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Papers by Joop Van Raaij

Research paper thumbnail of Improved appetite after multi-micronutrient supplementation for six months in HIV-infected South African children

Appetite

The aim of the study was to assess the effect of multi-micronutrient supplementation on the appet... more The aim of the study was to assess the effect of multi-micronutrient supplementation on the appetite of HIV-infected children. HIV-infected children (6-24 months) who had previously been hospitalized were enrolled into a double-blind randomized trial, and given daily multi-micronutrient supplements or placebos for six months. Appetite tests were performed at enrollment and after three and six months. Appetite was measured as ad libitum intake of a commercial cereal test food served after an overnight fast according to standardized procedures. Body weights and total amount of test food eaten were measured. In total, 99 children completed the study (50 on supplements and 49 on placebos). Amounts eaten per kilogram body weight in the supplement group at enrollment and after six months were 36.7+/-17.7 g/kg (mean+/-SD) and 41.3+/-15.0 g/kg respectively, while the amounts in the placebo group were 47.1+/-14.9 g/kg and 45.7+/-13.1g/kg respectively. The change in amount eaten per kilogram ...

Research paper thumbnail of Impact of Multi-Micronutrient Supplementation on Growth and Morbidity of HIV-Infected South African Children

Nutrients

Poor growth, micronutrient deficiencies and episodes of diarrhea and respiratory infections occur... more Poor growth, micronutrient deficiencies and episodes of diarrhea and respiratory infections occur frequently in HIV-infected children. We investigated whether multi-micronutrient supplementation would improve the growth performance and reduce the number of episodes of diarrhea and/or of respiratory symptoms in HIV-infected children. In a double-blind randomized trial, HIV-infected South African children aged 4-24 months (n = 201) were assigned to receive multi-micronutrient supplements or placebo daily for six months. The children were assessed for respiratory symptoms or diarrhea bi-weekly; weights and heights were measured monthly. In total, 121 children completed the six month follow up study period (60%). A total of 43 children died; 27 of them had received supplements. This difference in mortality was not statistically significant (p = 0.12). Weight-for-height Z-scores improved significantly (p < 0.05) among children given supplements compared with those given placebo (0.40 ...

Research paper thumbnail of Duration of hospitalization and appetite of HIV-infected South African children

Maternal and Child Nutrition

Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diar... more Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIV-infected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n=154) and appetite measurement (n=48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 ± 1.9 vs. 3.8 ± 1.5) (mean ± standard deviation) and with pneumo...

Research paper thumbnail of WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in Primary Schools

International Journal of Environmental Research and Public Health

Abstract: Background: Schools are important settings for the promotion of a healthy diet and suff... more Abstract: Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children’s weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children’s BMI/...

Research paper thumbnail of Resting metabolic rate and thermic effect of a meal in the follicular and luteal phases of the menstrual cycle in well-nourished Indian women

The resting metabolic rate (RMR) and ther-Am J Clin Nutr 1995;61:296-302 KEY WORDS Menstrual cycl... more The resting metabolic rate (RMR) and ther-Am J Clin Nutr 1995;61:296-302 KEY WORDS Menstrual cycle, resting metabolic rate, thermic effect of a meal, body composition, energy intakes

Research paper thumbnail of Changes in energy expenditure, anthropometry, and energy intake during the course of pregnancy and lactation in well-nourished Indian women

Basal metabolic rate (BMR), thermic effect of a meal (ThM), anthropometny, and dietary intakes we... more Basal metabolic rate (BMR), thermic effect of a meal (ThM), anthropometny, and dietary intakes were measured in 18 control subjects; 18 pregnant women at 12, 24, and 34 wk gestation; and in 17 of these women at 12 and 24 wk rather than by any metabolic economy or increase in fat mobilization. Am J Clin Nutr 1995;61:501-13 KEY WORDS Pregnancy, lactation, anthropometry, energy intake, basal metabolic rate, thermic effect of a meal, substrate oxidation rate

Research paper thumbnail of Health gain by salt reduction in europe: a modelling study

PloS one, 2015

Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake ex... more Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake exceeds the World Health Organization population nutrition goal of 5 grams per day in the European region. We assessed the health impact of salt reduction in nine European countries (Finland, France, Ireland, Italy, Netherlands, Poland, Spain, Sweden and United Kingdom). Through literature research we obtained current salt intake and systolic blood pressure levels of the nine countries. The population health modeling tool DYNAMO-HIA including country-specific disease data was used to predict the changes in prevalence of ischemic heart disease and stroke for each country estimating the effect of salt reduction through its effect on blood pressure levels. A 30% salt reduction would reduce the prevalence of stroke by 6.4% in Finland to 13.5% in Poland. Ischemic heart disease would be decreased by 4.1% in Finland to 8.9% in Poland. When salt intake is reduced to the WHO population nutrient goa...

Research paper thumbnail of Body fat mass and basal metabolic rate in Dutch women before, during, and after pregnancy: a reappraisal of energy cost of pregnancy

The American journal of clinical nutrition, 1989

Body weight, fat mass, and basal metabolic rate were measured longitudinally from early pregnancy... more Body weight, fat mass, and basal metabolic rate were measured longitudinally from early pregnancy until 2 mo postpartum in 57 healthy Dutch women; 23 of whom were also studied before pregnancy. Weight gain over pregnancy was 11.8 +/- 3.7 kg and weight gain from 12 wk gestation to delivery was 10.3 +/- 3.8 kg. Birth weights and placental weights were 3458 +/- 527 and 657 +/- 114 g, respectively. Gain in maternal fat stores over pregnancy was 2.0 +/- 2.6 kg and difference in fat mass from 12 wk gestation to 5 wk postpartum was 1.2 +/- 2.2 kg. The energy equivalent of the gain in fat stores, including costs of synthesizing, can be estimated as 22,000 kcal. The cumulative increment in basal metabolism over pregnancy was 34,350 +/- 30,000 kcal. When the energy equivalent of the gain in tissue other than fat stores is assumed to be approximately 11,750 kcal, total energy cost of pregnancy is at 68,100 +/- 38,560 kcal.

Research paper thumbnail of Risk-benefit analysis of healthy diet and safe food in the Netherlands

Research paper thumbnail of Length of hospital stay in relation to nutritional status of HIV-infected South African children

Research paper thumbnail of Reply to SN Thornton and P Lacolley

American Journal of Clinical Nutrition, 2014

Research paper thumbnail of WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010

BMC public health, 2014

The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obes... more The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change ...

Research paper thumbnail of Monitoring salt and iodine intakes in Dutch adults between 2006 and 2010 using 24 h urinary sodium and iodine excretions

Public Health Nutrition, 2013

To monitor the effectiveness of salt-reduction initiatives in processed foods and changes in Dutc... more To monitor the effectiveness of salt-reduction initiatives in processed foods and changes in Dutch iodine policy on Na and iodine intakes in Dutch adults between 2006 and 2010. Two cross-sectional studies among adults, conducted in 2006 and 2010, using identical protocols. Participants collected single 24 h urine samples and completed two short questionnaires on food consumption and urine collection procedures. Daily intakes of salt, iodine, K and Na:K were estimated, based on the analysis of Na, K and iodine excreted in urine. Doetinchem, the Netherlands. Men and women aged 19 to 70 years were recruited through random sampling of the Doetinchem population and among participants of the Doetinchem Cohort Study (2006: n 317, mean age 48·9 years, 43 % men; 2010: n 342, mean age 46·2 years, 45 % men). While median iodine intake was lower in 2010 (179 μg/d) compared with 2006 (257 μg/d; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0·0001), no difference in median salt intake was observed (8·7 g/d in 2006 v. 8·5 g/d in 2010, P = 0·70). In 2006, median K intake was 2·6 g/d v. 2·8 g/d in 2010 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0·01). In this 4-year period, median Na:K improved from 2·4 in 2006 to 2·2 in 2010 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0·001). Despite initiatives to lower salt in processed foods, dietary salt intake in this population remains well above the recommended intake of 6 g/d. Iodine intake is still adequate, although a decline was observed between 2006 and 2010. This reduction is probably due to changes in iodine policy.

Research paper thumbnail of Effect of Antenatal Zinc Supplementation on Impetigo in Infants in Bangladesh

The Pediatric Infectious Disease Journal, 2012

We sought to determine the effects of maternal zinc supplementation on skin infections among infa... more We sought to determine the effects of maternal zinc supplementation on skin infections among infants in poor urban areas of Dhaka, Bangladesh. A double-blind, placebo-controlled, randomized trial was conducted among 199 and 221 Bangladeshi infants whose mothers were administered 30 mg daily of zinc or placebo, respectively. The mothers received zinc supplementation from 12-16 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation until delivery, and the infants were followed up until 6 months of age. Among the infants of mothers who received zinc supplementation during the antenatal period, 10.6% had at least 1 episode of impetigo compared with 19.6% of the infants of mothers in the placebo group (P = 0.01). Infants in the treatment group had a 54% reduction in incidence rate of episodes of impetigo when compared with infants in the placebo group (P = 0.01). The effect of zinc supplementation was more pronounced among male infants (64% reduction) and intrauterine growth restricted and low birth weight infants (73% reduction) and among infants of mothers with increased parity (60% reduction) or decreased socioeconomic status (71% reduction).

Research paper thumbnail of Duration of hospitalization and appetite of HIV-infected South African children

Maternal & Child Nutrition, 2011

Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diar... more Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIVinfected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n = 154) and appetite measurement (n = 48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 Ϯ 1.9 vs. 3.8 Ϯ 1.5) (mean Ϯ standard deviation) and with pneumonia (9.0 Ϯ 2.5 vs. 5.9 Ϯ 1.9). Serum zinc, iron and transferrin concentrations, and haemoglobin levels were significantly lower in HIV-infected children compared with uninfected children. Appetites [amounts eaten (g) per kg body weight] of HIV-infected children were significantly poorer than those of ). The eating rates (g min -1 ) of HIVinfected children were also slower (17.6 Ϯ 6.2 vs. 10.1 Ϯ 3.7) Mean Z-scores for length-for-age were significantly lower among HIV-infected children compared with HIV-uninfected children. Weight-for-length Z-scores were not significantly different. In summary, HIV-infected children had a 55% longer duration of hospitalization and a 21% lower appetite.

Research paper thumbnail of Exposure and effectiveness of phytosterol/-stanol-enriched margarines

European Journal of Clinical Nutrition, 2007

Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community ... more Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community have received low priority. For postlaunch monitoring purposes including risk-benefit analyses, it is needed to investigate both exposure and effectiveness of these margarines. Objective: To study the use and effectiveness of phytosterol/-stanol-enriched margarine. Design, setting and subjects: The study population consisted of 2379 subjects that participated in a community intervention study ('Hartslag Limburg') aged 28-76 years. In 1998 and 2003, blood samples for total and high-density lipoprotein (HDL) cholesterol were obtained. A general questionnaire and food frequency questionnaire (FFQ) were administered. From 1999 onwards, phytosterol/-stanol-enriched margarines were introduced on the Dutch market. On the basis of 2003 data, subjects were classified in users of (a) phytosterol/-stanol-enriched margarine, (b) cholesterol-lowering drugs, (c) the combination (both enriched margarine and drugs) and (d) neither enriched margarines nor cholesterol-lowering drugs. Results: Mean (7s.d.) daily intake of phytosterol-enriched margarine (n ¼ 99) and phytostanol-enriched margarine (n ¼ 16) was 1479 g. From 1998 to 2003, total serum cholesterol concentration changed significantly different among the four groups: in the combination users À2.0471.50 mmol/l (À29%), in cholesterol-lowering drug users À1.0971.17 mmol/l (À17%), in the enriched margarine users À0.2470.75 mmol/l (À4%) and in non-users þ 0.1070.72 mmol/l ( þ 2%)(Po0.05). Conclusion: Recommended doses are not consumed, but phytosterol/-stanol-enriched margarines can modestly reduce serum total cholesterol in the community. These margarines cannot equal the effect of cholesterol-lowering drugs, but may act additively. Further investigation of the health effects that may occur during simultaneous cholesterol lowering drugs and phytosterol-or -stanol-enriched margarines usage is important, as well as community education about the cholesterol lowering foods and drugs.

Research paper thumbnail of Potential effect of salt reduction in processed foods on health

American Journal of Clinical Nutrition, 2014

Excessive salt intake has been associated with hypertension and increased cardiovascular disease ... more Excessive salt intake has been associated with hypertension and increased cardiovascular disease morbidity and mortality. Reducing salt intake is considered an important public health strategy in the Netherlands. The objective was to evaluate the health benefits of salt-reduction strategies related to processed foods for the Dutch population. Three salt-reduction scenarios were developed: 1) substitution of high-salt foods with low-salt foods, 2) a reduction in the sodium content of processed foods, and 3) adherence to the recommended maximum salt intake of 6 g/d. Health outcomes were obtained in 2 steps: after salt intake was modeled into blood pressure levels, the Chronic Disease Model was used to translate modeled blood pressures into incidences of cardiovascular diseases, disability-adjusted life years (DALYs), and life expectancies. Health outcomes of the scenarios were compared with health outcomes obtained with current salt intake. In total, 4.8% of acute myocardial infarction cases, 1.7% of congestive heart failure cases, and 5.8% of stroke cases might be prevented if salt intake meets the recommended maximum intake. The burden of disease might be reduced by 56,400 DALYs, and life expectancy might increase by 0.15 y for a 40-y-old individual. Substitution of foods with comparable low-salt alternatives would lead to slightly higher salt intake reductions and thus to more health gain. The estimates for sodium reduction in processed foods would be slightly lower. Substantial health benefits might be achieved when added salt is removed from processed foods and when consumers choose more low-salt food alternatives.

Research paper thumbnail of The supply of bioavailable iron and zinc may be affected by phytate in Beninese children

Journal of Food Composition and Analysis, 2008

Food composition data are important for estimating energy and nutrient intakes. The objectives of... more Food composition data are important for estimating energy and nutrient intakes. The objectives of this study were, first, to evaluate the proximate and inorganic composition of foods eaten in northern Benin and second, to estimate the potentially inhibiting effect of phytate on iron and zinc bioavailability. Chemical analyses were performed in 23 samples of most frequently consumed foodstuffs collected from

Research paper thumbnail of Improved appetite after multi-micronutrient supplementation for six months in HIV-infected South African children

Appetite

The aim of the study was to assess the effect of multi-micronutrient supplementation on the appet... more The aim of the study was to assess the effect of multi-micronutrient supplementation on the appetite of HIV-infected children. HIV-infected children (6-24 months) who had previously been hospitalized were enrolled into a double-blind randomized trial, and given daily multi-micronutrient supplements or placebos for six months. Appetite tests were performed at enrollment and after three and six months. Appetite was measured as ad libitum intake of a commercial cereal test food served after an overnight fast according to standardized procedures. Body weights and total amount of test food eaten were measured. In total, 99 children completed the study (50 on supplements and 49 on placebos). Amounts eaten per kilogram body weight in the supplement group at enrollment and after six months were 36.7+/-17.7 g/kg (mean+/-SD) and 41.3+/-15.0 g/kg respectively, while the amounts in the placebo group were 47.1+/-14.9 g/kg and 45.7+/-13.1g/kg respectively. The change in amount eaten per kilogram ...

Research paper thumbnail of Impact of Multi-Micronutrient Supplementation on Growth and Morbidity of HIV-Infected South African Children

Nutrients

Poor growth, micronutrient deficiencies and episodes of diarrhea and respiratory infections occur... more Poor growth, micronutrient deficiencies and episodes of diarrhea and respiratory infections occur frequently in HIV-infected children. We investigated whether multi-micronutrient supplementation would improve the growth performance and reduce the number of episodes of diarrhea and/or of respiratory symptoms in HIV-infected children. In a double-blind randomized trial, HIV-infected South African children aged 4-24 months (n = 201) were assigned to receive multi-micronutrient supplements or placebo daily for six months. The children were assessed for respiratory symptoms or diarrhea bi-weekly; weights and heights were measured monthly. In total, 121 children completed the six month follow up study period (60%). A total of 43 children died; 27 of them had received supplements. This difference in mortality was not statistically significant (p = 0.12). Weight-for-height Z-scores improved significantly (p < 0.05) among children given supplements compared with those given placebo (0.40 ...

Research paper thumbnail of Duration of hospitalization and appetite of HIV-infected South African children

Maternal and Child Nutrition

Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diar... more Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIV-infected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n=154) and appetite measurement (n=48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 ± 1.9 vs. 3.8 ± 1.5) (mean ± standard deviation) and with pneumo...

Research paper thumbnail of WHO European Childhood Obesity Surveillance Initiative: School Nutrition Environment and Body Mass Index in Primary Schools

International Journal of Environmental Research and Public Health

Abstract: Background: Schools are important settings for the promotion of a healthy diet and suff... more Abstract: Background: Schools are important settings for the promotion of a healthy diet and sufficient physical activity and thus overweight prevention. Objective: To assess differences in school nutrition environment and body mass index (BMI) in primary schools between and within 12 European countries. Methods: Data from the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) were used (1831 and 2045 schools in 2007/2008 and 2009/2010, respectively). School personnel provided information on 18 school environmental characteristics on nutrition and physical activity. A school nutrition environment score was calculated using five nutrition-related characteristics whereby higher scores correspond to higher support for a healthy school nutrition environment. Trained field workers measured children’s weight and height; BMI-for-age (BMI/A) Z-scores were computed using the 2007 WHO growth reference and, for each school, the mean of the children’s BMI/...

Research paper thumbnail of Resting metabolic rate and thermic effect of a meal in the follicular and luteal phases of the menstrual cycle in well-nourished Indian women

The resting metabolic rate (RMR) and ther-Am J Clin Nutr 1995;61:296-302 KEY WORDS Menstrual cycl... more The resting metabolic rate (RMR) and ther-Am J Clin Nutr 1995;61:296-302 KEY WORDS Menstrual cycle, resting metabolic rate, thermic effect of a meal, body composition, energy intakes

Research paper thumbnail of Changes in energy expenditure, anthropometry, and energy intake during the course of pregnancy and lactation in well-nourished Indian women

Basal metabolic rate (BMR), thermic effect of a meal (ThM), anthropometny, and dietary intakes we... more Basal metabolic rate (BMR), thermic effect of a meal (ThM), anthropometny, and dietary intakes were measured in 18 control subjects; 18 pregnant women at 12, 24, and 34 wk gestation; and in 17 of these women at 12 and 24 wk rather than by any metabolic economy or increase in fat mobilization. Am J Clin Nutr 1995;61:501-13 KEY WORDS Pregnancy, lactation, anthropometry, energy intake, basal metabolic rate, thermic effect of a meal, substrate oxidation rate

Research paper thumbnail of Health gain by salt reduction in europe: a modelling study

PloS one, 2015

Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake ex... more Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake exceeds the World Health Organization population nutrition goal of 5 grams per day in the European region. We assessed the health impact of salt reduction in nine European countries (Finland, France, Ireland, Italy, Netherlands, Poland, Spain, Sweden and United Kingdom). Through literature research we obtained current salt intake and systolic blood pressure levels of the nine countries. The population health modeling tool DYNAMO-HIA including country-specific disease data was used to predict the changes in prevalence of ischemic heart disease and stroke for each country estimating the effect of salt reduction through its effect on blood pressure levels. A 30% salt reduction would reduce the prevalence of stroke by 6.4% in Finland to 13.5% in Poland. Ischemic heart disease would be decreased by 4.1% in Finland to 8.9% in Poland. When salt intake is reduced to the WHO population nutrient goa...

Research paper thumbnail of Body fat mass and basal metabolic rate in Dutch women before, during, and after pregnancy: a reappraisal of energy cost of pregnancy

The American journal of clinical nutrition, 1989

Body weight, fat mass, and basal metabolic rate were measured longitudinally from early pregnancy... more Body weight, fat mass, and basal metabolic rate were measured longitudinally from early pregnancy until 2 mo postpartum in 57 healthy Dutch women; 23 of whom were also studied before pregnancy. Weight gain over pregnancy was 11.8 +/- 3.7 kg and weight gain from 12 wk gestation to delivery was 10.3 +/- 3.8 kg. Birth weights and placental weights were 3458 +/- 527 and 657 +/- 114 g, respectively. Gain in maternal fat stores over pregnancy was 2.0 +/- 2.6 kg and difference in fat mass from 12 wk gestation to 5 wk postpartum was 1.2 +/- 2.2 kg. The energy equivalent of the gain in fat stores, including costs of synthesizing, can be estimated as 22,000 kcal. The cumulative increment in basal metabolism over pregnancy was 34,350 +/- 30,000 kcal. When the energy equivalent of the gain in tissue other than fat stores is assumed to be approximately 11,750 kcal, total energy cost of pregnancy is at 68,100 +/- 38,560 kcal.

Research paper thumbnail of Risk-benefit analysis of healthy diet and safe food in the Netherlands

Research paper thumbnail of Length of hospital stay in relation to nutritional status of HIV-infected South African children

Research paper thumbnail of Reply to SN Thornton and P Lacolley

American Journal of Clinical Nutrition, 2014

Research paper thumbnail of WHO European Childhood Obesity Surveillance Initiative: body mass index and level of overweight among 6-9-year-old children from school year 2007/2008 to school year 2009/2010

BMC public health, 2014

The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obes... more The World Health Organization (WHO) Regional Office for Europe has established the Childhood Obesity Surveillance Initiative (COSI) to monitor changes in overweight in primary-school children. The aims of this paper are to present the anthropometric results of COSI Round 2 (2009/2010) and to explore changes in body mass index (BMI) and overweight among children within and across nine countries from school years 2007/2008 to 2009/2010. Using cross-sectional nationally representative samples of 6-9-year-olds, BMI, anthropometric Z-scores and overweight prevalence were derived from measured weight and height. Significant changes between rounds were assessed using variance and t-tests analyses. At Round 2, the prevalence of overweight (including obesity; WHO definitions) ranged from 18% to 57% among boys and from 18% to 50% among girls; 6 - 31% of boys and 5 - 21% of girls were obese. Southern European countries had the highest overweight prevalence. Between rounds, the absolute change ...

Research paper thumbnail of Monitoring salt and iodine intakes in Dutch adults between 2006 and 2010 using 24 h urinary sodium and iodine excretions

Public Health Nutrition, 2013

To monitor the effectiveness of salt-reduction initiatives in processed foods and changes in Dutc... more To monitor the effectiveness of salt-reduction initiatives in processed foods and changes in Dutch iodine policy on Na and iodine intakes in Dutch adults between 2006 and 2010. Two cross-sectional studies among adults, conducted in 2006 and 2010, using identical protocols. Participants collected single 24 h urine samples and completed two short questionnaires on food consumption and urine collection procedures. Daily intakes of salt, iodine, K and Na:K were estimated, based on the analysis of Na, K and iodine excreted in urine. Doetinchem, the Netherlands. Men and women aged 19 to 70 years were recruited through random sampling of the Doetinchem population and among participants of the Doetinchem Cohort Study (2006: n 317, mean age 48·9 years, 43 % men; 2010: n 342, mean age 46·2 years, 45 % men). While median iodine intake was lower in 2010 (179 μg/d) compared with 2006 (257 μg/d; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0·0001), no difference in median salt intake was observed (8·7 g/d in 2006 v. 8·5 g/d in 2010, P = 0·70). In 2006, median K intake was 2·6 g/d v. 2·8 g/d in 2010 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0·01). In this 4-year period, median Na:K improved from 2·4 in 2006 to 2·2 in 2010 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0·001). Despite initiatives to lower salt in processed foods, dietary salt intake in this population remains well above the recommended intake of 6 g/d. Iodine intake is still adequate, although a decline was observed between 2006 and 2010. This reduction is probably due to changes in iodine policy.

Research paper thumbnail of Effect of Antenatal Zinc Supplementation on Impetigo in Infants in Bangladesh

The Pediatric Infectious Disease Journal, 2012

We sought to determine the effects of maternal zinc supplementation on skin infections among infa... more We sought to determine the effects of maternal zinc supplementation on skin infections among infants in poor urban areas of Dhaka, Bangladesh. A double-blind, placebo-controlled, randomized trial was conducted among 199 and 221 Bangladeshi infants whose mothers were administered 30 mg daily of zinc or placebo, respectively. The mothers received zinc supplementation from 12-16 weeks&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; gestation until delivery, and the infants were followed up until 6 months of age. Among the infants of mothers who received zinc supplementation during the antenatal period, 10.6% had at least 1 episode of impetigo compared with 19.6% of the infants of mothers in the placebo group (P = 0.01). Infants in the treatment group had a 54% reduction in incidence rate of episodes of impetigo when compared with infants in the placebo group (P = 0.01). The effect of zinc supplementation was more pronounced among male infants (64% reduction) and intrauterine growth restricted and low birth weight infants (73% reduction) and among infants of mothers with increased parity (60% reduction) or decreased socioeconomic status (71% reduction).

Research paper thumbnail of Duration of hospitalization and appetite of HIV-infected South African children

Maternal & Child Nutrition, 2011

Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diar... more Human immunodeficiency virus (HIV)-infected children generally show poor growth. Episodes of diarrhoea and pneumonia in HIV-infected children are thought to be more severe than in HIV-uninfected children. The objective of this study was to compare duration of hospitalization, appetite and nutritional status of HIVinfected children with that of uninfected children. A cross-sectional study was performed on children (2-24 months) admitted with diarrhoea or pneumonia to the university hospital. Children were tested for HIV, and the duration of hospitalization was noted for 189 children. Follow-up for blood analysis (n = 154) and appetite measurement (n = 48) was performed 4-8 weeks after discharge. Appetite was measured as ad libitum intake of a commercial infant cereal using highly standardized procedures. Hospitalization (in days) was significantly longer in HIV-infected children; among children admitted with diarrhoea (5.9 Ϯ 1.9 vs. 3.8 Ϯ 1.5) (mean Ϯ standard deviation) and with pneumonia (9.0 Ϯ 2.5 vs. 5.9 Ϯ 1.9). Serum zinc, iron and transferrin concentrations, and haemoglobin levels were significantly lower in HIV-infected children compared with uninfected children. Appetites [amounts eaten (g) per kg body weight] of HIV-infected children were significantly poorer than those of ). The eating rates (g min -1 ) of HIVinfected children were also slower (17.6 Ϯ 6.2 vs. 10.1 Ϯ 3.7) Mean Z-scores for length-for-age were significantly lower among HIV-infected children compared with HIV-uninfected children. Weight-for-length Z-scores were not significantly different. In summary, HIV-infected children had a 55% longer duration of hospitalization and a 21% lower appetite.

Research paper thumbnail of Exposure and effectiveness of phytosterol/-stanol-enriched margarines

European Journal of Clinical Nutrition, 2007

Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community ... more Background: Studies on effectiveness of phytosterol/-stanol-enriched margarines in the community have received low priority. For postlaunch monitoring purposes including risk-benefit analyses, it is needed to investigate both exposure and effectiveness of these margarines. Objective: To study the use and effectiveness of phytosterol/-stanol-enriched margarine. Design, setting and subjects: The study population consisted of 2379 subjects that participated in a community intervention study ('Hartslag Limburg') aged 28-76 years. In 1998 and 2003, blood samples for total and high-density lipoprotein (HDL) cholesterol were obtained. A general questionnaire and food frequency questionnaire (FFQ) were administered. From 1999 onwards, phytosterol/-stanol-enriched margarines were introduced on the Dutch market. On the basis of 2003 data, subjects were classified in users of (a) phytosterol/-stanol-enriched margarine, (b) cholesterol-lowering drugs, (c) the combination (both enriched margarine and drugs) and (d) neither enriched margarines nor cholesterol-lowering drugs. Results: Mean (7s.d.) daily intake of phytosterol-enriched margarine (n ¼ 99) and phytostanol-enriched margarine (n ¼ 16) was 1479 g. From 1998 to 2003, total serum cholesterol concentration changed significantly different among the four groups: in the combination users À2.0471.50 mmol/l (À29%), in cholesterol-lowering drug users À1.0971.17 mmol/l (À17%), in the enriched margarine users À0.2470.75 mmol/l (À4%) and in non-users þ 0.1070.72 mmol/l ( þ 2%)(Po0.05). Conclusion: Recommended doses are not consumed, but phytosterol/-stanol-enriched margarines can modestly reduce serum total cholesterol in the community. These margarines cannot equal the effect of cholesterol-lowering drugs, but may act additively. Further investigation of the health effects that may occur during simultaneous cholesterol lowering drugs and phytosterol-or -stanol-enriched margarines usage is important, as well as community education about the cholesterol lowering foods and drugs.

Research paper thumbnail of Potential effect of salt reduction in processed foods on health

American Journal of Clinical Nutrition, 2014

Excessive salt intake has been associated with hypertension and increased cardiovascular disease ... more Excessive salt intake has been associated with hypertension and increased cardiovascular disease morbidity and mortality. Reducing salt intake is considered an important public health strategy in the Netherlands. The objective was to evaluate the health benefits of salt-reduction strategies related to processed foods for the Dutch population. Three salt-reduction scenarios were developed: 1) substitution of high-salt foods with low-salt foods, 2) a reduction in the sodium content of processed foods, and 3) adherence to the recommended maximum salt intake of 6 g/d. Health outcomes were obtained in 2 steps: after salt intake was modeled into blood pressure levels, the Chronic Disease Model was used to translate modeled blood pressures into incidences of cardiovascular diseases, disability-adjusted life years (DALYs), and life expectancies. Health outcomes of the scenarios were compared with health outcomes obtained with current salt intake. In total, 4.8% of acute myocardial infarction cases, 1.7% of congestive heart failure cases, and 5.8% of stroke cases might be prevented if salt intake meets the recommended maximum intake. The burden of disease might be reduced by 56,400 DALYs, and life expectancy might increase by 0.15 y for a 40-y-old individual. Substitution of foods with comparable low-salt alternatives would lead to slightly higher salt intake reductions and thus to more health gain. The estimates for sodium reduction in processed foods would be slightly lower. Substantial health benefits might be achieved when added salt is removed from processed foods and when consumers choose more low-salt food alternatives.

Research paper thumbnail of The supply of bioavailable iron and zinc may be affected by phytate in Beninese children

Journal of Food Composition and Analysis, 2008

Food composition data are important for estimating energy and nutrient intakes. The objectives of... more Food composition data are important for estimating energy and nutrient intakes. The objectives of this study were, first, to evaluate the proximate and inorganic composition of foods eaten in northern Benin and second, to estimate the potentially inhibiting effect of phytate on iron and zinc bioavailability. Chemical analyses were performed in 23 samples of most frequently consumed foodstuffs collected from