Biomedical subjects

W A Van Staveren

Publications and source records attributed to W A Van Staveren.

At least 19 recordsLinked to original sources

PubMed2005

Potentials and pitfalls for nutrition counselling in general practice.

This paper was based on collaborative research efforts from Wageningen University and the University Medical Centre St Radboud in The Netherlands and describes the rationale for web-based nutrition counselling applications in general practice as well as some of the frequently used models and theories (predominantly the Stages of Change Model). General practitioners can play an important role in cardiovascular risk reduction by giving nutrition counselling to patients at elevated cardiovascular risk. Unfortunately, general practitioners perceive barriers that may limit their nutrition counselling practices. Some of these barriers may be overcome using computer and Internet technologies. Computerized reminders for preventive services, and websites with reliable high-quality information may prove to be valuable additions to usual care. Cooperation with dietitians may also lead to improvements in nutrition counselling in general practice. For example, general practitioners could use their unique position to create awareness and motivation among patients. They could subsequently refer motivated patients to dietitians for detailed personal dietary advice.

Counseling↗

PubMed2002

Implementation research for 'evidence-based' guideline development by dietitians: a pilot study to test an instrument.

AIM: To improve the quality of dietetic care, dietitians in the University Medical Center Utrecht (UMCU) are encouraged to develop and implement 'evidence-based' guidelines. The aim of this pilot study was to develop and test a questionnaire for implementation research to monitor the process of developing and implementing these guidelines. METHODS: A questionnaire was developed and distributed to 15 dietitians, who have started developing an 'evidence-based' guideline. The questionnaire measures determinants of dietitians' behaviour and the presence of conditions facilitating the development of a guideline. Cronbach's alpha with a cut-off point of 0.7 was used to analyse the internal consistence between the items related to behavioural determinants. A panel of professionals such as a member of staff from the UMCU, a communication expert and project-managers ensured the completeness of the questionnaire. RESULTS: The internal consistency was high (alpha > 0.7) between the items related to the determinants of behaviour. The questionnaire gives a structured overview of factors affecting positively or negatively the process of guideline development. Although dietitians have a positive behaviour towards guideline development, they perceived barriers related to the presence of conditions to develop a guideline. CONCLUSION: We concluded that the applied questionnaire is appropriate for implementation research and has given a structured overview of factors that influence the development of dietetic guidelines by dietitians in the UMCU.

Attitude of Health Personnel↗

PubMed2002

European Prospective Investigation into Cancer and Nutrition (EPIC) calibration study: rationale, design and population characteristics.

The European Prospective Investigation into Cancer and Nutrition (EPIC), which covers a large cohort of half a million men and women from 23 European centres in 10 Western European countries, was designed to study the relationship between diet and the risk of chronic diseases, particularly cancer. Information on usual individual dietary intake was assessed using different validated dietary assessment methods across participating countries. In order to adjust for possible systematic over- or underestimation in dietary intake measurements and correct for attenuation bias in relative risk estimates, a calibration approach was developed. This approach involved an additional dietary assessment common across study populations to re-express individual dietary intakes according to the same reference scale. A single 24-hour diet recall was therefore collected, as the EPIC reference calibration method, from a stratified random sample of 36 900 subjects from the entire EPIC cohort, using a software program (EPIC-SOFT) specifically designed to standardise the dietary measurements across study populations. This paper describes the design and populations of the calibration sub-studies set up in the EPIC centres. In addition, to assess whether the calibration sub-samples were representative of the entire group of EPIC cohorts, a series of subjects' characteristics known possibly to influence dietary intakes was compared in both population groups. This was the first time that calibration sub-studies had been set up in a large multi-centre European study. These studies showed that, despite certain inherent methodological and logistic constraints, a study design such as this one works relatively well in practice. The average response in the calibration study was 78.3% and ranged from 46.5% to 92.5%. The calibration population differed slightly from the overall cohort but the differences were small for most characteristics and centres. The overall results suggest that, after adjustment for age, dietary intakes estimated from calibration samples can reasonably be interpreted as representative of the main cohorts in most of the EPIC centres.

Adult↗

PubMed2002

Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project.

OBJECTIVE: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. SUBJECTS: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study. RESULTS: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. CONCLUSIONS: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.

Adult↗

PubMed2002

Energy balance and malnutrition in institutionalized elderly people.

Screening tools and more extensive assessment methods have signaled that malnutrition is common in institutionalized elderly. There are multiple factors - physiologic and non-physiologic - which hereby increase the risk of negative energy balance leading to weight loss and subsequent undesirable outcomes. Addressing this problem a number of controlled intervention studies have shown positive effects of 'simple' nutrition interventions in institutionalized older persons.

Journal Article↗

PubMed2001

Flavor enhancement of food improves dietary intake and nutritional status of elderly nursing home residents.

BACKGROUND: Taste and smell losses occur with aging. These changes may decrease the enjoyment of food and may subsequently reduce food consumption and negatively influence the nutritional status of elderly persons, especially those who are frail. The objective of this study was to determine if the addition of flavor enhancers to the cooked meals for elderly residents of a nursing home promotes food consumption and provides nutritional benefits. METHODS: We performed a 16-week parallel group intervention consisting of sprinkling flavor enhancers over the cooked meals of the "flavor" group (n = 36) and not over the meals of the control group (n = 31). Measurements of intake of the cooked meals were taken before and after 8 and 16 weeks of intervention. Appetite, daily dietary intake, and anthropometry were assessed before and after the intervention. RESULTS: On average, the body weight of the flavor group increased (+1.1 +/- 1.3 kg; p <.05) compared with that of the control group (-0.3 +/- 1.6 kg; p <.05). Daily dietary intake decreased in the control group (-485 +/- 1245 kJ; p <.05) but not in the flavor group (-208 +/- 1115 kJ; p =.28). Intake of the cooked meal increased in the flavor group (133 +/- 367 kJ; p <.05) but not in the control group (85 +/- 392 kJ). A similar trend was observed for hunger feelings, which increased only in the flavor group. CONCLUSION: Adding flavor enhancers to the cooked meals was an effective way to improve dietary intake and body weight in elderly nursing home residents.

Aged↗

PubMed2000

Short- and long-term effects of changes in pleasantness on food intake.

This study concerns the effects of pleasantness on ad libitum food intake, liking and appetite over 5 successive days. Pleasantness was manipulated by varying the salt level in bread. Thirty-five students consumed ad libitum sandwiches for lunch, made with bread individually perceived as low, medium or high in pleasantness, in a balanced cross-over design. Pleasantness and desire-to-eat the sandwich were rated at first bite, after the consumption of each sandwich and at the end of the lunch. Fullness was rated just before and at several intervals after lunch. On the first day, the students ate less of the least pleasant bread than of the medium and most pleasant bread. On the fifth day, however, consumption of all breads was similar. For the least pleasant bread, energy intake at lunch, desire-to-eat and fullness, all increased over days, whereas these variables remained constant for the medium and most pleasant bread. Mean pleasantness ratings for all breads remained unaltered across the days. We conclude that, with repeated exposure, the desire-to-eat, fullness and intake of a less preferred food can increase over time. Thus, the relationship between pleasantness and food intake changes over this period.

Adult↗

PubMed1999

Determinants of salt use in cooked meals in The Netherlands: attitudes and practices of food preparers.

OBJECTIVE: To assess current habits of using salt and other seasonings in food preparation, and to investigate the psychosocial determinants of salt use. In addition we examined differences in salt consumption and psychosocial determinants with respect to stages of change and socio-economic classes. SUBJECTS AND METHODS: 400 adults were interviewed to determine: 1) use of salt and other seasonings in food preparation; 2) added table salt; 3) consumption of foods with high salt content; and 4) psychosocial determinants of salt consumption. Subjects were divided into 5 stages of change for salt content of the cooked meal: precontemplation, contemplation, decision, action and maintenance. RESULTS: Salt appeared to be the type of seasoning mostly added in food preparation. Frequently used seasonings containing no added salt were pepper, onion, nutmeg, garlic, curry, sweet pepper powder, parsley, and bay-leaf. Spearman correlation coefficients between added cooking salt and taste attitude, health attitude, social influence and self-efficacy were 0.51, 0.14, 0.36, and 0.32 respectively. Correlations between consumption of foods with high salt content and convenience attitude, taste attitude, health attitude and self-efficacy were 0.41, 0.27, 0.18 and 0.21 respectively. Subjects in maintenance of low salt consumption, used less salt than subjects in precontemplation. Socio-economic status only showed an effect on the use of foods with high salt content. CONCLUSION AND PRACTICAL IMPLICATIONS: Health aspects did not play a major role in salt intake, whereas taste attitude was an important predictor of added cooking salt. Attempts to reduce cooking salt should be directed at satisfying taste. Nutrition education tailored to stages of change may be very helpful in decreasing salt consumption.

Adult↗

PubMed1998

[Changes in the energy needs of the elderly: an often encountered cause of nutritional deficiencies and frailty].

Changes in the body composition of elderly people and diminished physical activity reduce the energy requirement and the daily energy intake. It is especially frail elderly people who run an increased risk of a poor nutritional condition which further enhances fragility. Frailty is often defined as the state of reduced physiologic reserve associated with increased susceptibility to disability. In frail elderly people energy requirement is often reduced. Studies have shown that when energy intake falls below a level of about 6.3 MJ, it is hard to obtain a diet with a sufficient supply of minerals and water soluble vitamins. It is especially the daily intake of vitamins of the B complex and of vitamin C that then prove insufficient. In addition, immobile elderly and elderly of 75 years and older are at risk for an inadequate vitamin D status. An adequate diet is one of the factors that may prevent frail health. Screening lists have been developed to quickly obtain information about the nutritional status of older adults. However, these lists still have to be adapted to the Dutch dietary pattern. Currently, a change of the body weight is the best warning of insufficient nutrition.

Aged↗

PubMed1997

Longitudinal development and tracking of calcium and dairy intake from teenager to adult.

OBJECTIVES: Because of growing interest in the potential role of calcium in preventive pediatric strategies against osteoporosis, the longitudinal development and tracking of calcium had a dairy intake from adolescence into adulthood was addressed. DESIGN: In the Amsterdam Growth and Health Study, a group of 84 males and 98 females were followed over a 15 y period from age 13-27 y. The calcium and dairy intake was assessed six times by a cross-check dietary history method. To assess tracking, two traditional approaches, interperiod correlation coefficients and percent of subjects who remained in the same quartile of calcium intake over time, and a new approach based on generalized estimating equations were used. RESULTS: The mean calcium intake was relatively high and increased over time (30%). The tracking of calcium and dairy intake from adolescence into adulthood was moderate in both sexes (for example the correlation for calcium was 0.43 in males and 0.38 in females). CONCLUSIONS: The predictability of calcium intake over time does not seem to be sufficiently strong to identify teenagers who are likely to maintain an inadequate calcium intake in adulthood. Therefore, the identification and treatment of subjects with a low calcium intake cannot be limited to the teenage period but should be extended into adulthood.

Adolescent↗

PubMed1997

Fluid intake of elderly Europeans.

Dehydration is a common fluid disorder which occurs in residents, hospitalised and community-dwelling elderly people. In this study the intake of water and fluids of community-dwelling elderly Europeans is presented in relation to risk factors of dehydration: mental state, ability to perform activities of daily living (ADL), medicine use and body composition. As part of the SENECA-study of 1993, data were collected from a random age-stratified sample (birth cohorts 1913-1918) of inhabitants of small traditional towns in Europe. Food intake data were collected by using the dietary history method. The study population consisted of 629 men and 696 women of the following towns: Hamme/Belgium, Roskilde/Denmark, Haguenau/France, Romans/France, Padua/Italy, Culemborg/the Netherlands, Lisbon/Portugal, Yverdon/Switzerland, Marki/Poland and Ballymoney-Limavady-Portstewart/Northern Ireland/United Kingdom. Fluid intake of elderly people varied between the towns of Europe and between men and women. A high percentage of the female population had a water intake below the cut-off value of 1,700 g. In most towns about 70 percent of daily water intake came from the food groups 'Milk products', 'Alcoholic drinks', 'Juices' and 'Other non-alcoholic drinks'. The consumption of 'Other non-alcoholic drinks' contributed most to daily fluid intake. In the total female population, women with the lowest water intake (first tertile) scored negatively on factors influencing fluid intake (mental state, ADL) in comparison to women of the second and third tertile. However, in the distinct towns no unequivocal relationship emerged between those factors and fluid intake. Yet, women were found to be at higher risk of dehydration because of much lower water intakes than men and because of the overall relationship between a low fluid intake and a poor mental state and ADL problems.

Activities of Daily Living↗

PubMed1996

Effect of sucrose in breakfast items on pleasantness and food intake in the elderly.

This study was designed to determine the differences between young and elderly people on the perceived intensity and pleasantness of sucrose in foods, in relation to their food intake. First, a group of 35 young subjects (mean age: 22 +/- 2 years) and 29 elderly subjects (mean age: 79 +/- 6 years) judged the intensity and the pleasantness of 5 series of breakfast items: orange lemonade, strawberry jam, strawberry yoghurt, chocolate paste, and grain porridge, each with 5 geometrically spaced sucrose concentration levels. On average, the elderly people had a lower slope of the sucrose psychophysical function. Optimal preferred sucrose concentrations were higher for the elderly compared to the young. The second phase in the study concerned the effects of the different optimal sucrose concentrations in foods on food intake. The second experiment dealt with 2 different optimal preferred sucrose concentrations (elderly vs. young subjects) in the food items: orange lemonade, strawberry and blueberry jam, and strawberry and blueberry yoghurt, served during breakfast. A group of 33 young people (mean age: 23 +/- 2 years) and 25 elderly subjects (mean age: 82 +/- 5 years) participated in a crossover study of 2 5-day (breakfast) treatments. Subjects are ad lib from these foods and other items such as bread, coffee, and tea. The results showed that the sucrose concentration had no effect on the absolute amount consumed, although total energy intake of the breakfast increased with the higher sucrose foods. No clear difference was found in pleasantness between the 2 breakfasts with the different sucrose concentrations. These findings indicate that a flavor concentration evaluated as being most pleasant by the elderly with the help of small amounts of stimuli (in a lab setting) does not necessarily predict the pleasantness and the food intake behaviour in realistic settings.

Adult↗

PubMed1996

Relative validity of 16-year recall of calcium intake by a dairy questionnaire in young Dutch adults.

Assessing past calcium intake in studies of osteoporosis is of major importance because calcium intake during young adulthood is thought to influence bone mass in later life. However, uncertainty exists about the accuracy of retrospectively reported calcium intake. We therefore evaluated whether a dairy questionnaire estimating calcium intake only from dairy products is a valid method to assess the retrospectively reported calcium intake of 29-year old Dutch males and females 8 and 16 y previously. This was examined in 166 subjects by comparing their original calcium intake reported in 1977 and 1985 by a cross-check dietary history method, with their 1977 and 1985 calcium intake values recalled in 1993 by the dairy questionnaire. The overestimation of the retrospectively reported calcium intake compared with the original intake (11-33%) suggests that the dairy questionnaire is a relatively poor tool to assess the absolute calcium intake of young adults 8 and 16 y ago. Based on the agreement statistics, the dairy questionnaire is a reasonably valid instrument to rank subjects according to their retrospective calcium intake. However, the reporting of the retrospective calcium intake appears to have been influenced by the current calcium intakes reported at the age of 29 y. Nevertheless, the retrospective calcium intake appears to be a better indicator of the original intake than the current intake because the subjects markedly increased their calcium intake over the 16-y period.

Adolescent↗

PubMed1996

Catch-up growth in children fed a macrobiotic diet in early childhood.

To study the relationship between diet and growth, a longitudinal anthropometric study was conducted in a Dutch population consuming a macrobiotic diet. Measurements (anthropometry and food habit questionnaire) were taken in 1985 (0-7 y), 1987, and in 1993 (7-16 y, n = 209). Z-scores were calculated for anthropometric measures and changes expressed as the differences between 1993 and the mean of 1985 and 1987. Analysis indicated significant (P < 0.002) catch-up in height [(mean Z-score +/-sEM) +0.59 +/- 0.071 and arm circumference (+0.34 +/- 0.09) for age (boys and girls combined). In 1993, both girls and boys were still significantly (P < 0.05) below the reference for height and sum of four skinfolds for age, and girls were below reference for weight-for-height and arm circumference for age. In girls, multiple regression analyses showed a significant positive effect of the consumption frequency of dairy products on catch-up growth in height, weight and arm circumference, after adjustment for menarche, age, and baseline height, weight and arm circumference (P < 0.05). The addition of moderate amounts of dairy products to a vegan type of diet improved growth of children, especially girls.

Anthropometry↗

PubMed1996

Nutrition knowledge and attitudes towards high-fat foods and low-fat alternatives in three generations of women.

OBJECTIVES: To assess family resemblance in food habits in three generations of maternally related family members. DESIGN AND SUBJECTS: Ninety-seven adult women, their mothers and grandmothers were asked about nutrition knowledge, attitudes and fat intake. Nutrition knowledge and attitudes were determined by means of a self-administered questionnaire. A food frequency questionnaire was used to assess fat intake. RESULTS: Mean percentage energy derived from fat was 39% for the younger generation, and 40% for their mothers and grandmothers. Generations differed in their nutrition knowledge score (P <0.0001), the grandmothers having a lower nutrition knowledge than the other generations. Correlations of nutrition knowledge scores were 0.30 (95% confidence limits (c.l.) 0.10 and 0.48) between the younger and middle generations, 0.35 (95% c.l. 0.16 and 0.52) between the middle and older generations, and 0.14 (95% c.l. -0.06 and 0.34) between the younger generation and their grandmothers. For attitudes towards high-fat foods and their low-fat alternatives these figures were 0.27 (95% c.l. 0.07 and 0.45), 0.22 (95% c.l. 0.01 and 0.41), and 0.17 (95% c.l. - 0.03 and 0.36), respectively, while for energy percentage of fat intake the correlations were only 0.19 (95% c.l. -0.01 and 0.37), -0.02 (95% c.l. -0.22 and 0.18), and 0.12 (95% c.l. limits - 0.08 and 0.31), respectively. Within generations the correlations between attitudes and nutrition knowledge or percentage energy derived from fat were found to be higher in the middle generation than in other generations. No statistically significant correlations were found between nutrition knowledge and percentage energy derived from fat. CONCLUSIONS: From this study it can be concluded that mothers and their adult daughters resemble each other in nutrition knowledge and attitudes.

Adult↗

PubMed1995

Family resemblance in beliefs, attitudes and intentions towards consumption of 20 foods; a study among three generations of women.

Family resemblance in beliefs, attitudes and intentions towards the consumption of 20 foods that contribute to the fat intake was investigated in 97 adult women, their mothers and their grandmothers. Mean correlation for elements from the Fishbein and Ajzen theory of reasoned action between younger and middle generations ranged from 0.09 to 0.17 and between middle and older generations from 0.12 to 0.17. All significant correlations were positive. More statistically significant correlations were found for liking attitudes between the younger and middle generations (p < 0.05 for ten out of 20 correlations) than for other pairs. Between the older and younger generation the number of significant correlations could be due to chance alone. From the relative importance of liking and good/bad attitude on intention it appeared that liking contributed the most to the variance in intention scores. Health related beliefs and attitudes became of increasing importance in the older generations. From this study it can be concluded that mothers and their adult daughters resemble each other in beliefs, food preferences, attitudes and intentions, although resemblance is poor.

Adult↗

PubMed1995

Reproducibility of a semiquantitative food frequency questionnaire to assess the intake of fats and cholesterol in The Netherlands.

The reproducibility of a 104 item semiquantitative food frequency questionnaire to estimate the intake of energy, fat, fatty acids and cholesterol was assessed in a group of 93 men and women in the Netherlands. The questionnaire was administered by trained interviewers. Subjects were asked to recall the consumption of 104 items during the past month. A second interview was conducted 8 weeks later. The mean difference in nutrient intake between the two assessments was very small, with a maximum of 5% for cholesterol intake, but the variance of individual differences was considerable. Pearson correlation coefficients between two assessments 8 weeks apart ranged from 0.71 for polyunsaturated fatty acids intake (when expressed as percentage of energy intake) up to 0.91 for energy intake. The reproducibility was found to be similar in males and females. Reproducibility was assessed for separate food items as well as for 20 food groups. Items consumed were often highly reproducible and rarely had a poor reproducibility. This food frequency questionnaire is considered to be a suitable tool to estimate and monitor the intake of fat, fatty acids and cholesterol in the Netherlands.

Adult↗

PubMed1995

Validation of dietary history method in a group of elderly women using measurements of total energy expenditure.

The objective of the present study was to validate energy intake data, obtained by dietary history, in twelve elderly women aged 69-82 years. Energy and protein intakes were obtained using the dietary history method with a reference period of 30 d. Reported energy intake was compared with total energy expenditure (TEE) measured on two consecutive days in a respiration chamber. Reported protein intake was compared with mean N excretion from four 24 h urine collections. Mean reported energy intake was 7.2 (SD 1.5) MJ/d which was lower than TEE (P = 0.059). Reported protein intake was 64 (SD 13) g/d and lower than estimated protein intake (P = 0.053). The percentage underestimation was not related to body weight or percentage body fat. Subjects with a relatively high TEE or a relatively high estimated protein intake underestimated their energy intake to a greater extent. The discrepancy between reported energy intake and TEE was positively associated with the discrepancy between reported and estimated protein intakes. The results of this present study show an underestimation of energy intake of about 12% when using the dietary history method. Physical activity diaries completed in the chamber and during 4 d at home, as well as pedometer counts, indicated a higher level of physical activity in the free-living situation compared with the chamber situation. This suggests that the actual underestimation of energy intake may be even higher in this group of elderly women. These results have implications for the use of the dietary history method in, for example, epidemiological studies carried out in elderly subjects.

Aged↗