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

Prevention for HealthNutrition 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,

Department for Nutrition and Home Economics

Mönchengladbach/Germany

Working Group 2, 26 February 2007

Our objective: an active healthy life

P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany

Prevention for Health – Badenweiler – 25-27 February 2007

Sources: aid (1999) Fit ab 50 ... durch gesunde Ernährung, p 33;

aid/DGE (2005) Senioren in der Gemeinschaftverpflegung

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

Target groups and levels of preventive measures

• Adult and elderly people

• Children and adolescents

• Deprived people



General target group based strategies

Strategies for high-risk individuals

Screening

Interventions for adult and elderly people




e.g. information in the media, health campaign at place of work, food labelling, sports, events at public places

Screening instruments

for the detection of high-risk individuals

Type 2 Diabetes

Strategies for high-risk individuals in order to prevent..

Cancer

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:

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.

The MAGE - Project

Prof. Peter Kronsbein – Hochschule Niederrhein – 26.2.2007

The MAGE - Project

Development and Implementation of a European Guideline and Training Standards for Diabetes Prevention

The MAGE - Project


Partners involved

• Main partner:

Medical Faculty Carl Gustav Carus, Technical University Dresden

• Associated partners:

27 partners in

13 EU-member-countries

• Collaborating partners:

Israel, Ukraine, Serbia,

FEND, PCD Europe

The MAGE - Project


Specific objectives

• Development of European, practice-oriented guidelines

• Development of a European curriculum for the training of prevention managers

• Development of European standards for the assessment of the occurrence of type-2-diabetes and its known risk factors => key indicators for quality control of preventive measures

• Development of a European e-health training portal for prevention managers

=> European standards applicable in all member states will help to reduce inequalities in health



Source:

Bild-Zeitung 06-02-2007

Foto: JENS KOCH

Johannes Heesters,

Actor,

aged 103

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 1,0025 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 1,0025 to <30 0.91 (0.83 – 1.01)30 to < 35 1.03 (0.91 – 1.17)>35 1.17 (0.94 – 1.47)

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!



Interventions for children and adolescents




e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district

environment

Standards for school meals

... 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 ...

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

Interventions for children and adolescents





environment


e.g. weighing, measuring, motorial development testing

Obesity

Strategies for high-risk individuals in order to prevent..

Motorial deficits

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!



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



Interventions for deprived people



Sources:

www.planet-wissen.de(Claudia Heidenfelder, 07-11-05)

Ann Intern Med 142: 322, Foto: Karen Tisdel

Interventions for deprived people



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

Children Specific persons/ subgroups Women

Accessible measures for all children and adolescents





environment


e.g. weighing, measuring, motorial development testing

Strategies for high-risk individuals in order to prevent.. Obesity Motorial

deficits



environment

Decisions, commitments, intersectoral cooperation, networking, coordination, legislation



EU State

Local coordinator

Province

County/Town

Health claims,

objectives

A

B

C

...

Z

Decisions, commitments, intersectoral cooperation, networking, coordination, legislation



EU State

Local coordinator

Province

County/Town

Health claims,

objectives

A√

B

C

...

Z

I

II

III

√√

√√

√√

√

Siesta in Healthy Adults and Coronary Mortality in the General Population

Data 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 1,00Yes 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 1,00Yes 0.51 (0.32 – 0.83)

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

Documents

health badenweiler

n engl j med

fit ab

prevention of type

lindstrm j et

lindstrom j et

health campaign

durch richtige ernhrung