The DZHK research platform: maximisation of scientific value by enabling access to health data and biological samples collected in cardiovascular clinical studies.

The German Centre for Cardiovascular Research (DZHK) is one of the German Centres for Health Research and aims to conduct early and guideline-relevant studies to develop new therapies and diagnostics that impact the lives of people with cardiovascular disease. Therefore, DZHK members designed a collaboratively organised and integrated research platform connecting all sites and partners. The overarching objectives of the research platform are the standardisation of prospective data and biological sample collections among all studies and the development of a sustainable centrally standardised storage in compliance with general legal regulations and the FAIR principles. The main elements of the DZHK infrastructure are web-based and central units for data management, LIMS, IDMS, and transfer office, embedded in a framework consisting of the DZHK Use and Access Policy, and the Ethics and Data Protection Concept. This framework is characterised by a modular design allowing a high standardisation across all studies. For studies that require even tighter criteria additional quality levels are defined. In addition, the Public Open Data strategy is an important focus of DZHK. The DZHK operates as one legal entity holding all rights of data and biological sample usage, according to the DZHK Use and Access Policy. All DZHK studies collect a basic set of data and biosamples, accompanied by specific clinical and imaging data and biobanking. The DZHK infrastructure was constructed by scientists with the focus on the needs of scientists conducting clinical studies. Through this, the DZHK enables the interdisciplinary and multiple use of data and biological samples by scientists inside and outside the DZHK. So far, 27 DZHK studies recruited well over 11,200 participants suffering from major cardiovascular disorders such as myocardial infarction or heart failure. Currently, data and samples of five DZHK studies of the DZHK Heart Bank can be applied for.

Prognostic differences of the Mini Nutritional Assessment short form and long form in relation to 1-year functional decline and mortality in community-dwelling older adults receiving home care.

OBJECTIVES: To compare the prognostic value of the revised Mini Nutritional Assessment short form (MNA-SF) classification with that of the long form (MNA-LF) in relation to mortality and functional change in community-dwelling older adults receiving home care in Germany. DESIGN: Multicenter, 1-year prospective observational study. SETTING: Community. PARTICIPANTS: Older adults (≥ 65) receiving home care (n = 309). MEASUREMENTS: Nutritional status (well nourished, at risk of malnutrition, malnourished) was classified using the MNA-SF and MNA-LF at baseline. Functional status was determined according to the Barthel Index of activities of daily living (ADLs) at baseline and after 1 year. Hazard ratios (HRs) and 95% confidence intervals (CIs) of mortality were calculated for MNA-SF and MNA-LF categories using stepwise Cox regression analyses. Repeated-measurements analysis of covariance was used to examine changes in ADL scores over time for MNA-SF and MNA-LF categories. RESULTS: MNA-SF classified 15% of the sample as malnourished and 41% as being at risk of malnutrition, whereas the MNA-LF classified 14% and 58%, respectively. During the follow-up year, 15% of participants died. The estimated hazard ratios (HR) for 1-year mortality were lower for MNA-SF than for MNA-LF categories (at risk of malnutrition: HR = 2.21, 95% confidence interval (CI) = 1.02-4.75 vs HR = 5.05, 95% CI = 1.53-16.58; malnourished: HR = 3.27, 95% CI = 1.34-8.02 vs HR = 8.75, 95% CI = 2.45-31.18). For MNA-SF categories, no differences in functional change were found. According to the MNA-LF, ADL decline tended to be greater in those at risk of malnutrition (7.1 ± 10.1 points) than in those who were well nourished (3.7 ± 10.1 points) and malnourished (4.9 ± 10.1 points). CONCLUSION: In this sample of older adults receiving home care, the MNA-LF was superior to the MNA-SF in predicting mortality and differentiating functional decline during 1 year of follow-up.

Nutritional status and related factors in elderly nursing home residents: comparative cross-sectional study in migrants and native Germans.

Former guest workers in Germany who stayed on after retirement are now older than 70 years. Nursing homes (NH) are broadening their offer to meet specific requirements of this population. The nutritional status and related problems of the older ethnic minority group living in German NH has so far not been investigated. The aim of this study was, thus, to compare the nutritional situation of older migrants to that of native residents in two "multicultural" NH (cross-sectional study). All residents 65 years and older with a migration background were enrolled and compared to nonmigrants using frequency matching for age and gender. Nutritional status was assessed using body mass index (BMI; cut-off for undernourishment: BMI < 22 kg/m(2)) and calf circumference (CC; CC < 31 cm). Care staff completed a questionnaire on residents' health. Consecutive 3-day food records were evaluated to analyze the intake of energy, macro-, and micronutrients. Participants were n = 23 migrants (76 ± 6 years, 52% female) and n = 37 nonmigrants (78 ± 7 years, 59% female). Undernourishment was more prevalent in migrants according to BMI (39 vs. 11%; P < 0.05) and CC (57 vs. 22%; P < 0.05). Main nutritional problems in both groups were "loss of appetite" (56 vs. 19%; P < 0.05) and "refusal to eat" (56 vs. 25%; P < 0.05). Energy intake was low (6.4 ± 1.4, 6.8 ± 1.6 MJ/d). More than 50% of participants fell below recommended values for vitamin C, B1, B6, D, folate, calcium, and iron; 61% of the migrants had a low vitamin B12 intake. Migrant NH residents were more often undernourished than German NH residents.

Functionality and mortality in obese nursing home residents: an example of 'risk factor paradox'?

BACKGROUND: Although the percentage of obese nursing home residents is increasing, few longitudinal studies have reported on functionality and mortality in this subpopulation. The aim of the present study was to explore functionality and mortality in obese nursing home residents during a 1-year follow-up and to compare these results with those of residents within the normal and low BMI range. METHODS: Two hundred residents (147 female, 53 male, mean age 85.6 +/- 7.8 years) from 2 Nuremberg nursing homes were included. Body weight and height were measured in all participants. BMI was calculated and categorized as low (<20 kg/m(2)), normal (20-30 kg/m(2)), and high (>30 kg/m(2)). Handgrip strength, timed "up and go" test, and Barthel's Activities of Daily Living were applied as functional parameters. All measurements were done at baseline and after a 1-year follow-up. RESULTS: At baseline, the prevalence of obesity was 23.5%, whereas low BMI values were present in 8.5% of the residents. After 1 year, there was no significant decline of functionality in the obese group, whereas functional parameters deteriorated significantly in study participants with normal BMI. One-year mortality was lowest in the obese (12.8%), with no deaths in residents with BMI of 35 kg/m(2) or higher. Mortality was highest in residents with low BMI (58.8%). CONCLUSION: In nursing home residents, obesity is associated with increased survival and stable functionality. These observations may therefore be regarded as an expression of "risk factor paradox" in this specific population of older individuals.

Nutritional situation of the elderly in Eastern/Baltic and Central/Western Europe - the AgeingNutrition project.

BACKGROUND/AIMS: In the AgeingNutrition project, funded by the European Commission, partners from 10 'Eastern/Baltic' (new) European (Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Poland, Romania, Slovak Republic, Slovenia, and Turkey) and 5 'Central/Western' (old) European countries (Austria, Belgium, Germany, Greece, and Spain) performed a comparative analysis of existing data on nutritional status, food intake, nutrient intake, dietary habits and lifestyle of the aging population in Europe. METHODS: Using predefined inclusion criteria, 36 studies (22 from Eastern/Baltic, 14 from Central/Western countries) were chosen for evaluation. The studies varied in general design, data assessment and parameters and methods applied (especially regarding assessment of nutritional situation, comprising anthropometry, blood lipid profile, dietary nutrient and food intake). Thus, data evaluation by recalculation of raw data had to be restricted to a few distinct, common parameters. RESULTS AND CONCLUSION: Energy intake is too high in both regions, especially in some of the 'younger old' and seems not to be adjusted to energy expenditure. Simultaneously, energy intake was considerably lower than recommended in some very old seniors in Eastern/Baltic countries. Interestingly, quantity and quality of available information is similar in 'new' and 'old' member states. Immense variations in methodology hampered performing reliable comparative evaluation. It is, thus, mandatory to standardize methods for assessment of nutrition and health status for future international multicenter studies.

The fatty acid pattern of dietary fat influences the oral bioavailability of the flavonol quercetin in pigs.

We have shown recently that dietary fat content influences the bioavailability of the flavonol quercetin. In the present study, the influence of the fatty acid pattern of dietary fats on the oral bioavailability of quercetin was investigated. Quercetin (30 micromol/kg body weight) was administered to growing pigs (n 6) in test meals consisting either of 200 g of a standard pig diet (2% crude fat) or of the same diet supplemented with 15 g fat/100 g diet using either medium-chain (MCT) or long-chain fatty acid triacylglycerols (LCT). Blood samples were drawn repeatedly over a period of 24 h and analysed by HPLC. In addition, the influence of the different diets on gastric emptying was investigated in rats. In pigs, the bioavailability of quercetin was measured by quantifying its plasma metabolites with an intact flavonol structure. Bioavailability was enhanced by 38% (P<0.05) and 12% (P>0.05) after intake with the MCT and LCT diets, respectively, compared to the standard diet. Maximum plasma concentrations of quercetin were reached significantly later with the MCT diet than with the LCT or the standard diet (P<0.05). No differences in dry matter of the gastric content were observed 60 min after intake of the experimental diets in rats. Thus, administration of quercetin together with a diet containing MCT fat enhances the bioavailability of the flavonol. Absorption of quercetin was delayed significantly with this diet. However, this was probably not due to slower gastric emptying of the MCT diet.

Bioavailability of quercetin in pigs is influenced by the dietary fat content.

The flavonol quercetin is one of the most prevalent flavonoids found in edible plants. In this study, the influence of dietary fat on oral bioavailability of quercetin was investigated. Quercetin (30 micromol/kg body weight) was administered either as the lipophilic aglycone or as the more hydrophilic quercetin-3-O-glucoside in test meals differing in fat content (3, 17, or 32 g fat/100 g diet) to growing pigs. Blood samples were drawn repeatedly over a 24-h period and analyzed by HPLC. The main metabolite found in plasma was always conjugated quercetin. Quercetin bioavailability from each diet was always higher from the glucoside than from the aglycone. Irrespective of the chemical form applied, the bioavailability of quercetin was higher in the 17% fat diet compared with the 3% fat diet (P < 0.05). No further effect on bioavailability was observed when the flavonols were administered with diets containing 32% fat. The elimination of quercetin was significantly delayed after its application with fat-enriched diets (P < 0.05). Thus, in addition to the chemical form of the flavonol, the fat content of the diet influences oral bioavailability of quercetin.