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The complexity of obesity and onset and susceptibility of cardio-metabolic disorders are still poorly understood and is addressed here through studies of genetic influence on weight gain and increased metabolic risk longitudinally.    Subjects/Methods  Twenty seven previously identified obesity, eating disorder or metabolic risk susceptibility SNPs were tested for association with weight or metabolically related traits longitudinally in 3999 adults participating both in the HUNT2 (1995–97) and HUNT3 (2006–08) surveys. Regression analyses were performed with changes from normal weight to overweight/obesity or from metabolically healthy to adverse developments with regards to blood pressure, glucose, HDL cholesterol, triglycerides or metabolic syndrome as outcomes. Additionally, a sub-sample of 1380 adolescents was included for testing association of nine SNPs with longitudinal weight gain into young adulthood.    Results  The most substantial effect on BMI-based weight gain from normal to overweight/obesity in adults was observed for the  DRD2  variant (rs6277)(OR: 0.79, 95% CI: 0.69–0.90, P = 3.9x10 -4 , adj. P = 0.015).  DRD2  was not associated with BMI on a cross-sectional level. In the adolescent sample,  FTO  (rs1121980) was associated with change to overweight at adulthood in the combined male-female sample (OR: 1.27, 95% CI: 1.09–1.49, P = 3.0x10 -3 , adj. P = 0.019) and in females (OR: 1.53, 95% CI: 1.23–1.91, P = 1.8x10 -4 , adj. P = 0.003). When testing for association to longitudinal adverse developments with regard to blood pressure, blood lipids and glucose, only rs964184 ( ZNF259/APOA5)  was significantly associated to unfavourable triglyceride changes (OR: 1.66, 95% CI: 1.36–2.03, P = 5.7x10 -7 , adj. P = 0.001). Pleiotropic effects on metabolic traits, however, were observed for several genetic loci cross-sectionally,  ZNF259/APOA5 ,  LPL  and  GRB14  being the most important.    Conclusions    DRD2  exhibits effects on weight gain from normal weight to overweight/obesity in adults, while,  FTO  is associated to weight gain from adolescence to young adulthood. Unhealthy longitudinal triglyceride development is strongly affected by  ZNF259/APOA . Our main finding, linking the  DRD2  variant directly to the longitudinal weight gain observed, has not previously been identified. It suggests a genetic pre-disposition involving the dopaminergic signalling pathways known to play a role in food reward and satiety linked mechanisms.

Genetic Effects on Longitudinal Changes from Healthy to Adverse Weight and Metabolic Status — The HUNT Study