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Title: A global multicenter study on reference values: 2. Exploration of sources of variation across the countries
Authors: Ichihara, Kiyoshi 
Ozarda, Yesim 
Barth, Julian H 
Klee, George 
Shimizu, Yoshihisa 
Xia, Liangyu 
Hoffmann, Mariza 
Shah, Swarup 
Matsha, Tandi Edith 
Wassung, Janette 
Smit, Francois 
Ruzhanskaya, Anna 
Straseski, Joely 
Bustos, Daniel N 
Kimura, Shogo 
Takahashi, Aki 
Keywords: Reference values;Worldwide multicenter study;Body mass index (BMI);Multiple regression analysis;Age-related changes;Ethnicity-related changes;BMI-related changes;Smoking-related changes;Alcohol-related changes
Issue Date: 2017
Publisher: Elsevier
Journal: Clinica Chimica Acta 
Abstract: Objectives: The intent of this study, based on a global multicenter study of reference values (RVs) for serum analytes was to explore biological sources of variation (SVs) of the RVs among 12 countries around the world. Methods: As described in the first part of this paper, RVs of 50 major serum analytes from 13,396 healthy individuals living in 12 countries were obtained. Analyzed in this study were 23 clinical chemistry analytes and 8 analytes measured by immunoturbidimetry. Multiple regression analysis was performed for each gender, country by country, analyte by analyte, by setting four major SVs (age, BMI, and levels of drinking and smoking) as a fixed set of explanatory variables. For analytes with skewed distributions, log-transformation was applied. The association of each source of variation with RVs was expressed as the partial correlation coefficient (rp). Results: Obvious gender and age-related changes in the RVs were observed in many analytes, almost consistently between countries. Compilation of age-related variations of RVs after adjusting for between-country differences revealed peculiar patterns specific to each analyte. Judged from the rp, BMI related changes were observed for many nutritional and inflammatory markers in almost all countries. However, the slope of linear regression of BMI vs. RV differed greatly among countries for some analytes. Alcohol and smoking-related changes were observed less conspicuously in a limited number of analytes. Conclusion: The features of sex, age, alcohol, and smoking-related changes in RVs of the analytes were largely comparable worldwide. The finding of differences in BMI-related changes among countries in some analytes is quite relevant to understanding ethnic differences in susceptibility to nutritionally related diseases
ISSN: 0009-8981
Appears in Collections:HWSci - Journal Articles (DHET subsidised)

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