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  • 1.
    Bergman, Patrick
    et al.
    Karolinska Institutet.
    Grjibovski, A. M.
    Norwegian Institute of Public Health, Norway;University of Tromsø, Norway;Northern State Medical University, Russia.
    Hagströmer, M.
    Karolinska Institutet.
    Patterson, E.
    Karolinska Institutet.
    Sjöström, M.
    Karolinska Institutet.
    Congestion road tax and physical activity2010In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 38, no 2, p. 171-177Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Large-scale policy and environmental changes, such as congestion road taxes, may be a way to promote active transportation. PURPOSE: This study aimed to examine the potential effect of a congestion road tax on physical activity. METHODS: Baseline data were collected during October-November 2003, follow-up data in May 2006, and analysis was performed in September 2008. The short self-administered version of the International Physical Activity Questionnaire was used to assess physical activity. Data from those with access to motorized vehicles in the Stockholm region (n=165), where the tax was in place, were compared with those from the Goteborg/Malmo regions (n=138). Within each region before and during the road tax implementation, the data were analyzed for differences in time spent at different intensity levels of physical activity, in addition to sitting, as well as for changes in reported time in overall (weighted) physical activity. RESULTS: There were no significant differences in the magnitude of the changes of the intensity levels of physical activity, weighted overall physical activity, or sitting, between Stockholm and Goteborg/Malmo. Among those exposed to the congestion road tax and with access to motorized vehicles, an increase in moderate physical activity (p=0.036); overall physical activity (p=0.015); and a reduction in time spent sitting (p=0.009) was observed. No differences were observed among those unexposed. CONCLUSIONS: The results from this study on the influence of a congestion road tax on levels of physical activity, though inconclusive, suggest that policy changes such as a congestion road tax might promote improvements in physical activity levels in individuals with motorized vehicles.

  • 2.
    Farvid, Maryam S.
    et al.
    Harvard T.H. Chan School of Public Health, USA ; Tehran University of Medical Sciences, Iran ; Massachusetts General Hospital, USA.
    Malekshah, Akbar F.
    Tehran University of Medical Sciences, Iran.
    Pourshams, Akram
    Tehran University of Medical Sciences, Iran.
    Poustchi, Hossein
    Tehran University of Medical Sciences, Iran.
    Sepanlou, Sadaf G.
    Tehran University of Medical Sciences, Iran.
    Sharafkhah, Maryam
    Tehran University of Medical Sciences, Iran.
    Khoshnia, Masoud
    Golestan University of Medical Sciences, Iran.
    Farvid, Mojtaba
    Linnaeus University, Faculty of Technology, Department of Mechanical Engineering.
    Abnet, Christian C.
    National Cancer Institute, USA.
    Kamangar, Farin
    Morgan State University, USA.
    Dawsey, Sanford M.
    National Cancer Institute, USA.
    Brennan, Paul
    International Agency for Research on Cancer, France.
    Pharoah, Paul D.
    University of Cambridge, UK.
    Boffetta, Paolo
    Icahn School of Medicine at Mount Sinai, USA.
    Willett, Walter C.
    Harvard T.H. Chan School of Public Health, USA ; Brigham and Women's Hospital, USA ; Harvard University, USA.
    Malekzadeh, Reza
    Tehran University of Medical Sciences, Iran.
    Dietary Protein Sources and All-Cause and Cause-Specific Mortality: The Golestan Cohort Study in Iran2017In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 52, no 2, p. 237-248Article in journal (Refereed)
    Abstract [en]

    Introduction: Dietary protein comes from foods with greatly different compositions that may not relate equally with mortality risk. Few cohort studies from non-Western countries have examined the association between various dietary protein sources and cause-specific mortality. Therefore, the associations between dietary protein sources and all-cause, cardiovascular disease, and cancer mortality were evaluated in the Golestan Cohort Study in Iran. Methods: Among 42,403 men and women who completed a dietary questionnaire at baseline, 3,291 deaths were documented during 11 years of follow up (2004-2015). Cox proportional hazards models estimated age-adjusted and multivariate-adjusted hazard ratios (HRs) and 95% CIs for all cause and disease-specific mortality in relation to dietary protein sources. Data were analyzed from 2015 to 2016. Results: Comparing the highest versus the lowest quartile, egg consumption was associated with lower all-cause mortality risk (HR=0.88, 95% CI=0.79, 0.97, ptrend=0.03). In multivariate analysis, the highest versus the lowest quartile of fish consumption was associated with reduced risk of total cancer (HR=0.79, 95% CI=0.64, 0.98, ptrend=0.03) and gastrointestinal cancer (HR=0.75, 95% CI=0.56, 1.00, ptrend=0.02) mortality. The highest versus the lowest quintile of legume consumption was associated with reduced total cancer (HR=0.72, 95% CI=0.58, 0.89, ptrend=0.004), gastrointestinal cancer (HR=0.76, 95% CI=0.58, 1.01, ptrend=0.05), and other cancer (HR=0.66, 95% CI=0.47, 0.93, ptrend=0.04) mortality. Significant associations between total red meat and poultry intake and allcause, cardiovascular disease, or cancer mortality rate were not observed among all participants. Conclusions: These findings support an association of higher fish and legume consumption with lower cancer mortality, and higher egg consumption with lower all-cause mortality. (C) 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  • 3. Long, Gráinne H.
    et al.
    Simmons, Rebecca K.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS). Ageing and Living Conditions Programme.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Rolandsson, Olov
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Griffin, Simon J.
    Weinehall, Lars
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Temporal shifts in cardiovascular risk factor distribution2014In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 46, no 2, p. 112-121Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Complementary strategies to shift risk factor population distributions and target high-risk individuals are required to reduce the burden of type 2 diabetes and cardiovascular disease (CVD).

    PURPOSE: To examine secular changes in glucose and CVD risk factors over 20 years during an individual and population-based CVD prevention program in Västerbotten County, Sweden.

    METHODS: Population-based health promotion intervention was conducted and annual invitation for individuals turning 40, 50, and 60 years to attend a health assessment, including an oral glucose tolerance test, biochemical measures, and a questionnaire. Data were collected between 1991 and 2010, analyzed in 2012 and available for 120,929 individuals. Linear regression modeling examined age-adjusted differences in CVD risk factor means over time. Data were direct-age-standardized to compare disease prevalence.

    RESULTS: Between 1991-1995 and 2006-2010, mean age-adjusted cholesterol (men=-0.53, 95% CI=-0.55, -0.50 mmol/L; women=-0.48, 95% CI=-0.50, -0.45 mmol/L) and systolic blood pressure declined (men=-3.06, 95% CI=-3.43, -2.70 mm Hg; women=-5.27, 95% CI=-5.64, -4.90 mm Hg), with corresponding decreases in the age-standardized prevalence of hypertension and hyperlipidemia. Mean age-adjusted 2-hour plasma glucose (men=0.19, 95% CI=0.15, 0.23 mmol/L; women=0.08, 95% CI=0.04, 0.11 mmol/L) and BMI increased (men=1.12, 95% CI=1.04, 1.21; women=0.65, 95% CI=0.55, 0.75), with increases in the age-standardized prevalence of diabetes and obesity.

    CONCLUSIONS: These data demonstrate the potential of combined individual- and population-based approaches to CVD risk factor control and highlight the need for additional strategies addressing hyperglycemia and obesity.

  • 4.
    Murray, Elizabeth
    et al.
    UCL, England.
    Hekler, Eric B.
    Arizona State University, AZ USA.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Institute, Sweden.
    Collins, Linda M.
    Penn State University, PA USA.
    Doherty, Aiden
    University of Oxford, England.
    Hollis, Chris
    University of Nottingham, England.
    Rivera, Daniel E.
    Arizona State University, AZ USA.
    West, Robert
    UCL, England.
    Wyatt, Jeremy C.
    University of Southampton, England.
    Evaluating Digital Health Interventions Key Questions and Approaches2016In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 51, no 5, p. 843-851Article in journal (Refereed)
    Abstract [en]

    Digital health interventions have enormous potential as scalable tools to improve health and healthcare delivery by improving effectiveness, efficiency, accessibility, safety, and personalization. Achieving these improvements requires a cumulative knowledge base to inform development and deployment of digital health interventions. However, evaluations of digital health interventions present special challenges. This paper aims to examine these challenges and outline an evaluation strategy in terms of the research questions needed to appraise such interventions. As they are at the intersection of biomedical, behavioral, computing, and engineering research, methods drawn from all of these disciplines are required. Relevant research questions include defining the problem and the likely benefit of the digital health intervention, which in turn requires establishing the likely reach and uptake of the intervention, the causal model describing how the intervention will achieve its intended benefit, key components, and how they interact with one another, and estimating overall benefit in terms of effectiveness, cost effectiveness, and harms. Although RCTs are important for evaluation of effectiveness and cost effectiveness, they are best undertaken only when: (1) the intervention and its delivery package are stable; (2) these can be implemented with high fidelity; and (3) there is a reasonable likelihood that the overall benefits will be clinically meaningful (improved outcomes or equivalent outcomes at lower cost). Broadening the portfolio of research questions and evaluation methods will help with developing the necessary knowledge base to inform decisions on policy, practice, and research. (C) 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  • 5. Müezzinler, Aysel
    et al.
    Mons, Ute
    Gellert, Carolin
    Schöttker, Ben
    Jansen, Eugène
    Kee, Frank
    O'Doherty, Mark G
    Kuulasmaa, Kari
    Freedman, Neal D
    Abnet, Christian C
    Wolk, Alicja
    Håkansson, Niclas
    Orsini, Nicola
    Wilsgaard, Tom
    Bueno-de-Mesquita, Bas
    van der Schouw, Yvonne T
    Peeters, Petra H M
    de Groot, Lisette C P G M
    Peters, Annette
    Orfanos, Philippos
    Linneberg, Allan
    Pisinger, Charlotta
    Tamosiunas, Abdonas
    Baceviciene, Migle
    Luksiene, Dalia
    Bernotiene, Gailute
    Jousilahti, Pekka
    Petterson-Kymmer, Ulrika
    Jansson, Jan Håkan
    Söderberg, Stefan
    Eriksson, Sture
    Jankovic, Nicole
    Sánchez, María-José
    Veronesi, Giovanni
    Sans, Susana
    Drygas, Wojciech
    Trichopoulou, Antonia
    Boffetta, Paolo
    Brenner, Hermann
    Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium.2015In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 49, no 5, p. e53-e63, article id S0749-3797(15)00188-9Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years.

    METHODS: Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014.

    RESULTS: A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively.

    CONCLUSIONS: Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.

  • 6. Müezzinler, Aysel
    et al.
    Mons, Ute
    Gellert, Carolin
    Schöttker, Ben
    Jansen, Eugène
    Kee, Frank
    O'Doherty, Mark G
    Kuulasmaa, Kari
    Freedman, Neal D
    Abnet, Christian C
    Wolk, Alicja
    Håkansson, Niclas
    Orsini, Nicola
    Wilsgaard, Tom
    Bueno-de-Mesquita, Bas
    van der Schouw, Yvonne T
    Peeters, Petra H M
    de Groot, Lisette C P G M
    Peters, Annette
    Orfanos, Philippos
    Linneberg, Allan
    Pisinger, Charlotta
    Tamosiunas, Abdonas
    Baceviciene, Migle
    Luksiene, Dalia
    Bernotiene, Gailute
    Jousilahti, Pekka
    Pettersson-Kymmer, Ulrika
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jansson, Jan Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Eriksson, Sture
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Jankovic, Nicole
    Sánchez, María-José
    Veronesi, Giovanni
    Sans, Susana
    Drygas, Wojciech
    Trichopoulou, Antonia
    Boffetta, Paolo
    Brenner, Hermann
    Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium2015In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 49, no 5, p. e53-e63Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years.

    METHODS: Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014.

    RESULTS: A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively.

    CONCLUSIONS: Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.

  • 7. Rockette-Wagner, Bonny
    et al.
    Storti, Kristi L.
    Dabelea, Dana
    Edelstein, Sharon
    Florez, Hermes
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Clinical Science, Genetic and Molecular Epidemiology Unit, Lund University, Malmö, Sweden; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
    Montez, Maria G.
    Pomeroy, Jeremy
    Kriska, Andrea M.
    Activity and Sedentary Time 10 Years After a Successful Lifestyle Intervention: The Diabetes Prevention Program2017In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 52, no 3, p. 292-299Article in journal (Refereed)
    Abstract [en]

    Introduction: This study aims to determine if evidence exists for a lasting effect of the Diabetes Prevention Program (DPP) lifestyle intervention on activity levels by comparing objectively collected activity data between the DPP Outcome Study (DPPOS) cohort and adults from the National Health and Nutrition Examination Survey (NHANES; 2003-2006). Methods: Average minutes/day of light and moderate to vigorous physical activity (MVPA) and sedentary behavior from ActiGraph accelerometers (collected 2010-2012) were examined (2013-2014) for comparable DPPOS and NHANES subgroups by age, sex, and diabetes status. Longitudinal questionnaire data on leisure activity, collected yearly from DPP baseline to the time of accelerometer measurement (1996-2010; 11.9-year mean follow-up), were also examined to provide support for a long-term intervention effect. Results: Average minutes/day of accelerometer-derived MVPA was higher in all DPPOS subgroups versus NHANES subgroups of similar age/sex/diabetes status; with values as much as twice as high in some DPPOS subgroups. Longitudinal questionnaire data from DPP/DPPOS showed a maintained increase of 1.24 MET hours/week (p=0.026) of leisure activity in DPPOS participants from all original study arms between DPP baseline and accelerometer recording. There were no consistent differences between comparable DPPOS and NHANES subgroups for accelerometer derived sedentary or light-intensity activity minutes/day. Conclusions: More than 10 years after the start of DPP, DPPOS participants performed more accelerometer-measured MVPA than similar adults from NHANES. Longitudinal questionnaire data support the accelerometer-based findings by suggesting that leisure activity levels at the time of accelerometer recording remained higher than DPP baseline levels. 

  • 8. Sallis, James F
    et al.
    Bowles, Heather R
    Bauman, Adrian
    Ainsworth, Barbara E
    Bull, Fiona C
    Craig, Cora L
    Sjöström, Michael
    De Bourdeaudhuij, Ilse
    Lefevre, Johan
    Matsudo, Victor
    Matsudo, Sandra
    Macfarlane, Duncan J
    Gomez, Luis F
    Inoue, Shigeru
    Murase, Norio
    Volbekiene, Vida
    McLean, Grant
    Carr, Harriette
    Heggebo, Lena K
    Tomten, Heidi
    Bergman, Patrick
    Department of Biosciences and Nutrition at Novum, Karolinska Institute, Stockholm, Sweden.
    Neighborhood environments are related to physical activity among adults in 11 countries2009In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 36, no 6, p. 484-490Article in journal (Refereed)
    Abstract [en]

    Background

    Understanding environmental correlates of physical activity can inform policy changes. Surveys were conducted in 11 countries using the same self-report environmental variables and the International Physical Activity Questionnaire, allowing analyses with pooled data.

    Methods

    The participating countries were Belgium, Brazil, Canada, Colombia, China (Hong Kong), Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S., with a combined sample of 11,541 adults living in cities. Samples were reasonably representative, and seasons of data collection were comparable. Participants indicated whether seven environmental attributes were present in their neighborhood. Outcomes were measures of whether health-related guidelines for physical activity were met. Data were collected in 2002–2003 and analyzed in 2007. Logistic regression analyses evaluated associations of physical activity with environmental attributes, adjusted for age, gender, and clustering within country.

    Results

    Five of seven environmental variables were significantly related to meeting physical activity guidelines, ranging from access to low-cost recreation facilities (OR=1.16) to sidewalks on most streets (OR=1.47). A graded association was observed, with the most activity–supportive neighborhoods having 100% higher rates of sufficient physical activity compared to those with no supportive attributes.

    Conclusions

    Results suggest neighborhoods built to support physical activity have a strong potential to contribute to increased physical activity. Designing neighborhoods to support physical activity can now be defined as an international public health issue.

  • 9.
    Titova, Olga E.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Baron, John A.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina..
    Fall, Tove
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular epidemiology.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Larsson, Susanna C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology. Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Swedish Snuff (Snus), Cigarette Smoking, and Risk of Type 2 Diabetes2023In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 65, no 1, p. 60-66Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Cigarette smoking is a known risk factor for Type 2 diabetes, but evidence regarding former smoking and moist snuff (snus) use and Type 2 diabetes risk is inconclusive. This study investigated the relationships of cigarette smoking and Swedish snus use with the risk of Type 2 diabetes in a cohort of middle-aged and elderly participants.

    METHODS: Participants (N=36,742; age range=56-95 years) were followed for incident Type 2 diabetes and death between 2009 and 2017 through linkage to the Swedish National Patient, Prescribed Drug and Death Registers. Cox proportional hazards regression was used to obtain hazard ratios and 95% CIs adjusted for potential confounders, including physical activity, education, BMI, and alcohol intake. Analyses were conducted in 2021‒2022.

    RESULTS: Former and current smoking was associated with an increased risk of Type 2 diabetes (hazard ratios [95% CI]=1.17 [1.07, 1.29] and 1.57 [1.36, 1.81], respectively). In those who stopped smoking, Type 2 diabetes risk remained elevated up to approximately 15 years after cessation. In participants who have never smoked, snus use was linked to a higher risk of Type 2 diabetes in the model adjusted for age and sex (hazard ratio [95% CI]=1.49 [1.04, 2.15]), but this was attenuated after multivariable adjustment (hazard ratio [95% Cl]=1.29 [0.89, 1.86]).

    CONCLUSIONS: This study indicates that current and former smoking are associated with an increased risk of Type 2 diabetes in middle-aged and older individuals. There was less evidence of an association of snus use with the risk of Type 2 diabetes, suggesting that compounds other than nicotine may underlie the detrimental association of smoking with the risk of Type 2 diabetes.

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  • 10.
    Yuan, Shuai
    et al.
    Zhejiang Univ, Sch Publ Hlth, Dept Big Data Hlth Sci, Sch Med, Hangzhou, Peoples R China.;Zhejiang Univ, Affiliated Hosp 2, Sch Med, Hangzhou, Peoples R China.;Karolinska Inst, Inst Environm Med, Unit Cardiovasc & Nutr Epidemiol, Stockholm, Sweden..
    Dan, Lintao
    Zhejiang Univ, Sch Publ Hlth, Dept Big Data Hlth Sci, Sch Med, Hangzhou, Peoples R China.;Zhejiang Univ, Affiliated Hosp 2, Sch Med, Hangzhou, Peoples R China..
    Zhang, Yao
    Shanghai Jiao Tong Univ, Ruijin Hosp, Dept Gastroenterol, Sch Med, Shanghai, Peoples R China..
    Wu, Jing
    Karolinska Inst, Aging Res Ctr ARC, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Zhao, Jianhui
    Zhejiang Univ, Sch Publ Hlth, Dept Big Data Hlth Sci, Sch Med, Hangzhou, Peoples R China.;Zhejiang Univ, Affiliated Hosp 2, Sch Med, Hangzhou, Peoples R China..
    Kivipelto, Miia
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Finnish Inst Healthand Welf, Dept Publ Hlth & Welf, Populat Hlth Unit, Helsinki, Finland.;Imperial Coll London, Sch Publ Hlth, Ageing Epidemiol Res Unit, London, England.;Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Kuopio, Finland.;Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden..
    Chen, Jie
    Zhejiang Univ, Sch Publ Hlth, Dept Big Data Hlth Sci, Sch Med, Hangzhou, Peoples R China.;Zhejiang Univ, Affiliated Hosp 2, Sch Med, Hangzhou, Peoples R China.;Zhejiang Univ, Ctr Global Hlth, Sch Publ Hlth, Sch Med, Hangzhou, Peoples R China..
    Ludvigsson, Jonas F.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Örebro Univ Hosp, Dept Pediat, Örebro, Sweden..
    Li, Xue
    Zhejiang Univ, Sch Publ Hlth, Dept Big Data Hlth Sci, Sch Med, Hangzhou, Peoples R China.;Zhejiang Univ, Affiliated Hosp 2, Sch Med, Hangzhou, Peoples R China..
    Larsson, Susanna C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Digestive System Diseases, Genetic Risk, and Incident Dementia: A Prospective Cohort Study2024In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 66, no 3, p. 516-525Article in journal (Refereed)
    Abstract [en]

    Introduction: Although digestive system disease affects gut microbiota and their metabolites associated with dementia risk, the association between digestive system diseases and incident dementia has not yet been established.

    Methods: This cohort analysis included 458,181 participants free of baseline dementia in the UK Biobank (2006-2021). The associations of 14 digestive system diseases with dementia incidence were examined in 2022 using Cox proportional hazards regression models. Analyses were performed to differentiate the associations for early-onset (age <65 years) and late-onset (age ≥ 65 years) dementia. Interaction and stratification analyses were performed for polygenic risk score and APOE.

    Results: During a median follow-up of 12.4 years, 6,415 incident dementia cases were diagnosed. Eleven digestive system diseases showed significant associations with an increased risk of dementia after controlling for covariates and multiple testing. Compared with hazard ratios for individuals without digestive system diseases, the hazard ratios of dementia increased from 1.15 (95% confi- dence interval=1.09, 1.23) for patients with intestinal diverticular disease to 2.31 (95% confidence interval=1.98, 2.70) for patients with cirrhosis. The associations were different between certain digestive system diseases and dementia by onset age. The associations appeared to be stronger for cirrhosis (Q=0.001), irritable bowel syndrome (Q<0.001), gastritis and duodenitis (Q=0.002), gastroesophageal reflux disease (Q<0.001), ulcerative colitis (Q=0.047), gallbladder disease (Q=0.012), and peptic ulcer (Q=0.030) with early-onset dementia. There were no interactions for polygenic risk score or APOE (p>0.05).

    Conclusions: These findings suggest an increased need for dementia prevention among patients with digestive system diseases.

  • 11. Yuan, Shuai
    et al.
    Dan, Lintao
    Zhang, Yao
    Wu, Jing
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Zhao, Jianhui
    Kivipelto, Miia
    Chen, Jie
    Ludvigsson, Jonas F.
    Li, Xue
    Larsson, Susanna C.
    Digestive System Diseases, Genetic Risk, and Incident Dementia: A Prospective Cohort Study2024In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 66, no 3, p. 516-525Article in journal (Refereed)
    Abstract [en]

    Introduction: Although digestive system disease affects gut microbiota and their metabolites associated with dementia risk, the association between digestive system diseases and incident dementia has not yet been established.

    Methods: This cohort analysis included 458,181 participants free of baseline dementia in the UK Biobank (2006–2021). The associations of 14 digestive system diseases with dementia incidence were examined in 2022 using Cox proportional hazards regression models. Analyses were performed to differentiate the associations for early-onset (age <65 years) and late-onset (age ≥65 years) dementia. Interaction and stratification analyses were performed for polygenic risk score and APOE.

    Results: During a median follow-up of 12.4 years, 6,415 incident dementia cases were diagnosed. Eleven digestive system diseases showed significant associations with an increased risk of dementia after controlling for covariates and multiple testing. Compared with hazard ratios for individuals without digestive system diseases, the hazard ratios of dementia increased from 1.15 (95% confidence interval=1.09, 1.23) for patients with intestinal diverticular disease to 2.31 (95% confidence interval=1.98, 2.70) for patients with cirrhosis. The associations were different between certain digestive system diseases and dementia by onset age. The associations appeared to be stronger for cirrhosis (Q=0.001), irritable bowel syndrome (Q<0.001), gastritis and duodenitis (Q=0.002), gastroesophageal reflux disease (Q<0.001), ulcerative colitis (Q=0.047), gallbladder disease (Q=0.012), and peptic ulcer (Q=0.030) with early-onset dementia. There were no interactions for polygenic risk score or APOE (p>0.05).

    Conclusions: These findings suggest an increased need for dementia prevention among patients with digestive system diseases.

  • 12. Yuan, Shuai
    et al.
    Yu, Hong-Jie
    Liu, Ming-Wei
    Tang, Bo-Wen
    Zhang, Jie
    Gasevic, Danijela
    Larsson, Susanna C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    He, Qi-Qiang
    Fat Intake and Hypertension Among Adults in China: The Modifying Effects of Fruit and Vegetable Intake.2020In: American Journal of Preventive Medicine, ISSN 0749-3797, E-ISSN 1873-2607, Vol. 58, no 2, p. 294-301, article id S0749-3797(19)30409-XArticle in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Evidence on the combined effect of fruit and vegetable intake and total fat intake on hypertension is scarce. This study aimed to explore the relationship among fruit and vegetable intake, fat intake, and hypertension risk among Chinese adults.

    METHODS: Individuals who participated in the China Health and Nutrition Survey (2004, 2006, 2009, and 2011) and were free of hypertension at baseline (n=4,368) were categorized into quartiles (Q1, lowest; Q4, highest) according to their dietary fruit and vegetable intake and fat intake. Generalized estimation equation models, adjusted for confounders, were used to explore the relationship of fat intake with hypertension and systolic and diastolic blood pressure among all adults and within quartiles of fruit and vegetable intake. Data analyses were performed in 2018.

    RESULTS: A total of 1,086 adults developed hypertension during follow-up. In the total population, the OR of the highest quartile of fat intake was 1.40 (95% CI=1.12, 1.75) compared with the lowest. Among individuals with low fruit and vegetable intake, the odds of hypertension for those in Q3 (OR=1.97, 95% CI=1.37, 2.83) and Q4 (OR=1.81, 95% CI=1.14, 2.90) of fat intake, compared with individuals in Q1, were even higher than for the overall sample. For each 50-gram increase in FI per day, the ORs of hypertension increased from fat intake Q1 to Q4 among all respondents and those with low fruit and vegetable intake, but not among those with high fruit and vegetable intake. Systolic blood pressure increased by 1.08 mm Hg (95% CI=0.03, 2.13) per 50-gram fat intake per day increment in the fruit and vegetable intake Q1 group, whereas the association was not significant in the fruit and vegetable intake Q2-Q4 groups.

    CONCLUSIONS: Fruit and vegetable intake modifies the relationship between fat intake and hypertension, whereby high fruit and vegetable intake may offset the detrimental effect of fat intake on hypertension. Increased fruit and vegetable intake and controlled fat intake are recommended to prevent hypertension in Chinese adults.

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