@phdthesis{Polemiti2022, author = {Polemiti, Elli}, title = {Identifying risk of microvascular and macrovascular complications of type 2 diabetes}, doi = {10.25932/publishup-57103}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-571038}, school = {Universit{\"a}t Potsdam}, pages = {xii, 292}, year = {2022}, abstract = {Diabetes is hallmarked by high blood glucose levels, which cause progressive generalised vascular damage, leading to microvascular and macrovascular complications. Diabetes-related complications cause severe and prolonged morbidity and are a major cause of mortality among people with diabetes. Despite increasing attention to risk factors of type 2 diabetes, existing evidence is scarce or inconclusive regarding vascular complications and research investigating both micro- and macrovascular complications is lacking. This thesis aims to contribute to current knowledge by identifying risk factors - mainly related to lifestyle - of vascular complications, addressing methodological limitations of previous literature and providing comparative data between micro- and macrovascular complications. To address this overall aim, three specific objectives were set. The first was to investigate the effects of diabetes complication burden and lifestyle-related risk factors on the incidence of (further) complications. Studies suggest that diabetes complications are interrelated. However, they have been studied mainly independently of individuals' complication burden. A five-state time-to-event model was constructed to examine the longitudinal patterns of micro- (kidney disease, neuropathy and retinopathy) and macrovascular complications (myocardial infarction and stroke) and their association with the occurrence of subsequent complications. Applying the same model, the effect of modifiable lifestyle factors, assessed alone and in combination with complication load, on the incidence of diabetes complications was studied. The selected lifestyle factors were body mass index (BMI), waist circumference, smoking status, physical activity, and intake of coffee, red meat, whole grains, and alcohol. Analyses were conducted in a cohort of 1199 participants with incident type 2 diabetes from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam, who were free of vascular complications at diabetes diagnosis. During a median follow-up time of 11.6 years, 96 cases of macrovascular complications (myocardial infarction and stroke) and 383 microvascular complications (kidney disease, neuropathy and retinopathy) were identified. In multivariable-adjusted models, the occurrence of a microvascular complication was associated with a higher incidence of further micro- (Hazard ratio [HR] 1.90; 95\% Confidence interval [CI] 0.90, 3.98) and macrovascular complications (HR 4.72; 95\% CI 1.25, 17.68), compared with persons without a complication burden. In addition, participants who developed a macrovascular event had a twofold higher risk of future microvascular complications (HR 2.26; 95\% CI 1.05, 4.86). The models were adjusted for age, sex, state duration, education, lifestyle, glucose-lowering medication, and pre-existing conditions of hypertension and dyslipidaemia. Smoking was positively associated with macrovascular disease, while an inverse association was observed with higher coffee intake. Whole grain and alcohol intake were inversely associated with microvascular complications, and a U-shaped association was observed for red meat intake. BMI and waist circumference were positively associated with microvascular events. The associations between lifestyle factors and incidence of complications were not modified by concurrent complication burden, except for red meat intake and smoking status, where the associations were attenuated among individuals with a previous complication. The second objective was to perform an in-depth investigation of the association between BMI and BMI change and risk of micro- and macrovascular complications. There is an ongoing debate on the association between obesity and risk of macrovascular and microvascular outcomes in type 2 diabetes, with studies suggesting a protective effect among people with overweight or obesity. These findings, however, might be limited due to suboptimal control for smoking, pre-existing chronic disease, or short-follow-up. After additional exclusion of persons with cancer history at diabetes onset, the associations between pre-diagnosis BMI and relative annual change between pre- and post-diagnosis BMI and incidence of complications were evaluated in multivariable-adjusted Cox models. The analyses were adjusted for age, sex, education, smoking status and duration, physical activity, alcohol consumption, adherence to the Mediterranean diet, and family history of diabetes and cardiovascular disease (CVD). Among 1083 EPIC-Potsdam participants, 85 macrovascular and 347 microvascular complications were identified during a median follow-up period of 10.8 years. Higher pre-diagnosis BMI was associated with an increased risk of total microvascular complications (HR per 5 kg/m2 1.21; 95\% CI 1.07, 1.36), kidney disease (HR 1.39; 95\% CI 1.21, 1.60) and neuropathy (HR 1.12; 95\% CI 0.96, 1.31); but no association was observed for macrovascular complications (HR 1.05; 95\% CI 0.81, 1.36). Effect modification was not evident by sex, smoking status, or age groups. In analyses according to BMI change categories, BMI loss of more than 1\% indicated a decreased risk of total microvascular complications (HR 0.62; 95\% CI 0.47, 0.80), kidney disease (HR 0.57; 95\% CI 0.40, 0.81) and neuropathy (HR 0.73; 95\% CI 0.52, 1.03), compared with participants with a stable BMI. No clear association was observed for macrovascular complications (HR 1.04; 95\% CI 0.62, 1.74). The impact of BMI gain on diabetes-related vascular disease was less evident. Associations were consistent across strata of age, sex, pre-diagnosis BMI, or medication but appeared stronger among never-smokers than current or former smokers. The last objective was to evaluate whether individuals with a high-risk profile for diabetes and cardiovascular disease (CVD) also have a greater risk of complications. Within the EPIC-Potsdam study, two accurate prognostic tools were developed, the German Diabetes Risk Score (GDRS) and the CVD Risk Score (CVDRS), which predict the 5-year type 2 diabetes risk and 10-year CVD risk, respectively. Both scores provide a non-clinical and clinical version. Components of the risk scores include age, sex, waist circumference, prevalence of hypertension, family history of diabetes or CVD, lifestyle factors, and clinical factors (only in clinical versions). The association of the risk scores with diabetes complications and their discriminatory performance for complications were assessed. In crude Cox models, both versions of GDRS and CVDRS were positively associated with macrovascular complications and total microvascular complications, kidney disease and neuropathy. Higher GDRS was also associated with an elevated risk of retinopathy. The discrimination of the scores (clinical and non-clinical) was poor for all complications, with the C-index ranging from 0.58 to 0.66 for macrovascular complications and from 0.60 to 0.62 for microvascular complications. In conclusion, this work illustrates that the risk of complication development among individuals with type 2 diabetes is related to the existing complication load, and attention should be given to regular monitoring for future complications. It underlines the importance of weight management and adherence to healthy lifestyle behaviours, including high intake of whole grains, moderation in red meat and alcohol consumption and avoidance of smoking to prevent major diabetes-associated complications, regardless of complication burden. Risk scores predictive for type 2 diabetes and CVD were related to elevated risks of complications. By optimising several lifestyle and clinical factors, the risk score can be improved and may assist in lowering complication risk.}, language = {en} } @misc{KozielHermanussenGomulaetal.2017, author = {Koziel, Slawomir and Hermanussen, Michael and Gomula, Alexandra and Swanson, James and Kaczmarek, Maria and El-Shabrawi, Mortada and Elhusseini, Mona and Satake, Takashi and Martinovic Klaric, Irena and Scheffler, Christiane and Morkuniene, Ruta and Godina, Elena and Sasa, Missoni and Tutkuviene, Janina and Siniarska, Anna and Nieczuja-Dwojacka, Joanna and Nunez, Javier and Groth, Detlef and Barbieri, Davide}, title = {Adolescence - a Transition to Adulthood Proceedings of the 24th Aschauer Soiree, held at Jurata, Poland, November 5th 2016}, series = {Pediatric Endocrinology Reviews}, volume = {14}, journal = {Pediatric Endocrinology Reviews}, number = {3}, publisher = {Medical Media}, address = {Netanya}, issn = {1565-4753}, pages = {326 -- 334}, year = {2017}, abstract = {Eighteen scientists met at Jurata, Poland, to discuss various aspects of the transition from adolescence to adulthood. This transition is a delicate period facing complex interactions between the adolescents and the social group they belong to. Social identity, group identification and identity signalling, but also stress affecting basal salivary cortisol rhythms, hypertension, inappropriate nutrition causing latent and manifest obesity, moreover, in developing and under-developed countries, parasitosis causing anaemia thereby impairing growth and development, are issues to be dealt with during this period of the human development. In addition, some new aspects of the association between weight, height and head circumference in the newborns were discussed, as well as intrauterine head growth and head circumference as health risk indicators.}, language = {en} } @article{ParfentevaGrothScheffleretal.2019, author = {Parfenteva, Olga and Groth, Detlef and Scheffler, Christiane and Zaharova, Maria F.}, title = {Influence of the A/T polymorphism of the FTO gene and sport specializations on the body composition of young Russian athletes}, series = {Journal of biological and clinical anthropology : Anthropologischer Anzeiger ; Mitteilungsorgan der Gesellschaft f{\"u}r Anthropologie}, volume = {76}, journal = {Journal of biological and clinical anthropology : Anthropologischer Anzeiger ; Mitteilungsorgan der Gesellschaft f{\"u}r Anthropologie}, number = {5}, publisher = {Schweizerbart}, address = {Stuttgart}, issn = {0003-5548}, doi = {10.1127/anthranz/2019/0943}, pages = {401 -- 408}, year = {2019}, abstract = {Background: The polymorphism in FTO gene (rs9939609) is known to be associated with higher BMI and body fat mass content. However, environmental factors can modify this effect. The purpose of the present study was to investigate an association between sport specialization and the rs9939609 SNP in FTO gene in the cohort of professional and amateur young athletes. Methods: A total number of 250 young individuals 8-18 years old living in Moscow or Moscow district participated in the study. Individuals were divided into 3 groups in accordance with their physical activity level: control group (n = 49), amateurs (n = 67) and professionals (n = 137). Amateur and professional athletes were subdivided into groups according to their sport specialization. Quantile regression was used as a regression model, where the dependent (outcome) variable was BMI, along with percentage of body fat mass, and the independent variables (predictors) were the rs9939609 SNP in FTO gene, physical activity (active versus inactive), sport specialization (aerobic, intermittent sports and martial arts), nationality, level of sport experience (in years), gender and percentage of free fat mass content. Results: The regression analysis revealed that physical activity and sport specialization had greater impact compared to FTO allele in the group of physically active individuals. Physical activity, in particular aerobic, had negative associations with body fat mass and BMI. The rs9939609 SNP in FTO gene is associated with physical activity and aerobic activity. The magnitude of association becomes significantly larger at the upper quantiles of the body fat mass distribution. Conclusion: Physical activity and sport specialization explained more variance in body composition of physically active young individuals compared to the FTO polymorphism. Effect of interaction of physical activity, in particular aerobic, with the FTO polymorphism on body composition of young athletes was found.}, language = {en} } @article{KoelmanPivovarovaRamichPfeifferetal.2019, author = {Koelman, Liselot A. and Pivovarova-Ramich, Olga and Pfeiffer, Andreas F. H. and Grune, Tilman and Aleksandrova, Krasimira}, title = {Cytokines for evaluation of chronic inflammatory status in ageing research}, series = {Immunity \& Ageing}, volume = {16}, journal = {Immunity \& Ageing}, publisher = {BMC}, address = {London}, issn = {1742-4933}, doi = {10.1186/s12979-019-0151-1}, pages = {12}, year = {2019}, abstract = {Background: There is a growing interest in the role of inflammageing for chronic disease development. Cytokines are potent soluble immune mediators that can be used as target biomarkers of inflammageing; however, their measurement in human samples has been challenging. This study aimed to assess the reliability of a pro- and anti-inflammatory cytokine panel in a sample of healthy people measured with a novel electrochemiluminescent multiplex immunoassay platform (Meso Scale Discovery, MSD), and to characterize their associations with metabolic and inflammatory phenotypes.}, language = {en} } @misc{HelfertWarschburger2013, author = {Helfert, Susanne and Warschburger, Petra}, title = {The face of appearance-related social pressure}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus4-401155}, pages = {11}, year = {2013}, abstract = {Background Appearance-related social pressure plays an important role in the development of a negative body image and self-esteem as well as severe mental disorders during adolescence (e.g. eating disorders, depression). Identifying who is particularly affected by social pressure can improve targeted prevention and intervention, but findings have either been lacking or controversial. Thus the aim of this study is to provide a detailed picture of gender, weight, and age-related variations in the perception of appearance-related social pressure by peers and parents. Methods 1112 German students between grades 7 and 9 (mean age: M = 13.38, SD = .81) filled in the Appearance-Related Social Pressure Questionnaire (German: FASD), which considers different sources (peers, parents) as well as various kinds of social pressure (e.g. teasing, modeling, encouragement). Results Girls were more affected by peer pressure, while gender differences in parental pressure seemed negligible. Main effects of grade-level suggested a particular increase in indirect peer pressure (e.g. appearance-related school and class norms) from early to middle adolescence. Boys and girls with higher BMI were particularly affected by peer teasing and exclusion as well as by parental encouragement to control weight and shape. Conclusion The results suggest that preventive efforts targeting body concerns and disordered eating should bring up the topic of appearance pressure in a school-based context and should strengthen those adolescents who are particularly at risk - in our study, girls and adolescents with higher weight status. Early adolescence and school transition appear to be crucial periods for these efforts. Moreover, the comprehensive assessment of appearance-related social pressure appears to be a fruitful way to further explore social risk-factors in the development of a negative body image.}, language = {en} } @phdthesis{Rietsch2013, author = {Rietsch, Katrin}, title = {Body composition especially external skeletal robustness in association with physical activity and recreation in pre-pubertal children : a national and international investigation}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus-66913}, school = {Universit{\"a}t Potsdam}, year = {2013}, abstract = {In children the way of life, nutrition and recreation changed in recent years and as a consequence body composition shifted as well. It is established that overweight belongs to a global problem. In addition, German children exhibit a less robust skeleton than ten years ago. These developments may elevate the risk of cardiovascular diseases and skeletal modifications. Heredity and environmental factors as nutrition, socioeconomic status, physical activity and inactivity influence fat accumulation and the skeletal system. Based on these negative developments associations between type of body shape, skeletal measures and physical activity; relations between external skeletal robustness, physical activity and inactivity, BMI and body fat and also the progress of body composition especially external skeletal robustness in comparison in Russian and German children were investigated. In a cross-sectional study 691 German boys and girls aged 6 to 10 years were examined. Anthropometric measurements were taken and questionnaires about physical activity and inactivity were answered by parents. Additionally, pedometers were worn to determinate the physical activity in children. To compare the body composition in Russian and German children data from the years 2000 and 2010 were used. The study has shown that pyknomorphic individuals exhibit the highest external skeletal robustness and leptomorphic ones the lowest. Leptomorphic children may have a higher risk for bone diseases in adulthood. Pyknomorphic boys are more physically active by tendency. This is assessed as positive because pyknomorphic types display the highest BMI and body fat. Results showed that physical activity may reduce BMI and body fat. In contrast physical inactivity may lead to an increase of BMI and body fat and may rise with increasing age. Physical activity encourages additionally a robust skeleton. Furthermore external skeletal robustness is associated with BMI in order that BMI as a measure of overweight should be consider critically. The international 10-year comparison has shown an increase of BMI in Russian children and German boys. Currently, Russian children exhibit a higher external skeletal robustness than the Germans. However, in Russian boys skeleton is less robust than ten years ago. This trend should be observed in the future as well in other countries. All in all, several measures should be used to describe health situation in children and adults. Furthermore, in children it is essential to support physical activity in order to reduce the risk of obesity and to maintain a robust skeleton. In this way diseases are able to prevent in adulthood.}, language = {en} } @phdthesis{Trippo2000, author = {Trippo, Ulrike}, title = {K{\"o}rperbau, K{\"o}rperzusammensetzung und Ern{\"a}hrungsgewohnheiten bei Erwachsenen in Abh{\"a}ngigkeit von Alter und Geschlecht}, url = {http://nbn-resolving.de/urn:nbn:de:kobv:517-0000306}, school = {Universit{\"a}t Potsdam}, year = {2000}, abstract = {Die vorliegende Arbeit ist eine aktuelle Dokumentation von K{\"o}rperbau, K{\"o}rperzusammensetzung und Ern{\"a}hrungsgewohnheiten an 708 j{\"u}ngeren und {\"a}lteren M{\"a}nnern und Frauen aus dem Bundesland Brandenburg. Der K{\"o}rperbau wurde {\"u}ber ein 42 L{\"a}ngen-, Breiten-, Tiefen- und Umfangsmaße umfassendes anthropometrisches Untersuchungsprogramm bestimmt. Die Einsch{\"a}tzung von Gesamtk{\"o}rperfettanteil und Magermasse erfolgte mit zwei Feldmethoden, der Hautfaltendickenmessung und der bioelektrischen Impedanzanalyse. Mit Hilfe eines semiquantitativen Fragebogens zu den Ern{\"a}hrungsgewohnheiten wurde der Lebensmittelverzehr erfasst und daraus die Energie- und N{\"a}hrstoffaufnahme berechnet. Die Ergebnisse zum K{\"o}rperbau zeigen im Mittel eine Abnahme der L{\"a}ngenmaße, jedoch eine Zunahme der Breiten-, Tiefen- und Umfangsmaße mit steigendem Erwachsenenalter. Einfache Parameter zur Beurteilung des Ern{\"a}hrungszustandes, wie K{\"o}rpermasse und Body-Mass-Index (BMI) nehmen im Alter geschlechtsspezifisch zu. Nach den Richtlinien der WHO f{\"u}r den BMI gelten 55,3\% der untersuchten M{\"a}nnern als {\"u}bergewichtig, davon 10\% als adip{\"o}s. Von allen untersuchten Frauen sind 41,6\% {\"u}bergewichtig, davon sind 14,3\% adip{\"o}s. Der Anteil der {\"U}bergewichtigen ist zwar beim weiblichen Geschlecht geringer, aber daf{\"u}r haben mehr Frauen die Grenze zur Adipositas {\"u}berschritten. F{\"u}r eine wissenschaftlich exakte Beurteilung des Ern{\"a}hrungszustandes reichen K{\"o}rpermasse und BMI nicht aus, da sie die K{\"o}rperzusammensetzung nicht bzw. nicht gen{\"u}gend ber{\"u}cksichtigen. Die subkutane Fettschichtdicke nimmt insbesondere am Rumpf zu, was als zus{\"a}tzliches Gesundheitsrisiko gilt. Der Gesamtk{\"o}rperfettanteil steigt im Erwachsenenalter abh{\"a}ngig von der Berechnungsmethode an. Die untersuchten Frauen sind gegen{\"u}ber den M{\"a}nnern in allen Altersgruppen durch einen etwa ein Drittel h{\"o}heren K{\"o}rperfettanteil gekennzeichnet. Die t{\"a}gliche Nahrungsenergieaufnahme der untersuchten Personen l{\"a}sst eine abnehmende Tendenz bis zum 65. Lebensjahr erkennen. Trotz einer sinkenden Nahrungsenergieaufnahme im Alter, nimmt der BMI zu. M{\"o}gliche Ursachen hierf{\"u}r werden in der Arbeit diskutiert. Der Anteil der Grundn{\"a}hrstoffe an der Energiebereitstellung entspricht in keiner der untersuchten Gruppen den Empfehlungen der Deutschen Gesellschaft f{\"u}r Ern{\"a}hrung. Allgemein ist der Fettkonsum zu hoch und der Kohlenhydratanteil zu gering. Das zeigt sich besonders in den beiden mittleren untersuchten Altersgruppen und bei den M{\"a}nnern st{\"a}rker als bei den Frauen.}, language = {de} }