Nudging towards better cardio metabolic health

Healthy eating and sufficient physical activity is key for cardiometabolic health. A health-promoting environment makes  a healthy lifestyle easier to adopt and maintain, and may be especially helpful to reach individuals with a lower socio-economic status (SES). In a paper just published in BMC Public Health we describe the Supreme Nudge project in which we will study the effects of pricing and nudging strategies in the supermarket – one of the most important point-of-choice settings for food choices – and of a context-specific mobile physical activity promotion app. Supreme Nudge uses a multi-disciplinary and mixed methods approach, integrating participatory action research, qualitative interviews, experimental pilot studies, and a randomized controlled trial in a real-life (supermarket) setting. First, we will identify the needs, characteristics and preferences of the target group as well as of the participating supermarket chain. Second, we will conduct a series of pilot studies to test novel, promising and feasible intervention components. Third, a final selection of intervention components will be implemented in a full-scale randomised controlled supermarket trial. Approximately 1000 adults with lower SES will be recruited across 8–12 supermarkets and randomised at supermarket level to receive 1) no intervention (control); 2) environmental nudges such as food product placement or promotion; 3) nudges and a tailored physical activity app that provides time- and context specific feedback; 4) pricing interventions, nudges, and the physical activity app. The effects on dietary behaviours, physical activity and cardiometabollic health will be evaluated. Additionally the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of the intervention will be evaluated and insights from System Innovation and Transition Management theories will be used to define the best strategies for implementation and upscaling beyond the study period.

Associations of self-reported physical activity and depression

The purpose of a study recently published in BMC Public Health was to investigate the cross-sectional associations between self-reported physical activity (PA) and depressive symptoms and status using data from of over 10,000 Irish adults from two existing datasets, i.e. The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study.
The databases of the two studies were pooled  and relevant variables were harmonized. PA was measured using the short form International Physical Activity Questionnaire. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Participants were classified as meeting World Health Organization moderate-to-vigorous PA (MVPA) guidelines or not, and divided into tertiles based on weekly minutes of MVPA. A CES-D score of ≥16 indicated elevated depressive symptoms.
Significantly higher depressive symptoms were reported by women than by men. Meeting the PA guidelines was associated with 44.7% lower odds of elevated depressive symptoms., and study participants in the highest PA tertile had 50.8% lower odds of elevated depressive symptoms, than participants in the lowest PA tertile.
In conclusion: meeting the PA guidelines was associated with lower odds of elevated depressive symptoms, and increased volumes of MVPA are associated with lower odds of elevated depressive symptoms.

Data on Determinants Are Needed to Curb the Sedentary Epidemic in Europe

Societal and technological changes have resulted in sitting during most activities of daily living, such as learning, working, travelling and leisure time. Too much time spent in such sedentary activities, or 'sedentary behaviour', is a concern for public health. The European DEDIPAC (Determinants of Diet and Physical Activity) Knowledge Hub coordinated the work of 35 institutions across 12 European member states to investigate the determinants of sedentary behaviour as well as of nutrition behaviours and physical activity. In an earlier paper we provided a brief overview of relevant results of DEDIPAC. In a paper just published in the International Journal of Environment and Public Health, we summarize what was done and provide recommendations concerning research on determinants of sedentary behaviour. DEDIPAC reviewed current evidence, set a theoretical framework and harmonised the available epidemiological data.
The conclusion is that there is a dire lack of data that is exploitable across Europe to inform policy and intervention. There is an urgent need to develop international data collection compliant with FAIR (Findable, Accessible, Interoperable, Re-usable) and standardised surveillance systems for sedentary behaviour.

Recent trend in population sitting levels in Australia

In a study just published in the journal PLOS One, we explored the trend in population levels, as well as the correlates, of occupational and leisure sitting time in full-time employed Australian adults between 2007 and 2015. We used data from three Australian Health Surveys held between 2007 and 2015, in which nationally representative samples of the Australian population were interviewed. Full-time (≥35 hours/week) employed respondents reported sitting time at work and during leisure on a usual workday. Trends over time and associations between socio-demographic and health-related characteristics and sitting time were analyzed. Over 21,000 observations were included in the analyses. Across the three surveys, approximately 51% of the respondents reported 4 or more hours occupational sitting time per workday, 40% reported ≥4 hours/workday lei
sure sitting time, and 55% reported ≥7 hours/workday combined occupational and leisure sitting time. However, there were no clear trends over time, i.e. we found no evidence that sitting time increased or decreased between 2007 and 2015. All potential correlates were associated with occupational sitting time and all but educational level were associated with leisure sitting time. The directions of the associations with gender, age and leisure-time physical activity were reversed for occupational sitting time and leisure sitting time. These findings show that the average levels of occupational and leisure sitting time on workdays were high but stable over the past decade. The observed differences in correlates of occupational and leisure sitting time demonstrate the need to assess and address sedentary behaviour domains separately in research and policy.

High intensity training is more (cost) effective than low-moderate training among cancer survivors

In a study just published in the Journal of Cancer Survivorship, with Drs. Caroline Kampshoff and Hanneke van Dongen as joined first authors, we aimed to evaluate the long-term effectiveness and cost-effectiveness of high intensity (HI) versus low-to-moderate intensity (LMI) exercise on physical fitness, fatigue, and health-related quality of life (HRQoL) in cancer survivors.
Two hundred seventy-seven cancer survivors participated in the Resistance and Endurance exercise After ChemoTherapy (REACT) study and were randomized to 12 weeks of HI (n = 139) or LMI exercise (n = 138) that had similar exercise types, durations, and frequencies, but different intensities. Measurements were performed at baseline (4–6 weeks after primary treatment), and 12 (i.e., short term) and 64 (i.e., longer term) weeks later. Outcomes included cardiorespiratory fitness, muscle strength, self-reported fatigue, HRQoL, quality-adjusted life years (QALYs) and societal costs.
At longer term, we found larger intervention effects on role and social functioning for HI than for LMI exercise. Furthermore, HI exercise was cost-effective with regard to QALYs compared to LMI exercise.

Functional determinants of dietary intake in community-dwelling older adults

The identification of determinants of dietary intake is an important prerequisite for the development of interventions to improve dietary behaviors. In a systematic literature review just published in Public Health Nutrition with Eva Kiesswetter as first author, we aimed to compile the current knowledge on individual functional determinants of dietary intake in community-dwelling older adults. The paper was part of the Determinants of Diet and Physical Activity (DEDIPAC) joint action of the Healthy Diet for a Healthy Life joint programming initiative.
Thirty-six studies were included in the review. For chemosensory, cognitive and physical function only few studies were available, which reported inconsistent results regarding the relationship to dietary intake. In contrast, oral function was extensively studied in 31 studies.  As oral factors general aspects of oral health like number of teeth, dental status (inadequate v. adequate), caries or wearing dentures were investigated. Additionally, some studies focused on functional aspects by
assessing chewing ability and bite force. Only one study considered also the aspect of swallowing function as a component of an oral health indicator. The different surrogate measures of oral function were associated with food as well as nutrient intakes including lower intakes of vegetables and fibre, and dietary variety. As all except six studies had a cross-sectional design, no causal relationships could be derived.

Built environment and diabetes: a systematic review and meta-analysis

The built environment may influence behaviours like physical activity, diet and sleep. Such behaviours are important for risk of type 2 diabetes mellitus (T2DM). In a study just published in BMC Medicine, we systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk worldwide. Nicole den Braver was first author on this paper and this study is part of the ENDEAVOR project.
We included 109 studies in our review and 40 studies were meta-analysed.
Living in an urban residence was associated with a 1.4 higher T2DM risk/prevalence compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence and we found some evidence that more green space was associated with somewhat lower T2DM risk/prevalence. No convincing evidence was found for a significant association between food environment and T2DM risk/prevalence.

Psychosocial interventions improve quality of life in patients with cancer

In a study just published in the journal Psycho-oncology -by the POLARIS consortium and with Dr. Laurien Buffart as senior author-, we present the results of an individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions on quality of life, emotional function and social function in patients with cancer, and to study for which patients such interventions work better. Therefore we looked at moderator effects of demographic, clinical, personal, and intervention-related characteristics.
We pooled IPD from 22 randomized controlled trials (RCTs), with in total more than 4000 patients for our analyses.
Overall, we found clear evidence that psychosocial interventions significantly improve quality of life  as well as emotional and social function in patients with cancer, with largest effects for psychotherapy. We found evidence that effects of coping skills training were moderated by age, treatment type, and targeted interventions. We found some evidence that effects of psychotherapy on emotional function may be moderated by cancer type, but these analyses were based on few studies.

Happiness in European Neighbourhoods

In a paper just published in the journal PLOS One, we aimed to examine the associations of both objectively assessed and perceived physical and social neighborhood characteristics with happiness in European adults. Eva Anna Christina Hart was first author and Dr. Joreintje Mackenbach was senior author on this paper and for this study we used data from the SPOTLIGHT study. Respondents reported their level of happiness on a 5-point Likert scale, and rated their perceptions of physical and social environmental neighbourhood characteristics. Objective physical environmental characteristics were also assessed, using a Google Street View-based neighbourhood audit. Associations of 14 physical and social environmental characteristics with happiness were analysed.
Living in neighbourhoods that look better ('better aesthetics') and more water and green space was associated with being very happy. Individuals who perceived their neighbourhood to be safer, more functional and more aesthetic were more likely to be very happy. The associations of functionality and aesthetics with happiness were strongest in the Ghent region (Belgium), the Randstad (the Netherlands) and Greater London (United Kingdom). Perceived absence of air pollution was only associated with higher levels of happiness among more highly educated participants. Individuals with a larger social network, more social cohesion and who trusted their neighbours were more likely to be very happy. The association between social networks and happiness was somewhat stronger in men than in women. In general, the associations between environmental characteristics and happiness had similar directions and sizes across socio-economic and socio-demographic subgroups.

Is Home Cooking associated with access to grocery stores and restaurants?

Little is known about the relation between the neighbourhood food environment and home cooking.We explored the independent and combined associations between residential neighbourhood spatial access to restaurants and grocery stores with home cooking in European adults. For this we used data from 5076 adults from five urban areas in different countries in Europe, as part of the Spotlight study. Food retailers were classified into grocery stores and restaurants. A paper describing this study was just published in the International Journal of Behavioural Nutrition and Physical Activity, with Gabi Pinho as first author.
Our study showed that greater neighbourhood spatial access to restaurants was associated with lower frequency of home cooking, largely independent of access to grocery stores.

Access to fast food outlets and body weight in European adults

In a paper just published in the journal 'Environment and Behaviour' we examined explanatory pathways for the association between spatial access to fast food outlets and body weight in 5,076 European adults (18+) in different urban regions across Europe. Dr. Joreintje Mackenbach is first author on this paper, and we made use of the data from the Spotlight project. The total association of spatial access to fast food outlets with self-reported weight status was examined and in the analyses we took possible clustering at the neighborhood level into account. We also explored if the association between spatial access and body weight was mediated by perceived availability and usage of fast food outlets, and self-reported fast food consumption. We further explored if the associations were different according to age, gender, socioeconomic status, and urban region.
Objective spatial access to fast food outlets was not significantly related to weight status. Spatial access to fast food outlets was associated with perceptions about presence of fast food outlets and usage of fast food outlets, and this was in turn associated with greater reported fast food consumption and unhealthier weight status.