Publications by authors named "Lisette Cpgm de Groot"

17 Publications

  • Page 1 of 1

Prevalence of lactose intolerance and nutrients intake in an older population regarded as lactase non-persistent.

Clin Nutr ESPEN 2021 Jun 10;43:317-321. Epub 2021 Apr 10.

Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 176700, AA, Wageningen, the Netherlands.

Background And Aims: Energy and nutrient intakes of community-dwelling older adults in Indonesia are inadequate whereby milk consumption is among the lowest in the world. Lactose intolerance is probably one of the reasons for such low milk consumption, but information on the burden of this problem and its consequences for dietary intake is lacking. We obtained data on the prevalence of lactose intolerance and dietary intakes in Indonesian older outpatients, thereby comparing dairy users and non-dairy users.

Methods: A cross-sectional study was conducted in 2019 involving 103 community-dwelling older adults in the outpatient geriatric clinic, Dr. Cipto Mangunkusumo Hospital, Jakarta. A structured questionnaire was used to categorize participants as dairy- or non-dairy users. Food records were collected to assess nutrients intake from the diet. The prevalence of lactose intolerance (LI) was estimated based on the results of the hydrogen breath test (HBT) and on symptoms of lactose malabsorption. The difference in LI prevalence between dairy- and non-dairy user group was presented as a prevalence ratio (with 95% confidence interval). Chi-square tests, t-test, and Mann-Whitney tests were used to evaluate differences in demographic and clinical characteristics, as well as in nutrient intake profiles between dairy and non-dairy users.

Results: The prevalence of lactose intolerance amounted to 66% (57-75%), 54% (37-70%), and 73% (61-84%) in the total population, dairy- and non-dairy users, respectively. Lactose intolerance tended to be higher among non-dairy users (PR 1.36 95% CI 0.99-1.89). On the other hand, we found no pronounced differences in symptoms of lactose intolerance between dairy and non-dairy users. The overall mean protein, calcium, vitamin D, and vitamin B12 intakes of the older adults were low. Intakes of protein, calcium, vitamin D and vitamin B12 were higher among dairy than among non-dairy users.

Conclusions: This study uncovered the large size of the lactose intolerance problem in Indonesian older adults. Especially in non-dairy users, the intakes of proteins and some micronutrients are a concern. Strategies to tackle lactose intolerance are most relevant as to open the door for more nutrient-dense foods in the diet of Indonesian older adults.
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June 2021

Genetic variants modify the associations of concentrations of methylmalonic acid, vitamin B-12, vitamin B-6, and folate with bone mineral density.

Am J Clin Nutr 2021 May 8. Epub 2021 May 8.

Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.

Background: Elevated plasma homocysteine has been found to be associated with an increased risk of osteoporosis, especially hip and vertebral fractures. The plasma concentration of homocysteine is dependent on the activities of several B vitamin-dependent enzymes, such as methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTR), methionine synthase reductase (MTRR), and cystathionine β-synthase (CBS).

Objectives: We investigated whether genetic variants in some of the genes involved in 1 carbon metabolism modify the association of B vitamin-related measures with bone mineral density (BMD) and strength.

Methods: We measured several B vitamins and biomarkers in participants of the Framingham Offspring Study, and performed analyses of methylmalonic acid (MMA) continuously and <210 nmol/L; pyridoxal-5'-phosphate; vitamin B-12 continuously and ≥258 pmol/L; and folate. The outcomes of interest included areal and volumetric BMD, measured by DXA and quantitative computed tomography (QCT), respectively. We evaluated associations between the bone measures and interactions of single nucleotide polymorphism with a B vitamin or biomarker in Framingham participants (n = 4310 for DXA and n = 3127 for QCT). For analysis of DXA, we validated the association results in the B-PROOF cohort (n = 1072). Bonferroni-corrected locus-wide significant thresholds were defined to account for multiple testing.

Results: The interactions between rs2274976 and vitamin B-12 and rs34671784 and MMA <210 nmol/L were associated with lumbar spine BMD, and the interaction between rs6586281 and vitamin B-12 ≥258 pmol/L was associated with femoral neck BMD. For QCT-derived traits, 62 interactions between genetic variants and B vitamins and biomarkers were identified.

Conclusions: Some genetic variants in the 1-carbon methylation pathway modify the association of B vitamin and biomarker concentrations with bone density and strength.  These interactions require further replication and functional validation for a mechanistic understanding of the role of the 1-carbon metabolism pathway on BMD and risks of fracture.
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May 2021

Randomized Controlled Trial of Exercise and Nutrition Supplementation on Physical and Cognitive Function in Older Chinese Adults Aged 50 Years and Older.

J Am Med Dir Assoc 2020 03 23;21(3):395-403. Epub 2019 Sep 23.

Wageningen University, Division of Human Nutrition and Health, Wageningen, the Netherlands.

Objectives: To assess whether a 24-week multidomain lifestyle intervention including a nutritional milk supplement and an exercise program had any effect on physical and cognitive function, self-rated health, and health-related quality of life in older Chinese adults.

Design: Randomized controlled trial.

Setting And Participants: Community-living people aged 50 years and older.

Methods: 180 participants (mean age 61 ± 6 years) were randomized to 24 weeks of exercise plus nutrition supplementation or no intervention. The primary outcome was gait speed, with additional physical and cognitive function measures, self-rated health, and health-related quality of life as secondary outcomes. Information collected also included dietary intake by 3-day dietary records, and blood sampling for renal function, glycated hemoglobin, serum vitamin B, 25-hydroxyvitamin D, and biochemical indices of bone turnover.

Results: There was no significant group difference in the change of gait speed, muscle strength, muscle power, cardiovascular fitness, or cognitive function over time, either by intention-to-treat or per-protocol analysis. A significant time × group effect (P = .039) on self-rated health was detected, but there was no significant time or time × group difference in the change of physical and mental health-related quality of life measures over time. In addition, moderate physical activity level was greatly increased from baseline to 24 weeks in the intervention group compared with the control group.

Conclusions And Implications: A 24-week exercise and nutrition supplementation program among community-living people in late midlife to early old age improved self-rated health and the overall level of physical activity, without objective improvements in physical and cognitive function.
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March 2020

Addressing nutritional requirements of ageing consumers in Asia-recommendations from an expert workshop.

Asia Pac J Clin Nutr 2019 ;28(2):204-213

Division of Human Nutrition and Health, Wageningen University, The Netherlands.

The number of older persons in Asia is expected to triple by 2050. Ageing is associated with non-communicable chronic diseases, malnutrition, and geriatric syndromes, which influences the burden on the cost related to healthcare, health outcomes, and the quality of life. Experts in the field of older adult nutrition from Asia, Australia, and Europe were invited to participate in a two-day workshop to review the available data, current policies and programs for the ageing population in different countries of Asia to identify the gaps in knowledge and to develop recommendations for action. In Asia, most of the data pertaining to health status, nutritional status, and nutrient intake of the older persons were mainly obtained by conducting studies in nursing homes or hospitals and small cohort studies. There were limited country-specific data on this population. Moreover, the available data pertaining to different countries were difficult to compare due to differences in the reporting format and reference values used. Although nutrition initiatives and policies were realized and public education was conducted to support the older persons, most of these efforts targeted the general population rather than the older persons population segment. In healthcare management, a higher amount of education is required pertaining to the knowledge of nutritional requirements and appropriate feeding of the older persons to reduce underfeeding and its consequences. The expert group recommended the use of a systematic approach for reviewing data pertaining to different countries, initiatives, and programs to further evaluate the available data to underpin future research.
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January 2020

Implementation of a multicomponent telemonitoring intervention to improve nutritional status of community-dwelling older adults: a process evaluation.

Public Health Nutr 2019 02 3;22(2):363-374. Epub 2018 Sep 3.

1Wageningen University & Research,Division of Human Nutrition,PO Box 17,6700 AAWageningen,The Netherlands.

Objective: The present study aimed to conduct a process evaluation of a multicomponent nutritional telemonitoring intervention implemented among Dutch community-dwelling older adults.

Design: A mixed-methods approach was employed, guided by the process evaluation framework of the Medical Research Council and the Unified Theory of Acceptance and Use of Technology. The process indicators reach, dose, fidelity and acceptability were measured at several time points within the 6-month intervention among participants and/or nurses.

Setting: The intervention was implemented in the context of two care organisations in the Netherlands.

Subjects: In total, ninety-seven participants (average age 78 years) participated in the intervention and eight nurses were involved in implementation.

Results: About 80 % of participants completed the intervention. Dropouts were significantly older, had worse cognitive and physical functioning, and were more care-dependent. The intervention was largely implemented as intended and received well by participants (satisfaction score 4·1, scale 1-5), but less well by nurses (satisfaction score 3·5, scale 1-5). Participants adhered better to weight telemonitoring than to telemonitoring by means of questionnaires, for which half the participants needed help. Intention to use the intervention was predicted by performance expectancy (β=0·40; 95 % CI 0·13, 0·67) and social influence (β=0·17; 95 % CI 0·00, 0·34). No association between process indicators and intervention outcomes was found.

Conclusions: This process evaluation showed that nutritional telemonitoring among older adults is feasible and accepted by older adults, but nurses' satisfaction should be improved. The study provided relevant insights for future development and implementation of eHealth interventions among older adults.
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February 2019

Protein intake in hospitalized older people with and without increased risk of malnutrition.

Eur J Clin Nutr 2018 06 15;72(6):917-919. Epub 2018 May 15.

Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.

A protein intake of ≥1.2 grams per kg body weight (g/kg) is recommended for ill older adults. In a cross-sectional study, we investigated if this recommendation was met by 62 hospitalized adults of 65 years and older in a Dutch hospital. We compared protein intake between two subgroups based on the risk of malnutrition and the prescribed diet: a low risk group (n = 31) receiving a standard hospital diet and a medium/high risk group (n = 31) receiving a protein-enriched diet. A 24h-recall was performed to calculate protein intake per patient. Protein intake was on average 1.2 g/kg in the medium/high risk group and 0.9 g/kg in the low-risk group. Seventeen patients reached a protein intake of ≥1.2 g/kg. Fifteen patients had a protein intake below 0.8 g/kg. It seems sensible to consider providing a protein-enriched diet to all older hospitalized adults, regardless of their risk of malnutrition.
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June 2018

The effect of vitamin B12 and folic acid supplementation on routine haematological parameters in older people: an individual participant data meta-analysis.

Eur J Clin Nutr 2018 06 8;72(6):785-795. Epub 2018 Mar 8.

Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.

Background/objectives: Low vitamin B12 and folate levels in community-dwelling older people are usually corrected with supplements. However, the effect of this supplementation on haematological parameters in older persons is not known. Therefore, we executed a systematic review and individual participant data meta-analysis of randomised placebo-controlled trials (RCTs).

Subjects/methods: We performed a systematic search in PubMed, EMBASE, Web of Science, Cochrane and CENTRAL for RCTs published between January 1950 and April 2016, where community-dwelling elderly (60+ years) who were treated with vitamin B12 or folic acid or placebo. The presence of anaemia was not required. We analysed the data on haematological parameters with a two-stage IPD meta-analysis.

Results: We found 494 full papers covering 14 studies. Data were shared by the authors of four RCTs comparing vitamin B12 with placebo (n = 343) and of three RCTs comparing folic acid with placebo (n = 929). We found no effect of vitamin B12 supplementation on haemoglobin (change 0.00 g/dL, 95% CI: -0.19;0.18), and no effect of folic acid supplementation (change -0.09 g/dL, 95% CI: -0.19;0.01). The effects of supplementation on other haematological parameters were similar. The effects did not differ by sex or by age group. Also, no effect was found in a subgroup of patients with anaemia and a subgroup of patients who were treated >4 weeks.

Conclusions: Evidence on the effects of supplementation of low concentrations of vitamin B12 and folate on haematological parameters in community-dwelling older people is inconclusive. Further research is needed before firm recommendations can be made concerning the supplementation of vitamin B12 and folate.
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June 2018

Self-rated health and all-cause and cause-specific mortality of older adults: Individual data meta-analysis of prospective cohort studies in the CHANCES Consortium.

Maturitas 2017 Sep 17;103:37-44. Epub 2017 Jun 17.

Hellenic Health Foundation, 115 27, Athens, Greece; Department of Epidmiology, Harvard School of Public Health, Boston, MA 02115, USA; Bureau of Epidemiologic Research, Academy of Athens, 115 27Athens, Greece.

Objectives: To evaluate, among the elderly, the association of self-rated health (SRH) with mortality, and to identify determinants of self-rating health as "at-least-good".

Study Design: Individual data on SRH and important covariates were obtained for 424,791 European and United States residents, ≥60 years at recruitment (1982-2008), in eight prospective studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios, HRs) in relation to SRH were calculated and subsequently combined with random-effect meta-analyses.

Main Outcome Measures: All-cause, cardiovascular and cancer mortality.

Results: Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH "fair" or "poor" vs. "at-least-good" was associated with increased mortality: HRs 1.46 (95% CI 1·23-1.74) and 2.31 (1.79-2.99), respectively. These associations were evident: for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently, for medical history explained only a modest amount of the unadjusted associations. Factors favourably associated with SRH were: sex (males), age (younger-old), education (high), marital status (married/cohabiting), physical activity (active), body mass index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence).

Conclusion: SRH provides a quick and simple tool for assessing health and identifying groups of elders at risk of early mortality that may be useful also in clinical settings. Modifying determinants of favourably rating health, e.g. by increasing physical activity and/or by eliminating obesity, may be important for older adults to "feel healthy" and "be healthy".
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September 2017

Translation of a tailored nutrition and resistance exercise intervention for elderly people to a real-life setting: adaptation process and pilot study.

BMC Geriatr 2017 01 18;17(1):25. Epub 2017 Jan 18.

Division of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV, Wageningen, The Netherlands.

Background: Combining increased dietary protein intake and resistance exercise training for elderly people is a promising strategy to prevent or counteract the loss of muscle mass and decrease the risk of disabilities. Using findings from controlled interventions in a real-life setting requires adaptations to the intervention and working procedures of healthcare professionals (HCPs). The aim of this study is to adapt an efficacious intervention for elderly people to a real-life setting (phase one) and test the feasibility and potential impact of this prototype intervention in practice in a pilot study (phase two).

Methods: The Intervention Mapping approach was used to guide the adaptation in phase one. Qualitative data were collected from the original researchers, target group, and HCPs, and information was used to decide whether and how specified intervention elements needed to be adapted. In phase two, a one-group pre-test post-test pilot study was conducted (n = 25 community-dwelling elderly), to elicit further improvements to the prototype intervention. The evaluation included participant questionnaires and measurements at baseline (T0) and follow-up (T1), registration forms, interviews, and focus group discussions (T1). Qualitative data for both phases were analysed using an inductive approach. Outcome measures included physical functioning, strength, body composition, and dietary intake. Change in outcomes was assessed using Wilcoxon signed-rank tests.

Results: The most important adaptations to the original intervention were the design of HCP training and extending the original protein supplementation with a broader nutrition programme aimed at increasing protein intake, facilitated by a dietician. Although the prototype intervention was appreciated by participants and professionals, and perceived applicable for implementation, the pilot study process evaluation resulted in further adaptations, mostly concerning recruitment, training session guidance, and the nutrition programme. Pilot study outcome measures showed significant improvements in muscle strength and functioning, but no change in lean body mass.

Conclusion: The combined nutrition and exercise intervention was successfully adapted to the real-life setting and seems to have included the most important effective intervention elements. After adaptation of the intervention using insights from the pilot study, a larger, controlled trial should be conducted to assess cost-effectiveness.

Trial Registration: Trial registration number: NL51834.081.14 (April 22, 2015).
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January 2017

Habituation to low or high protein intake does not modulate basal or postprandial muscle protein synthesis rates: a randomized trial.

Am J Clin Nutr 2017 02 30;105(2):332-342. Epub 2016 Nov 30.

NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, Netherlands;

Background: Muscle mass maintenance is largely regulated by basal muscle protein synthesis rates and the ability to increase muscle protein synthesis after protein ingestion. To our knowledge, no previous studies have evaluated the impact of habituation to either low protein intake (LOW PRO) or high protein intake (HIGH PRO) on the postprandial muscle protein synthetic response.

Objective: We assessed the impact of LOW PRO compared with HIGH PRO on basal and postprandial muscle protein synthesis rates after the ingestion of 25 g whey protein.

Design: Twenty-four healthy, older men [age: 62 ± 1 y; body mass index (in kg/m): 25.9 ± 0.4 (mean ± SEM)] participated in a parallel-group randomized trial in which they adapted to either a LOW PRO diet (0.7 g · kg · d; n = 12) or a HIGH PRO diet (1.5 g · kg · d; n = 12) for 14 d. On day 15, participants received primed continuous l-[ring-H]-phenylalanine and l-[1-C]-leucine infusions and ingested 25 g intrinsically l-[1-C]-phenylalanine- and l-[1-C]-leucine-labeled whey protein. Muscle biopsies and blood samples were collected to assess muscle protein synthesis rates as well as dietary protein digestion and absorption kinetics.

Results: Plasma leucine concentrations and exogenous phenylalanine appearance rates increased after protein ingestion (P < 0.01) with no differences between treatments (P > 0.05). Plasma exogenous phenylalanine availability over the 5-h postprandial period was greater after LOW PRO than after HIGH PRO (61% ± 1% compared with 56% ± 2%, respectively; P < 0.05). Muscle protein synthesis rates increased from 0.031% ± 0.004% compared with 0.039% ± 0.007%/h in the fasted state to 0.062% ± 0.005% compared with 0.057% ± 0.005%/h in the postprandial state after LOW PRO compared with HIGH PRO, respectively (P < 0.01), with no differences between treatments (P = 0.25).

Conclusion: Habituation to LOW PRO (0.7 g · kg · d) compared with HIGH PRO (1.5 g · kg · d) augments the postprandial availability of dietary protein-derived amino acids in the circulation and does not lower basal muscle protein synthesis rates or increase postprandial muscle protein synthesis rates after ingestion of 25 g protein in older men. This trial was registered at as NCT01986842.
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February 2017

Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium.

BMC Med 2016 Apr 5;14:62. Epub 2016 Apr 5.

Department Epidemiology and Public Health, University College London, London, UK.

Background: Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality.

Methods: This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs.

Results: Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking.

Conclusions: This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.
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April 2016

WHO guidelines for a healthy diet and mortality from cardiovascular disease in European and American elderly: the CHANCES project.

Am J Clin Nutr 2015 Oct 9;102(4):745-56. Epub 2015 Sep 9.

Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;

Background: Cardiovascular disease (CVD) represents a leading cause of mortality worldwide, especially in the elderly. Lowering the number of CVD deaths requires preventive strategies targeted on the elderly.

Objective: The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged ≥60 y.

Design: We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model.

Results: During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points (complete adherence to an additional WHO guideline) was, on average, not associated with CVD mortality (HR: 0.94; 95% CI: 0.86, 1.03), CAD mortality (HR: 0.99; 95% CI: 0.85, 1.14), or stroke mortality (HR: 0.95; 95% CI: 0.88, 1.03). However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts (HR: 0.87; 95% CI: 0.79, 0.96; I(2) = 0%) and in the US cohort (HR: 0.85; 95% CI: 0.83, 0.87; I(2) = not applicable).

Conclusion: Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States.
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October 2015

Dietary patterns, cognitive decline, and dementia: a systematic review.

Adv Nutr 2015 Mar 13;6(2):154-68. Epub 2015 Mar 13.

Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.

Nutrition is an important modifiable risk factor that plays a role in the strategy to prevent or delay the onset of dementia. Research on nutritional effects has until now mainly focused on the role of individual nutrients and bioactive components. However, the evidence for combined effects, such as multinutrient approaches, or a healthy dietary pattern, such as the Mediterranean diet, is growing. These approaches incorporate the complexity of the diet and possible interaction and synergy between nutrients. Over the past few years, dietary patterns have increasingly been investigated to better understand the link between diet, cognitive decline, and dementia. In this systematic review we provide an overview of the literature on human studies up to May 2014 that examined the role of dietary patterns (derived both a priori as well as a posteriori) in relation to cognitive decline or dementia. The results suggest that better adherence to a Mediterranean diet is associated with less cognitive decline, dementia, or Alzheimer disease, as shown by 4 of 6 cross-sectional studies, 6 of 12 longitudinal studies, 1 trial, and 3 meta-analyses. Other healthy dietary patterns, derived both a priori (e.g., Healthy Diet Indicator, Healthy Eating Index, and Program National Nutrition Santé guideline score) and a posteriori (e.g., factor analysis, cluster analysis, and reduced rank regression), were shown to be associated with reduced cognitive decline and/or a reduced risk of dementia as shown by all 6 cross-sectional studies and 6 of 8 longitudinal studies. More conclusive evidence is needed to reach more targeted and detailed guidelines to prevent or postpone cognitive decline.
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March 2015

Stability of dietary patterns assessed with reduced rank regression; the Zutphen Elderly Study.

Nutr J 2014 Apr 1;13:30. Epub 2014 Apr 1.

Division of Human Nutrition, Wageningen University, PO Box 8129, 6700 EV Wageningen, The Netherlands.

Background: Reduced rank regression (RRR) combines exploratory analysis with a-priori knowledge by including risk factors in the model. Dietary patterns, derived from RRR analysis, can be interpreted by the chosen risk factor profile and give an indication of positive or adverse health effects for a specific disease. Our aim was to assess the stability of dietary patterns derived by RRR over time.

Methods: We used data from 467 men, aged 64-85 years, participating in the 1985 and 1990 examination rounds of the Zutphen Elderly Study. Backwards regression on risk factors and food groups was applied prior to the RRR analysis to exclude food groups with low predictability (from 36 to 19 food groups) for the chosen risk factor profile. For the final RRR analysis, dietary intake data from 19 food groups as predictor variables and 6 established risk factors for cardiovascular diseases (body mass index, systolic and diastolic blood pressure, high density lipoprotein and total cholesterol levels, and uric acid) were used.

Results: Three RRR dietary patterns were derived for both examination years: a "(low in) cereal fibre pattern", an "alcohol pattern" and an "inconsistent pattern". The "(low in) cereal fibre pattern" was most stable over time, with a correlation coefficient of 0.47 (95% CI: 0.38-0.53) between 1985 and 1990 measurements.

Conclusion: Dietary patterns as measured by RRR, after backwards regression, are reasonably stable over a period of five years. Thus, RRR appears to be an attractive method to measure long-term dietary exposure for nutritional epidemiological studies, with one dietary measurement at baseline.
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April 2014

The association between waist circumference and risk of mortality considering body mass index in 65- to 74-year-olds: a meta-analysis of 29 cohorts involving more than 58 000 elderly persons.

Int J Epidemiol 2012 Jun 31;41(3):805-17. Epub 2012 Mar 31.

Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.

Background: For the elderly, the association between waist circumference (WC) and mortality considering body mass index (BMI) remains unclear, and thereby also the evidence base for using these anthropometric measures in clinical practice. This meta-analysis examined the association between WC categories and (cause-specific) mortality within BMI categories. Furthermore, the association of continuous WC with lowest and increased mortality risks was examined.

Methods: Age- and smoking-adjusted relative risks (RRs) of mortality associated with WC-BMI categories and continuous WC (including WC and WC(2)) were calculated by the investigators and pooled by means of random-effects models.

Results: During a 5-year-follow-up of 32 678 men and 25 931 women, we ascertained 3318 and 1480 deaths, respectively. A large WC (men: ≥102 cm, women: ≥88 cm) was associated with increased all-cause mortality RRs for those in the 'healthy' weight {1.7 [95% confidence interval (CI): 1.2-2.2], 1.7 (95% CI: 1.3-2.3)}, overweight [1.1(95% CI: 1.0-1.3), 1.4 (95%: 1.1-1.7)] and obese [1.1 (95% CI: 1.0-1.3), 1.6 (95% CI: 1.3-1.9)] BMI category compared with the 'healthy' weight (20-24.9 kg/m(2)) and a small WC (<94 cm, men; <80 cm, women) category. Underweight was associated with highest all-cause mortality RRs in men [2.2 (95% CI: 1.8-2.8)] and women [2.3 (95% CI: 1.8-3.1]. We found a J-shaped association for continuous WC with all-cause, cardiovascular (CVD) and cancer, and a U-shaped association with respiratory disease mortality (P < 0.05). An all-cause (CVD) mortality RR of 2.0 was associated with a WC of 132 cm (123 cm) in men and 116 cm (105 cm) in women.

Conclusions: Our results showed increased mortality risks for elderly people with an increased WC-even across BMI categories- and for those who were classified as 'underweight' using BMI. The results provide a solid basis for re-evaluation of WC cut-points in ageing populations.
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June 2012

Evaluation design for a complex intervention program targeting loneliness in non-institutionalized elderly Dutch people.

BMC Public Health 2010 Sep 13;10:552. Epub 2010 Sep 13.

GGD Gelre-IJssel (Community Health Service), PO Box 51, 7300 AB Apeldoor, Academic Collaborative Centre AGORA, The Netherlands.

Background: The aim of this paper is to provide the rationale for an evaluation design for a complex intervention program targeting loneliness among non-institutionalized elderly people in a Dutch community. Complex public health interventions characteristically use the combined approach of intervening on the individual and on the environmental level. It is assumed that the components of a complex intervention interact with and reinforce each other. Furthermore, implementation is highly context-specific and its impact is influenced by external factors. Although the entire community is exposed to the intervention components, each individual is exposed to different components with a different intensity.

Methods/design: A logic model of change is used to develop the evaluation design. The model describes what outcomes may logically be expected at different points in time at the individual level. In order to address the complexity of a real-life setting, the evaluation design of the loneliness intervention comprises two types of evaluation studies. The first uses a quasi-experimental pre-test post-test design to evaluate the effectiveness of the overall intervention. A control community comparable to the intervention community was selected, with baseline measurements in 2008 and follow-up measurements scheduled for 2010. This study focuses on changes in the prevalence of loneliness and in the determinants of loneliness within individuals in the general elderly population. Complementarily, the second study is designed to evaluate the individual intervention components and focuses on delivery, reach, acceptance, and short-term outcomes. Different means of project records and surveys among participants are used to collect these data.

Discussion: Combining these two evaluation strategies has the potential to assess the effectiveness of the overall complex intervention and the contribution of the individual intervention components thereto.
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September 2010

Effect of fish-oil supplementation on mental well-being in older subjects: a randomized, double-blind, placebo-controlled trial.

Am J Clin Nutr 2008 Sep;88(3):706-13

Wageningen University, Division of Human Nutrition, Wageningen, Netherlands.

Background: It is suggested that a low intake of fish and/or n-3 PUFA is associated with depressed mood. However, results from epidemiologic studies are mixed, and randomized trials have mainly been performed in depressed patients, yielding conflicting results.

Objective: We investigated the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on mental well-being in a double-blind, placebo-controlled trial.

Design: Independently living individuals (n = 302) aged > or =65 y were randomly assigned to consume 1800 mg/d EPA+DHA, 400 mg/d EPA+DHA, or placebo capsules for 26 wk. Changes in mental well-being were assessed as the primary outcome with the Center for Epidemiologic Studies Depression Scale (CES-D), Montgomery-Asberg Rating Scale (MADRS), Geriatric Depression Scale (GDS-15), and Hospital Anxiety and Depression Scale (HADS-A).

Results: Plasma concentrations of EPA+DHA increased by 238% in the high-dose and 51% in the low-dose fish-oil group compared with the placebo group, reflecting excellent compliance. Baseline CES-D scores ranged from 5.9 to 6.8 in the 3 groups and were not significantly different between groups. Mean changes in CES-D scores after 26 wk were -0.2, 0.2, and -0.4 (P = 0.87) in the high-dose fish oil, low-dose fish oil, and placebo groups, respectively. Treatment with neither 1800 mg nor 400 mg EPA+DHA differentially affected any of the measures of mental well-being after 13 or 26 wk of intervention compared with placebo.

Conclusions: In this randomized, double-blind, placebo-controlled trial we observed no effect of EPA+DHA supplementation for 26 wk on mental well-being in the general older population studied. This trial was registered at as NCT00124852.
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September 2008