Evaluating the diet in Germany with two indices focusing on healthy eating and planetary healthy eating using nationwide cross-sectional food intake data from DEGS1 (2008-2011).

PURPOSE: To improve sustainability, adjustments to current diets are necessary. Therefore, limited planetary resources are considered within the healthy reference diet proposed by the EAT-Lancet Commission. The agreement with nationwide food intake was evaluated with two indices which reflect this reference and German food intake recommendations. METHODS: A healthy eating index (HEI-MON) reflecting the dietary guidelines of the German nutrition society and a planetary healthy eating index (PHEI-MON) reflecting the healthy reference diet were developed, with scores from 0 to 100. Both indices were applied to data from a nationally representative sample of the German population aged 18-79 years for which data from a 53-item food frequency questionnaire are available. RESULTS: Mean scores for the indices were 53 for HEI-MON and 39 for PHEI-MON. A better adherence to either guideline could be found among women, persons of older age as well as persons with higher education level. The sub-scores for HEI-MON showed high agreement with the recommendations for side dishes, fruit/nuts, (processed) meat and cereals, but low agreement with the recommendations for free sugar and vegetables/legumes. PHEI-MON sub-scores were highest for poultry, fruits and potatoes, and lowest for nuts, red meat and legumes. High scores in one index do not necessarily correspond to high scores in the other index. Individuals with more plantbased diets had higher scores in both indices, while high sugar and meat consumption led to lower scores. CONCLUSIONS: More plant-based diets are crucial for individual and planetary health. Both indices reflect such diets which consider already health and sustainability aspects. At an individual level, the scores for both indices may differ considerably, but overall there is a huge potential in the population to adapt to a diet more in line with both guidelines.

Climate protection, health and other motives for active transport - results of a cross-sectional survey in Germany.

BACKGROUND: Active transport- for example walking and bicycling to travel from place to place- may improve physical fitness and health and mitigate climate change if it replaces motorised transport. The aim of this study is to analyse the active transport behaviour of adults living in Germany, to investigate differences among population groups and to determine whether climate protection is a frequent motive for this behaviour. METHODS: This study uses self-reported data of 4,971 adults who participated in a national health survey (German Health Update 2021), which was conducted as a telephone survey from July to December 2021. Associations between active transport behaviour and corresponding motives with sociodemographic and health-related variables were analysed using logistic regression models. RESULTS: Of the adult population, 83% use active transport at least once a week. The frequency and duration of walking per week are significantly higher than those for bicycling (walking 214 min/week; bicycling 57 min/week). Those with a lower education level are less likely to practise active transport than those with a higher education level. Furthermore, women are less likely to use a bicycle for transport than men. Among those practising active transport, the most frequently mentioned motive is "is good for health" (84%) followed by "to be physically active" (74%) and "is good for the climate/environment" (68%). Women and frequent bicyclists (at least 4 days/week) mention climate protection as a motive more often than men and those bicycling occasionally. CONCLUSIONS: The improvement of active transport, especially among people with lower education and women (for bicycling), may benefit from better insights into motives and barriers. Climate protection is an important motivator for practising active transport within the adult population living in Germany and should therefore have greater emphasis in behavioural change programmes.

[Eating Habits with Climate Impact: At Which Meals and How Often Do 6- to 11-year-olds Eat Meat and Meat Products?] / Klimarelevante Ernährungsgewohnheiten: Zu welchen Mahlzeiten und wie häufig essen 6- bis 11-Jährige Fleisch und Wurstwaren?

BACKGROUND: Climate change presents one of the greatest public health challenges. Regarding diet, the production of animal-based foods contributes significantly to greenhouse gas emissions. In Germany, even children often eat more meat and meat products than is recommended for a healthy diet. To plan, implement, and tailor interventions to the needs of different target groups, it is crucial to better understand people's eating habits. METHODS: Using data from 4-day eating records of 1,190 participants of the EsKiMo II study (Nutrition study as KiGGS module, 2nd survey), which was carried out nationwide in Germany from 2015 to 2017, a detailed analysis of the consumption of meat and meat products of children aged 6-11 years, including consumption quantities and frequencies with regard to different meals, was conducted. RESULTS: On average, children ate 71 g of meat and meat products per day, 2/3 of the amount during lunch and dinner. More red meat (pork, beef, and lamb) were chosen than poultry. Almost half of the children ate these food items twice a day, another 40% once a day. Only five percent consumed meat or meat products less than once a day. CONCLUSIONS: Meat and meat products are therefore part of the daily diet of almost all children at this age with a general high intake among both boys and girls. Consumption could be reduced by replacing meat and meat products with vegetarian dishes or plant-based sandwich fillings, particularly for lunch and dinner. While school lunch can considerably contribute to a healthy and climate-friendly diet, families should also reduce meat servings at dinner.

Perspectives of individuals on reducing meat consumption to mitigate climate change: protocol for a scoping review.

INTRODUCTION: High consumption of red and processed meat increases the risk of several chronic diseases. Many people, especially in high-income countries, eat more meat than recommended by nutritional and health agencies. Meat production also has negative impacts on the environment and contributes to climate change. Therefore, climate protection, besides health or animal welfare, could motivate individuals to eat less meat. Willingness to reduce meat consumption and motives to do so are not yet fully understood. METHODS AND ANALYSIS: Based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extended guidelines, a scoping review of peer-reviewed original studies will be conducted to address three questions: What is the evidence regarding (1) the willingness of individuals to reduce meat consumption to mitigate climate change, (2) the awareness of individuals about the link between their meat consumption and the potential to mitigate climate change and (3) individuals having reduced meat consumption for the reason of climate protection? We will search the databases Medline (via PubMed), Scopus, Embase, Greenfile (via Ebsco) and PsynDex/CurrentContent/Agris (via Livivo) using a systematic search string. Studies from 2015 onwards, published in English, German, Danish or Dutch, will be included. We will include observational studies, qualitative studies, intervention studies (if they include surveys) and reviews. Data will be summarised in a narrative synthesis, comprising methods, population characteristics, meat type under study, indicators measured and limitations. Key findings will be grouped according to the research questions. This scoping review will help clarify the role of climate protection in individual reduction of meat consumption and identify research gaps in this field. ETHICS AND DISSEMINATION: Formal ethical approval is not required, as primary data will not be collected in this study. Findings of this scoping review will be presented at scientific conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/MWB85.

Dietary Patterns in Adolescent Obesity as Predictors of Long-Term Success Following an Intensive Inpatient Lifestyle Programme.

(1) Background: Lifestyle interventions for adolescents with obesity show minor long-term effects on anthropometric parameters. The persistence of dietary changes after obesity inpatient rehabilitation has not been sufficiently investigated. (2) Objectives: To analyse dietary patterns in German adolescents with obesity as predictors of long-term success following an intensive inpatient lifestyle programme regarding food choices as well as body weight and comorbidities. (3) Methods: Food consumption data of 137 German adolescents with obesity aged 10-17 years were collected by a nutrition interview. Cluster analysis was used to group the participants according to their food consumption. Dietary patterns, changes in body weight and insulin resistance were compared over a 2-year-period. (4) Results: Three dietary patterns were identified. Big Eaters (n = 32) consume high amounts of total sugar and meat, Moderate Eaters (n = 66) have a diet comparable to the national average, and Snackers (n = 39) have a particularly high consumption of total sugar. Big Eaters and Snackers significantly reduced the consumption of total sugar. Among Moderate Eaters, no persistent changes were observed. (5) Conclusion: Weight reduction interventions can induce long-lasting changes in the diet of adolescents with obesity. Therefore, the success of a weight reduction intervention should not be determined by weight reduction only.

Smoking behaviour and passive smoke exposure of adults - Results from GEDA 2019/2020-EHIS.

Background: Smoking is a significant health risk and the leading cause of premature death. Passive smoke causes the same negative effects on health as smoking, albeit to a lesser extent. The reduction of tobacco consumption and the protection against passive smoke are thus important health objectives. Methods: The study German Health Update (GEDA 2019/2020-EHIS) is a cross-sectional telephone survey (04/2019 to 09/2020) of the resident population in Germany with questions relating to the current smoking behaviour and relating to the passive smoke exposure. The analysis sample comprises 22,708 persons from 18 years of age. Results: 24.0% of women and 33.9% of men from 18 years of age smoke currently, at least occasionally. Among both sexes, adults from 65 years of age smoke significantly more rarely than adults in the younger age groups. 4.1% of adults, who do not smoke themselves, are subjected daily to passive smoke exposure indoors. This affects in particular young adults and men. There are educational differences in tobacco consumption and in passive smoke exposure to the disadvantage of adults from lower educational groups. Conclusions: In Germany, there is still a need for action for effective measures for tobacco prevention, smoking cessation and tobacco control policy, which are effective in all population groups and which take into account the concerns of socially disadvantaged groups.

Biobanking in everyday clinical practice in psychiatry-The Munich Mental Health Biobank.

Translational research on complex, multifactorial mental health disorders, such as bipolar disorder, major depressive disorder, schizophrenia, and substance use disorders requires databases with large-scale, harmonized, and integrated real-world and research data. The Munich Mental Health Biobank (MMHB) is a mental health-specific biobank that was established in 2019 to collect, store, connect, and supply such high-quality phenotypic data and biosamples from patients and study participants, including healthy controls, recruited at the Department of Psychiatry and Psychotherapy (DPP) and the Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital of the Ludwig-Maximilians-University (LMU), Munich, Germany. Participants are asked to complete a questionnaire that assesses sociodemographic and cross-diagnostic clinical information, provide blood samples, and grant access to their existing medical records. The generated data and biosamples are available to both academic and industry researchers. In this manuscript, we outline the workflow and infrastructure of the MMHB, describe the clinical characteristics and representativeness of the sample collected so far, and reveal future plans for expansion and application. As of 31 October 2021, the MMHB contains a continuously growing set of data from 578 patients and 104 healthy controls (46.37% women; median age, 38.31 years). The five most common mental health diagnoses in the MMHB are recurrent depressive disorder (38.78%; ICD-10: F33), alcohol-related disorders (19.88%; ICD-10: F10), schizophrenia (19.69%; ICD-10: F20), depressive episode (15.94%; ICD-10: F32), and personality disorders (13.78%; ICD-10: F60). Compared with the average patient treated at the recruiting hospitals, MMHB participants have significantly more mental health-related contacts, less severe symptoms, and a higher level of functioning. The distribution of diagnoses is also markedly different in MMHB participants compared with individuals who did not participate in the biobank. After establishing the necessary infrastructure and initiating recruitment, the major tasks for the next phase of the MMHB project are to improve the pace of participant enrollment, diversify the sociodemographic and diagnostic characteristics of the sample, and improve the utilization of real-world data generated in routine clinical practice.

Health situation in Germany during the COVID-19 pandemic. Developments over time for selected indicators of GEDA 2019/2020 - An update.

The spread of the coronavirus SARS-CoV-2 in 2020 and the containment measures associated therewith have changed many aspects of daily life. An impact on health even beyond infections itself is assumed as well. The health situation of the population in the first phase of the pandemic was thus analysed using data from the German Health Update (GEDA 2019/2020-EHIS). By continuing the survey, the analyses for 2020 are completed (n=26,507 participants), whereby the focus is now on the third phase of the pandemic (second wave of infection, gradual reintroduction of containment measures). The health indicators are presented on a monthly basis. As in the first phase of the pandemic, no pandemic-related changes were observed for tobacco smoking/ second-hand smoke exposure and for received/lack of/provided support. In contrast to the first phase of the pandemic, declines in utilisation of medical services and depressive symptoms are not observed in the third phase. The increase in body weight/body mass index after the first phase of the pandemic did not continue. The survey period allows for a comparison of the periods before and as of the pandemic situation. A decrease in the medical services utilisation and depressive symptoms as well as an increase in the body weight/body mass index is observed in the period from March 2020 to January 2021 compared to the pre-pandemic period from April 2019 to March 2020.

How has body weight changed since the beginning of the COVID-19 pandemic?

Background: Measures for containing the COVID-19 pandemic in 2020 and 2021 resulted in drastic changes in physical activity and dietary habits that also impacted body weight. Methods: The representative study German Health Update (GEDA 2021) includes self-reported information about body weight and body height for adults aged 18 years and older (n=2,985) from July to October 2021. In addition, the study asked about changes in body weight since the beginning of the COVID-19 pandemic. Results: For 59% of participants, body weight has not changed since the beginning of the COVID-19 pandemic, 26% report weight gain, and 15% report weight loss. Younger people indicate weight gain more often than older people, and individuals with obesity report weight gain more often than individuals without obesity. 1.5 years after the beginning of the COVID-19 pandemic, the average weight change within the population is approximately +0.34kg. Conclusions: The effects of restrictions in everyday life with regard to the possible negative impacts on body weight should be given greater consideration and should be monitored in the future.

Health-promoting behaviour among adults in Germany - Results from GEDA 2019/2020-EHIS.

Health-promoting behaviours are important at any age to prevent diseases and to promote well-being. Using data from GEDA 2019/2020-EHIS, a Germany-wide, representative survey, this article describes how often the adult population in Germany reports certain types of health-promoting behaviour in their everyday lives. The behaviours considered are nonsmoking, low-risk alcohol consumption, achievement of the World Health Organization's (WHO) recommendations on aerobic physical activity, at least daily fruit and vegetable consumption, and maintaining a body weight within the normal range. This article describes the proportion of people who report these behaviours in their everyday lives by gender, age and education level, the number of health-promoting behaviours each person reports and the most common combinations in which they occur. Young adults between 18 and 29 years are most likely to achieve a health-promoting lifestyle. The proportion of people who report at least 150 minutes of physical activity per week and a normal body weight is lower in later adulthood than among 18- to 29-year-olds. The recommendation to eat fruit and vegetables daily is implemented least often of all five aspects of health behaviour under study. Finally, women are more likely to lead a health-promoting lifestyle than men.

Developments in the health situation in Germany during the initial stage of the COVID-19 pandemic for selected indicators of GEDA 2019/2020-EHIS.

SARS-CoV-2, the novel coronavirus, has posed major challenges in Germany in 2020. It is unclear whether the pandemic and containment measures will have an impact on the health of the population beyond the point of infection. The German Health Update (GEDA 2019/2020-EHIS) is a nationwide survey of the population aged 15 years and older (n=23,001) that was conducted between April 2019 and September 2020. The focus of the analysis was on indicators for which pandemic-related changes could be expected. Based on regression models, adjusted proportions and mean values were estimated as trends over time. Any differences in the values found for the time period of containment measures in spring 2020 and the reference period 2019 were statistically tested. Since the implementation of containment measures, both body weight and body mass index (BMI) have increased. The utilisation of general and specialist medical services decreased temporarily. The number of tobacco smokers during the observation period also decreased, yet without revealing a clear link to the pandemic situation. No differences were found in the general population for depressive symptoms and household assistance received and provided. During the period of containment measures, changes to the health situation beyond the occurrence of infections can be observed. However, a more differentiated explanation of these findings will require further analyses.

Corrigendum: Developments in the health situation in Germany during the initial stage of the COVID-19 pandemic for selected indicators of GEDA 2019/2020-EHIS.

[This corrects the article on p. 3-20 in vol. 5.].

Use of vitamin and mineral supplements among adolescents living in Germany-Results from EsKiMo II.

Dietary supplements may contribute to nutrient intake; however, actual data on dietary supplement use among adolescents living in Germany are rare. The aim of this analysis was to describe the current use of dietary supplements, its determinants, and reasons of use. Changes in supplement use over time were evaluated by comparing the results with those from EsKiMo I (2006). Data from the Eating Study as a KiGGS Module EsKiMo II (2015-2017) were used to analyze supplement intake according to sociodemographic, health characteristics, and physical exercise behavior of 12-17-year-olds (n = 1356). Supplement use during the past four weeks was assessed by a standardized computer assisted personal interview. Multivariable logistic regression was used to identify the association between supplement use and its determinants. Between 2015-2017, 16.4% (95%-CI: 13.0-19.7%) of the adolescents used dietary supplements, and its use decreased with lower levels of physical exercise and overweight. Most supplement users used only one supplement, often containing both vitamins and minerals. The most frequently supplemented nutrients were vitamin C and magnesium. The main reported reason to use supplements was 'to improve health'. Prevalence of supplement use was slightly lower in 2015-2017 than in 2006 (18.5%; 95%-CI: 15.8-21.2%). The results underline the importance of including nutrient intake through dietary supplements in nutrition surveys.

Consumption of sugary soft drinks among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

Consuming large amounts of sugary beverages has been related to developing obesity, diabetes mellitus type II and other chronic diseases. KiGGS Wave 2 (2014-2017) provides data on the consumption of sugary soft drinks in the 3-17 year age group in Germany. Overall, 13.7% of girls and 17.6% of boys consume one to three times a day sugary soft drinks and 3.3% of girls and 4.7% of boys four or more times. Consumption frequency increases with age and is higher among children and adolescents with low socioeconomic status (SES) than for those of the same age with high SES. The share of adolescents who drink sugary soft drinks daily has decreased since the KiGGS baseline study (2003-2006).

Sports and dietary behaviour among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

This article focuses on selected indicators related to sports and dietary behaviour - two important factors that influence the development of obesity. The analyses are based on data collected for the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), which was conducted between 2014 and 2017. These data were collected, using a questionnaire, from 6,810 girls and 6,758 boys aged between 3 and 17. The analyses also compare the data collected for wave 2 with those from the KiGGS baseline study (2003-2006). More than 70% of 3- to 17-year-olds state that they participated in sports. However, boys do so significantly more often than girls, and 11- to 17-year-olds do so more frequently than 3- to 10-year-olds. In addition, there is a correlation between children's and adolescents' sports participation and those of their parents, and with an activity-friendly living environment. Younger children and girls have healthier diets than older children and boys. However, although the consumption of confectionery and sugary drinks by 3- to 17-year-olds has declined significantly since the KiGGS baseline study was conducted, 11- to 17-year-olds, in particular, eat significantly smaller amounts of vegetables than they did about ten years ago. Significantly more 3- to 10-year-olds currently eat at least five servings of fruit and vegetables per day than ten years ago, although the proportion of the children who reach this recommendation continues to remain very low at 14% overall. It is important to set an example by following a healthy lifestyle within families and other settings in early life. Furthermore, the living environments also need to be made more health-oriented to support children and adolescents in reaching the national recommendations on physical activity and healthy eating.

Food purchase patterns: empirical identification and analysis of their association with diet quality, socio-economic factors, and attitudes.

BACKGROUND: Empirically derived food purchase patterns provide information about which combinations of foods were purchased from households. The objective of this study was to identify what kinds of patterns exist, which level of diet quality they represent and which factors are associated with the patterns. METHODS: The study made use of representative German consumption data in which approximately 12 million food purchases from 13,125 households are recorded. In accordance with healthy diet criteria the food purchases were assigned to 18 food groups of the German Food Pyramid. Based on these groups a factor analysis with a principal component technique was applied to identify food patterns. For these patterns nutrient and energy densities were examined. Using regression analysis, associations between pattern scores and socio-economic as well as attitude variables, reflecting personal statements about healthy eating, were analyzed. RESULTS: In total, three food purchase patterns could be identified: a natural, a processed and a traditional one. The first one was characterized by a higher purchasing of natural foods, the second by an increased purchasing of processed foods and the third by a meat-oriented diet. In each pattern there were specific diet quality criteria that could be improved whereas others were in line with actual dietary guidelines. In addition to socio-demographic factors, attitudes were significantly associated with the purchase patterns. CONCLUSIONS: The findings of this study are interesting from a public health perspective, as it can be assumed that measures focusing on specific aspects of diet quality are more promising than general ones. However, it is a major challenge to identify the population groups with their specific needs of improvement. As the patterns were associated with both socio-economic and attitude variables these grouping criteria could be used to define target groups.

New data for action. Data collection for KiGGS Wave 2 has been completed.

The fieldwork of the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was completed in August 2017. KiGGS is part of the Robert Koch Institute's Federal Health Monitoring. The study consists of the KiGGS cross-sectional component (a nationally representative, periodic cross-sectional survey of children and adolescents aged between 0 and 17) and the KiGGS cohort (the follow-up into adulthood of participants who took part in the KiGGS baseline study). KiGGS collects data on health status, health-related behaviour, psychosocial risk and protective factors, health care and the living conditions of children and adolescents in Germany. The first interview and examination survey (the KiGGS baseline study; undertaken between 2003 and 2006; n=17,641; age range: 0-17) was carried out in a total of 167 sample points in Germany. Physical examinations, laboratory analyses of blood and urine samples and various physical tests were conducted with the participants and, in addition, all parents and participants aged 11 or above were interviewed. The first follow-up was conducted via telephone-based interviews (KiGGS Wave 1 2009-2012; n=11,992; age range: 6-24) and an additional sample was included (n=4,455; age range: 0-6). KiGGS Wave 2 (2014-2017) was conducted as an interview and examination survey and consisted of a new, nationwide, representative cross-sectional sample of 0- to 17-year-old children and adolescents in Germany, and the second KiGGS cohort follow-up. The completion of the cross-sectional component of KiGGS Wave 2 means that the health of children and adolescents in Germany can now be assessed using representative data gained from three study waves. Trends can therefore be analysed over a period stretching to over ten years now. As the data collected from participants of the KiGGS cohort can be individually linked across the various surveys, in-depth analyses can be conducted for a period ranging from childhood to young adulthood and developmental processes associated with physical and mental health and the associated risk and protective factors can be explored. As such, KiGGS Wave 2 expands the resources available to health reporting, as well as policy planning and research, with regard to assessing the health of children and adolescents in Germany.

EsKiMo II - the Eating study as a KiGGS Module in KiGGS Wave 2.

Nutrition plays an important role for health, in particular of children and adolescents. In addition to the baseline German Health Interview and Examination Survey for Children and Adolescents (KiGGS, 2003-2006), the nutrition survey EsKiMo (Eating study as a KiGGS Module) assessed the dietary habits of children and adolescents aged 6 to 17 in detail. In KiGGS Wave 2 (2014-2017) the corresponding module is EsKiMo II. Between June 2015 and September 2017, specially trained nutritionists will visit EsKiMo II participants at their homes. The parents of 6-to 11-year-olds are instructed on how to complete food records on four randomly chosen days - three consecutive days, followed later by an additional day. Participants aged 12 to 17 are interviewed personally on their food intake during the past four weeks with the dietary interview programme DISHES. Further information, for example, regarding dietary supplements is also recorded. EsKiMo II will provide an up-to-date and representative overview of the current nutrition status of 6-to 17-year-olds living in Germany, and it allows analysing changes in dietary behaviour over time. EsKiMo II can identify shortcomings in the nutrition of children and adolescents and thus may contribute with important information to nutrition and health policy.

Folate status in Germany.

Folate is important for cell division and thus for growth and physical development. Serum folate concentrations can be used to assess a population's folate status. In Germany, the median serum folate level of adults aged 18 to 79 is 7.5 ng/ml (women: 7.9 ng/ml, and men: 7.2 ng/ml). Approximately 86% of the adult population in Germany has adequate folate levels. Higher folate concentrations are observed among older age groups and individuals with a higher socio-economic status. However, the World Health Organization recommends that women of reproductive age should, at the population level, have significantly higher folate levels in order to reduce the risk for neural tube defects. However, the majority of women in this age group do not achieve these concentrations.