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Breslin G, Fakoya O, Wills W, Lloyd N, Bontoft C, Wellings A, Harding S, Jackson J, Barrett K, Wagner AP, Miners L, Greco HA, Brown KE. Whole systems approaches to diet and healthy weight: A scoping review of reviews. PLoS One 2024; 19:e0292945. [PMID: 38478570 PMCID: PMC10936799 DOI: 10.1371/journal.pone.0292945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/03/2023] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Obesity is a global epidemic affecting all age groups, populations, and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial, and environmental factors and government policy. Consequently, a Whole System Approach (WSA)-which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live-is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. METHOD Systematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts. RESULTS A total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight, and obesity to inform their planning or delivery, and to understand/map the associated systems. Common mathematical approaches include agent based or System Dynamic Modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight, and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake, and increasing physical activity. Public and user involvement in WSA was not widely reported. CONCLUSION The application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required.
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Affiliation(s)
- Gavin Breslin
- School of Psychology, Queen’s University Belfast, Belfast, United Kingdom
| | - Olujoke Fakoya
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Wendy Wills
- Centre for Research in Public Health and Community Care (CRIPACC), School of Health and Social Work, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Nigel Lloyd
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Charis Bontoft
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Amander Wellings
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Sian Harding
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - John Jackson
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Katherine Barrett
- Member of the PHIRST Public Involvement in Research Group, School of Life and Medical Sciences & School of Health & Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Adam P. Wagner
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
| | - Lisa Miners
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
| | - Honey-Anne Greco
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
| | - Katherine E. Brown
- Department of Psychology, Sport and Geography, School of Life and Medical Sciences, College Lane, University of Hertfordshire, Hatfield, United Kingdom
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Muñoz Laguna J, Puhan MA, Rodríguez Artalejo F, De Pauw R, Wyper GMA, Devleesschauwer B, Santos JV, Hincapié CA. Certainty of the Global Burden of Disease 2019 Modelled Prevalence Estimates for Musculoskeletal Conditions: A Meta-Epidemiological Study. Int J Public Health 2023; 68:1605763. [PMID: 37325175 PMCID: PMC10266422 DOI: 10.3389/ijph.2023.1605763] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/27/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives: To describe and assess the risk of bias of the primary input studies that underpinned the Global Burden of Disease Study (GBD) 2019 modelled prevalence estimates of low back pain (LBP), neck pain (NP), and knee osteoarthritis (OA), from Australia, Brazil, Canada, Spain, and Switzerland. To evaluate the certainty of the GBD modelled prevalence evidence. Methods: Primary studies were identified using the GBD Data Input Sources Tool and their risk of bias was assessed using a validated tool. We rated the certainty of modelled prevalence estimates based on the GRADE Guidelines 30-the GRADE approach for modelled evidence. Results: Seventy-two primary studies (LBP: 67, NP: 2, knee OA: 3) underpinned the GBD estimates. Most studies had limited representativeness of their study populations, used suboptimal case definitions and applied assessment instruments with unknown psychometric properties. The certainty of modelled prevalence estimates was low, mainly due to risk of bias and indirectness. Conclusion: Beyond the risk of bias of primary input studies for LBP, NP, and knee OA in GBD 2019, the certainty of country-specific modelled prevalence estimates still have room for improvement.
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Affiliation(s)
- Javier Muñoz Laguna
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Fernando Rodríguez Artalejo
- Department of Preventive Medicine, Public Health and Microbiology, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA Food Institute, CEI UAM + CSIC, Madrid, Spain
| | - Robby De Pauw
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Grant M. A. Wyper
- School of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
- Place and Wellbeing Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - João V. Santos
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS—Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto V – Porto Ocidental, ARS Norte, Porto, Portugal
| | - Cesar A. Hincapié
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland
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Jayasinghe S, Soward R, Dalton L, Holloway TP, Murray S, Patterson KAE, Ahuja KDK, Hughes R, Byrne NM, Hills AP. Domains of Capacity Building in Whole-Systems Approaches to Prevent Obesity-A "Systematized" Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10997. [PMID: 36078714 PMCID: PMC9517932 DOI: 10.3390/ijerph191710997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Despite increased awareness of its risks, for the most part, contemporary efforts for obesity prevention have been patchy at best. As such, the burgeoning interest in whole-systems approaches (WSAs) that acknowledge the complex, dynamic nature of overweight and obesity and operate across multiple levels of society is particularly timely. Many components of "community capacity building" (CB), an essential but often neglected aspect of obesity prevention, overlap with "best practice principles" in effective/optimal community-based obesity-prevention initiatives. Rhetoric urging WSAs and community CB in public health abounds although operative and efficacious contemporary examples of these approaches to reducing obesity levels are scarce. The aim of this investigation was to undertake a systematized review of the level of capacity building incorporated in published literature on WSAs targeting obesity to better understand how domains of CB have been incorporated. A PubMed search and a recently published systematic review were utilized to identify WSAs to obesity prevention between 1995-2020. A team-based approach to qualitative thematic data analysis was used to systematically assess and describe each intervention regarding explicit capacity-building practice. Despite not being specifically designed for building capacity, a significant proportion of the WSAs studied in the current report had implemented several CB domains.
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Affiliation(s)
- Sisitha Jayasinghe
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Robert Soward
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Lisa Dalton
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Timothy P. Holloway
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Sandra Murray
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Kira A. E. Patterson
- College of Arts, Law and Education, University of Tasmania, Launceston, TAS 7250, Australia
| | - Kiran D. K. Ahuja
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Roger Hughes
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Nuala M. Byrne
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
| | - Andrew P. Hills
- College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
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Lytvyak E, Straube S, Modi R, Lee KK. Trends in obesity across Canada from 2005 to 2018: a consecutive cross-sectional population-based study. CMAJ Open 2022; 10:E439-E449. [PMID: 35609927 PMCID: PMC9259440 DOI: 10.9778/cmajo.20210205] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Obesity is increasingly prevalent worldwide and is becoming an epidemic in many countries, including Canada. We sought to describe and analyze temporal obesity trends in the Canadian adult population from 2005 through 2018 at the national and provincial or territorial levels. METHODS We conducted a consecutive, cross-sectional study using data from 7 sequential Canadian Community Health Survey (CCHS) cycles (2005 to 2017/18). We included data from Canadian adults (age ≥ 18 yr) who participated in at least 1 of the 7 consecutive CCHS cycles and who had body mass index values (calculated by Statistics Canada based on respondents' self-reported weight and height). Obesity prevalence (adjusted body mass index ≥ 30) was a primary outcome variable. We analyzed temporal trends in obesity prevalence using Pearson χ2 tests with Bonferroni adjustment, and the Cochran-Armitage test of trend. RESULTS We included data from 746 408 (403 582 female and 342 826 male) CCHS participants. Across Canada, the prevalence of obesity increased significantly between 2005 and 2017/18, from 22.2% to 27.2% (p < 0.001). We observed increases across both sexes, all age groups and all Canadian provinces and territories (p < 0.001). In 2017/18, the prevalence of obesity was higher among males than females (28.9% v. 25.4%; p < 0.001); the prevalence among adults aged 40-69 years exceeded 30%. In 2017/18, Newfoundland and Labrador had the highest prevalence (39.4%), and British Columbia had the lowest (22.8%) prevalence of obesity. Over the 14-year study period, Quebec and Alberta exhibited the largest relative increases in obesity. INTERPRETATION In 2017/18, more than 1 in 4 adult Canadians lived with obesity, and from 2005 to 2017/18, the prevalence of obesity among adults in Canada increased substantially across sexes, age groups and all Canadian provinces and territories to 27.2%. Our findings call for urgent actions to identify, implement and evaluate solutions for obesity prevention and management in all Canadian provinces and territories.
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Affiliation(s)
- Ellina Lytvyak
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta.
| | - Sebastian Straube
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta
| | - Renuca Modi
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta
| | - Karen K Lee
- Division of Preventive Medicine (Lytvyak, Straube, Lee); Department of Family Medicine (Modi), University of Alberta; Edmonton Adult Bariatric Specialty Clinic (Modi), Alberta Health Services, Edmonton, Alta
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Nickel S, von dem Knesebeck O. Effectiveness of Community-Based Health Promotion Interventions in Urban Areas: A Systematic Review. J Community Health 2021; 45:419-434. [PMID: 31512111 DOI: 10.1007/s10900-019-00733-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Over the past few decades, a community-based approach was seen to be the "gold standard" for health promotion and disease prevention, especially in the field of socially deprived neighborhoods in urban areas. Up to the beginning of the 2000s, earlier reviews provide valuable information on activities in this context. However, in their conclusions they were limited to North America and Europe. Therefore, we conducted a systematic literature review on community-based health promotion and prevention programs worldwide. The Pubmed and PsycINFO databases were screened for relevant articles published between January 2002 and December 2018, revealing 101 potentially eligible publications out of 3646 hits. After a systematic review process including searching the reference lists, 32 papers met the inclusion criteria and were included in the review. Twenty-four (75.0%) articles reported improvements in at least one health behavior, health service access, health literacy, and/or a range of health status outcomes. Large-scale community-based health promotion programs, however, often resulted in limited or missing population-wide changes. Possible reasons are methodological limitations, concurrent context effects, and limitations of the interventions used. Our results confirm that community-based interventions are promising for health promotion and disease prevention but so far their potential is not fully realized. For the future, such interventions should aim at proximal outcomes and invest in community capacity building.
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Affiliation(s)
- Stefan Nickel
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Nickel S, von dem Knesebeck O. Do multiple community-based interventions on health promotion tackle health inequalities? Int J Equity Health 2020; 19:157. [PMID: 32912257 PMCID: PMC7488049 DOI: 10.1186/s12939-020-01271-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. METHODS The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. RESULTS More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. CONCLUSIONS Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.
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Affiliation(s)
- Stefan Nickel
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany
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Williamson DHZ, Yu EX, Hunter CM, Kaufman JA, Komro K, Jelks NO, Johnson DA, Gribble MO, Kegler MC. A Scoping Review of Capacity-Building Efforts to Address Environmental Justice Concerns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3765. [PMID: 32466474 PMCID: PMC7312702 DOI: 10.3390/ijerph17113765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 11/17/2022]
Abstract
Environmental justice (EJ) efforts aimed at capacity building are essential to addressing environmental health disparities; however, limited attention has been given to describing these efforts. This study reports findings from a scoping review of community-academic partnerships and community-led efforts to address environmental inequities related to air, water, and land pollution in the United States. Literature published in peer-reviewed journals from January 1986 through March 2018 were included, and community capacity theory was applied as a framework for understanding the scope of capacity-building and community change strategies to address EJ concerns. Paired teams of independent analysts conducted a search for relevant articles (n = 8452 citations identified), filtered records for content abstraction and possible inclusion (n = 163) and characterized selected studies (n = 58). Most articles implemented activities that were aligned with community capacity dimensions of citizen participation (96.4%, n = 53), community power (78%, n = 45), leadership (78%, n = 45), and networks (81%, n = 47); few articles identified a direct policy change (22%, n = 13), and many articles discussed the policy implications of findings for future work (62%, n = 36). This review synthesizes three decades of efforts to reduce environmental inequities and identifies strategic approaches used for strengthening community capacity.
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Affiliation(s)
- Dana H. Z. Williamson
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (K.K.); (M.C.K.)
| | - Emma X. Yu
- Gangarosa Department of Environmental Health, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (E.X.Y.); (C.M.H.); (M.O.G.)
| | - Candis M. Hunter
- Gangarosa Department of Environmental Health, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (E.X.Y.); (C.M.H.); (M.O.G.)
| | - John A. Kaufman
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | - Kelli Komro
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (K.K.); (M.C.K.)
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | | | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | - Matthew O. Gribble
- Gangarosa Department of Environmental Health, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (E.X.Y.); (C.M.H.); (M.O.G.)
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (J.A.K.); (D.A.J.)
| | - Michelle C. Kegler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA; (K.K.); (M.C.K.)
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de Groot R, van den Hurk K, Schoonmade LJ, de Kort WLAM, Brug J, Lakerveld J. Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001017. [PMID: 30740247 PMCID: PMC6347938 DOI: 10.1136/bmjgh-2018-001017] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction The built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults. Methods PubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome. Results After screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively). Conclusions Total and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas. Prospero registration number CRD42016043226.
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Affiliation(s)
- Rosa de Groot
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Linda J Schoonmade
- Department of Medical Library, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Wim L A M de Kort
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes Brug
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Bagnall AM, Radley D, Jones R, Gately P, Nobles J, Van Dijk M, Blackshaw J, Montel S, Sahota P. Whole systems approaches to obesity and other complex public health challenges: a systematic review. BMC Public Health 2019; 19:8. [PMID: 30606173 PMCID: PMC6318991 DOI: 10.1186/s12889-018-6274-z] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/28/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. METHODS Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. RESULTS Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. CONCLUSIONS Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations.
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Affiliation(s)
- Anne-Marie Bagnall
- Centre for Health Promotion Research, School of Health & Community Studies, Leeds Beckett University, Portland 519, Leeds, LS1 3HE UK
| | - Duncan Radley
- School of Sport, Leeds Beckett University, Leeds, UK
| | - Rebecca Jones
- Centre for Health Promotion Research, School of Health & Community Studies, Leeds Beckett University, Portland 519, Leeds, LS1 3HE UK
| | - Paul Gately
- School of Sport, Leeds Beckett University, Leeds, UK
| | - James Nobles
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Margie Van Dijk
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Jamie Blackshaw
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Sam Montel
- Diet & Obesity, Health Improvement Directorate, Public Health England, London, UK
| | - Pinki Sahota
- School of Clinical & Applied Sciences, Leeds Beckett University, Leeds, UK
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10
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Broyles ST, Gollub EA, Tohme A, Katzmarzyk PT. Improving Health Behaviors Through Community Engagement: Challenge for a Healthier Louisiana. Health Promot Pract 2018; 21:106-113. [PMID: 30132365 DOI: 10.1177/1524839918792018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is increasing recognition that community-based approaches may have merit in improving physical activity and healthy eating behaviors. The "Challenge for a Healthier Louisiana" program supported twelve projects that addressed the root causes of obesity through integrated community-level changes. Partnerships provided community-based obesity prevention by promoting healthier eating and/or physical activity through enhanced infrastructure, policy changes, and programming. To evaluate whether the program resulted in changes in healthy eating and/or physical activity among adults, surveys were conducted pre- and postintervention among participants. Participants who were exposed to physical activity programs were more likely to adopt the consumption of fruits (odds ratio = 2.0; 95% confidence interval [1.1, 3.6]), were more likely to eat vegetables once per day (p = .028), and were more likely to participate in physical activity (p = .053). Participants who were exposed to healthy eating programs were more likely to eat fruit once per day (p = .035), were more likely to eat vegetables at least once per day (p = .008), and were more likely to participate in physical activity (p = .018). In conclusion, there is some indication that the Challenge for a Healthier Louisiana program produced changes in health behaviors among program participants; however, the sustainability of these changes will require further evaluation.
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Affiliation(s)
| | | | - Allison Tohme
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
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11
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Willows N, Dyck Fehderau D, Raine KD. Analysis Grid for Environments Linked to Obesity (ANGELO) framework to develop community-driven health programmes in an Indigenous community in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:567-575. [PMID: 25825319 DOI: 10.1111/hsc.12229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/10/2015] [Indexed: 06/04/2023]
Abstract
Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes.
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Affiliation(s)
- Noreen Willows
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David Dyck Fehderau
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kim D Raine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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12
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Lytvyak E, Olstad DL, Schopflocher DP, Plotnikoff RC, Storey KE, Nykiforuk CIJ, Raine KD. Impact of a 3-year multi-centre community-based intervention on risk factors for chronic disease and obesity among free-living adults: the Healthy Alberta Communities study. BMC Public Health 2016; 16:344. [PMID: 27090293 PMCID: PMC4835846 DOI: 10.1186/s12889-016-3021-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/10/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Healthy Alberta Communities (HAC) was a 3-year community-based intervention to reduce lifestyle-related risk factors for chronic disease and obesity at a population-level. The current paper examines changes in blood pressure (BP) and anthropometric indicators within HAC communities compared to secular trends. METHODS Between 2006 and 2009, this community-academic partnership sought to create environments supportive of healthier dietary and physical activity behaviours within four diverse communities in Alberta, Canada. Height, weight, waist and hip circumference and BP were measured among 1554 and 1808 community residents at baseline (2006) and follow-up (2009), respectively. A comparison sample was drawn from a representative national survey. Samples were stratified by age and change between pre- and post-intervention was assessed using t-tests. Changes in parameters over time between groups were compared using meta-analysis. The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention. RESULTS Adjusted systolic (SBP) and diastolic (DBP) BP declined within most age groups in HAC communities from pre- to post-intervention. The net decline in SBP was 1 mmHg in 20-39 year olds (p = 0.006) and 2 mmHg in 40-59 year olds (p = 0.001), while the net decline in DBP was 3 mmHg in 20-39 year olds (p < 0.001), 2 mmHg in 40-59 year olds (p < 0.001) and 3 mmHg in 60-79 year olds (p < 0.001). The net increase in the proportion of individuals with normal BP was 5.9 % (p < 0.001), while the net decline in the proportion of individuals with stage 1 hypertension was 4.5 % (p < 0.001). BMI and body weight were unchanged. There was a significant net increase in waist and hip circumference among 20-39 year olds within intervention communities. CONCLUSIONS Findings suggest HAC succeeded in shifting the population distribution of BP in a leftward direction. By contrast, anthropometric parameters remained unchanged or worsened within intervention communities. Therefore, while improvements in some clinical risk factors can be achieved through relatively diffuse and shorter-term community-level environmental changes, improvements in others may require interventions of greater intensity and duration. Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.
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Affiliation(s)
- Ellina Lytvyak
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Dana Lee Olstad
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
- />Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Donald P. Schopflocher
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Ronald C. Plotnikoff
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
- />Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle Callaghan, Callaghan, NSW 2308 Australia
| | - Kate E. Storey
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Candace I. J. Nykiforuk
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Kim D. Raine
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
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Plotnikoff R, Karunamuni N, Lytvyak E, Penfold C, Schopflocher D, Imayama I, Johnson ST, Raine K. Osteoarthritis prevalence and modifiable factors: a population study. BMC Public Health 2015; 15:1195. [PMID: 26619838 PMCID: PMC4666016 DOI: 10.1186/s12889-015-2529-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/19/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study's objectives were to investigate the prevalence of self-reported knee and hip osteoarthritis (OA) stratified by age and sex and to examine the association of modifiable factors with knee and hip OA prevalence. The study was conducted using randomly sampled data gathered from four communities in the province of Alberta, Canada. METHODS A large adult population sample (N = 4733) of individuals ≥18 years were selected. Health-related information was collected through telephone interviews and community measurement clinics for which a sub-sample (N = 1808) attended. Participants self-reported OA during telephone interviews. Clinic interviews further assessed if the diagnosis was made by a health care professional. Statistical analyses compared prevalence of OA between sexes and across age categories. Associations between modifiable factors for OA and the prevalence of knee and hip OA were assessed using binary logistic regression modelling. RESULTS Overall prevalence of self-reported OA in the total sample was 14.8 %, where 10.5 % of individuals reported having knee OA and 8.5 % reported having hip OA. Differences in prevalence were found for males and females across age categories for both knee and hip OA. In terms of modifiable factors, being obese (BMI >30 kg/m2) was significantly associated with the prevalence of knee (OR: 4.37; 95 % CI: 2.08,9.20) and hip (OR: 2.52; 95 % CI: 1.17,5.43) OA. Individuals who stand or walk a lot, but do not carry or lift things during their occupational activities were 2.0 times less likely to have hip OA (OR: 0.50; 95 % CI: 0.26,0.96). Individuals who usually lift or carry light loads or have to climb stairs or hills were 2.2 times less likely to have hip OA (OR: 0.45; 95 % CI: 0.21,0.95). The odds of having hip OA were 1.9 times lower in individuals consuming recommended or higher vitamin C intake (OR: 0.52; 95 % CI: 0.29,0.96). Significant differences in prevalence were found for both males and females across age categories. CONCLUSION The prevalence of knee and hip OA obtained in this study is comparable to other studies. Females have greater knee OA prevalence and a greater proportion of women have mobility limitations as well as hip and knee pain; it is important to target this sub-group.
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Affiliation(s)
- Ronald Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | | | - Ellina Lytvyak
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Christopher Penfold
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | | | - Ikuyo Imayama
- Fred Hutchinson Cancer Research Center Seattle, Washington, USA.
| | - Steven T Johnson
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB, Canada.
| | - Kim Raine
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Compernolle S, De Cocker K, Lakerveld J, Mackenbach JD, Nijpels G, Oppert JM, Rutter H, Teixeira PJ, Cardon G, De Bourdeaudhuij I. A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project). Int J Behav Nutr Phys Act 2014; 11:147. [PMID: 25480391 PMCID: PMC4266878 DOI: 10.1186/s12966-014-0147-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 11/17/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. METHODS Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. RESULTS Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. CONCLUSIONS Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.
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Affiliation(s)
- Sofie Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Katrien De Cocker
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Research Foundation Flanders (FWO), B-1000, Ghent, Belgium.
| | - Jeroen Lakerveld
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Joreintje D Mackenbach
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Giel Nijpels
- The EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jean-Michel Oppert
- Université Paris 13, Sorbonne Paris Cité - UREN (Unité de Recherche en Epidémiologie Nutritionnelle), U557 Inserm; U1125 Inra; Cnam, Centre for Research on Human Nutrition Ile-de-France (CRNH IdF), Bobigny, France. .,Université Pierre et Marie Curie-Paris 6, Department of Nutrition Pitié-Salpêtrière Hospital (AP-HP), (CRNH IdF), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
| | - Harry Rutter
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
| | - Pedro J Teixeira
- Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Greet Cardon
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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