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Using Mendelian randomisation to assess causality in observational studies
  1. Panagiota Pagoni1,2,
  2. Niki L Dimou3,
  3. Neil Murphy3,
  4. Evie Stergiakouli1,2,4
  1. 1 Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
  2. 2 Population Health Sciences, University of Bristol, Bristol, UK
  3. 3 International Agency for Research on Cancer, Lyon, France
  4. 4 School of Oral and Dental Sciences, University of Bristol, Bristol, UK
  1. Correspondence to Dr Niki L Dimou, International Agency for Research on Cancer, Lyon 69372, France; DimouN{at}


Objective Mendelian randomisation (MR) is a technique that aims to assess causal effects of exposures on disease outcomes. The paper aims to present the main assumptions that underlie MR, the statistical methods used to estimate causal effects and how to account for potential violations of the key assumptions.

Methods We discuss the key assumptions that should be satisfied in an MR setting. We list the statistical methodologies used in two-sample MR when summary data are available to estimate causal effects (ie, Wald ratio estimator, inverse-variance weighted and maximum likelihood method) and identify/adjust for potential violations of MR assumptions (ie, MR-Egger regression and weighted Median approach). We also present statistical methods and graphical tools used to evaluate the presence of heterogeneity.

Results We use as an illustrative example of a published two-sample MR study, investigating the causal association of body mass index with three psychiatric disorders (ie, bipolar disorder, schizophrenia and major depressive disorder). We highlight the importance of assessing the results of all available methods rather than each method alone. We also demonstrate the impact of heterogeneity in the estimation of the causal effects.

Conclusions MR is a useful tool to assess causality of risk factors in medical research. Assessment of the key assumptions underlying MR is crucial for a valid interpretation of the results.

  • Schizophrenia and psychotic disorders

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  • Contributors All authors contributed to writing and commenting on this paper.

  • Funding ND was supported by the IKY scholarship programme in Greece, which is co-financed by the European Union (European Social Fund - ESF) and Greek national funds through the action entitled ”Reinforcement of Postdoctoral Researchers”, in the framework of the Operational Programme ”Human Resources Development Program, Education and Lifelong Learning” of the National Strategic Reference Framework (NSRF) 2014 – 2020 .PP, NM, ES have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization.

  • Competing interests None declared.

  • Ethics approval An ethics approval was not required as we used summary data publicly available at

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available in an open access publication

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