1
|
Turkiewicz A, Hellberg C, Dell'Isola A, Englund M. Antihistamine use and osteoarthritis or joint pain. Osteoarthritis Cartilage 2024:S1063-4584(24)01396-7. [PMID: 39277027 DOI: 10.1016/j.joca.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 08/13/2024] [Accepted: 09/07/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES Antihistamines have been reported to be linked with less pain in osteoarthritis. We aimed to estimate associations between antihistamine use and three outcomes: prevalent osteoarthritis, current joint pain, and developing osteoarthritis. METHODS We included 25 003 participants of EpiHealth - a cohort of persons aged 45 to 75 from Malmö/Uppsala in Sweden. Participants self-reported the presence of allergy, joint pain and osteoarthritis at a study visit between years 2010 and 2016. Further, we obtained data about diagnoses of allergy and osteoarthritis from health-care registers (primary, specialist and inpatient care). Exposure was prescribed dispensed antihistamines (H1-antagonists) during ∼6 years preceding the EpiHealth visit retrieved from the Prescribed Drugs Register. The outcomes were osteoarthritis (any location), pain in knees/hips/hands-wrists at the examination (cross-sectional) and future incident diagnosis of osteoarthritis (longitudinal, in a cohort free of osteoarthritis at EpiHealth). We report risk ratios (95% confidence intervals [CI]) from logistic regression and hazard ratios (HR) from Cox regression, from models adjusted for age, sex, body mass index, allergy and use of healthcare. We used prescribed dispensed penicillin as negative control. RESULTS The associations between use of antihistamines and osteoarthritis/joint pain at EpiHealth were 1.13 (95%CI 1.06, 1.20) and 1.02 (0.99, 1.05), respectively. The HR of future incident osteoarthritis diagnosis with use of antihistamines was 1.15 (1.03, 1.28). The association (HR) between penicillin use and future incident osteoarthritis diagnosis was 1.16 (1.07, 1.25). CONCLUSIONS In a large population-based observational cohort, use of antihistamines was neither associated with less joint pain/osteoarthritis nor lower risk of future osteoarthritis.
Collapse
Affiliation(s)
- Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences Lund, Lund University, Sweden.
| | - Clara Hellberg
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences Lund, Lund University, Sweden
| | - Andrea Dell'Isola
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences Lund, Lund University, Sweden
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Clinical Sciences Lund, Lund University, Sweden
| |
Collapse
|
2
|
da Silva M, Fritz J, Mboya IB, Sun M, Wahlström J, van Guelpen B, Michaëlsson K, Magnusson PKE, Melander O, Sandin S, Yin W, Trolle Lagerros Y, Nwaru B, Leppert J, Chabok A, Pedersen NL, Elmståhl S, Isaksson K, Ingvar C, Hedman L, Backman H, Häggström C, Stocks T. Cohort profile: The Obesity and Disease Development Sweden (ODDS) study, a pooled cohort. BMJ Open 2024; 14:e084836. [PMID: 39013647 PMCID: PMC11253753 DOI: 10.1136/bmjopen-2024-084836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
PURPOSE The Obesity and Disease Development Sweden (ODDS) study was designed to create a large cohort to study body mass index (BMI), waist circumference (WC) and changes in weight and WC, in relation to morbidity and mortality. PARTICIPANTS ODDS includes 4 295 859 individuals, 2 165 048 men and 2 130 811 women, in Swedish cohorts and national registers with information on weight assessed once (2 555 098 individuals) or more (1 740 761 individuals), in total constituting 7 733 901 weight assessments at the age of 17-103 years in 1963-2020 (recalled weight as of 1911). Information on WC is available in 152 089 men and 212 658 women, out of whom 108 795 have repeated information on WC (in total 512 273 assessments). Information on morbidity and mortality was retrieved from national registers, with follow-up until the end of 2019-2021, varying between the registers. FINDINGS TO DATE Among all weight assessments (of which 85% are objectively measured), the median year, age and BMI (IQR) is 1985 (1977-1994) in men and 2001 (1991-2010) in women, age 19 (18-40) years in men and 30 (26-36) years in women and BMI 22.9 (20.9-25.4) kg/m2 in men and 23.2 (21.2-26.1) kg/m2 in women. Normal weight (BMI 18.5-24.9 kg/m2) is present in 67% of assessments in men and 64% in women and obesity (BMI≥30 kg/m2) in 5% of assessments in men and 10% in women. The median (IQR) follow-up time from the first objectively measured or self-reported current weight assessment until emigration, death or end of follow-up is 31.4 (21.8-40.8) years in men and 19.6 (9.3-29.0) years in women. During follow-up, 283 244 men and 123 457 women died. FUTURE PLANS The large sample size and long follow-up of the ODDS Study will provide robust results on anthropometric measures in relation to risk of common diseases and causes of deaths, and novel findings in subgroups and rarer outcomes.
Collapse
Affiliation(s)
- Marisa da Silva
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Josef Fritz
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Institute of Medical Statistics and Informatics, Medical University of Innsbruck, Innsbruck, Austria
| | - Innocent B Mboya
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Ming Sun
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jens Wahlström
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Karl Michaëlsson
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Olle Melander
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Sven Sandin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Weiyao Yin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Center for Obesity, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Bright Nwaru
- Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jerzy Leppert
- Center for Clinical Research, Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Abbas Chabok
- Center for Clinical Research, Uppsala University, Västmanland Hospital, Västerås, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Karolin Isaksson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Surgery, Kristianstad Hospital, Kristianstad, Sweden
| | - Christian Ingvar
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Linnea Hedman
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Helena Backman
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Christel Häggström
- Northern Registry Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Tanja Stocks
- Department of Translational Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
3
|
Qvarfordt M, Lampa E, Cai GH, Lind L, Elmståhl S, Svartengren M. Bioelectrical impedance and lung function-associations with gender and central obesity: results of the EpiHealth study. BMC Pulm Med 2024; 24:319. [PMID: 38965493 PMCID: PMC11225376 DOI: 10.1186/s12890-024-03128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 06/24/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Obesity is a major public health concern associated with various health problems, including respiratory impairment. Bioelectrical impedance (BIA) is used in health screening to assess body fat. However, there is no consensus in healthcare on how body fat should be assessed in relation to lung function. In this study, we aimed to investigate how BIA in relation to waist circumference contribute, using data from a large Swedish population study. METHODS A total of 17,097 participants (aged 45-75 years) were included in the study. The relationships between fat mass, waist circumference, and lung function were analysed using weighted quantile sum regression. RESULTS Increased fat mass was significantly associated with decreased lung function (FEV1, FVC) in both sexes. Also, the influence of trunk fat and waist circumference on FVC and FEV1 differed by sex: in males, waist circumference and trunk fat had nearly equal importance for FVC (variable weights of 0.42 and 0.41), whereas in females, trunk fat was significantly more important (variable weights 0.84 and 0.14). For FEV1, waist circumference was more important in males, while trunk fat was more significant in females (variable weights male 0.68 and 0.28 and 0.23 and 0.77 in female). CONCLUSIONS Our results suggest that trunk fat should be considered when assessing the impact of adipose tissue on lung function and should potentially be included in the health controls.
Collapse
Affiliation(s)
- Mikaela Qvarfordt
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
- Department of Laboratory Medicine, Clinical Physiology, Karolinska Institute, Stockholm, Sweden.
| | - Erik Lampa
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Gui-Hong Cai
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Magnus Svartengren
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
4
|
Brolin KA, Bäckström D, Wallenius J, Gan-Or Z, Puschmann A, Hansson O, Swanberg M. Is GBA1 T369M not a risk factor for Parkinson's disease in the Swedish population? MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.15.24304347. [PMID: 38559109 PMCID: PMC10980128 DOI: 10.1101/2024.03.15.24304347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Variants in GBA1 are important genetic risk factors in Parkinson's disease (PD). GBA1 T369M has been linked to an ~80% increased PD risk but the reports are conflicting and the relevance of GBA1 variants in different populations varies. A lack of association between T369M and PD in the Swedish population was recently reported but needs further validation. We therefore investigated T369M in 1,808 PD patients and 2,183 controls and our results support that T369M is not a risk factor for PD in the Swedish population.
Collapse
Affiliation(s)
- Kajsa Atterling Brolin
- Translational Neurogenetics Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, EC1M 6BQ, London, UK
| | - David Bäckström
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Joel Wallenius
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Ziv Gan-Or
- Department of Neurology & Neurosurgery, McGill University, Montreal, Quebec, Canada
- Clinical Research Unit, The Neuro (Montreal Neurological Institute-Hospital), Montreal, Quebec, Canada
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Andreas Puschmann
- Division of Neurology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurology, Skåne University Hospital, Lund, Sweden
- SciLifeLab National Research Infrastructure, Lund University, Sweden
| | - Oskar Hansson
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, Lund, Sweden
- Memory Clinic, Skåne University Hospital, Malmö, Sweden
| | - Maria Swanberg
- Translational Neurogenetics Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| |
Collapse
|
5
|
Schuermans A, Truong B, Ardissino M, Bhukar R, Slob EAW, Nakao T, Dron JS, Small AM, Cho SMJ, Yu Z, Hornsby W, Antoine T, Lannery K, Postupaka D, Gray KJ, Yan Q, Butterworth AS, Burgess S, Wood MJ, Scott NS, Harrington CM, Sarma AA, Lau ES, Roh JD, Januzzi JL, Natarajan P, Honigberg MC. Genetic Associations of Circulating Cardiovascular Proteins With Gestational Hypertension and Preeclampsia. JAMA Cardiol 2024; 9:209-220. [PMID: 38170504 PMCID: PMC10765315 DOI: 10.1001/jamacardio.2023.4994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024]
Abstract
Importance Hypertensive disorders of pregnancy (HDPs), including gestational hypertension and preeclampsia, are important contributors to maternal morbidity and mortality worldwide. In addition, women with HDPs face an elevated long-term risk of cardiovascular disease. Objective To identify proteins in the circulation associated with HDPs. Design, Setting, and Participants Two-sample mendelian randomization (MR) tested the associations of genetic instruments for cardiovascular disease-related proteins with gestational hypertension and preeclampsia. In downstream analyses, a systematic review of observational data was conducted to evaluate the identified proteins' dynamics across gestation in hypertensive vs normotensive pregnancies, and phenome-wide MR analyses were performed to identify potential non-HDP-related effects associated with the prioritized proteins. Genetic association data for cardiovascular disease-related proteins were obtained from the Systematic and Combined Analysis of Olink Proteins (SCALLOP) consortium. Genetic association data for the HDPs were obtained from recent European-ancestry genome-wide association study meta-analyses for gestational hypertension and preeclampsia. Study data were analyzed October 2022 to October 2023. Exposures Genetic instruments for 90 candidate proteins implicated in cardiovascular diseases, constructed using cis-protein quantitative trait loci (cis-pQTLs). Main Outcomes and Measures Gestational hypertension and preeclampsia. Results Genetic association data for cardiovascular disease-related proteins were obtained from 21 758 participants from the SCALLOP consortium. Genetic association data for the HDPs were obtained from 393 238 female individuals (8636 cases and 384 602 controls) for gestational hypertension and 606 903 female individuals (16 032 cases and 590 871 controls) for preeclampsia. Seventy-five of 90 proteins (83.3%) had at least 1 valid cis-pQTL. Of those, 10 proteins (13.3%) were significantly associated with HDPs. Four were robust to sensitivity analyses for gestational hypertension (cluster of differentiation 40, eosinophil cationic protein [ECP], galectin 3, N-terminal pro-brain natriuretic peptide [NT-proBNP]), and 2 were robust for preeclampsia (cystatin B, heat shock protein 27 [HSP27]). Consistent with the MR findings, observational data revealed that lower NT-proBNP (0.76- to 0.88-fold difference vs no HDPs) and higher HSP27 (2.40-fold difference vs no HDPs) levels during the first trimester of pregnancy were associated with increased risk of HDPs, as were higher levels of ECP (1.60-fold difference vs no HDPs). Phenome-wide MR analyses identified 37 unique non-HDP-related protein-disease associations, suggesting potential on-target effects associated with interventions lowering HDP risk through the identified proteins. Conclusions and Relevance Study findings suggest genetic associations of 4 cardiovascular disease-related proteins with gestational hypertension and 2 associated with preeclampsia. Future studies are required to test the efficacy of targeting the corresponding pathways to reduce HDP risk.
Collapse
Affiliation(s)
- Art Schuermans
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Buu Truong
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Maddalena Ardissino
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rohan Bhukar
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Eric A. W. Slob
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
- Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus University Rotterdam Institute for Behavior and Biology, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tetsushi Nakao
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jacqueline S. Dron
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Aeron M. Small
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - So Mi Jemma Cho
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Zhi Yu
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Whitney Hornsby
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Tajmara Antoine
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Kim Lannery
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Darina Postupaka
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
| | - Kathryn J. Gray
- Division of Maternal-Fetal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Qi Yan
- Department of Obstetrics and Gynecology, Columbia University, New York, New York
| | - Adam S. Butterworth
- BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- BHF Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Malissa J. Wood
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
- Lee Health, Fort Myers, Florida
| | - Nandita S. Scott
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Colleen M. Harrington
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Amy A. Sarma
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Emily S. Lau
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Jason D. Roh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - James L. Januzzi
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
- Baim Institute for Clinical Research, Boston, Massachusetts
| | - Pradeep Natarajan
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| | - Michael C. Honigberg
- Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts
- Cardiovascular Research Center, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Cardiology Division, Massachusetts General Hospital, Boston
| |
Collapse
|
6
|
Tan X, Ljunggren M, Kilander L, Benedict C, Lindberg E. Obstructive sleep apnea during rapid eye movement sleep and cognitive performance in adults. Sleep Med 2024; 113:34-40. [PMID: 37980842 DOI: 10.1016/j.sleep.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep is often characterized with more frequent and lengthy breathing events and greater oxygen desaturation than during other sleep stages. Current evidence suggests an association between OSA and cognitive decline, however whether OSA during REM sleep plays a vital role in this link is understudied. METHODS A cross-sectional sample of 728 men and women (aged 59.1 ± 11.3 years) underwent a full night polysomnography for determining apnea-hypopnea index (AHI) and sleep stages. Trail Making Test (TMT) part A and B were conducted during the following day for assessing participants' cognitive function. Linear regression analyses were performed to test the possible association between AHI and AHI during REM sleep with TMT-A and B results. Similar analyses were carried out in a subsample involving participants aged ≥60 years with ≥30 min of REM sleep (n = 356). RESULTS Despite a slight difference in TMT-B between participants with and without OSA (AHI ≥5 vs AHI <5, β-coefficient: 4.83, 95 % CI: [-9.44, -0.22], P = 0.040), no other association between AHI or REM-AHI and TMT results were found in the full sample. In older participants (aged ≥60 years), a REM-AHI ≥5 events/hour was associated with longer time taken to finish TMT-A (vs REM-AHI <5 events/hour, 3.93, [0.96, 6.90], P = 0.010). There was no association between REM-AHI and time taken to finish TMT-B in older participants. CONCLUSIONS The results indicate that OSA during REM sleep may be of particular concern for attention-related cognitive function in older adults.
Collapse
Affiliation(s)
- Xiao Tan
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden
| | - Christian Benedict
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
7
|
Lind L, Titova O, Zeng R, Zanetti D, Ingelsson M, Gustafsson S, Sundström J, Ärnlöv J, Elmståhl S, Assimes T, Michaëlsson K. Plasma Protein Profiling of Incident Cardiovascular Diseases: A Multisample Evaluation. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2023; 16:e004233. [PMID: 38014560 DOI: 10.1161/circgen.123.004233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Proteomic profiling could potentially disclose new pathophysiological pathways for cardiovascular diseases (CVD) and improve prediction at the individual level. We therefore aimed to study the plasma protein profile associated with the incidence of different CVDs. METHODS Plasma levels of 245 proteins suspected to be linked to CVD or metabolism were measured in 4 Swedish prospective population-based cohorts (SIMPLER [Swedish Infrastructure for Medical Population-Based Life-Course and Environmental Research], ULSAM (Uppsala Longitudinal Study of Adult Men), EpiHealth, and POEM [Prospective Investigation of Obesity, Energy Production, and Metabolism]) comprising 11 869 individuals, free of CVD diagnoses at baseline. Our primary CVD outcome was defined by a combined end point that included either incident myocardial infarction, stroke, or heart failure. RESULTS Using a discovery/validation approach, 42 proteins were associated with our primary composite end point occurring in 1163 subjects. In separate meta-analyses for each of the 3 CVD outcomes, 49 proteins were related to myocardial infarction, 34 to ischemic stroke, and 109 to heart failure. Thirteen proteins were related to all 3 outcomes. Of those, urokinase plasminogen activator surface receptor, adrenomedullin, and KIM-1 (kidney injury molecule 1) were also related to several markers of subclinical CVD in Prospective Investigation of Obesity, Energy production and Metabolism, reflecting myocardial or arterial pathologies. In prediction analysis, a lasso selection of 11 proteins in ULSAM improved the discrimination of CVD by 3.3% (P<0.0001) in SIMPLER when added to traditional risk factors. CONCLUSIONS Protein profiling in multiple samples disclosed several new proteins to be associated with subsequent myocardial infarction, stroke, and heart failure, suggesting common pathophysiological pathways for these diseases. KIM-1, urokinase plasminogen activator surface receptor, and adrenomedullin were novel early markers of CVD. A selection of 11 proteins improved the discrimination of CVD.
Collapse
Affiliation(s)
- Lars Lind
- Department of Medical Sciences (L.L., R.Z., S.G., J.S.), Uppsala University, Sweden
| | - Olga Titova
- Department of Surgical Sciences (O.T., K.M.), Uppsala University, Sweden
| | - Rui Zeng
- Department of Medical Sciences (L.L., R.Z., S.G., J.S.), Uppsala University, Sweden
| | - Daniela Zanetti
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.A., D.Z.)
| | - Martin Ingelsson
- Department of Public Health and Caring Sciences/Geriatrics (M.I.), Uppsala University, Sweden
| | - Stefan Gustafsson
- Department of Medical Sciences (L.L., R.Z., S.G., J.S.), Uppsala University, Sweden
| | - Johan Sundström
- Department of Medical Sciences (L.L., R.Z., S.G., J.S.), Uppsala University, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge (J.A.)
| | - Sölve Elmståhl
- Department of Clinical Sciences in Malmö, Lund University, Sweden (S.E.)
| | - Themistocles Assimes
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (T.A., D.Z.)
- Palo Alto VA Healthcare System, CA (T.A.)
| | - Karl Michaëlsson
- Department of Surgical Sciences (O.T., K.M.), Uppsala University, Sweden
| |
Collapse
|
8
|
Dunder L, Salihovic S, Varotsis G, Lind PM, Elmståhl S, Lind L. Plasma levels of per- and polyfluoroalkyl substances (PFAS) and cardiovascular disease - Results from two independent population-based cohorts and a meta-analysis. ENVIRONMENT INTERNATIONAL 2023; 181:108250. [PMID: 37832261 DOI: 10.1016/j.envint.2023.108250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are persistent chemicals that have been linked to increased cholesterol levels and thus may have a role in the development of cardiovascular disease (CVD). OBJECTIVES To investigate associations between PFAS exposure and incident CVD (a combined CVD end-point consisting of myocardial infarction, ischemic stroke, or heart failure) in two independent population-based cohorts in Sweden. In addition, we performed a meta-analysis also including results from previous studies. METHODS In 2,278 subjects aged 45-75 years from the EpiHealth study, the risk of incident CVD in relation to relative plasma levels of perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) was investigated. Associations between plasma levels of six PFAS and incident CVD were also examined in the PIVUS-study (n = 1,016, all aged 70 years). In addition, a meta-analysis was performed including three previous prospective studies, together with the results from the present study. RESULTS There were no overall statistically significant associations between levels of the different PFAS and incident CVD, neither in EpiHealth nor in PIVUS. However, there was a significant sex interaction for PFOS in EpiHealth (p = 0.008), and an inverse association could be seen only in men (Men, HR: 0.68, 95 % CI: 0.52, 0.89) (Women, HR: 1.13, 95 % CI: 0.82, 1.55). A meta-analysis of five independent studies regarding PFOA and incident CVD showed a risk ratio (RR) of 0.80 (CI: 0.66, 0.94) when high levels were compared to low levels. CONCLUSIONS This longitudinal study using data from two population-based cohort studies in Sweden did not indicate any increased risk of incident CVD for moderately elevated PFAS levels. A meta-analysis of five independent cohort studies rather indicated a modest inverse association between PFOA levels and incident CVD, further supporting that increasing PFAS levels are not linked to an increased risk of CVD.
Collapse
Affiliation(s)
- Linda Dunder
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
| | - Samira Salihovic
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Georgios Varotsis
- Department of Medical Sciences, Molecular Epidemiology, Uppsala University, Uppsala, Sweden
| | - P Monica Lind
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
9
|
Dunder L, Salihovic S, Elmståhl S, Lind PM, Lind L. Associations between per- and polyfluoroalkyl substances (PFAS) and diabetes in two population-based cohort studies from Sweden. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:748-756. [PMID: 36964247 PMCID: PMC10541316 DOI: 10.1038/s41370-023-00529-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) have been suggested to contribute to the development of metabolic diseases such as obesity, diabetes and non-alcoholic fatty liver disease (NAFLD). However, evidence from epidemiological studies remain divergent. The aim of the present study was to evaluate associations between PFAS exposure and prevalent diabetes in a cross-sectional analysis and fasting glucose in a longitudinal analysis. METHODS In 2373 subjects aged 45-75 years from the EpiHealth study, three PFAS; perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) were analyzed in plasma together with information on prevalent diabetes. Participants in the PIVUS study (n = 1016 at baseline, all aged 70 years) were followed over 10 years regarding changes in plasma levels of six PFAS; PFHxS, PFOA, PFOS, perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), and changes in plasma levels of fasting glucose. RESULTS In the EpiHealth study, no overall associations could be observed between the levels of PFOA, PFOS or PFHxS and prevalent diabetes. However, there was a significant sex-interaction for PFOA (p = 0.02), and an inverse association could be seen between PFOA (on a SD-scale) and prevalent diabetes in women only (OR: 0.71, 95% CI: 0.52, 0.96, p-value: 0.02). This association showed a non-monotonic dose-response curve. In the PIVUS study, inverse relationships could be observed between the changes in levels (ln-transformed) of PFOA and PFUnDA vs the change in fasting glucose levels (ln-transformed) over 10 years (p = 0.04 and p = 0.02, respectively). As in EpiHealth, these inverse associations were significant only in women (PFOA: β: -0.03, p = 0.02, PFUnDA: β: -0.03, p = 0.03). IMPACT Exposure to per- and polyfluoroalkyl substances (PFAS) has been linked to unfavorable human health, including metabolic disorders such as obesity, diabetes and non-alcoholic fatty liver disease. However, results from in vivo, in vitro and epidemiological studies are incoherent. The aim of the present study was therefore to investigate associations between PFAS and diabetes in a cross-sectional study and glucose levels in a longitudinal study. Results show inverse associations in women only. Results also display non-monotonic dose response curves (i.e., that only low levels of PFOA are related to higher probability of prevalent diabetes). This suggests that sex differences and complex molecular mechanisms may underlie the observed findings. A better understanding of the factors and molecular mechanisms contributing to such differences is recognized as an important direction for future research. CONCLUSIONS PFOA was found to be inversely related to both prevalent diabetes and changes in plasma glucose levels among women only. Thus, our findings suggest there are sex differences in the inverse relationship of PFOA and type 2 diabetes and glucose levels.
Collapse
Affiliation(s)
- Linda Dunder
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
| | | | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - P Monica Lind
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Dunder L, Salihovic S, Lind PM, Elmståhl S, Lind L. Plasma levels of per- and polyfluoroalkyl substances (PFAS) are associated with altered levels of proteins previously linked to inflammation, metabolism and cardiovascular disease. ENVIRONMENT INTERNATIONAL 2023; 177:107979. [PMID: 37285711 DOI: 10.1016/j.envint.2023.107979] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) have been linked to immunotoxic and cardiometabolic effects in both experimental and epidemiological studies, but with conflicting results. AIM The aim of the present study was to investigate potential associations between plasma PFAS levels and plasma levels of preselected proteomic biomarkers previously linked to inflammation, metabolism and cardiovascular disease. METHODS Three PFAS (perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA) and perfluorohexane sulfonic acid (PFHxS)) were measured by non-targeted metabolomics and 249 proteomic biomarkers were measured by the proximity extension assay (PEA) in plasma from 2,342 individuals within the Epidemiology for Health (EpiHealth) study from Sweden (45-75 years old, 50.6 % men). RESULTS After adjustment for age and sex, 92% of the significant associations between PFOS concentrations and proteins were inverse (p < 0.0002, Bonferroni-adjusted). The results were not as clear for PFOA and PFHxS, but still with 80% and 64 % of the significant associations with proteins being inverse. After adjustment for age, sex, smoking, education, exercise habits and alcohol consumption, levels of epidermal growth factor receptor (EGFR), and paraoxonase type 3 (PON3) remained positively associated with all three PFAS, while resistin (RETN) and urokinase plasminogen activator surface receptor (uPAR) showed inverse associations with all three PFAS. CONCLUSIONS Our findings imply that PFAS exposure is cross-sectionally linked to altered levels of proteins previously linked to inflammation, metabolism and cardiovascular disease in middle-aged humans.
Collapse
Affiliation(s)
- Linda Dunder
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.
| | | | - P Monica Lind
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
11
|
Lind L, Ahmad S, Elmståhl S, Fall T. The metabolic profile of waist to hip ratio-A multi-cohort study. PLoS One 2023; 18:e0282433. [PMID: 36848351 PMCID: PMC9970070 DOI: 10.1371/journal.pone.0282433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The genetic background of general obesity and fat distribution is different, pointing to separate underlying physiology. Here, we searched for metabolites and lipoprotein particles associated with fat distribution, measured as waist/hip ratio adjusted for fat mass (WHRadjfatmass), and general adiposity measured as percentage fat mass. METHOD The sex-stratified association of 791 metabolites detected by liquid chromatography-mass spectrometry (LC-MS) and 91 lipoprotein particles measured by nuclear magnetic spectroscopy (NMR) with WHRadjfatmass and fat mass were assessed using three population-based cohorts: EpiHealth (n = 2350) as discovery cohort, with PIVUS (n = 603) and POEM (n = 502) as replication cohorts. RESULTS Of the 193 LC-MS-metabolites being associated with WHRadjfatmass in EpiHealth (false discovery rate (FDR) <5%), 52 were replicated in a meta-analysis of PIVUS and POEM. Nine metabolites, including ceramides, sphingomyelins or glycerophosphatidylcholines, were inversely associated with WHRadjfatmass in both sexes. Two of the sphingomyelins (d18:2/24:1, d18:1/24:2 and d18:2/24:2) were not associated with fat mass (p>0.50). Out of 91, 82 lipoprotein particles were associated with WHRadjfatmass in EpiHealth and 42 were replicated. Fourteen of those were associated in both sexes and belonged to very-large or large HDL particles, all being inversely associated with both WHRadjfatmass and fat mass. CONCLUSION Two sphingomyelins were inversely linked to body fat distribution in both men and women without being associated with fat mass, while very-large and large HDL particles were inversely associated with both fat distribution and fat mass. If these metabolites represent a link between an impaired fat distribution and cardiometabolic diseases remains to be established.
Collapse
Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Shafqat Ahmad
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Tove Fall
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
12
|
Lind L, Fall T, Ärnlöv J, Elmståhl S, Sundström J. Large-Scale Metabolomics and the Incidence of Cardiovascular Disease. J Am Heart Assoc 2023; 12:e026885. [PMID: 36645074 PMCID: PMC9939066 DOI: 10.1161/jaha.122.026885] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background The study aimed to show the relationship between a large number of circulating metabolites and subsequent cardiovascular disease (CVD) and subclinical markers of CVD in the general population. Methods and Results In 2278 individuals free from CVD in the EpiHealth study (aged 45-75 years, mean age 61 years, 50% women), 790 annotated nonxenobiotic metabolites were measured by mass spectroscopy (Metabolon). The same metabolites were measured in the PIVUS (Prospective Investigation of Vasculature in Uppsala Seniors) study (n=603, all aged 80 years, 50% women), in which cardiac and carotid artery pathologies were evaluated by ultrasound. During a median follow-up of 8.6 years, 107 individuals experienced a CVD (fatal or nonfatal myocardial infarction, stroke, or heart failure) in EpiHealth. Using a false discovery rate of 0.05 for age- and sex-adjusted analyses and P<0.05 for adjustment for traditional CVD risk factors, 37 metabolites were significantly related to incident CVD. These metabolites belonged to multiple biochemical classes, such as amino acids, lipids, and nucleotides. Top findings were dimethylglycine and N-acetylmethionine. A lasso selection of 5 metabolites improved discrimination when added on top of traditional CVD risk factors (+4.0%, P=0.0054). Thirty-five of the 37 metabolites were related to subclinical markers of CVD evaluated in the PIVUS study. The metabolite 1-carboxyethyltyrosine was associated with left atrial diameter as well as inversely related to both ejection fraction and the echogenicity of the carotid artery. Conclusions Several metabolites were discovered to be associated with future CVD, as well as with subclinical markers of CVD. A selection of metabolites improved discrimination when added on top of CVD risk factors.
Collapse
Affiliation(s)
- Lars Lind
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Tove Fall
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and SocietyKarolinska InstitutetHuddingeSweden,School of Health and Social StudiesDalarna UniversityFalunSweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in MalmöLund UniversityMalmöSweden
| | - Johan Sundström
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| |
Collapse
|
13
|
Mendham AE, Micklesfield LK, Karpe F, Kengne AP, Chikowore T, Kufe CN, Masemola M, Crowther NJ, Norris SA, Olsson T, Elmståhl S, Fall T, Lind L, Goedecke JH. Targeted proteomics identifies potential biomarkers of dysglycaemia, beta cell function and insulin sensitivity in Black African men and women. Diabetologia 2023; 66:174-189. [PMID: 36114877 DOI: 10.1007/s00125-022-05788-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/09/2022] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS Using a targeted proteomics approach, we aimed to identify and validate circulating proteins associated with impaired glucose metabolism (IGM) and type 2 diabetes in a Black South African cohort. In addition, we assessed sex-specific associations between the validated proteins and pathophysiological pathways of type 2 diabetes. METHODS This cross-sectional study included Black South African men (n=380) and women (n=375) who were part of the Middle-Aged Soweto Cohort (MASC). Dual-energy x-ray absorptiometry was used to determine fat mass and visceral adipose tissue, and fasting venous blood samples were collected for analysis of glucose, insulin and C-peptide and for targeted proteomics, measuring a total of 184 pre-selected protein biomarkers. An OGTT was performed on participants without diabetes, and peripheral insulin sensitivity (Matsuda index), HOMA-IR, basal insulin clearance, insulin secretion (C-peptide index) and beta cell function (disposition index) were estimated. Participants were classified as having normal glucose tolerance (NGT; n=546), IGM (n=116) or type 2 diabetes (n=93). Proteins associated with dysglycaemia (IGM or type 2 diabetes) in the MASC were validated in the Swedish EpiHealth cohort (NGT, n=1706; impaired fasting glucose, n=550; type 2 diabetes, n=210). RESULTS We identified 73 proteins associated with dysglycaemia in the MASC, of which 34 were validated in the EpiHealth cohort. Among these validated proteins, 11 were associated with various measures of insulin dynamics, with the largest number of proteins being associated with HOMA-IR. In sex-specific analyses, IGF-binding protein 2 (IGFBP2) was associated with lower HOMA-IR in women (coefficient -0.35; 95% CI -0.44, -0.25) and men (coefficient -0.09; 95% CI -0.15, -0.03). Metalloproteinase inhibitor 4 (TIMP4) was associated with higher insulin secretion (coefficient 0.05; 95% CI 0.001, 0.11; p for interaction=0.025) and beta cell function (coefficient 0.06; 95% CI 0.02, 0.09; p for interaction=0.013) in women only. In contrast, a stronger positive association between IGFBP2 and insulin sensitivity determined using an OGTT (coefficient 0.38; 95% CI 0.27, 0.49) was observed in men (p for interaction=0.004). A posteriori analysis showed that the associations between TIMP4 and insulin dynamics were not mediated by adiposity. In contrast, most of the associations between IGFBP2 and insulin dynamics, except for insulin secretion, were mediated by either fat mass index or visceral adipose tissue in men and women. Fat mass index was the strongest mediator between IGFBP2 and insulin sensitivity (total effect mediated 40.7%; 95% CI 37.0, 43.6) and IGFBP2 and HOMA-IR (total effect mediated 39.1%; 95% CI 31.1, 43.5) in men. CONCLUSIONS/INTERPRETATION We validated 34 proteins that were associated with type 2 diabetes, of which 11 were associated with measures of type 2 diabetes pathophysiology such as peripheral insulin sensitivity and beta cell function. This study highlights biomarkers that are similar between cohorts of different ancestry, with different lifestyles and sociodemographic profiles. The African-specific biomarkers identified require validation in African cohorts to identify risk markers and increase our understanding of the pathophysiology of type 2 diabetes in African populations.
Collapse
Affiliation(s)
- Amy E Mendham
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Health through Physical Activity, Lifestyle and Sport Research Centre, International Federation of Sports Medicine (FIMS), International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Lisa K Micklesfield
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
- National Institute for Health and Care Research, Oxford Biomedical Research Centre, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Andre Pascal Kengne
- Biomedical Research and Innovation Platform and Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Tinashe Chikowore
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clement N Kufe
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Epidemiology and Surveillance Section, National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Maphoko Masemola
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nigel J Crowther
- Department of Chemical Pathology, National Health Laboratory Service and University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Shane A Norris
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University, Lund, Sweden
- Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University Hospital, Uppsala University, Uppsala, Sweden
| | - Julia H Goedecke
- South African Medical Research Council/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health through Physical Activity, Lifestyle and Sport Research Centre, International Federation of Sports Medicine (FIMS), International Collaborating Centre of Sports Medicine, Division of Physiological Sciences, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Biomedical Research and Innovation Platform and Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
14
|
Sundbom F, Janson C, Ljunggren M, Lindberg E. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation. J Clin Sleep Med 2022; 18:2635-2641. [PMID: 35924855 PMCID: PMC9622994 DOI: 10.5664/jcsm.10178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Nocturnal symptoms are very common in asthma, which is associated with worse sleep quality. The nocturnal oxygen saturation may be decreased in asthma; however, whether this association is dependent on nocturnal asthma symptoms, lung function, coexisting obstructive sleep apnea (OSA), or other asthma-related comorbidities is unknown. The objective of this study was to examine the effects of asthma, OSA, lung function, airway symptoms, and asthma-related comorbidities on the nocturnal oxygen saturation in a cross-sectional community-based population study. METHODS In total, 395 women and 392 men underwent overnight polysomnography, performed spirometry, and completed questionnaires on airway symptoms and asthma-related comorbidities. RESULTS Participants with asthma (n = 88) had a lower nocturnal oxygen saturation than those without asthma (93.8% vs 94.3%, P = .01) also after adjusting for comorbidity, age, body mass index, and smoking status (coefficient -0.38; CI -0.67, -0.10; P < .01). The nocturnal oxygen saturation was lower among participants with wheezing, nocturnal chest tightness, fixed airflow limitation, gastroesophageal reflux, obesity, and OSA than in those without these conditions. The associations between lower oxygen saturation and wheezing, forced expiratory volume in 1 second, gastroesophageal reflux, and apnea-hypopnea index were significant also after adjusting for age, sex, body mass index, and smoking status. Participants with both wheezing and OSA had a significantly lower nocturnal oxygen saturation (92.5 ± 0.5%) than participants with wheezing only (94.3 ± 0.3%) and OSA only (93.6 ± 0.2% %) (P < .01). CONCLUSIONS Participants with asthma displayed a lower mean oxygen saturation during sleep, which could not be explained only by coexisting OSA or obesity. Also, asthma symptoms and lung function were associated with lower nocturnal oxygen saturation. The lower oxygen saturation seen in asthma is hence multifactorial in origin and is a result of the combination of symptoms, lung function, and comorbidity. CITATION Sundbom F, Janson C, Ljunggren M, Lindberg E. Asthma and asthma-related comorbidity: effects on nocturnal oxygen saturation. J Clin Sleep Med. 2022;18(11):2635-2641.
Collapse
Affiliation(s)
- Fredrik Sundbom
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| |
Collapse
|
15
|
Ljunggren M, Naessén T, Theorell‐Haglöw J, Franklin KA, Lindberg E. Rapid eye movement sleep apnea and carotid intima thickness in men and women: a SHE-MUSTACHE cohort study. J Sleep Res 2022; 31:e13599. [PMID: 35415915 PMCID: PMC9786679 DOI: 10.1111/jsr.13599] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/23/2022] [Accepted: 03/20/2022] [Indexed: 12/30/2022]
Abstract
Rapid eye movement (REM) obstructive sleep apnea might be particularly harmful to the cardiovascular system. We aimed to investigate the association between sleep apnea during REM sleep and signs of atherosclerotic disease in the form of carotid intima thickness in a community-based sample of men and women and possible sex differences in this association. The association between sleep apnea during REM sleep and intima thickness was analysed cross-sectionally in women from the community-based "Sleep and Health in Women" (SHE) study (n = 253) and age- and body mass index (BMI)-matched men from the "Men in Uppsala; a Study of sleep, Apnea and Cardiometabolic Health" (MUSTACHE) study (n = 338). Confounders adjusted for were age, BMI, gender, alcohol, and smoking. All participants underwent a full-night polysomnography, high-resolution ultrasonography of the common carotid artery, anthropometric measurements, blood pressure measurements, and answered questionnaires. There was an association between sleep apnea during REM sleep and thicker carotid intima that remained after adjustment for confounding (adjusted β = 0.008, p = 0.032). The intima was increased by 9.9% in the group with severe sleep apnea during REM sleep, and this association between severe sleep apnea during REM sleep and increased intima thickness remained after adjustment for confounders (adjusted β = 0.043, p = 0.021). More women than men had severe sleep apnea during REM sleep; moreover, in sex-stratified analyses, the association between sleep apnea during REM sleep and intima thickness was found in women but not in men. We conclude that severe REM sleep apnea is independently associated with signs of atherosclerosis. When stratified by sex, the association is seen in women but not in men.
Collapse
Affiliation(s)
- Mirjam Ljunggren
- Department of Medical Sciences, Respiratory, Allergy and Sleep ResearchUppsala UniversityUppsalaSweden
| | - Tord Naessén
- Department of Women's and Children's Health, Obstetrics and GynaecologyUppsala UniversityUppsalaSweden
| | - Jenny Theorell‐Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep ResearchUppsala UniversityUppsalaSweden
| | - Karl A. Franklin
- Department of Surgical and Perioperative Sciences, SurgeryUmeå UniversityUppsalaSweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep ResearchUppsala UniversityUppsalaSweden
| |
Collapse
|
16
|
Lind L, Sundström J, Elmståhl S, Dekkers KF, Smith JG, Engström G, Fall T, Ärnlöv J. The metabolomic profile associated with clustering of cardiovascular risk factors—A multi-sample evaluation. PLoS One 2022; 17:e0274701. [PMID: 36107885 PMCID: PMC9477278 DOI: 10.1371/journal.pone.0274701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background
A clustering of cardiovascular risk factors is denoted the metabolic syndrome (MetS), but the mechanistic underpinnings of this clustering is not clear. Using large-scale metabolomics, we aimed to find a metabolic profile common for all five components of MetS.
Methods and findings
791 annotated non-xenobiotic metabolites were measured by ultra-performance liquid chromatography tandem mass spectrometry in five different population-based samples (Discovery samples: EpiHealth, n = 2342 and SCAPIS-Uppsala, n = 4985. Replication sample: SCAPIS-Malmö, n = 3978, Characterization samples: PIVUS, n = 604 and POEM, n = 501). MetS was defined by the NCEP/consensus criteria. Fifteen metabolites were related to all five components of MetS (blood pressure, waist circumference, glucose, HDL-cholesterol and triglycerides) at a false discovery rate of <0.05 with adjustments for BMI and several life-style factors. They represented different metabolic classes, such as amino acids, simple carbohydrates, androgenic steroids, corticosteroids, co-factors and vitamins, ceramides, carnitines, fatty acids, phospholipids and metabolonic lactone sulfate. All 15 metabolites were related to insulin sensitivity (Matsuda index) in POEM, but only Palmitoyl-oleoyl-GPE (16:0/18:1), a glycerophospholipid, was related to incident cardiovascular disease over 8.6 years follow-up in the EpiHealth sample following adjustment for cardiovascular risk factors (HR 1.32 for a SD change, 95%CI 1.07–1.63).
Conclusion
A complex metabolic profile was related to all cardiovascular risk factors included in MetS independently of BMI. This profile was also related to insulin sensitivity, which provide further support for the importance of insulin sensitivity as an important underlying mechanism in the clustering of cardiovascular risk factors.
Collapse
Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Koen F. Dekkers
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - J. Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Tove Fall
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| |
Collapse
|
17
|
Abu Sabaa A, Shen Q, Lennmyr EB, Enblad AP, Gammelgård G, Molin D, Hein A, Freyhult E, Kamali-Moghaddam M, Höglund M, Enblad G, Eriksson A. Plasma protein biomarker profiling reveals major differences between acute leukaemia, lymphoma patients and controls. N Biotechnol 2022; 71:21-29. [PMID: 35779858 DOI: 10.1016/j.nbt.2022.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
Aiming to accommodate the unmet need for easily accessible biomarkers with a focus on biological differences between haematological diseases, the diagnostic value of plasma proteins in acute leukaemias and lymphomas was investigated. A multiplex proximity extension assay (PEA) was used to analyze 183 proteins in diagnostic plasma samples from 251 acute leukaemia and lymphoma patients and compared with samples from 60 healthy controls. Multivariate modelling using partial least square discriminant analysis revealed highly significant differences between distinct disease subgroups and controls. The model allowed explicit distinction between leukaemia and lymphoma, with few patients misclassified. Acute leukaemia samples had higher levels of proteins associated with haemostasis, inflammation, cell differentiation and cell-matrix integration, whereas lymphoma samples demonstrated higher levels of proteins known to be associated with tumour microenvironment and lymphoma dissemination. PEA technology can be used to screen for large number of plasma protein biomarkers in low µL sample volumes, enabling the distinction between controls, acute leukaemias and lymphomas. Plasma protein profiling could help gain insights into the pathophysiology of acute leukaemia and lymphoma and the technique may be a valuable tool in the diagnosis of these diseases.
Collapse
Affiliation(s)
- Amal Abu Sabaa
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden.
| | - Qiujin Shen
- Department of Immunology, Genetics & Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Anna Pia Enblad
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - Gustav Gammelgård
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden
| | - Daniel Molin
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden
| | - Anders Hein
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden
| | - Eva Freyhult
- Department of Medical Sciences, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Masood Kamali-Moghaddam
- Department of Immunology, Genetics & Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Martin Höglund
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics & Pathology, Uppsala University, Uppsala, Sweden
| | - Anna Eriksson
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
18
|
Lind L, Salihovic S, Sundström J, Elmståhl S, Hammar U, Dekkers K, Ärnlöv J, Smith JG, Engström G, Fall T. Metabolic Profiling of Obesity With and Without the Metabolic Syndrome: A Multisample Evaluation. J Clin Endocrinol Metab 2022; 107:1337-1345. [PMID: 34984454 DOI: 10.1210/clinem/dgab922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT There is a dispute whether obesity without major metabolic derangements may represent a benign condition or not. OBJECTIVE We aimed to compare the plasma metabolome in obese subjects without metabolic syndrome (MetS) with normal-weight subjects without MetS and with obese subjects with MetS. METHODS This was a cross-sectional study at 2 academic centers in Sweden. Individuals from 3 population-based samples (EpiHealth, n = 2342, SCAPIS-Uppsala, n = 4985, and SCAPIS-Malmö, n = 3978) were divided into groups according to their body mass index (BMI) and presence/absence of MetS (National Cholesterol Education Program [NCEP]/consensus criteria). In total, 791 annotated endogenous metabolites were measured by ultra-performance liquid chromatography-tandem mass spectrometry. RESULTS We observed major differences in metabolite profiles (427 metabolites) between obese (BMI ≥ 30 kg/m2) and normal-weight (BMI < 25 kg/m2) subjects without MetS after adjustment for major lifestyle factors. Pathway enrichment analysis highlighted branch-chained and aromatic amino acid synthesis/metabolism, aminoacyl-tRNA biosynthesis, and sphingolipid metabolism. The same pathways, and similar metabolites, were also highlighted when obese subjects with and without MetS were compared despite adjustment for BMI and waist circumference, or when the metabolites were related to BMI and number of MetS components in a continuous fashion. Similar metabolites and pathways were also related to insulin sensitivity (Matsuda index) in a separate study (POEM, n = 501). CONCLUSION Our data suggest a graded derangement of the circulating metabolite profile from lean to obese to MetS, in particular for metabolites involved in amino acid synthesis/metabolism and sphingolipid metabolism. Insulin resistance is a plausible mediator of this gradual metabolic deterioration.
Collapse
Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
| | - Samira Salihovic
- Inflammatory Response and Infection Susceptibility Centre, School of Medical Sciences, Örebro University, Örebro, Sweden
| | | | - Sölve Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Malmö University Hospital, Malmö, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Uppsala University, Sweden
| | - Koen Dekkers
- Department of Medical Sciences, Uppsala University, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital , Lund, Sweden
- The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University and the Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Tove Fall
- Department of Medical Sciences, Uppsala University, Sweden
| |
Collapse
|
19
|
Baldanzi G, Hammar U, Fall T, Lindberg E, Lind L, Elmståhl S, Theorell-Haglöw J. Evening chronotype is associated with elevated biomarkers of cardiometabolic risk in the EpiHealth cohort: a cross-sectional study. Sleep 2021; 45:6364133. [PMID: 34480568 PMCID: PMC8842133 DOI: 10.1093/sleep/zsab226] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/01/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Individuals with evening chronotype have a higher risk of cardiovascular and metabolic disorders, although the underlying mechanisms are not well understood. In a population-based cohort, we aimed to investigate the association between chronotype and 242 circulating proteins from three panels of established or candidate biomarkers of cardiometabolic processes. METHODS In 2,471 participants (49.7% men, mean age 61.2±8.4 SD years) from the EpiHealth cohort, circulating proteins were analyzed with a multiplex proximity extension technique. Participants self-reported their chronotype on a five-level scale from extreme morning to extreme evening chronotype. With the intermediate chronotype set as the reference, each protein was added as the dependent variable in a series of linear regression models adjusted for confounders. Next, the chronotype coefficients were jointly tested and the resulting p-values adjusted for multiple testing using false discovery rate (5%). For the associations identified, we then analyzed the marginal effect of each chronotype category. RESULTS We identified 17 proteins associated with chronotype. Evening chronotype was positively associated with proteins previously linked to insulin resistance and cardiovascular risk, namely retinoic acid receptor protein 2, fatty acid-binding protein adipocyte, tissue-type plasminogen activator, and plasminogen activator inhibitor 1 (PAI-1). Additionally, PAI-1 was inversely associated with the extreme morning chronotype. CONCLUSIONS In this population-based study, proteins previously related with cardiometabolic risk were elevated in the evening chronotypes. These results may guide future research in the relation between chronotype and cardiometabolic disorders.
Collapse
Affiliation(s)
- Gabriel Baldanzi
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala
| | - Ulf Hammar
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences in Malmö, Division of Geriatric Medicine, Lund University, Sweden; CRC, Skåne University Hospital, Malmö, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala.,Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Sweden
| |
Collapse
|
20
|
Lind L, Zethelius B, Lindberg E, Pedersen NL, Byberg L. Changes in leisure-time physical activity during the adult life span and relations to cardiovascular risk factors-Results from multiple Swedish studies. PLoS One 2021; 16:e0256476. [PMID: 34411192 PMCID: PMC8375969 DOI: 10.1371/journal.pone.0256476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/06/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate how self-reported leisure-time physical activity (PA) changes during the adult life span, and to study how PA is related to cardiovascular risk factors using longitudinal studies. METHODS Several Swedish population-based longitudinal studies were used in the present study (PIVUS, ULSAM, SHE, and SHM, ranging from hundreds to 30,000 participants) to represent information across the adult life span in both sexes. Also, two cross-sectional studies were used as comparison (EpiHealth, LifeGene). PA was assessed by questionnaires on a four or five-level scale. RESULTS Taking results from several samples into account, an increase in PA from middle-age up to 70 years was found in males, but not in females. Following age 70, a decline in PA was seen. Young adults reported both a higher proportion of sedentary behavior and a higher proportion high PA than the elderly. Females generally reported a lower PA at all ages. PA was mainly associated with serum triglycerides and HDL-cholesterol, but also weaker relationships with fasting glucose, blood pressure and BMI were found. These relationships were generally less strong in elderly subjects. CONCLUSION Using data from multiple longitudinal samples the development of PA over the adult life span could be described in detail and the relationships between PA and cardiovascular risk factors were portrayed. In general, a higher or increased physical activity over time was associated with a more beneficial cardiovascular risk factor profile, especially lipid levels.
Collapse
Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences/Respiratory, Allergy and Sleep Medicine, Uppsala University, Uppsala, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
21
|
Titova OE, Lindberg E, Elmståhl S, Lind L, Benedict C. Seasonal variations in sleep duration and sleep complaints: A Swedish cohort study in middle-aged and older individuals. J Sleep Res 2021; 31:e13453. [PMID: 34355440 DOI: 10.1111/jsr.13453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022]
Abstract
Subjective sleep reports are widely used research tools in epidemiology. Whether sleep reports can differ between seasons is less clear. Using multivariable binary or multinomial logistic regression analyses, in the present Swedish cross-sectional two-centre cohort study (N = 19,254; mean age 61 years), we found that participants surveyed during the summer (June-August) were more likely to report short sleep duration (defined as ≤ 6 hr) compared with those interviewed during the autumn (odds ratio [95% confidence interval] = 1.14 [1.04-1.25]). Individuals interviewed in the winter (December-February) were less likely to report early awakenings compared with participants surveyed in the autumn (September-November; odds ratio [95% confidence interval] = 0.85 [0.75-0.96]). Complaints of difficulties in falling asleep and disturbed sleep were less common among participants interviewed during spring (March-May) compared with those interviewed during the autumn (odds ratio [95% confidence interval] = 0.86 [0.74-0.99] and 0.88 [0.79-0.98], respectively). No seasonal variations in reports of long sleep, difficulty maintaining sleep, or feeling not rested after sleep were observed. Additional subgroup analysis revealed that summer participants were more likely to report short sleep duration and early morning awakenings than individuals surveyed in winter. In conclusion, this Swedish study indicates that self-reported sleep characteristics may vary across seasons. Further studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Olga E Titova
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Christian Benedict
- Department of Neuroscience, Sleep Science (BMC), Uppsala University, Uppsala, Sweden
| |
Collapse
|
22
|
Miguet M, Olivo G, Ciuculete DM, Elmståhl S, Lind L, Schiöth HB. Perceived stress is related to lower blood pressure in a Swedish cohort. Scand J Public Health 2021:14034948211030352. [PMID: 34282685 DOI: 10.1177/14034948211030352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS General psychosocial stress and job strain have been related to blood pressure (BP) with conflicting results. This study sought to explore the contribution of several lifestyle factors in the relation between general psychosocial stress, job strain and BP. METHODS This cross-sectional study investigated the association of general stress and job strain with systolic BP (SBP) and diastolic BP in a sample of 9441 employed individuals from the EpiHealth cohort. General stress was measured by the Perceived Stress Scale. Job strain was assessed with the Job Content Questionnaire, assessing two dimensions of job strain: psychological job demand and decision latitude. Linear regression and sensitivity analysis were performed. RESULTS At the uncorrected model, general stress, job demand and decision latitude were all inversely associated with SBP. After further adjustment for lifestyle and health parameters, only general stress was associated with SPB (β coefficient: -0.103; 95% confidence interval -0.182 to 0.023). CONCLUSIONS General stress is associated with lower SBP independently of lifestyle in middle-aged adults. Our findings point towards a major contribution for job-unrelated stressors in determining SBP and support the pivotal role of lifestyle behaviours and health status in modulating the effect of stress on BP, calling for a careful selection of confounders.
Collapse
Affiliation(s)
- Maud Miguet
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Sweden
| | - Gaia Olivo
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Sweden
| | | | | | - Lars Lind
- Uppsala Clinical Research Center (UCR), Sweden.,Department of Medical Sciences, Uppsala University, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Functional Pharmacology, Uppsala University, Sweden.,Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Russia
| |
Collapse
|
23
|
Theorell-Haglöw J, Hammar U, Lind L, Elmståhl S, Lindberg E, Fall T. Sleep duration is associated with protein biomarkers for cardiometabolic health: A large-scale population study. J Sleep Res 2021; 30:e13284. [PMID: 33751690 DOI: 10.1111/jsr.13284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
Sleep problems and short sleep duration have been linked to adverse health effects, such as cardiovascular disease and diabetes, but the mechanisms are not fully understood. Finding biomarkers could explain mechanistic pathways and help in understanding relationships between sleep and cardiometabolic health. The aim was to assess if sleep duration and sleep quality affect the cardiometabolic-related protein profile. In total, 242 proteins related to cardiometabolic health were measured in 2,430 plasma samples (male:female ratio 1:1, aged 45-75 years) from the population-based EpiHealth cohort, using a proximity extension assay. The association of self-reported sleep duration and sleep quality with each of the 242 proteins (primary outcome) was assessed with linear regression modelling, adjusting for confounders, and corrected for multiple testing using the false discovery rate (5%). Potential effect modification of age and sex was also tested using an interaction term. We identified U-shaped associations between sleep duration and the plasma levels of the proteins follistatin (more prominent in younger individuals), matrix metallopeptidase 9 (men only), urokinase receptor, adrenomedullin and kidney injury molecule, all previously known to be related to cardiovascular risk. There was no relationship between sleep quality and any of the proteins, after adjustment for confounders. These results give new leads to investigate the potential mechanistic pathways between sleep and cardiometabolic health.
Collapse
Affiliation(s)
- Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Department of Health Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden.,CRC, Skåne University Hospital, Malmö, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| |
Collapse
|
24
|
Mörth C, Sabaa AA, Freyhult E, Christersson C, Hashemi J, Hashemi N, Kamali-Moghaddam M, Molin D, Höglund M, Eriksson A, Enblad G. Plasma proteome profiling of cardiotoxicity in patients with diffuse large B-cell lymphoma. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2021; 7:6. [PMID: 33536059 PMCID: PMC7856776 DOI: 10.1186/s40959-021-00092-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/20/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiovascular toxicity is a notorious complication of doxorubicin (DXR) therapy for diffuse large B-cell lymphoma (DLBCL). Although surveillance of well-known biological markers for cardiovascular disease (CVD) as NTproBNP and Troponins may be helpful, there are no established markers to monitor for evolving CVD during treatment. New possibilities have arisen with the emergence of newer techniques allowing for analysis of plasma proteins that can be associated with cardiovascular disease. Proximity Extension Assay is one of them. OBJECTIVES We aimed to illustrate the incidence of CVD in DLBCL patients treated with DXR and to establish whether there are plasma proteins associated with pre-existing or emerging CVD. METHODS In 95 patients, 182 different proteins from OLINK panels, NTproBNP, Troponin I and CRP were assessed prior to, during and after treatment. For comparison, samples from controls were analyzed. RESULTS In the DLBCL cohort, 33.3% had pre-treatment CVD compared to 5.0% in the controls and 23.2% developed new CVD. Of the 32.6% who died during follow up, CVD was the cause in 4 patients. Spondin-1 (SPON-1) correlated to pre-treatment CVD (1.22 fold change, 95% CI 1.10-1.35, p = 0.00025, q = 0.045). Interleukin-1 receptor type 1 (IL-1RT1) was associated to emerging CVD (1.24 fold change, 95% CI 1.10-1.39, p = 0.00044, q = 0.082). CONCLUSION We observed a higher prevalence of CVD in DLBCL patients compared to controls prior to DXR therapy. Two proteins, SPON-1 and IL-1RT1, were related to pre-existing and emerging CVD in DXR treated patients. If confirmed in larger cohorts, IL-1RT1 may emerge as a reliable biomarker for unfolding CVD in DLBCL.
Collapse
Affiliation(s)
- Charlott Mörth
- Department of Immunology, Genetics & Pathology, Uppsala University, Rudbecklaboratoriet, 75185, Uppsala, Sweden.
- Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
| | - Amal Abu Sabaa
- Department of Immunology, Genetics & Pathology, Uppsala University, Rudbecklaboratoriet, 75185, Uppsala, Sweden
- Center for Research and Development, Uppsala University/Region Gävleborg, Uppsala, Sweden
| | - Eva Freyhult
- Department of Medical Sciences, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | | | - Jamileh Hashemi
- Department of Immunology, Genetics & Pathology, Uppsala University, Rudbecklaboratoriet, 75185, Uppsala, Sweden
| | - Nashmil Hashemi
- Department of Cardiology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Masood Kamali-Moghaddam
- Department of Immunology, Genetics & Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Daniel Molin
- Department of Immunology, Genetics & Pathology, Uppsala University, Rudbecklaboratoriet, 75185, Uppsala, Sweden
| | - Martin Höglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics & Pathology, Uppsala University, Rudbecklaboratoriet, 75185, Uppsala, Sweden
| |
Collapse
|
25
|
Svartengren M, Cai GH, Malinovschi A, Theorell-Haglöw J, Janson C, Elmståhl S, Lind L, Lampa E, Lindberg E. The impact of body mass index, central obesity and physical activity on lung function: results of the EpiHealth study. ERJ Open Res 2020; 6:00214-2020. [PMID: 33263030 PMCID: PMC7682662 DOI: 10.1183/23120541.00214-2020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Study objectives Obesity is often associated with lower lung function; however, the interaction of lung function with central obesity and physical inactivity is less clear. As such, we investigated the effect on lung function of body size (body mass index (BMI)), central obesity (waist circumference (WC)) and self-reported physical activity. Methods Lung function, height, weight and WC were measured in 22 743 participants (12 791 women), aged 45–75 years, from the EpiHealth cohort study. Physical activity, gender and educational level were assessed using a questionnaire. Results Obesity, central obesity and physical inactivity were all associated with lower forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). However, in participants without central obesity there was an increase in both FEV1 and FVC by BMI (% predicted FVC increasing from median 98%, interquartile range (IQR) 89–110% in underweight participants (BMI <20) to 103%, IQR 94–113% in obese participants (BMI ≥30)). In contrast, there was a decrease in % predicted FVC in participants with central obesity (from 98%, IQR 89–109% in the normal weight group to 95%, IQR 85–105% in the obese weight group). We further found a negative association between physical activity and lung function among those with low and high levels of physical activity (% predicted FEV1 97%, IQR 86–107% versus 103%, IQR 94–113%, respectively and % predicted FVC 96%, IQR 85–106% versus 103%, IQR 94–113%, respectively). All results remained when calculated by z-scores. Conclusions The association between BMI and lung function is dependent on the presence of central obesity. Independent of obesity, there is an association between physical activity and lung function. BMI and central obesity are related to lung function in the middle-aged and elderly. BMI association with lung function is dependent on the presence of central obesity, while the association of physical activity and lung function is independent of obesity.https://bit.ly/3eQl86C
Collapse
Affiliation(s)
- Magnus Svartengren
- Dept of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Gui-Hong Cai
- Dept of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden.,Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Jenny Theorell-Haglöw
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Dept of Health Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden.,Clinical Research Centre (CRC), Skåne University Hospital, Malmö, Sweden
| | - Lars Lind
- Dept of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| |
Collapse
|
26
|
Kamble PG, Theorell-Haglöw J, Wiklund U, Franklin KA, Hammar U, Lindberg E, Eriksson JW. Sleep apnea in men is associated with altered lipid metabolism, glucose tolerance, insulin sensitivity, and body fat percentage. Endocrine 2020; 70:48-57. [PMID: 32562183 PMCID: PMC7524823 DOI: 10.1007/s12020-020-02369-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is associated with obesity and risk for type 2 diabetes. In this community-based study, we thoroughly investigated fatty acid metabolism, incretin response, glucose tolerance, insulin secretion and insulin sensitivity, and autonomic nerve activity in men with or without OSA. METHODS Fifteen men without diabetes but with signs of severe OSA, defined as apnea-hypopnea index (AHI) >30, and 15 age- and BMI-matched men without OSA (AHI < 5) were recruited from a community-based cohort. Assessments included clinical and anthropometric measurements, a 2-h oral glucose tolerance test (OGTT), and autonomic nerve activity using heart rate variability (HRV). RESULTS Men with OSA had higher body fat % than BMI-matched men without OSA (p = 0.046) and it was associated with markers of insulin resistance. The area under the curve for nonesterified fatty acids (NEFA) during OGTT was higher in men with OSA (p = 0.021) and fasting NEFA levels were numerically higher (p = 0.097). The plasma glucose at fasting and during OGTT was higher in men with OSA (p < 0.001). Incretin response was similar between groups. Fasting and OGTT-derived indices indicated impaired insulin sensitivity in men with OSA. Compared with men without OSA, Matsuda index (p = 0.068) and Gutt index (p < 0.01) were lower in men with OSA. The HRV measures did not differ between groups. CONCLUSIONS Our study suggests that fatty acid handling, glucose tolerance, and insulin sensitivity are impaired in men with severe OSA. This might partly be explained by the increased body fat percentage.
Collapse
Affiliation(s)
- Prasad G Kamble
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Urban Wiklund
- Department of Radiation Sciences, Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Jan W Eriksson
- Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden.
| |
Collapse
|
27
|
Proteomic profiles before and during weight loss: Results from randomized trial of dietary intervention. Sci Rep 2020; 10:7913. [PMID: 32404980 PMCID: PMC7220904 DOI: 10.1038/s41598-020-64636-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/02/2020] [Indexed: 12/15/2022] Open
Abstract
Inflammatory and cardiovascular biomarkers have been associated with obesity, but little is known about how they change upon dietary intervention and concomitant weight loss. Further, protein biomarkers might be useful for predicting weight loss in overweight and obese individuals. We performed secondary analyses in the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized intervention trial that included healthy 609 adults (18–50 years old) with BMI 28–40 kg/m2, to evaluate associations between circulating protein biomarkers and BMI at baseline, during a weight loss diet intervention, and to assess predictive potential of baseline blood proteins on weight loss. We analyzed 263 plasma proteins at baseline and 6 months into the intervention using the Olink Proteomics CVD II, CVD III and Inflammation arrays. BMI was assessed at baseline, after 3 and 6 months of dietary intervention. At baseline, 102 of the examined inflammatory and cardiovascular biomarkers were associated with BMI (>90% with successful replication in 1,584 overweight/obese individuals from a community-based cohort study) and 130 tracked with weight loss shedding light into the pathophysiology of obesity. However, out of 263 proteins analyzed at baseline, only fibroblast growth factor 21 (FGF-21) predicted weight loss, and none helped individualize dietary assignment.
Collapse
|
28
|
Eriksen AK, Brunius C, Mazidi M, Hellström PM, Risérus U, Iversen KN, Fristedt R, Sun L, Huang Y, Nørskov NP, Knudsen KEB, Kyrø C, Olsen A, Tjønneland A, Dicksved J, Landberg R. Effects of whole-grain wheat, rye, and lignan supplementation on cardiometabolic risk factors in men with metabolic syndrome: a randomized crossover trial. Am J Clin Nutr 2020; 111:864-876. [PMID: 32097450 DOI: 10.1093/ajcn/nqaa026] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/31/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND A whole-grain (WG)-rich diet has shown to have potential for both prevention and treatment of the metabolic syndrome (MetS), which is a cluster of risk factors that increase the risk of type 2 diabetes and cardiovascular disease. Different WGs may have different health effects. WG rye, in particular, may improve glucose homeostasis and blood lipids, possibly mediated through fermentable dietary fiber and lignans. Recent studies have also suggested a crucial role of the gut microbiota in response to WG. OBJECTIVES The aim was to investigate WG rye, alone and with lignan supplements [secoisolariciresinol diglucoside (SDG)], and WG wheat diets on glucose tolerance [oral-glucose-tolerance test (OGTT)], other cardiometabolic outcomes, enterolignans, and microbiota composition. Moreover, we exploratively evaluated the role of gut microbiota enterotypes in response to intervention diets. METHODS Forty men with MetS risk profile were randomly assigned to WG diets in an 8-wk crossover study. The rye diet was supplemented with 280 mg SDG at weeks 4-8. Effects of treatment were evaluated by mixed-effects modeling, and effects on microbiota composition and the role of gut microbiota as a predictor of response to treatment were analyzed by random forest plots. RESULTS The WG rye diet (± SDG supplements) did not affect the OGTT compared with WG wheat. Total and LDL cholesterol were lowered (-0.06 and -0.09 mmol/L, respectively; P < 0.05) after WG rye compared with WG wheat after 4 wk but not after 8 wk. WG rye resulted in higher abundance of Bifidobacterium [fold-change (FC) = 2.58, P < 0.001] compared with baseline and lower abundance of Clostridium genus compared with WG wheat (FC = 0.54, P = 0.02). The explorative analyses suggest that baseline enterotype is associated with total and LDL-cholesterol response to diet. CONCLUSIONS WG rye, alone or with SDG supplementation, compared with WG wheat did not affect glucose metabolism but caused transient LDL-cholesterol reduction. The effect of WG diets appeared to differ according to enterotype. This trial was registered at www.clinicaltrials.gov as NCT02987595.
Collapse
Affiliation(s)
- Anne K Eriksen
- Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.,Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Carl Brunius
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Mohsen Mazidi
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Per M Hellström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Kia N Iversen
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Rikard Fristedt
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Li Sun
- Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Yi Huang
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, Uppsala, Sweden.,College of Animal Science and Technology, Guangxi University, Nanning, China
| | | | | | - Cecilie Kyrø
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anja Olsen
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Anne Tjønneland
- Unit of Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Johan Dicksved
- Department of Animal Nutrition and Management, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Rikard Landberg
- Division of Food and Nutrition Science, Department of Biology and Biological Engineering, Chalmers University of Technology, Gothenburg, Sweden
| |
Collapse
|
29
|
Titova OE, Lindberg E, Tan X, Elmståhl S, Lind L, Schiöth HB, Benedict C. Association between sleep duration and executive function differs between diabetic and non-diabetic middle-aged and older adults. Psychoneuroendocrinology 2020; 111:104472. [PMID: 31610410 DOI: 10.1016/j.psyneuen.2019.104472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/02/2019] [Accepted: 10/02/2019] [Indexed: 01/26/2023]
Abstract
Executive function is defined as a set of cognitive skills that are necessary to plan, monitor, and execute a sequence of goal-directed complex actions. Executive function is influenced by a variety of factors, including habitual sleep duration and diabetes. In the present study, we investigated in 18,769 Swedish adults (mean age: 61 y) the association between executive function, diabetes, and self-reported sleep duration. We observed a significant interaction between diabetes and sleep duration for the Trail Making Test (TMT) ratio (P < 0.01). This ratio is a measure of executive function where higher values indicate worse performance. Among diabetic participants (n = 1,523), long (defined as ≥9 h per day) vs. normal sleep duration (defined as 7-8 hours per day) was associated with a higher TMT ratio (P < 0.05). Similar significant results were observed in diabetic individuals without pharmacological treatment for diabetes (n = 1,062). Among non-diabetic participants (n = 17,246), no association between long sleep duration and the TMT ratio was observed (P > 0.05). Instead, short (defined as <7 h per day) vs. normal sleep duration was linked to a higher TMT ratio (P < 0.05). These findings suggest that the association between sleep duration and executive function differs between diabetic and non-diabetic middle-aged and older adults. Based on the cross-sectional design of the study, no firm conclusions can be drawn on the causality of the relations.
Collapse
Affiliation(s)
- Olga E Titova
- Department of Neuroscience, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences, Section of Orthopedics, Uppsala University, Uppsala, Sweden.
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Xiao Tan
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Health Sciences, Clinical Research Centre (CRC), Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Uppsala University, Uppsala, Sweden; Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia
| | | |
Collapse
|
30
|
Ohlsson B, Manjer J. Sociodemographic and Lifestyle Factors in relation to Overweight Defined by BMI and "Normal-Weight Obesity". J Obes 2020; 2020:2070297. [PMID: 31998533 PMCID: PMC6969981 DOI: 10.1155/2020/2070297] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/15/2019] [Accepted: 12/13/2019] [Indexed: 12/11/2022] Open
Abstract
Sociodemographic factors and lifestyle habits affect body weight and body composition. A new syndrome, called normal-weight obesity (NWO), is found in individuals with normal weight and excess body fat in contrast to lean and overweight individuals. The aim of the present study was to explore the associations between sociodemographic factors and smoking and alcohol habits and lower versus higher BMI (≥25 kg/m2) and to examine whether categorization into lean, NWO, and overweight leads to further information about sociodemographic and lifestyle associations, compared with the common categorization defined by BMI. A cohort of 17,724 participants (9,936 females, 56.1%) from the EpiHealth study, with a median age of 61 (53-67) years, was examined. The participants answered a questionnaire about lifestyle, and weight and fat percentage were measured. Associations between sociodemographic factors and lifestyle habits and lower versus higher BMI, and lean versus NWO or lean and NWO versus overweight were calculated by binary logistic regression. Male sex, age, sick leave/disability, married/cohabitating, divorced/widowed, former smoking, and a high alcohol consumption were associated with higher BMI, whereas higher education and frequent alcohol consumption were inversely associated (all p < 0.001). The associations were similar to associations with lean versus overweight and NWO versus overweight, except for age in the latter case. Associations with lean versus NWO differed from those of lower versus higher BMI, with an association with retirement, an inverse association with male sex (OR, 0.664; 95% confidence interval, 0.591-0.746), and no associations with marital status, smoking, and alcohol consumption frequency. Associations with age and occupation were sex dependent, in contrast to other variables examined. Thus, sociodemographic and lifestyle habits showed similar associations with lower versus higher BMI as with lean and NWO versus overweight, whereas lean versus NWO showed different directions of associations regarding sex, marital status, occupation, smoking, and frequency of alcohol consumption.
Collapse
Affiliation(s)
- Bodil Ohlsson
- Lund University, Skane University Hospital, Department of Internal Medicine, Malmö, Sweden
| | - Jonas Manjer
- Lund University, Skane University Hospital, Department of Surgery, Malmö, Sweden
| |
Collapse
|
31
|
Theorell-Haglöw J, Lemming EW, Michaëlsson K, Elmståhl S, Lind L, Lindberg E. Sleep duration is associated with healthy diet scores and meal patterns: results from the population-based EpiHealth study. J Clin Sleep Med 2019; 16:9-18. [PMID: 31957658 DOI: 10.5664/jcsm.8112] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
STUDY OBJECTIVES To investigate relationships between sleep duration and adherence to healthy diets, but also associations with meal patterns, in a large population-based cohort. METHODS Participants (n = 23,829, males and females, aged 45 to 75 years) from the Swedish EpiHealth cohort study were included in a cross-sectional analysis. The participants filled out an extensive Internet-based questionnaire, and also visited a test center for anthropometric measurements and blood sampling. Sleep duration was classified as short (< 6 h/night; n = 1,862), normal (6 to less fewer than 9 h/night; n = 19,907) and long sleep (≥ 9 h/night; n = 858). In addition, a combination variable of sleep duration (short/normal/long) and sleep quality (good/poor) was constructed, giving six categories. Adherence to a healthy diet was assessed using the modified Mediterranean diet (mMED) score and the Healthy Nordic Food Index (HNFI) score based on food groups from a food frequency questionnaire. A regular meal pattern was considered if the participant had breakfast, lunch and dinner on a daily basis. RESULTS Compared with normal sleepers, short sleepers displayed lower adherence to a healthy diet when using both the mMED score (adjusted odds ratio = 0.70; 95% confidence interval 0.56-0.88) and the HNFI score (0.70; 0.56-0.88). When combining sleep duration and sleep quality, short sleepers with poor sleep quality showed an independent relationship with low adherence to a healthy diet (0.67; 0.52-0.86) compared with normal sleepers with good sleep quality. In addition, both short sleepers (0.71; 0.62-0.82) and long sleepers (0.75; 0.62-0.91) showed low adherence to regular meal patterns, compared with normal sleepers. Furthermore, short sleepers with poor sleep quality had reduced odds of having a regular meal pattern (0.67; 0.57-0.79) as compared with normal sleepers with good sleep quality. CONCLUSIONS Short sleep duration combined with poor sleep quality is associated with low adherence to a healthy diet and regular meal patterns.
Collapse
Affiliation(s)
- Jenny Theorell-Haglöw
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Eva Warensjö Lemming
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Department of Health Sciences, Division of Geriatric Medicine, Lund University, Sweden and CRC, Skåne University Hospital, Malmö, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| |
Collapse
|
32
|
Beijer K, Nowak C, Sundström J, Ärnlöv J, Fall T, Lind L. In search of causal pathways in diabetes: a study using proteomics and genotyping data from a cross-sectional study. Diabetologia 2019; 62:1998-2006. [PMID: 31446444 PMCID: PMC6805963 DOI: 10.1007/s00125-019-4960-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/06/2019] [Indexed: 12/12/2022]
Abstract
AIMS/HYPOTHESIS The pathogenesis of type 2 diabetes is not fully understood. We investigated whether circulating levels of preselected proteins were associated with the outcome 'diabetes' and whether these associations were causal. METHODS In 2467 individuals of the population-based, cross-sectional EpiHealth study (45-75 years, 50% women), 249 plasma proteins were analysed by the proximity extension assay technique. DNA was genotyped using the Illumina HumanCoreExome-12 v1.0 BeadChip. Diabetes was defined as taking glucose-lowering treatment or having a fasting plasma glucose of ≥7.0 mmol/l. The associations between proteins and diabetes were assessed using logistic regression. To investigate causal relationships between proteins and diabetes, a bidirectional two-sample Mendelian randomisation was performed based on large, genome-wide association studies belonging to the DIAGRAM and MAGIC consortia, and a genome-wide association study in the EpiHealth study. RESULTS Twenty-six proteins were positively associated with diabetes, including cathepsin D, retinal dehydrogenase 1, α-L-iduronidase, hydroxyacid oxidase 1 and galectin-4 (top five findings). Three proteins, lipoprotein lipase, IGF-binding protein 2 and paraoxonase 3 (PON-3), were inversely associated with diabetes. Fourteen of the proteins are novel discoveries. The Mendelian randomisation study did not disclose any significant causal effects between the proteins and diabetes in either direction that were consistent with the relationships found between the protein levels and diabetes. CONCLUSIONS/INTERPRETATION The 29 proteins associated with diabetes are involved in several physiological pathways, but given the power of the study no causal link was identified for those proteins tested in Mendelian randomisation. Therefore, the identified proteins are likely to be biomarkers for type 2 diabetes, rather than representing causal pathways.
Collapse
Affiliation(s)
- Kristina Beijer
- Department of Medical Sciences, Uppsala University, UCR, Dag Hammarskjölds väg 38, SE-751 83, Uppsala, Sweden.
| | - Christoph Nowak
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, UCR, Dag Hammarskjölds väg 38, SE-751 83, Uppsala, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Stockholm, Sweden
- School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Tove Fall
- Department of Medical Sciences, Uppsala University, UCR, Dag Hammarskjölds väg 38, SE-751 83, Uppsala, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, UCR, Dag Hammarskjölds väg 38, SE-751 83, Uppsala, Sweden
| |
Collapse
|
33
|
Zazpe I, Santiago S, De la Fuente-Arrillaga C, Nuñez-Córdoba JM, Bes-Rastrollo M, Martínez-González MA. Paper-Based Versus Web-Based Versions of Self-Administered Questionnaires, Including Food-Frequency Questionnaires: Prospective Cohort Study. JMIR Public Health Surveill 2019; 5:e11997. [PMID: 31573924 PMCID: PMC6774237 DOI: 10.2196/11997] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/17/2019] [Accepted: 05/10/2019] [Indexed: 01/02/2023] Open
Abstract
Background Web-based questionnaires allow collecting data quickly, with minimal costs from large sample groups and through Web-based self-administered forms. Until recently, there has been a lack of evidence from large-scale epidemiological studies and nutrition surveys that have evaluated the comparison between traditional and new technologies to measure dietary intake. Objective This study aimed to compare results from the general baseline questionnaire (Q_0) and the 10-year follow-up questionnaire (Q_10) in the Seguimiento Universidad de Navarra (SUN) prospective cohort, obtained from different subjects, some of whom used a paper-based version, and others used a Web-based version. Both baseline and 10-year assessments included a validated 136-item semiquantitative food-frequency questionnaire (FFQ), used to collect dietary intake. Methods The SUN project is a prospective cohort study (with continuous open recruitment and many participants who were recently recruited). All participants were university graduates. Participants who completed the validated FFQ at baseline (FFQ_0, n=22,564) were selected. The variables analyzed were classified into 6 groups of questions: (1) FFQ (136 items), (2) healthy eating attitudes (10 items), (3) alcohol consumption (3 items), (4) physical activity during leisure time (17 items), (5) other activities (24 items), and (6) personality traits (3 items). Multiple linear and logistic regression models were used to assess the adjusted differences between the mean number of missing values and the risk of having apparently incorrect values for FFQ items or mismatches and inconsistencies in dietary variables. Results Only 1.5% (339/22564) and 60.71% (6765/11144) participants reported their information using the Web-based version for Q_0 and Q_10, respectively, and 51.40 % (11598/22564) and 100.00% (11144/11144) of participants who completed the Q_0 and Q_10, respectively, had the option of choosing the Web-based version. Sociodemographic, lifestyle, health characteristics, food consumption, and energy and nutrient intakes were similar among participants, according to the type of questionnaire used in Q_10. Less than 0.5% of values were missing for items related to healthy eating attitudes, alcohol consumption, and personality traits in the Web-based questionnaires. The proportion of missing data in FFQ, leisure time physical activity, and other activities was higher in paper-based questionnaires than Web-based questionnaires. In Web-based questionnaires, a high degree of internal consistency was found when comparing answers that should not be contradictory, such as the frequency of fruit as dessert versus total fruit consumption and the frequency of fried food consumptions versus oil consumption. Conclusions Incorporating a Web-based version for a baseline and 10-year questionnaire has not implicated a loss of data quality in this cohort of highly educated adults. Younger participants showed greater preference for Web-based questionnaires. Web-based questionnaires were filled out to a greater extent and with less missing items than paper-based questionnaires. Further research is needed to optimize data collection and response rate in Web-based questionnaires.
Collapse
Affiliation(s)
- Itziar Zazpe
- School of Pharmacy and Nutrition, Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain.,School of Medicine, Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Santiago
- School of Pharmacy and Nutrition, Department of Nutrition and Food Sciences and Physiology, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Carmen De la Fuente-Arrillaga
- School of Medicine, Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge M Nuñez-Córdoba
- School of Medicine, Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Maira Bes-Rastrollo
- School of Medicine, Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Angel Martínez-González
- School of Medicine, Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain.,Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
| |
Collapse
|
34
|
Kruger R. Proteomics insights on how physical inactivity can influence cardiovascular health. Eur J Prev Cardiol 2019; 26:1862-1864. [PMID: 31466470 DOI: 10.1177/2047487319872019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Ruan Kruger
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa.,MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| |
Collapse
|
35
|
Stattin K, Lind L, Elmståhl S, Wolk A, Lemming EW, Melhus H, Michaëlsson K, Byberg L. Physical activity is associated with a large number of cardiovascular-specific proteins: Cross-sectional analyses in two independent cohorts. Eur J Prev Cardiol 2019; 26:1865-1873. [PMID: 31409108 DOI: 10.1177/2047487319868033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS We aimed to discover and replicate associations between leisure-time physical activity and cardiovascular candidate plasma protein biomarkers and to examine whether the associations were independent of body fat. METHODS We used cross-sectional data from two population-based cohorts, the EpiHealth (discovery cohort; n = 2239) and the Swedish Mammography Cohort - Clinical (SMCC; replication cohort; n = 4320). Physical activity during leisure time was assessed using questionnaires, and plasma concentrations of 184 proteins were assayed using the Olink Proseek Multiplex Cardiovascular 2 and 3 kits. We applied adjusted linear regression models using the False Discovery Rate to control for multiple testing in discovery. RESULTS In EpiHealth, physical activity was associated with 75 cardiovascular plasma biomarkers, of which 28 associations were verified (replicated) in SMCC. Findings include seven novel associations in human: paraoxonase 3, cystatin B, cathepsin Z, alpha-L-iduronidase, prostasin, growth differentiation factor 2 and tumour necrosis factor alpha receptor superfamily member 11A. Estimates for associations were similar across tertiles of body fat and physical activity was associated with four biomarkers independent of body fat percentage: paraoxonase 3, cystatin B, fatty acid-binding protein 4 and interleukin-1 receptor antagonist. CONCLUSION Leisure-time physical activity was associated with 28 cardiovascular-specific proteins; four associations were independent of body fat. Biomarkers in novel associations are involved in several atherosclerotic processes including regulation of low-density lipoprotein oxidation, protein degradation and immune cell adhesion and migration. Further research into these pathways may yield new insights into how physical activity affects cardiovascular health.
Collapse
Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Sweden.,Unit of Cardiovascular and Nutritional Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Håkan Melhus
- Department of Medical Sciences, Uppsala University, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Sweden
| |
Collapse
|
36
|
Figarska SM, Gustafsson S, Sundström J, Ärnlöv J, Mälarstig A, Elmståhl S, Fall T, Lind L, Ingelsson E. Associations of Circulating Protein Levels With Lipid Fractions in the General Population. Arterioscler Thromb Vasc Biol 2019; 38:2505-2518. [PMID: 30354202 DOI: 10.1161/atvbaha.118.311440] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective- Revealing patterns of associations between circulating protein and lipid levels could improve biological understanding of cardiovascular disease (CVD). In this study, we investigated the associations between proteins related to CVD and triglyceride (TG), total cholesterol, LDL (low-density lipoprotein), and HDL (high-density lipoprotein) cholesterol levels in individuals from the general population. Approach and Results- We measured plasma protein levels using the Olink ProSeek CVD I or II+III arrays and analyzed 57 proteins available in 3 population-based cohorts: EpiHealth (n=2029; 52% women; median age, 61 years), PIVUS (Prospective Study of the Vasculature in Uppsala Seniors; n=790; 51% women; all aged 70 years), and ULSAM (Uppsala Longitudinal Study of Adult Men; n=551; all men aged 77 years). A discovery analysis was performed in EpiHealth in a regression framework (adjusted for sex, age, body mass index, smoking, glucose levels, systolic blood pressure, blood pressure medication, diabetes mellitus medication, and CVD history), and associations with false discovery rate <0.05 were further tested in PIVUS and ULSAM, where a P value of 0.05 was considered a successful replication (validation false discovery rate of 0.1%). We used summary statistics from a genome-wide association study on each protein biomarker (meta-analysis of EpiHealth, PIVUS, ULSAM, and IMPROVE [Carotid Intima-Media Thickness and IMT-Progression as Predictors of Vascular Events in a High-Risk European Population]) and publicly available data from Global Lipids Genetics Consortium to perform Mendelian randomization analyses to address possible causality of protein levels. Of 57 tested proteins, 42 demonstrated an association with at least 1 lipid fraction; 35 were associated with TG, 15 with total cholesterol, 9 with LDL cholesterol, and 24 with HDL cholesterol. Among these associations, we found KIM-1 (kidney injury molecule-1), TNFR (TNF [tumor necrosis factor] receptor) 1 and 2, TRAIL-R2 (TRAIL [TNF-related apoptosis-inducing ligand] receptor 2), and RETN (resistin) to be associated with all 4 lipid fractions. Further, 15 proteins were related to both TG and HDL cholesterol in a consistent and biologically expected manner, that is, higher TG and lower HDL cholesterol or vice versa. Another common pattern of associations was concomitantly higher TG, total cholesterol, and LDL cholesterol, which is associated with higher CVD risk. We did not find evidence of causal links for protein levels. Conclusions- Our comprehensive analysis of plasma proteins and lipid fractions of 3370 individuals from the general population provides new information about lipid metabolism.
Collapse
Affiliation(s)
- Sylwia M Figarska
- From the Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA (S.M.F., E.I.).,Stanford Cardiovascular Institute, Stanford University, CA (S.M.F., E.I.), Uppsala University, Sweden
| | - Stefan Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (S.G., T.F., E.I.), Uppsala University, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Cardiovascular Epidemiology (J.S., L.L.), Uppsala University, Sweden.,Uppsala Clinical Research Center (J.S.), Uppsala University, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden (J.Ä.).,School of Health and Social Sciences, Dalarna University, Falun, Sweden (J.Ä.)
| | - Anders Mälarstig
- Department of Medicine Solna, Cardiovascular Medicine Unit, Karolinska Institutet, Stockholm, Sweden (A.M.).,Pfizer Worldwide Research and Development, Stockholm, Sweden (A.M.)
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Clinical Sciences, Malmö University Hospital, Lund University, Sweden (S.E.)
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (S.G., T.F., E.I.), Uppsala University, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology (J.S., L.L.), Uppsala University, Sweden
| | - Erik Ingelsson
- From the Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA (S.M.F., E.I.).,Stanford Cardiovascular Institute, Stanford University, CA (S.M.F., E.I.), Uppsala University, Sweden.,Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (S.G., T.F., E.I.), Uppsala University, Sweden
| |
Collapse
|
37
|
Warensjö Lemming E, Byberg L, Stattin K, Ahmad S, Lind L, Elmståhl S, Larsson SC, Wolk A, Michaëlsson K. Dietary Pattern Specific Protein Biomarkers for Cardiovascular Disease: A Cross-Sectional Study in 2 Independent Cohorts. J Am Heart Assoc 2019; 8:e011860. [PMID: 31433701 PMCID: PMC6585372 DOI: 10.1161/jaha.118.011860] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/23/2019] [Indexed: 12/11/2022]
Abstract
Background Mechanisms related to the influence of diet on the development of cardiovascular disease are not entirely understood, and protein biomarkers may help to understand these pathways. Studies of biomarkers identified with multiplex proteomic methods and dietary patterns are largely lacking. Methods and Results Dietary patterns were generated through principal component analysis in 2 population-based Swedish cohorts, the EpiHealth (EpiHealth study; n=20 817 men and women) and the SMCC (Swedish Mammography Cohort Clinical [n=4650 women]). A set of 184 protein cardiovascular disease biomarkers were measured with 2 high-throughput, multiplex immunoassays. Discovery and replication multivariable linear regression analyses were used to investigate the associations between the principal component analysis-generated dietary patterns and the cardiovascular disease-associated protein biomarkers, first in the EpiHealth (n=2240) and then in the Swedish Mammography Cohort Clinical. Four main dietary patterns were identified in the EpiHealth, and 3 patterns were identified in the Swedish Mammography Cohort Clinical. The healthy and the Western/traditional patterns were found in both cohorts. In the EpiHealth, 57 protein biomarkers were associated with 3 of the dietary patterns, and 41 of these associations were replicated in the Swedish Mammography Cohort Clinical, with effect estimates ranging from 0.057 to 0.083 (P-value range, 5.0×10-2-1.4×10-9) for each SD increase in the relative protein concentration. Independent associations were established between dietary patterns and the 21 protein biomarkers. Two proteins, myeloperoxidase and resistin, were associated with both the healthy and the light meal pattern but in opposite directions. Conclusions We have discovered and replicated independent associations between dietary patterns and 21 biomarkers linked to cardiovascular disease, which have a role in the pathways related to inflammation, endothelial and immune function, cell adhesion, and metabolism.
Collapse
Affiliation(s)
- Eva Warensjö Lemming
- Section of OrthopedicsDepartment of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Liisa Byberg
- Section of OrthopedicsDepartment of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Karl Stattin
- Section of OrthopedicsDepartment of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Shafqat Ahmad
- Department of Medical SciencesUppsala UniversityUppsalaSweden
- Preventive Medicine DivisionBrigham and Women's HospitalHarvard Medical SchoolBostonMA
- Department of NutritionHarvard T.H. Chan School of Public HealthBostonMA
| | - Lars Lind
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - Sölve Elmståhl
- Division of Geriatric MedicineDepartment of Clinical SciencesLund UniversityLundSweden
| | - Susanna C. Larsson
- Section of OrthopedicsDepartment of Surgical SciencesUppsala UniversityUppsalaSweden
- Division of Nutritional EpidemiologyInstitute of Environmental MedicineKarolinska InstitutetStockholmSweden
| | - Alicja Wolk
- Section of OrthopedicsDepartment of Surgical SciencesUppsala UniversityUppsalaSweden
- Division of Nutritional EpidemiologyInstitute of Environmental MedicineKarolinska InstitutetStockholmSweden
| | - Karl Michaëlsson
- Section of OrthopedicsDepartment of Surgical SciencesUppsala UniversityUppsalaSweden
| |
Collapse
|
38
|
Sjöholm T, Ekström S, Strand R, Ahlström H, Lind L, Malmberg F, Kullberg J. A whole-body FDG PET/MR atlas for multiparametric voxel-based analysis. Sci Rep 2019; 9:6158. [PMID: 30992502 PMCID: PMC6467986 DOI: 10.1038/s41598-019-42613-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/04/2019] [Indexed: 01/12/2023] Open
Abstract
Quantitative multiparametric imaging is a potential key application for Positron Emission Tomography/Magnetic Resonance (PET/MR) hybrid imaging. To enable objective and automatic voxel-based multiparametric analysis in whole-body applications, the purpose of this study was to develop a multimodality whole-body atlas of functional 18F-fluorodeoxyglucose (FDG) PET and anatomical fat-water MR data of adults. Image registration was used to transform PET/MR images of healthy control subjects into male and female reference spaces, producing a fat-water MR, local tissue volume and FDG PET whole-body normal atlas consisting of 12 male (66.6 ± 6.3 years) and 15 female (69.5 ± 3.6 years) subjects. Manual segmentations of tissues and organs in the male and female reference spaces confirmed that the atlas contained adequate physiological and anatomical values. The atlas was applied in two anomaly detection tasks as proof of concept. The first task automatically detected anomalies in two subjects with suspected malignant disease using FDG data. The second task successfully detected abnormal liver fat infiltration in one subject using fat fraction data.
Collapse
Affiliation(s)
- Therese Sjöholm
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Simon Ekström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robin Strand
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Antaros Medical AB, Mölndal, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Filip Malmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Joel Kullberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Antaros Medical AB, Mölndal, Sweden
| |
Collapse
|
39
|
Fortier I, Dragieva N, Saliba M, Craig C, Robson PJ. Harmonization of the Health and Risk Factor Questionnaire data of the Canadian Partnership for Tomorrow Project: a descriptive analysis. CMAJ Open 2019; 7:E272-E282. [PMID: 31018973 PMCID: PMC6498449 DOI: 10.9778/cmajo.20180062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The Canadian Partnership for Tomorrow Project is a multistudy platform integrating the British Columbia Generations Project, Alberta's Tomorrow Project, the Ontario Health Study, CARTaGENE (Quebec) and the Atlantic Partnership for Tomorrow's Health. This paper describes the process used to harmonize the Health and Risk Factor Questionnaire data and provides an overview of the key information required to properly use the core data set generated. METHODS This is a descriptive analysis of the harmonization process that was developed on the basis of the Maelstrom Research guidelines for retrospective harmonization. Core variables (DataSchema) to be generated across cohorts were defined and the potential for cohort-specific data sets to generate the DataSchema variables was assessed. Where relevant, algorithms were developed and applied to process cohort-specific data into the DataSchema format, and information to be provided to data users was documented. RESULTS The Health and Risk Factor Questionnaire DataSchema (version 2.0, October 2017) comprised 694 variables. The assessment of harmonization potential for the variables over 12 cohort-specific data sets resulted in 6799 (81.6%) of the variables being considered as harmonizable. A total of 307 017 participants were included in the harmonized data set. Through the cohort data portal, researchers can find information about the definitions of variables, harmonization potential, algorithms applied to generate harmonized variables and participant distributions. INTERPRETATION The harmonization process enabled the creation of a unique data set including data on health and risk factors from over 307 000 Canadians. These data, in combination with complementary data sets, can be used to investigate the impact of biological, environmental and behavioural factors on cancer and chronic diseases.
Collapse
Affiliation(s)
- Isabel Fortier
- Research Institute of the McGill University Health Centre (Fortier, Dragieva, Saliba); Centre hospitalier de l'Université de Montréal (CHUM) Research Centre (Craig), Montréal, Que.; CancerControl Alberta and Cancer Strategic Clinical Network (Robson), Alberta Health Services; Department of Agricultural, Food and Nutritional Science (Robson), Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alta.
| | - Nataliya Dragieva
- Research Institute of the McGill University Health Centre (Fortier, Dragieva, Saliba); Centre hospitalier de l'Université de Montréal (CHUM) Research Centre (Craig), Montréal, Que.; CancerControl Alberta and Cancer Strategic Clinical Network (Robson), Alberta Health Services; Department of Agricultural, Food and Nutritional Science (Robson), Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alta
| | - Matilda Saliba
- Research Institute of the McGill University Health Centre (Fortier, Dragieva, Saliba); Centre hospitalier de l'Université de Montréal (CHUM) Research Centre (Craig), Montréal, Que.; CancerControl Alberta and Cancer Strategic Clinical Network (Robson), Alberta Health Services; Department of Agricultural, Food and Nutritional Science (Robson), Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alta
| | - Camille Craig
- Research Institute of the McGill University Health Centre (Fortier, Dragieva, Saliba); Centre hospitalier de l'Université de Montréal (CHUM) Research Centre (Craig), Montréal, Que.; CancerControl Alberta and Cancer Strategic Clinical Network (Robson), Alberta Health Services; Department of Agricultural, Food and Nutritional Science (Robson), Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alta
| | - Paula J Robson
- Research Institute of the McGill University Health Centre (Fortier, Dragieva, Saliba); Centre hospitalier de l'Université de Montréal (CHUM) Research Centre (Craig), Montréal, Que.; CancerControl Alberta and Cancer Strategic Clinical Network (Robson), Alberta Health Services; Department of Agricultural, Food and Nutritional Science (Robson), Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alta
| |
Collapse
|
40
|
Lind L, Elmståhl S, Ingelsson E. Cardiometabolic Proteins Associated with Metabolic Syndrome. Metab Syndr Relat Disord 2019; 17:272-279. [PMID: 30883260 DOI: 10.1089/met.2018.0123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Although metabolic syndrome (MetS) was described in the late 80s, the molecular mechanisms underlying clustering of risk factors in certain individuals are not fully understood. The present study used targeted proteomics to establish cardiometabolic proteins related to all MetS components, thereby providing new hypotheses regarding pathways involved in the pathogenesis of MetS. Methods: In the EpiHealth study, 249 cardiometabolic proteins were measured by proximity extension assay (PEA) and related to the five MetS components [consensus-modified National Cholesterol Education Program (NCEP) criteria] in 2,444 participants aged 45-75 years (50% women). Results: Thirty-one proteins were associated with systolic blood pressure following adjustment for age and sex (P < 0.000040, taking multiple testing into account). The corresponding number of proteins significantly associated with fasting glucose, waist circumference, high-density lipoprotein cholesterol, and serum triglycerides were 58, 132, 127, and 148. Twenty-two proteins were significantly related to all 5 MetS components, and of those, 20 were with MetS as a binary outcome (n = 600, 24% of the sample) following adjustment for age, sex, fat mass, and lifestyle factors (alcohol intake, smoking, education, and exercise habits). Conclusion: Using targeted proteomics, we identified 20 proteins reflecting a range of pathways, such as immunomodulation at different levels; regulation of adipocyte differentiation; lipid, carbohydrate, and amino acid metabolism; or insulin-like growth factor signaling, to be strongly associated with MetS independently of fat mass and lifestyle factors. Whether some of these proteins are causally involved in the pathogenesis of clustering of multiple risk factors in the same individual remains to be investigated.
Collapse
Affiliation(s)
- Lars Lind
- 1 Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- 2 Division of Geriatric Medicine, Department of Clinical Sciences, Lund University, Malmö University Hospital, Malmö, Sweden
| | - Erik Ingelsson
- 3 Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.,4 Stanford Cardiovascular Institute, Stanford University, Stanford, California.,5 Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| |
Collapse
|
41
|
Tan X, Titova OE, Lindberg E, Elmståhl S, Lind L, Schiöth HB, Benedict C. Association Between Self-Reported Sleep Duration and Body Composition in Middle-Aged and Older Adults. J Clin Sleep Med 2019; 15:431-435. [PMID: 30853046 DOI: 10.5664/jcsm.7668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/06/2018] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVES The current study sought to examine whether self-reported sleep duration is linked to an adverse body composition in 19,709 adults aged 45 to 75 years. METHODS All variables used in the current study were derived from the Swedish EpiHealth cohort study. Habitual sleep duration was measured by questionnaires. Body composition was assessed by bioimpedance. The main outcome variables were fat mass and fat-free mass (in kg). Analysis of covariance adjusting for age, sex, fat mass in the case of fat-free mass (and vice versa), leisure time physical activity, smoking, and alcohol consumption was used to investigate the association between sleep duration and body composition. RESULTS Short sleep (defined as ≤ 5 hours sleep per day) and long sleep (defined as 8 or more hours of sleep per day) were associated with lower fat-free mass and higher fat mass, compared with 6 to 7 hours of sleep duration (P < .05). CONCLUSIONS These observations could suggest that both habitual short and long sleep may contribute to two common clinical phenotypes in middle-aged and older humans, ie, body adiposity and sarcopenia. However, the observational nature of our study does not allow for causal interpretation.
Collapse
Affiliation(s)
- Xiao Tan
- Department of Neuroscience, Uppsala University, Sleep Research Laboratory, Uppsala, Sweden
| | - Olga E Titova
- Department of Neuroscience, Uppsala University, Sleep Research Laboratory, Uppsala, Sweden
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Department of Health Sciences, Division of Geriatric Medicine, Lund University, Sweden CRC, Skåne University Hospital, Malmö, Sweden
| | - Lars Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Department of Neuroscience, Uppsala University, Sleep Research Laboratory, Uppsala, Sweden
| | - Christian Benedict
- Department of Neuroscience, Uppsala University, Sleep Research Laboratory, Uppsala, Sweden
| |
Collapse
|
42
|
Abstract
The first population-based cohort study in Uppsala with the aim to study cardiovascular disease was initiated in 1970 (ULSAM). This cohort of 2300 middle-aged men has since then been followed in a longitudinal fashion for almost 50 years. This study has been followed by the PIVUS study, investigating 1000 men and women at ages 70, 75, and 80. A very detailed examination has also been performed in 500 subjects aged 50 years, the POEM study. In recent years, a high-throughput study conducted in 13000 subjects has also been performed, named EpiHealth. Uppsala also collects data in 5,000 subjects in the nationwide SCAPIS study. Taken together, these cardiovascular-oriented studies constitute a very rich source for cardiovascular epidemiological research in Uppsala. This review summarizes the design of these studies and highlights some of the important results published based on data from these studies.
Collapse
Affiliation(s)
- Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
- CONTACT Lars Lind E-mail: Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
43
|
Beijer K, Lampa E, Sundström J, Nilsson PM, Elmståhl S, Pedersen NL, Lind L. Physical activity may compensate for prolonged TV time regarding pulse rate-a cross-sectional study. Ups J Med Sci 2018; 123:247-254. [PMID: 30468101 PMCID: PMC6327624 DOI: 10.1080/03009734.2018.1540505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Regular exercise reduces pulse rate, but it is less clear how prolonged sitting time affects pulse rate. Our hypothesis was that high physical activity could compensate for prolonged sitting time regarding the pulse rate. METHODS Regression analysis was performed on cross-sectional data including 47,457 men and women based on two Swedish cohort studies, EpiHealth (18-45 years) and LifeGene (45-75 years). Self-reported leisure time physical activity was given in five levels, from low (level 1) to vigorous (level 5), and television time was used as a proxy of sitting time. RESULTS A higher physical activity (level 4 compared to level 1) was associated with a lower pulse rate in middle-aged females (-2.7 beats per minute [bpm]; 95% CI -3.3 to -2.2) and males (-4.0 bpm; 95% CI -4.7 to -3.4). The relationship between physical activity and pulse rate was strongest in the young. A prolonged television time (3 h compared to 1 h per day) was associated with a slightly higher pulse rate in middle-aged females (+0.6 bpm; 95% CI +0.3 to +0.8) and males (+0.9 bpm; 95% CI +0.7 to +1.2). Among participants with a prolonged television time (3 h), those with a high physical activity (level 4) had a lower pulse rate compared to those with a low physical activity (level 1). CONCLUSIONS A prolonged television time was associated with a high pulse rate, while high physical activity was associated with a low pulse rate. The results suggest that a high physical activity could compensate for a prolonged television time regarding pulse rate.
Collapse
Affiliation(s)
- Kristina Beijer
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, UppsalaSweden
- CONTACT Kristina Beijer PhD, Department of Medical Sciences, Uppsala University, UCR, Dag Hammarskjölds väg 38, SE-751 83Uppsala, Sweden
| | - Erik Lampa
- Uppsala Clinical Research Center (UCR), Uppsala, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, UppsalaSweden
- Uppsala Clinical Research Center (UCR), Uppsala, Sweden
| | | | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Health Sciences, Lund University, Malmö University Hospital, Malmö, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, UppsalaSweden
- Uppsala Clinical Research Center (UCR), Uppsala, Sweden
| |
Collapse
|
44
|
Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity. Sleep Med 2018; 46:81-87. [PMID: 29773216 DOI: 10.1016/j.sleep.2018.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/14/2018] [Accepted: 03/20/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Previous studies have shown that both sleep duration and insomnia have an impact on obesity and central obesity. However, studies of the joint effects of these sleep disorders are still sparse. METHODS The present study utilized data from the Swedish EpiHealth cohort study. Participants (45-78 y) were asked to fill out an internet-based questionnaire. Body mass index (BMI) and central obesity (calculated from waist circumference) were based on measured data. RESULTS A total of 18,823 participants (mean age = 60 ys) were included in this study. The reported prevalence of short (<6 h/night) and long (>9 h/night) sleep duration was 8% and 4% respectively, and insomnia symptoms was 19%. Of the study population, 16% were obese (BMI ≥ 30 kg/m2) and 40% had central obesity. There was a U-shaped association between sleep duration and obesity and central obesity, and significant associations between insomnia symptoms and obesity. When stratifying sleep duration by concurrent insomnia symptoms, there were associations (odds ratios, (95% confidence intervals)) between the combination of both short (1.48, (1.22-1.80)) and long sleep duration (1.77 (1.00-3.16)) with insomnia symptoms and obesity and central obesity (1.36 (1.16-1.61) and 2.44 (1.41-3.24) respectively). However, there was no significant association between insomnia symptoms and obesity or central obesity in participants with normal sleep duration. For central obesity there was an association with long sleep duration regardless of insomnia symptoms, while the association with short sleep duration was significant only if insomnia symptoms were present. CONCLUSIONS Both short and long sleep duration, as well as insomnia symptoms, are associated with obesity and central obesity. There is an important joint effect of sleep duration and insomnia symptoms and there is no association between insomnia symptoms and obesity, as long as a normal sleeping time can be attained. This indicates that sleep duration rather than insomnia symptoms per se is of importance for the relationship between sleep and obesity.
Collapse
|
45
|
Cornelis MC, Gustafsson S, Ärnlöv J, Elmståhl S, Söderberg S, Sundström J, Michaëlsson K, Lind L, Ingelsson E. Targeted proteomic analysis of habitual coffee consumption. J Intern Med 2018; 283:200-211. [PMID: 29044854 DOI: 10.1111/joim.12703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Coffee drinking has been implicated in mortality and a variety of diseases but potential mechanisms underlying these associations are unclear. Large-scale systems epidemiological approaches may offer novel insights to mechanisms underlying associations of coffee with health. OBJECTIVE We performed an analysis of known and novel protein markers linked to cardiovascular disease and their association with habitual coffee intake in the Prospective Study of the Vasculature in Uppsala Seniors (PIVUS, n = 816) and followed up top proteins in the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 635) and EpiHealth (n = 2418). METHODS In PIVUS and ULSAM, coffee intake was measured by 7-day dietary records whilst a computer-based food frequency questionnaire was used in EpiHealth. Levels of up to 80 proteins were assessed in plasma by a proximity extension assay. RESULTS Four protein-coffee associations adjusted for age, sex, smoking and BMI, met statistical significance in PIVUS (FDR < 5%, P < 2.31 × 10-3 ): leptin (LEP), chitinase-3-like protein 1 (CHI3L), tumour necrosis factor (TNF) receptor 6 and TNF-related apoptosis-inducing ligand. The inverse association between coffee intake and LEP replicated in ULSAM (β, -0.042 SD per cup of coffee, P = 0.028) and EpiHealth (β, -0.025 SD per time of coffee, P = 0.004). The negative coffee-CHI3L association replicated in EpiHealth (β, -0.07, P = 1.15 × 10-7 ), but not in ULSAM (β, -0.034, P = 0.16). CONCLUSIONS The current study supports an inverse association between coffee intake and plasma LEP and CHI3L1 levels. The coffee-CHI3L1 association is novel and warrants further investigation given links between CHI3L1 and health conditions that are also potentially influenced by coffee.
Collapse
Affiliation(s)
- M C Cornelis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Gustafsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - J Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - S Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Malmö University Hospital, Malmö, Sweden
| | - S Söderberg
- Department of Public Health and Clinical Medicine, Cardiology, Umeå University, Umeå, Sweden
| | - J Sundström
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - K Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - L Lind
- Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - E Ingelsson
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.,Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| |
Collapse
|
46
|
Glimelius B, Melin B, Enblad G, Alafuzoff I, Beskow A, Ahlström H, Bill-Axelson A, Birgisson H, Björ O, Edqvist PH, Hansson T, Helleday T, Hellman P, Henriksson K, Hesselager G, Hultdin M, Häggman M, Höglund M, Jonsson H, Larsson C, Lindman H, Ljuslinder I, Mindus S, Nygren P, Pontén F, Riklund K, Rosenquist R, Sandin F, Schwenk JM, Stenling R, Stålberg K, Stålberg P, Sundström C, Thellenberg Karlsson C, Westermark B, Bergh A, Claesson-Welsh L, Palmqvist R, Sjöblom T. U-CAN: a prospective longitudinal collection of biomaterials and clinical information from adult cancer patients in Sweden. Acta Oncol 2018. [PMID: 28631533 DOI: 10.1080/0284186x.2017.1337926] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Progress in cancer biomarker discovery is dependent on access to high-quality biological materials and high-resolution clinical data from the same cases. To overcome current limitations, a systematic prospective longitudinal sampling of multidisciplinary clinical data, blood and tissue from cancer patients was therefore initiated in 2010 by Uppsala and Umeå Universities and involving their corresponding University Hospitals, which are referral centers for one third of the Swedish population. MATERIAL AND METHODS Patients with cancer of selected types who are treated at one of the participating hospitals are eligible for inclusion. The healthcare-integrated sampling scheme encompasses clinical data, questionnaires, blood, fresh frozen and formalin-fixed paraffin-embedded tissue specimens, diagnostic slides and radiology bioimaging data. RESULTS In this ongoing effort, 12,265 patients with brain tumors, breast cancers, colorectal cancers, gynecological cancers, hematological malignancies, lung cancers, neuroendocrine tumors or prostate cancers have been included until the end of 2016. From the 6914 patients included during the first five years, 98% were sampled for blood at diagnosis, 83% had paraffin-embedded and 58% had fresh frozen tissues collected. For Uppsala County, 55% of all cancer patients were included in the cohort. CONCLUSIONS Close collaboration between participating hospitals and universities enabled prospective, longitudinal biobanking of blood and tissues and collection of multidisciplinary clinical data from cancer patients in the U-CAN cohort. Here, we summarize the first five years of operations, present U-CAN as a highly valuable cohort that will contribute to enhanced cancer research and describe the procedures to access samples and data.
Collapse
Affiliation(s)
- Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anna Beskow
- Uppsala Biobank, Uppsala Clinical Research Center, Uppsala, Sweden
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Bill-Axelson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Helgi Birgisson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ove Björ
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Per-Henrik Edqvist
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tony Hansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Thomas Helleday
- Science for Life Laboratory, Division of Translational Medicine and Chemical Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Per Hellman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Kerstin Henriksson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Magnus Hultdin
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Michael Häggman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Martin Höglund
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Håkan Jonsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Chatarina Larsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | | | - Peter Nygren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Richard Rosenquist
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Sandin
- RCC Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden
| | - Jochen M. Schwenk
- Affinity Proteomics, SciLifeLab, School of Biotechnology, KTH Royal Institute of Technology, Solna, Sweden
| | - Roger Stenling
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Karin Stålberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Peter Stålberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christer Sundström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Bengt Westermark
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Lena Claesson-Welsh
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Tobias Sjöblom
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
47
|
Interaction between physical activity and television time on blood pressure level: cross-sectional data from 45 000 individuals. J Hypertens 2018; 36:1041-1050. [PMID: 29369146 DOI: 10.1097/hjh.0000000000001675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim was to investigate if there is an interaction between sitting time and leisure time physical activity on blood pressure and if there are age differences and sex differences in this respect. METHODS Linear regression analysis on cross-sectional data was performed in more than 45 000 men and women from two Swedish cohort studies, EpiHealth (45-75 years) and LifeGene (18-45 years). Self-reported leisure time physical activity was given in five levels from low (level 1) to vigorous physical activity (level 5) and television time was used as a proxy measure of sitting time. RESULTS High physical activity was associated with lower DBP (P = 0.001), but not SBP. Active middle-aged men had lower DBP (-1.1 mmHg; 95% CI -1.7 to -0.4) compared with inactive participants. Prolonged television time was associated with higher SBP (P < 0.001) and DBP (P = 0.011) in both sexes and in most age groups. Watching 3 h instead of 1 h television per day was associated with higher SBP in middle-aged women (SBP: 1.1 mmHg; 95% CI 0.7-1.4) and men (SBP: 1.2 mmHg; 95% CI 0.8-1.6). Only in young men, a high physical activity (level 4 instead of level 1) could compensate for a prolonged television time (3 h per day) in terms of DBP. CONCLUSION Prolonged television time was associated with higher SBP and DBP in both sexes and at most ages, whereas an increased physical activity was mainly associated with a lower DBP. Only in young men, a high physical activity could compensate for prolonged television time regarding DBP.
Collapse
|
48
|
Cai GH, Janson C, Theorell-Haglöw J, Benedict C, Elmståhl S, Lind L, Lindberg E. Both Weight at Age 20 and Weight Gain Have an Impact on Sleep Disturbances Later in Life: Results of the EpiHealth Study. Sleep 2018; 41:4817528. [DOI: 10.1093/sleep/zsx176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
49
|
Titova OE, Lindberg E, Elmståhl S, Lind L, Schiöth HB, Benedict C. Associations Between the Prevalence of Metabolic Syndrome and Sleep Parameters Vary by Age. Front Endocrinol (Lausanne) 2018; 9:234. [PMID: 29867766 PMCID: PMC5958301 DOI: 10.3389/fendo.2018.00234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/23/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine whether the relationship between the metabolic syndrome (MetS) and various sleep parameters [sleep duration, symptoms of sleep-disordered breathing (SDB), and sleep disturbances] varies by age. METHODS Waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting glucose were used to determine MetS status in a cohort (N = 19,691) of middle-aged (aged 45-64 years) and older (aged ≥65 years) subjects. Habitual sleep duration (short, ≤6 h/day; normal, 7-8 h/day; and long ≥9 h/day), sleep disturbances (such as problems with falling and staying asleep), and symptoms of sleep-disordered breathing (SDB, such as snoring and sleep apneas) were measured by questionnaires. RESULTS Among the participants, 4,941 subjects (25.1%) fulfilled the criteria for MetS. In the entire sample, both short and long sleep durations were associated with higher prevalence of MetS as compared to normal sleep duration. When stratified by age, a similar pattern was observed for middle-aged subjects (<65 years old; prevalence ratio (PR) [95% CI], 1.13 [1.06-1.22] for short sleep and 1.26 [1.06-1.50] for long sleep duration). In contrast, in older individuals (≥65 years old), only long sleep duration was linked to a higher prevalence of MetS (1.26 [1.12-1.42]; P < 0.01 for sleep duration × age). In the entire cohort, having at least one SDB symptom ≥4 times per week was linked to an increased prevalence of MetS; however, the PR was higher in middle-aged subjects compared with older subjects (1.50 [1.38-1.63] vs. 1.36 [1.26-1.47], respectively; P < 0.001 for SDB × age). Finally, independent of subjects' age, reports of sleep disturbances (i.e., at least one symptom ≥4 times per week) were associated with a higher likelihood of having MetS (1.12 [1.06-1.18]; P > 0.05 for sleep disturbance × age). CONCLUSION Our results suggest that age may modify the associations between some sleep parameters and the prevalence of MetS.
Collapse
Affiliation(s)
- Olga E. Titova
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
- *Correspondence: Olga E. Titova, ; Christian Benedict,
| | - Eva Lindberg
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Sölve Elmståhl
- Division of Geriatric Medicine, Department of Health Sciences, Clinical Research Centre (CRC), Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Lind
- Cardiovascular Epidemiology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Christian Benedict
- Department of Neuroscience, Uppsala University, Uppsala, Sweden
- *Correspondence: Olga E. Titova, ; Christian Benedict,
| |
Collapse
|
50
|
Moding M, Ohlsson B. The role of fermentable carbohydrates and beverages in the symptomatology of functional gastrointestinal disease. Scand J Gastroenterol 2017; 52:1224-1234. [PMID: 28826271 DOI: 10.1080/00365521.2017.1365931] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The pathophysiology behind functional gastrointestinal disease (FGID) has not been defined, but an intestinal accumulation of fermentable short-chain carbohydrates (FODMAPs) is thought to be involved. A restricted coffee intake is recommended. The aim was to investigate if symptoms of FGID were associated with intake of certain foods (including FODMAPs), as well as beverages (including coffee and tea). METHOD AND MATERIALS Data were used from participants, age range 45-75 years, who had answered the EpiHealth questionnaire about their background factors, health status and intake of food and beverages. After exclusion of organic bowel diseases, 16,840 participants remained. The impact of food and beverages on functional abdominal pain, functional bloating, functional constipation and functional diarrhea were examined by adjusted binary logistic regression. RESULTS Wholemeal bread (Swedish cracker) (OR: 1.361; 95% CI: 1.001-1.851) and white bread (low fiber content) (OR: 1.527; 95% CI: 1.075-2.169) were associated with constipation, whereas soft wholemeal bread (high fiber content) was associated with diarrhea (OR: 1.601; 95% CI: 1.040-2.463). Cheese was associated with bloating (OR: 1.460; 95% CI: 1.004-2.123). A high tea intake was associated with abdominal pain (p for trend =.003), bloating (p for trend = .039) and diarrhea (p for trend <.001), whereas coffee intake was associated with a decreased risk of abdominal pain (p for trend = .002) and bloating (p for trend = .007). High soda intake associated with abdominal pain and bloating and juice with diarrhea. CONCLUSION There are weak associations between intake of grain and dairy products and FGID symptoms. Tea is associated with increased risks, whereas coffee is associated with lower risks, of FGID symptoms.
Collapse
Affiliation(s)
- Magnus Moding
- a Department of Internal Medicine , Lund University, Skåne University Hospital , Malmö , Sweden
| | - Bodil Ohlsson
- a Department of Internal Medicine , Lund University, Skåne University Hospital , Malmö , Sweden
| |
Collapse
|