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Töpfer P, Siewert-Markus U, Klinger-König J, Grabe HJ, Stracke S, Dörr M, Völzke H, Ittermann T, Markus MRP. Sex-specific associations of childhood maltreatment with obesity-related traits - The Study of Health in Pomerania (SHIP). Child Abuse Negl 2024; 149:106704. [PMID: 38395019 DOI: 10.1016/j.chiabu.2024.106704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Child maltreatment (CM) is linked to obesity in adulthood. However, sex-differences and direct measurements of body fat have previously been insufficiently considered in this context. OBJECTIVE To assess sex-specific associations of CM with anthropometric markers of overweight/obesity and direct measures of body fat. PARTICIPANTS AND SETTING Analyses were conducted in 4006 adults from a population-based cohort in Northeastern Germany (SHIP-TREND-0). METHODS CM was assessed using the Childhood Trauma Questionnaire (CTQ). Obesity-related traits included anthropometric indicators (i.e., height, weight, body mass index [BMI], waist [WC] and hip circumference [HC], waist-to-hip ratio [WHR], waist-to-height ratio [WHtR]), fat mass (FM) and fat-free mass (FFM) derived from bioelectrical impedance analysis (BIA), and subcutaneous (SAT) and visceral adipose tissue (VAT) ascertained using magnetic resonance imaging (MRI). Sex-stratified linear regression models predicting obesity-related traits from total CTQ scores were adjusted for age and education. Exploratory analyses investigated effects of CTQ subscales on obesity-related traits. RESULTS In men, CM was positively associated with WHtR (β = 0.04; p = .030) and VAT (β = 0.02; p = .031) and inversely with body height (β = -0.05; p = .010). In women, CM-exposure was positively associated with body weight (β = 0.07; p = .018), BMI (β = 0.03; p = .013), WC (β = 0.07; p = .005), HC (β = 0.05; p = .046), WHR (β = 0.03; p = .015), WHtR (β = 0.04; p = .006), FM (β = 0.04; p = .006), and SAT (β = 0.06; p = .041). In both sexes, effects were mainly driven by exposure to emotional and physical abuse. CONCLUSIONS Results suggest that associations between CM-exposure and obesity-related traits in adulthood are primarily present in women. This may have implications for sex-specific obesity-related cardiometabolic risk after CM.
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Affiliation(s)
- Philipp Töpfer
- Department of Medical Psychology, University Medicine Greifswald, Germany.
| | | | - Johanna Klinger-König
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Germany
| | - Sylvia Stracke
- Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Henry Völzke
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcello R P Markus
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD) partner site Greifswald, Greifswald, Germany
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Spielmann M, Krolo-Wicovsky F, Tiede A, Krause K, Baumann S, Siewert-Markus U, John U, Freyer-Adam J. Patient motivation and preferences in changing co-occurring health risk behaviors in general hospital patients. Patient Educ Couns 2023; 114:107841. [PMID: 37354731 DOI: 10.1016/j.pec.2023.107841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES More than 60% of general hospital patients report ≥ 2 health risk behaviors (HRBs), i.e. tobacco smoking, at-risk alcohol use, unhealthy diet, and/or insufficient physical activity. This study investigates a) the association between numbers of HRBs and motivation to change, b) patient preferences for receiving feedback on HRBs, and c) patients' expected gain in quality of life if behavior change made. METHODS In 2020/2021, 256 18-64-year-old general hospital patients (72.1% of eligibles) reported on their motivation to change each of their HRBs. Associations between HRB number and motivation were assessed using multivariate linear regressions. Participants ranked HRBs concerning their interest in receiving feedback and concerning their expected gain in quality of life if behavior change occurred. RESULTS Higher HRB number was negatively related to motivation among at-risk alcohol users (p = 0.034); 24.6% expected gain in their quality of life from behavior change. Participants overall appeared more favorable to feedback about vegetable/fruit intake and physical activity. CONCLUSIONS Unhealthier lifestyle may be accompanied by decreased motivation to change in at-risk alcohol users. In case of co-occurring HRBs, asking patients for expected gain in quality of life may help guiding intervention target. PRACTICE IMPLICATIONS Relying on patient selection only, may often leave substance-use unaddressed.
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Affiliation(s)
- Marie Spielmann
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany.
| | - Filipa Krolo-Wicovsky
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany; German Center for Cardiovascular Research Site, Greifswald, Germany
| | - Anika Tiede
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany; German Center for Cardiovascular Research Site, Greifswald, Germany
| | | | - Sophie Baumann
- Department of Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Ulrich John
- German Center for Cardiovascular Research Site, Greifswald, Germany; Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany; German Center for Cardiovascular Research Site, Greifswald, Germany
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Pierdant G, Ittermann T, Freyer-Adam J, Siewert-Markus U, Grabe HJ, Dörr M, Heckmann M, Zygmunt M, Lange AE, Markus MRP. Maternal socioeconomic and lifestyle factors and life dissatisfaction associated with a small for gestational age infant. The Survey of Neonates in Pomerania (SNiP). Arch Gynecol Obstet 2023; 307:1243-1254. [PMID: 35599250 PMCID: PMC10023753 DOI: 10.1007/s00404-022-06598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim is to investigate the associations of the mother's socioeconomic and lifestyle factors and life satisfaction with the delivery of a small for gestational age (SGA) infant. METHODS Data from 4598 participants of the population-based birth cohort study Survey of Neonates in Pomerania (SniP) including comprehensive information on pregnancies, mothers, and their offspring in Western Pomerania, Germany were used in this study. The associations were analyzed using linear and logistic regression models. RESULTS After logistic regression analysis adjusted for height of the mother, women who delivered SGA infants, had lower education (p < 0.01) and smoked more frequently during pregnancy (p < 0.01) compared with mothers of adequate for gestational age (AGA) neonates. A mother with less than 10 years of education and one who continued smoking during pregnancy had an odds ratio (OR) of 2.23 [95% confidence interval (CI) = 1.44 to 3.46] and 2.68 (95% CI = 2.06-3.49) of having an SGA infant, respectively. There was no association between the employment of the mother (p = 0.28), the monthly income (p = 0.09), the family status (p = 0.80), the number of friendships outside the household that the mother would not wish to relinquish (p = 0.47), the number of people that she could rely on in case of an emergency (p = 0.75), or alcohol consumption prior to (p = 0.14) or during the pregnancy (p = 0.99) with SGA. Finally, women who delivered SGA infants were more frequently dissatisfied with their employment (p = 0.03) and financial status (p < 0.01). CONCLUSIONS Women who delivered SGA infants had more associated socioeconomic and lifestyle risk factors and were more frequently dissatisfied with their life conditions than mothers of AGA neonates.
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Affiliation(s)
- Guillermo Pierdant
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Till Ittermann
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
| | - Jennis Freyer-Adam
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Heckmann
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Marek Zygmunt
- Department of Gynecology and Obstetrics, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Anja Erika Lange
- Department of Neonatology and Pediatric Intensive Care, University Medicine Greifswald, Greifswald, Germany
| | - Marcello Ricardo Paulista Markus
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- DZD (German Center for Diabetes Research), Partner site Greifswald, Greifswald, Germany
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Siewert-Markus U, Ulbricht S, Gaertner B, Zyriax BC, Dörr M, Tobschall S, Baumann S, John U, Freyer-Adam J. Behavioral Health Risk Factors and Motivation to Change among Cardiovascular General Hospital Patients Aged 50 to 79 Years. Nutrients 2022; 14:nu14091963. [PMID: 35565928 PMCID: PMC9105822 DOI: 10.3390/nu14091963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/01/2023] Open
Abstract
Little is known about the (co-)occurrence of smoking, alcohol at-risk drinking, physical inactivity and overweight, and the motivation to change these behavioral health risk factors (HRFs) in older general hospital patients with cardiovascular disease. Between October and December 2016, all consecutively admitted patients aged 50 to 79 years were proactively recruited on 3 cardiology wards and asked to participate in a survey on HRFs and behavior change motivation. Of the eligible patients, 80.4% participated in the survey (n = 328). The mean age was 66.5 years (standard deviation 9.0), and 65.5% were male. At least 1 HRF was present in 91.8% (n = 280), at least 2 HRFs in 54.4% (n = 166), and 3 or 4 HRFs in 12.1% (n = 37) of participants. The proportion of older adults who contemplated or were changing or planning to change their behavior to meet health behavior recommendations ranged between 66.0% (smoking) and 93.2% (alcohol consumption). The results indicate a notable co-occurrence of behavioral HRFs in older patients with cardiovascular disease. The majority of older adults were at least considering changing the respective behavior. To prevent and treat diseases efficiently, hospitalization may be a suitable moment for systematic multiple HRF screening and intervention.
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Affiliation(s)
- Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.T.); (J.F.-A.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 17475 Greifswald, Germany; (S.U.); (M.D.); (S.B.); (U.J.)
- Correspondence: ; Tel.: +49-(0)3834-86-5610; Fax: +49-(0)3834-86-5605
| | - Sabina Ulbricht
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 17475 Greifswald, Germany; (S.U.); (M.D.); (S.B.); (U.J.)
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | | | - Birgit-Christiane Zyriax
- Preventive Medicine and Nutrition, Institute for Health Service Research in Dermatology and Nursing (IVDP), University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany;
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg, 20251 Hamburg, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 17475 Greifswald, Germany; (S.U.); (M.D.); (S.B.); (U.J.)
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Stefanie Tobschall
- Institute for Medical Psychology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.T.); (J.F.-A.)
| | - Sophie Baumann
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 17475 Greifswald, Germany; (S.U.); (M.D.); (S.B.); (U.J.)
- Section Methods in Community Medicine, Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Ulrich John
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 17475 Greifswald, Germany; (S.U.); (M.D.); (S.B.); (U.J.)
- Department of Prevention Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.T.); (J.F.-A.)
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, 17475 Greifswald, Germany; (S.U.); (M.D.); (S.B.); (U.J.)
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Markus MRP, Ittermann T, Kim S, Schipf S, Siewert-Markus U, Santana CC, Buchmann N, Völzke H, Bülow R, Felix SB, Bahls M, Steinhagen-Thiessen E, Dörr M. Lower muscular strength is associated with smaller left and right chambers and lower cardiac mass in the general population - The Sedentary's Heart. Prog Cardiovasc Dis 2021; 68:36-51. [PMID: 34562438 DOI: 10.1016/j.pcad.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The cardiac muscle has the ability to adapt to different loading conditions. We analyzed the associations of the age-related decreasing handgrip strength (HGS), a marker of muscular fitness, on cardiac structure and function in a community-based sample. METHODS We performed cross-sectional analyses of 4646 subjects (2554 women; 55.0%) aged 20 to 93 years from two independent cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analyzed the associations of HGS with structural and functional left and right ventricular (LV and RV) and left atrial (LA) parameters as determined by echocardiography and magnetic resonance imaging (MRI) as well with log-transformed NT-proBNP values using multivariable-adjusted linear regression models. RESULTS MRI data showed that a 1 kg lower HGS was associated with a 0.40 mL (95% confidence interval: 0.26 to 0.54; p < 0.001) lower LV end-diastolic volume, a 0.011 mm (0.005 to 0.018; p = 0.001) lower LV wall-thickness, a 0.59 g (0.43 to 0.75; p < 0.001) lower LV mass, a 0.58 mL/beat (0.43 to 0.74; p < 0.001) lower LV stroke volume, a 0.03 L/min (0.02 to 0.04; p < 0.001) lower LV cardiac output, a 0.48 mL (0.27 to 0.68; p < 0.001) lower LA end-diastolic volume, and a 1.02 mL (0.71 to 1.32) lower RV end-diastolic volume. Similar findings were observed for echocardiographic parameters. Moreover, lower HGS was associated with higher echocardiographic LV diastolic stiffness and NT-proBNP levels. CONCLUSIONS In this large population-based sample, lower muscular fitness as assessed by HGS was associated with lower LV wall thickness and mass as well as with smaller chamber size, stroke volume and cardiac output of the LV, LA and RV. Moreover, HGS was inversely related to LV diastolic stiffness and NT-proBNP values. These outcomes might demonstrate the effects of an aging-related decrease in physical activity and lower muscular fitness on the heart - "the sedentary's heart".
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany.
| | - Till Ittermann
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Simon Kim
- Center for Hand-and Functional Microsurgery, University Medicine Greifswald, Greifswald, Germany
| | - Sabine Schipf
- German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Camila Campos Santana
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; Faculty of Medical Sciences of Santos, Santos, Brazil; Faculty of Medical Sciences of Santa Casa of São Paulo, São Paulo, Brazil
| | - Nikolaus Buchmann
- Department of Cardiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Burkhard Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | | | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
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Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, Schipf S, Siewert-Markus U, Baumeister SE, Schumacher P, Ewert R, Völzke H, Steinhagen-Thiessen E, Bülow R, Schunkert H, Vasan RS, Felix SB, Dörr M. Cardiac MRI shows an association of lower cardiorespiratory fitness with decreased myocardial mass and higher cardiac stiffness in the general population - The Sedentary's Heart. Prog Cardiovasc Dis 2021; 68:25-35. [PMID: 34537204 DOI: 10.1016/j.pcad.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/11/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The heart has the capacity to adapt to different demands. The pathophysiological mechanisms involved with sedentarism are not fundamentally the opposite of those related with physical activity and regular exercise. We investigated the impact of lower cardiorespiratory fitness (CRF) on heart's plasticity and function in a population-based setting. METHODS We used data from 1165 participants (539 women; 46.3%) aged 21-81 years from two independent cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analyzed the cross-sectional associations of peak oxygen uptake (VO2peak), determined by symptom-limited cardiopulmonary exercise testing, with structural and functional left ventricular (LV) and left atrial (LA) parameters determined by magnetic resonance imaging (MRI) using multivariable- adjusted linear regression models. RESULTS A 1 L/min lower VO2peak was associated with a 10.5 g (95% confidence interval: 8.00 to 12.9; p < 0.001) lower LV mass, a 14.8 mL (10.9 to 18.6; p < 0.001) lower LV end-diastolic volume, a 0.29 mm (0.19 to 0.40; p < 0.001) lower LV wall-thickness, a 8.85 mL/beat (6.53 to 11.2; p < 0.001) lower LV stroke volume, a 0.42 L/min (0.25 to 0.60; p < 0.001) lower LV cardiac output and a 7.51 mL (3.88 to 11.1; p < 0.001) lower LA end-diastolic volume. Moreover, there were no associations with a concentric or eccentric remodeling and LV and LA ejection fraction. CONCLUSIONS Lower CRF was associated with a smaller heart, LV wall-thickness and mass, LV and LA stroke volume and cardiac output. Conversely, there was no association with LA and LV ejection fraction. Our cross-sectional observations are consistent with cardiac adaptations reflecting reduced volume loading demands of a sedentary lifestyle - "the sedentary's heart".
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany.
| | - Till Ittermann
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christine Julia Drzyzga
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Sabine Schipf
- German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Edgar Baumeister
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T Augsburg, Augsburg, Germany; Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany; Institute of Health Services Research in Dentistry, University of Münster, Münster, Germany
| | - Paul Schumacher
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Robin Bülow
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Heribert Schunkert
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany; German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Ramachandran S Vasan
- Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, USA; Preventive Medicine and Cardiology Sections, Evans Department of Medicine, Boston University School of Medicine, Boston, USA; Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Stephan Burkhard Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
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Ullrich A, Voigt L, Siewert-Markus U, Meyer C, Dörr M, Ulbricht S. The effect of a video-supported assessment to increase the accuracy of self-reported physical activity. Scand J Med Sci Sports 2021; 31:1059-1068. [PMID: 33420736 DOI: 10.1111/sms.13916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/03/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
Self-reported physical activity differs from activity levels measured by device. We tested the effect of a video that visualizes the intensity levels of physical activity to increase the agreement between self-reported and accelerometer-based moderate-to-vigorous physical activity (MVPA) within a single-blinded, randomized study. Participants (N = 378, 40-75 years) wore an accelerometer for seven days. Prior to the collection of self-reported data by the IPAQ-SF, participants were randomly assigned (1:1) to a control group (CG) or a video group (VG). The outcome was the absolute difference between self-reported and accelerometer-based time spent in MVPA (Δ MVPAIPAQ-Accelerometry ). To examine the agreement, we used Spearman correlation coefficients and Bland-Altman analysis. To test the video effect, we used Wilcoxon signed-rank test, Bayes factor, and simultaneous-quantile regression. In total, 302 participants fulfilled the accelerometer wear time criteria (≥10 hours/day; ≥6 days) and completed self-reports within three days after the wearing period. The median of Δ MVPAIPAQ-Accelerometry was -9.0 min/day (IQR: -32.0 to 66.6) for CG and -11.5 min/day (IQR: -29.9 to 14.3) for VG. Wilcoxon signed-rank test revealed no differences in Δ MVPAIPAQ-Accelerometry between study groups whereas Bayes factor indicated insensitivity of the data. Simultaneous-quantile regression revealed no relationship between video presentation and Δ MVPAIPAQ-Accelerometry in the 25th percentile. In the 50th (b = -12.4 [95% CI = -23.2 to -1.5] and 75th percentile (b = -45.7 [95% CI = -70.5 to -20.9]), Δ MVPAIPAQ-Accelerometry was negatively associated with video presentation. To conclude, video-supported assessment may increase the accuracy of self-reported MVPA among individuals who slightly underestimated and those who overestimated their MVPA.
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Affiliation(s)
- Antje Ullrich
- Department of Preventive Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Lisa Voigt
- Department of Preventive Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Christian Meyer
- Department of Preventive Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Sabina Ulbricht
- Department of Preventive Research and Social Medicine, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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8
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Markus MRP, Ittermann T, Drzyzga CJ, Bahls M, Schipf S, Siewert-Markus U, Baumeister SE, Ewert R, Völzke H, Steinhagen-Thiessen E, Bülow R, Schunkert H, Vasan RS, Felix SB, Dörr M. Lower Cardiorespiratory Fitness Is Associated With a Smaller and Stiffer Heart: The Sedentary's Heart. JACC Cardiovasc Imaging 2020; 14:310-313. [PMID: 32950452 DOI: 10.1016/j.jcmg.2020.07.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
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9
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Freyer-Adam J, Noetzel F, Baumann S, Aghdassi AA, Siewert-Markus U, Gaertner B, John U. Behavioral health risk factor profiles in general hospital patients: identifying the need for screening and brief intervention. BMC Public Health 2019; 19:1594. [PMID: 31783832 PMCID: PMC6884835 DOI: 10.1186/s12889-019-7931-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/08/2019] [Indexed: 11/30/2022] Open
Abstract
Background Little is known about the clustering of behavioral health risk factors (HRFs), namely the occurrence of 16 specific combinations of tobacco smoking, at-risk alcohol use, overweight and physical inactivity in general hospital patients. Furthermore, social inequalities in HRFs, health and life expectancy are a major concern in public health. In order to establish the need for screening and intervention in general hospital care, the study aimed to determine the co-occurrence of HRFs in patients in four medical departments, and to investigate differences by gender, age and socio-economic characteristics. Methods Over 17 months, a systematic multiple HRF screening was conducted at one general hospital in northeastern Germany. In total, 6251 18–64 year old patients (92% of eligibles) participated. Proportions and confidence intervals were calculated for all 16 HRF profiles stratified by department, gender, age group, school education, and employment status. Results In total, 92.2% of the participants (58.6% male) reported ≥1 HRF, and 65.7% ≥2 HRFs. Men (71.2%), patients aged 35–49 (67.9%) and 50–64 years (69.5%), lower educated (79.0%), and unemployed (77.8%) patients had larger proportions of ≥2 HRFs than their counterparts. In all departments, the most common HRF profiles included overweight. HRF profiles that included alcohol and/ or smoking were more common in ear-nose-throat and trauma surgery than in internal medicine and general surgery patients. Men had higher rates concerning almost all HRF profiles including ≥2 HRFs and alcohol; women concerning profiles that included ≤2 HRFs and inactivity. In older patients, profiles with ≥2 HRFs including overweight; and in younger patients, profiles with smoking and/or alcohol were more common. In lower educated patients, profiles with ≥2 HRFs including inactivity; and in higher educated patients profiles with ≤2 HRFs including alcohol were more common. Compared to others, unemployed patients had higher rates of profiles with ≥3 HRFs including smoking. Conclusions Two in three patients require interventions targeting two or more HRFs. The findings help to develop screening and brief intervention for patients with specific health risk profiles, that can reach most patients, including those most in need and those most hard to reach, with socio-economically disadvantaged people in particular. Registry clinicaltrials.gov: NCT01291693.
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Affiliation(s)
- Jennis Freyer-Adam
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany. .,German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.
| | - Florian Noetzel
- Clinic and Policlinic of Urology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Sophie Baumann
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.,Institute of Social Medicine and Prevention, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Ali Alexander Aghdassi
- Department of Internal Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, 17475, Greifswald, Germany.,German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany
| | - Beate Gaertner
- Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, General-Pape-Str. 62-66, 12101, Berlin, Germany
| | - Ulrich John
- German Center for Cardiovascular Research, Site Greifswald, Fleischmannstr. 42-44, 17475, Greifswald, Germany.,Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
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10
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Markus MRP, Rospleszcz S, Ittermann T, Baumeister SE, Schipf S, Siewert-Markus U, Lorbeer R, Storz C, Ptushkina V, Peters A, Meisinger C, Bamberg F, Nauck M, Bahls M, Völzke H, Felix SB, Bülow R, Rathmann W, Dörr M. Glucose and insulin levels are associated with arterial stiffness and concentric remodeling of the heart. Cardiovasc Diabetol 2019; 18:145. [PMID: 31684945 PMCID: PMC6829934 DOI: 10.1186/s12933-019-0948-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/19/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Mortality attributable to heart failure remains high. The prevalence of heart failure in patients with diabetes mellitus ranges from 19 to 26%. It is estimated that up to 21.1 million adults in the United States have diagnosed diabetes mellitus and around 80.8 million have impaired fasting glucose. We investigated the associations of fasting glucose (FG) and fasting insulin (FI), the homeostasis model assessment-insulin resistance index (HOMA-IR) and 2-h postload glucose (2HG) and insulin (2HI) with parameters of left ventricular geometry and function and arterial stiffness determined by magnetic resonance imaging in individuals without diagnosed type 2 diabetes. METHODS Cross-sectional analyses of 1001 individuals (453 women, 45.3%), aged 21 to 80 years, from two independent population-based studies, the Study of Health in Pomerania (SHIP-TREND-0) and KORA FF4 Study. FG, FI, HOMA-IR, 2HG and 2HI, as well as glucose tolerance categories, were analyzed for associations with heart and arterial parameters using multivariable-adjusted linear regression models. RESULTS In total, 390 individuals (39%) had prediabetes (isolated impaired fasting glucose, isolated glucose tolerance or both), and 49 (4.9%) were found to have unknown type 2 diabetes. In the multivariable-adjusted analysis, positive linear associations of FG, FI, HOMA-IR, 2HG and 2HI with arterial stiffness index and left ventricular wall-thickness and concentricity and inverse linear associations with left ventricular end-diastolic volume were observed. A 1 mmol/l higher FG was associated with a 1.18 ml/m2.7 (1.80 to 0.57; p < 0.001) lower left ventricular end-diastolic volume index, a 0.042 mm/m2.7 (0.014 to 0.070) higher left ventricular wall-thickness index, a 0.12 mmHg m2.7/ml (0.06 to 0.17; p < 0.001) greater arterial stiffness index and a 0.037 g/ml (0.018 to 0.056; p < 0.001) higher left ventricular concentricity. CONCLUSIONS Our findings suggest that higher glucose levels in the prediabetic range and insulin resistance might lead to higher arterial stiffness and concentric remodeling of the heart.
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany. .,German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany. .,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Till Ittermann
- German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Edgar Baumeister
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Sabine Schipf
- German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany.,Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Corinna Storz
- Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tübingen, Germany
| | - Violetta Ptushkina
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Christa Meisinger
- Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T Augsburg, Augsburg, Germany.,Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Nauck
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Henry Völzke
- German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Burkhard Felix
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Robin Bülow
- German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.,Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center (DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
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11
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Voigt L, Ullrich A, Siewert-Markus U, Dörr M, John U, Ulbricht S. Visualization of Intensity Levels to Reduce the Gap Between Self-Reported and Directly Measured Physical Activity. J Vis Exp 2019. [PMID: 30907881 DOI: 10.3791/58997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Physical activity (PA) assessment needs tools that are inexpensive and easy to administer. Common questionnaires inquire time spent in light, moderate, and vigorous PA. However, inaccuracies may occur due to individually different understanding of PA intensity levels. Alternatively used direct measures (e.g., accelerometers) are susceptible to reactivity bias and may lack the ability to capture certain activities. Compared to accelerometer measurement, respondents report more time spent in higher-intensity PA. A video that visualizes PA intensity levels might help to overcome this problem. This report describes the design of a randomized controlled trial as a methodology to investigate the effect of a video on the difference between self-reported and directly measured PA. It is hypothesized that the video reduces the mean difference between the two measures. Individuals from the general population are recruited. Hip-worn accelerometers are used to collect directly measured PA data on seven consecutive days. Afterwards, participants are randomly allocated to the experimental and the control group. The experimental group receives a video demonstration on PA intensity levels and subsequent PA assessment via self-administered computer-assisted questionnaire. The control group receives PA assessment only. Thereafter, the data are processed to compare the difference between self-reported and accelerometer-based moderate-to-vigorous physical activity (MVPA) between the study groups using a two-sample t-test. This methodology is appropriate for investigating the effect of any existing or self-produced video on the difference between the two measurement methods. It can be used not only for persons from the general population, but for a variety of other populations and contexts as accurate measures are needed to evaluate PA levels.
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Affiliation(s)
- Lisa Voigt
- Institute of Social Medicine and Prevention, University Medicine Greifswald; partner site Greifswald, DZHK (German Centre for Cardiovascular Research);
| | - Antje Ullrich
- Institute of Social Medicine and Prevention, University Medicine Greifswald; partner site Greifswald, DZHK (German Centre for Cardiovascular Research)
| | - Ulrike Siewert-Markus
- Institute of Social Medicine and Prevention, University Medicine Greifswald; Institute for Medical Psychology, University Medicine Greifswald; partner site Greifswald, DZHK (German Centre for Cardiovascular Research)
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald; partner site Greifswald, DZHK (German Centre for Cardiovascular Research)
| | - Ulrich John
- Institute of Social Medicine and Prevention, University Medicine Greifswald; partner site Greifswald, DZHK (German Centre for Cardiovascular Research)
| | - Sabina Ulbricht
- Institute of Social Medicine and Prevention, University Medicine Greifswald; partner site Greifswald, DZHK (German Centre for Cardiovascular Research)
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12
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Lein S, Siewert-Markus U, Lehnert K, Freyer-Adam J, John U, Ulbricht S. Der Verzehr ausgewählter mediterraner Ernährungskomponenten bei Menschen mit kardiovaskulärer Erkrankung und im Alter ab 60 Jahre. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Lein
- Institut für Sozialmedizin und Prävention, Unimedizin Greifswald, Greifswald, Deutschland
| | - U Siewert-Markus
- Institut für Sozialmedizin und Prävention, Unimedizin Greifswald, Greifswald, Deutschland
- Universitätsmedizin Greifswald, Institut für Medizinische Psychologie, Greifswald, Deutschland
| | - K Lehnert
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Deutschland
- Universitätsmedizin Greifswald, Abteilung für Innere Medizin B, Greifswald, Deutschland
| | - J Freyer-Adam
- Institut für Sozialmedizin und Prävention, Unimedizin Greifswald, Greifswald, Deutschland
- Universitätsmedizin Greifswald, Institut für Medizinische Psychologie, Greifswald, Deutschland
| | - U John
- Institut für Sozialmedizin und Prävention, Unimedizin Greifswald, Greifswald, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Deutschland
| | - S Ulbricht
- Institut für Sozialmedizin und Prävention, Unimedizin Greifswald, Greifswald, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Deutschland
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13
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Voigt L, Siewert-Markus U, Ullrich A, Dörr M, John U, Ulbricht S. Ist die Visualisierung von Intensitäten körperlicher Aktivität geeignet, die Diskrepanz zwischen selbstberichteter und objektiv gemessener Aktivität zu reduzieren? Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- L Voigt
- Universitätsmedizin Greifswald, Institut für Sozialmedizin und Prävention, Greifswald, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Greifswald, Deutschland
| | - U Siewert-Markus
- Universitätsmedizin Greifswald, Institut für Sozialmedizin und Prävention, Greifswald, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Greifswald, Deutschland
- Universitätsmedizin Greifswald, Institut für Medizinische Psychologie, Greifswald, Deutschland
| | - A Ullrich
- Universitätsmedizin Greifswald, Institut für Sozialmedizin und Prävention, Greifswald, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Greifswald, Deutschland
| | - M Dörr
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Greifswald, Deutschland
- Universitätsmedizin Greifswald, Abteilung für Innere Medizin B, Greifswald, Deutschland
| | - U John
- Universitätsmedizin Greifswald, Institut für Sozialmedizin und Prävention, Greifswald, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Greifswald, Deutschland
| | - S Ulbricht
- Universitätsmedizin Greifswald, Institut für Sozialmedizin und Prävention, Greifswald, Deutschland
- DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Standort Greifswald, Greifswald, Deutschland
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14
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Siewert-Markus U, Ulbricht S, Lehnert K, Dörr M, John U, Freyer-Adam J. Verhaltensbezogene Risikofaktoren bei älteren Patientinnen und Patienten mit kardiovaskulären Erkrankungen. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- U Siewert-Markus
- Institut für Sozialmedizin und Prävention, Universitätsmedizin Greifswald, Greifswald, Deutschland
- Institut für Medizinische Psychologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Standort Greifswald, Greifswald, Deutschland
| | - S Ulbricht
- Institut für Sozialmedizin und Prävention, Universitätsmedizin Greifswald, Greifswald, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Standort Greifswald, Greifswald, Deutschland
| | - K Lehnert
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Standort Greifswald, Greifswald, Deutschland
| | - M Dörr
- Klinik und Poliklinik für Innere Medizin B, Universitätsmedizin Greifswald, Greifswald, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Standort Greifswald, Greifswald, Deutschland
| | - U John
- Institut für Sozialmedizin und Prävention, Universitätsmedizin Greifswald, Greifswald, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Standort Greifswald, Greifswald, Deutschland
| | - J Freyer-Adam
- Institut für Medizinische Psychologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung e.V., Standort Greifswald, Greifswald, Deutschland
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15
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Markus MRP, Ittermann T, Baumeister SE, Huth C, Thorand B, Herder C, Roden M, Siewert-Markus U, Rathmann W, Koenig W, Dörr M, Völzke H, Schipf S, Meisinger C. Prediabetes is associated with microalbuminuria, reduced kidney function and chronic kidney disease in the general population: The KORA (Cooperative Health Research in the Augsburg Region) F4-Study. Nutr Metab Cardiovasc Dis 2018; 28:234-242. [PMID: 29337019 DOI: 10.1016/j.numecd.2017.12.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 12/10/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS We investigated the associations of serum fasting (FG) and 2-h postload (2HG) glucose from an oral glucose tolerance test (OGTT), glycated hemoglobin (HbA1c), fasting insulin and the homeostasis model assessment-insulin resistance index (HOMA-IR) with urinary albumin-to-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR). METHODS AND RESULTS We performed cross-sectional analyses of 2713 subjects (1429 women; 52.7%) without known type 2 diabetes, aged 31-82 years, from the KORA (Cooperative Health Research in the Augsburg Region) F4-Study. FG, 2HG, HbA1c, fasting insulin, HOMA-IR and glucose tolerance categories were analyzed for association with ACR and eGFR in multivariable adjusted linear and median regression models, and with isolated microalbuminuria (i-MA), isolated reduced kidney function (i-RKF) and chronic kidney disease (CKD, defined as MA and/or RKF) in multivariable adjusted logistic regression models. Among the 2713 study participants, 28% revealed prediabetes (isolated impaired fasting glucose [i-IFG], isolated glucose tolerance [i-IGT] or both by American Diabetes Association definition), 4.2% had unknown type 2 diabetes, 6.5% had i-MA, 3.1% i-RKF and 10.9% CKD. In multivariable adjusted analysis, all continuous variables (FG, 2HG, HbA1c, fasting insulin and HOMA-IR) were associated with i-MA, i-RKF and CKD. The odds ratios (ORs) for i-MA and CKD were 1.54 (95% confidence interval: 1.02-2.33) and 1.58 (1.10-2.25) for individuals with i-IFG. Moreover, the OR for i-RKF was 2.57 (1.31-5.06) for individuals with IFG + IGT. CONCLUSION Our findings suggest that prediabetes might have harmful effects on the kidney.
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Affiliation(s)
- M R P Markus
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany.
| | - T Ittermann
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - S E Baumeister
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany; Chair of Epidemiology, Ludwig-Maximilians-University Munich, UNIKA-T Augsburg, Augsburg, Germany
| | - C Huth
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - B Thorand
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - C Herder
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - M Roden
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany; Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - U Siewert-Markus
- Institute for Psychology, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany; Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - W Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - W Koenig
- Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - M Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - H Völzke
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - S Schipf
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), Partner Site Greifswald, Greifswald, Germany
| | - C Meisinger
- Chair of Epidemiology, Ludwig-Maximilians-University Munich, UNIKA-T Augsburg, Augsburg, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Markus MRP, Ittermann T, Wittfeld K, Schipf S, Siewert-Markus U, Bahls M, Bülow R, Werner N, Janowitz D, Baumeister SE, Felix SB, Dörr M, Rathmann W, Völzke H, Grabe HJ. Prediabetes is associated with lower brain gray matter volume in the general population. The Study of Health in Pomerania (SHIP). Nutr Metab Cardiovasc Dis 2017; 27:1114-1122. [PMID: 29162362 DOI: 10.1016/j.numecd.2017.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/21/2017] [Accepted: 10/04/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS We investigated the associations of fasting (FG) and 2-h postload (2HG) plasma glucose from oral glucose tolerance test (OGTT) with gray (GMV) and white (WMV) matter volume. METHODS AND RESULTS We analyzed data from 1330 subjects without known diabetes mellitus, aged 21 to 81, from the second cohort (SHIP-Trend-0) of the population-based Study of Health in Pomerania (SHIP). Following the OGTT, individuals were classified in five groups (according to the American Diabetes Association criteria): normal glucose tolerance (NGT), isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT) and unknown type 2 diabetes mellitus (UDM). GMV and WMV were determined by magnetic resonance imaging. FG, 2HG and OGTT groups were associated with GMV and WMV by linear regression models adjusted for confounders. FG and 2HG were inversely associated with GMV. The adjusted mean GMV, when compared with the NGT group (584 ml [95% CI: 581 to 587]), was significantly lower in the groups i-IFG (578 ml [95% CI: 573 to 582]; p = 0.035) and UDM (562 ml [95% CI: 551 to 573]; p < 0.001), but not different in the i-IGT (586 ml [95% CI: 576 to 596]; p = 0.688) and IFG + IGT (579 ml [95% CI: 571 to 586]; p = 0.209) groups. There were no associations of FG, 2HG and OGTT parameters with WMV. CONCLUSION Our findings suggest that elevated FG levels, even within the prediabetic range, might already have some harmful effects on GMV.
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Affiliation(s)
- M R P Markus
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZD (German Center for Diabetes Research), Partner Site Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany.
| | - T Ittermann
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; DZD (German Center for Diabetes Research), Partner Site Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - K Wittfeld
- DZNE (German Center for Neurodegenerative Diseases), Partner Site Rostock, Greifswald, Germany
| | - S Schipf
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; DZD (German Center for Diabetes Research), Partner Site Greifswald, Greifswald, Germany
| | - U Siewert-Markus
- Institute for Psychology, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald, Germany; Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - M Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - R Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - N Werner
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - D Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - S E Baumeister
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; Division of Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - S B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - M Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - W Rathmann
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - H Völzke
- Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; DZD (German Center for Diabetes Research), Partner Site Greifswald, Greifswald, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - H J Grabe
- DZNE (German Center for Neurodegenerative Diseases), Partner Site Rostock, Greifswald, Germany; Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
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Markus MRP, Werner N, Schipf S, Siewert-Markus U, Bahls M, Baumeister SE, Völzke H, Felix SB, Ittermann T, Dörr M. Changes in Body Weight and Composition Are Associated With Changes in Left Ventricular Geometry and Function in the General Population. Circ Cardiovasc Imaging 2017; 10:e005544. [DOI: 10.1161/circimaging.116.005544] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023]
Abstract
Background—
The different effects of total body weight (TBW), fat-free mass (FFM), and fat mass (FM) on left ventricular (LV) geometry and function are complex. We investigated the associations of changes over time in TBW, FM, and FFM with changes in LV geometry and function.
Methods and Results—
We analyzed data from 1189 subjects (694 women), aged 44 to 86 years, from the baseline and the 5-year follow-up examination of the population-based SHIP (Study of Health in Pomerania). TBW was measured, and FFM and FM were calculated based on height-weight models derived from bioelectrical impedance studies. Echocardiographic measurements of LV geometry and function were performed according to the guidelines of the American Society of Echocardiography. Changes in body composition measures were associated with changes in LV geometry and function by multivariable-adjusted linear regression models. A 1-kg increase/decrease in TBW or FM was associated, respectively, with an increase/decrease of 0.89 g or 1.84 g in LV mass, whereas there was no such association on changes in FFM. Moreover, an increase in FM was associated with LV concentric remodeling and impairment of systolic and diastolic function parameters, whereas an increase in FFM was associated with LV eccentric remodeling and improved systolic and diastolic functional variables.
Conclusions—
Our findings indicate that changes in LV morphology and function depend on the type of body mass composition. Prospective data need to address whether specific changes in body composition over time may affect the risk for heart dysfunction more precisely than the change in TBW.
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Nicole Werner
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Sabine Schipf
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Ulrike Siewert-Markus
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Martin Bahls
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Sebastian Edgar Baumeister
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Henry Völzke
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Stephan Burkhard Felix
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Till Ittermann
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Marcus Dörr
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
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