Health, Wellness, and the Health Care Experiences of Female Adolescents Living with Increased Weight

Clinic-based health care encounters (HCEs) remain a beneficial setting for early assessment, identification and treatment of overweight in adolescents. The purpose of this study is to describe how female adolescents who are obese or overweight perceive the health care encounter with a particular focus on obesity. Using a qualitative design, a purposive sample of 28 English speaking female adolescents, 13–19 years of age, who were overweight or obese, participated in in-depth interviews. Five themes emerged from the thematic analysis: Mental and physical wellness, The impact of weight, Cause I’m a teenager, Talking about weight affects me, and Help me instead of just telling me. The findings from this study revealed that the adolescents’ view of health encompasses physical, mental, and psychosocial health dimensions. The female adolescents felt they were healthy, despite their increased weight. Discussing weight in the HCE can incite negative perceptions of the self. Within the HCE, the adolescents identified the desire for respect, to have autonomy, and to be an active participant in the decision-making process. Conversely, the adolescents felt their health care was inadequate when they received impersonal and vague advice on weight loss. Adolescents desired providers who were kind, friendly, and did not judge them based upon their weight. The most helpful recommendations providers provided were small, individualized goals that the adolescents felt they could successfully achieve. The insights derived from female adolescents living with increased weight in this study can provide guidance on how providers can improve the HCE. Implications for nursing policy, education, and research emerged from the interviews with the participants

GENETIC DETERMINANTS OF BONE MINERAL DENSITY IN MEN: A CANDIDATE GENE APPROACH TO STUDYING A COMPLEX TRAIT

Osteoporosis is commonly considered a women's health problem, but is also a significant health concern for older men. Less is known about the predictors of osteoporosis and bone mineral density (BMD) in men. The aging of the population and expected increase in osteoporosis prevalence makes understanding the determinants of BMD of great public health importance.Genetics is an important determinant of BMD, but little is known about specific loci associated with BMD in men and even less is known about the genetic influences on volumetric BMD (vBMD). With this in mind, we investigated 4108 single nucleotide polymorphisms (SNPs) in 383 candidate genes for their association within a population of older Caucasian men. In addition, we investigated 148 of these SNPs in 28 WNT pathway genes for gene-gene interactions and gene-environment interactions with physical activity and body weight. We identified several SNPs that were associated with lumbar spine and femoral neck integral vBMD and explained 3.5% and 1.7% of the phenotypic variation in these traits, respectively. SNPs in two genes, adenomatous polyposis coli (APC) and the homeo box A gene cluster (HOXA) were associated with integral vBMD at both the femoral neck and lumbar spine. Analysis of cortical and trabecular vBMD at the femoral neck identified SNPs that explained 1.8% and 4.0% of the phenotypic variance, respectively. None of the SNPs for cortical vBMD were associated with trabecular vBMD. Statistically significant gene-gene and gene-environment interactions were also identified. Of note, statistically significant interaction effects of SNPs in the low density lipoprotein receptor-related protein 5 and physical activity level on integral vBMD at the femoral neck and lumbar spine were identified. Although additional work is needed to confirm and extend these findings we identified a number of novel associations for vBMD in older Caucasian men. Our results suggest the presence of genetic loci that are skeletal-site specific and specific to either cortical or trabecular bone. Additionally, these findings underscore the importance of evaluating genetic variation in the context of other genes and environmental factors

Candidate gene analysis of femoral neck trabecular and cortical volumetric bone mineral density in older men.

In contrast to conventional dual-energy X-ray absorptiometry, quantitative computed tomography separately measures trabecular and cortical volumetric bone mineral density (vBMD). Little is known about the genetic variants associated with trabecular and cortical vBMD in humans, although both may be important for determining bone strength and osteoporotic risk. In the current analysis, we tested the hypothesis that there are genetic variants associated with trabecular and cortical vBMD at the femoral neck by genotyping 4608 tagging and potentially functional single-nucleotide polymorphisms (SNPs) in 383 bone metabolism candidate genes in 822 Caucasian men aged 65 years or older from the Osteoporotic Fractures in Men Study (MrOS). Promising SNP associations then were tested for replication in an additional 1155 men from the same study. We identified SNPs in five genes (IFNAR2, NFATC1, SMAD1, HOXA, and KLF10) that were robustly associated with cortical vBMD and SNPs in nine genes (APC, ATF2, BMP3, BMP7, FGF18, FLT1, TGFB3, THRB, and RUNX1) that were robustly associated with trabecular vBMD. There was no overlap between genes associated with cortical vBMD and trabecular vBMD. These findings identify novel genetic variants for cortical and trabecular vBMD and raise the possibility that some genetic loci may be unique for each bone compartment

Large meta-analysis of genome-wide association studies identifies five loci for lean body mass

Lean body mass, consisting mostly of skeletal muscle, is important for healthy aging. We performed a genome-wide association study for whole body (20 cohorts of European ancestry with n = 38,292) and appendicular (arms and legs) lean body mass (n = 28,330) measured using dual energy X-ray absorptiometry or bioelectrical impedance analysis, adjusted for sex, age, height, and fat mass. Twenty-one single-nucleotide polymorphisms were significantly associated with lean body mass either genome wide (p < 5 × 10−8) or suggestively genome wide (p < 2.3 × 10−6). Replication in 63,475 (47,227 of European ancestry) individuals from 33 cohorts for whole body lean body mass and in 45,090 (42,360 of European ancestry) subjects from 25 cohorts for appendicular lean body mass was successful for five single-nucleotide polymorphisms in/near HSD17B11, VCAN, ADAMTSL3, IRS1, and FTO for total lean body mass and for three single-nucleotide polymorphisms in/near VCAN, ADAMTSL3, and IRS1 for appendicular lean body mass. Our findings provide new insight into the genetics of lean body mass

Genetic evidence for a normal-weight "metabolically obese" phenotype linking insulin resistance, hypertension, coronary artery disease, and type 2 diabetes

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tThe mechanisms that predispose to hypertension, coronary artery disease (CAD), and type 2 diabetes (T2D) in individuals of normal weight are poorly understood. In contrast, in monogenic primary lipodystrophy-a reduction in subcutaneous adipose tissue-it is clear that it is adipose dysfunction that causes severe insulin resistance (IR), hypertension, CAD, and T2D. We aimed to test the hypothesis that common alleles associated with IR also influence the wider clinical and biochemical profile of monogenic IR. We selected 19 common genetic variants associated with fasting insulin-based measures of IR. We used hierarchical clustering and results from genome-wide association studies of eight nondisease outcomes of monogenic IR to group these variants. We analyzed genetic risk scores against disease outcomes, including 12,171 T2D cases, 40,365 CAD cases, and 69,828 individuals with blood pressure measurements. Hierarchical clustering identified 11 variants associated with a metabolic profile consistent with a common, subtle form of lipodystrophy. A genetic risk score consisting of these 11 IR risk alleles was associated with higher triglycerides (β = 0.018; P = 4 × 10(-29)), lower HDL cholesterol (β = -0.020; P = 7 × 10(-37)), greater hepatic steatosis (β = 0.021; P = 3 × 10(-4)), higher alanine transaminase (β = 0.002; P = 3 × 10(-5)), lower sex-hormone-binding globulin (β = -0.010; P = 9 × 10(-13)), and lower adiponectin (β = -0.015; P = 2 × 10(-26)). The same risk alleles were associated with lower BMI (per-allele β = -0.008; P = 7 × 10(-8)) and increased visceral-to-subcutaneous adipose tissue ratio (β = -0.015; P = 6 × 10(-7)). Individuals carrying ≥17 fasting insulin-raising alleles (5.5% population) were slimmer (0.30 kg/m(2)) but at increased risk of T2D (odds ratio [OR] 1.46; per-allele P = 5 × 10(-13)), CAD (OR 1.12; per-allele P = 1 × 10(-5)), and increased blood pressure (systolic and diastolic blood pressure of 1.21 mmHg [per-allele P = 2 × 10(-5)] and 0.67 mmHg [per-allele P = 2 × 10(-4)], respectively) compared with individuals carrying ≤9 risk alleles (5.5% population). Our results provide genetic evidence for a link between the three diseases of the "metabolic syndrome" and point to reduced subcutaneous adiposity as a central mechanism

Wnt receptors, bone mass, and fractures: gene-wide association analysis of LRP5 and LRP6 polymorphisms with replication

Objectives. Genes explaining the susceptibility to osteoporosis have not been fully elucidated. Our objective was to explore the association of polymorphisms capturing common variations of the lipoprotein receptor related protein (LRP) 5 and 6 genes, encoding two Wnt receptors, with femoral neck bone mineral density (BMD) and osteoporotic fractures of the spine and the hip. Design. Cross-sectional, case-control and replication genetic association study. Methods. Thirty nine tagging and functional single nucleotide polymorphisms (SNP) were analyzed in a group of 1043 postmenopausal women and 394 women with hip fractures. The results were replicated in a different group of 342 women. Results. Three SNPs of the LRP6 gene were associated with BMD (nominal uncorrected pvalues< 0.05) in the discovery cohort. One showed a significant association after multiple test correction; two of them were also associated in the replication cohort, with a combined standardized mean difference of 0.51 (p=0.009) and 0.65 (p<0.0001) across rs11054704 and rs2302685 genotypes. In the discovery cohort, several LRP5 SNPs were associated with vertebral fractures (odds ratio 0.67; p=0.01), with hip fractures (unadjusted odds ratios between 0.59 and 1.21, p=0.005-0.033, but not significant after multiple test- or age-adjustment), and with height and the projected femoral neck area, but not with BMD. Transcripts of LRP5 and LRP6 were similarly abundant in bone samples. Conclusions. In this study we found common polymorphisms of LRP5 associated with osteoporotic fractures, and polymorphisms of the LRP6 gene associated with BMD, thus suggesting them as likely candidates to contribute explaining the hereditary influence on osteoporosis

Meta-analysis of genome-wide studies identifies MEF2C SNPs associated with bone mineral density at forearm

Background: Forearm fractures affect 1.7 million individuals worldwide each year and most occur earlier in life than hip fractures. While the heritability of forearm bone mineral density (BMD) and fracture is high, their genetic determinants are largely unknown. Aim: To identify genetic variants associated with forearm BMD and forearm fractures. Methods: BMD at distal radius, measured by dualenergy x-ray absorptiometry, was tested for association with common genetic variants. We conducted a metaanalysis of genome-wide association studies for BMD in 5866 subjects of European descent and then selected the variants for replication in 715 Mexican American samples. Gene-based association was carried out to supplement the single-nucleotide polymorphism (SNP) association test. We then tested the BMD-associated SNPs for association with forearm fracture in 2023 cases and 3740 controls. Results: We found that five SNPs in the introns of MEF2C were associated with forearm BMD at a genome-wide significance level (

Parent-of-origin-specific allelic associations among 106 genomic loci for age at menarche.

Age at menarche is a marker of timing of puberty in females. It varies widely between individuals, is a heritable trait and is associated with risks for obesity, type 2 diabetes, cardiovascular disease, breast cancer and all-cause mortality. Studies of rare human disorders of puberty and animal models point to a complex hypothalamic-pituitary-hormonal regulation, but the mechanisms that determine pubertal timing and underlie its links to disease risk remain unclear. Here, using genome-wide and custom-genotyping arrays in up to 182,416 women of European descent from 57 studies, we found robust evidence (P < 5 × 10(-8)) for 123 signals at 106 genomic loci associated with age at menarche. Many loci were associated with other pubertal traits in both sexes, and there was substantial overlap with genes implicated in body mass index and various diseases, including rare disorders of puberty. Menarche signals were enriched in imprinted regions, with three loci (DLK1-WDR25, MKRN3-MAGEL2 and KCNK9) demonstrating parent-of-origin-specific associations concordant with known parental expression patterns. Pathway analyses implicated nuclear hormone receptors, particularly retinoic acid and γ-aminobutyric acid-B2 receptor signalling, among novel mechanisms that regulate pubertal timing in humans. Our findings suggest a genetic architecture involving at least hundreds of common variants in the coordinated timing of the pubertal transition

Insulin Resistance Exacerbates Genetic Predisposition to Nonalcoholic Fatty Liver Disease in Individuals Without Diabetes

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149741/1/hep41353.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149741/2/hep41353_am.pd