The prevention indicator system of the German Federal States – a tool to monitor prevention policies

 

In 2015 the German Prevention Act was implemented. The National Prevention Conference published the first National Prevention Report in 2019 to evaluate the health promotion activities. The second National Prevention Report is planned for 2023. Development of a harmonized prevention reporting system for the German Federal States is needed to form the basis for the contribution of the Federal States to the next National Prevention Report. A working group mandated from the sub-national health authorities has developed a harmonized prevention reporting system for the German Federal States since 2018. The Robert Koch Institute collaborated as representative of the national level during the process. Subject areas for indicators were selected based on a survey in which all 16 State Ministries of Health participated. Indicator subgroups developed indicators for each subject area based on predefined indicator selection criteria. Final set of indicators was adopted by indicator rating and majority voting process. The German Health Ministers Conference acknowledged the indicator system in June 2021. The conceptual framework is adapted from the health determinants model of Dahlgren and Whitehead. The indicator system is divided into 14 subject areas categorized into upstream, midstream and downstream level of prevention indicators. Seventy-three prevention indicators were included as a whole. The indicator short list consists of 32 Core indicators. An overview of the prevention indicator system will be given. First results of a pilot data collection will be shown. Health promotion and prevention reporting tools are needed to monitor prevention policies and evaluate health promotion measures. The prevention indicator system of the German Federal States will be used for the National Prevention Strategy in Germany of which one component is the next National Prevention Report 2023.

Key messages

• The prevention indicator system of the German Federal States is a useful tool to monitor prevention policies.

• The indicator system will form the basis for the German Federal States’ contribution to the National Prevention Report 2023.

Comprehensive assessment of food and nutrient intake of children and adolescents in Germany: EsKiMo II - the eating study as a KiGGS module

Background

As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6–17 years living in Germany is assessed in EsKiMo II – the Eating Study as a KiGGS Module.

Methods

EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6–11 years. Dietary intake for adolescents aged 12–17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02).

Discussion

EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.

Temporal changes in the prevalence of diagnosed diabetes, undiagnosed diabetes and prediabetes: findings from the German Health Interview and Examination Surveys in 1997-1999 and 2008-2011

AIMS

Nationally representative data on temporal changes in the prevalence of diagnosed diabetes, as well as undiagnosed diabetes and prediabetes, have been lacking in Germany as in most other European countries. We aimed to fill this gap using data from nationwide examination surveys of German adults.

METHODS

The study population comprised 18-79-year-old participants from the German Health Interview and Examination Surveys in 1997-1999 (GNHIES98, n = 6655) and 2008-2011 (DEGS1, n = 7017). Participants were classified as having diagnosed diabetes based on self-reported physician-diagnosed diabetes or the use of anti-diabetes agents. Among those without diagnosed diabetes, HbA1c measures were used to define undiagnosed diabetes [≥ 48 mmol/mol (≥ 6.5%)] or prediabetes [39-47 mmol/mol (5.7-6.4%)].

RESULTS

Although the age- and sex-standardized prevalence of total diabetes remained stable between 1997-1999 at 9.3% (95% CI 8.3-10.5%) and 2008-2011 at 9.2% (8.3-10.3%), the prevalence of diagnosed diabetes increased from 5.6% (4.9-6.3%) to 7.2% (6.5-8.0%), whereas the prevalence of undiagnosed diabetes decreased from 3.8% (3.1-4.6%) to 2.0% (1.5-2.7%), resulting in a decreased proportion of undiagnosed diabetes (40.9% vs. 21.7%). Over the same period, the prevalence of prediabetes decreased from 27.7% (25.6-29.8%) to 20.8% (18.2-23.7%). Observed temporal changes were not explained by changes in BMI, sport activity and educational level.

CONCLUSIONS

The two nationwide surveys indicate a shift from undiagnosed to diagnosed diabetes. However, the unchanged prevalence of total diabetes and the considerably high proportion of prediabetes strongly call for a continued and concerted effort in diabetes prevention among German adults.

Changes in body weight and obesity status in German adults: results of seven population-based prospective studies

BACKGROUND/OBJECTIVES

The objective of this study was to quantify body weight changes in German adult populations during the past decades.

SUBJECTS/METHODS

Longitudinal analysis of seven cohort studies covering different age ranges between 18 and 83 years. Baseline examinations were between 1994 and 2007 and follow-up durations between 4.0 and 11.9 years. For each study, mean change in body weight per year and 10-year change in body mass index (BMI) classification were analyzed. For the middle age group of 45-64 years, meta-analysis was conducted to obtain an overall estimate for Germany.

RESULTS

Among men weight gain was highest in the youngest participants and decreased with advancing age. Among women weight gain was on a stable high level among those younger than 45 years and decreased at older age. Within 10 years, 30-40% of middle-aged participants with normal baseline weight became pre-obese or obese and 20-25% of those with pre-obesity at baseline became obese, whereas >80% of persons who were obese at baseline remained obese over time. The estimated average weight change in adults aged 45-64 years was 0.25 (95% confidence interval (CI): 0.18-0.33) kg/year among men and 0.24 (0.17-0.30) kg/year among women.

CONCLUSIONS

We could observe a moderate weight gain over the past years in German middle-aged populations of 0.25 kg/year. Obesity prevention needs to be targeted to specific subgroups in the population, especially to younger adults, who seem to be most vulnerable for gaining weight. Obesity intervention needs to be improved, as the majority of obese adults remained obese over time.

[Overweight and obesity in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]

The increase in overweight and obesity is a worldwide health problem. The first wave of the "German Health Interview and Examination Survey for Adults" (DEGS1), conducted from 2008 through 2011, provides current data about overweight and obesity among adults in Germany. Within DEGS1, a representative sample of the 18- to 79-year-old population was interviewed with regard to health relevant issues and physically examined (n = 7,116). From measurements of body height and weight, the body mass index (BMI) was calculated, which was used to define overweight (BMI ≥ 25 kg/m(2)) and obesity (BMI ≥ 30 kg/m(2)). Results are stratified for gender, age group, socioeconomic status and region and compared with results from the German National Health Interview and Examination Survey 1998 (GNHIES98) and the National Examination Surveys 1990/92. According to DEGS1, 67.1% of men and 53.0% of women are overweight. The prevalence of overweight has not changed compared to GNHIES98. The prevalence of obesity, however, has risen substantially, especially among men: in GNHIES98, 18.9% of men and 22.5% of women were obese, in DEGS1, these figures were 23.3% and 23.9%, respectively. The increase in obesity occurred especially among young adults. An English full-text version of this article is available at SpringerLink as supplemental.

[Prevalence of sensitisation to aeraoallergens and food allergens: results of the German Health Interview and Examination Survey for Adults (DEGS1)]

In view of the increasing prevalence of allergies, up-to-date data on the prevalence of allergic sensitisation are of major interest. In the German Health Interview and Examination Survey for Adults (DEGS1) (2008-2011) blood samples from a population-based sample of 7,025 participants aged 18 to 79 years were analysed for specific IgE antibodies against 50 common single allergens and screened for common aeroallergens (SX1) and grass pollen (GX1). In all, 48.6 % of the participants were sensitised to at least one allergen. Overall, men were more frequently sensitised to at least one allergen than women were. Sensitisations to at least one allergen were more common among younger than older participants and among participants with a higher socio-economic status. In all, 33.6 % of the participants were sensitised to common aeroallergens, 25.5  % to food allergens and 22.6 % to wasp or bee venoms. Compared with the German National Health Interview and Examination Survey 1998 (GNHIES98), the prevalence of sensitisation to common aeroallergens increased from 29.8 to 33.6 %.This increase was statistically significant only in women. The results of DEGS1 still showed a high prevalence of allergic sensitisation. An English full-text version of this article is available at SpringerLink as supplemental.

[Social inequities regarding annoyance to noise and road traffic intensity: results of the German Health Interview and Examination Survey for Adults (DEGS1)]

To study the associations of annoyance to noise and exposure to residential traffic with sociodemographic, socioeconomic and regional characteristics as well as housing conditions, a population-based sample of 7,988 adults 18-79 years of age was studied in the German Health Interview and Examination Survey for Adults (DEGS1). Annoyance to noise and exposure to residential traffic were assessed by self-administered questionnaires. A total of 6.3 % of the participants reported a high to very high exposure to residential traffic noise, 3.7 % to neighbourhood noise and 2.1 % to aircraft noise. An excessive exposure to residential traffic was reported by 21.3 % of the participants. A high annoyance to traffic and neighborhood noise was associated with a lower equivalised disposable income and poor housing conditions. Additionally annoyance to neighborhood noise was associated with low socioeconomic and occupational status. A high annoyance to aircraft noise was only associated with a low equivalised disposable income and living in apartment blocks. Exposure to residential traffic was associated with all investigated indicators. At present in Germany environmental exposures are social unequally distributed and may lead to negative health consequences in social disadvantaged groups. An English full-text version of this article is available at SpringerLink as supplemental.

[Determinants of asthma among children and adolescents in Germany. Results of the German Health and Examination Survey for Children and Adolescents (KiGGS)]

In this study, associations between current asthma and possible determinants were studied using data of the German Health Interview and Examination Survey for Children and Adolescents ("Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland," KiGGS). In this nationwide cross-sectional survey, 17,461 subjects aged 0-17 years were examined between 2003 and 2006. Data collection included a medical examination of the child, an interview of the parents, and written questionnaires. Apart from prevalence estimates, multivariate logistic regression analyses were performed. Increasing age and male sex, previous atopic diseases of the child, a positive family history of allergic diseases and low birth weight were significant risk factors of asthma, as were overweight and moldy walls in the residence. Breast feeding was not associated with a reduced risk of asthma. Low age at delivery of the mother and living in rural or provincial regions were shown to be protected. Overall, this study suggests that allergies of the parents and previous atopic disease of the child are the strongest determinants of asthma. However, environmental factors (mold on walls, living in rural and provincial towns) and lifestyle factors could also modify asthma risk.

Physical activity of subjects aged 50-64 years involved in the European Prospective Investigation into Cancer and Nutrition (EPIC)

OBJECTIVE

To describe physical activity of participants in the European Prospective Investigation into Cancer and Nutrition (EPIC).

DESIGN

A cross-sectional analysis of baseline data of a European prospective cohort study.

SUBJECTS

This analysis was restricted to participants in the age group 50-64 years, which was represented in all EPIC centres. It involved 236 386 participants from 25 centres in nine countries. In each EPIC centre, physical activity was assessed by standardised and validated questions. Frequency distribution of type of professional activity and participation in non-professional activities, and age-adjusted means, medians and percentiles of time dedicated to non-professional activities are presented for men and women from each centre.

RESULTS

Professional activity was most frequently classified as sedentary or standing in all centres. There was a wide variation regarding participation in different types of non-professional activities and time dedicated to these activities across EPIC centres. Over 80% of all EPIC participants engaged in walking, while less than 50% of the subjects participated in sport. Total time dedicated to recreational activities was highest among the Dutch participants and lowest among men from Malmö (Sweden) and women from Naples (Italy). In all centres, total time dedicated to recreational activity in the summer was higher than in the winter. Women from southern Europe spent the most time on housekeeping.

CONCLUSIONS

There is a considerable variation of physical activity across EPIC centres. This variation was especially evident for recreational activities in both men and women.

Overweight, obesity and fat distribution in 50- to 64-year-old participants in the European Prospective Investigation into Cancer and Nutrition (EPIC)

OBJECTIVE

To describe anthropometric characteristics of participants of the European Prospective Investigation into Cancer and Nutrition (EPIC).

DESIGN

A cross-sectional analysis of baseline data of a European prospective cohort study.

SUBJECTS

This analysis includes study populations from 25 centres in nine European countries. The British populations comprised both a population-based and a 'health-conscious' group. The analysis was restricted to 83 178 men and 163 851 women aged 50-64 years, this group being represented in all centres.

METHODS

Anthropometric examinations were undertaken by trained observers using standardised methods and included measurements of weight, height, and waist and hip circumferences. In the 'health-conscious' group (UK), anthropometric measures were predicted from self-reports.

RESULTS

Except in the 'health-conscious' group (UK) and in the French centres, mean body mass index (BMI) exceeded 25.0 kg m-2. The prevalence of obesity (BMI> or =30 kg m(-2)) varied from 8% to 40% in men, and from 5% to 53% in women, with high prevalences (>25%) in the centres from Spain, Greece, Ragusa and Naples (Italy) and the lowest prevalences (<10%) in the French centres and the 'health-conscious' group (UK). The prevalence of a large waist circumference or a high waist-to-hip ratio was high in centres from Spain, Greece, Ragusa and Naples (Italy) and among women from centres in Germany and Bilthoven (The Netherlands).

CONCLUSIONS

Anthropometric measures varied considerably within the EPIC population. These data provide a strong base for further investigation of anthropometric measures in relation to the risk of chronic diseases, especially cancer.

Soy product consumption in 10 European countries: the European Prospective Investigation into Cancer and Nutrition (EPIC) study

OBJECTIVE

The aim of this study was to describe the variation of soy product intake in 10 European countries by using a standardised reference dietary method. A subsidiary aim was to characterise the pattern of soy consumption among a sub-group of participants with a habitual health-conscious lifestyle (HHL), i.e. non-meat eaters who are fish eaters, vegetarians and vegans.

DESIGN

A 24-hour dietary recall interview (24-HDR) was conducted among a sample (5-12%) of all cohorts in the European Prospective Investigation into Cancer and Nutrition (EPIC). Study participants totalled 35 955 after exclusion of subjects younger than 35 or older than 74 years of age. Soy products were subdivided into seven sub-groups by similarity. Distribution of consumption and crude and adjusted means of intake were computed per soy product group across countries. Intake of soy products was also investigated among participants with an HHL.

RESULTS

In total, 195 men and 486 women reported consuming soy products in the 24-HDR interview. Although soy product intake was generally low across all countries, the highest intake level was observed in the UK, due to over-sampling of a large number of participants with an HHL. The most frequently consumed soy foods were dairy substitutes in the UK and France and beans and sprouts among mid-European countries. For both genders, the sub-group of soy dairy substitutes was consumed in the highest quantities (1.2 g day-1 for men; 1.9 g day-1 for women). Participants with an HHL differed substantially from others with regard to demographic, anthropometric and nutritional factors. They consumed higher quantities of almost all soy product groups.

CONCLUSIONS

Consumption of soy products is low in centres in Western Europe. Soy dairy substitutes are most frequently consumed. Participants with an HHL form a distinct sub-group with higher consumptions of fruit, vegetables, legumes, cereals and soy products compared with the other participants.

Total fluoride intake and urinary excretion in German children aged 3-6 years

There have only been few investigations comparing total fluoride intake and the fluoride proportion excreted in urine in pre-school children. In addition, the results of available studies are conflicting. Total fluoride intake was assessed in 11 healthy children aged 3-6 years on 2 consecutive days and urinary fluoride excretion was determined. The duplicate-diet approach was used for the assessment of fluoride intake from solid and liquid foods. Fluoride intake from toothbrushing was calculated as the difference between the amount of fluoride in the paste put on the toothbrush and the drinking water (fluoride concentration 0.25 mg/l) used for rinsing vs. the fluoride amounts recovered in the toothpaste spat out and in the rinsing water. Use of fluoridated domestic salt and/or fluoride tablets was recorded. The children's intake of fluoride from food averaged 202.5+/-116.2 microg F/day. They swallowed an average amount of 273.9+/-175.6 microg F/day when brushing their teeth. Daily fluoride ingestion from all sources totalled 930.7+/-391.5 microg or 53.0+/-21.4 microg/kg body weight. On average 51.5% of the fluoride ingested was excreted in urine. The wide interindividual variation makes it necessary to evaluate the urinary excretion rate for fluoride in larger study populations with varied fluoride exposure.

Validity of DISHES 98, a computerised dietary history interview: energy and macronutrient intake

OBJECTIVE

To estimate the relative validity of a computerised dietary history instrument (DISHES 98).

SETTINGS

Munich and Berlin.

SUBJECTS

A total of 148 persons aged 19-59 y recruited from two research centres.

DESIGN

A relative validation study. Energy and macronutrient intakes obtained with DISHES 98 were compared to those assessed with 3-day weighed dietary records and with a 24 h dietary recall.

RESULTS

Intakes of energy, total, saturated and monounsaturated fat, polysaccharides and alcohol were significantly higher and intake of dietary fibre was significantly lower with the 3-day records than with DISHES 98. For intakes of total, animal and vegetable protein, total carbohydrates, mono- and disaccharides and cholesterol the mean difference between DISHES 98 and the 3-day dietary records was less than 5% of the intake with DISHES 98. Pearson's correlation coefficients between DISHES 98 and 3-day records varied from 0.34 for intake of polyunsaturated fat to 0.69 for intake of disaccharides and from 0.27 for polyunsaturated fat to 0.65 for total carbohydrates between DISHES 98 and the 24 h recall. The proportion of participants classified into the same or adjacent quintile of intake varied between 66.9% for polyunsaturated fat and 90.4% for alcohol comparing DISHES 98 and 3-day records and between 60.2% for polyunsaturated fat and 78.4% for total carbohydrates comparing DISHES 98 and 24 h recalls.

CONCLUSION

The observed differences between DISHES 98 and the other methods are in an acceptable range for assessing dietary intake in epidemiologic studies.