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Objective: To investigate the content of lunchboxes of primary school children and to examine children's support and preferences for alternative healthy school lunch concepts.Design: A cross-sectional study among Dutch children from seven primary schools. The content of the lunchboxes was assessed by photographs. Support and preferences for alternative lunch concepts were examined via a self-reported questionnaire. Linear regression analyses were used to investigate the associations between children's support and preferences and sex, educational group and migration background.Setting: The Netherlands.Participants: Primary school children.Results: A total of 660 children were included (average 9·9 years old). Most lunchboxes contained sandwiches and a drink. Few lunchboxes contained fruit or vegetables. The alternative school lunch concepts elicited mixed support among children. The lunch concepts 'Sandwiches prepared by the children themselves' and a 'hot lunch buffet' had the highest mean support, while the concept 'a healthy lunch brought from home' was the most preferred concept. Small significant differences were observed depending on sex, educational group and migration background.Conclusion: Lunchboxes of Dutch children contained sandwiches and a drink but rarely fruit and vegetables. Among different alternatives, children reported the highest support for the preparation of their own sandwiches in class or a hot lunch buffet. Future studies should investigate if these alternative lunch concepts improve the dietary intake of children. [ABSTRACT FROM AUTHOR]

The purpose of this article is to describe a series of recent studies from the authors and many of their colleagues aimed at improving the food environments of adolescents in the Netherlands and thereby improving their food choices. These studies are performed in the wider context of national and local strategies for the prevention of overweight and obesity in the Netherlands. Interventions were developed with local stakeholders and carried out in schools, supermarkets and low-income neighbourhoods. We conclude that current national policies in the Netherlands are largely ineffective in reducing the prevalence of overweight and obesity. Local integrated programmes in the Netherlands, however, seem to result in a reduction of overweight, especially in low-income neighbourhoods. It is impossible to say which elements of such an integrated approach are effective elements on their own. We found very little evidence for the effectiveness of separate interventions aimed at small changes in the food environment. This suggests that such interventions are only effective in combination with each other and in a wider systems approach. Future studies are needed to further develop the practical methodology of implementation and evaluation of systems science in combination with participatory action research. [ABSTRACT FROM AUTHOR]

Objective: To investigate to what extent promotions in Dutch supermarket sales flyers contribute to a healthy diet and whether there are differences between supermarket types.Design: A cross-sectional study investigating promotions on foods and beverages (n 7825) in supermarket sales flyers from thirteen Dutch supermarket chains (8-week period), including ten traditional, two discount and one organic supermarket chain(s). Promoted products were categorised by food group (e.g. bread), contribution to a healthy diet (yes/no), degree of processing (e.g. ultra-processed), promotion type (temporary reduction in price, volume-based promotions or advertised only) and percentage discount of price promotions. Differences between supermarket chains in the degree of healthiness and processing of products and the types of price promotions were investigated.Results: In total, 70·7 % of all promoted products in supermarket sales flyers did not contribute to a healthy diet and 56·6 % was ultra-processed. The average discount on less healthy products (28·7 %) was similar to that of healthy products (28·9 %). Less healthy products were more frequently promoted via volume-based promotions than healthy products (37·6 % v. 25·4 %, P < 0·001). Discount supermarket chains promoted less healthy (80·3 %) and ultra-processed (65·1 %) products more often than traditional supermarket chains (69·6 % and 56·6 %, respectively).Conclusions: The majority of promoted products via supermarket sales flyers do not contribute to a healthy diet. As promotions are an important determinant of food purchasing decisions, supermarkets do not support healthy choices. Future studies should identify barriers that withhold supermarket chains from promoting more healthy foods in supermarket sales flyers. [ABSTRACT FROM AUTHOR]

This study aimed to assess the evidence regarding the relationship between early-life antibiotic exposure and childhood overweight/obesity by reviewing observational studies on prenatal antibiotic exposure and systematic reviews on infant antibiotic exposure. A search in Pubmed, Embase and Google Scholar covering the period 1st January till 1st December 2018 led to the identification of five studies on prenatal antibiotic exposure and four systematic reviews on infant antibiotic exposure. Positive trends between prenatal antibiotic exposure and overweight/obesity were reported in all studies; two studies reported a significant overall relationship and the other three reported significant relationships under certain conditions. Effect sizes ranged from odds ratio (OR): 1.04 (0.62–1.74) to relative risk (RR): 1.77 (1.25–2.51). Regarding infant antibiotics, one review concluded there was substantial evidence that infant antibiotic exposure increased the risk of childhood overweight/obesity [pooled effect sizes: RR: 1.21 (1.09–1.33) for overweight and RR: 1.18 (1.12–1.25) for obesity]. Two reviews concluded there was some evidence for a relationship [pooled effect sizes: OR: 1.05 (1.00–1.11) and OR: 1.11 (1.02–1.20)]. The fourth review concluded the studies were too heterogeneous for meta-analyses and the evidence regarding the relationship between infant antibiotic exposure and childhood overweight/obesity was inconclusive. More well-designed studies are needed that include data on intra-partum antibiotics and address important potential confounders (including maternal and childhood infections). This review points to some evidence of a relationship between early-life antibiotic exposure and childhood overweight/obesity; this is especially evident in certain children (i.e. exposed to multiple and broad-spectrum antibiotics, earlier postnatal exposure and male gender) and merits further research. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of providing free fruit and snack vegetables at a university on students' fruit intake, snack vegetable intake and total vegetable intake.Design: Free fruit and raw snack vegetables (e.g. bite-sized tomatoes) were provided in a stand in the form of a miniature wooden house located in the central hall of the university's main building, which students regularly pass through on their way to lectures and the cafeteria. Three interventions tested with a pre-test/post-test design were performed. In these three interventions, small changes to the appearance of the stand were made, such as placing potted plants around it. Demographic characteristics and fruit and vegetable intakes were assessed with questionnaires.Setting: A Dutch university of applied science.Participants: Intervention 1 included 124 students; Intervention 2 included ninety-two students; Intervention 3 included 237 students.Results: Longitudinal linear regression analyses showed that post-test snack vegetable intake was consistently higher compared with pre-test. In the three interventions, post-test snack vegetable intakes were between 11 and 14 g/d higher than at the pre-test, which is comparable to three bite-sized tomatoes. No differences in fruit intake or total vegetable intake were found. Subgroup analyses showed that, in all three interventions, students with the lowest pre-test fruit intake and total vegetable intake reported the largest increase in fruit intake and snack vegetable intake after the interventions.Conclusions: Providing free fruit and vegetables to students at their university might be beneficial for those with low habitual intakes. [ABSTRACT FROM AUTHOR]

Objective: To investigate fruit and vegetable (F&V) intakes of university students and associated demographic and lifestyle characteristics, and students' perceptions of F&V availability and F&V intervention strategies in the university environment.Design: Cross-sectional questionnaire data were collected; F&V intakes were measured using a food frequency tool. Multivariable linear regression analyses were used to analyse the associations between demographic and lifestyle characteristics and F&V intakes.Setting: Universities in the Netherlands.Subjects: University students (n 717).Results: The majority of students did not adhere to Dutch F&V guidelines (71 % and 93 %, respectively). Fruit intake was lower among students who were male, living independently, enrolled in a technical study, not adhering to physical activity guidelines, and heavy to excessive alcohol drinkers. Vegetable intake was lower among students who were non-Dutch, living with their parents, not adhering to physical activity guidelines, and moderate and heavy to excessive alcohol drinkers. Most students perceived that their university environment offers sufficient healthy foods (60 %) and F&V (65 %), but also indicated that their F&V intakes would increase with interventions concerning affordable F&V in the university canteen (64 %) or university supermarket (60 %). Students were less disposed to indicate that weekly local farmers' markets, vegetable parcels or a vegetable garden would increase their F&V intakes.Conclusions: Dutch university students do not consume enough F&V. Future efforts that aim to promote students' F&V intakes should consider the differences between subgroups based on demographic and lifestyle characteristics and that affordable F&V in the university environment might be an effective strategy. [ABSTRACT FROM AUTHOR]

Objective: To test Koctürk's model of dietary change among South-Asian Surinamese in the Netherlands. The model categorizes foods into staple, complementary and accessory foods and postulates that dietary change after migration begins with accessory foods while foods associated with ethnic identity (staple foods) change at a slower rate.Design: Cross-sectional data from the HELIUS study. Dietary intake was assessed with an FFQ. Acculturation was based on social contacts and sense of belonging and was translated into four strategies of acculturation: assimilation, integration, separation and marginalization. Other indicators of acculturation included residence duration, age at migration and migration generation status.Setting: Amsterdam, the Netherlands.Subjects: Participants of Dutch (n 1456) and South-Asian Surinamese origin (n 968).Results: Across all acculturation strategies, South-Asian Surinamese participants reported significantly higher intakes of rice (staple food) and chicken (complementary food) and significantly lower intakes of red meat and vegetables (complementary foods) and cookies and sweets (accessory food) than Dutch participants. Men, second-generation and assimilated South-Asian Surinamese were inclined towards Dutch foods such as potato, pasta and red meat. Accessory foods like fruits showed variation across acculturation strategies.Conclusions: Consistent with the Koctürk model, the intake of staple foods was stable among South-Asian Surinamese irrespective of acculturation strategy while the intake of accessory foods like fruit varied. Contrary to expectations, South-Asian Surinamese showed consistently high intakes of complementary foods like chicken and fish irrespective of acculturation strategy. Public health practitioners should take into consideration the complex and dynamic nature of dietary acculturation. [ABSTRACT FROM AUTHOR]

The article presents the discussion on measurements conducted at the department of human nutrition at the Agricultural University in Wageningen the Netherlands. Topics include performing large series of anthropometric measurements of people from all ages enrolled in different projects on body composition; and ethnic-specific criteria needed for specifying the levels of fatness and associated cardiometabolic health indicators.

Objective: To assess the mean package size and manufacturer-recommended serving size of sweet beverages available in four high-income countries: Australia, Canada, the Netherlands and New Zealand.Design: Cross-sectional surveys.Setting: The two largest supermarket chains of each country in 2012/2013.Subjects: Individual pack size (IPS) drinks (n 891) and bulk pack size (BPS) drinks (n 1904).Results: For all IPS drinks, the mean package size was larger than the mean serving size (mean (sd)=412 (157) ml and 359 (159) ml, respectively). The mean (sd) package size of IPS drinks was significantly different for all countries (range: Australia=370 (149) ml to New Zealand=484 (191) ml; P<0·01). The mean (sd) package size of Dutch BPS drinks (1313 (323) ml) was significantly smaller compared with the other countries (New Zealand=1481 (595) ml, Australia=1542 (595) ml, Canada=1550 (434) ml; P<0·01). The mean (sd) serving size of BPS drinks was significantly different across all countries (range: Netherlands=216 (30) ml to Canada=248 (31) ml; P<0·00). New Zealand had the largest package and serving sizes of the countries assessed. In all countries, a large number of different serving sizes were used to provide information on the amount appropriate to consume in one sitting.Conclusions: At this point there is substantial inconsistency in package sizes and manufacturer-recommended serving sizes of sweet beverages within and between four high-income countries, especially for IPS drinks. As consumers do factor serving size into their judgements of healthiness of a product, serving size regulations, preferably set by governments and global health organisations, would provide consistency and assist individuals in making healthier food choices. [ABSTRACT FROM AUTHOR]

ObjectiveThe aim of the present study was to gain insight into (i) processed snack-food availability, (ii) processed snack-food salience and (iii) the size of dinnerware among households with overweight gatekeepers. Moreover, associations between gatekeepers’ characteristics and in-home observations were determined.DesignA cross-sectional observation of home food environments was conducted as part of a baseline measurement of a larger study.SettingHome food environments of overweight and obese gatekeepers in the Netherlands.SubjectsHousehold gatekeepers (n 278). Mean household size of the gatekeepers was 3·0 (sd 1·3) persons. Mean age of the gatekeepers was 45·7 (sd 9·2) years, 34·9 % were overweight and 65·1 % were obese. Of the gatekeepers, 20·9 % had a low level of education and 42·7 % had a high level of education.ResultsIn 70 % of the households, eight or more packages of processed snack foods were present. In 54 % of the households, processed snack foods were stored close to non-processed food items and in 78 % of households close to non-food items. In 33 % of the households, processed snack foods were visible in the kitchen and in 15 % of the households processed snack foods were visible in the living room. Of the dinnerware items, 14 % (plates), 57 % (glasses), 78 % (dessert bowls), 67 % (soup bowls) and 58 % (mugs) were larger than the reference norms of the Netherlands Nutrition Centre Foundation. Older gatekeepers used significantly smaller dinnerware than younger gatekeepers.ConclusionsEnvironmental factors endorsing overconsumption are commonly present in the home environments of overweight people and could lead to unplanned eating or passive overconsumption. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between energy density and energy costs in single food items and composed diets, and to explore differences in energy density and energy cost between income levels. Design: A cross-sectional study using data from two Dutch cohort studies and recent national food prices. Food prices were retrieved from two market leader supermarkets. Data on dietary intake were measured using a computerized face-to-face interview (cohort 1) and 24 h recalls (cohort 2). Setting: The Netherlands. Subjects: A sample of 373 young adults from the Amsterdam Growth and Health Longitudinal Study (AGHLS, measured in 2000) and a sample of 200 community-dwelling elderly from the Longitudinal Ageing Study Amsterdam (LASA, measured in 2007). Results: We found significant inverse associations between energy density and energy costs in single food items (r=20·436, P<0·01) and composed diets (AGHLS men r=20·505, women r=20·413, P<0·001; LASA men r=20·559, women r=20·562, P<0·001). Furthermore, we found that people stratified into higher energy density quartiles consumed significantly more energy per day, less fruits and vegetables, and had significantly lower diet costs. Explorative analyses on income did not reveal significant differences regarding energy density, costs, or fruit and vegetable intake. Conclusions: In the Netherlands also, energy density was inversely related with energy costs, implying that healthier diets cost more. However, we could not find differences in energy density or costs between income levels. Future research, using precise food expenditures, is of main importance in studying the economics of obesity and in the aim of making the healthier choice easier. [ABSTRACT FROM AUTHOR]

Objective: To quantify the environmental component of aetiology of overweight and obesity by examining the relationship between the degree of overweight in dogs and cats and the degree of overweight in their owners. Design: Cross-sectional study. Main outcome measures of the owners were weight, height (stature) and BMI. Of the animals, weight and divergence from ideal weight were measured by a veterinarian. Setting: Three veterinary clinics in Amsterdam, The Netherlands. Subjects: Dogs and cats, together with their owners, who visited the veterinary clinic. Dogs and cats had to be older than 1 year, and their owners had to be at least 21 years old. After exclusion, there remained forty-seven pairs of dogs and their owners and thirty-six pairs of cats and their owners. Results: We found a significant relationship between the degree of overweight of dogs and the BMI of their owners (r=0·31). Correction for length of ownership, gender and age of the animal, and gender, age, education level and activity score of the owner did not materially affect this relationship. However, after correction for the amount of time the dog was being walked each day, this relationship disappeared. No significant relationship was found between the degree of overweight of cats and the BMI of their owners. Conclusions: The degree to which dogs are overweight is, in contrast to the degree to which cats are overweight, related to the BMI of their owners. [ABSTRACT FROM AUTHOR]

Objective: To study the development of body weight with ageing, in a general adult population, taking into account possible period and cohort effects. Design: A prospective cohort study with 11 years of follow-up. At baseline and after 6 and 11 years, body weight and height were measured. Setting: The Doetinchem Cohort Study, consisting of inhabitants of Doetinchem, a town in a rural area of The Netherlands. Subjects: In total, 4070 healthy men and women aged 20-59 years at baseline. Results: Increase in BMI with ageing was less profound based on cross-sectional data than based on longitudinal data. More recent-born cohorts had a higher BMI at a given age than cohorts who were born earlier. Increase in mean BMI with ageing was observed in all age groups and was similar for groups with a different educational level. Highest increase in BMI over 11 years was observed in the youngest group, aged 20-29 years at baseline (2.2 [95% CL 2.0, 2.3] kg/m²), and lowest increase in the oldest group, aged 50-59 years at baseline (1.1 [1.0, 1.3] kg/m²). Conclusions: Findings of the present study using longitudinal data suggest that increase in BMI with ageing is underestimated in all age groups by studying cross-sectional data only. Further, weight gain is present in all educational levels and does not stop at middle age. [ABSTRACT FROM AUTHOR]

Objective: To study changes in lifestyle in relation to changes in body weight and waist circumference associated with occupational retirement in men.Design: A prospective cohort study with 5 years of follow-up. At baseline and at follow-up, questionnaires were completed and body weight and waist circumference were measured.Setting: The Doetinchem Cohort Study, consisting of inhabitants of Doetinchem, a town in a rural area of The Netherlands.Subjects: In total 288 healthy men aged 50-65 years at baseline, who either remained employed or retired over follow-up.Results: The effect of retirement on changes in weight and waist circumference was dependent on type of former occupation. Increase in body weight and waist circumference was higher among men who retired from active jobs (0.42 kg year(-1) and 0.77 cm year(-1), respectively) than among men who retired from sedentary jobs (0.08 kg year(-1) and 0.23 cm year(-1), respectively). Weight gain and increase in waist circumference were associated with a decrease in fruit consumption and fibre density of the diet, with an increase in frequency of eating breakfast, and with a decrease in several physical activities, such as household activities, bicycling, walking and doing odd jobs.Conclusion: Retirement was associated with an increase in weight and waist circumference among those with former active jobs, but not among those with former sedentary jobs. Retirement may bring opportunities for healthy changes in diet and physical activity, which could be used in health promotion programmes. [ABSTRACT FROM AUTHOR]

Cost-effective prevention strategies to prevent weight gain and the development of obesity should be based on appropriate knowledge of the determinants of weight gain. The body of evidence on the dietary determinants of weight gain is, however, fragmentary at best, partly because inappropriate research methods are used to study the determinants of obesity under normal circumstances. Evidence from studies using experimental diets have shortcomings because of their short duration and selection of highly-motivated subjects and because the outcomes can be easily influenced by the choice of foods to be used in the intervention. Of the observational studies, many have severe methodological shortcomings, e.g. ecological studies, cross-sectional surveys and classical cohort studies in which the baseline diet is linked to subsequent weight development over long periods of time. Longitudinal studies with repeated measurements in which changes in diet and physical activity are linked to changes in weight are probably the most informative, but these studies are relatively rare. There is a great interest in interventions that are effective and efficient for the prevention of obesity. Many countries and research funding agencies seem to show a strong tendency to develop interventions for children and adolescents exclusively. It can be easily shown, however, that intervention programmes are much more likely to be cost-effective in older adults than in children, which indicates that adults should not be neglected as target populations for obesity prevention. Obesity prevention should follow a life-course approach, as currently recommended for non-communicable diseases in general by the WHO. [ABSTRACT FROM AUTHOR]

Obesity is now commonly defined in adults as a BMI > 30 kg/m2. The prevalence of obesity in established market economies (Europe, USA, Canada, Australia, etc.) varies greatly, but a weighed estimate suggests an average prevalence in the order of 15???20 %. The prevalence in these countries generally shows increasing trends over time. Obesity is also relatively common in Latin America, but much less so in sub-Saharan Africa and Asia where the majority of the world population lives. Nevertheless obesity rates are increasing there as well and, more importantly, rates of diabetes are increasing even more quickly, particularly in Asian countries. The risks of type 2 diabetes mellitus in these countries tend to increase sharply at levels of BMI generally classified as acceptable in European and North American white people. There have been suggestions to adopt specific classifications of obesity in Asians (e.g. BMI 23 for overweight and 25 or 27 kg/m2 for obesity) and this will greatly affect the prevalence estimates of obesity worldwide (currently at about 250 million people). Particularly for health promotion purposes BMI may be replaced by a classification based on waist circumference, but also specific classifications for different ethnic groups may be necessary. The number of diabetics has been projected to increase from 135 million in 1995 to 300 million in 2025. Much of this increase will be seen in Asia. In summary, both obesity and type 2 diabetes are common consequences of changing lifestyles (increased sedentary lifestyles and increased energy density of diets). Both are potentially preventable through lifestyle modification on a population level, but this requires a coherent and multifaceted strategy. Such strategies are not developed or implemented. These developments point toward the great urgency to develop global and national plans for adequate prevention and management of obesity and type 2 diabetes mellitus. [ABSTRACT FROM PUBLISHER]

Objective: A front-of-pack nutrition logo on products with relatively favourable product compositions might help consumers to make more healthful choices. Studies investigating actual nutrition label use in point-of-purchase settings are scarce. The present study investigates the use of the 'Choices' nutrition logo in Dutch supermarkets., Design: Adults were asked to complete a validated questionnaire about motivation for food choice and their purchased products were scored for the Choices logo after they had done their shopping., Setting: Nine supermarkets in The Netherlands., Subjects: A total of 404 respondents participated., Results: Of the respondents, 62 % reported familiarity with the logo. The motivations for food choice that were positively associated with actually purchasing products with the logo were attention to 'weight control' and 'product information'. The food choice motive 'hedonism' was negatively associated with purchasing products with the logo., Conclusions: This is the first study to investigate actual use of the Choices logo. In order to stimulate consumers to purchase more products with a favourable product composition, extra attention should be paid to hedonistic aspects such as the tastefulness and the image of healthy products.