Lin Yun, Chen Haohao, Cai Xiaorui, Tang Xiaoling
Department of Pharmacy Shantou Central Hospital Shantou Guangdong Province China.
Department of Pharmacy The First Affiliated Hospital of Shantou University Medical College Shantou Guangdong Province China.
Food Sci Nutr. 2025 Aug 30;13(9):e70568. doi: 10.1002/fsn3.70568. eCollection 2025 Sep.
Restless legs syndrome (RLS) has a multifactorial etiology, and current treatments are suboptimal. Micronutrients influence neuromuscular and dopaminergic function, yet their causal role in RLS is uncertain. This study aimed to investigate whether circulating micronutrients causally influence the risk of RLS by applying an integrated two-sample, bidirectional, and multivariable Mendelian Randomization (MR) strategy. Genetic instruments for micronutrient levels were obtained from genome-wide association studies (GWAS) in the IEU Open GWAS database. RLS outcome data were from the EU-RLS-GENE consortium (7248 cases, 19,802 controls of European ancestry). Single nucleotide polymorphisms significantly associated with each micronutrient ( < 5 × 10) served as instrumental variables. Primary MR analyses employed the inverse-variance weighted (IVW) method, supplemented by the robust adjusted profile score (RAPS), MR-PRESSO, weighted median, MR-Egger regression, and IVW radial analyses. Bidirectional and multivariable MR were also performed. Sensitivity analyses for heterogeneity and horizontal pleiotropy were conducted to ensure robustness. No micronutrient passed FDR < 0.05, but three achieved suggestive evidence. Higher genetically predicted retinol and magnesium were associated with lower RLS risk (retinol OR 0.46, 95% CI 0.25-0.86; magnesium OR 0.62, 0.39-0.98). After excluding two pleiotropic SNPs, higher folate was associated with higher risk (OR 1.48, 1.10-2.00). Reverse MR showed no effect of RLS liability on these nutrients. In multivariable MR, folate remained positively associated (OR 2.88, 1.07-7.77) and magnesium inversely associated (OR 0.38, 0.15-0.98); the retinol signal weakened (OR 0.55, 0.30-1.01). No other micronutrient demonstrated a causal link. Sensitivity tests showed no material heterogeneity or directional pleiotropy. Genetic evidence supports folate excess and magnesium insufficiency as independent, potentially modifiable contributors to RLS, whereas any protective effect of retinol appears sensitive to joint modeling. These findings warrant replication in non-European cohorts and mechanistic studies addressing brain-specific micronutrient regulation.
不宁腿综合征(RLS)病因多因素,目前治疗效果欠佳。微量营养素影响神经肌肉和多巴胺能功能,但其在RLS中的因果作用尚不确定。本研究旨在通过应用综合的两样本、双向和多变量孟德尔随机化(MR)策略,调查循环中的微量营养素是否因果性地影响RLS风险。微量营养素水平的遗传工具变量来自IEU开放GWAS数据库中的全基因组关联研究(GWAS)。RLS结局数据来自欧盟-RLS-基因联盟(7248例病例,19802例欧洲血统对照)。与每种微量营养素显著相关的单核苷酸多态性(<5×10)用作工具变量。主要的MR分析采用逆方差加权(IVW)方法,并辅以稳健调整轮廓评分(RAPS)、MR-PRESSO、加权中位数、MR-Egger回归和IVW径向分析。还进行了双向和多变量MR分析。进行了异质性和水平多效性的敏感性分析以确保稳健性。没有微量营养素通过FDR<0.05,但有三种获得了提示性证据。遗传预测的视黄醇和镁水平较高与较低的RLS风险相关(视黄醇OR 0.46,95%CI 0.25-0.86;镁OR 0.62,0.39-0.98)。排除两个多效性单核苷酸多态性后,较高的叶酸水平与较高风险相关(OR 1.48,1.10-2.00)。反向MR显示RLS易感性对这些营养素无影响。在多变量MR中,叶酸仍呈正相关(OR 2.88,1.07-7.77),镁呈负相关(OR 0.38,0.15-0.98);视黄醇信号减弱(OR 0.55,0.30-1.01)。没有其他微量营养素显示出因果联系。敏感性测试未显示实质性异质性或方向性多效性。遗传证据支持叶酸过量和镁缺乏是RLS独立的、潜在可改变的因素,而视黄醇的任何保护作用似乎对联合建模敏感。这些发现需要在非欧洲队列中重复验证,并通过针对大脑特异性微量营养素调节的机制研究来证实。