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Bassey PE, Numthavaj P, Rattanasiri S, Sritara P, McEvoy M, Ongphiphadhanakul B, Thakkinstian A. Causal association pathways between fetuin-A and kidney function: a mediation analysis. J Int Med Res 2022; 50:3000605221082874. [PMID: 35435033 PMCID: PMC9019358 DOI: 10.1177/03000605221082874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Body mass index (BMI), uric acid, diabetes mellitus, and hypertension are risk factors for reduced kidney function and are associated with fetuin-A levels, but their causal pathways remain unclear. The objective of this study was to investigate this knowledge gap. Methods A repeated cross-sectional design was used to assess causal pathway effects of fetuin-A on the estimated glomerular filtration rate (eGFR), which is mediated through BMI, uric acid, diabetes mellitus, and hypertension. Results Among 2305 participants, the mean eGFR at baseline decreased from 98.7 ± 23.6 mL/minute/1.73 m2 in 2009 to 92.4 ± 22.9 mL/minute/1.73 m2 in 2014. Fetuin-A was significantly associated with eGFR , suggesting that increasing fetuin-A levels predict a decrease in eGFR. Additionally, the indirect effect of fetuin-A on eGFR, as assessed through BMI, was also significant. The effects of fetuin-A on eGFR through other mediation pathways showed variable results. Conclusions Our study revealed a possible role of fetuin-A in the etiology of declining renal function through mediating body mass index, uric acid, diabetes mellitus, and hypertension via complex causal pathways. Further studies to clarify these mediated effects are recommended.
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Affiliation(s)
- Philip Etabee Bassey
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
- Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, CRS, Nigeria
| | - Pawin Numthavaj
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Sasivimol Rattanasiri
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Piyamitr Sritara
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
| | - Mark McEvoy
- Center for Clinical Epidemiology and Biostatistics, The School of Medicine and Public Health, the University of Newcastle, Newcastle, NSW, Australia
| | | | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
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Metabolic Syndrome: Updates on Pathophysiology and Management in 2021. Int J Mol Sci 2022; 23:ijms23020786. [PMID: 35054972 PMCID: PMC8775991 DOI: 10.3390/ijms23020786] [Citation(s) in RCA: 422] [Impact Index Per Article: 211.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/18/2022] Open
Abstract
Metabolic syndrome (MetS) forms a cluster of metabolic dysregulations including insulin resistance, atherogenic dyslipidemia, central obesity, and hypertension. The pathogenesis of MetS encompasses multiple genetic and acquired entities that fall under the umbrella of insulin resistance and chronic low-grade inflammation. If left untreated, MetS is significantly associated with an increased risk of developing diabetes and cardiovascular diseases (CVDs). Given that CVDs constitute by far the leading cause of morbidity and mortality worldwide, it has become essential to investigate the role played by MetS in this context to reduce the heavy burden of the disease. As such, and while MetS relatively constitutes a novel clinical entity, the extent of research about the disease has been exponentially growing in the past few decades. However, many aspects of this clinical entity are still not completely understood, and many questions remain unanswered to date. In this review, we provide a historical background and highlight the epidemiology of MetS. We also discuss the current and latest knowledge about the histopathology and pathophysiology of the disease. Finally, we summarize the most recent updates about the management and the prevention of this clinical syndrome.
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Icer MA, Yıldıran H. Effects of fetuin-A with diverse functions and multiple mechanisms on human health. Clin Biochem 2020; 88:1-10. [PMID: 33245873 DOI: 10.1016/j.clinbiochem.2020.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 12/14/2022]
Abstract
Fetuin-A (Alfa 2-Heremans-Schmid) is a glycoprotein that is mainly synthesized by hepatocytes and then released into the bloodstream. While fetuin-A, a multifunctional protein, has inhibitory effects on health in the processes of calcification, mineralization, coronary artery calcification (CAC), and kidney stone formation by various mechanisms, it has such stimulatory effects as obesity, diabetes, and tumor progression processes. Fetuin-A produces these effects on the organism mainly by playing a role in the secretion levels of some inflammatory cytokines and exosomes, preventing unwanted calcification, inhibiting the autophosphorylation of tyrosine kinase, suppressing the release of adiponectin and peroxisome proliferator-activated receptor-γ (PPARγ), activating the toll-like receptor 4 (TLR-4), triggering the phosphatidylinositol 3 (PI3) kinase/Akt signaling pathway and cell proliferation, and mimicking the transforming growth factor-beta (TGF-β) receptor. In the present review, fetuin-A was examined in a wide perspective from the structure and release of fetuin-A to its effects on health.
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Affiliation(s)
- Mehmet Arif Icer
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06500 Ankara, Turkey.
| | - Hilal Yıldıran
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, 06500 Ankara, Turkey
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4
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Abstract
PURPOSE OF REVIEW There is substantial inter-individual variability in body weight change, which is not fully accounted by differences in daily energy intake and physical activity levels. The metabolic responses to short-term perturbations in energy intake can explain part of this variability by quantifying the degree of metabolic "thriftiness" that confers more susceptibility to weight gain and more resistance to weight loss. It is unclear which metabolic factors and pathways determine this human "thrifty" phenotype. This review will investigate and summarize emerging research in the field of energy metabolism and highlight important metabolic mechanisms implicated in body weight regulation in humans. RECENT FINDINGS Dysfunctional adipose tissue lipolysis, reduced brown adipose tissue activity, blunted fibroblast growth factor 21 secretion in response to low-protein hypercaloric diets, and impaired sympathetic nervous system activity might constitute important metabolic factors characterizing "thriftiness" and favoring weight gain in humans. The individual propensity to weight gain in the current obesogenic environment could be ascertained by measuring specific metabolic factors which might open up new pathways to prevent and treat human obesity.
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Affiliation(s)
- Tim Hollstein
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Paolo Piaggi
- Obesity and Diabetes Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
- Department of Information Engineering, University of Pisa, Pisa, Italy.
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5
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Pan X, Wen SW, Bestman PL, Kaminga AC, Acheampong K, Liu A. Fetuin-A in Metabolic syndrome: A systematic review and meta-analysis. PLoS One 2020; 15:e0229776. [PMID: 32134969 PMCID: PMC7058339 DOI: 10.1371/journal.pone.0229776] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/13/2020] [Indexed: 12/11/2022] Open
Abstract
Objective Fetuin-A has been associated with the progression of metabolic syndrome, but previous studies found inconsistent results on the relationship between metabolic syndrome and the concentration of fetuin-A. The aim of this study was to perform a meta-analysis to summarize previous findings on this relationship. Method This study was registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019129566). Studies examining the relationship between metabolic syndrome and the concentration of circulating fetuin-A were identified using a systematic search in the electronic databases of Embase, PubMed, Web of Science, and Cochrane Library before March 2019. A random effects model was used to summarize the effect size of the association in terms of the standardized mean difference (SMD). Results Fourteen eligible studies compared fetuin-A concentrations between 4,551 metabolic syndrome patients and 8,805 controls. The circulating fetuin-A concentration was significantly higher in the metabolic syndrome patients than in the controls (SMD = 0.65, 95% confidence interval (CI): 0.48 to 0.83, Z = 7.18, p<0.001). Besides, circulating fetuin-A was a risk factor for metabolic syndrome (odds ratio 1.23, 95% CI: 1.08 to 1.40). Conclusion These findings suggest that fetuin-A may be an important indicator for metabolic syndrome, in which case this may lead to new perspectives in early diagnosis, identification of novel biomarkers, and providing novel targets for pharmacological interventions.
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Affiliation(s)
- Xiongfeng Pan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Shi Wu Wen
- Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | - Kwabena Acheampong
- Department of Public, School of Postgraduate Studies, Adventist University of Africa, Nairobi, Kenya
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- * E-mail:
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Wang WJ, Wang S, Yang MN, Dong Y, He H, Fang F, Huang R, Yu XG, Zhang GH, Zhao X, Zheng T, Huang XY, Zhang J, Ouyang F, Luo ZC. Fetuin-A in Infants Born Small- or Large-for-Gestational-Age. Front Endocrinol (Lausanne) 2020; 11:567955. [PMID: 33117283 PMCID: PMC7561389 DOI: 10.3389/fendo.2020.567955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Fetuin-A is a multifunctional glycoprotein that has been implicated in insulin resistance and bone metabolism. We assessed whether fetuin-A is associated with poor or excessive fetal growth. In the Shanghai Birth Cohort, we conducted a nested case-control study of 60 trios of small-for-gestational-age (SGA, birth weight <10th percentile), optimal-for-gestational-age (OGA, 25-75th, the reference) and large-for-gestational-age (LGA, >90th percentile) infants matched by sex and gestational age. Cord plasma concentrations of fetuin-A and fetal growth factors [insulin, proinsulin, insulin-like growth factor (IGF)-I and IGF-II] were measured. Cord plasma fetuin-A concentrations were higher in SGA (809.4 ± 306.9 μg/ml, P = 0.026) and LGA (924.2 ± 375.9 μg/ml, P < 0.001) relative to OGA (680.7 ± 262.1 μg/ml) newborns, and were not correlated to insulin, proinsulin, IGF-I and IGF-II (all P > 0.2). Higher fetuin-A concentrations were associated with increased risks of SGA [OR = 1.67 (1.08-2.58) per SD increment, P = 0.024] and LGA [OR = 2.36 (1.53-3.66), P < 0.001]. Adjusting for maternal and neonatal characteristics and fetal growth factors, the elevated risk changed little for LGA [adjusted OR = 2.28 (1.29-4.01), P = 0.005], but became non-significant for SGA (P = 0.202). Our study is the first to demonstrate that fetuin-A may be involved in excessive fetal growth. This association is independent of fetal growth factors.
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Affiliation(s)
- Wen-Juan Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalla Lana School of Public Health, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Shufan Wang
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalla Lana School of Public Health, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Meng-Nan Yang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalla Lana School of Public Health, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Yu Dong
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Hua He
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Fang Fang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Rong Huang
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalla Lana School of Public Health, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Xiao-Gang Yu
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Guang-Hui Zhang
- Department of Clinical Assay Laboratory, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Xia Zhao
- Department of Clinical Assay Laboratory, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Tao Zheng
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Xiao-Yi Huang
- Department of Pediatric, International Peace Maternity and Child Health Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Fengxiu Ouyang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Fengxiu Ouyang
| | - Zhong-Cheng Luo
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
- Department of Obstetrics and Gynecology, Faculty of Medicine, Dalla Lana School of Public Health, Lunenfeld-Tanenbaum Research Institute, Prosserman Center for Population Health Research, Mount Sinai Hospital, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- *Correspondence: Zhong-Cheng Luo
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Wu HT, Chen SC, Fan KC, Kuo CH, Lin SY, Wang SH, Chang CJ, Li HY. Targeting fibrinogen-like protein 1 is a novel therapeutic strategy to combat obesity. FASEB J 2019; 34:2958-2967. [PMID: 31908014 DOI: 10.1096/fj.201901925r] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/06/2019] [Accepted: 12/15/2019] [Indexed: 12/16/2022]
Abstract
Fibrinogen-like-protein 1 (FGL1) is a novel hepatokine that plays an important role in hepatic steatosis and insulin resistance. Although FGL1 expression can be detected in adipose tissues, the functions of FGL1 in adipose tissues are still unknown. In this study, 356 participants with (body mass index (BMI) ≥25 kg/m2 ; n = 134) or without obesity (BMI <25 kg/m2 ; n = 222) were recruited, and we found that the plasma FGL1 concentrations were significantly higher in obese group than those of in the normal weight group, and were positively correlated with age, BMI, waist circumference, fat content, plasma glucose at 2 hours during an oral glucose tolerance test, and the insulin sensitivity index. In univariate analyses, BMI, waist circumference, total fat, visceral fat, and subcutaneous fat areas were positively correlated with FGL1 levels. After adjusting for age and gender, obesity indices, including the BMI and different fat areas, remained significantly associated with FGL1 levels. In order to investigate the causal relationship between FGL1 and obesity, animal and cell models were used. Overexpression of FGL1 in epididymal adipose tissue by lentiviral vector encoding FGL1 increased the fat pad size, whereas FGL1-knockdown by lentiviral vector encoding short-hairpin RNA targeted to FGL1 decreased high-fat diet-induced adiposity. In addition, 3T3-L1 adipocytes were used to clarify the possible mechanism of FGL1-induced adipogenesis. FGL1 induced adipogenesis through an ERK1/2-C/EBPβ-dependent pathway in 3T3-L1 adipocytes. These findings highlight the pathophysiological role of FGL1 in obesity, and FGL1 might be a novel therapeutic target to combat obesity.
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Affiliation(s)
- Hung-Tsung Wu
- Graduate Institute of Metabolism and Obesity Sciences, Taipei Medical University, Taipei, Taiwan
| | - Szu-Chi Chen
- Division of Endocrinology, Department of Internal Medicine, Cardinal Tien Hospital, Xindian, Taiwan
| | - Kang-Chih Fan
- Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Chun-Heng Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shin-Yu Lin
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Huei Wang
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hung-Yuan Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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8
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Abstract
Fetuin-A is a glycoprotein structured molecule which is mostly released by the liver. As a multifunctional protein, fetuin-A has positive effects on health such as calcification, cardiovascular diseases and tumor development processes with various mechanisms, whereas it plays a negative role in the processes of obesity, diabetes and fatty liver disease. There are a large number of studies reporting that serum fetuin-A levels are affected by several dietary factors. It is reported in some of these studies that several nutrients increase fetuin-A release, while some others have adverse effects. It is put forward that some nutrients such as dairy products, curcumin, niacin, palmitate, coffee and alcohol consumption decrease fetuin-A level, and dietary omega-3 fatty acids intake may increase fetuin-A concentration. In addition, it is indicated that high blood glucose levels increase hepatic fetuin-A release by activating extracellular signal-regulated kinase 1/2 enzymes and increased plasma free fatty acids do the same effect by increasing NF-KB activity. Despite these studies in the literature, there is not any review evaluating fetuin-A, chronic diseases and nutrition together. Therefore, in this study, the relationship between serum fetuin levels and some diseases and the effects of nutrients on fetuin A levels were investigated with possible mechanisms.
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Affiliation(s)
- Mehmet Arif Icer
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Hilal Yıldıran
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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9
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Huang HH, Yeh C, Chen JC, Lee TH, Chen SC, Lee WJ, Chen CY. Does bariatric surgery influence plasma levels of fetuin-A and leukocyte cell-derived chemotaxin-2 in patients with type 2 diabetes mellitus? PeerJ 2018; 6:e4884. [PMID: 29910974 PMCID: PMC6003398 DOI: 10.7717/peerj.4884] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022] Open
Abstract
Background Fetuin-A and leukocyte cell-derived chemotaxin-2 (LECT-2) are liver-derived proteins. Fetuin-A is an independent risk factor for type 2 diabetes (T2D) and obese patients with T2D have higher plasma fetuin-A levels than those without T2D. LECT-2 has positive correlation with the severity of both obesity and insulin resistance. The changes in plasma fetuin-A are not consistent after bariatric surgery and no studies have investigated the changes in LECT-2 on the obese patients with T2D after bariatric surgery. Methods Overall, 18 patients undergoing gastric bypass (GB) and 16 patients undergoing sleeve gastrectomy (SG) were enrolled. The fasting plasma fetuin-A and LECT-2 levels were measured at baseline, one week, three months, and one year after surgery. Results Both the GB and SG groups significantly decreased the body mass index (BMI), waist-to-hip ratio, a body shape index; the triglyceride, fasting blood sugar (FBS), hemoglobin A1c, C-peptide levels; and homeostatic model assessment (HOMA-IR) one year after surgery. The SG group showed a decreasing trend in plasma fetuin-A levels one year after SG surgery. There are no significant changes in LECT-2 one year after either GB or SG. Fetuin-A had a near significant negative relationship with insulin (P = 0.056) and HOMA-IR (P = 0.050) in the SG group. Changes in fetuin-A had a significant positive relationship with changes in BMI (P = 0.031) and waist-to-hip ratio (P = 0.031) in the GB group and had a near significant positive correlation with FBS (P = 0.051) in the SG group. Discussion Neither GB nor SG modifies plasma levels of plasma fetuin-A or LECT-2 in T2D patients after surgery. The changes in plasma fetuin-A have a positive correlation with those of the BMI and waist-to-hip ratio 12 months after GB.
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Affiliation(s)
- Hsien-Hao Huang
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Emergency and Critical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chun Yeh
- Division of Gastroenterology, Department of Internal Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chien Chen
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan
| | - Tzong-Hsi Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Nursing, Oriental Institute of Technology, New Taipei, Taiwan
| | - Shu-Chun Chen
- Department of Nursing, Min-Sheng General Hospital, Taoyuan, Taiwan.,Taiwan Society for Metabolic and Bariatric Surgery, Taoyuan, Taiwan
| | - Wei-Jei Lee
- Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.,Taiwan Society for Metabolic and Bariatric Surgery, Taoyuan, Taiwan
| | - Chih-Yen Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Bariatric and Metabolic Surgery Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Taiwan Association for the Study of Small Intestinal Diseases, Guishan, Taiwan.,Chinese Taipei Society for the Study of Obesity, Taipei, Taiwan
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10
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Recent progress in genetics, epigenetics and metagenomics unveils the pathophysiology of human obesity. Clin Sci (Lond) 2017; 130:943-86. [PMID: 27154742 DOI: 10.1042/cs20160136] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/24/2016] [Indexed: 12/19/2022]
Abstract
In high-, middle- and low-income countries, the rising prevalence of obesity is the underlying cause of numerous health complications and increased mortality. Being a complex and heritable disorder, obesity results from the interplay between genetic susceptibility, epigenetics, metagenomics and the environment. Attempts at understanding the genetic basis of obesity have identified numerous genes associated with syndromic monogenic, non-syndromic monogenic, oligogenic and polygenic obesity. The genetics of leanness are also considered relevant as it mirrors some of obesity's aetiologies. In this report, we summarize ten genetically elucidated obesity syndromes, some of which are involved in ciliary functioning. We comprehensively review 11 monogenic obesity genes identified to date and their role in energy maintenance as part of the leptin-melanocortin pathway. With the emergence of genome-wide association studies over the last decade, 227 genetic variants involved in different biological pathways (central nervous system, food sensing and digestion, adipocyte differentiation, insulin signalling, lipid metabolism, muscle and liver biology, gut microbiota) have been associated with polygenic obesity. Advances in obligatory and facilitated epigenetic variation, and gene-environment interaction studies have partly accounted for the missing heritability of obesity and provided additional insight into its aetiology. The role of gut microbiota in obesity pathophysiology, as well as the 12 genes associated with lipodystrophies is discussed. Furthermore, in an attempt to improve future studies and merge the gap between research and clinical practice, we provide suggestions on how high-throughput '-omic' data can be integrated in order to get closer to the new age of personalized medicine.
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11
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Abstract
Obesity is a risk factor for a plethora of severe morbidities and premature death. Most supporting evidence comes from observational studies that are prone to chance, bias and confounding. Even data on the protective effects of weight loss from randomized controlled trials will be susceptible to confounding and bias if treatment assignment cannot be masked, which is usually the case with lifestyle and surgical interventions. Thus, whilst obesity is widely considered the major modifiable risk factor for many chronic diseases, its causes and consequences are often difficult to determine. Addressing this is important, as the prevention and treatment of any disease requires that interventions focus on causal risk factors. Disease prediction, although not dependent on knowing the causes, is nevertheless enhanced by such knowledge. Here, we provide an overview of some of the barriers to causal inference in obesity research and discuss analytical approaches, such as Mendelian randomization, that can help to overcome these obstacles. In a systematic review of the literature in this field, we found: (i) probable causal relationships between adiposity and bone health/disease, cancers (colorectal, lung and kidney cancers), cardiometabolic traits (blood pressure, fasting insulin, inflammatory markers and lipids), uric acid concentrations, coronary heart disease and venous thrombosis (in the presence of pulmonary embolism), (ii) possible causal relationships between adiposity and gray matter volume, depression and common mental disorders, oesophageal cancer, macroalbuminuria, end-stage renal disease, diabetic kidney disease, nuclear cataract and gall stone disease, and (iii) no evidence for causal relationships between adiposity and Alzheimer's disease, pancreatic cancer, venous thrombosis (in the absence of pulmonary embolism), liver function and periodontitis.
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Affiliation(s)
- P W Franks
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden.,Unit of Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - N Atabaki-Pasdar
- Genetic & Molecular Epidemiology Unit, Department of Clinical Sciences, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden
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12
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Temesszentandrási G, Vörös K, Márkus B, Böröcz Z, Kaszás E, Prohászka Z, Falus A, Cseh K, Kalabay L. Human Fetuin-A Rs4918 Polymorphism and its Association with Obesity in Healthy Persons and in Patients with Myocardial Infarction in Two Hungarian Cohorts. Med Sci Monit 2016; 22:2742-50. [PMID: 27487851 PMCID: PMC4982529 DOI: 10.12659/msm.896232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Human fetuin A (AHSG) has been associated with the development of obesity, insulin resistance, type 2 diabetes mellitus, and atherosclerosis. Observations on the role of AHSG rs4918 single-nucleotide polymorphism are contradictory. We investigated the association between variants of rs4918 and parameters of obesity, lipid status, tumor necrosis factor-α (TNFα), adipokines (adiponectin, resistin, leptin), and insulin resistance in healthy persons and in patients with previous myocardial infarction. Material/Methods This was a cross-sectional study comprising cohort 1 (81 healthy individuals) and cohort 2 (157 patients with previous myocardial infarction). We used the allele-specific KASP genotyping assay to detect rs4918 polymorphism. Results In cohort 1, G-nucleotide carriers had significantly lower serum TNFα, adiponectin, and higher leptin concentrations than in non-G carriers. These differences, however, were not observed in cohort 2. In cohort 2, G-carriers had lower BMI and waist circumferences than in non-G carriers. The G allele was more frequent among lean than obese patients (RR=1.067, 95%CI=1.053–2.651, p=0.015). An association between BMI and rs4918 polymorphism was observed among patients without diabetes (CC/CG/GG genotypes: p=0.003, G vs. non-G allele: p=0.008) but not in diabetics. In addition, a strong linearity between BMI and the CC/CG/GG genotypes (association value: 4.416, p=0.036) and the frequency of the G allele (7.420, p=0.006) could be identified. In cohort 2, non-obese, non-diabetic G-carriers still had lower BMI and waist circumferences than in non-G carriers. Conclusions The rs4918 minor variant is associated with lower TNFα and adiponectin, higher leptin levels in healthy persons, and more favorable anthropomorphic parameters of obesity in cohort 2.
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Affiliation(s)
| | - Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Bernadett Márkus
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Böröcz
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Edit Kaszás
- Department of Internal Medicine, Károlyi Sándor Municipal Hospital, Budapest, Hungary
| | - Zoltán Prohászka
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - András Falus
- Department of Genetics and Immunology, and Cell Sciences, Semmelweis University, Budapest, Hungary
| | - Károly Cseh
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - László Kalabay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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13
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Millard LAC, Davies NM, Timpson NJ, Tilling K, Flach PA, Davey Smith G. MR-PheWAS: hypothesis prioritization among potential causal effects of body mass index on many outcomes, using Mendelian randomization. Sci Rep 2015; 5:16645. [PMID: 26568383 PMCID: PMC4644974 DOI: 10.1038/srep16645] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 10/16/2015] [Indexed: 01/03/2023] Open
Abstract
Observational cohort studies can provide rich datasets with a diverse range of phenotypic variables. However, hypothesis-driven epidemiological analyses by definition only test particular hypotheses chosen by researchers. Furthermore, observational analyses may not provide robust evidence of causality, as they are susceptible to confounding, reverse causation and measurement error. Using body mass index (BMI) as an exemplar, we demonstrate a novel extension to the phenome-wide association study (pheWAS) approach, using automated screening with genotypic instruments to screen for causal associations amongst any number of phenotypic outcomes. We used a sample of 8,121 children from the ALSPAC dataset, and tested the linear association of a BMI-associated allele score with 172 phenotypic outcomes (with variable sample sizes). We also performed an instrumental variable analysis to estimate the causal effect of BMI on each phenotype. We found 21 of the 172 outcomes were associated with the allele score at an unadjusted p < 0.05 threshold, and use Bonferroni corrections, permutation testing and estimates of the false discovery rate to consider the strength of results given the number of tests performed. The most strongly associated outcomes included leptin, lipid profile, and blood pressure. We also found novel evidence of effects of BMI on a global self-worth score.
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Affiliation(s)
- Louise A C Millard
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol.,Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
| | - Nic J Timpson
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
| | - Kate Tilling
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
| | - Peter A Flach
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol.,Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol
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14
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Association between dietary factors and plasma fetuin-A concentrations in the general population. Br J Nutr 2015; 114:1278-85. [PMID: 26316198 DOI: 10.1017/s0007114515002639] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Circulating fetuin-A, a novel marker for hepatic fat accumulation, has been related to a higher risk of type 2 diabetes and cardiovascular diseases in a growing number of prospective studies. However, little is known about dietary determinants of fetuin-A concentrations in the general population. Therefore, we aimed to investigate the association between dietary intake of energy, energy-providing nutrients, alcohol and major food groups and plasma fetuin-A concentrations in the Bavarian Food Consumption Survey II. Dietary intake was assessed by three 24-h dietary recalls, and plasma concentrations of fetuin-A were measured in 558 adults (18-81 years). After multivariable adjustment for lifestyle factors and body fatness, higher energy intake was nonsignificantly associated with higher fetuin-A concentrations (per 2092 kJ/d (500 kcal/d) 3·7 µg/ml, 95 % CI -0·5, 7·8 µg/ml). There was no clear association between energy-providing nutrients and fetuin-A concentrations. Higher alcohol intake was associated with lower fetuin-A concentrations (P trend 0·003): mean fetuin-A concentrations were 324 (95 % CI 313, 335) µg/ml in non-drinkers, and with 293 (95 % CI 281, 306) µg/ml significantly lower in participants who drank ≥30 g alcohol per d. Mean fetuin-A concentrations decreased across quintiles of milk and dairy product intake (lowest quintile 319 (95 % CI 309, 330) µg/ml; highest quintile 304 (95 % CI 293, 314) µg/ml; P trend 0·03), and each 150-g increment in milk/dairy products per d was associated with 5·6 (95 % CI -9·6, -1·5) µg/ml lower fetuin-A. Dietary intakes of vegetables, meat or fish were not associated with fetuin-A concentrations. Because of the preventive potential of our findings, further exploration is warranted.
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15
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de Seigneux S, Ponte B, Berchtold L, Hadaya K, Martin PY, Pasch A. Living kidney donation does not adversely affect serum calcification propensity and markers of vascular stiffness. Transpl Int 2015; 28:1074-80. [PMID: 25903063 DOI: 10.1111/tri.12595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 03/09/2015] [Accepted: 04/17/2015] [Indexed: 12/14/2022]
Abstract
Living kidney donors (LKDs) experience a decline in glomerular filtration rate (GFR) after donation. Calcification propensity (T50 ) can be determined by a blood test predicting all-cause mortality in patients with chronic kidney disease. We studied the impact of kidney donation on T50 and markers of arterial stiffness. We analyzed T50 prospectively before and 1 year after kidney donation in 21 LKDs along with fetuin-A, mineral metabolism markers, kidney length, pulse wave velocity (PWV), augmentation index (AI), and renal resistive index (RRI) as markers of arterial stiffness. We studied the impact of kidney donation on these parameters. LKDs were 54 ± 10 years old and had a GFR of 101 ± 18 ml/min/1.73 m(2) before donation, decreasing to 67 ± 8 ml/min/1.73 m(2) after donation (P < 0.001). Despite this, T50 improved after donation (290 ± 53 to 312 ± 38 min, P = 0.049). This change was inversely related to plasma phosphate (P = 0.03), which declined after donation (P = 0.002). Fetuin-A levels increased after donation (P = 0.01). Upon donation, the length of the remaining kidney increased (P < 0.001) while PWV, AI, and RRI remained unchanged. Calcification propensity was not adversely affected by kidney donation. This indicates that T50 is independent from GFR in LKDs and that kidney donation does neither worsen calcification propensity nor markers of vascular stiffness at 1 year.
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Affiliation(s)
- Sophie de Seigneux
- Service of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Belen Ponte
- Service of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Lena Berchtold
- Service of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Karine Hadaya
- Service of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Pierre-Yves Martin
- Service of Nephrology, University Hospital of Geneva, Geneva, Switzerland
| | - Andreas Pasch
- Department of Clinical Chemistry, University Hospital and University of Bern, Bern, Switzerland
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16
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Boef AGC, Dekkers OM, le Cessie S. Mendelian randomization studies: a review of the approaches used and the quality of reporting. Int J Epidemiol 2015; 44:496-511. [PMID: 25953784 DOI: 10.1093/ije/dyv071] [Citation(s) in RCA: 292] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mendelian randomization (MR) studies investigate the effect of genetic variation in levels of an exposure on an outcome, thereby using genetic variation as an instrumental variable (IV). We provide a meta-epidemiological overview of the methodological approaches used in MR studies, and evaluate the discussion of MR assumptions and reporting of statistical methods. METHODS We searched PubMed, Medline, Embase and Web of Science for MR studies up to December 2013. We assessed (i) the MR approach used; (ii) whether the plausibility of MR assumptions was discussed; and (iii) whether the statistical methods used were reported adequately. RESULTS Of 99 studies using data from one study population, 32 used genetic information as a proxy for the exposure without further estimation, 44 performed a formal IV analysis, 7 compared the observed with the expected genotype-outcome association, and 1 used both the latter two approaches. The 80 studies using data from multiple study populations used many different approaches to combine the data; 52 of these studies used some form of IV analysis; 44% of studies discussed the plausibility of all three MR assumptions in their study. Statistical methods used for IV analysis were insufficiently described in 14% of studies. CONCLUSIONS Most MR studies either use the genotype as a proxy for exposure without further estimation or perform an IV analysis. The discussion of underlying assumptions and reporting of statistical methods for IV analysis are frequently insufficient. Studies using data from multiple study populations are further complicated by the combination of data or estimates. We provide a checklist for the reporting of MR studies.
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Affiliation(s)
- Anna G C Boef
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands. Department of Clinical Epidemiology, Department of Endocrinology and Metabolic Diseases, and Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
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17
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Evans DM, Davey Smith G. Mendelian Randomization: New Applications in the Coming Age of Hypothesis-Free Causality. Annu Rev Genomics Hum Genet 2015; 16:327-50. [PMID: 25939054 DOI: 10.1146/annurev-genom-090314-050016] [Citation(s) in RCA: 280] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mendelian randomization (MR) is an approach that uses genetic variants associated with a modifiable exposure or biological intermediate to estimate the causal relationship between these variables and a medically relevant outcome. Although it was initially developed to examine the relationship between modifiable exposures/biomarkers and disease, its use has expanded to encompass applications in molecular epidemiology, systems biology, pharmacogenomics, and many other areas. The purpose of this review is to introduce MR, the principles behind the approach, and its limitations. We consider some of the new applications of the methodology, including informing drug development, and comment on some promising extensions, including two-step, two-sample, and bidirectional MR. We show how these new methods can be combined to efficiently examine causality in complex biological networks and provide a new framework to data mine high-dimensional studies as we transition into the age of hypothesis-free causality.
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Affiliation(s)
- David M Evans
- University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland 4102, Australia;
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18
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Trepanowski JF, Mey J, Varady KA. Fetuin-A: a novel link between obesity and related complications. Int J Obes (Lond) 2014; 39:734-41. [PMID: 25468829 DOI: 10.1038/ijo.2014.203] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/04/2014] [Accepted: 11/02/2014] [Indexed: 12/13/2022]
Abstract
Fetuin-A (FetA) is a 64-kDa glycoprotein that is secreted from both the liver and adipose tissue. Circulating FetA is elevated in obesity and related disorders including type 2 diabetes mellitus, nonalcoholic fatty liver disease and the metabolic syndrome; and a FetA-related parameter, caliciprotein particle, is highly relevant to vascular calcification in overweight/obese patients with chronic kidney disease. FetA level is also associated with impaired insulin sensitivity and glucose tolerance. Accumulating evidence suggests that elevated FetA level causes impaired glycemic control, as FetA has been implicated in impairment of insulin receptor signaling, toll-like receptor 4 activation, macrophage migration and polarization, adipocyte dysfunction, hepatocyte triacylglycerol accumulation and liver inflammation and fibrosis. Weight loss, aerobic exercise, metformin and pioglitazone have each been shown to be effective for reducing FetA level.
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Affiliation(s)
- J F Trepanowski
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - J Mey
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - K A Varady
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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19
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Davey Smith G, Hemani G. Mendelian randomization: genetic anchors for causal inference in epidemiological studies. Hum Mol Genet 2014; 23:R89-98. [PMID: 25064373 PMCID: PMC4170722 DOI: 10.1093/hmg/ddu328] [Citation(s) in RCA: 2304] [Impact Index Per Article: 230.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 12/13/2022] Open
Abstract
Observational epidemiological studies are prone to confounding, reverse causation and various biases and have generated findings that have proved to be unreliable indicators of the causal effects of modifiable exposures on disease outcomes. Mendelian randomization (MR) is a method that utilizes genetic variants that are robustly associated with such modifiable exposures to generate more reliable evidence regarding which interventions should produce health benefits. The approach is being widely applied, and various ways to strengthen inference given the known potential limitations of MR are now available. Developments of MR, including two-sample MR, bidirectional MR, network MR, two-step MR, factorial MR and multiphenotype MR, are outlined in this review. The integration of genetic information into population-based epidemiological studies presents translational opportunities, which capitalize on the investment in genomic discovery research.
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Affiliation(s)
- George Davey Smith
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, School of Social and Community Medicine, Bristol, UK
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, School of Social and Community Medicine, Bristol, UK
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20
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Sritara C, Thakkinstian A, Ongphiphadhanakul B, Chailurkit L, Chanprasertyothin S, Ratanachaiwong W, Vathesatogkit P, Sritara P. Causal relationship between the AHSG gene and BMD through fetuin-A and BMI: multiple mediation analysis. Osteoporos Int 2014; 25:1555-62. [PMID: 24570294 DOI: 10.1007/s00198-014-2634-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/29/2014] [Indexed: 12/29/2022]
Abstract
UNLABELLED Using mediation analysis, a causal relationship between the AHSG gene and bone mineral density (BMD) through fetuin-A and body mass index (BMI) mediators was suggested. INTRODUCTION Fetuin-A, a multifunctional protein of hepatic origin, is associated with bone mineral density. It is unclear if this association is causal. This study aimed at clarification of this issue. METHODS A cross-sectional study was conducted among 1,741 healthy workers from the Electricity Generating Authority of Thailand (EGAT) cohort. The alpha-2-Heremans-Schmid glycoprotein (AHSG) rs2248690 gene was genotyped. Three mediation models were constructed using seemingly unrelated regression analysis. First, the ln[fetuin-A] group was regressed on the AHSG gene. Second, the BMI group was regressed on the AHSG gene and the ln[fetuin-A] group. Finally, the BMD model was constructed by fitting BMD on two mediators (ln[fetuin-A] and BMI) and the independent AHSG variable. All three analyses were adjusted for confounders. RESULTS The prevalence of the minor T allele for the AHSG locus was 15.2%. The AHSG locus was highly related to serum fetuin-A levels (P < 0.001). Multiple mediation analyses showed that AHSG was significantly associated with BMD through the ln[fetuin-A] and BMI pathway, with beta coefficients of 0.0060 (95% CI 0.0038, 0.0083) and 0.0030 (95% CI 0.0020, 0.0045) at the total hip and lumbar spine, respectively. About 27.3 and 26.0% of total genetic effects on hip and spine BMD, respectively, were explained by the mediation effects of fetuin-A and BMI. CONCLUSIONS Our study suggested evidence of a causal relationship between the AHSG gene and BMD through fetuin-A and BMI mediators.
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Affiliation(s)
- C Sritara
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,
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