Towards healthy diets for parents: effectiveness of a counselling intervention

Towards Healthy Diets for parents: efectiveness of a counselling intervention Eveline J.C. Hooft van Huysduynen Abstract Introduction and Objective: As parents’ modelling of dietary behaviour is one of the factors influencing children’s diets, improving parents’ diets is expected to result in improved dietary intake of their children. This thesis describes research that was conducted to develop and evaluate a counselling intervention to improve parental adherence to the Dutch dietary guidelines. Methods: A counselling intervention was developed, which was underpinned with the theory of planned behaviour and the transtheoretical model. In 20 weeks, five face-to-face counselling sessions were provided by a registered dietician who used motivational interviewing to improve parental adherence to the Dutch dietary guidelines. In addition, parents received three individually tailored email messages. During the counselling, the dietary guidelines and additional eating behaviours, that were hypothesized to affect diet quality, were addressed. The intervention was evaluated in a randomised controlled trial with 92 parents receiving the counselling and 94 parents as controls. Effects on dietary intake, biomarkers, intermediate markers of health and children’s dietary intake were evaluated. With mediation analyses, it was investigated if changes in dietary intake were established via changes in behavioural determinants. Thereby, it was also examined if spot urine samples could be used to replace 24 h urine samples for evaluating changes in sodium and potassium intake. Results: The intervention group increased their adherence to the dietary guidelines, as assessed with the Dutch Healthy Diet-index (ranging from 0 to 100 points), by 6.7 points more than the control group did. This improvement was achieved by small increases in the scores of seven out of ten index components. The most substantial changes were shown in fruit and fish intakes of which increases in fish intake were reflected in changes in fatty acid profiles derived from blood plasma. Also a small decrease in waist circumference was observed. Based on parental reports, the children in the intervention group increased their intakes of fruit, vegetables and fish more than the children in the control group. Improvements in parental fruit intake were mediated by changes in the behavioural determinants attitude and habit strength. Decreases in snack intake were mediated by changes in self-identity as a healthy eater. Although the results of a study in young Caucasian women showed that spot urine can be used to rank individuals for their ratios of sodium to potassium, no intervention effects on these ratios were observed. Conclusion: This thesis provides empirical knowledge on potential effective elements for counselling interventions aiming at improving the dietary pattern as a whole of parents and provides knowledge on methods to evaluate changes in dietary intake.</p

The Dutch Healthy Diet index (DHD-index): an instrument to measure adherence to the Dutch Guidelines for a Healthy diet

Background The objective was to develop an index based on the Dutch guidelines for a healthy diet of 2006 that reflects dietary quality and to apply it to the Dutch National Food Consumption Survey (DNFCS) to examine the assocations with the micronutrient intakes. Methods A total of 749 men and women, aged 19-30 years, contributed two 24-hour recalls and additional questionnaires in the DNFCS of 2003. The Dutch Healthy Diet index (DHD-index) includes ten components representing the ten Dutch Guidelines for a Healthy Diet. Per component the score ranges between zero and ten, resulting in a total score between zero (no adherence) and 100 (complete adherence). Results The mean+/-SD of the DHD-index was 60.4 +/-11.5 for women and 57.8 +/-10.8 for men (P for difference = 0.002). Each component score increased across the sex-specific quintiles of the DHD-index. An inverse association was observed between the sex-specific quintiles of the DHD-index and total energy intake. Calcium, Riboflavin, and vitamin E intake decreased with increasing DHD-index, an inverse association which disappeared after energy adjustment. Vitamin C showed a positive association across quintiles, also when adjusted for energy. For folate, iron, magnesium, potassium, thiamin, and vitamin B6 a positive association emerged after adjustment for energy. Conclusions The DHD-index is capable of ranking participants according to their adherence to the Dutch Guidelines for a Healthy Diet by reflecting variation in nine out of ten components that constitute when based on two 24-hour recalls. Furthermore, the index showed to be a good measure of nutrient density of diet

Loneliness literacy scale; development and evaluation of an early indicator for loneliness prevention

To develop and evaluate the Loneliness Literacy Scale for the assessment of short-term outcomes of a loneliness prevention programme among Dutch elderly persons. Scale development was based on evidence from literature and experiences from local stakeholders and representatives of the target group. The scale was pre-tested among 303 elderly persons aged 65 years and over. Principal component analysis and internal consistency analysis were used to affirm the scale structure, reduce the number of items and assess the reliability of the constructs. Linear regression analysis was conducted to evaluate the association between the literacy constructs and loneliness. The four constructs “motivation”, “self-efficacy”, “perceived social support” and “subjective norm” derived from principal component analysis captured 56 % of the original variance. Cronbach’s coefficient a was above 0.7 for each construct. The constructs “self-efficacy” and “perceived social support” were positively and “subjective norm” was negatively associated with loneliness. To our knowledge this is the first study developing a short-term indicator for loneliness prevention. The indicator contributes to the need of evaluating public health interventions more close to the intervention activities

Towards healthy diets for parents: effectiveness of a counselling intervention

Towards Healthy Diets for parents: efectiveness of a counselling intervention Eveline J.C. Hooft van Huysduynen Abstract Introduction and Objective: As parents’ modelling of dietary behaviour is one of the factors influencing children’s diets, improving parents’ diets is expected to result in improved dietary intake of their children. This thesis describes research that was conducted to develop and evaluate a counselling intervention to improve parental adherence to the Dutch dietary guidelines. Methods: A counselling intervention was developed, which was underpinned with the theory of planned behaviour and the transtheoretical model. In 20 weeks, five face-to-face counselling sessions were provided by a registered dietician who used motivational interviewing to improve parental adherence to the Dutch dietary guidelines. In addition, parents received three individually tailored email messages. During the counselling, the dietary guidelines and additional eating behaviours, that were hypothesized to affect diet quality, were addressed. The intervention was evaluated in a randomised controlled trial with 92 parents receiving the counselling and 94 parents as controls. Effects on dietary intake, biomarkers, intermediate markers of health and children’s dietary intake were evaluated. With mediation analyses, it was investigated if changes in dietary intake were established via changes in behavioural determinants. Thereby, it was also examined if spot urine samples could be used to replace 24 h urine samples for evaluating changes in sodium and potassium intake. Results: The intervention group increased their adherence to the dietary guidelines, as assessed with the Dutch Healthy Diet-index (ranging from 0 to 100 points), by 6.7 points more than the control group did. This improvement was achieved by small increases in the scores of seven out of ten index components. The most substantial changes were shown in fruit and fish intakes of which increases in fish intake were reflected in changes in fatty acid profiles derived from blood plasma. Also a small decrease in waist circumference was observed. Based on parental reports, the children in the intervention group increased their intakes of fruit, vegetables and fish more than the children in the control group. Improvements in parental fruit intake were mediated by changes in the behavioural determinants attitude and habit strength. Decreases in snack intake were mediated by changes in self-identity as a healthy eater. Although the results of a study in young Caucasian women showed that spot urine can be used to rank individuals for their ratios of sodium to potassium, no intervention effects on these ratios were observed. Conclusion: This thesis provides empirical knowledge on potential effective elements for counselling interventions aiming at improving the dietary pattern as a whole of parents and provides knowledge on methods to evaluate changes in dietary intake

The use of theory in research on nutrition guidance practices by primary care physicians from 1995 to Oct 2008: A review

Background - Theory-based interventions on nutrition guidance practices of primary care physicians (PCPs) are thought to be more effective than those that do not use theory. Objective - To assess how often and which theoretical models of behaviour change are used in research on nutrition guidance practices of PCPs. Method - A review of articles published from 1995 to October 2008 (n = 111). Results - It was found that 45% of the articles in this review included theories or theoretical models of behaviour change. No difference in proportion of model use was found with time. Model use differed between type of study. In 29% of the articles, the Transtheoretical Model was used. Little was found on authors’ views on theoretical model applicability. Conclusions - Forty-five per cent of the articles on nutrition guidance practices of PCPs published from 1995 to October 2008 included theories or theoretical models of behaviour change. It would be beneficial for nutrition behaviour change research if more researchers use theoretical models and report on applicability of the selected theory, to increase effectiveness of nutrition guidance by PCPs

The use of theory in research on nutrition guidance practices by primary care physicians from 1995 to Oct 2008: A review

Background - Theory-based interventions on nutrition guidance practices of primary care physicians (PCPs) are thought to be more effective than those that do not use theory. Objective - To assess how often and which theoretical models of behaviour change are used in research on nutrition guidance practices of PCPs. Method - A review of articles published from 1995 to October 2008 (n = 111). Results - It was found that 45% of the articles in this review included theories or theoretical models of behaviour change. No difference in proportion of model use was found with time. Model use differed between type of study. In 29% of the articles, the Transtheoretical Model was used. Little was found on authors’ views on theoretical model applicability. Conclusions - Forty-five per cent of the articles on nutrition guidance practices of PCPs published from 1995 to October 2008 included theories or theoretical models of behaviour change. It would be beneficial for nutrition behaviour change research if more researchers use theoretical models and report on applicability of the selected theory, to increase effectiveness of nutrition guidance by PCPs

The Dutch Healthy Diet index (DHD-index): an instrument to measure adherence to the Dutch Guidelines for a Healthy diet

Background The objective was to develop an index based on the Dutch guidelines for a healthy diet of 2006 that reflects dietary quality and to apply it to the Dutch National Food Consumption Survey (DNFCS) to examine the assocations with the micronutrient intakes. Methods A total of 749 men and women, aged 19-30 years, contributed two 24-hour recalls and additional questionnaires in the DNFCS of 2003. The Dutch Healthy Diet index (DHD-index) includes ten components representing the ten Dutch Guidelines for a Healthy Diet. Per component the score ranges between zero and ten, resulting in a total score between zero (no adherence) and 100 (complete adherence). Results The mean+/-SD of the DHD-index was 60.4 +/-11.5 for women and 57.8 +/-10.8 for men (P for difference = 0.002). Each component score increased across the sex-specific quintiles of the DHD-index. An inverse association was observed between the sex-specific quintiles of the DHD-index and total energy intake. Calcium, Riboflavin, and vitamin E intake decreased with increasing DHD-index, an inverse association which disappeared after energy adjustment. Vitamin C showed a positive association across quintiles, also when adjusted for energy. For folate, iron, magnesium, potassium, thiamin, and vitamin B6 a positive association emerged after adjustment for energy. Conclusions The DHD-index is capable of ranking participants according to their adherence to the Dutch Guidelines for a Healthy Diet by reflecting variation in nine out of ten components that constitute when based on two 24-hour recalls. Furthermore, the index showed to be a good measure of nutrient density of diet

Associations between company at dinner and daily diet quality in Dutch men and women from the NQplus study

BACKGROUND/OBJECTIVES: Consuming the evening meal in the company of others has been associated with overall diet quality. Nevertheless, studies on the association between type of company at dinner and diet quality in adults are scarce.SUBJECTS/METHODS: Dutch men (n = 895) and women (n = 845) aged between 20 and 70 years, included in a population-based observational study, were studied. Dietary intake was assessed by multiple 24-h recalls (6013 recalls) to estimate the Dutch Healthy Diet index (0–80 points) representing daily diet quality. Sex-specific linear mixed models adjusting for covariates were calculated. Out-of-home dinners and company at dinner were strongly associated (r = 0.66), and hence in additional analyses, out-of-home dinners were excluded to avoid multicollinearity.RESULTS: Among men, daily diet quality was similar when dinners were consumed in company or consumed alone, but higher when dinner was accompanied by family (mean 46.0, s.e. 0.3) than when dinner was accompanied by others (mean 42.3, s.e. 0.7; P = 0.001). Adjustment for dinner location attenuated this association, but it remained significant when excluding out-of-home dinners. Among women, daily diet quality was lower when dinner was consumed in company (mean 48.9, s.e. 0.3) than when consumed alone (mean 51.1, s.e. 0.6; Po0.001). Dinners consumed in the company of family were associated with higher daily diet quality (mean 49.3, s.e. 0.4) than dinners consumed with others (mean 45.7, s.e. 0.6; P = 0.001). These associations persisted when excluding out-of-home dinners.CONCLUSIONS: Only among women, dinners consumed alone as compared with dinners in company were associated with higher diet quality. In both men and women, dinners consumed with family were associated with higher diet quality as compared with dinners with others

The Dutch Healthy Diet index as assessed by 24 h recalls and FFQ: associations with biomarkers from a cross-sectional study

The Dutch Healthy Diet index (DHD-index) was developed using data from two 24 h recalls (24hR) and appeared useful to evaluate diet quality in Dutch adults. As many epidemiologic studies use FFQ, we now estimated the DHD-index score using FFQ data. We compared whether this score showed similar associations with participants' characteristics, micronutrient intakes, and biomarkers of intake and metabolism compared with the DHD-index using 24hR data. Data of 121 Dutch participants of the European Food Consumption Validation study were used. Dietary intake was assessed by two 24hR and a 180-item FFQ. Biomarkers measured were serum total cholesterol and carotenoids, EPA + DHA in plasma phospholipids and 24 h urinary Na. A correlation of 0·48 (95 % CI 0·33, 0·61) was observed between the DHD-index score based on 24hR data and on FFQ data. Classification of participants into the same tertiles of the DHD-index was achieved for 57 %. Women showed higher DHD-index scores. Energy intake was inversely associated with both DHD-index scores. Furthermore, age and intakes of folate, Fe, Mg, K, vitamin B6 and vitamin C were positively associated with both DHD-index scores. DHD-index scores showed acceptable correlations with the four combined biomarkers taking energy intake into account (r24hR 0.55; rFFQ 0.51). In conclusion, the DHD-index score based on FFQ data shows similar associations with participants' characteristics, energy intake, micronutrient intake and biomarkers compared with the score based on 24hR data. Furthermore, ranking of participants was acceptable for both methods. FFQ data may therefore be used to assess diet quality using the DHD-index in Dutch populations

Evaluation of a screener to assess diet quality in the Netherlands

Generally, there is a need for short questionnaires to estimate diet quality in the Netherlands. We developed a thirty-four-item FFQ - the Dutch Healthy Diet FFQ (DHD-FFQ) - to estimate adherence to the most recent Dutch guidelines for a healthy diet of 2006 using the DHD-index. The objectives of the present study were to evaluate the DHD-index derived from the DHD-FFQ by comparing it with the index based on a reference method and to examine associations with participant characteristics, nutrient intakes and levels of cardiometabolic risk factors. Data of 1235 Dutch men and women, aged between 20 and 70 years, participating in the Nutrition Questionnaires plus study were used. The DHD-index was calculated from the DHD-FFQ and from a reference method consisting of a 180-item FFQ combined with a 24-h urinary Na excretion value. Ranking was studied using Spearman's correlations, and absolute agreement was studied using a Bland-Altman plot. Nutrient intakes derived from the 180-item FFQ were studied according to quintiles of the DHD-index using DHD-FFQ data. The correlation between the DHD-index derived from the DHD-FFQ and the reference method was 0·56 (95 % CI 0·52, 0·60). The Bland-Altman plot showed a small mean overestimation of the DHD-index derived from the DHD-FFQ compared with the reference method. The DHD-index score was in the favourable direction associated with most macronutrient and micronutrient intakes when adjusted for energy intake. No associations between the DHD-index score and cardiometabolic risk factors were observed. In conclusion, the DHD-index derived from the DHD-FFQ was considered acceptable in ranking but relatively poor in individual assessment of diet quality