MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
Eur J Epidemiol. 2023 Jul;38(7):795-807. doi: 10.1007/s10654-023-00986-6. Epub 2023 May 3.
Musculoskeletal conditions, including fractures, can have severe and long-lasting consequences. Higher body mass index in adulthood is widely acknowledged to be protective for most fracture sites. However, sources of bias induced by confounding factors may have distorted previous findings. Employing a lifecourse Mendelian randomisation (MR) approach by using genetic instruments to separate effects at different life stages, this investigation aims to explore how prepubertal and adult body size independently influence fracture risk in later life.Using data from a large prospective cohort, univariable and multivariable MR were conducted to simultaneously estimate the effects of age-specific genetic proxies for body size (n = 453,169) on fracture risk (n = 416,795). A two-step MR framework was additionally applied to elucidate potential mediators. Univariable and multivariable MR indicated strong evidence that higher body size in childhood reduced fracture risk (OR, 95% CI: 0.89, 0.82 to 0.96, P = 0.005 and 0.76, 0.69 to 0.85, P = 1 × 10, respectively). Conversely, higher body size in adulthood increased fracture risk (OR, 95% CI: 1.08, 1.01 to 1.16, P = 0.023 and 1.26, 1.14 to 1.38, P = 2 × 10, respectively). Two-step MR analyses suggested that the effect of higher body size in childhood on reduced fracture risk was mediated by its influence on higher estimated bone mineral density (eBMD) in adulthood.This investigation provides novel evidence that higher body size in childhood reduces fracture risk in later life through its influence on increased eBMD. From a public health perspective, this relationship is complex since obesity in adulthood remains a major risk factor for co-morbidities. Results additionally indicate that higher body size in adulthood is a risk factor for fractures. Protective effect estimates previously observed are likely attributed to childhood effects.
肌肉骨骼疾病,包括骨折,可能会产生严重且持久的后果。成年时较高的体重指数被广泛认为对大多数骨折部位有保护作用。然而,混杂因素引起的偏倚来源可能扭曲了先前的发现。本研究采用生命历程孟德尔随机化(MR)方法,利用遗传工具将不同生命阶段的效应分开,旨在探讨青春期前和成年期的体型大小如何独立影响晚年的骨折风险。
本研究使用来自大型前瞻性队列的数据,采用单变量和多变量 MR 同时估计年龄特异性身体大小遗传指标(n=453169)对骨折风险(n=416795)的影响。此外,还应用了两步 MR 框架来阐明潜在的中介因素。单变量和多变量 MR 均表明,儿童时期较高的体型可降低骨折风险(OR,95%CI:0.89,0.82 至 0.96,P=0.005 和 0.76,0.69 至 0.85,P=1×10,分别)。相反,成年时较高的体型增加了骨折风险(OR,95%CI:1.08,1.01 至 1.16,P=0.023 和 1.26,1.14 至 1.38,P=2×10,分别)。两步 MR 分析表明,儿童时期较高体型对降低骨折风险的影响是通过其对成年时更高的估计骨密度(eBMD)的影响来介导的。
本研究提供了新的证据,表明儿童时期较高的体型通过影响成年时更高的 eBMD 来降低晚年的骨折风险。从公共卫生的角度来看,这种关系很复杂,因为成年期肥胖仍然是合并症的主要危险因素。研究结果还表明,成年时较高的体型是骨折的一个危险因素。以前观察到的保护作用估计可能归因于儿童时期的影响。
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