Comparison of intergenerational instrumental variable analyses of body mass index and mortality in UK Biobank.

Comparison of intergenerational instrumental variable analyses of body mass index and mortality in UK Biobank.
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DOI:
10.1093/ije/dyac159
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发表时间:
2023-04-19
影响因子:
7.7
通讯作者:
--
中科院分区:
医学1区
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--
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越来越多的人的身体质量指数(BMI)被归类为超重或肥胖,已发表的研究不同意这是否对健康有益或有害。我们应用并评估了两种代际工具变量方法来估计BMI对一个有许多死亡的队列中死亡率的平均因果影响:英国生物银行参与者的父母。在考克斯回归模型中,父母BMI通过使用“后代作为工具”(OAI)估计的后代BMI和使用“代理基因型孟德尔随机化”(PGMR)估计的后代BMI相关遗传变异进行工具化。在233361名英国生物样本库参与者的父母中进行了完整的病例分析,并提供了完整的表型、基因型和协变量数据。 PGMR方法表明,较高的BMI会增加死亡率,母亲和父亲的风险比分别为1.02(95% CI:1.01,1.04)和1.04(95% CI:1.02,1.05)/kg/m2。OAI方法给出了相当高的估计值,其根据父母-后代配对在1.08(95%CI:1.06,1.10;母亲-儿子)和1.23(95%CI:1.16,1.29;父亲-女儿)之间变化。这两种方法都支持较高的BMI增加死亡率的因果作用,尽管需要谨慎考虑这些确切值的直接因果解释。对于OAI方法,来自测量协变量的仪器无效性证据有限,对于PGMR方法,则最小。这些方法对于询问平均推定的因果效应是互补的,因为预计它们之间的偏差是不同的。
An increasing proportion of people have a body mass index (BMI) classified as overweight or obese and published studies disagree whether this will be beneficial or detrimental to health. We applied and evaluated two intergenerational instrumental variable methods to estimate the average causal effect of BMI on mortality in a cohort with many deaths: the parents of UK Biobank participants. In Cox regression models, parental BMI was instrumented by offspring BMI using an ‘offspring as instrument’ (OAI) estimation and by offspring BMI-related genetic variants in a ‘proxy-genotype Mendelian randomization’ (PGMR) estimation. Complete-case analyses were performed in parents of 233 361 UK Biobank participants with full phenotypic, genotypic and covariate data. The PGMR method suggested that higher BMI increased mortality with hazard ratios per kg/m2 of 1.02 (95% CI: 1.01, 1.04) for mothers and 1.04 (95% CI: 1.02, 1.05) for fathers. The OAI method gave considerably higher estimates, which varied according to the parent–offspring pairing between 1.08 (95% CI: 1.06, 1.10; mother–son) and 1.23 (95% CI: 1.16, 1.29; father–daughter). Both methods supported a causal role of higher BMI increasing mortality, although caution is required regarding the immediate causal interpretation of these exact values. Evidence of instrument invalidity from measured covariates was limited for the OAI method and minimal for the PGMR method. The methods are complementary for interrogating the average putative causal effects because the biases are expected to differ between them.
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