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  • 1. Amundadottir, Laufey T.
    et al.
    Sulem, Patrick
    Gudmundsson, Julius
    Helgason, Agnar
    Baker, Adam
    Agnarsson, Bjarni A.
    Sigurdsson, Asgeir
    Benediktsdottir, Kristrun R.
    Cazier, Jean-Baptiste
    Sainz, Jesus
    Jakobsdottir, Margret
    Kostic, Jelena
    Magnusdottir, Droplaug N.
    Ghosh, Shyamali
    Agnarsson, Kari
    Birgisdottir, Birgitta
    Le Roux, Louise
    Olafsdottir, Adalheidur
    Blondal, Thorarinn
    Andresdottir, Margret
    Gretarsdottir, Olafia Svandis
    Bergthorsson, Jon T.
    Gudbjartsson, Daniel
    Gylfason, Arnaldur
    Thorleifsson, Gudmar
    Manolescu, Andrei
    Kristjansson, Kristleifur
    Geirsson, Gudmundur
    Isaksson, Helgi
    Douglas, Julie
    Johansson, Jan-Erik
    Bälter, Katarina
    Karolinska institutet, Sweden.
    Wiklund, Fredrik
    Montie, James E.
    Yu, Xiaoying
    Suarez, Brian K.
    Ober, Carole
    Cooney, Kathleen A.
    Gronberg, Henrik
    Catalona, William J.
    Einarsson, Gudmundur V.
    Barkardottir, Rosa B.
    Gulcher, Jeffrey R.
    Kong, Augustine
    Thorsteinsdottir, Unnur
    Stefansson, Kari
    A common variant associated with prostate cancer in European and African populations2006In: Nature Genetics, ISSN 1061-4036, E-ISSN 1546-1718, Vol. 38, no 6, p. 652-658Article in journal (Refereed)
    Abstract [en]

    With the increasing incidence of prostate cancer, identifying common genetic variants that confer risk of the disease is important. Here we report such a variant on chromosome 8q24, a region initially identified through a study of Icelandic families. Allele -8 of the microsatellite DG8S737 was associated with prostate cancer in three case-control series of European ancestry from Iceland, Sweden and the US. The estimated odds ratio ( OR) of the allele is 1.62 (P = 2.7 x 10(-11)). About 19% of affected men and 13% of the general population carry at least one copy, yielding a population attributable risk ( PAR) of similar to 8%. The association was also replicated in an African American case-control group with a similar OR, in which 41% of affected individuals and 30% of the population are carriers. This leads to a greater estimated PAR (16%) that may contribute to higher incidence of prostate cancer in African American men than in men of European ancestry.

  • 2.
    Augustsson, Katarina
    et al.
    Karolinska institutet, Sweden.
    Lindblad, J
    Overvik, E
    Steineck, G
    A population-based dietary inventory of cooked meat and assessment of the daily intake of food mutagens1999In: Food Additives and Contaminants, ISSN 0265-203X, E-ISSN 1464-5122, Vol. 16, no 5, p. 215-225Article in journal (Refereed)
    Abstract [en]

    Frequent consumption of meat has been associated with an increased risk of colorectal cancer. Such a risk may be due to naturally occurring compounds in the meat, substances added to the meat, or agents formed during cooking. Concerning the latter alternative, mutagenic heterocyclic amines are multi-site animal carcinogens, but their relevance to human cancer has yet to be determined. In the present study, we made a population-based inventory of cooked meat dishes consumed in the county of Stockholm, ranked dishes according to cooking method and frequency of consumption and, in addition, determined levels of mutagenic activity in six commonly consumed fried meat dishes. Meat was consumed, on average, 493 times per year, giving 1.4 daily servings. Frying was the most common way to cook meat. When ranking meat dishes according to intake frequency, the top eight dishes were as follows. sausage, steak casserole, meatballs, pork chops, pork belly, bacon, ground beef patties, and, finally, mincemeat sauce. The frying sessions were pel;formed under controlled conditions at four different temperatures, and we documented the degree of surface browning and measured mutagenic activity in six frequently eaten dishes (sausage, meatballs, pork chops, pork belly, ground beef patties, and minute beef). We found extracts from all six dishes to be mutagenic, and a mean daily dose of exposure was calculated, giving 862 revertants. This investigation leaves no doubt that a major portion of the total meat consumption is fried before ingestion and that fried meat dishes frequently consumed by an elderly population in Stockholm contain mutagenic substances. Furthermore, the study provides usable information for future epidemiological research in which it is necessary to disentangle the effect of meat per se from the effect of potentially carcinogenic heterocyclic amines.

  • 3.
    Augustsson, Katarina
    et al.
    Karolinska institutet, Sweden.
    Michaud, D S
    Rimm, E B
    Leitzmann, M F
    Stampfer, M J
    Willett, W C
    Giovannucci, E
    A prospective study of intake of fish and marine fatty acids and prostate cancer2003In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 12, no 1, p. 64-67Article in journal (Refereed)
    Abstract [en]

    Experimental studies suggest that marine fatty acids have an antitumor effect on prostate tumor cells. The aim of this study was to investigate whether high consumption of fish and marine fatty acids reduces the risk of prostate cancer in humans. We followed 47,882 men participating in the Health Professionals Follow-up Study. Dietary intake was assessed in 1986, 1990, and 1994, using a validated food frequency questionnaire. During 12 years of follow-up, 2,482 cases of prostate cancer were diagnosed, of which 617 were diagnosed as advanced prostate cancer including 278 metastatic prostate cancers. Eating fish more than three times per week was associated with a reduced risk of prostate cancer, and the strongest association was for metastatic cancer (multivariate relative risk, 0.56; 95% confidence interval, 0.37-0.86, compared with infrequent consumption, i.e., less than twice per month). Intake of marine fatty acids from food showed a similar but weaker association. Each additional daily intake of 0.5 g of marine fatty acid from food was associated with a 24% decreased risk of metastatic cancer. We found that men with high consumption of fish had a lower risk of prostate cancer, especially for metastatic cancer. Marine fatty acids may account for part of the effect, but other factors in fish may also play a role.

  • 4.
    Augustsson, Katarina
    et al.
    Karolinska institutet, Sweden.
    Skog, K
    Jagerstad, M
    Dickman, P W
    Steineck, G
    Dietary heterocyclic amines and cancer of the colon, rectum, bladder, and kidney: a population-based study1999In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 353, no 9154, p. 703-707Article in journal (Refereed)
    Abstract [en]

    Background Heterocyclic amines formed in cooked meat and fish are carcinogenic in animal models and form DNA adducts in human beings. We undertook a study to assess whether these substances are related to the risks of cancer in the large bowel and urinary tract. Methods In a population-based case-control study, cases were identified from the Swedish cancer registry. Controls were randomly selected from the population register. Information on intake of various foods and was assessed by questionnaire, with photographs of foods cooked at various temperatures. We measured the content of heterocyclic amines in foods cooked under these conditions. Findings Information was retrieved from 553 controls, 352 cases of colon cancer, 249 cases of rectal cancer, 273 cases of bladder cancer, and 138 cases of kidney cancer. The response rate was 80% for controls and 70% for cases. The estimated daily median intake of heterocyclic amines was 77 ng for controls, and 66 ng, 63 ng, 96 ng, and 84 ng for cases with cancer of the colon, rectum, bladder, and kidney, respectively. The relative risk for the intake of heterocyclic amines (highest vs lowest quintile) was 0.6 (95% CI 0.4-1.0) for colon cancer, 0.7 (0.4-1.1) for rectal cancer, 1.2 (0.7-2.1) for bladder cancer, and 1.0 (0.5-1.9) for kidney cancer. Seven cases, but no controls, had an estimated daily intake of heterocyclic amines above 1900 ng. Interpretation Intake of heterocyclic amines, within the usual dietary range in this study population, is unlikely to increase the incidence of cancer in the colon, rectum, bladder, or kidney. For daily intakes above 1900 ng, our data are consistent with human carcinogenicity, but the precision was extremely low.

  • 5.
    Augustsson, Katarina
    et al.
    Karolinska institutet, Sweden.
    Skog, K
    Jagerstad, M
    Steineck, G
    Assessment of the human exposure to heterocyclic amines1997In: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 18, no 10, p. 1931-1935Article in journal (Refereed)
    Abstract [en]

    Heterocyclic amines are possible human carcinogens and fried meat is an important source of exposure in the Western diet, To study the effect of heterocyclic amines in humans, accurate assessment of individual food consumption is essential, Parameters influencing the intake include the amount and type of meat ingested, frequency of consumption, cooking method, cooking temperature and the duration of cooking, The aim of the present study was to develop a practical method for assessing individual intakes of specific heterocyclic amines in a large sample of people, This has been done by combining information on food consumption and laboratory findings of heterocyclic amines in food products, Diet was assessed using a semi-quantitative food frequency questionnaire including photos of fried meat and, in all, 22 dishes were cooked and chemically analyzed. The method was employed in an elderly population in Stockholm to estimate the daily mean intake of the five heterocyclic amines 2-amino-3-methylimidazo[4,5-f]quinoline (IQ), 2-amino-3,4-dimethylimidazo [4,5-f]quinoline (MeIQ), 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-3,4,8-trimethylimidazo [4,5-f]quinoxaline (DiMeIQx) and 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), The total daily intake ranged from none to 1816 ng, with a mean intake of 160 ng, which is well below estimates reported previously, Highest amounts ingested were of PhIP (mean 72, range 0-865 ng/day) and MeIQx (mean 72, range 0-1388 ng/day), followed by DiMeIQx (mean 16, range 0-171 ng/day), while MeIQ and IQ were ingested only in very small amounts (mean <1 ng/day).

  • 6. Balter, O
    et al.
    Bälter, Katarina
    Demands on web survey tools for epidemiological research2005In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 20, no 2, p. 137-139Article in journal (Refereed)
    Abstract [en]

    In countries where the Internet access is high, a web-based questionnaire could save time and money compared to printed questionnaires, mainly by eliminating the two steps of transferring answers from printed to a digital data set and manually completing missing and impossible answers. However, many of the features wanted for conducting large epidemiological studies are not available in many web survey systems. Here we describe design issues the investigator needs to be aware of when using web-based questionnaires in epidemiological research.

  • 7.
    Balter, Olle
    et al.
    Royal Inst Technol, Sch Comp Sci & Commun, Stockholm, Sweden..
    Fondell, Elinor
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden.;Karolinska Inst, Osher Ctr Integrat Med, SE-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Feedback in web-based questionnaires as incentive to increase compliance in studies on lifestyle factors2012In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 15, no 6, p. 982-988Article in journal (Refereed)
    Abstract [en]

    Objective: We explored the use of feedback in interactive web-based questionnaires for collecting data on lifestyle factors in epidemiological studies. Design: Here we report from a cohort study on lifestyle factors and upper respiratory tract infections among 1805 men and women. We introduced interactivity in the form of personalized feedback and feedback on a group level regarding dietary intake, physical activity and incidence of infections in web-based questionnaires as incentives for the respondents to continue answering questions and stay in the study. Setting: The study was performed in Sweden. Subjects: All participants were randomly selected from the population registry. Results: Personalized feedback was offered in the baseline questionnaire and feedback on a group level in the five follow-up questionnaires. In total, 88% of the participants actively chose to get personalized feedback at least once in the baseline questionnaire. The follow-up questionnaires were sent by email and the overall compliance at each follow-up was 83-84%, despite only one reminder. In total, 74% completed all five follow-ups. However, the compliance was higher among those who chose feedback in the baseline questionnaire compared with those who did not choose feedback. Conclusions: The results show that it is possible to use feedback in web questionnaires and that it has the potential to increase compliance. The majority of the participants actively chose to take part in the personalized feedback in the baseline questionnaire and future research should focus on improving the design of the feedback, which may ultimately result in even higher compliance in research studies.

  • 8. Barrett, J H
    et al.
    Smith, G
    Waxman, R
    Gooderham, N
    Lightfoot, T
    Garner, R C
    Augustsson, Katarina
    Karolinska institutet, Sweden.
    Wolf, C R
    Bishop, D T
    Forman, D
    Investigation of interaction between N-acetyltransferase 2 and heterocyclic amines as potential risk factors for colorectal cancer2003In: Carcinogenesis, ISSN 0143-3334, E-ISSN 1460-2180, Vol. 24, no 2, p. 275-282Article in journal (Refereed)
    Abstract [en]

    Fast N-acetyltransferase 2 (NAT2) acetylators may be at increased risk of colorectal cancer through the activation of carcinogenic heterocyclic amines (HA), which are produced by meat cooked at high temperatures and are found in cigarette smoke. A study of 500 incident colorectal cancer cases and population controls, matched for age, sex and general practitioner, was conducted in the UK to investigate this hypothesis. Usual meat intake and lifetime smoking habits were estimated using a detailed questionnaire administered by interview. Subjects also indicated how well cooked they ate their meat. Subjects were classified as fast or slow NAT2 acetylators on the basis of NAT2 genotype. Complete genotype data were available on 433 matched pairs. The risk of colorectal cancer showed a steady increase with meat intake, rising to an odds ratio of 1.51 [95% confidence interval (1.03, 2.23)] for the highest versus the lowest quartile, after adjustment for total energy intake, and this was even more pronounced for red meat [odds ratio 1.97 (1.30, 2.98)]. However, this effect was not influenced by the preference for well-done meat. Smoking was also associated with an increased risk [odds ratio 1.47 (1.10, 1.98) for ever- versus never-smokers]. In both cases and controls similar to40% of subjects were classified as fast acetylators, and the risks associated with (red) meat intake and smoking did not vary with NAT2 status. This study provides no support for the hypothesis that fast NAT2 acetylators are at increased risk of colorectal cancer, even if exposed to high levels of HA from well-cooked meat or smoking.

  • 9. Bonn, S. E
    et al.
    Surkan, P. J.
    Trolle Lagerros, Y.
    Bälter, Katarina
    Karolinska institutet, Sweden.
    Feasibility of a novel web-based physical activity questionnaire for young children2012In: Pediatric Reports, ISSN 2036-749X, E-ISSN 2036-7503, Vol. 4, no 4, article id e37Article in journal (Refereed)
    Abstract [en]

    Accurate assessment of children's physical activity is critical in determining associations between childhood physical activity and health later in life. We have developed a web-based questionnaire, KidActive-Q, to assess physical activity in early childhood. The feasibility and reproducibility of KidActive-Q were assessed in a sample of 20 children aged 2 to 6 years. The questionnaire was distributed to parents via e-mail on two occasions. The median time required to complete KidActive-Q was 2.5 minutes. All the parents reported that the questionnaire was easy or very easy to fill. The intraclass correlations for test-retest reliability were 0.60 (95% confidence interval: 0.31-0.88) for daily time spent outdoors, and 0.85 (95% confidence interval: 0.72-0.97) for daily time watching television. Our results suggest that KidActive-Q is a user-friendly tool for assessing physical activity in early childhood. To our knowledge, this is the first web-based questionnaire specifically developed for young children. 

  • 10.
    Bonn, S. E.
    et al.
    Karolinska Inst, Stockholm, Sweden..
    Wiklund, F.
    Karolinska Inst, Stockholm, Sweden..
    Sjolander, A.
    Karolinska Inst, Stockholm, Sweden..
    Szulkin, R.
    Karolinska Inst, Stockholm, Sweden..
    Stattin, P.
    Umea Univ, Umea, Sweden..
    Holmberg, E.
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden..
    Gronberg, H.
    Karolinska Inst, Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Stockholm, Sweden..
    Body Mass Index and Weight Change in Men with Prostate Cancer: Progression and Mortality.2015In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 44, p. 141-142Article in journal (Other academic)
  • 11.
    Bonn, Stephanie E.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Holmberg, Erik
    Univ Gothenburg, Sahlgrenska Acad, Gothenburg, Sweden.
    Hugosson, Jonas
    Karolinska Institutet, Stockholm, Sweden.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Is leisure time sitting associated with mortality rates among men diagnosed with localized prostate cancer?2020In: European Journal of Cancer Prevention, ISSN 0959-8278, E-ISSN 1473-5709, Vol. 29, no 2, p. 134-140Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Being physically active postdiagnosis has been associated with lower rates of prostate cancer progression and mortality, but studies investigating postdiagnostic time spent sitting are lacking. We aim to study the association between leisure time sitting after a prostate cancer diagnosis and overall and prostate cancer-specific mortality. METHODS: Data from 4595 men in Sweden, diagnosed with localized prostate cancer between 1997-2002 and followed-up until the end of 2012, were analyzed. Time spent sitting during leisure time postdiagnosis was categorized into <2, 2-3, 3-4, and >4 h/day. Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CI) of postdiagnosis leisure time sitting and a joint variable of sitting time and exercise, and time to overall or prostate cancer-specific death. RESULTS: The results showed no significant associations between postdiagnostic leisure time sitting and overall or prostate cancer-specific mortality rates. When the joint effect of both sitting and exercise time was considered, borderline significantly lower mortality rates for overall and prostate cancer-specific mortality were seen among participants that sat the least and exercised the most compared to the reference category with participants sitting the most and exercising least (HR: 0.75; 95% CI: 0.56-1.00 and HR: 0.61; 95% CI: 0.36-1.05, respectively). CONCLUSIONS: No significant association between leisure time sitting and mortality rates among men diagnosed with localized prostate cancer was seen. This study does not support an association between leisure time sitting per se; however, being physically active may have beneficial effects on survival among men diagnosed with localized prostate cancer.

  • 12.
    Bonn, Stephanie E.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Sjolander, Arvid
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Lagerros, Ylva Trolle
    Karolinska Inst, Dept Med, Clin Epidemiol Unit, S-17177 Stockholm, Sweden..
    Wiklund, Fredrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Stattin, Par
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Holmberg, Erik
    Univ Gothenburg, Inst Clin Sci, Dept Oncol, Sahlgrenska Acad, Gothenburg, Sweden..
    Gronberg, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Physical Activity and Survival among Men Diagnosed with Prostate Cancer2015In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 24, no 1, p. 57-64Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have investigated the association between post-diagnosis physical activity and mortality among men diagnosed with prostate cancer. The aim of this study was to investigate the effect of physical activity after a prostate cancer diagnosis on both overall and prostate cancer-specific mortality in a large cohort. Methods: Data from 4,623 men diagnosed with localized prostate cancer 1997-2002 and followed-up until 2012 were analyzed. HRs with 95% confidence intervals (CI) were estimated using Cox proportional hazards models to examine the association between post-diagnosis recreational MET-h/d, time spent walking/bicycling, performing household work or exercising, and time to overall and prostate cancer-specific death. All models were adjusted for potential confounders. Results: During the follow-up, 561 deaths of any cause and 194 deaths from prostate cancer occurred. Statistically significantly lower overall mortality rates were found among men engaged in 5 recreationalMET-h/d (HR, 0.63; 95% CI, 0.52-0.77), walking/ bicycling 20 min/d (HR, 0.70; 95% CI, 0.57-0.86), performing householdwork > 1 h/d (HR, 0.71; 95% CI, 0.59-0.86), or exercising > 1 h/wk (HR, 0.74; 95% CI, 0.61-0.90), compared with less active men within each activity type. For prostate cancer-specific mortality, statistically significantly lower mortality rates were seen among men walking/bicycling >= 20 min/d (HR, 0.61; 95% CI, 0.43-0.87) or exercising 1 h/wk (HR, 0.68; 95% CI, 0.48-0.94). Conclusions: Higher levels of physical activity were associated with reduced rates of overall and prostate cancer-specific mortality. Impact: Our study further strengthens previous results indicating beneficial effects of physical activity on survival among men with prostate cancer. Cancer Epidemiol Biomarkers Prev; 24(1); 57-64. (C) 2014 AACR.

  • 13.
    Bonn, Stephanie E.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Sjolander, Arvid
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Tillander, Annika
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Wiklund, Fredrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Gronberg, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12A, S-17177 Stockholm, Sweden.;Stanford Univ, Stanford Prevent Res Ctr, Stanford, CA 94305 USA..
    Body mass index in relation to serum prostate-specific antigen levels and prostate cancer risk2016In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 139, no 1, p. 50-57Article in journal (Refereed)
    Abstract [en]

    High Body mass index (BMI) has been directly associated with risk of aggressive or fatal prostate cancer. One possible explanation may be an effect of BMI on serum levels of prostate-specific antigen (PSA). To study the association between BMI and serum PSA as well as prostate cancer risk, a large cohort of men without prostate cancer at baseline was followed prospectively for prostate cancer diagnoses until 2015. Serum PSA and BMI were assessed among 15,827 men at baseline in 2010-2012. During follow-up, 735 men were diagnosed with prostate cancer with 282 (38.4%) classified as high-grade cancers. Multivariable linear regression models and natural cubic linear regression splines were fitted for analyses of BMI and log-PSA. For risk analysis, Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) and natural cubic Cox regression splines producing standardized cancer-free probabilities were fitted. Results showed that baseline Serum PSA decreased by 1.6% (95% CI: -2.1 to -1.1) with every one unit increase in BMI. Statistically significant decreases of 3.7, 11.7 and 32.3% were seen for increasing BMI-categories of 25<30, 30<35 and 35 kg/m(2), respectively, compared to the reference (18.5<25 kg/m(2)). No statistically significant associations were seen between BMI and prostate cancer risk although results were indicative of a positive association to incidence rates of high-grade disease and an inverse association to incidence of low-grade disease. However, findings regarding risk are limited by the short follow-up time. In conclusion, BMI was inversely associated to PSA-levels. BMI should be taken into consideration when referring men to a prostate biopsy based on serum PSA-levels. What's new? High body mass index (BMI) has been associated with risk of aggressive or fatal prostate cancer. One possible explanation may be an effect on serum prostate-specific antigen (PSA) levels. Here, the authors assessed the association between BMI and serum PSA level and prostate cancer risk in a large prospective cohort study. While no statistically significant associations were found between BMI and overall risk of prostate cancer, increasing BMI was associated with decreased serum PSA levels among men with no previous prostate cancer diagnosis. BMI should be taken into consideration when referring men to a prostate biopsy based on PSA-test results.

  • 14.
    Bonn, Stephanie E.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Wiklund, Fredrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Sjolander, Arvid
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Szulkin, Robert
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Stattin, Par
    Umea Univ, Dept Surg & Perioperat Sci Urol & Androl, Umea, Sweden..
    Holmberg, Erik
    Univ Gothenburg, Dept Oncol, Inst Clin Sci, Sahlgrenska Acad, Gothenburg, Sweden..
    Gronberg, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Body mass index and weight change in men with prostate cancer: progression and mortality2014In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 25, no 8, p. 933-943Article in journal (Refereed)
    Abstract [en]

    Body mass index (BMI) is a modifiable lifestyle factor that has been associated with an increased risk of fatal prostate cancer and biochemical recurrence. The main purpose of the present study was to investigate the association between the exposure BMI at the time of a prostate cancer diagnosis and weight change after diagnosis, and the outcomes of prostate cancer progression and mortality in a large cohort study. Data from 4,376 men diagnosed with clinically localized prostate cancer between 1997 and 2002 were analyzed. BMI and weight change were self-reported in 2007. Hazard ratios (HRs) with 95 % confidence intervals (CIs) were estimated in complete-case analysis (n = 3,214) using Cox proportional hazards models. Progression was experienced among 639 (14.6 %) of the study participants, and in total, 450 (10.3 %) deaths of any cause and 134 (3.1 %) prostate cancer-specific deaths were recorded during follow-up. Obese men had a 47 % increased rate of overall mortality compared to normal weight men (HR 1.47, 95 % CI 1.03-2.10). No statistically significant associations were found for BMI and prostate cancer progression or prostate cancer-specific mortality. A weight loss > 5 % after diagnosis almost doubled the rate of overall mortality compared to maintaining a stable weight (HR 1.94, 95 % CI 1.41-2.66), while a weight gain > 5 % was associated with an almost doubled increased rate of prostate cancer-specific mortality (HR 1.93, 95 % CI 1.18-3.16). Being obese was associated with an increased rate of overall mortality, and gaining weight after a prostate cancer diagnosis was associated with an increased rate of prostate cancer-specific mortality.

  • 15.
    Bonn, Stephanie Erika
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12a, SE-17177 Stockholm, Sweden..
    Bergman, Patrick
    Linnaeus Univ, Dept Sport Sci, Kalmar, Sweden..
    Lagerros, Ylva Trolle
    Karolinska Inst, Dept Med, Clin Epidemiol Unit, SE-17177 Stockholm, Sweden.;Karolinska Univ, Huddinge Hosp, Dept Endocrinol Metab & Diabet, Stockholm, Sweden..
    Sjolander, Arvid
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12a, SE-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Nobels Vag 12a, SE-17177 Stockholm, Sweden..
    A Validation Study of the Web-Based Physical Activity Questionnaire Active-Q Against the GENEA Accelerometer2015In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 4, no 3, article id UNSP e86Article in journal (Refereed)
    Abstract [en]

    Background: Valid physical activity assessment in epidemiological studies is essential to study associations with various health outcomes. Objective: To validate the Web-based physical activity questionnaire Active-Q by comparing results of time spent at different physical activity levels with results from the GENEA accelerometer and to assess the reproducibility of Active-Q by comparing two admissions of the questionnaire Methods: A total of 148 men (aged 33 to 86 years) responded to Active-Q twice and wore the accelerometer during seven consecutive days on two occasions. Time spent on six different physical activity levels including sedentary, light (LPA), moderate (MPA), and vigorous (WA) as well as additional combined categories of sedentary-to-light and moderate-to-vigorous (MVPA) physical activity was assessed. Validity of Active-Q was determined using Spearman correlation coefficients with 95% confidence intervals (CI) and the Bland-Altman method. Reproducibility was assessed using intraclass correlation coefficients (ICCs) comparing two admissions of the questionnaire Results: The validity correlation coefficients were statistically significant for time spent at all activity levels; sedentary (r=0.19, 95% CI: 0.04-0.34), LPA (r=0.15, 95% CI: 0.00-0.31), sedentary-to-light (r=0.35, 95% CI: 0.19-0.51), MPA (r=0.27, 95% CI: 0.12-0.42), WA (r=0.54, 95% CI: 0.42-0.67), and MVPA (r=0.35, 95% CI: 0.21-0.48). The Bland-Altman plots showed a negative mean difference for time in LPA and positive mean differences for time spent in MPA, WA and MVPA. The ICCs of test-retest reliability ranged between r=0.51-0.80 for the different activity levels in Active-Q. Conclusions: More moderate and vigorous activities and less light activities were reported in Active-Q compared to accelerometer measurements. Active-Q shows comparable validity and reproducibility to other physical activity questionnaires used today.

  • 16.
    Bonn, Stephanie Erika
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Lagerros, Ylva Trolle
    Karolinska Inst, Dept Med, Clin Epidemiol Unit, SE-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    How Valid are Web-Based Self-Reports of Weight?2013In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 15, no 4, article id UNSP e52Article in journal (Refereed)
    Abstract [en]

    Background: Many studies rely on self-reported anthropometric data. While paper-based self-reports have been the standard collection mode, the number of studies collecting self-reported data via the Web is increasing rapidly. Although numerous studies have shown good agreement between self-reported and measured weight using paper-based questionnaires, the validity of using the Web to inquire about weight is unknown. Objective: The objective of this study was to validate Web-based self-reports of bodyweight compared to weight measured at the study center. Methods: The validity of weight self-reported via the Web was assessed by comparing self-reports against measurements of weight in a convenience sample of 149 individuals (77.2% women, 115/149), aged 20-65 years. Study participants self-reported their weight via a Web-based questionnaire and thereafter had their weight measured in the research center. Results: The Spearman correlation coefficient between self-reported and measured weight was 0.98 (P<.001). The mean difference between self-reported and measured weight was -1.2 (SD 2.6) kg. There was a statistically significant difference between self-reported and measured weight with the self-reported being lower (P<.001). Subjects with a body mass index (BMI) >= 25 kg/m(2), and subjects >= 30 years of age, under-reported their weight statistically significantly more than subjects with a BMI <25 kg/m(2), and subjects <30 years of age, respectively. Conclusions: Our results show that self-reported weight via the Web can be a valid method of data collection.

  • 17.
    Bonn, Stephanie Erika
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Lagerros, Ylva Trolle
    Karolinska Inst, Clin Epidemiol Unit, Dept Med, SE-17177 Stockholm, Sweden..
    Christensen, Sara Elisabeth
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Moller, Elisabeth
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Wright, Antony
    MRC, Cambridge, England..
    Sjolander, Arvid
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Active-Q: Validation of the Web-Based Physical Activity Questionnaire Using Doubly Labeled Water2012In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 14, no 1, article id e29Article in journal (Refereed)
    Abstract [en]

    Background: Increased use of the Internet provides new opportunities for collecting data in large studies. The aim of our new Web-based questionnaire, Active-Q, is to assess total physical activity and inactivity in adults. Active-Q assesses habitual activity during the past year via questions in four different domains: (1) daily occupation, (2) transportation to and from daily occupation, (3) leisure time activities, and (4) sporting activities. Objective: The objective of our study is to validate Active-Q's energy expenditure estimates using the doubly labeled water (DLW) method, and to assess the reproducibility of Active-Q by comparing the results of the questionnaire completed by the same group on two occasions. Methods: The validity and reproducibility of Active-Q were assessed in a group of 37 individuals, aged 20 to 65 years. Active-Q was distributed via email to the participants. The total energy expenditure of the participants was assessed using DLW for 11 consecutive days. Results: The median time to complete Active-Q was 6.1 minutes. The majority of participants (27/37, 73%) reported that the questionnaire was "easy" or "very easy" to answer. On average, Active-Q overestimated the total daily energy expenditure by 440 kJ compared with the DLW. The Spearman correlation between the two methods was r = 0.52 (P < .001). The intraclass correlation coefficient for total energy expenditure between the results of Active-Q completed on two occasions was 0.83 (95% CI 0.73-0.93). Conclusions: Active-Q is a valid and reproducible method of assessing total energy expenditure. It is also a user-friendly method and suitable for Web-based data collection in large epidemiological studies.

  • 18.
    Brown, David A.
    et al.
    St Vincents Hosp, Ctr Appl Med Res, Sydney, NSW 2010, Australia.;Univ New S Wales, Sydney, NSW, Australia..
    Lindmark, Fredrik
    Umea Univ, Dept Radiat Sci, Umea, Sweden..
    Stattin, Par
    Umea Univ, Dept Surg & Preoperat Sci, Umea, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Adami, Hans-Olov
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden.;Harvard Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA..
    Zheng, Sigun L.
    Wake Forest Univ, Ctr Human Genom, Winston Salem, NC 27109 USA..
    Xu, Jianfeng
    Wake Forest Univ, Ctr Human Genom, Winston Salem, NC 27109 USA..
    Isaacs, William B.
    Johns Hopkins Univ, Dept Urol, Baltimore, MD USA..
    Gronberg, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Breit, Samuel N.
    St Vincents Hosp, Ctr Appl Med Res, Sydney, NSW 2010, Australia.;Univ New S Wales, Sydney, NSW, Australia..
    Wiklund, Fredrik E.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Macrophage Inhibitory Cytokine 1: A New Prognostic Marker in Prostate Cancer2009In: Clinical Cancer Research, ISSN 1078-0432, E-ISSN 1557-3265, Vol. 15, no 21, p. 6658-6664Article in journal (Refereed)
    Abstract [en]

    Purpose: High serum levels of macrophage inhibitory cytokine 1 (MIC-1) are strongly associated with metastatic prostate cancer, suggesting MIC-1 is a biomarker for prostate cancer prognosis. Experimental Design: We conducted a prospective cohort study of 1,442 Swedish men with a pathologically verified diagnosis of prostate cancer between 2001 and 2003. Blood was drawn either pretreatment (n = 431) or posttreatment (n = 1,011) and cases were followed for a mean time of 4.9 years (range, 0.1-6.8 years). Results: MIC-1 serum levels independently predicted poor cancer-specific survival with an almost 3-fold higher cancer death rate in patients with serum levels in the highest quartile compared with men with serum levels in the lowest quartile (adjusted hazard ratio, 2.98; 95% confidence interval, 1.82-4.68). Pretreatment MIC-1 levels revealed an even stronger association with disease outcome with an 8-fold higher death rate in the highest compared with the lowest category (adjusted hazard ratio, 7.98; 95% confidence interval, 1.73-36.86). Among patients considered to have localized disease, MIC-1 significantly increased the discriminative capacity between indolent and lethal prostate cancer compared with the established prognostic markers clinical stage, pathologic grade, and prostate-specific antigen level (P = 0.016). A sequence variant in the MIC-1 gene was associated with decreased MIC-1 serum levels (P = 0.002) and decreased prostate cancer mortality (P = 0.003), suggesting a causative role of MIC-1 in prostate cancer prognosis. Conclusions: Serum MIC-1 concentration is a novel biomarker capable of predicting prostate cancer prognosis. (Clin Cancer Res 2009;15(21):6658-64)

  • 19.
    Buli, Benti Geleta
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Tillander, Annika
    Linköping University, Sweden.
    Fell, Terence
    Mälardalen University, School of Business, Society and Engineering, Industrial Economics and Organisation.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet, Sweden.
    Active Commuting and Healthy Behavior among Adolescents in Neighborhoods with Varying Socioeconomic Status: The NESLA Study2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 7, article id 3784Article in journal (Refereed)
    Abstract [en]

    (1) Background: The World Health Organization recommends active commuting as a source of physical activity. Active commuting is determined by various factors, including the socioeconomic status (SES) of families and neighborhoods, distance to schools, perceived neighborhood safety, lifestyles, and availability of walkways and biking paths. This study aimed to assess factors associated with modes of transportation to and from school among adolescents aged 16–19 living in a middle-sized city in Sweden. (2) Method: Three hundred and fourteen students, of whom 55% were females, from schools in the city of Västerås participated in the study. Printed as well as web-based self-administered questionnaires were used to collect the data. (3) Results: Adolescents living in high SES neighborhoods were 80% more likely to bike or walk to school (OR = 1.80; CI: 1.01, 3.20) than adolescents living in low SES neighborhoods. Furthermore, active commuting was associated with higher consumption of fruits and vegetables (OR = 1.77; CI: 1.05, 2.97) and less consumption of junk foods (OR = 0.43; CI: 0.26, 0.71), as compared to passive commuting. (4) Conclusions: Active commuting is a cost-effective and sustainable source of regular physical activity and should be encouraged at a societal level. 

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  • 20.
    Buli, Benti Geleta
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Mälardalen Univ, Div Publ Hlth Sci, Västerås, Sweden..
    Tillander, Annika
    Linköping Univ, Dept Comp & Informat Sci, Linköping, Sweden.
    Fell, Terence
    Mälardalen University, School of Business, Society and Engineering, Industrial Economics and Organisation.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    O3-3 Active commuting and healthy behavior among adolescents in neighborhoods with varying socioeconomic status2022In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 32, no 2Article in journal (Other academic)
  • 21.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet.
    Climate friendly food habits and risk factors for cardiovascular disease in young adults in the LifeGene study2019Conference paper (Other academic)
    Abstract [en]

    Background: Different food products, and thus also diets, are associated with various levels of greenhouse gas emission. Animal food products typically cause larger emissions than plant-based products and it would be beneficial for the climate to limit the global consumption of beef and dairy products while increasing the intake of vegetables, legumes, and grains.

    Aim: We will relate a climate friendly diet to individual risk factors for cardiovascular disease (CVD) such as overweight, triglyceride levels, HDL cholesterol levels, systolic and diastolic blood pressure and glucose levels, as well as a combination of risk factors, i.e. a proxy of the metabolic syndrome.

    Method: LCA data expressed as kilogram COequivalents per kilogram of food products (kg CO2e/kg) were linked to the dietary intake in the LifeGene study of 5,364 subjects in Sweden.

    Results: A diet generating high levels of CO2e was associated with higher BMI, waist circumference and body fat than a diet with lower levels of CO2e.

    Conclusions: A climate friendly diet is also a healthy diet i.e. a win-win situation.

  • 22.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    The importance of considering both nutrient quality and climate impact to support sustainable development2021In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 114, no 2, p. 412-413Article in journal (Refereed)
  • 23. Bälter, Katarina
    et al.
    Balter, O
    Fondell, E
    Lagerros, Y T
    Web-based and mailed questionnaires: A comparison of response rates and compliance2005In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 16, no 4, p. 577-579Article in journal (Refereed)
    Abstract [en]

    Background: We assessed response rates and compliance for a printed questionnaire and a Web questionnaire in a Swedish population-based study and explored the influence of adding personalized feedback to the Web questionnaire. Methods: We assigned 875 subjects to I of 3 groups: printed questionnaire, plain Web questionnaire, or Web questionnaire with personalized feedback. The questionnaire had 2 parts, first a general section and then a dietary section. Results: The response rate for the general section was 64% for the printed questionnaire, compared with 50% for the Web questionnaire with feedback. For the dietary questionnaire, the rates were reversed, resulting in a total response rate for the dietary questionnaire that did not differ between printed and web questionnaire with feedback. Conclusions: Interactivity in the Web questionnaire increased compliance in completion of the second section of the questionnaire. Web questionnaires can be useful for research purposes in settings in which Internet access is high.

  • 24.
    Bälter, Katarina
    et al.
    Department of Public Health, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden;Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Javan Abraham, Feben
    Department of Public Health, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Chantal, Mutimukwe
    KTH, School of Electrical Engineering and Computer Science (EECS), Human Centered Technology, Media Technology and Interaction Design, MID.
    Mugisha, Reuben
    KTH, School of Electrical Engineering and Computer Science (EECS), Human Centered Technology, Media Technology and Interaction Design, MID.
    Persson Osowski, Christine
    Department of Public Health, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Bälter, Olof
    KTH, School of Electrical Engineering and Computer Science (EECS), Human Centered Technology, Media Technology and Interaction Design, MID.
    A Web-Based Program About Sustainable Development Goals Focusing on Digital Learning, Digital Health Literacy, and Nutrition for Professional Development in Ethiopia and Rwanda: Development of a Pedagogical Method2022In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 6, no 12, p. e36585-e36585Article in journal (Refereed)
    Abstract [en]

    Background:East African countries face significant societal challenges related to sustainable development goals but have limited resources to address these problems, including a shortage of nutrition experts and health care workers, limited access to physical and digital infrastructure, and a shortage of advanced educational programs and continuing professional development.

    Objective:This study aimed to develop a web-based program for sustainable development with a focus on digital learning, digital health literacy, and child nutrition, targeting government officials and decision-makers at nongovernmental organizations (NGOs) in Ethiopia and Rwanda.

    Methods:A web-based program—OneLearns (Online Education for Leaders in Nutrition and Sustainability)—uses a question-based learning methodology. This is a research-based pedagogical method developed within the open learning initiative at Carnegie Mellon University, United States. Participants were recruited during the fall of 2020 from ministries of health, education, and agriculture and NGOs that have public health, nutrition, and education in their missions. The program was conducted during the spring of 2021.

    Results:Of the 70 applicants, 25 (36%) were selected and remained active throughout the entire program and filled out a pre- and postassessment questionnaire. After the program, of the 25 applicants, 20 (80%, 95% CI 64%-96%) participants reported that their capacity to drive change related to the sustainable development goals as well as child nutrition in their organizations had increased to large extent or to a very large extent. Furthermore, 17 (68%, 95% CI 50%-86%) and 18 (72%, 95% CI 54%-90%) participants reported that their capacity to drive change related to digital health literacy and digital learning had increased to a large extent and to a very large extent, respectively.

    Conclusions:Digital learning based on a question-based learning methodology was perceived as a useful method for increasing the capacity to drive change regarding sustainable development among government officials and decision-makers at NGOs in Ethiopia and Rwanda.

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  • 25.
    Bälter, Katarina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet , Stockholm , Sweden.
    Javan Abraham, Feben
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Mutimukwe, Chantal
    Kungliga Tekniska Högskolan, Royal Institute of Technology, Stockholm , Sweden.
    Mugisha, Reuben
    Kungliga Tekniska Högskolan, Royal Institute of Technology, Stockholm , Sweden.
    Persson Osowski, Christine
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bälter, Olle
    Kungliga Tekniska Högskolan, Royal Institute of Technology, Stockholm , Sweden.
    A Web-Based Program About Sustainable Development Goals Focusing on Digital Learning, Digital Health Literacy, and Nutrition for Professional Development in Ethiopia and Rwanda: Development of a Pedagogical Method2022In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 6, no 12, article id e36585Article in journal (Refereed)
    Abstract [en]

    Background: East African countries face significant societal challenges related to sustainable development goals but have limited resources to address these problems, including a shortage of nutrition experts and health care workers, limited access to physical and digital infrastructure, and a shortage of advanced educational programs and continuing professional development.

    Objective: This study aimed to develop a web-based program for sustainable development with a focus on digital learning, digital health literacy, and child nutrition, targeting government officials and decision-makers at nongovernmental organizations (NGOs) in Ethiopia and Rwanda.

    Methods: A web-based program—OneLearns (Online Education for Leaders in Nutrition and Sustainability)—uses a question-based learning methodology. This is a research-based pedagogical method developed within the open learning initiative at Carnegie Mellon University, United States. Participants were recruited during the fall of 2020 from ministries of health, education, and agriculture and NGOs that have public health, nutrition, and education in their missions. The program was conducted during the spring of 2021.

    Results: Of the 70 applicants, 25 (36%) were selected and remained active throughout the entire program and filled out a pre- and postassessment questionnaire. After the program, of the 25 applicants, 20 (80%, 95% CI 64%-96%) participants reported that their capacity to drive change related to the sustainable development goals as well as child nutrition in their organizations had increased to large extent or to a very large extent. Furthermore, 17 (68%, 95% CI 50%-86%) and 18 (72%, 95% CI 54%-90%) participants reported that their capacity to drive change related to digital health literacy and digital learning had increased to a large extent and to a very large extent, respectively.

    Conclusions: Digital learning based on a question-based learning methodology was perceived as a useful method for increasing the capacity to drive change regarding sustainable development among government officials and decision-makers at NGOs in Ethiopia and Rwanda.

  • 26.
    Bälter, Katarina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Johansson, Julia
    Karvonen Sheikh, Sara
    Eriksson, Camilla
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Division of Public Health, Mälardalen University, Västerås, Sweden.
    Making leisure time meaningful for adolescents: an interview study from Sweden2023In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1Article in journal (Refereed)
    Abstract [en]

    Adolescents' school performance is influenced by several factors and meaningful leisure time, especially organized activities, has great potential to impact academic results. Therefore, this study aimed to gain a greater understanding of how community actors perceive meaningful leisure time and how they work to create meaningful leisure time with the intention of increasing the chances for more adolescents completing upper secondary school. Semi-structured interviews with 14 informants, representing nine different community actors in a middle-sized city in Sweden, were conducted and analysed using content analysis. Results suggest that meaningful leisure time positively impacts adolescents' mental health through social relations, support, and guidance. Leisure is believed to have spillover effects on reducing stress, manage school demands and performance. Nevertheless, leisure time activities and school performance must be balanced with time and effort. Community actors work proactively with availability, individual approaches, and offering activities to create meaning. From a societal perspective, places to hang out with supportive adults, in particular structured activities, should be regarded as a social investment in adolescents' health and prospects, especially in deprived areas where fewer activities are available. Finally, ensuring meaningful leisure time is in line with the Convention on the Rights of the Child.

  • 27.
    Bälter, Katarina
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Moller, Elisabeth
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Fondell, Elinor
    Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA..
    The effect of dietary guidelines on cancer risk and mortality2012In: Current Opinion in Oncology, ISSN 1040-8746, E-ISSN 1531-703X, Vol. 24, no 1, p. 90-102Article, review/survey (Refereed)
    Abstract [en]

    Purpose of review Dietary guidelines are important tools for educating the general public and helping health professionals promote good health and prevent chronic diet-related diseases. However, it is of major public health relevance that the effect of the guidelines per se is evaluated to make sure that they serve their purpose. The aim of this article is to review the current research on dietary guidelines and their effect on cancer risk and mortality. Recent findings Since the last 30-40 years, most industrialized countries have had dietary guidelines. The guidelines are based on thorough reviews of the current scientific evidence regarding dietary intake and health. Potential health benefits associated with good adherence to the guidelines have been evaluated in observational studies during the last 15 years, with an increase in the number of studies during the most recent years. Summary Available data on the potential association between dietary guidelines and cancer are limited and inconclusive. A meta-analysis of studies on overall cancer risk shows no protective effect for good adherence to the dietary guidelines as compared with poor adherence. However, good adherence was associated with a 21% reduced risk of colorectal cancer, and 22% reduced cancer-specific mortality.

  • 28.
    Bälter, Katarina
    et al.
    Karolinska institutet, Sweden.
    Möller, E.
    Fondell, E.
    The effect of dietary guidelines on cancer risk and mortality.2012In: Current Opinion in Oncology, ISSN 1040-8746, E-ISSN 1531-703X, Vol. 24, no 1, p. 90-102Article in journal (Refereed)
    Abstract [en]

    Dietary guidelines are important tools for educating the general public and helping health professionals promote good health and prevent chronic diet-related diseases. However, it is of major public health relevance that the effect of the guidelines per se is evaluated to make sure that they serve their purpose. The aim of this article is to review the current research on dietary guidelines and their effect on cancer risk and mortality. Since the last 30-40 years, most industrialized countries have had dietary guidelines. The guidelines are based on thorough reviews of the current scientific evidence regarding dietary intake and health. Potential health benefits associated with good adherence to the guidelines have been evaluated in observational studies during the last 15 years, with an increase in the number of studies during the most recent years. Available data on the potential association between dietary guidelines and cancer are limited and inconclusive. A meta-analysis of studies on overall cancer risk shows no protective effect for good adherence to the dietary guidelines as compared with poor adherence. However, good adherence was associated with a 21% reduced risk of colorectal cancer, and 22% reduced cancer-specific mortality.

  • 29.
    Bälter, Katarina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Rydenstam, Tove
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Fell, Terence
    Mälardalen University, School of Business, Society and Engineering, Industrial Economics and Organisation.
    King, Abby C.
    Stanford University School of Medicine, Stanford, CA, USA.
    Geleta Buli, Benti
    Mälardalen University, School of Health, Care and Social Welfare.
    Data from an Our Voice citizen science initiative in neighborhoods with low socioeconomic status in Sweden: A proof of concept for collecting complex data2020In: Data in Brief, E-ISSN 2352-3409, Vol. 33, article id 106394Article in journal (Refereed)
    Abstract [en]

    This data article describes data from an Our Voice citizen science data collection aiming at identifying elements that facilitate or hinder physical activity among adolescents in a medium sized city in Sweden. Twenty-four adolescents from two neighborhoods with low socioeconomic status in Sweden used the Stanford Healthy Neighborhood Discovery Tool app on their phones to take photographs and record audio narratives of aspects of their neighborhood that they perceived as facilitating or hindering their physically activity. In total, 186 photos of the neighborhood elements were taken by the adolescents and thereafter the research group categorized the photos into a final set of 16 elements of which 12 described the built environment and 4 the social environment. The data collection included the combination of the following data collected using the app: photographs, geocoded data of where the photographs were taken, recorded narratives describing the photographs, positive and negative neighborhood attributes (portrayed as a happy or sad “smiley face”), and an 8-item survey. In addition, we used official statistics from the City of Västerås describing the two neighborhoods as well as the whole city. This data article is associated with the article titled “Using citizen science to understand the prerequisites for physical activity among adolescents in low socioeconomic status neighborhoods - the NESLA study”

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  • 30.
    Bälter, Katarina
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet, Stockholm, Sweden.
    Sjörs, C.
    Karolinska Institutet, Stockholm, Sweden.
    Sjölander, A.
    Karolinska Institutet, Stockholm, Sweden.
    Gardner, C.
    Stanford School of Medicine, USA.
    Hedenus, Fredrik
    Chalmers University of Technology, Sweden.
    Tillander, A.
    Karolinska Institutet, Stockholm, Sweden.
    Is a diet low in greenhouse gas emissions a nutritious diet?: - Analyses of self-selected diets in the LifeGene study2017In: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 75, no 1, article id 17Article in journal (Refereed)
    Abstract [en]

    Background: Climate change is an urgent global issue and the food sector is a major contributor to greenhouse gas emissions (GHGE). Here we study if a diet low in GHGE could be a nutritious diet compared to the Nordic Nutrition Recommendations (NNR). Methods: The environmental impact of foods from Life Cycle Assessment (LCA) data was linked to a food frequency questionnaire (FFQ) filled out by 5,364 participants in the Swedish LifeGene study. Thereafter, we calculated the daily emission of CO2 equivalents (CO2e) as well as the intake of selected nutrients associated with vegetables, fruits, meat and dairy products. The CO2e was divided into quartiles were quartile 1 corresponds to a diet generating the lowest CO2e, and quartile 4 corresponds to a diet with the highest CO2e. Results: The overall diet-related emission was 4.7kg CO2e/day and person, corresponding to 1.7 ton CO2e/year. In general, there were only small differences in nutrient intake between groups of varying levels of CO2e, regardless if the intake was analyzed as absolute intake, energy percent or as nutrient density. Moreover, adherence to NNR was high for the group with the lowest CO2e, except for saturated fat where the intake was higher than recommended for all CO2e groups. On the other hand, only the group with the lowest CO2e fulfilled recommended intake of fiber. However, none of the CO2e groups reached the recommended intake of folate and vitamin D. Conclusions: Here we show that a self-selected diet low in CO2e provides comparable intake of nutrients as a diet high in in CO2e. 

  • 31.
    Bälter, Olle
    et al.
    KTH, School of Electrical Engineering and Computer Science (EECS), Human Centered Technology, Media Technology and Interaction Design, MID.
    Jemstedt, Andreas
    KTH, School of Electrical Engineering and Computer Science (EECS), Human Centered Technology, Media Technology and Interaction Design, MID.
    Abraham, Feben Javan
    Mälardalen Univ, Dept Publ Hlth Sci, Västerås, Sweden..
    Osowski, Christine Persson
    Mälardalen Univ, Dept Publ Hlth Sci, Västerås, Sweden..
    Mugisha, Reuben
    KTH, School of Electrical Engineering and Computer Science (EECS), Human Centered Technology, Media Technology and Interaction Design, MID.
    Bälter, Katarina
    Mälardalen Univ, Dept Publ Hlth Sci, Västerås, Sweden.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Effect of Personalized Email-Based Reminders on Participants' Timeliness in an Online Education Program: Randomized Controlled Trial2023In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 7, article id e43977Article in journal (Refereed)
    Abstract [en]

    Background: Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students' study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination. Objective: The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time. Methods: Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course. Results: In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one's studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time. Conclusions: Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was-adding a few words with the page number the student ought to be on to a reminder-we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming.

  • 32.
    Bälter, Olle
    et al.
    Division of Media Technology and Interaction Design, Kungliga Tekniska Högskolan - Royal Institute of Technology, Stockholm, Sweden .
    Jemstedt, Andreas
    Division of Media Technology and Interaction Design, Kungliga Tekniska Högskolan - Royal Institute of Technology, Stockholm, Sweden .
    Javan Abraham, Feben
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Persson Osowski, Christine
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Mugisha, Reuben
    Division of Media Technology and Interaction Design, Kungliga Tekniska Högskolan - Royal Institute of Technology, Stockholm, Sweden .
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Effect of Personalized Email-Based Reminders on Participants’ Timeliness in an Online Education Program: Randomized Controlled Trial2023In: JMIR Formative Research, E-ISSN 2561-326X, Vol. 7, article id e43977Article in journal (Refereed)
    Abstract [en]

    Background: Postsecondary students need to be able to handle self-regulated learning and manage schedules set by instructors. This is particularly the case with online courses, as they often come with a limited number of social reminders and less information directly from the teacher compared to courses with physical presence. This may increase procrastination and reduce timeliness of the students. Reminders may be a tool to improve the timeliness of students’ study behavior, but previous research shows that the effect of reminders differs between types of reminders, whether the reminder is personalized or general, and depending on the background of the students. In the worst cases, reminders can even increase procrastination.

    Objective: The aim of this study was to test if personalized email reminders, as compared to general email reminders, affect the time to completion of scheduled online coursework. The personalized reminders included information on which page in the online material the participants ought to be on at the present point in time and the last page they were on during their last session. The general reminders only contained the first part of this information: where they ought to be at the present point in time.

    Methods: Weekly email reminders were sent to all participants enrolled in an online program, which included 39 professional learners from three East African countries. All participants in the Online Education for Leaders in Nutrition and Sustainability program, which uses a question-based learning methodology, were randomly assigned to either personalized or general reminders. The structure of the study was AB-BA, so that group A received personalized reminders for the first unit, then general reminders for the rest of the course, while group B started with general reminders and received personalized reminders only in the third (and last) unit in the course.

    Results: In total, 585 email reminders were distributed, of which 390 were general reminders and 195 were personalized. A Bayesian mixed-effects logistic regression was used to estimate the difference in the probability of being on time with one’s studies. The probability of being on time was 14 percentage points (95% credible interval 3%-25%) higher following personalized reminders compared to that following general reminders. For a course with 100 participants, this means 14 more students would be on time.

    Conclusions: Personalized reminders had a greater positive effect than general reminders for a group of adults working full-time while enrolled in our online educational program. Considering how small the intervention was—adding a few words with the page number the student ought to be on to a reminder—we consider this effect fairly substantial. This intervention could be repeated manually by anyone and in large courses with some basic programming.

  • 33.
    Cantarutti, Anna
    et al.
    Univ Milano Bicocca, Dept Stat & Quantitat Methods, I-20126 Milan, Italy.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bonn, Stephanie E.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Adami, Hans-Olov
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Gronberg, Henrik
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bellocco, Rino
    Univ Milano Bicocca, Dept Stat & Quantitat Methods, I-20126 Milan, Italy.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Body mass index and mortality in men with prostate cancer2015In: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 75, no 11, p. 1129-1136Article in journal (Refereed)
    Abstract [en]

    BACKGROUNDBody Mass index (BMI) has been shown to affect risk and mortality of several cancers. Prostate cancer and obesity are major public health concerns for middle-aged and older men. Previous studies of pre-diagnostic BMI have found an increased risk of prostate cancer mortality in obese patients. OBJECTIVETo study the associations between BMI at time of prostate cancer diagnosis and prostate cancer specific and overall mortality. METHODSBMI was analyzed both as a continuous variable and categorized into four groups based on the observed distribution in the cohort (BMI<22.5, 22.5<25, 25<27.5 and 27.5kg/m(2)). The association between BMI and mortality was assessed using stratified Cox proportional hazards models and by fitting regression splines for dose response analysis in 3,161 men diagnosed with prostate cancer. After 11 years of follow up via linkage to the population-based cause of death registry, we identified 1,161 (37%) deaths off which 690 (59%) were due to prostate cancer. RESULTSHigh BMI (BMI27.5kg/m(2)) was associated with a statistically significant increased risk of prostate cancer specific mortality (HR:1.44, 95%CI: 1.09-1.90) and overall mortality (HR:1.33, 95%CI: 1.09-1.63) compared to the reference group (BMI 22.5<25kg/m(2)). Additionally, men with a low BMI (<22.5kg/m(2)), had a statistically significant increased risk of prostate cancer specific mortality (HR:1.33, 95%CI: 1.02-1.74) and overall mortality (HR:1.36, 95%CI: 1.11-1.67) compared to the reference. However, this effect disappeared when men who died within the first two years of follow-up were excluded from the analyses while the increased risk of prostate cancer specific mortality and overall mortality remained statistically significant for men with a BMI27.5kg/m(2) (HR:1.44, 95%CI: 1.09-1.90 and HR: 1.33, 95%CI: 1.09-1.63, respectively). CONCLUSIONThis study showed that a high BMI at time of prostate cancer diagnosis was associated with increased overall mortality. Prostate 75: 1129-1136, 2015. (c) 2015 Wiley Periodicals, Inc.

  • 34. Chang, E T
    et al.
    Hedelin, M
    Adami, H O
    Gronberg, H
    Bälter Augustsson, Katarina
    Alcohol drinking and risk of localized versus advanced and sporadic versus familial prostate cancer in Sweden2005In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 16, no 3, p. 275-284Article in journal (Refereed)
    Abstract [en]

    Background: It is unknown whether the association of alcohol consumption with prostate cancer risk varies between localized and advanced cases, or between sporadic and familial cases. Methods: We assessed recent alcohol drinking in a population-based case-control study of Swedish men, including 1499 cases and 1130 controls. Drinking status and average volume, frequency, and type of alcohol consumed were evaluated. Unconditional logistic regression was performed to estimate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for associations between alcohol consumption and prostate cancer risk. Results: Prostate cancer cases were more likely than controls to be current or former, rather than never, drinkers. However, there was no association between recent total alcohol, beer, wine, and liquor consumption and risk of overall prostate cancer, nor advanced, sporadic, or familial prostate cancer. The OR for risk of overall disease among men who drank more than 135 g of total alcohol per week versus non-drinkers was 1.2 (95% CI: 0.9, 1.5), p(trend)=0.12. There was a marginal positive association between alcohol intake and risk of localized disease. Conclusions: We detected no association between recent alcohol consumption and risk of advanced, sporadic, or familial prostate cancer, and a borderline positive association with localized disease.

  • 35. Chang, E T
    et al.
    Hedelin, M
    Adami, H O
    Gronberg, H
    Bälter, Katarina
    Re: Zinc supplement use and risk of prostate cancer2004In: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 96, no 14, p. 1108-1108Article in journal (Refereed)
  • 36. Chang, E. T.
    et al.
    Hedelin, M.
    Adami, H. -O
    Grönberg, H.
    Bälter Augustsson, Katarina
    Karolinska institutet, Sweden.
    Leitzmann, M. F.
    Giovannucci, E.
    Re: Zinc supplement use and risk of prostate cancer (multiple letters) [1]2004In: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 96, no 14, p. 1108-1109Article in journal (Refereed)
  • 37.
    Christensen, S.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Moller, E.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bonn, S.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Lissner, L.
    Univ Gothenburg, Sahlgrenska Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Ploner, A.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Sjolander, A.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Meal-Q - a new meal-based FFQ on the web2011In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 58, p. 414-414Article in journal (Other academic)
  • 38.
    Christensen, Sara E.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Moller, Elisabeth
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Bonn, Stephanie E.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Ploner, Alexander
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Balter, Olle
    KTH Royal Inst Technol, Sch Comp Sci & Commun, Stockholm, Sweden..
    Lissner, Lauren
    Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Relative Validity of Micronutrient and Fiber Intake Assessed With Two New Interactive Meal- and Web-Based Food Frequency Questionnaires2014In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 16, no 2, article id e59Article in journal (Refereed)
    Abstract [en]

    Background: The meal-and Web-based food frequency questionnaires, Meal-Q and MiniMeal-Q, were developed for cost-efficient assessment of dietary intake in epidemiological studies. Objective: The objective of this study was to evaluate the relative validity of micronutrient and fiber intake assessed with Meal-Q and MiniMeal-Q. The reproducibility of Meal-Q was also evaluated. Methods: A total of 163 volunteer men and women aged between 20 and 63 years were recruited from Stockholm County, Sweden. Assessment of micronutrient and fiber intake with the 174-item Meal-Q was compared to a Web-based 7-day weighed food record (WFR). Two administered Meal-Q questionnaires were compared for reproducibility. The 126-item MiniMeal-Q, developed after the validation study, was evaluated in a simulated validation by using truncated Meal-Q data. Results: The study population consisted of approximately 80% women (129/163) with a mean age of 33 years (SD 12) who were highly educated (130/163, 80% with >12 years of education) on average. Cross-classification of quartiles with the WFR placed 69% to 90% in the same/adjacent quartile for Meal-Q and 67% to 89% for MiniMeal-Q. Bland-Altman plots with the WFR and the questionnaires showed large variances and a trend of increasing underestimation with increasing intakes. Deattenuated and energy-adjusted Spearman rank correlations between the questionnaires and the WFR were in the range rho=.25-.69, excluding sodium that was not statistically significant. Cross-classifications of quartiles of the 2 Meal-Q administrations placed 86% to 97% in the same/adjacent quartile. Intraclass correlation coefficients for energy-adjusted intakes were in the range of .50-.76. Conclusions: With the exception of sodium, this validation study demonstrates Meal-Q and MiniMeal-Q to be useful methods for ranking micronutrient and fiber intake in epidemiological studies with Web-based data collection.

  • 39.
    Christensen, Sara E.
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Moller, Elisabeth
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Bonn, Stephanie E.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Ploner, Alexander
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Wright, Antony
    UK Med Res Council, MRC Collaborat Ctr Human Nutr Res, Cambridge, England..
    Sjolander, Arvid
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Balter, Olle
    KTH Royal Inst Technol, Sch Comp Sci & Commun, Stockholm, Sweden..
    Lissner, Lauren
    Univ Gothenburg, Dept Publ Hlth & Community Med, Gothenburg, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Two New Meal- and Web-Based Interactive Food Frequency Questionnaires: Validation of Energy and Macronutrient Intake2013In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 15, no 6, article id UNSP e109Article in journal (Refereed)
    Abstract [en]

    Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility.

  • 40. Duggan, D.
    et al.
    Zheng, S. L.
    Knowlton, M.
    Benitez, D.
    Dimitrov, L.
    Wiklund, F.
    Robbins, C.
    Isaacs, S. D.
    Cheng, Y.
    Li, G.
    Sun, J.
    Chang, B. -L
    Marovich, L.
    Wiley, K. E.
    Bälter, Katarina
    Karolinska institutet, Sweden.
    Stattin, P.
    Adami, H. -O
    Gielzak, M.
    Yan, G.
    Sauvageot, J.
    Liu, W.
    Kim, J. W.
    Bleecker, E. R.
    Meyers, D. A.
    Trock, B. J.
    Partin, A. W.
    Walsh, P. C.
    Isaacs, W. B.
    Grönberg, H.
    Xu, J.
    Carpten, J. D.
    Two genome-wide association studies of aggressive prostate cancer implicate putative prostate tumor suppressor gene DAB2IP2007In: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 99, no 24, p. 1836-1844Article in journal (Refereed)
    Abstract [en]

    Background: The consistent finding of a genetic susceptibility to prostate cancer suggests that there are germline sequence variants predisposing individuals to this disease. These variants could be useful in screening and treatment. Methods: We performed an exploratory genome-wide association scan in 498 men with aggressive prostate cancer and 494 control subjects selected from a population-based case-control study in Sweden. We combined the results of this scan with those for aggressive prostate cancer from the publicly available Cancer Genetic Markers of Susceptibility (CGEMS) Study. Single-nucleotide polymorphisms (SNPs) that showed statistically significant associations with the risk of aggressive prostate cancer based on two-sided allele tests were tested for their association with aggressive prostate cancer in two independent study populations composed of individuals of European or African American descent using one-sided tests and the genetic model (dominant or additive) associated with the lowest value in the exploratory study. Results: Among the approximately 60000 SNPs that were common to our study and CGEMS, we identified seven that had a similar (positive or negative) and statistically significant (P<.01) association with the risk of aggressive prostate cancer in both studies. Analysis of the distribution of these SNPs among 1032 prostate cancer patients and 571 control subjects of European descent indicated that one, rs1571801, located in the DAB2IP gene, which encodes a novel Ras GTPase-activating protein and putative prostate tumor suppressor, was associated with aggressive prostate cancer (one-sided P value =. 004). The association was also statistically significant in an African American study population that included 210 prostate cancer patients and 346 control subjects (one-sided P value =. 02). Conclusion: A genetic variant in DAB2IP may be associated with the risk of aggressive prostate cancer and should be evaluated further.

  • 41.
    Fell, Terence
    et al.
    Mälardalen University, School of Business, Society and Engineering, Industrial Economics and Organisation.
    Rydenstam, Tove
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Buli, Benti Geleta
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    King, A. C.
    Stanford University School of Medicine, Stanford University, Stanford, CA, United States.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institute, Stockholm.
    Citizen science in sweden’s stigmatized neighborhoods2021In: Sustainability, E-ISSN 2071-1050, Vol. 13, no 18, article id 10205Article in journal (Refereed)
    Abstract [en]

    Based on the synthesis of outside versus inside perspectives, this paper weighs the positive attributes of the so-called deprived place against its negative media image. Applying the concept of territorial stigmatization, small-scale citizen science was conducted to gain a unique understanding of the Swedish neighborhood from within. With the United Nations’ Sustainable Development Goal 11 in mind, this approach enables researchers to reach otherwise difficult to access young urban outcasts and probe the potential to overcome their community’s lack of political influence. An overlap between local media narratives and urban outcasts’ perceptions of “drug and crime” and “football and school” was revealed. Yet, this first-generation study also painted a somewhat different picture of the stigmatized neighborhood, supplying new insights about places that matter most for marginalized young males. In this Swedish case, their pictures revealed that the local corner market, football court and youth club act as an antidote for the effects of stigmatization. This Our Voice citizen science initiative proved to be a good measure of two communities’ abilities to withstand stigmatization, which is either tainted by false perceptions from the outside or weakened by crime from within. Finally, attempting to bypass structural discrimination, citizen scientists’ findings and researchers’ conclusions were made available to students, colleagues and guests at a poster presentation hosted by Mälardalen University and to concerned politicians from Eskilstuna City Hall as well as the broader public via a local Swedish television station. 

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  • 42.
    Fondell, Elinor
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden.;Karolinska Inst, Osher Ctr Integrat Med, S-17177 Stockholm, Sweden..
    Axelsson, John
    Karolinska Inst, Osher Ctr Integrat Med, S-17177 Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden..
    Franck, Kristina
    Swedish Inst Infect Dis Control, Stockholm, Sweden..
    Ploner, Alexander
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Lekander, Mats
    Karolinska Inst, Osher Ctr Integrat Med, S-17177 Stockholm, Sweden.;Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, S-17177 Stockholm, Sweden..
    Gaines, Hans
    Swedish Inst Infect Dis Control, Stockholm, Sweden..
    Short natural sleep is associated with higher T cell and lower NK cell activities2011In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 25, no 7, p. 1367-1375Article in journal (Refereed)
    Abstract [en]

    Short sleep duration increases the risk of several diseases, possibly involving compromised immune function. However, most previous studies are based on experimentally induced sleep deprivation, and only a few have studied natural variations in sleep duration. Thus our aim was to study how natural variations in sleep duration affect immune function. In total, 36 healthy men and women, aged 20-54, donated blood; 29 on three consecutive mornings, and seven on one morning. Each morning, participants selfreported sleep duration the night prior to blood draw. General sleep patterns, physical activity and stress were also assessed. A flow-cytometric assay was used to measure natural killer cell activity (NKCA). T cell function (in response to PHA, influenza, and SEA + B), and B cell function (in response to PWM) per volume whole blood. Short sleep duration prior to blood draw (<7 h) was associated with 49% higher PHA-induced T cell function (95% CI 7/109%) and 30% lower NKCA compared with normal prior sleep (7-9 h) (95% CI -46/-8%). In addition, high perceived stress was associated with 39% higher PHA-induced T cell function (95% CI 0/94%). High general physical activity was associated with 47% increased numbers of B cells and 28% increased numbers of T cells, but not with immune function. Our results suggest strong relationships between short sleep duration and T- and NK-cell functions. The stability of the findings as well as the clinical consequences of the link between short sleep and immune function should be explored in future studies. 

  • 43.
    Fondell, Elinor
    et al.
    Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Osher Ctr Integrat Med, Stockholm, Sweden..
    Balter, Olle
    Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Karolinska Inst, Sch Comp Sci & Commun, Royal Inst Technol, Stockholm, Sweden..
    Rothman, Kenneth J.
    RTI Hlth Solut, Res Triangle Pk, NC USA.;Boston Univ, Sch Publ Hlth, Dept Epidemiol, Boston, MA USA.;Boston Univ, Sch Publ Hlth, Dept Med, Boston, MA USA..
    Bälter, Katarina
    Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Dietary Intake and Supplement Use of Vitamins C and E and Upper Respiratory Tract Infection2011In: Journal of the American College of Nutrition (Print), ISSN 0731-5724, E-ISSN 1541-1087, Vol. 30, no 4, p. 248-258Article in journal (Refereed)
    Abstract [en]

    Objective: Antioxidants are regulators of immune function and may play a role in upper respiratory tract infections (URTI). We investigated the potential effects of dietary intake from food and supplement use of vitamins C and E on the risk of self-reported URTI. Methods: We conducted a population-based cohort study of 1509 Swedish men and women ages 20 to 60 with a follow-up period of 4 months. Participants reported a total of 1181 occurrences of URTI. Poisson regression model was used to control for age, sex, and other confounding factors. Results: Among women, we found that the incidence rate ratio (IRR) for high intake of vitamin C (>200 mg/d) from food was 0.69 (95% CI 0.49-0.98) compared with low intake (<100 mg/d). This association was not seen among men, for whom the IRR was 1.16 (95% CI 0.79-1.70) for high intake of vitamin C (>150 mg/d) compared with low intake (<50 mg/d). We saw no protective effect of vitamin E from food among either men or women, but a possible protective effect of vitamin C and E supplement use among men (vitamin C, 0.69 [95% CI 0.47-1.02]; vitamin E, 0.56 [95% CI 0.33-0.95]), although not among women. Conclusion: The present study is the first observational study to suggest that intake of vitamin C from food is sufficient to lower the risk of URTI among women. In addition, it appears that supplement use of vitamin E and vitamin C may reduce the risk of URTI among men, who overall had a lower intake of vitamin C from food than women.

  • 44.
    Fondell, Elinor
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden.;Karolinska Inst, Osher Ctr Integrat Med, SE-17177 Stockholm, Sweden..
    Christensen, Sara E.
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostat, SE-17177 Stockholm, Sweden.;Royal Inst Technol, Sch Comp Sci & Commun, Stockholm, Sweden..
    Adherence to the Nordic Nutrition Recommendations as a measure of a healthy diet and upper respiratory tract infection2011In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 14, no 5, p. 860-869Article in journal (Refereed)
    Abstract [en]

    Objective: The Nordic countries have published joint dietary recommendations, the Nordic Nutrition Recommendations (NNR), since 1980. We evaluated adherence to the NNR as a measure of a healthy diet and its potential association with self-reported upper respiratory tract infection (URTI). Design: A prospective, population-based study with a follow-up period of 4 months. Dietary intake was assessed using a semi-quantitative FFQ with ninety-six items, along with other lifestyle factors, at baseline. URTI was assessed every three weeks. A Poisson regression model was used to control for age, sex and other confounding factors. Setting: A middle-sized county in northern Sweden. Subjects: Swedish men and women (n 1509) aged 20-60 years. Results: The NNR include recommendations on macronutrient proportions, physical activity and intake of micronutrients, sodium, fibre and alcohol. We found that overall adherence to the NNR was moderately good. In addition, we found that high adherence to the NNR (>5.5 adherence points) was not associated with a lower risk of URTI (incidence rate ratio (IRR) 0.89, 95% CI 0.73, 1.08) compared with low adherence (<4.5 adherence points). When investigating individual components of the NNR, only high physical activity was associated with lower URTI risk (IRR=0.82, 95% CI 0.69, 0.97) whereas none of the dietary components were associated with risk of URTI. Conclusions: Overall adherence to the NNR was moderately good. Overall adherence to the NNR was not associated with URTI risk in our study. However, when investigating individual components of the NNR, we found that high physical activity was associated with lower URTI risk.

  • 45.
    Fondell, Elinor
    et al.
    Karolinska Inst, Dept Med Epidemiol & Biostatist, S-17177 Stockholm, Sweden.;Osher Ctr Integrat Med, Karolinska Inst, Stockholm, Sweden..
    Lagerros, Ylva Trolle
    Karolinska Inst, Dept Med, Clin Epidemiol Unit, S-17177 Stockholm, Sweden..
    Sundberg, Carl Johan
    Karolinska Inst, Dept Physiol & Pharmacol, S-17177 Stockholm, Sweden..
    Lekander, Mats
    Osher Ctr Integrat Med, Karolinska Inst, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden..
    Balter, Olle
    Karolinska Inst, Dept Med Epidemiol & Biostatist, S-17177 Stockholm, Sweden.;Sch Comp Sci & Commun, Royal Inst Technol, Stockholm, Sweden..
    Rothman, Kenneth J.
    RTI Hlth Solut, Res Triangle Pk, NC USA.;Boston Univ, Dept Epidemiol, Sch Publ Hlth, Boston, MA 02215 USA.;Boston Univ, Dept Med, Sch Publ Hlth, Boston, MA 02215 USA..
    Bälter, Katarina
    Karolinska Inst, Dept Med Epidemiol & Biostatist, S-17177 Stockholm, Sweden..
    Physical Activity, Stress, and Self-Reported Upper Respiratory Tract Infection2011In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 43, no 2, p. 272-279Article in journal (Refereed)
    Abstract [en]

    FONDELL, E., Y. T. LAGERROS, C. J. SUNDBERG, M. LEKANDER, O. BALTER, K. J. ROTHMAN, and K. BALTER. Physical Activity, Stress, and Self-Reported Upper Respiratory Tract Infection. Med. Sci. Sports Exerc., Vol. 43, No. 2, pp. 272-279, 2011. Purpose: Upper respiratory tract infection (URTI) is the most common reason for seeking primary care in many countries. Still, little is known about potential strategies to reduce susceptibility. We investigated the relationships between physical activity level, perceived stress, and incidence of self-reported URTI. Methods: We conducted a population-based prospective cohort study of 1509 Swedish men and women aged 20-60 yr with a follow-up period of 4 months. We used a Web-based questionnaire to assess disease status and lifestyle factors at the start of the study. We assessed physical activity and inactivity as total MET-hours (MET task) per day and perceived stress by the 14-item Perceived Stress Scale. Participants were contacted every 3 wk via e-mail to assess incidence of URTI. They reported a total of 1181 occurrences of URTI. We used Poisson regression models to control for age, sex, and other potential confounding factors. Results: We found that high levels of physical activity (>= 55 MET.h.d(-1)) were associated with an 18% reduced risk (incidence rate ratio (IRR) = 0.82, 95% confidence interval (CI) = 0.69-0.98) of self-reporting URTI compared with low levels of physical activity (< 45 MET.h.d(-1)). This association was stronger among those reporting high levels of stress (IRR = 0.58, 95% CI = 0.43-0.78), especially among men (IRR = 0.37, 95% CI = 0.24-0.59), but absent in the group with low levels of stress. Conclusions: We found that high physical activity was associated with a lower risk of contracting URTI for both men and women. In addition, we found that highly stressed people, particularly men, appear to benefit more from physical activity than those with lower stress levels.

  • 46.
    Glympi, Alkyoni
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Chasioti, Amalia
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Karolinska Institutet, Sweden.
    Dietary interventions to promote healthy eating among office workers: A literature review2020In: Nutrients, E-ISSN 2072-6643, Vol. 12, no 12, p. 1-24, article id 3754Article, review/survey (Refereed)
    Abstract [en]

    Our aim is to review published studies on dietary interventions to promote healthy eating habits among office workers. The databases PubMed, EBSCO (MEDLINE, Academic Search Elite, CINAHL Plus, PsycARTICLES, PsycINFO), Cochrane Library, SCOPUS, and Google Scholar were searched between February and April 2019. Initially, 6647 articles were identified, and the final number of articles that met the inclusion criteria was 25. We identified four different types of interventions that included educational and/or environmental components, where environmental components provided healthy food in a work-related context. The interventions at the offices included web-based material, availability of food, provision of information in various ways, and a combination of environmental, educational and theory-based psychological approaches (i.e., multicomponent). The most commonly used designs were web-based and information interventions, respectively, which are the least expensive ways to intervene. The interventions assessed a range of outcomes, but this literature review focused on three, i.e., dietary intake, dietary behavior and health-related outcomes. Although the studies were heterogenous in terms of outcomes, design, number of participants, gender distribution and duration, all studies reported at least one positive effect. Thus, workplace dietary interventions are an unutilized area to positively influence dietary intake and health outcomes among office workers. However, the intervention needs to be tailored to the workplace.

  • 47.
    Halling Ullberg, Oskar
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Toivanen, Susanna
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
    Tillander, A.
    Department of Statistics and Machine Learning, Linköping University, Linköping, Sweden.
    Bälter, Katarina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Workplace health promotion to facilitate physical activity among office workers in Sweden2023In: Frontiers In Public Health, ISSN 2296-2565, Vol. 11, article id 1175977Article in journal (Refereed)
    Abstract [en]

    Office workers spend most of their working time being sedentary, contributing to a sedentary lifestyle that increases the risk of developing disease and disability. A gradual decline in cardiorespiratory fitness among adults, along with increased rate of non-communicable diseases across developed countries, makes the workplace an important opportunity for promoting healthy behaviors. This study aimed to investigate: how office companies in Sweden organize and provide workplace health promotion services related to physical activity; the companies' vision for providing workplace health promotion; and potential facilitators and barriers. Nine informants from eight companies participated in the study, and both qualitative and quantitative data were collected by semi-structured interviews. Informants were selected through purposive sampling in collaboration with eight companies in the office market, including companies that own and develop office buildings, shared workspaces, interior design, sustainable solutions, or consult on issues related to the office sector. The framework method was used to analyze the data in a flexible and systematic way. The results showed that workplace health promotion is implemented to maintain employee health, productivity, and employee branding. Also, a significant number of financial resources, organizational support and office space are devoted to workplace health promotion. Convenience and easy access to storage and fitness facilities are key facilitators. In conclusion, this study highlights the importance of employees' engagement in developing and improving workplace health promotion and addressing work-life balance constraints that hinder a healthy lifestyle. Removing barriers on an organizational level may improve the usage of workplace health promotion related to physical activity among office employees. Copyright © 2023 Halling Ullberg, Toivanen, Tillander and Bälter.

  • 48. Hedelin, M
    et al.
    Klint, A
    Chang, E T
    Bellocco, R
    Johansson, J E
    Andersson, S O
    Heinonen, S M
    Adlercreutz, H
    Adami, H O
    Gronberg, H
    Bälter Augustsson, Katarina
    Karolinska institutet, Sweden.
    Dietary phytoestrogen, serum enterolactone and risk of prostate cancer: the Cancer Prostate Sweden Study (Sweden)2006In: Cancer Causes and Control, ISSN 0957-5243, E-ISSN 1573-7225, Vol. 17, no 2, p. 169-180Article in journal (Refereed)
    Abstract [en]

    Based on evidence that phytoestrogens may protect against prostate cancer, we evaluated the associations between serum enterolactone concentration or dietary phytoestrogen intake and risk of prostate cancer. In our Swedish population-based case-control study, questionnaire-data were available for 1,499 prostate cancer cases and 1,130 controls, with serum enterolactone levels in a sub-group of 209 cases and 214 controls. Unconditional logistic regression was performed to estimate multivariate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with risk of prostate cancer. High intake of food items rich in phytoestrogens was associated with a decreased risk of prostate cancer. The OR comparing the highest to the lowest quartile of intake was 0.74 (95% CI: 0.57-0.95; p-value for trend: 0.01). In contrast, we found no association between dietary intake of total or individual lignans or isoflavonoids and risk of prostate cancer. Intermediate serum levels of enterolactone were associated with a decreased risk of prostate cancer. The ORs comparing increasing quartiles of serum enterolactone concentration to the lowest quartile were, respectively, 0.28 (95% CI: 0.15-0.55), 0.63 (95% CI: 0.35-1.14) and 0.74 (95% CI: 0.41-1.32). Our results support the hypothesis that certain foods high in phytoestrogens are associated with a lower risk of prostate cancer.

  • 49. Hedelin, Maria
    et al.
    Bälter Augustsson, Katarina
    Karolinska institutet, Sweden.
    Chang, Ellen T.
    Bellocco, Rino
    Klint, Asa
    Johansson, Jan-Erik
    Wiklund, Fredrik
    Thellenberg-Karlsson, Camilla
    Adami, Hans-Olov
    Gronberg, Henrik
    Dietary intake of phytoestrogens, estrogen receptor-beta polymorphisms and the risk of prostate cancer2006In: The Prostate, ISSN 0270-4137, E-ISSN 1097-0045, Vol. 66, no 14, p. 1512-1520Article in journal (Refereed)
    Abstract [en]

    BACKGROUND. The causes of prostate cancer are poorly understood, but genetic factors may be more important than for many other malignancies, and dietary phytoestrogens may be protective. Because phytoestrogens bind tightly to the estrogen receptor-beta, we conducted an epiderniologic investigation of synergistic effects between phytoestrogen intake and estrogen receptor-beta gene polymorphisms. METHODS. We performed a population-based case-control study in Sweden. All participants reported their phytoestrogen intake and donated a blood sample. We identified four haplotype-tagging single nucleotide polymorphisms (htSNPs) and genotyped these htSNPs in 1314 prostate cancer patients and 782 controls. Odds ratios were estimated by multivariate logistic regression. Interactions between phytoestrogen intake and estrogen receptor-beta SNPs on prostate cancer risk were evaluated considering both multiplicative and additive effect scales. RESULTS. We found a significant multiplicative interaction (P = 0.04) between dietary intake of phytoestrogens and a promoter SNP in the estrogen receptor-beta gene (rs 2987983-13950), but not with any of the three other htSNPs (P = 0.11, 0.69, 0.85). Among carriers of the variant promoter alleles, we found strong inverse associations with increasing intake of total phytoestrogens (odds ratio for highest vs. lowest quartile = 0.43; P for trend < 0.001), isoflavonoids (odds ratio = 0.63; P for trend = 0.05), and coumestrol (odds ratio = 0.57; P for trend = 0.003). We found no association between phytoestrogens and prostate cancer among carriers homozygous for the wild-type allele (TT). CONCLUSIONS. Our study provides strong evidence that high intake of phytoestrogens substantially reduce prostate cancer risk among men with specific polymorphic variation in the promoter region of the estrogen receptor-beta gene.

  • 50. Hedelin, Maria
    et al.
    Chang, Ellen T.
    Wiklund, Fredrik
    Bellocco, Rino
    Klint, Asa
    Adolfsson, Jan
    Shahedi, Katarina
    Xu, Jianfeng
    Adami, Hans-Olov
    Gronberg, Henrik
    Bälter Augustsson, Katarina
    Karolinska institutet, Sweden.
    Association of frequent consumption of fatty fish with prostate cancer risk is modified by COX-2 polymorphism2007In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 120, no 2, p. 398-405Article in journal (Refereed)
    Abstract [en]

    Dietary intake of marine fatty acids from fish may protect against prostate cancer development. We studied this association and whether it is modified by genetic variation in cyclooxygenase (COX)-2, a key enzyme in fatty acid metabolism and inflammation. We assessed dietary intake of fish among 1,499 incident prostate cancer cases and 1,130 population controls in Sweden. Five single nucleotide polymorphisms (SNPs) were identified and genotyped in available blood samples for 1,378 cases and 782 controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by multivariate logistic regression. Multiplicative and additive interactions between fish intake and COX-2 SNPs on prostate cancer risk were evaluated. Eating fatty fish (e.g. salmon-type fish) once or more per week, compared to never, was associated with reduced risk of prostate cancer (OR: 0.57, 95% CI: 0.43-0.76). The OR comparing the highest to the lowest quartile of marine fatty acids intake was 0.70 (95% CI: 0.51-0.97). We found a significant interaction (p < 0.001) between salmon-type fish intake and a SNP in the COX-2 gene (rs5275: +6365 T/C), but not with the 4 other SNPs examined. We found strong inverse associations with increasing intake of salmon-type fish among carriers of the variant allele (OR for once per week or more vs. never = 0.28, 95% CI: 0.18-0.45; p(trend) < 0.01), but no association among carriers of the more common allele. Frequent consumption of fatty fish and marine fatty acids appears to reduce the risk of prostate cancer, and this association is modified by genetic variation in the COX-2 gene. 

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