Dietary patterns of adolescents in Germany - Associations with nutrient intake and other health related lifestyle characteristics

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to identify dietary patterns among a representative sample of German adolescents and their associations with energy and nutrient intake, socioeconomic and lifestyle characteristics, and overweight status.</p> <p>Methods</p> <p>In the analysis, data from the German Health Interview and Examination Survey for Children and Adolescents were used. The survey included a comprehensive dietary history interview conducted among 1272 adolescents aged 12 to 17 years. Dietary patterns were determined with principal component analysis (PCA) based on 48 food groups, for boys and girls separately.</p> <p>Results</p> <p>Three dietary patterns among boys and two among girls were identified. Among boys, high adherence to the 'western' pattern was associated with higher age, lower socioeconomic status (SES), and lower physical activity level (PA). High adherence to the 'healthy' pattern among boys, but not among girls, was associated with higher SES, and higher PA. Among boys, high adherence to the 'traditional' pattern was associated with higher age. Among girls, high adherence to the 'traditional and western' pattern was associated with lower age, lower SES and more hours watching TV per day. The nutrient density of several vitamins and minerals, particularly of B-vitamins and calcium, increased with increasing scores of the 'healthy' pattern among both sexes. Conversely, with increasing scores of the 'western' pattern among boys, most nutrient densities decreased, particularly of fibre, beta-carotene, vitamin D, biotin and calcium. Among girls with higher scores of the 'traditional and western' pattern, nutrient densities of vitamin A, C, E, K and folate decreased. Among boys, high adherence to the 'traditional' pattern was correlated with higher densities of vitamin B₁₂and vitamin D and lower densities of fibre, magnesium and iron. No significant associations between dietary patterns and overweight were found.</p> <p>Conclusions</p> <p>Higher scores for dietary patterns characterized by higher consumption of take away food, meat, confectionary and soft drinks ('western' and 'traditional and western') were found particularly among 16- to 17-years old boys and among adolescents with lower SES. These patterns were also associated with higher energy density, higher percent of energy from unsaturated fatty acids and lower percent of energy from carbohydrates as well as lower nutrient densities of several vitamins and minerals. Therefore, nutritional interventions should try to focus more on adolescents with lower SES and boys in general.</p

Associations between dietary patterns and biomarkers of nutrient status and cardiovascular risk factors among adolescents in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS)

Background: The aim of this study is to analyse prevailing dietary patterns among German adolescents and their associations with biomarkers of nutrient status and cardiovascular risk factors. Methods: Analyses were based on data from the nationwide, representative Health Interview and Examination Survey for Children and Adolescents in Germany, conducted between 2003 and 2006 (KiGGS baseline). Dietary habits of 12 to 17 year olds (2646 boys and 2551 girls) were determined using 34 food groups assessed with a food frequency questionnaire. Principal component analysis was applied to determine the major dietary patterns. The associations between dietary patterns and biomarkers were analysed using linear regression analyses. Results: We identified three major dietary patterns among boys and two among girls. Higher scores of the ‘healthy’ patterns (fruits, salad vegetables, wholemeal bread) were associated with higher levels of serum folate and lower levels of homocysteine among both sexes and higher levels of serum vitamin B12 among girls. Conversely, higher scores of the ‘western’ pattern among boys (salty snacks, burger, French fries) were associated with a lower ferritin level and lower diastolic blood pressure. The ‘traditional’ pattern among boys (white bread, processed meat, meat) was associated with a lower folate level and the ‘western and traditional’ pattern among girls (salty snacks, burger, French fries) with lower folate and higher homocysteine levels. No associations between dietary patterns and blood lipids, HbA1c and uric acid were found. The mean age of boys with higher scores in the ‘western’ pattern was higher, whereas the mean age of girls with higher scores in the ‘western and traditional’ dietary patterns was lower. Conclusions: Adolescents with higher scores in the ‘healthy’ dietary patterns had a better nutrient profile. Therefore, healthy dietary patterns should be promoted early in life, with a special focus on the sex differences

Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation

BACKGROUND The effect of single as compared with dual antiplatelet treatment on bleeding and thromboembolic events after transcatheter aortic-valve implantation (TAVI) in patients who do not have an indication for long-term anticoagulation has not been well studied. METHODS In a randomized, controlled trial, we assigned a subgroup of patients who were undergoing TAVI and did not have an indication for long-term anticoagulation, in a 1:1 ratio, to receive aspirin alone or aspirin plus clopidogrel for 3 months. The two primary outcomes were all bleeding (including minor, major, and life-threatening or disabling bleeding) and non-procedure-related bleeding over a period of 12 months. Most bleeding at the TAVI puncture site was counted as non-procedure-related. The two secondary outcomes were a composite of death from cardiovascular causes, non-procedure-related bleeding, stroke, or myocardial infarction (secondary composite 1) and a composite of death from cardiovascular causes, ischemic stroke, or myocardial infarction (secondary composite 2) at 1 year, with both outcomes tested sequentially for noninferiority (noninferiority margin, 7.5 percentage points) and superiority. RESULTS A total of 331 patients were assigned to receive aspirin alone and 334 were assigned to receive aspirin plus clopidogrel. A bleeding event occurred in 50 patients (15.1%) receiving aspirin alone and in 89 (26.6%) receiving aspirin plus clopidogrel (risk ratio, 0.57; 95% confidence interval [CI], 0.42 to 0.77; P=0.001). Non-procedure-related bleeding occurred in 50 patients (15.1%) and 83 patients (24.9%), respectively (risk ratio, 0.61; 95% CI, 0.44 to 0.83; P=0.005). A secondary composite 1 event occurred in 76 patients (23.0%) receiving aspirin alone and in 104 (31.1%) receiving aspirin plus clopidogrel (difference, −8.2 percentage points; 95% CI for noninferiority, −14.9 to −1.5; P<0.001; risk ratio, 0.74; 95% CI for superiority, 0.57 to 0.95; P=0.04). A secondary composite 2 event occurred in 32 patients (9.7%) and 33 patients (9.9%), respectively (difference, −0.2 percentage points; 95% CI for noninferiority, −4.7 to 4.3; P=0.004; risk ratio, 0.98; 95% CI for superiority, 0.62 to 1.55; P=0.93). A total of 44 patients (13.3%) and 32 (9.6%), respectively, received oral anticoagulation during the trial. CONCLUSIONS Among patients undergoing TAVI who did not have an indication for oral anticoagulation, the incidence of bleeding and the composite of bleeding or thromboembolic events at 1 year were significantly less frequent with aspirin than with aspirin plus clopidogrel administered for 3 months

Traumatic brain injury in the elderly: beyond the tip of the iceberg

Traumatic brain injury in elderly people imposes an increasing burden on Western society. The outcome is far worse compared with younger victims, which seems logical at first sight. However, specific pathophysiological processes that are responsible for these poorer outcomes largely remain unclear, which makes it difficult to assess individual prognosis. This review summarizes recent specific literature in an attempt to list factors that characterize geriatric traumatic brain injury as different to traumatic brain injury in younger people, and to identify factors that are potential candidates to explain the poorer outcome in this age category. Reduced cardiovascular and endocrinological resilience seem to be potential explanatory variables, compromising cerebral autoregulation and oxidative glucose metabolism, respectively. © 2013 Future Medicine Ltd.status: publishe

Associations of dietary indices with biomarkers of dietary exposure and cardiovascular status among adolescents in Germany

Background: Adolescence is an important life stage for the development of dietary preferences and health behaviour. Longitudinal studies indicated that cardiovascular status in adolescence predicts cardiovascular risk marker values in adulthood. Several diet quality indices for adolescents have been developed in the past, but literature concerning associations between indices and biomarkers of dietary exposure and cardiovascular status is rather sparse. Hence, the aim of this study was to analyse associations of dietary indices with biomarkers of dietary exposure and cardiovascular status. Methods: For the present analysis, data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS 2003–2006) were used. The analysis included 5,198 adolescents, aged 12 to 17 years. The Healthy Food Diversity Index (HFD), the Healthy Nutrition Score for Kids and Youth (HuSKY), the Indicator Food Index (IFI) and a simple fruit/vegetable intake index were derived from food frequency questionnaire information to indicate a healthy diet. Adjusted mean values for homocysteine, uric acid, CRP, total cholesterol, HDL-C, ferritin, HbA1c, folate, vitamin B12 and BMI were calculated using complex-samples general linear models for quintiles of the different indices. Furthermore, the agreement in ranking between the different indices was calculated by weighted kappa. All statistical analyses were conducted for boys and girls separately, and were adjusted for potential confounders. Results: Folate was positively associated with the HFD, the HuSKY, and fruit/vegetable intake for both boys and girls and with IFI for boys. Among girls, positive associations were seen between vitamin B12 and the IFI and between diastolic blood pressure and the IFI as well as fruit/vegetable intake. A negative association was found between homocysteine and the HFD, the HuSKY, and the IFI for both boys and girls and with fruit/vegetable intake for boys. Among boys, uric acid and HbA1c were negatively and prevalence of obesity positively associated with the IFI. Conclusions: Overall, the indices, even the simpler ones, seem to have a similar general capability in predicting biomarkers of dietary exposure. To predict risk of cardiovascular disease dietary indices may have to be more specific

Traumatic brain injury in the elderly: a significant phenomenon

INTRODUCTION: Traumatic brain injury (TBI) in the elderly is becoming an increasingly frequent phenomenon. Studies have mainly analyzed the influence of age as a continuous variable and have not specifically looked at geriatric patients as a group. The aim of this study is to map the magnitude and characteristics of geriatric TBI and to identify factors contributing to their poorer outcome. MATERIAL AND METHODS: Based on the ICD-9 register of the University Hospitals Leuven demographic and clinical variables of TBI were analyzed (2002-2008). The influence of older age on physiological variables was assessed using the Brain-IT database. RESULTS: The elderly (aged ≥65 years) accounted for 38.2% of non-concussion TBI and 32.6% of ICU admissions, representing the largest age group. The elderly had a significantly lower ICP (median 10.06 mmHg versus median 14.52 mmHg; p = 0.048), but no difference in their measure of autoregulation (daily mABP/ICP correlation coefficient) compared with 20-35 year-olds. TBI was caused by a fall in 78.9% of elderly patients and 42.3% suffered a mass lesion. 72.1% had cardiovascular comorbidity. Complications did not differ from their younger counterparts. DISCUSSION: Geriatric TBI is a significant phenomenon. Poorer outcomes are not yet sufficiently explained by physiological monitoring data, but reduced vascular versatility is likely to contribute. More research is needed in order to develop specific management protocols.status: publishe

Associations between dietary patterns and biomarkers of nutrient status and cardiovascular risk factors among adolescents in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS)

BACKGROUND: The aim of this study is to analyse prevailing dietary patterns among German adolescents and their associations with biomarkers of nutrient status and cardiovascular risk factors. METHODS: Analyses were based on data from the nationwide, representative Health Interview and Examination Survey for Children and Adolescents in Germany, conducted between 2003 and 2006 (KiGGS baseline). Dietary habits of 12 to 17 year olds (2646 boys and 2551 girls) were determined using 34 food groups assessed with a food frequency questionnaire. Principal component analysis was applied to determine the major dietary patterns. The associations between dietary patterns and biomarkers were analysed using linear regression analyses. RESULTS: We identified three major dietary patterns among boys and two among girls. Higher scores of the ‘healthy’ patterns (fruits, salad vegetables, wholemeal bread) were associated with higher levels of serum folate and lower levels of homocysteine among both sexes and higher levels of serum vitamin B12 among girls. Conversely, higher scores of the ‘western’ pattern among boys (salty snacks, burger, French fries) were associated with a lower ferritin level and lower diastolic blood pressure. The ‘traditional’ pattern among boys (white bread, processed meat, meat) was associated with a lower folate level and the ‘western and traditional’ pattern among girls (salty snacks, burger, French fries) with lower folate and higher homocysteine levels. No associations between dietary patterns and blood lipids, HbA1c and uric acid were found. The mean age of boys with higher scores in the ‘western’ pattern was higher, whereas the mean age of girls with higher scores in the ‘western and traditional’ dietary patterns was lower. CONCLUSIONS: Adolescents with higher scores in the ‘healthy’ dietary patterns had a better nutrient profile. Therefore, healthy dietary patterns should be promoted early in life, with a special focus on the sex differences