[15 years of the Kiel Obesity Prevention Study (KOPS). Results and its importance for obesity prevention in children and adolescents]. / 15 Jahre Kieler Adipositas-Präventionsstudie (KOPS). Ergebnisse sowie deren Einordnung und Bedeutung für die Prävention von Adipositas bei Kindern und Jugendlichen.

The Kiel Obesity Prevention Study (KOPS) has been performed since 1996 and aims to characterize determinants and to prevent overweight. A total of 15,251 children and adolescents aged 5-16 years were recruited, of whom 780 and 92, respectively, underwent school-based and family-based interventions. Long-term evaluation of the school-based intervention was available over 4 and 8 years, while family-based intervention was evaluated over 1 year. The prevalence of overweight was 18.8% for the whole KOPS cohort. Determinants of overweight were parental overweight and obesity, low socioeconomic status (SES), early life factors, and lifestyle factors. School-based intervention ameliorated the weight status of children of high SES and of normal weight mothers over the long-term. The intervention effect was small but within the expectable range as calculated from analysis of determinants. Alternative outcome variables (e.g., fat mass) and new evaluation approaches (e.g., excess gain in fat mass) gave no detailed information of the intervention success. Family-based intervention showed that even with this individual approach children of low SES could not be reached.

Parental overweight, socioeconomic status and high birth weight are the major determinants of overweight and obesity in 5-7 y-old children: baseline data of the Kiel Obesity Prevention Study (KOPS).

OBJECTIVES: To identify the major risk factors of overweight and obesity in prepubertal children. DESIGN: Cross-sectional study. SETTING: In all, 32 primary schools in Kiel (248 000 inhabitants), northwest Germany. SUBJECTS: A total of 2631 5-7-y-old German children and their parents. MAIN OUTCOME MEASURES: Weight status, socio-economic status (SES), parental overweight, dietary intake, activity, inactivity and further determinants (birth weight, breast feeding, nutritional status of siblings) of the children. RESULTS: The prevalence of overweight (>/=90th BMI percentile of reference) was 9.2% in boys and 11.2% in girls, respectively. Considered univariately, family-, environment- and development-related determinants showed some relations to overweight and obesity. In multivariate analyses parental overweight, a low SES as well as a high birth weight were the strongest independent risk factors of overweight and obesity in children. Additionally, there were sex-specific risk factors: parental smoking and single households were risk factors in boys, whereas a low activity was associated with obesity in girls. Birth weight was associated with obesity, but not with overweight. The prevalence of obesity reached 29.2% in boys and 33.4% in girls with all the three main risk factors. CONCLUSIONS: Overweight families of low SES have the highest risk of overweight and obese children. Future prevention programmes must also take into account sex-specific risk factors.

Use of BMI as a measure of overweight and obesity in a field study on 5-7 year old children.

OBJECTIVE: The present field study examines the use of BMI in comparison with estimates of percent fat mass to screen for overweight and obesity in children. DESIGN: Cross-sectional field study. SETTING: Four waves of children 1996-1999 at Kiel, North West Germany. SUBJECTS: A representative large sample of 2,286 5-7 year old children representing 40% of the total child population examined by school physicians within the same period in Kiel. MAIN OUTCOME MEASURES: BMI was compared with anthropometric measures (TSF, BSF, SIF, SSF) and bioelectrical impedance analysis (BIA). The 90th and 97th BMI percentiles were used as cut offs for overweight and obesity, respectively. RESULTS: BMI reached a low sensitivity to identify overweight children when compared with the two estimates of % FM (0.60 to 0.78 for girls, 0.71 to 0.82 for boys, respectively). The specificity of BMI was 93 to 95 %. By contrast, BMI reached higher sensitivity to screen for obese children of 0.83 to 0.85 for boys and 0.62 to 0.80 for girls at a concomitant specificity of 0.95 to 0.98 for boys and 0.96 to 0.97 for girls as defined by assessment of body fat mass. Comparing nutritional status of overweight children classified as overweight or non overweight by BMI shows that BMI only identified obese but not-overweight children. CONCLUSION: BMI can be used to screen for obese children. In contrast BMI has a poor sensitivity to screen for overweight children. Body composition analysis should be used to screen for children at risk of becoming obese.

Social class differences in overweight of prepubertal children in northwest Germany.

OBJECTIVES: To assess social class differences in overweight and health-related behaviours in 5-7-y-old German children. DESIGN: Cross-sectional study. SETTING: Twenty-nine primary schools in Kiel (inhabitants: 248000), northwest Germany. SUBJECTS: A total of 1350 German 5-7-y-old children and their parents. MAIN OUTCOME MEASURES: Body mass index (BMI), fat mass and health-related behaviours of the children. Self-reported height and weight of their parents, parental school education as a measure of social class. RESULTS: The prevalence of overweight (> or = 90th percentile of reference) was 18.5%. There was an inverse social gradient (P < 0.01): the highest fat mass was observed in children from low social class. The odds ratios for overweight reached 3.1 (CI 1.7-5.4) in boys and 2.3 (CI 1.2-4.3) in girls, respectively (low vs high social class). Overweight parents (BMI > or = 25 kg/m2) were more likely to have overweight children. Parental overweight enhanced the inverse social gradient. The prevalence of overweight was 37.5% (low social class) vs 22.9% (high social class) in children from overweight parents, respectively. There was an inverse social gradient in unhealthy behaviours. Parental BMI and physical inactivity were independent risk factors of overweight in children. CONCLUSIONS: In 5 to 7-y-old children overweight and health-related behaviours are inversely related to social class. Parental overweight enhanced the risk of childhood overweight. The familial effect on body weight is most pronounced in children with low social class. Preventive measures should specifically tackle 'overweight families' from low social class.

Inconsistencies in bioelectrical impedance and anthropometric measurements of fat mass in a field study of prepubertal children.

The present study examined the consistency of bioelectrical impedance analysis (BIA) and anthropometric measurements in body composition analysis in a field study of prepubertal children using a representative group of 2286 5-7-year-old children from Kiel, north-west Germany. Body composition was assessed using anthropometric measures (A; four skinfolds) and BIA. Various published algorithms (according to Lohmann (1986) and Deurenberg et al. (1990) for A, Kushner et al. (1992), Schaefer et al. (1994) and Wabitsch et al. (1996) for BIA and Goran et al. (1996) for a combined approach) were used to estimate body composition. Using A resulted in a sum of four skinfolds varying between age-dependent median values of 24.0 and 28.2 mm in boys and 30.5 and 33.3 mm in girls. When fat mass (FM) was calculated from A, age- and algorithm-dependent differences in median values were observed, with values varying between 8.5 and 14.6% for boys and 1.11 and 14.9% for girls. Using different algorithms (Lohmann (1986) v. Deurenberg et al. (1990)) only minor inconsistencies were observed. BIA-derived resistance index (height2/resistance) varied between 18.8 and 24.4 cm2/omh for boys and 17.1 and 19.0cm2/ohm for girls. Using four different algorithms to estimate FM from BIA data resulted in high intra-individual variances in percentage FM (from 13.8 to 33.4) as well as in the prevalence of overweight (from 14.7 to 98.4% for boys and from 42.3 to 98.5 % for girls). Data obtained using the different BIA algorithms showed some, or even marked, inconsistencies as well as systematic deviations (an overestimation of FM at low percentage FM, Schaefer et al. (1994) v. Wabitsch et al. (1996)). When comparing BIA with A, BIA systematically overestimated FM. The differences between the results were influenced by BMI, gender and height. Considerable inconsistencies were observed at low BMI (<10th percentile) for girls and for small children. Although the within-observer as well as between-observer CV for both techniques are acceptable, we recommend caution in relation to the algorithms used for data analysis. The use of an interchange table of percentage FM derived from different algorithms for different percentile groups of skinfold thicknesses is recommended.

[Problems in defining obesity in prepubescent children: consequences for assessing the requirements for medical rehabilitation]. / Probleme der Definition der Adipositas bei Kindern vor der Pubertät: Konsequenzen für die Ermittlung ihres Rehabilitationsbedarfs.

INTRODUCTION: Prevalence of obesity has been on the increase in recent years. In contrast to obesity in adulthood, childhood obesity is still not uniformly defined. This results in problems to determine the need for medical rehabilitation. METHODS: The Kiel Obesity Prevention Study (KOPS) is a cross-sectional study assessing the nutritional status of 5-7 year-old German children. Three different definitions of overweight and obesity (German reference data for triceps skinfold thickness [90(th) percentile] and BMI [90(th)/97(th) percentile] as well as an international standard for BMI [extrapolated to levels of adults]) were applied to 1,643 children of KOPS enrolled between 1996 and 2000 (19 % of all first-graders in Kiel in this period). RESULTS: The prevalence of overweight varies from 9 to 21 % depending on the applied definition. With the definitions of overweight and obesity based on newer BMI percentiles a part of overweight children are not classified as such. The present state of art is that there is only a need for obese children for medical rehabilitation: these are 3.3 and 3.5 % of 5-7 year-old children in Kiel, respectively. CONCLUSIONS: Experts should work out an agreement concerning a uniform definition of childhood obesity. Currently, medical rehabilitation services are offered only to extremely obese children. There is a need for more and earlier preventive measures.

[WHO warns of obesity epidemic. Are we becoming a society of obese persons?]. / WHO warnt vor Adipositasepidemie. Werden wir eine Gesellschaft der Dicken?

Overweight and obesity, together with their concomitant diseases and sequelae, have reached epidemic proportions. The problem is therefore not merely personal, but also societal. We have become an overweight society on its way to obesity. What we need is effective treatment over the long-term and a public health strategy to combat the condition. These two strategies are complementary, not in competition with each other. Without the latter, the successes of the former remain limited. We require national campaigns involving various aspects of our society aimed at promoting health and preventing disease. This makes necessary the involvement of politicians and representatives of various interested groups with appropriate responsibility. Members of health-related occupations should take the lead in initiating and maintaining such action.

Prevention of obesity--more than an intention. Concept and first results of the Kiel Obesity Prevention Study (KOPS).

OBJECTIVE: Obesity prevention is necessary to address the steady rise in the prevalence of obesity. Although all experts agree that obesity prevention has high priority there is almost no research in this area. The effectiveness of different intervention strategies is not well documented. There is also no structured framework for obesity prevention. DESIGN: Based on (i) our current and limited knowledge and (ii) the idea that prevention of childhood obesity is an effective treatment of adult obesity, the Kiel Obesity Prevention Study (KOPS) was started in 1996. Concept, intervention strategies and first results of KOPS are reported in this paper. KOPS is an ongoing 8 y follow-up study. We first enrolled a large scale cohort of 5 to 7-y-old children, providing sufficient baseline data. KOPS allows further analyses of the role of individual risk factors as well as of long-term effectiveness of different intervention strategies. RESULTS: From 1996 to 1999 a representative group of 2440 5 to 7-y-old children was recruited (ie 30.2% of the total population of 5 to 7-y-old children examined by the school physicians) and a full data set was obtained from 1640 children. Of the children, 340 (20.7%) were considered as overweight and obese, 1108 children (67.6%) were normal weight, and underweight was found in 192 children (11.7%). Of the normal-weight children, 31% or 346 (21.1% of the total population) were considered to have a risk of becoming obese. Cross-sectional data provided evidence that (i) there is an inverse social gradient in childhood overweight as well as health-related behaviours and (ii) parental fatness had a strong influence on childhood overweight. We observed considerable changes in health-related behaviours within 1 y after combined "school-" and "family-based" interventions. Interventions aimed to improve health-related behaviours had significant effects on the age-dependent increases in median triceps skinfolds of the whole group (from 10.9 to 11.3 mm in "intervention schools" vs from 10.7 to 13.0 mm in "control schools", P<0.01) as well as in percentage fat mass of overweight children (increase by 3.6 vs 0.4% per year without and with intervention, respectively; P<0.05). CONCLUSION: First results of KOPS are promising. Besides health promotion, a better school education and social support seem to be promising strategies for future interventions.

Nutrition and health in an adult urban homeless population in Germany.

OBJECTIVE: To assess the association between nutrition and health in an adult urban homeless population. DESIGN: Cross-sectional--nutritional state (body mass index (BMI), triceps skinfold (TSF), upper arm circumference), dietary habits (food frequency), socio-demographic data and self-stated diseases were assessed. SETTING: Four sites for homeless people in Kiel and Hamburg, Germany. SUBJECTS: Sample of 75 homeless people (60 males, 15 females) aged 19-62 years. RESULTS: A lack of food was not found in the majority of the homeless. Seventy-six per cent of the study population showed a normal dietary pattern. Critical food groups were fresh fruit and vegetables, rice and noodles. However, 52 or 29% of the homeless were malnourished (i.e. they were below the 25th or 5th percentile of arm muscle area). In addition, 22.7% of the homeless were obese (i.e. BMI>30 kg m-2 and/or TSF>90th percentile). Almost two-thirds of the population suffered from at least one chronic disease (prevalence of nutrition-related disorders 33.3%, gastrointestinal disorders 32.0%, dental diseases 22.7%, psychiatric disorders 18.7%, wasting diseases 6.7%). Smoking (prevalence rate 82%), drinking alcohol (51%) and drug abuse (20%) were frequent among homeless people. Food intake was not related to nutritional state, the prevalence of chronic diseases or addiction habits. By contrast, a poor nutritional state was associated with drug abuse and the prevalence of wasting diseases. CONCLUSION: Prevention of nutritional problems should be directed to health-related problems such as the prevention or treatment of chronic diseases and addiction habits.

Prevention of obesity--is it possible?

Obesity prevention is necessary to address the steady rise in the prevalence of obesity. Although all experts agree that obesity prevention has high priority there is almost no research in this area. There is also no structured framework for obesity prevention. The effectiveness of different intervention strategies is not well documented. Regarding universal prevention little rigorous evaluation has been carried out in larger populations. Obesity prevention has been integrated into community-wide programmes preventing coronary heart disease. Although effective with respect to reduction in cardiovascular risk factors these programmes did not affect mean body mass index (BMI) of the target populations. Selective prevention directed at high risk individuals (e.g. at children with obese parents) exhibited various degrees of effectiveness. However, at present, definitive statements cannot be made because of the limited number of studies as well as limits in study design. Finally, targeted prevention produced promising results in obese children when compared to no treatment. However, there are only very few longterm follow-up data. There is no clear idea about comprehensive interventions studying combinations of different strategies. It is tempting to speculate that predictors of treatment outcome (e.g. psychological and sociodemographic factors) may also serve as barriers to preventive strategies, but this has not yet been investigated. Taken together, obesity prevention should become a high priority research goal. First results of obesity prevention programmes are promising. As well as health promotion and counselling, better school education and social support appear to be promising strategies for future interventions.

The synaptic glycoprotein neuroplastin is involved in long-term potentiation at hippocampal CA1 synapses.

Neuroplastin-65 and -55 (previously known as gp65 and gp55) are glycoproteins of the Ig superfamily that are enriched in rat forebrain synaptic membrane preparations. Whereas the two-Ig domain isoform neuroplastin-55 is expressed in many tissues, the three-Ig domain isoform neuroplastin-65 is brain-specific and enriched in postsynaptic density (PSD) protein preparations. Here, we have assessed the function of neuroplastin in long-term synaptic plasticity. Immunocytochemical studies with neuroplastin-65-specific antibodies differentially stain distinct synaptic neuropil regions of the rat hippocampus with most prominent immunoreactivity in the CA1 region and the proximal molecular layer of the dentate gyrus. Kainate-induced seizures cause a significant enhancement of neuroplastin-65 association with PSDs. Similarly, long-term potentiation (LTP) of CA1 synapses in hippocampal slices enhanced the association of neuroplastin-65 with a detergent-insoluble PSD-enriched protein fraction. Several antibodies against the neuroplastins, including one specific for neuroplastin-65, inhibited the maintenance of LTP. A similar effect was observed when recombinant fusion protein containing the three extracellular Ig domains of neuroplastin-65 was applied to hippocampal slices before LTP induction. Microsphere binding experiments using neuroplastin-F(c) chimeric proteins show that constructs containing Ig1-3 or Ig1 domains, but not Ig2-3 domains mediate homophilic adhesion. These data suggest that neuroplastin plays an essential role in implementing long-term changes in synaptic activity, possibly by means of a homophilic adhesion mechanism.

Physical activity and diet in 5 to 7 years old children.

OBJECTIVE: To assess the possible associations between physical activity, diet, social state and overweight in children. DESIGN: Cross-sectional study on 1468 children aged between 5 and 7 years old in Kiel, northwest Germany. METHODS: Assessment of physical activity and social factors by a questionnaire, food frequency record, body composition analysis by anthropometrics and bioelectrical impedance analysis. RESULTS: 23% of our children were overweight or obese. Low levels of physical activity (as assessed by TV viewing time) were associated with increased body mass index and a higher prevalence of overweight. TV-viewing of more than 1 h per day was associated with a high consumption fast food, sweets, chips and pizza whereas fruits and vegetables were less frequently consumed. Overweight, inactivity and unhealthy eating habits were seen more frequently in families with a low social status. CONCLUSIONS: In 5 to 7 years old children, overweight is associated with physical inactivity, unhealthy eating habits and a low social status. Primary prevention efforts should be directed to low income families.