Experiences of Vegans with General Practitioners in the Austrian Health Care System: A Qualitative Study.

This article explores the factors influencing the choice of general practitioners (GPs) and their role in the health care of vegans in Austria. The number of people identifying as vegan is on the rise, and GPs are increasingly confronted with vegan patients. A qualitative method was chosen for this study, and 14 semi-structured interviews with vegans were conducted between April 2022 and July 2022. Participants were recruited primarily through vegan social media groups. In their experiences with health care, vegans felt treated unequally or sometimes incorrectly. The experiences described highlight that participants felt that most GPs were biased against their veganism. Information exchange among vegans primarily takes place online and through publications of vegan associations, while GPs play a minor role in information provision. As the number of vegans grows, an appreciative way of communicating between GPs and vegan patients ought to be promoted. Voluntary interdisciplinary nutritional training, collaboration of the medical field with support organizations, provision of evidence-based information, and collaboration with dietitians and nutritionists could enrich the care of patients with a vegan diet.

Associations of Apolipoprotein ε4 Genotypes with Motor and Nonmotor Symptoms in Parkinson's Disease: A Cross-Sectional Study.

Background: The apolipoprotein E (APOE) ε4 allele has been associated with cognitive decline in Parkinson's disease (PD), but little is known about its relationship with motor and other nonmotor symptoms and whether APOE ε4 retains an influence on cognition when other factors are considered. Objective: To investigate the impact of APOE ε4 on motor/nonmotor symptoms and its relationship with other factors affecting cognition in individuals with PD. Methods: We analyzed data from 7616 individuals, comparing motor/nonmotor symptoms in different APOE genotypes using binary logistic regression. Multivariate logistic regression examined factors associated with cognitive impairments, including APOE ε4, Geriatric Depression Scale (GDS) score, Non-motor Symptom Questionnaire (NMS) score, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part II score, and physical activity level. Results: APOE ε4 heterozygosity was modestly associated with lower cognitive scores (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.87-0.99), whereas no significant association was found for any other nonmotor and motor symptoms. However, in multivariate analysis, cognitive impairment was associated with higher GDS (OR, 1.28; 95% CI, 1.23-1.34), NMS (OR, 1.22; 95% CI, 1.19-1.25), and MDS-UPDRS Part II (OR, 1.07; 95% CI, 1.06-1.09) scores, whereas physical activity was negatively associated (OR, 0.99; 95% CI, 0.98-0.99). APOE ε4 was no longer significant after adjusting for these factors. Conclusions: There is a link between cognition and APOE ε4 in patients with PD; however, when considering multiple factors, APOE ε4 plays a subordinate role. Other factors, such as depression, physical activity, and other nonmotor symptoms, demonstrate a stronger influence on cognitive impairment.

[Overweight and obesity in adults: general principles of treatment and conservative management]. / Übergewicht und Adipositas bei Erwachsenen: allgemeine Behandlungsgrundsätze und konservatives Management.

The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by a multidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for a structured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.

[Postoperative management]. / Postoperatives Management.

Bariatric surgery results in significant weight loss, reduction or even remission of obesity-associated comorbidities, reduced mortality, and improved quality of life in many patients; however, obesity is a chronic disease, thus follow-up care is required after bariatric surgery. Furthermore, specific issues, such as micronutrient deficiencies and subsequent complications, can arise both in the short-term and the long-term. Abdominal pain after bariatric surgery must always be regarded as a serious symptom. A further focus should be on the diagnosis and treatment of dumping syndrome. Patients with type 2 diabetes should be regularly screened for recurrent hyperglycemia as well as specific sequelae, even though blood glucose levels may be substantially improved or normalized. In addition to centers with multidisciplinary teams, primary care and, in particular, general practitioners will play an increasingly more important role in the follow-up care after bariatric surgery.

Health aspects of vegan diets among children and adolescents: a systematic review and meta-analyses.

Health effects of vegan diets among children and adolescents are a controversial public health topic. Thus, the aim of the present systematic review is to evaluate a broad range of health outcomes among vegan children and adolescents aged 0 to 18 years. 18 studies met the inclusion criteria (17 cross-sectional, 1 RCT). Meta-analyses showed lower protein, calcium, vitamin B2, saturated fatty acid, and cholesterol intakes, and lower ferritin, HDL and LDL levels as well as height in vegan compared to omnivorous children/adolescents. Higher intakes of carbohydrates, polyunsaturated fatty acids, fiber, folate, vitamins C and E, magnesium, iron, and potassium were observed in vegans. Blood levels of vitamin B12 were higher among vegan children due to supplement use. Single study results suggested further differences between vegan and non-vegan children, such as lower bone mineral content or urinary iodine among vegan children. Risk of Bias was rated as high or very high in 7 out of 18 studies. The certainty of evidence for the meta-analyses was low (n = 2) or very low (n = 46). Overall, the available evidence points to both risks and benefits associated with a vegan diet among children, although more and better designed studies are needed.

Investigating the Relationships between Taste Preferences and Beverage Intake in Preadolescents.

Sugar-sweetened beverages are known promotors of adverse health outcomes. This study aimed to find a relation between taste perception, preferences for beverages, anthropometric parameters, and frequency of beverage consumption. Taste perception of sweetness was tested using an adopted sensitivity test with sucrose and different concentrations of sugar-sweetened apple juice. Furthermore, bitter-compound 6-n-propylthiouracil (PROP) and salty perception were tested and accompanied by a questionnaire on beverage intake. We did not find a clear relationship between taste perception, anthropometrics, and beverage intake. Nevertheless, in males, the bitter intensity perception of PROP was positively correlated with the BMI percentiles (CDC, r = 0.306, p ≤ 0.043) and the waist circumference (r = 0.326, p = 0.031). Furthermore, the liking of sweet taste (p < 0.05) and sweet intensity rating (p < 0.05) of apple juice increased with intensity, and adolescents with overweight or obesity had a higher intake of free sugars from beverages (p < 0.001). The role of taste perception on anthropometric measures and beverage intake remains unclear and requires further investigation.

The Association between Vegan Dietary Patterns and Physical Activity-A Cross-Sectional Online Survey.

A balanced diet and sufficient physical activity (PA) are known to have positive health effects. The relationship between a vegan diet and PA levels is understudied. This cross-sectional online survey aimed to analyze whether different vegan dietary patterns differ in PA. In total, 516 vegan participants were included (June to August 2022). Different dietary patterns were compiled through principal component analysis, while group differences were calculated using independent tests, or chi-squared tests as well as logistic regression analyses. The population had an average age of 28.0 (SD: 7.7) years and had been living vegan for 2.6 (95% CI: 2.5-3.0) years. Two dietary patterns, the "convenience" and the "health-conscious" group, were identified. People with a convenience dietary pattern had significantly higher odds of sitting more (OR 1.10, 95% CI 1.04-1.18) and not achieving aerobic PA (OR 1.81, 95% CI 1.18-2.79) or strength training recommendations (OR 1.81, 95% CI 1.26-2.61) than people with a health-conscious dietary pattern. This study suggests the heterogeneity of vegan diets and that dietary patterns must be differentiated, as they also differ in the level of PA. Additional studies involving complete dietary assessment with a focus on ultraprocessed foods, blood metabolite analysis, and objective PA assessment are required.

Promotion of Food and Beverages by German-Speaking Influencers Popular with Adolescents on TikTok, YouTube and Instagram.

The promotion of nutritionally poor food and beverages (F&B) has a proven effect on children's eating preferences and, therefore, plays a significant role in today's childhood obesity epidemic. This study's objective was to assess the prevalence (exposure) and context (power) of the F&B cues in influencer content across three platforms: TikTok, YouTube, and Instagram. The selected influencers were popular with adolescents, with a combined total of more than 34 million followers/subscribers. We employed the YouTube Influencer Marketing Protocol from the World Health Organization (WHO) as our basis for coding. We analysed a total of 360 videos/posts and, of these, 24% contained F&B cues, which is equivalent to 18.1 F&B cues/hour. In total, 77% of the cues were not permitted for children's advertising, according to WHO criteria, and this was stable across all platforms, with chocolate and sugary confectionery (23%) as the most frequently featured products. Not-permitted F&B had a four-times higher chance of being branded, a five-times higher chance of being described positively, and received significantly more 'likes'. In 62% of the analysed presentations, the branded product was mentioned, yet only 6% of the content was labelled as advertising. The present analysis delivers further grounds for discussion for policies and regulations of influencer marketing.

Obesity, Fruit and Vegetable Intake, and Physical Activity Patterns in Austrian Farmers Compared to the General Population.

Low fruit and vegetable (F&V) intake, sedentary behavior, excessive alcohol consumption, and smoking are risk factors for the development of non-communicable diseases. This study describes the patterns and factors of nutrition (F&V and alcohol intake), physical activity (PA), obesity, and other chronic diseases of 10,053 adult farmers (52.7% female) in Austria, based on the cross-sectional survey from the Austrian Social Insurance Institution for the Self-Employed and compared with the results of the general Austrian population from 2019 (n = 14,606; 53.7% female). Compared to the general Austrian population, farmers showed a higher prevalence of overweight and obesity (42.8% vs. 36.5%; 18.8% vs. 17.1%), as well as hypertension, hypercholesterolemia, and diabetes mellitus. Additionally, farmers ate less F&V (0 servings/day 39.7% vs. 14.0%; 1−4 servings/day 55.5% vs. 80.8%) and only 4.8% vs. 5.1% (p < 0.001) fulfilled the F&V recommendations. Lower participation in endurance training (38.3% vs. 52.1%) was found, whereas farmers did more strength training (64.1% vs. 27.6%). Those who failed to fulfill the PA recommendations reported worse health status (OR: 3.14; 95%-CI: 2.08−4.76) and a higher chance for obesity (OR: 1.68; 95%-CI: 1.38−2.05). Since obesity rates among farmers are high and recommendations have rarely been met, every opportunity should be taken to promote healthy eating and adequate PA.

Impact of a nutrition education programme on free sugar intake & nutrition-related knowledge in fifth-grade schoolchildren.

BACKGROUND: The objective was to evaluate a 5-week nutrition education programme (ACTION) in fifth-grade schoolchildren in Austria on free sugar intake, nutrition-related knowledge (NRK) and with the RE-AIM framework on the overall public health impact. METHODS: A prospective case-controlled cohort (pre-post design) from seven secondary schools in Vienna tested programme efficacy. NRK was assessed with a 20-item questionnaire and dietary behaviour and free sugar intake with a semi-quantitative Food Frequency Questionnaire. A total of 12 intervention classes (IG) received the programme, conducted by teachers and integrated in the curriculum, and 6 control classes followed their usual curriculum. RESULTS: In 344 children, aged 10.4 (0.8) years, free sugar intake decreased significantly over time in IG by 13% (P=0.001) with a group difference of -10.1 (95% CI -18.8, -1.5; P=0.021) g/day. The food groups 'sweets & pastries', 'soft drinks', 'fast food' and 'salty snacks' mainly contributed to this reduction. Moreover, NRK increased significantly over time in IG with a group difference of 9.0% of correct answers (95% CI 5.8, 12.2; P<0.001; Cohen's d 0.57). The programme was disseminated to 10% of fifth-grade classrooms in Austrian secondary schools and to 12% in Vienna. CONCLUSIONS: The ACTION programme shows potential for public health impact with improving dietary behaviour as free sugar intake, NRK, and its dissemination. It required a minimum of money per schoolchild as the programme was conducted by teachers and was integrated in the curriculum.

Course of depressive symptomatology and its association with serum uric acid in one-anastomosis gastric bypass patients.

The changes in depressive symptomatology during the first year following one-anastomosis gastric bypass (OAGB) were evaluated and its association with uric acid (sUA). Fifty patients were included in this analysis. Beck Depression Inventory (BDI) for measuring depressive symptomatology, blood samples, and anthropometric measurements were assessed before (T0), at 6 (T6), and 12 months (T12) after surgery. There was a significant reduction in BDI total score at T6 (- 5.6 (95% CI - 2.1, - 9.1) points; p = 0.001) and at T12 (- 4.3 (95% CI - 0.9, - 7.9) points; p = 0.011). BMI loss was unrelated to depressive symptomatology. Patients with moderate to severe depressive symptomatology presented lower sUA levels than patients with none or minimal to mild (p = 0.028). ROC analysis revealed that sUA levels below 5.0 at T6 and 4.5 mg/dl at T12 had a prognostic accuracy for depression severity. Furthermore, delta sUA was significantly associated with delta BMI (ß = 0.473; p = 0.012) and delta waist circumference (ß = 0.531; p = 0.003). These findings support an improvement in depressive symptomatology in the first year postoperatively, however, without relation to BMI loss. Patients with moderate to severe depressive symptomatology presented with lower sUA levels over time. Therefore, sUA could be useful to predict moderate to severe depressive symptomatology in patients undergoing OAGB in clinical practice.

Effect of one-anastomosis gastric bypass on cardiovascular risk factors in patients with vitamin D deficiency and morbid obesity: A secondary analysis.

BACKGROUND AND AIMS: Bariatric patients often suffer from vitamin D (VD) deficiency, and both, morbid obesity and VD deficiency, are related to an adverse effect on cardiovascular disease (CVD) risk. Therefore, we assessed the change of known CVD risk factors and its associations during the first 12 months following one-anastomosis gastric bypass (OAGB). METHODS AND RESULTS: In this secondary analysis, CVD risk factors, medical history and anthropometric data were assessed in fifty VD deficient (25-hydroxy-vitamin D (25(OH)D) <75 nmol/l) patients, recruited for a randomized controlled trial of VD supplementation. Based on previous results regarding bone-mass loss and the association between VD and CVD risk, the study population was divided into patients with 25(OH)D ≥50 nmol/l (adequate VD group; AVD) and into those <50 nmol/l (inadequate VD group; IVD) at 6 and 12 months (T6/12) postoperatively. In the whole cohort, substantial remission rates for hypertension (38%), diabetes (30%), and dyslipidaemia (41%) and a significant reduction in CVD risk factors were observed at T12. Changes of insulin resistance markers were associated with changes of total body fat mass (TBF%), 25(OH)D, and ferritin. Moreover, significant differences in insulin resistance markers between AVD and IVD became evident at T12. CONCLUSION: These findings show that OAGB leads to a significant reduction in CVD risk factors and amelioration of insulin resistance markers, which might be connected to reduced TBF%, change in 25(OH)D and ferritin levels, as an indicator for subclinical inflammation, and an adequate VD status. REGISTERED AT CLINICALTRIALS.GOV: (Identifier: NCT02092376) and EudraCT (Identifier: 2013-003546-16).

Relationship between nutrition knowledge, education and other determinants of food intake and lifestyle habits among adolescents from urban and rural secondary schools in Tyrol, Western Austria.

OBJECTIVE: The aim of this study was to investigate the association of the number of hours of nutrition education and teachers' qualifications with nutrition knowledge and dietary behaviour in students. DESIGN: In this representative cross-sectional study, socio-demographic data, anthropometric measurements, socio-economic status (SES), physical fitness, nutrition knowledge and eating habits were assessed. Differences between groups were tested by χ2 and t tests. Multiple linear and logistic regression modelling was used to examine the relationship between demographic characteristics, lifestyle and dietary behaviours, nutrition knowledge, nutrition-trained teachers and number of nutrition lessons. SETTING: Sixteen secondary schools in urban (n 6) and rural regions (n 10) of Tyrol, Western Austria. PARTICIPANTS: Students (n 513) aged 14·2 (sd 0·7) years. RESULTS: Higher nutrition knowledge was significantly associated with attending rural school (P = 0·001), having no migration background (P < 0·001), (very) good physical activity behaviour (P = 0·040), non-trained teacher (P = 0·006) but higher number of hours of nutrition education (P = 0·013). Regression models showed that higher nutrition knowledge was independently associated with lower intake of meat and iced tea and higher intake of vegetables and plant-based oils. A higher amount of nutrition education (h/week) was significantly associated with higher intake of dark (wholegrain) bread, lower intake of meat and of energy drinks sweetened with sweeteners. CONCLUSIONS: Our results suggest that more hours in nutrition education result in higher nutrition knowledge and greater nutrition literacy, which may lead to health-promoting dietary habits. School-based nutrition education can be seen as preventive measure to increase nutritional competences in adolescents independent of their SES.

Differences in Serum Magnesium Levels in Diabetic and Non-Diabetic Patients Following One-Anastomosis Gastric Bypass.

Patients with obesity and type 2 diabetes mellitus (T2DM) are regarded to have reduced serum magnesium (Mg) concentrations. We aimed to assess the changes in serum Mg concentrations at 12-month follow-up in patients, with and without T2DM, who underwent one anastomosis gastric bypass surgery. Overall, 50 patients (80% female, age 42.2 (12.5) years) with morbid obesity (mean baseline BMI 43.8 (4.3) kg/m2) were included in the analysis. Half of the included patients had T2DM diagnosed at baseline, and these patients showed lower serum Mg concentration (0.78 (0.07)) vs. 0.83 (0.05) mmol/L; p = 0.006), higher blood glucose levels (129.9 (41.3) vs. 87.6 (8.1) mg/dL; p < 0.001) as well as HbA1c concentrations (6.7 (1.4) vs. 5.3 (0.5)%; p < 0.001). During follow-up, BMI and glucose levels showed a decrease; however, serum Mg levels remained stable. At baseline 42% of patients were found to be Mg deficient, which was reduced to 33% at six months and to 30% at 12 months follow-up. Moreover, patients with T2DM had an odds ratio of 9.5 (95% CI = 3.0-29.7; p < 0.001) for magnesium deficiency when compared to patients without T2DM. Further research into the role of Mg and its role in T2DM and other obesity-related comorbidities are needed.