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Background Optimal approaches to promote sustained adherence to lifestyle and bodyweight recommendations in postmenopausal breast cancer (PMBC) survivors are lacking. Purpose This Delphi-study aims to identify and understand expert-opinion on potential barriers and facilitators for promoting adherence to these lifestyle and bodyweight recommendations in (clinical) care for PMBC survivors, and to determine potential effective intervention strategies. Methods The expert panel consisted of oncology Health Care Professionals (HCPs) (N = 57), patient advocates (N = 5), and PMBC survivors (N = 38). They completed three questionnaires: Q1—idea generation; Q2—validation and prioritization; Q3—ranking. The Behavior Change Wheel was used as theoretical framework for analysis. Thematic analysis was applied to identify key overarching themes based on the top-ranked facilitators and barriers. Potential Behavior Change Techniques (BCTs) and intervention strategies were identified using the Behavior Change Technique Taxonomy version 1 and the Behavior Change Wheel. Results Eleven core categories of key barriers/facilitators for the promotion of adherence to recommendations for lifestyle and bodyweight among PMBC survivors were identified. For each core category, relevant BCTs and practical potential intervention strategies were selected based on suggestions from the expert panel. These included: increasing knowledge about the link between lifestyle and cancer; enabling self-monitoring of lifestyle behaviors followed by evaluation; offering group lifestyle counseling for PMBC survivors, enhancing social support for favorable lifestyle behaviors; and stimulating multidisciplinary collaboration among HCPs. Conclusions Findings provide valuable insight for the development of interventions changing behavior of PMBC survivors and HCPs toward increased healthy lifestyle (support) behavior. [ABSTRACT FROM AUTHOR]

This review evaluates the methodological quality of current front-of-pack labeling research and discusses future research challenges. Peer-reviewed articles were identified using a computerized search of the databases PubMed and Web of Science (ISI) from 1990 to February 2011; reference lists from key published articles were used as well. The quality of the 31 included studies was assessed. The results showed that the methodological quality of published front-of-pack labeling research is generally low to mediocre; objective observational data-based consumer studies were of higher quality than consumer studies relying on self-reports. Experimental studies that included a control group were lacking. The review further revealed a lack of a validated methodology to measure the use of front-of-pack labels and the effects of these labels in real-life settings. In conclusion, few methodologically sound front-of-pack labeling studies are presently available. The highest methodological quality and the greatest public health relevance are achieved by measuring the health effects of front-of-pack labels using biomarkers in a longitudinal, randomized, controlled design in a real-life setting. [ABSTRACT FROM AUTHOR]

By both increasing the availability of healthy foods and labeling these products with the Choices logo, caterers may facilitate employees to make a healthier choice in their worksite cafeterias. The aim of this study was to explore which attributes influence the implementation of the Choices logo in worksite cafeterias in the Netherlands. Questionnaires were completed by catering managers of 316 cafeterias of two large caterers in the Netherlands (response rate 49.8%). Attributes from the Diffusion of Innovations Theory were used to investigate whether they could predict implementation. Compatibility (consistency with the beliefs of the catering manager; OR = 1.52), voluntariness (perception of the implementation as voluntary; OR = 0.50), result demonstrability (ability to communicate the implementation; OR = 1.52) and complexity in the sense of time (time needed for implementation; OR = 0.70) were the best predictors for the frequency of offering fresh Choices products (all significant). For the frequency of using Choices promotion material, voluntariness (OR = 0.54), result demonstrability (OR = 1.51) and relative advantage (perceived advantage of the implementation; OR = 1.44) were the best predictors (all significant). In conclusion, this study provides unique insights into which perceived attributes influence the implementation of a nutrition logo in worksite cafeterias. To increase the implementation, the Choices logo should be consistent with catering managers' ideas about healthy food, the workload of implementing the logo should be limited and it could be recommended to incorporate the logo in the health policy of the caterer. [ABSTRACT FROM AUTHOR]

Background: Pricing strategies are an important component in the marketing mix and may also be useful in stimulating healthier food choices. However, due to competing interests and feasibility problems, the introduction of pricing strategies is complicated. For successfully introducing food pricing strategies, it is essential to explore incentives that are not only promising but also realizable and being approved by different sectors. Methods: We aimed to assemble a list of pricing strategies by exploring expert views using the Delphi method. Subjects included experts from academia, industry, retail, agriculture, policymakers, consumers and non-governmental organizations. Data were collected in three rounds. In round one, experts designed promising pricing strategies. Based on a time-budget model incorporating Sleep, Leisure, Occupation, Transportation and Home-based activities, these strategies were in the subsequent rounds judged on several criteria. Results were analysed using median and interquartile deviations scores. Results: We found fair consensus levels among experts and a varied list of promising pricing strategies. The panel agreed on the potential success of offering small presents, providing price-cuts on healthy foods and discounting healthier foods more frequently. Also, it was found that experts gave higher rates to pricing strategies for which the implementation responsibilities could be placed elsewhere. Conclusion: The resulted list of promising monetary incentives is an essential first step for the future design of pricing strategies. Following this study, it is important to determine how to make solid agreements on responsibility and implementation issues. Also, consumer perceptions regarding the proposed pricing strategies should be studied. [ABSTRACT FROM PUBLISHER]

This qualitative study assessed consumers’ opinions of food portion sizes and their attitudes toward portion-size interventions located in various point-of-purchase settings targeting overweight and obese people. Eight semi-structured focus group discussions were conducted with 49 participants. Constructs from the diffusion of innovations theory were included in the interview guide. Each focus group was recorded and transcribed verbatim. Data were coded and analyzed with Atlas.ti 5.2 using the framework approach. Results showed that many participants thought that portion sizes of various products have increased during the past decades and are larger than acceptable. The majority also indicated that value for money is important when purchasing and that large portion sizes offer more value for money than small portion sizes. Furthermore, many experienced difficulties with self-regulating the consumption of large portion sizes. Among the portion-size interventions that were discussed, participants had most positive attitudes toward a larger availability of portion sizes and pricing strategies, followed by serving-size labeling. In general, reducing package serving sizes as an intervention strategy to control food intake met resistance. The study concludes that consumers consider interventions consisting of a larger variety of available portion sizes, pricing strategies and serving-size labeling as most acceptable to implement. [ABSTRACT FROM PUBLISHER]

Background: Large food portion sizes are determinants of a high caloric intake, especially if they have been made attractive through value size pricing (i.e. lower unit prices for large than for small portion sizes). The purpose of the two questionnaire studies that are reported in this article was to assess the impact of proportional pricing (i.e. removing beneficial prices for large sizes) on people's portion size choices of high caloric food and drink items. Methods: Both studies employed an experimental design with a proportional pricing condition and a value size pricing condition. Study 1 was conducted in a fast food restaurant (N = 150) and study 2 in a worksite cafeteria (N = 141). Three different food products (i.e. soft drink, chicken nuggets in study 1 and a hot meal in study 2) with corresponding prices were displayed on pictures in the questionnaire. Outcome measures were consumers’ intended portion size choices. Results: No main effects of pricing were found. However, confronted with proportional pricing a trend was found for overweight fast food restaurant visitors being more likely to choose small portion sizes of chicken nuggets (OR = 4.31, P = 0.07) and less likely to choose large soft drink sizes (OR = 0.07, P = 0.04). Conclusion: Among a general public, proportional pricing did not reduce consumers’ size choices. However, pricing strategies can help overweight and obese consumers selecting appropriate portion sizes of soft drink and high caloric snacks. More research in realistic settings with actual behaviour as outcome measure is required. [ABSTRACT FROM PUBLISHER]

Background: Differences in dietary and supplementary intake of antioxidants were determine between different categories of smokers and never-smokers.Methods: Data from a large, cross-sectional, population-based study were used. Subjects (n = 4244) were divided into five smoking categories according to the number of cigarettes smoked per day. Differences in intake of antioxidants or frequency of supplement use were assessed using multiple linear regression analysis and multiple logistic regression analysis, adjusting for potential confounders such as age, body mass index, education level, alcohol intake, and total energy intake.Results: Men who smoked > 20 cigarettes/day had significantly lower intakes of beta-carotene and especially ascorbic acid compared to those who never smoked, resulting from an almost 60% lower fruit intake. Moderate and heavy smoking women also had lower ascorbic acid and fruit intake but differences were not as large as in men. A higher percentage of female heavy smokers compared with never-smokers consumed vitamin C (21.1% versus 14.1%), vitamin E (5.6% versus 1.8%), and multivitamin supplements (18.5% versus 12.2%). Among men only the moderate smokers differed significantly from never-smokers in supplement intake, in the sense that male moderate smokers had a higher percentage of multivitamin use (15.3% versus 12.2%) compared to never-smokers.Conclusions: Male heavy smokers not only have a lower dietary antioxidant intake than never-smokers, but additionally seem to use supplementation relatively infrequently. [ABSTRACT FROM AUTHOR]

Background: The quantitative contribution of dietary calcium, potassium and magnesium to blood pressure levels remains unknown as does the combined effect of dietary calcium, potassium and magnesium.Methods: The relation between blood pressure and dietary calcium, potassium and magnesium and the combined effect of these minerals on blood pressure was studied in 20,921 Dutch men and women aged 20-59 years. Food intake was measured by a food frequency questionnaire. The data were adjusted for age, body mass index, heart rate, alcohol and energy intake.Results: An inverse association was observed between blood pressure and dietary potassium and magnesium in both men and women. Dietary calcium was inversely related to systolic blood pressure (SBP) in women and with diastolic blood pressure (DBP) in men. The relation between magnesium intake and blood pressure was stronger than those between blood pressure and intakes of potassium and calcium. Men and women who consumed a diet with intakes in the upper tertiles of all three minerals had a lower SBP and DBP compared to those who had intakes in the lower tertiles (men: SBP = -1.3 (95% CI: -2.6, -0.1), DBP = -1.9 (95% CI: -2.7, -1.0), women: SBP = -1.8 (95% CI: -3.1, -0.5), DBP = -1.5 (95% CI: -2.4, -0.7).Conclusion: These results suggest that diets rich in calcium, potassium and magnesium are associated with lower blood pressure. [ABSTRACT FROM AUTHOR]

van Noord P A H (Department of Epidemiology (Preventicon), University of Utrecht, Utrecht, The Netherlands), Seidell J C, den Tonkelaar I, Baanders-van Halewijn E A and Ouwehand I J. The relationship between fat distribution and some chronic diseases in 11 825 women participating in the DOM-project. 1990, : 564–570. The prevalence of reported chronic diseases was studied in quintiles of waist/hip ratio and Quetelet index in 11 825 women aged 40–73 presenting for mammographic screening in the DOM-project. After adjustment for age and Quetelet index, increased waist/hip ratio was found to be associated with an increased prevalence of diabetes mellitus, hypertension, cholecystectomy and a lower prevalence of varicose veins. No associations were observed between waist/hip ratio and the prevalence of angina pectoris, gout and rheumatism. The odds ratios, adjusted for age and Quetelet index, of the highest versus the lowest quintile of waist/hip ratio were 3.4 (95% Cl 1.4–8.3) for diabetes mellitus; 2.2 (95% Cl 1.7–2.8) for hypertension; 2.0 (95% Cl 1.2–3.4) for cholecystectomy, and 0.81 (95% Cl 0.68–0.95) for varicose veins. After adjustment for waist/hip ratio and age, Quetelet index was found to be associated with an increased prevalence of hypertension, cholecystectomy and varicose veins. Quetelet index, however, was not found to be related to diabetes, gout or rheumatism. We conclude that in a representative sample of Dutch women older than 40 years, fat distribution in addition to overweight is related to important chronic diseases. [ABSTRACT FROM PUBLISHER]

Seidell J C (Department of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV Wageningen, The Netherlands), Cigolini M, Charzewska J, Ellsinger B M and Di Biase G. Fat distribution in European women: A comparison of anthropometric measurements in relation to cardiovascular risk factors. 1990, : 303–308. In this study in 437 women born in 1948 selected from five European towns we show that several anthropometric measurements are consistently and significantly associated with a metabolic risk profile in premenopausal women of 38 years of age. Among the circumferences, breast and waist circumference were, after adjustment for body mass index positively correlated with diastolic blood pressure, serum total cholesterol, HDL-cholesterol (negative associations), serum triglycerides, and serum insulin. The optimal level for measuring waist circumference was determined as being midway between the lower rib margin and the superior anterior iliac crest. Circumference ratios generally did show less consistent and similar or lower correlations with diastolic blood pressure, serum cholesterol and serum insulin. Waist/thigh circumference ratio showed the strongest partial associations with HDL-cholesterol and serum triglycerides among all anthropometric variables studied. The authors conclude that, independently of the degree of fatness, indicators of truncal fat distribution (in the region of the breast as well as the abdomen) are related to an unfavourable risk profile in European Premenopausal women. The study gives a rationale for selecting the most informative anthropometric measurements to be added to height and weight in epidemiological studies. [ABSTRACT FROM PUBLISHER]