View
33
Download
0
Category
Tags:
Preview:
DESCRIPTION
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, - PowerPoint PPT Presentation
Citation preview
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
Prevention for Health – Badenweiler – 25-27 February 2007
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
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
General target group based strategies
Strategies for high-risk individuals
Screening
Interventions for adult and elderly people
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
General target group based strategies
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)
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
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
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
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
Prof. Peter Kronsbein – Hochschule Niederrhein – 26.2.2007
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
Prof. Peter Kronsbein – Hochschule Niederrhein – 26.2.2007
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
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
Prevention for Health – Badenweiler – 25-27 February 2007
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
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
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!
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
Interventions for children and adolescents
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
General target group based strategies
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
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
Source:
www.expertmeeting-hepa.de
Interventions for children and adolescents
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
General target group based strategies
e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district
environment
Screening instruments
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!
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
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
Prevention for Health – Badenweiler – 25-27 February 2007
Interventions for deprived people
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
Sources:
www.planet-wissen.de(Claudia Heidenfelder, 07-11-05)
Ann Intern Med 142: 322, Foto: Karen Tisdel
Interventions for deprived people
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
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
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
General target group based strategies
e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district
environment
Screening instruments
e.g. weighing, measuring, motorial development testing
Strategies for high-risk individuals in order to prevent.. Obesity Motorial
deficits
General target group based strategies
e.g. information in the media, food labelling, sports, eating, exercising and learning at school, urban district
environment
Decisions, commitments, intersectoral cooperation, networking, coordination, legislation
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
EU State
Local coordinator
Province
County/Town
Health claims,
objectives
A
B
C
...
Z
Decisions, commitments, intersectoral cooperation, networking, coordination, legislation
Prevention for Health – Badenweiler – 25-27 February 2007
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
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
P. Kronsbein, Niederrhein University of Applied Sciences - Mönchengladbach/Germany
•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)
Recommended