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.

Health surveillance indicators for diet and physical activity: what is available in European data sets for policy evaluation?

BACKGROUND: Policies targeting diet and physical activity have the potential to improve health and well-being at a population level. However, the impact of these policies in Europe is currently unknown. Based on existing data, as well as on a needs assessment, we derived a catalogue of indicators that can be employed to evaluate such policies. These indicators may also inform the further development and harmonization of surveillance systems. METHODS: Forty EU experts agreed on a list of key indicators and ranked their priority for future surveillance. We mapped these indicators onto variables provided by ongoing European surveillance systems. Using a Likert scale (well matched, somewhat matched, poorly matched, unmatched), we assessed the suitability of these variables as measures for the indicators. RESULTS: Key indicators included behaviour outcome indicators relating to diet (n = 72) and physical activity and sedentary behaviour (n = 67) as well as upstream determinants of these behaviours. It was possible to map 72% of diet indicators and 86% of physical activity and sedentary behaviour indicators onto at least one variable in an ongoing surveillance system. CONCLUSIONS: Current monitoring and surveillance systems focus mainly on measuring 'downstream' indicators, while gaps exist in policy and environmental level data in dimensions such as inequality, funding and resources and governance.

Towards a harmonized European surveillance for dietary and physical activity indicators in young and adult populations.

BACKGROUND: The Policy Evaluation Network proposes a consolidated approach to measure comparable health indicators across European health surveillance systems to evaluate effectiveness of policy action. METHODS: In a stepwise approach, questionnaire items used by the systems for measuring diet and physical activity data to describe health indicators were identified based on their validity, reliability, and suitability to monitor achievement of health recommendations. They were collated to unified questionnaire modules and discussed bilaterally with representatives of these systems to explore barriers and facilitators for implementation. Also, establishment of a methodological competence platform was proposed, in which the surveillance and monitoring systems agree on the priorities and common quality standards for the harmonization process and to coordinate the integration of questionnaire modules into existing systems. RESULTS: In total, seven questionnaire modules were developed, of which two diet and two physical activity modules were proposed for implementation. Each module allows measurement of data reflecting only partial aspects of national and WHO recommendations related to diet and physical activity. Main barriers were the requirements of systems to monitor temporal trends and to minimize costs. Main facilitator for implementation was the systems' use of questionnaire items that were comparable to the unified modules. Representatives agreed to participate in a methodological competence platform. CONCLUSION: We successfully took first steps in the realization of the roadmap towards a harmonization of European surveillance by introducing unified questionnaire modules allowing the collection of comparable health indicators and by initiating the establishment of a competence platform to guide this process.

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.

Time trends of non-alcoholic beverage consumption among adults in Germany, 1990-2011.

BACKGROUND: In Germany, information on trends in non-alcoholic beverage intake over the last decades is sparse. The aim of this analysis is to examine trends in non-alcoholic beverage consumption among adults living in Germany between 1990 and 2011 with special focus on gender, age and education level. METHODS: We used self-reported food frequency questionnaire information from 25 to 69 year old participants of three German National Health Interview and Examination Surveys conducted in 1990-1992 (n = 7466), 1997-1999 (n = 5825) and 2008-2011 (n = 5375) and focused on consumption frequency of fruit juice, soft drinks, water, tea and coffee. Positive answers in the categories "almost daily", "daily" and "daily and more" were categorized as frequent beverage intake. Proportion estimates and 95%-CI were weighted to better reflect the German population using SAS 9.4 survey procedures for complex sample designs. RESULTS: Between 1990-1992 and 2008-2011, the proportion of men and women who reported to frequently drink juice, soft drinks, water or tea has increased from 21.9% (95%-CI: 20.8-23.0%) to 27.2% (25.6-29.0%), 10.0% (9.0-11.1%) to 18.7% (17.3-20.3%), 59.1% (56.8-61.4%) to 87.6% (86.2-88.9%), and 32.2% (30.3-34.2%) to 39.2% (36.9-41.5%), respectively. Frequent consumption of coffee decreased from 80.6% (79.1-82.0%) in 1990-1992 to 74.9% (73.3-76.5%) in 1997-1999 and increased to 81.2% (79.8-82.6%) in 2008-2011. Frequent consumption of juice increased over time among men with middle and high education (17.7% (15.7-19.8%) to 26.4% (23.4-29.6%) and 22.9% (20.2-25.8%) to 32.7% (29.4-36.2%), respectively), whereas a similar increase was only seen among women with low education (19.8% (17.1-22.9%) to 28.4% (22.9-34.7%). Frequent soft drink consumption increased among men in all age and education groups but among women only in the 25 to 34 year age group and in the low education group. Frequent water consumption increased about 20% or more among men and women, in all age and education groups. CONCLUSIONS: The results show changes in non-alcoholic beverage consumption over the past two decades in Germany. Exploring non-alcoholic beverage intake over time is important for the evaluation of consumption patterns with regard to guidelines and to design appropriate prevention measures.

Health-related quality of life in children and adolescents with overweight and obesity: results from the German KIGGS survey.

BACKGROUND: The well-being of persons with overweight and obesity, in particular of children and adolescents, may be impaired. The present study investigates the health-related quality of life (HRQoL) of girls and boys with overweight and obesity living in Germany as compared to those of normal-weight, while taking a selection of relevant determinants of HRQoL into account. METHODS: The sample comprises 1771 children and adolescents aged 11 to 17 years that took part in the cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KIGGS Wave 2, 2014-2017). Sex-and age-specific BMI (kg/m2) percentiles were utilized to classify overweight and obesity. HRQoL was measured with the KIDSCREEN-27 questionnaire, which gathers detailed information about the five dimensions physical and psychological well-being, well-being regarding peers (i.e., social acceptance), parents (i.e., autonomy) and within the school environment. Multiple regression analyses were performed with HRQoL dimensions as outcomes to test for differences between children and adolescents with normal-weight vs. those with overweight and vs. those with obesity, separately for girls and boys. In a next step, age, physical activity, media consumption, social support and self-efficacy were considered as potential confounders in the analyses. RESULTS: 18.7% of the children and adolescents under study were affected by overweight and among them 8.0% by obesity. After adjusting for potential confounders, overweight and obesity were associated with lower physical well-being as compared to normal weight in both sexes (boys with overweight: standardized beta [ß] = -.14, standard error [SE] = .03, p < .001, and obesity: ß = -.16, SE = .03, p < .001; girls with overweight: ß = -.09, SE = .04, p = .011, and obesity: ß = -.11, SE = .03, p = .003). Results moreover suggest lower levels of psychological (ß = -.10, SE = .04, p = .002) and parent-related well-being (ß = -.08, SE = .04, p = .036) of boys with obesity as compared to normal-weight peers. CONCLUSION: HRQoL of German children and adolescents with overweight and obesity is impaired according to physical well-being in general, while psychological and parent-related well-being is particularly affected in boys. Public health approaches should therefore promote children and adolescents with overweight and obesity by improving diverse facets of HRQoL as well as relevant associated factors (i.e., media consumption, self-efficacy) in general and in boys in particular.

Dietary Potential Renal Acid Load Is Positively Associated with Serum Uric Acid and Odds of Hyperuricemia in the German Adult Population.

Background: Initial interventional data indicate that a reduction in dietary acid load (e.g., by an increased consumption of alkalizing fruit and vegetables) can increase renal uric acid excretion and decrease serum uric acid (SUA). Objective: Against this background, we examined the association between dietary potential renal acid load (PRAL) and SUA in a representative population sample. Methods: Cross-sectional analyses were performed in 6894 participants (aged 18-79 y) of the German Health Interview and Examination Survey for Adults (DEGS1). Dietary intake was assessed with a food-frequency questionnaire. Nutritive acid load and the intake of uric acid equivalents (UAEs) were characterized by assigning PRAL and UAE values to reported food consumption. In multiple linear regression models, the associations of PRAL, UAEs, and relevant food groups with SUA were analyzed. Multiple logistic regressions were used to calculate ORs for hyperuricemia comparing lower and upper tertiles of the predictors. Results: After adjustment for relevant confounders, PRAL (P = 0.003), alcohol (P < 0.0001), and UAE (P = 0.03) intakes were positively associated with SUA, whereas the intake of dairy products and fruit and vegetables was inversely associated (both P < 0.0001). Subgroup analyses among participants without interacting medication use confirmed these results. In addition, participants with lower PRAL had lower odds for hyperuricemia (OR: 0.60; 95% CI: 0.43, 0.83). Conclusions: Apart from observing known dietary influences on SUA, we found in this population-based, cross-sectional study in adults that low PRAL may represent a potentially SUA-reducing dietary pattern. This highlights dietary alkalization as a possible nonpharmacologic option to influence elevated SUA concentrations.

How you live is how you feel? Positive associations between different lifestyle factors, cognitive functioning, and health-related quality of life across adulthood.

PURPOSE: Self-reported health-related quality of life (HRQoL) represents one central indicator for the need of prevention or intervention with gaining importance for public health monitoring. As part of this framework, the present study aims to identify potentially supportive factors of HRQoL and to determine age-related differences. METHODS: In a sample of young to older adults (18-79 years; M = 52.71, SD = 16.06) from the German Health Interview and Examination Survey for Adults (DEGS1 subsample, n = 3667, 52% female), we investigated interrelations between individual (e.g., chronic condition), social (e.g., social support), and lifestyle factors (e.g., healthy eating) and executive functioning with the physical composite scale (PCS) and the mental composite scale (MCS) of HRQoL with the help of path analyses. Secondly, we performed multiple regression analyses to determine age interactions. RESULTS: Results suggest direct and indirect paths on PCS, respectively, MCS from various lifestyle factors and executive functioning in addition to individual and social factors with a good model fit (PCS: CD = .63, SRMR = .001; MCS: CD = .64, SRMR = .003). Furthermore, results suggest physical activity and healthy eating to become particularly relevant with advancing age (age group × physical activity on PCS, ß = .09, p < .05; age group × healthy eating on MCS, ß > .50, p < .01). CONCLUSIONS: Several lifestyle factors and executive functioning offer the potential to promote HRQoL in the everyday life of individuals at various ages, independent of individual or social determinants. Public health action might want to foster behavioral multicomponent approaches supporting healthy aging.

Implications of standardization of serum 25-hydroxyvitamin D data for the evaluation of vitamin D status in Germany, including a temporal analysis.

BACKGROUND: Comparability of 25-hydroxyvitamin D (25(OH)D) measurements is hampered by method-related differences in measurement values. International standardization of laboratory assays has been suggested to solve this problem. METHODS: As part of the European Commission-funded project 'Food-based solutions for optimal vitamin D nutrition and health through the life cycle' (ODIN), original measurements of serum 25(OH)D of three German national health surveys conducted between 1998 and 2011 have been standardized retrospectively. In these representative population-based samples including persons aged between 1 and 79 years, the original 25(OH)D values were compared with those after standardization. Mean values and prevalences of vitamin D deficiency, insufficiency, and sufficiency (25(OH)D levels < 30, 30- < 50, and > =50 nmol/l, respectively) were calculated by sex and age groups based on original and standardized 25(OH)D data. RESULTS: In comparison to the original 25(OH)D levels, the standardized levels showed higher means overall and in age- and sex-specific analyses. After standardization, the prevalence of vitamin D deficiency was lower in all surveys while the prevalence of vitamin D sufficiency was higher. Nevertheless, even after standardization ~ 15% of adults and 12.5% of children had serum 25(OH)D levels < 30 nmol/l. Thus, the proportion of deficient vitamin D levels in the German population is still considerable. CONCLUSIONS: The use of standardization of 25(OH)D levels has a substantial impact on estimates of the vitamin D status in Germany. Since clinical diagnostic, therapeutic and public health decision-making require valid and comparable data, standardization and calibration of commercial, clinical and research laboratory assays for 25(OH)D measurement should become common practice. Until then, researchers, health practitioners and policy makers should be aware of the peculiarities of the measurement methods when comparing and interpreting 25(OH)D levels.

Physical health-related quality of life in relation to metabolic health and obesity among men and women in Germany.

BACKGROUND: This study examined sex-specific differences in physical health-related quality of life (HRQoL) across subgroups of metabolic health and obesity. We specifically asked whether (1) obesity is related to lower HRQoL independent of metabolic health status and potential confounders, and (2) whether associations are similar in men and women. METHODS: We used cross-sectional data from the German Health Interview and Examination Survey 2008-11. Physical HRQoL was measured using the Short Form-36 version 2 physical component summary (PCS) score. Based on harmonized ATPIII criteria for the definition of the metabolic health and a body mass index ≥ 30 kg/m2 to define obesity, individuals were classified as metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese (MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Sex-specific analyses including multivariable linear regression analyses were based on PCS as the dependent variable, metabolic health and obesity category as the independent variable with three categories and MHNO as the reference, and age, education, lifestyle and comorbidities as confounders. RESULTS: This study included 6860 participants (3298 men, 3562 women). Compared to MHNO, all other metabolic health and obesity categories had significantly lower PCS in both sexes. As reflected by the beta coefficients [95% confidence interval] from bivariable linear regression models, a significant inverse association with PCS was strongest for MUO (men: -7.0 [-8.2; -5.8]; women: -9.0 [-10.2; -7.9]), intermediate for MUNO (men: -4.2 [-5.3; -3.1]; women: -5.6 [-6.8; -4.4]) and least pronounced for MHO (men: -2.2 [-3.6; -0.8]; women -3.9 [-5.4; -2.5]). Differences in relation to MHNO remained statistically significant for all groups after adjusting for confounders, but decreased in particular for MUNO (men:-1.3 [-2.3; -0.3]; women: -1.5 [-2.7; -0.3]. CONCLUSIONS: Obesity was significantly related to lower physical HRQoL, independent of metabolic health status. Potential confounders including age, educational status, health-related behaviors, and comorbidities explained parts of the inverse relationship. Associations were evident in both sexes and consistently more pronounced among women than men.

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.

Changes in mean serum lipids among adults in Germany: results from National Health Surveys 1997-99 and 2008-11.

BACKGROUND: Monitoring of serum lipid concentrations at the population level is an important public health tool to describe progress in cardiovascular disease risk control and prevention. Using data from two nationally representative health surveys of adults 18-79 years, this study identified changes in mean serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) in relation to changes in potential determinants of serum lipids between 1997-99 and 2008-11 in Germany. METHODS: Sex-specific multivariable linear regression analyses were performed with serum lipids as dependent variables and survey wave as independent variable and adjusted for the following covariables: age, fasting duration, educational status, lifestyle, and use of medication. RESULTS: Mean TC declined between the two survey periods by 13 % (5.97 mmol/l vs. 5.19 mmol/l) among men and by 12 % (6.03 mmol/l vs. 5.30 mmol/l) among women. Geometric mean TG decreased by 14 % (1.66 mmol/l vs. 1.42 mmol/l) among men and by 8 % (1.20 mmol/l vs. 1.10 mmol/l) among women. Mean HDL-C remained unchanged among men (1.29 mmol/l vs. 1.27 mmol/l), but decreased by 5 % among women (1.66 mmol/l vs. 1.58 mmol/l). Sports activity and coffee consumption increased, while smoking and high alcohol consumption decreased only in men. Processed food consumption increased and wholegrain bread consumption decreased in both sexes, and obesity increased among men. The use of lipid-lowering medication, in particular statins nearly doubled over time in both sexes. Among women, hormonal contraceptive use increased and postmenopausal hormone therapy halved over time. The changes in lipid levels between surveys remained significant after adjusting for covariables. CONCLUSION: Serum TC and TG considerably declined over one decade in Germany, which can be partly explained by increased use of lipid-lowering medication and improved lifestyle among men. The decline in serum lipids among women, however, remains unexplained.

Dietary intake and food sources of choline in European populations.

Choline is an important nutrient for humans. Choline intake of the European population was assessed considering the European Food Safety Authority European Comprehensive Food Consumption Database and the United States Department of Agriculture Nutrient Database. Average choline intake ranges were 151-210 mg/d among toddlers (1 to ≤3 years old), 177-304 mg/d among other children (3 to ≤10 years old), 244-373 mg/d among adolescents (10 to ≤18 years old), 291-468 mg/d among adults (18 to ≤65 years old), 284-450 mg/d among elderly people (65 to ≤75 years old) and 269-444 mg/d among very elderly people (≥75 years old). The intakes were higher among males compared with females, mainly due to larger quantities of food consumed per day. In most of the population groups considered, the average choline intake was below the adequate intake (AI) set by the Institute of Medicine in the USA. The main food groups contributing to choline intake were meat, milk, grain, egg and their derived products, composite dishes and fish. The main limitations of this study are related to the absence of choline composition data of foods consumed by the European population and the subsequent assumption made to assess their intake levels. Given the definition of AI, no conclusion on the adequacy of choline intake can be drawn for most European population groups. Such results improve the knowledge on choline intake in Europe that could be further refined by the collection of choline composition data for foods as consumed in Europe.

Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS).

BACKGROUND: The positive association between parental socioeconomic position (PSEP) and health among adolescents may be partly explained by dietary behaviour. We investigated the associations between fruit intake, vegetable intake, energy-dense food intake, the Healthy Nutrition Score for Kids and Youth (HuSKY) and parental education in a nationwide, cluster-randomized sample of adolescents in Germany. METHODS: The German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS) included 17,641 individuals aged 0-17 years and their parents. Complete information on relevant variables was available for 6359 individuals in the 11-17 age group. The associations between nutrition indicators and parental education were analysed separately for boys and girls, using multivariate logistic regression analysis. Odds ratios (ORs) adjusted for age, region, income, occupation, physical activity and weight status related variables, were calculated for the associations between parental education and nutrition indicators. RESULTS: After full adjustment, higher parental education level was associated with lower energy-dense food intake - with an OR of 1.3 (95 % CI 1.0-1.7) for boys with secondary educated parents and 1.8 (1.4-2.3) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.2 (0.9-1.5) and 1.6 (1.2-2.2). Higher parental education was associated with higher fruit intake - with an OR of 1.3 (1.0-1.7) for boys with secondary educated parents and 2.0 (1.5-2.7) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.0 (0.8-1.4) and 1.5 (1.0-2.1). Among boys and girls with tertiary educated parents compared to those with primary educated parents an OR of 1.3 (CI boys: 1.0-1.7, CI girls: 1.0-1.6) was observed for high vegetable intake. Among boys with tertiary educated parents compared to boys with primary educated parents an OR of 1.6 (1.2-2.2) was observed for a high HuSKY; the corresponding OR for girls was 1.5 (1.1-1.9). CONCLUSIONS: A high PSEP is associated with consumption of less energy-dense food, more fruits and vegetables and more favourable overall dietary behaviour. Preferably school-based interventions are needed to promote healthy dietary behaviour among German adolescents and a special effort is needed to reach adolescents from low-PSEP families.

Modifiable cardiovascular risk factors in adults aged 40-79 years in Germany with and without prior coronary heart disease or stroke.

BACKGROUND: Control of modifiable cardiovascular disease (CVD) risk factors has substantially reduced CVD mortality, but risk factor levels in populations may change and need continuous monitoring. This study aims to provide current estimates of the prevalence of these risk factors in Germany according to sex and history of coronary heart disease (CHD) or stroke. METHODS: The analyses were based on data from the German Health Interview and Examination Survey for Adults (DEGS1; age 40-79 years, n = 5101), which is a cross-sectional population-based examination survey. CVD risk factors were defined according to recommendations in the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2012. RESULTS: The mean age was 57 years and 52% were female; 493 participants had prior CHD and 163 participants a prior stroke. The overall prevalence of behavioural risk factors ranged from 17.9% for high risk alcohol consumption to 90% for low vegetable intake. Blood pressure ≥ 140/90 mmHg was found in 21% and 69% had total cholesterol ≥ 5.0 mmol/l. Only 16% met the targets for five behavioural factors combined (smoking, physical activity, fruit intake, alcohol intake and obesity), 13% of those with and 16% of those without CHD or stroke. The prevalences of most behavioural risk factors were higher among men compared to women. CONCLUSIONS: There is a high prevention potential from modifiable cardiovascular risk factors in the general population aged 40-79 years in Germany and among those with prior CHD or stroke. Risk factors are often co-occurring, are interrelated and require combined educational, behavioral, medical and policy approaches.

Vitamin D status among adults in Germany--results from the German Health Interview and Examination Survey for Adults (DEGS1).

BACKGROUND: In 1998, more than half of the adult population in Germany had serum 25-hydroxy-vitamin-D [25(OH)D] levels below the common threshold of 50 nmol/l. Since then, there has been a lot of attention for vitamin D in the scientific community, the media and the general population and serum 25(OH)D levels may have increased as a consequence. With data from the 'German Health Interview and Examination Survey for Adults' (DEGS1) the current situation of vitamin D status can be analysed. METHODS: DEGS1, a national health survey among adults in Germany conducted by the Robert Koch Institute between 2008 and 2011, included 6,995 persons with available serum 25(OH)D levels. We calculated the proportion of participants with serum 25(OH)D levels <30 nmol/l, 30- < 50 nmol/l and > =50 nmol/l overall and according to age, season and latitude of residence as well as percentiles of serum 25(OH)D according to month of examination. Determinants of vitamin D status were analysed with multiple linear regression models. RESULTS: Mean serum 25(OH)D level was 45.6 nmol/l with no significant sex differences (p = 0.47). 61.6% of the participants had serum 25(OH)D levels <50 nmol/l, 30.2% had levels <30 nmol/l. During summer, half of the participants had levels > =50 nmol/l, during winter time, 25% of the participants had levels <30 nmol/l. A significant latitudinal gradient was observed in autumn for men and in winter for women. In multiple linear regression analyses, examination during winter time, residing in northern latitude, non-use of vitamin D supplements, low sport activity, high Body Mass Index (BMI) and high media consumption were independently and significantly associated with lower serum 25(OH)D levels in both sexes. In addition, among women, significant associations with lower 25(OH)D levels were observed for older age and lower socio-economic status, among men, for low vitamin D intake and more residential traffic. CONCLUSIONS: Serum 25(OH)D levels below the threshold of 50 nmol/l are still common among adults in Germany, especially during winter and spring and in higher latitudes. Potentially modifiable factors of poorer vitamin D status are higher BMI, lack of sport activity and high media use.

Healthy behaviours and mental health: findings from the German Health Update (GEDA).

BACKGROUND: Health risk behaviours such as smoking, physical inactivity and poor diet are independently associated with depression. However, there is a paucity of data examining associations between combined healthy behaviours and mental distress and depression. METHODS: Using cross-sectional data from a nationwide population-based sample of adults in Germany [German Health Update (GEDA) 2009 and 2010 telephone surveys; n = 21 940 women, n = 17 061 men], we examined associations between five healthy behaviours and frequent mental distress (FMD) and self-reported diagnosed depression in the past 12 months. Healthy behaviours included non-smoking, low-risk alcohol drinking, regular sport, maintaining normal weight and healthy fruit and vegetable consumption. Multiple logistic regression analyses adjusted for potential confounders examined associations between the combined number of healthy behaviours and FMD and self-reported diagnosed depression. RESULTS: FMD was reported by 13.6 and 8.0% and diagnosed depression in the last 12 months by 8.3 and 4.7% of women and men, respectively. At least four of five assessed healthy behaviours were reported by 29.1% of women and 17.8% of men. Compared with those with less than two healthy behaviours, women and men with at least four behaviours were about half as likely to report FMD [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.44-0.64, and OR 0.52, 95% CI 0.41-0.66, respectively) and women with at least four behaviours were less likely to report diagnosed depression (OR 0.76, 95% CI 0.61-0.95). CONCLUSION: A higher number of healthy behaviours are associated with a lower prevalence of FMD for both women and men and of self-reported diagnosed depression in women.

[Fruit and vegetable consumption by children and adolescents in Germany: Results of KiGGS wave 1]. / Obst- und Gemüsekonsum von Kindern und Jugendlichen in Deutschland : Ergebnisse der KiGGS-Welle 1.

BACKGROUND: A high fruit and vegetable intake contributes to a healthy diet, which is very important for the development of children and adolescents. OBJECTIVES: With data from the first follow-up survey of the Child and Adolescent Health Surveys (KiGGS wave 1) the fruit and vegetable intake and its association with determinants are analyzed. METHODS: Via telephone interviews the average numbers of portions of fruits and vegetables consumed by 9,950 girls and boys aged 3-17 years were assessed. In addition, the proportion of persons achieving five portions of fruits and vegetables per day was calculated. The number of portions was analyzed in association with social status, parent's educational level, media consumption, and other determinants via multiple linear regression models. RESULTS: Only 12.2 % of girls and 9.4 % of boys consume the recommended five portions of fruits and vegetables per day. 38.6 % of girls and 33.5 % of boys consume at least three portions per day. On average, girls consume 2.7 and boys 2.4 portions of fruits and vegetables per day. Younger participants consume significantly more portions of fruits than older participants. The percentage of persons consuming five or at least three portions per day increases significantly with higher socioeconomic status, higher parent's educational level, and lower media consumption. Furthermore, children who conduct sport outside of school, those who are physically active every day, and boys living in central Germany consume significantly more portions of fruit and vegetables. CONCLUSION: Most children and adolescents do not consume enough fruits and particularly vegetables. The consumption differs considerably according to socio-demographic background and lifestyle factors, which should be considered in promotional campaigns.

Physical activity, aerobic fitness and parental socio-economic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS).

BACKGROUND: The positive association between parental socio-economic position (PSEP) and health among adolescents may be partly explained by physical activity behaviour. We investigated the associations between physical activity, aerobic fitness and PSEP in a population based sample of German adolescents. METHODS: 5,251 participants, aged 11-17 years, in the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS) underwent a sub-maximal cycle ergometer test and completed a questionnaire obtaining information on physical activity and media use. The associations between physical activity, media use, aerobic fitness and PSEP were analysed with multivariate logistic regression models for boys and girls separately. Odds ratios (ORs) of PSEP (education, occupation and income) on the outcomes were calculated adjusted for age, region, and other influencing factors. RESULTS: Parental education was more strongly associated with the outcome variables than parental occupation and income. After adjusting for age and region, a higher parental education level was associated with better aerobic fitness - with an OR of 1.5 (95% CI 1.2-1.9) for girls whose parents had secondary education and 1.9 (1.4-2.5) for girls whose parents had tertiary education compared to girls whose parents had primary education. The corresponding ORs for boys were 1.3 (1.0-1.6) and 1.6 (1.2-2.1), respectively. Higher parental education level was associated with lower media use: an OR of 2.1 (1.5-3.0) for girls whose parents had secondary education and 2.7 (1.8-4.1) for girls whose parents had primary education compared to girls whose parents had tertiary education. The corresponding ORs for boys were 1.5 (1.2-1.9) and 1.9 (1.5-2.5), respectively. Higher parental education level was associated with a higher physical activity level only among girls: an OR of 1.3 (1.0-1.6) for girls whose parents had secondary education and 1.2 (0.9-1.5) for girls whose parents had tertiary education compared to girls whose parents had primary education. The corresponding ORs for boys were 0.9 (0.8-1.2) and 0.8 (0.6-1.0), respectively. CONCLUSIONS: Adolescents of parents with low SEP showed a lower level of aerobic fitness and higher levels of media use than adolescents of parents with higher SEP. Health-promotion interventions need to reach adolescents of parents with low PSEP and stimulate physical activity.