EPIGENETIC-GENETIC-MENTAL HEALTH CASCADE BASED PERSONALISED PREVENTION OF NONCOMMUNICABLE DISEASE IN ADOLESCENTS DIAGNOSED WITH AUTISM (ETHEREAL)

五种非传染性疾病--糖尿病、心血管疾病、癌症、慢性呼吸系统疾病和精神卫生疾病--在世卫组织欧洲区域造成86%的死亡和77%的疾病负担。在这五种非传染性疾病中，MHD是独一无二的，因为它与其他四种主要非传染性疾病有着复杂的双向关系，这意味着，一方面，它可能是其他非传染性疾病的始作俑者，或者其他非传染性疾病可能导致MHD，进而可能进一步加剧原发非传染性疾病，导致恶性循环。最近的研究发现，MHD在青少年人群中是排名最高的NCD。在这一人群中，患有MHD和随后的NCD的特定群体是被诊断为自闭症谱系障碍(ASD)的青少年，其易感性是MHD和随后的NCD的3-6倍。目前还没有证据为基础的干预措施(EBI)来预防ASD青少年的MHD，因为1)主要危险因素在他们的生物学过程中是根深蒂固的，2)他们存在多种MHD共病。个性化是防止他们已经脆弱的精神状态过渡到MHD的关键--哪种EBI适合哪种ASD青少年，以及如何选择-这是一个悬而未决的问题。由于它们的神经生物学特征，个性化必须在生物层面上进行。最近的研究表明，环境因素如何通过表观遗传/代谢-心理健康(EGM)过程改变导致MHD的基因表达。通过对这一过程的量化建模，ETHREAL将开发一种个性化、灵活、单一的服务提供模式，使ASD青少年能够自我控制他们的环境因素，同时无缝地获得社区护理服务，以防止他们的精神健康过渡到MHD-这是可持续预防MHD和随后的NCDs的独特解决方案。在不丧失一般性的情况下，建议的解决方案可以适用于在更广泛的青少年人群中预防MHD。

Five Noncommunicable Diseases (NCD) – diabetes, cardiovascular disease, cancer, chronic respiratory disease and Mental Health Disorders (MHD) – account for 86% deaths and 77% disease burden in the WHO Europe region. Of these five NCDs, MHD is unique as it has a complex bi-directional relationship with the other four major NCDs, meaning that, on one hand, it could be the initiator of the other NCDs, or other NCDs could lead to MHD which, in turn, can further aggravate the primary NCD leading to a vicious circle. Recent research identified MHD as the highest ranked NCD in adolescent population. A specific group in this population that is 3 - 6 times more vulnerable for developing MHD and subsequent NCD is the adolescents diagnosed with Autism Spectrum Disorders (ASD). There is no Evidence Based Intervention (EBI) for preventing MHD in an ASD adolescent since 1) the major risk factors are in-grained in their biological process and 2) they present with multiple MHD comorbidity. Personalisation is the key to prevent their already vulnerable mental states making transition to an MHD - "which" EBI is appropriate for "which" ASD adolescent and "how" to choose it - an unsolved question. Because of their neurobiological characteristics, personalisation must be done at biological level. Recent research showed how the environmental factors can alter gene expressions that leads to an MHD through Epigenetic-Genetic/metabolomicMental health (EGM) process. Using quantitative modelling of this process, ETHREAL will develop a personalised, flexible, single service delivery model that will empower an ASD adolescent to self-control their environmental factors while seamlessly accessing the community care services to prevent their mental health making transition to an MHD - a unique solution for sustainable prevention of MHD and subsequent NCDs in this population. Without loss of generality, the proposed solution could be adapted to prevent MHD in wider adolescent population.