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Time trends in healthy lifestyle among adults in Germany: Results from three national health interview and examination surveys between 1990 and 2011


Autoři: Jonas D. Finger aff001;  Markus A. Busch aff001;  Christin Heidemann aff001;  Cornelia Lange aff001;  Gert B. M. Mensink aff001;  Anja Schienkiewitz aff001
Působiště autorů: Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany aff001
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222218

Souhrn

Background

The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany.

Methods

A data set of 18,058 adults aged 25–69 years from three population-based national health examination surveys 1990–92, 1997–99 and 2008–11 with complete information for five healthy behavior factors was used. A ‘daily intake of both fruits and vegetables, ‘sufficient physical exercise’, ‘no current smoking’ and ‘no current risk drinking’ were assessed with self-reports and ‘normal body weight’ was calculated based on measured body weight and height. A dichotomous ‘healthy lifestyle’ indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25–34, 35–44, 45–54 and 55–69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990–92 and 2008–11.

Results

In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990–92 to 13.5% in 1997–99 and to 14.7% in 2008–11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45–54 years. The RC of increasing healthy lifestyle prevalence between 1990–92 and 2008–11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990–92 and 2008–11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level.

Conclusions

The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990–92 to 2008–11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level.

Klíčová slova:

Biology and life sciences – Psychology – Social sciences – Sociology – People and places – Population groupings – Geographical locations – Europe – Medicine and health sciences – Health care – Nutrition – Public and occupational health – Diet – Physical activity – Alcohol consumption – Behavior – Education – Age groups – Health education and awareness – Sports science – Sports and exercise medicine – Exercise – Educational attainment – Physical fitness – Behavioral and social aspects of health – European Union – Germany


Zdroje

1. World Health Organization. Healthy Living. What is a healthy lifestyle? Copenhagen: WHO Regional Office for Europe; 1999.

2. Arthur R, Kirsh VA, Kreiger N, Rohan T. A healthy lifestyle index and its association with risk of breast, endometrial, and ovarian cancer among Canadian women. Cancer causes & control: CCC. 2018;29(6):485–93. Epub 2018/04/19. doi: 10.1007/s10552-018-1032-1 29667103.

3. Buckland G, Travier N, Huerta JM, Bueno-de-Mesquita HB, Siersema PD, Skeie G, et al. Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study. International journal of cancer. 2015;137(3):598–606. Epub 2015/01/06. doi: 10.1002/ijc.29411 25557932.

4. Lucini D, Zanuso S, Blair S, Pagani M. A simple healthy lifestyle index as a proxy of wellness: a proof of concept. Acta diabetologica. 2015;52(1):81–9. Epub 2014/06/12. doi: 10.1007/s00592-014-0605-z 24915785.

5. Adams ML, Katz DL, Shenson D. A healthy lifestyle composite measure: Significance and potential uses. Preventive medicine. 2016;84:41–7. doi: 10.1016/j.ypmed.2015.12.005 26724520.

6. Khaw K-T, Wareham N, Bingham S, Welch A, Luben R, Day N. Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study. PLOS Medicine. 2008;5(1):e12. doi: 10.1371/journal.pmed.0050012 18184033

7. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. The New England journal of medicine. 2000;343(1):16–22. Epub 2000/07/07. doi: 10.1056/NEJM200007063430103 10882764.

8. Agha G, Loucks EB, Tinker LF, Waring ME, Michaud DS, Foraker RE, et al. Healthy lifestyle and decreasing risk of heart failure in women: the Women’s Health Initiative observational study. Journal of the American College of Cardiology. 2014;64(17):1777–85. Epub 2014/12/03. doi: 10.1016/j.jacc.2014.07.981 25443698.

9. Myint PK, Luben RN, Wareham NJ, Bingham SA, Khaw KT. Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years’ follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study. BMJ (Clinical research ed). 2009;338:b349. Epub 2009/02/21. doi: 10.1136/bmj.b349 19228771.

10. Duncan MJ, Kline CE, Vandelanotte C, Sargent C, Rogers NL, Di Milia L. Cross-sectional associations between multiple lifestyle behaviors and health-related quality of life in the 10,000 Steps cohort. PloS one. 2014;9(4):e94184. Epub 2014/04/10. doi: 10.1371/journal.pone.0094184 24714564.

11. Sabia S, Singh-Manoux A, Hagger-Johnson G, Cambois E, Brunner EJ, Kivimaki M. Influence of individual and combined healthy behaviours on successful aging. CMAJ: Canadian Medical Association journal = journal de l’Association medicale canadienne. 2012;184(18):1985–92. Epub 2012/10/24. doi: 10.1503/cmaj.121080 23091184.

12. Krokstad S, Ding D, Grunseit AC, Sund ER, Holmen TL, Rangul V, et al. Multiple lifestyle behaviours and mortality, findings from a large population-based Norwegian cohort study—The HUNT Study. BMC Public Health. 2017;17(1):58. doi: 10.1186/s12889-016-3993-x 28068991

13. Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Preventive medicine. 2012;55(3):163–70. Epub 2012/06/28. doi: 10.1016/j.ypmed.2012.06.017 22735042.

14. Li Y, Pan A, Wang DD, Liu X, Dhana K, Franco OH, et al. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population. Circulation. 2018;138(4):345–55. Epub 2018/05/02. doi: 10.1161/CIRCULATIONAHA.117.032047 29712712.

15. Li Y, Ley SH, Tobias DK, Chiuve SE, VanderWeele TJ, Rich-Edwards JW, et al. Birth weight and later life adherence to unhealthy lifestyles in predicting type 2 diabetes: prospective cohort study. BMJ: British Medical Journal. 2015;351:h3672. doi: 10.1136/bmj.h3672 26199273

16. Barbaresko J, Rienks J, Nothlings U. Lifestyle Indices and Cardiovascular Disease Risk: A Meta-analysis. American journal of preventive medicine. 2018;55(4):555–64. Epub 2018/09/23. doi: 10.1016/j.amepre.2018.04.046 30241617.

17. Rhee CW, Kim JY, Park BJ, Li ZM, Ahn YO. Impact of individual and combined health behaviors on all causes of premature mortality among middle aged men in Korea: the Seoul Male Cohort Study. Journal of preventive medicine and public health = Yebang Uihakhoe chi. 2012;45(1):14–20. Epub 2012/03/06. doi: 10.3961/jpmph.2012.45.1.14 22389754.

18. Marques A, Peralta M, Martins J, Loureiro V, Almanzar PC, de Matos MG. Few European Adults are Living a Healthy Lifestyle. American journal of health promotion: AJHP. 2018;33(3):391–8. Epub 2018/07/18. doi: 10.1177/0890117118787078 30012013.

19. Buttery AK, Mensink GB, Busch MA. Healthy behaviours and mental health: findings from the German Health Update (GEDA). European journal of public health. 2015;25(2):219–25. Epub 2014/07/26. doi: 10.1093/eurpub/cku094 25061231.

20. Eikemo TA, Hoffmann R, Kulik MC, Kulhanova I, Toch-Marquardt M, Menvielle G, et al. How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations. PloS one. 2014;9(11):e110952. Epub 2014/11/05. doi: 10.1371/journal.pone.0110952 25369287.

21. Hoffmann R, Eikemo TA, Kulhanova I, Dahl E, Deboosere P, Dzurova D, et al. The potential impact of a social redistribution of specific risk factors on socioeconomic inequalities in mortality: illustration of a method based on population attributable fractions. Journal of epidemiology and community health. 2013;67(1):56–62. Epub 2012/07/05. doi: 10.1136/jech-2011-200886 22760220.

22. Stringhini S, Dugravot A, Shipley M, Goldberg M, Zins M, Kivimaki M, et al. Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Med. 2011;8(2):e1000419. Epub 2011/03/03. doi: 10.1371/journal.pmed.1000419 21364974.

23. Troost JP, Rafferty AP, Luo Z, Reeves MJ. Temporal and regional trends in the prevalence of healthy lifestyle characteristics: United States, 1994–2007. American journal of public health. 2012;102(7):1392–8. Epub 2011/11/19. doi: 10.2105/AJPH.2011.300326 22095344.

24. Kurth BM. [The RKI health monitoring—What it contains and how it can be used]. Public Health Forum. 2012;20 (3): 4.e1–4.e3.

25. Hoffmeister H, Bellach BM. [Health of the Germans. A East-West comparison of health data] Berlin: Robert Koch Institute; 1995.

26. Bellach BM, Knopf H, Thefeld W. [The German Federal Health Survey 1997/98]. Gesundheitswesen. 1998;60 Suppl 2:S59–68. 10063725.

27. Scheidt-Nave C, Kamtsiuris P, Gosswald A, Holling H, Lange M, Busch MA, et al. German health interview and examination survey for adults (DEGS)—design, objectives and implementation of the first data collection wave. BMC Public Health. 2012;12:730. doi: 10.1186/1471-2458-12-730 22938722.

28. Finger JD, Busch MA, Du Y, Heidemann C, Knopf H, Kuhnert R, et al. Time Trends in Cardiometabolic Risk Factors in Adults. Dtsch Arztebl International. 2016;113(42):712–9. doi: 10.3238/arztebl.2016.0712 27866566

29. Kamtsiuris P, Lange M, Hoffmann R, Schaffrath Rosario A, Dahm S, Kuhnert R, et al. [The first wave of the German Health Interview and Examination Survey for Adults (DEGS1): sample design, response, weighting and representativeness]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(5–6):620–30. 23703478.

30. Haftenberger M, Heuer T, Heidemann C, Kube F, Krems C, Mensink GB. Relative validation of a food frequency questionnaire for national health and nutrition monitoring. Nutrition journal. 2010;9:36. Epub 2010/09/16. doi: 10.1186/1475-2891-9-36 20840739.

31. World Health Organisation. Global Recommendations on Physical Activity for Health. Geneva: World Health Organisation; 2010.

32. Gaertner B, Buttery AK, Finger JD, Wolfsgruber S, Wagner M, Busch MA. Physical exercise and cognitive function across the life span: Results of a nationwide population-based study. Journal of Science and Medicine in Sport. 2018;21(5):489–94. https://doi.org/10.1016/j.jsams.2017.08.022 28919495

33. Burger M, Bronstrup A, Pietrzik K. Derivation of tolerable upper alcohol intake levels in Germany: a systematic review of risks and benefits of moderate alcohol consumption. Preventive medicine. 2004;39(1):111–27. Epub 2004/06/23. doi: 10.1016/j.ypmed.2003.11.011 15207992.

34. Seitz H, Bühringer G. [Recommendations of the scientific trustees of the German Centre for Addiction Issues (DHS) for the consumption of alcoholic beverages]. Hamm: German Centre for Addiction Issues (Deutsche Hauptstelle für Suchtfragen, DHS); 2010.

35. World Health Organization. Obesity: preventing and managing the global epidemic. Technical Report Series 894. Geneva: World Health Organization; 2000.

36. Eurostat. Eurostat Statistics Explained. International Standard Classification of Education (ISCED) [https://ec.europa.eu/eurostat/statistics-explained/index.php/International_Standard_Classification_of_Education_(ISCED)#Implementation_of_ISCED_2011_.28levels_of_education.29; accessed: 15 October 2018]. Luxemburg: Eurostat; 2018.

37. Rucker V, Wiedmann S, O’Flaherty M, Busch MA, Heuschmann PU. Decline in Regional Trends in Mortality of Stroke Subtypes in Germany From 1998 to 2015. Stroke. 2018;49(11):2577–83. Epub 2018/10/26. doi: 10.1161/STROKEAHA.118.023193 30355214.

38. Organization WH. Noncommunicable Diseases (NCD) Country Profiles: Germany. Geneva: World Health Organization; 2018.

39. Federal Statistical Office (DESTATIS). Causes of death statistics [accessed: 26 March 2019, https://www-genesis.destatis.de/genesis/online;sid=845DED905D0423F7C82E06B923512774.GO_2_1?operation=previous&levelindex=2&levelid=1539699348220&step=2]. Wiesbaden: DESTATIS; 2019.

40. Du Y, Heidemann C, Schaffrath Rosario A, Buttery A, Paprott R, Neuhauser H, et al. Changes in diabetes care indicators: findings from German National Health Interview and Examination Surveys 1997–1999 and 2008–2011. BMJ open diabetes research & care. 2015;3(1):e000135. Epub 2015/12/03. doi: 10.1136/bmjdrc-2015-000135 26629347.

41. Sarganas G, Knopf H, Grams D, Neuhauser HK. Trends in Antihypertensive Medication Use and Blood Pressure Control Among Adults With Hypertension in Germany. American journal of hypertension. 2016;29(1):104–13. Epub 2015/05/15. doi: 10.1093/ajh/hpv067 25968124.

42. Heidemann C, Du Y, Paprott R, Haftenberger M, Rathmann W, Scheidt-Nave C. Temporal changes in the prevalence of diagnosed diabetes, undiagnosed diabetes and prediabetes: findings from the German Health Interview and Examination Surveys in 1997–1999 and 2008–2011. Diabetic medicine: a journal of the British Diabetic Association. 2016;33(10):1406–14. Epub 2015/10/27. doi: 10.1111/dme.13008 26498983.

43. Gose M, Krems C, Heuer T, Hoffmann I. Trends in food consumption and nutrient intake in Germany between 2006 and 2012: results of the German National Nutrition Monitoring (NEMONIT). The British journal of nutrition. 2016;115(8):1498–507. Epub 2016/03/05. doi: 10.1017/S0007114516000544 26934826.

44. Grunert G. [0.5 per mille alcohol limit in road traffic] http://www.verkehrsportal.de/verkehrsrecht/promille.php, accessed: 21 August 2019. Verkehrsportalde. 2019.

45. Koeppe A, Wienemann E. [Alcohol at workplace. A practical guide for executive staff] https://www.dhs.de/fileadmin/user_upload/pdf/Broschueren/Alkohol_am_Arbeitsplatz_BARMER.pdf, accessed: 21 August 2019. Wuppertal: BARMER GEK; 2014.

46. Walther D, Curjuric I, Dratva J, Schaffner E, Quinto C, Schmidt-Trucksäss A, et al. Hypertension, diabetes and lifestyle in the long-term—Results from a swiss population-based cohort. Preventive medicine. 2017;97:56–61. doi: 10.1016/j.ypmed.2016.12.016 28011135.

47. Reeves MJ, Rafferty AP. Healthy lifestyle characteristics among adults in the united states, 2000. Archives of Internal Medicine. 2005;165(8):854–7. doi: 10.1001/archinte.165.8.854 15851634

48. Saint Onge JM, Krueger PM. Health lifestyle behaviors among U.S. adults. SSM—Population Health. 2017;3:89–98. https://doi.org/10.1016/j.ssmph.2016.12.009 28785602

49. Ryu SY, Park J, Choi SW, Han MA. Associations between socio-demographic characteristics and healthy lifestyles in Korean Adults: the result of the 2010 Community Health Survey. Journal of Preventive Medicine and Public Health. 2014;47(2):113. doi: 10.3961/jpmph.2014.47.2.113 24744828.

50. Strauss W, Howe N. Generations: The History of Americas Future, 1584 to 2069. New York: Harper Perennial.; 1991.

51. Kroløkke C, Scott Sørensen A. Three waves of feminism: from suffragettes to grrls. Gender communication theories & analyses: From silence to performance. Thousand Oaks, CA: SAGE Publications; 2006. p. 1–24.

52. United Nations. Women, gender equality and sport. New York: United nations, Division for the Advancement of Women, Department of Economic and Social Affairs; 2007.

53. Flandorfer P, Wegner C, Bube I. Gender Roles and Smoking Behaviour. Vienna: Vienna Institute of Demography, Austrian Academy of Sciences; 2010.

54. Kennedy CL. A New Frontier For Women’s Sports (Beyond Title IX). Gender Issues. 2010;27(1):78–90. doi: 10.1007/s12147-010-9091-y

55. Alonso-Blanco C, Palacios-Cena D, Hernandez-Barrera V, Carrasco-Garrido P, Jimenez-Garcia R, Fernandez-de-Las-Penas C. Trends in leisure time and work-related physical activity in the Spanish working population, 1987–2006. Gaceta sanitaria. 2012;26(3):223–30. Epub 2011/12/27. doi: 10.1016/j.gaceta.2011.07.027 22197322.

56. Busch M, Hapke U, Mensink GBM. [Mental health and healthy lifestyle]. Berlin: Robert Koch Institute; 2011.

57. Blossfeld PN, Blossfeld GJ, Blossfeld H-P. Educational Expansion and Inequalities in Educational Opportunity: Long-Term Changes for East and West Germany. European Sociological Review. 2015;31(2):144–60. doi: 10.1093/esr/jcv017

58. Friebel H. The Children of the Educational Expansion Era in Germany: Education and Further Training Participation in the Life-Course. Br J Sociol Educ. 2008;29(5):479–92.

59. Hoebel J, Kuntz B, Kroll LE, Finger JD, Zeiher J, Lange C, et al. Trends in Absolute and Relative Educational Inequalities in Adult Smoking Since the Early 2000s: The Case of Germany. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco. 2018;20(3):295–302. Epub 2017/04/22. doi: 10.1093/ntr/ntx087 28431153.

60. Hoebel J, Finger JD, Kuntz B, Kroll LE, Manz K, Lange C, et al. Changing educational inequalities in sporting inactivity among adults in Germany: a trend study from 2003 to 2012. BMC Public Health. 2017;17(1):547. Epub 2017/06/08. doi: 10.1186/s12889-017-4478-2 28587641.

61. Van de Mortel TF. Faking it: social desirability response bias in self-report research. Australian Journal of Advanced Nursing, The. 2008;25(4):40.

62. Finger JD, Gisle L, Mimilidis H, Santos-Hoevener C, Kruusmaa EK, Matsi A, et al. How well do physical activity questions perform? A European cognitive testing study. Archives of public health = Archives belges de sante publique. 2015;73:57. Epub 2015/12/03. doi: 10.1186/s13690-015-0109-5 26629340.

63. Lange C, Manz K, Rommel A, Schienkiewitz A, Mensink GBM. Alcohol consumption of adults in Germany. Harmful drinking quantities, consequences and measures. Journal of Health Monitoring. 2016;1(1):2–20. doi: 10.17886/RKI-GBE-2016-029

64. Beullens K, Loosveldt G, Vandenplas C, Stoop I. Response Rates in the European Social Survey: Increasing, Decreasing, or a Matter of Fieldwork Efforts? Survey Methods: Insights from the Field. 2018; doi: 10.13094/SMIF-2018-00003

65. Tolonen H, Helakorpi S, Talala K, Helasoja V, Martelin T, Prättälä R. 25-Year Trends and Socio-Demographic Differences in Response Rates: Finnish Adult Health Behaviour Survey. European Journal of Epidemiology. 2006;21(6):409–15; doi: 10.1007/s10654-006-9019-8 16804763.

66. World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization; 2018.

67. World health Organization. Health in all policies: Helsinki statement. Framework for country action. Geneva: World Health Organization; 2014.


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