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Evans JT, Buscot MJ, Fraser BJ, Juonala M, Guo Y, Fernandez C, Kähönen M, Sabin MA, Armstrong MK, Viikari JSA, Bazzano LA, Raitakari OT, Magnussen CG. Life-period associations of body mass index with adult carotid intima-media thickness: The Bogalusa Heart Study and the Cardiovascular Risk in Young Finns Study. Prev Med 2024; 189:108128. [PMID: 39244160 DOI: 10.1016/j.ypmed.2024.108128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Child and adult body mass index (BMI) associates with adult carotid artery intima-media thickness (cIMT). However, the relative contribution of BMI at different life-periods on adult cIMT has not been quantified. This study aimed to determine the life-course model that best explains the relative contribution of BMI at different life-periods (childhood, adolescence, and young-adulthood) on cIMT in adulthood. METHODS BMI was calculated from direct measurements of height and weight at up to seven time-points from childhood to adulthood (1973-2007) among 2485 participants of the Cardiovascular Risk in Young Finns Study (YFS) and 1271 participants in the Bogalusa Heart Study (BHS). BMI measures at three ages representative of childhood (9-years), adolescence (18 years) and young-adulthood (30 years) life-periods were used. B-mode ultrasound was used to measure common cIMT in adulthood (>30 years). Associations were evaluated using the Bayesian relative life-course exposure model. RESULTS In both cohorts, cumulative exposure to higher levels of BMI across the life-course was associated with greater cIMT. Of the examined life-periods, BMI in young-adulthood provided the greatest relative contribution towards the development of adult cIMT for YFS (49.9 %, 95 % CrI = 34-68 %) and white BHS participants (48.6 %, 95 % CrI = 9-86 %), whereas BMI in childhood had the greatest relative contribution for black BHS participants (54.0 %, 95 % CrI = 8-89 %). CONCLUSION Although our data suggest sensitive periods in the life-course where prevention and intervention aimed at reducing BMI might provide most benefit in limiting the effects of BMI on cIMT, maintaining lower BMI across the life-course appears to be optimal.
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Affiliation(s)
- Jack T Evans
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Department of Health, Tasmanian Government, Hobart, Australia
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Yajun Guo
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Camilo Fernandez
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Clinical Physiology, Tampere University Hospital, Tampere, Finland
| | - Matthew A Sabin
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.; Cabrini Health, Brighton, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland; Division of Medicine, Turku University Hospital, Turku, Finland
| | - Lydia A Bazzano
- Department of Epidemiology Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland; Baker Heart and Diabetes Institute, Melbourne, Australia.
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2
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Larsson SC, Butterworth AS, Burgess S. Mendelian randomization for cardiovascular diseases: principles and applications. Eur Heart J 2023; 44:4913-4924. [PMID: 37935836 PMCID: PMC10719501 DOI: 10.1093/eurheartj/ehad736] [Citation(s) in RCA: 82] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023] Open
Abstract
Large-scale genome-wide association studies conducted over the last decade have uncovered numerous genetic variants associated with cardiometabolic traits and risk factors. These discoveries have enabled the Mendelian randomization (MR) design, which uses genetic variation as a natural experiment to improve causal inferences from observational data. By analogy with the random assignment of treatment in randomized controlled trials, the random segregation of genetic alleles when DNA is transmitted from parents to offspring at gamete formation is expected to reduce confounding in genetic associations. Mendelian randomization analyses make a set of assumptions that must hold for valid results. Provided that the assumptions are well justified for the genetic variants that are employed as instrumental variables, MR studies can inform on whether a putative risk factor likely has a causal effect on the disease or not. Mendelian randomization has been increasingly applied over recent years to predict the efficacy and safety of existing and novel drugs targeting cardiovascular risk factors and to explore the repurposing potential of available drugs. This review article describes the principles of the MR design and some applications in cardiovascular epidemiology.
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Affiliation(s)
- Susanna C Larsson
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Adam S Butterworth
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Cambridge, UK
- British Heart Foundation Centre of Research Excellence, School of Clinical Medicine, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
- Health Data Research UK, Wellcome Genome Campus and University of Cambridge, Hinxton, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Papworth Road, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
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3
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Meyer JF, Larsen SB, Blond K, Damsgaard CT, Bjerregaard LG, Baker JL. Associations between body mass index and height during childhood and adolescence and the risk of coronary heart disease in adulthood: A systematic review and meta-analysis. Obes Rev 2021; 22:e13276. [PMID: 33960625 DOI: 10.1111/obr.13276] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 01/08/2023]
Abstract
Body mass index (BMI) at child and adolescent ages is positively associated with adult coronary heart disease (CHD) whereas height at these ages may be inversely associated with CHD. However, potential effects of age, sex, and socioeconomic status on associations between BMI and CHD are less investigated. We conducted a systematic review and meta-analysis of BMI and height at ages 2-19 years in relation to adult CHD and examined effects of age, sex, socioeconomic status, and other factors. Twenty-two studies on BMI and five on height were included, comprising 5,538,319 individuals and 69,830 CHD events. Random effects meta-analyses were conducted. Child and adolescent BMI were positively associated with CHD (hazard ratio = 1.12; 95% confidence interval [CI] [1.01, 1.25] per standard deviation [SD]), and categorical analyses supported these findings. The associations did not significantly differ by age, sex, or by adjustment for socioeconomic status. Child and adolescent height were inversely associated with CHD (hazard ratio = 0.87; 95% CI [0.81, 0.93] per SD), and categorical analyses agreed. Insufficient studies on height precluded subgroup analyses. Heterogeneity was generally high in all analyses. We found that BMI in youth is positively associated with adult CHD regardless of sex or adjustment for socioeconomic status whereas height is inversely associated with later risk of CHD.
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Affiliation(s)
- Julie F Meyer
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Sara B Larsen
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Kim Blond
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Camilla T Damsgaard
- Department of Nutrition, Exercise, and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Lise G Bjerregaard
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jennifer L Baker
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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4
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Sun J, Xi B, Yang L, Zhao M, Juonala M, Magnussen CG. Weight change from childhood to adulthood and cardiovascular risk factors and outcomes in adulthood: A systematic review of the literature. Obes Rev 2021; 22:e13138. [PMID: 32875696 DOI: 10.1111/obr.13138] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 12/16/2022]
Abstract
The magnitude of the associations between life-course change in weight status and health outcomes in adulthood has been inconsistent. This study aims to examine the associations between weight change from childhood to adulthood and cardiovascular disease (CVD) risk factors and outcomes in adulthood. PubMed, Embase and ISI Web of Science between 1 August 1953 and 13 July 2020 were searched, and a total of 52 eligible articles were included. The systematic review supported significant associations between the life-course increase in BMI and high odds of markers in adulthood. In the meta-analyses, normal weight in childhood but excess weight in adulthood or persistent excess weight was associated with increased odds of adult markers. However, those who had excess weight in childhood but were normal weight in adulthood did not have increased odds of nearly all adult markers. This systematic review and meta-analysis suggest that individuals who developed excess weight in adulthood or had excess weight in both periods had higher odds of developing CVD risk factors and outcomes in adulthood. In contrast, the probability of these adult markers could be limited or eliminated for children with excess weight who are able to become adults with normal weight.
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Affiliation(s)
- Jiahong Sun
- Department of Epidemiology, School of Public Health, Shandong University, Cheeloo College of Medicine, Jinan, China
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Shandong University, Cheeloo College of Medicine, Jinan, China
| | - Lili Yang
- Department of Epidemiology, School of Public Health, Shandong University, Cheeloo College of Medicine, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Shandong University, Cheeloo College of Medicine, Jinan, China
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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5
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Determinants of Intima-Media Thickness in the Young: The ALSPAC Study. JACC Cardiovasc Imaging 2021; 14:468-478. [PMID: 31607674 PMCID: PMC7851110 DOI: 10.1016/j.jcmg.2019.08.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study characterized the determinants of carotid intima-media thickness (cIMT) in a large (n > 4,000) longitudinal cohort of healthy young people age 9 to 21 years. BACKGROUND Greater cIMT is commonly used in the young as a marker of subclinical atherosclerosis, but its evolution at this age is still poorly understood. METHODS Associations between cardiovascular risk factors and cIMT were investigated in both longitudinal (ages 9 to 17 years) and cross-sectional (ages 17 and 21 years) analyses, with the latter also related to other measures of carotid structure and stress. Additional use of ultra-high frequency ultrasound in the radial artery at age 21 years allowed investigation of the distinct layers (i.e., intima or media) that may underlie observed differences. RESULTS Fat-free mass (FFM) and systolic blood pressure were the only modifiable risk factors positively associated with cIMT (e.g., mean difference in cIMT per 1-SD increase in FFM at age 17: 0.007 mm: 95% confidence interval [CI]: 0.004 to 0.010; p < 0.001), whereas fat mass was negatively associated with cIMT (difference: -0.0032; 95% CI: 0.004 to -0.001; p = 0.001). Similar results were obtained when investigating cumulative exposure to these factors throughout adolescence. An increase in cIMT maintained circumferential wall stress in the face of increased mean arterial pressure when increases in body mass were attributable to increased FFM, but not fat mass. Risk factor-associated differences in the radial artery occurred in the media alone, and there was little evidence of a relationship between intimal thickness and any risk factor. CONCLUSIONS Subtle changes in cIMT in the young may predominantly involve the media and represent physiological adaptations as opposed to subclinical atherosclerosis. Other vascular measures may be more appropriate for the identification of arterial disease before adulthood.
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Koeder C, Hahn A, Englert H. Effect of a 6-Month Controlled Lifestyle Intervention on Common Carotid Intima-Media Thickness. J Nutr Health Aging 2021; 25:869-877. [PMID: 34409964 DOI: 10.1007/s12603-021-1628-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The intima-media thickness of the common carotid artery (ccIMT) is an established risk marker for cardiovascular disease (CVD). However, it is unclear whether lifestyle interventions can easily demonstrate an improvement in ccIMT. The objective was to test if our intervention would beneficially affect ccIMT (among other CVD markers). DESIGN Non-randomized controlled trial. SETTING Rural northwest Germany. PARTICIPANTS Middle-aged and elderly participants from the general population (intervention: n = 114; control: n = 87). INTERVENTION A community-based, 6-month controlled lifestyle intervention focusing on four areas of lifestyle change: a plant-based diet, physical activity, stress management, and an improved social life. A strong emphasis was on dietary change. MEASUREMENTS We tested whether ccIMT change from baseline to 6 months was different between groups. RESULTS With all participants included, no significant difference in mean ccIMT change between groups was observed (p = 0.708). However, in a subgroup analysis with participants with high baseline mean ccIMT (≥0.800 mm) a significant difference in mean ccIMT change between intervention (-0.023 [95% CI -0.052, 0.007] mm; n = 22; baseline mean ccIMT: 0.884 ± 0.015 mm) and control (0.041 [95% CI 0.009, 0.073] mm; n = 13; baseline mean ccIMT: 0.881 ± 0.022 mm) was observed (p = 0.004). Adjusting for potential confounders did not substantially alter the results. CONCLUSION The results indicate that healthy lifestyle changes can beneficially affect ccIMT within 6 months and that such a beneficial effect may be more easily demonstrated if participants with high baseline ccIMT are recruited. The observed effect is of relevance for the prevention of CVD events, including myocardial infarction and stroke.
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Affiliation(s)
- C Koeder
- Christian Koeder, Department of Nutrition, University of Applied Sciences Münster, Corrensstr. 25, 48149 Münster, Germany;
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7
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Chiesa ST, Charakida M, Deanfield JE. Adolescent health and future cardiovascular disability: it’s never too early to think about prevention. Eur Heart J 2019; 41:1511-1513. [DOI: 10.1093/eurheartj/ehz869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
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Affiliation(s)
- Scott T Chiesa
- Institute of Cardiovascular Science, University College London, London, UK
| | - Marietta Charakida
- Department of Imaging Science and Biomedical Engineering, King’s College London, London, UK
| | - John E Deanfield
- Institute of Cardiovascular Science, University College London, London, UK
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8
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Millard LAC, Davies NM, Tilling K, Gaunt TR, Davey Smith G. Searching for the causal effects of body mass index in over 300 000 participants in UK Biobank, using Mendelian randomization. PLoS Genet 2019; 15:e1007951. [PMID: 30707692 PMCID: PMC6373977 DOI: 10.1371/journal.pgen.1007951] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/13/2019] [Accepted: 01/09/2019] [Indexed: 12/30/2022] Open
Abstract
Mendelian randomization (MR) has been used to estimate the causal effect of body mass index (BMI) on particular traits thought to be affected by BMI. However, BMI may also be a modifiable, causal risk factor for outcomes where there is no prior reason to suggest that a causal effect exists. We performed a MR phenome-wide association study (MR-pheWAS) to search for the causal effects of BMI in UK Biobank (n = 334 968), using the PHESANT open-source phenome scan tool. A subset of identified associations were followed up with a formal two-stage instrumental variable analysis in UK Biobank, to estimate the causal effect of BMI on these phenotypes. Of the 22 922 tests performed, our MR-pheWAS identified 587 associations below a stringent P value threshold corresponding to a 5% estimated false discovery rate. These included many previously identified causal effects, for instance, an adverse effect of higher BMI on risk of diabetes and hypertension. We also identified several novel effects, including protective effects of higher BMI on a set of psychosocial traits, identified initially in our preliminary MR-pheWAS in circa 115,000 UK Biobank participants and replicated in a different subset of circa 223,000 UK Biobank participants. Our comprehensive MR-pheWAS identified potential causal effects of BMI on a large and diverse set of phenotypes. This included both previously identified causal effects, and novel effects such as a protective effect of higher BMI on feelings of nervousness.
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Affiliation(s)
- Louise A. C. Millard
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
- Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, Bristol, United Kingdom
| | - Neil M. Davies
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Tom R. Gaunt
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - George Davey Smith
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
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9
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Fyfe-Johnson AL, Ryder JR, Alonso A, MacLehose RF, Rudser KD, Fox CK, Gross AC, Kelly AS. Ideal Cardiovascular Health and Adiposity: Implications in Youth. J Am Heart Assoc 2018; 7:JAHA.117.007467. [PMID: 29654202 PMCID: PMC6015406 DOI: 10.1161/jaha.117.007467] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The American Heart Association set 2020 Strategic Impact Goals that defined cardiovascular risk factors to be included in the concept of ideal cardiovascular health (ICH). The prevalence of ICH among differing levels of adiposity in youth, especially severe obesity, is uncertain. METHODS AND RESULTS The cross-sectional study measured ICH metrics in 300 children and adolescents stratified by adiposity: normal weight, overweight/obese, and severely obese. ICH incorporates 7 behavioral and health metrics, and was characterized as poor, intermediate, or ideal. Individual ICH metrics were transformed into standardized sample z-scores; a summary ICH sample z-score was also calculated. Multivariable linear regression models were used to estimate differences in ICH sample z-scores by adiposity status. Of the 300 participants, 113 were classified as having normal weight, 87 as having overweight/obesity, and 100 as having severe obesity (mean age 12.8 years, SD 2.7; 48% female). No participants met the criteria for ICH; 80% of those classified as having normal weight, 81% of those with overweight/obesity, and all of those with severe obesity were in poor cardiovascular health. After multivariable adjustment, those with overweight/obesity (sample z-score: -1.35; 95% confidence interval, -2.3, -1.1) and severe obesity (sample z-score: -1.45; 95% confidence interval, -2.9, -0.92) had lower overall ICH sample z-scores compared with participants with normal weight. Results were similar for individual ICH metrics. CONCLUSIONS Poor cardiovascular health was highly prevalent in youth; ICH sample z-scores increased across levels of adiposity. Youth with obesity, particularly those with severe obesity, remain a rich target for primary prevention efforts. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01508598.
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Affiliation(s)
- Amber L Fyfe-Johnson
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN .,College of Medicine, Washington State University, Seattle, WA
| | - Justin R Ryder
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Alvaro Alonso
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kyle D Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Claudia K Fox
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Amy C Gross
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN
| | - Aaron S Kelly
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
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10
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Wei FF, Thijs L, Zhang ZY, Jacobs L, Yang WY, Salvi E, Citterio L, Cauwenberghs N, Kuznetsova T, E A Drummen N, Hara A, Manunta P, Li Y, Verhamme P, Allegaert K, Cusi D, Vermeer C, Staessen JA. The risk of nephrolithiasis is causally related to inactive matrix Gla protein, a marker of vitamin K status: a Mendelian randomization study in a Flemish population. Nephrol Dial Transplant 2018; 33:514-522. [PMID: 28340119 DOI: 10.1093/ndt/gfx014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 01/15/2017] [Indexed: 01/12/2023] Open
Abstract
Background Vitamin K (VK)-dependent γ-glutamate carboxylation and serine phosphorylation activate matrix Gla protein (MGP) to a potent locally acting inhibitor of calcification. Nephrolithiasis represents a process of unwanted calcification associated with substantial mortality and high recurrence rates. We hypothesized that the risk of nephrolithiasis increases with VK shortage, as exemplified by higher plasma levels of desphospho-uncarboxylated MGP (dp-ucMGP). Methods In 1748 randomly recruited Flemish individuals (51.1% women; mean age 46.8 years), we determined dp-ucMGP and the prevalence of nephrolithiasis at baseline (April 1996-February 2015) and its incidence during follow-up until March 2016. We estimated the multivariable-adjusted relative risk associated with the doubling of dp-ucMGP, using logistic or Cox regression. We did a Mendelian randomization analysis using four MGP genotypes as instrumental variables. Results With adjustments applied for sex, age and 24-h urinary volume and calcium excretion, the odds of having prevalent nephrolithiasis [n = 144 (8.2%)] associated with dp-ucMGP was 1.31 [95% confidence interval (CI) 1.04-1.64; P = 0.022]. dp-ucMGP levels were associated (P ≤ 0.001) with MGP variants rs2098435, rs4236 and rs2430692. In the Mendelian analysis, the causal odds ratio was 3.82 (95% CI 1.15-12.7; P = 0.029). The incidence of nephrolithiasis over 12.0 years (median) was 37 cases (0.2%). With similar adjustments as before, the hazard ratio in relation to dp-ucMGP was 2.48 (95% CI 1.71-3.61; P < 0.001). Additional adjustment for a nephrolithiasis propensity score produced consistent results. Conclusion Higher levels of inactive dp-ucMGP may be causally associated with the risk of nephrolithiasis. Whether or not VK deficiency plays a role in these observations remains to be firmly established.
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Affiliation(s)
- Fang-Fei Wei
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Lotte Jacobs
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Wen-Yi Yang
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Erika Salvi
- Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy
| | - Lorena Citterio
- Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute and School of Nephrology, University Vita-Salute San Raffaele, Milan, Italy
| | - Nicholas Cauwenberghs
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Azusa Hara
- Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan
| | - Paolo Manunta
- Division of Nephrology and Dialysis, IRCCS San Raffaele Scientific Institute and School of Nephrology, University Vita-Salute San Raffaele, Milan, Italy
| | - Yan Li
- Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluations, Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Peter Verhamme
- Research Unit of Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Karel Allegaert
- Research Unit of Organ Systems, KU Leuven Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Daniele Cusi
- Genomics and Bioinformatics Platform at Filarete Foundation, Department of Health Sciences and Graduate School of Nephrology, Division of Nephrology, San Paolo Hospital, University of Milan, Italy
| | - Cees Vermeer
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit of Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- R&D Group VitaK, Maastricht University, Maastricht, The Netherlands
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Dimou NL, Tsilidis KK. A Primer in Mendelian Randomization Methodology with a Focus on Utilizing Published Summary Association Data. Methods Mol Biol 2018; 1793:211-230. [PMID: 29876899 DOI: 10.1007/978-1-4939-7868-7_13] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Mendelian randomization (MR) is becoming a popular approach to estimate the causal effect of an exposure on an outcome overcoming limitations of observational epidemiology. The advent of genome-wide association studies and the increasing accumulation of summarized data from large genetic consortia make MR a powerful technique. In this review, we give a primer in MR methodology, describe efficient MR designs and analytical strategies, and focus on methods and practical guidance for conducting an MR study using summary association data. We show that the analysis is straightforward utilizing either the MR-base platform or available packages in R. However, further research is required for the development of specialized methodology to assess MR assumptions.
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Affiliation(s)
- Niki L Dimou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Konstantinos K Tsilidis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece. .,Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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12
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Choi JW, Moon S, Jang EJ, Lee CH, Park JS. Association of prediabetes-associated single nucleotide polymorphisms with microalbuminuria. PLoS One 2017; 12:e0171367. [PMID: 28158221 PMCID: PMC5291388 DOI: 10.1371/journal.pone.0171367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/19/2017] [Indexed: 01/14/2023] Open
Abstract
Increased glycemic exposure, even below the diagnostic criteria for diabetes mellitus, is crucial in the pathogenesis of diabetic microvascular complications represented by microalbuminuria. Nonetheless, there is limited evidence regarding which single nucleotide polymorphisms (SNPs) are associated with prediabetes and whether genetic predisposition to prediabetes is related to microalbuminuria, especially in the general population. Our objective was to answer these questions. We conducted a genomewide association study (GWAS) separately on two population-based cohorts, Ansung and Ansan, in the Korean Genome and Epidemiology Study (KoGES). The initial GWAS was carried out on the Ansung cohort, followed by a replication study on the Ansan cohort. A total of 5682 native Korean participants without a significant medical illness were classified into either control group (n = 3153) or prediabetic group (n = 2529). In the GWAS, we identified two susceptibility loci associated with prediabetes, one at 17p15.3-p15.1 in the GCK gene and another at 7p15.1 in YKT6. When variations in GCK and YKT6 were used as a model of prediabetes, this genetically determined prediabetes increased microalbuminuria. Multiple logistic regression analyses revealed that fasting glucose concentration in plasma and SNP rs2908289 in GCK were associated with microalbuminuria, and adjustment for age, gender, smoking history, systolic blood pressure, waist circumference, and serum triglyceride levels did not attenuate this association. Our results suggest that prediabetes and the associated SNPs may predispose to microalbuminuria before the diagnosis of diabetes mellitus. Further studies are needed to explore the details of the physiological and molecular mechanisms underlying this genetic association.
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Affiliation(s)
- Jong Wook Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Shinje Moon
- Division of Endocrinology and Metabolism, Hallym University College of Medicine, Seoul, South Korea
| | - Eun Jung Jang
- Korea Centers for Disease Control and Prevention, Cheongju-si, Chungcheongbuk-do, Korea
| | - Chang Hwa Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Joon-Sung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
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13
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Dixon P, Davey Smith G, von Hinke S, Davies NM, Hollingworth W. Estimating Marginal Healthcare Costs Using Genetic Variants as Instrumental Variables: Mendelian Randomization in Economic Evaluation. PHARMACOECONOMICS 2016; 34:1075-1086. [PMID: 27484822 PMCID: PMC5073110 DOI: 10.1007/s40273-016-0432-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Accurate measurement of the marginal healthcare costs associated with different diseases and health conditions is important, especially for increasingly prevalent conditions such as obesity. However, existing observational study designs cannot identify the causal impact of disease on healthcare costs. This paper explores the possibilities for causal inference offered by Mendelian randomization, a form of instrumental variable analysis that uses genetic variation as a proxy for modifiable risk exposures, to estimate the effect of health conditions on cost. Well-conducted genome-wide association studies provide robust evidence of the associations of genetic variants with health conditions or disease risk factors. The subsequent causal effects of these health conditions on cost can be estimated using genetic variants as instruments for the health conditions. This is because the approximately random allocation of genotypes at conception means that many genetic variants are orthogonal to observable and unobservable confounders. Datasets with linked genotypic and resource use information obtained from electronic medical records or from routinely collected administrative data are now becoming available and will facilitate this form of analysis. We describe some of the methodological issues that arise in this type of analysis, which we illustrate by considering how Mendelian randomization could be used to estimate the causal impact of obesity, a complex trait, on healthcare costs. We describe some of the data sources that could be used for this type of analysis. We conclude by considering the challenges and opportunities offered by Mendelian randomization for economic evaluation.
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Affiliation(s)
- Padraig Dixon
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Stephanie von Hinke
- School of Economics, Finance and Management, University of Bristol, 8 Woodland Road, Bristol, BS8 1TN, UK
| | - Neil M Davies
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - William Hollingworth
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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14
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Frilander H, Viikari-Juntura E, Heliövaara M, Mutanen P, Mattila VM, Solovieva S. Obesity in early adulthood predicts knee pain and walking difficulties among men: A life course study. Eur J Pain 2016; 20:1278-87. [PMID: 26996726 DOI: 10.1002/ejp.852] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Few studies have addressed the role of obesity in young adulthood in knee problems later in life. We assessed the associations of overweight/obesity with knee pain and functional limitations of the knee across the life course. METHODS Military health records from 1967 to 2000 (baseline) were searched for 18- to 50-year-old Finnish men (n = 1913) who participated in the Health 2000 Study (follow-up). Visits to health care were followed during service. Height and weight were measured at baseline and follow-up and waist circumference at follow-up. Weight was inquired at follow-up for ages of 20, 30, 40 and 50 years, if applicable. Life course body mass index (BMI) was calculated. One-month knee pain and functional limitations (walking difficulties and limping) due to knee problems were enquired with interview at follow-up. Cox regression model, logistic regression and trajectory analysis were applied. RESULTS Body mass index at the age of 20 increased the risk of unilateral knee pain by 38% and functional limitations by 27% for one standard deviation increment of BMI, respectively. One-unit increment of Z-score of life course BMI increased knee pain by 32%. Development of severe obesity during the follow-up increased the risk of knee pain by 80% and functional limitations by 93%. The effect of obesity on functional limitations was partly mediated by traumatic knee problems during military service. CONCLUSIONS Reducing overweight already in adolescence and avoiding further weight gain during life course may prevent knee pain and associated disability. WHAT DOES THIS STUDY ADD?: BMI at the age of 20 increases the likelihood of knee pain and functional limitations of the knee later in life. Development of severe obesity in adulthood increases the risk of knee pain by 80% and functional limitations by more than 90%. Both general and abdominal obesity are associated with knee pain, associations being stronger for general obesity.
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Affiliation(s)
- H Frilander
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.,Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - E Viikari-Juntura
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - M Heliövaara
- Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare, Helsinki, Finland
| | - P Mutanen
- Statistics and Health Economics, Finnish Institute of Occupational Health, Helsinki, Finland
| | - V M Mattila
- Department of Orthopedics and Traumatology, Karolinska University Hospital, Stockholm, Sweden.,Department of Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - S Solovieva
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland.,Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
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15
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von Hinke S, Davey Smith G, Lawlor DA, Propper C, Windmeijer F. Genetic markers as instrumental variables. JOURNAL OF HEALTH ECONOMICS 2016; 45:131-48. [PMID: 26614692 PMCID: PMC4770870 DOI: 10.1016/j.jhealeco.2015.10.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 08/07/2015] [Accepted: 10/19/2015] [Indexed: 05/09/2023]
Abstract
The use of genetic markers as instrumental variables (IV) is receiving increasing attention from economists, statisticians, epidemiologists and social scientists. Although IV is commonly used in economics, the appropriate conditions for the use of genetic variants as instruments have not been well defined. The increasing availability of biomedical data, however, makes understanding of these conditions crucial to the successful use of genotypes as instruments. We combine the econometric IV literature with that from genetic epidemiology, and discuss the biological conditions and IV assumptions within the statistical potential outcomes framework. We review this in the context of two illustrative applications.
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Affiliation(s)
| | | | | | - Carol Propper
- University of Bristol, Bristol, United Kingdom; Imperial College London, London, United Kingdom
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16
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Millard LAC, Davies NM, Timpson NJ, Tilling K, Flach PA, Davey Smith G. MR-PheWAS: hypothesis prioritization among potential causal effects of body mass index on many outcomes, using Mendelian randomization. Sci Rep 2015; 5:16645. [PMID: 26568383 PMCID: PMC4644974 DOI: 10.1038/srep16645] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 10/16/2015] [Indexed: 01/03/2023] Open
Abstract
Observational cohort studies can provide rich datasets with a diverse range of phenotypic variables. However, hypothesis-driven epidemiological analyses by definition only test particular hypotheses chosen by researchers. Furthermore, observational analyses may not provide robust evidence of causality, as they are susceptible to confounding, reverse causation and measurement error. Using body mass index (BMI) as an exemplar, we demonstrate a novel extension to the phenome-wide association study (pheWAS) approach, using automated screening with genotypic instruments to screen for causal associations amongst any number of phenotypic outcomes. We used a sample of 8,121 children from the ALSPAC dataset, and tested the linear association of a BMI-associated allele score with 172 phenotypic outcomes (with variable sample sizes). We also performed an instrumental variable analysis to estimate the causal effect of BMI on each phenotype. We found 21 of the 172 outcomes were associated with the allele score at an unadjusted p < 0.05 threshold, and use Bonferroni corrections, permutation testing and estimates of the false discovery rate to consider the strength of results given the number of tests performed. The most strongly associated outcomes included leptin, lipid profile, and blood pressure. We also found novel evidence of effects of BMI on a global self-worth score.
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Affiliation(s)
- Louise A C Millard
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol.,Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
| | - Nic J Timpson
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
| | - Kate Tilling
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
| | - Peter A Flach
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol.,Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
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17
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FTO Is Associated with Aortic Valve Stenosis in a Gender Specific Manner of Heterozygote Advantage: A Population-Based Case-Control Study. PLoS One 2015; 10:e0139419. [PMID: 26431034 PMCID: PMC4592246 DOI: 10.1371/journal.pone.0139419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 09/14/2015] [Indexed: 12/18/2022] Open
Abstract
Background Single nucleotide polymorphisms (SNPs) within the Fat mass and obesity associated (FTO) gene have been linked with increased body weight. However, the data on an association of FTO with cardiovascular diseases remains conflicting. Therefore, we ascertained whether FTO is associated with aortic valve stenosis (AVS), one of the most frequent cardiovascular diseases in the Western world. Methods and Findings In this population-based case-control study the FTO SNP rs9939609 was analyzed in 300 German patients with AVS and 429 German controls of the KORA survey S4, representing a random population. Blood samples were collected prior to aortic valve replacement in AVS cases and FTO rs9939609 was genotyped via ARMS-PCR. Genotype frequencies differed significantly between AVS cases and KORA controls (p = 0.004). Separate gender-analyses uncovered an association of FTO with AVS exclusively in males; homozygote carriers for the risk-allele (A) had a higher risk to develop AVS (p = 0.017, odds ratio (OR) 1.727; 95% confidence interval (CI) 1.087–2.747, recessive model), whereas heterozygote carriers for the risk-allele showed a lower risk (p = 0.002, OR 0.565, 95% CI 0.384–0.828, overdominant model). After adjustment for multiple co-variables, the odds ratios of heterozygotes remained significant for an association with AVS (p = 0.008, OR 0.565, 95% CI 0.369–0.861). Conclusions This study revealed an association of FTO rs9939609 with AVS. Furthermore, this association was restricted to men, with heterozygotes having a significantly lower chance to develop AVS. Lastly, the association between FTO and AVS was independent of BMI and other variables such as diabetes mellitus.
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18
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Chan NPT, Choi KC, Nelson EAS, Chan JC, Kong APS. Associations of pubertal stage and body mass index with cardiometabolic risk in Hong Kong Chinese children: A cross-sectional study. BMC Pediatr 2015; 15:136. [PMID: 26403455 PMCID: PMC4582725 DOI: 10.1186/s12887-015-0446-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 09/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Puberty is associated with a clustering of cardiometabolic risk factors (CMRFs) during adolescence that are manifested in later life. Although anthropometric variables such as body mass index (BMI) can predict cardiometabolic risk in children and adolescents, it is not clear whether there is an interaction between pubertal stage and BMI associated with cardiometabolic risk in this age group. This paper examines the association of pubertal stage and BMI with CMRFs in Hong Kong Chinese children. METHODS A cross-sectional school-based study was conducted among 1985 (95.1%) students aged 6 to 18 years. Fasting lipid profile and plasma glucose, blood pressure, body weight, body height and waist circumference were measured. A self-reported pubertal stage questionnaire was used to assess pubertal stage of participants. Two cardiometabolic risk scores, alpha and beta, were constructed to quantify cardiometabolic risk. Cardiometabolic risk score alpha refers to the sum of z-scores of sex-specific, age-adjusted waist circumference, height-adjusted systolic and diastolic blood pressure, fasting plasma glucose, triglyceride and low-density lipoprotein cholesterol, and minus z-score of sex-specific age-adjusted high-density lipoprotein cholesterol. Cardiometabolic risk score beta includes all components of risk score alpha except waist circumference. RESULTS The interaction of BMI z-score (ZBMI) and pubertal stage demonstrated a further increase in variance explained in both the cardiometabolic risk scores alpha and beta (0.5% and 0.8% respectively) in boys and (0.7% and 0.5% respectively) in girls. CONCLUSIONS Pubertal stage has an interaction effect on the association of cardiometabolic risk by BMI in boys and may have a similar but lesser effect in girls.
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Affiliation(s)
- Noel P T Chan
- The School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
| | - Kai C Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 7th floor, Esther Lee Building, Shatin, N.T., Hong Kong SAR, China.
| | - E Anthony S Nelson
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Juliana C Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
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19
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Abstract
A life course approach in epidemiology investigates the biological, behavioral and social pathways that link physical and social exposures and experiences during gestation, childhood, adolescence and adult life, and across generations, to later-life health and disease risk. We illustrate how a life course approach has been applied to cardiovascular disease, highlighting the evidence in support of the early origins of disease risk. We summarize how trajectories of cardiometabolic risk factors change over the life course and suggest that understanding underlying 'normal' or 'healthy' trajectories and the characteristics that drive deviations from such trajectories offer the potential for early prevention and for identifying means of preventing future disease.
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Affiliation(s)
- Rebecca Hardy
- MRC Unit for Lifelong Health & Ageing at UCL, 33 Bedford Place, London, WC1B 5JU, UK
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20
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Boef AGC, Dekkers OM, le Cessie S. Mendelian randomization studies: a review of the approaches used and the quality of reporting. Int J Epidemiol 2015; 44:496-511. [PMID: 25953784 DOI: 10.1093/ije/dyv071] [Citation(s) in RCA: 282] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mendelian randomization (MR) studies investigate the effect of genetic variation in levels of an exposure on an outcome, thereby using genetic variation as an instrumental variable (IV). We provide a meta-epidemiological overview of the methodological approaches used in MR studies, and evaluate the discussion of MR assumptions and reporting of statistical methods. METHODS We searched PubMed, Medline, Embase and Web of Science for MR studies up to December 2013. We assessed (i) the MR approach used; (ii) whether the plausibility of MR assumptions was discussed; and (iii) whether the statistical methods used were reported adequately. RESULTS Of 99 studies using data from one study population, 32 used genetic information as a proxy for the exposure without further estimation, 44 performed a formal IV analysis, 7 compared the observed with the expected genotype-outcome association, and 1 used both the latter two approaches. The 80 studies using data from multiple study populations used many different approaches to combine the data; 52 of these studies used some form of IV analysis; 44% of studies discussed the plausibility of all three MR assumptions in their study. Statistical methods used for IV analysis were insufficiently described in 14% of studies. CONCLUSIONS Most MR studies either use the genotype as a proxy for exposure without further estimation or perform an IV analysis. The discussion of underlying assumptions and reporting of statistical methods for IV analysis are frequently insufficient. Studies using data from multiple study populations are further complicated by the combination of data or estimates. We provide a checklist for the reporting of MR studies.
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Affiliation(s)
- Anna G C Boef
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
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21
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Goodman D, Park HL, Stefanick M, Hingle M, Lamonte M, LeBlanc E, Johnson K, Desai M, Anton-Culver H. Self-recalled Youth Physical Activity and Postmenopausal Cardiovascular Disease. HEALTH BEHAVIOR AND POLICY REVIEW 2014; 1:472-483. [PMID: 26523282 PMCID: PMC4627784 DOI: 10.14485/hbpr.1.6.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the association between childhood physical activity and incident cardiovascular disease (CVD) during postmenopausal years. METHODS Proportional hazards and logistic regression were used describe the association between self-reported childhood physical activity and CVD incidence and mortality in 36,741 postmenopausal women. RESULTS Older women, African-Americans, or nondrinkers or past drinkers self-reported the highest levels of youth physical activity and women with a history of diabetes, hypertension, overweight or obesity, or current smoking reported the highest youth physical activity dose. Youth physical activity was not associated with CVD incidence (HR=1.11; 0.93, 1.34) or mortality (HR=1.2; 0.9, 1.73). CONCLUSIONS Self-reported youth activity was not associated with postmenopausal CVD incidence or mortality.
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Affiliation(s)
- Deborah Goodman
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Hannah Lui Park
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Marcia Stefanick
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Melanie Hingle
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Michael Lamonte
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Erine LeBlanc
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Karen Johnson
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Manisha Desai
- Department of Epidemiology, University of California, Irvine, Irvine, CA
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, Irvine, CA
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22
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Burgess S, Malarstig A. Using Mendelian randomization to assess and develop clinical interventions: limitations and benefits. J Comp Eff Res 2014; 2:209-12. [PMID: 24236616 DOI: 10.2217/cer.13.14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Stephen Burgess
- Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
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23
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Mathur J, Guthrie JD, Javed U, Sheikh MY. Evaluation of the Association between Compensated Hepatitis C Infectivity and Endothelial Dysfunction, Using Flow-Mediated Vasodilatation of the Brachial Artery. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314531854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Aim: We prospectively investigated, using sonographic methods, whether hepatitis C infection in compensated patients is related to endothelial dysfunction of the brachial artery, a potential indicator of subclinical atherosclerosis. Methods: Brachial artery flow-mediated dilatation (FMD) was used as a noninvasive test to measure the endothelial function of the brachial artery among the cases and the controls. The peak systolic velocity (PSV) and the resistive index (RI) were also measured. Multivariate statistics were used to compare the FMD, PSV, and RI in 28 cases (diagnosed with hepatitis C) and 14 healthy controls, all of whom were without cardiovascular risk factors or a history of cardiovascular disease. Results: Flow-mediated dilatation (baseline to 1 minute post-cuff inflation) was positively correlated with the patient’s body mass index (BMI) (Pearson’s r = .309, P = .025). When the BMI was accounted for using analysis of covariance (ANCOVA), there was no evidence for a significant difference between the mean FMD of the cases versus the controls ( F = 0.11, P = .598). The mean FMD was 6.6% (95% confidence interval [CI], 3.1%-10.2%) among the cases and 7.3% (95% CI, 1.1%-13.6%) among the controls. Peak systolic velocity and RI (baseline to 3 minutes post-cuff inflation) were not positively correlated with BMI. The mean PSV was 0.57 m/s (95% CI, 0.51-0.66) for the cases and 0.64 m/s (95% CI, 0.56-0.72) for the controls; repeated measures analysis of variance (ANOVA) indicated no significant difference ( F = 1.65, P = .208). Similarly, the mean RI was 0.87 (95% CI, 0.85-0.89) among the cases and 0.64 (95% CI, 0.82-0.88) among the controls, with no significant difference ( P = .772). Conclusion: Our results show that hepatitis C positivity in compensated patients, in the absence of cardiovascular risk factors, does not appear to be independently associated with endothelial dysfunction when objectively analyzed by brachial artery flow-mediated vasodilatation.
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Affiliation(s)
- Jagrati Mathur
- Division of Internal Medicine, University of California, San Francisco, Fresno, CA, USA
| | - Joy D. Guthrie
- Medical Imaging, Community Regional Medical Center, Fresno, CA, USA
| | - Usman Javed
- Medical Imaging, Community Regional Medical Center, Fresno, CA, USA
- Division of Cardiology, University of California, San Francisco, Fresno, CA, USA
| | - Muhammad Y. Sheikh
- Division of Gastroenterology, University of California, San Francisco, Fresno, CA, USA
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24
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von Hinke Kessler Scholder S, Wehby GL, Lewis S, Zuccolo L. Alcohol Exposure In Utero and Child Academic Achievement. ECONOMIC JOURNAL (LONDON, ENGLAND) 2014; 124:634-667. [PMID: 25431500 PMCID: PMC4243528 DOI: 10.1111/ecoj.12144] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We examine the effect of alcohol exposure in utero on child academic achievement. As well as studying the effect of any alcohol exposure, we investigate the effect of the dose, pattern, and duration of exposure. We use a genetic variant in the maternal alcohol-metabolism gene ADH1B as an instrument for alcohol exposure, whilst controlling for the child's genotype on the same variant. We show that the instrument is unrelated to an extensive range of maternal and paternal characteristics and behaviours. OLS regressions suggest an ambiguous association between alcohol exposure in utero and children's academic attainment, but there is a strong social gradient in maternal drinking, with mothers in higher socio-economic groups more likely to drink. In stark contrast to the OLS, the IV estimates show negative effects of prenatal alcohol exposure on child educational attainment. These results are very robust to an extensive set of model specifications. In addition, we show that that the effects are solely driven by the maternal genotype, with no impact of the child's genotype.
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25
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When to prevent cardiovascular disease? As early as possible: lessons from prospective cohorts beginning in childhood. Curr Opin Cardiol 2014; 28:561-8. [PMID: 23928921 DOI: 10.1097/hco.0b013e32836428f4] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW To detail recent developments linking modifiable youth risk factors with preclinical markers of cardiovascular disease such as carotid artery intima-media thickness, pulse-wave velocity (PVW) and large artery stiffness, brachial artery flow-mediated dilatation, left ventricular geometry, and coronary artery calcification in adulthood. RECENT FINDINGS Population-based data from prospective cohort studies beginning in youth with follow-up into adulthood have shown that the modifiable youth risk factors of elevated blood lipids, blood pressure, and adiposity, smoking (active and passive), metabolic disorders, physical inactivity, low cardiorespiratory fitness, and diet associate with preclinical markers of cardiovascular disease in adulthood. The data suggest that, in some instances, those who amend their trajectory by not maintaining these risk factors into adulthood experience reductions in preclinical markers to levels associated with never having had the risk factor. SUMMARY Though avoidance of risk factors in youth is ideal, there is still a window for intervention where long-lasting cardiovascular effects might be avoided. Health-enhancing changes in the rates of active and passive smoking, adiposity, increased physical activity, accentuated fitness, modified diet, and socioeconomic position in the transition from youth to adulthood might be important in modifying an individual's trajectory from high risk in youth to low risk in adulthood.
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Holmes MV, Lange LA, Palmer T, Lanktree MB, North KE, Almoguera B, Buxbaum S, Chandrupatla HR, Elbers CC, Guo Y, Hoogeveen RC, Li J, Li YR, Swerdlow DI, Cushman M, Price TS, Curtis SP, Fornage M, Hakonarson H, Patel SR, Redline S, Siscovick DS, Tsai MY, Wilson JG, van der Schouw YT, FitzGerald GA, Hingorani AD, Casas JP, de Bakker PIW, Rich SS, Schadt EE, Asselbergs FW, Reiner AP, Keating BJ. Causal effects of body mass index on cardiometabolic traits and events: a Mendelian randomization analysis. Am J Hum Genet 2014; 94:198-208. [PMID: 24462370 PMCID: PMC3928659 DOI: 10.1016/j.ajhg.2013.12.014] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022] Open
Abstract
Elevated body mass index (BMI) associates with cardiometabolic traits on observational analysis, yet the underlying causal relationships remain unclear. We conducted Mendelian randomization analyses by using a genetic score (GS) comprising 14 BMI-associated SNPs from a recent discovery analysis to investigate the causal role of BMI in cardiometabolic traits and events. We used eight population-based cohorts, including 34,538 European-descent individuals (4,407 type 2 diabetes (T2D), 6,073 coronary heart disease (CHD), and 3,813 stroke cases). A 1 kg/m(2) genetically elevated BMI increased fasting glucose (0.18 mmol/l; 95% confidence interval (CI) = 0.12-0.24), fasting insulin (8.5%; 95% CI = 5.9-11.1), interleukin-6 (7.0%; 95% CI = 4.0-10.1), and systolic blood pressure (0.70 mmHg; 95% CI = 0.24-1.16) and reduced high-density lipoprotein cholesterol (-0.02 mmol/l; 95% CI = -0.03 to -0.01) and low-density lipoprotein cholesterol (LDL-C; -0.04 mmol/l; 95% CI = -0.07 to -0.01). Observational and causal estimates were directionally concordant, except for LDL-C. A 1 kg/m(2) genetically elevated BMI increased the odds of T2D (odds ratio [OR] = 1.27; 95% CI = 1.18-1.36) but did not alter risk of CHD (OR 1.01; 95% CI = 0.94-1.08) or stroke (OR = 1.03; 95% CI = 0.95-1.12). A meta-analysis incorporating published studies reporting 27,465 CHD events in 219,423 individuals yielded a pooled OR of 1.04 (95% CI = 0.97-1.12) per 1 kg/m(2) increase in BMI. In conclusion, we identified causal effects of BMI on several cardiometabolic traits; however, whether BMI causally impacts CHD risk requires further evidence.
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Affiliation(s)
- Michael V Holmes
- Division of Transplantation, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Genetic Epidemiology Group, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | - Leslie A Lange
- Department of Genetics, University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Tom Palmer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Matthew B Lanktree
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Kari E North
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Berta Almoguera
- Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sarah Buxbaum
- Jackson Heart Study Coordinating Center, Jackson State University, 350 West Woodrow Wilson Avenue, Suite 701, Jackson, MS 39213, USA
| | - Hareesh R Chandrupatla
- Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Clara C Elbers
- Complex Genetics Section, Department of Medical Genetics, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Yiran Guo
- Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Ron C Hoogeveen
- Division of Atherosclerosis & Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jin Li
- Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yun R Li
- Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Daniel I Swerdlow
- Genetic Epidemiology Group, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, 208 South Park Drive, Colchester, VT 05446 USA
| | - Tom S Price
- The Institute for Translational Medicine and Therapeutics, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sean P Curtis
- Merck Research Laboratories, P.O. Box 2000, Rahway, NJ 07065, USA
| | - Myriam Fornage
- The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Sanjay R Patel
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - David S Siscovick
- Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA 98101, USA
| | - Michael Y Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN 55414, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands
| | - Garret A FitzGerald
- The Institute for Translational Medicine and Therapeutics, School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aroon D Hingorani
- Genetic Epidemiology Group, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Juan P Casas
- Genetic Epidemiology Group, Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, 1-19 Torrington Place, London WC1E 6BT, UK; Faculty of Epidemiology and Public Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Paul I W de Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands; Brigham and Women's Hospital, 77 Avenue Louis Pasteur, New Research Building, Room 168, Boston, MA 02115, USA
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA
| | - Eric E Schadt
- Department of Genomics, Mount Sinai School of Medicine, New York, NY 10029, USA
| | - Folkert W Asselbergs
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; Durrer Center for Cardiogenetic Research, ICIN - Netherlands Heart Institute, Catharijnesingel 52, Postbus 19258, 3501 DG Utrecht, the Netherlands; Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London WC1E 6BT, UK
| | - Alex P Reiner
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA 22908, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Brendan J Keating
- Division of Transplantation, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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What the Long Term Cohort Studies that Began in Childhood Have Taught Us about the Origins of Coronary Heart Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0373-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Fall T, Ingelsson E. Genome-wide association studies of obesity and metabolic syndrome. Mol Cell Endocrinol 2014; 382:740-757. [PMID: 22963884 DOI: 10.1016/j.mce.2012.08.018] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 05/04/2012] [Accepted: 08/27/2012] [Indexed: 11/29/2022]
Abstract
Until just a few years ago, the genetic determinants of obesity and metabolic syndrome were largely unknown, with the exception of a few forms of monogenic extreme obesity. Since genome-wide association studies (GWAS) became available, large advances have been made. The first single nucleotide polymorphism robustly associated with increased body mass index (BMI) was in 2007 mapped to a gene with for the time unknown function. This gene, now known as fat mass and obesity associated (FTO) has been repeatedly replicated in several ethnicities and is affecting obesity by regulating appetite. Since the first report from a GWAS of obesity, an increasing number of markers have been shown to be associated with BMI, other measures of obesity or fat distribution and metabolic syndrome. This systematic review of obesity GWAS will summarize genome-wide significant findings for obesity and metabolic syndrome and briefly give a few suggestions of what is to be expected in the next few years.
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Affiliation(s)
- Tove Fall
- Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Erik Ingelsson
- Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden.
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Johnson W, Kuh D, Tikhonoff V, Charakida M, Woodside J, Whincup P, Hughes AD, Deanfield JE, Hardy R. Body mass index and height from infancy to adulthood and carotid intima-media thickness at 60 to 64 years in the 1946 British Birth Cohort Study. Arterioscler Thromb Vasc Biol 2014; 34:654-60. [PMID: 24458709 DOI: 10.1161/atvbaha.113.302572] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Atherosclerosis begins early in life and obesity is a key determinant. We investigated the role of body mass index (BMI) and height from infancy to adulthood in presenting with high adulthood carotid intima-media thickness. APPROACH AND RESULTS Odds ratios of BMI, and height Z scores at 2, 4, 6, 7, 11, 15, and 20 years, and changes between 2 and 4, 4 and 7, 7 and 15, and 15 and 20 years, for carotid intima-media thickness at 60 to 64 years in the upper quartile were estimated for 604 men and 669 women. Confounding by early-life environments, mediating by body size and cardiometabolic measures at 60 to 64 years, and effect modification were investigated. In men, there was positive association of BMI at 4 years (odds ratio, 1.256; 95% confidence interval, 1.026-1.538) and 20 years (1.282; 1.022-1.609), negative association of height at 4 years (0.780; 0.631-0.964), and negative association of height growth between 2 and 4 years (0.698; 0.534-0.913) with high carotid intima-media thickness. The childhood estimates were robust, but the estimate for BMI at 20 years was attenuated by adjustment for BMI at 60 to 64 years. The protective influence of greater early childhood height was strongest in those with the lowest systolic blood pressure at 60 to 64 years. In women, there was no pattern of association and all confidence intervals crossed 1. CONCLUSIONS Early childhood in men might be a sensitive developmental period for atherosclerosis, in which changes in BMI and height represent 2 distinct biological mechanisms. The maintenance of healthy weight in men from adolescence onward may be a useful strategy to avoid the atherosclerotic complications of adiposity tracking.
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Affiliation(s)
- William Johnson
- From the MRC Unit for Lifelong Health and Ageing at UCL (W.J., D.K., V.T., R.H.) and National Centre for Cardiovascular Prevention and Outcomes, Institute of Cardiovascular Science (M.C., J.W., J.E.D.), University College London, London, United Kingdom; Population Health Research Centre, Division of Population Health Sciences and Education, St George's University of London, London, United Kingdom (P.W.); and International Centre for Circulatory Health, National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom (A.D.H.)
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Kelleher RJ, Soiza RL. Evidence of endothelial dysfunction in the development of Alzheimer's disease: Is Alzheimer's a vascular disorder? AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2013; 3:197-226. [PMID: 24224133 PMCID: PMC3819581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
The etiology of Alzheimer's disease (AD) remains unclear. The emerging view is that cerebrovascular dysfunction is a feature not only of cerebrovascular diseases, such as stroke, but also of neurodegenerative conditions, such as AD. In AD, there is impaired structure and function of cerebral blood vessels and cells in the neurovascular unit. These effects are mediated by vascular oxidative stress. Injury to the neurovascular unit alters cerebral blood flow regulation, depletes vascular reserves, disrupts the blood-brain barrier and reduces the brain's repair capacity. Such injury can exacerbate the cognitive dysfunction exerted by incident ischemia and coexisting neurodegeneration. This article summarises data regarding cardiovascular risk factors, vascular abnormalities and brain endothelial damage in AD. In view of accumulating evidence of vascular pathology in AD, we also review the literature (MEDLINE, EMBASE) for clinical evidence of impaired endothelial function in AD. A total of 15 articles investigating endothelial dysfunction in AD were identified. 10 of these articles showed impaired endothelial function in AD patients. The current literature suggests endothelial dysfunction may be involved in the pathogenesis of AD. This aspect of AD pathology is particularly interesting in view of its potential for therapeutic intervention. Future research on endothelial function in AD should concentrate on population-based analysis and combine multiple methods to evaluate endothelial function.
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Affiliation(s)
- Rory J Kelleher
- School of Medical Sciences, University of AberdeenUnited Kingdom
| | - Roy L Soiza
- Health Services Research Unit, University of AberdeenAberdeen, United Kingdom
- Department of Medicine for The Elderly, NHS GrampianAberdeen, United Kingdom
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The FTO gene rs9939609 polymorphism predicts risk of cardiovascular disease: a systematic review and meta-analysis. PLoS One 2013; 8:e71901. [PMID: 23977173 PMCID: PMC3747067 DOI: 10.1371/journal.pone.0071901] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 07/05/2013] [Indexed: 01/09/2023] Open
Abstract
Objective Genome-wide association studies have shown that variance in the fat mass- and obesity- associated gene (FTO) is associated with risk of obesity in Europeans and Asians. Since obesity is associated with an increased risk of cardiovascular disease (CVD), several studies have investigated the association between variant in the FTO gene and CVD risk, with inconsistent results. In this study, we performed a meta-analysis to clarify the association of rs9939609 variant (or its proxies [r2>0.90]) in the FTO gene with CVD risk. Methods Published literature from PubMed and Embase was retrieved. Pooled odds ratios with 95% confidence intervals were calculated using the fixed- or random- effects model. Results A total of 10 studies (comprising 19,153 CVD cases and 103,720 controls) were included in the meta-analysis. The results indicated that the rs9939609 variant was significantly associated with CVD risk (odds ratio = 1.18, 95% confidence interval = 1.07–1.30, p = 0.001 [Z test], I2 = 80.6%, p<0.001 [heterogeneity]), and there was an insignificant change after adjustment for body mass index (BMI) and other conventional CVD risk factors (odds ratio = 1.16, 95% confidence interval = 1.05–1.27, p = 0.003 [Z test], I2 = 75.4%, p<0.001 [heterogeneity]). Conclusions The present meta-analysis confirmed the significant association of the rs9939609 variant in the FTO gene with CVD risk, which was independent of BMI and other conventional CVD risk factors.
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Winter Y, Sankowski R, Back T. Genetic determinants of obesity and related vascular diseases. VITAMINS AND HORMONES 2013; 91:29-48. [PMID: 23374711 DOI: 10.1016/b978-0-12-407766-9.00002-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obesity is one of the major risk factors of vascular diseases, and its prevalence is increasing worldwide. In the past decade, progress has been made in the understanding of genetic determinants of obesity and obesity-associated diseases. Genome-wide association studies identified a number of genetic variants associated with obesity. In addition to common variants, FTO and MC4R, new loci, such as TMEM18, KCTD15, GNPDA2, SH2B1, MTCH2, and NEGR1 have been detected. In the past years, abdominal obesity has been shown to be a more important vascular risk factor than the body mass index. In the context of vascular risk assessment, identification of genetic polymorphisms associated with accumulation of visceral fat is of special importance. Some polymorphisms associated with abdominal obesity, such as variants of gene encoding microsomal triglyceride transfer protein, have been already discovered. In this chapter, we provide a review of genetic determinants of obesity and discuss their role in obesity-related vascular diseases.
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Affiliation(s)
- Yaroslav Winter
- Department of Neurology, Philipps-University, Marburg Germany
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von Hinke Kessler Scholder S, Davey Smith G, Lawlor DA, Propper C, Windmeijer F. Child height, health and human capital: Evidence using genetic markers. EUROPEAN ECONOMIC REVIEW 2013; 57:1-22. [PMID: 25673883 PMCID: PMC4318168 DOI: 10.1016/j.euroecorev.2012.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 09/27/2012] [Indexed: 05/09/2023]
Abstract
Height has long been recognized as being associated with better outcomes: the question is whether this association is causal. We use children's genetic variants as instrumental variables to deal with possible unobserved confounders and examine the effect of child/adolescent height on a wide range of outcomes: academic performance, IQ, self-esteem, depression symptoms and behavioral problems. OLS findings show that taller children have higher IQ, perform better in school, and are less likely to have behavioral problems. The IV results differ: taller girls (but not boys) have better cognitive performance and, in contrast to the OLS, greater height appears to increase behavioral problems.
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Affiliation(s)
- Stephanie von Hinke Kessler Scholder
- Department of Economics and Related Studies, University of York, Heslington, York YO10 5DD, UK
- CMPO, University of Bristol, 2 Priory Road, Bristol BS8 1TX, UK
| | - George Davey Smith
- MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Debbie A. Lawlor
- MRC Centre for Causal Analyses in Translational Epidemiology (CAiTE), School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK
| | - Carol Propper
- CMPO and Department of Economics, University of Bristol, 2 Priory Road, Bristol BS8 1TX, UK
- Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Frank Windmeijer
- CMPO and Department of Economics, University of Bristol, 2 Priory Road, Bristol BS8 1TX, UK
- Centre for Microdata, Methods and Practice, UK
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The role of adiposity in cardiometabolic traits: a Mendelian randomization analysis. PLoS Med 2013; 10:e1001474. [PMID: 23824655 PMCID: PMC3692470 DOI: 10.1371/journal.pmed.1001474] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 05/14/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The association between adiposity and cardiometabolic traits is well known from epidemiological studies. Whilst the causal relationship is clear for some of these traits, for others it is not. We aimed to determine whether adiposity is causally related to various cardiometabolic traits using the Mendelian randomization approach. METHODS AND FINDINGS We used the adiposity-associated variant rs9939609 at the FTO locus as an instrumental variable (IV) for body mass index (BMI) in a Mendelian randomization design. Thirty-six population-based studies of individuals of European descent contributed to the analyses. Age- and sex-adjusted regression models were fitted to test for association between (i) rs9939609 and BMI (n = 198,502), (ii) rs9939609 and 24 traits, and (iii) BMI and 24 traits. The causal effect of BMI on the outcome measures was quantified by IV estimators. The estimators were compared to the BMI-trait associations derived from the same individuals. In the IV analysis, we demonstrated novel evidence for a causal relationship between adiposity and incident heart failure (hazard ratio, 1.19 per BMI-unit increase; 95% CI, 1.03-1.39) and replicated earlier reports of a causal association with type 2 diabetes, metabolic syndrome, dyslipidemia, and hypertension (odds ratio for IV estimator, 1.1-1.4; all p < 0.05). For quantitative traits, our results provide novel evidence for a causal effect of adiposity on the liver enzymes alanine aminotransferase and gamma-glutamyl transferase and confirm previous reports of a causal effect of adiposity on systolic and diastolic blood pressure, fasting insulin, 2-h post-load glucose from the oral glucose tolerance test, C-reactive protein, triglycerides, and high-density lipoprotein cholesterol levels (all p < 0.05). The estimated causal effects were in agreement with traditional observational measures in all instances except for type 2 diabetes, where the causal estimate was larger than the observational estimate (p = 0.001). CONCLUSIONS We provide novel evidence for a causal relationship between adiposity and heart failure as well as between adiposity and increased liver enzymes.
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Wehby GL, von Hinke Kessler Scholder S. Genetic instrumental variable studies of effects of prenatal risk factors. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2013; 59:4-36. [PMID: 23701534 PMCID: PMC3690512 DOI: 10.1080/19485565.2013.774615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Identifying the effects of maternal risk factors during pregnancy on infant and child health is an area of tremendous research interest. However, policymakers are primarily interested in unraveling the causal effects of prenatal risk factors, not their associations with child health, which may be confounded by several unobserved factors. In this article, we evaluate the utility of genetic variants in three genes that have unequivocal evidence of being related to three major risk factors-CHRNA3 for smoking, ADH1B for alcohol use, and FTO for obesity-as instrumental variables for identifying the causal effects of such factors during pregnancy. Using two independent datasets, we find that these variants are overall predictive of the risk factors and are not systematically related to observed confounders, suggesting that they may be useful instruments. We also find some suggestive evidence that genetic effects are stronger during than before pregnancy. We provide an empirical example illustrating the use of these genetic variants as instruments to evaluate the effects of risk factors on birth weight. Finally, we offer suggestions for researchers contemplating the use of these variants as instruments.
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Affiliation(s)
- George L. Wehby
- Assistant Professor, Department of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 GH, Iowa City, IA 52242, Phone: 1-319-384-5133, Fax: 1-319-384-5125,
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Richmond RC, Timpson NJ. Recent Findings on the Genetics of Obesity: Is there Public Health Relevance? Curr Nutr Rep 2012. [DOI: 10.1007/s13668-012-0027-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Magnussen CG, Niinikoski H, Juonala M, Kivimäki M, Rönnemaa T, Viikari JSA, Simell O, Raitakari OT. When and how to start prevention of atherosclerosis? Lessons from the Cardiovascular Risk in the Young Finns Study and the Special Turku Coronary Risk Factor Intervention Project. Pediatr Nephrol 2012; 27:1441-52. [PMID: 21877168 DOI: 10.1007/s00467-011-1990-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 12/14/2022]
Abstract
This review provides an up-to-date summary of findings from two ongoing population-based, prospective studies conducted in Finland: The Cardiovascular Risk in Young Finns Study, and the Special Turku Coronary Risk Factor Intervention Project (STRIP), which have contributed significantly to the scientific literature concerning the childhood origin of cardiovascular disease, and whether prevention efforts in adults can be expanded to young people. From the Young Finns Study, we summarize evidence demonstrating childhood risk factors to be associated with both risk factors and preclinical markers of atherosclerosis in adulthood, and from STRIP, we summarize evidence showing that supervised dietary counseling of a low saturated fat diet effectively decreases exposure to cardiovascular risk factors without affecting growth and development of healthy children and adolescents. The evidence available from these studies supports that the ability to prevent or delay the risk of premature atherosclerosis and its clinical sequelae later in life lies in maintaining a low lifetime risk by preventing the development of risk factors in early life.
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Affiliation(s)
- Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520, Finland, Finland
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Haring R, Teumer A, Völker U, Dörr M, Nauck M, Biffar R, Völzke H, Baumeister SE, Wallaschofski H. Mendelian randomization suggests non-causal associations of testosterone with cardiometabolic risk factors and mortality. Andrology 2012; 1:17-23. [PMID: 23258625 DOI: 10.1111/j.2047-2927.2012.00002.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/11/2012] [Accepted: 06/19/2012] [Indexed: 11/30/2022]
Abstract
Prospective studies showed that low serum testosterone concentrations are associated with various cardiometabolic risk factors and mortality. However, the causal nature of these associations is controversial. We studied 1 882 men aged 20-79 years with serum testosterone concentrations and genotyping data from the longitudinal population-based Study of Health in Pomerania. Testosterone concentrations were cross-sectionally associated with cardiometabolic risk factors, including anthropometric, lipid, blood pressure and glycaemic parameters; and prospectively with all-cause mortality (277 deaths, 14.7%) during the 10-year follow-up. To overcome problems of residual confounding, reverse causation, or regression dilution bias in the investigated testosterone-outcome associations, we used two-stage least square regression models with previously identified polymorphisms at the SHBG gene (rs12150660) and X chromosome (rs5934505) as multiple genetic instruments in an instrumental variable (IV) approach, also known as Mendelian randomization. In standard regression analyses, testosterone was robustly associated with a wide range of cardiometabolic risk factors. In subsequent IV analyses, no such significant associations were observed. Similarly, prospective analyses showed a consistent association of low testosterone concentrations with increased all-cause mortality risk, which was not apparent in subsequent IV analyses. The present Mendelian randomization analyses did not detect any evidence for causal associations of testosterone concentrations with cardiometabolic risk factors and mortality, suggesting that previously reported associations might largely result from residual confounding or reverse causation. Although testosterone assessment might improve risk prediction, implementation of testosterone replacement therapy requires further evidence of a direct effect on cardiometabolic outcomes from double-blinded randomized controlled trials and large-scale Mendelian randomization meta-analyses.
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Affiliation(s)
- R Haring
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, Greifswald, Germany.
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Choquet H, Meyre D. Genetics of Obesity: What have we Learned? Curr Genomics 2011; 12:169-79. [PMID: 22043165 PMCID: PMC3137002 DOI: 10.2174/138920211795677895] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 03/31/2011] [Accepted: 03/31/2011] [Indexed: 12/14/2022] Open
Abstract
Candidate gene and genome-wide association studies have led to the discovery of nine loci involved in Mendelian forms of obesity and 58 loci contributing to polygenic obesity. These loci explain a small fraction of the heritability for obesity and many genes remain to be discovered. However, efforts in obesity gene identification greatly modified our understanding of this disorder. In this review, we propose an overlook of major lessons learned from 15 years of research in the field of genetics and obesity. We comment on the existence of the genetic continuum between monogenic and polygenic forms of obesity that pinpoints the role of genes involved in the central regulation of food intake and genetic predisposition to obesity. We explain how the identification of novel obesity predisposing genes has clarified unsuspected biological pathways involved in the control of energy balance that have helped to understand past human history and to explore causality in epidemiology. We provide evidence that obesity predisposing genes interact with the environment and influence the response to treatment relevant to disease prediction.
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Affiliation(s)
- Hélène Choquet
- Ernest Gallo Clinic and Research Center, Department of Neurology, University of California, San Francisco, Emeryville, California 94608, USA
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Kivimäki M, Jokela M, Hamer M, Geddes J, Ebmeier K, Kumari M, Singh-Manoux A, Hingorani A, Batty GD. Examining overweight and obesity as risk factors for common mental disorders using fat mass and obesity-associated (FTO) genotype-instrumented analysis: The Whitehall II Study, 1985-2004. Am J Epidemiol 2011; 173:421-9. [PMID: 21248310 DOI: 10.1093/aje/kwq444] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Mendelian randomization approach exploits genetic variants to improve causal inference when using observational data. The authors examined the relation between long-term obesity and common mental disorders (CMD) by utilizing the known relation between fat mass and obesity-associated (FTO) genotype and body mass index (BMI; weight (kg)/height (m)(2)). Data collection in 2,981 men and 1,164 women (mean age at baseline = 44 years) from the Whitehall II Study (London, United Kingdom) included 4 repeated examinations of BMI and CMD over a 19-year follow-up period (1985-2004), plus an assessment of FTO polymorphism rs1421085. In men, there was an association of FTO genotype with all measures of adiposity (mean BMI, number of times obese, and, in nonobese persons, number of times overweight). FTO was also associated with CMD in men. This was independent of adiposity, thus potentially violating the exclusion restriction assumption. According to both conventional and FTO-instrumented regression analysis, measurement of obesity was associated with an increased occurrence of CMD. In the FTO-instrumented analysis only, higher BMI and overweight were also associated with CMD. In women, there was no link between FTO and adiposity. Mendelian randomization analyses supported the status of long-term obesity as a risk factor for CMD in men-a finding that should be interpreted cautiously because the function of the FTO gene is unknown.
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Affiliation(s)
- Mika Kivimäki
- Department of Epidemiology and Public Health, Faculty of Biomedical Sciences, University College London, United Kingdom
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Mumby HS, Elks CE, Li S, Sharp SJ, Khaw KT, Luben RN, Wareham NJ, Loos RJF, Ong KK. Mendelian Randomisation Study of Childhood BMI and Early Menarche. J Obes 2011; 2011:180729. [PMID: 21773002 PMCID: PMC3136158 DOI: 10.1155/2011/180729] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/04/2011] [Accepted: 04/07/2011] [Indexed: 02/03/2023] Open
Abstract
To infer the causal association between childhood BMI and age at menarche, we performed a mendelian randomisation analysis using twelve established "BMI-increasing" genetic variants as an instrumental variable (IV) for higher BMI. In 8,156 women of European descent from the EPIC-Norfolk cohort, height was measured at age 39-77 years; age at menarche was self-recalled, as was body weight at age 20 years, and BMI at 20 was calculated as a proxy for childhood BMI. DNA was genotyped for twelve BMI-associated common variants (in/near FTO, MC4R, TMEM18, GNPDA2, KCTD15, NEGR1, BDNF, ETV5, MTCH2, SEC16B, FAIM2 and SH2B1), and for each individual a "BMI-increasing-allele-score" was calculated by summing the number of BMI-increasing alleles across all 12 loci. Using this BMI-increasing-allele-score as an instrumental variable for BMI, each 1 kg/m(2) increase in childhood BMI was predicted to result in a 6.5% (95% CI: 4.6-8.5%) higher absolute risk of early menarche (before age 12 years). While mendelian randomisation analysis is dependent on a number of assumptions, our findings support a causal effect of BMI on early menarche and suggests that increasing prevalence of childhood obesity will lead to similar trends in the prevalence of early menarche.
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Affiliation(s)
- Hannah S. Mumby
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, P.O. Box 285, Cambridge CB2 0QQ, UK
| | - Cathy E. Elks
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, P.O. Box 285, Cambridge CB2 0QQ, UK
| | - Shengxu Li
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, P.O. Box 285, Cambridge CB2 0QQ, UK
| | - Stephen J. Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, P.O. Box 285, Cambridge CB2 0QQ, UK
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | - Robert N. Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge CB2 0SR, UK
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, P.O. Box 285, Cambridge CB2 0QQ, UK
| | - Ruth J. F. Loos
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, P.O. Box 285, Cambridge CB2 0QQ, UK
| | - Ken K. Ong
- MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, P.O. Box 285, Cambridge CB2 0QQ, UK
- *Ken K. Ong:
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Winter Y, Back T, Scherag A, Linseisen J, Rohrmann S, Lanczik O, Hinney A, Scherag S, Neumaier M, Ringleb PA, Dodel R, Hebebrand J. Evaluation of the obesity genes FTO and MC4R and the type 2 diabetes mellitus gene TCF7L2 for contribution to stroke risk: The Mannheim-Heidelberg Stroke Study. Obes Facts 2011; 4:290-6. [PMID: 21921652 PMCID: PMC6444624 DOI: 10.1159/000330881] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Studies evaluating genetic markers for vascular risk and risk of stroke are limited, and none of them evaluated obesity genes. The objective was to investigate the genetic markers related to obesity genes FTO and MC4R and the gene of type 2 diabetes mellitus TCF7L2 for their contribution to risk of stroke and transient ischemic attacks (TIA). METHODS We recruited 379 consecutive patients with stroke/TIA and 379 healthy population-based controls. The single-nucleotide polymorphisms (SNPs) rs9937053 (FTO), rs2229616 (MC4R V103I), rs17782313 (188kb downstream of MC4R), and rs7903146 (TCF7L2) were evaluated for association with stroke using logistic regression analyses. RESULTS The odds ratios for stroke/TIA were 1.14 (95%CI 0.91-1.42) for rs9937053/FTO, 1.11 (95%CI 0.49-2.51) for rs2229616/MC4R, 1.05 (95%CI 0.82-1.3) for rs17782313/MC4R, and 0.99 (95%CI 0.78-1.25) for rs7903146/TCF7L2. Further exploration revealed that male patients with the T allele of rs7903146/TCF7L2 had a worse clinical outcome compared with male patients carrying the C allele. CONCLUSION The observed trends of obesity risk alleles for risk of stroke/TIA as well as the possible sex-specific differences in clinical outcomes found for the TCF7L2 (rs7903146) require replication in future studies. Our study demonstrates that candidate gene studies for common stroke may benefit from focusing on polymorphisms that predispose to vascular risk.
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Affiliation(s)
| | - Tobias Back
- Department of Neurology, Saxon Hospital Arnsdorf, Arnsdorf/Dresden
- * Department of Neurology, Saxon Hospital Arnsdorf, Hufelandstraße 15, 01477 Arnsdorf/Dresden, Germany, Tel. +49 35200 263-511, Fax -513,
| | - André Scherag
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen
| | - Jakob Linseisen
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg
- Institute of Epidemiology, Helmholtz Center Munich, Neuherberg
| | - Sabine Rohrmann
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg
| | - Oliver Lanczik
- Department of Neurology, Klinikum Mannheim, University of Heidelberg
| | - Anke Hinney
- Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, Essen
| | - Susann Scherag
- Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, Essen
| | | | - Peter A. Ringleb
- Department of Neurology, Klinikum Heidelberg, University of Heidelberg, Germany
| | - Richard Dodel
- Department of Neurology, Philipps University Marburg
| | - Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University of Duisburg-Essen, Essen
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Kivimäki M, Magnussen CG, Juonala M, Kähönen M, Kettunen J, Loo BM, Lehtimäki T, Viikari J, Raitakari OT. Conventional and Mendelian randomization analyses suggest no association between lipoprotein(a) and early atherosclerosis: the Young Finns Study. Int J Epidemiol 2010; 40:470-8. [PMID: 21078622 DOI: 10.1093/ije/dyq205] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Lipoprotein(a) [Lp(a)] is an established risk factor for coronary disease and stroke, but mechanisms underlying this association are unknown. We examined the association of Lp(a) with early atherosclerosis by using conventional epidemiologic analysis and a Mendelian randomization analysis. The latter utilized genetic variants that are associated with Lp(a) to estimate causal effect. METHODS A prospective population-based cohort study of 939 men and 1141 women was conducted. Lp(a) was measured repeatedly at mean ages 17 and 38 years. Measurements of carotid intima-media thickness (IMT) and brachial flow-mediated dilation (FMD) at mean ages 32 and 38 years were used to determine the level and 6-year progression of subclinical atherosclerosis. Lp(a)-related genetic variant, rs783147, was identified by a genome wide association analysis (P = 3.1 × 10⁻⁵⁸), and a genetic score was constructed based on 10 Lp(a)-related variants. Mendelian randomization test was performed using a two-stage instrumental variables analysis. RESULTS rs783147 and the genetic score were strong instruments for nonconfounded Lp(a) levels (F-statistics 269.6 and 446.0 in the first-stage instrumental variable analysis). However, Lp(a) levels were not associated with the levels of or change in IMT or FMD in any of the conventional and instrumental variables tests. The null finding was observed both with rs783147 and the genetic score as instruments and remained unchanged after adjustment for clinical characteristics, such as age, sex, HDL and LDL cholesterol, ApoB, systolic and diastolic blood pressure, diabetes and smoking. CONCLUSIONS Data from conventional and Mendelian randomization analyses provide no support for early atherogenic effects of increased Lp(a) levels.
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Affiliation(s)
- Mika Kivimäki
- Department of Epidemiology, University College London, London, UK.
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Effects of a diet with inulin-enriched pasta on gut peptides and gastric emptying rates in healthy young volunteers. Eur J Nutr 2010; 50:271-7. [DOI: 10.1007/s00394-010-0135-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 09/28/2010] [Indexed: 12/13/2022]
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Lewis SJ. Mendelian randomization as applied to coronary heart disease, including recent advances incorporating new technology. ACTA ACUST UNITED AC 2010; 3:109-17. [PMID: 20160203 DOI: 10.1161/circgenetics.109.880955] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sarah J Lewis
- Department of Social Medicine, University of Bristol, United Kingdom.
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Bochud M, Rousson V. Usefulness of Mendelian randomization in observational epidemiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:711-28. [PMID: 20616999 PMCID: PMC2872313 DOI: 10.3390/ijerph7030711] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 02/16/2010] [Indexed: 11/16/2022]
Abstract
Mendelian randomization refers to the random allocation of alleles at the time of gamete formation. In observational epidemiology, this refers to the use of genetic variants to estimate a causal effect between a modifiable risk factor and an outcome of interest. In this review, we recall the principles of a "Mendelian randomization" approach in observational epidemiology, which is based on the technique of instrumental variables; we provide simulations and an example based on real data to demonstrate its implications; we present the results of a systematic search on original articles having used this approach; and we discuss some limitations of this approach in view of what has been found so far.
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Affiliation(s)
- Murielle Bochud
- University Institute of Social and Preventive Medicine, Rue du Bugnon 17, Lausanne, Switzerland.
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Abstract
Nutritional epidemiology aims to identify dietary and lifestyle causes for human diseases. Causality inference in nutritional epidemiology is largely based on evidence from studies of observational design, and may be distorted by unmeasured or residual confounding and reverse causation. Mendelian randomization is a recently developed methodology that combines genetic and classical epidemiological analysis to infer causality for environmental exposures, based on the principle of Mendel's law of independent assortment. Mendelian randomization uses genetic variants as proxies for environmental exposures of interest. Associations derived from Mendelian randomization analysis are less likely to be affected by confounding and reverse causation. During the past 5 years, a body of studies examined the causal effects of diet/lifestyle factors and biomarkers on a variety of diseases. The Mendelian randomization approach also holds considerable promise in the study of intrauterine influences on offspring health outcomes. However, the application of Mendelian randomization in nutritional epidemiology has some limitations.
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Affiliation(s)
- Lu Qi
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
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Pausova Z, Syme C, Abrahamowicz M, Xiao Y, Leonard GT, Perron M, Richer L, Veillette S, Smith GD, Seda O, Tremblay J, Hamet P, Gaudet D, Paus T. A common variant of the FTO gene is associated with not only increased adiposity but also elevated blood pressure in French Canadians. ACTA ACUST UNITED AC 2009; 2:260-9. [PMID: 20031594 DOI: 10.1161/circgenetics.109.857359] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND FTO is the first gene established as contributing to common forms of obesity. The gene is highly expressed in the hypothalamus and is thought to mediate this effect through its influence on energy homeostasis. The hypothalamus, however, also regulates blood pressure (BP). Therefore, we investigated whether the FTO-risk variant is associated not only with increased adiposity but also with elevated BP and whether the latter may be mediated, in part, by increased sympathetic modulation of vasomotor tone. METHODS AND RESULTS The primary study was carried out in 485 adolescents recruited from a French Canadian founder population who underwent detailed body-composition and cardiovascular phenotyping. Body fat was examined with MRI, bioimpedance, and anthropometry. BP was recorded beat to beat at rest and during physical and mental challenges. Sympathetic modulation of vasomotor tone was assessed with power spectral analysis of BP. We found that individuals with the FTO-risk genotype compared with those without it demonstrate greater adiposity, including the amount of intra-abdominal fat (by 38%). They also showed higher systolic BP throughout the entire protocol, with a maximum difference during a mental stress (6.4 [1.5 to 11.3] mm Hg). The difference in BP was accompanied by elevated index of sympathetic modulation of vasomotor tone. A replication in an independent sample of adults from the same founder population confirmed the association between FTO and BP. CONCLUSIONS These results suggest that, in a French Canadian founder population, FTO may increase not only risk for obesity, as demonstrated in other populations, but also for hypertension. The latter may be related, at least in part, to the regulation of sympathetic vasomotor tone.
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Affiliation(s)
- Zdenka Pausova
- Brain and Body Centre, University of Nottingham, Nottingham, United Kingdom.
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