NAKO Health Study

The NAKO Health Study, also known as the NAKO Gesundheitsstudie, is a large, population-based prospective cohort study conducted throughout Germany. It was established to create a long-term scientific resource for understanding how chronic diseases develop and how genetic, environmental, behavioral, occupational, and social factors influence health over the life course. Rather than being a commercial product or conventional healthcare provider, NAKO is a coordinated national research program whose outputs include longitudinal health data, clinical measurements, biospecimens, imaging records, and scientific publications. Preparatory work began in 2009, and a formal study protocol was submitted to Germany's Federal Ministry of Education and Research in 2011. The protocol was reviewed by an international scientific panel before the project received funding. NAKO e.V., the coordinating association, was established in 2013 in Heidelberg. The study is implemented by a consortium of approximately 25 German research institutions, including organizations associated with the Helmholtz Association, German universities, the Leibniz Association, and other scientific bodies. Recruitment took place from 2014 through 2018. Approximately 205,000 adults aged 20 to 69 at enrollment were recruited through 18 regional study centers. In most regions, people were randomly selected from municipal population registers; the Augsburg and Neubrandenburg centers used larger invitation pools. The design aims to follow participants for at least two to three decades, allowing researchers to connect baseline characteristics with later diagnoses, health events, functional changes, and mortality-related outcomes. The study investigates cardiovascular disease, cancer, diabetes, neurological and psychiatric disorders, respiratory disease, infectious disease, musculoskeletal conditions, dental health, and other chronic health outcomes. It is designed to examine interactions among inherited characteristics, biological markers, lifestyle, physical surroundings, socioeconomic conditions, and healthcare-related factors. These data may support improved prevention, earlier detection, risk prediction, and evaluation of future healthcare interventions. At baseline, all participants underwent a broad examination lasting roughly three to four hours. Assessments included questionnaires on lifestyle, medical history, and medication use; cognitive testing; measurements of height, weight, waist circumference, and body composition; grip strength; blood pressure and cardiovascular function; spirometry; and dental examinations. A subgroup of approximately one-fifth of participants received a more extensive examination lasting about five hours. This included metabolic testing, echocardiography, resting and long-term electrocardiography, sleep monitoring, abdominal-fat ultrasound, musculoskeletal tests, sensory examinations, and additional biomarker collection. NAKO also maintains a major biological sample resource containing blood, urine, saliva, stool, and nasal specimens. The central biobank is located at Helmholtz Zentrum München, with additional storage at participating institutions. Follow-up questionnaires are conducted at intervals of roughly two to three years, while repeat physical examinations are planned approximately every four to five years. The first follow-up phase ran from 2018 to 2024, and a further follow-up phase began in May 2024. Research based on NAKO data has produced findings concerning depression, traffic noise, sleep, hypertension, psychological strain, body composition, chronic back pain, biological aging, mortality risk, biodiversity, mental health, and dental and periodontal health. Magnetic-resonance-imaging analyses and large biosample collections have expanded the study's value for epidemiology, medical imaging, artificial intelligence, and translational health research. Its long duration and national scope make NAKO a central infrastructure for studying health and disease trajectories in the German adult population.

The NAKO Health Study was developed as a German national cohort intended to address the causes and progression of widespread chronic diseases. Preparatory work began in 2009, followed by submission of a study protocol to the German Federal Ministry of Education and Research in 2011. The proposal underwent international scientific review before funding approval. NAKO e.V., the association responsible for coordinating the project, was formed in 2013 and is based in Heidelberg. Implementation is distributed across a consortium of roughly 25 German research institutions. These include research organizations connected with the Helmholtz Association, universities, the Leibniz Association, and other scientific institutions. The first ten years of the project received approximately 210 million euros in public and institutional funding from the Federal Ministry of Education and Research, Germany's federal states, and the Helmholtz Association. Participating institutions also contribute resources and infrastructure. The field phase recruited adults between 20 and 69 years of age from 2014 to 2018. Eighteen regional study centers were established across Germany. Most centers selected around 10,000 potential participants at random from population registers, while Augsburg and Neubrandenburg each used invitation pools of approximately 20,000 people. The resulting cohort contains about 205,000 participants, making it one of Germany's largest population-based health studies. NAKO's design combines questionnaires, physical examinations, cognitive assessments, laboratory and biomarker work, imaging, biospecimen storage, and later linkage to health events. The standard examination includes lifestyle and medical-history questions, medication information, cognitive testing, anthropometry, body-composition measurement, grip strength, blood-pressure and cardiovascular assessment, lung-function testing, and dental evaluation. A smaller subgroup receives extended metabolic, cardiac, sleep, musculoskeletal, sensory, and biomarker examinations. The cohort is intended to continue for at least 20 to 30 years. Participants receive periodic questionnaires approximately every two to three years, while full examinations are repeated at longer intervals of approximately four to five years. The first follow-up phase took place from 2018 through 2024, and another phase began in May 2024. The project has accumulated approximately 28 million biological specimens, including blood, urine, saliva, stool, and nasal samples. The principal biobank is at Helmholtz Zentrum München, with further storage at participating centers. NAKO has become a platform for research in epidemiology, prevention, medical imaging, genetics, environmental health, mental health, neurology, oncology, cardiometabolic disease, respiratory medicine, musculoskeletal medicine, and dentistry. Published analyses have reported findings involving depression prevalence, nighttime traffic noise and health, muscle and fat distribution, chronic back pain, biological-age and mortality modeling, biodiversity and mental health, and oral and periodontal health. The continuing follow-up is intended to increase the study's value by connecting initial exposures and measurements with later disease trajectories and health outcomes.

• 2024

  Further follow-up phase starts

  [1]NAKO Health Studyen.wikipedia.org

  A subsequent follow-up phase begins in May 2024, extending the cohort's planned longitudinal observation.

• 2018

  Baseline recruitment concludes

  [1]NAKO Health Studyen.wikipedia.org

  The baseline field phase concludes after enrolling approximately 205,000 adults aged 20 to 69 at enrollment.

• 2018

  First follow-up phase begins

  [1]NAKO Health Studyen.wikipedia.org

  The first follow-up phase starts, combining renewed participant contact with additional health information and examinations.

• 2014

  Participant recruitment begins

  [1]NAKO Health Studyen.wikipedia.org

  Recruitment begins through 18 regional study centers using population-register sampling.

• 2013

  NAKO e.V. is established

  [1]NAKO Health Studyen.wikipedia.org

  The coordinating association NAKO e.V. is established in Heidelberg to organize the national research consortium.

• 2011

  Study protocol submitted for federal review

  [1]NAKO Health Studyen.wikipedia.org

  The proposed study protocol is submitted to the German Federal Ministry of Education and Research and later reviewed by an international scientific panel.

• 2009

  Preparatory work begins

  [1]NAKO Health Studyen.wikipedia.org

  Initial planning and preparatory work begins for a nationwide German population-health cohort.

A national, publicly supported research infrastructure for long-term population health research, combining representative recruitment, repeated examinations, biological samples, imaging, and linked health outcomes.

• Population-health assessment · 2014

  Level 1 examination

  The standard NAKO examination administered to the full participant cohort. It combines questionnaires about lifestyle, medical history, and medicines with cognitive tests, anthropometric and body-composition measurements, grip strength, blood-pressure and cardiovascular assessments, spirometry, and dental evaluation. The session generally takes about three to four hours and creates a common baseline for comparisons across the national cohort.

• Extended clinical assessment · 2014

  Level 2 examination

  An expanded assessment performed for approximately 20 percent of participants. It adds oral glucose-tolerance and other metabolic testing, skin glycation measurements, three-dimensional echocardiography, resting and long-term ECG, sleep monitoring, abdominal-fat ultrasound, musculoskeletal examinations, eye, hearing, and smell tests, and additional biomarker collection. The extended visit generally requires about five hours.

• Biological sample resource · 2014

  NAKO biobank

  A large biological resource containing approximately 28 million specimens, including blood, urine, saliva, stool, and nasal swabs. Samples are held at a central biobank at Helmholtz Zentrum München and at selected participating institutions. The resource enables studies of biomarkers, genetics, disease mechanisms, environmental exposure, and future research questions.

• Medical imaging research

  NAKO MRI research data

  Magnetic-resonance-imaging data collected within the cohort support research into body composition, muscle and fat distribution, chronic pain, biological aging, and mortality risk. Large imaging analyses have been used to investigate relationships between intermuscular fat, muscle mass, and chronic back pain, as well as to develop computational health measures.

• 2024

  Continuation of longitudinal follow-upStrategy

  Background

  The study's value depends on repeated observation of participants after baseline recruitment and the first follow-up period.

  Action taken

  A further participant follow-up phase began in May 2024.

  Aftermath

  The continuation preserves NAKO's planned multi-decade design and expands the opportunity to relate earlier measurements to later health outcomes.

  Source

• 2013

  Establishment of a long-term national cohort consortiumStrategy

  Background

  Germany sought a large, harmonized population-health resource capable of tracking chronic disease risk over several decades.

  Action taken

  NAKO e.V. was created to coordinate approximately 25 research institutions and 18 regional study centers around a common protocol.

  Aftermath

  The consortium recruited approximately 205,000 adults and developed recurring examinations, follow-up surveys, imaging, and a national biospecimen infrastructure.

  Initial funding for the first ten years. Approximately €210 million (First ten years of the project)

  Source

1. 1NAKO Health Studyen.wikipedia.org
2. 2NAKO official websitenako.de