[Accessed 6 April 2020].
Kind regards,
Thank u Derek Your lectures are effectively informative and easily understood. They are clear and organized.
I’m so glad I came across this website. Thank you Derek !!!
You’re welcome, Rabia 🙂
Dear Derek,
Thanks for your extremely useful video tutorials. Please can you send me a link to open your Lit Review Excel Templates.
Thanks for your feedback. You can download the template following the instructions in the orange box.
All the best with your studies!
great effort
Thank you for this document. I am in the beginning stages of the dissertation process.
You’re welcome, Jerry 🙂
The video on literature review was very useful. I especially like the cataloging suggestion.
Great to hear that, Rishi. All the best for your research!
I`m busy writing my minor dissertation my master’s in engineering. I’m following your videos on youtube for writing a literature review. I’m looking for the excel sheet to save a list of references.
The literature video was helpful. Thank you. I haven’t received the excel template its been a week now . Please assist me .
Hi Morakane
That’s very unusual. At most, it should take a few minutes. Please re-attempt the download (use an alternative address if need be).
Thank you for the template. it seems useful to organize my literature review.
You’re very welcome.
Thank you for this informative site and all the tips. Very useful for my research.
You’re welcome, Feyi.
Currently writing a dissertation for a masters in social sciences. Found the youtube videos which are of great help.
You’re most welcome 🙂 Good luck with your literature review.
Thank you very much for the support!!
your videos are great helpful.
Glad to hear that! Good luck with your lit review.
You are the BEST
Thanks for the feedback, Annie. I wish you best of luck with your literature review.
where is the download link for the excel template?
Hi Lebogang
The download is below the first image. Good luck with your literature review!
Your videos literally saved me!!!! Due to recent issues, most of my classes were cancelled and i was completely lost. No words can explain how much grateful i am to you!!
Glad to hear we helped you! Good luck with your literature review.
You guys are the kinds of people who should survive covid-19. You are the type of people we really need in this planet. You are a star. You really saved me from many headaches. Thank you very much for the useful videos and the literature organisation spreadsheet.
Thanks for the kind words, Abel. All the best for your literature review!
Thanks so much for your video. I have consistently received comments that my arguments don’t flow well and I could never figure out how to successfully fix this issue. Now I feel I have a plan and someone to help me and provide feedback if I still don’t get it quite well. Looking forward to getting an improved mark on my next Lit review Thank you
Great to hear that, Helen. Good luck with your future literature reviews!
Excellent lecture
Thanks Biren – good luck with your literature review
i have watched your video on three steps to write a literature review and i found it very useful. thank you for sharing. keep it up.
Thanks again
Thank you for providing such excellent information and sources. Your videos helped me so much. I was on the verge of quitting. Thank you again for your videos and recommended tools.
Great to hear that, Tanya. All the best for your literature review, and for your research.
The video was very informative and timely for me. I am about to start, so Gradcoach is a source I will be revisiitng
Thanks, Nina – glad to hear that. Good luck with your literature review 🙂
hey your video is awesome I had to make an assignment on literature Review and it helped me to get an outline on how I should start ! i was fed of reading books and online articles. Your video served as a boon and clarified my thought process – how I should move forward .Thank you so much!
Great to hear that, Kavita. All the best with your literature review!
Hi Derek, I have tried unsuccessfully to download the Excel template but it keeps bringing me back to this comment section. Is it a technical issue? Kindly help.
Sorry about that. Can you please send me a screenshot of what you’re seeing – [email protected] . I will send you the template as well.
Best of luck with your literature review.
This is so very helpful!! I am writing my first lit review within a proposal (rather last minute, yikes) and this is so helpful to stay organized!
Pleasure. Good luck with your lit review 🙂
Hi i like the video,it is very helpful especially now that I am working on my proposal for thesis project….Hope I will be able to use the excel template to organize for my literature review
Great to hear that, Faith. All the best with your literature review!
hey Derek this video is absolutely amazing. One problem though I’m one of the few that are struggling to download excel. I keep clicking on it and nothing happens.
Thanks for letting us know. Please email me a screenshot of your error and I’ll sort you out – [email protected]
Thanks, Derek
Thanks a lot! Very well explained and easy to follow…now I guess I have no excuse to actually do the work 😉
Thanks for your comment! Good luck with your literature review.
Your video is very informative and useful. Thanks a lot. I also want to try the template but I can’t the find the download link…
The download button is below the main image.
Very helpful thank you
Hi! It is a big help for beginners, such as me. Thanks a lot for sharing!
Thank you. All the best with your literature review.
This is brilliant, Pls sir, in writing a review article, how deep can u go. Is it necessary to go down to the inception of your area of research?
How do I know the country/region of research article?
This will usually be covered somewhere in the article itself.
I would like this free resource
You’re welcome to download it. The download button is below the main image. Good luck with your literature review 🙂
I’d love to have this resource pls. Thank you so much
You’re welcome to download it. The download button is below the main image.
Thanks for the you tube videos. they are very informative
Thank you so much for the full tutorial with so much detailed information. I’m a Ph.D. Candidate in China. The whole syllabus of the Ph.D. program sucks. Thanks again for sharing all this helpful information. I hope your team will getting better in the future!
You’re very welcome. Good luck writing your literature review.
It’s such a big help for me. Thank you!
I’ve watched your video on writing a research proposal. I am interested in the lit review excel template.
I have watched your lecture video on writing a research proposal. I am interested in the literature review excel template and the book write smarter not harder.
It is very helpful. Thank you for your experience sharing.
You’re welcome – good luck with your literature review 🙂
Good afternoon, I recall listening/seeing in 1 of your videos *of saving the abstract (PDF) together with the excel database. How do you do this? is it also with this excel sheet
Thank you ..your videos are a confidence booster
*How To Write A Literature Review In 3 Steps (Full Tutorial)
Wonderful work !!! Please share more !!!! I will be very happy.
Thanks so much for your precision in your presentation. I have not yet started practicing but it’s one of the best I have come across. More grease to your elbows.
I love every video on research that you ve made so far. Thanks a lot
انت رائع جدا
You’re welcome. Good luck with your literature review 🙂
Excellent work. Very helpful. I am starting in this beautiful activity of writing papers with my research . I am learning a lot. Thank you very much.
Glad to hear that. Good luck writing up your research papers!
Thank you so much for the free Excel document! It’s such a huge time-saver!
You’re most welcome, Rebecca. Good luck writing your literature review 🙂
I am so grateful that I have found you on YouTube!
In the meantime, is it better to make another excel file for another variable of the same thesis or just put all articles of all variables in 1 excel file?
Thank you very much!
The notes have been very helpful to me thank you very much for sharing
You’re most welcome, Juan 🙂
Just recently seen your youtube video. Its very information. I usually gets running out of words while writing literature review. Example: XX et al investigated, YY et al shown that, ZZ et al demonstrated…….. After 4-5 references, I feels like again am repeating the words investigated, demonstrated… Could you please shoe some references with a set of vocabularies that can be used while writing literature review section.
Thank you in advance
Thank you so much. Amazing tutorial. Am feeling educated now. Lol…
Glad to hear that, Frank. Good luck with your literature review!
Very helpful stuff, thank you so much for the free Excel! I’m going to use it for my DBA and get your YT channel.
Hi, thank you for the great insights! I was unable download the template even though I completed the form. Would you be able to help me?
Derek thanks for sharing your sacrifices. I love the clarity and confidence, it takes experience to do such.
I just downloaded the excel template for LR coupled with the explanation on how to use. I found it useful, thank you!
Do you have any recommendations for adding Key quotes from a reference ?
Great content. Template very useful
Awesome! An answer to my prayer. I found this in time I need it most. Thank you for the spirit of service.
You’re most welcome, Jojo. Good luck with your literature review.
I am really impressed. This discussion helped me a lot to reconsider a lot of issues.
Thanks for the kind words. Good luck with your literature review!
This is amazing! I really like the guidance you are giving here. However, can you throw more light on the ‘category’ columns for me? I’m really nit clear on that. Thanks
Thanks for your comment. Please see my reply to Sasquia’s question re the same thing.
Good luck with your research!
I have been sitting on an enormous amount of articles for months with difficulties in organizing them until i discovered your video on literature review (YouTube). It brought me to this page where you also had a free template for us. Research process is so much bearable now than i expected. Highly recommended for all researchers. Thank you very much.
Great template. Quick question: Are the categories KEYWORDS that I draw from each source? or pre-planned TOPICS that I come up with to organize the source content?
Thanks for your comment. You can use the category columns in whichever way works for you. It would be different for each student depending on the nature of their research and their research objectives.
Hi there, can you suggest how the corresponding literature resources are best saved into a document folder for retrieval later.
I have seen some suggesting using a unique identifier in a master tab in the spreadsheet so as to be able to create a separate tab for quotes or similar thus using the id as the link
But no one has gone on to say if they are also saving the source document in a folder and naming it 57 or author last name, title or other.
I checked out your Literature Kickstarter and the screen shot of the articles didn’t look to correspond with the catalogue. Have been meaning to sort out my reference folders for sometime and am inspired by the use of an excel spreadsheet but not sure what to name files (currently saved in theme folders) Any help would be gratefully received. Thanks
I am happy if I get a catalogue excel template on the research are of zeolite synthesis from local clay for water treatment mechanism. I need help.
I love the template! But I would like to change the name of some of the headings, used in the dropdown, i.e. change “Audio Recording” to “Podcast”. How could I do that?
Very helpful!
Great!!! Very handy.
Thankyou so much. The excel file is really helpful. This really means and is helping a lot for me.
Hello, please, how can i get your excel document to catacogue the ideas for my literature review. Can you also assist on how to build the methodology section of my literature review? Thank you in advance.
I’m a student from Indonesia..This is very useful for me.. Thank you Derek..
What is the better, download all literatures and then log them into the excel sheet or do that for one by one?
Dear Derek.
I was utterly stressed when taking on an MSc Educational Leadership distance learning degree after 30 years of no academic studying. However, I found your literature review tutorial on Youtube and I immediately experienced a sense of calm direction. I am working full time in the Cayman Islands and am native Afrikaans speaking, so it was such a great help with my literature review for my first assignment. However, I have to write an evaluative essay for my second module and can not find any tutorial done by you about this. Do you perhaps have a template I could use? I have also used your services for editing and proofreading and am super grateful for the amazing help I have received! THANK YOU!
Hi Mr Derek,
It really really helps me to summarise my LR in Excel form and start-up writing
Hi Derek I have tried to download the template and it has failed to. I am not receiving the email either, could this be network issues.
Hi Derek I have been able to download the template. thank you for all your support. let me get started
I have downloaded the template. I would like to print out the guide so I can easily follow. Hope that is fine with you.
THANKS A LOTTTTT This template is exactly the one I needed when reading the literature review for my Bachelor’s dissertation
Thank you so much for your support ,I have downloaded your template and it is amazing .
Derek, The products you and the team members have put together continue to provide exemplary help as I finish the journey toward completing my dissertation! I wish I would have known of GradCoach during both of my MBAs. It could have helped alleviate a lot of time and frustration! I look forward to learning and seeing new things as I complete the dissertation.
Thanks for the kind words 🙂
Can data will be entered in excel sheet automatically like in Mendeley or i have to enter manually, pl?
Thank you GRADCOACH, I’m keenly following your tutorials as I’m about to start my literature review. These videos have been very helpful. So for the literature review you recommend only checking abstract, introduction and conclusion of the relevant literature?
Thanks for providing such an amazing resource.
I wish I knew about this when I was doing my masters. I’m doing my PhD now and sitting on Word files of reference lists and quotes I made for my MEd. This catalog will help me to keep everything more organized in one place. I’ve already started making your template my own by adding additional columns that are important for my research topic. One of the best features of your template is the Literature summary page. My question is how do I get the information I put into my new columns to auto-populate with descriptive statistics on the Literature Summary page?
Hi, I still don’t understand what you would put as ‘Category 1’, ‘Category 2’, ‘Category X’. Are they like the sort of big topics covered in the paper?
This is very helpful
Thank you so much for this summary of the process. I found your advice so helpful, and will apply it to improve the way I write. One small problem: I can´t get the Excel spreadsheet to download: every time I press on the button, it takes me back to the top of the screen.
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Paper Templates
Preparing a thesis can be extremely stressful for a student. They have to collect the relevant data, prepare the questionnaire, run the relevant tests to find the results for their hypothesis, and finally put everything in an appropriate format. When it comes to writing down all the information on paper, it can be extremely tough for some students since they would not be aware of the correct layout, however, a research paper template can be of great assistance and would help the students to write the perfect research paper.
Here are some research paper samples and templates to help you.
A research paper template MLA format would guide a researcher to write the research paper according to the MLA guidelines. They have to provide the relevant citations and it would be a lot easier to keep the template in front. With the assistance of a certain template, it becomes a lot easier to follow the MLA format, which otherwise can be a little difficult.
A research paper template for word would enable a user to find the relevant style and layout in the word file, which is usually .doc. With the assistance of a template in word format, it becomes a lot easier to follow the specific guidelines. Most universities or colleges would require submitting the research papers in a specific style and it is wise to go through the relevant templates for finding all the information, which is necessary for the completion of the research paper.
A research paper outline template would guide a researcher about the outline of the research paper. When writing a research paper, it is important to follow the correct guidelines and sometimes it becomes very difficult if there is no sample or template available to follow. With the help of a template, an individual would know about the outline of the research paper and thus would be able to write the research paper perfectly.
A research paper template APA format as the name implies give information on how to write a research paper based on the APA style of formatting. A researcher would know how to give the relevant citations and what to include and exclude from their research paper.
A research paper template example would guide a researcher to follow the pattern in a perfect manner. For example, they need to include a table of contents, abstract, introduction, literature review, research and methodology, analysis of the results, and a conclusion. For example, an individual would also get information on how to manage the content in a systematic manner. They would also know what writing style to follow for the research.
A research paper template for PDF would be available in a PDF format thus assisting an individual to go through all the specific requirements. Going through the entire document in the PDF format would be necessary to write the perfect research paper, which captures the attention of the readers as well.
Writing a research paper means a person is qualified enough to present their ideas in a certain way, which tells the reader about the acceptance or rejection of their hypothesis. It is wise to follow a certain template or a research paper sample in order to write it according to the guidelines whether they are based on MLA, APA, Chicago, or Harvard style of referencing.
Opps what went wrong, related posts.
Thank you for your feedback.
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Nature Metabolism ( 2024 ) Cite this article
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As the microbiome field moves from descriptive and associative research to mechanistic and interventional studies, being able to account for all confounding variables in the experimental design, which includes the maternal effect 1 , cage effect 2 , facility differences 3 , as well as laboratory and sample handling protocols 4 , is critical for interpretability of results. Despite significant procedural and bioinformatic improvements, unexplained variability and lack of replicability still occur. One underexplored factor is that the microbiome is dynamic and exhibits diurnal oscillations that can change microbiome composition 5 , 6 , 7 . In this retrospective analysis of 16S amplicon sequencing studies in male mice, we show that sample collection time affects the conclusions drawn from microbiome studies and its effect size is larger than those of a daily experimental intervention or dietary changes. The timing of divergence of the microbiome composition between experimental and control groups is unique to each experiment. Sample collection times as short as only 4 hours apart can lead to vastly different conclusions. Lack of consistency in the time of sample collection may explain poor cross-study replicability in microbiome research. The impact of diurnal rhythms on the outcomes and study design of other fields is unknown but likely significant.
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Literature review data are at https://github.com/knightlab-analyses/dynamics/data/ . Figure 1 , mock data are at https://github.com/knightlab-analyses/dynamics/data/MockData . Figure 2 (Allaband/Zarrinpar 2021) data are under EBI accession ERP110592 . Figure 3 data (longitudinal IHC) are under EBI accession ERP110592 and (longitudinal circadian TRF) EBI accession ERP123226 . Figure 4 data (Zarrinpar/Panda 2014) are in the Supplementary Excel file attached to the source paper 13 ; (Leone/Chang 2015) figshare for the 16S amplicon sequence data are at https://doi.org/10.6084/m9.figshare.882928 (ref. 63 ). Extended Data Fig. 2 data (Caporaso/Knight 2011) are at MG-RAST project mgp93 (IDs mgm4457768.3 and mgm4459735.3). Extended Data Fig. 3 data (Wu/Chen 2018) are under ENA accession PRJEB22049 . Extended Data Fig. 4 data (Tuganbaev/Elinav 2021) are under ENA accession PRJEB38869 .
All relevant code notebooks are on GitHub at https://github.com/knightlab-analyses/dynamics/notebooks .
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C.A. was supported by NIH T32 OD017863. S.F.R. is supported by the Soros Foundation. A.L. is supported by the AHA Postdoctoral Fellowship grant. T.K. is supported by NIH T32 GM719876. A.C.D.M. is supported by R01 HL148801-02S1. G.G.H. and A.Z. are supported by NIH R01 HL157445. A.Z. is further supported by the VA Merit BLR&D Award I01 BX005707 and NIH grants R01 AI163483, R01 HL148801, R01 EB030134 and U01 CA265719. All authors receive institutional support from NIH P30 DK120515, P30 DK063491, P30 CA014195, P50 AA011999 and UL1 TR001442.
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Division of Biomedical Sciences, University of California, San Diego, La Jolla, CA, USA
Celeste Allaband & Stephany Flores Ramos
Division of Gastroenterology, University of California, San Diego, La Jolla, CA, USA
Celeste Allaband, Amulya Lingaraju, Stephany Flores Ramos, Haniyeh Javaheri, Maria D. Tiu, Ana Carolina Dantas Machado, R. Alexander Richter & Amir Zarrinpar
Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
Celeste Allaband, Stephany Flores Ramos, Gabriel G. Haddad, Pieter C. Dorrestein & Rob Knight
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Emmanuel Elijah, Pieter C. Dorrestein, Rob Knight & Amir Zarrinpar
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C.A. and A.Z. conceptualized the work. C.A., E.E., P.C.D., R.K. and A.Z. determined the methodology. C.A., A.L., S.F.R., T.K., H.J., M.D.T., A.C.D.M. and R.A.R. were involved in data investigation. C.A., S.F.R., T.K., H.J., M.D.T., A.C.D.M. and R.A.R. created visualizations. A.Z. acquired funding and was the project administrator. R.K. and A.Z. supervised the work. G.G.H. and V.A.L. provided resources. C.A., A.L., S.F.R., T.K., H.J., M.D.T. and A.Z. wrote the first draft. All authors contributed to the review and editing of the manuscript.
Correspondence to Amir Zarrinpar .
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A.Z. is a co-founder and a chief medical officer, and holds equity in Endure Biotherapeutics. P.C.D. is an advisor to Cybele and co-founder and advisor to Ometa and Enveda with previous approval from the University of California, San Diego. All other authors declare no competing interests.
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Extended data fig. 1 microbiome literature review..
A ) 2019 Literature Review Summary. Of the 586 articles containing microbiome (16 S or metagenomic) data, found as described in the methods section, the percentage of microbiome articles from each of the publication groups. B ) The percentage of microbiome articles belonging to each individual journal in 2019. Because the numerous individual journals from Science represented low percentages individually, they were grouped together. C ) The percentage articles where collection time was explicitly stated (yes: 8 AM, ZT4, etc.), implicitly stated (relative: ‘before surgery’, ‘in the morning’, etc.), or unstated (not provided: ‘daily’, ‘once a week’, etc.). D ) Meta-Analysis Inclusion Criteria Flow Chart. Literature review resulting in the five previously published datasets for meta-analysis 11 , 13 , 28 , 29 , 30 .
A ) Weighted UniFrac PCoA Plot - modified example from Moving Pictures Qiime2 tutorial data [ https://docs.qiime2.org/2022.11/tutorials/moving-pictures/ ]. Each point is a sample. Points were coloured by body site of origin. There are 8 gut, 8 left palm, 9 right palm, and 9 tongue samples. B ) Within-Condition Distances (WCD) boxplot/stripplot for each body site (n = 8–9 mouse per group per time point). C ) Between Condition Distances (BCD) boxplot/stripplot for each unique body site comparison (n = 8–9 mouse per group per time point). D ) All pairwise grouping comparisons, both WCD and BCD, are shown in the boxplots/stripplots (n = 8–9 mouse per group per time point). Only WCD to BCD statistical differences are shown. Boxplot centre line indicates median, edges of boxes are quartiles, error bars are min and max values. Significance was determined using a paired Mann-Whitney-Wilcoxon test two-sided with Bonferroni correction. Notation: ns (not significant) = p > 0.05, * = p < 0.05; ** = p < 0.01; *** = p < 0.001, **** = p < 0.00001.
A ) Weighted UniFrac PCoA stacked view (same as Fig. 2b but different orientation). Good for assessing overall similarity not broken down by time point. Significance determined by PERMANOVA (p = 0.005). B ) Weighted UniFrac PCoA of only axis 1 over time. C ) Boxplot/scatterplot of within-group weighted UniFrac distance values for the control group (Air, n = 3–4 samples per time point). Unique non-zero values in the matrix were kept. Dotted line indicates the mean of all values presented. No significant differences (p > 0.05) found. D ) Boxplot/scatterplot of within-group weighted UniFrac distance values for the experimental group (IHC, n = 3–4 samples per time point)). Unique non-zero values in the matrix were kept. Dotted line indicates the mean of all values presented. No significant differences (p > 0.05) found. E ) Boxplot/scatterplot of within-group weighted UniFrac distance values for both control (Air) and experimental (IHC) groups [n = 3–4 samples per group per time point]. Mann-Whitney-Wilcoxon test with Bonferroni correction used to determine significant differences between groups. Boxplot centre line indicates median, edges of boxes are quartiles, error bars are min and max values. Notation: ns = not significant, p > 0.05; * = p < 0.05; ** = p < 0.01; *** = p < 0.001.
A ) Experimental design. Balb/c mice were fed NCD ad libitum under 0:24 L:D (24 hr darkness, DD) experimental conditions and compared to 12:12 L:D (LD) control conditions. After 2 weeks, mice from each group were euthanized every 4 hours for 24 hours (N = 4–5 mice/condition) and samples were collected from the proximal small intestine (‘jejunum’) and distal small intestine (‘ileum’) contents. B ) BCD for luminal contents of proximal small intestine samples comparing LD to DD mice (N = 4–5 mice/condition). Dotted line is the average of all shown weighted UniFrac distances. Significance was determined using a paired Mann-Whitney-Wilcoxon test two-sided with Bonferroni correction; notation: **** = p < 0.00001. C ) BCD for luminal contents of distal small intestine samples comparing LD to DD mice (N = 4–5 mice/condition). Dotted line is the average of all shown weighted UniFrac distances. Boxplot centre line indicates median, edges of boxes are quartiles, error bars are min and max values.
A ) Experimental design and sample collection for a local site study. Small intestinal samples were collected every 4 hours for 24 hours (N = 4–5 mice/condition, skipping ZT8). Mice were fed ad libitum on the same diet (NCD) for 4 weeks before samples were taken. B ) BCD for luminal vs mucosal conditions (N = 4–5 mice/condition). The dotted line is the average of all shown weighted UniFrac distances. Significance is determined using the Mann-Whitney-Wilcoxon test two-sided with Bonferroni correction. C ) Heatmap of mean BCD distances comparing luminal and mucosal by time point (N = 4–5 mice/condition). Highest value highlighted in navy, lowest value highlighted in gold. Boxplot centre line indicates median, edges of boxes are quartiles, error bars are min and max values. Significance was determined using a paired Mann-Whitney-Wilcoxon test two-sided with Bonferroni correction. Notation: * = p < 0.05; ** = p < 0.01; *** = p < 0.001, **** = p < 0.00001. D ) Experimentally relevant log ratio, highlighting the changes seen at ZT20 (N = 4–5 mice/condition). Boxplot center line indicates median, edges of boxes are quartiles, error bars are min and max values. Significance was determined using a paired Mann-Whitney-Wilcoxon test two-sided with Bonferroni correction. Notation: * = p < 0.05; ** = p < 0.01; *** = p < 0.001, **** = p < 0.00001.
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Allaband, C., Lingaraju, A., Flores Ramos, S. et al. Time of sample collection is critical for the replicability of microbiome analyses. Nat Metab (2024). https://doi.org/10.1038/s42255-024-01064-1
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DOI : https://doi.org/10.1038/s42255-024-01064-1
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The relationship between gut microbiota and insomnia: a bi-directional two-sample mendelian randomization research.
Introduction: Insomnia is the second most common mental health issue, also is a social and financial burden. Insomnia affects the balance between sleep, the immune system, and the central nervous system, which may raise the risk of different systemic disorders. The gut microbiota, referred to as the “second genome,” has the ability to control host homeostasis. It has been discovered that disruption of the gut-brain axis is linked to insomnia.
Methods: In this study, we conducted MR analysis between large-scale GWAS data of GMs and insomnia to uncover potential associations.
Results: Ten GM taxa were detected to have causal associations with insomnia. Among them, class Negativicutes , genus Clostridiuminnocuumgroup , genus Dorea , genus Lachnoclostridium , genus Prevotella7 , and order Selenomonadalesare were linked to a higher risk of insomnia. In reverse MR analysis, we discovered a causal link between insomnia and six other GM taxa.
Conclusion: It suggested that the relationship between insomnia and intestinal flora was convoluted. Our findings may offer beneficial biomarkers for disease development and prospective candidate treatment targets for insomnia.
Insomnia disorder, defined by self-reported sleep difficulties, is characterized by persistent difficulty initiating or sustaining sleep as well as related daytime dysfunction. With 10% to 20% of the population affected, insomnia is the second most common mental health issue (after anxiety disorder), and it is more common in older people and women. In adults, 5.8% to 20% of the population suffers from insomnia, but the prevalence of insomnia in the elderly ranges from 30% to 48%. Insomnia disorder is among the top 10 reasons for general practitioners’ consultations ( Lo Yun et al., 2022 ). It is also a social and financial burden, raising questions about public health. Insomnia affects the balance between sleep, the immune system, and the central nervous system, which may raise the risk of infection, depression, cardiovascular disease, gastrointestinal disorders, and respiratory illnesses. Chronic insomnia contributes to a variety of negative outcomes, including decreased physical and mental health (e.g., cardiovascular disease and stroke), worsened health-related life quality, and poorer mental health (e.g., chronic pain, anxiety, depression, substance misuse, and suicide). Given the severity of the negative impacts of insomnia, identifying risk factors is essential for treatments ( Jia et al., 2022 ; Yao et al., 2022 ; Gibson et al., 2023 ).
The intestinal flora, also referred to as the “second genome,” has the ability to control host homeostasis, which includes metabolic rate, immune/inflammatory response, and cardiovascular function ( Le Chatelier et al., 2013 ). The gut microbiome (GM) is also linked to neuropsychiatric illnesses, as it may regulate brain function and behavior through the microbiota-gut-brain axis ( Iannone et al., 2019 ; Zhang et al., 2021 ; Wang Z. et al., 2022 ). There are variations in GM taxa among people with epilepsy, depression, autistic spectrum disorder, and Parkinson’s disease. Recent research has shown that the gut-brain axis is dysregulated in relation to insomnia and that abnormalities in the gut microbiota can make the condition worse. To date, there have been few investigations into the relationship between intestinal flora and insomnia ( Qi et al., 2022 ; Bundgaard-Nielsen et al., 2023 ; Chalet et al., 2023 ).
Fortunately, large-scale genome-wide association studies (GWASs) on gut microbiota and insomnia are now available, allowing for a meaningful assessment of association in MR analysis. Through instrumental variables (IV) that are genetic variants strongly related to the exposure of interest, Mendelian randomization (MR) analysis is used to investigate the causal relationship between exposure and outcome. In MR research, single nucleotide polymorphisms (SNPs) are used as instrumental variables (IV) ( Burgess and Thompson, 2017 ; Burgess et al., 2017 ). SNPs adhere to the principle of random genetic variation assignment at meiosis, which eliminates the influence of confounding factors and the potential impact of reverse causation because genetic variants exist prior to the start of the disease ( Lawlor et al., 2008 ). Therefore, when compared to RCT, MR analysis can more quickly identify the causal relationships between relevant exposure components and outcomes. Currently, no MR studies on insomnia and GM have been undertaken. Here, we conduct an MR analysis through large-scale GWAS summary statistics of GMs and insomnia to uncover potential GM taxa that could support some current findings and offer novel viewpoints on the identification and management of insomnia.
Study design.
The overall flow chart of this study is shown in Figure 1 . The three presumptions below must be satisfied by MR studies: (i) IVs are highly linked with exposure variables, (ii) IVs are independent of confounding factors, and (iii) IVs are only associated with outcomes via exposure factors ( Burgess et al., 2017 ). Our results followed the STROBE-MR guidelines ( Skrivankova et al., 2021a ).
Figure 1 Flowchart of current study.
From the MiBioGen project, we obtained the gut microbiota statistics summary-level data, the largest genome-wide meta-analysis to date ( Kurilshikov et al., 2021 ). In the MiBioGen project, the 16S rRNA gene sequencing profiles of 18,340 individuals were assembled and evaluated, and 211 GM taxa were identified (from genus to phylum level, including 9 phyla, 16 classes, 20 orders, 35 families, and 131 genera). The GWAS summary statistics for GMs can be found at https://mibiogen.gcc.rug.nl ( Swertz and Jansen, 2007 ; Swertz et al., 2010 ; van der Velde et al., 2019 ). Insomnia GWAS summary data were obtained from the UK Biobank Sleep Traits GWAS: Self-report (insomnia associations and sleep duration associations) ( https://sleep.hugeamp.org/downloads.html ). Insomnia symptoms were self-reported by European-ancestry UK Biobank participants (n=453,379). Participants were asked the question: “Do you have trouble falling asleep at night or do you wake up in the middle of the night?” and were asked to select from responses of “never/rarely”, “sometimes”, “usually”, and “prefer not to answer” in this sample; twenty-nine percent of people self-reported experiencing frequent insomnia symptoms on a regular basis (or “usually”) ( Gibson et al., 2023 ).
In this MR study, IVs were SNPs that were highly correlated with each GM taxon. We obtained the number of IVs for gut microbiota data with the threshold (p<5×10 -5 ), and the threshold in reverse MR analyses was set under p<5×10 -8 for insomnia data. Additionally, we removed SNPs within a window size of 500 kb and a threshold of r 2 <0.1 to reduce linkage disequilibrium (LD) for gut microbiota data, whereas for insomnia data in reverse MR analysis, the window size was set at kb=10000 and a threshold of r 2 <0.001. Then, we eliminated palindromic SNPs and SNPs that were not present in the IV results. Finally, to measure the degree of weak instrumental bias, the F-statistic of IVs was computed. If the F-statistic was >10, it was assumed that no bias was caused by weak IVs. The formula for calculating the F-value is F = ( R 2 1 − R 2 ) ( n − k − 1 ) k , R 2 = 2 × ( 1 − M A F ) × M A F × ( β ) 2 ( Pierce et al., 2011 ).
The principal MR method for determining causation was the inverse variance weighted random effect (IVW-RE). Based on the meta-analysis principles, the IVW approach is a Wald ratio estimator extension ( Pagoni et al., 2019 ). Methods of MR-Egger, weighted median, simple mode, and weighted mode were carried out for each GM taxon on insomnia ( Bowden et al., 2016 ; Burgess and Thompson, 2017 ; Davies et al., 2018 ). If the IVW approach revealed a causal association for that taxon (p<0.05), these four MR methods were used to supplement the IVW findings. The criterion of the weighted median method is that at least 50% of the SNPs must satisfy the premise that they are valid IVs ( Davies et al., 2018 ; Verbanck et al., 2018 ). The MR-Egger method provides unbiased estimates even when all selected IVs are multivariate ( Burgess and Thompson, 2017 ). Finally, odds ratios (OR) and 95% confidence intervals (CI) were utilized to present the findings of causal connections. The significance cutoff was established at p<0.05.
Only exposure-outcome pairs that were discovered using all MR techniques and had the same direction were thought to have a causal relationship. We also carried out a number of sensitivity studies to examine the consistency of the causal association. First, horizontal pleiotropy was identified through the MR-Egger and MR-PRESSO tests ( Rees et al., 2017 ; Verbanck et al., 2018 ; Skrivankova et al., 2021b ). Additionally, the leave-one-out and Funnel plots analyses were conducted to evaluate the reliability of the findings. In this study, “TwoSampleMR” and “MR-PRESSO” packages of R software (version 4.3.0) were used to carry out the MR analysis.
To investigate the reverse causality of insomnia (as exposures) on gut microbiota (as outcomes), a reverse MR analysis was carried out for insomnia on each GM taxa. The process followed the same guidelines as the methodology indicated above for the two-sample MR. This bidirectional MR and sensitivity analysis follows the rules of the TwoSample MR and MR-PRESSO packages.
Details of ivs.
Under a suggestive significance level of P<1×10 -5 , 2,284 SNPs were discovered, and three duplicated SNPs (rs10805326, rs2728491, and rs2704155) were deleted. These SNPs were grouped into five categories as final IVs: class, family, order, genus, and phylum. Particularly, there were 200 IVs in 18 classes, 439 IVs in 35 families, 245 IVs in 20 orders, 1,483 IVs in 131 genera, and 112 IVs in 9 phyla. Furthermore, all IVs were shown to be more strongly related to exposure than to outcome ( p exposure < p outcome ), and all F-statistics were greater than 10. Details of the IVs of insomnia are presented in Supplementary Table 1 .
First, 211 GM taxa with five methods (IVW-RE, MR-Egger, weighted median, simple mode, and weighted mode) were evaluated using MR analysis to determine their causal relationship with insomnia ( Figure 2 ). The IVW-FE results revealed that 10 GM taxa had a significant association with insomnia. Family FamilyXIII (ID: 1957) [OR=0.982 (0.966, 0.997), p =0.020], genus Odoribacter (ID: 952) [OR=0.976(0.954,0.999), p =0.044], genus Oscillibacter (ID: 2063) [OR=0.985(0.974,0.996), p =0.005], and phylum Verrucomicrobia (ID: 3982) [OR=0.986(0.974,0.999), p =0.032] were related to a lower risk for insomnia, while class Negativicutes (ID: 2164) [OR=1.031(1.016,1.047), p =7.53E-05], genus Clostridiuminnocuumgroup (ID: 14397) [OR=1.018(1.005,1.031), p =0.006], genus Dorea (ID: 1997) [OR=1.017(1.001,1.034), p =0.039], genus Lachnoclostridium (ID: 11308) [OR=1.029(1.007,1.052), p =0.009], genus Prevotella7 (ID: 11182) [OR=1.009(1.002,1.017), p =0.017], and order Selenomonadales (ID: 2165) [OR=1.031(1.016,1.047), p =7.53E-05] were associated with a higher risk of insomnia. Additionally, the findings of Cochran’s Q test showed that there was no heterogeneity.
Figure 2 Results [OR (95%CI)] for MR analyses for GWAS data of 211 GM taxa (exposure) on insomnia (outcome) through inverse variance weighted random effect (IVW-RE) method: 9 phyla, 16 classes, 20 orders, 35 families, and 131 genera. It showed that 10 GM taxa, including class Negativicutes (ID: 2164), Family FamilyXIII (ID: 1957), order Selenomonadales (ID: 2165), phylum Verrucomicrobia (ID: 3982), genus Odoribacter (ID: 952), genus Oscillibacter (ID: 2063), genus Clostridiuminnocuumgroup (ID: 14397), genus Dorea (ID: 1997), genus Lachnoclostridium (ID: 11308), and genus Prevotella7 (ID: 11182), had causality with insomnia.
Additionally, four additional methods, MR-Egger, weighted median, simple mode, and weighted mode, were performed to assess the causal effect of these 10 GM taxa on insomnia ( Figure 3 ). The results were consistent with the IVW-FE results. Family FamilyXIII (ID: 1957), phylum Verrucomicrobia (ID: 3982), genus Odoribacter (ID: 952), and genus Oscillibacter (ID: 2063) were related with a lower risk for insomnia, while the other six GMs [class Negativicutes (ID: 2164), genus Clostridiuminnocuumgroup (ID: 14397), genus Dorea (ID: 1997), genus Lachnoclostridium (ID: 11308), genus Prevotella7 (ID: 11182), and order Selenomonadales (ID: 2165)] showed a higher risk of insomnia. There was no indication of heterogeneity, pleiotropy, or weak instrument bias in the heterogeneity (IVW test and MR-Egger regression), pleiotropy (MR-PRESSO test and MR-Egger regression), or weak instrument bias (F statistic) tests. Additional details are summarized in Supplementary Table 2 .
Figure 3 Five methods’ (MR-Egger, weighted median, inverse variance weighted, simple mode, and weighted mode) results (OR[95%CI]) of MR analyses for 10 GM taxa on insomnia.
IVs were retrieved from GWAS datasets of insomnia in a previous MR analysis of the relationship between gut microbiota and insomnia, with a significance of P-value at 1×10 -8 . Forty SNPs were discovered from 2,500 SNPs (SNPs of insomnia GWAS data at P<1×10 -8 ) after removing SNPs with linkage disequilibrium. First, we conducted MR analysis to determine the relationship between insomnia and 10 GM taxa, including the class Negativicutes (ID: 2164), family FamilyXIII (ID: 1957), genera Odoribacter (ID: 952), Oscillibacter (ID: 2063), Clostridiuminnocuumgroup (ID: 14397), Dorea (ID: 1997), Lachnoclostridium (ID: 11308), Prevotella7 (ID: 11182), order Selenomonadales (ID: 2165), and phylum Verrucomicrobia (ID: 3982). It demonstrated the lack of a causal relationship between insomnia and these 10 GM taxa, which was consistent with our prior MR findings. Additional details are summarized in Supplementary Table 3 and Supplementary Figure S1 .
Reverse MR analysis was then used to investigate the other 201 GM taxa for insomnia. According to the IVW-FE results, six GM taxa substantially correlate with insomnia. Insomnia could increase the abundance of the gut microbiota of family Oxalobacteraceae (ID:2966) [OR=3.075 (1.453, 6.511), p =0.003], genus Butyrivibrio (ID:1993) [OR=2.656(1.005, 7.016), p =0.049], genus Clostridiumsensustricto1 (ID:1873) [OR=1.708 (1.085, 2.687), p =0.021], and genus Oxalobacter (ID:2978) [OR=2.434(1.104,5.370), p =0.028], while insomnia could decrease the abundance of genus Eubacteriumnodatumgroup (ID:11297) [OR=0.310(0.098,0.961), p =0.042] and genus RuminococcaceaeUCG013 (ID:11370)[OR=0.522(0.345, 0.791), p =0.002]. Furthermore, four additional methods, MR-Egger, weighted median, simple mode, and weighted mode, were performed to assess the causal effect of insomnia on these GM taxa ( Figure 4 ). The outcomes matched those of the IVW in a similar way. In this investigation, neither the IVW test nor the MR-Egger regression showed any evidence of heterogeneity, pleiotropy, or weak instrument bias. The MR-PRESSO test and the MR-Egger regression also showed no evidence of these phenomena. Then, we conducted scatter plots and leave-one-out plots for insomnia on six GM taxa [family Oxalobacteraceae (ID:2966), genus Butyrivibrio (ID:1993), genus Clostridiumsensustricto1 (ID:1873), genus Oxalobacter (ID:2978), genus Eubacteriumnodatumgroup (ID:11297), and genus RuminococcaceaeUCG013 (ID:11370)]. Furthermore, the inverse variance weighted, MR-Egger, and weighted median results of the MR Steiger directionality test demonstrated a strong direction from insomnia to the six GM taxa. The robustness of our findings was demonstrated by the leave-one-out sensitivity analysis, which showed that no one SNP drives a causal association ( Figure 5 ). Funnel plots of Inverse variance weighted and MR Egger results excluded a potential bias ( Supplementary Figure S2 ).
Figure 4 Reverse MR analyses results (OR[95%CI]) of five methods (MR-Egger, weighted median, inverse variance weighted, simple mode, and weighted mode) for insomnia on six GM taxa (family Oxalobacteraceae , genus Butyrivibrio , genus Clostridiumsensustricto1 , genus Oxalobacter , genus Eubacteriumnodatumgroup , and genus RuminococcaceaeUCG013 ).
Figure 5 The scatter plot and leave-one-out plot of MR analyses for insomnia on six GM taxa. (A) : exposure: insomnia, outcome: family Oxalobacteraceae (ID:2966). (B) : exposure: insomnia, outcome: genus Eubacteriumnodatumgroup (ID:11297). (C) : exposure: insomnia, outcome: genus Butyrivibrio (ID:1993). (D) : exposure: insomnia, outcome: genus Clostridiumsensustricto1 (ID:1873). (E) : exposure: insomnia, outcome: genus Oxalobacter (ID:2978). (F) : exposure: insomnia, outcome: genus RuminococcaceaeUCG013 (ID:11370).
To the best of our knowledge, this is the first MR investigation using huge GWAS summary-level data to indicate a probable causal connection between gut microbiota and insomnia. This study examined the causative impact of 211 GM taxa (from the class, family, order, genus, and phylum level) on insomnia. In this study design, we checked and confirmed the assumptions of Mendelian Randomization (MR). We discovered 10 GM taxa that are connected to insomnia, and reverse MR analysis revealed that 6 GM taxa may be affected. The gut microbiome’s potential protective or contributing effects on insomnia suggest a close connection between the two conditions.
Nowadays, the gut microbiome and its impact on humans are receiving increasing attention. Growing data suggest that the gut microbiota (GM) can control host homeostasis in both health and disease, for example, through the gut-brain axis, gut-lung axis, gut-kidney axis, gut-skin axis, gut-liver axis, and gut-immune axis. Researchers have discovered links between gut microbiota and many diseases, such as autism spectrum disorder, depression, epilepsy, Alzheimer’s disease, type 2 diabetes, obesity, chronic obstructive pulmonary disease, atopic dermatitis, COVID-19 illness, psoriasis, and systemic autoimmune diseases. Clinical trials on intestinal flora have shown efficacy in the treatment of disorders such as epilepsy, autism, Alzheimer’s disease, inflammatory bowel disease, rheumatoid arthritis, and psoriasis ( Iannone et al., 2019 ; Orru et al., 2020 ; Mahmud et al., 2022 ; Mousa et al., 2022 ; Qin et al., 2022 ). Recent research has shown that GMs are involved in neuropsychiatric disorders because they affect brain activity and behavior through the microbiota-gut-brain axis ( Johnson and Foster, 2018 ). It has been discovered that disruption of the gut-brain axis is linked to insomnia. In our study, we identified six GMs in the reverse MR. Given that gut microbiota was related to many diseases, these disorders may directly or indirectly arise in the six GMs. The gut microbiota’s particular metabolites have been reported to be related to insomnia, and alterations in the gut microbiota may worsen the condition. Its molecular mechanism is not yet fully understood ( Haimov et al., 2022 ; Feng et al., 2023 ).
Insomnia is believed to have a negative impact on the quality of life in adults and the elderly population around the world. In general, insomnia affects 5.8 to 20% of the adult population, whereas it affects 30% to 48% of the elderly population. Insomnia is the result of a complex interaction of behavioral (such as stress, lifestyle, workplace culture, environment, and sleeping arrangements), physiological, and genetic factors. The negative effects of insomnia on many organs lead to abnormal sleep patterns, cognitive performance, and emotional reactions ( Li et al., 2020 ; Jia et al., 2022 ; Gibson et al., 2023 ). In addition to contributing to the pathological progression of the immunological, endocrine, and cardiovascular systems, it also causes neuropsychiatric illnesses such as depression, dementia, mania, schizophrenia, and anxiety disorders. The risk of hypertension, diabetes mellitus, arthritis, stomach ulcers, gastroesophageal reflux illness, migraine, depression, obesity, heart attack or stroke, asthma, menstruation issues, obesity, and infection has also been linked to insomnia. These conditions and consequences have a cumulative effect on insomnia. Multiple attempts have been made to build models to interpret and explain the onset and evolution of insomnia; nevertheless, these models are insufficient to represent comprehensive knowledge ( Reynolds et al., 2017 ; Gao et al., 2019 ; Cai et al., 2021 ; Jiang et al., 2022 ; Wang Q. et al., 2022 ; Zeng et al., 2023 ).
In this study, through MR analysis of the GWAS database, we investigated whether there is a connection between intestinal flora and insomnia. The findings demonstrated a strong relationship and potential interaction between gut flora and insomnia. Studies have suggested that gut bacteria play a role in the development of insomnia, but the specific mechanism is unknown. Growing evidence points to a critical function for the gut microbiota in the regulation of sleep behavior, both directly and indirectly, as well as a potential role in the pathophysiology and etiology of sleep disorders. It has been found that in older people with insomnia, differences in the composition of the gut microbiota and the abundance of particular genera are associated with poor sleep and poor cognitive function. Studies revealed that insomniacs had considerably higher relative abundances of Lactobacillus crispatus and Streptococcus compared to healthy controls. Five metabolic pathways, including those for glycerophospholipid metabolism, glutathione metabolism, nitrogen metabolism, aspartate, glutamate, alanine metabolism, and aminoacyl-tRNA production, may be involved in the gut microbiota’s ability to cause insomnia ( Le Chatelier et al., 2013 ; Ning et al., 2022 ). In both human studies and animal models, it has been suggested by researchers that gut bacteria may contribute to sleep issues.
When compared to the findings of earlier studies, this study’s findings exhibit parallels and discrepancies. Pro-inflammatory activation may be one major component causing insomnia. According to studies, chronic sleep deprivation is linked to higher levels of IL-1 and TNF-α in the brain, as well as higher levels of IL-6 in the blood during the day. According to research ( Wang Q. et al., 2022 ), people with acute and chronic insomnia disorders have lower abundances of several anaerobic gut flora taxa, including Lachnospira , Roseburia , and Prevotella 9 . We discovered that the genera Prevotella7 (ID:11182) and Lachnoclostridium (ID:11308) are associated with a significant incidence of insomnia. Prevotella is a Gram-negative bacterium that helps break down protein and carbohydrate foods. Prevotella is frequently believed to have a lower abundance in certain diseases ( Ley, 2016 ). Studies ( Feng et al., 2023 ) also identified that several Prevotella (such as Prevotella amnii , Prevotella buccalis , Prevotella colorans , and Prevotella timonensis ) were associated with changes in inflammatory and metabolite levels, indicating that Prevotella may affect sleep by regulating metabolites and promoting inflammation. However, more is not always better; recent human research has showed an increase in Prevotella to systemic illnesses such as periodontitis, bacterial vaginosis, rheumatoid arthritis, metabolic problems, low-grade systemic inflammation, and schizophrenia ( Bertelsen et al., 2021 ; Iljazovic et al., 2021 ). The gut taxon Lachnoclostridium is a genus of Gram-positive bacteria, and people with ulcerative colitis and irritable bowel syndrome tend to have higher concentrations of Lachnoclostridium ( Cai et al., 2022 ). Lachnoclostridium was more prevalent in patients with COVID-19 and was identified by MR analysis as having a high risk of AD ( Iannone et al., 2019 ; Zhang and Zhou, 2023 ).
In contrast to earlier research, our findings show that the genus Dorea (ID:1997) has a high risk of sleeplessness. According to studies ( Zhang et al., 2021 ), patients with major depressive illnesses and sleep disorders had lower levels of Streptococcus , Dorea , Barnesiella , and Intestinibacter . Dorea bacteria is a member of the thick-walled bacterial porophyllium group, which is widely distributed in the human intestine. By inducing Treg cells and preventing Th17 cell differentiation and function, Dorea bacteria can control the intestinal immune response and preserve the stability and integrity of the gut mucous barrier. Dorea is more prevalent and is suspected to have an inflammatory effect in patients with multiple sclerosis, inflammatory bowel disease, colorectal cancer, autism spectrum disorders, and obesity. Studies have shown that the composition, diversity, and metabolic activity of the gut microbiota change significantly between healthy individuals and insomniacs. Bacteroides and Clostridiales are considered to be the two most crucial biomarkers for differentiating between insomniacs and healthy people. Additionally, the mechanism behind the connection between gut microbiota and insomnia is unclear. Research has found that the microbial ecosystem in the human gut is complex and diverse, and the collaborative relationships between different types of bacteria can disrupt the stability of the microbial ecosystem; the competitive relationship between different bacterial communities helps maintain the stability of the intestinal ecosystem. Rakoff-Nahoum S ( Rakoff-Nahoum et al., 2016 ) evolved cooperation within the Bacteroidales , the dominant Gram-negative bacteria of the human intestine. We know little about cooperation within this important ecosystem and studies are few. Our research provides guidance and a foundation for the management of insomnia. This current study is also incomplete, we did not identify GMs and the associated SNPs to understand the meaning of the SNPs to the GM. It will be very meaningful to figure out the function of SNPs to the GMs in the future.
The current study has a number of limitations that need to be mentioned. Firstly, because the study only included participants with primarily European ancestry, there could be already many genomic variations within European ancestry. It may be possible that the SNPs in the host can directly or indirectly cause insomnia. Therefore, in order to strengthen the conclusion, additional research involving participants from diverse parts of the world would be necessary to extend the findings to other groups without constraint. Secondly, a higher permissive threshold (p<1×10 -5 ) was used because there were so few IVs that met the rigorous criteria (p<5×10 -8 ) for screening. Thirdly, self-reporting insomnia symptoms has limitations, including recall bias and lack of granularity; the cases of insomnia in this study were not strictly defined, so future analysis based on strict criteria for insomnia GWAS data is required to strengthen confidence in a conclusion. Fourthly, the GM GWAS data included in this analysis was based solely on 16S rRNA sequencing from genus to phylum level; additional metagenomic and multiomic techniques should target gut microbiota composition at a more precise level to prevent bias. Fifthly, MR analysis relies on three important assumptions mentioned above. In this study, SNPs are used as instrumental variables (IV), GMs as exposure, and insomnia as outcome (GMs>SNPs>insomnia); in reverse MR analysis, insomnia is used as exposure and GMs as outcome (insomnia>SNPs>GMs); considering the complicated links between insomnia and GMs, it may be possible that host SNPs may affect insomnia through GMs; another MR study (GMs as IV, SNPs as exposure, and insomnia as outcome; SNPs>GMs>insomnia) could be conducted to explore the causality between host SNPs and insomnia in the future. Finally, the identified GMs might exist in both insomnia and healthy individuals; therefore, it is necessary to regroup the individuals with or without the GM-associated significant IVs, and intervening with GMs in insomnia research can help strengthen the causal link in the future.
Overall, we detected 10 causal associations after performing an MR analysis on the causal impacts of 211 GM taxa on insomnia. Among them, class Negativicutes , genus Clostridiuminnocuumgroup , genus Dorea , genus Lachnoclostridium , genus Prevotella7 , and order Selenomonadalesare were significantly associated with increased insomnia risk. We discovered a causal link between insomnia and six other GM taxa through reverse MR analysis. It suggested that the relationship between insomnia and intestinal flora is convoluted. However, since the current work was based on a GWAS summary-level dataset derived from 16S rRNA sequencing, more in-depth analyses based on more advanced large-scale studies generated from metagenomics sequencing are required. Nevertheless, our findings may offer beneficial biomarkers for disease development and prospective candidate treatment targets for insomnia.
The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/ Supplementary Material .
This study of “The relationship between gut microbiota and insomnia: a bi-directional two-sample Mendelian randomization research” relied on publicly available de-identified data from participant studies that had been authorized by an ethical standards committee. There was hence no need for extra, separate ethical approval for this investigation. Written informed consent for participation was not required from the participants or the participants’ legal guardians/next of kin in accordance with the national legislation and institutional requirements.
YL: Conceptualization, Data curation, Formal Analysis, Funding acquisition, Investigation, Methodology, Project administration, Software, Visualization, Writing – original draft, Writing – review & editing. QD: Data curation, Supervision, Writing – review & editing. ZL: Project administration, Supervision, Visualization, Writing – review & editing.
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the Medical and Health Technology Plan Project of Zhejiang Province (2023RC247).
We appreciate the MiBioGen group for releasing GM-related GWAS summary data. We want to acknowledge the participants and investigators of the UK Biobank Sleep Traits.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fcimb.2023.1296417/full#supplementary-material
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Keywords: gut microbiome, insomnia, sleep disorders, bi-directional Mendelian randomization analysis, relationship
Citation: Li Y, Deng Q and Liu Z (2023) The relationship between gut microbiota and insomnia: a bi-directional two-sample Mendelian randomization research. Front. Cell. Infect. Microbiol. 13:1296417. doi: 10.3389/fcimb.2023.1296417
Received: 18 September 2023; Accepted: 07 November 2023; Published: 28 November 2023.
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Copyright © 2023 Li, Deng and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yan Li, [email protected]
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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University ranking is crucial as it attracts prospective students and academics. The ranking of public research universities in Malaysia works as a catalyst for securing government and other corporate research funding. This study measures the technical efficiency of five public research universities in Malaysia (PRUMs). This study employs a triangular fuzzy number in the Banker, Charnes, and Cooper (BCC) Fuzzy Data Envelopment Analysis (BCC-FDEA) model. The three world ranking indicators employed as output variables are teaching and research reputations and citations, and the input variables are the number of full-time students and staff. Data gathered for the academic years from 2018/2019 to 2020/2021 are used to project the efficiency scores for 2021/2022. The BCC-FDEA model is also used to consider five public research universities in Asia (APRUs) as the decision-making units (DMUs) to solve the issue of sample size adequacy. This study projects three PRUMs as technically inefficient due to input factor issues. Two main contributions of this study are: (1) QS world ranking indicators are profound parameters that research universities should consider to attain a better position in the world ranking; (2) fuzzy efficiency scores shed light on how inefficient PRUMs can improve their operations by emulating their referent DMUs.
JATI PUBLICATION ETHICS & PUBLICATION MALPRACTICE STATEMENT: These guidelines are fully consistent with the COPE Principles of Transparency and Best Practice Guidelines and the COPE Code of Conduct ( https://publicationethics.org ). We encourage the best standards of publication ethics and take all possible principles of transparency and measures against publication malpractices. The Department of Southeast Asian Studies, as the publisher, plays its role of guardianship over all processes of publishing seriously, and we perform our ethical and other tasks.
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Methodology
Published on June 7, 2021 by Shona McCombes . Revised on November 20, 2023 by Pritha Bhandari.
A research design is a strategy for answering your research question using empirical data. Creating a research design means making decisions about:
A well-planned research design helps ensure that your methods match your research objectives and that you use the right kind of analysis for your data.
Step 1: consider your aims and approach, step 2: choose a type of research design, step 3: identify your population and sampling method, step 4: choose your data collection methods, step 5: plan your data collection procedures, step 6: decide on your data analysis strategies, other interesting articles, frequently asked questions about research design.
Before you can start designing your research, you should already have a clear idea of the research question you want to investigate.
There are many different ways you could go about answering this question. Your research design choices should be driven by your aims and priorities—start by thinking carefully about what you want to achieve.
The first choice you need to make is whether you’ll take a qualitative or quantitative approach.
Qualitative approach | Quantitative approach |
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and describe frequencies, averages, and correlations about relationships between variables |
Qualitative research designs tend to be more flexible and inductive , allowing you to adjust your approach based on what you find throughout the research process.
Quantitative research designs tend to be more fixed and deductive , with variables and hypotheses clearly defined in advance of data collection.
It’s also possible to use a mixed-methods design that integrates aspects of both approaches. By combining qualitative and quantitative insights, you can gain a more complete picture of the problem you’re studying and strengthen the credibility of your conclusions.
As well as scientific considerations, you need to think practically when designing your research. If your research involves people or animals, you also need to consider research ethics .
At each stage of the research design process, make sure that your choices are practically feasible.
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Within both qualitative and quantitative approaches, there are several types of research design to choose from. Each type provides a framework for the overall shape of your research.
Quantitative designs can be split into four main types.
Type of design | Purpose and characteristics |
---|---|
Experimental | relationships effect on a |
Quasi-experimental | ) |
Correlational | |
Descriptive |
With descriptive and correlational designs, you can get a clear picture of characteristics, trends and relationships as they exist in the real world. However, you can’t draw conclusions about cause and effect (because correlation doesn’t imply causation ).
Experiments are the strongest way to test cause-and-effect relationships without the risk of other variables influencing the results. However, their controlled conditions may not always reflect how things work in the real world. They’re often also more difficult and expensive to implement.
Qualitative designs are less strictly defined. This approach is about gaining a rich, detailed understanding of a specific context or phenomenon, and you can often be more creative and flexible in designing your research.
The table below shows some common types of qualitative design. They often have similar approaches in terms of data collection, but focus on different aspects when analyzing the data.
Type of design | Purpose and characteristics |
---|---|
Grounded theory | |
Phenomenology |
Your research design should clearly define who or what your research will focus on, and how you’ll go about choosing your participants or subjects.
In research, a population is the entire group that you want to draw conclusions about, while a sample is the smaller group of individuals you’ll actually collect data from.
A population can be made up of anything you want to study—plants, animals, organizations, texts, countries, etc. In the social sciences, it most often refers to a group of people.
For example, will you focus on people from a specific demographic, region or background? Are you interested in people with a certain job or medical condition, or users of a particular product?
The more precisely you define your population, the easier it will be to gather a representative sample.
Even with a narrowly defined population, it’s rarely possible to collect data from every individual. Instead, you’ll collect data from a sample.
To select a sample, there are two main approaches: probability sampling and non-probability sampling . The sampling method you use affects how confidently you can generalize your results to the population as a whole.
Probability sampling | Non-probability sampling |
---|---|
Probability sampling is the most statistically valid option, but it’s often difficult to achieve unless you’re dealing with a very small and accessible population.
For practical reasons, many studies use non-probability sampling, but it’s important to be aware of the limitations and carefully consider potential biases. You should always make an effort to gather a sample that’s as representative as possible of the population.
In some types of qualitative designs, sampling may not be relevant.
For example, in an ethnography or a case study , your aim is to deeply understand a specific context, not to generalize to a population. Instead of sampling, you may simply aim to collect as much data as possible about the context you are studying.
In these types of design, you still have to carefully consider your choice of case or community. You should have a clear rationale for why this particular case is suitable for answering your research question .
For example, you might choose a case study that reveals an unusual or neglected aspect of your research problem, or you might choose several very similar or very different cases in order to compare them.
Data collection methods are ways of directly measuring variables and gathering information. They allow you to gain first-hand knowledge and original insights into your research problem.
You can choose just one data collection method, or use several methods in the same study.
Surveys allow you to collect data about opinions, behaviors, experiences, and characteristics by asking people directly. There are two main survey methods to choose from: questionnaires and interviews .
Questionnaires | Interviews |
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) |
Observational studies allow you to collect data unobtrusively, observing characteristics, behaviors or social interactions without relying on self-reporting.
Observations may be conducted in real time, taking notes as you observe, or you might make audiovisual recordings for later analysis. They can be qualitative or quantitative.
Quantitative observation | |
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There are many other ways you might collect data depending on your field and topic.
Field | Examples of data collection methods |
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Media & communication | Collecting a sample of texts (e.g., speeches, articles, or social media posts) for data on cultural norms and narratives |
Psychology | Using technologies like neuroimaging, eye-tracking, or computer-based tasks to collect data on things like attention, emotional response, or reaction time |
Education | Using tests or assignments to collect data on knowledge and skills |
Physical sciences | Using scientific instruments to collect data on things like weight, blood pressure, or chemical composition |
If you’re not sure which methods will work best for your research design, try reading some papers in your field to see what kinds of data collection methods they used.
If you don’t have the time or resources to collect data from the population you’re interested in, you can also choose to use secondary data that other researchers already collected—for example, datasets from government surveys or previous studies on your topic.
With this raw data, you can do your own analysis to answer new research questions that weren’t addressed by the original study.
Using secondary data can expand the scope of your research, as you may be able to access much larger and more varied samples than you could collect yourself.
However, it also means you don’t have any control over which variables to measure or how to measure them, so the conclusions you can draw may be limited.
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As well as deciding on your methods, you need to plan exactly how you’ll use these methods to collect data that’s consistent, accurate, and unbiased.
Planning systematic procedures is especially important in quantitative research, where you need to precisely define your variables and ensure your measurements are high in reliability and validity.
Some variables, like height or age, are easily measured. But often you’ll be dealing with more abstract concepts, like satisfaction, anxiety, or competence. Operationalization means turning these fuzzy ideas into measurable indicators.
If you’re using observations , which events or actions will you count?
If you’re using surveys , which questions will you ask and what range of responses will be offered?
You may also choose to use or adapt existing materials designed to measure the concept you’re interested in—for example, questionnaires or inventories whose reliability and validity has already been established.
Reliability means your results can be consistently reproduced, while validity means that you’re actually measuring the concept you’re interested in.
Reliability | Validity |
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) ) |
For valid and reliable results, your measurement materials should be thoroughly researched and carefully designed. Plan your procedures to make sure you carry out the same steps in the same way for each participant.
If you’re developing a new questionnaire or other instrument to measure a specific concept, running a pilot study allows you to check its validity and reliability in advance.
As well as choosing an appropriate sampling method , you need a concrete plan for how you’ll actually contact and recruit your selected sample.
That means making decisions about things like:
If you’re using a probability sampling method , it’s important that everyone who is randomly selected actually participates in the study. How will you ensure a high response rate?
If you’re using a non-probability method , how will you avoid research bias and ensure a representative sample?
It’s also important to create a data management plan for organizing and storing your data.
Will you need to transcribe interviews or perform data entry for observations? You should anonymize and safeguard any sensitive data, and make sure it’s backed up regularly.
Keeping your data well-organized will save time when it comes to analyzing it. It can also help other researchers validate and add to your findings (high replicability ).
On its own, raw data can’t answer your research question. The last step of designing your research is planning how you’ll analyze the data.
In quantitative research, you’ll most likely use some form of statistical analysis . With statistics, you can summarize your sample data, make estimates, and test hypotheses.
Using descriptive statistics , you can summarize your sample data in terms of:
The specific calculations you can do depend on the level of measurement of your variables.
Using inferential statistics , you can:
Regression and correlation tests look for associations between two or more variables, while comparison tests (such as t tests and ANOVAs ) look for differences in the outcomes of different groups.
Your choice of statistical test depends on various aspects of your research design, including the types of variables you’re dealing with and the distribution of your data.
In qualitative research, your data will usually be very dense with information and ideas. Instead of summing it up in numbers, you’ll need to comb through the data in detail, interpret its meanings, identify patterns, and extract the parts that are most relevant to your research question.
Two of the most common approaches to doing this are thematic analysis and discourse analysis .
Approach | Characteristics |
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Thematic analysis | |
Discourse analysis |
There are many other ways of analyzing qualitative data depending on the aims of your research. To get a sense of potential approaches, try reading some qualitative research papers in your field.
If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.
Statistics
Research bias
A research design is a strategy for answering your research question . It defines your overall approach and determines how you will collect and analyze data.
A well-planned research design helps ensure that your methods match your research aims, that you collect high-quality data, and that you use the right kind of analysis to answer your questions, utilizing credible sources . This allows you to draw valid , trustworthy conclusions.
Quantitative research designs can be divided into two main categories:
Qualitative research designs tend to be more flexible. Common types of qualitative design include case study , ethnography , and grounded theory designs.
The priorities of a research design can vary depending on the field, but you usually have to specify:
A sample is a subset of individuals from a larger population . Sampling means selecting the group that you will actually collect data from in your research. For example, if you are researching the opinions of students in your university, you could survey a sample of 100 students.
In statistics, sampling allows you to test a hypothesis about the characteristics of a population.
Operationalization means turning abstract conceptual ideas into measurable observations.
For example, the concept of social anxiety isn’t directly observable, but it can be operationally defined in terms of self-rating scores, behavioral avoidance of crowded places, or physical anxiety symptoms in social situations.
Before collecting data , it’s important to consider how you will operationalize the variables that you want to measure.
A research project is an academic, scientific, or professional undertaking to answer a research question . Research projects can take many forms, such as qualitative or quantitative , descriptive , longitudinal , experimental , or correlational . What kind of research approach you choose will depend on your topic.
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There is a major epidemic of obesity, and many obese patients suffer from respiratory symptoms and disease. However, limited research explores the associations between abdominal obesity and lung function indices, yielding mixed results. This study aims to analyze the association between waist circumference (WC), an easily measurable marker of abdominal obesity, and lung function parameters in middle-aged and older adults using the National Health and Nutrition Examination Survey (NHANES).
This study utilized data obtained from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2012, with a total sample size of 6089 individuals. A weighted multiple regression analysis was conducted to assess the relationship between WC and three pulmonary function parameters. Additionally, a weighted generalized additive model and smooth curve fitting were applied to capture any potential nonlinear relationship within this association.
After considering all confounding variables, it was observed that for each unit increase in WC, in males, Forced Vital Capacity (FVC) increased by 23.687 ml, Forced Expiratory Volume in one second (FEV1) increased by 12.029 ml, and the FEV1/FVC ratio decreased by 0.140%. In females, an increase in waist circumference by one unit resulted in an FVC increase of 6.583 ml and an FEV1 increase of 4.453 ml. In the overall population, each unit increase in waist circumference led to a FVC increase of 12.014 ml, an FEV1 increase of 6.557 ml, and a decrease in the FEV1/FVC ratio by 0.076%. By constructing a smooth curve, we identified a positive correlation between waist circumference and FVC and FEV1. Conversely, there was a negative correlation between waist circumference and the FEV1/FVC ratio.
Our findings indicate that in the fully adjusted model, waist circumference, independent of BMI, positively correlates with FVC and FEV1 while exhibiting a negative correlation with FEV1/FVC among middle-aged and older adults in the United States. These results underscore the importance of considering abdominal obesity as a potential factor influencing lung function in American middle-aged and older adults.
Obesity has emerged as a significant global public health challenge. Obesity has markedly increased in over 70 countries since 1980 and continues to rise in most others [ 1 , 2 ]. In 2015, the global population of individuals classified as obese surpassed one-third [ 3 ], and this number is projected to reach a staggering 1.12 billion by 2030 [ 4 ]. Obesity constitutes a substantial risk factor for numerous ailments, including metabolic disorders, cardiovascular and cerebrovascular diseases, dyslipidemia, asthma, chronic obstructive pulmonary disease (COPD), and cancer [ 5 , 6 , 7 , 8 ]. Obesity is commonly categorized into two types: abdominal obesity, assessed by waist circumference, and general obesity, determined by body mass index (BMI) [ 9 ]. However, BMI has inherent limitations, as it relies on weight and height measurements [ 10 , 11 ]. Consequently, BMI may not be a perfect indicator of obesity, particularly among men with higher muscle mass [ 12 ]. Furthermore, BMI fails to accurately assess the relationship between obesity and associated diseases due to its inability to account for variations in body fat distribution [ 13 , 14 , 15 ]. The commonly utilized pulmonary function parameters in the respiratory system include FVC, FEV1, and the FEV1/FVC ratio. The normal reference range for FVC is approximately 3000 ml to 5000 ml, while the normal reference range for FEV1 typically falls between 2000 ml and 4000ml [ 16 ]. However, these values are more influenced by factors such as age, gender, height, and weight [ 16 ]. A strong association between obesity, particularly abdominal obesity, and lung function has been established in the literature [ 17 , 18 ].
In addition, obesity can be divided into android obesity (fat distribution in the chest, abdomen and internal organs) and gynoid obesity (fat distribution in the subcutaneous tissue of the limbs and buttocks) according to the characteristics of fat distribution [ 19 ]. This difference in fat distribution leads to android obesity having a more direct effect on lung mechanics than female obesity, because the increase in chest fat and the increase in abdominal volume can affect diaphragm contraction and reduce lung volume [ 20 ]. Not only that, android obesity will also secrete more pro-inflammatory adipokines because of its special fat distribution, aggravating the activation of immune cells and metabolic disorders [ 20 ].
However, existing research has focused mainly on children and adolescents, with mixed results. A study of Chinese people aged 20–80 years showed that WC was positively correlated with FEV1 and FVC [ 21 ] whereas another study of Chinese elderly people reported that an increase in WC was associated with a decrease in FEV1 and FVC [ 22 ]. Marga et al. [ 23 ] reported no significant association between WC and FVC or FEV1 in 8-year-olds. In contrast, Feng et al. [ 24 ] found that WC in Chinese children was negatively correlated with lung function. Zhang et al. [ 10 ] discovered that abdominal obesity was associated with impaired lung function among adults with asthma. Since the decline in lung function is closely related to changes in body size, we hypothesize that WC, independent of BMI, may be associated with impairment of lung function.
Therefore, our study aimed to use the National Health and Nutrition Survey (NHANES) database to investigate the correlation between WC and lung function in middle-aged and older adults. By using WC as a measure, we aim to elucidate the potential association between abdominal obesity and lung function in this particular population.
The data for our study were sourced from the National Health and Nutrition Examination Survey (NHANES), a comprehensive survey conducted by the Centers for Disease Control and Prevention (CDC). Our study drew on data from NHANES spanning 2007 to 2012. The dataset comprises demographic, examination, laboratory, and questionnaire information. After an initial screening of the NHANES database, we identified that lung function data were available only for the period mentioned. Consequently, we included all participants ( n = 30,442) from the NHANES conducted between 2007 and 2012. We excluded individuals (1) aged < 40 years old ( n = 18,679) (2); missing lung function test results data (FEV1 or FVC) or having low data quality (C, D, F) ( n = 4619) (3); missing WC data ( n = 159) (4); missing data about covariates at least one of following ( n = 896): BMI, the ratio of family income to poverty (PIR), total cholesterol, total bilirubin, total protein, aspartate aminotransferase (AST), or alanine aminotransferase (ALT). Ultimately, our study incorporated a substantial and nationally representative sample of middle-aged and older adults from the United States. A flowchart illustrating the screening process is presented in Fig. 1 for clarity. This study was approved by the ethics review board of the National Center for Health Statistics (NCHS) and obtained written informed consent from all participants.
Flowchart for selecting analyzed participants FEV1, forced expiratory volume in one second; FVC, forced vital capacity; NHANES, National Health and Nutrition Examination Survey
Lung function tests are performed by trained professional researchers and are tested in a standing position, unless the participant was physically limited. Lung function assessments were conducted using the Ohio 822/827 dry-roll volume spirometer, following the recommended guidelines from the American Thoracic Society (ATS) and the European Respiratory Society (ERS). The spirometry variables utilized in this study included FEV1, FVC, and the FEV1/FVC ratio. To ensure the reliability and accuracy of the spirometry measurements, the ATS/ERS criteria for acceptability and reproducibility were applied, resulting in spirometry quality grades ranging from A to F. Grades A and B indicated measurements that fulfilled or exceeded the ATS criteria. In contrast, grade C could still be considered for analysis. Grades D to F, conversely, were deemed less likely to be useful.
It is important to note that our study only included data with spirometry quality grades A and B for FEV1 and FVC. This rigorous selection criterion was employed to guarantee the accuracy and reliability of the measurement data while excluding data with lower quality grades (C, D, and F).
WC measurements were conducted by trained health technicians in the Mobile Examination Center as part of the NHANES survey. The measurement procedure involved determining the waist circumference at the uppermost lateral border of the right ilium, with precision recorded to the nearest 0.1 cm.
The criteria for selecting covariates in this study were: (1) demographic data; (2) variables affecting WC and lung function parameters in the published literature [ 25 , 26 ]; (3) according to the recommendation of the STROBE statement, covariates with regression coefficients on the outcome variables with a P value < 0.10 or covariates that resulted in more than a 10% change in the regression coefficients of the risk factors after introduction of the covariates in the base model; (4) other variables accumulated on the basis of clinical experience.The demographic data consisted of age (in years), gender, race/ethnicity (including Mexican American, other Hispanic, non-Hispanic white, non-Hispanic black, and others), poverty-to-income ratio, educational level (categorized as less than high school, high school, and more than high school), and marital status (married, single, living with a partner). Furthermore, examination data and personal life history variables were included in our analysis. These variables encompassed BMI (in kg/m²), alcohol consumption (defined as having consumed at least 12 alcoholic drinks/1 year), smoking history (defined as having smoked at least 100 cigarettes in life), histories of diabetes, hypertension, and respiratory diseases. Last, laboratory data variables were incorporated, comprising measurements of total protein levels (in g/L), total cholesterol levels (in mmol/L), total bilirubin levels (in µmol/L), aspartate aminotransferase (AST) levels (in U/L), and alanine aminotransferase (ALT) levels (in U/L). For more detailed information regarding these variables, including specific measurement methods and ranges, ( https://www.cdc.gov/nchs/nhanes/ ) provides comprehensive access to publicly available data.
Statistical analyses were conducted following the guidelines provided by the Centers for Disease Control and Prevention (CDC) [CDC guideline criteria: https://wwwn.cdc.gov/nchs/nhanes/tutorials/default.aspx ]. Continuous variables were reported as the means ± standard deviations (SD). Categorical variables are presented as percentages. Initially, weighted χ^2 tests were employed for categorical variables, while weighted linear regression models were used for continuous variables. Subsequently, we constructed four weighted linear regression models (Model 1, Model 2, Model 3, and Model 4), adjusting various variables to examine the association between WC and lung function parameters. A stratified analysis was also performed based on the fully adjusted model to explore potential stratified associations between WC and lung function. Additionally, a generalized additive model (GAM) with a penalty spline method was utilized to construct a smoothed curve-fitting fully adjusted model, treating WC as a continuous variable. We also calculated the variance inflation factor (VIF) for the variables, with VIF values of 5.8 and 6.6 for BMI and WC (supplementary Table 1 ), respectively. As a rule of thumb, the threshold for VIF values with multicollinearity between variables is 10 [ 27 ].
All statistical analyses were performed using Empower Stats software and R version 4.2.0. A p value of less than 0.05 was considered statistically significant in our study.
Table 1 shows the weighted distribution of baseline characteristics, including demographic, examination, laboratory, and questionnaire data, for the participants selected from the NHANES survey conducted between 2007 and 2012. A total of 6,089 participants aged 40–79 years were included in our study. The average age of the selected participants was 56.49 years (± 10.65), and non-Hispanic whites constituted the majority of the study population. The distribution of all included variables across the quartiles demonstrated statistically significant differences (p values < 0.05).
Weighted multiple regression analysis was conducted to examine the association between WC and lung function parameters, as presented in Table 2 . In males, both Model 1 and Model 2, representing unadjusted and age, race adjusted associations, revealed a negative correlation between WC and FVC as well as FEV1, while a positive correlation was observed with FEV1/FVC. In Model 3, which additionally adjusted for BMI based on Model 2, WC exhibited a positive correlation with FVC and FEV1, and a negative correlation with FEV1/FVC. Finally, in the fully adjusted Model 4, WC showed a positive correlation with FVC (β = 23.687, 95% CI: 18.523, 28.852) and FEV1 (β = 12.029, 95% CI: 7.789, 16.270), but a negative correlation with FEV1/FVC (β = -0.140, 95% CI: -0.192, -0.088).Similar results were observed in females and the total population. In fully adjusted analyses for females, WC exhibited a positive correlation with FVC (β = 6.583, 95% CI: 3.629, 9.538) and FEV1 (β = 4.453, 95% CI: 1.988, 6.918), and a negative correlation with FEV1/FVC (β = -0.034, 95% CI: -0.072, 0.004), although without statistical significance. In the fully adjusted analysis for the total population, WC showed a positive correlation with FVC (β = 12.014, 95% CI: 9.251, 14.777) and FEV1 (β = 6.557, 95% CI: 4.284, 8.831), and a negative correlation with FEV1/FVC (β = -0.076, 95% CI: -0.107, -0.046). Due to partial collinearity between WC and BMI, we assessed individual associations between WC, BMI, and pulmonary function to elucidate the potential mediating role of BMI in the relationship between WC and pulmonary function (Supplementary Figs. 1 – 4 ).
To assess the stability of the multivariate regression analysis results, we conducted stratified analyses to examine the associations between WC and lung function parameters in different subgroups. The results are presented in Table 3 .
In the subgroup analyses, WC demonstrated a positive relationship with FVC in most subgroups, except for the subgroup of other races, less than high school, living with a partner, BMI > 30, and borderline diabetes history. Similarly, WC showed a positive relationship with FEV1 in most subgroups, except for the subgroup of age > 60, other race, less than high school, high school, living with a partner, BMI25-30, BMI > 30 (negative correlation with statistical significance), at least 12 alcohol drinks/1 year, with diabetes history, borderline diabetes history, and respiratory diseases history. On the other hand, WC exhibited a negative relationship with FEV1/FVC in most subgroups, except for the non-Hispanic Black, other race, more than high school, living with a partner, all BMI subgroups, no smoking, borderline diabetes history and hypertension history subgroups. Furthermore, gender and BMI have a significant interaction with FVC (p for interaction < 0.0001); BMI and diabetes history have a significant interaction with FEV1 (p for interaction < 0.0001).
To ensure the reliability of the regression analysis results, we used a generalized additive model (GAM) to investigate whether there is a linear or nonlinear correlation between WC and lung function parameters. In our study, based on Model 4 (adjusted for all covariates), we constructed a smooth-fitting curve to observe potential correlations. Figure 2 shows the results obtained from the GAM analysis. We observed a nonlinear relationship between WC and lung function parameters. After adjusting for all covariates, we found that WC, FVC and FEV1 were positively correlated and nonlinear. Conversely, we observe a nonlinear negative correlation between WC and FEV1/FVC ratios. With the increase of WC, the FEV1/FVC ratio tends to decrease.
Based on the fully adjusted model, the relationship between waist circumference and lung function
To our knowledge, there has been limited investigation into the relationship between WC and lung function parameters in middle-aged and older adults in the United States, accounting for the influence of BMI. We investigated the correlation between WC and lung function parameters in 6089 middle-aged and older adults who participated in the NHANES survey in the United States between 2007 and 2012. Four weighted multiple linear regression models were used to determine the relationship between WC and three lung function parameters. Based on NHANES data from 2007 to 2012, we found that WC was negatively associated with FVC and FEV1 and positively associated with FEV1/FVC in the unadjusted model and after adjusting for age and race. After adjusting for BMI, the correlation between WC and FVC and FEV1 became positive, and the correlation with FEV1/FVC became negative. Finally, the correlation between WC and lung function parameters in the fully adjusted model was the same as above (Male: FVC, β = 23.687; FEV1, β = 12.029; FEV1/FVC, β = -0.140; Female: FVC, β = 6.583; FEV1, β = 4.453; FEV1/FVC, β = -0.034; Total population: FVC, β = 12.014; FEV1, β = 6.557; FEV1/FVC, β=-0.076). To verify the accuracy and stability of this association, we performed a stratified analysis. Then, we build a smooth curve model to further assess the reliability of the results.
Our study results indicate an association between increased WC and decreased FEV1/FVC ratio, aligning with the majority of previously published findings. A study by Zhang et al. [ 28 ]. in American adults found that abdominal obesity was associated with an increased risk of airflow obstruction defined by FEV1/FVC. A cohort study in the Netherlands by Marga et al. [ 23 ]. found that large WC in girls only, independent of BMI, was associated with lower FEV1/FVC. Feng et al. [ 24 ]. found that waist-to-chest ratio (WCR) was negatively correlated with FVC, FEV1, FVC/FEV1 in Chinese adolescents and children, after adjusting for gender height and BMI. Chen et al [ 29 ]. found that an increase in WC in children aged 6–17 years is associated with an increase in FVC and FEV1, while it is associated with a decrease in the FEV1/FVC ratio. With respect to FVC and FEV1, Zeng et al. [ 21 ]. discovered that in the Chinese population aged 20–80 years, WC and obesity defined by WC are positively correlated with FVC and FEV1. A cohort study by Pan et al. [ 22 ]. reported that abdominal obesity and its indicators (WC, WHtR, WHR and body fat) were associated with decreased FVC and FEV1 in the older Chinese population. Zhang et al. [ 10 ] reported that in adult asthma patients in the United States, the abdominal obesity group was associated with lower FVC and FEV1 compared to the normal group. Our data reveals that in the model without adjusting for BMI, WC is negatively correlated with FVC and FEV1, while after adjusting for BMI, it exhibits a positive correlation. These divergent conclusions about FVC and FEV1 may be attributed to differences in study designs, study population, and the confounding factors included, particularly BMI.
Central obesity is a specific type of obesity characterized by the accumulation of fat in the chest, abdomen, and internal organs [ 30 ]. Obesity reduces respiratory compliance, alters breathing patterns, affecting lung function [ 19 , 31 ]. The fatty deposition also causes narrowing, closure, and hyperresponsiveness of the airways, resulting in uneven ventilation [ 32 , 33 ]. Excess body fat alters respiratory physiology and impairs lung function [ 34 ]. Abdominal fat accumulation can affect the contraction of the diaphragm and impair lung function. The effect of intra-abdominal pressure on the diaphragm is one of the important reasons for the impairment of lung function [ 14 , 35 ]. Thus, abdominal obesity leads to decreased lung compliance, increased airway resistance, and limited daily exercise [ 19 , 36 ]. People with abdominal obesity may also change their breathing pattern to rapid and shallow breathing. This style of breathing increases the risk of airflow limitation, hypoxia, respiratory overload, and respiratory complications [ 37 ]. In addition, inflammation and oxidative stress have been identified as key factors in impaired lung function due to abdominal obesity [ 38 , 39 ]. Systemic adipose tissue inflammation may be responsible for impaired lung function due to abdominal obesity [ 40 ]. Abdominal obesity is considered to be an inflammatory state [ 18 ], and many inflammatory factors come from visceral adipose tissue, such as IL-6, TNF-α, C-reactive protein (CRP), leptin, etc., which may lead to obesity-related airway inflammation [ 41 ]. In addition, CRP is also thought to cause impairment of lung function [ 42 ]. An in vitro study found that CRP is present in human respiratory secretions [ 43 ] and may play a local role in lung tissue, decreasing airway diameter and lung function [ 18 , 44 ]. Besides, studies have demonstrated that the relationship between lung function and abdominal obesity is also affected by CRP gene polymorphisms. The researchers found that the CRP rs1205 CC genotype was associated with impaired lung function [ 45 ], suggesting that the CRP gene plays a partial role in lung function inheritance.
Compared with previously published articles, our study has the following advantages. First, our sample includes 6089 nationally representative middle-aged and older adults, and the sample size is relatively large. Second, we have taken into account BMI, an important confounding factor, so that WC as an indicator of abdominal fat deposits can be understood in the context of body type so that we can understand its full impact on respiratory function. Also, we performed a stratified analysis that considered the possible impact of BMI and other confounding factors on the results, which helped verify the reliability of the results and identify possible susceptible populations. Finally, based on completely adjusting the model, we performed smooth curve fitting and explored the relationship between WC and lung function parameters.
However, it should be noted that our study design is a cross-sectional study and cannot prove a causal relationship between abdominal obesity and altered lung function, so more prospective cohort studies are needed to validate the conclusions. Second, we chose WC as a marker of abdominal obesity, while other markers, such as waist-to-height ratio or waist-hip ratio, were not included in the study due to lack of data or small sample sizes. Future studies are needed to confirm our results with other methods of measuring abdominal obesity. Third, while we adjusted for many confounders, other potential confounding factors were not considered, similar to other cross-sectional studies. Finally, our survey is based on the NHANES database, which applies to the US population and, therefore, is geographically limited in versatility. More comprehensive studies are needed to determine the relationship between WC and lung function parameters.
No datasets were generated or analysed during the current study.
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This study was supported by the Natural Science Foundation of Education Department of Anhui Province (No. 2022AH051221), Anhui Province Key Laboratory of Biological Macromolecules Research of Wannan Medical College (No. LAB202204) and Anhui Province Key Clinical Specialist Construction Programs.
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Department of Laboratory Medicine, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
Zichen Xu, Lingdan Zhuang, Lei Li, Luqing Jiang, Jianjun Huang & Qiwen Wu
Department of Kidney Medicine, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
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ZXC and QWW designed the study and wrote the manuscript. LDZ, LL, LQJ, DQL, and JJH performed the statistical analysis and prepared Figs. 1 and 2. All authors reviewed and approved the final manuscript.
Correspondence to Daoqin Liu or Qiwen Wu .
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The National Center for Health Statistics (NCHS) conducted the survey and received approval from the NCHS Institutional Review Board (IRB). Before data collection and NHANES health examinations, informed consent was obtained from all eligible subjects. ( https://www.cdc.gov/nchs/nhanes/irba98.htm ).
Furthermore, all authors affirmed that the methods employed in the study adhered to the relevant NHANES Analytic Guidelines. ( https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx#analytic-guidelines ).
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Xu, Z., Zhuang, L., Li, L. et al. Association between waist circumference and lung function in American middle-aged and older adults: findings from NHANES 2007–2012. J Health Popul Nutr 43 , 98 (2024). https://doi.org/10.1186/s41043-024-00592-6
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DOI : https://doi.org/10.1186/s41043-024-00592-6
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The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the Medical and Health Technology Plan Project of Zhejiang Province (2023RC247). Acknowledgments. We appreciate the MiBioGen group for releasing GM-related GWAS summary data.
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