Body Composition

Polygenic scores capture genetic modification of the adiposity-cardiometabolic risk factor relationship.

TL;DR

A generalized pipeline for developing and comparing interaction-based, variance-based, and standard polygenic scores identified significant PGS-by-BMI interactions for 16/20 cardiometabolic risk factors, most consistently using the interaction PGS approach, with many interactions replicating in All of Us.

Key Findings

The interaction PGS (iPGS) approach most consistently detected significant PGS-by-BMI interactions across cardiometabolic risk factors in UK Biobank.

  • Significant PGS×BMI interactions were identified for 16 out of 20 cardiometabolic risk factors tested.
  • The iPGS approach outperformed both standard PGSs and variance PGSs (vPGSs) in detecting PGS×exposure interactions.
  • The pipeline was applied to UK Biobank as the primary discovery cohort.
  • Three PGS types were systematically compared: standard PGSs, interaction-based iPGSs, and variance-effect-based vPGSs.

Many PGS×BMI interactions identified in UK Biobank replicated in the All of Us (AoU) research program.

  • Replication was assessed in the All of Us cohort, which has greater ancestral diversity than UK Biobank.
  • A 72% larger BMI-alanine aminotransferase association was observed in the top iPGS decile in AoU.
  • The replication in AoU supports the generalizability of the identified gene-by-adiposity interactions across cohorts.

PGSs based on interactions (iPGSs) and variance effects (vPGSs) were hypothesized to be more powerful than standard PGSs for detecting PGS×exposure interactions.

  • Standard PGSs are typically constructed to predict trait levels, not differential responses to exposures.
  • iPGSs are built directly from SNP-by-exposure interaction effects.
  • vPGSs leverage variance-quantitative trait loci (vQTLs) as proxies for interaction effects.
  • Prior to this study, these three PGS types had not been systematically compared for PGS×E detection.

The study developed a generalized pipeline for constructing and comparing multiple PGS types in the context of gene-by-environment interaction detection.

  • The pipeline encompasses development of standard PGSs, iPGSs, and vPGSs.
  • The pipeline was applied to the relationship between adiposity (measured by BMI) and a broad set of cardiometabolic risk factors.
  • Twenty cardiometabolic risk factors were analyzed.
  • The framework is described as applicable to future efforts toward clinically useful response-focused PGSs.

Genetic modification of the adiposity-cardiometabolic risk factor relationship was detectable using observational data via PGS×exposure interaction analyses.

  • PGS×BMI interactions were detectable as observational signals consistent with genetic modification of the BMI-risk factor relationship.
  • 16 of 20 cardiometabolic risk factors showed significant PGS×BMI interactions in UK Biobank.
  • The analysis supports the premise that PGS×E interactions in observational datasets can identify individuals with differential responses to exposures such as adiposity.

The iPGS for alanine aminotransferase (ALT) showed a particularly strong interaction with BMI, with the top decile showing a 72% larger BMI-ALT association in All of Us.

  • The BMI-ALT association was 72% larger in the top iPGS decile compared to the reference group in AoU.
  • This finding exemplifies the clinical relevance of response-focused PGSs for liver-related metabolic risk.
  • ALT is a marker of liver function and hepatic steatosis, which is closely related to adiposity.

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Citation

Westerman K, Gervis J, O'Connor L, Udler M, Manning A. (2026). Polygenic scores capture genetic modification of the adiposity-cardiometabolic risk factor relationship.. Cell genomics. https://doi.org/10.1016/j.xgen.2025.101075