1
|
Beelen NA, Molenbroeck SJJ, Groeneveld L, Voorter CE, Bos GMJ, Wieten L. HLA class I NK-epitopes and KIR diversities in patients with multiple myeloma. Immunogenetics 2024; 76:155-164. [PMID: 38478091 PMCID: PMC11087314 DOI: 10.1007/s00251-024-01336-w] [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: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 05/12/2024]
Abstract
Multiple myeloma (MM) is a hematological malignancy caused by the clonal expansion of malignant plasma cells in the bone marrow. Myeloma cells are susceptible to killing by natural killer (NK) cells, but NK cells fail to control disease progression, suggesting immunosuppression. The activation threshold of NK-effector function is regulated by interaction between KIRs and self-HLA class I, during a process called "education" to ensure self-tolerance. NK cells can respond to diseased cells based on the absence of HLA class I expression ("Missing-self" hypothesis). The HLA and KIR repertoire is extremely diverse; thus, the present study aimed to characterize potential variances in genotypic composition of HLA Class I NK-epitopes and KIRs between MM patients and healthy controls. Genotypic expression of KIR and HLA (HLA-C group-C1/C2 and Bw4 motifs (including HLA-A*23, A*24, A*32) were analyzed in 172 MM patients and 195 healthy controls. Compared to healthy controls, we did not observe specific KIR genes or genotypes, or HLA NK-epitopes with higher prevalence among MM patients. The presence of all three HLA NK-epitopes (C1+C2+Bw4+) was not associated with MM occurrence. However, MM patients were more likely to be C1-/C2+/Bw4+ (p = 0.049, OR 1.996). In line with this, there was a trend of increased genetic co-occurrence of Bw4 and KIR3DL1 in MM patients (p = 0.05, OR 1.557). Furthermore, MM patients were more likely to genetically express both C2/KIR2DL1 and Bw4/KIR3DL1 (p = 0.019, OR 2.453). Our results reveal an HLA NK-epitope combination that is associated with the occurrence of MM. No specific KIR genotypes were associated with MM.
Collapse
Affiliation(s)
- Nicky A Beelen
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Stefan J J Molenbroeck
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Lisette Groeneveld
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Christien E Voorter
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gerard M J Bos
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - Lotte Wieten
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
- Department of Transplantation Immunology, Tissue Typing Laboratory, Maastricht University Medical Center+, Maastricht, the Netherlands.
| |
Collapse
|
2
|
Lear R, Metcalf B, Hillsdon M, Bond B, Koster A, Vandercappellen E, de Galan B, Berendschot TTJM, Houben A, Kooman J, Kroon AA, Bosma H, Eussen SJPM, Pulsford R. Associations of between- and within-day patterns of physical activity accumulation with arterial stiffness and indices of microvascular health-Evidence from The Maastricht study. Scand J Med Sci Sports 2024; 34:e14649. [PMID: 38757450 DOI: 10.1111/sms.14649] [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: 12/30/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024]
Abstract
While physical activity (PA) is understood to promote vascular health, little is known about whether the daily and weekly patterns of PA accumulation associate with vascular health. Accelerometer-derived (activPAL3) 6- or 7-day stepping was analyzed for 6430 participants in The Maastricht Study (50.4% women; 22.4% Type 2 diabetes mellitus (T2DM)). Multivariable regression models examined associations between stepping metrics (average step count, and time spent slower and faster paced stepping) with arterial stiffness (measured as carotid-femoral pulse wave velocity (cfPWV)), and several indices of microvascular health (heat-induced skin hyperemia, retinal vessel reactivity and diameter), adjusting for confounders and moderators. PA pattern metrics were added to the regression models to identify associations with vascular health beyond that of stepping metrics. Analyses were stratified by T2DM status if an interaction effect was present. Average step count and time spent faster paced stepping was associated with better vascular health, and the association was stronger in those with compared to those without T2DM. In fully adjusted models a higher step count inter-daily stability was associated with a higher (worse) cfPWV in those without T2DM (std β = 0.04, p = 0.007) and retinal venular diameter in the whole cohort (std β = 0.07, p = 0.002). A higher within-day variability in faster paced stepping was associated with a lower (worse) heat-induced skin hyperemia in those with T2DM (std β = -0.31, p = 0.008). Above and beyond PA volume, the daily and weekly patterns in which PA was accumulated were additionally associated with improved macro- and microvascular health, which may have implications for the prevention of vascular disease.
Collapse
Affiliation(s)
- Rebecca Lear
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, Devon, UK
| | - Brad Metcalf
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, Devon, UK
| | - Melvyn Hillsdon
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, Devon, UK
| | - Bert Bond
- Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, University of Exeter, Exeter, Devon, UK
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Evelien Vandercappellen
- Department of Internal Medicine and Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bastiaan de Galan
- Department of Internal Medicine and School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Alfons Houben
- Department of Internal Medicine and School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jeroen Kooman
- Department of Internal Medicine, Division of Nephrology, NUTRIM Research Institute, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine and School for Cardiovascular Diseases CARIM, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
| | - Richard Pulsford
- Department of Public Health and Sports Sciences, University of Exeter, Exeter, Devon, UK
| |
Collapse
|
3
|
Hodzelmans JJA, Janssen MLF, Reulen JPH, Blijham PJ, Koster A, Stehouwer CDA, Mess WH, Sutedja NA. Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population-based cohort: Associations with demographic and anthropometric characteristics-The Maastricht study. Muscle Nerve 2024; 69:588-596. [PMID: 38459960 DOI: 10.1002/mus.28076] [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: 07/03/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION/AIMS Nerve conduction studies (NCSs) are widely used to support the clinical diagnosis of neuromuscular disorders. The aims of this study were to obtain reference values for peroneal, tibial, and sural NCSs and to examine the associations with demographic and anthropometric factors. METHODS In 5099 participants (aged 40-79 years) without type 2 diabetes of The Maastricht Study, NCSs of peroneal, tibial, and sural nerves were performed. Values for compound muscle action potential (CMAP) and sensory nerve action potential amplitude, nerve conduction velocity (NCV), and distal latency were acquired. The association of age, sex, body mass index (BMI), and height with NCS values was determined using uni- and multivariate linear regression analyses. RESULTS Detailed reference values are reported per decade for men and women. Significantly lower NCVs and longer distal latencies were observed in all nerves in older and taller individuals as well as in men. In these groups, amplitudes of the tibial and sural nerves were significantly lower, whereas a lower peroneal nerve CMAP was only significantly associated with age. BMI showed a multidirectional association. After correction for anthropometric factors in the multivariate analysis, the association between sex and NCS values was less straightforward. DISCUSSION These values from a population-based dataset could be used as a reference for generating normative values. Our findings show the association of NCS values with anthropometric factors. In clinical practice, these factors can be considered when interpreting NCS values.
Collapse
Affiliation(s)
- Jurriaan J A Hodzelmans
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcus L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Jos P H Reulen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul J Blijham
- Department of Clinical Neurophysiology, Máxima Medical Center, Veldhoven, The Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - Werner H Mess
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nadia A Sutedja
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
4
|
Gigic B, van Roekel E, Holowatyj AN, Brezina S, Geijsen AJMR, Ulvik A, Ose J, Koole JL, Damerell V, Kiblawi R, Gumpenberger T, Lin T, Kvalheim G, Koelsch T, Kok DE, van Duijnhoven FJ, Bours MJ, Baierl A, Li CI, Grady W, Vickers K, Habermann N, Schneider M, Kampman E, Ueland PM, Ulrich A, Weijenberg M, Gsur A, Ulrich C. Cohort profile: Biomarkers related to folate-dependent one-carbon metabolism in colorectal cancer recurrence and survival - the FOCUS Consortium. BMJ Open 2022; 12:e062930. [PMID: 36549742 PMCID: PMC9772678 DOI: 10.1136/bmjopen-2022-062930] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The overarching goal of the FOCUS (biomarkers related to folate-dependent one-carbon metabolism in colorectal cancer (CRC) recurrence and survival) Consortium is to unravel the effect of folate and folate-mediated one-carbon metabolism (FOCM) biomarkers on CRC prognosis to provide clinically relevant advice on folate intake to cancer patients and define future tertiary prevention strategies. PARTICIPANTS The FOCUS Consortium is an international, prospective cohort of 2401 women and men above 18 years of age who were diagnosed with a primary invasive non-metastatic (stages I-III) CRC. The consortium comprises patients from Austria, two sites from the Netherlands, Germany and two sites from the USA. Patients are recruited after CRC diagnosis and followed at 6 and 12 months after enrolment. At each time point, sociodemographic data, data on health behaviour and clinical data are collected, blood samples are drawn. FINDINGS TO DATE An increased risk of cancer recurrences was observed among patients with higher compared with lower circulating folic acid concentrations. Furthermore, specific folate species within the FOCM pathway were associated with both inflammation and angiogenesis pathways among patients with CRC. In addition, higher vitamin B6 status was associated with better quality of life at 6 months post-treatment. FUTURE PLANS Better insights into the research on associations between folate and FOCM biomarkers and clinical outcomes in patients with CRC will facilitate the development of guidelines regarding folate intake in order to provide clinically relevant advice to patients with cancer, health professionals involved in patient care, and ultimately further tertiary prevention strategies in the future. The FOCUS Consortium offers an excellent infrastructure for short-term and long-term research projects and for combining additional biomarkers and data resulting from the individual cohorts within the next years, for example, microbiome data, omics and multiomics data or CT-quantified body composition data.
Collapse
Affiliation(s)
- Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Eline van Roekel
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andreana N Holowatyj
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Stefanie Brezina
- Center for Cancer Research, Medical University of Vienna, Wien, Austria
| | - Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Janna L Koole
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Victoria Damerell
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Rama Kiblawi
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | | | - Torsten Koelsch
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Franzel J van Duijnhoven
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Martijn J Bours
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Wien, Austria
| | - Christopher I Li
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - William Grady
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathy Vickers
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Nina Habermann
- Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | | | - Alexis Ulrich
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
- Surgical Department I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Matty Weijenberg
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Andrea Gsur
- Center for Cancer Research, Medical University of Vienna, Wien, Austria
| | - Cornelia Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
5
|
Clemmensen KKB, Koster A, Nielen YTH, Dagnelie PC, Stehouwer CDA, Bosma H, Wesselius A, Færch K, Eussen SJPM. Role of Weekday Variation on Glucose, Insulin, and Triglyceride: A Cross-Sectional Analysis From the Maastricht Study. J Clin Endocrinol Metab 2022; 107:e3145-e3151. [PMID: 35575196 PMCID: PMC9797041 DOI: 10.1210/clinem/dgac286] [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: 11/20/2021] [Indexed: 01/05/2023]
Abstract
CONTEXT The timing of sleep, physical activity, and dietary intake show variation over the week, with different timings in the weekend compared to the weekdays, which may potentially lead to impaired glucose and lipid regulation on Mondays compared to other weekdays. OBJECTIVE The aim of the study was to investigate differences in glucose metabolism and fasting triglyceride concentrations on Mondays compared to the rest of the week. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study is based on data from the Maastricht Study, including 6067 participants without known diabetes and 1568 previously diagnosed with type 2 diabetes. MAIN OUTCOME MEASURES Confounder-adjusted linear regression analysis was applied to study the associations of day of the week of examination with glucose and insulin responses to an oral glucose tolerance test and fasting triglyceride concentrations. RESULTS In fully confounder-adjusted models, mean (95% CI) concentrations of fasting glucose, insulin, and triglycerides were slightly higher on Mondays compared with the other weekdays [glucose: 1% (0-2); insulin: 9% (1-18); triglycerides: 5% (2-8)]. Interaction analyses revealed that the association of weekday with insulin was only pronounced in men [18% (3-35)], but not in women [1% (-8-10)], whereas the associations with glucose and triglycerides were only apparent for individuals with known type 2 diabetes [glucose: 4% (0-7); triglycerides: 14% (6-23)] compared to the background population [glucose: 0% (0-1); triglycerides: 3% (0-6)]. DISCUSSION Being examined on a Monday was associated with higher fasting insulin concentrations among men but not women.
Collapse
Affiliation(s)
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- School for Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Yannick T H Nielen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Coen D A Stehouwer
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- School for Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anke Wesselius
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Kristine Færch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Simone J P M Eussen
- Correspondence: Simone JPM Eussen, PhD, Department of Epidemiology, School for Cardiovascular Diseases (CARIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands. E-mail:
| |
Collapse
|
6
|
Vandercappellen EJ, Koster A, Savelberg HHCM, Eussen SJPM, Dagnelie PC, Schaper NC, Schram MT, van der Kallen CJH, van Greevenbroek MMJ, Wesselius A, Schalkwijk CG, Kroon AA, Henry RMA, Stehouwer CDA. Sedentary behaviour and physical activity are associated with biomarkers of endothelial dysfunction and low-grade inflammation-relevance for (pre)diabetes: The Maastricht Study. Diabetologia 2022; 65:777-789. [PMID: 35119485 PMCID: PMC8960649 DOI: 10.1007/s00125-022-05651-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [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: 10/07/2021] [Accepted: 10/28/2021] [Indexed: 12/18/2022]
Abstract
AIMS/HYPOTHESIS Biomarkers of endothelial dysfunction and low-grade inflammation are important in the pathogenesis of CVD and can potentially be modified by physical activity and sedentary behaviour. Effects of physical activity on biomarkers of endothelial dysfunction may be especially prominent in type 2 diabetes. METHODS In the population-based Maastricht Study (n = 2363, 51.5% male, 28.3% type 2 diabetes, 15.1% prediabetes [defined as impaired glucose tolerance and impaired fasting glucose]), we determined biomarkers of endothelial dysfunction and low-grade inflammation, and combined z scores were calculated. Physical activity and sedentary behaviour were measured by activPAL. Linear regression analyses were used with adjustment for demographic, lifestyle and cardiovascular risk factors. RESULTS The association between total, light, moderate-to-vigorous and vigorous intensity physical activity and sedentary time on the one hand and biomarkers of endothelial dysfunction on the other were generally significant and were consistently stronger in prediabetes and type 2 diabetes as compared with normal glucose metabolism status (p for interaction <0.05). Associations between physical activity and sedentary behaviour on the one hand and low-grade inflammation on the other were also significant and were similar in individuals with and without (pre)diabetes (p for interaction >0.05). CONCLUSIONS/INTERPRETATION Physical activity and sedentary behaviour are associated with biomarkers of endothelial dysfunction and low-grade inflammation. For biomarkers of endothelial dysfunction, associations between physical activity and sedentary behaviour were consistently stronger in (pre)diabetes than in normal glucose metabolism. Whether increasing physical activity or decreasing sedentary time can positively influence biomarkers of endothelial dysfunction in individuals with prediabetes and type 2 diabetes requires further study.
Collapse
Affiliation(s)
- Evelien J Vandercappellen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - Hans H C M Savelberg
- Department of Nutrition and Movement Science, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Simone J P M Eussen
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Marleen M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Anke Wesselius
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Department of Complex Genetics and Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands.
| |
Collapse
|
7
|
Weerts J, Barandiarán Aizpurua A, Henkens MTHM, Lyon A, van Mourik MJW, van Gemert MRAA, Raafs A, Sanders-van Wijk S, Bayés-Genís A, Heymans SRB, Crijns HJGM, Brunner-La Rocca HP, Lumens J, van Empel VPM, Knackstedt C. The prognostic impact of mechanical atrial dysfunction and atrial fibrillation in heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2021; 23:74-84. [PMID: 34718457 PMCID: PMC8685598 DOI: 10.1093/ehjci/jeab222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS This study assessed the prognostic implications of mechanical atrial dysfunction in heart failure with preserved ejection fraction (HFpEF) patients with different stages of atrial fibrillation (AF) in detail. METHODS AND RESULTS HFpEF patients (n = 258) systemically underwent an extensive clinical characterization, including 24-h Holter monitoring and speckle-tracking echocardiography. Patients were categorized according to rhythm and stages of AF: 112 with no history of AF (no AF), 56 with paroxysmal AF (PAF), and 90 with sustained (persistent/permanent) AF (SAF). A progressive decrease in mechanical atrial function was seen: left atrial reservoir strain (LASr) 30.5 ± 10.5% (no AF), 22.3 ± 10.5% (PAF), and 13.9 ± 7.8% (SAF), P < 0.001. Independent predictors for lower LASr values were AF, absence of chronic obstructive pulmonary disease, higher N-terminal-pro hormone B-type natriuretic peptide, left atrial volume index, and relative wall thickness, lower left ventricular global longitudinal strain, and echocardiographic signs of elevated left ventricular filling pressure. LASr was an independent predictor of adverse outcome (hazard ratio per 1% decrease =1.049, 95% confidence interval 1.014-1.085, P = 0.006), whereas AF was not when the multivariable model included LASr. Moreover, LASr mediated the adverse outcome associated with AF in HFpEF (P = 0.008). CONCLUSION Mechanical atrial dysfunction has a possible greater prognostic role in HFpEF compared to AF status alone. Mechanical atrial dysfunction is a predictor of adverse outcome independently of AF presence or stage, and may be an underlying mechanism (mediator) for the worse outcome associated with AF in HFpEF. This may suggest mechanical atrial dysfunction plays a crucial role in disease progression in HFpEF patients with AF, and possibly also in HFpEF patients without AF.
Collapse
Affiliation(s)
- Jerremy Weerts
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Arantxa Barandiarán Aizpurua
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Michiel T H M Henkens
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Aurore Lyon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Manouk J W van Mourik
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Mathijs R A A van Gemert
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Anne Raafs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Sandra Sanders-van Wijk
- Department of Cardiology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands
| | - Antoni Bayés-Genís
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, CIBERCV, 08916 Badalona, Barcelona, Spain
| | - Stephane R B Heymans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
- Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, bus 911, 3000 Leuven, Belgium
| | - Harry J G M Crijns
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), PO Box 616, 6200 MD Maastricht, the Netherlands
| |
Collapse
|
8
|
Abstract
OBJECTIVES Evaluate the effect of a health promotion campaign aimed at increasing awareness about dementia risk reduction in middle-aged community-dwelling individuals in the Netherlands. DESIGN A 10-month public health campaign using mass media and community participation, supported by eHealth. Population-level difference in awareness before and after the campaign, including variation between demographic groups, was assessed in two independent cross-sectional samples from the same target population. SETTING The public health campaign was launched in the Province of Limburg, the Netherlands, targeting all inhabitants aged 40-75 years old. Three specific districts within the Province were chosen for an additional community participation approach, in which local stakeholders were invited to support the campaign. RESULTS No pre- (n=590) post- (n=602) difference was observed in people agreeing to the statement that dementia risk reduction is possible (X2(1)=1.27, p=0.260). For the individual lifestyle factors, physical activity (7.6% increase (X2(1)=7.48, p=0.006)) and healthy diet (10.5% increase (X2(1)=12.37, p≤0.001)) were identified more often as being protective against dementia after the campaign. Of all risk/protective factors assessed, cognitive activity was identified most often at both preassessment (79.4%) and postassessment (80.4%), but there was no increase in awareness (X2(1)=0.17, p=0.677). Self-reported exposure to the campaign was associated with greater awareness and motivation for behavioural change (X2(1)=6.52, p=0.011). Compared with mass media only, the addition of community participation resulted in better recognition of campaign material and the eHealth platform. CONCLUSIONS This study was not able to reach a population-level increase of awareness of dementia risk reduction. Two out of the three lifestyle factors that formed the foundation of the campaign were identified more often after the campaign. Those reported having been exposed to the campaign were more aware and more inclined towards behavioural change.
Collapse
Affiliation(s)
- Irene Heger
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Martin van Boxtel
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | | | - Frans Verhey
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Kay Deckers
- Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
9
|
Geijsen AJMR, Ulvik A, Gigic B, Kok DE, van Duijnhoven FJB, Holowatyj AN, Brezina S, van Roekel EH, Baierl A, Bergmann MM, Böhm J, Bours MJL, Brenner H, Breukink SO, Bronner MP, Chang-Claude J, de Wilt JHW, Grady WM, Grünberger T, Gumpenberger T, Herpel E, Hoffmeister M, Huang LC, Jedrzkiewicz JD, Keulen ETP, Kiblawi R, Kölsch T, Koole JL, Kosma K, Kouwenhoven EA, Kruyt FM, Kvalheim G, Li CI, Lin T, Ose J, Pickron TB, Scaife CL, Schirmacher P, Schneider MA, Schrotz-King P, Singer MC, Swanson ER, van Duijvendijk P, van Halteren HK, van Zutphen M, Vickers K, Vogelaar FJ, Wesselink E, Habermann N, Ulrich AB, Ueland PM, Weijenberg MP, Gsur A, Ulrich CM, Kampman E. Circulating Folate and Folic Acid Concentrations: Associations With Colorectal Cancer Recurrence and Survival. JNCI Cancer Spectr 2020; 4:pkaa051. [PMID: 33134831 PMCID: PMC7583160 DOI: 10.1093/jncics/pkaa051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Folates, including folic acid, may play a dual role in colorectal cancer development. Folate is suggested to be protective in early carcinogenesis but could accelerate growth of premalignant lesions or micrometastases. Whether circulating concentrations of folate and folic acid, measured around time of diagnosis, are associated with recurrence and survival in colorectal cancer patients is largely unknown. METHODS Circulating concentrations of folate, folic acid, and folate catabolites p-aminobenzoylglutamate and p-acetamidobenzoylglutamate were measured by liquid chromatography-tandem mass spectrometry at diagnosis in 2024 stage I-III colorectal cancer patients from European and US patient cohort studies. Multivariable-adjusted Cox proportional hazard models were used to assess associations between folate, folic acid, and folate catabolites concentrations with recurrence, overall survival, and disease-free survival. RESULTS No statistically significant associations were observed between folate, p-aminobenzoylglutamate, and p-acetamidobenzoylglutamate concentrations and recurrence, overall survival, and disease-free survival, with hazard ratios ranging from 0.92 to 1.16. The detection of folic acid in the circulation (yes or no) was not associated with any outcome. However, among patients with detectable folic acid concentrations (n = 296), a higher risk of recurrence was observed for each twofold increase in folic acid (hazard ratio = 1.31, 95% confidence interval = 1.02 to 1.58). No statistically significant associations were found between folic acid concentrations and overall and disease-free survival. CONCLUSIONS Circulating folate and folate catabolite concentrations at colorectal cancer diagnosis were not associated with recurrence and survival. However, caution is warranted for high blood concentrations of folic acid because they may increase the risk of colorectal cancer recurrence.
Collapse
Affiliation(s)
- Anne J M R Geijsen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Dieuwertje E Kok
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Andreana N Holowatyj
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Stefanie Brezina
- Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Eline H van Roekel
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, Vienna, Austria
| | | | - Jürgen Böhm
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Martijn J L Bours
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Hermann Brenner
- Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stéphanie O Breukink
- Department of Surgery, GROW School for Oncology and Development Biology, Maastricht University, Maastricht, the Netherlands
| | - Mary P Bronner
- Department of Pathology, University of Utah, Salt Lake City, UT, USA
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Johannes H W de Wilt
- Department of Surgery, Division of Surgical Oncology and Gastrointestinal Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - William M Grady
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Tanja Gumpenberger
- Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Esther Herpel
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lyen C Huang
- Huntsman Cancer Institute, Salt Lake City, UT, USA
| | | | - Eric T P Keulen
- Department of Internal Medicine and Gastroenterology, Zuyderland Medical Center, Sittard, the Netherlands
| | - Rama Kiblawi
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
- Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Torsten Kölsch
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Janna L Koole
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Katharina Kosma
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Flip M Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | | | - Christopher I Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Tengda Lin
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Ose
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Martin A Schneider
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Petra Schrotz-King
- Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany
| | - Marie C Singer
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eric R Swanson
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Henk K van Halteren
- Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, the Netherlands
| | - Moniek van Zutphen
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Kathy Vickers
- Department of Surgery, Hospital Gelderse Vallei, Ede, the Netherlands
| | - F Jeroen Vogelaar
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
| | - Evertine Wesselink
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Nina Habermann
- Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany
| | - Alexis B Ulrich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | | | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Andrea Gsur
- Department of Medicine I, Institute of Cancer Research, Medical University of Vienna, Vienna, Austria
| | - Cornelia M Ulrich
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| |
Collapse
|
10
|
de Ritter R, Sep SJS, van der Kallen CJH, Schram MT, Koster A, Kroon AA, van Greevenbroek MMJ, Eussen SJPM, Dagnelie PC, de Jong M, Vos RC, Woodward M, Bots ML, Peters SAE, Stehouwer CDA. Adverse differences in cardiometabolic risk factor levels between individuals with pre-diabetes and normal glucose metabolism are more pronounced in women than in men: the Maastricht Study. BMJ Open Diabetes Res Care 2019; 7:e000787. [PMID: 31798903 PMCID: PMC6861068 DOI: 10.1136/bmjdrc-2019-000787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/27/2019] [Revised: 09/20/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate whether adverse differences in levels of cardiovascular risk factors in women than men, already established when comparing individuals with and without diabetes, are also present before type 2 diabetes onset. RESEARCH DESIGN AND METHODS In a population-based cohort study of individuals aged 40-75 years (n=3410; 49% women, 29% type 2 diabetes (oversampled by design)), we estimated associations with cardiometabolic and lifestyle risk factors of (1) pre-diabetes and type 2 diabetes (reference category: normal glucose metabolism) and (2) among non-diabetic individuals, of continuous levels of hemoglobin A1c (HbA1c). Age-adjusted sex differences were analyzed using linear and logistic regression models with sex interaction terms. RESULTS In pre-diabetes, adverse differences in cardiometabolic risk factors were greater in women than men for systolic blood pressure (difference, 3.02 mm Hg; 95% CI:-0.26 to 6.30), high-density lipoprotein (HDL) cholesterol (difference, -0.10 mmol/L; 95% CI: -0.18 to -0.02), total-to-HDL cholesterol ratio (difference, 0.22; 95% CI: -0.01 to 0.44), triglycerides (ratio: 1.11; 95% CI: 1.01 to 1.22), and inflammation markers Z-score (ratio: 1.18; 95% CI: 0.98 to 1.41). In type 2 diabetes, these sex differences were similar in direction, and of greater magnitude. Additionally, HbA1c among non-diabetic individuals was more strongly associated with several cardiometabolic risk factors in women than men: per one per cent point increase, systolic blood pressure (difference, 3.58 mm Hg; 95% CI: -0.03 to 7.19), diastolic blood pressure (difference, 2.10 mm Hg; 95% CI: -0.02 to 4.23), HDL cholesterol (difference, -0.09 mmol/L; 95% CI: -0.19 to 0.00), and low-density lipoprotein cholesterol (difference, 0.26 mmol/L; 95% CI: 0.05 to 0.47). With regard to lifestyle risk factors, no consistent pattern was observed. CONCLUSION Our results are consistent with the concept that the more adverse changes in cardiometabolic risk factors in women (than men) arise as a continuous process before the onset of type 2 diabetes.
Collapse
Affiliation(s)
- Rianneke de Ritter
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Simone J S Sep
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
| | - Carla J H van der Kallen
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Heart and Vascular Centre, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Annemarie Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Marleen M J van Greevenbroek
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Simone J P M Eussen
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Marit de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rimke C Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Public Health and Primary Care / LUMC-Campus, Leiden University Medical Center, The Hague, The Netherlands
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
11
|
de Waard EAC, de Jong JJA, Koster A, Savelberg HHCM, van Geel TA, Houben AJHM, Schram MT, Dagnelie PC, van der Kallen CJ, Sep SJS, Stehouwer CDA, Schaper NC, Berendschot TTJM, Schouten JSAG, Geusens PPMM, van den Bergh JPW. The association between diabetes status, HbA1c, diabetes duration, microvascular disease, and bone quality of the distal radius and tibia as measured with high-resolution peripheral quantitative computed tomography-The Maastricht Study. Osteoporos Int 2018; 29:2725-2738. [PMID: 30209523 PMCID: PMC6267131 DOI: 10.1007/s00198-018-4678-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 06/30/2017] [Accepted: 08/19/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED In this small cross-sectional study of predominantly well-treated participants with relatively short-term type 2 diabetes duration, HbA1c > 7% (53 mmol/mol) was associated with lower cortical density and thickness and higher cortical porosity at the distal radius, lower trabecular thickness at the distal tibia, and higher trabecular number at both sites. INTRODUCTION To examine the association between diabetes status and volumetric bone mineral density (vBMD), bone microarchitecture and strength of the distal radius and tibia as assessed with HR-pQCT. Additionally-in participants with type 2 diabetes (T2DM), to examine the association between HbA1c, diabetes duration, and microvascular disease (MVD) and bone parameters. METHODS Cross-sectional data from 410 (radius) and 198 (tibia) participants of The Maastricht Study (mean age 58 year, 51% female). Diabetes status (normal glucose metabolism, prediabetes, or T2DM) was based on an oral glucose tolerance test and medication history. RESULTS After full adjustment, prediabetes and T2DM were not associated with vBMD, bone microarchitecture, and strength of the radius and tibia, except for lower trabecular number (Tb.N) of the tibia (- 4%) in prediabetes and smaller cross-sectional area of the tibia (- 7%) in T2DM. In T2DM, HbA1c > 7% was associated with lower cortical vBMD (- 5%), cortical thickness (- 16%), higher cortical porosity (+ 20%) and Tb.N (+ 9%) of the radius, and higher Tb.N (+ 9%) and lower trabecular thickness (- 13%) of the tibia. Diabetes duration > 5 years was associated with higher Tb.N (+ 6%) of the radius. The presence of MVD was not associated with any bone parameters. CONCLUSIONS In this study with predominantly well-treated T2DM participants with relatively short-term diabetes duration, inadequate blood glucose control was negatively associated with cortical bone measures of the radius. In contrast, trabecular number was increased at both sites. Studies of larger sample size are warranted for more detailed investigations of bone density and bone quality in patients with T2DM.
Collapse
Affiliation(s)
- E A C de Waard
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University, Maastricht, the Netherlands.
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - J J A de Jong
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - A Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - H H C M Savelberg
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
- Department of Human Movement Science, Maastricht University, Maastricht, the Netherlands
| | - T A van Geel
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - A J H M Houben
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - M T Schram
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - P C Dagnelie
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - C J van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - S J S Sep
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - N C Schaper
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | | | | | - P P M M Geusens
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Biomedical Research Institute, University of Hasselt, Hasselt, Belgium
| | - J P W van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Center, Venlo, the Netherlands
| |
Collapse
|
12
|
de Waard EAC, Koster A, Melai T, van Geel TA, Henry RMA, Schram MT, Dagnelie PC, van der Kallen CJ, Sep SJS, Stehouwer CDA, Schaper NC, Köhler S, Savelberg HHCM, Geusens PPMM, van den Bergh JPW. The association between glucose metabolism status, diabetes severity and a history of fractures and recent falls in participants of 50 years and older-the Maastricht Study. Osteoporos Int 2016; 27:3207-3216. [PMID: 27234668 PMCID: PMC5059422 DOI: 10.1007/s00198-016-3645-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 05/17/2016] [Indexed: 12/23/2022]
Abstract
UNLABELLED In this cohort of relatively young and well-treated participants with type 2 diabetes, we found no association between diabetes status and a history of previous fractures and recent falls. Furthermore, no association between diabetes severity and previous fractures or recent falls was found. INTRODUCTION In this study, we examined the association between glucose metabolism status and historical fractures or recent falls and the effect of diabetes severity (glucose control, insulin use, and diabetes duration) on falls and fractures in the participants with type 2 diabetes. METHODS Cross-sectional data from 2005 participants of the Maastricht Study. Falls in the past 6 months and fractures ≥age 50 were assessed by questionnaire. Glucose metabolism status (normal glucose metabolism, impaired glucose metabolism, or type 2 diabetes) was based on the oral glucose tolerance test and medication use. RESULTS In the completely adjusted model, the odds for a fall were not significantly higher in those with impaired glucose metabolism status (OR (95%CI) 1.28 (0.93-1.77)) or with type 2 diabetes (OR (95%CI) 1.21 (0.80-1.81)) compared with the group with normal glucose metabolism. Within the group with type 2 diabetes, there were no significant differences with regard to reported falls between participants with HbA1c >7 % (53 mmol/mol) versus HbA1c ≤7 % (OR (95%CI) 1.05 (0.58-1.90)), insulin users versus non-insulin users (OR (95%CI) 1.51 (0.79-2.89)), and with a diabetes duration >5 versus ≤5 years (OR (95%CI) 0.52 (0.46-1.47)). Similarly, neither glucose metabolism status nor diabetes severity was associated with prior fractures. CONCLUSIONS Glucose metabolism status was not significantly associated with previous fractures and recent falls. In addition, in this cohort of relatively young and well-treated participants with type 2 diabetes, diabetes severity was not associated with previous fractures and recent falls.
Collapse
Affiliation(s)
- E A C de Waard
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University, Maastricht, The Netherlands.
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - A Koster
- Department of Social Medicine, Maastricht University, Maastricht, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - T Melai
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Human Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - T A van Geel
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, The Netherlands
| | - R M A Henry
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - M T Schram
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - P C Dagnelie
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - C J van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - S J S Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - N C Schaper
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, The Netherlands
| | - S Köhler
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry and Neurophysiology, Maastricht University, Maastricht, The Netherlands
| | - H H C M Savelberg
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Human Movement Sciences, Maastricht University, Maastricht, The Netherlands
| | - P P M M Geusens
- CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Biomedical Research Institute, University of Hasselt, Hasselt, Belgium
| | - J P W van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Center, Venlo, The Netherlands
| |
Collapse
|
13
|
Douven E, Schievink SHJ, Verhey FRJ, van Oostenbrugge RJ, Aalten P, Staals J, Köhler S. The Cognition and Affect after Stroke - a Prospective Evaluation of Risks (CASPER) study: rationale and design. BMC Neurol 2016; 16:65. [PMID: 27176617 PMCID: PMC4866410 DOI: 10.1186/s12883-016-0588-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 05/05/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cognitive impairment and neuropsychiatric syndromes, like depression and apathy, are frequent residual consequences of stroke. These have a large impact on quality of life and long-term prognosis. Several factors are involved in the development of these residual syndromes, although their exact role and their interrelationships remain still rather unclear. The Cognition and Affect after Stroke: a Prospective Evaluation of Risks (CASPER) study has been primarily designed to examine whether stroke-specific (e.g. lesion location, volume, type, severity), cerebrovascular and neurodegenerative (e.g. white matter changes, atrophy, microbleeds, perivascular spaces), inflammatory, endothelial, and (epi)genetic markers are associated with cognitive impairment, post-stroke depression, and post-stroke apathy, and whether they predict their course over 12 months. The secondary aims are to investigate how the above-mentioned markers interact with each other, and to determine if patients with apathy and depression after stroke differ in pathogenesis, course, and outcome (e.g. functional outcome, neurocognitive performance, quality of life). METHODS/DESIGN CASPER is a 1-year prospective clinical cohort follow-up study in 250 stroke patients recruited at the neurological in- and outpatient services at Maastricht University Medical Center (MUMC+, Maastricht, The Netherlands), and Zuyderland Medical Center (Sittard and Heerlen, The Netherlands). At baseline (3 months post-stroke), a neuropsychological assessment, neuropsychiatric interview, blood sample, and brain magnetic resonance imaging (MRI) scan are conducted. Assessment of neuropsychiatric and neurocognitive status are repeated 6 and 12 months later. DISCUSSION The CASPER study investigates stroke-specific, vascular, neurodegenerative, inflammatory, and genetic markers of the development of vascular cognitive impairment, depression, and apathy after stroke. This creates the possibility to study not only the contribution of these individual markers but also their joint contribution, which differentiates this study from earlier stroke cohorts who lacked long-term follow-up data, a large sample size, an extensive MRI protocol, and markers from the blood. The knowledge we derive from this study might help in identifying markers that are associated with, or can predict the onset, maintenance, and progression of vascular cognitive impairment, depression, and apathy after stroke, and could provide new insights into possibilities for treatment and rehabilitation that result in better functional outcome after stroke. TRIAL REGISTRATION ClinicalTrials.gov NCT02585349.
Collapse
Affiliation(s)
- Elles Douven
- Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Syenna H J Schievink
- Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Frans R J Verhey
- Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- Cardiovascular Research Institute Maastricht (CARIM), Department of Neurology, and School for Mental Health and Neuroscience, Maastricht University Medical Center (MUMC+), P.O. BOX 616 (DRT12), 6200 MD, Maastricht, The Netherlands
| | - Pauline Aalten
- Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Julie Staals
- Cardiovascular Research Institute Maastricht (CARIM), Department of Neurology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Sebastian Köhler
- Alzheimer Center Limburg and School for Mental Health and Neuroscience (MHeNS), Department of Psychiatry and Neuropsychology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| |
Collapse
|