Area-level and individual correlates of active transportation among adults in Germany: A population-based multilevel study.

This study aimed at estimating the prevalence in adults of complying with the aerobic physical activity (PA) recommendation through transportation-related walking and cycling. Furthermore, potential determinants of transportation-related PA recommendation compliance were investigated. 10,872 men and 13,144 women aged 18 years or older participated in the cross-sectional 'German Health Update 2014/15 - EHIS' in Germany. Transportation-related walking and cycling were assessed using the European Health Interview Survey-Physical Activity Questionnaire. Three outcome indicators were constructed: walking, cycling, and total active transportation (≥600 metabolic equivalent, MET-min/week). Associations were analyzed using multilevel regression analysis. Forty-two percent of men and 39% of women achieved ≥600 MET-min/week with total active transportation. The corresponding percentages for walking were 27% and 28% and for cycling 17% and 13%, respectively. Higher population density, older age, lower income, higher work-related and leisure-time PA, not being obese, and better self-perceived health were positively associated with transportation-related walking and cycling and total active transportation among both men and women. The promotion of walking and cycling among inactive people has great potential to increase PA in the general adult population and to comply with PA recommendations. Several correlates of active transportation were identified which should be considered when planning public health policies and interventions.

Comprehensive assessment of food and nutrient intake of children and adolescents in Germany: EsKiMo II - the eating study as a KiGGS module.

BACKGROUND: As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6-17 years living in Germany is assessed in EsKiMo II - the Eating Study as a KiGGS Module. METHODS: EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6-11 years. Dietary intake for adolescents aged 12-17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02). DISCUSSION: EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.

Changes in body weight and obesity status in German adults: results of seven population-based prospective studies.

BACKGROUND/OBJECTIVES: The objective of this study was to quantify body weight changes in German adult populations during the past decades. SUBJECTS/METHODS: Longitudinal analysis of seven cohort studies covering different age ranges between 18 and 83 years. Baseline examinations were between 1994 and 2007 and follow-up durations between 4.0 and 11.9 years. For each study, mean change in body weight per year and 10-year change in body mass index (BMI) classification were analyzed. For the middle age group of 45-64 years, meta-analysis was conducted to obtain an overall estimate for Germany. RESULTS: Among men weight gain was highest in the youngest participants and decreased with advancing age. Among women weight gain was on a stable high level among those younger than 45 years and decreased at older age. Within 10 years, 30-40% of middle-aged participants with normal baseline weight became pre-obese or obese and 20-25% of those with pre-obesity at baseline became obese, whereas >80% of persons who were obese at baseline remained obese over time. The estimated average weight change in adults aged 45-64 years was 0.25 (95% confidence interval (CI): 0.18-0.33) kg/year among men and 0.24 (0.17-0.30) kg/year among women. CONCLUSIONS: We could observe a moderate weight gain over the past years in German middle-aged populations of 0.25 kg/year. Obesity prevention needs to be targeted to specific subgroups in the population, especially to younger adults, who seem to be most vulnerable for gaining weight. Obesity intervention needs to be improved, as the majority of obese adults remained obese over time.

[Physical activity: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Körperliche Aktivität : Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

Regular physical activity can have a positive effect on health at any age. Today's lifestyles, however, can often be characterised as sedentary. Therefore, the promotion of physical activity and sports has become an integral part of public health measures. The representative data of adults aged 18 to 79 years in Germany obtained from the "German Health Interview and Examination Survey for Adults" (DEGS1) provide an overview of self-estimated current physical activity behaviour. The results show that one third of the adult population claims to pay close attention to reaching a sufficient level of physical activity and one fourth participates in sports for at least 2 h/week on a regular basis. Thus, the percentage of adults regularly engaged in sports has increased compared to the previous "German National Health Interview and Examination Survey 1998". Still, four out of five adults do not achieve at least 2.5 h/week of moderate-intensity physical activity as recommended by the World Health Organisation. Consequently, future individual-level and population-level interventions should focus on target group-specific measures while continuing to promote regular physical activity in all segments of the population. An English full-text version of this article is available at SpringerLink as supplemental.

[Fruit and vegetable intake in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Obst- und Gemüsekonsum in Deutschland : Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

Until now, the recommendations of the German Nutrition Society on fruit and vegetable intake have not been reached by the majority of the population. In the first wave of the"German Health Interview and Examination Survey for Adults" (DEGS1), which was conducted from 2008 to 2011, food consumption was determined with a validated food frequency questionnaire in a representative random sample of the 18-79-year-old residential population in Germany (n=7116). The number of portions of fruit and vegetables consumed on average every day and the number of persons meeting the recommended five portions of fruit and vegetables per day were calculated. On average, women consume 3.1 and men 2.4 portions of fruit and vegetables per day. 15 % of women and 7 % of men reach the recommended quantity of five portions per day. Fruit intake increases in both men and women up to the age of 60- 69 years. 39 % of women and 25 % of men consume at least three portions of fruit and vegetables every day. The proportion of men and women who consume at least three portions every day tends to increase with rising social status. Although the intake of fruit has increased slightly compared to previous surveys, the percentage of persons who consume five portions of fruit and vegetables per day is still very low. An English full-text version of this article is available at SpringerLink as supplemental.

[Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Übergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The increase in overweight and obesity is a worldwide health problem. The first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1), conducted from 2008 through 2011, provides current data about overweight and obesity among adults in Germany. Within DEGS1, a representative sample of the 18- to 79-year-old population was interviewed with regard to health relevant issues and physically examined (n = 7,116). From measurements of body height and weight, the body mass index (BMI) was calculated, which was used to define overweight (BMI ≥ 25 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)). Results are stratified for gender, age group, socioeconomic status and region and compared with results from the German National Health Interview and Examination Survey 1998 (GNHIES98) and the National Examination Surveys 1990/92. According to DEGS1, 67.1% of men and 53.0% of women are overweight. The prevalence of overweight has not changed compared to GNHIES98. The prevalence of obesity, however, has risen substantially, especially among men: in GNHIES98, 18.9% of men and 22.5% of women were obese, in DEGS1, these figures were 23.3% and 23.9%, respectively. The increase in obesity occurred especially among young adults. An English full-text version of this article is available at SpringerLink as supplemental.

Mapping low intake of micronutrients across Europe.

Achieving an understanding of the extent of micronutrient adequacy across Europe is a major challenge. The main objective of the present study was to collect and evaluate the prevalence of low micronutrient intakes of different European countries by comparing recent nationally representative dietary survey data from Belgium, Denmark, France, Germany, The Netherlands, Poland, Spain and the United Kingdom. Dietary intake information was evaluated for intakes of Ca, Cu, I, Fe, Mg, K, Se, Zn and the vitamins A, B1, B2, B6, B12, C, D, E and folate. The mean and 5th percentile of the intake distributions were estimated for these countries, for a number of defined sex and age groups. The percentages of those with intakes below the lower reference nutrient intake and the estimated average requirement were calculated. Reference intakes were derived from the UK and Nordic Nutrition Recommendations. The impact of dietary supplement intake as well as inclusion of apparently low energy reporters on the estimates was evaluated. Except for vitamin D, the present study suggests that the current intakes of vitamins from foods lead to low risk of low intakes in all age and sex groups. For current minerals, the study suggests that the risk of low intakes is likely to appear more often in specific age groups. In spite of the limitations of the data, the present study provides valuable new information about micronutrient intakes across Europe and the likelihood of inadequacy country by country.

[Overview of primary prevention measures to promote physical activity in Germany]. / Überblick über primärpräventive Maßnahmen zur Förderung von körperlicher Aktivität in Deutschland.

This article provides an overview of primary prevention measures to promote physical activity. First, health-related recommendations for physical activity are presented together with a brief description of the frequency and determinants of physical activity. Prevention measures in Germany to promote physical activity are categorized taking into account the respective level of intervention (individual, setting, population) and contextual reference (with and without relying on structural conditions). Typical preventive measures to promote physical activity will be presented along with some examples. This is followed by concluding remarks about the current state in the area of preventive measures in Germany for the promotion of physical activity.

[Physical and sporting activity among adults in Germany. Results from the "German Health Update 2009" survey]. / Körperlich-sportliche Aktivität bei Erwachsenen in Deutschland. Ergebnisse der Studie "Gesundheit in Deutschland aktuell 2009"

The study analyses the distribution of physical and sporting activity among the adult population in Germany. The data came from the "German Health Update 2009" survey, which is based on 21,262 telephone interviews conducted by the Robert Koch Institute between July 2008 and June 2009. The study shows that 56% of men aged 18 and over and 38% of women in the same age group engaged in physical activity with an intensity that made them sweat or be out of breath for at least 2.5 h/week. In addition, 64% of both men and women stated that they had actively engaged in sporting activities over the previous 3 months. Comparing 1998 and 2003, participation in sport was observed to have increased among men and women in all age groups over time. Furthermore, socio-economic differences were observed, indicating lower physical activity among higher-status groups and lower sporting activity among lower-status groups. Measures to promote physical activity and sport prove to be especially necessary for people who are not physically active (19% of men and 26% of women) or who do not engage in sport at all (36% of both men and women).

[Monitoring and quality assurance of prevention and health promotion at the federal level]. / Monitoring und Qualitätssicherung von Prävention und Gesundheitsförderung auf Bundesebene.

Monitoring and quality assurance are gaining in importance for the identification of needs and the effectiveness of prevention and health promotion activities. This paper presents examples of activities of monitoring and quality assurance at the federal level, carried out by the Federal Centre for Health Education and the Robert Koch Institute. Examples include the prevention issues "HIV/AIDS", "nutrition and physical activity" and "child health". They illustrate the roles of epidemiological surveillance, health monitoring, evaluation, and intervention reporting. The Robert Koch Institute and the Federal Centre for Health Education provide complementary information on health and intervention reporting at the federal level. With their reports, they provide essential information for health policy to formulate, to implement and to evaluate evidence-based national health goals and action plans.

[Which implications for obesity prevention can be offered by the KiGGS follow-up study?]. / Welche Ansatzpunkte zur Adipositasprävention bietet die KiGGS-Kohorte?

From 2003-2006, the health status of 17,641 girls and boys was comprehensively assessed by interview and medical examinations in the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Therewith, data exists for a broad spectrum of health relevant questions in childhood and adolescence, including indicators, determinants and consequences of obesity. As part of the health monitoring system of the Robert Koch Institute, KiGGS is being continued as a longitudinal study. This enables the observation of health development of children and adolescents up to adulthood as well as the detection of changes in behavior and circumstances within this population. This offers many new perspectives for analyses, whose findings may be helpful for the prevention of obesity. Current insights and future perspectives are discussed.

[Development and implementation of health targets for children and adolescents. What contribution can the Robert Koch Institute's National Health Interview and Examination Survey for Children and Adolescents (KiGGS) make?]. / Entwicklung und Evaluation der nationalen Gesundheitsziele für Kinder und Jugendliche. Welchen Beitrag leistet der Kinder- und Jugendgesundheitssurvey des Robert Koch-Instituts (KiGGS)?

Health targets are increasingly becoming a health-policy control instrument, both nationally and internationally. In the project gesundheitsziele.de, targets have been formulated for children and adolescents in Germany - currently in the areas of nutrition, exercise, and stress management. Implementing and evaluating health targets requires regularly updated, informative data that allow a comprehensive and precise description of the relevant problems and developments. The Robert Koch Institute's National Health Interview and Examination Survey for Children and Adolescents - conducted during the period from 2003 to 2006 - provides a pool of data with information on virtually all facets of health development during childhood and adolescence which can be used to determine the starting point of the health-targeting process. This article describes the data provided by the survey of the areas nutrition, exercise, and stress management and the contribution these data could make towards further developing and implementing the health targets for children and adolescents.

[Alcohol consumption among adolescents in Germany. Results of EsKiMo]. / Alkoholkonsum bei Jugendlichen in Deutschland. Ergebnisse aus EsKiMo.

The study EsKiMo (Eating study as a KiGGS Module) was conducted from January to December 2006 as a follow-up study of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). With data from this study, the alcohol consumption of adolescents in Germany is explored. Interviews were conducted with 1272 adolescents, aged 12 to 17 years, using the dietary assessment software DISHES which is based on the diet history method. From consumption data of the previous four weeks, means and percentiles of the average daily consumption of alcoholic beverages as well as pure alcohol intake were calculated, stratified by age, sex, new and old federal states, social status, type of school, and migration background. Furthermore, the associations of these variables with alcohol intake were determined in univariate and multiple linear regression analyses. The highest amount of alcoholic beverages is consumed as beer. Among 16- to 17-year-olds, boys consume on average 10.4 g alcohol and girls 3.8 g alcohol per day and even 11% of boys and 6% of girls exceed the tolerable upper intake levels for adults. Alcohol consumption increases significantly with age (p< 0.001), boys drink significantly more alcohol than girls of the same age (p< 0.001), and migrants significantly less than non-migrants (p< 0.05). Differences between new and old federal states, social status, and type of school are not statistically significant. Alcohol consumption is high among adolescents, most particular among boys aged 16 to 17 years. Since about a quarter of 12- to 13-year-olds consumed alcohol at least once in the last four weeks, there is a need for action already in this age group.

[Dietary supplement use among adolescents in Germany. Results of EsKiMo]. / Supplementenkonsum bei Jugendlichen in Deutschland. Ergebnisse aus EsKiMo.

In 2006, 20 % of adolescents aged 12-17 years used dietary supplements. Persons with high physical activity levels as well as those with high education levels consumed dietary supplements more often than others. Many supplement users used only one single-nutrient supplement. A similarly large proportion of users consumed one supplement with multiple nutrients. Most often supplements containing vitamin C, magnesium, B-vitamins, vitamin E and calcium were used.

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 microg/day, in either men (2.8 microg/day) or women (2.3 microg/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.

[Physical activity among children and adolescents in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. / Körperlich-sportliche Aktivität von Kindern und Jugendlichen in Deutschland. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS).

Regular physical activity has a positive effect on health and wellbeing at any age. For this reason, sports and exercise enhancing measures are inherent parts of public health in Germany. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides a nationally representative database which allows a comprehensive analysis of physical activity behaviour among young people. This may support the planning and implementation of health intervention measures. Primary results of KiGGS indicate that most children aged 3 to 10 years regularly go in for sports: around three quarters of girls and boys go in for sports at least once a week, and even more than one third three times a week or more. Children without sport engagement come disproportionately often from families with low socioeconomic status, with a migration background or from former East Germany. Also among adolescents sports and exercise activity is very common. Among 11-17 year olds, how ever, the current recommendation to conduct physical and or sports activities on most days of the week is only achieved by every fourth boy and every sixth girl. Especially girls with low socioeconomic status and with a migration background show a lack of physical activity. These results underline the importance of sports- and exercise-promoting measures in childhood and adolescence, designed for specific target groups.

[Food consumption of children and adolescents in Germany. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. / Lebensmittelverzehr bei Kindern und Jugendlichen in Deutschland. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS).

Since dietary behaviour has an essential impact on health, information on food consumption was obtained in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The average food frequency and portion size "in recent weeks" was assessed with a food frequency questionnaire. Two versions of the questionnaire, identical in content, exist: one aimed at parents of 1-10-year-olds and the other directly at 11-17-year-olds. The results include data on 7,186 boys and 6,919 girls, aged 3-17. About half of the participants each consume bread, milk and fresh fruits every day. The majority (about three quarter) eat fast food only once a month or less. However, 16 % of the participants eat chocolate, and almost 20 % other sweets every day. More boys than girls individually consume soft drinks, milk, dairy products, meat, sausage, cereals and white bread every day. More girls consume fresh fruits and raw vegetables each day. With increasing age the proportion of daily consumers of soft drinks, cheese (and among boys also meat and sausage) increases, but the proportion of daily consumers of juices, tap water, milk, dairy products, fresh fruits, raw vegetables, cookies, chocolate, sweets (and among girls also breakfast cereals) falls. As expected the consumption of sweets and soft drinks is relatively high. Whereas more than half of the children each consume fruits and vegetables on a daily base, this consumption declines with increasing age.

[EsKiMo - the nutrition module in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. / EsKiMo - Das Ernährungsmodul im Kinder- und Jugendgesundheitssurvey (KiGGS).

In a module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the dietary behaviour of 6-17-year-olds was assessed from January to December 2006. The study, named EsKiMo (Eating Study as a KiGGS Module), was performed by the Robert Koch Institute together with the division of nutrition and consumer education at the University of Paderborn. It was funded by the Federal Ministry of Food, Agriculture and Consumer Protection. Parents of participants younger than 12 years were asked to conduct a 3-day dietary record. Participants of 12 years and older were personally interviewed about their eating behaviour during the last four weeks using DISHES (Dietary Interview Software for Health Examination Studies). In addition, they were asked to fill in the KiGGS food frequency questionnaire a second time. Furthermore, all participants were asked about their socio-demographic background, leisure time activities, supplement use, meals at school, body weight and height. The study will provide up-to-date, representative data on the nutrition of children and adolescents in Germany. The analyses will include the amounts of foods and food groups consumed as well as the nutrient intake. By connecting these nutrition data with other health data from KiGGS, comprehensive analyses of relationships between nutrition and health are possible.

Dietary intake and sources of long-chain n-3 PUFAs in German adults.

Dietary intake of long-chain polyunsaturated fatty acids (EPA and DHA) was analysed, stratified by sex and age groups, using data from the German Nutrition Survey 1998. The median intake of both fatty acids combined (EPA and DHA) was 141 mg per day among women and 186 mg among men. In all age groups, women consumed less EPA and DHA than men, partly because of lower total intake. The lowest median intake was observed among women aged 18-24 years (84 mg) and the highest median intake among men aged 45-54 years (217 mg). The main sources of these fatty acids are fish (68%), eggs (12%), poultry (7%), meat and sausages (7%). The remaining 6% of EPA and DHA is supplied by bakery products.

[Sport and health among adults in Germany]. / Sport und Gesundheit bei Erwachsenen in Deutschland.

Regularly participating in sports activities can have a positive effect on people's health and is therefore an important area of health promotion. Data of the Telephone Health Survey 2003 indicate that until now there is an unexploited potential for programmes promoting sports: in total 37.3% of men aged 18 years and above and 38.4% of equally aged women do not participate in sports at all; another 20.9% of men and 28.4% of women only engage in sports activities for up to 2 h/week. The highest prevalence of sports activity is seen among young adults, whereas it is lowest among older people. However, the latter slightly increased their sports activity during the last 10 years, while the trend observed among younger adults seems to point rather in the opposite direction. Also relevant for the planning and implementation of group-specific interventions is the observation that persons with low socioeconomic status tend to engage less often in sports than people with middle or high status do. The present study underlines the health relevance of sports participation by presenting inverse relationships between sports activity and behaviour-related health risks such as smoking and obesity as well as a positive effect of sports on self-assessed health.