Letters to the Editor
In Reply
Dahlmann and Klingmüller raise important points and limitations of our study. We agree that anthropometric individual measurements have limitations, as do indices, especially at the patient related level. We will respond to the matters raised.
The German National Cohort (NAKO) investigates a multitude of diseases and their potential factors of influence (1). In this it differs from other population based cohort studies in terms of its sample size and the level of detail of the information gathered. When designing the study, a balance has to be struck between the extent that is reasonable for participants and what it is financially possible. At the start of the baseline study, adjustments had to be made and, as a consequence, hip circumference—among others—was measured only in a sub-sample. Standardized measurements are ensured as a result of appropriate quality assurance measures (2).
Anthropometric indices certainly have their limitations, and especially the body mass index (BMI) has been the subject of critical discussion for some time. Still, such markers are useful for epidemiologic studies in order to investigate the spread of common diseases and their possible causes. Large cohorts, such as the NAKO, are therefore important for studying the information gained from individual markers and indices in large population groups and specific sub-populations.
The results of the bioelectric impedance analyses in the NAKO study will be presented in greater detail in further publications.
Our study presented between-group differences for BMI, hip and waist circumference, subcutaneous and visceral adipose tissue, and percentage of body fat in equal measures/to an equal extent. Although limited in its representativeness/generalizability, the NAKO is with regard to bioelectric impedance analyses and sonographically measured abdominal fat the first population based cohort that presents such values for Germany in association with health status.
DOI: 10.3238/arztebl.m2024.0141
On behalf of the authors
Michael J. Stein, M.Sc.
Institut für Epidemiologie und Präventivmedizin, Universität Regensburg
michael.stein@ukr.de
Conflict of interest statement
The author declares that no conflict of interest exists.
| 1. | Stein MJ, Fischer B, Bohmann P, et al.: Differences in anthropometric measures based on sex, age, and health status: findings from the German National Cohort (NAKO). Dtsch Arztebl Int 2024; 121: 207–13 VOLLTEXT |
| 2. | Schipf S, Schöne G, Schmidt B, et al.: Die Basiserhebung der NAKO Gesundheitsstudie: Teilnahme an den Untersuchungsmodulen, Qualitätssicherung und Nutzung von Sekundärdaten. Bundesgesundheitsbl Gesundheitsforschung Gesundheitsschutz 2020; 63, 254–66 CrossRef |
