Reinhild Prinz-Langenohl

Potential determinants of obesity among children and adolescents in Germany: results from the cross-sectional KiGGS study

BackgroundObesity among children and adolescents is a growing public health problem. The aim of the present paper is to identify potential determinants of obesity and risk groups among 3- to 17-year old children and adolescents to provide a basis for effective prevention strategies.MethodsData were collected in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a nationally representative and comprehensive data set on health behaviour and health status of German children and adolescents. Body height and weight were measured and body mass index (BMI) was classified according to IOTF cut-off points. Statistical analyses were conducted on 13,450 non-underweight children and adolescents aged 3 to 17 years. The association between overweight, obesity and several potential determinants was analysed for this group as well as for three socio-economic status (SES) groups. A multiple logistic regression model with obesity as the dependent variable was also calculated.ResultsThe strongest association with obesity was observed for parental overweight and for low SES. Furthermore, a positive association with both overweight (including obesity) and obesity was seen for maternal smoking during pregnancy, high weight gain during pregnancy (only for mothers of normal weight), high birth weight, and high media consumption. In addition, high intakes of meat and sausages, total beverages, water and tea, total food and beverages, as well as energy-providing food and beverages were significantly associated with overweight as well as with obesity. Long sleep time was negatively associated with obesity among 3- to 10-year olds. Determinants of obesity occurred more often among children and adolescents with low SES.ConclusionParental overweight and a low SES are major potential determinants of obesity. Families with these characteristics should be focused on in obesity prevention.

Beneficial role for folate in the prevention of colorectal and breast cancer.

Summary Folate is involved in the synthesis of nucleotides and amino acid metabolism such as methylation of homocysteine to methionine. Methionine is activated by adenosine triphosphate (ATP) to produce S-adenosylmethionine (SAM), the primary intracellular methyl donor. Thus, folate is essential for the synthesis, methylation, and repair of DNA. With regard to its biochemical function it has been hypothesized that a diminished folate status may contribute to carcinogenesis by alteration of gene expression and increased DNA damage. Animal and human studies support this hypothesis, particularly with respect to colorectal cancer. Epidemiological evidence for the association between folate status and cancer was first observed among ulcerative colitis patients. Several case-control studies demonstrated reduction in colorectal cancer risk with better folate status. Two large, prospective cohort studies support the concept that high folate intake is protective against colon cancer. In contrast to colorectal cancer, the potential association of folate status and risk has been less investigated in breast cancer. Recently, convincing epidemiological data establishing a positive effect of folate status on breast cancer risk were published.This review summarizes the epidemiological evidence for the association between folate status and colorectal and breast cancer risk. In addition, a short overview is given on the discussed mechanism(s) by which folate might be involved in carcinogenesis.

Relation of isoflavones and fiber intake in childhood to the timing of puberty

BACKGROUND It has been suggested that phytoestrogens and dietary fiber can affect puberty timing. OBJECTIVE We examined whether intake of isoflavone and fiber in healthy white children before their pubertal growth spurt [age at take-off (ATO)] was associated with puberty timing. DESIGN Multivariate regression analyses were performed in 227 DONALD (DOrtmund Nutritional and Anthropometric Longitudinally Designed) Study participants with 3-d weighed dietary records and information on potential confounders at baseline (1 and 2 y before ATO). In a subsample (n = 111), urinary isoflavones were determined in 24-h urine samples by gas chromatography-mass spectrometry analysis. Puberty timing was examined by using ATO and chronologic ages at pubertal stage 2 for breast development (B2) or gonadal development, peak height velocity (PHV), and menarche or voice break. RESULTS Girls whose diet was in the highest dietary isoflavone tertile experienced Tanner stage 2 for breast development ap 0.7 y later and reached PHV ap 0.6 y later than did girls whose diet was in the lowest isoflavone tertile [age (95% CI) at B2: 10.7 y (10.4, 10.9 y) compared with 10.0 y ( 9.7, 10.3 y), respectively; P for trend = 0.04; age at PHV: 11.9 y (11.6, 12.2 y) compared with 11.3 y (11.0, 11.6 y), respectively; P for trend = 0.04; adjusted for body mass index z score and fiber intake]. In boys, dietary isoflavones were not associated with pubertal markers. Urinary isoflavone and dietary fiber intakes were not associated with pubertal markers. CONCLUSIONS Girls, but not boys, with higher prepubertal isoflavone intakes appear to enter puberty at a later age. Fiber intake in this sample of healthy white girls and boys was not relevant for puberty timing.

Supplementation with a multivitamin containing 800 µg of folic acid shortens the time to reach the preventive red blood cell folate concentration in healthy women

BACKGROUND The lowest risk of having a child with a neural tube defect (NTD) was related to red blood cell (RBC) folate concentrations of >906 nmol/L. For NTD prevention, it is recommended that women use periconceptional supplementation of 400 microg/day folic acid. Using this dose previous studies indicate that RBC folate >906 nmol/L was not reached within four weeks of supplementation. OBJECTIVE The effectiveness of a multivitamin/multimineral supplement containing 800 microg folic acid (verum) was evaluated using RBC folate concentration exceeding 906 nmol/L as primary endpoint. In addition, the time frame of achieving the threshold level was established as well as the effect of supplementation of other B vitamins on folate metabolism. SUBJECTS AND METHODS 46 healthy females received 800 microg/day of folic acid or placebo for 16 weeks. Blood samples were collected in four-week intervals. Plasma and RBC folate were measured with the microbiological method. RESULTS Mean (+/-SED) RBC folate increased over time to 1430+/-53 nmol/L, but did not reach a steady state after 16 weeks of intervention. Mean time to reach the target level was 4.2 +/- 3.5 weeks in the verum group. Intake of verum also led to an increase over time of plasma folate. CONCLUSIONS Preventive RBC folate concentration of more than 906 nmol/L can be reached within four weeks of supplementation with daily intake of 800 microg folic acid. With respect to NTD prevention, we suggest the re-evaluation of the current recommendation of folic acid supplementation.

Folate status in Germany 1997-2000.

Data about folate intake and blood values of the German population, published between 1997 and 2000, have been reviewed. Median folate intake is about 250 micrograms/day in the adult population, which indicates a high likelihood of inadequate intake when compared to the Estimated Average Requirement (EAR) of 320 micrograms/day. Only a few studies have evaluated serum and erythrocyte folate or plasma homocysteine as a marker of folate status. The most representative data show that 25% of German women of childbearing age have an inadequate recent folate intake. Only 13.3% of the women have red blood cell folate values above the critical value of 400 micrograms/day established by Daly et al (1995). Folic acid fortification of food is shown to be responsible for about 25% of folate intake in the German child and adolescent population in one study. If we extrapolate these data to the general population, folic acid fortification could be the explanation for the differences observed between folate intake and blood values. The discrepancy might also be explained by slight inaccuracies in food composition tables. Folate intake from fortified food or from supplements is not taken into account in most of the studies, which is a variable that can lead to confusion. Nutrition surveys should adapt official composition tables for local food patterns, and include fortified commercial foods, in order to make folate intake data more accurate. However, representative serum and erythrocyte folate values are lacking for most age groups. Before taking public health measures concerning folate fortification of food, the real folate status of the German population should be established.

Indicators of overweight and cardiovascular disease risk factors among 11- to 17-year-old boys and girls in Germany.

Objective: We analyzed the magnitude of the association between cardiovascular disease (CVD) risk factors and various measures of overweight among adolescents, to determine which indicator of overweight is most relevant for risk assessment. Methods: 5,546 boys and girls aged 11–17 years participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were studied. Overweight was assumed when different anthropometric variables exceeded age- and sex-specific 90th percentiles. Blood pressure was measured and blood samples were analyzed for serum total cholesterol, lipoproteins, high-sensitivity C-reactive protein, and glycosylated hemoglobin (HbA1c). Results: In both sexes, overweight was significantly associated with adverse levels of CVD risk factors, except HbA1c. These associations were most pronounced for overweight as defined by waist circumference (WC), waist-to-height ratio (WHtR), or BMI. Between 11% and 37% of the overweight children exceeded the defined cut-offs for individual CVD risk factors, with age- and puberty-adjusted significant odds ratios (95% confidence interval (CI)) in comparison to normal-weight age mates ranging from 1.7 (1.0–3.0) to 6.1 (4.5–8.2). Conclusions: The findings of this population-based survey suggest that, among adolescents, WC, WHtR, and BMI are easily applicable measures of overweight that appear to be relevant for CVD risk assessment.

A study of plasma folate under the influence of [6S]-5-MTHF in women with 677C→T polymorphism of mthfr with different types of inheritance

Предпосылки и цель: фермент 5,10-метилентетрагидрофолатредуктаза отвечает за синтез 5-метилтетрагидрофолата (5-МТГФ). Мутация гена 677Ц→T 5,10-метилентетрагидрофолатредуктазы снижает активность этого фермента. Целью данного исследования было, во-первых, сравнить фармакокинетические параметры [6S]- 5-МТГФ и фолиевой кислоты у женщин с гомозиготным типом наследования (TT) и аллелями дикого типа (CC) полиморфизма гена 677Ц→T, а во-вторых, изучить генетические различия. Метаболизм [6S]-5-MTHF и фолиевой кислоты оценивали путем измерения производных фолатов в плазме крови. Экспериментальный подход: здоровые женщины (TT, n = 16; CC, n = 8) получили однократную пероральную дозу фолиевой кислоты (400 мкг) и [6S]-5-МГТФ (416 мкг) в рандомизированном перекрестном проекте. Содержание фолатов в плазме крови измеряли через 8 ч после приема. Был рассчитан профиль концентрация-время (площадь под кривой концентрации фолатов в плазме крови в зависимости от времени), максимальное содержание фолатов (Cmax) и время, необходимое для достижения максимального общего сывороточного уровня фолатов (tmax). Основные результаты: площадь под кривой концентрации фолатов в плазме крови в зависимости от времени и Cmax была значительно выше, а tmax значительно короче для [6S]-5-МГТФ по сравнению с фолиевой кислотой в обоих исследуемых генотипах. Значительная разница между генотипами наблюдалась только для tmax после приема фолиевой кислоты (p < 0,05). Содержание фолатов в плазме крови состояло в основном из 5-МГТФ независимо от формы фолата. Неметаболизированная фолиевая кислота в плазме крови регулярно появляется после приема фолиевой кислоты, но редко – после добавления [6S]-5-МГТФ. Выводы: данные, полученные в результате исследования, позволяют предположить, что прием [6S]-5-МГТФ повышает общее содержание фолатов в плазме крови в большей степени, чем фолиевая кислота, независимо от генотипа мутации гена 677Ц→T 5,10-метилентетрагидрофолатредуктазы. Эта натуральная форма фолата может бать альтернативой добавкам с фолиевой кислотой или обогащению ею пищи.