Regular consumption of flavonoids may reduce the risk for CVD. However, the effects of individual flavonoids, for example, quercetin, remain unclear. The present study was undertaken to examine the effects of quercetin supplementation on blood pressure, lipid metabolism, markers of oxidative stress, inflammation, and body composition in an at-risk population of ninety-three overweight or obese subjects aged 25-65 years with metabolic syndrome traits. Subjects were randomised to receive 150 mg quercetin/d in a double-blinded, placebo-controlled cross-over trial with 6-week treatment periods separated by a 5-week washout period. Mean fasting plasma quercetin concentrations increased from 71 to 269 nmol/l (P,0·001) during quercetin treatment. In contrast to placebo, quercetin decreased systolic blood pressure (SBP) by 2·6 mmHg (P,0·01) in the entire study group, by 2·9 mmHg (P,0·01) in the subgroup of hypertensive subjects and by 3·7 mmHg (P,0·001) in the subgroup of younger adults aged 25 -50 years. Quercetin decreased serum HDL-cholesterol concentrations (P,0·001), while total cholesterol, TAG and the LDL:HDL-cholesterol and TAG:HDL-cholesterol ratios were unaltered. Quercetin significantly decreased plasma concentrations of atherogenic oxidised LDL, but did not affect TNF-a and C-reactive protein when compared with placebo. Quercetin supplementation had no effects on nutritional status. Blood parameters of liver and kidney function, haematology and serum electrolytes did not reveal any adverse effects of quercetin. In conclusion, quercetin reduced SBP and plasma oxidised LDL concentrations in overweight subjects with a high-CVD risk phenotype. Our findings provide further evidence that quercetin may provide protection against CVD.Quercetin: Blood pressure: Inflammation: Oxidised LDL: CVD Flavonoids in general and quercetin in particular have been associated with a decreased risk for CVD (1) . Furthermore, there was a trend towards a reduction in the incidence of type 2 diabetes mellitus at higher quercetin intakes (2) . In Western populations, the primary dietary sources of quercetin are tea, red wine, fruits and vegetables (3,4) . Quercetin is one of the major flavonoids, ubiquitously distributed in (edible) plants, and one of the most potent antioxidants of plant origin (1) . Numerous biological effects of quercetin, including antioxidant, anti-inflammatory, anti-thrombotic and vasodilatory actions, have been described in vitro (1) . However, quercetin intervention trials in human subjects have so far shown inconclusive and even conflicting results (5) . Quercetin supplementation increased plasma antioxidant capacity, ex vivo resistance of LDL to oxidation and resistance of lymphocyte DNA to strand breakage, but decreased urinary 8-hydroxy-2 0 -deoxyguanosine concentrations (5) . Other human studies, however, failed to confirm effects on these biomarkers (5) . A recent meta-analysis of 133 controlled flavonoid trials (6) suggested that there may be clinically relevant effects of some flavonoids or flavonoid-ri...

Objective: To identify lifestyle clusters in adolescents and to characterize their association with overweight and obesity. Design: Cross-sectional and longitudinal data of the Kiel Obesity Prevention Study. Setting: Schools in Kiel, Germany. Subjects and methods: Cross-sectional data of 1894 adolescents aged 14 years and 4-year longitudinal data of a subsample of 389 children aged 10 and 14 years. Selfreported data of physical activity, modes of commuting to school, media time, nutrition, alcohol consumption and smoking were used to identify lifestyle clusters with two-step cluster analysis. Obesity indices (height, weight, waist circumference and fat mass (FM)) were measured. Results: Three lifestyle clusters were identified: a 'low activity and low-risk behaviour' cluster (cluster 1: n 740, 39?1 %); a 'high media time and high-risk behaviour' cluster (cluster 2: n 498, 26?3 %); and a 'high activity and medium-risk behaviour' cluster (cluster 3: n 656, 34?6 %). Strictly speaking, none of these clusters was considered to be markedly healthy. The prevalence of overweight and obesity tended to be lower in cluster 3 (15?9 %) than in clusters 1 (20?4 %) and 2 (20?5 %; P 5 0?053). Longitudinally, 4-year changes in FM were found to be lowest in cluster 2, but the 4-year incidence rate of obesity was lowest in cluster 3. Conclusions: Explicit healthy lifestyles do not exist, but an active lifestyle reduces the incidence of obesity. In adolescents, health promotion should take into account the diversity of lifestyles and address specific lifestyle clusters.

Objective: The aim of this study was to evaluate the 8-year outcome of school-based intervention on weight status, lifestyle and blood pressure (BP) as part of the Kiel Obesity Prevention Study (KOPS). Methods: Within a quasi-randomized controlled trial, 240 intervention (I) and 952 non-intervention (NI) students at age 6 and 14 years were assessed in schools. Six nutrition units followed by 20-min running games were performed within the first year at school. Primary outcome was the 8-year change in body mass index standard deviation score (BMI-SDS) according to German references. Effective intervention was tested using multilevel linear regression analysis. Results: Eight-year changes in BMISDS were +0.18 and +0.22 with increases in prevalence of overweight from 8.3 to 10.4% and 7.0 to 11.2% in I and NI students, respectively. Cumulative 8-year incidence of overweight was 5.9% and 7.1% in I and NI students, respectively. There was no overall effect of intervention, but a significant interaction was shown between the intervention and the socio-economic status (SES), which demonstrated that in high SES, the 8-year change in BMI-SDS was in favour of I (–0.17 in I and +0.17 in NI; p < 0.01). Intervention had no measurable effects on lifestyle and BP. Conclusions: School-based health promotion has some favourable and sustained effects on 8-year changes in BMI-SDS, which are most pronounced in students of high SES families. The data argue in favour of further preventive measures.

The Kiel Obesity Prevention Study (KOPS) has been performed since 1996. Examinations were performed at age 6, 10 and 14 years. In addition, birth weight as well as height and weight at age 2 years were collected retrospectively. For the study 4,997, 1,671 and 748 children were recruited at baseline (at age 6 years) as well as at 4 and 8-year follow-up, respectively. In this paper we will analyze and discuss (i) the important time period for preventive measures, (ii) effect sizes needed for successful interventions and (iii) suitable approaches for preventive measures. The main results were: (i) at age 6 years persistence of overweight was 69% while at younger ages persistence was 21% only. Thus, school entry was shown to be an important period for preventive measures. (ii) Interventions have to reduce energy balance by 140 kcal/day to prevent overweight (e.g. a reduction of energy intake). (iii) Prevention programs should involve the family and focus on increasing physical activity.

Aim: Health literacy (HL) is a key outcome of health education. Low HL is associated with a higher risk of health-related impairments and high health-related costs. This article therefore describes the contents and evaluation of the school-based programme “Health literacy in school-aged children” (GeKoKidS) and its acceptance by teachers. A second focus of the study is the description of methods to increase the response of schools, students and parents as a crucial condition for the validity and generalizability of results from epidemiologic prevention studies. Subjects and methods: The evaluation of the prevention program GeKoKidS included 5th grade students aged 9–13 years in schools in the region of Greifswald and East Pomerania [longitudinal randomised control group pre-post design (RCT)]. Data collections took place within the extended school dentist examination visits at the beginning of the 2007/2008 school year and at the beginning of the second half term of the 2008/2009 school year. This included medical examinations and self-completion questionnaires of students, parents and teachers. The study was authorised by the data protection commissioner of Mecklenburg-West Pomerania, the Ministry of Education, Science and Culture of Mecklenburg-West Pomerania and the Ethics Commitee of the Ernst Moritz Arndt University Greifswald. Based on the authorisation of the data protection concept and concerns about selective response, parents were not granted a consent but rather a right to refuse participation. Results: In Greifswald/East Pomerania, 19 of 22 schools with 5th year classes participated in GeKoKidS (response rate: 86.3%). Out of 914 eligible students in the participating schools, 882 children (96.4%) took part in the school dentist examinations. A total of 863 children (94.4%) participated in the extended school dentist examination; 852 children (93.2%) took part in the student survey. In the parental survey 721 parents participated (response rate: 78.8%). A high level of acceptance referring to teacher training and the appropriateness of the GeKoKidS programme was achieved. Conclusion: As shown by the low rate of refusal, the programme and the evaluation study were well accepted. Possible reasons for these results could be the chosen procedure of establishing contact with schools before sending the questionnaires and the parent’s right to refuse their child's participation instead of giving an active confirmation. Because of this high response rate, the database enables comprehensive conclusions to be reached on the health-related state of students in Greifswald/East Pomerania