Biomedical subjects

A Döring

Publications and source records attributed to A Döring.

At least 19 recordsLinked to original sources

PubMed2006

Association of cigarette smoking and tar and nicotine intake with development of type 2 diabetes mellitus in men and women from the general population: the MONICA/KORA Augsburg Cohort Study.

AIMS/HYPOTHESIS: We examined sex-specific associations between cigarette smoking and incident type 2 diabetes mellitus in Germany. SUBJECTS, MATERIALS AND METHODS: The study was based on 5,470 men and 5,422 women (aged 25-74 years) without diabetes who participated in one of the three population-based MONICA Augsburg surveys between 1984 and 1995. Incident cases of type 2 diabetes were assessed using follow-up questionnaires. Hazard ratios (HRs) were estimated from Cox proportional hazard models. RESULTS: Up to 31 December 2002 a total of 409 cases of incident type 2 diabetes among men and 263 among women were registered. The number of cigarettes and the nicotine and tar consumption per day were associated with a significantly increased risk of type 2 diabetes among men, but not among women; this could be due to the low power of the study in women. After multivariable adjustment, the HRs for type 2 diabetes compared with never-smokers were 1.48, 2.03 and 2.10 for men smoking 1 to 14, 15 to 19 and > or =20 cigarettes/day (p for trend <0.0001) and 1.25, 1.34 and 1.37 for women smoking 1 to 9, 10 to 19 and > or =20 cigarettes/day (p for trend 0.0985). Compared with never-smokers, the HRs for increasing tar intake in men (1-167, 168-259 and > or =260 mg/day) were 1.45, 2.32 and 2.07 (p for trend <0.0001); the respective HRs in women (1-89, 90-194 and > or =195 mg/day) were 1.18, 1.57 and 1.24 (p for trend 0.1159). CONCLUSIONS/INTERPRETATION: Cigarette smoking is an important modifiable risk factor of type 2 diabetes particularly in men from the general population.

Adult↗

PubMed2006

Synergistic effects of depressed mood and obesity on long-term cardiovascular risks in 1510 obese men and women: results from the MONICA-KORA Augsburg Cohort Study 1984-1998.

OBJECTIVE: To examine the contribution of depressed mood in obese subjects on the prediction of a future coronary heart disease event (CHD). DESIGN: A prospective population-based cohort study of three independent cross-sectional surveys with 6239 subjects, 45-74 years of age and free of diagnosed CHD, stroke and cancer. During a mean follow-up of 7 years, 179 CHD events occurred among men and 50 events among women. SUBJECTS: A total of 737 (23%) male and 773 (26%) female subjects suffering from obesity (BMI >or=30 kg/m2). MEASUREMENTS: Body weight determined by trained medical staff following a standardized protocol; standardized questionnaires to assess subsyndromal depressive mood and other psychosocial features. RESULTS: The main effect of obesity to predict a future CHD (hazard ratio, HR=1.38, 95% CI 1.03-1.84; P=0.031) and the interaction term of obesity by depression (HR=1.73, 95% CI 0.98-3.05; P=0.060) were borderline significant, both covariate adjusted for multiple risk factors. Relative to the male subgroup with normal body weight and no depression, the male obese group with no depression was not at significantly increased risk for CHD events (HR=1.17, 95% CI 0.76-1.80; P=0.473) whereas CHD risk in males with both obesity and depressed mood was substantially increased (HR=2.32, 95% CI 1.45-3.72, P>0.0001). The findings for women were similar, however, not significant probably owing to lack of power associated with low event rates. Combining obesity and depressed mood resulted in a relative risk to suffer from a future CHD event of HR 1.84 (95% CI 0.79-4.26; P=0.158). CONCLUSIONS: Depressed mood substantially amplifies the CHD risk of middle-aged obese, but otherwise apparently healthy men. The impact of depression on the obesity risk in women is less pronounced.

Adult↗

PubMed2006

Serum gamma-glutamyltransferase is a predictor of incident coronary events in apparently healthy men from the general population.

OBJECTIVE: To investigate whether serum gamma-glutamyltransferase (GGT) is an independent predictor for incident coronary events in initially healthy men from the general population. METHODS AND RESULTS: The study was based on 1878 men (aged 25-64 years) who participated in the first MONICA Augsburg survey 1984/1985, and who were free of coronary heart disease at baseline. Up to 2002 a total of 150 incident acute coronary events occurred. Baseline levels of GGT were higher in men who experienced an event than in event-free men (28.4+/-2.0 units/l versus 22.4+/-2.1 units/l, p 0.0002). GGT was highly correlated with other cardiovascular risk factors. In a Cox proportional hazards model after age adjustment hazard ratios (HR) for incident myocardial infarction across GGT quartiles (<13, 13 to <20, 20 to <35, and >/=35 units/l) were 1.0, 1.84, 2.02, and 3.08 (p for trend 0.0001). Further adjustment for hypertension, TC/HDL ratio, diabetes, smoking, physical activity, alcohol intake, education years and BMI attenuated the association; comparing the highest versus lowest quartile of GGT the HR for a first-ever coronary event was then 2.34 (95% CI, 1.23-4.44). CONCLUSIONS: Serum GGT is a strong predictor of acute coronary events in apparently healthy men from the general population, independent of other risk factors for cardiovascular disease.

Adult↗

PubMed2006

Swimming pool attendance and hay fever rates later in life.

BACKGROUND: Exposure to chlorination by-products through swimming pool attendance showed adverse health effects on children. The aim of our study was to assess whether pool attendance in childhood would be related to higher rates of allergic diseases in adulthood, with special regard to hay fever. METHODS: 2606 adults aged 35-74 years provided retrospectively collected information on swimming pool attendance and medical history, including data on atopic diseases. Information was assessed by a combination of a personal interview and a self-administered questionnaire. Logistic regression models were applied to study associations between hay fever and swimming pool attendance, adjusted for potentially relevant confounders, such as age, gender, region, education and smoking. RESULTS: Higher rates of hay fever could be seen when frequently exposed at school age (aOR: 1.74, 95% CI: 1.09-2.77), frequently exposed during the past 12 months (aOR: 1.32, 95% CI: 0.92-1.89) and ever exposed (aOR: 1.65, 95% CI: 0.98-2.78). Strongest associations were found for the youngest subjects and were dose-related to the extent of current and school-age pool attendance. CONCLUSIONS: Impaired integrity of the lung epithelial by exposure to chlorination by-products might facilitate a closer contact to allergens and therefore could result in higher rates of hay fever.

Adult↗

PubMed2005

BNP as a marker of diastolic dysfunction in the general population: Importance of left ventricular hypertrophy.

BNP is a marker of systolic left ventricular dysfunction (LVSD) and heart failure. To assess BNP for the detection of diastolic dysfunction in the general population, we examined 1678 subjects within an age- and sex-stratified survey (MONICA Augsburg). BNP was measured using a commercially available RIA (Shionogi). BNP increased in subjects with diastolic dysfunction (mean 20.3+/-4.7 pg/ml vs. control 9.6+/-0.5 pg/ml, p<0.001), but to a lesser extent than in subjects with LV hypertrophy (LVH, mean 37.3+/-49.1 pg/ml, p<0.001 vs. control) or LVSD (mean 76.2+/-23.2 pg/ml, p<0.001 vs. control). Individuals with sole diastolic abnormality displayed BNP concentrations at the control level (mean 9.7+/-1.7 pg/ml). In univariate analysis, age, BMI, systolic blood pressure, left atrial size, LV mass index, diastolic dysfunction and EF displayed a significant correlation with BNP (p<0.001). However, LV mass index displaced diastolic dysfunction as a significant predictor of BNP in multivariate analysis. Upon ROC analysis, sensitivity and specificity for the detection of diastolic dysfunction by BNP were only 61% and 55%, respectively. Nevertheless, a normal BNP test virtually excluded the presence of diastolic dysfunction and concomitant LVH (NPV 99.9%). Increased BNP concentrations in subjects with diastolic dysfunction are strongly related to LVH. Population-wide screening for diastolic dysfunction with BNP cannot be recommended although a normal BNP test usually excludes diastolic dysfunction and LV hypertrophy.

Adult↗

PubMed2005

The MONICA Augsburg surveys--basis for prospective cohort studies.

As part of the WHO MONICA project three population-representative surveys were conducted in the study region of Augsburg since 1984/85 to describe time trends of classical cardiovascular risk factors. These surveys provide relevant baseline-information for prospective health outcome studies. Three independent study populations were recruited in 1984/85 (S1: age 25 - 64 years), 1989/90 (S2: age 25 - 74 years), and 1994/95 (S3: age 25 - 74 years) by a two-stage cluster sampling, with random sampling for the city of Augsburg, and a random selection of 16 communities by community size in the two adjacent counties. In the three surveys, 13,427 persons have had 13,818 study participations, since some subjects were by chance sampled for more than one survey. From 1984 to 1995, no trends in hypertension could be observed, but an increase of 15 % (men) resp. 30 % (women) in dyslipidaemia (total/HDL cholesterol ratio > or = five). Cigarette smoking decreased in 55 to 64 year old men und increased in 35 to 64-year old women. The predictive impact for incident Acute Myocardial Infarction (AMI) per 100,000 person years is highest for cigarette smoking (men 880, women 360), followed by dyslipidemia (men 739, women 318) and systolic blood pressure > or = 160 mm Hg (men 658, women 276). By 31st December 2002 1,551 persons (1,031 men, 520 women) had died. The surveys will be used for further gender-specific cross-sectional and longitudinal analyses with special focus on classical, new laboratory and genetic risk factors as determinants of mortality, incident AMI and incident type 2 diabetes, to improve preventive strategies.

Adult↗

PubMed2005

[Temporal changes and determinants of smoking habits with respect to prevention].

Smoking habits are seen as one of the most important risk factors in developed countries for the incidence of cardiovascular diseases and as the major single cause of premature death. The present study analysed smoking habits in participants of the MONICA-Surveys S1 (1984/85), S2 (1989/90) and S3 (1994/95) concerning prevalence, associated factors, time trends and preventive consequences. An essential aim of these studies was to identify risk groups, that should be addressed in prevention campaigns leading to a reduction of the high mortality due to cardiovascular diseases. The participants of the MONICA-Survey S3 (1994/95) had lower proportions of smokers (31.2 % for men and 22.0 % for women) as compared to estimated proportions of the entire German population (National health survey 1998: 37.4 % und 29.9 %). Women had always a lower proportion of smokers than men in each age group or sociodemographic factor. Strong associations of smoking habits with educational levels, family status and occupational position were observed for men and women. A positive time trend with decreasing smoking prevalence was determined for men. In contrast, an increase in the prevalence of female smokers was observed. The intention to change smoking habits was associated with different factors in men and women. For men, mainly "external" factors like social status or physical activity were important. Women seemed to be more influenced by "internal" matters (somatic complaints, negative self-rated health). Sex-, age- and educational status-specific activities and recommendations are considered to be essential for targeting different person groups in a more focused way.

Adult↗

PubMed2005

Ankle-brachial index and peripheral arterial disease.

Patients with peripheral arterial disease including those with intermittent claudication have a high risk for cardiovascular and cerebrovascular morbidity and mortality. The outcome of patients with intermittent claudication is less limited by local complications in the leg than by the systemic complications of coronary and cerebral vessels. About 30 % of these patients will die within 5 years, three-quarters of them due to vascular events. Analyses using data of the KORA Study 2004/2005 (F3), a follow-up examination of the participants of the MONICA Survey 1994/95 (S3), will try to identify biochemical as well as genetic risk factors for peripheral arterial disease. The anti-atherogenic apolipoprotein A-IV will be one of our candidates of interest.

Adult↗

PubMed2005

[Distribution, determinants and reference values of left ventricular parameters in the general population--results of the MONICA/KORA echocardiography studies].

For successful fighting against the burden of cardiovascular disease in the community a comprehensive knowledge about the prevalence and the impact of underlying risk factors is important. The present paper summarises some studies undertaken on more than 2000 persons from the MONICA/KORA-studies (parts of S1 and S3) where left ventricular mass (LVM) and other left ventricular parameters were determined by echocardiography. We especially investigated the associations of LVM with blood pressure and obesity. A special focus was on sex-specific factors in the determination of LVM and the influence of different indices of body size when normalising LVM. It could be shown that hypertension and obesity are major determinants of LV hypertrophy. Especially women with both hypertension and obesity on showed a high prevalence of concentric hypertrophy, significantly more than men. We also showed that the prevalence of LV hypertrophy in a representative sample of the general population (25 to 74 years) is 17.5 % for men, and 18.5 % for women. This underscores the need for primary and secondary prevention regarding the development of LV hypertrophy. Finally, our data in a selected group of normal subjects (reference sample) may be used for the development of reference values for left ventricular parameters in the general German population.

Adult↗

PubMed2005

Cardiovascular phenotypes and functional parameters in the general population--results of the MONICA/KORA studies.

The MONICA/KORA surveys are characterized by a careful and broad investigation of multiple cardiovascular phenotypes. Particularly, repeated blinded measurements of blood pressure, comprehensive echocardiographic and electrocardiographic evaluations as well as differentiation between fat and fat-free body mass have led to manifold innovative observations. Specifically, genetic and serological markers of the renin angiotensin system could be associated with high blood pressure and left ventricular hypertrophy. The same applies to the importance of parameters of body composition as obesity and muscular mass. Moreover, the prevalence of heart failure in the general population could be determined for the first time in Germany. Additionally, the prevalence of left ventricular systolic and diastolic dysfunction could be obtained in the region of the survey, exemplarily for the Federal Republic of Germany. Finally, the surveys of the population random sample were used to define normal serum levels of natriuretic peptides. In summary, the evaluation of cardiovascular phenotypes in the MONICA/KORA surveys resulted in a -- in the European region unique -- documentation of cardiovascular functional parameters in the general population. Moreover, multiple epidemiological observations as to pathophysiologically relevant topics of heart and vascular diseases could be studied in extraordinary details.

Adult↗

PubMed2005

[Case-cohort studies: an effective design for the investigation of biomarkers as risk factors for chronic diseases--demonstrated by the example of the MONICA/KORA Augsburg Case-Cohort Study 1984-2002].

As it is often not possible to determine specific measures of exposure in all participants of a prospective cohort study due to financial or other restrictions, new study designs have been developed. The aim of these designs is to obtain valid results even though expensive measurements are restricted to a limited number of participants of the original cohort study. The case-cohort study is a design that has recently become interesting as an alternative to the well known nested case-control study. The following article describes the case-cohort design considering as an example data from the MONICA/KORA Augsburg cohort study 1984-2002 and the outcomes of type 2 diabetes mellitus and acute myocardial infarction. Furthermore, results obtained in the full cohort for selected exposures are compared with results obtained in the case-cohort study.

Adult↗

PubMed2005

Type 2 diabetes mellitus in Augsburg--an epidemiological overview.

This article provides an overview of the prevalence of type 2 diabetes and the antidiabetic treatment over a 17 year study period. The causes of the disease and the impact of diabetes on cardiovascular disease (CVD) morbidity are discussed. Furthermore, changes in lifestyle and risk factor profile in persons with diabetes are reported. We present data from the MONICA/KORA surveys S1-S4 conducted between 1984/85 and 1999/2001 in the region of Augsburg, Southern Germany and the Augsburg Myocardial Infarction Registry. Contrary to most studies from other countries, in the 25 to 74 year old Augsburg population the prevalence of known diabetes did not increase over the last years. Obesity and decreased physical activity are the two main lifestyle related risk factors for type 2 diabetes. Recently, further modifiable risk factors such as smoking and hypertension have been associated with the development of type 2 diabetes in the Augsburg population. Consistent with recommendations to intensify glucose control in diabetic persons the diabetes treatment continuously improved during the study period. However, health status of persons with diabetes is far from optimal in the Augsburg population suggesting that recommendations for primary prevention of CVD in diabetic persons were not sufficiently put into practice until 1999/2001. Furthermore, data from the MONICA/KORA Augsburg Myocardial infarction registry underline the challenge that in particular men and women with diabetes should receive intensive preventive interventions proven to reduce CVD risk. In conclusion, data from the MONICA/KORA Augsburg studies suggest that it should become an important public health priority to prevent diabetes mellitus.

Adult↗

PubMed2005

[Fractures in the elderly--a challenge for prevention and health promotion--results from the KORA fracture study Augsburg].

Fractures of the appendicular bones are frequent and can cause a loss of the ability for independent living, depending on age and fracture localisation. They affect both sexes at different times and in different ways. The basic epidemiology for Germany of this injury resp. disease and knowledge regarding medium-term health-related consequences has been provided by work done in the context of the KORA Augsburg Fracture Study 1998, a follow-up of older participants of the third MONICA Augsburg survey S3 (1994/95) and through further research in the past years. Results of a validation study support the value of questionnaire-based patients recall of fractures and their location. It could be shown that age, gender, time since fracture and impaired walking have the greatest predictive value among a number of factors. Limitations of physical function are apparent especially during the first two years after a fragility fracture. After five years functional capacity of survivors equals the functional capacity of control persons of the same age. These population-representative and validated data support model-based cost-effective strategies of population-orientated disease prevention and health promotion. An age and gender-specific approach (gender mainstreaming) is mandatory.

Age Distribution↗

PubMed2005

Association of the 103I MC4R allele with decreased body mass in 7937 participants of two population based surveys.

BACKGROUND: The melanocortin-4-receptor gene (MC4R) is part of the melanocortinergic pathway that controls energy homeostasis. In a recent meta-analysis, the MC4R V103I (rs2229616) polymorphism was shown to be associated with body weight regulation. Although no functional differences between the isoleucine comprising receptor and the wild type receptor have been detected as yet, this meta-analysis of 14 case-control studies reported a mild negative association with obesity (odds ratio (OR) 0.69, p = 0.03). However, evidence in a large population based study in a homogeneous population and a significant estimate of the change in quantitative measures of obesity is still lacking. METHODS: We analysed the data of two surveys of a white population with the same high quality study protocol, giving a total of 7937 participants. RESULTS: By linear regression, we found a significant decrease of 0.52 body mass index (BMI) units (95% confidence interval (CI) -0.02 to -1.03, p = 0.043) for carriers of the heterozygote rs2229616G/A genotype, which was observed in 3.7% of the participants. Logistic regression yielded a significantly negative association of the MC4R variant with "above average weight" (BMI > or = median BMI) yielding an OR of 0.75 (95% CI 0.59 to 0.95 p = 0.017). We obtained similar results comparing obese (BMI > or =30 kg/m2, World Health Organization results for 1997) with non-obese (BMI < 30 kg/m2) participants. The results were found for both sexes and each survey separately, and did not depend on the modelling of age, sex, or survey effects. CONCLUSIONS: Our study confirms previous findings of a meta-analysis that the relatively infrequent G/A genotype of the V103I MC4R polymorphism is negatively associated with above average weight and obesity in population based original data of 7937 participants, and extends previous findings by showing for the first time a significantly lower BMI in individuals carrying the infrequent allele of this MC4R variant.

Adult↗

PubMed2004

Leisure time physical activity and the risk of type 2 diabetes in men and women from the general population. The MONICA/KORA Augsburg Cohort Study.

AIMS/HYPOTHESIS: The aim of this study was to examine sex-specific associations between leisure time physical activity and incident type 2 diabetes in a representative population sample in Germany. METHODS: The study was based on 4,069 men and 4,034 women (aged 25 to 74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. Subjects were free of diabetes at baseline. Incident cases of type 2 diabetes were assessed in 1998 using a follow-up questionnaire. Sex-specific hazard ratios (HRs) were estimated from Cox proportional hazard models. RESULTS: A total of 145 cases of incident type 2 diabetes among men and 82 among women were registered during the mean follow-up period of 7.4 years. In both sexes, a high leisure time physical activity level was associated with a reduced risk of incident type 2 diabetes. After adjustment for confounding factors, the HR in highly active men (more than 2 h physical activity per week in summer and winter) was 0.83 (95% CI: 0.50-1.36). In contrast, highly active women had the lowest risk of type 2 diabetes even after multivariable adjustment (HR 0.24; 95% CI: 0.06-0.98). In subgroup analyses, after multivariable adjustment, the protective effect of moderate to high physical activity was significant in women with a BMI below 30 kg/m(2) (HR 0.24; 95% CI: 0.09-0.65) but not in women with a BMI of 30 kg/m(2) or higher (HR 0.97; 95% CI: 0.44-2.11). CONCLUSIONS/INTERPRETATION: Leisure time physical activity is effective in preventing type 2 diabetes, especially in nonobese women, in the general population.

Alcohol Drinking↗

PubMed2004

[Use of vitamin and mineral supplements in Germany].

Recent regulations on supplement use in Europe address the necessity to include information on dietary intake to derive maximum amounts for vitamins and minerals in food supplements. Therefore, information about supplement use in Germany, as well as data on micronutrient intake (from supplements and traditional foods), in particular of persons who use several supplements, is examined in detail. As part of the representative German National Health Interview and Examination Study 1998, in the Nutrition Survey 4030 persons, aged 18-79 years, were asked about their dietary habits, including vitamin and mineral supplement use, in a personal computer-aided interview. About 43% of the population reported using supplements at least once in the observation period of 12 months. Women use supplements more frequently than men. A relatively small group uses several supplements, most often vitamin plus multivitamin supplements. Considering single nutrients, vitamin C is most commonly consumed from more than one supplement. However, a micronutrient intake above the tolerable upper intake level is rare. Use of supplements is common in Germany. Nevertheless, only a small proportion of the population uses more than one supplement containing the same micronutrient daily. Even among these persons an intake above the tolerable upper intake level is seldom.

Adolescent↗

PubMed2004

Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA Project.

OBJECTIVE: To explore the relationship between hypercholesterolaemia, age and BMI among females and males. DESIGN: Population-based cross-sectional survey. SUBJECTS: The data came from the initial surveys of the WHO MONICA Project. In all, 27 populations with 48 283 subjects (24 017 males and 24 266 females) aged 25-64 y were used for the analysis. MEASUREMENTS: Total cholesterol, weight, height, BMI, prevalence of hypercholesterolaemia (PHC) defined as cholesterol >/=6.5 mmol/l, and the prevalence of obesity (POB) defined as BMI >/=30 kg/m(2). RESULTS: PHC increased with age, with PHC in males being significantly higher than in females at age range 25-49 y and significantly lower than in females at age range 50-64 y. Age-related increase in hypercholesterolaemia was steeper in females than in males. There was a statistically significant positive association between hypercholesterolaemia and BMI. Multiple logistic regression analysis revealed a negative statistically significant (P<0.001) effect modification involving age and BMI on the risk of having hypercholesterolaemia both in females and males. The relation between PHC and BMI became weaker in higher age groups, with no statistically significant association in females aged 50-64 y. CONCLUSION: Public health measures should be directed at the prevention of obesity in young adults since the strongest effect of obesity on the risk of hypercholesterolaemia has been found in subjects aged 25-39 y.

Adult↗

PubMed2003

[Epidemiology of left ventricular systolic dysfunction in the general population of Germany: results of an echocardiographic study of a large population-based sample].

The prevalence of left ventricular systolic dysfunction (LVSD) in the general population is poorly defined. Specifically, the number of asymptomatic individuals with LVSD and, thus, the most appropriate strategy to identify and treat such subjects is still unknown. Therefore, the aim of this study was to document LV dysfunction in a middle-aged (25 to 75 years, mean 51.8+/-13.8) population - based sample in Germany (MONICA Augsburg, n=1678; echocardiography technically adequate n=1418) by M-mode and 2D-echocardiography and to analyze the importance of predisposing contributors. The overall prevalence of an ejection fraction (EF) less than 48% (mean minus 2 SD=LVSD) was 2.3% (n=33), with a slightly higher rate in men than in women (2.8% vs 1.9%, n.s.). LVSD rate increased with age: from 1.5% in individuals younger than 40 years to 4.0% among those older than 60 years of age (p<0.05). Of 33 participants with reduced left ventricular systolic function, 20 presented with at least one cardiovascular disease. The most frequent diagnoses were arterial hypertension, obesity and coronary heart disease. Only 13 subjects (0.9%) of the study population were asymptomatic without a history of cardiovascular disease. Furthermore, only 6 subjects (0.4%, 4 male) in this population presented with a moderate impairment of LV function (EF of 30 to 40%) and only 1 subject (0.07%, male) had severe LVSD (EF less than 30%). Almost all subjects with an EF less than 40% (6 of 7 individuals) had a known history of cardiovascular disease. In conclusion, LVSD is a relatively common finding in the general population. However, severe LVSD is rare in subjects without any concomitant cardiovascular disease. Thus, echocardiographic screening cannot be recommended in the unselected, middle-aged population to identify such patients.

Adult↗