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Riedl A, Wawro N, Gieger C, Meisinger C, Peters A, Roden M, Kronenberg F, Herder C, Rathmann W, Völzke H, Reincke M, Koenig W, Wallaschofski H, Hauner H, Daniel H, Linseisen J. Identification of Comprehensive Metabotypes Associated with Cardiometabolic Diseases in the Population-Based KORA Study. Mol Nutr Food Res 2018; 62:e1800117. [PMID: 29939495 DOI: 10.1002/mnfr.201800117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/24/2018] [Indexed: 12/17/2022]
Abstract
SCOPE "Metabotyping" describes the grouping of metabolically similar individuals. We aimed to identify valid metabotypes in a large cohort for targeted dietary intervention, for example, for disease prevention. METHODS AND RESULTS We grouped 1729 adults aged 32-77 years of the German population-based KORA F4 study (2006-2008) using k-means cluster analysis based on 34 biochemical and anthropometric parameters. We identified three metabolically distinct clusters showing significantly different biochemical parameter concentrations. Cardiometabolic disease status was determined at baseline in the F4 study and at the 7 year follow-up termed FF4 (2013/2014) to compare disease prevalence and incidence between clusters. Cluster 3 showed the most unfavorable marker profile with the highest prevalence of cardiometabolic diseases. Also, disease incidence was higher in cluster 3 compared to clusters 2 and 1, respectively, for hypertension (41.2%/25.3%/18.2%), type 2 diabetes (28.3%/5.1%/2.0%), hyperuricemia/gout (10.8%/2.3%/0.7%), dyslipidemia (19.2%/18.3%/5.6%), all metabolic (54.5%/36.8%/19.7%), and all cardiovascular (6.3%/5.5%/2.3%) diseases together. CONCLUSION Cluster analysis based on an extensive set of biochemical and anthropometric parameters allows the identification of comprehensive metabotypes that were distinctly different in cardiometabolic disease occurrence. As a next step, targeted dietary strategies should be developed with the goal of preventing diseases, especially in cluster 3.
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Affiliation(s)
- Anna Riedl
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156, Augsburg, Germany
| | - Nina Wawro
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156, Augsburg, Germany
| | - Christian Gieger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Michael Roden
- German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Division of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Schöpfstr. 41, 6020, Innsbruck, Austria
| | - Christian Herder
- German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Wolfgang Rathmann
- German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
| | - Henry Völzke
- German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,DZHK - German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Pettenkoferstr. 8a & 9, 80336, Munich, Germany.,Institute for Community Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany
| | - Martin Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 81377, Munich, Germany
| | - Wolfgang Koenig
- DZHK - German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, Pettenkoferstr. 8a & 9, 80336, Munich, Germany.,Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str., 17489, Greifswald, Germany
| | - Hans Hauner
- Else Kröner-Fresenius Centre for Nutritional Medicine, Technical University of Munich, Gregor-Mendel-Str. 2, 85354, Freising-Weihenstephan, Germany.,ZIEL - Institute for Food and Health, Technical University of Munich, Weihenstephaner Berg 1, 85354, Freising, Germany.,Institute of Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Uptown München Campus D, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.,Technical University of Munich, Gregor-Mendel-Str. 2, 85354, Freising-Weihenstephan, Germany
| | - Hannelore Daniel
- Technical University of Munich, Gregor-Mendel-Str. 2, 85354, Freising-Weihenstephan, Germany
| | - Jakob Linseisen
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians-Universität München, at UNIKA-T (Universitäres Zentrum für Gesundheitswissenschaften am Klinikum Augsburg), Neusässer Str. 47, 86156, Augsburg, Germany.,ZIEL - Institute for Food and Health, Technical University of Munich, Weihenstephaner Berg 1, 85354, Freising, Germany
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Desguerre I, Christov C, Mayer M, Zeller R, Becane HM, Bastuji-Garin S, Leturcq F, Chiron C, Chelly J, Gherardi RK. Clinical heterogeneity of duchenne muscular dystrophy (DMD): definition of sub-phenotypes and predictive criteria by long-term follow-up. PLoS One 2009; 4:e4347. [PMID: 19194511 PMCID: PMC2633042 DOI: 10.1371/journal.pone.0004347] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 12/08/2008] [Indexed: 01/16/2023] Open
Abstract
Background To explore clinical heterogeneity of Duchenne muscular dystrophy (DMD), viewed as a major obstacle to the interpretation of therapeutic trials Methodology/Principal Findings A retrospective single institution long-term follow-up study was carried out in DMD patients with both complete lack of muscle dystrophin and genotyping. An exploratory series (series 1) was used to assess phenotypic heterogeneity and to identify early criteria predicting future outcome; it included 75 consecutive steroid-free patients, longitudinally evaluated for motor, respiratory, cardiac and cognitive functions (median follow-up: 10.5 yrs). A validation series (series 2) was used to test robustness of the selected predictive criteria; it included 34 more routinely evaluated patients (age>12 yrs). Multivariate analysis of series 1 classified 70/75 patients into 4 clusters with distinctive intellectual and motor outcomes: A (early infantile DMD, 20%): severe intellectual and motor outcomes; B (classical DMD, 28%): intermediate intellectual and poor motor outcome; C (moderate pure motor DMD, 22%): normal intelligence and delayed motor impairment; and D (severe pure motor DMD, 30%): normal intelligence and poor motor outcome. Group A patients had the most severe respiratory and cardiac involvement. Frequency of mutations upstream to exon 30 increased from group A to D, but genotype/phenotype correlations were restricted to cognition (IQ>71: OR 7.7, 95%CI 1.6–20.4, p<0.003). Diagnostic accuracy tests showed that combination of “clinical onset <2 yrs” with “mental retardation” reliably assigned patients to group A (sensitivity 0.93, specificity 0.98). Combination of “lower limb MMT score>6 at 8 yrs” with “normal or borderline mental status” reliably assigned patients to group C (sensitivity: 1, specificity: 0.94). These criteria were also predictive of “early infantile DMD” and “moderate pure motor DMD” in series 2. Conclusions/Significance DMD can be divided into 4 sub-phenotypes differing by severity of muscle and brain dysfunction. Simple early criteria can be used to include patients with similar outcomes in future therapeutic trials.
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Affiliation(s)
- Isabelle Desguerre
- Department of Neuropediatrics, Neuromuscular Disease Reference Center “Garches-Necker-Mondor-Hendaye”, Necker - Enfants Malades Hospital, Paris, France
- Department of Neurosciences, Team 10 INSERM U841 Mondor Biomedical Research Institute, Paris XII University, Créteil, France
| | - Christo Christov
- Department of Neurosciences, Team 10 INSERM U841 Mondor Biomedical Research Institute, Paris XII University, Créteil, France
- Cellular and Tissular Imaging Plateform, INSERM U841 Mondor Biomedical Research Institute, Créteil, France
| | - Michele Mayer
- Department of Neuropediatrics, Trousseau Hospital, Paris, France
| | - Reinhard Zeller
- Department of Biochemistry and Genetics, Cochin-Saint Vincent-de-Paul Hospital Group, Paris, France
| | - Henri-Marc Becane
- CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Paris, France
| | | | - France Leturcq
- Department of Biochemistry and Genetics, Cochin-Saint Vincent-de-Paul Hospital Group, Paris, France
- CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Paris, France
| | | | - Jamel Chelly
- Department of Biochemistry and Genetics, Cochin-Saint Vincent-de-Paul Hospital Group, Paris, France
- CNRS (UMR 8104), Institut Cochin, Université Paris Descartes, Paris, France
| | - Romain K. Gherardi
- Department of Neuropediatrics, Neuromuscular Disease Reference Center “Garches-Necker-Mondor-Hendaye”, Necker - Enfants Malades Hospital, Paris, France
- Department of Neurosciences, Team 10 INSERM U841 Mondor Biomedical Research Institute, Paris XII University, Créteil, France
- * E-mail:
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