Intra-national variation in trends in overweight and leisure time physical activities in The Netherlands since 1980: stratification according to sex, age and urbanisation degree.
ABSTRACT To investigate time trends in overweight and Leisure Time Physical Activities (LTPA) in The Netherlands since 1980. Intra-national differences were examined stratified for sex, age and urbanisation degree.
We used a random sample of about 140,000 respondents aged 20-69 years from the Health Interview Survey (Nethhis) and subsequent Permanent Survey on Living Conditions (POLS). Self-reported data on weight and height and demographic characteristics were gathered through interviews (every year) and data on LTPA were collected by self-administered questionnaires (1990-1997, 2001-2004). Linear regression analysis was performed for trend analyses.
During 1981-2004, mean body mass index (BMI) increased significantly by 1.0 kg/m(2) (average per year=0.05 kg/m(2)). Trends were similar across sex and different degrees of urbanisation, but varied across age groups. In 20-to 39-year-old women, mean BMI increased by 1.7 kg/m(2), which was more than in older age groups (P<or=0.05). With respect to LTPA, no clear trend was observed during 1990-1997 and 2001-2004. The (absence of) trends were similar across sex and urbanisation degrees, but varied across age groups. During 2001-2004, 20-to 39-year-old women spent approximately 150 min/week less on LTPA compared to older women, while this difference was smaller during 1990-1997.
Mean BMI increased more in younger women, which is consistent with the observation that this group spent less time on LTPA during recent years. Although the overall increase in overweight could not be explained by trends in LTPA, the younger women should be considered as a target group for future physical activity interventions. The influence of the 'obesogenic environment' seems to be similar across different degrees of urbanisation.
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ABSTRACT: This report describes the current diabetes situation in the Netherlands and future developments in the absence of policy changes. In 2003, over 600.000 people in the Netherlands were suffering from diabetes. Especially due to ageing of the population and the growing number of overweight people, the number of people with diabetes is estimated to have doubled by the year 2025. At least five million Dutch people are overweight and/or do not engage in physical activity, with a consequent increased risk of diabetes. In addition, some 900.000 persons of 60 years and older have pre-stage diabetes (Impaired Glucose Tolerance) and another 115.000 to 300.000 persons are even unaware that they have diabetes. Diabetes is a serious chronic disease. At minimum 40 to 56 percent of the people with diabetes experience at least one chronic complication, such as cardiovascular diseases, eye-anomalies and kidney disease. The risk of complications is higher for people with a longer history of the disease and for diabetics with high blood glucose levels, high blood pressure and high cholesterol levels. Prevention and health care interventions may lower the risk of diabetes and its complications. Such interventions include promoting a healthy lifestyle among high-risk populations, early detection and treatment of high-risk people and of people who are unaware they have diabetes, and improving diabetes care. The Ministry of Health, Welfare and Sport is currently developing a National Diabetes Action Program. To underpin this program, RIVM will estimate the program's effect on the future number of people suffering from diabetes and its complications. This report presents data on the current situation of diabetes in the Netherlands that will allow such estimates to be made. Dit rapport beschrijft de huidige situatie rondom diabetes in Nederland en de toekomstige situatie bij ongewijzigd beleid. In 2003 hadden ruim 600.000 Nederlanders diabetes, een ernstige chronische ziekte. Vooral door de vergrijzing en het toenemende aantal mensen met overgewicht kan het aantal mensen met diabetes in 2025 verdubbelen. Minimaal vijf miljoen Nederlanders hebben overgewicht en/of zijn lichamelijk inactief, waardoor zij een verhoogd risico op diabetes hebben. Daarnaast zijn er 900.000 mensen van 60 jaar en ouder die een voorstadium van diabetes hebben (Impaired Glucose Tolerance) en 115.000 tot 300.000 mensen weten niet dat ze diabetes hebben. Diabetes is een ernstige chronische ziekte. Minimaal 40 tot 56 procent van de mensen met diabetes heeft last van een of meerdere chronische complicaties van diabetes, zoals hart- en vaatziekten, oogafwijkingen en nieraandoeningen. De kans op deze complicaties stijgt naarmate mensen de ziekte langer hebben en als gevolg van hoge bloedsuikerwaarden, een te hoge bloeddruk en een te hoog cholesterolgehalte. Preventie- en zorgactiviteiten kunnen het risico op diabetes en op de complicaties ervan verminderen. Dit kan door een gezonde leefstijl te bevorderen bij mensen met een verhoogd risico op diabetes; door vroege opsporing en behandeling te stimuleren van mensen met een verhoogd risico of met ongediagnosticeerde diabetes; en door goede (keten) zorg te bevorderen voor mensen met diabetes. Het ministerie van VWS ontwikkelt momenteel een Nationaal Diabetes Actieprogramma. Het RIVM berekent of en in welke mate de activiteiten uit dit programma effect hebben op het aantal mensen met diabetes en de complicaties ervan. Hiervoor zijn gegevens nodig over de huidige situatie rondom diabetes in Nederland, die in dit rapport beschreven zijn.
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ABSTRACT: After a systematic mass mammography breast cancer screening programme was implemented between 1991 and 1996 (attendance 80%), we evaluated its impact on survival according to socioeconomic status (SES). We studied survival rates up to 1-1-2005 for all consecutive breast cancer patients aged 50-69 and diagnosed in the period 1983-2002 in the area of the Eindhoven Cancer Registry (n = 4939). Multivariate analyses were performed using Cox regression analysis. The proportion of breast cancer patients with a low SES decreased from 22% in 1983-1990 to 14% in 1997-2002 when attendance was 85%. The proportion of newly diagnosed patients with stage III or IV disease in 1997-2002 was only 10% compared to 14% in 1991-1996 and 26% in 1983-1989 (P < 0.0001). Stage distribution improved for all socio-economic groups (P = 0.01). Survival was similar for all socio-economic groups in 1983-1990, but after the introduction of the screening programme women with low SES had lower age- and stage-adjusted survival rates (HR 2.0, 95%CI: 1.3-3.0). Survival was better for patients diagnosed in 1997-2002 compared to 1983-1990 for all socioeconomic strata; it was substantially better for the high SES group (HR 0.36, 0.2-0.5) compared to the lowest SES (HR 0.77, 0.6-1.1). Although survival improved for women from each of the socio-economic strata, related to the high participation rate of the screening programme, women from lower socio-economic strata clearly benefited less from the breast cancer screening programme. That is also related to the higher prevalence of comorbidity and possibly suboptimal treatment.Breast Cancer Research and Treatment 11/2007; 105(3):369-75. DOI:10.1007/s10549-006-9464-9
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ABSTRACT: To gain insight in realistic policy targets for overweight at a population level and the accompanying costs. Therefore, the effect on overweight prevalence was estimated of large scale implementation of a community intervention (applied to 90% of general population) and an intensive lifestyle program (applied to 10% of overweight adults), and costs and cost-effectiveness were assessed. Costs and effects were based on two Dutch projects and verified by similar international projects. A markov-type simulation model estimated long-term health benefits, health care costs and cost-effectiveness. Combined implementation of the interventions--at the above mentioned scale--reduces prevalence rates of overweight by approximately 3 percentage points and of physical inactivity by 2 percentage points after 5 years, at a cost of 7 euros per adult capita per year. The cost-effectiveness ratio of combined implementation amounts to euro 6000 per life-year gained and euro 5700 per QALY gained (including costs of unrelated diseases in life years gained). Sensitivity analyses showed that these ratios are quite robust. A realistic policy target is a decrease in overweight prevalence of three percentage points, compared to a situation with no interventions. In reality, large scale implementation of the interventions may not counteract the expected upward trends in The Netherlands completely. Nonetheless, implementation of the interventions is cost-effective.Preventive Medicine 03/2008; 46(2):127-32. DOI:10.1016/j.ypmed.2007.07.029