[HN Gopher] Epigenetic age oscillates during the day
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       Epigenetic age oscillates during the day
        
       Author : kkoncevicius
       Score  : 74 points
       Date   : 2024-04-19 16:48 UTC (6 hours ago)
        
 (HTM) web link (onlinelibrary.wiley.com)
 (TXT) w3m dump (onlinelibrary.wiley.com)
        
       | Terr_ wrote:
       | That certainly breathes new life into old metaphors like
       | "twilight years".
       | 
       | It sounds like the most immediate takeaway is that anyone
       | analyzing this stuff needs to control for _when_ measure
       | individuals.
        
         | kkoncevicius wrote:
         | And not just this stuff but a lot of health metrics probably
         | have this occult dependence on the time of day. For example
         | MRIs [1].
         | 
         | [1]: https://www.nature.com/articles/s41467-023-42588-6
        
         | gwern wrote:
         | The potential for systematic bias here is also quite
         | concerning. Imagine your experimental group tends to come in
         | the morning (maybe because they're on-site) but your control
         | group is scheduled to come in the rest of the day...
        
           | biomcgary wrote:
           | This problem is VERY real and happens in surprising ways. My
           | biotech has a dataset that was collected over several years
           | and we found this pattern of older people having more Vitamin
           | D in their blood than younger people, which is the opposite
           | of the published literature. It turns out that the sample
           | collection was initially year round but switched to summer
           | only and everyone in the cohort was older, by definition, in
           | the later collection.
        
       | huytersd wrote:
       | Even things like posture seem to affect my parameters. My temp
       | will be 98.4 while seated but if I stand up and check it, it
       | drops down to 97.9.
        
         | jajko wrote:
         | Maybe its just not a good enough measure for any form of age?
         | Some folks get obsessed with numbers without seeing bigger
         | picture and focusing on actually important things in life (just
         | general observation, please don't take any of this personally)
        
         | Aurornis wrote:
         | > My temp will be 98.4 while seated but if I stand up and check
         | it, it drops down to 97.9
         | 
         | Body temperature measurements from outside the body are
         | impacted by changes in blood flow, which will happen when you
         | stand up.
         | 
         | Your core body temperature isn't fluctuating, the temperature
         | at the measurement point is changing slightly because you've
         | changed your blood flow.
         | 
         | We're constantly losing heat from our bodies to the
         | environment. You could probably get similar measurements if you
         | heavily insulated the entire area around the thermometer and
         | let measurements stabilized.
         | 
         | In other words: Don't read too much into this experiment.
        
       | biomcgary wrote:
       | I work at a biotech that does intersecting research (predicting
       | disease risk). We obsess about temporal variation at various time
       | scales and the effects are quite real. We use multiple data
       | planes (multi-omics) to evaluate temporal effects across diverse
       | biology. Our goal is to ensure that our long-term predictions are
       | minimally impacted by short-term fluctuations.
        
         | canadiantim wrote:
         | What's your company? I'd be interested in learning more about
         | (multi-omics, etc.)
        
           | biomcgary wrote:
           | We're still in lite stealth mode, so posting the name on HN
           | isn't the best idea. :-)
        
             | greenish_shores wrote:
             | I think I can relate to this, even despite mine is just
             | purely software startup (but it's low-level
             | software/firmware for off-the-shelf devices, which can only
             | run commercial closed ones at the moment). Too much
             | attention before our product is mature enough would be
             | easily able to kill that. We won't be able to handle
             | whatever could arise from that with our several-person
             | team.
             | 
             | But that's me. Mind sharing your reasons? Of course could
             | be obscured as much as you need.
        
               | biomcgary wrote:
               | In this context, stealth helps with trust and
               | communication. Although that might seem paradoxical, we
               | are initially working with a small number of members
               | reached by word of mouth.
               | 
               | We walk members through our data usage policies in person
               | and ask questions to ensure we understand both their
               | health and privacy concerns. Without long-term
               | trustworthiness on our part, we won't get the
               | longitudinal data that we need to ensure that we continue
               | building the best in class predictive models.
               | 
               | There are other reasons, but that's the biggest one.
        
       | renewiltord wrote:
       | Haha it's really a marketing tool for bespoke medicine. Not
       | really that useful in that field but people like it.
        
         | JumpCrisscross wrote:
         | > _Not really that useful in that field_
         | 
         | Source? Because I know people working on it as a target measure
         | at a national lab in India as well as at Pfizer (in America)
         | and Novartis (in Switzerland).
        
           | renewiltord wrote:
           | If they think so, and I don't, then we just disagree on this
           | and history will see who is right.
        
             | JumpCrisscross wrote:
             | > _then we just disagree on this and history will see who
             | is right_
             | 
             | That's not how science works.
             | 
             | Epigenetic age prediction is an area of active research for
             | general diagnostic and treatment vectors [1]. There are
             | peer-reviewed studies on the stuff. You claimed "really a
             | marketing tool for bespoke medicine". That appears to be
             | false.
             | 
             | [1] https://pubmed.ncbi.nlm.nih.gov/34415665/
        
               | renewiltord wrote:
               | All right. Use it as a health target for yourself. It's
               | no skin off my back.
        
           | nradov wrote:
           | Here's one source.
           | 
           | https://doi.org/10.1016/j.cell.2022.11.001
           | 
           | Epigenetic alterations such as DNA methylation are only one
           | hallmark of aging, and not the most useful one in most cases.
           | Interventions to reduce those epigenetic alternations have
           | generally not proven effective in extending lifespans or
           | improving health outcomes.
        
             | JumpCrisscross wrote:
             | > _Epigenetic alterations such as DNA methylation are only
             | one hallmark of aging, and not the most useful one in most
             | cases. Interventions to reduce those epigenetic
             | alternations have generally not proven effective in
             | extending lifespans or improving health outcomes_
             | 
             | Thank you. And I totally agree. It reminds me of telomere
             | craze in the early noughties.
             | 
             | It not being a panacea, however, is different from it being
             | useless. Marking it as pure marketing makes it sound like
             | it's cosmetics. It's not. The first research on
             | chronological age prediction dates from 2011; we're still
             | in the basic research phase. (Which the article mentioned
             | is. It's not marketing any treatment.) To the degree it's
             | being turned into a scam it's in supplements, not bespoke
             | medicine.
        
           | dahinds wrote:
           | That doesn't really contradict the post you're responding to,
           | does it? (they say it is not that useful for bespoke
           | medicine, you say that people are using it for research
           | purposes, both can be true?)
        
       | claytongulick wrote:
       | One of the "dirty secrets" in healthcare is similar issues with
       | BP.
       | 
       | Things like posture, white-coat syndrome, having to pee, cuff
       | placement, cuff size, arm position, muscularity, arm diameter,
       | time sitting, and many other variables have a massive influence
       | on blood pressure.
       | 
       | BP is kind of like weight - it should be taken at regular
       | intervals during the day, at the same times, and averaged out
       | over time to look at trends. "Snapshot" BP readings are most
       | useful for things like hypertensive crisis, not ongoing BP
       | management.
       | 
       | Unfortunately, we see a lot of people put on BP meds where other
       | interventions may be more appropriate based on bad BP
       | measurements.
       | 
       | I think there are a lot of things in healthcare like this, where
       | our models are too simplistic and result in flawed understanding
       | and consequently ineffective treatments.
        
         | hzay wrote:
         | Is it really secret though? It's the first thing you learn when
         | you google "how to take bp". Like I'm not a medical person but
         | when I was pregnant, I was asked to check BP and I asked the
         | doctor "should I like average 3 readings or something?" and she
         | said "just take one, don't stress it".
         | 
         | This is well known re thyroid medication as well. Also re
         | weight, progesterone, a bunch of things.
        
           | pc86 wrote:
           | It's not a secret. Most of my immediate family is or was in
           | healthcare and nobody is getting put on BP meds because of a
           | single errant reading. They're getting put on meds because of
           | persistent, uncontrolled elevated BPs and with non-
           | pharmaceutical interventions not addressing it. Everyone,
           | especially physicians, know there's a list of 20-30 things
           | that can give you temporarily elevated BP that won't respond
           | to BP meds.
        
             | importantbrian wrote:
             | Yeah, that's been my experience. Everytime I see my primary
             | my BP is elevated in the office and they send me home with
             | a log and I have to take my BP multiple times a day for 2
             | weeks and at home it's fine, so I've never been put on meds
             | for it even though it's very high in the office.
        
         | devmor wrote:
         | I realized this a couple years ago when I moved and started
         | getting my blood tests done at a new lab that was nearby.
         | 
         | My entire life I've had perfect blood pressure, but suddenly
         | this lab thinks I have hypertension. After 3-4 visits and
         | checking my own BP during the day, I realized that my blood
         | pressure is just higher in the morning - I never set
         | appointments in the morning previously because I lived too far
         | from a lab to make morning appointments convenient.
        
           | greenish_shores wrote:
           | What makes them think you have hypertension with purely blood
           | laboratory tests? Electrolyte levels ratios? They aren't
           | changed in all types of hypertension (won't be changed in
           | most, probably), but that's just my wild guess.
        
         | nradov wrote:
         | Yes, blood pressure measurement is a real mess. Besides the
         | factors you listed, I have found that temperature has a
         | surprisingly large impact. If your hands are cold, then that
         | causes peripheral vasoconstriction and raises BP.
        
         | voisin wrote:
         | Question, since you seem to know a lot about this: is high
         | blood pressure meant to be a description of a persistent
         | condition (I.e. took a reading at 5, 10, 20 minute intervals at
         | rest and stayed elevated) or is it meant to be a description of
         | something else (after standing up, or after walking, etc etc)?
        
         | importantbrian wrote:
         | I have really bad white-coat hypertension. Like 150-90 in the
         | drs. office. So every time I go in they send me home with a
         | chart and I have to dutifully record my blood pressure a couple
         | of times a day for 2 weeks and send it back to them, and when
         | measured at home it's totally fine.
         | 
         | Since I have the cuff I check it every so often to make sure
         | it's still fine and it is, but the moment I get in a drs.
         | office boom it spikes. This is even true when I'm there for
         | someone else like my son or my wife. I can feel that my blood
         | pressure is high.
         | 
         | I have absolutely no explanation for why except that I had a
         | major surgery when I was 5 and there must be some suppressed
         | trauma from that that comes out physically when I'm in a
         | doctor's office.
        
         | greenish_shores wrote:
         | "Cuffless" blood pressure measurements, which could be easily
         | used to measure BP continuously, could easily solve this
         | problem.[0][1]
         | 
         | [0]
         | https://www.frontiersin.org/articles/10.3389/fcvm.2019.00040...
         | 
         | [1] https://www.cnet.com/health/medical/i-have-high-hopes-for-
         | th...
        
       | V__ wrote:
       | I mean epigenetic clocks are extremely unreliable and have
       | enormous error bars. It is not surprising that they are easily
       | influenced by additional variables.
        
         | kkoncevicius wrote:
         | Epigenetic clocks are one of the (if not the) most accurate
         | ways to estimate someone's real chronological age using
         | molecular level data. So not sure what you mean by "extremely
         | unreliable".
        
           | epistasis wrote:
           | I disagree, because "real age" is defined in terms of the
           | epigenetic clock. We don't have enough time observing them
           | with humans to connect them to real age, at least as far as I
           | have ever seen. If there's some major paper I have missed,
           | and my other sources have missed, I'd love to see it.
        
             | pc86 wrote:
             | Real age is chronological age, full stop.
             | 
             | If you were born 50 years ago today, you're 50 years old.
             | Age is a concrete, mathematical thing. That your cells
             | appear to be younger or older to your actual
             | (chronological) age is irrelevant. You don't get to say
             | your "real age" is 45 because your cells are slightly
             | better than they "should be."
        
               | voisin wrote:
               | I think you two are talking past each other.
               | 
               | "I am 50 years old" is a statement of fact like you
               | refer.
               | 
               | "Real age" is essentially a term of art used to describe
               | your relative health - a single number to indicate the
               | cumulative impact of your lifestyle, genes, etc.
               | 
               | No one says "I have a real age of 50" to the question
               | "how old are you?"
        
               | epistasis wrote:
               | Thanks. Moreover nobody would use an epigenetic clock to
               | refer to chronological age, because it's inferior in
               | every way for that purpose.
               | 
               | The purported use of an epigenetic clock in humans is
               | that it predicts either aging effects of remaining life
               | span in some sense; neither of these have been proven to
               | be biologically true because in the first we don't
               | necessarily have the definition of aging, and certainly
               | don't have it down to a single axis, at best it is
               | understood along many different dimensions, many of which
               | are not captured by epigenetic measures.
               | 
               | And second sense, predicting remaining life span, is
               | completely unproven. Even more speculative is whether
               | measures which change a person's epigenetic age will
               | result in changes in remaining lifespan.
               | 
               | There's a chance that epigenetic age becomes useful for
               | something, but it's just a chance. It's not established
               | science.
        
           | V__ wrote:
           | They probably are the most accurate way, but that still
           | doesn't make them good. If there haven't been any recent
           | breakthroughs I missed, then we are talking about getting it
           | right +/- 4 years under ideal conditions. Repeating these
           | test on the same subjects can result in fluctuations of 8 to
           | 12 years [1].
           | 
           | Additionally, there are a lot of biotech/junk studies
           | claiming some new intervention reduces/reverses biologic age
           | using these epigenetic clocks as evidence. Making me very
           | wary of the whole thing, though unfairly to those actually
           | doing sound studies I admit.
           | 
           | [1] https://clinicalepigeneticsjournal.biomedcentral.com/arti
           | cle...
        
             | kkoncevicius wrote:
             | I think we mostly agree. If you are interested, there are
             | developments that reduce the fluctuations of clock
             | predictions - like principal component based clocks [1],
             | where the authors claim average difference between
             | replicate measurements of 1.5 years.
             | 
             | And the study you are citing (8 to 12 year errors) - seems
             | to report maximum errors, not averages. These might be
             | caused by poor quality samples, so it's unfair to report it
             | like that. Also the publication under discussion
             | (epigenetic age oscillates) would answer where the
             | fluctuations observed by the article you linked to come
             | from - part of them are of course technical due to
             | measurement error, but part of them are influenced by
             | differences in sample collection times.
             | 
             | I also share your skepticism about intervention research
             | and using "biological clocks" to measure how healthy you
             | are. Curiously chronological clocks seem to not be easily
             | affected by interventions. And I would guess this is why
             | most people doing epigenetic aging for sport use biological
             | clocks (like DunedinPACE). But then the question - if you
             | are younger according to "biological age", but we still can
             | measure your true chronological age accurately - are you
             | actually younger in a meaningful sense.
             | 
             | [1]: https://www.nature.com/articles/s43587-022-00248-2
        
               | V__ wrote:
               | Thanks for the link, that would be a great improvment. I
               | really hope they get their someday.
        
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