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1. Principles of engagement on research and other collaborations between the brewing sector and research entities : The FACT Principles

Author

Frans J. Kok, Martin Zarnkow, and Aafje Sierksma

Subjects
Global Nutrition, Wereldvoeding, Nutrition and Dietetics, Humane Voeding & Gezondheid, Principles of engagement, Medicine (miscellaneous), Research Collaboration, Research entities, Brewing sector, Human Nutrition & Health
Abstract

Public–private partnerships are subject to intense scrutiny. This is specifically the case for sensitive health-related topics such as alcohol consumption. The brewing sector and representatives of the scientific community therefore stressed the need for specific principles for the proper and transparent governance of research and other collaborations between the brewing sector and research entities. At a 1-day seminar, a group of scientists and representatives from the brewing and food sector reached a consensus for such principles. They adhere to the following four fundamental conditions: Freedom of research, Accessibility, Contextualisation and Transparency. The points of focus in the FACT principles are open science, meaning that the methods and results are made accessible and reusable, and relationships are clearly disclosed. Actions to be taken for dissemination and implementation of the FACT Principles are, for instance, publishing them on public websites, including them in formal research agreements, and citing them in scientific publications. Scientific journals and (research) societies are encouraged to support the FACT Principles. In conclusion, the FACT Principles provide a framework for increased transparency and control of funding-related bias in research and other collaborations between the brewing sector and research entities. Monitoring their use and evaluating their impact will help to further refine and enforce the FACT Principles in the future.

Published
2023

2. Combined Urinary Biomarkers to Assess Coffee Intake Using Untargeted Metabolomics: Discovery in Three Pilot Human Intervention Studies and Validation in Cross-Sectional Studies

Author

Muyao Xi, Natalia Vázquez-Manjarrez, Agnes A M Berendsen, Tu Hu, Edith J. M. Feskens, Madeleine Ernst, Lars O. Dragsted, and Giorgia La Barbera

Subjects
0106 biological sciences, Nutrition and Disease, Cross-sectional study, Metabolite, metabolite, Coffee, 01 natural sciences, Ferulic acid, chemistry.chemical_compound, beverage, Voeding en Ziekte, Coffee intake, Humans, Metabolomics, Medicine, Food science, Chromatography, High Pressure Liquid, VLAG, Human Nutrition & Health, mass spectrometry, Global Nutrition, Wereldvoeding, business.industry, Humane Voeding & Gezondheid, 010401 analytical chemistry, prediction, General Chemistry, Intervention studies, 0104 chemical sciences, Cross-Sectional Studies, chemistry, Polyphenol, chromatography, General Agricultural and Biological Sciences, Glucuronide, business, Caffeine, Biomarkers, 010606 plant biology & botany
Abstract

Coffee is a widely consumed beverage worldwide and has a high content of chlorogenic acids, polyphenols, methylxanthines, and volatile flavor compounds. Scientific evidence to support the beneficial health effects of coffee is limited, and validated urinary biomarkers of coffee intake are therefore needed. We observed 23 common putative biomarkers of coffee intake in three separate parallel intervention studies by ultra-high-performance liquid chromatography-electrospray ionization-quadrupole time-of-flight-mass spectrometry (UHPLC-ESI-QTOF-MS) and multivariate analyses. Baseline samples from the NU-AGE study were used to confirm and validate 16 of these candidate biomarkers, including their robustness, time response, and dose response. These validated candidate biomarkers are N-methylpyridinium cation, 1-methyl-1H-pyrrole-2-carboxaldehyde, 1H-pyrrole-2-carboxaldehyde sulfate, 3-piperidinemethanol, furfurylidene-furfurylamine, 2-furoylglycine, N-substituted-5-(aminoethyl) furan-2-carbaldehyde derivative, 3′,4′-dihydroxyacetophenone sulfate, caffeine, dihydroxystyrene glucuronide, ferulic acid sulfate, 4-ethylcatechol glucuronide, 3-feruloylquinic acid, 3,4-dihydroxystyrene sulfate, one unknown glucuronide, and one unknown sulfate. Combinations of candidate biomarkers gave a better prediction of coffee consumption than individual biomarkers. The robustness of the combined biomarkers requires additional validation in cohort studies covering other populations.

Published
2021

3. Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer

Author

Jeanne H.M. de Vries, Marjolein Visser, Irene M. van der Staaij, Maaike M.G.A. van den Berg, Renate M. Winkels, Anja J.Th.C.M. de Kruif, Ellen Kampman, Marije S. Koster, Michiel R. de Boer, Marjan J. Westerman, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, APH - Aging & Later Life, APH - Quality of Care, Health Sciences, Nutrition and Health, APH - Societal Participation & Health, Epidemiology and Data Science, and Internal medicine

Subjects
0301 basic medicine, Gerontology, Nutrition and Disease, medicine.medical_treatment, Appetite, physical activity, Medicine (miscellaneous), perceptions, 0302 clinical medicine, Surveys and Questionnaires, Voeding en Ziekte, Longitudinal Studies, Cancer, Human Nutrition & Health, media_common, Nutrition and Dietetics, Qualitative interviews, Dietary intake, Humane Voeding & Gezondheid, Middle Aged, Smell, Lifestyle factors, Taste, Female, Adult, mixed methods, media_common.quotation_subject, Physical activity, Antineoplastic Agents, Breast Neoplasms, 030209 endocrinology & metabolism, Body weight, body weight, 03 medical and health sciences, breast cancer, Breast cancer, SDG 3 - Good Health and Well-being, medicine, Humans, Exercise, Aged, VLAG, Global Nutrition, Wereldvoeding, Chemotherapy, 030109 nutrition & dietetics, business.industry, medicine.disease, Diet, Energy Intake, dietary intake, business
Abstract

Background The present study aimed (i) to assess changes in dietary intake (DI), physical activity (PA) and body weight (BW) in breast cancer patients during chemotherapy; (ii) to describe how women explained, experienced and dealt with these potential changes; and (iii) to eventually develop lifestyle intervention strategies tailored to the women's personal needs during chemotherapy. Methods A longitudinal parallel mixed‐method design was used with quantitative assessment of changes in dietary intake (24‐h recall, Appetite, Hunger, Sensory Perception questionnaire), physical activity (Short Questionnaire to Assess Health‐enhancing physical activity, Multidimensional Fatigue Inventory) and BW (dual‐energy X‐ray absorptiometry), in addition to qualitative interviews with 25 women about these potential changes during chemotherapy. Results Most women who perceived eating less healthily with low energy intake (EI) and being less active before diagnosis continued to do so during chemotherapy, according to quantitative measurements. They struggled to maintain sufficient energy intake. Despite a lower than average reported EI, they unexpectedly gained weight and explained that fatigue made them even more inactive during chemotherapy. Active women usually managed to stay active because exercise was very important to them and made them feel good, although they also suffered from the side‐effects of chemotherapy. They found more ways to deal with taste, smell and appetite problems than women with a lower energy intake. Conclusions The combination of the quantitative and qualitative data provided more insight into the changes in dietary intake, physical activity and BW during chemotherapy. The women's explanations showed why some women remain active and others need support to deal with changes in lifestyle factors such as healthy nutrition and fatigue., In this longitudinal mixed‐method study, we quantitatively assessed changes in diet, physical activity and body weight, and qualitatively assessed how individual women with breast cancer experienced, explained, and responded to these changes during chemotherapy, enriching and clarifying the quantitative data. The findings showed that some women remained active with fewer dietary problems, while others struggled with adequate food intake, opportunities to be active, and experienced unexpected weight gain. Women with breast cancer need support to be active and to cope with fatigue, and they need help with their eating habits to develop lifestyle intervention strategies tailored to their personal needs during chemotherapy.

Published
2021

4. Optimizing Multivitamin Supplementation for Sleeve Gastrectomy Patients

Author

Edo O. Aarts, Eric J. Hazebroek, Agnes A M Berendsen, Laura Heusschen, Laura N. Deden, and Mellody I. Cooiman

Subjects
medicine.medical_specialty, Sleeve gastrectomy, Nutrition and Disease, Supplementation, Original Contributions, Endocrinology, Diabetes and Metabolism, Serum folic acid, medicine.medical_treatment, Gastroenterology, law.invention, Morbid obesity, Randomized controlled trial, Gastrectomy, law, Voeding en Ziekte, Internal medicine, Sleeve gastrectomy (SG), medicine, Humans, Micronutrients, Vitamin B12, Human Nutrition & Health, Bariatric surgery, Serum vitamin, Minerals, Nutrition and Dietetics, business.industry, Humane Voeding & Gezondheid, Malnutrition, Vitamins, Micronutrient, Obesity, Morbid, Dietary Supplements, Lower prevalence, Surgery, Deficiencies, Metabolic surgery, Multivitamin, business
Abstract

Purpose Micronutrient deficiencies are frequently reported after sleeve gastrectomy (SG), and therefore lifelong daily multivitamin supplementation is highly recommended. Based on literature and the results of a previous randomized controlled trial, a specialized multivitamin supplement for SG patients was further optimized (WLS Optimum 2.0, FitForMe). The present study reports on its short-term effectiveness. Materials and Methods An open-label study was performed in which 76 patients were included to receive WLS Optimum 2.0 for 12 months (Opt 2.0 group). This group was compared with a group of 75 patients that had received WLS Optimum 1.0 for 12 months during a previous study (Opt 1.0 group). Results Intention-to-treat analysis (Opt 1.0, n = 69; Opt 2.0, n = 75) showed higher serum levels of vitamin B12, vitamin B6, and zinc, and a lower prevalence of deficiencies for vitamin B12 and phosphate in the Opt 2.0 group. MCV and serum folic acid levels were higher in the Opt 1.0 group. Over the 12-month study period, mean increase in serum levels of phosphate, vitamin B6, and zinc was higher in the Opt 2.0 group, and MCV and serum vitamin D levels increased more in the Opt 1.0 group. Conclusion The present study showed that the use of a specialized multivitamin supplement for SG patients is effective at preventing deficiencies for most vitamins and minerals, specifically in compliant patients. However, a strict follow-up regime remains necessary to monitor nutritional status and to improve patient compliance.

Published
2021

5. Fatty acids in the de novo lipogenesis pathway and incidence of type 2 diabetes

Author

William S. Harris, Jason H Y Wu, Matti Uusitupa, Barbara McKnight, Tomi-Pekka Tuomainen, Amanda M. Fretts, Qi Sun, Julie K. Bassett, Allison M. Hodge, Fumiaki Imamura, Rozenn N. Lemaitre, David S. Siscovick, Hung-Ju Lin, Nona Sotoodehnia, Michael Y. Tsai, Lynne E. Wagenknecht, Kalina Rajaobelina, Kuo-Liong Chien, Sabita S. Soedamah-Muthu, Renata Micha, Liana C Del Gobbo, Rachel A. Murphy, Markku Laakso, Dariush Mozaffarian, Albert Koulman, Nita G. Forouhi, Ulf Risérus, Graham G. Giles, Janette de Goede, Andres V Ardisson Korat, Nathan L. Tintle, Nicholas J. Wareham, Waqas Qureshi, Johanna M. Geleijnse, Maria Lankinen, Mackenzie K Senn, Cécilia Samieri, Lars Lind, Wei-Sin Yang, Yun-yu Chen, Frank B. Hu, Matti Marklund, Jyrki K. Virtanen, Alexis C. Wood, Vilmundur Gudnason, Tzu-An Chen, Chaoyu Yu, Luc Djoussé, Jennifer G. Robinson, Catherine Helmer, Kerry L. M. Wong, Ingeborg A. Brouwer, Medical and Clinical Psychology, Imamura, Fumiaki [0000-0002-6841-8396], Marklund, Matti [0000-0002-3320-796X], Ardisson Korat, Andres V [0000-0003-4599-2245], Lankinen, Maria [0000-0002-9158-283X], Qureshi, Waqas [0000-0002-5189-4417], Wong, Kerry [0000-0002-4400-2257], Bassett, Julie K [0000-0003-0799-4821], Tintle, Nathan [0000-0003-1447-9107], Brouwer, Ingeborg A [0000-0002-8762-382X], Chien, Kuo-Liong [0000-0003-4979-8351], Chen, Yun-Yu [0000-0001-7009-7838], Wood, Alexis C [0000-0001-7616-2119], Geleijnse, Johanna M [0000-0001-7638-0589], Giles, Graham G [0000-0003-4946-9099], de Goede, Janette [0000-0002-6174-0681], Gudnason, Vilmundur [0000-0001-5696-0084], Harris, William S [0000-0003-3042-9353], Hodge, Allison [0000-0001-5464-2197], Koulman, Albert [0000-0001-9998-051X], McKnight, Barbara [0000-0002-3180-666X], Riserus, Ulf [0000-0002-8620-4586], Samieri, Cecilia [0000-0001-9809-7506], Senn, Mackenzie [0000-0002-0298-8142], Siscovick, David S [0000-0003-0461-175X], Soedamah-Muthu, Sabita S [0000-0002-8830-3502], Sun, Qi [0000-0002-8480-1563], Tuomainen, Tomi-Pekka [0000-0002-1949-3787], Wareham, Nick J [0000-0003-1422-2993], Wu, Jason HY [0000-0003-2073-3562], Micha, Renata [0000-0002-3983-1632], Mozaffarian, Dariush [0000-0001-7958-9492], Forouhi, Nita G [0000-0002-5041-248X], Apollo - University of Cambridge Repository, Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Health Sciences, APH - Health Behaviors & Chronic Diseases, APH - Mental Health, Ardisson Korat, Andres V. [0000-0003-4599-2245], Bassett, Julie K. [0000-0003-0799-4821], Brouwer, Ingeborg A. [0000-0002-8762-382X], Chen, Yun-yu [0000-0001-7009-7838], Wood, Alexis C. [0000-0001-7616-2119], Geleijnse, Johanna M. [0000-0001-7638-0589], Giles, Graham G. [0000-0003-4946-9099], Harris, William S. [0000-0003-3042-9353], Siscovick, David S. [0000-0003-0461-175X], Soedamah-Muthu, Sabita S. [0000-0002-8830-3502], Wareham, Nick J. [0000-0003-1422-2993], Wu, Jason H. Y. [0000-0003-2073-3562], and Forouhi, Nita G. [0000-0002-5041-248X]

Subjects
Male, Nutrition and Disease, Physiology, Type 2 diabetes, 030204 cardiovascular system & hematology, Biochemistry, LEHA, Geographical locations, 0302 clinical medicine, Endocrinology, Mathematical and Statistical Techniques, Voeding en Ziekte, Medicine and Health Sciences, Macromolecular Structure Analysis, Medicine, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Human Nutrition & Health, 2. Zero hunger, chemistry.chemical_classification, RISK, Lipid Analysis, PLASMA, Incidence (epidemiology), Incidence, Fatty Acids, Statistics, Humane Voeding & Gezondheid, General Medicine, ASSOCIATION, Middle Aged, Metaanalysis, Lipids, CANCER, 3. Good health, Type 2 Diabetes, ADIPOSE-TISSUE, BETA-CELL TURNOVER, Lipogenesis, Physical Sciences, Endokrinologi och diabetes, COFFEE CONSUMPTION, Female, Metabolic Networks and Pathways, Research Article, Endocrine Disorders, BIOMARKERS, Endocrinology and Diabetes, Research and Analysis Methods, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Diabetes mellitus, Diabetes Mellitus, Life Science, Humans, CORONARY-HEART-DISEASE, Statistical Methods, Molecular Biology, Aged, VLAG, business.industry, Fatty acid, Biology and Life Sciences, medicine.disease, United States, PHOSPHOLIPIDS, Human nutrition, Metabolism, chemistry, Diabetes Mellitus, Type 2, Metabolic Disorders, North America, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, People and places, business, Dyslipidemia, Mathematics
Abstract

Background De novo lipogenesis (DNL) is the primary metabolic pathway synthesizing fatty acids from carbohydrates, protein, or alcohol. Our aim was to examine associations of in vivo levels of selected fatty acids (16:0, 16:1n7, 18:0, 18:1n9) in DNL with incidence of type 2 diabetes (T2D). Methods and findings Seventeen cohorts from 12 countries (7 from Europe, 7 from the United States, 1 from Australia, 1 from Taiwan; baseline years = 1970–1973 to 2006–2010) conducted harmonized individual-level analyses of associations of DNL-related fatty acids with incident T2D. In total, we evaluated 65,225 participants (mean ages = 52.3–75.5 years; % women = 20.4%–62.3% in 12 cohorts recruiting both sexes) and 15,383 incident cases of T2D over the 9-year follow-up on average. Cohort-specific association of each of 16:0, 16:1n7, 18:0, and 18:1n9 with incident T2D was estimated, adjusted for demographic factors, socioeconomic characteristics, alcohol, smoking, physical activity, dyslipidemia, hypertension, menopausal status, and adiposity. Cohort-specific associations were meta-analyzed with an inverse-variance-weighted approach. Each of the 4 fatty acids positively related to incident T2D. Relative risks (RRs) per cohort-specific range between midpoints of the top and bottom quintiles of fatty acid concentrations were 1.53 (1.41–1.66; p < 0.001) for 16:0, 1.40 (1.33–1.48; p < 0.001) for 16:1n-7, 1.14 (1.05–1.22; p = 0.001) for 18:0, and 1.16 (1.07–1.25; p < 0.001) for 18:1n9. Heterogeneity was seen across cohorts (I2 = 51.1%–73.1% for each fatty acid) but not explained by lipid fractions and global geographical regions. Further adjusted for triglycerides (and 16:0 when appropriate) to evaluate associations independent of overall DNL, the associations remained significant for 16:0, 16:1n7, and 18:0 but were attenuated for 18:1n9 (RR = 1.03, 95% confidence interval (CI) = 0.94–1.13). These findings had limitations in potential reverse causation and residual confounding by imprecisely measured or unmeasured factors. Conclusions Concentrations of fatty acids in the DNL were positively associated with T2D incidence. Our findings support further work to investigate a possible role of DNL and individual fatty acids in the development of T2D., Fumiaki Imamura and colleagues investigate the association between concentrations of fatty acid involved in de-novo lipogensis and incidence of Type 2 diabetes., Author summary Why was this study done? De novo lipogenesis (DNL) is a metabolic pathway involved in the endogenous synthesis of specific fatty acids, such as 16:0, 16:1n7, 18:0, and 18:1n9, and it is linked to the pathophysiology of cardiometabolic diseases, including type 2 diabetes (T2D). Circulating or tissue concentrations of these fatty acids have been investigated for the associations with T2D incidence in epidemiological research. However, published studies reported inconsistent associations inconsistently and were subject to publication bias. Summary evidence is not available to date for the associations between these fatty acids and T2D incidence. An integration of available cohort studies would increase statistical power and allow assessment of generalizability, standardization of analytical strategies, and evidence synthesis with the potential publication bias minimized. What did the researchers do and find? As a part of the Fatty Acids and Outcomes Research Consortium (FORCE), we conducted new individual-participant data analyses of 17 cohort studies of a total of 65,225 adults free of T2D at baseline, among whom 15,383 developed incident T2D over up to 20 years of follow-up. The cohort studies analyzed the associations between fatty acids (16:0, 16:1n7, 18:0, and 18:1n9) and the risk of developing T2D with standardized analytic strategy. In pooled analyses, each of the fatty acids was positively associated with a higher risk of developing T2D. The associations were independent of major risk factors for T2D, such as age, sex, race/ethnicity, socioeconomic characteristics, smoking status, physical activity, and obesity. What do these findings mean? The findings provide the first summary evidence to date for the positive relationships of concentrations of the DNL-related fatty acids with a risk of T2D, indicating the strong relevance of DNL and its determinants to the development of T2D. These fatty acids potentially reflect the status of DNL activity, which may be stimulated or suppressed by a combination of carbohydrate intake, alcohol intake, polyunsaturated fatty acid intake, and other lifestyle and clinical factors. Therefore, the current findings indicate the need for investigation into determinants and consequences of elevated concentrations of these fatty acids. Despite several advantages of our individual-level data analysis in this pooling project, the results cannot establish whether elevated concentrations of these fatty acids caused the development of T2D or whether underlying peripheral or hepatic insulin resistance, for example, may elevate both the fatty acid concentrations and the risk of T2D independently.

Published
2020

6. Associations of Abdominal Skeletal Muscle Mass, Fat Mass, and Mortality among Men and Women with Stage I–III Colorectal Cancer

Author

Matty P. Weijenberg, Liesbeth Posthuma, Fränzel J.B. van Duijnhoven, Ernst Jan Spillenaar Bilgen, Jesca G. M. Brouwer, Sandra Beijer, Birgitta M E Hansson, Moniek van Zutphen, Renate M. Winkels, Ellen Kampman, Dieuwertje E. Kok, Johannes H. W. de Wilt, Harm van Baar, Hendriek C. Boshuizen, Gerrit D. Slooter, Martijn J.L. Bours, Evertine Wesselink, Epidemiologie, and RS: GROW - R1 - Prevention

Subjects
Male, 0301 basic medicine, Nutrition and Disease, Epidemiology, Colorectal cancer, Abdominal ct, Body Mass Index, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Risk Factors, Voeding en Ziekte, Prospective Studies, Stage (cooking), Abdominal Muscles, Human Nutrition & Health, OUTCOMES, Humane Voeding & Gezondheid, Middle Aged, CHEMOTHERAPY, Oncology, 030220 oncology & carcinogenesis, Body Composition, SURVIVAL, Female, SEX, HEALTH, SUBCUTANEOUS ADIPOSE-TISSUE, Colorectal Neoplasms, medicine.medical_specialty, BODY-COMPOSITION, RESECTION, Abdominal Fat, Risk Assessment, Fat mass, 03 medical and health sciences, Sex Factors, All institutes and research themes of the Radboud University Medical Center, Internal medicine, medicine, Humans, Life Science, SARCOPENIC OBESITY, Sarcopenic obesity, Aged, Neoplasm Staging, VLAG, business.industry, Cancer, medicine.disease, Skeletal muscle mass, 030104 developmental biology, PROGNOSTIC-FACTOR, Subcutaneous adipose tissue, Tomography, X-Ray Computed, business, Follow-Up Studies
Abstract

Background: The associations of abdominal skeletal muscle mass index (SMI), visceral and subcutaneous adipose tissue (VAT and SAT, respectively), and mortality among patients with stage I–III colorectal cancer may differ for men and women, but only few studies stratified their data into men and women. We investigated associations of abdominal SMI, VAT, and SAT with overall mortality among men and among women with stage I–III colorectal cancer. Methods: SMI, VAT, and SAT were assessed from abdominal CT images for 1,998 patients with stage I–III colorectal cancer diagnosed between 2006 and 2015. Restricted cubic splines (RCS) were used to investigate associations of SMI, VAT, and SAT with overall mortality. Results: Average age of the participants was 67.9 ± 10.6 years and 58% were men. During a median follow-up of 4.3 years, 546 (27%) patients died. Among men, the association of SMI and mortality was statistically significant in a nonlinear way in the RCS analyses, with lower SMI levels associated with higher mortality. SMI was not associated with mortality among women. SAT was associated with mortality in a nonlinear way for men and for women, with lower SAT levels being associated with higher mortality. VAT was not significantly associated with mortality in men or women. Conclusion: Associations of abdominal skeletal muscle mass with mortality among patients with colorectal cancer were not the same for men and for women. Impact: This study stresses the importance for more attention on sex-related differences in body composition and cancer outcomes.

Published
2020

7. Changing from a Western to a Mediterranean-style diet does not affect iron or selenium status: results of the New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe (NU-AGE) 1-year randomized clinical trial in elderly Europeans

Author

John Dutton, Barbara Pietruszka, Lisette C. P. G. M. de Groot, Agnes A M Berendsen, Antonio Perfecto, Rita Ostan, Rachel Gillings, Jonathan Tang, William D. Fraser, Aurelia Santoro, Aurélie Caille, Elodie Caumon, Marta Jeruszka-Bielak, Claudio Franceschi, Jim Speakman, Susan J. Fairweather-Tait, Claudio Nicoletti, Amy Jennings, Jennings, Amy, Tang, Jonathan, Gillings, Rachel, Perfecto, Antonio, Dutton, John, Speakman, Jim, Fraser, William D, Nicoletti, Claudio, Berendsen, Agnes A M, de Groot, Lisette C P G M, Pietruszka, Barbara, Jeruszka-Bielak, Marta, Caumon, Elodie, Caille, Aurélie, Ostan, Rita, Franceschi, Claudio, Santoro, Aurelia, and Fairweather-Tait, Susan J

Subjects
Male, 0301 basic medicine, Mediterranean climate, Mediterranean diet, Mediterranean-style diet, Medicine (miscellaneous), Diet, Mediterranean, law.invention, Healthy Aging, meat, iron, Vitamins, Minerals, and Phytochemicals, Randomized controlled trial, law, Medicine, selenium, Human Nutrition & Health, 2. Zero hunger, Ageing, Nutrition, Diet, NU-AGE project, Nutrition and Dietetics, Humane Voeding & Gezondheid, Nutritional Biology, 3. Good health, Europe, Original Research Communications, Red Meat Consumption, Female, Anemia, Iron, Nutritional Status, chemistry.chemical_element, European, Affect (psychology), elderly, Selenium, 03 medical and health sciences, Environmental health, Humans, VLAG, Aged, fish, 030109 nutrition & dietetics, Europeans, business.industry, medicine.disease, 030104 developmental biology, chemistry, Ageing, randomized controlled trial, business
Abstract

Background: Mediterranean diets limit red meat consumption and increase intakes of high-phytate foods, a combination that could reduce iron status. Conversely, higher intakes of fish, a good source of selenium, could increase selenium status. Objectives: A 1-y randomized controlled trial [New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe (NU-AGE)] was carried out in older Europeans to investigate the effects of consuming a Mediterraneanstyle diet on indices of inflammation and changes in nutritional status. Methods: Selenium and iron intakes and status biomarkers were measured at baseline and after 1 y in 1294 people aged 65–79 y from 5 European countries (France, Italy, the Netherlands, Poland, and the United Kingdom) who had been randomly allocated either to a Mediterranean-style diet or to remain on their habitual, Western diet. Results: Estimated selenium intakes increased significantly with the intervention group (P < 0.01), but were not accompanied by changes in serum selenium concentrations. Iron intakes also increased (P < 0.001), but there was no change in iron status. However, when stratified by study center, there were positive effects of the intervention on iron status for serum ferritin for participants in Italy (P = 0.04) and France (P = 0.04) and on soluble transferrin receptor (sTfR) for participants in Poland (P < 0.01). Meat intake decreased and fish intake increased to a greater degree in the intervention group, relative to the controls (P < 0.01 for both), but the overall effects of the intervention on meat and fish intakes were mainly driven by data from Poland and France. Changes in serum selenium in the intervention group were associated with greater changes in serum ferritin (P = 0.01) and body iron (P = 0.01), but not sTfR (P = 0.73); there were no study center × selenium status interactions for the iron biomarkers. Conclusions: Consuming a Mediterranean-style diet for 1 y had no overall effect on iron or selenium status, although there were positive effects on biomarkers of iron status in some countries. The NU-AGE trial was registered at clinicaltrials.gov as NCT01754012. Am J Clin Nutr 2019;00:1–12.

Published
2020

8. Adherence to a food group based dietary guideline and incidence of prediabetes and type 2 diabetes

Author

Nicolette R. den Braver, Andrea L. J. Kortlever van der Spek, Dorina Ibi, Jeroen Lakerveld, Anouk Geelen, Sabita S. Soedamah-Muthu, Amber A. van der Heijden, Femke Rutters, Johannes Brug, Moniek Looman, Joline W.J. Beulens, Petra J. M. Elders, Epidemiology and Data Science, APH - Health Behaviors & Chronic Diseases, General practice, APH - Methodology, APH - Aging & Later Life, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, and Medical and Clinical Psychology

Subjects
medicine.medical_specialty, Nutrition and Disease, Medicine (miscellaneous), Dietary pattern, HEALTHY DIET, Type 2 diabetes, Food group, symbols.namesake, Internal medicine, Diabetes mellitus, Voeding en Ziekte, Medicine, COHORT, Prediabetes, Poisson regression, FREQUENCY QUESTIONNAIRE, VALIDITY, Prospective cohort study, Dutch healthy diet index 2015, INDEX, METAANALYSIS, VLAG, Human Nutrition & Health, Global Nutrition, RISK, Wereldvoeding, Nutrition and Dietetics, VLAG A, business.industry, Incidence (epidemiology), Intermediate hyperglycemia, MORTALITY, Humane Voeding & Gezondheid, Original Contribution, medicine.disease, CANCER, MEDITERRANEAN DIET, Cohort, symbols, business
Abstract

Purpose In this study, we investigated the association between adherence to the Dutch Healthy Diet index 2015 (DHD15-index) and incidence of prediabetes (preT2D) and Type 2 Diabetes (T2D) in a representative sample for the general Dutch population. Methods Two prospective cohort studies, The Hoorn and The New Hoorn Study, were used for data analyses. In total, data from 2951 participants without diabetes at baseline (mean age 56.5 ± 7.5 years; 49.6% male) were harmonized. Baseline dietary intake was assessed with validated Food Frequency Questionnaires and adherence to the DHD15-index was calculated (range 0–130). PreT2D and T2D were classified according to the WHO criteria 2011. Poisson regression was used to estimate prevalence ratios between participant scores on the DHD15-index and preT2D and T2D, adjusted for follow-up duration, energy intake, socio-demographic, and lifestyle factors. Change in fasting plasma glucose levels (mmol/L) over follow-up was analysed using linear regression analyses, additionally adjusted for baseline value. Results During a mean follow-up of 6.3 ± 0.7 years, 837 participants developed preT2D and 321 participants developed T2D. The highest adherence to the DHD15-index was significantly associated with lower T2D incidence [model 3, PRT3vsT1: 0.70 (0.53; 0.92), ptrend = 0.01]. The highest adherence to the DHD15-index pointed towards a lower incidence of preT2D [PRT3vsT1: 0.87 (0.74; 1.03), ptrend = 0.11]. Higher adherence to the DHD15-index was not associated with change in fasting plasma glucose levels [β10point: − 0.012 (− 0.034; 0.009)mmol/L]. Conclusion The present study showed that the highest compared to the lowest adherence to the DHD15-index was associated with a lower T2D incidence, and pointed towards a lower incidence of preT2D. These results support the benefits of adhering to the guidelines in T2D prevention.

Published
2020

9. The impact of protein quantity during energy restriction on genome-wide gene expression analysis in human adipose tissue

Subjects
Global Nutrition, Wereldvoeding, Homo sapiens, Voeding, Expression profiling by array, Metabolisme en Genomica, Humane Voeding & Gezondheid, Metabolism and Genomics, VLAG, Nutrition, Human Nutrition & Health
Abstract

Overweight is a growing health problem worldwide. The most effective strategy to reduce weight is energy restriction (ER): restriction of food intake without malnutrition. ER has been shown to be beneficial in disease prevention, healthy aging, and inflammation. Recent studies suggest that reducing the protein content of a diet contributes to the beneficial effects by ER. The first objective of our study was to assess the effect of energy restriction on changes in gene expression in adipose tissue. Secondly, the changes in gene expression were compared between a high protein diet and a normal protein diet during energy restriction. In a parallel double-blinded study, overweight older subjects adhered to a 25% ER diet, either combined with high protein intake (HP-ER, 1.7 g/kg per day), or with normal protein intake (NP-ER, 0.9 g/kg per day) for 12 weeks. From 10 HP-ER subjects and 12 NP-ER subjects subcutaneous adipose tissue biopsies were collected before and after the diet. Adipose tissue was used to isolate total RNA and to evaluate whole genome gene expression changes upon a HP-ER and NP-ER diet. Upon 25% ER, clusters of gene sets in energy metabolism, such as lipid metabolism and PPARα targets, NRF2 targets, glucose metabolism, and TCA cycle, as well as gene sets in oxidative phosphorylation, adaptive immune response, immune cell infiltration, and cell cycle were decreased, and RNA translation and processing gene sets were increased. A different gene expression response between HP-ER and NP-ER was observed for 530 genes. Pathway analysis revealed that after NP-ER a downregulation in expression of genes involved in adaptive immune response was present. HP-ER resulted in an upregulation of pathways involved in cell cycle, GPCR signalling, olfactory signalling and nitrogen metabolism. Based on the gene expression changes, we concluded that HP seems to be less beneficial for ER’s effect on immune-related gene expression in adipose tissue.

Published
2022

10. Drug use is associated with lower plasma magnesium levels in geriatric outpatients; possible clinical relevance

Author

Elske M. Brouwer-Brolsma, A.C.B. van Orten-Luiten, A. Janse, E. Verspoor, and Renger F. Witkamp

Subjects
Male, 0301 basic medicine, Osteoporosis, Disease, Critical Care and Intensive Care Medicine, 0302 clinical medicine, Risk Factors, Magnesium deficiency (medicine), Ambulatory Care, Prevalence, Drug Interactions, Magnesium, Human Nutrition & Health, media_common, Aged, 80 and over, Nutrition and Dietetics, Humane Voeding & Gezondheid, Diabetes, Drug-food interaction, Cardiovascular disease, Nutritional Biology, Female, Drug, endocrine system, medicine.medical_specialty, Drug-Related Side Effects and Adverse Reactions, media_common.quotation_subject, Adverse drug reaction, 030209 endocrinology & metabolism, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], Hypomagnesemia, 03 medical and health sciences, Diabetes mellitus, Internal medicine, medicine, Humans, Hypoglycemic Agents, Aged, VLAG, Global Nutrition, Polypharmacy, Wereldvoeding, 030109 nutrition & dietetics, business.industry, Cardiovascular Agents, medicine.disease, Magnesium deficiency, Cross-Sectional Studies, business
Abstract

Contains fulltext : 215418.pdf (Publisher’s version ) (Closed access) BACKGROUND: Hypomagnesemia has been associated with diabetes, cardiovascular disease, and other disorders. Drug use has been suggested as one of the risk factors for low magnesium (Mg) levels. In the elderly population, prone to polypharmacy and inadequate Mg intake, hypomagnesemia might be relevant. Therefore, we aimed to investigate associations between drug use and plasma Mg. METHODS: Cross-sectional data of 343 Dutch geriatric outpatients were analysed by Cox and linear regression, while adjusting for covariates. Drug groups were coded according to the Anatomical Therapeutic Chemical classification system; use was compared to non-use. Hypomagnesemia was defined as plasma Mg < 0.75 mmol/l and /=5 medications (polypharmacy). The number of different drugs used was inversely linearly associated with Mg level (beta -0.01; p < 0.01). Fully adjusted Cox regression showed significant associations of polypharmacy with hypomagnesemia (Mg < 0.75 mmol/l) (prevalence ratio (PR) 1.81; 95%CI 1.08-3.14), proton pump inhibitors (PR 1.80; 95%CI 1.20-2.72), and metformin (PR 2.34; 95%CI 1.56-3.50). Moreover, stratified analyses pointed towards associations with calcium supplements (PR 2.26; 95%CI 1.20-4.26), insulins (PR 3.88; 95%CI 2.19-6.86), vitamin K antagonists (PR 2.01; 95%CI 1.05-3.85), statins (PR 2.44; 95%CI 1.31-4.56), and bisphosphonates (PR 2.97; 95%CI 1.65-5.36) in patients

Published
2019

11. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention is associated with better health-related quality of life among long-term colorectal cancer survivors

Author

Martijn J.L. Bours, Sandra Beijer, Floortje Mols, Ellen Kampman, Merel R. van Veen, Matty P. Weijenberg, Epidemiologie, RS: GROW - R1 - Prevention, and Medical and Clinical Psychology

Subjects
Male, Nutrition and Disease, Colorectal cancer, Health-related quality of life, Overweight, GUIDELINES, Body composition, FATIGUE, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Quality of life, Cancer Survivors, Voeding en Ziekte, Global health, PROSTATE, 030212 general & internal medicine, Longitudinal Studies, Registries, Human Nutrition & Health, Netherlands, 2. Zero hunger, RISK, INSTRUMENT, Nursing research, Humane Voeding & Gezondheid, Middle Aged, humanities, 3. Good health, Dietary guidelines, Oncology, WCRF guidelines, 030220 oncology & carcinogenesis, Original Article, Female, Guideline Adherence, medicine.symptom, Colorectal Neoplasms, Adult, medicine.medical_specialty, Colorectal cancer survivors, EXERCISE, STYLE FACTORS, BREAST, DIET, 03 medical and health sciences, Internal medicine, medicine, Humans, Healthy Lifestyle, VLAG, Aged, Cancer prevention, business.industry, Physical activity, FRUIT, Cancer, medicine.disease, Cross-Sectional Studies, Quality of Life, Patient Compliance, business, Body mass index
Abstract

Contains fulltext : 215383.pdf (Publisher’s version ) (Open Access) Since colorectal cancer (CRC) survivors often suffer from long-term adverse health effects of the cancer and its treatment, having a negative impact on their health-related quality of life (HRQL), this study focuses on the association between adherence to WCRF/AICR recommendations and HRQL among CRC survivors. In a cross-sectional PROFILES registry study in 1096 CRC survivors (mean time since diagnosis 8.1 years), WCRF/AICR adherence scores (range 0-8, with a higher score for better adherence) were calculated, and HRQL was assessed using the EORTC QLQ-C30. Associations between adherence scores and HRQL scores were investigated using linear regression analyses. Additionally, associations with adherence to guidelines for body mass index (BMI) (normal weight, overweight and obese), physical activity (PA) (score 0/1) and diet (score < 3, 3- < 4 and > 4) were evaluated separately. Mean adherence score was 4.81 +/- 1.04. Higher WCRF/AICR scores were associated with better global health status (beta 1.64; 95%CI 0.69/2.59), physical functioning (beta 2.71; 95%CI 1.73/3.68), role functioning (beta 2.87; 95%CI 1.53/4.21), cognitive functioning (beta 1.25; 95%CI 0.19/2.32), social functioning (beta 2.01; 95%CI 0.85/3.16) and fatigue (beta - 2.81; 95%CI - 4.02/- 1.60). Adherence versus non-adherence PA was significantly associated with better physical, role, emotional and social functioning, global health status and less fatigue. Except for the association between being obese and physical functioning (beta - 4.15; 95%CI - 47.16/- 1.15), no statistically significant associations with physical functioning were observed comparing adherence to non-adherence to BMI and dietary recommendations. Better adherence to the WCRF/AICR recommendations was positively associated with global health status, most functioning scales and less fatigue among CRC survivors. PA seemed to be the main contributor.

Published
2019

12. Estimating disease prevalence from drug utilization data using the Random Forest algorithm

Author

Markus M J Nielen, Laurentius C J Slobbe, Koen Füssenich, Albert Wong, Hendriek Boshuizen, Hans van Oers, Johan Polder, Talitha L Feenstra, Tranzo, Scientific center for care and wellbeing, PharmacoTherapy, -Epidemiology and -Economics, Value, Affordability and Sustainability (VALUE), and Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET)

Subjects
Adult, Male, NATIONAL-HEALTH, medicine.medical_specialty, 030232 urology & nephrology, Prevalence, Disease, 03 medical and health sciences, 0302 clinical medicine, Acquired immunodeficiency syndrome (AIDS), Internal medicine, Diabetes mellitus, medicine, Life Science, Humans, 030212 general & internal medicine, Medical prescription, Aged, Netherlands, Probability, Human Nutrition & Health, Asthma, Aged, 80 and over, COPD, business.industry, Humane Voeding & Gezondheid, Public Health, Environmental and Occupational Health, Area under the curve, DIABETES-MELLITUS, Middle Aged, CARE, medicine.disease, TRENDS, Drug Utilization, Hospitalization, Biometris, Population Surveillance, Chronic Disease, GERMANY, Female, Public Health Monitoring, business, Algorithms, Forecasting
Abstract

Background Aggregated claims data on medication are often used as a proxy for the prevalence of diseases, especially chronic diseases. However, linkage between medication and diagnosis tend to be theory based and not very precise. Modelling disease probability at an individual level using individual level data may yield more accurate results. Methods Individual probabilities of having a certain chronic disease were estimated using the Random Forest (RF) algorithm. A training set was created from a general practitioners database of 276 723 cases that included diagnosis and claims data on medication. Model performance for 29 chronic diseases was evaluated using Receiver-Operator Curves, by measuring the Area Under the Curve (AUC). Results The diseases for which model performance was best were Parkinson’s disease (AUC = .89, 95% CI = .77–1.00), diabetes (AUC = .87, 95% CI = .85–.90), osteoporosis (AUC = .87, 95% CI = .81–.92) and heart failure (AUC = .81, 95% CI = .74–.88). Five other diseases had an AUC >.75: asthma, chronic enteritis, COPD, epilepsy and HIV/AIDS. For 16 of 17 diseases tested, the medication categories used in theory-based algorithms were also identified by our method, however the RF models included a broader range of medications as important predictors. Conclusion Data on medication use can be a useful predictor when estimating the prevalence of several chronic diseases. To improve the estimates, for a broader range of chronic diseases, research should use better training data, include more details concerning dosages and duration of prescriptions, and add related predictors like hospitalizations.

Published
2019

13. The association between 25-hydroxyvitamin D concentration, physical performance and frailty status in older adults

Author

Lisette C. P. G. M. de Groot, Anouk M.M. Vaes, Nicole Toussaint, Luc J. C. van Loon, Michael Tieland, Margot F. de Regt, Elske M. Brouwer-Brolsma, Nutrition and Health, Humane Biologie, and RS: NUTRIM - R3 - Respiratory & Age-related Health

Subjects
0301 basic medicine, Male, Medicine (miscellaneous), Total population, Timed Up and Go test, Physical performance, Grip strength, chemistry.chemical_compound, MUSCLE STRENGTH, 0302 clinical medicine, Vitamin D, Human Nutrition & Health, Netherlands, Nutrition and Dietetics, Hand Strength, Frailty, Humane Voeding & Gezondheid, FALLS, MEN, Original Contribution, Physical Functional Performance, Female, HEALTH, medicine.medical_specialty, Frail Elderly, 030209 endocrinology & metabolism, 25-Hydroxyvitamin D, CALCIUM, 03 medical and health sciences, VITAMIN-D LEVELS, Internal medicine, Linear regression, medicine, Vitamin D and neurology, Humans, Geriatric Assessment, VLAG, Aged, Global Nutrition, Wereldvoeding, 030109 nutrition & dietetics, Muscle strength, business.industry, MORTALITY, Gait speed, Cross-Sectional Studies, chemistry, Calcifediol, business, human activities
Abstract

Purpose: Sufficient 25-hydroxyvitamin D (25(OH)D) concentrations might prevent a decline in physical performance, and are considered important for the prevention of frailty. This study investigates the association of serum 25(OH)D concentration with physical performance and frailty status in Dutch older adults. Methods: This cross-sectional study included 756 men and women, aged ≥ 65 years. Serum 25(OH)D concentration and frailty status (Fried criteria) were assessed in the total population. Screening for frailty status included functional tests of gait speed and hand grip strength. In a subgroup (n = 494), the Timed Up and Go test (TUG) and knee-extension strength were measured. Associations of serum 25(OH)D status with physical performance were examined by multiple linear regression. Prevalence ratios (PR) were used to quantify associations between serum 25(OH)D deficiency (< 50 nmol/L) and frailty. Results: In total, 45% of the participants were vitamin D deficient. Participants with vitamin D status < 50 and 50–75 nmol/L had significantly lower scores on the TUG and gait speed test, compared to participants with vitamin D status > 75 nmol/L. No significant associations with serum 25(OH)D concentrations were observed for handgrip strength or knee-extension strength. Participants with serum 25(OH)D status < 50 nmol/L were about two times more likely to be frail compared to participants with serum 25(OH)D status ≥ 50 nmol/L. No significant associations were observed between the pre-frail state and serum 25(OH)D status. Conclusion: In this study, serum 25(OH)D concentrations were significantly associated with frailty status and measures of physical performance, including gait speed and TUG, but not with strength-related outcomes.

Published
2019

14. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer

Author

M.R. de Boer, Marjolein Visser, M. B. Scholtens, J. Th C.M. de Kruif, Y. de Vries, J. van der Rijt, Renate M. Winkels, Ellen Kampman, Marjan J. Westerman, M. van den Berg, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, APH - Methodology, Nutrition and Health, APH - Aging & Later Life, APH - Quality of Care, VU University medical center, AGEM - Endocrinology, metabolism and nutrition, and IOO

Subjects
Dieticians, Nutrition and Disease, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Breast cancer, Voeding en Ziekte, Health care, 030212 general & internal medicine, Sensory Science and Eating Behaviour, Qualitative Research, Human Nutrition & Health, media_common, Nursing research, Humane Voeding & Gezondheid, Middle Aged, Health care professionals, Health risks, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Original Article, Female, medicine.symptom, Adult, medicine.medical_specialty, Pain medicine, media_common.quotation_subject, Health Personnel, education, Breast Neoplasms, 03 medical and health sciences, SDG 3 - Good Health and Well-being, Perception, medicine, Humans, Exercise, Weight gain, VLAG, business.industry, Physical activity, Dietary intake, medicine.disease, Sensoriek en eetgedrag, Family medicine, business, Qualitative research
Abstract

Contains fulltext : 203373.pdf (Publisher’s version ) (Open Access) PURPOSE: Dutch Health care professionals (HCPs) provide little information concerning health risks associated with weight gain during chemotherapy for breast cancer. Women with breast cancer have specified the need for more information on nutrition and physical activity to deal with weight gain. The aims of this study were to assess the perceptions of Dutch HCPs on weight gain during chemotherapy and in addition evaluate whether and what kind of information on dietary intake and physical activity HCPs provide to prevent/treat weight gain during (neo)adjuvant chemotherapy. METHODS: A qualitative study was conducted using semi-structured interviews with 34 HCPs involved in breast cancer care: general practitioners, oncologists, specialized nurses, and dieticians. RESULTS: To date, little information about nutrition, physical activity, and weight gain is given during chemotherapy because it is not part of most HCPs' training, it is not included in the guidelines and it is not the best time to bring up information in the opinion of HCPs. Weight gain was perceived as just a matter of a few kilos and not an important health issue during treatment. All HCPs felt it is better that women themselves addressed their weight gain after chemotherapy. CONCLUSION: More knowledge about health risks associated with chemotherapy-induced weight gain and how to combat these issues needs to be made readily available to the HCPs and should become part of their training. Existing patient guidelines should include information on how to prevent and/or reduce weight gain through self-management of nutrition intake and physical activity during and post chemotherapy.

Published
2019

15. Gender-specific association of body composition with inflammatory and adipose-related markers in healthy elderly Europeans from the NU-AGE study

Author

Agnes A M Berendsen, Aurelia Santoro, Lisette C. P. G. M. de Groot, Cristina Fabbri, Katarzyna Kozlowska, Elodie Caumon, Alessandro Napoli, Claudio Nicoletti, Giulia Guidarelli, Fawzi Kadi, Olga Januszko, Enrico Giampieri, Claudio Franceschi, Alberto Bazzocchi, Susan J. Fairweather-Tait, Claudia Bertarelli, Anna Brzozowska, Edith J. M. Feskens, Daniele Mercatelli, Nathalie Meunier, Amy Jennings, Miriam Capri, Giuseppe Battista, Rita Ostan, Santoro, Aurelia, Guidarelli, Giulia, Ostan, Rita, Giampieri, Enrico, Fabbri, Cristina, Bertarelli, Claudia, Nicoletti, Claudio, Kadi, Fawzi, de Groot, Lisette C. P. G. M., Feskens, Edith, Berendsen, Agne, Brzozowska, Anna, Januszko, Olga, Kozlowska, Katarzyna, Fairweather-Tait, Susan, Jennings, Amy, Meunier, Nathalie, Caumon, Elodie, Napoli, Alessandro, Mercatelli, Daniele, Battista, Giuseppe, Capri, Miriam, Franceschi, Claudio, and Bazzocchi, Alberto

Subjects
Male, Radiology, Nuclear Medicine and Imaging, Aging, Sarcopenia, Adipose tissue, Body composition, 030218 nuclear medicine & medical imaging, Absorptiometry, Photon, 0302 clinical medicine, Bone Density, Adiposity, Human Nutrition & Health, DXA, Leptin, Humane Voeding & Gezondheid, General Medicine, 3. Good health, Europe, 030220 oncology & carcinogenesis, Cohort, Female, Ghrelin, Radiology, Inflammation Mediators, medicine.symptom, medicine.medical_specialty, Inflammation, 03 medical and health sciences, Sex Factors, Internal medicine, medicine, Humans, Obesity, Muscle, Skeletal, Aged, VLAG, Global Nutrition, Wereldvoeding, Adiponectin, business.industry, medicine.disease, Cross-Sectional Studies, Endocrinology, Musculoskeletal, Resistin, business, Biomarkers
Abstract

Objectives The aim of this work was to examine the cross-sectional relationship between body composition (BC) markers for adipose and lean tissue and bone mass, and a wide range of specific inflammatory and adipose-related markers in healthy elderly Europeans. Methods A whole-body dual-energy X-ray absorptiometry (DXA) scan was made in 1121 healthy (65–79 years) women and men from five European countries of the “New dietary strategies addressing the specific needs of elderly population for a healthy aging in Europe” project (NCT01754012) cohort to measure markers of adipose and lean tissue and bone mass. Pro-inflammatory (IL-6, IL-6Rα, TNF-α, TNF-R1, TNF-R2, pentraxin 3, CRP, alpha-1-acid glycoprotein, albumin) and anti-inflammatory (IL-10, TGF-β1) molecules as well as adipose-related markers such as leptin, adiponectin, ghrelin, and resistin were measured by magnetic bead-based multiplex-specific immunoassays and biochemical assays. Results BC characteristics were different in elderly women and men, and more favorable BC markers were associated with a better adipose-related inflammatory profile, with the exception of skeletal muscle mass index. No correlation was found with the body composition markers and circulating levels of some standard pro- and anti-inflammatory markers like IL-6, pentraxin 3, IL-10, TGF-β1, TNF-α, IL-6Rα, glycoprotein 130, TNF-α-R1, and TNF-α-R2. Conclusions The association between BC and inflammatory and adipose-related biomarkers is crucial in decoding aging and pathophysiological processes, such as sarcopenia. DXA can help in understanding how the measurement of fat and muscle is important, making the way from research to clinical practice. Key Points • Body composition markers concordantly associated positively or negatively with adipose-related and inflammatory markers, with the exception of skeletal muscle mass index. • No correlation was found with the body composition markers and circulating levels of some standard pro- and anti-inflammatory markers like IL-6, pentraxin 3, IL-10, TGF-β1, TNF-α, IL-6Rα, gp130, TNF-α-R1, and TNF-α-R2. • Skeletal muscle mass index (SMI) shows a good correlation with inflammatory profile in age-related sarcopenia. Electronic supplementary material The online version of this article (10.1007/s00330-018-5973-2) contains supplementary material, which is available to authorized users.

Published
2019

16. Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Subjects
Humane Voeding & Gezondheid, Toxicology, Toxicologie, Human Nutrition & Health
Abstract

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Published
2019

17. Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women

Author

Sabita S. Soedamah-Muthu, Gita D. Mishra, Danielle A J M Schoenaker, Edith J. M. Feskens, Anouk Geelen, Moniek Looman, and Medical and Clinical Psychology

Subjects
0301 basic medicine, Nutrition and Disease, Endocrinology, Diabetes and Metabolism, Pregnant, NUTRIENTS, Cohort Studies, MELLITUS, 0302 clinical medicine, Endocrinology, Nutrient, Pregnancy, Voeding en Ziekte, Micronutrient, Longitudinal Studies, Micronutrients, Prospective Studies, Gestational diabetes, Human Nutrition & Health, Nutrition and Dietetics, SUPPLEMENTS, Humane Voeding & Gezondheid, PREVALENCE, Quartile, Cohort, Female, PREGNANT-WOMEN, Human, Adult, Risk, 030209 endocrinology & metabolism, Lower risk, 03 medical and health sciences, FOOD, Environmental health, medicine, Humans, VLAG, Global Nutrition, Wereldvoeding, 030109 nutrition & dietetics, IRON INTAKE, VITAMIN-C, business.industry, Australia, medicine.disease, Diet, Diabetes, Gestational, ENERGY-INTAKE, Relative risk, PATTERNS, business, Follow-Up Studies
Abstract

Evidence on pre-pregnancy dietary micronutrient intake in relation to gestational diabetes (GDM) development is limited. Therefore, we examined the prevalence of inadequate micronutrient intake before pregnancy and the association between pre-pregnancy dietary micronutrient adequacy, i.e. meeting micronutrient intake recommendations for a range of micronutrients, and risk of developing GDM in an Australian population. We hypothesized that women with an overall higher micronutrient adequacy would have a lower risk of developing GDM. We used data from the prospective Australian Longitudinal Study on Women's Health cohort, in which 3607 women, aged 25-30 years at baseline in 2003 and without diabetes, were followed-up until 2015. Diet was assessed with a validated 101-item food frequency questionnaire. The Micronutrient Adequacy Ratio (MAR) was calculated as the micronutrient intake divided by its recommended dietary intake averaged over 13 micronutrients. Multivariable regression models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (95% CI). In 6263 pregnancies, 285 cases of GDM were documented (4.6%). High prevalences of inadequate dietary micronutrient intake were observed for calcium (47.9%), folate (80.8%), magnesium (52.5%), potassium (63.8%) and vitamin E (78.6%), indicating suboptimal pre-pregnancy micronutrient intakes. Inadequate intakes of individual micronutrients were not associated with risk of developing GDM. However, women in the highest quartile of the MAR had a 39% lower risk of developing GDM compared to women in the lowest quartile (RR 0.61, 95% CI 0.43-0.86, p for trend 0.01). These results highlight the importance of adequate pre-pregnancy micronutrient intake. (C) 2018 Elsevier Inc. All rights reserved.

Published
2019

18. Metformin Alters Human Host Responses to Mycobacterium tuberculosis in Healthy Subjects

Author

Hazel M. Dockrell, Jacqueline M. Ratter, Mardiana Marzuki, Elise J. Smolders, Mihai G. Netea, Julia Böhme, Rob J.W. Arts, Clare Eckold, Corina N. A. M. van den Heuvel, Jinmiao Chen, Bastiaan A. Blok, Karen Wei Weng Teng, Valerie A. C. M. Koeken, Rinke Stienstra, Amit Singhal, Evan W. Newell, Jacqueline M. Cliff, Reinout van Crevel, Ekta Lachmandas, Lee Kong Chian School of Medicine (LKCMedicine), and Agency for Science, Technology and Research (A∗STAR)

Subjects
0301 basic medicine, Pathogenesis and Host Response, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Pharmacology, Monocytes, Voeding, Metabolisme en Genomica, Interferon, Immunology and Allergy, Myeloid Cells, Human Nutrition & Health, biology, Humane Voeding & Gezondheid, Interleukin, Metabolic Disorders Radboud Institute for Molecular Life Sciences [Radboudumc 6], Healthy Volunteers, Metabolism and Genomics, Metformin, 3. Good health, Up-Regulation, Infectious Diseases, tuberculosis, Metabolisme en Genomica, Host-Pathogen Interactions, Nutrition, Metabolism and Genomics, antimycobacterial mechanisms, medicine.drug, Signal Transduction, 030106 microbiology, Down-Regulation, host-directed therapy, Mycobacterium tuberculosis, 03 medical and health sciences, Major Articles and Brief Reports, Immune system, Downregulation and upregulation, Phagocytosis, Voeding, In vivo, medicine, Humans, Hypoglycemic Agents, Medicine [Science], Cell Proliferation, VLAG, Nutrition, business.industry, biology.organism_classification, gene transcription, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], 030104 developmental biology, Leukocytes, Mononuclear, business, Reactive Oxygen Species, Nanomedicine Radboud Institute for Molecular Life Sciences [Radboudumc 19], Ex vivo
Abstract

Background Metformin, the most widely administered diabetes drug, has been proposed as a candidate adjunctive host-directed therapy for tuberculosis, but little is known about its effects on human host responses to Mycobacterium tuberculosis. Methods We investigated in vitro and in vivo effects of metformin in humans. Results Metformin added to peripheral blood mononuclear cells from healthy volunteers enhanced in vitro cellular metabolism while inhibiting the mammalian target of rapamycin targets p70S6K and 4EBP1, with decreased cytokine production and cellular proliferation and increased phagocytosis activity. Metformin administered to healthy human volunteers led to significant downregulation of genes involved in oxidative phosphorylation, mammalian target of rapamycin signaling, and type I interferon response pathways, particularly following stimulation with M. tuberculosis, and upregulation of genes involved in phagocytosis and reactive oxygen species production was increased. These in vivo effects were accompanied by a metformin-induced shift in myeloid cells from classical to nonclassical monocytes. At a functional level, metformin lowered ex vivo production of tumor necrosis factor α, interferon γ, and interleukin 1β but increased phagocytosis activity and reactive oxygen species production. Conclusion Metformin has a range of potentially beneficial effects on cellular metabolism, immune function, and gene transcription involved in innate host responses to M. tuberculosis., Metformin has shown beneficial effects in a murine model of tuberculosis. Using in-vitro and in-vivo studies we show that metformin has beneficial effects on cellular metabolism, immune function and genetranscription involved in innate host responses to M. tuberculosis in humans.

Published
2019

19. Using enhanced regression calibration to combine dietary intake estimates from 24 h recall and FFQ reduces bias in diet-disease associations

Author

Edith J. M. Feskens, Moniek Looman, Hendriek C. Boshuizen, and Anouk Geelen

Subjects
Adult, Male, Regression calibration, Dietary assessment, Nutrition and Disease, Medicine (miscellaneous), FFQ, Diet Surveys, Young Adult, Measurement error, Bias, Voeding en Ziekte, Statistics, Humans, Statistical analysis, Mathematics, Aged, Netherlands, VLAG, Human Nutrition & Health, 24 h recall, Global Nutrition, Wereldvoeding, Nutrition and Dietetics, VLAG A, Dietary intake, Humane Voeding & Gezondheid, Public Health, Environmental and Occupational Health, Reproducibility of Results, Middle Aged, Random effects model, Regression, Diet Records, Diet, Biometris, Calibration, Chronic Disease, Mental Recall, Reference database, Female, Research Paper
Abstract

Objective:To illustrate the impact of combining 24 h recall (24hR) and FFQ estimates using regression calibration (RC) and enhanced regression calibration (ERC) on diet–disease associations.Setting:Wageningen area, the Netherlands, 2011–2013.Design:Five approaches for obtaining self-reported dietary intake estimates of protein and K were compared: (i) uncorrected FFQ intakes (FFQ); (ii) uncorrected average of two 24hR ( $\overline {\rm R}$ ); (iii) average of FFQ and $\overline {\rm R}$ ( ${\overline {\rm F}}\,\overline {\rm R}}$ ); (iv) RC from regression of 24hR v. FFQ; and (v) ERC by adding individual random effects to the RC approach. Empirical attenuation factors (AF) were derived by regression of urinary biomarker measurements v. the resulting intake estimates.Participants:Data of 236 individuals collected within the National Dietary Assessment Reference Database.Results:Both FFQ and 24hR dietary intake estimates were measured with substantial error. Using statistical techniques to correct for measurement error (i.e. RC and ERC) reduced bias in diet–disease associations as indicated by their AF approaching 1 (RC 1·14, ERC 0·95 for protein; RC 1·28, ERC 1·34 for K). The larger sd and narrower 95% CI of AF obtained with ERC compared with RC indicated that using ERC has more power than using RC. However, the difference in AF between RC and ERC was not statistically significant, indicating no significantly better de-attenuation by using ERC compared with RC. AF larger than 1, observed for the ERC for K, indicated possible overcorrection.Conclusions:Our study highlights the potential of combining FFQ and 24hR data. Using RC and ERC resulted in less biased associations for protein and K.

Published
2019

20. Protein supplementation improves lean body mass in physically active older adults: a randomized placebo controlled trial

Author

Astrid M. H. Horstman, Maria T. E. Hopman, Silvie Timmers, Thijs M. H. Eijsvogels, Coen C. W. G. Bongers, Lisette C. P. G. M. de Groot, and Dominique S M Ten Haaf

Subjects
0301 basic medicine, Male, lcsh:Diseases of the musculoskeletal system, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Placebo-controlled study, Isometric exercise, Body composition, law.invention, Grip strength, 0302 clinical medicine, Elderly, Randomized controlled trial, law, Medicine, Orthopedics and Sports Medicine, Human Nutrition & Health, Aged, 80 and over, Humane Voeding & Gezondheid, lcsh:Human anatomy, Middle Aged, Physical Functional Performance, Nutritional Biology, 030220 oncology & carcinogenesis, Muscle, Original Article, Female, Dietary Proteins, Randomized clinical trial, Muscle Contraction, medicine.medical_specialty, Renal function, Placebo, lcsh:QM1-695, 03 medical and health sciences, Physiology (medical), Internal medicine, Humans, Muscle Strength, Muscle, Skeletal, Exercise, Geriatric Assessment, Aged, VLAG, business.industry, Protein, Metabolic Disorders Radboud Institute for Health Sciences [Radboudumc 6], Cardiorespiratory fitness, Original Articles, Diet, 030104 developmental biology, Endocrinology, Nutrition Assessment, Dietary Supplements, Lean body mass, lcsh:RC925-935, business, Biomarkers
Abstract

Contains fulltext : 203382.pdf (Publisher’s version ) (Open Access) BACKGROUND: An inadequate protein intake may offset the muscle protein synthetic response after physical activity, reducing the possible benefits of an active lifestyle for muscle mass. We examined the effects of 12 weeks of daily protein supplementation on lean body mass, muscle strength, and physical performance in physically active older adults with a low habitual protein intake (

Published
2019

21. Quercetin, but Not Epicatechin, Decreases Plasma Concentrations of Methylglyoxal in Adults in a Randomized, Double-Blind, Placebo-Controlled, Crossover Trial with Pure Flavonoids

Author

Coen D.A. Stehouwer, Johanna M. Geleijnse, Lydia A. Afman, Nordin M J Hanssen, Mathias D G Van den Eynde, James I Dower, Peter C. H. Hollman, Jean L.J.M. Scheijen, Casper G. Schalkwijk, Promovendi CD, Interne Geneeskunde, RS: CARIM - R3.01 - Vascular complications of diabetes and the metabolic syndrome, MUMC+: MA Alg Onderzoek Interne Geneeskunde (9), MUMC+: MA Med Staf Artsass Interne Geneeskunde (9), MUMC+: HVC Pieken Maastricht Studie (9), and MUMC+: MA Interne Geneeskunde (3)

Subjects
Male, 0301 basic medicine, Nutrition and Disease, Medicine (miscellaneous), Catechin, SERUM-ALBUMIN, quercetin, Voeding, Metabolisme en Genomica, chemistry.chemical_compound, Lactoylglutathione lyase, ANTIGLYCATION ACTIVITY, 0302 clinical medicine, (pre)hypertension, Glycation, Voeding en Ziekte, methylglyoxal, intervention, Human Nutrition & Health, Epicatechin, STRUCTURAL REQUIREMENTS, Cross-Over Studies, Nutrition and Dietetics, biology, Humane Voeding & Gezondheid, Methylglyoxal, Advanced glycation endproducts, clinical trial, Middle Aged, Pyruvaldehyde, Metabolism and Genomics, Clinical trial, CARDIOVASCULAR-DISEASE, Metabolisme en Genomica, Female, Nutrition, Metabolism and Genomics, Quercetin, GLYCATION END-PRODUCTS, advanced glycation endproducts, Adult, medicine.medical_specialty, Serum albumin, 030209 endocrinology & metabolism, Intervention, DARK CHOCOLATE, DIETARY POLYPHENOLS, Placebo, glyoxalase 1, 03 medical and health sciences, Double-Blind Method, Voeding, Internal medicine, Diabetes mellitus, medicine, Humans, Aged, Nutrition, VLAG, Flavonoids, epicatechin, medicine.disease, Crossover study, 030104 developmental biology, Endocrinology, chemistry, Glyoxalase 1, flavonoids, ENDOTHELIAL DYSFUNCTION, biology.protein, VASCULAR FUNCTION, TRAPPING METHYLGLYOXAL
Abstract

Background: Methylglyoxal (MGO) is the most potent precursor of advanced glycation end products (AGEs). MGO and AGEs have been associated with diabetes, its complications, and other age-related diseases. Experimental studies have shown that the flavonoids quercetin and epicatechin are able to scavenge MGO and lower AGE formation.Objective: Data on the effects of these flavonoids on MGO and AGE concentrations in humans are not yet available. We therefore investigated the effect of quercetin and epicatechin on the concentrations of MGO and AGEs in a post hoc analysis.Methods: Thirty-seven apparently healthy, nonsmoking adults with a systolic blood pressure between 125 and 160 mm Hg at screening were included in a randomized, double-blind, placebo-controlled crossover trial. Participants ingested (-)-epicatechin (100 mg/d), quercetin 3-glucoside (160 mg/d), or placebo capsules for periods of 4 wk separated by 4-wk washout periods. Fasting blood samples were collected at the start and end of each intervention period. Liquid chromatography-tandem mass spectrometry was used to determine plasma concentrations of the dicarbonyl compounds MGO, glyoxal (GO), and 3-deoxyglucosone (3-DG) and free and protein-bound AGEs. Gene expression of glyoxalase 1 (GLO1), the enzyme involved in the degradation of MGO, was determined by either microarray or quantitative reverse transcriptase-polymerase chain reaction.Results: The treatment effect (Delta treatment - Delta placebo) of quercetin on MGO was -40.2 nmol/L (95% CI: -73.6, -6.8 nmol/L; P = 0.019), a decrease of 11% from baseline values, whereas GO, 3-DG, and free and protein-bound AGEs did not change significantly. Epicatechin did not affect the concentrations of dicarbonyls and free and protein-bound AGEs. We did not find a significant change in expression of GLO1.Conclusions: In apparently healthy (pre)hypertensive men and women, quercetin but not epicatechin decreased plasma MGO concentrations. Quercetin may potentially form a new treatment strategy for diseases in which MGO plays a pivotal role.

Published
2018

22. Vitamin B-6 intake is related to physical performance in European older adults: results of the New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe (NU-AGE) study

Author

Claudio Franceschi, Agnes A M Berendsen, Stephan J. L. Bakker, Edith J. M. Feskens, Aurelia Santoro, Corinne Malpuech-Brugère, Lisette C. P. G. M. de Groot, Agata Bialecka-Debek, Ido P. Kema, Nathalie Meunier, Marco Mensink, Susan J. Fairweather-Tait, Amy Jennings, Katarzyna Rolf, Pol Grootswagers, Carolien P J Deen, Guided Treatment in Optimal Selected Cancer Patients (GUTS), Groningen Institute for Organ Transplantation (GIOT), Groningen Kidney Center (GKC), Wageningen University and Research [Wageningen] (WUR), University of Groningen [Groningen], University of Bologna/Università di Bologna, Lobachevsky State University of Nizhny Novgorod, Lobachevsky State University [Nizhni Novgorod], Centre de Recherche en Nutrition Humaine Auvergne [CHU Clermont-Ferrand] (CRNH A), Direction de la recherche clinique et de l’innovation [CHU Clermont-Ferrand] (DRCI), CHU Clermont-Ferrand-CHU Clermont-Ferrand, Unité de Nutrition Humaine (UNH), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Université Clermont Auvergne (UCA), Centre de Recherche en Nutrition Humaine - Ile de France (CRNH - IDF), Warsaw University of Life Sciences (SGGW), University of East Anglia [Norwich] (UEA), University of Bologna, University of Nizhny Novgorod, Grootswagers, Pol, Mensink, Marco, Berendsen, Agnes A M, Deen, Carolien P J, Kema, Ido P, Bakker, Stephan J L, Santoro, Aurelia, Franceschi, Claudio, Meunier, Nathalie, Malpuech-Brugère, Corinne, Bialecka-Debek, Agata, Rolf, Katarzyna, Fairweather-Tait, Susan, Jennings, Amy, Feskens, Edith J M, and de Groot, Lisette C P G M

Subjects
Male, Aging, Homocysteine, Nutrition and Disease, muscle, Medicine (miscellaneous), Physiology, niacin, AcademicSubjects/MED00160, Healthy Aging, chemistry.chemical_compound, 0302 clinical medicine, Voeding en Ziekte, Medicine, 030212 general & internal medicine, Human Nutrition & Health, 0303 health sciences, education.field_of_study, Nutrition and Dietetics, Hand Strength, Humane Voeding & Gezondheid, Physical Functional Performance, Nutritional Biology, Europe, Original Research Communications, vitamin B-6, Quartile, Female, Niacin, Vitamin, Population, Nutritional Status, folate, 03 medical and health sciences, AcademicSubjects/MED00060, physical function, Humans, Vitamin B12, education, Exercise, 030304 developmental biology, Aged, VLAG, vitamin B-12, Global Nutrition, Wereldvoeding, business.industry, homocysteine, Physical activity level, Vitamin B 6, Diet, B vitamins, chemistry, Dietary Supplements, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition
Abstract

International audience; ABSTRACT Background Maintenance of high physical performance during aging might be supported by an adequate dietary intake of niacin, vitamins B-6 and B-12, and folate because these B vitamins are involved in multiple processes related to muscle functioning. However, not much is known about the association between dietary intake of these B vitamins and physical performance. Objectives The objectives of this study were to investigate the association between dietary intake of niacin, vitamins B-6 and B-12, and folate and physical performance in older adults and to explore mediation by niacin status and homocysteine concentrations. Methods We used baseline data from the New Dietary Strategies Addressing the Specific Needs of the Elderly Population for Healthy Aging in Europe (NU-AGE) trial, which included n = 1249 healthy older adults (aged 65–79 y) with complete data on dietary intake measured with 7-d food records and questionnaires on vitamin supplement use and physical performance measured with the short physical performance battery and handgrip dynamometry. Associations were assessed by adjusted linear mixed models. Results Intake of vitamin B-6 was related to lower chair rise test time [β: –0.033 ± 0.016 s (log); P = 0.043]. Vitamin B-6 intake was also significantly associated with handgrip strength, but for this association, a significant interaction effect between vitamin B-6 intake and physical activity level was found. In participants with the lowest level of physical activity, higher intake of vitamin B-6 tended to be associated with greater handgrip strength (β: 1.5 ± 0.8 kg; P = 0.051), whereas in participants in the highest quartile of physical activity, higher intake was associated with lower handgrip strength (β: –1.4 ± 0.7 kg; P = 0.041). No evidence was found for an association between intake of niacin, vitamin B-12, or folate and physical performance or for mediation by niacin status or homocysteine concentrations. Conclusions Vitamin B-6 intake was associated with better chair rise test time in a population of European healthy older adults and also with greater handgrip strength in participants with low physical activity only. Homocysteine concentrations did not mediate these associations. The NU-AGE trial was registered at clinicaltrials.gov as NCT01754012.

Published
2021

23. Assessing factors influencing adolescents' dietary behaviours in urban Ethiopia using participatory photography

Author

Michelle Holdsworth, Kaleab Baye, Edith J. M. Feskens, Ursula Trübswasser, Megan Loeffen, and Elise F. Talsma

Subjects
Adult, Male, Adolescent, media_common.quotation_subject, Medicine (miscellaneous), Dietary behaviour, Themed Section: Maternal and child nutrition in sub-Saharan Africa, Adolescents, Young Adult, Hygiene, RA0421, Environmental health, Food choice, Photography, Photovoice, Humans, Neighbourhood (mathematics), media_common, VLAG, Human Nutrition & Health, Global Nutrition, Wereldvoeding, Nutrition and Dietetics, business.industry, Humane Voeding & Gezondheid, digestive, oral, and skin physiology, Public Health, Environmental and Occupational Health, Feeding Behavior, Food safety, Focus group, Preference, Diet, Food environment, Africa, Fast Foods, Female, Ethiopia, Thematic analysis, Psychology, business, RA, Research Paper
Abstract

Objective:To assess factors influencing dietary behaviours of adolescents in Addis Ababa, Ethiopia.Design:Using the qualitative participatory method Photovoice, participants received training on the basics of Photovoice and took photographs related to (un)healthy eating in their environment. Transcripts of individual interviews, focus group discussions and photographs were coded for thematic analysis.Setting:One private and one public school located in the same, central neighbourhood in Addis Ababa, Ethiopia to explore how school populations of different socio-economic status experience the same neighbourhood environment.Participants:Twenty-six adolescents aged 14–19 years old, of which there were seventeen girls and nine boys.Results:Findings from the current study indicate that food safety concerns appear to be the major influencing factors for adolescents’ dietary choices. Unhealthy and unsafe foods appear to be widely available and/or affordable in adolescents’ neighbourhoods and almost half of the photographs taken by adolescents depicted poor hygiene conditions related to food vendors. Participants considered foods available in their environments as generally unsafe, calling for more packaged food.Conclusions:Concerns for food safety, hygiene and affordability are the dominating factors for adolescents’ food choices. These concerns, together with limited nutrition knowledge and preference for packaged foods, could make cheap, ultra-processed packaged foods more desirable.

Published
2021

24. The Effect of Protein Supplementation versus Carbohydrate Supplementation on Muscle Damage Markers and Soreness Following a 15-km Road Race: A Double-Blind Randomized Controlled Trial

Author

Monique A H Steegers, Lisette C. P. G. M. de Groot, Hans Timmerman, Astrid M. H. Horstman, Dominique S M Ten Haaf, Maria T. E. Hopman, Martin Flipsen, and Thijs M. H. Eijsvogels

Subjects
Male, 0301 basic medicine, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], Running, law.invention, chemistry.chemical_compound, 0302 clinical medicine, Randomized controlled trial, law, Medicine, Creatine Kinase, Human Nutrition & Health, Nutrition and Dietetics, biology, Humane Voeding & Gezondheid, Muscle recovery, Nutritional Biology, Endurance exercise, Intention to Treat Analysis, Female, Dietary Proteins, lcsh:Nutrition. Foods and food supply, Adult, Pain Threshold, medicine.medical_specialty, lcsh:TX341-641, Placebo, Article, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Double-Blind Method, Endurance training, Internal medicine, Lactate dehydrogenase, Threshold of pain, Dietary Carbohydrates, Humans, Brief Pain Inventory, VLAG, 030109 nutrition & dietetics, L-Lactate Dehydrogenase, business.industry, Metabolic Disorders Radboud Institute for Health Sciences [Radboudumc 6], Myalgia, 030229 sport sciences, Carbohydrate supplementation, Endocrinology, chemistry, Dietary Supplements, biology.protein, Milk protein, Creatine kinase, business, Delayed onset of muscle soreness, Biomarkers, Food Science
Abstract

We assessed whether a protein supplementation protocol could attenuate running-induced muscle soreness and other muscle damage markers compared to iso-caloric placebo supplementation. A double-blind randomized controlled trial was performed among 323 recreational runners (age 44 ± 11 years, 56% men) participating in a 15-km road race. Participants received milk protein or carbohydrate supplementation, for three consecutive days post-race. Habitual protein intake was assessed using 24 h recalls. Race characteristics were determined and muscle soreness was assessed with the Brief Pain Inventory at baseline and 1–3 days post-race. In a subgroup (n = 149) muscle soreness was measured with a strain gauge algometer and creatine kinase (CK) and lactate dehydrogenase (LDH) concentrations were measured. At baseline, no group-differences were observed for habitual protein intake (protein group: 79.9 ± 26.5 g/d versus placebo group: 82.0 ± 26.8 g/d, p = 0.49) and muscle soreness (protein: 0.45 ± 1.08 versus placebo: 0.44 ± 1.14, p = 0.96). Subjects completed the race with a running speed of 12 ± 2 km/h. With the Intention-to-Treat analysis no between-group differences were observed in reported muscle soreness. With the per-protocol analysis, however, the protein group reported higher muscle soreness 24 h post-race compared to the placebo group (2.96 ± 2.27 versus 2.46 ± 2.38, p = 0.039) and a lower pressure muscle pain threshold in the protein group compared to the placebo group (71.8 ± 30.0 N versus 83.9 ± 27.9 N, p = 0.019). No differences were found in concentrations of CK and LDH post-race between groups. Post-exercise protein supplementation is not more preferable than carbohydrate supplementation to reduce muscle soreness or other damage markers in recreational athletes with mostly a sufficient baseline protein intake running a 15-km road race.

Published
2021

25. Exposure to aflatoxins and fumonisins and linear growth of children in rural Ethiopia : A longitudinal study

Author

Anastasia Karakitsou, Tefera Belachew, Masresha Tessema, Arnau Vidal Corominas, Barbara J. Stoecker, Marthe De Boevre, Nilupa S. Gunaratna, Edith J. M. Feskens, Hugo De Groote, and Inge D. Brouwer

Subjects
Aflatoxin, Longitudinal study, Veterinary medicine, CHILDHOOD, Medicine (miscellaneous), chemistry.chemical_compound, 0302 clinical medicine, Aflatoxins, Serum biomarkers, Fumonisin, Medicine and Health Sciences, BENIN, Longitudinal Studies, 030212 general & internal medicine, Intervention trial, IMPAIRED GROWTH, Child, Sensory Science and Eating Behaviour, Human Nutrition & Health, Linear growth, FOODS, Nutrition and Dietetics, Humane Voeding & Gezondheid, food and beverages, 04 agricultural and veterinary sciences, 040401 food science, HEALTH, Research Paper, TOXICOLOGY, BIOMARKERS, Food Contamination, Themed Section: Maternal and child nutrition in sub-Saharan Africa, Biology, Fumonisins, Linear Growth Failure, 03 medical and health sciences, 0404 agricultural biotechnology, Humans, Protein status, VLAG, Global Nutrition, Inflammation, Wereldvoeding, CONSEQUENCES, MYCOTOXINS, Public Health, Environmental and Occupational Health, Rural ethiopia, Sensoriek en eetgedrag, chemistry, Ethiopia, MAIZE
Abstract

Objective:We hypothesise that exposure to aflatoxins and fumonisins, measured in serum, alters protein synthesis, reducing serum protein and insulin-like growth factor 1 (IGF-1), increasing inflammation and infection, leading to child’s linear growth failure.Design:Children 6–35 months, stratified by baseline stunting, were subsampled from an intervention trial on quality protein maize consumption and evaluated at two time-points.Setting:Blood samples and anthropometric data were collected in the pre-harvest (August–September 2015) and post-harvest (February 2016) seasons in rural Ethiopia.Participants:102 children (50 stunted and 52 non-stunted).Results:Proportions of children exposed to aflatoxin G1, aflatoxin G2 and aflatoxin M1 were higher in the pre-harvest (8, 33 and 7, respectively) compared to post-harvest season (4, 28 and 4, respectively). The proportion of children exposed to any aflatoxin was higher in the pre-harvest than post-harvest season (51 % v. 41 %). Fumonisin exposure ranged from 0 % to 11 %. In joint statistical tests, aflatoxin exposure was associated with serum biomarkers of inflammation (C-reactive protein, α-1-glycoprotein) and protein status (transthyretin, lysine, tryptophan), IGF-1 and linear growth (all P < 0·01). However, exposure to specific aflatoxins was not significantly associated with any biomarkers or outcomes (all P > 0·05).Conclusions:Aflatoxin exposure among rural Ethiopian children was high, with large variation between seasons and individual aflatoxins. Fumonisin exposure was low. There was no clear association between aflatoxin exposure and protein status, inflammation or linear growth. A larger study may be needed to examine the potential biological interactions, and the assessment of aflatoxins in food is needed to determine sources of high exposure.

Published
2021

26. Imaging all the people : Associations of computed tomography-based body composition with mortality and fatigue in stage I-III colorectal cancer patients

Author

Harm van Baar, Wageningen University, E. Kampman, R.M. Winkels, S. Beijer, and M.J.L. Bours

Subjects
medicine.medical_specialty, medicine.diagnostic_test, Nutrition and Disease, Colorectal cancer, business.industry, Humane Voeding & Gezondheid, Computed tomography, medicine.disease, Voeding en Ziekte, medicine, Life Science, Radiology, business, VLAG, Human Nutrition & Health
Abstract

Colorectal cancer (CRC) is the third most common cancer worldwide. Mainly due to the implementation of screening practices and improved treatment, survival rates for stage I-III CRC patients have increased for several decades. Identifying modifiable factors associated with better prognosis could contribute to further improvement of cancer outcomes such as better survival, good quality of life (QoL) and less recurrence in patients with stage I-III CRC. One potential modifiable factor might be body composition.Over the last decade, the relationship between skeletal muscle mass index (SMI, skeletal muscle cross-sectional surface area divided by height squared in meters), skeletal muscle radiodensity (SMR, which reflects the lipid content of the muscle cells), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) at time of diagnosis, and outcomes including mortality, complications after surgery, length of hospital stay, QoL and fatigue has received much attention. At the start of this PhD project, no studies had reported on these associations in exclusively stage I-III CRC patients.Furthermore, an association between higher adherence to the World Cancer Research Fund / American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and less fatigue had been observed among stage I-III CRC patients who had been diagnosed with CRC more than 5 years ago. If better adherence to the recommendations is also associated with less fatigue experienced during or shortly after treatment, was still unknown. Additionally, the potential mediating role of inflammation in this association needed to be confirmed.The overall objectives of this thesis were 1) to increase knowledge about the association of body composition in stage I-III CRC patients with both mortality and fatigue by using CT images to quantify skeletal muscle mass, skeletal muscle radiodensity and adipose tissue, and 2) to increase knowledge about the association of adherence to the WCRF/AICR lifestyle recommendations with fatigue among stage I-III CRC and to elucidate the underlying mechanism.Body composition and mortalityIn Chapter 2 the association between low SMR and mortality was investigated among 1,681stage I-III CRC patients. The average age of the study population was 67.7 ± 10.3 years, 41% were women and 414 patients (25%) died. Thirty-nine percent of the patients had low SMR. Low SMR was significantly associated with higher overall mortality (low vs. normal: adjusted HR 1.91, 95% CI 1.53–2.38).The association of SMI, VAT and SAT with mortality among 2,016 men and among women with stage I-III CRC was investigated in Chapter 3, using restricted cubic splines analyses. The average age of the patients was 67.9 ± 10.6 years, 42% were women and 558 (28%) patients died. Among men, the association of SMI and mortality was statistically significant in a non-linear way, with lower SMI levels associated with higher mortality, but there was no association among women. SAT was non-linearly associated with mortality for both men and women, with lower SAT levels being associated with higher mortality. VAT was not significantly associated with mortality.Body composition and fatigueIn Chapter 4 we studied how SMR, SMI, VAT and SAT at diagnosis are associated with fatigue at diagnosis, at 6 and 24 months post-diagnosis in 646 stage I-III CRC patients. The association of SMI, SMR, VAT, and SAT with fatigue (yes/no) was assessed using confounder-adjusted restricted cubic spline analyses. At diagnosis, a significant non-linear association of higher levels of SAT with higher prevalence of fatigue was observed. Lower SMR was linearly associated with higher prevalence of fatigue at 6 months post-diagnosis. None of the body composition parameters were significantly associated with fatigue at 24 months.Adherence to the WCRF/AICR lifestyle recommendations and fatigueWe examined the association between adherence to the WCRF/AICR lifestyle recommendations and fatigue among 1,417 stage I-III CRC patients in Chapter 5. Within a subpopulation we investigated whether inflammation mediated this association. Adherence to the WCRF/AICR recommendations was assessed shortly after diagnosis. Six months post-diagnosis fatigue and plasma levels of inflammation markers (IL6, IL8, TNFα, and hsCRP) in non-fasting blood samples were assessed.A higher WCRF/AICR adherence score at diagnosis was associated with less fatigue six months after diagnosis. A statistically significant indirect association via inflammation was explaining 45% of the total association between lifestyle and fatigue. Thus, inflammation is probably one of the underlying mechanisms linking lifestyle to fatigue.General conclusion and recommendationsThe results presented in this thesis show that low SMR, low SAT and, among men, low SMI are associated with higher mortality risk among stage I-III CRC patients. SMI in women and VAT in men and women were not statistically significantly associated with mortality risk. Low SMR was associated with more fatigue at six months post-diagnosis and high levels of SAT were associated with more fatigue at diagnosis. Furthermore, a higher WCRF/AICR adherence score at diagnosis was associated with less fatigue six months after diagnosis among stage I-III CRC patients. This association was observed to be partly mediated by inflammation. The next step will be investigating the effect of improving pre-treatment body composition in a controlled setting (i.e. prehabilitation) on fatigue, QoL and surgical outcomes; and investigating the effect of improving body composition by healthy lifestyle changes on fatigue and other QoL components after treatment.

Published
2021

27. Associations of Height With the Risks of Colorectal and Endometrial Cancer in Persons With Lynch Syndrome

Author

Polly A. Newcomb, Ellen Kampman, John L. Hopper, Tanya M. Bisseling, Noralane M. Lindor, Fränzel J.B. Van Duijnhoven, Aung Ko Win, Jan J. Koornstra, Hans F. A. Vasen, Jesca G. M. Brouwer, Jane C. Figueiredo, and Mark A. Jenkins

Subjects
Male, Oncology, Nutrition and Disease, Epidemiology, Colorectal cancer, DNA Mismatch Repair, 0302 clinical medicine, Risk Factors, Voeding en Ziekte, Tumours of the digestive tract Radboud Institute for Molecular Life Sciences [Radboudumc 14], Human Nutrition & Health, 0303 health sciences, Hazard ratio, Humane Voeding & Gezondheid, Age Factors, Original Contribution, Middle Aged, Lynch syndrome, mismatch repair, hereditary cancer, 030220 oncology & carcinogenesis, endometrial cancer, body height, Female, weighted cohort, Colorectal Neoplasms, Cohort study, Adult, medicine.medical_specialty, colorectal cancer, 03 medical and health sciences, Sex Factors, All institutes and research themes of the Radboud University Medical Center, Internal medicine, Cox proportional hazards regression, medicine, Humans, AcademicSubjects/MED00860, Proportional Hazards Models, 030304 developmental biology, VLAG, business.industry, Endometrial cancer, medicine.disease, Colorectal Neoplasms, Hereditary Nonpolyposis, Confidence interval, Endometrial Neoplasms, Cancer risk, business
Abstract

People with Lynch syndrome (LS), who carry a pathogenic mutation in a DNA mismatch repair gene, have increased risks of colorectal cancer (CRC) and endometrial cancer (EC). A high reported variability in cancer risk suggests the existence of factors that modify cancer risk for persons with LS. We aimed to investigate the associations between height and CRC and EC risk for persons with LS using data from 2 large studies. Information on 1,115 men and 1,553 women with LS from the Colon Cancer Family Registry (1998–2007) and the GEOLynch Cohort Study (2006–2017) was harmonized. We used weighted Cox proportional hazards regression models with age on the time axis to estimate adjusted hazard ratios and 95% confidence intervals for each 5-cm increment in self-reported height. CRC was diagnosed in 947 persons during 65,369 person-years of observation, and 171 women were diagnosed with EC during 39,227 person-years. Height was not associated with CRC for either men (per 5-cm increment, hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.91, 1.11) or women (per 5-cm increment, HR = 1.01, 95% CI: 0.92, 1.11), nor was height associated with EC (per 5-cm increment, HR = 1.08, 95% CI: 0.94, 1.24). Hence, we observed no evidence for an association of height with either CRC or EC among persons with LS.

Published
2021

28. Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

Author

Maryam Sharafkhah, Emanuel Zitt, Majid Ezzati, Luxia Zhang, Young-Ho Khang, Ellina Rakhimova, Kairit Mikkel, Tiina Vlasoff, Eruke E. Egbagbe, Sidsel Graff-Iversen, Ilona Nenko, Magdalena Klimek, Mathilde Savy, Sanjib Kumar Sharma, Alfonso Siani, Luís Lopes, Vanina Bongard, Gregor Jurak, Jacqueline F. Price, Christina-Paulina Lambrinou, Maria Lc Iurilli, Rainford J. Wilks, Bontha V. Babu, Fereidoun Azizi, Harunobu Nakamura, Marialaura Bonaccio, Angela Döring, Zhenyu Zhang, Naser Ahmadi, Jolanta Słowikowska-Hilczer, Ana Paula Carlos Cândido, Clive Osmond, Thirunavukkarasu Sathish, Robert J. Adams, Themistoklis Tzotzas, Reina Engle-Stone, Atul Trivedi, Shoichiro Tsugane, Niels Møller, Jorge Bezerra, Dénes Molnár, Muhammad Fadhli Mohd Yusoff, Badreya Al-Lahou, J. Jaime Miranda, Bahram Mohajer, Sigmund A. Anderssen, Lital Keinan Boker, Eero Kajantie, Martin Gulliford, Maties Torrent, Sumit Bharadwaj, Toshiharu Ninomiya, Zbigniew Gaciong, Nayu Ikeda, Li Juan Wu, Adrian Richter, Licia Iacoviello, Marc J. Gunter, Wenbin Wei, Norsyamlina Che Abdul Rahim, Eman Aly, Ambady Ramachandran, Nils Lehmann, Soile E. Puhakka, Giovanni Veronesi, Hongsheng Bi, Eiji Oda, Jia Li Duan, Per Tynelius, José María Huerta, Janne Schurmann Tolstrup, Rodrigo M. Carrillo-Larco, Rosangela Fernandes Lucena Batista, Victoria E Soto-Rojas, Hanno Ulmer, Shukri F. Mohamed, Anthony Kafatos, Suyeon Park, Mohsen Ibrahim, Hamed Pouraram, Bin Zhou, May Soe Aung, Lars Bo Andersen, Erfan Ghasemi, René Charles Sylva, Himanshu K. Chaturvedi, Luc Dauchet, Ahmad Ali Zainuddin, Angela Chetrit, Dan Zhu, Valérie Deschamps, Ko Ko Zaw, Peter Vollenweider, Tomas Vega, Yves Martin-Prével, Mahfuzar Rahman, Dorja Vočanec, Roman Topor-Madry, Vinay Nangia, Herculina S. Kruger, Asher Fawwad, Emily Sonestedt, Elena Pahomova, Aleksander Giwercman, Elżbieta Dziankowska-Zaborszczyk, Cecilia Björkelund, Tatjana Hejgaard, Maria Puiu, Maria Benedetta Donati, Andrew Wong, Carlos P. Boissonnet, Santosh K. Bhargava, Patrick Kolsteren, Dermot O'Reilly, Bahareh Kheiri, Wolfgang Kratzer, Susanne R. de Rooij, H. Bas Bueno-de-Mesquita, Günther Fink, José R. Banegas, Michele Monroy-Valle, Drude Molbo, Mahmudur Rahman, Hynek Pikhart, Rafael N. Pichardo, Massimo Salvetti, Hui Cai, Sarah Filippi, Georg Posch, Hung-Kwan So, Yonghua Hu, Katsuyasu Kouda, Joana Carvalho, Gailute Bernotiene, Hannu Uusitalo, Thein Thein Htay, Felix Kaducu, Maigeng Zhou, Lars Ängquist, Thi Tuyet-Hanh Tran, Charles Lunogelo, Michel Joffres, Sabina Zambon, Ronald D. 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Magliano, Jitendra Jonnagaddala, Konstantinos Gkiouras, Paola Nardone, Alberto Barceló, Tomi-Pekka Tuomainen, Francesco Gianfagna, Stefania Maggi, Mohammad Hossein Somi, Behrooz Hamzeh, Miquel Porta, Vesna Jureša, Alexander D. Deev, David Faeh, Antonio Bernabe-Ortiz, Sirkka Keinänen-Kiukaanniemi, Ian Hambleton, Stefan Savin, Andre Pascal Kengne, R. Krishna Kumar, Kurt Widhalm, Marco M Ferrario, Parisa Amiri, Anjani Kumar Jha, Thamara Hubler Figueiró, Jana Kratenova, Claudia M. Hormiga, Maria Tsigga, Zivka Dika, Indrapal I. Meshram, Ei Ei K. Nang, Ian Rouse, Rusidah Selamat, Paul Korrovits, Grethe S. Tell, Julie Taylor, Anabela Mota-Pinto, Paolo Vineis, Kotsedi D Monyeki, Khuong Quynh Long, Frank J Rühli, Shelly R. McFarlane, Sara Santos Sanz, Edyta Łuszczki, Maria G. Stathopoulou, Tara Coppinger, Karin De Ridder, Lucie Viet, Anna Bugge, Mehdi Yaseri, Safiah Md Yusof, Sandra C. 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Liu , J Jaime Miranda , Olfa Saidi , Sylvain Sebert , Maroje Sorić , Gregor Starc , Edward W Gregg , Leandra Abarca-Gómez , Ziad A Abdeen , Shynar Abdrakhmanova , Suhaila Abdul Ghaffar , Hanan F Abdul Rahim , Niveen M Abu-Rmeileh , Jamila Abubakar Garba , Benjamin Acosta-Cazares , Robert J Adams , Wichai Aekplakorn , Kaosar Afsana , Shoaib Afzal , Imelda A Agdeppa , Javad Aghazadeh-Attari , Carlos A Aguilar-Salinas , Charles Agyemang , Mohamad Hasnan Ahmad , Noor Ani Ahmad , Ali Ahmadi , Naser Ahmadi , Soheir H Ahmed , Wolfgang Ahrens , Gulmira Aitmurzaeva , Kamel Ajlouni , Hazzaa M Al-Hazzaa , Badreya Al-Lahou , Rajaa Al-Raddadi , Monira Alarouj , Fadia AlBuhairan , Shahla AlDhukair , Mohamed M Ali , Abdullah Alkandari , Ala'a Alkerwi , Kristine Allin , Mar Alvarez-Pedrerol , Eman Aly , Deepak N Amarapurkar , Parisa Amiri , Norbert Amougou , Philippe Amouyel , Lars Bo Andersen , Sigmund A Anderssen , Lars Ängquist , Ranjit Mohan Anjana , Alireza Ansari-Moghaddam , Hajer Aounallah-Skhiri , Joana Araújo , Inger Ariansen , Tahir Aris , Raphael E Arku , Nimmathota Arlappa , Krishna K Aryal , Thor Aspelund , Felix K Assah , Maria Cecília F Assunção , May Soe Aung , Juha Auvinen , Mária Avdicová , Shina Avi , Ana Azevedo , Mohsen Azimi-Nezhad , Fereidoun Azizi , Mehrdad Azmin , Bontha V Babu , Maja Bæksgaard Jørgensen , Azli Baharudin , Suhad Bahijri , Jennifer L Baker , Nagalla Balakrishna , Mohamed Bamoshmoosh , Maciej Banach , Piotr Bandosz , José R Banegas , Joanna Baran , Barbagallo CM, Alberto Barceló , Amina Barkat , Aluisio Jd Barros , Mauro Virgílio Gomes Barros , Abdul Basit , Joao Luiz D Bastos , Iqbal Bata , Anwar M Batieha , Rosangela L Batista , Zhamilya Battakova , Assembekov Batyrbek , Louise A Baur , Robert Beaglehole , Silvia Bel-Serrat , Antonisamy Belavendra , Habiba Ben Romdhane , Judith Benedics , Mikhail Benet , Ingunn Holden Bergh , Salim Berkinbayev , Antonio Bernabe-Ortiz , Gailute Bernotiene , Heloísa Bettiol , Jorge Bezerra , Aroor Bhagyalaxmi , Sumit Bharadwaj , Santosh K Bhargava , Zulfiqar A Bhutta , Hongsheng Bi , Yufang Bi , Daniel Bia , Elysée Claude Bika Lele, Mukharram M Bikbov , Bihungum Bista , Dusko J Bjelica , Peter Bjerregaard , Espen Bjertness , Marius B Bjertness , Cecilia Björkelund , Katia V Bloch , Anneke Blokstra , Simona Bo , Martin Bobak , Lynne M Boddy , Bernhard O Boehm , Heiner Boeing , Jose G Boggia , Elena Bogova , Carlos P Boissonnet , Stig E Bojesen , Marialaura Bonaccio , Vanina Bongard , Alice Bonilla-Vargas , Matthias Bopp , Herman Borghs , Lien Braeckevelt , Lutgart Braeckman , Marjolijn Ce Bragt , Imperia Brajkovich , Francesco Branca , Juergen Breckenkamp , João Breda , Hermann Brenner , Lizzy M Brewster , Garry R Brian , Lacramioara Brinduse , Sinead Brophy , Graziella Bruno , H Bas Bueno-de-Mesquita , Anna Bugge , Marta Buoncristiano , Genc Burazeri , Con Burns , Antonio Cabrera de León , Joseph Cacciottolo , Hui Cai , Tilema Cama , Christine Cameron , José Camolas , 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Cottel , Chris Cowell , Cora L Craig , Amelia C Crampin , Ana B Crujeiras , Semánová Csilla , Alexandra M Cucu , Liufu Cui , Felipe V Cureau , Ewelina Czenczek-Lewandowska , Graziella D'Arrigo , Eleonora d'Orsi , Liliana Dacica , María Ángeles Dal Re Saavedra , Jean Dallongeville , Camilla T Damsgaard , Rachel Dankner , Thomas M Dantoft , Parasmani Dasgupta , Saeed Dastgiri , Luc Dauchet , Kairat Davletov , Guy De Backer , Dirk De Bacquer , Giovanni de Gaetano , Stefaan De Henauw , Paula Duarte de Oliveira , David De Ridder , Karin De Ridder , Susanne R de Rooij , Delphine De Smedt , Mohan Deepa , Alexander D Deev , Vincent Jr DeGennaro , Abbas Dehghan , Hélène Delisle , Francis Delpeuch , Stefaan Demarest , Elaine Dennison , Katarzyna Dereń , Valérie Deschamps , Meghnath Dhimal , Augusto F Di Castelnuovo , Juvenal Soares Dias-da-Costa , María Elena Díaz-Sánchez , Alejandro Diaz , Zivka Dika , Shirin Djalalinia , Visnja Djordjic , Ha Tp Do , Annette J Dobson , Maria Benedetta Donati , 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, Daniel Fernández-Bergés , Daniel Ferrante , Thomas Ferrao , Marika Ferrari , Marco M Ferrario , Catterina Ferreccio , Eldridge Ferrer , Jean Ferrieres , Thamara Hubler Figueiró , Anna Fijalkowska , Günther Fink , Krista Fischer , Leng Huat Foo , Maria Forsner , Heba M Fouad , Damian K Francis , Maria do Carmo Franco , Ruth Frikke-Schmidt , Guillermo Frontera , Flavio D Fuchs , Sandra C Fuchs , Isti I Fujiati , Yuki Fujita , Matsuda Fumihiko , Takuro Furusawa , Zbigniew Gaciong , Mihai Gafencu , Andrzej Galbarczyk , Henrike Galenkamp , Daniela Galeone , Myriam Galfo , Fabio Galvano , Jingli Gao , Manoli Garcia-de-la-Hera , Marta García-Solano , Dickman Gareta , Sarah P Garnett , Jean-Michel Gaspoz , Magda Gasull , Adroaldo Cesar Araujo Gaya , Anelise Reis Gaya , Andrea Gazzinelli , Ulrike Gehring , Harald Geiger , Johanna M Geleijnse , Ali Ghanbari , Erfan Ghasemi , Oana-Florentina Gheorghe-Fronea , Simona Giampaoli , Francesco Gianfagna , Tiffany K Gill , Jonathan Giovannelli , Glen 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, Zhanna Kalmatayeva , Ofra Kalter-Leibovici , Yves Kameli , Freja B Kampmann , Kodanda R Kanala , Srinivasan Kannan , Efthymios Kapantais , Argyro Karakosta , Line L Kårhus , Khem B Karki , Marzieh Katibeh , Joanne Katz , Peter T Katzmarzyk , Jussi Kauhanen , Prabhdeep Kaur , Maryam Kavousi , Gyulli M Kazakbaeva , Ulrich Keil , Lital Keinan Boker , Sirkka Keinänen-Kiukaanniemi , Roya Kelishadi , Cecily Kelleher , Han Cg Kemper , Andre P Kengne , Maryam Keramati , Alina Kerimkulova , Mathilde Kersting , Timothy Key , Yousef Saleh Khader , Davood Khalili , Kay-Tee Khaw , Bahareh Kheiri , Motahareh Kheradmand , Alireza Khosravi , Ilse Msl Khouw , Ursula Kiechl-Kohlendorfer , Stefan Kiechl , Japhet Killewo , Dong Wook Kim , Hyeon Chang Kim , Jeongseon Kim , Jenny M Kindblom , Heidi Klakk , Magdalena Klimek , Jeannette Klimont , Jurate Klumbiene , Michael Knoflach , Bhawesh Koirala , Elin Kolle , Patrick Kolsteren , Jürgen König , Raija Korpelainen , Paul Korrovits , Magdalena Korzycka , 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Morteza Shamshirgaran , Coimbatore Subramaniam Shanthirani , Maryam Sharafkhah , Sanjib K Sharma , Jonathan E Shaw , Amaneh Shayanrad , Ali Akbar Shayesteh , Lela Shengelia , Zumin Shi , Kenji Shibuya , Hana Shimizu-Furusawa , Dong Wook Shin , Majid Shirani , Rahman Shiri , Namuna Shrestha , Khairil Si-Ramlee , Alfonso Siani , Rosalynn Siantar , Abla M Sibai , Antonio M Silva , Diego Augusto Santos Silva , Mary Simon , Judith Simons , Leon A Simons , Agneta Sjöberg , Michael Sjöström , Gry Skodje , Jolanta Slowikowska-Hilczer , Przemyslaw Slusarczyk , Liam Smeeth , Hung-Kwan So , Fernanda Cunha Soares , Grzegorz Sobek , Eugène Sobngwi , Morten Sodemann , Stefan Söderberg , Moesijanti Ye Soekatri , Agustinus Soemantri , Reecha Sofat , Vincenzo Solfrizzi , Mohammad Hossein Somi , Emily Sonestedt , Yi Song , Thorkild Ia Sørensen , Elin P Sørgjerd , Charles Sossa Jérome , Victoria E Soto-Rojas , Aïcha Soumaré , Slavica Sovic , Bente Sparboe-Nilsen , Karen Sparrenberger , Angela Spinelli , Igor Spiroski , Jan A Staessen , Hanspeter Stamm , Maria G Stathopoulou , Kaspar Staub , Bill Stavreski , Jostein Steene-Johannessen , Peter Stehle , Aryeh D Stein , George S Stergiou , Jochanan Stessman , Ranko Stevanovic , Jutta Stieber , Doris Stöckl , Tanja Stocks , Jakub Stokwiszewski , Ekaterina Stoyanova , Gareth Stratton , Karien Stronks , Maria Wany Strufaldi , Lela Sturua , Ramón Suárez-Medina , Machi Suka , Chien-An Sun , Johan Sundström , Yn-Tz Sung , Jordi Sunyer , Paibul Suriyawongpaisal , Boyd A Swinburn , Rody G Sy , Holly E Syddall , René Charles Sylva , Moyses Szklo , Lucjan Szponar , E Shyong Tai , Mari-Liis Tammesoo , Abdonas Tamosiunas , Eng Joo Tan , Xun Tang , Maya Tanrygulyyeva , Frank Tanser , Yong Tao , Mohammed Rasoul Tarawneh , Jakob Tarp , Carolina B Tarqui-Mamani , Radka Taxová Braunerová , Anne Taylor , Julie Taylor , Félicité Tchibindat , William R Tebar , Grethe S Tell , Tania Tello , Yih Chung Tham , K R Thankappan , Holger Theobald , Xenophon Theodoridis , Lutgarde Thijs , Nihal Thomas , Betina H Thuesen , Lubica Tichá , Erik J Timmermans , Anne Tjonneland , Hanna K Tolonen , Janne S Tolstrup , Murat Topbas , Roman Topór-Madry , Liv Elin Torheim , María José Tormo , Michael J Tornaritis , Maties Torrent , Laura Torres-Collado , Stefania Toselli , Giota Touloumi , Pierre Traissac , Thi Tuyet-Hanh Tran , Dimitrios Trichopoulos , Antonia Trichopoulou , Oanh Th Trinh , Atul Trivedi , Lechaba Tshepo , Maria Tsigga , Shoichiro Tsugane , Azaliia M Tuliakova , Marshall K Tulloch-Reid , Fikru Tullu , Tomi-Pekka Tuomainen , Jaakko Tuomilehto , Maria L Turley , Gilad Twig , Per Tynelius , Themistoklis Tzotzas , Christophe Tzourio , Peter Ueda , Eunice Ugel , Flora Am Ukoli , Hanno Ulmer , Belgin Unal , Zhamyila Usupova , Hannu Mt Uusitalo , Nalan Uysal , Justina Vaitkeviciute , Gonzalo Valdivia , Susana Vale , Damaskini Valvi , Rob M van Dam , Johan Van der Heyden , Yvonne T van der Schouw , Koen Van Herck , Hoang Van Minh , Natasja M 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Weghuber , Wenbin Wei , Aneta Weres , Bo Werner , Peter H Whincup , Kurt Widhalm , Indah S Widyahening , Andrzej Wiecek , Rainford J Wilks , Johann Willeit , Peter Willeit , Julianne Williams , Tom Wilsgaard , Bogdan Wojtyniak , Roy A Wong-McClure , Andrew Wong , Jyh Eiin Wong , Tien Yin Wong , Jean Woo , Mark Woodward , Frederick C Wu , Jianfeng Wu , Li Juan Wu , Shouling Wu , Haiquan Xu , Liang Xu , Nor Azwany Yaacob , Uruwan Yamborisut , Weili Yan , Ling Yang , Xiaoguang Yang , Yang Yang , Nazan Yardim , Mehdi Yaseri , Tabara Yasuharu , Xingwang Ye , Panayiotis K Yiallouros , Moein Yoosefi , Akihiro Yoshihara , Qi Sheng You , San-Lin You , Novie O Younger-Coleman , Safiah Md Yusof , Ahmad Faudzi Yusoff , Luciana Zaccagni , Vassilis Zafiropulos , Ahmad A Zainuddin , Seyed Rasoul Zakavi , Farhad Zamani , Sabina Zambon , Antonis Zampelas , Hana Zamrazilová , Maria Elisa Zapata , Abdul Hamid Zargar , Ko Ko Zaw , Tomasz Zdrojewski , Kristyna Zejglicova , Tajana Zeljkovic Vrkic , Yi Zeng 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Mohebbi, Iraj, Mohebi, Farnam, Moitry, Marie, Molbo, Drude, Møllehave, Line T, Møller, Niels C, Molnár, Déne, Momenan, Amirabba, Mondo, Charles K, Monroy-Valle, Michele, Monterrubio-Flores, Eric, Monyeki, Kotsedi Daniel K, Moon, Jin Soo, Moosazadeh, Mahmood, Moreira, Leila B, Morejon, Alain, Moreno, Luis A, Morgan, Karen, Morin, Suzanne N, Mortensen, Erik Lykke, Moschonis, George, Mossakowska, Malgorzata, Mostafa, Aya, Mota-Pinto, Anabela, Mota, Jorge, Motlagh, Mohammad Esmaeel, Motta, Jorge, Moura-dos-Santos, Marcos André, Mridha, Malay K, Msyamboza, Kelias P, Mu, Thet Thet, Muc, Magdalena, Mugoša, Boban, Muiesan, Maria L, Mukhtorova, Parvina, Müller-Nurasyid, Martina, Murphy, Neil, Mursu, Jaakko, Murtagh, Elaine M, Musa, Kamarul Imran, Milanovic, Sanja Music, Musil, Vera, Mustafa, Norlaila, Nabipour, Iraj, Naderimagham, Shohreh, Nagel, Gabriele, Naidu, Balkish M, Najafi, Farid, Nakamura, Harunobu, Námešná, Jana, Ei K Nang, Ei, Nangia, Vinay B, Nankap, Martin, Narake, Sameer, Nardone, 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Poudyal, Anil, Poulimeneas, Dimitrio, Pouraram, Hamed, Pourfarzi, Farhad, Pourshams, Akram, Poustchi, Hossein, Pradeepa, Rajendra, Price, Alison J, Price, Jacqueline F, Providencia, Rui, Puder, Jardena J, Pudule, Iveta, Puhakka, Soile E, Puiu, Maria, Punab, Margu, Qasrawi, Radwan F, Qorbani, Mostafa, Bao, Tran Quoc, Radic, Ivana, Radisauskas, Ricarda, Rahimikazerooni, Salar, Rahman, Mahfuzar, Rahman, Mahmudur, Raitakari, Olli, Raj, Manu, Rakhimova, Ellina, Rakhmatulloev, Sherali, Rakovac, Ivo, Rao, Sudha Ramachandra, Ramachandran, Ambady, Ramke, Jacqueline, Ramos, Elisabete, Ramos, Rafel, Rampal, Lekhraj, Rampal, Sanjay, Rarra, Vayia, Rascon-Pacheco, Ramon A, Rasmussen, Mette, Rech, Cassiano Ricardo, Redon, Josep, Reganit, Paul Ferdinand M, Regecová, Valéria, Revilla, Lui, Rezaianzadeh, Abba, Ribas-Barba, Lourde, Ribeiro, Robespierre, Riboli, Elio, Richter, Adrian, Rigo, Fernando, Rinaldo, Natascia, de Wit, Tobias F Rinke, Rito, Ana, Ritti-Dias, Raphael M, Rivera, Juan A, Robitaille, Cynthia, Roccaldo, Romana, Rodrigues, Daniela, Rodríguez-Artalejo, Fernando, del Cristo Rodriguez-Perez, María, Rodríguez-Villamizar, Laura A, Roggenbuck, Ulla, Rojas-Martinez, Rosalba, Rojroongwasinkul, Nipa, Romaguera, Dora, Romeo, Elisabetta L, Rosario, Rafaela V, Rosengren, Annika, Rouse, Ian, Roy, Joel GR, Rubinstein, Adolfo, Rühli, Frank J, Ruidavets, Jean-Bernard, Ruiz-Betancourt, Blanca Sandra, Ruiz-Castell, Maria, Moreno, Emma Ruiz, Rusakova, Iuliia A, Jonsson, Kenisha Russell, Russo, Paola, Rust, Petra, Rutkowski, Marcin, Sabanayagam, Charumathi, Sacchini, Elena, Sachdev, Harshpal S, Sadjadi, Alireza, Safarpour, Ali Reza, Safiri, Saeid, Saki, Nader, Salanave, Benoit, Martinez, Eduardo Salazar, Salmerón, Diego, Salomaa, Veikko, Salonen, Jukka T, Salvetti, Massimo, Samoutian, Margarita, Sánchez-Abanto, Jose, Sandjaja, null, Sans, Susana, Marina, Loreto Santa, Santos, Diana A, Santos, Ina S, Santos, Lèlita C, Santos, Maria Paula, Santos, Osvaldo, Santos, Rute, Sanz, Sara Santo, Saramies, Jouko L, Sardinha, Luis B, Sarrafzadegan, Nizal, Sathish, Thirunavukkarasu, Saum, Kai-Uwe, Savva, Savva, Savy, Mathilde, Sawada, Norie, Sbaraini, Mariana, Scazufca, Marcia, Schaan, Beatriz D, Rosario, Angelika Schaffrath, Schargrodsky, Herman, Schienkiewitz, Anja, Schipf, Sabine, Schmidt, Carsten O, Schmidt, Ida Maria, Schnohr, Peter, Schöttker, Ben, Schramm, Sara, Schramm, Stine, Schröder, Helmut, Schultsz, Constance, Schutte, Aletta E, Sein, Aye Aye, Selamat, Rusidah, Sember, Vedrana, Sen, Abhijit, Senbanjo, Idowu O, Sepanlou, Sadaf G, Sequera, Victor, Serra-Majem, Lui, Servais, Jennifer, Ševcíková, Ludmila, Shalnova, Svetlana A, Shamah-Levy, Teresa, Shamshirgaran, Morteza, Shanthirani, Coimbatore Subramaniam, Sharafkhah, Maryam, Sharma, Sanjib K, Shaw, Jonathan E, Shayanrad, Amaneh, Shayesteh, Ali Akbar, Shengelia, Lela, Shi, Zumin, Shibuya, Kenji, Shimizu-Furusawa, Hana, Shin, Dong Wook, Shirani, Majid, Shiri, Rahman, Shrestha, Namuna, Si-Ramlee, Khairil, Siani, Alfonso, Siantar, Rosalynn, Sibai, Abla M, Silva, Antonio M, Silva, Diego Augusto Santo, Simon, Mary, Simons, Judith, Simons, Leon A, Sjöberg, Agneta, Sjöström, Michael, Skodje, Gry, Slowikowska-Hilczer, Jolanta, Slusarczyk, Przemyslaw, Smeeth, Liam, So, Hung-Kwan, Soares, Fernanda Cunha, Sobek, Grzegorz, Sobngwi, Eugène, Sodemann, Morten, Söderberg, Stefan, Soekatri, Moesijanti YE, Soemantri, Agustinu, Sofat, Reecha, Solfrizzi, Vincenzo, Somi, Mohammad Hossein, Sonestedt, Emily, Song, Yi, Sørensen, Thorkild IA, Sørgjerd, Elin P, Jérome, Charles Sossa, Soto-Rojas, Victoria E, Soumaré, Aïcha, Sovic, Slavica, Sparboe-Nilsen, Bente, Sparrenberger, Karen, Spinelli, Angela, Spiroski, Igor, Staessen, Jan A, Stamm, Hanspeter, Stathopoulou, Maria G, Staub, Kaspar, Stavreski, Bill, Steene-Johannessen, Jostein, Stehle, Peter, Stein, Aryeh D, Stergiou, George S, Stessman, Jochanan, Stevanovic, Ranko, Stieber, Jutta, Stöckl, Dori, Stocks, Tanja, Stokwiszewski, Jakub, Stoyanova, Ekaterina, Stratton, Gareth, Stronks, Karien, Strufaldi, Maria Wany, Sturua, Lela, Suárez-Medina, Ramón, Suka, Machi, Sun, Chien-An, Sundström, Johan, Sung, Yn-Tz, Sunyer, Jordi, Suriyawongpaisal, Paibul, Swinburn, Boyd A, Sy, Rody G, Syddall, Holly E, Sylva, René Charle, Szklo, Moyse, Szponar, Lucjan, Tai, E Shyong, Tammesoo, Mari-Lii, Tamosiunas, Abdona, Tan, Eng Joo, Tang, Xun, Tanrygulyyeva, Maya, Tanser, Frank, Tao, Yong, Tarawneh, Mohammed Rasoul, Tarp, Jakob, Tarqui-Mamani, Carolina B, Braunerová, Radka Taxová, Taylor, Anne, Taylor, Julie, Tchibindat, Félicité, Tebar, William R, Tell, Grethe S, Tello, Tania, Tham, Yih Chung, Thankappan, KR, Theobald, Holger, Theodoridis, Xenophon, Thijs, Lutgarde, Thomas, Nihal, Thuesen, Betina H, Tichá, Lubica, Timmermans, Erik J, Tjonneland, Anne, Tolonen, Hanna K, Tolstrup, Janne S, Topbas, Murat, Topór-Madry, Roman, Torheim, Liv Elin, Tormo, María José, Tornaritis, Michael J, Torrent, Matie, Torres-Collado, Laura, Toselli, Stefania, Touloumi, Giota, Traissac, Pierre, Tran, Thi Tuyet-Hanh, Trichopoulos, Dimitrio, Trichopoulou, Antonia, Trinh, Oanh TH, Trivedi, Atul, Tshepo, Lechaba, Tsigga, Maria, Tsugane, Shoichiro, Tuliakova, Azaliia M, Tulloch-Reid, Marshall K, Tullu, Fikru, Tuomainen, Tomi-Pekka, Tuomilehto, Jaakko, Turley, Maria L, Twig, Gilad, Tynelius, Per, Tzotzas, Themistokli, Tzourio, Christophe, Ueda, Peter, Ugel, Eunice, Ukoli, Flora AM, Ulmer, Hanno, Unal, Belgin, Usupova, Zhamyila, Uusitalo, Hannu MT, Uysal, Nalan, Vaitkeviciute, Justina, Valdivia, Gonzalo, Vale, Susana, Valvi, Damaskini, van Dam, Rob M, Van der Heyden, Johan, van der Schouw, Yvonne T, Van Herck, Koen, Van Minh, Hoang, Van Schoor, Natasja M, van Valkengoed, Irene GM, Vanderschueren, Dirk, Vanuzzo, Diego, Varbo, Anette, Varela-Moreiras, Gregorio, Varona-Pérez, Patricia, Vasan, Senthil K, Vega, Toma, Veidebaum, Tooma, Velasquez-Melendez, Gustavo, Velika, Biruta, Veronesi, Giovanni, Verschuren, WM Monique, Victora, Cesar G, Viegi, Giovanni, Viet, Lucie, Villalpando, Salvador, Vineis, Paolo, Vioque, Jesu, Virtanen, Jyrki K, Visser, Marjolein, Visvikis-Siest, Sophie, Viswanathan, Bharathi, Vladulescu, Mihaela, Vlasoff, Tiina, Vocanec, Dorja, Vollenweider, Peter, Völzke, Henry, Voutilainen, Ari, Voutilainen, Sari, Vrijheid, Martine, Vrijkotte, Tanja GM, Wade, Alisha N, Wagner, Aline, Waldhör, Thoma, Walton, Janette, Wambiya, Elvis OA, Bebakar, Wan Mohamad Wan, Mohamud, Wan Nazaimoon Wan, de Souza Wanderley Júnior, Rildo, Wang, Ming-Dong, Wang, Ningli, Wang, Qian, Wang, Xiangjun, Wang, Ya Xing, Wang, Ying-Wei, Wannamethee, S Goya, Wareham, Nichola, Weber, Adelheid, Wedderkopp, Niel, Weerasekera, Deepa, Weghuber, Daniel, Wei, Wenbin, Weres, Aneta, Werner, Bo, Whincup, Peter H, Widhalm, Kurt, Widyahening, Indah S, Wiecek, Andrzej, Wilks, Rainford J, Willeit, Johann, Willeit, Peter, Williams, Julianne, Wilsgaard, Tom, Wojtyniak, Bogdan, Wong-McClure, Roy A, Wong, Andrew, Wong, Jyh Eiin, Wong, Tien Yin, Woo, Jean, Woodward, Mark, Wu, Frederick C, Wu, Jianfeng, Wu, Li Juan, Wu, Shouling, Xu, Haiquan, Xu, Liang, Yaacob, Nor Azwany, Yamborisut, Uruwan, Yan, Weili, Yang, Ling, Yang, Xiaoguang, Yang, Yang, Yardim, Nazan, Yaseri, Mehdi, Yasuharu, Tabara, Ye, Xingwang, Yiallouros, Panayiotis K, Yoosefi, Moein, Yoshihara, Akihiro, You, Qi Sheng, You, San-Lin, Younger-Coleman, Novie O, Md Yusof, Safiah, Yusoff, Ahmad Faudzi, Zaccagni, Luciana, Zafiropulos, Vassili, Zainuddin, Ahmad A, Zakavi, Seyed Rasoul, Zamani, Farhad, Zambon, Sabina, Zampelas, Antoni, Zamrazilová, Hana, Zapata, Maria Elisa, Zargar, Abdul Hamid, Ko Zaw, Ko, Zdrojewski, Tomasz, Zejglicova, Kristyna, Vrkic, Tajana Zeljkovic, Zeng, Yi, Zhang, Luxia, Zhang, Zhen-Yu, Zhao, Dong, Zhao, Ming-Hui, Zhao, Wenhua, Zhen, Shiqi, Zheng, Wei, Zheng, Yingfeng, Zholdin, Bekbolat, Zhou, Maigeng, Zhu, Dan, Zins, Marie, Zitt, Emanuel, Zocalo, Yanina, Cisneros, Julio Zuñiga, Zuziak, Monika, Ezzati, Majid, Filippi, Sarah, Cohortes épidémiologiques en population (CONSTANCES), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay-Université Paris Cité (UPCité), Université Paris Cité (UPCité), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut Agro - Montpellier SupAgro, and Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)

Subjects
Population -- Health aspects, Leanness, Baixo peso/Underweight, none, Double burden, alipainoisuus, tulotaso, global health, systematic analysis, Sedentary behaviors, RC1200, Prospective associations, 0302 clinical medicine, underweight, nälänhätä, Biology (General), skin and connective tissue diseases, Children, ComputingMilieux_MISCELLANEOUS, Body mass index, Human Nutrition & Health, education.field_of_study, Humane Voeding & Gezondheid, ylipaino, General Medicine, kansainvälinen vertailu, 3. Good health, World health, Medicine, A100 Pre-clinical Medicine, Population distribution, medicine.medical_specialty, QH301-705.5, Science, Socio-culturale, Nursing, Social sciences, General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Thinness, SDG 3 - Good Health and Well-being, BMI, epidemiology, obesity, None, Humans, Obesidade/Obesity, SDG 2 - Zero Hunger, education, VLAG, US adults, Omvårdnad, body mass index, malnutrition, obesity, underweight, nutritional and metabolic diseases, medicine.disease, terveellisyys, Obesity, Faculdade de Ciências Sociais, Body Mass Index, Prevalence, Risk Factors, General Biochemistry, WIAS, lihavuus, RA, Demography, N.A, double burden, Settore MED/09 - Medicina Interna, alueelliset erot, Nutrition and Disease, Animal Nutrition, [SDV]Life Sciences [q-bio], Medizin, 030204 cardiovascular system & hematology, 0601 Biochemistry and Cell Biology, Change distribution of body mass index, RA0421, Voeding en Ziekte, Epidemiology, Medicine and Health Sciences, Global health, Índice de massa corporal/Body Mass Index, 030212 general & internal medicine, Underweight, painoindeksi, 2. Zero hunger, General Neuroscience, aliravitsemus, elintarvikkeet, health, Public Health, Global Health, Social Medicine and Epidemiology, Diervoeding, 3142 Public health care science, environmental and occupational health, purl.org/pe-repo/ocde/ford#3.01.03 [https], Chinese adults, pooled analysis, medicine.symptom, Diet quality, B120 Physiology, Research Article, trends, purl.org/pe-repo/ocde/ford#1.06.03 [https], prevalence, Population, Mothers, Genetics and Molecular Biology, 3121 Internal medicine, medicine, Life Science, ddc:610, 3125 Otorhinolaryngology, ophthalmology, kehonkoostumus, Nutrition, Australian adults, General Immunology and Microbiology, purl.org/pe-repo/ocde/ford#3.01.04 [https], Ciências sociais, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, Malnutrition, Epidemiology and Global Health, sense organs, Estilos de Vida e Impacto na Saúde
Abstract

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions., Wellcome Trust, Medical Research Council, peer-reviewed

Published
2021

29. Patient experiences with the role of physical activity in inflammatory bowel disease : results from a survey and interviews

Author

Lola J M Koppelman, Maria T. E. Hopman, Ben J.M. Witteman, Carlijn R Lamers, and Nicole M. de Roos

Subjects
Crohn’s disease, medicine.medical_specialty, Nutrition and Disease, Physical fitness, Disease, RC799-869, Inflammatory bowel disease, 03 medical and health sciences, Interviews, 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Quality of life, Internal medicine, Voeding en Ziekte, Surveys and Questionnaires, medicine, Humans, Exercise, General fitness training, Human Nutrition & Health, Crohn's disease, business.industry, Physical activity, Metabolic Disorders Radboud Institute for Health Sciences [Radboudumc 6], Humane Voeding & Gezondheid, Gastroenterology, General Medicine, Diseases of the digestive system. Gastroenterology, medicine.disease, Inflammatory Bowel Diseases, Ulcerative colitis, Physical activity level, Patient Outcome Assessment, 030220 oncology & carcinogenesis, Quality of Life, 030211 gastroenterology & hepatology, Colitis, Ulcerative, business, Research Article
Abstract

Background Physical activity may affect disease activity in patients with inflammatory bowel disease. We used a survey to investigate this association and performed interviews to get a better understanding of patient experiences, and therefore the nature of this association. Methods Patients with Crohn’s disease (CD, n = 176) and ulcerative colitis (UC, n = 162) completed the short Crohn’s Disease Activity (sCDAI) or Patient Simple Clinical Colitis Activity Index (P-SCCAI) and the Short Questionnaire to Assess Health-enhancing physical activity (SQUASH). Associations were investigated by multiple linear regression. Semi-structured interviews (7 CD, 7 UC) were conducted to assess patient experiences with the role of physical activity in their disease. Results The majority of survey participants were in remission (70%) and adhered to the Dutch physical activity guidelines (61%). In Crohn’s disease, the total physical activity score was inversely associated with disease activity, even after adjustment for confounders (β = − 0.375; p = 0.013). No association between physical activity and disease activity was found in ulcerative colitis. Of the interviewees, 86% experienced beneficial effects of physical activity, such as improved general fitness, quality of life and self-image. However, during periods of active disease they struggled to find the motivation and perseverance to be physically active due to physical barriers. Conclusions Crohn’s disease participants with a higher physical activity level had a lower disease activity. This inverse association was not found in ulcerative colitis. Interviews revealed that IBD patients generally experience beneficial effects from physical activity, although the barriers caused by active disease may put them off to be physically active.

Published
2021

30. Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status : the NU-AGE 1-year dietary intervention across five European countries

Author

Blandine Comte, Claudio Franceschi, Paul W. O'Toole, Joanna Kaluza, Silvia Turroni, Barbara Pietruszka, Amy Jennings, Tarini Shankar Ghosh, Susan J. Fairweather-Tait, Corinne Malpuech Brugere, Patrizia Brigidi, Claudio Nicoletti, Enrico Giampieri, Aedin Cassidy, Ian B. Jeffery, Gerben D. A. Hermes, Estelle Pujos-Guillot, Lisette C. P. G. M. de Groot, Miriam Capri, Marta Jeruszka Bielak, Nathalie Meunier, Simone Rampelli, Willem M. de Vos, Marco Candela, Caumon Elodie, Erwin G. Zoetendal, Aurelia Santoro, Marta C Neto, Monica Maijo-Ferre, Agnes A M Berendsen, Edith J M Feskins, Department of Bacteriology and Immunology, Willem Meindert Vos de / Principal Investigator, de Vos & Salonen group, Research Programs Unit, HUMI - Human Microbiome Research, Faculty of Medicine, University of Helsinki, HUS Helsinki and Uusimaa Hospital District, University College Cork (UCC), University of Bologna/Università di Bologna, University of East Anglia [Norwich] (UEA), Wageningen University and Research [Wageningen] (WUR), Centre de Recherche en Nutrition Humaine d'Auvergne (CRNH d'Auvergne), Unité de Nutrition Humaine (UNH), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Warsaw University of Life Sciences (SGGW), Quadram Institute Bioscience [Norwich, U.K.] (QIB), Biotechnology and Biological Sciences Research Council (BBSRC), Université de Florence, Università degli Studi di Firenze = University of Florence (UniFI), Human Microbiome Research Program, Helsingin yliopisto = Helsingfors universitet = University of Helsinki-Helsingin yliopisto = Helsingfors universitet = University of Helsinki, Queens University Belfast, Queen's University [Belfast] (QUB), Lobachevsky State University [Nizhni Novgorod], Science Foundation Ireland APC/SFI/12/RC/2273 13/SIRG/2128European Union (EU) 266 486, University of Bologna, Quadram Institute Bioscience, Università degli Studi di Firenze = University of Florence [Firenze] (UNIFI), University of Helsinki-University of Helsinki, University of Nizhny Novgorod, Ghosh, Tarini Shankar, Rampelli, Simone, Jeffery, Ian B, Santoro, Aurelia, Neto, Marta, Capri, Miriam, Giampieri, Enrico, Jennings, Amy, Candela, Marco, Turroni, Silvia, Zoetendal, Erwin G, Hermes, Gerben D A, Elodie, Caumon, Meunier, Nathalie, Brugere, Corinne Malpuech, Pujos-Guillot, Estelle, Berendsen, Agnes M, De Groot, Lisette C P G M, Feskins, Edith J M, Kaluza, Joanna, Pietruszka, Barbara, Bielak, Marta Jeruszka, Comte, Blandine, Maijo-Ferre, Monica, Nicoletti, Claudio, De Vos, Willem M, Fairweather-Tait, Susan, Cassidy, Aedin, Brigidi, Patrizia, Franceschi, Claudio, and O'Toole, Paul W

Subjects
Male, 0301 basic medicine, obesity, Mediterranean diet, Nutrition and Disease, Health Status, intestinal microbiology, Gut flora, Diet, Mediterranean, 0302 clinical medicine, Microbiologie, RNA, Ribosomal, 16S, Voeding en Ziekte, Medicine, Single-Blind Method, colonic microflora, Microbial metabolite, Human Nutrition & Health, 2. Zero hunger, Frailty, biology, Humane Voeding & Gezondheid, Gastroenterology, Nutritional Biology, 3. Good health, enteric bacterial microflora, Europe, diabetes mellitus, BACTERIA, Female, METABOLISM, Microbiology, 03 medical and health sciences, Intervention (counseling), Environmental health, Humans, Microbiome, MolEco, Aged, Nutrition, VLAG, Global Nutrition, Wereldvoeding, business.industry, [SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology, BacGen, biology.organism_classification, ageing, Mediterranean diet, gut microbiota, Gut microbiome, Gastrointestinal Microbiome, 030104 developmental biology, Ageing, ageing, inflammation, 3121 General medicine, internal medicine and other clinical medicine, Commentary, Patient Compliance, intestinal bacteria, 3111 Biomedicine, Older people, business, diet, 030217 neurology & neurosurgery
Abstract

ObjectiveAgeing is accompanied by deterioration of multiple bodily functions and inflammation, which collectively contribute to frailty. We and others have shown that frailty co-varies with alterations in the gut microbiota in a manner accelerated by consumption of a restricted diversity diet. The Mediterranean diet (MedDiet) is associated with health. In the NU-AGE project, we investigated if a 1-year MedDiet intervention could alter the gut microbiota and reduce frailty.DesignWe profiled the gut microbiota in 612 non-frail or pre-frail subjects across five European countries (UK, France, Netherlands, Italy and Poland) before and after the administration of a 12-month long MedDiet intervention tailored to elderly subjects (NU-AGE diet).ResultsAdherence to the diet was associated with specific microbiome alterations. Taxa enriched by adherence to the diet were positively associated with several markers of lower frailty and improved cognitive function, and negatively associated with inflammatory markers including C-reactive protein and interleukin-17. Analysis of the inferred microbial metabolite profiles indicated that the diet-modulated microbiome change was associated with an increase in short/branch chained fatty acid production and lower production of secondary bile acids, p-cresols, ethanol and carbon dioxide. Microbiome ecosystem network analysis showed that the bacterial taxa that responded positively to the MedDiet intervention occupy keystone interaction positions, whereas frailty-associated taxa are peripheral in the networks.ConclusionCollectively, our findings support the feasibility of improving the habitual diet to modulate the gut microbiota which in turn has the potential to promote healthier ageing.

Published
2020

31. A context analysis on how oral care is delivered in hospitalised patients: A mixed-methods study

Author

Getty Huisman-de Waal, Harm H J van Noort, Hester Vermeulen, Ben J.M. Witteman, Ria den Hertog-Voortman, Babette Everaars, and Oral Public Health

Subjects
Male, Health Knowledge, Attitudes, Practice, Mixed methods, interviews, nondental care professional, Oral care, Nursing Staff, Hospital, Nondental care professional, 0302 clinical medicine, nursing, Medicine, hospitalised patients, 030212 general & internal medicine, Prospective Studies, Hospitalised patients, General Nursing, Qualitative Research, Human Nutrition & Health, 030504 nursing, Diagnosis, Oral, Humane Voeding & Gezondheid, General Medicine, Oral health assessment tool, Female, 0305 other medical science, medicine.medical_specialty, Oral health, mixed methods, Attitude of Health Personnel, Context (language use), Nursing, Oral hygiene, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, Interviews, Intervention (counseling), Humans, fundamental care, SDG 2 - Zero Hunger, VLAG, oral care, business.industry, oral hygiene, oral health assessment tool, medicine.disease, Context analysis, Malnutrition, stomatognathic diseases, Family medicine, oral health, Observational study, Fundamental care, business, Delivery of Health Care, Qualitative research
Abstract

Contains fulltext : 220980.pdf (Publisher’s version ) (Closed access) AIMS AND OBJECTIVES: To analyse oral care delivery in one hospital through exploring experiences from both nurses' and patients' perspectives and examining patients' oral health. BACKGROUND: Oral health problems are associated with undernutrition and other general health outcomes. Although oral care belongs to the essentials of nursing, it is often neglected. Improving oral health may require behaviour change of both nurses and patients. Defining tailored strategies need a clear view on the context. DESIGN: A context analysis in one hospital using a convergent parallel mixed-methods design was reported following the EQUATOR guidelines using two checklists: COnsolidated criteria for REporting Qualitative research (qualitative research) and STROBE (observational research). METHODS: Semi-structured interviews were conducted with 19 nurses and 11 patients. The topic list was based on the Integrated Change Model. Prospective oral examination was performed among 91 surgical patients using the Oral Health Assessment Tool (OHAT). RESULTS: Nurses acknowledged that they did not prioritise oral care in daily practice. Furthermore, they lacked knowledge and skills to identify and provide care for oral problems. Nurses mentioned helpful resources to perform oral care, like standardised language and instruments. However, they had no access to or were unaware of them. Patients admitted that they did not prioritise oral care due to their sickness during hospitalisation, were unaware of the importance of oral care, but felt responsible for their oral care. The most prominent oral problems identified with the OHAT were unclean mouths (n = 75, 82%), unhealthy gum and tissues (n = 55, 60%) and dry mouth (n = 42, 46%). CONCLUSIONS: This context analysis identified inadequate oral care due to lack of positive attitude and knowledge in both nurses and patients, skills for nurses, and resources. RELEVANCE TO CLINICAL PRACTICE: The behavioural factors indicate strategies for development of a multicomponent intervention to improve oral care in this hospital, nutritional status and general health outcomes.

Published
2020

32. Protein intake pattern over the day and its association with low total protein intake in Dutch community-dwelling older adults

Author

Marga C. Ocké, Marjolein Visser, Jolanda M. A. Boer, Teuni H Rooijackers, Linda M. Hengeveld, Nutrition and Health, APH - Health Behaviors & Chronic Diseases, APH - Aging & Later Life, and APH - Societal Participation & Health

Subjects
Evening, Low protein, 030309 nutrition & dietetics, Medicine (miscellaneous), 030209 endocrinology & metabolism, Protein intake pattern, 03 medical and health sciences, 0302 clinical medicine, Animal science, Low total protein, Ethnicity, Humans, Nutritional Epidemiology, Medicine, Aged, Human Nutrition & Health, Total protein, Morning, Global Nutrition, 2. Zero hunger, Wereldvoeding, 0303 health sciences, Nutrition and Dietetics, business.industry, Low protein intake, High protein, Humane Voeding & Gezondheid, Public Health, Environmental and Occupational Health, Dutch National Food Consumption Survey, Protein intake, Diet Records, Diet, Cross-Sectional Studies, Older adults, Independent Living, Energy Intake, business, Research Paper
Abstract

Objective:Investigate protein intake patterns over the day and their association with total protein intake in older adults.Design:Cross-sectional study utilising the dietary data collected through two non-consecutive, dietary record-assisted 24-h recalls. Days with low protein intake (n 290) were defined using the RDA (Setting:Community.Participants:739 Dutch community-dwelling adults ≥70 years.Results:The mean protein intake was 76·3 (sd 0·7) g/d. At each hour of the day, the amount of protein ingested was higher on days with a high protein intake than on days with a low protein intake and associated with a higher total protein intake. The proportion of protein ingested during morning hours was higher (22 v. 17 %, P < 0·0001) on days with a low protein intake, and a higher proportion of protein ingested during morning hours was associated with a lower total protein intake (P < 0·0001) and a higher odds of low protein intake (OR 1·04, 95 % CI 1·03, 1·06). For the proportion of protein intake during mid-day or evening hours, opposite but weaker associations were found.Conclusions:In this sample, timing of protein intake was associated with total protein intake. Additional studies need to clarify the importance of these findings to optimise protein intake.

Published
2020

33. Changes in body composition during and after adjuvant or neo-adjuvant chemotherapy in women with breast cancer stage I–IIIB compared with changes over a similar timeframe in women without cancer

Author

Liesbeth Posthuma, J. Th C.M. de Kruif, M. van den Berg, Dieuwertje E. Kok, Y. de Vries, Dirkje W. Sommeijer, Renate M. Winkels, J.H.M. de Vries, Ellen Kampman, A Timmer-Bonte, H.W.M. van Laarhoven, Maartje Los, Marjolein Visser, Epidemiology and Data Science, Human genetics, Medical oncology, Oncology, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Nutrition and Health, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, APH - Aging & Later Life, and APH - Societal Participation & Health

Subjects
Oncology, Adult, medicine.medical_specialty, Nutrition and Disease, medicine.medical_treatment, Breast Neoplasms, Body weight, Body composition, 03 medical and health sciences, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, Breast cancer, Absorptiometry, Photon, SDG 3 - Good Health and Well-being, Internal medicine, Voeding en Ziekte, medicine, Humans, Chemotherapy, 030212 general & internal medicine, Stage (cooking), Neo adjuvant chemotherapy, VLAG, Human Nutrition & Health, Neoplasm Staging, Global Nutrition, Wereldvoeding, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Humane Voeding & Gezondheid, Body Weight, Cancer, Middle Aged, medicine.disease, Neoadjuvant Therapy, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Lean body mass, Female, Original Article, business, Adjuvant
Abstract

Contains fulltext : 220748.pdf (Publisher’s version ) (Open Access) PURPOSE: Body weight and body composition may change during and after adjuvant or neo-adjuvant chemotherapy for breast cancer. However, most studies did not include a comparison group of women without cancer, thus could not assess whether observed changes differed from age-related fluctuations in body weight and body composition over time. We assessed changes in body composition during and after chemotherapy in breast cancer patients compared with age-matched women not diagnosed with cancer. METHODS: We recruited 181 patients with stage I-IIIb breast cancer and 180 women without cancer. In patients, we assessed body composition using a dual-energy X-ray scan before start of chemotherapy (T1), shortly after chemotherapy (T2), and 6 months after chemotherapy (T3); for the comparison group, the corresponding time points were recruitment (T1) and 6 (T2) and 12 (T3) months. RESULTS: Fifteen percent of patients and 8% of the comparison group gained at least 5% in body weight between T1 and T3. Among the comparison group, no statistically significant changes in body weight, or body composition were observed over time. Body weight of patients significantly increased from baseline (72.1 kg +/- 0.4 kg) to T2 (73.3 kg +/- 0.4 kg), but decreased to 73.0 kg +/- 0.4 kg after chemotherapy (T3). Lean mass of patients significantly increased from 43.1 kg +/- 0.5 kg at baseline to 44.0 kg +/- 0.5 kg at T2, but returned to 43.1 kg +/- 0.5 kg at T3. There were no differential changes in fat mass over time between patients and the comparison group. CONCLUSIONS: Changes in body weight and body composition during and after chemotherapy for early stage breast cancer were modest, and did not differ substantially from changes in body weight and body composition among women without cancer.

Published
2020

34. The nutritious drink: a specialized nutrient supplement for adults and adults living with HIV in Malawi

Author

Rodas-Moya, Santiago, Wageningen University, K. de Graaf, and S. de Pee

Subjects
Humane Voeding & Gezondheid, Life Science, VLAG, Human Nutrition & Health
Abstract

INTRODUCTIONUndernutrition is a major problem in the world, affecting vulnerable population groups such as people living with HIV (PLHIV). Ready-to-use-therapeutic-foods or corn-soy-blends [e.g., Super Cereal (SC)] are often used to treat undernutrition among PLHIV. However, their acceptability and compliant use are not optimal.THESIS AIMTo develop a culturally appropriate food nutrient supplement with sensory properties tailored to the preference, primarily of PLHIV, and potentially of adults from the general population, leading to more optimal micronutrient intake.METHODSWe conducted two qualitative studies based on Grounded Theory. In-depth interviews with a triangulation of participants and an iterative approach to data collection were used to investigate the factors influencing preferences for food and nutrient supplements among PLHIV. Based on the results of the qualitative research, we developed eight samples of a nutritious drink.Next, we studied the olfactory and gustatory (chemosensory) function of PLHIV to assess whether they suffer from chemosensory losses that could explain possible differences in preferences for the eight samples of the nutritious drink. We used the Sniffin’ Sticks and Taste Strips to assess the olfactory and gustatory function of 100 PLHIV and 100 healthy adults for comparison.Subsequently, 100 PLHIV and 98 healthy adults evaluated the nutritious drink samples. We used hedonic scales for assessing liking, and CATA (check-all-that-apply) questions to develop a sensory characterization of the nutritious drink samples. Penalty analysis was conducted to identify the drivers of liking and disliking of the samples for subsequent product optimization.Our last study assessed the acceptability and ad libitum intake of the nutritious drink, RUTF, and SC. Fifty-four PLHIV evaluated the products, monadically on three consecutive days. The three food nutrient supplements were served in isocaloric portions of 1000 kcal each. Participants were instructed to consume the products ad libitum. The participants were also asked to rate their liking and wanting for each product. Time of consumption (ad libitum), the number of bites used to consume the products were also measured, and the eating rate was calculated.RESULTSThe findings from the qualitative studies indicated that PLHIV preferred a thick beverage slightly sweet and sour as a nutrient supplement. Maheu, a maize-based drink of sweet and sour flavor and a thick, gritty consistency was utilized as a benchmark for the development of the nutritious drink samples for Malawi. The results from the study on olfactory and gustatory function, suggest that PLHIV suffer from olfactory loss. However, their gustatory function was normal.The findings from the study using CATA questions showed clear and significant differences in the acceptability of the samples, but no significant differences in preferences between PLHIV and healthy adults. The sensory characterization of the samples made by the two groups was also similar. A preference toward sweet, somewhat sour, thick samples with a soft texture and a milky flavor was identified.The results from the ad libitum intake study showed a significantly higher intake of the nutritious drink (356 g) compared to RUTF (107 g) and SC-porridge (312 g). The average intake of eight essential micronutrients as a percentage of target quantities was 58 % from the nutritious drink, 33 % from RUTF, and 20 % from SC. The average caloric intake from the nutritious drink, RUTF, and SC was 507, 581, and 339 kcal, respectively.DISCUSSION AND CONCLUSIONSThe combination of qualitative research and advanced techniques from sensory science allowed us to identify a product of high acceptability and to identify directions for tailoring the sensory properties of the product to the preference of the potential consumers. A more substantial weight of food and larger quantities of micronutrients were ingested from the nutritious drink compared to RUTF and SC. The nutritious drink also had a much higher eating rate compared to the semisolid supplements. These findings suggest that nutrient-dense food supplements in liquid form may be more effective than semisolid products (e.g., RUTF and SC) in treating undernutrition among PLHIV and other adults. Future research should focus on testing the efficacy of the nutritious drink in the treatment of undernutrition in comparison to RUTF and SC.

Published
2020

35. An outpatient nursing nutritional intervention to prehabilitate undernourished patients planned for surgery : A multicentre, cluster-randomised pilot study

Author

Harm H J van Noort, Hester Vermeulen, Ben J.M. Witteman, Jan P.H. Hamers, and Getty Huisman-de Waal

Subjects
0301 basic medicine, Adult, Male, Prehabilitation, 030209 endocrinology & metabolism, Pilot Projects, Critical Care and Intensive Care Medicine, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, Nursing care, 0302 clinical medicine, Patient satisfaction, Postoperative Complications, All institutes and research themes of the Radboud University Medical Center, Nursing, medicine, Ambulatory Care, Outpatient clinic, Cluster Analysis, Humans, Mass Screening, Elective surgery, Nutritional support, VLAG, Human Nutrition & Health, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Telephone call, Preoperative care, Malnutrition, Humane Voeding & Gezondheid, Preoperative Exercise, Undernutrition, Middle Aged, medicine.disease, Essential care, Intention to Treat Analysis, Clinical trial, Treatment Outcome, Surgical Procedures, Operative, Feasibility Studies, Female, Nutrition Therapy, business
Abstract

Background & aims: To improve the nutritional status of surgical patients before hospital admission, an Outpatient Nursing Nutritional Intervention (ONNI) was developed. The ONNI comprehends five components: determining causes of undernutrition, performing a nutritional care plan including tailored and general advice, self-monitoring of nutritional intake and eating patterns, counselling and encouragement, and conducting a follow-up telephone call to discuss improvements in nutritional behaviour. Here, we evaluate the feasibility and effectiveness of the ONNI. Methods: In a multi-centred, cluster-randomised pilot study, nurses from outpatient clinics were randomly allocated to usual care (UC) or the ONNI. Patients planned for elective surgery were included if they were at increased risk for undernutrition based on the Malnutrition Universal Screening Tool (MUST) and hospital admission was not planned within seven days. Feasibility outcomes included participation rate, extent of intervention delivery, and patient satisfaction. Nutritional intake was monitored for two days before admission. Body weight, BMI and MUST scores at hospital admission were compared to measurements from the outpatient clinic visit. Data were analysed on an intention-to-treat basis by researchers who were blinded for patients and caregivers. Results: Forty-eight patients enrolled the feasibility phase. Participation rate was 72%. Nurses delivered all intervention components adequately in the end of the implementation period. Finally, 152 patients (IG: n = 66, 43%) participated in the study. A significant difference in mean energy intake (870 kcal/d, 95%CI:630-1109 p < 0.000) and mean protein intake (34.1 g/d, 95%CI: 25.0–43.2; p < 0.000) was observed in favour of the IG. Nutritional energy requirements were achieved in 74% (n = 46) of the IG and in 17% (n = 13) of the UC group (p < 0.000), and protein requirements were achieved in 52% (n = 32) of the IG, compared to 8% (n = 6) of the UC group (p < 0.000). Body weight, BMI and MUST scores did not change in either group. Conclusions: The ONNI is a feasible and effective intervention tool for nurses at outpatient clinics. Patients in the IG had more nutritional intake and fulfilled nutritional requirements significantly more often than patients receiving UC. Further research is required to determine the optimal pre-operative timing of nutritional support and to measure its effect on other patients groups. Clinical trial registration: The study protocol was registered at the ClinicalTrial.gov website with the following identifier: NCT02440165.

Published
2020

36. Strategies to compensate for undesired gritty sensations in foods

Author

Marco Santagiuliana, Layla Broers, Betina Piqueras-Fiszman, Elke Scholten, Inés Sampedro Marigómez, and Markus Stieger

Subjects
Marketing and Consumer Behaviour, Physics and Physical Chemistry of Foods, 030309 nutrition & dietetics, Fat content, Texture perception, WASS, Microparticles, 03 medical and health sciences, Multiparticulate, 0404 agricultural biotechnology, Average size, Food science, TDS, VLAG, Human Nutrition & Health, 0303 health sciences, Nutrition and Dietetics, Chemistry, High protein, Grittiness, Humane Voeding & Gezondheid, 04 agricultural and veterinary sciences, Sweetness, 040401 food science, Food Quality and Design, Marktkunde en Consumentengedrag, Food Science, Composite foods
Abstract

This study investigated whether the addition of macroparticles or fat can be used to compensate for negative texture sensations in quark. Cellulose beads were added as model microparticles (1.5% w/w; average size: 263 µm) to quark (0% fat) to induce unpleasant gritty sensations. The addition of microparticles to quark significantly increased grittiness and dryness, while creaminess and liking decreased. Three strategies were explored to reduce the impact of unpleasant gritty sensations on consumer perception: two strategies involved the addition of macroparticles (granola or peach gel pieces); the third one consisted of increasing the fat content of the quark (4.4 and 8.8% w/w). For all three strategies, grittiness caused by microparticles did not significantly decrease when macroparticles or fat were present. Addition of peach gel pieces to quark with microparticles did not increase liking. When granola pieces were added to quark containing microparticles, liking increased significantly despite that grittiness was still perceived. Temporal Dominance of Sensations (TDS) revealed that addition of granola pieces caused prolonged dominance of positive, crunchy sensations and minimized dominance of negative, gritty sensations. The addition of fat did not lead to a significant increase in liking of quark, although when a medium amount of fat was added (4.4%), it also did not decrease liking significantly. This was probably due to an effective hedonic compensation triggered by more positive sensations (i.e. sweetness). We conclude that addition of crunchy granola pieces or fat can be used as strategies to shift and increase dominance of positive and liked attributes, leading to an increase of overall liking, although negative sensations (grittiness) caused by microparticles are still perceived. This approach could be used to compensate for undesired texture sensations in different types of foods, such as high protein foods.

Published
2020

37. Assessment of dietary intake by self-reports and biological markers

Author

Paul J.M. Hulshof, Jeanne H.M. de Vries, and Marga C. Ocké

Subjects
Global Nutrition, Diet history, Technology, Wereldvoeding, Dietary assessment, business.industry, Dietary intake, Food frequency questionnaire, 24-Hour food recall, Intake biomarker, Humane Voeding & Gezondheid, Automatic dietary monitoring, Diet assessment, Food record, Nutritional Biology, Environmental health, Medicine, Sources of error, business, VLAG, Human Nutrition & Health
Abstract

Summary Accurate assessment of dietary intake is crucial in the field of nutrition. In this chapter, different dietary assessment methods and types of biomarkers of dietary intake, their strengths and weaknesses, and the importance of examining the sources of error and variation are described. There is no best method of diet assessment for all purposes; therefore, the investigator has to select the method appropriate for the purpose and target group of the survey. Performing validation studies is essential to further improve dietary assessment methods, for a better interpretation of dietary assessment results, and for the correction of associations with outcomes for measurement errors, so that such associations are not obscured by these errors. Innovations in dietary assessment methods and validated biomarkers of intake will certainly improve assessments, but they are not the solution to all of the inherent problems in applying dietary assessment methods.

Published
2020

38. Colorectal cancer survivors beliefs on nutrition and cancer;: correlates with nutritional information provision

Author

Lian Smeets, Sandra Beijer, Merel R. van Veen, Floortje Mols, Ellen Kampman, and Medical and Clinical Psychology

Subjects
Male, Nutrition and Disease, Colorectal cancer, PREFERENCES, GUIDELINES, 0302 clinical medicine, Cancer Survivors, Surveys and Questionnaires, Voeding en Ziekte, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Information provision, media_common, Human Nutrition & Health, LONG-TERM EVALUATION, Nursing research, Humane Voeding & Gezondheid, Nutritional information, humanities, 3. Good health, Oncology, Feeling, 030220 oncology & carcinogenesis, INITIAL TREATMENT, Original Article, Female, HEALTH, Colorectal Neoplasms, RESEARCH FUND/AMERICAN INSTITUTE, medicine.medical_specialty, media_common.quotation_subject, Nutritional Status, Colorectal cancer survivor, 03 medical and health sciences, ADHERENCE, medicine, Humans, Aged, VLAG, Nutrition, Health professionals, business.industry, Cancer, medicine.disease, PREVENTION, LIFE, PHYSICAL-ACTIVITY, Family medicine, business
Abstract

PurposeTo investigate CRC survivors’ beliefs on nutrition and cancer and the association with nutritional information provision by (kind and number) of health professionals and to inquire about foods that CRC survivors believed either had a positive or negative influence on their cancer.MethodsA total of 326 CRC survivors of an ongoing prospective cohort study filled out questionnaires 1 month after surgery on whether they had received nutritional information from health professionals. Also, their beliefs that nutrition influences (1) feelings of well-being, (2) complaints after treatment, (3) recovery and (4) cancer recurrence were investigated. Prevalence ratios were calculated (using Cox proportional hazard regression analysis) to study associations between information provision and the four beliefs adjusted for age, gender and cancer stage.ResultsSixty-two percent of respondents received information about nutrition from one or more health professionals. Most respondents who received information strongly believe nutrition influences feelings of well-being (59%) and recovery after cancer (62%). Compared with those who did not receive information, respondents who received information from three professionals showed the strongest beliefs on the influence of nutrition on complaints after treatment (PR 3.4; 95% CI 1.6–7.4), recovery after treatment (PR 2.0; 95% CI 1.2–3.3) and recurrence (PR 2.8; 95% CI 1.3–6.2).ConclusionNutritional information provision by health professionals positively influences the beliefs of CRC survivors on the influence of nutrition on cancer outcomes: stronger beliefs occur when respondents received information from three health professionals.

Published
2020

39. Implementing immersive technologies in consumer testing : Liking and Just-About-Right ratings in a laboratory, immersive simulated café and real café

Author

R.A. de Wijk, Elizabeth H. Zandstra, E. Vennik, Daisuke Kaneko, and Garmt Dijksterhuis

Subjects
Predictive validity, Salt content, 030309 nutrition & dietetics, Applied psychology, Context (language use), Session (web analytics), 03 medical and health sciences, 0404 agricultural biotechnology, Immersive technology, VLAG, Food, Health & Consumer Research, Human Nutrition & Health, 0303 health sciences, Engagement, Nutrition and Dietetics, Humane Voeding & Gezondheid, Product testing, Context, 04 agricultural and veterinary sciences, 040401 food science, Health & Consumer Research, Food, Wine tasting, Psychology, Liking, Just-About-Right ratings, Food Science
Abstract

Initial research indicates that the use of immersive technologies may improve the predictive validity and reliability of liking scores in consumer testing. However, how immersive technologies impact Just-About-Right ratings is hardly known. Forty-five participants took part in three tasting sessions, each in a different context: 1) laboratory, 2) immersive context simulating a café using audiovisual cues, and 3) real café. Each session, participants tasted four tomato soups varying in salt content preceded by a warm-up sample. Liking, optimal levels of sensory attributes (JAR) and engagement were measured. Results showed that there were no differences in liking or JAR ratings on sensory attributes of the soups across the three contexts. Nevertheless, participants felt more engaged in the real café and simulated café than in the laboratory. These results contribute to a better understanding of how sensory differences as assessed in a laboratory or immersive context relate to sensory differences that consumers would notice when they use the products in real-life.

Published
2020

40. Food preferences and intake in a population of Dutch individuals with self-reported smell loss: An online survey

Author

Sanne Boesveldt, Elbrich M. Postma, and C. de Graaf

Subjects
Taste, 030309 nutrition & dietetics, Saturated fat, Anosmia, Population, Affect (psychology), 03 medical and health sciences, 0404 agricultural biotechnology, Hyposmia, Environmental health, medicine, Eating behavior, education, Sensory Science and Eating Behaviour, VLAG, Human Nutrition & Health, 0303 health sciences, education.field_of_study, Nutrition and Dietetics, business.industry, Dietary intake, digestive, oral, and skin physiology, Smell loss, Humane Voeding & Gezondheid, 04 agricultural and veterinary sciences, 040401 food science, Preference, Sensoriek en eetgedrag, Cohort, Macronutrients, medicine.symptom, business, Food Science
Abstract

Olfaction plays a major role in food intake regulation. Losing the sense of smell might therefore affect eating behavior. This study investigated food preferences and intake in individuals suffering from self-reported smell loss with an online survey. Members of the Dutch Anosmia Foundation (DAF) performed the Macronutrient and Taste Preference Ranking Task (n = 71) to measure preference for foods high in fat, carbohydrates or protein and low energy foods, and for sweet and savory tastes. To assess dietary intake, adherence to the Dutch Dietary Guidelines for consumption of vegetables, fruit, fiber, fish, saturated fat, trans fatty acids, salt and alcohol was measured (n = 105). Results of the DAF participants were compared to local cohort groups. Both the control and DAF participants showed the lowest preference for carbohydrate-rich foods and highest preference for low-energy foods. Participants suffering from congenital smell loss showed an aberrant pattern, with a higher preference for fat. The total adherence score to the Dutch Dietary Guidelines was similar for the control and DAF group, but adherence scores for fiber, trans fatty acids and alcohol were lower in DAF participants. Overall, no major significant differences in food preferences and intake were found for participants who lost their sense of smell during life. Participants suffering from congenital smell loss did show changes in food preferences, suggesting they are potentially more taste-oriented during eating. Together these results show the importance of tailored advice on dietary intake for this patient group.

Published
2020

41. The association between circulating levels of vitamin D and inflammatory markers in the first 2 years after colorectal cancer diagnosis

Author

Johannes H. W. de Wilt, Moniek van Zutphen, Dieuwertje E. Kok, Ellen Kampman, Jody van den Ouweland, Anne J.M.R. Geijsen, Michiel G.J. Balvers, Henk K. van Halteren, Martijn J.L. Bours, Harm van Baar, Fränzel J.B. van Duijnhoven, Eric T.P. Keulen, Ewout A. Kouwenhoven, Evertine Wesselink, Renger F. Witkamp, Matty P. Weijenberg, Epidemiologie, and RS: GROW - R1 - Prevention

Subjects
0301 basic medicine, Oncology, medicine.medical_specialty, Calcitriol, Nutrition and Disease, Colorectal cancer, NF-KAPPA-B, MODELS, interleukin 6, PROGRESSION, colorectal cancer, IMMUNITY, 25(OH)D3, 03 medical and health sciences, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 0302 clinical medicine, All institutes and research themes of the Radboud University Medical Center, Internal medicine, Voeding en Ziekte, medicine, Vitamin D and neurology, 25(OH)D-3, SERUM INTERLEUKIN-6 LEVELS, lcsh:RC799-869, Interleukin 6, HNRU&LB, Original Research, VLAG, Human Nutrition & Health, biology, 25(OH)D, business.industry, Humane Voeding & Gezondheid, Gastroenterology, Advances and Future Perspectives in Colorectal Cancer, QUANTIFICATION, medicine.disease, inflammatory markers, PREVENTION, Nutritional Biology, cytokines, LIFE, 030104 developmental biology, 030220 oncology & carcinogenesis, biology.protein, lcsh:Diseases of the digestive system. Gastroenterology, HEALTH, business, medicine.drug
Abstract

Background: Calcitriol, the active form of vitamin D, may inhibit colorectal cancer (CRC) progression, which has been mechanistically linked to an attenuation of a pro-inflammatory state. The present study investigated the associations between circulating 25 hydroxy vitamin D3 (25(OH)D3) levels and inflammatory markers (IL10, IL8, IL6, TNFα and hsCRP) in the 2 years following CRC diagnosis. Methods: Circulating 25(OH)D3 levels and inflammatory markers were assessed at diagnosis, after 6, 12 and 24 months from 798 patients with sporadic CRC participating in two prospective cohort studies. Associations between 25(OH)D3 levels and individual inflammatory markers as well as a summary inflammatory z-score were assessed at each time point by multiple linear regression analyses. To assess the association between 25(OH)D3 and inflammatory markers over the course of 2 years, linear mixed model regression analyses were conducted. Results: Higher 25(OH)D3 levels were associated with lower IL6 levels at diagnosis, at 6 months after diagnosis and over the course of 2 years (β −0.06, 95% CI −0.08 to −0.04). In addition, 25(OH)D3 levels were inversely associated with the summary inflammatory z-score at diagnosis and over the course of 2 years (β −0.17, 95% CI −0.25 to −0.08). In addition, a significant inverse association between 25(OH)D3 levels and IL10 was found over the course of 2 years. Intra-individual analyses showed an inverse association between 25(OH)D3 and IL10, IL6 and TNFα. No statistically significant associations between 25(OH)D3 and IL8 and hsCRP levels were observed. Conclusions: Serum 25(OH)D3 levels were inversely associated with the summary inflammatory z-score and in particular with IL6 in the years following CRC diagnosis. This is of potential clinical relevance as IL6 has an important role in chronic inflammation and is also suggested to stimulate cancer progression. Further observational studies should investigate whether a possible 25(OH)D3-associated reduction of inflammatory mediators influences treatment efficacy and CRC recurrence.

Published
2020

42. Muscle Toxicity of Drugs: When Drugs Turn Physiology into Pathophysiology

Author

Silvie Timmers, Christiaan G J Saris, Lando Janssen, Jaap Keijer, Maria T. E. Hopman, and Neeltje A. E. Allard

Subjects
Physiology, Bioinformatics, statins, 03 medical and health sciences, 0302 clinical medicine, Muscular Diseases, Predictive Value of Tests, Risk Factors, Physiology (medical), Medicine, Animals, Humans, Muscle, Skeletal, Molecular Biology, muscle toxicity, VLAG, Human Nutrition & Health, business.industry, Humane Voeding & Gezondheid, Metabolic Disorders Radboud Institute for Health Sciences [Radboudumc 6], General Medicine, Myotoxicity, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], Prognosis, drug-induced myopathy, statin myopathy, Pathophysiology, 030220 oncology & carcinogenesis, Human and Animal Physiology, Toxicity, WIAS, Fysiologie van Mens en Dier, Drug-induced myopathy, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, 030217 neurology & neurosurgery
Abstract

Item does not contain fulltext Drugs are prescribed to manage or prevent symptoms and diseases, but may sometimes cause unexpected toxicity to muscles. The symptomatology and clinical manifestations of the myotoxic reaction can vary significantly between drugs and between patients on the same drug. This poses a challenge on how to recognize and prevent the occurrence of drug-induced muscle toxicity. The key to appropriate management of myotoxicity is prompt recognition that symptoms of patients may be drug related and to be aware that inter-individual differences in susceptibility to drug-induced toxicity exist. The most prevalent and well-documented drug class with unintended myotoxicity are the statins, but even today new classes of drugs with unintended myotoxicity are being discovered. This review will start off by explaining the principles of drug-induced myotoxicity and the different terminologies used to distinguish between grades of toxicity. The main part of the review will focus on the most important pathogenic mechanisms by which drugs can cause muscle toxicity, which will be exemplified by drugs with high risk of muscle toxicity. This will be done by providing information on key clinical and laboratory aspects, muscle electromyography patterns and biopsy results, and pathological mechanism and management for a specific drug from each pathogenic classification. In addition, rather new classes of drugs with unintended myotoxicity will be highlighted. Furthermore, we will explain why it is so difficult to diagnose drug-induced myotoxicity, and which tests can be used as a diagnostic aid. Lastly, a brief description will be given of how to manage and treat drug-induced myotoxicity.

Published
2020

43. Consumption of a diet high in dairy leads to higher 15:0 in cholesteryl esters of healthy people when compared to diets high in meat and grain

Author

Yvonne T. van der Schouw, Johanna M. Geleijnse, Sabita S. Soedamah-Muthu, Ivonne Sluijs, Linda E.T. Vissers, Nicolaas P.A. Zuithoff, and Medical and Clinical Psychology

Subjects
Male, Nutrition and Disease, Endocrinology, Diabetes and Metabolism, Myristic acid, Medicine (miscellaneous), 030204 cardiovascular system & hematology, Pentadecanoic acid, Recommended Dietary Allowances, Random order, chemistry.chemical_compound, Endocrinology, 0302 clinical medicine, Voeding en Ziekte, Total fat, Margaric Acid, Netherlands, Human Nutrition & Health, chemistry.chemical_classification, Nutrition and Dietetics, Cross-Over Studies, Fatty Acids, Humane Voeding & Gezondheid, Healthy Volunteers, Up-Regulation, Diabetes and Metabolism, Cholesteryl ester, Female, Cholesterol Esters, Cardiology and Cardiovascular Medicine, Nutritive Value, Adult, Meat, Adolescent, 030209 endocrinology & metabolism, 03 medical and health sciences, Young Adult, Animal science, Journal Article, Humans, Margaric acid, VLAG, Myristates, Fatty acid, Feeding Behavior, Diet, chemistry, Circulating fatty acids, Edible Grain, Biomarkers, Randomized cross-over trial, Dairy products
Abstract

Background and aimsA higher dairy product intake has been associated to higher blood concentrations of 15:0 (pentadecanoic acid), 17:0 (margaric acid), and 14:0 (myristic acid). This study investigates whether a diet high in dairy products influences cholesteryl ester fatty acid concentrations of these specific fatty acids (FA).Methods and resultsIn a randomized multiple cross-over study, 13 men and 17 women aged 22 ± 4 years with a BMI of 21.6 ± 2.2 kg/m2 received 3 isocaloric intervention diets (dairy, meat or grain) in random order. For this post-hoc analysis, FA in plasma cholesteryl esters were measured using gas chromatography. We performed a linear mixed model per centered log-ratio transformed FA, adjusting for period, and the interaction between diet and period. Consumed total fat intake per controlled intervention diet was 31.0 ± 0.9 en%/day (dairy), 31.5 ± 0.6 en%/day (meat), and 28.4 ± 1.2 en%/day (grain), respectively. The dairy diet led to higher relative concentrations of 15:0 when compared to diets high in meat and grain, (β; 0.27, 95%CI: 0.18,0.37; p = 1.2 × 10−5, and β: 0.15; 95%CI: 0.06,0.24; p = 1.2 × 10−2, respectively). The dairy diet also led to higher 14:0 when compared to the meat diet (β: 0.34; 95%CI: 0.21,0.46; p = 6.0 × 10−5), but not when compared to the grain diet. 17:0 did not differ between diets.ConclusionThe plasma cholesteryl ester fraction after a diet high in dairy was characterized by higher 15:0 levels. Concentrations of 14:0 were only higher when comparing the FA profile after a diet high in dairy when compared to a diet high in meat.Clinical trial registrationClinicalTrials.gov, NCT01314040.

Published
2020

44. Linear growth failure of Ethiopian children : The role of protein, zinc and mycotoxin intake

Author

Masresha Tessema Anegago, Wageningen University, E.J.M. Feskens, I.D. Brouwer, and N.S. Gunaratna

Subjects
Global Nutrition, Wereldvoeding, Humane Voeding & Gezondheid, chemistry.chemical_element, Zinc, Biology, Linear Growth Failure, chemistry.chemical_compound, chemistry, Life Science, Food science, Mycotoxin, VLAG, Human Nutrition & Health
Abstract

Linear growth failure manifested as stunting is a major public health problem in developing countries. Stunting is often considered as an important marker of an adverse quality of population’s life and child development. Over 90% of stunted children live in 10 developing countries, in Asia and Africa. Ethiopia is the country with the high burden of linear growth failure. In 2016, it was estimated that about 5 million children suffered from poor linear growth or stunting in Ethiopia. The prevalence of stunting in Ethiopia has been reduced from 52% in 2000 to 37% in 2019, however, the number of stunted children has increased by about 1 million in the same period. There is a high level of commitment to reducing stunting globally and nationally. Although the government of Ethiopia formulated ambitious goals to reduce stunting, the progress to reduce stunting in Ethiopia remains too slow partly due to the fact that the aetiology of linear growth failure is still poorly understood. Stunting or poor linear growth is caused by a diverse and complex interaction of household, environmental, socioeconomic and cultural influences, related to, amongst others, poor nutrition, infectious diseases, unfavorable prenatal conditions and genetic disorders. The aim of this thesis was to contribute to the understanding of the aetiology of poor linear growth and stunting in rural Ethiopia by studying the effect of household-level quality protein maize (QPM) promotion and consumption, and the role of protein, zinc, and mycotoxins intake on linear growth of Ethiopian children. The first chapter provides background information on the role of QPM, protein, and zinc (in soil and serum) in linear growth of children. Furthermore, the research questions were described in detail.Chapter 2 describes a randomized controlled trial conducted in real practice in which households make their own decisions whether to adopt QPM, how much to adopt and cultivate, and whether and how to incorporate QPM into children’s diets. The intervention had two components: a) nutrition-focused adoption encouragement and provision of free QPM seed (AE), and b) a consumption encouragement (CE) primarily targeting female caregivers and encouraging earmarking and integration of QPM into diets for infants and young children. Eligible children (n=873) aged 6-35 months at baseline were randomly assigned to 3 groups: a first intervention group receiving AE only; a second intervention group receiving both AE and CE; and a control group. We hypothesized that promotion and consumption of QPM could improve the protein and amino acids status, which could, in turn, improve linear growth of children. Children consumed QPM based foods on average 4 days per week, while non-QPM based foods were consumed mostly. In addition, the quantitative intake of QPM was low (27 gram per day) contributing to only 5% of their total protein, 12% of lysine and 15% of tryptophan intakes, compared with conventional maize (80 gram per day) contributing to 16%, 9%, 13% of protein, lysine and tryptophan intakes respectively. Encouragement to adopt and feed QPM to infants and young children in a real-life setting had no effect on children’s protein biomarkers (p=0.19) or linear growth (p=0.17). Further evaluation of multi-year interventions is needed to understand how biofortified crops promoted at scale could change behavior and increase intakes at the household level which in turn improve biomarkers and outcomes in target populations.In chapter 3, we performed a cross-sectional analysis using baseline data of the QPM intervention study conducted in chapter 2. We investigated the association between protein intake, and protein and amino acids status with linear growth of children. The results indicated that protein intake (b=0.01, p=0.01) and protein status (b=2.58, p=0.04) as well as tryptophan intake/status (p0.05), serum transthyretin (p >0.05) or serum IGF-1 (p >0.05), nor with linear growth (p >0.05) after adjusting for potential confounders. Our study revealed that exposure to most aflatoxins was high in pre-harvest season. Good practices in both post-harvest (to reduce accumulation of aflatoxins) and pre-harvest (to reduce aflatoxin levels) are needed for preventing contamination of aflatoxin. The mechanism in which aflatoxin affects linear growth of children is not clear. Aflatoxins are carcinogenic properties and the current exposure is a major public health problem that warrants intervention. Future studies on mechanisms between aflatoxin exposure and linear growth and sources of exposure with large sample size needed. In addition, future research is also needed on the complex and interacting pathophysiology of multiple mycotoxins and exposure management.In chapter 5, we use data from the cross-sectional, nationally representative Ethiopian National Micronutrient Survey (n=1776), which provided anthropometric and serum zinc (n=1171) data on children aged 6–59 months. Data on soil zinc levels were extracted for each child from the Africa Soil Information Service. With these data, we assessed the geographic distribution of poor soil zinc, poor zinc status and growth faltering at the national level. Zinc deficiency in soil was prevalent (20%) at the national level, with a higher prevalence in low land of Ethiopia (87%). Nationally, one in four children was zinc deficient, as measured by serum zinc level. High zinc in agricultural soils was positively associated with zinc status (b=0.9, p=0.02), however, linear growth of children was not associated with soil zinc or serum zinc. The findings from our study suggest that agricultural biofortification of zinc could be an alternative strategy for reducing zinc deficiency in developing countries. In Ethiopia most households consume food that comes from own production, however, crop production on zinc-deficient soils and its effect on human health has not yet been studied. Therefore, a future longitudinal experimental study on the effects of soil zinc application on crop zinc content and human serum zinc levels will help to elucidate this relationship. The phytate content of foods may affect zinc bioavailability. Future research is also needed on the effect of phytate on zinc bioavailability of crops grown on zinc-deficient soils.Finally, chapter 6 discusses the main findings, and the internal and external validity of the studies addressed in this thesis. Furthermore, the public health perspective including recommendations for possible future research is presented. Overall, we can conclude that low protein (of low quality) intake, high prevalence of zinc deficiency and high exposure to multiple aflatoxins are public health problems in Ethiopia. Linear growth of children is positively associated with protein intake, energy intake, as well as protein status, but not with zinc soil levels, zinc status or multiple aflatoxin exposure. Our study has demonstrated that the implementation of QPM in real life had no effect on the protein and amino acids status nor on linear growth of children. Therefore, in our study and also in other nutrition intervention programs, measuring intermediate indicators as outcomes of improved linear growth may be a more feasible approach than measuring linear growth or stunting.

Published
2020

45. Potential impact of meat replacers on nutrient quality and greenhouse gas emissions of diets in four European countries

Author

Sander Biesbroek, Aida Turrini, Laura D'Addezio, Carine Dubuisson, Pieter van 't Veer, Johanna M. Geleijnse, Lorenza Mistura, Elly Mertens, Ellen Trolle, Sabrina Havard, and Marcela Dofkova

Subjects
Food intake, Nutrition and Disease, 030309 nutrition & dietetics, Geography, Planning and Development, Fortification, TJ807-830, Nutritional quality, 010501 environmental sciences, Management, Monitoring, Policy and Law, Biology, TD194-195, 01 natural sciences, Diet modelling, Renewable energy sources, Scenario analysis, Nutrient density, Environmental impact, 03 medical and health sciences, Animal science, Nutrient, Voeding en Ziekte, Greenhouse gas emissions, GE1-350, Preferable, 0105 earth and related environmental sciences, VLAG, Human Nutrition & Health, Global Nutrition, 0303 health sciences, Potential impact, Wereldvoeding, Environmental effects of industries and plants, Renewable Energy, Sustainability and the Environment, Humane Voeding & Gezondheid, food and beverages, Environmental sciences, Current consumption, Greenhouse gas
Abstract

Meat replacers could play a role in achieving more plant-based diets, but their current consumption is limited. The present modelling study aimed to explore the nutritional and greenhouse gas emissions impacts of meat replacers. Using dietary surveys from Denmark, Czech Republic, Italy and France (~6500 adults), we composed alternative diets in which all the meat in the observed diet (in grams) was substituted by similar use meat replacers (with and without fortification). Starting from the observed diets and meat-replacement diets, diets with improved adherence to food-based dietary guidelines (FBDGs) were modelled using Data Envelopment Analysis. These improved diets were then further optimised for dietary preferences (MaxP, diet similarity index), nutrient quality (MaxH, Nutrient Rich Diet score, NRD15.3) or diet-related greenhouse gas emissions (GHGE) (MaxS, CO2 equivalents). In all optimised modelled diets, the total amount of meat was lower than in the observed diets, i.e., 30% lower in the MaxP, 50% lower in the MaxH, and 75% lower in the MaxS diets. In the MaxP diet, NRD15.3 was ~6% higher, GHGE was ~9% lower, and ~83% of food intake remained similar. In the MaxH diet, NRD15.3 was ~17% higher, GHGE was ~15% lower, and ~66% of food intake remained similar. In the MaxS diet, NRD15.3 was ~9% higher, GHGE was ~33% lower, and ~65% of food intake remained similar. When using fortified meat replacers, for all modelled diets, the diet similarity was on average 2% lower and the GHGE reduction was on average 3% higher as compared with the same scenarios without fortification. This analysis showed that meat replacers, provided their preference is similar to meat, can provide benefits for GHGE, without necessarily compromising nutrient quality.

Published
2020

46. A 4-week exercise and protein program improves muscle mass and physical functioning in older adults - A pilot study

Author

Margot de Regt, Marlieke Visser, Maria T. E. Hopman, Marco Mensink, Pol Grootswagers, Jacintha Domić, Jaap Dronkers, and Ben J.M. Witteman

Subjects
0301 basic medicine, Male, Aging, medicine.medical_specialty, Nutrition and Disease, Prehabilitation, Physical exercise, Pilot Projects, Isometric exercise, Muscle mass, Biochemistry, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Physical functioning, Isometric Contraction, Voeding en Ziekte, Genetics, Medicine, Aerobic exercise, Humans, Muscle Strength, Muscle, Skeletal, Molecular Biology, Exercise, Supervised training, Aged, VLAG, Human Nutrition & Health, Hand Strength, business.industry, Protein, Metabolic Disorders Radboud Institute for Health Sciences [Radboudumc 6], Humane Voeding & Gezondheid, VO2 max, Resistance Training, Cell Biology, Nutritional Biology, Ageing, 030104 developmental biology, Physical therapy, Physical function, Female, business, 030217 neurology & neurosurgery
Abstract

Contains fulltext : 229788.pdf (Publisher’s version ) (Open Access) BACKGROUND: Prehabilitation might attenuate common surgery-induced losses in muscle mass and physical performance. Beneficial effects of physical exercise with protein supplementation have been reported in older adults, but typically after an intervention of at least 12 weeks. The time-window for pre-surgery training is often limited to around 30 days, and it is not known if it is possible to achieve comparable results in such a short time window. OBJECTIVES: The aim of this study was to pilot-test the effectiveness of a controlled four-week combined exercise and protein supplementation program on skeletal muscle-related outcomes in a Dutch older adult population. DESIGN: This study was a one-armed pilot trial. PARTICIPANTS: Seventeen older men and women, aged 55-75y, not scheduled for surgery. INTERVENTION: A 4-week intervention program consisting of a twice-weekly supervised resistance and high-intensity aerobic exercise training of 75 min, combined with daily protein supplementation (2 doses of 15.5 g/day at breakfast and lunch). MEASUREMENT: After two and four weeks, isometric quadriceps maximal voluntary contraction (MVC) was assessed via Biodex and quadriceps cross-sectional area (CSA) via magnetic resonance imaging. Other outcome measures were handgrip strength, chair rise time and maximal aerobic capacity (VO(2)-max), as assessed from a submaximal exercise test. RESULTS: Compliance to the supervised training sessions (99.3%) and the protein supplementation (97%) was very high. The 4-week exercise and protein program led to an increase in quadriceps CSA of 2.3 ± 0.7 cm(2) (P = 0.008) in the dominant leg and 3.2 ± 0.7 cm(2) (P

Published
2020

47. Pre-to-post diagnosis weight trajectories in colorectal cancer patients with non-metastatic disease

Author

Paul C. van de Meeberg, Johannes H. W. de Wilt, Fränzel J.B. van Duijnhoven, Renate M. Winkels, Ellen Kampman, Merel Snellen, Moniek van Zutphen, Anne J.M.R. Geijsen, Ewout A. Kouwenhoven, Anouk Geelen, Henk K. van Halteren, Dieuwertje E. Kok, Ernst Jan Spillenaar Bilgen, Evertine Wesselink, and Hendriek C. Boshuizen

Subjects
Male, medicine.medical_specialty, Nutrition and Disease, Colorectal cancer, medicine.medical_treatment, Disease, Gastroenterology, Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14], 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, 0302 clinical medicine, Weight loss, Voeding en Ziekte, Internal medicine, Weight Loss, medicine, Humans, Chemotherapy, 030212 general & internal medicine, Prospective cohort study, Weight gain, Aged, Netherlands, VLAG, Human Nutrition & Health, business.industry, Body Weight, Weight change, Humane Voeding & Gezondheid, Middle Aged, medicine.disease, Biometris, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Disease Progression, Body-Weight Trajectory, Female, Original Article, Observational study, medicine.symptom, Colorectal Neoplasms, business
Abstract

Purpose: Previous studies have shown that > 50% of colorectal cancer (CRC) patients treated with adjuvant chemotherapy gain weight after diagnosis. This may affect long-term health. Therefore, prevention of weight gain has been incorporated in oncological guidelines for CRC with a focus on patients that undergo adjuvant chemotherapy treatment. It is, however, unknown how changes in weight after diagnosis relate to weight before diagnosis and whether weight changes from pre-to-post diagnosis are restricted to chemotherapy treatment. We therefore examined pre-to-post diagnosis weight trajectories and compared them between those treated with and without adjuvant chemotherapy. Methods: We included 1184 patients diagnosed with stages I–III CRC between 2010 and 2015 from an ongoing observational prospective study. At diagnosis, patients reported current weight and usual weight 2 years before diagnosis. In the 2 years following diagnosis, weight was self-reported repeatedly. We used linear mixed models to analyse weight trajectories. Results: Mean pre-to-post diagnosis weight change was −0.8 (95% CI −1.1, −0.4) kg. Post-diagnosis weight gain was + 3.5 (95% CI 2.7, 4.3) kg in patients who had lost ≥ 5% weight before diagnosis, while on average clinically relevant weight gain after diagnosis was absent in the groups without pre-diagnosis weight loss. Pre-to-post diagnosis weight change was similar in patients treated with (−0.1 kg (95%CI −0.8, 0.6)) and without adjuvant chemotherapy (−0.9 kg (95%CI −1.4, −0.5)). Conclusions: Overall, hardly any pre-to-post diagnosis weight change was observed among CRC patients, because post-diagnosis weight gain was mainly observed in patients who lost weight before diagnosis. This was observed independent of treatment with adjuvant chemotherapy.

Published
2018

48. Modulation of event-related potentials to food cues upon sensory-specific satiety

Author

H.F.A. Zoon, Kathrin Ohla, Sanne Boesveldt, and Cees de Graaf

Subjects
0301 basic medicine, Food intake, medicine.medical_specialty, Sensory-specific satiety, media_common.quotation_subject, Olfactory cues, Appetite, Neural response, Experimental and Cognitive Psychology, Satiation, Audiology, Eating, Young Adult, 03 medical and health sciences, Behavioral Neuroscience, 0302 clinical medicine, Event-related potential, Perception, medicine, Humans, Food consumption, Valence (psychology), Evoked Potentials, Sensory Science and Eating Behaviour, VLAG, Human Nutrition & Health, media_common, Meal, 030109 nutrition & dietetics, Food anticipation, Humane Voeding & Gezondheid, digestive, oral, and skin physiology, Brain, Electroencephalography, Cognition, Olfactory Perception, Electro-encephalography, Sensoriek en eetgedrag, Food, Visual Perception, Female, Cues, Visual, Psychology, 030217 neurology & neurosurgery, Olfactory
Abstract

Tempting environmental food cues and metabolic signals are important factors in appetite regulation. Food intake reduces liking of food cues that are congruent to the food eaten (sensory-specific satiety). With this study we aimed to assess effects of sensory-specific satiety on neural processing (perceptual and evaluative) of visual and olfactory food cues. Twenty healthy female subjects (age: 20 ± 2 years; BMI: 22 ± 2 kg/m2) participated in two separate test sessions during which they consumed an ad libitum amount of a sweet or savoury meal. Before and after consumption, event-related potentials were recorded in response to visual and olfactory cues signalling high-energy sweet, high-energy savoury, low-energy sweet and low-energy savoury food and non-food items. In general, we observed that food intake led to event-related potentials with an increased negative and decreased positive amplitudes for food, but also non-food cues. Changes were most pronounced in response to high-energy sweet food pictures after a sweet meal, and occurred in early processes of perception (~80–150 ms) and later processes of cognitive evaluation (~300–700 ms). Food intake appears to lead to general changes in neural processing that are related to motivated attention, and sensory-specific changes that reflect decreased positive valence of the stimuli and/or modulation of top-down cognitive control over processing of cues congruent to the food eaten to satiety.

Published
2018

49. Evaluation of dietary taste patterns as assessed by FFQ against 24-h recalls and biomarkers of exposure

Author

Edith J. M. Feskens, Astrid W.B. van Langeveld, Jeanne H M de Vries, Pey Sze Teo, Cees de Graaf, and Monica Mars

Subjects
Adult, Male, 0301 basic medicine, Food intake, Taste, Validation study, Medicine (miscellaneous), Physiology, 030209 endocrinology & metabolism, Umami, Diet Surveys, Eating, Food Preferences, 03 medical and health sciences, 0302 clinical medicine, Food choice, Life Science, Humans, Medicine, Sensory Science and Eating Behaviour, VLAG, Human Nutrition & Health, Netherlands, Global Nutrition, Wereldvoeding, 030109 nutrition & dietetics, Nutrition and Dietetics, business.industry, Humane Voeding & Gezondheid, Reproducibility of Results, food and beverages, Sodium, Dietary, Middle Aged, medicine.disease, Obesity, Sensoriek en eetgedrag, Human nutrition, Mental Recall, Female, Dietary Proteins, Wine tasting, Energy Intake, business, Biomarkers
Abstract

Background/objective: Taste is of key importance in food choice and dietary patterns, but studies on taste profiles are limited. We previously assessed dietary taste patterns by 24 h recalls (24hR), but for epidemiological studies food frequency questionnaires (FFQ) may also be suitable. This study compared dietary taste patterns based on FFQ against 24hR and biomarkers of exposure. Subjects/methods: A taste database including 467 foods’ sweet, sour, bitter, salt, umami and fat sensation values was combined with food intake data to assess dietary taste patterns: the contribution to energy intake of 6 taste clusters. The FFQ’s reliability was assessed against 3-d 24hR and urinary biomarkers for sodium (Na) and protein intake (N) in Dutch men (n = 449) and women (n = 397) from the NQplus validation study (mean age 53 ± 11 y, BMI 26 ± 4 kg/m2). Results: Correlations of dietary taste patterns ranged from 0.39–0.68 between FFQ and 24hR (p < 0.05). Urinary Na levels, but not N levels, were positively associated with % energy intake from ‘salt, umami & fat’ tasting foods (Na; FFQ, r = 0.24, 24hR, r = 0.23, p < 0.001, N; FFQ, r = 0.08, p = 0.1394, 24hR, r = 0.05, p = 0.3427). Conclusions: The FFQ’s reliability against 24hR was acceptable to good for ranking of adults’ dietary taste patterns. Associations between dietary taste patterns and urinary Na and N were similar for FFQ and 24hR. These findings suggests that both FFQ and 24hR can be used in combination with our taste database, to investigate potential relationships between dietary taste patterns and subgroups at risk of obesity and chronic diseases such as cardiovascular disease.

Published
2018

50. Validity of Absolute Intake and Nutrient Density of Protein, Potassium, and Sodium Assessed by Various Dietary Assessment Methods: An Exploratory Study

Author

Gertjan van Dijk, Paul J.M. Hulshof, Pieter van 't Veer, Jeanne H.M. de Vries, Peter C. H. Hollman, Laura Trijsburg, Edith J. M. Feskens, Hendriek C. Boshuizen, Anouk Geelen, and Van Dijk lab

Subjects
0301 basic medicine, Male, Multivariate statistics, Dietary assessment, Nutrition and Disease, Potassium, 5 VALIDATION, 0302 clinical medicine, Nutrient, MARKERS, Surveys and Questionnaires, Voeding en Ziekte, Validation, 030212 general & internal medicine, Nutrient density, Multivariate models, Netherlands, Human Nutrition & Health, validation, Nutrition and Dietetics, Dietary exposure, Humane Voeding & Gezondheid, dietary assessment, Middle Aged, Nutritional Biology, TOTAL-ENERGY INTAKE, BALANCE, Female, Dietary Proteins, Nutritive Value, lcsh:Nutrition. Foods and food supply, RECOVERY BIOMARKERS, Adult, Doubly labeled water, Sodium, nutrient density, CORRELATED MEASUREMENT ERROR, chemistry.chemical_element, Nutritional Status, lcsh:TX341-641, ADJUSTMENT, multivariate models, Diet Surveys, Article, 03 medical and health sciences, Measurement errors, Young Adult, Animal science, COMPLETENESS, Humans, Aged, VLAG, Global Nutrition, Wereldvoeding, 030109 nutrition & dietetics, Potassium, Dietary, Sodium, Dietary, Nutrients, QUESTIONNAIRES, doubly labeled water, Nutrition Assessment, chemistry, Multivariate Analysis, Energy Intake, measurement errors, Food Science
Abstract

It is suggested that nutrient densities are less affected by measurement errors than absolute intake estimates of dietary exposure. We compared the validity of absolute intakes and densities of protein (kJ from protein/total energy (kJ)), potassium, and sodium (potassium or sodium (in mg)/total energy (kJ)) assessed by different dietary assessment methods. For 69 Dutch subjects, two duplicate portions (DPs), five to fifteen 24-h dietary recalls (24 hRs, telephone-based and web-based) and two food frequency questionnaires (FFQs) were collected and compared to duplicate urinary biomarkers and one or two doubly labelled water measurements. Multivariate measurement error models were used to estimate validity coefficients (VCs) and attenuation factors (AFs). This research showed that group bias diminished for protein and sodium densities assessed by all methods as compared to the respective absolute intakes, but not for those of potassium. However, the VCs and AFs for the nutrient densities did not improve compared to absolute intakes for all four methods, except for the AF of sodium density (0.71) or the FFQ which was better than that of the absolute sodium intake (0.51). Thus, using nutrient densities rather than absolute intakes does not necessarily improve the performance of the DP, FFQ, or 24 hR.

Published
2019

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