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Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

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    Goede voeding voor het hart : zorg dat het klopt
    Geleijnse, Marianne - \ 2016
    Wageningen : Wageningen University & Research - ISBN 9789463430234 - 32
    gezondheidsgedrag - voeding en gezondheid - hart- en vaatziekten - obesitas - roken - zout - levensstijl - health behaviour - nutrition and health - cardiovascular diseases - obesity - smoking - salt - lifestyle
    Targeting persons with low socioeconomic status of different ethnic origins with lifestyle interventions : opportunities and effectiveness
    Bukman, A.J. - \ 2016
    Wageningen University. Promotor(en): Edith Feskens, co-promotor(en): Reint-Jan Renes. - Wageningen : Wageningen University - ISBN 9789462577022 - 169
    socioeconomic status - lifestyle - ethnic groups - intervention - cardiovascular diseases - type 2 diabetes - diabetes - obesity - dutch - turkish - glucose tolerance - morocco - physical activity - prevention - sociaal-economische positie - levensstijl - etnische groepen - interventie - hart- en vaatziekten - diabetes type 2 - suikerziekte - obesitas - nederlands - turks - glucosetolerantie - marokko - lichamelijke activiteit - preventie

    Lifestyle intervention studies have shown that the development of cardiometabolic diseases can be partly prevented or postponed by the combination of a healthy diet and physical activity. Cardiometabolic diseases and their risk factors are particularly prevalent among individuals with low socioeconomic status and some ethnic minorities, and therefore these groups especially may benefit from participating in lifestyle interventions. Although individuals with low socioeconomic status and ethnic minorities could potentially benefit from lifestyle interventions, it seems that these groups are often not successfully reached for such interventions. Moreover, when they do participate in these interventions, they seem more likely to quit. The overall aim of this thesis was therefore to study opportunities for, and the effectiveness of, lifestyle interventions to reduce the risk of cardiometabolic diseases, targeting individuals with low socioeconomic status of different ethnic origins. To this end, this thesis reports two studies that identified opportunities for adapting lifestyle interventions to the target group’s needs, one study describing the process of adapting an effective lifestyle intervention (SLIM) into a new lifestyle intervention targeting individuals with low SES of different ethnic origins (MetSLIM) and two studies that determined the effectiveness of lifestyle interventions among the target group.

    The aim of the study described in chapter 2 was to identify opportunities for adapting lifestyle interventions in such a way as to be more appealing for individuals with low socioeconomic status. The study provided insight into perspectives of groups with different socioeconomic positions regarding their current eating and physical activity behaviour; triggers for lifestyle change; and preferred ways to support lifestyle change. Data were gathered in semi-structured focus group interviews with adults with low socioeconomic status (four groups) and with adults with high socioeconomic status (five groups). In general, three key topics were identified, namely: current lifestyle is logical for participants given their personal situation; lifestyle change is prompted by feedback from their body; and support for lifestyle change should include individually tailored advice and could profit from involving others. The perceptions of the participants with low socioeconomic status were generally comparable to the perceptions shared by the participants with high socioeconomic status. Some perceptions were, however, especially mentioned in the low socioeconomic status groups. Participants with low socioeconomic status indicated that their current eating behaviour was sometimes affected by cost concerns. They seemed to be especially motivated to change their lifestyle when they experienced health complaints but were rather hesitant to change their lifestyle for preventive purposes. Regarding support for lifestyle change, participants with low socioeconomic status preferred to receive advice in a group rather than on their own. For physical activities, groups should preferably consist of persons of the same age, gender or physical condition.

    The aim of the study described in chapter 3 was to identify how Turkish and Moroccan adults living in the Netherlands, aged 45 years and older, could be reached to participate in health checks for cardiometabolic diseases and follow-up (lifestyle) advice. In this study, questionnaire data were combined with interview data. This was done in order to use the narratives from the interviews to get a better understanding of the numbers that resulted from the questionnaire data. It turned out that both ethnic groups preferred an invitation from their general practitioner (GP) for a health check and preferred to fill out the health check questionnaire at the GP’s office or at home, on paper. They preferred to receive advice at individual level in relation to personal matters via either a physician or a specialised healthcare professional. Sixty-one percent of the Turkish respondents preferred to receive information in their native language, compared to 37% of the Moroccan respondents. Several participants mentioned a low proficiency in the local language as an explanation for their preference to fill out the health check questionnaire at home, to receive advice from an ethnicity-matched professional and to receive information in their native language. The results of this study suggested that the GP would be a promising contact to reach adults of Turkish and Moroccan origin for health checks or (lifestyle) advice. Furthermore, the findings suggested that it would be necessary to provide information in individuals’ native language to overcome language barriers and that (lifestyle) advice should be tailored towards the needs of the targeted individuals.

    The insights gained into the needs and preferences of the target group – as described in chapter 2 and chapter 3 – were taken into account in the design of the MetSLIM intervention study. The MetSLIM study targeted individuals with low socioeconomic status of Dutch, Turkish and Moroccan origin. The MetSLIM study protocol was based on the SLIM study protocol. The SLIM study showed the beneficial effects of nutrition advice and physical activity promotion on the prevention type 2 diabetes, but drop-out was relatively high among low SES participants. Chapter 4 provides a detailed description of the development from the SLIM study protocol to the MetSLIM study protocol. Furthermore, this chapter gives insight into the obstacles encountered in developing the MetSLIM study to target individuals with low socioeconomic status of different ethnic origins. The new elements regarding the lifestyle intervention programme were: 1) additional group meetings about price concerns and social occasions with regard to a healthy diet; 2) ethnicity-matched dieticians; 3) gender-matched sports instructors; 4) all activities in the participants’ own neighbourhood; and 5) activities for women and men separately. The new elements regarding the study design, in order to study the effectiveness of the MetSLIM intervention programme, included: 1) from an university stetting to a community setting; 2) from a randomised controlled trial to a quasi-experimental study; 3) waist circumference – as a visible cardiometabolic risk factor – as main study outcome; 4) recruitment via GPs and in community centres; 5) translated study materials and ethnicity-matched research assistants involved in measuring; and 6) fewer measurements and measurements that could take place at different locations. Adaptations to the original SLIM study protocol were considered necessary in order to overcome practical barriers that hinder the target group’s participation; to suit the target group’s (cultural) needs; and to make it feasible to perform the study in a local (community) setting.

    MetSLIM was not the only study set up based on the SLIM study. The SLIMMER study translated SLIM from a university setting to a real-world setting. The intervention was implemented in the public health and primary healthcare setting involving local GPs, practice nurses, dieticians, physiotherapists and sports clubs. The SLIMMER study did not target individuals with low socioeconomic status in particular; however, 52% of the study participants did have a low socioeconomic status, as determined by highest completed educational level. Chapter 5 describes how we explored the role of socioeconomic status in willingness to participate, programme attendance, programme acceptability, adherence to lifestyle guidelines, drop-out and effectiveness in the SLIMMER diabetes prevention intervention. The SLIMMER study was a randomised controlled trial, targeting 40- to 70-year-old adults at increased risk of type 2 diabetes, carried out in Apeldoorn and Doetinchem. The intervention group participated in a 10-month lifestyle programme: weekly training sessions were guided by a physiotherapist, and dietary advice was given by a dietician during 5–8 individual consultations and one group session. Measurements were carried out at baseline, after 12 months and six months after the active intervention period ended. The study showed that participation, attendance, acceptability, adherence, drop-out and effect of the SLIMMER study were mostly not affected by socioeconomic status. The SLIMMER study was able to reach the low socioeconomic status group as effectively as the higher socioeconomic status group, resulting in at least similar health benefits. The SLIMMER sample size was too small to study differences within the low socioeconomic status group, e.g. comparing the low vs. the least educated or comparing ethnic groups. Only 10% of the 316 SLIMMER participants had the lowest educational levels (no education or primary education) and only 11% had a foreign background.

    The aim of the study described in chapter 6 was to measure the effectiveness of the MetSLIM intervention on waist circumference and other cardiometabolic risk factors, lifestyle and quality of life among 30- to 70-year-old adults with an elevated waist-to-height ratio. In the MetSLIM study, 220 individuals participated, of whom 40% had no education or only primary education and of whom 64% had a foreign background. MetSLIM had a quasi-experimental design with measurements at baseline and after 12 months. Participants were recruited in deprived neighbourhoods of Arnhem and Eindhoven via either their GP or in community centres. The intervention group participated in a 12-month lifestyle programme: an introductory group meeting was guided by the researcher, weekly physical activity lessons were guided by a sports instructor and dietary advice was given by an ethnicity-matched dietician (in total four hours of individual consultations and three group sessions). The study showed that the MetSLIM lifestyle intervention was effective in reducing waist circumference, other measures of obesity, total and LDL cholesterol, and quality of life. MetSLIM had a drop-out of 31%, which was higher than at 12 months in the SLIM study (10%) and SLIMMER study (13%), but comparable to drop-out in similar studies among ethnic minorities or low socioeconomic status populations.

    Finally, in chapter 7, the main results of this thesis are described, followed by a discussion of methodological considerations, public health implications, suggestions for future research and the general conclusion. The adaptation process from SLIM to MetSLIM is discussed, including a reflection on the decision to use SLIM as a starting point and the decision to target three different ethnic groups at the same time. Moreover, difficulties in defining and selecting persons with low socioeconomic status and specific ethnic groups within research are addressed. As SLIMMER and MetSLIM proved that low socioeconomic status populations can be reached, and that their health can be improved when they participate in lifestyle interventions, it is suggested that further implementation should be considered. Insight should be gained into the ‘black box’ of lifestyle interventions; i.e. we should get to know what works for whom. Planned future research includes a process and economic evaluation of MetSLIM.

    This thesis has shown that intensive combined lifestyle interventions can be effective in low socioeconomic status populations and identified possible adaptations to make lifestyle interventions more suitable for individuals with low socioeconomic status of Dutch, Turkish and Moroccan origin. The question is not whether a lifestyle intervention can be effective, but how diverse groups can be reached and benefit from it. For this purpose, further insight into the success of different adaptations for different target groups should be obtained to reveal the effective elements to reach, inspire and retain different low socioeconomic status populations and ethnic minorities with lifestyle interventions.

    Blijven Bewegen na de BeweegKuur : De rol van groen in de woonomgeving
    Vries, S. de; Langers, F. ; Meis, Jessie ; Berendsen, B. ; Kremers, Stef - \ 2016
    Wageningen : Alterra, Wageningen-UR (Alterra-rapport 2701) - 25
    voeding en gezondheid - lichamelijke activiteit - levensstijl - openbaar groen - herstellen - gezondheid - voeding - beweging - welzijn - nutrition and health - physical activity - lifestyle - public green areas - reconditioning - health - nutrition - movement - well-being
    De BeweegKuur is een leefstijlinterventie die beoogt blijvend gezonder voedings- en beweeggedrag te
    realiseren. Qua beweging is het de bedoeling dat de deelnemers op het eind van de BeweegKuur
    uitstromen naar het reguliere beweegaanbod in hun leefomgeving. In deze studie is gekeken of groen
    in de woonomgeving een rol speelt bij het volhouden van het beweegniveau tot een jaar na afloop van
    de BeweegKuur. Specifiek is gekeken naar a) de rol van groen bij de keuze voor uitstroomactiviteit en
    b) die van uitstroomactiviteit op de kans op uitval. Daarnaast is, min of meer los van de activiteit,
    gekeken naar c) het volhouden van de mate van lichamelijke activiteit in termen van beweegminuten,
    zoals die op het eind van de BeweegKuur bestond.
    Portraying the sustainable consumer : exploring sustainable food consumption using a lifestyle segmentation approach
    Verain, M.C.D. - \ 2015
    Wageningen University. Promotor(en): Gerrit Antonides, co-promotor(en): Siet Sijtsema; H. Dagevos. - Wageningen : Wageningen University - ISBN 9789462575790 - 220
    consumenten - consumptie - voedselconsumptie - voedsel - duurzaamheid (sustainability) - levensstijl - consumentengedrag - consumers - consumption - food consumption - food - sustainability - lifestyle - consumer behaviour
    Dietary supplement use and colorectal tumors : from prevention to diagnosis
    Bröring, R.C. - \ 2015
    Wageningen University. Promotor(en): Ellen Kampman, co-promotor(en): Renate Winkels. - Wageningen : Wageningen University - ISBN 9789462575011 - 213
    voedselsupplementen - colorectaal kanker - adenoom - risicoanalyse - risicovermindering - levensstijl - kwaliteit van het leven - cohortstudies - kankerbestrijdende eigenschappen - anticarcinogene eigenschappen - terugval - preventie - food supplements - colorectal cancer - adenoma - risk analysis - risk reduction - lifestyle - quality of life - cohort studies - anticancer properties - anticarcinogenic properties - relapse - prevention

    Background: Expert guidelines formulated by the World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) advised no use of dietary supplements for cancer prevention. However, it is unclear whether those recommendations also apply to populations at high risk for incident or recurrent colorectal tumors specifically, since dietary supplement use is ubiquitous in western countries where colorectal tumors are common. Furthermore, before the association between dietary supplement use and recurrence and survival in colorectal cancer patients can be examined, more information about the consistency of dietary supplement use is needed, as it is plausible that use varies over time after colorectal cancer diagnosis. This thesis focuses on the association between dietary supplement use and colorectal tumor risk and recurrence in the general population and in high-risk populations, and describes the consistency of use in patients who were diagnosed with colorectal cancer.

    Methods and results: First, we conducted a systematic literature review with meta-analyses of observational studies about the association between dietary supplement use and colorectal cancer risk. Our findings suggested inverse associations between multivitamins (use versus no use: RR=0.92; 95% CI 0.87–0.97, calcium supplements (use versus no use: RR=0.86; 95% CI 0.79–0.95) and colorectal cancer risk, while the association for other supplements and colorectal cancer risk was inconsistent.

    Second, we investigated the role of dietary supplements in recurrence of colorectal adenomas and advanced colorectal adenomas in a prospective cohort study of 565 patients with a history of sporadic colorectal adenomas. Dietary supplement was not associated with total adenoma recurrence (HR=1.03; 95% CI 0.79–1.34).

    Third, dietary supplement use and colorectal adenoma risk was examined in a prospective cohort study among 470 individuals with Lynch syndrome. No associations were found between dietary supplement use (HR=1.18; 95% CI 0.80–1.73) and colorectal adenoma risk in these individuals.

    Finally, in an ongoing prospective cohort study among incident colorectal cancer patients we evaluated whether dietary supplement use was consistent over time. Dietary supplement use was extensively assessed with a detailed self-administered questionnaire at diagnosis, six months and two years post-diagnosis. We observed that dietary supplement use among 160 colorectal cancer patients was common at all time points, but use was inconsistent from diagnosis to two years post-diagnosis.

    Conclusion: The results in this thesis do not point toward a preventive nor a harmful role for dietary supplement use in colorectal tumor risk and recurrence in the general population and in high-risk populations for colorectal cancer. However, dietary supplement use appeared to be inconsistent over time after colorectal cancer diagnosis, and use should be repetitively assessed over time. Since dietary supplement use is rising in countries where colorectal tumors are prevalent and the incidence of colorectal tumors will increase due to screening practices, research on the role of dietary supplement use for primary or tertiary prevention of colorectal tumors should continue in which use should be repetitively and comprehensively assessed.

    Laagopgeleide wil samen gezonder worden
    Bukman, A.J. - \ 2014
    Resource: weekblad voor Wageningen UR 9 (2014)6. - ISSN 1874-3625 - p. 8 - 8.
    gezondheidsbevordering - levensstijl - sociaal-economische positie - voeding en gezondheid - health promotion - lifestyle - socioeconomic status - nutrition and health
    Samen werken aan je gezondheid werkt beter. Mensen met een lage sociaaleconomische status werken het liefst in groepsverband aan een gezondere levensstijl.
    Hypertension in Vietnam: prevalence, risk groups and effects of salt substitution
    Do, H.T.P. - \ 2014
    Wageningen University. Promotor(en): Edith Feskens; Frans Kok, co-promotor(en): Marianne Geleijnse. - Wageningen : Wageningen University - ISBN 9789462571372 - 159
    hypertensie - risicogroepen - risico - gezondheid - zout - vervangmiddelen - voeding - levensstijl - vietnam - hypertension - risk groups - risk - health - salt - substitutes - nutrition - lifestyle - vietnam


    Background: Over the past decades, the morbidity and mortality patterns have changed rapidly in Vietnam, with a reduction in infectious diseases in parallel with a rapid increase in non-communicable diseases (NCDs), leading to the so-called double burden. It was estimated that in 2008 NCDs accounted for 75% of all deaths in Vietnam, and cardiovascular diseases were the leading cause accounting for 40% of total mortality. Hypertension is one of the major risk factors for cardiovascular disease, but information on the nationwide prevalence and main determinants is lacking. There is an urgent need for appropriate population-based interventions for hypertension control and prevention in Vietnam.

    Methods and Results: Data of 17,213 adults aged 25-64 years from the nationally representative 2005 National Adult Obesity Survey were used to study the prevalence of hypertension and prehypertension and their determinants. The overall prevalence of hypertension was 20.7% and the prevalence of prehypertension was 41.8%. Hypertension and prehypertension were more prevalent in men than in women (25.2% vs. 15.9%). Determinants of raised blood pressure including advancing age, overweight, alcohol use (among men), and living in rural areas (among women) were independently associated with a higher prevalence of hypertension, whereas higher levels of physical activity and education were inversely associated. Age, body mass index (BMI), and living in rural areas were independently associated with an increased prevalence of prehypertension. Among the hypertensives, only 25.9% were aware of having hypertension and 12.2% were treated. Among the treated hypertensives, 32.4% had their blood pressure controlled.

    Overweight and obesity, important risk factors for hypertension, were investigated using data of 14,452 Vietnamese adults aged 25-64 years from the nationally representative 2000 National Nutrition Survey and data of 17,213 adults aged 25-64 years from the nationally representative 2005 National Adult Obesity Survey. The results showed that the distribution of BMI across the population and in population subgroups indicated a shift towards higher levels in 2005 as compared to 2000. The nationwide prevalences of overweight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were 6.6% and 0.4% respectively in 2005, almost twice the rates of 2000 (3.5% and 0.2%). Using the Asian BMI cut-off of 23 kg/m2 the overweight prevalence was 16.3% in 2005 and 11.7% in 2000. Women were more likely to be both underweight and overweight than men in both 2000 and 2005. Urban residents were more likely to be overweight and less likely to be underweight as compared to rural residents in both years. The shifts from underweight to overweight were more pronounced in those with higher food expenditure levels.

    A survey on sodium intake among a rural community near Hanoi (n=121) showed that mean 24-hour sodium excretion was 188.6 ± 57.5 mmol (4.3g), which corresponds to an intake of salt (sodium chloride) of 10.8 ± 3.3 g/day. Men had a higher mean sodium excretion (196.8 ± 56.9 mmol/day or 4.5g/day) than women (181.1 ± 57.4 mmol/day or 4.2g/day); 97.5% of the men and women had a salt intake higher than the World Health Organization’s recommendation of < 5g/day. Subjects with complete urine collection had a salt excretion of 11.7 g/day. Sodium in condiments added during cooking or eating at the table accounted for 81% of sodium intake. Processed foods contributed 11.6% and natural foods 7.4%. Regarding the condiments, the largest source was the mixed seasoning (35.1% of total); 31.6% of total dietary sodium was provided by fish sauce, 7.4% by monosodium glutamate and 6.1% by table salt.

    Sodium-reduced and potassium-enriched salt and ‘bot canh’, a traditional seasoning, were experimentally produced and underwent organoleptic testing, which showed high acceptance. An 8-week randomized double-blind trial was carried out in 173 men and women between 45 and 64 years of age with untreated (pre)hypertension in a rural Vietnamese community. The intervention group that received sodium-reduced and potassium-enriched condiments (salt and bot canh) experienced a median 24-hour sodium excretion decrease of 28.5 mmol/d (1.6 g/d salt) compared to the control group that received regular condiments for home food preparation and dining. The mean change in BP in the intervention compared to the control group was -2.6 mmHg (95% CI: -4.6 to -0.5, p = 0.013) for systolic BP and -1.6 mmHg (95% CI: -3.0 to -0.2, p= 0.024) for diastolic BP. The prevalence of iodine deficiency was significantly reduced in both groups (from 66% to 41% in the intervention group and from 72% to 36% in the controls).

    Conclusion: Hypertension and prehypertension are prevalent in Vietnam, but awareness, treatment, and control are low. Lifestyle modifications, including the prevention of overweight, and the promotion of physical activity, particularly in urban areas, and the reduction of high alcohol consumption in men, may help to prevent hypertension in Vietnam. Between 2000 and 2005, BMI in the population shifted towards higher levels, especially in those with higher food expenditure levels, but under nutrition was also still prevalent in 2005. Most dietary sodium (81%) comes from adding salty condiments during food preparation or at the table. Therefore, limiting condiments added during cooking and at the table should be given priority. Alternatively, regular condiments may be replaced with sodium-reduced and potassium-enriched salt and ‘bot canh’ to lower BP in (pre)hypertensive Vietnamese adults. Salt iodization should be reconsidered to ensure adequate iodine intake of the population.


    Chapter 1

    General introduction

    1 - 24

    Chapter 2

    National prevalence and associated risk factors of hypertension and prehypertension among Vietnamese adults.

    American Journal of Hypertension, Epub ahead of print 2014/05/28

    25 - 44

    Chapter 3

    Nationwide shifts in the double burden of overweight and underweight in Vietnamese adults in 2000 and 2005: two national nutrition surveys.

    BMC Public Health 2011, 11:62

    45 - 66

    Chapter 4

    Sodium intake and its dietary sources in Vietnamese rural adults


    67 - 80

    Chapter 5

    Sodium-reduced and potassium-enriched condiments reduce sodium intake and blood pressure in Vietnamese adults: a randomized controlled trial.


    81 - 100

    Chapter 6

    General discussion

    101 - 120


    Summary in Dutch

    Summary in Vietnamese


    About the author

    Diet, lifestyle and type 2 diabetes in China
    He, Y. - \ 2014
    Wageningen University. Promotor(en): Edith Feskens, co-promotor(en): -- Guansheng Ma; Xiaomei Yang. - Wageningen : Wageningen University - ISBN 9789461739216 - 161
    dieet - levensstijl - diabetes type 2 - china - volwassenen - diet - lifestyle - type 2 diabetes - china - adults


    Over the past two decades, China has been undergoing rapid socio-economic and nutrition transitions. Along with these transitions, chronic non-communicable diseases, such as obesity and type 2 diabetes, are becoming serious public health problems. However, only few studies on determinants of type 2 diabetes, such as fetal exposure, dietary patterns, physical activity, and obesity, have been carried out in China.


    The 2002 China National Nutrition and Health Survey (CNNHS), which is a nationally representative cross-sectional survey, was the source of data for this study. Body weight, height, and fasting blood glucose levels were measured by trained technicians and persons whose fasting glucose was >5.5 mmol/l were given an oral glucose tolerance test. Information on food intake was collected using the 24h recall method for three consecutive days. The amounts of cooking oil and condiments consumed during the three survey days were obtained using a food weighing method. A semi-quantitative food frequency questionnaire was used to investigate the usual diet of persons aged above 14 years in the year before the study. Information on physical activity was collected by trained investigators using a 1-year recall physical activity questionnaire.


    Central obesity is a better predictor of the presence of glucose tolerance abnormalities than BMI. The optimal cut-off value for waist to height ratio (WHtR) was 0.5, and the prevalenceratio (PR) for this cut-off was 2.85 (95% CI 2.54, 3.21) for men and 3.10 (95% CI 2.74, 3.51) for women.

    Dietary patterns and are associated with the presence of glucose tolerance abnormalities in China. Persons in the ‘Green Water’ dietary pattern had the lowest prevalence of glucose tolerance abnormality (3.9%). Persons in the ‘Yellow Earth’ dietary pattern (PR 1.22, CI: 1.04–1.43) and the ‘New Affluence’ dietary pattern(PR 2.05 CI: 1.76–2.37) had significantly higher prevalence rates than the ‘Green Water’ dietary pattern.

    A high fat/protein–low carbohydrate diet score was associated with a higher prevalence of type 2 diabetes in the Chinese population. The odds ratio comparing the highest with the lowest quintile was 2.75 (95% CI: 2.09–3.61). The odds ratio was 1.87 (95% CI: 1.35–2.58) after further adjustment for socioeconomic status and physical activity.

    The ‘Green Water’dietary pattern was related to the lowest prevalence of metabolic syndrome (MS) (15.9%). Compared to the ‘Green Water’ dietary pattern, the ‘Yellow Earth’and the ‘Western/New Affluence’dietary patterns resulted in an odds ratio of1.66(95% CI: 1.40–1.96)and 1.37 (95% CI: 1.13–1.67),respectively. Physical activity showed a significant interaction with the dietary patterns in relation to MS risk (P for interaction = 0.008). Participants with a combination of sedentary activity and a ‘Yellow Earth’ or a ‘Western/New Affluence’ dietary patternboth had more than three times (95% CI: 2.8–6.1) higher odds of MS than active persons with a ‘Green Water’dietary pattern.

    In areas severely affected by famine in 1959–1961, fetal-exposed persons had an increased risk of hyperglycemia compared to non-exposed persons (OR=3.92; 95% CI: 1.64–9.39; P=0.002). Also, in severely affected famine areas, fetal-exposed persons who followed a ‘Western/New Affluence’dietary pattern (OR=7.63; 95% CI: 2.41–24.1; P=0.0005) or had a high economic status in later life experienced a substantially elevated risk of hyperglycemia (OR=6.20; 95% CI: 2.08-18.5; P=0.001).


    The findings in this thesis indicate that early life environment, central obesity, dietary pattern, and physical activity are associated with the risk of diabetes and metabolic syndrome in the general Chinese population. Keeping body weight in the normal range, improving diet quality, and promoting physical activity would be benefit for Chinese population to prevent diabetes.

    Considering the path of nutrigenomics: a pragmatic ethical approach
    Komduur, R.H. - \ 2013
    Wageningen University. Promotor(en): Michiel Korthals, co-promotor(en): Hedwig te Molder. - S.l. : s.n. - ISBN 9789461735195 - 200
    nutrigenomica - ethiek - voeding en gezondheid - voeding - voedsel - gezondheid - onderzoek - gezondheidsgedrag - levensstijl - genen - consumentengedrag - nutrigenomics - ethics - nutrition and health - nutrition - food - health - research - health behaviour - lifestyle - genes - consumer behaviour
    Nutrigenomics research promises a future in which health risks of different diets can be exactly calculated on a personal basis. This seems great, but we need to consider how this will change our ideas about eating and health, and reflect on the ethical consequences of such a change. Therefore normative assumptions are compared within nutrigenomics research with norms about food, genes and health in everyday life.
    Lifestyle factors and risk of cardiovascular diseases
    Hoevenaar-Blom, M.P. - \ 2013
    Wageningen University. Promotor(en): Daan Kromhout, co-promotor(en): W.M.M. Verschuren; A.M.W. Spijkerman. - S.l. : s.n. - ISBN 9789461735072 - 119
    hart- en vaatziekten - levensstijl - risicofactoren - dieet - lichamelijke activiteit - slaap - cardiovascular diseases - lifestyle - risk factors - diet - physical activity - sleep


    Evidence is accumulating that lifestyle factors influence the incidence of fatal and non-fatal cardiovascular diseases (CVD). A healthy diet, being physically active, moderate alcohol consumption and not smoking are associated with a lower CVD risk. In addition to these lifestyle factors, recent research suggests that poor sleep may also be a risk factor of CVD. In this thesis, we focussed on a Mediterranean style diet, specific leisure time physical activities, and sleep duration and quality as risk factors for CVD.


    Our analyses are based on the prospective Doetinchem Cohort Study (N ~ 3 400), the Monitoring Project on Risk Factors for Chronic Diseases (MORGEN) Study (N ~ 20 400) and the Dutch contribution to the European Prospective Investigation into Cancer and Nutrition (EPIC-NL) (N ~ 34 700). These studies included men and women aged 20-65 years when examined between 1993 and 1997. Diet was assessed with the validated EPIC food frequency questionnaire and operationalized with the Mediterranean Diet Score (MDS, range: 0-9). Physical activity was estimated with the validated EPIC physical activity questionnaire, with an emphasis on different leisure time activities. In addition, information was collected on duration and quality of sleep by two questions. Cardiovascular morbidity and mortality were ascertained through linkage with national registers. Multivariable Cox models were used to estimate the strength of the associations and 95% confidence intervals.


    During 12 years of follow-up, 206 CVD cases occurred in the Doetinchem Cohort Study, 1 486 cases in the MORGEN Study and 4 881 cases in the EPIC-NL Study. In the study on diet, a two unit increment in MDS was associated with a 22% lower risk of fatal CVD, and a 5% lower risk of total CVD. For specific CVDs, a 14% lower risk of myocardial infarction, a 12% lower risk of stroke, and a 26% lower risk of pulmonary embolism was observed. The MDS was not related to incident angina pectoris, transient ischemic attack and peripheral arterial disease. The use of multiple measurements of the MDS increased the strength of the associations with CVD and narrowed the confidence intervals. For leisure time physical activity, we showed that cycling was associated with an 18% lower risk of total CVD, sports with a 26% lower risk, and those who both cycled and performed sports had a 34% lower risk. Walking and gardening were not associated with CVD risk. Short sleep duration was associated with a 15% higher risk of total CVD, whereas long sleep duration and sleep quality separately were not associated. Short sleepers with a poor sleep quality had a 63% higher risk of total CVD compared to those with a normal sleep duration and good sleep quality. Finally, the combination of a healthy diet, sufficient physical activity, moderate alcohol consumption and non-smoking was associated with a 57% lower risk of composite CVD and a 67% lower risk of fatal CVD. The addition of sufficient sleep duration to these four traditional healthy lifestyle factors resulted in a 65% lower risk of composite CVD and an 83% lower risk of fatal CVD.


    In this thesis, we showed that the strength of the association between dietary patterns and CVD incidence is likely underestimated because most studies used only the baseline measurement of diet. Furthermore, leisure time physical activities should be of at least moderate intensity to contribute to lower CVD risk. We also observed that sufficient sleep is a factor that should be taken into consideration in the prevention of CVD, in combination with a healthy diet, sufficient physical activity, moderate alcohol consumption and not smoking. Our results underscore the importance of a healthy lifestyle for CVD prevention.

    Project van SLIM naar SLIMMER
    Feskens, E.J.M. ; Duijzer, G. ; Blaak, E.E. ; Boer, A. de; Haveman-Nies, A. ; Oord-Jansen, S.J. van - \ 2012
    Voeding Nu 4/5 (2012). - ISSN 1389-7608 - p. 20 - 20.
    gezondheidsbevordering - diabetes type 2 - suikerziekte - levensstijl - voeding en gezondheid - ziektepreventie - health promotion - type 2 diabetes - diabetes - lifestyle - nutrition and health - disease prevention
    In 1998 is in Maastricht een onderzoek gestart naar de mogelijkheid om het optreden van type 2 diabetes te voorkomen door middel van een gecombineerd leefstijlprogramma (SLIM). Dit programma was gebaseerd op de Finse Diabetes Prevention Study, en omvatte de richtlijnen Goede Voeding van destijds, en een beweegadvies annex sportprogramma. De interventie duurde maximaal 6 jaar. Onlangs zijn alle deelnemers opnieuw opgeroepen. Ook is het programma omgezet in draaiboeken voor de praktijk die op dit moment worden getest in de gemeente Apeldoorn. Dt project heet SLIMMER.
    Eerlijke economie : Calvijn en het sociaaleconomische leven
    Jongeneel, R.A. - \ 2012
    Amsterdam : Buijten & Schipperheijn (Verantwoording 30) - ISBN 9789058816702 - 224
    christendom - religie - economie - geschiedenis - levensstijl - economische theorie - sociologie - kerk - christianity - religion - economics - history - lifestyle - economic theory - sociology - church
    Kijk naar de context : de alledaagse sociale omgeving als startpunt voor patiëntgebonden leefstijladvisering
    Bouwman, L.I. ; Koelen, M.A. ; Binsbergen, J.J. van; Dapper, T. - \ 2012
    Voeding Nu 14 (2012)6/7. - ISSN 1389-7608 - p. 18 - 20.
    gezondheidsbevordering - levensstijl - voeding en gezondheid - gedrag - patiënten - sociaal milieu - health promotion - lifestyle - nutrition and health - behaviour - patients - social environment
    Het verband tussen leefstijl en gezondheid is evident. De voordelen van een gezonde leefstijl zijn bekend, maar hoe begeleid je patiënten optimaal op hun pad richting die gezonde leefstijl? Deze intrigerende vraag, die speelt op zowel het gebied van beleid, wetenschap als in de huisartsenpraktijk, stond centraal tijdens een afscheidssymposium op 10 mei 2012 in Nijmegen.
    Een gezonder aanbod in kantine via een eigen boomgaard
    Bruijn, F.J. de; Ravesloot, M.B.M. - \ 2012
    Sport Knowhow XL
    voeding en gezondheid - boomgaarden - fruitproducten - levensstijl - eetpatronen - voedingsgedrag - fruitteelt - nutrition and health - orchards - fruit products - lifestyle - eating patterns - feeding behaviour - fruit growing
    Het eetgedrag en de levensstijl van burgers positief beïnvloeden hoeft geen hogere wiskunde te zijn. Wageningen Universiteit ontwikkelt in opdracht van het InnovatieNetwerk samen met Maatschappelijk Verantwoord Verenigen (MVV) een maatschappelijk concept om dit te bewerkstelligen, middels kleine boomgaarden. Niets meer, niets minder. En dat concept, Fruit4Sport, is een gegarandeerd succes: "Als mensen uiteindelijk niet gezonder gaan eten, dan zorgt het project in ieder geval tot het upgraden van de groene leefomgeving rond sportterreinen," aldus Marc Ravesloot, onderzoeker bij PPO Fruit, onderdeel van Wageningen Universiteit & Research.
    Een gedeelde passie voor gezonder leven. Evaluatieonderzoek naar netwerken rondom de beweegkuur en gecombineerde leefstijl interventies
    Hartog-van den Esker, F.G. den; Wagemakers, A. ; Vaandrager, L. ; Koelen, M. - \ 2012
    Wageningen : Wageningen University - 69
    gezondheidsbevordering - gezondheidsbeleid - levensstijl - lichamelijke activiteit - lichaamsbeweging - voeding en gezondheid - overgewicht - netwerken - health promotion - health policy - lifestyle - physical activity - exercise - nutrition and health - overweight - networks
    NISB (Nederlands Instituut voor Sport en Bewegen), projectleider van de BeweegKuur, is in 2010 gestart met het project 'Netwerken bouwen in de BeweegKuur'. In dit project gaat het om het opbouwen van regionale en lokale netwerken voor de afstemming tussen preventie, curatie en sport en voor de borging in gezondheidsbeleid. NISB heeft de Leerstoelgroep Gezondheid en Maatschappij van Wageningen University gevraagd onderzoek te doen naar de netwerkvorming rondom de BeweegKuur. Het doel van het onderzoek is inzicht te krijgen in de factoren van belang voor duurzame netwerken, de resultaten die de netwerken boeken en de wijze waarop netwerken gefaciliteerd kunnen worden. Een tweede doel is het leveren van direct bruikbare kennis voor de netwerken.
    Er is geen enkel werkzaam principe dat altijd werkt. Een eerste verkenning van het begrip werkzame principes
    Wartna, J. ; Vaandrager, L. ; Wagemakers, A. ; Koelen, M. - \ 2012
    Wageningen : Wageningen University - 31
    gezondheidsbevordering - levensstijl - interventie - gezondheidsbescherming - health promotion - lifestyle - intervention - health protection
    Sinds 2008 onderhoudt RIVM Centrum Gezond Leven (CGL) het met een interventie database (I-database). In deze I-database zijn leefstijlinterventies opgenomen die geclassificeerd zijn als ‘theoretische goed onderbouwd’, als ‘waarschijnlijk effectief’ of als ‘bewezen effectief’. In de databank Effectieve Jeugdinterventies staan jeugdinterventies die op dezelfde manier geclassificeerd zijn evenals op de web portal het Nederlands Centrum Jeugdgezondheid. Professionals kunnen een interventie indienen en ter beoordeling voorleggen aan de Erkenningscommissie Interventies. Werkzame principes zijn gekoppeld aan de doelen van een interventie en gaan over principes die het effect van een interventie tot stand brengen. Het is echter nog onduidelijk wat er precies bedoeld wordt met 'werkzame principes' en wat dit vervolgens betekent voor het erkenningstraject. De leerstoelgroep Gezondheid en Maatschappij is daarom gevraagd een beperkt literatuuronderzoek te doen en een aantal interviews uit te voeren met personen uit de praktijk van gezondheidsbevordering en de jeugdgezondheidszorg (december 2011- februari 2012). Doel van dit onderzoek is om meer helderheid te krijgen over het begrip werkzame principes zodat er een besluit kan worden genomen of het expliciteren van werkzame principes waardevol is voor het erkenningstraject.
    Evaluatie netwerken Amsterdam. Onderzoek naar netwerken rondom gecombineerde leefstijlinterventies in Amsterdam
    Hartog-van den Esker, F.G. den; Wagemakers, A. - \ 2012
    Wageningen : Wageningen Universiteit - 35
    gezondheidsbevordering - levensstijl - netwerken - gezondheidsbescherming - health promotion - lifestyle - networks - health protection
    Op verzoek van 1ste Lijn Amsterdam heeft Wageningen Universiteit (WUR) een evaluatieonderzoek gedaan naar de netwerken rondom gecombineerde leefstijlinterventies in Amsterdam. Het doel van het evaluatieonderzoek van de netwerken in Amsterdam was om inzicht te krijgen in de succes- en verbeterpunten van de netwerken, de doelen en beoogde resultaten van de netwerken, de resultaten die de netwerken boeken en factoren van belang voor het opbouwen van duurzame netwerken ofwel blijvende netwerkverbindingen.
    Van vonkjes naar vuurtjes. Pilot evaluatie netwerkvorming rondom de BeweegKuur
    Wagemakers, A. ; Hartog-van den Esker, F.G. den; Vaandrager, L. - \ 2011
    Wageningen : Leerstoelgroep Gezondheid en Maatschappij. Wageningen Universiteit. - 68
    gezondheidsbevordering - gezondheidsbescherming - lichamelijke activiteit - lichaamsbeweging - netwerken - levensstijl - voeding en gezondheid - health promotion - health protection - physical activity - exercise - networks - lifestyle - nutrition and health
    NISB heeft de leerstoelgroep Gezondheid en Maatschappij van de Wageningen Universiteit gevraagd onderzoek te doen naar de netwerkvorming rondom de BeweegKuur. Het doel van het onderzoek is het evalueren van de lokale en regionale netwerkvorming rondom de BeweegKuur. Hiertoe is onderzocht hoe de netwerkvorming vorm is gegeven, wat de successen en knelpunten zijn en welke werkwijzen geschikt zijn voor het evalueren van de netwerkvorming. Dit verslag beschrijft het pilot onderzoek.
    Naar een gezondere voedselkeuze
    Winter, M.A. de; Backus, G.B.C. - \ 2010
    Voedingsmiddelentechnologie 2010 (2010)14/15. - ISSN 0042-7934 - p. 26 - 28.
    voedselconsumptie - consumentengedrag - levensstijl - voedingsgewoonten - reclamecampagne van voedsel - gezondheidsgevaren - gedragsveranderingen - gezondheidsbescherming - westerse wereld - voeding en gezondheid - food consumption - consumer behaviour - lifestyle - feeding habits - food merchandising - health hazards - behavioural changes - health protection - western world - nutrition and health
    Meer wetenschappelijk onderzoek met inbegrip van keiharde data om onderbouwd en gericht maatregelen te kunnen nemen. Dat was de belangrijkste aanbeveling uit een bijzonder rondetafelgesprek, gehouden op initiatief van Wageningen UR en Ahold. Een internationale groep topmensen uit de industrie, universiteit en onderzoekswereld inventariseerde de redenen waarom er in de westerse wereld steeds minder gezond wordt gegeten en formuleerde oplossingsrichtingen om mensen aan te zetten tot een gezondere voedselkeuze. Aanwezig waren onder meer Gerda Verburg (minister LNV), Louise Fresco (Universiteit van Amsterdam) en Frans Kok (Wageningen Universiteit).
    Community aanpak overgewicht. Participatie van Turkse en Marokkaanse vrouwen
    Wagemakers, A. ; Boer, A. de; Corstjens, C. - \ 2010
    Voeding Nu 12 (2010)9. - ISSN 1389-7608 - p. 11 - 13.
    overgewicht - ziektepreventie - levensstijl - immigranten - minderheden - etnische groepen - lichamelijke activiteit - voeding en gezondheid - overweight - disease prevention - lifestyle - immigrants - minorities - ethnic groups - physical activity - nutrition and health
    In de periode 2003-2006 heeft de GGD Amsterdam het project Gezonde leefgewoonten Westerpark uitgevoerd. In het project is participatief actieonderzoek toegepast als middel en als doel, om de gezondheid van Turkse en Marokkaanse vrouwen te verbeteren. Met behulp van de participatieladder van Pretty is de participatie van de doelgroep inzichtelijk en meetbaar gemaakt. Het project heeft veel resultaten geboekt die zelfs buiten het terrein van gezondheidsbevordering liggen
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