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Wang M, Tang WHW, Li XS, de Oliveira Otto MC, Lee Y, Lemaitre RN, Fretts A, Nemet I, Sotoodehnia N, Sitlani CM, Budoff M, DiDonato JA, Wang Z, Bansal N, Shlipak MG, Psaty BM, Siscovick DS, Sarnak MJ, Mozaffarian D, Hazen SL. The Gut Microbial Metabolite Trimethylamine N-oxide, Incident CKD, and Kidney Function Decline. J Am Soc Nephrol 2024:00001751-990000000-00282. [PMID: 38593157 DOI: 10.1681/asn.0000000000000344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Trimethylamine N-oxide (TMAO) is a gut microbiota-derived metabolite of dietary phosphatidylcholine and carnitine. Experimentally, TMAO causes kidney injury and tubulointerstitial fibrosis. Little is known about prospective associations between TMAO and kidney outcomes, especially incident CKD. We hypothesized that higher plasma TMAO levels would be associated with higher risk of incident CKD and greater rate of kidney function decline. METHODS We included 10,564 participants from two community-based, prospective cohorts with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73m2 to assess incident CKD. TMAO was measured using targeted mass spectrometry at baseline and one follow-up visit. Creatinine and Cystatin C were measured up to 4 times during follow-up and used to compute eGFR. Incident CKD was defined as an eGFR decline ≥ 30% from baseline and a resulting eGFR<60 ml/min/1.73 m2. Time-varying Cox models assessed the association of serial TMAO measures with incident CKD, adjusting for sociodemographic, lifestyle, diet, and cardiovascular disease risk factors. Linear mixed models assessed the association with annualized eGFR change in 10,009 participants with at least one follow-up eGFR measure without exclusions for baseline eGFR levels. RESULTS During a median follow-up of 9.4 years (interquartile range: 9.1-11.6 years), 979 incident CKD events occurred. Higher TMAO levels associated with higher risk of incident CKD (2nd to 5th vs. 1st quintile HR[95%CI]= 1.65 [1.22-2.23], 1.68 [1.26-2.25], 2.28 [1.72-3.02], and 2.24[1.68-2.98], respectively) and greater annualized eGFR decline ( 2nd to 5th vs. 1st quintile annualized eGFR change= -0.21 [-0.32, -0.09], -0.17 [-0.29, -0.05], -0.35 [-0.47, -0.22], and -0.43[-0.56, -0.30], respectively) with monotonic dose-response relationships. These associations were consistent across different racial/ethnic groups examined. The association with eGFR decline was similar to or larger than that seen for established CKD risk factors including diabetes, per 10 mmHg of higher systolic blood pressure, per 10 years of older age, and Black race. CONCLUSIONS In community-based US adults, higher serial measures of plasma TMAO were associated with higher risk of incident CKD and greater annualized kidney function decline.
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Affiliation(s)
- Meng Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - W H Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Xinmin S Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH
| | - Marcia C de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX
| | - Yujin Lee
- Department of Food and Nutrition, Myongji University, Yongin, South Korea
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Ina Nemet
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Colleen M Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Matthew Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Joseph A DiDonato
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH
| | - Nisha Bansal
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Michael G Shlipak
- Kidney Health Research Collaborative and Department of Medicine, San Francisco Veterans Administration Medical Center and University of California-San Francisco, San Francisco, CA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | | | - Mark J Sarnak
- Department of Medicine (Nephrology), Tufts University School of Medicine, Boston MA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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2
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Wang M, Li XS, Wang Z, de Oliveira Otto MC, Lemaitre RN, Fretts A, Sotoodehnia N, Budoff M, Nemet I, DiDonato JA, Tang WHW, Psaty BM, Siscovick DS, Hazen SL, Mozaffarian D. Trimethylamine N-oxide is associated with long-term mortality risk: the multi-ethnic study of atherosclerosis. Eur Heart J 2023; 44:1608-1618. [PMID: 36883587 PMCID: PMC10411925 DOI: 10.1093/eurheartj/ehad089] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS Little is known about associations of trimethylamine N-oxide (TMAO), a novel gut microbiota-generated metabolite of dietary phosphatidylcholine and carnitine, and its changes over time with all-cause and cause-specific mortality in the general population or in different race/ethnicity groups. The study aimed to investigate associations of serially measured plasma TMAO levels and changes in TMAO over time with all-cause and cause-specific mortality in a multi-ethnic community-based cohort. METHODS AND RESULTS The study included 6,785 adults from the Multi-Ethnic Study of Atherosclerosis. TMAO was measured at baseline and year 5 using mass spectrometry. Primary outcomes were adjudicated all-cause mortality and cardiovascular disease (CVD) mortality. Secondary outcomes were deaths due to kidney failure, cancer, or dementia obtained from death certificates. Cox proportional hazards models with time-varying TMAO and covariates assessed the associations with adjustment for sociodemographics, lifestyles, diet, metabolic factors, and comorbidities. During a median follow-up of 16.9 years, 1704 participants died and 411 from CVD. Higher TMAO levels associated with higher risk of all-cause mortality [hazard ratio (HR): 1.12, 95% confidence interval (CI): 1.08-1.17], CVD mortality (HR: 1.09, 95% CI: 1.00-1.09), and death due to kidney failure (HR: 1.44, 95% CI: 1.25-1.66) per inter-quintile range, but not deaths due to cancer or dementia. Annualized changes in TMAO levels associated with higher risk of all-cause mortality (HR: 1.10, 95% CI: 1.05-1.14) and death due to kidney failure (HR: 1.54, 95% CI: 1.26-1.89) but not other deaths. CONCLUSION Plasma TMAO levels were positively associated with mortality, especially deaths due to cardiovascular and renal disease, in a multi-ethnic US cohort.
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Affiliation(s)
- Meng Wang
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
| | - Xinmin S Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Center for Microbiome and Human Health, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Center for Microbiome and Human Health, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Marcia C de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA
| | - Matthew Budoff
- Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, 124 West Carson Street, Torrance, CA 90502, USA
| | - Ina Nemet
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Center for Microbiome and Human Health, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Joseph A DiDonato
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Center for Microbiome and Human Health, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Wai Hong Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Center for Microbiome and Human Health, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, 1730 Minor Ave, Suite 1360, Seattle, WA 98101, USA
- Department of Epidemiology, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA
- Department of Health Systems and Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - David S Siscovick
- The New York Academy of Medicine, 1216 5th Ave, New York City, NY 10029, USA
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Center for Microbiome and Human Health, Lerner Research Institute, 9500 Euclid Ave, Cleveland, OH 44195, USA
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA 02111, USA
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Zhao D, Domingo-Relloso A, Tellez-Plaza M, Nigra AE, Valeri L, Moon KA, Goessler W, Best LG, Ali T, Umans JG, Fretts A, Cole SA, Navas-Acien A. High Level of Selenium Exposure in the Strong Heart Study: A Cause for Incident Cardiovascular Disease? Antioxid Redox Signal 2022; 37:990-997. [PMID: 35350849 PMCID: PMC9689768 DOI: 10.1089/ars.2022.0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/12/2022]
Abstract
Increasing evidence suggests that high selenium (Se) exposure is associated with adverse health effects. However, limited evidence exists on the association of Se exposure with cardiovascular disease (CVD), especially in communities affected by high naturally occurring Se in environmental media. We evaluated the prospective association between urinary Se levels and CVD incidence and mortality for 2727 American Indian adults who participated in the Strong Heart Study, with urinary Se levels measured at baseline (1989-1991) and CVD outcomes ascertained through 2017. The median (interquartile range) of urinary Se was 49.0 (36.7-67.4) μg/g creatinine. The multivariable adjusted hazard ratios (95% confidence interval) of incident CVD, coronary heart disease, and stroke comparing the 75th versus 25th percentile of urinary Se distributions were 1.11 (1.01-1.22), 1.05 (0.94-1.17), and 1.08 (0.88-1.33), respectively. In flexible dose-response models, increased risk for CVD incidence was only observed when the urinary Se level exceeded 60 μg/g creatinine. For CVD mortality, a nonstatistically significant U-shaped relationship was found across urinary Se levels. There was no evidence of effect modification by other urinary metal/metalloid levels. Our observation leads to the hypothesis that elevated Se exposure is a risk factor for CVD, especially in Se-replete populations. Antioxid. Redox Signal. 37, 990-997.
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Affiliation(s)
- Di Zhao
- State Key Laboratory of Crop Genetics and Germplasm Enhancement, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing, Jiangsu, China
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Arce Domingo-Relloso
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Maria Tellez-Plaza
- Department of Epidemiology of Chronic Diseases, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Anne E. Nigra
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Linda Valeri
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Katherine A. Moon
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Lyle G. Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, South Dakota, USA
| | - Tauqeer Ali
- Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jason G. Umans
- MedStar Health Research Institute, Washington, District of Columbia, USA
- Georgetown-Howard Universities Center for Clinical and Translational Sciences, Washington, District of Columbia, USA
| | - Amanda Fretts
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Shelley A. Cole
- Department of Epidemiology, University of North Carolina Gillings School of Public Health, Chapel Hill, North Carolina, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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4
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Galvez-Fernandez M, Powers M, Grau-Perez M, Domingo-Relloso A, Lolacono N, Goessler W, Zhang Y, Fretts A, Umans JG, Maruthur N, Navas-Acien A. Urinary Zinc and Incident Type 2 Diabetes: Prospective Evidence From the Strong Heart Study. Diabetes Care 2022; 45:2561-2569. [PMID: 36134919 PMCID: PMC9679259 DOI: 10.2337/dc22-1152] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 06/11/2022] [Accepted: 08/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hyperglycemia can increase urinary zinc excretion. We evaluated the association of higher urinary zinc level with new diagnosis of incident type 2 diabetes mellitus (T2DM) in adult populations with a high burden of T2DM from AZ, OK, and ND and SD. We also assessed the cross-sectional association of urinary zinc levels with prevalent prediabetes. RESEARCH DESIGN AND METHODS We included 1,339 adults free of T2DM at baseline (1989-1991) followed through 1998-1999 in the Strong Heart Study (SHS) and 1,905 family members of SHS participants followed as part of the Strong Heart Family Study (SHFS) through 2006-2009. RESULTS T2DM incidence was 14.7% (mean follow-up 6.6 years) in the SHS and 13.5% (mean follow-up 5.6 years) in the SHFS. After adjustment for sex, site, education, smoking status, BMI, and estimated glomerular filtration rate, the hazard ratio of T2DM in comparing 75th vs. 25th percentiles of urinary zinc distribution was 1.21 (95% CI 1.08, 1.36) in the SHS and 1.12 (0.96, 1.31) in the SHFS. These associations were attenuated but significant in the SHS after adjustment for HOMA of insulin resistance (HOMA-IR) score. With exclusion of participants with prediabetes at baseline, urinary zinc remained significantly associated with T2DM in the SHS. In cross-sectional analyses, prediabetes was associated with higher urinary zinc levels. CONCLUSIONS Urinary zinc levels were associated with T2DM incidence and prediabetes prevalence even after adjustment for HOMA-IR in populations with a high burden of T2DM. These results highlight the importance of zinc metabolism in diabetes development.
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Affiliation(s)
- Marta Galvez-Fernandez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
- Department of Preventive Medicine, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Martha Powers
- Department of Sociology and Anthropology, Northeastern University, Boston, MA
| | - Maria Grau-Perez
- Biomedical Research Institute of Valencia (INCLIVA), Valencia, Spain
| | - Arce Domingo-Relloso
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Nancy Lolacono
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | | | - Ying Zhang
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, Seattle, WA
| | - Jason G. Umans
- Division of Nephrology and Hypertension, Department of Medicine, Georgetown University Medical Center, Washington, DC
| | - Nisa Maruthur
- Division of General Internal Medicine, Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
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Wang M, Wang Z, Lee Y, Lai HTM, de Oliveira Otto MC, Lemaitre RN, Fretts A, Sotoodehnia N, Budoff M, DiDonato JA, McKnight B, Tang WHW, Psaty BM, Siscovick DS, Hazen SL, Mozaffarian D. Dietary Meat, Trimethylamine N-Oxide-Related Metabolites, and Incident Cardiovascular Disease Among Older Adults: The Cardiovascular Health Study. Arterioscler Thromb Vasc Biol 2022; 42:e273-e288. [PMID: 35912635 PMCID: PMC9420768 DOI: 10.1161/atvbaha.121.316533] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Effects of animal source foods (ASF) on atherosclerotic cardiovascular disease (ASCVD) and underlying mechanisms remain controversial. We investigated prospective associations of different ASF with incident ASCVD and potential mediation by gut microbiota-generated trimethylamine N-oxide, its L-carnitine-derived intermediates γ-butyrobetaine and crotonobetaine, and traditional ASCVD risk pathways. METHODS Among 3931 participants from a community-based US cohort aged 65+ years, ASF intakes and trimethylamine N-oxide-related metabolites were measured serially over time. Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, other atherosclerotic death) was adjudicated over 12.5 years median follow-up. Cox proportional hazards models with time-varying exposures and covariates examined ASF-ASCVD associations; and additive hazard models, mediation proportions by different risk pathways. RESULTS After multivariable-adjustment, higher intakes of unprocessed red meat, total meat, and total ASF associated with higher ASCVD risk, with hazard ratios (95% CI) per interquintile range of 1.15 (1.01-1.30), 1.22 (1.07-1.39), and 1.18 (1.03-1.34), respectively. Trimethylamine N-oxide-related metabolites together significantly mediated these associations, with mediation proportions (95% CI) of 10.6% (1.0-114.5), 7.8% (1.0-32.7), and 9.2% (2.2-44.5), respectively. Processed meat intake associated with a nonsignificant trend toward higher ASCVD (1.11 [0.98-1.25]); intakes of fish, poultry, and eggs were not significantly associated. Among other risk pathways, blood glucose, insulin, and C-reactive protein, but not blood pressure or blood cholesterol, each significantly mediated the total meat-ASCVD association. CONCLUSIONS In this large, community-based cohort, higher meat intake associated with incident ASCVD, partly mediated by microbiota-derived metabolites of L-carnitine, abundant in red meat. These novel findings support biochemical links between dietary meat, gut microbiome pathways, and ASCVD.
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Affiliation(s)
- Meng Wang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Yujin Lee
- Department of Food and Nutrition, Myongji University, Yongin, South Korea 17055
| | - Heidi TM Lai
- Imperial College London, Department of Primary Care and Public Health, London, SW7 2AZ, UK
| | - Marcia C. de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Matthew Budoff
- Los Angeles BioMedical Research Institute, Harbor UCLA Medical Center, CA
| | - Joseph A. DiDonato
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Barbara McKnight
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Biostatistics, University of Washington, Seattle, WA
| | - W. H. Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
- Department of Epidemiology, University of Washington, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | | | - Stanley L. Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Sawyer L, Oddo VM, Fretts A, Knox MA, Chan N, Saelens BE, Jones-Smith JC. Impacts of the Seattle Sweetened Beverage Tax on the Perceived Healthfulness of Sweetened Beverages. Nutrients 2022; 14:nu14050993. [PMID: 35267968 PMCID: PMC8912807 DOI: 10.3390/nu14050993] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
Sweetened beverage taxes are associated with significant reductions in the purchase of sweetened beverages. However, it is unclear whether these taxes play a role in shifting perceptions about sweetened beverages and their health impacts. We utilized pre- and post-tax survey data collected from residents in Seattle, WA, a city that implemented a sweetened beverage tax in 2018 and from residents in an untaxed comparison area. We used income-stratified difference-in-difference linear probability models to compare net changes in the perceived healthfulness of overall sweetened beverage consumption and of different types of sugary beverages over time and across income groups. We found significant increases in the percentage of Seattle respondents with lower incomes who agreed that sweetened beverage consumption raises the risk of diabetes (DD = 9 percentage points (pp) (95% CI: 5 pp, 13 pp); p = 0.002), heart disease (DD = 7 pp (95% CI: 2 pp, 12 pp); p = 0.017), and serious health problems (DD = 12 pp (95% CI: 5 pp, 19 pp); p = 0.009), above and beyond changes in the comparison area. The most prominent changes in perceived health impacts of sweetened beverages were found among lower-income Seattle respondents, while fewer changes were found among higher-income Seattle respondents. Future work could examine the relationship between exposure to pro-tax messaging and changes in consumer perceptions of sweetened beverages.
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Affiliation(s)
- Lauren Sawyer
- Nutritional Sciences Program, School of Public Health, University of Washington, Seattle, WA 98195, USA
- Correspondence:
| | - Vanessa M. Oddo
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL 60612, USA;
| | - Amanda Fretts
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA; (A.F.); (N.C.); (J.C.J.-S.)
| | - Melissa A. Knox
- Department of Economics, University of Washington, Seattle, WA 98195, USA;
| | - Nadine Chan
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA; (A.F.); (N.C.); (J.C.J.-S.)
- Public Health—Seattle & King County, Assessment, Policy Development and Evaluation Division, Seattle, WA 98104, USA
| | - Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, WA 98101, USA;
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98105, USA
| | - Jessica C. Jones-Smith
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA; (A.F.); (N.C.); (J.C.J.-S.)
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, USA
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7
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de Oliveira Otto MC, Li XS, Wang Z, Siscovick DS, Newman AB, Lai HTM, Nemet I, Lee Y, Wang M, Fretts A, Lemaitre RN, Tang WW, Lopez O, Hazen SL, Mozaffarian D. Longitudinal Associations of Plasma TMAO and Related Metabolites with Cognitive Impairment and Dementia in Older Adults: The Cardiovascular Health Study. J Alzheimers Dis 2022; 89:1439-1452. [PMID: 36057823 PMCID: PMC9720755 DOI: 10.3233/jad-220477] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Animal studies suggest that gut microbiome metabolites such as trimethylamine N-oxide (TMAO) may influence cognitive function and dementia risk. However potential health effects of TMAO and related metabolites remain unclear. OBJECTIVE We examined prospective associations of TMAO, γ-butyrobetaine, crotonobetaine, carnitine, choline, and betaine with risk of cognitive impairment and dementia among older adults aged 65 years and older in the Cardiovascular Health Study (CHS). METHODS TMAO and metabolites were measured in stored plasma specimens collected at baseline. Incident cognitive impairment was assessed using the 100-point Modified Mini-Mental State Examination administered serially up to 7 times. Clinical dementia was identified using neuropsychological tests adjudicated by CHS Cognition Study investigators, and by ICD-9 codes from linked Medicare data. Associations of each metabolite with cognitive outcomes were assessed using Cox proportional hazards models. RESULTS Over a median of 13 years of follow-up, 529 cases of cognitive impairment, and 522 of dementia were identified. After multivariable adjustment for relevant risk factors, no associations were seen with TMAO, carnitine, choline, or betaine. In contrast, higher crotonobetaine was associated with 20-32% higher risk of cognitive impairment and dementia per interquintile range (IQR), while γ-butyrobetaine was associated with ∼25% lower risk of the same cognitive outcomes per IQR.∥Conclusion:These findings suggest that γ-butyrobetaine, crotonobetaine, two gut microbe and host metabolites, are associated with risk of cognitive impairment and dementia. Our results indicate a need for mechanistic studies evaluating potential effects of these metabolites, and their interconversion on brain health, especially later in life.
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Affiliation(s)
- Marcia C de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Xinmin S. Li
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA
| | - Zeneng Wang
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA
| | | | - Anne B Newman
- Department of Epidemiology, University of Pittsburg, Pittsburg, Pennsylvania
| | - Heidi Tsz Mung Lai
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ina Nemet
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA
| | - Yujin Lee
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA,Department of Food and Nutrition, Myongji University, Korea
| | - Meng Wang
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - W.H. Wilson. Tang
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Oscar Lopez
- Department of Neurology, University of Pittsburg School of Medicine Pittsburg, PA
| | - Stanley L. Hazen
- Department of Cardiovascular & Metabolic Sciences, Lerner Research Institute, Cleveland, OH, USA,Center for Microbiome and Human Health, Lerner Research Institute, Cleveland, OH, USA,Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy. Tufts University, Boston, MA
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8
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Melough M, Day D, Fretts A, Wang S, Flynn J, de Boer I, Zhu H, Kannan K, Sathyanarayana S. Associations of Dietary Intake with Urinary Melamine Concentrations among Children aged 4-6 Years in the GAPPS Cohort. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Wang M, Li X, Wang Z, Otto MDO, Lemaitre R, Fretts A, Sotoodehnia N, Budoff M, Nemet I, DiDonato J, McKnight B, Tang W, Psaty B, Siscovick D, Hazen S, Mozaffarian D. The Association of Plasma Trimethylamine N-Oxide With All-Cause and Cardiovascular Mortality: The Multi-Ethnic Study of Atherosclerosis. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab033_063] [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
Objectives
Trimethylamine N-oxide (TMAO) is a gut-microbiota generated metabolite of dietary phosphatidylcholine, choline, and carnitine. TMAO has been suggested to play a role in the pathogenesis of multiple diseases. Yet, studies of TMAO and mortality were conducted in convenience samples of patients with prevalent diseases and lacked socioeconomic and lifestyle data, raising the likelihood of selection bias and residual confounding. To address these research gaps, we investigated the associations of plasma TMAO levels with all-cause and cardiovascular disease (CVD) mortality in a prospective multi-ethnic community-based cohort.
Methods
The study included 6776 participants from the Multi-Ethnic Study of Atherosclerosis. TMAO was measured at baseline using mass spectrometry. Adjudicated CVD deaths included death due to coronary heart disease, stroke, other atherosclerotic diseases, or other CVDs. Multivariable Cox proportional hazards models assessed associations with adjustment for baseline sociodemographic, lifestyle, diet, and traditional CVD risk factors (BMI, blood pressure, lipids, diabetes, CRP, medications). We also assessed pre-specified interactions by age, sex, race/ethnicity, low vs. high adherence to Alternate Healthy Eating index, and renal function measured by creatinine-based estimated glomerular filtration rate (eGFR).
Results
During median follow-up of 15.9 years, 1548 participants died, 362 from CVD. Higher TMAO levels were associated with higher risk of both all-cause mortality (HR = 1.09, 95%CI: 1.04 - 1.13, per inter-quintile range increase, 7.5 µM/L) and CVD mortality (HR = 1.10, 95%CI: 1.02 - 1.19). Interaction by renal function was observed for all-cause mortality (P-interaction < 0.005), with a positive association between TMAO and risk in those with impaired renal function (eGFR < 60) [HR = 1.15, 95%CI: 1.09 -1.21], but not normal or mildly reduced renal function (eGFR ≥ 60) [HR = 1.02, 95%CI: 0.95 - 1.08]. No other significant interactions were observed.
Conclusions
In this multi-ethnic community-based cohort of US adults, higher plasma TMAO levels were associated with a higher risk of all-cause and CVD mortality. The mechanisms of interaction by renal function need to be further studied, especially given that TMAO is renally cleared.
Funding Sources
NIH
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10
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Qian F, Ardisson Korat AV, Imamura F, Marklund M, Tintle N, Virtanen JK, Zhou X, Bassett JK, Lai H, Hirakawa Y, Chien KL, Wood AC, Lankinen M, Murphy RA, Samieri C, Pertiwi K, de Mello VD, Guan W, Forouhi NG, Wareham N, Hu ICFB, Riserus U, Lind L, Harris WS, Shadyab AH, Robinson JG, Steffen LM, Hodge A, Giles GG, Ninomiya T, Uusitupa M, Tuomilehto J, Lindström J, Laakso M, Siscovick DS, Helmer C, Geleijnse JM, Wu JHY, Fretts A, Lemaitre RN, Micha R, Mozaffarian D, Sun Q. n-3 Fatty Acid Biomarkers and Incident Type 2 Diabetes: An Individual Participant-Level Pooling Project of 20 Prospective Cohort Studies. Diabetes Care 2021; 44:1133-1142. [PMID: 33658295 PMCID: PMC8132316 DOI: 10.2337/dc20-2426] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Prospective associations between n-3 fatty acid biomarkers and type 2 diabetes (T2D) risk are not consistent in individual studies. We aimed to summarize the prospective associations of biomarkers of α-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA) with T2D risk through an individual participant-level pooled analysis. RESEARCH DESIGN AND METHODS For our analysis we incorporated data from a global consortium of 20 prospective studies from 14 countries. We included 65,147 participants who had blood measurements of ALA, EPA, DPA, or DHA and were free of diabetes at baseline. De novo harmonized analyses were performed in each cohort following a prespecified protocol, and cohort-specific associations were pooled using inverse variance-weighted meta-analysis. RESULTS A total of 16,693 incident T2D cases were identified during follow-up (median follow-up ranging from 2.5 to 21.2 years). In pooled multivariable analysis, per interquintile range (difference between the 90th and 10th percentiles for each fatty acid), EPA, DPA, DHA, and their sum were associated with lower T2D incidence, with hazard ratios (HRs) and 95% CIs of 0.92 (0.87, 0.96), 0.79 (0.73, 0.85), 0.82 (0.76, 0.89), and 0.81 (0.75, 0.88), respectively (all P < 0.001). ALA was not associated with T2D (HR 0.97 [95% CI 0.92, 1.02]) per interquintile range. Associations were robust across prespecified subgroups as well as in sensitivity analyses. CONCLUSIONS Higher circulating biomarkers of seafood-derived n-3 fatty acids, including EPA, DPA, DHA, and their sum, were associated with lower risk of T2D in a global consortium of prospective studies. The biomarker of plant-derived ALA was not significantly associated with T2D risk.
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Affiliation(s)
- Frank Qian
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Andres V Ardisson Korat
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, U.K
| | - Matti Marklund
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nathan Tintle
- Department of Mathematics and Statistics, Dordt University, Sioux Center, IA.,Fatty Acid Research Institute, Sioux Falls, SD
| | - Jyrki K Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Xia Zhou
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - Heidi Lai
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,Imperial College London, London, U.K
| | - Yoichiro Hirakawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Alexis C Wood
- Children's Nutrition Research Center, U.S. Department of Agriculture/Agricultural Research Service, Houston, TX
| | - Maria Lankinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Rachel A Murphy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Cecilia Samieri
- INSERM, UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Kamalita Pertiwi
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Vanessa D de Mello
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Weihua Guan
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Nita G Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, U.K
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, U.K
| | - InterAct Consortium Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.,Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Ulf Riserus
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lars Lind
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - William S Harris
- Fatty Acid Research Institute, Sioux Falls, SD.,Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA
| | | | - Lyn M Steffen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Allison Hodge
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Graham G Giles
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN.,Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jaana Lindström
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Markku Laakso
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Catherine Helmer
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Johanna M Geleijnse
- INSERM, UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Jason H Y Wu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Amanda Fretts
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA.,Division of Cardiology, Tufts Medical Center, Boston, MA
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11
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Lee Y, Wang Z, Lai H, Otto MDO, Lemaitre R, Fretts A, Sotoodehnia N, Budoff M, Didonato J, McKnight B, Tang WHW, Psaty B, Siscovick D, Hazen S, Mozaffarian D. Longitudinal Measures of Trimethylamine N-oxide and Incident Atherosclerotic Cardiovascular Disease Events in Older Adults: The Cardiovascular Health Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa061_062] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Trimethylamine N-oxide (TMAO) is a gut microbiota-dependent metabolite of dietary choline, L-carnitine and phosphatidylcholine-rich animal foods. Based on experimental studies and cohorts with prevalent disease, elevated TMAO may increase risk of atherosclerotic cardiovascular disease (ASCVD). TMAO is also renally cleared and may interact with and causally contribute to renal dysfunction and elevated cystatin-C. Yet, the associations of serial TMAO levels with incident ASCVD in a community-based prospective cohort, and the potential mediating and modifying role of renal function, are not established.
Methods
We investigated the associations of serial measures of plasma TMAO, assessed at baseline and 7 years post baseline, with incident ASCVD among 4144 older adults in the Cardiovascular Health Study (CHS). TMAO was measured using stable isotope dilution LC/MS/MS (lab CV <6%). Incident ASCVD (myocardial infarction, fatal coronary heart disease, stroke, sudden cardiac death, or other atherosclerotic death) was centrally adjudicated using medical records. Risk was assessed by multivariable Cox proportional hazards regression including time-varying demographics, lifestyle factors, medical history, and laboratory and dietary variables. We assessed potential mediating effects and interaction by renal function estimated by cystatin-C.
Results
During a median 15 years follow-up, 1757 ASCVD events occurred. After multivariable adjustment, TMAO was associated with a higher risk of ASCVD, with an extreme quintile HR (95% CI) of 1.22 (1.04, 1.44), P-trend = 0.01. This relationship appeared further mediated or confounded by estimated glomerular filtration rate (eGFR): adjusting for cystatin-C-based eGFR, the HR (95% CI) was 1.06 (0.98–1.25). Significant interaction was also observed by renal function (P-interaction < 0.001), with TMAO associated with higher risk of ASCVD among individuals with impaired renal function (eGFR ≤ 60) [1.63 (1.03–2.59)], but not normal baseline renal function (eGFR > 60) [1.15 (0.96–1.37)], even with further adjustment for continuous eGFR.
Conclusions
In this large community-based cohort of older US adults, higher serial measures of TMAO were associated with an elevated risk of ASCVD, in particular among those with impaired renal function.
Funding Sources
NIH, NHLBI.
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Affiliation(s)
- Yujin Lee
- Friedman School of Nutrition Science and Policy, Tufts University
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12
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Marklund M, Wu JHY, Imamura F, Del Gobbo LC, Fretts A, de Goede J, Shi P, Tintle N, Wennberg M, Aslibekyan S, Chen TA, de Oliveira Otto MC, Hirakawa Y, Eriksen HH, Kröger J, Laguzzi F, Lankinen M, Murphy RA, Prem K, Samieri C, Virtanen J, Wood AC, Wong K, Yang WS, Zhou X, Baylin A, Boer JM, Brouwer IA, Campos H, Chaves PHM, Chien KL, de Faire U, Djoussé L, Eiriksdottir G, El-Abbadi N, Forouhi NG, Gaziano JM, Geleijnse JM, Gigante B, Giles G, Guallar E, Gudnason V, Harris T, Harris WS, Helmer C, Hellenius ML, Hodge A, Hu FB, Jacques PF, Jansson JH, Kalsbeek A, Khaw KT, Koh WP, Laakso M, Leander K, Hung-Ju Lin, Lind L, Luben R, Luo J, McKnight B, Mursu J, Ninomiya T, Overvad K, Psaty BM, Rimm E, Schulze MB, Siscovick D, Nielsen MS, Smith AV, Steffen BT, Steffen L, Sun Q, Sundström J, Tsai MY, Tunstall-Pedoe H, Uusitupa MIJ, van Dam RM, Veenstra J, Verschuren WM, Wareham N, Willett W, Woodward M, Yuan JM, Micha R, Lemaitre RN, Mozaffarian D. Biomarkers of Dietary Omega-6 Fatty Acids and Incident Cardiovascular Disease and Mortality. Circulation 2019; 139:2422-2436. [PMID: 30971107 PMCID: PMC6582360 DOI: 10.1161/circulationaha.118.038908] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Global dietary recommendations for and cardiovascular effects of linoleic acid, the major dietary omega-6 fatty acid, and its major metabolite, arachidonic acid, remain controversial. To address this uncertainty and inform international recommendations, we evaluated how in vivo circulating and tissue levels of linoleic acid (LA) and arachidonic acid (AA) relate to incident cardiovascular disease (CVD) across multiple international studies. METHODS We performed harmonized, de novo, individual-level analyses in a global consortium of 30 prospective observational studies from 13 countries. Multivariable-adjusted associations of circulating and adipose tissue LA and AA biomarkers with incident total CVD and subtypes (coronary heart disease, ischemic stroke, cardiovascular mortality) were investigated according to a prespecified analytic plan. Levels of LA and AA, measured as the percentage of total fatty acids, were evaluated linearly according to their interquintile range (ie, the range between the midpoint of the first and fifth quintiles), and categorically by quintiles. Study-specific results were pooled using inverse-variance-weighted meta-analysis. Heterogeneity was explored by age, sex, race, diabetes mellitus, statin use, aspirin use, omega-3 levels, and fatty acid desaturase 1 genotype (when available). RESULTS In 30 prospective studies with medians of follow-up ranging 2.5 to 31.9 years, 15 198 incident cardiovascular events occurred among 68 659 participants. Higher levels of LA were significantly associated with lower risks of total CVD, cardiovascular mortality, and ischemic stroke, with hazard ratios per interquintile range of 0.93 (95% CI, 0.88-0.99), 0.78 (0.70-0.85), and 0.88 (0.79-0.98), respectively, and nonsignificantly with lower coronary heart disease risk (0.94; 0.88-1.00). Relationships were similar for LA evaluated across quintiles. AA levels were not associated with higher risk of cardiovascular outcomes; in a comparison of extreme quintiles, higher levels were associated with lower risk of total CVD (0.92; 0.86-0.99). No consistent heterogeneity by population subgroups was identified in the observed relationships. CONCLUSIONS In pooled global analyses, higher in vivo circulating and tissue levels of LA and possibly AA were associated with lower risk of major cardiovascular events. These results support a favorable role for LA in CVD prevention.
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Affiliation(s)
- Matti Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Sweden
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jason HY Wu
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Fumiaki Imamura
- Medical Research Council Epidemiology Unit, University of Cambridge, United Kingdom
| | - Liana C. Del Gobbo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Janette de Goede
- Division of Human Nutrition, Wageningen University, The Netherlands
| | - Peilin Shi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Nathan Tintle
- Department of Mathematics and Statistics, Dordt College, Sioux Centre, IA
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Sweden
| | | | - Tzu-An Chen
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Marcia C. de Oliveira Otto
- Division of Epidemiology, Human Genetics and Environmental Sciences, the University of Texas Health Science Center, School of Public Health, Houston
| | - Yoichiro Hirakawa
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Janine Kröger
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Federica Laguzzi
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Lankinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio
| | - Rachel A. Murphy
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Cécilia Samieri
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, TUMR 1219, France
| | - Jyrki Virtanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio
| | - Alexis C. Wood
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX
| | - Kerry Wong
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Australia
| | - Wei-Sin Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Xia Zhou
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Ana Baylin
- Departments of Nutritional Sciences and Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | - Jolanda M.A. Boer
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Hannia Campos
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Paulo H. M. Chaves
- Benjamin Leon for Geriatrics Research and Education, Herbert Wertheim College of Medicine, Florida International University, Miami
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Ulf de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Luc Djoussé
- Brigham and Women's Hospital, Boston Veterans Affairs Healthcare System, MA
| | - Gudny Eiriksdottir
- Icelandic Heart Association, Kópavogur, Iceland; and Faculty of Medicine, University of Iceland, Reykjavik
| | - Naglaa El-Abbadi
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- USDA Jean Mayer Human Nutrition Research Center, Boston, MA
| | - Nita G. Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge, United Kingdom
| | - J. Michael Gaziano
- Brigham and Women's Hospital, Boston Veterans Affairs Healthcare System, MA
| | | | - Bruna Gigante
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Graham Giles
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Australia
| | - Eliseo Guallar
- Division of Environmental Epidemiology, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kópavogur, Iceland; and Faculty of Medicine, University of Iceland, Reykjavik
| | | | - William S. Harris
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls
- OmegaQuant Analytics, LLC, Sioux Falls, SD
| | - Catherine Helmer
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, TUMR 1219, France
| | - Mai-Lis Hellenius
- Department of Medicine, Cardiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Allison Hodge
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Australia
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Paul F. Jacques
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
- USDA Jean Mayer Human Nutrition Research Center, Boston, MA
| | - Jan-Håkan Jansson
- Department of Public Health and Clinical Medicine, Research Unit Skellefteå, Umeå University, Umeå, Sweden
| | - Anya Kalsbeek
- Department of Mathematics and Statistics, Dordt College, Sioux Centre, IA
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, United Kingdom
| | - Woon-Puay Koh
- Saw Swee Hock School of Public Health, National University of Singapore
- Duke-NUS Medical School, Singapore
| | - Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Karin Leander
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hung-Ju Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Sweden
| | - Robert Luben
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, United Kingdom
| | - Juhua Luo
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington
| | - Barbara McKnight
- Department of Biostatistics, School of Public Health, University of Washington, Seattle
| | - Jaakko Mursu
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kim Overvad
- Department of Public Health, Section for Epidemiology, Aarhus University, Denmark
- Department of Cardiology, Aalborg University Hospital, Denmark
| | - Bruce M. Psaty
- Cardiovascular Health Study, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Eric Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Matthias B. Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | | | | | - Albert V. Smith
- Icelandic Heart Association, Kópavogur, Iceland; and Faculty of Medicine, University of Iceland, Reykjavik
| | - Brian T. Steffen
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Lyn Steffen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Hugh Tunstall-Pedoe
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, United Kingdom
| | - Matti I. J. Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Jenna Veenstra
- Department of Mathematics and Statistics, Dordt College, Sioux Centre, IA
| | - W.M. Monique Verschuren
- Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Nick Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, United Kingdom
| | - Walter Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mark Woodward
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
- Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, United Kingdom
- The George Institute for Global Health, University of Oxford, United Kingdom
| | - Jian-Min Yuan
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer, and Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
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Imamura F, Fretts A, Marklund M, Ardisson Korat AV, Yang WS, Lankinen M, Qureshi W, Helmer C, Chen TA, Wong K, Bassett JK, Murphy R, Tintle N, Yu CI, Brouwer IA, Chien KL, Frazier-Wood AC, del Gobbo LC, Djoussé L, Geleijnse JM, Giles GG, de Goede J, Gudnason V, Harris WS, Hodge A, Hu F, Koulman A, Laakso M, Lind L, Lin HJ, McKnight B, Rajaobelina K, Risérus U, Robinson JG, Samieri C, Siscovick DS, Soedamah-Muthu SS, Sotoodehnia N, Sun Q, Tsai MY, Uusitupa M, Wagenknecht LE, Wareham NJ, Wu JHY, Micha R, Forouhi NG, Lemaitre RN, Mozaffarian D. Fatty acid biomarkers of dairy fat consumption and incidence of type 2 diabetes: A pooled analysis of prospective cohort studies. PLoS Med 2018; 15:e1002670. [PMID: 30303968 PMCID: PMC6179183 DOI: 10.1371/journal.pmed.1002670] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [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: 04/16/2018] [Accepted: 09/07/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We aimed to investigate prospective associations of circulating or adipose tissue odd-chain fatty acids 15:0 and 17:0 and trans-palmitoleic acid, t16:1n-7, as potential biomarkers of dairy fat intake, with incident type 2 diabetes (T2D). METHODS AND FINDINGS Sixteen prospective cohorts from 12 countries (7 from the United States, 7 from Europe, 1 from Australia, 1 from Taiwan) performed new harmonised individual-level analysis for the prospective associations according to a standardised plan. In total, 63,682 participants with a broad range of baseline ages and BMIs and 15,180 incident cases of T2D over the average of 9 years of follow-up were evaluated. Study-specific results were pooled using inverse-variance-weighted meta-analysis. Prespecified interactions by age, sex, BMI, and race/ethnicity were explored in each cohort and were meta-analysed. Potential heterogeneity by cohort-specific characteristics (regions, lipid compartments used for fatty acid assays) was assessed with metaregression. After adjustment for potential confounders, including measures of adiposity (BMI, waist circumference) and lipogenesis (levels of palmitate, triglycerides), higher levels of 15:0, 17:0, and t16:1n-7 were associated with lower incidence of T2D. In the most adjusted model, the hazard ratio (95% CI) for incident T2D per cohort-specific 10th to 90th percentile range of 15:0 was 0.80 (0.73-0.87); of 17:0, 0.65 (0.59-0.72); of t16:1n7, 0.82 (0.70-0.96); and of their sum, 0.71 (0.63-0.79). In exploratory analyses, similar associations for 15:0, 17:0, and the sum of all three fatty acids were present in both genders but stronger in women than in men (pinteraction < 0.001). Whereas studying associations with biomarkers has several advantages, as limitations, the biomarkers do not distinguish between different food sources of dairy fat (e.g., cheese, yogurt, milk), and residual confounding by unmeasured or imprecisely measured confounders may exist. CONCLUSIONS In a large meta-analysis that pooled the findings from 16 prospective cohort studies, higher levels of 15:0, 17:0, and t16:1n-7 were associated with a lower risk of T2D.
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Affiliation(s)
- Fumiaki Imamura
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Amanda Fretts
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Matti Marklund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Sweden
| | - Andres V. Ardisson Korat
- Department of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Wei-Sin Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Maria Lankinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Waqas Qureshi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Bowman Gray Center, Winston-Salem, North Carolina, United States of America
| | - Catherine Helmer
- INSERM, UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Tzu-An Chen
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Kerry Wong
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | - Julie K. Bassett
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
| | - Rachel Murphy
- Centre of Excellence in Cancer Prevention, School of Population & Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Nathan Tintle
- Department of Mathematics and Statistics, Dordt College, Sioux Center, Iowa, United States of America
| | - Chaoyu Ian Yu
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Ingeborg A. Brouwer
- Department of Health Sciences, Faculty of Earth & Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Alexis C. Frazier-Wood
- USDA/ARS Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States of America
| | - Liana C. del Gobbo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Luc Djoussé
- Divisions of Aging, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Graham G. Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Australia
| | - Janette de Goede
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Holtasmári 1, Kópavogur, Iceland, Iceland
| | - William S. Harris
- Department of Internal Medicine, Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, United States of America
- OmegaQuant Analytics LLC, Sioux Falls, South Dakota, United States of America
| | - Allison Hodge
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Parkville, Australia
| | - Frank Hu
- Department of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - InterAct Consortium
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Albert Koulman
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- National Institute for Health Research Biomedical Research Centres Core Nutritional Biomarker Laboratory, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- National Institute for Health Research Biomedical Research Centres Core Metabolomics and Lipidomics Laboratory, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Medical Research Council Elsie Widdowson Laboratory, Cambridge, United Kingdom
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland, Kuopio, Finland
| | - Markku Laakso
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Lars Lind
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hung-Ju Lin
- Department of Internal Medicine, National Taiwan University Hospital, Zhongzheng District, Taipei City, Taiwan
| | - Barbara McKnight
- Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington, United States of America
| | - Kalina Rajaobelina
- INSERM, UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Ulf Risérus
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Sweden
| | - Jennifer G. Robinson
- Departments of Epidemiology and Medicine at the University of Iowa College of Public Health, Iowa City, Iowa, United States of America
| | - Cécilia Samieri
- INSERM, UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - David S. Siscovick
- The New York Academy of Medicine, New York, New York, United States of America
| | - Sabita S. Soedamah-Muthu
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
- Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Qi Sun
- Department of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Lynne E. Wagenknecht
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Nick J. Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Jason HY Wu
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Renata Micha
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Nita G. Forouhi
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
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14
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Deen JF, Adams AK, Fretts A, Jolly S, Navas-Acien A, Devereux RB, Buchwald D, Howard BV. Cardiovascular Disease in American Indian and Alaska Native Youth: Unique Risk Factors and Areas of Scholarly Need. J Am Heart Assoc 2017; 6:e007576. [PMID: 29066451 PMCID: PMC5721901 DOI: 10.1161/jaha.117.007576] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jason F Deen
- Division of Cardiology, Seattle Children's Hospital, University of Washington, Seattle, WA
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, WA
| | - Alexandra K Adams
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT
| | - Amanda Fretts
- Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA
| | - Stacey Jolly
- Department of General Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Dedra Buchwald
- College of Medicine, Washington State University, Spokane, WA
| | - Barbara V Howard
- MedStar Health Research Institute, Hyattsville, MD
- Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, DC
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15
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Spratlen MJ, Gamble MV, Grau-Perez M, Kuo CC, Best LG, Yracheta J, Francesconi K, Goessler W, Mossavar-Rahmani Y, Hall M, Umans JG, Fretts A, Navas-Acien A. Arsenic metabolism and one-carbon metabolism at low-moderate arsenic exposure: Evidence from the Strong Heart Study. Food Chem Toxicol 2017; 105:387-397. [PMID: 28479390 DOI: 10.1016/j.fct.2017.05.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 02/27/2017] [Revised: 05/01/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
Abstract
B-vitamins involved in one-carbon metabolism (OCM) can affect arsenic metabolism efficiency in highly arsenic exposed, undernourished populations. We evaluated whether dietary intake of OCM nutrients (including vitamins B2, B6, folate (B9), and B12) was associated with arsenic metabolism in a more nourished population exposed to lower arsenic than previously studied. Dietary intake of OCM nutrients and urine arsenic was evaluated in 405 participants from the Strong Heart Study. Arsenic exposure was measured as the sum of iAs, monomethylarsonate (MMA) and dimethylarsenate (DMA) in urine. Arsenic metabolism was measured as the individual percentages of each metabolite over their sum (iAs%, MMA%, DMA%). In adjusted models, increasing intake of vitamins B2 and B6 was associated with modest but significant decreases in iAs% and MMA% and increases in DMA%. A significant interaction was found between high folate and B6 with enhanced arsenic metabolism efficiency. Our findings suggest OCM nutrients may influence arsenic metabolism in populations with moderate arsenic exposure. Stronger and independent associations were observed with B2 and B6, vitamins previously understudied in relation to arsenic. Research is needed to evaluate whether targeting B-vitamin intake can serve as a strategy for the prevention of arsenic-related health effects at low-moderate arsenic exposure.
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Affiliation(s)
- Miranda Jones Spratlen
- Department of Environmental Health, Johns Hopkins Bloomberg School of Public Health Department, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Mary V Gamble
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA.
| | - Maria Grau-Perez
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA.
| | - Chin-Chi Kuo
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, No.91, Hsueh-Shih Road, Taichung 40402, Taiwan; Big Data Center, China Medical University Hospital and China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan.
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., 118 S. Willow St, Eagle Butte, SD 57625, USA.
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., 118 S. Willow St, Eagle Butte, SD 57625, USA.
| | - Kevin Francesconi
- Institute of Chemistry - Analytical Chemistry, Universitätsplatz 1/1, 8010 Graz, Austria.
| | - Walter Goessler
- Institute of Chemistry - Analytical Chemistry, Universitätsplatz 1/1, 8010 Graz, Austria.
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY 10461, USA.
| | - Meghan Hall
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA.
| | - Jason G Umans
- MedStar Health Research Institute, 6525 Belcrest Rd #700, Hyattsville, MD 20782, USA; Georgetown-Howard Universities Center for Clinical and Translational Science, 4000 Reservoir Road, Washington, DC 20007, USA.
| | - Amanda Fretts
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Bldg, F-262 Box 357236, Seattle, WA 98195, USA.
| | - Ana Navas-Acien
- Department of Environmental Health, Johns Hopkins Bloomberg School of Public Health Department, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, USA.
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16
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Olmedo P, Grau-Perez M, Fretts A, Tellez-Plaza M, Gil F, Yeh F, Umans JG, Francesconi KA, Goessler W, Franceschini N, Lee ET, Best LG, Cole SA, Howard BV, Navas-Acien A. Dietary determinants of cadmium exposure in the Strong Heart Family Study. Food Chem Toxicol 2016; 100:239-246. [PMID: 28012896 DOI: 10.1016/j.fct.2016.12.015] [Citation(s) in RCA: 20] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/09/2016] [Accepted: 12/13/2016] [Indexed: 11/17/2022]
Abstract
Urinary cadmium (Cd) concentrations in the Strong Heart Family Study (SHFS) participants are higher than in the general US population. This difference is unlikely to be related to tobacco smoking. We evaluated the association of consumption of processed meats and other dietary products with urinary Cd concentrations in the SHFS, a family-based study conducted in American Indian communities. We included 1725 participants with urine Cd concentrations (standardized to urine creatinine) and food frequency questionnaire data grouped in 24 categories, including processed meat. Median (IQR) urinary Cd concentrations were 0.42 (0.20-0.85) μg/g creatinine. The age, sex, smoking, education, center, body mass index, and total kcal adjusted geometric mean ratio (GMR) (95%CI) of urinary cadmium concentrations per IQR increase in each dietary category was 1.16 (1.04-1.29) for processed meat, 1.10 (1.00-1.21) for fries and chips, 0.87 (0.80-0.95) for dairy products, and 0.89 (0.82-0.97) for fruit juices. The results remained similar after further adjustment for the dietary categories associated with urinary Cd in the previous model except for fries and chips, which was no longer statistically significant. These findings revealed the potential importance of processed meat products as a dietary source of cadmium.
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Affiliation(s)
- Pablo Olmedo
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Maria Grau-Perez
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amanda Fretts
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
| | - Maria Tellez-Plaza
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Fundación de Investigación Hospital Clínico de Valencia INCLIVA, Valencia, Spain
| | - Fernando Gil
- Department of Legal Medicine and Toxicology, School of Medicine, University of Granada, Spain
| | - Fawn Yeh
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jason G Umans
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | | | - Walter Goessler
- Institute of Chemistry -Analytical Chemistry, University of Graz, Austria
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Elisa T Lee
- Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc, Timber Lake, SD, USA
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | | | - Ana Navas-Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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17
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Eilat-Adar S, Mete M, Fretts A, Fabsitz RR, Handeland V, Lee ET, Loria C, Xu J, Yeh J, Howard BV. Dietary patterns and their association with cardiovascular risk factors in a population undergoing lifestyle changes: The Strong Heart Study. Nutr Metab Cardiovasc Dis 2013; 23:528-535. [PMID: 22534653 PMCID: PMC3674116 DOI: 10.1016/j.numecd.2011.12.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 12/07/2011] [Accepted: 12/12/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Rates of cardiovascular disease (CVD) are disproportionately high in American Indians (AI), and changes in lifestyle may be responsible. It is not known whether diverse dietary patterns exist in this population and whether the patterns are associated with CVD risk factors. This article describes the relationships between dietary patterns and CVD risk factors in this high-risk population. METHODS AND RESULTS Nutrition data were collected via food frequency questionnaire from 3438 Strong Heart Study (SHS) participants, ≥ age 15 y. All participants were members of 94 extended families. The final sample consisted of 3172 men and women. Diet patterns were ascertained using factor analysis with the principal component factoring method. We derived four predominant dietary patterns: Western, traditional AI/Mexican, healthy, and unhealthy. Participants following the Western pattern had higher LDL cholesterol (LDL-C) (p < 0.001), slightly higher systolic blood pressure (BP) (p < 0.001), lower HDL cholesterol (HDL-C) (p < 0.001), and slightly lower homeostasis model assessment estimates of insulin resistance (HOMA-IR) in the lowest vs. highest deciles of adherence to this pattern (p < 0.001). The traditional diet was associated with higher HDL-C (p < 0.001), but higher body mass index (BMI) (p < 0.001) and HOMA-IR (p < 0.001). Followers of the healthy pattern had lower systolic BP, LDL-C, BMI, and HOMA-IR in increasing deciles (p < 0.001). The unhealthy pattern was associated with higher LDL-C. CONCLUSIONS Dietary patterns reflect the changing lifestyle of AI and several of the patterns are associated with CVD risk factors. Evolving methods of food preparation have made the traditional pattern less healthy.
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Affiliation(s)
- S Eilat-Adar
- MedStar Health Research Institute, Hyattsville, MD 20782, USA.
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