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Fuzhong Xue
Department of Biostatistics School of Public Health Cheeloo College of MedicineShandong University Jinan Shandong China

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Research article
Published: 03 August 2021 in Journal of the American Heart Association
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Background This Mendelian randomization study aims to investigate causal associations between genetically predicted insomnia and 14 cardiovascular diseases (CVDs) as well as the potential mediator role of 17 cardiometabolic risk factors. Methods and Results Using genetic association estimates from large genome‐wide association studies and UK Biobank, we performed a 2‐sample Mendelian randomization analysis to estimate the associations of insomnia with 14 CVD conditions in the primary analysis. Then mediation analysis was conducted to explore the potential mediator role of 17 cardiometabolic risk factors using a network Mendelian randomization design. After correcting for multiple testing, genetically predicted insomnia was consistent significantly positively associated with 9 of 14 CVDs, those odds ratios ranged from 1.13 (95% CI, 1.08–1.18) for atrial fibrillation to 1.24 (95% CI, 1.16–1.32) for heart failure. Moreover, genetically predicted insomnia was consistently associated with higher body mass index, triglycerides, and lower high‐density lipoprotein cholesterol, each of which may act as a mediator in the causal pathway from insomnia to several CVD outcomes. Additionally, we found very little evidence to support a causal link between insomnia with abdominal aortic aneurysm, thoracic aortic aneurysm, total cholesterol, low‐density lipoprotein cholesterol, glycemic traits, renal function, and heart rate increase during exercise. Finally, we found no evidence of causal associations of genetically predicted body mass index, high‐density lipoprotein cholesterol, or triglycerides on insomnia. Conclusions This study provides evidence that insomnia is associated with 9 of 14 CVD outcomes, some of which may be partially mediated by 1 or more of higher body mass index, triglycerides, and lower high‐density lipoprotein cholesterol.

ACS Style

Xinhui Liu; Chuanbao Li; Xiaoru Sun; Yuanyuan Yu; Shucheng Si; Lei Hou; Ran Yan; Yifan Yu; Mingzhuo Li; Hongkai Li; Fuzhong Xue. Genetically Predicted Insomnia in Relation to 14 Cardiovascular Conditions and 17 Cardiometabolic Risk Factors: A Mendelian Randomization Study. Journal of the American Heart Association 2021, 10, e020187 .

AMA Style

Xinhui Liu, Chuanbao Li, Xiaoru Sun, Yuanyuan Yu, Shucheng Si, Lei Hou, Ran Yan, Yifan Yu, Mingzhuo Li, Hongkai Li, Fuzhong Xue. Genetically Predicted Insomnia in Relation to 14 Cardiovascular Conditions and 17 Cardiometabolic Risk Factors: A Mendelian Randomization Study. Journal of the American Heart Association. 2021; 10 (15):e020187.

Chicago/Turabian Style

Xinhui Liu; Chuanbao Li; Xiaoru Sun; Yuanyuan Yu; Shucheng Si; Lei Hou; Ran Yan; Yifan Yu; Mingzhuo Li; Hongkai Li; Fuzhong Xue. 2021. "Genetically Predicted Insomnia in Relation to 14 Cardiovascular Conditions and 17 Cardiometabolic Risk Factors: A Mendelian Randomization Study." Journal of the American Heart Association 10, no. 15: e020187.

Original research article
Published: 27 July 2021 in Frontiers in Immunology
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Background C-reactive protein (CRP) has been used as a biomarker of chronic low-grade inflammation in observational studies. We aimed to determine whether genetically determined CRP was associated with hundreds of human phenotypes to guide anti-inflammatory interventions. Methods We used individual data from the UK Biobank to perform a phenome-wide two-stage least squares (2SLS) Mendelian randomization (MR) analysis for CRP with 879 diseases. Summary-level data from the FinnGen consortium were utilized to perform phenome-wide two-sample MR analysis on 821 phenotypes. Systematic two-sample MR methods included MR-IVW, MR-WME, MR-Mod, and MR-PRESSO as sensitivity analyses combined with multivariable MR to identify robust associations. Genetic correlation analysis was applied to identify shared genetic risks. Results We found genetically determined CRP was robustly associated with 15 diseases in the UK Biobank and 11 diseases in the FinnGen population (P < 0.05 for all MR analyses). CRP was positively associated with tongue cancer, bronchitis, hydronephrosis, and acute pancreatitis and negatively associated with colorectal cancer, colon cancer, cerebral ischemia, electrolyte imbalance, Parkinson’s disease, epilepsy, anemia of chronic disease, encephalitis, psychophysical visual disturbances, and aseptic necrosis of bone in the UK Biobank. There were positive associations with impetigo, vascular dementia, bipolar disorders, hypercholesterolemia, vertigo, and neurological diseases, and negative correlations with degenerative macular diseases, metatarsalgia, interstitial lung disease, and idiopathic pulmonary fibrosis, and others. in the FinnGen population. The electrolyte imbalance and anemia of chronic disease in UK Biobank and hypercholesterolemia and neurological diseases in FinnGen pass the FDR corrections. Neurological diseases and bipolar disorders also presented positive genetic correlations with CRP. We found no overlapping causal associations between the populations. Previous causal evidence also failed to support these associations (except for bipolar disorders). Conclusions Genetically determined CRP was robustly associated with several diseases in the UK Biobank and the FinnGen population, but could not be replicated, suggesting heterogeneous and non-repeatable effects of CRP across populations. This implies that interventions at CRP are unlikely to result in decreased risk for most human diseases in the general population but may benefit specific high-risk populations. The limited causal evidence and potential double-sided effects remind us to be cautious about CRP interventions.

ACS Style

Shucheng Si; Jiqing Li; Marlvin Anemey Tewara; Fuzhong Xue. Genetically Determined Chronic Low-Grade Inflammation and Hundreds of Health Outcomes in the UK Biobank and the FinnGen Population: A Phenome-Wide Mendelian Randomization Study. Frontiers in Immunology 2021, 12, 1 .

AMA Style

Shucheng Si, Jiqing Li, Marlvin Anemey Tewara, Fuzhong Xue. Genetically Determined Chronic Low-Grade Inflammation and Hundreds of Health Outcomes in the UK Biobank and the FinnGen Population: A Phenome-Wide Mendelian Randomization Study. Frontiers in Immunology. 2021; 12 ():1.

Chicago/Turabian Style

Shucheng Si; Jiqing Li; Marlvin Anemey Tewara; Fuzhong Xue. 2021. "Genetically Determined Chronic Low-Grade Inflammation and Hundreds of Health Outcomes in the UK Biobank and the FinnGen Population: A Phenome-Wide Mendelian Randomization Study." Frontiers in Immunology 12, no. : 1.

Journal article
Published: 25 June 2021 in International Journal of Cardiology
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Background Although observational studies have shown an association between sex hormone-binding globulin (SHBG), testosterone (T) and cardiovascular diseases (CVD), controversy remains. In this study, we aim to explore the causal effects of SHBG and T on Coronary heart disease (CHD). Methods We used univariable, network and multivariable mendelian randomization (MR) analysis to investigate the causal effect of SHBG and T on CHD. We performed inverse variance weighted (IVW) MR as the primary analysis, with the robustness of this approach further tested by other methods in sensitivity analysis. The SHBG and T were collected from the UK Biobank data, about 180,000 men aged 40 to 69 years. CHD was collected from CARDIoGRAMplusC4D 1000 Genomes-based GWAS, which was a meta-analysis including 48 studies and involving 60,801 CHD cases and 123,504 controls. Results Using univariable MR-IVW, the results suggested that a one standard deviation (SD) increase in SHBG, the risk of CHD decreased by approximately 14% (OR (95% CI): 0.86(0.76,0.97)), and that a SD increase in total testosterone (TT), the risk also decreased, approximately 8% (OR (95% CI): 0.92(0.85,0.99)). Multivariable MR showed that both SHBG and TT had no direct causal effect with CHD (a SD increase in SHBG: OR (95% CI):0.75(0.57,1.00), P = 0.053; a SD increase in TT: OR (95% CI): 1.05(0.90,1.22), P = 0.53). In the network MR analysis, the results suggested that TT might act as mediator in the causal pathway from SHBG to CHD and account for 93% of the total effect of SHBG on CHD, and that SHBG might be a mediator in the causal pathway from TT to CHD and account for 67% of the total effect of TT on CHD. Conclusions Genetically predicted SHBG and TT were negatively correlated with CHD in both univariable and network MR, which may provide a causal explanation behind the observed conclusion. In addition, TT and SHBG had a bidirectional causal effect. Further work is required to disentangle the downstream effects of SHBG/TT on CHD and the molecular pathways involved, as the simultaneous regulation of SHBG and TT may make it a viable strategy for the prevention or treatment of CHD.

ACS Style

Yunxia Li; Shucheng Si; Lei Hou; Tonghui Yuan; Xiaolu Chen; Congcong Liu; Wenchao Li; Hongkai Li; Yanxun Liu; Fuzhong Xue. Causal effect of sex hormone-binding globulin and testosterone on coronary heart disease: A multivariable and network Mendelian randomization analysis. International Journal of Cardiology 2021, 1 .

AMA Style

Yunxia Li, Shucheng Si, Lei Hou, Tonghui Yuan, Xiaolu Chen, Congcong Liu, Wenchao Li, Hongkai Li, Yanxun Liu, Fuzhong Xue. Causal effect of sex hormone-binding globulin and testosterone on coronary heart disease: A multivariable and network Mendelian randomization analysis. International Journal of Cardiology. 2021; ():1.

Chicago/Turabian Style

Yunxia Li; Shucheng Si; Lei Hou; Tonghui Yuan; Xiaolu Chen; Congcong Liu; Wenchao Li; Hongkai Li; Yanxun Liu; Fuzhong Xue. 2021. "Causal effect of sex hormone-binding globulin and testosterone on coronary heart disease: A multivariable and network Mendelian randomization analysis." International Journal of Cardiology , no. : 1.

Original research
Published: 24 May 2021 in Brain and Behavior
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Purpose Although homocysteine (Hcy) has been proven to be associated with the incidence of white matter hyperintensities (WMH) in patients with stroke, this association remains unclear in participants with asymptomatic intracranial arterial stenosis (aICAS). This study aimed to investigate the association of Hcy with WMH in participants with aICAS. Materials and methods This was a cross-sectional study based on the Kongcun Town Study. Participants diagnosed with aICAS by magnetic resonance angiography in the Kongcun Town Study were enrolled in this study. Data on demographics, lifestyle, medical histories, and Hcy levels were collected via interviews, clinical examinations, and laboratory tests. The volume of WMH was calculated using the lesion segmentation tool system for the Statistical Parametric Mapping package based on magnetic resonance imaging. The association between Hcy and WMH volume was analyzed using linear and logistic regression analyses. Results A total of 137 aICAS participants were enrolled in the present study. Hcy was associated with the incidence of severe WMH (4th quartile, ≥4.20 ml) after adjustment for certain covariates [Hcy as a continuous variable, odds ratio (95% confidence interval) (OR (95% CI)): 1.09 (1.00, 1.19), p = .047; as a categorical variable (Hcy ≥15 μmol/L), OR (95% CI): 3.74 (1.37, 10.19), p = .010)]. After stratification according to the degree of aICAS, this relationship remained significant only in the moderate-to-severe stenosis group (stenosis ≥50%). (Hcy as continuous variable, OR (95% CI): 1.14 (1.02, 1.27), p = .025; as a categorical variable (Hcy ≥15 μmol/L), OR (95% CI): 5.59 (1.40, 15.25), p = .015). Conclusion Serum Hcy concentration may be positively associated with the volume of WMH in rural-dwelling Chinese people with moderate-to-severe (stenosis ≥50%) aICAS.

ACS Style

Xiang Wang; Hao Yin; Xiaokang Ji; ShaoWei Sang; Sai Shao; Guangbin Wang; Ming Lv; Fuzhong Xue; Yifeng Du; Qinjian Sun. Association between homocysteine and white matter hyperintensities in rural‐dwelling Chinese people with asymptomatic intracranial arterial stenosis: A population‐based study. Brain and Behavior 2021, 11, e02205 .

AMA Style

Xiang Wang, Hao Yin, Xiaokang Ji, ShaoWei Sang, Sai Shao, Guangbin Wang, Ming Lv, Fuzhong Xue, Yifeng Du, Qinjian Sun. Association between homocysteine and white matter hyperintensities in rural‐dwelling Chinese people with asymptomatic intracranial arterial stenosis: A population‐based study. Brain and Behavior. 2021; 11 (7):e02205.

Chicago/Turabian Style

Xiang Wang; Hao Yin; Xiaokang Ji; ShaoWei Sang; Sai Shao; Guangbin Wang; Ming Lv; Fuzhong Xue; Yifeng Du; Qinjian Sun. 2021. "Association between homocysteine and white matter hyperintensities in rural‐dwelling Chinese people with asymptomatic intracranial arterial stenosis: A population‐based study." Brain and Behavior 11, no. 7: e02205.

Preprint content
Published: 20 April 2021
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Background Our objective is to investigate whether obtaining a higher level of education was causally associated with lower breast cancer risk and to identify the causal mechanism linking them. Methods Firstly, we performed a meta-analysis for educational attainment on breast cancer using 33 MR studies, including 15 case-control studies, 10 cross-sectional studies, and 8 cohort studies. Secondly, the main data analysis used publicly available summary-level data from two large GWAS consortia (Breast Cancer Association Consortium [BCAC] and the Social Science Genetic Association Consortium [SSGAC]). Mendelian randomization (MR) analysis used 65 genetic variants derived from the SSGAC as instrumental variables for years of schooling. The outcomes were the overall breast cancer risk (122,977 cases/105,974 controls in women) and its two subtypes: estrogen receptor (ER)-positive breast cancer (ER+: 69,501 cases) and ER-negative breast cancer (ER-: 21,468 cases). Furthermore, six additional consortia were analyzed to investigate the causal pathways from education to breast cancer. The fixed and random effects inverse variance weighted methods were used to estimate the causal effects, along with other additional MR methods as sensitivity analyses. Results The results showed that each additional standard deviation of 4.2 years of education was causally associated with a 27% lower risk of ER- (OR 0.73, 95% CI [0.64, 0.84]; P-value < 0.001). However, very weak causal relationship was found with overall breast cancer and no causal association with ER + risk, consistent with the sensitivity analyses. A genetic predisposition for higher education was causally associated with lower ER- risk and was found to be partially related to hip circumference, body mass index, triglyceride and HDL levels, smoking, and physical activity. Conclusion A low level of education is a causal risk factor in the development of ER- as it is associated with a poor lipid profile, anthropometric measurements, smoking, and types of physical activity.

ACS Style

Hongkai Li; Lei Hou; Yuanyuan Yu; Xiaoru Sun; Xinhui Liu; Ran Yan; Yifan Yu; Sijia Wu; Yina He; Yutong Wu; Li He; Fuzhong Xue. Lipids, Anthropometric Measures, Smoking and Physical Activity Mediate the Causal Pathway from Education to Breast Cancer in Women: A Mendelian Randomization Study. 2021, 1 .

AMA Style

Hongkai Li, Lei Hou, Yuanyuan Yu, Xiaoru Sun, Xinhui Liu, Ran Yan, Yifan Yu, Sijia Wu, Yina He, Yutong Wu, Li He, Fuzhong Xue. Lipids, Anthropometric Measures, Smoking and Physical Activity Mediate the Causal Pathway from Education to Breast Cancer in Women: A Mendelian Randomization Study. . 2021; ():1.

Chicago/Turabian Style

Hongkai Li; Lei Hou; Yuanyuan Yu; Xiaoru Sun; Xinhui Liu; Ran Yan; Yifan Yu; Sijia Wu; Yina He; Yutong Wu; Li He; Fuzhong Xue. 2021. "Lipids, Anthropometric Measures, Smoking and Physical Activity Mediate the Causal Pathway from Education to Breast Cancer in Women: A Mendelian Randomization Study." , no. : 1.

Journal article
Published: 02 February 2021 in Journal of Affective Disorders
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Although the 2000s observed enormous changes in China, little is known about the variation in the prevalence of mental disorders. The study compared the prevalence in a Chinese population between 2004 and 2015. Multistage stratified random sampling methods were used to identify primary sampling sites for cross-sectional surveys in 2004 and 2015 in Shandong, China. In 2004 and 2015, 22,718 and 28,194 adults, respectively, completed an expanded version of the General Health Questionnaire, then 5,402 and 9,420 adults, respectively, were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV axis I disorders. The adjusted 1-month prevalence of any mental disorders was 18•7% (95% CI: 16•7-20•8) and 17•1% (95% CI:15•9-18•4) in 2004 and 2015, respectively. However, the prevalence of major depressive disorders increased from 1•5% (95% CI: 1•2 -1•8) in 2004 to 2•3% (95% CI: 1•9-2•8) in 2015; meanwhile the prevalence of alcohol abuse disorders were becoming more common among men and urban residents. Although mood and anxiety disorders were more prevalent in women, a much more prevalent alcohol abuse disorders for men contributed to a higher overall prevalence among men than among women. Compared to that in urban residents, the overall prevalence in rural residents declined more, and it was lower in 2015 than in 2004. The results may not apply to the population from other regions. Despite of the stable overall prevalence, mental disorders beyond psychotic disorders should be focused on, especially alcohol abuse and major depressive disorders.

ACS Style

Jingxuan Zhang; Ruzhan Wang; Can Wang; Yanhu Wang; Xiuzhe Chen; Guolin Mi; Xu Chen; Xiaojing Cheng; Lina Wang; Xinying Wu; Fuzhong Xue; Qing Wang. Prevalence of mental disorders in 21st century Shandong Province, China: A ten-year comparative study. Journal of Affective Disorders 2021, 283, 344 -353.

AMA Style

Jingxuan Zhang, Ruzhan Wang, Can Wang, Yanhu Wang, Xiuzhe Chen, Guolin Mi, Xu Chen, Xiaojing Cheng, Lina Wang, Xinying Wu, Fuzhong Xue, Qing Wang. Prevalence of mental disorders in 21st century Shandong Province, China: A ten-year comparative study. Journal of Affective Disorders. 2021; 283 ():344-353.

Chicago/Turabian Style

Jingxuan Zhang; Ruzhan Wang; Can Wang; Yanhu Wang; Xiuzhe Chen; Guolin Mi; Xu Chen; Xiaojing Cheng; Lina Wang; Xinying Wu; Fuzhong Xue; Qing Wang. 2021. "Prevalence of mental disorders in 21st century Shandong Province, China: A ten-year comparative study." Journal of Affective Disorders 283, no. : 344-353.

Journal article
Published: 11 January 2021 in Atherosclerosis
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Background and aims Few studies estimated the impact of antihypertensive adherence on cardiovascular diseases (CVD) in a longitudinal cohort with presence of time-dependent confounders. This study aims to assess the association between antihypertensive adherence and CVD using marginal structural Cox model (MSM-Cox) and to characterize blood pressure (BP) trajectories of patients with different adherence. Methods This longitudinal study included 16,896 hypertensive patients receiving antihypertensive medication. The median follow-up time was 3.5 years (25th to 75th, 1.75–4.75 years). BP and medication adherence were measured four times every year. We used MSM-Cox and Cox model to assess association between antihypertensive adherence and CVD events. The linear mixed-effects model was used to characterize BP trajectories of patients with different adherence, and the area under curves (AUC) was calculated as BP burden. Results We documented 4735 CVD events, crude incidence of CVD was 80.8 (95% CI, 78.1–83.4) and 112.6 (95% CI, 107.2–118.0) per 1000 person-years for baseline high-adherence and low-adherence, respectively. Compared with high adherence, the adjusted hazard ratio (HR) for association between low adherence with CVD was 1.75 (95%CI, 1.62–1.89) and 1.34 (95%CI, 1.26–1.42) based on the MSM-Cox and the Cox model, respectively. The BP burden and fluctuation range of BP trajectory in low-adherence patients were larger than those of high-adherence patients. Patients with high adherence got 28% greater reduction of BP burden than low-adherence patients. Conclusions Antihypertensive adherence was more strongly associated with the risk of CVD than conventional regression analyses based on a single adherence measurement.

ACS Style

Jiqing Li; Zhentang Zhang; Shucheng Si; Bojie Wang; Fuzhong Xue. Antihypertensive medication adherence and cardiovascular disease risk: A longitudinal cohort study. Atherosclerosis 2021, 320, 24 -30.

AMA Style

Jiqing Li, Zhentang Zhang, Shucheng Si, Bojie Wang, Fuzhong Xue. Antihypertensive medication adherence and cardiovascular disease risk: A longitudinal cohort study. Atherosclerosis. 2021; 320 ():24-30.

Chicago/Turabian Style

Jiqing Li; Zhentang Zhang; Shucheng Si; Bojie Wang; Fuzhong Xue. 2021. "Antihypertensive medication adherence and cardiovascular disease risk: A longitudinal cohort study." Atherosclerosis 320, no. : 24-30.

Imaging informatics and artificial intelligence
Published: 06 January 2021 in European Radiology
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The aim of this study was to develop and validate a radiomics signature for predicting survival and chemotherapeutic benefits of patients with lower-grade gliomas (LGG). Radiomics features were extracted from precontrast axial fluid-attenuated inversion recovery (FLAIR) and contrast-enhanced axial T-1 weighted (CE-T1-w) sequence. Lasso Cox regression model was used for feature selection and radiomics signature building. The radiomics signature was developed in a primary cohort that consisted of 149 LGG patients and was then validated on an entirely new validation cohort that contained 66 LGG patients. A radiomics nomogram for the prediction of OS was established by adding the radiomics to clinicopathologic nomogram which developed with clinical data. A radiomics signature derived from joint CE-T1-w and FLAIR images showed better prognostic performance (C-index, 0.798) than signatures derived from CE-T1-w (C-index, 0.744) or FLAIR (C-index, 0.736) sequences alone. Multivariable Cox regression revealed that the radiomics signature was an independent prognostic factor. One radiomics nomogram integrated the radiomics signature from joint CE-T1-w and FLAIR sequences with the clinicopathologic nomogram outperformed the clinicopathologic nomogram based on clinicopathologic data alone in predicting OS of LGG (C-index, 0.821 vs. 0.692; p < 0.001). Further analysis revealed that patients with higher radiomics signature were prone to benefit from chemotherapy. The radiomics signature was independent with clinicopathologic data and was a noninvasive pretreatment predictor for LGG patients’ survival. Moreover, it could predict which patients with LGG benefit from chemotherapy. • A radiomics signature derived from joint CE-T1-w and FLAIR sequences showed better prognostic performance than signatures derived from either single imaging modality. • The radiomics signature is an independent prognostic factor and outperformed clinicopathologic features in predicting overall survival of LGG patients. • The radiomics signature could help preoperatively identify LGG patients who may benefit from chemotherapy.

ACS Style

Jingtao Wang; Xuejun Zheng; Jinling Zhang; Hao Xue; Lijie Wang; Rui Jing; Shuo Chen; Fengyuan Che; Xueyuan Heng; Gang Li; Fuzhong Xue. An MRI-based radiomics signature as a pretreatment noninvasive predictor of overall survival and chemotherapeutic benefits in lower-grade gliomas. European Radiology 2021, 31, 1785 -1794.

AMA Style

Jingtao Wang, Xuejun Zheng, Jinling Zhang, Hao Xue, Lijie Wang, Rui Jing, Shuo Chen, Fengyuan Che, Xueyuan Heng, Gang Li, Fuzhong Xue. An MRI-based radiomics signature as a pretreatment noninvasive predictor of overall survival and chemotherapeutic benefits in lower-grade gliomas. European Radiology. 2021; 31 (4):1785-1794.

Chicago/Turabian Style

Jingtao Wang; Xuejun Zheng; Jinling Zhang; Hao Xue; Lijie Wang; Rui Jing; Shuo Chen; Fengyuan Che; Xueyuan Heng; Gang Li; Fuzhong Xue. 2021. "An MRI-based radiomics signature as a pretreatment noninvasive predictor of overall survival and chemotherapeutic benefits in lower-grade gliomas." European Radiology 31, no. 4: 1785-1794.

Original article
Published: 03 January 2021 in International Journal of Earth Sciences
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Type 2 diabetes (T2D) is affected by a combination of genetic and environmental factors. However, the comprehensive genomic risk scores (GRSs) for T2D prediction have not been evaluated. Using a meta-scoring approach, we developed a metaGRS for T2D; T2D-related traits consist of 1,692 genetic variants in the UK Biobank training set (n = 40,423 + 7,558 events) and evaluate this score in the validation set (n = 303,053). The hazard ratio (HR) for T2D was 1.32 (95% confidence interval [CI]: 1.29–1.35) per standard deviation of metaGRS and was larger than previously published T2D-GRS. Individuals, in the top 25% of metaGRS, have an HR of 2.08 (95%CI: 1.93–2.23) compared with those in the bottom 25%. The addition of metaGRS to all conventional risk factors significantly increased the AUC (P < 0.001). Adding metaGRS to all conventional risk factors significantly improved the reclassification accuracy (continuous net reclassification improvement = 11.8%, 95%CI: 9.2%–14.2%). All analyses adjusted for age, sex, and 10PCs. The metaGRS significantly improves T2D prediction ability.

ACS Style

Xiaolu Chen; Congcong Liu; Shucheng Si; Yunxia Li; Wenchao Li; Tonghui Yuan; Fuzhong Xue. Genomic risk score provides predictive performance for type 2 diabetes in the UK biobank. International Journal of Earth Sciences 2021, 58, 467 -474.

AMA Style

Xiaolu Chen, Congcong Liu, Shucheng Si, Yunxia Li, Wenchao Li, Tonghui Yuan, Fuzhong Xue. Genomic risk score provides predictive performance for type 2 diabetes in the UK biobank. International Journal of Earth Sciences. 2021; 58 (4):467-474.

Chicago/Turabian Style

Xiaolu Chen; Congcong Liu; Shucheng Si; Yunxia Li; Wenchao Li; Tonghui Yuan; Fuzhong Xue. 2021. "Genomic risk score provides predictive performance for type 2 diabetes in the UK biobank." International Journal of Earth Sciences 58, no. 4: 467-474.

Journal article
Published: 01 January 2021 in Journal of Epidemiology
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Background Causal evidence of circulating lipids especially the remnant cholesterol with cardiovascular and cerebrovascular disease (CVD) is lacking. This research aimed to explore the causal roles of extensive lipid traits especially the remnant lipids in CVD. Methods Two-sample Mendelian randomization (TSMR) analysis was performed based on large-scale meta-analysis datasets in European ancestry. The causal effect of 15 circulating lipid profiles including 6 conventional lipids and 9 remnant lipids on coronary heart disease (CHD) and ischemic stroke (IS), as well as the subtypes, was assessed. Results Apo B, TC, LDL-C, and TG were still important risk factors for CHD and MI but not for IS. Apo B is the strongest which increased the CHD and MI risk by 44% and 41%, respectively. The OR(95%CI) of total TG on CHD and MI were 1.25(1.13 to 1.38) and 1.24(1.11 to 1.38), respectively. 1-SD increased M.VLDL.TG, S.VLDL.TG, XS.VLDL.TG, IDL.TG, XL.HDL.TG, and S.HDL.TG particles also robustly increased the risk of CHD and MI by 9%-28% and 9%-27%, respectively. TG in very/extremely large VLDL (XXL.VLDL.TG and XL.VLDL.TG) were insignificant or even negatively associated with CHD (in multivariable MR), and negatively associated with IS as well. Conclusions The remnant lipids presented heterogeneity and two-sided effects for the risk of CHD and IS that may partially rely on the particle size. The findings suggested that the remnant lipids were required to be intervened according to specific components. This research confirms the importance of remnant lipids and provides causal evidence for potential targets for intervention.

ACS Style

Shucheng Si; Lei Hou; Xiaolu Chen; Wenchao Li; Xinhui Liu; Congcong Liu; Yunxia Li; Tonghui Yuan; Jiqing Li; Bojie Wang; Hongkai Li; Fuzhong Xue. Exploring the causal roles of circulating remnant lipid profile on cardiovascular and cerebrovascular diseases: Mendelian randomization study. Journal of Epidemiology 2021, JE20200305 .

AMA Style

Shucheng Si, Lei Hou, Xiaolu Chen, Wenchao Li, Xinhui Liu, Congcong Liu, Yunxia Li, Tonghui Yuan, Jiqing Li, Bojie Wang, Hongkai Li, Fuzhong Xue. Exploring the causal roles of circulating remnant lipid profile on cardiovascular and cerebrovascular diseases: Mendelian randomization study. Journal of Epidemiology. 2021; ():JE20200305.

Chicago/Turabian Style

Shucheng Si; Lei Hou; Xiaolu Chen; Wenchao Li; Xinhui Liu; Congcong Liu; Yunxia Li; Tonghui Yuan; Jiqing Li; Bojie Wang; Hongkai Li; Fuzhong Xue. 2021. "Exploring the causal roles of circulating remnant lipid profile on cardiovascular and cerebrovascular diseases: Mendelian randomization study." Journal of Epidemiology , no. : JE20200305.

Journal article
Published: 07 December 2020 in Atherosclerosis
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Background and aims Some studies reported that mildly elevated serum bilirubin levels were associated with decreased risk of cardiovascular disease (CVD) and diabetes. Whether these are causal relationships remains unclear. This study aims to examine the causal effects of bilirubin on CVD, diabetes and their subtypes. Methods The data we used in this study includes individual data from the UK Biobank cohort with 331,002 white British participants, and summary data from published genome wide associations studies (GWAS) findings. We used individual data to perform logistic regression for the observational study and two-stage least squares method for the Mendelian randomization (MR) study. We also performed several traditional MR methods and MR-TRYX by summary data. Results The observational study supported the association relationships between bilirubin and CVD and diabetes and their subtypes. Results of MR showed strong evidence for negative causal associations of loge total bilirubin with CVD [OR 0.92, 95%CI 0.88-0.95, p-value 2.15×10-6], coronary heart disease [OR 0.90, 95%CI 0.85-0.96, p -value 1.54×10-3] and hypertensive diseases [OR 0.91, 95%CI 0.88-0.95, p -value 5.89×10-6] but no evidence for diabetes [OR 0.94, 95%CI 0.86-1.02, p -value 0.14] and its subtypes. We also obtained similar results for direct bilirubin. We found that blood pressure, cholesterol, C-reactive protein, alcohol and white blood cell count played important roles in the causal pathway from bilirubin to CVD. Two sample MR and sensitivity analyses showed consistent results with one sample MR. Conclusions Genetically determined bilirubin was negatively associated with the risk of CVD but had no evident causal association with diabetes in the UK Biobank cohort of white British.

ACS Style

Lei Hou; Hongkai Li; Shucheng Si; Yuanyuan Yu; Xiaoru Sun; Xinhui Liu; Ran Yan; Yifan Yu; Chuan Wang; Fan Yang; Qing Wang; Fuzhong Xue. Exploring the causal pathway from bilirubin to CVD and diabetes in the UK biobank cohort study: Observational findings and Mendelian randomization studies. Atherosclerosis 2020, 320, 112 -121.

AMA Style

Lei Hou, Hongkai Li, Shucheng Si, Yuanyuan Yu, Xiaoru Sun, Xinhui Liu, Ran Yan, Yifan Yu, Chuan Wang, Fan Yang, Qing Wang, Fuzhong Xue. Exploring the causal pathway from bilirubin to CVD and diabetes in the UK biobank cohort study: Observational findings and Mendelian randomization studies. Atherosclerosis. 2020; 320 ():112-121.

Chicago/Turabian Style

Lei Hou; Hongkai Li; Shucheng Si; Yuanyuan Yu; Xiaoru Sun; Xinhui Liu; Ran Yan; Yifan Yu; Chuan Wang; Fan Yang; Qing Wang; Fuzhong Xue. 2020. "Exploring the causal pathway from bilirubin to CVD and diabetes in the UK biobank cohort study: Observational findings and Mendelian randomization studies." Atherosclerosis 320, no. : 112-121.

Research
Published: 30 September 2020 in Health Information Science and Systems
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With the rapid global spread of the COVID-19 pandemic, researchers have contributed several important advances. The WHO and countries with severe outbreaks have developed diagnosis and treatment guidelines. Here, we analyze the current transformation and application of scientific research to global epidemic prevention and control. We described and analyzed current COVID-19 research from the perspectives of international cooperation, interdisciplinary cooperation, and research hotspots using a bibliometric clustering algorithm. Using the diagnosis and treatment guidelines of the WHO and the United States and China as examples, we evaluate the transformation of scientific results from basic research to applications. Scientific research results that have not yet been incorporated into these guidelines are summarized to encourage updates and improvements by applying scientific research to prevention and control. COVID-19 has fostered interdisciplinary cooperative research, and the current results are mainly focused on the origin, epidemiological characteristics, clinical research, and diagnosis and treatment methods for the virus. Due to the ongoing publication of new research, diagnosis and treatment guidelines are constantly improving. However, some research gaps still exist, and some results have not yet been incorporated into the guidelines. The current research is still in the preliminary exploratory stage, and some problems, such as weak international cooperation, unbalanced interdisciplinary cooperation, and the lack of coordination between research and applications, exist. Therefore, countries around the world must improve the International Public Health Emergency Management System and prepare for major public health emergencies in the future.

ACS Style

Fan Yang; Shuaijie Zhang; Qing Wang; Qi Zhang; Junming Han; Lijie Wang; Xinying Wu; Fuzhong Xue. Analysis of the global situation of COVID-19 research based on bibliometrics. Health Information Science and Systems 2020, 8, 1 -10.

AMA Style

Fan Yang, Shuaijie Zhang, Qing Wang, Qi Zhang, Junming Han, Lijie Wang, Xinying Wu, Fuzhong Xue. Analysis of the global situation of COVID-19 research based on bibliometrics. Health Information Science and Systems. 2020; 8 (1):1-10.

Chicago/Turabian Style

Fan Yang; Shuaijie Zhang; Qing Wang; Qi Zhang; Junming Han; Lijie Wang; Xinying Wu; Fuzhong Xue. 2020. "Analysis of the global situation of COVID-19 research based on bibliometrics." Health Information Science and Systems 8, no. 1: 1-10.

Journal article
Published: 26 August 2020 in International Journal of Hygiene and Environmental Health
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The ongoing pandemic of 2019 novel coronavirus disease (COVID-19) is challenging global public health response system. We aim to identify the risk factors for the transmission of COVID-19 using data on mainland China. We estimated attack rate (AR) at county level. Logistic regression was used to explore the role of transportation in the nationwide spread. Generalized additive model and stratified linear mixed-effects model were developed to identify the effects of multiple meteorological factors on local transmission. The ARs in affected counties ranged from 0.6 to 9750.4 per million persons, with a median of 8.8. The counties being intersected by railways, freeways, national highways or having airports had significantly higher risk for COVID-19 with adjusted odds ratios (ORs) of 1.40 (p = 0.001), 2.07 (p < 0.001), 1.31 (p = 0.04), and 1.70 (p < 0.001), respectively. The higher AR of COVID-19 was significantly associated with lower average temperature, moderate cumulative precipitation and higher wind speed. Significant pairwise interactions were found among above three meteorological factors with higher risk of COVID-19 under low temperature and moderate precipitation. Warm areas can also be in higher risk of the disease with the increasing wind speed. In conclusion, transportation and meteorological factors may play important roles in the transmission of COVID-19 in mainland China, and could be integrated in consideration by public health alarm systems to better prevent the disease.

ACS Style

Jia-Te Wei; Yun-Xia Liu; Yu-Chen Zhu; Jie Qian; Run-Ze Ye; Chun-Yu Li; Xiao-Kang Ji; Hong-Kai Li; Chang Qi; Ying Wang; Fan Yang; Yu-Hao Zhou; Ran Yan; Xiao-Ming Cui; Yuan-Li Liu; Na Jia; Shi-Xue Li; Xiu-Jun Li; Fu-Zhong Xue; Lin Zhao; Wu-Chun Cao. Impacts of transportation and meteorological factors on the transmission of COVID-19. International Journal of Hygiene and Environmental Health 2020, 230, 113610 -113610.

AMA Style

Jia-Te Wei, Yun-Xia Liu, Yu-Chen Zhu, Jie Qian, Run-Ze Ye, Chun-Yu Li, Xiao-Kang Ji, Hong-Kai Li, Chang Qi, Ying Wang, Fan Yang, Yu-Hao Zhou, Ran Yan, Xiao-Ming Cui, Yuan-Li Liu, Na Jia, Shi-Xue Li, Xiu-Jun Li, Fu-Zhong Xue, Lin Zhao, Wu-Chun Cao. Impacts of transportation and meteorological factors on the transmission of COVID-19. International Journal of Hygiene and Environmental Health. 2020; 230 ():113610-113610.

Chicago/Turabian Style

Jia-Te Wei; Yun-Xia Liu; Yu-Chen Zhu; Jie Qian; Run-Ze Ye; Chun-Yu Li; Xiao-Kang Ji; Hong-Kai Li; Chang Qi; Ying Wang; Fan Yang; Yu-Hao Zhou; Ran Yan; Xiao-Ming Cui; Yuan-Li Liu; Na Jia; Shi-Xue Li; Xiu-Jun Li; Fu-Zhong Xue; Lin Zhao; Wu-Chun Cao. 2020. "Impacts of transportation and meteorological factors on the transmission of COVID-19." International Journal of Hygiene and Environmental Health 230, no. : 113610-113610.

Methodology article
Published: 08 August 2020 in BMC Genetics
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Background Biological pathways play an important role in the occurrence, development and recovery of complex diseases, such as cancers, which are multifactorial complex diseases that are generally caused by mutation of multiple genes or dysregulation of pathways. Results We propose a path-specific effect statistic (PSE) to detect the differential specific paths under two conditions (e.g. case VS. control groups, exposure Vs. nonexposure groups). In observational studies, the path-specific effect can be obtained by separately calculating the average causal effect of each directed edge through adjusting for the parent nodes of nodes in the specific path and multiplying them under each condition. Theoretical proofs and a series of simulations are conducted to validate the path-specific effect statistic. Applications are also performed to evaluate its practical performances. A series of simulation studies show that the Type I error rates of PSE with Permutation tests are more stable at the nominal level 0.05 and can accurately detect the differential specific paths when comparing with other methods. Specifically, the power reveals an increasing trends with the enlargement of path-specific effects and its effect differences under two conditions. Besides, the power of PSE is robust to the variation of parent or child node of the nodes on specific paths. Application to real data of Glioblastoma Multiforme (GBM), we successfully identified 14 positive specific pathways in mTOR pathway contributing to survival time of patients with GBM. All codes for automatic searching specific paths linking two continuous variables and adjusting set as well as PSE statistic can be found in supplementary materials. Conclusion The proposed PSE statistic can accurately detect the differential specific pathways contributing to complex disease and thus potentially provides new insights and ways to unlock the black box of disease mechanisms.

ACS Style

Hongkai Li; Zhi Geng; Xiaoru Sun; Yuanyuan Yu; Fuzhong Xue. A novel path-specific effect statistic for identifying the differential specific paths in systems epidemiology. BMC Genetics 2020, 21, 1 -12.

AMA Style

Hongkai Li, Zhi Geng, Xiaoru Sun, Yuanyuan Yu, Fuzhong Xue. A novel path-specific effect statistic for identifying the differential specific paths in systems epidemiology. BMC Genetics. 2020; 21 (1):1-12.

Chicago/Turabian Style

Hongkai Li; Zhi Geng; Xiaoru Sun; Yuanyuan Yu; Fuzhong Xue. 2020. "A novel path-specific effect statistic for identifying the differential specific paths in systems epidemiology." BMC Genetics 21, no. 1: 1-12.

Journal article
Published: 23 July 2020 in International Journal of Environmental Research and Public Health
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Glycosylated hemoglobin (HbA1c) was the best indicator of glycemic control, which did not show the dynamic relationship between glycemic control and lipid profiles. In order to guide the health management of Type 2 diabetes (T2D), we assessed the levels of lipid profiles and fasting plasma glucose (FPG) and displayed the relationship between FPG control and lipid profiles. We conducted a cross-sectional study that included 5822 participants. Descriptive statistics were conducted according to gender and glycemic status respectively. Comparisons for the control of lipid profiles were conducted according to glycemic control. Four logistic regression models were generated to analyze the relationship between lipid profiles and glycemic control according to different confounding factors. The metabolic control percentage of FPG, triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) was 27.50%, 73.10%, 28.10%, 64.20% and 44.80% respectively. In the fourth model with the most confounding factors, the odds ratios (ORs) and 95% confidence intervals (CIs) of TG, TC, LDL-C and HDL-C were 0.989 (0.935, 1.046), 0.862 (0.823, 0.903), 0.987 (0.920, 1.060) and 2.173 (1.761, 2.683). TC and HDL-C were statistically significant, and TG and LDL-C were not statistically significant with adjustment for different confounding factors. In conclusion, FPG was significantly associated with HDL and TC and was not associated with LDL and TG. Our findings suggested that TC and HDL should be focused on in the process of T2D health management.

ACS Style

Shukang Wang; Xiaokang Ji; Zhentang Zhang; Fuzhong Xue. Relationship Between Lipid Profiles and Glycemic Control Among Patients with Type 2 Diabetes in Qingdao, China. International Journal of Environmental Research and Public Health 2020, 17, 5317 .

AMA Style

Shukang Wang, Xiaokang Ji, Zhentang Zhang, Fuzhong Xue. Relationship Between Lipid Profiles and Glycemic Control Among Patients with Type 2 Diabetes in Qingdao, China. International Journal of Environmental Research and Public Health. 2020; 17 (15):5317.

Chicago/Turabian Style

Shukang Wang; Xiaokang Ji; Zhentang Zhang; Fuzhong Xue. 2020. "Relationship Between Lipid Profiles and Glycemic Control Among Patients with Type 2 Diabetes in Qingdao, China." International Journal of Environmental Research and Public Health 17, no. 15: 5317.

Original article
Published: 22 July 2020 in Obesity
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Objective The aim of this study was to explore the causal effects and pathways from body components to extensive metabolic phenotypes. Methods Summarized data including 24 metabolic phenotypes from 10 consortiums were used to perform univariate, multivariable, and bidirectional Mendelian randomization analysis based on the network design. Results For metabolically related biomarkers, a 1‐SD increase in body fat mass (BFM) was robustly associated with increased fasting insulin, systolic blood pressure, diastolic blood pressure, and urate and decreased high‐density lipoprotein cholesterol levels. For metabolically related diseases, the odds ratios and 95% CIs of a 1‐SD increase in BFM were 1.76 (1.37 to 2.25) for type 2 diabetes mellitus (T2DM), 1.11 (1.09 to 1.13) for hypertension, 1.40 (1.25 to 1.57) for coronary artery disease, 1.41 (1.25 to 1.59) for myocardial infarction, 1.25 (1.12 to 1.40) for ischemic stroke, and 1.62 (1.02 to 2.57) for gout. The effects of body fat on diseases were mediated by extensive intermediate biomarkers, including blood pressure, lipids, glycemic traits, and urate. Regional fats had a similar effect with body fat in both absolute and relative scales, whereas fat‐free components increased only the risk of T2DM 1.73 (1.11 to 2.68) and chronic kidney disease 1.51 (1.11 to 2.06). Conclusions Several potential pathways were found and confirmed the tremendous benefits of fat‐lowering measures, including lowering of various regional fats. Future policies or interventions should focus more on the role of body fat.

ACS Style

Shucheng Si; Marlvin Anemey Tewara; Yunxia Li; Wenchao Li; Xiaolu Chen; Tonghui Yuan; Congcong Liu; Jiqing Li; Bojie Wang; Hongkai Li; Lei Hou; Qing Wang; Fuzhong Xue. Causal Pathways from Body Components and Regional Fat to Extensive Metabolic Phenotypes: A Mendelian Randomization Study. Obesity 2020, 28, 1536 -1549.

AMA Style

Shucheng Si, Marlvin Anemey Tewara, Yunxia Li, Wenchao Li, Xiaolu Chen, Tonghui Yuan, Congcong Liu, Jiqing Li, Bojie Wang, Hongkai Li, Lei Hou, Qing Wang, Fuzhong Xue. Causal Pathways from Body Components and Regional Fat to Extensive Metabolic Phenotypes: A Mendelian Randomization Study. Obesity. 2020; 28 (8):1536-1549.

Chicago/Turabian Style

Shucheng Si; Marlvin Anemey Tewara; Yunxia Li; Wenchao Li; Xiaolu Chen; Tonghui Yuan; Congcong Liu; Jiqing Li; Bojie Wang; Hongkai Li; Lei Hou; Qing Wang; Fuzhong Xue. 2020. "Causal Pathways from Body Components and Regional Fat to Extensive Metabolic Phenotypes: A Mendelian Randomization Study." Obesity 28, no. 8: 1536-1549.

Technical advance
Published: 22 July 2020 in BMC Medical Research Methodology
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Controlling unobserved confounding still remains a great challenge in observational studies, and a series of strict assumptions of the existing methods usually may be violated in practice. Therefore, it is urgent to put forward a novel method. We are interested in the causal effect of an exposure on the outcome, which is always confounded by unobserved confounding. We show that, the causal effect of an exposure on a continuous or categorical outcome is nonparametrically identified through only two independent or correlated available confounders satisfying a non-linear condition on the exposure. Asymptotic theory and variance estimators are developed for each case. We also discuss an extension for more than two binary confounders. The simulations show better estimation performance by our approach in contrast to the traditional regression approach adjusting for observed confounders. A real application is separately applied to assess the effects of Body Mass Index (BMI) on Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Fasting Blood Glucose (FBG), Triglyceride (TG), Total Cholesterol (TC), High Density Lipoprotein (HDL) and Low Density Lipoprotein (LDL) with individuals in Shandong Province, China. Our results suggest that SBP increased 1.60 (95% CI: 0.99–2.93) mmol/L with per 1- kg/m2 higher BMI and DBP increased 0.37 (95% CI: 0.03–0.76) mmol/L with per 1- kg/m2 higher BMI. Moreover, 1- kg/m2 increase in BMI was causally associated with a 1.61 (95% CI: 0.96–2.97) mmol/L increase in TC, a 1.66 (95% CI: 0.91–55.30) mmol/L increase in TG and a 2.01 (95% CI: 1.09–4.31) mmol/L increase in LDL. However, BMI was not causally associated with HDL with effect value − 0.20 (95% CI: − 1.71–1.44). And, the effect value of FBG per 1- kg/m2 higher BMI was 0.56 (95% CI: − 0.24–2.18). We propose a novel method to control unobserved confounders through double binary confounders satisfying a non-linear condition on the exposure which is easy to access.

ACS Style

Lu Liu; Lei Hou; Yuanyuan Yu; Xinhui Liu; Xiaoru Sun; Fan Yang; Qing Wang; Ming Jing; Yeping Xu; Hongkai Li; Fuzhong Xue. A novel method for controlling unobserved confounding using double confounders. BMC Medical Research Methodology 2020, 20, 1 -12.

AMA Style

Lu Liu, Lei Hou, Yuanyuan Yu, Xinhui Liu, Xiaoru Sun, Fan Yang, Qing Wang, Ming Jing, Yeping Xu, Hongkai Li, Fuzhong Xue. A novel method for controlling unobserved confounding using double confounders. BMC Medical Research Methodology. 2020; 20 (1):1-12.

Chicago/Turabian Style

Lu Liu; Lei Hou; Yuanyuan Yu; Xinhui Liu; Xiaoru Sun; Fan Yang; Qing Wang; Ming Jing; Yeping Xu; Hongkai Li; Fuzhong Xue. 2020. "A novel method for controlling unobserved confounding using double confounders." BMC Medical Research Methodology 20, no. 1: 1-12.

Journal article
Published: 11 July 2020 in Nutrition Journal
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Available data about the effects of circulating polyunsaturated fatty acids (PUFAs) on ischemic stroke (IS) and its main risk factors remains limited and conflicting. Therefore, we conducted Mendelian randomization (MR) to assess whether genetically predicted PUFA affected IS, lipids and blood pressure (BP). Genetic instruments associated with IS were derived from ISGC Consortium (n = 29,633), with lipids were derived from GLGC(n = 188,577), with BP were derived from Neale Lab(n = 337,000). The inverse-variance weighted method was the main analysis to estimate the effect of exposure on outcome. Sensitivity analyses included principal components analysis, MR-Egger, weighted median, and weighted mode. Per SD increases in serum α-linolenic acid (ALA) were associated with lower IS risk, with odd ratio (OR) of 0.867(0.782,0.961), arachidonic acid (AA) were associated with higher IS risk (OR: 1.053(1.014,1.094)). Likewise, Per SD increases in ALA were associated with the lower-level low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC) (β:-0.122(− 0.144, − 0.101), − 0.159(− 0.182, − 0.135), − 0.148(− 0.171, − 0.126), respectively), AA were associated with the higher-level of LDL-C, HDL-C and TC (β:0.045(0.034,0.056), 0.059(0.050,0.067), 0.055(0.046,0.063), respectively). Linoleic acid (LA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA) had little or no association with IS, lipids or BP at Bonferroni-corrected significance. Different analytic methods supported these findings. The intercept test of MR-Egger implied no pleiotropy. High-level plasma ALA was protective for IS but AA was the opposite. LA, EPA, DHA, and DPA had no effects on IS.

ACS Style

Tonghui Yuan; Shucheng Si; Yunxia Li; Wenchao Li; Xiaolu Chen; Congcong Liu; Jiqing Li; Bojie Wang; Lei Hou; Yanxun Liu; Fuzhong Xue. Roles for circulating polyunsaturated fatty acids in ischemic stroke and modifiable factors: a Mendelian randomization study. Nutrition Journal 2020, 19, 1 -11.

AMA Style

Tonghui Yuan, Shucheng Si, Yunxia Li, Wenchao Li, Xiaolu Chen, Congcong Liu, Jiqing Li, Bojie Wang, Lei Hou, Yanxun Liu, Fuzhong Xue. Roles for circulating polyunsaturated fatty acids in ischemic stroke and modifiable factors: a Mendelian randomization study. Nutrition Journal. 2020; 19 (1):1-11.

Chicago/Turabian Style

Tonghui Yuan; Shucheng Si; Yunxia Li; Wenchao Li; Xiaolu Chen; Congcong Liu; Jiqing Li; Bojie Wang; Lei Hou; Yanxun Liu; Fuzhong Xue. 2020. "Roles for circulating polyunsaturated fatty acids in ischemic stroke and modifiable factors: a Mendelian randomization study." Nutrition Journal 19, no. 1: 1-11.

Journal article
Published: 06 July 2020
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Prevention and control of cardiometabolic conditions and cardiovascular disease (CVD) in China may contribute to sustainable CVD reduction globally, given the fact that one-fifth of the worldwide population is in China. Knowing the distribution of behavioral risk factors (e.g., smoking and physical inactivity), especially at a national level in China, would be extremely relevant to the field of public health and CVD prevention. The objectives of this study were to investigate the nationwide prevalence of obesity, smoking, heavy drinking, and physical inactivity in Chinese adults, and further explore whether cardiometabolic conditions would modify the distribution of behavioral risk factors. This population-based study is based on the China Health and Retirement Longitudinal Study (2011-2012), including 17,302 adults (≥45 years, mean age 59.67 years, female 51.66%) from 25 provinces in China. Data on demographics, lifestyle factors, health status and history of diseases were collected via structured interviews and laboratory tests. Smoking, heavy drinking, obesity, and physical inactivity were defined following standard guidelines. We performed descriptive analysis and logistic regressions in this study. The overall prevalence of heavy drinking, obesity, current smoking, and physical inactivity among middle-aged and older adults was 7.23% (95% confidence interval 6.53-7.29%), 11.53% (10.43-12.62%), 27.46% (26.30-28.62%), and 44.06% (41.19-46.92%), respectively. The prevalence varied between rural and urban areas as well as among geographic areas, with higher prevalence in the Northern and Northeastern regions. Heavy drinking and obesity were significantly associated with incident hypertension, diabetes, and high cholesterol; while current smoking was significantly associated with incident hypertension. Compared with healthy individuals, participants who self-reported a diagnosis of hypertension, high cholesterol, or diabetes were less likely to smoke currently and drink alcohol heavily, but more likely to be physically inactive and obese. Among Chinese middle-aged and older adults, the prevalence of behavioral risk factors varies by geographic region. Further effort is required to improve physical activity and fitness for Chinese adults, especially those with cardiometabolic conditions.

ACS Style

Lijie Ding; Yajun Liang; Edwin C. K. Tan; Yin Hu; Chi Zhang; Yanxun Liu; Fuzhong Xue; Rui Wang. Smoking, heavy drinking, physical inactivity, and obesity among middle-aged and older adults in China: cross-sectional findings from the baseline survey of CHARLS 2011-2012. 2020, 20, 1062 .

AMA Style

Lijie Ding, Yajun Liang, Edwin C. K. Tan, Yin Hu, Chi Zhang, Yanxun Liu, Fuzhong Xue, Rui Wang. Smoking, heavy drinking, physical inactivity, and obesity among middle-aged and older adults in China: cross-sectional findings from the baseline survey of CHARLS 2011-2012. . 2020; 20 (1):1062.

Chicago/Turabian Style

Lijie Ding; Yajun Liang; Edwin C. K. Tan; Yin Hu; Chi Zhang; Yanxun Liu; Fuzhong Xue; Rui Wang. 2020. "Smoking, heavy drinking, physical inactivity, and obesity among middle-aged and older adults in China: cross-sectional findings from the baseline survey of CHARLS 2011-2012." 20, no. 1: 1062.

Original research
Published: 27 April 2020 in Cancer Medicine
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Limited studies have compared the association between various physical measurements and the risk of cancer or cardiovascular disease (CVD). We aim to explore the best-individualized indicators of cancer and CVD risk assessment. From May 2004 to December 2017, a community-based cohort in China involving 100 280 participants were enrolled. BMI, height, body surface area (BSA), and body fat percentage (BFP) were compared in parallel about cancer and CVD risk with the multivariable-adjusted Cox proportional hazard regression model. Within the follow-up period, 3107 (3.10%) were diagnosed with cancer and 3721 (3.71%) had CVD. Per-level increased (in tertile: T1, T2, and T3 level) BSA, height, and BFP was positively associated with the risk of overall cancer [HR (95% CI): 1.10 (1.05-1.15), 1.12 (1.07-1.18), and 1.10 (1.03-1.16), respectively], whereas BMI was insignificant. Compared with the reference group (T2), the highest BSA level (T3) was positively associated with overall cancer incidence for both male [HR (95% CI): 1.28 (1.13-1.45)] and female [HR (95% CI): 1.13 (1.00-1.28)]. The BSA, height, and BFP also significantly associated with some site-specific cancers including thyroid, stomach, breast, urinary system, and skin cancer. Meanwhile, BFP presented a strong positive association with overall CVD [HR (95% CI): 1.22 (1.15-1.30) in trend] in both gender and associated with nearly all CVD subtypes especially the myocardial infarction and heart failure. BSA, height, and BFP have more sensitivity in assessing cancer risk and BFP shows the largest hazard ratios for CVD incident. We provided valuable evidence for the application of height, BSA, and BFP in routine healthcare practice. These encouraging findings should be tested in more well-defined studies for risk prediction.

ACS Style

Shucheng Si; Marlvin Anemey Tewara; Xiaokang Ji; Yongchao Wang; Yanxun Liu; Xiaoyu Dai; Zhiheng Wang; Fuzhong Xue. Body surface area, height, and body fat percentage as more sensitive risk factors of cancer and cardiovascular disease. Cancer Medicine 2020, 9, 4433 -4446.

AMA Style

Shucheng Si, Marlvin Anemey Tewara, Xiaokang Ji, Yongchao Wang, Yanxun Liu, Xiaoyu Dai, Zhiheng Wang, Fuzhong Xue. Body surface area, height, and body fat percentage as more sensitive risk factors of cancer and cardiovascular disease. Cancer Medicine. 2020; 9 (12):4433-4446.

Chicago/Turabian Style

Shucheng Si; Marlvin Anemey Tewara; Xiaokang Ji; Yongchao Wang; Yanxun Liu; Xiaoyu Dai; Zhiheng Wang; Fuzhong Xue. 2020. "Body surface area, height, and body fat percentage as more sensitive risk factors of cancer and cardiovascular disease." Cancer Medicine 9, no. 12: 4433-4446.