Scientific Concept of the National Cohort (status ... - Nationale Kohorte

� Cardiovascular diseases
� Diabetes mellitus
� Cancer
� Neurologic and psychiatric diseases
� Respiratory diseases
� Infectious diseases
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A.1 Introduction and overview
The high incidence of these diseases is largely the result of lifestyle factors such as smoking,
alcohol consumption, nutrition, or lack of physical activity, as well as other risk factors
such as chronic infections, occupational and environmental influences, child-bearing patterns,
and hormone use for contraception and for treatment of postmenopausal symptoms.
However, many questions are still open concerning the specificity with which particular risk
factors – and their interactions – cause disease, the pathomechanisms, and the quantitative
importance of risk factors in terms of etiological and population-attributable fractions. In the
National Cohort, therefore, a major emphasis will be placed on the impact of lifestyle and
environmental factors as possible causes of disease, with particular interest in the following
domains:
� Body composition, physical fitness, and related metabolic factors
� Physical activity
� Diet and nutrition
� Psychosocial factors
� Viral and bacterial infections
� Immune status and immune senescence
For the major disease outcomes, table 1.1 provides a series of specific study aims which
are based on our current knowledge. Many of these can be addressed by the National Cohort
in ways that are not possible with currently ongoing prospective studies.
Table 1.1: Selected specific study aims, related to major disease outcomes of interest. These are
examples – based on our current knowledge – demonstrating the scientific potential of the National
Cohort.
Cardiovascular disease (CVD)
� To assess the relations of physical activity, physical fitness, and cardiorespiratory
fitness to subclinical and clinical CVD; to provide more precise estimates of the
relative risk (RR) and attributable fraction of physical activity and physical fitness in
relation to CVD; and to better quantify the relative contributions of physical activity
and cardiorespiratory fitness to understudied cardiovascular outcomes, such as
cerebrovascular diseases, subtypes of stroke, or peripheral arterial disease
� To assess the burden of subclinical left ventricular diastolic and systolic dysfunction
in the general population in Germany; to evaluate the role of subclinical left
ventricular dysfunction for incident cardiac disease; and to identify determinants of
early left ventricular dysfunction and its progression to overt clinical disease
� To assess the associations between cardiac dysfunction and subclinical vascular
disease, cognitive function, and neurodegenerative disease
� To improve risk predictions for subclinical and clinical CVD by identifying novel
A.1