OBJECTIVE: Gynaecologic surgeries and hormone medication increasingly interfere with the concept of determining menopausal status based on self-reported data about the last menstrual period-an approach frequently applied in epidemiological studies. This analysis compared different approaches of menopausal status determination, including a probabilistic approach that was developed to reduce misclassification of menopausal status. METHODS: Interview and questionnaire data relating to hormone status from about 16,000 German women were used to determine menopausal status using different approaches: menses based, age based, self-assessment based, and a probabilistic approach. RESULTS: Applying strict menses-based criteria, 29.1% of the women were found to be with undetermined menopausal status. The probabilistic approach was applied to determine menopausal status and age at menopause for these women. The proposed approach uses the current age of the women with undetermined menopausal status, and the relative age-dependent frequencies of pre- or postmenopausal status among those with natural menopausal status to calculate weighting factors, which represent the probabilities of being pre- and postmenopausal of each woman previously undetermined. Correspondingly, the missing age at menopause was estimated with the same probabilistic approach. Applying various approaches to determine menopausal status, the ratio of pre- to postmenopausal women differed considerably, ranging from 1.03 to 1.61. In addition, considerable differences were observed with respect to the number of missing values for both menopausal status and age at menopause. CONCLUSION: The probabilistic approach allowed to estimate menopausal status and age at menopause with the advantage that all available information from the entire study population and from the individual is used.

Adult↗

PubMed2001

Human cytosolic sulphotransferases: genetics, characteristics, toxicological aspects.

Cytosolic sulphotransferases transfer the sulpho moiety from the cofactor 5'-phosphoadenosine-3'-phosphosulphate (PAPS) to nucleophilic groups of xenobiotics and small endogenous compounds (such as hormones and neurotransmitters). This reaction often leads to products that can be excreted readily. However, other sulpho conjugates are strong electrophiles and may covalently bind with DNA and proteins. All known cytosolic sulphotransferases are members of an enzyme/gene superfamily termed SULT. In humans, 10 SULT genes are known. One of these genes encodes two different enzyme forms due to the use of alternative first exons. Different SULT forms substantially differ in their substrate specificity and tissue distribution. Genetic polymorphisms have been described for three human SULTs. Several allelic variants differ in functional properties, including the activation of promutagens. Only initial results are available from the analysis of SULT allele frequencies in different population groups, e.g. subjects suffering from specific diseases and corresponding controls.

Arylsulfotransferase↗

PubMed2001

Dietary antioxidants and peripheral arterial disease : the Rotterdam Study.

This study examined cross-sectionally the association of dietary beta-carotene, vitamin C, and vitamin E with peripheral arterial disease in Rotterdam, the Netherlands (1990--1993). The 4,367 subjects from the Rotterdam Study were aged 55--94 years and had no previous cardiovascular disease at baseline. Diet was assessed with a food frequency questionnaire. Peripheral arterial disease was defined as an ankle-arm systolic blood pressure index (AAI) of < or = 0.9 and was present in 204 men and 370 women. In multivariate-adjusted logistic regression analyses, vitamin C intake was significantly inversely associated with peripheral arterial disease in women (highest vs. lowest quartile: relative risk = 0.64, 95% confidence interval (CI): 0.48, 0.89; p(trend) = 0.006), and a 100-mg increase in intake was associated with a 0.013 AAI increase (95% CI: 0.001, 0.025). In men, vitamin E intake was inversely associated with peripheral arterial disease (relative risk = 0.67, 95% CI: 0.44, 1.03; p(trend) = 0.067); a 10-mg increase in intake was associated with a 0.015 AAI increase (95% CI: 0.001, 0.031). Whether these differences in antioxidant intake and the risk of a low AAI and of peripheral arterial disease between sexes are attributable to a different food pattern for men compared with women remains to be elucidated.

Aged↗

PubMed2001

Effect of alcohol consumption on systemic markers of inflammation.

BACKGROUND: Epidemiological studies suggest that light to moderate alcohol intake is associated with lower all-cause mortality than abstention or heavy alcohol intake, primarily through reduced risk of coronary heart disease. The underlying mechanisms are incompletely understood. METHODS: We investigated the association between alcohol consumption (assessed by a 7-day food record) and concentrations of C-reactive protein (CRP), alpha1-globulins, alpha2-globulins, albumin, and transferrin, and leucocyte count in a sample of 2006 men and women aged 18-88 years participating in a national health survey carried out in former West Germany in 1987-88. Analyses were based on 781 men and 995 women with complete data. FINDINGS: Among men, alcohol consumption showed a U-shaped association with mean values of CRP (p for linear term 0.65, for quadratic term 0.048), alpha1-globulins (p=0.20, 0.0006), alpha2-globulins (p=0.82, 0.31), and leucocyte count (p=0.51, 0.26) even after adjustment for age, smoking, body-mass index, HDL and LDL cholesterol, history of hypertension, education, and income. There were inverted U-shaped associations between the negative acute-phase reactants albumin (p=0.41, 0.006) and transferrin (p=0.14, 0.28) and alcohol intake. In women, the associations were less strong for CRP (p=0.35, 0.31), leucocyte count (p=0.28, 0.15), and transferrin (p=0.86, 0.83). Concentrations of alpha1-globulins and alpha2-globulins were inversely related to alcohol consumption, and albumin showed a positive association with increasing alcohol intake in women. INTERPRETATION: Non-drinkers and heavy drinkers had higher CRP concentrations than moderate drinkers. In view of the robust association between markers of inflammation, especially CRP, and risk of coronary heart disease, an anti-inflammatory action of alcohol could contribute to the link between moderate consumption and lower cardiovascular mortality.

Acute-Phase Proteins↗

PubMed2001

Giessen Wholesome Nutrition Study: relation between a health-conscious diet and blood lipids.

OBJECTIVE: To study in humans the relationship between a diet consistent with most of the current recommendations for the prevention of nutrition-related diseases (Wholesome Nutrition) and the blood lipid profile (total cholesterol, LDL-, HDL-cholesterol, LDL/HDL-ratio, triglycerides). DESIGN: Cross-sectional study with two diet groups. SETTING: Former West Germany. SUBJECTS: Healthy women (n=243, aged 25-65 y) adhering to Wholesome Nutrition for at least 5 y (subdivided into 111 ovo-lacto vegetarians and 132 low-meat eaters) and an according control group of 175 women eating an average German mixed diet. They were all recruited through an advertisement campaign and selected on the basis of their food consumption. RESULTS: Considering potential confounders, the Wholesome Nutrition subgroups had higher HDL-cholesterol levels than the control group. No differences were observed for total cholesterol and LDL-cholesterol. For LDL/HDL-ratio and triglycerides the effect of diet was dependent on interaction terms. With increasing risk factors (age or body mass index (BMI)) the Wholesome Nutrition subgroups showed more favourable blood lipids. CONCLUSIONS: Women eating a preventive diet on a long-term basis exhibit more favourable blood lipid profiles than women consuming an average mixed diet. This is particularly obvious for HDL-cholesterol in the presence of certain risk factors and when an ovo-lacto vegetarian version is practised. SPONSORSHIP: Eden Foundation, Bad Soden, Germany.

Adult↗

PubMed2001

Factors explaining the difference of total homocysteine between men and women in the European Investigation Into Cancer and Nutrition Potsdam study.

Interestingly, plasma total homocysteine (tHcy) concentration is consistently higher in men than in women. This observation deserves further investigations because elevated tHcy concentrations have been shown to be independently associated with coronary, peripheral, and cerebral vascular diseases. It was the aim of the present study to define major determinants of plasma tHcy in a healthy middle-aged German population under particular consideration of the gender factor. The study population was obtained from an ongoing recruitment procedure for a cohort study and comprised 336 men and women, aged 40 to 65 years. Exclusion criteria were elevated creatinine levels in blood, history of skin or atherosclerotic diseases, current use of vitamins or other supplements, and heavy smoking. Plasma tHcy, folate, vitamin B12, vitamin B6, creatinine, testosterone and estradiol, protein, and hematocrit were measured. Fat-free mass was assessed by skinfold thickness. The C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR), a key enzyme of folate and homocysteine metabolism, was determined by polymerase chain reaction (PCR) with restriction enzyme analysis. In this population, plasma tHcy ranged from 5 to 46 micromol/L. The frequency of the T allele of the MTHFR was 0.29, which is lower than in other populations. A total of 54.2% of this population was homozygote for the wild-type, 39.6% heterozygote, and 6.2% homozygote for the mutation. tHcy correlated negatively with folate and cobalamin concentration in blood and positively with creatinine. No correlation was seen with vitamin B6. From the gender-related variables, tHyc correlated significantly with fat-free mass and testosterone and inversely with estradiol. The difference between gender with regard to tHcy was mainly explained by differences in fat-free mass, but also by estradiol concentrations. The following contributions to the variation of tHcy were seen in a multivariate regression model: plasma cobalamin (11%), creatinine (11%), plasma folate (8%), fat-free mass (5%), estradiol (2%), MTHFR polymorphisms (2%), and plasma protein (1%). We concluded that tHcy in the general population has a variety of determinants ranging from nutrition, internal metabolic parameters to gender-related variables.

Adult↗

PubMed2001

[Data protection--an obstacle for prospective studies? Solutions exemplified by a cohort study].

Prospective studies require the storage of the participants' personal data for follow-up. This demands special precautions for the protection of these data. Additional to the informed consent of the participant which enables the researchers to collect the prospective study data, the participant's right of informal self-determination should be protected. In the EPIC (European Prospective Investigation into Cancer and Nutrition) Potsdam study, therefore, an internal trustee was established that collects follow-up information from participants, physicians, clinics, health offices, tumour and population registries with the aim to obtain valid information on vital status and diseases of the participants. The internal trustee is a spatial and organizational separated working group. The isolated electronic data processing network, the alarm system which controls the rooms of the working group, the access control for employees are special security arrangements. During follow-up the individual identification number of the study data base is replaced by a specific identification number solely for the follow-up. Further, unique identification numbers are allocated to every single action and every single document such as inquiry forms which are sent to physicians, health offices, or population registries, that allow anonymous mailing and processing of the collected information. On copies of important documents, the name is erased and replaced by a specific record number. The inquiry forms for the physicians, for instance, contain the name of the participant at the head which has to be cut off before returning the form to the internal trustee. The identification number is also printed as bar code on each document facilitating its processing with technical aids such as scanners. If checkbacks are necessary, only certain work group members are able to reconnect the document number with the name. Depending on the task, the computer programmes confine automatically the details presented to the assistant. All arrangements to protect personal data do not interfere with research interests; on the contrary they lead to an efficient work routine and guarantee follow-up according to international rules.

Cohort Studies↗

PubMed2001

Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study.

Dietary pattern analysis has recently received growing attention, as it might be more appropriate in studies of diet-disease associations than the single food or nutrient approach that has dominated past epidemiological research. Factor analysis is a technique which is commonly used to identify dietary patterns within study populations. However, the ability of factor solutions to account for variance of food and nutrient intake has so far remained unclear. The present study therefore explored the statistical properties of dietary patterns with regard to the explained variance. Food intake of 8975 men and 13 379 women, assessed by a food-frequency questionnaire, was aggregated into forty-seven separate food groups. Dietary patterns were identified by principal component analysis and subsequent varimax rotation. Seven factors were retained for both men and women, which accounted for about 31 % of the total variance. The explained variance was relatively high (>40 %) for cooked vegetables, sauce, meat, dessert, cake, bread other than wholemeal, raw vegetables, processed meat, high-fat cheese, butter and margarine. Factor scores were used to investigate associations between the factors and nutrient intake. The patterns accounted for relatively large proportions of variance of energy and macronutrient intake, but for less variance of alcohol and micronutrient intake, especially of retinol, beta-carotene, vitamin E, Ca and ascorbic acid. In addition, factors were related to age, BMI, physical activity, education, smoking and vitamin and mineral supplement use.

Adult↗

PubMed2001

Comparison of self-reported alcohol intake with the urinary excretion of 5-hydroxytryptophol:5-hydroxyindole-3-acetic acid, a biomarker of recent alcohol intake.

Under-reporting of alcohol intake has been frequently reported. However, due to the lack of an objective reference method, e.g. a biomarker, information about the extent of under-reporting of alcohol intake obtained with dietary assessment instruments is not available. The objective of this study was to compare reported alcohol intake data derived from a 24 h recall with a biomarker of recent alcohol intake, the urinary excretion of 5-hydroxytryptophol (5-HTOL):5-hydroxyindole-3-acetic acid (5-HIAA). Embedded into the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study, Germany, a validation study that collected 24 h recall data and 24 h urine samples was conducted. Cohort study participants (n 107) volunteered to participate in this validation study. Among them were five subjects who reported no consumption of alcoholic beverages but had a 5-HTOL:5-HIAA ratio that indicated recent alcohol intake when the clinical cut-off point was taken as a judging criterion. After exclusion of these under-reporters, the Pearson's correlation coefficient between reported alcohol intake and the 5-HTOL:5-HIAA ratio was 0.92 (P<0.0001). Except for low alcohol intake of <0.1 g/kg body mass, a significant increase in 5-HTOL:5-HIAA excretion was observed with increasing amounts of alcohol intake. In conclusion, the 5-HTOL:5-HIAA excretion ratio appears to be a valuable quantitative biomarker of recent alcohol consumption. Denial of alcohol intake can be detected, but for the quantification of under-reporting of alcohol intake 24 h reference data are not yet available. With these data at hand, however, 5-HTOL:5-HIAA could become a biomarker for validation purposes in nutritional epidemiology.

5-Hydroxytryptophan↗

PubMed2001

Inverse correlation between alcohol consumption and lymphocyte levels of 8-hydroxydeoxyguanosine in humans.

In a cross-sectional study of 115 premenopausal non-smoking women, we examined the relationship between lymphocyte levels of 8-hydroxy-2'-deoxyguanosine (8-oxodGuo) and habitual alcohol consumption. The study was conducted in four different regions of Europe, including Potsdam (Germany), Turin (Italy), Malmö (Sweden) and Granada (Spain). Mean 8-oxodGuo levels differed significantly across study centres (P = 0.001), with the highest levels in Granada [2.17 8-oxodGuox10(-6) 2'-deoxyguanosine (95% confidence interval 1.27-4.40)] and lowest levels in Turin [1.19 (0.36-4.29)]. Mean levels of total alcohol intake and of types of alcoholic beverages consumed (wine, fortified wines, beer and cider) also differed across the study centres (P < 0.05), with the highest total alcohol consumption in Turin, and the lowest intake in GRANADA: When combining all the data, but adjusting for study centre, individual 8-oxodGuo level correlated inversely with alcohol intake. This inverse association remained unaltered after further adjustment for Quetelet Index, fruit and vegetable consumption, and plasma carotenoid levels. Furthermore, the inverse association was also observed for each of the study centres separately, and for different beverage types, with the exception of Granada, where the majority of women were non-drinkers and where alcohol intakes were also very low for the consumers. Finally, on a group level, mean levels of 8-oxodGuo and alcohol intake were also inversely associated between the four study centres. The finding of a relationship between alcohol consumption and 8-oxodGuo in lymphocytes was unexpected and not based on a prior hypothesis. This finding consequently requires confirmation from a randomized intervention study.

8-Hydroxy-2'-Deoxyguanosine↗

PubMed2001

Helicobacter pylori infection and serum ferritin: A population-based study among 1806 adults in Germany.

OBJECTIVE: Helicobacter pylori may possibly affect the iron metabolism by occult bleeding, impaired absorption of non-hem iron, and by scavenging hem iron or ferritin, as some studies have suggested. The aim of this study was to analyze the association between H. pylori infection and serum ferritin, a marker of the body iron stores. In this analysis, we paid particular attention to the role of dietary iron intake and CagA, an established virulence factor of the agent. METHODS: The analysis is based on a cross-sectional national health and nutrition survey among healthy people in Germany conducted in 1987/1988. The examination included a detailed questionnaire on medical history and lifestyle factors, a 7-day food record, and blood samples. Infection with H. pylori was measured serologically by ELISA and Westernblot. RESULTS: In total, 39.2% of 1806 persons aged 18 to 89 yr included in the study were H. pylori positive, of whom 57.6% had an infection with a CagA-positive H. pylori strain. Age- and sex-adjusted geometric mean of ferritin was 54.5 microg/dl among H. pylori-infected compared with 63.8 microg/dl among uninfected persons. A multiple linear regression model with log-transformed serum ferritin concentration as dependent variable and H. pylori infection and several potential confounding factors as independent variable was fitted. In this model, H. pylori infection was associated with a 17.0% decrease of the serum ferritin concentration (95% CI = 9.8-23.6). The association between H. pylori infection and serum ferritin levels did not vary by gender, age, and iron intake, and it was similar for CagA-positive and CagA-negative H. pylori infections. CONCLUSIONS: The decreased serum ferritin concentration among subjects infected with H. pylori might be induced by the uptake of ferritin in the stomach by H. pylori. Possible health implications of H. pylori-induced low ferritin levels warrant further investigation.

Adolescent↗

PubMed2001

Macronutrient, vitamin, and mineral intakes in the EPIC-Germany cohorts.

This article presents intakes of nutrients in the EPIC-Heidelberg and the EPIC-Potsdam (European Investigation into Cancer and Nutrition) studies. Estimates are based on standardized 24-hour dietary recalls. Recalls from 1,013 men and 1,078 women in Heidelberg and from 1,032 men and 898 women in Potsdam were included in the analysis. The estimated nutrient intake was based on the German Food Code and Nutrient Data Base version II.3. Analyses were carried out stratified by sex and weighted for the day of the week and age. Men in Potsdam reported significantly higher intakes of energy (mean Potsdam = 10,718 kJ, mean Heidelberg = 10,387 kJ) and higher intakes of vitamins and minerals as compared with men in Heidelberg. However, Heidelberg men consumed more alcohol, alpha-tocopherol, phosphorus, calcium, and magnesium. Potsdam women reported lower energy (mean Potsdam = 7,537 kJ, mean Heidelberg = 7,855 kJ), alcohol, and cholesterol intakes as compared with Heidelberg women. Vitamin and mineral intakes were lower too, except for retinol and ascorbic acid. The intakes of energy and most nutrients observed in the Potsdam and Heidelberg study populations were within the range reported from other German studies. The observed differences between both study populations indicate different dietary patterns, increasing the exposure variation in the EPIC study.

Adult↗