Human complex diseases are affected by both genetic and environmental factors. When multiple environmental risk factors are present, the interaction effect between a gene and the environmental mixture can be larger than the addition of individual interactions, resulting in the so-called synergistic gene–environment (G \(\times\) E) interactions. Existing literature has shown the power of synergistic gene-environment interaction analysis with cross-sectional traits. In this work, we propose a functional varying index coefficient model for longitudinal traits together with multiple longitudinal environmental risk factors and assess how the genetic effects on a longitudinal disease trait are nonlinearly modified by a mixture of environmental influences. We derive an estimation procedure for the nonparametric functional varying index coefficients under the quadratic inference function and penalized spline framework. We evaluate some theoretical properties such as estimation consistency and asymptotic normality of the estimates. We further propose a hypothesis testing procedure to assess the significance of the synergistic G \(\times\) E effect. The performance of the estimation and testing procedure is evaluated through Monte Carlo simulation studies. Finally, the utility of the method is illustrated by a real dataset from a pain sensitivity study in which SNP effects are nonlinearly modulated by a mixture of drug dosages and other environmental variables to affect patients’ blood pressure and heart rate.
