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Unlocking Skills: Successful Initiatives for Integrating Foreign-Trained Immigrant Professionals

Nearly 2 million college-educated immigrants in the United States, more than half coming with academic and professional credentials, are unable to fully utilize their professional skills and instead are stuck in low-skilled work or are unemployed. This report explores a range of programs and policies that are providing cutting-edge career navigation, relicensing, gap filling, and job search assistance to remedy this brain waste.




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Reducing Integration Barriers Facing Foreign-Trained Immigrants: Policy and Practice Lessons from Across the United States

Marking the release of a report on the barriers foreign-trained high-skilled immigrants face in the United States, this webinar examines programs and initiatives that assist with credential recognition, employment, and relicensure, as well as recent policy developments. Discussants review recommendations for community-based organizations, employers, and policymakers to expand successful efforts aimed at preventing brain waste. 




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The Education and Work Profiles of the DACA Population

The future of the Deferred Action for Childhood Arrivals (DACA) program is uncertain, amid skepticism from the Trump administration about its merits and the promise of legal challenge from ten state attorneys general. This issue brief presents a profile of young adults eligible for DACA in terms of their educational attainment and labor force participation, as well as what is at stake should the program be terminated.




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All Eyes Turn to Congress, Following Trump Decision to Terminate DACA Program

By winding down DACA over six months, President Trump may have addressed a short-term political dilemma. But this action ensures debate will rage on in search of a lasting solution, as many in Congress and beyond recognize the loss of work authorization and deportation relief will affect not only DACA recipients and their families, but also employers, universities, and communities alike, as this commentary explores.




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Promoting Refugee Integration in Challenging Times: The Potential of Two-Generation Strategies

At a time when the U.S. refugee resettlement system is facing unprecedented challenges, innovative and cost-effective tools for supporting refugee integration are in demand. This report explores how a two-generation approach to service provision could help all members of refugee families—from young children to working-age adults and the elderly—find their footing.




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More Than a DREAM (Act), Less Than a Promise

The first bill introduced in the 116th Congress to offer a path to legal status to DREAMers, the American Dream and Promise Act of 2019, could legalize nearly 2.7 million unauthorized immigrants brought to the United States as children, as well as those eligible for Temporary Protected Status or Deferred Enforced Departure, as this commentary explains.




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Immigrant-Origin Adults without Postsecondary Credentials: A 50-State Profile

With immigrants and their U.S.-born children poised to be the main source of labor-force growth, these adults are an important target for efforts to build the skills of the U.S. workforce to meet the knowledge-based economy of tomorrow. This fact sheet and state data snapshots explore the characteristics of adults without an academic degree or professional credential, by immigrant generation, race/ethnicity, and more.




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A Mirror for the Nation? The Changing Profile of Mexican Immigrants in Texas

At this event, experts from MPI and Southern Methodist University’s Texas-Mexico Center offer an overview of immigration trends and key characteristics of highly skilled Mexican immigrant adults at the national level and for Texas, and engage in a discussion on the causes behind the changing trends in immigration and implications for Texas, its economy, and more broadly for the nation.




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A Mirror for the Nation? The Changing Profile of Mexican Immigrants in Texas

At this discussion, experts from MPI and Southern Methodist University’s Texas-Mexico Center offer an overview of trends and key characteristics of highly skilled Mexican adults at the national level and for Texas, including educational levels by legal status and top industries of employment across Texas metro areas. They also discuss the policy implications of these findings.




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Specificity and affinity of the N-terminal residues in staphylocoagulase in binding to prothrombin [Computational Biology]

In Staphylococcus aureus–caused endocarditis, the pathogen secretes staphylocoagulase (SC), thereby activating human prothrombin (ProT) and evading immune clearance. A previous structural comparison of the SC(1–325) fragment bound to thrombin and its inactive precursor prethrombin 2 has indicated that SC activates ProT by inserting its N-terminal dipeptide Ile1-Val2 into the ProT Ile16 pocket, forming a salt bridge with ProT's Asp194, thereby stabilizing the active conformation. We hypothesized that these N-terminal SC residues modulate ProT binding and activation. Here, we generated labeled SC(1–246) as a probe for competitively defining the affinities of N-terminal SC(1–246) variants preselected by modeling. Using ProT(R155Q,R271Q,R284Q) (ProTQQQ), a variant refractory to prothrombinase- or thrombin-mediated cleavage, we observed variant affinities between ∼1 and 650 nm and activation potencies ranging from 1.8-fold that of WT SC(1–246) to complete loss of function. Substrate binding to ProTQQQ caused allosteric tightening of the affinity of most SC(1–246) variants, consistent with zymogen activation through occupation of the specificity pocket. Conservative changes at positions 1 and 2 were well-tolerated, with Val1-Val2, Ile1-Ala2, and Leu1-Val2 variants exhibiting ProTQQQ affinity and activation potency comparable with WT SC(1–246). Weaker binding variants typically had reduced activation rates, although at near-saturating ProTQQQ levels, several variants exhibited limiting rates similar to or higher than that of WT SC(1–246). The Ile16 pocket in ProTQQQ appears to favor nonpolar, nonaromatic residues at SC positions 1 and 2. Our results suggest that SC variants other than WT Ile1-Val2-Thr3 might emerge with similar ProT-activating efficiency.




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Walking & Depression

In his starting section, "Path", Macfarlane admits that not all walkers are benign or appealing. While I think he is a little hard on Morris Dancers and people who walk in sandals (p. 23) he does mention that trampers can have more sinister motives than mere enjoyment of nature and movement. He mentions people who walk because they are delusional or racist.

He also discusses two writers who walked to stave off depression -  19th-century walker George Borrow and poet Edward Thomas, who was killed in World War I. Borrow, who rode around on a black Arab stallion when at home, walked over not only England but also France, Spain, Portugal, Russia, and Morocco. He knew twelve languages and was acquainted with another forty. The activity of walking exposed him to new people and allowed him to exercise his mind as he exercised his body.

Edward Thomas and his poetry had the most influence over Macfarlane. The author admits that Thomas is the guiding spirit of his book (p. 24) and his first walk in The Old Ways is one that Thomas took a hundred years earlier. Macfarlane says that while Thomas

"was drawn to the romantic figure of the self-confident solitary walker, he was more interestingly alert to how we are scattered, as well as affirmed, by the places through which we move" (p. 25).

Thomas appears throughout The Old Ways, and Macfarlane gradually tells the story of Thomas's life in the "Ghost" section of the book. Thomas suffered badly from depression and moved frequently in the hopes that his new house would help him battle it; walking was a similar way to stave it off.

Interestingly enough, American poet Robert Frost knew Thomas. The famous Frost poem, "The Road Not Taken", was inspired by a walk that Frost and Thomas took together. When Frost sent Thomas a draft of the poem, Thomas decided that it was a sign that he should enlist in the British army. He was later killed in France in 1917.




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Latinos & Immigrants in Kansas City Metro Area Face Higher Health Insurance Coverage Gaps, Even as They Represent Fast-Growing Share of Workforce

WASHINGTON — Latinos and immigrants are at least twice as likely to lack health insurance coverage as the overall population in three central Kansas City metro counties, a new Migration Policy Institute (MPI) study reveals. In fact, they are four times as likely to be uninsured in Johnson County, Kansas. 




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As Global Refugee Forum approaches, MPI Europe brief offers a road map for smart investment in refugee sponsorship programmes

BRUSSELS — Even as the number of refugees in need of protection has reached an all-time high, the resettlement spots offered by countries in 2018 were less than half the level in 2016—and future commitments may shrink further. With refugee needs high and generosity dimming, there is increasing urgency for humanitarian actors to find new ways to bring refugees to safety as well as to rebuild public interest and consensus around the importance of protection.




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Las puertas abiertas para los migrantes venezolanos y nicaragüenses en América Latina y el Caribe se cierran un poco a medida que aumenta la escala de los flujos y la presión en los servicios públicos

WASHINGTON – A pesar de que los gobiernos de América Latina y el Caribe han tomado medidas generosas e innovadoras para lidiar con el desplazamiento forzado desde Venezuela y más recientemente desde Nicaragua, la cálida bienvenida se ha enfriado en algunos lugares a medida que el número de entradas, la presión sobre los servicios públicos y la preocupación del público aumenta.




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MPI Analysis of All State ESSA Accountability Plans Finds Fractured Picture of Education Policy for English Learners & Differing Approaches

WASHINGTON – Four years since the Every Student Succeeds Act (ESSA) was signed into law, all 50 states, the District of Columbia and Puerto Rico have developed accountability plans that include blueprints for serving English Learners (ELs), as well as measuring these students’ progress and being accountable for their outcomes. This marked a significant development, as EL performance was previously not well integrated with factors that determined whether a school was performing well or poorly.




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As European policymakers take stock of seasonal worker programmes, MPI Europe brief outlines principles to improve these schemes for all parties

Findings will be discussed during 25 February MPI Europe – SVR webinar




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Immigrant Workers Are Vital to the U.S. Coronavirus Pandemic Response, But Disproportionately Vulnerable

WASHINGTON — Six million immigrant workers are at the frontlines of keeping U.S. residents healthy, safe and fed during the COVID-19 pandemic, according to a Migration Policy Institute (MPI) analysis of U.S. Census Bureau data issued today. While the foreign born represented 17 percent of the 156 million civilians working in 2018, they account for larger shares in pandemic-response frontline occupations: 29 percent of all physicians in the United States, 38 percent of home health aides and 23 percent of retail-store pharmacists, for example.




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Is a U.S. Immigration System Rebuilt after 9/11 Prepared to Tackle Ever-Evolving Security Threats, Including Pandemics? Report Assesses Successes, Gaps

WASHINGTON — The U.S. immigration system was dramatically reshaped by the terrorist attacks of September 11, 2001, which shone a harsh spotlight on weaknesses in visa and immigration screening processes. From the creation of the Department of Homeland Security (DHS) to expanded national security protections in immigration and tourism policies, countless changes in the immigration arena have unfolded over the past 19 years.




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Effectively Serving Immigrant and Dual Language Learner Families through Home Visiting Programs

This MPI webinar marks the release of a policy brief that explores program and policy opportunities to improve home visiting services for immigrant and DLL families currently underparticipating in these programs due to a lack of culturally and linguistically responsive programming and other barriers




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Global Demand for Medical Professionals Drives Indians Abroad Despite Acute Domestic Health-Care Worker Shortages

India is the world's largest source for immigrant physicians, and for Indian-trained doctors and nurses the allure of working abroad is strong despite an acute domestic shortage of health-care workers. Against this pull, the Indian government has enacted a number of policies to limit and regulate the emigration of health-care professionals, though these have been more ad hoc in nature and not part of a fully realized strategy.




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An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA

Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, and areas where the law and state efforts to support English Learners can be improved.






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Apricot & Vanilla Jam

This recipe features on Foodie Tuesday, a weekly segment with Raf Epstein on Drive , 774, 3.30pm, courtesy of Alice Zaslavsky.




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Thai Style Fried Chicken - Gai Tod Nahm Prik Pao

A spicy Thai take on fried chicken, perfect as an entree to get the taste-buds sizzling or part of a main meal with rice and vegetables.




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Stir-fried water spinach with preserved bean curd - fu yu ong choy

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Tony Tan




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Prosciutto and cheese croquettes

75g butter 75g (1/2 cup) plain flour 500ml (2 cups) milk 75g finely grated parmesan 1 small red onion, finely diced 200g prosciutto, finely chopped 2 tablespoons chopped fresh parsley 3 eggs, lightly whisked 1 cup plain flour 270g (3 cups) dried breadcrumbs Vegetable oil, to deep-fry




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Beetroot and pinot risotto with king prawns

Four of my favourite ingredients combined into one dish!




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Left over lamb ragout with mushrooms and Spring market peas

Always something nice about discovering new dishes by utilising left overs from the night before . Seriously who doesn't love a bowl of pasta with a rich ragout of slow braised meat . Add a fresh twist with sweet seasonal peas from the markets .




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Brussels Sprout Caesar with Croutons, Borlotti Beans and Sunflower Seeds

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Hetty McKinnon, founder of Surry Hills community kitchen Arthur Street Kitchen and author of 'Neighbourhood'.




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Eucalyptus smoked Marburg emu fillet, beets, macadamia plus Lilly Pilly and finger lime spritzer

Delicious Australian dish with fresh Lilly Pilly and finger lime spritzer.




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Jerusalem artichokes cooked overnight with hazelnut praline

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Dan Hunter, chef and owner of Otways' restaurant Brae.




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Ginger Prawn Dumplings

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Alice Zaslavsky.




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Spring chicken soup

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, shared by Matt Purbrick author of Grown & Gathered.




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MACADAMIA PESTO POTATO SALAD WITH CRISPY PROSCIUTTO AND MARKET CHERRY TOMATOES

Love this time of year where our makers are abundant with the sweet aroma of fresh basil . Here is my take on a fancy potato salad of macadamia pesto , crispy prosciutto, sweet cherry tomatoes




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chocolate mousse with honeycomb and espresso sauce

honeycomb 40 g (11/2 oz) honey 70 g (21/2 oz) glucose syrup 200 g (7 oz) caster (superfine) sugar 1 teaspoon bicarbonate of soda (baking soda), sifted mousse 200 g (7 oz/11/3 cups) chopped good-quality dark chocolate, such as couverture (see note, page 235) 40 g (11/2 oz) unsalted butter, chopped 4 eggs, separated 150 g (51/2 oz/2/3 heaped cup) sugar espresso sauce 250 ml (9 fl oz/1 cup) espresso coffee 100 g (31/2 oz/1/2 cup) sugar 2 tablespoons kahlua






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CHAR-GRILLED PRAWNS WITH GREEN MANGO SALAD

It's Christmas, the middle of summer, and the outdoors beckons. For me, on a hot day, the traditional Christmas fare of roast turkey, baked potatoes and gravy, with plum pudding and custard for dessert, is about as tempting as a dental appointment. With a little planning and preparation you can impress your family and friends with a beautiful and healthy menu perfectly suited to our climate - and which allows maximum time for the more important tasks of socialising, opening presents and enjoying the spirit of Christmas. King prawns, fresh fish, salads and seasonal fruit are ideal for Christmas lunch. Cooking time is minimal, the aromas of the char-grill enticing, everything is light and fresh. Combine this with some pre-prepared zesty dressings and sauces and perhaps a platter of leg ham and Christmas 2001 will take on a whole new flavour. For dessert, look to cherries served on ice or perhaps plums, paw-paw, apricots, pineapple, strawberries or blueberries. Goat's cheese, cheddar or blue cheese would be an ideal finale, especially when teamed with a sticky dessert wine. Lash out on handmade chocolates to go with coffee. A summer juice of melon, lime and mint is health-giving and goes well with seafood. However, I will start with a sparkling shiraz or Champagne and enjoy a fruity riesling or pinot with the barbecued fish. Merry Christmas.




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Turmeric King Prawn Curry

Turmeric is a wonderful spice, it's loud in colour (and stains big-time) but it's mild in flavour; exquisite complex and peppery. Make sure you use fresh turmeric - powdered turmeric is the equivalent of canned asparagus!




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Preserved lemons

Preserved lemons are exotic, easily prepared at home and impart a flavour and perfume like no other - they are the next best thing to a holiday in Morocco, transforming any dish from the ho-hum to the sublime. When using them cooking, only use the yellow zest, discarding any white pith, pulp and juice. It is best to preserve lemons during autumn and spring when they are in season and have maximum aroma and juice. Any lemon worth its salt can be preserved, although having preserved a number of different varieties I can report most success with the thin-skinned Meyer lemon. I also think organic lemons give the best results. When choosing lemons for preserving, ensure you choose fully ripe, very yellow fragrant fruit with unblemished skin. In the case of store-bought lemons, wash well to remove the wax that is used to make them shiny.




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Spring chicken & mushroom casserole

Easy weekend entertaining featuring another great recipe from Geoff Jansz




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Spring cleansing beetroot and pomegranate salad

Beets have strong detoxifying properties, as they are high in chlorine, which assists in the cleansing of the liver, kidneys and bloodstream. They are also rich in potassium, which balances the metabolism. The mighty beets nourish the blood, tonify the heart, calm the spirit and nervousness, and they lubricate the intestines and cleanse the liver! Oh my giddy Aunt!




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Refugee Sponsorship Programs: A Global State of Play and Opportunities for Investment

From Argentina to New Zealand and points beyond, a growing number of countries have begun exploring refugee sponsorship as a way to expand protection capacity at a time of rising need, involving individuals and communities more directly in resettlement. This brief takes stock of what both new and well-established programs need to succeed, and outlines opportunities for private philanthropic actors to support them.




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Ponting takes aim at 'underdone' Proteas

Ricky Ponting believes South Africa could suffer from a lack of first-class preparation in the opening Test in Cape Town on Wednesday.




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Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry

OBJECTIVE

Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes.

RESEARCH DESIGN AND METHODS

Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization.

RESULTS

MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7–11.6] and 3.9 [95% CI 2.8–5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21–3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%.

CONCLUSIONS

For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia.




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Glycated Hemoglobin, Prediabetes, and the Links to Cardiovascular Disease: Data From UK Biobank

OBJECTIVE

HbA1c levels are increasingly measured in screening for diabetes; we investigated whether HbA1c may simultaneously improve cardiovascular disease (CVD) risk assessment, using QRISK3, American College of Cardiology/American Heart Association (ACC/AHA), and Systematic COronary Risk Evaluation (SCORE) scoring systems.

RESEARCH DESIGN AND METHODS

UK Biobank participants without baseline CVD or known diabetes (n = 357,833) were included. Associations of HbA1c with CVD was assessed using Cox models adjusting for classical risk factors. Predictive utility was determined by the C-index and net reclassification index (NRI). A separate analysis was conducted in 16,596 participants with known baseline diabetes.

RESULTS

Incident fatal or nonfatal CVD, as defined in the QRISK3 prediction model, occurred in 12,877 participants over 8.9 years. Of participants, 3.3% (n = 11,665) had prediabetes (42.0–47.9 mmol/mol [6.0–6.4%]) and 0.7% (n = 2,573) had undiagnosed diabetes (≥48.0 mmol/mol [≥6.5%]). In unadjusted models, compared with the reference group (<42.0 mmol/mol [<6.0%]), those with prediabetes and undiagnosed diabetes were at higher CVD risk: hazard ratio (HR) 1.83 (95% CI 1.69–1.97) and 2.26 (95% CI 1.96–2.60), respectively. After adjustment for classical risk factors, these attenuated to HR 1.11 (95% CI 1.03–1.20) and 1.20 (1.04–1.38), respectively. Adding HbA1c to the QRISK3 CVD risk prediction model (C-index 0.7392) yielded a small improvement in discrimination (C-index increase of 0.0004 [95% CI 0.0001–0.0007]). The NRI showed no improvement. Results were similar for models based on the ACC/AHA and SCORE risk models.

CONCLUSIONS

The near twofold higher unadjusted risk for CVD in people with prediabetes is driven mainly by abnormal levels of conventional CVD risk factors. While HbA1c adds minimally to cardiovascular risk prediction, those with prediabetes should have their conventional cardiovascular risk factors appropriately measured and managed.




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The Prevalence and Determinants of Cognitive Deficits and Traditional Diabetic Complications in the Severely Obese

OBJECTIVE

To determine the prevalence of cognitive deficits and traditional diabetic complications and the association between metabolic factors and these outcomes.

RESEARCH DESIGN AND METHODS

We performed a cross-sectional study in severely obese individuals before bariatric surgery. Lean control subjects were recruited from a research website. Cognitive deficits were defined by the National Institutes of Health (NIH) Toolbox (<5th percentile for lean control subjects). Cardiovascular autonomic neuropathy (CAN) was defined by an expiration-to-inspiration (E-to-I) ratio of <5th percentile for lean control subjects. Retinopathy was based on retinal photographs and nephropathy on the estimated glomerular filtration rate (<60 mg/dL) and/or the albumin-to-creatinine ratio (ACR) (≥30 mg/g). NIH Toolbox, E-to-I ratio, mean deviation on frequency doubling technology testing, and ACR were used as sensitive measures of these outcomes. We used multivariable linear regression to explore associations between metabolic factors and these outcomes.

RESULTS

We recruited 138 severely obese individuals and 46 lean control subjects. The prevalence of cognitive deficits, CAN, retinopathy, and nephropathy were 6.5%, 4.4%, 0%, and 6.5% in lean control subjects; 22.2%, 18.2%, 0%, and 6.1% in obese participants with normoglycemia; 17.7%, 21.4%, 1.9%, and 17.9% in obese participants with prediabetes; and 25.6%, 31.9%, 6.1%, and 16.3% in obese participants with diabetes. Waist circumference was significantly associated with cognitive function (–1.48; 95% CI –2.38, –0.57) and E-to-I ratio (–0.007; 95% CI –0.012, –0.002). Prediabetes was significantly associated with retinal function (–1.78; 95% CI –3.56, –0.002).

CONCLUSIONS

Obesity alone is likely sufficient to cause cognitive deficits but not retinopathy or nephropathy. Central obesity is the key metabolic risk factor.




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Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort

OBJECTIVE

To determine the effect of fitness on the association between BMI and mortality among patients with diabetes.

RESEARCH DESIGN AND METHODS

We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford Exercise Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (<6), moderate (6–9.9), or high (≥10). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5–24.9), overweight (25–29.9), and obese (≥30). Adjusted splines centered at 22.5 kg/m2 were used to examine BMI as a continuous variable.

RESULTS

Patients had a mean age of 58 ± 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 ± 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P < 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI ≥30 kg/m2. Compared with the lowest fitness group, patients with higher fitness had an ~50% (6–9.9 METs) and 70% (≥10 METs) lower mortality hazard regardless of BMI (P < 0.001).

CONCLUSIONS

Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality.




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Plasma N-Glycans as Emerging Biomarkers of Cardiometabolic Risk: A Prospective Investigation in the EPIC-Potsdam Cohort Study

OBJECTIVE

Plasma protein N-glycan profiling integrates information on enzymatic protein glycosylation, which is a highly controlled ubiquitous posttranslational modification. Here we investigate the ability of the plasma N-glycome to predict incidence of type 2 diabetes and cardiovascular diseases (CVDs; i.e., myocardial infarction and stroke).

RESEARCH DESIGN AND METHODS

Based on the prospective European Prospective Investigation of Cancer (EPIC)-Potsdam cohort (n = 27,548), we constructed case-cohorts including a random subsample of 2,500 participants and all physician-verified incident cases of type 2 diabetes (n = 820; median follow-up time 6.5 years) and CVD (n = 508; median follow-up time 8.2 years). Information on the relative abundance of 39 N-glycan groups in baseline plasma samples was generated by chromatographic profiling. We selected predictive N-glycans for type 2 diabetes and CVD separately, based on cross-validated machine learning, nonlinear model building, and construction of weighted prediction scores. This workflow for CVD was applied separately in men and women.

RESULTS

The N-glycan–based type 2 diabetes score was strongly predictive for diabetes risk in an internal validation cohort (weighted C-index 0.83, 95% CI 0.78–0.88), and this finding was externally validated in the Finland Cardiovascular Risk Study (FINRISK) cohort. N-glycans were moderately predictive for CVD incidence (weighted C-indices 0.66, 95% CI 0.60–0.72, for men; 0.64, 95% CI 0.55–0.73, for women). Information on the selected N-glycans improved the accuracy of established and clinically applied risk prediction scores for type 2 diabetes and CVD.

CONCLUSIONS

Selected N-glycans improve type 2 diabetes and CVD prediction beyond established risk markers. Plasma protein N-glycan profiling may thus be useful for risk stratification in the context of precisely targeted primary prevention of cardiometabolic diseases.