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Fayosse A, Dumurgier J, Dugravot A, Landré B, Singh-Manoux A, Sabia S. Cross-sectional and longitudinal associations of obesity with disability between age 50 and 90 in the SHARE study. Arch Gerontol Geriatr 2024; 119:105320. [PMID: 38171031 DOI: 10.1016/j.archger.2023.105320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Obesity is associated with disability but whether age and ageing modify this association remains unclear. We examined whether this association changes between 50 and 90 years, and whether change in disability rates over 14 years differs by body mass index (BMI) categories. METHODS BMI and ADL-disability data on 28,453 individuals from 6 waves (2004-2018, SHARE study) were used to examine the cross-sectional absolute and relative associations, extracted at age 50, 60, 70, 80, and 90 years using logistic mixed models. Then baseline BMI and change in disability rates over 14-years were examined using logistic-mixed models. RESULTS At age 50, the probabilities of ADL disability in individuals with BMI 30-34.9 and ≥35 kg/m² were 0.07 (0.06, 0.09) and 0.11 (0.09, 0.12), increasing to 0.47 (0.44, 0.50) and 0.55 (0.50, 0.60) at age 90; the increase in both these groups was greater than that in the normal-weight group (p for increase with age<0.001). On the relative scale the OR at age 50 in these obesity groups was 2.37 (1.79, 3.13) and 5.03 (3.38, 7.48), decreasing to 1.51 (1.20, 1.89) and 2.19 (1.50, 3.21) at age 90; p for decrease with age=0.05 and 0.02 respectively. The 14-year increase in probability of disability was greatest in those with BMI≥35 kg/m² at age 50, 60, and 70 at baseline: differences in increase compared to normal weight were 0.08 (0.02, 0.14), 0.11 (0.07, 0.15), and 0.09 (0.02, 0.16) respectively. CONCLUSIONS ADL disability is increasingly prevalent with age in individuals with obesity. Relative measures of change obscure the association between obesity and disability due to age-related increase in disability rates in all groups.
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Affiliation(s)
- Aurore Fayosse
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France
| | - Julien Dumurgier
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France; Cognitive Neurology Center, Saint Louis, Lariboisiere - Fernand Widal Hospital, AP-HP; Université Paris Diderot, France
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France
| | - Benjamin Landré
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France; Faculty of Brain Sciences, Division of Psychiatry, University College London, United Kingdom.
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris 75010, France; Faculty of Brain Sciences, Division of Psychiatry, University College London, United Kingdom
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van der Heide FC, Valeri L, Dugravot A, Danilevicz I, Landre B, Kivimaki M, Sabia S, Singh-Manoux A. Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies. EClinicalMedicine 2024; 70:102539. [PMID: 38516105 PMCID: PMC10955651 DOI: 10.1016/j.eclinm.2024.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background The contribution of modifiable risk factors to social inequalities in dementia, observed in longitudinal studies, remains unclear. We aimed to quantify the role of cardiovascular health factors, assessed using Life's Essential 8 (LE8) score, in mediating social inequalities in incidence of dementia and, for comparison, in incidence of stroke, coronary heart disease, and mortality. Methods In this prospective, population-based cohort study, we collected data from the UK Whitehall II Study and UK Biobank databases. Participants were included if data were available on SEP, outcomes and LE8 (smoking, physical activity, diet, body mass index, blood pressure, fasting blood glucose, lipid levels, sleep duration). The primary outcome was incident dementia and secondary outcomes were stroke, coronary heart disease, and mortality. Outcomes were derived from electronic healthcare records. Socioeconomic position (SEP) was measured by occupation in Whitehall II and education in UK Biobank. Counterfactual mediation analysis was used to quantify the extent to which LE8 score explained the associations of SEP with all outcomes. Analyses involved Cox regression, accelerated failure time models, and linear regression; and were adjusted for age, sex, and ethnicity. Findings Between 10.09.1985 and 29.03.1988, a total of 9688 participants (mean age ± SD 44.9 ± 6.0; 67% men) from the Whitehall II study, and between 19.12.2006 and 01.10.2010, 278,215 participants (mean age ± SD 56.0 ± 8.1; 47% men) from the UK Biobank were included. There were 606 and 4649 incident dementia cases over a median (interquartile range) follow-up of 31.7 (31.1-32.7) and 13.5 (12.7-14.1) years respectively in Whitehall II and UK Biobank. In Whitehall II, the hazard ratio was 1.85 [95% CI 1.42, 2.32] for the total effect of SEP on dementia and 1.20 [1.12, 1.28] for the indirect effect via the LE8, the proportion mediated being 36%. In UK Biobank, the total effect of SEP on dementia was 1.65 [1.54, 1.78]; the indirect effect was 1.11 [1.09, 1.12], and the proportion mediated was 24%. The proportions mediated for stroke, coronary heart disease, and mortality were higher, ranging between 34% and 63% in Whitehall II and between 36% and 50% in UK Biobank. Interpretation In two well-characterised cohort studies, up to one third of the social inequalities in incidence of dementia was attributable to cardiovascular health factors. Promotion of cardiovascular health in midlife may contribute to reducing social inequalities in risk of dementia, in addition to cardiovascular diseases and all-cause mortality. This study used adult measures of SEP, further research is warranted using lifecourse measures of SEP. Funding NIH (RF1AG062553).
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Affiliation(s)
- Frank C.T. van der Heide
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Ian Danilevicz
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landre
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimaki
- Faculty of Brain Sciences, University College London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Faculty of Brain Sciences, University College London, UK
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Faculty of Brain Sciences, University College London, UK
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Kumaradev S, Roux C, Sellam J, Perrot S, Pham T, Moltó A, Dugravot A. Do subjective components of disease activity contribute to heterogeneity in opioid prescriptions in inflammatory rheumatic diseases? Results from ESPOIR and DESIR cohorts. Clin Exp Rheumatol 2024; 42:671-681. [PMID: 38019160 DOI: 10.55563/clinexprheumatol/nq59pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/18/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To determine whether subjective components of disease activity are associated with heterogeneity in opioid prescription in inflammatory rheumatic diseases (IRDs) after accounting for objective inflammatory markers. METHODS Data from two prospective observational cohorts of early IRDs (ESPOIR for rheumatoid arthritis (RA) and DESIR for spondyloarthritis (SpA)) were included. Opioid prescription duration (converted to monthly binary opioid prescription), disease activity (Disease activity score 28 (DAS28) for RA; Axial spondyloarthritis disease activity score-C-reactive protein (ASDAS-CRP) for SpA) and its components were measured respectively at 13 and 9 occasions spanning 10- and 6-years of follow-up. Group-based trajectory modelling defined opioid-prescription trajectories and mixed-models characterised the evolution of disease activity and its subjective components by opioid-prescription trajectories. RESULTS Four distinct opioid-prescription trajectories: no/low (60.5% and 54.3%), declining (14.7% and 15.8%), augmenting (11.9% and 10.7%), and persistent (12.9% and 19.1%) were identified in RA and SpA respectively (60% were prescribed opioids at least once). Those with regular opioid prescriptions (up to 30%) are often older, less educated, have higher BMI and worse disease. No/low trajectory was the reference for examining evolution of disease activity and subjective components (n=810 RA, n=679 SpA). In IRDs, consistently higher disease activity throughout follow-up were seen with persistent (DAS28(β=0.4-0.8); ASDAS-CRP(β=0.4-0.6)), and augmenting (DAS28(β=0.2-0.5); ASDAS-CRP(β=0.3-0.6)) trajectories and until 3- or 4-years of follow-up (DAS28(β=0.3-0.4); ASDAS-CRP(β=0.2-0.3)) with declining trajectory. Likewise, despite accounting for objective inflammation, subjective components had worse scores over follow-up in augmenting and persistent trajectory. CONCLUSIONS Non-inflammatory pain mechanisms amplify subjective outcomes, thus, worsening composite measures like disease activity.
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Affiliation(s)
- Sushmithadev Kumaradev
- Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université Paris Cité, Inserm U1153, Paris; and Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Cité, Inserm U1153, Paris, France.
| | - Christian Roux
- Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université Paris Cité, Inserm U1153, Paris; and Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, APHP, Sorbonne Université, Inserm UMRS_938, Saint-Antoine Hospital, Paris, France
| | - Serge Perrot
- Pain Clinic, APHP-Centre, INSERM U897, Cochin Hospital, Paris, France
| | - Thao Pham
- Department of Rheumatology, APHM, Sainte-Marguerite Hospital, Aix-Marseille University, Marseille, France
| | - Anna Moltó
- Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université Paris Cité, Inserm U1153, Paris; and Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France
| | - Aline Dugravot
- Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Cité, Inserm U1153, Paris, France
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Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Yerramalla MS, Sabia S, Schnitzler A. Role of age and sex in the association between BMI and functional limitations in stroke patients: Cross-sectional analysis in three European and US cohorts. J Stroke Cerebrovasc Dis 2023; 32:107270. [PMID: 37481939 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND A U- or J-shaped association between BMI and different post-stroke outcomes is suggested. Thus, the aim is to evaluate the association between BMI with ADL, IADL and mobility limitations in the ageing post-stroke population at different ages, as well as the differences in this association by sex. METHODS A total of 5,468 participants with stroke and 21,872 without stroke over 50 years of age were assessed for the number of limitations in basic or instrumental activities of daily living (ADL/IADL) as well as mobility tasks. The association between BMI at the interview (continuous time-dependent variable) and the level of limitations was assessed using a linear mixed model stratified by sex and stroke status. RESULTS The association between BMI and ADL/IADL and mobility limitations were found to be significant in both men and women regardless of stroke status (p<0.001 for all). The association differs between those who have suffered a stroke and those who have not (p<0.001 for all). In ADL/IADL limitations, men with stroke showed a transition from an inverted J-shape to a U-shape association with age. In women, the BMI showed a less pronounced association between BMI and ADL/IADL limitations compared to men but with similar trends. A effect of sex was observed in the association between BMI and mobility, with women with and without stroke showing a linear association that differed from the inverted J-shaped or U-shaped association of men. CONCLUSION Our results suggest that BMI is associated with limitations in ADL, IADL and mobility in stroke patients. In addition, this association differs between men and women and is also influenced by age.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Manasa S Yerramalla
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France.
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France; Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Service de neurologie hôpital A. Mignot, Garches, France.
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Régy M, Dugravot A, Sabia S, Bouaziz-Amar E, Paquet C, Hanseeuw B, Singh-Manoux A, Dumurgier J. Association between ATN profiles and mortality in a clinical cohort of patients with cognitive disorders. Alzheimers Res Ther 2023; 15:77. [PMID: 37038213 PMCID: PMC10088112 DOI: 10.1186/s13195-023-01220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the 5th leading cause of death in people 65 years and older. The ATN classification reflects a biological definition of AD pathology with markers of Aβ deposition (A), pathologic tau (T), and neurodegeneration (N). Little is known about the relationship between ATN status and the risk of mortality, leading us to examine this association in a relatively large population of patients seen at a memory clinic for cognitive disorders. METHODS Data were drawn from the BioCogBank Study, including patients seen for cognitive disorders in Lariboisiere Hospital (Paris, France), followed up to 15 years. All participants underwent a lumbar puncture for an assessment of the levels of CSF tau (tau), phosphorylated tau (p-tau181), and β-amyloid 42 peptide (Aβ42). Vital status on July 1, 2020, was recorded for each participant using the national mortality register. Individuals were categorized according to their ATN profiles based on CSF Aβ42 or Aβ42/40 ratio, p-tau181, and tau. Kaplan-Meier and multivariate Cox analyses were performed with A-T-N - participants as the reference using a short (5 years) and long follow-up (15 years). RESULTS Of the 1353 patients in the study (mean age: 68 years old, 53% of women, mean MMSE score: 22.6), 262 died during the follow-up. At 5 years of follow-up, A-T-N + individuals had the highest risk of mortality in Kaplan-Meier and adjusted Cox analyses [HR (95% CI) = 2.93 (1.31-6.56)]. At 15 years of follow-up, patients in the AD spectrum had a higher mortality risk with a gradient effect for biomarker positivity: A-T + [HR = 1.63 (1.04-2.55)], A + T - [HR = 2.17 (1.44-3.26)], and A + T + individuals [HR = 2.38 (1.66-3.39)], compared to A-T-N - patients. Adjustments on potential confounders had little impact on these associations. CONCLUSION This study shows ATN profiles to be associated with mortality in a relatively large patient cohort based on a memory clinic. Patients with isolated evidence of neurodegeneration had a higher mortality rate in the short follow-up, and patients with the AD profile had the highest mortality rate in the long follow-up.
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Affiliation(s)
- Mélina Régy
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Université Catholique de Louvain, Brussels, Belgium
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Elodie Bouaziz-Amar
- Université Paris-Cité, Department of Biochemistry, GHU APHP Nord Lariboisière Fernand-Widal Hospital, Paris, France
| | - Claire Paquet
- Université Paris-Cité, Inserm U1144, Cognitive Neurology Center, GHU APHP Nord Lariboisière Fernand-Widal Hospital, Paris, France
| | - Bernard Hanseeuw
- Université Catholique de Louvain, Brussels, Belgium
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Julien Dumurgier
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.
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Landré B, Ben Hassen C, Kivimaki M, Bloomberg M, Dugravot A, Schniztler A, Sabia S, Singh-Manoux A. Trajectories of physical and mental functioning over 25 years before onset of frailty: results from the Whitehall II cohort study. J Cachexia Sarcopenia Muscle 2023; 14:288-297. [PMID: 36397170 PMCID: PMC9891967 DOI: 10.1002/jcsm.13129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Research on frailty, a major contributor to heterogeneity in health, is undertaken on older adults although the processes leading to frailty are likely to begin earlier in the life course. Using repeat data spanning 25 years, we examined changes in physical and mental functioning before the onset of frailty, defined using Fried's frailty phenotype (FFP). METHODS Functioning was measured using the Short-Form 36 General Health Survey (SF-36) on nine occasions from 1991 (age range 40-63 years) to 2015 (age range 63-85 years). The poorest of four FFP scores from 2002, 2007, 2012 and 2015 was used to classify participants as frail, pre-frail, or robust. We used linear mixed models with a backward timescale such that time 0 was the person-specific date of frailty classification for frail and pre-frail participants and the end of follow-up for robust participants. Analyses adjusted for socio-demographic factors, health behaviours, body mass index and multi-morbidity status were used to compare SF-36 physical (PCS) and mental (MCS) component summary scores over 25 years before time 0 as a function of FFP classification, with estimates extracted at time 0, -5, -10, -15, -20 and -25 years. We also used illness-death models to examine the prospective association between SF-36 component summary scores at age 50 and incident FFP-defined frailty. RESULTS Among 7044 participants of the Whitehall II cohort study included in the analysis [29% female, mean age 49.7 (SD = 6.0) at baseline in 1991], 2055 (29%) participants remained robust, and 4476 (64%) became pre-frail and 513 (7%) frail during follow-up. Frail compared with robust participants had lower SF-36 scores at t = -25 before onset of frailty with a difference of 3.4 [95% confidence interval (CI) 1.6, 5.1] in PCS and 1.8 (-0.2, 3.8) in MCS. At t = 0, the differences increased to 11.5 (10.5, 12.5) and 9.1 (8.0, 10.2), respectively. The differences in SF-36 between the robust and pre-frail groups, although smaller [at t = 0, 1.7 (1.2, 2.2) in PCS and 4.0 (3.4, 4.5) in MCS], were already observed 20 and 25 years, respectively, before the onset of pre-frailty. Prospective analyses showed that at age 50, scores in the bottom quartiles of PCS [hazard ratio (HR) compared with the top quartile = 2.39, 95% CI 1.85, 3.07] and MCS [HR = 1.49 (1.15, 1.93)] were associated with a higher risk of FFP-defined frailty at older ages. CONCLUSIONS Differences in trajectories of physical and mental functioning in individuals who developed physical frailty at older ages were observable 25 years before onset of FFP-defined frailty. These findings highlight the need for a life course approach in efforts to prevent frailty.
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Affiliation(s)
- Benjamin Landré
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Céline Ben Hassen
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimaki
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Alexis Schniztler
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
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Bloomberg M, Dugravot A, Sommerlad A, Kivimäki M, Singh-Manoux A, Sabia S. Comparison of sex differences in cognitive function in older adults between high- and middle-income countries and the role of education: a population-based multicohort study. Age Ageing 2023; 52:7049632. [PMID: 36821646 PMCID: PMC9949595 DOI: 10.1093/ageing/afad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The extent to which education explains variations in sex differences in cognitive function between countries at different levels of economic development is unknown. We examined the role of education in sex differences in four cognitive domains in high- and middle-income countries. METHODS Analyses were based on 70,846 participants, aged 60 years and older, in cohort studies from a high-income (United States) and four middle-income countries (Mexico, Brazil, China, and India). We used weighted linear models to allow nationally-representative comparisons of sex differences in orientation, memory, attention, and fluency using the United States as the reference, before and after adjustment for education, and after stratification by education. RESULTS Females had lower levels of education than males in all countries, particularly in India. Before adjustment for education, sex differences in orientation and attention in all middle-income countries, memory in Brazil, China, and India, and fluency in India were less favourable to females than in the United States (P < 0.010). For example, females outperformed males in memory in the United States (mean difference [male-female scores] = -0.26 standard deviations [95% CI -0.30, -0.22]) but not in China (0.15 [0.09, 0.21]) or India (0.16 [0.13, 0.19]). Adjustment for education attenuated these sex differences. In analyses stratified by education, there were minimal sex differences in the high education group in all countries. CONCLUSION Education contributes to larger female disadvantages in cognitive function at older ages in middle-income countries compared with the United States. Gender equity in education is an important target to reduce sex disparities in cognitive function globally.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, UK
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
| | | | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, UK.,Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, UK.,Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France
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Machado-Fragua MD, Landré B, Chen M, Fayosse A, Dugravot A, Kivimaki M, Sabia S, Singh-Manoux A. Circulating serum metabolites as predictors of dementia: a machine learning approach in a 21-year follow-up of the Whitehall II cohort study. BMC Med 2022; 20:334. [PMID: 36163029 PMCID: PMC9513883 DOI: 10.1186/s12916-022-02519-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/08/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Age is the strongest risk factor for dementia and there is considerable interest in identifying scalable, blood-based biomarkers in predicting dementia. We examined the role of midlife serum metabolites using a machine learning approach and determined whether the selected metabolites improved prediction accuracy beyond the effect of age. METHODS Five thousand three hundred seventy-four participants from the Whitehall II study, mean age 55.8 (standard deviation (SD) 6.0) years in 1997-1999 when 233 metabolites were quantified using nuclear magnetic resonance metabolomics. Participants were followed for a median 21.0 (IQR 20.4, 21.7) years for clinically-diagnosed dementia (N=329). Elastic net penalized Cox regression with 100 repetitions of nested cross-validation was used to select models that improved prediction accuracy for incident dementia compared to an age-only model. Risk scores reflecting the frequency with which predictors appeared in the selected models were constructed, and their predictive accuracy was examined using Royston's R2, Akaike's information criterion, sensitivity, specificity, C-statistic and calibration. RESULTS Sixteen of the 100 models had a better c-statistic compared to an age-only model and 15 metabolites were selected at least once in all 16 models with glucose present in all models. Five risk scores, reflecting the frequency of selection of metabolites, and a 1-SD increment in all five risk scores was associated with higher dementia risk (HR between 3.13 and 3.26). Three of these, constituted of 4, 5 and 15 metabolites, had better prediction accuracy (c-statistic from 0.788 to 0.796) compared to an age-only model (c-statistic 0.780), all p<0.05. CONCLUSIONS Although there was robust evidence for the role of glucose in dementia, metabolites measured in midlife made only a modest contribution to dementia prediction once age was taken into account.
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Affiliation(s)
- Marcos D Machado-Fragua
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, 10 Avenue de Verdun, 75010, Paris, France.
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, 10 Avenue de Verdun, 75010, Paris, France
| | - Mathilde Chen
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, 10 Avenue de Verdun, 75010, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, 10 Avenue de Verdun, 75010, Paris, France
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, 10 Avenue de Verdun, 75010, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, 10 Avenue de Verdun, 75010, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, 10 Avenue de Verdun, 75010, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
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9
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Rouanet A, Avila-Rieger J, Dugravot A, Lespinasse J, Stuckwisch R, Merrick R, Anderson E, Long L, Helmer C, Jacqmin-Gadda H, Dufouil C, Judd S, Manly J, Sabia S, Gross A, Proust-Lima C. How Selection Over Time Contributes to the Inconsistency of the Association Between Sex/Gender and Cognitive Decline Across Cognitive Aging Cohorts. Am J Epidemiol 2022; 191:441-452. [PMID: 34521111 DOI: 10.1093/aje/kwab227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
The association between sex/gender and aging-related cognitive decline remains poorly understood because of inconsistencies in findings. Such heterogeneity could be attributable to the cognitive functions studied and study population characteristics, but also to differential selection by dropout and death between men and women. We aimed to evaluate the impact of selection by dropout and death on the association between sex/gender and cognitive decline. We first compared the statistical methods most frequently used for longitudinal data, targeting either population estimands (marginal models fitted by generalized estimating equations) or subject-specific estimands (mixed/joint models fitted by likelihood maximization) in 8 studies of aging: 6 population-based studies (the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) Study (1996-2009), Personnes Âgées QUID (PAQUID; 1988-2014), the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (2003-2016), the Three-City Study (Bordeaux only; 1999-2016), the Washington Heights-Inwood Community Aging Project (WHICAP; 1992-2017), and the Whitehall II Study (2007-2016)) and 2 clinic-based studies (the Alzheimer's Disease Neuroimaging Initiative (ADNI; 2004-2017) and a nationwide French cohort study, MEMENTO (2011-2016)). We illustrate differences in the estimands of the association between sex/gender and cognitive decline in selected examples and highlight the critical role of differential selection by dropout and death. Using the same estimand, we then contrast the sex/gender-cognitive decline associations across cohorts and cognitive measures suggesting a residual differential sex/gender association depending on the targeted cognitive measure (memory or animal fluency) and the initial cohort selection. We recommend focusing on subject-specific estimands in the living population for assessing sex/gender differences while handling differential selection over time.
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10
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Regy M, Dugravot A, Sabia S, Fayosse A, Mangin JF, Chupin M, Fischer C, Bouteloup V, Dufouil C, Chêne G, Paquet C, Hanseeuw B, Singh-Manoux A, Dumurgier J. Association of APOE ε4 with cerebral gray matter volumes in non-demented older adults: the MEMENTO cohort study. Neuroimage 2022; 250:118966. [PMID: 35122970 DOI: 10.1016/j.neuroimage.2022.118966] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 10/19/2022] Open
Abstract
Data on 2,045 non-demented individuals with memory complaints were drawn from the Memento cohort study to examine the association between Apolipoprotein E ε4 allele (APOE4) and regional brain gray matter volumes. Linear regression was used to examine the association of APOE4 and measures of regional gray matter volumes in cross-sectional analysis and change therein using longitudinal analyses based on two brain MRI performed at baseline and at two-year follow-up. Overall, in analyses adjusted for age, sex, and intracranial volume, the presence of APOE4 was associated with lower total gray matter volume at baseline and with a higher atrophy rate over the follow-up. The hippocampus and entorhinal cortex were the two gray matter regions most associated with APOE4. Further adjustment for cardiovascular risk factors had little impact on these associations. There was an interaction between age, APOE4 status and total brain volume atrophy rate, with evidence of an earlier age at onset of atrophy in hippocampal volume in APOE4 carriers compared to non-carriers. Those results are in accordance with the role of medial temporal structures in the greater risk of dementia observed in people carrying the APOE4 allele.
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Affiliation(s)
- Melina Regy
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France; Université catholique de Louvain, Louvain, Belgium.
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France; University College London, Department of Epidemiology and Public Health, London, United Kingdom
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Jean-Francois Mangin
- Université Paris-Saclay, CEA, CNRS, CATI, NeuroSpin, Baobab, Gif sur Yvette, France
| | - Marie Chupin
- Université Paris-Saclay, CEA, CNRS, CATI, NeuroSpin, Baobab, Gif sur Yvette, France
| | - Clara Fischer
- Université Paris-Saclay, CEA, CNRS, CATI, NeuroSpin, Baobab, Gif sur Yvette, France
| | - Vincent Bouteloup
- Université de Bordeaux, Bordeaux, France; Pôle de Santé publique Centre Hospitalier Universitaire de Bordeaux, Inserm, UMR 1219, Inserm, CIC1401-EC, Bordeaux, France
| | - Carole Dufouil
- Université de Bordeaux, Bordeaux, France; Pôle de Santé publique Centre Hospitalier Universitaire de Bordeaux, Inserm, UMR 1219, Inserm, CIC1401-EC, Bordeaux, France
| | - Geneviève Chêne
- Université de Bordeaux, Bordeaux, France; Pôle de Santé publique Centre Hospitalier Universitaire de Bordeaux, Inserm, UMR 1219, Inserm, CIC1401-EC, Bordeaux, France
| | - Claire Paquet
- GHU APHP Nord Université de Paris Lariboisiere - Fernand Widal Paris, France; Université de Paris, INSERMU1144, Paris France
| | - Bernard Hanseeuw
- Université catholique de Louvain, Louvain, Belgium; Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France; University College London, Department of Epidemiology and Public Health, London, United Kingdom
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France; GHU APHP Nord Université de Paris Lariboisiere - Fernand Widal Paris, France
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11
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Gil-Salcedo A, Dugravot A, Fayosse A, Landré B, Jacob L, Bloomberg M, Sabia S, Schnitzler A. Pre-stroke Disability and Long-Term Functional Limitations in Stroke Survivors: Findings From More of 12 Years of Follow-Up Across Three International Surveys of Aging. Front Neurol 2022; 13:888119. [PMID: 35775052 PMCID: PMC9237334 DOI: 10.3389/fneur.2022.888119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background Almost 50% of the post-stroke disabled population already have a premorbid disability before stroke. These patients may be offered a different care pathway in the acute and subacute phase than those without pre-morbid disability. Therefore, the aim of this study was to assess the association of the severity of premorbid disability with change of limitations in basic and instrumental activities of daily living (ADL/IADL) 1 year after stroke and over the following decade. Methods Among 3,432 participants from HRS, SHARE and ELSA cohorts with a first stroke, ADL/IADL limitations were measured at 1-2 years prior to stroke, at 1 year post-stroke, and during the chronic phase. Modified Ranking Scale (P-mRS) was used to categorize the participants by level of premorbid disability (1-2 years pre-stroke). Change in ADL/IADL limitations by P-mRS level (0-1, 2-3, and 4-5) was assessed using a piecewise linear mixed model with a breakpoint set at 1 year post-stroke, stratified by median age groups. Results Increase in ADL limitations at 1 year post-stroke was less pronounced in P-mRS ≥2 (p < 0.005). After years of relative stability, limitations of ADL increased for all P-mRS levels (p = 0.003). In those aged ≥75 years at stroke event, the increase was similar irrespective of P-mRS (p = 0.090). There were no significant differences in IADL trajectories between P-mRS levels (p ≥ 0.127). Conclusion These results suggest similar trajectories of functional limitations between P-mRS levels up to 9 years post-stroke, highlighting the possible benefit of including patients with pre-morbid disability to certain treatments during the acute phase.
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Affiliation(s)
- Andres Gil-Salcedo
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aline Dugravot
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aurore Fayosse
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landré
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France.,Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Séverine Sabia
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Alexis Schnitzler
- Université Paris-Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Service de neurologie hôpital A. Mignot, Garches, France
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12
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Gil-Salcedo A, Dugravot A, Fayosse A, Jacob L, Bloomberg M, Sabia S, Schnitzler A. Long-Term Evolution of Functional Limitations in Stroke Survivors Compared With Stroke-Free Controls: Findings From 15 Years of Follow-Up Across 3 International Surveys of Aging. Stroke 2022; 53:228-237. [PMID: 34470497 DOI: 10.1161/strokeaha.121.034534] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE In the chronic phase 2 to 5 years poststroke, limitations in activities of daily living (ADL) and instrumental ADL (IADL) initially plateau before steady increasing. However, the impact of age and differences in initial levels of disability on the evolution of these limitations remains unclear. As such, this study aims to evaluate differences in long-term evolution of ADL/IADL limitations between stroke survivors and stroke-free population, and how limitations differ by initial level of disability for stroke survivors. METHODS Thirty-three thousand six hundred sixty participants (5610 first-ever stroke cases with no recurrence during follow-up and 28 050 stroke-free controls) aged ≥50 from the Health and Retirement Study, Survey of Health, Ageing and Retirement in Europe, and English Longitudinal Study of Ageing were assessed for number of ADL/IADL limitations during the poststroke chronic phase (for cases) and over follow-up years 1996 to 2018 (for controls). Three thousand seven hundred eighteen stroke cases were additionally categorized by disability level using the modified Rankin Scale score of 1 to 2 years poststroke. Evolution of ADL/IADL limitations was assessed in stroke cases and controls and by modified Rankin Scale score (0-1, 2-3, 4-5) using linear mixed models. Models were stratified by age group (50-74 and ≥75 years) and adjusted for baseline characteristics, health behaviors, BMI, and comorbidities. RESULTS Findings showed relative stability of ADL/IADL limitations during 3 to 6 years poststroke followed by an increase for both populations, which was faster for younger stroke cases, suggesting a differential age-effect (P<0.001). Disability level at 1 to 2 years poststroke influenced the evolution of limitations over time, especially for severe disability (modified Rankin Scale score, 4-5) associated with a reduction in limitations at 5 to 6 years poststroke. CONCLUSIONS Our findings showed that during the poststroke chronic phase functional limitations first plateau and then increase and the evolution differs by disability severity. These results highlight the importance of adaptive long-term health and social care measures for stroke survivors.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
| | - Louis Jacob
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Spain (L.J.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain (L.J.)
| | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, United Kingdom (M.B., S.S.)
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
- Department of Epidemiology and Public Health, University College London, United Kingdom (M.B., S.S.)
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, France (A.G.-S., A.D., A.F., L.J., S.S., A.S.)
- Université Versailles Saint Quentin en Yvelines, EA 4047 Handi-Resp, Garches, France (A.S.)
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13
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Bloomberg M, Dugravot A, Landré B, Britton A, Steptoe A, Singh-Manoux A, Sabia S. Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis. Lancet Healthy Longev 2021; 2:e780-e790. [PMID: 34901907 PMCID: PMC8636280 DOI: 10.1016/s2666-7568(21)00249-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Women are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations. METHODS Longitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895-1929, 1930-38, 1939-45, and 1946-60) were analysed before and after adjustment for socioeconomic factors (education and labour force status). FINDINGS The prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895-1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6-4·7) and 1·7% (1·1-2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895-1929 cohort) was 3·2% (2·3-4·1) before adjustment for socioeconomic factors and 1·4% (0·9-1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4-17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7-15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations. INTERPRETATION Socioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions. FUNDING National Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Annie Britton
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
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14
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Yerramalla MS, McGregor DE, Hees VTV, Fayosse A, Dugravot A, Tabak AG, Chen M, Chastin SFM, Sabia S. Daily composition of movement behaviors with cardiovascular disease incidence in elderly. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Moderate-to-vigorous physical activity (MVPA) is proposed as key for cardiovascular diseases (CVD) prevention. At older ages, the role of sedentary behavior (SB) and light intensity physical activity (LIPA) remains unclear. Evidence so far is based on studies examining movement behaviors as independent entities ignoring their co-dependency. This study aims to examine the association between daily composition of objectively-assessed movement behaviors (MVPA, LIPA, SB) and incident CVD in older adults.
Methods
Whitehall II accelerometer sub-study participants free of CVD at baseline (N = 3319, 26.7% women, mean age=68.9 years in 2012-2013) wore a wrist-accelerometer from which times in SB, LIPA, and MVPA were extracted. Compositional Cox regression was used to estimate the hazard ratio (HR) for incident CVD for daily compositions of movement behaviors characterized by 10 (20 or 30) minutes greater duration in one movement behavior accompanied by decrease in another behavior, while keeping the third behavior constant, compared to reference composition.
Results
Of the 3319 participants, 299 had an incident CVD over a mean (SD) follow-up of 6.2 (1.3) years. Compared to individuals with daily movement behavior composition composed with MVPA at recommended 21 minutes per day (150 minutes/week), composition with additional 10 minutes of MVPA and 10 minutes less SB were associated with smaller risk reduction -8% (HR, 0.92; 95% CI, 0.87-0.99) - than the 14% increase in risk associated with a composition of similarly reduced time in MVPA and more time in SB (HR, 1.14; 95% CI, 1.02-1.27). For a given MVPA duration, the CVD risk did not differ as a function of LIPA and SB durations.
Conclusions
An increase in MVPA duration at the expense of time in either SB or LIPA was associated with lower risk of incident CVD. This study lends support to public health guidelines encouraging increase in MVPA or at least maintain MVPA at their current duration.
Key messages
Older adults should be encouraged to increase their moderate-to-vigorous physical activity or at least maintain at their current levels to lower risk of incident cardiovascular disease. Highly sedentary older adults should increase their moderate-to-vigorous physical activity by decreasing sedentary time rather than light-intensity activity to prevent cardiovascular disease.
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Affiliation(s)
- MS Yerramalla
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - DE McGregor
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Biomathematics and Statistics Scotland, Edinburgh, UK
| | | | - A Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - A Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - AG Tabak
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Internal Medicine and Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary
- Department of Public Health, Semmelweis University, Budapest, Hungary
| | - M Chen
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - SFM Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - S Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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15
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Bloomberg M, Dugravot A, Landré B, Britton A, Steptoe A, Singh-Manoux A, Sabia S. Sex differences in functional limitation level and the role of socioeconomic factors. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Women are more likely to have functional limitations than men, partly due to socioeconomic disadvantage. As much of this research is based on dichotomised measures of limitation, how sex differences vary by level of limitations remains unclear. The aim of our study was to examine sex differences in functional limitations in people born between 1895 and 1960, with attention to the role of socioeconomic factors and level of limitations.
Methods
Longitudinal data on limitations in basic/instrumental activities of daily living (ADL/IADL) and mobility activities were drawn from studies in 14 countries. For ADL, IADL, and mobility activities, participants were grouped into limitation levels based on number of limited activities (0, 1, 2, or ≥ 3). Sex differences in limitations in four birth cohorts (1895-1929, 1930-1938, 1939-1945, 1946-1960) were analysed before and after adjustment for socioeconomic factors using mixed effects ordinal logistic models.
Findings
Among 62,375 participants, sex differences in IADL and ADL limitations (≥1) were minor after adjustment for socioeconomic factors (sex difference in probability of limitations (female - male) age 75, 1895-1929 cohort for IADL=3.7% (95% CI 2.6, 4.7) before and 1.7% (1.1, 2.2) after adjustment; ADL=3.2% (2.3, 4.1) before, 1.4% (0.9, 1.8) after). Sex differences remained for mobility (16.1% (14.4, 17.7) before, 14.3% (12.7, 15.9) after). At older ages, women were more likely to have ≥3 IADL or mobility limitations, while men were more likely to have 1 to 2.
Conclusions
Socioeconomic factors explain the majority of sex differences in IADL and ADL limitations but not mobility, with women reporting greater mobility limitations than men starting in middle age. Our findings suggest sex differences in mobility limitations from middle age might be important targets for future study and interventions.
Key messages
Sex differences in disability vary considerably between disability measures. Comprehensive assessment of sex differences in disability should consider disability severity across different measures. Findings suggest there may be fewer sex differences in disability in the future with progressively decreasing socioeconomic disparities between men and women.
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Affiliation(s)
- M Bloomberg
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Dugravot
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - B Landré
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - A Britton
- Department of Epidemiology and Public Health, University College London, London, UK
| | - A Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - A Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - S Sabia
- Department of Epidemiology and Public Health, University College London, London, UK
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
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16
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Kumaradev S, Roux C, Sellam J, Perrot S, Pham T, Dugravot A, Molto A. Sociodemographic determinants in the evolution of pain in inflammatory rheumatic diseases: results from ESPOIR and DESIR cohorts. Rheumatology (Oxford) 2021; 61:1496-1509. [PMID: 34270700 PMCID: PMC8996788 DOI: 10.1093/rheumatology/keab562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/30/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether socio-demographic factors are associated with heterogeneity in pain evolution in inflammatory rheumatic diseases (IRDs) after accounting for disease-specific characteristics in a system with universal health care. Methods This analysis included the data from two prospective observational cohorts of early IRDs (ESPOIR for early RA and DESIR for early SpA). Data on pain was measured, respectively, on 13 and 9 occasions spanning 10 and 6 years of follow-up using the Short-Form 36 bodily pain score for 810 participants of ESPOIR, and 679 participants of DESIR. Linear mixed models were used to characterize differences in pain evolution as a function of age (tertiles), sex, ethnicity, education, marital, and professional status, after accounting for disease-related, treatment, lifestyle, and health factors. Results While transitioning from early (disease duration ≤6 months for RA and ≤3 years for SpA) to long-standing disease, differences in pain evolution emerged as a function of age (P < 0.001), sex (P = 0.050), and ethnicity (P = 0.001) in RA, and as a function of age (P = 0.048) in SpA; younger age, males, and Caucasians exhibited lower pain in the latter phases of both diseases. Highly educated participants (RA, β = −3.8, P = 0.007; SpA, β = −6.0, P < 0.001) for both diseases, and Caucasians (β = −5.6, P = 0.021) for SpA presented with low pain early in the disease, with no changes throughout disease course. Conclusion Being older, female, non-Caucasian and having lower education was found to be associated with worse pain in early and/or long-standing IRDs, despite universally accessible health-care. Early identification of at-risk populations and implementation of multidisciplinary strategies may reduce patient-reported health outcome disparities. Trial registration registrations ESPOIR: ClinicalTrials.gov, www.clinicaltrials.gov, NCT03666091. DESIR: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01648907.
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Affiliation(s)
- Sushmithadev Kumaradev
- Clinical epidemiology applied to rheumatic and musculoskeletal diseases, Inserm 1153, Université de Paris, Paris, France.,Epidemiology of Ageing and Neurodegenerative diseases, Inserm 1153, Université de Paris, Paris, France
| | - Christian Roux
- Clinical epidemiology applied to rheumatic and musculoskeletal diseases, Inserm 1153, Université de Paris, Paris, France.,Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, APHP-Centre, Saint-Antoine Hospital, Paris, France
| | - Serge Perrot
- Pain clinic, APHP-Centre, INSERM U897, Cochin Hospital, Paris, France
| | - Thao Pham
- Department of Rheumatology, APHM, Sainte-Marguerite Hospital, Aix-Marseille Univ, Marseille, France
| | - Aline Dugravot
- Epidemiology of Ageing and Neurodegenerative diseases, Inserm 1153, Université de Paris, Paris, France
| | - Anna Molto
- Clinical epidemiology applied to rheumatic and musculoskeletal diseases, Inserm 1153, Université de Paris, Paris, France.,Department of Rheumatology, APHP-Centre, Cochin Hospital, Paris, France
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17
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Yerramalla MS, McGregor DE, van Hees VT, Fayosse A, Dugravot A, Tabak AG, Chen M, Chastin SFM, Sabia S. Association of daily composition of physical activity and sedentary behaviour with incidence of cardiovascular disease in older adults. Int J Behav Nutr Phys Act 2021; 18:83. [PMID: 34247647 PMCID: PMC8273960 DOI: 10.1186/s12966-021-01157-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Moderate-to-vigorous physical activity (MVPA) is proposed as key for cardiovascular diseases (CVD) prevention. At older ages, the role of sedentary behaviour (SB) and light intensity physical activity (LIPA) remains unclear. Evidence so far is based on studies examining movement behaviours as independent entities ignoring their co-dependency. This study examines the association between daily composition of objectively-assessed movement behaviours (MVPA, LIPA, SB) and incident CVD in older adults. METHODS Whitehall II accelerometer sub-study participants free of CVD at baseline (N = 3319, 26.7% women, mean age = 68.9 years in 2012-2013) wore a wrist-accelerometer from which times in SB, LIPA, and MVPA during waking period were extracted over 7 days. Compositional Cox regression was used to estimate the hazard ratio (HR) for incident CVD for daily compositions of movement behaviours characterized by 10 (20 or 30) minutes greater duration in one movement behaviour accompanied by decrease in another behaviour, while keeping the third behaviour constant, compared to reference composition. Analyses were adjusted for sociodemographic, lifestyle, cardiometabolic risk factors and multimorbidity index. RESULTS Of the 3319 participants, 299 had an incident CVD over a mean (SD) follow-up of 6.2 (1.3) years. Compared to daily movement behaviour composition with MVPA at recommended 21 min per day (150 min/week), composition with additional 10 min of MVPA and 10 min less SB was associated with smaller risk reduction - 8% (HR, 0.92; 95% CI, 0.87-0.99) - than the 14% increase in risk associated with a composition of similarly reduced time in MVPA and more time in SB (HR, 1.14; 95% CI, 1.02-1.27). For a given MVPA duration, the CVD risk did not differ as a function of LIPA and SB durations. CONCLUSIONS Among older adults, an increase in MVPA duration at the expense of time in either SB or LIPA was found associated with lower incidence of CVD. This study lends support to public health guidelines encouraging increase in MVPA or at least maintain MVPA at current duration.
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Affiliation(s)
- Manasa S Yerramalla
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, 10 Avenue de Verdun, 75010, Paris, France.
| | - Duncan E McGregor
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.,Biomathematics and Statistics Scotland, Edinburgh, UK
| | | | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, 10 Avenue de Verdun, 75010, Paris, France
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, 10 Avenue de Verdun, 75010, Paris, France
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College London, London, UK.,Department of Internal Medicine and Oncology, Semmelweis University, Faculty of Medicine, Budapest, Hungary.,Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Mathilde Chen
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, 10 Avenue de Verdun, 75010, Paris, France
| | - Sebastien F M Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.,Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, 10 Avenue de Verdun, 75010, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
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18
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Kumaradev S, Fayosse A, Dugravot A, Dumurgier J, Roux C, Kivimäki M, Singh-Manoux A, Sabia S. Timeline of pain before dementia diagnosis: a 27-year follow-up study. Pain 2021; 162:1578-1585. [PMID: 33003109 PMCID: PMC7985036 DOI: 10.1097/j.pain.0000000000002080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/26/2020] [Accepted: 09/10/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study examines the importance of length of follow-up on the association between pain and incident dementia. Further objective was to characterize pain trajectories in the 27 years preceding dementia diagnosis and compare them with those among persons free of dementia during the same period. Pain intensity and pain interference (averaged as total pain) were measured on 9 occasions (1991-2016) using the Short-Form 36 Questionnaire amongst 9046 (women = 31.4%) dementia-free adults aged 40 to 64 years in 1991; 567 dementia cases were recorded between 1991 and 2019. Cox regression was used to assess the association between pain measures at different time points and incident dementia and mixed models to assess pain trajectories preceding dementia diagnosis or end point for dementia-free participants. Results from Cox regression showed moderate/severe compared with mild/no total pain, pain intensity, and pain interference not to be associated with dementia when the mean follow-up was 25.0, 19.6, 14.5, or 10.0 years. These associations were evident for a mean follow-up of 6.2 years: for total pain (hazard ratio = 1.72; 95% confidence intervals = 1.28-2.33), pain intensity (1.41; 1.04-1.92), and pain interference (1.80; 1.30-2.49). These associations were stronger when the mean follow-up for incidence of dementia was 3.2 years. Twenty-seven-year pain trajectories differed between dementia cases and noncases with small differences in total pain and pain interference evident 16 years before dementia diagnosis (difference in the total pain score = 1.4, 95% confidence intervals = 0.1-2.7) and rapidly increasing closer to diagnosis. In conclusion, these findings suggest that pain is a correlate or prodromal symptom rather than a cause of dementia.
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Affiliation(s)
- Sushmithadev Kumaradev
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Aurore Fayosse
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Aline Dugravot
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Julien Dumurgier
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Christian Roux
- Inserm 1153, Clinical Epidemiology Applied to Rheumatic and Musculoskeletal Diseases, Université de Paris, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Séverine Sabia
- Inserm 1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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19
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Barbiellini Amidei C, Fayosse A, Dumurgier J, Machado-Fragua MD, Tabak AG, van Sloten T, Kivimäki M, Dugravot A, Sabia S, Singh-Manoux A. Association Between Age at Diabetes Onset and Subsequent Risk of Dementia. JAMA 2021; 325:1640-1649. [PMID: 33904867 PMCID: PMC8080220 DOI: 10.1001/jama.2021.4001] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Trends in type 2 diabetes show an increase in prevalence along with younger age of onset. While vascular complications of early-onset type 2 diabetes are known, the associations with dementia remains unclear. OBJECTIVE To determine whether younger age at diabetes onset is more strongly associated with incidence of dementia. DESIGN, SETTING, AND PARTICIPANTS Population-based study in the UK, the Whitehall II prospective cohort study, established in 1985-1988, with clinical examinations in 1991-1993, 1997-1999, 2002-2004, 2007-2009, 2012-2013, and 2015-2016, and linkage to electronic health records until March 2019. The date of final follow-up was March 31, 2019. EXPOSURES Type 2 diabetes, defined as a fasting blood glucose level greater than or equal to 126 mg/dL at clinical examination, physician-diagnosed type 2 diabetes, use of diabetes medication, or hospital record of diabetes between 1985 and 2019. MAIN OUTCOMES AND MEASURES Incident dementia ascertained through linkage to electronic health records. RESULTS Among 10 095 participants (67.3% men; aged 35-55 years in 1985-1988), a total of 1710 cases of diabetes and 639 cases of dementia were recorded over a median follow-up of 31.7 years. Dementia rates per 1000 person-years were 8.9 in participants without diabetes at age 70 years, and rates were 10.0 per 1000 person-years for participants with diabetes onset up to 5 years earlier, 13.0 for 6 to 10 years earlier, and 18.3 for more than 10 years earlier. In multivariable-adjusted analyses, compared with participants without diabetes at age 70, the hazard ratio (HR) of dementia in participants with diabetes onset more than 10 years earlier was 2.12 (95% CI, 1.50-3.00), 1.49 (95% CI, 0.95-2.32) for diabetes onset 6 to 10 years earlier, and 1.11 (95% CI, 0.70-1.76) for diabetes onset 5 years earlier or less; linear trend test (P < .001) indicated a graded association between age at onset of type 2 diabetes and dementia. At age 70, every 5-year younger age at onset of type 2 diabetes was significantly associated with an HR of dementia of 1.24 (95% CI, 1.06-1.46) in analyses adjusted for sociodemographic factors, health behaviors, and health-related measures. CONCLUSIONS AND RELEVANCE In this longitudinal cohort study with a median follow-up of 31.7 years, younger age at onset of diabetes was significantly associated with higher risk of subsequent dementia.
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Affiliation(s)
- Claudio Barbiellini Amidei
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Aurore Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Julien Dumurgier
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
- Cognitive Neurology Center, Lariboisière – Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Marcos D. Machado-Fragua
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Adam G. Tabak
- Department of Epidemiology and Public Health, University College London, United Kingdom
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Thomas van Sloten
- Cardiovascular Research Institute Maastricht (CARIM), Department of Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Mika Kivimäki
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy
- Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Aline Dugravot
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Séverine Sabia
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
- Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Archana Singh-Manoux
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
- Department of Epidemiology and Public Health, University College London, United Kingdom
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20
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Sabia S, Fayosse A, Dumurgier J, van Hees VT, Paquet C, Sommerlad A, Kivimäki M, Dugravot A, Singh-Manoux A. Association of sleep duration in middle and old age with incidence of dementia. Nat Commun 2021; 12:2289. [PMID: 33879784 PMCID: PMC8058039 DOI: 10.1038/s41467-021-22354-2] [Citation(s) in RCA: 218] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/09/2021] [Indexed: 01/10/2023] Open
Abstract
Sleep dysregulation is a feature of dementia but it remains unclear whether sleep duration prior to old age is associated with dementia incidence. Using data from 7959 participants of the Whitehall II study, we examined the association between sleep duration and incidence of dementia (521 diagnosed cases) using a 25-year follow-up. Here we report higher dementia risk associated with a sleep duration of six hours or less at age 50 and 60, compared with a normal (7 h) sleep duration, although this was imprecisely estimated for sleep duration at age 70 (hazard ratios (HR) 1.22 (95% confidence interval 1.01-1.48), 1.37 (1.10-1.72), and 1.24 (0.98-1.57), respectively). Persistent short sleep duration at age 50, 60, and 70 compared to persistent normal sleep duration was also associated with a 30% increased dementia risk independently of sociodemographic, behavioural, cardiometabolic, and mental health factors. These findings suggest that short sleep duration in midlife is associated with an increased risk of late-onset dementia.
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Affiliation(s)
- Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France.
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Université de Paris, Inserm U1144, Cognitive Neurology Center, GHU APHP Nord Lariboisière - Fernand Widal Hospital, Paris, France
| | | | - Claire Paquet
- Université de Paris, Inserm U1144, Cognitive Neurology Center, GHU APHP Nord Lariboisière - Fernand Widal Hospital, Paris, France
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
- Clinicum, University of Helsinki, Helsinki, Finland
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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21
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Bloomberg M, Dugravot A, Dumurgier J, Kivimaki M, Fayosse A, Steptoe A, Britton A, Singh-Manoux A, Sabia S. Sex differences and the role of education in cognitive ageing: analysis of two UK-based prospective cohort studies. Lancet Public Health 2021; 6:e106-e115. [PMID: 33516287 PMCID: PMC8141610 DOI: 10.1016/s2468-2667(20)30258-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have shown an excess risk of Alzheimer's disease and related dementias among women. Education is thought to have a causal association with dementia onset. We aimed to investigate the role of education in influencing sex differences in cognitive ageing. METHODS We analysed data from two prospective cohort studies in the UK; the English Longitudinal Study of Ageing (ELSA) and the Whitehall II study, to assess sex differences in cognitive performance and cognitive decline by birth cohort (birth year 1930-38, 1939-45, or 1946-55), before and after adjustment for education, and by high and low education level. Memory was assessed using immediate recall, for which data were available from all waves of the ELSA (2002-14) and Whitehall II (1997-2015) studies. Fluency was assessed using a semantic fluency test based on an animal naming task, with data available from all waves of the Whitehall II study and waves one to five (2002-10) and wave seven (2014) of the ELSA study. Cognitive scores were standardised separately in each study based on the mean and SD of the corresponding test among participants aged 50-59 years with secondary education. FINDINGS 15 924 participants were included from the two studies. In pooled analyses, women had better memory scores than men in all birth cohorts, irrespective of adjustment for education (eg, at age 60 years, birth cohort 1930-38, mean difference between sexes [male scores minus female scores] -0·25 SDs [95% CI -0·32 to -0·19] after adjustment for education), and in both education level groups. Memory decline was faster in men than in women (at age 60 years, birth cohort 1946-55, mean difference in 13-year change -0·15 SDs [-0·20 to -0·09]; after adjustment for education -0·14 SDs [-0·20 to -0·08]). Men had better fluency scores than women in earlier birth cohorts and in the low education group (at age 60 years, birth cohort 1930-38, mean difference 0·20 SDs [95% CI 0·05 to 0·36]); but women had better fluency scores than men in later birth cohorts and in the high education group (at age 60 years, birth cohort 1946-55, mean difference -0·17 SDs [-0·24 to -0·10]). No sex differences were observed for fluency decline. INTERPRETATION Our findings suggest that decreasing disparities between sexes in education, due to secular increases in educational opportunities, could attenuate sex differences in dementia risk and cognitive decline in the future. FUNDING National Institute on Aging, National Institutes of Health; UK Medical Research Council; British Heart Foundation; and National Institute for Health Research.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Aline Dugravot
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Julien Dumurgier
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France; Cognitive Neurology Centre, Saint-Louis Lariboisière Fernand-Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aurore Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Annie Britton
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, UK; Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, London, UK; Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
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22
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Gharbi-Meliani A, Dugravot A, Sabia S, Regy M, Fayosse A, Schnitzler A, Kivimäki M, Singh-Manoux A, Dumurgier J. The association of APOE ε4 with cognitive function over the adult life course and incidence of dementia: 20 years follow-up of the Whitehall II study. Alzheimers Res Ther 2021; 13:5. [PMID: 33397450 PMCID: PMC7784268 DOI: 10.1186/s13195-020-00740-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/07/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Approximately 25% of the general population carries at least one ε4 allele of the Apolipoprotein E (APOE ε4), the strongest genetic risk factor for late onset Alzheimer's disease. Beyond its association with late-onset dementia, the association between APOE ε4 and change in cognition over the adult life course remains uncertain. This study aims to examine whether the association between Apolipoprotein E (APOE) ε4 zygosity and cognition function is modified between midlife and old age. METHODS A cohort study of 5561 participants (mean age 55.5 (SD = 5.9) years, 27.1% women) with APOE genotyping and repeated cognitive tests for reasoning, memory, and semantic and phonemic fluency, during a mean (SD) follow-up of 20.2 (2.8) years (the Whitehall II study). We used joint models to examine the association of APOE genotype with cognitive function trajectories between 45 and 85 years taking drop-out, dementia, and death into account and Fine and Gray models to examine associations with dementia. RESULTS Compared to non-carriers, heterozygote (prevalence 25%) and homozygote (prevalence 2%) APOE ε4 carriers had increased risk of dementia, sub-distribution hazard ratios 2.19 (95% CI 1.73, 2.77) and 5.97 (95% CI 3.85, 9.28) respectively. Using data spanning 45-85 years with non-ε4 carriers as the reference, ε4 homozygotes had poorer global cognitive score starting from 65 years; ε4 heterozygotes had better scores between 45 and 55 years, then no difference until poorer cognitive scores from 75 years onwards. In analysis of individual cognitive tests, better cognitive performance in the younger ε4 heterozygotes was primarily attributable to executive function. CONCLUSIONS Both heterozygous and homozygous ε4 carriers had poorer cognition and greater risk of dementia at older ages. Our findings show some support for a complex antagonist pleiotropic effect of APOE ε4 heterozygosity over the adult life course, characterized by cognitive advantage in midlife.
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Affiliation(s)
- Amin Gharbi-Meliani
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Melina Regy
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France. .,Cognitive Neurology Center, Lariboisiere - Fernand Widal Hospital, AP-HP, Université de Paris, 200 rue du Faubourg Saint Denis, 75010, Paris, France.
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23
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Saddiki H, Fayosse A, Cognat E, Sabia S, Engelborghs S, Wallon D, Alexopoulos P, Blennow K, Zetterberg H, Parnetti L, Zerr I, Hermann P, Gabelle A, Boada M, Orellana A, de Rojas I, Lilamand M, Bjerke M, Van Broeckhoven C, Farotti L, Salvadori N, Diehl-Schmid J, Grimmer T, Hourregue C, Dugravot A, Nicolas G, Laplanche JL, Lehmann S, Bouaziz-Amar E, Hugon J, Tzourio C, Singh-Manoux A, Paquet C, Dumurgier J. Age and the association between apolipoprotein E genotype and Alzheimer disease: A cerebrospinal fluid biomarker-based case-control study. PLoS Med 2020; 17:e1003289. [PMID: 32817639 PMCID: PMC7446786 DOI: 10.1371/journal.pmed.1003289] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/22/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The ε4 allele of apolipoprotein E (APOE) gene and increasing age are two of the most important known risk factors for developing Alzheimer disease (AD). The diagnosis of AD based on clinical symptoms alone is known to have poor specificity; recently developed diagnostic criteria based on biomarkers that reflect underlying AD neuropathology allow better assessment of the strength of the associations of risk factors with AD. Accordingly, we examined the global and age-specific association between APOE genotype and AD by using the A/T/N classification, relying on the cerebrospinal fluid (CSF) levels of β-amyloid peptide (A, β-amyloid deposition), phosphorylated tau (T, pathologic tau), and total tau (N, neurodegeneration) to identify patients with AD. METHODS AND FINDINGS This case-control study included 1,593 white AD cases (55.4% women; mean age 72.8 [range = 44-96] years) with abnormal values of CSF biomarkers from nine European memory clinics and the American Alzheimer's Disease Neuroimaging Initiative (ADNI) study. A total of 11,723 dementia-free controls (47.1% women; mean age 65.6 [range = 44-94] years) were drawn from two longitudinal cohort studies (Whitehall II and Three-City), in which incident cases of dementia over the follow-up were excluded from the control population. Odds ratio (OR) and population attributable fraction (PAF) for AD associated with APOE genotypes were determined, overall and by 5-year age categories. In total, 63.4% of patients with AD and 22.6% of population controls carried at least one APOE ε4 allele. Compared with non-ε4 carriers, heterozygous ε4 carriers had a 4.6 (95% confidence interval 4.1-5.2; p < 0.001) and ε4/ε4 homozygotes a 25.4 (20.4-31.2; p < 0.001) higher OR of AD in unadjusted analysis. This association was modified by age (p for interaction < 0.001). The PAF associated with carrying at least one ε4 allele was greatest in the 65-70 age group (69.7%) and weaker before 55 years (14.2%) and after 85 years (22.6%). The protective effect of APOE ε2 allele for AD was unaffected by age. Main study limitations are that analyses were based on white individuals and AD cases were drawn from memory centers, which may not be representative of the general population of patients with AD. CONCLUSIONS In this study, we found that AD diagnosis based on biomarkers was associated with APOE ε4 carrier status, with a higher OR than previously reported from studies based on only clinical AD criteria. This association differs according to age, with the strongest effect at 65-70 years. These findings highlight the need for early interventions for dementia prevention to mitigate the effect of APOE ε4 at the population level.
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Affiliation(s)
- Hana Saddiki
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Emmanuel Cognat
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Sebastiaan Engelborghs
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - David Wallon
- Inserm U1245, Rouen University Hospital, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Panagiotis Alexopoulos
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, UK Dementia Research Institute, London, United Kingdom
| | - Lucilla Parnetti
- Center for Memory Disturbances-Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center, University Medical Center Göttingen and German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Peter Hermann
- Department of Neurology, Clinical Dementia Center, University Medical Center Göttingen and German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Audrey Gabelle
- Department of Neurology, Memory Research and Resources Centre, University of Montpellier, Montpellier, France
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurciències Aplicades, Universitat International de Catalunya, Barcelona, Spain
| | - Adelina Orellana
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurciències Aplicades, Universitat International de Catalunya, Barcelona, Spain
| | - Itziar de Rojas
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurciències Aplicades, Universitat International de Catalunya, Barcelona, Spain
| | - Matthieu Lilamand
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Maria Bjerke
- VIB Center for Molecular Neurology, Institute Born-Bunge and Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Christine Van Broeckhoven
- VIB Center for Molecular Neurology, Institute Born-Bunge and Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Lucia Farotti
- Center for Memory Disturbances-Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Nicola Salvadori
- Center for Memory Disturbances-Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Claire Hourregue
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Gaël Nicolas
- Inserm U1245, Rouen University Hospital, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Jean-Louis Laplanche
- Department of Biochemistry and Molecular Biology, Lariboisière Hospital, APHP, Paris, France
| | - Sylvain Lehmann
- Department of Biochemistry, University of Montpellier, Montpellier, France
| | - Elodie Bouaziz-Amar
- Department of Biochemistry and Molecular Biology, Lariboisière Hospital, APHP, Paris, France
| | | | - Jacques Hugon
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Christophe Tzourio
- Bordeaux Population Health Research Center, Team HEALTHY, UMR1219, University of Bordeaux, Inserm, Bordeaux, France
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Claire Paquet
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
- * E-mail:
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Gil-Salcedo A, Dugravot A, Fayosse A, Dumurgier J, Bouillon K, Schnitzler A, Kivimäki M, Singh-Manoux A, Sabia S. Healthy behaviors at age 50 years and frailty at older ages in a 20-year follow-up of the UK Whitehall II cohort: A longitudinal study. PLoS Med 2020; 17:e1003147. [PMID: 32628661 PMCID: PMC7337284 DOI: 10.1371/journal.pmed.1003147] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/11/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Frailty is associated with increased risk of various health conditions, disability, and death. Health behaviors are thought to be a potential target for frailty prevention, but the evidence from previous studies is based on older populations with short follow-ups, making results susceptible to reverse causation bias. We examined the associations of healthy behaviors at age 50, singly and in combination, as well as 10-year change in the number of healthy behaviors over midlife with future risk of frailty. METHODS AND FINDINGS In this prospective cohort study of 6,357 (29.2% women; 91.7% white) participants from the British Whitehall II cohort, healthy behaviors-nonsmoking, moderate alcohol consumption, ≥2.5 hours per week of moderate to vigorous physical activity, and consumption of fruits or vegetables at least twice a day-were measured at age 50, and change in behaviors was measured between 1985 (mean age = 44.4) and 1997 (mean age = 54.8). Fried's frailty phenotype was assessed in clinical examinations in 2002, 2007, 2012, and 2015. Participants were classified as frail if they had ≥3 of the following criteria: slow walking speed, low grip strength, weight loss, exhaustion, and low physical activity. An illness-death model accounting for both competing risk of death and interval censoring was used to examine the association between healthy behaviors and risk of frailty. Over an average follow-up of 20.4 years (standard deviation, 5.9), 445 participants developed frailty. Each healthy behavior at age 50 was associated with lower risk of incident frailty: hazard ratio (HR) after adjustment for other health behaviors and baseline characteristics 0.56 (95% confidence interval [CI] 0.44-0.71; p < 0.001) in nonsmokers, 0.73 (95% CI 0.61-0.88; p < 0.001) for moderate alcohol consumption, 0.66 (95% CI 0.54-0.81; p < 0.001) for ≥2.5 hours of physical activity per week, and 0.76 (95% CI 0.59-0.98; p = 0.03) for consumption of fruits or vegetables at least twice a day. A greater number of healthy behaviors was associated with reduced risk of frailty, with the HR for each additional healthy behavior being 0.69 (95% CI 0.62-0.76; p < 0.001) and the HR for having all versus no healthy behaviors at age 50 being 0.28 (95% CI 0.15-0.52; p < 0.001). Among participants with no or 1 healthy behavior in 1985, those who increased the number of healthy behaviors by 1997 were at a lower risk of frailty (mean follow-up = 16 years) compared with those with no such increase: the HR was 0.64 (95% CI 0.44-0.94; p = 0.02) for change to 2 healthy behaviors and 0.57 (95% CI 0.38-0.87; p < 0.001) for change to 3-4 healthy behaviors in 1997. The primary limitation of this study is potential selection bias during the follow-up due to missing data on frailty components. CONCLUSIONS Our findings suggest that healthy behaviors at age 50, as well as improvements in behaviors over midlife, are associated with a lower risk of frailty later in life. Their benefit accumulates so that risk of frailty decreases with greater number of healthy behaviors. These results suggest that healthy behaviors in midlife are a good target for frailty prevention.
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Affiliation(s)
- Andres Gil-Salcedo
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France
| | - Kim Bouillon
- Département d’Information Médicale, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
| | - Alexis Schnitzler
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
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25
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Fayosse A, Nguyen DP, Dugravot A, Dumurgier J, Tabak AG, Kivimäki M, Sabia S, Singh-Manoux A. Risk prediction models for dementia: role of age and cardiometabolic risk factors. BMC Med 2020; 18:107. [PMID: 32423410 PMCID: PMC7236124 DOI: 10.1186/s12916-020-01578-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score is the only currently available midlife risk score for dementia. We compared CAIDE to Framingham cardiovascular Risk Score (FRS) and FINDRISC diabetes score as predictors of dementia and assessed the role of age in their associations with dementia. We then examined whether these risk scores were associated with dementia in those free of cardiometabolic disease over the follow-up. METHODS A total of 7553 participants, 39-63 years in 1991-1993, were followed for cardiometabolic disease (diabetes, coronary heart disease, stroke) and dementia (N = 318) for a mean 23.5 years. Cox regression was used to model associations of age at baseline, CAIDE, FRS, and FINDRISC risk scores with incident dementia. Predictive performance was assessed using Royston's R2, Harrell's C-index, Akaike's information criterion (AIC), the Greenwood-Nam-D'Agostino (GND) test, and calibration-in-the-large. Age effect was also assessed by stratifying analyses by age group. Finally, in multistate models, we examined whether cardiometabolic risk scores were associated with incidence of dementia in persons who remained free of cardiometabolic disease over the follow-up. RESULTS Among the risk scores, the predictive performance of CAIDE (C-statistic = 0.714; 95% CI 0.690-0.739) and FRS (C-statistic = 0.719; 95% CI 0.693-0.745) scores was better than FINDRISC (C-statistic = 0.630; 95% CI 0.602-0.659); p < 0.001), AIC difference > 3; R2 32.5%, 32.0%, and 12.5%, respectively. When the effect of age in these risk scores was removed by drawing data on risk scores at age 55, 60, and 65 years, the association with dementia in all age groups remained for FRS and FINDRISC, but not for CAIDE. Only FRS at age 55 was associated with dementia in persons who remained free of cardiometabolic diseases prior to dementia diagnosis while no such association was observed at older ages for any risk score. CONCLUSIONS Our analyses of CAIDE, FRS, and FINDRISC show the FRS in midlife to predict dementia as well as the CAIDE risk score, its predictive value being also evident among individuals who did not develop cardiometabolic events. The importance of age in the predictive performance of all three risk scores highlights the need for the development of multivariable risk scores in midlife for primary prevention of dementia.
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Affiliation(s)
- Aurore Fayosse
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Dinh-Phong Nguyen
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Aline Dugravot
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Julien Dumurgier
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France
| | - Adam G Tabak
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France.,First Department of Medicine, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 10 avenue de Verdun, 75010, Paris, France. .,Department of Epidemiology and Public Health, University College London, London, UK.
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Singh-Manoux A, Yerramalla MS, Sabia S, Kivimäki M, Fayosse A, Dugravot A, Dumurgier J. Association of big-5 personality traits with cognitive impairment and dementia: a longitudinal study. J Epidemiol Community Health 2020; 74:799-805. [PMID: 32303596 DOI: 10.1136/jech-2019-213014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Personality traits have been liked to cognitive outcomes such as dementia, but whether these associations are robust to the effects of third variables remains the subject of debate. We examined the role of socioeconomic status, depression (history and depressive symptoms), health behaviours and chronic conditions in the association of the big-5 personality traits with cognitive performance, cognitive impairment and incidence of dementia. METHODS Data on 6135 persons (30% women), aged 60-83 years in 2012/13, are drawn from the Whitehall II Study. Participants responded to the 26-item Midlife Development Inventory to assess personality traits (openness, conscientiousness, extraversion, agreeableness and neuroticism), underwent cognitive testing in 2012/13 and 2015/16 and were followed for incidence of dementia (N=231) until 2019. RESULTS Logistic regression, adjusted for sociodemographic factors, suggested a cross-sectional association with cognitive impairment for four of the five traits but only neuroticism was associated with incident cognitive impairment. All associations were completely attenuated when the analyses were adjusted for depression. Cox regression (mean follow-up: 6.18 years) adjusted for sociodemographic variables showed higher conscientiousness (HR per SD increment=0.72; 95% CI 0.65 to 0.81) and extraversion (HR=0.85; 95% CI 0.75 to 0.97) to be associated with lower dementia risk; higher neuroticism (HR=1.32; 95% CI 1.17 to 1.49) was associated with increased risk. Further adjustment for depression led to only conscientiousness retaining an association with dementia (HR=0.81; 95% CI 0.69 to 0.96), which was robust to adjustment for all covariates (HR=0.84; 95% CI 0.71 to 0.91; P=0.001). CONCLUSION Our results show that only conscientiousness has an association with incidence of dementia that is not attributable to socioeconomic status or depression. The association of neuroticism with dementia was explained by depression.
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Affiliation(s)
- A Singh-Manoux
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France .,Department of Epidemiology and Public Health, University College London, London, UK
| | - M S Yerramalla
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - S Sabia
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France.,Department of Epidemiology and Public Health, University College London, London, UK
| | - A Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - A Dugravot
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Inserm U1153, Paris, France
| | - J Dumurgier
- Cognitive Neurology Center, Saint Louis -Lariboisiere - Fernand Widal Hospital, AP-HP; Université Paris Diderot, Paris, France
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Yerramalla MS, Fayosse A, Dugravot A, Tabak AG, Kivimäki M, Singh-Manoux A, Sabia S. Association of moderate and vigorous physical activity with incidence of type 2 diabetes and subsequent mortality: 27 year follow-up of the Whitehall II study. Diabetologia 2020; 63:537-548. [PMID: 31792574 PMCID: PMC6997261 DOI: 10.1007/s00125-019-05050-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/16/2019] [Indexed: 12/20/2022]
Abstract
AIMS/HYPOTHESIS This work examined the role of physical activity in the course of diabetes using data spanning nearly three decades. Our first aim was to examine the long-term association of moderate and vigorous physical activity with incidence of type 2 diabetes. Our second aim was to investigate the association of moderate-to-vigorous physical activity post-diabetes diagnosis with subsequent risk of all-cause and cardiovascular disease mortality. METHODS A total of 9987 participants from the Whitehall II cohort study free of type 2 diabetes at baseline (1985-1988) were followed for incidence of type 2 diabetes, based on clinical assessments between 1985 and 2016 and linkage to electronic health records up to 31 March 2017. We first examined the association of moderate and vigorous physical activity measured by questionnaire in 1985-1988 (mean age 44.9 [SD 6.0] years; women, 32.7%) with incident type 2 diabetes, using the interval-censored, illness-death model, a competing risk analysis that takes into account both competing risk of death and intermittent ascertainment of diabetes due to reliance on data collection cycles (interval-censored). The second analysis was based on individuals with type 2 diabetes over the follow-up period where we used Cox regression with inverse probability weighting to examine the association of moderate-to-vigorous physical activity after diagnosis of type 2 diabetes with risk of all-cause and cardiovascular disease mortality. RESULTS Of the 9987 participants, 1553 developed type 2 diabetes during a mean follow-up of 27.1 (SD 6.3) years. Compared with participants who were inactive in 1985-1988, those who undertook any duration of moderate-to-vigorous physical activity had a lower risk of type 2 diabetes (HR 0.85 [95% CI 0.75, 0.97], p = 0.02; analysis adjusted for sociodemographic, behavioural and health-related factors). In 1026 participants with a diagnosis of type 2 diabetes over the follow-up period, data on moderate-to-vigorous physical activity after diabetes diagnosis were available; 165 all-cause deaths and 55 cardiovascular disease-related deaths were recorded during a mean follow-up of 8.8 (SD 6.1) years. In these participants with diabetes, any duration of moderate-to-vigorous physical activity was associated with lower all-cause mortality (HR 0.61 [95% CI 0.41, 0.93], p = 0.02) while the association with cardiovascular mortality was evident only for physical activity undertaken at or above recommendations (≥2.5 h per week of moderate-to-vigorous physical activity or ≥1.25 h per week of vigorous physical activity; HR 0.40 [95% CI 0.16, 0.96], p = 0.04) in fully adjusted models. CONCLUSIONS/INTERPRETATION Moderate-to-vigorous physical activity plays an important role in diabetes, influencing both its incidence and prognosis. A protective effect on incidence was seen for durations of activity below recommendations and a marginal additional benefit was observed at higher durations. Among individuals with type 2 diabetes, any duration of moderate-to-vigorous physical activity was associated with reduced all-cause mortality while recommended durations of physical activity were required for protection against cardiovascular disease-related mortality. DATA AVAILABILITY Whitehall II data, protocols and other metadata are available to the scientific community. Please refer to the Whitehall II data sharing policy at https://www.ucl.ac.uk/epidemiology-health-care/research/epidemiology-and-public-health/research/whitehall-ii/data-sharing.
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Affiliation(s)
- Manasa S Yerramalla
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, 75010, Paris, France
| | - Aurore Fayosse
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, 75010, Paris, France
| | - Aline Dugravot
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, 75010, Paris, France
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College London, London, UK
- 1st Department of Medicine, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, 75010, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, 75010, Paris, France.
- Department of Epidemiology and Public Health, University College London, London, UK.
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Dugravot A, Fayosse A, Dumurgier J, Bouillon K, Rayana TB, Schnitzler A, Kivimaki M, Sabia S, Singh-Manoux A. Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study. Lancet Public Health 2019; 5:e42-e50. [PMID: 31837974 PMCID: PMC7098476 DOI: 10.1016/s2468-2667(19)30226-9] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Social inequalities in mortality persist in high-income countries with universal health care, and the mechanisms by which these inequalities are generated remain unclear. We aimed to examine whether social inequalities were present before or after the onset of adverse health conditions (multimorbidity, frailty, and disability). METHODS Our analysis was based on data from the ongoing Whitehall II cohort study, which enrolled British civil servants aged 35-55 years in 1985-88. Participants were assessed for three indicators of socioeconomic status (education, occupational position, and literacy) at age 50 years. Participants underwent clinical examinations (in 2002-04, 2007-09, 2012-13, and 2015-16) for assessment of frailty (two or more of low physical activity, slow walking speed, poor grip strength, weight loss, and exhaustion) and disability (two or more difficulties in bathing, dressing, going to the toilet, transferring, feeding, and walking). In addition, electronic health records were used to assess the incidence of multimorbidity (two or more of diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, arthritis, cancer, dementia, and Parkinson's disease) and mortality. In analyses adjusted for sociodemographic factors, we used multistate models to examine social inequalities in transitions from healthy state to adverse health conditions and subsequently to mortality. FINDINGS Of 10 308 individuals in the Whitehall II study cohort, 6425 had relevant data available at 50 years and to the end of follow-up on Aug 31, 2017, and were included in our analysis. Participants were followed up for a median of 23·6 years (IQR 19·6-28·9). 1694 (26·4%) of 6425 participants developed multimorbidity, 1733 (27·0%) became frail, 692 (10·8%) had a disability, and 611 (9·5%) died. Multimorbidity (hazard ratio [HR] 4·12 [95% CI 3·41-4·98]), frailty (HR 2·38 [95% CI 1·93-2·93]), and disability (HR 1·73 [95% CI 1·34-2·22]) were associated with increased risk of mortality; these associations were not modified by socioeconomic status. In multistate models, occupation was the socioeconomic status indicator that was most strongly associated with inequalities in the transition from healthy state to multimorbidity (HR 1·54 [95% CI 1·37-1·73]), to frailty (HR 2·08 [95% CI 1·85-2·33]), and to disability (HR 1·44 [95% CI 1·18-1·74]). Socioeconomic status indicators did not affect transitions to mortality in those with multimorbidity, frailty, or disability. INTERPRETATION Socioeconomic status affects the risk of multimorbidity, frailty, and disability, but does not affect the risk of mortality after the onset of these adverse health conditions. Therefore, primary prevention is key to reducing social inequalities in mortality. Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health. FUNDING UK Medical Research Council; National Institute on Aging, National Institutes of Health; British Heart Foundation.
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Affiliation(s)
- Aline Dugravot
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Aurore Fayosse
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Julien Dumurgier
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France; Cognitive Neurology Center, Hôpitaux Universitaires Saint-Louis, Lariboisière, Fernand-Widal, Assistance Hôpitaux Publique de Paris, Université de Paris, Paris, France
| | - Kim Bouillon
- Département d'Information Médicale, Centre Hospitalier de Saint-Brieuc, Saint-Brieuc, France
| | - Tesnim Ben Rayana
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Alexis Schnitzler
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France; Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France; Department of Epidemiology and Public Health, University College London, London, UK.
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Luquiens A, Dugravot A, Panjo H, Benyamina A, Gaïffas S, Bacry E. Self-Exclusion among Online Poker Gamblers: Effects on Expenditure in Time and Money as Compared to Matched Controls. Int J Environ Res Public Health 2019; 16:ijerph16224399. [PMID: 31717923 PMCID: PMC6887990 DOI: 10.3390/ijerph16224399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 11/29/2022]
Abstract
Background: No comparative data is available to report on the effect of online self-exclusion. The aim of this study was to assess the effect of self-exclusion in online poker gambling as compared to matched controls, after the end of the self-exclusion period. Methods: We included all gamblers who were first-time self-excluders over a 7-year period (n = 4887) on a poker website, and gamblers matched for gender, age and account duration (n = 4451). We report the effects over time of self-exclusion after it ended, on money (net losses) and time spent (session duration) using an analysis of variance procedure between mixed models with and without the interaction of time and self-exclusion. Analyzes were performed on the whole sample, on the sub-groups that were the most heavily involved in terms of time or money (higher quartiles) and among short-duration self-excluders (<3 months). Results: Significant effects of self-exclusion and short-duration self-exclusion were found for money and time spent over 12 months. Among the gamblers that were the most heavily involved financially, no significant effect on the amount spent was found. Among the gamblers who were the most heavily involved in terms of time, a significant effect was found on time spent. Short-duration self-exclusions showed no significant effect on the most heavily involved gamblers. Conclusions: Self-exclusion seems efficient in the long term. However, the effect on money spent of self-exclusions and of short-duration self-exclusions should be further explored among the most heavily involved gamblers.
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Affiliation(s)
- Amandine Luquiens
- Hôpital Paul Brousse, APHP Villejuif, France. Université Paris-Saclay, 94800 Villejuif, France;
- CMAP, Ecole Polytechnique, 91128 Palaiseau Cedex, France; (S.G.); (E.B.)
- Université Paris-Sud membre de Université Paris-Saclay, UVSQ, CESP, INSERM, 94800 Villejuif, France; (A.D.); (H.P.)
- Addictions Department, Nîmes University Hospital, 30000 Nîmes, France
- Correspondence: ; Tel.: +33145594018; Fax: +33140593568
| | - Aline Dugravot
- Université Paris-Sud membre de Université Paris-Saclay, UVSQ, CESP, INSERM, 94800 Villejuif, France; (A.D.); (H.P.)
| | - Henri Panjo
- Université Paris-Sud membre de Université Paris-Saclay, UVSQ, CESP, INSERM, 94800 Villejuif, France; (A.D.); (H.P.)
| | - Amine Benyamina
- Hôpital Paul Brousse, APHP Villejuif, France. Université Paris-Saclay, 94800 Villejuif, France;
| | - Stéphane Gaïffas
- CMAP, Ecole Polytechnique, 91128 Palaiseau Cedex, France; (S.G.); (E.B.)
- LPSM UMR 8001, Université Paris Diderot, 8001 Paris, France
| | - Emmanuel Bacry
- CMAP, Ecole Polytechnique, 91128 Palaiseau Cedex, France; (S.G.); (E.B.)
- CEREMADE UMR 7534 CNRS, Université Paris-Dauphine PSL, 75765 Paris Cedex 16, France
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Climie RE, van Sloten TT, Périer MC, Tafflet M, Fayosse A, Dugravot A, Singh-Manoux A, Empana JP. Change in Cardiovascular Health and Incident Type 2 Diabetes and Impaired Fasting Glucose: The Whitehall II Study. Diabetes Care 2019; 42:1981-1987. [PMID: 31416895 PMCID: PMC7364667 DOI: 10.2337/dc19-0379] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Most previous studies on cardiovascular health (CVH) and incident type 2 diabetes (T2D) have used a single measure of CVH, and none have investigated the association with impaired fasting glucose (IFG). We examined the association between changes in CVH and incident T2D and IFG. RESEARCH DESIGN AND METHODS Within the Whitehall II study, CVH was examined every 5 years from 1991/93 until 2015/16. Subjects with 0-2, 3-4, and 5-6 ideal metrics of CVH from the American Heart Association were categorized as having low, moderate, or high CVH, respectively. RESULTS There were 6,234 participants (mean age 49.8 ± 6.0 years, 70% male) without prior cardiovascular disease and T2D, including 5,015 who were additionally free from IFG at baseline. Over a median follow-up of 24.8 (interquartile range 24.0-25.2) years, 895 and 1,703 incident cases of T2D and IFG occurred, respectively. Change in CVH between 1991/93 and 2002/04 was calculated among 4,464 participants free from CVD and T2D and among 2,795 participants additionally free from IFG. In multivariate analysis, compared with those with stable low CVH, risk of T2D was lower in those with initially high CVH (hazard ratio [HR] 0.21; 95% CI 0.09, 0.51), those who had persistently moderate CVH or changed from moderate to high CVH (moderate-moderate/high; HR 0.53; 95% CI 0.41, 0.69), low-moderate/high (HR 0.62; 95% CI 0.45, 0.86), and moderate-low (HR 0.74; 95% CI 0.56, 0.98). Results were similar for IFG, but the effect sizes were smaller. CONCLUSIONS Compared with stable low CVH, other patterns of change in CVH were associated with lower risk of T2D and IFG.
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Affiliation(s)
- Rachel E Climie
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Thomas T van Sloten
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
- Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marie-Cécile Périer
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | - Muriel Tafflet
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | - Aurore Fayosse
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Aline Dugravot
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Archana Singh-Manoux
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College, London, U.K
| | - Jean-Philippe Empana
- Université de Paris, INSERM U970, Paris Cardiovascular Research Centre (PARCC), Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
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Sabia S, Fayosse A, Dumurgier J, Schnitzler A, Empana JP, Ebmeier KP, Dugravot A, Kivimäki M, Singh-Manoux A. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. BMJ 2019; 366:l4414. [PMID: 31391187 PMCID: PMC6664261 DOI: 10.1136/bmj.l4414] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia. DESIGN Prospective cohort study. SETTING Civil service departments in London (Whitehall II study; study inception 1985-88). PARTICIPANTS 7899 participants with data on the cardiovascular health score at age 50. EXPOSURES The cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health. MAIN OUTCOME MEASURE Incident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017. RESULTS 347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were -1.5 (95% confidence interval -2.3 to -0.7) for the group with intermediate cardiovascular health and -1.9 (-2.8 to -1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score). CONCLUSION Adherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.
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Affiliation(s)
- Séverine Sabia
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aurore Fayosse
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
| | - Julien Dumurgier
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
- Cognitive Neurology Center, Lariboisière - Fernand Widal Hospital, AP-HP, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Alexis Schnitzler
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
| | - Jean-Philippe Empana
- Inserm, U970, Integrative Epidemiology of Cardiovascular Disease, Paris Descartes University, Paris, France
| | | | - Aline Dugravot
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
- Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland
| | - Archana Singh-Manoux
- Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris, 75010 Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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Abstract
IMPORTANCE Observational studies suggest that diet is linked to cognitive health. However, the duration of follow-up in many studies is not sufficient to take into account the long preclinical phase of dementia, and the evidence from interventional studies is not conclusive. OBJECTIVE To examine whether midlife diet is associated with subsequent risk for dementia. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study established in 1985-1988 that had dietary intake assessed in 1991-1993, 1997-1999, and 2002-2004 and follow-up for incident dementia until March 31, 2017. EXPOSURES Food frequency questionnaire to derive the Alternate Healthy Eating Index (AHEI), an 11-component diet quality score (score range, 0-110), with higher scores indicating a healthier diet. MAIN OUTCOME AND MEASURES Incident dementia ascertained through linkage to electronic health records. RESULTS Among 8225 participants without dementia in 1991-1993 (mean age, 50.2 years [SD, 6.1 years]; 5686 [69.1%] were men), a total of 344 cases of incident dementia were recorded during a median follow-up of 24.8 years (interquartile range, 24.2-25.1 years). No significant difference in the incidence rate for dementia was observed in tertiles of AHEI exposure during 1991-1993, 1997-1999 (median follow-up, 19.1 years), and 2002-2004 (median follow-up, 13.5 years). Compared with an incidence rate for dementia of 1.76 (95% CI, 1.47-2.12) per 1000 person-years in the worst tertile of AHEI (lowest tertile of diet quality) in 1991-1993, the absolute rate difference for the intermediate tertile was 0.03 (95% CI, -0.43 to 0.49) per 1000 person-years and for the best tertile was 0.04 (95% CI, -0.42 to 0.51) per 1000 person-years. Compared with the worst AHEI tertile in 1997-1999 (incidence rate for dementia, 2.06 [95% CI, 1.62 to 2.61] per 1000 person-years), the absolute rate difference for the intermediate AHEI tertile was 0.14 (95% CI, -0.58 to 0.86) per 1000 person-years and for the best AHEI tertile was 0.14 (95% CI, -0.58 to 0.85) per 1000 person-years. Compared with the worst AHEI tertile in 2002-2004 (incidence rate for dementia, 3.12 [95% CI, 2.49 to 3.92] per 1000 person-years), the absolute rate difference for the intermediate AHEI tertile was -0.61 (95% CI, -1.56 to 0.33) per 1000 person-years and for the best AHEI tertile was -0.73 (95% CI, -1.67 to 0.22) per 1000 person-years. In the multivariable analysis, the adjusted hazard ratios (HRs) for dementia per 1-SD (10-point) AHEI increment were not significant as assessed in 1991-1993 (adjusted HR, 0.97 [95% CI, 0.87 to 1.08]), in 1997-1999 (adjusted HR, 0.97 [95% CI, 0.83 to 1.12]), or in 2002-2004 (adjusted HR, 0.87 [95% CI, 0.75 to 1.00]). CONCLUSIONS AND RELEVANCE In this long-term prospective cohort study, diet quality assessed during midlife was not significantly associated with subsequent risk for dementia.
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Affiliation(s)
- Tasnime N. Akbaraly
- Université Montpellier, Inserm, U1198, Ecole Pratique des Hautes Etudes, Montpellier, France
- Department of Epidemiology and Public Health, University College London, London, England
- Department of Psychiatry and Autism Resources Centre, University Research and Hospital Center of Montpellier, Inserm, Montpellier, France
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, University College London, London, England
- Inserm, U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Descartes, Paris, France
| | - Aline Dugravot
- Inserm, U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Descartes, Paris, France
| | - Eric J. Brunner
- Department of Epidemiology and Public Health, University College London, London, England
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, England
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Séverine Sabia
- Department of Epidemiology and Public Health, University College London, London, England
- Inserm, U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université Paris Descartes, Paris, France
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van Sloten TT, Tafflet M, Périer MC, Dugravot A, Climie RED, Singh-Manoux A, Empana JP. Association of Change in Cardiovascular Risk Factors With Incident Cardiovascular Events. JAMA 2018; 320:1793-1804. [PMID: 30398604 PMCID: PMC6248104 DOI: 10.1001/jama.2018.16975] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/05/2018] [Indexed: 11/14/2022]
Abstract
Importance There is consistent evidence of the association between ideal cardiovascular health and lower incident cardiovascular disease (CVD); however, most studies used a single measure of cardiovascular health. Objective To examine how cardiovascular health changes over time and whether these changes are associated with incident CVD. Design, Setting, and Participants Prospective cohort study in a UK general community (Whitehall II), with examinations of cardiovascular health from 1985/1988 (baseline) and every 5 years thereafter until 2015/2016 and follow-up for incident CVD until March 2017. Exposures Using the 7 metrics of the American Heart Association (nonsmoking; and ideal levels of body mass index, physical activity, diet, blood pressure, fasting blood glucose, and total cholesterol), participants with 0 to 2, 3 to 4, and 5 to 7 ideal metrics were categorized as having low, moderate, and high cardiovascular health. Change in cardiovascular health over 10 years between 1985/1988 and 1997/1999 was considered. Main Outcome and Measure Incident CVD (coronary heart disease and stroke). Results The study population included 9256 participants without prior CVD (mean [SD] age at baseline, 44.8 [6.0] years; 2941 [32%] women), of whom 6326 had data about cardiovascular health change. Over a median follow-up of 18.9 years after 1997/1999, 1114 incident CVD events occurred. In multivariable analysis and compared with individuals with persistently low cardiovascular health (consistently low group, 13.5% of participants; CVD incident rate per 1000 person-years, 9.6 [95% CI, 8.4-10.9]), there was no significant association with CVD risk in the low to moderate group (6.8% of participants; absolute rate difference per 1000 person-years, -1.9 [95% CI, -3.9 to 0.1]; HR, 0.84 [95% CI, 0.66-1.08]), the low to high group, (0.3% of participants; absolute rate difference per 1000 person-years, -7.7 [95% CI, -11.5 to -3.9]; HR, 0.19 [95% CI, 0.03-1.35]), and the moderate to low group (18.0% of participants; absolute rate difference per 1000 person-years, -1.3 [95% CI, -3.0 to 0.3]; HR, 0.96 [95% CI, 0.80-1.15]). A lower CVD risk was observed in the consistently moderate group (38.9% of participants; absolute rate difference per 1000 person-years, -4.2 [95% CI, -5.5 to -2.8]; HR, 0.62 [95% CI, 0.53-0.74]), the moderate to high group (5.8% of participants; absolute rate difference per 1000 person-years, -6.4 [95% CI, -8.0 to -4.7]; HR, 0.39 [95% CI, 0.27-0.56]), the high to low group (1.9% of participants; absolute rate difference per 1000 person-years, -5.3 [95% CI, -7.8 to -2.8]; HR, 0.49 [95% CI, 0.29-0.83]), the high to moderate group (9.3% of participants; absolute rate difference per 1000 person-years, -4.5 [95% CI, -6.2 to -2.9]; HR, 0.66 [95% CI, 0.51-0.85]), and the consistently high group (5.5% of participants; absolute rate difference per 1000 person-years, -5.6 [95% CI, -7.4 to -3.9]; HR, 0.57 [95% CI, 0.40-0.80]). Conclusions and Relevance Among a group of participants without CVD who received follow-up over a median 18.9 years, there was no consistent relationship between direction of change in category of a composite metric of cardiovascular health and risk of CVD.
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Affiliation(s)
- Thomas T. van Sloten
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
- Cardiovascular Research Institute Maastricht, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Muriel Tafflet
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | - Marie-Cécile Périer
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Rachel E. D. Climie
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
- Menzies Institute for Medical Research, University of Tasmania, Hobert, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jean-Philippe Empana
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
- INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
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Abell JG, Kivimäki M, Dugravot A, Tabak AG, Fayosse A, Shipley M, Sabia S, Singh-Manoux A. Association between systolic blood pressure and dementia in the Whitehall II cohort study: role of age, duration, and threshold used to define hypertension. Eur Heart J 2018; 39:3119-3125. [PMID: 29901708 PMCID: PMC6122131 DOI: 10.1093/eurheartj/ehy288] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/24/2017] [Accepted: 05/03/2018] [Indexed: 01/04/2023] Open
Abstract
Aims To examine associations of diastolic and systolic blood pressure (SBP) at age 50, 60, and 70 years with incidence of dementia, and whether cardiovascular disease (CVD) over the follow-up mediates this association. Methods and results Systolic and diastolic blood pressure were measured on 8639 persons (32.5% women) from the Whitehall II cohort study in 1985, 1991, 1997, and 2003. Incidence of dementia (n dementia/n total = 385/8639) was ascertained from electronic health records followed-up until 2017. Cubic splines using continuous blood pressure measures suggested SBP ≥130 mmHg at age 50 but not at age 60 or 70 was associated with increased risk of dementia, confirmed in Cox regression analyses adjusted for sociodemographic factors, health behaviours, and time varying chronic conditions [hazard ratio (HR) 1.38; 95% confidence interval (95% CI) 1.11, 1.70]. Diastolic blood pressure was not associated with dementia. Participants with longer exposure to hypertension (SBP ≥ 130 mmHg) between mean ages of 45 and 61 years had an increased risk of dementia compared to those with no or low exposure to hypertension (HR 1.29, 95% CI 1.00, 1.66). In multi-state models, SBP ≥ 130 mmHg at 50 years of age was associated with greater risk of dementia in those free of CVD over the follow-up (HR 1.47, 95% CI 1.15, 1.87). Conclusion Systolic blood pressure ≥130 mmHg at age 50, below the conventional ≥140 mmHg threshold used to define hypertension, is associated with increased risk of dementia; in these persons this excess risk is independent of CVD.
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Affiliation(s)
- Jessica G Abell
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
| | - Adam G Tabak
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Faculty of Medicine, 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Aurore Fayosse
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, London, UK
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Sabia S, Fayosse A, Dumurgier J, Dugravot A, Akbaraly T, Britton A, Kivimäki M, Singh-Manoux A. Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study. BMJ 2018; 362:k2927. [PMID: 30068508 PMCID: PMC6066998 DOI: 10.1136/bmj.k2927] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the association between alcohol consumption and risk of dementia. DESIGN Prospective cohort study. SETTING Civil service departments in London (Whitehall II study). PARTICIPANTS 9087 participants aged 35-55 years at study inception (1985/88). MAIN OUTCOME MEASURES Incident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017. Measures of alcohol consumption were the mean from three assessments between 1985/88 and 1991/93 (midlife), categorised as abstinence, 1-14 units/week, and >14 units/week; 17 year trajectories of alcohol consumption based on five assessments of alcohol consumption between 1985/88 and 2002/04; CAGE questionnaire for alcohol dependence assessed in 1991/93; and hospital admission for alcohol related chronic diseases between 1991 and 2017. RESULTS 397 cases of dementia were recorded over a mean follow-up of 23 years. Abstinence in midlife was associated with a higher risk of dementia (hazard ratio 1.47, 95% confidence interval 1.15 to 1.89) compared with consumption of 1-14 units/week. Among those drinking >14 units/week, a 7 unit increase in alcohol consumption was associated with a 17% (95% confidence interval 4% to 32%) increase in risk of dementia. CAGE score >2 (hazard ratio 2.19, 1.29 to 3.71) and alcohol related hospital admission (4.28, 2.72 to 6.73) were also associated with an increased risk of dementia. Alcohol consumption trajectories from midlife to early old age showed long term abstinence (1.74, 1.31 to 2.30), decrease in consumption (1.55, 1.08 to 2.22), and long term consumption >14 units/week (1.40, 1.02 to 1.93) to be associated with a higher risk of dementia compared with long term consumption of 1-14 units/week. Analysis using multistate models suggested that the excess risk of dementia associated with abstinence in midlife was partly explained by cardiometabolic disease over the follow-up as the hazard ratio of dementia in abstainers without cardiometabolic disease was 1.33 (0.88 to 2.02) compared with 1.47 (1.15 to 1.89) in the entire population. CONCLUSION The risk of dementia was increased in people who abstained from alcohol in midlife or consumed >14 units/week. In several countries, guidelines define thresholds for harmful alcohol consumption much higher than 14 units/week. The present findings encourage the downward revision of such guidelines to promote cognitive health at older ages.
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Affiliation(s)
- Séverine Sabia
- Inserm, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, France; Hôpital Paul Brousse, Bât 15/16, Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, UK
| | - Aurore Fayosse
- Inserm, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, France; Hôpital Paul Brousse, Bât 15/16, Villejuif Cedex, France
| | - Julien Dumurgier
- Cognitive Neurology Center, Lariboisière-Fernand Widal hospital, AP-HP, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Aline Dugravot
- Inserm, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, France; Hôpital Paul Brousse, Bât 15/16, Villejuif Cedex, France
| | - Tasnime Akbaraly
- Department of Epidemiology and Public Health, University College London, UK
- Inserm U1198, Montpellier, France; University Montpellier, Montpellier, France; EPHE, Paris, France
- Department of Psychiatry & Autism Resources Centre, University Research and Hospital Center (CHRU) of Montpellier, Montpellier, France
| | - Annie Britton
- Department of Epidemiology and Public Health, University College London, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, UK
| | - Archana Singh-Manoux
- Inserm, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay, France; Hôpital Paul Brousse, Bât 15/16, Villejuif Cedex, France
- Department of Epidemiology and Public Health, University College London, UK
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Singh-Manoux A, Fayosse A, Sabia S, Tabak A, Shipley M, Dugravot A, Kivimäki M. Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: A cohort study. PLoS Med 2018; 15:e1002571. [PMID: 29782486 PMCID: PMC5962054 DOI: 10.1371/journal.pmed.1002571] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multimorbidity is increasingly common and is associated with adverse health outcomes, highlighting the need to broaden the single-disease framework that dominates medical research. We examined the role of midlife clinical characteristics, socioeconomic position, and behavioural factors in the development of cardiometabolic multimorbidity (at least 2 of diabetes, coronary heart disease, and stroke), along with how these factors modify risk of mortality. METHODS AND FINDINGS Data on 8,270 men and women were drawn from the Whitehall II cohort study, with mean follow-up of 23.7 years (1985 to 2017). Three sets of risk factors were assessed at age 50 years, each on a 5-point scale: clinical profile (hypertension, hypercholesterolemia, overweight/obesity, family history of cardiometabolic disease), occupational position, and behavioural factors (smoking, alcohol consumption, diet, physical activity). The outcomes examined were cardiometabolic disease (diabetes, coronary heart disease, stroke), cardiometabolic multimorbidity, and mortality. We used multi-state models to examine the role of risk factors in 5 components of the cardiometabolic disease trajectory: from healthy state to first cardiometabolic disease, from first cardiometabolic disease to cardiometabolic multimorbidity, from healthy state to death, from first cardiometabolic disease to death, and from cardiometabolic multimorbidity to death. A total of 2,501 participants developed 1 of the 3 cardiometabolic diseases, 511 developed cardiometabolic multimorbidity, and 1,406 died. When behavioural and clinical risk factors were considered individually, only smoking was associated with all five transitions. In a model containing all 3 risk factor scales, midlife clinical profile was the strongest predictor of first cardiometabolic disease (hazard ratio for the least versus most favourable profile: 3.74; 95% CI: 3.14-4.45) among disease-free participants. Among participants with 1 cardiometabolic disease, adverse midlife socioeconomic (1.54; 95% CI: 1.10-2.15) and behavioural factors (2.00; 95% CI: 1.40-2.85), but not clinical characteristics, were associated with progression to cardiometabolic multimorbidity. Only midlife behavioural factors predicted mortality among participants with cardiometabolic disease (2.12; 95% CI: 1.41-3.18) or cardiometabolic multimorbidity (3.47; 95% CI: 1.81-6.66). A limitation is that the study was not large enough to estimate transitions between each disease and subsequent outcomes and between all possible pairs of diseases. CONCLUSIONS The importance of specific midlife factors in disease progression, from disease-free state to single disease, multimorbidity, and death, varies depending on the disease stage. While clinical risk factors at age 50 determine the risk of incident cardiometabolic disease in a disease-free population, midlife socioeconomic and behavioural factors are stronger predictors of progression to multimorbidity and mortality in people with cardiometabolic disease.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Aurore Fayosse
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Adam Tabak
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Laouali N, Brailly-Tabard S, Helmer C, Ancelin ML, Tzourio C, Singh-Manoux A, Dugravot A, Elbaz A, Guiochon-Mantel A, Canonico M. Testosterone and All-Cause Mortality in Older Men: The Role of Metabolic Syndrome. J Endocr Soc 2018; 2:322-335. [PMID: 29577108 PMCID: PMC5848820 DOI: 10.1210/js.2018-00005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/21/2018] [Indexed: 01/07/2023] Open
Abstract
Previous studies have shown controversial results about the role of testosterone in all-cause mortality in elderly men. We hypothesized that metabolic syndrome (MetS) could partly explain this discrepancy. We therefore examined the association of all-cause mortality with total and bioavailable testosterone, taking into account the MetS. We used data from the Three-City Cohort (3C) study with 12-year follow-up. The 3C study included 3650 men aged >65 years in three French cities. Hormone was measured in a random subsample of 444 men, and MetS was determined as stated by the International Diabetes Federation criteria. We used inverse-probability-weighted Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). Of 444 men included in the analysis, 106 (23.9%) had MetS at baseline, and 166 died over the follow-up. There was a significant interaction between testosterone level and MetS for all-cause mortality (P = 0.002 and P = 0.008 for total and bioavailable testosterone, respectively). Among men with MetS, a decrease in one standard deviation of testosterone was associated with higher mortality risk [HR 1.78 (95% CI 1.13 to 2.78) and HR 1.83 (95% CI 1.17 to 2.86) for total and bioavailable testosterone, respectively]. By contrast, there was no association of testosterone with mortality risk among men without MetS. Our results suggest that MetS modifies the association between testosterone and mortality in older men. If confirmed, these findings could contribute to improve risk stratification and better manage the health of older men.
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Affiliation(s)
- Nasser Laouali
- Paris-Saclay University, Paris-South University, Université de Versailles St-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, INSERM, Versailles, France
| | - Sylvie Brailly-Tabard
- Department of Molecular Genetics, Pharmacogenetics, and Hormonology, Paris-South University, Le Kremlin-Bicêtre, France.,Bicêtre Hospital, Public Assistance-Paris Hospital, Le Kremlin-Bicêtre, France.,INSERM U693, Le Kremlin-Bicetre, France
| | - Catherine Helmer
- INSERM, U1219-Bordeaux Population Health Research Center, Bordeaux, France.,Bordeaux University, Institut de Santé Publique d'Epidémiologie et de Développement, Bordeaux, France
| | | | - Christophe Tzourio
- INSERM, U1219-Bordeaux Population Health Research Center, Bordeaux, France.,Bordeaux University, Institut de Santé Publique d'Epidémiologie et de Développement, Bordeaux, France
| | - Archana Singh-Manoux
- Paris-Saclay University, Paris-South University, Université de Versailles St-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, INSERM, Versailles, France
| | - Aline Dugravot
- Paris-Saclay University, Paris-South University, Université de Versailles St-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, INSERM, Versailles, France
| | - Alexis Elbaz
- Paris-Saclay University, Paris-South University, Université de Versailles St-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, INSERM, Versailles, France
| | - Anne Guiochon-Mantel
- Department of Molecular Genetics, Pharmacogenetics, and Hormonology, Paris-South University, Le Kremlin-Bicêtre, France.,Bicêtre Hospital, Public Assistance-Paris Hospital, Le Kremlin-Bicêtre, France.,INSERM U693, Le Kremlin-Bicetre, France
| | - Marianne Canonico
- Paris-Saclay University, Paris-South University, Université de Versailles St-Quentin-en-Yvelines, Center for Research in Epidemiology and Population Health, INSERM, Versailles, France
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Singh-Manoux A, Dugravot A, Shipley M, Brunner EJ, Elbaz A, Sabia S, Kivimaki M. Obesity trajectories and risk of dementia: 28 years of follow-up in the Whitehall II Study. Alzheimers Dement 2018; 14:178-186. [PMID: 28943197 PMCID: PMC5805839 DOI: 10.1016/j.jalz.2017.06.2637] [Citation(s) in RCA: 208] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/25/2017] [Accepted: 06/08/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION We examined whether obesity at ages 50, 60, and 70 years is associated with subsequent dementia. Changes in body mass index (BMI) for more than 28 years before dementia diagnosis were compared with changes in BMI in those free of dementia. METHODS A total of 10,308 adults (33% women) aged 35 to 55 years in 1985 were followed up until 2015. BMI was assessed six times and 329 cases of dementia were recorded. RESULTS Obesity (BMI ≥30 kg/m2) at age 50 years (hazard ratio = 1.93; 1.35-2.75) but not at 60 or 70 years was associated with risk of dementia. Trajectories of BMI differed in those with dementia compared with all others (P < .0001) or to matched control subjects (P < .0001) such that BMI in dementia cases was higher from 28 years (P = .001) to 16 years (P = .05) and lower starting 8 years before diagnosis. DISCUSSION Obesity in midlife and weight loss in the preclinical phase characterizes dementia; the current obesity epidemic may affect future dementia rates.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France; Department of Epidemiology and Public Health, University College London, UK.
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, UK
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, UK
| | - Alexis Elbaz
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France; Department of Epidemiology and Public Health, University College London, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, UK
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Singh-Manoux A, Fayosse A, Sabia S, Canonico M, Bobak M, Elbaz A, Kivimäki M, Dugravot A. Atrial fibrillation as a risk factor for cognitive decline and dementia. Eur Heart J 2017; 38:2612-2618. [PMID: 28460139 PMCID: PMC5837240 DOI: 10.1093/eurheartj/ehx208] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 03/08/2017] [Accepted: 04/24/2017] [Indexed: 11/12/2022] Open
Abstract
AIMS To assess whether AF is a risk factor for cognitive dysfunction we used prospective data on AF, repeat cognitive scores, and dementia incidence in adults followed over 45 to 85 years. METHODS AND RESULTS Data are drawn from the Whitehall II study, N = 10 308 at study recruitment in 1985. A battery of cognitive tests was administered four times (1997-2013) to 7428 participants (414 cases of AF), aged 45-69 years in 1997. Compared with AF-free participants, those with longer exposure to AF (5, 10, or 15 years) experienced faster cognitive decline after adjustment for sociodemographic, behavioural, and chronic diseases (P for trend = 0.01). Incident stroke or coronary heart disease individually did not explain the excess cognitive decline; however, this relationship was impacted when considering them together (P for trend 0.09). Analysis of incident dementia (N = 274/9302 without AF; N = 50/912 with AF) showed AF was associated with higher risk of dementia in Cox regression adjusted for sociodemographic factors, health behaviours and chronic diseases [hazard ratio (HR): 1.87; 95% confidence interval (CI): 1.37, 2.55]. Multistate models showed AF to increase risk of dementia in those free of stroke (HR: 1.67; 95% CI: 1.17, 2.38) but not those free of stroke and coronary heart disease (HR: 1.29; 95% CI: 0.74, 2.24) over the follow-up. CONCLUSION In adults aged 45-85 years AF is associated with accelerated cognitive decline and higher risk of dementia even at ages when AF incidence is low. At least in part, this was explained by incident cardiovascular disease in patients with AF.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Aurore Fayosse
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Marianne Canonico
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Alexis Elbaz
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Université Paris-Saclay., Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, VILLEJUIF CEDEX, 94807, France
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Artaud F, Sabia S, Dugravot A, Kivimaki M, Singh-Manoux A, Elbaz A. TRAJECTORIES OF UNHEALTHY BEHAVIORS IN MIDLIFE AND RISK OF DISABILITY AT OLDER AGES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - S. Sabia
- INSERM U1018, Paris, France,
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | | | - M. Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - A. Singh-Manoux
- INSERM U1018, Paris, France,
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Singh-Manoux A, Dugravot A, Fournier A, Abell J, Ebmeier K, Kivimäki M, Sabia S. Trajectories of Depressive Symptoms Before Diagnosis of Dementia: A 28-Year Follow-up Study. JAMA Psychiatry 2017; 74:712-718. [PMID: 28514478 PMCID: PMC5710246 DOI: 10.1001/jamapsychiatry.2017.0660] [Citation(s) in RCA: 291] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Neuropsychiatric symptoms, depressive symptoms in particular, are common in patients with dementia but whether depressive symptoms in adulthood increases the risk for dementia remains the subject of debate. OBJECTIVE To characterize the trajectory of depressive symptoms over 28 years prior to dementia diagnosis to determine whether depressive symptoms carry risk for dementia. DESIGN, SETTING, AND PARTICIPANTS Up to 10 308 persons, aged 35 to 55 years, were recruited to the Whitehall II cohort study in 1985, with the end of follow-up in 2015. Data analysis for this study in a UK general community was conducted from October to December 2016. EXPOSURES Depressive symptoms assessed on 9 occasions between 1985 and 2012 using the General Health Questionnaire. MAIN OUTCOMES AND MEASURES Incidence of dementia (n = 322) between 1985 and 2015. RESULTS Of the 10 189 persons included in the study, 6838 were men (67%) and 3351 were women (33%). Those reporting depressive symptoms in 1985 (mean follow-up, 27 years) did not have significantly increased risk for dementia (hazard ratio [HR], 1.21; 95% CI, 0.95-1.54) in Cox regression adjusted for sociodemographic covariates, health behaviors, and chronic conditions. However, those with depressive symptoms in 2003 (mean follow-up, 11 years) had an increased risk (HR, 1.72; 95% CI, 1.21-2.44). Those with chronic/recurring depressive symptoms (≥2 of 3 occasions) in the early study phase (mean follow-up, 22 years) did not have excess risk (HR, 1.02; 95% CI, 0.72-1.44) but those with chronic/recurring symptoms in the late phase (mean follow-up, 11 years) did have higher risk for dementia (HR, 1.67; 95% CI, 1.11-2.49). Analysis of retrospective depressive trajectories over 28 years, using mixed models and a backward time scale, shows that in those with dementia, differences in depressive symptoms compared with those without dementia became apparent 11 years (difference, 0.61; 95% CI, 0.09-1.13; P = .02) before dementia diagnosis and became more than 9 times larger at the year of diagnosis (difference, 5.81; 95% CI, 4.81-6.81; P < .001). CONCLUSIONS AND RELEVANCE Depressive symptoms in the early phase of the study corresponding to midlife, even when chronic/recurring, do not increase the risk for dementia. Along with our analysis of depressive trajectories over 28 years, these results suggest that depressive symptoms are a prodromal feature of dementia or that the 2 share common causes. The findings do not support the hypothesis that depressive symptoms increase the risk for dementia.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris, France,Department of Epidemiology and Public Health, University College London, London, England
| | - Aline Dugravot
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris, France
| | - Agnes Fournier
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris, France
| | - Jessica Abell
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris, France,Department of Epidemiology and Public Health, University College London, London, England
| | - Klaus Ebmeier
- Department of Psychiatry, University of Oxford, Oxford, England
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, England
| | - Séverine Sabia
- INSERM U1018, Centre for Research in Epidemiology and Population Health, Paris, France,Department of Epidemiology and Public Health, University College London, London, England
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Sabia S, Dugravot A, Elbaz A, Singh-Manoux A. RISK FACTORS TRAJECTORIES PRIOR TO DEMENTIA DIAGNOSIS: BMI AND PHYSICAL ACTIVITY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sabia S, Dugravot A, Dartigues JF, Abell J, Elbaz A, Kivimäki M, Singh-Manoux A. Physical activity, cognitive decline, and risk of dementia: 28 year follow-up of Whitehall II cohort study. BMJ 2017; 357:j2709. [PMID: 28642251 PMCID: PMC5480222 DOI: 10.1136/bmj.j2709] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective To test the hypotheses that physical activity in midlife is not associated with a reduced risk of dementia and that the preclinical phase of dementia is characterised by a decline in physical activity.Design Prospective cohort study with a mean follow-up of 27 years.Setting Civil service departments in London (Whitehall II study).Participants 10 308 participants aged 35-55 years at study inception (1985-88). Exposures included time spent in mild, moderate to vigorous, and total physical activity assessed seven times between 1985 and 2013 and categorised as "recommended" if duration of moderate to vigorous physical activity was 2.5 hours/week or more.Main outcome measures A battery of cognitive tests was administered up to four times from 1997 to 2013, and incident dementia cases (n=329) were identified through linkage to hospital, mental health services, and mortality registers until 2015.Results Mixed effects models showed no association between physical activity and subsequent 15 year cognitive decline. Similarly, Cox regression showed no association between physical activity and risk of dementia over an average 27 year follow-up (hazard ratio in the "recommended" physical activity category 1.00, 95% confidence interval 0.80 to 1.24). For trajectories of hours/week of total, mild, and moderate to vigorous physical activity in people with dementia compared with those without dementia (all others), no differences were observed between 28 and 10 years before diagnosis of dementia. However, physical activity in people with dementia began to decline up to nine years before diagnosis (difference in moderate to vigorous physical activity -0.39 hours/week; P=0.05), and the difference became more pronounced (-1.03 hours/week; P=0.005) at diagnosis.Conclusion This study found no evidence of a neuroprotective effect of physical activity. Previous findings showing a lower risk of dementia in physically active people may be attributable to reverse causation-that is, due to a decline in physical activity levels in the preclinical phase of dementia.
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Affiliation(s)
- Séverine Sabia
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Hôpital Paul Brousse, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Aline Dugravot
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Hôpital Paul Brousse, Paris, France
| | | | - Jessica Abell
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Hôpital Paul Brousse, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Alexis Elbaz
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Hôpital Paul Brousse, Paris, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Centre for Research in Epidemiology and Population Health, INSERM U1018, Université Paris-Saclay, Hôpital Paul Brousse, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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Rusmaully J, Dugravot A, Moatti JP, Marmot MG, Elbaz A, Kivimaki M, Sabia S, Singh-Manoux A. Contribution of cognitive performance and cognitive decline to associations between socioeconomic factors and dementia: A cohort study. PLoS Med 2017; 14:e1002334. [PMID: 28650972 PMCID: PMC5484463 DOI: 10.1371/journal.pmed.1002334] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Socioeconomic disadvantage is a risk factor for dementia, but longitudinal studies suggest that it does not affect the rate of cognitive decline. Our objective is to understand the manner in which socioeconomic disadvantage shapes dementia risk by examining its associations with midlife cognitive performance and cognitive decline from midlife to old age, including cognitive decline trajectories in those with dementia. METHODS AND FINDINGS Data are drawn from the Whitehall II study (N = 10,308 at study recruitment in 1985), with cognitive function assessed at 4 waves (1997, 2002, 2007, and 2012). Sociodemographic, behavioural, and cardiometabolic risk factors from 1985 and chronic conditions until the end of follow-up in 2015 (N dementia/total = 320/9,938) allowed the use of inverse probability weighting to take into account data missing because of loss to follow-up between the study recruitment in 1985 and the introduction of cognitive tests to the study in 1997. Generalized estimating equations and Cox regression were used to assess associations of socioeconomic markers (height, education, and midlife occupation categorized as low, intermediate, and high to represent hierarchy in the socioeconomic marker) with cognitive performance, cognitive decline, and dementia (N dementia/total = 195/7,499). In those with dementia, we examined whether retrospective trajectories of cognitive decline (backward timescale) over 18 years prior to diagnosis differed as a function of socioeconomic markers. Socioeconomic disadvantage was associated with poorer cognitive performance (all p < 0.001). Using point estimates for the effect of age, the differences between the high and low socioeconomic groups corresponded to an age effect of 4, 15, and 26 years, for height, education, and midlife occupation, respectively. There was no evidence of faster cognitive decline in socioeconomically disadvantaged groups. Low occupation, but not height or education, was associated with risk of dementia (hazard ratio [HR] = 2.03 [95% confidence interval (CI) 1.23-3.36]) in an analysis adjusted for sociodemographic factors; the excess risk was unchanged after adjustment for cognitive decline but was completely attenuated after adjustment for cognitive performance. In further analyses restricted to those with dementia, retrospective cognitive trajectories over 18 years prior to dementia diagnosis showed faster cognitive decline in the high education (p = 0.006) and occupation (p = 0.001) groups such that large differences in cognitive performance in midlife were attenuated at dementia diagnosis. A major limitation of our study is the use of electronic health records rather than comprehensive dementia ascertainment. CONCLUSIONS Our results support the passive or threshold cognitive reserve hypothesis, in that high cognitive reserve is associated with lower risk for dementia because of its association with cognitive performance, which provides a buffer against clinical expression of dementia.
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Affiliation(s)
- Jennifer Rusmaully
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | | | - Michael G. Marmot
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Alexis Elbaz
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
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Kravietz A, Kab S, Wald L, Dugravot A, Singh-Manoux A, Moisan F, Elbaz A. Association of UV radiation with Parkinson disease incidence: A nationwide French ecologic study. Environ Res 2017; 154:50-56. [PMID: 28033496 DOI: 10.1016/j.envres.2016.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/07/2016] [Accepted: 12/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Vitamin D is thought to contribute to brain health, but it is unclear whether low vitamin D levels are associated with increased incidence of Parkinson's disease (PD). Using ultraviolet B (UV-B) as a surrogate for vitamin D levels, we conducted a nationwide ecologic study in France in order to examine the association of UV-B with PD incidence. METHODS We used French national drug claims databases to identify PD cases using a validated algorithm. UV-B data from the solar radiation database were derived from satellite images. We estimated PD incidence (2010-2012) at the canton level (small administrative French unit) and used multilevel Poisson regression to examine its association with UV-B (2005 annual average), after adjustment for age, sex, deprivation index, density of neurologists, smoking, proportion of agricultural land, and vitamin D supplementation. RESULTS Analyses are based on 69,010 incident PD patients. The association between UV-B and PD incidence was quadratic (P<0.001) and modified by age (P<0.001). Below 70y, incidence was higher in the bottom quintile (relative risk, RRQ1:45-49y=1.18, 95% CI=1.08-1.29) compared with the middle UV-B quintile, and lower in the top quintile (RRQ5:45-49y=0.85 [0.77-0.94]). An opposite pattern was observed in older subjects (RRQ1:85-89y=0.92 [0.89-0.96]; RRQ5:85-89y=1.06 [1.02-1.11]). Analysis based on continuous UV-B yielded similar conclusions. CONCLUSIONS In this nationwide study, there was an age-dependent quadratic association between UV-B and PD incidence. This study suggests that reasonable UV-B exposure is associated with lower PD risk in younger persons and that future studies should examine dose-response relations and take age into account.
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Affiliation(s)
- Adam Kravietz
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sofiane Kab
- Santé publique France, Direction santé travail, F-94415 Saint-Maurice, France; CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France
| | - Lucien Wald
- MINES ParisTech, PSL Research University, Sophia Antipolis, France
| | - Aline Dugravot
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France
| | - Archana Singh-Manoux
- CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France; Department of Epidemiology and Public Health, University College London, London, UK
| | - Frédéric Moisan
- Santé publique France, Direction santé travail, F-94415 Saint-Maurice, France
| | - Alexis Elbaz
- Santé publique France, Direction santé travail, F-94415 Saint-Maurice, France; CESP, Fac. de médecine - Univ. Paris-Sud, Fac. de médecine - UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France.
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Bert D, Lasnier JB, Capdevielle X, Dugravot A, Desprez-Loustau ML. Powdery Mildew Decreases the Radial Growth of Oak Trees with Cumulative and Delayed Effects over Years. PLoS One 2016; 11:e0155344. [PMID: 27177029 PMCID: PMC4866782 DOI: 10.1371/journal.pone.0155344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/08/2016] [Indexed: 01/01/2023] Open
Abstract
Quercus robur and Q. petraea are major European forest tree species. They have been affected by powdery mildew caused by Erysiphe alphitoides for more than a century. This fungus is a biotrophic foliar pathogen that diverts photosynthetate from the plant for its own nutrition. We used a dendrochronological approach to investigate the effects of different levels of infection severity on the radial growth of young oak trees. Oak infection was monitored at individual tree level, at two sites in southwestern France, over a five-year period (2001-2005). Mean infection severity was almost 75% (infected leaf area) at the end of the 2001 growing season, at both sites, but only about 40% in 2002, and 8%, 5% and 2% in 2003, 2004 and 2005, respectively. Infection levels varied considerably between trees and were positively related between 2001 and 2002. Increment cores were taken from each tree to assess annual ring widths and increases in basal area. Annual radial growth was standardised to take the effect of tree size into account. Annual standardised radial growth was significantly and negatively correlated with infection severity in the same year, for both 2001 and 2002, and at both sites. The decrease in growth reached 70-90% for highly infected trees. The earlywood width was poorly correlated with infection severity, but the proportion of latewood in tree rings was lower in highly infected trees (60%) than in less heavily infected trees (85%). Infection in 2001 and 2002 was found to have a cumulative effect on radial growth in these years, together with a delayed effect detectable in 2003. Thus, even non-lethal pathogens like powdery mildew can have a significant impact on tree functioning. This impact should be taken into account in growth and yield models, to improve predictions of forest net primary production.
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Affiliation(s)
- Didier Bert
- BIOGECO, INRA, Univ. Bordeaux, 33610 Cestas, France
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Artaud F, Sabia S, Dugravot A, Kivimaki M, Singh-Manoux A, Elbaz A. Trajectories of Unhealthy Behaviors in Midlife and Risk of Disability at Older Ages in the Whitehall II Cohort Study. J Gerontol A Biol Sci Med Sci 2016; 71:1500-1506. [PMID: 27034508 PMCID: PMC5055647 DOI: 10.1093/gerona/glw060] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 03/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Most of the evidence on the association between unhealthy behaviors and disability comes from studies in the elderly, where reverse causation and selection bias may distort associations; thus, studies based on midlife trajectories of health behaviors are needed. We examined the association of trajectories of four health behaviors (physical activity, fruit and vegetable consumption, smoking, alcohol), starting in midlife and over 20 years, with subsequent disability risk in early old age (range = 54-84 years) in the Whitehall II cohort study. METHODS Disability was assessed three times over 3 years. A hierarchical disability indicator was constructed; participants were considered disabled if they reported difficulties with mobility and instrumental activities of daily living or with mobility and instrumental and basic activities of daily living. Behavior trajectories were defined using group-based trajectory models. Multivariable generalized estimating equations logistic models were used to examine their independent associations with disability. RESULTS Of 6,825 participants, 19.2% reported being disabled at least once. In mutually adjusted models, participants with persistent inactivity or declining physical activity, recent ex- or current smokers, and persistent/recent abstainers or persistent heavy drinkers had a higher disability risk, whereas fruit and vegetable consumption was not associated with disability. Disability risk increased progressively with the number of unhealthy behavior trajectories: the odds ratio of disability for 2-3 unhealthy trajectories was 2.69 (95% confidence interval = 2.26-3.19); these associations remained after adjustment for a wide range of covariates. CONCLUSIONS Unhealthy behavior trajectories in midlife are associated with greater disability risk later in life.
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Affiliation(s)
- Fanny Artaud
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France. .,University Versailles St-Quentin, UMRS-1018, Versailles, France
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.,Department of Epidemiology and Public Health, University College London, UK.,University Paris-Sud, UMRS-1018, Villejuif, France
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.,University Paris-Sud, UMRS-1018, Villejuif, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, UK
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.,Department of Epidemiology and Public Health, University College London, UK.,University Paris-Sud, UMRS-1018, Villejuif, France
| | - Alexis Elbaz
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.,University Paris-Sud, UMRS-1018, Villejuif, France
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Azevedo Da Silva M, Dugravot A, Balkau B, Roussel R, Fumeron F, Elbaz A, Canonico M, Singh-Manoux A, Nabi H. Antidepressant medication use and trajectories of fasting plasma glucose, glycated haemoglobin, β-cell function and insulin sensitivity: a 9-year longitudinal study of the D.E.S.I.R. cohort. Int J Epidemiol 2015; 44:1927-40. [PMID: 26245205 DOI: 10.1093/ije/dyv153] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Use of antidepressants is seen to be a risk factor for type 2 diabetes, even though the underlying mechanisms remain unclear. We examined whether antidepressant use was associated with change in fasting plasma glucose, glycated haemoglobin (HbA1c), β-cell function (HOMA2-%B) and insulin sensitivity (HOMA2-%S) over time. METHODS Participants in the French D.E.S.I.R. cohort study included over 4700 men (48.1%) and women, free of diabetes, aged 30-65 years at baseline in 1994-96 (D.E.S.I.R. 0), who were followed for 9 years at 3-yearly intervals (D.E.S.I.R. 3, 1997-99; 6, 2000-02; 9, 2003-05). Antidepressant use, fasting plasma glucose, HbA1c, HOMA2-%B and HOMA2-%S were assessed concurrently at four medical examinations. Linear mixed models were used to examine the cross-sectional and longitudinal associations of time-dependent antidepressant use with changes in these four biological parameters. RESULTS Mean fasting plasma glucose and HbA1c increased whereas HOMA2-%B and HOMA2-%S decreased over the follow-up. In a fully adjusted model, there were no differences in: mean fasting plasma glucose (β = 0.01 mmol/l, P = 0.702); HbA1c (β = 0.01 %, P = 0.738); HOMA2-%B (β = 0.00, P = 0.812); or HOMA2-%S (β =-0.01, P = 0.791) at baseline (1994-96) between antidepressant users and non-users. The interaction term with time also suggested no differences in the annual change in: fasting plasma glucose (β = 0.00 mmol/l, P = 0.322); HbA1c (β = 0.00 %, P = 0.496); HOMA2-%B (β = 0.00, P = 0.609); or HOMA2-%S (β = 0.00, P = 0.332) between antidepressant users and non-users. Similar associations were observed in analyses of type and cumulative use of antidepressants over follow-up. CONCLUSION Our longitudinal data show that use of antidepressants is not associated with altered glucose metabolism, suggesting that the association between antidepressant use and diabetes reported by previous studies may not be causal. Detection bias or clinical ascertainment bias may account for much of this apparent association.
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Affiliation(s)
- Marine Azevedo Da Silva
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France,
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Beverley Balkau
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Ronan Roussel
- Service d'Endocrinologie, Diabétologie et Nutrition, DHU FIRE, Hôpital Bichat Assistance Publique-Hôpitaux de Paris, Paris, France, INSERM, Centre de Recherche des Cordeliers, Paris, France, Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France and
| | - Frédéric Fumeron
- INSERM, Centre de Recherche des Cordeliers, Paris, France, Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France and
| | - Alexis Elbaz
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Marianne Canonico
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
| | - Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France, Department of Epidemiology and Public Health, University College London, London, UK
| | - Hermann Nabi
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, F-94807, Villejuif, France, University Paris Sud 11, UMRS 1018, F-94807 Villejuif, France
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Artaud F, Singh-Manoux A, Dugravot A, Tzourio C, Elbaz A. Decline in Fast Gait Speed as a Predictor of Disability in Older Adults. J Am Geriatr Soc 2015; 63:1129-36. [DOI: 10.1111/jgs.13442] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Fanny Artaud
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
| | - Archana Singh-Manoux
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
- Department of Epidemiology and Public Health; University College London; London UK
| | - Aline Dugravot
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
| | - Christophe Tzourio
- INSERM U897; Neuroepidemiology Team; Bordeaux France
- University of Bordeaux; Bordeaux France
| | - Alexis Elbaz
- INSERM; Centre for Research in Epidemiology and Population Health; U1018, Epidemiology of Ageing and Age-Related Diseases; Villejuif France
- UMRS 1018; University Versailles St-Quentin; Versailles France
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