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Dietary Patterns: Identification and Health Implications in the Swedish Population
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

We eat foods not nutrients. What is more, we eat them in combinations. Consequently, capturing our complex food habits is likely an advantage in nutrition research. The overall aim of this doctoral thesis was therefore to investigate dietary patterns in the Swedish population –nutrient intakes, nutritional biomarkers and health aspects.

Prostate cancer is the most common cancer among men in the developed world. However, the impact of dietary factors on disease risk is largely unknown. In Study I we investigated the association between a Mediterranean- and a Low-carbohydrate-high-protein dietary pattern and prostate cancer risk, in a cohort of elderly Swedish men. The latter (but not the former) was associated, inversely, with prostate cancer risk when taking validity in food records into account.

Diet is one of our main exposure routes to environmental contaminants. Hence, such exposure could act as a mediating factor in the relation between diet and health. In Study II we investigated the association between; a Mediterranean- and a Low-carbohydrate-high-protein dietary pattern, as well as the official dietary recommendations, and circulating levels of environmental contaminants, in an elderly Swedish population. The first two patterns were positively related to levels of both persistent organic pollutants and heavy metals, whilst the dietary recommendations were inversely associated to dioxin and lead.

Finally, although dietary patterns are likely to influence health, little is known about current dietary patterns in Sweden. In Study III we used a data-reduction method to identify dietary patterns in a nationwide sample of the Swedish population. Two major patterns were derived; a Healthy pattern of foods generally considered healthy (e.g. vegetables, fruits, fish and vegetable-oils) and a Swedish traditional pattern (with e.g. meats, potatoes, sauces, non-Keyhole milk-products, sweet-bakery products and margarine). Derived patterns were associated to population characteristics and the Healthy dietary pattern was inversely associated to anthropometric variables in Study IV. Dietary characteristics of the patterns were well reflected in correlations to nutrient intake and (to a lesser extent) in nutritional biomarkers.

In conclusion dietary patterns for overall health should be considered, as well as other lifestyle-factors, when interpreting results in nutrition epidemiology and establishing dietary recommendations.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. , 91 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1104
Keyword [en]
Dietary Pattern, Dietary Recommendations, Dietary Survey, Environmental Contaminants, Healthy Diet Indicator, Heatlhy dietary pattern, Low-Carbohydrate, Mediterranean diet, Nutritional Biomarkers, Obesity, Overweight, Principal Component Analysis, Prostate Cancer, Sweden, Traditional dietary pattern
National Category
Medical and Health Sciences
Research subject
Medical Science; Nutrition
Identifiers
URN: urn:nbn:se:uu:diva-250280ISBN: 978-91-554-9242-7 (print)OAI: oai:DiVA.org:uu-250280DiVA: diva2:803860
Public defence
2015-06-04, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2015-05-12 Created: 2015-04-14 Last updated: 2015-07-07Bibliographically approved
List of papers
1. Dietary Patterns and Prostate Cancer Risk: Report from the Population Based ULSAM Cohort Study of Swedish Men
Open this publication in new window or tab >>Dietary Patterns and Prostate Cancer Risk: Report from the Population Based ULSAM Cohort Study of Swedish Men
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2014 (English)In: Nutrition and Cancer, ISSN 0163-5581, E-ISSN 1532-7914, Vol. 66, no 1, 77-87 p.Article in journal (Refereed) Published
Abstract [en]

Dietary pattern analyses have increased the possibilities to detect associations between diet and disease. However, studies on dietary pattern and prostate cancer are scarce. Food intake data in the Uppsala Longitudinal Study of Adult Men cohort was determined by 7-day food records. Adherence to a modified Mediterranean Diet Score (mMDS) and a low carbohydrate-high protein (LCHP) score were grouped as low, medium, or high in the whole study population (n = 1,044) and in those identified as adequate reporters of energy intake (n = 566), respectively. Prostate cancer risk was analyzed with Cox proportional hazard regression (median follow-up 13years) and competing risk of death was considered. There were no associations between dietary patterns and prostate cancer (n = 133) in the whole study population. Among adequate reporters the mMDS was not associated with prostate cancer (n = 72). The LCHP score was inversely related to prostate cancer in adequate reporters, adjusted hazard ratios; 0.55 (0.32-0.96) for medium and 0.47 (0.21-1.04) for high compared to low adherent participants (P-for-trend 0.04). Risk relations were not attributable to competing risk of death. In this study, a LCHP diet was associated with lower prostate cancer incidence. Relations emerged in adequate reporters, underscoring the importance of high-quality dietary data.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-217622 (URN)10.1080/01635581.2014.851712 (DOI)000329141100009 ()
Available from: 2014-02-06 Created: 2014-02-04 Last updated: 2017-12-06Bibliographically approved
2. Circulating levels of environmental contaminants are associated with dietary patterns in older adults
Open this publication in new window or tab >>Circulating levels of environmental contaminants are associated with dietary patterns in older adults
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2015 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 75, 93-102 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Food intake contributes substantially to our exposure to environmental contaminants. Still, little is known about our dietary habits' contribution to exposure variability.

OBJECTIVE: The aim of this study was to assess circulating levels of environmental contaminants in relation to predefined dietary patterns in an elderly Swedish population.

METHODS: Dietary data and serum concentrations of environmental contaminants were obtained from 844 70-year-old Swedish subjects (50% women) in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Dietary data from 7-day food records was used to assess adherence to a Mediterranean-like diet, a low carbohydrate-high protein diet and the WHO dietary recommendations. Circulating levels of 6 polychlorinated biphenyl markers, 3 organochlorine pesticides, 1 dioxin and 1 polybrominated diphenyl ether, the metals cadmium, lead, mercury and aluminum and serum levels of bisphenol A and 4 phthalate metabolites were investigated in relation to dietary patterns in multivariate linear regression models.

RESULTS: A Mediterranean-like diet was positively associated with levels of several polychlorinated biphenyls (118, 126, 153, and 209), trans-nonachlor and mercury. A low carbohydrate-high protein diet was positively associated with polychlorinated biphenyls 118 and 153, trans-nonachlor, hexachlorobenzene and p, p'-dichlorodiphenyldichloroethylene, mercury and lead. The WHO recommended diet was negatively related to levels of dioxin and lead, and borderline positively to polychlorinated biphenyl 118 and trans-nonachlor.

CONCLUSION: Dietary patterns were associated in diverse manners with circulating levels of environmental contaminants in this elderly Swedish population. Following the WHO dietary recommendations seems to be associated with a lower burden of environmental contaminants.

National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:uu:diva-248607 (URN)10.1016/j.envint.2014.11.008 (DOI)000348746600009 ()25461418 (PubMedID)
Available from: 2015-04-02 Created: 2015-04-02 Last updated: 2017-12-04Bibliographically approved
3. Dietary patterns in Swedish adults: results from a national dietary survey
Open this publication in new window or tab >>Dietary patterns in Swedish adults: results from a national dietary survey
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2016 (English)In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 115, no 1, 95-104 p.Article in journal (Refereed) Published
Abstract [en]

Dietary patterns derived by statistical procedures is a way to identify overall dietary habits in specific populations. The aim of this study was to identify and characterise dietary patterns in Swedish adults using data from the national dietary survey Riksmaten adults 2010–11 (952 women, 788 men). Principal component analyses were used and two patterns were identified in both sexes: a healthy pattern loading positively on vegetables, fruits, fish and seafood, and vegetable oils, and negatively on refined bread and fast food, and a Swedish traditional pattern loading positively on potatoes, meat and processed meat, full-fat milk products, sweet bakery products, sweet condiments and margarine. In addition, a light-meal pattern was identified in women with positive loadings on fibre-rich bread, cheese, rice, pasta and food grain dishes, substitute products for meat and dairy products, candies and tea. The healthy pattern was positively correlated to dietary fibre (r 0·51–0·58) and n-3 (r 0·25–0·31) (all P<0·0001), and had a higher nutrient density of folate, vitamin D and Se. The Swedish traditional and the light-meal pattern were positively correlated to added sugar (r 0·20–0·25) and the Swedish traditional also to SFA (r 0·13–0·21) (all P<0·0001); both patterns were in general negatively correlated to micronutrients. Dietary pattern scores were associated with, for example, age, physical activity, education and income. In conclusion, we identified three major dietary patterns among Swedish adults. The patterns can be further used for examining the association between whole diet and health outcomes.

Keyword
Dietary pattern, Food habits, National survey, Principal component analysis, Total diet quality, Sweden
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-249160 (URN)10.1017/S0007114515004110 (DOI)000367234800012 ()26490112 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-1166
Available from: 2015-04-11 Created: 2015-04-11 Last updated: 2017-12-04Bibliographically approved
4. Dietary patterns in relation to anthropometry,inflammation, and nutritional biomarkers in a nationwide population of Swedish adults
Open this publication in new window or tab >>Dietary patterns in relation to anthropometry,inflammation, and nutritional biomarkers in a nationwide population of Swedish adults
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(English)Manuscript (preprint) (Other (popular science, discussion, etc.))
Keyword
Dietary pattern, Body mass index, waist circumference, C-reactive protein, nutritional biomarkers, Sweden
National Category
Medical and Health Sciences
Research subject
Nutrition; Epidemiology
Identifiers
urn:nbn:se:uu:diva-249161 (URN)
Available from: 2015-04-13 Created: 2015-04-11 Last updated: 2015-05-12

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