Using epidemiological models to estimate the health effects of diet behaviour change: the example of tailored fruit and vegetable promotion.
OBJECTIVE
To explore the use of epidemiological modelling for the estimation of health effects of behaviour change interventions, using the example of computer-tailored nutrition education aimed at fruit and vegetable consumption in The Netherlands.


METHODS
The effects of the intervention on changes in consumption were obtained from an earlier evaluation study. The effect on health outcomes was estimated using an epidemiological multi-state life table model. Input data for the model consisted of relative risk estimates for cardiovascular disease and cancers, data on disease occurrence and mortality, and survey data on the consumption of fruits and vegetables.


RESULTS
If the computer-tailored nutrition education reached the entire adult population and the effects were sustained, it could result in a mortality decrease of 0.4 to 0.7% and save 72 to 115 life-years per 100,000 persons aged 25 years or older. Healthy life expectancy is estimated to increase by 32.7 days for men and 25.3 days for women. The true effect is likely to lie between this theoretical maximum and zero effect, depending mostly on durability of behaviour change and reach of the intervention.


CONCLUSIONS
Epidemiological models can be used to estimate the health impact of health promotion interventions.
Veerman
J Lennert
JL
Department of Public Health, Erasmus MC - University Medical Centre Rotterdam, The Netherlands. j.veerman@erasmus.mc
Barendregt
Jan J
JJ
Mackenbach
Johan P
JP
Brug
Johannes
J
D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality; D004032:Diet / Q000639:trends*; D005260:Female; D005638:Fruit; D006266:Health Education / Q000379:methods; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008017:Life Expectancy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D009765:Obesity / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D014675:Vegetables