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2. Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants
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Zhou, B, Carrillo-Larco, Rm, Danaei, G, Riley, Lm, Paciorek, Cj, Stevens, Ga, Gregg, Ew, Bennett, Je, Solomon, B, Singleton, Rk, Sophiea, Mk, Iurilli, Mlc, Lhoste, Vpf, Cowan, Mj, Savin, S, Woodward, M, Balanova, Y, Cifkova, R, Damasceno, A, Elliott, P, Farzadfar, F, He, J, Ikeda, N, Kengne, Ap, Khang, Yh, Kim, Hc, Laxmaiah, A, Lin, Hh, Maira, Pm, Miranda, Jj, Neuhauser, H, Sundstrom, J, Varghese, C, Widyahening, Is, Zdrojewski, T, Ezzati, M, Abarca-Gomez, L, Abdeen, Za, Rahim, Hfa, Abu-Rmeileh, Nm, Acosta-Cazares, B, Adams, Rj, Aekplakorn, W, Afsana, K, Afzal, S, Agdeppa, Ia, Aghazadeh-Attari, J, Aguilar-Salinas, Ca, Agyemang, C, Ahmad, Na, Ahmadi, A, Ahmadi, N, Ahmadizar, F, Ahmed, Sh, Ahrens, W, Ajlouni, K, Al-Raddadi, R, Alarouj, M, Albuhairan, F, Aldhukair, S, Ali, Mm, Alkandari, A, Alkerwi, A, Allin, K, Aly, E, Amarapurkar, Dn, Amougou, N, Amouyel, P, Andersen, Lb, Anderssen, Sa, Anjana, Rm, Ansari-Moghaddam, A, Ansong, D, Aounallah-Skhiri, H, Araujo, J, Ariansen, I, Aris, T, Arku, Re, Arlappa, N, Aryal, Kk, Aspelund, T, Assah, Fk, Assuncao, Mcf, Auvinen, J, Avdicova, M, Azevedo, A, Azimi-Nezhad, M, Azizi, F, Azmin, M, Babu, Bv, Bahijri, S, Balakrishna, N, Bamoshmoosh, M, Banach, M, Banadinovic, M, Bandosz, P, Banegas, Jr, Baran, J, Barbagallo, Cm, Barcelo, A, Barkat, A, Barreto, M, Barros, Ajd, Barros, Mvg, Bartosiewicz, A, Basit, A, Bastos, Jld, Bata, I, Batieha, Am, Batyrbek, A, Baur, La, Beaglehole, R, Belavendra, A, Ben Romdhane, H, Benet, M, Benson, Ls, Berkinbayev, S, Bernabe-Ortiz, A, Bettiol, H, Bezerra, J, Bhagyalaxmi, A, Bhargava, Sk, Bia, D, Biasch, K, Lele, Ecb, Bikbov, Mm, Bista, B, Bjerregaard, P, Bjertness, E, Bjertness, Mb, Bjorkelund, C, Bloch, Kv, Blokstra, A, Bo, S, Bobak, M, Boeing, H, Boggia, Jg, Boissonnet, Cp, Bojesen, Se, Bongard, V, Bonilla-Vargas, A, Bopp, M, Borghs, H, Bovet, P, Boyer, Cb, Braeckman, L, Brajkovich, I, Branca, F, Breckenkamp, J, Brenner, H, Brewster, Lm, Briceno, Y, Brito, M, Bruno, G, Bueno-de-Mesquita, Hb, Bueno, G, Bugge, A, Burns, C, Bursztyn, M, de Leon, Ac, Cacciottolo, J, Cameron, C, Can, G, Candido, Apc, Capanzana, Mv, Capkova, N, Capuano, E, Capuano, V, Cardoso, Vc, Carlsson, Ac, Carvalho, J, Casanueva, Ff, Censi, L, Cervantes-Loaiza, M, Chadjigeorgiou, Ca, Chamukuttan, S, Chan, Aw, Chan, Q, Chaturvedi, Hk, Chaturvedi, N, Chee, Ml, Chen, Cj, Chen, Ff, Chen, Hs, Chen, Sh, Chen, Zm, Cheng, Cy, Cheraghian, B, Dekkaki, Ic, Chetrit, A, Chien, Kl, Chiolero, A, Chiou, St, Chirita-Emandi, A, Chirlaque, Md, Cho, B, Christensen, K, Christofaro, Dg, Chudek, J, Cinteza, E, Claessens, F, Clarke, J, Clays, E, Cohen, E, Concin, H, Cooper, C, Coppinger, Tc, Costanzo, S, Cottel, D, Cowell, C, Craig, Cl, Crampin, Ac, Crujeiras, Ab, Cruz, Jj, Csilla, S, Cui, Lf, Cureau, Fv, Cuschieri, S, D'Arrigo, G, D'Orsi, E, Dallongeville, J, Dankner, R, Dantoft, Tm, Dauchet, L, Davletov, K, De Backer, G, De Bacquer, D, De Curtis, A, de Gaetano, G, De Henauw, S, de Oliveira, Pd, De Ridder, D, De Smedt, D, Deepa, M, Deev, Ad, Degennaro, V, Delisle, H, Demarest, S, Dennison, E, Deschamps, V, Dhimal, M, Di Castelnuovo, Af, Dias-da-Costa, Js, Diaz, A, Dickerson, Tt, Dika, Z, Djalalinia, S, Htp, Do, Dobson, Aj, Donfrancesco, C, Donoso, Sp, Doring, A, Dorobantu, M, Dorr, M, Doua, K, Dragano, N, Drygas, W, Duante, Ca, Duboz, P, Duda, Rb, Dulskiene, V, Dushpanova, A, Dzakula, A, Dzerve, V, Dziankowska-Zaborszczyk, E, Eddie, R, Eftekhar, E, Eggertsen, R, Eghtesad, S, Eiben, G, Ekelund, U, El-Khateeb, M, El Ati, J, Eldemire-Shearer, D, Eliasen, M, Elosua, R, Erasmus, Rt, Erbel, R, Erem, C, Eriksen, L, Eriksson, Jg, Escobedo-de la Pena, J, Eslami, S, Esmaeili, A, Evans, A, Faeh, D, Fakhretdinova, Aa, Fall, Ch, Faramarzi, E, Farjam, M, Fattahi, Mr, Fawwad, A, Felix-Redondo, Fj, Felix, Sb, Ferguson, Ts, Fernandes, Ra, Fernandez-Berges, D, Ferrante, D, Ferrao, T, Ferrari, M, Ferrario, Mm, Ferreccio, C, Ferreira, Hs, Ferrer, E, Ferrieres, J, Figueiro, Th, Fink, G, Fischer, K, Foo, Lh, Forsner, M, Fouad, Hm, Francis, Dk, Grego, Franco, Frikke-Schmidt, R, Frontera, G, Fuchs, Fd, Fuchs, Sc, Fujita, Y, Fumihiko, M, Furdela, V, Furer, A, Furusawa, T, Gaciong, Z, Galbarczyk, A, Galenkamp, H, Galvano, F, Gao, Jl, Gao, P, Garcia-de-la-Hera, M, Garcia, P, Gareta, D, Garnett, Sp, Gaspoz, Jm, Gasull, M, Gazzinelli, A, Gehring, U, Geleijnse, Jm, George, R, Ghanbari, A, Ghasemi, E, Gheorghe-Fronea, Of, Ghimire, A, Gialluisi, A, Giampaoli, S, Gieger, C, Gill, Tk, Giovannelli, J, Gironella, G, Giwercman, A, Gkiouras, K, Goldberg, M, Goldsmith, Ra, Gomez, Lf, Gomula, A, da Silva, Bgc, Goncalves, H, Goncalves, M, Gonzalez-Chica, Da, Gonzalez-Gross, M, Gonzalez-Rivas, Jp, Gonzalez-Villalpando, C, Gonzalez-Villalpando, Me, Gonzalez, Ar, Gorbea, Mb, Gottrand, F, Graff-Iversen, S, Grafnetter, D, Grajda, A, Grammatikopoulou, Mg, Gregor, Rd, Grodzicki, T, Grosso, G, Gruden, G, Df, Gu, Guan, Op, Gudmundsson, Ef, Gudnason, V, Guerrero, R, Guessous, I, Guimaraes, Al, Gulliford, Mc, Gunnlaugsdottir, J, Gunter, Mj, Gupta, Pc, Gupta, R, Gureje, O, Gurzkowska, B, Gutierrez, L, Gutzwiller, F, Ha, S, Hadaegh, F, Haghshenas, R, Hakimi, H, Halkjaer, J, Hambleton, Ir, Hamzeh, B, Hange, D, Hanif, Aam, Hantunen, S, Hao, J, Hardman, Cm, Kumar, Rh, Hashemi-Shahri, Sm, Hata, J, Haugsgjerd, T, Hayes, Aj, Yn, He, Heier, M, Hendriks, Me, Henrique, Rd, Henriques, A, Cadena, Lh, Herrala, S, Heshmat, R, Hill, Ag, Sy, Ho, Sc, Ho, Hobbs, M, Holdsworth, M, Homayounfar, R, Dinc, Gh, Horimoto, Arvr, Hormiga, Cm, Horta, Bl, Houti, L, Howitt, C, Htay, Tt, Htet, As, Htike, Mmt, Yh, Hu, Huerta, Jm, Huhtaniemi, It, Huiart, L, Huisman, M, Husseini, As, Huybrechts, I, Hwalla, N, Iacoviello, L, Iannone, Ag, Ibrahim, Mm, Wong, Ni, Ikram, Ma, Iotova, V, Irazola, Ve, Ishida, T, Isiguzo, Gc, Islam, M, Islam, Sms, Iwasaki, M, Jackson, Rt, Jacobs, Jm, Jaddou, Hy, Jafar, T, James, K, Jamrozik, K, Janszky, I, Janus, E, Jarvelin, Mr, Jasienska, G, Jelakovic, A, Jelakovic, B, Jennings, G, Jha, Ak, Jiang, Cq, Jimenez, Ro, Jockel, Kh, 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Laatikainen, T, Lachat, C, Laid, Y, Lam, Th, Landrove, O, Lanska, V, Lappas, G, Larijani, B, Latt, Ts, Le Coroller, G, Bao, Kln, Le, THUY DUNG, Lee, J, Lehmann, N, Lehtimaki, T, Lemogoum, D, Levitt, Ns, Yp, Li, Lilly, Cl, Lim, Wy, Lima-Costa, Mf, Lin, X, Lin, Yt, Lind, L, Lingam, V, Linneberg, A, Lissner, L, Litwin, M, Wc, Lo, Loit, Hm, Lopez-Garcia, E, Lopez, T, Lotufo, Pa, Lozano, Je, Lovrencic, Il, Lukrafka, Jl, Luksiene, D, Lundqvist, A, Lundqvist, R, Lunet, N, Lustigova, M, Luszczki, E, Gs, Ma, Ma, J, Machado-Coelho, Gll, Machado-Rodrigues, Am, Macia, E, Macieira, Lm, Madar, Aa, Maggi, S, Magliano, Dj, Magriplis, E, Mahasampath, G, Maire, B, Majer, M, Makdisse, M, Malekzadeh, F, Malekzadeh, R, Malhotra, R, Mallikharjuna, K, Malyutina, Sk, Maniego, Lv, Manios, Y, Mann, Ji, Mansour-Ghanaei, F, Manzato, E, Marcil, A, Margozzini, P, Marild, Sb, Glavic, Mm, Marques-Vidal, P, Marques, Lp, Marrugat, J, Martorell, R, Mascarenhas, Lp, Matasin, M, Mathiesen, Eb, Mathur, P, Matijasevich, A, Matlosz, P, Matsha, Te, Mavrogianni, C, Mbanya, Jcn, Posso, Ajm, Mcfarlane, Sr, Mcgarvey, St, Mclachlan, S, Mclean, Rm, Mclean, Sb, Mcnulty, Ba, Benchekor, Sm, Medzioniene, J, Mehdipour, P, Mehlig, K, Mehrparvar, Ah, Meirhaeghe, A, Meisinger, C, Montano, Cm, Menezes, Amb, Menon, Gr, Mereke, A, Meshram, Ii, Metspalu, A, Meyer, He, Mi, J, Michels, N, Mikkel, K, Milkowska, K, Miller, Jc, Minderico, Cs, Mini, Gk, Mirjalili, Mr, Mirrakhimov, E, Misigoj-Durakovic, M, Modesti, Pa, Moghaddam, Ss, Mohajer, B, Mohamed, Mk, Mohamed, Sf, Mohammad, K, Mohammadi, Mr, Mohammadi, Z, Mohammadifard, N, Mohammadpourhodki, R, Mohan, V, Mohanna, S, Yusoff, Mfm, Mohebbi, I, Mohebi, F, Moitry, M, Mollehave, Lt, Molnar, D, Momenan, A, Mondo, Ck, Monterrubio-Flores, E, Monyeki, Kdk, Moon, Js, Moosazadeh, M, Moreira, Lb, Morejon, A, Moreno, La, Morgan, K, Moschonis, G, Mossakowska, M, Mostafa, A, Mostafavi, Sa, Mota, J, Motlagh, Me, Motta, J, Moura-dos-Santos, Ma, Mridha, Mk, Msyamboza, Kp, Tt, Mu, Muhihi, Aj, 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Kazakbaeva, Ulrich Keil, Lital Keinan Boker, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Han Cg Kemper, Maryam Keramati, Alina Kerimkulova, Mathilde Kersting, Timothy Key, Yousef Saleh Khader, Davood Khalili, Kay-Tee Khaw, Bahareh Kheiri, Motahareh Kheradmand, Alireza Khosravi, Ursula Kiechl-Kohlendorfer, Stefan Kiechl, Japhet Killewo, Dong Wook Kim, Jeongseon Kim, Heidi Klakk, Magdalena Klimek, Jurate Klumbiene, Michael Knoflach, Elin Kolle, Patrick Kolsteren, Jukka P Kontto, Raija Korpelainen, Paul Korrovits, Jelena Kos, Seppo Koskinen, Katsuyasu Kouda, Sudhir Kowlessur, Slawomir Koziel, Jana Kratenova, Vilma Kriaucioniene, Peter Lund Kristensen, Steiner Krokstad, Daan Kromhout, Herculina S Kruger, Ruzena Kubinova, Renata Kuciene, Urho M Kujala, Zbigniew Kulaga, R Krishna Kumar, Pawel Kurjata, Yadlapalli S Kusuma, Vladimir Kutsenko, Kari Kuulasmaa, Catherine Kyobutungi, Tiina Laatikainen, Carl Lachat, Youcef Laid, Tai Hing Lam, Orlando Landrove, Vera Lanska, Georg Lappas, Bagher Larijani, Tint Swe Latt, Gwenaëlle Le Coroller, Khanh Le Nguyen Bao, Tuyen D Le, Jeannette Lee, Jeonghee Lee, Nils Lehmann, Terho Lehtimäki, Daniel Lemogoum, Naomi S Levitt, Yanping Li, Christa L Lilly, Wei-Yen Lim, M Fernanda Lima-Costa, Xu Lin, Yi-Ting Lin, Lars Lind, Vijaya Lingam, Allan Linneberg, Lauren Lissner, Mieczyslaw Litwin, Wei-Cheng Lo, Helle-Mai Loit, Esther Lopez-Garcia, Tania Lopez, Paulo A Lotufo, José Eugenio Lozano, Iva Lukačević Lovrenčić, Janice L Lukrafka, Dalia Luksiene, Annamari Lundqvist, Robert Lundqvist, Nuno Lunet, Michala Lustigová, Edyta Luszczki, Guansheng Ma, Jun Ma, George Ll Machado-Coelho, Aristides M Machado-Rodrigues, Enguerran Macia, Luisa M Macieira, Ahmed A Madar, Stefania Maggi, Dianna J Magliano, Emmanuella Magriplis, Gowri Mahasampath, Bernard Maire, Marjeta Majer, Marcia Makdisse, Fatemeh Malekzadeh, Reza Malekzadeh, Rahul Malhotra, Kodavanti Mallikharjuna Rao, Sofia K Malyutina, Lynell V Maniego, Yannis Manios, Jim I Mann, Fariborz 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M., Hantunen, Sari, Hao, Jie, Hardman, Carla Meneses, Kumar, Rachakulla Hari, Hashemi-Shahri, Seyed Mohammad, Hata, Jun, Haugsgjerd, Teresa, Hayes, Alison J., He, Yuna, Heier, Margit, Hendriks, Marleen Elisabeth, Henrique, Rafael dos Santos, Henriques, Ana, Cadena, Leticia Hernandez, Herrala, Sauli, Heshmat, Ramin, Hill, Allan G., Ho, Sai Yin, Ho, Suzanne C., Hobbs, Michael, Holdsworth, Michelle, Homayounfar, Reza, Dinc, Gonul Horasan, Horimoto, Andrea R. V. R., Hormiga, Claudia M., Horta, Bernardo L., Houti, Leila, Howitt, Christina, Htay, Thein Thein, Htet, Aung Soe, Htike, Maung Maung Than, Hu, Yonghua, Huerta, Jose Maria, Huhtaniemi, Ilpo Tapani, Huiart, Laetitia, Huisman, Martijn, Husseini, Abdullatif S., Huybrechts, Inge, Hwalla, Nahla, Iacoviello, Licia, Iannone, Anna G., Ibrahim, Mohsen M., Wong, Norazizah Ibrahim, Ikram, M. Arfan, Iotova, Violeta, Irazola, Vilma E., Ishida, Takafumi, Isiguzo, Godsent C., Islam, Muhammad, Islam, Sheikh Mohammed Shariful, Iwasaki, Masanori, Jackson, Rod T., Jacobs, Jeremy M., Jaddou, Hashem Y., Jafar, Tazeen, James, Kenneth, Jamrozik, Konrad, Janszky, Imre, Janus, Edward, Jarvelin, Marjo-Riitta, Jasienska, Grazyna, Jelakovic, Ana, Jelakovic, Bojan, Jennings, Garry, Jha, Anjani Kumar, Jiang, Chao Qiang, Jimenez, Ramon O., Joeckel, Karl-Heinz, Joffres, Michel, Johansson, Mattias, Jokelainen, Jari J., Jonas, Jost B., Jorgensen, Torben, Joshi, Pradeep, Joukar, Farahnaz, Jozwiak, Jacek, Juolevi, Anne, Jurak, Gregor, Juresa, Vesna, Kaaks, Rudolf, Kafatos, Anthony, Kajantie, Eero O., Kalmatayeva, Zhanna, Kalpourtzi, Natasa, Kalter-Leibovici, Ofra, Kampmann, Freja B., Kannan, Srinivasan, Karaglani, Eva, Karhus, Line L., Karki, Khem B., Katibeh, Marzieh, Katz, Joanne, Kauhanen, Jussi, Kaur, Prabhdeep, Kavousi, Maryam, Kazakbaeva, Gyulli M., Keil, Ulrich, Boker, Lital Keinan, Keinanen-Kiukaanniemi, Sirkka, Kelishadi, Roya, Kemper, Han C. G., Keramati, Maryam, Kerimkulova, Alina, Kersting, Mathilde, Key, Timothy, Khader, Yousef Saleh, Khalili, Davood, Khaw, Kay-Tee, Kheiri, Bahareh, Kheradmand, Motahareh, Khosravi, Alireza, Kiechl-Kohlendorfer, Ursula, Kiechl, Stefan, Killewo, Japhet, Kim, Dong Wook, Kim, Jeongseon, Klakk, Heidi, Klimek, Magdalena, Klumbiene, Jurate, Knoflach, Michael, Kolle, Elin, Kolsteren, Patrick, Kontto, Jukka P., Korpelainen, Raija, Korrovits, Paul, Kos, Jelena, Koskinen, Seppo, Kouda, Katsuyasu, Kowlessur, Sudhir, Koziel, Slawomir, Kratenova, Jana, Kriaucioniene, Vilma, Kristensen, Peter Lund, Krokstad, Steiner, Kromhout, Daan, Kruger, Herculina S., Kubinova, Ruzena, Kuciene, Renata, Kujala, Urho M., Kulaga, Zbigniew, Kumar, R. Krishna, Kurjata, Pawel, Kusuma, Yadlapalli S., Kutsenko, Vladimir, Kuulasmaa, Kari, Kyobutungi, Catherine, Laatikainen, Tiina, Lachat, Carl, Laid, Youcef, Lam, Tai Hing, Landrove, Orlando, Lanska, Vera, Lappas, Georg, Larijani, Bagher, Latt, Tint Swe, Le Coroller, Gwenaelle, Khanh Le Nguyen Bao, Le, Tuyen D., Lee, Jeannette, Lee, Jeonghee, Lehmann, Nils, Lehtimaki, Terho, Lemogoum, Daniel, Levitt, Naomi S., Li, Yanping, Lilly, Christa L., Lim, Wei-Yen, Lima-Costa, M. Fernanda, Lin, Xu, Lin, Yi-Ting, Lind, Lars, Lingam, Vijaya, Linneberg, Allan, Lissner, Lauren, Litwin, Mieczyslaw, Lo, Wei-Cheng, Loit, Helle-Mai, Lopez-Garcia, Esther, Lopez, Tania, Lotufo, Paulo A., Lozano, Jose Eugenio, Lovrencic, Iva Lukacevic, Lukrafka, Janice L., Luksiene, Dalia, Lundqvist, Annamari, Lundqvist, Robert, Lunet, Nuno, Lustigova, Michala, Luszczki, Edyta, Ma, Guansheng, Ma, Jun, Machado-Coelho, George L. L., Machado-Rodrigues, Aristides M., Macia, Enguerran, Macieira, Luisa M., Madar, Ahmed A., Maggi, Stefania, Magliano, Dianna J., Magriplis, Emmanuella, Mahasampath, Gowri, Maire, Bernard, Majer, Marjeta, Makdisse, Marcia, Malekzadeh, Fatemeh, Malekzadeh, Reza, Malhotra, Rahul, Mallikharjuna, Kodavanti, Malyutina, Sofia K., Maniego, Lynell V., Manios, Yannis, Mann, Jim I., Mansour-Ghanaei, Fariborz, Manzato, Enzo, Marcil, Anie, Margozzini, Paula, Marild, Staffan B., Glavic, Mihalea Marinovic, Marques-Vidal, Pedro, Marques, Larissa Pruner, Marrugat, Jaume, Martorell, Reynaldo, Mascarenhas, Luis P., Matasin, Marija, Mathiesen, Ellisiv B., Mathur, Prashant, Matijasevich, Alicia, Matlosz, Piotr, Matsha, Tandi E., Mavrogianni, Christina, Mbanya, Jean Claude N., Mc Donald Posso, Anselmo J., McFarlane, Shelly R., McGarvey, Stephen T., McLachlan, Stela, McLean, Rachael M., McLean, Scott B., McNulty, Breige A., Benchekor, Sounnia Mediene, Medzioniene, Jurate, Mehdipour, Parinaz, Mehlig, Kirsten, Mehrparvar, Amir Houshang, Meirhaeghe, Aline, Meisinger, Christa, Mendoza Montano, Carlos, Menezes, Ana Maria B., Menon, Geetha R., Mereke, Alibek, Meshram, Indrapal I., Metspalu, Andres, Meyer, Haakon E., Mi, Jie, Michels, Nathalie, Mikkel, Kairit, Milkowska, Karolina, Miller, Jody C., Minderico, Claudia S., Mini, G. K., Mirjalili, Mohammad Reza, Mirrakhimov, Erkin, Misigoj-Durakovic, Marjeta, Modesti, Pietro A., Moghaddam, Sahar Saeedi, Mohajer, Bahram, Mohamed, Mostafa K., Mohamed, Shukri F., Mohammad, Kazem, Mohammadi, Mohammad Reza, Mohammadi, Zahra, Mohammadifard, Noushin, Mohammadpourhodki, Reza, Mohan, Viswanathan, Mohanna, Salim, Yusoff, Muhammad Fadhli Mohd, Mohebbi, Iraj, Mohebi, Farnam, Moitry, Marie, Mollehave, Line T., Molnar, Denes, Momenan, Amirabbas, Mondo, Charles K., Monterrubio-Flores, Eric, Monyeki, Kotsedi Daniel K., Moon, Jin Soo, Moosazadeh, Mahmood, Moreira, Leila B., Morejon, Alain, Moreno, Luis A., Morgan, Karen, Moschonis, George, Mossakowska, Malgorzata, Mostafa, Aya, Mostafavi, Seyed-Ali, Mota, Jorge, Motlagh, Mohammad Esmaeel, Motta, Jorge, Andre Moura-dos-Santos, Marcos, Mridha, Malay K., Msyamboza, Kelias P., Mu, Thet Thet, Muhihi, Alfa J., Muiesan, Maria L., Muller-Nurasyid, Martina, Murphy, Neil, Mursu, Jaakko, Musa, Kamarul Imran, Milanovic, Sanja Music, Musil, Vera, Mustafa, Norlaila, Nabipour, Iraj, Naderimagham, Shohreh, Nagel, Gabriele, Naidu, Balkish M., Najafi, Farid, Nakamura, Harunobu, Namesna, Jana, Nang, Ei Ei K., Nangia, Vinay B., Narake, Sameer, Ndiaye, Ndeye Coumba, Neal, William A., Nejatizadeh, Azim, Nenko, Ilona, Neovius, Martin, Neuhauser, Hannelore K., Nguyen, Chung T., Nguyen, Nguyen D., Nguyen, Quang V., Quang Ngoc Nguyen, Nieto-Martinez, Ramfis E., Niiranen, Teemu J., Nikitin, Yury P., Ninomiya, Toshiharu, Nishtar, Sania, Njelekela, Marina A., Noale, Marianna, Noboa, Oscar A., Noorbala, Ahmad Ali, Norat, Teresa, Nordendahl, Maria, Nordestgaard, Borge G., Noto, Davide, Nowak-Szczepanska, Natalia, Al Nsour, Mohannad, Nunes, Baltazar, O'Neill, Terence W., O'Reilly, Dermot, Ochimana, Caleb, Oda, Eiji, Odili, Augustine N., Oh, Kyungwon, Ohara, Kumiko, Ohtsuka, Ryutaro, Olie, Valerie, Olinto, Maria Teresa A., Oliveira, Isabel O., Omar, Mohd Azahadi, Onat, Altan, Ong, Sok King, Ono, Lariane M., Ordunez, Pedro, Ornelas, Rui, Ortiz, Pedro J., Osmond, Clive, Ostojic, Sergej M., Ostovar, Afshin, Otero, Johanna A., Overvad, Kim, Owusu-Dabo, Ellis, Paccaud, Fred Michel, Padez, Cristina, Pahomova, Elena, de Paiva, Karina Mary, Pajak, Andrzej, Palli, Domenico, Palmieri, Luigi, Pan, Wen-Harn, Panda-Jonas, Songhomitra, Panza, Francesco, Paoli, Mariela, Papandreou, Dimitrios, Park, Soon-Woo, Park, Suyeon, Parnell, Winsome R., Parsaeian, Mahboubeh, Pasquet, Patrick, Patel, Nikhil D., Pavlyshyn, Halyna, Pecin, Ivan, Pednekar, Mangesh S., Pedro, Joao M., Peer, Nasheeta, Peixoto, Sergio Viana, Peltonen, Markku, Pereira, Alexandre C., Peres, Karen G. D. A., Peres, Marco A., Peters, Annette, Petkeviciene, Janina, Peykari, Niloofar, Son Thai Pham, Pichardo, Rafael N., Pigeot, Iris, Pikhart, Hynek, Pilav, Aida, Pilotto, Lorenza, Pitakaka, Freda, Piwonska, Aleksandra, Pizarro, Andreia N., Plans-Rubio, Pedro, Polasek, Ozren, Porta, Miquel, Poudyal, Anil, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J., Price, Jacqueline F., Providencia, Rui, Puhakka, Soile E., Puiu, Maria, Punab, Margus, Qasrawi, Radwan F., Qorbani, Mostafa, Queiroz, Daniel, Tran Quoc Bao, Radic, Ivana, Radisauskas, Ricardas, Rahimikazerooni, Salar, Rahman, Mahfuzar, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina M., Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramos, Elisabete, Rampal, Lekhraj, Rampal, Sanjay, Rangel Reina, Daniel A., Rarra, Vayia, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M., Regecova, Valeria, Revilla, Luis, Rezaianzadeh, Abbas, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, de Wit, Tobias F. Rinke, Ritti-Dias, Raphael M., Robitaille, Cynthia, Rodriguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, Maria, Rodriguez-Villamizar, Laura A., Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Romaguera, Dora, Romeo, Elisabetta L., Rosengren, Annika, Roy, Joel G. R., Rubinstein, Adolfo, Ruidavets, Jean-Bernard, Sandra Ruiz-Betancourt, Blanca, Ruiz-Castell, Maria, Rusakova, Iuliia A., Russo, Paola, Rutkowski, Marcin, Sabanayagam, Charumathi, Sabbaghi, Hamideh, Sachdev, Harshpal S., Sadjadi, Alireza, Safarpour, Ali Reza, Safi, Sare, Safiri, Saeid, Saidi, Olfa, Saki, Nader, Salanave, Benoit, Salazar Martinez, Eduardo, Salmeron, Diego, Salomaa, Veikko, Salonen, Jukka T., Salvetti, Massimo, Sanchez-Abanto, Jose, Sans, Susana, Santos, Diana A., Santos, Ina S., Santos, Lelita C., Santos, Maria Paula, Santos, Rute, Saramies, Jouko L., Sardinha, Luis B., Sarganas, Giselle, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savvas, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D., Schargrodsky, Herman, Schipf, Sabine, Schmidt, Carsten O., Schnohr, Peter, Schoettker, Ben, Schramm, Sara, Schultsz, Constance, Schutte, Aletta E., Sebert, Sylvain, Sein, Aye Aye, Sen, Abhijit, Senbanjo, Idowu O., Sepanlou, Sadaf G., Servais, Jennifer, Shalnova, Svetlana A., Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K., Shaw, Jonathan E., Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M., de Moura Silva, Caroline Ramos, Santos Silva, Diego Augusto, Simon, Mary, Simons, Judith, Simons, Leon A., Sjostrom, Michael, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobngwi, Eugene, Soderberg, Stefan, Soemantri, Agustinus, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sorensen, Thorkild I. A., Sorgjerd, Elin P., Soric, Maroje, Jerome, Charles Sossa, Soumare, Aicha, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Staessen, Jan A., Starc, Gregor, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D., Stergiou, George S., Stessman, Jochanan, Stieber, Jutta, Stoeckl, Doris, Stocks, Tanja, Stokwiszewski, Jakub, Stronks, Karien, Strufaldi, Maria Wany, Suka, Machi, Sun, Chien-An, Sung, Yn-Tz, Suriyawongpaisal, Paibul, Sy, Rody G., Syddall, Holly E., Sylva, Rene Charles, Szklo, Moyses, Tai, E. Shyong, Tammesoo, Mari-Liis, Tamosiunas, Abdonas, Tan, Eng Joo, Tang, Xun, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarqui-Mamani, Carolina B., Taylor, Anne, Taylor, Julie, Tebar, William R., Tell, Grethe S., Tello, Tania, Tham, Yih Chung, Thankappan, K. R., Theobald, Holger, Theodoridis, Xenophon, Thinggaard, Mikael, Thomas, Nihal, Thorand, Barbara, Thuesen, Betina H., Timmermans, Erik J., Tjandrarini, Dwi H., Tjonneland, Anne, Toft, Ulla, Tolonen, Hanna K., Tolstrup, Janne S., Topbas, Murat, Topor-Madry, Roman, Jose Tormo, Maria, Tornaritis, Michael J., Torrent, Maties, Torres-Collado, Laura, Touloumi, Giota, Traissac, Pierre, Triantafyllou, Areti, Trichopoulos, Dimitrios, Trichopoulou, Antonia, Trinh, Oanh T. H., Trivedi, Atul, Tshepo, Lechaba, Tsugane, Shoichiro, Tuliakova, Azaliia M., Tulloch-Reid, Marshall K., Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L., Twig, Gilad, Tynelius, Per, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ulmer, Hanno, Uusitalo, Hannu M. T., Valdivia, Gonzalo, Valvi, Damaskini, van Dam, Rob M., van den Born, Bert-Jan, Van der Heyden, Johan, van der Schouw, Yvonne T., Van Herck, Koen, Hoang Van Minh, Van Schoor, Natasja M., van Valkengoed, Irene G. M., van Zutphen, Elisabeth M., Vanuzzo, Diego, Varbo, Anette, Vasan, Senthil K., Vega, Tomas, Veidebaum, Toomas, Velasquez-Melendez, Gustavo, Veronesi, Giovanni, Verschuren, W. M. Monique, Verstraeten, Roosmarijn, Victora, Cesar G., Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesus, Virtanen, Jyrki K., Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vlasoff, Tiina, Vollenweider, Peter, Voutilainen, Ari, Wade, Alisha N., Walton, Janette, Wambiya, Elvis O. A., Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, Wanderley Junior, Rildo de Souza, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S. Goya, Wareham, Nicholas, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H., Widhalm, Kurt, Wiecek, Andrzej, Wilks, Rainford J., Willeit, Johann, Willeit, Peter, Williams, Emmanuel A., Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A., Wong, Andrew, Wong, Tien Yin, Woo, Jean, Wu, Frederick C., Wu, Shouling, Wyszynska, Justyna, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K., Yoosefi, Moein, Yoshihara, Akihiro, You, San-Lin, Younger-Coleman, Novie O., Yusoff, Ahmad Faudzi, Zainuddin, Ahmad A., Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antonis, Elisa Zapata, Maria, Zaw, Ko Ko, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhao, Dong, Zhao, Ming-Hui, Zhen, Shiqi, Zheng, Yingfeng, Zholdin, Bekbolat, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Zoghlami, Nada, Zuniga Cisneros, Julio., School of Medicine, ACS - Diabetes & metabolism, APH - Global Health, Pulmonology, Medical Informatics, Adult Psychiatry, Global Health, APH - Quality of Care, APH - Methodology, Vascular Medicine, ACS - Atherosclerosis & ischemic syndromes, Anesthesiology, Graduate School, and ACS - Heart failure & arrhythmias
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Male ,Latin Americans ,Nutrition and Disease ,Epidemiology ,[SDV]Life Sciences [q-bio] ,Medizin ,BLOOD-PRESSURE ,030204 cardiovascular system & hematology ,Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants ,Hypertension ,Prevalence ,Control ,Tretament ,GUIDELINES ,Global Health ,Worldwide trends ,0302 clinical medicine ,Hypertension prevalence ,Voeding en Ziekte ,Medicine and Health Sciences ,kohonnut verenpaine ,Medicine ,030212 general & internal medicine ,Prevention and Control ,11 Medical and Health Sciences ,ComputingMilieux_MISCELLANEOUS ,education.field_of_study ,food and beverages ,Public Health, Global Health, Social Medicine and Epidemiology ,General Medicine ,Noncommunicable diseases ,Period prevalence ,Middle Aged ,kansainvälinen vertailu ,3142 Public health care science, environmental and occupational health ,3. Good health ,MIDDLE-INCOME ,Pooled analysis ,SYSTEMATIC ANALYSIS ,INCOME COUNTRIES ,ADULTS ,PREVENTION ,MANAGEMENT ,ADHERENCE ,DIAGNOSIS ,Western europe ,[SDE]Environmental Sciences ,Hypertension/diagnosis ,NCD Risk Factor Collaboration (NCD-RisC) ,Female ,B990 Subjects Allied to Medicine not elsewhere classified ,Life Sciences & Biomedicine ,Adult ,health-care ,esiintyvyys ,Central asia ,Population ,Nursing ,3121 Internal medicine ,03 medical and health sciences ,Medicine, General & Internal ,Drug Therapy ,General & Internal Medicine ,Life Science ,Humans ,ddc:610 ,education ,Antihypertensive Agents ,VLAG ,Aged ,Science & Technology ,Antihypertensive Agents/therapeutic use ,business.industry ,Omvårdnad ,fungi ,General and internal medicine ,Estados de Saúde e de Doença ,Taking medication ,Treatment ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Blood pressure ,Faculdade de Ciências Sociais ,3121 General medicine, internal medicine and other clinical medicine ,lääkehoito ,1182 Biochemistry, cell and molecular biology ,business ,Demography - Abstract
Background: hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods: we used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings: the number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings., British Heart Foundation Centre of Research Excellence Grant; World Health Organization (WHO); Abdul Latif Jameel Institute for Disease and Emergency Analytics Fellowship
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- 2021
3. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight
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Bennett, JE, Jackson, RT, Baker, JL, Cooper, C, Hill, AG, Islam, Shariful, James, K, Khosravi, Abbas, Kim, J, Kos, J, Lee, J, McLean, SB, Mohan, V, Rahman, M, Sharma, SK, Shaw, Jonathan, Swinburn, BA, Tan, Andrew, Taylor, A, Tran, TT-H, Vasan, SK, Wade, AN, Wang, X, Williams, J, Yang, X, Bennett, JE, Jackson, RT, Baker, JL, Cooper, C, Hill, AG, Islam, Shariful, James, K, Khosravi, Abbas, Kim, J, Kos, J, Lee, J, McLean, SB, Mohan, V, Rahman, M, Sharma, SK, Shaw, Jonathan, Swinburn, BA, Tan, Andrew, Taylor, A, Tran, TT-H, Vasan, SK, Wade, AN, Wang, X, Williams, J, and Yang, X
- Abstract
From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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- 2021
4. Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk
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Vasan, SK, Osmond, C, Canoy, D, Christodoulides, C, Neville, MJ, Di Gravio, C, Fall, CHD, Karpe, F, Vasan, SK, Osmond, C, Canoy, D, Christodoulides, C, Neville, MJ, Di Gravio, C, Fall, CHD, and Karpe, F
- Abstract
Background/Objectives:Fat distribution is a strong and independent predictor of type 2 diabetes (T2D) and cardiovascular disease (CVD) and is usually determined using conventional anthropometry in epidemiological studies. Dual-energy X-ray absorptiometry (DXA) can measure total and regional adiposity more accurately. Nonetheless, whether DXA provides more precise estimates of cardiovascular risk in relation to total and regional adiposity is not known. We determined the strength of the associations between DXA-and conventional anthropometry determined fat distribution and T2D and CVD risk markers.Subjects/Methods:Waist (WC) and hip circumference (HC) and DXA was used to measure total and regional adiposity in 4950 (2119 men) participants aged 29-55 years from the Oxford Biobank without pre-existing T2D or CVD. Cross-sectional associations were compared between WC and HC vs. DXA-determined regional adiposity (all z-score normalised) with impaired fasting glucose, hypertriglyceridemia, hypertension and insulin resistance (IR).Results:Following adjustment for total adiposity, upper body adiposity measurements showed consistently increased risk of T2D and CVD risk markers except for abdominal subcutaneous fat in both sexes, and arm fat in men, which showed protective associations. Among upper adiposity depots, visceral fat mass showed stronger odds ratios (OR) ranging from 1.69 to 3.64 compared with WC 1.07-1.83. Among lower adiposity depots, HC showed modest protection for IR in both sexes (men: OR 0.80 (95% confidence interval 0.67, 0.96); women: 0.69 (0.56, 0.86)), whereas gynoid fat and in particular leg fat showed consistent and strong protective effects for all outcomes in both men and women. The differential effect of body fat distribution on CVD and T2D were more pronounced at higher levels of total adiposity.Conclusions:Compared with DXA, conventional anthropometry underestimates the associations of regional adiposity with T2D and CVD risk markers. After correc
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- 2018
5. A common variant in the FTO locus is associated with waist-hip ratio in Indian adolescents
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Vasan, SK, Fall, T, Job, V, Gu, HF, Ingelsson, E, Brismar, K, Karpe, F, and Thomas, N
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nutritional and metabolic diseases - Abstract
Background: Common variants in the FTO locus, and near MC4R locus, have been shown to have a robust association with obesity in children and adults among various ethnic groups. Associations with obesity traits among Indian adolescents have not been determined. Objective: To study the association of rs9939609 (FTO) and rs17782313 (MC4R) to obesity related anthropometric traits in Indian adolescents. Methods: Subjects for the current study were recruited from a cross-sectional cohort of 1,230 adolescents (age mean ± SD: 17.1 ± 1.9 years) from South India. Results: The variant at the FTO locus was found to be associated with waist-hip ratio (WHR) but not with overall obesity in this population. No significant association was observed for obesity-traits and Mc4R variant rs17782313. Conclusion: The common variant of FTO (rs9939609) is associated with body fat distribution during early growth in Indian adolescents and may predispose to obesity and metabolic consequences in adulthood. © 2012 The Authors.
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- 2016
6. Evaluation of the phenotypic effects of common FTO and MC4R genetic polymorphisms in a general population from South India
- Author
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Vasan, SK, Samuel, P, Antonisamy, B, Thomas, N, Neville, MJ, Karpe, F, Gu, HF, and Brismar, K
- Published
- 2016
7. Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants
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Kuulasmaa K., Kyobutungi C., La Q.N., Laamiri F.Z., Laatikainen T., Lachat C., Laid Y., Lam T.H., Lambrinou C.-P., Landais E., Lanska V., Lappas G., Larijani B., Latt T.S., Lauria L., Lazo-Porras M., Le Nguyen Bao K., Le Port A., Le T.D., Lee J., Lee P.H., Lehmann N., Lehtimaki T., Lemogoum D., Levitt N.S., Li Y., Liivak M., Lilly C.L., Lim W.-Y., Lima-Costa M.F., Lin H.-H., Lin X., Lin Y.-T., Lind L., Linneberg A., Lissner L., Litwin M., Liu J., Liu L., Lo W.-C., Loit H.-M., Long K.Q., Lopes L., Lopes O., Lopez-Garcia E., Lopez T., Lotufo P.A., Lozano J.E., Lukrafka J.L., Luksiene D., Lundqvist A., Lundqvist R., Lunet N., Lunogelo C., Lustigova M., Luszczki E., Ma G., Ma J., Ma X., Machado-Coelho G.L., Machado-Rodrigues A.M., Machi S., Macieira L.M., Madar A.A., Maggi S., Magliano D.J., Magnacca S., Magriplis E., Mahasampath G., Maire B., Majer M., Makdisse M., Maki P., Malekzadeh F., Malhotra R., Mallikharjuna Rao K., Malyutina S.K., Maniego L.V., Manios Y., Mann J.I., Mansour-Ghanaei F., Manzato E., Margozzini P., Markaki A., Markey O., Markidou Ioannidou E., Marques-Vidal P., Marques L.P., Marrugat J., Martin-Prevel Y., Martin R., Martorell R., Martos E., Marventano S., Mascarenhas L.P., Masoodi S.R., Mathiesen E.B., Mathur P., Matijasevich A., Matsha T.E., Mavrogianni C., Mazur A., Mbanya J.C.N., McFarlane S.R., McGarvey S.T., McKee M., McLachlan S., McLean R.M., McLean S.B., McNulty B.A., Mediene-Benchekor S., Medzioniene J., Mehdipour P., Mehlig K., Mehrparvar A.H., Meirhaeghe A., Meisfjord J., Meisinger C., Menezes A.M.B., Menon G.R., Mensink G.B., Menzano M.T., Mereke A., Meshram I.I., Metspalu A., Mi J., Michaelsen K.F., Michels N., Mikkel K., Milkowska K., Miller J.C., Minderico C.S., Mini G.K., Miquel J.F., Mirjalili M.R., Mirkopoulou D., Mirrakhimov E., Misigoj-Durakovic M., Mistretta A., Mocanu V., Modesti P.A., Moghaddam S.S., Mohajer B., Mohamed M.K., Mohamed S.F., Mohammad K., Mohammadi Z., Mohammadifard N., Mohammadpourhodki R., Mohan V., Mohanna S., Mohd Yusoff M.F., Mohebbi I., Mohebi F., Moitry M., Molbo D., Mollehave L.T., Moller N.C., Molnar D., Momenan A., Mondo C.K., Monroy-Valle M., Monterrubio-Flores E., Monyeki K.D.K., Moosazadeh M., Moreira L.B., Morejon A., Moreno L.A., Morgan K., Morin S.N., Mortensen E.L., Moschonis G., Mossakowska M., Mostafa A., Mota-Pinto A., Mota J., Motlagh M.E., Motta J., Moura-dos-Santos M.A., Mridha M.K., Msyamboza K.P., Mu T.T., Muc M., Mugosa B., Muiesan M.L., Mukhtorova P., Muller-Nurasyid M., Murphy N., Mursu J., Murtagh E.M., Musa K.I., Music Milanovic S., Musil V., Mustafa N., Nabipour I., Naderimagham S., Nagel G., Naidu B.M., Najafi F., Nakamura H., Namesna J., Nang E.E.K., Nangia V.B., Nankap M., Narake S., Nardone P., Nauck M., Neal W.A., Nejatizadeh A., Nelis K., Nelis L., Nenko I., Neovius M., Nervi F., Nguyen C.T., Nguyen D., Nguyen Q.N., Nieto-Martinez R.E., Nikitin Y.P., Ning G., Ninomiya T., Nishtar S., Noale M., Noboa O.A., Nogueira H., Norat T., Nordendahl M., Nordestgaard B.G., Noto D., Nowak-Szczepanska N., Nsour M.A., Nuhoglu I., Nurk E., O'Neill T.W., O'Reilly D., Obreja G., Ochimana C., Ochoa-Aviles A.M., Oda E., Oh K., Ohara K., Ohlsson C., Ohtsuka R., Olafsson O., Olinto M.T.A., Oliveira I.O., Omar M.A., Onat A., Ong S.K., Ono L.M., Ordunez P., Ornelas R., Ortiz A.P., Ortiz P.J., Osler M., Osmond C., Ostojic S.M., Ostovar A., Otero J.A., Overvad K., Owusu-Dabo E., Paccaud F.M., Padez C., Pagkalos I., Pahomova E., Paiva K.M.D., Pajak A., Palli D., Palloni A., Palmieri L., Pan W.-H., Panda-Jonas S., Pandey A., Panza F., Papandreou D., Park S.-W., Park S., Parnell W.R., Parsaeian M., Pascanu I.M., Pasquet P., Patel N.D., Pednekar M.S., Peer N., Peixoto S.V., Peltonen M., Pereira A.C., Peres M.A., Perez-Farinos N., Perez C.M., Peterkova V., Peters A., Petersmann A., Petkeviciene J., Petrauskiene A., Pettenuzzo E., Peykari N., Pham S.T., Pichardo R.N., Pierannunzio D., Pigeot I., Pikhart H., Pilav A., Pilotto L., Pistelli F., Pitakaka F., Piwonska A., Pizarro A.N., Plans-Rubio P., Poh B.K., Pohlabeln H., Pop R.M., Porta M., Posch G., Poudyal A., Poulimeneas D., Pouraram H., Pourfarzi F., Pourshams A., Poustchi H., Pradeepa R., Price A.J., Price J.F., Providencia R., Puder J.J., Pudule I., Puhakka S.E., Puiu M., Punab M., Qasrawi R.F., Qorbani M., Quoc Bao T., Radic I., Radisauskas R., Rahimikazerooni S., Rahman M., Raitakari O., Raj M., Rakhimova E., Rakhmatulloev S., Rakovac I., Ramachandra Rao S., Ramachandran A., Ramke J., Ramos E., Ramos R., Rampal L., Rampal S., Rarra V., Rascon-Pacheco R.A., Rasmussen M., Rech C.R., Redon J., Reganit P.F.M., Regecova V., Revilla L., Rezaianzadeh A., Ribas-Barba L., Ribeiro R., Riboli E., Richter A., Rigo F., Rinaldo N., Rinke de Wit T.F., Rito A., Ritti-Dias R.M., Rivera J.A., Robitaille C., Roccaldo R., Rodrigues D., Rodriguez-Artalejo F., Rodriguez-Perez M.D.C., Rodriguez-Villamizar L.A., Roggenbuck U., Rojas-Martinez R., Rojroongwasinkul N., Romaguera D., Romeo E.L., Rosario R.V., Rosengren A., Rouse I., Roy J.G., Rubinstein A., Ruhli F.J., Ruidavets J.-B., Ruiz-Betancourt B.S., Ruiz Moreno E., Rusakova I.A., Russell Jonsson K., Russo P., Rust P., Rutkowski M., Sabanayagam C., Sacchini E., Sachdev H.S., Sadjadi A., Safarpour A.R., Safi S., Safiri S., Saidi O., Saki N., Salanave B., Salazar Martinez E., Salmeron D., Salomaa V., Salonen J.T., Salvetti M., Samoutian M., Sanchez-Abanto J., Sandjaja, Sans S., Santa Marina L., Santos D.A., Santos I.S., Santos L.C., Santos M.P., Santos O., Santos R., Santos Sanz S., Saramies J.L., Sardinha L.B., Sarrafzadegan N., Sathish T., Saum K.-U., Savva S., Savy M., Sawada N., Sbaraini M., Scazufca M., Schaan B.D., Schaffrath Rosario A., Schargrodsky H., Schienkiewitz A., Schindler K., Schipf S., Schmidt C.O., Schmidt I.M., Schnohr P., Schottker B., Schramm S., Schroder H., Schultsz C., Schutte A.E., Sebert S., Sein A.A., Selamat R., Sember V., Sen A., Senbanjo I.O., Sepanlou S.G., Sequera V., Serra-Majem L., Servais J., Sevcikova L., Shalnova S.A., Shamah-Levy T., Shamshirgaran M., Shanthirani C.S., Sharafkhah M., Sharma S.K., Shaw J.E., Shayanrad A., Shayesteh A.A., Shengelia L., Shi Z., Shibuya K., Shimizu-Furusawa H., Shin D.W., Shin Y., Shirani M., Shiri R., Shrestha N., Si-Ramlee K., Siani A., Siantar R., Sibai A.M., Silva A.M., Silva D.A.S., Simon M., Simons J., Simons L.A., Sjoberg A., Sjostrom M., Skodje G., Slowikowska-Hilczer J., Slusarczyk P., Smeeth L., So H.-K., Soares F.C., Sobek G., Sobngwi E., Sodemann M., Soderberg S., Soekatri M.Y., Soemantri A., Sofat R., Solfrizzi V., Somi M.H., Sonestedt E., Song Y., Sorgjerd E.P., Sossa Jerome C., Soto-Rojas V.E., Soumare A., Sovic S., Sparboe-Nilsen B., Sparrenberger K., Spinelli A., Spiroski I., Staessen J.A., Stamm H., Stathopoulou M.G., Staub K., Stavreski B., Steene-Johannessen J., Stehle P., Stein A.D., Stergiou G.S., Stessman J., Stevanovic R., Stieber J., Stockl D., Stocks T., Stokwiszewski J., Stoyanova E., Stratton G., Stronks K., Strufaldi M.W., Sturua L., Suarez-Medina R., Suka M., Sun C.-A., Sundstrom J., Sung Y.-T., Sunyer J., Suriyawongpaisal P., Swinburn B.A., Sy R.G., Syddall H.E., Sylva R.C., Szklo M., Szponar L., Tai E.S., Tammesoo M.-L., Tamosiunas A., Tan E.J., Tang X., Tanser F., Tao Y., Tarawneh M.R., Tarp J., Tarqui-Mamani C.B., Taxova Braunerova R., Taylor A., Taylor J., Tchibindat F., Tebar W.R., Tell G.S., Tello T., Thankappan K.R., Theobald H., Theodoridis X., Thijs L., Thomas N., Thuesen B.H., Ticha L., Timmermans E.J., Tjonneland A., Tolonen H.K., Tolstrup J.S., Topbas M., Topor-Madry R., Torheim L.E., Tormo M.J., Tornaritis M.J., Torrent M., Torres-Collado L., Toselli S., Traissac P., Tran T.T.-H., Trichopoulos D., Trichopoulou A., Trinh O.T., Trivedi A., Tshepo L., Tsigga M., Tsugane S., Tuliakova A.M., Tulloch-Reid M.K., Tullu F., Tuomainen T.-P., Tuomilehto J., Turley M.L., Tynelius P., Tzotzas T., Tzourio C., Ueda P., Ugel E., Ukoli F.A., Ulmer H., Unal B., Usupova Z., Uusitalo H.M., Uysal N., Vaitkeviciute J., Valdivia G., Vale S., Valvi D., van Dam R.M., Van der Heyden J., van der Schouw Y.T., Van Herck K., Van Minh H., van Valkengoed I.G., Vanderschueren D., Vanuzzo D., Varbo A., Varela-Moreiras G., Varona-Perez P., Vasan S.K., Vega T., Veidebaum T., Velasquez-Melendez G., Velika B., Veronesi G., Verschuren W.M., Victora C.G., Viegi G., Viet L., Villalpando S., Vineis P., Vioque J., Virtanen J.K., Visser M., Visvikis-Siest S., Viswanathan B., Vladulescu M., Vlasoff T., Vocanec D., Volzke H., Voutilainen A., Voutilainen S., Vrijheid M., Vrijkotte T.G., Wade A.N., Wagner A., Waldhor T., Walton J., Wambiya E.O., Wan Bebakar W.M., Wan Mohamud W.N., Wanderley Junior R.D.S., Wang M.-D., Wang N., Wang Q., Wang X., Wang Y.X., Wang Y.-W., Wannamethee S.G., Wareham N., Weber A., Wedderkopp N., Weerasekera D., Weghuber D., Wei W., Weres A., Werner B., Whincup P.H., Widhalm K., Widyahening I.S., Wiecek A., Wilks R.J., Willeit J., Willeit P., Williams J., Wilsgaard T., Wojtyniak B., Wong-McClure R.A., Wong A., Wong J.E., Wong T.Y., Woo J., Woodward M., Wu F.C., Wu J., Wu L.J., Wu S., Xu H., Xu L., Yaacob N.A., Yamborisut U., Yan W., Yang L., Yang X., Yang Y., Yardim N., Yaseri M., Yasuharu T., Ye X., Yiallouros P.K., Yoosefi M., Yoshihara A., You Q.S., You S.-L., Younger-Coleman N.O., Yusof S.M., Yusoff A.F., Zaccagni L., Zafiropulos V., Zakavi S.R., Zamani F., Zambon S., Zampelas A., Zamrazilova H., Zapata M.E., Zargar A.H., Zaw K.K., Zdrojewski T., Zeljkovic Vrkic T., Zeng Y., Zhang L., Zhang Z.-Y., Zhao D., Zhao M.-H., Zhao W., Zhen S., Zheng W., Zheng Y., Zholdin B., Zhou M., Zhu D., Zocalo Y., Zuniga Cisneros J., Zuziak M., and Ezzati M.
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Male ,body-mass index ,ADULTHOOD ,Adolescents ,pituuskasvu ,Pediatrics ,Body Mass Index ,0302 clinical medicine ,Child Development ,nuoret ,Public health surveillance ,Medicine ,Health Status Indicators ,10. No inequality ,Child ,11 Medical and Health Sciences ,Body mass index ,ComputingMilieux_MISCELLANEOUS ,education.field_of_study ,VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801 ,General Medicine ,Body mass indexes ,kansainvälinen vertailu ,3. Good health ,Geography ,Health ,030220 oncology & carcinogenesis ,Child, Preschool ,Medical and Health sciences ,purl.org/becyt/ford/3 [https] ,medicine.medical_specialty ,School-aged adolescents ,Socio-culturale ,lapset (ikäryhmät) ,Nursing ,territories ,ravinto ,purl.org/becyt/ford/3.3 [https] ,03 medical and health sciences ,School Children ,SDG 3 - Good Health and Well-being ,SYSTEMATIC ANALYSIS ,Humans ,school-aged children and adolescents ,Montenegro ,education ,Science & Technology ,Omvårdnad ,Health sciences, Medical and Health sciences ,Ciências médicas e da saúde ,Bayes Theorem ,Anthropometry ,Adolescent Development ,medicine.disease ,TRENDS ,Height and Body-mass Index ,Faculdade de Ciências Sociais ,UNDERNUTRITION ,Height index trajectories ,Height, body mass index, children , epidemiology ,risk factors, growth ,Stature ,Demography ,Settore MED/09 - Medicina Interna ,Internationality ,[SDV]Life Sciences [q-bio] ,030204 cardiovascular system & hematology ,Body-mass index trajectories ,Epidemiology ,Medicine and Health Sciences ,risk factors ,countries ,EPIDEMIOLOGY ,height ,children ,adolescents ,BMI ,030212 general & internal medicine ,painoindeksi ,Child development ,2. Zero hunger ,Medicine(all) ,School age child ,obestity children cardiovascular ,Population Health ,1. No poverty ,Pediatrik ,Public Health, Global Health, Social Medicine and Epidemiology ,3142 Public health care science, environmental and occupational health ,Pooled analysis ,NUTRITION ,Female ,medicine.symptom ,pooled analysis ,Life Sciences & Biomedicine ,terveys ,height, BMI, nutrition, health, children, adolescents ,Adolescent ,growth ,Population ,body-mass ,Population based ,Body-mass index ,Young Adult ,Medicine, General & Internal ,Meta-Analysis as Topic ,General & Internal Medicine ,parasitic diseases ,Weight gain ,School-aged childrens ,Age trajectories ,business.industry ,Height ,Weight ,Body Height ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Malnutrition ,ONSET ,Ciências da Saúde, Ciências médicas e da saúde ,School-aged children ,VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801 ,business ,terveysriskit ,Estilos de Vida e Impacto na Saúde - Abstract
BACKGROUND: Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents., METHODS: For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence., FINDINGS: We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls., INTERPRETATION: The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks., Wellcome Trust, AstraZeneca Young Health Programme, EU., peer-reviewed
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- 2020
8. Prevalence and long-term change in alcohol consumption: results from a population-based cohort in Southern India.
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Gowri SM, Belavendra A, Vasan SK, Keerthi S, and Andreasson S
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Background: Alcohol consumption in India is below the global average, with limited data on long-term effects. The current study aims to examine changes over time among alcohol consumers, the pattern of drinking and help-seeking for alcohol problems among South Indian men., Method: Data on the intake of various alcohol types were collected through standard questionnaires in two adult follow-ups [Baseline: 1998-2002, Follow-up: 2016-2019] from male participants in the Vellore birth cohort (VBC). Alcohol intake was converted to weekly standard drink units for analysis. Data on drinking patterns using the Alcohol Use Disorder Identification Test (AUDIT) and information on help-seeking among problem drinkers were collected during follow-up. Socio-demographic associations with alcohol consumption were determined using logistic regression., Results: The prevalence of alcohol consumption was 54.5% and 47.7% at the baseline and follow-up, respectively. Over two decades, 12% of men reported to have newly started drinking and 18% quit drinking. Lower education and lower socio-economic status (SES) were the strongest predictors of alcohol consumption. The AUDIT assessment among drinkers reported hazardous drinking of 38.4%, harmful drinking of 4.7% and 3.7% probable alcohol dependence. Among the persons with high AUDIT scores, 25% were concerned about high consumption, and 9% sought help to stop their alcohol consumption., Conclusion: Our results showed a decline in alcohol consumption in this cohort over two decades. Among drinkers, a high proportion report hazardous and harmful consumption. Low levels of education and SES are significant predictors of alcohol consumption. A low proportion of help-seeking reflects alcohol-related stigma in the community., (© 2024. The Author(s).)
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- 2024
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9. Are weight loss and metabolic outcomes of bariatric surgery influenced by candidate glucocorticoid receptor gene polymorphisms? A prospective study.
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Iqbal Z, Vasan SK, Fachim H, Warner-Levy J, Donn RP, Ammori BJ, Heald AH, Soran H, and Syed AA
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- Humans, Female, Middle Aged, Male, Prospective Studies, Treatment Outcome, Diabetes Mellitus, Type 2 genetics, Diabetes Mellitus, Type 2 metabolism, Diabetes Mellitus, Type 2 surgery, Obesity, Morbid surgery, Obesity, Morbid genetics, Obesity, Morbid metabolism, Adult, Receptors, Glucocorticoid genetics, Receptors, Glucocorticoid metabolism, Polymorphism, Single Nucleotide, Weight Loss genetics, Bariatric Surgery
- Abstract
Background: Bariatric surgery is the most effective treatment for severe obesity. There can be variation in the degree of weight reduction following bariatric surgery. It is unknown whether single nucleotide polymorphisms (SNPs) in the glucocorticoid receptor locus (GRL) affect postoperative weight loss and metabolic outcomes., Materials/methods: We studied the association between selected candidate SNPs and postoperative weight loss and metabolic outcomes in patients with severe obesity undergoing bariatric surgery. The polymorphisms rs41423247 (Bcl1), rs56149945 (N363S) and rs6189/rs6190 (ER22/23EK) were analysed., Results: The 139 participants included 95 women (68.3%) and had a median (interquartile range) age of 53.0 (46.0-60.0) years and mean (SD) weight of 140.8 (28.8) kg and body mass index of 50.3 (8.6) kg/m2. At baseline, 59 patients had type 2 diabetes (T2D), 60 had hypertension and 35 had obstructive sleep apnoea syndrome treated with continuous positive airway pressure (CPAP). 84 patients (60.4%) underwent gastric bypass and 55 (39.6%) underwent sleeve gastrectomy. There were no significant differences in weight loss, glycated haemoglobin (HbA1c) or lipid profile categorized by genotype status, sex or median age. There was significant weight reduction after bariatric surgery with a postoperative BMI of 34.1 (6.8) kg/m2 at 24 months ( p < 0.001)., Conclusion: While GRL polymorphisms with a known deleterious effect on adipose tissue mass and function may have a small, additive effect on the prevalence of obesity and related metabolic disorders in the population, we suggest that the relatively weak biological influence of these SNPs is readily overcome by bariatric surgery.
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- 2024
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10. Echocardiography protocol and cardiometabolic phenotyping in Indian birth cohorts-the IndEcho study.
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Vasan SK, Alex AG, Roy A, Gowri M, Sinha S, Suresh J, Philip RS, Kochumon J, Jaiswal N, Arulappan G, Ramakrishnan L, Sachdev HS, Tandon N, Thomas N, Jebasingh F, Osmond C, Karpe F, Bhargava SK, Antonisamy B, Prabhakaran D, Fall CHD, and Thomson VS
- Abstract
Background: Asian Indians are at higher risk of cardiometabolic disease compared to other ethnic groups, and the age of onset is typically younger. Cardiac structure and function are poorly characterized in this ethnic group. In this study, we describe image-acquisition methods and the reproducibility of measurements and detailed echocardiography characteristics in two large Indian population-based cohorts (the New Delhi and Vellore Birth Cohorts) from India., Methods: The IndEcho study captured transthoracic echocardiographic measurements of cardiac structure and function from 2,322 men and women aged 43-50 years. M-mode measurements in the parasternal long axis (PLAX) and 2-dimensional (2D) short axis recordings at the mitral valve, mid-papillary and apical level were recorded. Apical 2D recordings of two- three- and four-chamber (2C, 3C and 4C) views and Doppler images (colour, pulsed and continuous) were recorded in cine-loop format. Left ventricular (LV) mass, LV hypertrophy, and indices of LV systolic and diastolic function were derived., Results: Echocardiographic measurements showed good/excellent technical reproducibility. Hetero-geneity across sites, sex and rural/urban differences in cardiac structure and function were observed. Overall, this cohort of South Asian Indians had smaller LV mass and normal systolic and diastolic function when compared with published data on other Asian Indians and the West, (LV mass indexed for body surface area: Delhi men: 68 g/m
2 , women 63.9; Vellore men: 65.8, women 61.6) but were within ethnic-specific reference ranges. The higher prevalence of obesity, diabetes and hypertension is reflected by the higher proportion of LV remodelling and lesser hypertrophy., Conclusions: Our study adds to scarce population-based echocardiographic data for mid-life Asian Indians. Compared to published literature on other ethnic groups, the Asian Indian heart is characterised by smaller cardiac dimensions and normal range systolic and diastolic function on a background of a high prevalence of hypertension, diabetes and cardiac disease at a relatively young age. This data will form the basis for further analyses of lifecourse, metabolic and body composition predictors of cardiac structure and function, and echocardiographic predictors of future mortality., Isrctn Registration Number: 13432279., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Vasan, Alex, Roy, Gowri, Sinha, Suresh, Philip, Kochumon, Jaiswal, Arulappan, Ramakrishnan, Sachdev, Tandon, Thomas, Jebasingh, Osmond, Karpe, Bhargava, Antonisamy, Prabhakaran, Fall and Thomson.)- Published
- 2023
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11. Concealed pregnancy as an act of care? A qualitative analysis of motivations for concealing and non-disclosure of early pregnancy in The Gambia.
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Parrish S, Vasan SK, Karpe F, Hardy-Johnson P, Jarjou O, Bittaye M, Prentice AM, Ulijaszek S, and Jobe M
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- Female, Humans, Pregnancy, Gambia, Cognition, Community Health Workers, Motivation, Abortion, Spontaneous
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Background: A barrier to achieving first trimester antenatal care (ANC) attendance in many countries has been the widespread cultural practice of not discussing pregnancies in the early stages. Motivations for concealing pregnancy bear further study, as the interventions necessary to encourage early ANC attendance may be more complicated than targeting infrastructural barriers to ANC attendance such as transportation, time, and cost., Methods: Five focus groups with a total of 30 married, pregnant women were conducted to assess the feasibility of conducting a randomised controlled trial to evaluate the effectiveness of early initiation of physical activity and/or yoghurt consumption in reducing Gestational Diabetes Mellitus in pregnant women in The Gambia. Focus group transcripts were coded through a thematic analysis approach, assessing themes as they arose in relation to failure to attend early ANC., Results: Two reasons for the concealment of pregnancies in the first trimester or ahead of a pregnancy's obvious visibility to others were given by focus group participants. These were 'pregnancy outside of marriage' and 'evil spirits and miscarriage.' Concealment on both grounds was motivated through specific worries and fears. In the case of a pregnancy outside of marriage, this was worry over social stigma and shame. Evil spirits were widely considered to be a cause of early miscarriage, and as such, women may choose to conceal their pregnancies in the early stages as a form of protection., Conclusion: Women's lived experiences of evil spirits have been under-explored in qualitative health research as they relate specifically to women's access to early antenatal care. Better understanding of how such sprits are experienced and why some women perceive themselves as vulnerable to related spiritual attacks may help healthcare workers or community health workers to identify in a timely manner the women most likely to fear such situations and spirits and subsequently conceal their pregnancies., (© 2023. The Author(s).)
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- 2023
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12. TCF7L2 plays a complex role in human adipose progenitor biology, which might contribute to genetic susceptibility to type 2 diabetes.
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Verma M, Loh NY, Sabaratnam R, Vasan SK, van Dam AD, Todorčević M, Neville MJ, Toledo E, Karpe F, and Christodoulides C
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- Endothelial Cells metabolism, Genetic Predisposition to Disease, Humans, Lipid Metabolism, Adipose Tissue cytology, Adipose Tissue metabolism, Diabetes Mellitus, Type 2 genetics, Diabetes Mellitus, Type 2 metabolism, Transcription Factor 7-Like 2 Protein genetics, Transcription Factor 7-Like 2 Protein metabolism
- Abstract
Introduction: Non-coding genetic variation at TCF7L2 is the strongest genetic determinant of type 2 diabetes (T2D) risk in humans. TCF7L2 encodes a transcription factor mediating the nuclear effects of WNT signaling in adipose tissue (AT). In vivo studies in transgenic mice have highlighted important roles for TCF7L2 in adipose tissue biology and systemic metabolism., Objective: To map the expression of TCF7L2 in human AT, examine its role in human adipose cell biology in vitro, and investigate the effects of the fine-mapped T2D-risk allele at rs7903146 on AT morphology and TCF7L2 expression., Methods: Ex vivo gene expression studies of TCF7L2 in whole and fractionated human AT. In vitro TCF7L2 gain- and/or loss-of-function studies in primary and immortalized human adipose progenitor cells (APCs) and mature adipocytes (mADs). AT phenotyping of rs7903146 T2D-risk variant carriers and matched controls., Results: Adipose progenitors (APs) exhibited the highest TCF7L2 mRNA abundance compared to mature adipocytes and adipose-derived endothelial cells. Obesity was associated with reduced TCF7L2 transcript levels in whole subcutaneous abdominal AT but paradoxically increased expression in APs. In functional studies, TCF7L2 knockdown (KD) in abdominal APs led to dose-dependent activation of WNT/β-catenin signaling, impaired proliferation and dose-dependent effects on adipogenesis. Whilst partial KD enhanced adipocyte differentiation, near-total KD impaired lipid accumulation and adipogenic gene expression. Over-expression of TCF7L2 accelerated adipogenesis. In contrast, TCF7L2-KD in gluteal APs dose-dependently enhanced lipid accumulation. Transcriptome-wide profiling revealed that TCF7L2 might modulate multiple aspects of AP biology including extracellular matrix secretion, immune signaling and apoptosis. The T2D-risk allele at rs7903146 was associated with reduced AP TCF7L2 expression and enhanced AT insulin sensitivity., Conclusions: TCF7L2 plays a complex role in AP biology and has both dose- and depot-dependent effects on adipogenesis. In addition to regulating pancreatic insulin secretion, genetic variation at TCF7L2 might also influence T2D risk by modulating AP function., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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13. The associations between body fat distribution and bone mineral density in the Oxford Biobank: a cross sectional study.
- Author
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Hilton C, Vasan SK, Neville MJ, Christodoulides C, and Karpe F
- Subjects
- Absorptiometry, Photon, Adult, Body Fat Distribution, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Biological Specimen Banks, Bone Density
- Abstract
Background: Body composition is associated with bone mineral density (BMD), but the precise associations between body fat distribution and BMD remain unclear. The regional adipose tissue depots have different metabolic profiles. We hypothesized that they would have independent associations with BMD., Research Design and Methods: We used data from 4,900 healthy individuals aged 30-50 years old from the Oxford Biobank to analyze associations between regional fat mass, lean mass and total BMD., Results: Total lean mass was strongly positively associated with BMD. An increase in total BMD was observed with increasing mass of all the fat depots, as measured either by anthropometry or DXA, when accounting for lean mass. However, on adjustment for both total fat mass and lean mass, fat depot specific associations emerged. Increased android and visceral adipose tissue mass in men, and increased visceral adipose tissue mass in women, were associated with lower BMD., Conclusions: Fat distribution alters the association between adiposity and BMD.
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- 2022
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14. Distinct opposing associations of upper and lower body fat depots with metabolic and cardiovascular disease risk markers.
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Gowri S M, Antonisamy B, Geethanjali FS, Thomas N, Jebasingh F, Paul TV, Karpe F, Osmond C, Fall CHD, and Vasan SK
- Subjects
- Adipose Tissue physiopathology, Adult, Body Mass Index, Cross-Sectional Studies, Female, Humans, India, Male, Metabolic Diseases metabolism, Adipose Tissue growth & development, Heart Disease Risk Factors, Metabolic Diseases physiopathology
- Abstract
Background: To examine the associations of total and regional adiposity with metabolic and cardiovascular disease (CVD) risk markers., Methods: This cross-sectional study included 1080 (53.8% men, aged 39-44 years) individuals from South India. Anthropometry (height, weight, waist and hip circumference), body composition assessment using dual-energy X-ray absorptiometry (DXA), blood pressure (BP), and plasma glucose, insulin and lipids were measured. Regression analysis was used to examine associations of standardized fat measurements with type 2 diabetes (T2D), insulin resistance (IR), hypertension and hypertriglyceridemia and continuous measurements of BP, glucose, insulin, HOMA-IR and lipids. Contour plots were constructed to visualize the differential effect of upper and lower fat depots., Results: DXA-measured fat depots were positively associated with metabolic and CVD risk markers. After adjusting for fat mass index, upper body fat remained positively, while lower body fat was negatively associated with risk markers. A one standard deviation (SD) increase in android fat showed higher odds ratios (ORs) for T2D (6.59; 95% CI 3.17, 13.70), IR (4.68; 95% CI 2.31, 9.50), hypertension (2.57; 95% CI 1.56, 4.25) and hypertriglyceridemia (6.39; 95% CI 3.46, 11.90) in men. A 1 SD increase in leg fat showed a protective effect with ORs for T2D (0.42; 95% CI 0.24, 0.74), IR (0.31; 95% CI 0.17, 0.57) and hypertriglyceridemia (0.61; 95% CI 0.38, 0.98). The magnitude of the effect was greater with DXA-measured fat compared with anthropometry., Conclusion: At any level of total body fat, upper and lower body fat depots demonstrate opposite risk associations with metabolic and CVD risk markers in Asian Indians., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)
- Published
- 2021
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15. Pregnancy-related interventions in mothers at risk for gestational diabetes in Asian India and low and middle-income countries (PRIMORDIAL study): protocol for a randomised controlled trial.
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Vasan SK, Jobe M, Mathews J, Cole F, Rathore S, Jarjou O, Thompson D, Jarde A, Bittaye M, Ulijaszek S, Fall C, Osmond C, Prentice A, and Karpe F
- Subjects
- Adolescent, Adult, Africa, Africa, Western, Developing Countries, Female, Gambia, Humans, India, Infant, Newborn, Mothers, Multicenter Studies as Topic, Pregnancy, Randomized Controlled Trials as Topic, Diabetes, Gestational epidemiology, Diabetes, Gestational prevention & control
- Abstract
Introduction: Lifestyle modification is the mainstay of gestational diabetes mellitus (GDM) prevention. However, clinical trials evaluating the safety and efficacy of diet or physical activity (PA) in low-income and middle-income settings such as Africa and India are lacking. This trial aims to evaluate the efficacy of yoghurt consumption and increased PA (daily walking) in reducing GDM incidence in high-risk pregnant women., Methods and Analysis: The study is a 2×2 factorial, open-labelled, multicentre randomised controlled trial to be conducted in Vellore, South India and The Gambia, West Africa. 'High-risk' pregnant women (n=1856) aged ≥18 years and ≤16 weeks of gestational age, with at least one risk factor for developing GDM, will be randomised to either (1) yoghurt (2) PA (3) yoghurt +PA or (4) standard antenatal care. Participants will be followed until 32 weeks of gestation with total active intervention lasting for a minimum of 16 weeks. The primary endpoint is GDM incidence at 26-28 weeks diagnosed using International Association of the Diabetes and Pregnancy Study Groups criteria or elevated fasting glucose (≥5.1 mmol/L) at 32 weeks. Secondary endpoints include absolute values of fasting plasma glucose concentration at 32 weeks gestation, maternal blood pressure, gestational weight gain, intrapartum and neonatal outcomes. Analysis will be both by intention to treat and per-protocol. Continuous outcome measurements will be analysed using multiple linear regression and binary variables by logistic regression., Ethics and Dissemination: The study is approved by Oxford Tropical Research Ethics Committee (44-18), ethics committees of the Christian Medical College, Vellore (IRB 11367) and MRCG Scientific Coordinating Committee (SCC 1645) and The Gambia Government/MRCG joint ethics committee (L2020.E15). Findings of the study will be published in peer-reviewed scientific journals and presented in conferences., Trial Registration Number: ISRCTN18467720., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2021
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16. A prospective study of the relationships between change in body composition and cardiovascular risk factors across the menopause.
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Dehghan A, Vasan SK, Fielding BA, and Karpe F
- Subjects
- Adipose Tissue, Body Composition, Body Mass Index, Female, Heart Disease Risk Factors, Humans, Menopause, Prospective Studies, Risk Factors, Cardiovascular Diseases
- Abstract
Objective: Menopause increases the risk of cardiovascular disease (CVD) which in part has been attributed to the rise in cholesterol and blood pressure (BP). This study examined the hypothesis that menopausal changes in body composition and regional fat depots relate to the change in CVD risk factors., Methods: A prospective recall study was designed to capture premenopausal women to be re-examined soon after menopause. A total of 97 women from the Oxford Biobank underwent dual x-ray absorptiometry, blood biochemistry, and BP readings pre- and postmenopause., Results: Despite minimal changes in body weight over the 5.1 ± 0.9 year follow-up period, there was an increase in total fat mass and a decline in lean mass, where the proportional change of regional fat mass was the greatest for the visceral fat depot (+22%, P < 0.01). Plasma ApoB (+12%, P < 0.01) and C-reactive protein (+45%, P < 0.01) increased as did systolic (+7%, P < 0.001) and diastolic BP (+5%, P < 0.001). Plasma nonesterified fatty acids decreased (-20%, P < 0.05) which may reflect on a change in adipose tissue function across the menopause. PCSK-9 decreased (-26%, P < 0.01) which suggests a compensation for the postmenopausal reduction in low-density lipoprotein receptor activity. Using multilinear regression analyses the changes in ApoB and diastolic BP were associated with visceral fat mass change, but this association was lost when adjusted for total fat mass change., Conclusion: The increase in CVD risk factor burden across menopause may not be driven by changes in body composition, rather by functional changes in end organs such as adipose tissue and liver., Competing Interests: Financial disclosure/conflicts of interest: None reported., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The North American Menopause Society.)
- Published
- 2021
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17. Association of serum 25-Hydroxy vitamin D with total and regional adiposity and cardiometabolic traits.
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Karuppusami R, Antonisami B, Vasan SK, Gowri M, Selliah HY, Arulappan G, Jebasingh F, Thomas N, and Paul TV
- Subjects
- Adult, Female, Humans, Male, Sex Characteristics, Vitamin D blood, Adiposity, Cardiometabolic Risk Factors, Vitamin D analogs & derivatives
- Abstract
Background: Lower serum 25-hydroxyvitamin D [25(OH)D] is associated with greater adiposity and adverse cardiometabolic risk profile. The evidence is inconsistent among South Asian Indians. We aimed to examine associations between 25(OH)D and cardiovascular (CVD) risk markers in a rural and urban cohort from South India., Subjects/methods: In this cross sectional study, 373 individuals (men, n = 205) underwent detailed CVD risk marker assessment including anthropometry [body mass index (BMI), waist, (WC) and hip circumferences (HC)], body composition analysis using dual energy x-ray absorptiometry (DXA), blood pressure and biochemical analysis (glucose, insulin and lipids). The distribution of CVD risk factors were compared across serum 25(OH)D levels, stratified as deficiency (<20 ng/ml), insufficiency (20 to 29 ng/ml) and normal (≥30 ng/ml) levels. Multiple regression analysis, adjusting for potential confounders, was used to study associations of 25(OH)D with adiposity and cardiometabolic traits., Results: The mean and standard deviation (SD) of age, BMI and 25(OH)D levels were 41.4 (1.1) years, 25.5 (4.8) kg/m2 and 23.4 (10.4) ng/ml respectively. The prevalence of 25(OH)D deficiency was 39.9% in this cohort. Individuals in the 25(OH)D deficiency category had significantly higher mean (SD) BMI [26.6 (5.1) kg/m2], waist circumference [89.9 (12.5) cm] and total fat mass [20.6 (7.9) kg] compared with the Vitamin D sufficient group [BMI: 24.0 (4.4); WC 84.7 (12.0); total fat mass: 15.2 (6.8)]. Significantly inverse associations were observed with DXA measured total and regional fat depots with 25(OH)D levels, while anthropometric indices of adiposity showed significant inverse association only in women. After adjusting for total fat mass, no significant associations were observed between 25(OH)D and the cardiometabolic traits., Conclusions: Our results confirm that lower 25(OH)D is independently associated with both total and regional adiposity, but not with cardiometabolic traits, in this population., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2020
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18. Prevalence, incidence and predictors of cardiovascular risk factors: longitudinal data from rural and urban South India and comparison with global data.
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Vasan SK, Antonisamy B, Gowri M, Selliah HY, Geethanjali FS, Jebasingh FS, Paul TV, Thomas N, Karpe F, Johnson M, Osmond C, and Fall CHD
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- Adult, Humans, Incidence, India epidemiology, Male, Prevalence, Cardiovascular Diseases epidemiology, Diabetes Mellitus, Type 2
- Abstract
Introduction: India has high mortality rates from cardiovascular disease (CVD). Understanding the trends and identifying modifiable determinants of CVD risk factors will guide preventive strategies and policy making., Research Design and Methods: CVD risk factors (obesity, central obesity, and type 2 diabetes (T2D), hypertension, hypercholesterolemia and hypertriglyceridemia) prevalence and incidence were estimated in 962 (male 519) non-migrant adults from Vellore, South India, studied in: (1) 1998-2002 (mean age 28.2 years) and (2) 2013-2014 (mean age 41.7 years). Prevalence was compared with the Non-Communicable Disease Risk Collaboration (global) data. Incidence was compared with another Indian cohort from New Delhi Birth Cohort (NDBC). Regression analysis was used to test baseline predictors of incident CVD risk factors., Results: The prevalence at 28 and 42 years was 17% (95% CI 14% to 19%) and 51% (95% CI 48% to 55%) for overweight/obesity, 19% (95% CI 17% to 22%) and 59% (95% CI 56% to 62%) for central obesity, 3% (95% CI 2% to 4%) and 16% (95% CI 14% to 19%) for T2D, 2% (95% CI 1% to 3%) and 19% (95% CI 17% to 22%) for hypertension and 15% (95% CI 13% to 18%) and 30% (95% CI 27% to 33%) for hypertriglyceridemia. The prevalence of T2D at baseline and follow-up and hypertension at follow-up was comparable with or exceeded that in high-income countries despite lower obesity rates. The incidence of most risk factors was lower in Vellore than in the NDBC. Waist circumference strongly predicted incident T2D, hypertension and hypertriglyceridemia., Conclusions: A high prevalence of CVD risk factors was evident at a young age among Indians compared with high and upper middle income countries, with rural rates catching up with urban estimates. Adiposity predicted higher incident CVD risk, but the prevalence of hypertension and T2D was higher given a relatively low obesity prevalence. Preventive efforts should target both rural and urban India and should start young., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2020
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19. Hemoglobin concentration and risk of arterial and venous thrombosis in 1.5 million Swedish and Danish blood donors.
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Hultcrantz M, Modlitba A, Vasan SK, Sjölander A, Rostgaard K, Landgren O, Hjalgrim H, Ullum H, Erikstrup C, Kristinsson SY, and Edgren G
- Subjects
- Blood Donors, Cohort Studies, Denmark epidemiology, Female, Hemoglobins, Humans, Male, Risk Factors, Sweden epidemiology, Stroke, Venous Thrombosis
- Abstract
Introduction: There are conflicting results whether elevated hematocrit is associated with an increased risk of thromboembolic events in individuals without polycythemia vera. To assess the risk of vascular events in relation to hemoglobin concentration, we conducted a large population-based cohort study based on Scandinavian health registers., Materials and Methods: We included 1,538,019 Swedish and Danish blood donors between 1987 and 2012. Hazard ratios (HRs) of arterial and venous thrombosis were estimated using Cox regression. Additionally, we fitted person-stratified models where each donor was compared only to him-/herself., Results: The risk of myocardial infarction and ischemic stroke increased with higher hemoglobin concentration in both men and women. The HRs for myocardial infarction and ischemic stroke in men with hemoglobin concentration ≥ 17.5 g/dL were 3.52 (95% confidence interval [CI], 2.85-4.36) and 2.36 (95% CI, 1.63-3.43), respectively, compared to the reference group. The corresponding HRs for women with hemoglobin concentration ≥ 16.0 g/dL were 3.22 (2.12-4.89) and 2.35 (1.37-4.02) for myocardial infarction and ischemic stroke, respectively. The risk of venous thrombosis was highest in men with subnormal hemoglobin concentration (<13.0 g/dL), HR 1.69 (95% CI, 1.40-2.04). In the person-stratified model, the association between elevated hemoglobin concentration and risk of myocardial infarction was attenuated but remained significant., Conclusions: In this large cohort of Scandinavian blood donors, elevated hemoglobin concentration was associated with an increased risk of vascular events, primarily arterial events. Even though associations were weakened when each person served as their own control, a high hemoglobin concentration may serve as a cardiovascular risk marker., (Copyright © 2020 Elsevier Ltd. All rights reserved.)
- Published
- 2020
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20. The proposed systemic thermogenic metabolites succinate and 12,13-diHOME are inversely associated with adiposity and related metabolic traits: evidence from a large human cross-sectional study.
- Author
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Vasan SK, Noordam R, Gowri MS, Neville MJ, Karpe F, and Christodoulides C
- Subjects
- Adipocytes metabolism, Adipose Tissue, Brown metabolism, Adult, Body Mass Index, Cross-Sectional Studies, Energy Metabolism, Female, Humans, Insulin Resistance, Male, Mendelian Randomization Analysis, Middle Aged, Obesity, Adiposity, Oleic Acids metabolism, Succinic Acid chemistry, Thermogenesis
- Abstract
Aims/hypothesis: Circulating succinate and 12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME) were recently shown to promote brown adipocyte thermogenesis and protect against metabolic disorders in rodents. This study aimed to evaluate the associations between plasma levels of these metabolites and adiposity and metabolic profile in humans., Methods: Fasting plasma succinate and 12,13-diHOME levels were quantified using ultra HPLC-tandem MS in 2248 individuals (50% female, mean age 41.3 ± 5.9 years, mean BMI 26.1 ± 4.6 kg/m
2 ) in addition to fasting plasma biochemistry. Total and regional adiposity were assessed with dual-energy x-ray absorptiometry. An age- and sex-adjusted linear regression model was used to determine the associations between succinate and 12,13-diHOME levels and body composition and metabolic profile. Two-sample Mendelian randomisation was used to assess the associations between genetically determined BMI and metabolic traits with circulating plasma succinate and 12,13-diHOME., Results: A one-SD higher plasma succinate and 12,13-diHOME concentration was associated with a 0.15 SD (95% CI 0.28, 0.03) and 0.08 SD (0.15, 0.01) lower total fat mass respectively. Additionally, a one-SD higher plasma 12,13-diHOME level was associated with a 0.09 SD (0.16, 0.02) lower fasting plasma insulin and 0.10 SD (0.17, 0.04) lower plasma triacylglycerol. In Mendelian randomisation analyses, genetically determined higher BMI, fasting hyperinsulinaemia and elevated lipid levels were not associated with changes in either plasma succinate or plasma 12,13-diHOME concentrations. No indications of bias due to directional pleiotropy were detected in the Mendelian randomisation analyses., Conclusions/interpretation: Our findings tentatively suggest that plasma succinate and 12,13-diHOME may play a role in the regulation of energy metabolism and brown adipose tissue activation in humans. Further studies encompassing direct assessment of brown adipose tissue activity and dietary supplementation are necessary to investigate the potential beneficial effects of these metabolites on systemic metabolism.- Published
- 2019
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21. Relevance of human fat distribution on lipid and lipoprotein metabolism and cardiovascular disease risk.
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Piché ME, Vasan SK, Hodson L, and Karpe F
- Subjects
- Cardiovascular Diseases epidemiology, Humans, Risk, Body Fat Distribution, Cardiovascular Diseases metabolism, Lipoproteins metabolism
- Abstract
Purpose of Review: Upper body abdominal and lower body gluteofemoral fat depot masses display opposing associations with plasma lipid and lipoprotein and cardiovascular disease (CVD) risk profiles. We review developments on adipose tissue fatty acid metabolism in the context of body fat distribution and how that might be related to adverse lipid and lipoprotein profiles and CVD risk., Recent Findings: Recent data have confirmed the paradoxical relationship of upper abdominal and lower body gluteofemoral adiposity and CVD risk. Mechanistically, this is likely to reflect the different ways fat depots handle lipid storage and release, which impacts directly and indirectly on lipid and lipoprotein metabolism. The upper body enhances immediate fat storage pathway with rapid uptake of dietary-derived fatty acids, whereas the lower body fat depot has a reduced lipid turnover accommodating a slower fat redistribution. Body fat distribution and the fat depots' ability to undergo appropriate expansion when fat storage is required, rather than overall body fatness, appear as the important determinant of metabolic health., Summary: A focus on fat distribution in overweight people, preferably using precise imaging methods, rather than quantifying total body fatness, is likely to provide the medical community with better tools to stratify and treat patients with obesity-related complications.
- Published
- 2018
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22. IndEcho study: cohort study investigating birth size, childhood growth and young adult cardiovascular risk factors as predictors of midlife myocardial structure and function in South Asians.
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Vasan SK, Roy A, Samuel VT, Antonisamy B, Bhargava SK, Alex AG, Singh B, Osmond C, Geethanjali FS, Karpe F, Sachdev H, Agrawal K, Ramakrishnan L, Tandon N, Thomas N, Premkumar PS, Asaithambi P, Princy SFX, Sinha S, Paul TV, Prabhakaran D, and Fall CHD
- Subjects
- Adolescent, Adult, Body Mass Index, Cardiovascular Diseases epidemiology, Child, Female, Humans, India, Male, Middle Aged, Pregnancy, Prospective Studies, Risk Factors, Birth Weight, Child Development, Myocardial Infarction epidemiology
- Abstract
Introduction: South Asians have high rates of cardiovascular disease (CVD) and its risk factors (hypertension, diabetes, dyslipidaemia and central obesity). Left ventricular (LV) hypertrophy and dysfunction are features of these disorders and important predictors of CVD mortality. Lower birth and infant weight and greater childhood weight gain are associated with increased adult CVD mortality, but there are few data on their relationship to LV function. The IndEcho study will examine associations of birth size, growth during infancy, childhood and adolescence and CVD risk factors in young adulthood with midlife cardiac structure and function in South Asian Indians., Methods and Analysis: We propose to study approximately 3000 men and women aged 43-50 years from two birth cohorts established in 1969-1973: the New Delhi Birth Cohort (n=1508) and Vellore Birth Cohort (n=2156). They had serial measurements of weight and height from birth to early adulthood. CVD risk markers (body composition, blood pressure, glucose tolerance and lipids) and lifestyle characteristics (tobacco and alcohol consumption, physical activity, socioeconomic status) were assessed at age ~30 years. Clinical measurements in IndEcho will include anthropometry, blood pressure, biochemistry (glucose, fasting insulin and lipids, urinary albumin/creatinine ratio) and body composition by dual energy X-ray absorptiometry and bioelectrical impedance. Outcomes are LV mass and indices of LV systolic and diastolic function assessed by two-dimensional and Doppler echocardiography, carotid intimal-media thickness and ECG indicators of ischaemia. Regression and conditional growth models, adjusted for potential confounders, will be used to study associations of childhood and young adult exposures with these cardiovascular outcomes., Ethics and Dissemination: The study has been approved by the Health Ministry Steering Committee, Government of India and institutional ethics committees of participating centres in India and the University of Southampton, UK. Results will be disseminated through scientific meetings and peer-reviewed journals., Trial Registration Number: ISRCTN13432279; Pre-results., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2018
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23. Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk.
- Author
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Vasan SK, Osmond C, Canoy D, Christodoulides C, Neville MJ, Di Gravio C, Fall CHD, and Karpe F
- Subjects
- Absorptiometry, Photon, Adult, Anthropometry, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Risk Factors, Adipose Tissue diagnostic imaging, Body Size physiology, Cardiovascular Diseases epidemiology, Diabetes Mellitus, Type 2 epidemiology
- Abstract
Background/objectives: Fat distribution is a strong and independent predictor of type 2 diabetes (T2D) and cardiovascular disease (CVD) and is usually determined using conventional anthropometry in epidemiological studies. Dual-energy X-ray absorptiometry (DXA) can measure total and regional adiposity more accurately. Nonetheless, whether DXA provides more precise estimates of cardiovascular risk in relation to total and regional adiposity is not known. We determined the strength of the associations between DXA- and conventional anthropometry determined fat distribution and T2D and CVD risk markers., Subjects/methods: Waist (WC) and hip circumference (HC) and DXA was used to measure total and regional adiposity in 4950 (2119 men) participants aged 29-55 years from the Oxford Biobank without pre-existing T2D or CVD. Cross-sectional associations were compared between WC and HC vs. DXA-determined regional adiposity (all z-score normalised) with impaired fasting glucose, hypertriglyceridemia, hypertension and insulin resistance (IR)., Results: Following adjustment for total adiposity, upper body adiposity measurements showed consistently increased risk of T2D and CVD risk markers except for abdominal subcutaneous fat in both sexes, and arm fat in men, which showed protective associations. Among upper adiposity depots, visceral fat mass showed stronger odds ratios (OR) ranging from 1.69 to 3.64 compared with WC 1.07-1.83. Among lower adiposity depots, HC showed modest protection for IR in both sexes (men: OR 0.80 (95% confidence interval 0.67, 0.96); women: 0.69 (0.56, 0.86)), whereas gynoid fat and in particular leg fat showed consistent and strong protective effects for all outcomes in both men and women. The differential effect of body fat distribution on CVD and T2D were more pronounced at higher levels of total adiposity., Conclusions: Compared with DXA, conventional anthropometry underestimates the associations of regional adiposity with T2D and CVD risk markers. After correcting for overall adiposity, greater subcutaneous fat mass in particular in the lower body is protective relative to greater android or visceral adipose tissue mass.
- Published
- 2018
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24. Cohort Profile: The Oxford Biobank.
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Karpe F, Vasan SK, Humphreys SM, Miller J, Cheeseman J, Dennis AL, and Neville MJ
- Subjects
- Adult, Anthropometry, Cohort Studies, England epidemiology, Female, Genome-Wide Association Study, Glucose Metabolism Disorders epidemiology, Healthy Volunteers, Humans, Hypertension epidemiology, Hypertriglyceridemia epidemiology, Male, Middle Aged, Obesity epidemiology, Observational Studies as Topic, Overweight epidemiology, Phenotype, Prevalence, Health Status, Translational Research, Biomedical
- Published
- 2018
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25. No association between frequent apheresis donation and risk of fractures: a retrospective cohort analysis from Sweden.
- Author
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Grau K, Vasan SK, Rostgaard K, Bialkowski W, Norda R, Hjalgrim H, and Edgren G
- Subjects
- Adult, Databases, Factual, Denmark epidemiology, Female, Follow-Up Studies, Fractures, Bone etiology, Humans, Incidence, Male, Middle Aged, Retrospective Studies, Sweden epidemiology, Blood Component Removal adverse effects, Blood Donors, Fractures, Bone epidemiology, Registries
- Abstract
Background: Citrate anticoagulation during apheresis induces transient alterations in calcium homeostasis. It is unknown whether the repeated, transient alterations in calcium homeostasis experienced by repeated apheresis donors affects bone turnover to increase fracture risk. Our aim was to investigate the risk of osteoporotic and nonosteoporotic fracture among voluntary, frequent apheresis donors., Study Design and Methods: All apheresis donors were identified from the Scandinavian Donations and Transfusions database (SCANDAT2), which includes information on over 1.6 million blood donors from Sweden and Denmark from the years 1968 and 1981, respectively. Only data from Sweden were used for these analyses. Information on fractures was obtained by linking SCANDAT2 to hospital registers. Poisson regression was used to compute incidence rate ratios of fractures in relation to the cumulative number of apheresis donations, both overall and in fixed time windows., Results: In total, 140,289 apheresis donors (67,970 women and 72,319 men) were identified from the SCANDAT2 database and were followed for up to 23 years. We observed no association between the frequency of apheresis donation and the risk of fracture either in the overall study period or during fixed-length time windows. The incidence rate ratio of fractures in donors who had made 100 or more cumulative apheresis donations was 0.99 (95% confidence interval, 0.92-1.06) compared with donors who had made from 9 to 24 donations. The results were similar in analyses stratified by sex and restricted to postmenopausal women., Conclusions: The absence of an association between repeated apheresis donation and fracture risk indicates that apheresis collection is safe with regard to bone health., (© 2016 AABB.)
- Published
- 2017
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26. Correction: Immunohistochemical Typing of Adenocarcinomas of the Pancreatobiliary System Improves Diagnosis and Prognostic Stratification.
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Fernández Moro C, Fernandez-Woodbridge A, Alistair D'souza M, Zhang Q, Bozoky B, Vasan SK, Catalano P, Heuchel R, Shtembari S, Del Chiaro M, Danielsson O, Björnstedt M, Löhr JM, Isaksson B, Verbeke C, and Bozóky B
- Abstract
[This corrects the article DOI: 10.1371/journal.pone.0166067.].
- Published
- 2017
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27. Weight Gain and Height Growth during Infancy, Childhood, and Adolescence as Predictors of Adult Cardiovascular Risk.
- Author
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Antonisamy B, Vasan SK, Geethanjali FS, Gowri M, Hepsy YS, Richard J, Raghupathy P, Karpe F, Osmond C, and Fall CH
- Subjects
- Adolescent, Adult, Body Mass Index, Child, Child, Preschool, Female, Growth, Humans, Infant, Male, Prognosis, Prospective Studies, Risk Assessment, Young Adult, Body Height, Cardiovascular Diseases epidemiology, Weight Gain
- Abstract
Objectives: To investigate independent relationships of childhood linear growth (height gain) and relative weight gain to adult cardiovascular disease (CVD) risk traits in Asian Indians., Study Design: Data from 2218 adults from the Vellore Birth Cohort were examined for associations of cross-sectional height and body mass index (BMI) and longitudinal growth (independent conditional measures of height and weight gain) in infancy, childhood, adolescence, and adulthood with adult waist circumference (WC), blood pressure (BP), insulin resistance (homeostatic model assessment-insulin resistance [HOMA-IR]), and plasma glucose and lipid concentrations., Results: Higher BMI/greater conditional relative weight gain at all ages was associated with higher adult WC, after 3 months with higher adult BP, HOMA-IR, and lipids, and after 15 years with higher glucose concentrations. Taller adult height was associated with higher WC (men β = 2.32 cm per SD, women β = 1.63, both P < .001), BP (men β = 2.10 mm Hg per SD, women β = 1.21, both P ≤ .001), and HOMA-IR (men β = 0.08 log units per SD, women β = 0.12, both P ≤ .05) but lower glucose concentrations (women β = -0.03 log mmol/L per SD P = .003). Greater height or height gain at all earlier ages were associated with higher adult CVD risk traits. These positive associations were attenuated when adjusted for adult BMI and height. Shorter length and lower BMI at birth were associated with higher glucose concentration in women., Conclusions: Greater height or weight gain relative to height during childhood or adolescence was associated with a more adverse adult CVD risk marker profile, and this was mostly attributable to larger adult size., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2017
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28. ABO blood group and risk of cancer: A register-based cohort study of 1.6 million blood donors.
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Vasan SK, Hwang J, Rostgaard K, Nyrén O, Ullum H, Pedersen OBV, Erikstrup C, Melbye M, Hjalgrim H, Pawitan Y, and Edgren G
- Subjects
- ABO Blood-Group System adverse effects, Adult, Blood Donors, Cohort Studies, Female, Humans, Male, Risk, Young Adult, ABO Blood-Group System genetics, Neoplasms etiology
- Abstract
Introduction: The associations between ABO blood group and cancer risk have been studied repeatedly, but results have been variable. Consistent associations have only been reported for pancreatic and gastric cancers., Materials and Methods: We estimated associations between different ABO blood groups and site-specific cancer risk in a large cohort of healthy blood donors from Sweden and Denmark., Results: A total of 1.6 million donors were followed over 27 million person-years (20 million in Sweden and 7 million in Denmark). We observed 119,584 cancer cases. Blood groups A, AB and B were associated either with increased or decreased risk of cancer at 13 anatomical sites (p≤0.05), compared to blood group O. Consistent with assessment using a false discovery rate approach, significant associations with ABO blood group were observed for cancer of the pancreas, breast, and upper gastrointestinal tract (mouth, salivary glands, pharynx, esophageal adenocarcinoma and stomach)., Discussion: Our study reconfirms the association between ABO blood group and cancer risk and exact underlying mechanisms involved needs further research., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
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- 2016
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29. Adipose tissue: Fat, yet fit.
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Vasan SK and Karpe F
- Subjects
- Humans, Adipose Tissue, Obesity
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- 2016
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30. Parental determinants of metabolic syndrome among adolescent Asian Indians: A cross-sectional analysis of parent-offspring trios.
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Baxi R, Vasan SK, Hansdak S, Samuel P, Jeyaseelan V, Geethanjali FS, Murray RR, Venkatesan P, and Thomas N
- Subjects
- Adolescent, Adult, Asian People genetics, Asian People statistics & numerical data, Blood Pressure genetics, Body Mass Index, Child, Cross-Sectional Studies, Family Health, Female, Humans, India epidemiology, Logistic Models, Male, Metabolic Syndrome ethnology, Metabolic Syndrome genetics, Middle Aged, Multivariate Analysis, Nuclear Family, Obesity blood, Obesity ethnology, Obesity genetics, Prevalence, Triglycerides blood, Waist Circumference, Blood Glucose metabolism, Blood Pressure physiology, Lipids blood, Metabolic Syndrome blood, Parents
- Abstract
Background: The aim of the present study was to investigate the relationship between parental metabolic syndrome (MS) and the risk of MS and associated abnormalities in adolescent offspring., Methods: This cross-sectional study was performed on 304 adolescents (12-16 years; 236 children with at least one parent and 124 father-mother-child trios) recruited from four schools representing different socioeconomic strata from Vellore, India. Anthropometric data was collected and blood pressure, blood glucose, and lipids were measured., Results: The prevalence of MS in adolescent offspring, fathers, and mothers was 3.3%, 52.5%, and 48.7% respectively. The most commonly observed metabolic abnormality among adolescents was lower high-density lipoprotein. Maternal waist circumference (WC) was strongly correlated with adolescent body mass index (P = 0.007), WC (P < 0.001), serum triglycerides (P = 0.02), and systolic (P = 0.005) and diastolic (P = 0.01) blood pressure. Maternal MS status was significantly associated with a greater risk of central obesity (WC odds ratio [OR] 2.02; 95% confidence interval [CI] 1.21-3.17) in offspring. Both parents having MS conferred a significant effect on the child's WC (OR 1.21; 95% CI 1.72-2.07) and increased risk of MS (OR 6.19; 95% CI 1.64-23.26)., Conclusions: This study highlights the possible heritable parental components that may contribute to the MS phenotype in offspring: MS in adolescent offspring is related to parental MS status, and maternal traits reflect offspring adiposity and metabolic traits more strongly than paternal factors. Therefore, adolescent children of parents with MS should be targets for primordial prevention of cardiometabolic disease., (© 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.)
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- 2016
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31. ABO Blood Group and Risk of Thromboembolic and Arterial Disease: A Study of 1.5 Million Blood Donors.
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Vasan SK, Rostgaard K, Majeed A, Ullum H, Titlestad KE, Pedersen OB, Erikstrup C, Nielsen KR, Melbye M, Nyrén O, Hjalgrim H, and Edgren G
- Subjects
- ABO Blood-Group System genetics, Adult, Arterial Occlusive Diseases genetics, Denmark epidemiology, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Pregnancy, Pregnancy Complications, Cardiovascular epidemiology, Pregnancy Complications, Cardiovascular genetics, Pulmonary Embolism epidemiology, Pulmonary Embolism genetics, Recurrence, Regression Analysis, Risk, Sweden epidemiology, Thromboembolism genetics, Thrombophilia genetics, Venous Thrombosis epidemiology, Venous Thrombosis genetics, Young Adult, ABO Blood-Group System analysis, Arterial Occlusive Diseases epidemiology, Blood Donors statistics & numerical data, Thromboembolism epidemiology
- Abstract
Background: ABO blood groups have been shown to be associated with increased risks of venous thromboembolic and arterial disease. However, the reported magnitude of this association is inconsistent and is based on evidence from small-scale studies., Methods and Results: We used the SCANDAT2 (Scandinavian Donations and Transfusions) database of blood donors linked with other nationwide health data registers to investigate the association between ABO blood groups and the incidence of first and recurrent venous thromboembolic and arterial events. Blood donors in Denmark and Sweden between 1987 and 2012 were followed up for diagnosis of thromboembolism and arterial events. Poisson regression models were used to estimate incidence rate ratios as measures of relative risk. A total of 9170 venous and 24 653 arterial events occurred in 1 112 072 individuals during 13.6 million person-years of follow-up. Compared with blood group O, non-O blood groups were associated with higher incidence of both venous and arterial thromboembolic events. The highest rate ratios were observed for pregnancy-related venous thromboembolism (incidence rate ratio, 2.22; 95% confidence interval, 1.77-2.79), deep vein thrombosis (incidence rate ratio, 1.92; 95% confidence interval, 1.80-2.05), and pulmonary embolism (incidence rate ratio, 1.80; 95% confidence interval, 1.71-1.88)., Conclusions: In this healthy population of blood donors, non-O blood groups explain >30% of venous thromboembolic events. Although ABO blood groups may potentially be used with available prediction systems for identifying at-risk individuals, its clinical utility requires further comparison with other risk markers., (© 2016 American Heart Association, Inc.)
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- 2016
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32. Epidemiology of Massive Transfusion: A Binational Study From Sweden and Denmark.
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Halmin M, Chiesa F, Vasan SK, Wikman A, Norda R, Rostgaard K, Vesterager Pedersen OB, Erikstrup C, Nielsen KR, Titlestad K, Ullum H, Hjalgrim H, and Edgren G
- Subjects
- Adult, Aged, Cohort Studies, Databases, Factual, Denmark epidemiology, Erythrocyte Transfusion adverse effects, Erythrocyte Transfusion mortality, Female, Hemorrhage etiology, Humans, Incidence, Intraoperative Complications mortality, Kaplan-Meier Estimate, Male, Middle Aged, Retrospective Studies, Sweden epidemiology, Erythrocyte Transfusion statistics & numerical data, Intraoperative Complications epidemiology
- Abstract
Objective: There is an increasing focus on massive transfusion, but there is a paucity of comprehensive descriptions of the massively transfused patients and their outcomes. The objective of this study is to describe the incidence rate of massive transfusion, patient characteristics, and the mortality of massively transfused patients., Design: Descriptive cohort study., Setting: Nationwide study with data from Sweden and Denmark., Patients: The study was based on the Scandinavian Donations and Transfusions database, including all patients receiving 10 or more red cell concentrate transfusions in Sweden from 1987 and in Denmark from 1996. A total of 92,057 patients were included. Patients were followed until the end of 2012., Measurements and Main Results: Descriptive statistics were used to characterize the patients and indications. Post transfusion mortality was expressed as crude 30-day mortality and as long-term mortality using the Kaplan-Meier method and using standardized mortality ratios. The incidence of massive transfusion was higher in Denmark (4.5 per 10,000) than in Sweden (2.5 per 10,000). The most common indication for massive transfusion was major surgery (61.2%) followed by trauma (15.4%). Massive transfusion due to obstetrical bleeding constituted only 1.8%. The overall 5-year mortality was very high (54.6%), however with large differences between indication groups, ranging from 91.1% among those transfused for a malignant disease without surgery to 1.7% among patients transfused for obstetrical bleeding. The early standardized mortality ratios were high and decreased thereafter, but remained elevated throughout the time period., Conclusions: This large-scale study based on nationwide data from Sweden and Denmark describes the complete range of massive transfusion. We report a nonnegligible incidence and both a high absolute mortality and high standardized mortality ratio. The general pattern was similar for Sweden and Denmark, and we believe that similar patterns may be found in other high-resource countries. The study provides a relevant background for clinicians and researchers for designing future studies in this field.
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- 2016
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33. Lack of association between blood donor age and survival of transfused patients.
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Vasan SK, Chiesa F, Rostgaard K, Magnusson PK, Halmin M, Nielsen KR, Titlestad KE, Hjalgrim H, and Edgren G
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- Adult, Age Factors, Aged, Aged, 80 and over, Aging, Blood Donors, Cohort Studies, Female, Humans, Longevity, Male, Middle Aged, Survival Analysis, Blood Transfusion methods
- Published
- 2016
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34. No evidence of transmission of chronic lymphocytic leukemia through blood transfusion.
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Hjalgrim H, Rostgaard K, Vasan SK, Ullum H, Erikstrup C, Pedersen OB, Nielsen KR, Titlestad KE, Melbye M, Nyrén O, and Edgren G
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- Follow-Up Studies, Humans, Lymphocyte Count, Prognosis, Scandinavian and Nordic Countries, B-Lymphocytes pathology, Blood Donors, Leukemia, Lymphocytic, Chronic, B-Cell diagnosis, Leukemia, Lymphocytic, Chronic, B-Cell etiology, Lymphocytosis complications, Transfusion Reaction
- Abstract
Monoclonal B-cell lymphocytosis (MBL) is a precursor of chronic lymphocytic leukemia (CLL). Observations of MBL in blood donors raise concern that transmitted MBL may cause recipient CLL. Using a database with health information on 1.5 million donors and 2.1 million recipients, we compared CLL occurrence among 7413 recipients of blood from 796 donors diagnosed with CLL after donation cessation, and among 80, 431 recipients of blood from 7477 matched CLL-free donors. During follow-up, 12 and 107 cases of CLL occurred among the exposed and unexposed recipients, respectively, yielding a relative risk of 0.94 (95% confidence interval, 0.52-1.71). Analyses using the entire database showed no evidence of CLL clustering among recipients of blood from individual donors. In conclusion, when donor MBL was approximated by subsequent donor CLL diagnosis, data from 2 countries' entire computerized transfusion experience over more than 30 years indicate that MBL/CLL transmission does not contribute importantly to recipient CLL risk., (© 2015 by The American Society of Hematology.)
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- 2015
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35. The new Scandinavian Donations and Transfusions database (SCANDAT2): a blood safety resource with added versatility.
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Edgren G, Rostgaard K, Vasan SK, Wikman A, Norda R, Pedersen OB, Erikstrup C, Nielsen KR, Titlestad K, Ullum H, Melbye M, Nyrén O, and Hjalgrim H
- Subjects
- Denmark, Female, Humans, Male, Sweden, Blood Donors, Blood Transfusion, Databases, Factual
- Abstract
Background: Risks of transfusion-transmitted disease are currently at a record low in the developed world. Still, available methods for blood surveillance might not be sufficient to detect transmission of diseases with unknown etiologies or with very long incubation periods., Study Design and Methods: We have previously created the anonymized Scandinavian Donations and Transfusions (SCANDAT) database, containing data on blood donors, blood transfusions, and transfused patients, with complete follow-up of donors and patients for a range of health outcomes. Here we describe the re-creation of SCANDAT with updated, identifiable data. We collected computerized data on blood donations and transfusions from blood banks covering all of Sweden and Denmark. After data cleaning, two structurally identical databases were created and the entire database was linked with nationwide health outcomes registers to attain complete follow-up for up to 47 years regarding hospital care, cancer, and death., Results: After removal of erroneous records, the database contained 25,523,334 donation records, 21,318,794 transfusion records, and 3,692,653 unique persons with valid identification, presently followed over 40 million person-years, with possibility for future extension. Data quality is generally high with 96% of all transfusions being traceable to their respective donation(s) and a very high (>97%) concordance with official statistics on annual number of blood donations and transfusions., Conclusions: It is possible to create a binational, nationwide database with almost 50 years of follow-up of blood donors and transfused patients for a range of health outcomes. We aim to use this database for further studies of donor health, transfusion-associated risks, and transfusion-transmitted disease., (© 2015 AABB.)
- Published
- 2015
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36. ABO Blood Group and Dementia Risk--A Scandinavian Record-Linkage Study.
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Vasan SK, Rostgaard K, Ullum H, Melbye M, Hjalgrim H, and Edgren G
- Subjects
- Aged, Alzheimer Disease epidemiology, Dementia epidemiology, Dementia, Vascular epidemiology, Denmark epidemiology, Female, Humans, Male, Sweden epidemiology, ABO Blood-Group System metabolism, Dementia etiology
- Abstract
Background: Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail., Methods: We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models., Results: Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98), compared to those with blood group O., Conclusions: Our results provide no evidence that ABO blood group influences the risk of dementia.
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- 2015
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37. Maturity onset diabetes of the young in India - a distinctive mutation pattern identified through targeted next-generation sequencing.
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Chapla A, Mruthyunjaya MD, Asha HS, Varghese D, Varshney M, Vasan SK, Venkatesan P, Nair V, Mathai S, Paul TV, and Thomas N
- Subjects
- 5' Untranslated Regions, Adolescent, Adult, Basic Helix-Loop-Helix Transcription Factors genetics, Body Mass Index, Computational Biology, DNA Mutational Analysis, Female, Gene Library, Hepatocyte Nuclear Factor 1-alpha genetics, High-Throughput Nucleotide Sequencing, Homeodomain Proteins genetics, Humans, India, Insulin metabolism, Insulin Secretion, Male, Mutation, Pedigree, Polymerase Chain Reaction, Trans-Activators genetics, Young Adult, Diabetes Mellitus, Type 2 genetics, Diabetes Mellitus, Type 2 physiopathology
- Abstract
Objective: To establish and utilize a Next-Generation Sequencing (NGS)-based strategy to screen for maturity onset diabetes of the young (MODY) gene mutations in subjects with early-onset diabetes., Patients and Methods: Maturity onset diabetes of the young (MODY) genetic testing was carried out in 80 subjects of Asian Indian origin with young onset diabetes to identify mutations in a comprehensive panel of ten MODY genes. A novel multiplex polymerase chain reaction (PCR)-based target enrichment was established, followed by NGS on the Ion Torrent Personal Genome Machine (PGM). All the mutations and rare variants were confirmed by Sanger sequencing., Results: We identified mutations in 11 (19%) of the 56 clinically diagnosed MODY subjects and seven of these mutations were novel. The identified mutations include p.H241Q, p.E59Q, c.-162G>A 5' UTR in NEUROD1, p.V169I cosegregating with c.493-4G>A and c.493-20C>T, p.E271K in HNF4A, p.A501S in HNF1A, p.E440X in GCK, p.V177M in PDX1, p.L92F in HNF1B and p.R31L in PAX4 genes. Interestingly, two patients with NEUROD1 mutation were also positive for the p.E224K mutation in PDX1 gene. These patients with coexisting NEUROD1-PDX1 mutations showed a marked reduction in glucose-induced insulin secretion. All 24 subjects who had not met the clinical criteria of MODY were negative for the mutations. To the best of our knowledge, this is the first report of PDX1, HNF1B, NEUROD1 and PAX4 mutations from India., Conclusions: Multiplex PCR coupled with NGS provides a rapid, cost-effective and accurate method for comprehensive parallelized genetic testing of MODY. When compared to earlier reports, we have identified a higher frequency and a novel digenic mutation pattern involving NEUROD1 and PDX1 genes., (© 2014 John Wiley & Sons Ltd.)
- Published
- 2015
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38. Post-absorptive glucose lowering in normal healthy individuals: an epidemiological observation.
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Vasan SK, Ramachandran P, Mathew M, Natraj CV, Antonisamy B, and Thomas N
- Subjects
- Adolescent, Adult, Fasting, Female, Glucose Intolerance blood, Glucose Intolerance diagnosis, Glucose Tolerance Test, Humans, Hyperinsulinism blood, Hyperinsulinism diagnosis, Incidence, India epidemiology, Insulin blood, Male, Prevalence, Young Adult, Blood Glucose metabolism, Glucose pharmacokinetics, Glucose Intolerance epidemiology, Hyperinsulinism epidemiology, Insulin Resistance
- Abstract
Post-absorptive glucose lowering (PALG) is observed in individuals with glucose intolerance and in healthy individuals. We report a prevalence of about 23% among healthy Asian Indians. Individuals with PALG are characterized by leaner phenotype, low body fat percentage, increased insulin sensitivity and higher fasting glucose levels., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2014
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39. FTO genetic variants and risk of obesity and type 2 diabetes: a meta-analysis of 28,394 Indians.
- Author
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Vasan SK, Karpe F, Gu HF, Brismar K, Fall CH, Ingelsson E, and Fall T
- Subjects
- Adiposity genetics, Adult, Alleles, Alpha-Ketoglutarate-Dependent Dioxygenase FTO, Body Mass Index, Female, Genetic Loci, Genetic Predisposition to Disease, Humans, India, Male, Middle Aged, Phenotype, Polymorphism, Single Nucleotide, Waist-Hip Ratio, Diabetes Mellitus, Type 2 genetics, Obesity genetics, Proteins genetics, White People genetics
- Abstract
Objective: To investigate the magnitude of association of FTO variants with obesity, type 2 diabetes (T2DM), and related traits among Asian Indians., Methods: Random-effect meta-analysis was performed on pooled data from eight studies (n = 28,394) for obesity and related traits and six studies (n = 24,987) for assessment of T2DM risk in Indians where FTO variants were reported., Results: The minor A-allele of the FTO variant rs9939609 was associated with increased risk of obesity (OR 1.15, 95% CI 1.08-1.21, p = 2.14 × 10(-) (5) ), BMI (β = 0.30 kg/m2, 95% CI 0.21-0.38, p = 4.78 × 10(-) (11) ) and other regional adiposity measurements [waist (β = 0.74 cm, 95% CI 0.49-0.99), HC (β = 0.52, 95% CI 0.26-0.78), and waist-hip ratio (WHR) (β = 0.002, 95% CI 0.001-0.004)] in Indians (p ≤ 0.001). An increased risk for T2DM (OR 1.11; 95% CI 1.04-1.19, p = 0.002) was observed, which attenuated when adjusted for age, gender, and BMI (OR 1.09; 95%CI 1.02-1.16, p = 0.01)., Conclusions: Our study provides evidence of association between common FTO variant and obesity risk among Indians with comparable effect sizes as in Caucasians. The attenuation of FTO-T2DM risk on BMI adjustment reinforces that BMI does not fully account for the adiposity effects among Asian Indians who are more centrally obese., (Copyright © 2013 The Obesity Society.)
- Published
- 2014
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40. Structural and functional properties of deep abdominal subcutaneous adipose tissue explain its association with insulin resistance and cardiovascular risk in men.
- Author
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Marinou K, Hodson L, Vasan SK, Fielding BA, Banerjee R, Brismar K, Koutsilieris M, Clark A, Neville MJ, and Karpe F
- Subjects
- Absorptiometry, Photon, Adiposity ethnology, Adult, Asian People, Cardiovascular Diseases diagnostic imaging, Cohort Studies, Fatty Acids metabolism, Female, Humans, Liver metabolism, Male, Obesity diagnostic imaging, Obesity ethnology, Obesity metabolism, Obesity pathology, Risk Factors, Sex Characteristics, Ultrasonography, White People, Cardiovascular Diseases epidemiology, Insulin Resistance, Intra-Abdominal Fat diagnostic imaging, Intra-Abdominal Fat pathology, Intra-Abdominal Fat physiology, Subcutaneous Fat, Abdominal diagnostic imaging, Subcutaneous Fat, Abdominal pathology, Subcutaneous Fat, Abdominal physiology
- Abstract
Objective: Fat distribution is an important variable explaining metabolic heterogeneity of obesity. Abdominal subcutaneous adipose tissue (SAT) is divided by the Scarpa's fascia into a deep subcutaneous adipose tissue (dSAT) and a superficial subcutaneous adipose tissue (sSAT) layer. This study sought to characterize functional differences between the two SAT layers to explore their relative contribution to metabolic traits and cardiovascular risk (CVR) profile., Research Design and Methods: We recruited 371 Caucasians consecutively from a local random, population-based screening project in Oxford and 25 Asian Indians from the local community. The depth of the SAT layers was determined by ultrasound (US), and adipose tissue (AT) biopsies were performed under US guidance in a subgroup of 43 Caucasians. Visceral adipose tissue (VAT) mass was quantified by dual-energy X-ray absorptiometry scan., Results: Male adiposity in both ethnic groups was characterized by a disproportionate expansion of dSAT, which was strongly correlated with VAT mass. dSAT depth was a strong predictor of global insulin resistance (IR; homeostatic model assessment of IR), liver-specific IR (insulin-like growth factor binding protein-1), and Framingham risk score independently of other measures of adiposity in men. Moreover, dSAT had higher expression of proinflammatory, lipogenic, and lipolytic genes and contained higher proportions of saturated fatty acids. There was increased proportion of small adipocytes in dSAT., Conclusions: SAT is heterogeneous; dSAT expands disproportionally more than sSAT with increasing obesity in Caucasian males (confirmed also in Asian Indians). Its expansion is related to increased CVR independent of other adiposity measures, and it has biological properties suggestive of higher metabolic activity contributing to global IR.
- Published
- 2014
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41. A common variant in the FTO locus is associated with waist-hip ratio in Indian adolescents.
- Author
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Vasan SK, Fall T, Job V, Gu HF, Ingelsson E, Brismar K, Karpe F, and Thomas N
- Subjects
- Adolescent, Alpha-Ketoglutarate-Dependent Dioxygenase FTO, Body Mass Index, Cross-Sectional Studies, Female, Genetic Predisposition to Disease, Genetic Variation, Humans, India epidemiology, Male, Obesity ethnology, Phenotype, Waist-Hip Ratio, Diet, Obesity epidemiology, Obesity genetics, Proteins genetics, Receptor, Melanocortin, Type 4 genetics
- Abstract
Background: Common variants in the FTO locus, and near MC4R locus, have been shown to have a robust association with obesity in children and adults among various ethnic groups. Associations with obesity traits among Indian adolescents have not been determined., Objective: To study the association of rs9939609 (FTO) and rs17782313 (MC4R) to obesity related anthropometric traits in Indian adolescents., Methods: Subjects for the current study were recruited from a cross-sectional cohort of 1,230 adolescents (age mean ± SD: 17.1 ± 1.9 years) from South India., Results: The variant at the FTO locus was found to be associated with waist-hip ratio (WHR) but not with overall obesity in this population. No significant association was observed for obesity-traits and Mc4R variant rs17782313., Conclusion: The common variant of FTO (rs9939609) is associated with body fat distribution during early growth in Indian adolescents and may predispose to obesity and metabolic consequences in adulthood., (© 2013 The Authors. Pediatric Obesity © 2013 International Association for the Study of Obesity.)
- Published
- 2013
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42. Associations of variants in FTO and near MC4R with obesity traits in South Asian Indians.
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Vasan SK, Fall T, Neville MJ, Antonisamy B, Fall CH, Geethanjali FS, Gu HF, Raghupathy P, Samuel P, Thomas N, Brismar K, Ingelsson E, and Karpe F
- Subjects
- Adiposity ethnology, Adult, Aged, Alpha-Ketoglutarate-Dependent Dioxygenase FTO, Body Mass Index, Cardiovascular Diseases ethnology, Cardiovascular Diseases genetics, Diabetic Angiopathies epidemiology, Female, Gene Frequency, Genome-Wide Association Study, Genotype, Humans, India epidemiology, India ethnology, Male, Middle Aged, Obesity epidemiology, Phenotype, Risk Factors, Skinfold Thickness, Waist Circumference, Waist-Hip Ratio, White People, Adiposity genetics, Diabetic Angiopathies ethnology, Diabetic Angiopathies genetics, Obesity ethnology, Obesity genetics, Polymorphism, Single Nucleotide, Proteins genetics, Receptor, Melanocortin, Type 4 genetics
- Abstract
Recent genome-wide association studies show that loci in FTO and melanocortin 4 receptor (MC4R) associate with obesity-related traits. Outside Western populations the associations between these variants have not always been consistent and in Indians it has been suggested that FTO relates to diabetes without an obvious intermediary obesity phenotype. We investigated the association between genetic variants in FTO (rs9939609) and near MC4R (rs17782313) with obesity- and type 2 diabetes (T2DM)-related traits in a longitudinal birth cohort of 2,151 healthy individuals from the Vellore birth cohort in South India. The FTO locus displayed significant associations with several conventional obesity-related anthropometric traits. The per allele increase is about 1% for BMI, waist circumference (WC), hip circumference (HC), and waist-hip ratio. Consistent associations were observed for adipose tissue-specific measurements such as skinfold thickness reinforcing the association with obesity-related traits. Obesity associations for the MC4R locus were weak or nonsignificant but a signal for height (P < 0.001) was observed. The effect on obesity-related traits for FTO was seen in adulthood, but not at younger ages. The loci also showed nominal associations with increased blood glucose but these associations were lost on BMI adjustment. The effect of FTO on obesity-related traits was driven by an urban environmental influence. We conclude that rs9939609 variant in the FTO locus is associated with measures of adiposity and metabolic consequences in South Indians with an enhanced effect associated with urban living. The detection of these associations in Indians is challenging because conventional anthropometric obesity measures work poorly in the Indian "thin-fat" phenotype.
- Published
- 2012
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43. Developmental origins of adult metabolic disease: The Indian scenario, driving toward a unified hypothesis.
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Vasan SK and Thomas N
- Published
- 2012
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44. A prospective assessment of dietary patterns in Muslim subjects with type 2 diabetes who undertake fasting during Ramadan.
- Author
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Vasan SK, Karol R, Mahendri NV, Arulappan N, Jacob JJ, and Thomas N
- Abstract
Aims: The aim was to assess the dietary pattern during Ramadan season among type 2 diabetic Muslim subjects who underwent fasting and intensive dietary counseling., Materials and Methods: The study was conducted among 70 Muslim subjects with type 2 diabetes mellitus who undertook fasting during Ramadan and was part of a randomized control trial using pioglitazone published previously. All subjects were subjected to a dietary assessment and counseling at three stages, i.e., initiation of the study, mid-Ramadan and post-Ramadan, by a trained dietician. Dietary assessment was done by the 24-hour dietary recall method and the food frequency questionnaire. Diabetic diet sheets were dispensed to subjects based on their body mass index (BMI), daily activity, and needs., Results: The mean caloric intake between pre-Ramadan (before fasting) and mid-Ramadan (15 days after fasting) were 1506.80 kcal and 1614.29 (P = 0.001) respectively. The distribution of active components pre and during Ramadan were: carbohydrates (g) 260.76 and 265.35 g (P = 0.001), proteins (g) 43.64 and 46.19 (P = 0.001) and fat (g) was 32.88 and 44.16 (P = 0.0001) respectively. The percentage of energy from dietary carbohydrate prior to fasting (64.11 ± 6.73) and during fasting (68.41 ± 4.41) remained almost unchanged but statistically significant when compared at different intervals before and during fasting. Fat intake increased significantly during fasting (P = < 0.001)., Conclusions: The dietary composition in a type 2 diabetic Muslim population who undertook fasting during Ramadan showed a mean increase in consumption of all components of diet during the period of fasting. Nutritional compliance during such a time seems to be difficult and warrants repeated counseling and regular follow-up to achieve targets.
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- 2012
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45. Cause-specific mortality in diabetes: retrospective hospital based data from south India.
- Author
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Vasan SK, Pittard AE, Abraham J, Samuel P, Seshadri MS, and Thomas N
- Subjects
- Adult, Age Factors, Aged, Case-Control Studies, Cause of Death, Child, Diabetes Complications mortality, Female, Humans, India, Male, Middle Aged, Retrospective Studies, Sex Factors, Diabetes Mellitus mortality
- Abstract
Background: India lacks comprehensive mortality data in individuals with diabetes. The present retrospective case-control study compared the causes of death in diabetic and non-diabetic inpatients in a tertiary care hospital in 2007., Methods: Deaths in diabetic patients (n = 315) were compared with 307 randomly selected controls. Medical chart review established the primary cause of death, demographics, and clinical data. Data were summarized using descriptive statistics and comparative analyses were performed., Results: Of the 79 067 inpatient admissions during 2007, diabetes of any type was recorded for 6517 (8.2%). There were 2017 inpatient deaths registered, 315 (15.6%) in diabetic patients and 1702 (84.4%) in non-diabetic patients, corresponding to mortality rates of 48.3/1000 admissions for diabetic patients and 23.4/1000 admissions for non-diabetic patients. The mean duration of hospitalization prior to death in diabetic versus non-diabetic patients was 6.4 vs 7.7 days (P = 0.015). Causes of death in diabetic patients were vascular disease (38.4%), infection (34.3%), renal failure (8.9%), and malignancy (8.9%); diabetic patients had significantly higher odds of death from vascular disease (odds ratio [OR] 4.05, 95% confidence interval [CI] 2.67-6.16; P ≤ 0.0001), renal causes (OR 7.39, 95%CI 2.53-29.27; P ≤ 0.001) and infection (OR 1.61, 95% CI 1.12-2.32; P ≤ 0.0001). Comparing cases and controls after stratifying by age (<56 and ≥56 years), the greater odds of vascular death among diabetics remained significant in both age categories., Conclusions: We report vascular disease as the leading cause of death among diabetic hospital inpatients in one tertiary care center in India, in contrast with previous hospital-based studies from India., (© 2011 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.)
- Published
- 2012
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46. Anthropometric measurements for the prediction of the metabolic syndrome: a cross-sectional study on adolescents and young adults from southern india.
- Author
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Vasan SK, Thomas N, Christopher S, Geethanjali FS, Paul TV, and Sanjeevi CB
- Abstract
Objectives: To determine which anthropometric measurement correlates best with the metabolic abnormalities associated with the metabolic syndrome in adolescents and young adults., Design: Cross-sectional study., Setting: Schools, high schools and universities., Participants: 1359 adolescents and young adults aged 14-25 years., Main Outcome Measures: Anthropometric predictors of metabolic abnormalities as classified by International Diabetes Federation definition., Results: The waist circumference (OR 1.56, 95% CI 1.0 to 2.43: p≤0.01) and the abdominal skin fold thickness (OR 1.44, 95% CI 1.02 to 2.04, p≤0.01) above the third quintile cut-offs were found to be significantly associated with metabolic abnormalities. The sensitivity of either one of these measurements in predicting metabolic abnormalities was 66.1% with a negative predictive value of 82.8%. Hyperglycaemia was significantly associated with an abdominal skin fold thickness over the fourth quintile alone (OR 1.63, 95% CI 1.24 to 2.1). All the anthropometric measurements correlated well with elevated triglycerides and hypertension., Conclusions: In a large community-based cross-sectional survey of subjects aged 14-25 years, the waist circumference and the abdominal skin fold thickness are important predictors of the metabolic abnormalities associated with metabolic syndrome. This simple clinical tool may help in a primary care setting to identify subjects who require a further biochemical evaluation and would considerably reduce the cost of unwarranted testing.
- Published
- 2011
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47. Absence of birth-weight lowering effect of ADCY5 and near CCNL, but association of impaired glucose-insulin homeostasis with ADCY5 in Asian Indians.
- Author
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Vasan SK, Neville MJ, Antonisamy B, Samuel P, Fall CH, Geethanjali FS, Thomas N, Raghupathy P, Brismar K, and Karpe F
- Subjects
- Adult, Anthropometry, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 genetics, Female, Gene Frequency, Genetic Predisposition to Disease, Genetic Variation, Genotype, Homeostasis, Humans, India, Male, Adenylyl Cyclases genetics, Birth Weight genetics, Blood Glucose metabolism, Cyclins genetics, Ethnicity genetics, Insulin metabolism, White People genetics
- Abstract
Background: A feature of the Asian Indian phenotype is low birth weight with increased adult type 2 diabetes risk. Most populations show consistent associations between low birth weight and adult type 2 diabetes. Recently, two birth weight-lowering loci on chromosome 3 (near CCNL1 and ADCY5) were identified in a genome-wide association study, the latter of which is also a type 2 diabetes locus. We therefore tested the impact of these genetic variants on birth weight and adult glucose/insulin homeostasis in a large Indian birth cohort., Methodology/principal Findings: Adults (n = 2,151) enrolled in a birth cohort (established 1969-73) were genotyped for rs900400 (near CCNL1) and rs9883204 (ADCY5). Associations were tested for birth weight, anthropometry from infancy to adulthood, and type 2 diabetes related glycemic traits. The average birth weight in this population was 2.79±0.47 kg and was not associated with genetic variation in CCNL1 (p = 0.87) or ADCY5 (p = 0.54). Allele frequencies for the 'birth weight-lowering' variants were similar compared with Western populations. There were no significant associations with growth or adult weight. However, the 'birth weight-lowering' variant of ADCY5 was associated with modest increase in fasting glucose (β 0.041, p = 0.027), 2-hours glucose (β 0.127, p = 0.019), and reduced insulinogenic index (β -0.106, p = 0.050) and 2-hour insulin (β -0.058, p = 0.010)., Conclusions: The low birth weight in Asian Indians is not even partly explained by genetic variants near CCNL1 and ADCY5 which implies that non-genetic factors may predominate. However, the 'birth-weight-lowering' variant of ADCY5 was associated with elevated glucose and decreased insulin response in early adulthood which argues for a common genetic cause of low birth weight and risk of type 2 diabetes.
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- 2011
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48. Management of insulinomas: analysis from a tertiary care referral center in India.
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Paul TV, Jacob JJ, Vasan SK, Thomas N, Rajarathnam S, Selvan B, Paul MJ, Abraham D, Nair A, and Seshadri MS
- Subjects
- Adult, Aged, Angiography, Digital Subtraction, Female, Hospitals, Rural, Humans, Hypoglycemia etiology, India, Insulinoma diagnostic imaging, Insulinoma pathology, Longitudinal Studies, Magnetic Resonance Imaging, Male, Middle Aged, Pancreatic Neoplasms diagnostic imaging, Pancreatic Neoplasms pathology, Postoperative Complications etiology, Referral and Consultation, Retrospective Studies, Tomography, X-Ray Computed, Treatment Outcome, Insulinoma surgery, Pancreatic Neoplasms surgery
- Abstract
The aim of this study was to describe the localization and management of patients with pancreatic insulinomas and determine the most effective localization and surgical techniques in the presence of significant financial constraints in the patient population. We retrospectively reviewed the case records of 18 patients with insulinomas treated at our institution over a period of 10 years. The medical records were reviewed for demographic data, clinical presentation, biochemistry, details of localization studies, intraoperative findings, postoperative outcome, and long-term follow-up. The sensitivities of the various localization procedures were calculated using the intraoperative findings as the gold standard. There were 10 men and 8 women in the study, with a median age of 43 years. All patients underwent a supervised 72-hour fast and developed symptomatic hypoglycemia within 48 hours. An average of 1.9 localization procedures was performed per patient. Computed tomography (CT) had a sensitivity of 62% and specificity of 100%. Magnetic resonance imaging and digital subtraction angiography had specificities of 85% and 100%, respectively, with a specificity of 66% and 50%, respectively. Fourteen patients underwent surgery. Intraoperatively the excised tumor was palpable in nine patients, and all patients had postoperative euglycemia. In five patients the tumor was not palpable during the time of surgery; three of these patients underwent blind distal pancreactomy, with two patients having persistent hypoglycemia during the postoperative period. Two patients had a negative exploratory laparotomy. Patients with a surgical cure were followed up for a mean period of 24 months. On the background of financial constraints in connection with patient care, CT scanning is a cost-effective option with good specificity. Intraoperative palpation of the tumor and enucleation is the most effective technique for surgical cure. Blind distal pancreactomy is not advocated for tumors that are not localized intraoperatively.
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- 2008
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49. Visual vignette. Albright-McCune syndrome.
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Vasan SK, Jacob JJ, and Seshadri MS
- Subjects
- Bone and Bones abnormalities, Bone and Bones diagnostic imaging, Child, Preschool, Diagnosis, Differential, Female, Fibrous Dysplasia, Polyostotic diagnosis, Humans, Radiography, Skin Abnormalities, Fibrous Dysplasia, Polyostotic pathology
- Published
- 2007
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50. Identification of a novel mycobacterial transcriptional regulator and its involvement in growth rate dependence and stringent control.
- Author
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Kamalakannan V, Ramachandran G, Narayanan S, Vasan SK, and Narayanan PR
- Subjects
- Base Sequence, Carbon-Nitrogen Ligases genetics, Lac Operon, Molecular Sequence Data, Mutagenesis physiology, Mycobacterium smegmatis growth & development, Plasmids, Recombinant Proteins genetics, Ribosomes metabolism, Gene Expression Regulation, Bacterial, Mycobacterium smegmatis genetics, Promoter Regions, Genetic genetics, Transcriptional Activation genetics
- Abstract
A novel transcriptional regulator has been identified in the 400-bp upstream region of the guaA gene of Mycobacterium tuberculosis H37Rv that promotes the expression of lacZ gene in Mycobacterium smegmatis mc(2)155 and M. tuberculosis H37Rv but not in Escherichia coli DH5alpha. PCR-mediated deletion mutagenesis and cloning identified a 120-bp fragment upstream from the guaA gene to be the actual regulator. Primer extension analysis mapped the transcription start site to be the first 'G' residue of the translation start codon GTG of the guaA gene. Electrophoretic mobility shift assay showed strong binding of M. smegmatis RNA polymerase holoenzyme to the 400-bp fragment that expresses lacZ in mycobacterial species and a weak binding to the 280-bp fragment that expresses only in E. coli DH5alpha. Both promoter recombinants revealed varied response in the presence of purine nucleotides and exhibited down-regulation when subjected to amino acid starvation.
- Published
- 2002
- Full Text
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