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Zhang X, Cash RE, Bower JK, Focht BC, Paskett ED. Physical activity and risk of cardiovascular disease by weight status among U.S adults. PLoS One 2020; 15:e0232893. [PMID: 32384119 PMCID: PMC7209349 DOI: 10.1371/journal.pone.0232893] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/23/2020] [Indexed: 01/18/2023] Open
Abstract
PURPOSE We sought to determine whether the association between physical activity and 10-year cardiovascular disease (CVD) risk varies among normal weight, overweight, and obese adults in a nationally-representative sample of the United States. METHODS Data were from the National Health and Nutrition Examination Survey 2007-2016. A subset of 22,476 participants aged 30-64 years was included with no CVD history. Physical activity level was self-reported and stratified into sedentary (0 min/week), inactive (1-149 mins/week), or active (≥150 mins/week) of moderate or vigorous activities. Framingham risk scores were classified as low/intermediate (<20%) or high 10-year CVD risk (≥20%). RESULTS The average age of the population was 45.9 years, 52.3% were female, 33.6% were overweight (BMI 25.0-29.9kg/m2), and 35.7% were obese (BMI≥30kg/m2). Individuals who were overweight and obese had a higher 10-year CVD risk compared to those with normal weight (9.5 vs. 10.1 vs. 6.3%, P<0.001). The association of physical activity and high 10-year CVD risk differed by weight status. Among overweight and obese adults, individuals engaged in any physical activity had lower odds ofhigh 10-year CVD risk compared to sedentary individuals (overweight: OR active = 0.48, 95% CI: 0.36-0.64; OR inactive = 0.53, 95% CI: 0.45-0.86; obese: OR active = 0.50, 95% CI: 0.37-0.68; OR inactive = 0.66, 95% CI: 0.49-0.89). Among normal weight adults, individuals who were physically active had lower odds of high 10-year CVD risk (OR = 0.59, 95% CI: 0.28-0.87). When compared the joint effects of physical activity level and weight status, physical activity was associated with a larger magnitude of reduced odds of 10-year CVD risk than weight status. CONCLUSION Participation in any level of physical activity is associated with a lower 10-year CVD risk for overweight and obese adults. Future studies are needed to identify effective modes and doses of exercise that offer optimal CVD benefits for populations with different weight statuses.
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Affiliation(s)
- Xiaochen Zhang
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Rebecca E. Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Julie K. Bower
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Brian C. Focht
- Division of Kinesiology, Department of Human Sciences, The Ohio State University, Columbus, OH, United States of America
| | - Electra D. Paskett
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, OH, United States of America
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, United States of America
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Rafiq R, El Haddaoui H, de Mutsert R, Rosendaal FR, Hiemstra PS, Cobbaert CM, den Heijer M, de Jongh RT. Adiposity is a confounding factor which largely explains the association of serum vitamin D concentrations with C-reactive protein, leptin and adiponectin. Cytokine 2020; 131:155104. [PMID: 32325367 DOI: 10.1016/j.cyto.2020.155104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The role of adiposity in the relationship between vitamin D and inflammation is unknown. Our aim was therefore to assess the association of serum 25-hydroxyvitamin D (25(OH)D) with C-reactive protein (CRP), leptin and adiponectin and the role of adiposity in this relationship. METHODS This is a cross-sectional analysis of The Netherlands Epidemiology of Obesity Study (NEO), a population-based cohort study in men and women aged 45 to 65 years. Main outcome measures were CRP, leptin and adiponectin. In the linear regression analyses we adjusted for age, sex, ethnicity, creatinine, education, alcohol use, smoking status, physical activity, number of chronic diseases, season, total body fat and waist circumference. RESULTS Of the 6287 participants, 21% were vitamin D deficient (serum 25(OH)D < 50 nmol/L). Mean (SD) age and BMI were 56 (6) years and 26.3 (4.4) kg/m2, respectively. Although after adjustment for most examined potential confounders, each 10 nmol/L increase in serum 25(OH)D was associated with 2.3% (95%CI: -4.0 to -0.5) lower CRP, 3.5% (-4.7 to -2.2) lower leptin, and 0.13 ng/mL (0.04-0.21) higher adiponectin, most of these associations seemed to largely stem from an additional potential confounder - adiposity - as they either disappeared (leptin and CRP) or were largely diminished (adiponectin) upon further adjustment for adiposity indices (total body fat and waist circumference). CONCLUSION We found that measures of adiposity largely explained the negative association of serum 25(OH)D with the pro-inflammatory CRP and leptin, and the positive association with the anti-inflammatory adiponectin. These results suggest that future studies should take the effect of adiposity into account.
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Affiliation(s)
- Rachida Rafiq
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Hassana El Haddaoui
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, the Netherlands
| | - Christa M Cobbaert
- Department of Clinical Chemistry, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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Lee YM, Heo S, Kim SA, Lee DH. Is dietary macronutrient intake associated with serum concentrations of organochlorine pesticides in humans? ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 259:113819. [PMID: 31887593 DOI: 10.1016/j.envpol.2019.113819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/03/2019] [Accepted: 12/13/2019] [Indexed: 06/10/2023]
Abstract
In the general population, chronic exposure to low-dose persistent organic pollutants (POPs), particularly organochlorine pesticides (OCPs), has been recently linked to many chronic diseases. Widespread contamination of the food chain and human adipose tissue has made avoiding exposure to these chemicals impossible; thus, alternative strategies for decreasing the chemical burden must be investigated. Recently, macronutrient intake was found to significantly modify the toxicokinetics of POPs in animal experimental studies. Thus, we evaluated whether macronutrient intake was related to serum concentrations of OCPs in healthy adults without cardio-metabolic diseases. Subjects included 1,764 adults, aged 20 years or above, who participated in the National Health and Nutrition Examination Survey 1999-2004. Macronutrient intake was assessed based on a 24-h dietary recall interview. Six individual OCPs commonly detected among the general population were evaluated as markers of OCPs and other coexisting lipophilic chemicals stored in adipose tissue and released into circulation. High fat intake was associated with lower concentrations of OCPs, while high carbohydrate intake showed the opposite result. When three types of fats were individually evaluated, both saturated fatty acids and monounsaturated fatty acids, but not polyunsaturated fatty acids, were inversely associated with serum concentrations of OCPs. Adjustment for possible confounders did not change the results. When stratified by age, gender, body mass index, and physical activity, these associations were similar in most subgroups. Thus, similar to the findings observed in animal experimental studies, a moderate-fat diet with low carbohydrate intake was related to low serum concentrations of OCPs in humans. Although these findings need to be replicated, changing dietary macronutrient intake can be investigated as a practical strategy for dealing with unavoidable lipophilic chemical mixtures such as OCPs in modern society.
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Affiliation(s)
- Yu-Mi Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Somi Heo
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Se-A Kim
- Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, Republic of Korea; BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea.
| | - Duk-Hee Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea.
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Sheffel A, Wilson E, Munos M, Zeger S. Methods for analysis of complex survey data: an application using the Tanzanian 2015 Demographic and Health Survey and Service Provision Assessment. J Glob Health 2020; 9:020902. [PMID: 31893037 PMCID: PMC6925968 DOI: 10.7189/jogh.09.020902] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Low-income and middle-income countries (LMICs) seek to better utilize household and health facility survey data for monitoring and evaluation, as well as for health program planning. However, analysis of this complex survey data are complicated. In Tanzania, the National Evaluation Platform project sought to analyze Demographic and Health Survey (DHS) data and Service Provision Assessment (SPA) data as part of an evaluation of the national One Plan for Maternal and Child Health. To support this evaluation, we used this survey data to answer two key methodological questions: 1) what are the benefits and costs of using sampling weights in rate estimation; and 2) what is the best method for calculating standard errors in these two surveys? Methods We conducted a simulation study for each methodologic question. The first simulation study assessed the benefits and costs of using sampling weights in rate estimation. This simulation used weighted and unweighted estimates and examined bias, variance, and the mean squared error (MSE). The second simulation study assessed the best method for calculating standard errors comparing cluster bootstrapped variance estimation, design based asymptotic variance with one level (svy1), and design based asymptotic variance with three levels (svy3). We compared coverage probability and confidence interval length. Results Our results showed that although weighted estimates were less biased, unweighted estimates were less variable. The weighted estimates had a lower MSE, indicating that the effect of the bias trade-off was greater than the effect of the variance trade-off for most indicators assessed. The best performer for variance estimation was the cluster bootstrap method, followed by the svy3 method. The svy1 method was the worst performer for most indicators assessed. Conclusions As complex survey data become more widely used for policymaking in LMICs, there is a need for guidance on the best methods for analyzing this data. The standard of practice has been a design-based analysis using survey weights and the single-level svy method for calculating standard errors. This study puts forth an alternative approach to analysis. In addition, this study offers practical guidance on determining the best method for analysis of complex survey data.
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Affiliation(s)
- Ashley Sheffel
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Emily Wilson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Melinda Munos
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Zeger
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Luo K, Liu J, Wang Y, Aimuzi R, Luo F, Ao J, Zhang J. Associations between organophosphate esters and sex hormones among 6-19-year old children and adolescents in NHANES 2013-2014. ENVIRONMENT INTERNATIONAL 2020; 136:105461. [PMID: 31931349 DOI: 10.1016/j.envint.2020.105461] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Organophosphate esters (OPEs) are a class of alternative replacements for polybrominated diphenyl ethers. In vitro and in vivo studies suggested that OPEs may disrupt the homeostasis of sex steroid hormones. However, human evidence in children and adolescents is limited. OBJECTIVES We conducted a cross-sectional analysis of the associations between OPE biomarkers and sex steroid hormones among children (6-11 years) and adolescents (12-19 years) in the U.S. National Health and Nutrition Examination Survey, 2013-2014. METHODS Participants aged 6-19 years who had available data on urinary OPE metabolites, serum sex hormones [total testosterone (TT), estradiol (E2)] and sex hormone binding globulin (SHBG) were included (n = 544). Free androgen index (FAI) calculated as TT divided by SHBG and a ratio of TT to E2 (TT/E2) were generated. Five urinary OPE metabolites were examined. A constructed puberty status was defined as either high steroid hormone levels (TT ≥ 50 ng/dL in males and E2 ≥ 20 pg/ml in females) or onset of menarche. Multiple linear regression and weighted quantile sum (WQS) regression analyses stratified by sex-age and sex-puberty-status groups were conducted to examine the associations of OPE metabolites and its mixture with sex hormone levels. RESULTS After adjusting for covariates, dibutyl phosphate (DBUP) and dibutyl phosphate (DPHP) were significantly inversely associated with TT (or FAI) and E2; DBUP was negatively associated with SHBG; and DPHP was positively associated with SHBG and TT/E2 in female adolescents. In male adolescents, we observed monotonic negative associations of bis(1,3-dichloro-2-propyl) phosphate (BDCPP), DBUP or DPHP with TT (or FAI) and E2, and positive associations of BDCPP and DPHP with SHBG. Among adolescents, the OPEs index was negatively associated with TT [WQS beta = -0.29 (95% confidence interval: -0.51, -0.07) in males and -0.15 (-0.28, -0.01) in females ], FAI [-0.46 (-0.71, -0.2) in males and -0.23 (-0.41, -0.05) in females] and E2 [-0.25 (-0.41, -0.1) in males and -0.33 (-0.59, -0.08) in females], with stronger associations with TT and FAI in males and a slightly stronger association with E2 in females. In addition, the OPEs index presented a comparable positive association with SHBG in both sexes of adolescents. In contrast, significant associations of individual OPE metabolites or OPEs index with sex hormones were sparse in children. Results by sex-puberty status in single pollutant and WQS regression analyses presented a similar pattern, where most of the significant associations were limited to the pubertal individuals. Of note, stronger inverse associations of the OPEs index with TT and FAI remained in pubertal boys. But the association between the OPEs index and E2 was non-significant in pubertal girls, and only in pubertal boys did the OPEs index show a significant and stronger inverse association with E2. CONCLUSIONS Exposure to OPEs, either individually or as a mixture, was associated with decreased levels of certain sex steroid hormones (TT, FAI, and E2) and increased levels of SHBG in adolescents or pubertal individuals, with the associations presenting somewhat sex-dependent pattern. However, there is little evidence of the significant associations in children or prepubescent ones. Given the cross-sectional nature of the analysis, our findings need further confirmation.
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Affiliation(s)
- Kai Luo
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Jihong Liu
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Yuqing Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Ruxianguli Aimuzi
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Fei Luo
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Junjie Ao
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China
| | - Jun Zhang
- School of Public Health, Shanghai Jiao Tong University, Shanghai 200025, China; Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai 200092, China.
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Loef M, Ioan-Facsinay A, Mook-Kanamori DO, Willems van Dijk K, de Mutsert R, Kloppenburg M, Rosendaal FR. The association of plasma fatty acids with hand and knee osteoarthritis: the NEO study. Osteoarthritis Cartilage 2020; 28:223-230. [PMID: 31629023 DOI: 10.1016/j.joca.2019.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/20/2019] [Accepted: 10/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the association of postprandial and fasting plasma saturated fatty acid (SFAs), monounsaturated fatty acid (MUFAs) and polyunsaturated fatty acid (PUFAs) concentrations with hand and knee osteoarthritis (OA). DESIGN In the population-based NEO study clinical hand and knee OA were defined by the ACR classification criteria. Structural knee OA was defined on MRI. Hand and knee pain was determined by Australian/Canadian Hand Osteoarthritis Index (AUSCAN) and KOOS, respectively. Plasma was sampled fasted and 150 min after a standardized meal, and subsequently analysed using a nuclear magnetic resonance platform. Logistic regression analyses were used to investigate the association of total fatty acid, SFA, MUFA, total PUFA, omega-3 PUFA and omega-6 PUFA concentrations with clinical hand and knee OA, structural knee OA and hand and knee pain. Fatty acid concentrations were standardized (mean 0, SD 1). Analyses were stratified by sex and corrected for age, education, ethnicity and total body fat percentage. RESULTS Of the 5,328 participants (mean age 56 years, 58% women) 7% was classified with hand OA, 10% with knee OA and 4% with concurrent hand and knee OA. In men, postprandial SFAs (OR (95% CI)) 1.23 (1.00; 1.50), total PUFAs 1.26 (1.00; 1.58) and omega-3 PUFAs 1.24 (1.01; 1.52) were associated with hand OA. SFAs and PUFAs were associated with structural, but not clinical knee OA. Association of fasting fatty acid concentrations were weaker than postprandial concentrations. CONCLUSION Plasma postprandial SFA and PUFA levels were positively associated with clinical hand and structural knee OA in men, but not in women.
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Affiliation(s)
- M Loef
- Department of Rheumatology, Leiden University Medical center, the Netherlands.
| | - A Ioan-Facsinay
- Department of Rheumatology, Leiden University Medical center, the Netherlands.
| | - D O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical center, the Netherlands.
| | - K Willems van Dijk
- Department of Human Genetics, Leiden University Medical center, the Netherlands; Department of Internal Medicine, Leiden University Medical Center, the Netherlands.
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical center, the Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical center, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical center, the Netherlands.
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical center, the Netherlands.
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57
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Buis DTP, Christen T, Smit RAJ, de Mutsert R, Jukema JW, Cannegieter SC, Lijfering WM, Rosendaal FR. The association between leptin concentration and blood coagulation: Results from the NEO study. Thromb Res 2020; 188:44-48. [PMID: 32050106 DOI: 10.1016/j.thromres.2020.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/02/2020] [Accepted: 01/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The adipocyte-derived hormone leptin has been associated with altered blood coagulation in in vitro studies. However, it is unclear whether this association is relevant in vivo and to what extent this association is influenced by total body fat. Therefore, we aimed to examine the association between serum leptin and blood coagulation while taking total body fat into account in a population-based cohort study. METHODS We performed a cross-sectional analysis with baseline measurements of 5797 participants of the Netherlands Epidemiology of Obesity (NEO) study, a population-based cohort of middle-aged men and women. We examined associations between serum leptin concentration and coagulation factor concentrations and parameters of platelet activation in linear regression analyses. All analyses were adjusted for multiple covariates, including total body fat. RESULTS In multivariable adjusted analyses a 1 μg/L higher serum leptin concentration was associated with a 0.22 IU/dL (95% CI: 0.11, 0.32) higher FVIII concentration and a 0.20 IU/dL (95% CI: 0.14, 0.27) higher FIX concentration (3.5 IU/dL FVIII and 3.2 IU/dL FIX per SD leptin). Serum leptin concentration was not associated with FXI, fibrinogen, platelet count, mean platelet volume and platelet distribution width in multivariable adjusted analyses. DISCUSSION This study showed that serum leptin concentration was associated with higher concentrations of FVIII and FIX in an observational study, which could be clinically relevant.
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Affiliation(s)
- D T P Buis
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - T Christen
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - R A J Smit
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - R de Mutsert
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - J W Jukema
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - S C Cannegieter
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - W M Lijfering
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
| | - F R Rosendaal
- Clinical Epidemiology, C7-P, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, the Netherlands
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Vrinten C, Stoffel S, Dodd RH, Waller J, Lyratzopoulos Y, von Wagner C. Cancer worry frequency vs. intensity and self-reported colorectal cancer screening uptake: A population-based study. J Med Screen 2019; 26:169-178. [PMID: 31042098 PMCID: PMC6854611 DOI: 10.1177/0969141319842331] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/15/2019] [Indexed: 12/31/2022]
Abstract
Objectives Many studies of cancer worry use items measuring frequency or intensity. Little is known about how each of these relate to cancer screening uptake. This study compared the association between worry frequency vs. intensity and colorectal cancer screening intention/uptake. Methods Across four surveys (2014–2016), we collected data from 2878 screening-eligible men and women (aged 60–70) in England. Measures included single-items assessing cancer worry frequency and intensity, and a derived combination of both. We also assessed self-reported past faecal occult blood testing uptake (ever vs. never), intention to participate when next invited (yes vs. no), and demographics. Using logistic regression, we compared a model containing sociodemographic characteristics (Model 1), with four models adding cancer worry frequency (Model 2), intensity (Model 3), both (Model 4), or the combined measure (Model 5). Results A model with cancer worry intensity and demographics (Model 3) explained significantly more variance in uptake and intention (R 2 = 0.068 and 0.062, respectively) than demographics alone (Model 1: R 2 = 0.058 and 0.042; p < 0.001), or a model with demographics and cancer worry frequency (Model 2: R 2 = 0.059 and 0.052; p < 0.001). The model was also equally as effective as models including both the frequency and intensity items (Model 4: R 2 = 0.070 n.s. and 0.062 n.s.), or using the derived combination of both (Model 5: R 2 = 0.063 n.s. and 0.053 n.s.). Conclusion A single item measure of cancer worry intensity appeared to be most parsimonious for explaining variance in colorectal cancer screening intention and uptake.
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Affiliation(s)
- Charlotte Vrinten
- Department of Behavioural Science and Health, University College London, London, UK
| | - Sandro Stoffel
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rachael H Dodd
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Department of Behavioural Science and Health, University College London, London, UK
| | - Yoryos Lyratzopoulos
- Department of Behavioural Science and Health, University College London, London, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London, UK
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Alshehri T, Boone S, de Mutsert R, Penninx B, Rosendaal F, le Cessie S, Milaneschi Y, Mook-Kanamori D. The association between overall and abdominal adiposity and depressive mood: A cross-sectional analysis in 6459 participants. Psychoneuroendocrinology 2019; 110:104429. [PMID: 31526909 DOI: 10.1016/j.psyneuen.2019.104429] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/05/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aimed to evaluate the association between measures of adiposity with depressive mood and specific depressive symptoms. METHODS This study was performed in the Netherlands Epidemiology of Obesity (NEO) study, a population-based study that consists of 6671 middle-aged individuals. We examined the association between measures of overall adiposity (BMI and total body fat), and abdominal adiposity (waist circumference and visceral adipose tissue), with depressive mood severity subgroups and 30 depressive symptoms. Multinomial logistic regression was performed adjusting for potential confounding. RESULTS Measures of adiposity were associated with depressive mood in a graded fashion. Total body fat showed the strongest association with mild (Odds Ratio (OR): 1.59 per standard deviation, 95% Confidence Interval (95% CI): 1.41-1.80) and moderate to very severe (OR: 1.97, 95% CI: 1.59-2.44) depressive mood. Regarding individual symptoms of depressive mood, total body fat was associated with most depressive symptoms (strongest associations for hyperphagia and fatigability). CONCLUSIONS In the general population, overall and abdominal adiposity measures were associated with depressive mood. This association encompasses most of the depressive symptoms and appeared to be the strongest with specific ''atypical'' neurovegetative symptoms, which may be an indication of an alteration in the energy homeostasis.
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Affiliation(s)
- Tahani Alshehri
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Sebastiaan Boone
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Brenda Penninx
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam UMC, VU, the Netherlands
| | - Frits Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Statistics, Leiden University Medical Center, Leiden, the Netherlands
| | - Yuri Milaneschi
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam Neuroscience, Amsterdam UMC, VU, the Netherlands; GGZ inGeest, Research & Innovation, Amsterdam, the Netherlands
| | - Dennis 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
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Kroon FPB, Veenbrink AI, de Mutsert R, Visser AW, van Dijk KW, le Cessie S, Rosendaal FR, Kloppenburg M. The role of leptin and adiponectin as mediators in the relationship between adiposity and hand and knee osteoarthritis. Osteoarthritis Cartilage 2019; 27:1761-1767. [PMID: 31450004 DOI: 10.1016/j.joca.2019.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To investigate associations of leptin and adiponectin levels with knee and hand osteoarthritis, and explore whether these mediate the association between adiposity and osteoarthritis. METHODS This is a cross-sectional analysis of baseline data from the population-based Netherlands Epidemiology of Obesity study. Adiposity was assessed with body mass index (BMI) and percentage total body fat (%TBF). Osteoarthritis, defined as hand or knee osteoarthritis, was determined using American College of Rheumatology criteria. Fasting serum adipokine levels were measured using immunoassays. Associations between adiposity and osteoarthritis were examined with logistic regression, adjusted for age, sex, ethnicity and education, and additionally for leptin and adiponectin as potential mediators. RESULTS In 6408 participants (56% women, median age 56 years), prevalence of osteoarthritis was 22% (10% isolated knee and 8% isolated hand osteoarthritis). Leptin levels were positively associated with osteoarthritis, while adiponectin levels were not. Leptin partially mediated the association of adiposity with osteoarthritis (OR 1.40 (95%CI 1.30; 1.52) attenuated to 1.38 (1.24; 1.54) per 5 units BMI and OR 1.25 (1.17; 1.35) to 1.20 (1.10; 1.32) per 5 units %TBF, representing 4% and 17% mediation, respectively). Larger proportion mediation by leptin was found in knee (13%/27%) than in hand osteoarthritis (9%/18%). Sex-stratified analyses generally showed stronger associations between adiposity, leptin and osteoarthritis in women than in men. CONCLUSIONS Serum leptin levels were associated with osteoarthritis, and partially mediated the association between adiposity and osteoarthritis, while adiponectin levels were not associated with osteoarthritis. These findings provide evidence for systemic effects of adipose tissue in osteoarthritis.
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Affiliation(s)
- F P B Kroon
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands.
| | - A I Veenbrink
- Department of Internal Medicine, Medisch Spectrum Twente, the Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, LUMC, Leiden, the Netherlands
| | - A W Visser
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - K W van Dijk
- Department of Internal Medicine, LUMC, Leiden, the Netherlands; Department of Human Genetics, LUMC, Leiden, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, LUMC, Leiden, the Netherlands; Department of Biomedical Data Sciences, LUMC, Leiden, the Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, LUMC, Leiden, the Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands; Department of Clinical Epidemiology, LUMC, Leiden, the Netherlands
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Dekkers IA, de Vries APJ, Smit RAJ, Rosendaal FR, Rabelink TJ, Lamb HJ, de Mutsert R. The Separate Contributions of Visceral Fat and Liver Fat to Chronic Kidney Disease-Related Renal Outcomes. J Ren Nutr 2019; 30:286-295. [PMID: 31668939 DOI: 10.1053/j.jrn.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/04/2019] [Accepted: 09/08/2019] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES This study aims to investigate the separate contributions of liver fat and visceral fat on microalbuminuria and impaired renal function, and second, to examine whether non-alcoholic fatty liver disease is causally related to microalbuminuria and/or impaired renal function. METHODS Associations between visceral adipose tissue (VAT), hepatic triglyceride content (HTGC), and risk of microalbuminuria and renal function were studied cross-sectionally in the Netherlands Epidemiology of Obesity study. Mendelian randomization using GWAS meta-analysis data was performed to estimate the causal effect of non-alcoholic fatty liver disease (PNPLA3, LYPLAL1, NCAN, GCKR) on eGFR (Nmax 118,460), microalbuminuria (Nmax 54,116), and impaired renal function (Nmax 118,147). RESULTS In total, 2,023 participants (mean age 55.5 ± 6.0 years, 53% women) were included of which 29% had fatty liver and 2.0% chronic kidney disease stage ≥3. In joint models, VAT was associated with a 2-fold increased risk of microalbuminuria which was mainly driven by the association in women (total population: per standard deviation [SD] = 55.4 cm2, odds ratio [OR] 2.02, 95% confidence interval [CI] 1.18-3.47; women: OR 2.83, 95% CI 1.44, 5.56), but HTGC was not (total population: per SD = 7.9%, OR 1.20, 95% CI 0.85, 1.70). No associations were found for VAT and HTGC with eGFR (VAT: per SD = 55.4 cm2, OR 1.25, 95% CI 0.83, 1.87; HTGC: per SD = 7.9%, OR 0.65, 95% CI 0.42, 0.99). No causal effect of NAFLD on microalbuminuria or impaired renal function was found. CONCLUSIONS In observational analyses, visceral fat was associated with microalbuminuria in women. Liver fat was not associated with microalbuminuria or renal function, which was supported by Mendelian randomization. Visceral fat might be more important than liver fat in the etiology of microalbuminuria.
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Affiliation(s)
- Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Aiko P J de Vries
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roelof A J Smit
- Division of Nephrology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Division of Nephrology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Renée de Mutsert
- Division of Nephrology, Department of Medicine, Leiden University Medical Center, Leiden, The Netherlands
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62
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van der Toorn FA, de Mutsert R, Lijfering WM, Rosendaal FR, van Hylckama Vlieg A. Glucose metabolism affects coagulation factors: The NEO study. J Thromb Haemost 2019; 17:1886-1897. [PMID: 31325222 DOI: 10.1111/jth.14573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND It is insufficiently understood if there is an association between diabetes and VT, and what the underlying mechanism would be. OBJECTIVES We aimed to study the association between glucose concentrations with several coagulation factors in the general population. METHODS This is a cross-sectional analysis of baseline measurements within 5778 participants of the Netherlands Epidemiology of Obesity (NEO) study, a population-based cohort study of individuals 45 to 65 years. Associations between fasting glucose and HbA1c concentrations, and postprandial glucose response and factor (F) VIII, FIX, FXI, and fibrinogen levels were examined using linear regression analyses and by calculating mean levels per category of glucose concentrations while adjusting for confounding factors. RESULTS Per each mmol/L higher fasting glucose concentration we observed higher levels of fasting FVIII (5.33%, 95% CI: 4.00-6.65), FIX (6.19%, 95% CI: 5.15-7.23), and FXI (2.11%, 95% CI: 1.20-3.02). Results for fasting HbA1c and postprandial glucose response were similar. Participants with an impaired fasting glucose, high fasting glucose, and diabetes mellitus had higher mean levels of FVIII, FIX, and FXI than those with a normal glucose metabolism, with the highest differences in the levels of FVIII, FIX, and FXI between a high fasting glucose and a normal glucose metabolism. All associations attenuated after adjustment for total body fat, yet all of the above associations remained after adjustment for the confounding factors, except for fibrinogen when contrasted to glucose. CONCLUSION Concentrations of fasting glucose and HbA1c and postprandial glucose response were positively associated with FVIII, FIX, and FXI, and to some extent also with fibrinogen.
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Affiliation(s)
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Willem M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Boone S, Mook-Kanamori D, Rosendaal F, den Heijer M, Lamb H, de Roos A, le Cessie S, Willems van Dijk K, de Mutsert R. Metabolomics: a search for biomarkers of visceral fat and liver fat content. Metabolomics 2019; 15:139. [PMID: 31587110 PMCID: PMC6778586 DOI: 10.1007/s11306-019-1599-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 09/25/2019] [Indexed: 01/16/2023]
Abstract
INTODUCTION Excess visceral and liver fat are known risk factors for cardiometabolic disorders. Metabolomics might allow for easier quantification of these ectopic fat depots, instead of using invasive and costly tools such as MRI or approximations such as waist circumference. OBJECTIVE We explored the potential use of plasma metabolites as biomarkers of visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC). METHODS We performed a cross-sectional analysis of a subset of the Netherlands Epidemiology of Obesity study. Plasma metabolite profiles were determined using the Biocrates AbsoluteIDQ p150 kit in 176 individuals with normal fasting plasma glucose. VAT was assessed with magnetic resonance imaging and HTGC with proton-MR spectroscopy. We used linear regression to investigate the associations of 190 metabolite variables with VAT and HTGC. RESULTS After adjustment for age, sex, total body fat, currently used approximations of visceral and liver fat, and multiple testing, three metabolite ratios were associated with VAT. The strongest association was the lysophosphatidylcholines to total phosphatidylcholines (PCs) ratio [- 14.1 (95% CI - 21.7; - 6.6) cm2 VAT per SD of metabolite concentration]. Four individual metabolites were associated with HTGC, especially the diacyl PCs of which C32:1 was the strongest at a 1.31 (95% CI 1.14; 1.51) fold increased HTGC per SD of metabolite concentration. CONCLUSION Metabolomics may be a useful tool to identify biomarkers of visceral fat and liver fat content that have added diagnostic value over current approximations. Replication studies are required to validate the diagnostic value of these metabolites.
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Affiliation(s)
- Sebastiaan Boone
- Department of Clinical Epidemiology, Leiden University Medical Center, Postal Zone C7-P, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Dennis Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Postal Zone C7-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Postal Zone C7-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Martin den Heijer
- Department of Clinical Epidemiology, Leiden University Medical Center, Postal Zone C7-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Endocrinology, VU Medical Centre, Amsterdam, The Netherlands
| | - Hildo Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Postal Zone C7-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Section Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ko Willems van Dijk
- Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Postal Zone C7-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Verkouter I, Noordam R, le Cessie S, van Dam RM, Lamb HJ, Rosendaal FR, van Heemst D, de Mutsert R. The Association between Adult Weight Gain and Insulin Resistance at Middle Age: Mediation by Visceral Fat and Liver Fat. J Clin Med 2019; 8:jcm8101559. [PMID: 31569345 PMCID: PMC6832997 DOI: 10.3390/jcm8101559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/11/2019] [Accepted: 09/24/2019] [Indexed: 12/18/2022] Open
Abstract
We aimed to investigate the role of the amount of visceral fat and liver fat in the association between adult weight change and insulin resistance at middle age. In the Netherlands Epidemiology of Obesity study, adult weight change was calculated with recalled body weight at age 20 years and measured body weight at middle age. Measures of insulin resistance were calculated using both fasting and postprandial glucose and insulin concentrations. Visceral fat was assessed by magnetic resonance (MR) imaging and liver fat by proton-MR spectroscopy (N = 1758). We examined the association between adult weight change and insulin resistance with linear regression, adjusted for confounding factors. To investigate mediation, we additionally adjusted for total body fat, visceral fat, and liver fat. In participants who gained ≥50% of body weight during adulthood, homeostatic model assessment for insulin resistance (HOMA-IR) was 3.22 (95% CI 2.76; 3.77) times higher than in weight maintainers. In a joint model, total body fat mediated this association for 8.1% (95% CI −9.2; 25.4), visceral fat for 32.0% (18.6; 45.4%) and liver fat for 22.5% (15.0; 30.1). The association between adult weight gain and insulin resistance at middle age is largely mediated by both visceral fat and liver fat.
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Affiliation(s)
- Inge Verkouter
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Raymond Noordam
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Rob M van Dam
- Saw Swee Hock School of Public Health and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 117549, Singapore.
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Diana van Heemst
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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65
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Petrelli A, Rosano A, Rossi A, Mirisola C, Cislaghi C. The geography and economics of forgoing medical examinations or therapeutic treatments in Italy during the economic crisis. BMC Public Health 2019; 19:1202. [PMID: 31477064 PMCID: PMC6720380 DOI: 10.1186/s12889-019-7502-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 08/15/2019] [Indexed: 01/02/2023] Open
Abstract
Background In Italy, the number of individuals who have forgone medical examinations or treatments for economic reasons is one of the highest in Europe. During the global economic crisis of 2008, the restrictive policies concerning access to healthcare and the quality of these services, which differs widely throughout the country, may have accentuated the territorial differences in unmet needs, thereby penalizing the more disadvantaged segments of the population. The study aimed at evaluating the geographical and socioeconomic differences, in particular the risk of poverty, that influence forgoing healthcare services in Italy. Methods Cross-sectional Italian data from the 2004–2015 European Survey on Income and Living Conditions (EU-SILC) were used. Hierarchical logistic models were tested, using as the outcome unmet needs for medical examinations or treatment in the preceding 12 months, and as risk factor the condition of being at risk of poverty. Age, sex, citizenship, educational level, presence of chronic or severely limiting diseases and self-perceived health were used as adjustment factors. Analyses were stratified over three time periods: pre-crisis (2004–2007), initial phase of the crisis (2008–2012) and second phase of the crisis (2013–2015). Results In Central Italy and particularly in Southern Italy, a marked increase (9.9% in 2013–2015) was seen in the overall rate of unmet needs as well as in that of unmet needs due to economic reasons. The probability of unmet needs was higher, and increased over time, for those at risk of poverty (aOR = 1.54 in 2004–07, aOR = 1.70 in 2008–12, aOR = 2.21 in 2013–15). Individuals with a low educational level, who had a chronic or severely limiting disease, who perceived their health as not good and immigrants had a higher risk of forgoing healthcare. The regions in Southern Italy had a significantly higher probability of unmet needs. Conclusions A strong association was found between the probability of forgoing medical examination or treatment and being at risk of poverty. Study results underline the need for healthcare policies aimed at facilitating access to healthcare services, particularly in the South, by developing a progressive mechanism of contribution to healthcare costs proportional to income and by guaranteeing free access to the poor. Electronic supplementary material The online version of this article (10.1186/s12889-019-7502-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy.
| | - Aldo Rosano
- Italian National Institute of Health (ISS), Rome, Italy.,Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS), Rome, Italy
| | - Alessandra Rossi
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Concetta Mirisola
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy
| | - Cesare Cislaghi
- Agenzia Nazionale per i Servizi Sanitari Regionali (AGENAS), Rome, Italy
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66
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van Eekelen E, Geelen A, Alssema M, Lamb HJ, de Roos A, Rosendaal FR, de Mutsert R. Adherence to dietary guidelines in relation to visceral fat and liver fat in middle-aged men and women: the NEO study. Int J Obes (Lond) 2019; 44:297-306. [PMID: 31462693 PMCID: PMC6997120 DOI: 10.1038/s41366-019-0441-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/26/2019] [Accepted: 07/15/2019] [Indexed: 11/19/2022]
Abstract
Background It is unclear to what extent adherence to dietary guidelines may specifically affect visceral fat and liver fat. We aimed to study the association between the Dutch Healthy Diet Index (DHD-index) and total body fat, visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) in middle-aged men and women. Design In this cross-sectional study, VAT was assessed by magnetic resonance imaging (MRI) in 2580 participants, and HTGC by proton-MR spectroscopy in 2083 participants. Habitual dietary intake and physical activity were estimated by questionnaire. Adherence to the current Dutch dietary guidelines was estimated by the 2015 DHD-index score based on the thirteen components (vegetables, fruit, wholegrain products, legumes, nuts, dairy, fish, tea, liquid fats, red meat, processed meat, sweetened beverages, and alcohol). The DHD-index ranges between 0 and 130 with a higher score indicating a healthier diet. We used linear regression to examine associations of the DHD-index with VAT and HTGC, adjusted for age, smoking, education, ethnicity, basal metabolic rate, energy restricted diet, menopausal state, physical activity, total energy intake, and total body fat. We additionally excluded the components one by one to examine individual contributions to the associations. Results Included participants (43% men) had a mean (SD) age of 56 (6) years and DHD-index score of 71 (15). A 10-point higher DHD-index score was associated with 2.3 cm2 less visceral fat (95% CI; −3.5; −1.0 cm2) and less liver fat (0.94 times, 95% CI; 0.90; 0.98). Of all components, exclusion of dairy attenuated the associations with TBF and VAT. Conclusions Adherence to the dietary guidelines as estimated by the DHD-index was associated with less total body fat, and with less visceral and liver fat after adjustment for total body fat. These findings might contribute to better understanding of the mechanisms underlying associations between dietary habits and cardiometabolic diseases.
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Affiliation(s)
- Esther van Eekelen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Anouk Geelen
- Department of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - Marjan Alssema
- Unilever Research and Development, Vlaardingen, The Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Esmeijer K, de Vries AP, Mook-Kanamori DO, de Fijter JW, Rosendaal FR, Rabelink TJ, Smit RAJ, de Mutsert R, Hoogeveen EK. Low Birth Weight and Kidney Function in Middle-Aged Men and Women: The Netherlands Epidemiology of Obesity Study. Am J Kidney Dis 2019; 74:751-760. [PMID: 31358312 DOI: 10.1053/j.ajkd.2019.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/03/2019] [Indexed: 01/06/2023]
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD), defined as estimated glomerular filtration rate (eGFR)<60mL/min/1.73m2, is a risk factor for cardiovascular morbidity and mortality. Little is known about low birth weight and risk for CKD in middle-aged adults in the general population. We estimated the causal association between birth weight and eGFR in a Dutch cohort of middle-aged men and women. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 6,671 participants in the Netherlands Epidemiology of Obesity (NEO) Study. Replication study using data for 133,814 participants studied by the CKDGen consortium. EXPOSURE Birth weight was self-reported and also based on an instrumental variable, 59 birth weight-associated genetic variants, derived from an independent data source. OUTCOME eGFR at the age of 45 to 65 years. ANALYTICAL APPROACH We assessed the association between self-reported birth weight and eGFR in the NEO Study using multivariable linear regression, adjusted for age, sex, education, smoking, and alcohol use. The effect of the instrument on eGFR was estimated using separate 2-sample Mendelian randomization analyses: one using individual data from the NEO cohort and one using summary data from the CKDGen consortium. RESULTS At baseline, mean eGFR was 86±12.4 (SD) mL/min/1.73m2. After multivariable adjustment, self-reported birth weight was not associated with kidney function in middle age. Two-sample Mendelian randomization analysis showed that in the NEO cohort, for each 500-g lower birth weight defined using genetic variants, there was a 3.7 (95% CI, 0.5-6.9)-mL/min/1.73m2 lower eGFR at the age of 45 to 65 years. However, using CKDGen summary-level data, there was a smaller nonsignificant relationship between birth weight and eGFR. LIMITATIONS Birth weight was self-reported. CONCLUSIONS Lower birth weight defined using genetic variants was associated with lower eGFRs in Dutch middle-aged adults. However, this finding was not replicated within the CKDGen consortium.
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Affiliation(s)
- Kevin Esmeijer
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Aiko P de Vries
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - 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
| | - Johan W de Fijter
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ton J Rabelink
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roelof A J Smit
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ellen K Hoogeveen
- Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Nephrology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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68
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Christen T, Trompet S, Rensen PCN, Willems van Dijk K, Lamb HJ, Jukema JW, Rosendaal FR, le Cessie S, de Mutsert R. The role of inflammation in the association between overall and visceral adiposity and subclinical atherosclerosis. Nutr Metab Cardiovasc Dis 2019; 29:728-735. [PMID: 31138500 DOI: 10.1016/j.numecd.2019.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/23/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS Inflammation may underlie the association between obesity, atherosclerosis and cardiovascular disease. We investigated to what extent markers of inflammation mediate associations between overall and visceral body fat and subclinical atherosclerosis. METHODS AND RESULTS In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study we estimated total body fat (TBF) by bio-impedance analysis, carotid artery intima media thickness (cIMT) by ultrasound, C-reactive protein (hs-CRP) and glycoprotein acetyls (GlycA) concentrations in fasting blood samples (n = 5627), and visceral adipose tissue (VAT) by magnetic resonance imaging (n = 2247). We examined associations between TBF and VAT, and cIMT using linear regression, adjusted for potential confounding factors, and for mediators: cardiometabolic risk factors (blood pressure, glucose and low-density lipoprotein cholesterol), and inflammation using CRP and GlycA as proxies. Mean (SD) cIMT was 615 (90) μm. Per SD of TBF (8%), cIMT was 19 μm larger (95% confidence interval, CI: 10, 28). This association was 17 μm (95% CI: 8, 27) after adjustment for cardiometabolic risk factors, and did not change after adjustment for markers of inflammation. Per SD (56 cm2) VAT, cIMT was 9 μm larger (95% CI: 2, 16) which changed to 5 μm (95% CI: -3, 12) after adjustment for cardiometabolic risk factors, and did not change after adjustment for inflammatory markers. CONCLUSION Our results suggest that associations between measures of overall and visceral body fat and subclinical atherosclerosis are not mediated by inflammation as measured by CRP and GlycA. Obesity may exert cardiovascular risk via other markers of systemic inflammation.
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Affiliation(s)
- T Christen
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO Box 9600, 2300, RC, Leiden, the Netherlands.
| | - S Trompet
- Department of Medicine, Division of Gerontology and Geriatrics, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands
| | - P C N Rensen
- Department of Medicine, Division of Endocrinology, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands
| | - K Willems van Dijk
- Department of Medicine, Division of Endocrinology, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands; Department of Human Genetics, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands
| | - H J Lamb
- Department of Radiology, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands
| | - J W Jukema
- Department of Cardiology, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO Box 9600, 2300, RC, Leiden, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO Box 9600, 2300, RC, Leiden, the Netherlands; Department of Biomedical Data Sciences, LUMC, PO Box 9600, 2300, RC, Leiden, the Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO Box 9600, 2300, RC, Leiden, the Netherlands
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Noordam R, Ramkisoensing A, Loh NY, Neville MJ, Rosendaal FR, Willems van Dijk K, van Heemst D, Karpe F, Christodoulides C, Kooijman S. Associations of Outdoor Temperature, Bright Sunlight, and Cardiometabolic Traits in Two European Population-Based Cohorts. J Clin Endocrinol Metab 2019; 104:2903-2910. [PMID: 30759251 PMCID: PMC6543772 DOI: 10.1210/jc.2018-02532] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/07/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Seasonal variation in cold and light exposure may influence metabolic health. OBJECTIVE We assessed the associations of bright sunlight and outdoor temperature with measures of glucose and lipid metabolism in two populations of middle-aged European subjects. DESIGN Cross-sectional study. SETTING Two population-based European cohorts. PARTICIPANTS Middle-aged nondiabetic subjects from the Oxford Biobank (OBB; N = 4327; mean age, 41.4 years) and the Netherlands Epidemiology of Obesity (NEO) study (N = 5899; mean age, 55.6 years). INTERVENTIONS Data on outdoor bright sunlight and temperature collected from local weather stations. MAIN OUTCOME MEASURES Insulin resistance and fasting lipid levels. Multivariable regression analyses were adjusted for age, sex, percentage body fat, season, and either outdoor temperature or bright sunlight. RESULTS In the OBB cohort, increased bright sunlight exposure was associated with lower fasting insulin [-1.27% (95% CI, -2.09 to -0.47%) per extra hour of bright sunlight], lower homeostatic model assessment for insulin resistance (-1.36%; 95% CI, -2.23 to -0.50), lower homeostatic model assessment for β-cell function (-0.80%; 95% CI, -1.31 to -0.30), and lower triglyceride (-1.28%; 95% CI, -2.07 to -0.50) levels. In the NEO cohort generally unidirectional but weaker associations were observed. No associations between outdoor temperature and measures of glucose or lipid metabolism were detected following adjustment for bright sunlight. CONCLUSIONS Bright sunlight, but not outdoor temperature, might be associated with increased insulin sensitivity and lower triglyceride levels.
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Affiliation(s)
- Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Ashna Ramkisoensing
- Department of Molecular Cell Biology, Division of Neurophysiology, Leiden University Medical Center, Leiden, Netherlands
| | - Nellie Y Loh
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Matt J Neville
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
- Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Ko Willems van Dijk
- Department of Human Genetics, Leiden University Medical Center, Leiden, Netherlands
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Fredrik Karpe
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, United Kingdom
- Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
| | - Constantinos Christodoulides
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom
- Oxford University Hospitals Foundation Trust, Oxford, United Kingdom
- Correspondence and Reprint Requests: Constantinos Christodoulides, MD, PhD, Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Churchill Hospital, Headington OX3 7LE, United Kingdom. E-mail:
| | - Sander Kooijman
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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Antonakos CL, Coulton CJ, Kaestner R, Lauria M, Porter DE, Colabianchi N. Built Environment Exposures of Adults in the Moving to Opportunity Experiment. HOUSING STUDIES 2019; 35:703-719. [PMID: 32461709 PMCID: PMC7252208 DOI: 10.1080/02673037.2019.1630560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 05/25/2023]
Abstract
This paper describes environmental exposures of adult participants in the Moving to Opportunity for Fair Housing (MTO) experiment over a four to seven year period from baseline to the interim evaluation. The MTO experiment randomized participants living in public housing or private assisted housing at baseline into experimental and control groups and provided a housing voucher for experimental group participants to move to neighborhoods with less than 10 percent of the population below the poverty line. However, few studies have examined how this move affected exposures to health promoting environments. We used data on residential locations of MTO participants and archival data on the built and food environment to construct environmental exposure variables. MTO participants in the experimental and Section 8 groups lived in neighborhoods with higher food prices, less high intensity development and more open space relative to the control group. The findings suggest that housing policies can have potential health consequences by altering health-related environmental exposures.
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Affiliation(s)
| | - Claudia J. Coulton
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University. Cleveland OH
| | - Robert Kaestner
- Institute of Government and Public Affairs, University of Illinois, Chicago, Illinois
| | - Mickey Lauria
- College of Architecture, Arts and Humanities, Clemson University, Clemson, SC
| | - Dwayne E. Porter
- Arnold School of Public Health, University of South Carolina, Columbia, SC
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Vrinten C, Gallagher A, Waller J, Marlow LAV. Cancer stigma and cancer screening attendance: a population based survey in England. BMC Cancer 2019; 19:566. [PMID: 31185949 PMCID: PMC6561035 DOI: 10.1186/s12885-019-5787-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/31/2019] [Indexed: 02/07/2023] Open
Abstract
Background Cancer-related stigma attracts considerable research interest, but few studies have examined stigmatisation in the healthy population. Qualitative studies suggest that stigma can discourage people from attending cancer screening. We aimed to quantify the prevalence and socio-demographic patterning of cancer stigma in the general population and to explore its association with cancer screening attendance. Methods In 2016, 1916 adults aged 18–70 years took part in home-based interviews in England. Measures assessed demographic characteristics, self-reported screening uptake for cervical (n = 681), breast (n = 326) and colorectal cancer (n = 371), and cancer stigma. Cancer stigma was measured with the validated Cancer Stigma Scale which assesses six subdomains (Severity, Personal Responsibility, Awkwardness, Avoidance, Policy Opposition, and Financial Discrimination), from which a mean score was calculated. Logistic regression analyses examined the association between cancer stigma and having been screened as recommended versus not. Results Levels of cancer stigma were low, but varied across the six subdomains. Items regarding the severity of a cancer diagnosis attracted the highest levels of agreement (30–51%), followed by statements about the acceptability of making financial decisions on the basis of a cancer diagnosis such as allowing banks to refuse a mortgage (16–31%) and policy opposition statements such as not having a responsibility to provide the best possible care for cancer patients (10–17%). A similar proportion anticipated feeling awkward around someone with cancer (10–17%). Only 8–11% agreed with personal responsibility statements, such as that a person with cancer is to blame for their condition, while 4–5% of adults anticipated avoiding someone with cancer. Stigma was significantly higher in men (p < .05) and in those from ethnic minority backgrounds (p < .001). Higher cancer stigma was associated with not being screened as recommended for all three screening programmes (cervical: adjusted OR 1.59, 95% CI 1.15–2.20; breast: adjusted OR = 1.97, 95% CI 1.17–3.32; colorectal: adjusted OR = 1.59, 95% CI 1.06–2.38). Conclusions Cancer stigma is generally low, but some aspects of stigma are more prevalent than others. Stigma is more prevalent in certain population subgroups and is negatively associated with cancer screening uptake. These benchmark findings may help track and reduce cancer stigma over time. Electronic supplementary material The online version of this article (10.1186/s12885-019-5787-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Vrinten
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Ailish Gallagher
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jo Waller
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Laura A V Marlow
- Cancer Communication and Screening Group, Department of Behavioural Science and Health, UCL, Gower Street, London, WC1E 6BT, UK
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The Association between Habitual Sleep Duration and Sleep Quality with Glycemic Traits: Assessment by Cross-Sectional and Mendelian Randomization Analyses. J Clin Med 2019; 8:jcm8050682. [PMID: 31096629 PMCID: PMC6572144 DOI: 10.3390/jcm8050682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/03/2019] [Accepted: 05/13/2019] [Indexed: 12/28/2022] Open
Abstract
Evidence on whether habitual sleep duration and sleep quality are associated with increased insulin resistance is inconsistent. Here, we investigated the associations between different measures of habitual sleep with glycemic traits through cross-sectional and Mendelian randomization (MR) analyses. We assessed the associations of sleep duration and sleep quality with glycemic traits using multivariable linear regression models adjusted for potential confounders in 4672 middle-aged (45–65 years; 48% men) nondiabetic participants of the Netherlands Epidemiology of Obesity (NEO) study. Genetic variants for total, short, and long sleep duration were used as instrumental variables in MR analyses using summary-level data of glycemic traits in nondiabetic individuals (MAGIC; n = 58,074). In cross-sectional analyses, shortest sleepers (median 5.0 h of sleep per night) had 14.5% (95% confidence interval (CI): 2.0; 28.6%) higher fasting insulin level and 16.3% (95% CI: 2.7; 31.7%) higher HOMA-β. Bad sleep quality was associated with higher insulin resistance (e.g., 14.3% (95% CI: 4.7; 24.9%) higher HOMA-IR). All these associations disappeared after adjustment for BMI and the risk of sleep apnea. MR analyses did not indicate a causal association between total, short or long sleep duration and glycemic traits. Therefore, our used measures of habitual sleep duration and sleep quality are unlikely to directly associate with insulin resistance.
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Neeland IJ, Boone SC, Mook‐Kanamori DO, Ayers C, Smit RAJ, Tzoulaki I, Karaman I, Boulange C, Vaidya D, Punjabi N, Allison M, Herrington DM, Jukema JW, Rosendaal FR, Lamb HJ, van Dijk KW, Greenland P, de Mutsert R. Metabolomics Profiling of Visceral Adipose Tissue: Results From MESA and the NEO Study. J Am Heart Assoc 2019; 8:e010810. [PMID: 31017036 PMCID: PMC6512086 DOI: 10.1161/jaha.118.010810] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/19/2019] [Indexed: 12/22/2022]
Abstract
Background Identifying associations between serum metabolites and visceral adipose tissue ( VAT ) could provide novel biomarkers of VAT and insights into the pathogenesis of obesity-related diseases. We aimed to discover and replicate metabolites reflecting pathways related to VAT . Methods and Results Associations between fasting serum metabolites and VAT area (by computed tomography or magnetic resonance imaging) were assessed with cross-sectional linear regression of individual-level data from participants in MESA (Multi-Ethnic Study of Atherosclerosis; discovery, N=1103) and the NEO (Netherlands Epidemiology of Obesity) study (replication, N=2537). Untargeted 1H nuclear magnetic resonance metabolomics profiling of serum was performed in MESA, and metabolites were replicated in the NEO study using targeted 1H nuclear magnetic resonance spectroscopy. A total of 30 590 metabolomic spectral variables were evaluated. After adjustment for age, sex, race/ethnicity, socioeconomic status, smoking, physical activity, glucose/lipid-lowering medication, and body mass index, 2104 variables representing 24 nonlipid and 49 lipid/lipoprotein subclass metabolites remained significantly associated with VAT ( P=4.88×10-20-1.16×10-3). These included conventional metabolites, amino acids, acetylglycoproteins, intermediates of glucose and hepatic metabolism, organic acids, and subclasses of apolipoproteins, cholesterol, phospholipids, and triglycerides. Metabolites mapped to 31 biochemical pathways, including amino acid substrate use/metabolism and glycolysis/gluconeogenesis. In the replication cohort, acetylglycoproteins, branched-chain amino acids, lactate, glutamine (inversely), and atherogenic lipids remained associated with VAT ( P=1.90×10-35-8.46×10-7), with most associations remaining after additional adjustment for surrogates of VAT (glucose level, waist circumference, and serum triglycerides), reflecting novel independent associations. Conclusions We identified and replicated a metabolite panel associated with VAT in 2 community-based cohorts. These findings persisted after adjustment for body mass index and appear to define a metabolic signature of visceral adiposity.
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Affiliation(s)
- Ian J. Neeland
- Division of CardiologyDepartment of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Sebastiaan C. Boone
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Dennis O. Mook‐Kanamori
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
- Department of Public Health and Primary CareLeiden University Medical CenterLeidenthe Netherlands
| | - Colby Ayers
- Department of Clinical SciencesUniversity of Texas Southwestern Medical CenterDallasTX
| | - Roelof A. J. Smit
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Ioanna Tzoulaki
- Department of Epidemiology and BiostatisticsImperial College LondonLondonUnited Kingdom
| | - Ibrahim Karaman
- Department of Epidemiology and BiostatisticsImperial College LondonLondonUnited Kingdom
| | | | | | - Naresh Punjabi
- Department of MedicineJohns Hopkins UniversityBaltimoreMD
| | - Matthew Allison
- Department of Family Medicine and Public HealthUniversity of California San DiegoLa JollaCA
| | | | - J. Wouter Jukema
- Department of CardiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Hildo J. Lamb
- Department of RadiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Ko Willems van Dijk
- Department of Human GeneticsLeiden University Medical CenterLeidenthe Netherlands
- Department of Internal MedicineLeiden University Medical CenterLeidenthe Netherlands
- Einthoven Laboratory for Experimental Vascular MedicineLeiden University Medical CenterLeidenthe Netherlands
| | - Philip Greenland
- Department of Preventive MedicineNorthwestern UniversityChicagoIL
| | - Renée de Mutsert
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
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van Eekelen E, Beulens JWJ, Geelen A, Schrauwen-Hinderling VB, Lamb H, de Roos A, Rosendaal F, de Mutsert R. Consumption of Alcoholic and Sugar-Sweetened Beverages is Associated with Increased Liver Fat Content in Middle-Aged Men and Women. J Nutr 2019; 149:649-658. [PMID: 30949667 DOI: 10.1093/jn/nxy313] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/26/2018] [Accepted: 12/05/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Fatty liver is the leading cause of chronic liver diseases and increases the risk of cardiovascular disease. Besides alcohol consumption, energy-containing nonalcoholic beverages may contribute to liver fat accumulation. OBJECTIVE We aimed to study the consumption of alcoholic and nonalcoholic beverages and their mutual replacement in relation to hepatic triglyceride content (HTGC) in middle-aged men and women. METHODS In this cross-sectional analysis, HTGC was assessed by proton magnetic resonance spectroscopy. Habitual consumption of alcoholic and nonalcoholic beverages was assessed using a validated food-frequency questionnaire. All beverages were converted to standard servings and to percentage of total energy intake (En%). We performed linear regression to examine the association of alcoholic and nonalcoholic beverages with HTGC, adjusted for age, sex, smoking, education, ethnicity, physical activity, total energy intake, and total body fat. We studied replacement of alcoholic beverages with nonalcoholic beverages per 1 serving/d and per 5 En%/d. RESULTS After exclusion of individuals with missing values, 1966 participants (47% men) were analyzed, with a mean ± SD age of 55 ± 6 y, BMI of 26 ± 4 kg/m2, and HTGC of 5.7% ± 7.9%. Each extra alcoholic serving per day was associated with more liver fat (1.09 times; 95% CI: 1.05, 1.12). Replacing 5 En% of alcoholic beverages with milk was associated with less liver fat (0.89 times; 95% CI: 0.81, 0.98), whereas replacement with 5 En% of sugar-sweetened beverages was associated with liver fat to an extent similar to alcoholic beverages (1.00 times; 95% CI: 0.91, 1.09). CONCLUSION In a population-based cohort, consumption of each extra daily alcoholic beverage was associated with more liver fat. In isocaloric replacement of alcoholic beverages, milk was associated with less liver fat, whereas sugar-sweetened beverages were equally associated with liver fat. This suggests that intake of alcohol and sugars may contribute to liver fat accumulation. This trial was registered at clinicaltrials.gov as NCT03410316.
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Affiliation(s)
- Esther van Eekelen
- Departments of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Joline W J Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU Medical Center, Amsterdam, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University & Research, Wageningen, Netherlands
| | - Vera B Schrauwen-Hinderling
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, NUTRIM School of Nutrition and Translational Research in Metabolism.,Department of Radiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Hildo Lamb
- Departments of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Albert de Roos
- Departments of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Frits Rosendaal
- Departments of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Renée de Mutsert
- Departments of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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Iqbal MH. Disparities of health service for the poor in the coastal area: does Universal health coverage reduce disparities? JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1575683. [PMID: 30815240 PMCID: PMC6383612 DOI: 10.1080/20016689.2019.1575683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 01/18/2019] [Accepted: 01/25/2019] [Indexed: 06/09/2023]
Abstract
Background & Objective: Poor people, in general, get poor quality of health services. The situation is very much worsening for the poor who live in the remote areas in the coastal belt of Bangladesh as health care facilities and services are often less complete, farther away, and therefore most costly to reach than in urban hospitals and physician. Ensure of better health service for the poor, it is essential to examine the effectiveness of Universal Health Coverage (UHC). This study sets its objectives to evaluate the health service for the poor in the coastal area of Bangladesh and develop an approach of management strategy. Methods: This study followed a two-stage cluster sampling technique and carried out a household survey through the open-ended questionnaire. In addition, the study applied the logistic regression model to generate empirically supported assessments. Results: Result from the disparity rate ratio (DRR) revealed that there is a big health care disparity of different income groups like poor and rich. Furthermore, results from the model demonstrated that Medicaid, Medicare, Social Health Insurance, Telemedicine and Capitation under the provision Universal Health Coverage (UHC) are statistically significant compared to reduce the health care disparity. Conclusion: UHC becomes a critical issue for improved and quality health care system for all the groups especially, the poor in coastal Bangladesh. This study showed that Medicaid, Medicare and Social Health Insurance and Capitation perform well to provide better health care facilities for all.
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Affiliation(s)
- Md. Hafiz Iqbal
- Centre for Higher Studies and Research (CHSR), Bangladesh University of Professionals (BUP), Dhaka, Bangladesh
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76
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van Eekelen E, Geelen A, Alssema M, Lamb HJ, de Roos A, Rosendaal FR, de Mutsert R. Sweet Snacks Are Positively and Fruits and Vegetables Are Negatively Associated with Visceral or Liver Fat Content in Middle-Aged Men and Women. J Nutr 2019; 149:304-313. [PMID: 30657914 PMCID: PMC6374148 DOI: 10.1093/jn/nxy260] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/30/2018] [Accepted: 09/11/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) are major risk factors for cardiometabolic diseases. OBJECTIVE We aimed to investigate the association of dietary intake of the main food groups with VAT and HTGC in middle-aged men and women. METHODS We used data from the Netherlands Epidemiology of Obesity study, a population-based study including 6671 participants aged 45-65 y at baseline. In this cross-sectional analysis, VAT and HTGC were assessed by magnetic resonance imaging and spectroscopy, respectively, as the primary outcomes. Habitual intake of main food groups (dairy, meat, fish, fruits and vegetables, sweet snacks, and fats and oils) was estimated through the use of a food-frequency questionnaire. We examined associations of intake of different food groups with VAT and HTGC by linear regression analysis stratified by sex and adjusted for age, smoking, education, ethnicity, physical activity, basal metabolic rate, energy-restricted diet, menopausal state, and total energy intake. RESULTS In women, a 100-g/d higher intake of dairy was associated with 2.0 cm2 less VAT (95% CI: -3.4, -0.7 cm2) and a 0.95-fold lower HTGC (95% CI: 0.90-, 0.99-fold). Moreover, a 100-g/d higher intake of fruit and vegetables was associated with 1.6 cm2 less VAT (95% CI: -2.9, -0.2 cm2) in women. Fruit and vegetables were negatively associated (0.95; 95% CI: 0.91, 1.00) with HTGC, and sweet snacks were positively associated (1.29; 95% CI: 1.03, 1.63). Patterns were weaker but similar in men. Fish intake was not associated with VAT or HTGC and plant-based fat and oil intake were only associated with VAT after adjustment for total body fat. CONCLUSIONS Despite some variation in the strength of the associations between men and women, dietary intake of sweet snacks was positively associated with HTGC, and fruit and vegetable intake were negatively associated with visceral and liver fat content. Prospective studies are needed to confirm these results. The Netherlands Epidemiology of Obesity study is registered at clinicaltrials.gov with identifier NCT03410316.
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Affiliation(s)
- Esther van Eekelen
- Departments of Clinical Epidemiology and,Address correspondence to EvE (e-mail: )
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University & Research, Wageningen, Netherlands
| | - Marjan Alssema
- Unilever Research and Development, Vlaardingen, Netherlands,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Hildo J Lamb
- Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Albert de Roos
- Radiology, Leiden University Medical Center, Leiden, Netherlands
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Predictors of Quality of Life in Montreal, Canada: A Longitudinal Study. Community Ment Health J 2019; 55:189-201. [PMID: 30284139 DOI: 10.1007/s10597-018-0340-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
This study sought to assess factors associated with quality of life (QoL), and predictive of improvements in QoL over time, in a population-based cohort study. A 4-year longitudinal survey was administered to 2433 individuals at the study baseline; of these, 1828 individuals participated in Wave 2, and 1303 participated in Wave 3. QoL was measured by the Satisfaction with Life Domains Scale. Thirty-two variables were correlated with baseline QoL and together explained 58.2% of the variance. Eleven variables were independent predictors of improvement in QoL over time. Among these variables, social support and stress/coping showed the strongest association with QoL, and neighbourhood characteristics had an additional influence. Multidimensional modelling of a broad spectrum of the factors related to QoL enabled situating mental health and well-being in an ecological system with attendant implications for public health and social policy intervention to facilitate improvement of QoL in the population.
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78
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Nguyen VK, Colacino JA, Arnot JA, Kvasnicka J, Jolliet O. Characterization of age-based trends to identify chemical biomarkers of higher levels in children. ENVIRONMENT INTERNATIONAL 2019; 122:117-129. [PMID: 30528102 PMCID: PMC6903703 DOI: 10.1016/j.envint.2018.10.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/01/2018] [Accepted: 10/21/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND Chemical biomarker concentrations are driven by complex interactions between chemical use patterns, exposure pathways, and toxicokinetic parameters such as biological half-lives. Criteria to differentiate legacy from current exposures are helpful for interpreting variation in age-based and time trends of chemical exposure and identifying chemicals to which children are highly exposed. A systematic approach is needed to study temporal trends for a wide range of chemicals in the US population. OBJECTIVES Using National Health and Nutrition Examination Survey (NHANES) data on measured biomarker concentrations for 141 chemicals from 1999 to 2014, we aim to 1) understand the influence of temporal determinants, in particular time trends, biological half-lives, and restriction dates on age-based trends, 2) systematically define an age-based pattern to identify chemicals with ongoing and high exposure in children, and 3) characterize how age-based trends for six Per- and Polyfluoroalkyl Substances (PFASs) are changing over time. METHODS We performed an integrated analysis of biological half-lives and restriction dates, compared distributions of chemical biomarker concentrations by age group, and then applied a series of regression models to evaluate the linear (βage) and nonlinear (βage2) relationships between age and chemical biomarker levels. RESULTS For restricted chemicals, a minimum persistence of 1 year in the human body is needed to observe substantial differences between the less exposed young population and historically exposed adults. We define a metric ( [Formula: see text] ) that identifies several phthalates, brominated flame retardants, pesticides, and metals such as lead and tungsten as elevated and ongoing exposures in children. While a substantial reduction in children's exposures was reflected in PFOS and PFOA, levels of PFNA and PFHxS in children were higher in 2013-2014 compared to those in 1999-2000. CONCLUSIONS Integrating a series of regression models with systemized stratified analyses by age group enabled us to define an age-based pattern to identify chemicals that are of higher levels in children.
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Affiliation(s)
- Vy Kim Nguyen
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, Medical School, University of Michigan, Ann Arbor, MI, USA.
| | - Justin A Colacino
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, Medical School, University of Michigan, Ann Arbor, MI, USA; Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jon A Arnot
- ARC Arnot Research & Consulting Inc, Toronto, Ontario, Canada
| | - Jacob Kvasnicka
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Olivier Jolliet
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Computational Medicine and Bioinformatics, Medical School, University of Michigan, Ann Arbor, MI, USA
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79
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Elffers T, Trompet S, de Mutsert R, Maan A, Lamb H, Macfarlane P, Rosendaal F, Jukema J. Borderline Q-waves in individuals without overt cardiovascular disease: Relations with adiposity, subclinical atherosclerosis and vascular stiffness. Int J Cardiol 2019; 274:331-336. [DOI: 10.1016/j.ijcard.2018.08.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/16/2018] [Accepted: 08/29/2018] [Indexed: 01/18/2023]
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80
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Bulka CM, Persky VW, Daviglus ML, Durazo-Arvizu RA, Argos M. Multiple metal exposures and metabolic syndrome: A cross-sectional analysis of the National Health and Nutrition Examination Survey 2011-2014. ENVIRONMENTAL RESEARCH 2019; 168:397-405. [PMID: 30388496 PMCID: PMC6274587 DOI: 10.1016/j.envres.2018.10.022] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND Epidemiologic studies suggest toxic metals are linked with diabetes and cardiovascular disease, while experimental studies indicate nutritionally essential metals are involved in the metabolism of macronutrients and defense against oxidative stress. OBJECTIVES We sought to evaluate how essential and toxic metals are cross-sectionally related to metabolic syndrome, a clustering of cardiometabolic conditions. METHODS Using data from the 2011-2014 National Health and Nutrition Examination Survey (n = 1088), we characterized metal concentrations as measured in spot urine (arsenic, cadmium, and inorganic/elemental mercury), whole blood (manganese, lead, methylmercury, and selenium), and serum (copper and zinc) samples. Principal component analysis was performed to derive patterns of exposures. Metabolic syndrome was defined according to the 2009 Joint Scientific Statement as the presence of ≥ 3 of the following conditions: high blood pressure, high triglycerides, low HDL cholesterol, high fasting glucose, and abdominal obesity. RESULTS After adjustment for potential confounders, prevalence ratios for metabolic syndrome comparing the highest to the lowest quartiles were 1.41 (95% CI: 1.18-1.67) for the arsenic-inorganic/elemental mercury pattern, 0.95 (0.78-1.16) for the methylmercury-manganese pattern, 0.73 (0.57-0.94) for the cadmium-lead pattern, 0.91 (0.76-1.10) for the copper pattern, and 1.36 (1.13-1.63) for the selenium-zinc pattern. The positive associations observed for the arsenic-inorganic/elemental mercury pattern were due to an elevated prevalence of high blood pressure, low HDL cholesterol, and high triglycerides among those with greater exposures. Associations for the selenium-zinc pattern were driven by a positive relationship with high triglycerides. Greater lead-cadmium co-exposures were related to a lower prevalence of dyslipidemia and abdominal obesity. CONCLUSIONS These cross-sectional findings suggest both toxic and essential metal exposures may contribute to cardiometabolic health, but need to be confirmed with prospective data.
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Affiliation(s)
- Catherine M Bulka
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA.
| | - Victoria W Persky
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago, IL, USA
| | - Ramon A Durazo-Arvizu
- Institute for Minority Health Research, University of Illinois College of Medicine, Chicago, IL, USA
| | - Maria Argos
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
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81
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Soghaier MA, Abdelgadir DM, Abdelkhalig SM, Kafi H, Zarroug IMA, Sall AA, Eldegai MH, Elageb RM, Osman MM, Khogali H. Evidence of pre-existing active Zika virus circulation in Sudan prior to 2012. BMC Res Notes 2018; 11:906. [PMID: 30567583 PMCID: PMC6299991 DOI: 10.1186/s13104-018-4027-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The purpose of this study is to provide the first evidence of Zika virus circulation (ZIK) in Sudan. Zika virus was first isolated in the Zika forest of Uganda in 1947, and in 2016, the World Health Assembly declared it a public health emergency of international concern. The discovery of Zika virus circulation in Sudan came as a secondary finding in a 2012 country-wide yellow fever prevalence study, when laboratory tests were done to exclude cross-reactions between flaviviruses. The study was cross-sectional community-based, with randomly selected participants through multi-stage cluster sampling. A sub-set of samples were tested for the Zika virus using ELISA, and the ones that demonstrated reactive results were subsequently tested by PRNT. RESULTS The prevalence of Zika IgG antibodies among ELISA-tested samples was 62.7% (59.4 to 66.1, 95% CI), and only one sample was found positive when tested by PRNT. This provided the first documented evidence for the pre-existing circulation of Zika virus circulation in Sudan. This evidence provides the foundation for future research in this field, and further structured studies should be conducted to determine the epidemiology and burden of the disease.
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Affiliation(s)
- Mohammed A. Soghaier
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
| | - Deena M. Abdelgadir
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
| | - Sozan M. Abdelkhalig
- The Department of Epidemiology, National Public Health Laboratory, Federal Ministry of Heath, Khartoum, Sudan
| | - Hamoda Kafi
- Department of Integrated Vector Management, Federal Ministry of Health, Khartoum, Sudan
| | - Isam M. A. Zarroug
- The Department of Medical Entomology, National Public Health Laboratory, Federal Ministry of Health, Khartoum, Sudan
| | | | - Mawahib H. Eldegai
- The Department of Epidemiology, National Public Health Laboratory, Federal Ministry of Heath, Khartoum, Sudan
| | - Rehab M. Elageb
- The Department of Epidemiology, National Public Health Laboratory, Federal Ministry of Heath, Khartoum, Sudan
| | - Muntasir M. Osman
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
| | - Hayat Khogali
- Epidemiology and Zoonotic Diseases Department, Federal Ministry of Health, Osman Digna Street with Nile Avenue, PO Box 303, 1111 Khartoum, Sudan
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82
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Rafiq R, Walschot F, Lips P, Lamb HJ, de Roos A, Rosendaal FR, Heijer MD, de Jongh RT, de Mutsert R. Associations of different body fat deposits with serum 25-hydroxyvitamin D concentrations. Clin Nutr 2018; 38:2851-2857. [PMID: 30635144 DOI: 10.1016/j.clnu.2018.12.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Obesity is a well-established risk factor of vitamin D deficiency. However, it is unclear which fat deposit is most strongly related to serum 25-hydroxyvitamin D (25(OH)D) concentrations. Our aim was to distinguish the specific contributions of total body fat (TBF), abdominal subcutaneous adipose tissue (aSAT), visceral adipose tissue (VAT) and hepatic fat on 25(OH)D concentrations. METHODS We performed a cross-sectional analysis of the Netherlands Epidemiology of Obesity study, a population-based cohort study. We used linear regression analyses to examine associations of TBF, aSAT, VAT (n = 2441) and hepatic fat (n = 1980) with 25(OH)D concentrations. Standardized values were used to compare the different fat deposits. RESULTS Mean (SD) age and 25(OH)D concentrations of the study population was 56 (6) years and 70.8 (24.2) nmol/L, respectively. TBF was inversely associated with 25(OH)D concentrations in women, but not in men. One percent higher TBF was associated with 0.40 nmol/L (95%CI: -0.67 to -0.13) lower 25(OH)D. aSAT was not associated with 25(OH)D concentrations. One cm2 higher VAT was associated with 0.05 nmol/L (-0.09 to -0.02) lower 25(OH)D in men, and 0.06 nmol/L (-0.10 to -0.01) lower 25(OH)D in women. Hepatic fat was only associated with 25(OH)D in men. A tenfold increase in hepatic fat was associated with 6.21 nmol/L (-10.70 to -1.73) lower 25(OH)D. Regressions with standardized values showed VAT was most strongly related to 25(OH)D. CONCLUSIONS In women, TBF and VAT were inversely related to 25(OH)D concentrations. In men, VAT and hepatic fat were inversely related to 25(OH)D concentrations. In both groups, VAT was most strongly associated with 25(OH)D concentrations.
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Affiliation(s)
- Rachida Rafiq
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands.
| | - Floor Walschot
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Paul Lips
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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83
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Kim MH, Kim HN, Choi WS. The association between subclinical inflammation and abnormal glucose and lipid metabolisms in normal-weight Korean individuals. Nutr Metab Cardiovasc Dis 2018; 28:1106-1113. [PMID: 30287123 DOI: 10.1016/j.numecd.2018.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUNDS AND AIMS We aimed to reveal the association between subclinical inflammation and metabolic risk factors and to determine the difference in the association between normal-weight and obese Korean individuals. METHODS AND RESULTS Data collected from the Korean National Health and Nutrition Examination Survey (KNHANES) 2015, conducted from January to December 2015, were analyzed. Overall, 4620 subjects were examined and divided into two subgroups: 2987 and 1633 subjects in the normal-weight and obese groups, respectively. The prevalence of obesity in the study population was 34.5% (n = 1633). After multivariate adjustment, impaired fasting glucose (IFG) (odds ratio [OR] 1.22, 95% confidence interval [CI] 1.05-1.42, P = 0.010), high triglyceride (TG) levels (OR 1.29, 95% CI 1.13-1.47, P < 0.001), and low high-density lipoprotein-cholesterol (HDL-C) levels (OR 1.47, 95% CI 1.31-1.64, P < 0.001) were significantly associated with increased high-sensitivity C-reactive protein (hs-CRP) levels in the normal-weight group but not in the obesity group. CONCLUSION Subclinical inflammation was associated with IFG, high TG levels, and low HDL-C levels in normal-weight Korean individuals. Prospective and biochemical research is necessary to clarify the role of subclinical systemic inflammation in individuals with normal body weight and its impact on insulin resistance and abnormal lipid metabolism, which promote the incidence of metabolic syndrome and cardiovascular disease.
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Affiliation(s)
- M-H Kim
- Department of Family Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H-N Kim
- Department of Family Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - W-S Choi
- Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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84
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Bos MM, Noordam R, van den Berg R, de Mutsert R, Rosendaal FR, Blauw GJ, Rensen PCN, Biermasz NR, van Heemst D. Associations of sleep duration and quality with serum and hepatic lipids: The Netherlands Epidemiology of Obesity Study. J Sleep Res 2018; 28:e12776. [PMID: 30324729 PMCID: PMC7379241 DOI: 10.1111/jsr.12776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/09/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
Short and long sleep duration and poor sleep quality may affect serum and hepatic lipid content, but available evidence is inconsistent. Therefore, we aimed to investigate the associations of sleep duration and quality with serum and hepatic lipid content in a large population‐based cohort of middle‐aged individuals. The present cross‐sectional study was embedded in the Netherlands Epidemiology of Obesity (NEO) study and consisted of 4260 participants (mean age, 55 years; proportion men, 46%) not using lipid‐lowering agents. Self‐reported sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index questionnaire (PSQI). Outcomes of this study were fasting lipid profile (total cholesterol, low‐density lipoprotein [LDL]‐cholesterol, high‐density lipoprotein [HDL]‐cholesterol and triglycerides), postprandial triglyceride (response) levels, and hepatic triglyceride content (HTGC) as measured with magnetic resonance spectroscopy. We performed multivariable linear regression analyses, adjusted for confounders and additionally for measures that link to adiposity (e.g. body mass index [BMI] and sleep apnea). We observed that relative to the group with median sleep duration (≈7.0 hr of sleep), the group with shortest sleep (≈5.0 hr of sleep) had 1.5‐fold higher HTGC (95% confidence interval [CI]: 1.0‐2.2). The group with PSQI score ≥ 10 had a 1.1‐fold (95% CI: 1.0‐1.2) higher serum triglyceride level compared with the group with PSQI ≤ 5. However, these associations disappeared after adjustment for BMI and sleep apnea. Therefore, we concluded that previously observed associations of shorter sleep duration and poorer sleep quality with an adverse lipid profile, may be explained by BMI and sleep apnea, rather than by a direct effect of sleep on the lipid profile.
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Affiliation(s)
- Maxime M Bos
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Raymond Noordam
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Rosa van den Berg
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerard Jan Blauw
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Patrick C N Rensen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands.,Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke R Biermasz
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Diana van Heemst
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
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85
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Dekker SA, Noordam R, Biermasz NR, de Roos A, Lamb HJ, Rosendaal FR, Rensen PCN, van Heemst D, de Mutsert R. Habitual Sleep Measures are Associated with Overall Body Fat, and not Specifically with Visceral Fat, in Men and Women. Obesity (Silver Spring) 2018; 26:1651-1658. [PMID: 30277027 DOI: 10.1002/oby.22289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study aimed to investigate the associations of sleep duration and sleep quality with visceral adipose tissue (VAT) in middle-aged individuals. METHODS In this cross-sectional analysis of baseline measurements of the Netherlands Epidemiology of Obesity (NEO) study, participants underwent anthropometry and completed the Pittsburgh Sleep Quality Index (PSQI) for assessing short sleep duration (as sex-specific age-adjusted percentiles) and poor quality (PSQI > 5). VAT was assessed by magnetic resonance imaging in a random subgroup. We performed linear regression analyses to examine associations of short sleep and poor sleep with measures of body fat, adjusted for confounding, including total body fat in models with VAT. RESULTS A total of 5,094 participants (52% women; mean age of 56 [SD 6] years), 1,947 of whom had VAT measurements, were analyzed. The difference in VAT between poor sleep (PSQI > 5) and good sleep (PSQI ≤ 5) was 7.2cm2 (95% CI: 1.2-13.8) in women and 16.1cm2 (95% CI: 6.2-26.0) in men. These differences attenuated toward the null after the adjustment for total body fat. Similar patterns of associations were observed for short sleep (lowest 10% compared with median 60%). CONCLUSIONS Our results suggest that measures of sleep are not specifically associated with a higher amount of VAT.
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Affiliation(s)
- Sigrid A Dekker
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Nienke R Biermasz
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Patrick C N Rensen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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86
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Christen T, Trompet S, Noordam R, van Klinken JB, van Dijk KW, Lamb HJ, Cobbaert CM, den Heijer M, Jazet IM, Jukema JW, Rosendaal FR, de Mutsert R. Sex differences in body fat distribution are related to sex differences in serum leptin and adiponectin. Peptides 2018; 107:25-31. [PMID: 30076861 DOI: 10.1016/j.peptides.2018.07.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/23/2018] [Accepted: 07/29/2018] [Indexed: 01/01/2023]
Abstract
It is debated whether sex differences in adiponectin and leptin are due to sex differences in body fat distribution. In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, associations of measures of body fat and sex with serum adiponectin and leptin concentrations were examined using linear regression analysis (n = 6494, VAT: n = 2516). Sex differences were additionally adjusted for the measure of body fat that was most strongly associated with adiponectin or leptin concentrations. Median adiponectin concentrations in women and men were 10.5 mg/L (IQR, interquartile range: 7.7-13.9) and 6.1 mg/L (IQR: 4.5-8.2), mean difference 4.6 mg/L (95% CI: 4.3, 4.9). Median leptin concentrations in women and men were 19.2 μg/L (IQR: 11.5-30.0) and 7.1 μg/L (IQR: 4.6-11.1), mean difference 15.1 μg/L (95% CI: 14.4, 15.8). VAT was most strongly associated with adiponectin, total body fat percentage was most strongly associated with leptin. After adjustment for VAT, women had 3.8 mg/L (95% CI: 3.3, 4.3) higher adiponectin than men. After adjustment for total body fat percentage, leptin concentrations in women were 0.4 μg/L lower than in men (95% CI: -1.2, 2.0). One genetic variant (rs4731420) was associated with extreme leptin concentrations (>100 μg/L) in women: odds ratio 2.8 (95% CI: 1.7, 4.6). Total body fat percentage was strongly associated with leptin concentrations. Higher leptin concentrations in women than in men were completely explained by differences in total body fat percentage. Visceral fat was associated with adiponectin concentrations, and did not completely explain higher adiponectin concentrations in women than in men.
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Affiliation(s)
- Tim Christen
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Stella Trompet
- Department of Internal Medicine, Section of Gerontology and Geriatrics, PO-Box 9600, 2300RC, LUMC, Leiden, The Netherlands; Department of Cardiology, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, PO-Box 9600, 2300RC, LUMC, Leiden, The Netherlands
| | - Jan B van Klinken
- Department of Human Genetics, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Ko Willems van Dijk
- Department of Human Genetics, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands; Department of Medicine, Division of Endocrinology, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands; Einthoven Laboratory for Vascular and Regenerative Medicine, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Christa M Cobbaert
- Department of Clinical Chemistry and Laboratory Medicine, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Martin den Heijer
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO-Box 9600, 2300RC, Leiden, The Netherlands; Department of Internal Medicine, VU Medical Center, PO-Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Ingrid M Jazet
- Department of Medicine, Division of Endocrinology, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, LUMC, PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO-Box 9600, 2300RC, Leiden, The Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), PO-Box 9600, 2300RC, Leiden, The Netherlands.
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The impact of maternal smoking during pregnancy on childhood asthma: adjusted for exposure misclassification; results from the National Health and Nutrition Examination Survey, 2011-2012. Ann Epidemiol 2018; 28:697-703. [PMID: 30150159 DOI: 10.1016/j.annepidem.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 06/07/2018] [Accepted: 07/23/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE We sought to examine the association between childhood asthma and self-reported maternal smoking during pregnancy (MSDP) after adjusting for a range of exposure misclassification scenarios using a Bayesian approach that incorporated exposure misclassification probability estimates from the literature. METHODS Self-reported MSDP and asthma data were extracted from National Health and Nutrition Examination Survey 2011-2012. The association between self-reported MSDP and asthma was adjusted for exposure misclassification using a Bayesian bias model approach. RESULTS We included 3074 subjects who were 1-15 years of age, including 492 asthma cases. The mean (SD) of age of the participants was 8.5 (4.1) and 7.1 (4.2) years and the number (percentage) of female was 205 (42%) and 1314 (51%) among asthmatic and nonasthmatic groups, respectively. The odds ratio (OR) for the association between self-reported MSDP and asthma in logistic regression adjusted for confounders was 1.28 (95% confidence interval: 0.92, 1.77). In a Bayesian analysis that adjusted for exposure misclassification using external data, we found different ORs between MSDP and asthma by applying different priors (posterior ORs 0.90 [95% credible interval {CRI}: 0.47, 1.60] to 3.05 [95% CRI: 1.73, 5.53] in differential and 1.22 [CRI 95%: 0.62, 2.25] to 1.60 CRI: 1.18, 2.19) in nondifferential misclassification settings. CONCLUSIONS Given the assumptions and the accuracy of the bias model, the estimated effect of MSDP on asthma after adjusting for misclassification was strengthened in many scenarios.
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Adult weight change in relation to visceral fat and liver fat at middle age: The Netherlands epidemiology of obesity study. Int J Obes (Lond) 2018; 43:790-799. [PMID: 30026588 DOI: 10.1038/s41366-018-0163-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/15/2018] [Accepted: 06/15/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVE We aimed to investigate the associations between weight change during adulthood and the amount of abdominal subcutaneous fat, visceral fat, and liver fat at middle age. METHODS The Netherlands Epidemiology of Obesity (NEO) study is a population-based cohort of 6671 middle-aged men and women. We calculated the percentage of weight change during adulthood based on body weight at middle age and recalled body weight at age 20. Abdominal subcutaneous and visceral adipose tissue were assessed by magnetic resonance imaging (MRI), in addition to hepatic triglyceride content by 1H-MR spectroscopy in a random subgroup (maximum of n = 2580). With multivariable linear regression analysis, we examined the associations between categories of adult weight change, body mass index (BMI) at age 20 and measures of abdominal adiposity at middle age, adjusted for age, sex, ethnicity, lifestyle factors, menopausal status, parity, use of medication and total body fat at middle age. RESULTS In 2399 participants (54% women), individuals who gained more than 50% of body weight during adulthood had 1.96 (95% CI: 1.64; 2.33) times more visceral adipose tissue at middle age and 2.39 (95% CI: 1.70, 3.36) times more hepatic triglyceride content than weight maintainers (weight change between -5% and 5%). Associations with abdominal subcutaneous adipose tissue were weaker: participants who gained more than 50% of their body weight had 1.54 (95% CI: 1.38, 1.72) times more abdominal subcutaneous adipose tissue compared with weight maintainers. CONCLUSIONS In this population-based study, adult weight gain was associated with relatively more visceral adipose tissue and hepatic triglyceride content at middle age than abdominal subcutaneous adipose tissue. Overall, our study suggests that weight maintenance during adulthood plays an important role in limiting excess visceral adipose tissue and hepatic triglyceride content at middle age.
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Fuller SD, Mudie LI, Siordia C, Swenor BK, Friedman DS. Nationwide Prevalence of Self-Reported Serious Sensory Impairments and Their Associations with Self-Reported Cognitive and Functional Difficulties. Ophthalmology 2018; 125:476-485. [DOI: 10.1016/j.ophtha.2017.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022] Open
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Tavitian-Exley I, Boily MC, Heimer R, Uusküla A, Levina O, Maheu-Giroux M. Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis. AIDS Behav 2018; 22:1329-1340. [PMID: 28699018 PMCID: PMC5878835 DOI: 10.1007/s10461-017-1836-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Non-medical drug injection is a major risk factor for HIV infection in Russia and Estonia. Multiple drug use (polydrug) has further been associated with increased harms. We compared HIV, injecting and sexual risk associated with polydrug use among people who injected drugs (PWID) in 2012–2013 in Kohtla-Järve (Estonia, n = 591) and St Petersburg (Russia, n = 811). Using latent class analysis, we identified five (poly)drug classes, the largest consisting of single-drug injectors among whom an opioid was the sole drug injected (56% of PWID). The four remaining polydrug classes included polydrug-polyroute injectors who injected and used opiates and stimulants (9%), opiate-stimulant poly-injectors who injected amphetamine-type-stimulants with a primary opiate (7%) and opiate-opioid poly-injectors who injected opioids and opiates (16%). Non-injection stimulant co-users were injectors who also used non-injection stimulants (12%). In multivariable multinomial regressions, all four polydrug classes were associated with greater injection risks than single-drug injection, while opiate-stimulant and opiate-opioid poly-injection were also associated with having multiple sex partners. Riskier behaviours among polydrug-injectors suggest increased potential for transmission of blood-borne and sexually-transmitted infections. In addition to needles/syringes provision, services tailored to PWID drug and risk profiles, could consider drug-appropriate treatment and sexual risk reduction strategies to curb HIV transmission.
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Affiliation(s)
- Isabel Tavitian-Exley
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Robert Heimer
- Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, USA
| | - Anneli Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Olga Levina
- NGO Stellit, St Petersburg, Russian Federation
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
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91
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Dekkers IA, de Mutsert R, Rabelink TJ, Jukema JW, de Roos A, Rosendaal FR, Lamb HJ, de Vries APJ. Associations between normal range albuminuria, renal function and cardiovascular function in a population-based imaging study. Atherosclerosis 2018; 272:94-100. [PMID: 29579673 DOI: 10.1016/j.atherosclerosis.2018.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIMS In patients with impaired renal function and macroalbuminuria, cardiovascular risk factors are highly prevalent, however, whether this is also present in the general population is unclear. We investigated whether normal-range albuminuria and renal function are associated with cardiovascular function in the general population. METHODS In this cross-sectional analysis of the NEO study, urinary albumin-creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), and intima-media thickness were assessed in all participants (n = 6503), and a random subset underwent MRI for pulse wave velocity (n = 2451) and/or cardiac imaging (n = 1138). RESULTS Multiple linear regression analysis was performed while adjusting for sex, age, smoking, mean arterial blood pressure, total body fat, and fasting glucose. After adjustment, albuminuria and renal function were positively associated with left ventricle (LV) mass index (UACR, 0.941 g/m2 [95% CI: 0.21,1.67] p = 0.012; eGFR, 0.748 g/m2 [95% CI: 0.15,1.35] p = 0.015) and LV cardiac index (UACR, 0.056 L/min/m2 [95% CI: 0.00,0.11] p = 0.038; eGFR, 0.080 L/min/m2 [95% CI: 0.03,0.13] p = 0.001). Albuminuria showed a weak association with arterial thickness (UACR, 0.003 mm [95% CI: 0.00,0.01] p = 0.015) and arterial stiffness (UACR, 0.073 m/s [95% CI: 0.01,0.13] p = 0.036), but not with renal function. No associations were observed for LV ejection fraction and LV diastolic function. CONCLUSIONS Normal-range albuminuria was positively associated with LV mass index, LV cardiac index, arterial thickness and arterial stiffness. Our findings support the hypothesis that even within normal range, albuminuria is a marker of cardiovascular health.
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Affiliation(s)
- Ilona A Dekkers
- Leiden University Medical Center, Dept. of Radiology, Leiden, The Netherlands.
| | - Renée de Mutsert
- Leiden University Medical Center, Dept. of Clinical Epidemiology, Leiden, The Netherlands
| | - Ton J Rabelink
- Leiden University Medical Center, Dept. of Internal Medicine, Div. of Nephrology and Transplant Medicine Leiden, The Netherlands
| | - Johan W Jukema
- Leiden University Medical Center, Dept. of Cardiology Leiden, The Netherlands
| | - Albert de Roos
- Leiden University Medical Center, Dept. of Radiology, Leiden, The Netherlands
| | - Frits R Rosendaal
- Leiden University Medical Center, Dept. of Clinical Epidemiology, Leiden, The Netherlands
| | - Hildo J Lamb
- Leiden University Medical Center, Dept. of Radiology, Leiden, The Netherlands
| | - Aiko P J de Vries
- Leiden University Medical Center, Dept. of Internal Medicine, Div. of Nephrology and Transplant Medicine Leiden, The Netherlands
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92
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Dekkers IA, de Mutsert R, de Vries APJ, Rosendaal FR, Cannegieter SC, Jukema JW, le Cessie S, Rabelink TJ, Lamb HJ, Lijfering WM. Determinants of impaired renal and vascular function are associated with elevated levels of procoagulant factors in the general population. J Thromb Haemost 2018; 16:519-528. [PMID: 29285859 DOI: 10.1111/jth.13935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Indexed: 12/11/2022]
Abstract
Essentials Why venous thrombosis is more prevalent in chronic kidney disease is unclear. We investigated whether renal and vascular function are associated with hypercoagulability. Coagulation factors showed a procoagulant shift with impaired renal and vascular function. This suggests that renal and vascular function play a role in the etiology of thrombosis. SUMMARY Background Impaired renal and vascular function have been associated with venous thrombosis, but the mechanism is unclear. Objectives We investigated whether estimated glomerular filtration rate (eGFR), urinary albumin-creatinine ratio (UACR), and pulse wave velocity (PWV) are associated with a procoagulant state. Methods In this cross-sectional analysis of the NEO Study, eGFR, UACR, fibrinogen, and coagulation factors (F)VIII, FIX and FXI were determined in all participants (n = 6536), and PWV was assessed in a random subset (n = 2433). eGFR, UACR and PWV were analyzed continuously and per percentile: per six categories for eGFR (> 50th [reference] to < 1st) and UACR (< 50th [reference] to > 99th), and per four categories (< 50th [reference] to > 95th percentile) for PWV. Linear regression was used and adjusted for age, sex, total body fat, smoking, education, ethnicity, total cholesterol, C-reactive protein (CRP) and vitamin K antagonists use (FIX). Results Mean age was 55.6 years, mean eGFR 86.0 (12SD) mL 1.73 m- ² and median UACR 0.4 mg mmol-1 (25th, 75th percentile; 0.3, 0.7). All coagulation factors showed a procoagulant shift with lower renal function and albuminuria. For example, FVIII was 22 IU dL-1 (95% CI, 13-32) higher in the eGFR < 1st percentile compared with the > 50th percentile, and FVIII was 12 IU dL-1 (95% CI, 3-22) higher in the UACR > 99th percentile compared with the < 50th percentile. PWV was positively associated with coagulation factors FIX and FXI in continuous analysis; per m/s difference in PWV, FIX was 2.0 IU dL-1 (95% CI, 0.70-3.2) higher. Conclusions Impaired renal and vascular function was associated with higher levels of coagulation factors, underlining the role of renal function and vascular function in the development of venous thrombosis.
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Affiliation(s)
- I A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - A P J de Vries
- Department of Clinical Medicine, Division of Nephrology and Transplant Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - S C Cannegieter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Medicine, Division of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - J W Jukema
- Department of Clinical Medicine, Division of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - T J Rabelink
- Department of Clinical Medicine, Division of Nephrology and Transplant Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - W M Lijfering
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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93
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Noordam R, Zwetsloot CPA, de Mutsert R, Mook-Kanamori DO, Lamb HJ, de Roos A, de Koning EJP, Rosendaal FR, Willems van Dijk K, van Heemst D. Interrelationship of the rs7903146 TCF7L2 gene variant with measures of glucose metabolism and adiposity: The NEO study. Nutr Metab Cardiovasc Dis 2018; 28:150-157. [PMID: 29174029 DOI: 10.1016/j.numecd.2017.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/07/2017] [Accepted: 10/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS We investigated the interrelationship of rs7903146-T in TCF7L2 with measures of glucose metabolism and measures of adiposity. METHODS AND RESULTS This cross-sectional analysis was conducted in 5744 middle-aged participants (mean (standard deviation [SD]) age is 55.9 (6.0) years) from the Netherlands Epidemiology of Obesity (NEO) Study. Associations between rs7903146-T and Type 2 diabetes mellitus (T2D) were assessed with logistic regression. Additive (per-allele) associations with measures of glucose metabolism (e.g., fasting insulin) and adiposity (e.g., body mass index [BMI]) were examined with multivariable linear regression. In the total study population, rs7903146-T was associated with a higher risk of T2D (additive odds ratio: 1.42; 95% confidence interval: 1.17; 1.72), and specifically with T2D treated with insulin analogs (2.31 [1.19; 4.46]). After exclusion of participants treated with glucose-lowering medication, rs7903146-T was associated with lower mean insulin concentration (additive mean difference: -0.07 SD [-0.14; 0.00]), but not with higher mean glucose concentration (0.03 SD [-0.01; 0.07]). Furthermore, rs7903146-T was associated with, among other measures of adiposity, a lower mean BMI (-0.04 SD [-0.09; -0.00]), and a lower mean total body fat (-0.04 SD [-0.08; -0.00]). The association between rs7903146-T and T2D increased after adjustment for BMI (odds ratio: 1.51 [1.24; 1.86]); the association between rs7903146-T and fasting insulin diminished after adjustment (-0.05 SD [-0.11; 0.02]). CONCLUSION rs7903146-T is associated with a decreased insulin concentration and increased risk of T2D with opposing effects of adjustment for adiposity.
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Affiliation(s)
- R Noordam
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
| | - C P A Zwetsloot
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - D 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
| | - H J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - A de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E J P de Koning
- Department of Internal Medicine, Section Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - K Willems van Dijk
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands; Department of Internal Medicine, division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - D van Heemst
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
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94
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de Mutsert R, Gast K, Widya R, de Koning E, Jazet I, Lamb H, le Cessie S, de Roos A, Smit J, Rosendaal F, den Heijer M. Associations of Abdominal Subcutaneous and Visceral Fat with Insulin Resistance and Secretion Differ Between Men and Women: The Netherlands Epidemiology of Obesity Study. Metab Syndr Relat Disord 2018; 16:54-63. [PMID: 29338526 DOI: 10.1089/met.2017.0128] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Abdominal obesity is a well-established risk factor for the development of type 2 diabetes. However, sex differences may exist. We aimed to investigate the associations of abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) with insulin resistance and insulin secretion in men and women. METHODS In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, fasting and postprandial concentrations of glucose and insulin were measured and abdominal fat depots were assessed using magnetic resonance imaging in 2253 participants (53% women). With linear regression analysis, we examined associations of abdominal SAT and VAT with measures of insulin resistance and insulin secretion in men and women, while adjusting for age, ethnicity, education, smoking habits, alcohol consumption, menopausal state and hormone use in women, and models with VAT additionally for total body fat. RESULTS Participants had a mean [standard deviation (SD)] age of 56 (6) years, body mass index: 25.9 (3.9) kg/m2, VAT: 89 (55) cm2, and SAT: 235 (95) cm2. In the multivariate models in men, per SD of VAT the homeostatic model assessment of insulin resistance (HOMA-IR) was 20% (95% CI: 14-26) higher, and per SD SAT 21% (15-27) higher. In women, per SD of VAT the HOMA-IR was 40% (29-52) higher, and per SD SAT 12% (6-19) higher. Associations with measures of insulin secretion were weaker than with insulin resistance. CONCLUSIONS In men, abdominal SAT and VAT were associated with insulin resistance to a similar extent, whereas in women particularly VAT was associated with insulin resistance and insulin secretion. Future studies need to unravel the mechanisms underlying the metabolic effects of visceral fat in women. Simple and less expensive measures that can distinct abdominal subcutaneous and visceral fat are needed for an improved metabolic risk stratification.
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Affiliation(s)
- Renée de Mutsert
- 1 Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, the Netherlands
| | - Karin Gast
- 1 Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, the Netherlands .,2 Department of Internal Medicine, Leiden University Medical Center , Leiden, the Netherlands
| | - Ralph Widya
- 3 Department of Radiology, Leiden University Medical Center , Leiden, the Netherlands
| | - Eelco de Koning
- 2 Department of Internal Medicine, Leiden University Medical Center , Leiden, the Netherlands
| | - Ingrid Jazet
- 2 Department of Internal Medicine, Leiden University Medical Center , Leiden, the Netherlands
| | - Hildo Lamb
- 3 Department of Radiology, Leiden University Medical Center , Leiden, the Netherlands
| | - Saskia le Cessie
- 1 Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, the Netherlands .,4 Medical Statistics and Bioinformatics, Leiden University Medical Center , Leiden, the Netherlands
| | - Albert de Roos
- 3 Department of Radiology, Leiden University Medical Center , Leiden, the Netherlands
| | - Jan Smit
- 5 Department of Endocrinology, Radboud University Medical Center , Nijmegen, the Netherlands
| | - Frits Rosendaal
- 1 Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, the Netherlands
| | - Martin den Heijer
- 1 Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, the Netherlands .,6 Department of Internal Medicine, VU Medical Center , Amsterdam, the Netherlands
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Associations of Serum 25(OH)D Concentrations with Lung Function, Airway Inflammation and Common Cold in the General Population. Nutrients 2018; 10:nu10010035. [PMID: 29301349 PMCID: PMC5793263 DOI: 10.3390/nu10010035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/22/2017] [Accepted: 12/28/2017] [Indexed: 12/03/2022] Open
Abstract
Vitamin D is hypothesized to have a beneficial effect on lung function and respiratory infections. The aim of this study was to assess the relationship of serum 25-hydroxyvitamin D (25(OH)D) concentrations with lung function, airway inflammation and common colds. We performed a cross-sectional analysis in the Netherlands Epidemiology of Obesity (NEO) study, a population-based cohort study. We included participants with measurements of serum 25(OH)D, Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), Fractional Exhaled Nitric Oxide (FeNO), and data on self-reported common colds (n = 6138). In crude associations, serum 25(OH)D was positively associated with FEV1 and FVC, and negatively with FeNO and the occurrence of a common cold. After adjustment for confounders, however, these associations disappeared. Stratified analyses showed that Body Mass Index (BMI) was an effect modifier in the relationship between serum 25(OH)D and FEV1, FVC and FeNO. In obese participants (BMI ≥ 30 kg/m2), 10 nmol/L higher 25(OH)D was associated with 0.46% predicted higher FEV1 (95% Confidence Interval: 0.17 to 0.75), 0.46% predicted higher FVC (0.18 to 0.74), and 0.24 ppb lower FeNO (−0.43 to −0.04). Thus, in the total study population, 25(OH)D concentrations were not associated with lung function, airway inflammation and common colds. In obese participants, however, higher 25(OH)D concentrations were associated with a better lung function and lower airway inflammation.
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96
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97
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Attributable Cost of Clostridium difficile Infection in Pediatric Patients. Infect Control Hosp Epidemiol 2017; 38:1472-1477. [PMID: 29173236 DOI: 10.1017/ice.2017.240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The attributable cost of Clostridium difficile infection (CDI) in children is unknown. We sought to determine a national estimate of attributable cost and length of stay (LOS) of CDI occurring during hospitalization in children. DESIGN AND METHODS We analyzed discharge records of patients between 2 and 18 years of age from the Agency for Healthcare Research and Quality (AHRQ) Kids' Inpatient Database. We created a logistic regression model to predict CDI during hospitalization based on demographic and clinical characteristics. Predicted probabilities from the logistic regression model were then used as propensity scores to match 1:2 CDI to non-CDI cases. Charges were converted to costs and compared between patients with CDI and propensity-score-matched controls. In a sensitivity analysis, we adjusted for LOS as a confounder by including it in both the propensity score and a generalized linear model predicting cost. RESULTS We identified 8,527 pediatric hospitalizations (0.53%) with a diagnosis of CDI and 1,597,513 discharges without CDI. In our matched cohorts, the attributable cost of CDI occurring during a hospitalization ranged from $1,917 to $8,317, depending on whether model was adjusted for LOS. When not adjusting for LOS, CDI-associated hospitalizations cost 1.6 times more than non-CDI associated hospitalizations. Attributable LOS of CDI was approximately 4 days. CONCLUSIONS Clostridium difficile infection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority. Pediatric CDI cost analyses should account for LOS as an important confounder of cost. Infect Control Hosp Epidemiol 2017;38:1472-1477.
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98
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Christen T, Trompet S, Noordam R, Blauw LL, Gast KB, Rensen PCN, Willems van Dijk K, Rosendaal FR, de Mutsert R, Jukema JW. Mendelian randomization analysis of cholesteryl ester transfer protein and subclinical atherosclerosis: A population-based study. J Clin Lipidol 2017; 12:137-144.e1. [PMID: 29174438 DOI: 10.1016/j.jacl.2017.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/29/2017] [Accepted: 10/25/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Several trials to prevent cardiovascular disease by inhibiting cholesteryl ester transfer protein (CETP) have failed, except Randomized EValuation of the Effects of Anacetrapib through Lipid-modification. Thus far, it is unclear to what extent CETP is causally related to measures of atherosclerosis. OBJECTIVE The aim of the article was to study the causal relationship between genetically determined CETP concentration and carotid intima-media thickness (cIMT) in a population-based cohort study. METHODS In the Netherlands Epidemiology of Obesity study, participants were genotyped, and cIMT was measured by ultrasonography. We examined the relation between a weighted genetic risk score for CETP concentration, based on 3 single-nucleotide polymorphisms that have previously been shown to largely determine CETP concentration and cIMT using Mendelian randomization in the total population and in strata by sex, Framingham 10-year risk, (pre)diabetes, high-density lipoprotein cholesterol, triglycerides, and statin use. RESULTS We analyzed 5655 participants (56% women) with a mean age of 56 (range 44-66) years, body mass index of 26 (range 17-61) kg/m2, and serum CETP of 2.47 (range 0.68-5.33) μg/mL. There was no evidence for a causal relation between genetically determined CETP and cIMT in the total population, but associations were differently directed in men (16 μm per μg/mL increase in genetically determined CETP; 95% confidence interval: -8, 39) and women (-8 μm; -25, 9). Genetically determined CETP appeared to be associated with cIMT in normoglycemic men (26 μm; -1, 52) and in (pre)diabetic women (48 μm; -2, 98). CONCLUSION In this population-based study, there was no causal relation between genetically determined CETP concentration and cIMT in the total population although we observed directionally differing effects in men and women. Stratified results suggested associations in individuals with different cardiometabolic risk factor profiles, which require replication.
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Affiliation(s)
- Tim Christen
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - Stella Trompet
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Raymond Noordam
- Section of Gerontology and Geriatrics, Department of Internal Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Lisanne L Blauw
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Karin B Gast
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Patrick C N Rensen
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Ko Willems van Dijk
- Division of Endocrinology, Department of Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Human Genetics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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99
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Widya RL, de Mutsert R, Westenberg JJM, Gast KB, den Heijer M, le Cessie S, Smit JWA, Jukema JW, Rosendaal FR, de Roos A, Lamb HJ. Is Hepatic Triglyceride Content Associated with Aortic Pulse Wave Velocity and Carotid Intima-Media Thickness? The Netherlands Epidemiology of Obesity Study. Radiology 2017; 285:73-82. [DOI: 10.1148/radiol.2017160916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Ralph L. Widya
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Renée de Mutsert
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Jos J. M. Westenberg
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Karin B. Gast
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Martin den Heijer
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Saskia le Cessie
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Johannes W. A. Smit
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - J. Wouter Jukema
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Frits R. Rosendaal
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Albert de Roos
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
| | - Hildo J. Lamb
- From the Departments of Radiology (R.L.W., J.J.M.W., A.d.R., H.J.L.), Clinical Epidemiology (R.d.M., K.B.G., M.d.H., S.l.C., F.R.R.), Internal Medicine (K.B.G.), Medical Statistics and Bio-informatics (S.l.C.), Endocrinology (R.L.W., J.W.A.S.), and Cardiology (J.W.J.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands; Department of Internal Medicine, VU University Medical Center,
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Kim S, Kim S, Won S, Choi K. Considering common sources of exposure in association studies - Urinary benzophenone-3 and DEHP metabolites are associated with altered thyroid hormone balance in the NHANES 2007-2008. ENVIRONMENT INTERNATIONAL 2017; 107:25-32. [PMID: 28651165 DOI: 10.1016/j.envint.2017.06.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/09/2017] [Accepted: 06/14/2017] [Indexed: 05/25/2023]
Abstract
Epidemiological studies have shown that thyroid hormone balances can be disrupted by chemical exposure. However, many association studies have often failed to consider multiple chemicals with possible common sources of exposure, rendering their conclusions less reliable. In the 2007-2008 National Health and Nutrition Examination Survey (NHANES) from the U.S.A., urinary levels of environmental phenols, parabens, and phthalate metabolites as well as serum thyroid hormones were measured in a general U.S. population (≥12years old, n=1829). Employing these data, first, the chemicals or their metabolites associated with thyroid hormone measures were identified. Then, the chemicals/metabolites with possible common exposure sources were included in the analytical model to test the sensitivities of their association with thyroid hormone levels. Benzophenone-3 (BP-3), bisphenol A (BPA), and a metabolite of di(2-ethylhexyl) phthalate (DEHP) were identified as significant determinants of decreased serum thyroid hormones. However, significant positive correlations were detected (p-value<0.05, r=0.23 to 0.45) between these chemicals/metabolites, which suggests that they might share similar exposure sources. In the subsequent sensitivity analysis, which included the chemicals/metabolite with potentially similar exposure sources in the model, we found that urinary BP-3 and DEHP exposure were associated with decreased thyroid hormones among the general population but BPA exposure was not. In association studies, the presence of possible common exposure sources should be considered to circumvent possible false-positive conclusions.
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Affiliation(s)
- Sujin Kim
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - Sunmi Kim
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - Sungho Won
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea
| | - Kyungho Choi
- School of Public Health, Seoul National University, Seoul 08826, Republic of Korea.
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