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Framework and baseline examination of the German National Cohort (NAKO).

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.

SUBMITTER: Peters A

PROVIDER: S-EPMC9581448 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Framework and baseline examination of the German National Cohort (NAKO).

Peters Annette A Peters Annette A Greiser Karin Halina KH Göttlicher Susanne S Ahrens Wolfgang W Albrecht Maren M Bamberg Fabian F Bärnighausen Till T Becher Heiko H Berger Klaus K Beule Achim A Boeing Heiner H Bohn Barbara B Bohnert Kerstin K Braun Bettina B Brenner Hermann H Bülow Robin R Castell Stefanie S Damms-Machado Antje A Dörr Marcus M Ebert Nina N Ecker Margit M Emmel Carina C Fischer Beate B Franzke Claus-Werner CW Gastell Sylvia S Giani Guido G Günther Matthias M Günther Kathrin K Günther Klaus-Peter KP Haerting Johannes J Haug Ulrike U Heid Iris M IM Heier Margit M Heinemeyer Diana D Hendel Thomas T Herbolsheimer Florian F Hirsch Jochen J Hoffmann Wolfgang W Holleczek Bernd B Hölling Heike H Hörlein Andreas A Jöckel Karl-Heinz KH Kaaks Rudolf R Karch André A Karrasch Stefan S Kartschmit Nadja N Kauczor Hans-Ulrich HU Keil Thomas T Kemmling Yvonne Y Klee Bianca B Klüppelholz Birgit B Kluttig Alexander A Kofink Lisa L Köttgen Anna A Kraft Daniel D Krause Gérard G Kretz Lisa L Krist Lilian L Kühnisch Jan J Kuß Oliver O Legath Nicole N Lehnich Anna-Therese AT Leitzmann Michael M Lieb Wolfgang W Linseisen Jakob J Loeffler Markus M Macdonald Anke A Maier-Hein Klaus H KH Mangold Nina N Meinke-Franze Claudia C Meisinger Christa C Melzer Juliane J Mergarten Björn B Michels Karin B KB Mikolajczyk Rafael R Moebus Susanne S Mueller Ulrich U Nauck Matthias M Niendorf Thoralf T Nikolaou Konstantin K Obi Nadia N Ostrzinski Stefan S Panreck Leo L Pigeot Iris I Pischon Tobias T Pschibul-Thamm Irene I Rathmann Wolfgang W Reineke Achim A Roloff Stefanie S Rujescu Dan D Rupf Stefan S Sander Oliver O Schikowski Tamara T Schipf Sabine S Schirmacher Peter P Schlett Christopher L CL Schmidt Börge B Schmidt Georg G Schmidt Martin M Schöne Gina G Schulz Holger H Schulze Matthias B MB Schweig Alexandra A Sedlmeier Anja M AM Selder Sonja S Six-Merker Julia J Sowade Ramona R Stang Andreas A Stegle Oliver O Steindorf Karen K Stübs Gunthard G Swart Enno E Teismann Henning H Thiele Inke I Thierry Sigrid S Ueffing Marius M Völzke Henry H Waniek Sabina S Weber Andrea A Werner Nicole N Wichmann H-Erich HE Willich Stefan N SN Wirkner Kerstin K Wolf Kathrin K Wolff Robert R Zeeb Hajo H Zinkhan Melanie M Zschocke Johannes J

European journal of epidemiology 20221019 10

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 an ...[more]

PMID: 36260190

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Project description:BackgroundDespite considerable improvements in oral health in recent decades, caries and periodontitis are still widespread, ranking among the most prevalent diseases worldwide and requiring future research. The German National Cohort (NAKO Gesundheitsstudie, NAKO) is a large-scaled, multidisciplinary, nationwide, multi-centre, population-based, prospective cohort study with oral examinations that aims to provide a resource to study risk factors for major diseases. The aim of the present article is to provide the methodological background, to report on the data quality, and to present initial results of the oral examinations.MethodsDuring baseline examinations (2014-2019), a total of 205,184 persons aged 19-74 years has been examined in 18 study centres, including, among others, a dental interview, stimulated saliva sampling, and recording of the numbers of present teeth and prostheses (standard Level 1 program). As part of the Level 2 program that was offered to 20% randomly selected participants, each study centre selected one of three modules, one of them being the Level 2 oral examination. This extended program was carried out in a subgroup of 20,828 participants, including collection of detailed information on the dental and prosthetic status as well as on periodontal, cariological and functional aspects. To ensure reliability and reproducibility, study nurses were trained and calibrated by dental experts. In addition, a reliability study was conducted among 794 Level 1 and 359 Level 2 participants, reporting intra class correlation and kappa coefficients.ResultsIntra class correlation and kappa coefficients for observer agreement and reliability were consistently above 0.7, indicating good to excellent reliability of all dental measurements. For example, intra class correlation was 0.937 for the number of present teeth (Level 1), 0.740 for mean probing depth (PD) and 0.797 for active mouth opening. An initial inspection of the data showed that the median number of present teeth was 27, of which on average 6.9 teeth were healthy and caries-free. Average mean PD was 1.92 mm. An orthodontic treatment was reported by 35.5% of participants.DiscussionOverall, the dental study protocol was feasible and successfully integrated into the NAKO's overall assessment program. However, rigorous support of the study centres by dental professionals was required to ensure high quality data. In summary, high-quality data collection within the NAKO pave the way for future investigation of potential risk factors for oral diseases and links between oral and systemic diseases and conditions.

Project description:IntroductionFamily history of depression and childhood maltreatment are established risk factors for depression. However, how these factors are interrelated and jointly influence depression risk is not well understood. The present study investigated (i) if childhood maltreatment is associated with a family history of depression (ii) if family history and childhood maltreatment are associated with increased lifetime and current depression, and whether both factors interact beyond their main effects, and (iii) if family history affects lifetime and current depression via childhood maltreatment.MethodsAnalyses were based on a subgroup of the first 100,000 participants of the German National Cohort (NAKO), with complete information (58,703 participants, mean age = 51.2 years, 53% female). Parental family history of depression was assessed via self-report, childhood maltreatment with the Childhood Trauma Screener (CTS), lifetime depression with self-reported physician's diagnosis and the Mini-International Neuropsychiatric Interview (MINI), and current depressive symptoms with the depression scale of the Patient Health Questionnaire (PHQ-9). Generalized linear models were used to test main and interaction effects. Mediation was tested using causal mediation analyses.ResultsHigher frequencies of the childhood maltreatment measures were found in subjects reporting a positive family history of depression. Family history and childhood maltreatment were independently associated with increased depression. No statistical interactions of family history and childhood maltreatment were found for the lifetime depression measures. For current depressive symptoms (PHQ-9 sum score), an interaction was found, with stronger associations of childhood maltreatment and depression in subjects with a positive family history. Childhood maltreatment was estimated to mediate 7%-12% of the effect of family history on depression, with higher mediated proportions in subjects whose parents had a depression onset below 40 years. Abuse showed stronger associations with family history and depression, and higher mediated proportions of family history effects on depression than neglect.DiscussionThe present study confirms the association of childhood maltreatment and family history with depression in a large population-based cohort. While analyses provide little evidence for the joint effects of both risk factors on depression beyond their individual effects, results are consistent with family history affecting depression via childhood maltreatment to a small extent.

Project description:BackgroundParticipation in epidemiologic studies has been declining over the last decades. In addition to postal invitations and phone calls, home visits can be conducted to increase participation. The aim of this study was therefore to evaluate the effects of home visits in terms of response increase and composition of the additionally recruited and final sample.MethodsIn the framework of the German National Cohort (NAKO) recruitment process, two of 18 study centers, Halle (Saale) and Berlin-Center, performed home visits as additional recruitment step after postal invitation and reminders. Response increase was calculated and differences between participants recruited via home visits and standard recruitment were examined. Proportions are presented as percentages with 95%-confidence intervals.ResultsIn the general population in Halle, 21.3-22.8% participated after postal invitation and two reminders in the five assessed recruitment waves. The increase of the overall response was 2.8 percentage points (95%confidence interval: 1.9-4.0) for home visits compared to 2.4 percentage points (95%CI: 1.7-3.3) for alternatively sent third postal reminder. Participants recruited via home visits had similar characteristics to those recruited via standard recruitment. Among persons of Turkish descent in Berlin-Center site of the NAKO, home visits conducted by native speakers increased the participation of women, persons living together with their partner, were born in Turkey, had lower German language skills, lower-income, lower education, were more often smokers and reported more often diabetes and depression to a degree which changed overall estimates for this subsample.ConclusionsAs an additional recruitment measure in the general population, home visits increased response only marginally, and the through home visits recruited participants did not differ from those already recruited. Among persons with migration background, home visits by a native speaker increased participation of persons not reached by the standard recruitment, but the effects of using a native speaker approach could not be separated from the effect of home visits.

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Framework and baseline examination of the German National Cohort (NAKO).

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Framework and baseline examination of the German National Cohort (NAKO).

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