Marion Flechtner-Mors

Ulm University | UULM · Division of Sports and Rehabilitation Medicine

Background: Studies have shown that policies to promote physical activity in schools can have a positive impact on children's physical activity behavior. However, a large research gap exists as to what determinants may influence the adoption of such policies. Applying the Consolidated Framework for Implementation Research (CFIR), we investigated b...

Background: Active mobility and public transport increase physical activity (PA) levels. With varying intensity and effectiveness, European cities implement Sustainable Urban Mobility Plans (SUMPs) to spur transport-related PA. Therefore, we aim to examine drivers and barriers to SUMP implementation and assess its influence on PA across European c...

The European Policy Evaluation Network (PEN), initiated in autumn 2018, aimed at advancing the evidence base for public policies impacting dietary behaviour, physical activity and sedentary behaviours in Europe. This is needed because non-communicable diseases-the leading cause of global mortality-are substantially caused by physical inactivity and...

Background and Aim Childhood obesity is an emerging problem often leading to earlier onset of non-communicable diseases in later life. Biomarkers to identify individual risk scores are insufficient in routine clinical practice, which is related to the need for easily sampled, non-invasive survey methods in children. We aimed to investigate and stre...

Non-communicable diseases (NCDs) are the leading cause of global mortality. As the social and economic costs of NCDs have escalated, action is needed to tackle important causes of many NCD’s: low physical activity levels and unhealthy dietary behaviours. As these behaviours are driven by upstream factors, successful policy interventions are require...

Context: It is questioned whether the potato protein protease inhibitor II (PI2) reduces appetite and exerts effects on the satiety hormone cholecystokinin (CCK). Objective: To investigate PI2 impact on gastrointestinal hormones and appetite measures during weight reduction. Design: In a randomized, placebo-controlled trial over 20 weeks, fift...

Background & aims: Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic revi...

Background & aims: Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. Methods: Available studies within...

Objectives To identify determinants of incident malnutrition in community‐dwelling older adults. Design Meta‐analysis of 6 community‐based longitudinal datasets with follow‐up of 1 to 3 years. Setting Datasets from MaNuEL (MalNutrition in the Elderly) partners were included: 3 studies from Germany and 1 each from Ireland, the Netherlands, and New...

The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013-2016, was the first action taken by the 'Healthy Diet for a Healthy Life' European Joint Programming Initiative. DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behaviour across the life course, i....

The study aim was to investigate the effect of endogenous insulin release on lipolysis in subcutaneous adipose tissue after adrenergic stimulation in obese subjects diagnosed with type 2 diabetes (T2D). In 14 obese female T2D subjects, or 14 obese non-T2D controls, glycerol concentration was measured in response to the α1,2,ß-agonist norepinephrine...

Results of ANOVA for repeated measurement statistics. (DOCX)

Trend statement checklist. (PDF)

Peptide drugs delivered orally need be protected from degradation for achieving their functions. To fulfill the complicated task of oral drug delivery, we present a hierarchically structured drug delivery system that can undertake structural changes so that multiple functions can be triggered by a sequence of stimuli. Such hierarchical system is ac...

The hydrophilic peptide YY (PYY) is a promising hormone-based anti-obesity drug. We present a new concept for the delivery of PYY from pH-responsive chitosan-based nanocarriers. To overcome the drawbacks while retaining the merits of the polyelectrolyte complex (PEC) method, we propose a one-pot approach for the encapsulation of a hydrophilic pepti...

Aim: To evaluate the prevalence of overweight and obesity in paediatric type 1 diabetes (T1D) subjects, based on four commonly used reference populations. Methods: Using WHO, IOTF, AGA (German pediatric obesity), and KiGGS (German Health Interview and Examination Survey for Children and Adolescents) reference populations, prevalence of overweigh...

The aim of this study was to determine the prevalence of hypertension in overweight or obese pediatric subjects using different national or international references, which are based either on the entire population or on normal weight children only: 188 centers from Germany, Austria, and Switzerland participated in the Adipositas Patienten Verlaufsb...

Aims/hypothesis: This study investigated the accuracy of blood glucose meters for self-monitoring and its influence on glycated hemoglobin (HbA1c) levels and the frequency of hypoglycemic coma. Materials and methods: Self-measured and simultaneously obtained laboratory blood glucose values from 9,163 patients with type 1 diabetes <18 years of ag...

To address major societal challenges and enhance cooperation in research across Europe, the European Commission has initiated and facilitated ‘joint programming’. Joint programming is a process by which Member States engage in defining, developing and implementing a common strategic research agenda, based on a shared vision of how to address major...

The objective of the present study was to analyse the association between the plasma cortisol concentration and nonalcoholic fatty liver disease (NAFLD). A total of 1 326 subjects (age 18-65 years) were examined in the context of an epidemiological study of a population-based random sample. Medical history and anthropometric data of 662 women and 6...

Objective of the present study was to examine the association between adiponectin and hepatic steatosis, and other biochemical and anthropometric parameters in healthy subjects. A total of 1349 subjects (age 18-65 years) underwent ultrasound examination of the liver. Mean adiponectin concentration for the study collective was 11.35 +/- 6.28 mug/mL....

To address major societal challenges and enhance cooperation in research across Europe, the European Commission has initiated and facilitated 'joint programming'. Joint programming is a process by which Member States engage in defining, developing and implementing a common strategic research agenda, based on a shared vision of how to address major...

Aims: To describe the development of weight in children and adolescents with type 1 diabetes in Germany. Methods: We analyzed the body mass index (BMI) of the most recent treatment year of each patient with diabetes in the Pediatric Quality Initiative (DPV) database. BMI SD score (SDS) was calculated based on pooled historical German normative d...

Sex hormone binding globulin (SHBG) is a glycoprotein expressed predominantly in the hepatocytes. It regulates the transport of sex steroid hormones in the blood stream to their target tissues. The expression of the SHBG gene is subject to multifactorial regulation including hormonal, metabolic, and nutritional aspects. Against this background, we...

DPV centers contributing data for this analysis. (DOCX)

Objective: The aim of the study was to analyze the adherence to current guidelines for co-morbidity screening in overweight and obese pediatric patients participating in the Adipositas-Patienten-Verlaufsdokumentation (APV) initiative in three German-speaking countries. Methods: APV database: 181 centers from Germany, Austria and Switzerland, spe...

To estimate diabetes-related direct health care costs in pediatric patients with early-onset type 1 diabetes of long duration in Germany. Data of a population-based cohort of 1,473 subjects with type 1 diabetes onset at 0-4 years of age within the years 1993-1999 were included (mean age 13.9 (SD 2.2) years, mean diabetes duration 10.9 (SD 1.9) year...

Background & aims: To compare reported and recommended carbohydrate intake in children and adolescents with type 1 diabetes (T1D) and to explore associations with BMI, HbA1c and lipid profile. Methods: A cross-sectional observational study of reported carbohydrate intake in 46,010 patients with T1D aged 1-18 years from 332 diabetes centres in Ge...

The considerable increase of obesity in children and adolescents poses a major challenge to the health care system. In an observation study of the Bundeszentrale für gesundheitliche Aufklärung (BZgA) somatic data of 1916 overweight and obese children and adolescents aged 8-17 years were compared to data of 7 451 normal weight children and adolescen...

To assess cardiovascular risk factors in overweight or obese children and adolescents in Germany, Austria and Switzerland and to investigate the relationship to BMI category. Data of 63,025 overweight or obese patients (APV population) were compared to normal-weight subjects from a representative study on health status of 14,298 children and adoles...

Overweight and obese youth represent a challenge for the affected individual, the healthcare system as well as society as a whole. Increased long-term cardiovascular risk is one of the major consequences of early-onset obesity, affecting both life expectancy and quality of life. The aim of this report is to study the effects of age, gender and obes...

The objective of this study was to investigate the effects of a protein-rich diet in comparison with a conventional protein diet on weight loss, weight maintenance, and body composition in subjects with the metabolic syndrome. Obese subjects received instructions for an energy-restricted diet with a calorie deficit of 500 kcal/day and were randomly...

Zusammenfassung Die für die Gewichtsreduktion erforderliche Einschränkung der Energiezufuhr kann problemlos mit Formulaprodukten erreicht werden. Formulaprodukte sind Nährstoffmischungen, die in Magermilch, Sojamilch oder Wasser gelöst als Getränke eingenommen werden. Bei reiner Formuladiät werden alle Mahlzeiten durch Formula ersetzt. Die Formulad...

Ectonucleotide pyrophosphatase phosphodiesterase (ENPP1) is a positional candidate gene at chromosome 6q23 where we previously detected strong linkage with fasting-specific plasma insulin and obesity in Mexican Americans from the San Antonio Family Diabetes Study (SAFDS). We genotyped 106 single-nucleotide polymorphisms (SNPs) within ENPP1 in all 4...

The intake of antidepressants is often accompanied by weight gain. Antidepressants may influence lipid and carbohydrate metabolism that can result in metabolic changes and obesity. We investigated the effect of citalopram and trimipramine on interstitial glycerol, glucose and lactate concentration and blood flow in subcutaneous adipose tissue of ob...

The effect of non-selective (theophylline) inhibition of cyclic AMP breakdown on norepinephrine stimulated lipolysis rate was investigated in subcutaneous adipose tissue of obese subjects. In addition, changes in interstitial glucose and lactate concentration were assessed by means of the microdialysis technique. The interaction of endogenous relea...

Patients on dietary, weight-reducing treatment commonly are advised against alcohol consumption. In light of the widespread use of alcoholic beverages and the well-established benefits of light to moderate alcohol consumption in risk reduction, a revision of dietary treatment recommendations may be warranted. To investigate whether daily consumptio...

To investigate the involvement of alpha1-adrenoceptors in the sympathetic regulation of glucose uptake in human adipocytes. Twenty-four severely obese subjects participated in this study. The microdialysis technique was used to determine interstitial glucose concentration after stimulation of abdominal subcutaneous adipose tissue with the alpha1-ag...

The role of alpha(1)-adrenoceptors in lipid mobilization and blood flow was investigated in situ using microdialysis of subcutaneous adipose tissue in severely obese subjects. The lipolysis rate was assessed by determination of interstitial glycerol concentration. The alpha(1)-adrenoceptor agonist norfenefrine caused an increase in glycerol level i...

The role of α1-adrenoceptors in lipid mobilization and blood flow was investigated in situ using microdialysis of subcutaneous adipose tissue in severely obese subjects. The lipolysis rate was assessed by determination of interstitial glycerol concentration. The α1-adrenoceptor agonist norfenefrine caused an increase in glycerol level in adipose ti...

To examine changes in plasma lipids and lipoproteins after 51 months of reduced energy intake and sustained weight loss. One-hundred patients were randomized to one of two dietary interventions for 3 months (weight loss period). Groups A and B received an energy-restricted diet plan of 5.2-6.3 MJ/day but group B was further instructed to replace tw...

To examine changes in biomarkers of disease risk after 51 months of reduced energy intake and sustained weight loss. This study was conducted as a prospective, randomized, two-arm, parallel intervention for 12 weeks followed by a prospective, single-arm, 4-year trial in a university-based hospital clinic. One hundred patients were randomly assigned...

Acipimox is a hypolipidaemic agent reducing serum concentrations of triglycerides and non-esterified fatty acids. Acipimox may reduce triglyceride synthesis by decreasing non-esterified fatty acid availability from adipocytes, but this effect has yet to be demonstrated in vivo. Lipolysis after acipimox treatment was examined in subcutaneous adipose...

To investigate the contribution of meal and snack replacements for long-term weight maintenance and risk factor reduction in obese patients. Prospective, randomized, two-arm, parallel intervention for 12 weeks followed by a prospective single-arm 4-year trial in a University Hospital clinic. One hundred patients, >18 years old and with a body mass...

Metformin has been reported to decrease the plasma concentrations of non-esterified fatty acids in Type 2 diabetic subjects. This study investigated the effects of metformin on basal and catecholamine-stimulated lipolysis in abdominal subcutaneous adipose tissue of obese, hyperinsulinaemic, hypertensive subjects. Fourteen subjects with severe obesi...

We studied lipolytic activities in vivo in golden mantle ground squirrels during pre-hibernation and hibernation using microdialysis technique. Microdialysis probes were inserted into the abdominal subcutaneous adipose tissues. Baseline lipolysis were assessed by measuring glycerol concentration. Epinephrine-stimulated lipolysis was also examined....

To investigate the differences in the regulation of lipolysis between male and female obese subjects in vivo, we used an in situ microdialysis technique before and after 3 weeks of energy restriction. Using this method, we examined glycerol, glucose, and lactate responses after 5 minutes of epinephrine stimulation in the adipose tissues. Glycerol r...

Obesity is a chronic disease that has become one of the most serious health problems in Western society. We assessed the long-term effects of an energy-restricted diet combined with 1 or 2 daily meal replacements on body weight and biomarkers of disease risk in 100 obese patients. Phase 1 consisted of a 3-mo, prospective, randomized, parallel inter...

Background: Obesity is a chronic disease that has become one of the most serious health problems in Western society. Objective: We assessed the long-term effects of an energy-restricted diet combined with 1 or 2 daily meal replacements on body weight and biomarkers of disease risk in 100 obese patients. Design: Phase 1 consisted of a 3-mo, prospect...

Dexfenfluramine has been shown to reduce body weight and lower blood pressure in obese individuals. However. it is not clear whether the blood pressure-lowering effect is due to dexfenfluramine or to the loss of weight. This project was designed to study the effect of a 5-d treatment of dexfenfluramine on blood pressure changes in obese postmenopau...

Obesity has been identified as a risk factor for atherosclerosis, and fat distribution has proved to be a critical variable. Weight loss improves health, but failure rates in dietary treatment are high. The effects of dexfenfluramine, which is useful in many patients, were studied on cardiovascular risk factors in obese female patients with upper a...

In this study 25 patients, who had completed the INDEX trial (Guy-Grand et al. Lancet 1989; 2: 1142-1145) were reexamined 2 months after withdrawal of the study medication. The patients then in an open trial received dexfenfluramine (dF) for 6 months. The observed weight gain after withdrawal of study medication was higher in patients treated befor...

There is a strong association between elevated plasma Lp(a) concentrations and increased incidence of cardiovascular disease. The aim of the study was to investigate Lp(a) levels in obesity before and after weight reduction. Obese but otherwise healthy patients with weight problems were studied. Four hundred seventy-six female patients (40.3±13.3 y...

Several studies have shown that obesity is associated with atherosclerosis. The reason may be that there is often a gathering together of risk factors for cardiovascular disease in obesity. Recently plasma fibrinogen level has been identified as an important cardiovascular risk factor. The aim of the study was to investigate fibrinogen levels in ob...

The effects of dexfenfluramine on 24-hour profiles of ACTH, GH, norepinephrine, insulin and FFA were studied in a group of obese male patients. A controlled comparison trial under metabolic ward conditions was conducted. Dexfenfluramine (15 mg twice daily) was given for 8 days, while patients adhered to a weight maintaining diet. 9 obese patients w...

Triglyceride-rich lipoproteins are thought to be associated with an accelerated development of arteriosclerosis. The influence of an oral fat load of 100 g fat on blood lipids and lipoproteins has been investigated. 12 hours after the last food intake the triglycerides in the serum and in the lipoproteins VLDL, LDL and HDL were higher than in contr...

After an oral fat load of 1 g/kg body weight in 10 obese females with hyperlipoproteinaemia type IV, serum triglycerides concentrations were maximal at 4 h with a slight decline at 6 h, whereas serum cholesterol concentrations rose slightly at 4 h and 6 h. After 6 h, concentrations of triglycerides and cholesterol were significantly increased in ch...

Background: Triglyceride-rich lipoproteins circulating in the postprandial state have been postulated to play a role in the development of coronary atherosclerosis. We studied lipoproteins in healthy subjects who received an oral fat load and in patients with coronary artery disease receiving a similar meal and assessed the effects of acipimox. Met...