Levels and activity of cyclic guanosine monophosphate-dependent protein kinase in nurse and forager honeybees

Age-dependent division of labour in honeybees was shown to be connected to sensory response thresholds. Foragers show a higher gustatory responsiveness than nurse bees. It is generally assumed that nutrition-related signalling pathways underlie this behavioural plasticity. Here, one important candidate gene is the foraging gene, which encodes a cyclic guanosine monophosphate-dependent protein kinase (PKG). Several roles of members of this enzyme family were analysed in vertebrates. They own functions in important processes such as growth, secretion and neuronal adaptation. Honeybee foraging messenger RNA expression is upregulated in the brain of foragers. In vivo activation of PKG can modulate gustatory responsiveness. We present for the first time PKG protein level and activity data in the context of social behaviour and feeding. Protein level was significantly higher in brains of foragers than in those of nurse bees, substantiating the role of PKG in behavioural plasticity. However, enzyme activity did not differ between behavioural roles. The mediation of feeding status appears independent of PKG signalling. Neither PKG content nor enzyme activity differed between starved and satiated individuals. We suggest that even though nutrition-related pathways are surely involved in controlling behavioural plasticity, which involves changes in PKG signalling, mediation of satiety itself is independent of PKG.

Vitamin D measurement standardization: The way out of the chaos

Substantial variability is associated with laboratory measurement of serum total 25-hydroxyvitamin D [25(OH)D]. The resulting chaos impedes development of consensus 25(OH)D values to define stages of vitamin D status. As resolving this situation requires standardized measurement of 25(OH)D, the Vitamin D Standardization Program (VDSP) developed methodology to standardize 25(OH)D measurement to the gold standard reference measurement procedures of NIST, Ghent University and CDC. Importantly, VDSP developed protocols for standardizing 25(OH)D values from prior research based on availability of stored serum samples. The effect of such retrospective standardization on prevalence of "low" vitamin D status in national studies reported here for The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and the German Health Interview and Examination Survey for Children and Adolescents (KIGGS, 2003-2006) was such that in NHANES III 25(OH)D values were lower than original values while higher in KIGGS. In NHANES III the percentage with values below 30, 50 and 75 nmol/L increased from 4% to 6%, 22% to 31% and 55% to 71%, respectively. Whereas in KIGGS after standardization the percentage below 30, 50, and 70 nmol/L decreased from 28% to 13%, 64% to 47% and 87% to 85% respectively. Moreover, in a hypothetical example, depending on whether the 25(OH)D assay was positively or negatively biased by 12%, the 25(OH)D concentration which maximally suppressed PTH could vary from 20 to 35ng/mL. These examples underscore the challenges (perhaps impossibility) of developing vitamin D guidelines using unstandardized 25(OH)D data. Retrospective 25(OH)D standardization can be applied to old studies where stored serum samples exist. As a way forward, we suggest an international effort to identify key prior studies with stored samples for re-analysis and standardization initially to define the 25(OH)D level associated with vitamin D deficiency (rickets/osteomalacia). Subsequent work could focus on defining inadequacy. Finally, examples reported here highlight the importance of suspending publication of meta-analyses based on unstandardized 25(OH)D results.

Age-related prevalence of cross-reactive antibodies against influenza A(H3N2) variant virus, Germany, 2003 to 2010

Binary file ES_Abstracts_Final_ECDC.txt matches

Age-related prevalence of cross-reactive antibodies against influenza A(H3N2) variant virus, Germany, 2003 to 2010

To estimate susceptibility to the swine-origin influenza A(H3N2) variant virus (A(H3N2)v) in the German population, we investigated cross-reactive antibodies against this virus and factors associated with seroprotective titre using sera from representative health examination surveys of children and adolescents (n = 815, 2003–06) and adults (n = 600, 2008–10). Antibodies were assessed by haemagglutination inhibition assay (HI); in our study an HI titre ≥ 40 was defined as seroprotective. We investigated associated factors by multivariable logistic regression. Overall, 41% (95% confidence interval (CI): 37–45) of children and adolescents and 39% (95% CI: 34–44) of adults had seroprotective titres. The proportion of people with seroprotective titre was lowest among children younger than 10 years (15%; 95% CI: 7–30) and highest among adults aged 18 to 29 years (59%; 95% CI: 49–67). Prior influenza vaccination was associated with higher odds of having seroprotective titre (odds ratio (OR) for children and adolescents: 3.4; 95% CI: 1.8–6.5; OR for adults: 2.4; 95% CI: 1.7–3.4). Young children showed the highest and young adults the lowest susceptibility to the A(H3N2)v virus. Our results suggest that initial exposure to circulating seasonal influenza viruses may predict long-term cross-reactivity that may be enhanced by seasonal influenza vaccination.

Examination of iodine status in the German population: an example for methodological pitfalls of the current approach of iodine status assessment

PURPOSE

Preliminary iodine concentration (UIC) measurements in spot urines of the representative German adult study DEGS indicated a severe worsening of iodine status compared to previous results in German children (KiGGS study). Therefore, we aimed to evaluate adult iodine status in detail and to investigate the impact of hydration status on UIC.

METHODS

UIC and creatinine concentrations were measured in 6978 spot urines from the German nationwide DEGS study (2008-2011). Twenty-four-hour iodine excretions (24-h UIE) were estimated by relating iodine/creatinine ratios to age- and sex-specific 24-h creatinine reference values. Urine osmolality was measured in two subsamples of spot urines (n = 100 each) to determine the impact of hydration status on UIC.

RESULTS

In DEGS, median UIC was 69 µg/L in men and 54 µg/L in women, lying clearly below the WHO cutoff for iodine sufficiency (100 µg/L). Estimated median 24-h UIE was 113 µg/day, accompanied by 32 % of DEGS adults, lying below the estimated average requirement (EAR) for iodine. Comparative analysis with the KiGGS data (>14,000 spot urines of children; median UIC 117 µg/L) revealed a comparable percentage <EAR (33 %). In two DEGS subsamples with significantly different UIC but similar median 24-h UIE, osmolality was twofold higher in the high- versus the low-UIC group.

CONCLUSION

Over 30 % of participants in the two German surveys had an estimated iodine intake less than the respective age-group-specific EAR. Our data strongly suggest that even in large surveys, hydration status can considerably interfere with the epidemiological iodine assessment parameter UIC. The present data can serve as an example how to evaluate population-based spot urine data on a 24-h basis, independent of hydration status.

[Prevalence of sensitisation to aeraoallergens and food allergens: results of the German Health Interview and Examination Survey for Adults (DEGS1)]

In view of the increasing prevalence of allergies, up-to-date data on the prevalence of allergic sensitisation are of major interest. In the German Health Interview and Examination Survey for Adults (DEGS1) (2008-2011) blood samples from a population-based sample of 7,025 participants aged 18 to 79 years were analysed for specific IgE antibodies against 50 common single allergens and screened for common aeroallergens (SX1) and grass pollen (GX1). In all, 48.6 % of the participants were sensitised to at least one allergen. Overall, men were more frequently sensitised to at least one allergen than women were. Sensitisations to at least one allergen were more common among younger than older participants and among participants with a higher socio-economic status. In all, 33.6 % of the participants were sensitised to common aeroallergens, 25.5  % to food allergens and 22.6 % to wasp or bee venoms. Compared with the German National Health Interview and Examination Survey 1998 (GNHIES98), the prevalence of sensitisation to common aeroallergens increased from 29.8 to 33.6 %.This increase was statistically significant only in women. The results of DEGS1 still showed a high prevalence of allergic sensitisation. An English full-text version of this article is available at SpringerLink as supplemental.

[Epidemiology of hepatitis A, B, and C among adults in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]

Ten years after seroepidemiological data were obtained in the German National Health Interview and Examination Survey 1998 (GNHIES98), German Health Interview and Examination Survey (DEGS1) data contribute to a population-based, representative surveillance of hepatitis A and B immunity and of the serological markers for hepatitis C in Germany. The prevalence of antibodies against the hepatitis A virus is 48.6 %. In comparison to the situation 10 years ago, seroprevalence is significantly higher among 18- to 39-year-old adults and is significantly lower in those aged 50-79 years. The association between age and seroprevalence has changed, indicating a decrease in naturally acquired hepatitis A immunity. Individual and population immunity has to be achieved through vaccination. Prevalence of hepatitis B antibodies indicates that 5.1 % of adults have been exposed to the virus, significantly fewer than 10 years ago (7.9 %). Prevalence of hepatitis B surface antibodies indicates that 22.9 % of adults have been vaccinated against hepatitis B. Vaccination coverage has increased in all age groups and is highest in the younger age groups. These positive trends can be attributed to the general recommendation since 1995 to vaccinate against hepatitis B. For hepatitis C, the prevalence of antibodies in the general population is 0.3 %. Germany thus remains a low-HCV-endemic country. An English full-text version of this article is available at SpringerLink as supplemental.

Risk factors for Chlamydia trachomatis infection in adolescents: results from a representative population-based survey in Germany, 2003-2006

Infections with Chlamydia trachomatis (CT) can lead to severe sequelae; however, they are not notifiable in Germany. We tested urine samples from participants of KiGGS (German Health Interview and Examination Survey for Children and Adolescents) for CT infections and linked the results to demographic and behavioural data from 1,925 participants (girls aged 15-17 years and boys aged 16-17 years) to determine a representative prevalence of CT infection in adolescents in Germany and to assess associated risk factors. Prevalence of CT infection was 2.2% (95% CI: 1.4-3.5) in girls and 0.2% (95% CI: 0.1-0.7) in boys. CT infection in girls was associated with higher use of alcohol, marijuana and cigarettes, lower social status, oral contraceptive use, pregnancy, repeated lower abdominal pain and higher rates of doctors' consultations within the preceding three months and consultation of gynaecologists within the last 12 months. In multiple logistic regression, we identified two predictors for CT infection: marijuana consumption often or several times within the last 12 months (F(1,164)=7.56; p<0.05) and general health status less than 'very good' (F(1,164)=3.83; p=0.052). Given our findings, we recommend enhancing sex education before sexual debut and promoting safe sex practices regardless of the contraceptive method used. Well-informed consumption of alcohol should be promoted, the risky behaviour of people intoxicated through consumption of marijuana highlighted and doctors' awareness of CT screening enhanced.

[Iodine deficiency in infancy - a risk for cognitive development]

Severe iodine deficiency during pregnancy seriously influences fetal brain development and in the worst case induces cretinism. Recent studies have shown that even a mild iodine deficiency during pregnancy and during the first years of life adversely affects brain development. The World Health Organisation (WHO) considers iodine deficiency as the most common preventable cause of early childhood mental deficiency. In this context, the insufficient production of the four iodine atoms containing thyroxine seems to play a causal role, i. e., due to the iodine substrate deficiency the neuronally particularly relevant free-thyroxine level falls. Due to the very limited iodine storage capacity, the infantile thyroid is eminently dependent on an adequate and steady iodine supply. In the first month of life, when milk is the only energy- and nutrient provider, infants fed a commercial formula regularly have a sufficient iodine supply. However, breastfed infants, who depend on maternal iodine status, frequently show an inadequate iodine intake. Furthermore, iodine intake is critical when complementary food (CF) is introduced. Especially homemade CF is poor in iodine, but also commercial CFs are only partly fortified. A simultaneous inadequate iodine supply of the breastfeeding mother and the preferential use of mostly iodine-poor organic milk cannot ensure an adequate iodine supply of the infant. In terms of an improvement of nutrient supply, especially concerning an unhindered brain development, the corresponding German reference value for iodine intake of infants until age 4 month should be raised from currently 40 microg/d to at least 60 microg/d (WHO-reference: 90 microg/d).

First acute haemodynamic study of soluble guanylate cyclase stimulator riociguat in pulmonary hypertension

Pulmonary hypertension (PH) is associated with impaired production of the vasodilator nitric oxide (NO). Riociguat (BAY 63-2521; Bayer Healthcare AG, Wuppertal, Germany) acts directly on soluble guanylate cyclase, stimulating the enzyme and increasing sensitivity to low NO levels. The present study evaluates riociguat safety, tolerability and efficacy in patients with moderate-to-severe PH (pulmonary arterial hypertension, distal chronic thromboembolic PH or PH with mild to moderate interstitial lung disease). The optimal tolerated dose was identified by incremental dosing in four patients with PH; pharmacodynamic and pharmacokinetic parameters were assessed following single-dose administration (2.5 mg or 1 mg) in 10 and five patients with PH, respectively. All subjects (n = 19) were analysed for safety and tolerability. Riociguat had a favourable safety profile at single doses < or =2.5 mg. It significantly improved pulmonary haemodynamic parameters and cardiac index in patients with PH in a dose-dependent manner, to a greater extent than inhaled NO. Although riociguat also had significant systemic effects and showed no pulmonary selectivity, mean systolic blood pressure remained >110 mmHg. The present report is the first to describe the use of riociguat in patients with pulmonary hypertension. The drug was well-tolerated and superior to nitric oxide in efficacy and duration. Riociguat, therefore, has potential as a novel therapy for pulmonary hypertension and warrants further investigation.

[Blood pressure measurement in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Methodology and initial results]

Hypertension is one of the main risk factors for cardiovascular disease and ranks among the leading causes of morbidity and mortality worldwide. Hypertension in children is rare, but the blood pressure rank in relation to peers is often maintained from childhood into adulthood and is therefore of great public health relevance. For this reason, one of the aims of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was to collect representative data on blood pressure in children aged 3 to 17 years, in order to create an epidemiological basis for a comprehensive analysis of blood pressure in children and adolescents in Germany. Two oscillometric blood pressure measurements were obtained using an automated device (Datascope Accutorr Plus) and two readings of systolic, diastolic and mean arterial pressure and of heart rate were obtained in a standardised fashion in 14.730 children (7203 girls and 7527 boys). The main aim of this article is a detailed description of the blood pressure measurement in KiGGS, which is important for the interpretation of our findings compared to other studies. Our initial results on the distribution of systolic and diastolic blood pressure confirm previous findings of increasing blood pressure with age and height and of higher systolic blood pressure levels among boys compared with girls from the age of 14 years.

[Iodine intake in Germany. Results of iodine monitoring in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

Iodine is an essential trace element which is found in too low quantities in the soil in Germany. The resulting iodine deficiency in human beings is countered by iodine prophylaxis, essentially consisting of iodised table salt and the iodisation of agricultural animal feed. In iodine monitoring during the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the thyroid volumes of all children and adolescents from six years of age were determined using sonography. To assess iodine intake among the population, iodine excretion in the urine was also measured. The median ioduria value was 117 microg/l, putting it at the lower end of the scale of 100-200 microg/l recommended by the World Health Organisation. It can be concluded from these results that the iodine prophylaxis has been successful and that iodine intake has improved compared with the past. In accordance with the WHO recommendations there is no iodine deficiency in Germany any more; however, at the same time the population's iodine intake is at a relatively low level. The aim is at least to keep up what has been achieved, meaning that measures to improve iodine intake must not be allowed to slacken.

Tabak-, Alkohol- und Drogenkonsum von Jugendlichen in Deutschland

Due to its long-lasting effects, the consumption of tobacco, alcohol and drugs is one of the central topics of prevention and health promotion in childhood and adolescence. The data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) show that in Germany today 20.5 % of 11-17-year-old boys and 20.3 % of girls the same age smoke. More than one quarter of adolescents who do not smoke themselves are exposed to cigarette smoke several times a week; around one fifth are even exposed to it almost every day. In the case of alcohol, 64.8 % of boys and 63.8 % of girls have drunk it before. Around one third of boys and one quarter of girls indicated that they currently consumed alcohol at least once a week. In the last 12 months before the survey 9.2 % of the boys and 6.2 % of the girls had taken hashish or marijuana. Other drugs such as Ecstasy, amphetamines or speed had been consumed by less than 1 % of the adolescents. The use of psychoactive substances rises markedly as children get older and is thus the most widespread among 16-17-year-olds. Adolescents of low social status smoke more frequently; in the case of alcohol and drug consumption, however, no significant status-specific differences are observed. There is also a raised prevalence of smoking among boys and girls who attend a secondary school and live in the states of the former GDR. The results emphasise the need for an addiction prevention programme which should include intervention to prevent children taking up substance use, as well as withdrawal treatment.

Der Kinder- und Jugendgesundheitssurvey (KiGGS): Studienmanagement und Durchführung der Feldarbeit

From May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Nationwide data collection in 167 cities and municipalities was carried out by 4 survey teams, each consisting of a physician, centre interviewer, examiner, medical laboratory technician, environmental interviewer. Regional and seasonal factors were excluded by systematised route planning. Invitation of the participants and appointments for examinations were handled by a survey office with subsidised service telephone. Data processing in the survey office was performed using an SQL data base system programmed in the RKI. One central and several regional members of staff performing preparatory field visits were responsible for finding suitable examination rooms and for subject recruitment respectively. To further increase the response rate, continuous public relation actions were established. The survey involved questionnaires filled in by parents and parallel questionnaires for children from the age of 11 years onwards, physical examinations and tests and a computer assisted personal interview performed by the physician. The wide range of blood and urine testing carried out at central laboratories required standardised transport logistics. To achieve a high degree of standardisation of the survey, the examination teams were initially trained and then underwent continuous further training. The concept of quality management covered action of internal and independent external quality control monitoring each data collecting and data processing step as well as the training courses.

CONCLUSION

Dedicated public relations activities and the deployment of staff performing preparatory field visits increased the willingness of the subjects to participate. Intensive personnel care and continuous quality checks contribute to increased job satisfaction and data quality. By bindingly defining all laboratory diagnostic processes as well as transport logistics, high-quality laboratory test results are ensured. The conduct of the study from design via conduct to data processing and analysis by one institution guarantees complete control of all steps of the survey.

Soziale Ungleichheit des Rauchverhaltens in Deutschland

Data of the National Health Survey 1998 are used to analyze the impact of alternative indicators of social inequality on smoking of the 18- to 79-year-old population in Germany. The members of socially disadvantaged groups not only smoke more frequently, they show also lower rates in smoking cessation. This is most obvious in middle age while only small differences can be observed at older ages. Multivariate analyses evidence primarily education as a determinant of smoking among men and women. The effects of income and occupational status are fairly small. The results point out that health inequalities can partly be explained by different smoking habits and, therefore, underline the necessity of a differentiated and group-specific tobacco prevention and tobacco control policy.

[The Child and Adolescent Health Survey: collection of health behavior data from parents and children]

The first German Health Survey for Children and Adolescents will start in 2003. During three years, a representative sample of children and adolescents between 0 and 18 years of age shall be examined and will, together with their parents, be interviewed on health-relevant issues. With this survey, health information on about 18,000 children will be gathered. The health behaviour of the parents as far as their children's health is concerned, as well as the personal health behaviour during adolescence will be assessed, since this will be highly relevant for future health. Questions on nutrition behaviour, eating disorders, alcohol consumption, smoking as well as leisure-time behaviour, with special emphasis on physical activity, will be asked. These questions were tested for feasibility in a one-year pilot study. With this survey, the occurrence of certain unhealthy behaviour characteristics may be documented and risk groups may be identified. This may help to conceptualize prevention measures.

[Monitoring of iodine in The Child and Adolescent Health Survey]

In the first quarter of 2003 a National Health Survey for Children and Adolescents will be started and carried out over a period of three years. In 11,300 children and adolescents between 6 and 18 years a comprehensive iodine monitoring will be realised. The volume of the thyroid gland will be determined sonographically, thyroid hormones and the urinary iodine excretion will be measured. Apart from the nutritional intake of iodine and the use of supplements, socio-demographic and other variables relevant to health will be recorded in a self-administered questionnaire. In the pilot study of the Health Survey for Children and Adolescents from March 2001 to March 2002 the method was tested on 426 children and adolescents and has proved feasible. The sample for the pretest was not representative for the population of children and adolescents in Germany but may already be an indication for the iodine supply. A low goitre prevalence of 4.2% was found. The total thyroid volume correlated significantly with height and weight. There was no significant difference between boys and girls or between a rural and an urban sample point.

Vitamins--dietary intake and intake from dietary supplements in Germany

OBJECTIVE

To analyse the current vitamin intake and the contribution of dietary supplements to this intake of 4030 participants of the German Nutrition Survey (GeNuS) 1998, which was part of the representative German National Health Interview and Examination Survey (GNHIES), conducted from October 1997 until March 1999.

DESIGN

In the GeNuS participants were interviewed comprehensively about their usual diet and supplementation patterns using a modified dietary history.

SETTING

Population-based nutritional survey.

SUBJECTS

A subsample of 4030 persons, aged 18-79 y, randomly selected from the GNHIES 1998.

RESULTS

The contribution of dietary supplements to the vitamin intake reached 5% for vitamin E among men and 6% for vitamin C among women. Among the group of regular users, the contribution to the vitamin E intake is 36% among men and 43% among women. A substantial part of the population does not reach the current recommendations for some vitamins, especially for folate and vitamin E through their diet alone. Among regular supplement users, about one-third for folate and about half for the other vitamins reach the recommended intake only when supplemental intake is considered. Among the regular users of folate supplements, this proportion is about half.

CONCLUSION

If reference values are used as preference intake, a substantial population part improves their vitamin intake by taking supplements regularly. Nevertheless, there are persons who stay below the reference values including supplemental intake or already consume more than 100% of recommendation excluding supplemental intake.

Validity of DISHES 98, a computerised dietary history interview: energy and macronutrient intake

OBJECTIVE

To estimate the relative validity of a computerised dietary history instrument (DISHES 98).

SETTINGS

Munich and Berlin.

SUBJECTS

A total of 148 persons aged 19-59 y recruited from two research centres.

DESIGN

A relative validation study. Energy and macronutrient intakes obtained with DISHES 98 were compared to those assessed with 3-day weighed dietary records and with a 24 h dietary recall.

RESULTS

Intakes of energy, total, saturated and monounsaturated fat, polysaccharides and alcohol were significantly higher and intake of dietary fibre was significantly lower with the 3-day records than with DISHES 98. For intakes of total, animal and vegetable protein, total carbohydrates, mono- and disaccharides and cholesterol the mean difference between DISHES 98 and the 3-day dietary records was less than 5% of the intake with DISHES 98. Pearson's correlation coefficients between DISHES 98 and 3-day records varied from 0.34 for intake of polyunsaturated fat to 0.69 for intake of disaccharides and from 0.27 for polyunsaturated fat to 0.65 for total carbohydrates between DISHES 98 and the 24 h recall. The proportion of participants classified into the same or adjacent quintile of intake varied between 66.9% for polyunsaturated fat and 90.4% for alcohol comparing DISHES 98 and 3-day records and between 60.2% for polyunsaturated fat and 78.4% for total carbohydrates comparing DISHES 98 and 24 h recalls.

CONCLUSION

The observed differences between DISHES 98 and the other methods are in an acceptable range for assessing dietary intake in epidemiologic studies.

A comparison of serum total cholesterol levels and their determinants between the Federal Republic of Germany and the United States

Mean serum total cholesterol levels appear to be higher in the Federal Republic of Germany (FRG) than in the United States (US) while coronary heart disease death rates are lower. The study examined possible factors for the difference including possible differences in laboratory methodology. Cross-sectional data from the first two waves of the German National Health Surveys (1984-1986 and 1987-1989; n = 9709) and from the Second National Health and Nutrition Examination Survey (1976-1980; n = 7832) were compared for men and women 25-69 years of age. The influence of age, body mass index, diet, cigarette smoking, education, income, use of oral contraceptives or antihypertensive agents, alcohol consumption and potential differences in laboratory measurement were explored using multiple regression techniques separately for men and women for ages 25-39, 40-59 and 60-69 years of age. Overall ages, unadjusted mean total cholesterol levels were higher in German than US men (6.02 vs. 5.64 mmol/l) and in German than US women (6.04 vs. 5.80 mmol/l) as were HDL cholesterol levels (men: 1.30 vs 1.14 mmol/l; women: 1.65 vs. 1.38 mmol/l). Adjusting for lifestyle factors explained, on the average, 40% of the differences in mean total cholesterol of which half or 20% was accounted for by adjusting for alcohol intake. Adjusting for possible laboratory differences explained, on the average, an additional 30% of the differences. Frequency of alcohol intake was the most important factor in explaining differences in mean HDL cholesterol levels. Adjustment for differences in alcohol intake had negligible effects on reducing the differences in mean non-HDL cholesterol.

[Nutrition in Germany 1998]

In addition to the German National Health Interview and Examination Survey, the German Nutrition Survey 1998 (GeNuS) was conducted in a subsample of 4030 participants. Among these persons, a comprehensive dietary interview was performed with use of the software DISHES 98. The proportion of 33-34% energy from fat is considerably less than the 40% energy from fat which was estimated about ten years ago. In general, the supply of most vitamins, minerals and trace elements is sufficient. For a part of the population, the intake of dietary fibre, vitamins D and E, folate, zinc, iodine and, among women, also vitamins B1, B2, B6, iron and phosphorus is on a suboptimal level. Observed differences in dietary habits in the eastern and western part of Germany did not have an obviously more favourable dietary pattern in any part of Germany.

[Folic acid intake of women in childbearing age]

An optimal maternal folate status reduces the risk of neural tube defects in the offspring. In the German National Health Interview and Examination Survey, red cell folate and serum folate levels have been measured in 1,266 women aged between 18 and 40 years. Applying the dietary assessment software DISHES 98 made it possible to estimate the individual folate intake. A high proportion of the participants showed sub-optimal red cell folate levels as well as folate intakes below the recommendations.

[Blood pressure in Germany--current status and trends]

The blood pressure measurements performed in the course of the German National Health Interview and Examination Survey 1998 showed higher levels in men compared to women and higher levels in the Eastern part of Germany as compared to the West. Generally, blood pressure increased with age. The prevalence of hypertension was higher in men, reaching almost 30%, as compared to women (26.9%), and higher in the East compared to the West. A comparison of data of 1998 and data of the Health Examination Survey East-West 1991 reveals an increase in the incidence of hypertension in the West and a decrease in the East. This seems to imply a convergence of the two regions on a high level.

Determinants of p,p-dichlorodiphenyldichloroethane (DDE) concentration in adipose tissue in women from five European cities

To identify the determinants of p,p'-dichlorodiphenyldichloroethane (p,p'-DDE) in adipose tissue in subjects who participated in a cross-sectional study, we analyzed fatty acids, antioxidants, and p,p'-DDE in aspirates of adipose tissue of 328 postmenopausal women from 5 European countries. The overall mean of p,p'-DDE concentration was 1.66 microg/g of fatty acids (95% confidence interval = 1.46, 1.88). In a multiple-regression analysis, the main predictors of log10(p,p'DDE) were center of recruitment (p < .0001), adipose arachidic acid (p = .001), and adipose retinol (p = .04). These factors explained 14.9% of the overall variability of log10(p,p'-DDE). In our subjects, adipose tissue p,p'DDE concentrations were only weakly related with biomarkers reflecting intake of fish and other foods. This result is consistent with the notion that p,p'-DDE exists in different foods and, given the widespread contamination of the food chain, is relatively evenly distributed among foods.

Dietary recommendations and prevailing food and nutrient intakes in Germany

Dietary recommendations on nutrient intakes as published by the German Society of Nutrition are only met by a very small proportion of the adult population in East and in West Germany. Dietary data from the Nutrition Survey and Risk Factor Analysis Study in West Germany and from the National Health Survey in East Germany were used to identify differences in nutrient intakes and in food consumption patterns between subgroups of the study participants that were close to, or failed to meet the dietary guidelines. The subgroups were created by dividing subjects into quartiles on the basis of their daily intakes of total fat (%energy), saturated fatty acids (%energy), fibre (g/d) and the food group fruit and vegetables (g/d). Comparisons of the consumption patterns between subjects in the first and in the fourth quartile of intake of the nutrients under study were performed. Differences in food and nutrient intakes were seen among those more compliant and less compliant with the recommendations. The presented analysis provides first indications for future improvements of the existing food-based dietary guidelines in Germany.

Omega-3 fatty acids in adipose tissue and risk of myocardial infarction: the EURAMIC study

Omega-3 fatty acids have potential antiatherogenic, antithrombotic, and antiarrhythmic properties, but their role in coronary heart disease remains controversial. To evaluate the association of omega-3 fatty acids in adipose tissue with the risk of myocardial infarction in men, a case-control study was conducted in eight European countries and Israel. Cases (n=639) included patients with a first myocardial infarction admitted to coronary care units within 24 hours from the onset of symptoms. Controls (n=700) were selected to represent the populations originating the cases. Adipose tissue levels of fatty acids were determined by capillary gas chromatography. The mean (+/-SD) proportion of alpha-linolenic acid was 0.77% (+/-0.19) of fatty acids in cases and 0.80% (+/-0.19) of fatty acids in controls (P=0.01). The relative risk for the highest quintile of alpha-linolenic acid compared with the lowest was 0.42 (95% confidence interval [CI] 0.22 to 0.81, P-trend=0.02). After adjusting for classical risk factors, the relative risk for the highest quintile was 0.68 (95% CI 0.31 to 1.49, P-trend=0.38). The mean proportion of docosahexaenoic acid was 0.24% (+/-0.13) of fatty acids in cases and 0.25% (+/-0.13) of fatty acids in controls (P=0. 14), with no evidence of association with risk of myocardial infarction. In this large case-control study we could not detect a protective effect of docosahexaenoic acid on the risk of myocardial infarction. The protective effect of alpha-linolenic acid was attenuated after adjusting for classical risk factors (mainly smoking), but it deserves further research.

Differences between plasma and adipose tissue biomarkers of carotenoids and tocopherols

Biomarkers of dietary exposure or nutritional status are sought actively to overcome limitations of traditional dietary methodology. We compared plasma and adipose tissue biomarkers for carotenoids and tocopherols. The data consisted of samples from 91 men and 122 women, ages 45-70 years, from the control group of the European Community Multicentre Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC) Study. Pearson correlations between plasma and adipose tissue measurements for beta-carotene, lycopene, and alpha-tocopherol adjusted for smoking status displayed low, although significant, correlations of 0.39, 0.24, and 0.39, respectively. The correlation was further stratified by sex. After being corrected for measurement error using deattenuation factors obtained from a reproducibility study, the stratified correlation coefficients were as high as 0.80 for beta-carotene in men, 0.62 for lycopene in women, and 0.52 for alpha-tocopherol in women. In addition, plasma and adipose tissue measurements from the myocardial infarction (MI) subset of the EURAMIC study population were used to evaluate the odds of MI, adjusting for confounders. We found that the concentration of lycopene in plasma was not positively associated significantly with MI (odds ratio, 1.78; P = 0.26). Adipose tissue lycopene, in contrast to reports elsewhere on the total population, showed an inverse association with MI (odds ratio, 0.62; P = 0.15). These results suggest that plasma and adipose carotenoids represent different markers for nutritional status and cannot be used interchangeably in epidemiological and dietary validation studies.

Intake of fruits, vegetables, folic acid and related nutrients and risk of breast cancer in postmenopausal women

OBJECTIVE

To determine the role of fruit and vegetable consumption and dietary intake of folic acid and related nutrients such as methionine, cysteine and alcohol in the aetiology of breast cancer.

DESIGN

Population based case-control study.

SETTING

Part of the European Community Multicentre Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC) in Berlin, Germany.

SUBJECTS

As part of the EURAMIC study, dietary intake data were collected in 43 postmenopausal women diagnosed with breast cancer between 1991 and 1992 in Berlin, Germany, and compared to 106 population-based controls.

RESULTS

Odds ratios (ORs) adjusted for major risk factors of breast cancer but not for total energy intake showed a non-significant inverse association between a high intake of vegetables (OR=0.76, 95% CI=0.48-1.20) and fruits (OR=0.74, 95% CI=0.48-1.15) and breast cancer. Once results were adjusted for total energy intake the associations became much weaker (vegetables: R=0.86, 95% CI=0.51-1.46; fruits: OR=0.82, 95% CI=0.51-1.32). For all nutrients, the effect of energy adjustment was more profound and the inverse associations disappeared when results were adjusted for energy intake (total folate-not energy adjusted: OR = 0.79, 95% CI=0.51-1.21; energy adjusted: OR=1.14, 95% CI=0.73-1.79; folate equivalents-not energy adjusted: OR=0.81, 95% CI=0.53-1.23; energy adjusted: OR=1.16, 95% CI=0.78-1.74; methionine-not energy adjusted: OR=0.60, 95% CI=0.35-1.03; energy adjusted: OR=1.29, 95% CI=0.76-2.19; cysteine-not energy adjusted: OR=0.52, 95% CI=0.29-0.94; energy adjusted: OR=1.22, 95% CI=0.75-1.97). Alcohol intake was inversely associated with breast cancer in a non-significant way, possibly due to the relatively low alcohol intake of the study population.

CONCLUSIONS

The results of this study do not provide firm evidence that a high intake of fruits and vegetables, folic acid, methionine or cysteine reduces the risk of getting breast cancer.

Tissue stores of individual monounsaturated fatty acids and breast cancer: the EURAMIC study. European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer

The strongest evidence that monunsaturated fat may influence breast cancer risk comes from studies of southern European populations, in whom intake of oleic acid sources, particularly olive oil, appears protective. No previous study has examined the relation of adipose tissue fatty acid content to breast cancer in such a population. We used adipose biopsies with diverse fat intake patterns gathered in 5 European centers, including southern Europe (Malaga, Spain), to test the hypothesis that stores of oleic acid or other monounsaturates are inversely associated with breast cancer. Gluteal fat aspirates were obtained from 291 postmenopausal incident breast cancer patients and 351 control subjects, frequency-matched for age and catchment area. Logistic regression was used to model breast cancer by monounsaturates, with established risk factors controlled for. Oleic acid showed a strong inverse association with breast cancer in the Spanish center. The odds ratio for the difference between 75th and 25th percentiles was 0.40 (95% CI: 0.28, 0.58) in Malaga and 1.27 (0.88, 1.85) in all other centers pooled, with a peak at 2.36 (1.01, 5.50) for Zeist. Palmitoleic and myristoleic acids showed evidence of an inverse association outside Spain, and cis-vaccenic acid showed a positive association in 3 centers. These data do not support the hypothesis that increasing tissue stores of oleic acid are protective against breast cancer in non-Spanish populations. This finding implies that the strong protective associations reported for olive oil intake in dietary studies may be due to some other protective components of the oil and not to the direct effect of oleic acid uptake. Alternatively, high olive oil intake may indicate some other protective aspect of the lifestyle of these women.

Adipose tissue omega-3 and omega-6 fatty acid content and breast cancer in the EURAMIC study. European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer

The fatty acid content of adipose tissue in postmenopausal breast cancer cases and controls from five European countries in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Cancer (EURAMIC) breast cancer study (1991-1992) was used to explore the hypothesis that fatty acids of the omega-3 family inhibit breast cancer and that the degree of inhibition depends on background levels of omega-6 polyunsaturates. Considered in isolation, the level of omega-3 or omega-6 fat in adipose tissue displayed little consistent association with breast cancer across study centers. The ratio of long-chain omega-3 fatty acids to total omega-6 fat showed an inverse association with breast cancer in four of five centers. In Malaga, Spain, the odds ratio for the highest tertile relative to the lowest reached 0.32 (95% confidence interval 0.13-0.82). In this center, total omega-6 fatty acid was strongly associated with breast cancer. With all centers pooled, the odds ratio for long-chain omega-3 to total omega-6 reached 0.80 for the second tertile and 0.65 for the third tertile, a downward trend bordering on statistical significance (p for trend = 0.055). While not definitive, these results provide evidence for the hypothesis that the balance between omega-3 and omega-6 fat may play a role in breast cancer.

Alcohol intake and risk of breast cancer: the euramic study

To evaluate the association of alcohol intake with the risk of breast cancer in post-menopausal women, we analyzed the data from an international case-control study conducted in five European countries (FRG, Switzerland, Northern Ireland, the Netherlands and Spain). Information on alcohol intake was available in 315 cases and 364 controls. Medians for the tertiles of alcohol intake among current drinkers were 1.7, 6.0, and 20.0 g/day. Adjusted relative risks (and 95% confidence intervals) of breast cancer for each tertile of intake in current drinkers, compared to never drinkers, were 1.00 (0.60-1.67), 1.01 (0.60-1.73), and 1.18 (0.69-2.03). The adjusted relative risk for ex-drinkers was 1.73 (1.07-2.79). Among both current drinkers and ex-drinkers, the relative risk was higher for those with body mass index above the median compared to those with body mass index below the median. These results do not support a dose-response effect of alcohol on breast cancer risk, although consumption levels were too low to exclude increased risk with high regular intake. Further research is necessary to evaluate the risk of developing breast cancer among ex-drinkers and the potential interaction between body mass index and alcohol drinking.

Lycopene and myocardial infarction risk in the EURAMIC Study

A multicenter case-control study was conducted to evaluate the relations between antioxidant status assessed by biomarkers and acute myocardial infarction. Incidence cases and frequency matched controls were recruited from 10 European countries to maximize the variance in exposure within the study. Adipose tissue needle aspiration biopsies were taken shortly after the infarction and analyzed for levels of carotenoids and tocopherols. An examination of colinearity including all covariates and the three carotenoids, alpha-carotene, beta-carotene, and lycopene, showed that the variables were sufficiently independent to model simultaneously. When examined singularly, each of the carotenoids appeared to be protective. Upon simultaneous analyses of the carotenoids, however, using conditional logistic regression models that controlled for age, body mass index, socioeconomic status, smoking, hypertension, and maternal and paternal history of disease, lycopene remained independently protective, with an odds ratio of 0.52 for the contrast of the 10th and 90th percentiles (95% confidence interval 0.33-0.82, p = 0.005). The associations for alpha- and beta-carotene were largely eliminated. We conclude that lycopene, or some substance highly correlated which is in a common food source, may contribute to the protective effect of vegetable consumption on myocardial infarction risk.

Adipose tissue trans fatty acids and breast cancer in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer

To investigate the relationship between trans fatty acids and postmenopausal breast cancer in European populations differing greatly in their dietary fat intakes, a case control study using adipose tissue stores of trans fatty acids as a biomarker of exposure was conducted. Subjects included 698 postmenopausal incident cases of primary breast cancer and controls randomly drawn from local population and patient registries, ages 50-74 Concentrations of individual trans fatty acids in gluteal fat biopsies were measured in these women. The adipose concentration of trans fatty acids showed a positive association with breast cancer. The covariate-adjusted association with breast cancer. The covariate-adjusted OR was 1.40 (95% confidence interval: 1.02, 1.93) for the difference between the 75th and 25th percentiles of total adipose trans. The adjusted OR for trans in the lowest tertile of polyunsaturated fatty acid reached 3.6 (2.2, 6.1). These associations were not attributable to differences in age, body mass index, exogenous hormone use, or socioeconomic status. These findings suggest an association of adipose stores of trans fatty acids with postmenopausal breast cancer in European women. They require confirmation in other populations, with concomitant consideration of the potential roles of dietary saturated and monounsaturated fats.

DDT (dicophane) and postmenopausal breast cancer in Europe: case-control study

OBJECTIVE

To examine any possible links between exposure to DDE (1,1-dichloro-2,2-bis (p-chlorophenyl)ethylene), the persistent metabolite of the pesticide dicophane (DDT), and breast cancer.

DESIGN

Multicentre study of exposure to DDE by measurement of adipose tissue aspirated from the buttocks. Laboratory measurements were conducted in a single laboratory. Additional data on risk factors for breast cancer were obtained by standard questionnaires.

SETTING

Centres in Germany, the Netherlands, Northern Ireland, Switzerland, and Spain.

SUBJECTS

265 postmenopausal women with breast cancer and 341 controls matched for age and centre.

MAIN OUTCOME MEASURE

Adipose DDE concentrations.

RESULTS

Women with breast cancer had adipose DDE concentrations 9.2% lower than control women. No increased risk of breast cancer was found at higher concentrations. The odds ratio of breast cancer, adjusted for age and centre, for the highest versus the lowest fourth of DDE distribution was 0.73 (95% confidence interval 0.44 to 1.21) and decreased to 0.48 (0.25 to 0.95; P for trend = 0.02) after adjustment for body mass index, age at first birth, and current alcohol drinking. Adjustment for other risk factors did not materially affect these estimates.

CONCLUSIONS

The lower DDE concentrations observed among the women with breast cancer may be secondary to disease inception. This study does not support the hypothesis that DDE increases risk of breast cancer in postmenopausal women in Europe.

Association between toenail selenium and risk of acute myocardial infarction in European men. The EURAMIC Study. European Antioxidant Myocardial Infarction and Breast Cancer

The association between selenium status and risk of acute myocardial infarction was examined in a multicenter case-control study in 10 centers from Europe and Israel in 1991-1992. Selenium in toenails was assessed for 683 nonfatal male cases with first acute myocardial infarction and 729 controls less than 70 years of age. Median toenail selenium content was 0.553 microgram/g for cases and 0.590 microgram/g for controls. After adjustment for age, center, and smoking, the odds ratio for myocardial infarction in the highest quintile of selenium as compared with the lowest was 0.63 (95 percent confidence interval 0.37-1.07, p for trend = 0.08). The observed inverse trend was somewhat stronger when the authors adjusted for vitamin E status (p = 0.05). Analysis stratified for smoking habits showed an inverse association in former smokers (odds ratio for the 75th-25th percentile contrast = 0.63 (95 percent confidence interval 0.43-0.94)), but not in current smokers (odds ratio = 0.97 (0.71-1.32)) or in those who had never smoked (odds ratio = 1.55 (0.87-2.76)). Analysis stratified by center showed a significant inverse association between selenium levels and risk of myocardial infarction for Germany (Berlin) only (75th to 25th percentile odds ratio = 0.62 (95 percent confidence interval 0.42-0.91)), which was the center with the lowest selenium levels. It appears that the increased risk of acute myocardial infarction at low levels of selenium intake is largely explained by cigarette smoking; selenium status does not appear to be an important determinant of risk of myocardial infarction at the levels observed in a large part of Europe.

Tissue antioxidants and postmenopausal breast cancer: the European Community Multicentre Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast (EURAMIC)

Antioxidants may protect against free radical mediated carcinogenesis. Epidemiological studies have not confirmed this hypothesis for breast cancer, possibly because of methodological limitations. Time-integrated exposure of alpha-tocopherol and beta-carotene in adipose tissue, and selenium in toenails was investigated in a case-control study among postmenopausal women, ages 50-74 years, from five European countries. The study group comprised 347 incident breast cancer cases and 374 controls. Mean antioxidant levels, adjusted for age and center, did not significantly differ for alpha-tocopherol (cases were 4.5% higher than controls), beta-carotene (3.0% lower), or selenium (1.8% lower). Odds ratios for highest versus lowest tertiles of exposure, adjusted for potential confounders, were 1.15 (95% confidence interval, 0.75-1.77), 0.74 (0.45-1.23), and 0.96 (0.63-1.47), respectively, without evidence for a decreasing trend. No statistically significant interactions were observed. Moreover, a provisional antioxidant score, indicating whether concentrations were above the median for zero, one, two, or all three antioxidants, yielded odds ratios of 1.00 (reference; all below median), 1.58, 1.58, and 1.21, respectively (chi2 for association = 4.00; P = 0.26). These results do not support the hypothesis that antioxidants are important determinants of this hormone-related malignancy among postmenopausal women.

Pet birds as an independent risk factor for lung cancer: case-control study

OBJECTIVE

To test the hypothesis that exposure to pet birds increases risk of developing lung cancer.

DESIGN

Case-control study. Computerised interviews were used to assess previous exposure to pets and other risk factors for lung cancer.

SETTING

Three major hospitals treating respiratory disease in former West Berlin.

SUBJECTS

All people newly diagnosed as having primary malignant neoplasm of the trachea, bronchi, or lung who were 65 or younger and control subjects matched for age and sex from the general population of former West Berlin. 279 cases and 635 controls qualified for the study; 239 cases and 429 controls participated.

MAIN OUTCOME MEASURES

Odds ratio of developing lung cancer according to whether or not pet birds were kept and the duration of keeping pet birds.

RESULTS

In addition to the risk of lung cancer imposed by smoking, passive smoking, and occupational exposure to carcinogens, an increased relative risk of 2.14 (95% confidence interval 1.35 to 3.40) was found among people exposed to pet birds. The adjusted odds ratio for exposures longer than 10 years was 3.19 (1.48 to 8.21).

CONCLUSIONS

Avian exposure seems to carry a risk of lung cancer. Until the pathogenesis is understood, long term exposure to pet birds in living areas should be avoided, especially among people at high risk of developing lung cancer.