Perspectives of older women in the Netherlands: identifying motivators and barriers for healthy lifestyles and determinants of healthy aging.

BACKGROUND: Women have a higher life expectancy than men but experience more years with physical disabilities in daily life at older ages, especially women with a migration background. This pinpoints older women as an important target group for strategies that stimulate healthy lifestyle, which benefits healthy aging. Our study investigates motivators and barriers for healthy lifestyles and perspectives on determinants of healthy aging of older women. This provides essential information for developing targeted strategies. METHODS: Data was collected by semi-structured digital interviews from February till June 2021. Women aged 55 years and older living in the Netherlands (n = 34) with a native Dutch (n = 24), Turkish (n = 6) or Moroccan (n = 4) migration background were included. Two main subjects were investigated: (1) motivators and barriers on their current lifestyles regarding smoking, alcohol consumption, physical activity, diet and sleep and (2) perspectives on determinants of healthy aging. Interviews were analyzed using Krueger's framework. RESULTS: Personal health was the most common motivator for a healthy lifestyle. In addition, peer pressure and being outdoors were specific motivators for physical activity. Bad weather conditions and personal dislike to be active were specific barriers. The social environment, personal preferences and personal belief to compensate with other healthy lifestyle behaviors were barriers for low alcohol consumption. Personal preferences (liking unhealthy food and not making time) were the main barriers for a healthy diet. Sleep was not perceived as a form of lifestyle behavior, but rather as a personal trait. Since there were no smokers, specific barriers were not mentioned. For Turkish-Dutch and Moroccan-Dutch women, additional barriers and motivators were culture and religion. These were strong motivators to abstain from alcohol consumption and smoking, but a barrier for a healthy diet. With regard to perspectives on determinants of healthy aging, positive views on aging and being physically active were perceived as most important. Women often wanted to increase their physical activity or healthy diet to stimulate healthy aging. Among Turkish-Dutch and Moroccan-Dutch women, healthy aging was also perceived as something in the hands of God. CONCLUSIONS: Although motivators and barriers for a healthy lifestyle and perspectives on healthy aging vary for distinct lifestyles, personal health is a common motivator across all lifestyles. Having a migration background added culture and religion as distinct barriers and motivations. Strategies to improve lifestyle among older women should therefore have a tailored, culture sensitive approach (if applicable) for distinct lifestyle factors.

Milk intake and incident stroke and CHD in populations of European descent: a Mendelian randomisation study.

Higher milk intake has been associated with a lower stroke risk, but not with risk of CHD. Residual confounding or reverse causation cannot be excluded. Therefore, we estimated the causal association of milk consumption with stroke and CHD risk through instrumental variable (IV) and gene-outcome analyses. IV analysis included 29 328 participants (4611 stroke; 9828 CHD) of the European Prospective Investigation into Cancer and Nutrition (EPIC)-CVD (eight European countries) and European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) case-cohort studies. rs4988235, a lactase persistence (LP) SNP which enables digestion of lactose in adulthood was used as genetic instrument. Intake of milk was first regressed on rs4988235 in a linear regression model. Next, associations of genetically predicted milk consumption with stroke and CHD were estimated using Prentice-weighted Cox regression. Gene-outcome analysis included 777 024 participants (50 804 cases) from MEGASTROKE (including EPIC-CVD), UK Biobank and EPIC-NL for stroke, and 483 966 participants (61 612 cases) from CARDIoGRAM, UK Biobank, EPIC-CVD and EPIC-NL for CHD. In IV analyses, each additional LP allele was associated with a higher intake of milk in EPIC-CVD (ß = 13·7 g/d; 95 % CI 8·4, 19·1) and EPIC-NL (36·8 g/d; 95 % CI 20·0, 53·5). Genetically predicted milk intake was not associated with stroke (HR per 25 g/d 1·05; 95 % CI 0·94, 1·16) or CHD (1·02; 95 % CI 0·96, 1·08). In gene-outcome analyses, there was no association of rs4988235 with risk of stroke (OR 1·02; 95 % CI 0·99, 1·05) or CHD (OR 0·99; 95 % CI 0·95, 1·03). Current Mendelian randomisation analysis does not provide evidence for a causal inverse relationship between milk consumption and stroke or CHD risk.

Substitution among milk and yogurt products and the risk of incident type 2 diabetes in the EPIC-NL cohort.

BACKGROUND: Higher dairy consumption has been associated with lower type 2 diabetes (T2D) risk, whereas dairy product subtypes appear to differ in their T2D risk association. We investigated whether replacing one type of milk or yogurt product with another is associated with T2D incidence. METHODS: Participants of the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) cohort (n = 35 982) were included in the present study. Information on milk and yogurt consumption at baseline was obtained by a validated food frequency questionnaire. T2D cases were identified by self-report or linkage to the hospital discharge registry, and validated by consulting the general practitioner. Multivariable Cox proportional hazard models were used to estimate associations. RESULTS: During a mean of 15 years of follow-up, 1467 indecent T2D cases were validated. Median total milk and yogurt intake was 1.5 servings (25th percentile to 75th percentile: 0.8-2.4). After adjustment for demographic and cardiovascular risk factors, replacement of one serving (200 g) of whole-fat milk [hazard ratio (HR) = 0.93, 95% confidence interval (CI) = 0.60-1.44], buttermilk (HR = 0.88, 95% CI = 0.58-1.34), skimmed milk (HR = 0.87, 95% CI = 0.57-1.32) or skimmed fermented milk (HR = 0.99, 95% CI = 0.63-1.54) with whole-fat yogurt was not associated with T2D risk. Substitutions among other milk and yogurt products were also not associated with T2D risk. Sensitivity analysis investigating T2D risk halfway follow-up suggested a lower risk for substitutions with whole-fat yogurt. CONCLUSIONS: No evidence was found for the association between substitutions among milk and yogurt products and the risk of incident T2D, although we cannot exclude possible attenuation of results as a result of dietary changes over time. This analysis should be repeated in a population with a wider consumption range of whole-fat yogurt.

Fluidity of the dietary fatty acid profile and risk of coronary heart disease and ischemic stroke: Results from the EPIC-Netherlands cohort study.

BACKGROUND AND AIMS: The fluidity of dietary fatty acids consumed has been suggested to inversely affect coronary heart disease (CHD) risk. Lipophilic index (LI) represents overall fluidity of the dietary fatty acid profile. Lipophilic load (LL) represents a combination of overall fluidity and absolute intake of dietary fatty acids. We investigated the relations of dietary LI and LL with risk of CHD and ischemic stroke (iStroke). METHODS AND RESULTS: We used data from the prospective EPIC-NL study, including 36,520 participants aged 20-70 years. LI and LL were calculated using dietary intake data estimated with a validated FFQ. Incident CHD (n = 2348) and iStroke (n = 479) cases were obtained through linkage to national registers during 15 years follow-up. LI and LL were not associated with CHD risk (HRshighest-versus-lowest-quartiles: 0.93 [95%CI: 0.83, 1.04], and 0.92 [95%CI: 0.79, 1.07], respectively), and neither with iStroke risk (HRs 1.15 (95%CI: 0.89, 1.48), and 0.98 (95%CI: 0.70, 1.38), respectively). Original fatty acid classes (SFA, MUFA and PUFA), and LI and LL stratified by these fatty acid classes, were overall not related to CHD and ischemic stroke either. CONCLUSIONS: In this Dutch population, neither the overall fluidity of the dietary fatty acid profile (LI), nor the combined fluidity and amount of fatty acids consumed (LL) were related to CHD or iStroke risk. Dietary LI and LL may have limited added value above original fatty acid classes and food sources in establishing the relation of fatty acid consumption with CVD.

Back to the basics of ovarian aging: a population-based study on longitudinal anti-Müllerian hormone decline.

BACKGROUND: Anti-Müllerian hormone (AMH) is currently used as an ovarian reserve marker for individualized fertility counseling, but very little is known of individual AMH decline in women. This study assessed whether the decline trajectory of AMH is uniform for all women, and whether baseline age-specific AMH levels remain consistently high or low during this trajectory. METHODS: A total of 3326 female participants from the population-based Doetinchem Cohort Study were followed with five visits over a 20-year period. Baseline age was 40 ± 10 years with a range of 20-59 years. AMH was measured in 12,929 stored plasma samples using the picoAMH assay (AnshLabs). Decline trajectories of AMH were studied with both chronological age and reproductive age, i.e., time to menopause. Multivariable linear mixed effects models characterized the individual AMH decline trajectories. RESULTS: The overall rate of AMH decline accelerated after 40 years of age. Mixed models with varying age-specific AMH levels and decline rates provided the significantly best fit to the data, indicating that the fall in AMH levels over time does not follow a fixed pattern for individual women. AMH levels remained consistent along individual trajectories of age, with an intraclass correlation coefficient (ICC) of 0.87. The ICC of 0.32 for AMH trajectories with time to menopause expressed the large variation in AMH levels at a given time before the menopause. The differences between low and high age-specific AMH levels remained distinguishable, but became increasingly smaller with increasing chronological and reproductive age. CONCLUSIONS: This is the first study to characterize individual AMH decline over a long time period and broad age range. The varying AMH decline rates do not support the premise of a uniform AMH decline trajectory. Although age-specific AMH levels remain consistently high or low with increasing age, the converging trajectories and variance of AMH levels at a given time before menopause shed doubt on the added value of AMH to represent individualized reproductive age.

The association of low ovarian reserve with cardiovascular disease risk: a cross-sectional population-based study.

STUDY QUESTION: Is there a relationship between serum anti-Müllerian hormone (AMH) level and cardiovascular disease (CVD) risk in premenopausal women? SUMMARY ANSWER: There are indications that premenopausal women with very low ovarian reserve may have an unfavorable CVD risk profile. WHAT IS KNOWN ALREADY: Age at menopause is frequently linked to CVD occurrence. AMH is produced by ovarian antral follicles and provides a measure of remaining ovarian reserve Literature on whether AMH is related to CVD risk is still scarce and heterogeneous. STUDY DESIGN, SIZE, DURATION: Cross-sectional study in 2338 women (age range of 20-57 years) from the general population, participating in the Doetinchem Cohort Study between 1993 and 1997. PARTICIPANTS/MATERIALS, SETTING, METHODS: CVD risk was compared between 2338 premenopausal women in different AMH level-categories, with adjustment for confounders. CVD risk was assessed through levels of systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol and glucose, in addition to a summed score of CVD risk factors. Among other factors, analyses were corrected for smoking, oral contraceptive use and BMI. MAIN RESULTS AND THE ROLE OF CHANCE: The relationship of serum AMH levels with CVD risk factor outcomes was nonlinear. Women with AMH levels <0.16 µg/l had 0.11 (95% confidence intervals (CIs) 0.01; 0.21) more metabolic risk factors compared with women with AMH levels ≥0.16 µg/l. There was no association of individual risk factor levels with AMH levels, besides a tendency towards lower total cholesterol levels of 0.11 mmol/l (95% CI -0.23; 0.01) in women with AMH levels <0.002 µg/l compared with women with AMH levels ≥0.16 µg/l. Although not statistically significant, these effect sizes were larger in women below 40 years of age. LIMITATIONS, REASONS FOR CAUTION: Causality and temporality of the studied association cannot be addressed here. Moreover, the clinical and statistical significance of the results of this exploratory study should be interpreted with caution due to the absence of adjustment for multiple statistical testing. WIDER IMPLICATIONS OF THE FINDINGS: This population-based study supports previous findings that premenopausal women with very low AMH levels may have an increased CVD risk. It lays the groundwork for future research to focus on this group of women. Longitudinal studies with more sensitive AMH assays may furthermore help better understand the implications of these results. STUDY FUNDING/COMPETING INTEREST: No financial support was received for this research or manuscript. The Doetinchem Cohort Study is conducted and funded by the Dutch National Institute for Public Health and the Environment F.J.M.B. has received fees and grant support from Merck Serono, Gedeon Richter, Ferring BV and Roche. TRIAL REGISTRATION NUMBER: N/A.

Trends in risk factors for coronary heart disease in the Netherlands.

BACKGROUND: Favourable trends in risk factor levels in the general population may partly explain the decline in coronary heart disease (CHD) morbidity and mortality. Our aim was to present long-term national trends in established risk factors for CHD. METHODS: Data were obtained from five data sources including several large scale population based surveys, cohort studies and general practitioner registers between 1988 and 2012. We applied linear regression models to age-standardized time trends to test for statistical significant trends. Analyses were stratified by sex and age (younger <65 and older ≥65 years adults). RESULTS: The results demonstrated favourable trends in smoking (except in older women) and physical activity (except in older men). Unfavourable trends were found for body mass index (BMI) and diabetes mellitus prevalence. Although systolic blood pressure (SBP) and total cholesterol trends were favourable for older persons, SBP and total cholesterol remained stable in younger persons. CONCLUSIONS: Four out of six risk factors for CHD showed a favourable or stable trend. The rise in diabetes mellitus and BMI is worrying with respect to CHD morbidity and mortality.

Diagnosis of diabetes mellitus or cardiovascular disease and lifestyle changes - the Doetinchem cohort study.

OBJECTIVE: To study whether being diagnosed with a cardiovascular disease (CVD) or diabetes mellitus (DM) is associated with improvements in lifestyles. METHODS: We used data from the Doetinchem Cohort Study, a prospective study among 6386 Dutch men and women initially aged 20-59years who were examined four times over 15years (1987-2007). Logistic and linear regression models were used to assess the effect of a self-reported diagnosis of CVD (n=403) or DM (n=221) on smoking, alcohol consumption, weight, diet and physical activity. RESULTS: Self-reported diagnosis of CVD increased rates of smoking cessation (OR=2.2, 95%CI 1.6 - 3.1). Adults reporting a diagnosis of DM (relatively) decreased weight (3.2%, 95%CI 2.2 - 4.2), (relatively) decreased energy intake (4.2%, 95%CI 0.7 - 7.7), decreased energy percentage from saturated fat (0.4%, 95%CI 0.0 - 0.9) and increased fish consumption (2.8 g/day, 95%CI 0.4 - 5.1). A self-reported diagnosis of CVD or DM was not associated with changes in physical activity. CONCLUSION: A diagnosis of CVD or DM may act, along with possible effects of medical treatment, as a trigger to adopt a healthier lifestyle in terms of smoking cessation, healthier diet and weight loss.

Glycated hemoglobin measurement and prediction of cardiovascular disease.

IMPORTANCE: The value of measuring levels of glycated hemoglobin (HbA1c) for the prediction of first cardiovascular events is uncertain. OBJECTIVE: To determine whether adding information on HbA1c values to conventional cardiovascular risk factors is associated with improvement in prediction of cardiovascular disease (CVD) risk. DESIGN, SETTING, AND PARTICIPANTS: Analysis of individual-participant data available from 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline assessment. MAIN OUTCOMES AND MEASURES: Measures of risk discrimination for CVD outcomes (eg, C-index) and reclassification (eg, net reclassification improvement) of participants across predicted 10-year risk categories of low (<5%), intermediate (5% to <7.5%), and high (≥ 7.5%) risk. RESULTS: During a median follow-up of 9.9 (interquartile range, 7.6-13.2) years, 20,840 incident fatal and nonfatal CVD outcomes (13,237 coronary heart disease and 7603 stroke outcomes) were recorded. In analyses adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c values and CVD risk. The association between HbA1c values and CVD risk changed only slightly after adjustment for total cholesterol and triglyceride concentrations or estimated glomerular filtration rate, but this association attenuated somewhat after adjustment for concentrations of high-density lipoprotein cholesterol and C-reactive protein. The C-index for a CVD risk prediction model containing conventional cardiovascular risk factors alone was 0.7434 (95% CI, 0.7350 to 0.7517). The addition of information on HbA1c was associated with a C-index change of 0.0018 (0.0003 to 0.0033) and a net reclassification improvement of 0.42 (-0.63 to 1.48) for the categories of predicted 10-year CVD risk. The improvement provided by HbA1c assessment in prediction of CVD risk was equal to or better than estimated improvements for measurement of fasting, random, or postload plasma glucose levels. CONCLUSIONS AND RELEVANCE: In a study of individuals without known CVD or diabetes, additional assessment of HbA1c values in the context of CVD risk assessment provided little incremental benefit for prediction of CVD risk.

Modifiable Risk Factors for Accelerated Decline in Processing Speed: Results from Three Dutch Population Cohorts.

BACKGROUND: Several lifestyle, cardiovascular and psychosocial factors are associated with risk of cognitive decline and dementia. We studied the independent associations of a broad set of modifiable risk factors with decline in processing speed in three large population-based cohorts with up to 23 years of follow-up. METHODS: We used data of 9,666 participants from the Doetinchem Cohort Study, the Longitudinal Aging Study Amsterdam, and the Maastricht Aging Study. Decline in processing speed was measured with the letter digit substitution task or the alphabet coding task and modeled using quadratic latent growth curves. Associations of modifiable risk factors with level and rate of decline in processing speed were investigated by estimating associations with level of processing speed at different centering ages. RESULTS: Latent growth curves showed that decline in processing speed accelerated with age. Smoking, not drinking alcohol and depressive symptoms were associated with a lower level of processing speed in all cohorts. In two of the cohorts, more physical activity, drinking more than two glasses of alcohol per day, higher BMI and diabetes were associated with a lower level of processing speed. Depressive symptoms and diabetes were also associated with faster decline in processing speed. CONCLUSION: Several modifiable risk factors are associated with the level of processing speed in older age, while few are also related to the rate of decline.

Lifestyle factors and metabolomic aging biomarkers: Meta-analysis of cross-sectional and longitudinal associations in three prospective cohorts.

Biological age uses biophysiological information to capture a person's age-related risk of adverse outcomes. MetaboAge and MetaboHealth are metabolomics-based biomarkers of biological age trained on chronological age and mortality risk, respectively. Lifestyle factors contribute to the extent chronological and biological age differ. The association of lifestyle factors with MetaboAge and MetaboHealth, potential sex differences in these associations, and MetaboAge's and MetaboHealth's sensitivity to lifestyle changes have not been studied yet. Linear regression analyses and mixed-effect models were used to examine the cross-sectional and longitudinal associations of scaled lifestyle factors with scaled MetaboAge and MetaboHealth in 24,332 middle-aged participants from the Doetinchem Cohort Study, Rotterdam Study, and UK Biobank. Random-effect meta-analyses were performed across cohorts. Repeated metabolomics measurements had a ten-year interval in the Doetinchem Cohort Study and a five-year interval in the UK Biobank. In the first study incorporating longitudinal information on MetaboAge and MetaboHealth, we demonstrate associations between current smoking, sleeping ≥8 hours/day, higher BMI, and larger waist circumference were associated with higher MetaboHealth, the latter two also with higher MetaboAge. Furthermore, adhering to the dietary and physical activity guidelines were inversely associated with MetaboHealth. Lastly, we observed sex differences in the associations between alcohol use and MetaboHealth.

Longitudinal analysis of cardiovascular risk parameters in women with a history of hypertensive pregnancy disorders: the Doetinchem Cohort Study.

OBJECTIVE: Women with hypertensive pregnancy disorders (HPD) are at increased risk of developing hypertension and cardiovascular disease later in life; however, it is not known how cardiovascular risk develops throughout life. We evaluated the longitudinal trends in cardiovascular risk factors in women after hypertensive pregnancy disorders compared with women with normotensive pregnancies. DESIGN AND POPULATION: All women of the Doetinchem Cohort Study (1987-91), a population-based cohort study, were included. METHODS: Women were examined (questionnaires and physical examination) four times at 5-year intervals. History of HPD was assessed from questionnaires. We compared 5-year changes in risk factors between women with and without HPD, by analysing longitudinal trends using generalised estimating equation analysis to estimate the effects of HPD and mean age, adjusting for treatment, body mass index (BMI), smoking and socio-economic status. MAIN OUTCOME MEASURES: Change over time in traditional cardiovascular risk factors, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), BMI, total and high-density lipoprotein (HDL) cholesterol for women with and without a history of HPD. RESULTS: A total of 2703 women with normotensive pregnancies (mean age 40.5 years, SD 10.4) and 689 women with a history of HPD (mean age 38.4 years, SD 9.5) were included. Compared with normotensive women, in women with a history of HPD, SBP was 2.8 mmHg higher (95% CI 1.7-3.9), DBP was 2.3 mmHg higher (95% CI 1.6-3.0) and BMI was 0.7 kg/m(2) higher (95% CI 0.4-1.1). Total cholesterol (-0.05; 95% CI -0.1 to 0.0) and HDL cholesterol (0.02; 95% CI -0.0 to 0.1) were similar in both groups. No difference in annual change in blood pressure or in the other risk factors was observed between women with and without a history of HPD. CONCLUSION: Women with a history of HPD have higher levels of SBP, DBP and BMI compared with normotensive women, but the increase with ageing is similar in both groups.

N-6 and n-3 fatty acid cholesteryl esters in relation to incident stroke in a Dutch adult population: a nested case-control study.

BACKGROUND AND AIMS: There are few prospective studies on fatty acid status in relation to incident stroke, with inconsistent results. We assessed the associations of plasma n-6 and n-3 PUFA in cholesteryl esters with the risk of total stroke and stroke subtypes in Dutch adults. METHODS AND RESULTS: We conducted a nested case-control study using data from a population-based cohort study in adults aged 20-65 years. Blood sampling and data collection took place during 1993-1997 and subjects were followed for 8-13 years. We identified 179 incident cases of stroke and 179 randomly selected controls, matched on age, gender, and enrollment date. Odds ratios (OR) with 95% confidence intervals (95%CI) were calculated per standard deviation (SD) increase of PUFA in cholesteryl esters using multivariable conditional logistic regression. Cases comprised 93 ischemic, 50 hemorrhagic, and 36 unspecified strokes. The n-6 PUFA linoleic acid and arachidonic acid contributed ~55% and ~6.5% respectively to total plasma fatty acids, whereas the n-3 PUFA alpha-linolenic acid contributed ~0.5% and eicosapentaenoic acid plus docosahexaenoic acid (EPA-DHA) ~1.3%. After adjustment for confounders, n-6 and n-3 PUFA were not associated with incident total stroke or stroke subtypes. The OR (95% CI) for total stroke was 0.95 (0.74-1.23) per SD increase in linoleic acid and 1.02 (0.80-1.30) per SD increase in arachidonic acid. ORs (95% CI) for total stroke were 0.94 (0.72-1.21) for alpha-linolenic acid and 1.16 (0.94-1.45) for EPA-DHA. CONCLUSION: In the present study, plasma n-6 or n-3 fatty acids were not related to incident stroke or stroke subtypes.

Dietary patterns derived from principal component- and k-means cluster analysis: long-term association with coronary heart disease and stroke.

BACKGROUND AND AIMS: Studies comparing dietary patterns derived from different a posteriori methods in view of predicting disease risk are scarce. We aimed to explore differences between dietary patterns derived from principal component- (PCA) and k-means cluster analysis (KCA) in relation to their food group composition and ability to predict CHD and stroke risk. METHODS AND RESULTS: The study was conducted in the EPIC-NL cohort that consists of 40,011 men and women. Baseline dietary intake was measured using a validated food-frequency questionnaire. Food items were consolidated into 31 food groups. Occurrence of CHD and stroke was assessed through linkage with registries. After 13 years of follow-up, 1,843 CHD and 588 stroke cases were documented. Both PCA and KCA extracted a prudent pattern (high intakes of fish, high-fiber products, raw vegetables, wine) and a western pattern (high consumption of French fries, fast food, low-fiber products, other alcoholic drinks, soft drinks with sugar) with small variation between components and clusters. The prudent component was associated with a reduced risk of CHD (HR for extreme quartiles: 0.87; 95%-CI: 0.75-1.00) and stroke (0.68; 0.53-0.88). The western component was not related to any outcome. The prudent cluster was related with a lower risk of CHD (0.91; 0.82-1.00) and stroke (0.79; 0.67-0.94) compared to the western cluster. CONCLUSION: PCA and KCA found similar underlying patterns with comparable associations with CHD and stroke risk. A prudent pattern reduced the risk of CHD and stroke.

Willingness to get vaccinated against influenza, pneumococcal disease, pertussis, and herpes zoster - A pre-COVID-19 exploration among the older adult population.

BACKGROUND: Older adults are at increased risk for adverse health outcomes when having an influenza, pneumococcal disease, pertussis, or herpes zoster infection. Despite the ability of vaccinations to prevent these adverse outcomes, vaccination coverage is low in the European Union. This study aimed to explore the sociodemographic, lifestyle, and health-related characteristics associated with vaccination willingness for these vaccine-preventable diseases. METHODS: Cross-sectional data from wave 6 (years 2013-2017) of the population-based Doetinchem Cohort Study was analysed, with 3063 participants aged 46-86 years included. The outcome was the self-reported willingness to get vaccinated against influenza, pneumococcal disease, pertussis, and herpes zoster (willing, neutral, not willing). Multinomial logistic regression was used to investigate the socio-demographic, lifestyle and health characteristics associated with vaccination willingness. RESULTS: For influenza 36 % was willing to get vaccinated, 35 % was neutral and 28 % was not willing to get vaccinated. The willingness to get vaccinated for the relatively unfamiliar vaccine-preventable diseases was lower: 26 % for pneumococcal disease (neutral: 50 %, not willing: 23 %), 26 % for pertussis (neutral 53 %, not willing: 22 %), and 23 % for herpes zoster (neutral 54 %, not willing: 24 %). A relative lower willingness was found among those 46-64 years old (compared to those 65 years or older). Women, having a high SES, being employed and having a good health were all associated with lower willingness to get vaccinated, which was the case for all vaccine-preventable diseases. CONCLUSIONS: Older adults were generally more willing to get vaccinated against influenza than for the three less familiar diseases. Characteristics of those less willing may be used to improve strategies to increase vaccination coverage. Additional studies are needed to investigate the willingness to get vaccinated during and after the COVID-19 pandemic that may have changed the feel of urgency for vaccination.

[Population-level changes to promote cardiovascular health]. / Zmeny na úrovni populace zamerené na podporu kardiovaskulárního zdraví

BACKGROUND: Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD. DESIGN AND METHODS: Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol). RESULTS: Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life. CONCLUSION: Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.

Cycling and sports, but not walking, are associated with 10-year cardiovascular disease incidence: the MORGEN Study.

BACKGROUND: Physical activity is inversely related to cardiovascular diseases. However, the type of activities that contribute most to these beneficial effects remain unclear. For this reason, we investigated self-reported leisure time physical activities in relation to fatal/nonfatal cardiovascular disease incidence. DESIGN: The Dutch Monitoring Project on Risk Factors for Chronic Diseases Study, carried out between 1993 and 1997, is a prospective cohort study of over 23000 men and women aged 20­65 years from the general Dutch population. METHODS: From 1994 till 1997 physical activity was assessed with a questionnaire in 7451 men and 8991 women who were followed for an average of 9.8 years. Cox proportional hazards models were used adjusting for age, sex, other physical activities, smoking, alcohol consumption, and educational level. RESULTS: Almost the entire study population (97%) was engaged in walking, about 75% in regular cycling, and about half the population in sports or gardening. Cycling [hazard ratio (HR): 0.82, 95% confidence interval (CI): 0.71­0.95] and sports (HR: 0.74, 95% CI: 0.64­0.87) were both inversely related to cardiovascular disease incidence, whereas walking and gardening were not. For sports (P < 0.001), but not for cycling (P = 0.06), we found a dose - response relationship with respect to cardiovascular disease incidence. Engaging in both cycling and sports resulted in an even greater risk reduction (HR: 0.64, 95% CI: 0.52­0.77). CONCLUSION: In this relatively active population, types of activities of at least moderate intensity, such as cycling and sports were associated with lower CVD incidence, whereas activities of lower intensity, such as walking and gardening, were not.

Positive and negative experiences of social support and long-term mortality among middle-aged Dutch people.

This study investigated the relation between positive and negative experiences of social support and mortality in a population-based sample. Data were derived from Dutch men and women aged 20-59 years who participated in the Doetinchem Cohort Study in 1987-1991. Social support was measured at baseline and after 5 years of follow-up by using the Social Experiences Checklist indicating positive (n = 11,163) and negative (n = 11,161) experiences of support. Mortality data were obtained from 1987 until 2008. Cox proportional hazards regression models, adjusted for age and sex, showed that low positive experiences of support at baseline were associated with an increased mortality risk after, on average, 19 years of follow-up (hazard ratio = 1.26, 95% confidence interval: 1.04, 1.52). Even after additional adjustment for socioeconomic factors, lifestyle factors, and indicators of health status, the increased mortality risk remained statistically significant (hazard ratio = 1.23, 95% confidence interval: 1.01, 1.49). For participants with repeated measurements of social support at 5-year intervals, a stable low level of positive experiences of social support was associated with a stronger increase in age- and sex-adjusted mortality risk (hazard ratio = 1.57, 95% confidence interval: 1.03, 2.39). Negative experiences of social support were not related to mortality.

Relation between body mass index, physical inactivity and use of prescription drugs: the Doetinchem Cohort Study.

BACKGROUND: Obesity and physical inactivity are associated with several diseases such as diabetes, cardiovascular diseases, musculoskeletal complaints, osteoporosis, certain types of cancer and depression. However, few data are available on the specific types of medication associated with obesity and physical inactivity. OBJECTIVE: The aim of this study was to determine the independent association of body mass index (BMI) and physical inactivity with use of specific classes of prescription drugs, and the interaction between BMI and physical inactivity. METHODS: The Doetinchem Cohort Study is a population-based longitudinal study. We analyzed cross-sectional data of 1703 men and 1841 women, examined between 1998 and 2002, for whom drug-dispending data were available from the PHARMO database. Drugs were coded according to the WHO Anatomical Therapeutic Chemical (ATC) classification system. Body weight was measured during the physical examination. Physical activity was assessed using an extensive questionnaire. Persons were defined as a user of a certain drug class if they filed at least one prescription in the year around (+/-6 months) the examination. RESULTS: Compared with normal weight persons (BMI 18.5-25 kg m(-2)), obese persons (BMI>30 kg m(-2)) had a higher use of prescription drugs of several drug classes, especially cardiovascular drugs (OR (95% CI): 3.83 (2.61-5.64) in men and 2.80 (2.03-3.86) in women) and diabetes drugs (OR (95% CI): 5.72 (2.32-14.14) in men and 3.92 (1.80-8.54) in women). In women, physical inactivity was also associated with higher use of certain drug classes, such as drugs for blood and blood-forming organs (OR (95% CI): 2.11 (1.22-3.65)) and musculoskeletal drugs (OR (95% CI): 2.07 (1.45-2.97)), whereas in men this was not the case. We found no interaction between BMI and physical inactivity with respect to use of prescription drugs. CONCLUSION: In both men and women, obesity was associated with a higher use of several types of prescription drugs, whereas physical inactivity was only associated with a higher use of certain drug classes in women.

Weight change over five-year periods and number of components of the metabolic syndrome in a Dutch cohort.

Overweight and obesity are associated with the metabolic syndrome (MetS). We studied the association of weight change over three consecutive 5-year periods with the number of MetS components in people aged 20-59 years. 5735 participants from the Doetinchem Cohort Study were included. Weight was measured in round 1 and at each 5-year interval follow-up (round 2, 3 and 4). Weight change was defined as the absolute weight change between two consecutive measurements. The number of MetS components (assessed in round 2, 3 and 4) was based on the presence of the following components of the MetS: central obesity, raised blood pressure, reduced high density lipoprotein cholesterol and elevated glucose. Associations of weight change and the number of components of the MetS were analyzed with Generalized Estimating Equations for Poisson regression, stratified for 10-year age groups. For each age group, 1 kg weight gain was positively associated with the number of components of the MetS, independent of sex and measurement round. The association was stronger in 30-39 years (adjusted rate ratio: 1.044; 95%CI: 1.040-1.049) and smaller in older age groups. Compared to stable weight (>-2.5 kg and < 2.5 kg), weight loss (< or = -2.5 kg) and weight gain (> or =2.5 kg) was associated with a lower and higher rate ratio respectively, for the number of components of the MetS. Our results support the independent association of weight change with the number of MetS components with a more pronounced association in younger people.