The German National Cohort Wichmann, H-E; Kaaks, R; Hoffmann, W ...
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
55, Številka:
6-7
Journal Article
Recenzirano
The German National Cohort (GNC) is a joint interdisciplinary endeavour of scientists from the Helmholtz Association, universities and other German research institutes. Its aim is to investigate the ...development of major chronic diseases (cardiovascular diseases, cancer, diabetes, neurodegenerative psychiatric diseases, pulmonary and infectious diseases), the subclinical stages and functional changes. In 18 study centres across Germany, a representative sample of the general population will be drawn to recruit in total 200,000 men and women aged 20-69 years. In addition to interviews and questionnaires, the baseline assessment includes a series of medical examinations and the collection of a diverse range of biomaterials. In 20% of the participants, an intensified assessment programme is foreseen. Also in 40,000 participants, magnetic resonance imaging of the whole body, heart and brain will be performed. After 5 years, a follow-up examination will be performed in all subjects and active follow-up by postal questionnaires is planned every 2-3 years. The GNC will provide an excellent basis for future population-based epidemiology in Germany and results will help identify new and tailored strategies for prevention, prediction and early detection of major diseases.
Die Nationale Kohorte Wichmann, H.-E.; Kaaks, R.; Hoffmann, W. ...
Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz,
06/2012, Letnik:
55, Številka:
6-7
Journal Article
Recenzirano
Odprti dostop
Zusammenfassung
Die Nationale Kohorte (NK) ist ein gemeinsames interdisziplinäres Vorhaben von Wissenschaftlern aus der Helmholtz-Gemeinschaft, den Universitäten und anderen Forschungsinstituten in ...Deutschland. Ihr Ziel ist es, die Entstehung der wichtigsten chronischen Krankheiten (Krankheiten des Herz-Kreislauf-Systems und der Lunge, Diabetes, Krebs, neurodegenerative/-psychiatrische und Infektionskrankheiten), ihre subklinischen Vorstufen und auftretende funktionelle Veränderungen zu untersuchen. Die NK soll 200.000 Männer und Frauen im Alter von 20–69 Jahren umfassen, die in 18 Studienzentren aus einer repräsentativen Stichprobe der Bevölkerung ausgewählt werden. Zusätzlich zu Interviews und Fragebogenerhebungen werden eine Reihe medizinischer Untersuchungen durchgeführt und verschiedene Bioproben gesammelt. Bei 20% der Personen wird ein noch ausführlicheres Programm eingesetzt. Ferner werden etwa 40.000 Probanden eine Untersuchung mittels Magnetresonanztomographie (MRT) erhalten. Nach fünf Jahren werden alle Teilnehmer nochmals untersucht. Postalische Nachbefragungen zur Gesundheitssituation werden alle zwei bis drei Jahre erfolgen. Mit der NK wird eine herausragende Basis für die zukünftige epidemiologische Forschung in Deutschland geschaffen. Ihre Ergebnisse werden neue Möglichkeiten zur Prävention, Vorhersage und Früherkennung der wichtigsten Volkskrankheiten eröffnen.
Abstract Background and aims Higher ventricular mass has been reported in non-white US-Americans with low educational status and in socially isolated people. To assess the impact of education on ...cardiac mass and function in the general population and to identify mediators. Methods and results Data from a German population-based sample were used (CARLA cohort, n = 1779 at baseline, n = 1436 at the four-year follow-up). Ventricular mass indexed on height (LVMI) and ejection fraction, using Teichholz's formula (EFTZ), were measured. Education was assessed using the ISCED classification. Mediator analyses were performed using the R-macro ‘mediation’ to compute the average direct effect and the average causal mediated effect after confounder adjustment. Sensitivity analyses for unobserved confounders were performed. Considered mediators were BMI, waist-to-hip ratio, HbA1c, and systolic and diastolic blood pressures. We found differences in LVMI and EFTZ, both at baseline and follow-up, between educational levels in women (lowest vs highest educational level: 15.6 g, 95% CI: −25.7, −5.6), but not in men. Similarly, women (lowest vs highest educational level at baseline: 3.3%, 95% CI: 0.8–5.7), but not men, of higher educational levels had a higher EFTZ of comparable magnitude at baseline and follow-up. Of the considered mediators, BMI explained 55.9% at baseline and 54.1% at follow-up of the educational effect, while other potential mediators had no significant effect. Relations remained constant between baseline and follow-up. Conclusions Women with low educational levels tend to have a higher ventricular mass and lower EF, which can be explained by a higher BMI in this group.
In 2011, almost 20.0% of the population of Germany had a migration background. Studies on their health tend to have low participation rates. The aim of our study was to compare different sampling ...strategies and to test different approaches to recruit migrants for an epidemiological study.
Four recruitment centres of the German National Cohort recruited persons of Turkish origin and ethnic German immigrants from former Soviet Union countries. A register-based (random samples from residents' registration offices) and a community-orientated strategy were applied. Participants underwent a medical examination and self-completed a questionnaire.
Used approaches: The community-orientated strategies comprised the acquisition of key persons from migrant networks to support the recruitment, invitation talks and distribution of study materials in migrant settings, etc. The identifying variables in the registry data were name, nationality or country of birth. All but one centres used bilingual study material and study staff.
When comparing the two strategies, the register-based participation rates ranged from 10.1 to 21.0% (n = 668 participants) and the community-oriented recruitment resulted in 722 participants.
Register-based recruitment should use a combination of name, nationality and country of birth in order not to be limited to identifying persons with a foreign nationality. However, according to the study staff, the community-oriented approach involving key persons of the same cultural background leads to a better acceptance by the participants. Also, it covers a more heterogeneous group. Yet, it is time-consuming and needs considerably more staff. Further research should establish the effectiveness of a combination of both strategies.
Abstract
The German National Cohort (NAKO) is the largest population-based cohort study in Germany and provides a central resource for epidemiologic research. NAKO aims to investigate the development ...and aetiology of diseases, and to identify risk factors and enhance early detection and prevention of diseases with a focus on diabetes, cancer, cardiovascular, pulmonary, neurological, psychiatric, and infectious diseases. Between 2014 and 2019, overall 205,415 participants aged 20-74 years were recruited and examined at 18 study centres across Germany. During their visit to the study centre, they participated in an extensive examination programme including a face-to-face interview, self-administered, computer-based questionnaires, broad biomedical examinations (e.g., blood pressure, electrocardiograms, oral glucose tolerance tests) and provision of bio-samples (blood, urine, stool, saliva, nasal swabs). In addition, a subgroup of 30,861 participants received whole-body Magnet Resonance Imaging (MRI) with a focus on brain, heart, the musculoskeletal system, and body fat distribution. All study participants are re-invited for examinations at the study centres at 4-5 year intervals. The programme of the first re-examination is similar to the baseline programme in order to detect changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function. By 31.03.23, 100,822 participants were re-examined, including 14,950 with MRI re-examination. A third examination will start in 2024. Data collection is standardized, and central quality control and data cleaning is performed. For more complex data (e.g., echocardiography, accelerometry), competence units process the data and derive variables on exposure, functions, and disease. Due to its large sample size, the in-depth examination programme and the longitudinal design, NAKO provides an excellent source for better understanding of determinants for health and disease at the population level.
A reduced heart rate variability (HRV) is a marker of autonomic dysfunction and has been shown to be associated with an increased risk of cardiovascular morbidity and mortality. However, especially ...regarding the association of HRV with cardiovascular risk factors the literature is rather inconsistent. We therefore critically discuss the review of Thayer et al. concerning the relationship between autonomic imbalance, heart rate variability and cardiovascular disease risk factors.
Objectives: We examined which occupations and industries are currently at high risk for bladder cancer in men. Methods: We combined data from 11 case-control studies conducted between 1976-1996 in ...six European countries. The study comprised 3346 incident cases and 6840 controls, aged 30-79 years. Lifetime occupational and smoking histories were examined using common coding. Results: Odds ratios for eight a priori defined high-risk occupations were low, and with the exception of metal workers and machinists (OR = 1.16, 95% CI = 1.02-1.32), were not statistically significant. Higher risks were observed for specific categories of painters, metal, textile and electrical workers, for miners, transport operators, excavating-machine operators, and also for non-industrial workers such as concierges and janitors. Industries entailing a high risk included salt mining, manufacture of carpets, paints, plastics and industrial chemicals. An increased risk was found for exposure to PAHs (OR for highest exposure tertile = 1.23, 95% CI = 1.07-1.4). The risk attributable to occupation ranged from 4.2 to 7.4%, with an estimated 4.3% for exposure to PAHs. Conclusions: Metal workers, machinists, transport equipment operators and miners are among the major occupations contributing to occupational bladder cancer in men in Western Europe. In this population one in 10 to one in 20 cancers of the bladder can be attributed to occupation.
The presentation aims to give an overview of design, methods and first results of the German National Cohort (NAKO), the largest cohort study in Germany. NAKO is a multidisciplinary, population-based ...cohort study that provides a central resource for population-based epidemiologic research. NAKO aims to investigate the development and aetiology of diseases, identify risk factors and enhance early detection and prevention of diseases with a focus on diabetes, cancer, cardiovascular, pulmonary, neuropsychiatric and infectious diseases. Between 2014 and 2019, a total of 205,415 persons aged 20 - 74 years were recruited and examined at 18 study centres across Germany. The participants were invited to their local study centre to participate in a face-to-face interview, complete self-administered computer-based questionnaires, undergo a battery of biomedical examinations, and provide various biosamples. In addition, whole-body Magnet Resonance Imaging (MRI) was performed in 30,861 participants on dedicated 3 Tesla MRI scanners at 5 study centres. In 4-5 year intervals, all study participants are re-invited for examinations at the study centres. The programme for the first re-examination (including MRI scanning) was similar to the baseline programme. Thereby, longitudinal information on changes in risk factor profiles and in vascular, cardiac, metabolic, neurocognitive, pulmonary and sensory function is collected. During the COVID-19 pandemic, questions on pandemic-related aspects including the history of infection, severity and long-term health impacts of COVID-19 were added to the examination programme. Since October 2018, 77,896 participants have been re-examined, including 11,382 with additional MRI examination. A supplemental COVID-19 questionnaire was completed by 161,849 participants of NAKO during the first COVID-19-related lockdown in Spring 2020.
Summary
This study aimed to assess the mediating role of anthropometric parameters in the relation of education and inflammation in the elderly. Cross‐sectional data from the population‐based ...CARdio‐vascular Disease, Living and Ageing in Halle study were used after excluding subjects with a plasma level of high‐sensitive C‐reactive protein (hsCRP) above 10 mg L−1 (916 men/760 women remaining). Education was categorized in accordance with International Standard Classification of Education. As inflammation parameters, the soluble tumour necrosis factor type 1 (sTNF‐R1), hsCRP and interleukin 6 (IL‐6) were taken into account. Anthropometric parameters were the body mass index (BMI), waist‐to‐hip ratio (WHR) and waist‐to‐height ratio (WHeR). We used covariate adjusted mixed models to assess associations. Effect measures were the natural indirect effect (NIE), controlled direct effect and total effect (TE). Education was associated with sTNF‐R1, hsCRP and IL‐6 in men, and sTNF‐R1 and hsCRP in women. Anthropometric parameters correlated with all inflammation parameters after covariate adjustment. BMI and WHeR were strong mediators of educational differences in sTNF‐R1 (percentage of NIE of TE: 28% in men; 33% in women) and hsCRP (percentage of NIE of TE: 35% in men; 52% in women), while WHR was the weakest mediator. General obesity mediates roughly one‐third of the association of education with chronic inflammation in the elderly.
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