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1. Mental health of individuals with pre-existing mental illnesses at the beginning of the COVID-19 pandemic: results of the German National Cohort (NAKO)

Author: Janine Stein, Alexander Pabst, Klaus Berger, André Karch, Henning Teismann, Fabian Streit, Hans J. Grabe, Rafael Mikolajczyk, Janka Massag, Wolfgang Lieb, Stefanie Castell, Jana-Kristin Heise, Matthias B. Schulze, Sylvia Gastell, Volker Harth, Nadia Obi, Annette Peters, Marie-Theres Huemer, Patricia Bohmann, Michael Leitzmann, Sabine Schipf, Claudia Meinke-Franze, Antje Hebestreit, Daniela C. Fuhr, Karin B. Michels, Stefanie Jaskulski, Hannah Stocker, Lena Koch-Gallenkamp, Stefan N. Willich, Thomas Keil, Markus Löffler, Kerstin Wirkner, Steffi G. Riedel-Heller, and for German National Cohort (NAKO) Consortium
Subjects: COVID-19 pandemic, mental health, depression, anxiety, longitudinal cohort study, German National Cohort (NAKO), Public aspects of medicine, RA1-1270
Abstract: BackgroundThe COVID-19 pandemic prompted a range of studies on mental health, with mixed results. While numerous studies reported worsened conditions in individuals with pre-existing mental disorders, others showed resilience and stability in mental health. However, longitudinal data focusing on the German population are sparse, especially regarding effects of age and pre-existing mental disorders during the early stages of the pandemic.ObjectivesTo assess the interplay between psychiatric history, age, and the timing of the pandemic, with a focus on understanding how these factors relate to the severity of depression and anxiety symptoms.MethodsExploratory analyses were based on 135,445 individuals aged 20–72 years from the German National Cohort (NAKO). Depressive and anxiety symptoms were assessed before and after the first wave of the pandemic. Inferential statistical analyses and negative binomial regression models were calculated.ResultsPersons with a self-reported psychiatric history exhibited comparable levels of depression and anxiety symptom severity after the first wave of the pandemic compared to the time before. In contrast, individuals without a psychiatric history, particularly those in their 20s to 40s, experienced an increase in mental health symptom severity during the first wave of the pandemic.LimitationsAnalyses focuses on the first wave of the pandemic, leaving the long-term mental health effects unexplored.ConclusionFuture research should consider age-specific and mental-health-related factors when addressing global health crises. Additionally, it is important to explore factors influencing resilience and adaptation, aiming to develop targeted interventions and informed policies for effective mental health management during pandemics.
Published: 2024
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2. Large-scale assessment of physical activity in a population using high-resolution hip-worn accelerometry: the German National Cohort (NAKO)

Author: Andrea Weber, Vincent T. van Hees, Michael J. Stein, Sylvia Gastell, Karen Steindorf, Florian Herbolsheimer, Stefan Ostrzinski, Tobias Pischon, Mirko Brandes, Lilian Krist, Michael Marschollek, Karin Halina Greiser, Katharina Nimptsch, Berit Brandes, Carmen Jochem, Anja M. Sedlmeier, Klaus Berger, Hermann Brenner, Christoph Buck, Stefanie Castell, Marcus Dörr, Carina Emmel, Beate Fischer, Claudia Flexeder, Volker Harth, Antje Hebestreit, Jana-Kristin Heise, Bernd Holleczek, Thomas Keil, Lena Koch-Gallenkamp, Wolfgang Lieb, Claudia Meinke-Franze, Karin B. Michels, Rafael Mikolajczyk, Alexander Kluttig, Nadia Obi, Annette Peters, Börge Schmidt, Sabine Schipf, Matthias B. Schulze, Henning Teismann, Sabina Waniek, Stefan N. Willich, Michael F. Leitzmann, and Hansjörg Baurecht
Subjects: Medicine, Science
Abstract: Abstract Large population-based cohort studies utilizing device-based measures of physical activity are crucial to close important research gaps regarding the potential protective effects of physical activity on chronic diseases. The present study details the quality control processes and the derivation of physical activity metrics from 100 Hz accelerometer data collected in the German National Cohort (NAKO). During the 2014 to 2019 baseline assessment, a subsample of NAKO participants wore a triaxial ActiGraph accelerometer on their right hip for seven consecutive days. Auto-calibration, signal feature calculations including Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD), identification of non-wear time, and imputation, were conducted using the R package GGIR version 2.10-3. A total of 73,334 participants contributed data for accelerometry analysis, of whom 63,236 provided valid data. The average ENMO was 11.7 ± 3.7 mg (milli gravitational acceleration) and the average MAD was 19.9 ± 6.1 mg. Notably, acceleration summary metrics were higher in men than women and diminished with increasing age. Work generated in the present study will facilitate harmonized analysis, reproducibility, and utilization of NAKO accelerometry data. The NAKO accelerometry dataset represents a valuable asset for physical activity research and will be accessible through a specified application process.
Published: 2024
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3. Childhood and adolescence factors and multiple sclerosis: results from the German National Cohort (NAKO)

Author: Anja Holz, Nadia Obi, Wolfgang Ahrens, Klaus Berger, Barbara Bohn, Hermann Brenner, Beate Fischer, Julia Fricke, Amand Führer, Sylvia Gastell, Karin Halina Greiser, Volker Harth, Jana-Kristin Heise, Bernd Holleczek, Thomas Keil, Carolina J. Klett-Tammen, Michael Leitzmann, Wolfgang Lieb, Claudia Meinke-Franze, Karin B. Michels, Rafael Mikolajczyk, Katharina Nimptsch, Annette Peters, Tobias Pischon, Oliver Riedel, Tamara Schikowski, Sabine Schipf, Börge Schmidt, Matthias B. Schulze, Andreas Stang, Kerstin Hellwig, Karin Riemann-Lorenz, Christoph Heesen, and Heiko Becher
Subjects: Multiple Sclerosis, Childhood, Adolescence, Epidemiology, Neurology. Diseases of the nervous system, RC346-429
Abstract: Abstract Background Multiple Sclerosis (MS) represents the most common inflammatory neurological disease causing disability in early adulthood. Childhood and adolescence factors might be of relevance in the development of MS. We aimed to investigate the association between various factors (e.g., prematurity, breastfeeding, daycare attendance, weight history) and MS risk. Methods Data from the baseline assessment of the German National Cohort (NAKO) were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between childhood and adolescence factors and risk of MS. Analyses stratified by sex were conducted. Results Among a total of 204,273 participants, 858 reported an MS diagnosis. Male sex was associated with a decreased MS risk (HR 0.48; 95% CI 0.41–0.56), while overweight (HR 2.03; 95% CI 1.41–2.94) and obesity (HR 1.89; 95% CI 1.02–3.48) at 18 years of age compared to normal weight were associated with increased MS risk. Having been breastfed for ≤ 4 months was associated with a decreased MS risk in men (HR 0.59; 95% CI 0.40–0.86) compared to no breastfeeding. No association with MS risk was observed for the remaining factors. Conclusions Apart from overweight and obesity at the age of 18 years, we did not observe considerable associations with MS risk. The proportion of cases that can be explained by childhood and adolescence factors examined in this study was low. Further investigations of the association between the onset of overweight and obesity in childhood and adolescence and its interaction with physical activity and MS risk seem worthwhile.
Published: 2024
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4. Automated image quality assessment for selecting among multiple magnetic resonance image acquisitions in the German National Cohort study

Author: Christopher Schuppert, Susanne Rospleszcz, Jochen G. Hirsch, Daniel C. Hoinkiss, Alexander Köhn, Ricarda von Krüchten, Maximilian F. Russe, Thomas Keil, Lilian Krist, Börge Schmidt, Karin B. Michels, Sabine Schipf, Hermann Brenner, Thomas J. Kröncke, Tobias Pischon, Thoralf Niendorf, Jeanette Schulz-Menger, Michael Forsting, Henry Völzke, Norbert Hosten, Robin Bülow, Maxim Zaitsev, Hans-Ulrich Kauczor, Fabian Bamberg, Matthias Günther, and Christopher L. Schlett
Subjects: Medicine, Science
Abstract: Abstract In magnetic resonance imaging (MRI), the perception of substandard image quality may prompt repetition of the respective image acquisition protocol. Subsequently selecting the preferred high-quality image data from a series of acquisitions can be challenging. An automated workflow may facilitate and improve this selection. We therefore aimed to investigate the applicability of an automated image quality assessment for the prediction of the subjectively preferred image acquisition. Our analysis included data from 11,347 participants with whole-body MRI examinations performed as part of the ongoing prospective multi-center German National Cohort (NAKO) study. Trained radiologic technologists repeated any of the twelve examination protocols due to induced setup errors and/or subjectively unsatisfactory image quality and chose a preferred acquisition from the resultant series. Up to 11 quantitative image quality parameters were automatically derived from all acquisitions. Regularized regression and standard estimates of diagnostic accuracy were calculated. Controlling for setup variations in 2342 series of two or more acquisitions, technologists preferred the repetition over the initial acquisition in 1116 of 1396 series in which the initial setup was retained (79.9%, range across protocols: 73–100%). Image quality parameters then commonly showed statistically significant differences between chosen and discarded acquisitions. In regularized regression across all protocols, ‘structured noise maximum’ was the strongest predictor for the technologists’ choice, followed by ‘N/2 ghosting average’. Combinations of the automatically derived parameters provided an area under the ROC curve between 0.51 and 0.74 for the prediction of the technologists’ choice. It is concluded that automated image quality assessment can, despite considerable performance differences between protocols and anatomical regions, contribute substantially to identifying the subjective preference in a series of MRI acquisitions and thus provide effective decision support to readers.
Published: 2023
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5. Personality and the use of cancer screenings - Results of the German National Cohort

Author: André Hajek, Heiko Becher, Hermann Brenner, Bernd Holleczek, Verena Katzke, Rudolf Kaaks, Heike Minnerup, André Karch, Hansjörg Baurecht, Michael Leitzmann, Annette Peters, Sylvia Gastell, Wolfgang Ahrens, Ulrike Haug, Katharina Nimptsch, Tobias Pischon, Karin B. Michels, Anja Dorrn, Carolina J. Klett-Tammen, Stefanie Castell, Stefan N. Willich, Thomas Keil, Sabine Schipf, Claudia Meinke-Franze, Volker Harth, Nadia Obi, and Hans-Helmut König
Subjects: Cancer screening, Personality, Mammography, Prostate cancer, Health screening, Medicine
Abstract: Objective: To determine the association between personality characteristics and use of different cancer screenings. Methods: We used data from the German National Cohort (NAKO; mean age was 53.0 years (SD: 9.2 years)) – a population-based cohort study. A total of 132,298 individuals were included in the analyses. As outcome measures, we used (self-reported): stool examination for blood (haemoccult test, early detection of bowel cancer), colonoscopy (screening for colorectal cancer), skin examination for moles (early detection of skin cancer), breast palpation by a doctor (early detection of breast cancer), x-ray examination of the breast (“mammography”, early detection of breast cancer), cervical smear test, finger examination of the rectum (early detection of prostate cancer), and blood test for prostate cancer (determination of Prostate-Specific Antigen level). The established Big Five Inventory-SOEP was used to quantify personality factors. It was adjusted for several covariates based on the Andersen model. Unadjusted and adjusted multiple logistic regressions were computed. Results: A higher probability of having a skin examination for moles, for example, was associated with a higher conscientiousness (OR: 1.07, p
Published: 2024
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6. Health Service Use Among Migrants in the German National Cohort—The Role of Birth Region and Language Skills

Author: Christian Wiessner, Sara Licaj, Jens Klein, Barbara Bohn, Tilman Brand, Stefanie Castell, Amand Führer, Volker Harth, Margit Heier, Jana-Kristin Heise, Bernd Holleczek, Stefanie Jaskulski, Carmen Jochem, Lena Koch-Gallenkamp, Lilian Krist, Michael Leitzmann, Wolfgang Lieb, Claudia Meinke-Franze, Rafael Mikolajczyk, Ilais Moreno Velásquez, Nadia Obi, Tobias Pischon, Sabine Schipf, Sigrid Thierry, Stefan N. Willich, Hajo Zeeb, and Heiko Becher
Subjects: migrant health, health service research, mental health, German National Cohort, NAKO, Public aspects of medicine, RA1-1270
Abstract: Objective: To compare health service use (HSU) between migrants and non-migrants in Germany.Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU.Results: In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants.Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed.
Published: 2024
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7. Association of thyroid function with insulin resistance: data from two population-based studies

Author: Dominik Spira, Nikolaus Buchmann, Marcus Dörr, Marcello R P Markus, Matthias Nauck, Sabine Schipf, Joachim Spranger, Ilja Demuth, Elisabeth Steinhagen-Thiessen, Henry Völzke, and Till Ittermann
Subjects: thyroid function, insulin resistance, diabetes, lifespan, age, Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract: Objective: Thyroid dysfunction is associated with relevant disturbances in glucose metabolism. Moreover, thyroid function undergoes important changes with ageing. The objective of this study was to investigate the association of thyroid function with insulin resistance with particular consideration of possible age-related effect modifications. Design: A sample of 4193 participants from two independent epidemiological studies, the Study of Health in Pomerania-TREND-0 and the Berlin Aging Study II, was included in this cross-sectional analysis. Methods: Insulin resistance was estimated by homeostasis model of insulin resistance (HOMA-IR) and the insulin sensitivity index (ISI). Associations of thyroid biomarkers (thyroid-stimulating hormone, free thyroxine, and free triiodothyronine (fT3)) with parameters of glucose metabolism were analysed by regression models adjusted for age, sex, smoking status, and study site. Results: A higher fT3 was significantly associated with higher fasting g lucose and higher fasting and 2-h postload insulin levels, a higher HOMA-IR, and lower ISI. A higher fT3 was also associated with a higher risk for impaired fasting glucose (RR 1.09, 95 CI 1.02; 1.18; P = 0.017). Many of these associations between thyroid markers and parameters of glucose metabolism were significant in young and middle-aged participants but not in older individuals. Conclusions: The main finding of this study was a consistent association of fT3 with almost all markers of insulin resistance. However, this effect s eems to be wearing off in higher age highlighting a potential age-related modification of the interaction between thyroid function and glucose metabolism. Further studies are needed to clarify causal relationships.
Published: 2023
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8. Occupation and SARS-CoV-2 infection risk among 108 960 workers during the first pandemic wave in Germany

Author: Marvin Reuter, Mariann Rigó, Maren Formazin, Falk Liebers, Ute Latza, Stefanie Castell, Karl-Heinz Jöckel, Karin Halina Greiser, Karin B Michels, Gérard Krause, Stefan Albrecht, Ilter Öztürk, Oliver Kuss, Klaus Berger, Benedikt MJ Lampl, Michael Leitzmann, Hajo Zeeb, Karla Romero Starke, Sabine Schipf, Claudia Meinke-Franze, Wolfgang Ahrens, Andreas Seidler, Bianca Klee, Tobias Pischon, Andreas Deckert, Börge Schmidt, Rafael Mikolajczyk, André Karch, Barbara Bohn, Hermann Brenner, Bernd Holleczek, and Nico Dragano
Subjects: cohort study, workplace, germany, covid-19, pandemic, sars-cov-2, infection risk at work, isco-08, kldb 2010, Public aspects of medicine, RA1-1270
Abstract: OBJECTIVE: The aim of this study was to identify the occupational risk for a SARS-CoV-2 infection in a nationwide sample of German workers during the first wave of the COVID-19 pandemic (1 February–31 August 2020). METHODS: We used the data of 108 960 workers who participated in a COVID follow-up survey of the German National Cohort (NAKO). Occupational characteristics were derived from the German Classification of Occupations 2010 (Klassifikation der Berufe 2010). PCR-confirmed SARS-CoV-2 infections were assessed from self-reports. Incidence rates (IR) and incidence rate ratios (IRR) were estimated using robust Poisson regression, adjusted for person-time at risk, age, sex, migration background, study center, working hours, and employment relationship. RESULTS: The IR was 3.7 infections per 1000 workers [95% confidence interval (CI) 3.3–4.1]. IR differed by occupational sector, with the highest rates observed in personal (IR 4.8, 95% CI 4.0–5.6) and business administration (IR 3.4, 95% CI 2.8–3.9) services and the lowest rates in occupations related to the production of goods (IR 2.0, 95% CI 1.5–2.6). Infections were more frequent among essential workers compared with workers in non-essential occupations (IRR 1.95, 95% CI 1.59–2.40) and among highly skilled compared with skilled professions (IRR 1.36, 95% CI 1.07–1.72). CONCLUSIONS: The results emphasize higher infection risks in essential occupations and personal-related services, especially in the healthcare sector. Additionally, we found evidence that infections were more common in higher occupational status positions at the beginning of the pandemic.
Published: 2022
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9. Effects of Apolipoprotein E polymorphism on carotid intima-media thickness, incident myocardial infarction and incident stroke

Author: Anitha Pitchika, Marcello Ricardo Paulista Markus, Sabine Schipf, Alexander Teumer, Sandra Van der Auwera, Matthias Nauck, Marcus Dörr, Stephan Felix, Hans-Jörgen Grabe, Henry Völzke, and Till Ittermann
Subjects: Medicine, Science
Abstract: Abstract The Apolipoprotein E (APOE) gene polymorphism (rs429358 and rs7412) shows a well-established association with lipid profiles, but its effect on cardiovascular disease is still conflicting. Therefore, we examined the association of different APOE alleles with common carotid artery intima-media thickness (CCA-IMT), carotid plaques, incident myocardial infarction (MI) and stroke. We analyzed data from 3327 participants aged 20–79 years of the population-based Study of Health in Pomerania (SHIP) from Northeast Germany with a median follow-up time of 14.5 years. Linear, logistic, and Cox-regression models were used to assess the associations of the APOE polymorphism with CCA-IMT, carotid plaques, incident MI and stroke, respectively. In our study, the APOE E2 allele was associated with lower CCA-IMT at baseline compared to E3 homozygotes (β: − 0.02 [95% CI − 0.04, − 0.004]). Over the follow-up, 244 MI events and 218 stroke events were observed. APOE E2 and E4 allele were not associated with incident MI (E2 HR: 1.06 [95% CI 0.68, 1.66]; E4 HR: 1.03 [95% CI 0.73, 1.45]) and incident stroke (E2 HR: 0.79 [95% CI 0.48, 1.30]; E4 HR: 0.96 [95% CI 0.66, 1.38]) in any of the models adjusting for potential confounders. However, the positive association between CCA-IMT and incident MI was more pronounced in E2 carriers than E3 homozygotes. Thus, our study suggests that while APOE E2 allele may predispose individuals to lower CCA-IMT, E2 carriers may be more prone to MI than E3 homozygotes as the CCA-IMT increases. APOE E4 allele had no effect on CCA-IMT, plaques, MI or stroke.
Published: 2022
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10. Authors' response: Occupation and SARS-CoV-2 infection risk among workers during the first pandemic wave in Germany: potential for bias

Author: Marvin Reuter, Mariann Rigó, Maren Formazin, Falk Liebers, Ute Latza, Stefanie Castell, Karl-Heinz Jöckel, Karin Halina Greiser, Karin B Michels, Gérard Krause, Stefan Albrecht, Ilter Öztürk, Oliver Kuss, Klaus Berger, Benedikt MJ Lampl, Michael Leitzmann, Hajo Zeeb, Karla Romero Starke, Sabine Schipf, Claudia Meinke-Franze, Wolfgang Ahrens, Andreas Seidler, Bianca Klee, Tobias Pischon, Andreas Deckert Andreas Deckert, Börge Schmidt, Rafael Mikolajczyk, André Karch, Barbara Bohn, Hermann Brenner, Bernd Holleczek, and Nico Dragano
Subjects: covid-19, pandemic, sars-cov-2, bias, germany, Public aspects of medicine, RA1-1270
Abstract: We thank van Tongeren et al for responding to our study on occupational disparities in SARS-CoV-2 infection risks during the first pandemic wave in Germany (1). The authors address the potential for bias resulting from differential testing between occupational groups and propose an alternative analytical strategy for dealing with selective testing. In the following, we want to discuss two aspects of this issue, namely (i) the extent and reasons of differential testing in our cohort and (ii) the advantages and disadvantages of different analytical approaches to study risk factors for SARS-CoV-2 infection. Our study relied on nationwide prospective cohort data including more than 100 000 workers in order to compare the incidence of infections between different occupations and occupational status positions. We found elevated infection risks in personal services and business administration, in essential occupations (including health care) and among people in higher occupational status positions (ie, managers and highly skilled workers) during the first pandemic wave in Germany (2). Van Tongeren’s et al main concern is that the correlations found could be affected by a systematic bias because people in healthcare professions get tested more often than employees in other professions. A second argument is that better-off people could be more likely to use testing as they are less affected by direct costs (prices for testing) and the economic hardship associated with a positive test result (eg, loss of earnings in the event of sick leave). We share the authors’ view that differential testing must be considered when analysing and interpreting the data. Thus, in our study, we examined the proportion of tests conducted in each occupational group as part of the sensitivity analyses (see supplementary figure S1, accessible at www.sjweh.fi/article/4037). As expected, testing proportions were exceptionally high in medical occupations (due to employer requirements). However, we did not observe systematic differences among non-medical occupations or when categorising by skill-level or managerial responsibility. This might be explained by several reasons. First, SARS-CoV-2 testing was free of charge during the first pandemic wave in Germany, but reporting a risk contact or having symptoms was a necessary condition for testing ( https://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus.html (accessed 5 September 2022). The newspaper article cited by van Tongeren et al is misleading as it refers to a calendar date after our study period. Second, different motivation for testing due to economic hardship in case of a positive test result is an unlikely explanation, because Germany has a universal healthcare system, including paid sick leave and sickness benefits for all workers (3). Self-employed people carry greater financial risks in case of sickness. We therefore included self-employment in the multivariable analyses to address this potential source of bias. While the observed inverse social gradient may be surprising, it actually matches with findings of ecological studies from Germany (4, 5), the United States (6, 7) as well as Spain, Portugal, Sweden, The Netherlands, Israel, and Hong Kong (8), all of which observed higher infection rates in wealthier neighbourhoods during the initial outbreak phase of the pandemic. One possible explanation is the higher mobility of managers and better educated workers, who are more likely to participate in meetings and engage in business travel and holiday trips like skiing. Given the increasing number of studies providing evidence for this hypothesis, we conclude that the inverse social gradient in our study likely reflects different exposure probabilities and is not a result of systematic bias. This also holds true for the elevated infection risks in essential workers, which is actually corroborated by a large body of research (9–11). Regarding differential likelihood of testing, van Tongeren et al state that “[i]t is relatively simple to address this problem by using a test-negative design” (1). As van Tongeren et al describe, this is a case–control approach only including individuals who were tested (without considering those who were not tested). However, the proposed analytical strategy can lead to another (more serious) selection bias if testing proportions and/or testing criteria differ between groups (12). This can be easily illustrated when comparing the results based on a time-incidence design with those obtained by a test-negative design as shown in table 1 (see PDF). Both approaches show similar results in terms of vertical occupational differences. Infection was more common if individuals had a high skill level or had a managerial position, but associations were stronger in the time-incidence design and did not reach statistical significance in the test-negative design (as indicated by the confidence intervals overlapping “1”). Unfortunately, the test-negative approach relies on a strongly reduced sample size and thus results in greater statistical uncertainty and loss of statistical power (13). In contrast, the test-negative design yields a different picture when estimating the association between essential occupation and infection risk: In this analysis, essential workers did not differ from non-essential workers in their chance of being infected with SARS-CoV-2 (the test-negative design even exhibits a lower chance for essential workers). This is rather counter-intuitive and is not in accordance with what we know about the occupational hazards of healthcare workers during the pandemic (14). The main problem is that proportions of positive tests are highly unreliable when testing proportions and/or testing criteria differ between groups. As essential workers were tested more often without being symptomatic (due to employer requirements), a lower proportion of positive tests in this group does not necessarily correspond to a lower risk of infection. Consequently, we are not convinced that the test-negative design should be the ‘gold standard’ for studying risk factors for SARS-CoV-2 infections (15). Especially problematic is the loss of statistical power (increasing the probability of a type II error) and the low validity of the test-positivity when test criteria and/or test proportions differ between groups. References 1. van Tongeren M, Rhodes S, Pearce N. Occupation and SARS-CoV-2 infection risk among workers during the first pandemic wave in Germany: potential for bias. Scand J Work Environ Health 2022;48(7):586-587. https://doi.org/10.5271/sjweh.4052. 2. Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S, et al. Occupation and SARS-CoV-2 infection risk among 108 960 workers during the first pandemic wave in Germany. Scand J Work Environ Health 2022;48:446–56. https://doi.org/10.5271/sjweh.4037. 3. Busse R, Blümel M, Knieps F, Bärnighausen T. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. Lancet 2017;390:882–97. https://doi.org/10.1016/S0140-6736(17)31280-1. 4. Wachtler B, Michalski N, Nowossadeck E, Diercke M, Wahrendorf M, Santos-Hövener C, et al. Socioeconomic inequalities in the risk of SARS-CoV-2 infection – First results from an analysis of surveillance data from Germany. J Heal Monit 2020;5:18–29. https://doi.org/10.25646/7057. 5. Plümper T, Neumayer E. The pandemic predominantly hits poor neighbourhoods? SARS-CoV-2 infections and COVID-19 fatalities in German districts. Eur J Public Health 2020;30:1176–80. https://doi.org/10.1093/eurpub/ckaa168. 6. Abedi V, Olulana O, Avula V, Chaudhary D, Khan A, Shahjouei S, et al. Racial, Economic, and Health Inequality and COVID-19 Infection in the United States. J Racial Ethn Heal Disparities 2021;8:732–42. https://doi.org/10.1007/s40615-020-00833-4. 7. Mukherji N. The Social and Economic Factors Underlying the Incidence of COVID-19 Cases and Deaths in US Counties During the Initial Outbreak Phase. Rev Reg Stud 2022;52. https://doi.org/10.52324/001c.35255. 8. Beese F, Waldhauer J, Wollgast L, Pförtner T, Wahrendorf M, Haller S, et al. Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic—A Scoping Review. Int J Public Health 2022;67:1–14. https://doi.org/10.3389/ijph.2022.1605128. 9. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C-G, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Heal 2020;5:e475–83. https://doi.org/10.1016/S2468-2667(20)30164-X. 10. Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Ann Intern Med 2020;173:120–36. https://doi.org/10.7326/M20-1632. 11. Stringhini S, Zaballa M-E, Pullen N, de Mestral C, Perez-Saez J, Dumont R, et al. Large variation in anti-SARS-CoV-2 antibody prevalence among essential workers in Geneva, Switzerland. Nat Commun 2021;12:3455. https://doi.org/10.1038/s41467-021-23796-4. 12. Accorsi EK, Qiu X, Rumpler E, Kennedy-Shaffer L, Kahn R, Joshi K, et al. How to detect and reduce potential sources of biases in studies of SARS-CoV-2 and COVID-19. Eur J Epidemiol 2021;36:179–96. https://doi.org/10.1007/s10654-021-00727-7. 13. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Editio. New York: Routledge; 2013. https://doi.org/10.4324/9780203771587. 14. The Lancet. The plight of essential workers during the COVID-19 pandemic. Lancet 2020;395:1587. https://doi.org/10.1016/S0140-6736(20)31200-9. 15. Vandenbroucke JP, Brickley EB, Pearce N, Vandenbroucke-Grauls CMJE. The Evolving Usefulness of the Test-negative Design in Studying Risk Factors for COVID-19. Epidemiology 2022;33:e7–8. https://doi.org/10.1097/EDE.0000000000001438.
Published: 2022
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11. Association of sex-specific differences in lipoprotein(a) concentrations with cardiovascular mortality in individuals with type 2 diabetes mellitus

Author: Marcello Ricardo Paulista Markus, Till Ittermann, Sabine Schipf, Martin Bahls, Matthias Nauck, Henry Völzke, Raul Dias Santos, Annette Peters, Tanja Zeller, Stephan Burkhard Felix, Ramachandran S. Vasan, Barbara Thorand, Elisabeth Steinhagen-Thiessen, and Marcus Dörr
Subjects: Cardiovascular mortality, Dyslipidemia, Lipoprotein(a), Sex-specific, Type 2 diabetes mellitus, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Background Compared to individuals without type 2 diabetes mellitus, the relative increase in cardiovascular mortality is much higher in women than in men in individuals with type 2 diabetes mellitus. Methods We evaluated data from 7443 individuals (3792 women, 50.9%), aged 20 to 81 years, from two independent population-based investigations, SHIP-0 and MONICA/KORA S3. We analyzed the longitudinal sex-specific associations of lipoprotein(a) with cardiovascular mortality in individuals with and without type 2 diabetes mellitus using Cox regression. Results During a median follow-up of 20.5 years (136,802 person-years), 657 participants (404 men and 253 women) died of cardiovascular causes. Among individuals without type 2 diabetes mellitus, men had a significantly higher risk for cardiovascular mortality compared to women in unadjusted model and after adjustment. On the other hand, in participants with type 2 diabetes mellitus, the risk for cardiovascular mortality was not different between men and women in the unadjusted model and after adjustment for age, body mass index, low-density lipoprotein-cholesterol, fasting status and study sample (SHIP-0, MONICA/KORA S3). Further adjustment for lipoprotein(a) concentrations had no impact on the hazard ratio (HR) for cardiovascular mortality comparing men versus women in individuals without type 2 diabetes mellitus [HR: 1.94; 95% confidence interval (CI) 1.63 to 2.32; p
Published: 2021
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12. Association of hepatic steatosis derived from ultrasound and quantitative MRI with prediabetes in the general population

Author: Muhammad Naeem, Robin Bülow, Sabine Schipf, Nicole Werner, Marcus Dörr, Markus M. Lerch, Jens-Peter Kühn, Wolfgang Rathmann, Matthias Nauck, Marcello Ricardo Paulista Markus, Till Ittermann, and Henry Völzke
Subjects: Medicine, Science
Abstract: Abstract The aim of our study was to investigate the association of hepatic steatosis derived from quantitative ultrasound and magnetic resonance imaging (MRI) with prediabetes in a large population-based study conducted in Northeast Germany. Hepatic steatosis was assessed through transabdominal ultrasound and quantitative MRI. For analysis we included 1622 subjects with MRI who participated in an oral glucose tolerance test and reported no known type 2 diabetes mellitus (T2DM). We classified participants as proposed by the American Diabetes Association: isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT), and undiagnosed T2DM. Regression models were adjusted for age, sex body mass index and alcohol consumption. We observed positive associations of hepatic steatosis with glycated hemoglobin, fasting glucose and insulin, 2-h glucose and insulin, as well as homeostasis model assessment-insulin resistance index. Similarly, individuals having hepatic steatosis as defined by MRI had a higher relative risk ratio (RR) to be in the prediabetes groups i-IFG (RR = 1.6; 95% confidence interval (CI) 1.2; 2.2), i-IGT (RR = 3.3, 95% CI 2.0; 5.6) and IFG + IGT (RR = 2.5, 95% CI 1.6; 3.9) or to have undiagnosed T2DM (RR = 4.8, 95% CI 2.6; 9.0). All associations were attenuated when defining hepatic steatosis by ultrasound. Hepatic steatosis is associated with prediabetes and undiagnosed T2DM in the general population. Quantitative liver MRI revealed stronger associations with prediabetes and undiagnosed T2DM compared to ultrasound, which indicates the higher sensitivity and specificity of MRI to determine hepatic steatosis.
Published: 2021
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13. Laser-Based 3D Body Scanning Reveals a Higher Prevalence of Abdominal Obesity than Tape Measurements: Results from a Population-Based Sample

Author: Robert P. Kosilek, Till Ittermann, Dörte Radke, Sabine Schipf, Matthias Nauck, Nele Friedrich, and Henry Völzke
Subjects: metabolic syndrome, obesity, anthropometry, body weights and measures, diagnostic techniques and procedures, Medicine (General), R5-920
Abstract: Background: The global obesity epidemic is a major public health concern, and accurate diagnosis is essential for identifying at-risk individuals. Three-dimensional (3D) body scanning technology offers several advantages over the standard practice of tape measurements for diagnosing obesity. This study was conducted to validate body scan data from a German population-based cohort and explore clinical implications of this technology in the context of metabolic syndrome. Methods: We performed a cross-sectional analysis of 354 participants from the Study of Health in Pomerania that completed a 3D body scanning examination. The agreement of anthropometric data obtained from 3D body scanning with manual tape measurements was analyzed using correlation analysis and Bland–Altman plots. Classification agreement regarding abdominal obesity based on IDF guidelines was assessed using Cohen’s kappa. The association of body scan measures with metabolic syndrome components was explored using correlation analysis. Results: Three-dimensional body scanning showed excellent validity with slightly larger values that presumably reflect the true circumferences more accurately. Metabolic syndrome was highly prevalent in the sample (31%) and showed strong associations with central obesity. Using body scan vs. tape measurements of waist circumference for classification resulted in a 16% relative increase in the prevalence of abdominal obesity (61.3% vs. 52.8%). Conclusions: These results suggest that the prevalence of obesity may be underestimated using the standard method of tape measurements, highlighting the need for more accurate approaches.
Published: 2023
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14. Glucose and insulin levels are associated with arterial stiffness and concentric remodeling of the heart

Author: Marcello Ricardo Paulista Markus, Susanne Rospleszcz, Till Ittermann, Sebastian Edgar Baumeister, Sabine Schipf, Ulrike Siewert-Markus, Roberto Lorbeer, Corinna Storz, Violetta Ptushkina, Annette Peters, Christa Meisinger, Fabian Bamberg, Matthias Nauck, Martin Bahls, Henry Völzke, Stephan Burkhard Felix, Robin Bülow, Wolfgang Rathmann, and Marcus Dörr
Subjects: Arterial stiffness, Concentric remodeling, Diabetes mellitus, Insulin resistance, Prediabetes, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Background Mortality attributable to heart failure remains high. The prevalence of heart failure in patients with diabetes mellitus ranges from 19 to 26%. It is estimated that up to 21.1 million adults in the United States have diagnosed diabetes mellitus and around 80.8 million have impaired fasting glucose. We investigated the associations of fasting glucose (FG) and fasting insulin (FI), the homeostasis model assessment-insulin resistance index (HOMA-IR) and 2-h postload glucose (2HG) and insulin (2HI) with parameters of left ventricular geometry and function and arterial stiffness determined by magnetic resonance imaging in individuals without diagnosed type 2 diabetes. Methods Cross-sectional analyses of 1001 individuals (453 women, 45.3%), aged 21 to 80 years, from two independent population-based studies, the Study of Health in Pomerania (SHIP-TREND-0) and KORA FF4 Study. FG, FI, HOMA-IR, 2HG and 2HI, as well as glucose tolerance categories, were analyzed for associations with heart and arterial parameters using multivariable-adjusted linear regression models. Results In total, 390 individuals (39%) had prediabetes (isolated impaired fasting glucose, isolated glucose tolerance or both), and 49 (4.9%) were found to have unknown type 2 diabetes. In the multivariable-adjusted analysis, positive linear associations of FG, FI, HOMA-IR, 2HG and 2HI with arterial stiffness index and left ventricular wall-thickness and concentricity and inverse linear associations with left ventricular end-diastolic volume were observed. A 1 mmol/l higher FG was associated with a 1.18 ml/m2.7 (1.80 to 0.57; p
Published: 2019
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15. Educational Level, but Not Income or Area Deprivation, is Related to Macrovascular Disease: Results From Two Population-Based Cohorts in Germany

Author: Violetta Ptushkina, Esther Seidel-Jacobs, Werner Maier, Sabine Schipf, Henry Völzke, Marcello Ricardo Paulista Markus, Matthias Nauck, Christa Meisinger, Annette Peters, Christian Herder, Lars Schwettmann, Marcus Dörr, Stephan B. Felix, Michael Roden, and Wolfgang Rathmann
Subjects: macrovascular disease, education, income, area deprivation, population-based studies, Public aspects of medicine, RA1-1270
Abstract: Objectives: An inverse relationship between education and cardiovascular risk has been described, however, the combined association of education, income, and neighborhood socioeconomic status with macrovascular disease is less clear. The aim of this study was to evaluate the association of educational level, equivalent household income and area deprivation with macrovascular disease in Germany.Methods: Cross-sectional data from two representative German population-based studies, SHIP-TREND (n = 3,731) and KORA-F4 (n = 2,870), were analyzed. Multivariable logistic regression models were applied to estimate odds ratios and 95% confidence intervals for the association between socioeconomic determinants and macrovascular disease (defined as self-reported myocardial infarction or stroke).Results: The study showed a higher odds of prevalent macrovascular disease in men with low and middle educational level compared to men with high education. Area deprivation and equivalent income were not related to myocardial infarction or stroke in any of the models.Conclusion: Educational level, but not income or area deprivation, is significantly related to the macrovascular disease in men. Effective prevention of macrovascular disease should therefore start with investing in individual education.
Published: 2021
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16. Herpes zoster incidence in Germany - an indirect validation study for self-reported disease data from pretest studies of the population-based German National Cohort

Author: Mahrrouz Caputo, Johannes Horn, André Karch, Manas K. Akmatov, Heiko Becher, Bettina Braun, Hermann Brenner, Stefanie Castell, Beate Fischer, Guido Giani, Kathrin Günther, Barbara Hoffmann, Karl-Heinz Jöckel, Thomas Keil, Birgit Klüppelholz, Lilian Krist, Michael F. Leitzmann, Wolfgang Lieb, Jakob Linseisen, Christa Meisinger, Susanne Moebus, Nadia Obi, Tobias Pischon, Sabine Schipf, Börge Schmidt, Claudia Sievers, Astrid Steinbrecher, Henry Völzke, and Rafael Mikolajczyk
Subjects: German National Cohort, Incidence, Self-reports, Validity, Herpes zoster, Postherpetic neuralgia, Infectious and parasitic diseases, RC109-216
Abstract: Abstract Background Until now, herpes zoster (HZ)-related disease burden in Germany has been estimated based on health insurance data and clinical findings. However, the validity of self-reported HZ is unclear. This study investigated the validity of self-reported herpes zoster (HZ) and its complication postherpetic neuralgia (PHN) using data from the pretest studies of the German National Cohort (GNC) in comparison with estimates based on health insurance data. Methods Data of 4751 participants aged between 20 and 69 years from two pretest studies of the GNC carried out in 2011 and 2012 were used. Based on self-reports of physician-diagnosed HZ and PHN, age- and sex-specific HZ incidence rates and PHN proportions were estimated. For comparison, estimates based on statutory health insurance data from the German population were considered. Results Eleven percent (95%-CI, 10.4 to 12.3, n = 539) of the participants reported at least one HZ episode in their lifetime. Our estimated age-specific HZ incidence rates were lower than previous estimates based on statutory health insurance data. The PHN proportion in participants older than 50 years was 5.9% (1.9 to 13.9%), which was in line with estimates based on health insurance data. Conclusion As age- and sex-specific patterns were comparable with that in health insurance data, self-reported diagnosis of HZ seems to be a valid instrument for overall disease trends. Possible reasons for observed differences in incidence rates are recall bias in self-reported data or overestimation in health insurance data.
Published: 2019
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17. Regional differences of macrovascular disease in Northeast and South Germany: the population-based SHIP-TREND and KORA-F4 studies

Author: Violetta Ptushkina, Esther Jacobs, Sabine Schipf, Henry Völzke, Marcello Ricardo Paulista Markus, Matthias Nauck, Christa Meisinger, Annette Peters, Werner Maier, Christian Herder, Michael Roden, and Wolfgang Rathmann
Subjects: Type 2 diabetes, Macrovascular disease, Regional differences, Prevalence, Population-based studies, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Previous studies found regional differences in the prevalence and incidence of type 2 diabetes between Northeast and South of Germany. The aim of this study was to investigate if regional variations are also present for macrovascular disease in people with type 2 diabetes and in the general population. A further aim was to investigate if traditional risk factors of macrovascular complications can explain these regional variations. Methods Data of persons aged 30–79 from two regional population-based studies, SHIP-TREND (Northeast Germany, 2008–2012, n = 2539) and KORA-F4 (South Germany, 2006–2008, n = 2932), were analysed. Macrovascular disease was defined by self-reported previous myocardial infarction, stroke or coronary angiography. Multivariable logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI) for prevalence of macrovascular disease in persons with type 2 diabetes and in the general population. Results The prevalence of macrovascular disease in persons with type 2 diabetes and in the general population was considerably higher in the Northeast (SHIP-TREND: 32.8 and 12.0%) than in the South of Germany (KORA-F4: 24.9 and 8.8%), respectively. The odds of macrovascular disease in persons with type 2 diabetes was 1.66 (95% CI: 1.11–2.49) in the Northeast in comparison to the South after adjustment for sex, age, body mass index, hypertension, hyperlipidemia and smoking. In the general population, SHIP-TREND participants also had a significantly increased odds of macrovascular disease compared to KORA-F4 participants (OR = 1.63, 95% CI: 1.33–2.00). After excluding coronary angiography (myocardial infarction or stroke only), the ORs for region decreased in all models, but the difference between SHIP-TREND and KORA-F4 participants was still significant in the age- and sex-adjusted model for the general population (OR = 1.34, 95% CI: 1.01–1.78). Conclusions This study provides an indication for regional differences in macrovascular disease, which is not explained by traditional risk factors. Further examinations of other risk factors, such as regional deprivation or geographical variations in medical care services are needed.
Published: 2018
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18. Erratum: Large meta-analysis of genome-wide association studies identifies five loci for lean body mass

Author: M. Carola Zillikens, Serkalem Demissie, Yi-Hsiang Hsu, Laura M. Yerges-Armstrong, Wen-Chi Chou, Lisette Stolk, Gregory Livshits, Linda Broer, Toby Johnson, Daniel L. Koller, Zoltán Kutalik, Jian’an Luan, Ida Malkin, Janina S. Ried, Albert V. Smith, Gudmar Thorleifsson, Liesbeth Vandenput, Jing Hua Zhao, Weihua Zhang, Ali Aghdassi, Kristina Åkesson, Najaf Amin, Leslie J. Baier, Inês Barroso, David A. Bennett, Lars Bertram, Rainer Biffar, Murielle Bochud, Michael Boehnke, Ingrid B. Borecki, Aron S. Buchman, Liisa Byberg, Harry Campbell, Natalia Campos Obanda, Jane A. Cauley, Peggy M. Cawthon, Henna Cederberg, Zhao Chen, Nam H. Cho, Hyung Jin Choi, Melina Claussnitzer, Francis Collins, Steven R. Cummings, Philip L. De Jager, Ilja Demuth, Rosalie A. M. Dhonukshe-Rutten, Luda Diatchenko, Gudny Eiriksdottir, Anke W. Enneman, Mike Erdos, Johan G. Eriksson, Joel Eriksson, Karol Estrada, Daniel S. Evans, Mary F. Feitosa, Mao Fu, Melissa Garcia, Christian Gieger, Thomas Girke, Nicole L. Glazer, Harald Grallert, Jagvir Grewal, Bok-Ghee Han, Robert L. Hanson, Caroline Hayward, Albert Hofman, Eric P. Hoffman, Georg Homuth, Wen-Chi Hsueh, Monica J. Hubal, Alan Hubbard, Kim M. Huffman, Lise B. Husted, Thomas Illig, Erik Ingelsson, Till Ittermann, John-Olov Jansson, Joanne M. Jordan, Antti Jula, Magnus Karlsson, Kay-Tee Khaw, Tuomas O. Kilpeläinen, Norman Klopp, Jacqueline S. L. Kloth, Heikki A. Koistinen, William E. Kraus, Stephen Kritchevsky, Teemu Kuulasmaa, Johanna Kuusisto, Markku Laakso, Jari Lahti, Thomas Lang, Bente L. Langdahl, Lenore J. Launer, Jong-Young Lee, Markus M. Lerch, Joshua R. Lewis, Lars Lind, Cecilia Lindgren, Yongmei Liu, Tian Liu, Youfang Liu, Östen Ljunggren, Mattias Lorentzon, Robert N. Luben, William Maixner, Fiona E. McGuigan, Carolina Medina-Gomez, Thomas Meitinger, Håkan Melhus, Dan Mellström, Simon Melov, Karl Michaëlsson, Braxton D. Mitchell, Andrew P. Morris, Leif Mosekilde, Anne Newman, Carrie M. Nielson, Jeffrey R. O’Connell, Ben A. Oostra, Eric S. Orwoll, Aarno Palotie, Stephen C. J. Parker, Munro Peacock, Markus Perola, Annette Peters, Ozren Polasek, Richard L. Prince, Katri Räikkönen, Stuart H. Ralston, Samuli Ripatti, John A. Robbins, Jerome I. Rotter, Igor Rudan, Veikko Salomaa, Suzanne Satterfield, Eric E. Schadt, Sabine Schipf, Laura Scott, Joban Sehmi, Jian Shen, Chan Soo Shin, Gunnar Sigurdsson, Shad Smith, Nicole Soranzo, Alena Stančáková, Elisabeth Steinhagen-Thiessen, Elizabeth A. Streeten, Unnur Styrkarsdottir, Karin M. A. Swart, Sian-Tsung Tan, Mark A. Tarnopolsky, Patricia Thompson, Cynthia A. Thomson, Unnur Thorsteinsdottir, Emmi Tikkanen, Gregory J. Tranah, Jaakko Tuomilehto, Natasja M. van Schoor, Arjun Verma, Peter Vollenweider, Henry Völzke, Jean Wactawski-Wende, Mark Walker, Michael N. Weedon, Ryan Welch, H.-Erich Wichmann, Elisabeth Widen, Frances M. K. Williams, James F. Wilson, Nicole C. Wright, Weijia Xie, Lei Yu, Yanhua Zhou, John C. Chambers, Angela Döring, Cornelia M. van Duijn, Michael J. Econs, Vilmundur Gudnason, Jaspal S. Kooner, Bruce M. Psaty, Timothy D. Spector, Kari Stefansson, Fernando Rivadeneira, André G. Uitterlinden, Nicholas J. Wareham, Vicky Ossowski, Dawn Waterworth, Ruth J. F. Loos, David Karasik, Tamara B. Harris, Claes Ohlsson, and Douglas P. Kiel
Subjects: Science
Abstract: A correction to this article has been published and is linked from the HTML version of this article.
Published: 2017
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19. Large meta-analysis of genome-wide association studies identifies five loci for lean body mass

Author: M. Carola Zillikens, Serkalem Demissie, Yi-Hsiang Hsu, Laura M. Yerges-Armstrong, Wen-Chi Chou, Lisette Stolk, Gregory Livshits, Linda Broer, Toby Johnson, Daniel L. Koller, Zoltán Kutalik, Jian’an Luan, Ida Malkin, Janina S. Ried, Albert V. Smith, Gudmar Thorleifsson, Liesbeth Vandenput, Jing Hua Zhao, Weihua Zhang, Ali Aghdassi, Kristina Åkesson, Najaf Amin, Leslie J. Baier, Inês Barroso, David A. Bennett, Lars Bertram, Rainer Biffar, Murielle Bochud, Michael Boehnke, Ingrid B. Borecki, Aron S. Buchman, Liisa Byberg, Harry Campbell, Natalia Campos Obanda, Jane A. Cauley, Peggy M. Cawthon, Henna Cederberg, Zhao Chen, Nam H. Cho, Hyung Jin Choi, Melina Claussnitzer, Francis Collins, Steven R. Cummings, Philip L. De Jager, Ilja Demuth, Rosalie A. M. Dhonukshe-Rutten, Luda Diatchenko, Gudny Eiriksdottir, Anke W. Enneman, Mike Erdos, Johan G. Eriksson, Joel Eriksson, Karol Estrada, Daniel S. Evans, Mary F. Feitosa, Mao Fu, Melissa Garcia, Christian Gieger, Thomas Girke, Nicole L. Glazer, Harald Grallert, Jagvir Grewal, Bok-Ghee Han, Robert L. Hanson, Caroline Hayward, Albert Hofman, Eric P. Hoffman, Georg Homuth, Wen-Chi Hsueh, Monica J. Hubal, Alan Hubbard, Kim M. Huffman, Lise B. Husted, Thomas Illig, Erik Ingelsson, Till Ittermann, John-Olov Jansson, Joanne M. Jordan, Antti Jula, Magnus Karlsson, Kay-Tee Khaw, Tuomas O. Kilpeläinen, Norman Klopp, Jacqueline S. L. Kloth, Heikki A. Koistinen, William E. Kraus, Stephen Kritchevsky, Teemu Kuulasmaa, Johanna Kuusisto, Markku Laakso, Jari Lahti, Thomas Lang, Bente L. Langdahl, Lenore J. Launer, Jong-Young Lee, Markus M. Lerch, Joshua R. Lewis, Lars Lind, Cecilia Lindgren, Yongmei Liu, Tian Liu, Youfang Liu, Östen Ljunggren, Mattias Lorentzon, Robert N. Luben, William Maixner, Fiona E. McGuigan, Carolina Medina-Gomez, Thomas Meitinger, Håkan Melhus, Dan Mellström, Simon Melov, Karl Michaëlsson, Braxton D. Mitchell, Andrew P. Morris, Leif Mosekilde, Anne Newman, Carrie M. Nielson, Jeffrey R. O’Connell, Ben A. Oostra, Eric S. Orwoll, Aarno Palotie, Stephen C. J. Parker, Munro Peacock, Markus Perola, Annette Peters, Ozren Polasek, Richard L. Prince, Katri Räikkönen, Stuart H. Ralston, Samuli Ripatti, John A. Robbins, Jerome I. Rotter, Igor Rudan, Veikko Salomaa, Suzanne Satterfield, Eric E. Schadt, Sabine Schipf, Laura Scott, Joban Sehmi, Jian Shen, Chan Soo Shin, Gunnar Sigurdsson, Shad Smith, Nicole Soranzo, Alena Stančáková, Elisabeth Steinhagen-Thiessen, Elizabeth A. Streeten, Unnur Styrkarsdottir, Karin M. A. Swart, Sian-Tsung Tan, Mark A. Tarnopolsky, Patricia Thompson, Cynthia A. Thomson, Unnur Thorsteinsdottir, Emmi Tikkanen, Gregory J. Tranah, Jaakko Tuomilehto, Natasja M. van Schoor, Arjun Verma, Peter Vollenweider, Henry Völzke, Jean Wactawski-Wende, Mark Walker, Michael N. Weedon, Ryan Welch, H.-Erich Wichmann, Elisabeth Widen, Frances M. K. Williams, James F. Wilson, Nicole C. Wright, Weijia Xie, Lei Yu, Yanhua Zhou, John C. Chambers, Angela Döring, Cornelia M. van Duijn, Michael J. Econs, Vilmundur Gudnason, Jaspal S. Kooner, Bruce M. Psaty, Timothy D. Spector, Kari Stefansson, Fernando Rivadeneira, André G. Uitterlinden, Nicholas J. Wareham, Vicky Ossowski, Dawn Waterworth, Ruth J. F. Loos, David Karasik, Tamara B. Harris, Claes Ohlsson, and Douglas P. Kiel
Subjects: Science
Abstract: Lean body mass is a highly heritable trait and is associated with various health conditions. Here, Kiel and colleagues perform a meta-analysis of genome-wide association studies for whole body lean body mass and find five novel genetic loci to be significantly associated.
Published: 2017
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20. Association between hepatic iron overload assessed by magnetic resonance imaging and glucose intolerance states in the general population

Author: Muhammad Naeem, Sabine Schipf, Robin Bülow, Nicole Werner, Marcus Dörr, Markus M. Lerch, Jens-Peter Kühn, Wolfgang Rathmann, Matthias Nauck, Marcello Ricardo Paulista Markus, Giovanni Targher, Till Ittermann, and Henry Völzke
Subjects: Blood Glucose, Hepatic iron overload, Iron Overload, Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Medicine (miscellaneous), Fasting, Magnetic Resonance Imaging, Prediabetic State, Glucose, Diabetes Mellitus, Type 2, Glucose Intolerance, Diabetes Mellitus, Humans, Cardiology and Cardiovascular Medicine, Prediabetes, Biomarkers, Type 2, MRI
Abstract: While there is evidence that iron overload disorders are associated with type 2 diabetes, the relationship between hepatic iron overload and prediabetes remains unclear. We aimed to investigate the association between hepatic iron overload, as assessed by magnetic resonance imaging (MRI), and different glucose intolerance states in the population-based Study.We included data from 1622 individuals with MRI data, who did not have known type 2 diabetes (T2DM). Using an oral glucose tolerance testing, participants were classified as having isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT) or previously unknown T2DM. Hepatic iron and fat contents were assessed through quantitative MRI. We undertook linear and multinomial logistic regression models adjusted for potential confounders and MRI-assessed hepatic fat content to examine the association of hepatic iron overload with different glucose intolerance states or continuous markers of glucose metabolism. MRI-assessed hepatic iron overload was positively associated only with both 2-h plasma glucose (β = 0.32; 95%CI 0.04-0.60) and the combined IFG + IGT category (relative risk ratio = 1.87; 95%CI 1.15-3.06). No significant associations were found between hepatic iron overload and other glucose intolerance states or biomarkers of glucose metabolism, independently of potential confounders.MRI-assessed hepatic iron overload was associated with higher 2-h glucose concentrations and the combined IFG + IGT category, but not with other glucose intolerance states. Our findings suggest a weak adverse impact of hepatic iron overload on glucose metabolism, but further studies are needed to confirm these findings.
Published: 2022
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21. Changes in Waist Circumference among German Adults over Time - Compiling Results of Seven Prospective Cohort Studies

Author: Marjolein Haftenberger, Gert B.M. Mensink, Susanne Vogt, Barbara Thorand, Annette Peters, Beatrice Herzog, Saskia Hartwig, Karin Halina Greiser, Till Ittermann, Sabine Schipf, Henry Völzke, Benedikt Merz, Ute Nöthlings, Manja Koch, Jasmine Neamat-Allah, Verena Katzke, Rudolf Kaaks, Heiner Boeing, Ursula Bachlechner, Christa Scheidt-Nave, and Anja Schienkiewitz
Subjects: Waist circumference, Central obesity, Prospective cohort studies, Germany, Population-based, Nutrition. Foods and food supply, TX341-641, Nutritional diseases. Deficiency diseases, RC620-627
Abstract: Aim: This study aims to quantify longitudinal changes in waist circumference (WC) among adults aged 45-64 years in Germany. Methods: Data of 15,444 men and 17,207 women from one nationwide and six regional prospective German cohort studies were analyzed. The sex-specific mean change in WC per year of follow-up was assessed for each study separately. Findings from the cohort-by-cohort analysis were combined by applying meta-analytic methods. Progression to central obesity (WC ≥ 102 cm in men and ≥ 88 cm in women) within a standardized period of 10 years was described for each study. Results: The estimated mean change in WC per year of follow-up for all cohorts combined was 0.53 (95% confidence interval 0.29-0.76) cm/year for men and 0.63 (0.48-0.77) cm/year for women, but varied between the included studies. Within 10 years, about 20% of individuals with low WC (Conclusion: The increase in mean WC with aging along with a profound increase of central adiposity is obviously and may have several adverse health effects. Obesity prevention programs should also focus on abdominal obesity.
Published: 2016
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22. Low cardiopulmonary fitness is associated with higher liver fat content and higher <scp>gamma‐glutamyltransferase</scp> concentrations in the general population – 'The Sedentary’s Liver'

Author: Ines Zinterl, Till Ittermann, Sabine Schipf, Stefan Gross, Henryke Anspieler, Simon Kim, Ralf Ewert, Robin Bülow, Jens‐Peter Kühn, Markus M. Lerch, Henry Völzke, Stephan Burkhard Felix, Martin Bahls, Giovanni Targher, Marcus Dörr, and Marcello Ricardo Paulista Markus
Subjects: Adult, Male, cardiorespiratory fitness, Hepatology, MRI-proton-density-fat-fraction (PDFF), gamma-Glutamyltransferase, fat-free mass, Fatty Liver, Cross-Sectional Studies, Liver, NAFLD, Humans, Female, peak oxygen uptake, Exercise, liver fat content
Abstract: We investigated the association between low cardiorespiratory fitness and liver fat content (LFC) in the general population.We evaluated data from 2151 adults (51.1% women) from two population-based cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analysed the cross-sectional associations of peak oxygen uptake (VOWe observed significant inverse associations of VOLower VO
Published: 2022
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23. Grip strength values and cut-off points based on over 200,000 adults of the German National Cohort - a comparison to the EWGSOP2 cut-off points

Author: Marie-Theres Huemer, Alexander Kluttig, Beate Fischer, Wolfgang Ahrens, Stefanie Castell, Nina Ebert, Sylvia Gastell, Karl-Heinz Jöckel, Rudolf Kaaks, André Karch, Thomas Keil, Yvonne Kemmling, Lilian Krist, Michael Leitzmann, Wolfgang Lieb, Claudia Meinke-Franze, Karin B Michels, Rafael Mikolajczyk, Ilais Moreno Velásquez, Tobias Pischon, Sabine Schipf, Börge Schmidt, Ben Schöttker, Matthias B Schulze, Hannah Stocker, Henning Teismann, Kerstin Wirkner, Michael Drey, Annette Peters, and Barbara Thorand
Subjects: Aging, Cardiovascular and Metabolic Diseases, mortality, cut-off points, probable sarcopenia, grip strength, European Working Group on Sarcopenia in Older People (EWGSOP), General Medicine, Geriatrics and Gerontology
Abstract: Background The European Working Group on Sarcopenia in Older People (EWGSOP) updated in 2018 the cut-off points for low grip strength to assess sarcopenia based on pooled data from 12 British studies. Objective Comparison of the EWGSOP2 cut-off points for low grip strength to those derived from a large German sample. Methods We assessed the grip strength distribution across age and derived low grip strength cut-off points for men and women (peak mean -2.5 × SD) based on 200,389 German National Cohort (NAKO) participants aged 19–75 years. In 1,012 Cooperative Health Research in the Region of Augsburg (KORA)-Age participants aged 65–93 years, we calculated the age-standardised prevalence of low grip strength and time-dependent sensitivity and specificity for all-cause mortality. Results Grip strength increased in the third and fourth decade of life and declined afterwards. Calculated cut-off points for low grip strength were 29 kg for men and 18 kg for women. In KORA-Age, the age-standardised prevalence of low grip strength was 1.5× higher for NAKO-derived (17.7%) compared to EWGSOP2 (11.7%) cut-off points. NAKO-derived cut-off points yielded a higher sensitivity and lower specificity for all-cause mortality. Conclusions Cut-off points for low grip strength from German population-based data were 2 kg higher than the EWGSOP2 cut-off points. Higher cut-off points increase the sensitivity, thereby suggesting an intervention for more patients at risk, while other individuals might receive additional diagnostics/treatment without the urgent need. Research on the effectiveness of intervention in patients with low grip strength defined by different cut-off points is needed.
Published: 2023
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24. Regional differences in antihyperglycemic medication are not explained by individual socioeconomic status, regional deprivation, and regional health care services. Observational results from the German DIAB-CORE consortium.

Author: Christina Bächle, Heiner Claessen, Werner Maier, Teresa Tamayo, Michaela Schunk, Ina-Maria Rückert-Eheberg, Rolf Holle, Christa Meisinger, Susanne Moebus, Karl-Heinz Jöckel, Sabine Schipf, Henry Völzke, Saskia Hartwig, Alexander Kluttig, Lars Kroll, Ute Linnenkamp, and Andrea Icks
Subjects: Medicine, Science
Abstract: This population-based study sought to extend knowledge on factors explaining regional differences in type 2 diabetes mellitus medication patterns in Germany.Individual baseline and follow-up data from four regional population-based German cohort studies (SHIP [northeast], CARLA [east], HNR [west], KORA [south]) conducted between 1997 and 2010 were pooled and merged with both data on regional deprivation and regional health care services. To analyze regional differences in any or newer anti-hyperglycemic medication, medication prevalence ratios (PRs) were estimated using multivariable Poisson regression models with a robust error variance adjusted gradually for individual and regional variables.The study population consisted of 1,437 people aged 45 to 74 years at baseline, (corresponding to 49 to 83 years at follow-up) with self-reported type 2 diabetes. The prevalence of receiving any anti-hyperglycemic medication was 16% higher in KORA (PR 1.16 [1.08-1.25]), 10% higher in CARLA (1.10 [1.01-1.18]), and 7% higher in SHIP (PR 1.07 [1.00-1.15]) than in HNR. The prevalence of receiving newer anti-hyperglycemic medication was 49% higher in KORA (1.49 [1.09-2.05]), 41% higher in CARLA (1.41 [1.02-1.96]) and 1% higher in SHIP (1.01 [0.72-1.41]) than in HNR, respectively. After gradual adjustment for individual variables, regional deprivation and health care services, the effects only changed slightly.Neither comprehensive individual factors including socioeconomic status nor regional deprivation or indicators of regional health care services were able to sufficiently explain regional differences in anti-hyperglycemic treatment in Germany. To understand the underlying causes, further research is needed.
Published: 2018
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25. Longitudinal change in health-related quality of life in people with prevalent and incident type 2 diabetes compared to diabetes-free controls.

Author: Michaela Schunk, Peter Reitmeir, Ina-Maria Rückert-Eheberg, Teresa Tamayo, Sabine Schipf, Christa Meisinger, Annette Peters, Christa Scheidt-Nave, Ute Ellert, Saskia Hartwig, Alexander Kluttig, Henry Völzke, and Rolf Holle
Subjects: Medicine, Science
Abstract: The objective of this analysis is to compare people with prevalent type 2 diabetes, incident type 2 diabetes and without diabetes with respect to longitudinal change in health-related quality of life (HRQOL) when adjusting for baseline determinants of HRQOL.Primary baseline and follow-up data from three regional and one national population-based cohort studies in Germany were pooled for analysis. HRQOL was measured using physical and mental health summary scores (PCS and MCS) from the German version of the Short Form Health Survey with 36 or 12 items. Mean score change per observation year was compared between the three groups (prevalent diabetes, incident diabetes, no diabetes) based on linear regression models.The analysis included pooled data from 5367 people aged 45-74 years at baseline. Of these, 85.5% reported no diabetes at baseline and follow-up, 6.3% reported diabetes at both baseline and follow-up (prevalent diabetes), and 8.2% reported diabetes only at follow-up (incident diabetes). Over a mean observation period of 8.7 years, annual decline in HRQOL scores is pronounced at 0.27-0.32 (PCS) and 0.34-0.38 (MCS) in the group with prevalent diabetes compared with people without diabetes. Those with incident diabetes showed intermediate values but did not differ significantly from people without diabetes after adjustment for covariates in the full model.Compared with data from cross-sectional analysis, the HRQOL loss associated with prevalent diabetes appears to be much larger than previously assumed.
Published: 2017
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26. Lower Cardiorespiratory Fitness Is Associated With a Smaller and Stiffer Heart

Author: Marcus Dörr, Sabine Schipf, Martin Bahls, Till Ittermann, Marcello Ricardo Paulista Markus, Elisabeth Steinhagen-Thiessen, Henry Völzke, Robin Bülow, Ramachandran S. Vasan, Ulrike Siewert-Markus, Christine Julia Drzyzga, Stephan B. Felix, Heribert Schunkert, Sebastian E. Baumeister, and Ralf Ewert
Subjects: medicine.medical_specialty, business.industry, Physical activity, Cardiorespiratory fitness, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Atrophy, Predictive value of tests, Internal medicine, Heart rate, Cardiology, medicine, Radiology, Nuclear Medicine and imaging, Cardiology and Cardiovascular Medicine, business
Abstract: Contrary to the “athlete’s heart,” a condition associated with high levels of exercise training (ET) and physical activity (PA), it is not well known if low levels of PA may be associated with decreased left ventricular (LV) mass (LVM) or even cardiac atrophy. This is determined by a sedentary
Published: 2021
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27. Selbstberichtete Krebserkrankungen in der NAKO Gesundheitsstudie: Erfassungsmethoden und erste Ergebnisse

Author: Heiko Becher, Wolfgang Lieb, Hermann Brenner, Sylvia Gastell, Rafael T. Mikolajczyk, Michael F. Leitzmann, Jakob Linseisen, Tamara Schikowski, Katharina Nimptsch, Lina Jaeschke, Gérard Krause, Wolfgang Hoffmann, Oliver Kuß, Nadia Obi, Wolfgang Ahrens, Bernd Holleczek, Matthias B. Schulze, Kathrin Günther, Jenny Chang-Claude, Verena Katzke, Thomas Keil, Börge Schmidt, Beate Fischer, Andrea Schmidt-Pokrzywniak, Karl-Heinz Jöckel, Markus Löffler, Sabine Schipf, Tobias Pischon, Klaus Berger, Karin Halina Greiser, Rudolf Kaaks, Claus-Werner Franzke, Lilian Krist, and Karin B. Michels
Subjects: Gynecology, medicine.medical_specialty, business.industry, Medizin, Public Health, Environmental and Occupational Health, 030209 endocrinology & metabolism, Epidemiology, Self-report, Cohort study, Cancer, Deutschland, Germany, Epidemiologie, Krebs, Kohortenstudie, Selbstangabe, 03 medical and health sciences, 0302 clinical medicine, Neoplasms diagnosis, medicine, ddc:610, 030212 general & internal medicine, business, Self report
Abstract: HINTERGRUND: In der NAKO Gesundheitsstudie liegen die Daten zu selbstberichteten Krebserkrankungen der ersten Hälfte der Teilnehmenden vor. ZIEL: Beschreibung der Methoden zur Erfassung selbstberichteter Krebserkrankungen und Tumorlokalisationen in der NAKO und Darstellung erster Ergebnisse. MATERIAL UND METHODEN: In einem computergestützten, standardisierten persönlichen Interview wurden 101.787 Teilnehmende (54.526 Frauen, 47.261 Männer) gefragt, ob bei ihnen jemals eine Krebserkrankung (bösartiger Tumor einschließlich in situ) ärztlich diagnostiziert wurde und wie viele Krebserkrankungen sie hatten. Anhand einer Liste wurde die Tumorlokalisation erfragt. Absolute und relative Häufigkeiten von Selbstangaben zu Krebserkrankungen insgesamt und einzelnen Tumorlokalisationen wurden berechnet und mit krebsregisterbasierten Daten verglichen. ERGEBNISSE: Eine ärztlich diagnostizierte Krebserkrankung wurde von 9,4 % der Frauen und 7,0 % der Männer berichtet. Von den Personen, die eine Krebserkrankung berichteten, gaben 88,3 % der Teilnehmenden an, nur eine Krebserkrankung gehabt zu haben. Bei Frauen war die häufigste bösartige Krebserkrankung Brustkrebs, gefolgt von Gebärmutterhalskrebs und malignem Melanom, bei Männern Prostatakrebs, gefolgt von malignem Melanom und Darmkrebs. Beim Vergleich der Krebserkrankungen, die von 45- bis 74-jährigen NAKO-Teilnehmenden in den letzten fünf Jahren berichtet wurden, mit krebsregisterbasierten 5‑Jahres-Prävalenzen wurden für die meisten Tumorlokalisationen in der NAKO niedrigere relative Häufigkeiten beobachtet. Vergleichsweise häufiger traten das maligne Melanom sowie Gebärmutterhalskrebs und Leberkrebs bei Frauen und Harnblasenkrebs und Brustkrebs bei Männern auf. DISKUSSION: Die NAKO ist eine reichhaltige Datenbasis für die zukünftige Untersuchung inzidenter Krebserkrankungen. BACKGROUND: In the German National Cohort (NAKO Gesundheitsstudie), the largest prospective cohort study in Germany, data on self-reported cancer diagnoses are now available for the first half of participants. OBJECTIVES: Description of the methods to assess self-reported cancer diagnoses and type of cancer in the NAKO and presentation of first results. MATERIAL AND METHODS: In a computer-assisted, standardized personal interview, 101,787 participants (54,526 women, 47,261 men) were asked whether they had ever been diagnosed with cancer (malignant tumors including in situ) by a physician and how many cancer diagnoses they had. The type of cancer was classified with a list. Absolute and relative frequencies of self-reported cancer diagnoses and types of cancer were calculated and compared with cancer registry data. RESULTS: A physician-diagnosed cancer was reported by 9.4% of women and 7.0% of men. Of the participants who reported a cancer diagnosis, 88.3% reported to have had only one cancer diagnosis. In women, the most frequent malignancies were breast cancer, cervical cancer, and melanoma. In men, the most frequent malignancies were prostate cancer, melanoma, and colorectal cancer. Comparing the frequencies of cancer diagnoses reported by 45- to 74-year-old NAKO participants within the last five years to cancer registry-based 5‑year prevalences, most types of cancer were less frequent in the NAKO, with the exception of melanoma in men and women, cervical cancer and liver cancer in women, and bladder cancer and breast cancer in men. CONCLUSIONS: The NAKO is a rich data basis for future investigations of incident cancer.
Published: 2020
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28. Lipoprotein(a) and metabolic syndrome—evidence for an inverse association in a pooled cross-sectional analysis of the Berlin Aging Study II (BASE-II) and the Study of Health in Pomerania (SHIP-0)

Author: Nikolaus Buchmann, Till Ittermann, Ilja Demuth, Marcello R. P. Markus, Henry Völzke, Marcus Dörr, Nele Friedrich, Markus M. Lerch, Raul D. Santos, Sabine Schipf, and Elisabeth Steinhagen-Thiessen
Subjects: General Medicine
Published: 2022
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29. Statistical Analysis in the German National Cohort (NAKO) - Specific Aspects and General Recommendations

Author: Oliver Kuss, Heiko Becher, Andreas Wienke, Till Ittermann, Stefan Ostrzinski, Sabine Schipf, Carsten O Schmidt, Michael Leitzmann, Tobias Pischon, Lilian Krist, Stephanie Roll, Matthias Sand, Hermann Pohlabeln, Stefan Rach, Karl-Heinz Jöckel, Andreas Stang, Ulrich A Mueller, Andrea Werdecker, Ronny Westerman, Karin H Greiser, and Karin B Michels
Subjects: Cohort Studies, Male, Epidemiology, Research Design, Medizin, Humans, Female, Longitudinal Studies, Prospective Studies, Function and Dysfunction of the Nervous System, Follow-Up studies, Prospective studies, Biostatistics, Data interpretation, statistical
Abstract: The German National Cohort (NAKO) is an ongoing, prospective multicenter cohort study, which started recruitment in 2014 and includes more than 205,000 women and men aged 19–74 years. The study data will be available to the global research community for analyses. Although the ultimate decision about the analytic methods will be made by the respective investigator, in this paper we provide the basis for a harmonized approach to the statistical analyses in the NAKO. We discuss specific aspects of the study (e.g., data collection, weighting to account for the sampling design), but also give general recommendations which may apply to other large cohort studies as well.
Published: 2022

30. The bias from heaping on risk estimation: effect of age at diagnosis of hypertension on risk of subsequent cardiovascular comorbidities

Author: Lina Jaeschke, Matthias Becher, Ilais Moreno Velásquez, Wolfgang Ahrens, Christina Bächle, Hansjörg Baurecht, Julia Fricke, Karin Halina Greiser, Kathrin Günther, Margit Heier, André Karch, Alexander Kluttig, Lilian Krist, Michael Leitzmann, Karin Michels, Rafael Mikolajczyk, Annette Peters, Sabine Schipf, Henry Völzke, Tobias Pischon, and Heiko Becher
Subjects: Cohort Studies, Bias, Epidemiology, Hypertension, Humans, Computer Simulation, Comorbidity
Abstract: To investigate (1) the bias in effect estimation due to heaping or digit preference, (2) the association between age at hypertension diagnosis and risk of cardiovascular comorbidities, and (3) the influence of heaping on risk estimates.We performed a simulation study with various scenarios, binary outcome, and normal or lognormal distributed covariables. We calculated mean logistic coefficients under the original and heaped data and their relative deviation. The association of age at hypertension diagnosis and risk of ≥1 cardiovascular comorbidity was investigated using logistic regression among 50,858 participants in the NAKO Gesundheitsstudie (German National Cohort) who reported such diagnosis. We assessed the proportion of heaped observations and to what extent heaping may have influenced risk estimates.Based on the simulation study and assuming 50% of observations in the variable of interest to be heaped, relative bias waslt;6%. In NAKO, a 5-year younger age at hypertension diagnosis was associated with a 15% increased risk of having ≥1 cardiovascular comorbidity. Observed heaping in age at hypertension diagnosis was 12.6%, and bias of the risk estimate was 0.14%.Bias in effect estimation due to heaping is low in most common scenarios. Younger age at hypertension diagnosis is associated with a higher risk of cardiovascular comorbidities.
Published: 2022

31. Longitudinal association of Apolipoprotein E polymorphism with lipid profile, type 2 diabetes and metabolic syndrome: Results from a 15 year follow-up study

Author: Anitha Pitchika, Marcello Ricardo Paulista Markus, Sabine Schipf, Alexander Teumer, Sandra Van der Auwera, Matthias Nauck, Marcus Dörr, Stephan Felix, Hans Jörgen Grabe, Henry Völzke, and Till Ittermann
Subjects: Metabolic Syndrome, Inflammation, genetics [Metabolic Syndrome], epidemiology [Metabolic Syndrome], Polymorphism, Genetic, Genotype, Endocrinology, Diabetes and Metabolism, epidemiology [Diabetes Mellitus, Type 2], General Medicine, genetics [Diabetes Mellitus, Type 2], Lipids, Metabolic syndrome, Endocrinology, Apolipoproteins E, C-Reactive Protein, Diabetes Mellitus, Type 2, Type 2 diabetes mellitus, Internal Medicine, genetics [Apolipoproteins E], Humans, ddc:610, Alleles, APOE, Follow-Up Studies
Abstract: To examine the association of different APOE alleles with type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS) as well as the influence of high-sensitive C-reactive protein (hs-CRP) on these associations.We analyzed data from 3917 participants aged 20-81 years of the population-based Study of Health in Pomerania (SHIP) from Northeast Germany with a median follow-up time of 10.8 years. Linear and logistic mixed models were performed to test the association of APOE alleles with T2DM and MetS.We observed 393 T2DM and 1411 MetS events at baseline, and 576 T2DM and 1342 MetS events over the follow-up. The E4 carriers had a lower odds of developing T2DM (OR: 0.47 [0.24, 0.94]) than E3 homozygotes even after adjustment for potential confounders. The E2 carriers showed no associations. The inverse association between E4 alleles and T2DM moderately attenuated after adjustment for hs-CRP levels. The lower odds of developing T2DM in E4 carriers was more pronounced in participants without obesity, hypertension or MetS. However, both E2 and E4 carriers had higher odds of developing MetS (E2 OR: 1.45 [1.03, 2.03]; E4 OR: 1.56 [1.17, 2.09]) than E3 homozygotes.While the presence of APOE E4 allele might increase the chance of MetS through its major action on lipids, E4 allele might offer a protection towards T2DM through its influence on inflammation.
Published: 2022
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32. Regional Variability of Lifestyle Factors and Hypertension with Prediabetes and Newly Diagnosed Type 2 Diabetes Mellitus: The Population-Based KORA-F4 and SHIP-TREND Studies in Germany.

Author: Doris Stöckl, Ina-Maria Rückert-Eheberg, Margit Heier, Annette Peters, Sabine Schipf, Christine Krabbe, Henry Völzke, Teresa Tamayo, Wolfgang Rathmann, and Christa Meisinger
Subjects: Medicine, Science
Abstract: Type 2 diabetes mellitus (T2D) shows regional differences in Germany. The purpose of the project was to compare the prevalence of prediabetes and undiagnosed T2D in two regions in Germany, the Northeast and the South, and to evaluate their associations with regional variations in lifestyle factors and hypertension.Data from the KORA-F4 study (South Germany, 2006-2008) and the SHIP-TREND study (Northeast Germany, 2008-2012) were used. Participants aged 35-79 years without T2D with an overnight fasting of more than 8 hours and an oral glucose tolerance test were included: KORA-F4: n = 2,616 and SHIP-TREND: n = 1,968.The prevalence of prediabetes/newly diagnosed T2D was especially high in men (about 60%) and women (about 50%) in the Northeast, followed by men (about 50%) and women (about 30%) in the South. Lifestyle factors associated with T2D varied between the regions: more participants in the Northeast were active smokers and the percentages of people with overweight or obesity were greater than in their southern counterparts. However, these differences could not explain the striking disparity in prediabetes/newly diagnosed T2D. The frequency of hypertension was also distinctly higher in the Northeast than in the South and clearly associated with prediabetes/newly diagnosed T2D. Especially in men living in the Northeast, screening individuals with blood pressure ≥ 140/90mmHg might reveal up to 70% of those with prediabetes/newly diagnosed T2D.Knowledge about regional variability in T2D and related risk factors is important for the planning of diabetes prevention programs. In our analyses, common lifestyle factors did not nearly explain these variations between the northern SHIP-TREND and the southern KORA-F4 studies. Further examinations of regional socioeconomic, political, environmental and other aspects are needed. Meanwhile, targeted diabetes prevention strategies with a special focus on men living in the northern parts of Germany are reasonable.
Published: 2016
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33. Associations of liver volume and other markers of hepatic steatosis with all-cause mortality in the general population

Author: Muhammad Naeem, Marcello R. P. Markus, Mohammed Mousa, Sabine Schipf, Marcus Dörr, Antje Steveling, Ali Aghdassi, Jens‐Peter Kühn, Marie‐Luise Kromrey, Matthias Nauck, Giovanni Targher, Henry Völzke, and Till Ittermann
Subjects: Male, Metabolic Syndrome, Hepatology, hepatic markers, Middle Aged, Body Mass Index, Fatty Liver, Non-alcoholic Fatty Liver Disease, Risk Factors, all-cause mortality, Humans, Female, liver volume, MRI
Abstract: We examined the associations between liver volume and other quantitative and qualitative markers of hepatic steatosis with all-cause mortality in the general population.We included 2769 German middle-aged individuals with a median follow-up of 8.9 years (23,898 person-years). Quantitative markers used were serum liver enzymes and FIB-4 score, while qualitative markers of hepatic steatosis included magnetic resonance imaging (MRI) measurements of liver fat content and total liver volume. Cox proportional hazards models, adjusted for confounding factors, were undertaken to investigate the associations of liver volume and other markers of hepatic steatosis with all-cause mortality.A larger MRI-assessed liver volume was associated with a nearly three-fold increased risk of all-cause mortality (Hazard Ratio = 3.16; 95% confidence interval 1.88; 5.30), independent of age, sex, body mass index, food frequency score, alcohol consumption and education level. This association was consistent in all subgroups considered (men vs. women; presence or absence of overweight/obesity, metabolic syndrome or diabetes). Higher serum liver enzyme levels and FIB-4 score were also significantly associated with higher all-cause mortality in the total population and in all subgroups. No independent associations were found between other quantitative and qualitative markers of hepatic steatosis and the risk of all-cause mortality.We showed for the first time that larger liver volume was associated with a three-fold increase in long-term risk of all-cause mortality. This association remained significant after adjustment for age, sex, alcohol consumption, obesity and other coexisting metabolic disorders.
Published: 2021

34. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. Gregor, Vayia Rarra, Seyed Mohammad Hashemi-Shahri, Loreto Santa Marina, Galina Obreja, Rudolf Kaaks, Aya Mostafa, Maria do Carmo Franco, Beata Gurzkowska, Chien-Jen Chen, Marie Moitry, Nizal Sarrafzadegan, Xiangjun Wang, Diego Giulliano Destro Christofaro, Imperia Brajkovich, Fangfang Chen, Francesco Panza, Ling Yang, Holly E. Syddall, Cecily Kelleher, Michael Tornaritis, Ningli Wang, Lutgarde Thijs, Marjolein Visser, Angelika Schaffrath Rosario, María José Tormo, Jostein Steene-Johannessen, Norbert Amougou, Emmanuella Magriplis, Mar Alvarez-Pedrerol, Jingli Gao, Stig E. Bojesen, Giuseppe Grosso, Seongjun Ha, Lauren Lissner, Mikhail Benet, Anastasia Markaki, Sanjay Rampal, Antônio Augusto Moura da Silva, Maria Lorenza Muiesan, Angelique Chan, Yvonne T. van der Schouw, Annamari Lundqvist, Philippe Amouyel, Kristyna Zejglicova, Charalambos Hadjigeorgiou, João Breda, Jørgen Meisfjord, Fatima Zahra Laamiri, Carl Lachat, Kai-Uwe Saum, Vilma Irazola, Leng Huat Foo, Óscar Lopes, Dickman Gareta, Flavio Nervi, Imre Janszky, Ruzena Kubinova, Terho Lehtimäki, Mario V. Capanzana, Moyses Szklo, Ramfis Nieto-Martínez, Viswanathan Mohan, Shuohua Chen, Arvind Pandey, Luigi Palmieri, Roya Kelishadi, Srinivasan Kannan, Jie Mi, Robert Beaglehole, Liliana Dacica, Jyrki K. Virtanen, Mohan Deepa, Peter Ueda, Isti Ilmiati Fujiati, Hermann Pohlabeln, Morten Sodemann, Jytte Halkjær, Zbigniew Kułaga, Sophie Visvikis-Siest, Farshad Farzadfar, Mohsen Azimi-Nezhad, Henry Völzke, Karolina Milkowska, Zahra Mohammadi, Belgin Ünal, Magda Gasull, George S. Stergiou, Marshall K. Tulloch-Reid, Seppo Koskinen, James E. Bennett, Marcela González-Gross, Virginija Dulskiene, Idris Guessous, Assembekov Batyrbek, Kamarul Imran Musa, Jeannette Lee, Josep Redon, Bihungum Bista, Luisa M Macieira, Johan Sundström, Andres Metspalu, Lariane M Ono, Flora A. Ukoli, Salar Rahimikazerooni, Andrea Gualtieri, Trevor S. Ferguson, Félicité Tchibindat, Eliza Cinteza, Ha Tp Do, Tajana Zeljkovic Vrkic, Tuyen D Le, Alison J. Hayes, Abdul Basit, Chandini Nekkantti, Teresa Norat, Eunice Ugel, Gulmira Aitmurzaeva, Mariachiara Di Cesare, Abdul Hamid Zargar, Vincenzo Solfrizzi, Garry L. Jennings, Aline Meirhaeghe, Kaare Christensen, Päivi Mäki, Xu Lin, Ali Esmaeili, Joanna Baran, Aneta Grajda, Renata Cifkova, Alexandre C. Pereira, Martin Bobak, Iuliia A Rusakova, Keiu Nelis, Damian K Francis, Guansheng Ma, Axel C. Carlsson, Alejandro Diaz, Alireza Ansari-Moghaddam, N Capkova, Zumin Shi, Maria Turley, Imelda A. Agdeppa, Helena I. S. Nogueira, Marcia Scazufca, Katharina Maruszczak, Natascia Rinaldo, Paulo A. Lotufo, Nuno Lunet, Thor Aspelund, Caroline H.D. Fall, Antonio Cabrera de León, Ahmad Faudzi Yusoff, Holger Theobald, Beatriz D'Agord Schaan, Pedro Marques-Vidal, William A. Neal, Mihai Gafencu, Tandi E. Matsha, Ana B. Crujeiras, Ahmad Reza Dorosty, Alain Morejon, Weili Yan, Dominique Hange, Bekbolat Zholdin, Frédéric Gottrand, Jorge Mota, Jana Námešná, Stevo Popovic, Louise Eriksen, Line Lund Kårhus, Cihangir Erem, Juergen Breckenkamp, Mathilde Kersting, Yi Song, Martin McKee, Aleksandra Gomula, Rafaela Rosário, Enzo Manzato, S. Goya Wannamethee, Sounnia Mediene Benchekor, Azim Nejatizadeh, Krishna Kumar Aryal, Juan P. González-Rivas, Vedrana Sember, Stephen T. McGarvey, Jukka T. Salonen, Patrick Pasquet, Patricia Varona-Pérez, Amelia C. Crampin, Ramin Heshmat, Violeta Iotova, Juvenal Soares Dias-da-Costa, Oye Gureje, Aletta E. Schutte, João Luiz Bastos, Anelise Reis Gaya, Konrad Jamrozik, Dalia Luksiene, Amina Barkat, Maria Paula Santos, José Camolas, Azli Baharudin, Diego Vanuzzo, Doris Stöckl, Rosalynn Siantar, Jouko Saramies, Albertino Damasceno, Davood Khalili, Simona Bo, Martina Müller-Nurasyid, Dominique Cottel, Markku Peltonen, Fikru Tullu, Ana Isabel Rito, Angélica Ochoa-Avilés, Annette J. Dobson, Christopher T. Cowell, Charumathi Sabanayagam, Rildo de Souza Wanderley Júnior, Oanh T. H. Trinh, Farahnaz Joukar, Mostafa K. Mohamed, Mostafa Qorbani, Jeongseon Kim, Helmut Schröder, Machi Suka, Natasja M. van Schoor, Jussi Kauhanen, Teresa Haugsgjerd, Goodarz Danaei, M. Fernanda Lima-Costa, Yong Tao, Elisabetta L. Romeo, Grazyna Jasienska, Victor Guillermo Sequera, Kazem Mohammad, Yanina Zócalo, Fernanda Cunha Soares, Jianfeng Wu, Mohammad Esmaeel Motlagh, María Elena Díaz-Sánchez, Monika Zuziak, Eldridge Ferrer, Anette Varbo, Leila Beltrami Moreira, Jeremy M. 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Mini, Viktoria Anna Kovacs, Rosemarie Martin, Nahla Hwalla, Wei Zheng, Hoang Van Minh, Edward D Janus, Laetitia Huiart, Farhad Pourfarzi, Sudha Ramachandra Rao, Fred Paccaud, Marcia Makdisse, Aye Aye Sein, Enrique Gutiérrez-González, Yang Yang, Anneke Blokstra, Henrike Galenkamp, Jaume Marrugat, Nazan Yardim, Wan Nazaimoon Wan Mohamud, Jesús Ibarluzea, Julio Zuñiga Cisneros, Laura Lauria, Argyro Karakosta, Dragana P Jovic, Jun Hata, Elio Riboli, Piotr Bandosz, Xun Tang, Parvina Mukhtorova, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Guillermo Frontera, Rahul Malhotra, Thomas Ferrao, Aleksandra Piwońska, Dusan Grafnetter, Mette Rasmussen, Daniel Weghuber, Sherali Rakhmatulloev, Martine Vrijheid, Johann Willeit, Motahareh Kheradmand, Małgorzata Mossakowska, Lechaba Tshepo, Dongfeng Gu, Hyeon Chang Kim, Vilmundur Gudnason, Maria Forsner, Peter Bjerregaard, Leon A. Simons, Rachael McLean, Japhet Killewo, Ramón Suárez-Medina, Y Nikitin, Eng Joo Tan, Jean Claude Mbanya, Aroor Bhagyalaxmi, Renata Kuciene, Kairat Davletov, Jose Eugenio Lozano, Afshin Ostovar, Niloofar Peykari, Guy De Backer, Soheir H Ahmed, Nicholas J. Wareham, Sai Yin Ho, Constanta Huidumac Petrescu, Maria Hassapidou, Iris Pigeot, Myriam Galfo, Susana Cararo Confortin, Blanca Sandra Ruiz-Betancourt, W. M. Monique Verschuren, Catterina Ferreccio, Fabio Galvano, Leila Houti, Daniel Bia, Annika Rosengren, Marcin Rutkowski, Biruta Velika, Joana Araújo, Fernando Rigo, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Marie Kunešová, Boban Mugoša, Sania Nishtar, Mangesh S. Pednekar, Shahla AlDhukair, Helle-Mai Loit, Antonis Zampelas, Altan Onat, Maciej Banach, Shohreh Naderimagham, Hajer Aounallah-Skhiri, Maja Bæksgaard Jørgensen, Yin Guo, Ewelina Czenczek-Lewandowska, Parasmani Dasgupta, Elvis Oa Wambiya, Inge Huybrechts, Raimund Erbel, Jari Jokelainen, Ana P. Ortiz, Stefan Kiechl, Emmanuel Cohen, Caleb Ochimana, Shynar Abdrakhmanova, Laura Censi, Iqbal Bata, Geetha R Menon, Snehalatha Chamukuttan, Pedro Plans-Rubio, Domenico Palli, Ana Azevedo, Slawomir Koziel, Benoît Salanave, Parinaz Mehdipour, Shu Ti Chiou, Lela Sturua, Lubica Ticha, Felipe Vogt Cureau, Jin Soo Moon, Ming-Hui Zhao, Urho M. Kujala, Nathalie Michels, Ertugrul Celikcan, Jaakko Tuomilehto, Judith Benedics, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, Andrea Rodriguez-Martinez, Tai Hing Lam, Yn-Tz Sung, Jürgen König, Kodavanti Mallikharjuna Rao, Hazzaa M. Al-Hazzaa, Karen Morgan, Bogdan Wojtyniak, Cynthia M. Pérez, Ilse Khouw, Manoli Garcia-de-la-Hera, Dong Wook Shin, Genc Burazeri, Ausra Petrauskiene, Charles Sossa Jérome, Kenisha Russell Jonsson, José Boggia, Daniela Galeone, Alice Bonilla-Vargas, Han Cg Kemper, Rahman Shiri, Stefaan Demarest, Else Karin Grøholt, San-Lin You, Adelheid Weber, Juha Auvinen, Aida Pilav, Sibel Gogen, Suzanne N Morin, Wan Mohamad Wan Bebakar, Viviane Cunha Cardoso, Kavumpurathu Raman Thankappan, Hana Zamrazilová, Frank Claessens, Karien Stronks, Helen Gonçalves, Tahir Aris, Luis Revilla, Sérgio Viana Peixoto, Zhamilya Battakova, Jing Liu, Eliza Markidou Ioannidou, Leticia Hernandez Cadena, Priscilla Duboz, Sandjaja, Tiina Laatikainen, Rafel Ramos, Sareh Eghtesad, Judith Simons, Orn Olafsson, E. Shyong Tai, Louise A. Baur, Nihal Thomas, Aung Soe Htet, Bente Sparboe-Nilsen, Paul Elliott, Soon-Woo Park, Angel R. 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Eriksson, Margarita Samoutian, Andreia N. Pizarro, Mohammed Rasoul Tarawneh, Jean Woo, Kaspar Staub, Maria Teresa Menzano, Mojtaba Farjam, Adroaldo Cesar Araujo Gaya, Mohammad El-khateeb, Zulfiqar A Bhutta, Mukharram M. Bikbov, Hsien-Ho Lin, Oscar Noboa, Thomas Waldhör, Garry Brian, Simona Costanzo, Frank Tanser, Nor Azwany Yaacob, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ioannis Pagkalos, Ivan Pećin, Carlo M. Barbagallo, Abla M. Sibai, Yuna He, Matsuda Fumihiko, Bharathi Viswanathan, Ali Reza Safarpour, Wei Cheng Lo, Abdullatif Husseini, Jiang He, Liv Elin Torheim, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Davide Noto, Panayiotis K. Yiallouros, Kelias P. Msyamboza, William R. Tebar, Yingfeng Zheng, Eha Nurk, Bhawesh Koirala, Ana Jelakovic, Suhad Bahijri, Freja B Kampmann, Qi Sheng You, Marika Ferrari, María-Elena González-Villalpando, Aline Wagner, Olfa Saidi, Anwar Batieha, Eduardo Capuano, Coimbatore Subramaniam Shanthirani, Dong Wook Kim, Albina A Fakhretdinova, Tom Wilsgaard, Maria Avdicova, Moesijanti Soekatri, Chiara Donfrancesco, Salim Mohanna, Paola Russo, Uruwan Yamborisut, Rafael dos Santos Henrique, Martin Nankap, Allan Linneberg, Khairil Si-Ramlee, Kirsten Mehlig, Christina Mavrogianni, Raluca Pop, Lèlita Santos, Graziella Bruno, Valentina Peterkova, Iná S. Santos, Georg Lappas, Alberto Palloni, Malay K. Mridha, Andrzej Pajak, Marta García-Solano, Stefaan De Henauw, Daniel Ferrante, Rute Santos, Anders Grøntved, Lucjan Szponar, Mihaela Vladulescu, Chien-An Sun, Jan A. Staessen, Paula Duarte de Oliveira, Norazizah Ibrahim Wong, Maria Nordendahl, Elaine M. Dennison, Jeonghee Lee, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Noushin Mohammadifard, Igor Spiroski, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Valéria Regecová, Cláudia S. Minderico, Johanna A. Otero, Jamila Abubakar Garba, Vesselka Duleva, Rui Ornelas, Ilpo Huhtaniemi, Cesar G. Victora, Lijuan Liu, Rody G. Sy, Mahmood Moosazadeh, Ali Ahmadi, Antonio Pedro Graça, Natalia Nowak-Szczepanska, Miao Li Chee, Michael Sjöström, Charles Agyemang, Shiqi Zhen, Xiu-Hua Guo, Pawel Kurjata, Jardena J. Puder, Mehrdad Azmin, Neil Murphy, Kaosar Afsana, Alireza Sadjadi, Johanna M. Geleijnse, Prashant Mathur, Elysée Claude Bika Lele, Raphael Mendes Ritti-Dias, Yannis Manios, Majid Shirani, Rosemary B. Duda, Liis Nelis, Jurate Klumbiene, Zhengming Chen, Wichai Aekplakorn, Alun Evans, Andrzej Wiecek, Lars Lind, Denise Eldemire-Shearer, Bernardo L. Horta, Macia Enguerran, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Kumiko Ohara, Ursula Kiechl-Kohlendorfer, Hermann Brenner, Przemyslaw Slusarczyk, Espen Bjertness, Jutta Stieber, Augusto Di Castelnuovo, Joel G. R. Roy, Aryeh D. Stein, Ruth Frikke-Schmidt, Vera Musil, Amaneh Shayanrad, Marcel Goldberg, Ramon O. Jimenez, Mohammad Reza Fattahi, Jolanda Hyska, Amir Houshang Mehrparvar, Elin Kolle, Mohamed Bamoshmoosh, Michelle Holdsworth, Felipe F. Casanueva, Børge G. Nordestgaard, Niels Wedderkopp, Eva Corpeleijn, Elias F. Gudmundsson, Antonio Mistretta, Daniel Lemogoum, Larissa Pruner Marques, Slavica Sović, Olli T. Raitakari, Marco Aurélio Peres, Alexandra Cucu, Gregorio Varela-Moreiras, Janine Clarke, Andrea Gazzinelli, Mieczysław Litwin, Sara Schramm, Xenophon Theodoridis, Harshpal Singh Sachdev, Mohammad Reza Mirjalili, Dimitrios Papandreou, Peter T. Katzmarzyk, Benjamin Acosta-Cazares, Ben Schöttker, Prabhdeep Kaur, Norlaila Mustafa, Shariq Rashid Masoodi, Sadaf G. Sepanlou, Adolfo Rubinstein, Francis Delpeuch, Julianne Williams, Abbas Dehghan, Leanne M. Riley, Heloisa Bettiol, Gabriele Nagel, Ellisiv B. Mathiesen, Ekaterina Stoyanova, Alisha N. Wade, Zhamyila Usupova, Arnaud Chiolero, Oonagh Markey, Jacqueline Ramke, Elena Bogova, Niveen M E Abu-Rmeileh, Nguyen D Nguyen, Tomasz Zdrojewski, Marjo-Riitta Järvelin, Jose Sanchez-Abanto, Rômulo Araújo Fernandes, Lourdes Ribas-Barba, Nalan Uysal, Mohamad Hasnan Ahmad, Krista Fischer, Maria Wany Louzada Strufaldi, Ramiro Guerrero, Farnam Mohebi, Tran Quoc Bao, Flávio Danni Fuchs, Salim Berkinbayev, Enisa Kujundzic, Sari Voutilainen, Farzad Hadaegh, Robert Lundqvist, Saeid Safiri, Iraj Mohebbi, George Luiz Lins Machado-Coelho, Annette Peters, Gonzalo Valdivia, Magdalena Korzycka, Rajiv T Erasmus, Masanori Iwasaki, Charmaine A. Duante, Sheikh Mohammed Shariful Islam, Quang Ngoc La, Ricky Eddie, Petra Rust, Daniela Rodrigues, Dirk De Bacquer, Karen Sparrenberger, Agneta Sjöberg, Thet Thet Mu, Katarzyna Dereń, Cora L. Craig, Jorge Motta, Janina Petkeviciene, Boyd Swinburn, Paibul Suriyawongpaisal, Visnja Djordjic, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Daan Kromhout, Marius B. Bjertness, Stefano Marventano, Juel Jarani, Alireza Khosravi, Eva Martos, David De Ridder, Lizzy M. Brewster, Nico Dragano, Liam Smeeth, Kenji Shibuya, Emma Ruiz Moreno, Hashem Jaddou, Grzegorz Sobek, Dimitrios Trichopoulos, Marvin Cervantes-Loaiza, Abu Am Hanif, Elaine M. Murtagh, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Kyungwon Oh, Heiner Boeing, Regina Heidinger-Felso, André Luiz Sena Guimarães, Balkish M. Naidu, Avula Laxmaiah, Ana M. B. Menezes, Marie Eliasen, Francesco Pistelli, Yuan He, Dusko Bjelica, José A. Casajús, Guang Ning, Lutgart Braeckman, Dirk Vanderschueren, Jochanan Stessman, Ivana Radic, Yi Zeng, Hans Concin, Damaskini Valvi, Sari Hantunen, Catherine Kyobutungi, Diego Augusto Santos Silva, Wenhua Zhao, Sok King Ong, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Mattias Johansson, Samuel C. Dumith, Magdalena Muc, Sabine Schipf, Idowu O Senbanjo, Jim Mann, Rajaa Al-Raddadi, Yih Chung Tham, Kay-Tee Khaw, Joseph Cacciottolo, Ana Henriques, Sahar Saeedi Moghaddam, Reza Mohammadpourhodki, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Camilla T. Damsgaard, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Constance Schultsz, Santiago F. Gomez, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Pierre Traissac, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Eleonora d'Orsi, Irene G. M. van Valkengoed, Anna Fijałkowska, Wen-Harn Pan, Gregor Starc, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Abdullah Alkandari, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Saeed Dastgiri, Lien Braeckevelt, Nasheeta Peer, Radka Taxová Braunerová, Mohamed M. Ali, Steiner Krokstad, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Silvana Donoso, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Felix K. Assah, Juan A Rivera, Peter H. Whincup, Oana-Florentina Gheorghe-Fronea, Cassiano Ricardo Rech, Paul Ferdinand M. Reganit, Rachakulla Hari Kumar, Jaakko Mursu, Luis A. Moreno, Glen Gironella, Jelena Kos, Tilema Cama, Haakon E. Meyer, Jun Ma, Raphael E. Arku, Ziad Abdeen, Dianna J. Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. Fuchs, Muhammad Islam, Irfan Nuhoglu, Rui Providência, Bernard Maire, Leandra Abarca-Gómez, Sinead Brophy, Maria Ruiz-Castell, Daniela Pierannunzio, Cristina Taddei, Gowri Mahasampath, Gustavo Velasquez-Melendez, Hanna Tolonen, Sudhir Kowlessur, Bagher Larijani, Laura Torres-Collado, Susi Kriemler, Ali Akbar Shayesteh, Cynthia Robitaille, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Line Tang Møllehave, Vincent Jr DeGennaro, Noor Ani Ahmad, Anar Dushpanova, Agustinus Soemantri, Susana Sans, Ionela Pascanu, Gwenaëlle Le Coroller, Inger Ariansen, Kodanda R Kanala, Gert B. M. Mensink, Abhijit Sen, Sergej M. Ostojic, Hanan F. Abdul Rahim, Hélène Delisle, Francisco J. Félix-Redondo, Yadlapalli S. Kusuma, Michael Knoflach, Moein Yoosefi, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Bethlehem D. Solomon, Erik Lykke Mortensen, Nikhil D. Patel, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Herman Borghs, Zhanna Kalmatayeva, Heidi Klakk, Akram Pourshams, Naomi S. Levitt, Son Thai Pham, Simona Giampaoli, Dong Zhao, Indah Suci Widyahening, Merete Osler, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, Giota Touloumi, Janice Luisa Lukrafka, Adela Chirita-Emandi, Maryam Kavousi, Sanja Musić Milanović, Jean-Michel Gaspoz, Jalila El Ati, Sauli Herrala, Liang Xu, Pilar Guallar-Castillón, Bee Koon Poh, Luis Serra-Majem, Jonathan E. Shaw, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Yuki Fujita, Tiffany K. Gill, Nish Chaturvedi, Erkin M. Mirrakhimov, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Deepak Amarapurkar, Deepa Weerasekera, Diana A. Santos, Marjeta Majer, Herman Schargrodsky, Bruna Gonçalves Cordeiro da Silva, Ebrahim Eftekhar, Jesús Vioque, Marisa K. Sophiea, Teresa Shamah-Levy, María Dolores Chirlaque, Mohd Azahadi Omar, Stefan Söderberg, Isabel O. Oliveira, Joanne Katz, Xingwang Ye, Christophe Tzourio, Marie Zins, Aneta Weres, Ulrich Keil, Haiquan Xu, Akihiro Yoshihara, Rachel Dankner, Gabriella Gruden, Maroje Sorić, Hanspeter Stamm, Kim Overvad, Yanping Li, Carsten Oliver Schmidt, Christa L. Lilly, Veikko Salomaa, Gilad Twig, Senthil K Vasan, Qian Wang, Liufu Cui, Andrzej Galbarczyk, Sylvain Sebert, Wilma M. Hopman, Karl-Heinz Jöckel, Ari Voutilainen, Peter Schnohr, Jerzy Chudek, Katia Vergetti Bloch, Vincenzo Capuano, Jyh Eiin Wong, Torben Jørgensen, Anja Schienkiewitz, Nader Saki, Carolina Tarqui-Mamani, Maria Cecília Formoso Assunção, Kazi M. Jamil, Juraci Almeida Cesar, Pedro J Ortiz, Delphine De Smedt, Luciana Zaccagni, Lynne M. Boddy, Jie Hao, David Alejandro González-Chica, Romana Roccaldo, Sara Magnacca, Peter Stehle, Victoria Farrugia Sant'Angelo, Gry Skodje, Maryam Keramati, Tabara Yasuharu, Ali Ghanbari, Gyulli M. Kazakbaeva, Takuro Furusawa, Felicia Cañete, Kari Kuulasmaa, Justina Vaitkeviciute, (NCD-RisC), NCD Risk Factor Collaboration, Imperial College London, Harvard T.H. Chan School of Public Health, Middlesex University [London], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Montpellier Interdisciplinary center on Sustainable Agri-food systems (Social and nutritional sciences) (UMR MoISA), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut de Recherche pour le Développement (IRD)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Interactions Gène-Environnement en Physiopathologie Cardio-Vasculaire (IGE-PCV), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Wellcome TrustEuropean Commission, Clinical Developmental Psychology, APH - Mental Health, Sociology, The Social Context of Aging (SoCA), Nutrition and Health, Iurilli, Maria LC [0000-0003-0409-1635], Zhou, Bin [0000-0002-1741-8628], Ezzati, Majid [0000-0002-2109-8081], Apollo - University of Cambridge Repository, Epidemiology and Data Science, APH - Aging & Later Life, APH - Societal Participation & Health, Public and occupational health, APH - Health Behaviors & Chronic Diseases, VU University medical center, APH 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Ltd, Orebro University, University of London, Universitas Indonesia, Institute of Food and Nutrition Development of Ministry of Agriculture and Rural Affairs, Children’s Hospital of Fudan University, University of Cyprus, Niigata University, International Medical University, Iran University of Medical Sciences, Center for Diabetes and Endocrine Care, Peking University First Hospital, Jiangsu Provincial Center for Disease Control and Prevention, Sun Yat-sen University, West Kazakhstan Medical University, Inner Mongolia Medical University, University of Ghana, Maria Lc Iurilli , Bin Zhou , James E Bennett , Rodrigo M Carrillo-Larco , Marisa K Sophiea , Andrea Rodriguez-Martinez , Honor Bixby , Bethlehem D Solomon , Cristina Taddei , Goodarz Danaei , Mariachiara Di Cesare , Gretchen A Stevens , Leanne M Riley , Stefan Savin , Melanie J Cowan , Pascal Bovet , Albertino Damasceno , Adela Chirita-Emandi , Alison J Hayes , Nayu Ikeda , Rod T Jackson , Young-Ho Khang , Avula Laxmaiah , Jing 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Chiara Donfrancesco , Silvana P Donoso , Angela Döring , Maria Dorobantu , Ahmad Reza Dorosty , Kouamelan Doua , Nico Dragano , Wojciech Drygas , Jia Li Duan , Charmaine A Duante , Priscilla Duboz , Rosemary B Duda , Vesselka Duleva , Virginija Dulskiene , Samuel C Dumith , Anar Dushpanova , Vilnis Dzerve , Elzbieta Dziankowska-Zaborszczyk , Ricky Eddie , Ebrahim Eftekhar , Eruke E Egbagbe , Robert Eggertsen , Sareh Eghtesad , Gabriele Eiben , Ulf Ekelund , Mohammad El-Khateeb , Jalila El Ati , Denise Eldemire-Shearer , Marie Eliasen , Paul Elliott , Reina Engle-Stone , Macia Enguerran , Rajiv T Erasmus , Raimund Erbel , Cihangir Erem , Louise Eriksen , Johan G Eriksson , Jorge Escobedo-de la Peña , Saeid Eslami , Ali Esmaeili , Alun Evans , David Faeh , Albina A Fakhretdinova , Caroline H Fall , Elnaz Faramarzi , Mojtaba Farjam , Victoria Farrugia Sant'Angelo , Farshad Farzadfar , Mohammad Reza Fattahi , Asher Fawwad , Francisco J Felix-Redondo , Trevor S Ferguson , Romulo A Fernandes , Daniel Fernández-Bergés , Daniel Ferrante , Thomas Ferrao , Marika Ferrari , Marco M Ferrario , Catterina Ferreccio , Eldridge Ferrer , Jean Ferrieres , Thamara Hubler Figueiró , Anna Fijalkowska , Günther Fink , Krista Fischer , Leng Huat Foo , Maria Forsner , Heba M Fouad , Damian K Francis , Maria do Carmo Franco , Ruth Frikke-Schmidt , Guillermo Frontera , Flavio D Fuchs , Sandra C Fuchs , Isti I Fujiati , Yuki Fujita , Matsuda Fumihiko , Takuro Furusawa , Zbigniew Gaciong , Mihai Gafencu , Andrzej Galbarczyk , Henrike Galenkamp , Daniela Galeone , Myriam Galfo , Fabio Galvano , Jingli Gao , Manoli Garcia-de-la-Hera , Marta García-Solano , Dickman Gareta , Sarah P Garnett , Jean-Michel Gaspoz , Magda Gasull , Adroaldo Cesar Araujo Gaya , Anelise Reis Gaya , Andrea Gazzinelli , Ulrike Gehring , Harald Geiger , Johanna M Geleijnse , Ali Ghanbari , Erfan Ghasemi , Oana-Florentina Gheorghe-Fronea , Simona Giampaoli , Francesco Gianfagna , Tiffany K Gill , Jonathan Giovannelli , Glen 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, Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , 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, Luxia Zhang , Zhen-Yu Zhang , Dong Zhao , Ming-Hui Zhao , Wenhua Zhao , Shiqi Zhen , Wei Zheng , Yingfeng Zheng , Bekbolat Zholdin , Maigeng Zhou , Dan Zhu , Marie Zins , Emanuel Zitt , Yanina Zocalo , Julio Zuñiga Cisneros , Monika Zuziak , Majid Ezzati , Sarah Filippi, Epidemiology, Iurilli, Maria LC, Zhou, Bin, Bennett, James E, Carrillo-Larco, Rodrigo M, Sophiea, Marisa K, Rodriguez-Martinez, Andrea, Bixby, Honor, Solomon, Bethlehem D, Taddei, Cristina, Danaei, Goodarz, Di Cesare, Mariachiara, Stevens, Gretchen A, Riley, Leanne M, Savin, Stefan, Cowan, Melanie J, Bovet, Pascal, Damasceno, Albertino, Chirita-Emandi, Adela, Hayes, Alison J, Ikeda, Nayu, Jackson, Rod T, Khang, Young-Ho, Laxmaiah, Avula, Liu, Jing, Miranda, J Jaime, Saidi, Olfa, Sebert, Sylvain, Sorić, Maroje, Starc, Gregor, Gregg, Edward W, Abarca-Gómez, Leandra, Abdeen, Ziad A, Abdrakhmanova, Shynar, Ghaffar, Suhaila Abdul, Rahim, Hanan F Abdul, Abu-Rmeileh, Niveen M, Garba, Jamila Abubakar, Acosta-Cazares, 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Poudyal, Anil, Poulimeneas, Dimitrio, Pouraram, Hamed, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J, Price, Jacqueline F, Providencia, Rui, Puder, Jardena J, Pudule, Iveta, Puhakka, Soile E, Puiu, Maria, Punab, Margu, Qasrawi, Radwan F, Qorbani, Mostafa, Bao, Tran Quoc, Radic, Ivana, Radisauskas, Ricarda, Rahimikazerooni, Salar, Rahman, Mahfuzar, Rahman, Mahmudur, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina, Rakhmatulloev, Sherali, Rakovac, Ivo, Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramke, Jacqueline, Ramos, Elisabete, Ramos, Rafel, Rampal, Lekhraj, Rampal, Sanjay, Rarra, Vayia, Rascon-Pacheco, Ramon A, Rasmussen, Mette, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M, Regecová, Valéria, Revilla, Lui, Rezaianzadeh, Abba, Ribas-Barba, Lourde, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, Rinaldo, Natascia, de Wit, Tobias F Rinke, Rito, Ana, Ritti-Dias, Raphael M, Rivera, Juan A, Robitaille, Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)
Subjects: Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed
Published: 2021
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35. Variability of biomarkers used for the classification of metabolic syndrome: A repeated measurements study

Author: Till Ittermann, Marcus Dörr, Marcello R.P. Markus, Matthias Nauck, Clemens Jürgens, Sabine Schipf, Carsten O. Schmidt, Henry Völzke, and Adrian Richter
Subjects: Blood Glucose, Metabolic Syndrome, Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Cholesterol, HDL, Medicine (miscellaneous), Blood Pressure, Cholesterol, Glucose, Risk Factors, Humans, Cardiology and Cardiovascular Medicine, Biomarkers, Triglycerides
Abstract: The definition of the metabolic syndrome consists of five components. The underlying measurements are subject to intra-individual variability. This repeated measurements study investigated the impact of intra-individual measurement variability on the stability of the diagnosis of metabolic syndrome over 12 months.Twenty-five employees of the University Medicine Greifswald aged 22-70 years were examined once a month over one year. Examinations included blood sampling and anthropometric and blood pressure measurements. Laboratory measurements included glucose, cholesterol (high-density lipoprotein [HDL], and low-density lipoprotein [LDL]), and triglycerides. The metabolic syndrome was defined according to the International Diabetes Federation modified for non-fasting blood samples. Variations in continuous metabolic markers were assessed using coefficients of variation (CV) and intra-class correlation coefficients (ICC). Overall eight participants (32%) were categorized at least once within 12 months as having a metabolic syndrome; in none of those metabolic syndrome was found consistently over the study follow-ups. The Cohen's Kappa for metabolic syndrome was 0.57. CV was highest for triglycerides (27.5%) followed by glucose (10.1%), LDL- (9.5%), and HDL-cholesterol (8.6%). ICC's were lowest for glucose (0.51), triglycerides (0.65), systolic (0.68), and diastolic blood pressure (0.69).We showed that the measurement of biomarkers defining the metabolic syndrome is a time-varying condition with implications for the concept of the metabolic syndrome. To account for this uncertainty in prevalence studies we propose to identify uncertain cases according to the current definition of the metabolic syndrome. For analysing associations we recommend to apply probabilistic sensitivity analyses.
Published: 2021

36. Lower muscular strength is associated with smaller left and right chambers and lower cardiac mass in the general population - The Sedentary's Heart

Author: Martin Bahls, Sabine Schipf, Ulrike Siewert-Markus, Marcus Dörr, Nikolaus Buchmann, Henry Völzke, Simon Kim, Robin Bülow, Till Ittermann, Elisabeth Steinhagen-Thiessen, Stephan B. Felix, Camila Campos Santana, and Marcello Ricardo Paulista Markus
Subjects: Adult, Male, medicine.medical_specialty, Cardiac output, Heart Diseases, Population, Physical strength, Risk Assessment, Ventricular Function, Left, Young Adult, Predictive Value of Tests, Internal medicine, Germany, Natriuretic Peptide, Brain, Medicine, Humans, education, Muscle, Skeletal, Exercise, Aged, Aged, 80 and over, education.field_of_study, medicine.diagnostic_test, Hand Strength, business.industry, Myocardium, Cardiac muscle, Age Factors, Magnetic resonance imaging, Stroke volume, Middle Aged, Magnetic Resonance Imaging, Confidence interval, Peptide Fragments, medicine.anatomical_structure, Cross-Sectional Studies, Echocardiography, Heart Disease Risk Factors, Study of Health in Pomerania, Cardiology, Ventricular Function, Right, Atrial Function, Left, Female, Sedentary Behavior, Cardiology and Cardiovascular Medicine, business, Biomarkers
Abstract: The cardiac muscle has the ability to adapt to different loading conditions. We analyzed the associations of the age-related decreasing handgrip strength (HGS), a marker of muscular fitness, on cardiac structure and function in a community-based sample.We performed cross-sectional analyses of 4646 subjects (2554 women; 55.0%) aged 20 to 93 years from two independent cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analyzed the associations of HGS with structural and functional left and right ventricular (LV and RV) and left atrial (LA) parameters as determined by echocardiography and magnetic resonance imaging (MRI) as well with log-transformed NT-proBNP values using multivariable-adjusted linear regression models.MRI data showed that a 1 kg lower HGS was associated with a 0.40 mL (95% confidence interval: 0.26 to 0.54; p 0.001) lower LV end-diastolic volume, a 0.011 mm (0.005 to 0.018; p = 0.001) lower LV wall-thickness, a 0.59 g (0.43 to 0.75; p 0.001) lower LV mass, a 0.58 mL/beat (0.43 to 0.74; p 0.001) lower LV stroke volume, a 0.03 L/min (0.02 to 0.04; p 0.001) lower LV cardiac output, a 0.48 mL (0.27 to 0.68; p 0.001) lower LA end-diastolic volume, and a 1.02 mL (0.71 to 1.32) lower RV end-diastolic volume. Similar findings were observed for echocardiographic parameters. Moreover, lower HGS was associated with higher echocardiographic LV diastolic stiffness and NT-proBNP levels.In this large population-based sample, lower muscular fitness as assessed by HGS was associated with lower LV wall thickness and mass as well as with smaller chamber size, stroke volume and cardiac output of the LV, LA and RV. Moreover, HGS was inversely related to LV diastolic stiffness and NT-proBNP values. These outcomes might demonstrate the effects of an aging-related decrease in physical activity and lower muscular fitness on the heart - "the sedentary's heart".
Published: 2021

37. Cardiac MRI shows an association of lower cardiorespiratory fitness with decreased myocardial mass and higher cardiac stiffness in the general population - The Sedentary's Heart

Author: Sabine Schipf, Marcello Ricardo Paulista Markus, Ulrike Siewert-Markus, Ramachandran S. Vasan, Heribert Schunkert, Ralf Ewert, Christine Julia Drzyzga, Martin Bahls, Henry Völzke, Elisabeth Steinhagen-Thiessen, Till Ittermann, Sebastian E. Baumeister, Marcus Dörr, Robin Bülow, Stephan B. Felix, and Paul Schumacher
Subjects: Adult, Male, medicine.medical_specialty, Cardiac output, Heart Diseases, Health Status, Population, Risk Assessment, Ventricular Function, Left, Young Adult, Oxygen Consumption, Sex Factors, Predictive Value of Tests, Internal medicine, Germany, Medicine, Humans, education, Exercise, Sedentary lifestyle, Aged, Aged, 80 and over, education.field_of_study, Ejection fraction, business.industry, Myocardium, Age Factors, VO2 max, Cardiorespiratory fitness, Stroke volume, Middle Aged, Magnetic Resonance Imaging, Confidence interval, Cross-Sectional Studies, Cardiorespiratory Fitness, Heart Disease Risk Factors, Cardiology, Female, Sedentary Behavior, Cardiology and Cardiovascular Medicine, business
Abstract: BACKGROUND The heart has the capacity to adapt to different demands. The pathophysiological mechanisms involved with sedentarism are not fundamentally the opposite of those related with physical activity and regular exercise. We investigated the impact of lower cardiorespiratory fitness (CRF) on heart's plasticity and function in a population-based setting. METHODS We used data from 1165 participants (539 women; 46.3%) aged 21-81 years from two independent cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analyzed the cross-sectional associations of peak oxygen uptake (VO2peak), determined by symptom-limited cardiopulmonary exercise testing, with structural and functional left ventricular (LV) and left atrial (LA) parameters determined by magnetic resonance imaging (MRI) using multivariable- adjusted linear regression models. RESULTS A 1 L/min lower VO2peak was associated with a 10.5 g (95% confidence interval: 8.00 to 12.9; p
Published: 2021

38. Personen mit Migrationshintergrund in der NAKO Gesundheitsstudie – soziodemografische Merkmale und Vergleiche mit der autochthonen deutschen Bevölkerung

Author: Sylvia Gastell, Lena Koch-Gallenkamp, Nico Dragano, Nadia Obi, Heiko Becher, Gérard Krause, Matthias B. Schulze, Christa Meisinger, Wolfgang Ahrens, Klaus Berger, Claudia Meinke-Franze, Börge Schmidt, Wolfgang Lieb, Sara Schramm, Sabine Schipf, Julia Fricke, Stefan N. Willich, Halina Greiser, Oliver Kuss, Christian Wiessner, Claudia Wigmann, Lilian Krist, Stefanie Castell, Hajo Zeeb, Tobias Pischon, Amand Führer, Sabina Waniek, Thomas Keil, Nicole Sowarka, Michael F. Leitzmann, Lina Jaeschke, Carmen Jochem, Karl-Heinz Jöckel, Claudia Schmoor, Rafael T. Mikolajczyk, Feng Guo, Nicole Legath, and Rudolf Kaaks
Subjects: Gynecology, medicine.medical_specialty, 030219 obstetrics & reproductive medicine, Medizin, Public Health, Environmental and Occupational Health, Cancer screening, Migration, Health services, Gesundheitsversorgung, Sozialepidemiologie, Social epidemiology, Krebsfrüherkennung, Soziodemografie, Sociodemography, 03 medical and health sciences, 0302 clinical medicine, Political science, medicine, ddc:610, Cancer Screening, Health Services, Social Epidemiology, 030212 general & internal medicine
Abstract: HINTERGRUND: Personen mit Migrationshintergrund (PmM) unterscheiden sich als Bevölkerungsgruppe hinsichtlich Morbidität, Mortalität und Inanspruchnahme des Gesundheitssystems meist von der autochthonen Bevölkerung, sie nehmen jedoch seltener an Gesundheitsstudien teil. Die Gruppe der PmM ist sehr heterogen, was in Studien bisher kaum berücksichtigt wird. ZIEL DER ARBEIT: Es werden soziodemografische Charakteristika der PmM in der NAKO Gesundheitsstudie (Alter, Geschlecht, Zeit seit Migration, Bildung) dargestellt. Zudem wird exemplarisch untersucht, ob der Migrationshintergrund mit der Nutzung des Angebots zur Früherkennung von Darmkrebs (Hämoccult-Test) zusammenhängt. METHODEN: Daten der ersten 101.816 Teilnehmenden der NAKO wurden deskriptiv und kartografisch ausgewertet. Die Zuweisung des Migrationshintergrunds erfolgte anhand der Definition des Statistischen Bundesamts und basiert auf Staatsangehörigkeit, Geburtsland, Einreisejahr und Geburtsland der Eltern. ERGEBNISSE: Der Anteil der PmM liegt bei 16,0 %. Die Verteilung über die 18 Studienzentren variiert zwischen 6 % (Neubrandenburg) und 33 % (Düsseldorf). Mit 153 Herkunftsländern sind in der NAKO die meisten Länder vertreten. Bei allen Variablen zeigen sich deutliche Unterschiede zwischen den verschiedenen Herkunftsregionen. Am Hämoccult-Test nehmen türkeistämmige Personen (OR = 0,67) und Aussiedler aus der ehemaligen Sowjetunion (OR = 0,60) seltener teil. PmM, die in Deutschland geboren sind, unterscheiden sich diesbezüglich nicht von der autochthonen Bevölkerung (OR = 0,99). DISKUSSION: PmM in der NAKO sind eine sehr heterogene Gruppe. Jedoch lassen sich aufgrund der Stichprobengröße einzelne Untergruppen der PmM hinsichtlich ihrer Herkunftsregion separat untersuchen. BACKGROUND: Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far. OBJEKTIVES: Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test). METHODS: Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents. RESULTS: Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99). CONCLUSION: PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.
Published: 2020
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39. Modulation of genetic associations with serum urate levels by body-mass-index in humans.

Author: Jennifer E Huffman, Eva Albrecht, Alexander Teumer, Massimo Mangino, Karen Kapur, Toby Johnson, Zoltán Kutalik, Nicola Pirastu, Giorgio Pistis, Lorna M Lopez, Toomas Haller, Perttu Salo, Anuj Goel, Man Li, Toshiko Tanaka, Abbas Dehghan, Daniela Ruggiero, Giovanni Malerba, Albert V Smith, Ilja M Nolte, Laura Portas, Amanda Phipps-Green, Lora Boteva, Pau Navarro, Asa Johansson, Andrew A Hicks, Ozren Polasek, Tõnu Esko, John F Peden, Sarah E Harris, Federico Murgia, Sarah H Wild, Albert Tenesa, Adrienne Tin, Evelin Mihailov, Anne Grotevendt, Gauti K Gislason, Josef Coresh, Pio D'Adamo, Sheila Ulivi, Peter Vollenweider, Gerard Waeber, Susan Campbell, Ivana Kolcic, Krista Fisher, Margus Viigimaa, Jeffrey E Metter, Corrado Masciullo, Elisabetta Trabetti, Cristina Bombieri, Rossella Sorice, Angela Döring, Eva Reischl, Konstantin Strauch, Albert Hofman, Andre G Uitterlinden, Melanie Waldenberger, H-Erich Wichmann, Gail Davies, Alan J Gow, Nicola Dalbeth, Lisa Stamp, Johannes H Smit, Mirna Kirin, Ramaiah Nagaraja, Matthias Nauck, Claudia Schurmann, Kathrin Budde, Susan M Farrington, Evropi Theodoratou, Antti Jula, Veikko Salomaa, Cinzia Sala, Christian Hengstenberg, Michel Burnier, Reedik Mägi, Norman Klopp, Stefan Kloiber, Sabine Schipf, Samuli Ripatti, Stefano Cabras, Nicole Soranzo, Georg Homuth, Teresa Nutile, Patricia B Munroe, Nicholas Hastie, Harry Campbell, Igor Rudan, Claudia Cabrera, Chris Haley, Oscar H Franco, Tony R Merriman, Vilmundur Gudnason, Mario Pirastu, Brenda W Penninx, Harold Snieder, Andres Metspalu, Marina Ciullo, Peter P Pramstaller, Cornelia M van Duijn, Luigi Ferrucci, Giovanni Gambaro, Ian J Deary, Malcolm G Dunlop, James F Wilson, Paolo Gasparini, Ulf Gyllensten, Tim D Spector, Alan F Wright, Caroline Hayward, Hugh Watkins, Markus Perola, Murielle Bochud, W H Linda Kao, Mark Caulfield, Daniela Toniolo, Henry Völzke, Christian Gieger, Anna Köttgen, and Veronique Vitart
Subjects: Medicine, Science
Abstract: We tested for interactions between body mass index (BMI) and common genetic variants affecting serum urate levels, genome-wide, in up to 42569 participants. Both stratified genome-wide association (GWAS) analyses, in lean, overweight and obese individuals, and regression-type analyses in a non BMI-stratified overall sample were performed. The former did not uncover any novel locus with a major main effect, but supported modulation of effects for some known and potentially new urate loci. The latter highlighted a SNP at RBFOX3 reaching genome-wide significant level (effect size 0.014, 95% CI 0.008-0.02, Pinter= 2.6 x 10-8). Two top loci in interaction term analyses, RBFOX3 and ERO1LB-EDARADD, also displayed suggestive differences in main effect size between the lean and obese strata. All top ranking loci for urate effect differences between BMI categories were novel and most had small magnitude but opposite direction effects between strata. They include the locus RBMS1-TANK (men, Pdifflean-overweight= 4.7 x 10-8), a region that has been associated with several obesity related traits, and TSPYL5 (men, Pdifflean-overweight= 9.1 x 10-8), regulating adipocytes-produced estradiol. The top-ranking known urate loci was ABCG2, the strongest known gout risk locus, with an effect halved in obese compared to lean men (Pdifflean-obese= 2 x 10-4). Finally, pathway analysis suggested a role for N-glycan biosynthesis as a prominent urate-associated pathway in the lean stratum. These results illustrate a potentially powerful way to monitor changes occurring in obesogenic environment.
Published: 2015
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40. Blood Pressure Control Has Improved in People with and without Type 2 Diabetes but Remains Suboptimal: A Longitudinal Study Based on the German DIAB-CORE Consortium.

Author: Ina-Maria Rückert, Jens Baumert, Michaela Schunk, Rolf Holle, Sabine Schipf, Henry Völzke, Alexander Kluttig, Karin-Halina Greiser, Teresa Tamayo, Wolfgang Rathmann, and Christa Meisinger
Subjects: Medicine, Science
Abstract: Hypertension is a very common comorbidity and major risk factor for cardiovascular complications, especially in people with Type 2 Diabetes (T2D). Nevertheless, studies in the past have shown that blood pressure is often insufficiently controlled in medical practice. For the DIAB-CARE study, we used longitudinal data based on the German DIAB-CORE Consortium to assess whether health care regarding hypertension has improved during the last decade in our participants.Data of the three regional population-based studies CARLA (baseline 2002-2006 and follow-up 2007-2010), KORA (baseline 1999-2001 and follow-up 2006-2008) and SHIP (baseline 1997-2001 and follow-up 2002-2006) were pooled. Stratified by T2D status we analysed changes in frequencies, degrees of awareness, treatment and control. Linear mixed models were conducted to assess the influence of sex, age, study, and T2D status on changes of systolic blood pressure between the baseline and follow-up examinations (mean observation time 5.7 years). We included 4,683 participants aged 45 to 74 years with complete data and accounted for 1,256 participants who were lost to follow-up by inverse probability weighting.Mean systolic blood pressure decreased in all groups from baseline to follow-up (e.g. - 8.5 mmHg in those with incident T2D). Pulse pressure (PP) was markedly higher in persons with T2D than in persons without T2D (64.14 mmHg in prevalent T2D compared to 52.87 mmHg in non-T2D at baseline) and did not change much between the two examinations. Awareness, treatment and control increased considerably in all subgroups however, the percentage of those with insufficiently controlled hypertension remained high (at about 50% of those with hypertension) especially in prevalent T2D. Particularly elderly people with T2D often had both, high blood pressure ≥140/90 mmHg and a PP of ≥60 mmHg. Blood pressure in men had improved more than in women at follow-up, however, men still had higher mean SBP than women at follow-up.Blood pressure management has developed positively during past years in Germany. While hypertension prevalence, awareness and treatment were substantially higher in participants with T2D than in those without T2D at follow-up, hypertension control was achieved only in about half the number of people in each T2D group leaving much room for further improvement.
Published: 2015
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41. LP(A) AND METABOLIC SYNDROME IN OLDER PEOPLE

Author: Nikolaus Buchmann, Sabine Schipf, Till Ittermann, Elisabeth Steinhagen-Thiessen, Ilja Demuth, and Marcello Markus
Subjects: Health (social science), Life-span and Life-course Studies, Health Professions (miscellaneous)
Abstract: Background Although an inverse association between type II diabetes mellitus and Lipoprotein (a) [LP(a)] has already been well researched, there is sparse data on the association between metabolic syndrome (MetS) with Lp(a). MetS is highly prevalent in older people and insulin resistance in MetS might link Lp(a) with MetS. Thus, we analyzed the association between Lp(a) with MetS in two large cohorts the Berlin Aging Study II [BASE-II] and the Study of Health in Pomerania [SHIP-0] Methods Complete cross-sectional data was available for 5,743 BASE-II and SHIP-0 participants (48.7% men; age 58 [20-85] years). MetS was defined according to modified criteria of the AHA/NHLBI 2009 definition. The association between MetS with Lp(a) was examined by median regression adjusted for age, sex and study and models were stratified by gender and menopause. Results MetS was prevalent in 27.6% (n=1,573) participants. We found an inverse association between MetS with Lp(a) in the whole study sample (β=-11.9 [95% confidence interval (95% CI) -21.3 to -2.6]) as well as in men (β=-16.5 [95% CI -28.6 to -4.3]) and in postmenopausal women (β=-25.4 [95% CI -46.0 to -4.8]). In contrast to this, in premenopausal women a positive association between MetS and Lp(a) (β=39.2 [95% CI 12.3 to 65.9]) was evident. Conclusion Postmenopausal changes in hormone metabolism impact both MetS and Lp(a). With respect to the ongoing development of Lp(a)-lowering drugs, their use must be examined, particularly in old age and in subjects with MetS.
Published: 2022
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42. Lipoprotein(a) and Metabolic Syndrome

Author: Nikolaus, Buchmann, Till, Ittermann, Ilja, Demuth, Marcello R P, Markus, Henry, Völzke, Marcus, Dörr, Nele, Friedrich, Markus M, Lerch, Raul D, Santos, Sabine, Schipf, and Elisabeth, Steinhagen-Thiessen
Subjects: Male, Metabolic Syndrome, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Premenopause, Risk Factors, Humans, Female, Original Article, Middle Aged, Lipoprotein(a)
Abstract: BACKGROUND: An inverse association between lipoprotein(a) (Lp[a]) and type 2 diabetes mellitus is well documented. However, data on the association of the metabolic syndrome (MetS) with Lp(a) are sparse. METHODS: Cross-sectional data for MetS and Lp(a) were available for 5743 BASE-II and SHIP-0 participants (48.7% men; age 58 [20–85] years) (BASE, Berlin Aging Study; SHIP, Study of Health in Pomerania). The association of MetS and its components with Lp(a) was analyzed by means of median regression adjusted for age, sex, and study. Associations were evaluated for the total population as well as stratified by sex and menopausal status. RESULTS: Overall, 27.6% (n = 1573) of the participants in the two studies had MetS and 22.5% (n = 1291) were premenopausal women. There was an inverse association between MetS and Lp(a) in the whole study sample (ß = -11.9, 95% confidence interval [-21.3; -2.6]) as well as in men (ß = -16.5 [-28.6; -4.3]). Participants with MetS (whole study sample) had 11.9 mmol/L lower Lp(a). Analogous results were found in postmenopausal women (ß = -25.4 [-46.0; -4.8]). In premenopausal women with MetS, Lp(a) levels were higher by 39.1 mg/L on average [12.3; 65.9]) than in premenopausal women without MetS. CONCLUSION: Hormonal aspects and menopausal alterations seem to affect the association between MetS and Lp(a), as the expected inverse association was not present in premenopausal women.
Published: 2021

43. Regional differences of undiagnosed type 2 diabetes and prediabetes prevalence are not explained by known risk factors.

Author: Teresa Tamayo, Sabine Schipf, Christine Meisinger, Michaela Schunk, Werner Maier, Christian Herder, Michael Roden, Matthias Nauck, Annette Peters, Henry Völzke, and Wolfgang Rathmann
Subjects: Medicine, Science
Abstract: We have previously found regional differences in the prevalence of known type 2 diabetes between northeastern and southern Germany. We aim to also provide prevalence estimates for prediabetes (isolated impaired fasting glucose (i-IFG), isolated glucose intolerance (i-IGT), combined IFG and IGT) and unknown type 2 diabetes for both regions.Prevalence (95%CI) of prediabetes (i-IFG: fasting glucose 5.6-6.9 mmol/l; i-IGT: 2 h postchallenge glucose 7.8-11.0 mmol/l, oral glucose tolerance test (OGTT), ≥ 8 h overnight fasting) and unknown diabetes were analyzed in two regional population-based surveys (age group 35-79 years): SHIP-TREND (Study of Health in Pomerania (northeast), 2008-2012) and KORA F4 (Cooperative Health Research in the region of Augsburg (south), 2006-2008). Both studies used similar methods, questionnaires, and identical protocols for OGTT. Overall, 1,980 participants from SHIP-TREND and 2,617 participants from KORA F4 were included.Age-sex-standardized prevalence estimates (95%CI) of prediabetes and unknown diabetes were considerably higher in the northeast (SHIP-TREND: 43.1%; 40.9-45.3% and 7.1%; 5.9-8.2%) than in the south of Germany (KORA F4: 30.1%; 28.4-31.7% and 3.9%; 3.2-4.6%), respectively. In particular, i-IFG (26.4%; 24.5-28.3% vs. 17.2%; 15.7-18.6%) and IFG+IGT (11.2%; 9.8-12.6% vs. 6.6%; 5.7-7.5%) were more frequent in SHIP-TREND than in KORA. In comparison to normal glucose tolerance, the odds of having unknown diabetes (OR, 95%CI: 2.59; 1.84-3.65) or prediabetes (1.98; 1.70-2.31) was higher in the northeast than in the south after adjustment for known risk factors (obesity, lifestyle).The regional differences of prediabetes and unknown diabetes are in line with the geographical pattern of known diabetes in Germany. The higher prevalences in the northeast were not explained by traditional risk factors.
Published: 2014
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44. Hepatic steatosis and hepatic iron overload modify the association of iron markers with glucose metabolism disorders and metabolic syndrome

Author: Jens-Peter Kühn, Wolfgang Rathmann, Stephan B. Felix, Marcus Dörr, Marie-Luise Kromrey, Marcello Ricardo Paulista Markus, Markus M. Lerch, Anitha Pitchika, Henry Völzke, Matthias Nauck, Till Ittermann, and Sabine Schipf
Subjects: medicine.medical_specialty, Iron Overload, Iron, Population, Type 2 diabetes, Impaired glucose tolerance, 03 medical and health sciences, 0302 clinical medicine, Glucose Metabolism Disorder, Internal medicine, Germany, medicine, Humans, education, chemistry.chemical_classification, Metabolic Syndrome, education.field_of_study, Hepatology, biology, business.industry, medicine.disease, Ferritin, Endocrinology, chemistry, Diabetes Mellitus, Type 2, Transferrin, 030220 oncology & carcinogenesis, biology.protein, 030211 gastroenterology & hepatology, Steatosis, Metabolic syndrome, business
Abstract: Background Iron status has been linked with impaired glucose metabolism (IGM), type 2 diabetes mellitus (T2DM) and the metabolic syndrome (MetS), but the role of hepatic steatosis or iron overload on these associations remains uncertain. Methods We analysed data from 2310 participants without known T2DM of the population-based Study of Health in Pomerania (SHIP-TREND, Germany) through logistic regression models. We tested additive and multiplicative interactions between ferritin and hepatic steatosis or iron overload. Results Serum ferritin was positively associated with IGM (OR per 100 µg/L: 1.11 [1.01, 1.23]), T2DM (OR per 100 µg/L: 1.20 [1.06, 1.36]) and MetS (OR per 100 µg/L: 1.11 [1.02, 1.20]) in the total population as well as in participants without hepatic iron overload. However, the synergistic effect of higher ferritin concentrations and hepatic iron overload showed stronger associations with IGM and T2DM. Similarly, while ferritin was positively associated with T2DM and MetS even in the absence of hepatic steatosis, the synergistic effect of higher ferritin concentrations and hepatic steatosis showed stronger associations with IGM, T2DM and MetS. Transferrin was associated with isolated impaired glucose tolerance but not with T2DM and MetS. Conclusions Our study suggests that ferritin may be associated with glucose metabolism disorders and MetS even in people without hepatic steatosis or iron overload. However, in individuals with higher ferritin concentrations, the presence of hepatic steatosis may indicate stronger risk for glucose metabolism disorders and MetS, while the presence of hepatic iron overload may indicate stronger risk only for glucose metabolism disorders.
Published: 2021

45. Diabetes mellitus und Metabolisches Syndrom bei Erwachsenen – Prävalenz, Bedeutung und Implikationen für die Prävention und Gesundheitsförderung

Author: Sabine Schipf, Marcello Ricardo Paulista Markus, and Marcus Dörr
Abstract: Die zunehmende Pravalenz des Typ-2-Diabetes-mellitus (T2DM) stellt eine grose Belastung fur die Gesundheitssysteme dar. Die Verteilung des T2DM weist regionale Unterschiede auf und ist mit Risikofaktoren wie Ubergewicht, Adipositas und Bewegungsmangel assoziiert. Eine Kombination bestimmter Risikofaktoren kann zur Entwicklung eines Metabolischen Syndroms (MetSyn) fuhren. Das MetSyn besteht aus den Komponenten viszeraler Adipositas, erhohtem Blutdruck, erhohter Nuchternplasmaglukose, erhohten Serumtriglyzeriden und niedrigem HDL-Cholesterin. Das MetSyn gilt als haufigste Ursache fur Herz-Kreislauf-Erkrankungen und T2DM und geht mit einem Morbiditats- und Mortalitatsrisiko einher. Eine Haufung der Komponenten des MetSyn ist bei Personen mit einer Glukoseintoleranz und T2DM zu finden. Das nicht ausgeschopfte Praventionspotenzial sollte identifiziert werden und sowohl das Verhalten als auch die Verhaltnisse einbeziehen, um Masnahmen zu implementieren, die auch regionale Besonderheiten berucksichtigen.
Published: 2021
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46. Author response: Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author: Zahra Mohammadi, Abdul Basit, Helena I. S. Nogueira, Soile E. Puhakka, Hongsheng Bi, Ari Voutilainen, Davood Khalili, Bin Zhou, Dermot O'Reilly, Natascia Rinaldo, Paulo A. Lotufo, Bahareh Kheiri, Thein Thein Htay, Simona Giampaoli, Goodarz Danaei, M. Fernanda Lima-Costa, Simona Bo, Peter Schnohr, Jerzy Chudek, Francesco Panza, Ling Yang, Katia Vergetti Bloch, Vincenzo Capuano, Holly E. Syddall, Dong Zhao, Indah Suci Widyahening, Maria Lorenza Muiesan, Leng Huat Foo, Mohsen Azimi-Nezhad, Merete Osler, Laura Torres-Collado, Manu Raj, Adroaldo Cesar Araujo Gaya, Susi Kriemler, Ali Akbar Shayesteh, Aneta Grajda, Anette Varbo, Kazem Mohammad, Leila Beltrami Moreira, Shu Ti Chiou, Iuliia A Rusakova, Jyh Eiin Wong, Torben Jørgensen, Lela Sturua, Lubica Ticha, Hamid Hakimi, Hazzaa M. Al-Hazzaa, Yanina Zócalo, Freda Pitakaka, Savvas C. Savva, Rajeev Gupta, Jennifer Servais, Marie Kunešová, Johanna M. Geleijnse, Elysée Claude Bika Lele, Yannis Manios, Jorge Escobedo-de la Peña, Yufang Bi, Chinh Nguyen Huu, Sibel Gogen, Viviane Cunha Cardoso, Kristine H. Allin, Ana Azevedo, Line Tang Møllehave, Vincent Jr DeGennaro, Novie O. Younger-Coleman, Gretchen A Stevens, Dickman Gareta, Holger Theobald, Anja Schienkiewitz, Bekbolat Zholdin, Janice Luisa Lukrafka, Adela Chirita-Emandi, Ulla Roggenbuck, Kenisha Russell Jonsson, Robespierre Ribeiro, Gabriele Eiben, Eero Kajantie, Sounnia Mediene Benchekor, Fariborz Mansour-Ghanaei, Mary Simon, Prakash C. Gupta, Mohammad Esmaeel Motlagh, Emanuela Gualdi-Russo, María Elena Díaz-Sánchez, Pilar Guallar-Castillón, Bee Koon Poh, Cristina Padez, Azaliia M Tuliakova, Sarah P. Garnett, William R. Tebar, Yingfeng Zheng, Suhad Bahijri, Christina Mavrogianni, Mihaela Vladulescu, Jan A. Staessen, Paula Duarte de Oliveira, Rui Ornelas, Michael Sjöström, Charles Agyemang, Slawomir Koziel, Shohreh Naderimagham, Jari Jokelainen, Stephen T. McGarvey, Patrick Pasquet, Farnam Mohebi, Nader Saki, Aida Pilav, Azim Nejatizadeh, Marianna Noale, Habiba Ben Romdhane, Luís B. Sardinha, Laura Lauria, Jun Hata, Kodanda R Kanala, Gert B. M. Mensink, Nils Lehmann, Elio Riboli, Carolina Tarqui-Mamani, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Luis Serra-Majem, Martina Müller-Nurasyid, Felipe Vogt Cureau, Lekhraj Rampal, Zhamilya Battakova, Ludmila Sevcikova, Suhaila Abdul Ghaffar, Fikru Tullu, Aung Soe Htet, Angel R. Gonzalez, Annette J. Dobson, Kavumpurathu Raman Thankappan, Hélène Delisle, Francisco J. Félix-Redondo, Ramón Suárez-Medina, Annika Rosengren, Sania Nishtar, Tanja G. M. Vrijkotte, Wolfgang Ahrens, Osvaldo Santos, Maria Cecília Formoso Assunção, Kazi M. Jamil, Stefano Marventano, Wenbin Wei, Norsyamlina Che Abdul Rahim, Shukri F. Mohamed, Bente Sparboe-Nilsen, Soon-Woo Park, Ana Isabel Rito, David Goltzman, W. M. Monique Verschuren, Catterina Ferreccio, Marta Buoncristiano, Ramón Alberto Rascón-Pacheco, Pradeep Joshi, Edward D Janus, Laetitia Huiart, Ala'a Alkerwi, Lorenza Pilotto, Mohannad Al Nsour, Daan Kromhout, Marius B. Bjertness, Oanh T. H. Trinh, Nico Dragano, Angélica Ochoa-Avilés, Ingunn Holden Bergh, Yuki Fujita, Juraci Almeida Cesar, Hajer Aounallah-Skhiri, Maria Dorobantu, Jordi Sunyer, Wolfgang Kratzer, Susanne R. de Rooij, Drude Molbo, Rebecca Goldsmith, Jean Woo, Mohammad El-khateeb, Tiffany K. Gill, Nish Chaturvedi, Benjamin Acosta-Cazares, Erik Lykke Mortensen, Nikhil D. Patel, Francesco Pistelli, Yuan He, Ivana Radic, Yi Zeng, Ilse Khouw, Reynaldo Martorell, Ching-Yu Cheng, Stine Schramm, Hana Shimizu-Furusawa, Jacek Jóźwiak, Radwan Qasrawi, Isti Ilmiati Fujiati, Charles Sossa Jérome, Ben Schöttker, Mikhail Benet, Anastasia Markaki, Christopher T. Cowell, Bharathi Viswanathan, Renata Kuciene, Jose Eugenio Lozano, Pedro J Ortiz, Delphine De Smedt, Elaine M. Murtagh, Kamel Ajlouni, Carlos A. Aguilar-Salinas, Graziella D'Arrigo, Xiangjun Wang, Lars Lind, Macia Enguerran, Marjeta Mišigoj-Duraković, Bo Werner, Jean-Michel Gaspoz, Kyungwon Oh, Seyed Rasoul Zakavi, Daniel Fernández-Bergés, Felix Kaducu, Ramon O. Jimenez, Jonathan E. Shaw, Nipa Rojroongwasinkul, Aicha Soumare, Astrid Petersmann, Tomasz Grodzicki, Parvina Mukhtorova, Eha Nurk, Bhawesh Koirala, Óscar Lopes, Ana Jelakovic, Karolina Milkowska, Magda Gasull, Regina Heidinger-Felso, Marcela González-Gross, Belong Cho, Daphne Mirkopoulou, Salvador Villalpando, Tran Quoc Bao, José Boggia, Daniela Galeone, Josep Redon, Matthias Bopp, Abbas Rezaianzadeh, Dusko Bjelica, Amir Houshang Mehrparvar, Felipe F. Casanueva, Khairil Si-Ramlee, Soheir H Ahmed, Maria Nordendahl, Luciana Zaccagni, Mahboubeh Parsaeian, Rod Jackson, Jorge Motta, Keiu Nelis, Fernando Rigo, Andrzej Pajak, Christa Meisinger, Clara Homs, Namuna Shrestha, Mar Alvarez-Pedrerol, Xun Tang, Johann Willeit, Motahareh Kheradmand, Jean Dallongeville, Jean-Bernard Ruidavets, Anne Tjønneland, Diana A. Santos, Lynne M. Boddy, Jie Hao, David Alejandro González-Chica, Elin Kolle, Jingli Gao, Małgorzata Mossakowska, Isabel O. Oliveira, Giuseppe Grosso, Seongjun Ha, Olfa Saidi, Albina A Fakhretdinova, Oye Gureje, Raluca Pop, Iulia Jurca Simina, Nuno Lunet, Maria Forsner, Peter Bjerregaard, Rachael McLean, Antonio Cabrera de León, Guy De Backer, José A. Casajús, Guang Ning, Emmanuella Magriplis, Laura Censi, Graziella Bruno, Valentina Peterkova, Angelique Chan, Yvonne T. van der Schouw, Charalambos Hadjigeorgiou, Anjani Kumar Jha, Toomas Veidebaum, Thamara Hubler Figueiró, Jana Kratenova, Michelle Cilia, Ivo Rakovac, Bill Stavreski, Ya Xing Wang, Oscar Noboa, Romana Roccaldo, Sara Magnacca, Johan Sundström, Peter Stehle, Tania Lopez, Francis Delpeuch, Julianne Williams, Ellisiv B. Mathiesen, Leanne M. Riley, Claudia M. Hormiga, Joanne Katz, Ekaterina Stoyanova, Heloisa Bettiol, Gabriele Nagel, Alireza Khosravi, Lars Bo Andersen, João Breda, Jørgen Meisfjord, Ahmad Faudzi Yusoff, Marjeta Majer, Robert Beaglehole, Caleb Ochimana, Shynar Abdrakhmanova, George S. Stergiou, Blanca Sandra Ruiz-Betancourt, Leon A. Simons, Eng Joo Tan, Victoria Farrugia Sant'Angelo, Gry Skodje, Maryam Keramati, Liv Elin Torheim, Seppo Koskinen, Assembekov Batyrbek, Jaakko Tuomilehto, Marjo-Riitta Järvelin, Ming-Hui Zhao, Krista Fischer, Tobias F. Rinke de Wit, Agnès Le Port, Reza Homayounfar, James E. Bennett, Yuna He, Matsuda Fumihiko, Qi Sheng You, Angela Spinelli, Scott B. McLean, Shirin Djalalinia, Thet Thet Mu, Yves Martin-Prével, Rafael N. Pichardo, Gailute Bernotiene, Pietro Amedeo Modesti, Frederick C. W. Wu, Chandini Nekkantti, Daniela Rodrigues, Tandi E. Matsha, Mihai Gafencu, Xingwang Ye, Salar Rahimikazerooni, Trevor S. Ferguson, Christophe Tzourio, Marie Zins, Fernando Rodríguez-Artalejo, Xu Ma, Elin Pettersen Sørgjerd, Lourdes Ribas-Barba, Nalan Uysal, Salim Berkinbayev, Enisa Kujundzic, Sari Voutilainen, Iraj Mohebbi, Heiner Boeing, Jorge Mota, Jana Námešná, Maria Tsigga, Zivka Dika, Gulmira Aitmurzaeva, Xu Lin, Valéria Regecová, Herman Schargrodsky, Stevo Popovic, Amelia C. Crampin, Hannu Uusitalo, André Luiz Sena Guimarães, Ali Esmaeili, Catherine Kyobutungi, Virginija Dulskiene, Diego Augusto Santos Silva, David De Ridder, Lizzy M. Brewster, Hashem Jaddou, Eunice Ugel, José Camolas, Azli Baharudin, Idris Guessous, Sok King Ong, Tabara Yasuharu, Ali Ghanbari, Anne W. Taylor, Iraj Nabipour, Justyna Godos, Cyrus Cooper, Bruna Gonçalves Cordeiro da Silva, Gonzalo Valdivia, Gyulli M. Kazakbaeva, Takuro Furusawa, Pawel Kurjata, Diego Vanuzzo, Marvin Cervantes-Loaiza, Karen Morgan, Mostafa Qorbani, Rute Santos, Marika Ferrari, Diego Salmerón, Ida Maria Schmidt, Gao Pei, Abu Am Hanif, Balkish M. Naidu, Maria Wany Louzada Strufaldi, Moesijanti Soekatri, Marcia Scazufca, Katharina Maruszczak, Jacqueline Ramke, Elvis Oa Wambiya, Kairit Mikkel, Napoleón Pérez-Farinós, Natalia Nowak-Szczepanska, Miao Li Chee, Jose Sanchez-Abanto, Rajaa Al-Raddadi, Michel Joffres, Vayia Rarra, Ningli Wang, Charmaine A. Duante, Sheikh Mohammed Shariful Islam, Manoli Garcia-de-la-Hera, Weili Yan, Dong Wook Shin, Rômulo Araújo Fernandes, Ilona Nenko, Sanjib Kumar Sharma, Alfonso Siani, Indrapal I. Meshram, Imelda A. Agdeppa, Ei Ei K. Nang, Ian Rouse, Avula Laxmaiah, Ana M. B. Menezes, Yih Chung Tham, Ebrahim Eftekhar, María José Tormo, Felicia Cañete, Marie Eliasen, Lutgart Braeckman, Dirk Vanderschueren, Genc Burazeri, Kari Kuulasmaa, Jesús Vioque, Marisa K. Sophiea, Agneta Sjöberg, Katarzyna Dereń, Albertino Damasceno, Jochanan Stessman, Stig E. Bojesen, Aline Meirhaeghe, Else Karin Grøholt, Flávio Danni Fuchs, Robert Lundqvist, Frédéric Gottrand, Jeongseon Kim, Helmut Schröder, Joanna Baran, Karina Mary de Paiva, Yousef Khader, Eric Monterrubio-Flores, Aneta Weres, Hans Concin, Damaskini Valvi, Sari Hantunen, Machi Suka, Elena Sacchini, Norbert Amougou, Ursula Kiechl-Kohlendorfer, Edwige Landais, Viktoria Anna Kovacs, Rosemarie Martin, Kenneth James, Amaneh Shayanrad, Grethe S. Tell, Norazizah Ibrahim Wong, Vedrana Sember, Anelise Reis Gaya, Konrad Jamrozik, Thorkild I. A. Sørensen, Martin Neovius, Urho M. 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Levitt, Miquel Porta, Vesna Jureša, Alexander D. Deev, Son Thai Pham, Paula Margozzini, Silvia Bel-Serrat, Dora Romaguera, Monira Alarouj, Winsome R. Parnell, Marloes Cardol, David Faeh, Antonio Bernabe-Ortiz, Giota Touloumi, Maryam Kavousi, Sanja Musić Milanović, Jalila El Ati, Sauli Herrala, Liang Xu, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Yi Song, Jianfeng Wu, Jeannette Klimont, Jean Ferrières, Farhad Zamani, Shina Avi, Luis Paulo Gomes Mascarenhas, Aluísio J D Barros, Reecha Sofat, Koen Van Herck, Hoang Van Minh, Enrique Gutiérrez-González, Martine Vrijheid, Susana Cararo Confortin, Antonis Zampelas, Bogdan Wojtyniak, Ausra Petrauskiene, Juha Auvinen, Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Young-Ho Khang, Ellina Rakhimova, Magdalena Klimek, Luís Lopes, Erkin M. Mirrakhimov, Maria Lc Iurilli, Günay Can, Mark Woodward, Esther Lopez-Garcia, Mauro Virgílio Gomes de Barros, Ahmed A. Madar, Rainford J. Wilks, Shoaib Afzal, Melanie J. Cowan, Gareth Stratton, Eduardo Salazar Martinez, Sameer Narake, Norie Sawada, Li Juan Wu, Adrian Richter, Licia Iacoviello, Hanno Ulmer, Deepak Amarapurkar, Mohsen Ibrahim, Hamed Pouraram, Massimo Salvetti, Hung-Kwan So, Yonghua Hu, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Sabina Zambon, Angelika Schaffrath Rosario, Lauren Lissner, Kamarul Imran Musa, Deepa Weerasekera, Bihungum Bista, Takafumi Ishida, Ekaterina Chikova-Iscener, Mirjam M. Heinen, Tazeen H. Jafar, Semánová Csilla, Raija Korpelainen, Edward W. Gregg, Laura Gutierrez, Victor M. Herrera, Aristides M. Machado-Rodrigues, Fatemeh Malekzadeh, Shouling Wu, Jennifer L. Baker, Clicerio González-Villalpando, Irene G. M. van Valkengoed, Anna Fijałkowska, Meghnath Dhimal, Murat Topbaş, George Moschonis, Robert Eggertsen, Quang Ngoc Nguyen, Janette Walton, Elnaz Faramarzi, Nasheeta Peer, Radka Taxová Braunerová, Harald Geiger, Morteza Shamshirgaran, Lela Shengelia, María Ángeles Dal Re Saavedra, Khem Bahadur Karki, Timothy J. Key, Maria G. Grammatikopoulou, Susana Vale, Bernhard O. Boehm, Songhomitra Panda-Jonas, Iveta Pudule, Elisabete Ramos, Lacramioara Aurelia Brinduse, Paul H. Lee, Terence W O'Neill, Javad Aghazadeh-Attari, Margus Punab, Bojan Jelaković, Eliza Cinteza, Ha Tp Do, and Alison J. Hayes
Subjects: education.field_of_study, business.industry, Population, Distribution (economics), medicine.disease, Obesity, Geography, medicine, Underweight, medicine.symptom, education, business, Body mass index, Demography
Published: 2020
Full Text: View/download PDF

47. Disentangling the genetics of lean mass

Author: Tuomas O. Kilpeläinen, Jacqueline S. L. Kloth, Nam H. Cho, Peter Vollenweider, Georg Homuth, Unnur Thorsteinsdottir, Nicole C. Wright, Wen-Chi Chou, Yongmei Liu, Kari Stefansson, Kim M. Huffman, Ida Malkin, Andrew P. Morris, Robert Luben, Shad B. Smith, Lei Yu, Joel Eriksson, Aarno Palotie, Veikko Salomaa, Michael J. Econs, Liesbeth Vandenput, Elizabeth A. Streeten, Albert Hofman, Elisabeth Widen, Emmi Tikkanen, Braxton D. Mitchell, Natasja M. van Schoor, Caroline Hayward, Liisa Byberg, Joanne M. Jordan, Bruce M. Psaty, Elisabeth Steinhagen-Thiessen, Magnus Karlsson, Harry Campbell, John C. Chambers, Fernando Rivadeneira, Johan G. Eriksson, Jari Lahti, Reiner Biffar, James F. Wilson, Luda Diatchenko, Jerome I. Rotter, Eric S. Orwoll, Launer J. Lenore, Cornelia M. van Duijn, Frances M K Williams, Munro Peacock, David A. Bennett, Annette Peters, Ali A. Aghdassi, Gudny Eiriksdottir, Weihua Zhang, Östen Ljunggren, Daniel L. Koller, Nicole Soranzo, Patricia A. Thompson, Jane A. Cauley, John A Robbins, Mattias Lorentzon, Igor Rudan, Thomas Illig, Claes Ohlsson, Ilja Demuth, Zoltán Kutalik, Aron S. Buchman, Jian'an Luan, Erik Ingelsson, Natalia Campos-Obando, Karol Estrada, Chan Soo Shin, Lisette Stolk, Gudmar Thorleifsson, Douglas P. Kiel, Michael N. Weedon, Lars Bertram, Fiona E. McGuigan, Ben A. Oostra, Thomas Meitinger, Mary F. Feitosa, Christian Gieger, Jean Wactawski-Wende, Yanhua Zhou, Serkalem Demissie, Najaf Amin, Anke W. Enneman, Håkan Melhus, Stuart H. Ralston, Johanna Kuusisto, Markku Laakso, Mark Walker, Tim D. Spector, Karl Michaëlsson, John-Olov Jansson, Richard L. Prince, Leif Mosekilde, Sabine Schipf, Carolina Medina-Gomez, Antti Jula, Carrie M. Nielson, Bente L. Langdahl, André G. Uitterlinden, Kay-Tee Khaw, Ruth J. F. Loos, Kristina Åkesson, Albert V. Smith, Tamara B. Harris, Cynthia A. Thomson, Karin M. A. Swart, Unnur Styrkarsdottir, Yi-Hsiang Hsu, Anne B. Newman, Murielle Bochud, M. Carola Zillikens, Alena Stančáková, Markus M. Lerch, Maria Nethander, Gregory Livshits, Dawn Waterworth, Christina M. Lill, Henry Völzke, Steven R. Cummings, Lise B. Husted, Cecilia M. Lindgren, Jaspal S. Kooner, Joshua R. Lewis, Katri Räikkönen, Linda Broer, Inês Barroso, Teemu Kuulasmaa, Jeffery R. O'Connell, Harald Grallert, William E. Kraus, Nicholas J. Wareham, Lars Lind, David Karasik, H-Erich Wichmann, Gregory J. Tranah, Mao Fu, Toby Johnson, Samuli Ripatti, Dan Mellström, Suzanne Satterfield, Jing Hua Zhao, Hyung Jin Choi, Vilmundur Gudnason, Lisette C. P. G. M. de Groot, Stephen B. Kritchevsky, Zhao Chen, Norman Klopp, Till Ittermann, Daniel S. Evans, Phillip L. De Jager, Ingrid B. Borecki, Laura M. Yerges-Armstrong, Peggy M. Cawthon, Thomas Lang, Markus Perola, Internal Medicine, Epidemiology, Clinical Genetics, General practice, APH - Societal Participation & Health, APH - Aging & Later Life, Epidemiology and Data Science, and APH - Personalized Medicine
Subjects: Adipose Tissue/metabolism, Male, 0301 basic medicine, Medicine (miscellaneous), Body Fluid Compartments/metabolism, Genome-wide association study, FTO gene, ADAMTS Proteins, Absorptiometry, Photon, Versicans, 0302 clinical medicine, Electric Impedance, European Continental Ancestry Group/genetics, Aged, 80 and over, 2. Zero hunger, Genetics, Extracellular Matrix Proteins, Nutrition and Dietetics, ADAMTS Proteins/genetics, RNA-Binding Proteins, Body Fluid Compartments, Middle Aged, metabolic profile, Nutritional Biology, body fat, Original Research Communications, Phenotype, Adipose Tissue, Body Composition, Receptor, Melanocortin, Type 4, Female, Bioelectrical impedance analysis, Adult, meta-analysis of genome-wide association studies, Versicans/genetics, Adolescent, Alpha-Ketoglutarate-Dependent Dioxygenase FTO, 030209 endocrinology & metabolism, Locus (genetics), Single-nucleotide polymorphism, Biology, Extracellular Matrix Proteins/genetics, meta-Analysis of genome-wide association studies, Polymorphism, Single Nucleotide, White People, Young Adult, 03 medical and health sciences, Humans, Receptor, Melanocortin, Type 4/genetics, skeletal muscle, Allele, Muscle, Skeletal, VLAG, Aged, Global Nutrition, Wereldvoeding, Body Composition/genetics, body composition, Muscle, Skeletal/metabolism, 030109 nutrition & dietetics, Alpha-Ketoglutarate-Dependent Dioxygenase FTO/genetics, RNA-Binding Proteins/genetics, Genetic architecture, Lean body mass, Genome-Wide Association Study
Abstract: Background: Lean body mass (LM) plays an important role in mobility and metabolic function. We previously identified five loci associated with LM adjusted for fat mass in kilograms. Such an adjustment may reduce the power to identify genetic signals having an association with both lean mass and fat mass.Objectives: To determine the impact of different fat mass adjustments on genetic architecture of LM and identify additional LM loci.Methods: We performed genome-wide association analyses for whole-body LM (20 cohorts of European ancestry with n = 38,292) measured using dual-energy X-ray absorptiometry) or bioelectrical impedance analysis, adjusted for sex, age, age2, and height with or without fat mass adjustments (Model 1 no fat adjustment; Model 2 adjustment for fat mass as a percentage of body mass; Model 3 adjustment for fat mass in kilograms).Results: Seven single-nucleotide polymorphisms (SNPs) in separate loci, including one novel LM locus (TNRC6B), were successfully replicated in an additional 47,227 individuals from 29 cohorts. Based on the strengths of the associations in Model 1 vs Model 3, we divided the LM loci into those with an effect on both lean mass and fat mass in the same direction and refer to those as "sumo wrestler" loci (FTO and MC4R). In contrast, loci with an impact specifically on LM were termed "body builder" loci (VCAN and ADAMTSL3). Using existing available genome-wide association study databases, LM increasing alleles of SNPs in sumo wrestler loci were associated with an adverse metabolic profile, whereas LM increasing alleles of SNPs in "body builder" loci were associated with metabolic protection.Conclusions: In conclusion, we identified one novel LM locus (TNRC6B). Our results suggest that a genetically determined increase in lean mass might exert either harmful or protective effects on metabolic traits, depending on its relation to fat mass.
Published: 2019
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48. Lower Cardiorespiratory Fitness Is Associated With a Smaller and Stiffer Heart: The Sedentary's Heart

Author: Marcello Ricardo Paulista, Markus, Till, Ittermann, Christine Julia, Drzyzga, Martin, Bahls, Sabine, Schipf, Ulrike, Siewert-Markus, Sebastian Edgar, Baumeister, Ralf, Ewert, Henry, Völzke, Elisabeth, Steinhagen-Thiessen, Robin, Bülow, Heribert, Schunkert, Ramachandran S, Vasan, Stephan Burkhard, Felix, and Marcus, Dörr
Subjects: Cardiorespiratory Fitness, Heart Rate, Predictive Value of Tests, Exercise Test, Humans, Heart
Published: 2020

49. [Occurrence of bronchial asthma and age at initial asthma diagnosis-first results of the German National Cohort]

Author: Susan, Langer, Johannes, Horn, Alexander, Kluttig, Rafael, Mikolajczyk, Stefan, Karrasch, Holger, Schulz, Heinz-Erich, Wichmann, Jakob, Linseisen, Lina, Jaeschke, Tobias, Pischon, Julia, Fricke, Thomas, Keil, Wolfgang, Ahrens, Kathrin, Günther, Oliver, Kuß, Tamara, Schikowski, Börge, Schmidt, Karl-Heinz, Jöckel, Karin B, Michels, Claus-Werner, Franzke, Heiko, Becher, Annika, Jagodzinski, Stefanie, Castell, Yvonne, Kemmling, Wolfgang, Lieb, Sabina, Waniek, Kerstin, Wirkner, Markus, Löffler, Rudolf, Kaaks, Karin Halina, Greiser, Klaus, Berger, Nicole, Legath, Claudia, Meinke-Franze, Sabine, Schipf, Michael, Leitzmann, Hansjörg, Baurecht, Korbinian, Weigl, Efrat, Amitay, Cornelia, Gottschick, and HZI, Helmholtz Zentrum für Infektionsforschung GmbH, Inhoffenstr.7, 38124 Braunschweig, Germany.
Subjects: Adult, Male, Respiratory diseases, Age Factors, General population, Asthma, Cohort Studies, Germany, Surveys and Questionnaires, Chronic diseases, Chronic Disease, Humans, Female, Age of Onset, Child, Cohort study
Abstract: Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA.Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex.In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated.The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.HINTERGRUND: Asthma bronchiale stellt über alle Bildungsschichten hinweg eine der häufigsten chronischen Erkrankungen im Kindes- und Erwachsenenalter dar. Im Erwachsenenalter erstmals auftretendes Asthma (Adult-onset Asthma, AOA) ist im Vergleich zu Childhood-onset Asthma (COA) mit einer schlechteren Prognose assoziiert, was verstärkte Untersuchungen in diesem Bereich erfordert. Ziel der Arbeit war es, Häufigkeiten und das Alter bei Erstdiagnose aus Selbstangaben zu Asthma bei Erwachsenen in der NAKO Gesundheitsstudie darzustellen und mit Daten der Studie zur Gesundheit Erwachsener in Deutschland (DEGS) zu vergleichen.Unsere Analyse beruht auf einem Datensatz zur Halbzeit der NAKO-Basiserhebung mit 101.284 Personen. Verwendete Variablen waren die Selbstangabe zum jemals ärztlich diagnostizierten Asthma, Alter bei Erstdiagnose, Behandlung in den letzten 12 Monaten, Alter und Geschlecht.Laut Datenbasis zur Halbzeit berichteten in der NAKO 8,7 % der Frauen und 7,0 % der Männer, dass bei ihnen jemals Asthma diagnostiziert wurde. Etwa bei einem Drittel der Teilnehmenden mit Asthma wurde die Diagnose bereits im Kindes‑/Jugendalter (18 Jahre) gestellt. Dabei waren 2,2 % der Frauen und 2,8 % der Männer von COA betroffen und 6,5 % der Frauen und 4,2 % der Männer von AOA. In den vorangegangenen 12 Monaten gaben 33 % der COA-Fälle und 60 % der AOA-Fälle an, ärztlich behandelt worden zu sein.Die Häufigkeit von Asthma in der NAKO Gesundheitsstudie in Abhängigkeit von Alter und Geschlecht entspricht weitgehend den Daten aus anderen Studien wie DEGS. Allerdings ist der AOA-Anteil höher als in der Literatur beschrieben. Der Anstieg der kumulativen Asthmadiagnosen ist bei den jüngeren Geburtsjahrgängen deutlich steiler, was für eine Zunahme über die Zeit spricht.
Published: 2020

50. Genome-wide association study to identify common variants associated with brachial circumference: a meta-analysis of 14 cohorts.

Author: Vesna Boraska, Aaron Day-Williams, Christopher S Franklin, Katherine S Elliott, Kalliope Panoutsopoulou, Ioanna Tachmazidou, Eva Albrecht, Stefania Bandinelli, Lawrence J Beilin, Murielle Bochud, Gemma Cadby, Florian Ernst, David M Evans, Caroline Hayward, Andrew A Hicks, Jennifer Huffman, Cornelia Huth, Alan L James, Norman Klopp, Ivana Kolcic, Zoltán Kutalik, Debbie A Lawlor, Arthur W Musk, Marina Pehlic, Craig E Pennell, John R B Perry, Annette Peters, Ozren Polasek, Beate St Pourcain, Susan M Ring, Erika Salvi, Sabine Schipf, Jan A Staessen, Alexander Teumer, Nicholas Timpson, Veronique Vitart, Nicole M Warrington, Hanieh Yaghootkar, Tatijana Zemunik, Lina Zgaga, Ping An, Verneri Anttila, Ingrid B Borecki, Jostein Holmen, Ioanna Ntalla, Aarno Palotie, Kirsi H Pietiläinen, Juho Wedenoja, Bendik S Winsvold, George V Dedoussis, Jaakko Kaprio, Michael A Province, John-Anker Zwart, Michel Burnier, Harry Campbell, Daniele Cusi, George Davey Smith, Timothy M Frayling, Christian Gieger, Lyle J Palmer, Peter P Pramstaller, Igor Rudan, Henry Völzke, H-Erich Wichmann, Alan F Wright, and Eleftheria Zeggini
Subjects: Medicine, Science
Abstract: Brachial circumference (BC), also known as upper arm or mid arm circumference, can be used as an indicator of muscle mass and fat tissue, which are distributed differently in men and women. Analysis of anthropometric measures of peripheral fat distribution such as BC could help in understanding the complex pathophysiology behind overweight and obesity. The purpose of this study is to identify genetic variants associated with BC through a large-scale genome-wide association scan (GWAS) meta-analysis. We used fixed-effects meta-analysis to synthesise summary results across 14 GWAS discovery and 4 replication cohorts comprising overall 22,376 individuals (12,031 women and 10,345 men) of European ancestry. Individual analyses were carried out for men, women, and combined across sexes using linear regression and an additive genetic model: adjusted for age and adjusted for age and BMI. We prioritised signals for follow-up in two-stages. We did not detect any signals reaching genome-wide significance. The FTO rs9939609 SNP showed nominal evidence for association (p
Published: 2012
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