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Statham L, Pelling M, Hanson P, Kyrou I, Randeva H, Barber TM. Designer GLP1 poly-agonist peptides in the management of diabesity. Expert Rev Endocrinol Metab 2023; 18:231-240. [PMID: 37089108 DOI: 10.1080/17446651.2023.2204976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION To date, the 21st Century has witnessed key developments in the management of diabesity (a conflation of obesity and Type 2 Diabetes Mellitus [T2D]), including Glucagon Like Peptide 1 (GLP1) receptor agonist therapies, and recently the 'designer' GLP1 Poly-agonist Peptides (GLP1PPs). AREAS COVERED A PubMed search of published data on the GLP1PP class of therapies was conducted. The gut-brain axis forms complex multi-directional interlinks that include autonomic nervous signaling, components of the gut microbiota (including metabolic by-products and gram-negative cell wall components [e.g. endotoxinaemia]), and incretin hormones that are secreted from the gut in response to the ingestion of nutrients. The development of dual-incretin agonist therapies includes combinations of the GLP1 peptide with Glucose-dependent Insulinotropic Polypeptide (GIP), Glucagon (Gcg), Cholecystokinin (CCK), Peptide YY (PYY), and Glucagon-Like Peptide 2 (GLP2). Triple incretin agonist therapies are also under development. EXPERT OPINION At the dawn of a new era in the therapeutic management of diabesity, the designer GLP1PP class holds great promise, with each novel combination building on a preexisting palimpsest of clinical data and insights. Future innovations of the GLP1PP class will likely enable medically induced weight loss and glycemic control in diabesity to rival or even out-perform those resulting from bariatric surgery.
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Affiliation(s)
- Laura Statham
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Melina Pelling
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Petra Hanson
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Ioannis Kyrou
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry, UK
- Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece
| | - Harpal Randeva
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Thomas M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Coventry, UK
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Cohn W, Zhu C, Campagna J, Bilousova T, Spilman P, Teter B, Li F, Guo R, Elashoff D, Cole GM, Avidan A, Faull KF, Whitelegge J, Wong DTW, John V. Integrated Multiomics Analysis of Salivary Exosomes to Identify Biomarkers Associated with Changes in Mood States and Fatigue. Int J Mol Sci 2022; 23:5257. [PMID: 35563647 PMCID: PMC9105576 DOI: 10.3390/ijms23095257] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/07/2023] Open
Abstract
Fatigue and other deleterious mood alterations resulting from prolonged efforts such as a long work shift can lead to a decrease in vigilance and cognitive performance, increasing the likelihood of errors during the execution of attention-demanding activities such as piloting an aircraft or performing medical procedures. Thus, a method to rapidly and objectively assess the risk for such cognitive fatigue would be of value. The objective of the study was the identification in saliva-borne exosomes of molecular signals associated with changes in mood and fatigue that may increase the risk of reduced cognitive performance. Using integrated multiomics analysis of exosomes from the saliva of medical residents before and after a 12 h work shift, we observed changes in the abundances of several proteins and miRNAs that were associated with various mood states, and specifically fatigue, as determined by a Profile of Mood States questionnaire. The findings herein point to a promising protein biomarker, phosphoglycerate kinase 1 (PGK1), that was associated with fatigue and displayed changes in abundance in saliva, and we suggest a possible biological mechanism whereby the expression of the PGK1 gene is regulated by miR3185 in response to fatigue. Overall, these data suggest that multiomics analysis of salivary exosomes has merit for identifying novel biomarkers associated with changes in mood states and fatigue. The promising biomarker protein presents an opportunity for the development of a rapid saliva-based test for the assessment of these changes.
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Affiliation(s)
- Whitaker Cohn
- The Drug Discovery Lab, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (W.C.); (C.Z.); (J.C.); (T.B.); (P.S.); (B.T.)
| | - Chunni Zhu
- The Drug Discovery Lab, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (W.C.); (C.Z.); (J.C.); (T.B.); (P.S.); (B.T.)
| | - Jesus Campagna
- The Drug Discovery Lab, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (W.C.); (C.Z.); (J.C.); (T.B.); (P.S.); (B.T.)
| | - Tina Bilousova
- The Drug Discovery Lab, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (W.C.); (C.Z.); (J.C.); (T.B.); (P.S.); (B.T.)
| | - Patricia Spilman
- The Drug Discovery Lab, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (W.C.); (C.Z.); (J.C.); (T.B.); (P.S.); (B.T.)
| | - Bruce Teter
- The Drug Discovery Lab, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (W.C.); (C.Z.); (J.C.); (T.B.); (P.S.); (B.T.)
| | - Feng Li
- Center for Oral/Head & Neck Oncology Research, Laboratory of Salivary Diagnostics, School of Dentistry, 10833 Le Conte Avenue, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.L.); (D.T.W.W.)
| | - Rong Guo
- Department of Medicine Statistics Core, David Geffen School of Medicine, 1100 Glendon Avenue, University of California Los Angeles, Los Angeles, CA 90095, USA; (R.G.); (D.E.)
| | - David Elashoff
- Department of Medicine Statistics Core, David Geffen School of Medicine, 1100 Glendon Avenue, University of California Los Angeles, Los Angeles, CA 90095, USA; (R.G.); (D.E.)
| | - Greg M. Cole
- Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (G.M.C.); (A.A.)
| | - Alon Avidan
- Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (G.M.C.); (A.A.)
| | - Kym Francis Faull
- Pasarow Mass Spectrometry Laboratory, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (K.F.F.); (J.W.)
| | - Julian Whitelegge
- Pasarow Mass Spectrometry Laboratory, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (K.F.F.); (J.W.)
| | - David T. W. Wong
- Center for Oral/Head & Neck Oncology Research, Laboratory of Salivary Diagnostics, School of Dentistry, 10833 Le Conte Avenue, University of California Los Angeles, Los Angeles, CA 90095, USA; (F.L.); (D.T.W.W.)
| | - Varghese John
- The Drug Discovery Lab, Department of Neurology, David Geffen School of Medicine, 710 Westwood Plaza, University of California Los Angeles, Los Angeles, CA 90095, USA; (W.C.); (C.Z.); (J.C.); (T.B.); (P.S.); (B.T.)
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Al-Akl N, Thompson RI, Arredouani A. Elevated levels of salivary α- amylase activity in saliva associated with reduced odds of obesity in adult Qatari citizens: A cross-sectional study. PLoS One 2022; 17:e0264692. [PMID: 35271604 PMCID: PMC8912263 DOI: 10.1371/journal.pone.0264692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/14/2022] [Indexed: 11/22/2022] Open
Abstract
The relationship between salivary α-amylase activity (ssAAa) and the risk of metabolic disorders remains equivocal. We aimed to assess this relationship in adults from Qatar, where obesity and type 2 diabetes are highly prevalent. We cross-sectionally quantified ssAAa in saliva and estimated AMY1 CN from whole-genome sequencing data from 1499 participants. Linear regression was used to assess the relationship between ssAAa and adiposity and glycemic markers. Logistic regression was used to examine the association between ssAAa and occurrence of obesity or diabetes. The mean and median ssAAa were significantly lower in obese individuals. There were significant inverse associations between ssAAa and BMI, and fat mass. We detected a marked effect of ssAAa on reduced odds of obesity after adjusting for age and sex, glucose, LDL, HLD, total cholesterol, and systolic and diastolic blood pressure (OR per ssAAa unit 0.998 [95% CI 0.996–0.999], p = 0.005), with ssAAa ranging between 6.8 and 422U/mL. The obesity odds were significantly lower in the upper half of the ssAAa distributional (OR 0.58 [95% CI 0.42–0.76], p<0.001) and lower in the top versus the bottom decile of the ssAAa distribution (OR 0.46 [95% CI 0.23–0.92], p = 0.03). Our findings suggest a potential beneficial relationship between high sAAa in saliva and low odds of obesity in Qatari adults.
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Affiliation(s)
- Neyla Al-Akl
- Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
| | - Richard I. Thompson
- Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
| | - Abdelilah Arredouani
- Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Doha, Qatar
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- * E-mail:
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Farrell M, Ramne S, Gouinguenet P, Brunkwall L, Ericson U, Raben A, Nilsson PM, Orho-Melander M, Granfeldt Y, Tovar J, Sonestedt E. Effect of AMY1 copy number variation and various doses of starch intake on glucose homeostasis: data from a cross-sectional observational study and a crossover meal study. Genes Nutr 2021; 16:21. [PMID: 34789141 DOI: 10.1186/s12263-021-00701-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/31/2021] [Indexed: 12/16/2022]
Abstract
Background Copy number (CN) variation (CNV) of the salivary amylase gene (AMY1) influences the ability to digest starch and may influence glucose homeostasis, obesity and gut microbiota composition. Hence, the aim was to examine the association of AMY1 CNV with fasting glucose, BMI, and gut microbiota composition considering habitual starch intake and to investigate the effect of AMY1 CNV on the postprandial response after two different starch doses. Methods The Malmö Offspring Study (n = 1764, 18–71 years) was used to assess interaction effects between AMY1 CNV (genotyped by digital droplet polymerase chain reaction) and starch intake (assessed by 4-day food records) on fasting glucose, BMI, and 64 gut bacteria (16S rRNA sequencing). Participants with low (≤ 4 copies, n = 9) and high (≥ 10 copies, n = 10) AMY1 CN were recruited for a crossover meal study to compare postprandial glycemic and insulinemic responses to 40 g and 80 g starch from white wheat bread. Results In the observational study, no overall associations were found between AMY1 CNV and fasting glucose, BMI, or gut microbiota composition. However, interaction effects between AMY1 CNV and habitual starch intake on fasting glucose (P = 0.03) and BMI (P = 0.05) were observed, suggesting inverse associations between AMY1 CNV and fasting glucose and BMI at high starch intake levels and positive association at low starch intake levels. No associations with the gut microbiota were observed. In the meal study, increased postprandial glucose (P = 0.02) and insulin (P = 0.05) were observed in those with high AMY1 CN after consuming 40 g starch. This difference was smaller and nonsignificant after consuming 80 g starch. Conclusions Starch intake modified the observed association between AMY1 CNV and fasting glucose and BMI. Furthermore, depending on the starch dose, a higher postprandial glucose and insulin response was observed in individuals with high AMY1 CN than in those with low AMY1 CN. Trial registration ClinicalTrials.gov, NCT03974126. Registered 4 June 2019—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12263-021-00701-8.
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Shin D, Lee KW. Dietary carbohydrates interacts with AMY1 polymorphisms to influence the incidence of type 2 diabetes in Korean adults. Sci Rep 2021; 11:16788. [PMID: 34408213 DOI: 10.1038/s41598-021-96257-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/30/2021] [Indexed: 01/23/2023] Open
Abstract
The relationship between AMY1 single nucleotide polymorphisms (SNPs), dietary carbohydrates, and the risk of type 2 diabetes is unclear. We aimed to evaluate this association using an ongoing large-scale prospective study, namely the Korean Genome and Epidemiology Study. We selected six genetic variants of the AMY1 gene: rs10881197, rs4244372, rs6696797, rs1566154, rs1930212, and rs1999478. Baseline dietary data were obtained using a semi-quantitative food frequency questionnaire. Type 2 diabetes was defined according to the criteria of the World Health Organization and American Diabetes Association. During an average follow-up period of 12 years (651,780 person-years), 1082 out of 4552 (23.8%) patients had type 2 diabetes. Three AMY1 SNPs were significantly associated with diabetes incidence among patients with carbohydrate intake > 65% of total energy: rs6696797, rs4244372, and rs10881197. In multivariable Cox models, Korean women with the rs6696797 AG or AA genotype had 28% higher incidence of type 2 diabetes (hazard ratio 1.28, 95% confidence interval 1.06–1.55) than Korean women with the rs6696797 GG genotype. We did not observe significant associations between AMY1 SNPs, dietary carbohydrates, and diabetes incidence in Korean men. We conclude that AMY1 genetic variants and dietary carbohydrate intake influence the incidence of type 2 diabetes in Korean women only. Korean women who are minor carriers of the AMY1 rs6696797, rs4244372, and rs10881197 genotypes may benefit from a low-carbohydrate diet to prevent the future risk of type 2 diabetes.
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Hariharan R, Mousa A, de Courten B. Influence of AMY1A copy number variations on obesity and other cardiometabolic risk factors: A review of the evidence. Obes Rev 2021; 22:e13205. [PMID: 33432778 DOI: 10.1111/obr.13205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/01/2022]
Abstract
The rising incidence of obesity and type 2 diabetes is contributing to the escalating burden of disease globally. These metabolic disorders are closely linked with diet and in particular with carbohydrate consumption; hence, it is important to understand the underlying mechanisms that influence carbohydrate metabolism. Amylase, the enzyme responsible for the digestion of starch, is coded by the genes AMY1A, AMY1B, and AMY1C (salivary amylase) and AMY2A and AMY2B (pancreatic amylase). Previous studies demonstrate wide variations in AMY1A copy numbers, which can be attributed to several genetic, nutritional, and geographical diversities seen in populations globally. Current literature suggests that AMY1A copy number variations are important in obesity and other cardiometabolic disorders through their effects on glucose and lipid homeostasis, inflammatory markers, and the gut microbiome. This review synthesizes the available evidence to improve understanding of the role of AMY1A in obesity and related cardiometabolic risk factors and disorders including insulin resistance and type 2 diabetes, cardiovascular risk and inflammation, and the gut microbiome.
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Affiliation(s)
- Rohit Hariharan
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Aya Mousa
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
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Zhan F, Chen J, Yan H, Wang S, Zhao M, Zhang S, Lan X, Maekawa M. Association of Serum Amylase Activity and the Copy Number Variation of AMY1/2A/2B with Metabolic Syndrome in Chinese Adults. Diabetes Metab Syndr Obes 2021; 14:4705-4714. [PMID: 34880639 PMCID: PMC8648087 DOI: 10.2147/dmso.s339604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Low serum amylase activity and copy number (CN) variation (CNV) of the salivary amylase gene (AMY1) are reportedly associated with obesity and abnormal glucose metabolism; however, this association remains controversial. We aimed to clarify the relationship between serum amylase activity and the CNV of AMY1/2A/2B with the occurrence of metabolic syndrome (MetS) in Chinese adults. PATIENTS AND METHODS Anthropometry, metabolic risk factors, and serum amylase activity were assessed in 560 subjects (260 MetS patients; 300 healthy controls). AMY1/2A/2B CNs were evaluated using the highly sensitive droplet digital PCR. RESULTS The serum total, pancreatic, and salivary amylase activity, but not the AMY1/2A/2B CNs, was significantly lower in MetS patients than that in the control subjects. Patients <45 y had a lower AMY1 CN, compared to that in healthy controls. Low serum amylase activity was significantly associated with high MetS prevalence (p < 0.001). In the receiver operating characteristic curve analysis, serum amylase activity was a significant diagnostic indicator for MetS. The diagnostic value of total amylase was second only to that of γ-glutamyl transpeptidase; it was higher than that of alanine aminotransferase and uric acid. CONCLUSION Low serum amylase activity was significantly associated with increased risk of MetS in Chinese adults. Therefore, amylase could be a potential biomarker for predicting MetS.
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Affiliation(s)
- Fangjie Zhan
- Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, Fuzhou, People’s Republic of China
| | - Jin Chen
- Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, Fuzhou, People’s Republic of China
| | - Huihui Yan
- Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, Fuzhou, People’s Republic of China
| | - Shuiliang Wang
- Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, Fuzhou, People’s Republic of China
| | - Meng Zhao
- Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, Fuzhou, People’s Republic of China
| | - Shenghang Zhang
- Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, Fuzhou, People’s Republic of China
| | - Xiaopeng Lan
- Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, Fuzhou, People’s Republic of China
- Correspondence: Xiaopeng Lan Department of Clinical Laboratory Medicine, The 900th Hospital of Joint Logistics Support Force, 156th, Xierhuan Road, Fuzhou, 350025, People’s Republic of ChinaTel +86 591 22859482 Email
| | - Masato Maekawa
- Department of Laboratory Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Masato Maekawa Department of Laboratory Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu, 431-3192, JapanTel +81-53-435-2721Fax +81-53-435-2096 Email
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Al-Akl N, Thompson RI, Arredouani A. High plasma salivary α-amylase, but not high AMY1 copy number, associated with low obesity rate in Qatari adults: cross-sectional study. Sci Rep 2020; 10:17918. [PMID: 33087771 DOI: 10.1038/s41598-020-74864-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022] Open
Abstract
The relationship between salivary α-amylase activity (psAAa) or AMY1 copy number and the risk of obesity remains controversial. We aimed to assess this relationship in a cohort from Qatar, where obesity affects 43% of adults. The relationship was investigated cross-sectionally in 923 Qatari adults from the Qatar biobank cohort. AMY1 CN was estimated form whole genome sequencing data. The associations with obesity prevalence were assessed by linear and logistic regressions. We found no difference in AMY1 CN between obese and normal-weight individuals. However, the psAAa was significantly lower in obese individuals. Significant inverse correlations were found between adiposity markers and psAAa in both sexes, but were marginally stronger in men. A significant effect of high psAAa, but not AMY1 CN, on reduced obesity rates was identified in men (OR per psAAa unit 0.957 [95% CI 0.937–0.977], p < 0.001, with psAAa ranging between 5 to 66 U/L). A significantly higher prevalence of obesity was observed in the lowest quartile of psAAa in men (75% (Q1) vs. 36% (Q4), p < 0.001) and women (74% (Q1) vs 56% (Q4), p = 0.009). Our findings suggest that high psAAa, but not AMY1 CN, has a potential positive benefit against obesity in the Qatari population.
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