Vegetables and fruit provide a significant part of human nutrition, as they are important sources of nutrients, dietary fibre, and phytochemicals. However, it is uncertain whether the risk of certain chronic diseases can be reduced by increased consumption of vegetables or fruit by the general public, and what strength of evidence has to be allocated to such an association. Therefore, a comprehensive analysis of the studies available in the literature and the respective study results has been performed and evaluated regarding obesity, type 2 diabetes mellitus, hypertension, coronary heart disease (CHD), stroke, cancer, chronic inflammatory bowel disease (IBD), rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD), asthma, osteoporosis, eye diseases, and dementia. For judgement, the strength of evidence for a risk association, the level of evidence, and the number of studies were considered, the quality of the studies and their estimated relevance based on study design and size. For hypertension, CHD, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, COPD, and RA indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For IBD, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit. This critical review on the associations between the intake of vegetables and fruit and the risk of several chronic diseases shows that a high daily intake of these foods promotes health. Therefore, from a scientific point of view, national campaigns to increase vegetable and fruit consumption are justified. The promotion of vegetable and fruit consumption by nutrition and health policies is a preferable strategy to decrease the burden of several chronic diseases in Western societies.

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Critical review: vegetables and fruit in the prevention of chronic diseases

The objective of this study was to develop anatomically correct whole body human models of an adult male (34 years old), an adult female (26 years old) and two children (an 11-year-old girl and a six-year-old boy) for the optimized evaluation of electromagnetic exposure. These four models are referred to as the Virtual Family. They are based on high resolution magnetic resonance (MR) images of healthy volunteers. More than 80 different tissue types were distinguished during the segmentation. To improve the accuracy and the effectiveness of the segmentation, a novel semi-automated tool was used to analyze and segment the data. All tissues and organs were reconstructed as three-dimensional (3D) unstructured triangulated surface objects, yielding high precision images of individual features of the body. This greatly enhances the meshing flexibility and the accuracy with respect to thin tissue layers and small organs in comparison with the traditional voxel-based representation of anatomical models. Conformal computational techniques were also applied. The techniques and tools developed in this study can be used to more effectively develop future models and further improve the accuracy of the models for various applications. For research purposes, the four models are provided for free to the scientific community.

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The Virtual Family—development of surface-based anatomical models of two adults and two children for dosimetric simulations

Background Although inhibition of the renin–angiotensin system delays the progression of renal failure in adults with chronic kidney disease, the blood-pressure target for optimal renal protection is controversial. We assessed the long-term renoprotective effect of intensified blood-pressure control among children who were receiving a fixed high dose of an angiotensin-converting–enzyme (ACE) inhibitor. Methods After a 6-month run-in period, 385 children, 3 to 18 years of age, with chronic kidney disease (glomerular filtration rate of 15 to 80 ml per minute per 1.73 m 2 of body-surface area) received ramipril at a dose of 6 mg per square meter of bodysurface area per day. Patients were randomly assigned to intensified blood-pressure control (with a target 24-hour mean arterial pressure below the 50th percentile) or conventional blood-pressure control (mean arterial pressure in the 50th to 95th percentile), achieved by the addition of antihypertensive therapy that does not target the renin–angiotensin system; patients were followed for 5 years. The primary end point was the time to a decline of 50% in the glomerular filtration rate or progression to end-stage renal disease. Secondary end points included changes in blood pressure, glomerular filtration rate, and urinary protein excretion. Results A total of 29.9% of the patients in the group that received intensified blood-pressure control reached the primary end point, as assessed by means of a Kaplan– Meier analysis, as compared with 41.7% in the group that received conventional blood-pressure control (hazard ratio, 0.65; confidence interval, 0.44 to 0.94; P = 0.02). The two groups did not differ significantly with respect to the type or incidence of adverse events or the cumulative rates of withdrawal from the study (28.0% vs. 26.5%). Proteinuria gradually rebounded during ongoing ACE inhibition after an initial 50% decrease, despite persistently good blood-pressure control. Achievement of blood-pressure targets and a decrease in proteinuria were significant independent predictors of delayed progression of renal disease. Conclusions Intensified blood-pressure control, with target 24-hour blood-pressure levels in the low range of normal, confers a substantial benefit with respect to renal function among children with chronic kidney disease. Reappearance of proteinuria after initial successful pharmacologic blood-pressure control is common among children who are receiving long-term ACE inhibition. (ClinicalTrials.gov number, NCT00221845.)

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Strict blood-pressure control and progression of renal failure in children.

Objective To determine risk factors for childhood
overweight that can be identified during the first year of
life to facilitate early identification and targeted
intervention.
Design Systematic review and meta-analysis.
Search strategy Electronic database search of
MEDLINE, EMBASE, PubMed and CAB Abstracts.
Eligibility criteria Prospective observational studies
following up children from birth for at least 2 years.
Results Thirty prospective studies were identified.
Significant and strong independent associations with
childhood overweight were identified for maternal prepregnancy
overweight, high infant birth weight and rapid
weight gain during the first year of life. Meta-analysis
comparing breastfed with non-breastfed infants found a
15% decrease (95% CI 0.74 to 0.99; I2=73.3%; n=10)
in the odds of childhood overweight. For children of
mothers smoking during pregnancy there was a 47%
increase (95% CI 1.26 to 1.73; I2=47.5%; n=7) in the
odds of childhood overweight. There was some evidence
associating early introduction of solid foods and childhood
overweight. There was conflicting evidence for duration of
breastfeeding, socioeconomic status at birth, parity and
maternal marital status at birth. No association with
childhood overweight was found for maternal age or
education at birth, maternal depression or infant ethnicity.
There was inconclusive evidence for delivery type,
gestational weight gain, maternal postpartum weight loss
and ‘fussy’ infant temperament due to the limited
number of studies.
Conclusions Several risk factors for both overweight
and obesity in childhood are identifiable during infancy.
Future research needs to focus on whether it is clinically
feasible for healthcare professionals to identify infants at
greatest risk.

https://adc.bmj.com/content/archdischild/97/12/1019.full.pdf

Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy

Six-Minute Walk Test in Children and Adolescents

Fragestellung. Sowohl die Childhood Group der International Obesity Task Force (IOTF) als auch die European Childhood Obesity Group (ECOG) empfehlen den Body-mass-Index als Beurteilungskriterium fur Ubergewicht und Adipositas bei Kindern und Jugendlichen. Im Erwachsenenalter erfolgt die Definition von Ubergewicht und Adipositas anhand fester Grenzwerte, bei der Beurteilung von Kindern und Jugendlichen mussen die alters- und geschlechtsspezifischen Veranderungen des BMI berucksichtigt werden. 
Methode. Unter Heranziehung von 17 bereits durchgefuhrten Untersuchungen aus verschiedenen Regionen Deutschlands wurden BMI-Perzentile fur Kinder und Jugendliche erstellt. Die Berechnung der Perzentile basiert auf den Korperhohen- und Korpergewichtsdaten von 17.147 Jungen und 17.275 Madchen im Alter von 0–18 Jahren. 
Ergebnisse und Schlussfolgerung. Die vorgestellten Perzentile sollten als Referenz fur deutsche Kinder und Jugendliche angewendet werden. Die Arbeitsgemeinschaft “Adipositas im Kindes- und Jugendalter” (AGA) hat in ihren Leitlinien die Anwendung der hier vorgestellten 90. und 97. Perzentile zur Definition von Ubergewicht und Adipositas empfohlen.

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H. C. Geiß

Papers

Perzentile für den Body-mass-Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben