Vitamin D has been associated with depression, potentially via anti-inflammatory mechanisms, yet data are scarce, particularly in adolescence. We investigated (1) whether lower vitamin D status is associated with greater depression severity and (2) whether this association is statistically moderated by inflammation in patients of a child and adolescent psychiatry department. At admission, fasting morning venous blood was drawn. Serum vitamin D (25-hydroxy-cholecalciferol (25(OH)D)) and C-reactive protein (CRP) were analysed in all participants (n 465 (64·7 %♀; 11·3-18·9 years)). In a subsample (n 177), we additionally measured tumor necrosis factor-alpha (TNF-α), interferon-gamma (IFN-γ) and interleukin (IL)-1β, IL-6, IL-8 and IL-10. Depression severity was assessed by the Beck Depression Inventory II (BDI-II) (n 450), the Diagnostic System for Mental Disorders in Childhood and Adolescence via self-assessment (DISYPS Self) (n 441) and parent-assessment (DISYPS Proxy) (n 422). Overall, 43·2 % (n 201) were at risk for vitamin D deficiency (< 30 nmol/l), and 73·5-83·2 % - depending on assessment tool - showed at least mild depression. Linear regression revealed an inverse association between 25(OH)D and BDI-II in both crude and CRP-adjusted full-sample models. Logistic regressions showed a robust inverse association between 25(OH)D and DISYPS Proxy, but not for DISYPS Self. Although 25(OH)D was inversely correlated with some pro-inflammatory markers, neither their inclusion in regression models nor formal mediation analyses supported inflammation as a mediator of the vitamin D-depression association. Overall, our results suggest that vitamin D relates modestly to both depression and inflammation in adolescence. However, based on the measured parameters, we cannot confirm that anti-inflammatory effects are the link between vitamin D and depression.

The General Dietary Behavior Inventory (GDBI) is a low effort instrument with only 16 items to assess the general dietary behavior based on the dietary recommendations of the World Health Organization and the German Nutrition Society. In an online survey with a convenience sample, higher total GDBI scores indicating healthier dietary behavior were associated with a lower body mass index (BMI). Since mean value of the self-reported BMI in that sample was in the overweight range, the aim of the current study was to examine the adherence to dietary recommendations using the GDBI in a sample of young and healthy women at the lower normal BMI range. In total, 63 women aged 22.2 ± 2.2 years with a mean BMI of 20.4 ± 1.0 kg/m2 were included in this study. Body composition was determined using bioelectrical impedance analysis (BIA). GDBI sum score and single item scores were compared with those of the validation study. Spearman correlations were calculated between the GDBI sum score and age, BMI, waist circumference (WC), and BIA parameters. The mean GDBI score of 55.76 ± 6.46 in this sample was similar to that of the validation study. Regarding single items, the most pronounced difference compared with the validation study was found for the scores of item 2 indicating lower consumption of animal products in the current study. However, this item was not concordant with all further items. The GDBI sum score correlated with age, but neither with BMI nor WC nor any BIA parameter. In conclusion, other than expected we did not find a higher GDBI score compared with that of the validation study. Moreover, in this homogenous, healthy sample of young women at the lower normal BMI range, healthier dietary behavior as indicated by higher GDBI scores does not explain differences in BMI or body composition. The study is registered at the German Clinical Trials Register (DRKS-ID: DRKS00030472). Date of registration: October 10th, 2022, retrospectively registered.

The relationship between leptin levels and psychiatric disorders has been studied more extensively in adults than in children and adolescents. However, the results are conflicting. We investigated serum leptin levels in children and adolescents (11 to 18.9 years) with psychiatric disorders (n = 363). Absolute and relative (body-mass-index (BMI)-, sex- and pubertal-stage-adjusted z-scores using reference values of healthy children and adolescents) leptin levels of different patient groups according to diagnosis were compared. The association between leptin levels and depression (Beck Depression Inventory-II) and anxiety (Child Behavior Checklist and Youth Self Report) was examined using regression analysis. Leptin z-scores were higher in patients with psychiatric disorders than in healthy controls (median 1.50, p < .001). While global tests suggested differences in leptin z-scores between patients with different psychiatric disorders, these differences could not be attributed to diagnosis groups in post-hoc pairwise comparisons. Absolute leptin levels differed between psychiatric disorders (p < .001). Patients with anorexia nervosa (AN) had the lowest levels, and patients with mood disorders had higher leptin levels than patients with mental disorders other than mood disorders, anxiety or AN. Neither absolute nor relative leptin levels were related to depressive or anxiety symptoms in regression models adjusted for sex and BMI. Significantly elevated BMI-, sex- and puberty-stage-adjusted leptin levels were observed in children and adolescents with psychiatric disorders compared to a reference sample. Further controlled studies are needed to confirm and explain this finding. No relationship was found between absolute or relative leptin levels and symptoms of depression or anxiety.

Studies in adults suggest antidepressant effects of vitamin D, possibly via anti-inflammatory pathways, but evidence in youth is lacking. In the first randomized controlled trial (RCT) in depressed, vitamin D-deficient adolescents (DRKS00009758), symptom reduction emerged in only one of three outcomes. This secondary analysis investigates whether baseline inflammatory status modifies the effect of vitamin D. Data from 92 participants (78.3

Abstract Serum neurofilament light chain (sNfL) and glial fibrillary acidic protein (GFAP) are biomarkers of neuroaxonal and astrocytic damage but remain understudied in adolescent psychiatric populations. This study investigated sNfL and GFAP levels in 412 adolescents diagnosed with anorexia nervosa (AN) ( n = 52), depression ( n = 237), and other psychiatric disorders ( n = 123). We assessed their diagnostic utility, correlation with disease severity, and longitudinal changes during AN treatment. Biomarkers were measured using Single Molecule Array technology, with Z-scores derived from reference datasets. Compared to population norms, both biomarkers were elevated in AN (sNfL: 1.15 ± 1.17; GFAP: 1.50 ± 0.84) and in depression (sNfL: 0.34 ± 1.10; GFAP: 0.58 ± 1.00). Patients with AN showed significantly higher biomarker levels than those with depression or other psychiatric disorders; importantly, this distinction remained evident in sensitivity analyses restricted to underweight individuals with depression. In AN, sNfL levels correlated with baseline weight loss (β = −0.45, R² = 0.20) and declined significantly during treatment, while GFAP changes were less pronounced. Neither marker correlated with depressive symptom severity. Bootstrapped ROC analyses showed moderate-to-good discriminatory power (AUCs 0.70–0.84) for distinguishing AN from depression. These findings suggest that neuroaxonal and astrocytic stress is a component of adolescent psychopathology, particularly in AN. sNfL appears sensitive to starvation-related neurobiological changes, with levels normalizing alongside weight restoration. GFAP showed similar but less robust trends. Accordingly, the observed biomarker changes reflect more than underweight alone, supporting a potential role in differential diagnosis and treatment monitoring.

BACKGROUND:Steroid hormone profiles in affective disorders suggest hypothalamic-pituitary-adrenal (HPA) axis dysregulation and may reveal novel therapeutic targets. However, most existing studies focus narrowly on glucocorticoids. This study aims to comprehensively characterize alterations in the steroid metabolome of adolescents with depressive symptoms. METHODS:This cross-sectional study analyzed the urinary excretion of 39 steroid metabolites (via gas chromatography-mass spectrometry) from 75 adolescent psychiatric patients with depressive symptoms (63 females, age 15.6 ± 1.3 years) and 75 healthy controls (64 females, age 15.3 ± 1.3 years), matched for age, sex, and pubertal status. RESULTS:Patients exhibited significantly elevated excretion rates (μg/24h) of corticosterone metabolites (median = 608.4, interquartile range (IQR): 342.4 - 1208.2 vs. controls: median = 321.0, IQR: 243.9 - 443.8), dehydroepiandrosterone (DHEA) metabolites (median = 1253.8, IQR: 569.8 - 2796.2 vs. median = 519.5, IQR: 254.0 - 1028.7), androgen metabolites (median = 6721.0, IQR: 4185.6 - 9395.8 vs. median = 3680.4, IQR: 2510.8 - 5419.0), and individual progesterone and glucocorticoid metabolites, while estradiol excretion was lower (median = 4.0, IQR: 2.9 - 5.8 vs. median = 5.8, IQR: 4.3 - 7.7). Analyses of enzyme activities via multivariate machine learning identified the tetrahydrated urinary metabolite ratio of 11-deoxycorticosterone (TH-DOC) to corticosterone metabolites as a biomarker to distinguish patients from controls (AUC = 0.800, 95%-CI [0.702 - 0.882]). CONCLUSIONS:Elevated excretion rates of ACTH-dependent hormones indicate chronic stress in adolescents with depressive symptoms. The TH-DOC-to-corticosterone metabolite ratio may help identify at-risk patients or guide personalized therapies.

While circadian eating patterns seem to be involved in the aetiology of obesity in adulthood. Little is known about tracking of such patterns from infancy to pre- and primary school age and their prospective impact on body composition. Based on data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study we investigated whether circadian eating patterns in infancy (0–1 years) (1) track to pre- (3–4 years) or primary-school age (6–7 years) and (2) are associated with body composition at primary-school age, using multivariable linear regression models. Circadian patterns were extracted from 3-day weighed dietary records (n = 3,780 records from n = 510 children) and related to body mass index standard deviation scores (BMI-SDS), fat mass index (FMI) and fat free mass index (FFMI). Circadian eating patterns [i.e. eating occasion frequency (n/day), duration of nightly fasting (min), percentage of total energy intake from meals and snacks (

Anorexia nervosa (AN) is a severe mental disorder, and patients with AN are characterized by a low body weight and a fear of gaining weight. Restoration of body weight to the normal range is one major treatment aim, which can be a challenging process for the patients. Hence, as a psychopathological symptom of AN, weight manipulations such as water loading before weighing are commonly observed in clinical routine. Biological impedance analysis (BIA) is a helpful tool in routinely visualizing changes in body composition during the refeeding process. Here, we targeted the question whether BIA could potentially detect water loading in healthy, young and normal weight women serving as a preclinical model for patients with AN. Sixty-one women (mean ± SD, 22.2 ± 2.2 years, 20.4 ± 1.0 kg/m 2 ) were included in the analyses. We used a full experimental setting with a cross-over design on two consecutive days. On both days, all participants underwent a baseline BIA in the fasting state (t 0 ). Directly thereafter, participants either consumed 1000 ml of tap water (intervention-condition) or waited for the second BIA measurement 20 min (t 1 ) after baseline (control-condition), and vice versa the subsequent day. Two further BIA measurements took place at 40 (t 2 ) and 60 min (t 3 ) after baseline. After water consumption, we found increases in derived fat mass (FM) and phase angle at t 1 to t 3 , decreases at t 1 and subsequent increases at t 2 and t 3 in extracellular water (ECW) and total body water (TBW). In contrast, skeletal muscle mass (SMM) and ECW/TBW remained rather stable. In the control-condition, most parameters remained constant. Our study provided insight into the changes of impedance raw data and derived body compartments after water consumption among young, healthy and normal weight women. Although the considerable increase of FM in combination with a rather stable course of SMM, as found in our experiment after the consumption of water, could be a potential hint for water loading, further investigation considering the limitations of the present study as for instance the different metabolisms of patients with AN vs. healthy women is required, before transferability to the clinical setting will be given.

Total diet studies (TDS) and food monitoring programmes are different approaches for collecting occurrence data on substances in food. This case study evaluated the practical applicability of TDS data (BfR MEAL Study) and monitoring data for the assessment of long-term cadmium exposure in children in Germany. Cadmium data from both programmes were combined with food consumption data from the KiESEL study. Uncertainties associated with both assessments were systematically described. Using monitoring data resulted in cadmium intakes approximately 3 times higher than the use of BfR MEAL Study data. Incomplete data and neglect of market shares and consumption weights were considered by conservative data adjustments to the monitoring data and mainly explain the higher estimates. Fewer data adjustments were necessary for BfR MEAL Study data, which covered almost the entire diet and considered consumer behaviour during sample collection and sample preparation. In sum, the use of the BfR MEAL Study data resulted in less uncertainty and more reliable exposure estimates for chronic assessments over the entire diet. However, description of variability and upper tails of substance distributions in food remain essential features of monitoring data. The integration of both programmes into a complementary system further improves food safety.

ABSTRACT OBJECTIVE: The aim of this analysis was to investigate whether habitual intake of total dairy (TD) or different dairy types (liquid, solid, fermented, not-fermented, low-fat, high-fat, low-sugar and high-sugar dairy) during adolescence is associated with biomarkers of low-grade inflammation as well as risk factors of type 2 diabetes in young adulthood. DESIGN: Multivariable linear regression analyses were used to investigate prospective associations between estimated TD intake as well as intake of different types of dairy and a pro-inflammatory score, based on hsCRP, IL-6, IL-18, leptin and adiponectin, and insulin resistance assessed as HOMA2-IR in an open cohort study. SETTING: Dortmund, Germany PARTICIPANTS: Data from participants (n=375) of the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study were included, for whom at least two 3-day weighed dietary records during adolescence (median age: 11 years) and one blood sample in young adulthood (>18 years) were available. RESULTS: There was no statistically significant association between TD intake or intake of any dairy type and the pro-inflammatory score (all p>0.05). TD intake as well as each dairy type intake and insulin resistance also showed no association (all p>0.05). CONCLUSIONS: The habitual intake of dairy or individual types of dairy during adolescence does not seem to have a major impact on low-grade systemic inflammation and insulin resistance in the long term. There was no indication regarding a restriction of dairy intake for healthy children and adolescents in terms of diabetes risk reduction.

A previous follow-up of the GINIplus study showed that breastfeeding could protect against early eczema. However, effects diminished in adolescence, possibly indicating a “rebound effect” in breastfed children after initial protection. We evaluated the role of early eczema until three years of age on allergies until young adulthood and assessed whether early eczema modifies the association between breastfeeding and allergies. Data from GINIplus until 20-years of age (N = 4058) were considered. Information on atopic eczema, asthma, and rhinitis was based on reported physician’s diagnoses. Adjusted Odds Ratios (aOR) were modelled by using generalized estimating equations. Early eczema was associated with eczema (aORs = 3.2–14.4), asthma (aORs = 2.2–2.7), and rhinitis (aORs = 1.2–2.7) until young adulthood. For eczema, this association decreased with age (p-for-interaction = 0.002–0.006). Longitudinal models did not show associations between breastfeeding and the respective allergies from 5 to 20 years of age. Moreover, early eczema generally did not modify the association between milk feeding and allergies except for rhinitis in participants without family history of atopy. Early eczema strongly predicts allergies until young adulthood. While preventive effects of full breastfeeding on eczema in infants with family history of atopy does not persist until young adulthood, the hypothesis of a rebound effect after initial protection cannot be confirmed.

Young adults with a later chronotype are vulnerable for a discrepancy in sleep rhythm between work- and free days, called social jet lag (SJL). This study analysed (i) chronotype/SJL association with visceral fat/skeletal muscle mass, (ii) the attribution to physical activity behaviour, and (iii) chronotype-specific changes in physical activity behaviour in young adults during the Covid-19 pandemic lockdown. Chronotype and SJL were derived from the Munich-Chrono-Type-Questionnaire in 320 German students (age 18–25 years) from September 2019 to January 2020, 156 of these participated in an online follow-up survey in June 2020. Body composition was assessed by bioimpedance analysis at baseline. Multivariable linear regression analyses were used to relate chronotype/SJL to body composition; the contribution of self-reported physical activity was tested by mediation analysis. At baseline, a later chronotype and a larger SJL were associated with a higher visceral fat mass (P<0.05), this relation was notably mediated by the attention to physical activity (P<0.05). Chronotype (P = 0.02) but not SJL (P = 0.87) was inversely associated with skeletal muscle mass. During the pandemic lockdown, chronotype hardly changed, but SJL was reduced. Timing and physical activity behaviour remained in most participants and changes were unrelated to chronotype (all P>0.07). A later chronotype/higher SJL may increase the risk of a higher visceral fat mass even in this relatively healthy sample, which may be partly due to their physical activity behaviour. Despite a reduction in SJL during the pandemic lockdown, later chronotypes did not change their physical activity behaviour more than earlier chronotypes.

Background The German total diet study (TDS)—BfR MEAL Study—established its food list in 2016 based on food consumption data of children (0.5–<5 years) and adults (14–80 years). The list consists of 356 foods selected for analysis in order to ensure ≥90% coverage of the diet. Recently, new food consumption data for children (0.5–<6 and 6–<12 years) in Germany became available, which raised the opportunity to evaluate the applicability of the MEAL food list 2016 on new data. Objective We tested the hypotheses that the MEAL food list 2016 also covers ≥90% of the diet of the new collected food consumption data, and that the selection of foods from younger children and adults was sufficient to also cover the middle age group (6–<12 years). Strategies for updating the existing food list were assessed. Methods Three approaches evaluated the reusability and potential adjustment strategies of the existing food list. Approach 1 applied the existing food list to new food consumption data. Approach 2 allowed the extension of the existing food list to improve coverage of food consumption. Approach 3 set up a new food list based on the new data. Results The MEAL food list 2016 covered 94% of the overall diet of the new collected food consumption data. The diet of the middle age group was sufficiently covered with 91%. However, coverage on main food group or population subgroup level was <90% in some cases. Approach 3 most accurately identified relevant modifications to the existing food list. 94% of the MEAL food list 2016 could be re-used and 51 new foods were identified as potentially relevant. Significance The results suggest that a high investment in the coverage of a TDS food list will lower the effort and the resources to keep data updated in the long-term. Impact There is no established approach to update a TDS food list. This study provides comparative approaches to handle newly collected food consumption data for follow-on TDS activities. The results provide useful information for institutions planning or updating a TDS. Furthermore, new food consumption data for children in Germany recently became available and are here presented for the first time.

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.

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 ( N = 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 ( P < 0.001). All other glucocorticoid- and mineralocorticoid-related steroids were increased ( P < 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.

Background/objectives 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. Subjects/methods Participants of the 10- and 15-year follow-ups of the German GINIplus and LISA birth cohort studies were included (N 10 = 2257; N 15 = 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. Results 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, p = 0.0017). At 15 years, external eating was associated with total energy (kJ) in females ( β = 718, p = 0.0002) and high butter intake in males (RRR = 1.96, p = 0.0019). Dietary restraint in females was inversely associated with total energy ( β = −967, p < 0.0001) and omega-3 fatty acids (Means Ratio (MR) = 0.94, p = 0.0017), and positively associated with high fruit (RRR = 2.20, p = 0.0003) and whole grains (RRR = 1.94, p = 0.0013). Conclusion 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.