Early introduction of complementary foods and childhood overweight in breastfed and formula-fed infants in the Netherlands:the PIAMA birth cohort study

To investigate whether early introduction of complementary foods (CF) is associated with an increased risk of overweight during childhood, and whether this association differs between formula-fed and breastfed infants.We included 2611 participants that were born at term from a Dutch population-based birth cohort (n = 3963) designed to investigate the development of asthma and allergies. Parents kept records of their infant's age when CF were first introduced. Weight and height were parent reported yearly from age 1 to 8 years, and at ages 11, 14 and 17 years. We used multivariate generalized estimating equations analysis to investigate the association between timing of CF introduction (before 4 months vs at or after 4 months of age) and overweight at ages 1-17 years.Children with CF introduction before 4 months had higher odds of being overweight during childhood than children with CF introduction at or after 4 months (OR 1.32, 95% CI 1.19, 1.47). This association was observed in formula-fed infants (OR 1.51, 95% CI 1.17, 1.94) and breastfed infants (OR 1.32, 95% CI 1.19, 1.47). The duration of breastfeeding modified the association between CF introduction and overweight: children breastfed for shorter than 4 months, but not children breastfed for 4 months or longer with CF introduction before 4 months had higher odds of being overweight (OR 1.37, 95% CI 1.19, 1.57 and 1.07, 95% CI 0.87, 1.32, respectively), compared to those with CF introduction at or after 4 months.In children born at term, formula-fed infants and infants who were breastfed for shorter than 4 months, but not infants who were breastfed for 4 months or longer, had a higher risk of being overweight during childhood when being introduced to CF before 4 months of age.</p

Benefit-Harm Analysis for Informed Decision Making on Participating in Colorectal Cancer Screening: A Modeling Study

OBJECTIVES To facilitate informed decision making on participating in colorectal cancer (CRC) screening, we assessed the benefit-harm balance of CRC screening for a wide range of subgroups over different time horizons. METHODS The study combined incidence proportions of benefits and harms of (not) participating in CRC screening estimated by the Adenoma and Serrated pathway to CAncer microsimulation model, a preference eliciting survey, and benefit-harm balance modeling combining all outcomes to determine the net health benefit of CRC screening over 10, 20, and 30 years. Probability of net health benefit was estimated for 210 different subgroups based on age, sex, previous participation in CRC screening, and lifestyle. RESULTS CRC screening was net beneficial in 183 of 210 subgroups over 30 years (median probability [MP] of 0.79, interquartile range [IQR] of 0.69-0.85) across subgroups. Net health benefit was greater for men (MP 0.82; IQR 0.69-0.89) than women (MP 0.76; IQR 0.67-0.83) and for those without history of participation in previous screenings (MP 0.84; IQR 0.80-0.89) compared with those with (MP 0.69; IQR 0.59-0.75). Net health benefit decreased with increasing age, from MP of 0.84 (IQR 0.80-0.86) at age 55 to 0.61 (IQR 0.56-0.71) at age 75. Shorter time horizons led to lower benefit, with MP of 0.70 (IQR 0.62-0.80) over 20 years and 0.54 (IQR 0.48-0.67) over 10 years. CONCLUSIONS Our benefit-harm analysis provides information about net health benefit of screening participation, based on important characteristics and preferences of individuals, which could assist screening invitees in making informed decisions on screening participation

Benefit-harm analysis for informed decision making on participating in colorectal cancer screening: A Modeling Study

OBJECTIVES: To facilitate informed decision making on participating in colorectal cancer (CRC) screening, we assessed the benefit-harm balance of CRC screening for a wide range of subgroups over different time horizons. METHODS: The study combined incidence proportions of benefits and harms of (not) participating in CRC screening estimated by the Adenoma and Serrated pathway to CAncer microsimulation model, a preference eliciting survey, and benefit-harm balance modeling combining all outcomes to determine the net health benefit of CRC screening over 10, 20, and 30 years. Probability of net health benefit was estimated for 210 different subgroups based on age, sex, previous participation in CRC screening, and lifestyle. RESULTS: CRC screening was net beneficial in 183 of 210 subgroups over 30 years (median probability [MP] of 0.79, interquartile range [IQR] of 0.69-0.85) across subgroups. Net health benefit was greater for men (MP 0.82; IQR 0.69-0.89) than women (MP 0.76; IQR 0.67-0.83) and for those without history of participation in previous screenings (MP 0.84; IQR 0.80-0.89) compared with those with (MP 0.69; IQR 0.59-0.75). Net health benefit decreased with increasing age, from MP of 0.84 (IQR 0.80-0.86) at age 55 to 0.61 (IQR 0.56-0.71) at age 75. Shorter time horizons led to lower benefit, with MP of 0.70 (IQR 0.62-0.80) over 20 years and 0.54 (IQR 0.48-0.67) over 10 years. CONCLUSIONS: Our benefit-harm analysis provides information about net health benefit of screening participation, based on important characteristics and preferences of individuals, which could assist screening invitees in making informed decisions on screening participation

Crime among irregular immigrants and the influence of internal border control

Both the number of crime suspects without legal status and the number of irregular or undocumented immigrants held in detention facilities increased substantially in theNetherlands between 1997 and 2003. In this period, theDutch state increasingly attempted to exclude irregular immigrants from the formal labour market and public provisions. At the same time the registered crime among irregular migrants rose. The 'marginalisation thesis' asserts that a larger number of migrants have become involved in crime in response to a decrease in conventional life chances. Using police and administrative data, the present study takes four alternative interpretations into consideration based on: 1) reclassification of immigrant statuses by the state and redefinition of the law, 2) criminal migration and crossborder crime, 3) changes in policing, and 4) demographic changes. A combination of factors is found to have caused the rise in crime, but the marginalisation thesis still accounts for at least 28%. These findings accentuate the need for a more thorough discussion on the intended and unintended consequences of border control for immigrant crime

Appropriate age range for introduction of complementary feeding into an infant’s diet

Peer reviewedPublisher PD

A prospective survey in European Society of Cardiology member countries of atrial fibrillation management: baseline results of EURO bservational Research Programme Atrial Fibrillation (EORP-AF) Pilot General Registry

Aims: Given the advances in atrial fibrillation (AF) management and the availability of new European Society of Cardiology (ESC) guidelines, there is a need for the systematic collection of contemporary data regarding the management and treatment of AF in ESC member countries. Methods and results: We conducted a registry of consecutive in- and outpatients with AF presenting to cardiologists in nine participating ESC countries. All patients with an ECG-documented diagnosis of AF confirmed in the year prior to enrolment were eligible. We enroled a total of 3119 patients from February 2012 to March 2013, with full data on clinical subtype available for 3049 patients (40.4% female; mean age 68.8 years). Common comorbidities were hypertension, coronary disease, and heart failure. Lone AF was present in only 3.9% (122 patients). Asymptomatic AF was common, particularly among those with permanent AF. Amiodarone was the most common antiarrhythmic agent used (~20%), while beta-blockers and digoxin were the most used rate control drugs. Oral anticoagulants (OACs) were used in 80% overall, most often vitamin K antagonists (71.6%), with novel OACs being used in 8.4%. Other antithrombotics (mostly antiplatelet therapy, especially aspirin) were still used in one-third of the patients, and no antithrombotic treatment in only 4.8%. Oral anticoagulants were used in 56.4% of CHA 2DS2-VASc = 0, with 26.3% having no antithrombotic therapy. A high HAS-BLED score was not used to exclude OAC use, but there was a trend towards more aspirin use in the presence of a high HAS-BLED score. Conclusion: The EURObservational Research Programme Atrial Fibrillation (EORP-AF) Pilot Registry has provided systematic collection of contemporary data regarding the management and treatment of AF by cardiologists in ESC member countries. Oral anticoagulant use has increased, but novel OAC use was still low. Compliance with the treatment guidelines for patients with the lowest and higher stroke risk scores remains suboptimal. © The Author 2013

Early life determinants of childhood overweight and cardiometabolic health

The hypothesis on the influence of prenatal conditions on cardiovascular disease (CVD) risk in adulthood has become known as the “Developmental Origins of Health and Disease (DOHaD)” and has been supported by results from many epidemiological studies. There is growing recognition that the CVD process already starts in childhood, but less is known about the influence of early life conditions on CVD risk in childhood. The aim of this thesis was to investigate whether exposures during pregnancy and up to one year of age, are determinants of overweight and cardiometabolic health in childhood. To answer my research question, I performed a systematic review of the literature and I used the data from two Dutch birth cohorts. The Prevention and Incidence of Asthma and Mite Allergy study is a population based ongoing cohort that has followed Dutch children from before birth in 1996-1997 until early adulthood. The baseline population consisted of 3,963 children. We used the data for three studies in this thesis. Data on the exposures, i.e. CS delivery, breastfeeding and early introduction of complementary foods, were retrieved from parental questionnaires at the child’s age of 3 months and 1 year. Data on overweight and cardiometabolic markers were retrieved from clinical examinations at 4, 8, 12 and 16 years or from parental questionnaires at 1 until 8 years, 11, 14 and 17 years. The Wheezing Illnesses STudy LEidsche Rijn (WHISTLER) is an ongoing birth cohort in Leidsche Rijn, a residential area near the city of Utrecht, The Netherlands.Between 2001 and 2014, almost 3,000 newborns were enrolled in the study. We used the data for one study in this thesis. Data on infant formula with LCPUFAs were retrieved from 12 monthly parental questionnaires in the child’s first year of life. Data on blood pressure and vascular wall characteristics were retrieved from the clinical examination at 5 years. Based on the results in this thesis and on results of previous studies, I conclude that the risk of childhood overweight is, at least partly, increased by cesarean section delivery and decreased by breastfeeding and introduction of complementary foods after 4 months of age. Although our systematic review showed a higher blood pressure in children who were exposed in utero to a mother with pregnancy induced hypertension, and a lower blood pressure in breastfed children, I conclude that the observed association for both exposures is unlikely to be causal. With respect to the other cardiometabolic markers, the studies in this thesis showed no evidence for a relation with the early life risk factors of interest. The overall conclusion is that exposures during pregnancy and up to one year of age are determinants of childhood overweight but not of childhood cardiometabolic health. For future research, I hypothesize that early life determinants may have an effect on cardiometabolic health through their effect on overweight, and if this is the case, then this may come to expression later in life

Early life determinants of childhood overweight and cardiometabolic health

The hypothesis on the influence of prenatal conditions on cardiovascular disease (CVD) risk in adulthood has become known as the “Developmental Origins of Health and Disease (DOHaD)” and has been supported by results from many epidemiological studies. There is growing recognition that the CVD process already starts in childhood, but less is known about the influence of early life conditions on CVD risk in childhood. The aim of this thesis was to investigate whether exposures during pregnancy and up to one year of age, are determinants of overweight and cardiometabolic health in childhood. To answer my research question, I performed a systematic review of the literature and I used the data from two Dutch birth cohorts. The Prevention and Incidence of Asthma and Mite Allergy study is a population based ongoing cohort that has followed Dutch children from before birth in 1996-1997 until early adulthood. The baseline population consisted of 3,963 children. We used the data for three studies in this thesis. Data on the exposures, i.e. CS delivery, breastfeeding and early introduction of complementary foods, were retrieved from parental questionnaires at the child’s age of 3 months and 1 year. Data on overweight and cardiometabolic markers were retrieved from clinical examinations at 4, 8, 12 and 16 years or from parental questionnaires at 1 until 8 years, 11, 14 and 17 years. The Wheezing Illnesses STudy LEidsche Rijn (WHISTLER) is an ongoing birth cohort in Leidsche Rijn, a residential area near the city of Utrecht, The Netherlands.Between 2001 and 2014, almost 3,000 newborns were enrolled in the study. We used the data for one study in this thesis. Data on infant formula with LCPUFAs were retrieved from 12 monthly parental questionnaires in the child’s first year of life. Data on blood pressure and vascular wall characteristics were retrieved from the clinical examination at 5 years. Based on the results in this thesis and on results of previous studies, I conclude that the risk of childhood overweight is, at least partly, increased by cesarean section delivery and decreased by breastfeeding and introduction of complementary foods after 4 months of age. Although our systematic review showed a higher blood pressure in children who were exposed in utero to a mother with pregnancy induced hypertension, and a lower blood pressure in breastfed children, I conclude that the observed association for both exposures is unlikely to be causal. With respect to the other cardiometabolic markers, the studies in this thesis showed no evidence for a relation with the early life risk factors of interest. The overall conclusion is that exposures during pregnancy and up to one year of age are determinants of childhood overweight but not of childhood cardiometabolic health. For future research, I hypothesize that early life determinants may have an effect on cardiometabolic health through their effect on overweight, and if this is the case, then this may come to expression later in life