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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 Gennip ACE, van Sloten TT, Fayosse A, Sabia S, Singh‐Manoux A. Age at cardiovascular disease onset, dementia risk, and the role of lifestyle factors. Alzheimers Dement 2024; 20:1693-1702. [PMID: 38085549 PMCID: PMC10947967 DOI: 10.1002/alz.13562] [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: 05/12/2023] [Revised: 09/25/2023] [Accepted: 11/01/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION We first examined the role of age at cardiovascular disease (CVD) onset for incident dementia, and then examined whether lifestyle factors at guideline-recommended levels in individuals with CVD mitigates dementia risk. METHODS We used population-based data (Whitehall II: n = 10,308/baseline 1985-1988/examinations every 4-5 years). Lifestyle factors (non-smoking, body mass index [BMI], physical activity, diet) were extracted post-CVD. RESULTS Over a median of 31.6 years, 3275 (32.1%) developed CVD. At age 70, risk of dementia was higher in individuals with CVD onset before (hazard ratio [HR] of incident dementia for participants with CVD before age 60, using participants without CVD at age 70 as the reference: 1.56, 95% confidence interal [CI] 1.18-2.08) but not after 60 years. In participants with CVD, a greater number of lifestyle factors at recommended levels post-CVD was associated with a lower dementia risk (per lifestyle factor at recommended level HR: 0.73, 95% CI 0.59-0.92). DISCUSSION Our results suggest that early onset CVD is associated with a higher dementia risk at older ages. In those with CVD, the dementia risk was lower if lifestyle factors are at recommended levels following CVD diagnosis. HIGHLIGHTS CVD in midlife but not in late life is associated with a higher risk of dementia. Dementia risk in CVD patients is lower if their lifestyle factors are at recommended levels. These findings provide evidence to promote CVD prevention in midlife or earlier. Study findings also show the importance of a healthy lifestyle in those with CVD.
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Affiliation(s)
- April C. E. van Gennip
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- School for Cardiovascular Diseases CARIMMaastricht UniversityMaastrichtThe Netherlands
| | - Thomas T. van Sloten
- Department of Vascular MedicineUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Aurore Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
| | - Séverine Sabia
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
- Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Archana Singh‐Manoux
- Epidemiology of Ageing and Neurodegenerative Diseases, Inserm U1153Université Paris CitéParisFrance
- Faculty of Brain SciencesUniversity College LondonLondonUK
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Hassen CB, Machado‐Fragua MD, Landré B, Fayosse A, Dumurgier J, Kivimaki M, Sabia S, Singh‐Manoux A. Change in lipids before onset of dementia, coronary heart disease, and mortality: A 28-year follow-up Whitehall II prospective cohort study. Alzheimers Dement 2023; 19:5518-5530. [PMID: 37243914 PMCID: PMC10679471 DOI: 10.1002/alz.13140] [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: 11/09/2022] [Accepted: 04/07/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION The association of lipids with dementia remains a subject of debate. Using data from 7,672 participants of the Whitehall II prospective cohort study, we examined whether timing of exposure, length of follow-up, or sex modifies this association. METHODS Twelve markers of lipid levels were measured from fasting blood and eight among them a further five times. We performed time-to-event as well as trajectory analyses. RESULTS No associations were observed in men; in women most lipids were associated with the risk of dementia, but only for events occurring after the first 20 years of follow-up. Differences in lipid trajectories in men emerged only in the years immediately before diagnosis whereas in women total cholesterol (TC), LDL-cholesterol (LDL-C), non-HDL-cholesterol (non-HDL-C), TC/HDL-C, and LDL-C/HDL-C were higher in midlife among dementia cases before declining progressively. DISCUSSION Abnormal lipid levels in midlife seem to be associated with a higher risk of dementia in women.
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Affiliation(s)
- Céline Ben Hassen
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Marcos D Machado‐Fragua
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Benjamin Landré
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Aurore Fayosse
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
| | - Julien Dumurgier
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
- Cognitive Neurology Center, Lariboisière – Fernand Widal Hospital, AP‐HPUniversité Paris CitéParisFrance
| | - Mika Kivimaki
- Department of Mental Health of Older People, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
- Department of Mental Health of Older People, Faculty of Brain SciencesUniversity College LondonLondonUK
| | - Archana Singh‐Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseasesParisFrance
- Department of Mental Health of Older People, Faculty of Brain SciencesUniversity College LondonLondonUK
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Machado-Fragua MD, Sabia S, Fayosse A, Hassen CB, van der Heide F, Kivimaki M, Singh-Manoux A. Is metabolic-healthy obesity associated with risk of dementia? An age-stratified analysis of the Whitehall II cohort study. BMC Med 2023; 21:436. [PMID: 37957712 PMCID: PMC10644649 DOI: 10.1186/s12916-023-03155-4] [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: 04/19/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Metabolically healthy obesity is hypothesized to be a benign condition but whether this is the case for dementia remains debated. We examined the role of age at assessment of metabolic-obesity phenotypes in associations with incident dementia. METHODS Obesity (body mass index ≥ 30 kg/m2) and poor metabolic health (≥ 2 of elevated serum triglycerides, low HDL-C, elevated blood pressure, and elevated serum fasting glucose) were used to define four metabolic-obesity phenotypes (metabolically healthy (MHNO) and unhealthy non-obesity (MUNO), metabolically healthy (MHO) and unhealthy obesity (MUO)) at < 60, 60 to < 70, and ≥ 70 years using 6 waves of data from the Whitehall II study and their associations with incident dementia was examined using Cox regression. RESULTS Analyses with exposures measured < 60, 60 to < 70, and ≥ 70 years involved 410 (5.8%), 379 (5.6%), and 262 (7.4%) incident dementia cases over a median follow-up of 20.8, 10.3, and 4.2 years respectively. In analyses of individual components, obesity before 60 years (HR 1.41, 95% CI: [1.08, 1.85]) but not at older ages was associated with dementia; unhealthy metabolic status when present < 60 years (HR 1.33, 95% CI: [1.08, 1.62]) and 60 to < 70 years (HR 1.32, 95% CI: [1.07, 1.62]) was associated with dementia. Compared to the metabolically healthy non-obesity group, the risk of dementia was higher in those with metabolically healthy obesity before 60 years (1.69; 95% CI: [1.16, 2.45]); this was not the case when metabolic-obesity phenotype was present at 60 to < 70 years or ≥ 70 years. Analyses at older ages were on smaller numbers due to death and drop-out but inverse probability weighting to account for missing data yielded similar results. CONCLUSIONS Individuals with metabolically healthy obesity before age 60 had a higher risk of incident dementia over a 27-year follow-up; the excess risk dissipates when metabolic health and obesity are measured after 70 years.
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Affiliation(s)
- Marcos D Machado-Fragua
- 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
- Faculty of Brain Sciences, University College London, London, UK
| | - Aurore Fayosse
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Céline Ben Hassen
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Frank van der Heide
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimaki
- Faculty of Brain Sciences, University College London, 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, London, UK
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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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van Sloten TT, Climie RED, Deraz O, Périer MC, Valentin E, Fayosse A, Sabia S, Weiderpass E, Jouven X, Goldberg M, Zins M, Touvier M, Deschasaux-Tanguy M, Fezeu L, Hercberg S, Singh-Manoux A, Empana JP. Is the number of ideal cardiovascular health metrics in midlife associated with lower risk of cancer? Evidence from 3 European prospective cohorts. CMAJ Open 2023; 11:E774-E781. [PMID: 37607746 PMCID: PMC10449017 DOI: 10.9778/cmajo.20220175] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Primordial prevention may be a relevant strategy for the prevention of cancer. Given the commonality of risk factors and mechanisms between cancer and cardiovascular disease, we examined the associations between the number of ideal cardiovascular health metrics in midlife and incident cancer. METHODS In 3 European cohorts (NutriNet-Santé and GAZEL, France; Whitehall II, United Kingdom), the number of ideal cardiovascular health metrics was determined at baseline (range 0-7). Follow-up for cancer events was until October 2020 (NutriNet-Santé), March 2017 (Whitehall II) and December 2015 (GAZEL). Cox regression was conducted in each cohort, and results were thereafter pooled using a random-effects model. RESULTS Data were available on 39 718 participants. A total of 16 237 were from NutriNet-Santé (mean age 51.3 yr; 28% men), 9418 were from Whitehall II (mean age 44.8 yr; 68% men) and 14 063 were from GAZEL (mean age 45.2 yr; 75% men). The median follow-up was 8.1 years in NutriNet-Santé, 29.6 years in Whitehall II and 24.8 years in GAZEL, and yielded a total of 4889 cancer events. A greater number of ideal cardiovascular health metrics was associated with a lower overall cancer risk in each cohort, with an aggregate hazard ratio (HR) per 1 increment in number of ideal metrics of 0.91 (95% confidence interval [CI] 0.88-0.93). This association remained after removal of the smoking metric (aggregate HR per unit increment in number of ideal metrics: 0.94, 95% CI 0.90-0.97), and site-specific analysis demonstrated a significant association with lung cancer. INTERPRETATION A greater number of ideal cardiovascular health metrics in midlife was associated with lower cancer risk, notably lung cancer. Primordial prevention of cardiovascular risk factors in midlife may be a complementary strategy to prevent the onset of cancer.
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Affiliation(s)
- Thomas T van Sloten
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Rachel E D Climie
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Omar Deraz
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Marie-Cécile Périer
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Eugenie Valentin
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Aurore Fayosse
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Séverine Sabia
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Elisabete Weiderpass
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Marcel Goldberg
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Marie Zins
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Mathilde Touvier
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Mélanie Deschasaux-Tanguy
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Léopold Fezeu
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Serge Hercberg
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Archana Singh-Manoux
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
| | - Jean-Philippe Empana
- Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Institut national de la santé et de la recherche médicale, (INSERM) Unité Mixte de Recherche (UMR) S970 (van Sloten, Deraz, Périer, Valentin, Jouven, Empana), Université Paris Cité, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine (van Sloten), Maastricht University Medical Center, Maastricht, the Netherlands; Menzies Institute for Medical Research (Climie), University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute (Climie), Melbourne, Australia; Centre for Research in Epidemiology and Statistics, INSERM, UMR 1153 (Fayosse, Sabia, Singh-Manoux), Université Paris Cité, Paris, France; Department of Epidemiology and Public Health (Sabia, Singh-Manoux), University College London, London, UK; International Agency for Research in Cancer (Weiderpass), Lyon, France; Population-based Cohorts Unit (Goldberg, Zins), INSERM, Unité Mixte de Service (UMS) 011, Université Paris Cité, Paris Saclay University, Université de Versailles Saint-Quentin-en-Yvelines, Paris, France; Sorbonne Paris Nord University (Touvier, Deschasaux-Tanguy, Fezeu, Hercberg), INSERM, UMR 1153, Institut national de la recherche agronomique (INRAE) U1125, National Conservatory of Arts and Crafts, Nutritional Epidemiology Research Team, Epidemiology and Statistics Research Center - University of Paris, Bobigny, France
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7
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Le Cornu Q, Chen M, van Hees V, Léger D, Fayosse A, Yerramalla MS, Sabia S. Association of physical activity, sedentary behaviour, and daylight exposure with sleep in an ageing population: findings from the Whitehall accelerometer sub-study. Int J Behav Nutr Phys Act 2022; 19:144. [PMID: 36494722 PMCID: PMC9733167 DOI: 10.1186/s12966-022-01391-0] [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: 05/13/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Ageing is accompanied by changes in sleep, while poor sleep is suggested as a risk factor for several health outcomes. Non-pharmacological approaches have been proposed to improve sleep in elderly; their impact remains to be investigated. The aim of this study was to examine the independent day-to-day associations of physical behaviours and daylight exposure with sleep characteristics among older adults. METHODS Data were drawn from 3942 participants (age range: 60-83 years; 27% women) from the Whitehall II accelerometer sub-study. Day-to-day associations of objectively-assessed daytime physical behaviours (sedentary behaviour, light-intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA), mean acceleration, physical activity chronotype) and daylight exposure (proportion of waking window with light exposure > 1000 lx and light chronotype) with sleep characteristics were examined using mixed models. RESULTS A 10%-increase in proportion of the waking period spent sedentary was associated with 5.12-minute (4.31, 5.92) later sleep onset and 1.76-minute shorter sleep duration (95%confidence interval: 0.86, 2.66). Similar increases in LIPA and MVPA were associated with 6.69 (5.67, 7.71) and 4.15 (2.49, 5.81) earlier sleep onset respectively and around 2-minute longer sleep duration (2.02 (0.87, 3.17) and 2.23 (0.36, 4.11), respectively), although the association was attenuated for MVPA after adjustment for daylight exposure (1.11 (- 0.84, 3.06)). A 3-hour later physical activity chronotype was associated with a 4.79-minute later sleep onset (4.15, 5.43) and 2.73-minute shorter sleep duration (1.99, 3.47). A 10%-increase in proportion of waking period exposed to light> 1000 lx was associated with 1.36-minute longer sleep (0.69, 2.03), independently from mean acceleration. Associations found for sleep duration were also evident for duration of the sleep windows with slightly larger effect size (for example, 3.60 (2.37, 4.82) minutes for 10%-increase in LIPA), resulting in associations with sleep efficiency in the opposite direction (for example, - 0.29% (- 0.42, - 0.16) for 10%-increase in LIPA). Overall, associations were stronger for women than for men. CONCLUSIONS In this study, higher levels of physical activity and daylight exposure were associated with slightly longer sleep in older adults. Given the small effect sizes of the associations, increased physical activity and daylight exposure might not be enough to improve sleep.
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Affiliation(s)
- Quentin Le Cornu
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Mathilde Chen
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | | | - Damien Léger
- Department of Epidemiology and Public Health, University College London, London, UK.,APHP, Hôtel-Dieu, Consultation de pathologie professionnelle Sommeil Vigilance et Travail, Centre du Sommeil et de la Vigilance, Paris, France
| | - Aurore Fayosse
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Manasa S Yerramalla
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Séverine Sabia
- Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Université de Paris Cité, 10 avenue de Verdun, 75010, Paris, France. .,Department of Epidemiology and Public Health, University College London, London, UK.
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8
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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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Machado-Fragua MD, Fayosse A, Yerramalla MS, van Sloten TT, Tabak AG, Kivimaki M, Sabia S, Singh-Manoux A. Association of Metabolic Syndrome With Incident Dementia: Role of Number and Age at Measurement of Components in a 28-Year Follow-up of the Whitehall II Cohort Study. Diabetes Care 2022; 45:2127-2135. [PMID: 35819815 PMCID: PMC9472484 DOI: 10.2337/dc22-0206] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/31/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous research suggests an inconsistent association between Metabolic syndrome (MetS) and incident dementia. We examined the role of number of MetS components and age at their assessment for incident dementia. RESEARCH DESIGN AND METHODS MetS components (fasting glucose, triglycerides, waist circumference, blood pressure, and HDL cholesterol) on 7,265, 6,660, and 3,608 participants at <60, 60 to <70, and ≥70 years of age were used to examine associations with incident dementia using cause-specific Cox regression. RESULTS Analyses of MetS measured at <60, 60 to <70, and ≥70 years involved 393 (5.4%), 497 (7.5%), and 284 (7.9%) dementia cases over a median follow-up of 20.8, 10.4, and 4.2 years, respectively. Every additional MetS component before 60 (hazard ratio [HR] 1.13 [95% CI 1.05, 1.23]) and 60 to <70 (HR 1.08 [95% CI 1.00, 1.16]) but not ≥70 years (HR 1.04 [95% CI 0.96, 1.13]) was associated with higher dementia risk. MetS defined conventionally (≥3 components) before 60 years (HR 1.23 [95% CI 0.96, 1.57]), between 60 and 70 years (HR 1.14 [95% CI 0.91, 1.42]), or >70 years of age (HR 1.10 [95% CI 0.86, 1.40]) was not associated with incident dementia. Multistate models showed higher risk of dementia in those with ≥1 (HR 1.99 [95% CI 1.08, 3.66]) and ≥2 MetS components (HR 1.69 [95% CI 1.12, 2.56]) before 60 years of age, even when they remained free of cardiovascular disease over the follow-up. CONCLUSIONS Risk of incident dementia increases with every additional MetS component present in midlife rather than after accumulation of three components; only part of this risk is mediated by cardiovascular disease.
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Affiliation(s)
- Marcos D Machado-Fragua
- 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
| | - Manasa Shanta Yerramalla
- INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Thomas T van Sloten
- School for Cardiovascular Diseases (CARIM) and Department of Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Adam G Tabak
- Department of Epidemiology and Public Health, University College London, London, U.K.,Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary.,Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, U.K
| | - 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, U.K
| | - 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, U.K
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10
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Chen M, Yerramalla MS, van Hees VT, Bloomberg M, Landré B, Fayosse A, Benadjaoud MA, Sabia S. Individual Barriers to an Active Lifestyle at Older Ages Among Whitehall II Study Participants After 20 Years of Follow-up. JAMA Netw Open 2022; 5:e226379. [PMID: 35389501 PMCID: PMC8990327 DOI: 10.1001/jamanetworkopen.2022.6379] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Identification of individual-level barriers associated with decreased activity in older age is essential to inform effective strategies for preventing the health outcomes associated with high sedentary behavior and lack of physical activity during aging. OBJECTIVE To assess cross-sectional and prospective associations of a large set of factors with objectively assessed sedentary time and physical activity at older age. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted among participants in the Whitehall II accelerometer substudy with accelerometer data assessed in 2012 to 2013. Among 4880 participants invited to the accelerometer substudy, 4006 individuals had valid accelerometer data. Among them, 3808 participants also had factors assessed in 1991 to 1993 (mean [SD] follow-up time, 20.3 [0.5] years), 3782 participants had factors assessed in 2002 to 2004 (mean [SD] follow-up time, 9.1 [0.3] years), and 3896 participants had factors assessed in 2012 to 2013 (mean follow up time, 0 years). Data were analyzed from May 2020 through July 2021. EXPOSURES Sociodemographic factors (ie, age, sex, race and ethnicity, occupational position, and marital status), behavioral factors (ie, smoking, alcohol intake, and fruit and vegetable intake), and health-related factors (ie, body mass index, 36-Item Short Form Health Survey (SF-36) physical and mental component summary scores [PCS and MCS], and number of chronic conditions) were assessed among 3808 individuals in 1991 to 1993; 3782 individuals in 2002 to 2004; and 3896 individuals in 2012 to 2013. High alcohol intake was defined as more than 14 units of alcohol per week, and high fruit and vegetable intake was defined as twice daily or more. MAIN OUTCOMES AND MEASURES Accelerometer-assessed time spent in sedentary behavior, light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA) in 2012 to 2013 were analyzed in 2021 using multivariate linear regressions. RESULTS A total of 3896 participants (986 [25.3%] women; age range, 60-83 years; mean [SD] age, 69.4 [5.7] years) had accelerometer data and exposure factors available in 2012 to 2013. Older age, not being married or cohabiting, having overweight, having obesity, more chronic conditions, and poorer SF-36 PCS, assessed in midlife or later life, were associated with increased sedentary time at the expense of time in physical activity. Mean time differences ranged from 9.8 min/d (95% CI, 4.1 to 15.6 min/d) of sedentary behavior per 10-point decrease in SF-36 PCS to 51.4 min/d (95% CI, 37.2 to65.7 min/d) of sedentary behavior for obesity vs reference range weight, from -6.2 min/d (95% CI, -8.4 to -4.1 min/d) of LIPA per 5 years of age to -28.0 min/d (95% CI, -38.6 to -17.4 min/d) of LIPA for obesity vs reference range weight, and from -5.3 min/d (95% CI, -8.2 to -2.4 min/d) of MVPA per new chronic condition to -23.4 min/d (95% CI, -29.2 to -17.6 min/d) of MVPA for obesity vs reference range weight in 20-year prospective analyses for men. There was also evidence of clustering of behavioral factors: high alcohol intake, high fruit and vegetable consumption, and no current smoking were associated with decreased sedentary time (mean time difference in cross-sectional analysis in men: -12.7 min/d [95% CI, -19.8 to -5.5 min/d]; -6.0 min/d [95% CI, -12.3 to -0.2]; and -37.4 min/d [95% CI, - 56.0 to -18.8 min/d], respectively) and more physical activity. CONCLUSIONS AND RELEVANCE This study found a large range of individual-level barriers associated with a less active lifestyle in older age, including sociodemographic, behavioral, and health-related factors. These barriers were already evident in midlife, suggesting the importance of early implementation of targeted interventions to promote physical activity and reduce sedentary time.
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Affiliation(s)
- Mathilde Chen
- Centre of Research in Epidemiology and Statistics, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Manasa S. Yerramalla
- Centre of Research in Epidemiology and Statistics, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | | | - Mikaela Bloomberg
- Department of Epidemiology and Public Health, University College London, United Kingdom
| | - Benjamin Landré
- Centre of Research in Epidemiology and Statistics, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Aurore Fayosse
- Centre of Research in Epidemiology and Statistics, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Mohamed Amine Benadjaoud
- Department of Radiobiology and Regenerative Medicine, Institute for Radiological Protection and Nuclear Safety, Fontenay-Aux-Roses, France
| | - Séverine Sabia
- Centre of Research in Epidemiology and Statistics, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
- Department of Epidemiology and Public Health, University College London, United Kingdom
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11
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Yerramalla MS, van Hees VT, Chen M, Fayosse A, Chastin SFM, Sabia S. Objectively Measured Total Sedentary Time and Pattern of Sedentary Accumulation in Older Adults: Associations With Incident Cardiovascular Disease and All-Cause Mortality. J Gerontol A Biol Sci Med Sci 2022; 77:842-850. [PMID: 35094083 PMCID: PMC8974336 DOI: 10.1093/gerona/glac023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We examined associations of total duration and pattern of accumulation of objectively measured sedentary behavior (SB) with incident cardiovascular disease (CVD) and all-cause mortality among older adults. METHODS Total sedentary time and 8 sedentary accumulation pattern metrics were extracted from accelerometer data of 3 991 Whitehall II study participants aged 60-83 years in 2012-2013. Incident CVD and all-cause mortality were ascertained up to March 2019. RESULTS Two hundred and ninety-nine CVD cases and 260 deaths were recorded over a mean (standard deviation [SD]) follow-up of 6.2 (1.3) and 6.4 (0.8) years, respectively. Adjusting for sociodemographic and behavioral factors, 1-SD (100.2 minutes) increase in total sedentary time was associated with 20% higher CVD risk (hazard ratio [95% confidence interval]: 1.20 [1.05-1.37]). More fragmented SB was associated with reduced CVD risk (eg, 0.86 [0.76-0.97] for 1-SD [6.2] increase in breaks per sedentary hour). Associations were not evident once health-related factors and moderate-to-vigorous physical activity (MVPA) were considered. For all-cause mortality, associations with more fragmented SB (eg, 0.73 [0.59-0.91] for breaks per sedentary hour) were found only among the youngest older group (<74 years; p for interaction with age < .01) independently from all covariates. CONCLUSIONS In this study, no associations of total sedentary time and sedentary accumulation patterns with incident CVD and all-cause mortality were found in the total sample once MVPA was considered. Our findings of reduced mortality risk with less total and more fragmented SB independent from MVPA among individuals <74 years need to be replicated to support the recent recommendations to reduce and fragment SB.
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Affiliation(s)
- Manasa Shanta Yerramalla
- Université de Paris, INSERM U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris,France
| | | | - Mathilde Chen
- 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
| | - Sebastien F M Chastin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - 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
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12
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Ben Hassen C, Fayosse A, Landré B, Raggi M, Bloomberg M, Sabia S, Singh-Manoux A. Association between age at onset of multimorbidity and incidence of dementia: 30 year follow-up in Whitehall II prospective cohort study. BMJ 2022; 376:e068005. [PMID: 35110302 PMCID: PMC9086721 DOI: 10.1136/bmj-2021-068005] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 12/12/2022]
Abstract
OBJECTIVE To examine the association of midlife and late life multimorbidity, including severity of multimorbidity, with incident dementia. DESIGN Prospective cohort study. SETTING Civil service departments in London (Whitehall II study, study inception in 1985-88). PARTICIPANTS 10 095 participants, aged 35 to 55 at baseline. MAIN OUTCOME MEASURE Incident dementia at follow-up between 1985 and 2019. Cause specific Cox proportional hazards regression was used to examine the association of multimorbidity overall and at age 55, 60, 65, and 70 with subsequent dementia, taking into account the competing risk of death. RESULTS The prevalence of multimorbidity (≥2 chronic diseases) was 6.6% (655/9937) at age 55 and 31.7% (2464/7783) at age 70; 639 cases of incident dementia occurred over a median follow-up of 31.7 years. After adjustment for sociodemographic factors and health behaviours, multimorbidity at age 55 was associated with subsequent risk of dementia (difference in incidence rate per 1000 person years 1.56, 95% confidence interval 0.62 to 2.77; hazard ratio 2.44, 95% confidence interval 1.82 to 3.26). The association weakened progressively with older age at onset of multimorbidity. At age 65, onset of multimorbidity before age 55 was associated with 3.86 (1.80 to 6.52) per 1000 person years higher incidence of dementia (hazard ratio 2.46, 1.80 to 2.26) and onset between 60 and 65 was associated with 1.85 (0.64 to 3.39) per 1000 person years higher incidence (1.51, 1.16 to 1.97). Severity of multimorbidity (≥3 chronic diseases) at age 55 was associated with a 5.22 (1.14 to 11.95) per 1000 person years higher incidence of dementia (hazard ratio 4.96, 2.54 to 9.67); the same analyses at age 70 showed 4.49 (2.33 to 7.19) per 1000 person years higher incidence (1.65, 1.25 to 2.18). CONCLUSION Multimorbidity, particularly when onset is in midlife rather than late life, has a robust association with subsequent dementia. The increasingly younger age at onset of multimorbidity makes prevention of multimorbidity in people with a first chronic disease important.
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Affiliation(s)
- Céline Ben Hassen
- 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
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Martina Raggi
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mikaela Bloomberg
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - 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
| | - 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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13
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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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Singh-Manoux A, Oumarou-Ibrahim A, Machado-Fragua MD, Dumurgier J, Brunner EJ, Kivimaki M, Fayosse A, Sabia S. Association between kidney function and incidence of dementia: 10-year follow-up of the Whitehall II cohort study. Age Ageing 2022; 51:afab259. [PMID: 35061870 PMCID: PMC8782607 DOI: 10.1093/ageing/afab259] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/27/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cognitive dysfunction is common in haemodialysis patients but whether poor kidney function in the general population is also associated with higher risk of dementia remains unclear. OBJECTIVE To examine the association of kidney function with incident dementia in community dwelling older adults. DESIGN Whitehall II prospective study. SETTING Population-based study on 6,050 adults, mean age 65.8 in 2007-2009. METHODS Poor kidney function, defined as estimated Glomerular Filtration Rate (eGFR) <60 ml/min/1.73 m2 in 2007-2009, and adverse change in eGFR was defined as decrease ≥4 ml/min/1.73 m2 between 2007-2009 and 2012-2013.Incident dementia was ascertained through linkage to electronic health records, and Cox regression was used to examine associations with dementia. RESULTS A total of 306 cases of dementia were recorded over a mean follow-up of 10 years. Baseline eGFR <60 was associated with a hazard ratio (HR) for dementia of 1.37 (95% CI 1.02, 1.85) in analysis adjusted for sociodemographic factors, hypertension, obesity, stroke, diabetes and cardiovascular disease/medication. Removing stroke cases at baseline and censoring them over the follow-up yielded an HR of 1.42 (95% CI 1.00, 2.00) for the association between CKD and dementia. Decline of eGFR ≥4 between 2007-2009 and 2012-2013 was associated with incidence of dementia over a 6.3 year mean follow-up (HR: 1.37; 95% CI 1.02, 1.85), with somewhat stronger associations when analyses were restricted to those with eGFR ≥60 in 2007-2009 (1.56; 95% CI: 1.12, 2.19). CONCLUSION Poor and declining kidney function in older adults is associated with a higher risk of dementia that is not attributable to stroke and persists after accounting for major cardiometabolic conditions.
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Affiliation(s)
- 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
| | - Amina Oumarou-Ibrahim
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Marcos D Machado-Fragua
- 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
- Cognitive Neurology Center, Lariboisière – Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Erics J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
- Helsinki Institute of Life Sciences, University of Helsinki, Helsinki, Finland
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Sèverine 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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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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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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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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Barbiellini Amidei C, Fayosse A, Singh-Manoux A. Age at Diabetes Onset and Subsequent Risk of Dementia-Reply. JAMA 2021; 326:871-872. [PMID: 34547086 DOI: 10.1001/jama.2021.10488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Aurore Fayosse
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
| | - Archana Singh-Manoux
- Epidemiology of Ageing and Neurodegenerative Diseases, Université de Paris, Paris, France
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Landré B, Fayosse A, Ben Hassen C, Machado-Fragua MD, Dumurgier J, Kivimaki M, Sabia S, Singh-Manoux A. Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study. BMJ 2021; 374:n1743. [PMID: 34348957 PMCID: PMC8336001 DOI: 10.1136/bmj.n1743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 02/06/2023]
Abstract
OBJECTIVES To examine multiple objective and self-reported measures of motor function for their associations with mortality. DESIGN Prospective cohort study. SETTING UK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88; motor function component was added at the 2007-09 wave. PARTICIPANTS 6194 participants with motor function measures in 2007-09 (mean age 65.6, SD 5.9), 2012-13, and 2015-16. MAIN OUTCOME MEASURES All cause mortality between 2007 and 2019 in relation to objective measures (walking speed, grip strength, and timed chair rises) and self-reported measures (physical component summary score of the SF-36 and limitations in basic and instrumental activities of daily living (ADL)) of motor function. RESULTS One sex specific standard deviation poorer motor function in 2007-09 (cases/total, 610/5645) was associated with an increased mortality risk of 22% (95% confidence interval 12% to 33%) for walking speed, 15% (6% to 25%) for grip strength, 14% (7% to 23%) for timed chair rises, and 17% (8% to 26%) for physical component summary score over a mean 10.6 year follow-up. Having basic/instrumental ADL limitations was associated with a 30% (7% to 58%) increased mortality risk. These associations were progressively stronger when measures were drawn from 2012-13 (mean follow-up 6.8 years) and 2015-16 (mean follow-up 3.7 years). Analysis of trajectories showed poorer motor function in decedents (n=484) than survivors (n=6194) up to 10 years before death for timed chair rises (standardised difference 0.35, 95% confidence interval 0.12 to 0.59; equivalent to a 1.2 (men) and 1.3 (women) second difference), nine years for walking speed (0.21, 0.05 to 0.36; 5.5 (men) and 5.3 (women) cm/s difference), six years for grip strength (0.10, 0.01 to 0.20; 0.9 (men) and 0.6 (women) kg difference), seven years for physical component summary score (0.15, 0.05 to 0.25; 1.2 (men) and 1.6 (women) score difference), and four years for basic/instrumental ADL limitations (prevalence difference 2%, 0% to 4%). These differences increased in the period leading to death for timed chair rises, physical component summary score, and ADL limitations. CONCLUSION Motor function in early old age has a robust association with mortality, with evidence of terminal decline emerging early in measures of overall motor function (timed chair rises and physical component summary score) and late in basic/instrumental ADL limitations.
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Affiliation(s)
- Benjamin Landré
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Céline Ben Hassen
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Marcos D Machado-Fragua
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Cognitive Neurology Center, Lariboisière - Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Université de Paris, 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 de Paris, 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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20
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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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21
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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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22
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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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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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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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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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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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28
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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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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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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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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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