TY - JOUR AB - In multi-analyst studies, several analysts use the same data to independently investigate identical research questions. Multi-analyst studies have been conducted mainly in psychology, social sciences, and neuroscience, but rarely in epidemiology. Sixteen analyst groups (24 researchers) with backgrounds mainly in statistics, mathematics, and epidemiology were asked to independently perform an analysis on the influence of marital status (never married versus cohabiting married) on cardiovascular outcomes. They were asked to use data from the Survey of Health, Ageing and Retirement in Europe (SHARE), a panel study of 140,000 persons aged 50 years and above from 28 European countries and Israel, and to provide an effect estimate, a comment on their results, and the full syntax of their analyses. In additional analyses beyond the multi-analyst approach, one group selected an exemplary regression model and varied definitions of exposure and outcome and the confounder adjustment set. Each analysis was unique. The size of the 16 datasets used for the analyses ranged from 15,592 to 336,914 observations. The effect estimates (odds ratios, hazard ratios, or relative risks) ranged from 0.72 to 1.02 (reference: cohabiting married) in strictly or partly cross-sectional analyses and from 0.95 to 1.31 in strictly longitudinal analyses. The choice of regression models, adjustment sets for confounding, and variations in the precise definition of exposure and outcome, all had only small effects on the effect estimates. The range of results was mainly due to differences from cross-sectional versus longitudinal analyses rather than to single analytical decisions each of which had less influence. AU - Kowall, B.* AU - Ahrenfeldt, L.J.* AU - Basten, J.* AU - Becher, H.* AU - Brand, T.* AU - Braun, J.* AU - Casjens, S.* AU - Claessen, H.* AU - Denz, R.* AU - Diebner, H.H.* AU - Diexer, S.* AU - Eisemann, N.* AU - Furrer, E.* AU - Galetzka, W.* AU - Girschik, C.* AU - Karch, A.* AU - Mikolajczyk, R.* AU - Peters, M.* AU - Rospleszcz, S. AU - Rücker, V.* AU - Stang, A.* AU - Stolpe, S.* AU - Taylor, K.J.* AU - Timmesfeld, N.* AU - Tokic, M.* AU - Zeeb, H.* AU - Berg-Beckhoff, G.* AU - Behrens, T.* AU - Ittermann, T.* AU - Rübsamen, N.* C1 - 74286 C2 - 57418 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands TI - Marital status and risk of cardiovascular disease - a multi-analyst study in epidemiology. JO - Eur. J. Epidemiol. PB - Springer PY - 2025 SN - 0393-2990 ER - TY - JOUR AB - The German National Cohort (NAKO) is the largest population-based epidemiologic cohort study in Germany and investigates the causes of the most common chronic diseases. Between 2014 and 2019, a total of 1.3 million residents aged 20-69 years from 16 German regions were randomly selected from the general population and invited to participate following a highly standardized recruitment protocol. The overall response was 15.6% and differed considerably across study centers (7.6-30.7%). Females were more likely to participate than males (17.5% vs. 14.1%) and participation increased with age (10.2% in age group " < 29 years" up to 20.7% in age group " > 60 years"). Across all study regions, response was highest in rural areas (22.3%), followed by towns and suburbs (17.2%), and was lowest in cities (14.5%). Compared with the general population in the respective study regions, participants with low and medium education are underrepresented in the NAKO sample, while highly educated participants are overrepresented. Participants with non-German nationality and with a migration background are also underrepresented. Participants living in single households are underrepresented, while participants from larger households (2 or more persons) are overrepresented compared to the general population. Survey weights are made available to researchers along with the study data that account for the sampling design and adjust for differences in the distribution of age, sex, nationality (German vs. non-German), migration status, education, and household size. AU - Rach, S.* AU - Sand, M.* AU - Reineke, A.* AU - Becher, H.* AU - Greiser, K.H.* AU - Wolf, K. AU - Wirkner, K.* AU - Schmidt, C.O.* AU - Schipf, S.* AU - Jöckel, K.H.* AU - Krist, L.* AU - Ahrens, W.* AU - Brenner, H.* AU - Castell, S.* AU - Gastell, S.* AU - Harth, V.* AU - Holleczek, B.* AU - Ittermann, T.* AU - Janisch-Fabian, S.* AU - Karch, A.* AU - Keil, T.* AU - Klett-Tammen, C.J.* AU - Kluttig, A.* AU - Kuß, O.* AU - Leitzmann, M.* AU - Lieb, W.* AU - Meinke-Franze, C.* AU - Michels, K.B.* AU - Mikolajczyk, R.* AU - Moreno Velásquez, I.* AU - Obi, N.* AU - Övermöhle, C.* AU - Peters, A. AU - Pischon, T.* AU - Rospleszcz, S. AU - Schmidt, B.* AU - Schulze, M.B.* AU - Stang, A.* AU - Teismann, H.* AU - Töpfer, C.* AU - Wolff, R.* AU - Günther, K.* C1 - 74163 C2 - 57356 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands TI - The baseline examinations of the German National Cohort (NAKO): Recruitment protocol, response, and weighting. JO - Eur. J. Epidemiol. PB - Springer PY - 2025 SN - 0393-2990 ER - TY - JOUR AB - AIMS: Heart-rate variability (HRV) measures are surrogates of autonomic function at the level of the sinus node and have evolved as markers of cardiovascular mortality in patients after myocardial infarction (MI). Traditionally, HRV is assessed in time-domain and frequency domain. Advanced measures of autonomic function include deceleration capacity (DC) and periodic repolarization dynamics (PRD). DC predominantly quantifies the influence of parasympathetic tone. PRD captures low-frequency oscillations of repolarization instability and is considered to reflect sympathetic activity at the level of the left ventricular myocardium. However, population-based reference values are missing. METHODS AND RESULTS: In 505 participants of the population-based KORA F3 study (Cooperative Health Research in the Region of Augsburg) with extant digital 24-h Holter electrocardiograms we assessed markers of HRV in time and frequency domains. Additionally, we determined advanced measures of autonomic function including DC and PRD applying previously established technologies. We used standard, pre-defined cut-off values to define high-risk groups. The cohort's mean age was 63.6 ± 5.5 years, and 256 (50.1%) were women. Among HRV measures, exemplarily the median standard deviation of all normal-to-normal intervals (SDNN) was 141 ms [119;165] and the median low frequency to high frequency ratio (LF/HF-ratio) was 3.92 [2.69;6.18]. Regarding autonomic function, median DC was 5.32 ms [2.69;6.18], and median PRD was 2.92 ms [2.06;4.14]. Among these measures LF/HF-ratio was significantly higher among men (5.15 [3.23; 7.20]) than women (3.37 [2.36;4.53], p < 0.001). Measured distribution is also provided in a cohort subset without overt cardiovascular conditions. While DC decreased with age, SDNN, LF/HF-ratio, and PRD were stable across age-groups. For participants with comorbidities including hypertension, intake of betablockers, history of MI, stroke, or diabetes mellitus significantly lower SDNN, LF/HF-ratio, and DC were observed. CONCLUSION: In a large population-based cohort, we systematically present traditional and advanced measures of HRV of cardiac autonomic function. We report reference values in the overall cohort, as well as stratified by sex, age, and concomitant cardiovascular conditions. AU - von Falkenhausen, A.S.* AU - Wenner, F.N.* AU - Freyer, L.* AU - Sams, L.E.* AU - Heier, M. AU - Peters, A. AU - Linkohr, B. AU - Massberg, S.* AU - Bauer, A.* AU - Kääb, S.* AU - Rizas, K.D.* AU - Sinner, M.F.* C1 - 75027 C2 - 57707 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 815–832 TI - Traditional and advanced electrocardiographic measures of autonomic function in the population-based KORA-F3 study. JO - Eur. J. Epidemiol. VL - 40 PB - Springer PY - 2025 SN - 0393-2990 ER - TY - JOUR AB - Research has indicated that sex hormone-binding globulin (SHBG) is associated with glucose homeostasis and may play a role in the etiology of type 2 diabetes (T2D). While it is unclear whether SHBG may mediate sex differences in glucose control and subsequently, incidence of T2D. We used observational data from the German population-based KORA F4 study (n = 1937, mean age: 54 years, 41% women) and its follow-up examination KORA FF4 (median follow-up 6.5 years, n = 1387). T2D was initially assessed by self-report and validated by contacting the physicians and/ or reviewing the medical charts. Mediation analyses were performed to assess the role of SHBG in mediating the association between sex (women vs. men) and glucose- and insulin-related traits (cross-sectional analysis) and incidence of T2D (longitudinal analysis). After adjustment for confounders, (model 1: adjusted for age; model 2: model 1 + smoking + alcohol consumption + physical activity), women had lower fasting glucose levels compared to men (β = -4.94 (mg/dl), 95% CI: -5.77, -4.11). SHBG levels were significantly higher in women than in men (β = 0.47 (nmol/l), 95% CI:0.42, 0.51). Serum SHBG may mediate the association between sex and fasting glucose levels with a proportion mediated (PM) of 30% (CI: 22-41%). Also, a potential mediatory role of SHBG was observed for sex differences in incidence of T2D (PM = 95% and 63% in models 1 and 2, respectively). Our novel findings suggest that SHBG may partially explain sex-differences in glucose control and T2D incidence. AU - Raeisi-Dehkordi, H.* AU - Amiri, M.* AU - Rathmann, W.* AU - Zeller, T.* AU - Adamski, J. AU - Bano, A.* AU - van der Schouw, Y.T.* AU - Thorand, B. AU - Muka, T.* AU - Nano, J. C1 - 71026 C2 - 55831 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 915-924 TI - Sex hormone-binding globulin may explain sex differences for glucose homeostasis and incidence of type 2 diabetes: The KORA study. JO - Eur. J. Epidemiol. VL - 39 PB - Springer PY - 2024 SN - 0393-2990 ER - TY - JOUR AU - Bendt, A.K.* AU - Mir, S.A.* AU - Maier, A.B.* AU - Goh, J.* AU - Low, I.C.C.* AU - Lee, J.K.W.* AU - Koh, A.S.* AU - Wenk, M.R.* AU - Adamski, J. C1 - 68581 C2 - 54991 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 713-715 TI - Lessons from the Singapore cohorts showcase symposium—open call for collaborations. JO - Eur. J. Epidemiol. VL - 38 IS - 6 PB - Springer PY - 2023 SN - 0393-2990 ER - TY - JOUR AB - The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alcohol intake with hazard of all-cause mortality across EL (lower = primary-school; middle = secondary-school; higher = university/college degree) was assessed using multivariable Cox-regression and spline curves. A total of 16,695 deaths occurred in 11.8 years (median). In comparison with life-long abstainers, participants drinking 0.1–10 g/d of ethanol had 13% (HR = 0.87; 95%CI: 0.74–1.02), 11% (HR = 0.89; 0.84–0.95) and 5% (HR = 0.95; 0.89–1.02) lower rate of death in higher, middle and lower EL, respectively. Conversely, drinkers > 20 g/d had 1% (HR = 1.01; 0.82–1.25), 10% (HR = 1.10; 1.02–1.19) and 17% (HR = 1.17; 1.09–1.26) higher rate of death. The association of alcohol consumption with all-cause mortality was nonlinear, with a different J-shape by EL levels. It was consistent across both sexes and in various approaches of measuring alcohol consumption, including combining quantity and frequency and it was more evident when the beverage of preference was wine. We observed that drinking in moderation (≤ 10 g/d) is associated with lower mortality rate more evidently in individuals with higher EL than in people with lower EL, while heavy drinking is associated with higher mortality rate more evidently in individuals with lower EL than in people with higher EL, suggesting that advice on reducing alcohol intake should especially target individuals of low EL. AU - Di Castelnuovo, A.* AU - Bonaccio, M.* AU - Costanzo, S.* AU - McElduff, P.* AU - Linneberg, A.* AU - Salomaa, V.* AU - Männistö, S.* AU - Ferrieres, J.* AU - Dallongeville, J.* AU - Thorand, B. AU - Brenner, H.* AU - Ferrario, M.* AU - Veronesi, G.* AU - Tamosiunas, A.* AU - Grimsgaard, S.* AU - Drygas, W.* AU - Malyutina, S.* AU - Söderberg, S.* AU - Nordendahl, M.* AU - Kee, F.* AU - Grassi, G.* AU - Dabboura, S.* AU - Borchini, R.* AU - Westermann, D.* AU - Schrage, B.* AU - Zeller, T.* AU - Kuulasmaa, K.* AU - Blankenberg, S.* AU - Donati, M.B.* AU - Iacoviello, L.* AU - de Gaetano, G.* C1 - 68456 C2 - 54644 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 869-881 TI - Drinking alcohol in moderation is associated with lower rate of all-cause mortality in individuals with higher rather than lower educational level: Findings from the MORGAM project. JO - Eur. J. Epidemiol. VL - 38 IS - 8 PB - Springer PY - 2023 SN - 0393-2990 ER - TY - JOUR AB - The German National Cohort (NAKO) is a multidisciplinary, population-based prospective cohort study that aims to investigate the causes of widespread diseases, identify risk factors and improve early detection and prevention of disease. Specifically, NAKO is designed to identify novel and better characterize established risk and protection factors for the development of cardiovascular diseases, cancer, diabetes, neurodegenerative and psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases in a random sample of the general population. Between 2014 and 2019, a total of 205,415 men and women aged 19-74 years were recruited and examined in 18 study centres in Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires and a wide range of biomedical examinations. Biomaterials were collected from all participants including serum, EDTA plasma, buffy coats, RNA and erythrocytes, urine, saliva, nasal swabs and stool. In 56,971 participants, an intensified examination programme was implemented. Whole-body 3T magnetic resonance imaging was performed in 30,861 participants on dedicated scanners. NAKO collects follow-up information on incident diseases through a combination of active follow-up using self-report via written questionnaires at 2-3 year intervals and passive follow-up via record linkages. All study participants are invited for re-examinations at the study centres in 4-5 year intervals. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. NAKO is a major resource for population-based epidemiology to identify new and tailored strategies for early detection, prediction, prevention and treatment of major diseases for the next 30 years. AU - Peters, A. AU - German National Cohort (NAKO) Consortium* AU - Greiser, K.H.* AU - Göttlicher, S. AU - Ahrens, W.* AU - Albrecht, M.* AU - Bamberg, F.* AU - Barnighausen, T.* AU - Becher, H.* AU - Berger, K.* AU - Beule, A.* AU - Boeing, H.* AU - Bohn, B.* AU - Bohnert, K.* AU - Braun, B.* AU - Brenner, H.* AU - Bülow, R.* AU - Castell, S.* AU - Damms-Machado, A.* AU - Dörr, M.* AU - Ebert, N.* AU - Ecker, M.* AU - Emmel, C.* AU - Fischer, B.* AU - Franzke, C.W.* AU - Gastell, S.* AU - Giani, G.* AU - Günther, M.* AU - Günther, K.* AU - Günther, K.P.* AU - Haerting, J.* AU - Haug, U.* AU - Heid, I.M.* AU - Heier, M. AU - Heinemeyer, D.* AU - Hendel, T. AU - Herbolsheimer, F.* AU - Hirsch, J.* AU - Hoffmann, W.* AU - Holleczek, B.* AU - Hölling, H.* AU - Hörlein, A. AU - Jöckel, K.H.* AU - Kaaks, R.* AU - Karch, A.* AU - Karrasch, S. AU - Kartschmit, N.* AU - Kauczor, H.U.* AU - Keil, T.* AU - Kemmling, Y.* AU - Klee, B.* AU - Klüppelholz, B.* AU - Kluttig, A.* AU - Kofink, L.* AU - Köttgen, A.* AU - Kraft, D.* AU - Krause, G.* AU - Kretz, L.* AU - Krist, L.* AU - Kühnisch, J.* AU - Kuß, O.* AU - Legath, N.* AU - Lehnich, A.T.* AU - Leitzmann, M.* AU - Lieb, W.* AU - Linseisen, J. AU - Loeffler, M.* AU - Macdonald, A.J.* AU - Maier-Hein, K.H.* AU - Mangold, N.* AU - Meinke-Franze, C.* AU - Meisinger, C.* AU - Melzer, J.* AU - Mergarten, B.* AU - Michels, K.B.* AU - Mikolajczyk, R.* AU - Moebus, S.* AU - Mueller, U.* AU - Nauck, M.* AU - Niendorf, T.* AU - Nikolaou, K.* AU - Obi, N.* AU - Ostrzinski, S.* AU - Panreck, L.* AU - Pigeot, I.* AU - Pischon, T.* AU - Pschibul-Thamm, I. AU - Rathmann, W.* AU - Reineke, A.* AU - Roloff, S.* AU - Rujescu, D.* AU - Rupf, S.* AU - Sander, O.* AU - Schikowski, T.* AU - Schipf, S.* AU - Schirmacher, P.* AU - Schlett, C.L.* AU - Schmidt, B.* AU - Schmidt, G.* AU - Schmidt, M.* AU - Schöne, G.* AU - Schulz, H. AU - Schulze, M.B.* AU - Schweig, A.* AU - Sedlmeier, A.M.* AU - Selder, S.* AU - Six-Merker, J. AU - Sowade, R.* AU - Stang, A.* AU - Stegle, O.* AU - Steindorf, K.* AU - Stübs, G.* AU - Swart, E.* AU - Teismann, H.* AU - Thiele, I. AU - Thierry, S. AU - Ueffing, M.* AU - Völzke, H.* AU - Waniek, S.* AU - Weber, A.* AU - Werner, N.* AU - Wichmann, H.-E. AU - Willich, S.N.* AU - Wirkner, K.* AU - Wolf, K. AU - Wolff, R.* AU - Zeeb, H.* AU - Zinkhan, M.* AU - Zschocke, J.* C1 - 66476 C2 - 52837 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 1107-1124 TI - Framework and baseline examination of the German National Cohort (NAKO). JO - Eur. J. Epidemiol. VL - 37 IS - 10 PB - Springer PY - 2022 SN - 0393-2990 ER - TY - JOUR AB - The German government initiated the Network University Medicine (NUM) in early 2020 to improve national research activities on the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic. To this end, 36 German Academic Medical Centers started to collaborate on 13 projects, with the largest being the National Pandemic Cohort Network (NAPKON). The NAPKON's goal is creating the most comprehensive Coronavirus Disease 2019 (COVID-19) cohort in Germany. Within NAPKON, adult and pediatric patients are observed in three complementary cohort platforms (Cross-Sectoral, High-Resolution and Population-Based) from the initial infection until up to three years of follow-up. Study procedures comprise comprehensive clinical and imaging diagnostics, quality-of-life assessment, patient-reported outcomes and biosampling. The three cohort platforms build on four infrastructure core units (Interaction, Biosampling, Epidemiology, and Integration) and collaborations with NUM projects. Key components of the data capture, regulatory, and data privacy are based on the German Centre for Cardiovascular Research. By April 01, 2022, 34 university and 40 non-university hospitals have enrolled 5298 patients with local data quality reviews performed on 4727 (89%). 47% were female, the median age was 52 (IQR 36-62-) and 50 pediatric cases were included. 44% of patients were hospitalized, 15% admitted to an intensive care unit, and 12% of patients deceased while enrolled. 8845 visits with biosampling in 4349 patients were conducted by April 03, 2022. In this overview article, we summarize NAPKON's design, relevant milestones including first study population characteristics, and outline the potential of NAPKON for German and international research activities.Trial registration https://clinicaltrials.gov/ct2/show/NCT04768998 . https://clinicaltrials.gov/ct2/show/NCT04747366 . https://clinicaltrials.gov/ct2/show/NCT04679584. AU - Schons, M.* AU - Pilgram, L.* AU - Reese, J.P.* AU - Stecher, M.* AU - Anton, G. AU - Appel, K.S.* AU - Bahmer, T.* AU - Bartschke, A.* AU - Bellinghausen, C.* AU - Bernemann, I.* AU - Brechtel, M.* AU - Brinkmann, F.* AU - Bruenn, C.* AU - Dhillon, C.* AU - Fiessler, C.* AU - Geisler, R.* AU - Hamelmann, E.* AU - Hansch, S.* AU - Hanses, F.* AU - Hanss, S.* AU - Herold, S.* AU - Heyder, R.* AU - Hopff, S.M.* AU - Horn, A.* AU - Jakob, C.* AU - Keil, T.* AU - Khodamoradi, Y.* AU - Kohls, M.* AU - Kraus, M. AU - Krefting, D.* AU - Kunze, S. AU - Kurth, F.* AU - Lieb, W.* AU - Lippert, L.J.* AU - Lorbeer, R.* AU - Lorenz-Depiereux, B. AU - Maetzler, C.* AU - Miljukov, O.* AU - Nauck, M.* AU - Pape, D.* AU - Puntmann, V.O.* AU - Reinke, L.* AU - Roemmele, C.* AU - Rudolph, S.* AU - Sass, J.* AU - Schaefer, C.* AU - Schaller, J.* AU - Schattschneider, M.* AU - Scheer, C.E.* AU - Scherer, M.* AU - Schmidt, S.* AU - Schmidt, J.* AU - Seibel, K.* AU - Stahl, D.* AU - Steinbeis, F.* AU - Stoerk, S.* AU - Tauchert, M. AU - Tebbe, J.J.* AU - Thibeault, C.* AU - Toepfner, N.* AU - Ungethuem, K.* AU - Vadász, I.* AU - Valentin, H.* AU - Wiedmann, S.* AU - Zöller, T.* AU - Nagel, E.* AU - Krawczak, M.* AU - von Kalle, C.* AU - Illig, T.* AU - Schreiber, S.* AU - Witzenrath, M.* AU - Heuschmann, P.U.* AU - Vehreschild, J.J.* C1 - 65869 C2 - 52560 SP - 849-870 TI - The German National Pandemic Cohort Network (NAPKON): Rationale, study design and baseline characteristics. JO - Eur. J. Epidemiol. VL - 37 IS - 8 PY - 2022 SN - 0393-2990 ER - TY - JOUR AB - Infectious complications are the major cause of morbidity and mortality after solid organ and stem cell transplantation. To better understand host and environmental factors associated with an increased risk of infection as well as the effect of infections on function and survival of transplanted organs, we established the DZIF Transplant Cohort, a multicentre prospective cohort study within the organizational structure of the German Center for Infection Research. At time of transplantation, heart-, kidney-, lung-, liver-, pancreas- and hematopoetic stem cell- transplanted patients are enrolled into the study. Follow-up visits are scheduled at 3, 6, 9, 12 months after transplantation, and annually thereafter; extracurricular visits are conducted in case of infectious complications. Comprehensive standard operating procedures, web-based data collection and monitoring tools as well as a state of the art biobanking concept for blood, purified PBMCs, urine, and faeces samples ensure high quality of data and biosample collection. By collecting detailed information on immunosuppressive medication, infectious complications, type of infectious agent and therapy, as well as by providing corresponding biosamples, the cohort will establish the foundation for a broad spectrum of studies in the field of infectious diseases and transplant medicine. By January 2020, baseline data and biosamples of about 1400 patients have been collected. We plan to recruit 3500 patients by 2023, and continue follow-up visits and the documentation of infectious events at least until 2025. Information about the DZIF Transplant Cohort is available at https://www.dzif.de/en/working-group/transplant-cohort. AU - Karch, A.* AU - Schindler, D.* AU - Kühn-Steven, A. AU - Blaser, R.* AU - Kuhn, K.A.* AU - Sandmann, L.* AU - Sommerer, C.* AU - Guba, M.* AU - Heemann, U.* AU - Strohäker, J.* AU - Glöckner, S.* AU - Mikolajczyk, R.* AU - Busch, D.H.* AU - Schulz, T.F.* AU - Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium (Anton, G.) AU - Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium (Wichmann, H.-E.) C1 - 61151 C2 - 50069 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 233–241 TI - The transplant cohort of the German center for infection research (DZIF Tx-Cohort): Study design and baseline characteristics. JO - Eur. J. Epidemiol. VL - 36 IS - 2 PB - Springer PY - 2021 SN - 0393-2990 ER - TY - JOUR AB - Common carotid intima-media thickness (cIMT) is an index of subclinical atherosclerosis that is associated with ischemic stroke and coronary artery disease (CAD). We undertook a cross-sectional epigenome-wide association study (EWAS) of measures of cIMT in 6400 individuals. Mendelian randomization analysis was applied to investigate the potential causal role of DNA methylation in the link between atherosclerotic cardiovascular risk factors and cIMT or clinical cardiovascular disease. The CpG site cg05575921 was associated with cIMT (beta = -0.0264, p value = 3.5 × 10-8) in the discovery panel and was replicated in replication panel (beta = -0.07, p value = 0.005). This CpG is located at chr5:81649347 in the intron 3 of the aryl hydrocarbon receptor repressor gene (AHRR). Our results indicate that DNA methylation at cg05575921 might be in the pathway between smoking, cIMT and stroke. Moreover, in a region-based analysis, 34 differentially methylated regions (DMRs) were identified of which a DMR upstream of ALOX12 showed the strongest association with cIMT (p value = 1.4 × 10-13). In conclusion, our study suggests that DNA methylation may play a role in the link between cardiovascular risk factors, cIMT and clinical cardiovascular disease. AU - Portilla-Fernandez, E.* AU - Hwang, S.J.* AU - Wilson, R. AU - Maddock, J.* AU - Hill, W.D.* AU - Teumer, A.* AU - Mishra, P.P.* AU - Brody, J.A.* AU - Joehanes, R.* AU - Ligthart, S.* AU - Ghanbari, M.* AU - Kavousi, M.* AU - Roks, A.J.M.* AU - Danser, A.H.J.* AU - Levy, D.* AU - Peters, A. AU - Ghasemi, S.* AU - Schminke, U.* AU - Dörr, M.* AU - Grabe, H.J.* AU - Lehtimäki, T.* AU - Kähönen, M.* AU - Hurme, M.A.* AU - Bartz, T.M.* AU - Sotoodehnia, N.* AU - Bis, J.C.* AU - Thiery, J.* AU - Koenig, W.* AU - Ong, K.K.* AU - Bell, J.T.* AU - Meisinger, C. AU - Wardlaw, J.M.* AU - Starr, J.M.* AU - Seissler, J. AU - Then, C. AU - Rathmann, W.* AU - Ikram, M.A.* AU - Psaty, B.M.* AU - Raitakari, O.T.* AU - Völzke, H.* AU - Deary, I.J.* AU - Wong, A.* AU - Waldenberger, M. AU - O'Donnell, C.J.* AU - Dehghan, A.* C1 - 62187 C2 - 50719 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 1143-1155 TI - Meta-analysis of epigenome-wide association studies of carotid intima-media thickness. JO - Eur. J. Epidemiol. VL - 36 IS - 11 PB - Springer PY - 2021 SN - 0393-2990 ER - TY - JOUR AB - The aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on acute myocardial infarction (AMI) care, and to identify underlying stressors in the German model region for complete AMI registration. The analysis was based on data from the population-based KORA Myocardial Infarction Registry located in the region of Augsburg, Germany. All cases of AMI (n = 210) admitted to one of four hospitals in the city of Augsburg or the county of Augsburg from February 10th, 2020, to May 19, 2020, were included. Patients were divided into three groups, namely pre-lockdown, strict lockdown, and attenuated lockdown period. An additional survey was conducted asking the patients for stress and fears in the 4 weeks prior to their AMI. The AMI rate declined by 44% in the strict lockdown period; in the attenuated lockdown period the rate was 17% lower compared to the pre-lockdown period. The downward trend in AMI rates during lockdown was seen in STEMI and NSTEMI patients, and independent of sex and age. The door-to-device time decreased by 70-80% in the lockdown-periods. In the time prior to the infarction, patients felt stressed mainly due to fear of infection with Sars-CoV-2 and less because of the restrictions and consequences of the lockdown. A strict lockdown due to the Covid-19 pandemic had a marked impact on AMI care even in a non-hot-spot region with relatively few cases of COVID-19. Fear of infection with the virus is presumably the main reason for the drop in hospitalizations due to AMI. AU - Schmitz, T. AU - Meisinger, C. AU - Kirchberger, I. AU - Thilo, C.* AU - Amann, U. AU - Baumeister, S. AU - Linseisen, J. C1 - 62186 C2 - 50688 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 619–627 TI - Impact of COVID-19 pandemic lockdown on myocardial infarction care. JO - Eur. J. Epidemiol. VL - 36 PB - Springer PY - 2021 SN - 0393-2990 ER - TY - JOUR AB - Increased cardiorespiratory fitness is related to decreased risk of major chronic illnesses, including cardiovascular disease, type 2 diabetes, and cancer, but its association with colorectal cancer specifically has received very little attention. We examined the relation of cardiorespiratory fitness to colorectal cancer in 59,191 UK Biobank participants aged 39–70 years without prevalent cancer at baseline, followed from 2009 to 2014. Submaximal bicycle ergometry was conducted at study entry, and cardiorespiratory fitness was defined as physical work capacity at 75% of the maximum heart rate, standardised to body mass (PWC75%). Multivariable Cox proportional hazards regression was performed to obtain hazard ratios (HR) and corresponding 95% confidence intervals (CI). During a mean follow-up of 4.6 years, 232 participants developed colorectal cancer (151 colon cancers; 79 rectal cancers). When comparing the 75th to the 25th percentiles of PWC75%, the multivariable-adjusted HR of colorectal cancer was 0.78 (95% CI 0.62–0.97). That relation was largely driven by an inverse association with colon cancer (HR 0.74, 95% CI 0.56–0.97) and less so with rectal cancer (HR 0.88, 95% CI 0.62–1.26; p value for difference by colorectal cancer endpoint = 0.056). The inverse relation of cardiorespiratory fitness with colorectal cancer was more evident in men (HR 0.72, 95% CI 0.55–0.94) than women (HR 0.99, 95% CI 0.71–1.38), although the gender difference was not statistically significant (p value for interaction = 0.192). Increased cardiorespiratory fitness is associated with decreased risk of colorectal cancer. Potential heterogeneity by colorectal cancer anatomic subsite and gender requires further study. AU - Hillreiner, A.* AU - Baumeister, S. AU - Sedlmeier, A.M.* AU - Finger, J.D.* AU - Schlitt, H.J.* AU - Leitzmann, M.F.* C1 - 57306 C2 - 47683 SP - 961–973 TI - Association between cardiorespiratory fitness and colorectal cancer in the UK Biobank. JO - Eur. J. Epidemiol. VL - 35 PY - 2020 SN - 0393-2990 ER - TY - JOUR AB - ObjectiveTo revise the German guidelines and recommendations for ensuring Good Epidemiological Practice (GEP) that were developed in 1999 by the German Society for Epidemiology (DGEpi), evaluated and revised in 2004, supplemented in 2008, and updated in 2014.MethodsThe executive board of the DGEpi tasked the third revision of the GEP. The revision was arrived as a result of a consensus-building process by a working group of the DGEpi in collaboration with other working groups of the DGEpi and with the German Association for Medical Informatics, Biometry and Epidemiology, the German Society of Social Medicine and Prevention (DGSMP), the German Region of the International Biometric Society (IBS-DR), the German Technology, Methods and Infrastructure for Networked Medical Research (TMF), and the German Network for Health Services Research (DNVF). The GEP also refers to related German Good Practice documents (e.g. Health Reporting, Cartographical Practice in the Healthcare System, Secondary Data Analysis).ResultsThe working group modified the 11 guidelines (after revision: 1 ethics, 2 research question, 3 study protocol and manual of operations, 4 data protection, 5 sample banks, 6 quality assurance, 7 data storage and documentation, 8 analysis of epidemiological data, 9 contractual framework, 10 interpretation and scientific publication, 11 communication and public health) and modified and supplemented the related recommendations. All participating scientific professional associations adopted the revised GEP.ConclusionsThe revised GEP are addressed to everyone involved in the planning, preparation, execution, analysis, and evaluation of epidemiological research, as well as research institutes and funding bodies. AU - Hoffmann, W.* AU - Latza, U.* AU - Baumeister, S. AU - Brünger, M.* AU - Buttmann-Schweiger, N.* AU - Hardt, J.* AU - Hoffmann, V.* AU - Karch, A.* AU - Richter, A.* AU - Schmidt, C.O.* AU - Schmidtmann, I.* AU - Swart, E.* AU - van den Berg, N.* C1 - 55691 C2 - 46473 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 301–317 TI - Guidelines and recommendations for ensuring Good Epidemiological Practice (GEP): A guideline developed by the German Society for Epidemiology. JO - Eur. J. Epidemiol. VL - 34 IS - 3 PB - Springer PY - 2019 SN - 0393-2990 ER - TY - JOUR AB - The objective of the present study was to identify proteins that contribute to pathophysiology and allow prediction of incident type 2 diabetes or incident prediabetes. We quantified 14 candidate proteins using targeted mass spectrometry in plasma samples of the prospective, population-based German KORA F4/FF4 study (6.5-year follow-up). 892 participants aged 42-81years were selected using a case-cohort design, including 123 persons with incident type 2 diabetes and 255 persons with incident WHO-defined prediabetes. Prospective associations between protein levels and diabetes, prediabetes as well as continuous fasting and 2h glucose, fasting insulin and insulin resistance were investigated using regression models adjusted for established risk factors. The best predictive panel of proteins on top of a non-invasive risk factor model or on top of HbA1c, age, and sex was selected. Mannan-binding lectin serine peptidase (MASP) levels were positively associated with both incident type 2 diabetes and prediabetes. Adiponectin was inversely associated with incident type 2 diabetes. MASP, adiponectin, apolipoprotein A-IV, apolipoprotein C-II, C-reactive protein, and glycosylphosphatidylinositol specific phospholipase D1 were associated with individual continuous outcomes. The combination of MASP, apolipoprotein E (apoE) and adiponectin improved diabetes prediction on top of both reference models, while prediabetes prediction was improved by MASP plus CRP on top of the HbA1c model. In conclusion, our mass spectrometric approach revealed a novel association of MASP with incident type 2 diabetes and incident prediabetes. In combination, MASP, adiponectin and apoE improved type 2 diabetes prediction beyond non-invasive risk factors or HbA1c, age and sex. AU - Huth, C. AU - von Toerne, C. AU - Schederecker, F. AU - de Las Heras Gala, T. AU - Herder, C.* AU - Kronenberg, F.* AU - Meisinger, C. AU - Rathmann, W.* AU - Koenig, W.* AU - Waldenberger, M. AU - Roden, M.* AU - Peters, A. AU - Hauck, S.M. AU - Thorand, B. C1 - 55076 C2 - 46076 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 409-422 TI - Protein markers and risk of type 2 diabetes and prediabetes: A targeted proteomics approach in the KORA F4/FF4 study. JO - Eur. J. Epidemiol. VL - 34 IS - 4 PB - Springer PY - 2019 SN - 0393-2990 ER - TY - JOUR AB - Inferring a person's smoking habit and history from blood is relevant for complementing or replacing self-reports in epidemiological and public health research, and for forensic applications. However, a finite DNA methylation marker set and a validated statistical model based on a large dataset are not yet available. Employing 14 epigenome-wide association studies for marker discovery, and using data from six population-based cohorts (N = 3764) for model building, we identified 13 CpGs most suitable for inferring smoking versus non-smoking status from blood with a cumulative Area Under the Curve (AUC) of 0.901. Internal fivefold cross-validation yielded an average AUC of 0.897 +/- 0.137, while external model validation in an independent population-based cohort (N = 1608) achieved an AUC of 0.911. These 13 CpGs also provided accurate inference of current (average AUC(crossvalidation) 0.925 +/- 0.021, AUC(externalvalidation)0.914), former (0.766 +/- 0.023, 0.699) and never smoking (0.830 +/- 0.019, 0.781) status, allowed inferring pack-years in current smokers (10 pack-years 0.800 +/- 0.068, 0.796; 15 pack-years 0.767 +/- 0.102, 0.752) and inferring smoking cessation time in former smokers (5 years 0.774 +/- 0.024, 0.760; 10 years 0.766 +/- 0.033, 0.764; 15 years 0.767 +/- 0.020, 0.754). Model application to children revealed highly accurate inference of the true non- smoking status (6 years of age: accuracy 0.994, N = 355; 10 years: 0.994, N = 309), suggesting prenatal and passive smoking exposure having no impact on model applications in adults. The finite set of DNA methylation markers allow accurate inference of smoking habit, with comparable accuracy as plasma cotinine use, and smoking history from blood, which we envision becoming useful in epidemiology and public health research, and in medical and forensic applications. AU - Maas, S.C.E.* AU - Vidaki, A.* AU - Wilson, R. AU - Teumer, A.* AU - Liu, F.* AU - van Meurs, J.B.J.* AU - Uitterlinden, A.G.* AU - Boomsma, D.I.* AU - de Geus, E.J.C.* AU - Willemsen, G.* AU - van Dongen, J.* AU - van der Kallen, C.J.H.* AU - Slagboom, P.E.* AU - Beekman, M.* AU - van Heemst, D.* AU - van den Berg, L.H.* AU - Duijts, L.* AU - Jaddoe, V.W.V.* AU - Ladwig, K.-H. AU - Kunze, S. AU - Peters, A. AU - Ikram, M.A.* AU - Grabe, H.J.* AU - Felix, J.F.* AU - Waldenberger, M. AU - Franco, O.H.* AU - Ghanbari, M.* AU - Kayser, M.* C1 - 56858 C2 - 47403 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 1055-1074 TI - Validated inference of smoking habits from blood with a finite DNA methylation marker set. JO - Eur. J. Epidemiol. VL - 34 IS - 11 PB - Springer PY - 2019 SN - 0393-2990 ER - TY - JOUR AB - The impact of many unfavorable childhood traits or diseases, such as low birth weight and mental disorders, is not limited to childhood and adolescence, as they are also associated with poor outcomes in adulthood, such as cardiovascular disease. Insight into the genetic etiology of childhood and adolescent traits and disorders may therefore provide new perspectives, not only on how to improve wellbeing during childhood, but also how to prevent later adverse outcomes. To achieve the sample sizes required for genetic research, the Early Growth Genetics (EGG) and EArly Genetics and Lifecourse Epidemiology (EAGLE) consortia were established. The majority of the participating cohorts are longitudinal population-based samples, but other cohorts with data on early childhood phenotypes are also involved. Cohorts often have a broad focus and collect(ed) data on various somatic and psychiatric traits as well as environmental factors. Genetic variants have been successfully identified for multiple traits, for example, birth weight, atopic dermatitis, childhood BMI, allergic sensitization, and pubertal growth. Furthermore, the results have shown that genetic factors also partly underlie the association with adult traits. As sample sizes are still increasing, it is expected that future analyses will identify additional variants. This, in combination with the development of innovative statistical methods, will provide detailed insight on the mechanisms underlying the transition from childhood to adult disorders. Both consortia welcome new collaborations. Policies and contact details are available from the corresponding authors of this manuscript and/or the consortium websites. AU - Middeldorp, C.M.* AU - Felix, J.F.* AU - Mahajan, A.* AU - EArly Genetics and Lifecourse Epidemiology (EAGLE) Eczema Consortium (Heinrich, J. AU - Standl, M. AU - Thiering, E.) AU - Early Growth Genetics Consortium (Wichmann, H.-E.) AU - McCarthy, M.I.* C1 - 55969 C2 - 46675 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 279-300 TI - The Early Growth Genetics (EGG) and EArly Genetics and Lifecourse Epidemiology (EAGLE) consortia: Design, results and future prospects. JO - Eur. J. Epidemiol. VL - 34 IS - 3 PB - Springer PY - 2019 SN - 0393-2990 ER - TY - JOUR AB - Morbidity trends may result from cohort experiences in critical developmental age. Our objective was to compare the health status of 65-71year-olds who were in critical developmental age before (1937-June 1945), during (June 1945-June 1948) and after (June 1948-1950) the early reconstruction and food crisis (ERFC) period in Germany following World War II. Data originate from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study in Southern Germany. We used the 2008 baseline sample born 1937-1943 and the 2015 enrichment sample born 1944-1950. Health status was assessed as the number of accumulated health deficits using a Frailty Index (FI). Cohorts were defined based on co-occurrence of critical developmental age (gestation and the first 2years of life) and the ERFC period. Cohort, age and sex effects on older-age health status were analyzed using generalized linear models. We included 590 (53% male) pre-war and war (PWW), 475 (51% male) ERFC and 171 post-currency reform (PCR) cohort participants (46% male). Adjusted for covariates, FI levels were significantly higher for the ERFC (Ratio 1.14, CL [1.06, 1.23]) but not for the PCR (Ratio 1.06, CL [0.94, 1.20]) as compared to the PWW cohort. Being in critical developmental age during the ERFC period increased FI levels in adults aged 65-71years. Covariates did not explain these effects, suggesting a direct detrimental effect from being in critical developmental age during the ERFC period on older-age health. This expansion of morbidity in Germany was not detected in the PCR cohort. AU - Stephan, A.-J.* AU - Strobl, R.* AU - Schwettmann, L. AU - Meisinger, C. AU - Ladwig, K.-H. AU - Linkohr, B. AU - Thorand, B. AU - Peters, A. AU - Grill, E.* C1 - 55803 C2 - 46586 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 675-687 TI - Being born in the aftermath of World War II increases the risk for health deficit accumulation in older age: Results from the KORA-Age study. JO - Eur. J. Epidemiol. VL - 34 IS - 7 PB - Springer PY - 2019 SN - 0393-2990 ER - TY - JOUR AB - Intake of individual antioxidants has been related to a lower risk of type 2 diabetes. However, the overall diet may contain many antioxidants with additive or synergistic effects. Therefore, we aimed to determine associations between total dietary antioxidant capacity and risk of type 2 diabetes, prediabetes and insulin resistance. We estimated the dietary antioxidant capacity for 5796 participants of the Rotterdam Study using a ferric reducing ability of plasma (FRAP) score. Of these participants, 4957 had normoglycaemia and 839 had prediabetes at baseline. We used covariate-adjusted proportional hazards models to estimate associations between FRAP and risk of type 2 diabetes, risk of type 2 diabetes among participants with prediabetes, and risk of prediabetes. We used linear regression models to determine the association between FRAP score and insulin resistance (HOMA-IR). We observed 532 cases of incident type 2 diabetes, of which 259 among participants with prediabetes, and 794 cases of incident prediabetes during up to 15 years of follow-up. A higher FRAP score was associated with a lower risk of type 2 diabetes among the total population (HR per SD FRAP 0.84, 95% CI 0.75; 0.95) and among participants with prediabetes (HR 0.85, 95% CI 0.73; 0.99), but was not associated with risk of prediabetes. Dietary FRAP was also inversely associated with HOMA-IR (beta - 0.04, 95% CI - 0.06; - 0.03). Effect estimates were generally similar between sexes. The findings of this population-based study emphasize the putative beneficial effects of a diet rich in antioxidants on insulin resistance and risk of type 2 diabetes. AU - van der Schaft, N.* AU - Schoufour, J.D.* AU - Nano, J. AU - Kiefte-de Jong, J.C.* AU - Muka, T.* AU - Sijbrands, E.J.G.* AU - Ikram, M.A.* AU - Franco, O.H.* AU - Voortman, T.* C1 - 56732 C2 - 47238 CY - Van Godewijckstraat 30, 3311 Gz Dordrecht, Netherlands SP - 853-861 TI - Dietary antioxidant capacity and risk of type 2 diabetes mellitus, prediabetes and insulin resistance: The Rotterdam Study. JO - Eur. J. Epidemiol. VL - 34 IS - 9 PB - Springer PY - 2019 SN - 0393-2990 ER - TY - JOUR AB - Metabolomic approaches in prospective cohorts may offer a unique snapshot into early metabolic perturbations that are associated with a higher risk of cardiovascular diseases (CVD) in healthy people. We investigated the association of 105 serum metabolites, including acylcarnitines, amino acids, phospholipids and hexose, with risk of myocardial infarction (MI) and ischemic stroke in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam (27,548 adults) and Heidelberg (25,540 adults) cohorts. Using case-cohort designs, we measured metabolites among individuals who were free of CVD and diabetes at blood draw but developed MI (n = 204 and n = 228) or stroke (n = 147 and n = 121) during follow-up (mean, 7.8 and 7.3 years) and among randomly drawn subcohorts (n = 2214 and n = 770). We used Cox regression analysis and combined results using meta-analysis. Independent of classical CVD risk factors, ten metabolites were associated with risk of MI in both cohorts, including sphingomyelins, diacyl-phosphatidylcholines and acyl-alkyl-phosphatidylcholines with pooled relative risks in the range of 1.21-1.40 per one standard deviation increase in metabolite concentrations. The metabolites showed positive correlations with total- and LDL-cholesterol (r ranged from 0.13 to 0.57). When additionally adjusting for total-, LDL- and HDL-cholesterol, triglycerides and C-reactive protein, acyl-alkyl-phosphatidylcholine C36:3 and diacyl-phosphatidylcholines C38:3 and C40:4 remained associated with risk of MI. When added to classical CVD risk models these metabolites further improved CVD prediction (c-statistics increased from 0.8365 to 0.8384 in EPIC-Potsdam and from 0.8344 to 0.8378 in EPIC-Heidelberg). None of the metabolites was consistently associated with stroke risk. Alterations in sphingomyelin and phosphatidylcholine metabolism, and particularly metabolites of the arachidonic acid pathway are independently associated with risk of MI in healthy adults. AU - Floegel, A.* AU - Kühn, T.* AU - Sookthai, D.* AU - Johnson, T.* AU - Prehn, C. AU - Rolle-Kampczyk, U.E.* AU - Otto, W.* AU - Weikert, C.* AU - Illig, T.* AU - von Bergen, M.* AU - Adamski, J. AU - Boeing, H.* AU - Kaaks, R.* AU - Pischon, T.* C1 - 52416 C2 - 43952 CY - Dordrecht SP - 55–66 TI - Serum metabolites and risk of myocardial infarction and ischemic stroke: A targeted metabolomic approach in two German prospective cohorts. JO - Eur. J. Epidemiol. VL - 33 IS - 1 PB - Springer PY - 2018 SN - 0393-2990 ER - TY - JOUR AB - Troponins are sensitive markers of myocardial injury and predictive of cardiovascular events, but conventional assays fail to detect slightly elevated troponins in a considerable proportion of the general population. Using a novel ultrasensitive assay, we explored the relationship of troponin levels with the incidence of coronary heart disease (CHD) in a case-cohort sample (mean age 52.5 ± 0.2 years, 51.5% women) comprising 803 CHD cases and 1942 non-cases. Ultrasensitive troponin I was detectable in 99.9% of available case-cohort samples. In an age- and sex-adjusted model, individuals in the highest quartile of the troponin distribution had a more than threefold increased risk for CHD events compared to those in the bottom quartile [hazard ratio, HR, 3.11; 95% confidence interval (CI) 2.15-4.49]. In a model adjusting for cardiovascular risk factors including C-reactive protein, cystatin C and N-terminal pro brain natriuretic peptide, individuals in the highest troponin I quartile still showed a hazard ratio of 2.58 (95% CI 1.66-4.00) for incident CHD as compared to those in the lowest quartile. Ultrasensitive troponin I was detectable in almost all individuals of a study sample reflecting middle-aged to elderly European general population. Ultrasensitive troponin concentrations exhibit an independent, graded, positive relation with incident CHD. AU - Kaess, B.M.* AU - de Las Heras Gala, T. AU - Zierer, A. AU - Meisinger, C. AU - Wahl, S. AU - Peters, A. AU - Todd, J.A.* AU - Herder, C.* AU - Huth, C. AU - Thorand, B. AU - Koenig, W.* C1 - 51256 C2 - 43051 CY - Dordrecht SP - 583–591 TI - Ultra-sensitive troponin I is an independent predictor of incident coronary heart disease in the general population. JO - Eur. J. Epidemiol. VL - 32 IS - 7 PB - Springer PY - 2017 SN - 0393-2990 ER - TY - JOUR AB - Resettlers (in German: (Spät-)Aussiedler) form one of the biggest migrant groups in Germany. It is known that migrants have different mortality patterns compared to the autochthon population. In this paper, we combined data from three resettler cohorts and examined differences in mortality from non-communicable diseases among resettlers in Germany and the German population. Furthermore, we investigated time trends of cause-specific mortality for 20 years of follow-up and compared it with the German mortality rates. To assess differences in cause-specific mortality between resettlers and the general German population, we calculated standardized mortality ratios (SMRs). To ascertain mortality trends, cause-specific age-standardized mortality rates were calculated and modeled with Poisson regression and fractional polynomials. During the observation period, the study population accumulated almost 800,000 person-years and 5572 deaths were observed. All-cause mortality among resettlers was lower (SMR = 0.91, 95% CI = 0.89–0.94) compared to the general German population, as well as cardiovascular diseases (CVD) mortality (SMR = 0.82, 95% CI = 0.79–0.86). Results for cancer mortality varied considerably by cancer site. Analyses of time trends showed that all-cause and CVD mortality were decreasing over time in resettlers, as well as in the general German population. Lower all-cause mortality among resettlers is mainly explained by lower CVD mortality. Cancer-site specific mortality showed different results. Converging mortality rates may indicate an adaption of lifestyle behavior. However, there are no data on individual risk factors in this study. AU - Kaucher, S.* AU - Leier, V.* AU - Deckert, A.* AU - Holleczek, B.* AU - Meisinger, C. AU - Winkler, V.* AU - Becher, H.* C1 - 50847 C2 - 42877 SP - 289-298 TI - Time trends of cause-specific mortality among resettlers in Germany, 1990 through 2009. JO - Eur. J. Epidemiol. VL - 32 IS - 4 PY - 2017 SN - 0393-2990 ER - TY - JOUR AB - Did you ever hear about epidemiology in Germany? Starting from an epidemiological desert the discipline has grown remarkably, especially during the last 10–15 years: research institutes have been established, research funding has improved, multiple curriculae in Epidemiology and Public Health are offered. This increase has been quite steep, and now the epidemiological infrastructure is much better. Several medium-sized and even big population cohorts are ongoing, and the number and quality of publications from German epidemiologists has reached a respectable level. My own career in epidemiology started in the field of environmental health. After German reunification I concentrated for many years on environmental problems in East Germany and observed the health benefits after improvement of the situation. Later, I concentrated on population-based cohorts in newborns (GINI/LISA) and adults (KORA, German National Cohort), and on biobanking. This Essay describes the development in Germany after worldwar 2, illustrated by examples of research results and build-up of epidemiological infractructures worth mentioning. AU - Wichmann, H.-E. C1 - 51755 C2 - 43432 CY - Dordrecht SP - 635–656 TI - Epidemiology in Germany—general development and personal experience. JO - Eur. J. Epidemiol. VL - 32 IS - 8 PB - Springer PY - 2017 SN - 0393-2990 ER - TY - JOUR AB - To estimate the prevalence of refractive error in adults across Europe. Refractive data (mean spherical equivalent) collected between 1990 and 2013 from fifteen population-based cohort and cross-sectional studies of the European Eye Epidemiology (E(3)) Consortium were combined in a random effects meta-analysis stratified by 5-year age intervals and gender. Participants were excluded if they were identified as having had cataract surgery, retinal detachment, refractive surgery or other factors that might influence refraction. Estimates of refractive error prevalence were obtained including the following classifications: myopia ≤-0.75 diopters (D), high myopia ≤-6D, hyperopia ≥1D and astigmatism ≥1D. Meta-analysis of refractive error was performed for 61,946 individuals from fifteen studies with median age ranging from 44 to 81 and minimal ethnic variation (98 % European ancestry). The age-standardised prevalences (using the 2010 European Standard Population, limited to those ≥25 and <90 years old) were: myopia 30.6 % [95 % confidence interval (CI) 30.4-30.9], high myopia 2.7 % (95 % CI 2.69-2.73), hyperopia 25.2 % (95 % CI 25.0-25.4) and astigmatism 23.9 % (95 % CI 23.7-24.1). Age-specific estimates revealed a high prevalence of myopia in younger participants [47.2 % (CI 41.8-52.5) in 25-29 years-olds]. Refractive error affects just over a half of European adults. The greatest burden of refractive error is due to myopia, with high prevalence rates in young adults. Using the 2010 European population estimates, we estimate there are 227.2 million people with myopia across Europe. AU - Williams, K.M.* AU - Verhoeven, V.J.* AU - Cumberland, P.M.* AU - Bertelsen, G.* AU - Wolfram, C.* AU - Buitendijk, G.H.* AU - Hofman, A.* AU - van Duijn, C.M.* AU - Vingerling, J.R.* AU - Kuijpers, R.W.* AU - Höhn, R.* AU - Mirshahi, A.* AU - Khawaja, A.P.* AU - Luben, R.N.* AU - Erke, M.G.* AU - von Hanno, T.* AU - Mahroo, O.* AU - Hogg, R.* AU - Gieger, C. AU - Cougnard-Grégoire, A.* AU - Anastasopoulos, E.* AU - Bron, A.* AU - Dartigues, J.F.* AU - Korobelnik, J.F.* AU - Creuzot-Garcher, C.* AU - Topouzis, F.* AU - Delcourt, C.* AU - Rahi, J.S.* AU - Meitinger, T. AU - Fletcher, A.* AU - Foster, P.J.* AU - Pfeiffer, N.* AU - Klaver, C.C.* AU - Hammond, C.J.* C1 - 44374 C2 - 36803 SP - 305-315 TI - Prevalence of refractive error in Europe: The European Eye Epidemiology (E3) consortium. JO - Eur. J. Epidemiol. VL - 30 IS - 4 PY - 2015 SN - 0393-2990 ER - TY - JOUR AB - The mechanism of antihypertensive and lipid-lowering drugs on the human organism is still not fully understood. New insights on the drugs' action can be provided by a metabolomics-driven approach, which offers a detailed view of the physiological state of an organism. Here, we report a metabolome-wide association study with 295 metabolites in human serum from 1,762 participants of the KORA F4 (Cooperative Health Research in the Region of Augsburg) study population. Our intent was to find variations of metabolite concentrations related to the intake of various drug classes and-based on the associations found-to generate new hypotheses about on-target as well as off-target effects of these drugs. In total, we found 41 significant associations for the drug classes investigated: For beta-blockers (11 associations), angiotensin-converting enzyme (ACE) inhibitors (four assoc.), diuretics (seven assoc.), statins (ten assoc.), and fibrates (nine assoc.) the top hits were pyroglutamine, phenylalanylphenylalanine, pseudouridine, 1-arachidonoylglycerophosphocholine, and 2-hydroxyisobutyrate, respectively. For beta-blockers we observed significant associations with metabolite concentrations that are indicative of drug side-effects, such as increased serotonin and decreased free fatty acid levels. Intake of ACE inhibitors and statins associated with metabolites that provide insight into the action of the drug itself on its target, such as an association of ACE inhibitors with des-Arg(9)-bradykinin and aspartylphenylalanine, a substrate and a product of the drug-inhibited ACE. The intake of statins which reduce blood cholesterol levels, resulted in changes in the concentration of metabolites of the biosynthesis as well as of the degradation of cholesterol. Fibrates showed the strongest association with 2-hydroxyisobutyrate which might be a breakdown product of fenofibrate and, thus, a possible marker for the degradation of this drug in the human organism. The analysis of diuretics showed a heterogeneous picture that is difficult to interpret. Taken together, our results provide a basis for a deeper functional understanding of the action and side-effects of antihypertensive and lipid-lowering drugs in the general population. AU - Altmaier, E. AU - Fobo, G. AU - Heier, M. AU - Thorand, B. AU - Meisinger, C. AU - Römisch-Margl, W. AU - Waldenberger, M. AU - Gieger, C. AU - Illig, T. AU - Adamski, J. AU - Suhre, K. AU - Kastenmüller, G. C1 - 31275 C2 - 34267 CY - Dordrecht SP - 325-336 TI - Metabolomics approach reveals effects of antihypertensives and lipid-lowering drugs on the human metabolism. JO - Eur. J. Epidemiol. VL - 29 IS - 5 PB - Springer PY - 2014 SN - 0393-2990 ER - TY - JOUR AB - Oxidative stress and inflammation are major contributors to accelerated age-related relative telomere length (RTL) shortening. Both conditions are strongly linked to leptin and adiponectin, the most prominent adipocyte-derived protein hormones. As high leptin levels and low levels of adiponectin have been implicated in inflammation, one expects adiponectin to be positively associated with RTL while leptin should be negatively associated. Within the ENGAGE consortium, we investigated the association of RTL with adiponectin and leptin in seven independent cohorts with a total of 11,448 participants. We performed partial correlation analysis on Z-transformed RTL and LN-transformed leptin/adiponectin, adjusting for age and sex. In extended models we adjusted for body mass index (BMI) and C-reactive protein (CRP). Adiponectin showed a borderline significant association with RTL. This appeared to be determined by a single study and when the outlier study was removed, this association disappeared. The association between RTL and leptin was highly significant (r = -0.05; p = 1.81 × 10-7). Additional adjustment for BMI or CRP did not change the results. Sex-stratified analysis revealed no difference between men and women. Our study suggests that high leptin levels are associated with short RTL. AU - Broer, L.* AU - Raschenberger, J.* AU - Deelen, J.* AU - Mangino, M.* AU - Codd, V.* AU - Pietiläinen, K.H.* AU - Albrecht, E. AU - Amin, N.* AU - Beekman, M.* AU - de Craen, A.J.* AU - Gieger, C. AU - Haun, M.* AU - Henneman, P.* AU - Herder, C.* AU - Hovatta, I.* AU - Laser, A. AU - Kedenko, L.* AU - Koenig, W.* AU - Kollerits, B.* AU - Moilanen, E.* AU - Oostra, B.A.* AU - Paulweber, B.* AU - Quaye, L.* AU - Rissanen, A.* AU - Roden, M.* AU - Surakka, I.* AU - Valdes, A.M.* AU - Vuolteenaho, K.* AU - Thorand, B. AU - van Dijk, K.W.* AU - Kaprio, J.* AU - Spector, T.D.* AU - Slagboom, P.E.* AU - Samani, N.J.* AU - Kronenberg, F.* AU - van Duijn, C.M.* AU - Ladwig, K.-H. C1 - 31875 C2 - 34832 CY - Dordrecht SP - 629-638 TI - Association of adiponectin and leptin with relative telomere length in seven independent cohorts including 11,448 participants. JO - Eur. J. Epidemiol. VL - 29 IS - 9 PB - Springer PY - 2014 SN - 0393-2990 ER - TY - JOUR AB - The aim of the study was to analyse mortality after a first myocardial infarction (MI) and its trends in people with diabetes compared to those without diabetes in Southern Germany, 1985-2009. Using data of the population-based MONICA/KORA Myocardial Infarction Registry, we ascertained all patients with a first fatal or non-fatal MI between 1985 and 2009 (n = 16,478, age 25-74 years, 71 % male, 29 % with diabetes). The impact of diabetes and calendar time on mortality was examined using multiple logistic and Cox regression. Survival improved with calendar time: The crude cumulative 5-year survival was 26.9 and 46.3 % among diabetic and non-diabetic individuals (both sexes combined) with a first MI in the years 1985-1989, and 53.6 and 66.6 % among those with a first MI in the years 2005-2009. This significant decrease of mortality was confirmed in multivariate analyses. The proportion of fatal first MIs was significantly higher in diabetic compared to non-diabetic patients [adjusted odds ratio (OR) 1.26; 95 % confidence interval 1.17-1.36]. This association persisted in a similar manner between both sexes with no consistent change of OR over calendar time in which first MIs have been observed. Likewise, multiple adjusted risk of death after a non-fatal first MI was significantly higher among both diabetic men and women [hazard ratio (HR) 1.64; 1.47-1.82, 1.83; 1.55-2.14] with constant HR over calendar time. During the past 25 years, survival has improved in both diabetic and non-diabetic patients with incident MI in a similar manner. However, mortality after a first MI remained significantly higher in the diabetic population, particularly in women. AU - Icks, A.* AU - Claessen, H.* AU - Kirchberger, I. AU - Heier, M. AU - Peters, A. AU - Trentinaglia, I. AU - Giani, G.* AU - von Scheidt, W.* AU - Meisinger, C. C1 - 34363 C2 - 35234 SP - 899-909 TI - Mortality after first myocardial infarction in diabetic and non-diabetic people between 1985 and 2009. The MONICA/KORA registry. JO - Eur. J. Epidemiol. VL - 29 IS - 12 PY - 2014 SN - 0393-2990 ER - TY - JOUR AB - The German National Cohort (GNC) is a joint interdisciplinary endeavour of scientists from the Helmholtz and the Leibniz Association, universities, and other research institutes. Its aim is to investigate the causes for the development of major chronic diseases, i.e. cardiovascular diseases, cancer, diabetes, neurodegenerative/-psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases, and their pre-clinical stages or functional health impairments. Across Germany, a random sample of the general population will be drawn by 18 regional study centres, including a total of 100,000 women and 100,000 men aged 20-69 years. The baseline assessments include an extensive interview and self-completion questionnaires, a wide range of medical examinations and the collection of various biomaterials. In a random subgroup of 20 % of the participants (n = 40,000) an intensified examination ("Level 2") programme will be performed. In addition, in five of the 18 study centres a total of 30,000 study participants will take part in a magnetic resonance imaging examination programme, and all of these participants will also be offered the intensified Level 2 examinations. After 4-5 years, all participants will be invited for a re-assessment. Information about chronic disease endpoints will be collected through a combination of active follow-up (including questionnaires every 2-3 years) and record linkages. The GNC is planned for an overall duration of 25-30 years. It will provide a major, central resource for population-based epidemiology in Germany, and will help to identify new and tailored strategies for early detection, prediction, and primary prevention of major diseases. AU - German National Cohort (GNC) Consortium (Linseisen, J. AU - Peters, A.) C1 - 31708 C2 - 34672 CY - Dordrecht SP - 371-382 TI - The German National Cohort: Aims, study design and organization. JO - Eur. J. Epidemiol. VL - 29 IS - 5 PB - Springer PY - 2014 SN - 0393-2990 ER - TY - JOUR AB - Biomarkers are considered as tools to enhance cardiovascular risk estimation. However, the value of biomarkers on risk estimation beyond European risk scores, their comparative impact among different European regions and their role towards personalised medicine remains uncertain. Biomarker for Cardiovascular Risk Assessment in Europe (BiomarCaRE) is an European collaborative research project with the primary objective to assess the value of established and emerging biomarkers for cardiovascular risk prediction. BiomarCaRE integrates clinical and epidemiological biomarker research and commercial enterprises throughout Europe to combine innovation in biomarker discovery for cardiovascular disease prediction with consecutive validation of biomarker effectiveness in large, well-defined primary and secondary prevention cohorts including over 300,000 participants from 13 European countries. Results from this study will contribute to improved cardiovascular risk prediction across different European populations. The present publication describes the rationale and design of the BiomarCaRE project. AU - Zeller, T.* AU - Hughes, M.* AU - Tuovinen, T.* AU - Schillert, A.* AU - Conrads-Frank, A.* AU - Ruijter, H.D.* AU - Schnabel, R.B.* AU - Kee, F.* AU - Salomaa, V.* AU - Siebert, U.* AU - Thorand, B. AU - Ziegler, A.* AU - Breek, H.* AU - Pasterkamp, G.* AU - Kuulasmaa, K.* AU - Koenig, W.* AU - Blankenberg, S.* C1 - 32492 C2 - 35072 CY - Dordrecht SP - 777-790 TI - BiomarCaRE: Rationale and design of the European BiomarCaRE project including 300,000 participants from 13 European countries. JO - Eur. J. Epidemiol. VL - 29 IS - 10 PB - Springer PY - 2014 SN - 0393-2990 ER - TY - JOUR AB - Associations between traffic-related air pollution and incident childhood asthma can be strengthened by analysis of gene-environment interactions, but studies have typically been limited by lack of study power. We combined data from six birth cohorts on: asthma, eczema and allergic rhinitis to 7/8 years, and candidate genes. Individual-level assessment of traffic-related air pollution exposure was estimated using land use regression or dispersion modeling. A total of 11,760 children were included in the Traffic, Asthma and Genetics (TAG) Study; 6.3 % reported physician-diagnosed asthma at school-age, 16.0 % had asthma at anytime during childhood, 14.1 % had allergic rhinitis at school-age, 10.0 % had eczema at school-age and 33.1 % were sensitized to any allergen. For GSTP1 rs1138272, the prevalence of heterozygosity was 16 % (range amongst individual cohorts, 11-17 %) and homozygosity for the minor allele was 1 % (0-2 %). For GSTP1 rs1695, the prevalence of heterozygosity was 45 % (40-48 %) and homozygosity for the minor allele, 12 % (10-12 %). For TNF rs1800629, the prevalence of heterozygosity was 29 % (25-32 %) and homozygosity for the minor allele, 3 % (1-3 %). TAG comprises a rich database, the largest of its kind, for investigating the effect of genotype on the association between air pollution and childhood allergic disease. AU - MacIntyre, E.A. AU - Carlsten, C.* AU - Macnutt, M.* AU - Fuertes, E. AU - Melén, E.* AU - Tiesler, C.M. AU - Gehring, U.* AU - Krämer, U.* AU - Klümper, C.* AU - Kerkhof, M.* AU - Chan-Yeung, M.* AU - Kozyrskyj, A.L.* AU - Berdel, D.* AU - Bauer, C.P.* AU - Herbarth, O.* AU - Bauer, M. AU - Schaaf, B.* AU - Koletzko, S.* AU - Pershagen, G.* AU - Brunekreef, B.* AU - Heinrich, J. AU - Brauer, M.* C1 - 27546 C2 - 32713 SP - 597-606 TI - Traffic, asthma and genetics: Combining international birth cohort data to examine genetics as a mediator of traffic-related air pollution's impact on childhood asthma. JO - Eur. J. Epidemiol. VL - 28 IS - 7 PB - Springer PY - 2013 SN - 0393-2990 ER - TY - JOUR AB - Recently, prediction models for type 2 diabetes mellitus (T2DM) in older adults (aged ≥55 year) were developed in the KORA S4/F4 study, Augsburg, Germany. We aimed to externally validate the KORA models in a Dutch population. We used data on both older adults (n = 2,050; aged ≥55 year) and total non-diabetic population (n = 6,317; aged 28-75 year) for this validation. We assessed performance of base model (model 1: age, sex, BMI, smoking, parental diabetes and hypertension) and two clinical models: model 1 plus fasting glucose (model 2); and model 2 plus uric acid (model 3). For 7-year risk of T2DM, we calculated C-statistic, Hosmer-Lemeshow χ(2)-statistic, and integrated discrimination improvement (IDI) as measures of discrimination, calibration and reclassification, respectively. After a median follow-up of 7.7 years, 199 (9.7%) and 374 (5.9%) incident cases of T2DM were ascertained in the older and total population, respectively. In the older adults, C-statistic was 0.66 for model 1. This was improved for model 2 and model 3 (C-statistic = 0.81) with significant IDI. In the total population, these respective C-statistics were 0.77, 0.85 and 0.85. All models showed poor calibration (P < 0.001). After adjustment for the intercept and slope of each model, we observed good calibration for most models in both older and total populations. We validated the KORA clinical models for prediction of T2DM in an older Dutch population, with discrimination similar to the development cohort. However, the models need to be corrected for intercept and slope to acquire good calibration for application in a different setting. AU - Abbasi, A.* AU - Corpeleijn, E.* AU - Peelen, L.M.* AU - Gansevoort, R.T.* AU - de Jong, P.E.* AU - Gans, R.O.* AU - Rathmann, W.* AU - Kowall, B.* AU - Meisinger, C. AU - Hillege, H.L.* AU - Stolk, R.P.* AU - Navis, G.* AU - Beulens, J.W.* AU - Bakker, S.J.* C1 - 7311 C2 - 29672 SP - 47-52 TI - External validation of the KORA S4/F4 prediction models for the risk of developing type 2 diabetes in older adults: The PREVEND study. JO - Eur. J. Epidemiol. VL - 27 IS - 1 PB - Springer PY - 2012 SN - 0393-2990 ER - TY - JOUR AU - Schwab, S.* AU - Heier, M.* AU - Schneider, A.* AU - Döring, A. AU - Fischer, B.* AU - Huth, C.* AU - Grill, E.* AU - Holle, R. AU - Peters, A. AU - Thorand, B. C1 - 27999 C2 - 32895 SP - S15 TI - Prevalence of vitamin/mineral supplement use in the elderly: Results from the KORA-age study. JO - Eur. J. Epidemiol. VL - 27 IS - 1 PB - Springer PY - 2012 SN - 0393-2990 ER - TY - JOUR AB - Nutrition plays an important role in human metabolism and health. However, it is unclear in how far self-reported nutrition intake reflects de facto differences in body metabolite composition. To investigate this question on an epidemiological scale we conducted a metabolomics study analyzing the association of self-reported nutrition habits with 363 metabolites quantified in blood serum of 284 male participants of the KORA population study, aged between 55 and 79 years. Using data from an 18-item food frequency questionnaire, the consumption of 18 different food groups as well as four derived nutrition indices summarizing these food groups by their nutrient content were analyzed for association with the measured metabolites. The self-reported nutrition intake index "polyunsaturated fatty acids" associates with a decrease in saturation of the fatty acid chains of glycero-phosphatidylcholines analyzed in serum samples. Using a principal component analysis dietary patterns highly associating with serum metabolite concentrations could be identified. The first principal component, which was interpreted as a healthy nutrition lifestyle, associates with a decrease in the degree of saturation of the fatty acid moieties of different glycero-phosphatidylcholines. In summary, this analysis shows that on a population level metabolomics provides the possibility to link self-reported nutrition habits to changes in human metabolic profiles and that the associating metabolites reflect the self-reported nutritional intake. Moreover, we could show that the strength of association increases when composed nutrition indices are used. Metabolomics may, thus, facilitate evaluating questionnaires and improving future questionnaire-based epidemiological studies on human health. AU - Altmaier, E. AU - Kastenmüller, G. AU - Römisch-Margl, W. AU - Thorand, B. AU - Weinberger, K.M.* AU - Illig, T. AU - Adamski, J. AU - Döring, A. AU - Suhre, K. C1 - 3843 C2 - 28093 SP - 145-156 TI - Questionnaire-based self-reported nutrition habits associate with serum metabolism as revealed by quantitative targeted metabolomics. JO - Eur. J. Epidemiol. VL - 26 IS - 2 PB - Springer PY - 2011 SN - 0393-2990 ER - TY - JOUR AB - Few studies have investigated the independent effects of domain-specific physical activity on mortality. We sought to investigate the association of physical activity performed in different domains of daily living on all-cause, cardiovascular (CVD) and cancer mortality. Using a prospective cohort design, 4,672 men and women, aged 25-74 years, who participated in the baseline examination of the MONICA/KORA Augsburg Survey 1989/1990 were classified according to their activity level (no, light, moderate, vigorous). Domains of self-reported physical activity (work, transportation, household, leisure time) and total activity were assessed by the validated MOSPA (MONICA Optional Study on Physical Activity) questionnaire. After a median follow-up of 17.8 years, a total of 995 deaths occurred, with 452 from CVD and 326 from cancer. For all-cause mortality, hazard ratios and 95% confidence interval (HR, 95% CI) of the highly active versus the inactive reference group were 0.69 (0.48-1.00) for work, 0.48 (0.36-0.65) for leisure time, and 0.73 (0.59-0.90) for total activity after multivariable adjustments. Reduced risks of CVD mortality were observed for high levels of work (0.54, 0.31-0.93), household (0.80, 0.54-1.19), leisure time (0.50, 0.31-0.79) and total activity (0.75, 0.55-1.03). Leisure time (0.36, 0.23-0.59) and total activity (0.62, 0.43-0.88) were associated with reduced risks of cancer mortality. Light household activity was related to lower all-cause (0.82, 0.71-0.95) and CVD (0.72, 0.58-0.89) mortality. No clear effects were found for transportation activities. Our findings suggest that work, household, leisure time and total physical activity, but not transportation activity, may protect from premature mortality. AU - Autenrieth, C.S. AU - Baumert, J.J. AU - Baumeister, S.E.* AU - Fischer, B.* AU - Peters, A. AU - Döring, A. AU - Thorand, B. C1 - 6380 C2 - 28520 SP - 91-99 TI - Association between domains of physical activity and all-cause, cardiovascular and cancer mortality. JO - Eur. J. Epidemiol. VL - 26 IS - 2 PB - Springer PY - 2011 SN - 0393-2990 ER - TY - JOUR AB - We investigated the association of undiagnosed diabetes, previously known diabetes and prediabetes (WHO 1999 classification) with all-cause and cause-specific mortality in an older German population. Previous study results for mortality in patients with very low levels of HbA1c, fasting plasma glucose (FPG), and 2-h plasma glucose (2hPG) are still inconclusive. Thus we have extended the analyses to continuous measures of glycemia. A total of 1,466 subjects aged 55-74 years from the population-based KORA survey S4 (conducted from 1999 to 2001) were included in our observational mortality study (152 subjects with previously known diabetes, and 1,314 further subjects who underwent oral glucose tolerance tests). Mortality was followed up for a maximum of 10.0 years (median follow-up 8.8 years). A total of 180 (12.3%) of the 1,466 subjects have died during the follow-up period. The age- and sex-adjusted hazard ratios for all-cause mortality were 2.6 (95%CI, 1.7-3.8) for known diabetes, 2.8 (95%CI, 1.7-4.4) for undiagnosed diabetes, and 1.1 (95%CI, 0.8-1.7) for prediabetes [reference: normal glucose tolerance (NGT)]. After multivariable adjustment, undiagnosed diabetes was associated with 3.0-fold increased cancer mortality, 1.1-fold increased cardiovascular mortality, and 4.7-fold increased non-cancer, non-cardiovascular mortality compared with NGT. For HbA1c, FPG, and 2hPG, J-shaped associations with all-cause mortality were observed. Undiagnosed diabetes is associated with increased all-cause, cancer, and non-cancer non-cardiovascular mortality, but not with cardiovascular mortality in this older population. All-cause mortality in undiagnosed diabetes is similar to that in previously known diabetes but much higher than mortality in prediabetes and NGT. AU - Kowall, B.* AU - Rathmann, W.* AU - Heier, M. AU - Giani, G.* AU - Peters, A. AU - Thorand, B. AU - Huth, C. AU - Icks, A.* AU - Meisinger, C. C1 - 5784 C2 - 28944 CY - Dordrecht, Netherlands SP - 637-645 TI - Categories of glucose tolerance and continuous glycemic measures and mortality. JO - Eur. J. Epidemiol. VL - 26 IS - 8 PB - Springer PY - 2011 SN - 0393-2990 ER - TY - JOUR AB - Studies of the relationships between low socio-economic status and impaired lung function were conducted mainly in Western European countries and North America. East-West differences remain unexplored. Associations between parental education and lung function were explored using data on 24,010 school-children from eight cross-sectional studies conducted in North America, Western and Eastern Europe. Parental education was defined as low and high using country-specific classifications. Country-specific estimates of effects of low parental education on volume and flow parameters were obtained using linear and logistic regression, controlling for early life and other individual risk factors. Meta-regressions were used for assessment of heterogeneity between country-specific estimates. The association between low parental education and lung function was not consistent across the countries, but showed a more pronounced inverse gradient in the Western countries. The most consistent decrease associated with low parental education was found for peak expiratory flow (PEF), ranging from -2.80 to -1.14%, with statistically significant associations in five out of eight countries. The mean odds ratio for low PEF (<75% of predicted) was 1.34 (95% CI 1.06-1.70) after all adjustments. Although social gradients were attenuated after adjusting for known risk factors, these risk factors could not completely explain the social gradient in lung function. AU - Slachtova, H.* AU - Gehring, U.* AU - Hoek, G.* AU - Tomaskova, H.* AU - Luttmann-Gibson, H.* AU - Moshammer, H.* AU - Paldy, A.* AU - Pattenden, S.* AU - Slotova, K.* AU - Speizer, F.* AU - Zlotkowska, R.* AU - Heinrich, J. C1 - 5475 C2 - 28463 CY - Dordrecht, Netherlands SP - 45-54 TI - Parental education and lung function of children in the PATY study. JO - Eur. J. Epidemiol. VL - 26 IS - 1 PB - Springer PY - 2011 SN - 0393-2990 ER - TY - JOUR AB - Active smoking is a risk factor for type 2 diabetes (T2DM), but it is unclear whether exposure to environmental tobacco smoke (ETS) is also associated with T2DM. The effect of passive and active smoking on the 7-year T2DM incidence was investigated in a population-based cohort in Southern Germany (KORA S4/F4; 1,223 subjects aged 55-74 years at baseline in 1999-2001, 887 subjects at follow-up). Incident diabetes was identified by oral glucose tolerance tests or by validated physician diagnoses. Among never smokers, subjects exposed to ETS had an increased diabetes risk in the total sample (odds ratio (OR) = 2.5; 95% confidence interval (CI): 1.1, 5.6) and in a subgroup of subjects having prediabetes at baseline (OR = 4.4; 95% CI: 1.5, 13.4) after adjusting for age, sex, parental diabetes, socioeconomic status, and lifestyle factors. Active smoking also had a statistically significant effect on diabetes incidence in the total sample (OR = 2.8; 95% CI: 1.3, 6.1) and in prediabetic subjects (OR = 7.8; 95% CI: 2.4, 25.7). Additional adjustment for components of the metabolic syndrome including waist circumference did not attenuate any of these associations. This study provides evidence that both passive and active smoking is associated with T2DM. AU - Kowall, B.* AU - Rathmann, W.* AU - Strassburger, K.* AU - Heier, M. AU - Holle, R. AU - Thorand, B. AU - Giani, G.* AU - Peters, A. AU - Meisinger, C. C1 - 5916 C2 - 27482 SP - 393-402 TI - Association of passive and active smoking with incident type 2 diabetes mellitus in the elderly population: The KORA S4/F4 cohort study. JO - Eur. J. Epidemiol. VL - 25 IS - 6 PB - Springer PY - 2010 SN - 0393-2990 ER - TY - JOUR AB - Children's weight/growth development is age-specific and may be influenced by breastfeeding. We therefore assessed velocities of weight, length, body-mass-index and overweight/obesity development from birth up to age 6 years overall and in relation to breastfeeding. The method of this study is based on pooled data of the birth-cohorts GINI-plus and LISA-plus and follows 7,643 healthy full-term neonates in four study-centers in Germany. Up to nine anthropometric measurements are available. Overweight/obesity is percentile-defined according to WHO-Child-Growth-Standards. Fully-breastfed is defined as breastfed for at least 4 months. Piecewise-linear-random-coefficient-models were applied to assess growth trajectories and velocities between 0-3, 3-6, 6-12, 12-24 and beyond 24th months. Velocities for weight-, length- and BMI-development are highest in the first 3 months after birth and diminish, with differing pace, in the periods that follow. For overweight and obesity, peak-velocities are estimated in periods 6-12 and 3-6 months. The difference in the velocity of weight gain for breastfed vs. other children is -18 g/month in the first 3 month, -93 g/month between month 3 and 6, -14 g/month between month 6 and 12 and -3 g/month beyond the 24th month. Velocities in length are not different between breastfed and non-breastfed children. Over time, a slightly lower risk (difference < 2%) of being overweight was estimated for breastfed children, after adjustment for study-center, socio-economic-status and maternal smoking in pregnancy. Infants fully-breastfed gain less weight, but grow equally in length in the first 12 months of life versus mixed or formula-fed children. The protective effect of breastfeeding on becoming overweight is related to its weight-velocity-modifying-effect in early infancy. AU - Rzehak, P. AU - Sausenthaler, S. AU - Koletzko, S.* AU - Bauer, C.P. AU - Schaaf, B.* AU - von Berg, A.* AU - Berdel, D.* AU - Borte, M.* AU - Herbarth, O.* AU - Krämer, U.* AU - Fenske, N.* AU - Wichmann, H.-E. AU - Heinrich, J. C1 - 1421 C2 - 26440 SP - 449-467 TI - Period-specific growth, overweight and modification by breastfeeding in the GINI and LISA birth cohorts up to age 6 years. JO - Eur. J. Epidemiol. VL - 24 IS - 8 PB - Springer PY - 2009 SN - 0393-2990 ER - TY - JOUR AB - The dietary intake of certain fatty acids might have an impact on inflammatory processes in the lung and therefore contribute to the development of lung diseases like asthma or COPD. METHODS: In this study data from a population based cross-sectional study on respiratory health including measurement of fatty acids in serum phospholipids of 593 adults between 20 and 64 years of age were analyzed. RESULTS: Statistically significant positive associations were found between percentage predicted FEV1 (P = 0.0085) and FVC (P = 0.0267) and docosahexaenoic acid concentration in serum phospholipids in men. Dihomo-gamma-linolenic acid content in serum phospholipids was significantly negatively associated with percentage predicted FEV1 (P = 0.0003) and FVC (P = 0.0045) and transformed dose-response slopes (P = 0.0488) in men. Palmitoleic acid was negatively associated with percentage predicted FEV1 (P = 0.0037) and FVC (P = 0.0029) in men. Other fatty acids in serum phospholipids did not consistently affect lung function parameters or bronchial hyperreactivity. CONCLUSION: A high concentration of docosahexaenoic acid in serum phospholipids may have a protective effect on lung function. Because this long-chain n-3 polyunsaturated fatty acid is almost exclusively derived from marine oils, fish might have a beneficial effect on lung diseases. AU - Kompauer, I. AU - Demmelmair, H.* AU - Koletzko, B.* AU - Bolte, G.* AU - Linseisen, J.* AU - Heinrich, J. C1 - 1412 C2 - 25276 SP - 175-190 TI - Association of fatty acids in serum phospholipids with lung function and bronchial hyperresponsiveness in adults. JO - Eur. J. Epidemiol. VL - 23 IS - 3 PB - Springer PY - 2008 SN - 0393-2990 ER - TY - JOUR AB - Aim of this study was to examine the effect of hay fever in childhood for asthma onset from childhood to adulthood in a prospective cohort of 3,199 asthma-free children, initially aged 5-13 years, which were followed for up to 12 years in East-Germany. METHODS: Crude and adjusted incidence rate ratios (IRR) of asthma onset due to hay fever at baseline were calculated by a generalized estimation equation approach accounting for person years at risk, age at study entry, parental asthma, and gender. RESULTS: Overall 142 incident cases of asthma were observed. Prevalence of hay fever at baseline was 4%. Crude and adjusted IRR were essentially the same and showed overall and in each age group a substantial higher risk of asthma onset due to hay fever. The adjusted IRR was 4 overall and ranged between 3 and 5 within the three age groups. Restricting the analysis to those participants, who were 17-25 years of age at the end of follow-up resulted in similar IRR. CONCLUSION: Hay fever in childhood is a strong predictor of asthma onset later in life up to adulthood. The preventive potential of early and efficient treatment of allergic rhinitis to avoid asthma development needs to be investigated. AU - Rzehak, P. AU - Schoefer, Y. AU - Wichmann, H.-E. AU - Heinrich, J. C1 - 3307 C2 - 25270 SP - 17-22 TI - A prospective study on the association between hay fever among children and incidence of asthma in East Germany. JO - Eur. J. Epidemiol. VL - 23 IS - 1 PB - Springer PY - 2008 SN - 0393-2990 ER - TY - JOUR AB - Many long-term prospective studies have reported on associations of cardiovascular diseases with circulating lipid markers and/or inflammatory markers. Studies have not, however, generally been designed to provide reliable estimates under different circumstances and to correct for within-person variability. The Emerging Risk Factors Collaboration has established a central database on over 1.1 million participants from 104 prospective population-based studies, in which subsets have information on lipid and inflammatory markers, other characteristics, as well as major cardiovascular morbidity and cause-specific mortality. Information on repeat measurements on relevant characteristics has been collected in approximately 340,000 participants to enable estimation of and correction for within-person variability. Re-analysis of individual data will yield up to approximately 69,000 incident fatal or nonfatal first ever major cardiovascular outcomes recorded during about 11.7 million person years at risk. The primary analyses will involve age-specific regression models in people without known baseline cardiovascular disease in relation to fatal or nonfatal first ever coronary heart disease outcomes. This initiative will characterize more precisely and in greater detail than has previously been possible the shape and strength of the age- and sex-specific associations of several lipid and inflammatory markers with incident coronary heart disease outcomes (and, secondarily, with other incident cardiovascular outcomes) under a wide range of circumstances. It will, therefore, help to determine to what extent such associations are independent from possible confounding factors and to what extent such markers (separately and in combination) provide incremental predictive value. AU - Döring, A. AU - Koenig, W.* AU - Meisinger, C. AU - Emerging Risk Factors Collaboration (Döring, A. AU - Meisinger, C.) C1 - 4889 C2 - 25288 SP - 839-869 TI - Analysis of individual data on lipid, inflammatory and other markers in over 1.1 million participants in 104 prospective studies of cardiovascular diseases. JO - Eur. J. Epidemiol. VL - 22 IS - 12 PB - Springer PY - 2007 SN - 0393-2990 ER - TY - JOUR AB - Whether differences in obesity prevalences across social status levels have widened remains controversial. METHODS: We used German national health surveys (1990-1992 and 1998, n = 7,466 and 5,583, age 25-69 years) to estimate obesity prevalences and its associations with calendar year, age (25-39, 40-60, and 61-69), and educational level (low, middle, and high), as well as an interaction term (year x educational level) in men and women. We used multiple regression models, considering the sample design. RESULTS: Obesity prevalence in 1990 and 1998 was 18.1 (95% CI 16.5-19.7) and 19.9 (18.2-21.6) in men and 20.9 (19.2-22.6) and 21.6 (19.3-23.7) in women, with statistically significantly higher prevalences in higher age and lower education. A statistically significant increase of obesity prevalence was present only in men after adjustment for age and education. The increase seems to be highest in high-educated subjects. However, interaction was not statistically significant, except in middle compared to high-educated men (OR 0.67; 0.47-0.96). CONCLUSIONS: Obesity prevalence increased only moderately in Germany between 1990-1992 and 1998. There was a tendency of reduction of the social gradient in obesity instead of a widening. AU - Icks, A.* AU - Moebus, S.* AU - Feuersenger, A.* AU - Haastert, B.* AU - Jöckel, K.-H.* AU - Mielck, A. AU - Giani, G.* C1 - 3049 C2 - 25205 SP - 685-690 TI - Widening of a social gradient in obesity risk? German national health surveys 1990 and 1998. JO - Eur. J. Epidemiol. VL - 22 IS - 10 PB - Springer PY - 2007 SN - 0393-2990 ER - TY - JOUR AB - To investigate the effect of weight change and weight fluctuations on all-cause-mortality in men. METHODS: Within a prospective population-based cohort of 1,160 men aged 40-59 years at recruitment, complete weight change patterns from baseline and three follow-up examinations during a period of 15 years of follow-up was used to categorize the 505 men into stable obese, stable non-obese, weight gain, weight loss and weight fluctuation groups. For these men (age range: 55-74 years at start time of survival analysis) further survival was analyzed during the subsequent 15 years. RESULTS: Overall, 183 deaths were observed among the 505 men. Only weight fluctuations had a clear significant impact on all-cause mortality. Adjusted hazard rate ratio (HRR (95%-CI)) was 1.86 (1.31-2.66) after adjustment for age group, pre-existing cardiovascular disease or diabetes mellitus, smoking and socio-economic status. The risk rate due to weight loss was borderline significant (HRR = 1.81 (0.99-3.31)). Risk of death due to weight gain (HRR = 1.15 (0.70-1.88)) or stable obesity (HRR = 1.16 (0.69-1.94)), however, were not significantly increased compared to men staying non-obese for the first 15 years after cohort recruitment. CONCLUSION: Weight fluctuations are a major risk factor for all-cause mortality in middle aged men. Moreover, stable obesity does not increase further mortality in men aged 55-74 years in long-term follow-up. AU - Rzehak, P. AU - Meisinger, C. AU - Woelke, G. AU - Brasche, S.* AU - Strube, G.* AU - Heinrich, J. C1 - 2688 C2 - 24940 SP - 665-673 TI - Weight change, weight cycling and mortality in the ERFORT Male Cohort Study. JO - Eur. J. Epidemiol. VL - 22 IS - 10 PB - Springer PY - 2007 SN - 0393-2990 ER - TY - JOUR AU - Metzger, M.-H. AU - Heier, M. AU - Mäki, M.* AU - Bravi, E.* AU - Schneider, A.E. AU - Löwel, H. AU - Illig, T. AU - Schuppan, D.* AU - Wichmann, H.-E. C1 - 4824 C2 - 23842 SP - 359-365 TI - Mortality excess in individuals with elevated IgA anti-transglutaminase antibodies: The KORA/MONICA Augsburg cohort study 1989-1998. JO - Eur. J. Epidemiol. VL - 21 PY - 2006 SN - 0393-2990 ER - TY - JOUR AU - Rathmann, W.* AU - Haastert, B.* AU - Giani, G.* AU - Koenig, W.* AU - Imhof, A.* AU - Herder, C.* AU - Holle, R. AU - Mielck, A. C1 - 2745 C2 - 23465 SP - 55-60 TI - Is inflammation a causal chain between low socioeconomic status and type 2 diabetes? Results from the KORA survey 2000. JO - Eur. J. Epidemiol. VL - 21 PY - 2006 SN - 0393-2990 ER - TY - JOUR AU - Rzehak, P. AU - Heinrich, J. C1 - 5098 C2 - 24267 SP - 661-672 TI - Development of relative weight, overweight and obesity from childhood to young adulthood. A longitudinal analysis of individual change of height and weight. JO - Eur. J. Epidemiol. VL - 21 PY - 2006 SN - 0393-2990 ER - TY - JOUR AB - The objective of the study was to analyse macronutrient and food intakes of regular users (310 men, 495 women) and nonusers (1136 men, 1269 women) of vitamin and mineral supplements, aged 18–79 years. These were participants of the German Nutrition Survey, which was part of the German National Health Interview and Examination Survey 1998. Information on dietary behaviour including supplementation habits was assessed using a validated computerised dietary history method (DISHES 98). There were no major differences in macronutrient intakes between regular users and nonusers. After adjustment for age, energy intake, smoking, sport activity, socio-economic status and East/West German residence, regular supplement use was associated with a higher consumption of drinking water. Among men, a higher consumption of vegetable fat, poultry and fruit/vegetable juice, and among women, a higher consumption of fish, milk products, fruits and tea was also associated with regular supplement use. An inverse association was observed between regular supplement use and the consumption of coffee among women. Significant differences in food consumption between regular users and nonusers were observed, indicating a tendency for a healthier food choice among regular users. AU - Beitz, R.* AU - Mensink, G.B.M.* AU - Hinzpeter, B.* AU - Fischer, B. AU - Erbersdobler, H.F.* C1 - 2128 C2 - 23291 SP - 335-341 TI - Do users of dietary supplements differ from nonusers in their food consumption? JO - Eur. J. Epidemiol. VL - 19 IS - 4 PY - 2005 SN - 0393-2990 ER - TY - JOUR AB - We performed a survey on socioeconomic factors in 27 studies of children’s environmental health funded by EU FP4 and FP5. Parental education was the most common measure (74%). Socioeconomic factors were predominantly considered as confounder (74%) and less often as effect modifier (33%) or independent variable (37%). The awareness of the need to study the impact of socioeconomic factors further seems to have increased in recent years. AU - Bolte, G.* AU - Kohlhuber, M.* AU - Weiland, S.K.* AU - Zuurbier, M.* AU - Stansfeld, S.* AU - Heinrich, J. C1 - 3686 C2 - 23088 SP - 289-291 TI - Socioeconomic factors in EU-funded studies of children's environmental health. JO - Eur. J. Epidemiol. VL - 20 IS - 4 PY - 2005 SN - 0393-2990 ER - TY - JOUR AB - Sample surveys are used to investigate occurrence and determinants of diseases in populations. Their reliability is influenced by quality of sampling frame and response rate. We investigated relationship between sampling frame type and response rates and assessed their impact on non-response bias, using data from the WHO MONICA Project, where 37 centres in 20 countries conducted sample surveys, employing the best locally available sampling frame. Sampling frames fell into three categories: Population registers (PR), electoral registers (ER), and health care registers (HR). Response rate (rrs) was factored into components reflecting quality of sampling frame (contact rate cr) and characterizing willingness of sample members to participate (enrolment rate er). The mean quality score for the sampling frames was 92 for PR, 87 for HR and 85 for ER; they contributed on average 23, 20, and 26 to the respective non-response rates. For all frame types and both sexes the lowest quality score occurred in the age group 35–44, suggesting a reduced ability to track migration of a highly mobile population group. The patterns in the age/sex distribution of er indicate at least for males in PR and females in HR a potential for non-response bias. Estimation of non-response bias through an abbreviated questionnaire failed because of low item response. We found that contact rate characterizes sampling frame quality. For all frame types it had a major influence on response rate. It is likely that low er and low cr cause different kind of bias, requiring different measures to minimize their effects. AU - Wolf, H.E.* AU - Kuulasmaa, K.* AU - Tolonen, H.* AU - Sans, S.* AU - Molarius, A.* AU - Eastwood, B.J.* AU - Keil, U. AU - WHO MONICA Project (Bolte, H.-D. AU - Gostomzyk, J.G. AU - Hörmann, A. AU - Löwel, H.) C1 - 4317 C2 - 23147 SP - 293-299 TI - Effect of sampling frames on response rates in the WHO MONICA risk factor surveys. JO - Eur. J. Epidemiol. VL - 20 IS - 4 PY - 2005 SN - 0393-2990 ER - TY - JOUR AB - Gender differences in morbidity have been widely confirmed in representative health surveys in North America and Europe. Significantly more women than men suffer from somatic complaints. It is less clear whether differences in symptom reporting provide an impact on health care utilization and to which degree psychosocial factors exhibit confounding influence. METHODS: We analyzed data from a representative health examination survey in Germany with 7466 participants in the age range of 25 to 69 years. RESULTS: The analysis confirmed an overall excess in female symptom reporting, both in the total sample (n = 7460; p < or = 0.001) and in the healthy subsample (n = 906, p < or = 0.01). Also, female utilization of medical services was higher (p < or = 0.0001). A simultaneous age related increase in the prevalence of symptom reporting in both groups peaked in the age group of 55-59 years followed by a subsequent slight decrease in higher age groups whereas utilization steadily increased over the adult life span in both sexes. As expected, more medical utilization was associated with higher symptom reporting levels. Nevertheless, females constantly exhibited more medical utilization than males in all symptom reporting groups. Age and marital status had no univariate influence on symptom reporting whereas low social class status (p = 0.001), poor perceived/self assessed health (p < 0.0001), and high levels of chronic distress (p < 0.0001) were associated with more symptom reporting. In multivariate analysis, the female gender lost its significance on heightened symptom reporting. Poor perceived/self assessed health had the most pronounced impact on symptom count (F-value 59.1; p < 0.001). CONCLUSIONS: The present study confirms a female excess of symptom reporting and utilization of medical services. Nevertheless, symptom reporting and utilization are not closely related. The gender gap in symptom reporting may be largely explained by low social class status, high levels of chronic distress and poor perceived/self assessed health. AU - Ladwig, K.-H. AU - Marten-Mittag, B.* AU - Formanek, B.* AU - Dammann, G.* C1 - 2990 C2 - 25028 SP - 511-518 TI - Gender differences of symptom reporting and medical health care utilization in the German population. JO - Eur. J. Epidemiol. VL - 16 IS - 6 PB - Springer PY - 2000 SN - 0393-2990 ER -