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Lifestyle and prevention – a challenge for specific interventions in different target groups

Prevention for Health Nutrition and Physical Activity – A Key to Healthy Living 25 – 27 February 2007, Badenweiler/Germany. Lifestyle and prevention – a challenge for specific interventions in different target groups Peter Kronsbein Niederrhein University of Applied Sciences,

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Lifestyle and prevention – a challenge for specific interventions in different target groups

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  1. Prevention for HealthNutrition and Physical Activity – A Key to Healthy Living25 – 27 February 2007, Badenweiler/Germany Lifestyle and prevention – a challenge for specific interventions in different target groups Peter Kronsbein Niederrhein University of Applied Sciences, Department for Nutrition and Home Economics Mönchengladbach/Germany Working Group 2, 26 February 2007

  2. Prevention for Health – Badenweiler – 25-27 February 2007 Our objective: an active healthy life Sources: aid (1999) Fit ab 50 ... durch gesunde Ernährung, p 33; aid/DGE (2005) Senioren in der Gemeinschaftverpflegung P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  3. Prevention for Health – Badenweiler – 25-27 February 2007 Our objective: an active healthy life Sources: aid (1999) Fit ab 50 ... durch gesunde Ernährung, p 33; aid (2005) Fit ab 50 durch richtige Ernährung, p27 (Foto: MEV); aid/DGE (2005) Senioren in der Gemeinschaftverpflegung

  4. Prevention for Health – Badenweiler – 25-27 February 2007 Target groups and levels of preventive measures • Adult and elderly people • Children and adolescents • Deprived people Strategies for high-risk individuals Screening General target group based strategies P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  5. Prevention for Health – Badenweiler – 25-27 February 2007 Interventions for adult and elderly people Strategies for high-risk individuals in order to prevent.. Type 2 Diabetes Cancer Screening instruments for the detection of high-risk individuals General target group based strategies e.g. information in the media, health campaign at place of work, food labelling, sports, events at public places P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  6. Prevention for Health – Badenweiler – 25-27 February 2007 Preventive effects of lifestyle changes on Type 2- Diabetes among persons with impaired glucose tolerance • Tuomilehto J et al (2001) N Engl J Med 344: 1343-51 • DPP-Research Group (2002) N Engl J Med 346: 393-403 • DPP-Research Group (2003) Diabetes Care 26: 36-47 • Lindstrom J et al (2006) Lancet 368: 1673-9 Foto source:aid (2005) Fit ab 50 durch richtige Ernährung, p 7 (Foto: MEV) Prospective controlled intervention studies show positve effects of changes in food choice, weight reduction and increased physical activity: P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  7. Tuomilehto J, Lindström J et al (2001) Prevention of Type 2 Diabetes mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. N Engl J Med 344: 1343-51 n=256 n=250 58% risk reduction for the manifestation of Type 2 Diabetes m. P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  8. Prevention for Health – Badenweiler – 25-27 February 2007 Johannes Heesters, Actor, aged 103 Source: Bild-Zeitung 06-02-2007 Foto: JENS KOCH P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  9. Prevention for Health – Badenweiler – 25-27 February 2007 Results from the U.S. National Health and Nutrition Examination Survey (NHANES I – III) • Sample size: 36,859 subjects, aged > 25 years • Follow-up period: 6-19 years • Relative risk of mortality by BMI category for >70y-stratum: BMI level relative risk (95% confidence interval) <18.5 1.69 (1.38 – 2.07) 18.5 to <25 1,00 25 to <30 0.91 (0.83 – 1.01) 30 to < 35 1.03 (0.91 – 1.17) >35 1.17 (0.94 – 1.47) Ref.: Flegal KM et al (2005) Excess deaths associated with underweight, overweight, and obesity. JAMA 293: 1861-7 Relative risk of mortality by BMI category for >70y-stratum: BMI level relative risk (95% confidence interval) <18.5 1.69 (1.38 – 2.07) 18.5 to <25 1,00 25 to <30 0.91 (0.83 – 1.01) 30 to < 35 1.03 (0.91 – 1.17) >35 1.17 (0.94 – 1.47) P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  10. Prevention for Health – Badenweiler – 25-27 February 2007 Limitations and potential harm of prevention programmes in the elderly • at the General strategies level: At a certain age the message must be: „You are doing all right! Eat and drink whatever you like – and beware of underweight!“ • at the Screening level: We need valid, evidence based Cut-off-points/criterea for the „diagnosis“ You are at high-risk. A need for special preventive intervention always implies individual and economical burden. There have to be good reasons to alarm people in respect to their way of living and to spend money for respective measures! P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  11. Prevention for Health – Badenweiler – 25-27 February 2007 Interventions for children and adolescents ... to know about the great variety of food, ... to gain the skills to prepare tasty and healthy meals; positive impacts on: time management, self- confidence, self-determination ... Standards for school meals General target group based strategies e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district environment P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  12. Prevention for Health – Badenweiler – 25-27 February 2007 There are multifarious and outstanding activities in the development of programmes in the EU Examples for current meetings to interchange experiences: • Our conference „Prevention for Health“ incl. the Exibition • Intern. Expert meeting on Health Enhancing Physical Acticity (HEPA) in children and adolescents in Karlsruhe/Germany – 28 February to 01 March 2007 • Kinder-Kongress in Karlsruhe/Germany – 01-03 March 2007 Source: www.expertmeeting-hepa.de P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  13. Prevention for Health – Badenweiler – 25-27 February 2007 Interventions for children and adolescents Strategies for high-risk individuals in order to prevent.. Obesity Motorial deficits Screening instruments e.g. weighing, measuring, motorial development testing General target group based strategies e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district environment P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  14. Prevention for Health – Badenweiler – 25-27 February 2007 Potential harm of prevention programmes in children and adolecents • at the level of General strategies: If we promote less fat, less sugar, 5-a-day and more physical activity we may support the counterpart of the problem  increasing prevalence of underweight in adolescents • at the level of Screening instruments: Evidence based Cut-off-points/diagnosis criterea! • at the level of Strategies for high risk individuals: No stigmatisation! P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  15. Prevention for Health – Badenweiler – 25-27 February 2007 Steps to implement sustained and effective health prevention programmes • Definition of precise health objectives • Synopsis and further development of measures to meet the defined objectives for the different target groups on general and high-risk level, including the • Evaluation of its efficacy • Assurance of accessibility • Dissemination P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  16. Prevention for Health – Badenweiler – 25-27 February 2007 Interventions for deprived people Sources: www.planet-wissen.de(Claudia Heidenfelder, 07-11-05) Ann Intern Med 142: 322, Foto: Karen Tisdel P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  17. Prevention for Health – Badenweiler – 25-27 February 2007 Interventions for deprived people Children Women Specific persons/ subgroups Target group based health/prevention strategies e.g. family support, information in the media, summer camps; eating, exercising and learning at school; urban district environment, expedient financial support Superior political objectives e.g. education, occupation, shelter and protection P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  18. Prevention for Health – Badenweiler – 25-27 February 2007 Accessible measures for all children and adolescents Strategies for high-risk individuals in order to prevent.. Motorial deficits Obesity Screening instruments e.g. weighing, measuring, motorial development testing General target group based strategies e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district environment General target group based strategies e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district environment P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  19. Prevention for Health – Badenweiler – 25-27 February 2007 Decisions, commitments, intersectoral cooperation, networking, coordination, legislation EU State Province Health claims, objectives A B C ... Z County/Town Local coordinator P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  20. Prevention for Health – Badenweiler – 25-27 February 2007 Decisions, commitments, intersectoral cooperation, networking, coordination, legislation EU State Province Health claims, objectives A√ B C ... Z County/Town √ Local coordinator √ √ √ √ I II III √ √ P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

  21. Siesta in Healthy Adults and Coronary Mortality in the General PopulationData from the Greek component of the European Prospective Investigation into Cancer and Nutrition (EPIC) • Total Greek EPIC cohort followed up till Dec 2005: 26,886 indivduals from all regions of Greece; enrollment: 1994-99; aged 20-86y • Adjusted coronary mortality ratios among men free of serious prevalent diseases at enrollment (n= 9,569) Taking midday naps relative risk (95% confid.interval) No 1,00 Yes 0.51 (0.32 – 0.83) • Conclusion: After controlling for potential confounders, siesta in apparently healthy men is inversely associated with coronary mortality. Ref.: Naska A et al (2007) Arch Intern Med 167: 296-301 • Adjusted coronary mortality ratios among men free of serious prevalent diseases at enrollment (n= 9,569) • Taking midday naps relative risk (95% confid.interval) • No 1,00 • Yes 0.51 (0.32 – 0.83) P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

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