modules dedicated to burden, risk factors and prevention, and control and is oriented to quantitative aspects.