PurposeThe COVID-19 pandemic and containment measures disrupted daily life and worsened mental health. Stress, a key driver of mental disorders, likely intensified during this period. However, longitudinal studies tracking stress trajectories in the general population remain limited. This study aims to identify psychosocial stress trajectories from the pre- to post-pandemic period and examine associated characteristics in a population-based sample from a German city.Methods966 participants from the German National Cohort study-centre in Halle (240,000 inhabitants in Eastern Germany) were included. Those participated in a six-monthly intensified assessment and completed at least four questionnaires between 2019 and 2024 containing the PHQ-Stress module. First, latent class mixed models analysis identified heterogeneous stress trajectories. Second, associations between the most likely class membership and covariates were tested with multinomial and binomial logistic regressions.ResultsWe identified four psychosocial stress trajectory classes. Most participants followed a resilient trajectory (82%), while others showed chronic (4%), recovered (5%), or delayed (9%) trajectories. Membership in the resilient trajectory was associated with lower pre-pandemic psychological vulnerability, higher life satisfaction, greater agreeableness, and older age.ConclusionResilience predominated, while smaller subgroups showed less adaptive trajectories, with prior stress levels shaping long-term patterns. These findings demonstrate heterogeneity in stress responses and support the applicability of resilience frameworks such as Bonanno's.

BACKGROUND:The German National Cohort (NAKO Gesundheitsstudie) is a prospective cohort study with 205 053 participants. Its goal is to investigate risk factors for chronic diseases, including cancer. METHODS:We describe the methods of ascertaining cancer cases in NAKO (linkage with cancer registries and self-reporting), the incidence and prevalence figures obtained so far, and the ratio of observed to expected (O/E) case numbers. RESULTS:Altogether, 2774 prevalent (diagnosed within the 5 years prior to study enrollment) and 4295 incident (diagnosed up to 5 years after enrollment) cancer cases were identified. Breast, prostate, lung, and colorectal cancers made up 55% of the incident cases. Fewer incident cases were found than would have been expected on the basis of incidence rates in the general population (O/E ratio 0.80, 95% confidence interval [0.76;0.83] for the first 2 years of prospective follow-up). The O/E ratio varied, however, across tumor sites (breast 1.02, prostate 1.12, lung 0.38, colorectal 0.62). Possible explanations include bias caused by the fact that most study participants were healthy, delayed tumor reporting, incomplete data linkage, and incomplete self-reporting. CONCLUSION:Rising case numbers for the most commonly occurring types of cancer are expected in the next few years. This will enable comprehensive epidemiological analysis of the risk factors for cancer.

Background For early detection of breast cancer, clinical palpation of the breast is offered yearly to all women aged 30 and older, and the German Mammography Screening Programme (MSP) offers biennial mammograms to all women aged 50 to 75 years. We investigated the utilization of both screening methods across various migrant groups in Germany, as well as the effect of German language proficiency. Methods Cross-sectional data on participation frequencies from the baseline examination (2014 to 2019) of more than 100,000 women of the German National Cohort study (NAKO) were analysed by migrant status. Adjusted logistic regression analyses were conducted for palpation and MSP to compare screening uptake among six migrant groups, and non-migrant population. Results Palpation of the breast was less frequently utilized in all migrant groups with odds ratios ranging from 0.5 (95% CI 0.4-0.6) for Turkish women to 0.9 for women from western countries (95% CI 0.7-1.1) compared to autochthone Germans. Lower German language proficiency further decreases its use. In contrast, odds ratios for MSP participation did not differ substantially compared to Germans ranging from 0.8 to 1.2. German language proficiency had little effect on MSP participation. Discussion In contrast to earlier studies, our findings suggest that MSP participation and motivation does not significantly differ by migration status or language skills. This may indicate that information on MSP is broadly accessible through established invitation procedures in Germany. However, lower uptake of breast palpation by a physician in some migrant populations highlights potential gaps in broader preventive care engagement.

Background Albuminuria even at low levels and increased arterial stiffness are associated with higher cardiovascular risk. Very low-grade albuminuria (VLGA; urinary albumin–creatinine ratio [uACR] <30 mg/g) has been linked to adverse outcomes, but its association with arterial stiffness in the general population, particularly among individuals without major cardiometabolic disease, remains uncertain. Methods We analyzed data from 7613 participants of the German National Cohort (NAKO) with available uACR and brachial–ankle pulse wave velocity (PWV[ba]) measurements. Multivariable linear regression was used to assess the association between log₁₀-transformed uACR and PWV(ba), adjusting for age, sex, systolic blood pressure, obesity indices, LDL-cholesterol, HbA1c, and estimated glomerular filtration rate (eGFR). A low-risk subgroup excluded participants with arterial hypertension or diabetes mellitus. Results Among included participants, 49.6 % were female and 7100 (93.3 %) had uACR <30 mg/g. In the full cohort, a 10-fold higher uACR was associated with higher PWV(ba) by 0.10 m/s (95 % CI 0.03–0.17). Similar associations were observed in the VLGA subgroup (0.16 m/s; 95 % CI 0.07–0.25). In the low-risk VLGA subgroup (n = 4308), uACR remained positively associated with PWV(ba) (0.18 m/s per 10-fold higher uACR; 95 % CI 0.08–0.28). Conclusion Higher uACR was consistently associated with greater arterial stiffness across the full cohort and among individuals with very low-grade albuminuria, including those without arterial hypertension or diabetes mellitus.

Subjective and objective markers are important in describing healthy aging, yet little is known about their relationships. This study analysed the time-dependent association of dehydroepiandrosterone sulfate (DHEAS) with subjective health. At baseline, DHEAS was measured in participants aged 45-83 randomly selected from the general population. Subjective mental and physical health were assessed using the 12-item Short Form (SF-12) questionnaire at baseline and two follow-ups. In sex-specific linear regression models controlled for age, weight, tobacco consumption, Charlson Comorbidity Index, depression, and testosterone levels, the associations of DHEAS with the subscores of the SF-12 were analysed. DHEAS showed a positive cross-sectional association with subjective physical health, which was stronger in women and remained relevant after multivariable adjustment. However, longitudinal analyses revealed no long-term effect of DHEAS on subjective health. These findings suggest that the association between DHEAS and subjective physical health is temporary and that an underlying causality is unlikely.

In humans, uric acid is a product of purine metabolism that impacts the vascular system. In addition to effects on arterial vascular tone, associations between serum uric acid concentrations—even in the physiological range—and arterial hypertension and vascular-mediated end-organ damage due to an impact on vascular stiffness have been postulated. Therefore, we aim to investigate a possible cross-sectional association between serum uric acid concentrations in the physiological range and differences in arterial pulse wave velocity (PWV), an indicator of vascular remodeling, with a focus on possible differences between female and male individuals. We analyzed cross-sectional phenotypic and laboratory parameters, including PWV from 70,649 individuals in the population-based German National Cohort (NAKO) in a sex-specific manner. In parallel, we applied a machine learning approach to identify and quantify factors associated with PWV in a hypothesis-free manner. Our analysis uncovered a positive association between serum uric and PWV which was detected even if only individuals with urate values in the physiological range were included (n = 64,095). This correlation was more pronounced in women than in men. In multivariable linear regression models, we observed an association of uric acid (mmol/l) with PWV (m/s) of β = 1.12 (95

Physical activity supports weight regulation and metabolic health, but its timing in relation to obesity and diabetes remains unclear. We aimed to assess the diurnal timing of physical activity and its association with obesity and diabetes. We cross-sectionally analyzed hip-worn accelerometry data from 61,116 participants aged 20–75 in the German National Cohort between 2015 and 2019. We divided physical activity into sex- and age-standardized quartiles of total morning (06:00–11:59), afternoon (12:00–17:59), evening (18:00–23:59), and nighttime (00:00–06:00) physical activity. Using multivariable logistic regression, we estimated associations of physical activity timing with obesity (BMI ≥ 30.0 kg/m2) and diabetes (self-reported or HbA1c ≥ 6.5

Abstract Background Despite considerable improvements in oral health in recent decades, caries and periodontitis are still widespread, ranking among the most prevalent diseases worldwide and requiring future research. The German National Cohort (NAKO Gesundheitsstudie, NAKO) is a large-scaled, multidisciplinary, nationwide, multi-centre, population-based, prospective cohort study with oral examinations that aims to provide a resource to study risk factors for major diseases. The aim of the present article is to provide the methodological background, to report on the data quality, and to present initial results of the oral examinations. Methods During baseline examinations (2014–2019), a total of 205,184 persons aged 19–74 years has been examined in 18 study centres, including, among others, a dental interview, stimulated saliva sampling, and recording of the numbers of present teeth and prostheses (standard Level 1 program). As part of the Level 2 program that was offered to 20% randomly selected participants, each study centre selected one of three modules, one of them being the Level 2 oral examination. This extended program was carried out in a subgroup of 20,828 participants, including collection of detailed information on the dental and prosthetic status as well as on periodontal, cariological and functional aspects. To ensure reliability and reproducibility, study nurses were trained and calibrated by dental experts. In addition, a reliability study was conducted among 794 Level 1 and 359 Level 2 participants, reporting intra class correlation and kappa coefficients. Results Intra class correlation and kappa coefficients for observer agreement and reliability were consistently above 0.7, indicating good to excellent reliability of all dental measurements. For example, intra class correlation was 0.937 for the number of present teeth (Level 1), 0.740 for mean probing depth (PD) and 0.797 for active mouth opening. An initial inspection of the data showed that the median number of present teeth was 27, of which on average 6.9 teeth were healthy and caries-free. Average mean PD was 1.92 mm. An orthodontic treatment was reported by 35.5% of participants. Discussion Overall, the dental study protocol was feasible and successfully integrated into the NAKO’s overall assessment program. However, rigorous support of the study centres by dental professionals was required to ensure high quality data. In summary, high-quality data collection within the NAKO pave the way for future investigation of potential risk factors for oral diseases and links between oral and systemic diseases and conditions.

Zusammenfassung Die körperliche Fitness ist das Maß für die individuelle Fähigkeit, körperlich aktiv zu sein. Ihre wesentlichen Komponenten sind die kardiorespiratorische Fitness (Cardiorespiratory Fitness, CRF), die Muskelkraft und die Beweglichkeit. Neben der körperlichen Aktivität ist die körperliche Fitness ein wesentlicher Prädiktor für Morbidität und Mortalität. Ziel der Arbeit sind die Beschreibung der Erhebungsmethoden körperlicher Fitness in der NAKO Gesundheitsstudie und die Darstellung erster deskriptiver Ergebnisse. In der NAKO-Basiserhebung wurden die maximale Handgreifkraft (Grip Strength, GS) und die CRF als Komponenten der körperlichen Fitness über ein Handdynamometer bzw. über einen Fahrradergometertest mit submaximaler Belastung erhoben. Daraus wurde die maximale Sauerstoffaufnahme (VO 2max ) zur Beurteilung der CRF abgeleitet. Die Ergebnisse von insgesamt 99.068 GS-Messungen und 3094 Messungen der CRF beruhen auf einem Datensatz zur Halbzeit der Basiserhebung der NAKO (Alter 20–73 Jahre, 47 % Männer). Männer zeigten im Vergleich zu Frauen höhere Werte der körperlichen Fitness (Männer: GS = 47,8 kg, VO 2max = 36,4 ml·min −1 · kg −1 ; Frauen: GS = 29,9 kg, VO 2max = 32,3 ml·min −1 · kg −1 ). Ungefähr ab dem 50. Lebensjahr konnte ein Rückgang der GS verzeichnet werden, wohingegen die CRF ab der Altersgruppe 20–29 Jahre bis zu den ≥60-Jährigen kontinuierlich abfiel. Die GS und die VO 2max zeigten nach Korrektur für das Körpergewicht einen linear positiven Zusammenhang (Männer β = 0,21; Frauen β = 0,35). Die Analysen zeigten eine gute Übereinstimmung der Verteilung der körperlichen Fitness in der NAKO im Vergleich zu anderen bevölkerungsbasierten Studien. Zukünftige Auswertungen werden insbesondere die unabhängige Bedeutung der GS und CRF bei der Prädiktion von Morbidität und Mortalität beleuchten.

The German National Cohort (NAKO) is the largest population-based epidemiologic cohort study in Germany and investigates the causes of the most common chronic diseases. Between 2014 and 2019, a total of 1.3 million residents aged 20-69 years from 16 German regions were randomly selected from the general population and invited to participate following a highly standardized recruitment protocol. The overall response was 15.6% and differed considerably across study centers (7.6-30.7%). Females were more likely to participate than males (17.5% vs. 14.1%) and participation increased with age (10.2% in age group " < 29 years" up to 20.7% in age group " > 60 years"). Across all study regions, response was highest in rural areas (22.3%), followed by towns and suburbs (17.2%), and was lowest in cities (14.5%). Compared with the general population in the respective study regions, participants with low and medium education are underrepresented in the NAKO sample, while highly educated participants are overrepresented. Participants with non-German nationality and with a migration background are also underrepresented. Participants living in single households are underrepresented, while participants from larger households (2 or more persons) are overrepresented compared to the general population. Survey weights are made available to researchers along with the study data that account for the sampling design and adjust for differences in the distribution of age, sex, nationality (German vs. non-German), migration status, education, and household size.

Background Using data from the largest German cohort study, we aimed to investigate sex differences in the relationship of socioeconomic position (SEP) with cardiovascular disease (CVD), CVD risk factors, and estimated CVD risk. Methods and Results A total of 204 780 (50.5% women) participants from the baseline examination of the population‐based NAKO (German National Cohort) were included. Logistic, multinomial, and linear regression models were used to estimate sex‐specific odds ratios (ORs) and β coefficients with 95% CIs of CVD, CVD risk factors, and very high‐risk score (Systemic Coronary Risk Estimation‐2) for CVD associated with SEP. Women‐to‐men ratios of ORs (RORs) with 95% CIs were estimated. In women compared with men, low versus high SEP (educational attainment and relative income) was more strongly associated with myocardial infarction, hypertension, obesity, overweight, elevated blood pressure, antihypertensive medication, and current alcohol consumption, but less strongly with current and former smoking. In women with the lowest versus highest educational level, the OR for a very high 10‐year CVD risk was 3.61 (95% CI, 2.88–4.53) compared with 1.72 (95% CI, 1.51–1.96) in men. The women‐to‐men ROR was 2.33 (95% CI, 1.78–3.05). For the comparison of low versus high relative income, the odds of having a very high 10‐year CVD risk was 2.55 (95% CI, 2.04–3.18) in women and 2.25 (95% CI, 2.08–2.42) in men (women‐to‐men ROR, 1.31 [95% CI, 1.05–1.63]). Conclusions In women and men, there was an inverse relationship between indicators of SEP and the likelihood of having several CVD risk factors and a very high 10‐year CVD risk. This association was stronger in women, suggesting that CVD risk is more strongly influenced by SEP in women compared with men.

BACKGROUND:Allostatic load (AL) is a surrogate of the physiological response to stress and reflects the 'wear and tear' on the body. Previous studies indicated that socioeconomic and behavioral determinants influence AL, which in turn is associated with health outcomes. Therefore, AL is increasingly used to operationalize the relationship between social inequality, stress, and health outcomes. This study aimed to investigate associated factors and patterns of AL in the population over a 20-year period using data from the CARLA cohort. METHODS:The analysis included 473 participants from the CARLA study (Cardiovascular Disease, Living and Ageing in Halle), aged 45-80 years at baseline. From recruitment in 2002 in Halle (Saale), three follow-up examinations took place until 2022. We calculated AL scores as the sum of standardized z-scores for metabolic, immune, cardiovascular, and anthropometric components. Descriptive statistics of AL scores were stratified by sex and age categories. Multiple regression analyses were conducted for the first and third follow-up to assess if there were changes in associations between sociodemographic factors and AL. RESULTS:Average AL scores of men decreased, while women's AL scores returned to baseline levels after an initial decrease observed at the first follow-up. Stratified analyses of AL scores revealed that women in the younger age cohorts had lower mean AL scores at baseline than men (women: -3.47, 95% CI [-4.24; -2.71] vs. men: -1.13, 95% CI [-1.84; -0.42] at age <55). At the same time, women showed higher mean AL scores than men in older age cohorts (women: -0.32, 95% CI [-1.58; 0.95] vs. men: -0.93, 95% CI [-1.99; 0.14] at age 65-<70). Results of multiple regression models indicated lower AL scores for women (β: -1.21, 95% CI [-1.93, -0.49]). Professional status was associated with lower AL scores for men but not for women (β: -1.06, 95% CI [-2.02, -0.11] for men). Further, physical activity was negatively associated with AL scores for the total study sample and for women (β: -0.54, 95% CI [-0.82, -0.26]) for total sample and β: -0.74, 95% CI [-1.17, -0.32] for women). CONCLUSION:Our results highlight the importance of health awareness and physical activity for overall health, assessed by AL. Distinct AL score changes and sex-specific socioeconomic influences offer insights into sex-related patterns of aging. Further research is needed to understand the underlying mechanisms of socioeconomic influences on stress-related aging processes between sexes.

OBJECTIVE:This cross-sectional study examined a Lifestyle Risk Factor Index (LSRI) in relation to adiposity measures including visceral adipose tissue (VAT) in the German National Cohort (NAKO). METHODS:Based on self-reports at baseline among 30,920 of > 205,000 NAKO eligible participants with magnetic resonance imaging (MRI) scans, one point each for not smoking, adhering to ≥ 3/7 diet recommendations, consuming ≤ 1 (women)/≤ 2 (men) alcoholic drinks/day, and ≥ 150 min/week physical activity was assigned. VAT volume, obtained from whole-body MRI at 3T, was analyzed by deep learning-based image segmentation. General linear models estimated adjusted geometric mean adiposity measures by LSRI and stratified analyses by sex and BMI. RESULTS:Of 18,508 participants aged 48.2 ± 12.2 years, the respective proportions for 0/1, 2, 3, and 4 LSRI points were 7%, 24%, 51%, and 18%. Participants with LSRI scores of 4 versus 0/1 had lower adjusted geometric mean volumes of VAT (2.3; 95% CI 2.2, 2.3 vs. 3.0; 95% CI 2.9, 3.1 L). These differences were slightly attenuated after adding BMI. This association was weaker for individuals with obesity than normal/overweight. CONCLUSION:A combination of lifestyle factors appears to be associated with lower VAT volume, but an elevated BMI may have a greater influence on VAT accumulation than lifestyle behaviors alone.

Moderately elevated albumin excretion in the urine, semiquantified by the urine albumin-creatinine ratio (uACR), has been shown to increase the risk for vascular or renal end-points in patients with diabetes mellitus, arterial hypertension, high cardiovascular risk, or even the general population. The mechanisms behind this relation are still under debate. Pulse wave velocity (PWV) is a marker of arterial stiffness, which includes endothelial function. In patients with renal disease, a relation between uACR and enhanced PWV was described. Until now such relation has not been extensively studied in an average risk, low morbidity cohort. We cross-sectionally studied individuals participating in a local subcohort of the German National Cohort (NAKO), a large population-based cohort that recruited participants aged 19–74 years. Urinary albumin-creatinine ratio was determined from a spontaneously voided sample and pulse wave velocity was measured using a plethysmographic device (Vascular ExplorerTM) with cuffs at the upper arm and the ankle. The PWV was compared between categories auf uACR (0–<30 mg/g, 30–<300 mg/g and 300+ mg/g) by ANOVA. Further, a multivariate linear model corrected for age, BMI, eGFR, and HbA1c was analyzed. Complete data sets were available from 4,798 individuals of the local cohort, 51% male, age 50.3 ± 12.9 years, body mass index 26.9 ± 4.9 (mean ± SD). Among these participants, 207 (4.3%) reported a history of cardiac disease, 112 (2.3%) of peripheral artery disease, 353 of diabetes mellitus (7.4%), and 117 (2.4%) of kidney disease, 4.048 (84.3%) reported none of these conditions. The average uACR was 17.6 ± 152.9 mg/g with 341 (7.1%) participants showing a value above 30 mg/g. The average eGFR was 99.0 ± 15.2 ml/min with 65 (1.4%) participants showing eGFR <60 ml/min. The PWV was slightly higher in participants with uACR >30 mg/g than in those with uACR <30 mg/g (P < 0.001) (Fig. 1). The uACR was predictive for PWV in multivariate analysis correcting for typical vascular risk factors. Sensitivity analysis showed that this relation still held true after excluding individuals who reported a history of vascular, metabolic or renal disease. Albuminuria is associated with elevated pulse wave velocity in a population-based cohort with low metabolic, vascular, and renal disease load. Further studies should address the role of low-level albuminuria in the absence of overt cardiovascular disease.

Introduction:Previous studies provided inconclusive results regarding the effects of aging on the ability to flexibly switch between task rules (local switch cost). The goal of the present study was to investigate the influence of age on the local switch costs at two levels of difficulty (easy task switching: two task rules vs. difficult task switching: four task rules). Methods:The local switch costs, i.e., reaction time and error differences between trials with a task switch and task repetition relative to the previous trial, were compared in a group of young adults (19 to 33 years) and three groups of older adults (64-72; 73-80; 82-97 years). Results:The analysis of the switch costs showed significantly higher switch costs of the three groups of older adults compared to the younger adults and the effect was more pronounced in the difficult task switching than in the easy task switching. At the same time, there were no clear differences in the local switch costs between the three groups of older adults. Discussion:The results showed that even after the age-related slowdown was taken into account, age differences in local switch costs will emerge when the age range of older adults is extended and task difficulty is sufficiently high. These findings contribute to our understanding of how and when age differences in cognitive flexibility emerge and suggest that complex multitasking environments may disproportionately challenge older adults.

Purpose The COVID-19 pandemic and containment measures disrupted daily life and worsened mental health. Stress, a key driver of mental disorders, likely intensified during this period. However, longitudinal studies tracking stress trajectories in the general population remain limited. This study aims to identify psychosocial stress trajectories from the pre- to post-pandemic period and examine associated characteristics in a population-based sample from a German city. Methods 966 participants from the German National Cohort study-centre in Halle (240,000 inhabitants in Eastern Germany) were included. Those participated in a six-monthly intensified assessment and completed at least four questionnaires between 2019 and 2024 containing PHQ-Stress module. First, latent class growth analysis identified heterogeneous stress trajectories. Second, associations between class membership and covariates were tested with multinomial logistic regressions. Results We identified four psychosocial stress trajectory classes. Most participants followed an intermediate-level-stress trajectory (58%), while others showed low (30%), high (10%), or peak-recovery (3%) trajectories. Across classes, stress rose over time, with small to moderate changes, mostly early in the pandemic. Membership in the intermediate- or high-stress trajectories was associated with greater pre-pandemic stress, depressive and anxiety symptoms, lower life satisfaction, and greater loneliness at the pandemic’s onset. The peak-recovery class was associated with lower agreeableness and divorce before the pandemic, and reductions in sport activities at its onset. Conclusion Stable patterns of stress predominated, while a small subgroup showed stronger reactivity to pandemic-related strain. These findings suggest that, for most individuals, pre-existing vulnerability and stress levels shape long-term trajectories despite substantial contextual change.

Cancer registry data are an essential resource for population-based oncology research and quality assurance in Germany. With the revision of the Federal Cancer Registry Data Act in 2021, for the first time, a legal basis was created for the development of a nationwide clinical cancer dataset. This registry offers new opportunities for research, particularly in radiation oncology. This review aims to provide an overview of the current possibilities of and challenges to using German cancer registry data in radiation oncology, with a focus on data structure, missing data, access procedures, and methodological aspects for scientific research. We examined legal frameworks, data access procedures, and the structure of the nationwide basic oncology dataset (oBDS), particularly the components relevant to radiotherapy (RT). The completeness and comprehensiveness of RT data across federal states were assessed using national registry data from the German Center for Cancer Registry Data (ZfKD) for the years 2020–2022. The cancer registries provide structured data on RT through the oBDS, including treatment intent, technique, target area, and side effects. However, significant variability in terms of completeness and reporting standards persists among federal states. Missing data rates remain high in some regions, particularly for key RT parameters such as treatment technique, the relationship to surgery, and boost application. Methodological challenges for scientific use include handling missing data, confounding, immortal time bias, and exposure misclassification. Despite existing limitations, cancer registry data in Germany represent a valuable resource for real-world research in radiation oncology. They allow for large-scale population-based studies beyond the constraints of clinical trials. With improved data harmonization, methodological rigor, and future data linkages (e.g., to health insurance data), registry-based studies can contribute significantly to evidence-based decision-making and quality improvement in radiation oncology.

The long-term health effects of football (soccer) have received significant attention in recent years. While brain health is currently the focus of this interest, potential long-term risks or benefits related to cardiovascular and metabolic diseases and cancer are also of interest to sports medicine professionals. However, studies assessing the overall health risks for professional football players remain scarce. We introduce 'SoccHealth', a satellite project to the German National Cohort (NAKO), Germany's largest population-based cohort study. SoccHealth examined 348 former professional football players aged 40-69 using the infrastructure and comprehensive examination programme of NAKO. The German Statutory Accidental Insurance for Professional Athletes identified and invited male players, while female players were recruited among former national team members. Details of the examination programme and the sociodemographic and career-related characteristics of the participants are described. The identical examination programme for the NAKO participants provides the opportunity to draw general population controls according to various definitions and focus on the respective research question to be analysed. This report delineates one approach to evaluate the long-term health effects of football across a broad range of diseases.

Smoking has multiple detrimental effects on health, and is a major preventable cause of premature death and chronic disease. Despite the well-described effect of inhaled substances from tobacco smoke on cell toxicity, the association between smoking and suicidal erythrocyte death, termed eryptosis, is virtually unknown. Therefore, the blood samples of 2023 participants of the German National Cohort Study (NAKO) were analyzed using flow cytometry analysis to determine eryptosis from fluorescent annexin V-FITC-binding to phosphatidylserine-exposing erythrocytes. Blood analyses were complemented by the measurement of hematologic parameters including red blood cell count, hematocrit, hemoglobin, mean corpuscular cell volume (MCV) and mean corpuscular hemoglobin (MCH). Eryptosis was higher in smokers than in non- and ex-smokers, and positively associated with the number of cigarettes smoked daily (r = 0.08, 95% CI [0.03, 0.12]). Interestingly, despite increased eryptosis, smokers had higher red blood cell indices than non-smokers. To conclude, smokers were characterized by higher eryptosis than non-smokers, without showing any obvious detrimental effect on classic hematological parameters.