Publications by authors named "Jutta Dierkes"

78 Publications

Assessment of Dietary Choline Intake, Contributing Food Items and Associations with One-carbon and Lipid Metabolites in Middle-aged and Elderly Adults: The Hordaland Health Study.

J Nutr 2021 Oct 13. Epub 2021 Oct 13.

Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.

Background: Choline is an essential nutrient for humans and is involved in various physiological functions. Through its metabolite betaine, it is closely connected to the one-carbon metabolism and the fat-soluble choline form phosphatidylcholine is essential for very-low-density-lipoprotein synthesis and secretion in the liver connecting choline to the lipid metabolism. Dietary recommendations for choline are not available in the Nordic countries primarily due to data scarcity.

Objective: The aim of this study was to investigate the dietary intake of total choline and individual choline forms, dietary sources, and the association of total choline intake with circulating one-carbon metabolites and lipids.

Methods: We included 5746 participants in the Hordaland Health Study (HUSK), a survey including community-dwelling adults born in 1925-1927 (mean age 72 years, 55% women) and 1950-1951 (mean age 48 years, 57% women). Dietary data was obtained using a 169-item food frequency questionnaire and choline content was calculated using the USDA Database for Choline Content of Common Foods, release 2. Metabolites of the one-carbon and lipid metabolism were measured in a non-fasting blood sample obtained at baseline and association with total choline intake were assessed using polynomial splines.

Results: The geometric mean (95% prediction interval) energy-adjusted total choline intake was 260 (170, 389) mg/d with phosphatidylcholine being the main form (44%). The major food items providing dietary choline were eggs, low-fat milk, potatoes, and leafy vegetables. Dietary total choline was inversely associated with circulating concentrations of total homocysteine, glycine and serine and positively associated with choline, methionine, cystathionine, cysteine, trimethyllysine, trimethylamine-N-oxide and dimethylglycine. A weak association was observed between choline intake and serum lipids.

Conclusion: Phosphatidylcholine was the most consumed choline form in community-dwelling adults in Norway. Our findings suggest that choline intake is associated with the concentration of most metabolites involved in the one-carbon and lipid metabolism.
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http://dx.doi.org/10.1093/jn/nxab367DOI Listing
October 2021

Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol.

BMJ Paediatr Open 2021 28;5(1):e001214. Epub 2021 Jul 28.

School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.

Background: Following a finding of alcohol use among children aged 5-8 years old in Mbale, Uganda, this project investigates the magnitude of alcohol and substance use among children ged 6-13 years old and related household, community, school, health system and clinical factors.

Methods: The project includes four larger work packages (WPs). WP1 comprises management, WP2 and 3 include the scientific components and WP4 includes integration of results, dissemination, policy and implementation advice. This protocol presents the planned research work in WP 2 and 3. WP2 comprises the adaptation and validation of the alcohol use screening tool Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) to the age group and setting. WP3 comprises four substudies (SS). SS1 is a cross-sectional community household survey with an estimated sample size of 3500 children aged 6-13 years and their caregivers. We apply cluster sampling and systematic sampling within the clusters. Data collection includes a structured questionnaire for caregiver and child, measuring social and demographic factors, mental health status, alcohol and substance use, nutrition history and anthropometry. Urine samples from children will be collected to measure ethyl glucuronide (EtG), a biological marker of alcohol intake. Further, facilitators, barriers and response mechanisms in the health system (SS2) and the school system (SS3) is explored with surveys and qualitative assessments. SS4 includes qualitative interviews with children. Analysis will apply descriptive statistics for the primary outcome of establishing the magnitude of alcohol drinking and substance use, and associated factors will be assessed using appropriate regression models. The substudies will be analysed independently, as well as inform each other through mixed methods strategies at the stages of design, analysis, and dissemination.

Ethics And Dissemination: Data protection and ethical approvals have been obtained in Uganda and Norway, and referral procedures developed. Dissemination comprises peer-reviewed, open access research papers, policy recommendations and intersectoral dialogues.Trial registration numberClinicaltrials.gov 29.10.2020 (NCT04743024).
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http://dx.doi.org/10.1136/bmjpo-2021-001214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8322685PMC
July 2021

Meal patterns associated with energy intake in people with obesity.

Br J Nutr 2021 Jul 12:1-48. Epub 2021 Jul 12.

Mohn Nutrition Research Laboratory, Centre for Nutrition, Department of Clinical Science, University of Bergen, Norway.

It is widely assumed that people with obesity have several common eating patterns, including breakfast-skipping (1), eating during the night (2) and high fast-food consumption (3). However, differences in individual meal and dietary patterns may be crucial to optimizing obesity treatment. Therefore, we investigated the inter-individual variation in eating patterns, hypothesizing that individuals with obesity show different dietary and meal patterns, and that these associate with self-reported energy intake (rEI) and/or anthropometric measures.Cross-sectional data from 192 participants (aged 20-55 years) with obesity, including 6 days of weighed food records, were analyzed. Meal patterns and dietary patterns were derived using exploratory hierarchical cluster analysis and k-means cluster analysis, respectively.Five clear meal patterns were found based on the time-of-day with the highest mean rEI. The daily rEI (mean ± SD kcal) was highest among "midnight-eaters" (2550 ± 550), and significantly (p < 0.05) higher than "dinner-eaters" (2060 ± 550), "lunch-eaters" (2080 ± 520), and "supper-eaters" (2100 ± 460), but not "regular-eaters" (2330 ± 650). Despite differences of up to 490 kcal between meal patterns, there were no significant differences in anthropometric measures or physical activity level (PAL). Four dietary patterns were also found with significant differences in intake of specific food groups, but without significant differences in anthropometry, PAL, or rEI. Our data highlight meal timing as a determinant of individual energy intake in people with obesity. The study supports the importance of considering a person's specific meal pattern, with possible implications for more person-focused guidelines and targeted advice.
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http://dx.doi.org/10.1017/S0007114521002580DOI Listing
July 2021

Food Sources Contributing to Intake of Choline and Individual Choline Forms in a Norwegian Cohort of Patients With Stable Angina Pectoris.

Front Nutr 2021 14;8:676026. Epub 2021 May 14.

Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.

Choline is an essential nutrient involved in a wide range of physiological functions. It occurs in water- and lipid-soluble forms in the body and diet. Foods with a known high choline content are eggs, beef, chicken, milk, fish, and selected plant foods. An adequate intake has been set in the US and Europe, however, not yet in the Nordic countries. A higher intake of lipid-soluble choline forms has been associated with increased risk of acute myocardial infarction, highlighting the need for knowledge about food sources of the individual choline forms. In general, little is known about the habitual intake and food sources of choline, and individual choline forms. Investigate foods contributing to the intake of total choline and individual choline forms. The study population consisted of 1,929 patients with stable angina pectoris from the Western Norway B Vitamin Intervention Trial. Dietary intake data was obtained through a 169-item food frequency questionnaire. Intake of total choline and individual choline forms was quantified using the USDA database, release 2. The geometric mean (95% prediction interval) total choline intake was 287 (182, 437) mg/d. Phosphatidylcholine accounted for 42.5% of total choline intake, followed by free choline (25.8%) and glycerophosphocholine (21.2%). Phosphocholine and sphingomyelin contributed 4.2 and 4.5%, respectively. The main dietary choline sources were eggs, milk, fresh vegetables, lean fish, and bread. In general, animal food sources were the most important contributors to choline intake. This study is, to the best of our knowledge, the first to assess the intake of all choline forms and their dietary sources in a European population. Most choline was consumed in the form of phosphatidylcholine and animal food sources contributed most to choline intake. There is a need for accurate estimates of the dietary intake of this essential nutrient to issue appropriate dietary recommendations.
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http://dx.doi.org/10.3389/fnut.2021.676026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160433PMC
May 2021

Factors associated with nutritional risk in patients receiving haemodialysis assessed by Nutritional Risk Screening 2002 (NRS2002).

J Ren Care 2021 May 11. Epub 2021 May 11.

Department of Clinical Medicine, Centre for Nutrition, University of Bergen, Bergen, Norway.

Background: Nutritional Risk Screening 2002 is recommended as a screening tool to identify patients at risk of undernutrition for all patients in hospitals by the European Society of Clinical Nutrition and Metabolism. Nutritional risk is associated with increased morbidity and mortality in patients, and it is common among patients on haemodialysis. Factors associated with nutritional risk that could facilitate the screening/diagnostic procedures are warranted.

Objectives: Identification of factors that are associated with nutritional risk in patients with end-stage renal disease treated with haemodialysis.

Design And Participants: Single-centre, cross-sectional study in patients receiving haemodialysis (n = 53) were screened for nutritional risk using Nutritional Risk Screening 2002. Associations were made with data on dietary intake by 24-h dietary recall, and measurement of body composition, anthropometric measurements and biochemical variables.

Results: Nutritional risk was common among patients on haemodialysis (26%), and was associated with low energy and protein intake, and low pre-albumin concentrations also after adjustments for age and sex. Nutritional risk was neither associated with diabetes nor duration of dialysis treatment.

Conclusion: Measurement of pre-albumin and dietary assessment using a 24-h dietary recall can support the identification of patients receiving haemodialysis at nutritional risk.
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http://dx.doi.org/10.1111/jorc.12374DOI Listing
May 2021

The Association of Meat Intake With All-Cause Mortality and Acute Myocardial Infarction Is Age-Dependent in Patients With Stable Angina Pectoris.

Front Nutr 2021 4;8:642612. Epub 2021 Mar 4.

Department of Clinical Science, Centre for Nutrition, University of Bergen, Bergen, Norway.

Red and processed meat intake have been associated with increased risk of morbidity and mortality, and a restricted intake is encouraged in patients with cardiovascular disease. However, evidence on the association between total meat intake and clinical outcomes in this patient group is lacking. To investigate the association between total meat intake and risk of all-cause mortality, acute myocardial infarction, cancer, and gastrointestinal cancer in patients with stable angina pectoris. We also investigated whether age modified these associations. This prospective cohort study consisted of 1,929 patients (80% male, mean age 62 years) with stable angina pectoris from the Western Norway B-Vitamin Intervention Trial. Dietary assessment was performed by the administration of a semi-quantitative food frequency questionnaire. Cox proportional hazards models were used to investigate the association between a relative increase in total meat intake and the outcomes of interest. The association per 50 g/1,000 kcal higher intake of total meat with morbidity and mortality were generally inconclusive but indicated an increased risk of acute myocardial infarction [HR: 1.26 (95% CI: 0.98, 1.61)] and gastrointestinal cancer [1.23 (0.70, 2.16)]. However, we observed a clear effect modification by age, where total meat intake was associated with an increased risk of mortality and acute myocardial infarction among younger individuals, but an attenuation, and even reversal of the risk association with increasing age. Our findings support the current dietary guidelines emphasizing a restricted meat intake in cardiovascular disease patients but highlights the need for further research on the association between meat intake and health outcomes in elderly populations. Future studies should investigate different types of meat separately in other CVD-cohorts, in different age-groups, as well as in the general population.
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http://dx.doi.org/10.3389/fnut.2021.642612DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969515PMC
March 2021

Vitamin and Mineral Status in a Vegan Diet.

Dtsch Arztebl Int 2020 08;117(35-36):575-582

German Federal Institute for Risk Assessment, Department of Food Safety, Berlin, Germany; Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg/Saar, Germany; Department of Clinical Medicine, Center for Nutrition, University of Bergen, Bergen, Norway; BEVITAL AS, Bergen, Norway; Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich, Zurich, Switzerland; Medical Department of Endocrinology, Diabetes and Metabolic Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany; Clinical Research Unit, Berlin Institute of Health (BIH), Berlin, Germany; Charité-Center for Cardiovascular Research (CCR), Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin site, Berlin, Germany; Institute of Agricultural and Nutritional Science, Martin Luther University Halle-Wittenberg, Halle, Germany; Department of Food Chemistry, Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; TraceAge DFG Research Unit on Interactions of Essential Trace Elements in Healthy and Diseased Elderly, Potsdam-Berlin-Jena, Germany.

Background: In Germany, public interest in a vegan diet is steadily growing. There are, however, no current data on the macro- and micronutrient status of vegans.

Methods: In a cross-sectional study entitled "The Risks and Benefits of a Vegan Diet" (RBVD), we investigated the dietary intake, basic laboratory parameters, vitamin status, and trace-element status of 36 vegans and 36 persons on an omnivorous diet. Each group consisted of 18 men and 18 women aged 30-60.

Results: Nearly all the vegans and one-third of the persons on a mixed diet had consumed supplements in the previous 4 weeks. Vegans and nonvegans had similar energy intake but differed in the intake of both macronutrients (e.g., dietary fiber) and micronutrients (e.g., vitamins B12, B2, D, E, and K, as well as folate, iodine, and iron). There were no intergroup differences in the biomarkers of vitamin B12, vitamin D, or iron status. The ferritin values and blood counts indicated iron deficiency in four vegans and three non-vegans. Measurements in 24-hour urine samples revealed lower calcium excretion and markedly lower iodine excretion in vegans compared to non-vegans; in one-third of the vegans, iodine excretion was lower than the WHO threshold value (<20 μg/L) for severe iodine deficiency.

Conclusion: Vitamin B12 status was similarly good in vegans and non-vegans, even though the vegans consumed very little dietary B12. This may be due to the high rate of supplementation. The findings imply a need to also assure adequate iodine intake in the population, especially among persons on a vegan diet.
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http://dx.doi.org/10.3238/arztebl.2020.0575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779846PMC
August 2020

Weight changes and mobility in the early phase after hip fracture in community-dwelling older persons.

Eur Geriatr Med 2020 08 16;11(4):545-553. Epub 2020 Jun 16.

Department of Clinical Science, University of Bergen, Bergen, Norway.

Purpose: Hip fractures in older persons are associated with reduced mobility and loss of independence. Few studies address the nutritional status and mobility in the early phase after hip fracture. The objective of the present study was, therefore, to investigate weight changes and their effect on mobility during the first two months following hip fracture in community-dwelling older persons without dementia.

Methods: Patients (> 60 years) admitted for a first hip fracture were recruited from two tertiary referral hospitals in Bergen, Norway. The patients' weights and dietary intakes were determined in the hospital and at home after two months. Mobility was assessed based on the New Mobility Score (NMS) (scale 0-9, with values > 5 regarded as sufficient mobility).

Results: We included 64 patients (median age 80 years, 48 women, 16 men) with information on weight collected in the hospital. Follow-up measurements were available for 32 patients, corresponding to an attrition rate of 50%. The patients had a median weight loss of 1.8 kg (IQR = - 3.7, 0 kg). Most of them had reduced mobility at two months after the surgery [median NMS = 5 (IQR = 3-6)]. Both age and the weight change after surgery were predictors of the NMS at follow-up.

Conclusion: Bodyweight loss was observed in three out of four patients in the early phase after hip fracture and was associated with decreased mobility measured by the NMS. The results should be interpreted with caution as half of the patients dropped out of the study and did not participate in the follow-up visit.
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http://dx.doi.org/10.1007/s41999-020-00342-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438288PMC
August 2020

Short-term treatment with a peroxisome proliferator-activated receptor α agonist influences plasma one-carbon metabolites and B-vitamin status in rats.

PLoS One 2019 5;14(12):e0226069. Epub 2019 Dec 5.

Department of Clinical Science, University of Bergen, Bergen, Norway.

Introduction: Peroxisome proliferator-activated receptors (PPARs) have been suggested to be involved in the regulation of one-carbon metabolism. Previously we have reported effects on plasma concentrations of metabolites along these pathways as well as markers of B-vitamin status in rats following treatment with a pan-PPAR agonist. Here we aimed to investigate the effect on these metabolites after specific activation of the PPARα and PPARγ subtypes.

Methods: For a period of 12 days, Male Wistar rats (n = 20) were randomly allocated to receive treatment with the PPARα agonist WY-14.643 (n = 6), the PPARγ agonist rosiglitazone (n = 6) or placebo (n = 8). The animals were sacrificed under fasting conditions, and plasma concentration of metabolites were determined. Group differences were assessed by one-way ANOVA, and planned comparisons were performed for both active treatment groups towards the control group.

Results: Treatment with a PPARα agonist was associated with increased plasma concentrations of most biomarkers, with the most pronounced differences observed for betaine, dimethylglycine, glycine, nicotinamide, methylnicotinamide, pyridoxal and methylmalonic acid. Lower levels were observed for flavin mononucleotide. Fewer associations were observed after treatment with a PPARγ agonist, and the most notable was increased plasma serine.

Conclusion: Treatment with a PPARα agonist influenced plasma concentration of one-carbon metabolites and markers of B-vitamin status. This confirms previous findings, suggesting specific involvement of PPARα in the regulation of these metabolic pathways as well as the status of closely related B-vitamins.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226069PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894826PMC
March 2020

Dietary choline is related to increased risk of acute myocardial infarction in patients with stable angina pectoris.

Biochimie 2020 Jun 7;173:68-75. Epub 2019 Nov 7.

Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.

High plasma choline has been associated with the metabolic syndrome and risk of chronic diseases, including cardiovascular disease. However, dietary choline is not correlated with choline plasma concentrations, and there are few studies and contradictory evidence regarding dietary choline and cardiovascular events. In addition, a recommended dietary allowance for choline has not been established and remains a point of contention. This study assessed the association between dietary choline, including choline forms, and risk of incident acute myocardial infarction (AMI) in patients with suspected stable angina pectoris (SAP). In total 1981 patients (80% men, median age 62) from the Western Norway B Vitamin Intervention Trial were included in this analysis. Information on dietary choline was obtained using a 169-item food frequency questionnaire. The Cardiovascular Disease in Norway project provided data on AMI. Risk associations were estimated using Cox-regression analysis using energy-adjusted choline intake. Median (25th, 75th percentile) total energy-adjusted choline intake was 288 (255, 326) mg/d. During a median (25th, 75th percentile) follow-up of 7.5 (6.3, 8.8) years, 312 (15.7%) patients experienced at least one AMI. Increased intakes of energy-adjusted choline (HR [95% CI] per 50 mg increase 1.11 [1.03, 1.20]), phosphatidylcholine (HR per 50 mg increase 1.24 [1.08, 1.42]) and sphingomyelin (HR per 5 mg increase 1.16 [1.02, 1.31]) were associated with higher AMI risk. In conclusion, higher dietary intakes of total choline, phosphatidylcholine and sphingomyelin were associated with increased risk of AMI in patients with SAP. Future studies are necessary to explore underlying mechanisms for this observation.
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http://dx.doi.org/10.1016/j.biochi.2019.11.001DOI Listing
June 2020

Correction to: High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy - an observational cross-sectional study.

BMC Nephrol 2018 12 24;19(1):375. Epub 2018 Dec 24.

Department of Clinical Medicine, Center for Nutrition, University of Bergen, Jonas Lies vei 68, 5021, Bergen, Norway.

Following publication of the original article [1], the authors reported an error in the presentation of Table 3 and Table 4.
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http://dx.doi.org/10.1186/s12882-018-1149-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304759PMC
December 2018

High rates of central obesity and sarcopenia in CKD irrespective of renal replacement therapy - an observational cross-sectional study.

BMC Nephrol 2018 10 11;19(1):259. Epub 2018 Oct 11.

Department of Clinical Medicine, Center for Nutrition, University of Bergen, Jonas Lies vei 68, 5021, Bergen, Norway.

Background: Poor nutritional status of patients with renal disease has been associated with worsening of renal function and poor health outcomes. Simply measuring weight and height for calculation of the body mass index does however not capture the true picture of nutritional status in these patients. Therefore, we measured nutritional status by BMI, body composition, waist circumference, dietary intake and nutritional screening in three groups of renal patients.

Methods: Patients with chronic kidney disease not on renal replacement therapy (CKD stages 3-5, n = 112), after renal transplantation (n = 72) and patients treated with hemodialysis (n = 24) were recruited in a tertiary hospital in Bergen, Norway in a cross-sectional observational study. Dietary intake was assessed by a single 24 h recall. All patients underwent nutritional screening, anthropometric measurements, body composition measurement andfunctional measurements (hand grip strength). The prevalence of overweight and obesity, central obesity, sarcopenia, sarcopenic obesity and nutritional risk was calculated.

Results: Central obesity and sarcopenia were present in 49% and 35% of patients, respectively. 49% of patients with central obesity were normal weight or overweight according to their BMI. Factors associated with central obesity were a diagnosis of diabetes and increased fat mass, while factors associated with sarcopenia were age, female gender, number of medications. An increase in the BMI was associated with lower risk for sarcopenia.

Conclusion: Central obesity and sarcopenia were present in renal patients at all disease stages. More attention to these unfavorable nutritional states is warranted in these patients.
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http://dx.doi.org/10.1186/s12882-018-1055-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180401PMC
October 2018

The Limited Benefit of Fish Consumption on Risk of Hip Fracture among Men in the Community-Based Hordaland Health Study.

Nutrients 2018 Jul 6;10(7). Epub 2018 Jul 6.

Department of Global Public Health and Primary Care, University of Bergen, 5021 Bergen, Norway.

Hip fractures have a high prevalence worldwide. Few studies have investigated whether fish consumption is associated with risk of hip fractures. The objective of the present study was to investigate the effect of fish intake on the subsequent risk of a hip fracture because of the low number of studies on this topic. A community-based prospective cohort study of 2865 men and women from Hordaland county in Norway, born between 1925⁻1927 and enrolled in the study in 1997⁻1999. Information on hip fracture cases was extracted from hospital records until 31 December 2009. Baseline information on the intake of fish was obtained from a semi-quantitative food frequency questionnaire. Cox proportional hazard regression models with death as a competing risk were used to evaluate the association of fish intake with risk of hip fracture. During a mean (SD) follow-up time of 9.6 (2.7) years, 226 hip fractures (72 in men, 154 in women) were observed. The mean (SD) fish intake was 48 (25) g/1000 kcal. The association between fish intake and risk of hip fracture was not linear and displayed a threshold, with low intake of fish being associated with an increased risk of hip fracture in men (HR (Hazard Ratio) = 1.84, 95% CI 1.10, 3.08). In this community-based prospective study of men and women, a low intake of fish was associated with the risk of a hip fracture in men.
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http://dx.doi.org/10.3390/nu10070873DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073237PMC
July 2018

[Development and challenges to breastfeeding in sub-Saharan Africa].

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018 Aug;61(8):937-944

Department of Clinical Medicine, Center for Nutrition, University of Bergen, Jonas Lies vei 68, 5021, Bergen, Norwegen.

Since there is no doubt concerning the superiority of breastfeeding compared to other forms of infant feeding, the promotion of exclusive breastfeeding up to six months and continued breastfeeding up to two years and beyond are again embraced at the highest global nutrition agenda. The latest is the United Nations decade of action on nutrition 2016-2025, building on research results and the work by the World Health Organization (WHO) over the last two decades, and extensive societal, clinical, and academic discussions in the field of breastfeeding.While the discussion was about the optimal duration of exclusive breastfeeding around the millennium shift, the focus is on the most effective measures for the promotion and protection of breastfeeding. Contemporary breastfeeding rates are well behind the goals. In sub-Saharan Africa, almost all infants are breastfed, while exclusive breastfeeding is more seldom and not sufficient. Africa, being a vast and diverse continent with a myriad of cultural practices, has had some shared attitudes ranging from the west to east regarding views on motherhood, body fluids, including milk, infant feeding, and responsible others.The region still faces high maternal HIV infection rates and high infant and child mortality rates. However, due to effective antiretroviral therapies, it is now possible and safe for women living with HIV to breastfeed their infants and to ensure them HIV-free survival. However, there is need for improvement regarding availability, compliance, and adherence to these drugs. Research gaps include the long-term effects of antiretroviral therapy on the growth, health, and development of the exposed children.
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http://dx.doi.org/10.1007/s00103-018-2783-2DOI Listing
August 2018

Total and lean fish intake is positively associated with bone mineral density in older women in the community-based Hordaland Health Study.

Eur J Nutr 2019 Jun 15;58(4):1403-1413. Epub 2018 Mar 15.

Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.

Purpose: Fish is a source of various nutrients beneficial for bone health, but few studies have investigated the association between bone mineral density (BMD) and fish consumption. Thus, the aim was to investigate the relationship between total fish intake and BMD and between both lean and fatty fish intake and BMD.

Method: These cross-sectional analyses include 4656 participants in the Hordaland Health Study, a community-based study conducted in 1997-1999. The study includes two birth cohorts of men and women from Hordaland county (Norway) born in 1950-1951 and 1925-1927. BMD was measured by dual-energy X-ray absorptiometry and dietary intake was obtained from a semi-quantitative food-frequency questionnaire.

Results: The average total fish intake was 33 ± 18 g/1000 kcal and was primarily lean fish. Older women had significantly lower BMD than older men and middle-aged men and women. In older women, total and lean fish intake (50 g/1000 kcal) was significantly and positively associated with BMD also after multivariate adjustments (β-coefficient 0.018, p = 0.017 and 0.026, p = 0.021).

Conclusion: A high intake of fish, in particular lean fish, was positively associated with BMD in older women. No association between intake of fatty fish and BMD was found in either of the age and sex groups.
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http://dx.doi.org/10.1007/s00394-018-1665-6DOI Listing
June 2019

Plasma 25-Hydroxyvitamin D and Mortality in Patients With Suspected Stable Angina Pectoris.

J Clin Endocrinol Metab 2018 03;103(3):1161-1170

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Context And Objective: Vitamin D status may affect cardiovascular disease (CVD) development and survival. We studied the relationship between concentrations of the circulating biomarker 25-hydroxyvitamin D (25OHD) and all-cause and cardiovascular mortality risk.

Design, Setting, Participants, And Main Outcome Measures: 25OHD, the sum of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2, was analyzed in plasma samples from 4114 white patients suspected of having stable angina pectoris and was adjusted for seasonal variation. Hazard ratios (HRs) for all-cause and cardiovascular mortality were estimated by using multivariable Cox models with 25OHD as the main exposure variable, with adjustment for study site, age, sex, smoking, body mass index, estimated glomerular filtration rate, and systolic blood pressure.

Results: A total of 895 (21.8%) deaths, including 407 (9.9%) from CVD causes, occurred during a mean ± standard deviation follow-up of 11.9 ± 3.0 years. Compared with the first 25OHD quartile, HRs in the second, third, and fourth quartiles were 0.64 [95% confidence interval (CI), 0.54 to 0.77], 0.56 (95% CI, 0.46 to 0.67), and 0.56 (95% CI, 0.46 to 0.67) for all-cause mortality and 0.70 (95% CI, 0.53 to 0.91), 0.60 (95% CI, 0.45 to 0.79), and 0.57 (95% CI, 0.43 to 0.75) for cardiovascular mortality, respectively. Threshold analysis demonstrated increased all-cause and CVD mortality in patients with 25OHD concentrations below ∼42.5 nmol/L. Moreover, analysis suggested increased all-cause mortality at concentrations >100 nmol/L.

Conclusion: Plasma 25OHD concentrations were inversely associated with cardiovascular mortality and nonlinearly (U-shaped) associated with all-cause mortality.
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http://dx.doi.org/10.1210/jc.2017-02328DOI Listing
March 2018

Associations between fish intake and the metabolic syndrome and its components among middle-aged men and women: the Hordaland Health Study.

Food Nutr Res 2017 13;61(1):1347479. Epub 2017 Jul 13.

Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.

In epidemiologic studies, the relationship between fish consumption and the metabolic syndrome (MetS) have been inconclusive and sex differences reported. The aim was to investigate associations between fish intake and the MetS in a cross-sectional study of men and women. Fish intake, waist circumference, triglycerides (TG), HDL-C, glucose and blood pressure were assessed among 2874 men and women (46-49 y) in the Hordaland Health Study (1997-1999). Fatty fish intake was inversely associated with TG in men only; mean difference in TG between highest and lowest quartile of fatty fish intake was -0.33 mmol/L (95% CI: -0.51, -0.15). Lean fish intake was inversely associated with TG in women only; mean difference in TG between highest and lowest quartile of lean fish intake was -0.23 mmol/L (95% CI: -0.34, -0.11). Fatty fish intake was positively associated with serum HDL-C in both men and women. Total fish intake was inversely associated with MetS; adjusted OR 0.75 (95% CI 0.57, 0.97). Higher fish intake was associated with lower odds of having MetS possibly driven by associations of higher fish intake with lower TG and higher HDL-C. The findings of differential associations by sex needs to be confirmed and possible biologic mechanisms explored.
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http://dx.doi.org/10.1080/16546628.2017.1347479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510233PMC
July 2017

Serum Acylcarnitines and Risk of Cardiovascular Death and Acute Myocardial Infarction in Patients With Stable Angina Pectoris.

J Am Heart Assoc 2017 02 3;6(2). Epub 2017 Feb 3.

Department of Clinical Science, University of Bergen, Norway.

Background: Excess levels of serum acylcarnitines, which are intermediate products in metabolism, have been observed in metabolic diseases such as type 2 diabetes mellitus. However, it is not known whether acylcarnitines may prospectively predict risk of cardiovascular death or acute myocardial infarction in patients with stable angina pectoris.

Methods And Results: This study included 4164 patients (median age, 62 years; 72% men). Baseline serum acetyl-, octanoyl-, palmitoyl-, propionyl-, and (iso)valerylcarnitine were measured using liquid chromatography/tandem mass spectrometry. Hazard ratios (HRs) and 95% CIs for quartile 4 versus quartile 1 are reported. The multivariable model included age, sex, body mass index, fasting status, current smoking, diabetes mellitus, apolipoprotein A1, apolipoprotein B, creatinine, left ventricular ejection fraction, extent of coronary artery disease, study center, and intervention with folic acid or vitamin B6. During median 10.2 years of follow-up, 10.0% of the patients died of cardiovascular disease and 12.8% suffered a fatal or nonfatal acute myocardial infarction. Higher levels of the even-chained acetyl-, octanoyl-, and palmitoyl-carnitines were significantly associated with elevated risk of cardiovascular death, also after multivariable adjustments (HR [95% CI]: 1.52 [1.12, 2.06]; P=0.007; 1.73 [1.23, 2.44]; P=0.002; and 1.61 [1.18, 2.21]; P=0.003, respectively), whereas their associations with acute myocardial infarction were less consistent.

Conclusions: Among patients with suspected stable angina pectoris, elevated serum even-chained acylcarnitines were associated with increased risk of cardiovascular death and, to a lesser degree with acute myocardial infarction, independent of traditional risk factors.

Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00354081.
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http://dx.doi.org/10.1161/JAHA.116.003620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523736PMC
February 2017

Vitamin D supplementation does not modify cardiovascular risk profile of adults with inadequate vitamin D status.

Eur J Nutr 2017 Mar 30;56(2):621-634. Epub 2015 Nov 30.

Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Von-Danckelmann-Platz 2, 06120, Halle/Saale, Germany.

Purpose: The Nutrition Societies in Germany, Austria, and Switzerland recommend a daily intake of 20 µg vitamin D for adults when endogenous synthesis is absent. The current study aimed to elucidate whether this vitamin D dose impacts cardiovascular risk markers of adults during the winter months.

Methods: The study was conducted in Halle (Saale), Germany (51 northern latitude) as a placebo-controlled, double-blinded, randomised trial (from January to April). A total of 105 apparently healthy subjects (male and female, 20-71 years old) were included. Subjects were randomly allocated to two groups. One group received a daily 20-µg vitamin D dose (n = 54), and the other group received a placebo (n = 51) for 12 weeks. Outcome measures included blood pressure, heart rate, concentrations of renin, aldosterone, serum lipids and vascular calcification markers, and haematologic variables such as pro-inflammatory monocytes.

Results: Blood pressure and systemic cardiovascular risk markers remained unchanged by vitamin D supplementation, although serum 25-hydroxyvitamin D increased from 38 ± 14 to 73 ± 16 nmol/L at week 12. The placebo and vitamin D groups did not differ in their final cardiovascular risk profile.

Conclusion: Daily supplementation of 20 µg vitamin D during winter is unlikely to change cardiovascular risk profile.
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http://dx.doi.org/10.1007/s00394-015-1106-8DOI Listing
March 2017

Associations between intake of fish and n-3 long-chain polyunsaturated fatty acids and plasma metabolites related to the kynurenine pathway in patients with coronary artery disease.

Eur J Nutr 2017 Feb 19;56(1):261-272. Epub 2015 Oct 19.

Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Laboratory Building 8th Floor, P.O. Box 7804, 5020, Bergen, Norway.

Purpose: Enhanced tryptophan degradation via the kynurenine pathway has been related to several pathological conditions. However, little is known about the effect of diet on individual metabolites of this pathway. We investigated cross-sectional associations between reported intake of fish and omega-3 (n-3) long-chain PUFA (LC-PUFA) and plasma metabolites related to the kynurenine pathway.

Methods: Participants were 2324 individuals with coronary artery disease from the Western Norway B Vitamin Intervention Trial. Fish and n-3 LC-PUFA intakes were assessed using a food frequency questionnaire. Plasma concentrations of tryptophan, kynurenine, kynurenic acid, anthranilic acid, 3-hydroxykynurenine, xanthurenic acid, 3-hydroxyanthranilic acid, neopterin, and kynurenine-to-tryptophan ratio (KTR) were analyzed. Associations were investigated using partial Spearman's rank correlations and multiple linear regressions.

Results: Median age at inclusion was 62 years (80 % males), and 84 % had stable angina pectoris. Intake of fatty fish and n-3 LC-PUFA was inversely associated with plasma 3-hydroxykynurenine. Consumption of total fish, lean fish, and n-3 LC-PUFA was inversely associated with plasma neopterin. Intake of total fish, fatty fish, and n-3 LC-PUFA was inversely associated with KTR. All these correlations were weak (ρ between -0.12 and -0.06, P < 0.01). In 306 patients with diabetes, lean fish intake was positively associated with plasma 3-hydroxyanthranilic acid (ρ = 0.22, P < 0.001, P for interaction = 0.01), and total fish intake was inversely associated with KTR (ρ = -0.17, P < 0.01, P for interaction = 0.02).

Conclusion: Fish intake was not an important determinant of individual metabolites in the kynurenine pathway. However, some correlations were stronger in patients with diabetes. The inverse associations of fish or n-3 LC-PUFA with neopterin and KTR may suggest a slightly lower IFN-γ-mediated immune activation with a higher intake.
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http://dx.doi.org/10.1007/s00394-015-1077-9DOI Listing
February 2017

Bioavailability of iron, vitamin A, zinc, and folic acid when added to condiments and seasonings.

Ann N Y Acad Sci 2015 Nov 15;1357:29-42. Epub 2015 Oct 15.

Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Seasonings and condiments can be candidate vehicles for micronutrient fortification if consumed consistently and if dietary practices ensure bioavailability of the nutrient. In this review, we identify factors that may affect the bioavailability of iron, vitamin A, zinc, and folic acid when added to seasonings and condiments and evaluate their effects on micronutrient status. We take into consideration the chemical and physical properties of different forms of the micronutrients, the influence of the physical and chemical properties of foods and meals to which fortified seasonings and condiments are typically added, and interactions between micronutrients and the physiological and nutritional status of the target population. Bioavailable fortificants of iron have been developed for use in dry or fluid vehicles. For example, sodium iron ethylenediaminetetraacetic acid (NaFeEDTA) and ferrous sulfate with citric acid are options for iron fortification of fish and soy sauce. Furthermore, NaFeEDTA, microencapsulated ferrous fumarate, and micronized elemental iron are potential fortificants in curry powder and salt. Dry forms of retinyl acetate or palmitate are bioavailable fortificants of vitamin A in dry candidate vehicles, but there are no published studies of these fortificants in fluid vehicles. Studies of zinc and folic acid bioavailability in seasonings and condiments are also lacking.
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http://dx.doi.org/10.1111/nyas.12947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5019242PMC
November 2015

Efficacy of fish intake on vitamin D status: a meta-analysis of randomized controlled trials.

Am J Clin Nutr 2015 Oct 9;102(4):837-47. Epub 2015 Sep 9.

Clinical Medicine, and

Background: It is well known that fish is the major natural source of vitamin D in the diet; therefore, this meta-analysis investigated the influence of fish consumption in randomized controlled trials (RCTs) on serum 25-hydroxyvitamin D [25(OH)D] concentrations.

Objective: A literature search was carried out in Medline, Embase, Web of Science, and the Cochrane Library (up to February 2014) for RCTs that investigated the effect of fish consumption on 25(OH)D concentrations in comparison to other dietary interventions.

Results: Seven articles and 2 unpublished study data sets with 640 subjects and 14 study groups met the inclusion criteria and were included in this meta-analysis. Compared with controls, the consumption of fish increased 25(OH)D concentrations, on average, by 4.4 nmol/L (95% CI: 1.7, 7.1 nmol/L; P < 0.0001, I(2) = 25%; 9 studies).The type of the fish also played a key role: the consumption of fatty fish resulted in a mean difference of 6.8 nmol/L (95% CI: 3.7, 9.9 nmol/L; P < 0.0001, I(2) = 0%; 7 study groups), whereas for lean fish the mean difference was 1.9 nmol/L (95% CI: -2.3, 6.0 nmol/L; P < 0.38, I(2) = 37%; 7 study groups). Short-term studies (4-8 wk) showed a mean difference of 3.8 nmol/L (95% CI: 0.6, 6.9 nmol/L; P < 0.02, I(2) = 38%; 10 study groups), whereas in long-term studies (∼6 mo) the mean difference was 8.3 nmol/L (95% CI: 2.1, 14.5 nmol/L; P < 0.009, I(2) = 0%; 4 study groups).

Conclusion: As the major food source of vitamin D, fish consumption increases concentrations of 25(OH)D, although recommended fish intakes cannot optimize vitamin D status.
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http://dx.doi.org/10.3945/ajcn.114.105395DOI Listing
October 2015

Potential Predictors of Plasma Fibroblast Growth Factor 23 Concentrations: Cross-Sectional Analysis in the EPIC-Germany Study.

PLoS One 2015 20;10(7):e0133580. Epub 2015 Jul 20.

Research Group Cardiovascular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany; Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medical Center, Berlin, Germany; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.

Background: Increased fibroblast growth factor 23 (FGF23), a bone-derived hormone involved in the regulation of phosphate and vitamin D metabolism, has been related to the development of cardiovascular disease (CVD) in chronic kidney disease patients and in the general population. However, what determines higher FGF23 levels is still unclear. Also, little is known about the influence of diet on FGF23. The aim of this study was therefore to identify demographic, clinical and dietary correlates of high FGF23 concentrations in the general population.

Methods: We performed a cross-sectional analysis within a randomly selected subcohort of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany comprising 2134 middle-aged men and women. The Human FGF23 (C-Terminal) ELISA kit was used to measure FGF23 in citrate plasma. Dietary data were obtained at baseline via validated food frequency questionnaires including up to 148 food items.

Results: Multivariable adjusted logistic regression showed that men had a 66% lower and smokers a 64% higher probability of having higher FGF23 (≥ 90 RU/mL) levels compared, respectively, with women and nonsmokers. Each doubling in parathyroid hormone, creatinine, and C-reactive protein was related to higher FGF23. Among the dietary factors, each doubling in calcium and total energy intake was related, respectively, to a 1.75 and to a 4.41 fold increased probability of having higher FGF23. Finally, each doubling in the intake of iron was related to an 82% lower probability of having higher FGF23 levels. Results did not substantially change after exclusion of participants with lower kidney function.

Conclusions: In middle-aged men and women traditional and non-traditional CVD risk factors were related to higher FGF23 concentrations. These findings may contribute to the understanding of the potential mechanisms linking increased FGF23 to increased CVD risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133580PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508099PMC
April 2016

Vitamin D3 supplementation: Response and predictors of vitamin D3 metabolites - A randomized controlled trial.

Clin Nutr 2016 Apr 19;35(2):351-358. Epub 2015 May 19.

Institute of Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Germany. Electronic address:

Background & Aims: Large parts of the population are insufficiently supplied with vitamin D, in particular when endogenous synthesis is absent. Therefore many health care providers recommend the use of vitamin D supplements. The current study aimed to investigate the efficacy of an once-daily oral dose of 20 μg vitamin D3 to improve the vitamin D status and to evaluate predictors of response.

Methods: The study was conducted as a double-blind, randomized, placebo-controlled parallel trial from January till April 2013. In total, 105 subjects (20-71 years) were allocated to receive either a vitamin D3 supplement (20 μg/d) or a placebo for 12 weeks. Circulating levels of vitamin D3 metabolites such as the 25(OH)D3 and the 24,25(OH)2D3, and biomarkers of calcium and phosphate metabolism were quantified.

Results: The 25(OH)D3 serum concentrations in the placebo group decreased from 38 ± 15 nmol/L at baseline to 32 ± 14 nmol/L and 32 ± 13 nmol/L at weeks 8 and 12 of the study, respectively (p < 0.01). In the vitamin D3 group, the serum 25(OH)D3 concentration increased from 38 ± 14 nmol/L at baseline to 70 ± 15 nmol/L and 73 ± 16 nmol/L at weeks 8 and 12 of vitamin D3 supplementation (p < 0.001), respectively. As a result, 94% of the vitamin D3-supplemented participants reached 25(OH)D3 concentrations of ≥50 nmol/L and thereof 46% attained 25(OH)D3 levels of ≥75 nmol/L until the end of the study. The extent of the 25(OH)D3 increase upon vitamin D3 supplementation depended on 25(OH)D3 baseline levels, age, body weight and circulating levels of triglycerides. In contrast to 25(OH)D3, the response of 24,25(OH)2D3 to the vitamin D3 treatment was affected only by baseline levels of 24,25(OH)2D3 and age.

Conclusions: The average improvement of 25(OH)D3 levels in individuals who received 20 μg vitamin D3 per day during the winter months was 41 nmol/L compared to individuals without supplementation. As a result almost all participants with the vitamin D3 supplementation attained 25(OH)D3 concentrations of 50 nmol/L and higher. The suitability of 24,25(OH)2D3 as a marker of vitamin D status needs further investigation. Clinical trial registration number at clinicaltrials.gov: NCT01711905.
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http://dx.doi.org/10.1016/j.clnu.2015.04.021DOI Listing
April 2016

Dietary intake of saturated fat is not associated with risk of coronary events or mortality in patients with established coronary artery disease.

J Nutr 2015 Feb 10;145(2):299-305. Epub 2014 Dec 10.

Departments of Heart Disease Departments of Clinical Science.

Background: Data from recent meta-analyses question an association between dietary intake of saturated fatty acids (SFAs) and risk of cardiovascular disease (CVD). Moreover, the prognostic effect of dietary SFA in patients with established CVD treated with modern conventional medication has not been extensively studied.

Objective: We investigated the associations between self-reported dietary SFA intake and risk of subsequent coronary events and mortality in patients with coronary artery disease (CAD).

Methods: This study included patients who participated in the Western Norway B-Vitamin Intervention Trial and completed a 169-item semiquantitative food-frequency questionnaire after coronary angiography. Quartiles of estimated daily intakes of SFA were related to risk of a primary composite endpoint of coronary events (unstable angina pectoris, nonfatal acute myocardial infarction, and coronary death) and separate secondary endpoints (total acute myocardial infarction, fatal coronary events, and all-cause death) with use of Cox-regression analyses.

Results: This study included 2412 patients (81% men, mean age: 61.7 y). After a median follow-up of 4.8 y, a total of 292 (12%) patients experienced at least one major coronary event during follow-up. High intake of SFAs was associated with a number of risk factors at baseline. However, there were no significant associations between SFA intake and risk of coronary events [age- and sex-adjusted HR (95% CI) was 0.85 (0.61, 1.18) for the upper vs. lower SFA quartile] or any secondary endpoint. Estimates were not appreciably changed after multivariate adjustments.

Conclusions: There was no association between dietary intake of SFAs and incident coronary events or mortality in patients with established CAD.
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http://dx.doi.org/10.3945/jn.114.203505DOI Listing
February 2015

Plasma fibroblast growth factor 23 and risk of cardiovascular disease: results from the EPIC-Germany case-cohort study.

Eur J Epidemiol 2015 Feb 21;30(2):131-41. Epub 2014 Dec 21.

Research Group Cardiovascular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee, 114-116, 14558, Nuthetal, Germany,

Increased fibroblast growth factor 23 (FGF23) concentrations have emerged as a novel risk factor for heart failure and stroke but not for myocardial infarction (MI). Yet, most studies on MI were conducted in coronary artery disease (CAD) patients and the elderly. Evidence is unclear in subjects without CAD and for stroke subtypes. We investigated the relationships between FGF23 and overall major cardiovascular endpoints, incident MI, ischemic (IS) and haemorrhagic stroke (HS) in middle-aged adults without pre-existing cardiovascular disease. We used a case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition-Germany, including a randomly drawn subcohort (n = 1,978), incident MI (n = 463) and stroke cases (n = 359 IS; n = 88 HS) identified during a mean follow-up of 8.2 years. Compared with participants with FGF23 levels in the lowest quartile, those in the highest quartile had a 36% increased risk for cardiovascular events [hazard ratio: 1.36, 95% confidence interval (CI): 1.02-1.82] after adjustment for established cardiovascular risk factors, patahyroid hormone and 25-hydroxyvitamin D3 levels, dietary calcium and phosphorus intake, and kidney function. However, sub-analyses revealed significant relationships with risk of MI and HS, but not IS. Compared with the lowest quartile, individuals in the top two FGF23 quartiles had a 1.62 (95% CI 1.07-2.45) fold increased risk for MI and a 2.61 (95% CI 1.23-5.52) fold increase for HS. Increased FGF23 emerged as a risk factor for both MI and HS. Further studies are warranted to confirm these results and to identify underlying mechanisms.
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http://dx.doi.org/10.1007/s10654-014-9982-4DOI Listing
February 2015

Vitamin D status was not associated with 'one-year' progression of coronary artery disease, assessed by coronary angiography in statin-treated patients.

Eur J Prev Cardiol 2015 May 30;22(5):594-602. Epub 2014 Jan 30.

Department of Clinical Medicine, University of Bergen, Norway.

Background: Low vitamin D status is associated with increased risk of cardiovascular disease and may be involved in atherosclerosis. Our aim was to assess the association between vitamin D status and the progression of coronary artery disease (CAD).

Methods And Results: We measured 25-hydroxyvitamin D3 (25OHD3) by liquid chromatography tandem mass spectrometry (LC-MS/MS) in plasma from 348 participants with established CAD (84% males, mean ± standard deviation (SD) age 60 ± 10 years) of the Western Norway B-vitamin Intervention Trial (WENBIT, 1999-2006). The patients underwent invasive coronary angiography (CA) and percutaneous coronary intervention at baseline and a second CA after 302 ± 79 days of follow-up. From the angiograms, minimal lumen diameter (MLD) and diameter stenosis (DS) of atherosclerotic lesions were obtained. Significant CAD in non-intervened vessels was found in 309 coronary arteries from 183 participants either at baseline and/or at follow-up. To assess the association between levels of 25OHD3 and CAD progression in non-intervened vessels, we applied a linear quantile fitted mixed effects model with MLD or DS measured at follow-up as a function of continuous 25OHD3 concentrations. There were no statistically significant associations between plasma 25OHD3 concentrations (median: 63.9, 95% confidence interval (CI): 48.1-78.5 nmol/l) measured at baseline and the follow-up measures of either MLD (estimated effect per 10 nmol/l increase of 25OHD3 and 95% CI: -0.015 (-0.032-0.002) mm, p = 0.088) or DS (0.225 (-0.354-0.804) percentage points, p = 0.444). Multivariate adjustment did not alter these results.

Conclusion: Plasma 25OHD3 levels were not associated with 'one-year' progression of CAD, assessed by CA in statin-treated patients.
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http://dx.doi.org/10.1177/2047487314522137DOI Listing
May 2015

Plasma fibroblast growth factor 23, parathyroid hormone, 25-hydroxyvitamin D3, and risk of heart failure: a prospective, case-cohort study.

J Clin Endocrinol Metab 2014 Mar 1;99(3):947-55. Epub 2013 Jan 1.

Department of Epidemiology (R.d.G., B.B., J.W., M.A., H.B., C.W.), German Institute of Human Nutrition Potsdam-Rehbrücke, D-14558 Nuthetal, Germany; Institute of Agricultural and Nutritional Sciences (F.H., G.I.S.), Human Nutrition Group, Martin-Luther-University Halle-Wittenberg, D-06108 Halle, Germany; Department for Clinical Chemistry and Pathobiochemistry (S.W., B.I.), Otto-von-Guericke-University Magdeburg, 39106 Magdeburg, Germany; Institute of Epidemiology and Social Medicine (H.W.H.), Clinical Epidemiology Unit, University of Münster, D-48129 Münster, Germany; Department of Clinical Medicine (J.D.), University of Bergen, N-5020 Bergen Norway; and Institute for Social Medicine, Epidemiology, and Health Economics (C.W.), Charité University Medical Center, 10117 Berlin, Germany.

Context: Bone mineral metabolism may play a role in the development of heart failure (HF).

Objective: The aim of the study was to investigate the relationships of plasma fibroblast growth factor (FGF) 23, PTH, and 25-hydroxyvitamin D3 [25(OH)D3] with incident congestive HF in a population-based cohort of men and women aged 40-65 and 35-65 years, respectively, at baseline.

Design: We conducted a prospective case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort, including a randomly drawn sample of the total cohort free of HF and all incident HF cases that occurred during a mean follow-up of 8.2 ± 1.6 years.

Participants And Setting: A total of 221 incident congestive HF cases and 1228 individuals free of HF were included in the study.

Main Outcome Measures: Incident congestive HF was measured.

Results: In a multivariable model, each doubling of FGF23 [ie, per log (base 2) unit higher FGF23] was associated with a 29% higher HF risk (hazard ratio, 1.29 [95% confidence interval (CI), 1.07-1.56]). After multivariable adjustment, including estimated glomerular filtration rate, PTH was not related to HF risk (hazard ratio per doubling of PTH, 1.21 [95% CI, 0.99-1.48]). However, an interaction was observed between PTH and obesity, suggesting a relationship with HF risk in obese, but not in nonobese individuals. The hazard ratio for HF per doubling of 25(OH)D3 was 1.02 (95% CI, 0.73-1.41).

Conclusions: Our findings provide epidemiological evidence for a positive relationship between FGF23 and risk of HF. The role of PTH in the development of HF remains unclear, in particular in obese individuals, until further confirmation in other studies. 25(OH)D3 was not related to HF.
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http://dx.doi.org/10.1210/jc.2013-2963DOI Listing
March 2014

Dietary, lifestyle, and genetic determinants of vitamin D status: a cross-sectional analysis from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Germany study.

Eur J Nutr 2014 Apr 5;53(3):731-41. Epub 2013 Sep 5.

Department of Cancer Epidemiology, German Cancer Research Center (DKFZ) Heidelberg, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany,

Purpose: Considerable variation in 25-hydroxyvitamin D (25(OH)D) in populations worldwide that seems to be independent of latitude has been reported. Therefore, we aimed to assess vitamin D status of a mid-aged German general population and to identify its dietary, lifestyle, anthropometric, and genetic determinants.

Methods: 25(OH)D concentrations were measured by LC-MS/MS in plasma samples of a random subcohort of the German arm of the European Prospective Investigation into Cancer and Nutrition (EPIC) comprising 2,100 subjects aged 35-65 years. Associations between potential predictors and 25(OH)D were assessed by linear regression models.

Results: 32.8% of the variance in 25(OH)D was explained by a multivariable regression model, with season being the by far strongest predictor (semi-partial R²: 14.6%). Sex, waist circumference, leisure time physical activity, smoking, polymorphisms in the GC, CYP2R1, and DHCR7 genes, supplement use, exogenous hormone use, alcohol consumption, egg consumption, and fish consumption were significantly associated with 25(OH)D concentrations as well. However, none of these factors explained >2.3% of the variance in 25(OH)D.

Conclusion: Even with a comprehensive set of genetic, anthropometric, dietary, and lifestyle correlates, not more than 32.8% of the variation in 25(OH)D could be explained in the EPIC-Germany study, implying that vitamin D prediction scores may not provide an appropriate proxy for measured 25(OH)D. Food intake was only a weak predictor of 25(OH)D concentrations, while a strong seasonal fluctuation in 25(OH)D was shown.
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http://dx.doi.org/10.1007/s00394-013-0577-8DOI Listing
April 2014
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