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BACKGROUND Gestational weight gain (GWG) has been linked to childhood obesity. However, it is unclear if the timing of weight gain influences offspring body composition. A secondary analysis of a clinical trial examined the influence of total, early, and mid-pregnancy GWG on adiposity outcomes in 186 children at birth, 1, 3, and 5 years. METHODS Early (

Many molecular components in human milk (HM), such as human milk oligosaccharides (HMOs), assist in the healthy development of infants. It has been hypothesized that the functional benefits of HM may be highly dependent on the abundance and individual fine structures of contained HMOs and that distinctive HM groups can be defined by their HMO profiles. However, the structural diversity and abundances of individual HMOs may also vary between milk donors and at different stages of lactations. Improvements in efficiency and selectivity of quantitative HMO analysis are essential to further expand our understanding about the impact of HMO variations on healthy early life development. Hence, we applied here a targeted, highly selective, and semi-quantitative LC-ESI-MS2 approach by analyzing 2 × 30 mature human milk samples collected at 6 and 16 weeks post-partum. The analytical approach covered the most abundant HMOs up to hexasaccharides and, for the first time, also assigned blood group A and B tetrasaccharides. Principal component analysis (PCA) was employed and allowed for automatic grouping and assignment of human milk samples to four human milk groups which are related to the maternal Secretor (Se) and Lewis (Le) genotypes. We found that HMO diversity varied significantly between these four HM groups. Variations were driven by HMOs being either dependent or independent of maternal genetic Se and Le status. We found preliminary evidence for an additional HM subgroup within the Se- and Le-positive HM group I. Furthermore, the abundances of 6 distinct HMO structures (including 6′-SL and 3-FL) changed significantly with progression of lactation. Graphical abstract Electronic supplementary material The online version of this article (10.1007/s00216-020-02819-x) contains supplementary material, which is available to authorized users.

Purpose Orthorexia nervosa (ON) is characterized by a preoccupation to eat healthily and restrictive eating habits despite negative psychosocial and physical consequences. As a relatively new construct, its prevalence and correlates in the general population and the associated utilization of mental health services are unclear. Methods Adults from the general population completed the Düsseldorf Orthorexia Scale (DOS), the Patient Health Questionnaire (PHQ), the Short Eating Disorder Examination (SEED). Results Five-hundred eleven (63.4% female) participants with a mean age of 43.39 (SD = 18.06) completed the questionnaires. The prevalence of ON according to the DOS was 2.3%. Considering only effects of at least intermediate size, independent samples t-tests suggested higher DOS scores for persons with bulimia nervosa (p d = 1.14), somatoform syndrome (p = .012, d = .60), and major depressive syndrome (compared p d = 1.78) according to PHQ as well as those who reported to always experience fear of gaining weight (p d = 1.78). The DOS score correlated moderately strong and positively with the PHQ depression (r = .37, p r = .33, p r = .32, p p = .002) and intake of psychotropic medication in the last year (OR = 1.22, p = .013). Conclusions The prevalence of ON was low compared to international studies but is in line with other non-representative German studies. Orthorexic tendencies related to general mental distress and eating disorder symptoms but were no independent reason for seeking treatment. Level of evidence Level V, cross-sectional descriptive study.

Objective The recommendation for conventional body weight loss (BWL) treatment in obesity is 5-10%. It is not clear whether BWL is similar across the three different body mass index (BMI) obesity classes. The aim was to provide an overview on BWL across these classes in moderate lifestyle/diet intervention programs. Method A systematic literature search was conducted and the evidence of randomized controlled trials (RCTs) and pre-post design studies synthesized. The outcome was BWL. Results For RCTs, mean BWL in the intervention group was 3.6 kg (class I) and 5.3 kg (class II), which equates to 4 and 5% BWL, respectively. None of the assessed class III obesity studies met the inclusion criteria. For pre-post design studies, mean BWL was 5.4 kg (class I), 5.5 kg (class II) and 7.9 kg (class III), with high variation within and across studies in the latter. This equates to 6, 5 and, 6% BWL, respectively. Conclusions BWL of moderate BWL programs are similar across the different obesity classes. For class I obesity, the results differ between RCT and pre-post design studies by 2% BWL. The high variation of BWL in class III obesity might reflect different states of motivation such as the attitude towards bariatric surgery.

Die aktuelle Corona-Pandemie betrifft nahezu alle Bereiche der Medizin und des taglichen Lebens. Dementsprechend haufig tauchen Fragen zum Stellenwert der Ernahrung auf, z. B. welche Ernahrung einen Schutz vor der Corona-Infektion bieten kann und welche Bedeutung die Ernahrung im Krankheitsverlauf hat.

Zusammenfassung Hintergrund Daten zum Ernährungsstatus von Patienten mit Tumorerkrankungen in ambulanten Einrichtungen fehlen in Deutschland. Die durchgeführte Querschnittserhebung bei Patienten mit Tumorerkrankungen hatte daher das Ziel, die Häufigkeit eines Risikos für Mangelernährung bei Tumorpatienten in onkologischen Schwerpunktpraxen zu ermitteln. Methode Patienten mit Tumorerkrankungen wurden mittels eines standardisierten Fragebogens konsekutiv in 17 onkologischen Schwerpunktpraxen in Südbayern zwischen Juni 2017 und Mai 2018 befragt. Neben Fragen zum Gesundheitszustand und zur Ernährung wurden die validierten Screening-Fragebögen Malnutrition Universal Screening Tool (MUST) und Nutritional Risk Screening Tool-2002 (NRS-2002) zur Erfassung des Risikos für Mangelernährung (primärer Endpunkt) eingesetzt. Die statistische Auswertung erfolgte deskriptiv. Ergebnisse Insgesamt wurden Datensätze von 765 Patienten (60,9 % Frauen) ausgewertet. Die Teilnehmer waren im Mittel 63,1 ± 13,1 Jahre alt, der durchschnittliche Body-Mass-Index (BMI) betrug 25,2 ± 5,1 kg/m2. Bei Anwendung des MUST-Fragebogens hatten 15,4 % der Teilnehmer ein mittleres und 19,5 % ein hohes Risiko für eine Mangelernährung. Darunter wiesen am häufigsten Patienten mit Tumoren des Verdauungssystems ein Risiko für eine Mangelernährung auf (46,6 %). Die Kriterien für ein Mangelernährungsrisiko nach dem NRS-2002-Score (≥ 3 Punkte) erfüllten hingegen 29,1 % der befragten Patienten. Weniger als ein Drittel der Tumorpatienten hatte nach Diagnosestellung eine Ernährungsberatung erhalten (29,9 %). Schlussfolgerung Etwa jeder dritte Patient mit einer Tumorerkrankung in ambulanter Betreuung weist ein erhöhtes Risiko für eine Mangelernährung auf. Die Ergebnisse dieser Erhebung unterstreichen die Notwendigkeit für ein systematisches Screening auf Mangelernährung und ein leitliniengerechtes Ernährungsmanagement von Tumorpatienten in der ambulanten Versorgung.

Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes. © 2020 The Author(s) Published by S. Karger AG, Basel.

SCOPE: It is unclear which factors influence the inter-individual variations of postprandial changes in blood glucose. Therefore, we investigated whether the habitual diet is associated with the postprandial glycemic response. METHODS AND RESULTS: Clinical and metabolic data from healthy adults (young adults with 18-25 years, middle-aged adults with 40-65 years, and older adults with 75-85 years) at baseline and during an oral glucose tolerance test (OGTT) was collected. Habitual diet was assessed by a food frequency questionnaire and two 24-hour food lists. Regression models were fitted to examine associations between habitual diet and glucose incremental area under the curve (iAUCmin ). The intake of cereals and cereal products is negatively associated with glucose iAUCmin (p = 0.002) in the total cohort (N = 459, 50% women, 55±21 years, BMI 26±5kg/m2 ). Total carbohydrate intake and the intake of cereals and cereal products predict glucose iAUCmin in the total cohort. Up to 9% of the variance in the glycemic response was explained by the respective dietary parameters identified in the models of the specific age groups. CONCLUSION: These findings suggest, that there are age-specific diet-related effects on postprandial glucose response. Of all investigated dietary parameters, the usual intake of cereals and cereal products seems to play a greater role in postprandial glucose metabolism in more than one age group. Further research is needed, to establish how diet can be optimized based on age and the postprandial response. This article is protected by copyright. All rights reserved.

Evidence suggests that people react differently to the same diet due to inter-individual differences. However, few studies have investigated variation in response to dietary interventions based on individuals' baseline metabolic characteristics. This study aims to examine the differential reaction of metabotype subgroups to an OGTT and a dietary fiber intervention.We assigned 356 healthy participants of an OGTT sub-study and a 12-week dietary fiber intervention sub-study within the enable cluster to three metabotype subgroups previously identified in the KORA F4 study population. To explore the association between plasma glucose level and metabotype subgroups, we used linear mixed models adjusted for age, sex, and physical activity. Individuals in different metabotype subgroups showed differential responses to OGTT. Compared to the healthy metabotype (metabotype 1), participants in intermediate metabotype (metabotype 2) and unfavorable metabotype (metabotype 3) had significantly higher plasma glucose concentrations at 120 min after glucose bolus (β = 7.881, p = 0.005; β = 32.79, p 0.001, respectively). Additionally, the linear regression model showed that the Area under the curve (AUC) of plasma glucose concentrations was significantly different across the metabotype subgroups. The associations between metabotype subgroups and metabolic parameters among fiber intervention participants remained insignificant in the multivariate-adjusted linear model. However, the metabotype 3 had the highest mean reduction in insulin, cholesterol parameters (TC, LDLc, and non-HDLc), and systolic and diastolic blood pressure at the end of the intervention period.This study supports the use of the metabotype concept to identify metabolically similar subgroups and to develop targeted dietary interventions at the metabotype subgroup level for the primary prevention of diet-related diseases.

ZusammenfassungDer Leitfaden Ernährungstherapie in Klinik und Praxis (LEKuP) stellt eine grundlegende Überarbeitung des zuletzt im Jahr 2004 von der Deutschen Akademie für Ernährungsmedizin e. V. (DAEM) herausgegebenen Rationalisierungsschemas dar. Dabei erfolgte die Erstellung des LEKuP in enger Zusammenarbeit der verschiedenen Fachgesellschaften: Deutsche Gesellschaft für Ernährung e. V. (DGE) und die Deutsche Akademie für Ernährungsmedizin e. V. (DAEM) mit der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM), dem Berufsverband Deutscher Ernährungsmediziner e. V. (BDEM), der Deutschen Adipositas-Gesellschaft e. V. (DAG), dem Verband der Diätassistenten – Deutscher Bundesverband e. V. (VDD) und dem Berufsverband Oecotrophologie e. V. (VDOE).Gemeinsames Ziel der beteiligten Fachgesellschaften und -verbände war es, auf Grundlage evidenzbasierter Leitlinien einen aktuellen und konsensbasierten Leitfaden für die praktische Ernährungstherapie in Klinik und Praxis zu verfassen. Ein weiteres Ziel der Überarbeitung war es, damit eine Vorlage zu schaffen, aus der ein Kostformenkatalog für stationäre und ambulante medizinische Einrichtungen nach den lokalen Bedürfnissen abgeleitet werden kann.Die dem LEKuP zugrunde liegenden Empfehlungen basieren auf den D-A-CH-Referenzwerten für die Nährstoffzufuhr der Deutschen Gesellschaft für Ernährung e. V. (DGE) für Erwachsene und entsprechen einer vollwertigen und gesundheitsförderlichen Ernährung. Mittelmeerkost und vegetarische Ernährung werden als gleichwertig betrachtet. Abhängig von krankheitsspezifischen Erfordernissen werden Abweichungen und Ergänzungen vorgenommen, sodass eine Ernährungstherapie umgesetzt werden kann, die alle ernährungsbezogenen Maßnahmen zur Wiederherstellung von Gesundheit und Wiedererlangung des Handlungsvermögens von Patienten darstellt. Der vorliegende Leitfaden beschränkt sich auf die Darstellung der Prinzipien der Ernährungstherapie und deren praktische Umsetzung.

Aging is associated with reduced appetite as well as a slight increase in pro-inflammatory status, which both might contribute to the development of malnutrition. We aimed to evaluate the association between inflammation based on serum C-reactive protein (CRP), and appetite in healthy community-dwelling older adults. In this cross-sectional study of 158 healthy and non-smoking persons (aged 75-85 years), appetite was assessed in personal interviews by a single question with five answer categories. As nobody reported (very) poor appetite, the remaining three categories were dichotomised into "(very) good" and "moderate" appetite. Fasting serum CRP was analysed according to standard procedures, values ≥ 5.0 mg/L were considered as inflammation. The association between inflammation and appetite was examined by binary logistic regression, unadjusted and adjusted for age, sex, waist circumference, leptin, depressive mood, number of medications, interleukin-6 and tumor necrosis factor-α. Appetite was very good in 27.8%, good in 58.9%, and moderate in 13.3% of participants. Inflammation was present in 10.8% overall, in 8.8% of those with (very) good and in 23.8% of those with moderate appetite (

Maternal characteristics around pregnancy may influence obesity risk and neurodevelopment in children. To date, the effect of antenatal lifestyle interventions on long-term child development is unclear. The objective was to investigate the potential long-term effects of an antenatal lifestyle intervention programme conducted alongside routine care on child anthropometrics and neurodevelopment up to 3 years of age. Mother-child pairs from the cluster-randomised GeliS trial were followed up to 3 years of age. Data on child anthropometrics in both groups were collected from routine health examinations. Neurodevelopment was assessed via questionnaire. Of the 2286 study participants, 1644 mother-child pairs were included in the analysis. Children from the intervention group were less likely to score below the cut-off in Fine motor (p = 0.002), and more likely to have a score below the cut-off in Problem-solving (p < 0.001) compared to the control group at 3 years of age. Mean weight, height, head circumference, body mass index, and the respective z-scores and percentiles were comparable between the groups at 2 and 3 years of age. We found no evidence that the lifestyle intervention affected offspring development up to 3 years of age. Further innovative intervention approaches are required to improve child health in the long-term.

Food intake triggers extensive changes in the blood metabolome. The kinetics of these changes depend on meal composition and on intrinsic, health-related characteristics of each individual, making the assessment of changes in the postprandial metabolome an opportunity to assess someone's metabolic status. To enable the usage of dietary challenges as diagnostic tools, profound knowledge about changes that occur in the postprandial period in healthy individuals is needed. In this study, we characterize the time-resolved changes in plasma levels of 634 metabolites in response to an oral glucose tolerance test (OGTT), an oral lipid tolerance test (OLTT), and a mixed meal (SLD) in healthy young males (n = 15). Metabolite levels for samples taken at different time points (20 per individual) during the challenges were available from targeted (132 metabolites) and non-targeted (502 metabolites) metabolomics. Almost half of the profiled metabolites (n = 308) showed a significant change in at least one challenge, thereof 111 metabolites responded exclusively to one particular challenge. Examples include azelate, which is linked to ω-oxidation and increased only in OLTT, and a fibrinogen cleavage peptide that has been linked to a higher risk of cardiovascular events in diabetes patients and increased only in OGTT, making its postprandial dynamics a potential target for risk management. A pool of 89 metabolites changed their plasma levels during all three challenges and represents the core postprandial response to food intake regardless of macronutrient composition. We used fuzzy c-means clustering to group these metabolites into eight clusters based on commonalities of their dynamic response patterns, with each cluster following one of four primary response patterns: (i) “decrease-increase” (valley-like) with fatty acids and acylcarnitines indicating the suppression of lipolysis, (ii) “increase-decrease” (mountain-like) including a cluster of conjugated bile acids and the glucose/insulin cluster, (iii) “steady decrease” with metabolites reflecting a carryover from meals prior to the study, and (iv) “mixed” decreasing after the glucose challenge and increasing otherwise. Despite the small number of subjects, the diversity of the challenges and the wealth of metabolomic data make this study an important step toward the characterization of postprandial responses and the identification of markers of metabolic processes regulated by food intake.

Adipose tissue is an organ with great plasticity and its hypertrophic expansion is associated with adipocyte dysfunction. How changes in adipocyte morphology are linked to gene expression and which cellular functions are affected remains elusive. We show that adipocyte hypertrophy is associated with transcriptomic changes using RNA-Seq data obtained from adipose tissue and size-separated adipocytes. Genes involved in oxidative phosphorylation, protein biosynthesis and fatty acid metabolism were down-regulated in large adipocytes while genes involved in inflammation were upregulated. For mitochondrial function, a reduction in the expression of thermogenesis related genes and estimated brown/beige adipocyte content was observed in individuals with large adipocytes. As a novel finding the total adipose tissue fatty acid composition was dependent on cell size and depot. MR spectroscopy methods for clinical scanning were developed to characterize adipocyte size and fatty acid composition in a fast and non-invasive manner. Together, the present data provides mechanistic insights on how adipocyte hypertrophy contributes to the manifestation of metabolic disease at the molecular and cellular level. MR spectroscopy was identified as a promising technique for an in-parallel assessment of adipose morphology and fatty acid composition allowing to translate our findings into an improved, non-invasive phenotyping of adipose tissue.

IntroductionPrevious efforts to increase fiber intake in the general population were disappointing despite growing awareness of the multiple benefits of a high fiber intake. Aim of the study was to investigate the acceptance and consumption of fiber-enriched foods.MethodsOne hundred and fifteen middle-aged healthy individuals with and without elevated waist circumference (> 102 cm in males and > 88 cm in females) were recruited and randomized to an intervention or an age- and sex-matched control group. Subjects assigned to the intervention group were invited to select fiber-enriched foods from a broad portfolio of products to increase fiber intake by 10 g/day. Control subjects could choose items from the same food basket without fiber enrichment. The primary outcome was the increase in dietary fiber intake, and secondary outcomes were changes in cardiometabolic risk factors, microbiota composition, food choices, and consumer acceptance of the fiber-enriched foods.ResultsCompared to baseline, daily fiber intake increased from 22.5 ± 8.0 to 34.0 ± 9.6 g/day after 4 weeks (p < 0.001) and to 36.0 ± 8.9 g/day after 12 weeks (p < 0.001) in the intervention group, whereas fiber intake remained unchanged in the control group. Participants rated the taste of the food products as pleasant without group differences. In both groups, the most liked foods included popular convenience foods such as pretzel breadstick, pizza salami, and pizza vegetarian. After 12 weeks of intervention, there were minor improvements in plasma lipids and parameters of glucose metabolism in both the intervention and control group compared to baseline, but no differences between the two groups. Increased fiber consumption resulted in an increased (p < 0.001) relative abundance of Tannerellaceae.ConclusionsFiber-enrichment of popular foods increases fiber intake in a middle-aged population with and without cardiometabolic risk and may provide a simple, novel strategy to increase fiber intake in the population.

BackgroundThe difference of proton density fat fraction (PDFF) between supraclavicular and gluteal adipose tissue might indicate the presence of brown adipose tissue (BAT). Aim of this cross-sectional study was to investigate the association between PDFF over the supraclavicular fat region as a proxy of BAT proportion and resting metabolic rate (RMR). In addition, the association between the single nucleotide polymorphism (SNP) rs1421085 at the fat mass and obesity associated (FTO) gene locus and both PDFF and RMR was investigated.MethodsAnthropometric, clinical, and lifestyle data from 92 healthy adults (66.3% females, mean age: 36.2 ± 13.0 years, mean body mass index: 24.9 ± 5.4 kg/m2) were included in the analysis. The RMR was measured by indirect calorimetry. The magnetic resonance imaging (MRI) was used for the measurement of visceral and subcutaneous adipose tissue (VAT, SAT) volumes and for the measurement of adipose tissue PDFF.ResultsMean RMR of the whole group was 1 474.8 ± 242.2 kcal. Genotype data was available for 90 participants. After adjustment for age, sex, weight change and fat-free mass (FFM), no association was found between supraclavicular PDFF (p = 0.346) and gluteal PDFF (p = 0.252), respectively, and RMR, whereas statistically significant evidence for a negative association between delta PDFF (difference between gluteal PDFF and supraclavicular PDFF) and RMR (p = 0.027) was obtained. No statistically significant evidence was observed for per FTO risk allele change in RMR, gluteal and supraclavicular PDFF maps or volumes of VAT and SAT.ConclusionsSupraclavicular PDFF as a surrogate marker of BAT presence is not a determinant of RMR under basal conditions. In the present study, the FTO rs1421085 variant is not associated with either RMR or PDFF. Further studies are needed to elucidate the effect of BAT on RMR.

Lifestyle intervention (LI) can prevent type 2 diabetes, but response to LI varies depending on risk subphenotypes. We tested if prediabetic individuals with low risk benefit from conventional LI and individuals with high risk benefit from an intensification of LI in a multi-center randomized controlled intervention over 12 months with 2 years follow up. 1105 prediabetic individuals based on ADA glucose criteria were stratified into a high- and low-risk phenotype, based on previously described thresholds of insulin secretion, insulin sensitivity and liver fat content. Low-risk individuals were randomly assigned to conventional LI according to the DPP protocol or control (1:1), high-risk individuals to conventional or intensified LI with doubling of required exercise (1:1). A total of 908 (82%) participants completed the study. In high-risk individuals, the difference between conventional and intensified LI in post-challenge glucose change was -0.29 mmol/l [CI:-0.54;-0.04], p=0.025. Liver fat (-1.34 percentage points [CI:-2.17;-0.50], p=0.002) and cardiovascular risk (-1.82[CI:-3.13-0.50],p=0.007) underwent larger reductions with intensified than with conventional LI. During a follow up of 3 years, intensified compared to conventional LI had a higher probability to normalize glucose tolerance (p=0.008). In conclusion, it is possible in high-risk individuals with prediabetes to improve glycemic and cardiometabolic outcomes by intensification of LI. Individualized, risk-phenotype-based LI may be beneficial for the prevention of diabetes.

In this study, the associations of cervical and lumbar paraspinal musculature based on a texture analysis of proton density fat fraction (PDFF) maps were investigated to identify gender- and anatomical location-specific structural patterns. Seventy-nine volunteers (25 men, 54 women) participated in the present study (mean age ± standard deviation: men: 43.7 ± 24.6 years; women: 37.1 ± 14.0 years). Using manual segmentations of the PDFF maps, texture analysis was performed and texture features were extracted. A significant difference in the mean PDFF between men and women was observed in the erector spinae muscle (p < 0.0001), whereas the mean PDFF did not significantly differ in the cervical musculature and the psoas muscle (p > 0.05 each). Among others, Variance(global) and Kurtosis(global) showed significantly higher values in men than in women in all included muscle groups (p < 0.001). Not only the mean PDFF values (p < 0.001) but also Variance(global) (p < 0.001), Energy (p < 0.001), Entropy (p = 0.01), Homogeneity (p < 0.001), and Correlation (p = 0.037) differed significantly between the three muscle compartments. The cervical and lumbar paraspinal musculature composition seems to be gender-specific and has anatomical location-specific structural patterns.

Olfactory function and nutrition are closely related and may influence each other via metabolic parameters. However, the relationship between nutritional blood parameters and olfactory performance is still unclear. Inconclusive findings exist for specific blood parameters. In this extensive analysis, we examined the relationship between olfactory performance, measured with MONEX-40, as well as intensity and pleasantness ratings with 38 metabolic blood parameters, age, sex, and the anthropometric measurements body mass index (BMI) and body fat percentage (BFP). Therefore, we included data of 418 healthy, well-phenotyped Caucasians of the Enable cohort. We replicated age-dependent olfactory identification scores (p < 0.001) and found slight evidence for a body fat dependence measured with BFP (BF10 = 10.466). We further identified a sex difference only in middle-aged adults (p < 0.001) that could be explained by environmental factors. Several blood parameters correlated significantly with the MONEX-40 score (p < 0.05 – p < 0.001). However, these effects diminished after adjusting for sex and age (p > 0.9) that were identified as confounders. The same applies for BFP. In addition, no parameters were identified to correlate significantly with perceived olfactory intensity or pleasantness score if controlled for sex and age (p > 0.08). Our results suggest that metabolic blood parameters are not related to olfactory identification performance in a relevant manner and highlight the importance of controlling for sex and age in chemosensory research.

D-Allulose, also referred to as psicose, is a C3-epimer of D-fructose used as a sugar substitute in low energy products. It can be formed naturally during processing of food and drinks containing sucrose and fructose or is prepared by chemical synthesis or via enzymatic treatment with epimerases from fructose. Estimated intakes via Western style diets including sweetened beverages are below 500 mg per d but, when used as a sugar replacement, intake may reach 10 to 30 g per d depending on the food consumed. Due to its structural similarity with fructose, allulose uses the same transport and distribution pathways. But in contrast to fructose, the human genome does not encode for enzymes that are able to metabolise allulose leading to an almost complete renal excretion of the absorbed dose and near-to-zero energetic yield. However, in vitro studies have shown that certain bacteria such as Klebsiella pneumonia are able to utilise allulose as a substrate. This finding has been a subject of concern, since Klebsiella pneumoniae represents an opportunistic human pathogen. It therefore raised the question of whether a high dietary intake of allulose may cause an undesirable growth advantage for potentially harmful bacteria at mucosal sites such as the intestine or at systemic sites following invasive infection. In this brief review, we discuss the current state of science on these issues and define the research needs to better understand the fate of allulose and its metabolic and microbiological effects when ingested as a sugar substitute.

Effective policies to address poor food choices and dietary patterns need to consider the complex set of motives affecting eating behavior. This study examined how different eating motives are associated with anthropometry, body composition, and dietary intake. Our analysis is based on a cross-sectional sample with 429 healthy adults in three different age groups collected in Germany from 2016 to 2018. Dietary intake, Body Mass Index (BMI), waist circumference (WC), and fat-free mass (FFM) were measured by standardized methods. Eating motives were measured using The Eating Motivation Scale (TEMS). Regressing dietary intakes and anthropometric indicators on TEMS motives, we identify the main sources of variation in diet and nutritional status separately for men and women. Results indicated the Health motive to be positively associated with FFM (B±SE=1.72±0.44) and negatively with WC (B±SE=-3.23±0.81) for men. For women, the Need & Hunger motive was positively associated with FFM (B±SE=1.63±0.44) and negatively with WC (B±SE=-2.46±0.81). While Liking and Habits were the most frequently stated eating motives, we did not find them to be significantly related to the nutritional status. Other motives were associated with dietary intake but not anthropometry or body composition. The Price motive was positively and the Convenience motive was negatively associated with energy (B±SE=63.77±19.98;B±SE=-46.96±17.12) and carbohydrate intake (B±SE=7.15±2.65;B±SE=-5.98±2.27) for men. The results highlight the need for more differentiated analyses of eating motives, beyond comparing the relative importance of motives based on mean values, towards the association of motives with dietary intake and nutritional status.

SummaryA primary obstacle in translating genetics and genomics data into therapeutic strategies is elucidating the cellular programs affected by genetic variants and genes associated with human diseases. Broadly applicable high-throughput, unbiased assays offer a path to rapidly characterize gene and variant function and thus illuminate disease mechanisms. Here, we report LipocyteProfiler, an unbiased high-throughput, high-content microscopy assay that is amenable to large-scale morphological and cellular profiling of lipid-accumulating cell types. We apply LipocyteProfiler to adipocytes and hepatocytes and demonstrate its ability to survey diverse cellular mechanisms by generating rich context-, and process-specific morphological and cellular profiles. We then use LipocyteProfiler to identify known and novel cellular programs altered by polygenic risk of metabolic disease, including insulin resistance, waist-to-hip ratio and the polygenic contribution to lipodystrophy. LipocyteProfiler paves the way for large-scale forward and reverse phenotypic profiling in lipid-storing cells, and provides a framework for the unbiased identification of causal relationships between genetic variants and cellular programs relevant to human disease.

The obesity-linked FTO regulatory circuitry shows cross-species molecular, cellular, metabolic, and organismal conservation., Variants in FTO have the strongest association with obesity; however, it is still unclear how those noncoding variants mechanistically affect whole-body physiology. We engineered a deletion of the rs1421085 conserved cis-regulatory module (CRM) in mice and confirmed in vivo that the CRM modulates Irx3 and Irx5 gene expression and mitochondrial function in adipocytes. The CRM affects molecular and cellular phenotypes in an adipose depot–dependent manner and affects organismal phenotypes that are relevant for obesity, including decreased high-fat diet–induced weight gain, decreased whole-body fat mass, and decreased skin fat thickness. Last, we connected the CRM to a genetically determined effect on steroid patterns in males that was dependent on nutritional challenge and conserved across mice and humans. Together, our data establish cross-species conservation of the rs1421085 regulatory circuitry at the molecular, cellular, metabolic, and organismal level, revealing previously unknown contextual dependence of the variant’s action.

Die Zahl der Menschen, die sich vegan ernahren, ist niedrig. Allerdings interessieren sich besonders Frauen im gebarfahigen Alter fur das Thema — ein Problem, da vegane Ernahrung zu Mangelerscheinungen fuhren kann. Sie sollten deshalb eine seriose Ernahrungsberatung empfehlen, kritische Nahrstoffe uberprufen und ggf. substituieren.

Purpose Inter-individual metabolic differences may be a reason for previously inconsistent results in diet–diabetes associations. We aimed to investigate associations between dietary intake and diabetes for metabolically homogeneous subgroups (‘metabotypes’) in a large cross-sectional study. Methods We used data of 1517 adults aged 38–87 years from the German population-based KORA FF4 study (2013/2014). Dietary intake was estimated based on the combination of a food frequency questionnaire and multiple 24-h food lists. Glucose tolerance status was classified based on an oral glucose tolerance test in participants without a previous diabetes diagnosis using American Diabetes Association criteria. Logistic regression was applied to examine the associations between dietary intake and diabetes for two distinct metabotypes, which were identified based on 16 biochemical and anthropometric parameters. Results A low intake of fruits and a high intake of total meat, processed meat and sugar-sweetened beverages (SSB) were significantly associated with diabetes in the total study population. Stratified by metabotype, associations with diabetes remained significant for intake of total meat (OR 1.67, 95% CI 1.04–2.67) and processed meat (OR 2.23, 95% CI 1.24–4.04) in the metabotypes with rather favorable metabolic characteristics, and for intake of fruits (OR 0.83, 95% CI 0.68–0.99) and SSB (OR:1.21, 95% CI 1.09–1.35) in the more unfavorable metabotype. However, only the association between SSB intake and diabetes differed significantly by metabotype (p value for interaction = 0.01). Conclusions Our findings suggest an influence of metabolic characteristics on diet–diabetes associations, which may help to explain inconsistent previous results. The causality of the observed associations needs to be confirmed in prospective and intervention studies. Electronic supplementary material The online version of this article (10.1007/s00394-019-01988-5) contains supplementary material, which is available to authorized users.

2012 hatte das Netzwerk Gesund ins Leben erstmalig Empfehlungen herausgegeben, die sich mit der Ernährung und dem Lebensstil in der Schwangerschaft befassen. Behandelt werden unter anderem Themen wie Körpergewicht, Nährstoffbedarf, Supplemente und körperliche Aktivität. Diese Empfehlungen wurden nun aktualisiert und um das Thema präkonzeptioneller Lebensstil ergänzt. Eine Zusammenfassung von Katharina Kerlen-Petri.

Recent studies have suggested that obesity is associated with an increased intestinal permeability as well as an altered microbiota profile. These conditions can promote the translocation of lipopolysaccharide into the circulation and, subsequently, contribute to the observed systemic inflammation. Our aim was to assess gut permeability in patients with obesity compared to non-obese subjects as well as after excessive weight loss following laparoscopic sleeve gastrectomy (LSG). We analyzed the dietary intake, metabolic and inflammatory markers, gut permeability (four-probe sugar test), and microbiota composition in 17 morbidly obese patients before and after LSG as well as in 17 age- and gender-matched non-obese subjects. Additionally, we compared gut permeability and inflammatory markers in patients of different stages of obesity. Patients with obesity showed elevated levels of C-reactive protein and lipopolysaccharide-binding protein as compared to non-obese subjects, but no differences were noted for gut permeability between these two groups. LSG led to improvements in metabolic and inflammatory parameters in the obese patients. Moreover, gastroduodenal as well as small intestinal permeability decreased, whereas colonic permeability increased after surgery. Regarding gut microbiota, differences were noted for main phyla and alpha-diversity between non-obese and obese subjects. After surgery, the composition of the microbiota showed a tendency toward the pattern of the non-obese group. Gut permeability is not dependent on body mass index, whereas weight loss after LSG initiates distinct changes in gastroduodenal, intestinal, and colonic permeability. These changes do not seem to be associated with changes in the microbiota composition. The trials were registered at https://www.drks.de/drks_web/ with the number DRKS00009008 and DRKS00006210.

ZusammenfassungExperten sind sich einig, dass ein gesunder pränataler Lebensstil besonders wichtig ist, um gesundheitliche Risiken für Mutter und Kind zu minimieren. Welche Bedeutung dabei die Gewichtszunahme in der Schwangerschaft hat, inwiefern sich diese auf das Risiko für Komplikationen wie Schwangerschaftsdiabetes auswirkt und wie schwangere Frauen ausreichend informiert und unterstützt werden können, ist Thema dieses Beitrags.

PURPOSE The in vivo probing of restricted diffusion effects in large lipid droplets on a clinical MR scanner remains a major challenge due to the need for high b-values and long diffusion times. This work proposes a methodology to probe mean lipid droplet sizes using diffusion-weighted MRS (DW-MRS) at 3T. METHODS An analytical expression for restricted diffusion was used. Simulations were performed to evaluate the noise performance and the influence of particle size distribution. To validate the method, oil-in-water emulsions were prepared and examined using DW-MRS, laser deflection and light microscopy. The tibia bone marrow was scanned in volunteers to test the method repeatability and characterize microstructural differences at different locations. RESULTS The simulations showed accurate and precise droplet size estimation when a sufficient SNR is reached with minor dependence on the size distribution. In phantoms, a good correlation between the measured droplet sizes by DW-MRS and by laser deflection (R2 = 0.98; P = 0.01) and microscopy (R2 = 0.99; P \textless 0.01) measurements was obtained. A mean coefficient of variation of 11.5 % was found for the lipid droplet diameter in vivo. The average diameter was smaller at a proximal (50.1 $\pm$ 7.3 µm) compared with a distal tibia location (61.1 $\pm$ 6.8 µm) (P \textless 0.01). CONCLUSION The presented methods were able to probe restricted diffusion effects in lipid droplets using DW-MRS and to estimate lipid droplet size. The methodology was validated using phantoms and the in vivo feasibility in bone marrow was shown based on a good repeatability and findings in agreement with literature.

BACKGROUND: To study the spatial heterogeneity of liver fat fraction changes during a long-term lifestyle intervention study using magnetic resonance imaging (MRI). METHODS: Thirty-two subjects underwent two MRI-scans in a span of one year. A chemical shift encoding-based water-fat separation method was applied to measure liver proton density fat fraction (PDFF) maps. The PDFF changes in the two liver lobes and the Couinaud segments were compared with the mean liver PDFF change. RESULTS: The slope of the relationship between mean liver PDFF changes and PDFF liver lobe changes was higher in the right compared to the left lobe (slope(mean PDFF whole liver ~ mean PDFF right lobe) =1.08, slope(mean PDFF whole liver ~ mean PDFF left lobe) =0.93, P

Cold-induced non-shivering thermogenesis (CIT) of the human body is currently discussed as an important contributor to energy metabolism, and miRNAs have recently been reported as key regulators of metabolism. Identifying the link of CIT and circulating microRNAs (miRNAs) in a large cohort of human individuals remains elusive to date. Here, we analyzed a set of 158 miRNAs in the serum of 97 female and 72 male healthy individuals before and after cold exposure (CE). Validating the results of a miRNA array, a significant down-regulation of miR-375 was measured in individuals after CIT (P

Activation of brown adipose tissue may increase energy expenditure by non-shivering thermogenesis. Cold exposure is one of the options to activate brown adipocytes. To link changes in energy metabolism with microRNA expression (miRNAs), we analyzed 158 miRNAs in serum of 169 healthy individuals before and after cold exposure. Validating the results of a miRNA array, a significant down-regulation of miR-375 after cold exposure (P 0.0001) was detected. These changes went along with a significant negative correlation between miR-375 and visceral adipose tissue (VAT) mass (P 0.0001), implicating a specific function of miR-375 in this depot. Significantly higher expression levels of miR-375 were found in VAT in comparison to subcutaneous fat (SAT). Using in silico prediction, we identified putative miR-375 target genes involved in the thermogenesis pathway. Cold-stimulation of subcutaneous and visceral pre-adipocytes (PACs) led to significantly higher expression levels of FABP4, FGF21, PPARGC1A and PRDM16 in VC-PACs. Analyzing miR-375 knock down and cold stimulated VC-PACs revealed a significant up-regulation of thermogenesis associated genes PPARGC1A, ELOVL3 and PRDM16. In summary, our findings identified miR-375 as a potential adipogenic and thermogenesis-associated miRNA exclusively acting in visceral adipose tissue.

Lifestyle interventions during pregnancy were shown to beneficially influence maternal dietary behaviour and physical activity, but their effect on health behaviour after delivery is unclear. The objective of this secondary analysis was to investigate the sustained effect of a lifestyle intervention in routine care on maternal health behaviour during the first year postpartum. The cluster-randomised controlled “Healthy living in pregnancy” (GeliS) study included 2286 pregnant women. Data on maternal health behaviour were collected at 6–8 weeks (T1pp) and one year postpartum (T2pp) using validated questionnaires. The intervention group showed a lower mean intake of fast food (T1pp: p = 0.016, T2pp: p &lt, 0.001) and soft drinks (T1pp: p &lt, 0.001), a higher mean intake of vegetables (T2pp: p = 0.015) and was more likely to use healthy oils for meal preparation than the control group. Dietary quality rated by a healthy eating index was higher in the intervention group (T1pp: p = 0.093, T2pp: p = 0.043). There were minor trends towards an intervention effect on physical activity behaviour. The proportion of smokers was lower in the intervention group (p &lt, 0.001, both time points). The lifestyle intervention within routine care modestly improved maternal postpartum dietary and smoking behaviours.

Knowledge of the association between single nucleotide polymorphisms (SNPs) and weight loss is limited. The aim was to analyse whether selected obesity-associated SNPs within the fat mass and obesity-associated (FTO), transmembrane protein 18 (TMEM18), melanocortin-4 receptor (MC4R), SEC16 homolog B (SEC16B), and brain-derived neurotrophic factor (BDNF) gene are associated with anthropometric changes during behavioural intervention for weight loss. genetic and anthropometric data from 576 individuals with overweight and obesity from four lifestyle interventions were obtained. A genetic predisposition score (GPS) was calculated. Our results show that study participants had a mean age of 48.2 ± 12.6 years and a mean baseline body mass index of 33.9 ± 6.4 kg/m2. Mean weight reduction after 12 months was −7.7 ± 10.9 kg. After 12 months of intervention, the MC4R SNPs rs571312 and rs17782313 were significantly associated with a greater decrease in body weight and BMI (p = 0.012, p = 0.011, respectively). The investigated SNPs within the other four genetic loci showed no statistically significant association with changes in anthropometric parameters. The GPS showed no statistically significant association with weight reduction. In conclusion there was no consistent evidence for statistically significant associations of SNPs with anthropometric changes during a behavioural intervention. It seems that other factors play a more significant in weight management than the investigated SNPs.

We want to understand the changing shopping behaviour, influenced by health-targeting nutrition apps on mobile devices. To achieve that, we have built a realistic Virtual Reality (VR) supermarket simulation and addressed core aspects such as handling virtual products, prevention of cybersickness, rounded off with an initial pilot study. On top of that, we built a virtual replica smartphone in VR with nutritionrelated functionality. This has been extended with an Augmented Virtuality (AV) feature, that enables us to track the screen of a participant’s own smartphone, hence allowing us to integrate real-world apps and letting the user interact with them during the simulation. To achieve a high-quality tracking, we propose a hybrid approach, utilizing an add-on RGB camera on the VR headset fused with data provided through a WLAN connection in the case of self-made apps. This enables the users to manipulate the simulation from within the smartphone app, introducing a versatile, highly usability-centered controller because they can handle their phone naturally.

Background Fusobacterium nucleatum (Fn), a bacterium associated with a wide spectrum of infections, has emerged as a key microbe in colorectal carcinogenesis. However, the underlying mechanisms and clinical relevance of Fn in colorectal cancer (CRC) remain incompletely understood. Patients and Methods We examined associations between Fn abundance and clinicopathologic characteristics among 105 treatment-naive CRC patients enrolled in the international, prospective ColoCare Study. Electronic medical charts, including pathological reports, were reviewed to document clinicopathologic features. Quantitative real-time polymerase chain reaction (PCR) was used to amplify/detect Fn DNA in preoperative fecal samples. Multinomial logistic regression was used to analyze associations between Fn abundance and patient sex, age, tumor stage, grade, site, microsatellite instability, body mass index (BMI), alcohol consumption, and smoking history. Cox proportional hazards models were used to investigate associations of Fn abundance with overall survival in adjusted models. Results Compared to patients with undetectable or low Fn abundance, patients with high Fn abundance (n = 22) were 3-fold more likely to be diagnosed with rectal versus colon cancer (odds ratio [OR] = 3.01; 95% confidence interval [CI], 1.06-8.57; P = .04) after adjustment for patient sex, age, BMI, and study site. Patients with high Fn abundance also had a 5-fold increased risk of being diagnosed with rectal cancer versus right-sided colon cancer (OR = 5.32; 95% CI, 1.23-22.98; P = .03). There was no statistically significant association between Fn abundance and overall survival. Conclusion Our findings suggest that Fn abundance in fecal samples collected prior to surgery varies by tumor site among treatment-naive CRC patients. Overall, fecal Fn abundance may have diagnostic and prognostic significance in the clinical management of CRC.

Purpose To develop a methodology for probing lipid droplet sizes with a clinical system based on a diffusion-weighted stimulated echo-prepared turbo spin-echo sequence and to validate the methodology in water-fat emulsions and show its applicability in ex vivo adipose-tissue samples. Methods A diffusion-weighted stimulated echo-prepared preparation was combined with a single-shot turbo spin-echo readout for measurements at different b-values and diffusion times. The droplet size was estimated with an analytical expression, and three fitting approaches were compared: magnitude-based spatial averaging with voxel-wise residual minimization, complex-based spatial averaging with voxel-wise residual minimization, and complex-based spatial averaging with neighborhood-regularized residual minimization. Simulations were performed to characterize the fitting residual landscape and the approaches' noise performance. The applicability was assessed in oil-in-water emulsions in comparison with laser deflection and in ten human white adipose tissue samples in comparison with histology. Results The fitting residual landscape showed a minimum valley with increasing extent as the droplet size increased. In phantoms, a very good agreement of the mean droplet size was observed between the diffusion-weighted MRI-based and the laser deflection measurements, showing the best performance with complex-based spatial averaging with neighborhood-regularized residual minimization processing (R2 /P: 0.971/0.014). In the human adipose-tissue samples, complex-based spatial averaging with neighborhood-regularized residual minimization processing showed a significant correlation (R2 /P: 0.531/0.017) compared with histology. Conclusion The proposed acquisition and parameter-estimation methodology was able to probe restricted diffusion effects in lipid droplets. The methodology was validated using phantoms, and its feasibility in measuring an apparent lipid droplet size was demonstrated ex vivo in white adipose tissue.

BackgroundLifestyle intervention (LI) can successfully prevent type 2 diabetes, but response to LI strongly varies depending on risk subphenotypes. We tested if individuals with prediabetes and a high-risk phenotype benefit from an intensification of LI.Methods and findingsWe conducted a risk stratified multicenter randomized controlled intervention study over 12 months with additional 2 year follow up. In eight University Hospitals in Germany, 1105 individuals (female 59%, age 58±11 years, BMI 31.1±6.0 kg/m2 (mean±SD)) with impaired fasting glucose and/or impaired glucose tolerance were included between May 2012 and May 2016 in the study. Participants were stratified into 2 groups; a high- and low-risk phenotype, based on insulin secretion, insulin sensitivity and liver fat content. Low-risk individuals were randomly assigned to conventional LI or control (1:1), high-risk individuals to conventional or intensified LI (1:1), each over one year. Intensified LI included doubling of physical exercise and time of counselling. The primary endpoint was change in post-challenge glucose levels, assessed by frequently sampled oral glucose tolerance tests. Secondary endpoints included changes in liver fat content, assessed by magnetic resonance spectroscopy. A total of 908 (82%) participants completed the study after 12 months of LI. In high-risk individuals, the mean difference estimate between conventional and intensified LI in change in post-challenge glucose levels from baseline was −0.290 mmol/l [CI: −0.544;−0.036], p=0.025. Liver fat content was more reduced by intensified LI than by conventional LI (mean difference estimate: −1.34 percentage points [CI: −2.17;−0.50], p=0.002), and cardiovascular risk decreased stronger with intensified LI than with conventional LI (mean difference estimate −1.82 [CI: −3.13−0.50], p=0.007). In low-risk individuals, conventional LI was not superior to control in reducing postprandial glucose, liver fat or cardiovascular risk. During the total observation period of 3 years, high-risk participants with intensified LI had a higher probability to normalize glucose tolerance compared to conventional LI (p=0.003). The limitations of this study include a relative short duration of LI, a non-completer rate of 18% and an underrepresentation of low risk individuals.ConclusionsIn high-risk individuals with prediabetes it is possible to improve glycemic and cardiometabolic outcomes by intensification of the commonly recommended conventional LI. Our results show that individualized, risk-phenotype-based LI can be implemented for the prevention of diabetes.RegistrationNCT01947595Author summaryWhy Was This Study Done?Clinical trials in individuals with prediabetes have shown that the onset of type 2 diabetes can be delayed or prevented with lifestyle intervention.Among individuals with prediabetes, there is a large variability in the response to lifestyle intervention.It is unknown whether an intensification of intervention is able to improve the beneficial response.What Did the Researchers Do and Find?The present multicenter, risk stratified randomized and controlled intervention trial in 1105 German individuals with prediabetes prospectively confirms the existence of a high-risk prediabetes phenotypeThe intensification of lifestyle intervention in high-risk individuals improves the glycemic outcome after 1 year of lifestyle intervention, and additionally results in a higher frequency of regression to normal glucose tolerance after 3 years of follow up..Intensification of lifestyle intervention results in a larger reduction of liver fat content and stronger improves cardiometabolic outcomes in high-risk individuals.What Do These Findings Mean?Strategies for the prevention of type 2 diabetes should include risk stratification and individualised interventions.Our results highlight a dose-effect relationship for lifestyle intervention and suggest that “one size fits NOT all” in the field of diabetes prevention.It remains to be clarified whether low risk individuals benefit from lifestyle intervention, as there was a low number of individuals in this risk group in the current study.

Soluble dietary fibers (SDF) are known to reduce the post-prandial plasma glucose levels. However, the detailed mechanisms of this reduced glucose release in the human gut still remain unclear. The aim of our study was to systematically investigate the effect of different types of SDF on glucose release in an in vitro model as a prerequisite for the selection of fibers suitable for application in humans. Three types of carboxymethyl cellulose (CMC) were used to investigate the correlations between fiber concentration, molecular weight (MW), and viscosity on diffusion of glucose using a side-by-side system. CMC solutions below the coil overlap (c*) influenced the glucose diffusivity only marginally, whereas at concentrations above c* the diffusion of glucose was significantly decreased. Solutions of lower MW exhibited a lower viscosity with lower glucose diffusion compared to solutions with higher MW CMC, attributed to the higher density of the solutions. All CMC solutions showed a systematic positive deviation from Stokes-Einstein behavior indicating a greater rise in viscosity than reduction in diffusion. Therefore, our results pave the way for a new approach for assessing glucose diffusion in solutions comprising dietary fibers and may contribute to further elucidating the mechanisms of post-prandial plasma glucose level reduction.

Objectives To identify the effects of the first lockdown in Germany (March to May 2020) on glycemic control, BMI, and cardiovascular risk factors in persons with type 2 diabetes. Methods The nationwide Disease Analyzer database includes a representative panel of physicianś practices in Germany providing anonymized real-world patient data. For metabolic and renal factors, we estimated absolute changes of means comparing outcomes from June to November 2020 to outcomes in the same persons from June to November 2019, and June to November 2018, respectively. Results In 32,399 patients with type 2 diabetes, HbA1c change between 2019 and 2020 was + 0.04% (95 %CI: 0.03%; 0.05%) compared to −0.02% (95 %CI: −0.03%; −0.01%) between 2018 and 2019. Metabolic risk factors and creatinine changed only little between June to November 2019 and June to November 2020. The proportions of patients with BMI ≥ 30 kg/m2 were 56%, 55%, and 54% in June to November 2018, 2019, and 2020, respectively. The corresponding proportions for HbA1c > 53 mmol/mol Hb (>7.0%) were 39%, 39%, and 40%. Conclusions There is little evidence that the first COVID-19 lockdown in Germany had a short-term harmful influence on acute health care outcomes and vascular risk factors in people with type 2 diabetes.

Children get infected by SARS-CoV-2; however, compared to adults, they are far more likely to be asymptomatic shedders and have a relatively low risk of developing severe disease [1, 2]. Therefore, it has been assumed that the COVID-19 pandemic would induce little adverse health effects in children. However, concern was been raised that the COVID-19 pandemic will most likely aggravate food shortages and undernutrition among children in low- and low-medium-income countries [3]. In contrast, an online survey including 1,097 adults in Poland reported a greater degree of snacking (52%) and eating more (43%) during the nationwide quarantine due to the COVID-19 pandemic [4]. Almost 30% experienced weight gain, with a mean reported increase of 3 kg, while over 18% reported a mean weight loss of 3 kg. Data are lacking on possible effects of the pandemic in children in high-income countries. We hypothesized that the consequences of the pandemic, such as social distancing and closure of educational institutions, will affect dietary practices and related health indicators in children and their families. To explore this question, we performed a representative survey on dietary practices and health issues among German families. We designed a questionnaire with 15 questions. The questionnaire was applied in an online survey performed by the Forsa Institute for Social Research and Statistical Analysis (forsa Politik- und Sozialforschung GmbH, Berlin, Germany) during the time period of September 11–16, 2020. Standard questions on sociodemographic characteristics were included, but in order to keep the survey short, no information on migrant background was collected. Parents were advised to answer the questions in relation to the pandemic-induced changes during the preceding 6 months. During this time, the consequences of the pandemic in Germany included social distancing and reduced face-to-face meetings of people, a change to working in home office for many employees, and the at least partial closure of most day cares and schools and many sports facilities. Participants of this survey were 1,000 parents (age 20–65 years) with at least 1 child up to the age of 14 years living in the same household. The parents were selected with a systematic random method established by the Forsa Institute (forsa.ominet), considered to obtain a representative population sample. Almost two-thirds (64%) of the participating parents reported that they, or the other parent, or both, worked in home office, with equal proportions working (almost) fully or only partly in home office (Table 1). Working in the home office was more common among parents with completed higher or university education (79%) and those with high incomes (80% of those with a monthly family income of >4,500€). The proportion of parents fully working in home office increased with the size of the community they lived in (20% in communities with 500,000), whereas the child's age was not consistently related to working in home office. Parents reported eating more often healthier diets (14%) and cooking more at home for their child (30%), with higher proportions among those who worked mostly in home office (20 and 43%, respectively). About equal numbers near 10% reported an increase or decrease of using home delivery of foods or takeout foods, respectively (Table 1). Some 27% of parents reported having gained weight since the start of the pandemic, with equal proportions among mothers and fathers, and no clear association with income, community size, or child age. An increase of children's body weight during the pandemic was reported by 9%, with a much greater prevalence of 23% among children whose parents had a low level of school education (