Labeling van voedingsmiddelen en veranderingen in het aanbod in supermarkten en bedrijfsrestaurants: methoden om eetgedrag te veranderen?

In dit artikel worden twee studies beschreven naar de effectiviteit van twee omgevingsinterventies met als doel om de vetconsumptie te verlagen en de groente- en fruitconsumptie te verhogen. Beide studies vonden plaats in supermarkten en bedrijfsrestaurants. Het betrof een labelingsprogramma en een interventie waarbij het aanbod van gezonde voedingsmiddelen werd uitgebreid, in combinatie met een algemeen voorlichtingsprogramma. De studies waren experimenteel van opzet. Gegevensverzameling geschiedde door middel van vragenlijsten en het bijhouden van verkoopcijfers. De resultaten lieten geen effect zien van zowel de omgevings- als de voorlichtingsinterventies op het eetgedrag van de respondenten. Verkoopcijfers lieten een significant effect van de labelingsinterventie zien op het verkoopaandeel van magere desserts, echter voor de andere producten werden geen significante verschillen tussen condities gevonden. Geconcludeerd wordt dat de onderzochte omgevingsinterventies niet het verwachte effect sorteren, en dat vervolgonderzoek noodzakelijk is om meer inzicht te krijgen in welke type omgevingsinterventies mogelijk wel effectief zijn in het veranderen van eetgedrag

Process evaluation of two environmental nutrition programmes and an educational nutrition programme conducted at supermarkets and worksite cafeterias in the Netherlands

This article describes the process evaluation of two environmental programs and a educational nutrition program, implemented at supermarkets and worksite cafeterias. Studies conducted earlier, indicated that the programs had no effect on consumers’ eating behavior. Consequently, the more specific purpose of the present study was to identify explanations for the ineffectiveness of the programs and to formulate recommendations for future programs. Materials and Methods The environmental programs included labeling of healthy products and increasing the range of healthy foods on offer. The education program consisted of several elements, such as brochures and a self-help guide. Semi-structured interviews were conducted with twenty-one managers of supermarkets and worksite cafeterias where the programs were implemented. Results Although materials were not always entirely compatible with the different supermarkets and worksite cafeterias, the degree of implementation was satisfactory. According to the managers, the programs were not striking enough, the labeling would have been more effective if it had discriminated between different brands of a product, and the number of new products was too small compared to the total range of foods on offer. Discussion The results can be used to help design and check future intervention programs for use at supermarkets or worksite cafeterias. Recommendations for future programs and research are given

Blood-brain barrier P-glycoprotein function in healthy subjects and Alzheimer's disease patients: effect of polymorphisms in the ABCB1 gene

Background: P-glycoprotein is a blood-brain barrier efflux transporter involved in the clearance of amyloid-beta from the brain and, as such, might be involved in the pathogenesis of Alzheimer's disease. P-glycoprotein is encoded by the highly polymorphic ABCB1 gene. Single-nucleotide polymorphisms in the ABCB1 gene have been associated with altered P-glycoprotein expression and function. P-glycoprotein function at the blood-brain barrier can be quantified in vivo using the P-glycoprotein substrate tracer (R)-[11C]verapamil and positron emission tomography (PET). The purpose of this study was to assess the effects of C1236T, G2677T/A and C3435T single-nucleotide polymorphisms in ABCB1 on blood-brain barrier P-glycoprotein function in healthy subjects and patients with Alzheimer's disease. Methods: Thirty-two healthy subjects and seventeen patients with Alzheimer's disease underwent 60-min dynamic (R)-[11C]verapamil PET scans. The binding potential of (R)-[11C]verapamil was assessed using a previously validated constrained two-tissue plasma input compartment model and used as outcome measure. DNA was isolated from frozen blood samples and C1236T, G2677T/A and C3435T single-nucleotide polymorphisms were amplified by polymerase chain reaction. Results: In healthy controls, binding potential did not differ between subjects without and with one or more T present in C1236T, G2677T and C3435T. In contrast, patients with Alzheimer's disease with one or more T in C1236T, G2677T and C3435T had significantly higher binding potential values than patients without a T. In addition, there was a relationship between binding potential and T dose in C1236T and G2677T. Conclusions: In Alzheimer's disease patients, C1236T, G2677T/A and C3435T single-nucleotide polymorphisms may be related to changes in P-glycoprotein function at the blood-brain barrier. As such, genetic variations in ABCB1 might contribute to the progression of amyloid-beta deposition in the brain

The impact of educational and environmental interventions in Dutch worksite cafeterias

Environmental interventions as labeling of healthy foods and an increased availability of healthy foods may help consumers to meet the guidelines for a healthy diet. This article describes a study into the effectiveness of two environmental programs to be used in worksite cafeterias along with an educational program. The aim of the interventions was to reduce fat intake and increase fruit and vegetable intake. In the 'Labeling Program', low fat products were labeled. The 'Food Supply Program' comprised an increased availability of low-fat products and fruits and vegetables in worksite cafeterias. The 'Educational Program' consisted of information about healthy nutrition through brochures, table tents, a self help manual and posters. The design consisted of a pretest-posttest experimental control group design, with four conditions: the Educational Program, the Food Supply Program plus Educational Program, the Labeling Program plus Educational Program and a control group. Seventeen worksites were randomly assigned to one of the four research conditions. Total fat, fruit, and vegetable intake was measured with a quantitative, self-administered food frequency questionnaire (35 questions). Intake during lunch was measured by asking respondents to write down which food items they had purchased during their last lunch in the cafeteria. Furthermore, sales data for some targeted product categories were collected (milk, butter, cheese, meat products, desserts). For the whole study population, no significant effects on consumption data were found for any of the programs. The data showed a beneficial significant treatment effect of the Labeling Program on total fat intake, for respondents who believe they eat a high fat diet. Sales data revealed a significant effect of the labeling program on desserts, but not for the other products

Standardized image quality for 68Ga-DOTA-TATE PET/CT

Background: Positron emission tomography (PET) imaging with 68Gallium labeled somatostatin analogues (68Ga-DOTA-SSA) plays a key role in neuroendocrine tumor management. The impact of patient size on PET image quality is not well known for PET imaging with 68Ga-DOTA-SSA. The aim of this study is to propose a dose regimen based on patient size that optimizes image quality and yields sufficient image quality for diagnosis. Methods: Twenty-one patients (12 males, 9 females) were prospectively included for 68Gallium-DOTA-Tyr3-Octreotate (68Ga-DOTA-TATE) PET/CT, which was acquired in whole body list mode using 6 min per bed position (mbp). The list-mode events were randomly sampled to obtain 1 to 6 mbp PET reconstructions. For semi-quantitative assessment of image quality, the signal-to-noise ratio (SNR) was measured in the liver. The SNR normalized (SNRnorm) for admini

Is the process of delivery of an individually tailored lifestyle intervention associated with improvements in LDL cholesterol and multiple lifestyle behaviours in people with Familial Hypercholesterolemia?

<p>Abstract</p> <p>Background</p> <p>More insight in the association between reach, dose and fidelity of intervention components and effects is needed. In the current study, we aimed to evaluate reach, dose and fidelity of an individually tailored lifestyle intervention in people with Familial Hypercholesterolemia (FH) and the association between intervention dose and changes in LDL-Cholesterol (LDL-C), and multiple lifestyle behaviours at 12-months follow-up.</p> <p>Methods</p> <p>Participants (n = 181) randomly allocated to the intervention group received the PRO-FIT intervention consisting of computer-tailored lifestyle advice (<it>PRO-FIT*advice</it>) and counselling (face-to-face and telephone booster calls) using Motivational Interviewing (MI). According to a process evaluation plan, intervention reach, dose delivered and received, and MI fidelity were assessed using the recruitment database, website/counselling logs and the Motivational Interviewing Treatment Integrity (MITI 3.1.1.) code. Regression analyses were conducted to explore differences between participant and non-participant characteristics, and the association between intervention dose and change in LDL-C, and multiple lifestyle behaviours.</p> <p>Results</p> <p>A 34% (n = 181) representative proportion of the intended intervention group was reached during the recruitment phase; participants did not differ from non-participants (n = 623) on age, gender and LDL-C levels. Of the participants, 95% received a <it>PRO-FIT*advice</it> log on account, of which 49% actually logged on and completed at least one advice module. Nearly all participants received a face-to-face counselling session and on average, 4.2 telephone booster calls were delivered. None of the face-to-face sessions were implemented according to MI guidelines. Overall, weak non-significant positive associations were found between intervention dose and LDL-C and lifestyle behaviours.</p> <p>Conclusions</p> <p>Implementation of the PRO-FIT intervention in practice appears feasible, particularly <it>PRO-FIT*advice</it>, since it can be relative easily implemented with a high dose delivered. However, only less than half of the intervention group received the complete intervention-package as intended. Strategies to let participants optimally engage in using web-based computer-tailored interventions like <it>PRO-FIT*advice</it> are needed. Further, more emphasis should be put on more extensive MI training and monitoring/supervision.</p> <p>Trial registration</p> <p>NTR1899 at ww.trialregister.nl.</p

Design and evaluation protocol of "FATaintPHAT", a computer-tailored intervention to prevent excessive weight gain in adolescents

<p>Abstract</p> <p>Background</p> <p>Computer tailoring may be a promising technique for prevention of overweight in adolescents. However, very few well-developed, evidence-based computer-tailored interventions are available for this target group. We developed and evaluated a computer-tailored intervention for adolescents targeting energy balance-related behaviours: i.e. consumption of snacks, sugar-sweetened beverages, fruit, vegetables, and fibre, physical activity, and sedentary behaviours. This paper describes the planned development of a school-based computer-tailored intervention aimed at improving energy balance-related behaviours in order to prevent excessive weight gain in adolescents, and the protocol for evaluating this intervention.</p> <p>Methods/design</p> <p>Intervention development: Informed by the Precaution Adoption Process Model and the Theory of Planned Behaviour, the computer-tailored intervention provided feedback on personal behaviour and suggestions on how to modify it. The intervention (VETisnietVET translated as 'FATaintPHAT') has been developed for use in the first year of secondary school during eight lessons.</p> <p>Evaluation design: The intervention will be evaluated in a cluster-randomised trial including 20 schools with a 4-months and a 2-years follow-up. Outcome measures are BMI, waist circumference, energy balance-related behaviours, and potential determinants of these behaviours. Process measures are appreciation of and satisfaction with the program, exposure to the program's content, and implementation facilitators and barriers measured among students and teachers.</p> <p>Discussion</p> <p>This project resulted in a theory and evidence-based intervention that can be implemented in a school setting. A large-scale randomised controlled trial with a short and long-term follow-up will provide sound statements about the effectiveness of this computer-tailored intervention in adolescents.</p> <p>Trial Registration</p> <p>ISRCTN15743786</p

Go4it; study design of a randomised controlled trial and economic evaluation of a multidisciplinary group intervention for obese adolescents for prevention of diabetes mellitus type 2

<p>Abstract</p> <p>Background</p> <p>In the Netherlands, the first adolescents with diabetes mellitus type 2 as a result of obesity have recently been diagnosed. Therefore, it is very important that programs aiming at the prevention of type 2 diabetes of obese adolescents are developed and evaluated.</p> <p>Methods</p> <p>Go4it is a multidisciplinary group treatment that focuses on: 1) increasing awareness of the current dietary and physical activity behaviour (i.e. energy balance behaviour), 2) improving diet, 3) decreasing sedentary behaviour, 4) increasing levels of physical activity, and 5) coping with difficult situations. Go4it consists of 7 sessions with an interval of 2–3 weeks.</p> <p>The effectiveness of the multidisciplinary group treatment compared with usual care (i.e. referral to a dietician) was evaluated in a randomised controlled trial. We examined effects on BMI(sds), body composition, energy expenditure, glucose tolerance and insulin resistance (primary outcome measure), as well as dietary and physical activity behaviour and quality of life. An economic evaluation from a societal perspective was conducted alongside the randomised trial to evaluate the cost-effectiveness of the multidisciplinary treatment program vs. usual care.</p> <p>Discussion</p> <p>In this paper we described a multidisciplinary treatment program (Go4it) for obese adolescents and the design of a randomised controlled trial and economic evaluation to evaluate its effectiveness and cost-effectiveness.</p> <p>Trial registration</p> <p>Netherlands Trial Register (ISRCTN27626398).</p

The effects of a controlled worksite environmental intervention on determinants of dietary behavior and self-reported fruit, vegetable and fat intake

BACKGROUND: Eating patterns in Western industrialized countries are characterized by a high energy intake and an overconsumption of (saturated) fat, cholesterol, sugar and salt. Many chronic diseases are associated with unhealthy eating patterns. On the other hand, a healthy diet (low saturated fat intake and high fruit and vegetable intake) has been found important in the prevention of health problems, such as cancer and cardio-vascular disease (CVD). The worksite seems an ideal intervention setting to influence dietary behavior. The purpose of this study is to present the effects of a worksite environmental intervention on fruit, vegetable and fat intake and determinants of behavior. METHODS: A controlled trial that included two different governmental companies (n = 515): one intervention and one control company. Outcome measurements (short-fat list and fruit and vegetable questionnaire) took place at baseline and 3 and 12 months after baseline. The relatively modest environmental intervention consisted of product information to facilitate healthier food choices (i.e., the caloric (kcal) value of foods in groups of products was translated into the number of minutes to perform a certain (occupational) activity to burn these calories). RESULTS: Significant changes in psychosocial determinants of dietary behavior were found; subjects at the intervention worksite perceived more social support from their colleagues in eating less fat. But also counter intuitive effects were found: at 12 months the attitude and self-efficacy towards eating less fat became less positive in the intervention group. No effects were found on self-reported fat, fruit and vegetable intake. CONCLUSION: This environmental intervention was modestly effective in changing behavioral determinant towards eating less fat (social support, self-efficacy and attitude), but ineffective in positively changing actual fat, fruit and vegetable intake of office workers

Process Evaluation of a Dutch Community Intervention to improve Health Related Behaviour in deprived neighbourhoods

Objectives: To assess whether a community intervention on health related behaviour in deprived neighbourhoods was delivered as planned and the extent of exposure to the intervention programme. Methods: Data were gathered throughout the intervention period using minutes of meetings, registration forms and a postal questionnaire among residents in intervention and comparison neighbourhoods. Results: Overall, the intervention was delivered according to the key principles of a "community approach", although community participation could have been improved. Neighbourhood coalitions organized more than 50 health related activities in the neighbourhoods over a two-year period. Most activities were directed at attracting attention, providing information, and increasing awareness and knowledge, and at changing behaviours. Programme awareness and programme participation were 24% respectively 3% among residents in the intervention neighbourhoods. Conclusions: The process evaluation indicated that it was feasible to implement a community intervention according to the key principles of the "community approach" in deprived neighbourhoods. However, it is unlikely that the total package of intervention activities had enough strength and sufficient exposure to attain community-wide health behaviour change