Background: From

Objective: To analyze vitamin D status based on serum 25-hydroxyvitamin D (25OHD) measurements, its determinants and health correlates in a representative sample of German adults. Subjects: A total of 1763 men and 2267 women, 18-to 79-year old, who participated in the representative German National Health Interview and Examination Survey 1998 and the integrated German Nutrition Survey. Results: The median vitamin D intake from both diet and supplements did not meet the recommended level of 5 mg/day, in either men (2.8 mg/day) or women (2.3 mg/day). Altogether 80.9% of men and 88.5% of women had vitamin D intakes below this level. Moderate (12.5-25 nmol/l serum 25OHD levels) and mild (25-50 nmol/l) vitamin D deficiency was prevalent in the adult population in Germany, even in younger age groups. Overall, 57% of men and 58% of women had vitamin D levels below 50 nmol/l. Among 65-to 79-year-old women, the proportion amounted to 75%, even during the sunnier half of the year. In sexspecific multiple linear regression models, independent determinants of serum 25OHD levels consistently included season, vitamin D intake from both diet and supplements, physical activity and living in a partnership. In addition, age and current menopausal hormone use contributed to the model among women, as opposed to time of day of blood sampling and body mass index (marginally) among men. Significantly lower serum 25OHD levels were observed in women with hypertension, cardiovascular diseases and noninsulin-treated diabetes mellitus as well as in men with insulin-treated diabetes mellitus compared with nonaffected participants. Conclusions: Vitamin D deficiency is a public health issue in Germany. We identified a number of determinants with potential for primary prevention of vitamin D deficiency. Risk and benefits of preventive actions need to be examined in further studies.

Acute parvovirus B19 infection is a risk for pregnant women. After vertical transmission the infected fetus may develop hydrops fetalis. Since B19 infection occurs mainly during childhood, children represent a main source for virus transmission. In order to determine whether certain groups in the German population show increased risks for B19 infection we analysed the seroprevalence using 6583 sera collected from adults in former Eastern and Western Germany during the German National Health Survey and 649 sera from healthy Thuringian children and adolescents. In adults the overall seroprevalence was 72.1%, rising from 20.4% in children (1-3 years) and 66.9% in adolescents (18-19 years) to 79.1% in the elderly (65-69 years). Significant differences were observed between females (73.3%) and males (70.9%) and between inhabitants of small (74.8%) and big cities (69.0%) but not between people of the former Eastern (72.8%) and Western states (72.0%) of Germany. For women during childbearing age (18-49 years) highest values were observed in those living together with two or more children (81.6%) and in women with occupational contact with children aged <6 years (88.9%). In contrast seroprevalence was significantly lower in age-matched female singles (64.8%) and in women with occupational contact with children aged >6 years and adolescents (63.8%).

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SUMMARYTo inform current and future vaccination strategies, we describe the seroepidemiology of hepatitis B virus (HBV) infection in ten representative European countries using standardized serology that allowed international comparisons. Between 1996 and 2003, national serum banks were compiled by collecting residual sera or by community sampling ; sera were then tested by each country using its preferred enzyme immunoassays and testing algorithm, and assay results were standardized. Information on current and past HBV vaccination programmes in each country was also collected. Of the ten countries, six reported low levels (<3%) of antibodies against HBV core antigen (anti-HBc). Of the eight countries testing for HBV surface antigen (HBsAg), the highest prevalence was reported in Romania (5 . 6%) and in the remaining seven countries prevalence was <1 %. Universal HBV vaccination programmes had been established in seven countries as recommended by the World Health Organization, but the seroprevalence of antibodies against HBsAg (anti-HBs) was lower than the reported vaccine coverage in three countries. Regular serological surveys to ascertain HBV status within a population, such as reported here, provide important data to assess the need for and to evaluate universal HBV vaccination programmes.

Objective: To analyse the association of alcohol consumption and blood lipids, haemostatic factors, and homocysteine in German adults by gender and age groups. Design: Cross-sectional population-based survey. Setting: Data from the German National Health Interview and Examination Survey 1998, representative for age, gender, community size, and federal state. Subjects: From a sample of 7124 Germans between 18 and 79 y old, 2420 women and 2365 men were selected. Only individuals who were not currently receiving medical treatment or did not have disorders related to cardiovascular disease were selected for this study. Results: Using analyses of variance, mean blood levels of total cholesterol, HDL cholesterol, HDL/total cholesterol ratio, total glycerides, fibrinogen, antithrombin III, and homocysteine adjusted for age, socioeconomic status, East/West Germany residence, body mass index, tobacco use, sports activity, and coffee consumption, if appropriate are presented by alcohol consumption groups (0, 40-10, 410-20, 420-30 and 430 g/day). The HDL/total cholesterol ratio increased with higher alcohol groups up to 10-20 g/day ( þ 15%) for women and 430 g/day ( þ 18%) for men, showing the strongest rise among men aged 55-79 y. Fibrinogen decreased with higher alcohol groups up to 10-20 g/day for women and 20-30 g/day for men. Among women, homocysteine levels showed a U-shaped curve with a minimum of 8.49 mmol/l at 10-20 g alcohol/day (À8%, reference: nondrinking), whereas an inverse association was observed for men. Conclusions: Moderate alcohol consumption is associated with favourable levels of several cardiovascular risk factors. The most favourable cardiovascular risk factor profile among women was observed among those drinking 10-20 g alcohol/day. Beneficial effects seem to be more pronounced among older men.

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In the framework of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a series of clinical chemical parameters was determined in order to provide objective information on health status and particular health risks in addition to parent interview data and anthropometric measurements. In total, 43 parameters covered three areas of particular public health interest: nutrient deficiency, sero-epidemiology of past infectious diseases and immunization status, and risk indicators or risk factors for chronic non-communicable diseases. The parameters were classified into five categories: these reflected the availability of reference ranges or cut-off values that are valid for children and young people, and they also depended on the degree of standardization of each test method. The present paper discusses initial descriptive results for selected parameters representing the various categories. In order to assess the public health significance of the results, and perhaps to derive standard reference ranges relevant to health care, more detailed analyses will be required. As a first step, these will focus on cross-sectional analyses of the association between biochemical parameters and other health-related anthropometric and socio-demographic variables. Intermediate and long-term objectives will include the construction of multidimensional reference ranges taking into account several laboratory parameters and additional clinical information, and the prognostic validation of reference ranges or cut-off values for selected parameters based on follow-up of study participants for clinical outcomes.