Risk Due To Interaction Research Articles

Gene–gene interaction and association of Wnt/Β-catenin signalling pathway gene polymorphisms with ankylosing spondylitis susceptibility in the Chinese Han population

Objectives: To explore the genetic interaction between Wnt/β-catenin signalling pathway genes and ankylosing spondylitis (AS) in the Chinese population.Methods: Six single-nucleotide polymorphisms (SNPs) in DKK1, LRP5, LRP6, and SOST genes were genotyped in 673 AS patients and 687 healthy controls by using SNPs can Technic. Single marker genetic association analysis was performed. Haplotypes were constructed after linkage disequilibrium analysis; additive, multiplicative, and higher-order interactions were analysed.Results: The DKK1 gene rs1569198 polymorphism was significantly associated with AS susceptibility in females (χ2 = 4.55, p = .03), but the association disappeared after Bonferroni correction. Moreover, a haplotype (T-G) in the DKK1 gene showed a protective role in AS susceptibility in females (p = .04). Significant additive interactions were observed between DKK1: rs1896368 and LRP5: rs3736228, relative excess risk due to interaction (RERI) = 0.40, 95% CI = 0.08 – 0.71; attributable proportion due to interaction (AP) = 51%, 95% CI = 0.07 – 0.94, DKK1: rs1569198 and LRP5: rs3736228 (RERI = 0.49, 95% CI = 0.12 – 0.86; AP = 49%, 95% CI = 0.17 – 0.82), LRP5: rs3736228 and SOST: rs4792909 (RERI = 0.33, 95% CI = 0.002 – 0.65; AP = 41%, 95% CI = 0.01 – 0.81) in the dominant model.Conclusions: Our research implies a potential gene–gene interaction, thus revealing the importance of the Wnt/β-catenin signalling pathway for understanding the genetic architecture of AS.

Association of lifestyle factors with blood lipids and inflammation in adults aged 40\u2009years and above: a population-based cross-sectional study in Taiwan

BackgroundLifestyle factors were associated with an increased risk of cardiovascular disease (CVD) occurrence. We explored the associations between lifestyle factors and CVD risk factors, and assessed the interactive effects of lifestyle factors on CVD risk factors.MethodsA cross-sectional data of 114,082 (57,680 men and 56,402 women) middle-aged adults and elderly in Taiwan were collected from 2001 to 2010. Logistic regression analysis was used to assess the associations between lifestyle factors and CVD risk factors. The relative excess risk due to interaction (RERI) and the attributable proportion due to interaction were used to explore the interactive effect of lifestyle factors on CVD risk factors.ResultsThe interaction between alcohol consumption and smoking exhibited an excess risk of high triglycerides (RERI = 0.21; 95% CI: 0.14–0.29), and that of alcohol consumption and physical activity had an excess risk of high LDL-cholesterol (RERI = 0.11; 95% CI: 0.06–0.16) and high blood glucose (RERI = 0.05; 95% CI: 0.01–0.11). Alcohol consumption and vegetable-rich diet (intake of high vegetables with no or low meat) had an excess risk of high LDL-cholesterol and low HDL-cholesterol, but a reduced risk of high triglycerides (RERI = − 0.10; 95% CI: − 0.17 – -0.04). Smoking and physical activity had an increased risk of high blood glucose and a reduced risk of low HDL-cholesterol. Smoking and vegetable-rich diet reduced the risk of high triglycerides (RERI = − 0.11; 95% CI: − 0.18 – − 0.04), high blood glucose (RERI = − 0.14; 95% CI: − 0.21 – − 0.07) and low HDL-cholesterol (RERI = − 0.10; 95% CI: − 0.19 – -0.01).ConclusionsThe interaction between smoking, alcohol consumption, physical activity and diet were associated with lipid profile and blood glucose, hence there was an interaction between these lifestyle factors in an additive scale. Public health promotion should therefore consider multifaceted promotional activities that are likely to make a positive impact on the health status of the Taiwanese population.

Short-term effects of heatwave and PM2.5 exposure on the risk of preterm birth in Guangzhou, China

PDS 72: Environmental health issues in LMIC, Exhibition Hall (PDS), Ground floor, August 28, 2019, 10:30 AM - 12:00 PM Background: Extreme temperatures and air pollution both have significant burden on birth outcomes, however, the effects of short-term exposure to extreme heat and its interaction with air pollution on preterm birth (PTB) remain unclear. Objectives: To investigate the short-term effects of different definitions of heatwaves (n=12) and PM2.5 exposure on PTB and further explore interactive effects on the PTB risk. Methods: Using birth certificate data from Guangzhou, China, we included 249,489 singleton live births that occurred in the warm season (May 1-October 31) between January 2015 and July 2017. Daily average concentrations of PM2.5 from 11 monitoring stations and meteorological variables from five weather stations were used to estimate district-specific exposures. A series of cut-off temperatures and durations were used to define heatwaves. Distributed lag models (DLMs) using Cox proportional hazard models were used to estimate the effects of heatwave and PM2.5 exposure during the last week before delivery, and their additive interactive effect on PTB was assessed by using the relative excess risk due to interaction (RERI). Results: For most heatwave definitions used, an increased risk of PTB was observed for the women experienced at least one heatwave event in the last gestational week, with hazard ratios (HRs) of PTB ranging from 1.24 (95% CI: 1.01-1.52) to 1.78 (1.48-2.15). The effect estimates increased with the intensity of heatwave and the effects on later PTB (weeks 35-36) were stronger than those on earlier PTB (weeks 28-34). We observed weak effects of PM2.5 during the last week, and a negative additive interaction between heatwaves and PM2.5 exposure on PTB, with the RERIs<0. Conclusions: Exposure to heatwaves late in gestation is associated with a greater risk of PTB in Guangzhou. The finding of the negative interaction between short-term heatwaves and PM2.5 exposure on PTB warrants further investigation about the potential underlying mechanisms.

Racial/ethnic disparities in critical periods of vulnerability to fine particulate matter during pregnancy

TPS 743: Health effects in pregnancy, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Exposure to ambient fine particulate matter (PM2.5) during pregnancy is associated with preterm birth (PTB), a leading cause of infant morbidity and mortality. Recent studies have attempted to identify periods of susceptibility to PM2.5 during pregnancy. This study aims to identify racial/ethnic disparities in critical periods of susceptibility to PM2.5 during pregnancy. Methods: We linked all live singleton births in California from 2005 – 2010 with weekly average PM2.5 (μg/m3) exposure during pregnancy. Associations between PM2.5 and preterm birth were assessed using multi-level distributed lag Cox proportional hazard models and a distributed lag model. We also assessed effect measure modification by non-Hispanic White, non-Hispanic Black and Hispanic race/ethnicity by calculating the weekly relative excess risk due to interaction (RERI). Results: Gestational weeks 17-24 and 36 were associated with increased vulnerability to PM2.5 exposure across all pregnancies. We find that non-Hispanic Black mothers may be more susceptible to PM2.5 exposure effects when compared with non-Hispanic White mothers, particularly during weeks 28-33 of pregnancy. Conclusions: These findings extend our knowledge about the existence of specific susceptibility exposure periods during pregnancy that may differ across race/ethnic groups which can help to inform targeted prevention efforts among racial/ethnic subgroups.

The interaction between detectable plasma viral load and increased body mass index on hypertension among persons living with HIV

ABSTRACT Increased body mass index (BMI) and HIV are each associated with hypertension. This study tested interactions between BMI and detectable plasma viral load (pVL) on hypertension among 659 persons living with HIV (PLWH). All participants were categorized into four subgroups based on BMI (<25 and ≥25 kg/m2) and pVL (<200 and ≥200 copies/ml). Multiplicative interaction was assessed using logistic regression; addictive interaction was assessed using three measures: Relative Excess Risk due to Interaction (RERI), Attributable Proportion (AP), and Synergy index (S). Compared to the participants with normal BMI and undetectable pVL, those who had increased BMI with an undetectable pVL had an elevated risk of hypertension with OR [95%CI] = 1.80 [1.02, 3.20]; the risk was further increased for those who had increased BMI with detectable pVL with OR [95%CI] = 3.54 [1.71, 7.31]. The multiplicative interaction was significant (p = 0.01). Results from additive interaction indicated RERI [95%CI] =1.89 [0.76, 4.79] and AP [95%CI] = 0.64 [0.32, 0. 95]. The interaction effects of increased BMI and detectable pVL on hypertension on both multiplicative and additive scales suggested that PLWH with increased BMI and detectable pVL should be intensively managed and monitored for hypertension prevention and treatment.

Opioid use disorders, psychiatric comorbidities, and risk for suicide attempts among veterans seeking pain care.

The purpose of this study was to assess the associations of comorbid opioid use disorders and psychiatric disorders with suicide attempts among veterans seeking pain care. The cohort (N = 226 444) was selected by identifying pain care initiation from 2012 to 2014 using national Veterans Health Administration (VHA) data. Data on opioid use disorders (OUD), psychiatric disorders, medical comorbidity, demographics at baseline, and suicide attempts in the year following the initiation of pain care were extracted from VHA databases. Relative excess risk due to interaction (RERI) was used to assess departure from additivity of effects. Adjusted models indicated that both comorbid OUD and depression (RERI = 1.07) and comorbid OUD and AUD (RERI = 1.23) were significantly associated with additive risk of suicide attempt. In adjusted multiplicative interaction models, only comorbid OUD and bipolar disorder was significantly associated with suicide attempts; however, this association was protective (HR = 0.54). The current findings highlight the importance of addressing opioid use disorders and alcohol use disorders and depression together to mitigate the risk of suicidal behavior.

Synergic effect between high temperature and air pollution on mortality in Northeast Asia

High temperature and air pollutants have been reported as potential risk factors of mortality. Previous studies investigated interaction between the two variables; however, the excess death risk due to the synergic effect (i.e. interaction on the additive scale) between the two variables has not been investigated adequately on a multi-country scale. This study aimed to assess the excess death risk due to the synergism between high temperature and air pollution on mortality using a multicity time-series analysis. We collected time-series data on mortality, weather variables, and four air pollutants (PM10, O3, NO2, and CO) for 16 metropolitan cities of three countries (Japan, Korea, and Taiwan) in Northeast Asia (1979–2015). Quasi-Poisson time-series regression and meta-analysis were used to estimate the additive interaction between high temperature and air pollution. The additive interaction was measured by relative excess risk due to interaction (RERI) index. We calculated RERI with relative risks (RR) of the 99th/10th, 90th/90th, and 99th/90th percentiles of temperature/air pollution metrics, where risk at the 90th/10th percentiles of temperature/air pollution metrics was the reference category. This study showed that there may exist positive and significant excess death risks due to the synergism between high temperature and air pollution in the total population for all pollutants (95% lower confidence intervals of all RERIs>0 or near 0). In final, we measured quantitatively the excess death risks due to synergic effect between high temperature and air pollution, and the synergism should be considered in public health interventions and a composite warning system.

Impact of major depression on cardiovascular outcomes for individuals with hypertension: prospective survival analysis in UK Biobank

ObjectivesTo assess whether a history of major depressive disorder (MDD) in middle-aged individuals with hypertension influences first-onset cardiovascular disease outcomes.DesignProspective cohort survival analysis using Cox proportional hazards regression with a...

A general approach to detect gene (G)-environment (E) additive interaction leveraging G-E independence in case-control studies.

It is increasingly of interest in statistical genetics to test for the presence of an additive interaction between genetic (G) and environmental (E) risk factors. In case-control studies involving a rare disease, a statistical test of no additive G×E interaction typically entails a test of no relative excess risk due to interaction (RERI). It has been shown that a likelihood ratio test of a null RERI incorporating the G-E independence assumption (RERI-LRT) outperforms the standard approach. The RERI-LRT relies on correct specification of a logistic model for the binary outcome, as a function of G, E, and auxiliary covariates. However, when at least one exposure is not categorical or auxiliary covariates are present, nonparametric estimation may not be feasible, while parametric logistic regression will a priori rule out the null hypothesis of no additive interaction in most practical situations, inflating type I error rate. In this paper, we present a general approach to test for G × E additive interaction exploiting G-E independence. Unlike the RERI-LRT, it allows the regression model for the binary outcome to remain unrestricted, and nonetheless still allows for covariate adjustment in order to ensure the G-E independence assumption or to rule out residual confounding. The methods are illustrated through extensive simulation studies and an ovarian cancer study.

Does ethnic-racial identity modify the effects of racism on the social and emotional wellbeing of Aboriginal Australian children?

ObjectivesThis study investigates the protective role of ethnic-racial identity (ERI) affirmation on the longitudinal association between racism and Aboriginal Australian children’s social and emotional well-being (SEWB).Methods408 children from the K-Cohort of the Longitudinal Study of Indigenous Children were included in the analysis. Data were collected through questionnaire-guided interviews at 7–10 and 9–12 years of age. Children’s racism experience, SEWB (Strengths and Difficulties Questionnaire), and confounding were reported by caregivers. ERI was reported by children and dichotomized into high versus low. Generalized linear models with log-Poisson links and robust errors were used to estimate adjusted Risk Ratios (RRa) for the effect of racism on SEWB domains. Effect-measure modification analysis was used to verify differences on effect sizes per strata of ERI affirmation. The presence of modification was indicated by the Relative Excess Risk due to Interaction (RERI).ResultsSlightly above half (51.4%) of the children presented high ERI affirmation. Children exposed to racism and with low ERI affirmation were at increased risk of hyperactive behavior (RRa 2.53, 95% CI 1.17, 5.48), conduct problems (RRa 2.35, 95% CI 1.07, 5.15), and total difficulties (RRa 1.73, 95% CI 0.84, 3.55). Positive RERIs indicated the joint effects of racism and low ERI affirmation surpassed the sum of their separate effects in these domains. Children with high ERI affirmation were at increased risk of peer problems (RRa 1.66, 95% CI 0.78, 3.52).ConclusionsThese findings suggest that ERI may mitigate the risk of poor SEWB due to racism. Fostering affirmative ERI can be an important strategy in promoting resilience in Aboriginal Australian children.

The ACTB Variants and Alcohol Drinking Confer Joint Effect to Ischemic Stroke in Chinese Han Population.

Aim: β-actin (ACTB) participates in the vascular remodeling and contributes to the cardiovascular diseases. Herein, we investigated the associations of ACTB with hypertension and stroke.Methods: Three single-nucleotide polymorphisms in ACTB were selected for genotyping in 2,012 hypertension cases and 2,210 controls. The associations of ACTB with hypertension and stroke were examined in another follow-up study. Logistic and Cox regression were performed in a case-control study and a follow-up study, respectively. Additive scale interaction was examined by calculating the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (SI). The multiplicative interaction hazard ratio was calculated by fitting the Cox regression model. ACTB mRNA in peripheral blood mononuclear cells was measured in ischemic stroke (IS) cases and in controls.Results: The associations of rs852426 with hypertension and stroke had statistical significance in drinkers but not after Bonferroni correction. An additive interaction of rs852426 and drinking was observed for stroke incidence, the adjusted RERI was −0.907 (p = 4.108×10−4), and the multiplicative interaction was still sound (HR = 0.541, p = 0.048). Furthermore, the significant interaction was further replicated in a nested case-control study. In the drinking population, the relative expression of ACTB mRNA in IS was lower (0.99 ± 0.26) than that in controls (1.13 ± 0.20), with a p value of 0.026.Conclusions: ACTB rs852426 was significantly associated with alcohol consumption on stroke risk, and the expression of ACTB mRNA in IS who had a drinking habit was significantly down-regulated. This finding will provide a novel insight into the prevention of stroke.

Association between ambient particulate matter concentration and fetal growth restriction stratified by maternal employment

BackgroundFetal growth has been known to be associated with particulate matter (PM) air pollution during gestation. Given that regular working may deviate outdoor air pollution exposure, the association between air pollution and fetal growth restriction can be different across maternal working status. This study was to assess possible effect modification by maternal employment in the association between exposure to PM during pregnancy and fetal growth restriction.MethodsUsing hourly PM less than or equal to 10 and 2.5 μm in diameter (PM10 and PM2.5) regulatory monitoring data for 2001–2012 and 2008–2012, respectively, and birth certificate data for 2002–2012, we computed maternal exposures with district-level averages of PM10 and PM2.5 during one year before birth, entire pregnancy, and the 1st, 2nd and 3rd trimesters. The outcomes of fetal growth restriction were assessed by small for gestational age (SGA, weighted <10th percentile in the same gestational age) as well as low birth weight (LBW, < 2.5 kg) at term. We performed logistic regression to examine the association between PM and each of fetal growth restriction outcomes adjusting for individual risk factors. For effect modification by maternal employment, we estimated adjusted odds ratio (OR) of SGA or LBW for interquartile (IQR) increases in PM10 or PM2.5 stratified by employed and non-employed mothers. We also computed relative excess risk due to interaction (RERI) to investigate additive interaction.ResultsAmong 824,011 singleton term births, 34.0% (279,856) were employed and 66.0% (544,155) were non-employed mothers. Proportions of LBW were 1.5% in employed and 1.6% in non-employed (P < 0.001). SGA occurred in 12.7% of employed and 12.8% of non- employed (P = 0.124) mothers. For non-employed mothers, we observed increased odds of SGA per IQR increase in PM10 for one year before birth (OR = 1.02, 95% confidence intervals (CI): 1.00–1.04, P = 0.028). ORs of SGA for full pregnancy period and the 3rd trimester were also positive but did not reach statistical significance. We did not observe positive association for PM2.5. RERI was not significant both for PM10 and PM2.5.ConclusionsWe did not observe evidence of effect modification by maternal employment in the association between ambient PM and fetal growth restriction. Future studies using more refined exposure measures should confirm this finding.

The Additive Interaction between Body Mass Index and Hypertension Family History in Han and Yugur: The China National Health Survey (CNHS).

Objective To estimate the additive interaction of body mass index (BMI) and family history of hypertension (FHH) on hypertension and explore whether the interaction could be influenced by behavioural risk factors. Methods The cross-sectional data on 5791 participants were from the China National Health Survey in Gansu province in 2016. We assessed the additive interaction by calculating the relative excess risk due to interaction (RERI), the attributable proportion due to interaction (AP), and the synergy index (SI). Results ORs for hypertension were highest in Han (13.52, 95% CI: 9.45 to 19.34) and Yugur (13.85, 95% CI: 8.48 to 22.63) with the combination of obesity and FHH. The interaction of BMI and FHH was significant in Han people, with the RERI, AP, and SI and their 95% CIs being 2.48 (1.13 to 3.82), 0.33 (0.19 to 0.47), and 1.61 (1.26 to 2.07) for overweight and FHH and 6.32 (1.91 to 10.73), 0.47 (0.27 to 0.67), and 2.02 (1.33 to 3.07) for obesity and FHH, respectively. The interaction of BMI and FHH was not significant in Yugur people. Adjustment for behavioural risk factors had little influence on the interactions, and risks of hypertension remained increased. Conclusions BMI and FHH were associated with hypertension, and the interaction of BMI and FHH on hypertension was significant in Han but not in Yugur people. Behavioural risk factors had little influence on the associations and interactions. The exacerbation of hypertension risks by overweight or obesity in hypertension families deserves attention in weight control and community care.

Oophorectomy and risk of non-alcoholic fatty liver disease and primary liver cancer in the Clinical Practice Research Datalink.

Incidence of non-alcoholic fatty liver disease (NAFLD) and liver cancer are 2-3 times higher in males than females. Hormonal mechanisms are hypothesized, with studies suggesting that oophorectomy may increase risk, but population-based evidence is limited. Thus, we conducted a study within the Clinical Practice Research Datalink, with controls matched to cases of NAFLD (n = 10,082 cases/40,344 controls) and liver cancer (n = 767 cases/3068 controls). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. Effect measure modification by menopausal hormone therapy (MHT) was examined, using likelihood ratio tests and relative excess risk due to interaction (RERI). Oophorectomy was associated with a 29% elevated NAFLD risk (OR = 1.29, 95% CI 1.18-1.43), which was more pronounced in women without diabetes (OR = 1.41, 95% CI 1.27-1.57) and in women who had oophorectomy prior to age 50 (OR = 1.37, 95% CI 1.22-1.52). Compared to women without oophorectomy or MHT use, oophorectomy and MHT were each associated with over 50% elevated risk of NAFLD. However, the combination of oophorectomy and MHT showed evidence of a negative interaction on the multiplicative (p = 0.003) and additive scales (RERI = - 0.28, 95% CI - 0.60 to 0.03, p = 0.08). Oophorectomy, overall, was not associated with elevated liver cancer risk (OR = 1.16, 95% CI 0.79-1.69). These findings suggest that oophorectomy may increase the risk of NAFLD, but not liver cancer.

1682-P: A Rule-Based Discovery of Gene-Environment Interactions on Risk of Islet Autoimmunity: TEDDY Study

Type 1 diabetes (T1D) associated genetic factors affect risk of islet autoantibodies (IA), but non-genetic factors show conflicting associations. Mechanistic interactions may play a role. Under a sufficient-component causal framework, we used a rule-based discovery method to investigate if genetic factors, early environment and first appearing IA (IAA or GADA) act synergistically to mark different disease mechanisms. TEDDY children (n=7512) were followed until age 6 years for IA development (n=518). Rules differentiating IAA-first (n=258) from GADA-first (n=243) were identified by a rule discovery algorithm (RuleFit) and examined in logistic regression models. Rule components were assessed for additive interaction on IAA-first and GADA-first separately using Relative Excess Risk due to Interaction (RERI) calculated from Cox regression models. Here we show 2 of the 5 top rules, the first involving the child having CTLA4-AA (rs231775) and mother with a gestational respiratory but no skin infection (rule1, OR=5.6, 95% CI=2.6-12.0, p&amp;lt;0.0001); the second involving child having BACH2-T (rs3757247) and sufficient weight gain by age 3 months (rule2, OR=0.47, 95% CI=0.30-0.72, p&amp;lt;0.0001). Each differentiated IAA from GADA, and rule components showed interaction on absolute risk of IAA-first or GADA-first. Figure 1. Gene-environmental interaction with first appearing IA may mark different mechanisms. Disclosure K.F. Lynch: None. T. Feng: None. X. Qian: None. W. Hagopian: Research Support; Self; Novo Nordisk A/S. Å. Lernmark: None. A. Ziegler: None. J. Toppari: None. M. Rewers: None. J. She: None. D. Schatz: None. B. Akolkar: None. J. Krischer: None. S. Huang: None. K. Vehik: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases; National Institute of Allergy and Infectious Diseases; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute of Environmental Health Sciences; Centers for Disease Control and Prevention; JDRF; University of Florida (UL1TR000064); University of Colorado (UL1TR001082)

Application of an intersectional framework to understanding the association of disability and sexual orientation with suicidal ideation among Oregon Teens

BackgroundSuicide is the second leading cause of death among U.S. youth. Prior research has found that disability and sexual orientation are each independently associated with suicide risk. However, most analyses regarding sexual orientation or disability in relation to teenagers’ health have isolated the effects of these identities via multiple regression models. That approach assumes there is no multiplicative or synergistic effect between the two identities. ObjectiveTo examine the association between suicidal ideation and the intersection of disability and sexual orientation. MethodsCross-sectional data from the 2015 Oregon Healthy Teens Survey were analyzed using Poisson regression analysis with robust variance to estimate the relationship between the intersection of disability and sexual orientation and youth reports of suicidal ideation. We calculated three measures of interaction: 1) the excess risk due to interaction (RERI); 2) the proportion attributable to interaction (AP); and 3) the synergy index (SI). ResultsSexual minority teenagers with disabilities had higher risk of suicidal ideation (adjusted relative risk [ARR] = 2.82, 95% CI: 2.47–3.21) with respect to heterosexual teenagers without disabilities. The risk was also elevated, to a lesser degree, for heterosexual youth with disabilities (ARR = 1.97, 95% CI: 1.78–2.19) and LGB youth without disabilities (ARR = 2.17, 95% CI: 1.95–2.42) with respect to the reference group. Our measures of interaction were indicative of a synergistic effect between disability and sexual orientation. ConclusionsOur findings suggest the combination of disability and minority sexual orientation may be associated with compounded negative experiences that could exacerbate the risk of suicide.

The association of diabetes risk score and body mass index with incidence of diabetes among urban and rural adult communities in Qingdao, China

The Qingdao diabetes risk score (QDRS) is an accurate tool for identifying individuals who are at a high risk for diabetes. This study was designed to determine the association of the QDRS with the incidence of diabetes in the general population in urban and rural settings. A stratified, random, cluster-sampling method was used to select representative individuals in 2006 and 2009, and the follow-up survey was conducted from 2012 to 2015. Of 5851 participants, 3248 were available in cohort study. The individuals without data of FPG, 2 h PG was excluded in follow-up survey. Finally, a total of 3033 participants were included. Waist circumference, age, and family history of diabetes were collected to determine the QDRS. Cox proportional hazards regression models were used to evaluate the association of QDRS and BMI with the incidence of diabetes. Further, we assessed the relative excess risk due to interaction (RERI), synergy index (S), and attributable proportion due to interaction (AP). Their age-standardized cumulative incidence of diabetes was 16.9% and 10.8% among the urban and rural populations, respectively. In both urban and rural settings, individuals with a QDRS ≥ 14 had a significantly higher risk for diabetes than the individuals with a QDRS < 14 (hazard ratio (HR): 2.37 vs. 1.49; 95% CI 1.35–4.15 vs. 1.09–2.04). Further, having a QDRS of ≥ 14 concurrently with being overweight/obese showed an additive effect on the risk for diabetes in urban settings (RERI = 1.59, S = 2.34, AP = 42.06%). In contrast, a negative interaction was noted in rural settings (RERI = 0.07, S = 0.89, AP = 4.55%). Having a QDRS ≥ 14 demonstrated a strong positive association with the incidence of diabetes. An elevated QDRS combined with BMI showed value in predicting the incidence of diabetes among high-risk populations for diabetes in urban but not rural settings.

Risk of disordered eating at the intersection of gender and racial/ethnic identity among U.S. high school students

BackgroundGender and racial/ethnic disparities in disordered eating among youth exist, although whether having multiple marginalized identities disproportionately increases risk is unclear. Therefore, we aimed to quantify the risk of disordered eating associated with intersecting gender and racial/ethnic identities of U.S. adolescents. MethodsWe analyzed data from 11,514 U.S. high school students identifying as White, Black/African American, or Hispanic/Latino who participated in the 2013 National Youth Risk Behavior Surveillance System. Age-adjusted relative risks (RR) of purging, fasting, diet pill use, and any disordered eating were estimated using log-binomial models. Relative excess risk due to interaction (RERI) was estimated to evaluate the degree to which the combined effect of marginalized gender and racial/ethnic identity was larger than the sum of their individual effects. ResultsDisordered eating was prevalent (girls: 20.4% Black/African American, 29.2% Hispanic/Latina, 21.4% White; boys: 13.4% Black/African American, 12.4% Hispanic/Latino; 8.1% Whites). Girls of all racial/ethnic identities and racial/ethnic minority boys had elevated risks of purging, fasting, and any disordered eating compared to White boys (RR range = 1.57–7.43); Hispanic/Latina and White girls also had elevated risk of diet pill use (RR range = 1.98–3.20). Among Hispanic/Latina girls, positive interaction between gender and race/ethnicity produced excess risk of any disordered eating and purging (RERI: any = 0.42 (95% confidence interval (CI) = −0.02, 0.87); purging = 1.74 (95% CI = 0.06, 3.42). ConclusionsFindings illustrate the advantages of adopting an intersectional approach to disordered eating research. Future research should investigate the mechanisms of these disparities.

The age modification to leukocyte telomere length effect on bone mineral density and osteoporosis among Chinese elderly women.

Critically short telomeres indicate cellular senescence. Leukocyte telomere length (LTL) is regarded as an aging predictor. Osteoporosis is an age-related disease. The purpose of our study is to examine the association between LTL, and BMD and osteoporosis among an elderly Chinese population. A total of 1017 participants (584 postmenopausal women) with a mean age of 66.4years were recruited from April 2016 to August 2017. Dual-energy X-ray absorptiometry was used for BMD measurement at skeleton sites of lumbar spine (LS), femoral neck (FN), and total hip (TH). LTL was measured using quantitative real-time polymerase chain reaction. Among women, age significantly modified the effect of LTL on BMD at FN. Additionally, significant age modification was observed for the association between LTL and LS BMD category (indicative of control or osteopenia or osteoporosis), and the number of osteoporotic sites at LS or TH. The corresponding estimates (95% CI) for the relative excess risk due to interaction (RERI) were -0.07 (-0.11, -0.01) and -0.11 (-0.16, -0.03) sequentially in ordinal logistic regression models. The estimated RERIs (95% CI) were -0.11 (-0.25, -0.02) and -0.23 (-0.39, -0.10) in multinomial logistic regression models for LS/FN/TH BMD category, and -0.20 (-0.31, -0.09) and -0.34 (-0.49, -0.21) for FN BMD category. However, similar findings did not show in men. The effect of LTL on BMD and osteoporosis risk is modified by age in elderly women but not in men, suggesting that the predictive role of LTL in bone loss differs by sex.

Physical workload and obesity have a synergistic effect on work ability among construction workers.

Obesity and high physical workload are both associated with poor work ability, but the interaction between obesity and high physical workload on work ability is not yet fully understood. Obesity and high physical workload may share a common mechanical pathway, possibly leading to a synergistic negative effect on work ability. The purpose of this study was to investigate the effect of obesity on work ability in workers with high versus low physical work load. A longitudinal study was conducted among 36,435 Dutch construction workers who participated in at least two periodic medical examinations during the years 2008-2015. Logistic regression analyses were used to investigate the effect of manual material handling and strenuous work postures in sports on the association between obesity and work ability. Work ability was measured using the self-reported Work Ability Index consisting of seven dimensions. Confounding effects were tested for age, educational level, smoking, vigorous physical activity, psychosocial work demands, and working hours. Additive interaction between obesity and physical workload on work ability was tested using the relative excess risk due to interaction (RERI). Construction workers with overweight (OR = 1.09; 95% CI 1.02-1.16) or obesity (OR = 1.27; 95% CI 1.17-1.38) had an increased risk of poor/moderate work ability. Exposure to manual material handling (OR = 1.58; 95% CI 1.49-1.68) or strenuous work postures (OR = 1.80; 95% CI 1.70-1.90) also increased the risk of poor/moderate work ability. The effect of the combination of obesity with high physical workload was greater than the sum of the individual effects (strenuous work postures: RERI = 0.39; 95% CI 0.10-0.67; manual material handling: RERI = 0.26; 95% CI 0.02-0.51). Obesity and high physical workload were associated with poor work ability and had a synergistic, negative effect on work ability. Interventions that prevent obesity and high physical workload might have a beneficial effect on work ability.