Wulf Thierfelder

The challenge of comprehensively mapping children's health in a nation-wide health survey: Design of the German KiGGS-Study

BackgroundFrom May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Aim of this first nationwide interview and examination survey was to collect comprehensive data on the health status of children and adolescents aged 0 to 17 years.Methods/DesignParticipants were enrolled in two steps: first, 167 study locations (sample points) were chosen; second, subjects were randomly selected from the official registers of local residents. The survey involved questionnaires filled in by parents and parallel questionnaires for children aged 11 years and older, physical examinations and tests, and a computer assisted personal interview performed by study physicians. A wide range of blood and urine testing was carried out at central laboratories. A total of 17 641 children and adolescents were surveyed – 8985 boys and 8656 girls. The proportion of sample neutral drop-outs was 5.3%. The response rate was 66.6%.DiscussionThe response rate showed little variation between age groups and sexes, but marked variation between resident aliens and Germans, between inhabitants of cities with a population of 100 000 or more and sample points with fewer inhabitants, as well as between the old West German states and the former East German states. By analysing the short non-responder questionnaires it was proven that the collected data give comprehensive and nationally representative evidence on the health status of children and adolescents aged 0 to 17 years.

Vitamin D status and health correlates among German adults

Objective:To analyze vitamin D status based on serum 25-hydroxyvitamin D (25OHD) measurements, its determinants and health correlates in a representative sample of German adults.Subjects:A total of 1763 men and 2267 women, 18- to 79-year old, who participated in the representative German National Health Interview and Examination Survey 1998 and the integrated German Nutrition Survey.Results:The median vitamin D intake from both diet and supplements did not meet the recommended level of 5 μg/day, in either men (2.8 μg/day) or women (2.3 μg/day). Altogether 80.9% of men and 88.5% of women had vitamin D intakes below this level. Moderate (12.5–25 nmol/l serum 25OHD levels) and mild (25–50 nmol/l) vitamin D deficiency was prevalent in the adult population in Germany, even in younger age groups. Overall, 57% of men and 58% of women had vitamin D levels below 50 nmol/l. Among 65- to 79-year-old women, the proportion amounted to 75%, even during the sunnier half of the year. In sex-specific multiple linear regression models, independent determinants of serum 25OHD levels consistently included season, vitamin D intake from both diet and supplements, physical activity and living in a partnership. In addition, age and current menopausal hormone use contributed to the model among women, as opposed to time of day of blood sampling and body mass index (marginally) among men. Significantly lower serum 25OHD levels were observed in women with hypertension, cardiovascular diseases and noninsulin-treated diabetes mellitus as well as in men with insulin-treated diabetes mellitus compared with nonaffected participants.Conclusions:Vitamin D deficiency is a public health issue in Germany. We identified a number of determinants with potential for primary prevention of vitamin D deficiency. Risk and benefits of preventive actions need to be examined in further studies.

Der Kinder- und Jugendgesundheitssurvey (KiGGS): Studienmanagement und Durchführung der Feldarbeit

UNLABELLED From May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Nationwide data collection in 167 cities and municipalities was carried out by 4 survey teams, each consisting of a physician, centre interviewer, examiner, medical laboratory technician, environmental interviewer. Regional and seasonal factors were excluded by systematised route planning. Invitation of the participants and appointments for examinations were handled by a survey office with subsidised service telephone. Data processing in the survey office was performed using an SQL data base system programmed in the RKI. One central and several regional members of staff performing preparatory field visits were responsible for finding suitable examination rooms and for subject recruitment respectively. To further increase the response rate, continuous public relation actions were established. The survey involved questionnaires filled in by parents and parallel questionnaires for children from the age of 11 years onwards, physical examinations and tests and a computer assisted personal interview performed by the physician. The wide range of blood and urine testing carried out at central laboratories required standardised transport logistics. To achieve a high degree of standardisation of the survey, the examination teams were initially trained and then underwent continuous further training. The concept of quality management covered action of internal and independent external quality control monitoring each data collecting and data processing step as well as the training courses. CONCLUSION Dedicated public relations activities and the deployment of staff performing preparatory field visits increased the willingness of the subjects to participate. Intensive personnel care and continuous quality checks contribute to increased job satisfaction and data quality. By bindingly defining all laboratory diagnostic processes as well as transport logistics, high-quality laboratory test results are ensured. The conduct of the study from design via conduct to data processing and analysis by one institution guarantees complete control of all steps of the survey.ZusammenfassungVon Mai 2003 bis Mai 2006 führte das Robert Koch-Institut (RKI) den Kinder- und Jugendgesundheitssurvey (KiGGS) durch. Zur Datenerhebung waren bundesweit in 167 Städten und Gemeinden insgesamt 4 Untersuchungsteams – bestehend aus Arzt, Zentrumsinterviewern, Untersucherin, MTA, Umweltinterviewer – im Einsatz. Regionale und saisonale Einflüsse wurden mit einem systematisierten Routenplan ausgeschlossen. Die Einladung der Teilnehmer und die Vergabe von Untersuchungsterminen erfolgten über eine Survey-Geschäftsstelle mit kostensubventioniertem Service-Telefon. Die Datenverarbeitung in der Geschäftsstelle geschah mit Hilfe eines im RKI programmierten SQL-Datenbanksystems. Für die Beschaffung geeigneter Untersuchungsräume sowie zur Probandenwerbung wurden ein Zentraler bzw. mehrere Regionale Feldvorbegeher beschäftigt. Um die Ausschöpfungsquote zusätzlich zu erhöhen, wurde eine kontinuierliche Öffentlichkeitsarbeit eingerichtet. Im Rahmen der Untersuchung kamen schriftliche Selbstausfüllfragebogen für Eltern und zusätzlich für Kinder ab 11 Jahren körperliche Untersuchungen und Tests und ein computergestütztes ärztliches Interview zum Einsatz. Für die in zentralen Labors durchgeführte umfangreiche Blut- und Urindiagnostik war eine standardisierte Transportlogistik erforderlich. Zwecks weitgehender Standardisierung der Erhebung wurden die Untersuchungsteams initial geschult und kontinuierlich nachgeschult. Das Qualitätsmanagementkonzept umfasste Maßnahmen der internen und externen Qualitätskontrolle, die sich auf alle datenerhebenden und -verarbeitenden Schritte sowie die Schulungen erstreckte. Fazit: Engagierte Öffentlichkeitsarbeit und der Einsatz von Feldvorbegehern erhöhen die Teilnahmebereitschaft. Intensive Personalbetreuung und kontinuierliche Qualitätskontrollen tragen zu einer Erhöhung der Arbeitszufriedenheit und der Datenqualität bei. Eine verbindliche Festlegung sämtlicher labordiagnostischer Arbeitsabläufe und der Transportlogistik sichert eine hohe Qualität der Labormessdaten. Die Durchführung der Studie vom Design über die Durchführung bis zur Datenaufbereitung und -auswertung in einer Hand ermöglicht eine lückenlose Kontrolle aller Arbeitsschritte.AbstractFrom May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Nationwide data collection in 167 cities and municipalities was carried out by 4 survey teams, each consisting of a physician, centre interviewer, examiner, medical laboratory technician, environmental interviewer. Regional and seasonal factors were excluded by systematised route planning. Invitation of the participants and appointments for examinations were handled by a survey office with subsidised service telephone. Data processing in the survey office was performed using an SQL data base system programmed in the RKI. One central and several regional members of staff performing preparatory field visits were responsible for finding suitable examination rooms and for subject recruitment respectively. To further increase the response rate, continuous public relation actions were established. The survey involved questionnaires filled in by parents and parallel questionnaires for children from the age of 11 years onwards, physical examinations and tests and a computer assisted personal interview performed by the physician. The wide range of blood and urine testing carried out at central laboratories required standardised transport logistics. To achieve a high degree of standardisation of the survey, the examination teams were initially trained and then underwent continuous further training. The concept of quality management covered action of internal and independent external quality control monitoring each data collecting and data processing step as well as the training courses. Conclusion: Dedicated public relations activities and the deployment of staff performing preparatory field visits increased the willingness of the subjects to participate. Intensive personnel care and continuous quality checks contribute to increased job satisfaction and data quality. By bindingly defining all laboratory diagnostic processes as well as transport logistics, high-quality laboratory test results are ensured. The conduct of the study from design via conduct to data processing and analysis by one institution guarantees complete control of all steps of the survey.

[The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): study management and conduct of fieldwork].

UNLABELLED From May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Nationwide data collection in 167 cities and municipalities was carried out by 4 survey teams, each consisting of a physician, centre interviewer, examiner, medical laboratory technician, environmental interviewer. Regional and seasonal factors were excluded by systematised route planning. Invitation of the participants and appointments for examinations were handled by a survey office with subsidised service telephone. Data processing in the survey office was performed using an SQL data base system programmed in the RKI. One central and several regional members of staff performing preparatory field visits were responsible for finding suitable examination rooms and for subject recruitment respectively. To further increase the response rate, continuous public relation actions were established. The survey involved questionnaires filled in by parents and parallel questionnaires for children from the age of 11 years onwards, physical examinations and tests and a computer assisted personal interview performed by the physician. The wide range of blood and urine testing carried out at central laboratories required standardised transport logistics. To achieve a high degree of standardisation of the survey, the examination teams were initially trained and then underwent continuous further training. The concept of quality management covered action of internal and independent external quality control monitoring each data collecting and data processing step as well as the training courses. CONCLUSION Dedicated public relations activities and the deployment of staff performing preparatory field visits increased the willingness of the subjects to participate. Intensive personnel care and continuous quality checks contribute to increased job satisfaction and data quality. By bindingly defining all laboratory diagnostic processes as well as transport logistics, high-quality laboratory test results are ensured. The conduct of the study from design via conduct to data processing and analysis by one institution guarantees complete control of all steps of the survey.ZusammenfassungVon Mai 2003 bis Mai 2006 führte das Robert Koch-Institut (RKI) den Kinder- und Jugendgesundheitssurvey (KiGGS) durch. Zur Datenerhebung waren bundesweit in 167 Städten und Gemeinden insgesamt 4 Untersuchungsteams – bestehend aus Arzt, Zentrumsinterviewern, Untersucherin, MTA, Umweltinterviewer – im Einsatz. Regionale und saisonale Einflüsse wurden mit einem systematisierten Routenplan ausgeschlossen. Die Einladung der Teilnehmer und die Vergabe von Untersuchungsterminen erfolgten über eine Survey-Geschäftsstelle mit kostensubventioniertem Service-Telefon. Die Datenverarbeitung in der Geschäftsstelle geschah mit Hilfe eines im RKI programmierten SQL-Datenbanksystems. Für die Beschaffung geeigneter Untersuchungsräume sowie zur Probandenwerbung wurden ein Zentraler bzw. mehrere Regionale Feldvorbegeher beschäftigt. Um die Ausschöpfungsquote zusätzlich zu erhöhen, wurde eine kontinuierliche Öffentlichkeitsarbeit eingerichtet. Im Rahmen der Untersuchung kamen schriftliche Selbstausfüllfragebogen für Eltern und zusätzlich für Kinder ab 11 Jahren körperliche Untersuchungen und Tests und ein computergestütztes ärztliches Interview zum Einsatz. Für die in zentralen Labors durchgeführte umfangreiche Blut- und Urindiagnostik war eine standardisierte Transportlogistik erforderlich. Zwecks weitgehender Standardisierung der Erhebung wurden die Untersuchungsteams initial geschult und kontinuierlich nachgeschult. Das Qualitätsmanagementkonzept umfasste Maßnahmen der internen und externen Qualitätskontrolle, die sich auf alle datenerhebenden und -verarbeitenden Schritte sowie die Schulungen erstreckte. Fazit: Engagierte Öffentlichkeitsarbeit und der Einsatz von Feldvorbegehern erhöhen die Teilnahmebereitschaft. Intensive Personalbetreuung und kontinuierliche Qualitätskontrollen tragen zu einer Erhöhung der Arbeitszufriedenheit und der Datenqualität bei. Eine verbindliche Festlegung sämtlicher labordiagnostischer Arbeitsabläufe und der Transportlogistik sichert eine hohe Qualität der Labormessdaten. Die Durchführung der Studie vom Design über die Durchführung bis zur Datenaufbereitung und -auswertung in einer Hand ermöglicht eine lückenlose Kontrolle aller Arbeitsschritte.AbstractFrom May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Nationwide data collection in 167 cities and municipalities was carried out by 4 survey teams, each consisting of a physician, centre interviewer, examiner, medical laboratory technician, environmental interviewer. Regional and seasonal factors were excluded by systematised route planning. Invitation of the participants and appointments for examinations were handled by a survey office with subsidised service telephone. Data processing in the survey office was performed using an SQL data base system programmed in the RKI. One central and several regional members of staff performing preparatory field visits were responsible for finding suitable examination rooms and for subject recruitment respectively. To further increase the response rate, continuous public relation actions were established. The survey involved questionnaires filled in by parents and parallel questionnaires for children from the age of 11 years onwards, physical examinations and tests and a computer assisted personal interview performed by the physician. The wide range of blood and urine testing carried out at central laboratories required standardised transport logistics. To achieve a high degree of standardisation of the survey, the examination teams were initially trained and then underwent continuous further training. The concept of quality management covered action of internal and independent external quality control monitoring each data collecting and data processing step as well as the training courses. Conclusion: Dedicated public relations activities and the deployment of staff performing preparatory field visits increased the willingness of the subjects to participate. Intensive personnel care and continuous quality checks contribute to increased job satisfaction and data quality. By bindingly defining all laboratory diagnostic processes as well as transport logistics, high-quality laboratory test results are ensured. The conduct of the study from design via conduct to data processing and analysis by one institution guarantees complete control of all steps of the survey.

Jodversorgung in Deutschland

ZusammenfassungJod ist ein essenzielles Spurenelement, das in Deutschland in zu geringen Mengen im Boden vorkommt. Dem daraus resultierenden Jodmangel beim Menschen wird durch eine Jodprophylaxe begegnet, die im Wesentlichen aus der Jodierung von Speisesalz sowie der Jodierung von Futtermitteln in der Landwirtschaft besteht. Im Jodmonitoring des Kinder- und Jugendgesundheitssurvey (KiGGS) wurden die Schilddrüsenvolumina aller Kinder und Jugendlichen ab 6 Jahren sonografisch ermittelt. Um die Jodversorgung auf Bevölkerungsebene zu beurteilen, wurde zusätzlich die Jodausscheidung im Urin gemessen. Die Jodurie betrug im Median 117 μg/l und lag damit am unteren Ende der von der Weltgesundheitsorganisation (WHO) empfohlenen Spanne von 100–200 μg/l. Aus diesen Ergebnissen kann man schließen, dass die Jodprophylaxe erfolgreich war und sich die Jodversorgung im Vergleich zu früher verbessert hat. Gemäß den Empfehlungen der WHO herrscht zwar in Deutschland kein Jodmangel mehr, die Jodversorgung der Bevölkerung befindet sich dabei aber auf einem relativ niedrigen Niveau. Das Erreichte gilt es zumindest zu erhalten, sodass die Maßnahmen zur Verbesserung der Jodversorgung nicht nachlassen dürfen.AbstractIodine is an essential trace element which is found in too low quantities in the soil in Germany. The resulting iodine deficiency in human beings is countered by iodine prophylaxis, essentially consisting of iodised table salt and the iodisation of agricultural animal feed. In iodine monitoring during the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the thyroid volumes of all children and adolescents from six years of age were determined using sonography. To assess iodine intake among the population, iodine excretion in the urine was also measured. The median ioduria value was 117 μg/l, putting it at the lower end of the scale of 100–200 μg/l recommended by the World Health Organisation. It can be concluded from these results that the iodine prophylaxis has been successful and that iodine intake has improved compared with the past. In accordance with the WHO recommendations there is no iodine deficiency in Germany any more; however, at the same time the populations iodine intake is at a relatively low level. The aim is at least to keep up what has been achieved, meaning that measures to improve iodine intake must not be allowed to slacken.

Biochemical measures in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

ZusammenfassungIm Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) in Deutschland wurde eine Reihe verschiedener Laborparameter bestimmt, um Elternangaben und anthropometrische Messdaten zu bestehenden Erkrankungen und Gesundheitsrisiken durch weitere objektive Messdaten zu ergänzen. Insgesamt wurden 43 Parameter zu 3 wesentlichen Themenbereichen erhoben: Nährstoffmangel, Seroepidemiologie zu durchgemachten Infektionskrankheiten und Impfstatus, Risikoindikatoren und Risikofaktoren für chronische, nicht übertragbare Erkrankungen. Je nach Verfügbarkeit valider Referenzbereiche oder Schwellenwerte speziell für Kinder und Jugendliche sowie des Standardisierungsgrades der jeweiligen Labormethodik wurden die Laborparameter in 5 Bewertungskategorien eingeteilt. Wir berichten hier erste, deskriptive Ergebnisse zu ausgewählten Laborparametern, die beispielhaft für diese 5 Kategorien stehen. Um die bevölkerungsmedizinische Bedeutung der Messergebnisse beurteilen zu können und gegebenenfalls auch versorgungsrelevante, normative Referenzbereiche daraus abzuleiten, sind weitergehende Analysen notwendig. Diese werden sich zunächst auf Querschnittsanalysen der Zusammenhänge zwischen Laborparametern und anderen gesundheitsrelevanten, anthropometrischen und soziodemographischen Variablen konzentrieren. Mittel- und längerfristiges Ziel ist die Ableitung multidimensionaler Referenzbereiche unter gleichzeitiger Berücksichtigung mehrerer Laborparameter und zusätzlicher klinischer Informationen sowie die Überprüfung der prognostischen Validität von Referenzbereichen und Schwellenwerten für ausgewählte Laborparameter anhand der medizinischen Ergebnisse bei Weiterbeobachtung der Studienteilnehmer.AbstractIn the framework of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) a variety of biochemical parameters was determined in order to provide objective information on health status and particular health risks, in addition to parent interview data and anthropometric measurements. Overall 43 parameters covered three areas of particular public health interest: micronutrient deficiency, seroepidemiology of infectious diseases and immunization status, and risk indicators or risk factors for chronic non-communicable diseases. A review of available evidence regarding valid reference or cutoff values as well as the standardization of laboratory methods led to the categorization of these parameters into five classification categories. Here, we discuss the present first descriptive results on selected parameters representing the various categories. In order to determine the public health impact of measurement results, and perhaps even derive normative reference data relevant to health care, more detailed analyses will be required. In the first step, these will focus on cross-sectional analyses of the association between biochemical parameters and other health-related anthropometric and sociodemographic variables. Intermediate and long-term objectives will include the construction of multidimensional reference values taking into account several laborato ry data and other clinical information at the same time, and the prognostic validation of reference or cut-off values based on a follow- up of the study participants for clinical outcomes.

Biochemische Messparameter im Kinder- und Jugendgesundheitssurvey (KiGGS)

ZusammenfassungIm Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) in Deutschland wurde eine Reihe verschiedener Laborparameter bestimmt, um Elternangaben und anthropometrische Messdaten zu bestehenden Erkrankungen und Gesundheitsrisiken durch weitere objektive Messdaten zu ergänzen. Insgesamt wurden 43 Parameter zu 3 wesentlichen Themenbereichen erhoben: Nährstoffmangel, Seroepidemiologie zu durchgemachten Infektionskrankheiten und Impfstatus, Risikoindikatoren und Risikofaktoren für chronische, nicht übertragbare Erkrankungen. Je nach Verfügbarkeit valider Referenzbereiche oder Schwellenwerte speziell für Kinder und Jugendliche sowie des Standardisierungsgrades der jeweiligen Labormethodik wurden die Laborparameter in 5 Bewertungskategorien eingeteilt. Wir berichten hier erste, deskriptive Ergebnisse zu ausgewählten Laborparametern, die beispielhaft für diese 5 Kategorien stehen. Um die bevölkerungsmedizinische Bedeutung der Messergebnisse beurteilen zu können und gegebenenfalls auch versorgungsrelevante, normative Referenzbereiche daraus abzuleiten, sind weitergehende Analysen notwendig. Diese werden sich zunächst auf Querschnittsanalysen der Zusammenhänge zwischen Laborparametern und anderen gesundheitsrelevanten, anthropometrischen und soziodemographischen Variablen konzentrieren. Mittel- und längerfristiges Ziel ist die Ableitung multidimensionaler Referenzbereiche unter gleichzeitiger Berücksichtigung mehrerer Laborparameter und zusätzlicher klinischer Informationen sowie die Überprüfung der prognostischen Validität von Referenzbereichen und Schwellenwerten für ausgewählte Laborparameter anhand der medizinischen Ergebnisse bei Weiterbeobachtung der Studienteilnehmer.AbstractIn the framework of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) a variety of biochemical parameters was determined in order to provide objective information on health status and particular health risks, in addition to parent interview data and anthropometric measurements. Overall 43 parameters covered three areas of particular public health interest: micronutrient deficiency, seroepidemiology of infectious diseases and immunization status, and risk indicators or risk factors for chronic non-communicable diseases. A review of available evidence regarding valid reference or cutoff values as well as the standardization of laboratory methods led to the categorization of these parameters into five classification categories. Here, we discuss the present first descriptive results on selected parameters representing the various categories. In order to determine the public health impact of measurement results, and perhaps even derive normative reference data relevant to health care, more detailed analyses will be required. In the first step, these will focus on cross-sectional analyses of the association between biochemical parameters and other health-related anthropometric and sociodemographic variables. Intermediate and long-term objectives will include the construction of multidimensional reference values taking into account several laborato ry data and other clinical information at the same time, and the prognostic validation of reference or cut-off values based on a follow- up of the study participants for clinical outcomes.

Iodine intake in Germany. Results of iodine monitoring in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

ZusammenfassungJod ist ein essenzielles Spurenelement, das in Deutschland in zu geringen Mengen im Boden vorkommt. Dem daraus resultierenden Jodmangel beim Menschen wird durch eine Jodprophylaxe begegnet, die im Wesentlichen aus der Jodierung von Speisesalz sowie der Jodierung von Futtermitteln in der Landwirtschaft besteht. Im Jodmonitoring des Kinder- und Jugendgesundheitssurvey (KiGGS) wurden die Schilddrüsenvolumina aller Kinder und Jugendlichen ab 6 Jahren sonografisch ermittelt. Um die Jodversorgung auf Bevölkerungsebene zu beurteilen, wurde zusätzlich die Jodausscheidung im Urin gemessen. Die Jodurie betrug im Median 117 μg/l und lag damit am unteren Ende der von der Weltgesundheitsorganisation (WHO) empfohlenen Spanne von 100–200 μg/l. Aus diesen Ergebnissen kann man schließen, dass die Jodprophylaxe erfolgreich war und sich die Jodversorgung im Vergleich zu früher verbessert hat. Gemäß den Empfehlungen der WHO herrscht zwar in Deutschland kein Jodmangel mehr, die Jodversorgung der Bevölkerung befindet sich dabei aber auf einem relativ niedrigen Niveau. Das Erreichte gilt es zumindest zu erhalten, sodass die Maßnahmen zur Verbesserung der Jodversorgung nicht nachlassen dürfen.AbstractIodine is an essential trace element which is found in too low quantities in the soil in Germany. The resulting iodine deficiency in human beings is countered by iodine prophylaxis, essentially consisting of iodised table salt and the iodisation of agricultural animal feed. In iodine monitoring during the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the thyroid volumes of all children and adolescents from six years of age were determined using sonography. To assess iodine intake among the population, iodine excretion in the urine was also measured. The median ioduria value was 117 μg/l, putting it at the lower end of the scale of 100–200 μg/l recommended by the World Health Organisation. It can be concluded from these results that the iodine prophylaxis has been successful and that iodine intake has improved compared with the past. In accordance with the WHO recommendations there is no iodine deficiency in Germany any more; however, at the same time the populations iodine intake is at a relatively low level. The aim is at least to keep up what has been achieved, meaning that measures to improve iodine intake must not be allowed to slacken.

Allergische Rhinitis und Sensibilisierungsraten – Nimmt die Prävalenz wirklich zu?

ZusammenfassungZahlreiche epidemiologische Studien weisen auf einen Prävalenzanstieg bei allergischen Krankheiten hin. Die Prävalenzschätzungen basieren häufig nur auf Fragebogendaten. Wenige Studien enthalten zusätzlich objektive Messmethoden z. B. allergen-spezifische IgE-Tests. Da das “Allergiebewusstsein” ebenfalls zugenommen hat, ist zu fragen, ob die berichteten Zunahmen einen tatsächlichen Anstieg in der Allergiehäufigkeit darstellen oder z. B. nur ein besseres Erkennen von allergischen Krankheiten widerspiegeln. In Deutschland ist bei Erwachsenen über den zeitlichen Trend bei der Prävalenz von allergischer Rhinitis und allergischen Sensibilisierungen bisher wenig bekannt. Um zu prüfen, wie sicher die Prävalenzdaten sind, wurden verschiedene Informationsquellen (Fragebogen, Interview, spezifische IgE-Bestimmung) miteinander verglichen. Zusätzlich werden die Daten von Querschnittsstudien, die im Abstand von sechs bis acht Jahren durchgeführt wurden, verglichen, um zu untersuchen, ob das Sensibilisierungs- und Erkrankungsrisiko auch in Deutschland zugenommen hat. Die Berechnungen zeigten, dass es deutliche Anhaltspunkte für eine Prävalenzzunahme sowohl bei den allergischen Sensibilisierungen als auch bei der allergischen Rhinitis gibt. Insgesamt ist die Sensibilisierungsrate von 27% auf 31% gestiegen und die Prävalenz der atopischen Rhinitis von 8% auf 13%. Bei Erwachsenen unter 45 Jahren ist die Prävalenz wesentlich höher als bei Erwachsenen im Alter von 45 bis 79 Jahren. Die Sensibilisierungsraten betragen bei 20- bis 44-Jährigen rund 38% und bei Älteren 23%, eine manifeste Erkrankung (Befragungsdaten und positiver allergen-spezifischer IgE-Test) haben 15% der jüngeren und 5% der älteren Erwachsenen (Jahresprävalenz).AbstractNumerous epidemiological studies indicate an increase in the prevalence of allergic diseases. However, the estimations of the prevalence are very often based on questionnaire data only. Additional objective measurements e.g. of allergen-specific IgE antibodies were included only in a few surveys. Since the public awareness of allergic diseases has increased, too, the question arose, whether the reported increase represents a true rise in the frequency of allergies or simply reflects greater recognition of allergic diseases. Little is known about the time trend in the prevalence of allergic rhinitis and sensitisations in adults in Germany. To prove, how reliable the prevalence data are, different sources of information (questionnaire, interview, specific IgE measurements) were compared. Additionally, to investigate whether the risk of atopic sensitisation and the risk of allergic rhinitis has increased in Germany, too, data of cross-sectional studies, conducted 6 – 8 years apart were compared. There is strong evidence that the prevalence of both, allergic rhinitis and sensitisations increased in the last years. In total, the rate of sensitisations increased from 27% to 31% and the prevalence of atopic rhinitis from 8% to 13%. In adults, under the age of 45, the prevalence is much higher than in adults aged 45 to 79 years. The prevalence of atopic sensitisation is 38% in the age group of 20 – 44 years and 23% in the older group, and the prevalence of allergic rhinitis (positive allergen-specific IgE test and reported allergic rhinitis) is 15% in the younger and 5% in the older group (prevalence in the last 12 months).

Differences of 25-hydroxyvitamin D3 concentrations in children and adults with neurofibromatosis type 1.

OBJECTIVES Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, frequently associated with reduced bone mineral density. Serum 25-hydroxyvitamin D3 concentrations in NF1 adults are lower than in healthy controls in autumn respectively winter and are inversely correlated with the number of dermal neurofibromas. We investigated 25-hydroxyvitamin D3 levels in children and adults with neurofibromatosis type 1 in winter and summer and compared them to healthy controls to get more pathogenic insights in vitamin D3 metabolism in NF1 patients. DESIGN AND METHODS NF1 patients were clinically examined and serum 25-hydroxyvitamin D3 concentrations were measured in 58 NF1 adults and 46 children in winter as well as in summer and compared to sex-, age- and month-matched controls. RESULTS 52 adults suffered from 10 to 5000 dermal neurofibromas, whereas none of the children presented neurofibromas. 25-Hydroxyvitamin D3 increased from winter to summer (mean: 21.0 to 46.5nmol/l) in NF1 adults. This increase was even larger (p=0.0001) than in healthy controls (mean: 50.5 to 60.5nmol/l). However, there were no differences of 25-hydroxyvitamin D3 concentrations in NF1 children and healthy controls both in winter and in summer. CONCLUSIONS Only adults with NF1 showed lower 25-hydroxyvitamin D3 levels in winter and summer, which are unlikely due to impaired UV-dependent dermal synthesis, but rather might be caused by an accelerated catabolism.