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Jiang Y, Yu T, Fan J, Guo X, Hua H, Xu D, Wang Y, Yan CH, Xu J. Longitudinal associations of social jetlag with obesity indicators among adolescents - Shanghai adolescent cohort. Sleep Med 2024; 121:171-178. [PMID: 38991425 DOI: 10.1016/j.sleep.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/17/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To explore the longitudinal association between social-jetlag (SJL) and obesity development among adolescents, sex-difference and related modifying factors in the association. METHODS Based on Shanghai-Adolescent-Cohort during 2017-2021, a total of 609 students were investigated. In grade 6, 7 and 9, the information on SJL was collected using questionnaires, and anthropometric measures were conducted. The fingernail cortisol and progesterone levels in grade 6 (using LC-MS/MS) and body composition in grade 9 (using Inbody-S10) were measured. By the latent-class-mixture-modeling, two trajectories for SJL (high-level vs. low-level) throughout 4 years were developed. The prospective associations of SJL trajectories and weight/fat gains were analyzed by sex and under different (high/moderate/low) cortisol/progesterone stratifications. RESULTS In grades 6-9, 39.00%-44.50 % of adolescents experienced at least 1 h of SJL. Compared with the low-level SJL trajectory, the high-level SJL trajectory was associated with greater differences in body-mass-index Z-scores and waist-to-height ratios across 4 years, higher levels of body-fat-percentage and fat-mass-index in grade 9 (P-values<0.05), and such associations were stronger among girls and under moderate-to-high (vs. low) baseline cortisol and progesterone levels. However, no significant associations among boys were observed. CONCLUSIONS High-level SJL in adolescents may be associated with the development of obesity, especially among adolescent girls and under relatively high baseline cortisol and progesterone levels.
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Affiliation(s)
- Yining Jiang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Ting Yu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jue Fan
- Department of Children's Healthcare, MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Changning Maternity & Infant Health Institute, Shanghai, China
| | - Xiangrong Guo
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Hui Hua
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Dongqing Xu
- Institute of Higher Education, Fudan University, Shanghai, China
| | - Yuefen Wang
- Shanghai Municipal Education Commission Department, Shanghai, China
| | - Chong-Huai Yan
- Department of Children's Healthcare, MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China; Department of Children's Healthcare, MOE-Shanghai Key Lab of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Arab A, Karimi E, Garaulet M, Scheer FAJL. Social jetlag and obesity: A systematic review and meta-analysis. Obes Rev 2024; 25:e13664. [PMID: 38072635 DOI: 10.1111/obr.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 02/28/2024]
Abstract
Social jetlag, the weekly variation in sleep timing, is proposed to contribute to increased obesity risk, potentially because of the misalignment of behavioral cycles relative to the endogenous circadian timing system. This systematic review and meta-analysis aim to determine the association between social jetlag and adiposity-related measures using observational studies. We reviewed 477 references, of which 43 studies met inclusion criteria with a total sample size of 231,648. There was a positive association between social jetlag and body mass index (correlation coefficient [r]: 0.12; 95%CI, 0.07, 0.17; P < 0.001; I2 = 94.99%), fat mass (r: 0.10; 95%CI, 0.05, 0.15; P < 0.001; I2 = 0.00%), fat mass index (fat mass divided by height in meter squared, β: 0.14 kg/m2 ; 95%CI, 0.05, 0.23; P < 0.001; I2 = 56.50%), percent of body fat (r: 0.37; 95%CI, 0.33, 0.41; P < 0.001; I2 = 96.17%), waist circumference (r: 0.15; 95%CI, 0.06, 0.24; P = 0.001; I2 = 90.83%), and the risk of having overweight/obesity (odds ratio: 1.20; 95%CI, 1.02, 1.140; P = 0.039; I2 = 98.25%). Social jetlag is positively and consistently associated with multiple obesity-related anthropometric measures. Further studies are needed to test causality, underlying mechanisms, and whether obesity interventions based on increasing regularity of the sleep/wake cycle can aid in the battle against the obesity pandemic.
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Affiliation(s)
- Arman Arab
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marta Garaulet
- Department of Physiology, Regional Campus of International Excellence, University of Murcia, Murcia, Spain
- Biomedical Research Institute of Murcia, IMIB-Arrixaca-UMU, University Clinical Hospital, Murcia, Spain
| | - Frank A J L Scheer
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Chang CS, Chang LY, Wu CC, Chang HY. Associations between social jetlag trajectories and body mass index among young adults. Sleep 2024; 47:zsad270. [PMID: 37855456 DOI: 10.1093/sleep/zsad270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
STUDY OBJECTIVES This study employed longitudinal data collected repeatedly from individuals over the course of several years to examine the trajectories of social jetlag from ages 11 to 22 years and their associations with subsequent body mass index (BMI). Potential sex differences were also investigated. METHODS Data were obtained from two longitudinal studies conducted in Taiwan (N = 4287). Social jetlag was defined as ≥ 2 hours of absolute difference in sleep midpoint between weekdays and weekends. BMI was calculated using weight (kg)/height(m)2 and categorized as underweight (<18 kg/m2), normal weight (18 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 27 kg/m2), and obese (≥27 kg/m2). Group-based trajectory modeling and multinomial logistic regression were applied to investigate study objectives. RESULTS Four distinct trajectories of social jetlag throughout the adolescent years were identified, with corresponding proportions as follows: low-stable (42%), moderate-decreasing (19%), low-increasing (22%), and chronic (17%) trajectories. Among males, the risk of being underweight (aOR, 1.96; 95% CI: 1.35 to 2.84) or obese (aOR, 1.40; 95% CI: 1.02 to 1.92) was higher in individuals with a low-increasing trajectory than in those with a low-stable trajectory. Among females, those with a low-increasing (aOR, 1.61; 95% CI: 1.02 to 2.54) or chronic (aOR, 2.04; 95% CI: 1.27 to 3.25) trajectory were at a higher risk of being obese relative to those with a low-stable trajectory. CONCLUSIONS Addressing the development of increasing or chronic social jetlag during adolescence can help prevent abnormal BMI in young adulthood. Practitioners should consider sex differences in treatment or consultation.
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Affiliation(s)
- Chia-Shuan Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ling-Yin Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chi-Chen Wu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Hsing-Yi Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
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Bermingham KM, Stensrud S, Asnicar F, Valdes AM, Franks PW, Wolf J, Hadjigeorgiou G, Davies R, Spector TD, Segata N, Berry SE, Hall WL. Exploring the relationship between social jetlag with gut microbial composition, diet and cardiometabolic health, in the ZOE PREDICT 1 cohort. Eur J Nutr 2023; 62:3135-3147. [PMID: 37528259 PMCID: PMC10611873 DOI: 10.1007/s00394-023-03204-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE In this study, we explore the relationship between social jetlag (SJL), a parameter of circadian misalignment, and gut microbial composition, diet and cardiometabolic health in the ZOE PREDICT 1 cohort (NCT03479866). METHODS We assessed demographic, diet, cardiometabolic, stool metagenomics and postprandial metabolic measures (n = 1002). We used self-reported habitual sleep (n = 934) to calculate SJL (difference in mid-sleep time point of ≥ 1.5 h on week versus weekend days). We tested group differences (SJL vs no-SJL) in cardiometabolic markers and diet (ANCOVA) adjusting for sex, age, BMI, ethnicity, and socio-economic status. We performed comparisons of gut microbial composition using machine learning and association analyses on the species level genome bins present in at least 20% of the samples. RESULTS The SJL group (16%, n = 145) had a greater proportion of males (39% vs 25%), shorter sleepers (average sleep < 7 h; 5% vs 3%), and were younger (38.4 ± 11.3y vs 46.8 ± 11.7y) compared to the no-SJL group. SJL was associated with a higher relative abundance of 9 gut bacteria and lower abundance of 8 gut bacteria (q < 0.2 and absolute Cohen's effect size > 0.2), in part mediated by diet. SJL was associated with unfavourable diet quality (less healthful Plant-based Diet Index), higher intakes of potatoes and sugar-sweetened beverages, and lower intakes of fruits, and nuts, and slightly higher markers of inflammation (GlycA and IL-6) compared with no-SJL (P < 0.05 adjusted for covariates); rendered non-significant after multiple testing adjustments. CONCLUSIONS Novel associations between SJL and a more disadvantageous gut microbiome in a cohort of predominantly adequate sleepers highlight the potential implications of SJL for health.
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Affiliation(s)
- Kate M Bermingham
- Department of Nutritional Sciences, King's College London, London, UK
- ZOE Ltd, London, UK
| | - Sophie Stensrud
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Ana M Valdes
- School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham, UK
| | - Paul W Franks
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | | | | | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Nicola Segata
- Department CIBIO, University of Trento, Trento, Italy
| | - Sarah E Berry
- Department of Nutritional Sciences, King's College London, London, UK.
| | - Wendy L Hall
- Department of Nutritional Sciences, King's College London, London, UK
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Song Y, Gong L, Lou X, Zhou H, Hao Y, Chen Q, Zhao Y, Jiang X, Li L, Wang X. Sleep-Body Composition Relationship: Roles of Sleep Behaviors in General and Abdominal Obesity in Chinese Adolescents Aged 17-22 Years. Nutrients 2023; 15:4130. [PMID: 37836414 PMCID: PMC10574676 DOI: 10.3390/nu15194130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
This study aimed to investigate the association between sleep behaviors and body composition, which was measured by bioelectrical impedance analysis (BIA) among Chinese adolescents. Overall, 444 students (65.3% females, 19.12 ± 1.177 years) completed questionnaires describing sleep characteristics. Sleep characteristics were derived from subjective means. Body composition was obtained from BIA by InBody 720 (Biospace Co. Ltd., Seoul, Republic of Korea). Regression models tested relationships between sleep and body composition after adjustment for covariates. Students with weekday nap duration (>30 min/d) exerted higher waist-height ratio (WHtR) (B = 0.013, FDR-corrected p = 0.080). Average sleep duration (≤7 h/d) was linked to more WHtR (B = 0.016, FDR-corrected p = 0.080). People with high social jetlag showed gained visceral fat area (B = 7.475), WHtR (B = 0.015), waist to hip ratio (B = 0.012), fat mass index (B = 0.663) and body fat percentage (B = 1.703) (all FDR-corrected p < 0.1). Individuals with screen time before sleep (>0.5 h) exhibited higher visceral fat area (B = 7.934, FDR-corrected p = 0.064), WHtR (B = 0.017, FDR-corrected p = 0.080), waist to hip ratio (B = 0.016, FDR-corrected p = 0.090), fat mass index (B = 0.902, FDR-corrected p = 0.069) and body fat percentage (B = 2.892, FDR-corrected p = 0.018). We found poor sleep characteristics were closely related to general and abdominal obesity.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xian Wang
- College of Public Health, Zhengzhou University, No. 100 Science Avenue, Zhengzhou 450001, China; (Y.S.); (L.G.); (X.L.); (H.Z.); (Y.H.); (Q.C.); (Y.Z.); (X.J.); (L.L.)
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Pompeia S, Panjeh S, Louzada FM, D'Almeida V, Hipolide DC, Cogo-Moreira H. Social jetlag is associated with adverse cardiometabolic latent traits in early adolescence: an observational study. Front Endocrinol (Lausanne) 2023; 14:1085302. [PMID: 37469985 PMCID: PMC10352840 DOI: 10.3389/fendo.2023.1085302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Adolescence is marked by physiological and social changes, such as puberty, increased responsibilities and earlier school start times. This often leads to insufficient sleep on school nights and the need to compensate for lost sleep on weekends, causing a misalignment between biological and social times, which has been termed social jetlag (SJL). SJL triggers stress responses and is associated with several negative health outcomes, including higher cardiometabolic risk in adults. In adolescence, however, SJL has only been consistently related to increases in adiposity but its association with other cardiometabolic indicators are unclear. Method In a sample of 278 healthy early adolescents (9-15 years of age; 168 girls) we investigated: 1) whether self-reported SJL is associated (using path analyses) with a cardiometabolic status latent factor obtained by testing the best fitting model via confirmatory factor analyses from an initial set of eight indicators [body mass index (BMI), waist/height ratio, triglyceride concentration, diastolic and systolic blood pressure, glycated hemoglobin, total cholesterol/high-density lipoprotein ratio (chol/HDL), and % body fat]; and 2) whether age and/or pubertal status influence the association between SJL and cardiometabolic status. Result We found that, for girls, higher SJL was associated with more adverse cardiometabolic latent scores (the shared variance of BMI, waist/height ratio, chol/HDL and systolic blood pressure, which had acceptable model fit indices). However, the role of age and pubertal status in this association was unclear for both sexes. Discussion SJL was associated with adverse cardiometabolic latent traits beyond increases in adiposity in this observational study in early female adolescents. Because disruptions of circadian rhythms are believed to lead to dysregulated energy homeostasis and not vice-versa, our findings highlight the need for sleep interventions in adolescence to help reduce the global burden of cardiometabolic ill health, especially in girls.
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Affiliation(s)
- Sabine Pompeia
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sareh Panjeh
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Vania D'Almeida
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Hugo Cogo-Moreira
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Education, ICT and Learning, Østfold University College, Halden, Norway
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Tan C, Sato K, Shiotani H. The relationship between social jetlag and subjective sleep quality: differences in young and middle-aged workers. Sleep Biol Rhythms 2023; 21:7-12. [PMID: 38468901 PMCID: PMC10899945 DOI: 10.1007/s41105-022-00410-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/21/2022] [Indexed: 10/16/2022]
Abstract
Social jetlag is a recent problem that is associated with a wide range of issues in the context of modern life. However, differences in the effects of social jetlag on sleep quality between young and middle-aged workers remain unclear. Accordingly, we aimed to examine the different effects of social jetlag on sleep quality in young (20-39 years) and middle-aged (40-59 years) workers from one factory. We included 106 male full-time workers (average age: 35.8 ± 11.5 years) who worked at the Kobe Factory of Fuji Electric Co., Ltd. Social jetlag was evaluated using the Munich ChronoType Questionnaire Japanese Version. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index Japanese Version. Chronotype was determined using the Morningness-Eveningness Questionnaire Japanese Version (MEQ), while the health-related quality-of-life was evaluated using a revised version of the MOS 36-Item Short-Form Survey. Furthermore, we examined factors related to sleep quality in each age group using multiple regression analysis. Subjective sleep quality in the analysis set was poor; moreover, 39.4% of the participants had social jetlag for ≥ 1 h. Compared with middle-aged workers, young workers showed significantly longer and lower social jetlag and MEQ scores, respectively. Multiple regression analysis revealed that mental health and social jet lag were significantly associated with sleep quality in young participants. Contrastingly, social jetlag was not associated with sleep quality in middle-aged workers. Our findings demonstrate the importance of considering the effects of age-based factors on sleep quality.
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Affiliation(s)
- Chieko Tan
- School of Health Sciences, Nursing, Kobe Tokiwa University, 2-6-2 Otani-cho, Nagata-ku, Kobe, 653-0838 Japan
| | - Kaori Sato
- Kobe Factory of Fuji Electric Co., Ltd., Kobe, Japan
| | - Hideyuki Shiotani
- School of Health Sciences, Nursing, Kobe Tokiwa University, 2-6-2 Otani-cho, Nagata-ku, Kobe, 653-0838 Japan
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Bouman EJ, Beulens JWJ, Groeneveld L, de Kruijk RS, Schoonmade LJ, Remmelzwaal S, Elders PJM, Rutters F. The association between social jetlag and parameters of metabolic syndrome and type 2 diabetes: a systematic review and meta‐analysis. J Sleep Res 2022; 32:e13770. [PMID: 36351658 DOI: 10.1111/jsr.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/11/2022]
Abstract
This study aims to determine the association between social jetlag and parameters of metabolic syndrome and type 2 diabetes (T2D) in a systematic review and meta-analysis. A systematic literature search was conducted in PubMed/Embase/Scopus until May 2022. Included studies described an association between social jetlag and parameters of the metabolic syndrome and/or T2D, were available full text and written in English or Dutch. Data extraction and quality assessment were performed on pre-piloted forms independently by two reviewers. Results were meta-analysed using random-effects analysis. A total of 6,290 titles/abstracts were screened, 176 papers were read full-text, 68 studies were included. Three studies were rated as low quality, 27 were moderate, and 38 were high quality. High quality studies showed that having social jetlag compared to no social jetlag was significantly associated with higher body mass index in 20 studies (0.49 kg/m2 , 95% confidence interval [CI] 0.21-0.77; I2 = 100%), higher waist circumference in seven studies (1.11 cm, 95% CI 0.42-1.80; I2 = 25%), higher systolic blood pressure in 10 studies (0.37 mmHg, 95% CI 0.00-0.74; I2 = 94%) and higher glycated haemoglobin in 12 studies (0.42%, 95% CI 0.12- 0.72; I2 = 100%). No statistically significant associations were found for obesity, abdominal obesity, high- and low-density lipoprotein levels, cholesterol, triglycerides, diastolic blood pressure, hypertension, fasting glucose, homeostatic model assessment for insulin resistance, metabolic syndrome or T2D. Sensitivity analyses did not reduce heterogeneity. Despite substantial heterogeneity, social jetlag is associated with certain parameters of the metabolic syndrome and T2D, but not with prevalent metabolic syndrome or T2D. These findings should be interpreted with caution as the level of evidence is low and mostly based on cross-sectional data. Longitudinal studies are needed to further assess the direction of causality.
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Affiliation(s)
- Emma J. Bouman
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Joline W. J. Beulens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
- Julius Centre for Health Sciences and Primary Care University Medical Centre Utrecht Utrecht the Netherlands
| | - Lenka Groeneveld
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Rozemarijn S. de Kruijk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | | | - Sharon Remmelzwaal
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
| | - Petra J. M. Elders
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, General Practice Amsterdam Netherlands
| | - Femke Rutters
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science Amsterdam Netherlands
- Amsterdam Public Health Health Behaviors & Chronic Diseases Amsterdam The Netherlands
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