Genetics of Plasma Bilirubin and Associations between Bilirubin and Cardiometabolic Risk Profiles in Danish Children and Adolescents

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Bilirubin is the end product of heme catabolism, mainly produced by the breakdown of mature red blood cells. Due to its anti-inflammatory, antioxidant, antidiabetic, and antilipemic properties, circulating bilirubin concentrations are inversely associated with the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality in adults. Some genetic loci associated with circulating bilirubin concentrations have been identified by genome-wide association studies in adults. We aimed to examine the relationship between circulating bilirubin, cardiometabolic risk factors, and inflammation in children and adolescents and the genetic architecture of plasma bilirubin concentrations. We measured fasting plasma bilirubin, cardiometabolic risk factors, and inflammatory markers in a sample of Danish children and adolescents with overweight or obesity (n = 1530) and in a population-based sample (n = 1820) of Danish children and adolescents. Linear and logistic regression analyses were performed to analyze the associations between bilirubin, cardiometabolic risk factors, and inflammatory markers. A genome-wide association study (GWAS) of fasting plasma concentrations of bilirubin was performed in children and adolescents with overweight or obesity and in a population-based sample. Bilirubin is associated inversely and significantly with a number of cardiometabolic risk factors, including body mass index (BMI) standard deviation scores (SDS), waist circumference, high-sensitivity C-reactive protein (hs-CRP), homeostatic model assessment for insulin resistance (HOMA-IR), hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), triglycerides, and the majority of measured inflammatory markers. In contrast, bilirubin was positively associated with fasting plasma concentrations of alanine transaminase (ALT), high-density lipoprotein cholesterol (HDL-C), systolic blood pressure (SDS), and the inflammatory markers GH, PTX3, THBS2, TNFRSF9, PGF, PAPPA, GT, CCL23, CX3CL1, SCF, and TRANCE. The GWAS showed that two loci were positively associated with plasma bilirubin concentrations at a p-value threshold of <5 × 10−8 (rs76999922: β = −0.65 SD; p = 4.3 × 10−8, and rs887829: β = 0.78 SD; p = 2.9 × 10−247). Approximately 25% of the variance in plasma bilirubin concentration was explained by rs887829. The rs887829 was not significantly associated with any of the mentioned cardiometabolic risk factors except for hs-CRP. Our findings suggest that plasma concentrations of bilirubin non-causally associates with cardiometabolic risk factors in children and adolescents.

Udgave nummer8
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
The study was funded by Innovation Fund Denmark (grants 0603-00484B and 0603-00457B), the Danish Diabetes Academy, the Region Zealand Health Scientific Research Foundation, and the MicrobLiver Challenge (grant number: NNF15OC0016692). SES is funded by The Novo Nordisk Foundation Copenhagen Bioscience PhD Programme (grant number: NNF18CC0033668). CEF is supported by the BRIDGE—Translational Excellence Programme (grant number: NNF18SA0034956). The Novo Nordisk Foundation Center for Basic Metabolic Research is supported by an unrestricted grant from the Novo Nordisk Foundation (NNF18CC0034900).

Funding Information:
First: the authors wish to thank all children and adolescents participating in the present study, as well as their families. Additionally, we wish to thank Birgitte Holløse and Tanja Larsen (The Children’s Obesity Clinic, Department of Pediatrics, Copenhagen University Hospital Holbæk) for their skillful laboratory assistance. We also thank Annemette Forman, Tina Hvidtfeldt Lorentzen, and Gry Julie Klavsen for their laboratory assistance, Peter Sandbeck for data management, and Lise Ryborg for grant management (all from the Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen). This study is part of the TARGET (The impact of our genomes on individual treatment response in obese children, ) and BIOCHILD (Genetics and systems biology of childhood obesity in India and Denmark, ) consortia studies, as well as The HOLBAEK Study. The Novo Nordisk Foundation Center for Basic Metabolic Research is an independent Research Center at the University of Copenhagen, partially funded by an unrestricted donation from the Novo Nordisk Foundation ( ). We thank Stefan Stender, MD, PhD for his valuable input to the manuscript.

Publisher Copyright:
© 2023 by the authors.

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