@article{KranzKettlerAnandetal.2023,
  author    = {Kranz, Ragna-Marie and Kettler, Carmen and Anand, Corinna and Koeder, Christian and Husain, Sarah and Schoch, Nora and Buyken, Anette and Englert, Heike},
  title     = {Effect of a controlled lifestyle intervention on medication use and costs: The Healthy Lifestyle Community Program (cohort 2)},
  series = {Nutrition and Health},
  journal   = {Nutrition and Health},
  publisher = {Sage Publications},
  issn      = {2047-945X},
  doi       = {10.25974/fhms-16217},
  url       = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-162176},
  year      = {2023},
  abstract  = {Background: Establishing a healthy lifestyle has a great potential to reduce the prevalence of non-communicable diseases (NCDs) and their risk factors. NCDs contribute immensely to the economic costs of the health care system arising from therapy, medication use, and productivity loss. Aim: The aim of this study was to evaluate the effect of the Healthy Lifestyle Community Program (cohort 2; HLCP-2) on medication use and consequently on medication costs for selected NCDs (diabetes, hypertension, and dyslipidemia). Methods: Data stem from a 24-month non-randomised, controlled intervention trial aiming to improve risk factors for NCDs. Participants completed questionnaires at six measurement time points assessing medication use, from which costs were calculated. The following medication groups were included in the analysis as NCD medication: glucose-lowering medications (GLM), antihypertensive drugs (AHD) and lipid-lowering drugs (LLD). Statistical tests for inter- and intra-group comparison and multiple regression analysis were performed. Results: In total, 118 participants (intervention group [IG]: n = 79; control group [CG]: n = 39) were considered. Compared to baseline medication use decreased slightly in the IG and increased in the CG. Costs for NCD medication were significantly lower in the IG than in the CG after 6 (p = 0.004), 12 (p = 0.040), 18 (p = 0.003) and 24 months (p = 0.008). After multiple regression analysis and adjusting for confounders, change of costs differed significantly between the groups in all final models. Conclusion: The HLCP-2 was able to moderately prevent an increase of medication use and thus reduce costs for medication to treat NCDs with the greatest impact on AHD.},
  language  = {de}
}
@article{KoederAnandHusainetal.2023,
  author    = {Koeder, Christian and Anand, Corinna and Husain, Sarah and Kranz, Ragna-Marie and Schoch, Nora and Alzughayyar, Dima and Bitterlich, Norman and Hahn, Andreas and Englert, Heike},
  title     = {Exploratory analysis of the effect of a controlled lifestyle intervention on inflammatory markers - the Healthy Lifestyle Community Programme (cohort 2)},
  series = {BMC Nutrition},
  volume    = {9},
  journal   = {BMC Nutrition},
  number    = {25},
  issn      = {2055-0928},
  doi       = {10.1186/s40795-023-00684-2},
  year      = {2023},
  abstract  = {Background Chronic low-grade inflammation is associated with an increased risk of chronic disease and mortality. The objective of the study was to test the effect of a healthy lifestyle intervention on biomarkers of inflammation (among other risk markers). Methods We conducted a non-randomized controlled trial with mostly middle-aged and elderly participants from the general population in rural northwest Germany (intervention: n = 114; control: n = 87). The intervention consisted of a 1-year lifestyle programme focusing on diet (largely plant-based; strongest emphasis), physical activity, stress management, and social support. High-sensitivity C-reactive protein (hs-CRP) was assessed at baseline, 10 weeks, 6 months, and 1 year. Homocysteine (Hcy) was assessed at baseline, 10 weeks, and 1 year. Adiponectin (Apn) was assessed at baseline and 10 weeks. An exploratory analysis of these inflammatory markers assessing the between-group differences with ANCOVA was conducted. Results The 1-year trajectory of hs-CRP was significantly lower in the intervention group compared to control (between-group difference: -0.8 (95\% CI -1.2, -0.3) mg/l; p = 0.001; adjusted for baseline). The 1-year trajectory of Hcy was non-significantly higher in the intervention compared to control (between-group difference: 0.2 (95\% CI -0.3, 0.7) µmol/l; p = 0.439; adjusted for baseline). From baseline to 10 weeks, Apn decreased significantly more in the intervention group compared to control (between-group difference: -1.6 (95\% CI -2.7, -0.5) µg/ml; p = 0.004; adjusted for baseline). Conclusions Our study shows that healthy lifestyle changes can lower hs-CRP and Apn levels and are unlikely to significantly affect Hcy levels within 1 year. Trial registration German Clinical Trials Register (DRKS; reference: DRKS00018775, registered 12 Sept 2019; retrospectively registered; www.drks.de).},
  language  = {en}
}
@article{KoederAlzughayyarAnandetal.2022,
  author    = {Koeder, Christian and Alzughayyar, Dima and Anand, Corinna and Kranz, Ragna-Marie and Husain, Sarah and Schoch, Nora and Hahn, Andreas and Englert, Heike},
  title     = {The healthful plant-based diet index as a tool for obesity prevention - the Healthy Lifestyle Community Program cohort 3 study},
  series = {Obesity Science and Practice},
  journal   = {Obesity Science and Practice},
  doi       = {10.1002/osp4.649},
  year      = {2022},
  abstract  = {Background Worldwide the prevalence of obesity is high, and promoting a shift towards more healthful and more plant-based dietary patterns appears to be one promising strategy to address this issue. A dietary score to assess adherence to a healthy plant-based diet is the healthful plant-based diet index. While there is evidence from cohort studies that an increased healthful plant-based diet index is associated with improved risk markers, evidence from intervention studies is still lacking. Methods A lifestyle intervention was conducted with mostly middle-aged and elderly participants from the general population (n = 115). The intervention consisted of a 16-month lifestyle program focusing on a healthy plant-based diet, physical activity, stress management, and community support. Results After 10 weeks, significant improvements were seen in dietary quality, body weight, body mass index, waist circumference, total cholesterol, measured and calculated LDL cholesterol, oxidized LDL particles, non-HDL cholesterol, remnant cholesterol, glucose, insulin, blood pressure, and pulse pressure. After 16 months, significant decreases were seen in body weight (-1.8 kg), body mass index (-0.6 kg/m2), and measured LDL cholesterol (-12 mg/dl). Increases in the healthful plant-based diet index were associated with risk marker improvements. Conclusions The recommendation of moving towards a plant-based diet appears acceptable and actionable and may improve body weight. The healthful plant-based diet index can be a useful parameter for intervention studies.},
  language  = {de}
}
@incollection{EnglertDiehlGreenlawetal.2012,
  author    = {Englert, Heike and Diehl, H. and Greenlaw, R. and Aldana, S.},
  title     = {The Effects of Lifestyle Modification on Glycemic Levels and Medication Intake:The Rockford CHIP},
  series = {Dr. Oreste Capelli, Primary Care at a Glance - Hot Topics and New Insights},
  booktitle = {Dr. Oreste Capelli, Primary Care at a Glance - Hot Topics and New Insights},
  publisher = {InTech},
  address   = {Rijeka, Rum{\"a}nien},
  isbn      = {979-953-307-556-2},
  doi       = {10.25974/fhms-571},
  pages     = {323 -- 336},
  year      = {2012},
  abstract  = {Introduction: The high prevalence of cardiovascular disease (CVD) in the past 50 years has led to intense research, resulting in many improvements in treatment. At the same time, type 2 diabetes, with its concomitant increase in vascular complications, has become a serious, exploding and costly public health concern . Diabetes now affects 285 million adults worldwide and 344 million with pre-diabetes. Of these, 25.8 million diabetics and 79 million pre-diabetics are found in the United States alone.The current cost of diabetes in the US is likely to exceed the \$174 billion estimate, which includes 2/3 for direct medical costs and 1/3 for indirect costs, such as disability, work loss, and premature death, but omits the social cost of intangibles (e.g. pain, suffering, lower quality of life). The diabetes epidemic has been accompanied by a similarly drastic increase in obesity. Although the relationship between the two developments is a matter of debate, both are presumably caused by changes in dietary habits and an increasingly sedentary modern lifestyle . Compelling evidence has shown that lifestyle changes can effectively prevent or delay the occurrence of type 2 diabetes. Because individuals at risk for this disease can usually be identified during the pre-diabetic phase of impaired glucose tolerance, early intervention and lifestyle change offer a logical approach to preventing this disease and its devastating vascular complications. Additionally, community-based lifestyle interventions for high risk groups and for the general population are a cost-effective way of curbing the growing burden of the disease. Solidifying the scientific basis for the prevention, treatment and control of this disease and its implementation on a national level, however, remains a difficult challenge. Moreresearch is needed to provide comprehensive and more effective strategies for weight-loss,especially over time. Therefore, the objectives of this study were to identify diabetics and those at risk (prediabetics) out of the total cohort of 1,517 who selected themselves into an intensive community-based lifestyle intervention program, and to assess its clinical efficacy ineffecting medication status as determined and managed by their personal physicians.},
  language  = {en}
}
@article{NkengfakTorimiroNkongangetal.2012,
  author    = {Nkengfak, G. and Torimiro, J. and Nkongang, N. and Englert, Heike},
  title     = {A review: Effects of antioxidants on CD4 and viral load in HIV-infected women in sub-Saharan Africa - dietary supplements vs. local diet.},
  series = {International Journal for Vitamin and Nutrition Research},
  volume    = {82},
  journal   = {International Journal for Vitamin and Nutrition Research},
  issn      = {0300-9831},
  pages     = {63 -- 72},
  year      = {2012},
  abstract  = {Abstract In sub-Sahara Africa, micronutrient deficiency, especially of antioxidant micronutrients including vitamins A, C, and E, beta-carotene, selenium, zinc, and polyphenols is very common in HIV-positive patients. Amongst adults, women are the most vulnerable. Antioxidants are known to play a vital role in the immune system, reducing oxidative stress. Oxidative stress is induced by excess production of reactive oxygen species (ROS), due to the HIV infection. Such damage may be prevented or moderated through adequate oral intake of antioxidants, scavenging ROS, as well as protecting cells and tissues against oxidative stress. Antioxidants can be provided to the body through locally available antioxidant rich-diets such as fruit-and-vegetable-based diets and/or dietary supplements. Provision of antioxidants through local diets or dietary supplements exercise beneficial effects on biological markers of the immune system (CD4 and viral load). However, while dietary supplements represent a costly and short-term strategy to limiting antioxidant deficiency, local diets, combined with adequate nutritional education, can provide a low-cost and long-term strategy to reduce oxidative stress, prevent micronutrient deficiency, and slow down HIV disease progression. The former can be applicable in countries around the West, Central, and South coast of Africa, which are rich in natural food resources. In contrast with significant evidence that dietary supplements confer benefits in HIV patients, fewer data are available relating to the benefits of local diets. Thus the need to do more research in this area arises. This review compares available data on effects of antioxidants on CD4 and viral load in HIV-positive women noneligible for antiretroviral therapy. Intake of antioxidants though dietary supplements and local diet, associated with nutritional education, is compared. Studies conducted in sub-Sahara Africa are considered.},
  language  = {en}
}
@article{WillichEnglertSonntagetal.2009,
  author    = {Willich, S. N. and Englert, Heike and Sonntag, F. and V{\"o}ller, H. and Meyer-Sabellek, W. and Wegscheider, K. and Windler, E. and Katus, H. A. and M{\"u}ller-Nordhorn, J.},
  title     = {Impact of a compliance program on cholesterol control: results of the randomized ORBITAL study in 8108 patients treated with rosuvastatin},
  series = {Eur J Cardiovasc Prev Rehabil},
  volume    = {16},
  journal   = {Eur J Cardiovasc Prev Rehabil},
  pages     = {180 -- 187},
  year      = {2009},
  abstract  = {Abstract This study extends previous research evaluating the association between the CHIP intervention, change in body weight, and change in psychological health. A randomized controlled health intervention study lasting 4 wk. was used with 348 participants from metropolitan Rockford, Illinois; ages ranged from 24 to 81 yr. Participants were assessed at baseline, 6 wk., and 6 mo. The Beck Depression Inventory (BDI) and three selected psychosocial measures from the SF-36 Health Survey were used. Significantly greater decreases in Body Mass Index (BMI) occurred after 6 wk. and 6 mo. follow-up for the intervention group compared with the control group, with greater decreases for participants in the overweight and obese categories. Significantly greater improvements were observed in BDI scores, role-emotional and social functioning, and mental health throughout follow-up for the intervention group. The greater the decrease in BMI through 6 wk., the better the chance of improved BDI score, role-emotional score, social functioning score, and mental health score, with odds ratios of 1.3 to 1.9. Similar results occurred through 6 mo., except the mental health variable became nonsignificant. These results indicate that the CHIP intervention significantly improved psychological health for at least six months afterwards, in part through its influence on lowering BMI.},
  language  = {en}
}
@techreport{EnglertMuellerNordhornSeewaldetal.2010,
  type      = {Working Paper},
  author    = {Englert, Heike and M{\"u}ller-Nordhorn, Jacqueline and Seewald, Sebastian and Sonntag, Frank and V{\"o}ller, Hans and Meyer-Sabellek, Wolfgang and Wegscheider, Karl and Windler, Eberhard and Katus, Hugo and Willich, Stefan N.},
  title     = {Is patient self-report an adequate tool for monitoring cardiovascular conditions in patients with hypercholesterolemia?},
  publisher = {Oxford University Press},
  doi       = {10.25974/fhms-576},
  url       = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-5761},
  year      = {2010},
  abstract  = {ABSTRACT Background: To determine the accuracy of patient self-reports of specific cardiovascular diagnoses and to identify individual patient characteristics that influence the accuracy. Methods: This investigation was conducted as a part of the randomized controlled ORBITAL study. Patients with hypercholesterolemia were enrolled in 1961 primary-care centers all over Germany. Self-reported questionnaire data of 7640 patients were compared with patients' case report forms (CRFs) and medical records on cardiovascular diseases, using k statistics and binomial logit models. Results: k values ranged from 0.89 for diabetes to 0.04 for angina. The percentage of overreporting varied from 1 percent for diabetes to 17 percent for angina, whereas the percentage of underreporting varied from 8.0 percent for myocardial infarction to 57 percent for heart failure. Individual characteristics such as choice of individual general practitioner, male gender and age were associated with the accuracy of self-report data. Conclusion: Since the agreement between patient self-report and CRFs/medical records varies with specific cardiovascular diagnoses in patients with hypercholesterolemia, the adequacy of this tool seems to be limited. However, the authors recommend additional data validation for certain patient groups and consideration of individual patient characteristics associated with over- and underreporting. Keywords agreement, cardiovascular disease, case report forms, general practitioner information, medical records, orbital study, overreporting, patient self-report, underreporting},
  language  = {de}
}
@inproceedings{NkengkfackEnglertCzech2012,
  author    = {Nkengkfack, Germaine and Englert, Heike and Czech, Marion},
  title     = {Einfluss eines HIV-Care-Programms auf den Ern{\"a}hrungsstatus von HIV- infizierten Patienten in Kamerun},
  series = {Zusammenfassung DGE-Kongress, 2012},
  booktitle = {Zusammenfassung DGE-Kongress, 2012},
  year      = {2012},
  abstract  = {Einfluss eines HIV-Care-Programms auf den Ern{\"a}hrungsstatus von HIV- infizierten Patienten in Kamerun B. Sc. Marion Czech, G. Nkengkfack, H. Englert, Oerlinghausen Zusammenfassung Weltweit sind {\"u}ber 33,3 Millionen Menschen mit dem HI-Virus infiziert (vgl. WHO, 2009). Die Subsahara z{\"a}hlt mit 24,5 Millionen Infizierten zu den L{\"a}ndern mit der gr{\"o}ßten HIV-Rate. Allein in Kamerun sind ca. 5,5 prozent der Bev{\"o}lkerung betroffen (vgl. UNAIDS, 2007). Die Ern{\"a}hrung kann hierbei den Krankheitsverlauf positiv beeinflussen und somit das Auftreten der charakteristischen Symptome von Aids sowie den Beginn der teuren antiretroviralen Therapie verz{\"o}gern (vgl. Eckert, 2006, Immel, 2006). Durch zahlreiche Faktoren der HIV- Infektion ist bei 20-30 prozent der Patienten bereits in der asymptomatischen Phase der Infektion eine Mangelern{\"a}hrung zu beobachten. Neben dem Absinken des K{\"o}rpergewichtes kommt es h{\"a}ufig zu einem reduziertem Plasmavitaminspiegel Proteinmangel sowie zu vermehrtem oxidativen Stress (vgl. Biesalski,F{\"u}rst, Kasper et. al., 1995, S. 417). Ziel dieser Arbeit ist es die Auswirkungen eines HIV- Care- Programmes auf den Ern{\"a}hrungszustand von HIV- Infizierten Personen in Kamerun im Vergleich zu einer Kontrollgruppe darzulegen. Daf{\"u}r erfolgt eine Messung des Ern{\"a}hrungszustands vor Beginn des HIV- Care- Programmes, sowie nach drei- monatiger Durchf{\"u}hrung des Programmes. Parallel finden diese Erhebungen auch bei den Patienten der Kontrollgruppe statt. F{\"u}r die Erfassung des Body- Mass. Index werden Daten von 30 Patienten der Interventionsgruppe vor Beginn und nach 3- monatiger Durchf{\"u}hrung des HIV- Care- Programmes miteinander verglichen. Anhand eines 3- Tage- Protokolls werden von 31 Patienten der Interventionsgruppe, sowie von 31 Patienten der Kontrollgruppe jeweils vor Beginn der Schulungen und nach drei Monaten der Durchf{\"u}hrung die Parameter Gesamtenergiezufuhr und Zufuhr der Antioxidantien Vitamin A, C, E, sowie Zink miteinander verglichen. Parallel erfolgt von diesen je 31 Patienten je Gruppe auch die Beurteilung der Verzehrsh{\"a}ufigkeit einzelner Lebensmittelgruppen anhand eines Food Frequency Questionnaires. Der Body- Mass. Index von den 30 Personen der Interventionsgruppe verringerte sich zwischen T0 und T1 nur minimal um 0,33. Bei der Auswertung des 3- Tage- Protokolles zeigte sich eine Erh{\"o}hung der Zufuhr der Antioxidantien. Die Vitamine A und C wurden nach drei- monatiger Durchf{\"u}hrung des HIV- Care Programms in h{\"o}heren Mengen zu sich genommen, w{\"a}hrend sich die Aufnahme dieser Mikron{\"a}hrstoffe innerhalb der Kontrollgruppe nicht in gr{\"o}ßerem Ausmaß ver{\"a}nderte. Hinsichtlich der Verzehrsh{\"a}ufigkeit l{\"a}sst sich nach drei Monaten.},
  language  = {de}
}
@article{KranzKettlerKoederetal.2023,
  author    = {Kranz, Ragna-Marie and Kettler, Carmen and Koeder, Christian and Husain, Sarah and Anand, Corinna and Schoch, Nora and Englert, Heike},
  title     = {Health Economic Evaluation of a Controlled Lifestyle Intervention: The Healthy Lifestyle Community Program (Cohort 2; HLCP-2)},
  series = {Nutrients},
  journal   = {Nutrients},
  doi       = {10.25974/fhms-17454},
  url       = {http://nbn-resolving.de/urn:nbn:de:hbz:836-opus-174544},
  year      = {2023},
  abstract  = {Non-communicable diseases (NCD) are associated with high costs for healthcare systems. We evaluated changes in total costs, comprising direct and indirect costs, due to a 24-month non-randomized, controlled lifestyle intervention trial with six measurement time points aiming to improve the risk profile for NCDs. Overall, 187 individuals from the general population aged ≥18 years were assigned to either the intervention group (IG; n = 112), receiving a 10-week intensive lifestyle intervention focusing on a healthy, plant-based diet; physical activity; stress management; and community support, followed by a 22-month follow-up phase including monthly seminars, or a control group (CG; n = 75) without intervention. The complete data sets of 118 participants (IG: n = 79; CG: n = 39) were analyzed. At baseline, total costs per person amounted to 67.80 ± 69.17 EUR in the IG and 48.73 ± 54.41 EUR in the CG per week. The reduction in total costs was significantly greater in the IG compared to the CG after 10 weeks (p = 0.012) and 6 months (p = 0.004), whereas direct costs differed significantly after 10 weeks (p = 0.017), 6 months (p = 0.041) and 12 months (p = 0.012) between the groups. The HLCP-2 was able to reduce health-related economic costs, primarily due to the reduction in direct costs.},
  language  = {en}
}
@inproceedings{KettlerKranzAnandetal.2024,
  author    = {Kettler, Carmen and Kranz, Ragna-Marie and Anand, Corinna and Husain, Sarah and K{\"o}der, Christian and Michaelsen, Maren M. and Esch, Tobias and Englert, Heike},
  title     = {Effekt eines community-basierten Lebensstil-Interventionsprogramms auf die Selbstwirksamkeitserwartung von B{\"u}rger*innen in Bezug auf eine gesunde Ern{\"a}hrung},
  series = {Proceedings of the German Nutrition Society},
  booktitle = {Proceedings of the German Nutrition Society},
  publisher = {Deutsche Gesellschaft f{\"u}r Ern{\"a}hrung e.V. (DGE)},
  address   = {Bonn},
  pages     = {93 -- 93},
  year      = {2024},
  language  = {de}
}