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Purpose Iodine deficiency in childhood and adolescence may lead to later thyroid dysfunction, stunted growth and cognitive impairment. The World Health Organization (WHO) has issued recommended age-dependent urine iodine concentration targets, but a critical threshold beyond which clinical sequelae are to be expected remains undefined. Our study aimed to investigate spot urine iodine concentration in a typical Central European cohort of children and adolescents, and consider the implications of these values in regard to laboratory parameters for evaluating thyroid function. Methods Using the Sandell-Kolthoff method, spot urine iodine concentration was measured cross-sectionally from 1802 healthy children and adolescent in the age range of 0.25–18 years within the LIFE-Child epidemiological study based in and around the city of Leipzig (Germany). Additionally, serum thyroid biomarkers of these subjects were measured and correlated to urine iodine levels. Results In our cohort, 61.39% of boys and 65.91% of girls had an iodine level of Conclusion In our cohort of children and adolescents, the relatively high number of iodine levels below the WHO recommendation appears not to be related to clinical or subclinical thyroid diseases in the respective participants.

Purpose Mild-to-moderate iodine deficiency was present in large parts of Germany up to the beginning 1990s and improved from then on. Current epidemiological data on spot urine iodine measurements in German children strongly suggest the re-occurrence of an impaired iodine status. We thus examined whether this re-occurrence is identifiable in more detail, through iodine analyses of 24-h urine samples of a well-characterized cohort of German children in whom samples have been systematically collected from 1985 onward. As iodized salt is a major source for iodine supply, urinary sodium excretion was additionally studied. Methods Daily iodine and sodium excretions were measured in 2600 24-h urine samples collected between 1985 and 2018 by 677 healthy children aged 6–12 years (participants of the DONALD study). These data were compared with 24-h iodine and sodium excretion estimates obtained from spot urine samples collected in the representative German Health Interview and Examination Surveys for Children and Adolescents KiGGS-baseline (2003–2006) and KiGGS-wave-2 (2014–2017). Results Between 1985 and1992, DONALD participants started with a median daily iodine excretion level of 40.1 µg/d. Then, during 1993–2003, iodine excretions mounted up to an approximate plateau (~ 84.8 µg/d). This plateau lasted until 2012. Thereafter, iodine concentrations started to decrease again resulting in a median iodine excretion of only 58.9 µg/d in 2018. Sodium excretion, however, had increased. The marked decrease in iodine status along with an abundant sodium excretion corresponded closely with nationwide KiGGS data. Conclusions As exemplified for the clearly worsening iodine status in German children, longitudinal cohort studies collecting detailed biomarker-based prospective data have the potential to reliably capture health-relevant nutritional changes and trends, applicable on a more comprehensive and even representative population level.

Background: Human Papillomavirus (HPV) vaccination of girls was introduced in Germany in 2007. However, data on the distribution of vaccine-relevant HPV types in the general population in Germany in the prevaccine era are limited. Methods: Serum samples collected during the German National Health Interview and Examination Survey 1998 (GNHIES98), a nationally representative study including men and women aged 18–79 years, were tested for antibodies to 19 mucosal and cutaneous HPV types. Multivariable regression models were developed to identify associations between demographic and behavioral characteristics and HPV seropositivity. Results: Of the 6517 serum samples tested, almost a quarter was seropositive for at least one of the nine HPV vaccine types with no clear age-pattern. HPV-6 and HPV-59 were the most common mucosal types, while HPV-1 and HPV-4 were the most common cutaneous HPV types. Factors independently associated with HPV-16 seroprevalence were seropositive to other sexually transmitted infections and lifetime number of sex partners, as well as urbanity (only among females). Conclusions: Prevalence of naturally acquired antibodies to HPV types which can be prevented by vaccination is high in both sexes and all age groups. These data can serve as baseline estimates to evaluate the population-level impact of the current vaccination strategy. Keywords: Human papillomavirus, Prevalence, Serology, Vaccine, General population, Seroepidemiologic studies, Predictors, Germany

OBJECTIVE The study was undertaken to determine the prevalence of subclinical and overt thyroid dysfunction as well as thyroid autoimmunity in depressed adolescents in comparison to the general pediatric population. Additionally, the relationship between parameters of thyroid function and Beck Depression Inventory-II (BDI-II) scores was examined. METHODS Parameters of thyroid function (thyrotropin, free thyroxine, thyroid peroxidase antibodies) and prevalence of thyroid dysfunction and autoimmunity were determined in 360 adolescents (11-19 years) with at least mild depression (BDI-II score > 13) between June 2016 and December 2019 and in a representative reference cohort without evidence of impaired mental health from a nationwide survey (German Health Interview and Examination Survey for Children and Adolescents [KiGGS], 2003-2006). RESULTS There was a higher prevalence of thyroid peroxidase antibody positivity in depressed adolescents (mean ± SD BDI-II, 30.0 ± 10.4) compared to KiGGS participants (depressed adolescents: 5.8%, 95% CI [3.7-8.6]; odds ratio [OR] 1.9, P = .009, d = 0.36; KiGGS participants: 3.1%, 95% CI [2.5-3.9]). The prevalence of subclinical hypothyroidism was likewise higher in depressed adolescents (9.1%, 95% CI [6.3-12.4] vs KiGGS participants: 2.1%, 95% CI [1.6-2.7]; OR 4.7, P

The relation between thyroid function biomarkers and attention deficit hyperactivity disorder (ADHD) in children and adolescents is currently unclear. Cross-sectional data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Baseline) was analyzed to assess the association between thyroid function biomarkers and ADHD in a population-based, nationally representative sample. The study cohort included 11,588 children and adolescents with 572 and 559 having an ADHD diagnosis or symptoms, respectively. ADHD symptoms were assessed through the Inattention/Hyperactivity subscale of the Strength and Difficulties Questionnaire. ADHD diagnosis was determined by a physician or psychologist. Serum thyroid stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) concentrations were determined enzymatically. Adjusted regression models were used to relate serum TSH, fT3, and fT4 with risk for ADHD diagnosis or symptoms. In children, a 1 mIU/l higher TSH was related to a 10% lower risk (odds ratio [OR] 0.90; 95% confidence interval [CI] 0.81–1.00) of ADHD diagnosis. We found a significant positive association between fT3 and continuously assessed ADHD symptoms in children (β 0.08; 95% CI 0.03–0.14). Our results suggest that physical maturity may influence the association between thyroid function biomarkers and risk for ADHD.

Die transurethrale Blasentumorresektion (TUR-B) wird aus diagnostischen und bei nicht-muskelinvasiven Tumoren aus therapeutischer Indikation durchgefuhrt. Die TUR-B muss bei Tumoren der Seitenwand in Relaxation erfolgen, um einen Obturatoriusreiz mit potentieller Blasenperforation zu vermeiden. Die radikale Zystektomie stellt die Therapie der Wahl bei muskelinvasiven Tumoren dar und umfasst bei der Frau die Entfernung von Harnblase, distalen Ureteren, Uterus, anteriorer Vaginalwand sowie pelvinen Lymhknoten. Beim Mann werden Harnblase, distale Ureteren, Prostata, Samenblaschen und pelvine Lymphknoten entfernt. Die Harnableitung erfolgt als Ureterokutaneostomie, Ileum conduit, kontinenter Poch oder orthotope Ileum Ersatzblase. Hilfreich in der perioperativen Fuhrung ist die Anlage eines periduralen Katheters; intraoperativ ist auf ein exaktes Flussigkeitsmanagement zu achten. Perioperativ sollte ein Fast-Track Schema realisiert werden.

Das vorliegende Kapitel beschreibt die operationstechnischen Besonderheiten der transurethralen Prostataresektion (TUR-P) und der (roboterassistierten) radikalen Prostatektomie. Diese Eingriffe stellen die haufigsten chirurgischen Eingriffe an der Prostata dar. Ursachlich sind sowohl benigne, die benigne Prostatahyperplasie ist die haufigste urologische Diagose, als auch maligne Erkrankungen der Prostata. Die Besonderheiten beider Eingriffe – insbesondere hinsichtlich des anasthesiologischen Vorgehens – werden im folgenden Kapitel ausfuhrlich dargestellt.

Background: Knowledge about the population's iodine status is important, because it allows adjustment of iodine supply and prevention of iodine deficiency. The validity and comparability of iodine-related population studies can be improved by standardization, which was one of the goals of the EUthyroid project. The aim of this study was to establish the first standardized map of iodine status in Europe by using standardized urinary iodine concentration (UIC) data. Materials and Methods: We established a gold-standard laboratory in Helsinki measuring UIC by inductively coupled plasma mass spectrometry. A total of 40 studies from 23 European countries provided 75 urine samples covering the whole range of concentrations. Conversion formulas for UIC derived from the gold-standard values were established by linear regression models and were used to postharmonize the studies by standardizing the UIC data of the individual studies. Results: In comparison with the EUthyroid gold-standard, mean UIC measurements were higher in 11 laboratories and lower in 10 laboratories. The mean differences ranged from −36.6% to 49.5%. Of the 40 postharmonized studies providing data for the standardization, 16 were conducted in schoolchildren, 13 in adults, and 11 in pregnant women. Median standardized UIC was

Allergic diseases are among the most common health issues children and adolescents face. Allergic reactions occur when the immune system becomes allergically sensitised and are detected by measuring levels of specific immunoglobulin E antibodies (IgE antibodies) in the blood. This article discusses the prevalences of bronchial asthma, hay fever, atopic dermatitis and allergic contact dermatitis for 0- to 17-year-olds, as well as the prevalence of allergic sensitisation to a mix of frequent inhalant allergens (SX1) among 3- to 17-year-olds based on data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). 12-month prevalence trends between KiGGS Wave 2 and the KiGGS baseline study (2003-2006) are shown according to gender and age group. There were no significant changes in the 12-month prevalence of hay fever (8.8%) atopic dermatitis (7.0%) and bronchial asthma (3.5%) compared to the KiGGS baseline study, which indicates a stabilisation at a high level. More than one in six children (16.1%) currently suffer from at least one of these three diseases. 37.1% of 3- to 17-year-olds are sensitised to the multiple allergen mix SX1. Similar to the development of disease prevalence, SX1 sensitisation too has remained stable at a high level over the course of the past ten years.

Background: Infection with cytomegalovirus (CMV) remains asymptomatic in most immunocompetent hosts, but is the leading cause of congenital viral infection worldwide and can be life-threatening in immunocompromised individuals. We aimed to assess CMV seroprevalence in a nationally representative sample of adults in Germany and to identify sociodemographic factors associated with CMV seropositivity. Methods: Blood samples from 6552 participants (18–79 years) of the “German National Health Interview and Examination Survey 1998”, a population-based sample of the adult population in Germany, were tested for the presence of CMV antibodies using an Ig-multiplex assay. Weighted seroprevalence was calculated and weighted binomial regression was used to identify factors associated with CMV seropositivity. Results: Overall CMV seroprevalence was 56.7% (95%CI: 54.8–58.7%), with a higher seroprevalence in women (62.3%) than in men (51.0%). Seroprevalence increased with age: from 31.8% to 63.7% in men and from 44.1% to 77.6% in women when comparing the 18–29 with the 70–79 year age-group, respectively. CMV seroprevalence in women of childbearing age (18–45 years) was 51.7%. Factors significantly associated with CMV seropositivity were age, country of birth, smoking status, education, living in northern Germany and number of household members. In addition, having attended child care was associated with seropositivity in men, and number of siblings and living in East Germany in women. Conclusion: Our results indicate that half the women of childbearing age were susceptible for primary CMV infection during pregnancy. CMV screening during pregnancy and informing seronegative women about CMV risk reduction measures could prevent congenital CMV infections with its serious consequences.

Diets rich in fruits and vegetables, like the Dietary Approaches to Stop Hypertension (DASH)-diet, are usually characterized by high potassium intake and reduced dietary acid load, and have been shown to reduce blood pressure (BP). However, the relevance of potential renal acid load (PRAL) for BP has not been compared with the relevance to BP of urinary biomarker (K-urine)- and dietary food frequency questionnaire (K-FFQ)-based estimates of potassium intake in a general adult population sample. For 6788 participants (aged 18–79 years) of the representative German Health-Interview and Examination Survey for Adults (DEGS1), associations of PRAL, K-urine, and K-FFQ with BP and hypertension prevalence were cross-sectionally examined in multivariable linear and logistic regression models. PRAL was significantly associated with higher systolic BP (p = 0.0002) and higher hypertension prevalence (Odds ratio [OR] high vs. low PRAL = 1.45, p = 0.0004) in models adjusted for age, sex, body mass index (BMI), estimated sodium intake, kidney function, relevant medication, and further important covariates. Higher estimates of K-FFQ and K-urine were related to lower systolic BP (p = 0.04 and p < 0.0001) and lower hypertension prevalence (OR = 0.82, p = 0.04 and OR = 0.77, p = 0.02) as well as a lower diastolic BP (p = 0.03 and p = 0.0003). Our results show, for the first time in a comparative analysis of a large representative population sample, significant relationships of BP and hypertension prevalence with questionnaire- and biomarker-based estimates of potassium intake and with an estimate of dietary acid load.

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 =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

Lyme borreliosis, the most common tickborne disease in the Northern Hemisphere, is caused by infection with spirochetes of the Borrelia burgdorferi sensu lato (s.l.) complex. Five genospecies are known to be pathogenic for humans: B. burgdorferi sensu stricto (s.s.), B. afzelii, B. garinii, B. bavariensis, and B. spielmanii (1). In Europe, the bacterium is transmitted to humans through the bite of Ixodes ricinus ticks; in eastern Europe, I. persulcatus ticks can also transmit the bacterium. In Europe, where the most common clinical manifestation of Lyme borreliosis is erythema migrans, followed by Lyme neuroborreliosis and Lyme arthritis (2), data are sparse regarding B. burgdorferi s.l. infection rates and risk factors (3). Persons of all ages are at risk for infection; however, surveillance data and prospective studies in Europe and the United States suggest that children and the elderly are particularly at risk (4–6). Population-based surveillance data suggest that Lyme borreliosis is endemic in eastern Germany: annual incidence is 20–35 cases/100,000 inhabitants (7). Regional differences in incidence are observed, but data cannot be easily compared because of reporting biases and differences in infection awareness. The limited representativeness and comparability of Lyme borreliosis surveillance data are well documented (8). Under such conditions, population-based serosurveys with high representativeness can provide valid estimates of the force of infection (rate at which susceptible persons acquire Lyme borreliosis) and the lifetime risk for infection; however, seroprevalence estimates do not necessarily represent cases of clinical disease. In a population-based seroprevalence study among 1- to 17-year-old children in Germany, seroprevalence increased cumulatively by age (9). We present data on the prevalence and determinants of B. burgdorferi s.l. seropositivity among adults in Germany during 2008–2011.

The Vitamin D Standardization Program (VDSP) coordinated an interlaboratory study to assess the comparability of measurements of total 25-hydroxyvitamin D [25(OH)D] in human serum, which is the primary marker of vitamin D status. A set of 50 individual donor samples were analyzed by 15 different laboratoriesrepresenting national nutrition surveys, assay manufacturers, and clinical and/or research laboratories to provide results for total 25(OH)D using both immunoassays (IAs) and LC tandem MS (MS/MS). The resultswere evaluated relative to bias compared with the target values assigned based on a combination of measurements at Ghent University (Belgium) and the U.S. National Institute of Standards and Technology using reference measurement procedures for the determination of 25(OH)D2 and 25(OH)D3. CV and mean bias for each laboratory and assay platform were assessed and compared with previously established VDSP performance criteria, namely CV ≤ 10% and mean bias ≤ 5%. Nearly all LC-MS/MS results achieved VDSP criteria, whereas only 50% of IAs met the criterion for a ≤10% CV and only three of eight IAs achieved the ≤5% bias. These results establish a benchmark for the evaluation of 25(OH)D assay performance and standardization activities in the future.

The Vitamin D Standardization Program (VDSP) coordinated a study in 2012 to assess the commutability of reference materials and proficiency testing/external quality assurance materials for total 25-hydroxyvitamin D [25(OH)D] in human serum, the primary indicator of vitamin D status. A set of 50 single-donor serum samples as well as 17 reference and proficiency testing/external quality assessment materials wereanalyzed by participating laboratories that used either immunoassay or LC-MS methods for total 25(OH)D. The commutability test materials included National Institute of Standards and Technology Standard Reference Material 972a Vitamin D Metabolites in Human Serum as well as materials from the College of AmericanPathologists and the Vitamin D External Quality Assessment Scheme. Study protocols and data analysis procedures were in accordance with Clinical and Laboratory Standards Institute guidelines. The majority of the test materials were found to be commutable with the methods used in this commutability study. These results provide guidance for laboratories needing tochoose appropriate reference materials and select proficiency or external quality assessment programs and will serve as a foundation for additional VDSP studies.

The association between selenium status and risk of acute myocardial infarction was examined in a multicenter case-control study in 10 centers from Europe and Israel in 1991-1992. Selenium in toenails was assessed for 683 nonfatal male cases with first acute myocardial infarction and 729 controls less than 70 years of age. Median toenail selenium content was 0.553 microgram/g for cases and 0.590 microgram/g for controls. After adjustment for age, center, and smoking, the odds ratio for myocardial infarction in the highest quintile of selenium as compared with the lowest was 0.63 (95 percent confidence interval 0.37-1.07, p for trend = 0.08). The observed inverse trend was somewhat stronger when the authors adjusted for vitamin E status (p = 0.05). Analysis stratified for smoking habits showed an inverse association in former smokers (odds ratio for the 75th-25th percentile contrast = 0.63 (95 percent confidence interval 0.43-0.94)), but not in current smokers (odds ratio = 0.97 (0.71-1.32)) or in those who had never smoked (odds ratio = 1.55 (0.87-2.76)). Analysis stratified by center showed a significant inverse association between selenium levels and risk of myocardial infarction for Germany (Berlin) only (75th to 25th percentile odds ratio = 0.62 (95 percent confidence interval 0.42-0.91)), which was the center with the lowest selenium levels. It appears that the increased risk of acute myocardial infarction at low levels of selenium intake is largely explained by cigarette smoking; selenium status does not appear to be an important determinant of risk of myocardial infarction at the levels observed in a large part of Europe.

Background Herpes simplex infections (HSV1/2) are characterized by recurrent symptoms, a risk of neonatal herpes, and the facilitation of HIV transmission. In Germany, HSV1/2 infections are not notifiable and data are scarce. A previous study found higher HSV1/2 seroprevalences in women in East Germany than in women in West Germany. We assessed changes in the HSV1/2 seroprevalences over time and investigated determinants associated with HSV1/2 seropositivity to guide prevention and control. Methods The study was based on the German Health Interview and Examination Survey for Adults (DEGS; 2008–2011) and the German National Health Interview and Examination Survey (GNHIES; 1997–1999). We tested serum samples from DEGS participants for HSV1 and HSV2 immunoglobulin G. We used Pearson’s χ2 test to compare the HSV1/HSV2 seroprevalences in terms of sex, age, and region of residence (East/West Germany) and investigated potential determinants by calculating prevalence ratios (PR) with log-binomial regression. All statistical analyses included survey weights. Results In total, 6627 DEGS participants were tested for HSV1, and 5013 were also tested for HSV2. Overall, HSV1 seroprevalence decreased significantly from 1997–1999 (82.1%; 95%CI 80.6–83.6) to 2008–2011 (78.4%; 95%CI 77.8–79.7). In the same period, overall HSV2 seroprevalence decreased significantly from 13.3% (95%CI 11.9–14.9) to 9.6% (95%CI 8.6–10.8), notably in 18–24-year-old men (10.4 to 0%) in East Germany. Women were more likely than men to be seropositive for HSV1 (PR 1.1) or HSV2 (PR 1.6). A lower level of education, smoking, and not speaking German were associated with HSV1 in both sexes. Women of older age, who smoked, or had a history of abortion and men of older age or who had not attended a nursery school during childhood were more often seropositive for HSV2. Conclusion The reduced seroprevalences of HSV1 and HSV2 leave more people susceptible to genital HSV1/2 infections. Practitioners should be aware of HSV infection as a differential diagnosis for genital ulcers. We recommend educational interventions to raise awareness of the sexual transmission route of HSV1/2, possible consequences, and prevention. Interventions should especially target pregnant women, their partners, and people at risk of HIV.

Background: The iodine status of populations is usually assessed by median urinary iodine concentrations (UIC) in population-based studies, but it is unclear to which extent UIC are comparable across different laboratories. The aim of our study was to investigate the variability of UIC measurements across three well-established German laboratories with long-term clinical-chemical expertise in iodine measurements and to compare these results to the gold standard inductively coupled plasma mass spectrometry (ICP-MS). Methods: UIC levels were measured from 303 urine samples derived from the “Dortmund Nutritional and Anthropometric Longitudinally Designed Study” and from volunteers of the University Medicine Greifswald at four different German laboratories. Three of these laboratories used Sandell-Kolthoff reaction with different digestion methods for UIC measurement (Lab1–Lab3), whereas one laboratory used ICP-MS as gold standard. Results: Median UIC levels were significantly different across the four laboratories (ICP-MS: 77 μg/L; Lab1: 69 μg/L; Lab2: 73 μg/L; Lab3: 111 μg/L). Linear regressions associating UIC levels of Lab1–Lab3 with UIC levels of ICP-MS showed intercepts significantly different from 0 and slopes significantly different from 1. Intraclass correlations (ICC) in comparison to ICP-MS were 0.91 for Lab1, 0.98 for Lab2, and 0.69 for Lab3. Using the digestion method of Lab2 in Lab3 improved the comparison of UIC levels of Lab3 with those from the ICP-MS (ICC=0.89). Conclusions: We have demonstrated larger interlaboratory variations across high-quality laboratories with long-lasting experience in iodine measurements indicating a relevant non-comparability of UIC measurements in iodine monitoring studies. Therefore, standardization of UIC measurements has to be expedited.

Background Vitamin D deficiency may be a risk factor for mortality but previous meta-analyses lacked standardization of laboratory methods for 25-hydroxyvitamin D (25[OH]D) concentrations and used aggregate data instead of individual participant data (IPD). We therefore performed an IPD meta-analysis on the association between standardized serum 25(OH)D and mortality. Methods In a European consortium of eight prospective studies, including seven general population cohorts, we used the Vitamin D Standardization Program (VDSP) protocols to standardize 25(OH)D data. Meta-analyses using a one step procedure on IPD were performed to study associations of 25(OH)D with all-cause mortality as the primary outcome, and with cardiovascular and cancer mortality as secondary outcomes. This meta-analysis is registered at ClinicalTrials.gov, number NCT02438488. Findings We analysed 26916 study participants (median age 61.6 years, 58% females) with a median 25(OH)D concentration of 53.8 nmol/L. During a median follow-up time of 10.5 years, 6802 persons died. Compared to participants with 25(OH)D concentrations of 75 to 99.99 nmol/L, the adjusted hazard ratios (with 95% confidence interval) for mortality in the 25(OH)D groups with 40 to 49.99, 30 to 39.99, and, This project has received funding from the European Community’s Seventh Framework Programme (FP7/2007-2013) under Grant Agreement 613977 for the ODIN Integrated Project [Food-based solutions for optimal vitamin D nutrition and health through the life cycle http://www.odin-vitd.eu/]. Funding for the individual studies contributing data to this effort can be found in Appendix (S1 File), section 11.

A high dietary salt intake is a serious risk factor for the development of hypertension. Daily salt intake in most of the European countries substantially exceeds the current recommendations of salt intake. For Germany, so far, no valid biomarker-based data on current daily salt intake are available. Data basis for this biomarker-based estimation of salt intake in the German population was the representative DEGS Study (German Health Interview and Examination Survey for Adults) conducted 2008–2011 in 18–79 old adults living in Germany. Daily salt intake was estimated from 6,962 sodium and creatinine measurements in spot urine samples. Median estimated daily salt intake of the 18–79 olds was 10.0 g in men and 8.4 g in women. More than 75 % of men and about 70 % of women exceeded the current recommendation of a maximum salt intake of 6 g/day. Fifty percentage of men and more than 35 % of the women had a daily salt intake >10 g. Daily salt intake of the German population considerably exceeds the current recommendation to eat no more than 6 g salt per day. A general reduction of salt content in processed foods—which are currently the main source of salt intake—offers a promising and cost-effective potential for the improvement of all salt intake-dependent health outcomes in the population.

Die erste Folgebefragung der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS Welle 1), die von 2009 bis 2012 als kombinierte Quer- und Langsschnitterhebung durchgefuhrt wurde, liefert u. a. aktuelle Daten zu allergischen Erkrankungen. Die Datenerhebung erfolgte mittels Telefoninterviews. Insgesamt nahmen 6093 Madchen und 6275 Jungen bzw. deren Eltern teil, darunter 4455 Ersteingeladene (0 bis 6 Jahre; Response 38,8 %) und 7913 Wiedereingeladene (7 bis 17 Jahre; Response 72,9 %). Laut Elternangaben war aktuell knapp ein Sechstel der Kinder und Jugendlichen von mindestens einer atopischen Erkrankung betroffen (15,6 %, 95 %-Konfidenzintervall 14,7–16,5). Die 12-Monats-Pravalenzen von Heuschnupfen, Neurodermitis und Asthma bronchiale betrugen 9,1 % (8,4–9,8), 6,0 % (5,4–6,6) bzw. 4,1 % (3,6–4,6). 2,2 % (1,9–2,6) der Kinder und Jugendlichen litten aktuell an einem allergischen Kontaktekzem. Im Vergleich zur KiGGS-Basiserhebung von 2003 bis 2006 hat in KiGGS Welle 1 ein hoherer Anteil von Eltern die Frage nach dem Auftreten von Asthma bronchiale in den letzten 12 Monaten bei ihren Kindern und Jugendlichen bejaht (4,1 vs. 3,2 %; p = 0,0034). Der Gesamtanstieg ist auf gestiegene Pravalenzen bei 0- bis 6-Jahrigen und hier vor allem bei Madchen zuruckzufuhren. Fur Heuschnupfen fallen hohere 12-Monats-Pravalenzen ebenfalls in den beiden unteren Altersgruppen und auch hier vor allem bei Madchen auf. Der Gesamtanstieg ist aber nicht statistisch signifikant (9,1 vs. 8,3 %; p = 0,08). Fur Neurodermitis war insgesamt ein rucklaufiger Trend in der aktuellen Betroffenheit zu beobachten [6,8 % (2003–2006) vs. 5,4 % (2009–2012); p = 0,0015].

Aufgrund der Zunahme von Allergien in Deutschland sind aktuelle Daten zur Pravalenz allergischer Sensibilisierungen von grosem Interesse. Im Rahmen der „Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)“ (2008–2011) wurden an einer bevolkerungsbezogenen Stichprobe von 7025 18- bis 79-Jahrigen Blutproben auf spezifische IgE-Antikorper gegen 50 verbreitete Einzelallergene untersucht sowie 2 Tests mit jeweils einer Mischung aus Inhalationsallergenen (SX1) und Graserpollen (GX1) durchgefuhrt. 48,6% der Teilnehmer wiesen mindestens eine Sensibilisierung auf. Mehr Manner als Frauen waren gegen mindestens ein Allergen sensibilisiert. Zudem waren mehr jungere als altere Teilnehmer und mehr Personen mit hoherem Sozialstatus von mindestens einer Sensibilisierung betroffen. Gegen Inhalationsallergene waren 33,6% der Teilnehmer sensibilisiert, gegen Nahrungsmittelallergene 25,5% und gegen Insektengifte 22,5%. Im Vergleich zum Bundes-Gesundheitssurvey 1998 (BGS98) hat die Pravalenz einer Sensibilisierung gegen Inhalationsallergene von 29,8% auf 33,6% zugenommen. Dieser Trend war nur bei Frauen signifikant. Die Ergebnisse des DEGS1 zeigen eine nach wie vor hohe Pravalenz allergischer Sensibilisierungen.

Substantial variability is associated with laboratory measurement of serum total 25-hydroxyvitamin D [25(OH)D]. The resulting chaos impedes development of consensus 25(OH)D values to define stages of vitamin D status. As resolving this situation requires standardized measurement of 25(OH)D, the Vitamin D Standardization Program (VDSP) developed methodology to standardize 25(OH)D measurement to the gold standard reference measurement procedures of NIST, Ghent University and CDC. Importantly, VDSP developed protocols for standardizing 25(OH)D values from prior research based on availability of stored serum samples. The effect of such retrospective standardization on prevalence of "low" vitamin D status in national studies reported here for The Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) and the German Health Interview and Examination Survey for Children and Adolescents (KIGGS, 2003-2006) was such that in NHANES III 25(OH)D values were lower than original values while higher in KIGGS. In NHANES III the percentage with values below 30, 50 and 75 nmol/L increased from 4% to 6%, 22% to 31% and 55% to 71%, respectively. Whereas in KIGGS after standardization the percentage below 30, 50, and 70 nmol/L decreased from 28% to 13%, 64% to 47% and 87% to 85% respectively. Moreover, in a hypothetical example, depending on whether the 25(OH)D assay was positively or negatively biased by 12%, the 25(OH)D concentration which maximally suppressed PTH could vary from 20 to 35ng/mL. These examples underscore the challenges (perhaps impossibility) of developing vitamin D guidelines using unstandardized 25(OH)D data. Retrospective 25(OH)D standardization can be applied to old studies where stored serum samples exist. As a way forward, we suggest an international effort to identify key prior studies with stored samples for re-analysis and standardization initially to define the 25(OH)D level associated with vitamin D deficiency (rickets/osteomalacia). Subsequent work could focus on defining inadequacy. Finally, examples reported here highlight the importance of suspending publication of meta-analyses based on unstandardized 25(OH)D results.

Representative data on the extent of endemicity, burden and risk of human toxoplasmosis are scarce. We assessed the prevalence and determinants of seropositivity of Toxoplasma gondii among adult participants of a nationwide representative cross-sectional survey in Germany. Sera collected from a representative cohort of adults (age 18–79; n = 6,663) in Germany were tested for anti-T. gondii IgG antibodies. Interview-derived data were used to evaluate associated factors. Multivariable logistic regression was applied using sampling weights and accounting for survey design cluster effects. Seroprevalence increased from 20% (95%-CI:17–23%) in the 18–29 age group to 77% (95%-CI:73–81%) in the 70–79 age group. Male gender, keeping cats and BMI ≥30 were independent risk factors for seropositivity, while being vegetarian and high socio-economic status were negatively associated. Based on these data, we estimate 1.1% of adults and 1.3% of women aged 18–49 to seroconvert each year. This implies 6,393 seroconversions annually during pregnancies. We conclude that T. gondii infection in Germany is highly prevalent and that eating habits (consuming raw meat) appear to be of high epidemiological relevance. High numbers of seroconversions during pregnancies pose substantial risks for unborn children. Efforts to raise awareness of toxoplasmosis in public health programs targeting to T. gondii transmission control are therefore strongly advocated.

In industrialized countries atopic diseases have been reported to be less likely in children and adolescents with a migrant background compared to non-migrants. This paper aimed at both examining and comparing prevalence of asthma, allergic rhinoconjunctivitis and atopic dermatitis and allergic sensitization to specific IgE antibodies in children and adolescents with and without a migrant background. Using data of the population-based German Health Interview and Examination Survey for children and adolescents (KiGGS; n = 17,450; 0–17 years), lifetime and 12-month prevalence of atopic diseases and point prevalence of 20 common allergic sensitizations were investigated among migrants compared to non-migrants. Multiple regression models were used to estimate the association of atopic disease and allergic sensitization with migrant background. In multivariate analyses with substantial adjustment we found atopic dermatitis about one-third less often (OR 0.73, 0.57–0.93) in participants with a two-sided migrant background. Statistically significant associations between allergic sensitizations and a two-sided migrant background remained for birch (OR 0.73, 0.58–0.90), soybean (OR 0.72, 0.54–0.96), peanut (OR 0.69, 0.53–0.90), rice (OR 0.64, 0.48–0.87), potato (OR 0.64, 0.48–0.85), and horse dander (OR 0.58, 0.40–0.85). Environmental factors and living conditions might be responsible for the observed differences.

It is currently unclear whether subclinical thyroid dysfunction is associated with blood pressure. Furthermore, data on the potential relation of thyroid function with blood pressure in children and adolescents are sparse. We investigated the association between serum TSH levels and blood pressure in a population-based study conducted in children aged 3-10 yr and adolescents aged 11-17 yr.Data from 6435 children and 5918 adolescents of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed. Two readings of systolic and diastolic blood pressure were taken in a sitting position after 5 min of rest. Hypertension was defined by an increased systolic or an increased diastolic blood pressure using age-, sex-, and height-specific reference values from the KiGGS study. Serum TSH levels were measured with the electrochemiluminescence method. High and low serum TSH levels were defined according to age-specific reference limits for the assay. Continuous and categorized serum TSH levels were associated with hypertension by multivariable logistic regression.Serum TSH levels were significantly associated with hypertension in children (odds ratio=1.12; 95% confidence interval=1.00-1.25; P=0.045) and adolescents (odds ratio=1.19; 95% confidence interval=1.12-1.26; P0.001). High serum TSH levels were positively associated with systolic and diastolic blood pressure, but not with hypertension in children and adolescents.There is a positive relationship between serum TSH levels and hypertension in children and adolescents, suggesting that subclinical hypothyroidism is associated with an increased risk of hypertension.

Severe iodine deficiency during pregnancy seriously influences fetal brain development and in the worst case induces cretinism. Recent studies have shown that even a mild iodine deficiency during pregnancy and during the first years of life adversely affects brain development. The World Health Organisation (WHO) considers iodine deficiency as the most common preventable cause of early childhood mental deficiency. In this context, the insufficient production of the four iodine atoms containing thyroxine seems to play a causal role, i. e., due to the iodine substrate deficiency the neuronally particularly relevant free-thyroxine level falls. Due to the very limited iodine storage capacity, the infantile thyroid is eminently dependent on an adequate and steady iodine supply. In the first month of life, when milk is the only energy- and nutrient provider, infants fed a commercial formula regularly have a sufficient iodine supply. However, breastfed infants, who depend on maternal iodine status, frequently show an inadequate iodine intake. Furthermore, iodine intake is critical when complementary food (CF) is introduced. Especially homemade CF is poor in iodine, but also commercial CFs are only partly fortified. A simultaneous inadequate iodine supply of the breastfeeding mother and the preferential use of mostly iodine-poor organic milk cannot ensure an adequate iodine supply of the infant. In terms of an improvement of nutrient supply, especially concerning an unhindered brain development, the corresponding German reference value for iodine intake of infants until age 4 month should be raised from currently 40 microg/d to at least 60 microg/d (WHO-reference: 90 microg/d).

Despite a growing interest in the epidemiology of paediatric hypertension, data on how often blood pressure in children and adolescents already exceeds adult thresholds for optimal blood pressure are scarce. The aim of this study was to estimate the prevalence of higher-than-optimal and hypertensive blood pressure values according to adult cutoffs in an unselected representative sample of children and adolescents living in Germany.Standardized oscillometric blood pressure measurements were performed in 14 730 children aged 3-17 years (7203 girls and 7527 boys) participating in a nationally representative examination survey of children and adolescents living in Germany (The German Health Interview and Examination Survey for Children and Adolescents, KiGGS, response rate 67%). The mean of two measurements was used for this analysis.The prevalences of higher-than-optimal blood pressure values by adult criteria (or=120/80 mmHg) increased with age and was 52.2% in boys aged 14-17 years and 26.2% in girls aged 14-17 years (including 6.0% of boys and 1.4% of girls with hypertensive valuesor=140/90 mmHg). More than half of these adolescents with nonoptimal blood pressure values had additional cardiovascular risk factors (overweight defined as body mass indexor=90th percentile for sex and age, dyslipidaemia defined as total cholesterol5.0 mmol/l or high-density lipoprotein cholesterol less than 1.0 mmol/l or smoking).These results suggest the need for routine blood pressure measurements in children and adolescents as required by clinical guidelines, for more attention to coexisting other cardiovascular risk factors and for a sustained focus on healthy lifestyles that can be learned best at a young age.

Jod ist ein essenzielles Spurenelement, das in Deutschland in zu geringen Mengen im Boden vorkommt. Dem daraus resultierenden Jodmangel beim Menschen wird durch eine Jodprophylaxe begegnet, die im Wesentlichen aus der Jodierung von Speisesalz sowie der Jodierung von Futtermitteln in der Landwirtschaft besteht. Im Jodmonitoring des Kinder- und Jugendgesundheitssurveys (KiGGS) wurde die Jodausscheidung im Urin gemessen. Die Jodurie betrug im Median 117 μg/l und lag damit am unteren Ende der von der Weltgesundheitsorganisation (WHO) empfohlenen Spanne von 100–200 μg/l. Aus diesen Ergebnissen kann man schliesen, dass die Jodprophylaxe erfolgreich war und sich die Jodversorgung im Vergleich zu fruher verbessert hat. Gemas den Empfehlungen der WHO herrscht in Deutschland zwar kein Jodmangel mehr, die Jodversorgung der Bevolkerung befindet sich dabei aber auf einem relativ niedrigen Niveau. Um das Erreichte zumindest zu erhalten, durfen die Aktivitaten zur Verbesserung der Jodversorgung nicht nachlassen.

Der Tabak-, Alkohol- und Drogenkonsum gehort aufgrund der nachhaltigen Folgen fur die Gesundheit zu den zentralen Themenfeldern der Pravention und Gesundheitsforderung im Kindes- und Jugendalter. Die Daten des Kinder- und Jugendgesundheitssurveys (KiGGS) zeigen, dass in Deutschland zurzeit 20,5 % der 11- bis 17-jahrigen Jungen und 20,3 % der gleichaltrigen Madchen rauchen. Von den Jugendlichen, die selbst nicht rauchen, sind mehr als ein Viertel mehrmals in der Woche Tabak rauch ausgesetzt, etwa ein Funftel sogar fast jeden Tag. Alkohol haben 64,8 % der Jungen und 63,8 % der Madchen schon einmal getrunken. Etwa ein Drittel der Jungen und ein Viertel der Madchen gaben an, zurzeit mindestens einmal in der Woche Alkohol zu konsumieren. Haschisch oder Marihuana haben in den letzten 12 Monaten vor der Befragung 9,2 % der Jungen und 6,2 % der Madchen genommen. Andere Drogen wie Ecstasy, Amphetamine oder Speed wurden von weniger als 1 % der Jugendlichen konsumiert. Der Gebrauch psychoaktiver Substanzen nimmt mit dem Alter deutlich zu und ist dementsprechend bei den 16- bis 17-Jahrigen am starksten verbreitet. Jugendliche aus Familien mit niedrigem Sozialstatus rauchen haufiger, beim Alkohol- und Drogenkonsum sind hingegen keine bedeutsamen statusspezifischen Unterschiede zu beobachten. Erhohte Rauchpravalenzen finden sich auserdem bei Jungen und Madchen, die eine Hauptschule besuchen und in den neuen Bundeslandern leben. Die Ergebnisse unterstreichen die Notwendigkeit einer fruh ansetzenden Suchtpravention, die sowohl Interventionen zur Verhinderung des Einstiegs in den Substanzgebrauch als auch Angebote zur Entwohnung beinhalten sollte.

Jod ist ein essenzielles Spurenelement, das in Deutschland in zu geringen Mengen im Boden vorkommt. Dem daraus resultierenden Jodmangel beim Menschen wird durch eine Jodprophylaxe begegnet, die im Wesentlichen aus der Jodierung von Speisesalz sowie der Jodierung von Futtermitteln in der Landwirtschaft besteht. Im Jodmonitoring des Kinder- und Jugendgesundheitssurvey (KiGGS) wurden die Schilddrusenvolumina aller Kinder und Jugendlichen ab 6 Jahren sonografisch ermittelt. Um die Jodversorgung auf Bevolkerungsebene zu beurteilen, wurde zusatzlich die Jodausscheidung im Urin gemessen. Die Jodurie betrug im Median 117 μg/l und lag damit am unteren Ende der von der Weltgesundheitsorganisation (WHO) empfohlenen Spanne von 100–200 μg/l. Aus diesen Ergebnissen kann man schliesen, dass die Jodprophylaxe erfolgreich war und sich die Jodversorgung im Vergleich zu fruher verbessert hat. Gemas den Empfehlungen der WHO herrscht zwar in Deutschland kein Jodmangel mehr, die Jodversorgung der Bevolkerung befindet sich dabei aber auf einem relativ niedrigen Niveau. Das Erreichte gilt es zumindest zu erhalten, sodass die Masnahmen zur Verbesserung der Jodversorgung nicht nachlassen durfen.

Von Mai 2003 bis Mai 2006 fuhrte das Robert Koch-Institut (RKI) den Kinder- und Jugendgesundheitssurvey (KiGGS) durch. Zur Datenerhebung waren bundesweit in 167 Stadten und Gemeinden insgesamt 4 Untersuchungsteams – bestehend aus Arzt, Zentrumsinterviewern, Untersucherin, MTA, Umweltinterviewer – im Einsatz. Regionale und saisonale Einflusse wurden mit einem systematisierten Routenplan ausgeschlossen. Die Einladung der Teilnehmer und die Vergabe von Untersuchungsterminen erfolgten uber eine Survey-Geschaftsstelle mit kostensubventioniertem Service-Telefon. Die Datenverarbeitung in der Geschaftsstelle geschah mit Hilfe eines im RKI programmierten SQL-Datenbanksystems. Fur die Beschaffung geeigneter Untersuchungsraume sowie zur Probandenwerbung wurden ein Zentraler bzw. mehrere Regionale Feldvorbegeher beschaftigt. Um die Ausschopfungsquote zusatzlich zu erhohen, wurde eine kontinuierliche Offentlichkeitsarbeit eingerichtet. Im Rahmen der Untersuchung kamen schriftliche Selbstausfullfragebogen fur Eltern und zusatzlich fur Kinder ab 11 Jahren korperliche Untersuchungen und Tests und ein computergestutztes arztliches Interview zum Einsatz. Fur die in zentralen Labors durchgefuhrte umfangreiche Blut- und Urindiagnostik war eine standardisierte Transportlogistik erforderlich. Zwecks weitgehender Standardisierung der Erhebung wurden die Untersuchungsteams initial geschult und kontinuierlich nachgeschult. Das Qualitatsmanagementkonzept umfasste Masnahmen der internen und externen Qualitatskontrolle, die sich auf alle datenerhebenden und -verarbeitenden Schritte sowie die Schulungen erstreckte. Fazit: Engagierte Offentlichkeitsarbeit und der Einsatz von Feldvorbegehern erhohen die Teilnahmebereitschaft. Intensive Personalbetreuung und kontinuierliche Qualitatskontrollen tragen zu einer Erhohung der Arbeitszufriedenheit und der Datenqualitat bei. Eine verbindliche Festlegung samtlicher labordiagnostischer Arbeitsablaufe und der Transportlogistik sichert eine hohe Qualitat der Labormessdaten. Die Durchfuhrung der Studie vom Design uber die Durchfuhrung bis zur Datenaufbereitung und -auswertung in einer Hand ermoglicht eine luckenlose Kontrolle aller Arbeitsschritte.