Epigenome-wide association study of incident type 2 diabetes: a meta-analysis of five prospective European cohorts
Authors: Fraszczyk Eliza , Spijkerman Annemieke M. W. , Zhang Yan , Brandmaier Stefan , Day Felix R. , Zhou Li , Wackers Paul , Dollé Martijn E. T. , Bloks Vincent W. , Gào Xīn , Gieger Christian , Kooner Jaspal , Kriebel Jennifer , Picavet H. Susan J. , Rathmann Wolfgang , Schöttker Ben , Loh Marie , Verschuren W. M. Monique , van Vliet-Ostaptchouk Jana V. , Wareham Nicholas J. , Chambers John C. , Ong Ken K. , Grallert Harald , Brenner Hermann , Luijten Mirjam , Snieder Harold 
Published: February 2022

Aims/hypothesis

Type 2 diabetes is a complex metabolic disease with increasing prevalence worldwide. Improving the prediction of incident type 2 diabetes using epigenetic markers could help tailor prevention efforts to those at the highest risk. The aim of this study was to identify predictive methylation markers for incident type 2 diabetes by combining epigenome-wide association study (EWAS) results from five prospective European cohorts.

Methods

We conducted a meta-analysis of EWASs in blood collected 7–10 years prior to type 2 diabetes diagnosis. DNA methylation was measured with Illumina Infinium Methylation arrays. A total of 1250 cases and 1950 controls from five longitudinal cohorts were included: Doetinchem, ESTHER, KORA1, KORA2 and EPIC-Norfolk. Associations between DNA methylation and incident type 2 diabetes were examined using robust linear regression with adjustment for potential confounders. Inverse-variance fixed-effects meta-analysis of cohort-level individual CpG EWAS estimates was performed using METAL. The methylGSA R package was used for gene set enrichment analysis. Confirmation of genome-wide significant CpG sites was performed in a cohort of Indian Asians (LOLIPOP, UK).

Results

The meta-analysis identified 76 CpG sites that were differentially methylated in individuals with incident type 2 diabetes compared with control individuals (pvalues <1.1 × 10−7). Sixty-four out of 76 (84.2%) CpG sites were confirmed by directionally consistent effects andpvalues <0.05 in an independent cohort of Indian Asians. However, on adjustment for baseline BMI only four CpG sites remained genome-wide significant, and addition of the 76 CpG methylation risk score to a prediction model including established predictors of type 2 diabetes (age, sex, BMI and HbA1c) showed no improvement (AUC 0.757 vs 0.753). Gene set enrichment analysis of the full epigenome-wide results clearly showed enrichment of processes linked to insulin signalling, lipid homeostasis and inflammation.

Conclusions/interpretation

By combining results from five European cohorts, and thus significantly increasing study sample size, we identified 76 CpG sites associated with incident type 2 diabetes. Replication of 64 CpGs in an independent cohort of Indian Asians suggests that the association between DNA methylation levels and incident type 2 diabetes is robust and independent of ethnicity. Our data also indicate that BMI partly explains the association between DNA methylation and incident type 2 diabetes. Further studies are required to elucidate the underlying biological mechanisms and to determine potential causal roles of the differentially methylated CpG sites in type 2 diabetes development.

Graphical abstract