Trends in lifestyle among three cohorts of adults aged 55–64 years in 1992/1993, 2002/2003 and 2012/2013

Trends in lifestyle among three cohorts of adults aged 55–64 years in 1992/1993, 2002/2003 and... Abstract Background Unhealthy lifestyle factors, such as obesity, smoking, excessive alcohol consumption and physical inactivity, are associated with increased morbidity and mortality risk, even in older age. We investigated trends in lifestyle among three cohorts of adults aged 55–64 years from the Netherlands. Methods Data from the Longitudinal Aging Study Amsterdam were used. This study consisted of three randomly selected samples of men and women. Lifestyle data were collected in 1992/1993 (cohort 1, n = 988), in 2002/2003 (cohort 2, n = 1002) and in 2012/2013 (cohort 3, n = 1023). Trends in lifestyle across cohorts were tested using multivariable regression analyses. Results Complete lifestyle data were available for 834 participants from cohort 1, 861 from cohort 2 and 845 from cohort 3. Among men, but not in women, mean BMI and prevalence of obesity increased over time. The mean minutes per day spent being physically active decreased among both men and women, from 130 ± 107 and 230 ± 122 (1992/1993) to 114 ± 100 and 192 ± 109 (2002/2003), and 126 ± 98 and 187 ± 112 (2012/2013), respectively. The percentage of men and women defined as excessive drinkers (>7 alcoholic consumptions per week) increased from 54.9%, 62.3% to 65.4% (men) and 22.7%, 36.1% to 37.4% (women), in 1992/1993, 2002/2003 and 2012/2013, respectively. The percentage of non-smoking men and women increased over time. Conclusion The lifestyle of Dutch adults aged 55–64 years was less healthy in 2012/2013 compared with 2002/2003 and 1992/1993. Political attention regarding healthy ageing should target the prevention of overweight, physical inactivity and excessive alcohol consumption in middle-aged persons. Introduction There is an increase in the older population worldwide. In the year 2000, 600 million people worldwide were 60 years or older, while it is expected that in the year 2050 this number will increase up to 2 billion.1 In addition to an increased share of older people, life expectancy has increased in the last decades, although life years with disability followed a lower rate, depending on the country.2 It has been hypothesized that the discrepancy between life expectancy and the number of healthy life years could be (partly) due to an unhealthy lifestyle. Obesity, smoking, excessive alcohol consumption and physical inactivity are lifestyle factors which are known to increase disease risk, disability and premature death.3–7 It is important to have insights in trends in these modifiable factors, in order to develop (intervention) programs to prevent functional decline and promote healthy ageing. Previously, we have shown that several lifestyle factors of men and women aged 55–64 years in 2002/2003 from the Netherlands were less healthy compared with adults with the same age 10 years before.8 It is of interest to determine whether this unhealthy lifestyle trend has continued over the subsequent 10 years. Therefore, the aim of this study was to describe trends in lifestyle across three cohorts of Dutch men and women aged 55–64 years, participants from the Longitudinal Aging Study Amsterdam (LASA). We compared lifestyle factors of men and women in 2012/2013 with those of previously collected data from 2002/2003 and 1992/1993. Methods Study sample Data were used from the LASA, an ongoing study investigating physical, emotional, cognitive and social functioning in late life.9,10 The study consisted of three randomly selected samples, collected at baseline in 1992/1993 and exactly 10 and 20 years after baseline, stratified by age, sex and expected 5-year mortality. Participants were from registers of 11 local municipalities from 3 geographical regions in the Netherlands. Citizens were randomly selected from municipal registries and received an invitation letter including additional information regarding the study. In the letter, it was mentioned that the research team would contact them to ask for their participation. The first LASA cohort (cohort 1, 1992/1993) consisted of 3107 men and women aged 55–85 years, with an oversampling of the oldest and older men in particular. Of these, 988 men and women were 55–64 years old. The second cohort was recruited in 2002/2003 (cohort 2, n = 1002) and the third in 2012/2013 (cohort 3, n = 1023), all 55–64 years old. The recruitment strategy was identical between the three cohorts. The response rate was 62% in 1992/1993, 62% in 2002/2003 and 63% in 2012/2013. Measurements were performed by trained interviewers who visited the study participants at home. Two separate interviews were conducted: a main interview and a medical interview, including clinical measurements. In addition, respondents were asked to complete a self-administered questionnaire. Details on the interviews and measurements have been described elsewhere.10 The lifestyle factors in the three cohorts were assessed using the exact same protocol in all three cohorts, which enables direct comparisons between cohorts. For the current analyses, we included men and women aged 55–64 years from all three cohorts with complete data on all lifestyle factors (cohort 1, n = 834; cohort 2, n = 861; cohort 3, n = 845). The LASA study was approved by the Ethical Review Board of the VU University Medical Center and all respondents provided informed consent. Obesity Weight was measured to the nearest 0.1 kg using a calibrated scale (Seca, model 100; Laméris, Amersfoort, the Netherlands). In addition, weight was adjusted for ‘clothing’ (−1.0 kg), ‘corset’ (−1.0 kg) and ‘shoes’ (−1.0 kg) whenever applicable.11 Height was measured to the nearest 0.1 cm after maximal inspiration using a stadiometer. Body mass index [BMI, body weight (kg) divided by height (m) squared] was calculated and classified as normal weight (< 25.0 kg/m2), overweight (25.0–30.0 kg/m2) and obese (> 30 kg/m2). Only 51 participants (2.0%) had a BMI < 20.0 kg/m2 and were therefore not considered as a separate category. Waist circumference was measured to the nearest 0.1 cm in the standing position, midway between the lower rib and the iliac crest, after a normal expiration. It was categorized into ‘high-risk waist circumference’ (>102 cm for men and >88 cm for women) and ‘normal waist circumference’.12 Smoking behaviour and alcohol intake Smoking status (non, former, current) was assessed with a self-administered questionnaire. Former smokers who stopped smoking ≥15 years ago were also classified as non-smokers. Alcohol intake (does not drink, does drink) and the number of glasses of alcoholic beverages per week were also assessed with a self-administered questionnaire. Excessive alcohol intake was defined as >7glasses per week, based on the recent Dutch Dietary Guidelines.13 To enable comparison with other studies regarding excessive alcohol consumption, we also performed analyses using >21 alcoholic beverages per week for men and >14 alcoholic beverages per week for women as cut-off points. Binge drinking was defined as the consumption of more than six alcoholic beverages for men and four alcoholic beverages for women each time they reported to drink. Physical activity Physical activity was assessed in minutes per day by the LASA Physical Activity Questionnaire (LAPAQ).14 Participants were asked to report the frequency and duration of physical activities during the 2 weeks preceding the main interview. The LAPAQ covers the following activities: walking outside, bicycling, light household activities, heavy household activities and a maximum of two sport activities. The sum of minutes per day spent on these activities was used as total physical activity. For the current analyses, we included only sports of minimally moderate intensity. The LAPAQ was shown to be a valid and reliable instrument for classifying physical activity in older people, and highly correlated with a 7-day diary (r = 0.68).14 Besides the number of minutes per day being physically active, a cut-off (≥150 minutes of moderate-intensity activity per week) was applied to approach identifying participants meeting the Dutch physical activity recommendation.15,16 This cut-off was based on time spent walking, biking, heavy household activities and sports of at least moderate intensity. Demographic variables included education, occupation, income and marital status. Education level included the highest attained education level. This was categorized into elementary school or less, secondary school or higher education. Participants were asked whether they were currently employed (yes/no), and among the current workers, the number of working hours per week were reported. Monthly income was categorized as 454–907 euro, 908–1361 euro, 1362–1815 euro, 1816–2269 euro, ≥2270 euro and missing. Marital status was defined as unmarried, married, divorced, widowed and registered partnership. Statistical analyses Data were analysed for men and women separately in order to enable comparison between the current study and previous observed trends in the LASA study.8 Mean values (±SD) and prevalences (%) were internally weighted to the age distribution of 2012/2013, which ensures an identical distribution of age across the three cohorts. Continuous variables were tested for normality using the Shapiro–Wilk test. Cohort differences in continuous variables not normally distributed (minutes of physical activity per day and minutes of sport activities per day) were tested using the Mann–Whitney U test. Cohort differences in all other continuous variables were tested using an ANOVA, and in case of categorical variables, a χ2 test was performed. We conducted tests for trends across cohorts by entering cohort as a categorical variable, adjusted for age and education level, using linear, logistic or ordinal regression analyses for continuous, binary or ordinal variables, respectively. Analyses were performed with IBM SPSS Statistics for Windows, version 22.0 (IBM Corp; Armonk, NY). A two-sided P value < 0.05 was considered statistically significant. Results Men and women from more recent cohorts were higher educated, more often currently working, had a higher income and were less often currently married (table 1). Lifestyle factors are presented by sex and per cohort in table 2. Table 1 Demographics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three generations. b P values for trend adjusted for age. c Registered partnership was introduced in 1998, and therefore not available for cohort 1. d Significantly different compared with cohort 1. e Significantly different compared with cohort 2. Table 1 Demographics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three generations. b P values for trend adjusted for age. c Registered partnership was introduced in 1998, and therefore not available for cohort 1. d Significantly different compared with cohort 1. e Significantly different compared with cohort 2. Table 2 Lifestyle characteristics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three cohorts. b P values for trend adjusted for age and education. c Significantly different compared with cohort 1. d Significantly different compared with cohort 2. e Men: > 102 cm; Women: > 88 cm. f ≥8 glasses of alcohol beverages per week. g Includes walking, biking, light and heavy house hold activities, and sports. Table 2 Lifestyle characteristics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three cohorts. b P values for trend adjusted for age and education. c Significantly different compared with cohort 1. d Significantly different compared with cohort 2. e Men: > 102 cm; Women: > 88 cm. f ≥8 glasses of alcohol beverages per week. g Includes walking, biking, light and heavy house hold activities, and sports. Obesity Among men, mean BMI increased over time from 26.3 ± 2.9 kg/m2 in 1992/1993 to 27.2 ± 3.6 kg/m2 in 2002/2003 and 27.4 ± 3.9 kg/m2 in 2012/2013 (P for trend < 0.001). In addition, the percentage of obese men increased over time (P for trend < 0.001) from 9.6% to 17.8% and 23.0%, in 1992/1993, 2002/2003 and 2012/2013, respectively. Mean waist circumference and the prevalence of high-risk waist circumference also increased over time (P for trend < 0.001 for both). Among women, mean BMI remained more stable compared with men (P for trend = 0.11), although a decrease between 2002/2003 and 2012/2013 was observed. Although a large proportion of the women in all cohorts were overweight or obese (58–67%), there was a positive trend towards a more healthy weight (P for trend = 0.04). Mean waist circumference and prevalence of high-risk waist circumference also fluctuated across cohorts in women. Smoking behaviour The prevalence of men who were current smokers in 1992/1993 was 37.4%. This prevalence was 33.6% in 2002/2003 and 20.3% in 2012/2013, which was significantly lower compared with 1992/1993 (P for trend < 0.001). The percentage of non-smoking men was lower in 1992/1993 (34.5%) compared with 2002/2003 (47.0%) and 2012/2013 (58.7%) (P for trend < 0.001). In contrast, we observed a different trend among women. The percentage of non-smoking women was 62.7% in 1992/1993, 59.4% in 2002/2003 and 68.1% in 2012/2013. However, the percentage of current smokers had decreased from 26.3% in 2002/2003 to 16.3% in 2012/2013. Alcohol consumption Results suggest a similar trend regarding the consumption of any alcoholic beverages among men and women, with an increase from 1992/1993 to 2002/2003, to a subsequent decrease from 2002/2003 to 2012/2013. A significant increasing trend was, however, observed for excessive alcohol consumption (>7 glasses per week) among both men and women. Using a different cut-off point (>21 alcoholic beverages per week for men and >14 alcoholic beverages per week for women), no trends in excessive alcohol consumption were observed among men or women. Prevalences among men increased from 12.7% in 1992/1993 to 16.8% in 2002/2003, but decreased to 13.2% in 2012/2013. Among women, prevalences fluctuated from 14.6% to 25.8% and 23.2% in 1992/1993, 2002/2003 and 2012/2013, respectively. The prevalence in men of binge drinking in 1992/1993 was 8.7% and 13.8% in 2002/2003, which was significantly higher, but no difference was observed compared with 2012/2013 (10.5%). No statistically significant trend across cohorts was observed (P for trend = 0.127). In contrast, in women, there was a significant increasing trend in the prevalence of binge drinking (P for trend = 0.009). In 1992/1993, among the alcohol consumers, 3.8% were defined as binge drinkers. In 2002/2003 and 2012/2013, 8.7% and 8.5% were defined as binge drinkers, respectively, which was significantly higher compared with 1992/1993. No difference was observed between 2002/2003 and 2012/2013. Physical activity A negative trend was observed for total minutes per day spent physically active. Based on self-reported data, men and women from 1992/1993 spent more time being physically active compared with their peers from more recent cohorts, although only a statistically significant trend was observed for women (P for trend = 0.457 for men and P for trend < 0.001 for women). Results suggest a non-significant trend regarding the percentage of men and women meeting the Dutch physical activity guideline (≥150 minutes of moderate-intensity activity per week), with a decrease from 1992/1993 to 2002/2003, to an increase from 2002/2003 to 2012/2013. In 1992/1993, 56.7% of men and 60.9% of women reported sport activities during the previous 2 weeks. These prevalences decreased slightly across cohorts with 53.9% of men and 55.9% of women in 2002/2003, to a significant increase of 64.1% of men and 68.6% of women in 2012/2013. Among the participants who reported sporting activities, no trends were observed regarding time (min/day) spent on sports. Discussion In this study, we investigated trends in lifestyle across three cohorts, each assessed 10 years apart, of adults aged 55–64 years from the Netherlands. We have shown that more recent cohorts have a less healthy lifestyle compared with their peers in 2002/2003 and 1992/1993, i.e. more men were obese and had a high-risk waist circumference, more men and women were excessive alcohol drinkers and less time was spent being physically active. On a positive note, fewer men and women were current smokers compared with the previous cohorts and more men and women from the most recent cohort met the Dutch physical activity guideline. Our results indicate an increase in the prevalence of obesity among men, whereas no change in prevalence over time among women was observed, even though the prevalence of obesity remained high. These results are in line with a study comparing generations of men and women aged > 65 years between 1999 and 2010 from the USA.17 In addition, a recent report from the NCD Risk Factor Collaboration investigating worldwide trends of BMI among adults between 1975 and 2014 showed that mean BMI increased over time and that age-standardized prevalence of obesity increased from 3.2% in 1997 to 10.8% in 2014 in men and from 6.4% to 14.9% in women aged 18 years and older.18 Trend data regarding physical activity are scarce, although our trend of decreasing time spent on total physical activity was also observed in several studies across the world.19–22 Our results showed a decreasing trend in time spent per day being physically active among women, while more women of the most recent cohort met the Dutch physical activity guideline compared with 2002/2003. This can potentially be explained by the fact that more non-active people became active, while at the same time the older people who were physically active for more than 150 minutes per week became less physically active, though still more than 150 minutes per week. Significantly more people from the more recent cohorts were alcohol consumers. When applying the relatively strict Dutch alcohol recommendation, we observe increasing trends for excessive drinking across cohorts. This is in line with the results from a comprehensive review of studies including men and women within the age range of 15–80 years, investigating cohort effects in alcohol consumption including studies from the USA and Europe, which showed that more recent birth cohorts (both men and women) consistently consumed more alcohol than older cohorts and were engaging in more episodic and problem drinking.23 In addition, based on the strongest methodological studies, the authors conclude a converge in differences between men and women, whereby an increasing trend of heavy drinking and alcohol disorders was observed among women in the more recent cohorts, but not in men.23 This is also in line with our results where an increasing trend was observed among the percentage of women, but not men, defined as binge drinkers. A positive trend observed in the current study was the decrease in the prevalence of current smoking. However, there was a different pattern in smoking behaviour among men compared with women, which could be explained by the different historical smoking patterns between men and women, with smoking prevalence having peaked approximately two decades earlier among men than women.24 Due to better welfare standards and medical and technological improvements, life expectancy has increased over time. However, the concomitant increase in years in good health has a slower rate, which results in higher numbers of older adults coping with physical limitations and poor health. For example, recent results from a large prospective cohort study investigating health expectancies over two decades in England showed that life expectancy at age 65 increased, with much smaller increases in disability-free years.25 Also in the Netherlands, life expectancy among men and women has increased in the last decades; however, the number of years in well perceived health and the number of years with disability has decreased.26 The discrepancy between the rate of increase in life expectancy and disability-free years may be explained by higher rates of obesity, lower physical activity and excessive alcohol consumption among recent generations of older men and women. Indeed, more than 10 years ago, Olshansky et al. predicted that the obesity trend would have a negative effect on life expectancy.27 This prediction is confirmed by recent data from the Centers for Disease Control and Prevention, showing that life expectancy in the USA has declined in the last 2 years,28 which is likely a result of the obesity epidemic that started in the late 1970s.29 Future studies should focus on improving lifestyle with the purpose of reversing the obesity epidemic, which is then likely to lead to an increase in the number of disability-free years. Hence, promoting and improving nutritional status and physical activity across the lifespan may help accomplishing a healthier lifestyle in old age. As a means of treatment of obesity, it is important to improve nutritional status by promoting weight loss and stimulating physical activity among obese, inactive adults. Previous studies have shown that weight loss and improvements in body composition are achievable by dietary restriction and/or exercise up to very old age.30–36 Independent of physical inactivity, sedentary behaviour—behaviour characterized by an energy expenditure ≤1.5 metabolic equivalents, such as television viewing, reading and computer use37—is associated with negative health outcomes, such as type 2 diabetes, cardiovascular diseases and mortality.38–41 Although trends in sedentary behaviour were not investigated in this study, we know that sedentary behaviour is most common among older adults and is greater in more recent generations.41 A recent meta-analysis suggests that the increased mortality risk associated with long sedentary time can be compensated by high levels of moderate-intensity physical activity (about 60–75 min per day).42 Taken together, these results highlight the importance of a healthy diet, physical activity and limited sedentary behaviour in order to promote healthy ageing. A strength of the current study is the inclusion of three samples of men and women aged 55–64 years old randomly selected 10 years apart. In addition, we performed the exact same sampling and recruitment strategies, which enabled direct cohort comparisons. Furthermore, objectively measured anthropometric variables were included, which limits the risk of reporting bias. Unfortunately, we did not have data regarding other lifestyle factors, such as dietary intake or stress management in each cohort, nor did we have an objective measure of physical activity, such as accelerometry data, available for all cohorts. Conclusions The lifestyle of more recent cohorts of adults aged 55–64 years in the Netherlands was less healthy in 2012/2013 compared with their peers in 2002/2003 and 1992/1993. Political attention regarding healthy ageing should focus on the prevention of obesity and physical inactivity at middle age, moderate alcohol consumption and on the development of effective and sustainable interventions aiming at improving body weight, increasing physical activity and lowering alcohol consumption. Key points The lifestyle of Dutch adults currently aged 55–64 years adults is less healthy compared with generations of similar age 10 and 20 years ago regarding nutritional status (obesity, physical activity) and alcohol consumption; The single exception is the decreasing trend in the proportion of current smokers among both men and women; Prevention of overweight, physical inactivity and excessive alcohol consumption is imperative for healthy ageing; Development of effective and sustainable interventions in order to improve nutritional status and to lower alcohol consumption is needed. Acknowledgements The Longitudinal Aging Study Amsterdam is largely supported by a grant from the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. Conflicts of interest: None declared. References 1 World Health Organization . What are the public health implications of global ageing? 2011. Available at: http://www.who.int/features/qa/42/en/ (22 July 2016, date last accessed). 2 Christensen K , Doblhammer G , Rau R , Vaupel JW . Ageing populations: the challenges ahead . Lancet 2009 ; 374 : 1196 – 208 . Google Scholar CrossRef Search ADS PubMed 3 Jenkins KR . Obesity's effects on the onset of functional impairment among older adults . Gerontologist 2004 ; 44 : 206 – 16 . Google Scholar CrossRef Search ADS PubMed 4 Vincent HK , Vincent KR , Lamb KM . Obesity and mobility disability in the older adult . Obes Rev 2010 ; 11 : 568 – 79 . Google Scholar CrossRef Search ADS PubMed 5 Al Snih S , Ottenbacher KJ , Markides KS , et al. The effect of obesity on disability vs mortality in older Americans . Arch Intern Med 2007 ; 167 : 774 – 80 . Google Scholar CrossRef Search ADS PubMed 6 Lee IM , Shiroma EJ , Lobelo F . Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy . Lancet 2012 ; 380 : 219 – 29 . Google Scholar CrossRef Search ADS PubMed 7 Koster A , Caserotti P , Patel KV , et al. Association of sedentary time with mortality independent of moderate to vigorous physical activity . PLoS One 2012 ; 7 : e37696 . Google Scholar CrossRef Search ADS PubMed 8 Visser M , Pluijm SMF , van der Horst MHL , et al. Leefstijl van 55-64-jarige Nederlanders in 2002/'03 minder gezond dan in 1992/'93 . Nederlands Tijdschrift voor Geneeskunde 2005 ; 149 : 2973 – 8 . Google Scholar PubMed 9 Huisman M , Poppelaars J , van der Horst M , et al. Cohort profile: the Longitudinal Aging Study Amsterdam . Int J Epidemiol 2011 ; 40 : 868 – 76 . Google Scholar CrossRef Search ADS PubMed 10 Hoogendijk EO , Deeg DJ , Poppelaars J , et al. The Longitudinal Aging Study Amsterdam: cohort update 2016 and major findings . Eur J Epidemiol 2016 ; 31 : 927 – 45 . Google Scholar CrossRef Search ADS PubMed 11 Frank E , Dunlop AL . What does a patient's outfit weight? Fam Med 2000 ; 32 : 595 – 6 . Google Scholar PubMed 12 Division of Noncommunicable Diseases WHO . Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; i–xii:1–253. 13 Kromhout D , Spaaij CJ , de Goede J , Weggemans RM . The 2015 Dutch food-based dietary guidelines . Eur J Clin Nutr 2016 ; 70 : 869 – 79 . Google Scholar CrossRef Search ADS PubMed 14 Stel VS , Smit JH , Pluijm SM , et al. Comparison of the LASA Physical Activity Questionnaire with a 7-day diary and pedometer . J Clin Epidemiol 2004 ; 57 : 252 – 8 . Google Scholar CrossRef Search ADS PubMed 15 Kemper HGC , Ooijendijk WTM , Stiggelbout M . Consensus over de Nederlandse Norm voor Gezond Bewegen . Tijdschr Soc Gezondheidsz 2000 ; 78 : 180 – 3 . 16 Hildebrandt VH , Bernaards CM , Hofstetter H . Trendrapport: Bewegen en Gezondheid 2000-2014 . Leiden : TNO Gezond Leven , 2007 . 17 Fakhouri TH , Ogden CL , Carroll MD , et al. Prevalence of obesity among older adults in the United States, 2007-2010 . NCHS Data Brief 2012 ; 1 – 8 . 18 NCD Risk Factor Collaboration . Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants . Lancet 2016 ; 387 : 1377 – 96 . CrossRef Search ADS PubMed 19 Sallis JF , Bull F , Guthold R , et al. Progress in physical activity over the Olympic quadrennium . Lancet 2016 ; 388 : 1325 – 36 . Google Scholar CrossRef Search ADS PubMed 20 Matthiessen J , Andersen EW , Raustorp A , et al. Reduction in pedometer-determined physical activity in the adult Danish population from 2007 to 2012 . Scand J Public Health 2015 ; 43 : 525 – 33 . Google Scholar CrossRef Search ADS PubMed 21 Inoue S , Ohya Y , Tudor-Locke C , et al. Time trends for step-determined physical activity among Japanese adults . Med Sci Sports Exerc 2011 ; 43 : 1913 – 9 . Google Scholar CrossRef Search ADS PubMed 22 Brownson RC , Boehmer TK , Luke DA . Declining rates of physical activity in the United States: what are the contributors? Annu Rev Public Health 2005 ; 26 : 421 – 43 . Google Scholar CrossRef Search ADS PubMed 23 Keyes KM , Li G , Hasin DS . Birth cohort effects and gender differences in alcohol epidemiology: a review and synthesis . Alcohol Clin Exp Res 2011 ; 35 : 2101 – 12 . Google Scholar CrossRef Search ADS PubMed 24 Alberg AJ , Brock MV , Ford JG , et al. Epidemiology of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines . Chest 2013 ; 143 : e1S – 29S . Google Scholar CrossRef Search ADS PubMed 25 Jagger C , Matthews FE , Wohland P , et al. A comparison of health expectancies over two decades in England: results of the Cognitive Function and Ageing Study I and II . Lancet 2016 ; 387 : 779 – 86 . Google Scholar CrossRef Search ADS PubMed 26 Essink-Bot ML , Deeg DJH , Nusselder WJ . Naar een ouderdom met minder gebreken? Trends in ge zonde levens verwachting [We are living longer, but are these additional years spent in good health] (In Dutch) . Nederlands Tijdschrift voor Geneeskunde 2016 ; 160 : 1 – 3 . 27 Olshansky SJ , Passaro DJ , Hershow RC , et al. A potential decline in life expectancy in the United States in the 21st century . N Engl J Med 2005 ; 352 : 1138 – 45 . Google Scholar CrossRef Search ADS PubMed 28 Ahmad FB . Quarterly provisional estimates for selected indicators of mortality, 2014–Quarter 1, 2016. National Center for Health Statistics. National Vital Statistics System, Vital Statistics Rapid Release Program. 2016. Available at: http://www.cdc.gov/nchs/products/vsrr/mortality-dashboard.htm (7 September 2016, date last accessed). 29 Ludwig DS . Lifespan weighed down by diet . JAMA 2016 ; 315 : 2269 – 70 . Google Scholar CrossRef Search ADS PubMed 30 Shaw K , Gennat H , O'Rourke P , Del Mar C . Exercise for overweight or obesity . Cochrane Database Syst Rev 2006 ; CD003817 . 31 Bales CW , Buhr G . Is obesity bad for older persons? A systematic review of the pros and cons of weight reduction in later life . J Am Med Dir Assoc 2008 ; 9 : 302 – 12 . Google Scholar CrossRef Search ADS PubMed 32 Villareal DT , Banks M , Sinacore DR , et al. Effect of weight loss and exercise on frailty in obese older adults . Arch Intern Med 2006 ; 166 : 860 – 6 . Google Scholar CrossRef Search ADS PubMed 33 Villareal DT , Chode S , Parimi N , et al. Weight loss, exercise, or both and physical function in obese older adults . N Engl J Med 2011 ; 364 : 1218 – 29 . Google Scholar CrossRef Search ADS PubMed 34 Beavers KM , Beavers DP , Nesbit BA , et al. Effect of an 18-month physical activity and weight loss intervention on body composition in overweight and obese older adults . Obesity (Silver Spring) 2014 ; 22 : 325 – 31 . Google Scholar CrossRef Search ADS PubMed 35 Nicklas BJ , Chmelo E , Delbono O , et al. Effects of resistance training with and without caloric restriction on physical function and mobility in overweight and obese older adults: a randomized controlled trial . Am J Clin Nutr 2015 ; 101 : 991 – 9 . Google Scholar CrossRef Search ADS PubMed 36 Manini TM , Buford TW , Lott DJ , et al. Effect of dietary restriction and exercise on lower extremity tissue compartments in obese, older women: a pilot study . J Gerontol A Biol Sci Med Sci 2014 ; 69 : 101 – 8 . Google Scholar CrossRef Search ADS PubMed 37 Pate RR , O'Neill JR , Lobelo F . The evolving definition of “sedentary” . Exerc Sport Sci Rev 2008 ; 36 : 173 – 8 . Google Scholar CrossRef Search ADS PubMed 38 Proper KI , Singh AS , van Mechelen W , Chinapaw MJ . Sedentary behaviors and health outcomes among adults: a systematic review of prospective studies . Am J Prev Med 2011 ; 40 : 174 – 82 . Google Scholar CrossRef Search ADS PubMed 39 Thorp AA , Owen N , Neuhaus M , Dunstan DW . Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011 . Am J Prev Med 2011 ; 41 : 207 – 15 . Google Scholar CrossRef Search ADS PubMed 40 Wilmot EG , Davies MJ , Edwardson CL , et al. Rationale and study design for a randomised controlled trial to reduce sedentary time in adults at risk of type 2 diabetes mellitus: project STAND (Sedentary Time ANd Diabetes) . BMC Public Health 2011 ; 11 : 908 . Google Scholar CrossRef Search ADS PubMed 41 Rezende L. F M d , Rey-López JP , Matsudo VKR , Luiz O. d C . Sedentary behavior and health outcomes among older adults: a systematic review . BMC Public Health 2014 ; 14 : 333 . Google Scholar CrossRef Search ADS PubMed 42 Ekelund U , Steene-Johannessen J , Brown WJ , et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women . Lancet 2016 ; 388 : 1302 – 10 . Google Scholar CrossRef Search ADS PubMed © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The European Journal of Public Health Oxford University Press

Trends in lifestyle among three cohorts of adults aged 55–64 years in 1992/1993, 2002/2003 and 2012/2013

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Oxford University Press
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© The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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1101-1262
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1464-360X
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10.1093/eurpub/ckx173
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Abstract

Abstract Background Unhealthy lifestyle factors, such as obesity, smoking, excessive alcohol consumption and physical inactivity, are associated with increased morbidity and mortality risk, even in older age. We investigated trends in lifestyle among three cohorts of adults aged 55–64 years from the Netherlands. Methods Data from the Longitudinal Aging Study Amsterdam were used. This study consisted of three randomly selected samples of men and women. Lifestyle data were collected in 1992/1993 (cohort 1, n = 988), in 2002/2003 (cohort 2, n = 1002) and in 2012/2013 (cohort 3, n = 1023). Trends in lifestyle across cohorts were tested using multivariable regression analyses. Results Complete lifestyle data were available for 834 participants from cohort 1, 861 from cohort 2 and 845 from cohort 3. Among men, but not in women, mean BMI and prevalence of obesity increased over time. The mean minutes per day spent being physically active decreased among both men and women, from 130 ± 107 and 230 ± 122 (1992/1993) to 114 ± 100 and 192 ± 109 (2002/2003), and 126 ± 98 and 187 ± 112 (2012/2013), respectively. The percentage of men and women defined as excessive drinkers (>7 alcoholic consumptions per week) increased from 54.9%, 62.3% to 65.4% (men) and 22.7%, 36.1% to 37.4% (women), in 1992/1993, 2002/2003 and 2012/2013, respectively. The percentage of non-smoking men and women increased over time. Conclusion The lifestyle of Dutch adults aged 55–64 years was less healthy in 2012/2013 compared with 2002/2003 and 1992/1993. Political attention regarding healthy ageing should target the prevention of overweight, physical inactivity and excessive alcohol consumption in middle-aged persons. Introduction There is an increase in the older population worldwide. In the year 2000, 600 million people worldwide were 60 years or older, while it is expected that in the year 2050 this number will increase up to 2 billion.1 In addition to an increased share of older people, life expectancy has increased in the last decades, although life years with disability followed a lower rate, depending on the country.2 It has been hypothesized that the discrepancy between life expectancy and the number of healthy life years could be (partly) due to an unhealthy lifestyle. Obesity, smoking, excessive alcohol consumption and physical inactivity are lifestyle factors which are known to increase disease risk, disability and premature death.3–7 It is important to have insights in trends in these modifiable factors, in order to develop (intervention) programs to prevent functional decline and promote healthy ageing. Previously, we have shown that several lifestyle factors of men and women aged 55–64 years in 2002/2003 from the Netherlands were less healthy compared with adults with the same age 10 years before.8 It is of interest to determine whether this unhealthy lifestyle trend has continued over the subsequent 10 years. Therefore, the aim of this study was to describe trends in lifestyle across three cohorts of Dutch men and women aged 55–64 years, participants from the Longitudinal Aging Study Amsterdam (LASA). We compared lifestyle factors of men and women in 2012/2013 with those of previously collected data from 2002/2003 and 1992/1993. Methods Study sample Data were used from the LASA, an ongoing study investigating physical, emotional, cognitive and social functioning in late life.9,10 The study consisted of three randomly selected samples, collected at baseline in 1992/1993 and exactly 10 and 20 years after baseline, stratified by age, sex and expected 5-year mortality. Participants were from registers of 11 local municipalities from 3 geographical regions in the Netherlands. Citizens were randomly selected from municipal registries and received an invitation letter including additional information regarding the study. In the letter, it was mentioned that the research team would contact them to ask for their participation. The first LASA cohort (cohort 1, 1992/1993) consisted of 3107 men and women aged 55–85 years, with an oversampling of the oldest and older men in particular. Of these, 988 men and women were 55–64 years old. The second cohort was recruited in 2002/2003 (cohort 2, n = 1002) and the third in 2012/2013 (cohort 3, n = 1023), all 55–64 years old. The recruitment strategy was identical between the three cohorts. The response rate was 62% in 1992/1993, 62% in 2002/2003 and 63% in 2012/2013. Measurements were performed by trained interviewers who visited the study participants at home. Two separate interviews were conducted: a main interview and a medical interview, including clinical measurements. In addition, respondents were asked to complete a self-administered questionnaire. Details on the interviews and measurements have been described elsewhere.10 The lifestyle factors in the three cohorts were assessed using the exact same protocol in all three cohorts, which enables direct comparisons between cohorts. For the current analyses, we included men and women aged 55–64 years from all three cohorts with complete data on all lifestyle factors (cohort 1, n = 834; cohort 2, n = 861; cohort 3, n = 845). The LASA study was approved by the Ethical Review Board of the VU University Medical Center and all respondents provided informed consent. Obesity Weight was measured to the nearest 0.1 kg using a calibrated scale (Seca, model 100; Laméris, Amersfoort, the Netherlands). In addition, weight was adjusted for ‘clothing’ (−1.0 kg), ‘corset’ (−1.0 kg) and ‘shoes’ (−1.0 kg) whenever applicable.11 Height was measured to the nearest 0.1 cm after maximal inspiration using a stadiometer. Body mass index [BMI, body weight (kg) divided by height (m) squared] was calculated and classified as normal weight (< 25.0 kg/m2), overweight (25.0–30.0 kg/m2) and obese (> 30 kg/m2). Only 51 participants (2.0%) had a BMI < 20.0 kg/m2 and were therefore not considered as a separate category. Waist circumference was measured to the nearest 0.1 cm in the standing position, midway between the lower rib and the iliac crest, after a normal expiration. It was categorized into ‘high-risk waist circumference’ (>102 cm for men and >88 cm for women) and ‘normal waist circumference’.12 Smoking behaviour and alcohol intake Smoking status (non, former, current) was assessed with a self-administered questionnaire. Former smokers who stopped smoking ≥15 years ago were also classified as non-smokers. Alcohol intake (does not drink, does drink) and the number of glasses of alcoholic beverages per week were also assessed with a self-administered questionnaire. Excessive alcohol intake was defined as >7glasses per week, based on the recent Dutch Dietary Guidelines.13 To enable comparison with other studies regarding excessive alcohol consumption, we also performed analyses using >21 alcoholic beverages per week for men and >14 alcoholic beverages per week for women as cut-off points. Binge drinking was defined as the consumption of more than six alcoholic beverages for men and four alcoholic beverages for women each time they reported to drink. Physical activity Physical activity was assessed in minutes per day by the LASA Physical Activity Questionnaire (LAPAQ).14 Participants were asked to report the frequency and duration of physical activities during the 2 weeks preceding the main interview. The LAPAQ covers the following activities: walking outside, bicycling, light household activities, heavy household activities and a maximum of two sport activities. The sum of minutes per day spent on these activities was used as total physical activity. For the current analyses, we included only sports of minimally moderate intensity. The LAPAQ was shown to be a valid and reliable instrument for classifying physical activity in older people, and highly correlated with a 7-day diary (r = 0.68).14 Besides the number of minutes per day being physically active, a cut-off (≥150 minutes of moderate-intensity activity per week) was applied to approach identifying participants meeting the Dutch physical activity recommendation.15,16 This cut-off was based on time spent walking, biking, heavy household activities and sports of at least moderate intensity. Demographic variables included education, occupation, income and marital status. Education level included the highest attained education level. This was categorized into elementary school or less, secondary school or higher education. Participants were asked whether they were currently employed (yes/no), and among the current workers, the number of working hours per week were reported. Monthly income was categorized as 454–907 euro, 908–1361 euro, 1362–1815 euro, 1816–2269 euro, ≥2270 euro and missing. Marital status was defined as unmarried, married, divorced, widowed and registered partnership. Statistical analyses Data were analysed for men and women separately in order to enable comparison between the current study and previous observed trends in the LASA study.8 Mean values (±SD) and prevalences (%) were internally weighted to the age distribution of 2012/2013, which ensures an identical distribution of age across the three cohorts. Continuous variables were tested for normality using the Shapiro–Wilk test. Cohort differences in continuous variables not normally distributed (minutes of physical activity per day and minutes of sport activities per day) were tested using the Mann–Whitney U test. Cohort differences in all other continuous variables were tested using an ANOVA, and in case of categorical variables, a χ2 test was performed. We conducted tests for trends across cohorts by entering cohort as a categorical variable, adjusted for age and education level, using linear, logistic or ordinal regression analyses for continuous, binary or ordinal variables, respectively. Analyses were performed with IBM SPSS Statistics for Windows, version 22.0 (IBM Corp; Armonk, NY). A two-sided P value < 0.05 was considered statistically significant. Results Men and women from more recent cohorts were higher educated, more often currently working, had a higher income and were less often currently married (table 1). Lifestyle factors are presented by sex and per cohort in table 2. Table 1 Demographics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three generations. b P values for trend adjusted for age. c Registered partnership was introduced in 1998, and therefore not available for cohort 1. d Significantly different compared with cohort 1. e Significantly different compared with cohort 2. Table 1 Demographics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e Mena Womena 1992/1993 2002/2003 2012/2013 P for trendb 1992/1993 2002/2003 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Education <0.001 <0.001     Elementary school or less 174 (43.0) 157 (38.5)d 114 (27.7)d,e 267 (62.2) 215 (47.4)d 110 (25.2)d,e     Secondary school 146 (36.0) 126 (30.9)d 145 (35.5)d,e 126 (29.4) 185 (40.8)d 204 (46.8)d,e     Higher education 85 (21.0) 125 (30.6)d 150 (36.8)d,e 36 (8.4) 53 (11.8)d 122 (28.0)d,e Occupation <0.001 <0.001     No 243 (60.1) 192 (47.0)d 117 (28.6)d,e 336 (78.2) 309 (68.2)d 193 (44.3)d,e     Yes 155 (38.2) 216 (53.0)d 292 (71.4)d,e 90 (20.9) 143 (31.6)d 243 (55.7)d,e     Working hours per week (among current workers) 40.9 ± 15.7 35.5 ± 15.6d 37.0 ± 13.0d 0.092 19.5 ± 16.0 21.9 ± 14.6 22.5 ± 11.1 0.066 Income <0.001 <0.001     454–907 euro 61 (15.0) 17 (4.2)d 15 (3.7)d,e 106 (24.7) 46 (10.2)d 26 (6.0)d,e     908–1361 euro 108 (26.7) 60 (14.6)d 31 (7.6)d,e 119 (27.7) 85 (18.7)d 46 (10.6)d,e     1362–1815 euro 84 (20.7) 75 (18.4)d 36 (8.8)d,e 58 (13.6) 77 (17.0)d 42 (9.6)d,e     1816–2269 euro 50 (12.4) 71 (17.4)d 60 (14.7)d,e 24 (5.6) 80 (17.7)d 68 (15.6)d,e     ≥2270 46 (11.7) 166 (40.8)d 250 (61.1)d,e 17 (4.0) 107 (23.6)d 222 (50.9)d,e     Missing 56 (13.8) 19 (4.7) 17 (4.2) 105 (24.5) 58 (12.8) 32 (7.3)e Marital status 0.349 0.026     Unmarried 26 (6.4) 24 (5.8) 46 (11.2)d,e 25 (5.8) 16 (3.5)d 50 (11.5)d,e     Married 338 (83.4) 329 (80.6) 302 (73.8)d,e 314 (73.3) 341 (75.2)d 301 (69.0)d,e     Divorced 24 (6.0) 33 (8.1) 40 (9.8)d,e 20 (4.7) 54 (12.0)d 36 (8.3)d,e     Widow 17 (4.2) 19 (4.7) 8 (2.0)d,e 70 (16.2) 39 (8.5)d 36 (8.3)d,e     Registered partnershipc – 3 (0.7) 13 (3.2) – 4 (0.9) 13 (3.0)e a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three generations. b P values for trend adjusted for age. c Registered partnership was introduced in 1998, and therefore not available for cohort 1. d Significantly different compared with cohort 1. e Significantly different compared with cohort 2. Table 2 Lifestyle characteristics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three cohorts. b P values for trend adjusted for age and education. c Significantly different compared with cohort 1. d Significantly different compared with cohort 2. e Men: > 102 cm; Women: > 88 cm. f ≥8 glasses of alcohol beverages per week. g Includes walking, biking, light and heavy house hold activities, and sports. Table 2 Lifestyle characteristics of three generations of older men and women aged 55–64 years from the Longitudinal Aging Study Amsterdam Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 Mena Womena Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb Cohort 1 1992/1993 Cohort 2 2002/2003 Cohort 3 2012/2013 P for trendb n = 405 n = 408 n = 409 n = 429 n = 453 n = 436 Body mass index (kg/m2) 26.3 ± 2.9 27.2 ± 3.6c 27.4 ± 3.9c <0.001 27.1 ± 4.3 27.6 ± 4.8 26.8 ± 5.1d 0.106 BMI class, n (%) <0.001 0.039     <25 kg/m2 (normal weight) 139 (34.3) 106 (26.0)c 124 (30.3)c,d 153 (35.7) 149 (33.0) 183 (42.0)d     25–30 kg/m2 (overweight) 227 (56.1) 229 (56.2)c 191 (46.7)c,d 186 (43.4) 179 (39.6) 160 (36.7)d     >30 kg/m2 (obesity) 39 (9.6) 72 (17.8)c 94 (23.0)c,d 90 (21.0) 124 (27.4) 93 (21.3)d Waist circumference (cm) 98.8 ± 9.5 100.2 ± 10.1c 101.2 ± 11.5c <0.001 93.5 ± 11.7 94.3 ± 12.4 92.6 ± 13.3d 0.141 High risk waist circumference, n (%)e 138 (34.0) 166 (40.7) 185 (45.2)c <0.001 284 (66.2) 308 (68.0) 270 (61.9) 0.456 Smoking, n (%) <0.001 0.022     Non-smoker 140 (34.5) 192 (47.0)c 240 (58.7)c,d 269 (62.7) 269 (59.4) 297 (68.1)c,d     Former 113 (27.9) 79 (19.4)c 84 (20.5)c,d 58 (13.5) 65 (14.3) 68 (15.6)c,d     Current 152 (37.4) 137 (33.6)c 83 (20.3)c,d 102 (23.8) 119 (26.3) 71 (16.3)c,d Alcohol consumers, n (%) 0.350 0.786     No 35 (8.6) 16 (4.0)c 39 (9.5)d 86 (20.1) 51 (11.2)c 70 (16.1)d     Yes 370 (91.4) 392 (96.0)c 370 (90.5)d 343 (79.9) 402 (88.8)c 366 (83.9)d     Excessive drinkingf 203 (54.9) 244 (62.3)c 242 (65.4)c 0.008 78 (22.7) 145 (36.1)c 137 (37.4)c 0.021     Binge drinking 32 (8.7) 54 (13.8)c 39 (10.5) 0.127 13 (3.8) 35 (8.7)c 31 (8.5)c 0.009 Total physical activityg, min/day 130 ± 107 114 ± 100c 126 ± 98 0.457 230 ± 122 192 ± 109c 187 ± 112c <0.001     ≥150 min/week of moderate intensity physical activity, n (%) 303 (74.9) 285 (69.9) 327 (80.0)d 0.238 372 (86.7) 344 (76.0)c 367 (84.2)d 0.236 Sports (min/day) (among those who perform sport activities) n=23038 ± 50 n=22031 ± 30 n=26237 ± 38c,d 0.902 n=26027 ± 34 n=25325 ± 27 n=29830 ± 27c,d 0.208 a Mean values (±SD) and prevalences (%) were internally weighted for age, which ensures an equal distribution of age across the three cohorts. b P values for trend adjusted for age and education. c Significantly different compared with cohort 1. d Significantly different compared with cohort 2. e Men: > 102 cm; Women: > 88 cm. f ≥8 glasses of alcohol beverages per week. g Includes walking, biking, light and heavy house hold activities, and sports. Obesity Among men, mean BMI increased over time from 26.3 ± 2.9 kg/m2 in 1992/1993 to 27.2 ± 3.6 kg/m2 in 2002/2003 and 27.4 ± 3.9 kg/m2 in 2012/2013 (P for trend < 0.001). In addition, the percentage of obese men increased over time (P for trend < 0.001) from 9.6% to 17.8% and 23.0%, in 1992/1993, 2002/2003 and 2012/2013, respectively. Mean waist circumference and the prevalence of high-risk waist circumference also increased over time (P for trend < 0.001 for both). Among women, mean BMI remained more stable compared with men (P for trend = 0.11), although a decrease between 2002/2003 and 2012/2013 was observed. Although a large proportion of the women in all cohorts were overweight or obese (58–67%), there was a positive trend towards a more healthy weight (P for trend = 0.04). Mean waist circumference and prevalence of high-risk waist circumference also fluctuated across cohorts in women. Smoking behaviour The prevalence of men who were current smokers in 1992/1993 was 37.4%. This prevalence was 33.6% in 2002/2003 and 20.3% in 2012/2013, which was significantly lower compared with 1992/1993 (P for trend < 0.001). The percentage of non-smoking men was lower in 1992/1993 (34.5%) compared with 2002/2003 (47.0%) and 2012/2013 (58.7%) (P for trend < 0.001). In contrast, we observed a different trend among women. The percentage of non-smoking women was 62.7% in 1992/1993, 59.4% in 2002/2003 and 68.1% in 2012/2013. However, the percentage of current smokers had decreased from 26.3% in 2002/2003 to 16.3% in 2012/2013. Alcohol consumption Results suggest a similar trend regarding the consumption of any alcoholic beverages among men and women, with an increase from 1992/1993 to 2002/2003, to a subsequent decrease from 2002/2003 to 2012/2013. A significant increasing trend was, however, observed for excessive alcohol consumption (>7 glasses per week) among both men and women. Using a different cut-off point (>21 alcoholic beverages per week for men and >14 alcoholic beverages per week for women), no trends in excessive alcohol consumption were observed among men or women. Prevalences among men increased from 12.7% in 1992/1993 to 16.8% in 2002/2003, but decreased to 13.2% in 2012/2013. Among women, prevalences fluctuated from 14.6% to 25.8% and 23.2% in 1992/1993, 2002/2003 and 2012/2013, respectively. The prevalence in men of binge drinking in 1992/1993 was 8.7% and 13.8% in 2002/2003, which was significantly higher, but no difference was observed compared with 2012/2013 (10.5%). No statistically significant trend across cohorts was observed (P for trend = 0.127). In contrast, in women, there was a significant increasing trend in the prevalence of binge drinking (P for trend = 0.009). In 1992/1993, among the alcohol consumers, 3.8% were defined as binge drinkers. In 2002/2003 and 2012/2013, 8.7% and 8.5% were defined as binge drinkers, respectively, which was significantly higher compared with 1992/1993. No difference was observed between 2002/2003 and 2012/2013. Physical activity A negative trend was observed for total minutes per day spent physically active. Based on self-reported data, men and women from 1992/1993 spent more time being physically active compared with their peers from more recent cohorts, although only a statistically significant trend was observed for women (P for trend = 0.457 for men and P for trend < 0.001 for women). Results suggest a non-significant trend regarding the percentage of men and women meeting the Dutch physical activity guideline (≥150 minutes of moderate-intensity activity per week), with a decrease from 1992/1993 to 2002/2003, to an increase from 2002/2003 to 2012/2013. In 1992/1993, 56.7% of men and 60.9% of women reported sport activities during the previous 2 weeks. These prevalences decreased slightly across cohorts with 53.9% of men and 55.9% of women in 2002/2003, to a significant increase of 64.1% of men and 68.6% of women in 2012/2013. Among the participants who reported sporting activities, no trends were observed regarding time (min/day) spent on sports. Discussion In this study, we investigated trends in lifestyle across three cohorts, each assessed 10 years apart, of adults aged 55–64 years from the Netherlands. We have shown that more recent cohorts have a less healthy lifestyle compared with their peers in 2002/2003 and 1992/1993, i.e. more men were obese and had a high-risk waist circumference, more men and women were excessive alcohol drinkers and less time was spent being physically active. On a positive note, fewer men and women were current smokers compared with the previous cohorts and more men and women from the most recent cohort met the Dutch physical activity guideline. Our results indicate an increase in the prevalence of obesity among men, whereas no change in prevalence over time among women was observed, even though the prevalence of obesity remained high. These results are in line with a study comparing generations of men and women aged > 65 years between 1999 and 2010 from the USA.17 In addition, a recent report from the NCD Risk Factor Collaboration investigating worldwide trends of BMI among adults between 1975 and 2014 showed that mean BMI increased over time and that age-standardized prevalence of obesity increased from 3.2% in 1997 to 10.8% in 2014 in men and from 6.4% to 14.9% in women aged 18 years and older.18 Trend data regarding physical activity are scarce, although our trend of decreasing time spent on total physical activity was also observed in several studies across the world.19–22 Our results showed a decreasing trend in time spent per day being physically active among women, while more women of the most recent cohort met the Dutch physical activity guideline compared with 2002/2003. This can potentially be explained by the fact that more non-active people became active, while at the same time the older people who were physically active for more than 150 minutes per week became less physically active, though still more than 150 minutes per week. Significantly more people from the more recent cohorts were alcohol consumers. When applying the relatively strict Dutch alcohol recommendation, we observe increasing trends for excessive drinking across cohorts. This is in line with the results from a comprehensive review of studies including men and women within the age range of 15–80 years, investigating cohort effects in alcohol consumption including studies from the USA and Europe, which showed that more recent birth cohorts (both men and women) consistently consumed more alcohol than older cohorts and were engaging in more episodic and problem drinking.23 In addition, based on the strongest methodological studies, the authors conclude a converge in differences between men and women, whereby an increasing trend of heavy drinking and alcohol disorders was observed among women in the more recent cohorts, but not in men.23 This is also in line with our results where an increasing trend was observed among the percentage of women, but not men, defined as binge drinkers. A positive trend observed in the current study was the decrease in the prevalence of current smoking. However, there was a different pattern in smoking behaviour among men compared with women, which could be explained by the different historical smoking patterns between men and women, with smoking prevalence having peaked approximately two decades earlier among men than women.24 Due to better welfare standards and medical and technological improvements, life expectancy has increased over time. However, the concomitant increase in years in good health has a slower rate, which results in higher numbers of older adults coping with physical limitations and poor health. For example, recent results from a large prospective cohort study investigating health expectancies over two decades in England showed that life expectancy at age 65 increased, with much smaller increases in disability-free years.25 Also in the Netherlands, life expectancy among men and women has increased in the last decades; however, the number of years in well perceived health and the number of years with disability has decreased.26 The discrepancy between the rate of increase in life expectancy and disability-free years may be explained by higher rates of obesity, lower physical activity and excessive alcohol consumption among recent generations of older men and women. Indeed, more than 10 years ago, Olshansky et al. predicted that the obesity trend would have a negative effect on life expectancy.27 This prediction is confirmed by recent data from the Centers for Disease Control and Prevention, showing that life expectancy in the USA has declined in the last 2 years,28 which is likely a result of the obesity epidemic that started in the late 1970s.29 Future studies should focus on improving lifestyle with the purpose of reversing the obesity epidemic, which is then likely to lead to an increase in the number of disability-free years. Hence, promoting and improving nutritional status and physical activity across the lifespan may help accomplishing a healthier lifestyle in old age. As a means of treatment of obesity, it is important to improve nutritional status by promoting weight loss and stimulating physical activity among obese, inactive adults. Previous studies have shown that weight loss and improvements in body composition are achievable by dietary restriction and/or exercise up to very old age.30–36 Independent of physical inactivity, sedentary behaviour—behaviour characterized by an energy expenditure ≤1.5 metabolic equivalents, such as television viewing, reading and computer use37—is associated with negative health outcomes, such as type 2 diabetes, cardiovascular diseases and mortality.38–41 Although trends in sedentary behaviour were not investigated in this study, we know that sedentary behaviour is most common among older adults and is greater in more recent generations.41 A recent meta-analysis suggests that the increased mortality risk associated with long sedentary time can be compensated by high levels of moderate-intensity physical activity (about 60–75 min per day).42 Taken together, these results highlight the importance of a healthy diet, physical activity and limited sedentary behaviour in order to promote healthy ageing. A strength of the current study is the inclusion of three samples of men and women aged 55–64 years old randomly selected 10 years apart. In addition, we performed the exact same sampling and recruitment strategies, which enabled direct cohort comparisons. Furthermore, objectively measured anthropometric variables were included, which limits the risk of reporting bias. Unfortunately, we did not have data regarding other lifestyle factors, such as dietary intake or stress management in each cohort, nor did we have an objective measure of physical activity, such as accelerometry data, available for all cohorts. Conclusions The lifestyle of more recent cohorts of adults aged 55–64 years in the Netherlands was less healthy in 2012/2013 compared with their peers in 2002/2003 and 1992/1993. Political attention regarding healthy ageing should focus on the prevention of obesity and physical inactivity at middle age, moderate alcohol consumption and on the development of effective and sustainable interventions aiming at improving body weight, increasing physical activity and lowering alcohol consumption. Key points The lifestyle of Dutch adults currently aged 55–64 years adults is less healthy compared with generations of similar age 10 and 20 years ago regarding nutritional status (obesity, physical activity) and alcohol consumption; The single exception is the decreasing trend in the proportion of current smokers among both men and women; Prevention of overweight, physical inactivity and excessive alcohol consumption is imperative for healthy ageing; Development of effective and sustainable interventions in order to improve nutritional status and to lower alcohol consumption is needed. 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Journal

The European Journal of Public HealthOxford University Press

Published: Oct 13, 2017

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