General aim
To develop, implement and evaluate intervention strategies at policy (macro level), environment (macro/meso level) and family/child level (micro level) that contribute to the maintenance and improvement of oral and metabolic health in the first 1,000 days.
Objectives
Active period
Year 4-8
AUAS, Inholland, ACTA, VU, AUMC, UvA-FMG, UTwente, TNO Microbiology & Systems Biology.
GGD, Sarphati Amsterdam, NVvK, Ivoren Kruis, Coop, Voedingscentrum, PANEL, Food4Smiles, MRN, NJi, Gezonde en Kansrijke Start, NCJ, JGZ, EVAA, SGF, NVD, Smallsteps/Partou.
June 2026
The PI of the WP5 has joined monthly meetings of the MetaHealth steering committee since the start of the project. As from January 2026, WP5 has monthly meetings as well.
Qualitative data collection and analyses on advertising bans in public spaces of several municipalities in the Netherlands is completed. The results are published in Food Policy and incorporated into an infographic, which was shared with Dutch municipalities, partners at the City Deal Healthy and Sustainable Food Environment, on social media (LinkedIn), and the MetaHealth website. In addition, Joreintje Mackenbach presented the results at the ‘Regionale Voedseldag Vlaanderen’.
In July 2025, Nine Droog was appointed as a junior researcher (under the supervision of Coosje Dijkstra) to organize, analyze and describe two Group Model Building (GMB) workshops with broader stakeholders in Amsterdam North. The aim was to gain insight into the complex system of underlying mechanisms that persistent the high prevalence of overweight/obesity and caries in children in the first 1,000 days of life in neighborhoods with a lower socio-economic position, and to identify potential leverage points for strengthening prevention efforts. Nine began, in collaboration with WP1, by setting up a causal loop diagram (CLD) with the central question: ‘Why are the prevalence and incidence of overweight/obesity and caries in children in the first 1000 days not decreasing in Amsterdam neighborhoods with low socio-economic status, despite existing preventive interventions? Originally (also part of WP1), we planned to have two GMB sessions with stakeholders from Amsterdam North in November 2025 to discuss (and update) the CLD (session 1) and identify leverage points for further action (session 2). Due to the limited opportunities for Nine to build on the existing warm stakeholder network within MetaHealth, it proved challenging to organize the sessions as originally intended. For this reason, and to reduce the burden on stakeholders, an alternative approach was adopted in which the CLD was further developed and validated through in-depth stakeholder interviews. This interview-based approach has been applied successfully in previous projects, although it lacks the added value of direct interaction and network dynamics between participants that is characteristic of GMB workshops (https://doi.org/10.1186/s12916-025-04360-z).
To date, Nine has conducted twelve interviews with a diverse group of professionals, including a debt counsellor, a youth health care nurse, a paediatric dietitian, a physical activity specialist, two dental hygienists, a social worker at a community centre, and a youth physician. The CLD has now been substantially expanded, and a draft final version is currently being prepared for internal discussion within the research team. A new stakeholder meeting will be scheduled for early 2026 to jointly identify leverage points using the Qualitative Systems Exploration Model (QSEM) tool. This tool will be used to support a semi-quantitative exploration of the system and to prioritize leverage points based on both potential impact and feasibility on a local level. From January 2026 onwards, Nine continued with this work as PhD student at VU Amsterdam and Joreintje Mackenbach will also join Nine’s weekly PhD supervision meetings.
Josine Stuber (postdoc WP5) returned from maternity leave in mid-October and has resumed her work for MetaHealth. She, Joreintje Mackenbach and Coosje Dijkstra had a meeting with the Amsterdam Municipal Health Service (GGD Amsterdam) to discuss the details of a new project. Through the healthy and promising start for vulnerable families (Gezonde en Kansrijke Start), the personal contribution for maternity care will be subsidized. WP5 will perform a mixed methods study to evaluate this arrangement. Does the subsidy indeed lead to an increase in the uptake of maternity care in Amsterdam-Zuidoost, and what are the experiences of professionals and parents (via professionals)? The research plan and pre-registration will be completed in April. As the number of families that have registered for the subsidy is still limited, the actual evaluation will take place later.
An MSc student, under supervision of Joreintje Mackenbach, is currently collecting data on the nutritional quality of baby- and toddler foods in supermarkets. The supermarket environment has an important influence on parental choices on what they feed their children in the first 1000 days, and this quantitative descriptive study will provide input on the challenges parents encounter when they want to choose healthy options.
The evaluation of the NutriScore, in collaboration with RIVM, has been postponed until at least 2027, as RIVM currently has insufficient data on the implementation of the NutriScore.
Dionne van Tatenhove started 1 June, 2026 PhD-candidate.
Samenvatting
Achtergrond. ‘Nudges’ voor gezonde voeding kunnen effectiever zijn, of juist vooral effectief, bij groepen die sociaaleconomisch achtergesteld zijn. We hebben onderzocht in hoeverre sociaaleconomische en demografische kenmerken de effectiviteit beïnvloeden van ‘nudge’-interventies gericht op gezonde voeding in de praktijkomgeving van supermarkten, met betrekking tot het aankoopgedrag van voedingsmiddelen.
Methoden We hebben individuele deelnemersgegevens uit meerdere onderzoeken gebundeld. In aanmerking komende onderzoeken werden geïdentificeerd via een zoekopdracht in PubMed en geselecteerd op basis van een gecontroleerd praktijkgericht ontwerp, waarbij een nudging-interventie ter bevordering van gezonde aankopen werd getest en tegelijkertijd sociodemografische en aankoopgegevens van deelnemers werden verzameld. Van de vier in aanmerking komende onderzoeken hadden er drie longitudinale metingen, bestond er één uit een enkel tijdstip, waren er twee gerandomiseerd en twee niet. De toegepaste nudges bestonden uit een combinatie van plaatsingsnudges (gericht op beschikbaarheid of positionering) en eigenschapsnudges (presentatie en/of informatie). De geharmoniseerde gegevens omvatten dichotome sociaaleconomische en demografische variabelen en het percentage aangekocht fruit en groenten ten opzichte van de totale aankopen. Er werd gebruikgemaakt van multilevel-metaregressie op basis van lineaire gemengde-effectmodellen om modificerende effecten te onderzoeken aan de hand van twee benaderingen: longitudinale en transversale analyses.
Resultaten De analytische steekproef in de longitudinale analyse bestond uit 638 deelnemers, die overwegend vrouw waren (76,3%), een lager opleidingsniveau hadden (67,7%) en een gemiddelde leeftijd van 46,6 jaar (SD 13,5). Deze kenmerken waren vergelijkbaar in de transversale analyse (n = 855). In vergelijking met deelnemers uit de controlegroep was er in de longitudinale analyse geen hoofdeffect van nudges voor gezonde voeding op het percentage aankopen van fruit en groenten door deelnemers uit de interventiegroep (β = 0,00; 95%-BI -0,03, 0,09). Dit hoofdeffect werd niet gemodificeerd door opleidingsniveau (βgroep*hoger onderwijs = -0,06; -0,40, 0,02), geslacht (βgroep*vrouwen = 0,13; -0,00, 0,61) noch leeftijd (βgroep*oudere volwassenen = -0,05; -0,39, 0,02). De resultaten van de transversale analyse waren vergelijkbaar.
Conclusies Deze gepoolde analyse van vier gecontroleerde studies leverde geen bewijs op ter ondersteuning van de hypothese dat ‘nudge’-interventies voor gezonde voeding in supermarkten effectiever werken bij sociaaleconomisch achtergestelde groepen. Er is verder onderzoek nodig om de geïdentificeerde beperkingen aan te pakken door middel van een rigoureus onderzoeksontwerp met uitgebreide interventiestrategieën en gestandaardiseerde uitkomstmaten, waarbij ook contextspecifieke benaderingen worden geëvalueerd. Dergelijke inzichten zullen bijdragen aan een beter begrip van de rechtvaardigheid van ‘nudge’-interventies in supermarkten en het potentieel voor het verminderen van voedingsgerelateerde gezondheidsongelijkheden.
Background Healthy food nudges may be more, or especially, effective among groups experiencing socioeconomic disadvantage. We investigated the modifying role of socioeconomic and demographic characteristics in the effectiveness of nudge interventions targeting healthy foods in real-world grocery store settings on food purchasing patterns.
Methods We pooled individual participant data from multiple trials. Eligible trials were identified via a PubMed search and selected based on having a controlled real-world design, testing a nudging intervention promoting healthy purchases, while collecting participants’ sociodemographic and purchasing data. Out of four eligible trials, three had longitudinal measurements, one consisted of a single time point, two were randomised and two were not. Applied nudges consisted of a combination of placement nudges (focussing on availability or positioning) and property nudges (presentation and/or information). Harmonised data included dichotomised socioeconomic and demographic variables and the percentage of purchased fruits and vegetables of total purchases. Multilevel meta-regression based on linear mixed-effects models were used to explore modifying effects using two approaches: longitudinal and cross-sectional analyses.
Results The analytical sample in the longitudinal analysis comprised of 638 participants, who were predominantly female (76.3%), had a lower education attainment (67.7%), and a mean age of 46.6 years (SD 13.5). These characteristics were similar in the cross-sectional analysis (n = 855). Compared to control group participants, there was no main effect of healthy food nudges on the percentage of fruit and vegetable purchases by intervention group participants in the longitudinal analysis (β = 0.00; 95%CI -0.03, 0.09). This main effect was not modified by educational attainment (βgroup*higher education = -0.06; -0.40, 0.02), sex (βgroup*females = 0.13; -0.00, 0.61) nor age (βgroup*older adults = -0.05; -0.39, 0.02). Results from the cross-sectional analysis were comparable.
Conclusions This pooled analyses of four controlled trials did not find evidence supporting the hypothesis that grocery store nudge interventions of healthy foods work more effectively among groups experiencing socioeconomic disadvantage. Future studies are needed to address the identified limitations through rigorous trial design using comprehensive interventional strategies, standardised outcome measures, while also evaluating context-specific approaches. Such insights will help to better understand the equity of nudging interventions in grocery store settings and the potential for reducing diet-related health disparities.
This study examined the perspectives of policy officials affiliated with Dutch municipalities exploring advertisement restrictions on unhealthy and unsustainable products in public outdoor spaces.
In this qualitative study, Dutch municipal policy officials were interviewed in person or online via semi-structured interviews in autumn 2024. Interviews covered the content of proposed restrictions, the municipality’s policy phase, key stakeholders, barriers, facilitators, and policy goals. Interviews were audio-recorded and transcribed verbatim. Analysis was based on a thematic content analysis.
We interviewed 18 policy officials from 13 Dutch municipalities. They indicated that advertisement restrictions were often initiated by left-wing council members, driven by the combination of a momentum (e.g., commitment to a healthy and green future), a favourable political climate (e.g., demand for restrictions from local political parties), and a policy window (e.g., revising municipality advertisement policies). They indicated that the development, implementation and long-term viability of advertisement restrictions depended on policy consistency (e.g., establishing definitions of products to restrict), managing the risks to policy implementation (e.g., financial losses following reduced advertisement revenue) and practical barriers (e.g., existing tenders). Some policy officials doubted the impact of these restrictions on consumer behaviours, but speculated that their signalling effect could affect public support for similar policies.
Political will, momentum and an opening policy window allowed for the development and sometimes implementation of advertisement restrictions. Future research should explore wider stakeholder support for these policies, how to effectively mitigate perceived risks associated with their implementation, and their long-term impact on consumer behaviours.
