title: Today's adult generations are less healthy than their predecessors: generation shifts in metabolic risk factors: the Doetinchem Cohort Study.
abstract: BACKGROUND
  The health of the elderly of the future is partly determined by their exposure to metabolic risk factors during their life course. Our aim is to study generation shifts in metabolic risk factors.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  We used data of the Doetinchem Cohort Study, that started in 1987-1991 and had follow-up examinations after 6, 11, and 16 years (n = 6,377). The analyses were stratified by sex and generation, i.e. 10-year age groups (20-29, 30-39, 40-49, and 50-59 years) at baseline. Whether a generation had, at a similar age, a different risk profile compared to a generation born 10 years earlier (i.e. generation shift) was tested by means of generalized estimation equations.
  
  
  RESULTS
  The prevalence of overweight, obesity, and hypertension increased with age within all generations, but in general more recently born generations had, at a similar age, a higher prevalence of these risk factors than generations born 10 years earlier (p < 0.05). Unfavourable generation shifts were most pronounced for overweight/obesity, present in men between every generation while in women especially present between the most recently born generations. We observed unfavourable generation shifts in diabetes among men but not among women. No generation shifts for hypercholesterolaemia were observed and favourable generation shifts for low high-density lipoprotein cholesterol between the oldest two generations only. In general, the pattern of generation shifts did not differ according to socioeconomic status.
  
  
  CONCLUSIONS
  The lifelong exposure to especially obesity will increase. As a consequence, more elderly of the future will develop overweight-related diseases such as diabetes and cardiovascular disease.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands gerben.hulsegge@rivm.nl.
authors.forename: Gerben
authors.initials: G
authors.lastname: Hulsegge
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: H Susan J
authors.initials: HS
authors.lastname: Picavet
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Anneke
authors.initials: A
authors.lastname: Blokstra
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Astrid C J
authors.initials: AC
authors.lastname: Nooyens
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Annemieke M W
authors.initials: AM
authors.lastname: Spijkerman
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Smit
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: W  M Monique
authors.initials: W
authors.lastname: Verschuren
mesh_terms: D000328:Adult; D017677:Age Distribution; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006304:Health Status; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000150:complications / Q000453:epidemiology*; D009017:Morbidity / Q000639:trends; D009426:Netherlands / Q000453:epidemiology; D050177:Overweight / Q000150:complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Cardiovascular disease; cohort study; generation shift; life course; metabolic risk factors; trends