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Aubert CE, Floriani C, Bauer DC, da Costa BR, Segna D, Blum MR, Collet TH, Fink HA, Cappola AR, Syrogiannouli L, Peeters RP, Åsvold BO, den Elzen WPJ, Luben RN, Bremner AP, Gogakos A, Eastell R, Kearney PM, Hoff M, Le Blanc E, Ceresini G, Rivadeneira F, Uitterlinden AG, Khaw KT, Langhammer A, Stott DJ, Westendorp RGJ, Ferrucci L, Williams GR, Gussekloo J, Walsh JP, Aujesky D, Rodondi N. Thyroid Function Tests in the Reference Range and Fracture: Individual Participant Analysis of Prospective Cohorts. J Clin Endocrinol Metab 2017; 102:2719-2728. [PMID: 28482002 PMCID: PMC6283437 DOI: 10.1210/jc.2017-00294] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 01/31/2017] [Accepted: 04/26/2017] [Indexed: 01/07/2023]
Abstract
CONTEXT Hyperthyroidism is associated with increased fracture risk, but it is not clear if lower thyroid-stimulating hormone (TSH) and higher free thyroxine (FT4) in euthyroid individuals are associated with fracture risk. OBJECTIVE To evaluate the association of TSH and FT4 with incident fractures in euthyroid individuals. DESIGN Individual participant data analysis. SETTING Thirteen prospective cohort studies with baseline examinations between 1981 and 2002. PARTICIPANTS Adults with baseline TSH 0.45 to 4.49 mIU/L. MAIN OUTCOME MEASURES Primary outcome was incident hip fracture. Secondary outcomes were any, nonvertebral, and vertebral fractures. Results were presented as hazard ratios (HRs) with 95% confidence interval (CI) adjusted for age and sex. For clinical relevance, we studied TSH according to five categories: 0.45 to 0.99 mIU/L; 1.00 to 1.49 mIU/L; 1.50 to 2.49 mIU/L; 2.50 to 3.49 mIU/L; and 3.50 to 4.49 mIU/L (reference). FT4 was assessed as study-specific standard deviation increase, because assays varied between cohorts. RESULTS During 659,059 person-years, 2,565 out of 56,835 participants had hip fracture (4.5%; 12 studies with data on hip fracture). The pooled adjusted HR (95% CI) for hip fracture was 1.25 (1.05 to 1.49) for TSH 0.45 to 0.99 mIU/L, 1.19 (1.01 to 1.41) for TSH 1.00 to 1.49 mIU/L, 1.09 (0.93 to 1.28) for TSH 1.50 to 2.49 mIU/L, and 1.12 (0.94 to 1.33) for TSH 2.50 to 3.49 mIU/L (P for trend = 0.004). Hip fracture was also associated with FT4 [HR (95% CI) 1.22 (1.11 to 1.35) per one standard deviation increase in FT4]. FT4 only was associated with any and nonvertebral fractures. Results remained similar in sensitivity analyses. CONCLUSIONS Among euthyroid adults, lower TSH and higher FT4 are associated with an increased risk of hip fracture. These findings may help refine the definition of optimal ranges of thyroid function tests.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Carmen Floriani
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California 94143
| | - Bruno R da Costa
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin), University of Bern, 3012 Bern, Switzerland
- Department of Cardiology, Swiss Cardiovascular Center Bern, Bern University Hospital, 3010 Bern, Switzerland
| | - Daniel Segna
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes, and Metabolism, University Hospital of Lausanne, 1011 Lausanne, Switzerland
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota 55417
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota 55455
| | - Anne R Cappola
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104
| | - Lamprini Syrogiannouli
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin), University of Bern, 3012 Bern, Switzerland
| | - Robin P Peeters
- Departments of Internal Medicine and Epidemiology, Erasmus University Rotterdam, 3062 Rotterdam, The Netherlands
| | - Bjørn O Åsvold
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, N-7006 Trondheim, Norway
| | - Wendy P J den Elzen
- Leiden University Medical Center, Department of Clinical Chemistry and Laboratory Medicine, 2300 RC Leiden, The Netherlands
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR, United Kingdom
| | - Alexandra P Bremner
- School of Population Health, University of Western Australia, Crawley, Perth, Western Australia 6009, Australia
| | - Apostolos Gogakos
- Molecular Endocrinology Laboratory, Hammersmith Campus, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom
| | - Richard Eastell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, South Yorkshire S10 2TN, United Kingdom
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, T12 PX46 Cork, Ireland
| | - Mari Hoff
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway
| | - Erin Le Blanc
- Center for Health Research NW, Kaiser Permanente, Portland, Oregon 97277
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Fernando Rivadeneira
- Departments of Internal Medicine and Epidemiology, Erasmus University Rotterdam, 3062 Rotterdam, The Netherlands
| | - André G Uitterlinden
- Departments of Internal Medicine and Epidemiology, Erasmus University Rotterdam, 3062 Rotterdam, The Netherlands
| | - Kay-Tee Khaw
- School of Population Health, University of Western Australia, Crawley, Perth, Western Australia 6009, Australia
| | - Arnulf Langhammer
- Department of Public Health and Nursing, Norges teknisk-naturvitenskapelige universitet, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G31 2ER, United Kingdom
| | - Rudi G J Westendorp
- Department of Public Health, Center for Health Aging, University of Copenhagen, 1004 Copenhagen, Denmark
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland 21224
| | - Graham R Williams
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, South Yorkshire S10 2TN, United Kingdom
| | - Jacobijn Gussekloo
- Leiden University Medical Center, Department of Clinical Chemistry and Laboratory Medicine, 2300 RC Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Perth, Western Australia 6009, Australia
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin), University of Bern, 3012 Bern, Switzerland
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10
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Rieben C, Segna D, da Costa BR, Collet TH, Chaker L, Aubert CE, Baumgartner C, Almeida OP, Hogervorst E, Trompet S, Masaki K, Mooijaart SP, Gussekloo J, Peeters RP, Bauer DC, Aujesky D, Rodondi N. Subclinical Thyroid Dysfunction and the Risk of Cognitive Decline: a Meta-Analysis of Prospective Cohort Studies. J Clin Endocrinol Metab 2016; 101:4945-4954. [PMID: 27689250 PMCID: PMC6287525 DOI: 10.1210/jc.2016-2129] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [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: 12/17/2022]
Abstract
CONTEXT Although both overt hyper- and hypothyroidism are known to lead to cognitive impairment, data on the association between subclinical thyroid dysfunction and cognitive function are conflicting. OBJECTIVE This study sought to determine the risk of dementia and cognitive decline associated with subclinical thyroid dysfunction among prospective cohorts. DATA SOURCES We searched in MEDLINE and EMBASE from inception until November 2014. STUDY SELECTION Two physicians identified prospective cohorts that assessed thyroid function and cognitive outcomes (dementia; Mini-Mental State Examination [MMSE]). DATA EXTRACTION Data were extracted by one reviewer following standardized protocols and verified by a second reviewer. The primary outcome was dementia and decline in cognitive function was the secondary outcome. DATA SYNTHESIS Eleven prospective cohorts followed 16,805 participants during a median followup of 44.4 months. Five studies analyzed the risk of dementia in subclinical hyperthyroidism (SHyper) (n = 6410), six in subclinical hypothyroidism (SHypo) (n = 7401). Five studies analyzed MMSE decline in SHyper (n = 7895), seven in SHypo (n = 8960). In random-effects models, the pooled adjusted risk ratio for dementia in SHyper was 1.67 (95% confidence interval, 1.04; 2.69) and 1.14 (95% confidence interval, 0.84; 1.55) in SHypo vs euthyroidism, both without evidence of significant heterogeneity (I2 = 0.0%). The pooled mean MMSE decline from baseline to followup (mean 32 mo) did not significantly differ between SHyper or SHypo vs euthyroidism. CONCLUSIONS SHyper might be associated with an elevated risk for dementia, whereas SHypo is not, and both conditions are not associated with faster decline in MMSE over time. Available data are limited, and additional large, high-quality studies are needed.
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Affiliation(s)
- Carole Rieben
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Daniel Segna
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Bruno R da Costa
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Tinh-Hai Collet
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Layal Chaker
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Carole E Aubert
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Christine Baumgartner
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Osvaldo P Almeida
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Eef Hogervorst
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Stella Trompet
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Kamal Masaki
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Simon P Mooijaart
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Jacobijn Gussekloo
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Robin P Peeters
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Douglas C Bauer
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Drahomir Aujesky
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
| | - Nicolas Rodondi
- Department of General Internal Medicine (C.R., D.S., C.E.A., C.B., D.A., N.R.), Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland; Institute of Primary Health Care (BIHAM), Faculty of Medicine (B.R.d.C., N.R.), University of Bern, 3012 Bern, Switzerland; Service of Endocrinology, Diabetes and Metabolism (T.-H.C.), University Hospital of Lausanne, 1011 Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories (T.-H.C.), Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom; Department of Epidemiology (L.C., R.P.P.), Rotterdam Thyroid Center, 3015 GE Rotterdam, The Netherlands; School of Psychiatry and Clinical Neurosciences (O.P.A.), University of Western Australia, Perth 6009, Australia; School of Sport, Exercise and Health Sciences (E.H.), Loughborough University, Loughborough LE11 3TU, United Kingdom; Department of Cardiology (S.T.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; Kuakini Medical Center and the Department of Geriatric Medicine (K.M.), John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96817; Department of Gerontology and Geriatrics (S.P.M.), Leiden University Medical Center, Leiden and Institute for Evidence-based Medicine in Old Age (IEMO), 2333 ZA Leiden, The Netherlands; Department of Public Health and Primary Care (J.G.), Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; and Department of Medicine (D.C.B.), University of California-San Francisco, San Francisco California 94143
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