Dietrich Alte

Cohort Profile: The Study of Health in Pomerania

Henry Volzke, y Dietrich Alte,1y Carsten Oliver Schmidt, Dorte Radke, Roberto Lorbeer, Nele Friedrich, Nicole Aumann, Katharina Lau, Michael Piontek, Gabriele Born, Christoph Havemann, Till Ittermann, Sabine Schipf, Robin Haring, Sebastian E Baumeister, Henri Wallaschofski, Matthias Nauck, Stephanie Frick, Andreas Arnold, Michael Junger, Julia Mayerle, Matthias Kraft, Markus M Lerch, Marcus Dorr, Thorsten Reffelmann, Klaus Empen, Stephan B Felix, Anne Obst, Beate Koch, Sven Glaser, Ralf Ewert, Ingo Fietze, Thomas Penzel, Martina Doren, Wolfgang Rathmann, Johannes Haerting, Mario Hannemann, Jurgen Ropcke, Ulf Schminke, Clemens Jurgens, Frank Tost, Rainer Rettig, Jan A Kors, Saskia Ungerer, Katrin Hegenscheid, Jens-Peter Kuhn, Julia Kuhn, Norbert Hosten, Ralf Puls, Jorg Henke, Oliver Gloger, Alexander Teumer, Georg Homuth, Uwe Volker, Christian Schwahn, Birte Holtfreter, Ines Polzer, Thomas Kohlmann, Hans J Grabe, Dieter Rosskopf, Heyo K Kroemer, Thomas Kocher, Reiner Biffar,17,y Ulrich John20y and Wolfgang Hoffmann1y

Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence.

Background/Aims:Cholelithiasis is a common disorder in north-eastern Germany. Analyses of risk factors for gallstone formation in this population may have high explanatory power. Gender-specific risk factors for gallstone formation and their interactions were investigated by using data of the population-based Study of Health in Pomerania (SHIP). Methods:Data of 4,202 persons aged 20–79 years were available. Cholelithiasis was defined by either a prior history of cholecystectomy or the presence of gallstones on abdominal ultrasound. Multivariable analyses were performed to identify independent risk factors for gallstone formation. Results:There were 468 persons (11.1%) with previous cholecystectomy and 423 persons (10.1%) with sonographic evidence of gallstones. Women had a twofold higher risk for cholelithiasis compared to men. Age, body mass index and low serum HDL cholesterol levels were independently associated with cholelithiasis in both men and women. In the male population, low alcohol and high coffee consumption and in the female population, low physical activity, were further independently related to gallstone formation. Additionally, sex-specific interactions between risk factors were found. Conclusions: Female sex, age and being overweight are major risk factors for gallstone formation in this region where cholelithiasis is a frequent disorder. Additional factors and interactions contribute to a gender-specific gallstone risk.

The relation of exposure to shift work with atherosclerosis and myocardial infarction in a general population

OBJECTIVES We tested the hypothesis that working shifts is related to atherosclerosis and myocardial infarction. BACKGROUND The number of shift workers is continuously increasing. Shift work is discussed to be related with cardiovascular heart disease. METHODS A total of 2510 subjects recruited for the population-based Study of Health in Pomerania were tested, 698 of whom were former shift workers. A general population sample was examined to reach generalizibility and to produce results independent from the effects of the personal shift schedule and from the specific working conditions. Carotid ultrasound was performed to evaluate carotid intima-media thickness. We used multivariable analyses to estimate the coronary heart disease risk, adjusted for age, sex and atherosclerotic risk factors, stratified by exposure to shift work and its duration. RESULTS Atherosclerotic risk factors differed in part between shift workers and non-shift workers. Shift work was associated with atherosclerosis and myocardial infarction, depending on the duration of the exposure and the age of the participants. Multivariable Cox regression analysis identified shift work as a risk factor for myocardial infarction to be manifest at younger ages (adjusted hazard ratio 1.53, 95% CI 1.06-2.22). CONCLUSIONS Exposure to shift work is a risk factor for atherosclerosis and myocardial infarction. Special prevention programs for shift workers should be provided.

Extended recruitment efforts minimize attrition but not necessarily bias

OBJECTIVES There has been a debate about the effect of extended recruitment efforts on attrition and bias. The aims of the present study are (1) to investigate the effectiveness of extensive multimode recruitment procedures; (2) to study their effect on attrition and bias; and (3) to determine the potential predictors of attrition. STUDY DESIGN AND SETTING We used data from the longitudinal population-based study of health in Pomerania. RESULTS Using multimode recruitment methods, we reached a follow-up response proportion of 83.6%. In-person contacts at home turned out to be an effective recruitment tool. Sociodemographic and health characteristics of late respondents and converted nonrespondents were most distinct from early respondents but not necessarily indicative of nonrespondents. Analyzing attrition bias, extended recruitment efforts produced an effect only for sociodemographic characteristics but not for health-related indicators. The strongest predictors for attrition from the regression model were late recruitment at baseline, unemployment, low educational level, female sex, and smoking habit. CONCLUSION Extended recruitment efforts appeared justified in terms of response maximization. However, enhanced response proportions may not necessarily minimize bias. In our analysis, aiming for a high-response proportion in terms of health-related indicators had no effect, because late respondents did not differ from early respondents.

Association of malocclusion and functional occlusion with signs of temporomandibular disorders in adults: results of the population-based study of health in Pomerania.

The objective of this study was to determine whether associations exist between occlusal factors and signs of temporomandibular disorders (TMD) in adults using the population-based Study of Health in Pomerania (SHIP), Germany. A representative sample of 4310 men and women aged 20 to 81 years (response 68.8%) was investigated for TMD signs, malocclusions, functional occlusion factors, and sociodemographic parameters. Multiple logistic regression analysis, adjusted for sex, age, and socioeconomic status, was used. The results were compared with other population-based studies identified by a systematic review. Few malocclusions and no factors of functional occlusion except socioeconomic parameters were associated with TMD signs, and these associations were mostly weak. Only bilateral open bite up to three mm appeared to be clinically relevant and was associated with TMD signs (odds ratio [OR] = 4.0). This malocclusion, however, was of rare occurrence, with a prevalence of 0.3% (n = 9), and this finding was not confirmed by other representative studies. Occlusal factors examined in this study explained only a small part of the differences between normal subjects and those with TMD signs. This and other population-based studies indicate that malocclusions and factors of functional occlusion surveyed should be seen as merely cofactors in the sense of one piece of the mosaic in the multifactorial problem of temporomandibular dysfunction. Single occlusal factors that showed significant effects throughout several studies could not be detected. In view of the large number of occlusal variables already investigated, other variables including nonocclusal ones probably also play a role and should be looked at more intensely.

The association between subclinical hyperthyroidism and blood pressure in a population-based study.

Objective Although evidence for an increased risk of hypertension in both overt hyperthyroidism and overt hypothyroidism is consistent, the relation between subclinical hyperthyroidism and blood pressure has not yet received sufficient attention. Methods The Study of Health in Pomerania is a population-based survey in Germany that was conducted in a previously iodine-deficient region. A study population of 4087 subjects (2050 women) without overt hyperthyroidism or increased serum thyrotropin levels was available for the present study. Serum thyrotropin levels < 0.25 mIU/l and < 0.1 mIU/l were considered decreased and suppressed, respectively. Results Multivariable analyses revealed lower adjusted mean values for systolic blood pressure in subjects with decreased [132.9 mmHg, 95% confidence interval (CI) = 131.1 mmHg; 134.8 mmHg] versus normal serum thyrotropin levels (135.0 mmHg, 95% CI = 134.4 mmHg; 135.6 mmHg, P = 0.04). The adjusted mean values for diastolic blood pressure and pulse pressure did not differ significantly between both groups. Analyses that were performed after all subjects receiving antihypertensive medications had been excluded did not reveal any statistically significant associations between decreased serum thyrotropin levels and the endpoints investigated. There was also no association of suppressed serum thyrotropin levels with blood pressure or hypertension. Conclusion It is concluded that subclinical hyperthyroidism, as demonstrated by decreased as well as suppressed serum thyrotropin levels and serum free thyroid hormone levels within the reference range, is not associated with hypertension.

Menopause and determinants of quality of life in women at midlife and beyond: the study of health in pomerania (SHIP).

Objective: Determinants of quality of life (QoL) in pre- and postmenopausal women including nonhormonal modulators of QoL in adult women are not well understood; there is an ongoing controversy about the impact of menopause on health-related QoL. We investigated the extent to which diverse mental and physical symptoms are associated with (a) menopausal status; (b) sociodemographic, psychosocial, and lifestyle factors; and (c) menopausal hormone therapy (MHT) in adult women after the German reunification in a region of the former German Democratic Republic. Design: The Study of Health in Pomerania is a cross-sectional, population-based survey. Computer-based structured interviews and self-administered questionnaires were used to capture QoL (Zerssen Symptom List) and sociodemographic parameters, psychosocial, and lifestyle indicators (age, socioeconomic status, abuse, social support, nutrition, body mass index, self-rated health, chronic diseases, and use of MHT) in 1,119 pre- and postmenopausal women with an intact uterus. Results: Analyses suggest that menopausal status was not associated with QoL. MHT was associated with physical, mental, and gastrointestinal symptoms. Age was a significant predictor for cardiopulmonary symptoms and sensory impairment. The relationship between age and both physical and mental complaints was inverse as was the relationship between age and both mood and gastrointestinal symptoms. Age, socioeconomic status, physical and sexual abuse, perceived social support, nutrition, body mass index, self-rated health, chronic diseases, and MHT modulated QoL. Conclusions: Our findings do not support the hypothesis that QoL is reduced after menopause. Differences between pre- and postmenopausal women can be explained by sociodemographic, psychosocial, and lifestyle factors.

Association Between Alcohol Consumption and Subclinical Carotid Atherosclerosis The Study of Health in Pomerania

Background and Purpose— Epidemiologic studies have shown a J-shaped association between alcohol consumption and vascular diseases. However, only few studies have reported on the association between alcohol intake and subclinical atherosclerosis. The aim of the study was to investigate the relation between alcohol intake and carotid intima-media thickness (IMT) in participants of the population-based Study of Health in Pomerania. Methods— In 1230 men and 1190 women, the mean IMT of the right and left common carotid arteries was measured by B-mode ultrasonography. Alcohol consumption was assessed with a computer-assisted face-to-face interview. Results— In men, carotid IMT as a function of alcohol intake was depicted as a J-shaped curve with a nadir for the alcohol intake category of 61 to 80g/d. Linear regression models controlled for age, diabetes, systolic blood pressure, leisure time physical activity, food frequency patterns, smoking status, and education revealed a significant inverse association between IMT and alcohol intake ≤80g/d in men (β=−0.009, P<0.02), which became insignificant after further controlling for HDL cholesterol and fibrinogen (β=−0.007, P=NS). In women, neither a J-shaped relation nor significant differences in IMT between the drinking and nondrinking groups were found. Conclusions— Alcohol consumption is inversely correlated with carotid IMT in men but not in women. However, the total daily level of alcohol intake that shows a maximum protective effect against atherosclerosis is above the threshold where severe alcohol related comorbidity and organ damage have been reported.

Laboratory markers carbohydrate-deficient transferrin, γ-glutamyltransferase, and mean corpuscular volume are not useful as screening tools for high-risk drinking in the general population: Results from the study of health in pomerania (SHIP)

BACKGROUND Assessment of high-risk drinking in the general population can be problematic: questionnaire-based instruments may carry the problem of random or systematic recall bias, and the effectiveness of screening of single biomarkers has been shown to be insufficient. In this article, we analyze the alcohol intake/biomarker relationship of carbohydrate-deficient transferrin (CDT), gamma-glutamyltransferase (GGT), and erythrocyte mean corpuscular volume (MCV). Specific aims were (1) screening effectiveness comparison of GGT, CDT, and MCV in terms of sensitivity, specificity, and positive (PPVs) and negative predictive values (NPVs) and the effect of covariates on these measures; (2) the comparison of summary measures for the effectiveness of screening: the receiver characteristic curve (ROC) and the area under the ROC; and (3) to answer the question of which covariates effect which biomarkers and whether accounting for relevant covariates increases the prognostic value of biomarkers to levels that allow for application in the general population. METHODS In a representative cross-sectional health survey in northeast Germany with data collection from 1997 to 2001, 4310 men and women were asked for their recent alcohol consumption and smoking. Biomarkers were analyzed from blood samples. The effectiveness of screening of CDT, GGT, and MCV for high-risk drinking (men: >60 g/day, women: >40 g/day) was analyzed with PPV and ROC curve analysis. RESULTS For all three biomarkers, PPVs for high-risk drinking are very low (< 50%). There are some effects of covariates on screening effectiveness and on PPV, and knowledge of these covariates increases screening effectiveness, but no subgroup that had a combination of covariate levels and prevalence of high-risk drinking that led to a PPV > 50% could be found. CONCLUSIONS : Accounting for covariates in the screening procedure does not lead to a sufficient increase in PPV. Screening effectiveness of laboratory markers CDT, GGT, and MCV is insufficient for their application as screening tools for high-risk alcohol drinking in the general population. This was found using self-reported alcohol consumption as an imperfect gold standard, which is a limitation of the study, although self-reports are the standard instrument in comparable epidemiologic studies.

Low total testosterone is associated with increased risk of incident type 2 diabetes mellitus in men: results from the Study of Health in Pomerania (SHIP)

Objective. There is increasing evidence suggesting that low total testosterone concentration is associated with incident type 2 diabetes mellitus (T2DM) in men. The aim of this study was to evaluate the association between total testosterone and incident T2DM in a large population-based cohort. Methods. Of 2117 men at baseline, 1589 were followed up 5 years later. Low total testosterone concentration at baseline determined by <10th percentile (10-year age-strata) were used as a risk factor for incident T2DM at follow-up. To evaluate for potential non-response bias, drop out weights were used in sensitivity analysis. Results. From 1339 men eligible for analyses, 68 (5.1%) developed T2DM. Men with low total testosterone concentration had an increased risk of developing T2DM (odds ratio [OR] 3.4, 95% CI 1.9–6.1), even after adjustment for age, waist circumference and smoking, OR 3.0; (95% CI 1.6–5.7). Recalculated weighted models revealed almost identical estimates indicating no relevant non-response bias. Discussion. Our prospective findings suggest that low total testosterone concentration is associated with incident T2DM in men and might represent a biomarker that might causally be involved in the risk of T2DM. This underlines the importance of measuring total testosterone in men as the predominant male sex hormone.