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Background Neighborhood socioeconomic status (nSES) can complement individual SES to better assess health-behavior inequalities. The aim of this study was to investigate the relationship between the nSES of defined areas in Berlin with healthy lifestyle. Methods This cross-sectional analysis used baseline data from the three Berlin study centers of the German National Cohort (NAKO). We assessed body mass index (BMI), smoking, alcohol consumption, and objectively measured physical activity and combined them to a healthy lifestyle index (HLI; range:0–12 points; 12 = best score). To assess nSES, the Social Index from Berlin’s Social Structure Atlas (1 = best; 7 = worst) was assigned to the participants’ residential locations. We used multivariable regression analyses to examine the association between nSES and the HLI (mean difference with 95% confidence interval, CI) as well as the four individual lifestyle factors (odds ratios (OR) with 95% CI). In sensitivity analyses, nSES was modelled using all seven Social Index categories and as a dichotomy (categories 1–4 vs. 5–7). Results Of 204,801 NAKO participants, 31,075 were recruited in Berlin, of those 11,922 with complete accelerometry data were included (mean ± SD age 50.6 ± 12.9 years; 52.8% women). The mean HLI was 8.3 ± 2.0 points. Worsening of nSES by one point was associated with a 0.08-point lower HLI (-0.08 (95%-CI -0.10; -0.06)), with a reduced odds of normal weight (0.95; 0.93–0.97) and being a never-smoker (0.96; 0.94–0.98), while it was neither associated with alcohol consumption (1.01; 0.99–1.04)) nor physical activity (0.99; 0.97–1.02)). Sensitivity analyses suggested that differences were mainly driven by a contrast between categories 1–4 and the more disadvantaged categories 5–7. However, the overall pattern of results did not change. Conclusions Our analyses suggest a rather small association between Berlin’s nSES and HLI, and slightly stronger associations with BMI and smoking. Future studies using longitudinal data and more neighbourhood measures are needed to better disentangle contextual influences from residential selection and to inform targeted prevention strategies.

Background Participation 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. Methods In 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. Results In 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. Conclusions As 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.

Background Physical activity (PA) plays a critical role in preventing non-communicable chronic diseases. However, engagement in PA differs widely between countries. The aim of this study was to examine PA patterns and associated factors in the urban populations of Singapore and Berlin, Germany. Methods This study used harmonized data from the Singapore Population Health Studies and the study center “Berlin-Mitte” of the German National Cohort Study (NAKO). PA was assessed with hip-worn accelerometers. Raw tri-axial accelerometry data was processed using the GGIR-R-package and classified into moderate-to-vigorous PA (MVPA), light PA (LPA), and inactivity. Multivariable regression analyses were applied to analyze associations between sociodemographic and lifestyle factors and PA intensities. Results The analyses included 1,195 (57.2% female, 46.6 ± 13.7 years) participants from Singapore and 2,060 (49.3% female, 49.9 ± 12.6 years) from Berlin. Singaporean participants engaged in more MVPA (+ 14.1 min [10.6;17.5] [95%-confidence interval]) and LPA (+ 66.2 min [57.4;74.9]) and less time inactive (-80.2 min [-90.0;-70.4]) than Berlin participants. In Singapore, more MVPA was associated with Chinese ethnicity and being employed, more LPA with male sex, normal weight, lower education and being married, while more inactivity was associated with female sex, overweight and non-smoking. In Berlin, more MVPA was associated with lower age, being employed, normal weight, and non-smoking, more LPA only with higher age, while singles, men, unemployed, and obese persons engaged in less LPA. Inactivity was associated with obesity and higher education. Conclusions Singaporean participants engaged more in both MVPA and LPA than those from Berlin. Factors associated with PA varied considerably between both urban populations but also in relation to PA intensities. These variations highlight the need for tailored PA promotion strategies that distinguish between reducing inactivity and increasing overall activity levels.

Musical activities (MA) such as singing, playing instruments, and listening to music may be associated with health benefits. However, evidence from epidemiological studies is still limited. This study aims at describing the relation between MA and both sociodemographic and health-related factors in a cross-sectional approach. A total of 6717 adults (50.3% women, 49.7% men, median age: 51 years (IQR 43–60) were recruited from the study center Berlin-Mitte of the German National Cohort (NAKO), a population-based prospective study. This study is based on a sample randomly selected from the population registry of Berlin, Germany, aged 20 to 69 years. 53% of the participants had been musically active at least once in their life (56.1% women, 43.9% men). Playing keyboard instruments (30%) and singing (21%) were the most frequent MA. Participants listened to music in median 90 min per day (IQR 30.0–150.0). Musically active individuals were more likely to have a higher education, higher alcohol consumption, were less likely to be physically active, and had a lower BMI compared to musically inactive individuals. This large population-based study offers a comprehensive description of demographic, health, and lifestyle characteristics associated with MA. Our findings may aid in assessing long-term health consequences of MA.

IntroductionTraditional, complementary and integrative medicine (TCIM) is widely used yet population-based data on user characteristics remain scarce in Germany. We aimed to describe patterns of non-pharmacological TCIM use and user profiles in the German National Cohort (NAKO).MethodThe NAKO baseline assessment (2017–2019) at the Berlin inner-city study centre included a self-report questionnaire on the use of seven non-pharmacological TCIM modalities in the last year. TCIM user groups were defined a priori using expert-based knowledge and exploratively through hierarchical clustering. Groups were compared descriptively based on sociodemographic factors and medical history. Associations with chronic pain disorders, pain medications, mental health indicators and time-limiting factors were analysed for the binary and ordinal outcomes of TCIM use.ResultsAmong 1970 participants, 1029 (52.2%) used TCIM in the last year, most commonly meditation (26.8%), chiropractic (24.8%) and yoga (21.8%). Compared with never users, frequent TCIM users were more often female (63.5%), reported slightly higher rates of mental health problems (7.6% and 15.2% vs 6.1%) and more frequent chronic conditions, including osteoarthritis (10.6% and 11.1% vs 2.7%) and back pain (26.6% and 31.7% vs 16.0%). Supplement use was strikingly more common among TCIM users (43.7% vs 20.9%).ConclusionIn this population-based Berlin sample, TCIM users combined higher prevalence of chronic disease with greater engagement in preventive practices, notably supplement use, suggesting an attempt to seek solutions for chronic problems alongside conventional medical care or a preventive health orientation. Integrating TCIM awareness into prevention and chronic care could better align clinical practice with already existing patients’ usage.

Background In humans, uric acid is a product of purine metabolism that impacts the vascular system. In addition to effects on arterial vascular tone, associations between serum uric acid concentrations—even in the physiological range—and arterial hypertension and vascular-mediated end-organ damage due to an impact on vascular stiffness have been postulated. Methods Therefore, we aim to investigate a possible cross-sectional association between serum uric acid concentrations in the physiological range and differences in arterial pulse wave velocity (PWV), an indicator of vascular remodeling, with a focus on possible differences between female and male individuals. We analyzed cross-sectional phenotypic and laboratory parameters, including PWV from 70,649 individuals in the population-based German National Cohort (NAKO) in a sex-specific manner. In parallel, we applied a machine learning approach to identify and quantify factors associated with PWV in a hypothesis-free manner. Results Our analysis uncovered a positive association between serum uric and PWV which was detected even if only individuals with urate values in the physiological range were included ( n  = 64,095). This correlation was more pronounced in women than in men. In multivariable linear regression models, we observed an association of uric acid (mmol/l) with PWV (m/s) of β  = 1.12 (95% confidence interval (CI): 0.78; 1.45) in males and β  = 1.35 (1.05; 1.66) in females, independent of other factors known to affect vascular stiffness. In addition, the machine learning approach identified uric acid as a major factor associated with PWV. The positive association was not restricted to hyperuricemia but evident even in the physiological concentration range. Based on the data from studies on the impact of aging on PWV, it is estimated that an increase in serum uric acid concentration by 0.1 mmol/l corresponds to an increase of approx. 7 years of age in females and of 4 years in males. Conclusions Already in the physiological concentration range, uric acid is positively associated with parameters of arterial stiffness. This association is more pronounced in females as compared to males. This finding provides a mechanistic explanation for the increased risk of vascular end-organ damage associated with higher serum uric acid concentrations and supports the observed greater benefit of therapeutic uric acid lowering in female. Future intervention studies have to address the mechanistic causality of the observed effect.

If health impairments due to coronavirus disease 2019 (COVID-19) persist for 12 weeks or longer, patients are diagnosed with Post-COVID Syndrome (PCS), or Long-COVID. Although the COVID-19 pandemic has largely subsided in 2024, PCS is still a major health burden worldwide, and identifying potential genetic modifiers of PCS remains of great clinical and scientific interest. We therefore performed a case-control type genome-wide association study (GWAS) of three recently developed PCS (severity) scores in 2,247 participants of COVIDOM, a prospective, multi-centre, population-based cohort study of SARS-CoV-2-infected individuals in Germany. Each PCS score originally represented the weighted sum of the binary indicators of all, or a subset, of 12 PCS symptom complexes, assessed six months or later after the PCR test-confirmed SARS-CoV-2 infection of a participant. For various methodical reasons, however, the PCS scores were dichotomized along their respective median values in the present study, prior to the GWAS. Of the 6,383,167 single nucleotide polymorphisms included, various variants were found to be associated with at least one of the PCS scores, although not at the stringent genome-wide statistical significance level of 5 × 10 − 8 . With p  = 6.6 × 10 − 8 , however, the genotype-phenotype association of SNP rs9792535 at position chr9:127,166,653 narrowly missed this threshold. The SNP is located in a region including the NEK6 , PSMB7 and ADGRD2 genes which, however, does not immediately suggest an etiological connection to PCS. As regards functional plausibility, variants of a possible effect mapped to the olfactory receptor gene region (lead SNP rs10893121 at position chr11:123,854,744; p  = 2.5 × 10 − 6 ). Impairment of smell and taste is a pathognomonic feature of both, acute COVID-19 and PCS, and our results suggest that this connection may have a genetic basis. Three other genotype-phenotype associations pointed towards a possible etiological role in PCS of cellular virus repression ( CHD6 gene region), activation of macrophages ( SLC7A2 ) and the release of virus particles from infected cells ( ARHGAP44 ). All other gene regions highlighted by our GWAS did not relate to pathophysiological processes currently discussed for PCS. Therefore, and because the genotype-phenotype associations observed in our GWAS were generally not very strong, the complexity of the genetic background of PCS appears to be as high as that of most other multifactorial traits in humans.

Objectives Low physical activity (PA) and poor cognitive function are associated with higher mortality risks. However, little is known about their interaction, including whether PA may moderate cognition-related mortality risks. This study examines the combined associations of PA and cognition with all-cause mortality, with attention to sex differences. Methods Using data from the German National Cohort and its mortality follow-up, we analyzed mortality risk based on: a) baseline low vs. sufficient PA (assessed via the global physical activity questionnaire using a threshold of < vs. ≥ 600 MET-minutes/week), b) baseline low vs. medium vs. high semantic memory (SM) and executive function/processing speed (EF/PS), assessed through factor analyses of a neurocognitive test battery, and c) their interaction on mortality in individuals aged 65 + up to 10 years of follow-up (N = 28,892). Cox models were estimated both in the total sample and stratified by sex, adjusting for relevant confounders and reporting both distinct and combined associations. Results During follow-up, 1,605 individuals (5.6%) died: 1,097 men (7.5%) and 508 women (3.6%). Compared to individuals with low cognitive function, those with high SM (Hazard Ratio (HR) = 0.83 [95%CI: 0.67–1.02]), as well as high EF/PS (HR = 0.66 [0.53–0.83]) and medium EF/PS (HR = 0.68 [0.60–0.78]) had lower mortality risks. PA was associated with a 29% decreased mortality risk (HR = 0.71 [0.62–0.82]) compared to low PA. PA moderated the elevated risk from low cognition, with regard to EF/PS (low EF/PS*PA: HR = 0.65 [0.50–0.84] vs. low EF/PS*low PA: HR = 1 (ref.)) and SM (low SM*PA: HR = 0.60 [0.46–0.77] vs. low SM*low PA: HR = 1 (ref.)). The associations did not differ between men and women. Conclusion Maintaining cognitive function and PA in older age is relevant for reducing mortality risk in both men and women. PA may offset risks linked to low cognition in both sexes, though mechanisms require further study. Trial registration Clinical trial number: not applicable.

In magnetic resonance imaging (MRI), the perception of substandard image quality may prompt repetition of the respective image acquisition protocol. Subsequently selecting the preferred high-quality image data from a series of acquisitions can be challenging. An automated workflow may facilitate and improve this selection. We therefore aimed to investigate the applicability of an automated image quality assessment for the prediction of the subjectively preferred image acquisition. Our analysis included data from 11,347 participants with whole-body MRI examinations performed as part of the ongoing prospective multi-center German National Cohort (NAKO) study. Trained radiologic technologists repeated any of the twelve examination protocols due to induced setup errors and/or subjectively unsatisfactory image quality and chose a preferred acquisition from the resultant series. Up to 11 quantitative image quality parameters were automatically derived from all acquisitions. Regularized regression and standard estimates of diagnostic accuracy were calculated. Controlling for setup variations in 2342 series of two or more acquisitions, technologists preferred the repetition over the initial acquisition in 1116 of 1396 series in which the initial setup was retained (79.9%, range across protocols: 73–100%). Image quality parameters then commonly showed statistically significant differences between chosen and discarded acquisitions. In regularized regression across all protocols, ‘structured noise maximum’ was the strongest predictor for the technologists’ choice, followed by ‘N/2 ghosting average’. Combinations of the automatically derived parameters provided an area under the ROC curve between 0.51 and 0.74 for the prediction of the technologists’ choice. It is concluded that automated image quality assessment can, despite considerable performance differences between protocols and anatomical regions, contribute substantially to identifying the subjective preference in a series of MRI acquisitions and thus provide effective decision support to readers.

Background/Objectives The aim of the study was to describe a novel dietary assessment strategy based on two instruments complemented by information from an external population applied to estimate usual food intake in the large-scale multicenter German National Cohort (GNC). As proof of concept, we applied the assessment strategy to data from a pretest study (2012–2013) to assess the feasibility of the novel assessment strategy. Subjects/Methods First, the consumption probability for each individual was modeled using three 24 h food lists (24h-FLs) and frequencies from one food frequency questionnaire (FFQ). Second, daily consumed food amounts were estimated from the representative German National Nutrition Survey II (NVS II) taking the characteristics of the participants into account. Usual food intake was estimated using the product of consumption probability and amounts. Results We estimated usual intake of 41 food groups in 318 men and 377 women. The participation proportion was 100, 84.4, and 68.5% for the first, second, and third 24h-FL, respectively. We observed no associations between the probability of participating and lifestyle factors. The estimated distributions of usual food intakes were plausible and total energy was estimated to be 2707 kcal/day for men and 2103 kcal/day for women. The estimated consumption frequencies did not differ substantially between men and women with only few exceptions. The differences in energy intake between men and women were mostly due to differences in estimated daily amounts. Conclusions The combination of repeated 24h-FLs, a FFQ, and consumption-day amounts from a reference population represents a user-friendly dietary assessment approach having generated plausible, but not yet validated, food intake values in the pretest study.