Mark Martin Haenle

Overweight, physical activity, tobacco and alcohol consumption in a cross-sectional random sample of German adults

BackgroundThere is a current paucity of data on the health behaviour of non-selected populations in Central Europe. Data on health behaviour were collected as part of the EMIL study which investigated the prevalence of infection with Echinococcus multilocularis and other medical conditions in an urban German population.MethodsParticipating in the present study were 2,187 adults (1,138 females [52.0%]; 1,049 males [48.0%], age: 18–65 years) taken from a sample of 4,000 persons randomly chosen from an urban population. Data on health behaviour like physical activity, tobacco and alcohol consumption were obtained by means of a questionnaire, documentation of anthropometric data, abdominal ultrasound and blood specimens for assessment of chemical parameters.ResultsThe overall rate of participation was 62.8%. Of these, 50.3% of the adults were overweight or obese. The proportion of active tobacco smokers stood at 30.1%. Of those surveyed 38.9% did not participate in any physical activity. Less than 2 hours of leisure time physical activity per week was associated with female sex, higher BMI (Body Mass Index), smoking and no alcohol consumption. Participants consumed on average 12 grams of alcohol per day. Total cholesterol was in 62.0% (>5.2 mmol/l) and triglycerides were elevated in 20.5% (≥ 2.3 mmol/l) of subjects studied. Hepatic steatosis was identified in 27.4% of subjects and showed an association with male sex, higher BMI, higher age, higher total blood cholesterol, lower HDL, higher triglycerides and higher ALT.ConclusionThis random sample of German urban adults was characterised by a high prevalence of overweight and obesity. This and the pattern of alcohol consumption, smoking and physical activity can be considered to put this group at high risk for associated morbidity and underscore the urgent need for preventive measures aimed at reducing the significantly increased health risk.

Prevalence of gallbladder stone disease in obese children and adolescents: influence of the degree of obesity, sex, and pubertal development.

Objectives: The objective of the present study was to investigate the prevalence of gallbladder stone disease (GD) in a collective of obese children and adolescents and to assess the role of potential influencing factors such as the degree of obesity, sex, age, and pubertal development. Methods: Four hundred ninety-three obese children and adolescents (body mass index standard deviation score [BMI-SDS] > 2.0p) aged 8 to 19 years (218 males, 275 females) were included in the study and underwent ultrasound for detection of GD. Results: Gallbladder stones were detected in 10 of 493 (2.0%; 8 girls, 2 boys) subjects studied. None of the 95 prepubertal children examined were found to suffer from GD. Patients with GD were more severely obese (BMI-SDS 3.4 ± 0.5 vs. 2.7 ± 0.4; P < 0.001) and older (16.1 ± 1.5 vs.13.9 ± 2.0 years; P < 0.008) than children and adolescents without GD. Conclusions: Compared with published data for unselected children an adolescents, the prevalence of GD (2.0%) in obese children and adolescents, previously treated with diet for obesity, is high. Obesity and female sex appear even in children and adolescents to be risk factors for the development of GD. The occurrence of prepubertal GD is rare.

Contrast-enhanced wideband harmonic imaging ultrasound (SonoVue®): A new technique for quantifying bowel wall vascularity in Crohn's disease

Objective. To assess the possibility of quantitative determination of bowel wall vascularity using contrast-enhanced (SonoVue®) wideband harmonic imaging ultrasound and the HDI-Lab software in patients with Crohns disease. Material and methods. Twenty-one patients (13 F, 8 M, average age 33.8±12.7 years, range 21–60 years) with histologically confirmed Crohns disease and bowel wall thickness ≥5 mm were recruited for the study. All ultrasound examinations were performed using a Philips HDI 5000 scanner. Bowel wall vascularity was determined at the site of maximum bowel wall thickness at baseline and at 30, 60, 90 and 120 s following application of the contrast enhancer SonoVue (1.2 ml) using the HDI-Lab software. Results. The mean length of bowel segments exhibiting increased wall thickness was 122.3 mm (range: 23–350±74.7 mm), with a mean wall thickness of 7.6±1.2 mm. Onset of echo enhancement secondary to contrast medium application was observed after an average 13.4 s (range 7–19±4.2 s). Echo intensity corresponding to maximum vascularity was measured 30 s after application of contrast medium. Maximum average contrast medium uptake was 217.5% (range 118–466±100.1%). Conclusions. It is possible to quantify bowel wall vascularity accurately in patients with Crohns disease using contrast-enhanced pulse inversion ultrasound (low-MI).

Factors affecting liver size: A sonographic survey of 2080 subjects

Objective. We sought to determine the size of the liver in a nonselected population sample to establish normal and reference values and to study potential factors influencing liver size. Methods. A total of 2080 subjects (983 male and 1097 female; age range, 18–88 years) underwent prospective ultrasound examination to determine the size of the liver. Subjects also underwent physical examination and completed a short standardized interview questionnaire covering potential factors influencing liver size. Data were evaluated descriptively. The influence of multiple variables on liver size was studied by means of a covariance analysis. Results. The average measured liver diameter (midclavicular line) ± SD was 14.0 ± 1.7 cm (median, 13.9 cm; range, 9.4–21.3 cm; average in male subjects, 14.5 ± 1.6 cm; and average in female subjects, 13.5 ± 1.7 cm). Results of the multivariate analysis showed that the factors body mass index, body height, sex, age, and (in male subjects) frequent alcohol consumption exert an influence over liver size measured at the midclavicular line. Conclusions. The sonographic measurement of liver size at the midclavicular line was shown to be an easy and practical method for routine use. Only in 239 (11.5%) of 2080 subjects did the size of the liver measured at the midclavicular line exceed 16 cm. Body mass index and body height are the most important factors associated with the diameter of the liver measured at the midclavicular line.

Ultrasonographically detected gallbladder polyps: A reason for concern? A seven-year follow-up study

BackgroundThe management of coincidental detected gallbladder polyps (GP) is still nebulous. There are few published data regarding their long-term growth. Objective of the present study was to investigate the prevalence and growth of gallbladder polyps in a survey of unselected subjects from the general population of a complete rural community.MethodsA total of 2,415 subjects (1,261 women; 1,154 men) underwent ultrasound examination of the gallbladder, in November 1996 as part of a prospective study. Subjects in whom GP were detected at the initial survey underwent follow-up ultrasound examinations after 30 and 84 months.ResultsAt the initial survey gallbladder polyps were detected in 34 subjects (1.4%; females: 1.1%, range 14 to 74 years; males: 1.7%, range 19 to 63 years). Median diameter was 5 ± 2.1 mm (range 2 to10 mm) at the initial survey, 5 mm ± 2.8 mm (range 2 to 12 mm) at 30 months and 4 ± 2.3 mm (range 2 to 9 mm) at 84 months. At the time of first follow-up no change in diameter was found in 81.0% (n = 17), reduction in diameter in 4.8% (n = 1) and increase in diameter in 14.3% (n = 3). At the time of second follow-up no increase in polyp diameter was found in 76.9% (n = 10) and reduction in diameter in 7.7% (n = 1). No evidence of malignant disease of the gallbladder was found.ConclusionOver a period of seven years little change was measured in the diameter of gallbladder polyps. There was no evidence of malignant disease of the gallbladder in any subject.

Percutaneous ultrasonographically guided liver punctures: an analysis of 1961 patients over a period of ten years

BackgroundUltrasonographically guided punctures of the liver represent a decisive tool in the diagnosis of many diseases of the liver. Objective of the study was to determine the extent to which the complication rate for ultrasonographically guided punctures of the liver is affected by less comprehensively studied risk factors.MethodsA total of 2,229 liver biopsies were performed in 1,961 patients (55.5% males; 44.5% females). We recorded actual complications and assessed the following risk factors: needle gauge, puncture technique, examiner experience, coagulation status, puncture target (focal lesion versus parenchyma), lesion size, patient sex and age.Resultshe rate of complications stood at 1.2% (n = 27), of which 0.5% (n = 12) were major and 0.7% (n = 15) minor complications. A significant increase in complications involving bleeding was observed with larger-gauge needles compared with smaller-gauge needles and for cutting biopsy punctures compared with aspiration biopsies (Menghini technique). In the bivariate analysis complications were 2.7 times more frequent in procedures performed by experienced examiners compared with those with comparatively less experience. Lower values for Quick’s test and higher partial thromboplastin times were associated with a higher rate of bleeding. Neither the puncture target, lesion size or patient sex exerted any measurable influence on the puncture risk. Advanced patient age was associated with a higher rate of complications involving bleeding.ConclusionsOur study helps to establish the importance of potential and less comprehensively studied risk factors and may contribute to further reduction in complications rates in routine clinical practice.

The effect of alcohol, tobacco and caffeine consumption and vegetarian diet on gallstone prevalence.

Aim To investigate the effects of alcohol, tobacco and caffeine consumption and of vegetarian diet on gallstone prevalence in an urban population sample. Methods A total of 2417 individuals underwent ultrasound examination and completed a standardized questionnaire as part of the EMIL study. Statistical analysis of the data considered the known risk factors of age, female sex, BMI, positive family history and potential confounders, such as alcohol, caffeine and tobacco consumption and vegetarian diet using multiple logistic regression with variable selection. Results The prevalence of gallstones in the population sample was 8% (171 out of 2147). Findings of the study confirmed the classic risk factors of age, female sex, obesity and positive family history. After the variable selection of potential risk factors in a logistic regression that was adjusted for age, female sex, BMI and positive family history, the factors like tobacco [odds ratio (OR) 1.09, 95% confidence interval (CI): 0.76–1.56, P=0.64] and caffeine consumption (OR: 0.77, 95% CI: 0.42–1.42, P=0.40) as well as vegetarian diet (OR: 1.14, 95% CI: 0.39–3.35, P=0.81) had no effect on gallstone prevalence. A protective effect against development of gallstones was shown for alcohol consumption (OR: 0.67, 95% CI: 0.46–0.99, P=0.04). Conclusion The factors like tobacco and caffeine consumption as well as vegetarian diet exerted no measurable effect on the prevalence of gallstones. A protective effect was found for alcohol consumption.

Prevalence of the metabolic syndrome in southwest Germany.

The metabolic syndrome is a highly prevalent multifaceted clinical entity. Obesity, which is part of the metabolic syndrome, is the fastest growing health‐related problem worldwide. Since currently prevalence data of the metabolic syndrome are lacking from Germany, we have applied ATP III‐criteria in two urban and rural cohorts. Our population‐based studies provide evidence that the prevalence of the metabolic syndrome increases with age. It was found to be more prevalent in a rural population and in this group it clustered in males. As a consequence of our population‐based studies evidence that especially the rural population is at high risk for future macrovascular complications is substantiated. The urgent need for preventive measures aimed at reducing the significantly increased health risk is underscored.

A single dose of intravenous zoledronate prevents glucocorticoid therapy-associated bone loss in acute flare of Crohn's disease, a randomized controlled trial.

OBJECTIVES:To assess the effectiveness and safety of zoledronate (ZOL) in preventing glucocorticoid therapy-associated bone loss in patients with acute flare of Crohns disease (CD) in a randomized, double-blind, placebo-controlled trial.METHODS:Forty CD patients starting a glucocorticoid therapy (60 mg prednisolone per day) for acute flare (CD activity index (CDAI) >220) were randomized to compare the effect of ZOL (4 mg intravenous, n=20) or placebo (n=20) on change in lumbar bone mineral density (BMD). All patients received calcium citrate (800 mg) and colecalciferol (1,000 IU) daily. Dual energy X-ray absorptiometry (DXA) of the lumbar spine (L1–L4) was performed at baseline and day 90. Follow-up examinations at day 1/7/14/30 and 90 included laboratory tests and adverse event/serious adverse events reports.RESULTS:Thirty-six patients were available for per-protocol analysis. With placebo (n=18), a decrease in BMD was seen (T-score: −0.98±0.8, day 0 and −1.25±0.77, day 90, P=0.06), with ZOL (n=18) BMD increased (−1.15±1.02, day 0 and −0.74±1.09, day 90, P=0.03). The change in BMD under placebo (−0.26±0.21) vs. ZOL (+0.41±0.19) was highly significant (P=0.006). In all, 14 out of 18 patients with ZOL had an increase in BMD (+0.64±0.48), 12 of 18 with placebo a decrease (−0.50±0.39). Changes of clinical findings and laboratory results of inflammation (leukocytes, platelets, and C-reactive protein) were the same in- and between-groups throughout the study. With ZOL, serum bone degradation marker β-Cross-Laps decreased. Study medication was safe and well tolerated.CONCLUSIONS:ZOL is effective in preventing glucocorticoid therapy-induced bone loss in patients with acute flare of CD and should be considered whenever a glucocorticoid therapy is started in CD patients.

Vitamin C supplement use may protect against gallstones: an observational study on a randomly selected population

BackgroundAnimal experiments have shown a protective effect of vitamin C on the formation of gallstones. Few data in humans suggest an association between reduced vitamin C intake and increased prevalence of gallstone disease. The aim of this study was to assess the possible association of regular vitamin C supplementation with gallstone prevalence.MethodsAn observational, population-based study of 2129 subjects aged 18-65 years randomly selected from the general population in southern Germany was conducted. Abdominal ultrasound examination, completion of a standardized questionnaire, compilation of anthropometric data and blood tests were used. Data were collected in November and December 2002. Data analysis was conducted between December 2005 and January 2006.ResultsPrevalence of gallstones in the study population was 7.8% (167/2129). Subjects reporting vitamin C supplementation showed a prevalence of 4.7% (11/232), whereas in subjects not reporting regular vitamin C supplementation, the prevalence was 8.2% (156/1897). Female gender, hereditary predisposition, increasing age and body-mass index (BMI) were associated with increased prevalence of gallstones. Logistic regression with backward elimination adjusted for these factors showed reduced gallstone prevalence for vitamin C supplementation (odds ratio, OR 0.34; 95% confidence interval, CI 0.14 to 0.81; P = 0.01), increased physical activity (OR 0.62; 95% CI, 0.42 to 0.94; P = 0.02), and higher total cholesterol (OR 0.65; 95% CI, 0.52 to 0.79; P < 0.001).ConclusionRegular vitamin C supplementation and, to a lesser extent, increased physical activity and total cholesterol levels are associated with a reduced prevalence of gallstones. Regular vitamin C supplementation might exert a protective effect on the development of gallstones.