Regina Pickford

BackgroundThere is limited evidence from multi-exposure models on the environmental impact on type 2 diabetes (T2D), considering complex interrelations between the exposures. We aimed to identify air pollution, temperature and greenness features associated with T2D prevalence in a large pan-European study, specifically predicting the impact of exposure change under different scenarios.MethodsWe included 10 European population-based cohorts within the EXPANSE project. Information on environmental exposures, covariates and T2D diagnosis at recruitment were obtained for 87,044 individuals, including 5,662 T2D cases. Data on air pollution, greenness, and temperature at residential addresses originated from uniform pan-European models. T2D identification was based on questionnaires, registers or biomarker measurements. Adjusted cross-sectional associations between exposures and T2D were assessed, and all exposure two-way interactions and square terms were a priori included in elastic net regression models to identify the most influential environmental factors and combinations. Results were contextualized within different environmental scenarios.ResultsPM10 and temperature annual mean and variability, as well as their interaction term, were consistently associated with T2D prevalence across strata of sex, body mass index, and urbanicity. Associations with greenness, PM2.5 and PM2.5-average temperature interaction were also observed but less consistently across strata. In the scenario analysis, reducing air pollution was related to lower T2D prevalence, while a beneficial association with increasing greenness was most consistently observed in the highly urbanized subgroup.ConclusionsOur findings support a role of particulate air pollution in T2D development and suggest that beneficial effects of increased greenness primarily occur in highly urbanized areas.

Aim: To evaluate regional disparities in the prevalence, severity and extent of probing depths (PDs) as well as tooth loss in German adults aged 19–74, using data from the baseline study of the German National Cohort (NAKO; 2014–2019). Methods: Dental examinations were recorded at two levels: Level 1 (18/18 centres; N = 184,871; tooth counts including third molars and dental interview) and Level 2 (8/18 centres, not geographically representative; N = 18,389; recording of PDs). We evaluated differences by sex, age and study region. All data were survey‐weighted. For individuals aged 65–74, we supplemented tooth loss data from the Fifth German Oral Health Study and the Study of Health in Pomerania. Results: Among Level 1 participants, the prevalence of edentulism was 1.7% (95% confidence interval: 1.6–1.9). The average mean PD was 1.89 mm (1.87–1.91). Both edentulism and PDs increased with increasing age. There were clear regional disparities, with the lowest prevalence of both in Augsburg/Regensburg in the south (1.3% and 1.64 mm) and the highest in Neubrandenburg in the north‐east (2.3% and 2.31 mm). Conclusion: Clear regional disparities emerged. In light of demographic changes, these results highlight the importance of incorporating region‐specific oral health burdens into future healthcare planning and treatment concepts.

Objectives: Low physical activity (PA) and poor cognitive function are associated with higher mortality risks. However, little is known about their interaction, including whether PA may moderate cognition-related mortality risks. This study examines the combined associations of PA and cognition with all-cause mortality, with attention to sex differences. Methods: Using data from the German National Cohort and its mortality follow-up, we analyzed mortality risk based on: a) baseline low vs. sufficient PA (assessed via the global physical activity questionnaire using a threshold of < vs. ≥ 600 MET-minutes/week), b) baseline low vs. medium vs. high semantic memory (SM) and executive function/processing speed (EF/PS), assessed through factor analyses of a neurocognitive test battery, and c) their interaction on mortality in individuals aged 65 + up to 10 years of follow-up (N = 28,892). Cox models were estimated both in the total sample and stratified by sex, adjusting for relevant confounders and reporting both distinct and combined associations. Results: During follow-up, 1,605 individuals (5.6%) died: 1,097 men (7.5%) and 508 women (3.6%). Compared to individuals with low cognitive function, those with high SM (Hazard Ratio (HR) = 0.83 [95%CI: 0.67–1.02]), as well as high EF/PS (HR = 0.66 [0.53–0.83]) and medium EF/PS (HR = 0.68 [0.60–0.78]) had lower mortality risks. PA was associated with a 29% decreased mortality risk (HR = 0.71 [0.62–0.82]) compared to low PA. PA moderated the elevated risk from low cognition, with regard to EF/PS (low EF/PS*PA: HR = 0.65 [0.50–0.84] vs. low EF/PS*low PA: HR = 1 (ref.)) and SM (low SM*PA: HR = 0.60 [0.46–0.77] vs. low SM*low PA: HR = 1 (ref.)). The associations did not differ between men and women. Conclusion: Maintaining cognitive function and PA in older age is relevant for reducing mortality risk in both men and women. PA may offset risks linked to low cognition in both sexes, though mechanisms require further study. Trial registration: Clinical trial number: not applicable.