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Merlijn T, Swart KMA, Niemeijer C, van der Horst HE, Netelenbos CJ, Elders PJM. The yield of routine laboratory examination in osteoporosis evaluation in primary care. Osteoporos Int 2024; 35:911-918. [PMID: 38494549 PMCID: PMC11031471 DOI: 10.1007/s00198-024-07042-3] [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: 09/25/2023] [Accepted: 02/14/2024] [Indexed: 03/19/2024]
Abstract
This study evaluated the yield of routine laboratory examination in a large population of older women in primary care. The prevalence of laboratory abnormalities was low and the clinical consequences in follow-up were limited. There was a weak association of laboratory abnormalities with osteoporosis but no association with vertebral fractures and recent fractures. PURPOSE Most osteoporosis guidelines advice routine laboratory examination. We have investigated the yield of laboratory examinations in facture risk evaluation of elderly women in primary care. METHODS We assessed the prevalence of laboratory abnormalities and their association with risk factors for fractures, recent fractures, low bone mineral density (BMD), and prevalent vertebral fracture in 8996 women ≥ 65 years of age participating in a primary care fracture risk screening study. In a sample of 2208 of these participants, we also evaluated the medical consequences in the medical records during a follow-up period of ≥ 1 year. RESULTS Vitamin D deficiency (< 30 nmol/L) was present in 13% and insufficiency (< 50 nmol/L) in 43% of the study sample. The prevalence of other laboratory abnormalities (ESR, calcium, creatinine, FT4) was 4.6% in women with risk factors for fractures, 6.1% in women with low BMD (T-score ≤ - 2.5), 6.0% after a prevalent vertebral fracture, 5.2% after a recent fracture and 2.6% in the absence of important risk factors for fractures. Laboratory abnormalities other than vitamin D were associated with low BMD (OR 1.4, 95%CI 1.1-1.8) but not with prevalent vertebral fractures nor recent fractures. Low BMD was associated with renal failure (OR 2.0, 95%CI 1.3-3.4), vitamin D insufficiency (OR 1.2, 95%CI 1.0-1.3) and deficiency (OR 1.3, 95%CI 1.1-.5). In the follow-up period, 82% of the laboratory abnormalities did not result in a new diagnosis or treatment reported in the medical records. CONCLUSIONS We identified a low prevalence of laboratory abnormalities in a primary care population of older women and the majority of these findings had no medical consequences.
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Affiliation(s)
- Thomas Merlijn
- Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Karin M A Swart
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Christy Niemeijer
- Stichting Artsen Laboratorium en Trombosedienst, Koog Aan de Zaan, Zaanstad, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Coen J Netelenbos
- Department of Internal Medicine, Endocrine Section, Amsterdam UMC, Amsterdam, The Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC, Amsterdam, The Netherlands
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Overbeek JA, Nijpels G, Swart KMA, Blom MT, Elders PJM, Herings RMC. Type 2 Diabetes, the Epidemic: Trends in Prevalence and Incidence, 2004-2020. Diabetes Metab Syndr Obes 2024; 17:1503-1509. [PMID: 38562280 PMCID: PMC10984193 DOI: 10.2147/dmso.s445288] [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: 10/18/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
Aims/Hypothesis Only a few studies reported the incidence of type 2 diabetes (T2D). Understanding recent trends in diabetes is vital for planning future diabetes care. This study updated national trends in the prevalence and incidence of type 2 diabetes (T2D) in the Netherlands from 2004-2020. Methods The DIAbetes, MANagement and Treatment (DIAMANT) cohort was used. A cross-sectional design with yearly measurements for the study period was used. The prevalence was calculated by dividing the total number of people with T2D by the total number of all residents. The incidence was calculated by dividing new cases of T2D by the resident population at risk during the calendar year of interest. Results Among men, the prevalence of T2D in the Netherlands increased from 2.3% in 2004 to 6.3% in 2020. Women's prevalence increased from 2.3% in 2004 to 5.3% in 2020. During 2005-2009, the incidence rate for both men and women was relatively stable Between 2010 and 2020, the incidence rate fell about 1.5 per 1000 in both men and women. Conclusion From 2004-2020, the prevalence of T2D in the Netherlands more than doubled, with a decreasing incidence from 2010 onwards.
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Affiliation(s)
- Jetty A Overbeek
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - Giel Nijpels
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - Marieke T Blom
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Petra J M Elders
- Amsterdam UMC, Location Vrije Universiteit Amsterdam, Department of General Practice, Amsterdam, Netherlands
- Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, Netherlands
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Brobert G, Ruigomez A, Schink T, Voss A, Herings R, Smits E, Swart KMA, Friberg L, Balabanova Y, Tarenz C, Suzart-Woischnik K, Soriano-Gabarró M, Vora P, Homering M, Dyszynski T, Nagel G, Amaya P, García Rodríguez LA. Challenges and lessons learned from a long-term postauthorisation safety study programme of rivaroxaban in Europe. BMJ Open 2024; 14:e081348. [PMID: 38531587 PMCID: PMC10966716 DOI: 10.1136/bmjopen-2023-081348] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/04/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES To describe opportunities and challenges experienced from the four pharmacoepidemiological database studies included in the rivaroxaban post authorisation safety study (PASS) programme and propose ways to maximise the value of population-based observational research when addressing regulatory requirements. DESIGN PASS programme of rivaroxaban carried out as part of the regulatory postapproval commitment to the European Medicines Agency. SETTING Clinical practice in Germany, the Netherlands, Sweden and the UK (electronic health records)-undertaken by pharmacoepidemiology research teams using country-specific databases with different coding structures. PARTICIPANTS 355 152 patients prescribed rivaroxaban and 338 199 patients prescribed vitamin K antagonists. RESULTS Two major challenges that were encountered throughout the lengthy PASS programme were related to: (1) finalising country-tailored study designs before the extent of rivaroxaban uptake was known, and (2) new research questions that arose during the programme (eg, those relating to an evolving prescribing landscape). RECOMMENDATIONS We advocate the following strategies to help address these major challenges (should they arise in any future PASS): conducting studies based on a common data model that enable the same analytical tools to be applied when using different databases; maintaining early, clear, continuous communication with the regulator (including discussing the potential benefit of studying drug use as a precursor to planning a safety study); consideration of adaptive designs whenever uncertainty exists and following an initial period of data collection; and setting milestones for the review of study objectives.
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Affiliation(s)
| | - Ana Ruigomez
- Spanish Centre for Pharmacoepidemiologic Research, Madrid, Spain
| | - Tania Schink
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS GmbH, Bremen, Germany
| | - Annemarie Voss
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS GmbH, Bremen, Germany
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
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Vandenput L, Johansson H, McCloskey EV, Liu E, Schini M, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, McGuigan FEA, Mellström D, Merlijn T, Nguyen TV, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. A meta-analysis of previous falls and subsequent fracture risk in cohort studies. Osteoporos Int 2024; 35:469-494. [PMID: 38228807 DOI: 10.1007/s00198-023-07012-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/27/2023] [Indexed: 01/18/2024]
Abstract
The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm. INTRODUCTION Previous falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD). METHODS The resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. RESULTS Falls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33-1.51) and men (HR 1.53, 95% CI 1.41-1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27-1.84) in men vs. HR 1.32 (95% CI 1.20-1.45) in women, P for interaction = 0.013). The HRs associated with previous falls decreased with age in women and with duration of follow-up in men and women for most fracture outcomes. There was no evidence of an interaction between falls and BMD for fracture risk. Subsequent risk for a major osteoporotic fracture increased with each additional previous fall in women and men. CONCLUSIONS A previous self-reported fall confers an increased risk of fracture that is largely independent of BMD. Previous falls should be considered as an additional risk factor in future iterations of FRAX to improve fracture risk prediction.
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Affiliation(s)
- Liesbeth Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Helena Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Enwu Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Marian Schini
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Kristina E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Fred A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rafael Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Cerdanyola del Vallès, Barcelona, Spain
- PRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona, Spain
| | | | - Charlotte Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Health Services Research, University of Maastricht, Maastricht, The Netherlands
| | - Heike A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jacqueline R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Roland Chapurlat
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Steven R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - José A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - Alyssa B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - John A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Serge Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yuki Fujita
- Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - Claus-Christian Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - Inbal Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Jill Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Didier Hans
- Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - Mari Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - Martijn Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | | | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Sundeep Khosla
- Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
| | - Heikki Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Olivier Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurt Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fiona E A McGuigan
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Dan Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - Thomas Merlijn
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Tuan V Nguyen
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
- School of Population Health, UNSW Medicine, UNSW Sydney, Kensington, Australia
| | - Anna Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Peter Nordström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Terence W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Eric S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Julie A Pasco
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - Eric J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | | | - Eleanor M Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Karin M A Swart
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Pawel Szulc
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | - Junko Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - David J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Natasja M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Tjeerd P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Joan Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | | | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - MCarola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marta Zwart
- PRECIOSA-Fundación Para La Investigación, Barberà del Vallés, Barcelona, Spain
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP/GROICAP (Research Groups), Unitat de Suport a La Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - John A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
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Kanis JA, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Vandenput L, Harvey NC, Lorentzon M, Leslie WD. Previous fracture and subsequent fracture risk: a meta-analysis to update FRAX. Osteoporos Int 2023; 34:2027-2045. [PMID: 37566158 PMCID: PMC7615305 DOI: 10.1007/s00198-023-06870-z] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
A large international meta-analysis using primary data from 64 cohorts has quantified the increased risk of fracture associated with a previous history of fracture for future use in FRAX. INTRODUCTION The aim of this study was to quantify the fracture risk associated with a prior fracture on an international basis and to explore the relationship of this risk with age, sex, time since baseline and bone mineral density (BMD). METHODS We studied 665,971 men and 1,438,535 women from 64 cohorts in 32 countries followed for a total of 19.5 million person-years. The effect of a prior history of fracture on the risk of any clinical fracture, any osteoporotic fracture, major osteoporotic fracture, and hip fracture alone was examined using an extended Poisson model in each cohort. Covariates examined were age, sex, BMD, and duration of follow-up. The results of the different studies were merged by using the weighted β-coefficients. RESULTS A previous fracture history, compared with individuals without a prior fracture, was associated with a significantly increased risk of any clinical fracture (hazard ratio, HR = 1.88; 95% CI = 1.72-2.07). The risk ratio was similar for the outcome of osteoporotic fracture (HR = 1.87; 95% CI = 1.69-2.07), major osteoporotic fracture (HR = 1.83; 95% CI = 1.63-2.06), or for hip fracture (HR = 1.82; 95% CI = 1.62-2.06). There was no significant difference in risk ratio between men and women. Subsequent fracture risk was marginally downward adjusted when account was taken of BMD. Low BMD explained a minority of the risk for any clinical fracture (14%), osteoporotic fracture (17%), and for hip fracture (33%). The risk ratio for all fracture outcomes related to prior fracture decreased significantly with adjustment for age and time since baseline examination. CONCLUSION A previous history of fracture confers an increased risk of fracture of substantial importance beyond that explained by BMD. The effect is similar in men and women. Its quantitation on an international basis permits the more accurate use of this risk factor in case finding strategies.
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Affiliation(s)
- J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Centre Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Health Services Research, University of Maastricht, Maastricht, the Netherlands
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - P J M Elders
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Center for Medical Education and Clinical Training, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - P Nordström
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Department of Medicine -Western Health, The University of Melbourne, St Albans, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - E Sornay-Rendu
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Petra JM Elders Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain
| | - L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Swart KMA, Baak BN, Lemmens L, Penning-van Beest FJA, Bengtsson C, Lobier M, Hoti F, Vojinovic D, van Burk L, Rhodes K, Garbe E, Herings RMC, Nordon C, Simons SO. Risk of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: results from the EXACOS-CV cohort study using the PHARMO Data Network in the Netherlands. Respir Res 2023; 24:293. [PMID: 37990197 PMCID: PMC10662240 DOI: 10.1186/s12931-023-02601-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND People living with chronic obstructive pulmonary disease (COPD) have an increased risk of experiencing cardiovascular (CV) events, particularly after an exacerbation. Such CV burden is not yet known for incident COPD patients. We examined the risk of severe CV events in incident COPD patients in periods following either moderate and/or severe exacerbations. METHODS Persons aged ≥ 40 years with an incident COPD diagnosis from the PHARMO Data Network were included. Exposed time periods included 1-7, 8-14, 15-30, 31-180 and 181-365 days following an exacerbation. Moderate exacerbations were defined as those managed in outpatient settings; severe exacerbations as those requiring hospitalisation. The outcome was a composite of time to first severe CV event (acute coronary syndrome, heart failure decompensation, cerebral ischaemia, or arrhythmia) or death. Hazard ratios (HR) were estimated for association between each exposed period and outcome. RESULTS 8020 patients with newly diagnosed COPD were identified. 2234 patients (28%) had ≥ 1 exacerbation, 631 patients (8%) had a non-fatal CV event, and 461 patients (5%) died during a median follow-up of 36 months. The risk of experiencing the composite outcome was increased following a moderate/severe exacerbation as compared to time periods of stable disease [range of HR: from 15.3 (95% confidence interval 11.8-20.0) in days 1-7 to 1.3 (1.0-1.8) in days 181-365]. After a moderate exacerbation, the risk was increased over the first 180 days [HR 2.5 (1.3-4.8) in days 1-7 to 1.6 (1.3-2.1) in days 31-180]. After a severe exacerbation, the risk increased substantially and remained higher over the year following the exacerbation [HR 48.6 (36.9-64.0) in days 1-7 down to 1.6 (1.0-2.6) in days 181-365]. Increase in risk concerned all categories of severe CV events. CONCLUSIONS Among incident COPD patients, we observed a substantial risk increase of severe CV events or all-cause death following either a moderate or severe exacerbation of COPD. Increase in risk was highest in the initial period following an exacerbation. These findings highlight the significant cardiopulmonary burden among people living with COPD even with a new diagnosis.
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Affiliation(s)
- Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
| | - Brenda N Baak
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Louise Lemmens
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | | | | | | | | | | | | | | | - Edeltraut Garbe
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC Location Vrije University Amsterdam, Amsterdam, The Netherlands
| | | | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Abtahi S, Pajouheshnia R, Durán CE, Riera-Arnau J, Gamba M, Alsina E, Hoxhaj V, Andersen M, Bartolini C, Kristiansen SB, Brown J, Hallgreen CE, Garcia-Poza P, Gardarsdottir H, Gini R, Girardi A, Holthuis E, Huerta C, Ibánez L, Limoncella G, Martín-Pérez M, Paoletti O, Roberto G, Souverein P, Swart KMA, Wing K, Sturkenboom M, Klungel O. Impact of 2018 EU Risk Minimisation Measures and Revised Pregnancy Prevention Programme on Utilisation and Prescribing Trends of Medicinal Products Containing Valproate: An Interrupted Time Series Study. Drug Saf 2023:10.1007/s40264-023-01314-3. [PMID: 37294532 DOI: 10.1007/s40264-023-01314-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Due to established teratogenicity of valproates, the EU risk minimisation measures (RMMs) with a pregnancy prevention programme (PPP) for valproate were updated in March 2018. OBJECTIVES To investigate the effectiveness of the 2018 EU RMMs on valproate utilisation in five European countries/regions. METHODS A multi-database, times series study of females of childbearing potential (12-55 years) was conducted using electronic medical records from five countries/regions (01.01.2010-31.12.2020): Denmark, Tuscany (Italy), Spain, the Netherlands, and the UK. Clinical and demographic information from each database was transformed to the ConcePTION Common Data Model, quality checks were conducted and a distributed analysis was performed using common scripts. Incident and prevalent use of valproate, proportion of discontinuers and switchers to alternative medicine, frequency of contraception coverage during valproate use, and occurrence of pregnancies during valproate exposure were estimated per month. Interrupted time series analyses were conducted to estimate the level or trend change in the outcome measures. RESULTS We included 69,533 valproate users from 9,699,371 females of childbearing potential from the five participating centres. A significant decline in prevalent use of valproates was observed in Tuscany, Italy (mean difference post-intervention -7.7%), Spain (-11.3%), and UK (-5.9%) and a non-significant decline in the Netherlands (-3.3%), but no decline in incident use after the 2018 RMMs compared to the period before. The monthly proportion of compliant valproate prescriptions/dispensings with a contraceptive coverage was low (<25%), with an increase after the 2018 RMMs only in the Netherlands (mean difference post-intervention 12%). There was no significant increase in switching rates from valproates to alternative medicine after the 2018 intervention in any of the countries/regions. We observed a substantial number of concurrent pregnancies during valproate exposure, but with a declining rate after the 2018 RMMs in Tuscany, Italy (0.70 per 1000 valproate users pre- and 0.27 post-intervention), Spain (0.48 and 0.13), the Netherlands (0.34 and 0.00), and an increasing rate in UK (1.13 and 5.07). CONCLUSION There was a small impact of the 2018 RMMs on valproate use in the studied European countries/regions. The substantial number of concurrent pregnancies with valproate exposure warrants a careful monitoring of implementation of the existing PPP for valproate in clinical practice in Europe, to see if there is any need for additional measures in the future.
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Affiliation(s)
- Shahab Abtahi
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Carlos E Durán
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Judit Riera-Arnau
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Magdalena Gamba
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Ema Alsina
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Vjola Hoxhaj
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Morten Andersen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Brøgger Kristiansen
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jeremy Brown
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Christine Erikstrup Hallgreen
- Copenhagen Centre for Regulatory Science, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
- Department of Clinical Pharmacy, UMCU, Utrecht, The Netherlands
| | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Anna Girardi
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | - Emily Holthuis
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Consuelo Huerta
- Department of Public Health, Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luisa Ibánez
- Clinical Pharmacology Department, Hospital Universitari de la Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | | | - Mar Martín-Pérez
- Agencia Espanola de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain
| | - Olga Paoletti
- Agenzia Regionale di Sanità della Toscana (ARS), Firenze, Italy
| | | | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Kevin Wing
- London School of Hygiene & Tropical Medicine (LSHTM), London, UK
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University (UU), David de Wiedgebouw, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands.
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Pronk AC, van Poelgeest EP, Seppala LJ, Ploegmakers KJ, Stricker BH, Swart KMA, van Dijk SC, Oliai Araghi S, de Groot LCPGM, van Schoor NM, Mathôt RAA, van der Velde N. Are higher antidepressant plasma concentrations associated with fall risk in older antidepressant users? Eur Geriatr Med 2023; 14:89-97. [PMID: 36656485 PMCID: PMC9902404 DOI: 10.1007/s41999-022-00742-1] [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] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Antidepressants are well-established fall-risk increasing drugs (FRIDs) and therefore falls should be considered an important adverse drug event (ADE) of antidepressants. However, not all antidepressant users experience fall incidents and factors associated with increased fall risk among antidepressant users are incompletely understood. Our objective was to explore whether antidepressant plasma concentrations are associated with falls in older antidepressant users. METHODS For this study, we included antidepressant users of the multicenter B-PROOF study. Fall incidents were recorded prospectively using fall calendars. Antidepressant plasma concentrations were analyzed by Liquid chromatography-mass spectrometry (LC-MS) at baseline and at 2 years follow-up. The associations between the observed antidepressant concentration and fall risk were assessed using Cox proportional hazard and logistic regression models and adjusted for potential confounders. RESULTS In total 93 selective serotonin reuptake inhibitor (SSRI) and 41 antidepressant (TCA) users were identified. There was a significant association between baseline TCA plasma concentration and fall risk within users (HR 2.50, 95% CI 1.07-5.87, crude model). In the adjusted model, there were no significant associations between concentrations of SSRIs and fall risk. CONCLUSION There might be an association between plasma concentrations of TCAs and the risk of falling in older users. However, these results needs to be interpreted with caution considering the small sample size and accompanying limitation of confinement to crude analyses. Therefore, these novel findings need to replicated in a larger cohort, preferably including adjustment for potential confounders and more frequent measures of plasma concentrations is needed.
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Affiliation(s)
- A C Pronk
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. .,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands.
| | - E P van Poelgeest
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - L J Seppala
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - K J Ploegmakers
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K M A Swart
- General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - S C van Dijk
- Department of Geriatrics, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - S Oliai Araghi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L C P G M de Groot
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - N M van Schoor
- Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands.,Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, Netherlands
| | - R A A Mathôt
- Hospital Pharmacy-Clinical Pharmacology, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - N van der Velde
- Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Aging and Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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9
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Voss A, Smits E, Swart KMA, Balabanova Y, Brobert G, Suzart-Woischnik K, Herings RMC, Schink T, Haug U. Time Trends in Patient Characteristics of New Rivaroxaban Users with Atrial Fibrillation in Germany and the Netherlands. Drugs Real World Outcomes 2023:10.1007/s40801-022-00350-2. [PMID: 36725812 DOI: 10.1007/s40801-022-00350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Use of the direct oral anticoagulant rivaroxaban has strongly increased in Europe since its market approval for non-valvular atrial fibrillation in 2011. Patients characteristics of rivaroxaban initiators may have changed over time but this has not been investigated so far. OBJECTIVE We aimed to describe time trends of patient baseline characteristics among new rivaroxaban users with non-valvular atrial fibrillation from 2011 to 2016/17 in two European countries. METHODS We used data from Germany (German Pharmacoepidemiological Research Database) and the Netherlands (PHARMO Database Network). We included new rivaroxaban users with (i) a first dispensing between 2011 and 2016/17, (ii) ≥ 2 years of age, and (iii) a diagnosis of non-valvular atrial fibrillation and described their baseline medication and comorbidity prior to starting rivaroxaban stratified by year of inclusion. RESULTS Overall, 130,652 new rivaroxaban users were included during the study period (Germany: N = 127,743, the Netherlands: N = 2909). The sex ratio and median age remained relatively stable over time. The proportion of patients without prior use of oral anticoagulants before initiation of rivaroxaban increased in both countries between 2011 and 2016/17 (Germany: from 51 to 76%, the Netherlands: from 57 to 85%). In Germany, we observed a relative decrease by 27% in the proportion of new rivaroxaban users with a history of ischemic stroke and by 18% in the proportion with a transient ischemic attack at baseline. No such a pattern was observed in the Netherlands. The proportion of patients with heart failure at baseline showed a three-fold increase in the Netherlands, while there was a relative decrease by 12% in Germany. CONCLUSIONS Patient characteristics of new rivaroxaban users with non-valvular atrial fibrillation changed between 2011 and 2016/17, but changes differed between countries. These patterns have methodological implications. They have to be considered in the interpretation of observational studies comparing effectiveness and safety of oral anticoagulants, especially regarding potential bias due to unmeasured confounding.
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Affiliation(s)
- Annemarie Voss
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Tania Schink
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany. .,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany.
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10
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Overbeek JA, Swart KMA, Houben E, Penning-van Beest FJA, Herings RMC. Completeness and Representativeness of the PHARMO General Practitioner (GP) Data: A Comparison with National Statistics. Clin Epidemiol 2023; 15:1-11. [PMID: 36636730 PMCID: PMC9830053 DOI: 10.2147/clep.s389598] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose When using incomplete or non-representative real-world data (RWD), bias is more likely to occur. The aim of the current study was to assess the completeness and representativeness of the PHARMO GP data for the Dutch population. Patients and Methods A cross-sectional study was performed. The PHARMO GP data comprise data from electronic health records registered by GPs. Data on the Dutch population were obtained from Statistics Netherlands (CBS), which offers publicly available data on several themes. The standardized difference (std.diff) was used to compare proportions between the PHARMO GP population and the Dutch population. An absolute std.diff >0.2 was considered a difference. Results On January 1st, 2018, 3,466,321 persons were included in the PHARMO GP data (mean age: 41.6 years, 49.7% males). The sex and age distribution was similar to the Dutch population. The PHARMO GP data captured less not urbanized areas compared to the Dutch population (not urbanized areas: 9.4% vs 17.1% [std.diff: -0.23]). Regarding medication use, only the pharmacological subgroups "viral vaccines" and "hormonal contraceptives for systemic use" differed (std.diff >0.2); use in the GP data was more complete than in the Statistics Netherlands (CBS) data. No differences were observed regarding diagnoses. Conclusion The PHARMO GP data are representative of the Dutch population with regard to the demographic characteristics and diagnoses in primary care. Medication data in the PHARMO GP data are more complete than national statistics, and differences are related to reimbursement. Use of the data and interpretation of results based on these sources should be done with experts on the data sources, the Dutch healthcare system and (pharmaco)epidemiology.
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Affiliation(s)
- Jetty A Overbeek
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands,Correspondence: Jetty A Overbeek, Department Research, PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, the Netherlands, Tel +3130 7440 800, Email
| | - Karin M A Swart
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Eline Houben
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | | | - Ron M C Herings
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
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11
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García Rodríguez LA, Ruigómez A, Schink T, Voss A, Smits E, Swart KMA, Balabanova Y, Suzart-Woischnik K, Brobert G, Herings RMC. Safety and effectiveness of rivaroxaban for prevention of stroke in patients with nonvalvular atrial fibrillation: analysis of routine clinical data from four countries. Expert Opin Drug Saf 2023; 22:493-500. [PMID: 36795067 DOI: 10.1080/14740338.2023.2181334] [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] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The safety and effectiveness of rivaroxaban versus vitamin K antagonists (standard of care [SOC]) for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF) was evaluated in Europe. RESEARCH DESIGN AND METHODS Observational studies were conducted in the UK, the Netherlands, Germany, and Sweden. Primary safety outcomes were hospitalization for intracranial hemorrhage, gastrointestinal bleeding, or urogenital bleeding among new users of rivaroxaban and SOC with NVAF; outcomes were analyzed using cohort (rivaroxaban or SOC use) and nested case-control designs (current vs nonuse). Statistical analyses comparing rivaroxaban and SOC cohorts were not performed. RESULTS Overall, 162,919 rivaroxaban users and 177,758 SOC users were identified. In the cohort analysis, incidence ranges for rivaroxaban users were 0.25-0.63 events per 100 person-years for intracranial bleeding, 0.49-1.72 for gastrointestinal bleeding, and 0.27-0.54 for urogenital bleeding. Corresponding ranges for SOC users were 0.30-0.80, 0.30-1.42, and 0.24-0.42, respectively. In the nested case-control analysis, current SOC use generally presented a greater risk of bleeding outcomes than nonuse. Rivaroxaban use (vs nonuse) was associated with a higher risk of gastrointestinal bleeding, but a similar risk of intracranial or urogenital bleeding, in most countries. Ischemic stroke incidence ranged from 0.31 to 1.52 events per 100 person-years for rivaroxaban users. CONCLUSIONS Incidences of intracranial bleeding were generally lower with rivaroxaban than with SOC, whereas incidences of gastrointestinal and urogenital bleeding were generally higher. The safety profile of rivaroxaban for NVAF in routine practice is consistent with findings from randomized controlled trials and other studies.
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Affiliation(s)
| | - Ana Ruigómez
- Centre for Pharmacoepidemiological Research (CEIFE), Madrid, Spain
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Annemarie Voss
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
| | - Yanina Balabanova
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Leverkusen, Germany
| | | | | | - Ron M C Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands
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12
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Overbeek JA, Swart KMA, van der Pal EYM, Blom MT, Beulens JWJ, Nijpels G, Elders PJM, Herings RMC. The DIAbetes MANagement and Treatment (DIAMANT) Cohort. Clin Epidemiol 2022; 14:1453-1462. [PMID: 36506003 PMCID: PMC9733447 DOI: 10.2147/clep.s381728] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
Introduction The increasing number of people with diabetes and the unclear long-term safety and effectiveness of newer and older blood-glucose-lowering treatments emphasize the need for more pharmaco-epidemiological studies in this field. A prospective, regularly updated cohort of people with diabetes would provide quick and up-to-date information regarding prevalence, treatment, safety and effectiveness. The current aim was to describe the design of the DIAbetes MANagement and Treatment (DIAMANT) cohort. Methods The DIAMANT cohort is a population-based, dynamic, prospective cohort of persons with diabetes. It contains real-world data (RWD) from general practitioners (GP), including diagnoses, symptoms, examinations, communication to/from specialists and medication. Diabetes is defined as a recorded diabetes diagnosis or a prescription of drugs used in diabetes. The cohort is part of the national infrastructure of "Stichting Informatievoorziening voor Zorg en Onderzoek" (STIZON) and is linked to other data sources. Results Currently, the cohort enables access to information of 89,883 patients in 2004 to 344,914 in 2020 (6% T1D, 84% T2D and 10% unclassified type of diabetes), with 193,931 participants still registered as being present in the GP practice (active) in 2020. The frequency of follow-up of persons with diabetes is practice dependent. The Dutch guidelines advise 2-4 contacts per year with a more extensive yearly check-up. The DIAMANT cohort is updated several times a year. Anonymised data from the DIAMANT cohort are available to researchers. Discussion The DIAMANT cohort provides the opportunity to gain RWD insights into the treatment and outcomes among people with diabetes in daily general practice. The data can be enriched by established linkages to other data sources (eg, hospital data, the Perinatal Registry, the Cancer Registry). The DIAMANT cohort serves as a start of a national infrastructure to study, manage and provide personalised care in order to ultimately improve care and outcomes for people with diabetes.
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Affiliation(s)
- Jetty A Overbeek
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands,Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands,Correspondence: Jetty A Overbeek, Department Research, PHARMO Institute for Drug Outcomes Research, Van Deventerlaan 30-40, Utrecht, 3528 AE, Netherlands, Tel +3130 7440 800, Email
| | - Karin M A Swart
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands,Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Emma Y M van der Pal
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Joline W J Beulens
- Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands,Department of Epidemiology and Data Science, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Giel Nijpels
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands
| | - Ron M C Herings
- Department Research, PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands,Health Behaviors & Chronic Diseases, Amsterdam Public Health, Amsterdam, Netherlands,Department of Epidemiology and Data Science, Amsterdam UMC - Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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13
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Bots SH, Riera-Arnau J, Belitser SV, Messina D, Aragón M, Alsina E, Douglas IJ, Durán CE, García-Poza P, Gini R, Herings RMC, Huerta C, Sisay MM, Martín-Pérez M, Martin I, Overbeek JA, Paoletti O, Pallejà-Millán M, Schultze A, Souverein P, Swart KMA, Villalobos F, Klungel OH, Sturkenboom MCJM. Myocarditis and pericarditis associated with SARS-CoV-2 vaccines: A population-based descriptive cohort and a nested self-controlled risk interval study using electronic health care data from four European countries. Front Pharmacol 2022; 13:1038043. [PMID: 36506571 PMCID: PMC9730238 DOI: 10.3389/fphar.2022.1038043] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Estimates of the association between COVID-19 vaccines and myo-/pericarditis risk vary widely across studies due to scarcity of events, especially in age- and sex-stratified analyses. Methods: Population-based cohort study with nested self-controlled risk interval (SCRI) using healthcare data from five European databases. Individuals were followed from 01/01/2020 until end of data availability (31/12/2021 latest). Outcome was first myo-/pericarditis diagnosis. Exposures were first and second dose of Pfizer, AstraZeneca, Moderna, and Janssen COVID-19 vaccines. Baseline incidence rates (IRs), and vaccine- and dose-specific IRs and rate differences were calculated from the cohort The SCRI calculated calendar time-adjusted IR ratios (IRR), using a 60-day pre-vaccination control period and dose-specific 28-day risk windows. IRRs were pooled using random effects meta-analysis. Findings: Over 35 million individuals (49·2% women, median age 39-49 years) were included, of which 57·4% received at least one COVID-19 vaccine dose. Baseline incidence of myocarditis was low. Myocarditis IRRs were elevated after vaccination in those aged < 30 years, after both Pfizer vaccine doses (IRR = 3·3, 95%CI 1·2-9.4; 7·8, 95%CI 2·6-23·5, respectively) and Moderna vaccine dose 2 (IRR = 6·1, 95%CI 1·1-33·5). An effect of AstraZeneca vaccine dose 2 could not be excluded (IRR = 2·42, 95%CI 0·96-6·07). Pericarditis was not associated with vaccination. Interpretation: mRNA-based COVID-19 vaccines and potentially AstraZeneca are associated with increased myocarditis risk in younger individuals, although absolute incidence remains low. More data on children (≤ 11 years) are needed.
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Affiliation(s)
- Sophie H. Bots
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Judit Riera-Arnau
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Svetlana V. Belitser
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Maria Aragón
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Ema Alsina
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ian J. Douglas
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Carlos E. Durán
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Rosa Gini
- Agenzia Regionale di Sanitá, Florence, Toscana, Italy
| | | | - Consuelo Huerta
- Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Malede Mequanent Sisay
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Martín-Pérez
- Spanish Agency for Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Ivonne Martin
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Olga Paoletti
- Agenzia Regionale di Sanitá, Florence, Toscana, Italy
| | - Meritxell Pallejà-Millán
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Anna Schultze
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | | | - Felipe Villalobos
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Olaf H. Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
| | - Miriam C. J. M. Sturkenboom
- Department of Datascience and Biostatistics, Julius Center for Health Sciences and Primary Health, University Medical Center Utrecht, Utrecht, Netherlands,Clinical Pharmacology Service, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain,*Correspondence: Miriam C. J. M. Sturkenboom,
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14
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Vandenput L, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schei B, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporos Int 2022; 33:2103-2136. [PMID: 35639106 DOI: 10.1007/s00198-022-06435-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022]
Abstract
UNLABELLED We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
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Affiliation(s)
- L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Center Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Bone Biology, Healthy Ageing Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research Oxford Biomedical Research Unit, , University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, University Hospital and University of Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - P J M Elders
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- School of Sport Sciences, Arctic University of Norway, Tromsø, Norway
| | - P Nordström
- Unit of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- Institute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Barwon Health, Geelong, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gynecology, St Olavs Hospital, Trondheim, Norway
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP (Research Group), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
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15
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Koelé MC, Willems HC, Harmsen IM, Swart KMA, van Dijk SC, Lips P, de Groot LCPGM, van der Cammen TJM, Zillikens MC, van Schoor NM, van der Velde N. The association between the kyphosis angle and physical performance in community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2022; 77:2298-2305. [PMID: 35648137 DOI: 10.1093/gerona/glac113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We investigated prospectively among community-dwelling older adults aged 65 years and over whether a larger kyphosis angle is associated with poorer physical performance (balance, muscle strength or both), and whether this association is unidirectional. METHODS ale and female participants performed a multicomponent physical performance test with subscores for gait, muscle strength and balance at baseline and after 2 years. Hand grip strength was also measured at baseline and at follow-up. The Cobb angle was measured on DXA-based Vertebral Fracture Assessments, made at the baseline and follow-up visit. Through linear and logistic regression analysis, we investigated the association between the kyphosis angle and physical performance and vice versa. We stratified for sex, and tested for effect modification by age and study center. RESULTS The mean kyphosis angle was 37° and 15% of the participants (n=1220, mean age 72.9±5.7 years) had hyperkyphosis (Cobb angle ≥50°). A larger kyphosis angle at baseline was independently associated with a poorer total physical performance score in women of the oldest quartile (≥77 years) in both the cross-sectional and longitudinal analyses (baseline B-0.32, 95%CI -0.56--0.08; follow-up B 0.32, 95%CI -0.55--0.10). There was no association between physical performance at baseline and kyphosis progression. CONCLUSIONS A larger kyphosis angle is independently associated with a poorer physical performance at baseline and over time, and the direction of this association is unidirectional. These results emphasize the importance of early detection and treatment of hyperkyphosis to prevent further worsening of the kyphosis angle, thereby potentially preserving physical performance.
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Affiliation(s)
- Marije C Koelé
- Amsterdam UMC, Academic Medical Centre Amsterdam, Department of Internal Medicine, Division of Geriatrics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Hanna C Willems
- Amsterdam UMC, Academic Medical Centre Amsterdam, Department of Internal Medicine, Division of Geriatrics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Iris M Harmsen
- Amsterdam UMC, Academic Medical Centre Amsterdam, Department of Internal Medicine, Division of Geriatrics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Karin M A Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Suzanne C van Dijk
- Erasmus MC, University Medical Center Rotterdam, Section of Geriatrics, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Paul Lips
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal Medicine, Endocrine Section, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Lisette C P G M de Groot
- Wageningen University, Division of Human Nutrition, P.O. Box 8129, 6700 EV Wageningen, the Netherlands
| | - Tischa J M van der Cammen
- Erasmus MC, University Medical Center Rotterdam, Section of Geriatrics, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - M Carola Zillikens
- Erasmus MC, University Medical Center Rotterdam, Section of Geriatrics, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
| | - Natasja M van Schoor
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Nathalie van der Velde
- Amsterdam UMC, Academic Medical Centre Amsterdam, Department of Internal Medicine, Division of Geriatrics, Amsterdam Public Health Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.,Erasmus MC, University Medical Center Rotterdam, Section of Geriatrics, Department of Internal Medicine, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands
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16
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Koelé MC, Willems HC, Swart KMA, van Dijk SC, Lips P, de Groot LCPGM, van der Cammen TJM, Zillikens MC, van Schoor NM, van der Velde N. The association between hyperkyphosis and fall incidence among community-dwelling older adults. Osteoporos Int 2022; 33:403-411. [PMID: 34495374 PMCID: PMC8813677 DOI: 10.1007/s00198-021-06136-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/25/2021] [Indexed: 11/01/2022]
Abstract
UNLABELLED Hyperkyphosis, an increased kyphosis angle of the thoracic spine, was associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults. Hyperkyphosis could serve as an indicator of an increased fall risk as well as a treatable condition. INTRODUCTION Hyperkyphosis is frequently found in adults aged 65 years and older and may be associated with falls. We aimed to investigate prospectively in community-dwelling older adults whether hyperkyphosis or change in the kyphosis angle is associated with fall incidence. METHODS Community-dwelling older adults (n = 1220, mean age 72.9 ± 5.7 years) reported falls weekly over 2 years. We measured thoracic kyphosis through the Cobb angle between the fourth and 12th thoracic vertebra on DXA-based vertebral fracture assessments and defined hyperkyphosis as a Cobb angle ≥ 50°. The change in the Cobb angle during follow-up was dichotomized (< 5 or ≥ 5°). Through multifactorial regression analysis, we investigated the association between the kyphosis angle and falls. RESULTS Hyperkyphosis was present in 15% of the participants. During follow-up, 48% of the participants fell at least once. In the total study population, hyperkyphosis was not associated with the number of falls (adjusted IRR 1.12, 95% CI 0.91-1.39). We observed effect modification by age (p = 0.002). In the oldest quartile, aged 77 years and older, hyperkyphosis was prospectively associated with a higher number of falls (adjusted IRR 1.67, 95% CI 1.14-2.45). Change in the kyphosis angle was not associated with fall incidence. CONCLUSIONS Hyperkyphosis was associated with a higher fall incidence in the oldest quartile of a large prospective cohort of community-dwelling older adults. Because hyperkyphosis is a partially reversible condition, we recommend investigating whether hyperkyphosis is one of the causes of falls and whether a decrease in the kyphosis angle may contribute to fall prevention.
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Affiliation(s)
- Marije C Koelé
- Department of Internal Medicine, Division of Geriatrics, Amsterdam Public Health Research Institute, Amsterdam UMC, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hanna C Willems
- Department of Internal Medicine, Division of Geriatrics, Amsterdam Public Health Research Institute, Amsterdam UMC, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Suzanne C van Dijk
- Section of Geriatrics, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Lisette C P G M de Groot
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - Tischa J M van der Cammen
- Section of Geriatrics, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Section of Geriatrics, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Division of Geriatrics, Amsterdam Public Health Research Institute, Amsterdam UMC, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Section of Geriatrics, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Meid AD, Gonzalez-Gonzalez AI, Dinh TS, Blom J, van den Akker M, Elders P, Thiem U, Küllenberg de Gaudry D, Swart KMA, Rudolf H, Bosch-Lenders D, Trampisch HJ, Meerpohl JJ, Gerlach FM, Flaig B, Kom G, Snell KIE, Perera R, Haefeli WE, Glasziou P, Muth C. Predicting hospital admissions from individual patient data (IPD): an applied example to explore key elements driving external validity. BMJ Open 2021; 11:e045572. [PMID: 34348947 PMCID: PMC8340284 DOI: 10.1136/bmjopen-2020-045572] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore factors that potentially impact external validation performance while developing and validating a prognostic model for hospital admissions (HAs) in complex older general practice patients. STUDY DESIGN AND SETTING Using individual participant data from four cluster-randomised trials conducted in the Netherlands and Germany, we used logistic regression to develop a prognostic model to predict all-cause HAs within a 6-month follow-up period. A stratified intercept was used to account for heterogeneity in baseline risk between the studies. The model was validated both internally and by using internal-external cross-validation (IECV). RESULTS Prior HAs, physical components of the health-related quality of life comorbidity index, and medication-related variables were used in the final model. While achieving moderate discriminatory performance, internal bootstrap validation revealed a pronounced risk of overfitting. The results of the IECV, in which calibration was highly variable even after accounting for between-study heterogeneity, agreed with this finding. Heterogeneity was equally reflected in differing baseline risk, predictor effects and absolute risk predictions. CONCLUSIONS Predictor effect heterogeneity and differing baseline risk can explain the limited external performance of HA prediction models. With such drivers known, model adjustments in external validation settings (eg, intercept recalibration, complete updating) can be applied more purposefully. TRIAL REGISTRATION NUMBER PROSPERO id: CRD42018088129.
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Affiliation(s)
- Andreas Daniel Meid
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Ana Isabel Gonzalez-Gonzalez
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | - Truc Sophia Dinh
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
| | - Jeanet Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
- School of CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Petra Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amstedarm Public Health Research Institute, Amsterdam, The Netherlands
| | - Ulrich Thiem
- Chair of Geriatrics and Gerontology, University Clinic Eppendorf, Hamburg, Germany
| | - Daniela Küllenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amstedarm Public Health Research Institute, Amsterdam, The Netherlands
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Donna Bosch-Lenders
- School of CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - Hans J Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
| | - Benno Flaig
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
| | | | - Kym I E Snell
- Centre for Prognosis Research, School of Primary Care Research, Community and Social Care, Keele University, Keele, UK
| | - Rafael Perera
- Nuffield Department of Primary Care, University of Oxford, Oxford, UK
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology & Pharmacoepidemiology, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Robina, Queensland, Australia
| | - Christiane Muth
- Institute of General Practice, Goethe University, Frankfurt am Main, Hessen, Germany
- Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, Bielefeld, Germany
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18
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van Dongen LH, Harms PP, Hoogendoorn M, Zimmerman DS, Lodder EM, 't Hart LM, Herings R, van Weert HCPM, Nijpels G, Swart KMA, van der Heijden AA, Blom MT, Elders PJ, Tan HL. Discovery of predictors of sudden cardiac arrest in diabetes: rationale and outline of the RESCUED (REcognition of Sudden Cardiac arrest vUlnErability in Diabetes) project. Open Heart 2021; 8:openhrt-2020-001554. [PMID: 33547224 PMCID: PMC7871346 DOI: 10.1136/openhrt-2020-001554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Early recognition of individuals with increased risk of sudden cardiac arrest (SCA) remains challenging. SCA research so far has used data from cardiologist care, but missed most SCA victims, since they were only in general practitioner (GP) care prior to SCA. Studying individuals with type 2 diabetes (T2D) in GP care may help solve this problem, as they have increased risk for SCA, and rich clinical datasets, since they regularly visit their GP for check-up measurements. This information can be further enriched with extensive genetic and metabolic information. Aim To describe the study protocol of the REcognition of Sudden Cardiac arrest vUlnErability in Diabetes (RESCUED) project, which aims at identifying clinical, genetic and metabolic factors contributing to SCA risk in individuals with T2D, and to develop a prognostic model for the risk of SCA. Methods The RESCUED project combines data from dedicated SCA and T2D cohorts, and GP data, from the same region in the Netherlands. Clinical data, genetic data (common and rare variant analysis) and metabolic data (metabolomics) will be analysed (using classical analysis techniques and machine learning methods) and combined into a prognostic model for risk of SCA. Conclusion The RESCUED project is designed to increase our ability at early recognition of elevated SCA risk through an innovative strategy of focusing on GP data and a multidimensional methodology including clinical, genetic and metabolic analyses.
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Affiliation(s)
- Laura H van Dongen
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Peter P Harms
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Mark Hoogendoorn
- Computer Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Dominic S Zimmerman
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Elisabeth M Lodder
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Leen M 't Hart
- Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands.,Biomedical Data Sciences, section Molecular Epidemiology, Leiden University Medical Centre, Leiden, Netherlands.,Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ron Herings
- PHARMO Institute, Utrecht, Utrecht, Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
| | - Giel Nijpels
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Karin M A Swart
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,PHARMO Institute, Utrecht, Utrecht, Netherlands
| | - Amber A van der Heijden
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marieke T Blom
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Petra J Elders
- General Practice Medicine, Amsterdam UMC - Locatie VUmc, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Hanno L Tan
- Clinical and Experimental Cardiology, Amsterdam UMC - Locatie AMC, Heart Centre, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands .,Netherlands Heart Institute, Utrecht, Netherlands
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19
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González-González AI, Dinh TS, Meid AD, Blom JW, van den Akker M, Elders PJM, Thiem U, Kuellenberg de Gaudry D, Snell KIE, Perera R, Swart KMA, Rudolf H, Bosch-Lenders D, Trampisch HJ, Meerpohl JJ, Flaig B, Kom G, Gerlach FM, Hafaeli WE, Glasziou PP, Muth C. Predicting negative health outcomes in older general practice patients with chronic illness: Rationale and development of the PROPERmed harmonized individual participant data database. Mech Ageing Dev 2021; 194:111436. [PMID: 33460622 DOI: 10.1016/j.mad.2021.111436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/11/2022]
Abstract
The prevalence of multimorbidity and polypharmacy increases significantly with age and are associated with negative health consequences. However, most current interventions to optimize medication have failed to show significant effects on patient-relevant outcomes. This may be due to ineffectiveness of interventions themselves but may also reflect other factors: insufficient sample sizes, heterogeneity of population. To address this issue, the international PROPERmed collaboration was set up to obtain/synthesize individual participant data (IPD) from five cluster-randomized trials. The trials took place in Germany and The Netherlands and aimed to optimize medication in older general practice patients with chronic illness. PROPERmed is the first database of IPD to be drawn from multiple trials in this patient population and setting. It offers the opportunity to derive prognostic models with increased statistical power for prediction of patient-relevant outcomes resulting from the interplay of multimorbidity and polypharmacy. This may help patients from this heterogeneous group to be stratified according to risk and enable clinicians to identify patients that are likely to benefit most from resource/time-intensive interventions. The aim of this manuscript is to describe the rationale behind PROPERmed collaboration, characteristics of the included studies/participants, development of the harmonized IPD database and challenges faced during this process.
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Affiliation(s)
- Ana I González-González
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | - Truc S Dinh
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, 2300RC, Leiden, the Netherlands
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany; School of CAPHRI, Department of Family Medicine, Maastricht University, 6211 LK, Maastricht, the Netherlands; Academic Centre for General Practice, Department of Public Health and Primary Care, KU, Leuven, Belgium
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, 1007 MB, Amsterdam, the Netherlands
| | - Ulrich Thiem
- Chair of Geriatrics and Gerontology, University Clinic Eppendorf, 20246, Hamburg, Germany
| | - Daniela Kuellenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, 79110, Freiburg, Germany
| | - Kym I E Snell
- Centre for Prognosis Research, School of Primary Care Research, Community and Social Care, Keele University, Staffordshire, ST5 5BG, United Kingdom
| | - Rafael Perera
- Nuffield Department of Primary Care, University of Oxford, Oxford, OX2 6GG, United Kingdom
| | - Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, 1007 MB, Amsterdam, the Netherlands
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44780, Bochum, Germany
| | - Donna Bosch-Lenders
- School of CAPHRI, Department of Family Medicine, Maastricht University, 6211 LK, Maastricht, the Netherlands
| | - Hans-Joachim Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44780, Bochum, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, 79110, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Breisacher Strasse 153, 79110, Freiburg, Germany
| | - Benno Flaig
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Ghainsom Kom
- Techniker Krankenkasse (TK), 22765, Hamburg, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Walter E Hafaeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Paul P Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Robina, QLD, 4226, Australia
| | - Christiane Muth
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany; Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, 33615, Bielefeld, Germany
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20
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Affiliation(s)
- T Merlijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, 1081 BT, Amsterdam, Netherlands
| | - K M A Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, 1081 BT, Amsterdam, Netherlands
| | - J C Netelenbos
- Internal Medicine, Endocrine Section, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, Netherlands
| | - P J M Elders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, 1081 BT, Amsterdam, Netherlands.
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21
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Merlijn T, Swart KMA, van der Horst HE, Netelenbos JC, Elders PJM. Fracture prevention by screening for high fracture risk: a systematic review and meta-analysis. Osteoporos Int 2020; 31:251-257. [PMID: 31838551 PMCID: PMC7010619 DOI: 10.1007/s00198-019-05226-w] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/05/2019] [Indexed: 12/12/2022]
Abstract
This systematic review and meta-analysis showed a significant reduction of (major) osteoporotic fractures and hip fractures after screening using fracture risk assessment and bone densitometry compared with usual care. The results indicate that screening is effective for fracture risk reduction, especially hip fractures. To perform a systematic review and meta-analysis of population screening for high fracture risk on fracture prevention compared with usual care. MEDLINE and Embase were searched for studies published until June 20th 2019. Randomized studies were selected that screened for high fracture risk using at least bone densitometry, screened in a general population, provided subsequent treatment with anti-osteoporosis medication, had a usual care group as comparator, and had at least one fracture-related outcome (all fractures, (major) osteoporotic fractures, or hip fractures). The primary assessment was the hazard ratio (HR) for fracture-related outcomes. All-cause mortality was a secondary outcome. Random-effects models were used to estimate pooled HRs. We identified 1186 potentially eligible articles and included three randomized studies: the ROSE study, the SCOOP study, and the SOS with a total number of N = 42,009 participants. Respectively, 11%, 15%, and 18% of the participants in the intervention group started medication. Meta-analysis showed a statistically significant and clinically relevant reduction of osteoporotic fractures (HR = 0.95, 95% confidence interval (CI) = 0.89-1.00), major osteoporotic fractures (HR = 0.91; 95%CI = 0.84-0.98), and hip fractures (HR = 0.80; 95%CI = 0.71-0.91), but no reduction of all fractures (HR = 0.95; 95%CI = 0.89-1.02). The pooled HR for the secondary outcome all-cause mortality was 1.04 (95% CI = 0.95-1.14). Numbers needed to screen to prevent one fracture were 247 and 272 for osteoporotic fractures and hip fractures, respectively (corresponding to 113 and 124 performed bone densitometry examinations, and 25 and 28 persons being treated). This meta-analysis showed that population screening is effective to reduce osteoporotic fractures and hip fractures. Implementation of screening in older women should be considered as serious option to prevent osteoporotic fractures, especially hip fractures.
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Affiliation(s)
- T Merlijn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine , Amsterdam Public Health Research Institute, 1081 BT, Amsterdam, Netherlands
| | - K M A Swart
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine , Amsterdam Public Health Research Institute, 1081 BT, Amsterdam, Netherlands
| | - H E van der Horst
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine , Amsterdam Public Health Research Institute, 1081 BT, Amsterdam, Netherlands
| | - J C Netelenbos
- Amsterdam UMC, Vrije Universiteit Amsterdam , Department of Internal Medicine, Endocrine Section, 1081 HV, Amsterdam, Netherlands
| | - P J M Elders
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of General Practice and Elderly Care Medicine , Amsterdam Public Health Research Institute, 1081 BT, Amsterdam, Netherlands.
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22
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Henstra MJ, Rhebergen D, Stek ML, Swart KMA, van Dijk SC, Zillikens MC, Oliai Araghi S, de Groot LCMGM, van Schoor NM, van der Velde N. The association between apathy, decline in physical performance, and falls in older persons. Aging Clin Exp Res 2019; 31:1491-1499. [PMID: 30600489 DOI: 10.1007/s40520-018-1096-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Symptoms of apathy are common in older persons. Negative effects on physical performance and fall risk are plausible, considering the pathophysiology of apathy. However, literature is scarce. AIM To longitudinally assess the association between apathy and (1) decline of physical performance and (2) the number of falls in older community-dwelling persons. METHODS The 'B vitamins for the PRevention Of Osteoporotic Fractures' study provided data on 2919 older persons over a period of 2 years. Apathy was assessed using the Geriatric Depression Scale 3. A physical performance score (PPS) was calculated using three performance tests. Falls were registered prospectively. We calculated adjusted odds ratios (ORs), Incidence Rate Ratios (IRRs), and their 95% confidence intervals. Effect modification by age and gender was investigated. We also investigated mediation by baseline PPS for the association between apathy and the number of falls. RESULTS Apathy and decline of PPS were independently associated. After stratification, the effect only remained in men. Age was an effect modifier; higher ORs for decreasing age. Apathy was also independently associated with the number of falls. After stratification, women had higher IRRs than men. Age modified the association in the opposite direction: higher IRRs for increasing age. Baseline PPS was a mediator in the association. CONCLUSION The impact of apathy on physical performance and fall incidents varied with age and gender. Potentially, in older individuals with apathy, fall risk is preceded by a decline in physical performance. In clinical practice, identifying apathy in older persons might be useful to target mobility preserving interventions.
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Affiliation(s)
- Marieke J Henstra
- Department of Internal Medicine, Geriatrics, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Didi Rhebergen
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
| | - Max L Stek
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, The Netherlands
| | - Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Suzanne C van Dijk
- Department of Geriatric Medicine, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands
| | | | - Sadaf Oliai Araghi
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Geriatrics, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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23
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Justice AE, Karaderi T, Highland HM, Young KL, Graff M, Lu Y, Turcot V, Auer PL, Fine RS, Guo X, Schurmann C, Lempradl A, Marouli E, Mahajan A, Winkler TW, Locke AE, Medina-Gomez C, Esko T, Vedantam S, Giri A, Lo KS, Alfred T, Mudgal P, Ng MCY, Heard-Costa NL, Feitosa MF, Manning AK, Willems SM, Sivapalaratnam S, Abecasis G, Alam DS, Allison M, Amouyel P, Arzumanyan Z, Balkau B, Bastarache L, Bergmann S, Bielak LF, Blüher M, Boehnke M, Boeing H, Boerwinkle E, Böger CA, Bork-Jensen J, Bottinger EP, Bowden DW, Brandslund I, Broer L, Burt AA, Butterworth AS, Caulfield MJ, Cesana G, Chambers JC, Chasman DI, Chen YDI, Chowdhury R, Christensen C, Chu AY, Collins FS, Cook JP, Cox AJ, Crosslin DS, Danesh J, de Bakker PIW, Denus SD, Mutsert RD, Dedoussis G, Demerath EW, Dennis JG, Denny JC, Di Angelantonio E, Dörr M, Drenos F, Dubé MP, Dunning AM, Easton DF, Elliott P, Evangelou E, Farmaki AE, Feng S, Ferrannini E, Ferrieres J, Florez JC, Fornage M, Fox CS, Franks PW, Friedrich N, Gan W, Gandin I, Gasparini P, Giedraitis V, Girotto G, Gorski M, Grallert H, Grarup N, Grove ML, Gustafsson S, Haessler J, Hansen T, Hattersley AT, Hayward C, Heid IM, Holmen OL, Hovingh GK, Howson JMM, Hu Y, Hung YJ, Hveem K, Ikram MA, Ingelsson E, Jackson AU, Jarvik GP, Jia Y, Jørgensen T, Jousilahti P, Justesen JM, Kahali B, Karaleftheri M, Kardia SLR, Karpe F, Kee F, Kitajima H, Komulainen P, Kooner JS, Kovacs P, Krämer BK, Kuulasmaa K, Kuusisto J, Laakso M, Lakka TA, Lamparter D, Lange LA, Langenberg C, Larson EB, Lee NR, Lee WJ, Lehtimäki T, Lewis CE, Li H, Li J, Li-Gao R, Lin LA, Lin X, Lind L, Lindström J, Linneberg A, Liu CT, Liu DJ, Luan J, Lyytikäinen LP, MacGregor S, Mägi R, Männistö S, Marenne G, Marten J, Masca NGD, McCarthy MI, Meidtner K, Mihailov E, Moilanen L, Moitry M, Mook-Kanamori DO, Morgan A, Morris AP, Müller-Nurasyid M, Munroe PB, Narisu N, Nelson CP, Neville M, Ntalla I, O'Connell JR, Owen KR, Pedersen O, Peloso GM, Pennell CE, Perola M, Perry JA, Perry JRB, Pers TH, Ewing A, Polasek O, Raitakari OT, Rasheed A, Raulerson CK, Rauramaa R, Reilly DF, Reiner AP, Ridker PM, Rivas MA, Robertson NR, Robino A, Rudan I, Ruth KS, Saleheen D, Salomaa V, Samani NJ, Schreiner PJ, Schulze MB, Scott RA, Segura-Lepe M, Sim X, Slater AJ, Small KS, Smith BH, Smith JA, Southam L, Spector TD, Speliotes EK, Stefansson K, Steinthorsdottir V, Stirrups KE, Strauch K, Stringham HM, Stumvoll M, Sun L, Surendran P, Swart KMA, Tardif JC, Taylor KD, Teumer A, Thompson DJ, Thorleifsson G, Thorsteinsdottir U, Thuesen BH, Tönjes A, Torres M, Tsafantakis E, Tuomilehto J, Uitterlinden AG, Uusitupa M, van Duijn CM, Vanhala M, Varma R, Vermeulen SH, Vestergaard H, Vitart V, Vogt TF, Vuckovic D, Wagenknecht LE, Walker M, Wallentin L, Wang F, Wang CA, Wang S, Wareham NJ, Warren HR, Waterworth DM, Wessel J, White HD, Willer CJ, Wilson JG, Wood AR, Wu Y, Yaghootkar H, Yao J, Yerges-Armstrong LM, Young R, Zeggini E, Zhan X, Zhang W, Zhao JH, Zhao W, Zheng H, Zhou W, Zillikens MC, Rivadeneira F, Borecki IB, Pospisilik JA, Deloukas P, Frayling TM, Lettre G, Mohlke KL, Rotter JI, Kutalik Z, Hirschhorn JN, Cupples LA, Loos RJF, North KE, Lindgren CM. Protein-coding variants implicate novel genes related to lipid homeostasis contributing to body-fat distribution. Nat Genet 2019; 51:452-469. [PMID: 30778226 PMCID: PMC6560635 DOI: 10.1038/s41588-018-0334-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [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: 11/17/2017] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
Body-fat distribution is a risk factor for adverse cardiovascular health consequences. We analyzed the association of body-fat distribution, assessed by waist-to-hip ratio adjusted for body mass index, with 228,985 predicted coding and splice site variants available on exome arrays in up to 344,369 individuals from five major ancestries (discovery) and 132,177 European-ancestry individuals (validation). We identified 15 common (minor allele frequency, MAF ≥5%) and nine low-frequency or rare (MAF <5%) coding novel variants. Pathway/gene set enrichment analyses identified lipid particle, adiponectin, abnormal white adipose tissue physiology and bone development and morphology as important contributors to fat distribution, while cross-trait associations highlight cardiometabolic traits. In functional follow-up analyses, specifically in Drosophila RNAi-knockdowns, we observed a significant increase in the total body triglyceride levels for two genes (DNAH10 and PLXND1). We implicate novel genes in fat distribution, stressing the importance of interrogating low-frequency and protein-coding variants.
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Affiliation(s)
- Anne E Justice
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Weis Center for Research, Geisinger Health System, Danville, PA, USA
| | - Tugce Karaderi
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Department of Biological Sciences, Faculty of Arts and Sciences, Eastern Mediterranean University, Famagusta, Cyprus
| | - Heather M Highland
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kristin L Young
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mariaelisa Graff
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yingchang Lu
- Division of Epidemiology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN, USA
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valérie Turcot
- Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
| | - Paul L Auer
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rebecca S Fine
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Claudia Schurmann
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adelheid Lempradl
- Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Eirini Marouli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Thomas W Winkler
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
| | - Adam E Locke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
- McDonnell Genome Institute, Washington University School of Medicine, Saint Louis, MO, USA
| | - Carolina Medina-Gomez
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tõnu Esko
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Sailaja Vedantam
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA
| | - Ayush Giri
- Department of Obstetrics and Gynecology, Institute for Medicine and Public Health, Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | - Ken Sin Lo
- Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
- Department of Obstetrics and Gynecology, Institute for Medicine and Public Health, Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN, USA
| | - Tamuno Alfred
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Poorva Mudgal
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Maggie C Y Ng
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nancy L Heard-Costa
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- NHLBI Framingham Heart Study, Framingham, MA, USA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Alisa K Manning
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard University Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Sara M Willems
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Suthesh Sivapalaratnam
- Massachusetts General Hospital, Boston, MA, USA
- Department of Vascular Medicine, AMC, Amsterdam, The Netherlands
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Goncalo Abecasis
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Dewan S Alam
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Canada
| | - Matthew Allison
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Philippe Amouyel
- INSERM U1167, Lille, France
- Institut Pasteur de Lille, U1167, Lille, France
- U1167-RID-AGE, Universite de Lille - Risk factors and molecular determinants of aging-related diseases, Lille, France
| | - Zorayr Arzumanyan
- Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Beverley Balkau
- INSERM U1018, Centre de recherche en Épidemiologie et Sante des Populations (CESP), Villejuif, France
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Sven Bergmann
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Matthias Blüher
- IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Carsten A Böger
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Jette Bork-Jensen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Erwin P Bottinger
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donald W Bowden
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ivan Brandslund
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Linda Broer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Amber A Burt
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA
| | - Adam S Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mark J Caulfield
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Research Centre, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Giancarlo Cesana
- Research Centre on Public Health, University of Milano-Bicocca, Monza, Italy
| | - John C Chambers
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Cardiology, London North West Healthcare NHS Trust, Ealing Hospital, Middlesex, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Daniel I Chasman
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Genetics, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Preventive Medicine, Brigham and Women's and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Yii-Der Ida Chen
- Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Rajiv Chowdhury
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Audrey Y Chu
- Division of Preventive Medicine, Brigham and Women's and Harvard Medical School, Boston, MA, USA
| | - Francis S Collins
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - James P Cook
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Amanda J Cox
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - David S Crosslin
- Department of Biomedical Infomatics and Medical Education, University of Washington, Seattle, WA, USA
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wellcome Trust Sanger Institute, Hinxton, UK
- British Heart Foundation Cambridge Centre of Excellence, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Paul I W de Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon de Denus
- Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
- Faculty of Pharmacy, Universite de Montreal, Montreal, Quebec, Canada
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - George Dedoussis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Ellen W Demerath
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joe G Dennis
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Josh C Denny
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Emanuele Di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- NIHR Blood and Transplant Research Unit in Donor Health and Genomics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- British Heart Foundation Cambridge Centre of Excellence, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Fotios Drenos
- Institute of Cardiovascular Science, University College London, London, UK
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Life Sciences, Brunel University London, Uxbridge, UK
| | - Marie-Pierre Dubé
- Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Evangelos Evangelou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Aliki-Eleni Farmaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Shuang Feng
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Ele Ferrannini
- CNR Institute of Clinical Physiology, Pisa, Italy
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Jean Ferrieres
- Toulouse University School of Medicine, Toulouse, France
| | - Jose C Florez
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard University Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Myriam Fornage
- Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Paul W Franks
- Department of Clinical Sciences, Genetic and Molecular Epidemiology Unit, Lund University, Malmo, Sweden
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
- Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wei Gan
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ilaria Gandin
- Ilaria Gandin, Research Unit, AREA Science Park, Trieste, Italy
| | - Paolo Gasparini
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Giorgia Girotto
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Mathias Gorski
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Department of Nephrology, University Hospital Regensburg, Regensburg, Germany
| | - Harald Grallert
- German Center for Diabetes Research, München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Niels Grarup
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Megan L Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jeff Haessler
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA, USA
| | - Torben Hansen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Iris M Heid
- Department of Genetic Epidemiology, University of Regensburg, Regensburg, Germany
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Oddgeir L Holmen
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - G Kees Hovingh
- Department of Vascular Medicine, AMC, Amsterdam, The Netherlands
| | - Joanna M M Howson
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yao Hu
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yi-Jen Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health, Norwegian University of Science and Technology, Levanger, Norway
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erik Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Anne U Jackson
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Gail P Jarvik
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA
- Department of Genome Sciences, University of Washington, Seattle, WA, USA
| | - Yucheng Jia
- Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Torben Jørgensen
- Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Research Center for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
| | | | - Johanne M Justesen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bratati Kahali
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
- Centre for Brain Research, Indian Institute of Science, Bangalore, India
| | | | - Sharon L R Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Queens University Belfast, Belfast, UK
| | - Hidetoshi Kitajima
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Pirjo Komulainen
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Jaspal S Kooner
- Department of Cardiology, London North West Healthcare NHS Trust, Ealing Hospital, Middlesex, UK
- Imperial College Healthcare NHS Trust, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
- National Heart and Lung Institute, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Peter Kovacs
- IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Bernhard K Krämer
- University Medical Centre Mannheim, 5th Medical Department, University of Heidelberg, Mannheim, Germany
| | - Kari Kuulasmaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Timo A Lakka
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - David Lamparter
- Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Verge Genomics, San Fransico, CA, USA
| | - Leslie A Lange
- Division of Biomedical and Personalized Medicine, Department of Medicine, University of Colorado-Denver, Aurora, CO, USA
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Eric B Larson
- Department of Medicine (Medical Genetics), University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Nanette R Lee
- Department of Anthropology, Sociology, and History, University of San Carlos, Cebu City, Philippines
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
| | - Wen-Jane Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Social Work, Tunghai University, Taichung, Taiwan
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huaixing Li
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Jin Li
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ruifang Li-Gao
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Li-An Lin
- Institute of Molecular Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xu Lin
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | | | - Jaana Lindström
- National Institute for Health and Welfare, Helsinki, Finland
| | - Allan Linneberg
- Research Center for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Dajiang J Liu
- Department of Public Health Sciences, Institute for Personalized Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere, Finland
- Department of Clinical Chemistry, Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Stuart MacGregor
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Reedik Mägi
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Satu Männistö
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Jonathan Marten
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Nicholas G D Masca
- Department of Cardiovascular Sciences, Univeristy of Leicester, Glenfield Hospital, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Mark I McCarthy
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Karina Meidtner
- German Center for Diabetes Research, München-Neuherberg, Germany
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | | | - Leena Moilanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Marie Moitry
- Department of Epidemiology and Public Health, University of Strasbourg, Strasbourg, France
- Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna Morgan
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Department of Medicine I, University Hospital Grosshadern, Ludwig-Maximilians-Universitat, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Patricia B Munroe
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Research Centre, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Narisu Narisu
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, Univeristy of Leicester, Glenfield Hospital, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Matt Neville
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Ioanna Ntalla
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jeffrey R O'Connell
- Program for Personalized and Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Katharine R Owen
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Oxford NIHR Biomedical Research Centre, Oxford University Hospitals Trust, Oxford, UK
| | - Oluf Pedersen
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Craig E Pennell
- Division of Obstetric and Gynaecology, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine and Public Health, Faculty of Medicine and Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine (FIMM) and Diabetes and Obesity Research Program, University of Helsinki, Helsinki, Finland
| | - James A Perry
- Program for Personalized and Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John R B Perry
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Tune H Pers
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Ailith Ewing
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ozren Polasek
- School of Medicine, University of Split, Split, Croatia
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Olli T Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Asif Rasheed
- Centre for Non-Communicable Diseases, Karachi, Pakistan
| | | | - Rainer Rauramaa
- Foundation for Research in Health Exercise and Nutrition, Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
- Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio Campus, Finland
| | - Dermot F Reilly
- Genetics and Pharmacogenomics, Merck & Co., Inc., Boston, MA, USA
| | - Alex P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's and Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Manuel A Rivas
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Neil R Robertson
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Antonietta Robino
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Katherine S Ruth
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Danish Saleheen
- Centre for Non-Communicable Diseases, Karachi, Pakistan
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, Univeristy of Leicester, Glenfield Hospital, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Pamela J Schreiner
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Matthias B Schulze
- German Center for Diabetes Research, München-Neuherberg, Germany
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany
| | - Robert A Scott
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Marcelo Segura-Lepe
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Xueling Sim
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
| | - Andrew J Slater
- Genetics, Target Sciences, GlaxoSmithKline, Research Triangle Park, NC, USA
- OmicSoft a QIAGEN Company, Cary, NC, USA
| | - Kerrin S Small
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Blair H Smith
- Division of Population Health Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
- Generation Scotland, Centre for Genomic and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lorraine Southam
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
- Wellcome Trust Sanger Institute, Hinxton, UK
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Elizabeth K Speliotes
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Kari Stefansson
- deCODE Genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | - Kathleen E Stirrups
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Department of Haematology, University of Cambridge, Cambridge, UK
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Germany
| | - Heather M Stringham
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Michael Stumvoll
- IFB Adiposity Diseases, University of Leipzig, Leipzig, Germany
- Department of Medicine, University of Leipzig, Leipzig, Germany
| | - Liang Sun
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Praveen Surendran
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Jean-Claude Tardif
- Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Kent D Taylor
- Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Deborah J Thompson
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Unnur Thorsteinsdottir
- deCODE Genetics/Amgen Inc., Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Betina H Thuesen
- Research Center for Prevention and Health, Capital Region of Denmark, Glostrup, Denmark
| | - Anke Tönjes
- Center for Pediatric Research, Department for Women's and Child Health, University of Leipzig, Leipzig, Germany
| | - Mina Torres
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Jaakko Tuomilehto
- National Institute for Health and Welfare, Helsinki, Finland
- Centre for Vascular Prevention, Danube-University Krems, Krems, Austria
- Dasman Diabetes Institute, Dasman, Kuwait
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Matti Uusitupa
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Mauno Vanhala
- Central Finland Central Hospital, Jyvaskyla, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Sita H Vermeulen
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henrik Vestergaard
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Veronique Vitart
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Thomas F Vogt
- Cardiometabolic Disease, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Dragana Vuckovic
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark Walker
- Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle, UK
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Feijie Wang
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Carol A Wang
- Division of Obstetric and Gynaecology, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine and Public Health, Faculty of Medicine and Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Shuai Wang
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Helen R Warren
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- NIHR Barts Cardiovascular Research Centre, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Jennifer Wessel
- Departments of Epidemiology & Medicine, Diabetes Translational Research Center, Fairbanks School of Public Health & School of Medicine, Indiana University, Indiana, IN, USA
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | - Cristen J Willer
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andrew R Wood
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ying Wu
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Hanieh Yaghootkar
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jie Yao
- Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Laura M Yerges-Armstrong
- Program for Personalized and Genomic Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- GlaxoSmithKline, King of Prussia, PA, USA
| | - Robin Young
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- University of Glasgow, Glasgow, UK
| | | | - Xiaowei Zhan
- Department of Clinical Sciences, Quantitative Biomedical Research Center, Center for the Genetics of Host Defense, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Weihua Zhang
- Department of Cardiology, London North West Healthcare NHS Trust, Ealing Hospital, Middlesex, UK
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge, UK
| | - Wei Zhao
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - He Zheng
- CAS Key Laboratory of Nutrition, Metabolism and Food Safety, Shanghai Institute of Nutrition and Health, Shanghai Institutes for Biological Sciences, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Wei Zhou
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - M Carola Zillikens
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders (PACER-HD), King Abdulaziz University, Jeddah, Saudi Arabia
| | - Timothy M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Guillaume Lettre
- Montreal Heart Institute, Universite de Montreal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Universite de Montreal, Montreal, Quebec, Canada
| | - Karen L Mohlke
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, LABioMed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Zoltán Kutalik
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Joel N Hirschhorn
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA, USA
- Departments of Pediatrics and Genetics, Harvard Medical School, Boston, MA, USA
| | - L Adrienne Cupples
- NHLBI Framingham Heart Study, Framingham, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Ruth J F Loos
- The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Genetics of Obesity and Related Metabolic Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kari E North
- Department of Epidemiology and Carolina Center of Genome Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Cecilia M Lindgren
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK.
- Li Ka Shing Centre for Health Information and Discovery, The Big Data Institute, University of Oxford, Oxford, UK.
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Karasik D, Zillikens MC, Hsu YH, Aghdassi A, Akesson K, Amin N, Barroso I, Bennett DA, Bertram L, Bochud M, Borecki IB, Broer L, Buchman AS, Byberg L, Campbell H, Campos-Obando N, Cauley JA, Cawthon PM, Chambers JC, Chen Z, Cho NH, Choi HJ, Chou WC, Cummings SR, de Groot LCPGM, De Jager PL, Demuth I, Diatchenko L, Econs MJ, Eiriksdottir G, Enneman AW, Eriksson J, Eriksson JG, Estrada K, Evans DS, Feitosa MF, Fu M, Gieger C, Grallert H, Gudnason V, Lenore LJ, Hayward C, Hofman A, Homuth G, Huffman KM, Husted LB, Illig T, Ingelsson E, Ittermann T, Jansson JO, Johnson T, Biffar R, Jordan JM, Jula A, Karlsson M, Khaw KT, Kilpeläinen TO, Klopp N, Kloth JSL, Koller DL, Kooner JS, Kraus WE, Kritchevsky S, Kutalik Z, Kuulasmaa T, Kuusisto J, Laakso M, Lahti J, Lang T, Langdahl BL, Lerch MM, Lewis JR, Lill C, Lind L, Lindgren C, Liu Y, Livshits G, Ljunggren Ö, Loos RJF, Lorentzon M, Luan J, Luben RN, Malkin I, McGuigan FE, Medina-Gomez C, Meitinger T, Melhus H, Mellström D, Michaëlsson K, Mitchell BD, Morris AP, Mosekilde L, Nethander M, Newman AB, O'Connell JR, Oostra BA, Orwoll ES, Palotie A, Peacock M, Perola M, Peters A, Prince RL, Psaty BM, Räikkönen K, Ralston SH, Ripatti S, Rivadeneira F, Robbins JA, Rotter JI, Rudan I, Salomaa V, Satterfield S, Schipf S, Shin CS, Smith AV, Smith SB, Soranzo N, Spector TD, Stančáková A, Stefansson K, Steinhagen-Thiessen E, Stolk L, Streeten EA, Styrkarsdottir U, Swart KMA, Thompson P, Thomson CA, Thorleifsson G, Thorsteinsdottir U, Tikkanen E, Tranah GJ, Uitterlinden AG, van Duijn CM, van Schoor NM, Vandenput L, Vollenweider P, Völzke H, Wactawski-Wende J, Walker M, J Wareham N, Waterworth D, Weedon MN, Wichmann HE, Widen E, Williams FMK, Wilson JF, Wright NC, Yerges-Armstrong LM, Yu L, Zhang W, Zhao JH, Zhou Y, Nielson CM, Harris TB, Demissie S, Kiel DP, Ohlsson C. Disentangling the genetics of lean mass. Am J Clin Nutr 2019; 109:276-287. [PMID: 30721968 PMCID: PMC6500901 DOI: 10.1093/ajcn/nqy272] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/11/2018] [Indexed: 12/17/2022] Open
Abstract
Background Lean body mass (LM) plays an important role in mobility and metabolic function. We previously identified five loci associated with LM adjusted for fat mass in kilograms. Such an adjustment may reduce the power to identify genetic signals having an association with both lean mass and fat mass. Objectives To determine the impact of different fat mass adjustments on genetic architecture of LM and identify additional LM loci. Methods We performed genome-wide association analyses for whole-body LM (20 cohorts of European ancestry with n = 38,292) measured using dual-energy X-ray absorptiometry) or bioelectrical impedance analysis, adjusted for sex, age, age2, and height with or without fat mass adjustments (Model 1 no fat adjustment; Model 2 adjustment for fat mass as a percentage of body mass; Model 3 adjustment for fat mass in kilograms). Results Seven single-nucleotide polymorphisms (SNPs) in separate loci, including one novel LM locus (TNRC6B), were successfully replicated in an additional 47,227 individuals from 29 cohorts. Based on the strengths of the associations in Model 1 vs Model 3, we divided the LM loci into those with an effect on both lean mass and fat mass in the same direction and refer to those as "sumo wrestler" loci (FTO and MC4R). In contrast, loci with an impact specifically on LM were termed "body builder" loci (VCAN and ADAMTSL3). Using existing available genome-wide association study databases, LM increasing alleles of SNPs in sumo wrestler loci were associated with an adverse metabolic profile, whereas LM increasing alleles of SNPs in "body builder" loci were associated with metabolic protection. Conclusions In conclusion, we identified one novel LM locus (TNRC6B). Our results suggest that a genetically determined increase in lean mass might exert either harmful or protective effects on metabolic traits, depending on its relation to fat mass.
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Affiliation(s)
- David Karasik
- Hebrew SeniorLife Institute for Aging Research and Harvard Medical School, Boston, MA
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Aging, Leiden, The Netherlands
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife Institute for Aging Research and Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA
| | - Ali Aghdassi
- Department of Medicine A, University of Greifswald, Greifswald, Germany
| | - Kristina Akesson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
- NIHR Cambridge Biomedical Research Centre
- University of Cambridge Metabolic Research Laboratories, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, University of Lübeck, Lübeck, Germany
| | - Murielle Bochud
- University Institute for Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Linda Broer
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, United Kingdom
| | | | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - John C Chambers
- Cardiology, Ealing Hospital NHS Trust, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, United Kingdom
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Youngtong-Gu, Suwon, Korea
| | - Hyung Jin Choi
- Department of Internal Medicine
- Department of Anatomy and Cell Biology, Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Korea
| | - Wen-Chi Chou
- Hebrew SeniorLife Institute for Aging Research and Harvard Medical School, Boston, MA
- Broad Institute, Cambridge, MA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA
| | | | - Phillip L De Jager
- Center for Translational and Computational Neuroimmunology, Neurology, Columbia University Medical Center, New York, NY
- Cell Circuits Program, Broad Institute, Cambridge, MA
| | - Ilja Demuth
- Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Luda Diatchenko
- Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Michael J Econs
- Department of Medicine and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | | | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Joel Eriksson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan G Eriksson
- National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Helsinki University Central Hospital, Unit of General Practice, Helsinki, Finland
- Folkhalsan Research Centre, Helsinki, Finland
| | - Karol Estrada
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Translational Biology, Biogen, Cambridge, MA
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics
| | - Mao Fu
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
| | - Christian Gieger
- Research Unit of Molecular Epidemiology
- Institute of Epidemiology II
- Institute of Genetic Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Harald Grallert
- Research Unit of Molecular Epidemiology
- Institute of Epidemiology II
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research, Neuherberg, Germany
- CCG Nutrigenomics and Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, Germany
| | - Vilmundur Gudnason
- Icelandic Heart Association Holtasmari, Kopavogur, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Launer J Lenore
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, NIA, Bethesda, MD
| | - Caroline Hayward
- MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, United Kingdom
| | - Albert Hofman
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Aging, Leiden, The Netherlands
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, Germany
| | - Kim M Huffman
- Duke Molecular Physiology Institute and Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lise B Husted
- Aarhus University Hospital, Endocrinology and Internal Medicine, Aarhus, Denmark
| | - Thomas Illig
- Research Unit of Molecular Epidemiology
- Department of Human Genetics, Hannover Medical School, Hanover, Germany
| | - Erik Ingelsson
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - John-Olov Jansson
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Toby Johnson
- University Institute for Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Reiner Biffar
- Centre of Oral Health, Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University of Greifswald, Greifswald, Germany
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Magnus Karlsson
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Tuomas O Kilpeläinen
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Norman Klopp
- Research Unit of Molecular Epidemiology
- Hannover Unified Biobank, Hannover Medical School, Hannover, Germany
| | | | - Daniel L Koller
- Department of Medicine and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Jaspal S Kooner
- Cardiology, Ealing Hospital NHS Trust, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Faculty of Medicine, National Heart & Lung Institute, Cardiovascular Science, Hammersmith Campus, Hammersmith Hospital, Imperial College London, United Kingdom
| | - William E Kraus
- Duke Molecular Physiology Institute and Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Stephen Kritchevsky
- Sticht Center for Healthy Aging and Alzheimer's Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Zoltán Kutalik
- University Institute for Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Teemu Kuulasmaa
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Jari Lahti
- Helsinki Collegium Advanced Studies, University of Helsinki, Helsinki, Finland
| | - Thomas Lang
- Department of Radiology and Biomedical Imaging, and School of Dentistry, UC San Francisco, San Francisco, CA
| | - Bente L Langdahl
- Aarhus University Hospital, Endocrinology and Internal Medicine, Aarhus, Denmark
| | - Markus M Lerch
- Department of Medicine A, University of Greifswald, Greifswald, Germany
| | - Joshua R Lewis
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Christina Lill
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Lars Lind
- Department. of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Cecilia Lindgren
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, United Kingdom
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Gregory Livshits
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, United Kingdom
| | - Östen Ljunggren
- Department. of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ruth J F Loos
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
- The Charles Bronfman Institute of Personalized Medicine
- Institute of Child Health and Development
- The Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mattias Lorentzon
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jian'an Luan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert N Luben
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ida Malkin
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fiona E McGuigan
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Thomas Meitinger
- Institute of Human Genetics, MRI, Technische Universität München, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München—German Research Center for Environmental Health, Neuherberg, Germany
| | - Håkan Melhus
- Department. of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Dan Mellström
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Braxton D Mitchell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
- Geriatric Research and Education Clinical Center—Veterans Administration Medical Center, Baltimore, MD
| | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, United Kingdom
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Leif Mosekilde
- Aarhus University Hospital, Endocrinology and Internal Medicine, Aarhus, Denmark
| | - Maria Nethander
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Jeffery R O'Connell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
| | - Ben A Oostra
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
- Centre for Medical Systems Biology & Netherlands Consortium on Healthy Aging, Leiden, The Netherlands
| | | | - Aarno Palotie
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Department of Medical Genetics, University of Helsinki and University Central Hospital, Helsinki, Finland
| | - Munro Peacock
- Department of Medicine and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland
- University of Helsinki, Institute for Molecular Medicine, Finland and Diabetes and Obesity Research Program, Helsinki, Finland
- University of Tartu, Estonian Genome Center, Tartu, Estonia
| | - Annette Peters
- Research Unit of Molecular Epidemiology
- Institute of Epidemiology II
| | - Richard L Prince
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gardiner Hospital, Perth, Australia
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Stuart H Ralston
- Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, United Kingdom
| | - Samuli Ripatti
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Aging, Leiden, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - John A Robbins
- Department of Medicine, University California at Davis, Sacramento, CA
| | - Jerome I Rotter
- Institute for Translational Genomic and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor UCLA Medical Center, Torrance, CA
| | - Igor Rudan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Sabine Schipf
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | | | - Albert V Smith
- Icelandic Heart Association Holtasmari, Kopavogur, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Shad B Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University, Durham, NC
| | - Nicole Soranzo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, United Kingdom
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, United Kingdom
| | - Alena Stančáková
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Kari Stefansson
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
- deCODE Genetics, Reykjavik, Iceland
| | | | - Lisette Stolk
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Aging, Leiden, The Netherlands
| | - Elizabeth A Streeten
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
- Geriatric Research and Education Clinical Center—Veterans Administration Medical Center, Baltimore, MD
| | | | - Karin M A Swart
- Department of Epidemiology and Biostatistics, and the EMGO+ Institute; VU University Medical Center, Amsterdam, The Netherlands
| | | | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | | | - Unnur Thorsteinsdottir
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
- deCODE Genetics, Reykjavik, Iceland
| | - Emmi Tikkanen
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
- Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Aging, Leiden, The Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
- Centre for Medical Systems Biology & Netherlands Consortium on Healthy Aging, Leiden, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, and the EMGO+ Institute; VU University Medical Center, Amsterdam, The Netherlands
| | - Liesbeth Vandenput
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Vollenweider
- Department of Medicine, Internal Medicine, Lausanne University Hospital and Faculty of Biology and Medicine, Lausanne, Switzerland
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, SUNY, Buffalo, NY
| | - Mark Walker
- Institute of Cellular Medicine (Diabetes), The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Michael N Weedon
- Genetics of Complex Traits, Royal Devon & Exeter Hospital, University of Exeter Medical School, Exeter, United Kingdom
| | - H-Erich Wichmann
- Institute of Epidemiology II
- Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität, Neuherberg/Munich, Germany
- Institute of Medical Statistics and Epidemiology, Technical University, Munich, Germany
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, United Kingdom
| | - James F Wilson
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Teviot Place, Edinburgh, United Kingdom
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
| | - Laura M Yerges-Armstrong
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD
- Genetics, GlaxoSmithKline, King of Prussia, PA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL
| | - Weihua Zhang
- Cardiology, Ealing Hospital NHS Trust, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | | | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, NIA, Bethesda, MD
| | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Douglas P Kiel
- Hebrew SeniorLife Institute for Aging Research and Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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25
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Oliai Araghi S, Kiefte-de Jong JC, van Dijk SC, Swart KMA, van Laarhoven HW, van Schoor NM, de Groot LCPGM, Lemmens V, Stricker BH, Uitterlinden AG, van der Velde N. Folic Acid and Vitamin B12 Supplementation and the Risk of Cancer: Long-term Follow-up of the B Vitamins for the Prevention of Osteoporotic Fractures (B-PROOF) Trial. Cancer Epidemiol Biomarkers Prev 2018; 28:275-282. [PMID: 30341095 DOI: 10.1158/1055-9965.epi-17-1198] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 03/21/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Folic acid and vitamin B12 play key roles in one-carbon metabolism. Disruption of one-carbon metabolism may be involved in the risk of cancer. Our aim was to assess the long-term effect of supplementation with both folic acid and vitamin B12 on the incidence of overall cancer and on colorectal cancer in the B Vitamins for the Prevention of Osteoporotic Fractures (B-PROOF) trial. METHODS Long-term follow-up of B-PROOF trial participants (N = 2,524), a multicenter, double-blind randomized placebo-controlled trial designed to assess the effect of 2 to 3 years daily supplementation with folic acid (400 μg) and vitamin B12 (500 μg) versus placebo on fracture incidence. Information on cancer incidence was obtained from the Netherlands cancer registry (Integraal Kankercentrum Nederland), using the International Statistical Classification of Disease (ICD-10) codes C00-C97 for all cancers (except C44 for skin cancer), and C18-C20 for colorectal cancer. RESULTS Allocation to B vitamins was associated with a higher risk of overall cancer [171 (13.6%) vs. 143 (11.3%); HR 1.25; 95% confidence interval (CI), 1.00-1.53, P = 0.05]. B vitamins were significantly associated with a higher risk of colorectal cancer [43(3.4%) vs. 25(2.0%); HR 1.77; 95% CI, 1.08-2.90, P = 0.02]. CONCLUSIONS Folic acid and vitamin B12 supplementation was associated with an increased risk of colorectal cancer. IMPACT Our findings suggest that folic acid and vitamin B12 supplementation may increase the risk of colorectal cancer. Further confirmation in larger studies and in meta-analyses combining both folic acid and vitamin B12 are needed to evaluate whether folic acid and vitamin B12 supplementation should be limited to patients with a known indication, such as a proven deficiency.
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Affiliation(s)
- Sadaf Oliai Araghi
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands. .,Leiden University College, The Hague, the Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center/LUMC Campus, The Hague, the Netherlands
| | - Suzanne C van Dijk
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Valery Lemmens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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26
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Swart KMA, van Vilsteren M, van Hout W, Draak E, van der Zwaard BC, van der Horst HE, Hugtenburg JG, Elders PJM. Factors related to intentional non-initiation of bisphosphonate treatment in patients with a high fracture risk in primary care: a qualitative study. BMC Fam Pract 2018; 19:141. [PMID: 30139341 PMCID: PMC6108118 DOI: 10.1186/s12875-018-0828-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adherence to osteoporosis treatment is crucial for good treatment effects. However, adherence has been shown to be poor and a substantial part of the patients don't even initiate treatment. This study aimed to gain insight into the considerations of both osteoporosis patients and general practitioners (GP) concerning intentional non-initiation of bisphosphonate treatment. METHODS Osteoporosis patients and GPs were recruited from the SALT Osteoporosis Study and a transmural fracture liaison service, both carried out in the Netherlands. Using questionnaires, we identified non-starters and starters of bisphosphonate treatment. Semi-structured interviews were conducted to gain a detailed overview of all considerations until saturation of the data was reached. Starters were asked to reflect on the considerations that were brought forward by the non-starters. Interviews were open coded and the codes were classified into main themes and subthemes using an inductive approach. RESULTS 16 non-starters, 10 starters, and 13 GPs were interviewed. We identified three main themes: insufficient medical advice, attitudes towards medication use including concerns about side effects, and disease awareness. From patients' as well as GPs' perspective, insufficient or ambiguous information from the GP influenced the decision of the non-starters to not start bisphosphonates. In contrast, starters were either properly informed, or they collected information themselves. Patients' aversion towards medication, fear of side effects, and a low risk perception also contributed to not starting the medication, whereas starters were aware of their fracture risk and were confident of the outcome of the treatment. Concerns about osteoporosis treatment and its side effects were also expressed by several GPs. Some GPs appeared to have a limited understanding of the current osteoporosis guidelines and the indications for treatment. CONCLUSIONS Many reasons we found for not starting bisphosphonate treatment were related to the patients or the GPs themselves being insufficiently informed. Attitudes of the GPs were shown to play a role in the decision of patients not to start treatment. Interventions need to be developed that are aimed at GPs, and at education of patients.
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Affiliation(s)
- Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands. .,Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR, Koog aan de Zaan, Netherlands.
| | - Myrthe van Vilsteren
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.,Stichting Artsen Laboratorium en Trombosedienst, Molenwerf 11, 1541 WR, Koog aan de Zaan, Netherlands
| | - Wesley van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Esther Draak
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Babette C van der Zwaard
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Henriette E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
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27
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Affiliation(s)
- Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, Netherlands; Stichting Artsen Laboratorium en Trombosedienst, Koog aan de Zaan, Netherlands
| | - Thomas Merlijn
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, Netherlands
| | - J Coen Netelenbos
- Department of Internal Medicine, Endocrine Section, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, 1081 BT Amsterdam, Netherlands.
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28
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Merlijn T, Swart KMA, Lips P, Heymans MW, Sohl E, Van Schoor NM, Netelenbos CJ, Elders PJM. Prediction of insufficient serum vitamin D status in older women: a validated model. Osteoporos Int 2018; 29:1539-1547. [PMID: 29808229 PMCID: PMC6061708 DOI: 10.1007/s00198-018-4410-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 01/24/2018] [Indexed: 12/20/2022]
Abstract
UNLABELLED We developed an externally validated simple prediction model to predict serum 25(OH)D levels < 30, < 40, < 50 and 60 nmol/L in older women with risk factors for fractures. The benefit of the model reduces when a higher 25(OH)D threshold is chosen. INTRODUCTION Vitamin D deficiency is associated with increased fracture risk in older persons. General supplementation of all older women with vitamin D could cause medicalization and costs. We developed a clinical model to identify insufficient serum 25-hydroxyvitamin D (25(OH)D) status in older women at risk for fractures. METHODS In a sample of 2689 women ≥ 65 years selected from general practices, with at least one risk factor for fractures, a questionnaire was administered and serum 25(OH)D was measured. Multivariable logistic regression models with backward selection were developed to select predictors for insufficient serum 25(OH)D status, using separate thresholds 30, 40, 50 and 60 nmol/L. Internal and external model validations were performed. RESULTS Predictors in the models were as follows: age, BMI, vitamin D supplementation, multivitamin supplementation, calcium supplementation, daily use of margarine, fatty fish ≥ 2×/week, ≥ 1 hours/day outdoors in summer, season of blood sampling, the use of a walking aid and smoking. The AUC was 0.77 for the model using a 30 nmol/L threshold and decreased in the models with higher thresholds to 0.72 for 60 nmol/L. We demonstrate that the model can help to distinguish patients with or without insufficient serum 25(OH)D levels at thresholds of 30 and 40 nmol/L, but not when a threshold of 50 nmol/L is demanded. CONCLUSIONS This externally validated model can predict the presence of vitamin D insufficiency in women at risk for fractures. The potential clinical benefit of this tool is highly dependent of the chosen 25(OH)D threshold and decreases when a higher threshold is used.
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Affiliation(s)
- T Merlijn
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
- Stichting ArtsenLaboratorium en Trombosedienst, Koog aan de Zaan, The Netherlands.
| | - K M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Stichting ArtsenLaboratorium en Trombosedienst, Koog aan de Zaan, The Netherlands
| | - P Lips
- Department of Internal Medicine and Endocrinology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - M W Heymans
- Department of Health Sciences, Faculty of Earth and Life Sciences, Amsterdam Public Health Research Institute, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - E Sohl
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N M Van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - C J Netelenbos
- Department of Internal Medicine and Endocrinology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - P J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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29
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Zillikens MC, Demissie S, Hsu YH, Yerges-Armstrong LM, Chou WC, Stolk L, Livshits G, Broer L, Johnson T, Koller DL, Kutalik Z, Luan J, Malkin I, Ried JS, Smith AV, Thorleifsson G, Vandenput L, Hua Zhao J, Zhang W, Aghdassi A, Åkesson K, Amin N, Baier LJ, Barroso I, Bennett DA, Bertram L, Biffar R, Bochud M, Boehnke M, Borecki IB, Buchman AS, Byberg L, Campbell H, Campos Obanda N, Cauley JA, Cawthon PM, Cederberg H, Chen Z, Cho NH, Jin Choi H, Claussnitzer M, Collins F, Cummings SR, De Jager PL, Demuth I, Dhonukshe-Rutten RAM, Diatchenko L, Eiriksdottir G, Enneman AW, Erdos M, Eriksson JG, Eriksson J, Estrada K, Evans DS, Feitosa MF, Fu M, Garcia M, Gieger C, Girke T, Glazer NL, Grallert H, Grewal J, Han BG, Hanson RL, Hayward C, Hofman A, Hoffman EP, Homuth G, Hsueh WC, Hubal MJ, Hubbard A, Huffman KM, Husted LB, Illig T, Ingelsson E, Ittermann T, Jansson JO, Jordan JM, Jula A, Karlsson M, Khaw KT, Kilpeläinen TO, Klopp N, Kloth JSL, Koistinen HA, Kraus WE, Kritchevsky S, Kuulasmaa T, Kuusisto J, Laakso M, Lahti J, Lang T, Langdahl BL, Launer LJ, Lee JY, Lerch MM, Lewis JR, Lind L, Lindgren C, Liu Y, Liu T, Liu Y, Ljunggren Ö, Lorentzon M, Luben RN, Maixner W, McGuigan FE, Medina-Gomez C, Meitinger T, Melhus H, Mellström D, Melov S, Michaëlsson K, Mitchell BD, Morris AP, Mosekilde L, Newman A, Nielson CM, O'Connell JR, Oostra BA, Orwoll ES, Palotie A, Parker SCJ, Peacock M, Perola M, Peters A, Polasek O, Prince RL, Räikkönen K, Ralston SH, Ripatti S, Robbins JA, Rotter JI, Rudan I, Salomaa V, Satterfield S, Schadt EE, Schipf S, Scott L, Sehmi J, Shen J, Soo Shin C, Sigurdsson G, Smith S, Soranzo N, Stančáková A, Steinhagen-Thiessen E, Streeten EA, Styrkarsdottir U, Swart KMA, Tan ST, Tarnopolsky MA, Thompson P, Thomson CA, Thorsteinsdottir U, Tikkanen E, Tranah GJ, Tuomilehto J, van Schoor NM, Verma A, Vollenweider P, Völzke H, Wactawski-Wende J, Walker M, Weedon MN, Welch R, Wichmann HE, Widen E, Williams FMK, Wilson JF, Wright NC, Xie W, Yu L, Zhou Y, Chambers JC, Döring A, van Duijn CM, Econs MJ, Gudnason V, Kooner JS, Psaty BM, Spector TD, Stefansson K, Rivadeneira F, Uitterlinden AG, Wareham NJ, Ossowski V, Waterworth D, Loos RJF, Karasik D, Harris TB, Ohlsson C, Kiel DP. Erratum: Large meta-analysis of genome-wide association studies identifies five loci for lean body mass. Nat Commun 2017; 8:1414. [PMID: 29116125 PMCID: PMC5676783 DOI: 10.1038/s41467-017-01008-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, 02115, USA
| | - Laura M Yerges-Armstrong
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Wen-Chi Chou
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA
| | - Lisette Stolk
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Gregory Livshits
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel.,Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Linda Broer
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Toby Johnson
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Daniel L Koller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Zoltán Kutalik
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Ida Malkin
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Janina S Ried
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Albert V Smith
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | | | - Liesbeth Vandenput
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Weihua Zhang
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Ali Aghdassi
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Kristina Åkesson
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden.,Department of Orthopedics, Skåne University Hospital, Malmö, S-205 02, Sweden
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK.,NIHR Cambridge Biomedical Research Centre, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 OQQ, UK.,Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, CB2 OQQ, UK
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics and Experimental & Integrative Genomics, University of Lübeck, Lübeck, 23562, Germany.,School of Public Health, Faculty of Medicine, Imperial College London, London, W6 8RP, UK
| | - Rainer Biffar
- Centre of Oral Health, Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University of Greifswald, Greifswald, 17489, Germany
| | - Murielle Bochud
- Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA.,Division of Biostatistics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | | | - Jane A Cauley
- Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Henna Cederberg
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Youngtong-Gu, Suwon, 16499, Korea
| | - Hyung Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju Si, Korea
| | - Melina Claussnitzer
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA.,Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, 02139, USA.,Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Francis Collins
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Philip L De Jager
- Harvard Medical School, Boston, MA, 02115, USA.,Program in Translational NeuroPsychiatric Genomics, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Ilja Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany.,Institute of Medical and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, 13353, Germany
| | | | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, H3A 0G1, Canada.,Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Mike Erdos
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, 00014, Finland.,Unit of General Practice, Helsinki University Central Hospital, Helsinki, 00014, Finland.,Folkhalsan Research Centre, Helsinki, 00250, Finland.,Vasa Central Hospital, Vasa, 65130, Finland.,National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Joel Eriksson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Karol Estrada
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Mao Fu
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Melissa Garcia
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Christian Gieger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Thomas Girke
- Institute for Integrative Genome Biology, University of California, Riverside, CA, 92521, USA.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA
| | - Nicole L Glazer
- Departments of Medicine and Epidemiology, Boston University School of Medicine and Public Health, Boston, MA, 02118, USA
| | - Harald Grallert
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,CCG Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, 85764, Germany.,CCG Nutrigenomics and Type 2 Diabetes. Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Jagvir Grewal
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Bok-Ghee Han
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Caroline Hayward
- MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Albert Hofman
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Eric P Hoffman
- Department of Pharmaceutical Sciences, SUNY Binghamton, Binghamton, NY, 13902, USA
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, 17487, Germany
| | - Wen-Chi Hsueh
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Monica J Hubal
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC, 20052, USA.,Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC, 20052, USA
| | - Alan Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Kim M Huffman
- Division of Rheumatology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Lise B Husted
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Thomas Illig
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Human Genetics, Hannover Medical School, Hannover, 30625, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | - Erik Ingelsson
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - John-Olov Jansson
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 405 30, Sweden
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Magnus Karlsson
- Department of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital SUS, Malmö, 22362, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Tuomas O Kilpeläinen
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, 2100, Denmark.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Norman Klopp
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | | | - Heikki A Koistinen
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Department of Health, National Institute for Health and Welfare, Helsinki, 00271, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, 00290, Finland
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Teemu Kuulasmaa
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Thomas Lang
- University of California San Francisco, San Francisco, CA, 94143, USA
| | - Bente L Langdahl
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Jong-Young Lee
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Markus M Lerch
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Joshua R Lewis
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Centre for Kidney Research, School of Public Health, University of Sydney, Sydney, 2006, Australia
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Cecilia Lindgren
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27517, USA
| | - Tian Liu
- Max Planck Institute for Molecular Genetics, Berlin, 14195, Germany.,Max Planck Institute for Human Development, Berlin, 14195, Germany
| | - Youfang Liu
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Mattias Lorentzon
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - William Maixner
- Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Fiona E McGuigan
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Thomas Meitinger
- Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Dan Mellström
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Simon Melov
- Buck Institute for Research on Aging, Novato, CA, 94945, USA.,Leonard Davis School of Gerontology, University of Southern California, LA, CA, 90089, USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Braxton D Mitchell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - Leif Mosekilde
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Anne Newman
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | | | - Jeffrey R O'Connell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ben A Oostra
- Department of Clinical Genetics, Erasmus MC, Rotterdam, 300 CA, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Department of Medical Genetics, University of Helsinki and University Central Hospital, Helsinki, FI00014, Finland
| | - Stephen C J Parker
- Human Genetics and Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Diabetes and Obesity Research Program, University of Helsinki, Helsinki, FI00014, Finland.,Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Ozren Polasek
- Faculty of Medicine, Department of Public Health, University of Split, Split, 21000, Croatia
| | - Richard L Prince
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gardiner Hospital, Perth, 6009, Australia
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Stuart H Ralston
- Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Hjelt Institute, University of Helsinki, Helsinki, Finland.,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - John A Robbins
- Department of Medicine, University of California at Davis, Sacramento, CA, 95817, USA
| | - Jerome I Rotter
- Institute for Translational Genomic and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor UCLA Medical Center, Torrance, CA, 90502, USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sabine Schipf
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Laura Scott
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joban Sehmi
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jian Shen
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Gunnar Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,Department of Endocrinology and Metabolism, Landspitali, The National University Hospital of Iceland, Reykjavik, 101, Iceland
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthiology, Duke University Medical Center, Durham, NC, 27110, USA
| | - Nicole Soranzo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - Alena Stančáková
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Elisabeth Steinhagen-Thiessen
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany
| | - Elizabeth A Streeten
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatric Research and Education Clinical Center (GRECC) - Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | | | - Karin M A Swart
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Sian-Tsung Tan
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Mark A Tarnopolsky
- Department of Medicine, McMaster University Medical Center, Hamilton, ON, Canada, L8N 3Z5
| | - Patricia Thompson
- Department of Pathology, Stony Brook School of Medicine, Stony Brook, NY, 11794, USA
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Unnur Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Emmi Tikkanen
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Jaakko Tuomilehto
- Vasa Central Hospital, Vasa, 65130, Finland.,Department of Neuroscience and Preventive Medicine, Danube-University Krems, Krems, 3500, Austria.,Diabetes Research Group, King Abdulaziz University, Jeddah, 12589, Saudi Arabia.,Dasman Diabetes Institute, Dasman, 15462, Kuwait
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Arjun Verma
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Peter Vollenweider
- Department of Medicine and Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH-1011, Switzerland
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Ryan Welch
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - H-Erich Wichmann
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, 81377, Germany.,Institute of Medical Statistics and Epidemiology, Technical University, Munich, 81675, Germany
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - James F Wilson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK.,MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Weijia Xie
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John C Chambers
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, SW3 6NP, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Angela Döring
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Michael J Econs
- Department of Medicine and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | - Jaspal S Kooner
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Bruce M Psaty
- Departments of Medicine, Epidemiology, and Health Services, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98101, USA.,Kaiser Permanente Washington Health Research Institute, Washington, Seattle, WA, 98101, USA
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Kari Stefansson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Vicky Ossowski
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Dawn Waterworth
- Medical Genetics, GlaxoSmithKline, Philadelphia, PA, 19112, USA
| | - Ruth J F Loos
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Institute of Child Health and Development, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,The Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - David Karasik
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, 1311502, Israel
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Claes Ohlsson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Douglas P Kiel
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA. .,Harvard Medical School, Boston, MA, 02115, USA. .,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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Elders PJM, Merlijn T, Swart KMA, van Hout W, van der Zwaard BC, Niemeijer C, Heymans MW, van der Heijden AA, Rutters F, van der Horst HE, Lips P, Netelenbos JC, van Schoor NM. Design of the SALT Osteoporosis Study: a randomised pragmatic trial, to study a primary care screening and treatment program for the prevention of fractures in women aged 65 years or older. BMC Musculoskelet Disord 2017; 18:424. [PMID: 29078762 PMCID: PMC5658954 DOI: 10.1186/s12891-017-1783-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 10/15/2017] [Indexed: 01/07/2023] Open
Abstract
Background Several drugs have become available for the treatment of osteoporosis. However, screening and treatment of patients with a high fracture risk is currently not recommended in the Netherlands, because the effectiveness of bone sparing drugs has not been demonstrated in the general primary care population. Here we describe the design of the SALT Osteoporosis study, which aims to examine whether the screening and treatment of older, female patients in primary care can reduce fractures, in comparison to usual care. Methods A randomised pragmatic trial has been designed using a stepwise approach in general care practices in the Netherlands. Women aged ≥65 years, who are not prescribed bone sparing drugs or corticosteroids are eligible for the study. First, women with at least one clinical risk factor for fractures, as determined by questionnaires, are randomly assigned to the intervention or control group. Second, women in the intervention group having a high fracture risk according to our screening program, including an adapted fracture risk assessment (FRAX) tool, combined with dual-energy x-ray absorptiometry (DXA), and instant vertebral assessment (IVA), are offered a structured treatment program. The women in the control group receive care as usual and will undergo the same screening as the intervention group at the end of the trial. The follow-up duration will be three years and the primary outcome is time to first incident fracture and the total number of fractures. Discussion The results of the current study will be very important for underpinnings of the prevention strategy of the osteoporosis guidelines. Trial registration ID NTR2430. Registered 26 July 2010.
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Affiliation(s)
- P J M Elders
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - T Merlijn
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - K M A Swart
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands.,Stichting ArtsenLaboratorium en Trombosedienst, Koog aan de Zaan, The Netherlands
| | - W van Hout
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - B C van der Zwaard
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - C Niemeijer
- Stichting ArtsenLaboratorium en Trombosedienst, Koog aan de Zaan, The Netherlands
| | - M W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - A A van der Heijden
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - H E van der Horst
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - P Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - J C Netelenbos
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - N M van Schoor
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health research institute, Amsterdam, The Netherlands
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Zillikens MC, Demissie S, Hsu YH, Yerges-Armstrong LM, Chou WC, Stolk L, Livshits G, Broer L, Johnson T, Koller DL, Kutalik Z, Luan J, Malkin I, Ried JS, Smith AV, Thorleifsson G, Vandenput L, Hua Zhao J, Zhang W, Aghdassi A, Åkesson K, Amin N, Baier LJ, Barroso I, Bennett DA, Bertram L, Biffar R, Bochud M, Boehnke M, Borecki IB, Buchman AS, Byberg L, Campbell H, Campos Obanda N, Cauley JA, Cawthon PM, Cederberg H, Chen Z, Cho NH, Jin Choi H, Claussnitzer M, Collins F, Cummings SR, De Jager PL, Demuth I, Dhonukshe-Rutten RAM, Diatchenko L, Eiriksdottir G, Enneman AW, Erdos M, Eriksson JG, Eriksson J, Estrada K, Evans DS, Feitosa MF, Fu M, Garcia M, Gieger C, Girke T, Glazer NL, Grallert H, Grewal J, Han BG, Hanson RL, Hayward C, Hofman A, Hoffman EP, Homuth G, Hsueh WC, Hubal MJ, Hubbard A, Huffman KM, Husted LB, Illig T, Ingelsson E, Ittermann T, Jansson JO, Jordan JM, Jula A, Karlsson M, Khaw KT, Kilpeläinen TO, Klopp N, Kloth JSL, Koistinen HA, Kraus WE, Kritchevsky S, Kuulasmaa T, Kuusisto J, Laakso M, Lahti J, Lang T, Langdahl BL, Launer LJ, Lee JY, Lerch MM, Lewis JR, Lind L, Lindgren C, Liu Y, Liu T, Liu Y, Ljunggren Ö, Lorentzon M, Luben RN, Maixner W, McGuigan FE, Medina-Gomez C, Meitinger T, Melhus H, Mellström D, Melov S, Michaëlsson K, Mitchell BD, Morris AP, Mosekilde L, Newman A, Nielson CM, O'Connell JR, Oostra BA, Orwoll ES, Palotie A, Parker SCJ, Peacock M, Perola M, Peters A, Polasek O, Prince RL, Räikkönen K, Ralston SH, Ripatti S, Robbins JA, Rotter JI, Rudan I, Salomaa V, Satterfield S, Schadt EE, Schipf S, Scott L, Sehmi J, Shen J, Soo Shin C, Sigurdsson G, Smith S, Soranzo N, Stančáková A, Steinhagen-Thiessen E, Streeten EA, Styrkarsdottir U, Swart KMA, Tan ST, Tarnopolsky MA, Thompson P, Thomson CA, Thorsteinsdottir U, Tikkanen E, Tranah GJ, Tuomilehto J, van Schoor NM, Verma A, Vollenweider P, Völzke H, Wactawski-Wende J, Walker M, Weedon MN, Welch R, Wichmann HE, Widen E, Williams FMK, Wilson JF, Wright NC, Xie W, Yu L, Zhou Y, Chambers JC, Döring A, van Duijn CM, Econs MJ, Gudnason V, Kooner JS, Psaty BM, Spector TD, Stefansson K, Rivadeneira F, Uitterlinden AG, Wareham NJ, Ossowski V, Waterworth D, Loos RJF, Karasik D, Harris TB, Ohlsson C, Kiel DP. Large meta-analysis of genome-wide association studies identifies five loci for lean body mass. Nat Commun 2017; 8:80. [PMID: 28724990 PMCID: PMC5517526 DOI: 10.1038/s41467-017-00031-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 05/02/2017] [Indexed: 12/25/2022] Open
Abstract
Lean body mass, consisting mostly of skeletal muscle, is important for healthy aging. We performed a genome-wide association study for whole body (20 cohorts of European ancestry with n = 38,292) and appendicular (arms and legs) lean body mass (n = 28,330) measured using dual energy X-ray absorptiometry or bioelectrical impedance analysis, adjusted for sex, age, height, and fat mass. Twenty-one single-nucleotide polymorphisms were significantly associated with lean body mass either genome wide (p < 5 × 10−8) or suggestively genome wide (p < 2.3 × 10−6). Replication in 63,475 (47,227 of European ancestry) individuals from 33 cohorts for whole body lean body mass and in 45,090 (42,360 of European ancestry) subjects from 25 cohorts for appendicular lean body mass was successful for five single-nucleotide polymorphisms in/near HSD17B11, VCAN, ADAMTSL3, IRS1, and FTO for total lean body mass and for three single-nucleotide polymorphisms in/near VCAN, ADAMTSL3, and IRS1 for appendicular lean body mass. Our findings provide new insight into the genetics of lean body mass. Lean body mass is a highly heritable trait and is associated with various health conditions. Here, Kiel and colleagues perform a meta-analysis of genome-wide association studies for whole body lean body mass and find five novel genetic loci to be significantly associated.
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Affiliation(s)
- M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Serkalem Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Yi-Hsiang Hsu
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Molecular and Integrative Physiological Sciences Program, Harvard School of Public Health, Boston, MA, 02115, USA
| | - Laura M Yerges-Armstrong
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Wen-Chi Chou
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA
| | - Lisette Stolk
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands
| | - Gregory Livshits
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel.,Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Linda Broer
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Toby Johnson
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Daniel L Koller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Zoltán Kutalik
- Department of Medical Genetics, University of Lausanne, Lausanne, 1011, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, 1015, Switzerland.,Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Ida Malkin
- Sackler Faculty of Medicine, Department of Anatomy and Anthropology, Tel Aviv University, Tel Aviv, 6997801, Israel
| | - Janina S Ried
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Albert V Smith
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | | | - Liesbeth Vandenput
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Weihua Zhang
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Ali Aghdassi
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Kristina Åkesson
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden.,Department of Orthopedics, Skåne University Hospital, Malmö, S-205 02, Sweden
| | - Najaf Amin
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Leslie J Baier
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Inês Barroso
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK.,NIHR Cambridge Biomedical Research Centre, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 OQQ, UK.,Institute of Metabolic Science, Addenbrooke's Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, CB2 OQQ, UK
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Lars Bertram
- Lübeck Interdisciplinary Platform for Genome Analytics, Institutes of Neurogenetics and Experimental & Integrative Genomics, University of Lübeck, Lübeck, 23562, Germany.,School of Public Health, Faculty of Medicine, Imperial College London, London, W6 8RP, UK
| | - Rainer Biffar
- Centre of Oral Health, Department of Prosthetic Dentistry, Gerodontology and Biomaterials, University of Greifswald, Greifswald, 17489, Germany
| | - Murielle Bochud
- Centre Hospitalier Universitaire (CHUV), University Institute for Social and Preventive Medicine, Lausanne, 1010, Switzerland
| | - Michael Boehnke
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA.,Division of Biostatistics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Harry Campbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | | | - Jane A Cauley
- Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Henna Cederberg
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Youngtong-Gu, Suwon, 16499, Korea
| | - Hyung Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju Si, Korea
| | - Melina Claussnitzer
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Broad Institute, Cambridge, MA, 02142, USA.,Computer Science and Artificial Intelligence Laboratory, MIT, Cambridge, MA, 02139, USA.,Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Francis Collins
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Philip L De Jager
- Harvard Medical School, Boston, MA, 02115, USA.,Program in Translational NeuroPsychiatric Genomics, Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, 02142, USA
| | - Ilja Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany.,Institute of Medical and Human Genetics, Charité - Universitätsmedizin Berlin, Berlin, 13353, Germany
| | | | - Luda Diatchenko
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, H3A 0G1, Canada.,Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | | | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Mike Erdos
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, 00014, Finland.,Unit of General Practice, Helsinki University Central Hospital, Helsinki, 00014, Finland.,Folkhalsan Research Centre, Helsinki, 00250, Finland.,Vasa Central Hospital, Vasa, 65130, Finland.,National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Joel Eriksson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Karol Estrada
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Mao Fu
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Melissa Garcia
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Christian Gieger
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Thomas Girke
- Institute for Integrative Genome Biology, University of California, Riverside, CA, 92521, USA.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA
| | - Nicole L Glazer
- Departments of Medicine and Epidemiology, Boston University School of Medicine and Public Health, Boston, MA, 02118, USA
| | - Harald Grallert
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Botany and Plant Sciences, University of California, Riverside, CA, 92521, USA.,German Center for Diabetes Research (DZD), Neuherberg, Germany.,CCG Type 2 Diabetes, Helmholtz Zentrum München, Neuherberg, 85764, Germany.,CCG Nutrigenomics and Type 2 Diabetes. Helmholtz Zentrum München, Neuherberg, 85764, Germany
| | - Jagvir Grewal
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Bok-Ghee Han
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Robert L Hanson
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Caroline Hayward
- MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Albert Hofman
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Eric P Hoffman
- Department of Pharmaceutical Sciences, SUNY Binghamton, Binghamton, NY, 13902, USA
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University of Greifswald, Greifswald, 17487, Germany
| | - Wen-Chi Hsueh
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Monica J Hubal
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC, 20052, USA.,Research Center for Genetic Medicine, Children's National Medical Center, Washington, DC, 20052, USA
| | - Alan Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, 94720, USA
| | - Kim M Huffman
- Division of Rheumatology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Lise B Husted
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Thomas Illig
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Department of Human Genetics, Hannover Medical School, Hannover, 30625, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | - Erik Ingelsson
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - John-Olov Jansson
- Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 405 30, Sweden
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Magnus Karlsson
- Department of Clinical Sciences and Orthopaedics, Lund University, Skåne University Hospital SUS, Malmö, 22362, Sweden
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Tuomas O Kilpeläinen
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, 2100, Denmark.,Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Norman Klopp
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Hannover Unified Biobank, Hannover Medical School, Hannover, 30625, Germany
| | | | - Heikki A Koistinen
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Endocrinology, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, 00029, Finland.,Department of Health, National Institute for Health and Welfare, Helsinki, 00271, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, 00290, Finland
| | - William E Kraus
- Division of Cardiology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Stephen Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Teemu Kuulasmaa
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Johanna Kuusisto
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Markku Laakso
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Thomas Lang
- University of California San Francisco, San Francisco, CA, 94143, USA
| | - Bente L Langdahl
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Jong-Young Lee
- Center for Genome Science, National Institute of Health, Osong Health Technology Administration Complex, Chungcheongbuk-do, 28159, Korea
| | - Markus M Lerch
- Department of Medicine A, University of Greifswald, Greifswald, 17489, Germany
| | - Joshua R Lewis
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Centre for Kidney Research, School of Public Health, University of Sydney, Sydney, 2006, Australia
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Cecilia Lindgren
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK
| | - Yongmei Liu
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27517, USA
| | - Tian Liu
- Max Planck Institute for Molecular Genetics, Berlin, 14195, Germany.,Max Planck Institute for Human Development, Berlin, 14195, Germany
| | - Youfang Liu
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27517, USA
| | - Östen Ljunggren
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Mattias Lorentzon
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - William Maixner
- Regional Center for Neurosensory Disorders, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Fiona E McGuigan
- Department of Clinical Sciences, Lund University, Malmö, 22362, Sweden
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Thomas Meitinger
- Institute of Human Genetics, MRI, Technische Universität München, Munich, 81675, Germany.,Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Dan Mellström
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Simon Melov
- Buck Institute for Research on Aging, Novato, CA, 94945, USA.,Leonard Davis School of Gerontology, University of Southern California, LA, CA, 90089, USA
| | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, 75185, Sweden
| | - Braxton D Mitchell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | - Andrew P Morris
- Wellcome Trust Centre for Human Genetics, Oxford University, Oxford, OX3 7BN, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - Leif Mosekilde
- Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, DK 8000, Denmark
| | - Anne Newman
- Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | | | - Jeffrey R O'Connell
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ben A Oostra
- Department of Clinical Genetics, Erasmus MC, Rotterdam, 300 CA, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Eric S Orwoll
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Department of Medical Genetics, University of Helsinki and University Central Hospital, Helsinki, FI00014, Finland
| | - Stephen C J Parker
- Human Genetics and Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Munro Peacock
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Diabetes and Obesity Research Program, University of Helsinki, Helsinki, FI00014, Finland.,Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Ozren Polasek
- Faculty of Medicine, Department of Public Health, University of Split, Split, 21000, Croatia
| | - Richard L Prince
- School of Medicine and Pharmacology, University of Western Australia, Perth, 6009, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gardiner Hospital, Perth, 6009, Australia
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, FI00014, Finland
| | - Stuart H Ralston
- Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Hjelt Institute, University of Helsinki, Helsinki, Finland.,Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - John A Robbins
- Department of Medicine, University of California at Davis, Sacramento, CA, 95817, USA
| | - Jerome I Rotter
- Institute for Translational Genomic and Population Sciences, Los Angeles Biomedical Research Institute and Department of Pediatrics, Harbor UCLA Medical Center, Torrance, CA, 90502, USA
| | - Igor Rudan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, 00271, Finland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Eric E Schadt
- Department of Genetics and Genomic Science, Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Sabine Schipf
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Laura Scott
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joban Sehmi
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jian Shen
- Oregon Health & Science University, Portland, OR, 97239, USA
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Gunnar Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,Department of Endocrinology and Metabolism, Landspitali, The National University Hospital of Iceland, Reykjavik, 101, Iceland
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthiology, Duke University Medical Center, Durham, NC, 27110, USA
| | - Nicole Soranzo
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK
| | - Alena Stančáková
- Department of Medicine, University of Eastern Finland and Kuopio University Hospital, Kuopio, 70210, Finland
| | - Elisabeth Steinhagen-Thiessen
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, 13353, Germany
| | - Elizabeth A Streeten
- Program in Personalized and Genomic Medicine, and Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.,Geriatric Research and Education Clinical Center (GRECC) - Veterans Administration Medical Center, Baltimore, MD, 21201, USA
| | | | - Karin M A Swart
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Sian-Tsung Tan
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Mark A Tarnopolsky
- Department of Medicine, McMaster University Medical Center, Hamilton, ON, Canada, L8N 3Z5
| | - Patricia Thompson
- Department of Pathology, Stony Brook School of Medicine, Stony Brook, NY, 11794, USA
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85714, USA
| | - Unnur Thorsteinsdottir
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Emmi Tikkanen
- National Institute for Health and Welfare, Helsinki, 00271, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland.,Molecular Medicine Centre, MRC Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, Scotland, EH4 2XU, UK
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA, 94107, USA
| | - Jaakko Tuomilehto
- Vasa Central Hospital, Vasa, 65130, Finland.,Department of Neuroscience and Preventive Medicine, Danube-University Krems, Krems, 3500, Austria.,Diabetes Research Group, King Abdulaziz University, Jeddah, 12589, Saudi Arabia.,Dasman Diabetes Institute, Dasman, 15462, Kuwait
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, and the EMGO Institute, VU University Medical Center, Amsterdam, BT1081, The Netherlands
| | - Arjun Verma
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK
| | - Peter Vollenweider
- Department of Medicine and Internal Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, CH-1011, Switzerland
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, 17489, Germany
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY, 14214, USA
| | - Mark Walker
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Michael N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Ryan Welch
- Department of Biostatistics and Center for Statistical Genetics, University of Michigan, Ann Arbor, MI, 48109, USA
| | - H-Erich Wichmann
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, 81377, Germany.,Institute of Medical Statistics and Epidemiology, Technical University, Munich, 81675, Germany
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, 00251, Finland
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - James F Wilson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, EH8 9AG, UK.,MRC Human Genetics Unit, IGMM, University of Edinburgh, Edinburgh, Scotland, EH4 2XU, UK
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Weijia Xie
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, EX1 2LU, UK
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Yanhua Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
| | - John C Chambers
- Department Epidemiology and Biostatistics, School of Public Health, Imperial College, London, SW7 2AZ, UK.,Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, SW3 6NP, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Angela Döring
- Institute of Epidemiology II, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands.,Centre for Medical Systems Biology and Netherlands Consortium on Healthy Aging, Leiden, RC2300, The Netherlands
| | - Michael J Econs
- Department of Medicine and Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, 201, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland
| | - Jaspal S Kooner
- Cardiology Department, Ealing Hospital NHS Trust, Middlesex, UB1 3HW, UK.,National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK.,Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Bruce M Psaty
- Departments of Medicine, Epidemiology, and Health Services, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, 98101, USA.,Kaiser Permanente Washington Health Research Institute, Washington, Seattle, WA, 98101, USA
| | - Timothy D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, St Thomas' Campus, London, WC2R 2LS, UK
| | - Kari Stefansson
- Faculty of Medicine, University of Iceland, Reykjavik, 101, Iceland.,deCODE Genetics, Reykjavik, 101, Iceland
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, 3000, The Netherlands.,Netherlands Genomics Initiative (NGI)-sponsored Netherlands Consortium for Healthy Aging (NCHA), Leiden, 2593, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, 3000, The Netherlands
| | - Nicholas J Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK
| | - Vicky Ossowski
- Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Phoenix, AZ, 85014, USA
| | - Dawn Waterworth
- Medical Genetics, GlaxoSmithKline, Philadelphia, PA, 19112, USA
| | - Ruth J F Loos
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 OQQ, UK.,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Institute of Child Health and Development, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,The Genetics of Obesity and Related Traits Program, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - David Karasik
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, 1311502, Israel
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute for Aging, Bethesda, MD, 20892, USA
| | - Claes Ohlsson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-405 30, Sweden
| | - Douglas P Kiel
- Hebrew SeniorLife, Institute for Aging Research, Roslindale, MA, 02131, USA. .,Harvard Medical School, Boston, MA, 02115, USA. .,Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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Ham AC, van Dijk SC, Swart KMA, Enneman AW, van der Zwaluw NL, Brouwer-Brolsma EM, van Schoor NM, Zillikens MC, Lips P, de Groot LCPGM, Hofman A, Witkamp RF, Uitterlinden AG, Stricker BH, van der Velde N. Beta-blocker use and fall risk in older individuals: Original results from two studies with meta-analysis. Br J Clin Pharmacol 2017; 83:2292-2302. [PMID: 28589543 DOI: 10.1111/bcp.13328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 04/24/2017] [Accepted: 04/27/2017] [Indexed: 02/04/2023] Open
Abstract
AIMS To investigate the association between use of β-blockers and β-blocker characteristics - selectivity, lipid solubility, intrinsic sympathetic activity (ISA) and CYP2D6 enzyme metabolism - and fall risk. METHODS Data from two prospective studies were used, including community-dwelling individuals, n = 7662 (the Rotterdam Study) and 2407 (B-PROOF), all aged ≥55 years. Fall incidents were recorded prospectively. Time-varying β-blocker use was determined using pharmacy dispensing records. Cox proportional hazard models adjusted for age and sex were applied to determine the association between β-blocker use, their characteristics - selectivity, lipid solubility, ISA and CYP2D6 enzyme metabolism - and fall risk. The results of the studies were combined using meta-analyses. RESULTS In total 2917 participants encountered a fall during a total follow-up time of 89 529 years. Meta-analysis indicated no association between use of any β-blocker, compared to nonuse, and fall risk, hazard ratio (HR) = 0.97 [95% confidence interval (CI) 0.88-1.06]. Use of a selective β-blocker was also not associated with fall risk, HR = 0.92 (95%CI 0.83-1.01). Use of a nonselective β-blocker was associated with an increased fall risk, HR = 1.22 (95%CI 1.01-1.48). Other β-blocker characteristics including lipid solubility and CYP2D6 enzyme metabolism were not associated with fall risk. CONCLUSION Our study suggests that use of a nonselective β-blocker, contrary to selective β-blockers, is associated with an increased fall risk in an older population. In clinical practice, β-blockers have been shown effective for a variety of cardiovascular indications. However, fall risk should be considered when prescribing a β-blocker in this age group, and the pros and cons for β-blocker classes should be taken into consideration.
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Affiliation(s)
- Annelies C Ham
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Suzanne C van Dijk
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | | | | | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Paul Lips
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard H.T. Chan School of Public Health, Boston, MA, USA
| | - Renger F Witkamp
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Inspectorate of Health Care, Utrecht, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, P.O. Box 22700, 1100 DD, Amsterdam, The Netherlands
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33
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Gaksch M, Jorde R, Grimnes G, Joakimsen R, Schirmer H, Wilsgaard T, Mathiesen EB, Njølstad I, Løchen ML, März W, Kleber ME, Tomaschitz A, Grübler M, Eiriksdottir G, Gudmundsson EF, Harris TB, Cotch MF, Aspelund T, Gudnason V, Rutters F, Beulens JWJ, van ‘t Riet E, Nijpels G, Dekker JM, Grove-Laugesen D, Rejnmark L, Busch MA, Mensink GBM, Scheidt-Nave C, Thamm M, Swart KMA, Brouwer IA, Lips P, van Schoor NM, Sempos CT, Durazo-Arvizu RA, Škrabáková Z, Dowling KG, Cashman KD, Kiely M, Pilz S. Vitamin D and mortality: Individual participant data meta-analysis of standardized 25-hydroxyvitamin D in 26916 individuals from a European consortium. PLoS One 2017; 12:e0170791. [PMID: 28207791 PMCID: PMC5312926 DOI: 10.1371/journal.pone.0170791] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [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: 10/03/2016] [Accepted: 12/16/2016] [Indexed: 01/15/2023] Open
Abstract
Background Vitamin D deficiency may be a risk factor for mortality but previous meta-analyses lacked standardization of laboratory methods for 25-hydroxyvitamin D (25[OH]D) concentrations and used aggregate data instead of individual participant data (IPD). We therefore performed an IPD meta-analysis on the association between standardized serum 25(OH)D and mortality. Methods In a European consortium of eight prospective studies, including seven general population cohorts, we used the Vitamin D Standardization Program (VDSP) protocols to standardize 25(OH)D data. Meta-analyses using a one step procedure on IPD were performed to study associations of 25(OH)D with all-cause mortality as the primary outcome, and with cardiovascular and cancer mortality as secondary outcomes. This meta-analysis is registered at ClinicalTrials.gov, number NCT02438488. Findings We analysed 26916 study participants (median age 61.6 years, 58% females) with a median 25(OH)D concentration of 53.8 nmol/L. During a median follow-up time of 10.5 years, 6802 persons died. Compared to participants with 25(OH)D concentrations of 75 to 99.99 nmol/L, the adjusted hazard ratios (with 95% confidence interval) for mortality in the 25(OH)D groups with 40 to 49.99, 30 to 39.99, and <30 nmol/L were 1.15 (1.00–1.29), 1.33 (1.16–1.51), and 1.67 (1.44–1.89), respectively. We observed similar results for cardiovascular mortality, but there was no significant linear association between 25(OH)D and cancer mortality. There was also no significantly increased mortality risk at high 25(OH)D levels up to 125 nmol/L. Interpretation In the first IPD meta-analysis using standardized measurements of 25(OH)D we observed an association between low 25(OH)D and increased risk of all-cause mortality. It is of public health interest to evaluate whether treatment of vitamin D deficiency prevents premature deaths.
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Affiliation(s)
- Martin Gaksch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Rolf Jorde
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Guri Grimnes
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Ragnar Joakimsen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Henrik Schirmer
- Tromsø Cardiovascular Research Group UNN, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B. Mathiesen
- Tromsø Endocrine Research Group, Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Winfried März
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Synlab Academy, Mannheim, Germany
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Marcus E. Kleber
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
- Department of Internal Medicine II - Cardiology, University of Ulm Medical Centre, Ulm, Germany
| | - Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Specialist Clinic for Rehabilitation Bad Aussee, Bad Aussee, Austria
- Department of Internal Medicine - Cardiology, Charité University Hospital Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Martin Grübler
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Department of Cardiology, Medical University of Graz, Graz, Austria
- Swiss Cardiovascular Center Bern, Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Tamara B. Harris
- National Institute on Aging, Laboratory of Epidemiology, and Population Sciences, Bethesda, Maryland, United States of America
| | - Mary F. Cotch
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, United States of America
| | - Thor Aspelund
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Femke Rutters
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Joline W. J. Beulens
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Esther van ‘t Riet
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Giel Nijpels
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Jacqueline M. Dekker
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Diana Grove-Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Markus A. Busch
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Gert B. M. Mensink
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Christa Scheidt-Nave
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Michael Thamm
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Karin M. A. Swart
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Ingeborg A. Brouwer
- Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, VU University medical center, Amsterdam, the Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - Christopher T. Sempos
- National Institute of Health Office of Dietary Supplements, Bethesda, Maryland, United States of America
| | - Ramón A. Durazo-Arvizu
- Department of Preventive Medicine and Epidemiology, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Zuzana Škrabáková
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Kirsten G. Dowling
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
| | - Kevin D. Cashman
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Mairead Kiely
- Cork Centre for Vitamin D and Nutrition Research, School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
- Irish Centre for Fetal and Neonatal Translational Research [INFANT], University College Cork, Cork, Ireland
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
- Department of Epidemiology and Biostatistics and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands
- * E-mail:
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34
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van Wijngaarden JP, Dhonukshe-Rutten RAM, Brouwer-Brolsma EM, Enneman AW, Swart KMA, van Dijk SC, In 't Veld PH, van Schoor NM, van der Velde N, de Jonge R, Lips P, Uitterlinden AG, de Groot LCPGM. Vitamin B12 Intake and Related Biomarkers: Associations in a Dutch Elderly Population. J Nutr Health Aging 2017; 21:1268-1276. [PMID: 29188889 DOI: 10.1007/s12603-017-0911-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Vitamin B12 status is measured by four plasma/ serum biomarkers: total vitamin B12 (total B12), holotranscobalamin (holoTC), methylmalonic acid (MMA) and homocysteine (tHcy). Associations of B12 intake with holoTC and tHcy and associations between all four biomarkers have not been extensively studied. A better insight in these associations may contribute to an improved differentiation between vitamin B12 deficiency and a normal vitamin B12 status. OBJECTIVE This study investigates associations between vitamin B12 intake and biomarkers and associations between biomarkers. DESIGN In this cross-sectional observational study, levels of total B12, HoloTC, MMA and tHcy were determined in participants of the B-PROOF study: 2919 elderly people (≥65 years, with a mean age of 74.1 years, a mean BMI of 27.1 and 50% women) with elevated tHcy levels (≥12 µmol/L). B12 intake was assessed in a subsample. We assessed the association between intake and status with multivariate regression analysis. We explored the dose-response association between B12 intake and biomarkers and the association of total B12 and holoTC with tHcy and MMA with restricted cubic spline plots. RESULTS A doubling of B12 intake was associated with 9% higher total B12, 15% higher HoloTC, 9% lower MMA and 2% lower tHcy. Saturation of biomarkers occurs with dietary intakes of >5 μg B12. Spline regression showed that levels of MMA and tHcy started to rise when vitamin B12 levels fall below 330 pmol/L and with HoloTC levels below 100 pmol/L, with a sharp increase with levels of B12 and HoloTC below 220 and 50 pmol/L respectively. CONCLUSIONS In this study we observed a significant association between vitamin B12 intake and vitamin B12 biomarkers and between the biomarkers. The observed inflections for total B12 and holoTC with MMA and tHcy could indicate cut-off levels for further testing for B12 deficiency and determining subclinical B12 deficiency.
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Affiliation(s)
- J P van Wijngaarden
- JP van Wijngaarden, Wageningen University, Division of Human Nutrition, P.O. Box 8129, 6700 EV Wageningen, The Netherlands.
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35
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van der Zwaluw NL, Brouwer-Brolsma EM, van de Rest O, van Wijngaarden JP, In 't Veld PH, Kourie DI, Swart KMA, Enneman AW, van Dijk SC, van der Velde N, Kessels RPC, Smeets PAM, Kok FJ, Dhonukshe-Rutten RAM, de Groot LCPGM. Folate and Vitamin B 12-Related Biomarkers in Relation to Brain Volumes. Nutrients 2016; 9:nu9010008. [PMID: 28029114 PMCID: PMC5295052 DOI: 10.3390/nu9010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/26/2016] [Accepted: 12/14/2016] [Indexed: 12/19/2022] Open
Abstract
AIM We investigated cross-sectional associations between circulating homocysteine, folate, biomarkers of vitamin B12 status and brain volumes. We furthermore compared brain volumes of participants who received daily folic acid and vitamin B12 supplementation with participants who did not. METHODS Participants of the B-PROOF study (n = 2919) were assigned to 400 µg folic acid and 500 µg vitamin B12, or a placebo. After two years of intervention, T₁-weighted magnetic resonance imaging (MRI) scans were made in a random subsample (n = 218) to obtain grey and white matter volume, and total brain volume (TBV). Plasma homocysteine, serum folate, vitamin B12, holotranscobalamin, and methylmalonic acid concentrations were measured. RESULTS Multiple linear regression analyses showed inverse associations between plasma homocysteine with TBV (β = -0.91, 95% CI -1.85-0.03; p = 0.06) and between serum folate and TBV (β = -0.20, 95% CI -0.38, -0.02; p = 0.03). No significant associations were observed for serum vitamin B12 and holotranscobalamin. Fully adjusted ANCOVA models showed that the group that received B-vitamins had a lower TBV (adjusted mean 1064, 95% CI 1058-1069 mL) than the non-supplemented group (1072, 95% CI 1067-1078 mL, p = 0.03). CONCLUSIONS Results were contradictory, with higher Hcy levels associated with lower TBV, but also with higher folate levels associated with lower TBV. In addition, the lack of a baseline measurement withholds us from giving recommendations on whether folic acid and vitamin B12 supplementation will be beneficial above and beyond normal dietary intake for brain health.
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Affiliation(s)
- Nikita L van der Zwaluw
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Ondine van de Rest
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
| | | | - Paulette H In 't Veld
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Daniella I Kourie
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Anke W Enneman
- Division of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Suzanne C van Dijk
- Division of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Nathalie van der Velde
- Division of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
- Department of Internal Medicine, Section Geriatric Medicine, Academic Medical Centre, Postbus 22660, 1100 DD Amsterdam, The Netherlands.
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
- Radboud Alzheimer Centre, Radboud University Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
- Donders Institute for Brain, Cognition and Behavior, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Paul A M Smeets
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
- Image Sciences Institute, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Frans J Kok
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
| | | | - Lisette C P G M de Groot
- Division of Human Nutrition, Wageningen University, Box 8129, 6700 EV Wageningen, The Netherlands.
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Ham AC, Ziere G, Broer L, Swart KMA, Enneman AW, van Dijk SC, van Wijngaarden JP, van der Zwaluw NL, Brouwer-Brolsma EM, Dhonukshe-Rutten RAM, van Schoor NM, Zillikens MC, van Gelder T, de Vries OJ, Lips P, Deeg DJH, de Groot LCPGM, Hofman A, Witkamp RF, Uitterlinden AG, Stricker BH, van der Velde N. CYP2C9 Genotypes Modify Benzodiazepine-Related Fall Risk: Original Results From Three Studies With Meta-Analysis. J Am Med Dir Assoc 2016; 18:88.e1-88.e15. [PMID: 27889507 DOI: 10.1016/j.jamda.2016.09.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate whether the CYP2C9*2 and *3 variants modify benzodiazepine-related fall risk. DESIGN Three prospective studies; the Rotterdam Study, B-PROOF, and LASA. SETTING Community-dwelling individuals living in or near five Dutch cities. PARTICIPANTS There were 11,485 participants aged ≥55 years. MEASUREMENTS Fall incidents were recorded prospectively. Benzodiazepine use was determined using pharmacy dispensing records or interviews. Cox proportional hazard models adjusted for age and sex were applied to determine the association between benzodiazepine use and fall risk stratified for CYP2C9 genotype and comparing benzodiazepine users to nonusers. The results of the three studies were combined applying meta-analysis. Within benzodiazepine users, the association between genotypes and fall risk was also assessed. RESULTS Three thousand seven hundred five participants (32%) encountered a fall during 91,996 follow-up years, and 4% to 15% (depending on the study population) used benzodiazepines. CYP2C9 variants had frequencies of 13% for the *2 allele and 6% for the *3 allele. Compared to nonusers, current benzodiazepine use was associated with an 18% to 36% increased fall risk across studies with a combined hazard ratio (HR) = 1.26 (95% confidence interval [CI], 1.13; 1.40). CYP2C9*2 or *3 allele variants modified benzodiazepine-related fall risk. Compared to nonusers, those carrying a CYP2C9*2 or *3 allele and using benzodiazepines had a 45% increased fall risk (HR, 1.45 95% CI, 1.21; 1.73), whereas CYP2C9*1 homozygotes using benzodiazepines had no increased fall risk (HR, 1.14; 95% CI, 0.90; 1.45). Within benzodiazepine users, having a CYP2C9*2 or *3 allele was associated with an increased fall risk (HR, 1.35; 95% CI, 1.06; 1.72). Additionally, we observed an allele dose effect; heterozygous allele carriers had a fall risk of (HR = 1.30; 95% CI, 1.05; 1.61), and homozygous allele carriers of (HR = 1.91 95% CI, 1.23; 2.96). CONCLUSIONS CYP2C9*2 and *3 allele variants modify benzodiazepine-related fall risk. Those using benzodiazepines and having reduced CYP2C9 enzyme activity based on their genotype are at increased fall risk. In clinical practice, genotyping might be considered for elderly patients with an indication for benzodiazepine use. However, because the exact role of CYP2C9 in benzodiazepine metabolism is still unclear, additional research is warranted.
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Affiliation(s)
- Annelies C Ham
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Gijsbertus Ziere
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Linda Broer
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Suzanne C van Dijk
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | | | | | | | | | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Teun van Gelder
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Oscar J de Vries
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Paul Lips
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Endocrinology, VU University Medical Centre, Amsterdam, the Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Albert Hofman
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Harvard H.T. Chan School of Public Health, Boston, MA
| | - Renger F Witkamp
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Bruno H Stricker
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Inspectorate of Health Care, Utrecht, the Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Centre, Amsterdam, the Netherlands.
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de Koning EJ, van der Zwaluw NL, van Wijngaarden JP, Sohl E, Brouwer-Brolsma EM, van Marwijk HWJ, Enneman AW, Swart KMA, van Dijk SC, Ham AC, van der Velde N, Uitterlinden AG, Penninx BWJH, Elders PJM, Lips P, Dhonukshe-Rutten RAM, van Schoor NM, de Groot LCPGM. Effects of Two-Year Vitamin B 12 and Folic Acid Supplementation on Depressive Symptoms and Quality of Life in Older Adults with Elevated Homocysteine Concentrations: Additional Results from the B-PROOF Study, an RCT. Nutrients 2016; 8:nu8110748. [PMID: 27886078 PMCID: PMC5133130 DOI: 10.3390/nu8110748] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 12/31/2022] Open
Abstract
Lowering elevated plasma homocysteine (Hcy) concentrations by supplementing vitamin B12 and folic acid may reduce depressive symptoms and improve health-related quality of life (HR-QoL) in older adults. This study aimed to test this hypothesis in a randomized controlled trial. Participants (N = 2919, ≥65 years, Hcy concentrations ≥12 µmol/L) received either 500 µg vitamin B12 and 400 µg folic acid daily or placebo for two years. Both tablets contained 15 µg vitamin D3. Depressive symptoms were measured with the Geriatric Depression Scale-15 (GDS-15). HR-QoL was assessed with the SF-12 Mental and Physical component summary scores and the EQ-5D Index score and Visual Analogue Scale. Differences in two-year change scores were analyzed with Analysis of Covariance (ANCOVA). Hcy concentrations decreased more in the intervention group, but two-year change scores of the GDS-15 and three of four HR-QoL measures did not differ between groups. The EQ-5D Index score declined less in the intervention group than in the placebo group (mean change 0.00 vs. −0.02, p = 0.004). In conclusion, two-year supplementation with vitamin B12 and folic acid in older adults with hyperhomocysteinemia showed that lowering Hcy concentrations does not reduce depressive symptoms, but it may have a small positive effect on HR-QoL.
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Affiliation(s)
- Elisa J de Koning
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Nikita L van der Zwaluw
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Janneke P van Wijngaarden
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Evelien Sohl
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Elske M Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Harm W J van Marwijk
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Primary Care Research Center, Institute of Population Health, University of Manchester, Oxford Road, M13 9PL Manchester, UK.
| | - Anke W Enneman
- Department of Internal Medicine, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Karin M A Swart
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Suzanne C van Dijk
- Department of Internal Medicine, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Annelies C Ham
- Department of Internal Medicine, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Brenda W J H Penninx
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Department of Psychiatry, VU University Medical Center/GGZ inGeest, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Paul Lips
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Department of Internal Medicine/Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | | | - Natasja M van Schoor
- EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Lisette C P G M de Groot
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands.
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Brouwer-Brolsma EM, Vaes AMM, van der Zwaluw NL, van Wijngaarden JP, Swart KMA, Ham AC, van Dijk SC, Enneman AW, Sohl E, van Schoor NM, van der Velde N, Uitterlinden AG, Lips P, Feskens EJM, Dhonukshe-Rutten RAM, de Groot LCPGM. Relative importance of summer sun exposure, vitamin D intake, and genes to vitamin D status in Dutch older adults: The B-PROOF study. J Steroid Biochem Mol Biol 2016; 164:168-176. [PMID: 26275945 DOI: 10.1016/j.jsbmb.2015.08.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [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: 06/13/2015] [Revised: 08/02/2015] [Accepted: 08/10/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES The prevalence of vitamin D deficiency among seniors is high. Whereas sun exposure, vitamin D intake, genes, demographics, and lifestyle have been identified as being important determinants of vitamin D status, the impact of these factors is expected to differ across populations. To improve current prevention and treatment strategies, this study aimed to explore the main determinants of vitamin D status and its relative importance in a population of community-dwelling Dutch older adults. METHODS/SUBJECTS Serum 25-hydroxyvitamin D (25(OH)D) was measured in 2857 adults aged ≥65 years. Sun exposure was assessed with a structured questionnaire (n=1012), vitamin D intake using a Food Frequency Questionnaire (n=596), and data on genetic variation that may affect 25(OH)D status was obtained for 4 genes, DHCR7 (rs12785878), CYP2R1 (rs10741657), GC (rs2282679), and CYP24A1 (rs6013897) (n=2530). RESULTS Serum 25(OH)D concentrations <50nmol/L were observed in 45% of the population; only 6% of these participants used vitamin D supplements. Sun exposure (being outside daily during summer: 66±25nmol/L vs not being outside daily during summer: 58±27nmol/L, P=0.02) and vitamin D intake (per unit μg/day during winter/spring: 3.1±0.75nmol/L, P<0.0001) were associated with higher 25(OH)D concentrations. Major allele carriers of SNPs related to DHCR7, CYP24A1, and GC, as well as CYP2R1 minor allele carriers had the highest 25(OH)D concentrations. Together, sun (R2=0.29), vitamin D intake (R2=0.24), and genes (R2=0.28) explained 35% (R2=0.35) of the variation in 25(OH)D concentrations during summer/autumn period, when adjusted for age, sex, BMI, education, alcohol consumption, smoking, physical activity, and self-rated health status (n=185). CONCLUSION The investigated determinants explained 35% of 25(OH)D status. Of the three main determinants under study, sun exposure still appeared to be an important determinant of serum 25(OH)D in older individuals, closely followed by genes, and vitamin D intake. Given the low frequency of vitamin D supplement use in this population, promoting supplement use may be an inexpensive, easy, and effective strategy to fight vitamin D deficiency.
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Affiliation(s)
- Elske M Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands.
| | - Anouk M M Vaes
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | - Nikita L van der Zwaluw
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | - Janneke P van Wijngaarden
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Annelies C Ham
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000CA Rotterdam, the Netherlands
| | - Suzanne C van Dijk
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000CA Rotterdam, the Netherlands
| | - Anke W Enneman
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000CA Rotterdam, the Netherlands
| | - Evelien Sohl
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000CA Rotterdam, the Netherlands; Department of Internal Medicine, Section of Geriatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Andre G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000CA Rotterdam, the Netherlands
| | - Paul Lips
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; Department of Internal Medicine, Endocrine Section, VU University Medical Center, P.O.Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Edith J M Feskens
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | | | - Lisette C P G M de Groot
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
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Swartz JE, Aarts MCJ, Swart KMA, Disa JJ, Gerressen M, Kuo YR, Wax MK, Grolman W, Braunius WW. The value of postoperative anticoagulants to improve flap survival in the free radial forearm flap: a systematic review and retrospective multicentre analysis. Clin Otolaryngol 2016; 40:600-9. [PMID: 25823832 DOI: 10.1111/coa.12425] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Free radial forearm flap (FRFF) reconstruction is a valuable technique in head and neck surgery, which allows closure of large defects while striving to maintain functionality. Anticoagulative drugs are often administered to improve flap survival, although evidence regarding effectiveness is lacking. OBJECTIVE OF REVIEW To investigate the effectiveness of postoperative anticoagulants to improve survival of the FRFF in head and neck reconstruction. TYPE OF REVIEW Systematic review and multicentre, individual patient data meta-analysis. SEARCH STRATEGY MEDLINE, EMBASE, Web of Science and CINAHL were searched for synonyms of 'anticoagulants' and 'free flap reconstruction'. EVALUATION METHOD Studies were critically appraised for directness of evidence and risk of bias. Authors of the highest quality publications were invited to submit their original data for meta-analysis. RESULTS Five studies were of adequate quality, and data from four studies (80%) were available for meta-analysis, describing 759 FRFF procedures. Anticoagulants used were as follows: aspirin (12%), low molecular weight dextran (18.3%), unfractioned heparin (28.1%), low molecular weight heparin (49%) and prostaglandin-E1 (2.1%). Thirty-one per cent did not receive anticoagulants. Flap failure occurred in 40 of 759 patients (5.3%) On univariate analysis, use of unfractioned heparin was associated with a higher rate of flap failure. However, these regimens were often administered to patients who had revision surgery of the anastomosis. In multivariate logistic regression analysis, anticoagulant use was not associated with improved flap survival or flap-related complications. CONCLUSIONS The studied anticoagulative drugs did not improve FRFF survival or lower the rate of flap-related complications. In addition, some anticoagulants may cause systemic complications.
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Affiliation(s)
- J E Swartz
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C J Aarts
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Otorhinolaryngology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - K M A Swart
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J J Disa
- Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Gerressen
- Department of Oral, Maxillofacial and Plastic Facial Surgery, Heinrich Braun Hospital, Zwickau, Germany.,Department of Oral, Maxillofacial and Plastic Facial Surgery, University Hospital of the Aachen University (RWTH), Aachen, Germany
| | - Y-R Kuo
- Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - M K Wax
- Department of Otolaryngology-HNS, Oregon Health and Sciences University, Portland, OR, USA
| | - W Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolph Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W W Braunius
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Swartz JE, Pothen AJ, Wegner I, Smid EJ, Swart KMA, de Bree R, Leenen LPH, Grolman W. Feasibility of using head and neck CT imaging to assess skeletal muscle mass in head and neck cancer patients. Oral Oncol 2016; 62:28-33. [PMID: 27865369 DOI: 10.1016/j.oraloncology.2016.09.006] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Patients with head and neck cancer (HNC) have a higher risk of malnutrition and sarcopenia, which is associated with adverse clinical outcome. As abdominal CT-imaging is often used to detect sarcopenia, such scans are rarely available in HNC patients, possibly explaining why no studies investigate the effect of sarcopenia in this population. We correlated skeletal muscle mass assessed on head and neck CT-scans with abdominal CT-imaging. METHODS Head and neck, and abdominal CT-scans of trauma (n=51) and HNC-patients (n=52) were retrospectively analyzed. On the head and neck CT-scans, the paravertebral and sternocleidomastoid muscles were delineated. On the abdominal CT-scans, all muscles were delineated. Cross-sectional area (CSA) of the muscles at the level of the C3 vertebra was compared to CSA at the L3 level using linear regression. A multivariate linear regression model was established. RESULTS HNC-patients had significantly lower muscle CSA than trauma patients (37.9 vs. 45.1cm2, p<0.001, corrected for sex and age). C3 muscle CSA strongly predicted L3 muscle CSA (r=0.785, p<0.001). This correlation was stronger in a multivariate model including sex, age and weight (r=0.891, p<0.001). DISCUSSION Assessment of skeletal muscle mass on head and neck CT-scans is feasible and may be an alternative to abdominal CT-imaging. This method allows assessment of sarcopenia using routinely performed scans without additional imaging or additional patient burden. Identifying sarcopenic patients may help in treatment selection, or to select HNC patients for physiotherapeutic or nutritional interventions to improve their outcome.
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Affiliation(s)
- Justin E Swartz
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Ajit J Pothen
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Inge Wegner
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Ernst J Smid
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Karin M A Swart
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Loek P H Leenen
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Wilko Grolman
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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41
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Lu Y, Day FR, Gustafsson S, Buchkovich ML, Na J, Bataille V, Cousminer DL, Dastani Z, Drong AW, Esko T, Evans DM, Falchi M, Feitosa MF, Ferreira T, Hedman ÅK, Haring R, Hysi PG, Iles MM, Justice AE, Kanoni S, Lagou V, Li R, Li X, Locke A, Lu C, Mägi R, Perry JRB, Pers TH, Qi Q, Sanna M, Schmidt EM, Scott WR, Shungin D, Teumer A, Vinkhuyzen AAE, Walker RW, Westra HJ, Zhang M, Zhang W, Zhao JH, Zhu Z, Afzal U, Ahluwalia TS, Bakker SJL, Bellis C, Bonnefond A, Borodulin K, Buchman AS, Cederholm T, Choh AC, Choi HJ, Curran JE, de Groot LCPGM, De Jager PL, Dhonukshe-Rutten RAM, Enneman AW, Eury E, Evans DS, Forsen T, Friedrich N, Fumeron F, Garcia ME, Gärtner S, Han BG, Havulinna AS, Hayward C, Hernandez D, Hillege H, Ittermann T, Kent JW, Kolcic I, Laatikainen T, Lahti J, Leach IM, Lee CG, Lee JY, Liu T, Liu Y, Lobbens S, Loh M, Lyytikäinen LP, Medina-Gomez C, Michaëlsson K, Nalls MA, Nielson CM, Oozageer L, Pascoe L, Paternoster L, Polašek O, Ripatti S, Sarzynski MA, Shin CS, Narančić NS, Spira D, Srikanth P, Steinhagen-Thiessen E, Sung YJ, Swart KMA, Taittonen L, Tanaka T, Tikkanen E, van der Velde N, van Schoor NM, Verweij N, Wright AF, Yu L, Zmuda JM, Eklund N, Forrester T, Grarup N, Jackson AU, Kristiansson K, Kuulasmaa T, Kuusisto J, Lichtner P, Luan J, Mahajan A, Männistö S, Palmer CD, Ried JS, Scott RA, Stancáková A, Wagner PJ, Demirkan A, Döring A, Gudnason V, Kiel DP, Kühnel B, Mangino M, Mcknight B, Menni C, O'Connell JR, Oostra BA, Shuldiner AR, Song K, Vandenput L, van Duijn CM, Vollenweider P, White CC, Boehnke M, Boettcher Y, Cooper RS, Forouhi NG, Gieger C, Grallert H, Hingorani A, Jørgensen T, Jousilahti P, Kivimaki M, Kumari M, Laakso M, Langenberg C, Linneberg A, Luke A, Mckenzie CA, Palotie A, Pedersen O, Peters A, Strauch K, Tayo BO, Wareham NJ, Bennett DA, Bertram L, Blangero J, Blüher M, Bouchard C, Campbell H, Cho NH, Cummings SR, Czerwinski SA, Demuth I, Eckardt R, Eriksson JG, Ferrucci L, Franco OH, Froguel P, Gansevoort RT, Hansen T, Harris TB, Hastie N, Heliövaara M, Hofman A, Jordan JM, Jula A, Kähönen M, Kajantie E, Knekt PB, Koskinen S, Kovacs P, Lehtimäki T, Lind L, Liu Y, Orwoll ES, Osmond C, Perola M, Pérusse L, Raitakari OT, Rankinen T, Rao DC, Rice TK, Rivadeneira F, Rudan I, Salomaa V, Sørensen TIA, Stumvoll M, Tönjes A, Towne B, Tranah GJ, Tremblay A, Uitterlinden AG, van der Harst P, Vartiainen E, Viikari JS, Vitart V, Vohl MC, Völzke H, Walker M, Wallaschofski H, Wild S, Wilson JF, Yengo L, Bishop DT, Borecki IB, Chambers JC, Cupples LA, Dehghan A, Deloukas P, Fatemifar G, Fox C, Furey TS, Franke L, Han J, Hunter DJ, Karjalainen J, Karpe F, Kaplan RC, Kooner JS, McCarthy MI, Murabito JM, Morris AP, Bishop JAN, North KE, Ohlsson C, Ong KK, Prokopenko I, Richards JB, Schadt EE, Spector TD, Widén E, Willer CJ, Yang J, Ingelsson E, Mohlke KL, Hirschhorn JN, Pospisilik JA, Zillikens MC, Lindgren C, Kilpeläinen TO, Loos RJF. New loci for body fat percentage reveal link between adiposity and cardiometabolic disease risk. Nat Commun 2016; 7:10495. [PMID: 26833246 PMCID: PMC4740398 DOI: 10.1038/ncomms10495] [Citation(s) in RCA: 191] [Impact Index Per Article: 23.9] [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: 06/15/2015] [Accepted: 12/16/2015] [Indexed: 12/24/2022] Open
Abstract
To increase our understanding of the genetic basis of adiposity and its links to cardiometabolic disease risk, we conducted a genome-wide association meta-analysis of body fat percentage (BF%) in up to 100,716 individuals. Twelve loci reached genome-wide significance (P<5 × 10(-8)), of which eight were previously associated with increased overall adiposity (BMI, BF%) and four (in or near COBLL1/GRB14, IGF2BP1, PLA2G6, CRTC1) were novel associations with BF%. Seven loci showed a larger effect on BF% than on BMI, suggestive of a primary association with adiposity, while five loci showed larger effects on BMI than on BF%, suggesting association with both fat and lean mass. In particular, the loci more strongly associated with BF% showed distinct cross-phenotype association signatures with a range of cardiometabolic traits revealing new insights in the link between adiposity and disease risk.
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Affiliation(s)
- Yingchang Lu
- The Charles Bronfman Institute for Personalized Medicine, The
Icahn School of Medicine at Mount Sinai, New York, New
York
10029, USA
- The Department of Preventive Medicine, The Icahn School of
Medicine at Mount Sinai, New York, New York
10029, USA
| | - Felix R. Day
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
| | - Stefan Gustafsson
- Science for Life Laboratory, Uppsala University, 750
85
Uppsala, Sweden
- Department of Medical Sciences, Molecular Epidemiology, Uppsala
University, 751 85
Uppsala, Sweden
| | - Martin L. Buchkovich
- Department of Genetics, University of North Carolina,
Chapel Hill, North Carolina
27599, USA
| | - Jianbo Na
- Department of Developmental and Regenerative Biology, The Icahn
School of Medicine at Mount Sinai, New York, New York
10029, USA
| | - Veronique Bataille
- West Herts NHS Trust, Herts
HP2 4AD, UK
- Department of Twin Research and Genetic Epidemiology,
King's College London, London
SE1 7EH, UK
| | - Diana L. Cousminer
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
| | - Zari Dastani
- Department Epidemiology, Biostatistics and Human Genetics, Lady
Davis Institute, Jewish General Hospital, McGill University,
Montréal, Quebec, Canada
H3T1E2
| | - Alexander W. Drong
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
| | - Tõnu Esko
- Estonian Genome Center, Univeristy of Tartu,
Tartu, 51010, Estonia
- Broad Institute of the Massachusetts Institute of Technology
and Harvard University, Cambridge
2142, USA
- Divisions of Endocrinology and Genetics and Center for Basic
and Translational Obesity Research, Boston Children's Hospital,
Boston, Massachusetts
02115, USA
- Department of Genetics, Harvard Medical School,
Boston, Massachusetts
02115, USA
| | - David M. Evans
- University of Queensland Diamantina Institute, Translational
Research Institute, Brisbane, Queensland
4102, Australia
- MRC Integrative Epidemiology Unit, School of Social and
Community Medicine, University of Bristol, Bristol
BS82BN, UKnited
| | - Mario Falchi
- Department of Twin Research and Genetic Epidemiology,
King's College London, London
SE1 7EH, UK
- Department of Genomics of Common Disease, School of Public
Health, Imperial College London, London
W12 0NN, UK
| | - Mary F. Feitosa
- Division of Statistical Genomics, Department of Genetics,
Washington University School of Medicine, St Louis,
Missouri
63108, USA
| | - Teresa Ferreira
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
| | - Åsa K. Hedman
- Science for Life Laboratory, Uppsala University, 750
85
Uppsala, Sweden
- Department of Medical Sciences, Molecular Epidemiology, Uppsala
University, 751 85
Uppsala, Sweden
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
| | - Robin Haring
- Institute of Clinical Chemistry and Laboratory Medicine,
University Medicine Greifswald, 17475
Greifswald, Germany
- European University of Applied Sciences, Faculty of Applied
Public Health, 18055
Rostock, Germany
| | - Pirro G. Hysi
- Department of Twin Research and Genetic Epidemiology,
King's College London, London
SE1 7EH, UK
| | - Mark M. Iles
- Leeds Institute of Cancer and Pathology, Cancer Research UK
Leeds Centre, University of Leeds, Leeds
LS9 7TF, UK
| | - Anne E. Justice
- Department of Epidemiology, University of North Carolina at
Chapel Hill, Chapel Hill, North Carolina
27599, USA
| | - Stavroula Kanoni
- William Harvey Research Institute, Barts and The London School
of Medicine and Dentistry, Queen Mary University of London,
London
EC1M 6BQ, UK
- Wellcome Trust Sanger Institute, Human Genetics,
Hinxton, Cambridge
CB10 1SA, UK
| | - Vasiliki Lagou
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism,
University of Oxford, Churchill Hospital, Oxford
OX3 7LJ, UK
| | - Rui Li
- Department Epidemiology, Biostatistics and Human Genetics, Lady
Davis Institute, Jewish General Hospital, McGill University,
Montréal, Quebec, Canada
H3T1E2
| | - Xin Li
- Department of Epidemiology, Harvard School of Public
Health, Boston, Massachusetts
02115, USA
| | - Adam Locke
- Center for Statistical Genetics, Department of Biostatistics,
University of Michigan, Ann Arbor, Michigan
48109, USA
| | - Chen Lu
- Department of Biostatistics, Boston University School of Public
Health, Boston, Massachusetts
02118, USA
| | - Reedik Mägi
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
- Estonian Genome Center, Univeristy of Tartu,
Tartu, 51010, Estonia
| | - John R. B. Perry
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
| | - Tune H. Pers
- Divisions of Endocrinology and Genetics and Center for Basic
and Translational Obesity Research, Boston Children's Hospital,
Boston, Massachusetts
02115, USA
- Department of Genetics, Harvard Medical School,
Boston, Massachusetts
02115, USA
- Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen, 2100
Copenhagen, Denmark
- Medical and Population Genetics Program, Broad Institute of MIT
and Harvard, Cambridge
02142, USA
- Department of Epidemiology Research, Statens Serum
Institut, 2100
Copenhagen, Denmark
| | - Qibin Qi
- Department of Epidemiology and Popualtion Health, Albert
Einstein College of Medicine, Bronx, New York
10461, USA
| | - Marianna Sanna
- Department of Twin Research and Genetic Epidemiology,
King's College London, London
SE1 7EH, UK
- Department of Genomics of Common Disease, School of Public
Health, Imperial College London, London
W12 0NN, UK
| | - Ellen M. Schmidt
- Department of Computational Medicine and Bioinformatics,
University of Michigan, Ann Arbor, Michigan
48109, USA
| | - William R. Scott
- Department of Epidemiology and Biostatistics, Imperial College
London, London
W2 1PG, UK
- Ealing Hospital NHS Trust, Middlesex
UB1 3HW, UK
| | - Dmitry Shungin
- Lund University Diabetes Centre, Department of Clinical
Science, Genetic and Molecular Epidemiology Unit, Skåne University
Hosptial, 205 02
Malmö, Sweden
- Department of Public Health and Clinical Medicine, Unit of
Medicine, Umeå University, 901 87
Umeå, Sweden
- Department of Odontology, Umeå University,
901 85
Umeå, Sweden
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine
Greifswald, 17475
Greifswald, Germany
- Interfaculty Institute for Genetics and Functional Genomics,
University Medicine Greifswald, 17475
Greifswald, Germany
| | | | - Ryan W. Walker
- The Charles Bronfman Institute for Personalized Medicine, The
Icahn School of Medicine at Mount Sinai, New York, New
York
10029, USA
- The Department of Preventive Medicine, The Icahn School of
Medicine at Mount Sinai, New York, New York
10029, USA
| | - Harm-Jan Westra
- Program in Medical and Population Genetics, Broad Institute of
Harvard and Massachusetts Institute of Technology, Cambridge,
Massachusetts
02142, USA
- Divisions of Genetics and Rheumatology, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School,
Boston, Massachusetts
02446, USA
- Partners Center for Personalized Genetic Medicine,
Boston, Massachusetts
02446, USA
| | - Mingfeng Zhang
- Department of Dermatology, Brigham and Women's
Hospital, Boston, Massachusetts
02115, USA
| | - Weihua Zhang
- Department of Epidemiology and Biostatistics, Imperial College
London, London
W2 1PG, UK
- Ealing Hospital NHS Trust, Middlesex
UB1 3HW, UK
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
| | - Zhihong Zhu
- Queensland Brain Institute, The University of Queensland,
Brisbane
4072, Australia
| | - Uzma Afzal
- Department of Epidemiology and Biostatistics, Imperial College
London, London
W2 1PG, UK
- Ealing Hospital NHS Trust, Middlesex
UB1 3HW, UK
| | - Tarunveer Singh Ahluwalia
- Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen, 2100
Copenhagen, Denmark
- Copenhagen Prospective Studies on Asthma in Childhood, Faculty
of Health and Medical Sceinces, University of Copenhagen, 2200
Copenhagen, Denmark
- Danish Pediatric Asthma Center, Gentofte Hospital, The Capital
Region, 2200
Copenhagen, Denmark
- Steno Diabetes Center A/S, DK-2820
Gentofte, Denmark
| | - Stephan J. L. Bakker
- University of Groningen, University Medical Center Groningen,
Department of Medicine, 9700 RB
Groningen, The Netherlands
| | - Claire Bellis
- Department of Genetics, Texas Biomedical Research
Institute, San Antonio, Texas
78245, USA
| | - Amélie Bonnefond
- CNRS UMR 8199, F-59019
Lille, France
- European Genomic Institute for Diabetes, 59000
Lille, France
- Université de Lille 2, 59000
Lille, France
| | - Katja Borodulin
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Aron S. Buchman
- Rush Alzheimer's Disease Center, Rush University
Medical Center, Chicago, Illinois
60612, USA
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical
Nutrition and Metabolism, Uppsala University, 751 85
Uppsala, Sweden
| | - Audrey C. Choh
- Lifespan Health Research Center, Wright State University
Boonshoft School of Medicine, Dayton, Ohio
45420, USA
| | - Hyung Jin Choi
- Department of Anatomy, Seoul National University College of
Medicine, Seoul
03080, Korea
| | - Joanne E. Curran
- South Texas Diabetes and Obesity Institute, University of Texas
Rio Grande Valley, Brownsville, Texas
78520
| | | | - Philip L. De Jager
- Program in Medical and Population Genetics, Broad Institute of
Harvard and Massachusetts Institute of Technology, Cambridge,
Massachusetts
02142, USA
- Harvard Medical School, Boston,
Massachusetts
02115, USA
- Program in Translational NeuroPsychiatric Genomics, Department
of Neurology, Brigham and Women's Hospital, Boston,
Massachusetts
02115, USA
| | | | - Anke W. Enneman
- Department of Internal Medicine, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
| | - Elodie Eury
- CNRS UMR 8199, F-59019
Lille, France
- European Genomic Institute for Diabetes, 59000
Lille, France
- Université de Lille 2, 59000
Lille, France
| | - Daniel S. Evans
- California Pacific Medical Center Research Institute,
San Francisco, California
94107, USA
| | - Tom Forsen
- Department of General Practice and Primary Health Care,
University of Helsinki, FI-00014
Helsinki, Finland
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine,
University Medicine Greifswald, 17475
Greifswald, Germany
| | - Frédéric Fumeron
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers,
F-75006
Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S
1138, Centre de Recherche des Cordeliers, F-75006
Paris, France
- Université Paris Descartes, Sorbonne Paris
Cité, UMR_S 1138, Centre de Recherche des Cordeliers,
F-75006
Paris, France
- Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138,
Centre de Recherche des Cordeliers, F-75006
Paris, France
| | - Melissa E. Garcia
- Laboratory of Epidemiology and Population Sciences, National
Institute on Aging, Bethesda, Maryland
20892, USA
| | - Simone Gärtner
- Department of Medicine A, University Medicine Greifswald,
17475
Greifswald, Germany
| | - Bok-Ghee Han
- Center for Genome Science, National Institute of Health, Osong
Health Technology Administration Complex, Chungcheongbuk-do
370914, Korea
| | - Aki S. Havulinna
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh
EH4 2XU, UK
| | - Dena Hernandez
- Laboratory of Neurogenetics, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland
20892, USA
| | - Hans Hillege
- University of Groningen, University Medical Center Groningen,
Department of Cardiology, 9700 RB
Groningen, The Netherlands
| | - Till Ittermann
- Institute for Community Medicine, University Medicine
Greifswald, 17475
Greifswald, Germany
| | - Jack W. Kent
- Department of Genetics, Texas Biomedical Research
Institute, San Antonio, Texas
78245, USA
| | - Ivana Kolcic
- Department of Public Health, Faculty of Medicine, University of
Split, Split
21000, Croatia
| | - Tiina Laatikainen
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
- Hospital District of North Karelia, FI-80210
Joensuu, Finland
- Institute of Public Health and Clinical Nutrition, University
of Eastern Finland, FI-70211
Kuopio, Finland
| | - Jari Lahti
- Folkhälsan Research Centre, FI-00290
Helsinki, Finland
- Institute of Behavioural Sciences, University of
Helsinki, FI-00014
Helsinki, Finland
| | - Irene Mateo Leach
- University of Groningen, University Medical Center Groningen,
Department of Cardiology, 9700 RB
Groningen, The Netherlands
| | - Christine G. Lee
- Department of Medicine, Oregon Health and Science
University, Portland, Oregon
97239, USA
- Research Service, Veterans Affairs Medical Center,
Portland, Oregon
97239, USA
| | - Jong-Young Lee
- Center for Genome Science, National Institute of Health, Osong
Health Technology Administration Complex, Chungcheongbuk-do
370914, Korea
| | - Tian Liu
- Max Planck Institute for Molecular Genetics, Department of
Vertebrate Genomics, 14195
Berlin, Germany
- Max Planck Institute for Human Development,
14194
Berlin, Germany
| | - Youfang Liu
- Thurston Arthritis Research Center, University of North
Carolina at Chapel Hill, Chaper Hill, North Carolina
27599-7280, USA
| | - Stéphane Lobbens
- CNRS UMR 8199, F-59019
Lille, France
- European Genomic Institute for Diabetes, 59000
Lille, France
- Université de Lille 2, 59000
Lille, France
| | - Marie Loh
- Department of Epidemiology and Biostatistics, Imperial College
London, London
W2 1PG, UK
- Translational Laboratory in Genetic Medicine (TLGM), Agency for
Science, Technology and Research (A*STAR), 8A Biomedical
Grove, Immunos, Level 5, Singapore
138648, Singapore
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, University of Tampere School
of Medicine, FI-33014
Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories and
School of Medicine, University of Tampere, FI-33520
Tampere, Finland
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands
Consortium for Healthy Aging (NCHA), Rotterdam
The Netherlands
- Department of Epidemiology, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala
University, 751 85
Uppsala, Sweden
| | - Mike A. Nalls
- Laboratory of Neurogenetics, National Institute on Aging,
National Institutes of Health, Bethesda, Maryland
20892, USA
| | - Carrie M. Nielson
- School of Public Health, Oregon Health & Science
University, Portland, Oregon
97239, USA
- Bone & Mineral Unit, Oregon Health & Science
University, Portland, Oregon
97239, USA
| | | | - Laura Pascoe
- Institute of Cell & Molecular Biosciences, Newcastle
University, Newcastle
NE1 7RU, UK
| | - Lavinia Paternoster
- MRC Integrative Epidemiology Unit, School of Social and
Community Medicine, University of Bristol, Bristol
BS82BN, UKnited
| | - Ozren Polašek
- Department of Public Health, Faculty of Medicine, University of
Split, Split
21000, Croatia
- Centre for Global Health Research, Usher Institute of
Population Health Sciences and Informatics, University of Edinburgh, Teviot
Place, Edinburgh
EH8 9AG, UK
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
- Wellcome Trust Sanger Institute, Human Genetics,
Hinxton, Cambridge
CB10 1SA, UK
- Hjelt Institute, University of Helsinki,
FI-00014
Helsinki, Finland
| | - Mark A. Sarzynski
- Human Genomics Laboratory, Pennington Biomedical Research
Center, Baton Rouge, Los Angeles
70808, USA
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University
College of Medicine, Seoul
03080, Korea
| | | | - Dominik Spira
- The Berlin Aging Study II; Research Group on Geriatrics;
Charité—Universitätsmedizin Berlin,
13347
Berlin, Germany
- Lipid Clinic at the Interdisciplinary Metabolism Center,
Charité-Universitätsmedizin Berlin, 13353
Berlin, Germany
| | - Priya Srikanth
- School of Public Health, Oregon Health & Science
University, Portland, Oregon
97239, USA
- Bone & Mineral Unit, Oregon Health & Science
University, Portland, Oregon
97239, USA
| | - Elisabeth Steinhagen-Thiessen
- The Berlin Aging Study II; Research Group on Geriatrics;
Charité—Universitätsmedizin Berlin,
13347
Berlin, Germany
- Lipid Clinic at the Interdisciplinary Metabolism Center,
Charité-Universitätsmedizin Berlin, 13353
Berlin, Germany
| | - Yun Ju Sung
- Division of Biostatistics, Washington University School of
Medicine, St Louis, Missouri
63110, USA
| | - Karin M. A. Swart
- EMGO Institute for Health and Care Research, VU University
Medical Center, 1081 BT
Amsterdam, The Netherlands
- VUMC, Department of Epidemiology and Biostatistics,
1081 BT
Amsterdam, The Netherlands
| | - Leena Taittonen
- Department of Pediatrics, University of Oulu,
FI-90014
Oulu, Finland
- Department of Pediatrics, Vaasa Central Hospital,
FI-65100
Vaasa, Finland
| | - Toshiko Tanaka
- Translational Gerontology Branch, National Institute on
Aging, Baltimore, Maryland
21225, USA
| | - Emmi Tikkanen
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
- Hjelt Institute, University of Helsinki,
FI-00014
Helsinki, Finland
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
| | - Natasja M. van Schoor
- EMGO Institute for Health and Care Research, VU University
Medical Center, 1081 BT
Amsterdam, The Netherlands
- VUMC, Department of Epidemiology and Biostatistics,
1081 BT
Amsterdam, The Netherlands
| | - Niek Verweij
- University of Groningen, University Medical Center Groningen,
Department of Cardiology, 9700 RB
Groningen, The Netherlands
| | - Alan F. Wright
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh
EH4 2XU, UK
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University
Medical Center, Chicago, Illinois
60612, USA
| | - Joseph M. Zmuda
- Department of Epidemiology; University of Pittsburgh,
Pittsburgh, Pennsylvania
15261, USA
| | - Niina Eklund
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Terrence Forrester
- Tropical Metabolism Research Unit, Tropical Medicine Research
Institute, University of the West Indies, Mona
JMAAW15, Jamaica
| | - Niels Grarup
- Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen, 2100
Copenhagen, Denmark
| | - Anne U. Jackson
- Center for Statistical Genetics, Department of Biostatistics,
University of Michigan, Ann Arbor, Michigan
48109, USA
| | - Kati Kristiansson
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Teemu Kuulasmaa
- Faculty of Health Sciences, Institute of Clinical Medicine,
Internal Medicine, University of Eastern Finland, 70210
Kuopio, Finland
| | - Johanna Kuusisto
- Faculty of Health Sciences, Institute of Clinical Medicine,
Internal Medicine, University of Eastern Finland, 70210
Kuopio, Finland
- Department of Medicine, University of Eastern Finland,
70210
Kuopio, Finland
- Kuopio University Hospital, 70029
Kuopio, Finland
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
| | - Anubha Mahajan
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
| | - Satu Männistö
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Cameron D. Palmer
- Broad Institute of the Massachusetts Institute of Technology
and Harvard University, Cambridge
2142, USA
- Divisions of Endocrinology and Genetics and Center for Basic
and Translational Obesity Research, Boston Children's Hospital,
Boston, Massachusetts
02115, USA
| | - Janina S. Ried
- Institute of Genetic Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
| | - Robert A. Scott
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
| | - Alena Stancáková
- Department of Medicine, University of Eastern Finland and
Kuopio University Hospital, 70210
Kuopio, Finland
| | - Peter J. Wagner
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Ayse Demirkan
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, 3015GE
Rotterdam, The Netherlands
| | - Angela Döring
- Institute of Epidemiology I, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur
201, Iceland
- University of Iceland, Faculty of Medicine,
Reykjavik
101, Iceland
| | - Douglas P. Kiel
- Department of Medicine Beth Israel Deaconess Medical Center
and Harvard Medical School, Boston, Massachusetts
02115
- Institute for Aging Research Hebrew Senior Life,
Boston, Massachusetts
02131, USA
| | - Brigitte Kühnel
- Institute of Genetic Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
| | - Massimo Mangino
- Department of Twin Research and Genetic Epidemiology,
King's College London, London
SE1 7EH, UK
| | - Barbara Mcknight
- Cardiovascular Health Research Unit, University of
Washington, Seattle, Washington
98101, USA
- Program in Biostatistics and Biomathematics, Divison of Public
Health Sciences, Fred Hutchinson Cancer Research Center,
Seattle, Washington
98109, USA
- Department of Biostatistics, University of Washington,
Seattle, Washington
98195, USA
| | - Cristina Menni
- Department of Twin Research and Genetic Epidemiology,
King's College London, London
SE1 7EH, UK
| | - Jeffrey R. O'Connell
- Program for Personalized and Genomic Medicine, Division of
Endocrinology, Diabetes and Nutrition, Department of Medicine, University of
Maryland School of Medicine, Baltimore, Maryland
21201, USA
| | - Ben A. Oostra
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, 3015GE
Rotterdam, The Netherlands
| | - Alan R. Shuldiner
- Program for Personalized and Genomic Medicine, Division of
Endocrinology, Diabetes and Nutrition, Department of Medicine, University of
Maryland School of Medicine, Baltimore, Maryland
21201, USA
- Geriatric Research and Education Clinical Center, Vetrans
Administration Medical Center, Baltimore, Maryland
21042, USA
| | - Kijoung Song
- Genetics, Projects Clinical Platforms and Sciences,
GlaxoSmithKline, Philadelphia, Pennsylvania
19112, USA
| | - Liesbeth Vandenput
- Centre for Bone and Arthritis Research, Department of Internal
Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy,
University of Gothenburg, 413 45
Gothenburg, Sweden
| | - Cornelia M. van Duijn
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands
Consortium for Healthy Aging (NCHA), Rotterdam
The Netherlands
- Genetic Epidemiology Unit, Department of Epidemiology, Erasmus
University Medical Center, 3015GE
Rotterdam, The Netherlands
- Center for Medical Systems Biology, 2300
Leiden, The Netherlands
| | - Peter Vollenweider
- Department of Internal Medicine, University Hospital Lausanne
(CHUV) and University of Lausanne, 1011
Lausanne, Switzerland
| | - Charles C. White
- Department of Biostatistics, Boston University School of Public
Health, Boston, Massachusetts
02118, USA
| | - Michael Boehnke
- Center for Statistical Genetics, Department of Biostatistics,
University of Michigan, Ann Arbor, Michigan
48109, USA
| | - Yvonne Boettcher
- University of Leipzig, IFB Adiposity Diseases,
04103
Leipzig, Germany
- University of Leipzig, Department of Medicine,
04103
Leipzig, Germany
| | - Richard S. Cooper
- Department of Public Health Sciences, Stritch School of
Medicine, Loyola University Chicago, Maywood, Illinois
61053, USA
| | - Nita G. Forouhi
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
| | - Christian Gieger
- Institute of Genetic Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
| | - Harald Grallert
- Institute of Epidemiology II, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- German Center for Diabetes Research (DZD),
85764
Neuherberg, Germany
| | - Aroon Hingorani
- Institute of Cardiovascular Science, University College
London, London
WC1E 6BT, UK
| | - Torben Jørgensen
- Department of Clinical Medicine, Faculty of Health and Medical
Sciences, University of Copenhagen, 2200
Copenhagen, Denmark
- Faculty of Medicine, University of Aalborg,
9220
Aalborg, Denmark
- Research Centre for Prevention and Health,
DK2600
Capital Region of Denmark, Denmark
| | - Pekka Jousilahti
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, UCL,
London
WC1E 6BT, UK
| | - Meena Kumari
- Department of Epidemiology and Public Health, UCL,
London
WC1E 6BT, UK
| | - Markku Laakso
- Faculty of Health Sciences, Institute of Clinical Medicine,
Internal Medicine, University of Eastern Finland, 70210
Kuopio, Finland
- Department of Medicine, University of Eastern Finland,
70210
Kuopio, Finland
- Kuopio University Hospital, 70029
Kuopio, Finland
| | - Claudia Langenberg
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
- Department of Epidemiology and Public Health, UCL,
London
WC1E 6BT, UK
| | - Allan Linneberg
- Research Centre for Prevention and Health, Glostrup
Hospital, 2600
Glostrup, Denmark
| | - Amy Luke
- Department of Public Health Sciences, Stritch School of
Medicine, Loyola University Chicago, Maywood, Illinois
61053, USA
| | - Colin A. Mckenzie
- Tropical Metabolism Research Unit, Tropical Medicine Research
Institute, University of the West Indies, Mona
JMAAW15, Jamaica
| | - Aarno Palotie
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
- Wellcome Trust Sanger Institute, Human Genetics,
Hinxton, Cambridge
CB10 1SA, UK
- Massachusetts General Hospital, Center for Human Genetic
Research, Psychiatric and Neurodevelopmental Genetics Unit,
Boston, Massachusetts
02114, USA
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen, 2100
Copenhagen, Denmark
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
| | - Konstantin Strauch
- Institute of Genetic Epidemiology, Helmholtz Zentrum
München—German Research Center for Environmental
Health, 85764
Neuherberg, Germany
- Institute of Medical Informatics, Biometry and Epidemiology,
Chair of Genetic Epidemiology, Ludwig-Maximilians-Universität,
81377
Munich, Germany
| | - Bamidele O. Tayo
- Department of Public Health Sciences, Stritch School of
Medicine, Loyola University Chicago, Maywood, Illinois
61053, USA
| | - Nicholas J. Wareham
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
| | - David A. Bennett
- Rush Alzheimer's Disease Center, Rush University
Medical Center, Chicago, Illinois
60612, USA
| | - Lars Bertram
- School of Public Health, Faculty of Medicine, Imperial College
London, London
W6 8RP, UK
- Lübeck Interdisciplinary Platform for Genome
Analytics, Institutes of Neurogenetics and Integrative and Experimental
Genomics, University of Lübeck, 23562
Lübeck, Germany
| | - John Blangero
- South Texas Diabetes and Obesity Institute, University of Texas
Rio Grande Valley, Brownsville, Texas
78520
| | - Matthias Blüher
- University of Leipzig, IFB Adiposity Diseases,
04103
Leipzig, Germany
- University of Leipzig, Department of Medicine,
04103
Leipzig, Germany
| | - Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research
Center, Baton Rouge, Los Angeles
70808, USA
| | - Harry Campbell
- Centre for Global Health Research, Usher Institute of
Population Health Sciences and Informatics, University of Edinburgh, Teviot
Place, Edinburgh
EH8 9AG, UK
| | - Nam H. Cho
- Ajou University School of Medicine, Department of Preventive
Medicine, Suwon Kyoung-gi
443-721, Korea
| | - Steven R. Cummings
- California Pacific Medical Center Research Institute,
San Francisco, California
94107, USA
| | - Stefan A. Czerwinski
- Lifespan Health Research Center, Wright State University
Boonshoft School of Medicine, Dayton, Ohio
45420, USA
| | - Ilja Demuth
- The Berlin Aging Study II; Research Group on Geriatrics;
Charité—Universitätsmedizin Berlin,
13347
Berlin, Germany
- Institute of Medical and Human Genetics,
Charité—Universitätsmedizin Berlin,
13353
Berlin, Germany
| | - Rahel Eckardt
- The Berlin Aging Study II; Research Group on Geriatrics;
Charité—Universitätsmedizin Berlin,
13347
Berlin, Germany
| | - Johan G. Eriksson
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
- Department of General Practice and Primary Health Care,
University of Helsinki, FI-00014
Helsinki, Finland
- Folkhälsan Research Centre, FI-00290
Helsinki, Finland
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on
Aging, Baltimore, Maryland
21225, USA
| | - Oscar H. Franco
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands
Consortium for Healthy Aging (NCHA), Rotterdam
The Netherlands
- Department of Epidemiology, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
| | - Philippe Froguel
- CNRS UMR 8199, F-59019
Lille, France
- European Genomic Institute for Diabetes, 59000
Lille, France
- Université de Lille 2, 59000
Lille, France
| | - Ron T. Gansevoort
- University of Groningen, University Medical Center Groningen,
Department of Medicine, 9700 RB
Groningen, The Netherlands
| | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen, 2100
Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern
Denmark, 5000
Odense, Denmark
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, National
Institute on Aging, Bethesda, Maryland
20892, USA
| | - Nicholas Hastie
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh
EH4 2XU, UK
| | - Markku Heliövaara
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Albert Hofman
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands
Consortium for Healthy Aging (NCHA), Rotterdam
The Netherlands
- Department of Epidemiology, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North
Carolina at Chapel Hill, Chaper Hill, North Carolina
27599-7280, USA
| | - Antti Jula
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University
Hospital, FI-33521
Tampere, Finland
- Department of Clinical Physiology, University of Tampere
School of Medicine, FI-33014
Tampere, Finland
| | - Eero Kajantie
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
- Children's Hospital, Helsinki University Hospital and
University of Helsinki, FI-00029
Helsinki, Finland
- Department of Obstetrics and Gynecology, MRC Oulu, Oulu
University Hospital and University of Oulu, FI-90029
Oulu, Finland
| | - Paul B. Knekt
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Seppo Koskinen
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Peter Kovacs
- University of Leipzig, IFB Adiposity Diseases,
04103
Leipzig, Germany
| | - Terho Lehtimäki
- Department of Clinical Chemistry, University of Tampere School
of Medicine, FI-33014
Tampere, Finland
- Department of Clinical Chemistry, Fimlab Laboratories and
School of Medicine, University of Tampere, FI-33520
Tampere, Finland
| | - Lars Lind
- Department of Medical Sciences, Uppsala University,
751 85
Uppsala, Sweden
| | - Yongmei Liu
- Center for Human Genetics, Division of Public Health Sciences,
Wake Forest School of Medicine, Winston-Salem, North
Carolina
27157, USA
| | - Eric S. Orwoll
- Bone & Mineral Unit, Oregon Health & Science
University, Portland, Oregon
97239, USA
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton,
Southampton General Hospital, Southampton
SO16 6YD, UK
| | - Markus Perola
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
- Estonian Genome Center, Univeristy of Tartu,
Tartu, 51010, Estonia
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Louis Pérusse
- Department of Kinesiology, Laval University,
Québec City, Quebec, Canada
G1V 0A6
- Institute of Nutrition and Functional Foods, Laval
University, Québec City, Quebec,
Canada
G1V 0A6
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku
University Hospital, FI-20521
Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular
Medicine, University of Turku, FI-20520
Turku, Finland
| | - Tuomo Rankinen
- Human Genomics Laboratory, Pennington Biomedical Research
Center, Baton Rouge, Los Angeles
70808, USA
| | - D. C. Rao
- Division of Statistical Genomics, Department of Genetics,
Washington University School of Medicine, St Louis,
Missouri
63108, USA
- Division of Biostatistics, Washington University School of
Medicine, St Louis, Missouri
63110, USA
- Department of Psychiatry, Washington University School of
Medicine, St Louis, Missouri
63110, USA
| | - Treva K. Rice
- Division of Biostatistics, Washington University School of
Medicine, St Louis, Missouri
63110, USA
- Department of Psychiatry, Washington University School of
Medicine, St Louis, Missouri
63110, USA
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands
Consortium for Healthy Aging (NCHA), Rotterdam
The Netherlands
- Department of Epidemiology, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute of
Population Health Sciences and Informatics, University of Edinburgh, Teviot
Place, Edinburgh
EH8 9AG, UK
| | - Veikko Salomaa
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Thorkild I. A. Sørensen
- MRC Integrative Epidemiology Unit, School of Social and
Community Medicine, University of Bristol, Bristol
BS82BN, UKnited
- Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen, 2100
Copenhagen, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederiksberg
Hospital, The Capital Region, 2000
Frederiksberg, Denmark
| | - Michael Stumvoll
- University of Leipzig, IFB Adiposity Diseases,
04103
Leipzig, Germany
- University of Leipzig, Department of Medicine,
04103
Leipzig, Germany
| | - Anke Tönjes
- University of Leipzig, Department of Medicine,
04103
Leipzig, Germany
| | - Bradford Towne
- Lifespan Health Research Center, Wright State University
Boonshoft School of Medicine, Dayton, Ohio
45420, USA
| | - Gregory J. Tranah
- California Pacific Medical Center Research Institute,
San Francisco, California
94107, USA
| | - Angelo Tremblay
- Department of Kinesiology, Laval University,
Québec City, Quebec, Canada
G1V 0A6
| | - André G. Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands
Consortium for Healthy Aging (NCHA), Rotterdam
The Netherlands
- Department of Epidemiology, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen,
Department of Cardiology, 9700 RB
Groningen, The Netherlands
- Durrer Center for Cardiogenetic Research, Interuniversity
Cardiology Institute Netherlands-Netherlands Heart Institute, 3501
DG
Utrecht, The Netherlands
- Department of Genetics, University Medical Center Groningen,
University of Groningen, 9700 RB
Groningen, The Netherlands
| | - Erkki Vartiainen
- National Institute for Health and Welfare,
FI-00271
Helsinki, Finland
| | - Jorma S. Viikari
- Department of Medicine, University of Turku,
FI-20521
Turku, Finland
| | - Veronique Vitart
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh
EH4 2XU, UK
| | - Marie-Claude Vohl
- Institute of Nutrition and Functional Foods, Laval
University, Québec City, Quebec,
Canada
G1V 0A6
- School of Nutrition, Laval University,
Québec City, Quebec, Canada
G1V 0A6
| | - Henry Völzke
- Institute for Community Medicine, University Medicine
Greifswald, 17475
Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site
Greifswald, 17475
Greifswald, Germany
- DZD (German Centre for Diabetes Research), partner site
Greifswald, 17475
Greifswald, Germany
| | - Mark Walker
- Program in Medical and Population Genetics, Broad Institute of
Harvard and Massachusetts Institute of Technology, Cambridge,
Massachusetts
02142, USA
- Institute of Cellular Medicine, Newcastle University,
Newcastle
NE2 4HH, UK
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine,
University Medicine Greifswald, 17475
Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site
Greifswald, 17475
Greifswald, Germany
| | - Sarah Wild
- Centre for Population Health Sciences, Usher Institute of
Population Health Sciences and Informatics, University of Edinburgh,
Edinburgh
EH8 9AG, UK
| | - James F. Wilson
- MRC Human Genetics Unit, Institute of Genetics and Molecular
Medicine, University of Edinburgh, Edinburgh
EH4 2XU, UK
- Centre for Global Health Research, Usher Institute of
Population Health Sciences and Informatics, University of Edinburgh, Teviot
Place, Edinburgh
EH8 9AG, UK
| | - Loïc Yengo
- CNRS UMR 8199, F-59019
Lille, France
- European Genomic Institute for Diabetes, 59000
Lille, France
- Université de Lille 2, 59000
Lille, France
| | - D. Timothy Bishop
- Leeds Institute of Cancer and Pathology, Cancer Research UK
Leeds Centre, University of Leeds, Leeds
LS9 7TF, UK
| | - Ingrid B. Borecki
- Division of Statistical Genomics, Department of Genetics,
Washington University School of Medicine, St Louis,
Missouri
63108, USA
- Analytical Genetics Group, Regeneron Genetics Center,
Regeneron Pharmaceuticals, Inc., Tarrytown, New York
10591, USA
| | - John C. Chambers
- Department of Epidemiology and Biostatistics, Imperial College
London, London
W2 1PG, UK
- Ealing Hospital NHS Trust, Middlesex
UB1 3HW, UK
- Imperial College Healthcare NHS Trust, London
W12 0HS, UK
| | - L. Adrienne Cupples
- Department of Biostatistics, Boston University School of Public
Health, Boston, Massachusetts
02118, USA
- National Heart, Lung, and Blood Institute, the Framingham
Heart Study, Framingham, Massachusetts
01702, USA
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus Medical Center,
3000CA
Rotterdam/Zuidholland, The Netherlands
| | - Panos Deloukas
- William Harvey Research Institute, Barts and The London School
of Medicine and Dentistry, Queen Mary University of London,
London
EC1M 6BQ, UK
- Wellcome Trust Sanger Institute, Human Genetics,
Hinxton, Cambridge
CB10 1SA, UK
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research
of Hereditary Disorders (PACER-HD), King Abdulaziz University,
Jeddah
21589, Saudi Arabia
| | - Ghazaleh Fatemifar
- MRC Integrative Epidemiology Unit, School of Social and
Community Medicine, University of Bristol, Bristol
BS82BN, UKnited
| | - Caroline Fox
- Harvard Medical School, Boston,
Massachusetts
02115, USA
- National Heart, Lung, and Blood Institute, the Framingham
Heart Study, Framingham, Massachusetts
01702, USA
| | - Terrence S. Furey
- Department of Genetics, University of North Carolina,
Chapel Hill, North Carolina
27599, USA
- Department of Biology, University of North Carolina,
Chapel Hill, North Carolina
27599, USA
| | - Lude Franke
- University of Groningen, University Medical Center Groningen,
Department of Cardiology, 9700 RB
Groningen, The Netherlands
- Department of Genetics, University Medical Center Groningen,
University of Groningen, 9700 RB
Groningen, The Netherlands
| | - Jiali Han
- Department of Epidemiology, Richard M. Fairbanks School of
Public Health, Melvin and Bren Simon Cancer Center,
Indianapolis, Indiana
46202, USA
| | - David J. Hunter
- Broad Institute of the Massachusetts Institute of Technology
and Harvard University, Cambridge
2142, USA
- Department of Epidemiology, Harvard School of Public
Health, Boston, Massachusetts
02115, USA
- Channing Division of Network Medicine, Department of Medicine,
Brigham and Women's Hospital and Harvard Medical School,
Boston, Massachusetts
02115, USA
- Department of Nutrition, Harvard School of Public
Health, Boston, Massachusetts
02115, USA
| | - Juha Karjalainen
- Department of Genetics, University Medical Center Groningen,
University of Groningen, 9700 RB
Groningen, The Netherlands
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism,
University of Oxford, Churchill Hospital, Oxford
OX3 7LJ, UK
- Oxford NIHR Biomedical Research Centre,
Oxford
OX3 7LJ, UK
| | - Robert C. Kaplan
- Department of Epidemiology and Popualtion Health, Albert
Einstein College of Medicine, Bronx, New York
10461, USA
| | - Jaspal S. Kooner
- Ealing Hospital NHS Trust, Middlesex
UB1 3HW, UK
- Imperial College Healthcare NHS Trust, London
W12 0HS, UK
- National Heart and Lung Institute, Imperial College
London, London
W12 0NN, UK
| | - Mark I. McCarthy
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism,
University of Oxford, Churchill Hospital, Oxford
OX3 7LJ, UK
- Oxford NIHR Biomedical Research Centre,
Oxford
OX3 7LJ, UK
| | - Joanne M. Murabito
- Boston University School of Medicine, Department of Medicine,
Section of General Internal Medicine, Boston,
Massachusetts
02118, USA
- NHLBI's and Boston University's Framingham
Heart Study, Framingham, Massachusetts
01702, USA
| | - Andrew P. Morris
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
- Department of Biostatistics, University of Liverpool,
Liverpool
L69 3GA, UK
| | - Julia A. N. Bishop
- Leeds Institute of Cancer and Pathology, Cancer Research UK
Leeds Centre, University of Leeds, Leeds
LS9 7TF, UK
| | - Kari E. North
- Carolina Center for Genome Sciences and Department of
Epidemiology, University of North Carolina at Chapel Hill, Chapel
Hill, North Carolina
27599-7400, USA
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal
Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy,
University of Gothenburg, 413 45
Gothenburg, Sweden
| | - Ken K. Ong
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
- MRC Unit for Lifelong Health and Ageing at UCL,
London
WC1B 5JU, UK
- Department of Paediatrics, University of Cambridge,
Cambridge
CB2 0QQ, UK
| | - Inga Prokopenko
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
- Department of Genomics of Common Disease, School of Public
Health, Imperial College London, London
W12 0NN, UK
- Oxford Centre for Diabetes, Endocrinology and Metabolism,
University of Oxford, Churchill Hospital, Oxford
OX3 7LJ, UK
| | - J. Brent Richards
- Department Epidemiology, Biostatistics and Human Genetics, Lady
Davis Institute, Jewish General Hospital, McGill University,
Montréal, Quebec, Canada
H3T1E2
- Department of Medicine, Lady Davis Institute, Jewish General
Hospital, McGill University, Montréal,
Quebec, Canada
H3T1E2
- Department of Twin Research, King's College
London, London
SE1 1E7, UK
- Division of Endocrinology, Lady Davis Institute, Jewish
General Hospital, McGill University, Montréal,
Quebec, Canada
H3T1E2
| | - Eric E. Schadt
- Icahn Institute for Genomics and Multiscale Biology, Icahn
School of Medicine at Mount Sinai, New York, New York
10029, USA
- Department of Genetics and Genomic Sciences, Icahn School of
Medicine at Mount Sinai, New York, New York
10029, USA
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology,
King's College London, London
SE1 7EH, UK
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland, University of
Helsinki, FI-00290
Helsinki, Finland
| | - Cristen J. Willer
- Department of Computational Medicine and Bioinformatics,
University of Michigan, Ann Arbor, Michigan
48109, USA
- Department of Human Genetics, University of Michigan,
Ann Arbor, Michigan
48109, USA
- Department of Internal Medicine, Division of Cardiovascular
Medicine, University of Michigan, Ann Arbor, Michigan
48109, USA
| | - Jian Yang
- Queensland Brain Institute, The University of Queensland,
Brisbane
4072, Australia
| | - Erik Ingelsson
- Science for Life Laboratory, Uppsala University, 750
85
Uppsala, Sweden
- Department of Medical Sciences, Molecular Epidemiology, Uppsala
University, 751 85
Uppsala, Sweden
- Department of Medicine, Division of Cardiovascular Medicine,
Stanford University School of Medicine, Stanford,
California
94305, USA
| | - Karen L. Mohlke
- Department of Genetics, University of North Carolina,
Chapel Hill, North Carolina
27599, USA
| | - Joel N. Hirschhorn
- Broad Institute of the Massachusetts Institute of Technology
and Harvard University, Cambridge
2142, USA
- Divisions of Endocrinology and Genetics and Center for Basic
and Translational Obesity Research, Boston Children's Hospital,
Boston, Massachusetts
02115, USA
- Department of Genetics, Harvard Medical School,
Boston, Massachusetts
02115, USA
| | - John Andrew Pospisilik
- Department of Epigenetics, Max Planck Institute of
Immunobiology and Epigenetics, D-76108
Freiburg, Germany
| | - M. Carola Zillikens
- Department of Internal Medicine, Erasmus Medical Center,
3015GE
Rotterdam, The Netherlands
- Netherlands Genomics Initiative (NGI)-sponsored Netherlands
Consortium for Healthy Aging (NCHA), Rotterdam
The Netherlands
| | - Cecilia Lindgren
- Wellcome Trust Centre for Human Genetics, University of
Oxford, Oxford
OX3 7BN, UK
- Broad Institute of the Massachusetts Institute of Technology
and Harvard University, Cambridge
2142, USA
- The Big Data Institute, University of Oxford,
Oxford
OX3 7LJ, UK
| | - Tuomas Oskari Kilpeläinen
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
- Novo Nordisk Foundation Center for Basic Metabolic Research,
Section of Metabolic Genetics, Faculty of Health and Medical Sciences,
University of Copenhagen, 2100
Copenhagen, Denmark
| | - Ruth J. F. Loos
- The Charles Bronfman Institute for Personalized Medicine, The
Icahn School of Medicine at Mount Sinai, New York, New
York
10029, USA
- The Department of Preventive Medicine, The Icahn School of
Medicine at Mount Sinai, New York, New York
10029, USA
- MRC Epidemiology Unit, University of Cambridge School of
Clinical Medicine, Institute of Metabolic Science, University of Cambridge,
Cambridge Biomedical Campus, Cambridge
CB2 0QQ, UK
- The Genetics of Obesity and Related Metabolic Traits Program,
The Icahn School of Medicine at Mount Sinai, New York, New
York, 10029, USA
- The Mindich Child Health and Development Institute, The Icahn
School of Medicine at Mount Sinai, New York, New York
10029, USA
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42
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van Dijk SC, Enneman AW, Swart KMA, van Wijngaarden JP, Ham AC, de Jonge R, Blom HJ, Feskens EJ, Geleijnse JM, van Schoor NM, Dhonukshe-Rutten RAM, de Jongh RT, Lips P, de Groot LCPGM, Uitterlinden AG, van den Meiracker TH, Mattace-Raso FUS, van der Velde N, Smulders YM. Effect of vitamin B12 and folic acid supplementation on biomarkers of endothelial function and inflammation among elderly individuals with hyperhomocysteinemia. Vasc Med 2016; 21:91-8. [PMID: 26774115 DOI: 10.1177/1358863x15622281] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
B-vitamin trials failed to demonstrate beneficial effects on cardiovascular outcomes, but hyperhomocysteinemia still stands out as an independent cardiovascular risk factor, particularly in elderly individuals. B-vitamins may influence early vascular dysfunction, such as endothelial dysfunction, or may have adverse effects, for example on inflammation. We investigated the effect of B-vitamins on endothelial function and inflammation within an interventional study. This study was conducted within the framework of the B-PROOF trial, which included 2919 hyperhomocysteinemic elderly individuals, who received daily vitamin B12 (500 μg) and folic acid (400 μg) or placebo for 2 years. Using an electrochemiluminescence platform, we measured intercellular adhesion molecule 1 (ICAM-1), vascular adhesion molecule 1 (VCAM-1), serum amyloid A (SAA), vascular endothelial growth factor (VEGF) and C-reactive protein (CRP) at baseline and follow-up in a subsample of 522 participants (271 intervention group; 251 placebo). Treatment effects were analyzed with ANCOVA. The participants had a mean age of 72 years, and 55% of them were male. At the 2-year follow-up, B-vitamins did not change the ICAM-1 (+36% change in the intervention group versus +32% change in the placebo group; p = 0.72), VCAM-1 (+27% vs +25%; p = 0.39), VEGF (-1% vs +4%; p = 0.40), SAA (+34% vs +38%; p = 0.85) or CRP levels (+26% vs +36%; p = 0.70) as compared to placebo. In conclusion, in elderly patients with hyperhomocysteinemia, vitamin B12 and folic acid are unlikely to influence either endothelial function or low-grade systemic inflammation. ClinicalTrials.gov Identifier: NCT00696514.
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Affiliation(s)
| | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Karin M A Swart
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Annelies C Ham
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - R de Jonge
- Department of Clinical Chemistry, Erasmus MC, Rotterdam, The Netherlands
| | - Henk J Blom
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, The Netherlands
| | - Edith J Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Renate T de Jongh
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Paul Lips
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Andre G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands Netherlands Consortium for Healthy Ageing, Rotterdam, Leiden, The Netherlands
| | | | | | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands Department of Internal Medicine, Section of Geriatrics, Academic Medical Center, Amsterdam, The Netherlands
| | - Yvo M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands Department of Internal Medicine and Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands
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43
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Swart KMA, Ham AC, van Wijngaarden JP, Enneman AW, van Dijk SC, Sohl E, Brouwer-Brolsma EM, van der Zwaluw NL, Zillikens MC, Dhonukshe-Rutten RAM, van der Velde N, Brug J, Uitterlinden AG, de Groot LCPGM, Lips P, van Schoor NM. A Randomized Controlled Trial to Examine the Effect of 2-Year Vitamin B12 and Folic Acid Supplementation on Physical Performance, Strength, and Falling: Additional Findings from the B-PROOF Study. Calcif Tissue Int 2016; 98:18-27. [PMID: 26412463 PMCID: PMC4703626 DOI: 10.1007/s00223-015-0059-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/22/2015] [Indexed: 11/26/2022]
Abstract
Elevated homocysteine concentrations are associated with a decline in physical function in elderly persons. Homocysteine-lowering therapy may slow down this decline. This study aimed to examine the effect of a 2-year intervention of vitamin B12 and folic acid supplementation on physical performance, handgrip strength, and risk of falling in elderly subjects in a double-blind, randomized placebo-controlled trial. Participants aged ≥65 years with elevated plasma homocysteine concentrations [12-50 µmol/L (n = 2919)] were randomly assigned to daily supplementation of 500 µg vitamin B12, 400 µg folic acid, and 600 IU vitamin D3, or to placebo with 600 IU vitamin D3. Physical performance (range 0-12) and handgrip strength (kg) were measured at baseline and after 2 years. Falls were reported prospectively on a research calendar. Intention-to-treat (primary) and per-protocol (secondary) analyses were performed. Physical performance level and handgrip strength significantly decreased during the follow-up period, but this decline did not differ between groups. Moreover, time to first fall was not significantly different (HR: 1.0, 95% CI 0.9-1.2). Secondary analyses on a per-protocol base identified an interaction effect with age on physical performance. In addition, the treatment was associated with higher follow-up scores on the walking test (cumulative OR: 1.3, 95% CI 1.1-1.5). Two-year supplementation of vitamin B12 and folic acid was neither effective in reducing the age-related decline in physical performance and handgrip strength, nor in the prevention of falling in elderly persons. Despite the overall null-effect, the results provide indications for a positive effect of the intervention on gait, as well as on physical performance among compliant persons >80 years. These effects should be further tested in future studies.
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Affiliation(s)
- Karin M A Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Annelies C Ham
- Department of Internal Medicine, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Janneke P van Wijngaarden
- Department of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - Anke W Enneman
- Department of Internal Medicine, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Suzanne C van Dijk
- Department of Internal Medicine, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Evelien Sohl
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Elske M Brouwer-Brolsma
- Department of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - Nikita L van der Zwaluw
- Department of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus MC, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Lisette C P G M de Groot
- Department of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section and the EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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44
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van Dijk SC, de Jongh RT, Enneman AW, Ham AC, Swart KMA, van Wijngaarden JP, van der Zwaluw NL, Brouwer-Brolsma EM, van Schoor NM, Dhonukshe-Rutten RAM, Lips P, de Groot CPGM, Smulders YM, Blom HJ, Feskens EJ, Geleijnse JM, van den Meiracker AH, Mattace Raso FUS, Uitterlinden AG, Zillikens MC, van der Velde N. Arterial stiffness is not associated with bone parameters in an elderly hyperhomocysteinemic population. J Bone Miner Metab 2016; 34:99-108. [PMID: 25804313 DOI: 10.1007/s00774-015-0650-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 08/25/2014] [Accepted: 12/25/2014] [Indexed: 10/23/2022]
Abstract
Several studies have observed positive associations between bone disease and cardiovascular disease. A potential common pathway is hyperhomocysteinemia; however, to date, there is a lack of data regarding hyperhomocysteinemic populations. Therefore, we examined both cross-sectionally and longitudinally, whether there is an association between bone parameters and arterial stiffness in a hyperhomocysteinemic population, and investigated the potential common role of homocysteine (hcy) level on these associations. Cross-sectional and longitudinal data of the B-PROOF study were used (n = 519). At both baseline and 2-year follow-up we determined bone measures-incident fractures and history of fractures, bone-mineral density (BMD) and quantitative ultrasound (QUS) measurement. We also measured arterial stiffness parameters at baseline-pulse wave velocity, augmentation index and aortic pulse pressure levels with applanation tonometry. Linear regression analysis was used to examine these associations and we tested for potential interaction of hcy level. The mean age of the study population was 72.3 years and 44.3 % were female. Both cross-sectionally and longitudinally there was no association between arterial stiffness measures and BMD or QUS measurements or with incident fractures (n = 16) within the 2-3 years of follow-up. Hcy level did not modify the associations and adjustment for hcy did not change the results. Arterial stiffness was not associated with bone parameters and fractures, and hcy neither acted as a pleiotropic factor nor as a mediator. The potential association between bone and arterial stiffness is therefore not likely to be driven by hyperhomocysteinemia.
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Affiliation(s)
- S C van Dijk
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - R T de Jongh
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - A W Enneman
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A C Ham
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - K M A Swart
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - J P van Wijngaarden
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - N L van der Zwaluw
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - E M Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - N M van Schoor
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | | | - P Lips
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - C P G M de Groot
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Y M Smulders
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands
| | - H J Blom
- Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - E J Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - J M Geleijnse
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - A H van den Meiracker
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - F U S Mattace Raso
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A G Uitterlinden
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Netherlands Consortium of Healthy Ageing, Rotterdam and Leiden, The Netherlands
| | - M C Zillikens
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - N van der Velde
- Section of Geriatrics, Department of Internal Medicine, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Section of Geriatrics, Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Oliai Araghi S, van Dijk SC, Ham AC, Brouwer-Brolsma EM, Enneman AW, Sohl E, Swart KMA, van der Zwaluw NL, van Wijngaarden JP, Dhonukshe-Rutten RAM, van Schoor NM, Zillikens MC, Lips P, de Groot L, Uitterlinden AG, van der Velde N. BMI and Body Fat Mass Is Inversely Associated with Vitamin D Levels in Older Individuals. J Nutr Health Aging 2015; 19:980-5. [PMID: 26624208 DOI: 10.1007/s12603-015-0657-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the association between obesity (measured by Body Mass Index (BMI) and fat percentage) and serum 25(OH)D levels in older persons. DESIGN Cross-sectional analysis of data from 'the B-PROOF study' (B-vitamins for the Prevention Of Osteoporotic Fractures). PARTICIPANTS 2842 participants aged 65 years and older. MEASUREMENTS BMI and fat percentage, measured by Dual Energy X-ray, and serum 25(OH)D levels. RESULTS Mean age was 74 years (6.5 SD), with 50% women. Mean serum 25(OH)D levels were 55.8 nmol/L (25 SD). BMI and total body fat percentage were significant inversely associated with serum 25(OH)D levels after adjustment for confouders (β-0.93; 95% CI [-1.15; -0.71], p<0.001 and β-0.84; 95% CI [-1.04; -0.64], p<0.001). This association was most prominent in individuals with a BMI in the 'overweight' and 'obesity' range (β -1.25 and -0.96 respectively) and fat percentage in the last two upper quartiles (β-1.86 and -1.37 respectively). CONCLUSION In this study, higher BMI and higher body fat percentage were significantly associated with lower serum 25(OH)D levels in older persons. This association was particularly present in individuals with overweight, and higher fat percentages, suggesting that these persons are at increased risk of vitamin D insufficiency.
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Affiliation(s)
- S Oliai Araghi
- Nathalie van der Velde, PhD, MD, Erasmus MC, Department of Internal Medicine, Section of Geriatrics, P.O. Box 2040; 3000 CA Rotterdam; the Netherlands, Phone: +31 10 70 35979 ; Fax: +31 10 70 34768;
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van Dijk SC, Swart KMA, Ham AC, Enneman AW, van Wijngaarden JP, Feskens EJ, Geleijnse JM, de Jongh RT, Blom HJ, Dhonukshe-Rutten RAM, de Groot LCPGM, van Schoor NM, Lips P, Uitterlinden AG, Mattace Raso FUS, Smulders YM, van den Meiracker AH, van der Velde N. Physical Fitness, Activity and Hand-Grip Strength Are Not Associated with Arterial Stiffness in Older Individuals. J Nutr Health Aging 2015; 19:779-84. [PMID: 26193863 DOI: 10.1007/s12603-015-0519-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Whereas evidence exists about the benefits of intensive exercise on cardiovascular outcomes in older adults, data are lacking regarding long-term effects of physical fitness and physical activity on cardiovascular health. Therefore, we aimed to investigate the longitudinal association of physical fitness, physical activity and muscle strength with arterial stiffness measures. DESIGN a longitudinal follow-up study (2 years) of data from the B-PROOF study. SETTING a subgroup of the B-PROOF study (n=497). PARTICIPANTS Four hundred ninety-seven participants with a mean age of 72.1 years (SD 5.4) of which 57% was male. MEASUREMENTS All performed at baseline and after two-year follow-up. Arterial stiffness was estimated by pulse wave velocity (PWV) measured with applanation tonometry. Furthermore, augmentation index (AIx) and aortic pulse pressure (PP) were assessed. Physical activity was estimated using a validated questionnaire regarding daily activities. Physical fitness was measured with a physical performance score, resulting from a walking, chair-stand and balance test. Muscle strength was assessed with hand-grip strength using a handheld dynamometer. RESULTS The median performance score was 9.0 [IQR 8.0-11.0], the mean physical activity was 744.4 (SD 539.4) kcal/day and the mean hand-grip strength was 33.1 (SD 10.2) kg. AIx differed between the baseline and follow-up measurement (26.2% (SD 10.1) vs. 28.1% (SD 9.9); p < 0.01), whereas PWV and aortic PP did not. In multivariable linear regression analysis, physical performance, physical activity and hand-grip strength at baseline were not associated with the amount of arterial stiffness after two years of follow-up. CONCLUSION Physical fitness, activity and muscle strength were not associated with arterial stiffness. More research is warranted to elucidate the long-term effects of daily and intensive physical activity on arterial stiffness in an elderly population.
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Affiliation(s)
- S C van Dijk
- S.C. van Dijk, MD, Erasmus Medical Center, Department of Internal Medicine, Section of Geriatrics, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands, Phone: +31 10 70 35979 ; Fax: +31 10 70 34768 ; E:
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47
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Brouwer-Brolsma EM, Dhonukshe-Rutten RAM, van Wijngaarden JP, van der Zwaluw NL, Sohl E, In't Veld PH, van Dijk SC, Swart KMA, Enneman AW, Ham AC, van Schoor NM, van der Velde N, Uitterlinden AG, Lips P, Feskens EJM, de Groot LCPGM. Low vitamin D status is associated with more depressive symptoms in Dutch older adults. Eur J Nutr 2015; 55:1525-34. [PMID: 26141257 PMCID: PMC4875055 DOI: 10.1007/s00394-015-0970-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/16/2015] [Indexed: 12/21/2022]
Abstract
Purpose The existence of vitamin D receptors in the brain points to a possible role of vitamin D in brain function. We examined the association of vitamin D status and vitamin D-related genetic make-up with depressive symptoms amongst 2839 Dutch older adults aged ≥65 years. Methods 25-Hydroxyvitamin D (25(OH)D) was measured, and five ‘vitamin D-related genes’ were selected. Depressive symptoms were measured with the 15-point Geriatric Depression Scale. Results were expressed as the relative risk of the score of depressive symptoms by quartiles of 25(OH)D concentration or number of affected alleles, using the lowest quartile or minor allele group as reference. Results A clear cross-sectional and prospective association between serum 25(OH)D and depressive symptom score was observed. Fully adjusted models indicated a 22 % (RR 0.78, 95 % CI 0.68–0.89), 21 % (RR 0.79, 95 % CI 0.68–0.90), and 18 % (RR 0.82, 95 % CI 0.71–0.95) lower score of depressive symptoms in people in the second, third, and fourth 25(OH)D quartiles, when compared to people in the first quartile (P for trend <0.0001). After 2 years of daily 15 µg vitamin D supplementation, similar associations were observed. 25(OH)D concentrations did not significantly interact with the selected genes. Conclusion Low serum 25(OH)D was associated with higher depressive symptom scores. No interactions between 25(OH)D concentrations and vitamin D genetic make-up were observed. In view of the probability of reverse causation, we propose that the association should be further examined in prospective studies as well as in randomized controlled trials. Electronic supplementary material The online version of this article (doi:10.1007/s00394-015-0970-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E M Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands.
| | - R A M Dhonukshe-Rutten
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - J P van Wijngaarden
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - N L van der Zwaluw
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - E Sohl
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - P H In't Veld
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - S C van Dijk
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - K M A Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - A W Enneman
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A C Ham
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - N M van Schoor
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - N van der Velde
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatrics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - P Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
| | - L C P G M de Groot
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV, Wageningen, The Netherlands
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Enneman AW, Swart KMA, van Wijngaarden JP, van Dijk SC, Ham AC, Brouwer-Brolsma EM, van der Zwaluw NL, Dhonukshe-Rutten RAM, van der Cammen TJM, de Groot LCPGM, van Meurs J, Lips P, Uitterlinden AG, Zillikens MC, van Schoor NM, van der Velde N. Effect of Vitamin B12 and Folic Acid Supplementation on Bone Mineral Density and Quantitative Ultrasound Parameters in Older People with an Elevated Plasma Homocysteine Level: B-PROOF, a Randomized Controlled Trial. Calcif Tissue Int 2015; 96:401-9. [PMID: 25712255 PMCID: PMC4415946 DOI: 10.1007/s00223-015-9968-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/09/2015] [Indexed: 11/03/2022]
Abstract
High plasma homocysteine (Hcy) levels are associated with increased osteoporotic fracture incidence. However, the mechanism remains unclear. We investigated the effect of Hcy-lowering vitamin B12 and folic acid treatment on bone mineral density (BMD) and calcaneal quantitative ultrasound (QUS) parameters. This randomized, double-blind, placebo-controlled trial included participants aged ≥65 years with plasma Hcy levels between 12 and 50 µmol/L. The intervention comprised 2-year supplementation with either a combination of 500 µg B12, 400 µg folic acid, and 600 IU vitamin D or placebo with 600 IU vitamin D only. In total, 1111 participants underwent repeated dual-energy X-ray assessment and 1165 participants underwent QUS. Femoral neck (FN) BMD, lumbar spine (LS) BMD, calcaneal broadband ultrasound attenuation (BUA), and calcaneal speed of sound (SOS) were assessed. After 2 years, FN-BMD and BUA had significantly decreased, while LS-BMD significantly increased (all p < 0.01) and SOS did not change in either treatment arm. No statistically significant differences between the intervention and placebo group were present for FN-BMD (p = 0.24), LS-BMD (p = 0.16), SOS (p = 0.67), and BUA (p = 0.96). However, exploratory subgroup analyses revealed a small positive effect of the intervention on BUA at follow-up among compliant persons >80 years (estimated marginal mean 64.4 dB/MHz for the intervention group and 61.0 dB/MHz for the placebo group, p = 0.04 for difference). In conclusion, this study showed no overall effect of treatment with vitamin B12 and folic acid on BMD or QUS parameters in elderly, mildly hyperhomocysteinemic persons, but suggests a small beneficial effect on BUA in persons >80 years who were compliant in taking the supplement.
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Affiliation(s)
- Anke W. Enneman
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Karin M. A. Swart
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | | | - Suzanne C. van Dijk
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Annelies C. Ham
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Elske M. Brouwer-Brolsma
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | - Nikita L. van der Zwaluw
- Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands
| | | | - Tischa J. M. van der Cammen
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Joyce van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Paul Lips
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Endocrinology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - André G. Uitterlinden
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - M. Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, P.O. Box 22700, 1100 DD Amsterdam, The Netherlands
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Menger DJ, Richard W, Swart KMA, Grolman W. Does Functional Septorhinoplasty Provide Improvement of the Nasal Passage in Validated Patient-Reported Outcome Measures? ORL J Otorhinolaryngol Relat Spec 2015; 77:123-31. [PMID: 25926049 DOI: 10.1159/000381025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether functional septorhinoplasty provides improvement of the nasal passage in validated patient-reported outcome measures (PROMs) for adults with an anatomical obstruction of the nasal valve. All patients with an anatomical obstruction of the nasal valve area due to nasal valve pathology and/or septal deviations in this area were included. METHODS A systematic PubMed, Embase and Cochrane Library search was performed to identify relevant articles. The articles were critically appraised and ranked according to validity and relevance. RESULTS Sixteen articles met our inclusion criteria, and after critical appraisal, 10 were eligible for further analysis. In 9 studies, the Nose Obstruction Symptom Evaluation (NOSE) score improved from 35 to 60 points. In 1 study, the Sino-Nasal Outcome Test (SNOT-22) improved 3.5 points. CONCLUSION The results suggest that there is a significant improvement of the validated PROMs after functional septorhinoplasty in the first postoperative year. We recommend that adults with nasal breathing problems due to an anatomical problem of the nasal valve area should consider undergoing functional septorhinoplasty.
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Affiliation(s)
- Dirk Jan Menger
- Department of Otorhinolaryngology/Head and Neck Surgery, Center for Facial Plastic and Reconstructive Surgery, University Medical Center, Utrecht, The Netherlands
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Menger DJ, Swart KMA, Nolst Trenité GJ, Georgalas C, Grolman W. Surgery of the external nasal valve: the correlation between subjective and objective measurements. Clin Otolaryngol 2015; 39:150-5. [PMID: 24725912 DOI: 10.1111/coa.12243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Minimum cross-sectional area of the nasal passage on CT (CT-MCA) is an objective computerised determination of the minimum cross-sectional area of the nasal passage on CT. CT-MCA was evaluated before and after surgery on the external nasal valve using the 'lateral crus pull-up' procedure (LCPU). The outcomes of CT-MCA were compared with other currently available objective tests for nasal valve patency. STUDY DESIGN Prospective cohort study. METHODS This study included 34 patients undergoing surgery on the external nasal valve with the use of the LCPU technique. CT-MCA was performed before and after surgery and compared with the subjective perception of nasal passage using the Nasal Obstruction Symptom Evaluation (NOSE) scale and with objective tests such as acoustic rhinometry (A-MCA), rhinomanometry (NAR) and peak nasal inspiratory flow (PNIF). RESULTS This study showed a significant correlation between CT-MCA and the NOSE scale, PNIF and NAR. Paired-samples t-tests showed significant improvement after surgery on CT-MCA, PNIF and the NOSE scale. Multiple linear regression analysis showed that PNIF, CT-MCA and NAR were significantly associated with the NOSE scale. CONCLUSION CT-MCA and PNIF were both significantly correlated and associated with the patient's subjective perception of nasal passage. The surgical procedure, the 'lateral crus pull-up', showed a significant improvement in the postoperative result both subjectively and objectively.
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Affiliation(s)
- D J Menger
- Department of Otorhinolaryngology - FPS, University Medical Center, Utrecht, The Netherlands; O.L.V.G., Amsterdam, The Netherlands
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