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Li LJ, Du R, Chan JKY, Tan KH, Wong TY, Eriksson JG, Su LL, Chong YS, Huang Z, Zhang C. Preconception maternal retinal arteriolar narrowing and fetal growth throughout pregnancy: A prospective cohort study. BJOG 2024; 131:278-287. [PMID: 37503769 DOI: 10.1111/1471-0528.17621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/25/2023] [Accepted: 07/11/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To investigate the association between preconception maternal retinal arteriolar calibre and fetal growth. DESIGN, SETTING AND POPULATION A hospital-based, prospective preconception cohort including 369 women with a singleton live birth. METHODS We collected detailed information on sociodemographic status, pregnancy history and lifestyle, and performed retinal imaging at the preconception visit. MAIN OUTCOME MEASURES We retrieved medical records documenting fetal growth biometrics (e.g., abdominal circumference [AC], head circumference [HC], femur length [FL]) at 11-13, 18-21, 24-28, and 32-34 weeks throughout pregnancy. We then computed the z scores for all fetal growth biometrics from 14 weeks of gestation where data were available, referencing the INTERGROWTH-21st fetal growth chart. We used a linear mixed model to estimate the association between maternal preconception retinal arteriolar calibre and fetal growth biometrics z scores throughout pregnancy, with random intercept accounting for repeated measures within individuals. We then performed a multivariable linear regression of maternal preconception retinal arteriolar calibre and z score changes for all fetal growth biometrics between 24-28 weeks and 32-34 weeks of gestation, after full adjustment. RESULTS Maternal preconception generalised retinal arteriolar narrowing was consistently associated with a reduction in fetal AC z scores (-0.34; 95% CI -0.66 to -0.03) throughout pregnancy. In addition, women with preconception generalised retinal arteriolar narrowing tended to have significantly reduced z score changes in AC (-0.41; 95% CI -0.90 to -0.001) and fetal FL (-0.55; 95% CI -1.00 to -0.10) between 24-28 weeks and 32-34 weeks of gestation, respectively. CONCLUSIONS Our findings suggest that women with narrower preconception retinal arterioles had smaller fetuses, evidenced by reductions in AC and FL z score throughout pregnancy.
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Affiliation(s)
- Ling-Jun Li
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Global Centre for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Ruochen Du
- Biostatics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Global Centre for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhongwei Huang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency of Science, Technology & Research, Singapore, Singapore, Singapore
| | - Cuilin Zhang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Global Centre for Asian Women's Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Mio M, Kennedy KG, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes PJ, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. White matter microstructural integrity is associated with retinal vascular caliber in adolescents with bipolar disorder. J Psychosom Res 2023; 175:111529. [PMID: 37856933 DOI: 10.1016/j.jpsychores.2023.111529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Reduced white matter integrity is observed in bipolar disorder (BD), and is associated with cardiovascular risk in adults. This topic is underexplored in youth, and in BD, where novel microvascular measures may help to inform understanding of the vascular-brain connection. We therefore examined the association of retinal vascular caliber with white matter integrity in a cross-sectional sample of adolescents with and without BD. METHODS Eighty-four adolescents (n = 42 BD, n = 42 controls) completed retinal imaging, yielding arteriolar and venular caliber. Diffusion tensor imaging measured white matter fractional anisotropy (FA). Multiple linear regression tested associations between retinal vascular caliber and FA in regions-of-interest; corpus callosum, anterior thalamic radiation, uncinate fasciculus, and superior longitudinal fasciculus. Complementary voxel-wise analyses were performed. RESULTS Arteriolar caliber was elevated in adolescents with BD relative to controls (F(1,79) = 6.15, p = 0.02, η2p = 0.07). In the overall sample, higher venular caliber was significantly associated with lower corpus callosum FA (β = -0.24, puncorrected = 0.04). In voxel-wise analyses, higher arteriolar caliber was significantly associated with lower corpus callosum and forceps minor FA in the overall sample (β = -0.46, p = 0.03). A significant diagnosis-by-venular caliber interaction on FA was noted in 5 clusters including the right retrolenticular internal capsule (β = 0.72, p = 0.03), corticospinal tract (β = 0.72, p = 0.04), and anterior corona radiata (β = 0.63, p = 0.04). In each instance, venular caliber was more positively associated with FA in BD vs. controls. CONCLUSION Retinal microvascular measures are associated with white matter integrity in BD, particularly in the corpus callosum. This study was proof-of-concept, designed to guide future studies focused on the vascular-brain interface in BD.
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Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter J Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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3
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Cheung CY, Zhang XJ, Chan HN, Zhang Y, Yuen VL, Hsu W, Lee ML, Xu D, Wong J, Tang FY, Kam KW, Young A, Ng MP, Ip P, Chen LJ, Wong TY, Pang CP, Tham CC, Yam JC. Influence of secondhand smoke exposure on the retinal vasculature of children in Hong Kong. COMMUNICATIONS MEDICINE 2023; 3:155. [PMID: 37884789 PMCID: PMC10603154 DOI: 10.1038/s43856-023-00389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND A recent prospective demonstrated that cardiovascular risk factors in early childhood were associated with later cardiovascular events. However, the impact of secondhand smoke (SHS) on children is unclear. The aims of this study is to determine the effects of SHS exposure on the retinal vasculature of children. METHODS This is a population-based cross-sectional study of children aged 6 to 8 years. All participants received comprehensive ophthalmic examinations and retinal photography. Data on SHS exposure was derived from a validated questionnaire. A validated deep-learning system was used to automatically estimate retinal arteriolar and venular calibers from retinal photographs. Associations of quantitative retinal vessel caliber values with SHS exposure, number of smokers in the household, and total number of cigarettes smoked were determined by analyses of covariance (ANCOVA) after adjusting for potential confounders. Test of trend was determined by treating categorical risk factors as continuous ordinal variables. RESULTS Here we show children exposed to SHS have wider retinal arteriolar (CRAE 152.1 µm vs. 151.3 µm, p < 0.001) and venular (CRVE 216.7 µm vs. 215.5 µm, p < 0.001) calibers compared to those in smoke-free homes, after adjustment for different factors. Wider arteriolar and venular calibers are also associated with increasing number of smokers in the family (p trend < 0.001) and more cigarettes smoked among family smokers (p trend<0.001). CONCLUSIONS Exposure to SHS at home is associated with changes in retinal vasculature among children. This reinforces the adverse effect of secondhand smoking around children though further research incorporating comprehensive assessment of potential confounders is necessary.
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Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hei-Nga Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wynne Hsu
- School of Computing, National University of, Singapore, Singapore
| | - Mong Li Lee
- School of Computing, National University of, Singapore, Singapore
| | - Dejiang Xu
- School of Computing, National University of, Singapore, Singapore
| | - Jason Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alvin Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Mandy P Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
- Tsinghua Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China.
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Chen R, Xu J, Shang X, Bulloch G, He M, Wang W, Zhu Z. Association between cardiovascular health metrics and retinal ageing. GeroScience 2023:10.1007/s11357-023-00743-3. [PMID: 36930331 PMCID: PMC10400488 DOI: 10.1007/s11357-023-00743-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/25/2023] [Indexed: 03/18/2023] Open
Abstract
The study aims to investigate associations between cardiovascular health (CVH) metrics and retinal ageing indexed by retinal age gap. A total of 26,354 participants from the UK Biobank study with available CVH metrics and qualified retinal imaging were included in the present analysis. CVH included 7 metrics (smoking, physical activity, diet, body mass index [BMI], total cholesterol, blood pressure [BP], blood glucose). These were summarized to classify the overall CVH as poor (0-7), intermediate (8-10) or ideal (11-14). Retinal age gap was defined as the difference between biological age predicted by fundus images and chronological age. Accelerated and non-accelerated retinal ageing was defined if retinal age gap was in the upper or lower 50% quantiles of the study population, respectively. Linear and logistic regression models estimated the association of overall CVH and each metric of CVH with retinal age gap respectively. Our results showed that in the fully adjusted model, each one-unit score increase in overall CVH was negatively associated with retinal age gap (odds ratio [OR] = 0.89, 95% confidence interval [CI]: 0.87-0.92, P < 0.001). Compared with poor overall CVH, people with intermediate and ideal overall CVH had significantly lower retinal age gap (OR = 0.76, 95%CI: 0.67-0.85, P < 0.001; OR = 0.58, 95%CI: 0.50-0.67, P < 0.001). Similar associations were found between overall CVH and accelerated retinal ageing. CVH metrics including smoking, BMI, BP, and blood glucose were also significantly associated with higher retinal age gap. Taken together, we found a significant and inverse dose-response association between CVH metrics and retinal age gap, indicating that maintaining healthy metrics especially smoking, BMI, BP, and blood glucose may be crucial to slow down biological ageing.
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Affiliation(s)
- Ruiye Chen
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Jinyi Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xianwen Shang
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China.,Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Gabriella Bulloch
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Mingguang He
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China. .,Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia. .,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia. .,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
| | - Zhuoting Zhu
- Department of Ophthalmology, Guangdong Academy of Medical Sciences, Guangdong Provincial People's Hospital, Guangzhou, China. .,Centre for Eye Research Australia; Ophthalmology, University of Melbourne, Melbourne, Australia. .,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, Australia.
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Williams DR, Burns SA, Miller DT, Roorda A. Evolution of adaptive optics retinal imaging [Invited]. BIOMEDICAL OPTICS EXPRESS 2023; 14:1307-1338. [PMID: 36950228 PMCID: PMC10026580 DOI: 10.1364/boe.485371] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 05/02/2023]
Abstract
This review describes the progress that has been achieved since adaptive optics (AO) was incorporated into the ophthalmoscope a quarter of a century ago, transforming our ability to image the retina at a cellular spatial scale inside the living eye. The review starts with a comprehensive tabulation of AO papers in the field and then describes the technological advances that have occurred, notably through combining AO with other imaging modalities including confocal, fluorescence, phase contrast, and optical coherence tomography. These advances have made possible many scientific discoveries from the first maps of the topography of the trichromatic cone mosaic to exquisitely sensitive measures of optical and structural changes in photoreceptors in response to light. The future evolution of this technology is poised to offer an increasing array of tools to measure and monitor in vivo retinal structure and function with improved resolution and control.
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Affiliation(s)
- David R. Williams
- The Institute of Optics and the Center for
Visual Science, University of Rochester,
Rochester NY, USA
| | - Stephen A. Burns
- School of Optometry, Indiana
University at Bloomington, Bloomington IN, USA
| | - Donald T. Miller
- School of Optometry, Indiana
University at Bloomington, Bloomington IN, USA
| | - Austin Roorda
- Herbert Wertheim School of Optometry and
Vision Science, University of California at Berkeley, Berkeley CA, USA
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6
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Mio M, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes P, McCrindle BW, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. Neurovascular correlates of retinal microvascular caliber in adolescent bipolar disorder. J Affect Disord 2023; 320:81-90. [PMID: 36162693 DOI: 10.1016/j.jad.2022.09.082] [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: 12/14/2021] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The connection between vascular and brain metrics is well-studied in older adults, but neglected in youth and in psychiatric populations at increased cardiovascular risk. We therefore examined the association of retinal vascular caliber with cerebral blood flow (CBF) in adolescents with and without bipolar disorder (BD). METHODS Ninety-four adolescents (n = 48 BD, n = 46 controls) completed retinal fundus imaging, yielding estimates of arteriolar and venular diameter. Arterial spin labelling MRI was performed to measure CBF. We tested for associations between retinal vascular caliber and CBF in regions of interest; anterior cingulate cortex (ACC), middle frontal gyrus, and hippocampus in BD and controls separately. Complementary voxel-wise analyses were also performed. RESULTS In the BD group, higher arteriovenous ratio (AVR) was associated with greater ACC CBF (β = 0.34, puncorrected = 0.02), after controlling for age, sex, and BMI, however this finding did not survive correction for multiple comparisons. The control group did not show any associations (β = 0.13, puncorrected = 0.40). Voxel-wise analyses within the BD group detected a significant positive association between AVR and regional CBF in two distinct clusters: i) left hippocampus (p < 0.0001); ii) right middle temporal gyrus (p = 0.04). LIMITATIONS Limited sample size; young, medically healthy sample limits signal detection; cross-sectional design. CONCLUSION This study reveals that higher AVR is associated with higher regional CBF in adolescents with BD. Present findings advance understanding of potential neurofunctional mechanisms linking retinal vascular caliber with psychiatric diagnoses. This proof-of-concept study was designed to generate initial insights to guide future studies focusing on the vascular-brain connection in youth and in psychiatry.
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Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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7
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Rudnicka AR, Welikala R, Barman S, Foster PJ, Luben R, Hayat S, Khaw KT, Whincup P, Strachan D, Owen CG. Artificial intelligence-enabled retinal vasculometry for prediction of circulatory mortality, myocardial infarction and stroke. Br J Ophthalmol 2022; 106:1722-1729. [PMID: 36195457 PMCID: PMC9685715 DOI: 10.1136/bjo-2022-321842] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/03/2022] [Indexed: 02/02/2023]
Abstract
AIMS We examine whether inclusion of artificial intelligence (AI)-enabled retinal vasculometry (RV) improves existing risk algorithms for incident stroke, myocardial infarction (MI) and circulatory mortality. METHODS AI-enabled retinal vessel image analysis processed images from 88 052 UK Biobank (UKB) participants (aged 40-69 years at image capture) and 7411 European Prospective Investigation into Cancer (EPIC)-Norfolk participants (aged 48-92). Retinal arteriolar and venular width, tortuosity and area were extracted. Prediction models were developed in UKB using multivariable Cox proportional hazards regression for circulatory mortality, incident stroke and MI, and externally validated in EPIC-Norfolk. Model performance was assessed using optimism adjusted calibration, C-statistics and R2 statistics. Performance of Framingham risk scores (FRS) for incident stroke and incident MI, with addition of RV to FRS, were compared with a simpler model based on RV, age, smoking status and medical history (antihypertensive/cholesterol lowering medication, diabetes, prevalent stroke/MI). RESULTS UKB prognostic models were developed on 65 144 participants (mean age 56.8; median follow-up 7.7 years) and validated in 5862 EPIC-Norfolk participants (67.6, 9.1 years, respectively). Prediction models for circulatory mortality in men and women had optimism adjusted C-statistics and R2 statistics between 0.75-0.77 and 0.33-0.44, respectively. For incident stroke and MI, addition of RV to FRS did not improve model performance in either cohort. However, the simpler RV model performed equally or better than FRS. CONCLUSION RV offers an alternative predictive biomarker to traditional risk-scores for vascular health, without the need for blood sampling or blood pressure measurement. Further work is needed to examine RV in population screening to triage individuals at high-risk.
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Affiliation(s)
| | - Roshan Welikala
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Sarah Barman
- Faculty of Science, Engineering and Computing, Kingston University, Kingston-Upon-Thames, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, University College London, London, UK
| | - Robert Luben
- MRC Epidemiology Unit, Cambridge University, Cambridge, UK
| | - Shabina Hayat
- Department of Psychiatry, Cambridge Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Kay-Tee Khaw
- MRC Epidemiology Unit, Cambridge University, Cambridge, UK
| | - Peter Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - David Strachan
- Population Health Research Institute, St George's University of London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's University of London, London, UK
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8
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Li LJ, Du R, Loy SL, Chong YS, Chan JKY, Wong TY, Eriksson JG, Huang Z, Zhang C. Retinal microvasculature and risk of spontaneous abortion in multiethnic Southeast Asian women. Fertil Steril 2022; 118:748-757. [PMID: 35981917 DOI: 10.1016/j.fertnstert.2022.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/14/2022] [Accepted: 06/28/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To better understand the underlying pathogenesis of spontaneous abortion that affects 10%-20% of recognized pregnancies. We used retinal imaging to study the role of systemic microvasculature and the risk of spontaneous abortion. DESIGN A prospective multiethnic preconception cohort study conducted in Singapore. SETTING Hospital-based. PATIENT(S) A total of 1,032 Southeast Asian women who intended to conceive naturally were screened at study entry, among which 480 women spontaneously conceived within the 12-month observation period. After excluding 24 women who were lost to follow-up, we calculated the spontaneous abortion rate among 456 women. Further, we included 379 women for the final association analysis because 63 women did not undergo preconception retinal imaging examination and 14 had other types of pregnancy loss instead of spontaneous abortion. INTERVENTION(S) Trained photographers performed retinal examination using a 45-degree nonmydriatic retinal camera at study entry during the preconception screening. Using a semiautomated, computer-based program, we assessed quantitative retinal microvascular measurements, including caliber, fractal dimension, curvature tortuosity, and branching angle. Clinical research coordinators collected information on sociodemographic status, menstrual characteristics, and lifestyle, and assessed blood pressure and anthropometry at study entry. MAIN OUTCOME MEASURE(S) We performed a modified Poisson regression model to estimate the relative risk (RR) and 95% confidence interval (CI) for each retinal microvascular feature and its association with spontaneous abortion after adjusting for major confounders such as maternal prepregnancy, body mass index, and previous pregnancy loss history. RESULT(S) We reported a spontaneous abortion rate of 13.4% (61 out of 456). Among all retinal microvascular features, retinal arteriolar caliber, retinal arteriolar, and venular curvature tortuosity were associated with a high risk of incident spontaneous abortion. In the regression model, per SD increase in retinal curvature tortuosity was associated with a 25%-34% increased risk of incident spontaneous abortion (arteriolar: unadjusted RR, 1.29 [95% CI, 1.06-1.56] and adjusted RR, 1.26 [1.04-1.53]; venule: unadjusted RR, 1.30 [1.08-1.55] and adjusted RR, 1.34 [1.09-1.64]). CONCLUSION(S) Our prospective cohort observed an increased risk of spontaneous abortion among Asian women with more tortuous retinal vessels assessed during the preconception phase. Our results indicate a role of vascular inflammatory and oxidative stress in the pathogenesis of spontaneous abortion. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT03531658.
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Affiliation(s)
- Ling-Jun Li
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.
| | - Ruochen Du
- Biostatics Unit, Yong Loo Lin School of Medicine, National University of Singapore
| | - See Ling Loy
- Duke-NUS Medical School, Singapore, Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jerry Kok Yen Chan
- Duke-NUS Medical School, Singapore, Singapore; Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Johan G Eriksson
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A∗STAR), Singapore
| | - Zhongwei Huang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Institute of Molecular and Cell Biology, Agency of Science, Technology & Research, Singapore, Singapore
| | - Cuilin Zhang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; NUS Bia-Echo Asia Centre for Reproductive Longevity and Equality (ACRLE), Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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9
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Lim HY, Burrell LM, Brook R, Nandurkar HH, Donnan G, Ho P. The Need for Individualized Risk Assessment in Cardiovascular Disease. J Pers Med 2022; 12:jpm12071140. [PMID: 35887637 PMCID: PMC9323107 DOI: 10.3390/jpm12071140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular disease remains the leading cause of death in the era of modern medicine despite major advancements in this field. Current available clinical surrogate markers and blood tests do not adequately predict individual risk of cardiovascular disease. A more precise and sophisticated tool that can reliably predict the thrombosis and bleeding risks at an individual level is required in order for clinicians to confidently recommend early interventions with a favorable risk–benefit profile. Critical to the development of this tool is the assessment and understanding of Virchow’s triad and its complex interactions between hypercoagulability, endothelial dysfunction and vessel flow, a fundamental concept to the development of thrombosis. This review explores the pathophysiology of cardiovascular disease stemming from the triad of factors and how individualized risk assessment can be improved through the multimodal use of tools such as global coagulation assays, endothelial biomarkers and vessel flow assessment.
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Affiliation(s)
- Hui Yin Lim
- Northern Pathology Victoria, Northern Health, Epping, Melbourne, VIC 3076, Australia; (H.Y.L.); (R.B.)
- Department of Hematology, Northern Health, Epping, Melbourne, VIC 3076, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3004, Australia;
- Department of Medicine, Northern Health, University of Melbourne, Epping, Melbourne, VIC 3076, Australia
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Melbourne, VIC 3084, Australia;
| | - Louise M. Burrell
- Department of Medicine, Austin Health, University of Melbourne, Heidelberg, Melbourne, VIC 3084, Australia;
| | - Rowena Brook
- Northern Pathology Victoria, Northern Health, Epping, Melbourne, VIC 3076, Australia; (H.Y.L.); (R.B.)
- Department of Hematology, Northern Health, Epping, Melbourne, VIC 3076, Australia
| | - Harshal H. Nandurkar
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3004, Australia;
| | - Geoffrey Donnan
- The Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, VIC 3010, Australia;
| | - Prahlad Ho
- Northern Pathology Victoria, Northern Health, Epping, Melbourne, VIC 3076, Australia; (H.Y.L.); (R.B.)
- Department of Hematology, Northern Health, Epping, Melbourne, VIC 3076, Australia
- Australian Centre for Blood Diseases, Monash University, Melbourne, VIC 3004, Australia;
- Department of Medicine, Northern Health, University of Melbourne, Epping, Melbourne, VIC 3076, Australia
- Correspondence: ; Tel.: +613-8405-8480
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10
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Appaji A, Harish V, Korann V, Devi P, Jacob A, Padmanabha A, Kumar V, Varambally S, Venkatasubramanian G, Rao SV, Suma HN, Webers CAB, Berendschot TTJM, Rao NP. Deep learning model using retinal vascular images for classifying schizophrenia. Schizophr Res 2022; 241:238-243. [PMID: 35176722 DOI: 10.1016/j.schres.2022.01.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/13/2022]
Abstract
Contemporary psychiatric diagnosis still relies on the subjective symptom report of the patient during a clinical interview by a psychiatrist. Given the significant variability in personal reporting and differences in the skill set of psychiatrists, it is desirable to have objective diagnostic markers that could help clinicians differentiate patients from healthy individuals. A few recent studies have reported retinal vascular abnormalities in patients with schizophrenia (SCZ) using retinal fundus images. The goal of this study was to use a trained convolution neural network (CNN) deep learning algorithm to detect SCZ using retinal fundus images. A total of 327 subjects [139 patients with Schizophrenia (SCZ) and 188 Healthy volunteers (HV)] were recruited, and retinal images were acquired using a fundus camera. The images were preprocessed and fed to a convolution neural network for the classification. The model performance was evaluated using the area under the receiver operating characteristic curve (AUC). The CNN achieved an accuracy of 95% for classifying SCZ and HV with an AUC of 0.98. Findings from the current study suggest the potential utility of deep learning to classify patients with SCZ and assist clinicians in clinical settings. Future studies need to examine the utility of the deep learning model with retinal vascular images as biomarkers in schizophrenia with larger sample sizes.
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Affiliation(s)
- Abhishek Appaji
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Vaishak Harish
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Vittal Korann
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Priyanka Devi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arpitha Jacob
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anantha Padmanabha
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Vijay Kumar
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Shyam Vasudeva Rao
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - H N Suma
- Department of Medical Electronics Engineering, B.M.S. College of Engineering, Bangalore, India
| | - Caroll A B Webers
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Naren P Rao
- National Institute of Mental Health and Neurosciences, Bangalore, India.
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11
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Montazeri P, Fossati S, Warembourg C, Casas M, Clemente DBP, Garcia-Esteban R, Nawrot TS, Vrijheid M. Prenatal exposure to phthalates and phenols and preclinical vascular health during early adolescence. Int J Hyg Environ Health 2021; 240:113909. [PMID: 34952328 DOI: 10.1016/j.ijheh.2021.113909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/10/2021] [Accepted: 12/15/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIM Exposure to endocrine-disrupting chemicals may increase cardiovascular risk from early life, but studies in children have shown inconsistent results, most focused on analysis of single chemicals, and none included measures of micro-vascularization as early preclinical markers. This study aimed to evaluate the association between prenatal exposure to phthalates and phenols and macro- and microvascular health during early adolescence. METHODS Using data from a Spanish birth cohort (n = 416), prenatal exposure to eight phthalate metabolites and seven phenols (bisphenol A, four parabens, benzophenone-3, triclosan) were assessed using first and/or third trimester spot-urine concentrations. Macrovascular health (systolic and diastolic blood pressure (SBP and DBP, mmHg), pulse wave velocity (PWV, m/s)) and microvascular health (central retinal artery/vein equivalent (CRAE/CRVE, μm)), were measured at 11 years old. Linear regression models assessed associations for individual chemicals and Bayesian weighted quantile sum regression (BWQS) evaluated the overall association of the phthalate and phenol mixture with cardiovascular health. RESULTS In single exposure models, bisphenol-A was associated with decreased PWV (β per doubling of exposure = -0.06; 95% CI: -0.10, -0.01). Mono-iso-butyl phthalate was associated with an increase in CRAE (β = 1.89; 95% CI: 0.34, 3.44). Methyl- and butyl-parabens were associated with a decrease in CRVE (β = -0.71; 95% CI: -1.41, -0.01) and (β = -0.96; 95% CI: -1.57, -0.35), respectively. No statistically significant associations were observed between any of the exposures and SBP or DBP. BWQS models showed no evidence of associations between the phthalate and phenol mixture and any of the outcomes. CONCLUSIONS Our results provide little evidence to suggest that prenatal exposure to phthalates and phenols is associated with macro- or microvascular health during early adolescence, except a few associations with certain compounds. Errors in exposure measurement and reduced variability in cardiovascular measures at this early age limit our ability to draw strong conclusions.
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Affiliation(s)
- Parisa Montazeri
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Serena Fossati
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Charline Warembourg
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Maribel Casas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Raquel Garcia-Esteban
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Department of Public Health and Primary Care, Leuven University, Leuven, Belgium
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
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12
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Huang L, Loy SL, Chen WQ, Eriksson JG, Chong YS, Huang Z, Chan JKY, Wong TY, Kramer M, Zhang C, Li LJ. Retinal microvasculature and time to pregnancy in a multi-ethnic pre-conception cohort in Singapore. Hum Reprod 2021; 36:2935-2947. [PMID: 34492112 DOI: 10.1093/humrep/deab197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/08/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Can abnormalities in retinal microvasculature representing adverse microcirculatory perfusion and inflammation shed light on the pathophysiology of female fecundability? SUMMARY ANSWER In our prospective study, abnormalities in retinal vascular geometric morphology (i.e. sparser arteriolar fractal and larger venular bifurcation) during pre-conception phase are temporarily associated with a prolonged time-to-pregnancy (TTP). WHAT IS KNOWN ALREADY Suboptimal retinal microcirculatory morphology has been associated with obesity, psychological stress and hypertension, all of which are known risk factors for reduced female fecundability. STUDY DESIGN, SIZE, DURATION A total of 652 women of Chinese, Malay or Indian ethnicity 18-45 years of age and planning to conceive spontaneously within the next 12 months were recruited during the pre-conception period into the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO), from February 2015 to October 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS During recruitment, we collected information on socio-demographic factors, menstrual characteristics and lifestyle behaviors and made anthropometric measurements. We assessed the following retinal microvascular features: caliber, branching angle and fractal dimension. We conducted follow-up telephone surveys to track each participant's pregnancy status at 6, 9 and 12 months after enrolment. We ascertained clinical pregnancies via ultrasonography, with TTP measured by the number of menstrual cycles required to achieve a clinical pregnancy over a 1-year follow-up. Then, we performed discrete-time proportional hazards models to estimate the fecundability odds ratio (FOR) and 95% CI for each retinal microvascular feature in association with TTP, after adjusting for major confounders, including body mass index and fasting glycemic level at study entry. MAIN RESULTS AND THE ROLE OF THE CHANCE Among 652 recruited women, 276 (42.3%) successfully conceived within 1 year of follow-up. The mean (and SD) was 1.24 (0.05) Df for retinal arteriolar dimension fraction and 78.45 (9.79) degrees for retinal venular branching angle, respectively. Non-linear relationship testing was performed before multiple adjustment in all associations and a non-monotonic association was detected between retinal venular branching angle and TTP. Compared with women in the highest tertile of retinal arteriolar fractal dimension, women in the second tertile had a prolonged TTP (FOR: 0.68; 95% CI: 0.51-0.92), as did women in the lowest tertile (FOR: 0.73; 95% CI: 0.55-0.98). Compared with women in the middle tertile of retinal venular branching angle, women in the highest tertile had a borderline prolonged TTP (FOR: 0.75; 95% CI: 0.56-1.02). No other retinal vascular features were significantly associated with TTP. LIMITATIONS, REASONS FOR CAUTION We were unable to adjust for other potential confounding factors such as female sexual function (e.g. frequency of sexual intercourse), which might introduce a residual bias. Moreover, even though this is a prospective cohort design, our findings can identify the temporal relationship but not necessarily infer a causal relationship between maternal microvasculature and TTP. Lastly, our study involving mainly Chinese, Malay and Indian ethnicities might not be generalizable to other races or ethnicities. WIDER IMPLICATIONS OF THE FINDINGS Suboptimal microcirculation may lead to reduced female fecundability. In the future, in addition to conventional ultrasonographic evaluation of ovarian and uterine physiological function, assessing the retinal microvasculature might be useful for assessment of ovarian age, fertility prediction and endometrial evaluation before assisted reproductive techniques for fertility treatments. STUDY FUNDING/COMPETING INTEREST(S) This research is supported by the Singapore National Research Foundation (NRF) under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health's National Medical Research Council (NMRC) (Singapore-NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014) and Singapore National Medical Research Council Transition Award (NMRC TA/0027/2014). The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT03531658.
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Affiliation(s)
- Lihua Huang
- Administration Department of Nosocomial Infection, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Wei-Qing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Department of Information Management, Xinhua College, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Johan G Eriksson
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, Singapore, Singapore.,Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yap Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Zhongwei Huang
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, Singapore, Singapore.,Institute of Molecular and Cell Biology, Agency of Science, Technology & Research, Singapore, Singapore
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tien Yin Wong
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Michael Kramer
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, Singapore, Singapore.,Department of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Cuilin Zhang
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA
| | - Ling-Jun Li
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, Singapore, Singapore.,Department of Obstetrics and Gynecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
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13
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Wei R, Xie J, Wu H, He F, Meng F, Liu J, Liang H, Zhao Y. Superficial Macula Capillary Complexity Changes Are Associated With Disability in Neuromyelitis Optica Spectrum Disorders. Front Neurol 2021; 12:724946. [PMID: 34630300 PMCID: PMC8492905 DOI: 10.3389/fneur.2021.724946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Abstract
Purpose: We examined the macular microvascular changes of the macula in neuromyelitis optica spectrum disorder (NMOSD) patients and its association with their disability and other clinical variables. Methods: Thirty-four NMOSD (13 patients without optic neuritis, NMOSD-NON, and 21 patients with a history of optic neuritis, NMOSD-ON) and 44 healthy controls (HCs) were included in the study. Optical coherence tomographic angiography (OCTA) was used to image the superficial (SCP), deep (DCP), and whole capillary plexus (WCP) in a 2.5-mm-diameter concentric circle [excluding the foveal avascular zone (FAZ)]. An algorithm (Dbox) was used to quantify the complexity of the three capillary layers by fractal analysis. We also evaluated the expanded disability scale status (EDSS). Results: Dbox values were significantly reduced in SCP (p < 0.001), DCP (p < 0.001), and WCP (p = 0.003) of NMOSD when compared with HCs. Dbox values were significantly reduced in NMOSD eyes with optic neuritis when compared with healthy controls (p < 0.001) and eyes without optic neuritis (p = 0.004) in the SCP. In the DCP, eyes with optic neuritis showed significantly reduced Dbox values when compared with eyes without optic neuritis (p = 0.016) and healthy controls (p < 0.001); eyes without optic neuritis showed significantly reduced Dbox values (p = 0.007) in the DCP when compared with healthy controls. A significant negative correlation (Rho = −0.475, p = 0.005) was shown between the superficial macula Dbox values and the EDSS in NMOSD patients. Additionally, a negative correlation (Rho = −0.715, p = 0.006) was seen in the superficial Dbox values in [e]eyes without optic neuritis and EDSS. Conclusions: Macular microvascular damage in the superficial plexus is associated with disability in NMOSD. Macular microvascular alterations arise independently of the occurrence of ON in NMOSD.
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Affiliation(s)
- Ruili Wei
- Neurology Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianyang Xie
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
| | - Huihui Wu
- Neurology Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangping He
- Neurology Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangxia Meng
- Neurology Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiang Liu
- Department of Computer Science and Engineering, Southern University of Science and Technology, Shenzhen, China
| | - Hui Liang
- Neurology Department, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yitian Zhao
- Cixi Institute of Biomedical Engineering, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, China
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14
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Neurostructural correlates of retinal microvascular caliber in adolescent bipolar disorder. JCPP ADVANCES 2021. [DOI: 10.1002/jcv2.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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15
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Wang N, Liang C. Relationship of Gensini score with retinal vessel diameter and arteriovenous ratio in senile CHD. Open Life Sci 2021; 16:737-745. [PMID: 34316514 PMCID: PMC8285989 DOI: 10.1515/biol-2021-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to find the correlation of Gensini score with retinal vessel diameter and arteriovenous ratio in elderly patients with coronary heart disease (CHD). Methods This study included 120 senile CHD patients as the CHD group and 100 healthy individuals as the normal group (NG). Gensini score was used to evaluate the severity of coronary artery lesions. Central retinal artery equivalents (CRAE), central retinal venular equivalents (CRVE), and arteriovenous ratio (AVR) were measured. Results CHD group has lower CRAE and AVR than NG, while higher CRVE was observed in NG. CRAE and AVR in UAP (unstable angina pectoris) and AMI (acute myocardial infarction) groups showed reduction (stable angina pectoris); however, enhanced CRVE and Gensini scores in UA and AMI groups were observed as compared to the SAP group. CRAE and AVR in moderate and severe groups were reduced to a greater extent compared to the mild groups, while enhanced CRVE and Gensini scores were observed more often in the severe group than the mild group. CRAE and AVR were negatively correlated with the Gensini score; however, CRVE was positively correlated with the Gensini score. Conclusion AVR is expected to be a noninvasive index to diagnose and predict senile CHD, which has a certain evaluation value. Diabetes, smoking history, and TC are independent risk factors of senile CHD.
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Affiliation(s)
- Ning Wang
- Department of Cardiovascularology, Jinan Seventh People’s Hospital, Jinan 250132, Shandong Province, China
| | - Changsen Liang
- Department of Ophthalmology, Jinan Seventh People’s Hospital, 21th Gongye North Road, Licheng District, Jinan 250132, Shandong Province, China
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16
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Early-childhood BMI trajectories in relation to preclinical cardiovascular measurements in adolescence. J Dev Orig Health Dis 2021; 13:322-329. [PMID: 34308826 DOI: 10.1017/s2040174421000441] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiovascular diseases are the leading causes of morbidity and mortality. Overweight, obesity, and accelerated growth during early childhood have been associated with adverse cardiovascular outcomes in later life. Few studies have assessed whether trajectories of accelerated growth in early childhood are associated with preclinical cardiovascular measurements. We aimed to evaluate the associations between childhood body mass index (BMI) growth trajectories and measures of macro- and microvascular function in early adolescence. Measurements of macrovascular function (systolic and diastolic blood pressure (SBP and DBP), pulse wave velocity (PWV), and microvascular function (central retinal arteriolar/veinular equivalent) were assessed at 11 years old in a Spanish birth cohort study (n = 489). BMI trajectories from birth to 9 years were identified using latent class growth analysis. Multiple linear regression assessed the associations between the BMI trajectories and macro- and microvascular function. Compared to children with average birth size and slower BMI gain (reference), children with a lower birth size and accelerated BMI gain had increased SBP [β = 6.57; (95% CI 4.00, 9.15)], DBP [β = 3.65; (95% CI 1.45, 5.86)], and PWV [β = 0.14; (95% CI 0.01, 0.27)]. Children with higher birth size and accelerated BMI gain had increased SBP [β = 4.75; (95% CI 1.79, 7.71) compared to the reference. No significant associations between BMI trajectories and the microvascular measurements were observed. In conclusion, we found that childhood BMI trajectories characterized by accelerated growth are associated with preclinical macrovascular measurements in young adolescents.
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Guo H, Wu H, Sajid A, Li Z. Whole grain cereals: the potential roles of functional components in human health. Crit Rev Food Sci Nutr 2021; 62:8388-8402. [PMID: 34014123 DOI: 10.1080/10408398.2021.1928596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Whole grain cereals have been the basis of human diet since ancient times. Due to rich in a variety of unique bioactive ingredients, they play an important role in human health. This review highlights the contents and distribution of primary functional components and their health effects in commonly consumed whole grain cereals, especially dietary fiber, protein, polyphenols, and alkaloids. In general, cereals exert positive effects in the following ways: 1) Restoring intestinal flora diversity and increasing intestinal short-chain fatty acids. 2) Regulating plasma glucose and lipid metabolism, thereby the improvement of obesity, cardiovascular and cerebrovascular diseases, diabetes, and other chronic metabolic diseases. 3) Exhibiting antioxidant activity by scavenging free radicals. 4) Preventing gastrointestinal cancer via the regulation of classical signaling pathways. In summary, this review provides a scientific basis for the formulation of whole-grain cereals-related dietary guidelines, and guides people to form scientific dietary habits, so as to promote the development and utilization of whole-grain cereals.
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Affiliation(s)
- Huiqin Guo
- Institute of Biotechnology, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, Taiyuan, PR China
| | - Haili Wu
- College of Life Science, Shanxi University, Taiyuan, PR China
| | - Amin Sajid
- Institute of Biotechnology, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, Taiyuan, PR China
| | - Zhuoyu Li
- Institute of Biotechnology, The Key Laboratory of Chemical Biology and Molecular Engineering of Ministry of Education, Shanxi University, Taiyuan, PR China;,College of Life Science, Shanxi University, Taiyuan, PR China
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18
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Noninvasive temporal detection of early retinal vascular changes during diabetes. Sci Rep 2020; 10:17370. [PMID: 33060607 PMCID: PMC7567079 DOI: 10.1038/s41598-020-73486-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/10/2020] [Indexed: 12/15/2022] Open
Abstract
Diabetes associated complications, including diabetic retinopathy and loss of vision, are major health concerns. Detecting early retinal vascular changes during diabetes is not well documented, and only few studies have addressed this domain. The purpose of this study was to noninvasively evaluate temporal changes in retinal vasculature at very early stages of diabetes using fundus images from preclinical models of diabetes.
Non-diabetic and Akita/+ male mice with different duration of diabetes were subjected to fundus imaging using a Micron III imaging system. The images were obtained from 4 weeks- (onset of diabetes), 8 weeks-, 16 weeks-, and 24 weeks-old male Akita/+ and non-diabetic mice. In total 104 fundus images were subjected to analysis for various feature extractions. A combination of Canny Edge Detector and Angiogenesis Analyzer plug-ins in ImageJ were utilized to quantify various retinal vascular changes in fundus images. Statistical analyses were conducted to determine significant differences in the various extracted features from fundus images of diabetic and non-diabetic animals. Our novel image analysis method led to extraction of over 20 features. These results indicated that some of these features were significantly changed with a short duration of diabetes, and others remained the same but changed after longer duration of diabetes. These patterns likely distinguish acute (protective) and chronic (damaging) associated changes with diabetes. We show that with a combination of various plugging one can extract over 20 features from retinal vasculature fundus images. These features change during diabetes, thus allowing the quantification of quality of retinal vascular architecture as biomarkers for disease progression. In addition, our method was able to identify unique differences among diabetic mice with different duration of diabetes. The ability to noninvasively detect temporal retinal vascular changes during diabetes could lead to identification of specific markers important in the development and progression of diabetes mediated-microvascular changes, evaluation of therapeutic interventions, and eventual reversal of these changes in order to stop or delay disease progression.
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19
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Liu M, Lycett K, Wong TY, Grobler A, Juonala M, He M, Dwyer T, Burgner D, Wake M. Associations of retinal microvascular caliber with large arterial function and structure: A population-based study of 11 to 12 year-olds and midlife adults. Microcirculation 2020; 27:e12642. [PMID: 32490591 DOI: 10.1111/micc.12642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/27/2020] [Accepted: 05/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined associations between retinal microvascular and large arterial phenotypes to explore relationships between the micro- and macro-vasculature in childhood and midlife. METHODS Participants were 1288 children (11-12 years, 50.9% female) and 1264 adults (mean age 44 years, 87.6% female) in a cross-sectional population-based study. Exposures were retinal arteriolar and venular caliber quantified from retinal images. Outcomes included arterial function (pulse wave velocity; carotid arterial elasticity) and structure (carotid intima-media thickness). Multivariable regression models were performed adjusting for age, sex, and family socioeconomic position. RESULTS In children, one standard deviation wider arteriolar caliber was associated with slower pulse wave velocity (-0.15 SD, 95% CI -0.21, -0.09) and higher elasticity (0.13 SD, 95% CI 0.06, 0.20); per SD wider venular caliber was associated with faster pulse wave velocity (0.09 SD, 95% CI 0.03, 0.15) and lower elasticity (-0.07 SD, 95% CI -0.13, -0.01). The size of adult associations was approximately double. Wider arteriolar caliber was associated with smaller carotid intima-media thickness (-0.09 SD, 95% CI -0.16, -0.03) in adults but not children. Venular caliber and carotid intima-media thickness showed little evidence of association. CONCLUSIONS Narrower retinal arterioles and wider venules are associated with large arterial function as early as mid-childhood. Associations strengthen by midlife and also extend to arterial structure, although effect sizes remain small.
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Affiliation(s)
- Mengjiao Liu
- The University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Kate Lycett
- The University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Centre for Social & Early Emotional Development, Deakin University, Melbourne, Vic., Australia
| | - Tien Yin Wong
- The University of Melbourne, Melbourne, Vic., Australia.,Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, The University of Melbourne, Melbourne, Vic., Australia.,Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
| | - Anneke Grobler
- The University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Markus Juonala
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Internal Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mingguang He
- The University of Melbourne, Melbourne, Vic., Australia.,Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, The University of Melbourne, Melbourne, Vic., Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Terry Dwyer
- Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - David Burgner
- The University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, Monash University, Melbourne, Vic., Australia.,Infectious Diseases, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Melissa Wake
- The University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics & The Liggins Institute, The University of Auckland, Auckland, New Zealand
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20
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Luyten LJ, Dockx Y, Provost EB, Madhloum N, Sleurs H, Neven KY, Janssen BG, Bové H, Debacq-Chainiaux F, Gerrits N, Lefebvre W, Plusquin M, Vanpoucke C, De Boever P, Nawrot TS. Children's microvascular traits and ambient air pollution exposure during pregnancy and early childhood: prospective evidence to elucidate the developmental origin of particle-induced disease. BMC Med 2020; 18:128. [PMID: 32450864 PMCID: PMC7249678 DOI: 10.1186/s12916-020-01586-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/06/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Particulate matter exposure during in utero life may entail adverse health outcomes later in life. The microvasculature undergoes extensive, organ-specific prenatal maturation. A growing body of evidence shows that cardiovascular disease in adulthood is rooted in a dysfunctional fetal and perinatal development, in particular that of the microcirculation. We investigate whether prenatal or postnatal exposure to PM2.5 (particulate matter with a diameter ≤ 2.5 μm) or NO2 is related to microvascular traits in children between the age of four and six. METHODS We measured the retinal microvascular diameters, the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE), and the vessel curvature by means of the tortuosity index (TI) in young children (mean [SD] age 4.6 [0.4] years), followed longitudinally within the ENVIRONAGE birth cohort. We modeled daily prenatal and postnatal PM2.5 and NO2 exposure levels for each participant's home address using a high-resolution spatiotemporal model. RESULTS An interquartile range (IQR) increase in PM2.5 exposure during the entire pregnancy was associated with a 3.85-μm (95% CI, 0.10 to 7.60; p = 0.04) widening of the CRVE and a 2.87-μm (95% CI, 0.12 to 5.62; p = 0.04) widening of the CRAE. For prenatal NO2 exposure, an IQR increase was found to widen the CRVE with 4.03 μm (95% CI, 0.44 to 7.63; p = 0.03) and the CRAE with 2.92 μm (95% CI, 0.29 to 5.56; p = 0.03). Furthermore, a higher TI score was associated with higher prenatal NO2 exposure. We observed a postnatal effect of short-term PM2.5 exposure on the CRAE and a childhood NO2 exposure effect on both the CRVE and CRAE. CONCLUSIONS Our results link prenatal and postnatal air pollution exposure with changes in a child's microvascular traits as a fundamental novel mechanism to explain the developmental origin of cardiovascular disease.
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Affiliation(s)
- Leen J Luyten
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Unité de Recherche en Biologie Cellulaire (URBC) - Namur Research Institute for Life Sciences (Narilis), Namur University, Namur, Belgium
| | - Yinthe Dockx
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Narjes Madhloum
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hanne Sleurs
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kristof Y Neven
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Bram G Janssen
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hannelore Bové
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Florence Debacq-Chainiaux
- Unité de Recherche en Biologie Cellulaire (URBC) - Namur Research Institute for Life Sciences (Narilis), Namur University, Namur, Belgium
| | - Nele Gerrits
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Wouter Lefebvre
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Michelle Plusquin
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | | | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium. .,Department of Public Health & Primary Care, Occupational and Environmental Medicine, Leuven University, Leuven, Belgium.
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21
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Jones AR, Tuckwell C, Wright IMR, Morrison JL, Kandasamy Y, Wittwer MR, Arstall MA, Stark MJ, Davies M, Hurst C, Okano S, Clifton VL. The impact of maternal asthma during pregnancy on offspring retinal microvascular structure and its relationship to placental growth factor production in utero. Microcirculation 2020; 27:e12622. [PMID: 32330353 DOI: 10.1111/micc.12622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/14/2022]
Abstract
Asthma is a common chronic disease in pregnancy that affects placental function and fetal growth and associated with cardio-metabolic disorders in the offspring but the mechanisms are unknown. This study explored whether maternal asthma in pregnancy is associated with the development of offspring microvascular structure and whether it was related to biomarkers of angiogenesis in utero. Children aged 4 to 6 years, born to either asthmatic mothers (n = 38) or healthy controls (n = 25), had their retinal microvascular structure examined. Maternal plasma PlGF concentrations at 18 and 36 weeks' gestation were measured. There was a significant global difference in all retinal microvascular measures between children of asthmatic mothers relative to controls and increased retinal venular tortuosity in children born to asthmatic mothers (7.1 (95% CI 0.7-13.5); P = .031). A rise in plasma PlGF from 18 to 36 weeks' gestation was observed in the control population which was significantly lower in the asthma group by 190.9 pg/mL. PlGF concentrations were correlated with microvascular structure including arteriolar branching and venular tortuosity. These exploratory findings indicate that exposure to maternal asthma during pregnancy is associated with persistent changes in microvascular structure in childhood that may be driven by alterations to angiogenic mechanisms in utero.
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Affiliation(s)
- Ailee R Jones
- Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia
| | - Christine Tuckwell
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Ian M R Wright
- Illawarra Health and Medical Research Institute and School of Medicine, The University of Wollongong, Wollongong, NSW, Australia
| | - Janna L Morrison
- Early Origins of Adult Health Research Group, School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | | | - Melanie R Wittwer
- Lyell McEwin Hospital, University of Adelaide, Adelaide, SA, Australia
| | | | - Michael J Stark
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Michael Davies
- Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
| | - Cameron Hurst
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Satomi Okano
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Vicki L Clifton
- Mater Medical Research Institute, University of Queensland, Brisbane, QLD, Australia.,Robinson Research Institute, University of Adelaide, Adelaide, SA, Australia
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22
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Cox B, Luyten LJ, Dockx Y, Provost E, Madhloum N, De Boever P, Neven KY, Sassi F, Sleurs H, Vrijens K, Vineis P, Plusquin M, Nawrot TS. Association Between Maternal Prepregnancy Body Mass Index and Anthropometric Parameters, Blood Pressure, and Retinal Microvasculature in Children Age 4 to 6 Years. JAMA Netw Open 2020; 3:e204662. [PMID: 32396192 PMCID: PMC7218490 DOI: 10.1001/jamanetworkopen.2020.4662] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Maternal prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) has previously been associated with offspring cardiometabolic risk factors, such as fat mass, glucose and insulin levels, and blood pressure, but these associations appear to be largely mediated by offspring BMI. To our knowledge, no studies have assessed alterations in the retinal microvasculature in association with maternal prepregnancy BMI. OBJECTIVE To investigate the association between maternal prepregnancy BMI and anthropometric parameters, blood pressure, and retinal vessel parameters in children age 4 to 6 years. DESIGN, SETTING, AND PARTICIPANTS Participants included mother-child pairs of the population-based Environmental Influence on Early Aging (ENVIRONAGE) birth cohort study (Flanders, Belgium) who were recruited at birth from February 2010 to June 2014 and followed-up at age 4 to 6 years between October 2014 and July 2018. Data were analyzed from February 2019 to April 2019. EXPOSURES Maternal prepregnancy BMI based on height and weight measurements at the first antenatal visit (weeks 7-9 of gestation). MAIN OUTCOMES AND MEASURES Children's anthropometric, blood pressure, and retinal microcirculation measurements at age 4 to 6 years. Retinal vessel diameters and the tortuosity index, a measure for the curvature of the retinal vasculature, were obtained by fundus image analysis. RESULTS This study included 240 mothers and children with a mean (SD) age of 29. 9 (4.2) years and 54.8 (4.7) months, respectively. Of these, 114 children (47.5%) were boys. Maternal prepregnancy BMI was positively associated with the child's birth weight, BMI, waist circumference, blood pressure, and retinal vessel tortuosity. A 1-point increase in maternal prepregnancy BMI was associated with a 0.26-mm Hg (95% CI, 0.08-0.44) higher mean arterial pressure for their children, with similar estimates for systolic and diastolic blood pressure. Independent from the association with blood pressure, a 1-point increase in maternal prepregnancy BMI was associated with a 0.40 (95% CI, 0.01-0.80) higher retinal tortuosity index (× 103). The hypothesis that these associations reflect direct intrauterine mechanisms is supported by the following observations: associations were independent of the current child's BMI and the estimates for paternal BMI at the follow-up visit did not reach significance. CONCLUSIONS AND RELEVANCE Considering that blood pressure tracks from childhood into adulthood and microvascular changes may be early markers of cardiometabolic disease development, our results suggest that maternal prepregnancy BMI is an important modifiable risk factor for later-life cardiovascular health of the offspring.
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Affiliation(s)
- Bianca Cox
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Leen J. Luyten
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Unité de Recherche en Biologie Cellulaire, Namur Research Institute for Life Sciences, Namur University, Namur, Belgium
| | - Yinthe Dockx
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Eline Provost
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Health Unit, Flemish Institute for Technological Research, Mol, Belgium
| | - Narjes Madhloum
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Patrick De Boever
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Health Unit, Flemish Institute for Technological Research, Mol, Belgium
| | - Kristof Y. Neven
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Franco Sassi
- Imperial College Business School, Centre for Health Economics and Policy Innovation, London, England
| | - Hanne Sleurs
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Karen Vrijens
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Paolo Vineis
- School of Public Health, Imperial College, London, England
| | - Michelle Plusquin
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S. Nawrot
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
- Environment & Health Unit, Department of Public Health, Leuven University, Leuven, Belgium
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23
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Liu M, Lycett K, Moreno-Betancur M, Wong TY, He M, Saffery R, Juonala M, Kerr JA, Wake M, Burgner DP. Inflammation mediates the relationship between obesity and retinal vascular calibre in 11-12 year-olds children and mid-life adults. Sci Rep 2020; 10:5006. [PMID: 32193466 PMCID: PMC7081237 DOI: 10.1038/s41598-020-61801-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 02/18/2020] [Indexed: 11/29/2022] Open
Abstract
Obesity predicts adverse microvasculature from childhood, potentially via inflammatory pathways. We investigated whether inflammation mediates associations between obesity and microvascular parameters. In 1054 children (mean age 11 years) and 1147 adults (44 years) from a cross-sectional study, we measured BMI (z-scores for children) and WHtR, Glycoprotein acetyls (GlycA), an inflammatory marker, and retinal arteriolar and venular calibre. Causal mediation analysis methods decomposed a "total effect" into "direct" and "indirect" components via a mediator, considering continuous and categorical measures and adjusting for potential confounders. Compared to normal-weight BMI children, those with overweight or obesity had narrower arteriolar calibre (total effects -0.21 to -0.12 standard deviation (SD)): direct (not mediated via GlycA) effects were similar. Children with overweight or obesity had 0.25 to 0.35 SD wider venular calibre, of which 19 to 25% was mediated via GlycA. In adults, those with obesity had 0.07 SD greater venular calibre, which was completely mediated by GlycA (indirect effect: 0.07 SD, 95% CI -0.01 to 0.16). Similar findings were obtained with other obesity measures. Inflammation mediated associations between obesity and retinal venules, but not arterioles from mid-childhood, with higher mediation effects observed in adults. Interventions targeting inflammatory pathways may help mitigate adverse impacts of obesity on the microvasculature.
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Affiliation(s)
- Mengjiao Liu
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Kate Lycett
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Social & Early Emotional Development, Deakin University, Melbourne, VIC, Australia
| | - Margarita Moreno-Betancur
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Tien Yin Wong
- The University of Melbourne, Melbourne, VIC, Australia.
- Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, The University of Melbourne, Melbourne, Australia.
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore.
| | - Mingguang He
- The University of Melbourne, Melbourne, VIC, Australia
- Department of Ophthalmic Epidemiology, Centre for Eye Research Australia, The University of Melbourne, Melbourne, Australia
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Richard Saffery
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Jessica A Kerr
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Melissa Wake
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - David P Burgner
- The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, Monash University, Melbourne, Australia
- Infectious Diseases, Royal Children's Hospital, Melbourne, Australia
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24
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Campbell MD, Laitinen TT, Hughes A, Pahkala K, Juonala M, Kähönen M, Wong TY, Lehtimäki T, Hutri-Kähönen N, Raitakari OT, Tapp RJ. Impact of Ideal Cardiovascular Health in Childhood on the Retinal Microvasculature in Midadulthood: Cardiovascular Risk in Young Finns Study. J Am Heart Assoc 2019; 7:e009487. [PMID: 30371260 PMCID: PMC6474976 DOI: 10.1161/jaha.118.009487] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background This study examined the association between ideal cardiovascular health (CVH) and the retinal microvasculature in midadulthood. Methods and Results The Cardiovascular Risk in Young Finns Study included children from 5 Finnish University cities, who were chosen randomly from the national population register. Participants ranged from 12 to 18 years in childhood (1986) and from 37 to 43 years in midadulthood (2011). Ideal CVH was defined according to the American Heart Association criteria. Retinal microvascular measures included diameters, lengths, length:diameter ratio, and tortuosity. From childhood to adulthood, fasting plasma glucose and blood pressure were significantly higher in those with impaired fasting glucose or diabetes mellitus. Childhood ideal CVH was negatively associated with adult arteriolar tortuosity (β=−0.008; 95% confidence interval [CI], −0.01 to −0.003; P=0.001). Improved ideal CVH from childhood to adulthood was positively associated with adult arteriolar diameter (β=0.122; 95% CI, 0.01–0.24; P=0.033) and negatively associated with adult length:diameter ratio (β=−0.666; 95% CI, −1.25 to −0.08; P=0.026). When stratified by glucose metabolism, among those with diabetes mellitus and impaired fasting glucose, there was a negative association between childhood ideal CVH and adult venular diameter (diabetes mellitus: β=−2.75; 95% CI, −5.46 to −0.04; P=0.047; impaired fasting glucose: β=−2.13; 95% CI, −4.18 to −0.08; P=0.042). Conclusions This study is the first to comprehensively examine the impact of CVH from childhood to midadulthood on quantitative measures of the retinal microvasculature. Ideal CVH in childhood and improvement in CVH from childhood to adulthood appears to have a protective effect on the retinal microvasculature in those with, without, and at risk of diabetes mellitus.
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Affiliation(s)
- Matthew D Campbell
- 1 School of Food Science and Nutrition University of Leeds United Kingdom.,2 Multidisciplinary Cardiovascular Research Centre University of Leeds United Kingdom
| | - Tomi T Laitinen
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland.,4 Paavo Nurmi Centre Sports & Exercise Medicine Unit Department of Health and Physical Activity University of Turku Finland
| | - Alun Hughes
- 5 Institute of Cardiovascular Science University College London United Kingdom
| | - Katja Pahkala
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland.,4 Paavo Nurmi Centre Sports & Exercise Medicine Unit Department of Health and Physical Activity University of Turku Finland
| | - Markus Juonala
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland
| | - Mika Kähönen
- 6 Department of Clinical Physiology Tampere University Hospital and the Faculty of Medicine and Life Sciences University of Tampere Finland
| | - Tien Y Wong
- 7 Singapore National Eye Centre Singapore & Ophthalmology and Visual Sciences Academic Clinical Program Duke-NUS Medical School National University of Singapore
| | - Terho Lehtimäki
- 8 Department of Clinical Chemistry Fimlab Laboratories Faculty of Medicine and Life Sciences University of Tampere Finland
| | - Nina Hutri-Kähönen
- 9 Department of Paediatrics Tampere University Hospital University of Tampere Finland
| | - Olli T Raitakari
- 3 Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Finland.,10 Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Robyn J Tapp
- 11 School of Clinical and Applied Sciences Leeds Beckett University Leeds United Kingdom.,12 Population Health Research Institute St George's University of London United Kingdom
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Rijks J, Vreugdenhil A, Dorenbos E, Karnebeek K, Joris P, Berendschot T, Mensink R, Plat J. Characteristics of the retinal microvasculature in association with cardiovascular risk markers in children with overweight, obesity and morbid obesity. Sci Rep 2018; 8:16952. [PMID: 30446681 PMCID: PMC6240121 DOI: 10.1038/s41598-018-35279-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/23/2018] [Indexed: 12/11/2022] Open
Abstract
To aim of this study was to evaluate characteristics of the retinal microvasculature, but particularly potential associations with classic and novel (endothelial function and low-grade inflammation)markers for cardiovascular risk, in a cohort of children with overweight and (morbid) obesity. Central retinal arteriolar equivalent(CRAE) and central retinal venular equivalent(CRVE) were assessed. CRAE was significantly lower and AVR significantly higher in children with morbid obesity than in children with overweight and normal weight(p < 0.01). CRVE did not differ significantly between the four weight categories. A multiple linear regression model with CRAE as dependent variable showed that only DBP z-score(β = −2.848,p = 0.029) and plasma glucose concentrations(β = 6.029,p = 0.019) contributed significantly to the variation in CRAE. Remarkably, despite a correlation between CRAE and circulating concentrations of the adhesion molecules VCAM-1 or ICAM-1, markers for inflammation and endothelial function did not contribute to the variation in CRAE. This is the first study showing in population of children with overweight and obesity that the retinal arteriolar microvasculature, but not venular diameter is aberrant, with increasing BMI z-score. CRAE was significantly associated with several cardiovascular risk markers, and multiple linear regression showed that a higher diastolic blood pressure z-score and lower fasting plasma glucose concentrations significantly contributed to the variance in CRAE.
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Affiliation(s)
- Jesse Rijks
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Anita Vreugdenhil
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands. .,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - Elke Dorenbos
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Kylie Karnebeek
- Centre for Overweight Adolescent and Children's Healthcare (COACH), Department of Paediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Peter Joris
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Tos Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ronald Mensink
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Human Biology, Maastricht University, Maastricht, The Netherlands
| | - Jogchum Plat
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.,Department of Human Biology, Maastricht University, Maastricht, The Netherlands
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Hypertensive Disorders During Pregnancy and Offspring Retinal Microvasculature During Adolescence. J Am Coll Cardiol 2018; 72:1318-1320. [PMID: 30190012 DOI: 10.1016/j.jacc.2018.06.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 11/22/2022]
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Siegrist M, Hanssen H, Lammel C, Haller B, Koch AM, Stemp P, Dandl E, Liestak R, Parhofer KG, Vogeser M, Halle M. Effects of a cluster-randomized school-based prevention program on physical activity and microvascular function (JuvenTUM 3). Atherosclerosis 2018; 278:73-81. [PMID: 30261471 DOI: 10.1016/j.atherosclerosis.2018.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 07/30/2018] [Accepted: 09/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS It is unknown whether a school-based prevention program has the potential to improve microvascular health in children. This study investigates the impact of the school-based lifestyle intervention program JuvenTUM 3 on physical activity, physical fitness, serum biomarkers and microvascular function. METHODS We studied 434 children (10-11 years) in a cluster-randomized setting (8 intervention schools, IG; 7 control schools, CG) over 18 months. The school-based prevention program included weekly lifestyle lessons for children with the aim to increase physical activity in and outside of school, physical fitness as well as health behavior. Anthropometric measurements and blood sampling were conducted using standard protocols, physical activity by use of a questionnaire and physical fitness by a 6-item-test battery. Central retinal arteriolar (CRAE) and venular (CRVE) vessel diameters as early marker of vascular dysfunction, as well as the arteriolar-to-venular diameter ratio (AVR), were investigated with a non-mydriatic vessel analyser. RESULTS School-based physical activity increased in 41% of children in IG (19% in CG, p = 0.038). Improvements in vascular parameters were observed for AVR (increase in 83% of children in IG versus 50% in CG; p < 0.001) and for CRVE (43% of children with retinal venular widening in IG versus 58% in CG, p = 0.019). These vascular improvements were also seen in overweight children for CRAE (p = 0.021) and AVR (p < 0.001). CONCLUSIONS The school-based prevention program JuvenTUM 3 increased physical activity at school inducing favourable effects on retinal microvasculature function. These findings underline the importance of early lifestyle interventions in children for primary prevention of cardiovascular disease.
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Affiliation(s)
- Monika Siegrist
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany.
| | - Henner Hanssen
- Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, University of Basel, Switzerland
| | - Christoph Lammel
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Anna-Maria Koch
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Pia Stemp
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Elke Dandl
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Roberta Liestak
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany
| | - Klaus G Parhofer
- Department of Internal Medicine II, University of Munich, Großhadern Campus, Munich, Germany
| | - Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technical University of Munich, Klinikum Rechts der Isar, Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner site Munich Heart Alliance, Munich, Germany
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28
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Retinal Vascular Geometry and the Prevalence of Atrial Fibrillation and Heart Failure in a Clinic-Based Sample. Heart Lung Circ 2018; 28:1631-1637. [PMID: 30224171 DOI: 10.1016/j.hlc.2018.06.1056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/29/2018] [Accepted: 06/22/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND We aimed to examine the cross-sectional association between a range of retinal vascular geometric variables and the prevalence of atrial fibrillation (AF) and heart failure. METHODS The Australian Heart Eye Study (AHES) surveyed 1,680 participants presenting to a tertiary referral hospital for the evaluation of potential coronary artery disease by coronary angiography. Retinal vascular geometric variables (tortuosity, branching, and fractal dimension) were measured from retinal photographs using a computer-assisted program (Singapore I Vessel Assessment). Atrial fibrillation was determined based on a combination of: self-reported history of AF; self-reported use of rate-control and anti-arrhythmic medications; and/or screening electrocardiogram. Self-reported echocardiography-confirmed heart failure was also documented. RESULTS A total of 1,169 participants had complete information on retinal vascular geometric variables and AF and of these 104 (8.9%) had AF. Participants in the second tertile of fractal dimension (Df) compared to those in the highest tertile (reference group), had 92% increased likelihood of having AF after multivariable adjustment. A threshold effect for Df was identified, and participants below versus those above a Df threshold value of 1.472, had greater odds of having AF: multivariable-adjusted OR 1.85 (95% CI 1.03-3.31). Measures of retinal tortuosity and branching were not associated with AF. Retinal vascular geometric variables were also not associated with prevalence of heart failure. CONCLUSIONS A sparser retinal microvascular network (lower Df) was independently associated with greater likelihood of AF. Further studies are needed to investigate whether temporal changes to the retinal vascular geometry are predictive of AF in the longer term.
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Li LJ, Tan KH, Aris IM, Man REK, Gan ATL, Chong YS, Saw SM, Gluckman P, Wong TY, Lamoureux E. Retinal vasculature and 5-year metabolic syndrome among women with gestational diabetes mellitus. Metabolism 2018; 83:216-224. [PMID: 29051041 DOI: 10.1016/j.metabol.2017.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/03/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) are at greater risk of metabolic syndrome (MetS). We studied the association between second-trimester retinal microvasculature and 5-year MetS incidence in women with GDM. METHODS A total of 142 mothers with GDM were recruited and followed up 5years after delivery. Retinal photography was performed at 26-28weeks gestation and metabolic outcomes were assessed at the 5-year postpartum follow-up visit. GDM and MetS were defined based on World Health Organization (WHO) guidelines and Adults Treatment Panel (ATP) III guidelines, respectively. Modified-Poisson regression was applied to study the association between second-trimester retinal microvasculature and incident 5-year maternal MetS, after adjusting for major confounders. Area under the curve (AUC) was calculated based on the final model. RESULTS Our prospective cohort reported a 9.2% incidence rate of 5-year MetS among women with GDM. After adjusting for maternal age, ethnicity, college degree, pre-pregnancy BMI and fasting glucose at 26-28week gestation, each 10μm widening in retinal venular caliber was associated with an increased relative risk of 1.6 (95% confidence interval [CI]: 1.0, 2.8) in incident MetS. In addition to traditional risks of pre-pregnancy BMI and fasting glucose level at 26-28week gestation, retinal venular caliber mildly increased the prediction of 5-year maternal MetS by 1.8%. CONCLUSIONS Second-trimester retinal venular widening was associated with incident 5-year maternal MetS in women with GDM. Our study suggests that mother with GDM at risk of future MetS development may have already presented retinal microvascular abnormalities during pregnancy.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore.
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore; KK Women's and Children's Hospital, Singapore
| | - Izzuddin M Aris
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Ryan Eyn Kidd Man
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Yap Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore
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30
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Lundberg K, Tarp J, Vestergaard AH, Jacobsen N, Thykjaer AS, Rønne MS, Bugge A, Goldschmidt E, Peto T, Wedderkopp N, Grauslund J. Retinal vascular diameters in relation to physical activity in Danish children - The CHAMPS Eye Study. Scand J Med Sci Sports 2018; 28:1897-1907. [PMID: 29701884 DOI: 10.1111/sms.13204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/17/2023]
Abstract
Our objective was to determine associations between retinal vascular caliber and physical activity (PA) in a school-based child cohort. In a prospective study, we created a childhood cumulative average PA-index using objectively measured PA (accelerometry) assessed at four periods between 2009 and 2015. Cumulative exposure to PA intensities was estimated. Cross-sectional examinations on biomarkers, anthropometry, and ophthalmological data including retinal fundus photographs were performed in 2015. Semi-automated measurements of retinal vascular diameters were performed and summarized into central retinal arteriolar and venular equivalents (CRAE, CRVE). We included 307 participants. Mean age in 2015 was 15.4 years (0.7). The mean CRAE and CRVE were 156.5 μm (2.8) and 217.6 μm (7.7), respectively. After adjusting for age, gender, and axial length, more time in PA was independently related to thinner retinal venules (β-coefficient = -1.25 μm/%, 95% confidence interval = -2.20, -0.30, P < .01). Sedentary time was associated with wider venules (P < .01). Furthermore, birthweight (β-coefficient = 0.56 μm/%, 95% confidence interval = 0.18, 0.95, P < .01) was associated with CRVE. Blood pressure was associated with thinner retinal arterioles (β-coefficient = -0.19 μm/mmHg, 95% confidence interval = -0.36, -0.01, P = .04). We concluded that children with higher PA in childhood had thinner retinal venular caliber. Our results suggest that PA during childhood positively impacts the retinal microcirculation and that retinal vascular analysis may be a possible assessment to detect microvascular impairments in children with an increased risk of future cardiovascular disease.
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Affiliation(s)
- K Lundberg
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - J Tarp
- Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - A H Vestergaard
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - N Jacobsen
- Department of Ophthalmology, Rigshospitalet-Glostrup University Hospital, Copenhagen, Denmark
| | - A S Thykjaer
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - M S Rønne
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - A Bugge
- Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
| | - E Goldschmidt
- Danish Institute for Myopia Research, Vedbaek, Denmark
| | - T Peto
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - N Wedderkopp
- Department of Sports Science and Clinical Biomechanics, Centre of Research in Childhood Health, Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark.,The Orthopedic Department, Institute of Regional Health Services Research, Sport Medicine Clinic, University of Southern Denmark, Middelfart, Denmark
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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31
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Newman A, Andrew N, Casson R. Review of the association between retinal microvascular characteristics and eye disease. Clin Exp Ophthalmol 2017; 46:531-552. [PMID: 29193621 DOI: 10.1111/ceo.13119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 10/29/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Computerized retinal imaging technologies enable the static and dynamic measurement of a range of retinal microvascular parameters. Large population-based studies have reported associations between these microvascular indices and various ophthalmic diseases including diabetes, age-related macular degeneration, retinal artery embolism, retinal vein occlusion, glaucoma and non-glaucomatous optic neuropathies. Increasingly, sophisticated imaging and analysis techniques have the potential to provide relevant clinical information regarding disease risk and progression; however, further studies are required to verify associations and strengthen the predictive power of these techniques. We summarize the current state of knowledge regarding retinal microvascular characteristics and eye disease.
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Affiliation(s)
- Alexander Newman
- Department of Ophthalmology, Gold Coast University Hospital, Queensland, Australia.,Griffith University School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Nicholas Andrew
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
| | - Robert Casson
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, South Australia, Australia
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Li LJ, Tan KH, Aris IM, Chong YS, Saw SM, Gluckman P, Wang JJ, Wong TY. Gestational retinal microvasculature and the risk of 5 year postpartum abnormal glucose metabolism. Diabetologia 2017; 60:2368-2376. [PMID: 28939944 DOI: 10.1007/s00125-017-4441-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/01/2017] [Indexed: 12/20/2022]
Abstract
AIMS/HYPOTHESIS Changes in retinal microvasculature may reflect insulin resistance. We examined the association of changes in retinal microvasculature during pregnancy and risk of subsequent abnormal glucose metabolism in a cohort of mothers at baseline and 5 years postpartum. METHODS Of the participants from the Singapore birth cohort (Growing Up in Singapore Towards Healthy Outcomes [GUSTO]), 276 mothers attended both baseline (at 26-28 weeks of gestation) and follow-up (5 year postpartum) visits. At baseline we performed retinal photography and assessed retinal microvascular variables using a validated grading system. At follow-up, we assessed glucose tolerance using a 75 g OGTT. We defined abnormal glucose metabolism if participants: (1) had onset of gestational diabetes mellitus (GDM) in subsequent pregnancies within a 5 year follow-up period (n = 103) or (2) had prediabetes (impaired fasting glucose, impaired glucose tolerance or HbA1c 5.7-6.4% [39-46 mmol/mol]) and diabetes diagnosed at the 5 year follow-up visit (n = 84), according to WHO guidelines. RESULTS The incidence of GDM in subsequent pregnancy and abnormal glucose metabolism 5 years postpartum was 25.2% and 30.4%, respectively. Each 10 μm widening in retinal venular calibre was associated with a significant risk of postpartum abnormal glucose metabolism (RR 1.2 [95% CI 1.0, 1.5]), independent of maternal age, college education, ethnicity, pre-pregnancy BMI and GDM at baseline. Narrower retinal arteriolar calibre and venular branching angle at baseline was associated with a higher insulin resistance index (1.4 [95% CI 1.1, 1.7] and 1.3 [95% CI 1.1, 1.6], respectively) at follow-up. CONCLUSIONS/INTERPRETATION Retinal microvasculature in pregnant women was associated with abnormal glucose metabolism 5 years postpartum. Alteration of microvascular structure during pregnancy may signal subclinical changes that underlie the development of prediabetes and diabetes.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore.
- Academic Medicine Research Institute, Duke-NUS Medical School, Singapore, Singapore.
| | - Kok Hian Tan
- Academic Medicine Research Institute, Duke-NUS Medical School, Singapore, Singapore
- Division of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Izzuddin M Aris
- Growth, Development and Metabolism, Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Yap Seng Chong
- Growth, Development and Metabolism, Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
- Academic Medicine Research Institute, Duke-NUS Medical School, Singapore, Singapore
| | - Peter Gluckman
- Growth, Development and Metabolism, Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Jie Jin Wang
- Academic Medicine Research Institute, Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
- Academic Medicine Research Institute, Duke-NUS Medical School, Singapore, Singapore
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Wang SB, Mitchell P, Liew G, Wong TY, Phan K, Thiagalingam A, Joachim N, Burlutsky G, Gopinath B. A spectrum of retinal vasculature measures and coronary artery disease. Atherosclerosis 2017; 268:215-224. [PMID: 29050745 DOI: 10.1016/j.atherosclerosis.2017.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/07/2017] [Accepted: 10/06/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIMS We aimed to comprehensively describe a spectrum of retinal vessel measures including fractal dimension (Df) and their associations with indices of coronary artery disease (CAD) extent and severity, as well as hypertension and diabetes. METHODS The Australian Heart Eye Study (AHES) is an observational study that surveyed 1680 participants presenting to a tertiary referral hospital for the evaluation of potential CAD by coronary angiography. A range of newer retinal vessel geometric measures (Df, curvature tortuosity, and branching angle) were quantified from retinal photographs using semi-automated software, the Singapore 'I' Vessel Assessment (SIVA) tool. A combined retinal score was constructed, aiming to assess the joint effect of multiple retinal vessel parameters on CAD, comprising of those variables that were most strongly significant in multivariate analysis - Df, arteriolar curvature tortuosity, and retinal arteriolar calibre. CAD was objectively quantified using a range of measures obtained from coronary angiography. RESULTS A total of 1187 participants had complete data on retinal vessel measurements and coronary vessel evaluation. Retinal vascular Df and curvature tortuosity decreased with increasing age; women had significantly lower Df than men (p<0.003). Straighter retinal vessels were associated with CAD extent and Gensini scores in multivariable analysis (p<0.02). Accounting for media opacity by sub-group analysis in pseudophakic patients, the combined retinal score was associated with stenosis greater than 50% in any coronary artery segment (vessel score) and obstructive coronary stenosis in all three main coronary arteries (segment score) (p = 0.01). Lower Df and narrower arteriolar branching angle were associated with CAD vessel score (p<0.03). In sex-stratified multivariate analyses, straighter arterioles were associated with greater odds of CAD in men, and narrower venular branching angle was associated with CAD in women. CONCLUSIONS A range of retinal vessel measures were associated with CAD extent and severity. A sparser retinal microvascular network (smaller Df) was associated with older age and female gender. After accounting for the impact of media opacity, retinal vessel measures were associated with more diffuse and severe CAD.
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Affiliation(s)
- Sarah B Wang
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Paul Mitchell
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Gerald Liew
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Kevin Phan
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Aravinda Thiagalingam
- Centre for Heart Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Nichole Joachim
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - George Burlutsky
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia
| | - Bamini Gopinath
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
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34
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Schuh DS, Piccoli ÂB, Paiani RL, Maciel CR, Pellanda LC, Vilela MA. Ocular Signs Related to Overweight and Arterial Hypertension in Children: A Systematic Review. Open Ophthalmol J 2017; 11:273-285. [PMID: 29081867 PMCID: PMC5633707 DOI: 10.2174/1874364101711010273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/20/2017] [Accepted: 06/18/2017] [Indexed: 12/18/2022] Open
Abstract
Background: The ocular effects of obesity and hypertension need to be established and can be used as prognostic markers. Objective: To estimate the prevalence of ophthalmological alterations in children and adolescents who are overweight and/or have SAH. Methods: The database for this study included all observational studies (CS, cohort, case-control and “baseline” description of randomized clinical trials) with children and/or adolescents who were overweight, obese or had SAH and that measured ophthalmological alterations. Results: Comparative studies with healthy children demonstrated positive association between body adiposity with retinal venular dilation, and SAH with retinal arteriolar narrowing. Different retinal fundus cameras and computer-assisted programs to evaluate the retinal vessels, variations in the methods of analysis, adjustments, populations, were the main arguments against formal meta-analysis. The heterogeneity was too high (I2 >90%, in fixed or randomized effects), and the lack of linearity, normal distribution and homoscedasticity did not recommend meta-regression. Conclusion: Obesity and SAH show associations with ophthalmological alterations, especially with retinal vessel diameter. Lack of standardization does not allow a quantitative evaluation.
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Affiliation(s)
- Daniela S Schuh
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Ângela B Piccoli
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Raquel L Paiani
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Cristiane R Maciel
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Lucia C Pellanda
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
| | - Manuel Ap Vilela
- Instituto de Cardiologia/Fundacao Universitária de Cardiologia, Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Hanvey AN, Mensah FK, Clifford SA, Wake M. Adolescent Cardiovascular Functional and Structural Outcomes of Growth Trajectories from Infancy: Prospective Community-Based Study. Child Obes 2017; 13:154-163. [PMID: 28092462 DOI: 10.1089/chi.2016.0263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Adult BMI trajectories outperform single BMI measurements as predictors of cardiovascular mortality; however, it is unknown whether this also holds in childhood. We aimed to identify BMI trajectory categories from birth to adolescence, and examine their associations with adolescent cardiovascular function and structure. METHODS Adolescents from a community-based prospective birth cohort completed 11-16 BMI measurements between birth and adolescence. BMI trajectory categories were identified using latent class analysis. Associations between trajectories and cardiovascular outcomes (14 years) were assessed using adjusted linear regression models (n = 187). Cardiovascular outcomes included systolic/diastolic blood pressure, augmentation index, pulse wave velocity, carotid intima-media thickness, and retinal arteriole-to-venule ratio. Regression models were adjusted for child age, gender, height, socioeconomic status, and puberty status at outcome. RESULTS Three BMI trajectories emerged that diverged sharply by the age of 1 year. BMI increments were thereafter roughly parallel for those in the low normal (39%) and high normal (51%) groups, but steeper in the consistently overweight (10%) group, which was notable for lack of an obvious adiposity rebound. Cardiovascular function and structure were similar across the three trajectory groups. The only exception was augmentation index, which was 7.8% (95% CI: 2.6 to 13.0) higher in the consistently overweight individuals than the low normal individuals. CONCLUSIONS We found little evidence that those with consistently higher BMI from infancy experienced poorer cardiovascular function or structure by the age of 14 years. Nonetheless, childhood BMI trajectories track strongly, meaning resolution of risky BMI, while essential to decrease later cardiovascular risk, is unlikely without intervention.
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Affiliation(s)
- Alanna N Hanvey
- 1 Centre for Community Child Health, Murdoch Childrens Research Institute , The Royal Children's Hospital, Parkville, Australia .,2 Department of Paediatrics, The University of Melbourne , Parkville, Australia
| | - Fiona K Mensah
- 2 Department of Paediatrics, The University of Melbourne , Parkville, Australia .,3 Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute , The Royal Children's Hospital, Parkville, Australia
| | - Susan A Clifford
- 1 Centre for Community Child Health, Murdoch Childrens Research Institute , The Royal Children's Hospital, Parkville, Australia .,2 Department of Paediatrics, The University of Melbourne , Parkville, Australia
| | - Melissa Wake
- 1 Centre for Community Child Health, Murdoch Childrens Research Institute , The Royal Children's Hospital, Parkville, Australia .,2 Department of Paediatrics, The University of Melbourne , Parkville, Australia
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[Structural and morphological changes in the eyes of arterial hypertensive patients with and without anti-CCP-positive rheumatoid arthritis]. Ophthalmologe 2016; 114:348-357. [PMID: 27572952 DOI: 10.1007/s00347-016-0349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION To investigate the additive systemic inflammatory process of rheumatoid arthritis (RA) in arterial hypertension patients, structural and morphological changes of the retina and optic nerve head were assessed by modern topographic technologies. Similarities of underlying vascular mechanisms between RA and arterial hypertension are interesting and have not been researched in depth. The aim of this study is to evaluate changes of RA and arterial hypertension with the optic coherence topography (OCT) and Heidelberg retina tomography (HRT III), to validate RA changes in comparison to arterial hypertension only patients and, finally, if these methods are useful to detect the chronic inflammatory influence of the RA on the eye. METHODS In this prospective study design, data of 18 patients with RA and arterial hypertension (55.3 ± 4.31 years old), positive for antibodies against cyclic citrullinated peptides, 21 patients with arterial hypertension (54.2 ± 4.18 years old) and 19 healthy subjects (53.1 ± 3.25 years old) were included. Intensive ophthalmologic and internistic screening tests were carried out in all subjects. All participants were investigated for the retinal nerve fiber layer (RNFL) and macula thickness with the OCT (Carl Zeiss AG Germany) and for stereometric parameters of the optic nerve head with the Heidelberg Retina Tomograph III (Heidelberg Engineering Germany). The pachymetry was conducted by the Orbscan II system (Bausch & Lomb). Statistical data were assessed by SPSS, v20.0. RESULTS No significant differences were found in visual function, diastolic and systolic blood pressure. RNFL, and macular thickness (Stratus-OCT) were almost consistent between the groups and even the main stereometric parameters measured with HRT III showed no significant differences. CONCLUSION Contrary to our study hypothesis no structural and morphological changes could be detected in patients with arterial hypertension without RA compared to healthy subjects. Furthermore, no RA-specific effects could be shown in comparison with the hypertension group. Thus, the used examination techniques are not suitable to prove the systemic inflammatory influence of RA on the eye.
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Mann GE. Cardiovascular and skeletal muscle ageing: consequences for longevity. J Physiol 2016; 594:1961-3. [PMID: 27079628 PMCID: PMC4933101 DOI: 10.1113/jp270578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/04/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Giovanni E Mann
- Cardiovascular Division, BHF Centre of Research Excellence, Faculty of Life & Health Sciences, King's College London, 150 Stamford Street, London, SE1 9NH, UK
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