Staff Publications

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.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    Ultrasonic inline inspection of a cement-based drinking water pipeline
    Hernandez Delgadillo, Hector ; Geelen, Caspar ; Kakes, Rutger ; Loendersloot, Richard ; Yntema, Doekle ; Tinga, Tiedo ; Akkerman, Remko - \ 2020
    Engineering Structures 210 (2020). - ISSN 0141-0296
    Cement-based pipeline - Data processing - Degradation - Inline inspection

    The integrity of the drinking water infrastructure deteriorates with time. Monitoring the condition of the drinking water mains can enhance the remaining operational lifetime assessment of the network. In this research a method to translate ultrasonic signals to degradation levels from an inline inspection in a cement-based drinking water pipeline is proposed. The data was obtained from an inspection performed in a Dutch drinking main section. The data is processed in two major steps. Firstly, the parameters that provide the condition of the cement are extracted. Secondly, images of the degradation within the pipes of the inspected trajectory were generated. The main contributions in this paper are (i) the estimation of relative degradation levels of a cement-based pipeline based on the ultrasonic pulse-echo technique and (ii) the upscaling of the processing method in an automated manner for visualization of the degraded condition. Lastly, a sensitivity study of the parameters relevant to the determination of the degraded depth has been performed. The speed of sound in cement is the most relevant parameter to consider. Estimating absolute degradation levels needs further study.

    Er is een grote volksverhuizing gaande in de Nederlandse natuur
    Wamelink, Wieger ; Vliet, Arnold van - \ 2020
    Optimizing Low–Socioeconomic Status Pregnant Women’s Dietary Intake in the Netherlands: Protocol for a Mixed-Methods Study
    Beulen, Yvette H. ; Geelen, Anouk ; Vries, Jeanne H.M. De; Super, Sabina ; Koelen, Maria A. ; Feskens, Edith J.M. ; Wagemakers, Annemarie - \ 2020
    JMIR Research Protocols 9 (2020)2. - ISSN 1929-0748
    Although the importance of maternal nutrition is evident, adherence to dietary guidelines is limited in pregnant women, especially in those with a low socioeconomic status. Promotion of a healthy diet in midwifery practice is promising, as prenatal diet affects both maternal and child health, pregnant women are open to dietary changes during this critical transition, and midwives are their first and most important source of information. Unfortunately, nutrition communication by Dutch midwives is limited.
    Objective: The objective of this study is to optimize the dietary intake of low–socioeconomic status pregnant women by contributing to the further development and adjustment of a tool or toolbox to support midwives in providing nutrition communication.
    Methods: This interdisciplinary, mixed-methods study includes 2 phases, in which quantitative and qualitative research are complementary. In phase 1, we will conduct a literature study and interviews to gain insight into midwives’ knowledge, needs, and practice. We will obtain data on the dietary intake of low–socioeconomic status pregnant women and factors influencing this intake from another literature study, an interviewer-administered meal-based food frequency questionnaire, and qualitative interviews with pregnant women. We will identify the availability of suitable tools to improve pregnant women’s dietary intake from the literature, interviews, focus groups, and expert meetings. In phase 2, we shall adapt an existing tool or develop a new tool(box), depending on the results of phase 1, and implement it in 5 midwifery practices. Ultimately, a process evaluation will provide insight into barriers and facilitating factors playing a role in the implementation of the tool(box).
    Results: The main outcome of this study will be a tool(box) to optimize the dietary intake of Dutch pregnant women. We anticipate that the developed or adjusted tool(s) will be available in February 2020. After we implement the tool(s) and evaluate the implementation process, the final results should be available by February 2021.
    Conclusions: This study is scientifically and socially relevant, as we will study low–socioeconomic status pregnant women’s contextual dietary intake in-depth from an ecological perspective on health. The results obtained will lead to recommendations for multidisciplinary strategies to promote a healthy maternal dietary intake in low–socioeconomic status populations.
    Validity of absolute intake and nutrient density of protein, potassium, and sodium assessed by various dietary assessment methods: An exploratory study
    Trijsburg, Laura ; Geelen, Anouk ; Hulshof, Paul J.M. ; Van’T Veer, Pieter ; Boshuizen, Hendriek C. ; Hollman, Peter C.H. ; Dijk, Gertjan van; Feskens, Edith J.M. ; Vries, Jeanne H.M. de - \ 2020
    Nutrients 12 (2020)1. - ISSN 2072-6643
    Dietary assessment - Doubly labeled water - Measurement errors - Multivariate models - Nutrient density - Validation

    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.

    Adherence to dietary guidelines in relation to visceral fat and liver fat in middle-aged men and women: the NEO study
    Eekelen, Esther van; Geelen, Anouk ; Alssema, Marjan ; Lamb, Hildo J. ; Roos, Albert de; Rosendaal, Frits R. ; Mutsert, Renée de - \ 2020
    International Journal of Obesity (2020)44. - ISSN 0307-0565 - p. 297 - 306.

    Background: It is unclear to what extent adherence to dietary guidelines may specifically affect visceral fat and liver fat. We aimed to study the association between the Dutch Healthy Diet Index (DHD-index) and total body fat, visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) in middle-aged men and women. Design: In this cross-sectional study, VAT was assessed by magnetic resonance imaging (MRI) in 2580 participants, and HTGC by proton-MR spectroscopy in 2083 participants. Habitual dietary intake and physical activity were estimated by questionnaire. Adherence to the current Dutch dietary guidelines was estimated by the 2015 DHD-index score based on the thirteen components (vegetables, fruit, wholegrain products, legumes, nuts, dairy, fish, tea, liquid fats, red meat, processed meat, sweetened beverages, and alcohol). The DHD-index ranges between 0 and 130 with a higher score indicating a healthier diet. We used linear regression to examine associations of the DHD-index with VAT and HTGC, adjusted for age, smoking, education, ethnicity, basal metabolic rate, energy restricted diet, menopausal state, physical activity, total energy intake, and total body fat. We additionally excluded the components one by one to examine individual contributions to the associations. Results: Included participants (43% men) had a mean (SD) age of 56 (6) years and DHD-index score of 71 (15). A 10-point higher DHD-index score was associated with 2.3 cm2 less visceral fat (95% CI; −3.5; −1.0 cm2) and less liver fat (0.94 times, 95% CI; 0.90; 0.98). Of all components, exclusion of dairy attenuated the associations with TBF and VAT. Conclusions: Adherence to the dietary guidelines as estimated by the DHD-index was associated with less total body fat, and with less visceral and liver fat after adjustment for total body fat. These findings might contribute to better understanding of the mechanisms underlying associations between dietary habits and cardiometabolic diseases.

    Adherence to a food group-based dietary guideline and incidence of prediabetes and type 2 diabetes
    Braver, Nicolette R. den; Rutters, Femke ; Kortlever - van der Spek, Andrea L.J. ; Ibi, Dorina ; Looman, Moniek ; Geelen, Anouk ; Elders, Petra ; Heijden, Amber A. van der; Brug, Johannes ; Lakerveld, Jeroen ; Soedamah-Muthu, Sabita S. ; Beulens, Joline W.J. - \ 2020
    European Journal of Nutrition 59 (2020). - ISSN 1436-6207 - p. 2159 - 2169.
    Dietary pattern - Dutch healthy diet index 2015 - Intermediate hyperglycemia - Prediabetes - Type 2 diabetes

    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.

    The Maastricht-FFQ: Development and Validation of a Comprehensive Food Frequency Questionnaire for The Maastricht Study
    Dongen, Martien C.J.M. van; Wijckmans-Duysens, Nicole E.G. ; Biggelaar, Louise J.C.J. den; Ock, Marga C. ; Meijboom, S. ; Brants, H.A.M. ; Vries, J.H.M. de; Feskens, E.J.M. ; Bueno-de-Mesquita, H.B. ; Geelen, M.M.E.E. ; Stehouwer, C.D.A. ; Dagnelie, Pieter C. ; Eussen, Simone J.P.M. - \ 2019
    Nutrition 62 (2019). - ISSN 0899-9007
    Objective: To develop and validate a comprehensive food frequency questionnaire (FFQ) for The Maastricht Study, a population-based prospective cohort study in Maastricht, The Netherlands. Research Methods & Procedures: Item selection for the FFQ was based on explained variation and contribution to intake of energy and 24 nutrients. For validation, the FFQ was filled out by 135 participants (25-70 years) of the Nutrition Questionnaires plus study. Per person, on average 2.8 (range 1 to 5) telephone-based 24h dietary recalls (24hRs), two 24h urinary samples and one blood sample were available. Validity of 54 nutrients and 22 food groups was assessed by ranking agreement, correlation coefficients, attenuation factors, and ultimately de-attenuated correlation coefficients (validity coefficients). Results: Median correlation coefficients for energy and macronutrients, micronutrients and food groups were 0.45, 0.36 and 0.38, respectively. Median de-attenuated correlation coefficients were 0.53 for energy and macronutrients, 0.45 for micronutrients and 0.64 for food groups, being >0.50 for 18 out of 22 macronutrients and 16 out of 30 micronutrients, and >0.50 for 17 out of 22 food groups. The FFQ underestimated protein and potassium intake compared to 24h urinary nitrogen and potassium excretion by -18% and -2%, respectively. Correlation coefficients ranged from 0.50 and 0.55 for (fatty) fish intake and plasma EPA and DHA, and from 0.26-0.42 between fruit and vegetable intake and plasma carotenoids. Conclusion: Overall, the validity of the 253-item Maastricht-FFQ is good. The comprehensiveness of this FFQ make it well-suited for use in The Maastricht Study and similar populations.
    Preconception lifestyle and cardiovascular health in the offspring of overweight and obese women
    Elten, Tessa M. van; Beek, Cornelieke van de; Geelen, Anouk ; Gemke, Reinoud J.B.J. ; Groen, Henk ; Hoek, Annemieke ; Mol, Ben Willem ; Poppel, Mireille N.M. van; Roseboom, Tessa J. - \ 2019
    Nutrients 11 (2019)10. - ISSN 2072-6643
    Offspring anthropometry - Offspring blood pressure - Offspring pulse wave velocity - Preconception dietary intake - Preconception physical activity

    Women’s lifestyle has important implications for the development and health of their offspring. Yet little is known about the association between women’s preconception dietary intake and physical activity with cardiovascular health of the offspring. We therefore examined this association in a group of Dutch women with overweight or obesity (BMI ≥ 29 kg/m2) and infertility, who participated in a 6-month randomized preconception lifestyle intervention trial, and their offspring (n = 46). Preconception dietary intake and physical activity were assessed during the 6-month intervention using a food frequency questionnaire and the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH), respectively. Offspring cardiovascular health (i.e., BMI, waist:height ratio, systolic and diastolic blood pressure, fat and fat free mass, and pulse wave velocity) was measured at age 3–6 years. Multivariable linear regression analyses were used to examine the associations between preconception lifestyle and offspring cardiovascular health. Higher preconception vegetable intake (per 10 g/day) was associated with lower offspring diastolic blood pressure (Z-score: −0.05 (−0.08; −0.01); p = 0.007) and higher preconception fruit intake (per 10 g/day) was associated with lower offspring pulse wave velocity (−0.05 m/s (−0.10; −0.01); p = 0.03). Against our expectations, higher preconception intake of sugary drinks was associated with a higher offspring fat free mass (0.54 kg (0.01; 1.07); p = 0.045). To conclude, preconception dietary intake is associated with offspring health.

    The role of self-control and the presence of enactment models on sugar-sweetened beverage consumption: A pilot study
    Wenzel, Mario ; Geelen, Anouk ; Wolters, Maike ; Hebestreit, Antje ; Laerhoven, Kristof Van; Lakerveld, Jeroen ; Andersen, Lene Frost ; van't Veer, Pieter ; Kubiak, Thomas - \ 2019
    Frontiers in Psychology 10 (2019). - ISSN 1664-1078
    Diet - Ecological momentary assessment - Self-control - Social norms - Sugar-sweetened beverages

    The objective of the present research was to investigate associations of dispositional and momentary self-control and the presence of other individuals consuming SSBs with the consumption frequency of sugar-sweetened beverages (SSBs) in a multi-country pilot study. We conducted an Ambulatory Assessment in which 75 university students (52 females) from four study sites carried smartphones and received prompts six times a day in their everyday environments to capture information regarding momentary self-control and the presence of other individuals consuming SSBs. Multilevel models revealed a statistically significant negative association between dispositional self-control and SSB consumption. Moreover, having more self-control than usual was only beneficial in regard to lower SSB consumption frequency, when other individuals consuming SSBs were not present but not when they were present. The findings support the hypothesis that self-control is an important factor regarding SSB consumption. This early evidence highlights self-control as a candidate to design interventions to promote healthier drinking through improved self-control.

    Monitoring Support for Water Distribution Systems based on Pressure Sensor Data
    Geelen, Caspar V.C. ; Yntema, Doekle R. ; Molenaar, Jaap ; Keesman, Karel J. - \ 2019
    Water Resources Management 33 (2019)10. - ISSN 0920-4741 - p. 3339 - 3353.
    Early warning system - Proactive leakage control - Real-time learning - Unsupervised learning - Water distribution network (WDS)

    The increasing age and deterioration of drinking water mains is causing an increasing frequency of pipe bursts. Not only are pipe repairs costly, bursts might also lead to contamination of the Dutch non-chlorinated drinking water, as well as damage to other above- and underground infrastructure. Detection and localization of pipe bursts have long been priorities for water distribution companies. Here we present a method for proactive leakage control, referred to as Monitoring Support. Contrary to most leak prevention methods, our method is based on real-time pressure sensor measurements and focuses on detection of recurring pressure anomalies, which are assumed to be indicative of misuse or malfunctioning of the water distribution network. The method visualizes and warns for both recurring and one-time anomalous events and offers monitoring experts an unsupervised decision support tool that requires no training data or manual labeling. Additionally, our method supports any time series data source and can be applied to other types of distribution networks, such as those for gas, electricity and oil. The performance of our method, including both instance-based and feature-based clustering, was validated on two pressure sensor data sets. Results indicate that feature-based clustering is the best method for detection of recurring pressure anomalies, with accuracy F1-scores of 92% and 94% for a 2013 and 2017 data set, respectively.

    Using enhanced regression calibration to combine dietary intake estimates from 24 h recall and FFQ reduces bias in diet-disease associations
    Looman, Moniek ; Boshuizen, Hendriek C. ; Feskens, Edith J.M. ; Geelen, Anouk - \ 2019
    Public Health Nutrition 22 (2019)15. - ISSN 1368-9800 - p. 2738 - 2746.
    24 h recall - Bias - FFQ - Measurement error - Regression calibration
    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 ( ); (iii) average of FFQ and ( ); (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.
    Consumption of Alcoholic and Sugar-Sweetened Beverages is Associated with Increased Liver Fat Content in Middle-Aged Men and Women
    Eekelen, Esther van; Beulens, Joline W.J. ; Geelen, Anouk ; Schrauwen-Hinderling, Vera B. ; Lamb, Hildo ; Roos, Albert de; Rosendaal, Frits ; Mutsert, Renée de - \ 2019
    The Journal of Nutrition 149 (2019)4. - ISSN 0022-3166 - p. 649 - 658.
    alcohol consumption - alcoholic beverages - liver fat - nonalcoholic beverages - substitution

    BACKGROUND: Fatty liver is the leading cause of chronic liver diseases and increases the risk of cardiovascular disease. Besides alcohol consumption, energy-containing nonalcoholic beverages may contribute to liver fat accumulation. OBJECTIVE: We aimed to study the consumption of alcoholic and nonalcoholic beverages and their mutual replacement in relation to hepatic triglyceride content (HTGC) in middle-aged men and women. METHODS: In this cross-sectional analysis, HTGC was assessed by proton magnetic resonance spectroscopy. Habitual consumption of alcoholic and nonalcoholic beverages was assessed using a validated food-frequency questionnaire. All beverages were converted to standard servings and to percentage of total energy intake (En%). We performed linear regression to examine the association of alcoholic and nonalcoholic beverages with HTGC, adjusted for age, sex, smoking, education, ethnicity, physical activity, total energy intake, and total body fat. We studied replacement of alcoholic beverages with nonalcoholic beverages per 1 serving/d and per 5 En%/d. RESULTS: After exclusion of individuals with missing values, 1966 participants (47% men) were analyzed, with a mean ± SD age of 55 ± 6 y, BMI of 26 ± 4 kg/m2, and HTGC of 5.7% ± 7.9%. Each extra alcoholic serving per day was associated with more liver fat (1.09 times; 95% CI: 1.05, 1.12). Replacing 5 En% of alcoholic beverages with milk was associated with less liver fat (0.89 times; 95% CI: 0.81, 0.98), whereas replacement with 5 En% of sugar-sweetened beverages was associated with liver fat to an extent similar to alcoholic beverages (1.00 times; 95% CI: 0.91, 1.09). CONCLUSION: In a population-based cohort, consumption of each extra daily alcoholic beverage was associated with more liver fat. In isocaloric replacement of alcoholic beverages, milk was associated with less liver fat, whereas sugar-sweetened beverages were equally associated with liver fat. This suggests that intake of alcohol and sugars may contribute to liver fat accumulation. This trial was registered at as NCT03410316.

    Importance of details in food descriptions in estimating population nutrient intake distributions
    Zhang, Liangzi ; Geelen, Anouk ; Boshuizen, Hendriek C. ; Ferreira, José ; Ocké, Marga C. - \ 2019
    Nutrition Journal 18 (2019)1. - ISSN 1475-2891
    24-h recall - Dietary assessment - Food consumption survey - Food descriptions - Population nutrient intake distributions - Variable importance measure

    Background: National food consumption surveys are important policy instruments that could monitor food consumption of a certain population. To be used for multiple purposes, this type of survey usually collects comprehensive food information using dietary assessment methods like 24-h dietary recalls (24HRs). However, the collection and handling of such detailed information require tremendous efforts. We aimed to improve the efficiency of data collection and handling in 24HRs, by identifying less important characteristics of food descriptions (facets) and assessing the impact of disregarding them on energy and nutrient intake distributions. Methods: In the Dutch National Food Consumption Survey 2007-2010, food consumption data were collected through interviewer-administered 24HRs using GloboDiet software in 3819 persons. Interviewers asked participants about the characteristics of each food item according to applicable facets. Food consumption data were subsequently linked to the food composition database. The importance of facets for predicting energy and each of the 33 nutrients was estimated using the random forest algorithm. Then a simulation study was performed to determine the influence of deleting less important facets on population nutrient intake distributions. Results: We identified 35% facets as unimportant and deleted them from the total food consumption database. The majority (79.4%) of the percent difference between percentile estimates of the population nutrient intake distributions before and after facet deletion ranged from 0 to 1%, while 20% cases ranged from 1 to 5% and 0.6% cases more than 10%. Conclusion: We concluded that our procedure was successful in identifying less important food descriptions in estimating population nutrient intake distributions. The reduction in food descriptions has the potential to reduce the time needed for conducting interviews and data handling while maintaining the data quality of the survey.

    Sweet Snacks Are Positively and Fruits and Vegetables Are Negatively Associated with Visceral or Liver Fat Content in Middle-Aged Men and Women
    Eekelen, Esther Van; Geelen, Anouk ; Alssema, Marjan ; Lamb, Hildo J. ; Roos, Albert De; Rosendaal, Frits R. ; Mutsert, Rencrossed De - \ 2019
    The Journal of Nutrition 149 (2019)2. - ISSN 0022-3166 - p. 304 - 313.
    food groups - liver fat - middle-aged men and women - obesity - visceral fat

    Visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) are major risk factors for cardiometabolic diseases. Objective: We aimed to investigate the association of dietary intake of the main food groups with VAT and HTGC in middle-aged men and women. Methods: We used data from the Netherlands Epidemiology of Obesity study, a population-based study including 6671 participants aged 45-65 y at baseline. In this cross-sectional analysis, VAT and HTGC were assessed by magnetic resonance imaging and spectroscopy, respectively, as the primary outcomes. Habitual intake of main food groups (dairy, meat, fish, fruits and vegetables, sweet snacks, and fats and oils) was estimated through the use of a food-frequency questionnaire. We examined associations of intake of different food groups with VAT and HTGC by linear regression analysis stratified by sex and adjusted for age, smoking, education, ethnicity, physical activity, basal metabolic rate, energy-restricted diet, menopausal state, and total energy intake. Results: In women, a 100-g/d higher intake of dairy was associated with 2.0 cm2 less VAT (95% CI: -3.4, -0.7 cm2) and a 0.95-fold lower HTGC (95% CI: 0.90-, 0.99-fold). Moreover, a 100-g/d higher intake of fruit and vegetables was associated with 1.6 cm2 less VAT (95% CI: -2.9, -0.2 cm2) in women. Fruit and vegetables were negatively associated (0.95; 95% CI: 0.91, 1.00) with HTGC, and sweet snacks were positively associated (1.29; 95% CI: 1.03, 1.63). Patterns were weaker but similar in men. Fish intake was not associated with VAT or HTGC and plant-based fat and oil intake were only associated with VAT after adjustment for total body fat. Conclusions: Despite some variation in the strength of the associations between men and women, dietary intake of sweet snacks was positively associated with HTGC, and fruit and vegetable intake were negatively associated with visceral and liver fat content. Prospective studies are needed to confirm these results. The Netherlands Epidemiology of Obesity study is registered at with identifier NCT03410316. J Nutr 2019;149:304-313.

    Changes in Micronutrient Intake and Status, Diet Quality and Glucose Tolerance from Preconception to the Second Trimester of Pregnancy
    Looman, M. ; Geelen, M.M.E.E. ; Samlal, Rahul A.K. ; Heijligenberg, Rik ; Klein Gunnewiek, Jacqueline T.M. ; Balvers, Michiel ; Wijnberger, Lia D.E. ; Brouwer-Brolsma, Elske ; Feskens, E.J.M. - \ 2019
    Nutrients 11 (2019)2. - ISSN 2072-6643
    Data on changes in dietary intake and related blood parameters throughout pregnancy are scarce; moreover, few studies have examined their association with glucose homeostasis. Therefore, we monitored intake of folate, vitamin B6, vitamin B12, vitamin D and iron, their status markers, and diet quality from preconception to the second trimester of pregnancy, and we examined whether these dietary factors were associated with glucose homeostasis during pregnancy. We included 105 women aged 18–40 years with a desire to get pregnancy or who were already <24 weeks pregnant. Women at increased gestational diabetes (GDM) risk were oversampled. Measurements were scheduled at preconception (n = 67), and 12 (n =53) and 24 weeks of pregnancy (n =66), including a fasting venipuncture, 75-grams oral glucose tolerance test, and completion of a validated food frequency questionnaire. Changes in micronutrient intake and status, and associations between dietary factors and glucose homeostasis, were examined using adjusted repeated measures mixed models. Micronutrient intake of folate, vitamin B6 and vitamin D and related status markers significantly changed throughout pregnancy, which was predominantly due to changes in the intake of supplements. Micronutrient intake or status levels were not associated with glucose homeostasis, except for iron intake (FE µg/day) with fasting glucose (β = −0.069 mmol/L, p = 0.013) and HbA1c (β = −0.4843 mmol, p = 0.002). Diet quality was inversely associated with fasting glucose (β = −0.006 mmol/L for each DHD15-index point, p = 0.017). It was shown that micronutrient intakes and their status markers significantly changed during pregnancy. Only iron intake and diet quality were inversely associated with glucose homeostasis.
    Preconception lifestyle intervention reduces long term energy intake in women with obesity and infertility : A randomised controlled trial
    Elten, T.M. van; Karsten, M.D.A. ; Geelen, A. ; Gemke, R.J.B.J. ; Groen, H. ; Hoek, A. ; Poppel, M.N.M. van; Roseboom, T.J. - \ 2019
    International journal of behavioral nutrition and physical activity 16 (2019)1. - ISSN 1479-5868
    Accelerometers - Diet - Diet quality - Lifestyle intervention program - Long term follow-up - Obesity - Physical activity - Weight loss

    Background: The preconceptional period may be an optimal window of opportunity to improve lifestyle. We previously showed that a 6 month preconception lifestyle intervention among women with obesity and infertility was successful in decreasing the intake of high caloric snacks and beverages, increasing physical activity and in reducing weight in the short term. We now report the effects of the preconception lifestyle intervention on diet, physical activity and body mass index (BMI) at 5.5 years (range = 3.7-7.0 years) after the intervention. Methods: We followed women who participated in the LIFEstyle study, a multicentre RCT in which women with obesity and infertility were assigned to a six-month lifestyle intervention program or prompt infertility treatment (N = 577). Diet and physical activity 5.5 years later were assessed with an 173-item food frequency questionnaire (N = 175) and Actigraph triaxial accelerometers (N = 155), respectively. BMI was calculated from self-reported weight and previously measured height (N = 179). Dietary intake, physical activity, and BMI in the intervention and control group were compared using multivariate regression models. Additionally, dietary intake, physical activity and BMI of women allocated to the intervention arm with successful weight loss during the intervention (i.e. BMI < 29 kg/m2 or ≥ 5% weight loss), unsuccessful weight loss and the control group were compared with ANCOVA. Results: Although BMI did not differ between the intervention and control group 5.5 years after the intervention (- 0.5 kg/m2 [- 2.0;1.1]; P = 0.56), the intervention group did report a lower energy intake (- 216 kcal/day [- 417;-16]; P = 0.04). Women in the intervention arm who successfully lost weight during the intervention had a significantly lower BMI at follow-up compared to women in the intervention arm who did not lose weight successfully (- 3.4 kg/m2 [- 6.3;-0.6]; P = 0.01), and they reported a significantly lower energy intake compared to the control group (- 301 kcal [- 589;-14]; P = 0.04). Macronutrient intake, diet quality, and physical activity did not differ between the intervention and control group, irrespective of successful weight loss during the intervention. Conclusions: In our study population, a preconception lifestyle intervention led to reduced energy intake 5.5 years later. Additionally, women allocated to the intervention group who were successful in losing weight during the intervention also had a lower BMI at follow-up. This shows the potential sustainable effect of a preconception lifestyle intervention. Trial registration: This trial was registered on 16 November 2008 in the Dutch trial register; clinical trial registry number NTR1530.

    Pre-pregnancy dietary micronutrient adequacy is associated with lower risk of developing gestational diabetes in Australian women
    Looman, Moniek ; Schoenaker, Danielle A.J.M. ; Soedamah-Muthu, Sabita S. ; Mishra, Gita D. ; Geelen, Anouk ; Feskens, Edith J.M. - \ 2019
    Nutrition Research 62 (2019). - ISSN 0271-5317 - p. 32 - 40.
    Diet - Gestational diabetes - Human - Micronutrient - Pregnant

    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.

    Pre-to-post diagnosis weight trajectories in colorectal cancer patients with non-metastatic disease
    Zutphen, Moniek van; Geelen, Anouk ; Boshuizen, Hendriek C. ; Winkels, Renate M. ; Geijsen, Anne J.M.R. ; Wesselink, Evertine ; Snellen, Merel ; Kok, Dieuwertje E. ; Wilt, Johannes H.W. de; Meeberg, Paul C. van de; Kouwenhoven, Ewout A. ; Halteren, Henk K. van; Spillenaar Bilgen, Ernst J. ; Kampman, Ellen ; Duijnhoven, Fränzel J.B. van - \ 2019
    Supportive Care in Cancer 27 (2019)4. - ISSN 0941-4355 - p. 1541 - 1549.
    Chemotherapy - Colorectal cancer - Weight change - Weight gain

    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.

    Diet and physical activity in pregnancy and offspring's cardiovascular health: A systematic review
    Elten, T.M. Van; Karsten, M.D.A. ; Poppel, M.N.M. Van; Geelen, A. ; Limpens, J. ; Roseboom, T.J. ; Gemke, R.J.B.J. - \ 2019
    Journal of Developmental Origins of Health and Disease 10 (2019)3. - ISSN 2040-1744 - p. 286 - 298.
    maternal diet - maternal physical activity - offspring's blood pressure - offspring's vascular health

    There is increasing evidence linking maternal diet and physical activity before and during pregnancy with offspring's cardiovascular health. Although many studies examined this association, the evidence has not been reviewed systematically. We therefore undertook a systematic review to synthesize evidence examining the association of maternal diet and physical activity before and during pregnancy with offspring's blood pressure and vascular health. We systematically searched the databases MEDLINE and EMBASE from inception to June 30, 2017. Eligibility screening, data extraction and quality assessment were performed by two independent reviewers. A total of 19 articles were included comprising three randomized controlled trials and 16 observational studies. Of the studies that examined the association of interest, 60% (three out of five studies) showed that high maternal carbohydrate intake was associated with higher offspring's blood pressure. Maternal protein intake during pregnancy was negatively associated with offspring carotid intima-media thickness in two out of two studies. No consistent findings for maternal fatty acid intake were found. There were too few studies to draw conclusions on energy intake, fibre intake, protein/carbohydrate ratio, specific foods, dietary patterns and maternal physical activity. Heterogeneity in exposure and outcome assessment hampered pooling. Also, owing to the observational nature of most studies, causality cannot be established. Harmonization of valid exposure and outcome measurements, and the development of core outcome sets are needed to enable more robust conclusions.

    Determinants of successful lifestyle change during a 6-month preconception lifestyle intervention in women with obesity and infertility
    Karsten, Matty D.A. ; Oers, Anne M. van; Groen, Henk ; Mutsaerts, Meike A.Q. ; Poppel, Mireille N.M. van; Geelen, Anouk ; Beek, Cornelieke van de; Painter, Rebecca C. ; Mol, Ben W.J. ; Roseboom, Tessa J. ; Hoek, Annemieke ; Burggraaff, J.M. ; Kuchenbecker, W.K.H. ; Perquin, D.A.M. ; Koks, C.A.M. ; Golde, R. van; Kaaijk, E.M. ; Schierbeek, J.M. ; Oosterhuis, G.J.E. ; Broekmans, F.J. ; Vogel, N.E.A. ; Lambalk, C.B. ; Veen, F. van der; Klijn, N.F. ; Mercelina, P.E.A.M. ; Kasteren, Y.M. van; Nap, A.W. ; Mulder, R.J.A.B. ; Gondrie, E.T.C.M. ; Bruin, J.P. de - \ 2019
    European Journal of Nutrition 58 (2019)6. - ISSN 1436-6207 - p. 2463 - 2475.
    Determinants - Lifestyle intervention - Obesity - Preconception

    Purpose: To identify demographic, (bio)physical, behavioral, and psychological determinants of successful lifestyle change and program completion by performing a secondary analysis of the intervention arm of a randomized-controlled trial, investigating a preconception lifestyle intervention. Methods: The 6-month lifestyle intervention consisted of dietary counseling, physical activity, and behavioral modification, and was aimed at 5–10% weight loss. We operationalized successful lifestyle change as successful weight loss (≥ 5% weight/BMI ≤ 29 kg/m2), weight loss in kilograms, a reduction in energy intake, and an increase in physical activity during the intervention program. We performed logistic and mixed-effect regression analyses to identify baseline factors that were associated with successful change or program completion. Results: Women with higher external eating behavior scores had higher odds of successful weight loss (OR 1.10, 95% CI 1.05–1.16). Women with the previous dietetic support lost 0.94 kg less during the intervention period (95% CI 0.01–1.87 kg). Women with higher self-efficacy reduced energy intake more than women with lower self-efficacy (p < 0.01). Women with an older partner had an increased energy intake (6 kcal/year older, 95% CI 3–13). A high stage of change towards physical activity was associated with a higher number of daily steps (p = 0.03). A high stage of change towards weight loss was associated with completion of the intervention (p = 0.04). Conclusions: Determinants of lifestyle change and program completion were: higher external eating behavior, not having received previous dietetic support, high stage of change. This knowledge can be used to identify women likely to benefit from lifestyle interventions and develop new interventions for women requiring alternative support. Trial registration: The LIFEstyle study was registered at the Dutch trial registry (NTR 1530;

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