Dietary Intake in the Lifelines Cohort Study: Baseline Results from the Flower Food Frequency Questionnaire among 59,982 Participants

The role of nutrition in health and disease is well established. However, more research on this topic is needed to fill gaps in our current knowledge. The Lifelines cohort study, a large Dutch prospective cohort study, was established as a resource for international researchers, aiming to obtain insight into the aetiology of healthy ageing. The study started with 167,729 participants, covering three generations, aiming to follow them for thirty years. This article describes the habitual dietary intake, assessed using the Flower Food Frequency Questionnaire (FFQ), among Lifelines cohort study participants at baseline, stratified by sex and different categories of age, socioeconomic status (SES) and body mass index (BMI). A total of 59,982 adults (23,703 men and 36,279 women), who completed the Flower FFQ and reported plausible habitual dietary intake, were included in the analyses. Median daily energy intake was higher in men (2368 kcal) than in women (1848 kcal), as well as macronutrient intake. Energy and macronutrient intake decreased with increasing age and BMI categories; no differences were observed between SES categories. Intake of most micronutrients was higher in men than in women. Differences were observed between age categories, but not between SES and BMI categories. Food groups were consumed in different amounts by men and women; differences between age, SES and BMI categories were observed as well. The Lifelines cohort study provides extensive dietary intake data, which are generalisable to the general Dutch population. As such, highly valuable dietary intake data are available to study associations between dietary intake and the development of chronic diseases and healthy aging.

Fatigue in children and adolescents perinatally infected with human immunodeficiency virus: an observational study

Background Fatigue is common among adults living with human immunodeficiency virus (HIV) as well as children with a chronic disease (CCD). Fatigue can have disastrous effects on health status, including health related quality of life (HRQOL). Even so, fatigue is underexplored in children and adolescents perinatally infected with HIV (PHIV+) in the Netherlands. The objective of this observational study is to explore fatigue in PHIV+ and its association with their HRQOL. Methods We measured HRQOL and fatigue using the Pediatric Quality of Life Inventory™ (PedsQL 4.0) and the PedsQL Multidimensional Fatigue Scale (MFS). The PedsQL MFS encompasses three subscales: general fatigue, sleep/rest fatigue and cognitive fatigue, and a total fatigue score. We compared outcomes of PHIV+ children and adolescents in the Amsterdam University Medical Centre with three groups: 1) HIV-uninfected controls (HIV-) matched for age, sex, region of birth, socioeconomic status and adoption status, 2) CCD, and 3) the general Dutch population. Within the PHIV+ group we explored associations between fatigue and HRQOL. Results We enrolled 14 PHIV+ (median age 10.2 years [IQR 9.2–11.4]) and 14 HIV-. Compared to CCD, PHIV+ significantly reported less general fatigue (mean difference 13.0, 95% CI 1.3 to 24.8). PHIV+ did not score significantly different on any of the other PedsQL MFS scales compared to HIV-, CCD or the general Dutch population. PHIV children scored relatively low on the cognitive fatigue scale in comparison to HIV-uninfected matched controls, CCD and the general population, although these differences did not reach significance. Among PHIV+, a lower score on total fatigue, general fatigue and cognitive fatigue was associated with a lower HRQOL score. Conclusions The results of this study suggest that PHIV children and adolescents do not experience more symptoms of fatigue than their healthy peers. However, PHIV children and adolescents may be more likely to experience cognitive fatigue. Fatigue in PHIV also appears to be associated with children’s HRQOL. Further research should confirm these exploratory findings.

SARS-CoV-2 Spike S1-specific IgG kinetic profiles following mRNA- versus vector-based vaccination in the general Dutch population

mRNA- and vector-based vaccines are used at a large scale to prevent COVID-19. We compared Spike S1-specific (S1) IgG antibodies after vaccination with mRNA-based (Comirnaty, Spikevax) or vector-based (Janssen, Vaxzevria) vaccines, using samples from a Dutch nationwide cohort. mRNA vaccines induced faster inclines and higher S1 antibodies compared to vector-based vaccines in adults 18-64 years old (n=2,412). For all vaccines, one dose resulted in boosting of S1 antibodies in adults with a history of SARS-CoV-2 infection. For Comirnaty, two to four months following the second dose (n=196), S1 antibodies in adults aged 18-64 years old (436 BAU/mL, interquartile range: 328-891) were less variable and median concentrations higher compared to those in persons ≥80 years old (366, 177-743), but differences were not statistically significant (p>0.100). Nearly all participants seroconverted following COVID-19 vaccination, including the aging population. These data confirm results from controlled vaccine trials in a general population, including vulnerable groups.

The ICECAP-A instrument for capabilities: assessment of construct validity and test–retest reliability in a general Dutch population

Purpose The ICEpop CAPability measure for Adults (ICECAP-A) assesses five capabilities that are important to one’s well-being. The instrument might be an important addition to generic health questionnaires when evaluating quality of life extending beyond health. This study aimed to conduct a psychometric assessment of the Dutch translation of the ICECAP-A. Methods Construct validity of the instrument was assessed in two ways. First, by measuring correlations with the EQ-5D-5L questionnaire and a measure of self-efficacy and, second, by investigating the ability to distinguish between groups known to differ on the construct the ICECAP-A means to capture. Additionally, test–retest reliability was evaluated. Results In total, 1002 participants representative of the general Dutch population completed an online survey. For test–retest reliability, 252 participants completed the same questionnaire 2 weeks later. The ICECAP-A indicated moderate to strong correlations with the EQ-5D-5L and a strong correlation with self-efficacy. Furthermore, it was capable of differentiating known groups. Moreover, results indicated adequate test–retest reliability with an intraclass correlation coefficient of 0.79. Conclusion In summary, results suggest adequate test–retest reliability and construct validity and indicate that the ICECAP-A might be of added value, especially when considering areas outside of the traditional health intervention model.

The impact of vestibular schwannoma and its management on employment

Background Employment is an important factor in quality of life. For vestibular schwannoma (VS) patients, employment is not self-evident, because of the sequelae of the disease or its treatment and their effects on daily life. Objectives This study assessed employment status, sick leave (absenteeism) and being less productive at work (presenteeism) in the long-term follow-up of VS patients, and evaluated the impact of treatment strategy (active surveillance, surgery or radiotherapy). Methods A cross-sectional survey study was performed in a tertiary university hospital in the Netherlands. Patients completed the iMTA-post productivity questionnaire (iPCQ). Employment status was compared to that of the general Dutch population. Employment, absenteeism and presenteeism were compared between patients under active surveillance, patients after radiotherapy and post-surgical patients. Result In total 239 patients participated, of which 67% were employed at the time of the study. Only 14% had a disability pension, which was comparable to the age-matched general Dutch population. The proportion of patients with absenteeism was 8%, resulting in a 4% reduction of working hours. Presenteeism was reported by 14% of patients, resulting in a 2% reduction of working hours. The median number of working hours per week was 36, and since the diagnosis, these hours had been reduced by 6%. There were no significant differences between treatment modalities. Conclusion On average, long-term employment status and working hours of VS patients are comparable to the age-matched general population. Treatment strategies do not seem to differentially impact on long-term employment of VS patients.

Fatigue in children and adolescents perinatally infected with human immunodeficiency virus: an observational study

Background Fatigue is common among adults living with human immunodeficiency virus (HIV) as well as children with a chronic disease (CCD). Fatigue can have disastrous effects on health status, including health related quality of life (HRQOL). Even so, fatigue is underexplored in children and adolescents perinatally infected with HIV (PHIV+) in the Netherlands. This study aims to explore fatigue in PHIV + and its association with their HRQOL. Methods We measured HRQOL and fatigue using the Pediatric Quality of Life Inventory™ (PedsQL 4.0) and the PedsQL Multidimensional Fatigue Scale (MFS). The PedsQL MFS encompasses three subscales: general fatigue, sleep/rest fatigue and cognitive fatigue, and a total fatigue score. We compared outcomes of PHIV + with three groups: 1) HIV-uninfected controls (HIV-) matched for age, sex, socioeconomic status and adoption status, 2) CCD, and 3) the general Dutch population. Within the PHIV + group we explored associations between fatigue and HRQOL. Results We enrolled 14 PHIV+ (median age 10.2 years [IQR 9.2–11.4]) and 14 HIV-. Compared to CCD, PHIV + significantly reported less general fatigue (mean difference 13.0, 95% CI 1.3 to 24.8). PHIV + did not score significantly different on any of the other PedsQL MFS scales compared to HIV-, CCD or the general Dutch population. PHIV children scored relatively low on the cognitive fatigue scale in comparison to HIV-uninfected matched controls, CCD and the general population, although these differences did not reach significance. Among PHIV+, a lower score on total fatigue, sleep/rest fatigue and cognitive fatigue was associated with a lower HRQOL score. Conclusions The results of this study suggest that PHIV children and adolescents do not experience more symptoms of fatigue than their healthy peers. However, PHIV children and adolescents may be more likely to experience cognitive fatigue. Fatigue in PHIV also appears to be associated with children’s HRQOL. Further research should confirm these exploratory findings.

Trajectories of Cognitive Symptoms in Sick-Listed Cancer Survivors

Many non-central nervous system (CNS) cancer survivors experience cognitive symptoms, which may affect their self-perceived work ability. Little is known about trajectories of self-perceived cognitive functioning in cancer survivors in the period after work disability assessment. Therefore, we evaluated: (1) trajectories of self-reported cognitive functioning, in cancer survivors with work capacity, (2) differences in trajectories of self-reported cognitive functioning between three work disability groups, and (3) explanatory factors of trajectories of self-reported cognitive functioning. Participants (n = 206) were assessed on self-reported cognitive functioning at three time points between two and four years after first day of sick leave. A statistically significant improvement in cognitive functioning was found in the total group (β = 4.62, SE = 0.91, p < 0.001). When comparing cancer survivors in different work disability groups, similar trajectories of cognitive functioning were observed. Fatigue was the only factor found to be associated with the reported trajectory (β = −0.23, SE = 0.086, p = 0.08). Self-perceived cognitive functioning scores remained considerably lower than the mean score of the general Dutch population, indicating that cognitive symptoms are a persistent problem in sick-listed cancer survivors and that evidence-based treatment options are warranted.

P339 Pregnant women with perianal Crohn’s Disease: suggestions for the improvement of the current guideline on delivery method

Background Pregnant women with active perianal Crohn’s disease (CD), have an indication for a caesarean section according to the current ECCO guidelines. This advice is based on the assumption that vaginal delivery leads to exacerbation of perianal disease and to worsening of faecal continence. However, there is no strong evidence to support this. This study aims to examine the effects of delivery method on perianal disease progression and faecal incontinence in women with perianal CD Methods In this retrospective cohort study, 209 women were selected from a large IBD database within a tertiary hospital in the Netherlands. All women are aged &gt;18 years, have perianal CD, and have at least one child. In addition, 102 women of this cohort completed a questionnaire. Faecal continence was scored using the Vaizey-score. Descriptive analysis using SPSS and linear regression analysis were performed. The outcome was corrected for the years after delivery (median 15, range 0-55). p-values &lt;0,05 were considered statistically significant. Results The caesarean section rate within this cohort was 27,8%, which is high when compared the general Dutch population (14%). Within the group of women who delivered at least one child vaginally (n=84), 25,5% reported an alteration of faecal continence, compared to 18,8% of the women who never had a vaginal delivery (n=18). No significant relation between mode of delivery and faecal continence was found (B 0,97 [-1,19-3,14] p 0,375). The average Vaizey-score within this cohort in women who delivered solely through caesarean section had a median Vaizey-score of 5 (range 0-12). Women who had at least one vaginal delivery had an median Vaizey-score of 7 (range 0-20). In a large study amongst the general Dutch population (n=1259) a median Vaizey-score of 11 (range 0-17) was reported. Conclusion Faecal incontinence after vaginal delivery in CD women with perianal fistula is not significantly increased. Therefore the current guideline to advice a caesarean section should be adjusted and other factors such as the location of the fistula should be taken into account. To draw solid conclusions, better registration of fistula location and objective documentation of fistula activity (using PDAI-score) and stool consistency is needed.