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Woodside JV, Sun Q, de Roos B, Rimm EB, Hu FB, Heinen MM, McEvoy CT, Piernas C, Scheelbeek PFD, Rushton J, Ensaff H, Brennan SF, Brennan L. Meeting report: plant-rich dietary patterns and health. Proc Nutr Soc 2022; 81:288-305. [PMID: 35996940 PMCID: PMC9839575 DOI: 10.1017/s002966512200266x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Dietary patterns (DP) rich in plant foods are associated with improved health and reduced non-communicable disease risk. In October 2021, the Nutrition Society hosted a member-led conference, held online over 2 half days, exploring the latest research findings examining plant-rich DP and health. The aim of the present paper is to summarise the content of the conference and synopses of the individual speaker presentations are included. Topics included epidemiological analysis of plant-rich DP and health outcomes, the effects of dietary interventions which have increased fruit and vegetable (FV) intake on a range of health outcomes, how adherence to plant-rich DP is assessed, the use of biomarkers to assess FV intake and a consideration of how modifying behaviour towards increased FV intake could impact environmental outcomes, planetary health and food systems. In conclusion, although there are still considerable uncertainties which require further research, which were considered as part of the conference and are summarised in this review, adopting a plant-rich DP at a population level could have a considerable impact on diet and health outcomes, as well as planetary health.
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Affiliation(s)
- Jayne V. Woodside
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
- Corresponding author: Jayne V. Woodside,
| | - Qi Sun
- Harvard TH Chan School of Public Health, Boston, USA
| | - Baukje de Roos
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Eric B. Rimm
- Harvard TH Chan School of Public Health, Boston, USA
| | - Frank B. Hu
- Harvard TH Chan School of Public Health, Boston, USA
| | - Mirjam M. Heinen
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Department of Country Health Programmes, WHO Regional Office for Europe, Geneva, Switzerland
| | - Claire T. McEvoy
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Carmen Piernas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pauline F. D. Scheelbeek
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Hannah Ensaff
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Sarah F. Brennan
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Lorraine Brennan
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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Woodside JV, Sun Q, de Roos B, Rimm EB, Hu FB, Heinen MM, McEvoy CT, Piernas C, Scheelbeek PFD, Rushton J, Ensaff H, Brennan SF, Brennan L. Meeting report: plant-rich dietary patterns and health - ERRATUM. Proc Nutr Soc 2022; 81:318. [PMID: 36273871 DOI: 10.1017/s0029665122002725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jayne V Woodside
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Qi Sun
- Harvard TH Chan School of Public Health, Boston, USA
| | - Baukje de Roos
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Eric B Rimm
- Harvard TH Chan School of Public Health, Boston, USA
| | - Frank B Hu
- Harvard TH Chan School of Public Health, Boston, USA
| | - Mirjam M Heinen
- WHO European Office for Prevention and Control of Noncommunicable Diseases, Department of Country Health Programmes, WHO Regional Office for Europe, Geneva, Switzerland
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Carmen Piernas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pauline F D Scheelbeek
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Jonathan Rushton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Hannah Ensaff
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Sarah F Brennan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Lorraine Brennan
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
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Spyreli E, McGowan L, Heery E, Kelly A, Croker H, Lawlor C, O'Neill R, Kelleher CC, McCarthy M, Wall P, Heinen MM. Public beliefs about the consequences of living with obesity in the Republic of Ireland and Northern Ireland. BMC Public Health 2022; 22:1910. [PMID: 36229815 PMCID: PMC9559245 DOI: 10.1186/s12889-022-14280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to capture public beliefs about living with obesity, examine how these beliefs have changed over time and to explore whether certain characteristics were associated with them in a nationally representative sample of adults from the Republic of Ireland (RoI) and Northern Ireland (NI). Methods A cross-sectional survey employed a random quota sampling approach to recruit a nationally representative sample of 1046 adults across NI and RoI. Telephone interviews captured information on demographics; health behaviours & attitudes; and beliefs about the consequences of obesity (measured using the Obesity Beliefs Scale). Univariable analyses compared beliefs about the consequences of living with obesity between participants with a self-reported healthy weight and those living with overweight or obesity, and non-responders (those for whom weight status could not be ascertained due to missing data). Multiple linear regression examined associations between obesity-related beliefs and socio-demographics, self-rated health and perceived ability to change health behaviours. Multiple linear regression also compared changes in obesity-related beliefs between 2013 and 2020 in the RoI. Results Higher endorsement of the negative outcomes of obesity was significantly associated with living with a healthy weight, higher self-rated health, dietary quality and perceived ability to improve diet and physical activity. Those who lived with overweight, with obesity and non-responders were less likely to endorse the negative consequences of obesity. Those living with obesity and non-responders were also more likely to support there is an increased cost and effort in maintaining a healthy weight. Comparison with survey data from 2013 showed that currently, there is a greater endorsement of the health benefits of maintaining a healthy weight (p < 0001), but also of the increased costs associated with it (p < 0001). Conclusion Beliefs about the consequences of maintaining a healthy body weight are associated with individuals’ weight, self-rated health, diet and perceived ease of adoption of dietary and exercise-related improvements. Beliefs about the health risks of obesity and perceived greater costs associated with maintaining a healthy weight appear to have strengthened over time. Present findings are pertinent to researchers and policy makers involved in the design and framing of interventions to address obesity. Supplementary information The online version contains supplementary material available at 10.1186/s12889-022-14280-9.
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Affiliation(s)
- Eleni Spyreli
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK.
| | - L McGowan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - E Heery
- Library and Research Service, Oireachtas, Houses of the Oireachtas Service, Dublin, Ireland
| | - A Kelly
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - H Croker
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - C Lawlor
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | - R O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - C C Kelleher
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | - M McCarthy
- Cork University Business School, University College Cork, Cork, Ireland
| | - P Wall
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | - M M Heinen
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
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4
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Whiting S, Buoncristiano M, Gelius P, Abu-Omar K, Pattison M, Hyska J, Duleva V, Milanović SM, Zamrazilová H, Hejgaard T, Rasmussen M, Nurk E, Shengelia L, Kelleher CC, Heinen MM, Spinelli A, Nardone P, Abildina A, Abdrakhmanova S, Aitmurzaeva G, Usuopva Z, Pudule I, Petrauskiene A, Angelo VFS, Kujundzic E, Popovic S, Fismen AS, Bergh IH, Fijalkowska A, Rito AI, Cucu A, Brinduse LA, Peterkova V, Gualtieri A, García-Solano M, Gutiérrez-González E, Abdurrahmonova Z, Boymatova K, Yardim N, Tanrygulyyeva M, Weghuber D, Schindler K, Stojisavljević D, Hadžiomeragić AF, Ionnaidu EM, Ahrens W, Hassapidou M, Kovacs VA, Ostojic SM, Ticha L, Starc G, Jonsson KR, Spiroski I, Rutter H, Mendes R, Williams J, Rakovac I, Breda J. S02-1 Physical activity and sedentary behaviour of children aged 6-9 in Europe: an analysis within the Childhood Obesity Surveillance Initiative (COSI). Eur J Public Health 2022. [PMCID: PMC9421738 DOI: 10.1093/eurpub/ckac093.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Children are becoming less physically active for a variety of interrelated reasons. The availability of opportunities for safe active playgrounds, recreational activities and active transport has decreased, while time spend on sedentary screen-based activities has increased. This study aimed to evaluate physical activity (PA), sedentary and sleep behaviours of children aged 6-9 years in Europe using data from the WHO Childhood Obesity Surveillance Initiative (COSI).
Methods
The fourth COSI data collection round was conducted in 36 countries from 2015-2018 using a standardized protocol including a family form completed by parents with specific questions about diet and physical activity-related behaviours.
Results
Nationally representative data from the 24 countries, who filled in the non-mandatory family record form, were included. Information on PA, screen-time and sleep behaviours of 137,807 children were analysed. Pooled analysis showed that: one in two children walked or cycled to school every day; one in two children were members of a sport or dancing club; around 40 % of children spent at least two hours per day watching TV or using electronic devices; around four in five children were actively or vigorously playing each day; around 88 % of children slept for at least nine hours per night. Country specific analyses showed pronounced differences in prevalence estimates between countries.
Conclusions
While the severity of the problem varies between countries, physical inactivity and sedentary behaviours are common across the European Region. Policy makers across the Region must do more in order to increase opportunities for young people to participate in daily activities. Furthermore, they should explore solutions to reduce the amount of time spend on sedentary activities, in order to halt the rise in overweight and obesity.
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Affiliation(s)
- Stephen Whiting
- Division of Country Health Programmes, WHO Regional Office for Europe , Copenhagen, Denmark
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto , Porto, Portugal
| | - Marta Buoncristiano
- Division of Country Health Programmes, WHO Regional Office for Europe , Copenhagen, Denmark
| | - Peter Gelius
- Department of Sport Science and Sport, FAU , Erlangen, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, FAU , Erlangen, Germany
| | - Mary Pattison
- Division of Country Health Programmes, WHO Regional Office for Europe , Copenhagen, Denmark
| | - Jolanda Hyska
- Nutrition and Food Safety Sector, Institute of Public Health , Tirana, Albania
| | - Vesselka Duleva
- National Center of Public Health and Analyses , Sofia, Bulgaria
| | - Sanja Musić Milanović
- School of Medicine, University of Zagreb, Croatian Institute of Public Health , Zagreb, Croatia
| | - Hana Zamrazilová
- Institute of Endocrinology, Obesity Management Centre , Prague, Czechia
| | | | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark , Copenhagen, Denmark
| | - Eha Nurk
- National Institute for Health Development , Tallinn, Estonia
| | - Lela Shengelia
- National Center for Disease Control and Public Health , Tbilisi, Georgia
| | - Cecily C Kelleher
- National Nutrition Surveillance Centre, University College Dublin , Dublin, Ireland
| | - Mirjam M Heinen
- National Nutrition Surveillance Centre, University College Dublin , Dublin, Ireland
| | | | | | - Akbota Abildina
- National Centre of Public Health of the Ministry of Health of the Republic of Kazakhstan , Nur-Sultan, Kazakhstan
| | - Shynar Abdrakhmanova
- National Centre of Public Health of the Ministry of Health of the Republic of Kazakhstan , Nur-Sultan, Kazakhstan
| | | | | | - Iveta Pudule
- Ministry of Health, Centre for Disease Prevention and Control , Riga, Latvia
| | - Aušra Petrauskiene
- Lithuanian University of Health Sciences, Health Research Institute and Department of Preventive Medicine , Kaunas, Lithuania
| | | | - Enisa Kujundzic
- Institute of Public Health of Montenegro , Podgorica, Montenegro
| | - Stevo Popovic
- Faculty for Sport and Physical Education, University of Montenegro , Niksic, Montenegro
| | - Anne-Siri Fismen
- Department of Health Promotion, Norwegian Institute of Public Health , Bergen, Norway
| | - Ingunn Holden Bergh
- Department of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health , Bergen, Norway
| | - Anna Fijalkowska
- Department of Cardiology, Institute of Mother and Child , Warsaw, Poland
| | - Ana Isabel Rito
- National Institute of Health Dr Ricardo Jorge I.P ., Lisbon, Portugal
| | - Alexandra Cucu
- National Institute of Public Health , Bucharest, Romania
| | | | | | - Andrea Gualtieri
- Health Authority San Marino , San Marino
- Republic of San Marino , San Marino
| | - Marta García-Solano
- Spanish Agency for Food Safety and Nutrition, Ministry of Health , Madrid, Spain
| | | | - Zulfinissio Abdurrahmonova
- Republican Centre for Nutrition, Ministry of Health and Social Protection of Population , Duschanbe, Tajikistan
| | | | - Nazan Yardim
- Diabetes and Metabolic Disorders Department, Ministry of Health, Public Health Institution , Ankara, Turkey
| | - Maya Tanrygulyyeva
- Scientific Research Institute of Maternal and Child Health , Ashgabat, Turkmenistan
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University , Salzburg, Austria
| | | | - Dragana Stojisavljević
- Public Health Institute of Republic of Srpska, the University of Banja Luka, Faculty of Medicine , Banja Luka
- Bosnia and Herzegovina , Banja Luka
| | - Aida Filipović Hadžiomeragić
- Institute of Public Health of Federation of Bosnia and Herzegovina , Banja Luka
- Bosnia and Herzegovina , Banja Luka
| | | | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Institute of Statistics, University of Bremen , Bremen, Germany
| | | | | | - Sergej M Ostojic
- Faculty of Sport and PE, University of Novi Sad , Novi Sad, Serbia
| | - Lubica Ticha
- National Institute of Children Diseases, Medical Faculty of Comenius University , Bratislava, Slovakia
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana , Ljubljana, Slovenia
| | - Kenisha Russell Jonsson
- Department of Living Conditions and Lifestyle, Public Health Agency of Sweden , Solna, Sweden
| | - Igor Spiroski
- Department of Physiology and Monitoring of Nutrition, Institute of Public Health , Skopje, Republic of Macedonia
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath , Bath, UK
| | - Romeu Mendes
- Division of Country Health Programmes, WHO Regional Office for Europe , Copenhagen, Denmark
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto , Porto, Portugal
| | - Julianne Williams
- Division of Country Health Programmes, WHO Regional Office for Europe , Copenhagen, Denmark
| | - Ivo Rakovac
- Division of Country Health Programmes, WHO Regional Office for Europe , Copenhagen, Denmark
| | - João Breda
- Division of Country Health Programmes, WHO Regional Office for Europe , Copenhagen, Denmark
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Vaughan KL, Cade JE, Hetherington MM, Cockroft JE, Heinen MM, Rippin H, Evans CEL. Evaluation of the PhunkyFoods intervention on food literacy and cooking skills of children aged 7-9 years: a cluster randomised controlled trial in Yorkshire Primary Schools UK. Trials 2022; 23:618. [PMID: 35915460 PMCID: PMC9344772 DOI: 10.1186/s13063-022-06558-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood obesity rates more than double during primary school in England. Acquiring competent cooking skills is a key part of children's education that can lead to improved knowledge of a healthy lifestyle and dietary behaviours. Evaluation of the impact of 'PhunkyFoods', a school-based food and nutrition education programme, will assess food literacy, cooking skills and dietary behaviour in primary-school children. METHODS A cluster randomised controlled trial will be undertaken in 28 primary schools in North Yorkshire, UK, including a total population of children aged 7-9 years (n = 420). The trial has two arms: (a) the intervention group receiving PhunkyFoods programme (n = 210) and (b) the wait-list control group receiving the usual school curriculum (n = 210). The intervention 'PhunkyFoods' will be delivered by Purely Nutrition Ltd. The participating school staff are supported with training, policy development and access to resources to improve the delivery of nutrition education. Children participate through whole school assemblies, classroom activities, and after-school clubs about food preparation, cooking healthy meals and healthy living. Schools, parents and children have access to healthy meal recipes through the PhunkyFoods website. The primary outcomes are differences in food literacy and cooking skills scores between control and intervention arms after 12 months of the intervention and adjusted for baseline values. The secondary outcome is differences in fruit and vegetable intake between the arms after 12 months (adjusted for baseline). Treatment effects will be examined using mixed ANOVA and regression analysis. Primary analyses will adjust for baseline food literacy and cooking skills scores and secondary analysis will adjust for pre-specified baseline school and child level covariates. DISCUSSION The PhunkyFoods programme is a flexible menu of options for schools to choose from, making this a highly complex intervention. Following Medical Research Council guidance, research perspectives will focus on effectiveness and theory-based approaches: to what extent the intervention produces the intended outcomes in real-world settings and what works in which circumstances. TRIAL REGISTRATION ISRCTN ISRCTN68114155 . Prospectively registered on 22 October 2021.
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Affiliation(s)
| | | | | | | | - Mirjam M Heinen
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
| | - Holly Rippin
- WHO European Office for Prevention and Control of Noncommunicable Diseases (NCD Office), Copenhagen, Denmark
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Ramos Salas X, Buoncristiano M, Williams J, Kebbe M, Spinelli A, Nardone P, Rito A, Duleva V, Musić Milanović S, Kunesova M, Braunerová RT, Hejgaard T, Rasmussen M, Shengelia L, Abdrakhmanova S, Abildina A, Usuopva Z, Hyska J, Burazeri G, Petrauskiene A, Pudule I, Sant'Angelo VF, Kujundzic E, Fijałkowska A, Cucu A, Brinduse LA, Peterkova V, Bogova E, Gualtieri A, Solano MG, Gutiérrez-González E, Rakhmatullaeva S, Tanrygulyyeva M, Yardim N, Weghuber D, Mäki P, Russell Jonsson K, Starc G, Juliusson PB, Heinen MM, Kelleher C, Ostojic S, Popovic S, Kovacs VA, Akhmedova D, Farpour-Lambert NJ, Rutter H, Li B, Boymatova K, Rakovac I, Wickramasinghe K, Breda J. Parental Perceptions of Children's Weight Status in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative: COSI 2015/2017. Obes Facts 2021; 14:658-674. [PMID: 34818257 PMCID: PMC8739931 DOI: 10.1159/000517586] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Parents can act as important agents of change and support for healthy childhood growth and development. Studies have found that parents may not be able to accurately perceive their child's weight status. The purpose of this study was to measure parental perceptions of their child's weight status and to identify predictors of potential parental misperceptions. METHODS We used data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative and 22 countries. Parents were asked to identify their perceptions of their children's weight status as "underweight," "normal weight," "a little overweight," or "extremely overweight." We categorized children's (6-9 years; n = 124,296) body mass index (BMI) as BMI-for-age Z-scores based on the 2007 WHO-recommended growth references. For each country included in the analysis and pooled estimates (country level), we calculated the distribution of children according to the WHO weight status classification, distribution by parental perception of child's weight status, percentages of accurate, overestimating, or underestimating perceptions, misclassification levels, and predictors of parental misperceptions using a multilevel logistic regression analysis that included only children with overweight (including obesity). Statistical analyses were performed using Stata version 15 1. RESULTS Overall, 64.1% of parents categorized their child's weight status accurately relative to the WHO growth charts. However, parents were more likely to underestimate their child's weight if the child had overweight (82.3%) or obesity (93.8%). Parents were more likely to underestimate their child's weight if the child was male (adjusted OR [adjOR]: 1.41; 95% confidence intervals [CI]: 1.28-1.55); the parent had a lower educational level (adjOR: 1.41; 95% CI: 1.26-1.57); the father was asked rather than the mother (adjOR: 1.14; 95% CI: 0.98-1.33); and the family lived in a rural area (adjOR: 1.10; 95% CI: 0.99-1.24). Overall, parents' BMI was not strongly associated with the underestimation of children's weight status, but there was a stronger association in some countries. DISCUSSION/CONCLUSION Our study supplements the current literature on factors that influence parental perceptions of their child's weight status. Public health interventions aimed at promoting healthy childhood growth and development should consider parents' knowledge and perceptions, as well as the sociocultural contexts in which children and families live.
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Affiliation(s)
- Ximena Ramos Salas
- WHO European Office for Prevention and Control of NCDs, Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
- European Association for the Study of Obesity, Teddington, United Kingdom
| | | | - Julianne Williams
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Maryam Kebbe
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | | | | | - Ana Rito
- National Institute of Health Dr. Ricardo Jorge I.P., Lisbon, Portugal
| | - Vesselka Duleva
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Sanja Musić Milanović
- University of Zagreb, School of Medicine/Croatian Institute of Public Health, Zagreb, Croatia
| | - Marie Kunesova
- Obesity Management Centre, Institute of Endocrinology, Prague, Czechia
| | | | | | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lela Shengelia
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Shynar Abdrakhmanova
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Akbota Abildina
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | | | | | | | - Aušra Petrauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Iveta Pudule
- Centre for Disease Prevention and Control, Riga, Latvia
| | | | | | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Alexandra Cucu
- Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Romania, Bucharest, Romania
| | - Lacramioara Aurelia Brinduse
- Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Romania, Bucharest, Romania
| | - Valentina Peterkova
- Institute of Pediatric Endocrinology, Endocrine Research Centre, Moscow, Russian Federation
| | - Elena Bogova
- Institute of Pediatric Endocrinology, Endocrine Research Centre, Moscow, Russian Federation
| | | | - Marta García Solano
- Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain
| | - Enrique Gutiérrez-González
- Observatory of Nutrition and Study of Obesity, Spanish Agency for Food Safety & Nutrition, Ministry of Health, Madrid, Spain
| | - Sanavbar Rakhmatullaeva
- Department for Organization of Health Services to Children, Mothers, Adolescents and Family Planning, Ministry of Health and Social Protection of the Population, Dushanbe, Tajikistan
| | - Maya Tanrygulyyeva
- Internal Diseases Department of the Scientific Clinical Centre of Mother and Child Health, Ashgabat, Turkmenistan
| | - Nazan Yardim
- Ministry of Health, Public Health General Directorate, Ankara, Turkey
| | - Daniel Weghuber
- WHO European Office for Prevention and Control of NCDs, Country Health Programmes, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Päivi Mäki
- European Association for the Study of Obesity, Teddington, United Kingdom
| | | | | | | | - Mirjam M. Heinen
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Cecily Kelleher
- National Center of Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Sergej Ostojic
- University of Zagreb, School of Medicine/Croatian Institute of Public Health, Zagreb, Croatia
| | - Stevo Popovic
- Obesity Management Centre, Institute of Endocrinology, Prague, Czechia
| | | | - Dilorom Akhmedova
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Harry Rutter
- National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Bai Li
- Centre for Health Promotion, Bishkek, Kyrgyzstan
| | | | - Ivo Rakovac
- European Association for the Study of Obesity, Teddington, United Kingdom
| | - Kremlin Wickramasinghe
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Joao Breda
- European Association for the Study of Obesity, Teddington, United Kingdom
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7
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Breda J, Farrugia Sant'Angelo V, Duleva V, Galeone D, Heinen MM, Kelleher CC, Menzano MT, Musić Milanović S, Mitchell L, Pudule I, Rito AI, Shengelia L, Spinelli A, Spiroski I, Yardim N, Buoncristiano M, Williams J, Rakovac I, McColl K. Mobilizing governments and society to combat obesity: Reflections on how data from the WHO European Childhood Obesity Surveillance Initiative are helping to drive policy progress. Obes Rev 2021; 22 Suppl 6:e13217. [PMID: 34378847 DOI: 10.1111/obr.13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/30/2022]
Abstract
To meet the need for regular and reliable data on the prevalence of overweight and obesity among children in Europe, the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established in 2007. The resulting robust surveillance system has improved understanding of the public health challenge of childhood overweight and obesity in the WHO European Region. For the past decade, data from COSI have helped to inform and drive policy action on nutrition and physical activity in the region. This paper describes illustrative examples of how COSI data have fed into national and international policy, but the real scope of COSI's impact is likely to be much broader. In some countries, there are signs that policy responses to COSI data have helped halt the rise in childhood obesity. As the countries of the WHO European Region commit to pursuing United Action for Better Health in Europe in WHO's new European Programme of Work, COSI provides an excellent example of such united action in practice. Further collaborative action will be key to tackling this major public health challenge which affects children throughout the region.
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Affiliation(s)
- João Breda
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | | | - Vesselka Duleva
- Department of Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | | | - Mirjam M Heinen
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Cecily C Kelleher
- College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | | | - Sanja Musić Milanović
- Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Lachlan Mitchell
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Iveta Pudule
- Department of Research and Health Statistics, Centre for Disease and Prevention Control, Riga, Latvia
| | - Ana Isabel Rito
- WHO/Europe Collaborating Center for Nutrition and Childhood Obesity - Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Lela Shengelia
- Maternal, Child and Reproductive Health, National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Angela Spinelli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Igor Spiroski
- Institute of Public Health, Skopje, North Macedonia.,Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Nazan Yardim
- Public Health General Directorate, Ministry of Health of Turkey, Ankara, Turkey
| | - Marta Buoncristiano
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Julianne Williams
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Ivo Rakovac
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Karen McColl
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
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8
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Spinelli A, Buoncristiano M, Nardone P, Starc G, Hejgaard T, Júlíusson PB, Fismen AS, Weghuber D, Musić Milanović S, García-Solano M, Rutter H, Rakovac I, Cucu A, Brinduse LA, Rito AI, Kovacs VA, Heinen MM, Nurk E, Mäki P, Abdrakhmanova S, Rakhmatulleoeva S, Duleva V, Farrugia Sant'Angelo V, Fijałkowska A, Gualtieri A, Sacchini E, Hassapidou M, Hyska J, Kelleher CC, Kujundžić E, Kunešová M, Markidou Ioannidou E, Ostojic SM, Peterkova V, Petrauskienė A, Popović S, Pudule I, Russell Jonsson K, Dal-Re Saavedra MÁ, Salanave B, Shengelia L, Spiroski I, Tanrygulyyeva M, Tichá Ľ, Usupova Z, Ozcebe LH, Abildina A, Schindler K, Weber MW, Filipović Hadžiomeragić A, Melkumova M, Stojisavljević D, Boymatova K, Williams J, Breda J. Thinness, overweight, and obesity in 6- to 9-year-old children from 36 countries: The World Health Organization European Childhood Obesity Surveillance Initiative-COSI 2015-2017. Obes Rev 2021; 22 Suppl 6:e13214. [PMID: 34235850 DOI: 10.1111/obr.13214] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 01/07/2023]
Abstract
In 2015-2017, the fourth round of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was conducted in 36 countries. National representative samples of children aged 6-9 (203,323) were measured by trained staff, with similar equipment and using a standardized protocol. This paper assesses the children's body weight status and compares the burden of childhood overweight, obesity, and thinness in Northern, Eastern, and Southern Europe and Central Asia. The results show great geographic variability in height, weight, and body mass index. On average, the children of Northern Europe were the tallest, those of Southern Europe the heaviest, and the children living in Central Asia the lightest and the shortest. Overall, 28.7% of boys and 26.5% of girls were overweight (including obesity) and 2.5% and 1.9%, respectively, were thin according to the WHO definitions. The prevalence of obesity varied from 1.8% of boys and 1.1% of girls in Tajikistan to 21.5% and 19.2%, respectively, in Cyprus, and tended to be higher for boys than for girls. Levels of thinness, stunting, and underweight were relatively low, except in Eastern Europe (for thinness) and in Central Asia. Despite the efforts to halt it, unhealthy weight status is still an important problem in the WHO European Region.
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Affiliation(s)
- Angela Spinelli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Marta Buoncristiano
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Paola Nardone
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Tatjana Hejgaard
- Health Promotion and Inequality, Danish Health Authority, Copenhagen, Denmark
| | - Petur Benedikt Júlíusson
- Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne-Siri Fismen
- Department of Health Promotion and Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | - Sanja Musić Milanović
- Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marta García-Solano
- Spanish Agency for Food Safety and Nutrition, Ministry of Consumer Affairs, Madrid, Spain
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Ivo Rakovac
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Alexandra Cucu
- Faculty of Midwifery and Nursing, Discipline of Public health and Health Management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania.,National Centre of Health Promotion and Health Evaluation, National Institute of Public Health, Bucharest, Romania
| | - Lacramioara Aurelia Brinduse
- National Centre of Health Promotion and Health Evaluation, National Institute of Public Health, Bucharest, Romania.,Faculty of Medicine, Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Ana Isabel Rito
- WHO/Europe Collaborating Center for Nutrition and Childhood Obesity - Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | | | - Mirjam M Heinen
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Eha Nurk
- Department of Nutrition Research, National Institute for Health Development, Tallinn, Estonia
| | - Päivi Mäki
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Shynar Abdrakhmanova
- Department of Science and Professional Development, National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan.,Kazakhstan School of Public Health, Kazakhstan's Medical University, Almaty, Kazakhstan
| | - Sanavbar Rakhmatulleoeva
- Department of the Organization of Medical Services for Mothers, Children and Family Planning Ministry of Health and Social Protection, Dushanbe, Tajikistan
| | - Vesselka Duleva
- Department Food and Nutrition, National Center of Public Health and Analyses, Sofia, Bulgaria
| | | | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | | | - Elena Sacchini
- Health Authority, Ministry of Health, San Marino, San Marino
| | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Jolanda Hyska
- Nutrition and Food Safety Sector, Institute of Public Health, Tirana, Albania
| | - Cecily C Kelleher
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Enisa Kujundžić
- Center for Health Ecology, Institute of Public Health, Podgorica, Montenegro
| | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | | | - Sergej M Ostojic
- Biomedical Sciences Department, Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Valentina Peterkova
- Institute of Paediatric Endocrinology, National Medical Research Centre for Endocrinology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Aušra Petrauskienė
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Stevo Popović
- Faculty for Sport and Physical Education, University of Montenegro, Niksic, Montenegro.,Montenegrin Sports Academy, Podgorica, Montenegro
| | - Iveta Pudule
- Department of Research and Health Statistics, Centre for Disease and Prevention Control, Riga, Latvia
| | - Kenisha Russell Jonsson
- Department of Living Conditions and Lifestyle, Public Health Agency of Sweden, Solna, Sweden
| | | | - Benoît Salanave
- Departement of Non-Communicable Diseases and Traumatisms, Santé publique France, the French Public Health Agency, Saint Maurice, France.,Nutritional Surveillance and Epidemiology Team (ESEN), University Sorbonne Paris Nord, Bobigny, France
| | - Lela Shengelia
- Maternal, Child and Reproductive Health, National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Igor Spiroski
- Institute of Public Health, Skopje, North Macedonia.,Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - Maya Tanrygulyyeva
- Scientific Research Institute of Maternal and Child Health, Ashgabat, Turkmenistan
| | - Ľubica Tichá
- Children's Hospital National Institute of Children's Diseases, Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Zhamilya Usupova
- Republican Center for Health Promotion and Mass Communication, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Lütfiye Hilal Ozcebe
- Medical Faculty, Department of Public Health, Hacettepe University, Ankara, Turkey
| | - Akbota Abildina
- National Center of Public Health, Ministry of Health of the Republic of Kazakhstan/WHO Collaborating Center for Promoting Healthy Lifestyle, Nur-Sultan, Kazakhstan
| | - Karin Schindler
- Federal Ministry Social Affairs, Health Care and Consumer Protection, Division of Mother, Child, Gender Health and Nutrition, Vienna, Austria
| | - Martin W Weber
- World Health Organization (WHO) Child and Adolescent Health and Development, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Aida Filipović Hadžiomeragić
- Department of Hygiene, Health Ecology Service, Institute of Public Health of Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Marina Melkumova
- Institute of Child and Adolescent Health, Arabkir Medical Centre- Institute of Child and Adolescent Health, Yerevan, Armenia
| | - Dragana Stojisavljević
- Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina.,Public Health Institute of Republic of Srpska, Banja Luka, Bosnia and Herzegovina
| | - Khadichamo Boymatova
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Tajikistan Country Office, Dushanbe, Tajikistan
| | - Julianne Williams
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - João Breda
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
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9
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Taxová Braunerová R, Kunešová M, Heinen MM, Rutter H, Hassapidou M, Duleva V, Pudule I, Petrauskienė A, Sjöberg A, Lissner L, Spiroski I, Gutiérrez-González E, Kelleher CC, Bergh IH, Metelcová T, Vignerová J, Brabec M, Buoncristiano M, Williams J, Simmonds P, Zamrazilová H, Hainer V, Yngve A, Rakovac I, Breda J. Waist circumference and waist-to-height ratio in 7-year-old children-WHO Childhood Obesity Surveillance Initiative. Obes Rev 2021; 22 Suppl 6:e13208. [PMID: 34402567 DOI: 10.1111/obr.13208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022]
Abstract
Childhood obesity is a serious global health problem. Waist circumference (WC) and waist-to-height ratio (WHtR) reflect body fat distribution in children. The objectives of this study were to assess WC and WHtR in 7-year-old children and to determine body mass index (BMI), WC, and WHtR differences in children from 10 selected countries across Europe (Bulgaria, Czechia, Greece, Ireland, Latvia, Lithuania, North Macedonia, Norway, Spain, and Sweden) participating in the World Health Organization (WHO) Europe Childhood Obesity Surveillance Initiative (COSI). The 50th and 90th percentile of WC (according to COSI and "Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS" (IDEFICS) cutoff values) and WHtR above 0.5 were used as measures of abdominal obesity in a unique sample of 38,975 children aged 7.00-7.99 years. Southern European countries, including Greece and Spain, showed significantly higher BMI, WC, and WHtRin both genders (p < 0.0001) than Eastern and Northern Europe. The highest values for WC were observed in Greece (60.8 ± 7.36 cm boys; 60.3 ± 7.48 cm girls), North Macedonia (60.4 ± 7.91 cm boys; 59.0 ± 8.01 cm girls), and Spain (59.7 ± 6.96 cm boys; 58.9 ± 6.77 cm girls). WC and WHtRin may add an information about the occurrence of central obesity in children.
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Affiliation(s)
| | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - Mirjam M Heinen
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Maria Hassapidou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Vesselka Duleva
- Department of Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | - Iveta Pudule
- Department of Research and Health Statistics, Centre for Disease and Prevention Control, Riga, Latvia
| | - Aušra Petrauskienė
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agneta Sjöberg
- Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine at Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Igor Spiroski
- Institute of Public Health, Skopje, North Macedonia.,Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | - Cecily C Kelleher
- College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Ingunn Holden Bergh
- Department of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Tereza Metelcová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic.,1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Vignerová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - Marek Brabec
- Institute of Computer Science, Czech Academy of Sciences, Prague, Czech Republic
| | - Marta Buoncristiano
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Julianne Williams
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Philippa Simmonds
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Hana Zamrazilová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - Vojtěch Hainer
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | - Agneta Yngve
- Department of Nutrition, Dietetics and Food Studies, Uppsala University, Sweden.,School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ivo Rakovac
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - João Breda
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
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10
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Heinen MM, Bel-Serrat S, Kelleher CC, Buoncristiano M, Spinelli A, Nardone P, Milanović SM, Rito AI, Bosi ATB, Gutiérrrez-González E, Pudule I, Abdrakhmanova S, Abdurrahmonova Z, Brinduse LA, Cucu A, Duleva V, Fijałkowska A, Gualtieri A, Hejgaard T, Hyska J, Kujundžić E, Petrauskiene A, Sacchini E, Shengelia L, Tanrygulyyeva M, Usupova Z, Bergh IH, Weghuber D, Taxová Braunerová R, Kunešová M, Sant'Angelo VF, Nurk E, Ostojic SM, Spiroski I, Tichá Ľ, Rutter H, Williams J, Boymatova K, Rakovac I, Weber MW, Breda J. Urban and rural differences in frequency of fruit, vegetable, and soft drink consumption among 6-9-year-old children from 19 countries from the WHO European region. Obes Rev 2021; 22 Suppl 6:e13207. [PMID: 34235832 DOI: 10.1111/obr.13207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/28/2022]
Abstract
In order to address the paucity of evidence on the association between childhood eating habits and urbanization, this cross-sectional study describes urban-rural differences in frequency of fruit, vegetable, and soft drink consumption in 123,100 children aged 6-9 years from 19 countries participating in the fourth round (2015-2017) of the WHO European Childhood Obesity Surveillance Initiative (COSI). Children's parents/caregivers completed food-frequency questionnaires. A multivariate multilevel logistic regression analysis was performed and revealed wide variability among countries and within macroregions for all indicators. The percentage of children attending rural schools ranged from 3% in Turkey to 70% in Turkmenistan. The prevalence of less healthy eating habits was high, with between 30-80% and 30-90% children not eating fruit or vegetables daily, respectively, and up to 45% consuming soft drinks on >3 days a week. For less than one third of the countries, children attending rural schools had higher odds (OR-range: 1.1-2.1) for not eating fruit or vegetables daily or consuming soft drinks >3 days a week compared to children attending urban schools. For the remainder of the countries no significant associations were observed. Both population-based interventions and policy strategies are necessary to improve access to healthy foods and increase healthy eating behaviors among children.
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Affiliation(s)
- Mirjam M Heinen
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Silvia Bel-Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Cecily C Kelleher
- College of Health and Agricultural Sciences, University College Dublin, Dublin, Ireland
| | - Marta Buoncristiano
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Angela Spinelli
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Paola Nardone
- National Centre for Disease Prevention and Health Promotion, Italian National Institute of Health (Istituto Superiore di Sanità), Rome, Italy
| | - Sanja Musić Milanović
- Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Isabel Rito
- WHO/Europe Collaborating Center for Nutrition and Childhood Obesity - Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - A Tülay Bağci Bosi
- Medical Faculty, Department of Public Health, Hacettepe University, Ankara, Turkey
| | | | - Iveta Pudule
- Department of Research and Health Statistics, Centre for Disease and Prevention Control, Riga, Latvia
| | - Shynar Abdrakhmanova
- Department of Science and Professional Development, National Center of Public Health of the Ministry of Health of the Republic of Kazakhstan, Almaty, Kazakhstan.,Kazakhstan School of Public Health, Kazakhstan's Medical University, Almaty, Kazakhstan
| | - Zulfiya Abdurrahmonova
- Republican Centre for Nutrition, Ministry of Health and Social Protection of Population, Duschanbe, Tajikistan
| | - Lacramioara Aurelia Brinduse
- Faculty of Medicine, Department of Public Health and Management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania.,National Centre of Health Promotion and Health Evaluation, National Institute of Public Health, Bucharest, Romania
| | - Alexandra Cucu
- National Centre of Health Promotion and Health Evaluation, National Institute of Public Health, Bucharest, Romania.,Faculty of Midwifery and Nursing, Discipline of Public Health and Health Management, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania
| | - Vesselka Duleva
- Department Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | | | - Tatjana Hejgaard
- Health Promotion and Inequality, Danish Health Authority, Copenhagen, Denmark
| | - Jolanda Hyska
- Nutrition and Food Safety Sector, Institute of Public Health, Tirana, Albania
| | - Enisa Kujundžić
- Center for Health Ecology, Institute of Public Health, Podgorica, Montenegro
| | - Ausra Petrauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elena Sacchini
- Health Authority, Ministry of Health, San Marino, San Marino
| | - Lela Shengelia
- Maternal, Child and Reproductive Health, National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - Maya Tanrygulyyeva
- Scientific Research Institute of Maternal and Child Health, Ashgabat, Turkmenistan
| | - Zhamilya Usupova
- Republican Center for Health Promotion and Mass Communication, Ministry of Health of the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | - Ingunn Holden Bergh
- Department of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | | | - Marie Kunešová
- Obesity Management Centre, Institute of Endocrinology, Prague, Czech Republic
| | | | - Eha Nurk
- Department of Nutrition Research, National Institute for Health Development, Tallinn, Estonia
| | - Sergej M Ostojic
- Biomedical Sciences Department, Faculty of Sport and Physical Education, University of Novi Sad, Novi Sad, Serbia
| | - Igor Spiroski
- Institute of Public Health, Skopje, North Macedonia.,Faculty of Medicine, SS. Cyril and Methodius University, Skopje, North Macedonia
| | - Ľubica Tichá
- Children's Hospital National Institute of Children's Diseases, Medical Faculty, Comenius University, Bratislava, Slovakia
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Julianne Williams
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Khadichamo Boymatova
- Division of Noncommunicable Diseases and Promoting Health Through the Life-Course, WHO Country Office for Tajikistan, Dushanbe, Tajikistan
| | - Ivo Rakovac
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Martin W Weber
- World Health Organization (WHO) Child and Adolescent Health and Development, WHO Regional Office for Europe, Copenhagen, Denmark
| | - João Breda
- World Health Organization (WHO) European Office for the Prevention and Control of Noncommunicable Diseases, Division of Country Health Programmes, WHO Regional Office for Europe, Moscow, Russian Federation
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11
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Roux TL, Heinen MM, Murphy SP, Buggy CJ. A Unified Theoretical Framework of Learning Theories to Inform and Guide Public Health Continuing Medical Education Research and Practice. J Contin Educ Health Prof 2021; 41:130-138. [PMID: 34057910 PMCID: PMC8168933 DOI: 10.1097/ceh.0000000000000339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Continuing medical education (CME) emerged at the start of the 20th century as a means of maintaining clinical competence among health care practitioners. However, evidence indicates that CME is often poorly developed and inappropriately used. Consequently, there has been increasing interest in the literature in evaluating wider contexts at play in CME development and delivery. In this article, the authors present a unified theoretical framework, grounded in learning theories, to explore the role of contextual factors in public health CME for health care practitioners. Discussion with pedagogical experts together with a narrative review of learning theories within medical and social science literature informed the framework's development. The need to consider sociocultural theories of learning within medical education restricted suitable theories to those that recognized contexts beyond the individual learner; adopted a systems approach to evaluate interactions between contexts and learner; and considered learning as more than mere acquisition of knowledge. Through a process of rigorous critical analysis, two theoretical models emerged as contextually appropriate: Biggs principle of constructive alignment and Bronfenbrenner bioecological model of human development. Biggs principle offers theoretical clarity surrounding interactive factors that encourage lifelong learning, whereas the Bronfenbrenner model expands on these factor's roles across multiple system levels. The authors explore how unification into a single framework complements each model while elaborating on its fundamental and practical applications. The unified theoretical framework presented in this article addresses the limitations of isolated frameworks and allows for the exploration of the applicability of wider learning theories in CME research.
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Whiting S, Buoncristiano M, Gelius P, Abu-Omar K, Pattison M, Hyska J, Duleva V, Musić Milanović S, Zamrazilová H, Hejgaard T, Rasmussen M, Nurk E, Shengelia L, Kelleher CC, Heinen MM, Spinelli A, Nardone P, Abildina A, Abdrakhmanova S, Aitmurzaeva G, Usuopva Z, Pudule I, Petrauskiene A, Sant'Angelo VF, Kujundzic E, Popovic S, Fismen AS, Bergh IH, Fijalkowska A, Rito AI, Cucu A, Brinduse LA, Peterkova V, Gualtieri A, García-Solano M, Gutiérrez-González E, Abdurrahmonova Z, Boymatova K, Yardim N, Tanrygulyyeva M, Weghuber D, Schindler K, Stojisavljević D, Filipović Hadžiomeragić A, Markidou Ionnaidu E, Ahrens W, Hassapidou M, Kovacs VA, Ostojic SM, Ticha L, Starc G, Russell Jonsson K, Spiroski I, Rutter H, Mendes R, Williams J, Rakovac I, Breda J. Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017. Obes Facts 2021; 14:32-44. [PMID: 33352575 PMCID: PMC7983588 DOI: 10.1159/000511263] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. OBJECTIVES This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). METHOD The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration. RESULTS Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night. CONCLUSIONS The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.
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Affiliation(s)
- Stephen Whiting
- WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation,
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal,
| | - Marta Buoncristiano
- WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
| | - Peter Gelius
- Department of Sport Science and Sport, FAU, Erlangen, Germany
| | - Karim Abu-Omar
- Department of Sport Science and Sport, FAU, Erlangen, Germany
| | - Mary Pattison
- WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
| | - Jolanda Hyska
- Nutrition and Food Safety Sector, Institute of Public Health, Tirana, Albania
| | - Vesselka Duleva
- National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Sanja Musić Milanović
- School of Medicine, University of Zagreb, Croatian Institute of Public Health, Zagreb, Croatia
| | - Hana Zamrazilová
- Institute of Endocrinology, Obesity Management Centre, Prague, Czechia
| | | | - Mette Rasmussen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Eha Nurk
- National Institute for Health Development, Tallinn, Estonia
| | - Lela Shengelia
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Cecily C Kelleher
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | - Mirjam M Heinen
- National Nutrition Surveillance Centre, University College Dublin, Dublin, Ireland
| | | | | | - Akbota Abildina
- National Centre of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Shynar Abdrakhmanova
- National Centre of Public Health of the Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | | | | | - Iveta Pudule
- Ministry of Health, Centre for Disease Prevention and Control, Riga, Latvia
| | - Aušra Petrauskiene
- Lithuanian University of Health Sciences, Health Research Institute and Department of Preventive Medicine, Kaunas, Lithuania
| | | | - Enisa Kujundzic
- Institute of Public Health of Montenegro, Podgorica, Montenegro
| | - Stevo Popovic
- Faculty for Sport and Physical Education, University of Montenegro, Niksic, Montenegro
| | - Anne-Siri Fismen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Ingunn Holden Bergh
- Department of Health and Inequality, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anna Fijalkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Ana Isabel Rito
- National Institute of Health Dr Ricardo Jorge I.P., Lisbon, Portugal
| | | | | | | | | | - Marta García-Solano
- Spanish Agency for Food Safety and Nutrition, Ministry of Health, Madrid, Spain
| | | | - Zulfinissio Abdurrahmonova
- Republican Centre for Nutrition, Ministry of Health and Social Protection of Population, Duschanbe, Tajikistan
| | | | - Nazan Yardim
- Diabetes and Metabolic Disorders Department, Ministry of Health, Public Health Institution, Ankara, Turkey
| | - Maya Tanrygulyyeva
- Scientific Research Institute of Maternal and Child Health, Ashgabat, Turkmenistan
| | - Daniel Weghuber
- Department of Pediatrics, Paracelsus Medical University, Salzburg, Austria
| | | | - Dragana Stojisavljević
- Public Health Institute of Republic of Srpska, the University of Banja Luka, Faculty of Medicine, Banja Luka, Bosnia and Herzegovina
| | | | | | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Institute of Statistics, University of Bremen, Bremen, Germany
| | | | | | - Sergej M Ostojic
- Faculty of Sport and PE, University of Novi Sad, Novi Sad, Serbia
| | - Lubica Ticha
- National Institute of Children Diseases, Medical Faculty of Comenius University, Bratislava, Slovakia
| | - Gregor Starc
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Kenisha Russell Jonsson
- Department of Living Conditions and Lifestyle, Public Health Agency of Sweden, Solna, Sweden
| | - Igor Spiroski
- Department of Physiology and Monitoring of Nutrition, Institute of Public Health, Skopje, North Macedonia
| | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Romeu Mendes
- WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Julianne Williams
- WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
| | - Ivo Rakovac
- WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
| | - João Breda
- WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
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Bel-Serrat S, Ojeda-Rodríguez A, Heinen MM, Buoncristiano M, Abdrakhmanova S, Duleva V, Sant'Angelo VF, Fijałkowska A, Hejgaard T, Huidumac C, Hyska J, Kujundzic E, Milanović SM, Ovezmyradova G, Pérez-Farinós N, Petrauskiene A, Rito AI, Shengelia L, Braunerová RT, Rutter H, Murrin CM, Kelleher CC, Breda J. Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity-WHO European Childhood Obesity Surveillance Initiative (COSI 2015⁻2017). Nutrients 2019; 11:E511. [PMID: 30818859 PMCID: PMC6471416 DOI: 10.3390/nu11030511] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 01/22/2023] Open
Abstract
It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster 'Physically active and healthy diet'. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.
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Affiliation(s)
- Silvia Bel-Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin,D4 Dublin, Ireland.
| | - Ana Ojeda-Rodríguez
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin,D4 Dublin, Ireland.
- Department of Nutrition, Food Science and Physiology, University of Navarra, 31008 Pamplona, Spain.
| | - Mirjam M Heinen
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin,D4 Dublin, Ireland.
| | - Marta Buoncristiano
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO European Office for Prevention and Control of Noncommunicable Diseases, 125009 Moscow, Russia.
| | - Shynar Abdrakhmanova
- National Center of Public Health, Ministry of Health of the Republic of Kazakhstan, 50010 Almaty, Kazakhstan.
| | - Vesselka Duleva
- National Center of Public Health and Analyses, 1431 Sofia, Bulgaria.
| | | | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, 01-211 Warsaw, Poland.
| | | | | | | | - Enisa Kujundzic
- Institute of Public Health of Montenegro, 8100 Podgorica, Montenegro.
| | - Sanja Musić Milanović
- Croatian Institute of Public Health, 10000 Zagreb, Croatia.
- School of Medicine, School of Public Health Andrija Štampar, University of Zagreb, 10000 Zagreb, Croatia.
| | | | | | - Ausra Petrauskiene
- Department of Preventive Medicine, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania.
| | - Ana Isabel Rito
- National Institute of Health Doutor Ricardo Jorge, I.P.,1649-016 Lisbon, Portugal.
| | - Lela Shengelia
- National Center for Disease Control and Public Health of Georgia, 0186 Tbilisi, Georgia.
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Claverton Down, BA2 7AYBath, UK.
| | - Celine M Murrin
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin,D4 Dublin, Ireland.
| | - Cecily C Kelleher
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin,D4 Dublin, Ireland.
| | - João Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO European Office for Prevention and Control of Noncommunicable Diseases, 125009 Moscow, Russia.
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14
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Bel-Serrat S, Heinen MM, Mehegan J, O'Brien S, Eldin N, Murrin CM, Kelleher CC. School sociodemographic characteristics and obesity in schoolchildren: does the obesity definition matter? BMC Public Health 2018. [PMID: 29523113 PMCID: PMC5845160 DOI: 10.1186/s12889-018-5246-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Existing evidence on the role of sociodemographic variables as risk factors for overweight and obesity in school-aged children is inconsistent. Furthermore, findings seem to be influenced by the obesity definition applied. Therefore, this study aimed to investigate if school sociodemographic indicators were associated with weight status in Irish primary schoolchildren and whether this association was sensitive to different obesity classification systems. METHODS A nationally representative cross-sectional sample of 7542 Irish children (53.9% girls), mean age 10.4 (±1.2SD) years, participating in the Childhood Obesity Surveillance Initiative in the 2010, 2012/2013 or 2015/2016 waves were included. Height, weight and waist circumference were objectively measured. Five definitions of obesity were employed using different approaches for either body mass index (BMI) or abdominal obesity. Associations between overweight and obesity and sociodemographic variables were investigated using adjusted multilevel logistic regression analyses. RESULTS Children attending disadvantaged schools were more likely to be overweight and obese than their peers attending non-disadvantaged schools, regardless of the obesity classification system used. Associations remained significant for the BMI-based obesity definitions when the sample was stratified by sex and age group, except for boys aged 8-10.5 years. Only boys aged ≥10.5 years in disadvantaged schools had higher odds of abdominal obesity (UK 1990 waist circumference growth charts: OR = 1.56, 95%CI = 1.09-2.24; waist-to-height ratio: OR = 1.78, 95%CI = 1.14-2.79) than those in non-disadvantaged schools. No associations were observed for school urbanisation level. CONCLUSIONS School socioeconomic status was a strong determinant of overweight and obesity in Irish schoolchildren, and these associations were age- and sex-dependent. School location was not associated with overweight or obesity. There remains a need to intervene with school-aged children in disadvantaged schools, specifically among those approaching adolescence, to prevent a trajectory of obesity into adult life.
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Affiliation(s)
- Silvia Bel-Serrat
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland.
| | - Mirjam M Heinen
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
| | - John Mehegan
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
| | - Sarah O'Brien
- Healthy Eating & Active Living Programme, Health Service Executive, Dublin, Ireland
| | | | - Celine M Murrin
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
| | - Cecily C Kelleher
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
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15
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O'Reilly P, Heinen MM, Viljoen K, O'Brien J, Somerville R, Murrin CM, Kelleher CC. A Prospective Analysis of the Relationship between Chronic Diseases and Adiposity in older adults: Findings from the Lifeways Cross-Generation Cohort Study of a Thousand Families 2001-2014. Ir Med J 2016; 109:407. [PMID: 27685878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study assesses the relationship between body mass index (BMI) and adult chronic diseases (diabetes mellitus type 2 [DM2], cardiovascular diseases [CVD] and cancers), in grandparents in the Lifeways Cross-Generation Cohort Study. BMI was either measured or reported, at baseline or 10-year follow-up, in 1,244 grandparents. Cumulative morbidity data were recorded at baseline, 3 and 10-year follow-up through questionnaires, General Practice note search, or both. Just over 42% of grandparents were overweight and 32.1% obese. In the multivariate analysis BMI showed a strong linear association with both DM2 (ptrend <0.001) and CVD (ptrend <0.001). There were no significant associations with cancers, but case numbers were small. Results were similar for waist circumference. This prospective study presents novel Irish data and confirms other recent Irish cross-sectional reports on adiposity and adult chronic disease, highlighting the need for effective health promotion interventions in older adults.
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Affiliation(s)
- P O'Reilly
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4
| | - M M Heinen
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4
| | - K Viljoen
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4
| | - J O'Brien
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4
| | - R Somerville
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4
| | - C M Murrin
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4
| | - C C Kelleher
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin 4
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16
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Quirke BB, Daly LE, Heinen MM, Kelleher CC. Predictors of Infectious diseases in Traveller Adults in Ireland (2008): A Multivariate Analysis. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv176.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Murrin CM, Heinen MM, Kelleher CC. Are Dietary Patterns of Mothers during Pregnancy Related to Children's Weight Status? Evidence from the Lifeways Cross- Generational Cohort Study. AIMS Public Health 2015; 2:274-296. [PMID: 29546111 PMCID: PMC5690236 DOI: 10.3934/publichealth.2015.3.274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/23/2015] [Indexed: 01/09/2023] Open
Abstract
Children's diet patterns are likely to be influenced by their mothers' diet pattern. The primary objective of this study was to examine whether children's adiposity could be influenced by diet patterns of mothers during pregnancy. A secondary objective was to study the relative influence of fathers' and children's dietary patterns on childhood adiposity. The design was a prospective cross-generational cohort study initiated with 1,124 mothers recruited during pregnancy. Self-reported questionnaires included a food frequency instrument (FFQ) to assess parental intakes during the perinatal period. Child body mass index (BMI) was measured at 5 years and an age-appropriate FFQ was administered. Dietary patterns for each group were identified by principal components analysis. Pearson's correlation and logistic regression were used to test for associations. Dietary patterns were described for n = 1,042 mothers during pregnancy and n = 331 fathers during the perinatal period. Dietary patterns and BMI data were available for n = 443 children at age 5 years. The diet patterns identified for mothers correlated with the corresponding diet patterns for fathers. The children's "pasta & vegetable" pattern was positively correlated with "healthy patterns" in mothers (r = 0.195, p < 0.01) and fathers (r = 0.250, p < 0.01). The children's "junk" food pattern was correlated with the "processed" pattern in mothers (r = 0.245, p < 0.01) and fathers (r = 0.257, p < 0.01). In multivariate logistic regression analysis the upper tertiles of children's "cereal and juice" [Tertile 2 (T2): OR 0.44, 95% CI (0.22-0.90); T3: 0.41, (0.19-0.85)] and the middle tertile of the "pasta and veg" patterns [T3: 0.37, (0.18-0.75)] were negatively associated with overweight and obesity. The mothers' processed pattern during pregnancy was positively associated with offspring overweight and obesity [T2: 2.64, (1.28-5.45); T3: 2.03, (0.87-4.73)]. No significant associations were observed for the paternal diet patterns. This analysis shows that the influence of maternal diet pattern on child obesity is apparent early in the lifecourse.
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Affiliation(s)
- Celine M Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
| | - Mirjam M Heinen
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
| | - Cecily C Kelleher
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Woodview House, Belfield, Dublin 4, Ireland
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18
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Heinen MM, van den Brandt PA, Schouten LJ, Goldbohm RA, Schouten HC, Verhage BAJ. Dietary one-carbon nutrient intake and risk of lymphoid and myeloid neoplasms: results of the Netherlands cohort study. Cancer Epidemiol Biomarkers Prev 2014; 23:2153-64. [PMID: 25047896 DOI: 10.1158/1055-9965.epi-14-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous epidemiologic research suggests a protective role of one-carbon nutrients in carcinogenesis. Folate, however, may play a dual role in neoplasms development: protect early in carcinogenesis and promote carcinogenesis at a later stage. We prospectively examined associations between intake of total folate, methionine, riboflavin, vitamin B6, and risk of lymphoid and myeloid neoplasms (including subtypes) and investigated whether alcohol modified the effects of folate. METHODS The Netherlands Cohort Study consists of 120,852 individuals who completed a baseline questionnaire in 1986, including a 150-item food-frequency questionnaire. After 17.3 years of follow-up, 1,280 cases of lymphoid and 222 cases of myeloid neoplasms were available for analysis. RESULTS Intakes of folate, methionine, and riboflavin were not associated with lymphoid or myeloid neoplasms. For vitamin B6, a statistically significantly increased myeloid neoplasms risk was observed (highest vs. lowest quintile: HR = 1.87; 95% confidence intervals, 1.08-3.25). When analyzing by lymphoid and myeloid neoplasms subtypes, no clear associations were observed for most subtypes, with just a few increased risks for some subtypes and nutrients. Some risks became nonsignificant after excluding early cases. No interaction between alcohol and folate was observed. CONCLUSIONS We observed a few significant positive associations; however, some of these would be expected to arise due to chance alone. Furthermore, some risks became nonsignificant after excluding early cases. Therefore, we conclude that there is no association between one-carbon nutrient intake and risk of lymphoid and myeloid neoplasms. IMPACT This study contributes substantially to the limited and inconclusive evidence on the association with one-carbon nutrients.
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Affiliation(s)
- Mirjam M Heinen
- Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Piet A van den Brandt
- Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Leo J Schouten
- Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - R Alexandra Goldbohm
- Department of Prevention and Health, TNO Quality of Life, Leiden, the Netherlands
| | - Harry C Schouten
- Division of Hematology, Department of Internal Medicine, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Bas A J Verhage
- Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University Medical Centre+, Maastricht, the Netherlands.
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Heinen MM, Verhage BAJ, Schouten LJ, Goldbohm RA, Schouten HC, van den Brandt PA. Alcohol consumption and risk of lymphoid and myeloid neoplasms: Results of the Netherlands cohort study. Int J Cancer 2013; 133:1701-12. [DOI: 10.1002/ijc.28175] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 02/12/2013] [Indexed: 12/31/2022]
Affiliation(s)
- Mirjam M. Heinen
- School for Oncology and Developmental Biology (GROW), Department of Epidemiology; Maastricht University Medical Center; Maastricht; The Netherlands
| | - Bas A. J. Verhage
- School for Oncology and Developmental Biology (GROW), Department of Epidemiology; Maastricht University Medical Center; Maastricht; The Netherlands
| | - Leo J. Schouten
- School for Oncology and Developmental Biology (GROW), Department of Epidemiology; Maastricht University Medical Center; Maastricht; The Netherlands
| | | | - Harry C. Schouten
- School for Oncology and Developmental Biology (GROW), Division of Hematology, Department of Internal Medicine; University Hospital Maastricht; Maastricht; The Netherlands
| | - Piet A. van den Brandt
- School for Oncology and Developmental Biology (GROW), Department of Epidemiology; Maastricht University Medical Center; Maastricht; The Netherlands
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Robben SHM, Heinen MM, Makai P, Olde Rikkert MGM, Perry M, Schers HJ, Melis RJF. [Reducing fragmentation in the care of frail older people: the successful development and implementation of the Health and Welfare Information Portal]. Tijdschr Gerontol Geriatr 2013; 44:59-71. [PMID: 23494689 DOI: 10.1007/s12439-013-0014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Our fragmented health care systems are insufficiently equipped to provide frail older people with high quality of care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), an e-health intervention which aims (1) to facilitate self-management by frail older people and informal caregivers and (2) to improve collaboration among professionals. The ZWIP is a personal conference table, accessible through a secure internet connection, for multidisciplinary communication and information exchange for frail older people, their informal caregivers and professionals. After development, the ZWIP was implemented in seven general practices, and this process was evaluated by means of a mixed-methods study. Eventually, 290 frail older people and 169 professionals participated in the ZWIP. Most professionals were positive about its implementation. Facilitators for the implementation were the experienced need for improvement of interprofessional collaboration and the user-friendliness of the ZWIP. Barriers were the low computer-literacy of frail older people, start-up problems, preferring personal contact, and limited use of the ZWIP by other professionals. In sum, this article describes the successful development and implementation of the ZWIP, an e-health intervention which can reduce fragmentation in the care of frail older people.
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Affiliation(s)
- S H M Robben
- Arts in opleiding tot klinisch geriater, Afdeling Klinische Geriatrie, UMC St Radboud, Nijmegen, The Netherlands.
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Heinen MM, Verhage BAJ, Goldbohm RA, Lumey LH, van den Brandt PA. Physical activity, energy restriction, and the risk of pancreatic cancer: a prospective study in the Netherlands. Am J Clin Nutr 2011; 94:1314-23. [PMID: 21955648 DOI: 10.3945/ajcn.110.007542] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Because of their influence on insulin concentrations, we hypothesized that both physical activity and energy restriction may reduce the risk of pancreatic cancer. OBJECTIVE We examined the associations between physical activity, proxies for energy restriction, and pancreatic cancer risk. DESIGN The Netherlands Cohort Study consisted of 120,852 individuals who completed a baseline questionnaire in 1986. After 13.3 y of follow-up, 408 cases were available for analysis. Self-reported information on physical activity was collected. Three indicators were used as proxies for energy restriction: father's employment status during the Economic Depression (1932-1940) and place of residence during the World War II years (1940-1944) and the Hunger winter (1944-1945). RESULTS For past sports activities, we observed a significantly decreased risk of pancreatic cancer (HR: 0.80; 95% CI: 0.64, 0.99). Proxies for energy restriction were not related to pancreatic cancer risk. When the results for energy restriction were stratified by height, a significant multiplicative interaction was observed for the Economic Depression period (P = 0.002). Shorter individuals (height less than the sex-specific median adult height) with an unemployed father during the Economic Depression period had a significantly lower cancer risk (HR: 0.31; 95% CI: 0.14, 0.66) than did taller individuals with an employed father. No significant interactions were observed for exposure to energy restriction during the World War II years and the Hunger winter. CONCLUSIONS Our results suggest a modestly decreased risk of pancreatic cancer associated with past sports activity. With respect to proxies for energy restriction, our findings suggest that shorter individuals exposed to energy restriction during adolescence may have a reduced risk, whereas taller individuals may not.
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Affiliation(s)
- Mirjam M Heinen
- Nutrition and Toxicology Research Institute Maastricht, Department of Epidemiology, Maastricht University Medical Centre+, Netherlands.
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Heinen MM, Verhage BAJ, Goldbohm RA, van den Brandt PA. Intake of vegetables, fruits, carotenoids and vitamins C and E and pancreatic cancer risk in The Netherlands Cohort Study. Int J Cancer 2011; 130:147-58. [PMID: 21328344 DOI: 10.1002/ijc.25989] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 01/26/2011] [Indexed: 02/06/2023]
Abstract
Epidemiological data investigating the relation between fruit and vegetable consumption and pancreatic cancer risk have shown inconsistent results so far. Most case-control studies observed an inverse association with total fruit and vegetable consumption, whereas results from most cohort studies have largely been null. We examined prospectively the relation between pancreatic cancer risk and intake of vegetables, fruits, carotenoids and vitamins C and E. The Netherlands Cohort Study consisted of 120,852 men and women who completed a questionnaire at baseline in 1986, including a validated 150-item food-frequency questionnaire. After 16.3 years of follow-up, 423 cases were available for analysis. Total vegetable and total fruit consumption were not associated with pancreatic cancer risk (highest vs. lowest quintile, multivariable-adjusted hazard rate ratio = 1.23, 95% confidence interval: 0.86-1.75 and multivariable-adjusted hazard rate ratio = 0.90, 95% confidence interval: 0.66-1.24, respectively). Also, for cooked vegetables, raw vegetables and vegetables and fruits classified into subgroups, no associations were observed. Dietary carotenoids, vitamin C and E intake and supplements containing vitamin C or E were not associated with pancreatic cancer risk. The results were not modified by sex, smoking status and body mass index. In conclusion, we observed no association between a high consumption of vegetables and fruits and pancreatic cancer risk in this large cohort study, which is in agreement with previous prospective studies. Furthermore, we observed no association between the intake of carotenoids, vitamins and vitamin supplements and pancreatic cancer risk.
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Affiliation(s)
- Mirjam M Heinen
- Department of Epidemiology, Nutrition and Toxicology Research Institute Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands.
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Heinen MM, Verhage BA, Goldbohm RA, van den Brandt PA. Abstract B140: Exposure and the risk of pancreatic cancer: Results of the Netherlands Cohort Study. Cancer Prev Res (Phila) 2010. [DOI: 10.1158/1940-6207.prev-09-b140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: We examined the role of active cigarette smoking, smoking cessation, and environmental tobacco smoking (ETS) as determinants for pancreatic cancer in a large prospective cohort study.
Methods: The Netherlands Cohort Study consisted of 120,852 men and women who completed a baseline questionnaire in 1986. After 16.3 years of follow-up, 520 pancreatic cancer cases were available for analysis.
Results: Compared to never cigarette smokers, both former and current cigarette smokers had an increased pancreatic cancer risk (multivariable-adjusted hazard rate ratio (HR) = 1.34; 95% confidence interval (CI) = 1.02–1.75 and HR = 1.82; 95% CI = 1.40–2.38, respectively). We observed an increased pancreatic cancer risk of 38% (95% CI = 1.01–1.87) with smoking ≥20 cigarettes per day compared to never cigarette smoking. The trend test was significant (P = 0.03), but no clear dose-response relation was present. For duration of smoking, we observed an increased pancreatic cancer risk per increment of 10 years (multivariable-adjusted HR = 1.15; 95% CI = 1.08–1.22), with a clear dose response effect observing a 2-fold increased cancer risk comparing ≥40 years of smoking to never cigarette smoking. Quitting smoking gradually reduced the risk of pancreatic cancer (HR = 1.83, 1.41, and 1.42 for currents smokers, ex-smokers quitted 0.1–<10 yrs, and quitted 10–<20 yrs, respectively) and reached unity after ≥20 years of quitting smoking (multivariable-adjusted HR = 1.17; 95% CI=0.80–1.70). Based on the current study, hypothetically 27% (95% CI = 15–37) of pancreatic cancer cases could be prevented if people would not smoke. We investigated which smoking aspect was most important in pancreatic cancer etiology by including smoking variables simultaneously in the model. Only duration remained significantly associated with pancreatic cancer risk (≥40 years of smoking vs. never cigarette smokers, multivariable-adjusted HR = 1.87; 95% CI = 1.24–2.80); the risk estimates of other smoking variables attenuated and became non-significant. When we investigated the interaction between ethanol intake and cigarette smoking, no significant interaction was found (P = 0.97). However, current smokers who consumed ≥30 g of ethanol daily experienced a significantly increased risk compared to abstainers who never smoked (multivariable-adjusted HR = 2.40; 95% CI = 1.06–5.41). No association was observed for ETS and pancreatic cancer risk in women.
Conclusion: Overall, our findings confirmed that cigarette smoking is an important risk factor for pancreatic cancer, while quitting smoking reduced risk. Therefore from a public health perspective, quitting smoking would benefit the burden on pancreatic cancer incidence and mortality. No association was observed between ETS and pancreatic cancer.
Citation Information: Cancer Prev Res 2010;3(1 Suppl):B140.
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Keszei AP, Verhage BAJ, Heinen MM, Goldbohm RA, van den Brandt PA. Dietary folate and folate vitamers and the risk of pancreatic cancer in the Netherlands cohort study. Cancer Epidemiol Biomarkers Prev 2009; 18:1785-91. [PMID: 19505911 DOI: 10.1158/1055-9965.epi-08-1220] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An association between high intake of folate and reduced risk of cancer has been suggested by previous research. However, epidemiologic data from cohort studies regarding the relationship between dietary folate and pancreatic cancer are sparse and inconsistent. We examined the association between dietary folate intake and risk of pancreatic cancer within the Netherlands Cohort Study on diet and cancer. Men and women (120,852), ages 55 to 69 years, were recruited. Information on diet was collected at baseline by means of food frequency questionnaires, and the cohort was followed for 13.3 years. Total folate and vitamer intake were calculated using folate contents of food items derived from a validated liquid chromatography trienzyme method. Cases (n = 363) were identified by record linkage with regional cancer registries and the Dutch National Database of Pathology Reports. A case-cohort approach was used using the follow-up data of a random subcohort (n = 5,000) identified at the onset of the cohort. Multivariable hazard ratios with 95% confidence intervals were estimated using Cox proportional hazards model. After adjusting for age, gender, smoking status, number of years smoked, number of cigarettes smoked per day, and intake of added sugar multivariate hazard ratio comparing the highest and lowest quintiles of folate intake for pancreatic cancer risk was 1.37 (confidence interval, 0.97-1.94; P(trend) = 0.07). When folate vitamers were analyzed separately, results did not show a difference in association. Our results do not support a protective association of total dietary folate or individual folate vitamers on the risk of pancreatic cancer.
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Affiliation(s)
- András P Keszei
- Department of Epidemiology, School for Oncology and Developmental Biology (GROW), Maastricht University, Maastricht, the Netherlands.
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Heinen MM, Verhage BAJ, Goldbohm RA, van den Brandt PA. Meat and fat intake and pancreatic cancer risk in the Netherlands Cohort Study. Int J Cancer 2009; 125:1118-26. [PMID: 19452526 DOI: 10.1002/ijc.24387] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Meat contains numerous carcinogens, such as heterocyclic amines, polycyclic aromatic hydrocarbons, and N-nitroso compounds, which can be derived either from natural food or during the process of food preparation. These carcinogens may increase pancreatic cancer risk. Furthermore, studies in animals showed that polyunsaturated fatty acids, especially linoleic acid, increase pancreatic cancer risk. We examined prospectively the relation between pancreatic cancer risk and intake of fresh meat, processed meat, fish, eggs, total fat, and different types of fat. The Netherlands Cohort Study consisted of 120,852 men and women who completed a baseline questionnaire in 1986. After 13.3 years of follow-up, 350 pancreatic cancer cases (66% microscopically confirmed) were available for analysis. A validated 150-item food-frequency questionnaire was used to calculate intake of fresh meat, processed meat, fish, eggs, fat and different types of fat. No association was found when examining the association between intake of fresh meat, other types of meat, fish, eggs, dietary intake of total fat and different types of fat and risk of pancreatic cancer. It is important for future studies to investigate the relation between different meat-cooking methods and pancreatic cancer.
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Affiliation(s)
- Mirjam M Heinen
- Department of Epidemiology, Nutrition and Toxicology Research Institute Maastricht, Maastricht University, The Netherlands.
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Heinen MM, Verhage BAJ, Ambergen TAW, Goldbohm RA, van den Brandt PA. Alcohol consumption and risk of pancreatic cancer in the Netherlands cohort study. Am J Epidemiol 2009; 169:1233-42. [PMID: 19318612 DOI: 10.1093/aje/kwp028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To examine prospectively the relation between alcohol consumption and pancreatic cancer risk, the authors analyzed data from the Netherlands Cohort Study. Participants were 120,852 persons who completed a baseline questionnaire in 1986. After 13.3 years of follow-up, 350 cases of pancreatic cancer (67% microscopically confirmed) were available for analysis. Compared with abstention, the highest category of alcohol consumption (> or =30 g/day of ethanol) was positively associated with pancreatic cancer risk (for all cases, rate ratio = 1.57, 95% confidence interval: 1.03, 2.39; P(trend) = 0.12; for microscopically confirmed cases, rate ratio = 1.54, 95% confidence interval: 0.94, 2.54; P(trend) = 0.22). In a subgroup of stable alcohol users (no change during the 5 years before baseline), a similarly increased risk of pancreatic cancer was found. This increased risk was limited to the first 7 years of follow-up. No associations were observed between consumption of specific alcoholic beverages and risk of pancreatic cancer. The associations were not modified by folate intake or smoking. Overall, these findings suggest an increased pancreatic cancer risk for persons with a high ethanol intake (> or =30 g/day). However, this increased risk was observed only during the first 7 years of follow-up.
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Affiliation(s)
- Mirjam M Heinen
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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van der Pols JC, Heinen MM, Hughes MC, Ibiebele TI, Marks GC, Green AC. Serum antioxidants and skin cancer risk: an 8-year community-based follow-up study. Cancer Epidemiol Biomarkers Prev 2009; 18:1167-73. [PMID: 19336544 DOI: 10.1158/1055-9965.epi-08-1211] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Antioxidant nutrients can help prevent skin damage caused by ultraviolet radiation from sunlight, but it is not clear whether serum concentrations of such nutrients influence skin cancer risk. METHODS We carried out a prospective study of the associations between serum concentrations of antioxidant nutrients and incidence (person-based and tumor-based) of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin among a random subsample of 485 adults from an Australian community. Participants were divided into thirds, ranked according to their serum concentrations of carotenoids, alpha-tocopherol, and selenium measured in 1996 and were monitored for incident, histologically confirmed BCC and SCC tumors until 2004. RESULTS Although there were no associations between baseline serum carotenoids or alpha-tocopherol concentrations and incidence of BCC or SCC, baseline serum selenium concentrations showed strong inverse associations with both BCC and SCC tumor incidence. Compared with participants with lowest selenium concentrations at baseline (0.4-1.0 micromol/L), those with the highest serum selenium concentrations (1.3-2.8 micromol/L) had a decreased incidence of BCC tumors (multivariate relative risk, 0.43; 95% confidence interval, 0.21-0.86; P(trend) = 0.02) and SCC tumors (multivariate relative risk, 0.36; 95% confidence interval, 0.15-0.82; P(trend) = 0.02). CONCLUSION Relatively high serum selenium concentrations are associated with an approximately 60% decrease in subsequent tumor incidence of both BCC and SCC, whereas serum concentrations of carotenoids or alpha-tocopherol are not associated with later skin cancer incidence. A possible U-shaped association between serum selenium concentrations and SCC of the skin needs confirmation.
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Affiliation(s)
- Jolieke C van der Pols
- Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia.
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Heinen MM, Verhage BA, Lumey L, Brants HA, Goldbohm RA, van den Brandt PA. Glycemic load, glycemic index, and pancreatic cancer risk in the Netherlands Cohort Study. Am J Clin Nutr 2008; 87:970-7. [PMID: 18400721 DOI: 10.1093/ajcn/87.4.970] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent studies of pancreatic cancer suggest a role for hyperinsulinemia in carcinogenesis. Because insulin is secreted in response to elevated blood glucose concentrations, dietary factors that increase these concentrations may be important in pancreatic carcinogenesis. OBJECTIVE The objective was to examine prospectively the relation between pancreatic cancer risk and dietary glycemic load (GL), overall glycemic index (GI), and intake of total carbohydrates and mono- and disaccharides. DESIGN The Netherlands Cohort Study consisted of 120,852 men and women who completed a baseline questionnaire in 1986. After 13.3 y of follow-up, 408 pancreatic cancer cases were detected, 66% of which were microscopically confirmed. A validated 150-item food-frequency questionnaire, completed at baseline, was used to calculate carbohydrate and mono- and disaccharide intakes and the GL and GI of the diet. RESULTS Dietary GL, GI, or intake of carbohydrates and mono- and disaccharides were not associated with pancreatic cancer risk in this cohort. Also, the associations were not modified by sex. Our results did not change after the analysis was restricted to microscopically confirmed pancreatic cancer cases or after individuals who reported a history of diabetes at baseline were excluded from the analyses. CONCLUSIONS Overall, our findings do not support the hypothesis that GL, GI, or intake of carbohydrates and mono- and disaccharides are positively associated with pancreatic cancer risk. This is in agreement with previous prospective studies that investigated the relation between GL and GI and pancreatic cancer risk.
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Affiliation(s)
- Mirjam M Heinen
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.
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Weijenberg MP, Mullie PFF, Brants HAM, Heinen MM, Goldbohm RA, van den Brandt PA. Dietary glycemic load, glycemic index and colorectal cancer risk: results from the Netherlands Cohort Study. Int J Cancer 2008; 122:620-9. [PMID: 17935129 DOI: 10.1002/ijc.23110] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since hyperinsulinemia is implicated in the development of colorectal cancer, determinants of serum insulin levels, like the glycemic load and the glycemic index of the diet, could influence cancer risk. Our objective was to evaluate whether a diet with a high glycemic load or glycemic index is associated with increased colorectal cancer risk. In the Netherlands Cohort Study, 120,852 subjects completed a food frequency questionnaire in 1986. After 11.3 years of follow-up, 1,225 colon and 418 rectal cancer cases were available for analysis. A case-cohort approach was used to estimate multivariate adjusted rate ratios and 95% confidence intervals for quintiles of energy-adjusted glycemic load and glycemic index. The RR for colorectal cancer comparing the highest versus the lowest quintile levels of glycemic load and glycemic index were 0.83 (95% CI: 0.64-1.08) and 0.81 (95% CI: 0.61-1.08) for men and 1.00 (95% CI: 0.73-1.36) and 1.20 (95% CI: 0.85-1.67) for women. In general, no clear associations with cancer subsites were observed. Glycemic load and glycemic index were borderline significantly associated with an increased risk of proximal colon cancer in women (p-trend = 0.06 and 0.08, respectively), however, these associations were attenuated after exclusion of the first 2 years of follow-up (p-trend = 0.165 and 0.254, respectively). In men, glycemic index was associated with a reduced risk of distal colon cancer (p-trend = 0.03). Overall, our findings do not support the hypothesis that a diet with a high glycemic load or index is associated with a higher risk of colorectal cancer.
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Affiliation(s)
- Matty P Weijenberg
- Department of Epidemiology, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands.
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Heinen MM, Hughes MC, Ibiebele TI, Marks GC, Green AC, van der Pols JC. Intake of antioxidant nutrients and the risk of skin cancer. Eur J Cancer 2007; 43:2707-16. [PMID: 17988857 DOI: 10.1016/j.ejca.2007.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 09/04/2007] [Accepted: 09/07/2007] [Indexed: 10/22/2022]
Abstract
To investigate the associations between intake of antioxidant nutrients and risk of basal cell (BCC) and squamous cell carcinomas (SCC) of the skin, we carried out a prospective study among 1001 randomly selected adults living in an Australian community. Intake of antioxidants was estimated in 1996. Incident, histologically-confirmed BCC and SCC were recorded between 1996 and 2004. High dietary intake of lutein and zeaxanthin was associated with a reduced incidence of SCC in persons who had a history of skin cancer at baseline (highest versus lowest tertile, multivariable adjusted relative risk (RR)=0.47, 95% confidence interval (CI): 0.25-0.89; P for trend=0.02). In persons without a history of skin cancer at baseline, development of BCC was positively associated with intake of vitamins C and E from foods plus supplements (RR=3.1, 95% CI: 1.1-8.6; P for trend=0.03 and RR=2.6, 95% CI: 1.1-6.3; P for trend=0.02, respectively). In those with a skin cancer history at baseline, dietary intake in the second tertile for beta-carotene (multivariable adjusted RR=2.2, 95% CI: 1.2-4.1) and for vitamin E (multivariable adjusted RR=2.1, 95% CI: 1.1-3.9) was associated with increased BCC risk, with no trend, and similar results were seen in those with a specific history of BCC. These data suggest quite different associations between antioxidant intake and SCC compared with BCC, consistent with other evidence of their different causal pathways.
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Affiliation(s)
- Mirjam M Heinen
- Cancer and Population Studies Group, Queensland Institute of Medical Research, Brisbane, Australia
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Heinen MM, Evers AWM, Van Uden CJT, Van der Vleuten CJM, van de Kerkhof PCM, Van Achterberg T. Sedentary patients with venous or mixed leg ulcers: determinants of physical activity. J Adv Nurs 2007; 60:50-7. [PMID: 17824939 DOI: 10.1111/j.1365-2648.2007.04376.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper is a report of a study to identify the determinants of physical activity (PA) in patients with venous leg ulcers to develop recommendations for behavioural interventions aimed at enhancing physical activity. BACKGROUND Physical activity promotes wound healing and prevents the recurrence of wounds in venous patients with leg ulcers. Many patients with leg ulcers, however, have a sedentary lifestyle. METHOD A random sample of 25 patients from two clinics were interviewed in 2003 using a combination of prestructured and open-ended questions. All these patients were being treated at an outpatient dermatology clinic and had a leg ulcer with venous or mixed aetiology at the time of the interview or in the month prior to the interview. FINDINGS Only nine of the 25 patients (36%) reported sufficient levels of moderate strenuous physical activity, defined as 30 minutes a day on at least 5 days a week. The results show limited knowledge about the relationship between physical activity and leg ulceration, and low self-efficacy for increasing physical activity. In addition, multi-morbidity, pain and social support were identified as main determinants of physical activity. CONCLUSION Suggestions for improving physical activity levels include influencing knowledge, beliefs and self-efficacy. Patient's individual physical limitations, pain, adequate footwear and social support should be taken into account. Programmes offered by specialized dermatology nurses to stimulate physical activity might fulfil patient needs and help enhance physical activity levels.
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Affiliation(s)
- M M Heinen
- Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Abstract
AIM This study explores the relevance of the International Classification of Functioning, Disability and Health (ICF) to nursing diagnoses. BACKGROUND As a multidisciplinary classification of human functioning, the ICF (previously known as ICIDH-2) is potentially relevant to nursing care. However, nurses have rarely used the classification during the 23 years of its existence. METHOD In part 1 of the study, 51 nursing diagnoses from anonymous patients were deliberately selected for diversity from an existing database. The 427 diagnostic elements from these diagnoses (problem statements, aetiological factors, signs and symptoms) were classified, using the ICF, by a panel of six nurses. In part 2 of the study, the panel classified 223 elements from 30 diagnoses of patients they had actually cared for. RESULTS Nearly all diagnostic elements could be classified, most often in the sub-dimensions of body functions and activities. Agreement on appropriate ICF components was 61% for anonymous patients and 75% for familiar patients. Agreement at the more detailed 3-digit level of the classification was 42% for anonymous and 60% for familiar patients. CONCLUSION The ICF has relevance to nursing care. As a general classification, it was not designed by nurses or specifically for nursing care. This can explain some difficulties in using the classification that were identified in this study, as well as the rather low levels of agreement. To resolve these issues and to further improve the classification, nurses should further explore the use of the ICF and participate in future revision processes.
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Affiliation(s)
- M M Heinen
- Centre for Quality of Care Research, Nursing Science, University Medical Centre St Raboud, Nijmegen, The Netherlands.
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de Weerd S, Steegers EAP, Heinen MM, van den Eertwegh S, Vehof RMEJ, Steegers-Theunissen RPM. Preconception nutritional intake and lifestyle factors: first results of an explorative study. Eur J Obstet Gynecol Reprod Biol 2003; 111:167-72. [PMID: 14597246 DOI: 10.1016/s0301-2115(03)00290-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe nutritional intake and lifestyle factors in women planning pregnancy. STUDY DESIGN A semi-quantitative, 1-month food frequency questionnaire and a questionnaire on health practices and personal views were filled out at home and verified by telephone interview. RESULTS One hundred and one women agreed to participate and data of 69 women were eligible for evaluation. Women planning pregnancy (n=46) consumed significantly more saturated fats and proteins, less carbohydrates and higher median intakes of Vitamin A, thiamin, riboflavin, calcium, selenium, magnesium and iron than controls (n=23; P<0.05). However, the percentage of women planning pregnancy with intakes below recommended dietary allowances was 74% for iron, 59% for selenium, 48% for Vitamin A and 91% for copper. Ninety-six percent and 20% of them reported alcohol use and smoking, respectively. CONCLUSIONS Nutritional intake of women in the preconception period appears to be inadequate. Efforts to increase awareness of a healthy diet and lifestyle before and throughout pregnancy should be continued.
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Affiliation(s)
- Sabina de Weerd
- Department of Obstetrics and Gynecology, Erasmus Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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