Anja Schienkiewitz

Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study.

BACKGROUND Our objective was to describe the reduction in relative risk of developing major chronic diseases such as cardiovascular disease, diabetes, and cancer associated with 4 healthy lifestyle factors among German adults. METHODS We used data from 23,153 German participants aged 35 to 65 years from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. End points included confirmed incident type 2 diabetes mellitus, myocardial infarction, stroke, and cancer. The 4 factors were never smoking, having a body mass index lower than 30 (calculated as weight in kilograms divided by height in meters squared), performing 3.5 h/wk or more of physical activity, and adhering to healthy dietary principles (high intake of fruits, vegetables, and whole-grain bread and low meat consumption). The 4 factors (healthy, 1 point; unhealthy, 0 points) were summed to form an index that ranged from 0 to 4. RESULTS During a mean follow-up of 7.8 years, 2006 participants developed new-onset diabetes (3.7%), myocardial infarction (0.9%), stroke (0.8%), or cancer (3.8%). Fewer than 4% of participants had zero healthy factors, most had 1 to 3 healthy factors, and approximately 9% had 4 factors. After adjusting for age, sex, educational status, and occupational status, the hazard ratio for developing a chronic disease decreased progressively as the number of healthy factors increased. Participants with all 4 factors at baseline had a 78% (95% confidence interval [CI], 72% to 83%) lower risk of developing a chronic disease (diabetes, 93% [95% CI, 88% to 95%]; myocardial infarction, 81% [95% CI, 47% to 93%]; stroke, 50% [95% CI, -18% to 79%]; and cancer, 36% [95% CI, 5% to 57%]) than participants without a healthy factor. CONCLUSION Adhering to 4 simple healthy lifestyle factors can have a strong impact on the prevention of chronic diseases.

Carbohydrate intake and incidence of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study

It remains unclear what long-term effects of substituting carbohydrates at the expense of protein or fat may have with regard to diabetes risk. Our objective was to evaluate carbohydrate intake in predicting type 2 diabetes using substitution models for fat and protein. We conducted a prospective cohort study of 9,702 men and 15,365 women aged 35-65 years and free of diabetes at baseline (1994-8) who were followed for incident type 2 diabetes until 2005. Dietary intake of macronutrients was estimated with a validated FFQ. We estimated the relative risk (RR) using Cox proportional hazards analysis. During 176,117 person-years of follow-up we observed 844 incident cases of physician-confirmed type 2 diabetes. After adjustment for age, BMI, waist circumference, potential lifestyle and dietary confounders, substituting 5 % of energy intake from total, saturated, or monounsaturated fat with carbohydrates was not associated with diabetes risk. In contrast, substituting carbohydrates for protein or PUFA was inversely related to diabetes risk (RR for 5 % energy substitution of protein 0.77 (95 % CI 0.64, 0.91); RR for PUFA 0.83 (95 % CI 0.70, 0.98)). These associations appeared to be similar for men and women, but gained statistical significance only among men for protein (RR 0.78 (95 % CI 0.61, 0.99)). Restricted cubic spline regression did not indicate non-linearity of these associations (P for non-linearity in full cohort was 0.353 and 0.349). In conclusion, a higher carbohydrate intake at the expense of protein and PUFA might be associated with decreased diabetes risk.

German height references for children aged 0 to under 18 years compared to WHO and CDC growth charts

Aim: The objective is to present height-for-age percentiles representative for infants, children, and adolescents in Germany and to compare them with older German height references by Kromeyer-Hauschild which are based on heterogeneous pooled data (KH) and with international growth charts from the Centers for Disease Control (CDC) as well as the growth standard and the growth reference of the World Health Organization (WHO). Subjects and methods: The reference population consists of a nationally representative sample of 17 079 children and adolescents aged 0–17 years (KiGGS study 2003–2006) with standardized height measurements. Height reference curves were created using Coles LMS method. To compare KiGGS with other reference systems, KiGGS height values were transformed to SD-scores using the KH, WHO and CDC references. Results: Height-for-age percentiles in KiGGS increase until age 16 years in girls and until the end of the observed age range (17.98 years) for boys. In general, boys are taller than girls, except for the age range 10.5–13.0 years. The difference in height between boys and girls is negligible before puberty and reaches 13 cm at age 17.98 years. KiGGS and KH percentiles differ only slightly. However, there are substantial differences in SD-score levels between KiGGS on the one hand and WHO and CDC on the other hand, KiGGS generally being higher, especially in the extreme percentiles. Conclusion: The KiGGS height-for-age references can be recommended as a national height reference for screening and monitoring growth in infants (starting from 4 months of age), children and adolescents in Germany. In German samples, the WHO and CDC references can be used for international comparisons.

Comorbidity of overweight and obesity in a nationally representative sample of German adults aged 18-79 years

BackgroundOverweight has increased in many countries over the past 20 years and excessive body weight is an established risk factor for adverse health outcomes and chronic diseases. This study aimed to determine comorbidity associated with overweight and obesity in a nationally representative sample of German adults.MethodsIn the German National Health Interview and Examination Survey 1998 standardized measures of body weight, height and waist circumference (WC) were obtained for 7,124 men and women 18 to 79 years of age. Information on pre-existing health conditions, health-related behaviors, and sociodemographic characteristics was collected using physician-administered computer-assisted interviews and self-administered questionnaires. World Health Organization (WHO) cut-off criteria were applied to define overweight (BMI 25.0-29.9 kg/m2) and obesity (BMI ≥30.0 kg/m2) and abdominal obesity (men: WC ≥102 cm; women: WC ≥88 cm).ResultsThe crude prevalence of persons with cardiometabolic risk factors, diabetes mellitus, cardiovascular disease (CVD), gall bladder disease, and osteoarthritis showed a significant stepwise increase from the lowest to the highest BMI category in both sexes. In multiple logistic regression models adjusting for age, social status, and smoking, significant associations with overweight and obesity persisted for cardiometabolic risk factors and osteoarthritis. For example, obese persons had a three- to fourfold higher chance of having any cardiometabolic risk factor compared to normal weight persons (odds ratio (OR) = 4.07, 95% CI: 3.16-5.25 for men; OR = 3.40 (2.60-4.46) for women). Only in women, overweight and obesity as well as abdominal obesity, independent of BMI category, were significantly and consistently associated with diabetes (overweight: OR = 1.85 (1.03-3.30); obesity: OR = 2.94 (1.63-5.31); abdominal obesity: OR = 1.44 (1.08-1.92) and gall bladder disease (overweight: OR = 1.65 (1.22-2.25); obesity: OR = 3.06 (2.26-4.14); abdominal obesity: OR = 1.73 (1.25-2.39)).ConclusionCurrent estimates of disease burden underline the public health importance and clinical relevance related to overweight and obesity and needs to take into account comorbidity aspects.

Abdominal obesity in German adolescents defined by waist-to-height ratio and its association to elevated blood pressure: the KiGGS study.

Objective: The aim of this study was to compare the fixed 0.5 cut-off and the age- and sex-specific 90th percentile (P90) for waist-to-height ratio (WHtR) in German adolescents with respect to the prevalence of abdominal obesity and to compare the screening ability of WHtR and BMI to identify hypertensive blood pressure (BP) values. Methods: Between 2003 and 2006, the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was carried out including 3,492 boys and 3,321 girls aged 11-17 years. Abdominal obesity was assessed by two WHtR cut-points (P90; 0.5). Hypertensive BP was defined as BP exceeding age-, sex- and height-specific 95th percentiles or the adult threshold for hypertension (140/90 mm Hg). Results: Agreement between the WHtR cut-offs was very good (Kappa 0.89 for boys; 0.81 for girls), and the prevalence of abdominal obesity was slightly higher using P90 (boys 12.0%; girls 11.3%) compared to 0.5 (boys 10.7%; girls 8.0%). WHtR and BMI-for-age had equivalent ability to discriminate hypertensive BP (ROC-AUC < 0.7; sensitivity of the 0.5 cut-off for detecting hypertensive BP < 30%). Conclusion: The fixed 0.5 WHtR cut-off can be used in German adolescents to characterize abdominal obesity. However, WHtR is not suitable as a screening tool for hypertensive BP in adolescents.

Referenzperzentile für anthropometrische Maßzahlen und Blutdruck aus der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS)

2. erweiterte Auflage Wachstumskurven gehören zu den wichtigsten Instrumenten zur Einschätzung der körperlichen Entwicklung und damit der Gesundheit und Ernährung von Kindern und Jugendlichen. Individuelle Maße eines Kindes werden dabei mit der Verteilung in einer Referenzpopulation verglichen. Die bundesweit repräsentative Studie zur Gesundheit von Kindern und Jugendlichen (KiGGS) 2003 – 2006 markiert einen Meilenstein in den Bemühungen, die unbefriedigende Datengrundlage zur Gesundheit bei Kindern und Jugendlichen in Deutschland zu verbessern. Mit dem vorliegenden Referenzband werden KiGGS-Referenzperzentile für verschiedene Körpermaße und Blutdruck für Kinder und Jugendliche der Öffentlichkeit zur Verfügung gestellt. Im Einzelnen werden Referenzperzentile für die folgenden anthropometrischen Maßzahlen vorgelegt: Körpergröße, Körpergewicht, Body Mass Index (BMI), Taillenumfang, Hüftumfang, Taillen-Hüfte-Index (Waist-to-Hip-Ratio WHR), Taillen-Größe-Index (Waist-to-Height-Ratio WHtR), Hautfaltendicke, daraus errechneter Körperfettanteil sowie Kopfumfang. Den dargestellten Perzentilkurven und tabellierten Verteilungswerten liegen standardisiert gemessene Werte von Kindern und Jugendlichen im Alter von 3 Monaten bis 17 Jahren zugrunde, die im Rahmen der KiGGS-Studie 2003 – 2006 erhoben wurden. Die in diesem Band vorgestellten KiGGS-Perzentile haben neben der bundesweiten Repräsentativität weitere Qualitätsmerkmale: die große Stichprobe, die die Zielpopulation der in Deutschland lebenden Kinder und Jugendlichen abbildet, die gleichmäßige Besetzung aller Altersgruppen bei Jungen und Mädchen im Alter von 0 bis unter 18 Jahren, die Standardisierung der Körpermessungen und die Anwendung moderner statistischer Verfahren zur Perzentilerstellung. Nur wenige Kinder unter 3 Monaten konnten an KiGGS teilnehmen. Um dem Praxisbedarf nach Perzentilen ab dem Geburtszeitpunkt gerecht zu werden, wurden die KiGGS-Daten für Gewicht, Körperlänge und Kopfumfang in der 2. erweiterten Auflage um Daten zum Zeitpunkt der Geburt (Perinatalerhebung 1995 – 2000) ergänzt und die dazwischen liegenden Werte interpoliert.

Prävalenz von Herzinfarkt und koronarer Herzkrankheit bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland

In the German Health Interview and Examination Survey for Adults (DEGS1), data on the prevalence of myocardial infarction and coronary heart disease were collected from 2008-2011 in a representative population-based sample of 5,901 adults aged 40-79 years. The results of DEGS1 were compared with the prevalence estimates from the German National Health Interview and Examination Survey 1998 (GNHIES98). The lifetime prevalence of myocardial infarction amongst 40-79 year olds in DEGS1 is 4.7 % (women 2.5 %; men 7 %). In comparison with GNHIES98 a small increase was observed in men, but not in women. The lifetime prevalence of coronary heart disease in adults aged 40-79 years in DEGS1 is 9.3 % (women 6.4 %; men 12.3 %). In comparison to GNHIES98 there is a slight reduction only in women. There is a significant inverse relationship between disease prevalence and socioeconomic status. The trend in prevalence of coronary heart disease is comparable with that in other high-income countries. Given a falling incidence of myocardial infarction and a decrease in the mortality rates due to coronary heart disease, the basically stable prevalence rates indicate a positive development in the field of cardiovascular prevention and therapy. An English full-text version of this article is available at SpringerLink as supplemental.

Verbreitung von Fettstoffwechselstörungen bei Erwachsenen in Deutschland

Interview and laboratory data from the first wave of the German health interview and examination survey for adults (DEGS1) from 2008 to 2011 were used to provide current estimates of the prevalence of dyslipidemia which are representative of the population in Germany 18 to 79 years of age. A total of 56.6 % of men and 60.5 % of women 18 to 79 years have elevated serum total cholesterol concentrations in excess of the currently recommended threshold of 190 mg/dL; 17.9 % of men and 20.3 % of women have highly elevated total cholesterol concentrations ≥ 240 mg/dL. A total of 19.3 % of men and 3.6 % of women have high density lipoprotein cholesterol concentrations below 40 mg/dL. The overall prevalence of dyslipidemia (total cholesterol ≥ 190 mg/dL or medical diagnosis of dyslipidemia) is 64.5 % for men and 65.7 % for women. Of these, more than half of both men and women have previously undiagnosed dyslipidemia. Among persons with known dyslipidemia, 30.8% take lipid-lowering medication. Dyslipidemia is widely prevalent among adults in Germany. More in-depth analyses will examine time trends in the prevalence of dyslipidemia in Germany and in an international comparison. An English full-text version of this article is available at SpringerLink as supplemental.

Prävalenz des Schlaganfalls bei Erwachsenen im Alter von 40 bis 79 Jahren in Deutschland

In the German Health Interview and Examination Survey (DEGS1), data on the prevalence of physician-diagnosed stroke were collected from 2008 to 2011 in a representative population-based sample of 5,901 adults aged 40-79 years. The stroke prevalence in DEGS1 was compared with prevalence estimates from the German National Health Interview and Examination Survey 1998 (GNHIES98). The lifetime prevalence of stroke in adults aged 40-79 years is 2.9 % (women: 2.5 %; men: 3.3 %). In both sexes, the prevalence increases continuously with age, up to 6.3 % in women and 8.1 % in men 70-79 years old. More pronounced in women than in men, the prevalence of stroke decreases with increasing socioeconomic status. Compared to GNHIES98, there is no evidence for a change in stroke prevalence over time. The prevalence of stroke in adults aged 40-79 years in Germany is comparable to prevalence estimates from other national and international studies. Further studies should examine the reasons behind stable prevalence rates, accounting for population ageing and changes in incidence, mortality and case fatality rates. An English full-text version of this article is available at SpringerLink as supplemental.

German head circumference references for infants, children and adolescents in comparison with currently used national and international references.

Aim:  To present valid head circumference (HC) percentiles from early infancy to 18 years and to compare them with percentiles currently used in Germany by Prader, as well as to international WHO and CDC references.