Heidi Fransen

Integraal Kankercentrum Nederland

3 Background: Previous studies on experienced quality of care and quality of life have not addressed the reciprocal relation between patients and their relatives. For the first time we were able to include almost 700 couples (patient – relative) in a palliative oncological care context. This study aims to assess the experienced quality of care and...

Background: Palliative care is becoming increasingly important because the number of patients with an incurable disease is growing and their survival is improving. Previous research tells us that early palliative care has the potential to improve quality of life (QoL) in patients with advanced cancer and their relatives. According to limited resea...

Objectives A significant proportion of women with advanced-stage ovarian cancer receive no cancer-directed treatment and limited research has been devoted to this group. This population-based study aimed to gain insight into treatment patterns and trends in patients with advanced epithelial ovarian cancer in the Netherlands and the main reasons for...

Purpose: Patient-reported outcome measures (PROMs) are becoming increasingly important in clinical practice. The implementation of PROMS in routine practice is challenging because information regarding psychometric quality of measurement instruments is fragmented and standardization is lacking. The aim of this study is to evaluate the quality of s...

Higher-educated people often have healthier diets, but it is unclear whether specific dietary patterns exist within educational groups. We therefore aimed to derive dietary patterns in the total population and by educational level and to investigate whether these patterns differed in their composition and associations with the incidence of fatal an...

The relation of alcohol consumption with disease burden remains debated partly due to opposite associations with cardiovascular disease (CVD) and cancer. The relation of alcohol consumption with disease burden expressed in disability-adjusted life years (DALYs) summarizes opposing associations of alcohol consumption on chronic diseases. This study...

Background: Unhealthy dietary patterns have been associated with other unhealthy lifestyle factors such as smoking and physical inactivity. Whether these associations are similar in high- and low-educated individuals is currently unknown. Methods: We used information of the EPIC-NL cohort, a prospective cohort of 39 393 men and women, aged 20-70...

Introduction: The differential associations of beer, wine, and spirit consumption on cardiovascular risk found in observational studies may be confounded by diet. We described and compared dietary intake and diet quality according to alcoholic beverage preference in European elderly. Methods: From the Consortium on Health and Ageing: Network of...

Adjusted food group and nutrient intakes (weighted mean and SE) across categories of alcoholic beverage preference in those excluding prevalent diseases, and stratified by gender, BMI-category, and alcohol consumption category. (DOCX)

Background: A healthy diet is important for normal growth and development. Exposure to undernutrition during important developmental periods such as childhood and adolescence can have effects later in life. Inhabitants of the west of the Netherlands were exposed to severe undernutrition during the famine in the last winter of the second World War...

Prevalence ratios and 95% CI for being a heavy drinker, according to level of famine exposure, stratified by age category. (DOCX)

Association between famine exposure and pack years of smoking, stratified by age category, regression coefficients and 95% CI, n = 3,894. (DOCX)

Association between famine exposure and alcohol intake in grams ethanol per day, stratified by age category, regression coefficients and 95% CI, n = 5,092. (DOCX)

Association between famine exposure and modified Mediterranean Diet Score (excluding alcohol), stratified by age category, regression coefficients and 95% CI, n = 7,525. (DOCX)

Prevalence ratios and 95% CI for smoking status, according to level of famine exposure, stratified by age category. (DOCX)

Prevalence ratios and 95% CI for having an unhealthy diet, according to level of famine exposure, stratified by age category. (DOCX)

Prevalence ratios and 95% CI for being physically inactive, according to level of famine exposure, stratified by age category. (DOCX)

The association between single health behaviours and incidence of and premature mortality from major chronic diseases, including myocardial infarction, stroke, diabetes mellitus, and cancer, has been demonstrated thoroughly. However, the association of several healthy behaviours with Disability-Adjusted Life Years (DALYs), which is a measure for to...

Dietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention. The aim of our study was to relate dietary patterns to health expectancy using quality-adjusted life years (QALYs) as outcome parameter. Data from the EPIC-NL study w...

The aim of our study was to relate four modifiable lifestyle factors (smoking status, body mass index, physical activity and diet) to health expectancy, using quality-adjusted life years (QALYs) in a prospective cohort study. Data of the prospective EPIC-NL study were used, including 33,066 healthy men and women aged 20-70 years at baseline (1993-7...

Background: Although diet is related to chronic disease risk and mortality, its association with total disease burden is not clear. Objective: We investigated the minimum impact of different dietary patterns on disability-adjusted life years (DALYs) by using individual longitudinal data. Design: A prospective cohort study was conducted in 33,0...

Background: Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH...

Principal component analysis (PCA) and cluster analysis are used frequently to derive dietary patterns. Decisions on how many patterns to extract are primarily based on subjective criteria, whereas different solutions vary in their food-group composition and perhaps association with disease outcome. Literature on reliability of dietary patterns is...

To examine the association between adherence to the Dutch Guidelines for a Healthy Diet created by the Dutch Health Council in 2006 and overall and smoking-related cancer incidence. Prospective cohort study. Adherence to the guidelines, which includes one recommendation on physical activity and nine on diet, was measured using an adapted version of...

Substituting added sugar in carbonated soft drinks with intense sweeteners may have potential beneficial, but also adverse health effects. This study assessed the benefits and risks associated with substituting added sugar in carbonated soft drinks with intense sweeteners in young adults in the Netherlands. A tiered approach was used analogous to t...

European Regulation 1924/2006 states that all health claims made on foods need to be substantiated scientifically. To apply the PASSCLAIM criteria for the scientific substantiation of health claims on foods to herbal supplements containing Ginkgo biloba. Evaluation of three selected claimed health effects for G. biloba (improvement of blood circula...

Risk-benefit analyses are introduced as a new paradigm for old problems. However, in many cases it is not always necessary to perform a full comprehensive and expensive quantitative risk-benefit assessment to solve the problem, nor is it always possible, given the lack of required date. The choice to continue from a more qualitative to a full quant...

Adequate mineral intake is important for the maintenance of bone health, cellular function and general metabolism, and possibly in the aetiology of cancer and other chronic diseases. This study aimed at investigating variation in intakes of selected minerals across 10 European countries participating in the EPIC (European Prospective Investigation...

The aim of the European Nutrition and Health Report (ENHR) 2009 is to provide a comprehensive view of the nutrition and health status in the European Union (EU). It is not intended to generate new data, but rather to collect available and authorised data, published or unpublished, on the nutrition and health situation in the countries of the EU

The present review provides an overview of the different dietary quality indices in use. In the first decades, most indices were developed for the general adult population and were based on the American dietary guidelines and the Mediterranean diet. This review focuses on new, other dietary quality indices with special attention to the make-up of t...

In 2004, the European Court of Justice decided that the prohibition of fortification with vitamin A, vitamin D, folic acid, selenium, copper, and zinc in the Netherlands conflicts with the principle of free movement of goods in the European Union. This decision led to a change in the Dutch policy, resulting in a more flexible handling of requests f...

The consumption of products enriched with plant sterol or stanol esters lowers serum total and LDL-cholesterol concentrations, thereby most likely reducing the risk of coronary heart disease. However, using plant sterol (not plant stanol) enriched products elevates serum plant sterol concentrations in humans. This may be unwanted because health eff...

It is important to be able to determine the actual supply of vitamins and minerals in the population, a procedure that can be carried out by using parameters applied to blood or urine. This is also called nutritional status assessment. At the moment, the intake of vitamins and minerals is determined in the Dutch National Food Consumption Surveys. I...

Few data are available in the Netherlands on the intake of nutrients or potentially harmful components from dietary supplements. However, on average there seems no need for concern about too high intakes of vitamins or minerals. For the future it is recommended to monitor dietary supplement intake within the food consumption surveys and to keep the...

Despite the availability of numerous cohort and monitoring studies in different populations in the Netherlands, the available information on functional food and/or supplement use on the whole from these studies is rather limited. Unfortunately, food intake data are vital for Post Launch Monitoring (PLM) of functional foods. Data gathered within the...

The recognized importance of a detection system of potential health hazards of functional foods consumption has led to the development of methods carrying out the initial phases of such a system. Special focus was placed on feasible methods, key players and the tasks and competences of the players. Although functional food consumption may imply ben...

Evidence is lacking for three health claims of herbal products with Ginkgo biloba. Besides, analysis of 29 Ginkgo products showed that most of these products did not comply with the declaration on the label. Furtermore, safety can not be guaranteed at the recommended daily dose. This was observed in a study performed by the Dutch National Institute...