[The Lifestyle Monitor: prevalence rates for health policy]. / De Leefstijlmonitor: Cijfers voor gezondheidsbeleid.

The Lifestyle Monitor (LSM) was launched in 2013 on behalf of the Ministry of Health, Welfare and Sports to reorganize the multiple data collections in the field of lifestyle and health in the Netherlands. The reorganization should enhance the efficiency and coherence of the lifestyle and health data collections and should provide unambiguous figures for policymakers. This article describes the background and content (including the lifestyle-themes) of the LSM and the tasks and roles of the collaborating parties involved. The measurement methods used and requirements for data requests are described as well. Finally, some examples of figures and trends over the period 2014-2020 to underpin the health policy are described.

Relative Validity of MijnEetmeter: A Food Diary App for Self-Monitoring of Dietary Intake.

This study aimed to evaluate the relative validity of intake of energy, nutrients and food groups assessed with MijnEetmeter food diary as compared to 24-h dietary recalls, and if this differed between experienced and new users. One hundred men and women aged 18-70 y participated, of whom 47 had prior experience with the tool. Participants kept MijnEetmeter on three days. Trained dietitians called them three times for a 24-h dietary recall interview, once recalling food consumption on the same day as the food recording in MijnEetmeter. Systematic differences and correlations were assessed, and Bland-Altman plots were created; both for 3-day mean intakes and for intakes on the same day. Relative to 24-h dietary recalls, MijnEetmeter underestimated consumption of drinks, added fat, cereal products, and potatoes. Relative underestimation was observed for energy intake (6%) and about half of the nutrients. Experienced MijnEetmeter users underestimated intake the least. For intake of energy and six key nutrients, correlations between 3-day mean intakes were above 0.7 except for sodium intake. In conclusion, MijnEetmeter moderately underestimates intakes of energy and some nutrients and food groups. To improve the self-monitoring of dietary intake, it is recommended that the users record food consumption for several days and that the apps probes for easily forgotten foods and drinks.

Development of healthy and sustainable food-based dietary guidelines for the Netherlands.

OBJECTIVE: To derive healthy and sustainable food-based dietary guidelines (FBDG) for different target groups in the Netherlands and describe the process. DESIGN: Optimised dietary patterns for children, adolescents, adults and the elderly were calculated using an optimisation model. Foods high in saturated and trans-fatty acids, salt and sugar, and low in dietary fibre, were excluded. The dietary patterns resembled the current food consumption as closely as possible, while simultaneously meeting recommendations for food groups, nutrients, maximum limits for foods with a high environmental impact, and within 85 % of the energy requirement. Recommended daily amounts of food groups were based on the optimised dietary patterns and expert judgement. SETTING: The Netherlands. PARTICIPANTS: FBDG were derived for Dutch people with different ages, genders, activity levels and food preferences. RESULTS: For most target groups the optimisation model provided dietary patterns that complied with all requirements. For some food groups, the optimised amounts varied largely between target groups. For consistent messages to consumers, the optimised dietary patterns were adjusted to uniform recommendations per target group. Recommendations were visualised in the Wheel of Five. The advice is to eat the recommended amounts of foods according to the Wheel of Five and limit consumption of other foods. CONCLUSIONS: Based on an optimisation model, scientific evidence, information on dietary patterns and expert knowledge, we derived FBDG for different target groups. The Wheel of Five is a key food-counselling model that can help Dutch consumers to make their diets healthier and more environmentally sustainable.

Multi-parameter comparison of a standardized mixed meal tolerance test in healthy and type 2 diabetic subjects: the PhenFlex challenge.

BACKGROUND: A key feature of metabolic health is the ability to adapt upon dietary perturbations. Recently, it was shown that metabolic challenge tests in combination with the new generation biomarkers allow the simultaneous quantification of major metabolic health processes. Currently, applied challenge tests are largely non-standardized. A systematic review defined an optimal nutritional challenge test, the "PhenFlex test" (PFT). This study aimed to prove that PFT modulates all relevant processes governing metabolic health thereby allowing to distinguish subjects with different metabolic health status. Therefore, 20 healthy and 20 type 2 diabetic (T2D) male subjects were challenged both by PFT and oral glucose tolerance test (OGTT). During the 8-h response time course, 132 parameters were quantified that report on 26 metabolic processes distributed over 7 organs (gut, liver, adipose, pancreas, vasculature, muscle, kidney) and systemic stress. RESULTS: In healthy subjects, 110 of the 132 parameters showed a time course response. Patients with T2D showed 18 parameters to be significantly different after overnight fasting compared to healthy subjects, while 58 parameters were different in the post-challenge time course after the PFT. This demonstrates the added value of PFT in distinguishing subjects with different health status. The OGTT and PFT response was highly comparable for glucose metabolism as identical amounts of glucose were present in both challenge tests. Yet the PFT reports on additional processes, including vasculature, systemic stress, and metabolic flexibility. CONCLUSION: The PFT enables the quantification of all relevant metabolic processes involved in maintaining or regaining homeostasis of metabolic health. Studying both healthy subjects and subjects with impaired metabolic health showed that the PFT revealed new processes laying underneath health. This study provides the first evidence towards adopting the PFT as gold standard in nutrition research.

Effects of mood inductions by meal ambiance and moderate alcohol consumption on endocannabinoids and N-acylethanolamines in humans: a randomized crossover trial.

BACKGROUND: The endocannabinoid system is suggested to play a regulatory role in mood. However, the response of circulating endocannabinoids (ECs) to mood changes has never been tested in humans. In the present study, we examined the effects of mood changes induced by ambiance and moderate alcohol consumption on plasma ECs 2-arachidonoylglycerol (2-AG), anandamide (AEA), and some N-acylethanolamine (NAE) congeners in humans. METHODS: Healthy women (n = 28) participated in a randomized cross-over study. They consumed sparkling white wine (340 mL; 30 g alcohol) or alcohol-free sparkling white wine (340 mL; <2 g alcohol) as part of a standard evening meal in a room with either a pleasant or an unpleasant ambiance. RESULTS: Plasma concentrations of palmitoylethanolamide (PEA) and stearoylethanolamide (SEA) increased after 30 min in the unpleasant ambiance, while they decreased in the pleasant ambiance. Changes in ECs and their NAE congeners correlated with mood states, such as happiness and fatigue, but in the pleasant ambiance without alcohol only. ECs and their NAE congeners were correlated with serum free fatty acids and cortisol. CONCLUSION: This is the first human study to demonstrate that plasma NAEs are responsive to an unpleasant meal ambiance. Furthermore, associations between mood states and ECs and their NAE congeners were observed. TRIAL REGISTRATION: Clinicaltrials.gov NCT01426022.

Moderate alcohol consumption stimulates food intake and food reward of savoury foods.

The aim of this study was to investigate whether food reward plays a role in the stimulating effect of moderate alcohol consumption on subsequent food intake. In addition, we explored the role of oral and gut sensory pathways in alcohol's effect on food reward by modified sham feeding (MSF) or consumption of a preload after alcohol intake.In a single-blind crossover design, 24 healthy men were randomly assigned to either consumption of vodka/orange juice (20 g alcohol) or orange juice only, followed by consumption of cake, MSF of cake or no cake. Food reward was evaluated by actual food intake measured by an ad libitum lunch 45 min after alcohol ingestion and by behavioural indices of wanting and liking of four food categories (high fat, low fat, sweet and savoury).Moderate alcohol consumption increased food intake during the ad libitum lunch by 11% (+338 kJ, P = 0.004). Alcohol specifically increased intake (+127 kJ, P <0.001) and explicit liking (P = 0.019) of high-fat savoury foods. Moreover, moderate alcohol consumption increased implicit wanting for savoury (P = 0.013) and decreased implicit wanting for sweet (P = 0.017) before the meal. Explicit wanting of low-fat savoury foods only was higher after alcohol followed by no cake as compared to after alcohol followed by cake MSF (P = 0.009), but not as compared to alcohol followed by cake consumption (P = 0.082). Both cake MSF and cake consumption had no overall effect on behavioural indices of food reward.To conclude, moderate alcohol consumption increased subsequent food intake, specifically of high-fat savoury foods. This effect was related to the higher food reward experienced for savoury foods. The importance of oral and gut sensory signalling in alcohol's effect on food reward remains largely unclear.

Parental perception of child's weight status and subsequent BMIz change: the KOALA birth cohort study.

BACKGROUND: Parents often fail to correctly perceive their children's weight status, but no studies have examined the association between parental weight status perception and longitudinal BMIz change (BMI standardized to a reference population) at various ages. We investigated whether parents are able to accurately perceive their child's weight status at age 5. We also investigated predictors of accurate weight status perception. Finally, we investigated the predictive value of accurate weight status perception in explaining children's longitudinal weight development up to the age of 9, in children who were overweight at the age of 5. METHODS: We used longitudinal data from the KOALA Birth Cohort Study. At the child's age of 5 years, parents filled out a questionnaire regarding child and parent characteristics and their perception of their child's weight status. We calculated the children's actual weight status from parental reports of weight and height at ages 2, 5, 6, 7, 8, and 9 years. Regression analyses were used to identify factors predicting which parents accurately perceived their child's weight status. Finally, regression analyses were used to predict subsequent longitudinal BMIz change in overweight children. RESULTS: Eighty-five percent of the parents of overweight children underestimated their child's weight status at age 5. The child's BMIz at age 2 and 5 were significant positive predictors of accurate weight status perception (vs. underestimation) in normal weight and overweight children. Accurate weight status perception was a predictor of higher future BMI in overweight children, corrected for actual BMI at baseline. CONCLUSIONS: Children of parents who accurately perceived their child's weight status had a higher BMI over time, probably making it easier for parents to correctly perceive their child's overweight. Parental awareness of the child's overweight as such may not be sufficient for subsequent weight management by the parents, implying that parents who recognize their child's overweight may not be able or willing to adequately manage the overweight.

Food parenting practices and child dietary behavior. Prospective relations and the moderating role of general parenting.

Research on parenting practices has focused on individual behaviors while largely failing to consider the context of their use, i.e., general parenting. We examined the extent to which food parenting practices predict children's dietary behavior (classified as unhealthy: snacking, sugar-sweetened beverage; and healthy: water and fruit intake). Furthermore, we tested the moderating role of general parenting on this relationship. Within the KOALA Birth Cohort Study, in the Netherlands, questionnaire data were collected at 6 and 8 years (N = 1654). Correlations were computed to assess the association between food parenting practices and general parenting (i.e., nurturance, behavioral control, structure, coercive control, and overprotection). Linear regression models were fitted to assess whether food parenting practices predict dietary behavior. Instrumental and emotional feeding, and pressure to eat were found to have associations with undesirable child dietary behavior (increased unhealthy intake/decreased healthy intake), whereas associations were in the desirable direction for covert control, encouragement and restriction. Moderation analyses were performed by evaluating interactions with general parenting. The associations of encouragement and covert control with desirable child dietary behaviors were found to be stronger for children who were reared in a positive parenting context. Future research should assess the influence of contextual parenting factors moderating the relationships between food parenting and child dietary behavior as the basis for the development of more effective family-based interventions.

The biphasic effects of moderate alcohol consumption with a meal on ambiance-induced mood and autonomic nervous system balance: a randomized crossover trial.

BACKGROUND: The pre-drinking mood state has been indicated to be an important factor in the mood effects of alcohol. However, for moderate alcohol consumption there are no controlled studies showing this association. Also, the mood effects of consuming alcohol combined with food are largely unknown. The aim of this study was to investigate the effects of moderate alcohol combined with a meal on ambiance-induced mood states. Furthermore effects on autonomic nervous system activity were measured to explore physiological mechanisms that may be involved in changes of mood state. METHODS: In a crossover design 28 women (age 18-45 y, BMI 18.5-27 kg/m2) were randomly allocated to 4 conditions in which they received 3 glasses of sparkling white wine (30 g alcohol) or alcohol-free sparkling white wine while having dinner in a room with either a pleasant or unpleasant created ambiance. Subjects filled out questionnaires (B-BAES, POMS and postprandial wellness questionnaire) at different times. Skin conductance and heart rate variability were measured continuously. RESULTS: Moderate alcohol consumption increased happiness scores in the unpleasant, but not in the pleasant ambiance. Alcohol consumption increased happiness and stimulation feelings within 1 hour and increased sedative feelings and sleepiness for 2.5 hour. Skin conductance was increased after alcohol within 1 hour and was related to happiness and stimulation scores. Heart rate variability was decreased after alcohol for 2 hours and was related to mental alertness. CONCLUSION: Mood inductions and autonomic nervous system parameters may be useful to evaluate mood changes by nutritional interventions. Moderate alcohol consumption elevates happiness scores in an unpleasant ambiance. However, drinking alcohol during a pleasant mood results in an equally positive mood state. TRIAL REGISTRATION: Clinicaltrials.gov NCT01426022.

Clustering of energy balance-related behaviors in 5-year-old children: lifestyle patterns and their longitudinal association with weight status development in early childhood.

BACKGROUND: This study identified lifestyle patterns by examining the clustering of eating routines (e.g. eating together as a family, having the television on during meals, duration of meals) and various activity-related behaviors (i.e. physical activity (PA) and sedentary screen-based behavior) in 5-year-old children, as well as the longitudinal association of these patterns with weight status (BMI and overweight) development up to age 8. METHODS: Data originated from the KOALA Birth Cohort Study (N = 2074 at age 5). Principal component analysis (PCA) was used to identify lifestyle patterns. Backward regression analyses were used to examine the association of lifestyle patterns with parent and child background characteristics, as well as the longitudinal associations between the patterns and weight status development. RESULTS: Four lifestyle patterns emerged from the PCA: a 'Television-Snacking' pattern, a 'Sports-Computer' pattern, a 'Traditional Family' pattern, and a "Fast' Food' pattern. Child gender and parental educational level, working hours and body mass index were significantly associated with the scores for the patterns. The Television-Snacking pattern was positively associated with BMI (standardized regression coefficient ß = 0.05; p < 0.05), and children with this pattern showed a positive tendency toward being overweight at age 8 (Odds ratio (OR) = 1.27, p = 0.06). In addition, the Sports-Computer pattern was significantly positively associated with an increased risk of becoming overweight at age 7 (OR = 1.28, p < 0.05). CONCLUSIONS: The current study showed the added value of including eating routines in cross-behavioral clustering analyses. The findings indicate that future interventions to prevent childhood overweight should address eating routines and activity/inactivity simultaneously, using the synergy between clustered behaviors (e.g. between television viewing and snacking).

Use of satiety peptides in assessing the satiating capacity of foods.

Foods differ in their satiating capacity. Satiety peptides may help to provide evidence for biological mechanisms behind these differences. The aim of this paper was to discuss the physiological relevance of three individual appetite peptides, i.e. CCK, GLP-1 and PYY, in assessing the satiating capacity of foods. A literature research was conducted on CCK, GLP-1, PYY and satiety; effective exogenous infusion studies and endogenous production studies, i.e. changes induced by foods, were identified. The relative changes in blood concentrations in these studies were compared in order to assess an indication of the physiological relevance of the peptides. Relative changes in the two types of studies investigating CCK overlapped, i.e. increases in serum were 3 to 14-fold in effective exogenous studies (n=7) and 2 to 8-fold in endogenous production studies (n=9). The relative changes in GLP-1 and PYY did not overlap; GLP-1: 4 to 16 fold in effective exogenous studies (n=4) and no effect to 4 fold in endogenous production studies (n=38). PYY: 3 to 11-fold in effective exogenous studies (n=14) and no effect to 2-fold in endogenous production studies (n=10). GLP-1 and PYY show effects on satiety at supra-physiological dosages, they are not likely to contribute individually to a difference in satiating capacity of foods and can therefore not be interpreted in isolation. The effects of CCK are likely to be in the physiological range and therefore may have an individual contribution to a difference in satiating capacity between foods.

Energy balance-related behavioural patterns in 5-year-old children and the longitudinal association with weight status development in early childhood.

OBJECTIVE: The current study examined clustering of dietary intake and activity behaviours (i.e. physical activity (PA) and sedentary behaviour) in 5-year-old children, as well as the longitudinal association with BMI and overweight development. DESIGN: Principal component analysis (PCA) was used to identify behavioural patterns. Backward regression analyses were used to examine the association of behavioural patterns with parent and child background characteristics, as well as the association of the patterns with BMI Z-score and overweight development up to ages 7 and 8 years. SETTING: The Netherlands. SUBJECTS: Data originated from the KOALA Birth Cohort Study (n 2074 at age 5 years). RESULTS: Four patterns emerged: a 'sedentary-snacking' pattern (including television viewing and snack consumption), a 'healthy intake' pattern (including healthy items such as fruit, vegetables and fish), a 'sandwich' pattern (including bread and sandwich fillings) and a 'sporty-traditional meal' pattern (including sports, meat and potatoes). The patterns were related to child gender, general appetite and various parental characteristics. The sedentary-snacking pattern was positively associated with longitudinal BMI development. CONCLUSIONS: Cross-behavioural energy balance-related behavioural patterns exist at age 5 years. Different activity types (e.g. sports, television viewing) clustered differently with the behavioural patterns, indicating the need to incorporate these different types instead of one general PA measure in energy balance-related pattern analyses. The clustering and potential synergy between activity behaviours and dietary intake, as well as the associations with weight status development, stress the importance of an integrated approach to PA and healthy nutrition promotion in preventing childhood overweight.

Expected satiation after repeated consumption of low- or high-energy-dense soup.

We investigated whether repeated consumption of a low-energy-dense (LED; 208 kJ/100 g) or high-energy-dense (HED; 645 kJ/100 g) soup modifies expectations relating to the satiating capacity of the food, and its subsequent intake. In study 1, participants consumed either a novel-flavoured LED (n 32; 21 (SD 1·6) years, BMI 21·4 (SD 1·6) kg/m(2)) or HED soup (n 32; 21 (SD 1·6) years, BMI 21·3 (SD 1·7) kg/m(2)). Soup was served in a fixed amount on days 1-4 and ad libitum on day 5. 'Expected satiation' was measured on days 1, 2 and 5. Expected satiation did not change after repeated consumption of the LED or HED soup. Ad libitum intake did not differ between the LED (461 (SD 213) g) and HED soup (391 (SD 164) g). Only on day 1, expected satiation was higher for the HED soup than for the LED soup (P = 0·03), suggesting a role for sensory attributes in expected satiation. In study 2, thirty participants (21 (SD 1·6) years, BMI 21·3 (SD 1·7) kg/m(2)) performed a single measurement of expected satiation of the LED and HED soup, and four commercially available types of soup. Ratings on sensory attributes were associated with expected satiation. Results on expected satiation coincided with those of study 1. Thickness and intensity of taste were independently associated with expected satiation. Expectations may initially rely on sensory attributes and previous experiences, and are not easily changed.

Texture, not flavor, determines expected satiation of dairy products.

Consumers' expectations about the satiating capacity of a food may differ markedly across a broad range of food products, but also between foods within one product category. Our objective is to investigate the role of sensory attributes and means of consumption in the expected satiation of dairy products. In three independent experiments we measured the expected satiation of (1) commercially available yogurts and custards (29 adults, age: 26 ± 5 y, BMI: 22.9 ± 2.4 kg/m(2)); (2) lemon- and meringue-flavored custards with different textures (30 adults, age: 23 ± 4 y, BMI: 22.1 ± 2.1 kg/m(2)); and (3) chocolate milk and chocolate custard consumed with either a straw or a spoon (30 adults, age: 20 ± 2.2 y, BMI: 21.5 ± 2.2 kg/m(2)); all based on a single mouthful. Expected satiation was linked to the product's perceived characteristics. We observed an effect of texture (p<0.0001), but not of flavor on expected satiation (p=0.98) in Experiment 2; and an effect of texture (p<0.0001), but not of means of consumption on expected satiation (p=0.63) in Experiment 3. Thickness was positively correlated with expected satiation in Experiment 1 (r=0.45; p<0.001) and Experiment 2 (r=0.54; p<0.001). Expected satiation of dairy products increased consistently with increasing thickness; flavor characteristics or means of consumption as tested did not change expected satiation effects.

Eating behaviour and retro-nasal aroma release in normal-weight and overweight adults: a pilot study.

Eating rate and bite size are important factors affecting food intake, and we hypothesise the underlying role of oral sensory exposure in this. However, the latter currently lacks objective measuring parameters, but an interesting measure could be the extent of in vivo retro-nasal aroma release. Second, the literature is ambiguous about overweight subjects differing from normal-weight subjects in eating behaviour. Consequently, we investigated: (1) whether eating behaviour (food intake, eating rate, bite size, number of bites and meal duration) relates to weight status and (2) whether the extent of retro-nasal aroma release relates to eating behaviour and weight status. A matched group (sex, age and dietary restraint) of twenty-seven normal-weight (BMI 21.8 (SD 1.6) kg/m2) and twenty-seven overweight/obese subjects (BMI 30.5 (SD 5.8) kg/m2) consumed a spiced rice meal and apple pie yogurt on separate test days. The extent of retro-nasal aroma release was measured on a third test day. Mean bite size for spiced rice was significantly (P = 0.03) larger in overweight/obese (10.3 (SD 3.2) g) v. normal-weight subjects (8.7 (SD 2.1) g). There were no other significant differences in eating behaviour or retro-nasal aroma release between the groups. Eating behaviours were not correlated with BMI or retro-nasal aroma release. Subjects showed consistent eating behaviour for both test products. Eating behaviour might be a characteristic of an individual but not by definition a characteristic for a group of people based on their weight. Given the large sample sizes, necessary according to a posteriori sample size calculations, one needs to consider the relevance of finding a statistically significant difference in eating behaviour between the weight groups in a laboratory setting.

Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study.

BACKGROUND: Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development. METHODS: Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics. RESULTS: Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for normal eaters. By contrast, stimulation to eat healthy worked particularly well for children with a deviant eating style or a high BMI. CONCLUSION: Although most energy balance-related parenting practices were associated with desirable behaviors, some practices showed associations with undesirable child behavior and weight outcomes. Only parental stimulation showed desirable associations with regard to both diet and activity behavior. The interaction between parenting and child characteristics in the association with behavior calls for parenting that is tailored to the individual child.

Interaction between physical environment, social environment, and child characteristics in determining physical activity at child care.

OBJECTIVE: To investigate the association between the child-care environment and physical activity of 2- and 3-year-olds. Based on an ecological view of environmental influences on health behavior, we hypothesized that the social and physical environment, as well as child characteristics (age and gender), would show independent and interactive effects on children's physical activity intensity. DESIGN: Observations of physical activity intensity were performed among children (N = 175) at 9 Dutch child-care centers. Aspects of the child-care environment were assessed using the validated Environment and Policy Assessment and Observation (EPAO) Instrument. Multilevel linear regression analyses examined the association of environment and child characteristics with children's activity intensity. Moderation was tested by including interaction terms in the analyses, with subsequent post hoc analyses for significant interaction terms. MAIN OUTCOME MEASURE: Observed child physical activity intensity, measured with the Observational System for Recording Physical Activity in Children-Preschool Version. RESULTS: A large proportion of the observed activities were classified as sedentary, while far fewer observations were classified as moderate or vigorous. Activity opportunities in the physical environment (assessed using EPAO) and prompts by staff and peers were significantly and positively related to physical activity intensity, while group size was negatively related to activity intensity. The influence of the physical environment was moderated by social environment (peer group size), while the social environment in turn interacted with child characteristics (age and gender) in determining activity intensity. CONCLUSION: Our findings are in line with the ecological perspective regarding environmental influences on behavior, and stress the importance of incorporating the child-care environment in efforts to prevent childhood overweight and obesity.

Validation of an FFQ and options for data processing using the doubly labelled water method in children.

OBJECTIVE: To validate an FFQ designed to estimate energy intake in children against doubly labelled water (DLW). To investigate how quality control and standard beverage portion sizes affect the validity of the FFQ. DESIGN: Thirty healthy children, aged 4-6 years, participated. Total energy expenditure (EE) was measured by the DLW method during an observation period of 15 d. At the end of this period parents filled out an FFQ designed to assess the child's habitual energy intake (EI) of the preceding four weeks. SETTING: Validation study in The Netherlands. SUBJECTS: Thirty healthy children (fifteen boys and fifteen girls), aged 4-6 years. RESULTS: Mean EI (6117 (sd 1025) kJ/d) did not differ significantly from mean EE (6286 (sd 971) kJ/d; P = 0·15); the mean EI:EE ratio was 0·98. The Pearson correlation coefficient between EI and EE was 0·62. The Bland-Altman plot showed no systematic bias and a constant bias close to zero. Less intensive quality control of the FFQ maintained the mean EI:EE ratio and decreased the correlation slightly. Using standard instead of individually measured beverage portion sizes decreased the mean EI:EE ratio, but maintained the correlation. CONCLUSIONS: It can be concluded that the developed FFQ is a valid instrument to estimate mean energy intake in a group of 4- to 6-year-old children and performs reasonably well to rank the subjects with respect to energy intake. It is therefore a useful instrument to estimate energy intake in children in surveys and epidemiological studies in The Netherlands.

Association of breast-feeding and feeding on demand with child weight status up to 4 years.

OBJECTIVES: The mechanisms underlying the protective effect of breast-feeding on the development of childhood overweight are unclear. This study examines the association of breast-feeding with weight gain in the first year, and body mass index (BMI) and overweight up to 4 years. In addition, we examine possible mechanisms of this effect (i.e., feeding pattern, eating style, unhealthy snacking behavior). METHODS: Data originated from the KOALA Birth Cohort Study (N = 2 834). Questionnaires assessed breast-feeding duration up to 12 months, feeding pattern (i.e., feeding on demand or feeding to schedule) at 3 months, BMI at 1, 2 and 4 years, eating style (e.g., slow eating) at age 1, and unhealthy snacking at age 2. Linear and logistic regression analyses were used to examine the association of breast-feeding and feeding pattern with eating style, unhealthy snacking, BMI z-scores and overweight. RESULTS: Each additional month of breast-feeding was associated with less weight gain in the first year (regression coefficient B = -37.6 g, p < 0.001), a lower BMI z-score at age 1 (B = -0.02, p < 0.01), and a lower odds of being overweight at age 1 (odds ratio = 0.96, p < 0.05). Breast-feeding was associated with fewer unhealthy snacking occasions per week at age 2 (B = -0.19 for each month of breast-feeding, p < 0.001), but was unrelated to eating style. Feeding pattern was unrelated to all outcome variables after adjustment for breast-feeding duration. CONCLUSIONS: The study showed a short-term protective effect of breast-feeding against overweight development. Possible mechanisms through which breast-feeding may protect against overweight include less unhealthy snacking behavior, but not feeding pattern or child's eating style.

The effect of texture differences on satiation in 3 pairs of solid foods.

This study explored the effect of texture differences on satiation (ad libitum food intake) in 3 pairs of solid foods. Test products were specially developed luncheon meat, meat replacers and sweets. Each food consisted of a "hard" and "soft" version, expected to lead to different eating rates and consequently to differences in oral sensory exposure time. One hundred and six subjects participated in 7 sessions. During the first sessions, subjects consumed the products ad libitum while watching a movie in a cinema. During the last session, eating rate of all products was measured. Mean intake did not differ significantly between the hard and soft version for any of the products, but subjects who ate more of the soft luncheon meat significantly outnumbered subjects who ate more of the hard version. Eating rate was significantly slower for the hard than for the soft luncheon meat (21 ± 10 vs. 25 ± 13 g/min); no differences were found for the other food types. Ad libitum intake was twice as high in the highest versus the lowest quartile of eating rate (p < 0.001). Texture differences between the hard and soft versions may have been too subtle to lead to differences in eating rate for meat replacers and sweets and consequently to differences in food intake.