Aim
Our objective was to test the hypothesis that the prevalence of Type 2 diabetes increases with increasing regional deprivation even after controlling for individual socio‐economic status.
Methods
...We pooled cross‐sectional data from five German population‐based studies. The data set contained information on n = 11 688 study participants (men 50.1%) aged 45–74 years, of whom 1008 people had prevalent Type 2 diabetes (men 56.2%). Logistic multilevel regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence. We controlled for sex, age and lifestyle risk factors, individual socio‐economic status and regional deprivation, based on a new small‐area deprivation measure, the German Index of Multiple Deprivation.
Results
Adjusted for sex, age, body mass index (BMI), physical activity, smoking status and alcohol consumption, the prevalence of Type 2 diabetes showed a stepwise increase in risk with increasing area deprivation OR 1.88 (95% CI 1.16–3.04) in quintile 4 and OR 2.14 (95% CI 1.29–3.55) in quintile 5 compared with the least deprived quintile 1, even after controlling for individual socio‐economic status. Focusing on individual socio‐economic status alone, the risk of having diabetes was significantly higher for low compared with medium or high educational level OR 1.46 (95% CI 1.24–1.71) and for the lowest compared with the highest income group OR 1.53 (95% CI 1.18–1.99).
Conclusion
Regional deprivation plays a significant part in the explanation of diabetes prevalence in Germany independently of individual socio‐economic status. The results of the present study could help to target public health measures in deprived regions.
Diet is known to play a decisive role in the development of coronary heart disease (CHD). One factor believed to decrease lifetime risk of CHD is the consumption of omega-3 fatty acids. Yet, ...conclusive evidence regarding the potential cardioprotective effects of fatty acids is far from being reached. The present study aimed to provide further evidence on the association of serum fatty acid profiles with CHD risk.
The CARdio-vascular Disease, Living and Ageing in Halle study (CARLA study) is an observational cohort study comprising an older adult's general population with a high level of cardiovascular risk factors. In a matched case–control design the serum fatty acid concentrations of 73 subjects with an incident fatal or nonfatal CHD event were compared to 146 controls matched for sex and age. Our data show that the participants of the CARLA study are underserved in unsaturated fatty acids with respect to current dietary recommendations. In addition, the ratio of omega-6 to omega-3 fatty acids was determined to be 8:1 which underlines the consumption of a Western-style diet enriched in omega-6 fatty acids. There were no significant differences in fatty acid patterns between cases and controls. Thus, no clear association of particular serum fatty acid levels with cardiovascular risk was found.
Our results support the conclusion that in populations with a homogenous low level of omega-3 polyunsaturated fatty acids consumption, serum fatty acid levels are not associated with CHD risk.
•Participants of the CARLA study underserved in overall unsaturated fatty acids.•Consumption of a Western-style diet with a homogenous level of omega-3 fatty acids.•Only small differences in fatty acid concentrations between cases and controls.•No fatty acid was associated with increased CHD risk after adjustment for confounders.
Although the impact of dietary patterns on human serum metabolites has been examined, the fasting effect on the metabolic profile has not yet been considered. The aim of this cross-sectional study is ...to investigate the influence of fasting regarding the association between dietary patterns, reflected by macro- and micronutrient intake, and human serum metabolites in a population-based cohort. A total 1197 non-diabetic German adults aged 45 to 83 years, who participated in baseline of the CARLA study 2002-2006 and had metabolite quantification were selected for this study. Macro- and micronutrient intakes were estimated from a food frequency questionnaire (FFQ). Concentrations of 134 serum metabolites were measured by targeted metabolomics AbsoluteIDQ p150 Kit. The association of dietary patterns with serum metabolites was calculated by means of linear regression and the influence of the fasting status was considered by including interaction terms with each macro- and micronutrient. Higher self-reported intake of alcohol and lower self-reported intake of organic acids were associated with higher concentrations of acylcarnitines and phosphatidylcholines. Mainly the associations between dietary patterns and acylcarnitines and hexose were altered after including interaction terms, suggesting effect modification by fasting status. No effect from fasting time was seen for amino acids and saturated, mono- and polyunsaturated phosphatidylcholines.
Diabet. Med. 29, e88–e95 (2012)
Aim In Germany, regional data on the prevalence of Type 2 diabetes mellitus are lacking for health‐care planning and detection of risk factors associated with this ...disease. We analysed regional variations in the prevalence of Type 2 diabetes and treatment with antidiabetic agents.
Methods Data of subjects aged 45–74 years from five regional population‐based studies and one nationwide study conducted between 1997 and 2006 were analysed. Information on self‐reported diabetes, treatment, and diagnosis of diabetes were compared. Type 2 diabetes prevalence estimates (95% confidence interval) from regional studies were directly standardized to the German population (31 December 2007).
Results Of the 11 688 participants of the regional studies, 1008 had known Type 2 diabetes, corresponding to a prevalence of 8.6% (8.1–9.1%). For the nationwide study, a prevalence of 8.2% (7.3–9.2%) was estimated. Prevalence was higher in men (9.7%; 8.9–10.4%) than in women (7.6%; 6.9–8.3%). The regional standardized prevalence was highest in the east with 12.0% (10.3–13.7%) and lowest in the south with 5.8% (4.9–6.7%). Among persons with Type 2 diabetes, treatment with oral antidiabetic agents was more frequently reported in the south (56.9%) and less in the northeast (46.0%), whereas treatment with insulin alone was more frequently reported in the northeast (21.6%) than in the south (16.4%).
Conclusion The prevalence of known Type 2 diabetes showed a southwest‐to‐northeast gradient within Germany, which is in accord with regional differences in the distribution of risk factors for Type 2 diabetes. Furthermore, the treatment with antidiabetic agents showed regional differences.
Diabet. Med. 29, 646–653 (2012)
Aims To estimate population values of health‐related quality of life (HRQL) in subjects with and without Type 2 diabetes mellitus across several large ...population‐based survey studies in Germany. Systematic differences in relation to age and sex were of particular interest.
Methods Individual data from four population‐based studies from different regions throughout Germany and the nationwide German National Health Interview and Examination Survey (GNHIES98) were included in a pooled analysis of primary data (N = 9579). HRQL was assessed using the generic index instrument SF‐36 (36‐item Short Form Health Survey) or its shorter version, the SF‐12 (12 items). Regression analysis was carried out to examine the association between Type 2 diabetes and the two component scores derived from the SF‐36/SF‐12, the physical component summary score (PCS‐12) and the mental component summary score (MCS‐12), as well as interaction effects with age and sex.
Results The PCS‐12 differed significantly by −4.1 points in subjects with Type 2 diabetes in comparison with subjects without Type 2 diabetes. Type 2 diabetes was associated with significantly lower MCS‐12 in women only. Higher age was associated with lower PCS‐12, but with an increase in MCS‐12, for subjects with and without Type 2 diabetes.
Conclusions Pooled analysis of population‐based primary data offers HRQL values for subjects with Type 2 diabetes in Germany, stratified by age and sex. Type 2 diabetes has negative consequences for HRQL, particularly for women. This underlines the burden of disease and the importance of diabetes prevention. Factors that disadvantage women with Type 2 diabetes need to be researched more thoroughly.
Disruption of metabolic homeostasis is an important factor in many diseases. Various metabolites have been linked to higher risk of morbidity and all-cause mortality using metabolomics in large ...population-based cohorts. In these studies, baseline metabolite levels were compared across subjects to identify associations with health outcomes, implying the existence of 'healthy' concentration ranges that are equally applicable to all individuals. Here, we focused on intra-individual changes in metabolite levels over time and their link to mortality, potentially allowing more personalized risk assessment. We analysed targeted metabolomics data for 134 blood metabolites from 1409 participants in the population-based CARLA cohort at baseline and after four years. Metabotypes of the majority of participants (59%) were extremely stable over time indicated by high correlation between the subjects' metabolite profiles at the two time points. Metabotype instability and, in particular, decrease of valine were associated with higher risk of all-cause mortality in 7.9 years of follow-up (hazard ratio (HR) = 1.5(95%CI = 1.0-2.3) and 0.2(95%CI = 0.1-0.3)) after multifactorial adjustment. Excluding deaths that occurred in the first year after metabolite profiling showed similar results (HR = 1.8(95%CI = 1.1-2.8)). Lower metabotype stability was also associated with incident cardiovascular disease (OR = 1.2(95%CI = 1.0-1.3)). Therefore, changes in the personal metabotype might be a valuable indicator of pre-clinical disease.
The objective of this study was to investigate the association between residential environment and type 2 diabetes. We pooled cross-sectional data from 5 population-based German studies (1997-2006): ...the Cardiovascular Disease, Living and Ageing in Halle Study, the Dortmund Health Study, the Heinz Nixdorf Recall Study, the Cooperative Health Research in the Region of Augsburg Study, and the Study of Health in Pomerania. The outcome of interest was the presence of self-reported type 2 diabetes. We conducted mixed logistic regression models in a hierarchical data set with 8,879 individuals aged 45-74 years on level 1; 226 neighborhoods on level 2; and 5 study regions on level 3. The analyses were adjusted for age, sex, social class, and employment status. The odds ratio for type 2 diabetes was highest in eastern Germany (odds ratio = 1.98, 95% confidence interval: 1.81, 2.14) and northeastern Germany (odds ratio = 1.58, 95% confidence interval: 1.40, 1.77) and lowest in southern Germany (reference) after adjustment for individual variables. Neighborhood unemployment rates explained a large proportion of regional differences. Individuals residing in neighborhoods with high unemployment rates had elevated odds of type 2 diabetes (odds ratio = 1.62, 95% confidence interval: 1.25, 2.09). The diverging levels of unemployment in neighborhoods and regions are an independent source of disparities in type 2 diabetes.
Active galactic nuclei (AGNs) display many energetic phenomena-broad emission lines, X-rays, relativistic jets, radio lobes-originating from matter falling onto a supermassive black hole. It is ...widely accepted that orientation effects play a major role in explaining the observational appearance of AGNs. Seen from certain directions, circum-nuclear dust clouds would block our view of the central powerhouse. Indirect evidence suggests that the dust clouds form a parsec-sized torus-shaped distribution. This explanation, however, remains unproved, as even the largest telescopes have not been able to resolve the dust structures. Here we report interferometric mid-infrared observations that spatially resolve these structures in the galaxy NGC 1068. The observations reveal warm (320 K) dust in a structure 2.1 parsec thick and 3.4 parsec in diameter, surrounding a smaller hot structure. As such a configuration of dust clouds would collapse in a time much shorter than the active phase of the AGN, this observation requires a continual input of kinetic energy to the cloud system from a source coexistent with the AGN.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The objective of this study was to quantify body weight changes in German adult populations during the past decades.
Longitudinal analysis of seven cohort studies covering different age ranges ...between 18 and 83 years. Baseline examinations were between 1994 and 2007 and follow-up durations between 4.0 and 11.9 years. For each study, mean change in body weight per year and 10-year change in body mass index (BMI) classification were analyzed. For the middle age group of 45-64 years, meta-analysis was conducted to obtain an overall estimate for Germany.
Among men weight gain was highest in the youngest participants and decreased with advancing age. Among women weight gain was on a stable high level among those younger than 45 years and decreased at older age. Within 10 years, 30-40% of middle-aged participants with normal baseline weight became pre-obese or obese and 20-25% of those with pre-obesity at baseline became obese, whereas >80% of persons who were obese at baseline remained obese over time. The estimated average weight change in adults aged 45-64 years was 0.25 (95% confidence interval (CI): 0.18-0.33) kg/year among men and 0.24 (0.17-0.30) kg/year among women.
We could observe a moderate weight gain over the past years in German middle-aged populations of 0.25 kg/year. Obesity prevention needs to be targeted to specific subgroups in the population, especially to younger adults, who seem to be most vulnerable for gaining weight. Obesity intervention needs to be improved, as the majority of obese adults remained obese over time.
Aim
To validate the German Diabetes Risk Score within the population‐based cohort of the Cardiovascular Disease – Living and Ageing in Halle (CARLA) study.
Methods
The sample included 582 women and ...719 men, aged 45–83 years, who did not have diabetes at baseline. The individual risk of every participant was calculated using the German Diabetes Risk Score, which was modified for 4 years of follow‐up. Predicted probabilities and observed outcomes were compared using Hosmer–Lemeshow goodness‐of‐fit tests and receiver–operator characteristic analyses. Changes in prediction power were investigated by expanding the German Diabetes Risk Score to include metabolic variables and by subgroup analyses.
Results
We found 58 cases of incident diabetes. The median 4‐year probability of developing diabetes based on the German Diabetes Risk Score was 6.5%. The observed and predicted probabilities of developing diabetes were similar, although estimation was imprecise owing to the small number of cases, and the Hosmer–Lemeshow test returned a poor correlation (chi‐squared = 55.3; P = 5.8*10‐12). The area under the receiver–operator characteristic curve (AUC) was 0.70 (95% CI 0.64–0.77), and after excluding participants ≥66 years old, the AUC increased to 0.77 (95% CI 0.70–0.84). Consideration of glycaemic diagnostic variables, in addition to self‐reported diabetes, reduced the AUC to 0.65 (95% CI 0.58–0.71). A new model that included the German Diabetes Risk Score and blood glucose concentration (AUC 0.81; 95% CI 0.76–0.86) or HbA1c concentration (AUC 0.84; 95% CI 0.80–0.91) was found to peform better.
Conclusions
Application of the German Diabetes Risk Score in the CARLA cohort did not reproduce the findings in the European Prospective Investigation into Cancer and Nutrition (EPIC) Potsdam study, which may be explained by cohort differences and model overfit in the latter; however, a high score does provide an indication of increased risk of diabetes.
What's new?
The German Diabetes Risk Score (DRS), developed within the European Prospective Investigation into Cancer and Nutrition (EPIC) Potsdam study, has not been prospectively validated in a representative sample of the general population apart from EPIC.
The aim of this study was to validate the DRS in the Cardiovascular Disease – Living and Ageing in Halle (CARLA) study, a population‐based cohort with a high response rate, that provides a more representative sample than the EPIC‐Potsdam study.
The predictive ability of the DRS observed in the CARLA cohort was consistently lower than in the EPIC cohort, a finding that could reflect cohort differences and model overfit in the EPIC study.
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