Association between PTPN1 polymorphisms and obesity-related phenotypes in European adolescents: influence of physical activity.


Journal

Pediatric research
ISSN: 1530-0447
Titre abrégé: Pediatr Res
Pays: United States
ID NLM: 0100714

Informations de publication

Date de publication:
Jun 2023
Historique:
received: 27 07 2022
accepted: 23 10 2022
revised: 06 10 2022
medline: 3 7 2023
pubmed: 13 11 2022
entrez: 12 11 2022
Statut: ppublish

Résumé

To study the associations of Protein Tyrosine Phosphatase-N1 (PTPN1) polymorphisms with obesity-related phenotypes in European adolescents, and the influence of physical activity on these relationships. Five polymorphisms of PTPN1 were genotyped in 1057 European adolescents (12-18 years old). We measured several phenotypes related to obesity, such as adiposity markers, and biochemical and clinical parameters. Physical activity was objectively measured by accelerometry. The T, A, T, T and G alleles of the rs6067472, rs10485614, rs2143511, rs6020608 and rs968701 polymorphisms, respectively, were associated with lower levels of obesity-related phenotypes (i.e., body mass index, body fat percentage, hip circumference, fat mass index, systolic blood pressure and leptin) in European adolescents. In addition, the TATTG haplotype was associated with lower body fat percentage and fat mass index compared to the AACCA haplotype. Finally, when physical activity levels were considered, alleles of the rs6067472, rs2143511, rs6020608 and rs968701 polymorphisms were only associated with lower adiposity in active adolescents. PTPN1 polymorphisms were associated with adiposity in European adolescents. Specifically, alleles of these polymorphisms were associated with lower adiposity only in physically active adolescents. Therefore, meeting the recommendations of daily physical activity may reduce obesity risk by modulating the genetic predisposition to obesity. Using gene-phenotype and gene*environment analyses, we detected associations between polymorphisms of the Protein Tyrosine Phosphatase-N1 (PTPN1) gene and obesity-related phenotypes, suggesting a mechanism that can be modulated by physical activity. This study shows that genetic variability of PTPN1 is associated with adiposity, while physical activity seems to modulate the genetic predisposition. This brings insights about the mechanisms by which physical activity positively influences obesity.

Sections du résumé

BACKGROUND BACKGROUND
To study the associations of Protein Tyrosine Phosphatase-N1 (PTPN1) polymorphisms with obesity-related phenotypes in European adolescents, and the influence of physical activity on these relationships.
METHODS METHODS
Five polymorphisms of PTPN1 were genotyped in 1057 European adolescents (12-18 years old). We measured several phenotypes related to obesity, such as adiposity markers, and biochemical and clinical parameters. Physical activity was objectively measured by accelerometry.
RESULTS RESULTS
The T, A, T, T and G alleles of the rs6067472, rs10485614, rs2143511, rs6020608 and rs968701 polymorphisms, respectively, were associated with lower levels of obesity-related phenotypes (i.e., body mass index, body fat percentage, hip circumference, fat mass index, systolic blood pressure and leptin) in European adolescents. In addition, the TATTG haplotype was associated with lower body fat percentage and fat mass index compared to the AACCA haplotype. Finally, when physical activity levels were considered, alleles of the rs6067472, rs2143511, rs6020608 and rs968701 polymorphisms were only associated with lower adiposity in active adolescents.
CONCLUSIONS CONCLUSIONS
PTPN1 polymorphisms were associated with adiposity in European adolescents. Specifically, alleles of these polymorphisms were associated with lower adiposity only in physically active adolescents. Therefore, meeting the recommendations of daily physical activity may reduce obesity risk by modulating the genetic predisposition to obesity.
IMPACT CONCLUSIONS
Using gene-phenotype and gene*environment analyses, we detected associations between polymorphisms of the Protein Tyrosine Phosphatase-N1 (PTPN1) gene and obesity-related phenotypes, suggesting a mechanism that can be modulated by physical activity. This study shows that genetic variability of PTPN1 is associated with adiposity, while physical activity seems to modulate the genetic predisposition. This brings insights about the mechanisms by which physical activity positively influences obesity.

Identifiants

pubmed: 36369476
doi: 10.1038/s41390-022-02377-1
pii: 10.1038/s41390-022-02377-1
doi:

Substances chimiques

Protein Tyrosine Phosphatases EC 3.1.3.48
PTPN1 protein, human EC 3.1.3.48
Protein Tyrosine Phosphatase, Non-Receptor Type 1 EC 3.1.3.48

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

2036-2044

Informations de copyright

© 2022. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

Références

GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N. Engl. J. Med. 377, 13–27 (2017).
doi: 10.1056/NEJMoa1614362
Xu, B. & Xie, X. Neurotrophic factor control of satiety and body weight. Nat. Rev. Neurosci. 17, 282–292 (2016).
pubmed: 27052383 pmcid: 4898883 doi: 10.1038/nrn.2016.24
Abdalla, M. M. I. Central and peripheral control of food intake. Endocr. Regul. 51, 52–70 (2017).
pubmed: 28222022 doi: 10.1515/enr-2017-0006
Loos, R. J. F. & Yeo, G. S. H. The genetics of obesity: from discovery to biology. Nat. Rev. Genet. 23, 120–133 (2022).
pubmed: 34556834 doi: 10.1038/s41576-021-00414-z
Farooqi, I. S. & O’Rahilly, S. Genetics of obesity in humans. Endocr. Rev. 27, 710–718 (2006).
pubmed: 17122358 doi: 10.1210/er.2006-0040
Sheikh, A. B. et al. The interplay of genetics and environmental factors in the development of obesity. Cureus 9, e1435 (2017).
pubmed: 28924523 pmcid: 5587406
Ruiz, J. R. et al. Attenuation of the effect of the FTO rs9939609 polymorphism on total and central body fat by physical activity in adolescents: the HELENA study. Arch. Pediatr. Adolesc. Med. 164, 328–333 (2010).
pubmed: 20368485 doi: 10.1001/archpediatrics.2010.29
Pascual-Gamarra, J. M. et al. Association between UCP1, UCP2, and UCP3 gene polymorphisms with markers of adiposity in European adolescents: the HELENA study. Pediatr. Obes. 14, e12504 (2019).
pubmed: 30659763 doi: 10.1111/ijpo.12504
Tanisawa, K., Tanaka, M. & Higuchi, M. Gene-exercise interactions in the development of cardiometabolic diseases. J. Phys. Fit. Sport. Med. 5, 25–36 (2016).
doi: 10.7600/jpfsm.5.25
Smith, J. K. Exercise and atherogenesis. Exerc. Sport Sci. Rev. 29, 49–53 (2001).
pubmed: 11337822
Graff, M. et al. Genome-wide physical activity interactions in adiposity ― a meta-analysis of 200,452 adults. PLoS Genet 13, 1–26 (2017).
Ruiz, J. R. et al. Objectively measured physical activity and sedentary time in European adolescents. Am. J. Epidemiol. 174, 173–184 (2011).
pubmed: 21467152 doi: 10.1093/aje/kwr068
Salazar‐Tortosa, D. F. et al. Association between lipoprotein lipase gene polymorphisms and cardiovascular disease risk factors in European adolescents: The Healthy Lifestyle in Europe by Nutrition in Adolescence study. Pediatr. Diabetes 21, 747–757 (2020).
pubmed: 32333632 doi: 10.1111/pedi.13035
Cho, H. Protein tyrosine phosphatase 1B (PTP1B) and obesity. Vitam. Horm. 91, 405–424 (2013).
pubmed: 23374726 doi: 10.1016/B978-0-12-407766-9.00017-1
Elchebly, M. et al. Increased insulin sensitivity and obesity resistance in mice lacking the protein tyrosine phosphatase-1B gene. Science 283, 1544–1548 (1999).
pubmed: 10066179 doi: 10.1126/science.283.5407.1544
Zabolotny, J. M. et al. PTP1B regulates leptin signal transduction in vivo. Dev. Cell 2, 489–495 (2002).
pubmed: 11970898 doi: 10.1016/S1534-5807(02)00148-X
Cheng, A. et al. Attenuation of leptin action and regulation of obesity by protein tyrosine phosphatase 1B. Dev. Cell 2, 497–503 (2002).
pubmed: 11970899 doi: 10.1016/S1534-5807(02)00149-1
Klaman, L. D. et al. Increased energy expenditure, decreased adiposity, and tissue-specific insulin sensitivity in Protein-Tyrosine Phosphatase 1B-deficient mice. Mol. Cell. Biol. 20, 5479–5489 (2000).
pubmed: 10891488 pmcid: 85999 doi: 10.1128/MCB.20.15.5479-5489.2000
Tsou, R. C. & Bence, K. K. The genetics of PTPN1 and obesity: Insights from mouse models of tissue-specific PTP1B deficiency. J. Obes. 2012, 1–8 (2012).
doi: 10.1155/2012/926857
Moreno, L. A. et al. Assessing, understanding and modifying nutritional status, eating habits and physical activity in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr. 11, 288–299 (2007).
pubmed: 17617932 doi: 10.1017/S1368980007000535
Moreno, L. A. et al. Design and implementation of the Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study. Int. J. Obes. 32, S4–S11 (2008).
doi: 10.1038/ijo.2008.177
Béghin, L. et al. Quality assurance of ethical issues and regulatory aspects relating to good clinical practices in the HELENA Cross-Sectional Study. Int. J. Obes. 32, S12–S18 (2008).
doi: 10.1038/ijo.2008.179
Nagy, E. et al. Harmonization process and reliability assessment of anthropometric measurements in a multicenter study in adolescents. Int. J. Obes. 32, S58–S65 (2008).
doi: 10.1038/ijo.2008.184
Cole, T. J., Bellizzi, M. C., Flegal, K. M. & Dietz, W. H. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320, 1240–1243 (2000).
pubmed: 10797032 pmcid: 27365 doi: 10.1136/bmj.320.7244.1240
Slaughter, M. et al. Skinfold equations for estimation of body fatness in children and youth. Hum. Biol. 60, 709–723 (1998).
González-Gross, M. et al. Sampling and processing of fresh blood samples within a European multicenter nutritional study: evaluation of biomarker stability during transport and storage. Int. J. Obes. 32, S66–S75 (2008).
doi: 10.1038/ijo.2008.185
R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/ . (2017).
Sham, P. C. & Purcell, S. M. Statistical power and significance testing in large-scale genetic studies. Nat. Rev. Genet. 15, 335–346 (2014).
pubmed: 24739678 doi: 10.1038/nrg3706
Benjamini, Y. & Hochberg, Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J. R. Stat. Soc. 57, 289–300 (1995).
Qu, H.-Q., Tien, M. & Polychronakos, C. Statistical significance in genetic association studies. Clin. Investig. Med. 33, E266–E270 (2010).
doi: 10.25011/cim.v33i5.14351
Sinnwell, J. P. & Schaid, D. J. haplo.stats: statistical analysis of haplotypes with traits and covariates when linkage phase is ambiguous. https://cran.r-project.org/package=haplo.stats (2016).
González, J. R. et al. SNPassoc: an R package to perform whole genome association studies. Bioinformatics 23, 644–645 (2007).
pubmed: 17267436 doi: 10.1093/bioinformatics/btm025
Wang, N. et al. Distribution of recombination crossovers and the origin of haplotype blocks: the interplay of population history, recombination, and mutation. Am. J. Hum. Genet. 71, 1227–1234 (2002).
pubmed: 12384857 pmcid: 385104 doi: 10.1086/344398
Sterne, J. A. C. & Smith, G. D. Sifting the evidence-what’s wrong with significance tests? BMJ 322, 226–231. https://www.bmj.com/content/322/7280/226.1 (2001).
Palmer, N. D. et al. Association of protein tyrosine phosphatase 1B gene polymorphisms with measures of glucose homeostasis in Hispanic Americans: The Insulin Resistance Atherosclerosis Study (IRAS) family study. Diabetes 53, 3013–3019 (2004).
pubmed: 15504985 doi: 10.2337/diabetes.53.11.3013
Spencer-Jones, N. J. et al. Protein tyrosine phosphatase-1B gene PTPN1: selection of tagging single nucleotide polymorphisms and association with body fat, insulin sensitivity, and the metabolic syndrome in a normal female population. Diabetes 54, 3296–3304 (2005).
pubmed: 16249458 doi: 10.2337/diabetes.54.11.3296
Cheyssac, C. et al. Analysis of common PTPN1 gene variants in type 2 diabetes, obesity and associated phenotypes in the French population. BMC Med. Genet. 7, 1–10 (2006).
doi: 10.1186/1471-2350-7-44
Bento, J. L. et al. Association of protein tyrosine phosphatase 1B gene polymorphisms with type 2 diabetes. Diabetes 53, 3007–3012 (2004).
pubmed: 15504984 doi: 10.2337/diabetes.53.11.3007
Bauer, F. et al. PTPN1 polymorphisms are associated with total and low-density lipoprotein cholesterol. Eur. J. Prev. Cardiol. 17, 28–34 (2010).
doi: 10.1097/HJR.0b013e32832d30c4
Florez, J. C. et al. Association testing of the protein tyrosine phosphatase 1B gene (PTPN1) with type 2 diabetes in 7,883 people. Diabetes 54, 1884–1891 (2005).
pubmed: 15919813 doi: 10.2337/diabetes.54.6.1884
Bauer, F. et al. No association of PTPN1 polymorphisms with macronutrient intake and measures of adiposity. Obesity 16, 2767–2771 (2008).
pubmed: 18846048 doi: 10.1038/oby.2008.426
Meshkani, R. et al. Polymorphisms within the protein tyrosine phosphatase IB (PTPN1) gene promoter: functional characterization and association with type 2 diabetes and related metabolic traits. Clin. Chem. 53, 1585–1592 (2007).
pubmed: 17634210 doi: 10.1373/clinchem.2007.088146
Traurig, M. et al. Protein tyrosine phosphatase 1B is not a major susceptibility gene for type 2 diabetes mellitus or obesity among Pima Indians. Diabetologia 50, 985–989 (2007).
pubmed: 17333110 doi: 10.1007/s00125-007-0611-6
EMBL-EBI. GWAS Catalogue: PTPN1. https://www.ebi.ac.uk/gwas/genes/PTPN1 (2022).
The International HapMap Consortium. A haplotype map of the human genome. Nature 437, 1299–1320 (2005).
pmcid: 1880871 doi: 10.1038/nature04226
Geraldes, P. Protein phosphatases and podocyte function. Curr. Opin. Nephrol. Hypertens. 27, 49–55 (2018).
pubmed: 29068796 doi: 10.1097/MNH.0000000000000376
Delibegovic, M. et al. Improved glucose homeostasis in mice with muscle-specific deletion of protein-tyrosine phosphatase 1B. Mol. Cell. Biol. 27, 7727–7734 (2007).
pubmed: 17724080 pmcid: 2169063 doi: 10.1128/MCB.00959-07
Ramachandran, C. & Kennedy, B. P. Protein tyrosine phosphatase 1B: a novel target for type 2 diabetes and obesity. Curr. Top. Med. Chem. 3, 749–757 (2003).
pubmed: 12678842 doi: 10.2174/1568026033452276
White, C. L. et al. HF diets increase hypothalamic PTP1B and induce leptin resistance through both leptin-dependent and -independent mechanisms. Am. J. Physiol. Endocrinol. Metab. 296, E291–E299 (2009).
pubmed: 19017730 doi: 10.1152/ajpendo.90513.2008
Ahima, R. S. & Flier, J. S. Leptin. Annu. Rev. Physiol. 62, 413–437 (2000).
pubmed: 10845097 doi: 10.1146/annurev.physiol.62.1.413
Bence, K. K. et al. Neuronal PTP1B regulates body weight, adiposity and leptin action. Nat. Med. 12, 917–924 (2006).
pubmed: 16845389 doi: 10.1038/nm1435
Banno, R. et al. PTP1B and SHP2 in POMC neurons reciprocally regulate energy balance in mice. J. Clin. Invest. 120, 720–734 (2010).
pubmed: 20160350 pmcid: 2827947 doi: 10.1172/JCI39620
Bruder-Nascimento, T. et al. Ptp1b deletion in pro-opiomelanocortin neurons increases energy expenditure and impairs endothelial function via TNF-α dependent mechanisms. Clin. Sci. 130, 881–893 (2016).
doi: 10.1042/CS20160073
Bruder-Nascimento, T. et al. Deletion of protein tyrosine phosphatase 1b in proopiomelanocortin neurons reduces neurogenic control of blood pressure and protects mice from leptin- and sympatho-mediated hypertension. Pharmacol. Res. 102, 235–244 (2015).
pubmed: 26523876 doi: 10.1016/j.phrs.2015.10.012
Cannon, B. & Nedergaard, J. Brown adipose tissue: function and physiological significance. Physiol. Rev. 84, 277–359, http://physrev.physiology.org/cgi/doi/10.1152/physrev.00015.2003 (2004).
pubmed: 14715917 doi: 10.1152/physrev.00015.2003
Minokoshi, Y. et al. Leptin stimulates fatty-acid oxidation by activating AMP-activated protein kinase. Nature 415, 339–343 (2002).
pubmed: 11797013 doi: 10.1038/415339a
Xue, B. et al. Neuronal Protein Tyrosine Phosphatase 1B deficiency results in Inhibition of hypothalamic AMPK and isoform-specific activation of AMPK in peripheral tissues. Mol. Cell. Biol. 29, 4563–4573 (2009).
pubmed: 19528236 pmcid: 2725736 doi: 10.1128/MCB.01914-08
de Jonghe, B. C. et al. Deficiency of PTP1B in POMC neurons leads to alterations in energy balance and homeostatic response to cold exposure. Am. J. Physiol. Endocrinol. Metab. 300, E1002–E1011 (2011).
pubmed: 21406615 pmcid: 3118594 doi: 10.1152/ajpendo.00639.2010
Miranda, S. et al. Beneficial effects of PTP1B deficiency on brown adipocyte differentiation and protection against apoptosis induced by pro- and anti-inflammatory stimuli. Cell. Signal. 22, 645–659 (2010).
pubmed: 20026400 doi: 10.1016/j.cellsig.2009.11.019
Matsuo, K. et al. Regulation of brown fat adipogenesis by protein tyrosine phosphatase 1B. PLoS One 6, e16446 (2011).
Vanevski, F. & Xu, B. Molecular and neural bases underlying roles of BDNF in the control of body weight. Front. Neurosci. 7, 1–10 (2013).
doi: 10.3389/fnins.2013.00037
Ozek, C. et al. Protein-tyrosine phosphatase 1B (PTP1B) is a novel regulator of central brain-derived neurotrophic factor and tropomyosin receptor kinase B (TrkB) signaling. J. Biol. Chem. 289, 31682–31692 (2014).
pubmed: 25288805 pmcid: 4231649 doi: 10.1074/jbc.M114.603621
de Moura, L. P. et al. Acute exercise decreases PTP-1B protein level and improves insulin signaling in the liver of old rats. Immun. Ageing 10, 1–9 (2013).
doi: 10.1186/1742-4933-10-8
Ropelle, E. R. et al. Reversal of diet-induced insulin resistance with a single bout of exercise in the rat: the role of PTP1B and IRS-1 serine phosphorylation. J. Physiol. 577, 997–1007 (2006).
pubmed: 17008371 pmcid: 1890392 doi: 10.1113/jphysiol.2006.120006
Guerra, B. et al. Leptin signaling in skeletal muscle after bed rest in healthy humans. Eur. J. Appl. Physiol. 114, 345–357 (2014).
pubmed: 24292882 doi: 10.1007/s00421-013-2779-4
Sun, C. et al. SIRT1 improves insulin sensitivity under insulin-resistant conditions by repressing PTP1B. Cell Metab. 6, 307–319 (2007).
pubmed: 17908559 doi: 10.1016/j.cmet.2007.08.014
Pauli, J. R. et al. Acute exercise reverses aged-induced impairments in insulin signaling in rodent skeletal muscle. Mech. Ageing Dev. 131, 323–329 (2010).
pubmed: 20307567 doi: 10.1016/j.mad.2010.03.004
Dinoff, A., Herrmann, N., Swardfager, W. & Lanctôt, K. L. The effect of acute exercise on blood concentrations of brain-derived neurotrophic factor (BDNF) in healthy adults: a meta-analysis. Eur. J. Neurosci. 46, 1635–1646 (2017).
pubmed: 28493624 doi: 10.1111/ejn.13603
Valgas da Silva, C. P., Hernández-Saavedra, D., White, J. D. & Stanford, K. I. Cold and exercise: therapeutic tools to activate brown adipose tissue and combat obesity. Biology 8, 1–29 (2019).
GTEx Consortium. GTEx v8 eQTLs: rs10485614 PTPN1. https://www.gtexportal.org/home/snp/rs10485614 (2021).
GTEx Consortium. GTEx v8 eQTLs: rs2143511 PTPN1. https://www.gtexportal.org/home/snp/rs2143511 (2021).

Auteurs

Diego F Salazar-Tortosa (DF)

PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain. dftortosa@arizona.edu.
Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA. dftortosa@arizona.edu.

Idoia Labayen (I)

Institute for Innovation & Sustainable Development in Food Chain (IS-FOOD), Department of Health Sciences, Navarra's Health Research Institute (IdiSNA), Public University of Navarra, Pamplona, Spain.

Marcela González-Gross (M)

Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain.

Miguel Seral-Cortes (M)

Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009, Zaragoza, Spain.
Instituto Agroalimentario de Aragón (IA2), 50013, Zaragoza, Spain.
Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain.
Department of Psychiatry and Nursing, Faculty of Health Sciences, Universidad de Zaragoza, Zaragoza, Spain.

Luis A Moreno (LA)

Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009, Zaragoza, Spain.
Instituto Agroalimentario de Aragón (IA2), 50013, Zaragoza, Spain.
Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009, Zaragoza, Spain.
Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029, Madrid, Spain.

Augusto G Zapico (A)

School of Education, Complutense University of Madrid, Madrid, Spain.

Kurt Widhalm (K)

Department of Pediatrics, Division of Clinical Nutrition, Medical University of Vienna, Währinger Gürtel 18-20, A-1090, Wien, Austria.

Aline Meirhaeghe (A)

Inserm, Institut Pasteur de Lille, University Lille, UMR1167-RID-AGE-Risk factors and molecular determinants of aging-related diseases, Lille, France.

David Enard (D)

Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA.

Jonatan R Ruiz (J)

PROFITH 'PROmoting FITness and Health through physical activity' Research Group, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain. ruizj@ugr.es.
Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, 28029, Madrid, Spain. ruizj@ugr.es.
Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain. ruizj@ugr.es.
Instituto de Investigación Biosanitaria, ibs.Granada, Granada, Spain. ruizj@ugr.es.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH