Ursula Krämer

Publications of Ursula Krämer

• Association of gas cooking with children's respiratory health: results from GINIplus and LISAplus birth cohort studies.

  Authors: Lidia Casas, Christina Tischer, Carla Tiesler, Irene Brüske, Sibylle Koletzko, Carl-Peter Bauer, H-Erich Wichmann, Andrea von Berg, Dietrich Berdel, Ursula Krämer, Beate Schaaf, Irina Lehmann, Olf Herbarth, Joachim Heinrich

  Indoor air. 04/2012;

  Previous studies have found inconsistent results on the association between asthma in children and gas cooking emissions. We aimed to assess the effects of the long term exposure to gas cooking onPrevious studies have found inconsistent results on the association between asthma in children and gas cooking emissions. We aimed to assess the effects of the long term exposure to gas cooking on the onset of asthma and respiratory symptoms, focusing on wheezing, in children from two German birth cohorts: LISAplus and GINIplus. A total of 5078 children were followed until the age of 10 years. Asthma, wheezing, gas cooking, and exposure to other indoor factors were assessed through parental reported questionnaires administered periodically. Logistic and multinomial regressions adjusting for potential confounders were performed. Asthma and persistent wheezing prevalences were higher among children exposed to gas cooking but the results were not statistically significant. Exposure to gas cooking was positively associated (p-value<0.05) with exposure to other indoor factors (dampness, environmental tobacco smoke, and pets). Our results did not show a statistically significant association between the exposure to gas cooking and children's respiratory health. © 2012 John Wiley & Sons A/S.

• Indoor factors and behavioural problems in children: The GINIplus and LISAplus birth cohort studies.

  Authors: Lidia Casas, Carla Tiesler, Elisabeth Thiering, Irene Brüske, Sibylle Koletzko, Carl-Peter Bauer, H-Erich Wichmann, Andrea von Berg, Dietrich Berdel, Ursula Krämer, Beate Schaaf, Irina Lehmann, Olf Herbarth, Jordi Sunyer, Joachim Heinrich

  International journal of hygiene and environmental health. 04/2012;

  Indoor microbial agents exposure is associated to depressive symptoms in adults and persistent exposure to indoor mould is associated to poorer cognitive function in children. In our study, we aimedIndoor microbial agents exposure is associated to depressive symptoms in adults and persistent exposure to indoor mould is associated to poorer cognitive function in children. In our study, we aimed to assess the effects of the exposure to indoor factors associated with increased microbial exposure (mould, dampness and pets) on behavioural problems in children aged 10 years, participating in two German birth cohorts. A total of 4860 children were followed until the age of 10years, and the strengths and difficulties questionnaire (SDQ) was administered to the parents. Indoor factors were assessed through parental reported questionnaires in periodical surveys. Logistic and multinomial regressions adjusting for potential confounders were performed. Prevalences of borderline/abnormal total scores in the SDQ at 10years of age were higher in children exposed to mould (aOR=1.23, 95%CI=1.00-1.56), dampness (aOR=1.51, 95%CI=1.10-2.07), and pets (aOR=1.48, 95%CI=1.20-1.94). The dimension "emotional symptoms" showed statistically significant risk estimates for mould and pets, meanwhile "conduct problems" and "hyperactivity/inattention" dimensions only did for pets. No significant associations were found for the "peer relationship problems" dimension. We found a significant strong interaction between dampness and pet, the risk of borderline/abnormal scores in the "total difficulties" scale and the "emotional symptoms" dimension for pets' was at least twice the risk in children with reported dampness than in children without. Our findings point to a potential effect of microbial exposure on children's behavioural problems, especially on emotional disorders, probably mediated through neurotoxicity and immune system activation.

• Birth weight and prenatal exposure to polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE): a meta-analysis within 12 European Birth Cohorts.

  Authors: Eva Govarts, Mark Nieuwenhuijsen, Greet Schoeters, Ferran Ballester, Karolien Bloemen, Michiel de Boer, Cécile Chevrier, Merete Eggesbø, Mònica Guxens, Ursula Krämer [......] Rémy Slama, Hein Stigum, Gunnar Toft, Tomas Trnovec, Stéphanie Vandentorren, Pál Weihe, Nynke Weisglas Kuperus, Michael Wilhelm, Jürgen Wittsiepe, Jens Peter Bonde

  Environmental health perspectives. 02/2012; 120(2):162-70.

  Exposure to high concentrations of persistent organochlorines may cause fetal toxicity, but the evidence at low exposure levels is limited. Large studies with substantial exposure contrasts andExposure to high concentrations of persistent organochlorines may cause fetal toxicity, but the evidence at low exposure levels is limited. Large studies with substantial exposure contrasts and appropriate exposure assessment are warranted. Within the framework of the EU (European Union) ENRIECO (ENvironmental Health RIsks in European Birth Cohorts) and EU OBELIX (OBesogenic Endocrine disrupting chemicals: LInking prenatal eXposure to the development of obesity later in life) projects, we examined the hypothesis that the combination of polychlorinated biphenyls (PCBs) and dichlorodiphenyldichloroethylene (DDE) adversely affects birth weight. We used maternal and cord blood and breast milk samples of 7,990 women enrolled in 15 study populations from 12 European birth cohorts from 1990 through 2008. Using identical variable definitions, we performed for each cohort linear regression of birth weight on estimates of cord serum concentration of PCB-153 and p,p´-DDE adjusted for gestational age and a priori selected covariates. We obtained summary estimates by meta-analysis and performed analyses of interactions. The median concentration of cord serum PCB-153 was 140 ng/L (range of cohort medians 20-484 ng/L) and that of p,p´-DDE was 528 ng/L (range of cohort medians 50-1,208 ng/L). Birth weight decreased with increasing cord serum concentration of PCB-153 after adjustment for potential confounders in 12 of 15 study populations. The meta-analysis including all cohorts indicated a birth weight decline of 150 g [95% confidence interval (CI): -250, -50 g] per 1-µg/L increase in PCB-153, an exposure contrast that is close to the range of exposures across the cohorts. A 1-µg/L increase in p,p´-DDE was associated with a 7-g decrease in birth weight (95% CI: -18, 4 g). The findings suggest that low-level exposure to PCB (or correlated exposures) impairs fetal growth, but that exposure to p,p´-DDE does not. The study adds to mounting evidence that low-level exposure to PCBs is inversely associated with fetal growth.

• The hygiene hypothesis does not apply to atopic eczema in childhood.

  Authors: Claudia Cramer, Elke Link, Sibylle Koletzko, Irina Lehmann, Joachim Heinrich, H-Erich Wichmann, Carl-P Bauer, Andrea V Berg, Dietrich Berdel, Olf Herbarth, Beate Schaaf, Michael Borte, Heidrun Behrendt, Ursula Krämer

  Chemical immunology and allergy. 01/2012; 96:15-23.

  There is evidence that environmental factors are important for the development of eczema. Different mechanisms have been discussed in the literature, the best known of which is the hygieneThere is evidence that environmental factors are important for the development of eczema. Different mechanisms have been discussed in the literature, the best known of which is the hygiene hypothesis. However, epidemiological data give reason for questioning this hypothesis with regard to childhood eczema. We present results from two German birth cohort studies (LISAplus and GINIplus) concerning regional prevalence patterns of eczema and the association of eczema with day care center attendance and older siblings. Our findings are not in line with the hygiene hypothesis and question its validity with regard to eczema. It seems reasonable to assume that the effect of environmental factors is somehow disease-specific.

• No reason to change the current guidelines on allergy prevention.

  Authors: Sibylle Koletzko, Birgit Filipiak-Pittroff, Berthold Koletzko, Andrea von Berg, Ursula Krämer, Dietrich Berdel, Joachim Heinrich

  The Journal of allergy and clinical immunology. 01/2012; 129(1):262.e1-2; author reply 262-3.

• Development of Lentigines in German and Japanese Women Correlates with Variants in the SLC45A2 Gene.

  Authors: Andrea Vierkötter, Ursula Krämer, Dorothee Sugiri, Akimichi Morita, Ai Yamamoto, Natsumi Kaneko, Mary Matsui, Jean Krutmann

  The Journal of investigative dermatology. 11/2011; 132(3):733-6.

• High frequency of diastolic dysfunction in a population-based cohort of elderly women--but poor association with the symptom dyspnea.

  Authors: Alfried Germing, Michael Gotzmann, Tamara Schikowski, Andrea Vierkötter, Ulrich Ranft, Ursula Krämer, Andreas Mügge

  BMC geriatrics. 11/2011; 11:71.

  The European Society of Cardiology recently proposed a new algorithm "How to diagnose heart failure with normal ejection fraction". Central element of the diagnostic strategy is the demonstration ofThe European Society of Cardiology recently proposed a new algorithm "How to diagnose heart failure with normal ejection fraction". Central element of the diagnostic strategy is the demonstration of diastolic dysfunction, either by tissue Doppler-derived indices in first line, or in second line by a combination of elevated blood levels of natriuretic peptide with abnormal tissue Doppler findings. We thought to use this diagnostic flowchart in a population-based cohort of elderly women, in whom the prevalence of diastolic dysfunction and heart failure is believed to be high. The purpose was to evaluate the association of dyspnea with the presence of diastolic dysfunction. The study cohort recruited from a cross-sectional follow-up examination of the SALIA cohort (study on the influence of air pollution on lung function, inflammation, and aging). Participants with cardiac or pulmonary disease were excluded, 291 participants formed the final study group (all women, age range 69 to 79 years, all in sinus rhythm, LV ejection fraction > 50%, LV enddiastolic volume index < 97 mL/m2). Quality of life was assessed by the Minnesota living with heart failure questionnaire, and actual symptoms by a structural questionnaire; the examination consisted of a physical examination, measurement of B-type natriuretic peptide, ECG and tissue Doppler echocardiography. Diastolic dysfunction was assumed when the E/E' ratio exceeded 15 as derived from tissue Doppler. In case, tissue Doppler yielded an E/E' ratio ranging from 8 to 15, additional non-invasive parameters had to be fulfilled: left atrial volume index > 40 ml/m2 body surface, or left ventricular mass index > 122 g/m2 body surface, or transmitral E/A ratio < 0.5 plus deceleration time > 280 ms, or blood level of brain natriuretic peptide (BNP) > 200 pg/mL. The examinations were concordant with the presence of diastolic dysfunction in 122/291 participants (41.9%). The diagnosis based in 94% of cases on two criteria: in 50 cases on the criterion "E/E' ratio > 15", and in 65 cases on the criterion "15 > E/E'>8 and LV mass index > 122 g/m2". The participants with diastolic dysfunction had on average a higher body mass index, more frequent a history of arterial hypertension and of hospitalization for congestive heart failure, poorer quality of life, and higher BNP blood levels as compared to those participants without signs of diastolic dysfunction. The number of participants complaining exertional dyspnea, however, was similar distributed among the subgroups with and without signs of diastolic dysfunction (40.2 vs 40.8%; p = n.s). In a logistic regression model, the symptom dyspnea was best predicted by systolic pulmonary artery pressure, followed by left atrial volume index, BNP, and body mass index. The demonstration of diastolic dysfunction showed only a poor association with the symptom dyspnea in a cohort of elderly women with otherwise normal systolic function. Additional structural or hemodynamic changes are necessary to "explain" the symptom dyspnea. It is unclear whether these additional factors are secondary to a more advanced stage of diastolic dysfunction, or are related to cardiovascular co-morbidities, or both.

• Activation of the inflammasome by amorphous silica and TiO2 nanoparticles in murine dendritic cells.

  Authors: Meike Winter, Hans-Dietmar Beer, Veit Hornung, Ursula Krämer, Roel P F Schins, Irmgard Förster

  Nanotoxicology. 09/2011; 5(3):326-40.

  Nanomaterials are increasingly used in various food applications. In particular, nanoparticulate amorphous SiO2 is already contained, e.g., in spices. Since intestinal dendritic cells (DC) could beNanomaterials are increasingly used in various food applications. In particular, nanoparticulate amorphous SiO2 is already contained, e.g., in spices. Since intestinal dendritic cells (DC) could be critical targets for ingested particles, we compared the in vitro effects of amorphous silica nanoparticles with fine crystalline silica, and micron-sized with nano-sized TiO2 particles on DC. TiO2- and SiO2-nanoparticles, as well as crystalline silica led to an upregulation of MHC-II, CD80, and CD86 on DC. Furthermore, these particles activated the inflammasome, leading to significant IL-1β-secretion in wild-type (WT) but not Caspase-1- or NLRP3-deficient mice. Silica nanoparticles and crystalline silica induced apoptosis, while TiO2 nanoparticles led to enhanced production of reactive oxygen species (ROS). Since amorphous silica and TiO2 nanoparticles had strong effects on the activation-status of DC, we suggest that nanoparticles, used as food additives, should be intensively studied in vitro and in vivo, to ensure their safety for the consumer.

• European birth cohorts for environmental health research.

  Authors: Martine Vrijheid, Maribel Casas, Anna Bergström, Amanda Carmichael, Sylvaine Cordier, Merete Eggesbø, Esben Eller, Maria P Fantini, Mariana F Fernández, Ana Fernández-Somoano [......] Radim J Sram, Carel Thijs, Christina Tischer, Gunnar Toft, Tomáš Trnovec, Stephanie Vandentorren, Tanja G M Vrijkotte, Michael Wilhelm, John Wright, Mark Nieuwenhuijsen

  Environmental health perspectives. 08/2011; 120(1):29-37.

  Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improveMany pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning. Our goal was to create a comprehensive overview of European birth cohorts with environmental exposure data. Birth cohort studies were included if they a) collected data on at least one environmental exposure, b) started enrollment during pregnancy or at birth, c) included at least one follow-up point after birth, d) included at least 200 mother-child pairs, and e) were based in a European country. A questionnaire collected information on basic protocol details and exposure and health outcome assessments, including specific contaminants, methods and samples, timing, and number of subjects. A full inventory can be searched on www.birthcohortsenrieco.net. Questionnaires were completed by 37 cohort studies of > 350,000 mother-child pairs in 19 European countries. Only three cohorts did not participate. All cohorts collected biological specimens of children or parents. Many cohorts collected information on passive smoking (n = 36), maternal occupation (n = 33), outdoor air pollution (n = 27), and allergens/biological organisms (n = 27). Fewer cohorts (n = 12-19) collected information on water contamination, ionizing or nonionizing radiation exposures, noise, metals, persistent organic pollutants, or other pollutants. All cohorts have information on birth outcomes; nearly all on asthma, allergies, childhood growth and obesity; and 26 collected information on child neurodevelopment. Combining forces in this field will yield more efficient and conclusive studies and ultimately improve causal inference. This impressive resource of existing birth cohort data could form the basis for longer-term and worldwide coordination of research on environment and child health.

• Long-term effects of hydrolyzed protein infant formulas on growth--extended follow-up to 10 y of age: results from the German Infant Nutritional Intervention (GINI) study.

  Authors: Peter Rzehak, Stefanie Sausenthaler, Sibylle Koletzko, Dietrich Reinhardt, Andrea von Berg, Ursula Krämer, Dietrich Berdel, Christina Bollrath, Armin Grübl, Carl P Bauer, H-Erich Wichmann, Joachim Heinrich

  The American journal of clinical nutrition. 08/2011; 94(6 Suppl):1803S-1807S.

  Previous analysis in a prospective, population-based cohort reported reduced weight gain in children fed extensively hydrolyzed casein (eHF-C) formula during the first year of life but showed noPrevious analysis in a prospective, population-based cohort reported reduced weight gain in children fed extensively hydrolyzed casein (eHF-C) formula during the first year of life but showed no effect on growth between 1 and 6 y of life. No studies have been conducted in children up to the age of 10 y. The objective was to investigate potential differences in body mass index (BMI) over the first 10 y of life between infants fed within the intervention period of the first 16 wk of life with partially hydrolyzed whey (pHF-W), extensively hydrolyzed whey (eHF-W), eHF-C, or cow-milk formula (CMF) and infants exclusively breastfed (BF) within the intervention period. This was a prospective, randomized, double-blind trial in full-term neonates with atopic heredity in the German birth cohort German Infant Nutritional Intervention (GINI) followed through the first 10 y of life. Analyses of absolute and World Health Organization (WHO)-standardized BMI trajectories for 1840 infants [pHF-W (n = 253), eHF-W (n = 265), eHF-C (n = 250), CMF (n = 276), and BF (n = 796)] were conducted according to intention-to-treat principles. Except for the previously reported slower BMI gain in infants fed with eHF-C formula within the first year of life, no significant differences in absolute or WHO-standardized BMI trajectories were shown between the pHF-W, eHF-W, eHF-C, CMF, and BF groups thereafter up to the age of 10 y. Extension of the follow-up period from 6 to 10 y for this randomized controlled trial showed no long-term consequences on BMI for the 4 infant formulas considered. These data need to be confirmed in future studies.

• Passive smoking and behavioural problems in children: results from the LISAplus prospective birth cohort study.

  Authors: Carla M T Tiesler, Chih-Mei Chen, Stefanie Sausenthaler, Olf Herbarth, Irina Lehmann, Beate Schaaf, Ursula Krämer, Andrea von Berg, Rüdiger von Kries, H-Erich Wichmann, Joachim Heinrich

  Environmental research. 07/2011; 111(8):1173-9.

  To analyse the association between pre- and postnatal exposure to tobacco smoke and child behavioural problems and to further investigate the influence of trimester-specific exposure to maternalTo analyse the association between pre- and postnatal exposure to tobacco smoke and child behavioural problems and to further investigate the influence of trimester-specific exposure to maternal smoking and the impact of paternal smoking at home on the same outcome. Data of 3097 German children recruited at birth for a population-based, prospective study were used. Detailed information on children's tobacco smoke exposure was collected by self-administered questionnaires at each follow-up. Behavioural outcomes were measured by the Strengths and Difficulties Questionnaire applied at 10-year follow-up. Children exposed to environmental tobacco smoke at home showed increased risks of hyperactivity/inattention problems. Only smoking during the entire pregnancy increased the risk for conduct and hyperactivity/inattention problems (proportional odds ratio (pOR)=1.58, 95% confidence interval (CI)=1.06-2.37 and pOR=1.67, CI=1.03-2.72). Pre- and postnatal exposure to paternal smoking was associated with hyperactivity/inattention problems in children of non-smoking mothers (pOR=1.97, CI=1.06-3.65). Effect estimates were adjusted for study centre, sex, parental educational level, mother's age at birth, having a single parent and time spent in front of a screen. Not only maternal smoking during pregnancy but also paternal smoking at home should be considered as a risk for hyperactivity/inattention problems in children.

• Prenatal and postnatal tobacco smoke exposure and development of insulin resistance in 10 year old children.

  Authors: Elisabeth Thiering, Irene Brüske, Jürgen Kratzsch, Joachim Thiery, Stefanie Sausenthaler, Christa Meisinger, Sibylle Koletzko, Carl-Peter Bauer, Beate Schaaf, Andrea von Berg, Dietrich Berdel, Irina Lehmann, Olf Herbarth, Ursula Krämer, H Erich Wichmann, Joachim Heinrich

  International journal of hygiene and environmental health. 05/2011; 214(5):361-8.

  In this study, we evaluated the association between prenatal and postnatal exposure to environmental tobacco smoke and the development of insulin resistance in 10 year old children. Fasting bloodIn this study, we evaluated the association between prenatal and postnatal exposure to environmental tobacco smoke and the development of insulin resistance in 10 year old children. Fasting blood samples were collected from 470 children participating in two prospective birth cohorts. Of those 276 were selected population based and enriched with 194 children exceeding the 85th percentile of body mass index in this age group. Children already having diabetes type 1 or 2 at the age of 10 years were excluded. Fasting blood insulin and glucose levels and calculated HOMA index for insulin resistance assessment were analysed using generalised additive models. Potential confounders were adjusted for. Insulin resistance was increased by 24% in children frequently exposed to environmental tobacco smoke during childhood (MR(adj) = 1.24, p = 0.001), while glucose levels were not. Exclusion of prenatally exposed children did not attenuate the association (MR(adj) = 1.25, p = 0.006). After stratification, the effect sizes were identical within overweight children and the population based sample of children. Insulin resistance and fasting insulin levels were increasing with increasing numbers of cigarettes smoked in children's home. Maternal smoking during the third trimester of pregnancy increased children's insulin levels (MR(adj) = 1.19, p = 0.037), and even more so, if children were exclusively breastfed after birth (MR(adj) = 1.31, p = 0.016). Increased mean ratios were found for smoking of a third person in addition to maternal smoking. Positive dose-dependent associations and independent effects of postnatal exposure suggest involvement of environmental tobacco smoke in the risk for development of insulin resistance in children.

• Relative weight-related costs of healthcare use by children--results from the two German birth cohorts, GINI-plus and LISA-plus.

  Authors: Ariane Breitfelder, Christina M Wenig, Silke B Wolfenstetter, Peter Rzehak, Petra Menn, Jürgen John, Reiner Leidl, Carl Peter Bauer, Sibylle Koletzko, Stefan Röder, Olf Herbarth, Andrea von Berg, Dietrich Berdel, Ursula Krämer, Beate Schaaf, H-Erich Wichmann, Joachim Heinrich

  Economics and human biology. 03/2011; 9(3):302-15.

  Obesity among children and adolescents is a growing public health burden. According to a national reference among German children and adolescents aged 3-17 years, 15% are overweight (including obese)Obesity among children and adolescents is a growing public health burden. According to a national reference among German children and adolescents aged 3-17 years, 15% are overweight (including obese) and 6.3% are obese. This study aims to assess the economic burden associated with overweight and obesity in children based on a cross-sectional survey from two birth cohort studies: the GINI-plus - German Infant Nutritional Intervention plus Non-Intervention study (3287 respondents aged 9 to <12 years) and the LISA-plus study - Influence of life-style factors on the development of the immune system and allergies in East and West Germany (1762 respondents aged 9 to <12 years). Using a bottom-up approach, we analyse direct costs induced by the utilisation of healthcare services and indirect costs emerging from parents' productivity losses. To investigate the impact of Body Mass Index (BMI) on costs, we perform various descriptive analyses and estimate a two-part regression model. Average annual total direct medical costs of healthcare use are estimated to be €418 (95% CI [346-511]) per child, split between physician (22%), therapist (29%), hospital (41%) and inpatient rehabilitation costs (8%). Bivariate analysis shows considerable differences between BMI groups: €469 (severely underweight), €468 (underweight), €402 (normal weight), €468 (overweight) and €680 (obese). Indirect costs make up €101 per year on average and tend to be higher for obese children, although this was not statistically significant. Drawing on these results, differences in healthcare costs between BMI groups are already apparent in children.

• Association between sun-exposure, smoking behaviour and plasma antioxidant levels with the different manifestation of skin ageing signs between Japanese and German women--a pilot study.

  Authors: Dany Perner, Andrea Vierkötter, Dorothee Sugiri, Mary Matsui, Ulrich Ranft, Charlotte Esser, Stephane Ethève, Regina Goralczyk, Natsumi Kaneko, Ai Yamamoto, Akimichi Morita, Jean Krutmann, Ursula Krämer

  Journal of dermatological science. 03/2011; 62(2):138-40.

• Prevalence of nickel sensitization and urinary nickel content of children are increased by nickel in ambient air.

  Authors: Monika Kasper-Sonnenberg, Dorothee Sugiri, Sabine Wurzler, Ulrich Ranft, Heinrich Dickel, Jürgen Wittsiepe, Jürgen Hölzer, Friederike Lemm, Georg Eberwein, Peter Altmeyer, Martin Kraft, Ursula Krämer, Michael Wilhelm

  Environmental research. 02/2011; 111(2):266-73.

  In a cross-sectional study performed in 2000, an unexpected positive association between nickel (Ni) in ambient air, urinary Ni content and the prevalence of Ni sensitization in a subgroup ofIn a cross-sectional study performed in 2000, an unexpected positive association between nickel (Ni) in ambient air, urinary Ni content and the prevalence of Ni sensitization in a subgroup of 6-yr-old children living near a steel mill was observed. Between 2005 and 2006, in a different and larger study population, we examined if Ni from ambient air or urinary Ni concentration was related to Ni sensitization in children living next to Ni-emitting steel mills. We studied 749 school beginners living in four Ni-polluted industrial areas of North Rhine-Westphalia, Germany. We assessed Ni in ambient air, Ni in urine from children and mothers, and Ni in tap water, conducted patch tests in children (including the NiSO(4)-dilution test) and collected questionnaire data. Statistics were done by linear and logistic regression analyses, adjusted for covariates. At increased Ni concentration in ambient air (unit of increase: 10 ng/m(3)), urinary Ni concentrations rose in both mothers (9.1%; 95% CI: 6.8-11.4%) and children (2.4%; 95% CI: 0.4-4.4%). The prevalence of Ni sensitization in children was associated with increased Ni from ambient air (unit of increase: 18 ng/m(3); odds ratio 1.28; 95% CI: 1.25-1.32) and urinary Ni concentration (unit of increase: 7.1 μg/L; odds ratio 2.4; 95% CI: 1.20-4.48). Ni in ambient air of areas with Ni-emitting factories contributes to internal Ni exposure in residents via inhalation and, furthermore, is a risk factor for the development of Ni sensitization in children.

• Respiratory effects of indoor particles in young children are size dependent.

  Authors: Ulrich Franck, Olf Herbarth, Stefan Röder, Uwe Schlink, Michael Borte, Ulrike Diez, Ursula Krämer, Irina Lehmann

  The Science of the total environment. 02/2011; 409(9):1621-31.

  Extensive epidemiological studies have provided evidence of an association between elevated outdoor particulate air pollution and adverse health effects. However, while people typically spendExtensive epidemiological studies have provided evidence of an association between elevated outdoor particulate air pollution and adverse health effects. However, while people typically spend majority of time indoors, there is limited knowledge on airborne indoor particles and on the correlation between the concentrations of indoor particles and health effects. Even insights into the influence of differently sized indoor particles on human health are still rare. The association between differentially sized indoor air particles and the development of respiratory diseases was studied for three year aged children. Short-term measurements of particle mass and number concentrations were carried out in children's rooms. Information on possible particle sources (smoking habits, type of heating, and traffic) and respiratory outcomes were obtained from questionnaires. Measured indoor particle concentrations were correlated with possible sources of indoor particles and with respiratory health impacts. Daily smoking, smoking more than 5 cigarettes per day at home and traffic density in front of the window of children's room were found to be related to indoor exposure by particles of different diameters. High indoor particle exposures were associated with an increased risk for the development of obstructive bronchitis and in some extent of non-obstructive bronchitis. The strongest impact was observed for the mass concentration of particles <1 μm and the number concentration of particles >0.5 μm. The risk increases still remain significant if tested for stability changing the number of adjustment variables or omitting randomly selected cases, respectively. Our results show significant associations between indoor particle concentrations and the risks for respiratory diseases in young children. The applied short-term measurements can help to assess the health risks of indoor particles with different sizes within epidemiological studies.

• Regional and socio-economic differences in food, nutrient and supplement intake in school-age children in Germany: results from the GINIplus and the LISAplus studies.

  Authors: Stefanie Sausenthaler, Marie Standl, Anette Buyken, Peter Rzehak, Sibylle Koletzko, Carl Peter Bauer, Beate Schaaf, Andrea von Berg, Dietrich Berdel, Michael Borte, Olf Herbarth, Irina Lehmann, Ursula Krämer, H-Erich Wichmann, Joachim Heinrich

  Public health nutrition. 01/2011; 14(10):1724-35.

  To describe regional differences between eastern and western Germany with regard to food, nutrient and supplement intake in 9-12-year-old children, and analyse its association with parental educationTo describe regional differences between eastern and western Germany with regard to food, nutrient and supplement intake in 9-12-year-old children, and analyse its association with parental education and equivalent income. Data were obtained from the 10-year follow-up of the two prospective birth cohort studies - GINIplus and LISAplus. Data on food consumption and supplement intake were collected using an FFQ, which had been designed for the specific study population. Information on parental educational level and equivalent income was derived from questionnaires. Logistic regression modelling was used to analyse the effect of parental education, equivalent income and region on food intake, after adjusting for potential confounders. Germany. A total of 3435 children aged 9-12 years. Substantial regional differences in food intake were observed between eastern and western Germany. Intakes of bread, butter, eggs, pasta, vegetables/salad and fruit showed a significant direct relationship with the level of parental education after adjusting for potential confounders, whereas intakes of margarine, meat products, pizza, desserts and soft drinks were inversely associated with parental education. Equivalent income had a weaker influence on the child's food intake. Nutritional education programmes for school-age children should therefore account for regional differences and parental education.

• Supplementation with cow's milk at birth is not recommended.

  Authors: Sibylle Koletzko, Birgit Filipiak-Pittroff, Andrea von Berg, Armin Grübl, Joachim Heinrich, Ursula Krämer, H-Erich Wichmann, Carl-Peter Bauer, Dietrich Reinhardt, Dietrich Berdel

  The Journal of allergy and clinical immunology. 01/2011; 127(3):836-8; author reply 839-40.

• Growth of infants fed formula rich in canola oil (low erucic acid rapeseed oil).

  Authors: Peter Rzehak, Sibylle Koletzko, Berthold Koletzko, Stefanie Sausenthaler, Dietrich Reinhardt, Armin Grübl, Carl Peter Bauer, Ursula Krämer, Christina Bollrath, Andrea von Berg, Dietrich Berdel, H-Erich Wichmann, Joachim Heinrich

  Clinical nutrition (Edinburgh, Scotland). 12/2010; 30(3):339-45.

  Canola oil is a variety of rapeseed oil low in erucic acid (<2%). For many years, canola oil has been widely used as an ingredient in infant formula in Europe, but not in North America due to safetyCanola oil is a variety of rapeseed oil low in erucic acid (<2%). For many years, canola oil has been widely used as an ingredient in infant formula in Europe, but not in North America due to safety concerns. A number of studies have used variable canola content of infant formulas to investigate the effects of linoleic acid: α-linolenic acid ratio on visual function of infants. However, little published data is available to compare the safety of canola versus non-canola containing infant formula. The aim of this study is to investigate whether infant formulas containing canola oil support normal growth in infants as assessed by weight and length gain. Re-analyses of data on infant weight and length gain from a prospective randomized double-blind trial in full-term infants in the German Infant Nutritional Intervention study (GINI). This analysis compared growth in infants receiving infant formulas with or without canola oil from week 4 to month 7. Absolute weight and length, weight and length gain in gram or cm per day and standardized weight and length measurements were analyzed by analyses of variance and a longitudinal random effects model. Standardization was conducted according to the new WHO 2006 age- and sex-specific child growth standards. Absolute and standardized weight and length measures did not differ between the formula groups with or without canola oil. This was true for both, analyses within each of the three anthropometric measurement periods (4-6 weeks, 3-4 months, 6-7 months) and for the longitudinal analyses over the whole period from 4 weeks to 7 months of life. Power analyses confirmed that sample size was sufficient to detect a difference of 3 g per day between 14 and 120 days between the two formula groups. Infant formula containing canola oil supports normal infant growth as assessed by weight and length gain.

• Early-life otitis media and incident atopic disease at school age in a birth cohort.

  Authors: Elaina A MacIntyre, Chih-Mei Chen, Olf Herbarth, Michael Borte, Beate Schaaf, Ursula Krämer, Andrea von Berg, H-Erich Wichmann, Joachim Heinrich

  The Pediatric infectious disease journal. 12/2010; 29(12):e96-9.

  Otitis media is a common and costly disease that peaks in early childhood. Recent reviews concluded that the relationship between otitis media and atopy is not well understood, and that furtherOtitis media is a common and costly disease that peaks in early childhood. Recent reviews concluded that the relationship between otitis media and atopy is not well understood, and that further research is warranted. Logistic regression was used to analyze data from a German Birth Cohort (n = 1690; born 1997–1999). Parental questionnaires were used to assess children for physician-diagnosed otitis media throughout the first 2 years of life and for incident atopic disease (asthma, allergic rhinitis, and eczema) during the sixth year of life. Odds ratios were adjusted for gender, older siblings, city, parental education, breast-feeding, and daycare. Parallel analyses were completed for the full birth cohort and for a population subset with atopic mothers. Results: The adjusted odds of asthma were elevated for children with early-life otitis media, but were statistically significant only for those children with at least 3 episodes (adjusted odds ratio: 4.26 [95% confidence interval: 1.34–13.6]). Associations between early-life otitis media and allergic rhinitis were largely inconsistent. There was a positive association between early-life otitis media and late-onset allergic eczema (≥2 episodes: 2.68 [1.35–5.33], ≥3 episodes: 3.84 [1.80–8.18]). Similar results were found for the maternal atopy subgroup but with greater effect estimates. Children diagnosed with otitis media during infancy were at greater risk for developing late-onset allergic eczema and asthma during school age, and associations were stronger for frequent otitis. These results indicate that frequent otitis media during infancy may predispose children to atopic disease in later life.