Determinants of obesity in the Ulm Research on Metabolism, Exercise and Lifestyle in Children (URMEL-ICE).

We investigated the prevalence of overweight and obesity in German schoolchildren and analyzed determinants of overweight. In the context of a randomized intervention study, a baseline cross-sectional assessment was carried out in 2006. During a physical examination, height, weight, skin fold thickness, and upper arm and waist circumferences were measured according to a standardized protocol among 1.079 children aged 6-9 years. Overweight and obesity were classified according to the definitions of the International Obesity Task Force. Parents completed a questionnaire on potential determinants of overweight. Logistic regression models were calculated for determinants of overweight and obesity. The prevalence of overweight was 16.5% in boys and 17.3% in girls and of obesity 3.5% and 3.6%, respectively. Migration (29.4 %) was correlated with overweight and obesity. In particular, among boys with migration background, overweight (24.0%) and obesity (6.6%) were highly prevalent. Higher obesity prevalence was associated with maternal smoking during pregnancy, parental overweight, and low parental education. Indicators for physical inactivity such as watching television more than 1 h per weekday, participation in club sports less than once a week, consumption of sweetened drinks (>or=3 times per week), and skipping breakfast before school were associated with childhood obesity. Our results provide further evidence that parental factors such as migration background and education are strongly associated with body mass of the offspring. Physically inactive children with regular consumption of sweetened drinks and no breakfast were prone to be overweight or obese. Changes of these lifestyle factors as targets of interventions are promising to prevent childhood obesity.

Prevalence and cluster of cardiometabolic biomarkers in overweight and obese schoolchildren: results from a large survey in southwest Germany.

BACKGROUND: Obesity is associated with substantial metabolic changes and subclinical inflammation. We explored associations between body mass index (BMI) and cardiometabolic biomarkers and their clustering in overweight and obese schoolchildren. METHODS: In this population-based, cross-sectional study among 450 children 10 years old, we measured adiponectin, leptin, inflammatory markers, apolipoprotein (apo) AI and B, and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)). Except for adiponectin and apoAI (10th percentile) the 90th percentile was used as cutoff point. Body weight was categorized in age- and sex-specific BMI percentiles and overweight and obesity according to International Obesity Task Force definitions. RESULTS: In linear regression models, all cardiometabolic markers except apoB were statistically significantly associated with overweight. In logistic regression models, compared with the reference category (25th-75th percentile of BMI), overweight was associated with increased concentrations of leptin [odds ratio (OR) 59.80; 95% CI 16.68-214.39], C-reactive protein (6.30; 2.95-13.45), fibrinogen (2.82; 1.33-6.01), and low apoAI (2.62; 1.19-5.75). Overweight was positively associated with interleukin-6, Lp-PLA(2), and apoB concentrations and inversely with adiponectin concentrations. Most importantly, in obese children 35% showed one, 20% two, 10% three, and 15% four or more abnormal cardiometabolic biomarkers. The number of abnormal cardiometabolic markers increased in overweight (p(trend) <0.001) and obese (p(trend) <0.001) children. CONCLUSIONS: Overweight and obesity in children are associated with complex metabolic changes and a low-grade inflammatory response, and thus might not only accelerate cardiovascular disease later on, but may also be associated with the initiation of atherosclerosis in early life.

Increasing life expectancy in Germany: quantitative contributions from changes in age- and disease-specific mortality.

BACKGROUND: Between 1962 and 2002 the average life expectancy in Germany has increased from 67.1 years to 75.6 years in men and from 72.7 years to 81.3 in women. METHODS: The cumulative and annual contributions of different age- and disease-groups on life expectancy were calculated using Pollard's actuarial method of decomposing mortality rates. Mortality data were provided by the German Statistical Office. RESULTS: Considering the cumulative contribution over the period of 40 years, the largest contributions came from persons with at least 65 years of age (2.9 years in men and 4.0 years in women). Reductions in cardiovascular disease mortality had the greatest cumulative impact on life expectancy (2.7 years in men and 3.0 years in women). The contribution from reduced cancer mortality on life expectancy was substantially lower (0.6 and 0.9 years, respectively). The annual contributions of several disease-groups varied considerably over time. The positive contribution from cardiovascular diseases started only after 1970, and in men it became solid only after 1980. Regarding malignant neoplasms, the largest cumulative contribution came from stomach cancer (0.4 in both sexes). The annual analyses showed increasing contributions from reduced cancer mortality after 1990. These were strongly influenced by lung, stomach, prostate and colorectal cancer in men, and by breast, colorectal and stomach cancer in women. CONCLUSIONS: While life expectancy has increased by about 2.2 years per decade the observed variations in the age- and disease-specific contributions over time have implications for future health care planning and prevention strategies.

Sleep duration and smoking cessation in student nurses.

STUDY OBJECTIVES: To assess predictors of smoking cessation in young adults. DESIGN: Prospective study of smoking cessation. SETTING: 32 Schools of Nursing in Southwest Germany. PARTICIPANTS: 500 student nurses, 82% female, median age 19.9 years, who smoked at baseline. MEASUREMENTS AND RESULTS: Smoking status and potential predictors of smoking cessation were assessed by two questionnaires within a median time interval of 13.1 months. At follow-up, 10.6% of the participants had stopped smoking. Sleep duration was positively associated with smoking cessation. One hour additional sleep per night at baseline increased the relative probability to stop smoking by 1.48 (95% CI 1.14-1.93). The number of cigarettes per day and the 'self-assessment of smoking behaviour in 5 years' were additional factors predicting smoking cessation. CONCLUSIONS: Sleep duration may influence smoking cessation and may have relevance for advising people who want to quit smoking.

Burden of overweight in Germany: prevalence differences between former East and West German children.

BACKGROUND: Given the increasing prevalence of childhood overweight, we aimed to quantify the population burden and evaluate potential regional differences in anthropometric characteristics and prevalence of overweight in fourth graders in two German cities. METHODS: Data were analysed from a cross-sectional school-based study conducted in 1995-96 in Dresden (former East Germany) and Munich (former West Germany) as part of the International Study of Asthma and Allergies in Childhood. Height and weight of the children were measured, and the parents completed a questionnaire. 2474 children age 9-10 years provided anthropometric data. Overweight was defined based on the age-specific and gender-specific international cut-off values for body mass index. RESULTS: Dresden children were on average 1.2 kg lighter and >1 cm taller than their Munich peers. The prevalence of overweight in Dresden was 15.2% in girls and 14.2% in boys compared with 24 and 22.2%, respectively, in Munich. Differences were observed between Dresden and Munich with respect to the proportion of children of non-German nationality, household smoking, breastfeeding practices, and individual dietary behaviours. Even in combination these factors were not able to explain entirely the between-city overweight differences. CONCLUSIONS: A substantial proportion of pre-adolescent children in Germany is now considered overweight with marked regional differences in prevalence. Comparison of population-level factors indicate that other unmeasured determinants of overweight may be responsible for the marked differences in the prevalence of overweight.

A cluster-randomized trial on smoking cessation in German student nurses.

OBJECTIVES: To evaluate the effect of a specific intervention on smoking cessation in health professionals. METHODS: Between 2003 and 2004, a cluster-randomized trial was performed in 32 schools of nursing with 956 student nurses in Southwest Germany. Students in the intervention group received three teaching units each lasting 1 day on how to give advice to people who want to stop smoking. The program addressed only nurses' professional role and not their individual smoking behavior. After a follow-up of 13 months, the change in smoking status was determined. Secondary endpoints included changes of smoking-related factors like stages of smoking or knowledge about health risks. RESULTS: Change of smoking status in the desired direction (stopping smoking or not starting smoking) occurred less often in the intervention than in the control group, but the difference did not reach statistical significance (odds ratio 0.69, 95% confidential interval: 0.43, 1.10). The program was successful in delivering medical knowledge (P=0.0056) and in enhancing competence in giving advice to smokers (P<0.0001). CONCLUSIONS: The applied approach is able to improve student nurses' medical knowledge and to augment their competence in giving advice to smokers, but it is not an effective strategy to reduce their own smoking behavior.

Predictors of health care utilization of children with asthma in the community.

The aim of this study was to assess the pattern of use of health care services among children with asthma symptoms within the community, and assess groups at increased risk of emergency department (ED) visits or hospital admissions (HA). Using International Study of Asthma and Allergies in Childhood phase II protocol, information about asthma management and utilization of health care services was collected by parental questionnaire in a community-based random sample of 5-7- and 9-11-year-old children (n = 11,094) in Dresden and Munich. Only 11.2% of children with current wheeze did not utilize any health care facility or consultation for their asthma symptoms in the 12 months prior to survey, while 86.2%, 12.3%, and 3.6% had at least one asthma related physician's consultation, ED visits, or HA, respectively. Predictors of ED visits and HA among current wheezers were: younger age, male gender, speech-limiting wheeze, level of exposure to environmental tobacco smoke. In addition, children of low socioeconomic status were more likely to have ED visits because of their asthma. Childhood asthma is a major public health problem in Germany leading to substantial morbidity and utilization of health care services. Exposure to tobacco smoke comes out as the major modifiable risk factor related to asthma morbidity in children.

Job titles and work areas as surrogate indicators of occupational exposure.

BACKGROUND: Job titles or work areas are often used as surrogate indicators of exposure in occupational epidemiological studies. In this article, we assess the validity and comparability of commonly used surrogate indicators. METHODS: We analyzed lung cancer mortality among a hypothetical and an actual cohort of rubber workers. Surrogate indicators of exposure were defined according to jobs in which workers were "only," "ever," "longest" or "last" employed, or in which they were employed at the "census" of the study. Occupational risks were estimated using standardized mortality ratios. Validity of surrogate indicators was assessed in the simulated data by comparison between estimated effects and the known underlying associations. Comparisons of surrogate indicators were conducted in both simulated and empirical data. RESULTS: Use of the definition "only" as the surrogate indicator gave valid but imprecise results. For all other definitions, we observed a moderate overestimation of risks in no-risk or low-risk jobs and attenuation of underlying dose-response relationships, without substantial differences among the applied definitions. CONCLUSIONS: Our results demonstrate a limitation of using surrogate indicators of exposure in occupational epidemiological studies. However, they suggest that the inconsistencies of published study findings in the rubber industry are unlikely to be attributable to the use of different surrogate indicators.

Smoking among adolescents in Muenster, Germany: increase in prevalence (1995-2000) and relation to tobacco advertising.

BACKGROUND: Understanding patterns and trends of smoking among youths is of major importance for the assessment of the burden of smoking in the society and efforts to decrease it. OBJECTIVE: The aims were to determine the prevalence and trends of smoking among adolescents in Muenster, Germany, and to assess its relation to youths' awareness of tobacco advertisement. DESIGN: Information on smoking habits was collected during two school-based surveys (1994/1995 and 1999/2000) of 12- to 15-year-old adolescents (3934 students in 1994/5 and 4028 students in 1999/2000) in Muenster, Germany. In addition, in 1994/1995 information about youths' awareness and appreciation of tobacco advertisement was collected. RESULTS: During the 5-year period, the prevalence of current smoking increased from 21.3 to 28.3%, and daily smoking increased from 10.0 to 14.2%. Among girls, daily smoking increased by 62% during this period. Almost all participants (94%) in 1994/1995 knew a tobacco brand, and appreciation of tobacco advertisement was strongly associated with the frequency of smoking. CONCLUSION: Smoking is increasing among adolescents in Germany especially among girls. These data are a cause of concern and call for efforts to reverse these trends, which should include a ban on tobacco advertisement in Germany.