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H Hauner

Publications and source records attributed to H Hauner.

At least 19 recordsLinked to original sources
PubMed2006

Differential association of adiponectin with cardiovascular risk markers in men and women? The KORA survey 2000.

BACKGROUND: In men, high adiponectin concentrations were related to a lower risk of myocardial infarction, whereas no association with cardiovascular events was found in women. OBJECTIVE: To investigate sex differences in the associations of adiponectin with cardiovascular risk factors. DESIGN: Cross-sectional population-based KORA Survey 2000 in Southern Germany using the same study methods for cardiovascular risk factors as the former WHO MONICA project. PARTICIPANTS: A total of 697 men and 657 women, aged 55-74 years. Glucose tolerance status was assessed by oral glucose tolerance tests. RESULTS: Adiponectin (geometric mean, interquartile range; microg/ml) levels were significantly higher in women (11.1; 8.5-14.9) than in men (7.1; 5.2-9.6) (P<0.05). In univariate analyses, HDL-cholesterol and age were significantly positively correlated with adiponectin in both sexes. Negative correlations were observed with BMI, waist circumference, fasting and postchallenge glucose, insulin, HOMA-IR, HbA1c, triglycerides, uric acid and CRP (P<0.01). In sex-specific multivariate regression, age and HDL-cholesterol were independently positively, and fasting insulin and 2-h glucose were negatively related to adiponectin in both sexes. Uric acid was significantly inversely related to adiponectin in women only (sex interaction: P=0.02). Exploratory sex-specific factor analysis of adiponectin and the core components of the metabolic syndrome yielded four similar factors. Adiponectin loaded negatively on the 'lipids' factor in both sexes. CONCLUSION: The associations of adiponectin with cardiovascular risk factors showed a similar pattern in both sexes, except for uric acid. This small sex difference may not explain previous conflicting results on the association of adiponectin with cardiovascular events in men and women.

Adiponectin↗
PubMed2006

Constitutive and regulated expression and secretion of interferon-gamma-inducible protein 10 (IP-10/CXCL10) in human adipocytes.

OBJECTIVE: Chemokine secretion by adipocytes has been postulated to initiate leukocyte infiltration in adipose tissue and might mediate an important step in the establishment of obesity-related chronic immune activation. The chemokine interferon (IFN)gamma-inducible protein-10 (IP-10/CXCL10) is a chemoattractant for various leukocyte subsets and has been implicated in the pathogenesis of atherosclerosis. This study investigates whether IP-10 is expressed in human adipocytes and whether its release is regulated by body mass index (BMI) or immunological stimuli. METHODS: In cultures of human mature adipocytes and in vitro differentiated adipocytes, IP-10 expression under basal conditions and in the presence of IFNgamma, lipopolysaccharide (LPS) or interleukin (IL)-4 was characterized by reverse transcriptase-polymerase chain reaction, Luminex technology and immunofluorescence. RESULTS: IP-10 was expressed and secreted constitutively in most cultures of mature adipocytes from omental and subcutaneous (s.c.) depots. The association between IP-10 release and donor BMI was not significant. In in vitro differentiated adipocytes from s.c. and mammary depots and in mature s.c. adipocytes, IP-10 secretion was strongly upregulated by IFNgamma, whereas LPS or IL-4 did not affect IP-10 expression in s.c. mature adipocytes. Immunofluorescence confirmed IP-10 expression in adipocytes with abundant lipid droplets. CONCLUSION: Mature human adipocytes express and secrete the chemokine IP-10 and are thus identified as a novel cellular source of this disease-related immune mediator. IP-10 expression could be significantly induced by IFNgamma, but not by LPS, which points to both similar reactivities and functional differences between adipocytes and innate immune cells.

Adipocytes↗
PubMed2006

The cost burden of diabetes mellitus: the evidence from Germany--the CoDiM study.

AIMS/HYPOTHESIS: The aim of this study was to identify the health care costs of diabetic patients in Germany in 2001, focusing on the influence of age, sex, and type of treatment. SUBJECTS AND METHODS: Annual direct costs of medical care and indirect costs of inability to work and early retirement in diabetic subjects were compared with costs of age- and sex-matched non-diabetic control subjects. The analysis was based on routine health care data from a random sample (18.75%) taken from a database of 1.9 million insured persons. Incremental differences in medical and national expenditure between subjects with and without diabetes were calculated. RESULTS: Annual direct mean costs per diabetic patient were 5,262 Euro, and indirect costs were 5,019 Euro. In the control group, mean direct and indirect costs were 2,755 Euro and 3,691 Euro, respectively. Analysis of cost components revealed that the high costs associated with the care of diabetic patients could be largely attributed to inpatient care and overall medication costs. Hypoglycaemic drugs amounted to only one-quarter of the medication costs. The total health care costs were correlated with the type of treatment. Direct excess costs increased with increasing age in insulin-treated patients, but were unaffected by age in patients receiving other types of treatment. CONCLUSIONS/INTERPRETATION: The Costs of Diabetes Mellitus (CoDiM) study is the first comprehensive study to provide estimates of costs associated with diabetes care in Germany. Direct costs of diabetic patients account for 14.2% of total health care costs, which includes the proportion that specifically accounts for diabetes-related costs (6.8%).

Adult↗
PubMed2006

[Heterogeneity of costs of diabetic patients: the Cost of Diabetes Mellitus Study].

BACKGROUND AND OBJECTIVE: Health economic studies in patients with diabetes mellitus have demonstrated that a large proportion of the excess cost is caused by the treatment of specific complications. It was the aim of this study to analyse the distribution of per capita cost of a large cohort of diabetic patients in order to develop new strategies for a better identification and care of high-risk patients. METHODS: The analysis was based on anonymous data on patients with diabetes and an age-matched control group from a large cohort of subjects insured by a large statutory health insurance fund (AOK Hesse) (n=305736). Costs were fully assessed and related to the state of complications and other criteria. RESULTS: The average cost was 5262 euros per diabetic patient and year. Excess costs due to the diabetes were estimated at 2507 euros. Costs were unevenly distributed, depending on the presence of complications. The average excess cost of patients with at least one complication was i 3730 euros (469 for patients without complication). In particular, patients on hemodialysis, after kidney transplantation or with lower leg amputation, stroke or with gangrene or foot ulcer incurred great costs. 5.3% of all diabetic patients incurred costs of > or = 20000 euros per year, totalling up to 33.6% of all costs of diabetic patients. Another 9.5% of patients incurred costs of between 10000 euros and 20000 euros per year. Both groups were responsible for 59.6% of total costs. In contrast, 55% of the patients incurred costs of < 2500 euros per year, amounting to 11.8% of all costs. CONCLUSIONS: There is a considerable variation of cost incurred in the management of diabetic patients, as demonstrated in a large population-based cohort of diabetics. This increased cost was largely due to the presence of complications. High-risk patients should be identified as early as possible so that they can receive intensive care to avoid the expensive complications of the disease.

Aged↗
PubMed2006

[Evidence based therapy of obesity].

For medical reasons, subjects with a BMI > or =30 kg/m(2) or a BMI > or =25 kg/m(2) and comorbidities such as type 2 diabetes mellitus should be considered for participation in a weight loss program. At present, there is a broad spectrum of measures to reduce body weight which have been validated in randomized controlled trials. The primary target of all intervention programs is to change lifestyle in order to establish an adequate calorie intake and an increase in physical activity. Other more aggressive options to escalate the efforts for reducing body weight include very low calorie diets, weight-lowering drugs and for the extreme forms of obesity surgical techniques. The treatment should be tailored to the "real world" and wishes of the individual patient. Patient empowerment is essential to achieve long-term self management of the weight problem. To effectively control the obesity epidemic it is of critical importance to establish preventive measures in the society. There is an urgent need to improve the structural prerequisites for a better treatment of people with overweight/obesity.

Bariatric Surgery↗
PubMed2006

[The costs of diabetes mellitus and its complications in Germany].

Analysis of hospital data makes it possible to gain an interesting insight into the quality and actuality of care of diabetic patients. But it also demonstrates what immense costs arise annually in Germany, especially in the treatment of diabetes-associated complications. The KODIM (costs of diabetes mellitus) study used anonymized data of a sample of patients insured with two German health insurances (AOK Hessen and KV Hessen). The data were based on the codes for diagnoses and services rendered as entered on the patients' medical certificate. Treatment costs of the underlying illness (prescriptions of antidiabetic drugs, medical consultations etc.) was around Euro 542 per diabetic patient for the year 2001. But the total cost of the treatment of diabetes-associated complications, averaging Euro 1,563, was very much greater. Total excess cost per patient per year was almost Euro 4,000. As the prevalence of diabetes mellitus is increasing in Germany each year by around 5 %, a marked increase is to be expected in costs to be met by the health service. Restrictions and decreased costs of the treatment of the underlying disease, as planned or already partly realized, may in future actually lead to an increase in the costs incurred in the diagnosis and treatment of diabetes-associated complications.

Costs and Cost Analysis↗
PubMed2005

[Prevention of diabetes mellitus type 1].

Primary prevention of type 1 diabetes is as yet not feasible. In contrast, prevention of acute and chronic complications of type 1 diabetes is highly effective. With a near normal blood glucose control the appearance and progression of microvascular complications (i.e. retinopathy, nephropathy and neuropathy) can be significantly reduced. Intensive insulin therapy is the gold standard for treatment of type 1 diabetes.

Acute Disease↗
PubMed2005

[Secretory activity of the adipocytes and comorbidities of obesity].

Fatty tissue synthesizes and secretes a wide range of products that may be directly involved in the pathogenesis of the complications associated with obesity. These so-called adipokines may trigger or sustain a chronic inflammatory process. By manipulating the secretory function of fat cells, it might in future be possible to prevent the development of the metabolic and cardiovascular complications of obesity. Current data already suggest that weight reduction and certain substances with an anti-inflammatory action reduce the risk for the metabolic and cardiovascular complications of obesity. To date, however, the evidence available is only indirect, and is insufficient to definitively establish causal relationships between certain secretory products of adipocytes and the comorbidities of adiposity. Further clinical studies are needed.

Adipocytes↗
PubMed2005

[Adiposis. A somatic or psychic disorder?].

Obesity, defined as a body mass index of > or =30 kg/m(2), is a modern epidemic and is increasing worldwide. Depending on genetic make-up, lifestyle factors such as nutrition, physical activity, and psychosocial conditions are the main determinants of its manifestation and severity. Numerous epidemiological studies show consistently that obesity is associated with many comorbidities and, moreover, reduces life expectancy. For this reason, there is a need for evidence-based treatment considering the individual risk. For patients with extreme obesity exceeding a BMI of 40 kg/m(2), surgical intervention is the most effective treatment, not only to improve most somatic and psychological comorbidities significantly but also to prolong life.

Adolescent↗
PubMed2005

Influence of Sibutramine on blood pressure: evidence from placebo-controlled trials.

OBJECTIVE: Sibutramine, a serotonin and norepinephrine transporter inhibitor, is widely used as an adjunctive obesity treatment. There have been concerns that norepinephrine reuptake inhibition with sibutramine could exacerbate arterial hypertension. DESIGN: Combined analysis of two placebo-controlled trials. SUBJECTS: The combined data set consisted of 1336 patients. Of these patients, 966 were randomized to sibutramine and 370 were randomized to placebo. MEASUREMENTS: Body weight, blood pressure, heart rate (HR). RESULTS: Sibutramine reduced body weight regardless of basal blood pressure. In the complete set of patients, systolic blood pressure did not change with either intervention over the 48-week period (-0.1+/-15.5 mmHg with sibutramine, -0.2+/-15.2 mmHg with placebo, P=0.9). The change in diastolic blood pressure over the 48 week period was 0.3+/-9.5 mmHg with sibutramine and -0.8+/-9.2 mmHg with placebo (P=0.049). The blood pressure response was not exacerbated in patients with grade 1 or 2 hypertension or in patients with isolated systolic hypertension. Sibutramine treatment caused a slight increase in supine HR that was sustained throughout the studies. CONCLUSIONS: Sibutramine treatment is unlikely to elicit a critical increase in blood pressure even in hypertensive patients. However, blood pressure and HR should be monitored closely. In patients who experience a clinically significant and sustained increase in blood pressure, the drug should probably be discontinued.

Adolescent↗
PubMed2004

[Low-carbohydrate or low-fat diet for weight loss--which is better?].

Several recent clinical studies show that a low-carbohydrate diet produces a greater initial weight loss than conventional low-fat diets, and is associated with a greater reduction of elevated serum triglycerides. After one year, however, weight loss is similar with both diets. Since the intake of saturated fat is higher on a low-carbohydrate diet, there may be an increased risk of elevated levels of LDL cholesterol, thus furthering atherosclerosis, over the long term. Before low-carbohydrate diets can be considered an equivalent alternative to low-fat diets for the treatment of obesity, long-term clinical trials are urgently required. The greater weight loss under low-carbohydrate diets would appear to be due to a lower caloric intake. Successful weight loss largely depends on restricting the intake of calories, but the supply of essential nutrients should be guaranteed.

Adolescent↗
PubMed2004

Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany.

BACKGROUND: Recent studies reported an increased prevalence of type II diabetes mellitus in obese children and adolescents, especially in specific ethnic subgroups. The aim of this study was to determine the prevalence of type II diabetes mellitus and impaired glucose regulation in a large group of Caucasian children and adolescents with obesity living in Germany. PATIENTS AND METHODS: A total of 520 subjects (237 boys, 283 girls) (mean age: 14.0+/-2.0 y (range 8.9-20.4 y)) with a BMI>97th percentile, BMI-SDS: 2.7+/-0.5 (range 1.9-4.6), who were consecutively admitted to an in-patient obesity unit participated in the study. A 2-h oral glucose tolerance test (1.75 mg of glucose per kilogram of body weight) was performed before entering a weight-loss program and capillary blood glucose concentrations were measured. Patients were categorized into normal glucose regulation, impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and diabetes. In addition, fasting venous blood was taken to determine the circulating insulin, C-peptide and lipids. Insulin resistance was estimated by homeostatic model assessment. RESULTS: Type II diabetes was present in 1.5% (n=8) of the patients, two patients were admitted with already diagnosed type II diabetes and six patients were identified with yet unknown diabetes. IFG was detected in 3.7% (n=19) and IGT in 2.1% (n=11) of the patients. All together, in 6.7% (n=35) (95% confidence interval: 4.7-9.2%) of the patients, impaired glucose regulation (IFG, IGT) or diabetes was identified. These patients had a higher BMI-SDS, higher levels of fasting insulin and C-peptide and a higher insulin resistance index than the patients with normal glucose regulation. Risk factors for the occurrence of impaired glucose regulation were a BMI-SDS>2.5 as well as a positive parents' history for diabetes. CONCLUSIONS: This is the first report on the prevalence of type II diabetes in a large cohort of Caucasian children and adolescents with obesity living in Europe. Impaired glucose regulation and type II diabetes were present in a substantial proportion of the patients studied. Screening for diabetes in severely obese children and adolescents (BMI-SDS>2.5) is therefore recommended. Patients identified with impaired glucose regulation need specific treatment programs in order to prevent progression to diabetes.

Acanthosis Nigricans↗
PubMed2004

Inhibitor kappaB kinase is involved in the paracrine crosstalk between human fat and muscle cells.

OBJECTIVE: Adipose tissue is now considered as an endocrine and secretory organ, and some adipocyte factors are thought to play a major role in the induction of insulin resistance in skeletal muscle. Here we tested the hypothesis that the crosstalk between fat and muscle involves activation of inhibitor kappaB Kinase (IKK) in the myocytes. MEASUREMENTS: Adipocyte-conditioned culture medium was added to the muscle cells overnight, or human fat and muscle cells were kept in co-culture. Insulin signalling was subsequently analysed in the myocytes. Involvement of IKK was assessed using I229, a highly specific inhibitor of the IKK complex. RESULTS: Adipocyte-conditioned medium strongly inhibited insulin-induced serine phosphorylation of Akt in myocytes with a rapid parallel activation of the nuclear factor kappaB pathway in these cells. Conditioned medium lacking the perturbation of insulin signalling did not activate NF-kappaB. Insulin signalling to Akt was completely abrogated under co-culture conditions. The IKK inhibitor I229 did not affect protein expression of Akt, but fully restored insulin action in myocytes subjected to co-culture. CONCLUSION: These data show that the release of fat cell factors may rapidly induce insulin resistance in human skeletal muscle cells. This process appears to be mediated by an IKK/NF-kappaB dependent pathway. We suggest that inhibitors of IKK would be of use to counteract the negative crosstalk between fat and muscle.

Adipocytes↗
PubMed2004

Obesity and impaired fibrinolysis: role of adipose production of plasminogen activator inhibitor-1.

Obesity is the central promoter of the metabolic syndrome which also includes disturbed fibrinolysis in addition to hypertension, dyslipidaemia and impaired glucose tolerance/type 2 diabetes mellitus. Plasminogen activator inhibitor-1 (PAI-1) is the most important endogenous inhibitor of tissue plasminogen activator and uro-plasminogen activator, and is a main determinant of fibrinolytic activity. There is now compelling evidence that obesity and, in particular, an abdominal type of body fat distribution are associated with elevated PAI-1 antigen and activity levels. Recent studies established that PAI-1 is expressed in adipose tissue. The greater the fat cell size and the adipose tissue mass, the greater is the contribution of adipose production to circulating PAI-1. Experimental data show that visceral adipose tissue has a higher capacity to produce PAI-1 than subcutaneous adipose tissue. Studies in human adipocytes indicate that PAI-1 synthesis is upregulated by insulin, glucocorticoids, angiotensin II, some fatty acids and, most potently, by cytokines such as tumour necrosis factor-alpha and transforming growth factor-beta, whereas catecholamines reduce PAI-1 production. Interestingly, pharmacological agents such as thiazolidinediones, metformin and AT(1)-receptor antagonists were found to reduce adipose expression of PAI-1. In addition, weight loss by dietary restriction or comprehensive lifestyle modification is effective in lowering PAI-1 plasma levels. In conclusion, impaired fibrinolysis in obesity is probably also due to an increased expression of PAI-1 in adipose tissue. An altered function of the endocrine system and an impaired auto-/paracrine function at the fat cell levels may mediate this disturbance of the fibrinolytic system and thereby increase the risk for cardiovascular disease..

Adipocytes↗