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EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2

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Nutrition plays an important role for health, in particular of children and adolescents. In addition to the baseline German Health Interview and Examination Survey for Children and Adolescents (KiGGS, 2003-2006), the nutrition survey EsKiMo (Eating study as a KiGGS Module) assessed the dietary habits of children and adolescents aged 6 to 17 in detail. In KiGGS Wave 2 (2014-2017) the corresponding module is EsKiMo II. Between June 2015 and September 2017, specially trained nutritionists will visit EsKiMo II participants at their homes. The parents of 6-to 11-year-olds are instructed on how to complete food records on four randomly chosen days - three consecutive days, followed later by an additional day. Participants aged 12 to 17 are interviewed personally on their food intake during the past four weeks with the dietary interview programme DISHES. Further information, for example, regarding dietary supplements is also recorded. EsKiMo II will provide an up-to-date and representative overview of the current nutrition status of 6-to 17-year-olds living in Germany, and it allows analysing changes in dietary behaviour over time. EsKiMo II can identify shortcomings in the nutrition of children and adolescents and thus may contribute with important information to nutrition and health policy.
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Journal of Health Monitoring CONCEPTS & METHODS
EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2Journal of Health Monitoring
Journal of Health Monitoring  (S)
Journal of Health Monitoring
Journal of Health Monitoring ·  (S)
DOI ./RKI-GBE--
Robert Koch Institute, Berlin
Authors:
Gert B.M. Mensink, Marjolein Haftenberger,
Anna-Kristin Brettschneider,
Clarissa Lage Barbosa, Hanna Perlitz,
Eleni Patelakis, Karoline Heide,
Melanie Frank, Franziska Lehmann,
Laura Krause, Robin Houben,
Hans Butschalowsky, Almut Richter,
Panagiotis Kamtsiuris
Journal of Health Monitoring
EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2
Abstract
Nutrition plays an important role for health, in particular of children and adolescents. In addition to the baseline
German Health Interview and Examination Survey for Children and Adolescents (KiGGS, 2003-2006), the nutrition
survey EsKiMo (Eating study as a KiGGS Module) assessed the dietary habits of children and adolescents aged
6 to 17 in detail. In KiGGS Wave 2 (2014-2017) the corresponding module is EsKiMo II. Between June 2015 and
September 2017, specially trained nutritionists will visit EsKiMo II participants at their homes. The parents of
6-to 11-year-olds are instructed on how to complete food records on four randomly chosen days - three consecutive
days, followed later by an additional day. Participants aged 12 to 17 are interviewed personally on their food intake
during the past four weeks with the dietary interview programme DISHES. Further information, for example, regarding
dietary supplements is also recorded. EsKiMo II will provide an up-to-date and representative overview of the current
nutrition status of 6-to 17-year-olds living in Germany, and it allows analysing changes in dietary behaviour over
time. EsKiMo II can identify shortcomings in the nutrition of children and adolescents and thus may contribute
with important information to nutrition and health policy.
NUTRITION · FOOD CONSUMPTION · NUTRIENT SUPPLY · HEALTH MONITORING · KIGGS
1. Background and objective
Eating and drinking are essential for our life, and indi
-
vidual dietary habits have great influence on our physical
and mental health. An adequate diet is particularly impor-
tant for the growth and health development of children
and adolescents. Compared to adults, children require
a higher amount of nutrients per kilogramme of body
weight. Due to their lower body weight and an immune
system which is still developing over the first years of
their life, children constitute a particularly vulnerable
group for the health implications of food contaminated
with pathogens or other harmful substances. Addition-
ally, dietary habits generally develop during childhood
and have implications for people’s dietary behaviour at
adult age [1]. Monitoring potential health risks related to
food intake and improving dietary habits are important
tasks of nutrition and health policy. Keeping track of pop-
ulation dietary behaviour on a regular basis is therefore
necessary.
In the context of the German Health Interview and
Examination Survey for Children and Adolescents
(KiGGS) of the Robert Koch Institute (RKI), a food fre-
quency questionnaire is used for participants aged 3 and
older to obtain both the frequency and the respective
portion size of certain food groups that were consumed

Journal of Health Monitoring EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2 CONCEPTS & METHODS
may be subject to change over time. Data for EsKiMo II
will be collected between June 2015 and September 2017.
EsKiMo II aims to provide an up-to-date overview of the
dietary habits of children and adolescents aged 6 to 17
living in Germany.
2. Methodology
2.1 Study design and sampling
Participants of EsKiMo II are sampled from the cross-sec-
tional study population of KiGGS Wave 2 (aged 6 to 17),
mostly those who took also part in the physical exami-
nation of KiGGS Wave 2, and partly those who only
answered the KiGGS questionnaire. The target popula-
tion and sampling for KiGGS Wave 2 is described in
detail in the article New data for action. Data collection
for KiGGS Wave 2 has been completed in this issue of
the Journal of Health Monitoring. Participants receive a
written invitation to EsKiMo II three to six months after
taking part in KiGGS Wave 2 and about six weeks prior
to the scheduled date of the nutrition survey in their
locality (routes). Participation and appointments for
EsKiMo II are arranged by telephone (Figure 1). During
a route, participants are visited at their homes in paral-
lel at several KiGGS Wave 2 sample points (Figure 2) by
specially trained nutritionists. Like in KiGGS Wave 2, the
order of routes ensures a broad distribution of the
regions visited across Germany within seasons, to
account for seasonal dierences. The survey aims for a
net sample of at least 2,400 children and adolescents.
EsKiMo II received an approval from the ethics com-
mittee of the Hannover School of Medicine (number
during the past four weeks [2, 3]. While this information
does provide an impression of respondents’ regular die-
tary behaviour, it cannot, however, answer more complex
questions, for example to identify deficits in respondents’
nutrient supply.
This led, in the context of the RKI’s KiGGS baseline
study (2003-2006), to the implementation of EsKiMo
(Eating study as a KiGGS Module, referred to as
EsKiMo I in the following), the first representative sur-
vey of the dietary behaviour of children and adolescents
aged 6 to 17 in Germany [4, 5]. Funding was provided by
the Federal Ministry for Consumer Protection, Food and
Agriculture, which today is the Federal Ministry of Food
and Agriculture (BMEL). Given that data collection for
EsKiMo I took place ten years ago, KiGGS Wave 2 (2014-
2017) will include the EsKiMo II module, funded by the
BMEL. The Federal Institute for Risk Assessment (BfR)
will conduct in addition to EsKiMo II a further module
on nutrition (KiESEL – the children’s nutrition survey
module in KiGGS Wave 2), assessing the dietary habits
of children below six years [6].
As a module of the KiGGS study, EsKiMo II will pro-
vide the basis for dierentiated analyses for example of
the relation between dietary habits, socio-demographic
criteria (such as size of town, social status, and educa-
tion), behavioural factors (such as levels of physical activ-
ity, use of media or smoking), as well as a diverse set of
health parameters (biochemical and physiological meas-
urements) and diseases. Some of the planned analyses
will require data collection on food intake to take place
as soon as possible after data collection for KiGGS
Wave 2, since certain parameters (such as blood values)
EsKiMo II
Second Wave of the Eating study as a KiGGS
Module, -
Acronym: EsKiMo - Eating study as a KiGGS
Module
Implementation: Robert Koch Institute
Aim: Providing an up-to-date representative
overview of the dietary habits of children and
adolescents aged  to  in Germany.
Study design: Cross-sectional study based
on a modified diet history interview and food
records
Population: Children and adolescents with
permanent residence in Germany
Sampling: EsKiMo II participants are randomly
selected from the cross-sectional sample of
KiGGS Wave  (registry oce sample). Being
invited to EsKiMo II requires participation in
KiGGS Wave .
Age range:  to  years
Sample size: at least , participants
Survey period: June  - September 
More information in German is available at
www.rki.de/eskimo

Journal of Health Monitoring EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2
Journal of Health Monitoring 2017 2(S3)
CONCEPTS & METHODS
2275-2015). Germany’s Federal Commissioner for Data
Protection and Freedom of Information has been
informed about and has also approved the survey. Par-
ents and guardians of all participants as well as adoles-
cents aged 14 and older have provided their informed
consent to participate in the survey.
2.2 Assessment methods and testing instruments
As in EsKiMo I, dierent assessment instruments are
used for the specific age groups. For children aged 6 to
11, the parents (or guardians) are asked to use weight-
ed food records to record children’s food intake on three
consecutive days, followed by an additional 1-day weight-
ed food record at a later point in time. A randomisation
process is used to determine the recording days. The
minimum timespan between the 3-day-weighted food
record and the 1-day-weighted food record should be
two weeks, the maximum timespan three months. The
parents (or guardians) are instructed on how to record
their children’s food intake. Entries are to include an
exact description of the foods consumed as well as
information on the brand, product name, fat content
Figure 
Organisational process of EsKiMo II
field phases
Own figure
Figure 
Sample points of EsKiMo II
Source: RKI Sample points
Preparatory phase
(- weeks)
Field phase
(- weeks)
Post-processing phase
(- months)
Ages - Invitations
sent out to
participants
Appoint-
ments
arranged
Instructions for the
use of weighted food
records
-day food records
and -day food
record
Data processing and
quality assurance Personal nutrition
analyses
Ages - DISHES interview Data processing and
quality assurance
Adequate nutrition is
essential in ensuring the
healthy development of
children and adolescents.

Journal of Health Monitoring EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2
Journal of Health Monitoring 2017 2(S3)
CONCEPTS & METHODS
food record requires participants to describe meals as
precisely as possible. Parents are asked to discuss the
entries with their children at home. The amounts con-
sumed are estimated based on the picture book or
household measures. The picture book aims to improve
the accuracy of participants’ estimates. It was adapted
for EsKiMo II and contains pictures provided by the
International Agency for Research on Cancer (IARC) and
the Pilot study for the Assessment of Nutrient intake
and food Consumption Among Kids in Europe (PAN-
CAKE) [7, 8]. Parents (or guardians) are also asked to
weigh and record in advance the food and beverages
that children take with them to school, as well as any
leftovers. For children who have school meals, parents
(for example of cheese), the actual amount of food on
the plate, and leftovers (Figure 3). Details on the time
of consumption, place of food preparation/consump-
tion, the state when purchased (for example raw), on
how the meal was prepared, and what type of packag-
ing it came in (for example plastic) are to be recorded
as well. In addition, participants are asked to provide
the recipes of self-prepared meals. Participants are giv-
en kitchen scales and instructions on how to use them,
as well as a picture book showing portion sizes. A sim-
plified version of the food record that children can fill
out themselves is provided for situations where partic-
ipants cannot weigh meals (for example in school can-
teens and/or restaurants). The simplified version of the
Wochentag: (bitte ankreuzen) Mo Di Mi Do Fr Sa So
. Tag
Beim Verzehr Marken name
(Firma) des
Produkts
Produktbeschreibung
(Fettgehalt, zugesetzte
Vitamine u. Mineral-
stoe)
Verpackung
bei Verkauf
Zustand
bei
Einkauf
Zubereitung Mengenangabe
Uhrzeit Ort Art Ort verzehrs-
fertige Menge
(Waage/
Fotobuch)
Restmenge/
Abfall
(Waage)
7:00 z. H. Dr. Oetker Vitalis Knusper Schoko K getr - z. H. 63 g -
+ Arla Friche BioWeidemilch
1,5 % Fett
V gek X - z. H. 127 g -
Becker's Bester Orangensaft G kons - z. H. 211 g 12 g
10:00 K Demeter Apfel, Sorte Elstar - fr X gew,
geschä,
geschn
z. H. 67 g -
12:30 z. H. Barilla Spaghetti aus
Hartweizengrieß
P getr geko z. H. 112 g -
+ Tomatensoße mit Gemüse*
(s. Rezept)
- - geko z. H. 68 g -
Leibniz Keks, Choco Vollmilch K - - - 15 g -
Beispiel Ernährungstagebuch
Figure 
Sample food record page (in German)
Source: RKI
EsKiMo II provides an
up-to-date overview of the
dietary behaviour of
6-to 17-year-olds in Germany.

Journal of Health Monitoring EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2
Journal of Health Monitoring 2017 2(S3)
CONCEPTS & METHODS
lope. On the scheduled date they receive the 1-day-
weighted food record, which is also to be sent back after
completion. After completion, survey participants receive
a personal nutrition analysis and a voucher. The infor-
mation provided in the food records is processed with
(or guardians) are asked to provide the menu where
possible.
Telephone support is available to respond to any pos-
sible question of participants. Participants return the
completed food record to the RKI via a post-paid enve-
Figure 
Example of a DISHES interview mask
(in German)
Source: RKI
The data provide the basis for
comprehensive analyses of
trends in dietary habits over
time of 6-to 17-year-olds.

Journal of Health Monitoring EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2 CONCEPTS & METHODS
3. Discussion and outlook
EsKiMo II will provide again up-to-date representative data
for Germany on the dietary behaviour and nutrient intake
of children and adolescents aged 6 to 17. This overview is
complemented by data on even younger children collect-
ed in the KiESEL survey. This means that a comprehensive
data set on the dietary behaviour of children and adoles-
cents of all ages will be available. For nutrition research,
food and health policy, as well as for the implementation
and evaluation of prevention measures, this data consti-
tutes an important source of information. Besides the
Federal Ministry of Food and Agriculture (BMEL) and the
Robert Koch Institute, further ministries including the
Federal Ministry of Health (BMG), the Federal Ministry for
the Environment, Nature Conservation, Building and
Nuclear Safety (BMUB), and subordinated institutes such
as the Federal Institute for Risk Assessment (BfR), the
German Environment Agency (UBA), as well as the Euro-
pean Food Safety Authority (EFSA) are greatly interested
in up-to-date data on the dietary behaviour of children and
adolescents in Germany. This is because this data helps
to identify deficits in the nutrition situation and to develop
corresponding consumer protection measures.
Because food supply and therefore also dietary be -
haviour are changing constantly, surveys on dietary be -
haviour should be conducted at regular intervals. During
the past years, for example, the number of gluten-free,
vegetarian, and vegan products on oer has increased
significantly. The contents of products such as breakfast
cereals are also regularly modified. Consumption of exotic
products in Germany has increased as a result of the
version 5.3 of the EAT software (Paderborn University)
using the codes of the German Nutrient Database ver-
sion 3.02 [9]. If necessary, discrepancies or missing infor-
mation is clarified by telephone.
With participants aged 12 to 17 a personal dietary inter-
view is conducted during the home visit using the DISHES
software (Dietary Interview Software for Health Examina-
tion Studies). Developed at the RKI, DISHES is a tool to
record regular dietary habits based on a modified diet his-
tory method. This method documents the frequency and
portion size of meals during the past four weeks (Figure 4),
the collected data are internally coded according to the
German Nutrient Database version 3.02 [9]. Portion sizes
are estimated using tableware and the picture book men-
tioned above. The instrument has been validated for
adults [10]. Provided respondents give their consent,
DISHES interviews are recorded digitally to allow sta to
clarify cases where the data provided by participants does
not seem plausible. In exchange, adolescents are remu-
nerated and receive a personal nutrition analysis.
For both age groups, the survey also records details
on school meals, diets, consumption of dietary supple-
ments, as well as information including height and
weight. This final item is important, because height and
weight may be subject to change in the interval between
data collection of KiGGS Wave 2 and EsKiMo II. EsKiMo II
also includes participants who were not previously exam-
ined in the context of KiGGS Wave 2. The participants’
current weight is required to evaluate their diet.
KiGGS Wave 
Second follow-up to the German Health
Interview and Examination Survey for Children
and Adolescents
Data owner: Robert Koch Institute
Aim: Providing reliable information on health
status, health-related behaviour, living condi-
tions, protective and risk factors, and health
care among children, adolescents and young
adults living in Germany, with the possibility
of trend and longitudinal analyses.
Study design: Combined cross-sectional and
cohort study conducted as an examination
and interview survey
KiGGS cross-sec tional study
Population: Children and adolescents with
permanent residence in Germany
Sampling: Samples from ocial residency
registries - randomly selected children and
adolescents from the  cities and municipal-
ities covered by the KiGGS baseline study
Age range: - years
Sample size: Approximately , participants
KiGGS cohort study
Sampling: Re-invitation of everyone who took
part in the KiGGS baseline study (-;
aged between  and  at that time) and who
was willing to participate in a follow-up
Age range:  - years
Sample size: Approximately , follow-up
participants
Survey period: September  - August 
Modules: BELLA, EsKiMo, GerES, KiESEL,
MoMo
More information is available at
www.kiggs-studie.de/english

Journal of Health Monitoring EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2
Journal of Health Monitoring 2017 2(S3)
CONCEPTS & METHODS
dren. Moreover, adolescents in particular spend a lot of
time outside of their homes, which could make filling
out a food record dicult. This is why for this group the
DISHES interview was used.
Home visits will be concluded in September 2017.
A more detailled description of the study design and
methods is available elsewhere [13]. First results for
EsKiMo II will be available in 2018. EsKiMo II results will
be made available to policy-makers, science, and the
interested public. Corresponding publication formats
are being considered, such as project reports, press
releases, and German and English language publications
in academic journals.
Acknowledgement
We would like to thank all participants of EsKiMo II, their
parents, and the entire KiGGS study sta.
References
1. Birch LL (1999) Development of food preferences. Annu Rev
Nutr 19:41-62
2. Mensink GBM, Burger M (2004) Was isst du? Ein Verzehrshäu-
figkeitsfragebogen für Kinder und Jugendliche. Bundesgesund-
heitsbl Gesundheitsforsch Gesundheitsschutz 47(3):219-226
edoc.rki.de/oa/articles/rexKPi8f0KZ3E/PDF/25okAR8peLJI.pdf
(As at 31.07.2017)
3. Truthmann J, Mensink GBM, Richter A (2011) Relative validation
of the KiGGS Food Frequency Questionnaire among adolescents
in Germany. Nutr J 10:133
4. Mensink GBM, Bauch A, Vohmann C et al. (2007) EsKiMo – Das
Ernährungsmodul im Kinder- und Jugendgesundheitssurvey
(KiGGS). Bundesgesundheitsbl Gesundheitsforsch Gesundheits-
schutz 50(5-6):902-908
edoc.rki.de/oa/articles/reEzagAaWOvY/PDF/26r8LhAfE99Dc.pdf
(As at 31.07.2017)
globalisation of trade. This steadily expanding and chang-
ing supply of foods increases the diculties of recording
data on food consumption. Therefore, within EsKiMo II,
food composition information on foods not yet included
in the German Nutrient Database as well as dietary
supplements is continually gathered.
The combination of EsKiMo I (2006) and EsKiMo II
(2015-2017) for the first time enables a comprehensive
analysis of changes in the dietary habits of children and
adolescents in Germany over the past ten years. This is
facilitated by the largely identical design and methods
used in both surveys. The most important dierences
between both surveys are that in EsKiMo II data collec-
tion was one year longer and that food amounts are
weighed instead of estimated. Both of these aspects
ought to be considered when interpreting the results. To
improve diet-related risk assessment, EsKiMo II uses a
3-day-weighted food record and an independent 1-day
food record. EsKiMo is therefore now in line with the
standards of other institutions such as EFSA [11]. All of
the instruments used in EsKiMo II were developed in
close collaboration with the KiESEL study team, a step
that will ensure a high degree of comparability between
both nutrition surveys.
The food record method produces a detailed and com-
plete appraisal of consumed foods. Frequently, however,
food consumption changes while conducting a record.
This method is used for young children, in particular,
because they cannot be interviewed on their dietary
behaviour yet [12]. With adolescents, the willingness to
keep such a diary for three consecutive days is probably
significantly lower than among parents of younger chil-
EsKiMo II is an important
source of information for
nutrition and health policy.

Journal of Health Monitoring EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2
Journal of Health Monitoring 2017 2(S3)
CONCEPTS & METHODS
5. Stahl A, Vohmann C, Richter A et al. (2009) Changes in food and
nutrient intake of 6- to 17-year-old Germans between the 1980s
and 2006. Public Health Nutr 12(10):1912-1923
6. Schweter A, Parreidt N, Lähnwitz C et al. (2015) Kinder-
Ernährungsstudie zur Erfassung des Lebensmittelverzehrs
(KiESEL). UMID 2(2):57-63
7. Ocké M, de Boer E, Brants H et al. (2012) PANCAKE - Pilot study
for the Assessment of Nutrient intake and food Consumption
Among Kids in Europe. European Food Safety Authority. Support-
ing Publications 2012:EN-339
8. Van Kappel A, Amoyel J, Slimani N et al. (1995) EPIC-SOFT pic-
ture book for the estimation of food portion sizes. International
Agency for Research on Cancer, Lyon
9. Hartmann BM, Vásquez-Caicedo AL, Bell S et al. (2008) The Ger-
man nutrient database: Basis for analysis of the nutritional status
of the German population. J Food Compost Anal 21, Supple-
ment:P115-P118
10. Mensink GBM, Haftenberger M, Thamm M (2001) Validity of
DISHES 98, a computerised dietary history interview: energy and
macronutrient intake. Eur J Clin Nutr 55(6):409-417
11. European Food Safety Authority (2009) General principles for the
collection of national food consumption data in the view of a
pan-European dietary survey. EFSA Journal 7(12):1435
12. Livingstone MB, Robson PJ (2000) Measurement of dietary
intake in children. Proc Nutr Soc 59(2):279-293
13. Lage Barbosa C, Brettschneider AK, Haftenberger M et al. (2017)
Comprehensive assessment of food and nutrient intake of
children and adolescents in Germany: EsKiMo II - the Eating
Study as a KiGGS Module. BMC Nutrition 3:75

Journal of Health Monitoring CONCEPTS & METHODS
Publisher
Robert Koch Institute
Nordufer 20
D-13353 Berlin, Germany
Editors
Susanne Bartig, Johanna Gutsche, Dr Franziska Prütz,
Martina Rabenberg, Alexander Rommel, Dr Anke-Christine Saß,
Stefanie Seeling, Martin Thißen, Dr Thomas Ziese
Robert Koch Institute
Department of Epidemiology and Health Monitoring
General-Pape-Str. 62-66
D-12101 Berlin, Germany
Phone: +49 (0)30-18 754-3400
E-mail: healthmonitoring@rki.de
www.rki.de/journalhealthmonitoring-en
Typesetting
Gisela Dugnus, Alexander Krönke, Kerstin Möllerke
Translation
Simon Phillips/Tim Jack
Please cite this publication as
Mensink GBM, Haftenberger M, Brettschneider AK et al. (2017)
EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2.
Journal of Health Monitoring 2(S3):36–44.
DOI 10.17886/RKI-GBE-2017-107
ISSN 2511-2708
Imprint
Journal of Health Monitoring
Author details
Robert Koch Institute
Department of Epidemiology and Health Monitoring, Berlin
Corresponding author
Dr Gert B.M. Mensink
Robert Koch Institute
Department of Epidemiology and Health Monitoring
General-Pape-Str. 62-66
D-12101 Berlin, Germany
E-mail: MensinkG@rki.de
Conflicts of interest
The authors declared no conflicts of interest.
Funding
According to a German Bundestag decision, EsKiMo II was financially
supported by the German Federal Ministry of Food and Agriculture
(BMEL) through the Federal Oce for Agriculture and Food (BLE),
grant number 2814HS004.
Note
External contributions do not necessarily reflect the opinions of the
Robert Koch Institute.
EsKiMo II – the Eating study as a KiGGS Module in KiGGS Wave 2
Journal of Health Monitoring  (S)
The Robert Koch Institute is a Federal Institute within
the portfolio of the German Federal Ministry of Health

This work is licensed under a
Creative Commons Attribution .
International License.
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Article
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Background: As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2), food and nutrient intake of children and adolescents aged 6-17 years living in Germany is assessed in EsKiMo II - the Eating Study as a KiGGS Module. Methods: EsKiMo II is a cross-sectional study, conducted from June 2015 until September 2017. The study population comprises 6 to 17-year-old study participants from the cross-sectional sample of KiGGS Wave 2 in 167 KiGGS sample points, which are revisited by trained nutritionists. Dietary intake is assessed by weighted food records during three consecutive days plus one randomly selected day within the following 3 months for children aged 6-11 years. Dietary intake for adolescents aged 12-17 years is assessed by computer-assisted dietary history interviews, reflecting the past four weeks, using the software DISHES. Further information, for example, about specific diets and dietary supplement intake, is reported during a standardised computer assisted interview for all participants. Food items are coded by the German Food Code and Nutrient Database (BLS 3.02). Discussion: EsKiMo II provides actual data on the dietary behaviour of children and adolescents living in Germany and their determinants. Results of EsKiMo II will be relevant for decision-making, measures, and evaluations within nutrition, consumer and health policy.
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The aim of this study was to determine the relative validity of the self-administered Food Frequency Questionnaire (FFQ) "What do you eat?", which was used in the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS 2003-2006). The validation was conducted in the EsKiMo Nutrition Module, a subsample of KiGGS. The study population included 1,213 adolescents aged between 12 and 17. A modified diet history interview DISHES (Dietary Interview Software for Health Examination Studies) was used as the reference method. In order to compare the food groups, the data assessed with both instruments were aggregated to 40 similar food groups. The statistical analysis included calculating and comparing Spearman's correlation coefficients, calculating the mean difference between both methods, and ranking participants (quartiles) according to food group consumption, including weighted kappa coefficients. Correlations were also evaluated for relative body weight and socioeconomic status subgroups. In the total study population the Spearman correlation coefficients ranged from 0.22 for pasta/rice to 0.69 for margarine; most values were 0.50 and higher. The mean difference ranged between 1.4% for milk and 100.3% for pasta/rice. The 2.5 percentiles and 97.5 percentiles indicated a wide range of differences. Classifications in the same and adjacent quartile varied between 70.1% for pasta/rice and 90.8% for coffee. For most groups, Cohen's weighted kappa showed values between 0.21 and 0.60. Only for white bread and pasta/rice were values less than 0.20. Most of the 40 food groups showed acceptable to good correlations in all investigated subgroups concerning age, sex, body weight and socio-economic status. The KiGGS FFQ showed fair to moderate ranking validity except for pasta/rice and white bread. However, the ability to assess absolute intakes is limited. The correlation coefficients for most food items were similar for normal weight and overweight as well as for different socio-economic status groups. Overall, the results of the relative validity were comparable to FFQs from the current literature.
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To compare the food consumption and nutrient intakes of German children and adolescents in the 1980s with present dietary habits. Two cross-sectional representative surveys, the German National Food Consumption Study (Nationale Verzehrsstudie, NVS) from 1985-8 and the nutrition module 'EsKiMo' of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) from 2006, were analysed for differences in food and nutrient intakes stratified by age and sex groups. Secondary analyses of data from representative observational studies. Children and adolescents aged 6-17 years living in Germany in the 1980s (n 2265) and in 2006 (n 2506). Food consumption was characterised by higher amounts of vegetables/pulses, fruits/nuts and beverages and less meat products/sausages, butter, fats/oils, potatoes/potato products and bread/pastries in 2006 than in 1985-8. The overall changes in food intake were reflected in improvements of macronutrient composition, increased water intake and lower energy density of the diet. Intake of most vitamins and minerals increased in relation to energy intake, but the nutrient density of the diet for vitamins B12 and D decreased. The most critical nutrients observed in NVS and EsKiMo were folate, vitamin D, vitamin A, vitamin E, Ca and Fe. In addition, dietary fibre intake was relatively low and fatty acid and carbohydrate compositions were not favourable. Further efforts will be necessary to improve dietary habits among children and adolescents.
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To estimate the relative validity of a computerised dietary history instrument (DISHES 98). Munich and Berlin. A total of 148 persons aged 19-59 y recruited from two research centres. A relative validation study. Energy and macronutrient intakes obtained with DISHES 98 were compared to those assessed with 3-day weighed dietary records and with a 24 h dietary recall. Intakes of energy, total, saturated and monounsaturated fat, polysaccharides and alcohol were significantly higher and intake of dietary fibre was significantly lower with the 3-day records than with DISHES 98. For intakes of total, animal and vegetable protein, total carbohydrates, mono- and disaccharides and cholesterol the mean difference between DISHES 98 and the 3-day dietary records was less than 5% of the intake with DISHES 98. Pearson's correlation coefficients between DISHES 98 and 3-day records varied from 0.34 for intake of polyunsaturated fat to 0.69 for intake of disaccharides and from 0.27 for polyunsaturated fat to 0.65 for total carbohydrates between DISHES 98 and the 24 h recall. The proportion of participants classified into the same or adjacent quintile of intake varied between 66.9% for polyunsaturated fat and 90.4% for alcohol comparing DISHES 98 and 3-day records and between 60.2% for polyunsaturated fat and 78.4% for total carbohydrates comparing DISHES 98 and 24 h recalls. The observed differences between DISHES 98 and the other methods are in an acceptable range for assessing dietary intake in epidemiologic studies.
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The German Nutrient Database (BLS) is the basis to determine the energy and nutrient intake for nutrition surveys in Germany. Food composition and food consumption data must be closely intertwined. The BLS receives direct feedback from food consumption surveys and is able to rapidly react by reviewing existing food composition data and adding information on new food items. Currently, the BLS is in a transition stage from a food composition database to a central facility for a national nutrient data network. Accordingly, the database has been technically improved, including the BLS gateway and a new online computation and cooperation platform for data generation and networking. The BLS is positioned as a trendsetting database. The aims are compilation of coherent nutrient data, development of flexible data structures, application of state-of-the-art data software and cooperation with national and international nutrient data networks.
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Im Rahmen des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) wurde von Januar bis Dezember 2006 in einem Modul das Ernährungsverhalten von 6- bis 17-Jährigen erfasst. Die Studie mit dem Namen EsKiMo (Ernährungsstudie als KiGGS-Modul) wurde vom Robert Koch-Institut (RKI) gemeinsam mit der Universität Paderborn, Fachgruppe Ernährung und Verbraucherbildung, durchgeführt und vom Bundesministerium für Ernährung, Lebensmittel und Verbraucherschutz finanziert. Die Eltern der teilnehmenden Kinder unter 12 Jahren wurden gebeten, gemeinsam mit ihrem Kind ein 3-Tage-Verzehrsprotokoll zu führen. Die älteren Kinder wurden persönlich mit Hilfe von DISHES (Dietary Interview Software for Health Examination Studies) zu ihrer Ernährung in den letzten 4 Wochen befragt. Außerdem sollten sie einen bereits im KiGGS eingesetzten Ernährungsfragebogen (Food Frequency Questionnaire) ein zweites Mal ausfüllen. Zusätzlich kam bei allen Teilnehmern ein Kurzfragebogen zum Einsatz, in dem unter anderem soziodemographische Daten, Aspekte der Freizeitgestaltung, Supplementeinnahme, Verpflegung in der Schule sowie Körpergröße und -gewicht erhoben wurden. Die Studie wird aktuelle, repräsentative Daten zur Ernährung von Kindern und Jugendlichen in Deutschland liefern. Diese werden sowohl hinsichtlich der Lebensmittelverzehrsmengen als auch Nährstoffversorgung ausgewertet. Durch die Verbindung der Ernährungsdaten mit den im KiGGS erhobenen Gesundheitsdaten sind außerdem umfangreiche Analysen zum Zusammenhang zwischen Ernährung und Gesundheit möglich.
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Using a developmental systems perspective, this review focuses on how genetic predispositions interact with aspects of the eating environment to produce phenotypic food preferences. Predispositions include the unlearned, reflexive reactions to basic tastes: the preference for sweet and salty tastes, and the rejection of sour and bitter tastes. Other predispositions are (a) the neophobic reaction to new foods and (b) the ability to learn food preferences based on associations with the contexts and consequences of eating various foods. Whether genetic predispositions are manifested in food preferences that foster healthy diets depends on the eating environment, including food availability and child-feeding practices of the adults. Unfortunately, in the United States today, the ready availability of energy-dense foods, high in sugar, fat, and salt, provides an eating environment that fosters food preferences inconsistent with dietary guidelines, which can promote excess weight gain and obesity.
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When children and adolescents are the target population in dietary surveys many different respondent and observer considerations surface. The cognitive abilities required to self-report food intake include an adequately developed concept of time, a good memory and attention span, and a knowledge of the names of foods. From the age of 8 years there is a rapid increase in the ability of children to self-report food intake. However, while cognitive abilities should be fully developed by adolescence, issues of motivation and body image may hinder willingness to report. Ten validation studies of energy intake data have demonstrated that mis-reporting, usually in the direction of under-reporting, is likely. Patterns of under-reporting vary with age, and are influenced by weight status and the dietary survey method used. Furthermore, evidence for the existence of subject-specific responding in dietary assessment challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Unfortunately, the ability to detect mis-reporters, by comparison with presumed energy requirements, is limited unless detailed activity information is available to allow the energy intake of each subject to be evaluated individually. In addition, high variability in nutrient intakes implies that, if intakes are valid, prolonged dietary recording will be required to rank children correctly for distribution analysis. Future research should focus on refining dietary survey methods to make them more sensitive to different ages and cognitive abilities. The development of improved techniques for identification of mis-reporters and investigation of the issue of differential reporting of foods should also be given priority.
Was isst du? Ein Verzehrshäufigkeitsfragebogen für Kinder und Jugendliche
  • GBM Mensink
  • M Burger
Mensink GBM, Burger M (2004) Was isst du? Ein Verzehrshäufigkeitsfragebogen für Kinder und Jugendliche. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 47(3):219-226 edoc.rki.de/oa/articles/rexKPi8f0KZ3E/PDF/25okAR8peLJI.pdf (As at 31.07.2017)
KinderErnährungsstudie zur Erfassung des Lebensmittelverzehrs (KiESEL)
  • A Schweter
  • N Parreidt
  • C Lähnwitz
Schweter A, Parreidt N, Lähnwitz C et al. (2015) Kinder-Ernährungsstudie zur Erfassung des Lebensmittelverzehrs (KiESEL). UMID 2(2):57-63