Retinol and Retinol Binding Protein 4 Levels and Cardiometabolic Disease Risk.

BACKGROUND: Despite mechanistic studies linking retinol and RBP4 (retinol binding protein 4) to the pathogenesis of cardiovascular diseases (CVD) and type 2 diabetes (T2D), epidemiological evidence is still conflicting. We investigated whether conflicting results of previous studies may be explained by differences in the association of retinol and RBP4 with cardiometabolic risk across subgroups with distinct sex, hypertension state, liver, or kidney function. METHODS: We used case-cohorts nested in the EPIC (European Prospective Investigation Into Cancer and Nutrition)-Potsdam cohort (N=27 548) comprising a random sample of participants (n=2500) and all physician-verified cases of incident CVD (n=508, median follow-up time 8.2 years) and T2D (n=820, median follow-up time 6.3 years). We estimated nonlinear and linear multivariable-adjusted associations between the biomarkers and cardiometabolic diseases by restricted cubic splines and Cox regression, respectively, testing potential interactions with hypertension, liver, and kidney function. Additionally, we performed 2-sample Mendelian Randomization analyses in publicly available data. RESULTS: The association of retinol with cardiometabolic risk was modified by hypertension state (P interaction CVD<0.001; P interaction T2D<0.001). Retinol was associated with lower cardiometabolic risk in participants with treated hypertension (hazard ratioper SD [95% CI]: CVD, 0.71 [0.56-0.90]; T2D, 0.81 [0.70-0.94]) but with higher cardiometabolic risk in normotensive participants (CVD, 1.32 [1.06-1.64]; T2D, 1.15 [0.98-1.36]). Our analyses also indicated a significant interaction between RBP4 and hypertension on CVD risk (P interaction=0.04). Regarding T2D risk, we observed a u-shaped association with RBP4 in women (P nonlinearity=0.01, P effect=0.02) and no statistically significant association in men. The biomarkers' interactions with liver or kidney function were not statistically significant. Hypertension state-specific associations for retinol concentrations with cardiovascular mortality risk were replicated in National Health and Nutrition Examination Survey III. CONCLUSIONS: Our findings suggest a hypertension-dependent relationship between plasma retinol and cardiometabolic risk and complex interactions of RBP4 with sex and hypertension on cardiometabolic risk.

Biomarker signatures associated with ageing free of major chronic diseases: results from a population-based sample of the EPIC-Potsdam cohort.

BACKGROUND: A number of biomarkers denoting various pathophysiological pathways have been implicated in the aetiology and risk of age-related diseases. Hence, the combined impact of multiple biomarkers in relation to ageing free of major chronic diseases, such as cancer, cardiovascular disease and type 2 diabetes, has not been sufficiently explored. METHODS: We measured concentrations of 13 biomarkers in a random subcohort of 2,500 participants in the European Prospective Investigation into Cancer and Nutrition Potsdam study. Chronic disease-free ageing was defined as reaching the age of 70 years within study follow-up without major chronic diseases, including cardiovascular disease, type 2 diabetes or cancer. Using a novel machine-learning technique, we aimed to identify biomarker clusters and explore their association with chronic disease-free ageing in multivariable-adjusted logistic regression analysis taking socio-demographic, lifestyle and anthropometric factors into account. RESULTS: Of the participants who reached the age of 70 years, 321 met our criteria for chronic-disease free ageing. Machine learning analysis identified three distinct biomarker clusters, among which a signature characterised by high concentrations of high-density lipoprotein cholesterol, adiponectin and insulin-like growth factor-binding protein 2 and low concentrations of triglycerides was associated with highest odds for ageing free of major chronic diseases. After multivariable adjustment, the association was attenuated by socio-demographic, lifestyle and adiposity indicators, pointing to the relative importance of these factors as determinants of healthy ageing. CONCLUSION: These data underline the importance of exploring combinations of biomarkers rather than single molecules in understanding complex biological pathways underpinning healthy ageing.

Internal exposure to heat-induced food contaminants in omnivores, vegans and strict raw food eaters: biomarkers of exposure to acrylamide (hemoglobin adducts, urinary mercapturic acids) and new insights on its endogenous formation.

The urinary mercapturic acids N-acetyl-S-(2-carbamoylethyl)-L-cysteine (AAMA) and N-acetyl-S-(2-carbamoyl-2-hydroxyethyl)-L-cysteine (GAMA) are short-term biomarkers of exposure from acrylamide and its metabolite glycidamide, respectively. The medium-term exposure to acrylamide and glycidamide is monitored by the adducts N-(2-carbamoylethyl)-Val (AA-Val) and N-(2-carbamoyl-2-hydroxyethyl)-Val (GA-Val) in hemoglobin (Hb), respectively. Three questions were addressed by application of these biomarkers in two diet studies including 36 omnivores, 36 vegans and 16 strict raw food eaters (abstaining from any warmed or heated food for at least four months): first, what is the internal acrylamide exposure following a vegan or a raw food diet in comparison to that in omnivores? Second, did the exposure change between 2017 and 2021? And third, what is the stability over time of AAMA/GAMA excretion compared to that of AA-Val/GA-Val levels in Hb between both time points? Median urinary AAMA excretion per day in non-smoking omnivores, vegans and raw food eaters were 62.4, 85.4 and 15.4 µg/day, respectively; the corresponding median AA-Val levels were 27.7, 39.7 and 13.3 pmol/g Hb, respectively. Median levels in strict raw food eaters were about 25% (AAMA excretion) and 48% (AA-Val) of those in omnivores. In comparison to 2017, AAMA and GAMA excretion levels were hardly altered in 2021, however, levels of AA-Val and GA-Val in 2021 slightly increased. There was a weak correlation between AAMA excretion levels determined four years apart (rS = 0.30), and a moderate correlation between levels of AA-Val (rS = 0.55) in this timeframe. Our data in strict raw food eaters confirm a significant endogenous formation to acrylamide in a size range, which is-based on the levels of AA-Val-distinctly higher than reported previously based on levels of urinary AAMA excretion. The relatively lower AAMA excretion in raw food eaters likely represents a lower extent of glutathione conjugation due to missing hepatic first-pass metabolism in case of endogenous formation of acrylamide, which leads to a higher systemic exposure.

Stable isotope ratios of nitrogen and carbon as biomarkers of a vegan diet.

PURPOSE: Dietary biomarkers can potentially overcome the limitations of self-reported dietary data. While in ecology and archaeology, stable isotope ratios of carbon and nitrogen are widely used as biomarkers, this is not the case in nutrition research. Since the abundance of the 13C and the 15N isotope differ in food sources from plant and animal origin, stable isotope ratios of carbon and nitrogen (δ13C and δ15N) may differ in human biological material. Here, we investigated the stable isotope ratios of nitrogen and carbon in serum and urine from vegans and omnivores. METHOD: Measurement of δ15N and δ13C in serum and 24 h urine was performed by Elemental Analyzer-Isotope Ratio Mass Spectrometer in the cross-sectional study "Risks and Benefits of a Vegan Diet". The study included 36 vegans and 36 omnivores with a median age of 37.5 years (matched for age and sex), who adhered to their diet for at least 1 year. RESULTS: Both δ15N and δ13C were significantly lower in both the serum and 24 h urine of vegans compared to omnivores. δ15N either in serum or urine had 100% specificity and sensitivity to discriminate between vegans and omnivores. Specificity of δ13C was also > 90%, while sensitivity was 93% in serum and 77% in urine. CONCLUSION: δ15N both in serum and urine was able to accurately identify vegans and thus appears to be a promising marker for dietary habits.

Amino acid intake and plasma concentrations and their interplay with gut microbiota in vegans and omnivores in Germany.

PURPOSE: It has been estimated that most vegans meet the total protein requirements, but whether this is also true for individual essential amino acids (AAs) is unclear. Furthermore, a shift in protein intake is suggested to alter microbiota composition, but this association is unknown in terms of veganism or individual AAs. This cross-sectional study compared vegans and omnivores regarding dietary intake and plasma concentration of AAs. The prevalence of insufficient intake of essential AAs among vegans was determined using estimated average requirements (EAR) of WHO. Moreover, correlations between AAs intake and gut microbiota were investigated. METHODS: Data of 36 vegans and 36 omnivores (30-60 years) were analysed. AA intake, AA plasma concentrations and gut microbiota were ascertained by three-day weighed food protocols, gas/liquid chromatography-tandem mass spectrometry and 16S rRNA sequencing, respectively. RESULTS: At almost the same energy intake, the intake of 9 AAs in vegans was significantly lower than in omnivores, with median differences of - 27.0% to - 51.9%. However, only one female vegan showed total protein and lysine intake below the EAR. Vegans showed lower lysine (- 25.0%), but higher glycine (+ 25.4%) and glutamate (+ 13.1%) plasma concentrations than omnivores. Correlation patterns between AA intake and bacterial microbiota differed between vegans and omnivores. In vegans 19 species and in omnivores 5 species showed correlations with AA intake. CONCLUSION: Vegans consumed apparently sufficient but lower AAs than omnivores. In addition, the different AAs intake seems to influence the microbiota composition. The use of short-term dietary data without considering usual intake limits these findings.

Knowledge and awareness about and use of iodised salt among students in Germany and Greece.

BACKGROUND: Iodine is an essential trace element, which is important for human metabolism, growth and mental development. Iodine deficiency may still occur in Europe and the use of iodised salt is an effective measure to enhance iodine intake. Knowledge and awareness about the importance of iodine in nutrition and health can have a positive impact on the use of iodised salt. Therefore, the aim of this study was to assess the knowledge about and use of iodised salt among university students in two European countries. METHOD: Data from two countries (Germany and Greece) were extracted from a multi-centre cross-sectional survey, conducted among non-nutrition science/non-medical students from October 2018 to April 2019. RESULTS: Among the 359 participants in Germany (35% females, median age: 22 years) and the 403 participants in Greece (51% females, median age: 21 years), 41% and 37%, respectively, reported use of iodised salt at home. Users and non-users did not differ by age, gender and Body Mass Index or general interest in nutrition in both cohorts. However, those who had a better knowledge about iodine and (iodised) salt or had previously attended nutrition classes were more likely to report iodised salt usage. CONCLUSION: The results suggest that strengthening the imparting of nutritional information and additional education of young adults are needed and may improve knowledge about and usage of iodised salt.

BMI and BMI change following incident type 2 diabetes and risk of microvascular and macrovascular complications: the EPIC-Potsdam study.

AIMS/HYPOTHESIS: Studies suggest decreased mortality risk among people who are overweight or obese compared with individuals with normal weight in type 2 diabetes (obesity paradox). However, the relationship between body weight or weight change and microvascular vs macrovascular complications of type 2 diabetes remains unresolved. We investigated the association between BMI and BMI change with long-term risk of microvascular and macrovascular complications in type 2 diabetes in a prospective cohort study. METHODS: We studied participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, who were free of cancer, cardiovascular disease and microvascular disease at diagnosis (n = 1083). Pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI were evaluated in multivariable-adjusted Cox models. RESULTS: There were 85 macrovascular (myocardial infarction and stroke) and 347 microvascular events (kidney disease, neuropathy and retinopathy) over a median follow-up of 10.8 years. Median pre-diagnosis BMI was 29.9 kg/m2 (IQR 27.4-33.2), and the median relative annual BMI change was -0.4% (IQR -2.1 to 0.9). Higher pre-diagnosis BMI was positively associated with total microvascular complications (multivariable-adjusted HR per 5 kg/m2 [95% CI]: 1.21 [1.07, 1.36], kidney disease 1.39 [1.21, 1.60] and neuropathy 1.12 [0.96, 1.31]) but not with macrovascular complications (HR 1.05 [95% CI 0.81, 1.36]). Analyses according to BMI categories corroborated these findings. Effect modification was not evident by sex, smoking status or age groups. In analyses according to BMI change categories, BMI loss of more than 1% indicated a decreased risk of total microvascular complications (HR 0.62 [95% CI 0.47, 0.80]), kidney disease (HR 0.57 [95% CI 0.40, 0.81]) and neuropathy (HR 0.73 [95% CI 0.52, 1.03]), compared with participants with a stable BMI; no clear association was observed for macrovascular complications (HR 1.04 [95% CI 0.62, 1.74]). The associations between BMI gain compared with stable BMI and diabetes-related vascular complications were less apparent. Associations were consistent across strata of sex, age, pre-diagnosis BMI or medication but appeared to be stronger among never-smokers compared with current or former smokers. CONCLUSIONS/INTERPRETATION: Among people with incident type 2 diabetes, pre-diagnosis BMI was positively associated with microvascular complications, while a reduced risk was observed with weight loss when compared with stable weight. The relationships with macrovascular disease were less clear.

Methionine restriction prevents onset of type 2 diabetes in NZO mice.

Dietary methionine restriction (MR) is well known to reduce body weight by increasing energy expenditure (EE) and insulin sensitivity. An elevated concentration of circulating fibroblast growth factor 21 (FGF21) has been implicated as a potential underlying mechanism. The aims of our study were to test whether dietary MR in the context of a high-fat regimen protects against type 2 diabetes in mice and to investigate whether vegan and vegetarian diets, which have naturally low methionine levels, modulate circulating FGF21 in humans. New Zealand obese (NZO) mice, a model for polygenic obesity and type 2 diabetes, were placed on isocaloric high-fat diets (protein, 16 kcal%; carbohydrate, 52 kcal%; fat, 32 kcal%) that provided methionine at control (Con; 0.86% methionine) or low levels (0.17%) for 9 wk. Markers of glucose homeostasis and insulin sensitivity were analyzed. Among humans, low methionine intake and circulating FGF21 levels were investigated by comparing a vegan and a vegetarian diet to an omnivore diet and evaluating the effect of a short-term vegetarian diet on FGF21 induction. In comparison with the Con group, MR led to elevated plasma FGF21 levels and prevented the onset of hyperglycemia in NZO mice. MR-fed mice exhibited increased insulin sensitivity, higher plasma adiponectin levels, increased EE, and up-regulated expression of thermogenic genes in subcutaneous white adipose tissue. Food intake and fat mass did not change. Plasma FGF21 levels were markedly higher in vegan humans compared with omnivores, and circulating FGF21 levels increased significantly in omnivores after 4 d on a vegetarian diet. These data suggest that MR induces FGF21 and protects NZO mice from high-fat diet-induced glucose intolerance and type 2 diabetes. The normoglycemic phenotype in vegans and vegetarians may be caused by induced FGF21. MR akin to vegan and vegetarian diets in humans may offer metabolic benefits via increased circulating levels of FGF21 and merits further investigation.-Castaño-Martinez, T., Schumacher, F., Schumacher, S., Kochlik, B., Weber, D., Grune, T., Biemann, R., McCann, A., Abraham, K., Weikert, C., Kleuser, B., Schürmann, A., Laeger, T. Methionine restriction prevents onset of type 2 diabetes in NZO mice.

Is a vegan or a vegetarian diet associated with the microbiota composition in the gut? Results of a new cross-sectional study and systematic review.

It is assumed that diet influences the composition of gut microbiota, which in turn may affect human health status. This systematic review aimed to summarize associations of a vegan or vegetarian diet with the composition of microbiota. A literature search was conducted in PubMed and Embase for eligible human studies with vegan or vegetarian diets as an exposure and microbiota composition as an outcome in healthy adults. Furthermore, data from our cross-sectional study with vegan participants were included. Out of sixteen included studies, six investigated the association between gut microbiota composition in both vegans and in vegetarians, six in vegans and four studies in vegetarians compared to omnivores, respectively. Among 5 different phyla, 28 families, 96 genera and 177 species, Bacteroides, Bifidobacterium and Prevotella were the most reported genera, followed by the species Prevotella copri, Faecalibacterium prausnitzii and Escherichia coli in all diets. No consistent association between a vegan diet or vegetarian diet and microbiota composition compared to omnivores could be identified. Moreover, some studies revealed contradictory results. This result could be due to high microbial individuality, and/or differences in the applied approaches. Standardized methods with high taxonomical and functional resolutions are needed to clarify this issue.

Internal exposure to perfluoroalkyl substances (PFASs) and biological markers in 101 healthy 1-year-old children: associations between levels of perfluorooctanoic acid (PFOA) and vaccine response.

Perfluoroalkyl substances (PFASs) are a complex group of man-made chemicals with high stability and mobility leading to ubiquitous environmental contamination and accumulation in the food chain. In human serum/plasma samples, perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) are the lead compounds. They are immunotoxic in experimental animals, and epidemiological studies provided evidence of a diminished production of vaccine antibodies in young children. However, information on children of the first year of age is missing but relevant, as they have a relatively high exposure if breastfed, and may have a higher susceptibility as their immune system is developing. In a cross-sectional study with 101 healthy 1-year-old children, internal levels of persistent organic pollutants and a broad panel of biological parameters were investigated at the end of the 1990s. Additional analysis of PFASs resulted in plasma levels (mean ± SD) of PFOA and PFOS of 3.8 ± 1.1 and 6.8 ± 3.4 µg/L, respectively, in the 21 formula-fed children, and of 16.8 ± 6.6 and 15.2 ± 6.9 µg/L in the 80 children exclusively breastfed for at least 4 months. The study revealed significant associations between levels of PFOA, but not of PFOS, and adjusted levels of vaccine antibodies against Haemophilus influenza type b (Hib, r = 0.32), tetanus (r = 0.25) and diphtheria (r = 0.23), with no observed adverse effect concentrations (NOAECs) determined by fitting a 'knee' function of 12.2, 16.9 and 16.2 µg/L, respectively. The effect size (means for PFOA quintiles Q1 vs. Q5) was quantified to be - 86, - 54 and - 53%, respectively. Furthermore, levels of PFOA were inversely associated with the interferon gamma (IFNÉ£) production of ex-vivo lymphocytes after stimulation with tetanus and diphtheria toxoid, with an effect size of - 64 and - 59% (means Q1 vs. Q5), respectively. The study revealed no influence of PFOA and PFOS on infections during the first year of life and on levels of cholesterol. Our results confirmed the negative associations of PFAS levels and parameters of immune response observed in other epidemiological studies, with high consistency as well as comparable NOAECs and effects sizes for the three vaccine antibodies investigated, but for PFOA only. Due to reduction of background levels of PFASs during the last 20 years, children in Germany nowadays breastfed for a long duration are for the most part not expected to reach PFOA levels at the end of the breastfeeding period above the NOAECs determined.

Effects of Osteopathic Manipulative Treatment on Musicians: A Systematic Review.

BACKGROUND: Professional musicians frequently suffer from musculoskeletal complaints and disorders (MCD), which can be treated by osteopathic manipulative treatment (OMT). The aim of this systematic review was to evaluate the effectiveness and efficacy of OMT in adult musicians. METHODS: A systematic literature search included the electronic databases PubMed/MEDLINE, Medpilot, EBSCOhost, BioMedCentral, OSTMED-Dr, osteopathic-research.com, PEDro, hand searches, and contact to European osteopathic academies. Interventional and observational studies published between January 1999 and January 2019, of professional or amateur musicians who were either healthy or had MCD treated by OMT, were included. The quality of the randomized controlled trials (RCTs) was assessed by the Physiotherapy Evidence Database (PEDro) Scale ranging between 0 and 10 points. RESULTS: Only 5 studies were identified investigating OMT in musicians, including 1 RCT (cross-over design), 3 clinical controlled trials, and 1 case report. The internal validity of the RCT was assessed as 6 points. OMT was reported to have a positive impact on healthy singers, improving phonation time, voice quality, and voice range. It also improved the cervical range of motion in violinists. No adverse events were observed, although only the cross-over RCT reported partly an assessment of adverse events. CONCLUSIONS: The evidence for OMT in adult musicians is very limited. Prospective controlled clinical trials investigating OMT in musicians are required.

Energy Drinks Induce Acute Cardiovascular and Metabolic Changes Pointing to Potential Risks for Young Adults: A Randomized Controlled Trial.

BACKGROUND: Case reports suggest a link between energy drinks (EDs) and adverse events, including deaths. OBJECTIVES: We examined cardiovascular and metabolic effects of EDs and mixtures providing relevant ingredients of EDs compared to a similarly composed control product (CP) without these components. METHODS: This randomized, crossover trial comprised 38 adults (19 women, mean BMI 23 kg/m2, mean age 22 y). We examined effects of a single administration of a commercial ED, the CP, and the CP supplemented with major ED-ingredients at the same concentrations as in the ED. The study products were administered at 2 volumes, 750 or 1000 mL. RESULTS: Both volumes of the study products were acceptably tolerated with no dose-dependent effects on blood pressure (BP, primary outcome), heart rate, heart rate corrected duration of QT-segment in electrocardiography (QTc interval), and glucose metabolism. After ED consumption, 11% of the participants reported symptoms, in contrast to 0-3% caused by other study products. After 1 h, administration of an ED caused an increase in systolic BP (116.9 ± 10.4 to 120.7 ± 10.7 mmHg, mean ± SD, P < 0.01) and a QTc prolongation (393.3 ± 20.6 to 400.8 ± 24.1 ms, P < 0.01). Also caffeine, but not taurine or glucuronolactone, caused an increase in BP, but no QTc prolongation. The BP effects were most pronounced after 1 h and returned to normal after a few hours. All study products caused a decrease in serum glucose and an increase in insulin concentrations after 1 h compared to baseline values, corresponding to an elevation in the HOMA-IR (ED + 4.0, other products + 1.0-2.8, all P < 0.001). CONCLUSION: A single high-volume intake of ED caused adverse changes in BP, QTc, and insulin sensitivity in young, healthy individuals. These effects of EDs cannot be easily attributed to the single components caffeine, taurine, or glucuronolactone. This trial was registered at clinicaltrials.gov as NCT01421979.

Breastfeeding Rates and Programs in Europe: A Survey of 11 National Breastfeeding Committees and Representatives.

INTRODUCTION: Among the world's regions, the WHO European Region has the lowest rates of exclusive breastfeeding at the age of 6 months with approximately 25%. Low rates and early cessation of breastfeeding have important adverse health consequences for women, infants, and young children. Protecting, promoting, and supporting breastfeeding are a public health priority. OBJECTIVES: National breastfeeding data and monitoring systems among selected European countries and the WHO European Region are compared. Mechanisms for the support, protection, and promotion of breastfeeding are reviewed and successes and challenges in implementation of national programs are presented. METHODS: National representatives of national breastfeeding committees and initiatives in 11 European countries, including Belgium, Croatia, Denmark, Germany, Ireland, Italy, The Netherlands, Norway, Spain, Sweden, and Switzerland, participated in a standardized survey. Results are evaluated and compared in a narrative review. RESULTS: Variation exists in Europe on breastfeeding rates; methodology for data collection; and mechanisms for support, protection, and promotion of breastfeeding. Directly after birth, between 56% and 98% of infants in all countries were reported to receive any human milk, and at 6 months 38% to 71% and 13% to 39% of infants to be breastfed or exclusively breastfed, respectively. National plans addressing breastfeeding promotion, protection, and support exist in 6 of the 11 countries. CONCLUSIONS: National governments should commit to evidence-based breastfeeding monitoring and promotion activities, including financial and political support, to improve breastfeeding rates in the Europe. Renewed efforts for collaboration between countries in Europe, including a sustainable platform for information exchange, are needed.

[Musical Inactivity - A Risk Factor? A Short Questionnaire to Assess Musical Activity (MusA)]. / Musikalische Inaktivität ­ ein Risikofaktor? Vorstellung eines kurzen Fragebogens zur Erfassung der musikalischen Aktivität (MusA).

BACKGROUND: There is only a limited number of studies on associations between musical activity and health issues. It seems that musical activity has physiological and psychological benefits, as well as effects on the mental capacity, but this has been studied only in a few clinical and epidemiological studies. One reason might be that no appropriate survey instrument assessing musical activity is available. AIM OF THE STUDY: Here we provide an overview of survey instruments that assess musicality and musical activity. One focus is the presentation of a newly developed German questionnaire (MusA), which assesses musical activity (active music making and music reception) and was specifically developed for the "German National Cohort", a German health study. METHOD: Through literature research, questionnaires were identified that assess musicality and / or musical activity. A new German questionnaire was developed from a panel of experts and tested in a small study (n=121, women and men age 18-70 years). RESULTS: In the literature research, 3 questionnaires were identified which focus on musicality and musical activity with different aspects (Gold-MSI, MUSE, MEQ). All 3 instruments may be characterized as large psychometric scales, which especially assess aspects of musicality in the English language. The Gold-MSI is additionally available in German. None of the existing questionnaires covers musical activities in detail. A new short German questionnaire consisting of 9 questions with a maximum filling time of 3-5 min has been developed. CONCLUSION: There are few questionnaires available for assessing musicality and musical activity with different aspects. The newly developed MusA in the German language focuses on the assessment of musical activity and is intended to be used in larger, population-based as well as clinical studies, to examine music activities and listening to music as independent factors in connection with prevention and therapy of chronic diseases.

Nordic diet, Mediterranean diet, and the risk of chronic diseases: the EPIC-Potsdam study.

BACKGROUND: The Mediterranean Diet (MedDiet) has been acknowledged as a healthy diet. However, its relation with risk of major chronic diseases in non-Mediterranean countries is inconclusive. The Nordic diet is proposed as an alternative across Northern Europe, although its associations with the risk of chronic diseases remain controversial. We aimed to investigate the association between the Nordic diet and the MedDiet with the risk of chronic disease (type 2 diabetes (T2D), myocardial infarction (MI), stroke, and cancer) in the EPIC-Potsdam cohort. METHODS: The EPIC-Potsdam cohort recruited 27,548 participants between 1994 and 1998. After exclusion of prevalent cases, we evaluated baseline adherence to a score reflecting the Nordic diet and two MedDiet scores (tMDS, reflecting the traditional MedDiet score, and the MedPyr score, reflecting the MedDiet Pyramid). Cox regression models were applied to examine the association between the diet scores and the incidence of major chronic diseases. RESULTS: During a follow-up of 10.6 years, 1376 cases of T2D, 312 of MI, 321 of stroke, and 1618 of cancer were identified. The Nordic diet showed a statistically non-significant inverse association with incidence of MI in the overall population and of stroke in men. Adherence to the MedDiet was associated with lower incidence of T2D (HR per 1 SD 0.93, 95% CI 0.88-0.98 for the tMDS score and 0.92, 0.87-0.97 for the MedPyr score). In women, the MedPyr score was also inversely associated with MI. No association was observed for any of the scores with cancer. CONCLUSIONS: In the EPIC-Potsdam cohort, the Nordic diet showed a possible beneficial effect on MI in the overall population and for stroke in men, while both scores reflecting the MedDiet conferred lower risk of T2D in the overall population and of MI in women.

Serum metabolites and risk of myocardial infarction and ischemic stroke: a targeted metabolomic approach in two German prospective cohorts.

Metabolomic approaches in prospective cohorts may offer a unique snapshot into early metabolic perturbations that are associated with a higher risk of cardiovascular diseases (CVD) in healthy people. We investigated the association of 105 serum metabolites, including acylcarnitines, amino acids, phospholipids and hexose, with risk of myocardial infarction (MI) and ischemic stroke in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam (27,548 adults) and Heidelberg (25,540 adults) cohorts. Using case-cohort designs, we measured metabolites among individuals who were free of CVD and diabetes at blood draw but developed MI (n = 204 and n = 228) or stroke (n = 147 and n = 121) during follow-up (mean, 7.8 and 7.3 years) and among randomly drawn subcohorts (n = 2214 and n = 770). We used Cox regression analysis and combined results using meta-analysis. Independent of classical CVD risk factors, ten metabolites were associated with risk of MI in both cohorts, including sphingomyelins, diacyl-phosphatidylcholines and acyl-alkyl-phosphatidylcholines with pooled relative risks in the range of 1.21-1.40 per one standard deviation increase in metabolite concentrations. The metabolites showed positive correlations with total- and LDL-cholesterol (r ranged from 0.13 to 0.57). When additionally adjusting for total-, LDL- and HDL-cholesterol, triglycerides and C-reactive protein, acyl-alkyl-phosphatidylcholine C36:3 and diacyl-phosphatidylcholines C38:3 and C40:4 remained associated with risk of MI. When added to classical CVD risk models these metabolites further improved CVD prediction (c-statistics increased from 0.8365 to 0.8384 in EPIC-Potsdam and from 0.8344 to 0.8378 in EPIC-Heidelberg). None of the metabolites was consistently associated with stroke risk. Alterations in sphingomyelin and phosphatidylcholine metabolism, and particularly metabolites of the arachidonic acid pathway are independently associated with risk of MI in healthy adults.

[Monitoring breastfeeding in Germany-the current need for action and perspectives]. / Stillmonitoring in Deutschland ­ aktueller Handlungsbedarf und Perspektiven.

Breastfeeding monitoring is understood to be the systematic assessment of current, comprehensive and precise data on breastfeeding rates, breastfeeding behaviour and relevant framework conditions at a national and regional level, with the aim of optimal breastfeeding support. For this purpose, in 2009, the National Breastfeeding Committee in Germany presented an integrative monitoring concept that included different assessment instruments and assessment fields. The hitherto fragmented implementation is still insufficient; in particular, the implementation of longer-term and sustainable concepts within the structures of the healthcare system is still lacking.To systematically collect breastfeeding data, it is mandatory to integrate the different modules. Longitudinal data on selected core breastfeeding indicators should be collected within the quality assurance structures of perinatal medicine and within the regular school entrance examinations, and be integrated into the health surveillance system. Detailed epidemiological studies on breastfeeding and infant nutrition should be carried out every 5 years, covering influencing factors from pregnancy until the end of the first year of life. The monitoring of high-risk groups should take place with systematic interventions within the institutionalized frameworks of "Early Preventions" (local support systems offering assistance to parents and children) and health authorities with social compensatory activities, with the immediate transfer to of the results into practice.The integrative concept of breastfeeding monitoring in Germany is in accordance with international criteria, tailored to existing structures and experiences, and can be presented internationally. Sufficient centralized resources are needed to coordinate and implement this concept.

[Breastfeeding rate and promotion in selected European countries]. / Stillquoten und Stillförderung in ausgewählten Ländern Europas.

BACKGROUND: Breastfeeding benefits the short- and long-term health of mothers and their children. Breastfeeding promotion is an important task for society and the healthcare system. AIMS: We report national breastfeeding data and monitoring systems of selected European countries based on data provided by national breastfeeding committees and international organisations. Strategies for promoting, protecting and supporting breastfeeding, achievements and challenges are reported. METHODS: Representatives of breastfeeding committees and initiatives from Belgium, Croatia, Denmark, Germany, Italy, Ireland, Norway, Sweden, Switzerland, Spain and The Netherlands completed a standardised questionnaire. Reported results were compiled and complemented by additional information compiled by the authors. RESULTS: Considerable differences in breastfeeding rates, data collection and strategies for breastfeeding promotion exist within Europe. At the age of 6 months 35-65% of infants are breastfed and 13-39% are fully or exclusively breastfed in the countries included. Varying methods of breastfeeding monitoring are established in 7 of 11 countries (not in Germany). National breastfeeding committees exist in 9 countries and a national plan for breastfeeding promotion in 6 countries. All country representatives supported stronger European collaboration on improved breastfeeding promotion. CONCLUSIONS: Governments and health systems should collaborate in strengthening evidence based breastfeeding monitoring and promotion and implement financial and policy support. Sustained enhanced collaboration of European countries with exchange of information and experience on breastfeeding support and a new initiative for establishing a strategic European masterplan on breastfeeding promotion appear necessary.

[Becoming breastfeeding friendly in Germany-an international research project to assess the readiness to scale up breastfeeding]. / Das internationale Forschungsvorhaben Becoming Breastfeeding Friendly. Untersuchung von Rahmenbedingungen zur Stillförderung.

Despite known positive effects for breastfed children and their mothers, only one third of children under four months of age are breastfed exclusively. In addition, an overview of structures, actors, and measures to promote breastfeeding in Germany is missing. In a two-year international research project entitled Becoming Breastfeeding Friendly (BBF), the current status of German breastfeeding support is systematically evaluated on the basis of the Breastfeeding Gear Model (BFGM) which was developed by the Yale School of Public Health. Therefore, committee members with expertise in the healthcare sector, science, policy, and communication evaluate 54 benchmarks of the eight relevant gears: advocacy, political will, legislation & policies, funding & resources, training & program delivery, promotion, research & evaluation, coordination, and goals & monitoring. Based on the identified strengths and needs, concrete calls to action for scaling up breastfeeding promotion are derived and prioritized. BBF started in September 2017 and is conducted in cooperation with the Yale School of Public Health by the Healthy Start - Young Family Network as well as the National Breastfeeding Committee as an initiative of the Federal Ministry of Nutrition and Agriculture. The project assesses the framework conditions for breastfeeding and thus makes a valuable contribution to the health promotion of mother and child and to breastfeeding protection in Germany.

[Xenobiotics and pathogens in breast milk : A risk for the child?] / Fremdstoffe und Krankheitserreger in der Muttermilch : Ein Risiko für das Kind?

Although breast milk is the best diet in the first few months of life, risks can arise for the breast-fed infant. The article gives a comprehensive overview of possible risks regarding xenobiotics and pathogens in mother's milk, including medications, smoking, alcohol consumption, coffee consumption, persistent environmental contaminants and residues as well as infections.Where drug therapy is indicated, suitable medications are available for most conditions nowadays, so that prolonged nursing breaks or even weaning is not required. Long-term treatment, especially under combination therapy, needs to be examined on a case-by-case basis, however. Smoking and alcohol consumption should be avoided during the breastfeeding period, while moderate coffee consumption (up to 2 cups daily) is not of concern. The current levels of environmental contaminants and residues in breast milk are considered to be harmless to health; indeed, the body burden of dioxins considered to be critically high more than 20 years ago has been reduced by a factor of 10 to date. Among maternal infections, an human deficiency virus (HIV) infection is one of the few medical indications for weaning in countries with adequate hygiene standards.All in all, the risks of xenobiotics and pathogens in mother's milk are generally low in exclusively breastfed infants, so that there is usually no need for prolonged nursing breaks or even weaning. In only a small number of maternal conditions (certain medications, HIV infection), the infant should not be breastfed.