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  • 1
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    Framework and baseline examination of the German National Cohort (NAKO)
    Springer Science and Business Media LLC ; 2022
    In:  European Journal of Epidemiology Vol. 37, No. 10 ( 2022-10), p. 1107-1124
    Details
    In: European Journal of Epidemiology, Springer Science and Business Media LLC, Vol. 37, No. 10 ( 2022-10), p. 1107-1124
    Abstract: The German National Cohort (NAKO) is a multidisciplinary, population-based prospective cohort study that aims to investigate the causes of widespread diseases, identify risk factors and improve early detection and prevention of disease. Specifically, NAKO is designed to identify novel and better characterize established risk and protection factors for the development of cardiovascular diseases, cancer, diabetes, neurodegenerative and psychiatric diseases, musculoskeletal diseases, respiratory and infectious diseases in a random sample of the general population. Between 2014 and 2019, a total of 205,415 men and women aged 19–74 years were recruited and examined in 18 study centres in Germany. The baseline assessment included a face-to-face interview, self-administered questionnaires and a wide range of biomedical examinations. Biomaterials were collected from all participants including serum, EDTA plasma, buffy coats, RNA and erythrocytes, urine, saliva, nasal swabs and stool. In 56,971 participants, an intensified examination programme was implemented. Whole-body 3T magnetic resonance imaging was performed in 30,861 participants on dedicated scanners. NAKO collects follow-up information on incident diseases through a combination of active follow-up using self-report via written questionnaires at 2–3 year intervals and passive follow-up via record linkages. All study participants are invited for re-examinations at the study centres in 4–5 year intervals. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. NAKO is a major resource for population-based epidemiology to identify new and tailored strategies for early detection, prediction, prevention and treatment of major diseases for the next 30 years.
    Type of Medium: Online Resource
    ISSN: 0393-2990 , 1573-7284
    URL: Article
    DOI: 10.1007/s10654-022-00890-5
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
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  • 2
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    Socio-demographic and employment-related factors in the German National Cohort (GNC; NAKO Gesundheitsstudie)
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 3 ( 2020-03), p. 267-278
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    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 3 ( 2020-03), p. 267-278
    Abstract: In epidemiologic studies, standardised measurement of socio-demographic and employment-related factors is becoming increasingly important, as variables such as gender, age, education or employment status are factors influencing health and disease risks. Aims The article gives an overview of the scientific background and assessment of socio-demographic factors in the German National Cohort Study. In addition, the distribution of individual characteristics in the cohort as well as relationships with health-related measures are presented by way of example. Material and methods The analysis is based on the data of the first half of the baseline survey ( n  = 101,724). On this basis, we present the distribution of key socio-demographic characteristics and analyse relationships with exemplary selected health indicators (body mass index, self-reported health) to assess the validity of socio-demographic data measurements. Results On average, study participants were 52.0 years old (SD = 12.4). Of the participants, 53.6% were women, 54.3% had high education, 60.1% were married and 72% were employed while 3.4% were unemployed. Well-established correlations between socio-demographic factors and health could be reproduced with the German National Cohort data. For example, low education, old age and unemployment were associated with an increased prevalence of obesity and poor self-reported health. Discussion The German National Cohort provides a comprehensive measurement of socio-demographic characteristics. Combined with a wide range of health data and the longitudinal measurements available in the future, this opens up new opportunities for health science and social epidemiological research in Germany.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03098-8
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 3
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    Lung function in the German National Cohort: methods and initial results
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 3 ( 2020-03), p. 322-331
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 3 ( 2020-03), p. 322-331
    Abstract: A nationwide assessment of the respiratory status on the basis of standardized lung function measurements has so far not been available in Germany. The present work describes the lung function tests in the German National Cohort (GNC) and presents initial results based on the GNC Midterm Baseline Dataset. Material and Methods The assessment of lung function in the GNC comprised spirometry (level 1) and the determination of exhaled nitric oxide (FeNO, level 2). Our quality assurance concept included regular training of lung function test procedures at various GNC sites, interim evaluations of test quality, as well as regular calibration/measurement checks of test equipment. For spirometry, we established a stepwise procedure for offline quality control based on raw flow volume curves. Results In the present dataset ( n  = 101,734), spirometry was available for 86,893 study participants and FeNO was available for 15,228 participants. The average (±SD) FEV 1 Z score (according to GLI 2012) was −0.321 ± 1.047, the FVC Z score was −0.153 ± 0.941, and the FEV 1 /FVC Z score was −0.337 ± 0.901. The difference in FEV 1 /FVC between current smokers and never-smokers increased with age. The average FeNO was 14.2 ÷ 2.0 ppb. Current smoking reduced FeNO levels by 43%, whereas respiratory allergy increased FeNO levels by 16% in nonsmokers. Discussion The results of spirometry and the FeNO measurements are in the expected range with regard to their distributions and correlates. The GNC provides a valuable basis for future investigations of respiratory health and its determinants as well as research into the prevention of respiratory diseases in Germany.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03102-1
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 4
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    Occurrence of bronchial asthma and age at initial asthma diagnosis—first results of the German National Cohort
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 4 ( 2020-04), p. 397-403
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 4 ( 2020-04), p. 397-403
    Abstract: Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA. Material and Methods Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex. Results In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated. Conclusion The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03105-y
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 5
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    Frequencies of musculoskeletal symptoms and disorders in the population-based German National Cohort (GNC)
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 4 ( 2020-04), p. 415-425
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 4 ( 2020-04), p. 415-425
    Abstract: Musculoskeletal diseases and symptoms are very common in the general population. They lead to high healthcare costs and pose a significant burden to the national economy. Objectives Based on data from the population-based German National Cohort (GNC), frequencies of musculoskeletal symptoms and diseases are reported, including back pain, osteoporosis, osteoarthritis, and arthritis. Materials and methods Data were collected from March 2014 to March 2017 in adults aged 20–75 years during the first half of the baseline survey of the GNC. The sample comprised 101,779 interviewed subjects, including 9370 subjects who underwent clinical musculoskeletal examinations. The interview included questions about specific musculoskeletal disorders. A clinical examination of the hand provided information about palpable swollen joints and pressure-sensitive joints. Resting pain of the knees and hips was also assessed by a clinical examination. Frequencies were standardized to the German standard population of the year 2011. Results Having ever been diagnosed with recurrent back pain (22.5%) or osteoarthritis (20.6%) were the most common complaints reported in the interview; osteoporosis (2.9%) and rheumatoid arthritis (1.9%) were stated more seldom. According to the hand examination, 6.0% of all participants experienced pain in at least one finger joint. Resting pain was present in at least one knee among 8.2% and in at least one hip among 5.1% of the participants as assessed during the clinical examination. Women were more likely to report musculoskeletal disorders and symptoms than men. The proportion of adults affected by musculoskeletal diseases increased strongly with age. Conclusion Musculoskeletal disorders and symptoms occur frequently. The burden of complaints and diagnoses is comparable to previous population-based surveys.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03110-1
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 6
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    Measuring physical fitness in the German National Cohort—methods, quality assurance, and first descriptive results
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 3 ( 2020-03), p. 312-321
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 3 ( 2020-03), p. 312-321
    Abstract: Physical fitness is defined as an individual’s ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality. The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort. In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO 2max ) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20–73 years, 47% men). Males showed higher values of physical fitness compared to women (males: GS = 47.8 kg, VO 2max  = 36.4 ml·min −1  · kg −1 ; females: GS = 29.9 kg, VO 2max  = 32.3 ml · min −1  · kg −1 ). GS declined from the age of 50 onwards, whereas VO 2max levels decreased continuously between the age groups of 20–29 and ≥60 years. GS and VO 2max showed a linear positive association after adjustment for body weight (males β = 0.21; females β = 0.35). These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03100-3
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 7
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    Nighttime transportation noise annoyance in Germany: personal and regional differences in the German National Cohort Study
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 3 ( 2020-03), p. 332-343
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 3 ( 2020-03), p. 332-343
    Abstract: Noise annoyance is associated with adverse health-related conditions and reduced wellbeing. Thereby, subjective noise annoyance depends on the objective noise exposure and is modified by personal and regional factors. Objective How many participants of the German National Cohort Study (GNC; NAKO Gesundheitsstudie) were annoyed by transportation noise during nighttime and what factors were associated with noise annoyance? Materials and methods This cross-sectional analysis included 86,080 participants from 18 study centers, examined from 2014 to 2017. We used multinomial logistic regression to investigate associations of personal and regional factors to noise annoyance (slightly/moderately or strongly/extremely annoyed vs. not annoyed) mutually adjusting for all factors in the model. Results Two thirds of participants were not annoyed by transportation noise during nighttime and one in ten reported strong/extreme annoyance with highest percentages for the study centers Berlin-Mitte and Leipzig. The strongest associations were seen for factors related to the individual housing situation like the bedroom being positioned towards a major road (OR of being slightly/moderately annoyed: 4.26 [95% CI: 4.01;4.52]; OR of being strongly/extremely annoyed: 13.36 [95% CI: 12.47;14.32] ) compared to a garden/inner courtyard. Participants aged 40–60 years and those in low- and medium-income groups reported greater noise annoyance compared to younger or older ones and those in the high-income group. Conclusion In this study from Germany, transportation noise annoyance during nighttime varied by personal and regional factors.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03094-y
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 8
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    The baseline assessment of the German National Cohort (NAKO Gesundheitsstudie): participation in the examination modules, quality assurance, and the use of secondary data
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 3 ( 2020-03), p. 254-266
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 3 ( 2020-03), p. 254-266
    Abstract: The German National Cohort (NAKO) is an interdisciplinary health study aimed at elucidating causes for common chronic diseases and detecting their preclinical stages. This article provides an overview of design, methods, participation in the examinations, and their quality assurance based on the midterm baseline dataset (MBD) of the recruitment. Methods More than 200,000 women and men aged 20–69 years derived from random samples of the German general population were recruited in 18 study centers (2014–2019). The data collection comprised physical examinations, standardized interviews and questionnaires, and the collection of biomedical samples for all participants (level 1). At least 20% of all participants received additional in-depth examinations (level 2), and 30,000 received whole-body magnet resonance imaging (MRI). Additional information will be collected through secondary data sources such as medical registries, health insurances, and pension funds. This overview is based on the MBD, which included 101,839 participants, of whom 11,371 received an MRI. Results The mean response proportion was 18%. The participation in the examinations was high with most of the modules performed by over 95%. Among MRI participants, 96% completed all 12 MRI sequences. More than 90% of the participants agreed to the use of complementary secondary and registry data. Discussion Individuals selected for the NAKO were willing to participate in all examinations despite the time-consuming program. The NAKO provides a central resource for population-based epidemiologic research and will contribute to developing innovative strategies for prevention, screening and prediction of chronic diseases.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03093-z
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 9
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    Blood pressure measurement in the NAKO German National Cohort (GNC) – differences in methods, distribution of blood pressure values, and awareness of hypertension compared to other population-based studies in Germany
    Springer Science and Business Media LLC ; 2020
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 63, No. 4 ( 2020-04), p. 452-464
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 63, No. 4 ( 2020-04), p. 452-464
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-020-03109-8
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
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  • 10
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    Loneliness during the first wave of the SARS-CoV-2 pandemic—results of the German National Cohort (NAKO)
    Springer Science and Business Media LLC ; 2021
    In:  Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Vol. 64, No. 9 ( 2021-09), p. 1157-1164
    Details
    In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, Springer Science and Business Media LLC, Vol. 64, No. 9 ( 2021-09), p. 1157-1164
    Abstract: Early during the pandemic and the following protective countermeasures, an interest in the consequences of the enacted restriction of social contacts for the mental health of the population arose. Loneliness describes the perceived quality of one’s own contacts and relationships with other individuals. Several prior studies reported associations of loneliness with different somatic and psychiatric disorders. Aim To analyse the frequency of loneliness and its association with depression and anxiety symptoms in the first wave of the pandemic in Germany in May 2020. Methods The German National Cohort (NAKO) had recruited and examined 205,000 individuals aged 20 to 69 years in 18 study centres across Germany between 2014 and 2019. The follow-up examination was temporarily stopped due to the pandemic between March and July 2020. In this period a COVID-related questionnaire was developed and sent to all participants. We analysed the first 113,928 questionnaires that were sent back within four weeks in May 2020. Loneliness was assessed with the three-item UCLA Loneliness Scale and anxiety and depression symptoms were collected using the PHQ‑9 and GAD‑7 scales from the Patient Health Questionnaire. Results Among the NAKO participants, 31.7% reported to be lonely in May 2020. Women and young adults reported more loneliness than men and older adults. With increasing scores of loneliness, the severity of depression and anxiety symptoms also steadily increased. Individuals who were lonely during the pandemic had already reported higher PHQ‑9 and GAD‑7 scores during the baseline examination on average 2.5 years earlier, compared to those who did not feel lonely. Conclusions Among participants of the German National Cohort, we observed an increase in loneliness during the first wave of the SARS-CoV‑2 pandemic in spring 2020 and a strong relationship of increasing loneliness with decreasing mental health.
    Type of Medium: Online Resource
    ISSN: 1436-9990 , 1437-1588
    URL: Article
    DOI: 10.1007/s00103-021-03393-y
    Language: German
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
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