Food consumption of adults in Germany: results of the German National Nutrition Survey II based on diet history interviews

The second German National Nutrition Survey (NVS II) aimed to evaluate food consumption and other aspects of nutritional behaviour of a representative sample of the German population, using a modular design with three different dietary assessment methods. To assess usual food consumption, 15 371 German speaking subjects 14–80 years of age completed a diet history interview between November 2005 and November 2006. With reference to the guidelines of the German Nutrition Society (DGE), NVS II observed that the German population did not eat enough foods of plant origin, especially vegetables and consumed too much of meat and meat products. While generally similar food consumption is observed in other European countries, consumption of bread, fruit juices/nectars and beer is higher in Germany. On average, men consumed two times more meat and soft drinks as well as six times more beer than women did, whereas the consumption of vegetables, fruit as well as herbal/fruit tea was higher in women. Older participants showed a lower consumption of meat, fruit juice/nectars, soft drinks and spirits as well as a higher consumption of fish, vegetables, fruit, and herbal/fruit tea than adolescents and younger adults did. There are also differences in food consumption with regard to socio-economic status (SES). Persons with higher SES consumed more vegetables, fruit, fish, water, coffee/tea and wine, while persons with lower SES consumed more meat and meat products, soft drinks and beer. In general, the food consumption of women, the elderly and the higher SES group tends to be closer to the official dietary guidelines in Germany

Altersabhängige Veränderungen im Antioxidanzienstatus von Teilnehmern der GISELA-Studie unter Berücksichtigung ausgewählter Einflussfaktoren : Eine Untersuchung im Rahmen der Gießener Senioren Langzeitstudie (GISELA)

Die vorliegende Arbeit wurde im Rahmen der Gießener Senioren Langzeitstudie (GISELA) durchgeführt. Bei der GISELA-Studie handelt es sich um eine prospektive Kohortenstudie, in der seit 1994 in ein- bzw. zweijährigen Abständen der Ernährungs- und Gesundheitsstatus von Gießener Senioren beobachtet wird. Im Rahmen dieser Arbeit wurde untersucht, inwieweit sich die nicht-enzymatischen (Vitamin C, beta-Carotin, Vitamin E und Selen) und enzymatischen (GPx, KAT und SOD) Antioxidanzien mit zunehmendem Alter verändern. Weiterhin wurden in dieser Arbeit bestimmte Einflussfaktoren auf den Antioxidanzienstatus wie Geschlecht, BMI, Einnahme von Vitamin- und Mineralstoffpräparate, Antioxidanzien-Zufuhr und Cholesterinspiegel im Blut untersucht. Für die Untersuchung des nicht-enzymatischen Antioxidanzienstatus der Senioren wurden die Langzeit-Daten aus den Jahren 1994 bis 2008 herangezogen. Insgesamt setzte sich das Untersuchungskollektiv aus 272 Frauen und 118 Männern im Alter von 60-79 Jahren (bei Studieneintritt) zusammen. Für die Untersuchung der enzymatischen Antioxidanzien wurden die Erhebungsjahre 1996-2008 verwendet. Hierfür setzte sich das Untersuchungskollektiv aus 235 Frauen und 100 Männern (Alter bei Studieneintritt: 60-79 Jahre) zusammen. Die durchschnittliche Beobachtungszeit für die nicht-enzymatischen Antioxidanzien betrug 11 Jahre und die der enzymatischen Antioxidanzien 10 Jahre. In dem linear gemischten Regressionsmodell konnte ein Alterseffekt auf den Plasmaspiegel von beta-Carotin (nur bei den Frauen), Vitamin E und Selen sowie Vitamin E/Cholesterin-Quotient beobachtet werden. Bei den Frauen sanken die Plasmaspiegel von beta-Carotin und Selen mit zunehmendem Alter, während der Vitamin E-Plasmaspiegel und Vitamin E/Cholesterin-Quotient stiegen. Unter Berücksichtigung der Einflussfaktoren BMI, Antioxidanzien-Zufuhr und Supplementation zeigte sich aber keine Veränderung des beta-Carotins mehr. Bei den Männern sanken mit zunehmendem Alter die Plasmakonzentrationen von Vitamin E und Selen, während der Vitamin E/Cholesterin-Quotient stieg. Unter Berücksichtigung ausgewählter Einflussfaktoren änderten sich die Vitamin E- und Selen-Plasmaspiegel jedoch nicht mehr. In der Regressionsanalyse mit Hilfe des linear gemischten Modells konnte ein signifikanter Alterseffekt auf den enzymatischen Antioxidanzienstatus festgestellt werden. Während des Alterns stiegen die Aktivitäten von GPx und SOD bei beiden Geschlechtern sowie der KAT-Aktivität bei den Frauen. Unter Berücksichtigung der Einflussfaktoren BMI, Gesamtcholesterin im Blut und Supplementation zeigte sich dazu auch eine Erhöhung der KAT-Aktivität bei den Männern. Des Weiteren wurden Gender-Effekte auf den Antioxidanzienstatus mit Hilfe des linear gemischten Modells überprüft. Die Frauen wiesen signifikant höhere Plasmakonzentrationen von Vitamin C, beta-Carotin und Vitamin E sowie SODAktivität in den Erythrozyten im Vergleich zu den Männern auf. Der Vitamin E/Cholesterin-Quotient und Selen-Plasmaspiegel sowie die Aktivitäten von GPx und KAT unterscheiden sich dagegen nicht signifikant zwischen den Frauen und den Männern. Abschließend wurde noch der Einfluss des BMI, der Antioxidanzien-Zufuhr, der Einnahme von Vitamin- oder Mineralstoffpräparaten und des Cholesterinspiegels im Blut auf die altersabhängigen Veränderungen des Antioxidanzienstatus getrennt nach Geschlecht überprüft. Bei Betrachtung des Zusammenhangs zwischen BMI und nicht-enzymatischen Antioxidanzien zeigte sich, dass der BMI einen signifikant negativen Einfluss auf das Plasma Vitamin C (bei den Frauen) und beta-Carotin (bei beiden Geschlechtern) hat. Bei der Analyse des Einflusses des BMI auf die enzymatischen Antioxidanzien kam es jedoch zu keinen eindeutigen Ergebnissen. Bei den Seniorinnen hat der BMI zwar einen positiven Einfluss auf die Aktivitäten von GPx und KAT, ist aber statistisch grenzwertig. Zudem hat der BMI bei den Senioren die GPx-Aktivität positiv und die KAT-Aktivität negativ beeinflusst. Während die Zufuhr von antioxidativen Nährstoffen aus Lebensmitteln keinen Einfluss auf die Antioxidanzien-Plasmaspiegel aufweist, haben regelmäßige oder gelegentliche Supplementierung von antioxidativen Vitaminen (bei beiden Geschlechtern) und Selen (nur bei den Frauen) jedoch einen signifikant positiven Einfluss auf deren Plasmaspiegel. In Bezug auf die enzymatischen Antioxidanzien zeigte sich, dass die Zink-Supplementation die SOD-Aktivität bei den Frauen bzw. die Selen-Supplementation die GPx-Aktivität bei den Männern positiv beeinflusst. In dieser Untersuchung zeigte sich eine signifikant negative Beziehung zwischen dem Gesamtcholesterinspiegel im Blut und den Aktivitäten von GPx (nur bei den Frauen) und KAT (bei beiden Geschlechtern), während das Gesamtcholesterin im Blut keinen Einfluss auf die SOD-Aktivität hat. Zusammenfassend lässt sich anhand der vorliegenden Ergebnisse festhalten, dass sich der Antioxidanzienstatus mit zunehmendem Alter teilweise ändert. Zudem können Geschlecht, BMI, Gesamtcholesterin im Blut und Supplementation als Prädiktoren des Antioxidanzienstatus festgestellt werden.The present investigation is part of a longitudinal study on nutrition and health status in a free-living elderly population in Giessen, Germany (GISELA). The GISELA study is a prospective cohort study in which the nutritional and health status of elderly citizens in Giessen have been observed at annual intervals since 1994 and at biannual intervals since 1998. Within the GISELA study, age-related alterations of vitamin C, beta-carotene, vitamin E and selenium status and antioxidant enzyme activities of glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD) were analyzed as well as their influencing factors gender, body mass index (BMI), supplement use, dietary intake of antioxidant nutrients and total serum cholesterol. The objective of the investigation of antioxidant vitamin and selenium status (272 women and 118 men with an initial age of 60-79 years) as well as of antioxidant enzyme activities (235 women and 100 men with an initial age of 60-79 years) was as follows: data of the GISELA study collected over a period of 14 years (1994 to 2008) and of 12 years (1996 to 2008) for antioxidant status and antioxidant enzyme activities, respectively, were analyzed for age trends and influencing factors. In women, a significant decrease in plasma concentrations of beta-carotene and selenium and a significant rise in plasma vitamin E and vitamin E/cholesterol ratio were shown with increasing age as results of the linear mixed models. In men, a significant decrease in plasma levels of vitamin E and selenium was observed, whereas the ratio of vitamin E to cholesterol increased significantly. Plasma selenium levels in men diminished with aging. After inclusion of BMI, supplement use, dietary intake of antioxidant vitamins as possible influencing factors in the analysis, no age effect on beta-carotene in women as well as on vitamin E and selenium in men was shown. In this long-term investigation age-dependent alterations in the activities of erythrocyte antioxidant enzymes were detected. The enzyme activities of GPx, CAT (only in women) and SOD raised significantly with aging. After consideration of BMI, supplement use and total serum cholesterol as possible influencing factors an age-related increase of CAT activity was observed in men. With regard to vitamin C, beta-carotene and vitamin E women had significantly higher plasma levels than men. After adjustment for total serum cholesterol a gender effect for vitamin E was no longer observed. Concerning selenium levels in plasma, no significant gender differences were detected. Women had a significantly higher SOD activity than men. However, there was no significant difference in GPx and CAT activities between both sexes. In a further analysis, BMI was significantly negatively correlated with vitamin C (in women) and beta-carotene. In addition, a weak positive relationship between BMI and GPx activity (in both sexes) and CAT (in women) was detected. In men, CAT activity was negatively related to BMI. In this study, vitamin C, beta-carotene, vitamin E or selenium supplement users had significantly higher plasma levels than non-users. At the same time, no significant association between dietary intake of antioxidant vitamins and their plasma concentrations was observed. Intake of selenium was not investigated in this study. Therefore, a possible relationship between intake of meat which is a main dietary source of selenium and the plasma selenium level was analyzed. However, no significant association was found. In addition, the association between antioxidant enzyme activities and supplementation of nutrients of these co-factors were investigated. Results showed that selenium supplementation positively affected GPx activity in men and zinc supplementation positively influenced SOD activity in women. Moreover, total serum cholesterol levels were inversely associated with GPx activity in women and CAT activity in both sexes. However, there was no association between SOD activity and total serum cholesterol levels. In conclusion, the results of the present study showed age-related changes in the blood levels of antioxidants. Furthermore, gender, BMI, total serum cholesterol and supplementation were found to be predictors of antioxidant status

Food consumption of adults in Germany: results of the German National Nutrition Survey II based on diet history interviews

The second German National Nutrition Survey (NVS II) aimed to evaluate food consumption and other aspects of nutritional behaviour of a representative sample of the German population, using a modular design with three different dietary assessment methods. To assess usual food consumption, 15371 German speaking subjects 14-80 years of age completed a diet history interview between November 2005 and November 2006. With reference to the guidelines of the German Nutrition Society (DGE), NVS II observed that the German population did not eat enough foods of plant origin, especially vegetables and consumed too much of meat and meat products. While generally similar food consumption is observed in other European countries, consumption of bread, fruit juices/nectars and beer is higher in Germany. On average, men consumed two times more meat and soft drinks as well as six times more beer than women did, whereas the consumption of vegetables, fruit as well as herbal/fruit tea was higher in women. Older participants showed a lower consumption of meat, fruit juice/nectars, soft drinks and spirits as well as a higher consumption of fish, vegetables, fruit, and herbal/fruit tea than adolescents and younger adults did. There are also differences in food consumption with regard to socio-economic status (SES). Persons with higher SES consumed more vegetables, fruit, fish, water, coffee/tea and wine, while persons with lower SES consumed more meat and meat products, soft drinks and beer. In general, the food consumption of women, the elderly and the higher SES group tends to be closer to the official dietary guidelines in German

Continuity in palliative care – analysis of intersectoral palliative care based on routine data of a statutory health insurance

Background!#!The goal of palliative care is to prevent and alleviate a suffering of incurable ill patients. A continuous intersectoral palliative care is important. The aim of this study is to analyse the continuity of palliative care, particularly the time gaps between hospital discharge and subsequent palliative care as well as the timing of the last palliative care before the patient's death.!##!Methods!#!The analysis was based on claims data from a large statutory health insurance. Patients who received their first palliative care in 2015 were included. The course of palliative care was followed for 12 months. Time intervals between discharge from hospital and first subsequent palliative care as well as between last palliative care and death were analysed. The continuity in palliative care was defined as an interval of less than 14 days between palliative care. Data were analysed using descriptive statistics and Chi-Square.!##!Results!#!In 2015, 4177 patients with first palliative care were identified in the catchment area of the statutory health insurance. After general inpatient palliative care, 415 patients were transferred to subsequent palliative care, of these 67.7% (n = 281) received subsequent care within 14 days. After a stay in a palliative care ward, 124 patients received subsequent palliative care, of these 75.0% (n = 93) within 14 days. Altogether, 147 discharges did not receive subsequent palliative care. During the 12-months follow-up period, 2866 (68.7%) patients died, of these 78.7% (n = 2256) received palliative care within the last 2 weeks of life. Of these, 1223 patients received general ambulatory palliative care, 631 patients received specialised ambulatory palliative care, 313 patients received their last palliative care at a hospital and 89 patients received it in a hospice.!##!Conclusions!#!The majority of the palliative care patients received continuous palliative care. However, there are some patients who did not receive continuous palliative care. After inpatient palliative care, each patient should receive a discharge management for a continuation of palliative care. Readmissions of patients after discharge from inpatients palliative care can be an indication for a lack of support in the ambulatory health care setting and for an insufficient discharge management. Palliative care training and possibilities for palliative care consultations by specialists should strengthen the GPs in palliative care

Comparison of survival between patients receiving general outpatient palliative care and patients receiving other palliative care - analysis of data of a statutory health insurance data

Background The care of palliative patients takes place as non-specialized and specialized care, in outpatient and inpatient settings. However, palliative care is largely provided as General Outpatient Palliative Care (GOPC). This study aimed to investigate whether the survival curves of GOPC patients differed from those of the more intensive palliative care modalities and whether GOPC palliative care was appropriate in terms of timing. Methods The study is based on claims data from a large statutory health insurance. The analysis included 4177 patients who received palliative care starting in 2015 and who were fully insured 1 year before and 1 year after palliative care or until death. The probability of survival was observed for 12 months. Patients were classified into group A, which consisted of patients who received palliative care only with GOPC, and group B including patients who received inpatient or specialized outpatient palliative care. Group A was further divided into two subgroups. Patients who received GOPC on only 1 day were assigned to subgroup A1, and patients who received GOPC on two or more days were assigned to subgroup A2. The survival analysis was carried out using Kaplan-Meier curves. The median survival times were compared with the log-rank test. Results The survival curves differed between groups A and B, except in the first quartile of the survival distribution. The median survival was significantly longer in group A (137 days, n = 2763) than in group B (47 days, n = 1424, p < 0.0001) and shorter in group A1 (35 days, n = 986) than in group A2 (217 days, n = 1767, p < 0.0001). The survival rate during the 12-month follow-up was higher in group A (42%) than in group B (11%) and lower in group A1 (38%) than in group A2 (44%). Conclusions The results of the analysis revealed that patients who received the first palliative care shortly before death suspected insufficient care, especially patients who received GOPC for only 1 day and no further palliative care until death or 12-month follow-up. Palliative care should start as early as necessary and be continuous until the end of life

Predictors of BMI Vary along the BMI Range of German Adults - Results of the German National Nutrition Survey II

Objective: The objective of the study was to identify predictors of BMI in German adults by considering the BMI distribution and to determine whether the association between BMI and its predictors varies along the BMI distribution. Methods: The sample included 9,214 adults aged 18-80 years from the German National Nutrition Survey II (NVS II). Quantile regression analyses were conducted to examine the association between BMI and the following predictors: age, sports activities, socio-economic status (SES), healthy eating index-NVS II (HEI-NVS II), dietary knowledge, sleeping duration and energy intake as well as status of smoking, partner relationship and self-reported health. Results: Age, SES, self-reported health status, sports activities and energy intake were the strongest predictors of BMI. The important outcome of this study is that the association between BMI and its predictors varies along the BMI distribution. Especially, energy intake, health status and SES were marginally associated with BMI in normal-weight subjects; this relationships became stronger in the range of overweight, and were strongest in the range of obesity. Conclusions: Predictors of BMI and the strength of these associations vary across the BMI distribution in German adults. Consequently, to identify predictors of BMI, the entire BMI distribution should be considered

Diagnostic delay in children with inflammatory bowel disease in the German-Austrian patient registry CEDATA-GPGE 2014–2018

The incidence and prevalence of pediatric-onset inflammatory bowel disease (PIBD) are on the rise worldwide. Initial symptoms are often recognized with a delay, which reduces the quality of life and may lead to an increased rate of complications. The aim of this study was to determine the diagnostic delay in PIBD and to identify potential influencing factors. Therefore, data from the German-Austrian patient registry CEDATA-GPGE for children and adolescents with PIBD were analyzed for the period January 2014 to December 2018. There were 456 children identified in the data, thereof 258 children (57%) with Crohn’s disease (CD) and 198 children (43%) with Ulcerative colitis (UC). The median age was 13.3 years (interquartile range (IQR) = 10.9−15.0), and 44% were females. The median diagnostic delay was 4.1 months (IQR = 2.1–7.0) in CD and 2.4 months (IQR = 1.2–5.1) in UC (p = 0.01). UC was associated with earlier diagnosis than CD (p < 0.001). Only a few factors influencing the diagnostic delay have been verified, e.g., abdominal pain at night and if video capsule endoscopy was performed. Diagnostic delay improved over the years in participating centers, but the level of awareness needs to be high even in common symptoms like abdominal pain

Population-Based, Spatial Analysis of Specialised Ambulatory Palliative Care in Mecklenburg-Western Pomerania, Germany, on the Basis of Reimbursement Data

In rural areas, healthcare providers, patients and relatives have to cover long distances. For specialised ambulatory palliative care (SAPV), a supply radius of max. 30 km is recommended. The aim of this study was to analyse whether there are regional disparities in the supply of SAPV and whether it is associated with the distance between the SAPV team&rsquo;s site and the patient&rsquo;s location. Therefore, anonymised data of the Association of Statutory Health Insurance Physicians of the Federal State of Mecklenburg-Western Pomerania (M-V) were retrospectively analysed for the period of 2014&ndash;2017. Identification as a palliative patient was based on palliative-specific items from the ambulatory reimbursement catalogue. In total, 6940 SAPV patients were identified; thereof, 48.9% female. The mean age was 73.3 years. For 28.3% of the identified SAPV patients (n = 1961), the SAPV teams had a travel distance of &gt;30 km. With increasing distance, the average number of treatment days per patient increased. It was found that there are regional disparities in the provision of SAPV services in M-V and that local structures have an important impact on regional supply patterns. The distance between the SAPV team&rsquo;s site and the patient&rsquo;s location is not the only determining factor; other causes must be considered

How can patient registries facilitate guideline-based healthcare? A retrospective analysis of the CEDATA-GPGE registry for pediatric inflammatory bowel disease

Background Early diagnosis is mandatory for the medical care of children and adolescents with pediatric-onset inflammatory bowel disease (PIBD). International guidelines (‘Porto criteria’) of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition recommend medical diagnostic procedures in PIBD. Since 2004, German and Austrian pediatric gastroenterologists document diagnostic and treatment data in the patient registry CEDATA-GPGE on a voluntary basis. The aim of this retrospective study was to analyze whether the registry CEDATA-GPGE reflects the Porto criteria and to what extent diagnostic measures of PIBD according to the Porto criteria are documented. Methods Data of CEDATA-GPGE were analyzed for the period January 2014 to December 2018. Variables representing the Porto criteria for initial diagnostic were identified and categorized. The average of the number of measures documented in each category was calculated for the diagnoses CD, UC, and IBD-U. Differences between the diagnoses were tested by Chi-square test. Data on possible differences between data documented in the registry and diagnostic procedures that were actually performed were obtained via a sample survey. Results There were 547 patients included in the analysis. The median age of patients with incident CD (n = 289) was 13.6 years (IQR: 11.2–15.2), of patients with UC (n = 212) 13.1 years (IQR: 10.4–14.8) and of patients with IBD-U (n = 46) 12.2 years (IQR: 8.6–14.7). The variables identified in the registry fully reflect the recommendations by the Porto criteria. Only the disease activity indices PUCAI and PCDAI were not directly provided by participants but calculated from obtained data. The category ‘Case history’ were documented for the largest part (78.0%), the category ‘Imaging of the small bowel’ were documented least frequently (39.1%). In patients with CD, the categories ‘Imaging of the small bowel’ (χ2 = 20.7, Cramer-V = 0.2, p < 0.001) and ‘Puberty stage’ (χ2 = 9.8, Cramer-V = 0.1, p < 0.05) were documented more often than in patients with UC and IBD-U. Conclusion The registry fully reproduces the guideline’s recommendations for the initial diagnosis of PIBD. The proportion of documented diagnostic examinations varied within the diagnostic categories and between the diagnoses. Despite technological innovations, time and personnel capacities at participating centers and study center are necessary to ensure reliable data entry and to enable researchers to derive important insights into guideline-based care