Pischon Lab

The German National Cohort (NAKO) is a multidisciplinary, population-based cohort study that aims to investigate the development and etiology of major chronic diseases, identify risk factors and enhance early detection and prevention of diseases (1,2). From 2014-2019, a total of 205,217 persons aged 20-74 years was recruited and examined at 18 study centers across Germany. Whole-body 3T magnetic resonance imaging (MRI) readings were performed on 30,861 participants at 5 study centers (3). All study participants are being invited for a re-examination, similar to the baseline program, since 2019. Participants are additionally followed-up for incident diseases via questionnaires, health records and disease registries. The first written follow-up questionnaire cycle was completed, and procedures have been developed and initiated to verify incident diseases. A mortality follow-up was established and collection of secondary data from health insurance companies and other registries was initiated.

The NAKO study center Berlin-North at the MDC has recruited and examined 10,110 participants between 2014-2019. The MDC biobank stores part of the biological samples from the 31,202 participants that were recruited by all three Berlin-based study centers (4). In Berlin, 5,926 NAKO participants underwent MRI measurement at a dedicated MRI site run by the MDC that is part of the Berlin Ultrahighfield Facility (led by Thoralf Niendorf).

Scientists can use the web-based NAKO TransferHub (transfer.nako.de) to obtain insight into data dictionary and study population, and to apply for data or biological samples, which are made available on the basis of a Use and Access Policy. The TransferHub was opened in 2022 to scientists from German-speaking countries and opens internationally in 2023.

So far, more than 100 papers with reference to NAKO have been published in national and international journals with peer-review (for selected references see 5-40). In 2020, two special issues of the journal “Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz” (BGB) had been published, which includes results on the first half of NAKO’s baseline examination (5-21).

During the first wave of the COVID-19 pandemic, a questionnaire was developed, circulated, and returned by 161,849 study participants of NAKO to assess changes in daily life and dynamics of the pandemic. Among others, it was shown that depressive and anxiety symptoms increased relative to baseline only in participants under 60 years of age, particularly in young women (38,39). Occupational and financial difficulties were an essential contributing factor (32), with higher infection risks in essential occupations and personal-related services, especially the healthcare sector (30). In 2022, a second COVID-19 questionnaire was sent to NAKO participants, with a particular focus on the assessment of post-COVID and its risk factors.

References

1) German National Cohort Consortium. The German National Cohort: aims, study design and organization. Eur J Epidemiol 2014;29:371-82.

2) Peters A, German National Cohort C, Peters A, et al. Framework and baseline examination of the German National Cohort (NAKO). Eur J Epidemiol 2022;37:1107-24.

3) Bamberg F, Kauczor HU, Weckbach S, et al. Whole-Body MR Imaging in the German National Cohort: Rationale, Design, and Technical Background. Radiology 2015:142242.

4) Steinbrecher A, Mall S, Niendorf T, et al. Gemeinsam forschen für eine gesündere Zukunft. Berliner Ärzte 2015;52:27-9.

5) Ahrens W, Pigeot I, Pischon T. [What makes us sick, what keeps us healthy?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:251-3.

6) Ahrens W, Greiser KH, Linseisen J, Pischon T, Pigeot I. [The investigation of health outcomes in the German National Cohort: the most relevant endpoints and their assessment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:376-84.

7) Ahrens W, Pigeot I, Pischon T. [The foundation has been laid - for improved prevention and early detection of major common diseases]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:373-5.

8) Dragano N, Reuter M, Greiser KH, et al. [Socio-demographic and employment-related factors in the German National Cohort (GNC; NAKO Gesundheitsstudie)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:267-78.

9) Fischer B, Sedlmeier AM, Hartwig S, et al. [Anthropometric measures in the German National Cohort-more than weight and height]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:290-300.

10) Hassenstein MJ, Aarabi G, Ahnert P, et al. [Self-reported infections in the German National Cohort (GNC) in the context of the current research landscape]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:404-14.

11) Holtfreter B, Samietz S, Hertrampf K, et al. [Design and quality control of the oral health status examination in the German National Cohort (GNC)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:426-38.

12) Jaeschke L, Steinbrecher A, Greiser KH, et al. [Assessment of self-reported cardiovascular and metabolic diseases in the German National Cohort (GNC, NAKO Gesundheitsstudie): methods and initial results]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:439-51.

13) Karrasch S, Peters A, Meisinger C, et al. [Lung function in the German National Cohort: methods and initial results]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:322-31.

14) Kluttig A, Zschocke J, Haerting J, et al. [Measuring physical fitness in the German National Cohort-methods, quality assurance, and first descriptive results]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:312-21.

15) Langer S, Horn J, Kluttig A, et al. [Occurrence of bronchial asthma and age at initial asthma diagnosis-first results of the German National Cohort]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:397-403.

16) Leitzmann M, Gastell S, Hillreiner A, et al. [Physical activity in the German National Cohort (NAKO): use of multiple assessment tools and initial results]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:301-11.

17) Nimptsch K, Jaeschke L, Chang-Claude J, et al. [Self-reported cancer in the German National Cohort (NAKO Gesundheitsstudie): assessment methods and first results]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:385-96.

18) Schipf S, Schone G, Schmidt B, et al. [The baseline assessment of the German National Cohort (NAKO Gesundheitsstudie): participation in the examination modules, quality assurance, and the use of secondary data]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:254-66.

19) Schmidt CO, Gunther KP, Goronzy J, et al. [Frequencies of musculoskeletal symptoms and disorders in the population-based German National Cohort (GNC)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:415-25.

20) Wiessner C, Keil T, Krist L, et al. [Persons with migration background in the German National Cohort (NAKO)-sociodemographic characteristics and comparisons with the German autochthonous population]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:279-89.

21) Wolf K, Kraus U, Dzolan M, et al. [Nighttime transportation noise annoyance in Germany: personal and regional differences in the German National Cohort Study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020;63:332-43.

22) Bosquillon de Jarcy L, Akbil B, Mhlekude B, et al. 90K/LGALS3BP expression is upregulated in COVID-19 but may not restrict SARS-CoV-2 infection. Clin Exp Med 2023.

23) Gatidis S, Kart T, Fischer M, et al. Better Together: Data Harmonization and Cross-Study Analysis of Abdominal MRI Data From UK Biobank and the German National Cohort. Investigative Radiology in press:10.1097/RLI.0000000000000941.

24) Merz S, Jaehn P, Pischon T, et al. Investigating people's attitudes towards participating in longitudinal health research: an intersectionality-informed perspective. International journal for equity in health 2023;22:23.

25) Huemer MT, Kluttig A, Fischer B, et al. Grip strength values and cut-off points based on over 200,000 adults of the German National Cohort - a comparison to the EWGSOP2 cut-off points. Age Ageing 2023;52.

26) Kart T, Fischer M, Winzeck S, et al. Automated imaging-based abdominal organ segmentation and quality control in 20,000 participants of the UK Biobank and German National Cohort Studies. Sci Rep 2022;12:18733.

27) Moreno Velasquez I, Jaeschke L, Steinbrecher A, et al. Association of general and abdominal adiposity with postural changes in systolic blood pressure: results from the NAKO pretest and MetScan studies. Hypertens Res 2022;45:1964-76.

28) Tanoey J, Baechle C, Brenner H, et al. Birth Order, Caesarean Section, or Daycare Attendance in Relation to Child- and Adult-Onset Type 1 Diabetes: Results from the German National Cohort. Int J Environ Res Public Health 2022;19.

29) Jaeschke L, Becher M, Velasquez IM, et al. The bias from heaping on risk estimation: effect of age at diagnosis of hypertension on risk of subsequent cardiovascular comorbidities. Ann Epidemiol 2022;74:84-96.

30) Reuter M, Rigo M, Formazin M, et al. Occupation and SARS-CoV-2 infection risk among 108 960 workers during the first pandemic wave in Germany. Scand J Work Environ Health 2022;48:446-56.

31) Kuss O, Becher H, Wienke A, et al. Statistical Analysis in the German National Cohort (NAKO) - Specific Aspects and General Recommendations. Eur J Epidemiol 2022;37:429-36.

32) Dragano N, Reuter M, Peters A, et al. Increase in Mental Disorders During the COVID-19 Pandemic-The Role of Occupational and Financial Strains. Dtsch Arztebl Int 2022;119:179-87.

33) Schuppert C, Kruchten RV, Hirsch JG, et al. Whole-Body Magnetic Resonance Imaging in the Large Population-Based German National Cohort Study: Predictive Capability of Automated Image Quality Assessment for Protocol Repetitions. Invest Radiol 2022;57:478-87.

34) Kleineidam L, Stark M, Riedel-Heller SG, et al. The assessment of cognitive function in the German National Cohort (NAKO) - Associations of demographics and psychiatric symptoms with cognitive test performance. World J Biol Psychiatry 2022:1-15.

35) Schmiedek F, Kroehne U, Goldhammer F, et al. General cognitive ability assessment in the German National Cohort (NAKO) - The block-adaptive number series task. World J Biol Psychiatry 2022:1-12.

36) Streit F, Zillich L, Frank J, et al. Lifetime and current depression in the German National Cohort (NAKO). World J Biol Psychiatry 2022:1-16.

37) Erhardt A, Gelbrich G, Klinger-Konig J, et al. Generalised anxiety and panic symptoms in the German National Cohort (NAKO). World J Biol Psychiatry 2022:1-16.

38) Berger K, Riedel-Heller S, Pabst A, Rietschel M, Richter D, Konsortium N. [Loneliness during the first wave of the SARS-CoV-2 pandemic-results of the German National Cohort (NAKO)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021;64:1157-64.

39) Peters A, Rospleszcz S, Greiser KH, Dallavalle M, Berger K, German National Cohort. The Impact of the COVID-19 Pandemic on Self-Reported Health. Dtsch Arztebl Int 2020;117:861-7.

40) Jaeschke L, Steinbrecher A, Boeing H, et al. Factors associated with habitual time spent in different physical activity intensities using multiday accelerometry. Sci Rep 2020;10:774.