[Assessment of self-reported cardiovascular and metabolic diseases in the German National Cohort (GNC, NAKO Gesundheitsstudie): methods and initial results]. / Erfassung selbst berichteter kardiovaskulärer und metabolischer Erkrankungen in der NAKO Gesundheitsstudie: Methoden und erste Ergebnisse.

BACKGROUND: Data on self-reported cardiovascular and metabolic diseases are available for the first 100,000 participants of the population-based German National Cohort (GNC, NAKO Gesundheitsstudie). OBJECTIVES: To describe assessment methods and the frequency of self-reported cardiovascular and metabolic diseases in the German National Cohort. MATERIALS AND METHODS: Using a computer-based, standardized personal interview, 101,806 participants (20-75 years, 46% men) from 18 nationwide study centres were asked to use a predefined list to report medical conditions ever diagnosed by a physician, including cardiovascular or metabolic diseases. For the latter, we calculated sex-stratified relative frequencies and compared these with reference data. RESULTS: With regard to cardiovascular diseases, 3.5% of men and 0.8% of women reported to have ever been diagnosed with a myocardial infarction, 4.8% and 1.5% with angina pectoris, 3.5% and 2.5% with heart failure, 10.1% and 10.4% with cardiac arrhythmia, 2.7% and 1.8% with claudicatio intermittens, and 34.6% and 27.0% with arterial hypertension. The frequencies of self-reported diagnosed metabolic diseases were 8.1% and 5.8% for diabetes mellitus, 28.6% and 24.5% for hyperlipidaemia, 7.9% and 2.4% for gout, and 10.1% and 34.3% for thyroid diseases. Observed disease frequencies were lower than reference data for Germany. CONCLUSIONS: In the German National Cohort, self-reported cardiovascular and metabolic diseases diagnosed by a physician are assessed from all participants, therefore representing a data source for future cardio-metabolic research in this cohort.

Herpes zoster incidence in Germany - an indirect validation study for self-reported disease data from pretest studies of the population-based German National Cohort.

BACKGROUND: Until now, herpes zoster (HZ)-related disease burden in Germany has been estimated based on health insurance data and clinical findings. However, the validity of self-reported HZ is unclear. This study investigated the validity of self-reported herpes zoster (HZ) and its complication postherpetic neuralgia (PHN) using data from the pretest studies of the German National Cohort (GNC) in comparison with estimates based on health insurance data. METHODS: Data of 4751 participants aged between 20 and 69 years from two pretest studies of the GNC carried out in 2011 and 2012 were used. Based on self-reports of physician-diagnosed HZ and PHN, age- and sex-specific HZ incidence rates and PHN proportions were estimated. For comparison, estimates based on statutory health insurance data from the German population were considered. RESULTS: Eleven percent (95%-CI, 10.4 to 12.3, n = 539) of the participants reported at least one HZ episode in their lifetime. Our estimated age-specific HZ incidence rates were lower than previous estimates based on statutory health insurance data. The PHN proportion in participants older than 50 years was 5.9% (1.9 to 13.9%), which was in line with estimates based on health insurance data. CONCLUSION: As age- and sex-specific patterns were comparable with that in health insurance data, self-reported diagnosis of HZ seems to be a valid instrument for overall disease trends. Possible reasons for observed differences in incidence rates are recall bias in self-reported data or overestimation in health insurance data.

Variability and reliability study of overall physical activity and activity intensity levels using 24 h-accelerometry-assessed data.

BACKGROUND: 24 h-accelerometry is now used to objectively assess physical activity (PA) in many observational studies like the German National Cohort; however, PA variability, observational time needed to estimate habitual PA, and reliability are unclear. METHODS: We assessed 24 h-PA of 50 participants using triaxial accelerometers (ActiGraph GT3X+) over 2 weeks. Variability of overall PA and different PA intensities (time in inactivity and in low intensity, moderate, vigorous, and very vigorous PA) between days of assessment or days of the week was quantified using linear mixed-effects and random effects models. We calculated the required number of days to estimate PA, and calculated PA reliability using intraclass correlation coefficients. RESULTS: Between- and within-person variance accounted for 34.4-45.5% and 54.5-65.6%, respectively, of total variance in overall PA and PA intensities over the 2 weeks. Overall PA and times in low intensity, moderate, and vigorous PA decreased slightly over the first 3 days of assessment. Overall PA (p = 0.03), time in inactivity (p = 0.003), in low intensity PA (p = 0.001), in moderate PA (p = 0.02), and in vigorous PA (p = 0.04) slightly differed between days of the week, being highest on Wednesday and Friday and lowest on Sunday and Monday, with apparent differences between Saturday and Sunday. In nested random models, the day of the week accounted for < 19% of total variance in the PA parameters. On average, the required number of days to estimate habitual PA was around 1 week, being 7 for overall PA and ranging from 6 to 9 for the PA intensities. Week-to-week reliability was good (intraclass correlation coefficients, range, 0.68-0.82). CONCLUSIONS: Individual PA, as assessed using 24 h-accelerometry, is highly variable between days, but the day of assessment or the day of the week explain only small parts of this variance. Our data indicate that 1 week of assessment is necessary for reliable estimation of habitual PA.

Policy determinants of physical activity across the life course: a 'DEDIPAC' umbrella systematic literature review.

Background: Despite the large number of studies and reviews available, the evidence regarding the policy determinants of physical activity (PA) is inconclusive. This umbrella systematic literature review (SLR) summarizes the current evidence on the policy determinants of PA across the life course, by pooling the results of the available SLRs and meta-analyses (MAs). Methods: A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus and SPORTDiscus databases up to April 2016. SLRs and MAs of observational studies investigating the association between policy determinants of PA and having PA as outcome were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence and the methodological quality. Results: Fourteen reviews on 27 policy determinants of PA were eligible for this umbrella SLR. The majority of the reviews were of moderate quality. Among children, a clear association between time spent outdoors and PA emerged. Among adults, working hours were negatively associated with PA, though evidence was limited. At the population level, community- and street-scale urban design and land use policies were found to positively support PA levels, but levels of evidences were low. Conclusions: With this umbrella SLR the policy determinants of PA at individual-level and population-level have been summarized and assessed. None of the investigated policy determinants had a convincing level of evidence, and very few had a probable level of evidence. Further research is needed, preferably by using prospective study designs, standardized definitions of PA and objective measurement of PA.

Behavioral determinants of physical activity across the life course: a "DEterminants of DIet and Physical ACtivity" (DEDIPAC) umbrella systematic literature review.

BACKGROUND: Low levels of physical activity (PA) are a global concern and increasing PA engagement is becoming a priority in current public health policies. Despite the large number of studies and reviews available, the evidence regarding the behavioral determinants of PA is still inconclusive. Thus, the aim of this umbrella systematic literature review (SLR) was to summarize the evidence on the behavioral determinants of PA across the life course. METHODS: A systematic online search was conducted on MEDLINE, ISI Web of Science, Scopus, and SPORTDiscus databases. The search was limited to studies published in English from January, 2004 to April, 2016. SLRs and meta-analyses (MAs) of observational studies that investigated the behavioral determinants of PA were considered eligible. The extracted data were assessed based on the importance of the determinants, the strength of evidence, and the methodological quality. The full protocol is available from PROSPERO (PROSPERO 2014:CRD42015010616). RESULTS: Seventeen reviews on 35 behavioral determinants of PA were eligible for this umbrella SLR. Regardless of age, the most investigated determinants were those related with 'screen use' and 'smoking'. For youth, probable positive evidence emerged for 'previous PA' and 'independent mobility and active transport' among children and adolescents. For the adult population, 'transition to university' and 'pregnancy/having a child' showed probable negative associations. CONCLUSIONS: Although the majority of the evidence was limited and most of the determinants were not associated with PA, this umbrella SLR provided a comprehensive overview of the associations between behavioral determinants and PA. Youth should be physically active in the early years and increase active transportation to/from school, independent mobility, and 'free-range activities' without adult supervision, whilst adult PA behaviors are mostly influenced by the life events. Finally, more research is needed that incorporates prospective study designs, standardized definitions of PA, objective measurement methods of PA assessment, and the use of interactionist and mediational approaches for the evaluation of different behavioral determinants influencing PA behaviors.

Socio-cultural determinants of physical activity across the life course: a 'Determinants of Diet and Physical Activity' (DEDIPAC) umbrella systematic literature review.

OBJECTIVE: Regular physical activity (PA) reduces the risk of disease and premature death. Knowing factors associated with PA might help reducing the disease and economic burden caused by low activity. Studies suggest that socio-cultural factors may affect PA, but systematic overviews of findings across the life course are scarce. This umbrella systematic literature review (SLR) summarizes and evaluates available evidence on socio-cultural determinants of PA in children, adolescents, and adults. METHODS: This manuscript was drafted following the recommendations of the 'Preferred Reporting Items for Systematic reviews and Meta-Analyses' (PRISMA) checklist. The MEDLINE, Web of Science, Scopus, and SPORTDiscus databases were searched for SLRs and meta-analyses (MAs) on observational studies published in English that assessed PA determinants between January 2004 and April 2016. The methodological quality was assessed and relevant information on socio-cultural determinants and any associations with PA was extracted. The available evidence was evaluated based on the importance of potential determinants and the strength of the evidence. RESULTS: Twenty SLRs and three MAs encompassing 657 eligible primary studies investigated potential socio-cultural PA determinants, with predominantly moderate methodological quality. Twenty-nine potential PA determinants were identified that were primarily assessed in children and adolescents and investigated the micro-environmental home/household level. We found probable evidence that receiving encouragement from significant others and having a companion for PA were associated with higher PA in children and adolescents, and that parental marital status (living with partner) and experiencing parental modeling were not associated with PA in children. Evidence for the other potential determinants was limited, suggestive, or non-conclusive. In adults, quantitative and conclusive data were scarce. CONCLUSIONS: A substantial number of SLRs and MAs investigating potential socio-cultural determinants of PA were identified. Our data suggest that receiving social support from significant others may increase PA levels in children and adolescents, whereas parental marital status is not a determinant in children. Evidence for other potential determinants was limited. This was mainly due to inconsistencies in results on potential socio-cultural determinants of PA across reviews and studies. TRIAL REGISTRATIONS: This umbrella SLR was recorded on PROSPERO (Record ID: CRD42015010616 ).

Using concept mapping in the development of the EU-PAD framework (EUropean-Physical Activity Determinants across the life course): a DEDIPAC-study.

BACKGROUND: A large proportion of European children, adults and older adults do not engage in sufficient physical activity (PA). Understanding individual and contextual factors associated with PA behaviours is essential for the identification and implementation of effective preventative environments, policies, and programmes that can promote an active lifestyle across life course and can potentially improve health. The current paper intends to provide 1) a multi-disciplinary, Pan-European and life course view of key determinants of PA behaviours and 2) a proposal of how these factors may cluster. METHODS: After gathering a list of 183 potential PA behaviours-associated factors and a consensus meeting to unify/consolidate terminology, a concept mapping software was used to collate European experts' views of 106 identified factors for youth (<19 years), adults (19-64 years), and older adults (≥65 years). The analysis evaluated common trends in the clustering of factors and the ratings of the distinct factors' expected modifiability and population-level impact on PA behaviours across the life course. Priority for research was also assessed for each cluster. RESULTS: The concept mapping resulted in six distinct clusters, broadly merged in two themes: 1) the 'Person', which included clusters 'Intra-Personal Context and Wellbeing' and 'Family and Social Economic Status' (42 % of all factors) and 2) the 'Society', which included the remaining four clusters 'Policy and Provision', 'Cultural Context and Media', 'Social Support and Modelling', and 'Supportive Environment' (58 % of all factors). Overall, 25 factors were rated as the most impactful on PA behaviours across the life course and being the most modifiable. They were mostly situated in the 'Intra-Personal Context and Wellbeing' cluster. Furthermore, 16 of them were rated as top priority for research. CONCLUSIONS: The current framework provides a preliminary overview of factors which may account for PA behaviour across the life course and are most relevant to the European community. These insights could potentially be a foundation for future Pan-European research on how these factors might interact with each other, and assist policy makers to identify appropriate interventions to maximize PA behaviours and thus the health of European citizens.

Pocket depth and bleeding on probing and their associations with dental, lifestyle, socioeconomic and blood variables: a cross-sectional, multicenter feasibility study of the German National Cohort.

BACKGROUND: To investigate the periodontal disease status in a multi-center cross-sectional study in Germany. Associations of dental, socio-economic, blood and biomedical variables with periodontal outcome parameters were evaluated. METHODS: From 4 different centers N = 311 persons were included, drawn randomly from the registration offices. Maximal pocket depth (PD) was used as primary indicator for periodontitis. It was classified as: no/mild ≤3 mm, moderate 4-5 mm, severe ≥6 mm. Associations between socioeconomic (household income, education), lifestyle, and biomedical factors and PD or bleeding on probing (BOP) per site ("Yes"/"No") was analyzed with logistic regression analysis. RESULTS: Mean age of subjects was 46.4 (range 20-77) years. A significantly higher risk of deeper pockets for smokers (OR = 2.4, current vs. never smoker) or persons with higher BMI (OR = 1.6, BMI increase by 5) was found. Severity of periodontitis was significantly associated with caries lesions (p = 0.01), bridges (p < .0001), crowns (p < .0001), leukocytes (p = 0.04), HbA1c (p < .0001) and MCV (p = 0.04). PD was positively correlated with BOP. No significant associations with BOP were found in regression analysis. CONCLUSIONS: Earlier findings for BMI and smoking with severity of PD were confirmed. Dental variables might be influenced by potential confounding factors e.g. dental hygiene. For blood parameters interactions with unknown systemic diseases may exist.

Coffee intake and risk of type 2 diabetes: the Multiethnic Cohort.

OBJECTIVE: We evaluated the influence of coffee consumption on diabetes incidence among the Hawaii component of the Multiethnic Cohort (MEC). DESIGN: Prospective cohort. SETTING: Population-based sample residing in Hawaii. SUBJECTS: After exclusions, 75 140 men and women of Caucasian, Japanese American and Native Hawaiian ancestry aged 45-75 years were part of the current analysis. All participants provided information on diet and lifestyle through an FFQ. After 14 years of follow-up 8582 incident diabetes cases were identified using self-reports, medication questionnaires and health plan linkages. Hazard ratios (HR) and 95 % confidence intervals were calculated using Cox regression while adjusting for known covariates. RESULTS: The risk for diabetes associated with total coffee consumption differed by sex (P interaction < 0·0001). Women consuming ≥3 cups of any type of coffee daily had a significantly lower risk (HR = 0·66; 95 % CI 0·58, 0·77; P trend < 0·0001) than those reporting <1 cup/d, whereas the relationship in men was borderline (HR = 0·89; 95 % CI 0·80, 0·99; P trend = 0·09). The same difference by sex was seen for regular coffee consumption, with HR of 0·65 (95 % CI 0·54, 0·78; P trend < 0·0001) and 0·86 (95 % CI 0·75, 0·98; P trend = 0·09) in men and women, respectively. No significant association with diabetes was apparent for decaffeinated coffee in women (HR = 0·85; 95 % CI 0·72, 1·01; P trend = 0·73) or men (HR = 1·07; 95 % CI 0·93, 1·23; P trend = 0·71). Despite small differences by ethnicity, the interaction terms between coffee intake and ethnicity were not significant. CONCLUSIONS: In this multiethnic population, regular, but not decaffeinated, coffee intake was much more protective against diabetes in women of all ethnic groups than in men.

Pregnancy associated plasma protein-A2 (PAPP-A2) and stanniocalcin-2 (STC2) but not PAPP-A are associated with circulating total IGF-1 in a human adult population.

The pappalysins pregnancy associated plasma protein-A (PAPP-A) and -A2 (PAPP-A2) act as proteinases of insulin-like growth factor-1 (IGF-1) binding proteins, while stanniocalcin-2 (STC2) was identified as a pappalysin inhibitor. While there is some evidence from studies in children and adolescents, it is unclear whether these molecules are related to concentrations of IGF-1 and its binding proteins in adults. We investigated cross-sectionally the association of circulating PAPP-A, PAPP-A2 and STC2 with IGF-1 and its binding proteins (IGFBPs) in 394 adult pretest participants (20-69 years) of the German National Cohort Berlin North study center. Plasma PAPP-A, PAPP-A2, total and free IGF-1, IGFBP-1, IGFBP-2, IGFBP-3, IGFBP-5 and STC2 were measured by ELISAs. The associations of PAPP-A, PAPP-A2 and STC2 with IGF-1 or IGFBPs were investigated using multivariable linear regression analyses adjusting for age, sex, body mass index and pretest phase. We observed significant inverse associations of PAPP-A2 (difference in concentrations per 0.5 ng/mL higher PAPP-A2 levels) with total IGF-1 (- 4.3 ng/mL; 95% CI - 7.0; - 1.6), the IGF-1:IGFBP-3 molar ratio (- 0.34%; 95%-CI - 0.59; - 0.09), but not free IGF-1 and a positive association with IGFBP-2 (11.9 ng/mL; 95% CI 5.0; 18.8). PAPP-A was not related to total or free IGF-1, but positively associated with IGFBP-5. STC2 was inversely related to total IGF-1, IGFBP-2 and IGFBP-3 and positively to IGFBP-1. This first investigation of these associations in a general adult population supports the hypothesis that PAPP-A2 as well as STC2 play a role for IGF-1 and its binding proteins, especially for total IGF-1. The role of PAPP-A2 and STC2 for health and disease in adults warrants further investigation.

Heterocyclic aromatic amine [HCA] intake and prostate cancer risk: effect modification by genetic variants.

The association between heterocyclic aromatic amine (HCA) intake and prostate cancer (PCa) risk may be modified by genetic variation in enzymes involved in HCA metabolism. We examined this question in a case-control study nested within the European Prospective Investigation into Cancer and Nutrition Heidelberg cohort. The study included 204 PCa cases and 360 matched controls. At baseline, participants provided dietary and lifestyle data and blood samples that were used for genotyping. Dietary HCA intake-2-amino-1-methyl-6-phenylimidazo[4,5-b] pyridine (PhIP), 2-amino-3,8-dimethylimidazo [4,5-f]quinoxaline (MeIQx), and 2-amino-3,4,8-dimethylimidazo [4,5-f]quinoxaline (DiMeIQx-was estimated using information on meat consumption, cooking methods, and browning degree. Risk estimates for gene × HCA interactions were calculated by unconditional logistic regression. We found inverse associations between PhIP, MeIQx, or DiMeIQx intake and PCa risk when having <2 deletions of the GSTT1 and GSTM1 genes (P(interaction): 0.03, 0.01, and 0.03, respectively), which is supported by analysis of darkly browned meat consumption data. Statistically significant effect modification of both HCA (DiMeIQx) and darkly browned meat intake and PCa risk was observed for allelic variants of MnSOD (rs4880) (P(interaction): 0.02). Despite limitations due to study size, we conclude that the association between HCA intake and PCa risk could be modified by polymorphisms of GSTT1, GSTM1, and MnSOD.

Effects of selenium status, dietary glucosinolate intake and serum glutathione S-transferase α activity on the risk of benign prostatic hyperplasia.

UNLABELLED: Study Type--Prognosis (case control) Level of Evidence 2. What's known on the subject? and What does the study add? Geographical and ethnic differences in the distribution of BPH and the results of migrant studies indicate that not only age, androgens and genetics, but also modifiable factors may play a role in the aetiology of BPH. Oxidative stress induced by chronic inflammation could be a cause and antioxidants, including selenoproteins, may reduce the risk. The published data related to this topic are scarce and are mainly based on cross-sectional and case-control studies. In a nested case-control study, we observed a significant inverse association between serum selenium concentrations and the risk of BPH. These results need to be confirmed in larger, prospective epidemiological studies. Prostate enlargement is an increasing health problem as a result of an ageing population in many countries. Modifiable factors may also play a role. In the present study, before this antioxidant can be recommended as a preventive measure. OBJECTIVE: • To determine whether geographical differences in the distribution of benign prostatic hyperplasia (BPH) and migrant studies indicate that modifiable factors play a role in the aetiology of BPH. Oxidative stress produced by chronic inflammation could represent one of the causes, and antioxidants, including selenoproteins, may reduce the risk. SUBJECTS AND METHODS: • Conditional logistic regression was used to examine the associations of serum selenium and selenoprotein P concentrations and glutathione peroxidase activity with respect to the risk of BPH in a case-control study nested in the European Prospective Investigation into Cancer and Nutrition-Heidelberg cohort, including 111 cases and 214 matched controls. • In addition, dietary glucosinolate intake and the serum glutathione S-transferase α concentration was investigated. RESULTS: • The risk of BPH significantly decreased with an increasing serum selenium concentration; the risk estimate was 0.83 (35% CI 0.69-0.99) per 10 µg/L increase in serum selenium concentration. • However, no significant association was present for serum selenoprotein P concentration or glutathione peroxidase activity. Risk estimates for BPH decreased with a higher intake of glucosinolates, although the results were not statistically significant. CONCLUSION: • A low serum selenium concentration may increase the risk of BPH, although the findings reported in the present study need to be confirmed in larger, well-designed epidemiological studies.

Association of general and abdominal adiposity with postural changes in systolic blood pressure: results from the NAKO pretest and MetScan studies.

The association between anthropometric measurements and postural changes in systolic blood pressure (SBP) has not been frequently reported. This study aimed to investigate the association of body mass index (BMI) and waist circumference (WC) with postural changes in SBP in two German cross-sectional studies. Data were derived from 506 participants of the population-based German National Cohort (NAKO) pretest and from 511 participants of the convenience sample-based MetScan studies. Linear regression models were used to estimate the association between BMI and WC with the difference between standing and sitting SBP (dSBP). Odds ratios (ORs) for an increase (dSBP > 10 mmHg) or decrease (dSBP ≤ -10 mmHg) in dSBP were calculated using logistic regression. The results were pooled by meta-analysis using an inverse variance model. In pooled analysis, a 5 kg/m2 higher BMI was associated with a 1.46 mmHg (95% confidence interval (CI) 0.98-1.94) higher dSBP, while a 5 cm higher WC was associated with a 0.51 mmHg (95% CI 0.32-0.69) higher dSBP. BMI or WC were associated with a higher odds of an increase in dSBP (adjusted OR, 1.71; 95% CI 1.36-2.14 per 5 kg/m2 higher BMI and 1.22; 95% CI 1.05-1.40 per 5 cm higher WC) but with a reduced odds of a decline in dSBP (adjusted OR, 0.67; 95% CI 0.44-1.00 per 5 kg/m2 higher BMI and 0.84; 95% CI 0.72-0.99 per 5 cm higher WC). The associations between WC and dSBP were no longer statistically significant after BMI adjustments. In conclusion, higher BMI and higher WC were associated with higher postural increases in SBP; however, WC was not related to postural changes in SBP once adjusted for BMI.

Prediction of activity-related energy expenditure under free-living conditions using accelerometer-derived physical activity.

The purpose of the study was to develop prediction models to estimate physical activity (PA)-related energy expenditure (AEE) based on accelerometry and additional variables in free-living adults. In 50 volunteers (20-69 years) PA was determined over 2 weeks using the hip-worn Actigraph GT3X + as vector magnitude (VM) counts/minute. AEE was calculated based on total daily EE (measured by doubly-labeled water), resting EE (indirect calorimetry), and diet-induced thermogenesis. Anthropometry, body composition, blood pressure, heart rate, fitness, sociodemographic and lifestyle factors, PA habits and food intake were assessed. Prediction models were developed by context-grouping of 75 variables, and within-group stepwise selection (stage I). All significant variables were jointly offered for second stepwise regression (stage II). Explained AEE variance was estimated based on variables remaining significant. Alternative scenarios with different availability of groups from stage I were simulated. When all 11 significant variables (selected in stage I) were jointly offered for stage II stepwise selection, the final model explained 70.7% of AEE variance and included VM-counts (33.8%), fat-free mass (26.7%), time in moderate PA + walking (6.4%) and carbohydrate intake (3.9%). Alternative scenarios explained 53.8-72.4% of AEE. In conclusion, accelerometer counts and fat-free mass explained most of variance in AEE. Prediction was further improved by PA information from questionnaires. These results may be used for AEE prediction in studies using accelerometry.

Feasibility of a Culturally Adapted Dietary Weight-Loss Intervention among Ghanaian Migrants in Berlin, Germany: The ADAPT Study.

BACKGROUND: Dietary weight-loss interventions often fail among migrant populations. We investigated the practicability and acceptability of a culturally adapted dietary weight-loss intervention among Ghanaian migrants in Berlin. METHODS: The national guidelines for the treatment of adiposity were adapted to the cultural characteristics of the target population, aiming at weight-loss of ≥2.5 kg in 3 months using food-based dietary recommendations. We invited 93 individuals of Ghanaian descent with overweight or obesity to participate in a 12-weeks intervention. The culturally adapted intervention included a Ghanaian dietician and research team, one session of dietary counselling, three home-based cooking sessions with focus on traditional Ghanaian foods, weekly smart-phone reminders, and monthly monitoring of diet and physical activity. We applied a 7-domains acceptability questionnaire and determined changes in anthropometric measures during clinic-based examinations at baseline and after the intervention. RESULTS: Of the 93 invitees, five participants and four family volunteers completed the study. Reasons for non-participation were changed residence (13%), lack of time to attend examinations (10%), and no interest (9%); 64% did not want to give any reason. The intervention was highly accepted among the participants (mean range: 5.3-6.0 of a 6-points Likert scale). Over the 12 weeks, median weight-loss reached -0.6 kg (range: +0.5, -3.6 kg); the diet was rich in meats but low in convenience foods. The median contribution of fat to daily energy intake was 24% (range: 16-40%). CONCLUSIONS: Acceptance of our invitation to the intervention was poor but, once initiated, compliance was good. Assessment centers in the participants' vicinity and early stakeholder involvement might facilitate improved acceptance of the invitation. A randomized controlled trial is required to determine the actual effects of the intervention.

Association of body surface scanner-based abdominal volume with parameters of the Metabolic Syndrome and comparison with manually measured waist circumference.

To investigate abdominal volume determined by a new body scanner algorithm as anthropometric marker for Metabolic Syndrome (MetS) and its parameters compared to manually measured waist circumference (WC), we performed body scans in 411 participants (38% men, 20-81 years). WC and triglyceride, HDL-cholesterol, and fasting glucose concentrations, and blood pressure were assessed as MetS parameters. We used Spearman correlations and linear regression to investigate associations and goodness-of-fit (R², BIC) of abdominal volume and WC with MetS parameters, and logistic regression to analyse the discriminative power of WC and abdominal volume to assess likelihoods of MetS components and MetS. Correlations with triglyceride, HDL-cholesterol, and glucose concentration were slightly stronger for abdominal volume (r; 0.32, -0.32, and 0.34, respectively) than for WC (0.28, -0.28, and 0.29, respectively). Explained variances in MetS parameters were slightly higher and goodness-of-fit slightly better for abdominal volume than for WC, but differences were small. Exemplarily, glucose levels were 0.28 mmol/L higher (R² = 0.25; BIC = 945.5) per 1-SD higher  WC, and 0.35 mmol/L higher (R² = 0.28; BIC = 929.1) per 1-SD higher abdominal volume. The discriminative power to estimate MetS components was similar for WC and abdominal volume. Our data show that abdominal volume allows metabolic characterization comparable to established WC.

School- and Leisure Time Factors Are Associated With Sitting Time of German and Irish Children and Adolescents During School: Results of a DEDIPAC Feasibility Study.

Objective: The study aims to investigate to what extent school- and leisure time-related factors are associated with sedentary behavior during school in German and Irish children and adolescents. Methods: The study based on a sample of 198 children and adolescents surveyed in 2015. Sedentary and activity behavior were measured using the activPAL physical activity monitor. Information on socio-economic status, school- and leisure-time related factors were provided by questionnaires. Associations between school- and leisure time-related factors and sedentary time during school were estimated using linear multi-level models. Results: Access to play equipment in school was associated with reduced sitting time (hours/day) of children (ß = 0.78; 95%CI = 0.06-1.48). Media devices in bedroom and assessing the neighborhood as activity friendly was associated with increased sitting time of children (ß = 0.92; 95%CI = 0.12-1.72 and ß = 0.30; 95%CI = 0.01-0.60, respectively). The permission to use media devices during breaks was associated with increased sitting time (hours/day) of adolescents (ß = 0.37; 95% CI = 0.06-0.69). A less safe traffic surrounding at school was associated with reduced sitting time of adolescents (ß = -0.42; 95% CI = -0.80 to -0.03). Conclusion: Results suggest that school- and leisure time-related factors are associated to the sedentary behavior during school. We suggest that future strategies to reduce sedentary time should consider both contexts.

Factors associated with habitual time spent in different physical activity intensities using multiday accelerometry.

To investigate factors associated with time in physical activity intensities, we assessed physical activity of 249 men and women (mean age 51.3 years) by 7-day 24h-accelerometry (ActiGraph GT3X+). Triaxial vector magnitude counts/minute were extracted to determine time in inactivity, in low-intensity, moderate, and vigorous-to-very-vigorous activity. Cross-sectional associations with sex, age, body mass index, waist circumference, smoking, alcohol consumption, education, employment, income, marital status, diabetes, and dyslipidaemia were investigated in multivariable regression analyses. Higher age was associated with more time in low-intensity (mean difference, 7.3 min/d per 5 years; 95% confidence interval 2.0,12.7) and less time in vigorous-to-very-vigorous activity (-0.8 min/d; -1.4, -0.2), while higher BMI was related to less time in low-intensity activity (-3.7 min/d; -6.3, -1.2). Current versus never smoking was associated with more time in low-intensity (29.2 min/d; 7.5, 50.9) and less time in vigorous-to-very-vigorous activity (-3.9 min/d; -6.3, -1.5). Finally, having versus not having a university entrance qualification and being not versus full time employed were associated with more inactivity time (35.9 min/d; 13.0, 58.8, and 66.2 min/d; 34.7, 97.7, respectively) and less time in low-intensity activity (-31.7 min/d; -49.9, -13.4, and -50.7; -76.6, -24.8, respectively). The assessed factors show distinct associations with activity intensities, providing targets for public health measures aiming to increase activity.

Dietary glucosinolate intake and risk of prostate cancer in the EPIC-Heidelberg cohort study.

Glucosinolates (GLS) are secondary plant metabolites occurring in cruciferous vegetables. Their biologically active break-down products show cancer preventive properties in animal and cell studies. So far, epidemiologic studies, using consumption of cruciferous vegetables as proxy for GLS intake, yielded inconsistent results. Here, we evaluated the association between dietary intake of GLS in comparison with consumption data of GLS-containing foods and the risk of prostate cancer. The study population comprised 11,405 male participants of the prospective EPIC-Heidelberg cohort study. During a mean follow-up time of 9.4 years, 328 incident cases of prostate cancer occurred. At recruitment, habitual food consumption was assessed by a validated food frequency questionnaire, and intake of individual GLS was estimated by means of a newly compiled database on food content of GLS. Adjusted hazard ratios (HR) for prostate cancer were calculated using the Cox proportional hazard model. Median daily intake of total GLS was 7.9 mg/day (interquartile range 5.1-11.9 mg/day). The risk of prostate cancer decreased significantly over quartiles of total GLS intake (multivariate HR [4th vs. 1st quartile] 0.68, 95% CI 0.48-0.97, p(trend) 0.03). Associations with GLS-containing food intake were weaker. Among GLS subgroups, aliphatic GLS showed the strongest inverse association with cancer risk. Analyses stratified by tumor stage and grade gave hint to inverse associations for localized and low-grade cancers. This study shows an inverse association between dietary intake of GLS and the risk of prostate cancer. Because this is the first prospective study using individual GLS intake data, confirmation in other studies is warranted.

Dietary intake of individual glucosinolates in participants of the EPIC-Heidelberg cohort study.

BACKGROUND/AIMS: To compile a database on content of individual glucosinolates in food and to describe the dietary intake of individual glucosinolates in a German population. METHODS: Studies analysing the content of individual glucosinolates in food were aggregated to form a database of 26 individual glucosinolates in 18 vegetables and condiments consumed in Germany. This database was linked to food intake data derived from 24-hour diet recalls of 2,121 participants of the EPIC-Heidelberg cohort study. RESULTS: Mean total glucosinolate intake (+/-standard error) was 14.2 (+/-1.1) mg/day for men and 14.8 (+/-1.3) mg/day for women. The intake increased with age and education; smokers ingested less glucosinolates than never or former smokers. The quantitatively most important individual glucosinolates were glucobrassicin and sinigrin with mean daily intakes of 3.5 (+/-0.3) and 1.7 (+/-0.2) mg/day for men, and 4.2 (+/-0.4) and 2.5 (+/-0.4) mg/day for women, respectively. Broccoli, Brussels sprouts and cauliflower contributed most to the total glucosinolate intake in this population. CONCLUSIONS: The established database allowed for the first time the estimation of dietary intake of individual glucosinolates. The database can be used for epidemiological research on the role of glucosinolates in health and disease.