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Hot Topics of the Day are picked by experts to capture the latest information and publications on public health genomics and precision health for various diseases and health topics. Sources include published scientific literature, reviews, blogs and popular press articles.

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226 hot topic(s) found with the query "Mendelian randomization"

An approach to identify gene-environment interactions and reveal new biological insight in complex traits
(Posted: Apr 25, 2024 9AM)

From the abstract: " Here, we present a powerful new approach to screen for interactions across the genome, an approach that shares substantial similarity to the Mendelian randomization framework. We identify and confirm 5 loci (6 independent signals) interacted with either cigarette smoking or alcohol consumption for serum lipids, and empirically demonstrate that interaction and mediation are the major contributors to genetic effect size heterogeneity across populations. "

Dose-Response Associations of Lipid Traits With Coronary Artery Disease and Mortality.
Guoyi Yang et al. JAMA Netw Open 2024 1 (1) e2352572 (Posted: Jan 20, 2024 10AM)

From the abstract: "Do apolipoprotein B (apoB), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) increase risk of coronary artery disease (CAD), all-cause mortality, or cause-specific mortality, and if so, what are the shapes of these associations? In this genetic association study using mendelian randomization including 347?797 participants of European ancestry from UK Biobank, genetically predicted apoB and LDL-C were positively associated with CAD, all-cause mortality, and cardiovascular mortality, all in a dose-dependent way. Genetically predicted TG was positively associated with CAD, although the presence of pleiotropy was suggested. "

Mediating Factors in the Association of Maternal Educational Level With Pregnancy Outcomes: A Mendelian Randomization Study.
Tormod Rogne et al. JAMA Netw Open 2024 1 (1) e2351166 (Posted: Jan 12, 2024 6AM)

From the abstract: " Which pathways mediate the inequity in pregnancy health associated with low educational attainment? In this cohort study of more than 3 million individuals, an association between genetically estimated lower educational attainment and increased risk of ectopic pregnancy, hyperemesis gravidarum, gestational diabetes, preeclampsia, preterm birth, and offspring low birth weight was observed. A sizeable portion of these associations were explained by targetable risk factors. These findings suggest that the association of socioeconomic inequalities with adverse pregnancy outcomes may be reduced by intervening for type 2 diabetes, body mass index, smoking, high-density lipoprotein cholesterol level, and systolic blood pressure."

Distilling causality between physical activity traits and obesity via Mendelian randomization.
Zhe Wang et al. Commun Med (Lond) 2023 11 (1) 173 (Posted: Dec 02, 2023 8AM)

From the abstract: "Whether obesity is a cause or consequence of low physical activity levels and more sedentary time has not yet been fully elucidated. Better instrumental variables and a more thorough consideration of potential confounding variables that may influence the causal inference between physical activity and obesity are needed. This MR study highlights the beneficial effect of education on improved health and suggest that a more physically active lifestyle leads to lower BMI, while sedentary behavior is a consequence of higher BMI."

Mendelian Randomization as a Tool for Cardiovascular Research: A Review.
Michael G Levin et al. JAMA Cardiol 2023 11 (Posted: Nov 11, 2023 4PM)

From the abstract: "Mendelian randomization (MR) is a statistical approach that has become increasingly popular in the field of cardiovascular disease research. It offers a way to infer potentially causal relationships between risk factors and outcomes using observational data, which is particularly important in cases where randomized clinical trials are not feasible or ethical. With the growing availability of large genetic data sets, MR has become a powerful and accessible tool for studying the risk factors for cardiovascular disease. "

Converging evidence from exome sequencing and common variants implicates target genes for osteoporosis
S Zhou et al, Nature Genetics, August 9, 2023 (Posted: Aug 09, 2023 4PM)

We undertook a large-scale multiancestry exome-wide association study for estimated bone mineral density, which showed that the burden of rare coding alleles in 19 genes was associated with estimated bone mineral density (P<3.6×10–7). These genes were highly enriched for a set of known causal genes for osteoporosis (65-fold; P=2.5×10–5). Exome-wide significant genes had 96-fold increased odds of being the top ranked effector gene at a given GWAS locus (P=1.8×10–10). By integrating proteomics Mendelian randomization evidence, we prioritized CD109 (cluster of differentiation 109) as a gene for which heterozygous loss of function is associated with higher bone density.

Association of Longer Leukocyte Telomere Length With Cardiac Size, Function, and Heart Failure
N Aung et al, JAMA Cardiology, July 26, 2023 (Posted: Jul 26, 2023 0PM)

Is leukocyte telomere length (LTL) associated with alterations in cardiovascular structure and function? In this cross-sectional study including 40 459 UK Biobank participants, longer LTL was associated with higher left ventricular mass, larger ventricular and atrial sizes, and higher stroke volumes. Mendelian randomization analysis demonstrated a potential causal genetic association between LTL and left ventricular mass, ventricular size, and left ventricular stroke volume, and longer LTL was associated with a lower risk of incident heart failure after accounting for potential confounders.

The causal effects of education on adult health, mortality and income: evidence from Mendelian randomization and the raising of the school leaving age.
Neil M Davies et al. Int J Epidemiol 2023 7 (Posted: Jul 23, 2023 9AM)

On average, educated people are healthier, wealthier and have higher life expectancy than those with less education. Numerous studies have attempted to determine whether education causes differences in later health outcomes or whether another factor ultimately causes differences in education and subsequent outcomes. Previous studies have used a range of natural experiments to provide causal evidence. Here we compare two natural experiments: a policy reform, raising the school leaving age in the UK in 1972; and Mendelian randomization.

A genetically supported drug repurposing pipeline for diabetes treatment using electronic health records.
Megan M Shuey et al. EBioMedicine 2023 7 104674 (Posted: Jul 05, 2023 7AM)

We developed and tested a genetically-informed drug-repurposing pipeline for diabetes management. This approach mapped genetically-predicted gene expression signals from the largest genome-wide association study for type 2 diabetes mellitus to drug targets using publicly available databases to identify drug–gene pairs. These drug–gene pairs were then validated using a two-step approach: 1) a self-controlled case-series (SCCS) using electronic health records from a discovery and replication population, and 2) Mendelian randomization (MR).

Mendelian randomization evidence for the causal effects of socio-economic inequality on human longevity among Europeans.
Chao-Jie Ye et al. Nat Hum Behav 2023 6 (Posted: Jul 03, 2023 8AM)

Here we performed two-sample Mendelian randomization analyses applying genetic instruments of education, income and occupation (n?=?248,847 to 1,131,881) to estimate their causal effects and consequences on parental lifespan and self-longevity (n?=?28,967 to 1,012,240) from the largest available genome-wide association studies in populations of European ancestry. Each 4.20 years of additional educational attainment were causally associated with a 3.23-year-longer parental lifespan independently of income and occupation and were causally associated with 30–59% higher odds of self-longevity.

Participation bias in the UK Biobank distorts genetic associations and downstream analyses.
Tabea Schoeler et al. Nat Hum Behav 2023 4 (Posted: Apr 30, 2023 6AM)

To evaluate the impact of selective participation, we derived UK Biobank participation probabilities on the basis of 14 variables harmonized across the UK Biobank and a representative sample. We then conducted weighted genome-wide association analyses on 19 traits. Comparing the output from weighted genome-wide association analyses with that from standard genome-wide association analyses, we found that increasing representativeness led to changes in SNP effect sizes and identified novel SNP associations for 12 traits. While heritability estimates were less impacted by weighting (maximum change in h2, 5%), we found substantial discrepancies for genetic correlations (maximum change in rg, 0.31) and Mendelian randomization estimates (maximum change in ßSTD, 0.15) for socio-behavioral traits.

Exploring the complex relationship between gut microbiota and risk of colorectal neoplasia using bidirectional Mendelian Randomization analysis.
Wanxin Li et al. Cancer Epidemiol Biomarkers Prev 2023 4 (Posted: Apr 29, 2023 3PM)

We find genetic liability to colorectal neoplasia may be associated with abundance of certain microbiota taxa. It is more likely that subset of CRC genetic liability variants changes gut biology by influencing both gut microbiota and CRC risk. This study highlights the need of future complementary studies to explore causal mechanisms linking both host genetic variation with gut microbiome and CRC susceptibility.

Mendelian randomization
AJHG, Special collection, April 2023 (Posted: Apr 12, 2023 11AM)

Mendelian randomization (MR) is a statistical technique used to investigate causal relationships between an exposure and an outcome in observational studies. The development of new and more robust MR methods has provided researchers with an important tool to gain new insights into the causal effects of genetic variants on outcomes such as cardiovascular disease, cancer, and mental health. This AJHG collection features recent research and reviews that highlight the utility of MR in exploring the ways in which genetic variation influences a range of health outcomes.

Causal factors underlying diabetes risk informed by Mendelian randomisation analysis: evidence, opportunities and challenges.
Shuai Yuan et al. Diabetologia 2023 2 (Posted: Mar 01, 2023 0PM)

Diabetes and its complications cause a heavy disease burden globally. Identifying exposures, risk factors and molecular processes causally associated with the development of diabetes can provide important evidence bases for disease prevention and spur novel therapeutic strategies. Mendelian randomisation (MR), an epidemiological approach that uses genetic instruments to infer causal associations between an exposure and an outcome, can be leveraged to complement evidence from observational and clinical studies. This narrative review aims to summarize the evidence on potential causal risk factors for diabetes by integrating published MR studies on type 1 and 2 diabetes.

Increasing serum iron levels and their role in the risk of infectious diseases: a Mendelian randomization approach.
Guillaume Butler-Laporte et al. International journal of epidemiology 2023 2 (Posted: Feb 20, 2023 6AM)

Using MR, we did not observe an increase in risk of most infectious diseases with increases in iron stores. However for bacterial infections, higher iron stores may increase odds of infections. Hence, using genetic variation in iron pathways as a proxy for iron supplementation, iron supplements are likely safe on a population level, but we should continue the current practice of conservative iron supplementation during bacterial infections or in those at high risk of developing them.

Association of Hypertensive Disorders of Pregnancy With Future Cardiovascular Disease.
Bilal Rayes et al. JAMA network open 2023 2 (2) e230034 (Posted: Feb 18, 2023 8AM)

Is there evidence for an association between hypertensive disorders of pregnancy (HDPs) and long-term risk of cardiovascular disease? In this large genome-wide genetic association study using mendelian randomization, HDPs were associated with higher risk of coronary artery disease and ischemic stroke but not heart failure or atrial fibrillation. Mediation analysis revealed a partial attenuation of the association between HDPs and coronary artery disease after adjustment for systolic blood pressure and type 2 diabetes. These results support the consideration of HDPs as potential risk factors for cardiovascular disease.

Using genetic association data to guide drug discovery and development: Review of methods and applications
S Burgess et al, AJHG, February 2, 2023 (Posted: Feb 02, 2023 11AM)

Evidence on the validity of drug targets from randomized trials is reliable but typically expensive and slow to obtain. In contrast, evidence from conventional observational epidemiological studies is less reliable because of the potential for bias from confounding and reverse causation. Mendelian randomization is a quasi-experimental approach analogous to a randomized trial that exploits naturally occurring randomization in the transmission of genetic variants.

Proteome-wide Mendelian randomization implicates nephronectin as an actionable mediator of the effect of obesity on COVID-19 severity
S Yojoshi et al, MEDRXIV, January 31, 2023 (Posted: Feb 01, 2023 6AM)

Genomic atlas of the plasma metabolome prioritizes metabolites implicated in human diseases.
Chen Yiheng et al. Nature genetics 2023 1 (1) 44-53 (Posted: Jan 15, 2023 3PM)

By conducting genome-wide association studies of 1,091 blood metabolites and 309 metabolite ratios, we identified associations with 690 metabolites at 248 loci and associations with 143 metabolite ratios at 69 loci. Integrating metabolite-gene and gene expression information identified 94 effector genes for 109 metabolites and 48 metabolite ratios. Using Mendelian randomization (MR), we identified 22 metabolites and 20 metabolite ratios having estimated causal effect on 12 traits and diseases.

Association between genetically proxied PCSK9 inhibition and prostate cancer risk: A Mendelian randomisation study.
Fang Si et al. PLoS medicine 2023 1 (1) e1003988 (Posted: Jan 04, 2023 6AM)

Using genetic variants associated with LDL cholesterol, liver-derived gene expression, and plasma protein levels, the researchers applied drug target Mendelian randomization (MR) and colocalization to examine the association between lipid-lowering drug targets and the risk of overall, early-onset, and advanced prostate cancer. Additional MR analyses were conducted to explore putative mediators of drug effects. This study provided evidence of an association between genetically proxied PCSK9 inhibition and lower risk of overall and early-onset prostate cancer supported by both MR and colocalization approaches.

Genomics and phenomics of body mass index reveals a complex disease network.
Huang Jie et al. Nature communications 2022 12 (1) 7973 (Posted: Jan 02, 2023 0PM)

Using a BMI genetic risk score including 2446 variants, 316 diagnoses are associated in the Million Veteran Program, with 96.5% showing increased risk. A co-morbidity network analysis reveals seven disease communities containing multiple interconnected diseases associated with BMI as well as extensive connections across communities. Mendelian randomization analysis confirms phenotypes across many organ systems, including conditions of the circulatory (heart failure, ischemic heart disease, atrial fibrillation), genitourinary (chronic renal failure), respiratory (respiratory failure, asthma), musculoskeletal and dermatologic systems.

Blood Leukocyte Counts in Alzheimer Disease
J Luo et al, JAMA Network Open (Posted: Oct 10, 2022 0PM)

In this cohort study of 101?582 individuals in the Danish general population, low baseline blood monocyte counts were associated with increased AD risk. In a mendelian randomization framework using the most powerful genomic data sets, genetically determined low monocyte counts were also associated with increased AD risk, an association independent of other types of blood leukocytes. The findings of this study suggest that the observational and genetic association observed between low monocyte counts and increased risk of AD highlights a possible role of the innate immune system in AD pathogenesis.

Tools for assessing quality and risk of bias in Mendelian randomization studies: a systematic review.
Spiga Francesca et al. International journal of epidemiology 2022 7 (Posted: Aug 06, 2022 7AM)

We present an overview of tools and methods to assess risk of bias/quality of evidence in MR analysis. Issues commonly addressed relate to the three standard assumptions of instrumental variables analyses, the choice of genetic instrument(s) and features of the population(s) from which the data are collected (particularly in two-sample MR), in addition to more traditional non-MR-specific epidemiological biases. The identified tools should be tested and validated for general use before recommendations can be made on their widespread use.

Joint Genetic Inhibition of PCSK9 and CETP and the Association With Coronary Artery Disease: A Factorial Mendelian Randomization Study.
Cupido Arjen J et al. JAMA cardiology 2022 8 (Posted: Aug 05, 2022 8AM)

In this cohort study, a 2?×?2 factorial Mendelian randomization study including 425?354 participants from the UK Biobank, an additive association of a genetically reduced combined concentration of CETP and PCSK9 was found for lipid levels and risk of coronary artery disease, while the association of CETP with age-related macular degeneration was not mitigated. Our findings suggest that joint inhibition of CETP and PCSK9 has additive effects on lipid concentrations and clinical outcomes.

Nongenetic Factors Associated With Psychotic Experiences Among UK Biobank Participants Exposome-Wide Analysis and Mendelian Randomization Analysis
BD Lin et al, JAMA Psychiatry, July 20, 2022 (Posted: Jul 20, 2022 0PM)

What are the factors associated with psychotic experiences? In this cohort study of 155?247 UK Biobank participants, exposome-wide association analysis yielded 148 correlates of psychotic experiences, with 36 independent associations further identified in the fully adjusted multivariable model. Mendelian randomization analyses of these 36 variables indicated a forward association with ever having experienced sexual assault and pleiotropy of risk-taking behavior and a reverse association with ever having experienced a physically violent crime, cannabis use, and worrying too long after embarrassment.

Mendelian randomization analysis for attention deficit/hyperactivity disorder: studying a broad range of exposures and outcomes.
Soler Artigas María et al. International journal of epidemiology 2022 6 (Posted: Jun 18, 2022 10AM)

We used genome-wide association study (GWAS) summary statistics for ADHD (n?=?53?293) and 124 traits related to anthropometry, cognitive function and intelligence, early life exposures, education and employment, lifestyle and environment, longevity, neurological, and psychiatric and mental health or personality and psychosocial factors available in the MR-Base database (16?067 =n?=766?345). Our findings strengthen previous evidence of a causal effect of ADHD liability on smoking and major depression, and are consistent with a causal effect on odds of decreased average total household income [odds ratio (OR)?=?0.966, 95% credible interval (CrI)?=?(0.954, 0.979)] and increased lifetime number of sexual partners [OR?=?1.023, 95% CrI?=?(1.013, 1.033)].

Mendelian randomization study of maternal coffee consumption and its influence on birthweight, stillbirth, miscarriage, gestational age and pre-term birth.
Brito Nunes Caroline et al. International journal of epidemiology 2022 6 (Posted: Jun 12, 2022 8AM)

Proteome-wide Mendelian randomization implicates nephronectin as an actionable mediator of the effect of obesity on COVID-19 severity
S Yojishi et al, MEDRXIV, June 8, 2022 (Posted: Jun 09, 2022 6AM)

Mendelian Randomization: Principles and its usage in Lp(a) research.
Lamina Claudia et al. Atherosclerosis 2022 5 36-41 (Posted: Jun 07, 2022 10AM)

Mendelian Randomization (MR) methods can be used to establish a causal link between a biomarker and a disease. Lp(a) is primarily genetically determined by KIV-repeats, apo(a) isoforms, single SNPs and SNP-scores. Lp(a) was the first phenotype for which a causal relationship with cardiovascular diseases was shown using the idea of MR. Lp(a) is causally related to CHD, MI, stroke, peripheral vascular disease, heart failure and aortic valve stenosis. It was estimated that Lp(a) would have to be reduced by 65–100 mg/dL to reduce CVD risk by about 22% over 5 years.

A multi-population phenome-wide association study of genetically-predicted height in the Million Veteran Program
S Raghavan et al, PLOS Genetics, June 2, 2022 (Posted: Jun 03, 2022 8AM)

Of approximately 350 traits associated with measured height, we found 127 associated with genetically-predicted height in non-Hispanic White individuals. While only 2 were also statistically significant in non-Hispanic Black individuals, we found evidence for consistent directions of effect for associations of traits with genetically-predicted height in non-Hispanic Black and White individuals. We conclude that height may be an unrecognized non-modifiable risk factor for several common conditions in adults.

Shared genetic etiology and causality between COVID-19 and venous thromboembolism: evidence from genome-wide cross trait analysis and bi-directional Mendelian randomization study
X Huang et al, MEDRXIV, May 27, 2022 (Posted: May 28, 2022 11AM)

Shared genetic etiology and causality between COVID-19 and venous thromboembolism: evidence from genome-wide cross trait analysis and bi-directional Mendelian randomization study
X Huang et al, MEDRXIV, May 21, 2022 (Posted: May 23, 2022 7AM)

Does Moderate Drinking Protect Your Heart? A Genetic Study Offers a New Answer.
G Kolata, NY Times, March 29, 2022 (Posted: Mar 30, 2022 6AM)

By studying the relationship between gene variants and alcohol consumption, scientists found no real cardiac benefit to drinking, even modestly. Researchers have found genetic variants that predispose a person to heavier or lighter drinking. Because the variants are distributed randomly in a population, they can serve in a study as the equivalent of randomly assigning people to abstain or to drink at varying levels. Researchers can ask if those with variants that are linked to greater alcohol consumption have more heart disease and high blood pressure than those with variants linked to lower consumption.

The evolution of mendelian randomization for investigating drug effects.
Gill Dipender et al. PLoS medicine 2022 2 (2) e1003898 (Posted: Feb 14, 2022 8AM)

Random allocation of genetic variants through meiosis and conception means that the genotype an individual inherits is not typically affected by environmental confounding factors or reverse causation, analogous to treatment allocation in a randomized controlled trial. Provided that the genetic proxy can only influence an outcome through its effect on the protein drug target and not some pleiotropic pathway, a genetic association with the outcome can serve as evidence for a potential effect of drug target perturbation on that outcome. This paradigm spawned the field of “drug target mendelian randomization,” which has now been used to prioritize the design of clinical trials for more than a decade

Causal associations between body fat accumulation and COVID-19 severity: A Mendelian randomization study
S Yojishi et al, MEDRXIV, January 21, 2022 (Posted: Jan 22, 2022 1PM)

The unique challenges of studying the genetics of diet and nutrition
J Merino et al, Nature Medicine, January 3, 2022 (Posted: Jan 05, 2022 9AM)

Epidemiologists increasingly embrace Mendelian randomization (MR), a methodological approach that uses genetic variation associated with modifiable exposures as instrumental variables to infer causal relationships between exposure and outcome1. A genotype that determines intake of a specific food or nutrient, randomly assigned at meiosis, could circumvent error and confounding of traditional epidemiologic methods. Could MR therefore be a route to redemption for nutrition science?

Novel insights into the consequences of obesity: a phenotype-wide Mendelian randomization study
C He et al, EJHG January 1, 2022 (Posted: Jan 03, 2022 2PM)

Obesity is thought to significantly impact the quality of life. In this study, we sought to evaluate the health consequences of obesity on the risk of a broad spectrum of human diseases. The causal effects of exposing to obesity on health outcomes were inferred using Mendelian randomization (MR) analyses using a fixed effects inverse-variance weighted model. Our MR results confirmed many putative disease risks due to obesity, such as diabetes, dyslipidemia, sleep disorder, gout, smoking behaviors, arthritis, myocardial infarction, and diabetes-related eye disease. The novel findings indicated that elevated red blood cell count was inferred as a mediator of BMI-induced type 2 diabetes in our bidirectional MR analysis.

Mendelian randomization analyses support causal relationships between blood metabolites and the gut microbiome
X Liu et al, Nature Genetics, January 3, 2022 (Posted: Jan 03, 2022 2PM)

Mendelian randomization analyses on 3,432 Chinese individuals with whole-genome, whole-metagenome, anthropometric and blood metabolic trait data. We identified 58 causal relationships between the gut microbiome and blood metabolites, and replicated 43 of them. Increased relative abundances of fecal Oscillibacter and Alistipes were causally linked to decreased triglyceride concentration. Conversely, blood metabolites such as glutamic acid appeared to decrease fecal Oxalobacter, and members of Proteobacteria were influenced by metabolites such as 5-methyltetrahydrofolic acid, alanine, glutamate and selenium.

Finding genetically-supported drug targets for Parkinson's disease using Mendelian randomization of the druggable genome.
Storm Catherine S et al. Nature communications 2021 12 (1) 7342 (Posted: Jan 02, 2022 4PM)

We use Mendelian randomization to investigate over 3,000 genes that encode druggable proteins and predict their efficacy as drug targets for Parkinson’s disease. We use expression and protein quantitative trait loci to mimic exposure to medications, and we examine the causal effect on Parkinson’s disease risk (in two large cohorts), age at onset and progression. We propose 23 drug-targeting mechanisms for Parkinson’s disease, including four possible drug repurposing opportunities and two drugs which may increase Parkinson’s disease risk. Of these, we put forward six drug targets with the strongest Mendelian randomization evidence. There is remarkably little overlap between our drug targets to reduce Parkinson’s disease risk versus progression, suggesting different molecular mechanisms.

Common and rare variant association analyses in amyotrophic lateral sclerosis identify 15 risk loci with distinct genetic architectures and neuron-specific biology
W van Rheenen et al, Nature Genetics, December 6, 2021 (Posted: Dec 07, 2021 7AM)

We conducted a cross-ancestry genome-wide association study (GWAS) including 29,612 patients with ALS and 122,656 controls, which identified 15 risk loci. When combined with 8,953 individuals with whole-genome sequencing (6,538 patients, 2,415 controls) and a large cortex-derived expression quantitative trait locus (eQTL) dataset (MetaBrain), analyses revealed locus-specific genetic architectures in which we prioritized genes either through rare variants, short tandem repeats or regulatory effects. ALS-associated risk loci were shared with multiple traits within the neurodegenerative spectrum but with distinct enrichment patterns across brain regions and cell types. Of the environmental and lifestyle risk factors obtained from the literature, Mendelian randomization analyses indicated a causal role for high cholesterol levels.

Strengthening the Reporting of Observational Studies in Epidemiology Using Mendelian Randomization The STROBE-MR Statement
V Skrivankova et al, JAMA October 26, 2021 (Posted: Oct 26, 2021 0PM)

An international expert committee, informed by the methodological framework for guideline development of the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network and using a consensus process, developed the STROBE-MR checklist, which includes 20 main items and 30 subitems for reporting the results of MR studies. Use of the STROBE-MR reporting guideline for MR studies could facilitate evaluation by editors, peer reviewers, researchers, clinicians, and other readers, and enhance the interpretation of their results.

Trans-ethnic Mendelian-randomization study reveals causal relationships between cardiometabolic factors and chronic kidney disease.
Zheng Jie et al. International journal of epidemiology 2021 10 (Posted: Oct 24, 2021 6PM)

51, 672 CKD cases and 958 102 controls of European ancestry from CKDGen, UK Biobank and HUNT, and 13 093 CKD cases and 238 118 controls of East Asian ancestry from Biobank Japan, China Kadoorie Biobank and Japan-Kidney-Biobank/ToMMo were included. Eight risk factors showed reliable evidence of causal effects on CKD in Europeans, including genetically predicted body mass index (BMI), hypertension, systolic blood pressure, high-density lipoprotein cholesterol, apolipoprotein A-I, lipoprotein(a), type 2 diabetes (T2D) and nephrolithiasis. In East Asians, BMI, T2D and nephrolithiasis showed evidence of causality on CKD.

The effect of circulating zinc, selenium, copper and vitamin K1 on COVID-19 outcomes: a Mendelian randomization study
MK Sobczyk et al, MEDRXIV, October 19, 2021 (Posted: Oct 20, 2021 4AM)

Mendelian Randomization: Using Genetics to Study Behaviors and Environments that Cause Disease
CDC, August 2021 Brand (Posted: Sep 01, 2021 7AM)

An important part of public health research is looking at whether behaviors, environments, and other factors, which can sometimes be changed, make people more likely to get certain diseases. However, showing that these factors cause a specific disease presents challenges. Mendelian randomization studies examine how certain behaviors, environments, or other factors lead to specific health outcomes by looking at genetic differences that affect the way people’s bodies react to the behavior, environment, or other factors.

Vexed causal inferences in nutritional epidemiology-call for genetic help.
Ohukainen Pauli et al. International journal of epidemiology 2021 8 (Posted: Aug 23, 2021 7AM)

Mendelian randomization is a form of instrumental variable analysis used to assess causality of exposures using genetic data and it has become increasingly popular in epidemiology over the past decade. A clear distinction should be made between Mendelian randomization and a GWAS, the former being based on the latter. This is also reflected in the interpretation of results: a GWAS provides genetic associations in a general sense but the Mendelian randomization framework assesses potential causal effects.

Ten simple rules for conducting a mendelian randomization study.
Gagliano Taliun Sarah A et al. PLoS computational biology 2021 8 (8) e1009238 (Posted: Aug 19, 2021 8AM)

Given the growing number of MR studies in the literature and the increasing amount of publicly available genome-wide association study (GWAS) datasets and variant–trait association summary statistics, which make such studies feasible, we describe 10 simple rules for conducting an MR study. Our aim is not to provide a comprehensive and detailed overview of MR (which can be found elsewhere, but rather to present a starting place for researchers to prepare to conduct and to begin to critically evaluate existing MR studies.

Advancing the use of genome-wide association studies for drug repurposing
WR Reay et al, Nat Rev Genetics, July 2021 (Posted: Jul 25, 2021 6AM)

We explore approaches that leverage common variant genetics to identify opportunities for repurposing existing drugs, also known as drug repositioning. These approaches include the identification of compounds by linking individual loci to genes and pathways that can be pharmacologically modulated, transcriptome-wide association studies, gene-set association, causal inference by Mendelian randomization, and polygenic scoring.

Mendelian Randomization: A Precision Public Health Tool for the COVID-19 Response
E Drzymalla et al, CDC Blog, July 20, 2021 Brand (Posted: Jul 21, 2021 7AM)

In the early days of the COVID-19 pandemic, when little was known about the natural history of the disease, predicting the course of the pandemic was of premier importance for treating sick patients and redoubling efforts to protect those at highest risk of adverse outcomes. To address this need, investigators used a study design that is rooted in human genetics, Mendelian randomization, an approach that has been used to identify important modifiable risk factors for common chronic diseases.

Coffee Consumption and Incident Tachyarrhythmias- Reported Behavior, Mendelian Randomization, and Their Interactions
EJ Kim et al, JAMA Int Med, July 2021 (Posted: Jul 20, 2021 7AM)

In this population-based community cohort study of more than 300?000 participants, each additional daily cup of coffee was associated with a 3% reduced risk of developing an arrhythmia; these associations were not significantly modified by genetic variants that affect caffeine metabolism. A mendelian randomization study leveraging did not reveal evidence that caffeine consumption increases the risk of incident arrhythmias.

Genetically Predicted Cigarette Smoking in Relation to Risk of Polycystic Ovary Syndrome.
Tao Yingli et al. Clinical epidemiology 2021 13527-532 (Posted: Jul 13, 2021 8AM)

Mapping the human genetic architecture of COVID-19
COVID-19 Host Genetics Initiative, Nature, July 8, 2021 (Posted: Jul 08, 2021 0PM)

We describe the results of three genome-wide association meta-analyses comprised of up to 49,562 COVID-19 patients from 46 studies across 19 countries. We reported 13 genome-wide significant loci that are associated with SARS-CoV-2 infection or severe manifestations of COVID-19. Several of these loci correspond to previously documented associations to lung or autoimmune and inflammatory diseases3–7. They also represent potentially actionable mechanisms in response to infection. Mendelian Randomization analyses support a causal role for smoking and body mass index for severe COVID-19.

Neuropsychiatric disorders as risk factors and consequences of COVID-19: A Mendelian randomization study
Y Xiang et al, MEDRXIV, July 3, 2021 (Posted: Jul 04, 2021 8AM)

Mendelian randomization suggests a bidirectional, causal relationship between physical inactivity and obesity
GD Carrasquilla, BIORXIV, June 19, 2021 (Posted: Jun 19, 2021 7AM)

Physical inactivity is associated with excess weight gain in observational studies. However, some longitudinal studies indicate reverse causality where weight gain leads to physical inactivity. As observational studies suffer from reverse causality, it is challenging to assess the true causal directions. Here, we assess the bidirectional causality between physical inactivity and obesity by bidirectional Mendelian randomization analysis. We used results from genome-wide association studies for accelerometer-based physical activity and sedentary time in 91,105 individuals and for body mass index (BMI) in 806,834 individuals.

The effect of obesity-related traits on COVID-19 severe respiratory symptoms is mediated by socioeconomic status: a multivariable Mendelian randomization study
BC Mendoza et al, MEDRXIV, June 12, 2021 (Posted: Jun 13, 2021 7AM)

Mendelian randomization analyses show that higher acetyl-carnitine and carnitine levels in blood protect against severe Covid19
N Kazmi et al, MEDRXIV, May 31, 2021 (Posted: Jun 01, 2021 9AM)

Causality Inference of Obesity and Cancer Risk by Mendelian Randomization Analysis: Are We There yet?
S Yao et al, JNCI, May 21, 2021 (Posted: May 23, 2021 8AM)

Extension of Mendelian Randomization to Identify Earliest Manifestations of Alzheimer's Disease: Genetic Risk Score for Alzheimer's Disease Reduces BMI by Age 50.
Brenowitz Willa D et al. American journal of epidemiology 2021 4 (Posted: Apr 18, 2021 8AM)

Weight loss or lower Body Mass Index (BMI) may be an early symptom of Alzheimer's disease (AD) but when this begins to emerge is difficult to estimate with traditional observational data. In an extension of Mendelian randomization, we used genetic risk for late-onset AD risk to estimate the causal effect of AD on BMI and the earliest ages at which AD-related weight loss (or lower BMI as a proxy) occurs. 407,386 UK Biobank participants enrolled 2007-2010 without dementia.

Actionable druggable genome-wide Mendelian randomization identifies repurposing opportunities for COVID-19
L Gaziano et al Nature Medicine, April 9, 2021 (Posted: Apr 10, 2021 6AM)

To identify therapeutic targets relevant to COVID-19, we conducted Mendelian randomization analyses, deriving genetic instruments based on transcriptomic and proteomic data for 1,263 actionable proteins that are targeted by approved drugs or in clinical phase of drug development. Using summary statistics from the Host Genetics Initiative and the Million Veteran Program, we studied 7,554 patients hospitalized with COVID-19 and >1 million controls. We found significant Mendelian randomization results for three proteins (ACE2, IFNAR2, and IL-10RB).

Association of genetic liability to smoking initiation with e-cigarette use in young adults: A cohort study.
Khouja Jasmine N et al. PLoS medicine 2021 3 (3) e1003555 (Posted: Mar 21, 2021 7AM)

This mendelian randomization study shows that there may be a shared genetic aetiology between smoking and e-cigarette use, and also with socioeconomic position, externalizing disorders in childhood, and risky behaviour more generally. This indicates that there may be a common genetic vulnerability to both smoking and e-cigarette use, which may reflect a broad risk-taking phenotype.

Exploring causal relationships between COVID-19 and cardiometabolic disorders: A bi-directional Mendelian randomization study
Y Xiang et al, MEDRXIV, March 20, 2021 (Posted: Mar 20, 2021 0PM)

Proteome-wide Mendelian randomization identifies causal links between blood proteins and severe COVID-19
AB Palmos et al, MEDRXIV, March 11, 2021 (Posted: Mar 14, 2021 0PM)

The causal effect of serum vitamin D concentration on COVID-19 susceptibility, severity and hospitalization traits: a Mendelian randomization study
Z Cui et al, MEDRXIV, March 13, 2021 (Posted: Mar 14, 2021 10AM)

Leveraging genetic data to elucidate the relationship between Covid-19 and ischemic stroke
V Zuber et al, MEDRXIV, March 1, 2021 (Posted: Mar 02, 2021 8AM)

Mendelian randomization analysis was performed to investigate whether liability to critical Covid-19 was associated with increased risk of any of the cardiovascular outcomes for which genetic correlation was identified. Results There was evidence of genetic correlation between critical Covid-19 and ischemic stroke (rg=0.29, FDR p-value=4.65x10-3), body mass index (rg=0.21, FDR-p-value=6.26x10-6) and C-reactive protein (rg=0.20, FDR-p-value=1.35x10-4).

A Neanderthal OAS1 isoform protects individuals of European ancestry against COVID-19 susceptibility and severity
S Zhou et al, Nature Medicine, February 25, 2021 (Posted: Feb 26, 2021 8AM)

To identify circulating proteins influencing Coronavirus Disease 2019 (COVID-19) susceptibility and severity, we undertook a two-sample Mendelian randomization (MR) study, rapidly scanning hundreds of circulating proteins while reducing bias due to reverse causation and confounding. In up to 14,134 cases and 1.2 million controls, we found that an s.d. increase in OAS1 levels was associated with reduced COVID-19 death or ventilation, hospitalization and susceptibility.

Distinguishing causality from correlation: What factors drive SARS-CoV-2 infection and Covid-19 Severity?
A Faucon et al, COVID-19 HG Consortium, February 5, 2021 (Posted: Feb 07, 2021 7AM)

It is possible to identify risk factors that increase (or decrease) the risk of infection or the severity of COVID-19. Scientists use observational studies that compare risk factors in people who have a disease against those who do not. Using mendelian randomization researchers are disentangling whether the factor itself is causing increased susceptibility or severity, or whether other unseen forces associated with the disease are driving the risk.

Genetically predicted serum vitamin D and COVID-19: a Mendelian randomization study
BK Patchen et al, MEDRXIV, February 1, 2021 (Posted: Feb 02, 2021 11AM)

Genetics of Smoking and Risk of Atherosclerotic Cardiovascular Diseases A Mendelian Randomization Study
MG Levin et al, JAMA Network Open, January 19, 2021 (Posted: Jan 20, 2021 7AM)

In this mendelian randomization study including summary data for more than 1 million individuals, genetic liability to smoking was associated with increased risk of ASCVD, with the largest association with peripheral artery disease, independent from other cardiovascular risk factors.

Genome-wide association study in 8,956 German individuals identifies influence of ABO histo-blood groups on gut microbiome
MC Ruhleman et al, Nature Genetics, January 18, 2021 (Posted: Jan 19, 2021 8AM)

In a GWAS of 8,956 German individuals, we identified 38 genetic loci to be associated with single bacteria and overall microbiome composition. Further analyses confirm the identified associations of ABO histo-blood groups and FUT2 secretor status with Bacteroides and Faecalibacterium spp. Mendelian randomization analysis suggests causative and protective effects of gut microbes.

Cardiometabolic risks of SARS-CoV-2 hospitalization using Mendelian Randomization
NJ Lorincz-Comi et al, MEDRXIV, January 4, 2021 (Posted: Jan 04, 2021 9AM)

A Neanderthal OAS1 Isoform Protects Against COVID-19 Susceptibility and Severity: Results from Mendelian Randomization and Case-Control Studies
S Zhou et al, MEDRXIV, December 24, 2020 (Posted: Dec 25, 2020 7AM)

15 Years of Genome-wide Association Studies: What’s the Public Health Impact?
MJ Khoury et al, December 8, 2020 Brand (Posted: Dec 09, 2020 9AM)

Most research translating GWAS findings has taken one of two paths: The first pursues biological insights that could lead to new therapies. The second path makes use of population-level data and statistical methods to develop indicators of disease risk. The two leading examples of this approach are polygenic risk scores and Mendelian randomization.

Genomics of hypertension: the road to precision medicine.
Padmanabhan Sandosh et al. Nature reviews. Cardiology 2020 Nov (Posted: Nov 28, 2020 0PM)

In this Review, we appraise the current knowledge of blood pressure genomics, explore the causal pathways for hypertension identified in Mendelian randomization studies and highlight the opportunities for drug repurposing and pharmacogenomics for the treatment of hypertension.

Coagulation factors and COVID-19 severity: Mendelian randomization analyses and supporting evidence
Y Zhou et al, MEDRXIV, November 23, 2020 (Posted: Nov 23, 2020 4PM)

We assessed causal relationship between 12 coagulation factors and severe COVID-19 illness based on Mendelian randomization (MR) analyses. We then curated clinical evidence supporting causal associations between COVID-19 severity and particular coagulation factors which showed significant results in MR analyses. We validated our results in an independent cohort from UK Biobank (UKBB) using polygenic risk score (PRS) analysis and logistic regression model.

Causal Inference for Genetic Obesity, Cardiometabolic Profile and COVID-19 Susceptibility: A Mendelian Randomization Study
N Aung et al, Front in Genetics, November 11, 2020 (Posted: Nov 12, 2020 8AM)

Using Mendelian randomization in the UK biobank, we identified causal associations between BMI, LDL cholesterol and susceptibility to COVID-19. In particular, individuals in higher genetic risk categories were predisposed to SARS-CoV-2 infection. These findings support the integration of BMI into the risk assessment of COVID-19 and allude to a potential role of lipid modification in the prevention and treatment.

Prescription Opioid Use and Risk for Major Depressive Disorder and Anxiety and Stress-Related Disorders A Multivariable Mendelian Randomization Analysis
DB Rosoff et al, JAMA Psychiatry, November 11, 2020 (Posted: Nov 11, 2020 11AM)

The findings of this mendelian randomization analysis suggest evidence for potential causal associations between the genetic liability for increased prescription opioid use and the risk for major depression. While replication studies are necessary, these findings may inform prevention and intervention strategies.

Mendelian randomization study of maternal influences on birthweight and future cardiometabolic risk in the HUNT cohort
GH Moen et al, Nature Comms, October 25, 2020 (Posted: Oct 27, 2020 0PM)

We explore if a genetic risk score (GRS) of maternal SNPs associated with offspring birthweight is also associated with offspring cardiometabolic risk factors, after controlling for offspring GRS, in up to 26,057 mother–offspring pairs. Our results suggest that the maternal intrauterine environment, as proxied by maternal SNPs that influence offspring birthweight, is unlikely to be a major determinant of adverse cardiometabolic outcomes.

Impact of body composition on COVID-19 susceptibility and severity: a two-sample multivariable Mendelian randomization study
D Freuer et al, MEDRXIV, October 24,2020 (Posted: Oct 25, 2020 10AM)

Using Mendelian randomization, we investigated the causal impact of body composition on the susceptibility and severity of COVID-19. Genetically predicted BMI was strongly associated with both, susceptibility (OR=1.31 per 1 SD increase) and hospitalization (OR=1.62 per 1 SD increase) even after adjustment for genetically predicted visceral obesity traits. These associations were neither mediated substantially by T2D nor by CVD.

Modifiable lifestyle factors and severe COVID-19 risk: Evidence from Mendelian randomization analysis
S Li, MEDRXIV, October 21, 2020 (Posted: Oct 22, 2020 9AM)

Dissecting the Association Between Inflammation, Metabolic Dysregulation, and Specific Depressive Symptoms: A Genetic Correlation and 2-Sample Mendelian Randomization Study.
Kappelmann Nils et al. JAMA psychiatry 2020 Oct (Posted: Oct 21, 2020 8AM)

This study reports coheritability between CRP levels and individual depressive symptoms, which may result from the potentially causal association of metabolic dysregulation with anhedonia, tiredness, changes in appetite, and feelings of inadequacy. The study also found that IL-6 signaling is associated with suicidality.

Circulating Proteins Influencing COVID-19 Susceptibility and Severity: a Mendelian Randomization Study
S Zhou et al, MEDRXIV, October 14, 2020 (Posted: Oct 16, 2020 7AM)

To identify circulating proteins influencing COVID-19 susceptibility and severity we undertook a large-scale two-sample Mendelian randomization (MR) study, since this study design can rapidly scan hundreds of circulating proteins and reduces bias due to confounding and reverse causation. We looked at 955 circulating proteins in 10,708 uninfected individuals.

Phenome-wide Mendelian randomization mapping the influence of the plasma proteome on complex diseases.
Zheng Jie et al. Nature genetics 2020 Sep (Posted: Sep 09, 2020 9AM)

The human proteome is a major source of therapeutic targets. Recent genetic association analyses of the plasma proteome enable systematic evaluation of the causal consequences of variation in plasma protein levels. Here we estimated the effects of 1,002 proteins on 225 phenotypes using two-sample Mendelian randomization (MR) and colocalization.

Mendelian randomization analysis identified genes pleiotropically associated with the risk and prognosis of COVID-19
D Liu et al, MEDRXIV, September 4, 2020 (Posted: Sep 06, 2020 10AM)

Association between Alzheimer's disease and COVID-19: A bidirectional Mendelian randomization
D Liu et al, MEDRXIV, July 30, 2020 (Posted: Jul 31, 2020 8AM)

Smoking, alcohol consumption, and cancer: A mendelian randomisation study in UK Biobank and international genetic consortia participants.
Larsson Susanna C et al. PLoS medicine 2020 Jul (7) e1003178 (Posted: Jul 29, 2020 8AM)

Our findings support the well-established relationship between smoking and lung cancer and suggest that smoking may also be a risk factor for cancer of the head and neck, oesophagus, stomach, cervix, and bladder. We found no evidence supporting a relationship between alcohol consumption and overall or site-specific cancer risk.

Genetic drug target validation using Mendelian randomisation
AF Schmidt et al, Nature Comms, June 26, 2020 (Posted: Jun 28, 2020 3PM)

Proteins are typically the proximal effectors of biological processes encoded in the genome. Moreover, proteins are the targets of most medicines, so mendelian randomization studies of drug targets are becoming a fundamental tool in drug development. To enable such studies, we introduce an analytical framework for evaluating the robustness of analyses.

Cardiometabolic traits, sepsis and severe covid-19 with respiratory failure: a Mendelian randomization investigation
PJ Mark et al, MEDRXIV, June 20, 2020 (Posted: Jun 22, 2020 8AM)

This mendelian randomization study used the UK biobank to investigate the role of several traits with COVID-19 severity. The findings support a causal effect of elevated BMI and smoking on risk of sepsis and severe covid-19. Clinical and public health interventions targeting obesity and smoking are likely to reduce sepsis and covid-19 related morbidity,

A Mendelian randomization study of telomere length and blood-cell traits
CDC Adams et al, MEDRXIV, June 3, 2020 (Posted: Jun 04, 2020 7AM)

Exploring diseases/traits and blood proteins causally related to expression of ACE2, the putative receptor of SARS-CoV-2: A Mendelian Randomization analysis highlights tentative relevance of diabetes-related traits
S Rao et al, MEDRXIV, May 12, 2020 (Posted: May 13, 2020 10AM)

On the use of Mendelian randomization to assess the consequences of metformin exposure.
Williams Dylan M et al. International journal of epidemiology 2020 May (Posted: May 10, 2020 7AM)

Cleft lip/palate and educational attainment: cause, consequence or correlation? A Mendelian-randomization study.
Dardani Christina et al. International journal of epidemiology 2020 May (Posted: May 10, 2020 7AM)

Mendelian randomization applied to pharmaceutical use: the case of metformin and lung cancer.
Yarmolinsky James et al. International journal of epidemiology 2020 May (Posted: May 10, 2020 7AM)

Association of Myopia and Intraocular Pressure With Retinal Detachment in European Descent Participants of the UK Biobank Cohort- A Mendelian Randomization Study
X Han et al, JAMA Ophthalmology, April 30, 2020 (Posted: May 04, 2020 7AM)

In this mendelian randomization analysis including nearly 500?000 participants in the UK Biobank cohort, genetic associations between myopia and intraocular pressure with the risk of retinal detachment were found. Meaning These results add weight to existing evidence suggesting that myopia prevention efforts may help prevent retinal detachment.

Genetic evidence for protective effects of smoking and drinking behavior on Parkinson's disease: A Mendelian Randomization study
CD Baleon et al, MEDRXIV, April 24, 2020 (Posted: Apr 24, 2020 8AM)

We use a two-sample Mendelian randomization (MR) experimental design to infer causal relationships between smoking (initiation, age of initiation, heaviness, and cessation) and alcohol (drinks per week) consumption as exposure variables and PD as the health outcome.

Mendel's laws, Mendelian randomization and causal inference in observational data: substantive and nomenclatural issues.
Davey Smith George et al. European journal of epidemiology 2020 Mar (Posted: Mar 28, 2020 8AM)

Using human genetics to guide the repurposing of medicines.
Bovijn Jonas et al. International journal of epidemiology 2020 Feb (Posted: Mar 06, 2020 8AM)

Mendelian randomization has unraveled new insights into causal mechanisms of disease. While elucidation of etiological role of risk factors and biomarkers in disease is of clinical and public health importance, it is also valuable to know whether particular pharmacological targets, typically proteins, are of therapeutic relevance in specific diseases.

Association of Long-term Exposure to Elevated Lipoprotein(a) Levels With Parental Life Span, Chronic Disease–Free Survival, and Mortality Risk- A Mendelian Randomization Analysis
B Arsenault et al, JAMA Network Open, February 27, 2020 (Posted: Mar 01, 2020 7AM)

In this genetic association study including 139?362 participants, 2-sample mendelian randomization showed that genetically elevated lipoprotein(a) levels were associated with parental life span. Measured lipoprotein(a) levels were also associated with all-cause mortality in a population-based study.

Smoking, DNA Methylation, and Lung Function: a Mendelian Randomization Analysis to Investigate Causal Pathways.
Jamieson Emily et al. American journal of human genetics 2020 Feb (Posted: Feb 28, 2020 8AM)

By using mendelian randomization, we found evidence of shared causal variants between lung function, gene expression, and DNA methylation. These findings highlight potential therapeutic targets for improving lung function and possibly smoking cessation, although larger, tissue-specific datasets are required to confirm these results.

Using human genetics to understand the disease impacts of testosterone in men and women
KS Ruth et al, Nature Medicine, February 10, 2020 (Posted: Feb 11, 2020 9AM)

Summary-data-based mendelian randomization reveals druggable targets for multiple sclerosis
BM Jacobs et al, BioRXIV preprints, January 25, 2020 (Posted: Jan 26, 2020 7AM)

Multiple Sclerosis is a complex autoimmune disease caused by a combination of genetic and environmental factors. Translation of Genome-Wide Association Study findings in MS into therapeutics and effective preventive strategies has been limited to date. We used Summary Data-Based Mendelian Randomization to synthesize findings from public databases.

The causal role of circulating vitamin D concentrations in human complex traits and diseases: a large-scale Mendelian randomization study
X Jiang et al, BIOXIV, December 2019 (Posted: Dec 30, 2019 10AM)

Our MR analyses did not convincingly support a causal effect of circulating 25(OH)D on complex traits and diseases examined here. Our results may inform ongoing and future randomized clinical trials of vitamin D supplementation. Future studies are warranted to prioritize the most promising target diseases for vitamin D intervention.

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Disclaimer: Articles listed in Hot Topics of the Day are selected by Public Health Genomics Branch to provide current awareness of the scientific literature and news. Inclusion in the update does not necessarily represent the views of the Centers for Disease Control and Prevention nor does it imply endorsement of the article's methods or findings. CDC and DHHS assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by CDC or DHHS. Opinion, findings and conclusions expressed by the original authors of items included in the Clips, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of CDC or DHHS. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by CDC or DHHS.
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