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Abstract: Objective: to obtain an in-depth understanding of verbal and written nutrition communication in Dutch midwifery practice. Design, setting and participants: data were collected by recording 12 initial antenatal consultations (12 weeks into the pregnancy) with primiparous women from four Dutch midwifery practices spread over The Netherlands, followed by two semi-structured qualitative interviews with the women. The interviews were undertaken on the day after the consultation and two weeks later. Findings: analysis of the recordings revealed that a nutrition brochure was offered in an information pack, but it was not used or referred to by the midwives. Verbally, clients were informed about healthy nutrition in general terms. Specific, personally relevant nutrition-related questions and motivators of nutrition behaviour were rarely clarified and addressed. Midwives tried to create a good relationship with their clients by being friendly, complimentary, confirmative and supportive. Women appreciated talking about nutrition with the midwife because of her expertise. The subsequent interviews with the women revealed, however, that nutrition communication took place relatively late in pregnancy at a point when women were more interested in ‘hearing the baby''s heart beat’. Furthermore, clients seldom looked through the nutrition brochure at home. Key conclusion: the provision of a nutrition brochure does not serve any real purpose. Implications for practice: to reach optimal synergy between verbal and written nutrition communication in midwifery practice, midwives should actively refer to a nutrition brochure in addition to verbal communication. Moreover, health organisations should realise that the provision of nutrition brochures to midwives does not mean that these brochures will be used as an integral part of midwives’ nutrition communication with clients. [Copyright &y& Elsevier]

Abstract: Objective: To explore the influence of a life event (pregnancy) on nutrition awareness and the motivations for nutrition behaviour. Study design: In-depth, face-to-face interviews with five groups of 12 women: women wishing to conceive a child, women in the first, second, and third trimesters of their first pregnancy, and women in the first trimester of their second pregnancy. As is common in qualitative research, participants were selected on the basis of diversity together with maximum representativeness within normal populations with respect to socio-demographic characteristics. Results: With respect to nutrition awareness, three groups of women can be distinguished: (1) those who are ‘going all the way’; these women try to live precisely by the book, (2) those who are ‘taking the flexible way’; these women are more aware of their nutrition, but are more flexible in handling it, and (3) women who ‘continue the same way’; these women have a no-nonsense mentality and do not experience essential shifts in their nutrition awareness. The extent and fluctuations in nutrition awareness throughout preconception and pregnancy are based on three types of motivations, the interest of (1) the child, (2) the mother, and (3) the social environment. Conclusions: This study provides indications that preconception and pregnancy could indeed be a life event leading to increased general nutrition awareness that might influence women''s future nutrition-related behaviours. [Copyright &y& Elsevier]

Abstract: Objective: The objectives of this study were to identify nutrition communication styles of Dutch GPs, their strategies regarding nutrition communication and nutrition information seeking behaviours. Another aim is to provide a hypothetical model for nutrition communication style, including psycho-social and socio-demographic variables. Methods: Nine focus groups with 81 GPs were used to obtain GPs’ perceptions of nutrition communication. Data were analysed with the computer software program NUD*IST. Results: Five nutrition communication styles were identified, namely informational, reference, motivational, confrontational and holistic style. Referring to a dietician, providing advice according to Dietary Guidelines, and offering written education materials were mentioned as strategies regarding nutrition communication. GPs sought nutrition information in scientific studies, specialist literature, and postgraduate training courses. Conclusion: The informational style of nutrition communication was dominant among Dutch GPs. GPs hardly provided maintenance advice for nutrition behaviour. Many GPs referred patients to dieticians, who were viewed as colleagues. GPs tried to get basic information about nutrition by scanning the literature, but they were seldom actively involved in seeking specific nutrition information. Although GPs felt that patients expect expert nutrition information, they perceived their nutrition knowledge as restricted. Practice implications: We advise to raise self-efficacy of GPs regarding nutrition communication and to build good collaboration with dieticians. [Copyright &y& Elsevier]

Background: Consumers have been exposed to nutrition information from a variety of sources, including the family doctor. They are often not aware of their own risk behavior regarding nutrition. Objective: This study sought to assess food associations, conversation topics, interest in food topics, and use of information sources by means of qualitative consumer research. Another aim was to provide a hypothetical model for nutrition awareness that could be tested in a quantitative survey. Design: Three focus groups with 30 Dutch consumers altogether were carried out. Qualitative data were analyzed with the computer software program NUD"IST (QSR, Melbourne) by sorting text blocks into categories, and new themes emerged. In addition, a hypothetical model for nutrition awareness was developed. Results: Consumers associated food most often with safe food, and food safety was the topic most often discussed. Tasty food was the most important food conversation topic. The family doctor was the information source most talked about. Furthermore, consumers possibly lacked some nutrition awareness. Conclusions: Careful analysis revealed new themes (new in the past 10 y), such as concerns about food safety and reconsideration of the roles of family doctors and dietitians. Based on these themes, recommendations for nutrition communication were composed. [ABSTRACT FROM AUTHOR]

During the Third Heelsum International Workshop, Nutrition Guidance of Family Doctors Towards Best Practice, December 10-12, 2001, Heelsum, the Netherlands, 17 papers were presented. Each paper was discussed by all the participants at the workshop. These discussions were tape-recorded, transcribed, rearranged into topics, and summarized here. There are situations that call for nutrition advice to be given by general practitioners (GPs). GPs are trusted, they are not selling any particular food, and patients accept that their GPs may talk to them about diet. Compared with dietitians, GPs have much less time to advise about diet, so they must condense information. It is easier for a GP to give dietary advice if the patient is registered on the practice's list and if the GP can be paid for preventive work. Six topics seemed to be particularly new and challenging in our changing world: (1) Use of dietary supplements, herbal preparations, and functional foods; (2) patients as partners; (3) computers in practices; (4) evidence-based medicine; (5) the Internet; and (6) the obesity epidemic. These topics were reported as problems and then discussed as opportunities. The aim of the Heelsum Collaboration on General Practice Nutrition was to facilitate the nutrition work of GPs in their practices by researching the problems and barriers and by testing solutions. In line with this aim, some suggestions for research are provided. [ABSTRACT FROM AUTHOR]

Subclinical vitamin B-12 deficiency is common in the elderly. Encouraged by early indications, we investigated the plasma vitamin B-12 status in association with bone mineral content (BMC) and bone mineral density (BMD) in frail elderly people. Data of 194 free-living Dutch frail elderly (143 women and 51 men) were available. BMC and BMD were measured by dual energy X-ray analysis. Biochemical analyses were performed on plasma or serum including vitamin B-12, methylmalonic acid, homocysteine, 25-hydroxy vitamin D and parathyroid hormone. Women had higher plasma vitamin B-12 (288 and 238 pmol/L, respectively) and lower plasma homocysteine levels (15.8 and 21.3 micro mol/L, respectively) than men. Of the total explained variance of BMC and BMD in women (46 and 22%, respectively), 1.3-3.1% was explained by plasma vitamin B-12, in addition to weight and height or energy intake. In men, the variance of BMC and BMD was explained by weight, smoking and/or height (total R(2) was 53 and 25%, respectively), but not by plasma vitamin B-12. Osteoporosis occurred more often among women whose vitamin B-12 status was considered marginal or deficient than in women with a normal status, i.e., the prevalence odds ratios (after adjustment for weight, age and calcium intake) (95% confidence intervals) were 4.5 (0.8;24.8) and 6.9 (1.2;39.4), respectively. These results suggest that vitamin B-12 status is associated with bone health in elderly women. Future studies on bone health should take into account a possible role of vitamin B-12 status in different populations. [ABSTRACT FROM AUTHOR]

Background: Conjugated linoleic acid (CLA), which is present in milk products and meat from ruminants, appears to have anticarcinogenic activity against breast cancer in animal and in vitro experiments. To date, few epidemiologic data are available in humans. Objective: This study evaluated the relation between intakes of CLA and other fatty acids and breast cancer incidence in the Netherlands Cohort Study. Design: Intake data derived from a validated 150-item foodfrequency questionnaire were linked to an existing database with analytic data on specific fatty acids in European foods (the TRANSFAIR study). With 6.3 y of follow-up and 941 incident cases of breast cancer, multivariate rate ratios and 95% CIs were calculated for energy-adjusted intakes of fatty acids and CLAcontaining food groups (eg, butter, cheese, milk, other milk products, and meat). Results: CLA intake showed a weak, positive relation with breast cancer incidence (rate ratio for highest compared with lowest quintile: 1.24, 95% CI: 0.91, 1.69; P for trend = 0.02). Statistically significant positive associations were found with total trans fatty acids and (borderline) with saturated fatty acids. Significant inverse associations were found with monounsaturated and cis unsaturated fatty acids, whereas total fat and energy intake of CLA-containing food groups were not related to breast cancer incidence. Conclusion: The suggested anticarcinogenic property of CLA in animal and tissue culture models could not be confirmed in this epidemiologic study in humans. [ABSTRACT FROM AUTHOR]

Studies the determinants of the nutrition guidance practices of Dutch primary care physicians (PCPs). Barriers to nutrition guidance practices; Nutrition attitudes and beliefs; PCPs and factors determining their extent of nutrition education and information of patients.

Studies the nutrition information seeking behavior of primary care physicians (PCPs) in Netherlands. PCPs' implementation of different strategies of nutrition guidance of patients; Determinants of nutrition information seeking behavior; Attitudes of primary care physicians about themselves receiving nutrition information.

Investigates the role of primary care physician in providing nutrition information to the public in Netherlands by using a random sample of Dutch consumers referral to 11 nutrition information sources (NIS). Response, characteristics and background of respondents; Perceived expertise of NIS; Factor analysis on NIS; Determinants of referral to NIS.

A letter to the editor concerning significance of nutritional education in medical schools for physicians is presented.

Objective Pilot-testing of the adapted Study on Lifestyle intervention and Impaired glucose tolerance Maastricht (SLIM) and to determine its feasibility and likelihood of achieving desired impact. Methods Pilot intervention study (a 10-month combined lifestyle intervention) using a one group pre-test post-test design with on-going process measures (i.e. reach, acceptability, implementation integrity, and applicability) and several health outcomes (e.g. body weight). Results In total, 31 subjects participated in the SLIMMER (SLIM iMplementation Experience Region Noord- en Oost-Gelderland) intervention. Participant weight loss was −3.5 kg ( p = 0.005). Both participants and health care professionals (i.e. practice nurses, dieticians, and physiotherapists) were satisfied with the intervention. The intervention was implemented as planned and appeared to be suitable for application in practice. Refinements have been identified and will be made prior to further implementation and evaluation. Conclusion Implementation of the SLIMMER intervention is feasible in a Dutch real-life setting and it is likely to achieve desired impact. Practising and optimising the intervention creates local support for SLIMMER among stakeholders. Practice implications Performing a pilot study on the basis of a structured approach is a meaningful step in the process of optimising the feasibility and potential impact of an evidence-based intervention in a real-life setting. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this critical review is to provide insight into the main outcomes of research on communication about nutrition and/or physical activity between GPs and patients for prevention or treatment of overweight and obesity. Methods: Relevant studies were identified by a computerized search of multiple electronic databases (MEDLINE, PsycINFO) for all available papers between 1 January 1995 and 1 January 2012. In addition, two independent reviewers judged all studies on ten quality criteria. Results: In total, 41 studies were retrieved. More studies were found about the guidance of obese patients than of overweight patients. The most common weight guidance practice was discussion of weight. The range of communication strategies for nutrition showed to be more diverse than for physical activity. Twelve studies were considered as high-quality studies, 18 were having medium quality, and 11 were seen as low quality. Conclusion: We reflected on the fact that the content of advice about nutrition and physical activity was quite general. GPs’ provision of combined lifestyle advice to overweight and obese patients seems to be rather low. Practice implications: Observational research is needed to unravel the quality of the advice given by GPs to overweight and obese patients. [Copyright &y& Elsevier]