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Georgescu D, Lighezan DF, Ionita I, Hadaruga N, Buzas R, Rosca CI, Ionita M, Suceava I, Mitu DA, Ancusa OE. Cholesterol Gallstones and Long-Term Use of Statins: Is Gut Microbiota Dysbiosis Bridging over Uncertainties? Diagnostics (Basel) 2024; 14:1234. [PMID: 38928650 PMCID: PMC11202934 DOI: 10.3390/diagnostics14121234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
A total of 300 research participants-200 consecutive patients diagnosed with dyslipidemia (100 statin (+), treated for at least five years, and 100 statin (-)) and 100 healthy controls-were included in this observational study. The aim of the study was to deliver insights into the relationship between the long-term use of statins for dyslipidemia and gallstone disease (GSD), as well as insights into the background particularities of the gut microbiota. All study participants underwent clinical examination, laboratory workups, stool microbiology/stool 16S r RNA, next-generation sequencing, and abdominal ultrasound/CT exams. Results: The research participants presented with similarities related to age, gender, and location. Patients displayed comparable heredity for GSs, metabolic issues, and related co-morbidities. Gut dysbiosis (DB) was present in 54% of the statin (-) patients vs. 35% of the statin (+) patients (p = 0.0070). GSs were present in 14% of patients in the statin (-) group vs. 5% of patients in the statin (+) group (p = 0.0304). Severe dysbiosis, with a significant reduction in biodiversity, an increase in LPS (+) bacteria, and a notable decrease in mucin-degrading bacteria, mucosa-protective bacteria, and butyrate-producing bacteria were observed in the statin (-) group. Strong positive correlations between GSD and diabetes/impaired glucose tolerance (r = 0.3368, p = 0.0006), obesity (r = 0.3923, p < 0.0001), nonalcoholic fatty liver disease (r = 0.3219, p = 0.0011), and DB (r = 0.7343, p < 0.0001), as well as significant negative correlations between GSD and alcohol use (r = -0.2305, p = 0.0211), were observed. The multiple regression equation demonstrated that only DB (95% CI: 0.3163 to 0.5670; p < 0.0001) and obesity (95% CI: 0.01431 to 0.2578; p = 0.0289) were independent risk factors predicting GSD in the group of patients treated with statins. Conclusion: The long-term use of statins in dyslipidemic patients was associated with a low risk of developing GSs. The gut microbiota associated with a long-term use of statins in dyslipidemic patients was characterized by a low risk of developing an imbalance of various functional bacteria and alterations in the metabolic microbiota. DB and obesity were found to be independent risk factors predicting GSD in statin (+) patients.
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Affiliation(s)
- Doina Georgescu
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Daniel-Florin Lighezan
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Ioana Ionita
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Nicoleta Hadaruga
- Department of Food Science, University of Life Sciences “King Michael I”, 300041 Timisoara, Romania;
| | - Roxana Buzas
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Ciprian-Ilie Rosca
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Mihai Ionita
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Ioana Suceava
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Diana-Alexandra Mitu
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
| | - Oana-Elena Ancusa
- Department V of Internal Medicine I, “V Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.G.); (D.-F.L.); (R.B.); (C.-I.R.); (M.I.); (I.S.); (D.-A.M.); (O.-E.A.)
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Li Y, Li J, Leng A, Zhang G, Qu J. Cardiac complications caused by biliary diseases: A review of clinical manifestations, pathogenesis and treatment strategies of cholecardia syndrome. Pharmacol Res 2024; 199:107006. [PMID: 38000562 DOI: 10.1016/j.phrs.2023.107006] [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: 08/02/2023] [Revised: 10/19/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023]
Abstract
Gallbladder and biliary diseases (GBDs) are one of the most common digestive diseases. The connections between GBDs and several organs other than the liver have gradually surfaced accompanied by the changes in people's diet structure and the continuous improvement of medical diagnosis technology. Among them, cholecardia syndrome that takes the heart as the important target of GBDs complications has been paid close attention. However, there are still no systematic report about its corresponding clinical manifestations and pathogenesis. This review summarized recent reported types of cholecardia syndrome and found that arrhythmia, myocardial injury, acute coronary syndrome and heart failure are common in the general population. Besides, the clinical diagnosis rate of intrahepatic cholestasis of pregnancy (ICP) and Alagille syndrome associated with gene mutation is also increasing. Accordingly, the underlying pathogenesis including abnormal secretion of bile acid, gene mutation, translocation and deletion (JAG1, NOTCH2, ABCG5/8 and CYP7A1), nerve reflex and autonomic neuropathy were further revealed. Finally, the potential treatment measures and clinical medication represented by ursodeoxycholic acid were summarized to provide assistance for clinical diagnosis and treatment.
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Affiliation(s)
- Yanan Li
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian 116011, China; Institute (College) of Integrative Medicine, Dalian Medical University, No. 9, South Road of Lvshun, Dalian 116044, China
| | - Jinghong Li
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian 116011, China; Institute (College) of Integrative Medicine, Dalian Medical University, No. 9, South Road of Lvshun, Dalian 116044, China
| | - Aijing Leng
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian 116011, China; Institute (College) of Integrative Medicine, Dalian Medical University, No. 9, South Road of Lvshun, Dalian 116044, China; Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian 116011, China
| | - Guixin Zhang
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian 116011, China; Institute (College) of Integrative Medicine, Dalian Medical University, No. 9, South Road of Lvshun, Dalian 116044, China; Department of General Surgery, Pancreatic-Biliary Center, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian 116011, China.
| | - Jialin Qu
- Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, No. 222, Zhongshan Road, Dalian 116011, China; Institute (College) of Integrative Medicine, Dalian Medical University, No. 9, South Road of Lvshun, Dalian 116044, China.
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Chen CH, Lin CL, Kao CH. Erectile Dysfunction in Men With Gallbladder Stone Disease: A Nationwide Population-Based Study. Am J Mens Health 2020; 13:1557988319839589. [PMID: 30907203 PMCID: PMC6440063 DOI: 10.1177/1557988319839589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We assessed the risk of erectile dysfunction after the diagnosis of gallbladder stone disease. We identified 9,362 men aged ≥20 years diagnosed with gallbladder stone disease between 2000 and 2011 from Taiwan’s National Health Insurance Research Database as the study cohort, and we randomly selected 9,362 men from the nongallbladder stone disease population by 1:1 frequency-matching with the case cohort based on age, the index date for the diagnosis of gallbladder stone disease, and comorbidities as the control cohort. All subjects were followed until December 31, 2011, for measuring the erectile dysfunction incidence. The risk of organic erectile dysfunction was higher in the gallbladder stone disease cohort than the nongallbladder stone disease cohort (4.01 vs. 2.69 per 1,000 person-years, adjusted hazard ratio = 1.41, 97.5% confidence interval [1.12, 1.78]), but the risk of psychogenic erectile dysfunction was comparable between the gallbladder stone disease cohort and the nongallbladder stone disease cohort (0.40 vs. 0.28 per 1,000 person-years, adjusted hazard ratio = 1.37, 97.5% confidence interval [0.67, 2.79]). Moreover, gallbladder stone disease men with cholecystectomy exhibited a lower risk of developing organic erectile dysfunction than gallbladder stone disease men without cholecystectomy (adjusted hazard ratio = 0.58, 97.5% confidence interval [0.41, 0.80]). The risk of organic erectile dysfunction contributed by gallbladder stone disease was only significantly higher in men aged ≥65 years (adjusted hazard ratio = 2.21, 97.5% confidence interval [1.34, 3.63]) and in men with comorbidities (adjusted hazard ratio = 1.42, 97.5% confidence interval [1.09, 1.85]). The risk of psychogenic erectile dysfunction contributed by gallbladder stone disease was nonsignificant in each age group and in men with or without comorbidities. Gallbladder stone disease is associated with an increased risk of organic erectile dysfunction, but it has no association with psychogenic erectile dysfunction. History of cholecystectomy for gallbladder stone disease may ameliorate the risk of organic erectile dysfunction; it requires more studies to ascertain the protective mechanism and to clarify whether the existence of gallbladder stone disease is an epiphenomenon or independent risk factor of erectile dysfunction.
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Affiliation(s)
- Chien-Hua Chen
- 1 Digestive Disease Center, Chang-Bing Show-Chwan Memorial Hospital, Lukang Town, Taiwan, ROC.,2 Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua, Taiwan, ROC.,3 Department of Food Science and Technology, Hungkuang University, Taichung, Taiwan, ROC
| | - Cheng-Li Lin
- 4 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan, ROC.,5 College of Medicine, China Medical University, Taichung, Taiwan, ROC
| | - Chia-Hung Kao
- 6 Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, ROC.,7 Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan, ROC.,8 Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan, ROC
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Zheng Y, Xu M, Li Y, Hruby A, Rimm EB, Hu FB, Wirth J, Albert CM, Rexrode KM, Manson JE, Qi L. Gallstones and Risk of Coronary Heart Disease: Prospective Analysis of 270 000 Men and Women From 3 US Cohorts and Meta-Analysis. Arterioscler Thromb Vasc Biol 2016; 36:1997-2003. [PMID: 27540264 PMCID: PMC5001914 DOI: 10.1161/atvbaha.116.307507] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Gallstone disease has been related to cardiovascular risk factors; however, whether presence of gallstones predicts coronary heart disease (CHD) is not well established. APPROACH AND RESULTS We followed up 269 142 participants who were free of cancer and cardiovascular disease at baseline from 3 US cohorts: the Nurses' Health Study (112 520 women; 1980-2010), Nurses' Health Study II (112 919 women; 1989-2011), and the Health Professionals Follow-up Study (43 703 men; 1986-2010) and documented 21 265 incident CHD cases. After adjustment for potential confounders, the hazard ratio for the participants with a history of gallstone disease compared with those without was 1.15 (95% confidence interval, 1.10-1.21) in Nurses' Health Study, 1.33 (95% confidence interval, 1.17-1.51) in Nurses' Health Study II, and 1.11 (95% confidence interval, 1.04-1.20) in Health Professionals Follow-up Study. The associations seemed to be stronger in individuals who were not obese, not diabetic, or were normotensive, compared with their counterparts. We identified 4 published prospective studies by searching PUBMED and EMBASE up to October 2015, coupled with our 3 cohorts, involving 842 553 participants and 51 123 incident CHD cases. The results from meta-analysis revealed that a history of gallstone disease was associated with a 23% (15%-33%) increased CHD risk. CONCLUSION Our findings support that a history of gallstone disease is associated with increased CHD risk, independently of traditional risk factors.
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Affiliation(s)
- Yan Zheng
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Min Xu
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Yanping Li
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Adela Hruby
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Eric B Rimm
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Frank B Hu
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Janine Wirth
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Christine M Albert
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Kathryn M Rexrode
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - JoAnn E Manson
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.)
| | - Lu Qi
- From the Department of Nutrition (Y.Z., M.X., Y.L., A.H., E.B.R., F.B.H., L.Q.) and Department of Epidemiology (E.B.R., F.B.H., J.E.M.), Harvard T.H. Chan School of Public Health, Boston, MA; Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (M.X.); Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany (J.W.); Division of Preventive Medicine, Department of Medicine (C.M.A., K.M.R., J.E.M.) and Channing Division of Network Medicine, Department of Medicine (E.B.R., F.B.H., J.E.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA (L.Q.).
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