Beate Fischer

Do users of dietary supplements differ from nonusers in their food consumption

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.

Comparison of associations of body mass index, abdominal adiposity, and risk of colorectal cancer in a large prospective cohort study

Background: Increased body mass index (BMI) is an established colorectal cancer risk factor. High waist circumference or waist-hip-ratio (WHR) may better reflect an abnormal metabolic state and be more predictive of colorectal cancer risk than BMI. Methods: We examined BMI, waist circumference, WHR, and hip circumference in relation to colorectal cancer risk among 203,177 participants followed for 10 years. We derived standardized colorectal cancer risk estimates for each anthropometric parameter and compared predictive characteristics (Harrells C-index). In women, we examined whether hormone replacement therapy (HRT) use modified the associations between anthropometric measures and colorectal cancer. Results: We ascertained 2,869 colorectal cancers. In men, increased colon cancer risks were associated with BMI [HR per SD, 1.14; 95% confidence interval (CI), 1.08–1.20], waist circumference (HR per SD, 1.17; 95% CI, 1.08–1.27), and WHR (HR per SD, 1.09; 95% CI, 1.04–1.14). In women, anthropometric variables were unrelated to colon cancer. For men and women, anthropometric variables were unrelated to rectal cancer. Compared with BMI, waist circumference and WHR did not materially influence colon cancer prediction models [C-index changes: −0.0041 and 0.0046 (men); 0.0004 and 0.0005 (women)]. In current HRT users, colon cancer was inversely or suggestively inversely associated with waist circumference (HR per SD, 0.78; 95% CI, 0.63–0.97) and WHR (HR per SD, 0.88; 95% CI, 0.76–1.01), but positively related to hip circumference (HR per SD, 1.39; 95% CI, 1.13–1.71). Conclusion: BMI, waist circumference, and WHR show comparable positive associations with colon cancer in men. Associations between anthropometric measures and colon cancer are weak or null in women, but there is some evidence for effect modification by HRT. Impact: These findings may improve our understanding of the relation of adiposity to colorectal cancer. Cancer Epidemiol Biomarkers Prev; 22(8); 1383–94. ©2013 AACR.

Body mass index, physical activity, and risk of adult meningioma and glioma A meta-analysis

Objective: Whether adiposity and lack of physical activity affect the risk for developing meningioma and glioma is poorly understood. Our objective was to characterize these associations in detail. Methods: We conducted a systematic review and meta-analysis of adiposity and physical activity in relation to meningioma and glioma using cohort and case-control studies published through February 2015. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: We identified 12 eligible studies of body mass index (BMI) and 6 studies of physical activity, comprising up to 2,982 meningioma cases and 3,057 glioma cases. Using normal weight as the reference group, overweight (summary relative risk [RR] = 1.21, 95% confidence interval [CI] = 1.01–1.43) and obesity (RR = 1.54, 95% CI = 1.32–1.79) were associated with increased risk of meningioma. In contrast, overweight (RR = 1.06, 95% CI = 0.94–1.20) and obesity (RR = 1.11, 95% CI = 0.98–1.27) were unrelated to glioma. Similarly, dose-response meta-analyses revealed a statistically significant positive association of BMI with meningioma, but not glioma. High vs low physical activity levels showed a modest inverse relation to meningioma (RR = 0.73, 95% CI = 0.61–0.88) and a weak inverse association with glioma (RR = 0.86, 95% CI = 0.76–0.97). Relations persisted when the data were restricted to prospective studies, except for the association between physical activity and glioma, which was rendered statistically nonsignificant (RR = 0.91, 95% CI = 0.77–1.07). Conclusions: Adiposity is related to enhanced risk for meningioma but is unassociated with risk for glioma. Based on a limited body of evidence, physical activity is related to decreased risk of meningioma but shows little association with risk of glioma.

The use of dietary supplements among older persons in Southern Germany — Results from the KORA-age study

ObjectivesCurrent population-based surveys in Europe on the prevalence of dietary supplement (DS) use in older individuals are scarce. The aim of the present study was to investigate patterns, prevalence and determinants of non-herbal DS use in aged subjects. Furthermore, the intake amounts of vitamins and minerals from supplements were assessed.DesignCross-sectional.SettingData on supplement use were available from an age- and sex-stratified random sample of the German population-based KORA (Cooperative Health Research in the Region of Augsburg)-Age study.Participants1,079 persons who were born in or before the year 1943.MeasurementsUse of dietary supplements and medications during the last seven days was recorded in a face-to-face interview in 2009. Participants were asked to bring all packages of ingested preparations to the study center. Not only vitamin/mineral supplements, but also non-vitamin non-mineral non-herbal supplements and drugs containing vitamins and minerals were coded as DS.ResultsThe age-standardized prevalence of DS intake was 54.3% in women and 33.8% in men, respectively. The most commonly supplemented mineral and vitamin, respectively, was magnesium (31.9%) and vitamin D (21.5%) in women and magnesium (18.0%) and vitamin E (12.0%) in men. The highest intakes, compared to the German Dietary Reference Intakes, were reported for biotin, vitamin B6 and B1. Excessive intakes (equal or above the European Tolerable Upper Intake Levels (UL)) were observed especially for magnesium and vitamin E. 20.2% of the women and 32.5% of the men who took magnesium supplements regularly exceeded the UL for magnesium. In case of vitamin E this was true for 8.0% of the women and 13.6% of the men. Determinants of DS use were sex, education, smoking, physical activity, neurological diseases, and stroke.ConclusionA high proportion of the general population aged 65 years and older in Southern Germany uses DS, especially supplements containing vitamins/minerals. The supplementation of vitamin D can be regarded as favorable in this age group, whereas the excessive intakes of vitamin E might be a cause of concern.

The Geriatric Nutritional Risk Index predicts increased healthcare costs and hospitalization in a cohort of community-dwelling older adults: Results from the MONICA/KORA Augsburg cohort study, 1994–2005

OBJECTIVE To determine if the Geriatric Nutritional Risk Index (GNRI), an index for the risk of nutrition-related complications, is associated with healthcare costs and risk of hospitalization at baseline and after 10 y. METHODS Data from a German population-based cohort of 1999 subjects 55 to 74 y of age at baseline were used. Self-reported physician visits, length of hospital stay, and drug intake were used to estimate costs. The GNRI is based on serum albumin values and the discrepancy between real and ideal body weights. Low GNRI values were defined as mean minus 2 times standard deviation. Mean GNRI values were regarded as normal. RESULTS Low baseline GNRI was consistently associated with increased total costs, probability of hospitalization, inpatient costs, and pharmaceutical costs at baseline and follow-up, after adjustment for socioeconomic characteristics, lifestyle factors, and coexisting conditions. Subjects with low GNRI at baseline had approximately 47% higher total costs, 50% higher risk of hospitalization, 62% higher inpatient costs and 27% higher pharmaceutical costs at follow-up than subjects with normal GNRI values. CONCLUSION The GNRI risk predicted increased future healthcare costs and higher risk of hospitalization in independent-living older adults. The GNRI is a rapid and low-cost tool that might be routinely used in population-based settings.

Blood Pressure and Vitamin C and Fruit and Vegetable Intake

Background: A high vitamin C intake was recently associated with lower blood pressure levels. We examined this association and compared it with that between blood pressure and fruit and vegetable intake among German adults. Methods: Complete data were available for 1,628 women and 1,340 men, aged 18–79 years, who participated in the German Nutrition Survey, a subsample of the National Health Survey 1998. The participants completed a health and lifestyle questionnaire and underwent a medical examination and a comprehensive dietary interview. Multiple regression models were used to analyze the association between blood pressure and vitamin C and fruit and vegetable intakes. The associations were adjusted for age and body mass index and in addition for smoking among women and alcohol intake and sport activity among men. Results: Systolic blood pressure showed a significant inverse association with fruit and vegetable but not with vitamin C intake among women. If information about vitamin C and fruit and vegetable intakes was considered simultaneously, a high fruit and vegetable intake was stronger associated with lower systolic blood pressure levels as compared with a high vitamin C intake among women. Among men, we did not observe significant associations between blood pressure and vitamin C and fruit and vegetable intakes. Conclusion: The total vitamin C intake seems to be less associated with blood pressure levels as compared with the intake of fruit and vegetables among women.

Dietary behaviour of German adults differing in levels of sport activity.

OBJECTIVE To analyse the dietary behaviour of persons engaging in different levels of sport activity. DESIGN A cross-sectional survey analysis. SETTING A population-based sample of German adults. SUBJECTS A total of 1756 men and 2254 women participating in the German National Health Interview and Examination Survey and the integrated German Nutrition Survey 1998. RESULTS Among both genders, the median micronutrient intakes of active persons were more preferable than those of sedentary persons when German current reference values were used as a criterion. The median nutrient densities were also higher in the diet of active persons, especially those of vitamin E, calcium, magnesium, and among women also those of folate and vitamin C. On average, active persons consumed higher amounts of fruit/vegetable juice, drinking water, milk products (including cheese) and fruits. Active men additionally consumed higher amounts of vegetables and vegetable fat. The contribution of dietary supplements to the total nutrient intake was 3%, on average, for active men and women. Compared with sedentary persons, this contribution was significantly higher for vitamins, and among men also for calcium and magnesium. CONCLUSION There was no indication of an impaired micronutrient intake of active and moderately active persons compared with sedentary persons.

Design and evaluation of a computer-based 24-Hour physical activity recall (cpar24) instrument

Background Widespread access to the Internet and an increasing number of Internet users offers the opportunity of using Web-based recalls to collect detailed physical activity data in epidemiologic studies. Objective The aim of this investigation was to evaluate the validity and reliability of a computer-based 24-hour physical activity recall (cpar24) instrument with respect to the recalled 24-h period. Methods A random sample of 67 German residents aged 22 to 70 years was instructed to wear an ActiGraph GT3X+ accelerometer for 3 days. Accelerometer counts per min were used to classify activities as sedentary (<100 counts per min), light (100-1951 counts per min), and moderate to vigorous (≥1952 counts per min). On day 3, participants were also requested to specify the type, intensity, timing, and context of all activities performed during day 2 using the cpar24. Using metabolic equivalent of task (MET), the cpar24 activities were classified as sedentary (<1.5 MET), light (1.5-2.9 MET), and moderate to vigorous (≥3.0 MET). The cpar24 was administered twice at a 3-h interval. The Spearman correlation coefficient (r) was used as primary measure of concurrent validity and test-retest reliability. Results As compared with accelerometry, the cpar24 underestimated light activity by −123 min (median difference, P difference <.001) and overestimated moderate to vigorous activity by 89 min (P difference <.001). By comparison, time spent sedentary assessed by the 2 methods was similar (median difference=+7 min, P difference=.39). There was modest agreement between the cpar24 and accelerometry regarding sedentary (r=.54), light (r=.46), and moderate to vigorous (r=.50) activities. Reliability analyses revealed modest to high intraclass correlation coefficients for sedentary (r=.75), light (r=.65), and moderate to vigorous (r=.92) activities and no statistically significant differences between replicate cpar24 measurements (median difference for sedentary activities=+10 min, for light activities=−5 min, for moderate to vigorous activities=0 min, all P difference ≥.60). Conclusion These data show that the cpar24 is a valid and reproducible Web-based measure of physical activity in adults.

Intake of Vitamin and Mineral Supplements and Longitudinal Association with HbA1c Levels in the General Non-Diabetic Population--Results from the MONICA/KORA S3/F3 Study.

Background Lower levels of hemoglobin A1c (HbA1c) are associated with a decreased risk of cardiovascular complications in diabetic and non-diabetic individuals. The aim of the study was to longitudinally investigate the association between the use of 11 vitamins and minerals (vitamins E, C, D, B1, folic acid, carotenoids, calcium, magnesium, zinc, iron, and selenium) and change in HbA1c levels over 10 years in non-diabetic individuals drawn from the general population. Methods Baseline data were available from 4447 subjects included in the population-based “Monitoring of Trends and Determinants in Cardiovascular Diseases” (MONICA) Augsburg S3 survey (1994/95). Follow-up data were derived from 2774 participants in the follow-up survey named “Cooperative Health Research in the Region of Augsburg” (KORA) F3 (2004/05). Vitamin/mineral intake from supplements and medications was assessed in a personal interview, where participants were asked to bring product packages of preparations that had been ingested during the last 7 days prior to the examination. Associations between regular vitamin/mineral intake amounts and HbA1c levels measured at baseline and follow-up were investigated using generalized estimating equation models. For carotenoids, analyses were stratified by smoking status. Results None of the investigated nutrients except for carotenoids was significantly associated with changes in HbA1c levels after 10 years. Regular intake of carotenoids from supplements and medications in amounts > 6.8mg/d (upper tertile) was associated with an absolute –0.26% (95% CI: –0.43 to –0.08) lower increase in HbA1c levels compared with no intake of carotenoids. An inverse association was observed in those who never smoked but not in (former) smokers. Conclusion Larger prospective and intervention studies in non-diabetic/non-smoking individuals are needed to confirm the results and to assess whether the observed associations between carotenoid intake and change in HbA1c levels are causal. If our results are confirmed, high carotenoid intake could be one strategy for the prevention of cardiovascular complications in non-diabetic people.