Blood pressure and resting heart rate in 3-17-year-olds in Germany in 2003-2006 and 2014-2017.

To track blood pressure (BP) and resting heart rate (RHR) in children and adolescents is important due to its associations with cardiovascular outcomes in the adulthood. Therefore, the aim of this study was to examine BP and RHR over a decade among children and adolescents living in Germany using national examination data. Cross-sectional data from 3- to 17-year-old national survey participants (KiGGS 2003-06, n = 14,701; KiGGS 2014-17, n = 3509) including standardized oscillometric BP and RHR were used for age- and sex-standardized analysis. Measurement protocols were identical with the exception of the cuff selection rule, which was accounted for in the analyses. Different BP and RHR trends were observed according to age-groups. In 3- to 6-year-olds adjusted mean SBP and DBP were significantly higher in 2014-2017 compared to 2003-2006 (+2.4 and +1.9 mm Hg, respectively), while RHR was statistically significantly lower by -3.8 bpm. No significant changes in BP or in RHR were observed in 7- to 10-year-olds over time. In 11- to 13-year-olds as well as in 14- to 17-year-olds lower BP has been observed (SBP -2.4 and -3.2 mm Hg, respectively, and DBP -1.8 and -1.7 mm Hg), while RHR was significantly higher (+2.7 and +3.7 bpm). BP trends did not parallel RHR trends. The downward BP trend in adolescents seemed to follow decreasing adult BP trends in middle and high-income countries. The increase in BP in younger children needs confirmation from other studies as well as further investigation. In school-aged children and adolescents, the increased RHR trend may indicate decreased physical fitness.

Selection of key indicators for European policy monitoring and surveillance for dietary behaviour, physical activity and sedentary behaviour.

BACKGROUND: A pan-European approach to evaluate policy impact on health behaviour requires the employment of a consensus set of established and relevant indicators. METHODS: As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life, the Policy Evaluation Network PEN identified key indicators of health behaviours and their determinants. These key indicators are already, or have the potential to be, adopted by large European Union surveillance systems for the assessment of policy impact. The iterative selection process included consultations in two rounds via email prior to a 2-days expert workshop. The experts collated a list of dietary behaviour, physical activity and sedentary behaviour indicators for European policy monitoring in young and adult populations based on existing frameworks and literature reviews. The expert panel was composed of researchers, policy makers and representatives of major European surveillance systems and related initiatives, as well as, representatives of organisations providing monitoring data, such as the European Commission and Eurostat. RESULTS: The process provided two lists of key indicators including 37 diet 'policy' indicators and 35 indicators for dietary behaviour and their 'determinants'; as well as 32 physical activity 'policy' indicators and 35 indicators for physical activity, sedentary behaviour and their 'determinants'. CONCLUSION: A total of 139 key indicators related to the individual, the setting and the population level, and suitable for the assessment of dietary behaviour, physical activity and sedentary behaviour were prioritised by policy makers and researchers with the ultimate aim to embed policy evaluation measures in existing surveillance systems across the European Union. In a next step, data sources and suitable instruments will be identified to assess these key indicators.

Domain-specific physical activity patterns and cardiorespiratory fitness among the working population: Findings from the cross-sectional German Health Interview and Examination Survey.

OBJECTIVES: This study aimed to investigate associations between occupational physical activity patterns (physical work demands linked to job title) and leisure time physical activity (assessed by questionnaire) with cardiorespiratory fitness (assessed by exercise test) among men and women in the German working population. DESIGN: Population-based cross-sectional study. SETTING: Two-stage cluster-randomised general population sample selected from population registries of 180 nationally distributed sample points. Information was collected from 2008 to 2011. PARTICIPANTS: 1296 women and 1199 men aged 18-64 from the resident working population. OUTCOME MEASURE: Estimated low maximal oxygen consumption ([Formula: see text]), defined as first and second sex-specific quintile, assessed by a standardised, submaximal cycle ergometer test. RESULTS: Low estimated [Formula: see text] was strongly linked to low leisure time physical activity, but not occupational physical activity. The association of domain-specific physical activity patterns with low [Formula: see text] varied by sex: women doing no leisure time physical activity with high occupational physical activity levels were more likely to have low [Formula: see text] (OR 6.54; 95% CI 2.98 to 14.3) compared with women with ≥2 hours of leisure time physical activity and high occupational physical activity. Men with no leisure time physical activity and low occupational physical activity had the highest odds of low [Formula: see text] (OR 4.37; 95% CI 2.02 to 9.47). CONCLUSION: There was a strong association between patterns of leisure time and occupational physical activity and cardiorespiratory fitness within the adult working population in Germany. Women doing no leisure time physical activity were likely to have poor cardiorespiratory fitness, especially if they worked in physically demanding jobs. However, further investigation is needed to understand the relationships between activity and fitness in different domains. Current guidelines do not distinguish between activity during work and leisure time, so specifying leisure time recommendations by occupational physical activity level should be considered.

Individual and interpersonal correlates of cardiorespiratory fitness in adults - Findings from the German Health Interview and Examination Survey.

Cardiorespiratory fitness (CRF) is an established predictor of adverse health outcomes. The aim of this study is to investigate potential behavioral, interpersonal and socioeconomic correlates of CRF among men and women living in Germany using data from a population-based nationwide cross-sectional study. 1,439 men and 1,486 women aged 18-64 participated in the German Health Interview and Examination Survey (2008-2011) and completed a standardized sub-maximal cycle ergometer test. Maximal oxygen consumption ([Formula: see text]) in ml·min-1·kg-1 was estimated. Mean values of VO2max for various anthropometric, behavioral, interpersonal, and sociodemographic variables were estimated. Linear regression analyses using multiple imputations technique for missing values was performed to analyze the influence of potential correlates on CRF. Women with high alcohol consumption had higher [Formula: see text], (ß = 2.20; 95% CI 0.98 to 3.42) than women with low alcohol consumption and women with high occupational status had higher [Formula: see text] (ß = 1.83; 95% CI 0.21 to 3.44) in comparison to women with low occupational status. Among men, high fruit intake (ß = 1.52; 95% CI 0.63 to 2.40), compared to low or medium fruit intake and performing at least 2.5 hours of total PA per week (ß = 2.19; 95% CI 1.11 to 3.28), compared to less than 2.5 hours was associated with higher [Formula: see text]. Among both men and women, lower body mass index, lower waist circumference and higher levels of physical exercise were considerably associated with higher [Formula: see text]. Among women, those in higher age groups showed a considerably lower level of [Formula: see text] compared with those aged 18-24. Furthermore, mean estimated [Formula: see text] was higher among men (36.5; 95% CI 36.0 to 37.0) than among women (30.3; 95% CI 29.8 to 30.7). Despite the cross-sectional nature of the current study, we conclude that several behavioral, anthropometric, and sociodemographic factors are associated with CRF in the general adult population in Germany. These results can provide evidence to tailor prevention measures according to the needs of specific subgroups.

Association between cardiorespiratory fitness and colorectal cancer in the UK Biobank.

Increased cardiorespiratory fitness is related to decreased risk of major chronic illnesses, including cardiovascular disease, type 2 diabetes, and cancer, but its association with colorectal cancer specifically has received very little attention. We examined the relation of cardiorespiratory fitness to colorectal cancer in 59,191 UK Biobank participants aged 39-70 years without prevalent cancer at baseline, followed from 2009 to 2014. Submaximal bicycle ergometry was conducted at study entry, and cardiorespiratory fitness was defined as physical work capacity at 75% of the maximum heart rate, standardised to body mass (PWC75%). Multivariable Cox proportional hazards regression was performed to obtain hazard ratios (HR) and corresponding 95% confidence intervals (CI). During a mean follow-up of 4.6 years, 232 participants developed colorectal cancer (151 colon cancers; 79 rectal cancers). When comparing the 75th to the 25th percentiles of PWC75%, the multivariable-adjusted HR of colorectal cancer was 0.78 (95% CI 0.62-0.97). That relation was largely driven by an inverse association with colon cancer (HR 0.74, 95% CI 0.56-0.97) and less so with rectal cancer (HR 0.88, 95% CI 0.62-1.26; p value for difference by colorectal cancer endpoint = 0.056). The inverse relation of cardiorespiratory fitness with colorectal cancer was more evident in men (HR 0.72, 95% CI 0.55-0.94) than women (HR 0.99, 95% CI 0.71-1.38), although the gender difference was not statistically significant (p value for interaction = 0.192). Increased cardiorespiratory fitness is associated with decreased risk of colorectal cancer. Potential heterogeneity by colorectal cancer anatomic subsite and gender requires further study.

Correlates and Determinants of Cardiorespiratory Fitness in Adults: a Systematic Review.

BACKGROUND: Enhanced cardiorespiratory fitness (CRF) is now a well-established predictor of numerous adverse health outcomes. Knowledge about the pathways leading to enhanced CRF is essential for developing appropriate interventions. Hence, the aim of this review was to provide a detailed overview of the current state of research regarding individual factors associated with or influencing CRF among the general adult population. METHODS: We searched the PubMed, EMBASE, and Cochrane Library databases and also conducted a search for grey literature (Google Scholar). Eligible indicators of CRF were objectively assessed measures of CRF by submaximal or maximal exercise testing measured using treadmill or cycle ergometer tests. We included quantitative observational studies of the general adult population. Using a semi-quantitative approach, we compiled summary tables aggregating the study results for each potential correlate or determinant of CRF. RESULTS: We identified 3005 studies, 78 of which met the inclusion criteria. Almost all of these studies were conducted in high-income countries. Study quality scores assessing the risk of bias in the individual studies ranged from 40 to 100%. Male sex, age (inverse), education, socioeconomic status, ethnicity, body mass index (inverse), body weight (inverse), waist circumference, body fat (inverse), resting heart rate (inverse), C-reactive protein (inverse), smoking (inverse), alcohol consumption, and multiple measures of leisure-time physical activity were independently and consistently associated with CRF. CONCLUSIONS: In synthesizing the current research on the correlates and determinants of CRF among adults, this systematic review identified gaps in the current understanding of factors influencing CRF. Beyond the scope of this review, environmental and interpersonal determinants should be further investigated. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42017055456.

Time trends in healthy lifestyle among adults in Germany: Results from three national health interview and examination surveys between 1990 and 2011.

BACKGROUND: The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. METHODS: A data set of 18,058 adults aged 25-69 years from three population-based national health examination surveys 1990-92, 1997-99 and 2008-11 with complete information for five healthy behavior factors was used. A 'daily intake of both fruits and vegetables, 'sufficient physical exercise', 'no current smoking' and 'no current risk drinking' were assessed with self-reports and 'normal body weight' was calculated based on measured body weight and height. A dichotomous 'healthy lifestyle' indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25-34, 35-44, 45-54 and 55-69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990-92 and 2008-11. RESULTS: In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990-92 to 13.5% in 1997-99 and to 14.7% in 2008-11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45-54 years. The RC of increasing healthy lifestyle prevalence between 1990-92 and 2008-11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990-92 and 2008-11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. CONCLUSIONS: The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990-92 to 2008-11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level.

Socioeconomic Inequalities in the Rise of Adult Obesity: A Time-Trend Analysis of National Examination Data from Germany, 1990-2011.

OBJECTIVE: Despite extensive study of the obesity epidemic, research on whether obesity has risen faster in lower or in higher socioeconomic groups is inconsistent. This study examined secular trends in obesity prevalence by socioeconomic position and the resulting obesity inequalities in the German adult population. METHODS: Data were drawn from three national examination surveys conducted in 1990-1992, 1997-1999 and 2008-2011 (n = 18,541; age range: 25-69 years). Obesity was defined by a body mass index ≥30 kg/m2 using standardised measurements of body height and weight. Education and equivalised household disposable income were used as indicators of socioeconomic position. Time trends in socioeconomic inequalities in obesity were examined using linear probability and log-binomial regression models. RESULTS: In each survey period, the highest socioeconomic groups had the lowest prevalence of obesity. The low and medium socioeconomic groups showed increases in obesity prevalence, whereas no such trend was observed in the high socioeconomic groups. Absolute inequalities in obesity by income increased by an average of 0.53 percentage points per year (95% confidence interval [CI] 0.01-1.05, p = 0.047) among men and 0.47 percentage points per year (95% CI 0.05-0.90, p = 0.029) among women. Absolute inequalities in obesity by education increased on average by 0.64 percentage points per year (95% CI 0.19-1.08, p = 0.005) among women but not among men (0.33 percentage points, 95% CI -0.27 to 0.92, p = 0.283). CONCLUSIONS: These findings suggest a widening obesity gap between the top and the bottom of the socioeconomic spectrum. This has the potential to have adverse consequences for population health and health inequalities in coming decades. Interventions that are effective in preventing and reducing obesity in socially disadvantaged groups are needed.

Associations between Physical Activity and Food Intake among Children and Adolescents: Results of KiGGS Wave 2.

A balanced diet and sufficient physical activity are essential for the healthy growth of children and adolescents and for obesity prevention. Data from the second wave of the population-based German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2; 2014-2017) were used to analyse the association between food intake and physical activity among 6- to 17-year-old children and adolescents (n = 9842). Physical exercise (PE) and recommended daily physical activity (RDPA) were assessed with self-administered questionnaires and food intake by a semi-quantitative food frequency questionnaire. Multivariable logistic regression was used to analyse the association between food group intake (dependent variable) and level of PE or RDPA. High levels of physical activity (PE or RDPA) were associated with higher consumption of juice, water, milk, dairy products, fruits, and vegetables among both boys and girls, and among boys with a higher intake of bread, potatoes/pasta/rice, meat, and cereals. Higher PE levels were also less likely to be associated with a high soft drink intake. High levels of RDPA were associated with high intake of energy-dense foods among boys, which was not observed for PE. This study indicates that school-aged children and adolescents with higher levels of physical activity consume more beneficial foods and beverages compared to those with lower physical activity levels.

Health inequalities among children and adolescents in Germany. Developments over time and trends from the KiGGS study.

This study examines the extent to which health inequalities among children and adolescents in Germany have developed over the past decade. The analyses are based on data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which are representative of the 0- to 17-year-old population in Germany. The KiGGS data were collected in three waves: the KiGGS baseline study (2003-2006), KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). Prevalences of five health outcomes are considered: general health, mental health problems, physical activity, the consumption of sugary soft drinks, and smoking. Moreover, it defines health inequalities in relation to differences in the socioeconomic status of the family (SES), an index derived from the parents' level of education, occupation and income, and considers both absolute and relative health inequalities. In order to do so, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated using linear probability or log-binomial models. Significant inequalities were identified to the detriment of young people from families with a low SES. These inequalities were particularly pronounced in the KiGGS Wave 2 data with regard to general health and the consumption of sugary soft drinks. Additionally, evidence from trend analyses for these two outcomes suggests that relative inequalities have increased. However, absolute inequalities decreased during the same period, and this also applies to smoking. The persistently high and, in some cases, widened levels of health inequalities indicate that adolescents from families with a low SES do not benefit to the same extent from disease prevention and health promotion measures for children and adolescents as young people from families with a higher SES.

Educational differences in the prevalence of behavioural risk factors in Germany and the EU - Results from the European Health Interview Survey (EHIS) 2.

This article examines educational differences in the prevalence of behavioural risk factors among adults and compares the results for Germany with the average from the European Union (EU). Data were derived from the second wave of the European Health Interview Survey, which took place between 2013 and 2015 (EHIS 2). Analyses were conducted using a regression-based calculation of relative and absolute educational differences in the prevalence of behavioural risk factors, based on self-reported data from women and men aged between 25 and 69 (n=217,215). Current smoking, obesity, physical activity lasting less than 150 minutes per week, heavy episodic drinking and non-daily fruit or vegetable intake are more prevalent among people with a low education level than those with a high education level. This applies to Germany as well as the EU average. Overall, the relative educational differences identified for these risk factors place Germany in the mid-range compared to the EU average. However, relative educational differences in current smoking and heavy episodic drinking are more manifest among women in Germany than the EU average, with the same applying to low physical activity among men. In contrast, relative educational differences in non-daily fruit or vegetable intake are less pronounced among women and men in Germany than the average across the EU. Increased efforts are needed in various policy fields to improve the structural conditions underlying health behaviour, particularly for socially disadvantaged groups, and increase health equity.

European Health Interview Survey (EHIS) 2 - Background and study methodology.

The scientific assessment of health issues, the design and further development of political guidelines as well as the targeted planning of measures in the European Union (EU) require data on population health. For this reason, all EU Member States regularly collect data on the health status, provision of healthcare, health determinants and socioeconomic situation of their respective populations in the European Health Interview Survey (EHIS). Participants are at least 15 years old and live in private households. The second wave of EHIS (EHIS 2) was conducted between 2013 and 2015. For EHIS 2, each EU Member State drew a nationally representative population sample from population registers, censuses, dwelling registers or other statistical or administrative sources. Data collection modes within individual EU Member States were used, according to nationally established methods, including the use of mixed-mode surveys. Across all EU Member States, data collection took an average of eight months to complete. Member States made considerable efforts to achieve the highest possible response rates. The harmonised EHIS data collected are highly comparable and constitute an important information base for European health policy and health reporting.

Socioeconomic Correlates and Determinants of Cardiorespiratory Fitness in the General Adult Population: a Systematic Review and Meta-Analysis.

BACKGROUND: This review aims to (1) consolidate evidence regarding the association between socioeconomic status (SES) and cardiorespiratory fitness (CRF), (2) conduct a meta-analysis of the association between SES and CRF using methodologically comparable data, stratified by sex, and (3) test whether the association varies after adjustment for physical activity (PA). METHODS: A systematic review of studies from MEDLINE, EMBASE, Latin American and Caribbean Health Sciences (LILACS), Scientific Electronic Library Online (ScIELO), and Cochrane Library without time or language restrictions, which investigated associations between SES and CRF. Risk of bias within studies was assessed using a customized quality assessment tool. Results were summarized in table format and methodologically similar studies were synthesized using meta-analysis of Hedges' g effect sizes. Synthesized results were appraised for cross-study bias. Results were tested for the impact of PA adjustment using meta-regression. RESULTS: Compared to individuals with low education, both men and women showed higher CRF among individuals with high education (men 0.12 [0.04-0.20], women 0.19 [0.02-0.36]), while participants with medium education showed no significant difference in CRF (men 0.03 [- 0.04-0.11], women 0.09 [- 0.03-0.21]). Adjustment for PA did not significantly impact the association between education and CRF. CONCLUSIONS: There is fair evidence for an association between high levels of education and increased CRF. This could have implications for monitoring, of health target compliance and of chronic disease risk among higher risk populations, to detect and prevent non-communicable diseases (NCDs) and to diminish social health inequalities. TRIAL REGISTRATION: PROSPERO, CRD42017055456.

Predictors of physical activity among older adults in Germany: a nationwide cohort study.

OBJECTIVES: To investigate individual, interpersonal and environmental baseline factors predicting regular aerobic physical activity (PA) participation among older adults in Germany at follow-up 12 years later. DESIGN: Population-based cohort study. SETTING: Cluster-randomised general population sample selected based on population registry address information from 130 nationally distributed sample points collected from 1997 to 1999 and re-evaluated 12 years later from 2008 to 2011. PARTICIPANTS: 1184 adults, aged 65 years or older at follow-up with complete data at baseline and follow-up, were included in the final study sample. OUTCOME MEASURE: Regular 'aerobic PA ≥1 day/week' assessed based on self-reported information. RESULTS: At follow-up, 53.2% of the participants engaged in aerobic PA ≥1 day/week. Participants aged 50 to 60 years at baseline were more likely to engage in aerobic PA ≥1 day/week than participants aged 61 to 78 years; OR 1.88, 95% CI 1.46 to 2.40. Participants with middle and high socioeconomic status (SES) were more likely to engage in aerobic PA ≥1 day/week than participants with low SES; OR middle SES 2.08, 1.33 to 3.25; high SES 3.44, 2.11 to 5.60. Participants with high social support were more likely to engage in aerobic PA ≥1 day/week at follow-up than participants with low social support; OR 1.98, 1.26 to 3.12. Furthermore, participants who engaged in leisure time PA at least once per week at baseline were more likely to engage in aerobic PA ≥1 day/week at follow-up than those who engaged less than once per week; OR 1.95, 1.46 to 2.60. CONCLUSIONS: Several influencing factors assessed at baseline predicted regular aerobic PA participation 12 years later. These factors should be considered when planning interventions to prevent physical inactivity in older adults. There is great potential to increase aerobic PA participation in older adults in Germany, in particular among those with low SES and low social support.

Physical exercise and cognitive function across the life span: Results of a nationwide population-based study.

OBJECTIVES: To examine cross-sectional and longitudinal associations between physical exercise and cognitive function across different age groups in a nationwide population-based sample of adults aged 18-79 years in Germany. DESIGN: Cross-sectional/prospective. METHODS: Cognitive function was assessed in the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, n=3535), using a comprehensive neuropsychological test battery. Cognitive domain scores for executive function and memory were derived from confirmatory factor analysis. Regular physical exercise in the last three months was assessed by self-report and defined as no exercise, <2 and ≥2h (hours) of exercise per week. A subgroup of DEGS1-MH participants who previously participated in the German National Health Interview and Examination Survey 1998 (GNHIES98, 1997-1999, n=1624) enabled longitudinal analyses with a mean follow-up of 12.4 years. RESULTS: Compared to no exercise, more weekly physical exercise was associated with better executive function in cross-sectional (<2h: ß=0.12; ≥2h: ß=0.17; all p<0.001) and longitudinal analyses (<2h: ß=0.14, p<0.001; ≥2h: ß=0.15, p=0.001) using linear regression models adjusted for age, sex, education, smoking, alcohol consumption, fruit and vegetable consumption and obesity. Slightly weaker associations were found for memory in cross-sectional (<2h: ß=0.08, p=0.009; ≥2h: ß=0.08, p=0.026) and longitudinal analysis (<2h: ß=0.09, p=0.036; ≥2h: ß=0.08, p=0.114). There was no evidence of interaction between physical exercise and age. CONCLUSIONS: Higher levels of physical exercise were associated with better executive function and memory in cross-sectional and longitudinal analyses with no evidence for differential effects by age.

Alcohol consumption and cardiorespiratory fitness in five population-based studies.

Background Poor cardiorespiratory fitness is a risk factor for cardiovascular morbidity. Alcohol consumption contributes substantially to the burden of disease, but its association with cardiorespiratory fitness is not well described. We examined associations between average alcohol consumption, heavy episodic drinking and cardiorespiratory fitness. Design The design of this study was as a cross-sectional population-based random sample. Methods We analysed data from five independent population-based studies (Study of Health in Pomerania (2008-2012); German Health Interview and Examination Survey (2008-2011); US National Health and Nutrition Examination Survey (NHANES) 1999-2000; NHANES 2001-2002; NHANES 2003-2004) including 7358 men and women aged 20-85 years, free of lung disease or asthma. Cardiorespiratory fitness, quantified by peak oxygen uptake, was assessed using exercise testing. Information regarding average alcohol consumption (ethanol in grams per day (g/d)) and heavy episodic drinking (5+ or 6+ drinks/occasion) was obtained from self-reports. Fractional polynomial regression models were used to determine the best-fitting dose-response relationship. Results Average alcohol consumption displayed an inverted U-type relation with peak oxygen uptake ( p-value<0.0001), after adjustment for age, sex, education, smoking and physical activity. Compared to individuals consuming 10 g/d (moderate consumption), current abstainers and individuals consuming 50 and 60 g/d had significantly lower peak oxygen uptake values (ml/kg/min) (ß coefficients = -1.90, ß = -0.06, ß = -0.31, respectively). Heavy episodic drinking was not associated with peak oxygen uptake. Conclusions Across multiple adult population-based samples, moderate drinkers displayed better fitness than current abstainers and individuals with higher average alcohol consumption.

Trends in Absolute and Relative Educational Inequalities in Adult Smoking Since the Early 2000s: The Case of Germany.

Introduction: Since the early 2000s, several tobacco control policies have been implemented in Germany. Current research is inconsistent about how strengthening tobacco control can affect social inequalities in smoking. This study examines whether educational inequalities in adult smoking have widened in Germany since 2003. Methods: Data were used from four cross-sectional national health surveys conducted between 2003 and 2012 (n = 54,197; age = 25-69 years). Participants who smoked daily or occasionally were classified as smokers. The regression-based Slope Index of Inequality and Relative Index of Inequality (RII) were calculated to estimate the extent of absolute and relative educational inequalities in smoking, respectively. Results: In each survey year, smoking was associated with lower education. Overall, crude and age-standardized smoking rates declined over time. Stratified by education, trends of declining smoking rates were observed only in the high and medium education groups, whereas no statistically significant trend was found in the low education group. Relative educational inequalities in smoking increased significantly in men (2003: RII=1.74, 95% confidence interval 1.46 to 2.07; 2012: RII = 2.25, 95% confidence interval 1.90 to 2.67; p-trend = .019). Absolute educational inequalities in smoking were not found to have changed significantly during the study period. Conclusions: In the course of declining smoking rates, educational inequalities in smoking persisted in both absolute and relative terms. In men, relative inequalities in smoking may even have widened within only 9 years. Tobacco control policies should not only be targeted at the entire population but also attempt to reduce social inequalities in smoking by focusing more on socially disadvantaged groups. Implications: Smoking is associated with lower education in most European countries and contributes to social inequalities in health. Since the beginning of the 2000s, Germany has implemented a variety of tobacco control policies to reduce smoking in the population. This study reveals that despite a general decline in adult smoking, educational inequalities in smoking have persisted and even widened in Germany since 2003. The findings emphasize that more targeted efforts are needed to tackle smoking-induced inequalities in health.

Physical activity among children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

Self-reported data from wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) provides the basis for assessing whether the levels of physical activity of children and adolescents in Germany meet the levels recommended by the World Health Organization (WHO). Merely 22.4% of girls and 29.4% of boys in the 3-17 age group are physically active for at least 60 minutes per day and therefore meet the WHO recommendations. Prevalence of recommended levels of physical activity decreases continuously with age, both for girls and boys. In KiGGS Wave 2, girls in the 3-10 age group met the levels of physical activity recommended by the World Health Organization significantly less often than in KiGGS Wave 1. Low levels of physical activity were highest amongst adolescent age girls, as well as among boys and girls of low socioeconomic status. The results indicate a great potential to promote physical activity.

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.

Socioeconomic differences in the health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study.

Childhood and adolescence are key determining stages for health behaviour in the life course. Frequently, health-related attitudes and patterns of behaviour that develop at young age are also maintained at adult age. As studies show, already during childhood and adolescence, patterns of health risk behaviour are more common in certain population groups. KiGGS Wave 2 results confirm that 3- to 17-year-old children and adolescents from families with low socioeconomic status (SES) eat a less healthy diet, do fewer sports and are more often overweight or obese than their peers from more affluent backgrounds. Whereas socioeconomic differences appear to have little effect on levels of alcohol consumption among 11- to 17 year-olds, girls and boys with low SES smoke more frequently than their peers with high SES. Prevention and health promotion encourage children and adolescents to adopt healthy lifestyles, and aim to drive structural changes to stimulate behaviour which promotes good health. Combining measures that target individual behaviour and a settings-based approach appears to be the most promising preventative approach to reduce health inequalities among young people. Due to the clear impacts of socioeconomic differences on health behaviour already at young age measures for disadvantaged children and adolescents and their living conditions should be given an even stronger focus in the future.