Which cancer survivors are at risk for a physically inactive and sedentary lifestyle? Results from pooled accelerometer data of 1447 cancer survivors.

BACKGROUND: Physical activity has beneficial effects on the health of cancer survivors. We aimed to investigate accelerometer-assessed physical activity and sedentary time in cancer survivors, and describe activity profiles. Additionally, we identify demographic and clinical correlates of physical activity, sedentary time and activity profiles. METHODS: Accelerometer, questionnaire and clinical data from eight studies conducted in four countries (n = 1447) were pooled. We calculated sedentary time and time spent in physical activity at various intensities using Freedson cut-points. We used latent profile analysis to identify activity profiles, and multilevel linear regression analyses to identify demographic and clinical variables associated with accelerometer-assessed moderate to vigorous physical activity (MVPA), sedentary time, the highly active and highly sedentary profile, adjusting for confounders identified using a directed acyclic graph. RESULTS: Participants spent on average 26 min (3%) in MVPA and 568 min (66%) sedentary per day. We identified six activity profiles. Older participants, smokers and participants with obesity had significantly lower MVPA and higher sedentary time. Furthermore, men had significantly higher MVPA and sedentary time than women and participants who reported less fatigue had higher MVPA time. The highly active profile included survivors with high education level and normal body mass index. Haematological cancer survivors were less likely to have a highly active profile compared to breast cancer survivors. The highly sedentary profile included older participants, males, participants who were not married, obese, smokers, and those < 12 months after diagnosis. CONCLUSIONS: Cancer survivors engage in few minutes of MVPA and spend a large proportion of their day sedentary. Correlates of MVPA, sedentary time and activity profiles can be used to identify cancer survivors at risk for a sedentary and inactive lifestyle.

Exploring absolute and relative measures of exposure to food environments in relation to dietary patterns among European adults.

OBJECTIVE: To explore the associations of absolute and relative measures of exposure to food retailers with dietary patterns, using simpler and more complex measures. DESIGN: Cross-sectional survey. SETTING: Urban regions in Belgium, France, Hungary, the Netherlands and the UK.ParticipantsEuropean adults (n 4942). Supermarkets and local food shops were classified as 'food retailers providing healthier options'; fast-food/takeaway restaurants, cafés/bars and convenience/liquor stores as 'food retailers providing less healthy options'. Simpler exposure measures used were density of healthy and density of less healthy food retailers. More complex exposure measures used were: spatial access (combination of density and proximity) to healthy and less healthy food retailers; density of healthier food retailers relative to all food retailers; and a ratio of spatial access scores to healthier and less healthy food retailers. Outcome measures were a healthy or less healthy dietary pattern derived from a principal component analysis (based on consumption of fruits, vegetables, fish, fast foods, sweets and sweetened beverages). RESULTS: Only the highest density of less healthy food retailers was significantly associated with the less healthy dietary pattern (ß = -129·6; 95 % CI -224·3, -34·8). None of the other absolute density measures nor any of the relative measures of exposures were associated with dietary patterns. CONCLUSIONS: More complex measures of exposure to food retailers did not produce stronger associations with dietary patterns. We had some indication that absolute and relative measures of exposure assess different aspects of the food environment. However, given the lack of significant findings, this needs to be further explored.

Built environmental characteristics and diabetes: a systematic review and meta-analysis.

BACKGROUND: The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide. METHODS: We systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663). RESULTS: From 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2-1.6; I2 = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7-0.9; I2 = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8-1.0; I2 = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence. CONCLUSIONS: An important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.

Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs.

OBJECTIVE: This individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention-related characteristics. METHODS: Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed-effect model analyses were used to study intervention effects on the post-intervention values of QoL, EF, and SF (z-scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention-related characteristics, and conducted subsequent stratified analyses for significant moderator variables. RESULTS: PSI significantly improved QoL (ß = 0.14,95%CI = 0.06;0.21), EF (ß = 0.13,95%CI = 0.05;0.20), and SF (ß = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. CONCLUSIONS: PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention-related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.

Exploring the relationship between perceived barriers to healthy eating and dietary behaviours in European adults.

PURPOSE: Dietary behaviours may be influenced by perceptions of barriers to healthy eating. Using data from a large cross-European study (N = 5900), we explored associations between various perceived barriers to healthy eating and dietary behaviours among adults from urban regions in five European countries and examined whether associations differed across regions and socio-demographic backgrounds. METHODS: Frequency of consumption of fruit, vegetables, fish, fast food, sugar-sweetened beverages, sweets, breakfast and home-cooked meals were split by the median into higher and lower consumption. We tested associations between barriers (irregular working hours; giving up preferred foods; busy lifestyle; lack of willpower; price of healthy food; taste preferences of family and friends; lack of healthy options and unappealing foods) and dietary variables using multilevel logistic regression models. We explored whether associations differed by age, sex, education, urban region, weight status, household composition or employment. RESULTS: Respondents who perceived any barrier were less likely to report higher consumption of healthier foods and more likely to report higher consumption of fast food. 'Lack of willpower', 'time constraints' and 'taste preferences' were most consistently associated with consumption. For example, those perceiving lack of willpower ate less fruit [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.50-0.64], and those with a busy lifestyle ate less vegetables (OR 0.54; 95% CI 0.47-0.62). Many associations differed in size, but not in direction, by region, sex, age and household composition. CONCLUSION: Perceived 'lack of willpower', 'time constraints' and 'taste preferences' were barriers most strongly related to dietary behaviours, but the association between various barriers and lower intake of fruit and vegetables was somewhat more pronounced among younger participants and women.

Lessons learnt from a process evaluation of an exercise intervention in patients treated with autologous stem cell transplantation.

This paper describes the process evaluation of an 18-week supervised exercise programme in 50 patients treated with high-dose chemotherapy followed by autologous stem cell transplantation. The intervention included 30 exercise sessions with six resistance exercises and interval training. We evaluated the context, dose delivered and received, and patients' and physiotherapists' satisfaction with the intervention. Ninety-two per cent of the patients trained within 15 km of their home address, with an average session attendance of 86%. Most patients trained at the prescribed intensity for four of the six resistance exercises, but the dose delivered and received of the two remaining resistance exercises and interval training could not be determined. Both patients and physiotherapists highly appreciated the programme (score of 8.3 and 7.9 out of 10 respectively). This process evaluation provided valuable lessons for future trials: (1) It is possible to deliver supervised exercise training to this patient group in local physiotherapy practices; (2) to determine dose received all intervention components should be standardised; and (3) to optimise data collection, all study materials should be tested more extensively prior to the start of the intervention.

Occurrence and duration of various operational definitions of sedentary bouts and cross-sectional associations with cardiometabolic health indicators: the ENERGY-project.

OBJECTIVE: This study examined the occurrence and duration of sedentary bouts and explored the cross-sectional association with health indicators in children applying various operational definitions of sedentary bouts. METHODS: Accelerometer data of 647 children (10-13 years old) were collected in five European countries. We analyzed sedentary time (<100 cpm) accumulated in bouts of at least 5, 10, 20 or 30 min based on four operational definitions, allowing 0, 30 or 60s ≥100 cpm within bouts. Health indicators included anthropometrics (i.e. waist circumference and body mass index (BMI)) and in a subsample from two European countries (n=112) fasting capillary blood levels of glucose, C-peptide, high-density- and low-density cholesterol, and triglycerides. Data collection took place from March to July 2010. Associations were adjusted for age, gender, moderate-to-vigorous physical activity, total wear time and country. RESULTS: Occurrence of sedentary bouts varied largely between the various definitions. Children spent most of their sedentary time in bouts of ≥5 min while bouts of ≥20 min were rare. Linear regression analysis revealed few significant associations of sedentary time accumulated in bouts of ≥5-30 min with health indicators. Moreover, we found that more associations became significant when allowing no tolerance time within sedentary bouts. CONCLUSION: Despite a few significant associations, we found no convincing evidence for an association between sedentary time accumulated in bouts and health indicators in 10-13 year old children.

Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments.

OBJECTIVE: We aimed to investigate the prevalence of depression in cancer patients assessed by diagnostic interviews and self-report instruments, and to study differences in prevalence between type of instrument, type of cancer and treatment phase. METHODS: A literature search was conducted in four databases to select studies on the prevalence of depression among adult cancer patients during or after treatment. A total of 211 studies met the inclusion criteria. Pooled mean prevalence of depression was calculated using Comprehensive Meta-Analysis. RESULTS: Hospital Anxiety and Depression Scale-depression subscale (HADS-D) ≥ 8, HADS-D ≥11, Center for Epidemiologic Studies ≥ 16, and (semi-)structured diagnostic interviews were used to define depression in 66, 53, 35 and 49 studies, respectively. Respective mean prevalence of depression was 17% (95% CI = 16-19%), 8% (95% CI = 7-9%), 24% (95% CI = 21-26%), and 13% (95% CI = 11-15%) (p < 0.001). Prevalence of depression ranged from 3% in patients with lung cancer to 31% in patients with cancer of the digestive tract, on the basis of diagnostic interviews. Prevalence of depression was highest during treatment 14% (95% CI = 11-17%), measured by diagnostic interviews, and 27% (95% CI = 25-30%), measured by self-report instruments. In the first year after diagnosis, prevalence of depression measured with diagnostic interviews and self-report instruments were 9% (95% CI = 7-11%) and 21% (95% CI = 19-24%), respectively, and they were 8% (95% CI = 5-12%) and 15% (95% CI = 13-17%) ≥ 1 year after diagnosis. CONCLUSIONS: Pooled mean prevalence of depression in cancer patients ranged from 8% to 24% and differed by the type of instrument, type of cancer and treatment phase. Future prospective studies should disentangle whether differences in prevalence of depression are caused by differences in the type of instrument, type of cancer or treatment phase. © 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd.

Mediators of physical exercise for improvement in cancer survivors' quality of life.

OBJECTIVE: Mediating mechanisms of a 12-week group-based exercise intervention on cancer survivors' quality of life (QoL) were examined to inform future exercise intervention development. METHODS: Two hundred nine cancer survivors ≥ 3 months posttreatment (57% breast cancer) aged 49.5 (± 10.4) years were assigned to physical exercise (n = 147) or wait-list control (n = 62). QoL, fatigue, emotional distress, physical activity, general self-efficacy and mastery were assessed at baseline and post-intervention using questionnaires. Path analysis was conducted using Mplus to explore whether improved physical activity, general self-efficacy and mastery mediated the effects of exercise on fatigue and distress and consequently QoL. RESULTS: The intervention was associated with increased physical activity (ß = 0.46, 95% confidence interval (CI) = 0.14;0.59), general self-efficacy (ß = 2.41, 95%CI = 0.35;4.73), and mastery (ß = 1.75, 95%CI = 0.36;2.78). Further, the intervention had both a direct effect on fatigue (ß = -1.09, 95%CI = -2.12;0.01), and an indirect effect (ß = -0.54, 95%CI = -1.00;-0.21) via physical activity (ß = -0.29, 95%CI = -0.64;-0.07) and general self-efficacy (ß = -0.25, 95%CI = -0.61;-0.05). The intervention had a borderline significant direct effect on reduced distress (ß = -1.32, 95%CI = -2.68;0.11), and a significant indirect effect via increased general self-efficacy and mastery (ß = -1.06, 95%CI = -1.89;-0.38). Reductions in fatigue (ß = -1.33, 95%CI =-1.85;-0.83) and distress (ß = -0.86, 95%CI = -1.25;-0.52) were associated with improved QoL. Further, increased physical activity was directly associated with improved QoL (ß = 3.37, 95%CI = 1.01;5.54). CONCLUSION: The beneficial effect of group-based physical exercise on QoL was mediated by increased physical activity, general self-efficacy and mastery, and subsequent reductions in fatigue and distress. In addition to physical activity, future interventions should target self-efficacy and mastery. This may lead to reduced distress and fatigue, and consequently improved QoL of cancer survivors.

Determinants of adherence to heart failure medication: a systematic literature review.

A systematic literature review was conducted to summarize the existing evidence on presumed determinants of heart failure (HF) medication adherence. The aim was to assess the evidence and provide directions for future medication adherence interventions for HF patients. Based on a search in relevant databases and a quality assessment, eleven articles were included in the review. A best evidence synthesis was used to combine the results of presumed determinants that were found more than once in the literature. Results were classified according the World Health Organization's (WHO) multidimensional adherence model. Results demonstrated a relationship between having been institutionalized in the past (including hospitalizations and nursing home visits) and higher adherence levels. This finding is related to the healthcare system dimension of the WHO model. The presumed determinants related to the other dimensions, such as social and economic factors, condition-related, therapy-related, and patient-related factors of the multidimensional adherence model all had inconsistent evidence. However, there was also an indication that patients' educational level and the number of healthcare professionals they have visited are not related to higher adherence levels. Based on the current review, HF patients who have been institutionalized in the past are more adherent to HF medication. Many other presumed determinants were investigated, but displayed inconsistent evidence. Due to the lack of evidence, it was not possible to make recommendations for future interventions.

Process evaluation of FATaintPHAT, a computer-tailored intervention to prevent excessive weight gain among Dutch adolescents.

UNLABELLED: Process evaluations can help us to better interpret intervention effects and provide guidance in improving interventions. This study describes the use and appreciation of FATaintPHAT, a computer-tailored intervention to prevent excessive weight gain in adolescents and link these data to the intervention effects. Use and appreciation were assessed among students (12-13 years old) from the intervention group of the FATaintPHAT evaluation study, using computer log (n = 458) and questionnaire data (n = 233, 48% response). Differences in use and appreciation between socio-demographic groups (gender, education, ethnicity, weight category), and associations with behavioural outcomes were analysed using descriptive and regression analyses. The results showed that a majority of the students (81%) was exposed to all intervention modules and 73% reported to have put the advice into practise. Half and one-third of the students appreciated the tailored advice positively and neutrally, respectively. Students attending vocational training appreciated FATaintPHAT better than students attending university preparation education. No associations were found between behavioural outcomes with appreciation and use. In conclusion, the school-based FATainPHAT intervention was used and appreciated well among adolescents. The fact that the intervention was appreciated better among the lower compared with higher educated students indicates that the technique of computer-tailoring is also suitable for lower educated students. TRIAL REGISTRATION: Netherlands Trial Registry, ISRCTN 15743786.

Resilience to obesity among socioeconomically disadvantaged women: the READI study.

OBJECTIVE: This cross-sectional study aimed to identify sociodemographic and behavioural characteristics of 'overweight-resilient' women, that is, women who were in a healthy body weight range, despite living in socioeconomically disadvantaged neighbourhoods that place them at increased risk of obesity. The study also aimed to test a comprehensive theoretically derived model of the associations between intrapersonal, social and environmental factors and obesity among this target group. PARTICIPANTS: A total of 3235 women aged 18-45 years from 80 urban and rural neighbourhoods throughout Victoria, Australia, participated in the Resilience for Eating and Activity Despite Inequality study. MEASUREMENTS: Women reported height, weight, sociodemographic characteristics, leisure-time physical activity, dietary behaviours and a range of theoretically derived cognitive, social and neighbourhood environmental characteristics hypothesized to influence obesity risk. A theoretical model predicting body mass index (BMI) was tested using structural equation models. RESULTS: Women classified as 'resilient' to obesity tended to be younger, born overseas, more highly educated, unmarried and to have higher or undisclosed household incomes. They engaged in more leisure-time physical activity and consumed less fast foods and soft drinks than overweight/obese women. Neighbourhood characteristics, social characteristics and cognitive characteristics all contributed to explaining variation in BMI in the hypothesized directions. CONCLUSIONS: These results demonstrate several characteristics of women appearing 'resilient' to obesity, despite their increased risk conferred by residing in socioeconomically disadvantaged neighbourhoods. Acknowledging the cross-sectional study design, the results advance theoretical frameworks aimed at investigating obesity risk by providing evidence in support of a comprehensive model of direct and indirect effects on obesity of neighbourhood, as well as social, cognitive and behavioural characteristics.

Determinants of heart failure self-care: a systematic literature review.

Self-care is an important aspect of heart failure (HF) management. Information on the determinants of self-care is necessary for the development of self-care promotion interventions. HF self-care includes self-care management, self-care maintenance, sodium, fluid and alcohol intake restriction, physical activity, smoking cessation, monitoring signs and symptoms and keeping follow-up appointments. To assess the evidence regarding presumed determinants of HF self-care and make recommendations for interventions to promote self-care behavior among HF patients, a systematic literature review was conducted. Based on inclusion and exclusion criteria and a quality assessment, twenty-six articles were included. A best evidence synthesis was used. Results showed that the length of time since patients' diagnosis with HF is positively related to their performance of self-care maintenance. Moreover, it was found that HF patients' perceived benefits and barriers are related to their restriction of sodium intake, and that patients with type-D personality are less likely to consult medical professionals. There was also evidence for a few non-significant relationships. All other evidence was inconsistent, mainly due to insufficient evidence. Interventions that aim to increase the performance of self-care maintenance can teach newly diagnosed patients the skills that are usually attained with experience acquired as a result of living with HF for a longer time. Perceived benefits and barriers of restricting sodium intake could be targeted in interventions for sodium intake reduction among HF patients. Finally, interventions for the promotion of adequate consulting of medical professionals can specifically target HF patients with a type-D personality.

What works in school-based energy balance behaviour interventions and what does not? A systematic review of mediating mechanisms.

OBJECTIVE: Obesity prevention requires effective interventions targeting the so-called energy balance-related behaviours (that is, physical activity, sedentary and dietary behaviours). To improve (cost-)effectiveness of these interventions, one needs to know the working mechanisms underlying behavioural change. Mediation analyses evaluates whether an intervention works via hypothesised working mechanisms. Identifying mediators can prompt intervention developers to strengthen effective intervention components and remove/adapt ineffective components. This systematic review aims to identify psychosocial and environmental mediators of energy balance-related behaviours interventions for youth. METHOD: Studies were identified by a systematic search of electronic databases (PubMed, Embase, PsycINFO, ERIC and SPORTDiscus). Studies were included if they (1) were school-based randomised controlled or quasi-experimental studies; (2) targeted energy balance behaviours; (3) conducted among children and adolescents (4-18 years of age); (4) written in English; and (5) conducted mediation analyses. RESULTS: A total of 24 studies were included. We found strong evidence for self-efficacy and moderate evidence for intention as mediators of physical activity interventions. Indications were found for attitude, knowledge and habit strength to be mediators of dietary behaviour interventions. The few sedentary behaviour interventions reporting on mediating effects prevented us from forming strong conclusions regarding mediators of sedentary behaviour interventions. The majority of interventions failed to significantly change hypothesised mediators because of ineffective intervention strategies, low power and/or use of insensitive measures. CONCLUSION: Despite its importance, few studies published results of mediation analysis, and more high-quality research into relevant mediators is necessary. On the basis of the limited number of published studies, self-efficacy and intention appear to be relevant mediators for physical activity interventions. Future intervention developers are advised to provide information on the theoretical base of their intervention including the strategies applied to provide insight into which strategies are effective in changing relevant mediators. In addition, future research is advised to focus on the development, validity, reliability and sensitivity of mediator measures.

The association between cycling to school and being overweight in Rotterdam (The Netherlands) and Kristiansand (Norway).

Active transportation is a behavior that might contribute to energy balance. However, no clear association between active commuting to school and weight status has been reported in the international literature. Also, new studies indicate that cycling to school might have a greater health potential than walking to school. The purpose of the present study is to assess the potential association between cycling to school and weight status in two European cities, Rotterdam and Kristiansand, where cycling to school remains common. Data from two studies, ENDORSE (Rotterdam) and Youth in Balance (Kristiansand), were used including, respectively, 1361 and 1197 adolescents with mean ages of 14.1 and 14.4 years. The adolescents were categorized as cyclist or non-cyclist based on questionnaires on the usual mode of transportation to school. A total of 25% and 18% were categorized as overweight, and 35% and 31% were categorized as cyclists, in Rotterdam and Kristiansand, respectively. In multilevel logistic analyses, after adjusting for potential moderators, the odds ratios for cyclists being overweight compared with non-cyclists were, respectively, 0.63 (95% CI=0.45-0.89) and 0.52 (95% CI=0.34-0.78) in Rotterdam and Kristiansand. The results presented clearly show a negative association between cycling to school and overweight among adolescents both in Rotterdam and in Kristiansand.

Product samples stimulate choice of unfamiliar healthful food products.

The purpose of this study was to assess whether the availability of a product sample of an unfamiliar low-fat or fruit and vegetable products stimulates choice for this product among food neophobic young adults. The study had a 2 (experimental vs. control group) by 4 (low-fat bread spread, low-fat cheese, fruit juice, fruit and vegetable juice) between subjects design with a pre-and post-experiment questionnaire. The study was conducted in restaurant rooms of several educational institutions in the Netherlands among a convenience sample of 197 food neophobic young adults aged 17-25 years. A small bite or sip-sized sample of the target product was provided as an intervention. The effect measure was choice of either an unfamiliar healthful food product or a traditional food product. Offering a sample of an unfamiliar healthful food product resulted in 51% of the participants in the experimental group choosing this product vs. 36.4% in the control group. Providing food product samples seems to be a promising strategy in healthy diet promotion programs for food neophobic young adults to increase first-time trial of unfamiliar low-fat and fruit and vegetable products.

The association between home environmental variables and soft drink consumption among adolescents. Exploration of mediation by individual cognitions and habit strength.

Soft-drink consumption is one of the important target behaviours for the prevention of excessive weight gain among adolescents. To be able to modify these behaviours in obesity prevention interventions, further understanding of the underlying factors and mediational pathways is required. The present study aimed to explore associations between home environment variables and adolescent soft drink consumption and potential mediation of these associations by individual cognitions derived from the Theory of Planned Behaviour and habit strength. The ENDORSE study (N=1005) provided data on soft drink consumption and on home environment variables related to soft drink consumption (availability, accessibility, parental modelling, and parental rules), cognitive variables (intention, attitude, perceived behaviour control, and parental norm) and habit strength. Multiple mediation analyses were conducted using regression analyses according to the steps described by MacKinnon to assess the association between home environment variables and soft drink consumption and mediation of these associations by cognitive variables and habit strength. The bootstrapping method was used to calculate the confidence intervals. There were significant associations between the home environment variables and soft drink consumption. After inclusion of the mediators the strength of these associations was reduced. In the multiple mediator models, habit strength (39.4-62.6%) and intention (19.1-36.6%) were the strongest mediators. Intention and habit strength partly mediate the associations between home environment factors and soft drink consumption, suggesting that home environment variables influence soft drink consumption both indirectly and directly.

Information about the taste stimulates choice of unfamiliar healthful food products.

BACKGROUND: The present study aimed to assess whether taste information about unfamiliar low-fat and fruit and vegetable products leads to more positive taste expectations and stimulates choice for these products. The impact of level of food neophobia on such effects was studied. METHODS: The present study had a two (taste information: yes/no) by four (food products: low-fat cheese/very low-fat margarine spread/fruit juice/fruit and vegetable juice) between subjects design among a convenience sample of 396 university students. Taste information was delivered by means of a poster providing information on the taste of the offered food product. Primary outcome measurements were taste expectations and product choice. Level of food neophobia, appetite level, mood states, usual intake of fruit, vegetables and fat, and demographics were taken into account as potential confounders. RESULTS: Taste information had no effect on taste expectations, although it had a positive effect on choosing unfamiliar healthful products. These effects were not moderated by level of food neophobia. CONCLUSIONS: Offering taste information on unfamiliar healthful products appears to be a promising strategy for increasing the first-time trial of such products, independent of the participants' level of food neophobia.

Dairy intake from adolescence into adulthood is not associated with being overweight and metabolic syndrome in adulthood: the Amsterdam Growth and Health Longitudinal Study.

BACKGROUND: Dairy intake may have beneficial effects with respect to becoming overweight, insulin resistance and metabolic syndrome (MS), although most of the available studies are cross-sectional and conducted among adults. The present study aimed to investigate whether dairy intake during adolescence and young adulthood protects against becoming overweight and (components of) MS at age 36 years. METHODS: Dairy intake was repeatedly measured between the ages of 13 and 36 years among participants (n=374) of a Dutch prospective longitudinal cohort study. Being overweight and components of MS were examined at age 36 years. A statistical method for longitudinal data, generalised estimating equations, was used to assess whether the time course of total dairy intake, high-fat and low-fat dairy was associated with being overweight and with (components of) MS. RESULTS: The time course from age 13-36 years for total dairy intake did not differ between overweight and non-overweight participants, nor for participants with and without MS at age 36 years. Significant differences between groups were only observed at certain time points, mainly around the age of 21 and 27 years. High-fat dairy intake during adolescence tended to be higher in subjects with lower weight, a lower body fat percentage, lower waist circumference and lower triglyceride concentrations at age 36 years. In those having at least two risk factors for MS and high glycosylated haemoglobin, differences in dairy intake were in the opposite direction. CONCLUSIONS: These results do not support the hypothesis that dairy consumption protects against potentially becoming overweight and metabolic disturbances.