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Obesogenic eating behaviour and dietary intake in German children and adolescents: results from the GINIplus and LISA birth cohort studies

A. Marb, L. Libuda, M. Standl, S. Koletzko, C. Bauer, T. Schikowski, D. Berdel, A. von Berg, G. Herberth, J. Bühlmeier, C.P. Harris, European Journal of Clinical Nutrition (2022)

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background/objectives</jats:title> <jats:p>The transition to adolescence is characterised by considerable behavioural changes, including diet. This study describes the level of obesogenic eating behaviours in 10- and 15-year-olds, and their association with dietary intake.</jats:p> </jats:sec><jats:sec> <jats:title>Subjects/methods</jats:title> <jats:p>Participants of the 10- and 15-year follow-ups of the German GINIplus and LISA birth cohort studies were included (N<jats:sub>10</jats:sub> = 2257; N<jats:sub>15</jats:sub> = 1880). Eating behaviours and dietary intake were assessed via self-report questionnaires. Sex-stratified, cross-sectional associations of “external eating”, “emotional eating” and “dietary restraint” (the latter at age 15 years only) with dietary intake (17 food groups—categorised into tertiles, macronutrients, and total energy) were assessed using multinomial logistic or multiple linear regression as required, adjusting for covariates and correcting for multiple testing.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Reported levels of eating behaviours were low in both age-groups. External eating was higher in 10-year-old males than females, while all eating behaviours were most pronounced in 15-year-old females. At 10 years, emotional eating was associated with medium vegetable intake in females (Relative Risk Ratio (RRR) = 1.84, <jats:italic>p</jats:italic> = 0.0017). At 15 years, external eating was associated with total energy (kJ) in females (<jats:italic>β</jats:italic> = 718, <jats:italic>p</jats:italic> = 0.0002) and high butter intake in males (RRR = 1.96, <jats:italic>p</jats:italic> = 0.0019). Dietary restraint in females was inversely associated with total energy (<jats:italic>β</jats:italic> = −967, <jats:italic>p</jats:italic> &lt; 0.0001) and omega-3 fatty acids (Means Ratio (MR) = 0.94, <jats:italic>p</jats:italic> = 0.0017), and positively associated with high fruit (RRR = 2.20, <jats:italic>p</jats:italic> = 0.0003) and whole grains (RRR = 1.94, <jats:italic>p</jats:italic> = 0.0013).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Obesogenic eating behaviour scores are low among children and adolescents of a predominantly high socioeconomic status population and present only few associations with specific aspects of diet, mainly among adolescent females.</jats:p> </jats:sec>

The adrenal steroid profile in adolescent depression: a valuable bio-readout?

R. Hirtz, L. Libuda, A. Hinney, M. Föcker, J. Bühlmeier, P. Holterhus, A. Kulle, C. Kiewert, B.P. Hauffa, J. Hebebrand, C. Grasemann, Translational Psychiatry (2022), 12(1), 255

<jats:title>Abstract</jats:title><jats:p>There is preliminary evidence that adrenal steroids other than cortisol may be valuable biomarkers for major depressive disorder (MDD). So far, studies have been conducted in adults only, and conclusions are limited, mainly due to small sample sizes. Therefore, the present study assessed whether adrenal steroids serve as biomarkers for adolescent MDD. In 261 depressed adolescents (170 females) treated at a single psychiatric hospital, serum adrenal steroids (progesterone, 17-hydroxyprogesterone, 21-deoxycortisol, 11-deoxycortisol, cortisol, cortisone, deoxycorticosterone, corticosterone) were determined by liquid chromatography-tandem mass spectrometry. Findings were compared to that of an age- and sex-matched reference cohort (<jats:italic>N</jats:italic> = 255) by nonparametric analysis of variance. Nonparametric receiver operating characteristics (ROC) analyses were conducted to evaluate the diagnostic performance of single steroids and steroid ratios to classify depression status. Sensitivity analyses considered important confounders of adrenal functioning, and ROC results were verified by cross-validation. Compared to the reference cohort, levels of deoxycorticosterone and 21-deoxycortisol were decreased (<jats:italic>P</jats:italic> &lt; 0.001). All other glucocorticoid- and mineralocorticoid-related steroids were increased (<jats:italic>P</jats:italic> &lt; 0.001). The corticosterone to deoxycorticosterone ratio evidenced excellent classification characteristics, especially in females (AUC: 0.957; sensitivity: 0.902; specificity: 0.891). The adrenal steroid metabolome qualifies as a bio-readout reflecting adolescent MDD by a distinct steroid pattern that indicates dysfunction of the hypothalamus–pituitary–adrenal axis. Moreover, the corticosterone to deoxycorticosterone ratio may prospectively qualify to contribute to precision medicine in psychiatry by identifying those patients who might benefit from antiglucocorticoid treatment or those at risk for recurrence when adrenal dysfunction has not resolved.</jats:p>

Correction to: Changes in patterns of eating habits and food intake during the first German COVID-19 lockdown: results of a cross-sectional online survey

J. Bühlmeier, S. Frölich, C. Ludwig, N. Knoll-Pientka, B. Schmidt, M. Föcker, L. Libuda, European Journal of Nutrition (2022), 61(6), pp. 3307-3308


Low leptin levels are associated with elevated physical activity among lean school children in rural Tanzania

C. Ludwig, N. Knoll-Pientka, A. Mwanri, C. Erfle, V. Onywera, M.S. Tremblay, J. Bühlmeier, A. Luzak, M. Ferland, H. Schulz, L. Libuda, J. Hebebrand, BMC Public Health (2022), 22(1), 933

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>In Sub-Saharan African countries, rapid urbanization and increasing socio-economic status are associated with a transition to decreased physical activity (PA). A more sedentary lifestyle is linked to increased body fat leading to increments in leptin levels. Since rodent and human studies in high-income countries have shown that starvation-induced hypoleptinemia triggers high PA, efforts are warranted to pursue the hypothesis that low leptin levels in lean children of low- and middle-income countries (LMIC) are also associated with high PA.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>In this cross-sectional study, we assessed seven-day PA with triaxial accelerometry (ActiGraph GT3X) among 223 primary school children (9 to 12 years of age) in rural Tanzania. Moderate-to-vigorous PA (MVPA) and total accelerometer counts per day were outcome variables. Leptin was determined using enzyme linked immunosorbent assay tests from dried blood spots. Anthropometric assessments were conducted and food insecurity and socio-demographic data were gathered using semi-structured interviews.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>In this sample of school children in rural Tanzania, leptin concentrations (median: 0.91 ng/mL, P25: 0.55, P75: 1.69), body mass index z-scores (median: -1.35, P25: -1.93, P75: -0.82), and height-for-age-z-scores (median: -1.16, P25: -1.96, P75: -0.61) were low. In contrast, PA levels were high with a median MVPA time of 119 min/day. Linear regression confirmed that leptin levels were negatively associated with MVPA (beta: -18.1; 95%CI: -29.7; -6.5; <jats:italic>p</jats:italic> = 0.002) and total accelerometer counts (beta: -90,256; 95%CI: -154,146; -26,365; <jats:italic>p</jats:italic> = 0.006). Children residing in areas with better infrastructure had lower MVPA levels (<jats:italic>p </jats:italic>&lt; 0.001) and tended to have higher leptin levels (<jats:italic>p</jats:italic> = 0.062) than children residing in areas only reachable via dirt roads.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Our cross-sectional field study is the first that supports the hypothesis of low leptin levels as a potential endocrine trigger of high PA in lean children of a LMIC. We observed early signs of a PA transition towards a less active lifestyle in a subgroup residing in areas with better infrastructure that concomitantly tended to have higher leptin concentrations. Considering that area-dependent PA differences were more pronounced among girls than boys, whereas differences in leptin levels were less pronounced, not only biological, but also external factors explain PA transition.</jats:p> </jats:sec>

Age at menarche relates to depression in adolescent girls: Comparing a clinical sample to the general pediatric population

R. Hirtz, L. Libuda, A. Hinney, M. Föcker, J. Bühlmeier, P. Holterhus, A. Kulle, C. Kiewert, R. Kuhnert, C. Cohrdes, T. Peters, J. Hebebrand, C. Grasemann, Journal of Affective Disorders (2022), 318, pp. 103-112



Increased Prevalence of Subclinical Hypothyroidism and Thyroid Autoimmunity in Depressed Adolescents

R. Hirtz, M. Focker, L. Libuda, J. Antel, D. Ozturk, C. Kiewert, M. Munteanu, T. Peters, D. Fuhrer, D. Zwanziger, M. Thamm, J. Hebebrand, C. Grasemann, The Journal of Clinical Psychiatry (2021)


Rapid amelioration of anorexia nervosa in a male adolescent during metreleptin treatment including recovery from hypogonadotropic hypogonadism

J. Antel, S. Tan, M. Grabler, C. Ludwig, D. Lohkemper, T. Brandenburg, N. Barth, A. Hinney, L. Libuda, M. Remy, G. Milos, J. Hebebrand, European Child & Adolescent Psychiatry (2021)

<jats:title>Abstract</jats:title><jats:p>With this case report we support our medical hypothesis that metreleptin treatment ameliorates starvation related emotional, cognitive and behavioral symptomatology of anorexia nervosa (AN) and show for the first time strong effects in a male patient with AN. A 15.9 year old adolescent with severe AN of eight-month duration was treated off-label with metreleptin. Hyperactivity was assessed with accelerometry. Visual analogue scales (VAS), validated self- and clinician rating scales and lab results tracked changes from baseline to end of the 24-day dosing period and a five-month follow-up. Substantial improvements of mood and eating disorder related cognitions and hyperactivity set in after two days of treatment. During dosing, sub-physiological testosterone and TT3 levels normalized; clinically libido reemerged. Weight did not increase substantially during the dosing period. During follow-up target weight was attained; mood did not deteriorate; hyperactivity ceased. The results substantiate the strong effects seen in female cases and underscore the need for a double-blind placebo-controlled trial to confirm the observed strong, multiple and rapid onset beneficial effects of metreleptin in AN.</jats:p>

Ebenen der genetischen Analyse komplexer Phänotypen am Beispiel der Anorexia nervosa und der Varianz des Körpergewichts

R. Hirtz, Y. Zheng, L.S. Rajcsanyi, L. Libuda, J. Antel, T. Peters, J. Hebebrand, A. Hinney, Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (2021)

<jats:p> Zusammenfassung. Genetische Varianten beeinflussen die Gewichtsregulation und die Entwicklung von Essstörungen. Zunächst haben familienbasierte, sogenannte formalgenetische Studien den erblichen Anteil an der Gewichtsregulation und an der Ätiologie von Essstörungen beleuchtet. In einer Vielzahl von Studien zeigten sich sowohl für die Varianz des Körpergewichts als auch für die Entstehung von Essstörungen Erblichkeitsschätzer (Heritabilitätsraten) von über 50 %. Mit diesem Wissen begab man sich in den 90er-Jahren des letzten Jahrhunderts auf die Suche nach den zugrundeliegenden Genen (genauer: genetischen Varianten), die das Körpergewicht, das Essverhalten oder beide Phänotypen auf Grundlage geteilter Mechanismen beeinflussen. Zunächst wurden Kandidatengenstudien durchgeführt. Dabei untersuchte man auf Grundlage unterschiedlicher, v. a. aber pathophysiologisch plausibler Überlegungen Gene mit hoher Relevanz für die untersuchten Phänotypen. Dieser Ansatz war für Essstörungen nicht sehr erfolgreich, für die Gewichtsregulation konnte eine Handvoll Gene identifiziert werden. Verbunden mit großen methodischen Fortschritten in der genetischen Forschung und v. a. der Etablierung sogenannter genomweiter Assoziationsstudien (GWAS) Anfang der 2000er-Jahre konnten bislang über 1000 Varianten/Genorte detektiert werden, die das Körpergewicht beeinflussen. Für die Essstörung Anorexia nervosa (AN) sind aktuell acht solcher Genorte beschrieben. Diese Ergebnisse, aber auch aktuelle Ansätze zu phänotypübergreifenden Analysen lassen Einblicke in die komplexe Regulation des Körpergewichtes zu und haben zudem unerwartete Pathomechanismen für AN aufgezeigt. </jats:p>

Ernährungseffekten auf der Spur – Wie die Genetik helfen kann, Zusammenhänge zwischen Ernährung und seelischer Gesundheit aufzudecken

L. Libuda, J. Hebebrand, M. Föcker, T. Peters, A. Hinney, Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (2021), pp. 1-10

<jats:p> Zusammenfassung. Einleitung: Klassische ernährungsepidemiologische Studien (Beobachtungsstudien und randomisierte Interventionsstudien) zeigen, dass die Ernährung ein wichtiger Ansatzpunkt für die Prävention und Therapie psychischer Störungen sein könnte. Diese Studientypen haben allerdings Limitationen, die bei der Ergebnisinterpretation berücksichtigt werden müssen. In dieser narrativen übersichtsarbeit wird beschrieben, wie genetische Studien ein Bindeglied darstellen können, um einen Zusammenhang zwischen Ernährung und psychischen Störungen herzustellen. Methodik: Im Artikel werden verschiedene Ansätze genetischer phänotypübergreifender Analysen sowie Beispiele für deren Anwendungen in der ernährungspsychiatrischen Forschung beschrieben. Darüber hinaus werden spezifische Voraussetzungen sowie Stärken und Schwächen diskutiert. Ergebnisse: Als Methoden genetischer phänotypübergreifender Analysen sind im Rahmen ernährungspsychiatrischer Forschung bislang genetische Korrelationsanalysen, Look-up-Analysen sowie Mendelsche Randomisierungsstudien (MR-Studien) eingesetzt worden. Genetische Korrelationsanalysen und Look-up-Analysen geben erste Hinweise auf mögliche genetische überlappungen zwischen einer psychischen Störung und einem Stoffwechselweg und/oder der Versorgung mit einem spezifischen Nährstoff. MR-Studien sind weitergehende Detailanalysen mit dem Ziel, Kausalzusammenhänge zu identifizieren, beinhalten allerdings sehr spezifische Grundvoraussetzungen für ihre Durchführung. Schlussfolgerung: Genetische phänotypübergreifende Analysen sind eine sinnvolle Ergänzung der klassischen Ernährungsepidemiologie. Insbesondere signifikante Ergebnisse von MR-Studien sind eine wichtige Grundlage zur Entwicklung geeigneter Ernährungsinterventionen, die in nachfolgenden randomisiert kontrollierten Interventionsstudien mit deutlich erhöhter Erfolgsaussicht getestet werden können. Sie sind somit wichtige Instrumente einer effizienten ernährungspsychiatrischen Forschung. </jats:p>

Lack of Evidence for a Relationship Between the Hypothalamus-Pituitary-Adrenal and the Hypothalamus-Pituitary-Thyroid Axis in Adolescent Depression

R. Hirtz, L. Libuda, A. Hinney, M. Föcker, J. Bühlmeier, J. Antel, P. Holterhus, A. Kulle, C. Kiewert, J. Hebebrand, C. Grasemann, Frontiers in Endocrinology (2021)

<jats:p>In adults with major depressive disorder (MDD), a dysfunction between the hypothalamus-pituitary-adrenal (HPA) and the hypothalamus-pituitary-thyroid (HPT) axis has been shown, but the interaction of both axes has not yet been studied in adolescent major depressive disorder (MDD). Data from 273 adolescents diagnosed with MDD from two single center cross-sectional studies were used for analysis. Serum levels of thyrotropin (TSH), free levothyroxine (fT4), and cortisol were determined as indicators of basal HPT and HPA axis functioning and compared to that of adolescent controls by t-tests. Quantile regression was employed in the sample of adolescents with MDD to investigate the relationship between both axes in the normal as well as the pathological range of cortisol levels, considering confounders of both axes. In adolescent MDD, cortisol levels and TSH levels were significantly elevated in comparison to controls (<jats:italic>p</jats:italic> = &amp;lt;.001, <jats:italic>d</jats:italic> = 1.35, large effect size, and <jats:italic>p</jats:italic> = &amp;lt;.001, <jats:italic>d</jats:italic> = 0.79, moderate effect size, respectively). There was a positive linear relationship between TSH and cortisol (<jats:italic>p</jats:italic> = .003, <jats:italic>d</jats:italic> = 0.25, small effect size) at the median of cortisol levels (50<jats:sup>th</jats:sup> percentile). However, no relationship between TSH and cortisol was found in hypercortisolemia (cortisol levels at the 97.5<jats:sup>th</jats:sup> percentile). These findings imply that HPT and HPA axis dysfunction is common in adolescents with MDD and that function of both axes is only loosely related. Moreover, the regulation of the HPA and HPT axis are likely subjected to age-related maturational adjustments since findings of this study differ from those reported in adults.</jats:p>

Impact of lunch with carbohydrates differing in glycemic index on children's cognitive functioning in the late postprandial phase: a randomized crossover study

A. Drozdowska, K. Sinningen, M. Falkenstein, H. Rudolf, L. Libuda, A.E. Buyken, T. Lücke, M. Kersting, European Journal of Nutrition (2021), 61(3), pp. 1637-1647

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>Studies about effects of lunch dietary Glycemic Index (GI) on cognition of schoolchildren are scarce. Our previous CogniDo GI study found no changes of cognition in the early postprandial phase after consumption of two rice types with medium vs. high dietary GI for lunch (i.e., 45 min after starting lunch). This study investigated whether the dietary GI of lunch has an impact on cognition of schoolchildren in the late postprandial phase, 90 min after lunch.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>A randomized, 2 × 2 crossover intervention study was conducted at a comprehensive school with 5th and 6th grade students. Participants (<jats:italic>n</jats:italic> = 212) were randomly assigned to either sequence 1 or 2. In the first period, participants of sequence 1 received a dish with high GI rice (GI: 79), those of sequence 2 with medium GI rice (GI: 64)—in the second period, 1 week later, vice versa. Computer-based cognitive testing was performed 90 min after lunch examining tonic alertness, visual search and task switching, and working memory. Treatment effects and treatment effects adjusted for estimated lunch glycemic load (GL) were analyzed using a linear mixed model.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The selected cognitive parameters were not affected by the GI of lunch 90 min after lunch, neither after intention-to-treat nor in the per-protocol analysis. Adjustment for GL also did not change results.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>The present study revealed no notable differences after the consumption of two rice types with medium vs. high dietary GI for lunch in children’s cognitive function in the late postprandial phase, 90 min after lunch.</jats:p> </jats:sec><jats:sec> <jats:title>Clinical trial registration</jats:title> <jats:p>German Clinical Trials Register (DRKS00013597); date of registration: 16/04/2018, retrospectively registered.</jats:p> </jats:sec>

Size Matters: The CAG Repeat Length of the Androgen Receptor Gene, Testosterone, and Male Adolescent Depression Severity

R. Hirtz, L. Libuda, A. Hinney, M. Föcker, J. Bühlmeier, P. Holterhus, A. Kulle, C. Kiewert, J. Hebebrand, C. Grasemann, Frontiers in Psychiatry (2021)

<jats:p>There is a distinct increase in the prevalence of depression with the onset of puberty. The role of peripubertal testosterone levels in boys in this context is insufficiently understood and may be modulated by a functional polymorphism of the androgen receptor gene (AR), a variable number of CAG repeats. Moreover, there is preliminary evidence that the relationship between testosterone, CAG repeat length, and the severity of depressive symptoms may differ between subclinical and overt depression, but this has neither been studied in a clinical sample of adolescents with depression nor compared between subclinical and overt depression in an adequately powered study. To investigate the relationship between free testosterone, CAG repeat length of the AR, depression status (subclinical vs. overt), and the severity of depressive symptoms, 118 boys treated as in- or daycare patients at a single psychiatric hospital were studied. Of these, 73 boys had at least mild depressive symptoms according to the Beck Depression Inventory-II (BDI-II &amp;gt; 13). Higher-order moderation analysis in the multiple regression framework revealed a constant relationship between free testosterone and depression severity irrespective of the number of CAG repeats in adolescents with a BDI-II score ≤ 13. In adolescents with a BDI-II score &amp;gt; 13, however, there was a significant negative relationship between free testosterone and BDI-II score in patients with &amp;lt;19 CAG repeats and a significant positive relationship regarding free testosterone and BDI-II score in those with more than 28 CAG repeats, even when considering important covariates. These results suggest that the effects of testosterone on mood in male adolescents with depression depend on the genetic make-up of the AR as well as on depression status. This complex relationship should be considered by future studies addressing mental health issues against an endocrine background and may, moreover, contribute to tailored treatment concepts in psychiatric medicine, especially in adults.</jats:p>

Vitamin D Level Trajectories of Adolescent Patients with Anorexia Nervosa at Inpatient Admission, during Treatment, and at One Year Follow Up: Association with Depressive Symptoms

M. Föcker, N. Timmesfeld, J. Bühlmeier, D. Zwanziger, D. Führer, C. Grasemann, S. Ehrlich, K. Egberts, C. Fleischhaker, C. Wewetzer, I. Wessing, J. Seitz, B. Herpertz-Dahlmann, J. Hebebrand, L. Libuda, Nutrients (2021), 2356

<jats:p>(1) Background: Evidence has accumulated that patients with anorexia nervosa (AN) are at higher risk for vitamin D deficiency than healthy controls. In epidemiologic studies, low 25(OH) vitamin D (25(OH)D) levels were associated with depression. This study analyzed the relationship between 25(OH)D serum levels in adolescent patients and AN and depressive symptoms over the course of treatment. (2) Methods: 25(OH)D levels and depressive symptoms were analyzed in 93 adolescent (in-)patients with AN from the Anorexia Nervosa Day patient versus Inpatient (ANDI) multicenter trial at clinic admission, discharge, and 1 year follow up. Mixed regression models were used to analyze the relationship between 25(OH)D levels and depressive symptoms assessed by the Beck Depression Inventory (BDI-II). (3) Results: Although mean 25(OH)D levels constantly remained in recommended ranges (≥50 nmol/L) during AN treatment, levels decreased from (in)patient admission to 1 year follow up. Levels of 25(OH)D were neither cross-sectionally, prospectively, nor longitudinally associated with the BDI-II score. (4) Conclusions: This study did not confirm that 25(OH)D levels are associated with depressive symptoms in patients with AN. However, increasing risks of vitamin D deficiency over the course of AN treatment indicate that clinicians should monitor 25(OH)D levels.</jats:p>

Lack of Evidence for a Relationship Between the Hypothalamus-Pituitary-Adrenal and the Hypothalamus-Pituitary-Thyroid Axis in Adolescent Depression

R. Hirtz, L. Libuda, A. Hinney, M. Föcker, J. Bühlmeier, J. Antel, P. Holterhus, A. Kulle, C. Kiewert, J. Hebebrand, C. Grasemann, Frontiers in Endocrinology (2021), 12

<jats:p>In adults with major depressive disorder (MDD), a dysfunction between the hypothalamus-pituitary-adrenal (HPA) and the hypothalamus-pituitary-thyroid (HPT) axis has been shown, but the interaction of both axes has not yet been studied in adolescent major depressive disorder (MDD). Data from 273 adolescents diagnosed with MDD from two single center cross-sectional studies were used for analysis. Serum levels of thyrotropin (TSH), free levothyroxine (fT4), and cortisol were determined as indicators of basal HPT and HPA axis functioning and compared to that of adolescent controls by t-tests. Quantile regression was employed in the sample of adolescents with MDD to investigate the relationship between both axes in the normal as well as the pathological range of cortisol levels, considering confounders of both axes. In adolescent MDD, cortisol levels and TSH levels were significantly elevated in comparison to controls (<jats:italic>p</jats:italic> = &amp;lt;.001, <jats:italic>d</jats:italic> = 1.35, large effect size, and <jats:italic>p</jats:italic> = &amp;lt;.001, <jats:italic>d</jats:italic> = 0.79, moderate effect size, respectively). There was a positive linear relationship between TSH and cortisol (<jats:italic>p</jats:italic> = .003, <jats:italic>d</jats:italic> = 0.25, small effect size) at the median of cortisol levels (50<jats:sup>th</jats:sup> percentile). However, no relationship between TSH and cortisol was found in hypercortisolemia (cortisol levels at the 97.5<jats:sup>th</jats:sup> percentile). These findings imply that HPT and HPA axis dysfunction is common in adolescents with MDD and that function of both axes is only loosely related. Moreover, the regulation of the HPA and HPT axis are likely subjected to age-related maturational adjustments since findings of this study differ from those reported in adults.</jats:p>

Suggestive Evidence for Causal Effect of Leptin Levels on Risk for Anorexia Nervosa: Results of a Mendelian Randomization Study

T. Peters, J. Antel, R. Naaresh, B. Laabs, M. Föcker, N. Albers, J. Bühlmeier, A. Hinney, L. Libuda, J. Hebebrand, Frontiers in Genetics (2021)

<jats:p>Genetic correlations suggest a coexisting genetic predisposition to both low leptin levels and risk for anorexia nervosa (AN). To investigate the causality and direction of these associations, we performed bidirectional two-sample Mendelian randomization (MR) analyses using data of the most recent genome-wide association study (GWAS) for AN and both a GWAS and an exome-wide-association-study (EWAS) for leptin levels. Most MR methods with genetic instruments from GWAS showed a causal effect of lower leptin levels on higher risk of AN (e.g. IVW b = −0.923, <jats:italic>p</jats:italic> = 1.5 × 10<jats:sup>−4</jats:sup>). Because most patients with AN are female, we additionally performed analyses using leptin GWAS data of females only. Again, there was a significant effect of leptin levels on the risk of AN (e.g. IVW b = −0.826, <jats:italic>p</jats:italic> = 1.1 × 10<jats:sup>−04</jats:sup>). MR with genetic instruments from EWAS showed no overall effect of leptin levels on the risk for AN. For the opposite direction, MR revealed no causal effect of AN on leptin levels. If our results are confirmed in extended GWAS data sets, a low endogenous leptin synthesis represents a risk factor for developing AN.</jats:p>

Kurzzeitige Behandlung von Patient_innen mit Anorexia nervosa mit rekombinant hergestelltem Human-Leptin (Metreleptin): Rasch einsetzende positive Effekte auf Stimmung, Kognition und Verhalten

J. Hebebrand, J. Antel, S. Tan, M. Wabitsch, U. Wiesing, N. Barth, C. Ludwig, J. Bühlmeier, L. Libuda, G. Milos, A. Hinney, Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie (2021), pp. 1-5



Long‐term effects of hydrolyzed formulae on atopic diseases in the GINI study

M. Gappa, B. Filipiak‐Pittroff, L. Libuda, A. Berg, S. Koletzko, C. Bauer, J. Heinrich, T. Schikowski, D. Berdel, M. Standl, Allergy (2020), pp. 1903-1907


A mendelian randomization study on causal effects of 25(OH)vitamin D levels on attention deficit/hyperactivity disorder

L. Libuda, R. Naaresh, C. Ludwig, B. Laabs, J. Antel, M. Föcker, J. Hebebrand, A. Hinney, T. Peters, European Journal of Nutrition (2020), pp. 2581-2591

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>While observational studies revealed an inverse association between serum 25(OH)vitamin D (25(OH)D) and the risk of attention deficit/hyperactivity disorder (ADHD), the causality of this relationship remains unclear.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We conducted a bidirectional two-sample Mendelian Randomization (MR) study to examine whether 25(OH)D has an effect on the risk to develop ADHD or vice versa. Information on single nucleotide polymorphisms (SNP) associated with serum 25(OH)D was obtained from a genome-wide association study (GWAS) considering phenotype data from 79,366 individuals of European ancestry. Data on risk for ADHD were derived from a GWAS analysis with 20,183 individuals diagnosed with ADHD and 35,191 controls. For our analysis, we considered effect sizes based on the European participants (19,099 cases and 34,194 controls).</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Single SNP analyses showed a causal effect of vitamin D on ADHD risk for only one SNP (rs12785878, <jats:italic>p</jats:italic> = 0.024). The overall MR estimates did not reveal a causal effect of 25(OH)D on risk for ADHD. In the reverse analysis, neither any single nor the multi-SNP MR analyses showed a causal effect of ADHD on 25(OH)D.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Results from this two-sample MR study did not confirm a causal effect of 25(OH)D on ADHD or vice versa. Accordingly, our study does not provide evidence that improving 25(OH)D via supplementation could reduce the risk of developing ADHD.</jats:p> </jats:sec>

The overall diet quality in childhood is prospectively associated with the timing of puberty

R. Duan, T. Qiao, Y. Chen, M. Chen, H. Xue, X. Zhou, M. Yang, Y. Liu, L. Zhao, L. Libuda, G. Cheng, European Journal of Nutrition (2020), pp. 2423-2434

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>The influences of nutrition in childhood on puberty onset could have sustained consequences for health and wellbeing later in life. The aim of this study was to investigate the prospective association of diet quality prior to puberty with the timing of puberty onset.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>We considered data from 3983 SCCNG (Southwest China Childhood Nutrition and Growth) study participants with dietary data, anthropometric measurement, and information on potential confounders at their baseline assessment (mean age: 7.1 years for girls and 7.3 years for boys; mean length of follow-up was 4.2 years). Cox proportional hazard regression estimating hazard ratios (HRs) and 95% confidence intervals (CIs) were used to examine the relationship between diet quality and puberty onset. Dietary intake at baseline was assessed using a validated food frequency questionnaire. Diet quality was determined using the Chinese Children Dietary Index (CCDI) which measures adherence to current dietary recommendations (theoretical range: 0–160 points). Age at Tanner stage 2 for breast/genital development (B2/G2), menarche or voice break (M/VB) were used as pubertal markers. </jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>The CCDI score ranged from 56.2 to 136.3 for girls and 46.1–131.5 for boys. Pubertal markers consistently indicate that girls and boys with higher diet quality were more likely to enter their puberty later than their counterparts with lower CCDI scores (higher vs. lower CCDI tertiles: adjusted HR for age at B2: 0.85 (95% CI, 0.81–0.94), <jats:italic>p</jats:italic> for trend = 0.02; G2: 0.86 (95% CI,0.80–0.96), <jats:italic>p</jats:italic> for trend = 0.02; M: 0.86 (95% CI,0.80–0.95), <jats:italic>p</jats:italic> for trend = 0.02; VB: 0.86 (95% CI,0.79–0.98), <jats:italic>p</jats:italic> for trend = 0.03), after adjustment for paternal education level, baseline energy intake, and pre-pubertal body fat.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our data suggested a later puberty onset and later timing of progressed puberty stages in children with a high diet quality, which were independent of pre-pubertal body fat.</jats:p> </jats:sec>

Short-term metreleptin treatment of patients with anorexia nervosa: rapid on-set of beneficial cognitive, emotional, and behavioral effects

G. Milos, J. Antel, L. Kaufmann, N. Barth, A. Koller, S. Tan, U. Wiesing, A. Hinney, L. Libuda, M. Wabitsch, R. von Känel, J. Hebebrand, Translational Psychiatry (2020)

<jats:title>Abstract</jats:title><jats:p>To examine the hypothesis that normalization of low circulating leptin levels in patients with anorexia nervosa ameliorates hyperactivity, three seriously ill females with hyperactivity were treated off-label with metreleptin (recombinant human leptin) for up to 14 days. Drive for activity, repetitive thoughts of food, inner restlessness, and weight phobia decreased in two patients. Surprisingly, depression improved rapidly in all patients. No serious adverse events occurred. Due to obvious limitations of uncontrolled case series, placebo-controlled clinical trials are mandatory to confirm the observed rapid onset of beneficial effects. Our findings suggest an important role of hypoleptinemia in the mental and behavioral phenotype of anorexia nervosa.</jats:p>

The Role of Genetic Variation of BMI, Body Composition, and Fat Distribution for Mental Traits and Disorders: A Look-Up and Mendelian Randomization Study

T. Peters, L. Nüllig, J. Antel, R. Naaresh, B. Laabs, L. Tegeler, C. Amhaouach, L. Libuda, A. Hinney, J. Hebebrand, Frontiers in Genetics (2020)


Short-term effects of carbohydrates differing in glycemic index (GI) consumed at lunch on children’s cognitive function in a randomized crossover study

K. Jansen, J. Tempes, A. Drozdowska, M. Gutmann, M. Falkenstein, A. Buyken, L. Libuda, H. Rudolf, T. Lücke, M. Kersting, European Journal of Clinical Nutrition (2020), pp. 757-764


Effect of vitamin D deficiency on depressive symptoms in child and adolescent psychiatric patients: results of a randomized controlled trial

L. Libuda, N. Timmesfeld, J. Antel, R. Hirtz, J. Bauer, D. Führer, D. Zwanziger, D. Öztürk, G. Langenbach, D. Hahn, S. Ring, T. Peters, A. Hinney, J. Bühlmeier, J. Hebebrand, C. Grasemann, M. Föcker, European Journal of Nutrition (2020), pp. 3415-3424

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>While observational studies revealed inverse associations between serum vitamin D levels [25(OH)D] and depression, randomized controlled trials (RCT) in children and adolescents are lacking. This RCT examined the effect of an untreated vitamin D deficiency compared to an immediate vitamin D<jats:sub>3</jats:sub> supplementation on depression scores in children and adolescents during standard day and in-patient psychiatric treatment.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Patients with vitamin D deficiency [25(OH)D ≤ 30 nmol/l] and at least mild depression [Beck Depression Inventory II (BDI-II) &gt; 13] (<jats:italic>n</jats:italic> = 113) were 1:1 randomized into verum (VG; 2640 IU vitamin D<jats:sub>3</jats:sub>/d) or placebo group (PG) in a double-blind manner. During the intervention period of 28 days, both groups additionally received treatment as usual. BDI-II scores were assessed as primary outcome, DISYPS-II (Diagnostic System for Mental Disorders in Childhood and Adolescence, Self- and Parent Rating) and serum total 25(OH)D were secondary outcomes.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>At admission, 49.3% of the screened patients (<jats:italic>n</jats:italic> = 280) had vitamin D deficiency. Although the intervention led to a higher increase of 25(OH)D levels in the VG than in the PG (treatment difference: + 14 ng/ml; 95% CI 4.86–23.77; <jats:italic>p</jats:italic> = 0.003), the change in BDI-II scores did not differ (+ 1.3; 95% CI − 2.22 to 4.81; <jats:italic>p</jats:italic> = 0.466). In contrast, DISYPS parental ratings revealed pronounced improvements of depressive symptoms in the VG (− 0.68; 95% CI − 1.23 to − 0.13; <jats:italic>p</jats:italic> = 0.016).</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Whereas this study failed to show a vitamin D supplementation effect on self-rated depression in adolescent in- or daycare patients, parents reported less depressive symptoms in VG at the end of our study. Future trials should consider clinician-rated depressive symptoms as primary outcome.</jats:p> </jats:sec><jats:sec> <jats:title>Trial registration</jats:title> <jats:p>“German Clinical Trials Register” (<jats:ext-link xmlns:xlink="" ext-link-type="uri" xlink:href=""></jats:ext-link>), registration number: DRKS00009758</jats:p> </jats:sec>

Evaluation of Metabolic Profiles of Patients with Anorexia Nervosa at Inpatient Admission, Short- and Long-Term Weight Regain—Descriptive and Pattern Analysis

M. Föcker, A. Cecil, C. Prehn, J. Adamski, M. Albrecht, F. Adams, A. Hinney, L. Libuda, J. Bühlmeier, J. Hebebrand, T. Peters, J. Antel, Metabolites (2020), 7

<jats:p>Acute anorexia nervosa (AN) constitutes an extreme physiological state. We aimed to detect state related metabolic alterations during inpatient admission and upon short- and long-term weight regain. In addition, we tested the hypothesis that metabolite concentrations adapt to those of healthy controls (HC) after long-term weight regain. Thirty-five female adolescents with AN and 25 female HC were recruited. Based on a targeted approach 187 metabolite concentrations were detected at inpatient admission (T0), after short-term weight recovery (T1; half of target-weight) and close to target weight (T2). Pattern hunter and time course analysis were performed. The highest number of significant differences in metabolite concentrations (N = 32) were observed between HC and T1. According to the detected main pattern, metabolite concentrations at T2 became more similar to those of HC. The course of single metabolite concentrations (e.g., glutamic acid) revealed different metabolic subtypes within the study sample. Patients with AN after short-term weight regain are in a greater “metabolic imbalance” than at starvation. After long-term weight regain, patients reach a metabolite profile similar to HC. Our results might be confounded by different metabolic subtypes of patients with AN.</jats:p>


Assessing causal links between metabolic traits, inflammation and schizophrenia: a univariable and multivariable, bidirectional Mendelian-randomization study

B.D. Lin, A. Alkema, T. Peters, J. Zinkstok, L. Libuda, J. Hebebrand, J. Antel, A. Hinney, W. Cahn, R. Adan, J.J. Luykx, International Journal of Epidemiology (2019), pp. 1505-1514

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Blood immunoreactive biomarkers, such as C-reactive protein (CRP), and metabolic abnormalities have been associated with schizophrenia. Studies comprehensively and bidirectionally probing possible causal links between such blood constituents and liability to schizophrenia are lacking.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>To disentangle putative causal links between CRP blood levels and schizophrenia in both directions, we conducted multiple univariable Mendelian-randomization (MR) analyses, ranging from fixed-effect to inverse variance-weighted (IVW), weighted-median, MR Egger and generalized summary-data-based Mendelian-randomization (GSMR) models. To prioritize metabolic risk factors for schizophrenia, a novel multivariable approach was applied: multivariable Mendelian-randomization–Bayesian model averaging (MR-BMA).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>All forward univariable MR analyses consistently showed that CRP has a protective effect on schizophrenia, whereas reverse MR analyses consistently suggested absent causal effects of schizophrenia liability on CRP blood levels. Using MR-BMA, as the top protective factors for schizophrenia we prioritized leucine and as the prime risk-factor triglycerides in medium very-low-density lipoprotein (VLDL). The five best-performing MR-BMA models provided one additional risk factor: triglycerides in large VLDL; and two additional protective factors: citrate and lactate.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Our results add to a growing body of literature hinting at metabolic changes—in particular of triglycerides—independently of medication status in schizophrenia. We also highlight the absent effects of genetic liability to schizophrenia on CRP levels.</jats:p> </jats:sec>

Effects of LC-PUFA supply via complementary food on infant development—a food based intervention (RCT) embedded in a total diet concept

H. Kalhoff, C.M. Mesch, M. Stimming, A. Israel, C. Spitzer, L. Beganovic, R.E. Perez, B. Koletzko, P. Warschburger, M. Kersting, L. Libuda, European Journal of Clinical Nutrition (2019), pp. 682-690


Vitamin D and the Risk of Depression: A Causal Relationship? Findings from a Mendelian Randomization Study

L. Libuda, B. Laabs, C. Ludwig, J. Bühlmeier, J. Antel, A. Hinney, R. Naaresh, M. Föcker, J. Hebebrand, I.R. König, T. Peters, Nutrients (2019), 1085

<jats:p>While observational studies show an association between 25(OH)vitamin D concentrations and depressive symptoms, intervention studies, which examine the preventive effects of vitamin D supplementation on the development of depression, are lacking. To estimate the role of lowered 25(OH)vitamin D concentrations in the etiology of depressive disorders, we conducted a two-sample Mendelian randomization (MR) study on depression, i.e., “depressive symptoms” (DS, n = 161,460) and “broad depression” (BD, n = 113,769 cases and 208,811 controls). Six single nucleotide polymorphisms (SNPs), which were genome-wide significantly associated with 25(OH)vitamin D concentrations in 79,366 subjects from the SUNLIGHT genome-wide association study (GWAS), were used as an instrumental variable. None of the six SNPs was associated with DS or BD (all p &gt; 0.05). MR analysis revealed no causal effects of 25(OH)vitamin D concentration, either on DS (inverse variance weighted (IVW); b = 0.025, SE = 0.038, p = 0.52) or on BD (IVW; b = 0.020, SE = 0.012, p = 0.10). Sensitivity analyses confirmed that 25(OH)vitamin D concentrations were not significantly associated with DS or BD. The findings from this MR study indicate no causal relationship between vitamin D concentrations and depressive symptoms, or broad depression. Conflicting findings from observational studies might have resulted from residual confounding or reverse causation.</jats:p>

Risk factors for a low weight gain in the early stage of adolescent anorexia nervosa inpatient treatment: findings from a pilot study

N. Knoll-Pientka, J. Bühlmeier, T. Peters, M. Albrecht, F. Adams, K. Wustrau, M. Teufel, J. Hebebrand, M. Föcker, L. Libuda, Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity (2019), pp. 911-919


Clinical Trials Required to Assess Potential Benefits and Side Effects of Treatment of Patients With Anorexia Nervosa With Recombinant Human Leptin

J. Hebebrand, G. Milos, M. Wabitsch, M. Teufel, D. Führer, J. Bühlmeier, L. Libuda, C. Ludwig, J. Antel, Frontiers in Psychology (2019)



Association between full breastfeeding, timing of complementary food introduction, and iron status in infancy in Germany: results of a secondary analysis of a randomized trial

L. Libuda, A. Hilbig, S. Berber-Al-Tawil, H. Kalhoff, M. Kersting, European Journal of Nutrition (2018), pp. 523-531


The role of genetic variation of human metabolism for BMI, mental traits and mental disorders

J. Hebebrand, T. Peters, D. Schijven, M. Hebebrand, C. Grasemann, T.W. Winkler, I.M. Heid, J. Antel, M. Föcker, L. Tegeler, L. Brauner, R.A. Adan, J.J. Luykx, C.U. Correll, I.R. König, A. Hinney, L. Libuda, Molecular Metabolism (2018), pp. 1-11


Effect of an vitamin D deficiency on depressive symptoms in child and adolescent psychiatric patients – a randomized controlled trial: study protocol

M. Föcker, J. Antel, C. Grasemann, D. Führer, N. Timmesfeld, D. Öztürk, T. Peters, A. Hinney, J. Hebebrand, L. Libuda, BMC Psychiatry (2018)


Polygene Formen der Adipositas und Störungs-übergreifende Analysen

J. Giuranna, J. Antel, L. Libuda, T. Reinehr, T. Peters, J. Hebebrand, A. Hinney, Adipositas - Ursachen, Folgeerkrankungen, Therapie (2018), pp. 176-182

<jats:title>Zusammenfassung</jats:title><jats:p>Neben monogenen Formen und Hauptgen-Effekten sind für die genetische Prädisposition zur Adipositas polygene Mechanismen relevant. Meta-Analysen von genom-weiten Assoziationsstudien (GWAMA) haben mehr als 700 polygene Loci oder Polygene identifiziert, die genom-weit mit dem Body Mass index (BMI) assoziiert sind. Diese prädisponierenden Genvarianten (Allele) finden sich bei adipösen Probanden häufiger als bei normalgewichtigen oder schlanken Individuen. Mittels statistischer Analysen wurden diese Allele als Adipositas-Risikoallele klassifiziert. Jede einzelne polygene Variante leistet nur einen kleinen Beitrag zur Entwicklung einer Adipositas und erhöht das Gewicht pro Risikoallel nur um ca. hundert Gramm bis 1,5 Kilogramm. Der Erfolg der GWAMA hat in letzter Zeit Phänotyp übergreifende, sogenannte Cross- Disorder- und Cross-Phänotyp-Analysen, ermöglicht. Dabei können Risiko-Gene identifiziert werden, die mittels Analysen der einzelnen Erkrankungen / Phänotypen nicht entdeckt werden konnten. Funktionelle Studien (in vitro und in vivo) der GWAMA-abgeleiteten Polygene können zu einem besseren Verständnis der Mechanismen der Körpergewichtsregulation führen.</jats:p>

Trinken – was und wie viel?

A. Hilbig, L. Libuda, H. Kalhoff, Kinder- und Jugendmedizin (2018), pp. 7-12

<jats:title>Zusammenfassung</jats:title><jats:p>Wasser ist für Menschen das wichtigste Nahrungsmittel. Die Verfügbarkeit von ausreichend Trinkwasser in hoher Qualität hat große Bedeutung und ist weltweit ein herausforderndes Entwicklungsziel. Wasser hat im Körper viele Funktionen, etwa als Baustoff, Reaktionsmedium und Reaktionspartner oder als wichtiges Transportmedium. Ein gut regulierter Wasserhaushalt ist Voraussetzung für normale Körperfunktionen und für langfristige Gesundheit. Eine Dehydratation kann zu Symptomen wie Schwäche, niedrigem Blutdruck und Hypotonie führen und die Bewusstseinslage beeinträchtigen. Ein vollständiger Wasserentzug ist schon nach Tagen tödlich. Aber auch eine leichte Dehydratation beeinträchtigt langfristig die körperliche und geistige Leistungsfähigkeit. Angaben zum täglichen Wasserbedarf stützen sich vornehmlich auf epidemiologisch ermittelte Zufuhrdaten, die für gesunde Kinder und Jugendliche adäquat sind. Im Durchschnitt sollten Schulkinder etwa einen Liter und Jugendliche etwa 1,5 Liter täglich trinken. Zuckergesüßte Getränke mit hoher Energiedichte könnten das Risiko für Übergewicht und Adipositas erhöhen. Ein gesunder Getränkeverzehr kann mit Maßnahmen zur Verhaltensund zur Verhältnisprävention gefördert werden.</jats:p>

Dietary Acid Load and Mental Health Outcomes in Children and Adolescents: Results from the GINIplus and LISA Birth Cohort Studies

J. Bühlmeier, C. Harris, S. Koletzko, I. Lehmann, C. Bauer, T. Schikowski, A. von Berg, D. Berdel, J. Heinrich, J. Hebebrand, M. Föcker, M. Standl, L. Libuda, Nutrients (2018), 582



High protein intake along with paternal part-time employment is associated with higher body fat mass among girls from South China

M. Yang, H. Xue, J. Pan, L. Libuda, R. Muckelbauer, M. Yang, L. Quan, G. Cheng, European Journal of Nutrition (2017), pp. 1845-1854


Low 25(OH)-vitamin D concentrations are associated with emotional and behavioral problems in German children and adolescents

C. Husmann, M. Frank, B. Schmidt, K. Jöckel, J. Antel, V. Reissner, L. Libuda, J. Hebebrand, M. Föcker, PLOS ONE (2017), e0183091


Breastfeeding trends in healthy infants since 1990—results of the DONALD study

L. Libuda, K. Bolzenius, U. Alexy, European Journal of Clinical Nutrition (2017), pp. 1016-1018


Vitamin D and mental health in children and adolescents

M. Föcker, J. Antel, S. Ring, D. Hahn, Kanal, D. Öztürk, J. Hebebrand, L. Libuda, European Child & Adolescent Psychiatry (2017), pp. 1043-1066



Fitness and fatness in relation with attention capacity in European adolescents: The HELENA study

C. Cadenas-Sanchez, J. Vanhelst, J.R. Ruiz, R. Castillo-Gualda, L. Libuda, I. Labayen, P. De Miguel-Etayo, A. Marcos, E. Molnár, A. Catena, L.A. Moreno, M. Sjöström, F. Gottrand, K. Widhalm, F.B. Ortega, Journal of Science and Medicine in Sport (2016), pp. 373-379


Sedentary Behavior Is Independently Related to Fat Mass among Children and Adolescents in South China

H. Xue, G. Tian, R. Duan, L. Quan, L. Zhao, M. Yang, L. Libuda, R. Muckelbauer, G. Cheng, Nutrients (2016), 667


Lunch at school and children’s cognitive functioning in the early afternoon: results from the Cognition Intervention Study Dortmund Continued (CoCo)

M. Schröder, K. Müller, M. Falkenstein, P. Stehle, M. Kersting, L. Libuda, British Journal of Nutrition (2016), pp. 1298-1305

<jats:title>Abstract</jats:title><jats:p>Studies about effects of school lunch on children’s cognition are rare; two previous studies (CogniDo, CogniDo PLUS) generally found no negative effects of lunch on children’s cognitive performance at the end of lunch break (i.e. 45 min after finishing lunch), but suggested potential beneficial effects for single parameters. Therefore, the present study investigated the hypothesis of potential positive effects of school lunch on cognitive performance at early afternoon (90 min after finishing lunch). A randomised, cross-over intervention trial was conducted at a comprehensive school with fifth and sixth grade students. Participants were randomised into two groups: On day 1, group 1 did not eat lunch, whereas group 2 received lunch <jats:italic>ad libitum</jats:italic>. On day 2 (1 week later), group 2 did not eat lunch and group 1 received lunch <jats:italic>ad libitum</jats:italic>. The cognitive parameters task switching, working memory updating and alertness were tested using a computerised test battery 90 min after finishing the meal. Of the 204 recruited children, fifty were excluded because of deviations from the study protocol or absence on one of the 2 test days, which resulted in 154 participants. Data showed no significant effects of lunch on task switching, working memory updating and alertness (<jats:italic>P</jats:italic> values between 0·07 and 0·79). The present study suggests that school lunch does not seem to have beneficial effects on children’s cognitive functions regarding the conducted tests at early afternoon. Together with our previous studies, we conclude that school lunch in general has no negative effects on cognitive performance in children. However, beneficial effects seem to be restricted to a relatively short time period after eating lunch.</jats:p>

Changes in water and sugar-containing beverage consumption and body weight outcomes in children

R. Muckelbauer, S.L. Gortmaker, L. Libuda, M. Kersting, K. Clausen, B. Adelberger, J. Müller-Nordhorn, British Journal of Nutrition (2016), pp. 2057-2066

<jats:title>Abstract</jats:title><jats:p>An intervention study showed that promoting water consumption in schoolchildren prevented overweight, but a mechanism linking water consumption to overweight was not substantiated. We investigated whether increased water consumption replaced sugar-containing beverages and whether changes in water or sugar-containing beverages influenced body weight outcomes. In a secondary analysis of the intervention study in Germany, we analysed combined longitudinal data from the intervention and control groups. Body weight and height were measured and beverage consumption was self-reported by a 24-h recall questionnaire at the beginning and end of the school year 2006/2007. The effect of a change in water consumption on change in sugar-containing beverage (soft drinks and juices) consumption, change in BMI (kg/m<jats:sup>2</jats:sup>) and prevalence of overweight and obesity at follow-up was analysed using regression analyses. Of 3220 enroled children, 1987 children (mean age 8·3 (<jats:sc>sd</jats:sc> 0·7) years) from thirty-two schools were analysed. Increased water consumption by 1 glass/d was associated with a reduced consumption of sugar-containing beverages by 0·12 glasses/d (95 % CI −0·16, −0·08) but was not associated with changes in BMI (<jats:italic>P</jats:italic>=0·63). Increased consumption of sugar-containing beverages by 1 glass/d was associated with an increased BMI by 0·02 (95 % CI 0·00, 0·03) kg/m<jats:sup>2</jats:sup> and increased prevalence of obesity (OR 1·22; 95 % CI 1·04, 1·44) but not with overweight (<jats:italic>P</jats:italic>=0·83). In conclusion, an increase in water consumption can replace sugar-containing beverages. As sugar-containing beverages were associated with weight gain, this replacement might explain the prevention of obesity through the promotion of water consumption.</jats:p>

Development of a Dietary Index to Assess Overall Diet Quality for Chinese School-Aged Children: The Chinese Children Dietary Index

G. Cheng, R. Duan, S. Kranz, L. Libuda, L. Zhang, Journal of the Academy of Nutrition and Dietetics (2016), pp. 608-617


Ernährung und psychische Erkrankungen

L. Libuda, J. Antel, J. Hebebrand, M. Föcker, Der Nervenarzt (2016), pp. 87-101



Fatty acid supply with complementary foods and LC-PUFA status in healthy infants: results of a randomised controlled trial

L. Libuda, C.M. Mesch, M. Stimming, H. Demmelmair, B. Koletzko, P. Warschburger, K. Blanke, E. Reischl, H. Kalhoff, M. Kersting, European Journal of Nutrition (2015), pp. 1633-1644


Short-term effects of lunch on children's executive cognitive functioning: The randomized crossover Cognition Intervention Study Dortmund PLUS (CogniDo PLUS)

M. Schröder, K. Müller, M. Falkenstein, P. Stehle, M. Kersting, L. Libuda, Physiology & Behavior (2015), pp. 307-314


Mittagessen in der Schule – macht es die Kinder schlau oder müde?

L. Libuda, M. Schröder, K.. Müller, M. Kersting, Pädiatrische Praxis (2015), 84, pp. 647-656


Fish and rapeseed oil consumption in infants and mothers: dietary habits and determinants in a nationwide sample in Germany

M. Stimming, C.M. Mesch, M. Kersting, L. Libuda, European Journal of Nutrition (2014), pp. 1069-1080


Vitamin E Content and Estimated Need in German Infant and Follow-On Formulas With and Without Long-Chain Polyunsaturated Fatty Acids (LC-PUFA) Enrichment

M. Stimming, C.M. Mesch, M. Kersting, H. Kalhoff, H. Demmelmair, B. Koletzko, A. Schmidt, V. Böhm, L. Libuda, Journal of Agricultural and Food Chemistry (2014), pp. 10153-10161


Dietary Lipid Intake only Partially Influences Variance in Serum Phospholipid Fatty Acid Composition in Adolescents: Impact of Other Dietary Factors

K. Vyncke, I. Huybrechts, M. Van Winckel, M. Cuenca Garcia, I. Labayen, F. Gottrand, K. Widhalm, C. Leclercq, L. Libuda, Y. Manios, M. Sjostrom, D. Molnar, L.A. Moreno, M. Gonzalez-Gross, A. Spinneker, F. Perez de Heredia, M. Plada, S. De Henauw, Lipids (2014), pp. 881-893


Associations between macronutrient intake and serum lipid profile depend on body fat in European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

S. Bel-Serrat, T. Mouratidou, I. Huybrechts, I. Labayen, M. Cuenca-García, G. Palacios, C. Breidenassel, D. Molnár, R. Roccaldo, K. Widhalm, F. Gottrand, A. Kafatos, Y. Manios, K. Vyncke, M. Sjöström, L. Libuda, S. Gómez-Martínez, L.A. Moreno, British Journal of Nutrition (2014), pp. 2049-2059

<jats:p>The present study aimed to investigate the relationships between macronutrient intake and serum lipid profile in adolescents from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) cross-sectional study (2006–7), and to assess the role of body fat-related variables in these associations. Weight, height, waist circumference, skinfold thicknesses, total cholesterol, HDL-cholesterol (HDL-C), LDL-cholesterol, TAG, apoB and apoA1 were measured in 454 adolescents (44 % boys) aged 12·5–17·5 years. Macronutrient intake (g/4180 kJ per d (1000 kcal per d)) was assessed using two non-consecutive 24 h dietary recalls. Associations were evaluated by multi-level analysis and adjusted for sex, age, maternal education, centre, sum of four skinfolds, moderate-to-vigorous physical activity, sedentary behaviours and diet quality index for adolescents. Carbohydrate intake was inversely associated with HDL-C (β = − 0·189, <jats:italic>P</jats:italic>&lt; 0·001). An inverse association was found between fat intake and TAG (β = − 0·319, <jats:italic>P</jats:italic>&lt; 0·001). Associations between macronutrient intake and serum lipids varied according to adiposity levels, i.e. an inverse association between carbohydrate intake and HDL-C was only observed in those adolescents with a higher waist:height ratio. As serum lipids and excess body fat are the major markers of CVD, these findings should be considered when developing strategies to prevent the risk of CVD among adolescents.</jats:p>

Food variety in commercial and homemade complementary meals for infants in Germany. Market survey and dietary practice

C.M. Mesch, M. Stimming, K. Foterek, A. Hilbig, U. Alexy, M. Kersting, L. Libuda, Appetite (2014), pp. 113-119



Time trends in dietary fat intake in a sample of German children and adolescents between 2000 and 2010: not quantity, but quality is the issue

L. Libuda, U. Alexy, M. Kersting, British Journal of Nutrition (2013), pp. 141-150

<jats:p>Dietary fat intake in childhood may influence the risk for developing chronic diseases. The objective of the present study was to examine secular trends in the parameters of fat intake between 2000 and 2010 in a sample of German children and adolescents (<jats:italic>n</jats:italic> 808) participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study. Dietary data from 4380 3 d weighed dietary records were analysed using repeated-measures regression to determine time trends in fat quantity, i.e. the intake of total fat, and in fat quality, i.e. the ratios of SFA, MUFA and PUFA. In young children (2–3 years) and in adolescents (13–18 years), total fat intake remained stable over time, but decreased by 0·08 % of total energy (%E) per year in 4–12-year-old children. In 2010, median fat intake was at the upper end of the recommendations. SFA intake decreased slightly in 2–3- and 4–12-year-old children by 0·09 and 0·05 %E per year, respectively. MUFA and PUFA intakes remained stable in all the age groups except in adolescents. Here, PUFA intake decreased initially, but increased between 2005 and 2010. In 2010, only between 3 and 18 % of the respective age groups had an intake of SFA or PUFA within the recommendations. In conclusion, fat quantity and quality did not change substantially between 2000 and 2010. Fat quality, in particular, needs to be improved, since a large percentage of our sample did not meet the recommended intakes for SFA and PUFA.</jats:p>

Frequencies and demographic determinants of breastfeeding and DHA supplementation in a nationwide sample of mothers in Germany

L. Libuda, M. Stimming, C. Mesch, P. Warschburger, H. Kalhoff, B.V. Koletzko, M. Kersting, European Journal of Nutrition (2013), pp. 1335-1344


Lunch at school, at home or elsewhere. Where do adolescents usually get it and what do they eat? Results of the HELENA Study

K. Müller, L. Libuda, K. Diethelm, I. Huybrechts, L.A. Moreno, Y. Manios, L. Mistura, J. Dallongeville, A. Kafatos, M. González-Gross, M. Cuenca-García, M. Sjöström, L. Hallström, K. Widhalm, M. Kersting, Appetite (2013), pp. 332-339


Effects of lunch on children’s short-term cognitive functioning: a randomized crossover study

K. Müller, L. Libuda, N. Gawehn, C. Drossard, K. Bolzenius, C. Kunz, M. Kersting, European Journal of Clinical Nutrition (2013), pp. 185-189


A Review of the Effects of Lunch: On Adults’ Short-term Cognitive Functioning

K. Müller, L. Libuda, A.M. Terschlüsen, M. Kersting, Canadian Journal of Dietetic Practice and Research (2013), pp. 181-188

<jats:p> Because of widespread irregular lunch consumption by both children and adults, information on the effects of lunch on short-term cognitive functioning is relevant to public health. In September 2012, a MEDLINE search was conducted for studies in which the effects of lunch on cognitive performance were examined. Eleven experimental studies published from 1981 to 1996 were found and evaluated; all involved adults. In three studies, the effects of lunch and lunch skipping were compared; the remaining studies involved a determination of the effects of lunch size and lunch composition. Results of studies in which lunch was compared with no lunch indicate that lunch leads to potential impairment of some aspects of cognitive functioning in the early afternoon. Lunch size may influence cognitive functioning, with impairment more likely to occur after a large lunch than a small lunch. Furthermore, in comparison with low-fat lunches, high-fat lunches seem to result in slower but more accurate responses to some cognitive tasks. However, these suggestions must be viewed with caution, as they are based on only a few studies and are not thoroughly supported by high-quality evidence. In addition, results obtained with adults are not applicable to children. Thus, the potential effects of lunch need further examination in children and adults. </jats:p>

Rekrutierung von Müttern mit Säuglingen in einer Interventionsstudie – erste Erkenntnisse aus der PINGU-Studie.

C. Mesch, M.. Stimming, A. Wagner, L. Libuda, M. Kersting, Ernährungsumschau International (2013), 7, pp. 110-115


Long term higher urinary calcium excretion within the normal physiologic range predicts impaired bone status of the proximal radius in healthy children with higher potential renal acid load

L. Shi, L. Libuda, E. Schönau, L. Frassetto, T. Remer, Bone (2012), pp. 1026-1031


Dietary fatty acid intake, its food sources and determinants in European adolescents: the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study.

K. Vyncke, L. Libuda, T. De Vriendt, L. Moreno, M. Van Winckel, Y. Manios, F. Gottrand, D. Molnar, B. Vanaelst, M. Sjöström, M. González-Gross, L. Censi, K. Widhalm, N. Michels, C. Gilbert, C. Xatzis, M. Cuenca García, F. de Heredia, S. De Henauw, I. Huybrechts, H. consortium, Br J Nutr (2012), 108(12), pp. 2261-2273

Beverage consumption among European adolescents in the HELENA study.

K. Duffey, I. Huybrechts, T. Mouratidou, L. Libuda, M. Kersting, T. De Vriendt, F. Gottrand, K. Widhalm, J. Dallongeville, L. Hallström, M. González-Gross, S. De Henauw, L. Moreno, B. Popkin, H. Study group, Eur J Clin Nutr (2012), 66(2), pp. 244-252

Der Verzehr von Kochsalz und die Entwicklung des Körpergewichts.

L. Libuda, U. Alexey, Pädiatrische Praxis (2012), 79(3), pp. 429-430


Consumption of dietary salt measured by urinary sodium excretion and its association with body weight status in healthy children and adolescents

L. Libuda, M. Kersting, U. Alexy, Public Health Nutrition (2011), pp. 433-441

<jats:title>Abstract</jats:title><jats:sec id="S1368980011002138_abs1" sec-type="general"><jats:title>Objective</jats:title><jats:p>Highly processed foods such as convenience foods usually have a high salt content and therefore might indirectly act as adipogenic due to an increasing consumption of sugar-containing beverages (SCB). We examined the association between dietary salt and body weight status.</jats:p></jats:sec><jats:sec id="S1368980011002138_abs2" sec-type="general"><jats:title>Design</jats:title><jats:p>We used data on urinary Na excretion as an indicator of dietary salt and BMI standard deviation score (BMI-SDS) and percentage body fat (%BF) of children and adolescents participating in the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study.</jats:p></jats:sec><jats:sec id="S1368980011002138_abs3" sec-type="general"><jats:title>Setting</jats:title><jats:p>Dortmund, Germany.</jats:p></jats:sec><jats:sec id="S1368980011002138_abs4" sec-type="subjects"><jats:title>Subjects</jats:title><jats:p>Children and adolescents (<jats:italic>n</jats:italic> 364) who had at least two 24 h urine samples and two dietary records in the observational period between 2003 and 2009 were considered in our data analysis.</jats:p></jats:sec><jats:sec id="S1368980011002138_abs5" sec-type="results"><jats:title>Results</jats:title><jats:p>Repeated-measures regression models revealed that urinary Na was positively associated with BMI-SDS (+0·202 SDS/g Na excretion at baseline; <jats:italic>P</jats:italic> &lt; 0·001) and %BF (+1·303 %BF/g Na excretion at baseline; <jats:italic>P</jats:italic> &lt; 0·01) at baseline in boys and girls. These associations remained significant after adjustment for SCB consumption and total energy intake. Furthermore, there was a positive trend between baseline Na excretion and the individual change in %BF in the study period (+0·364 increase in %BF/g Na excretion at baseline), which was confirmed after inclusion of SCB consumption or total energy intake. There was no significant association between the change in Na excretion and the concurrent change of either BMI-SDS or %BF in any model.</jats:p></jats:sec><jats:sec id="S1368980011002138_abs6" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>Our results suggest that a high intake of processed salty foods could have a negative impact on body weight status in children and adolescents independently from their consumption of SCB.</jats:p></jats:sec>

24h-Sodium excretion and hydration status in children and adolescents - Results of the DONALD Study

U. Alexy, G. Cheng, L. Libuda, A. Hilbig, M. Kersting, Clinical Nutrition (2011), pp. 78-84


Ansätze der Übergewichtsprävention durch verbessertes Trinkverhalten im Setting Grundschule

R. Muckelbauer, L. Libuda, K. Clausen, M. Kersting, Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz (2011), pp. 339-348


24h-Sodium excretion and hydration status in children and adolescents - Results of the DONALD Study

U. Alexy, G. Cheng, L. Libuda, A. Hilbig, M. Kersting, Clinical Nutrition (2011), pp. 78-84


Fluids and children’s health.

R. Muckelbauer, L. Libuda, M. Kersting, in: Developing Children´s Food Products., Woodhead Publishing Limited , 2011


Trends in dietary carbohydrate quality during puberty from 1988 to 2007: a cause for concern?

G. Cheng, L. Libuda, N. Karaolis-Danckert, U. Alexy, K. Bolzenius, T. Remer, A. Buyken, British Journal of Nutrition (2010), pp. 1375-1383

<jats:p>The extent to which the quality of dietary carbohydrates (CHO) changes throughout puberty is not known. We analysed trends in the quantity and quality of CHO intake among German adolescents by separately examining trends during puberty (pubertal trends) and trends in CHO intake from 1988 to 2007 (secular trends). Linear mixed-effects regression analyses were performed in 216 participants of the Dortmund Nutritional and Anthropometric Longitudinally Designed Study who had provided weighed 3 d dietary records at the onset of the pubertal growth spurt (defined by age at take-off) and over the subsequent 4 years. Over the course of puberty, CHO quality changed little: added sugar intake from beverages increased in girls (0·25 (<jats:sc>se</jats:sc> 0·12) % energy (% E)/year, <jats:italic>P</jats:italic> = 0·04) and added sugar intake from sweets decreased in both sexes (boys: − 0·22 (<jats:sc>se</jats:sc> 0·11) % E/year, <jats:italic>P</jats:italic> = 0·049; girls: − 0·20 (<jats:sc>se</jats:sc> 0·10) % E/year, <jats:italic>P</jats:italic> = 0·04). For both sexes, significant upward secular trends were observed for CHO (% E), glycaemic load (g/MJ) and added sugar intakes from sources other than sweets and soft drinks (% E), while absolute fibre intake (g/d) decreased (<jats:italic>P</jats:italic> ≤ 0·04). Concomitant increases in total added sugar intake (% E) and decreases in fibre and whole-grain densities (g/MJ) (<jats:italic>P</jats:italic> = 0·001–0·02) were confined to boys only. The quality of dietary CHO consumed by healthy German adolescents shows notable secular declines, but does not change markedly during puberty. Public health initiatives should be tailored to improve the overall quality of CHO nutrition.</jats:p>

Convenience foods in children's diet and association with dietary quality and body weight status

U. Alexy, L. Libuda, S. Mersmann, M. Kersting, European Journal of Clinical Nutrition (2010), pp. 160-166


Comparison of the effects of dietary protein, androstenediol and forearm muscle area on radial bone variables in healthy prepubertal children

L. Libuda, S.A. Wudy, E. Schoenau, T. Remer, British Journal of Nutrition (2010), pp. 428-435

<jats:p>Adequate dietary habits are supposed to be one of the most important modifiable factors in osteoporosis prevention. However, the importance of specific nutrients is controversial. We examined relevant nutrients which are supposed to have an impact on bone parameters and compared their effect sizes with those of two known predictors of bone development: bone-related muscle mass and androgen levels. We analysed nutritional, hormonal and anthropometric data from 107 prepubertal children participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Diaphyseal bone mineral content (BMC), cortical area (CA), periosteal circumference, strength strain index and muscle area of the non-dominant forearm were measured by peripheral quantitative computed tomography. Data on long-term nutrient intakes (e.g. protein, Ca and vitamin D) were derived from 3 d weighed dietary records. Twenty-four hour urinary excretion rates of androgen metabolites including the sex steroid androstenediol were measured using GC–MS. Of all considered nutrients, only protein showed a trend for an association with BMC (β = +0·11; <jats:italic>P</jats:italic> = 0·073) and CA (β = +0·11; <jats:italic>P</jats:italic> = 0·056) in stepwise linear regression models. None of the other considered dietary variables was associated with bone parameters. The size of the bone anabolic effect of protein was partly comparable with that of androstenediol. Even though boys gained more bone mass in comparison with girls, the protein effect did not differ between sexes. Bone-related muscle area and sex steroids have the strongest effects on prepubertal diaphyseal bone. However, dietary protein may have a similar bone anabolic influence compared with androstenediol. In children without explicit nutrient deficits, protein seems to be the most important dietary component for diaphyseal bone status.</jats:p>

Urinary fructose: a potential biomarker for dietary fructose intake in children

S.A. Johner, L. Libuda, L. Shi, A. Retzlaff, G. Joslowski, T. Remer, European Journal of Clinical Nutrition (2010), pp. 1365-1370


Longitudinal Associations between Endogenous Melatonin Production and Reported Sleep Duration from Childhood to Early Adulthood

K. Diethelm, L. Libuda, K. Bolzenius, B. Griefahn, A. Buyken, T. Remer, Hormone Research in Paediatrics (2010), pp. 390-398



Diet Quality in Childhood Is Prospectively Associated with the Timing of Puberty but Not with Body Composition at Puberty Onset

G. Cheng, S. Gerlach, L. Libuda, S. Kranz, A.L.B. Günther, N. Karaolis-Danckert, A. Kroke, A. Buyken, The Journal of Nutrition (2009), pp. 95-102


Immigrational Background Affects the Effectiveness of a School-based Overweight Prevention Program Promoting Water Consumption

R. Muckelbauer, L. Libuda, K. Clausen, A.M. Toschke, T. Reinehr, M. Kersting, Obesity (2009), pp. 528-534


Relative validity of a self-completion 24 h recall questionnaire to assess beverage consumption among schoolchildren aged 7 to 9 years

R. Muckelbauer, L. Libuda, M. Kersting, Public Health Nutrition (2009), pp. 187-195

<jats:title>Abstract</jats:title><jats:sec id="S1368980009990759_abs1" sec-type="general"><jats:title>Objective</jats:title><jats:p>Drinking habits in children are associated with diet quality, but validated assessment tools for large-scale studies in young children are lacking. Therefore, we validated a self-completion 24 h recall questionnaire (RQ) focusing on beverage consumption with a 24 h weighed record (WR).</jats:p></jats:sec><jats:sec id="S1368980009990759_abs2" sec-type="general"><jats:title>Design</jats:title><jats:p>Thirty-five voluntary participants from the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) Study cohort aged 7–9 years completed the RQ. The illustrated RQ required ticking the number of glasses of seven beverage categories consumed in five time intervals in the previous 24 h. As a reference, parents completed weighed records of their child’s diet. Agreement between the RQ and WR was tested by classification into consumers and non-consumers (kappa coefficients, <jats:italic>κ</jats:italic>), by the children’s ability to estimate the exact beverage and total volume consumed (Wilcoxon signed-rank test, Spearman rank correlation), and by ranking children according to reported beverage volumes.</jats:p></jats:sec><jats:sec id="S1368980009990759_abs3" sec-type="results"><jats:title>Results</jats:title><jats:p>The RQ and WR showed a good level of agreement for classifying participants into consumers and non-consumers of the single beverage categories (<jats:italic>κ</jats:italic> values between 0·78 and 0·94). Correlation coefficients for the volume of the single categories ranged between 0·81 and 0·91. The total beverage volume was overestimated in the RQ, on average, by 114 ml (<jats:italic>P</jats:italic> = 0·015). Agreement in ranking into tertiles by beverage volume was moderate to good for juice/soft drinks (<jats:italic>κ</jats:italic> = 0·44), milk (<jats:italic>κ</jats:italic> = 0·57) and water (<jats:italic>κ</jats:italic> = 0·70), but fair for the total beverage volume (<jats:italic>κ</jats:italic> = 0·23).</jats:p></jats:sec><jats:sec id="S1368980009990759_abs4" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>Our self-completion 24 h RQ could estimate the consumption of several beverage categories among young children at the group level, but quantification of total beverage volume was flawed.</jats:p></jats:sec>

Relation of Dietary Glycemic Index, Glycemic Load, and Fiber and Whole-Grain Intakes During Puberty to the Concurrent Development of Percent Body Fat and Body Mass Index

G. Cheng, N. Karaolis-Danckert, L. Libuda, K. Bolzenius, T. Remer, A.E. Buyken, American Journal of Epidemiology (2009), pp. 667-677


Long-term process evaluation of a school-based programme for overweight prevention

R. Muckelbauer, L. Libuda, K. Clausen, M. Kersting, Child: Care, Health and Development (2009), pp. 851-857


A Simple Dietary Intervention in the School Setting Decreased Incidence of Overweight in Children

R. Muckelbauer, L. Libuda, K. Clausen, T. Reinehr, M. Kersting, Obesity Facts (2009), pp. 282-285


Promotion and Provision of Drinking Water in Schools for Overweight Prevention: Randomized, Controlled Cluster Trial

R. Muckelbauer, L. Libuda, K. Clausen, A.M. Toschke, T. Reinehr, M. Kersting, PEDIATRICS (2009), pp. e661-e667


Soft drinks and body weight development in childhood: is there a relationship?

L. Libuda, M. Kersting, Current Opinion in Clinical Nutrition and Metabolic Care (2009), pp. 596-600


Getränkeverzehr und Übergewicht bei Kindern

L. Libuda, R. Muckelbauer, M. Kersting, Journal für Ernährungsmedizin (2009), 11, pp. 23

Einfluss des Konsums von Erfrischungsgetränken auf den Ernährungs- und Gesundheits¬status von Kindern

L. Libuda, Ernährungsumschau (2009), 56(8), pp. 480-481

DONALD News: Zusammenhang zwischen dem Verzehr von Erfrischungsgetränken und dem Knochenstatus von Kindern und Jugendlichen.

L. Libuda, T. Remer, M. Kersting, Ernährungsumschau (2009), 56(3), pp. 137


Consumption of sugar-sweetened beverages and its association with nutrient intakes and diet quality in German children and adolescents

L. Libuda, U. Alexy, A. Buyken, W. Sichert-Hellert, P. Stehle, M. Kersting, British Journal of Nutrition (2008), 1549


Association between long-term consumption of soft drinks and variables of bone modeling and remodeling in a sample of healthy German children and adolescents

L. Libuda, U. Alexy, T. Remer, P. Stehle, E. Schoenau, M. Kersting, The American Journal of Clinical Nutrition (2008), pp. 1670-1677


Konsum von Erfrischungsgetränken und Entwicklung des Körpergewichts im Kindes- und Jugendalter – Gibt es eine Verbindung?

L. Libuda, U. Alexey, P. Stehle, M. Kersting, Aktuelle Ernährungsmedizin (2008), 33, pp. 123-131


DONALD News: Erfrischungsgetränke und Ernährungsqualität.

L. Libuda, M. Kersting, Ernährungsumschau (2008), 55, pp. 646


Pattern of beverage consumption and long-term association with body-weight status in German adolescents – results from the DONALD study

L. Libuda, U. Alexy, W. Sichert-Hellert, P. Stehle, N. Karaolis-Danckert, A. Buyken, M. Kersting, British Journal of Nutrition (2007), pp. 1370-1379

<jats:p>In the present study the relationship between the consumption of different beverage groups and body-weight status in 5 years of study participation in German adolescents was investigated. We used anthropometric and dietary data from 3 d weighed records of 244 subjects between 9 and 18 years of age participating in the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study. Only subjects with at least four out of six possible weighed dietary records were considered. A repeated-measures regression model (PROC MIXED) was used to analyse the effect of beverage consumption on body-weight status. BMI standard deviation scores (BMI-SDS) and body fat percentage (%BF) were chosen as the dependent variables. In boys, energetic beverage consumption was not associated with BMI-SDS or %BF, neither cross-sectionally nor prospectively. In girls, baseline consumption of energetic beverages did not predict baseline BMI-SDS, baseline %BF, or change in either variable over the study period. However, an increase in energetic beverage consumption over the study period was associated with an increase in BMI-SDS (+0.070 SDS/MJ increase in energetic beverage consumption; <jats:italic>P</jats:italic> = 0·01). Separate consideration of regular soft drinks and fruit juices revealed that, in girls, BMI-SDS increased with increased fruit juice consumption (+0·096 SDS/MJ increase in fruit juice consumption; <jats:italic>P</jats:italic> = 0·01), and to a lesser extent with regular soft drink consumption (+0·055 SDS/MJ increase in regular soft drink consumption; <jats:italic>P</jats:italic> = 0·08). In conclusion, these results suggest that an increase in energetic beverage consumption may result in weight gain, at least in adolescent girls.</jats:p>

DONALD News: Zuckerhaltige Getränke und Übergewicht bei Kindern.

L. Libuda, U. Alexey, Monatsschriften Kinderheilkunde (2007), 155, pp. 684

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