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1.  Determinants of (sustained) overweight and complaints in children and adolescents in primary care: the DOERAK cohort study design 
BMC Family Practice  2012;13:70.
Almost half of the adult Dutch population is currently overweight and the prevalence of overweight children is rising at alarming rates as well. Obese children consult their general practitioner (GP) more often than normal weight children. The Dutch government has assigned a key role to the GP in the prevention of overweight.
The DOERAK cohort study aims to clarify differences between overweight and non-overweight children that consult the GP; are there differences in number of consultations and type and course of complaints? Is overweight associated with lower quality of life or might this be influenced by the type of complaint? What is the activity level of overweight children compared to non-overweight children? And is (sustained) overweight of children associated with parameters related to the energy balance equation?
A total of 2000 overweight (n = 500) and non-overweight children (n = 1500) aged 2 to 18 years who consult their GP, for any type of complaint in the South-West of the Netherlands are included.
At baseline, height, weight and waist circumference are measured during consultation. The number of GP consultations over the last twelve months and accompanying diagnoses are acquired from the medical file. Complaints, quality of life and parameters related to the energy balance equation are assessed with an online questionnaire children or parents fill out at home. Additionally, children or parents keep a physical activity diary during the baseline week, which is validated in a subsample (n = 100) with an activity monitor. Parents fill out a questionnaire about demographics, their own activity behaviour and perceptions on dietary habits and activity behaviour, health and weight status of their child. The physical and lifestyle behaviour questions are repeated at 6, 12 and 24 months follow-up.
The present study is a prospective observational cohort in a primary care setting.
The DOERAK cohort study is the first prospective study that investigates a large cohort of overweight and non-overweight children in primary care. The total study population is expected to be recruited by 2013, results will be available in 2015.
PMCID: PMC3437208  PMID: 22824438
2.  Primary prevention of overweight in children and adolescents: a meta-analysis of the effectiveness of interventions aiming to decrease sedentary behaviour 
The objectives of this meta-analysis were to provide an overview of the evidence regarding the effects of interventions, implemented in the school- and general population setting, aiming to prevent excessive sedentary behaviour in children and adolescents on (1) the amount of sedentary behaviour and (2) BMI. Differences in effects on sedentary behaviour and BMI between single health behaviour interventions (sedentary behaviour only) and multiple health behaviour interventions were explored.
A literature search was conducted in PubMed, EMBASE, Web of Science, PsycINFO and Cochrane Database of Systematic Reviews. Thirty-four (R)CT studies evaluating 33 general population interventions, published between 1990 and April 2011, aiming to decrease sedentary behaviour in normal weight children or adolescents (0–18 years) were included. Intervention duration ranged from 7 days to 4 years. Mean change in sedentary behaviour and BMI from baseline to post-intervention was calculated using a random effects model.
Results showed significant decreases for the amount of sedentary behaviour and BMI. For sedentary behaviour the post-intervention mean difference was −17.95 min/day (95%CI:-26.61;–9.28); the change-from-baseline mean difference was −20.44 min/day (95%CI:-30.69;–10.20). For BMI the post-intervention mean difference was −0.25 kg/m² (95%CI:-0.40;–0.09); the change-from-baseline mean difference was −0.14 kg/m² (95%CI:-0.23;–0.05). No differences were found between single and multiple health behaviour interventions.
Interventions in the school- and general population setting aiming to reduce only sedentary behaviour and interventions targeting multiple health behaviours can result in significant decreases in sedentary behaviour. Studies need to increase follow-up time to estimate the sustainability of the intervention effects found.
PMCID: PMC3462110  PMID: 22640437
Sedentary behaviour; Intervention; Overweight prevention; Children; General population

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