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Association of Parental Obesity with Levels in Non-Obese Offspring Of Diabetes Publish Ahead of Print, published online October 17, 2008 Association of Parental Obesity with Concentrations of Select Systemic Biomarkers in Non-obese Offspring: The Framingham Heart Study Wolfgang Lieb, MD; Michael J. Pencina, PhD; Katherine J. Lanier, MA; Geoffrey H. Tofler, MD; Daniel Levy, MD; Caroline S. Fox, MD, MPH; Thomas J. Wang, MD, MPH; Ralph B. D’Agostino Sr., PhD; Ramachandran S. Vasan, MD From the Framingham Heart Study, 73 Mount Wayte Avenue, Framingham, MA (WL, MJP, DL, CSF, TJW, RSV); Department of Mathematics (MJP, KJL, RDA Sr.), and Preventive Medicine and Cardiology Sections (RSV), Boston University School of Medicine, Boston, MA; Royal North Shore Hospital, Sydney, Australia (GHT); The Center for Population Studies of the National Heart, Lung, and Blood Institute, Bethesda, MD (DL, CSF); Endocrinology Division, Brigham and Women's Hospital (CSF) and Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (TJW) This work was supported through National Institutes of Health/National Heart, Lung, and Blood Institute Contract N01-HC-25195, 1R01DK080739 and 2K24 HL04334 (RSV). Correspondence to: Ramachandran S. Vasan, MD, FACC Framingham Heart Study, 73 Mount Wayte Ave, Framingham, MA 01702–5803. E-mail: [email protected] Submitted 8 July 2008 and accepted 7 October 2008. Additional information for this article can be found in an online appendix at http://diabetes.diabetesjournals.org This is an uncopyedited electronic version of an article accepted for publication in Diabetes. The American Diabetes Association, publisher of Diabetes, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version will be available in a future issue of Diabetes in print and online at http://diabetes.diabetesjournals.org. Copyright American Diabetes Association, Inc., 2008 Parental Obesity and Offspring Biomarker Levels ABSTRACT Objective: Parental obesity is a risk factor for offspring obesity. It is unclear whether parental obesity also confers risk for obesity-associated conditions (e.g., a pro-inflammatory or pro- thrombotic state) in the absence of offspring obesity. Research Design and Methods: We compared concentrations of multiple biomarkers representing distinct biological pathways, (C-reactive protein [CRP], aldosterone, renin, B-type natriuretic peptide, N-terminal proatrial natriuretic peptide, fibrinogen, and plasminogen activator inhibitor-1) in non-obese Framingham Offspring study participants with none (n=665), one (n=488) or two (n=119) parents with obesity (body mass index ≥30 kg/m²). Results: Non-obese offspring with both parents with obesity had higher CRP levels (median: 2.16 mg/L) compared with offspring with one (median: 1.58 mg/L) or no (median: 1.35 mg/L) parents with obesity. After multivariable adjustment, a non-linear relation with parental obesity became evident: compared to people without parental obesity, CRP levels were higher in offspring with two obese parents (p=0.04) but not in offspring with only one obese parent (p=0.76). Renin levels were more linearly related to parental obesity status, being significantly higher in offspring with one (p=0.04) or two parents (p=0.09) with obesity (p=0.02 for trend). The other systemic biomarkers did not vary according to parental obesity status (all p>0.05). Conclusions: Our findings suggest that offspring with a high risk of developing obesity have an altered biomarker profile, characterized by systemic inflammation and increased neurohormonal activity, even in the absence of obesity. This is consistent with the notion, that parental obesity may confer an increased susceptibility to other adiposity-associated traits. 2 Parental Obesity and Offspring Biomarker Levels besity is highly prevalent in the disease at examination cycle 6 (1995-1998) United States (1) and predisposes to and who had both parents in the original Ometabolic and cardiovascular diseases cohort were eligible for the present analysis (2). Previous studies have documented that (n=1,272). Offspring who did not have both excess adiposity is associated with parents in the original cohort were older, had concomitant alterations of several biological higher systolic blood pressure and lower total pathways, as reflected by the presence of a cholesterol levels. prothrombotic state (3,4), neurohormonal Clinical evaluation of the participants. activation (5,6), and systemic inflammation Participants underwent a physical (7,8). examination, anthropometry, laboratory Obesity clusters in families, and parental assessment of cardiovascular risk factors and obesity substantially increases the risk of a medical history at each Heart Study visit obesity in the offspring (9). It is, however, (approximately every 4 years). less clear whether parental obesity also Biomarker Measurements. We analyzed 7 confers a greater risk for developing a pro- biomarkers that have been previously inflammatory or pro-thrombotic state, a associated with adiposity-related traits or with natriuretic handicap, or increased obesity in our cohort. Details of the different neurohormonal activation in the offspring, biomarker assays are provided in the online and whether these conditions may even supplement. antedate the occurrence of obesity in these Statistical analysis. Baseline characteristics individuals. One way to approach this in Table 1 and biomarker concentrations in question is to compare biomarker levels that Table 2 were compared using ordinary linear represent the above mentioned pathways in (normally distributed continuous traits) and non-obese offspring with versus without logistic regression models (binary traits) as obese parents. well as median regression models (for To the best of our knowledge, no previous continuous traits that were not normally study has related circulating levels of a broad distributed), respectively. For the following panel of biomarkers in non-obese offspring to analyses, biomarkers were natural parental obesity status in a community-based logarithmically-transformed for better setting. We hypothesized that non-obese symmetry of their distributions. Biomarker offspring with obese parents will have higher concentrations among offspring of obese levels of C-reactive protein (CRP), renin and parents vs. offspring of non-obese parents aldosterone, plasminogen activator inhibitor were compared using generalized estimating (PAI)-1, and fibrinogen; but lower levels of equation models (accounting for relatedness B-type natriuretic peptide (BNP) and N- among study participants) adjusting for terminal proatrial natriuretic peptide (NT- relevant covariates among offspring (age, sex, ANP) compared to offspring without parental body mass index [BMI], systolic and diastolic obesity. blood pressure (BP), hypertension treatment, diabetes, total/HDL cholesterol, and smoking; RESEARCH DESIGN AND METHODS factors known to influence systemic Study sample. A detailed description of the biomarkers). Parental obesity was defined as study sample is provided in the online BMI≥30 kg/m² at any time over their life- supplement. Participants of the Framingham course as determined by longitudinal Offspring cohort who were non-obese (BMI examinations of the original cohort at the <30 kg/m²), free of prevalent cardiovascular Heart Study. We chose this definition because 3 Parental Obesity and Offspring Biomarker Levels individuals become obese at different ages, whether paternal or maternal obesity was but once they are obese, the condition is related to those markers. relatively stable (10). Parental obesity was modeled as a categorical variable (0, 1, and 2 RESULTS parents with obesity) with 0 parents serving as The clinical and anthropometric the referent group. characteristics of our sample are shown in In additional analyses, we evaluated Table 1. whether those biomarkers that were related to Association of Parental Obesity with parental obesity in the primary analyses, Offspring Biomarker Levels. might be important mediators of the effect of Table 2 displays offspring biomarker parental obesity on offspring BMI. In a first levels according to the number of parents with step, we developed a multivariable model obesity. CRP demonstrated a non-linear with offspring BMI as dependent variable and association with parental obesity status. with age, sex, smoking status, physical Offspring with two obese parents displayed activity index, and caloric intake as higher CRP levels compared with the referent covariates. Next, we analyzed whether group without parental obesity (Table 2). parental obesity was significantly related to This association remained significant in offspring BMI in the multivariable model, multivariable-adjusted models (Table 3). using parental obesity as the predictor Offspring with a single obese parent did not variable. In a third step, the parental obesity have higher CRP levels compared with the variable was omitted from the model and referent group. those biomarkers that were significantly Offspring with one obese parent had associated with parental obesity in our significantly higher renin levels in primary analyses were added as predictor multivariable-adjusted models (Table 3). variable to the multivariable model with BMI Offspring with two obese parents likewise serving as the dependent variable. Finally, we had higher renin levels than offspring without analyzed whether the regression coefficient parental obesity,
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