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  • 1351.
    Wallin, Alice
    et al.
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Box 210, S-17177 Stockholm, Sweden.
    Orsini, Nicola
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Box 210, S-17177 Stockholm, Sweden; Karolinska Inst, Publ Hlth Sci, Tomtebodavagen 18A,Widerstromska Huset, S-17177 Stockholm, Sweden.
    Forouhi, Nita G
    Univ Cambridge, Sch Clin Med, MRC, Epidemiol Unit,Inst Metab Sci, Box 285,Cambridge Biomed Campus, Cambridge CB2 0QQ, England.
    Wolk, Alicja
    Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Box 210, S-17177 Stockholm, Sweden.
    Fish consumption in relation to myocardial infarction, stroke and mortality among women and men with type 2 diabetes: A prospective cohort study2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 2, p. 590-596Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: The accumulated evidence supports an inverse association of fish consumption with cardiovascular disease and mortality, but data among patients with type 2 diabetes are sparse. We aimed to assess fish consumption in relation to myocardial infarction (MI), stroke and mortality among individuals with type 2 diabetes.

    METHODS: Women and men with diagnosed type 2 diabetes (n = 2225; aged 45-84 years) within two population-based cohorts (the Swedish Mammography Cohort and the Cohort of Swedish Men) were followed from 1998 through 2012. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs).

    RESULTS: We identified 333 incident MI events, 321 incident stroke events and 771 deaths (154 with coronary heart disease [CHD] as underlying cause) during follow-up of up to 15 years. The multivariable HRs comparing >3 servings/week with ≤3 servings/month were 0.60 (95% CI, 0.39-0.92) for MI and 1.04 (95% CI, 0.66-1.64) for stroke. HRs for total mortality were lowest for moderate fish consumption of 1-<2 servings/week (0.82; 95% CI, 0.64-1.04) and 2-3 servings/week (0.79; 95% CI, 0.61-1.01) compared with ≤3 servings/month. The corresponding HRs for CHD-related mortality were 0.53; 95% CI, 0.32-0.90 and 0.75; 95% CI, 0.45-1.27.

    CONCLUSIONS: Fish consumption was associated with lower MI incidence among individuals with type 2 diabetes, whereas no association was observed with stroke. Our data further indicated an association with lower mortality, particularly for CHD-related deaths. These findings support the current general advice on regular fish consumption also in the high risk group of type 2 diabetes patients.

  • 1352.
    Wallin, Gisela van der Ster
    et al.
    Department of Nutrition, Uppsala University, Uppsala, Sweden.
    Norring, Claes E. A.
    Department of Nutrition, Uppsala University, Uppsala, Sweden.
    Lennernäs, Maria
    Department of Nutrition, Uppsala University, Uppsala, Sweden.
    Holmgren, Sven
    Department of Nutrition, Uppsala University, Uppsala, Sweden.
    Food selection in anorectics and bulimics: Food items, nutrient content and nutrient density1995In: Journal of the American College of Nutrition (Print), ISSN 0731-5724, E-ISSN 1541-1087, Vol. 14, no 3, p. 271-277Article in journal (Refereed)
    Abstract [en]

    The food selection and nutrient intake were investigated in women with anorexia nervosa, bulimia nervosa and controls. Methods Dietary data was obtained by 24-hour recall, and 7-day recording among eating disordered patients, and by 3-day registration among controls. Results: The intake of energy and nutrients differed from controls, as expected, while there were no differences between anorectics and bulimics in this respect, except for iron. There were only minor differences among the three groups studied with respect to nutrient density. Energy percentages of protein, fat, and carbohydrates, were similar in all groups, but a subdivision of the macronutrients into respective sources showed that bulimics had a lower relative and absolute intake of carbohydrates from bread and cereals than anorectics and controls. Conclusion: Eating disorder patients, despite their marginal food intake, still met the minimum requirement for most nutrients according to the Nordic Nutrient recommendations. Abbreviations: AN = anorexia nervosa, AN/BN = anorectic bulimics, BMI = body mass index, BN = bulimia nervosa, DSM-III-R = Diagnostic and Statistical Manual of Mental Disorders, ED = eating disorder, NNR = Nordic Nutrient Recommendation

  • 1353.
    Wallin, Sanna
    et al.
    Karolinska institutet, Institutionen för folkhälsovetenskap.
    Hansson, LM
    Wilmer, M
    Heitman, Berit
    Copenhagen University Hospital Institute of Preventive Medicine, Research Unit for Dietary Studies.
    Larsson, Christel
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Rasmusen, Finn
    Karolinska institutet, Institutionen för folkhälsovetenskap.
    Swedish mothers reporting intake of healthy and unhealthy food items in a food frequency questionnaire and a food diary2011Conference paper (Refereed)
  • 1354.
    Wanby, Pär
    et al.
    Kalmar County Hospital, Sweden.
    Berglund, J.
    University Hospital of Linköping, Sweden.
    Brudin, L.
    Kalmar County Hospital, Sweden.
    Hedberg, D.
    Kalmar County Hospital, Sweden.
    Carlsson, Martin
    Kalmar County Hospital, Sweden.
    Increased ferritin levels in patients with anorexia nervosa: impact of weight gain.2016In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 21, no 3, p. 411-417Article in journal (Refereed)
    Abstract [en]

    PURPOSE: A few recent studies have found elevated ferritin levels in patients with anorexia nervosa (AN), indicating ferritin as a potential biomarker of disease severity. The purpose of this study was to study how body mass index (BMI) and changes in BMI affect plasma ferritin concentrations in Swedish patients with eating disorders.

    MATERIALS AND METHODS: In a retrospective computer search from 2009 to 2014, 662 patients with an eating disorder were identified from more than 200,000 individuals with electronic medical records. Three hundred and eighty-nine patients (374 females and 15 males) were found to have at least one p-ferritin value with a corresponding BMI value. Patients with AN were compared to a combined group consisting of patients with bulimia nervosa (BN) and patients with an eating disorder not otherwise specified (EDNOS).

    RESULTS: Patients with AN had lower BMI compared to the combined group of patients with other eating disorders (BMI = 16.5 ± 1.5, n = 77 vs. 21.0 ± 4.7, n = 312, p < 0.001). Patients with AN also had higher plasma ferritin levels (median 42 μg/L (range 3.3-310) vs. 31 μg/L (range 2.8-280); p < 0.001). As BMI increased in patients with AN, ferritin levels decreased (from a median of 40 μg/L (7-400) to 26 (4-170), n = 47; p < 0.001).

    DISCUSSION: Measuring ferritin in patients with AN could be valuable in monitoring improvements of nutritional status, but the full clinical value of following ferritin in individual patients has yet to be determined. The study also shows how research can benefit from electronically captured clinical data using electronic health records.

  • 1355. Wang, Liyun
    et al.
    Guo, Xiong
    Yi, Jianhua
    Qu, Chengjuan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Lei, Jian
    Guo, Qingquan
    Han, Jing
    The effects of long-term low selenium diet on the expression of CHST-3, CHST-12 and UST in knee cartilage of growing rats2018In: Journal of Trace Elements in Medicine and Biology, ISSN 0946-672X, E-ISSN 1878-3252, Vol. 50, p. 123-129Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the effect of low selenium diet on rat´s knee cartilage and expression of chondroitin sulfate (CS) sulfated enzymes in articular and epiphyseal-plate cartilage of rats' femur and tibia.

    METHODS: Twenty-four SD rats were randomly divided into two groups with six female and six male in each group: control group (selenium 0.18 mg/kg), and low selenium group (selenium 0.02 mg/kg). After 109 days, the rats were sacrificed. The ultrastructural changes in chondrocytes of rat knee cartilage were observed by transmission electron microscopy (TEM). The morphology and pathology changes of knee cartilage were examined by hematoxylin-eosin (HE) and toluidine blue (TB) staining. The localization and expression of enzymes involved in CS sulfation, including chondroitin 6-O-sulfotransferase 1 (CHST-3), chondroitin 4-O-sulfotransferase 2 (CHST-12) and uronyl 2-O-sulfotransferase (UST) were examined by immunohistochemical staining and semi-quantitative analysis.

    RESULTS: In low selenium group, ultrastructural changes of chondrocytes were observed in articular cartilage of femur (AF), articular cartilage of tibia (AT), epiphyseal-plate cartilage of femur (EF) and epiphyseal-plate cartilage of tibia (ET); however, no significant changes in chondrocytes number were observed in the above AF, AT, EF or ET. Moreover, reduced thickness of cartilage layer in AF, EF and ET was detected along with reduced staining areas of sulfated glycosaminoglycan in EF and ET in low selenium group. In addition, positive staining rate of CHST-3 was lower in AF, AT and EF, while positive staining rates of CHST-12 and UST were lower in AF, AT, EF and ET in low selenium group when compared with control group.

    CONCLUSIONS: Low selenium undermines the ultrastructure of chondrocytes, inhibits the normal development of cartilage and the expression of CS sulfated enzymes.

  • 1356.
    Wang, Liyun
    et al.
    School of Public Health, Health Science Center, Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Key Laboratory of Trace Elements and Endemic Diseases, Ministry of Health, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.; Shenzhen Institute, Xi'an Jiaotong University, Shenzhen, 518057, Guangzhou, People's Republic of China.
    Yin, Jiafeng
    Department of Laboratory Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, Shaanxi, China..
    Yang, Bo
    Department of Laboratory Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
    Qu, Chengjuan
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Lei, Jian
    School of Public Health, Health Science Center, Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Key Laboratory of Trace Elements and Endemic Diseases, Ministry of Health, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China;.Shenzhen Institute, Xi'an Jiaotong University, Shenzhen, 518057, Guangzhou, People's Republic of China.
    Han, Jing
    School of Public Health, Health Science Center, Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Key Laboratory of Trace Elements and Endemic Diseases, Ministry of Health, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China; Shenzhen Institute, Xi'an Jiaotong University, Shenzhen, 518057, Guangzhou, People's Republic of China.
    Guo, Xiong
    School of Public Health, Health Science Center, Key Laboratory of Environment and Gene Related Diseases of Ministry Education, Key Laboratory of Trace Elements and Endemic Diseases, Ministry of Health, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China..
    Serious selenium deficiency in the serum of patients with Kashin-Beck disease and the effect of nano-selenium on their chondrocytes2019In: Biological Trace Element Research, ISSN 0163-4984, E-ISSN 1559-0720Article in journal (Refereed)
    Abstract [en]

    To investigate selenium (Se) concentrations in serum of patients with rheumatoid arthritis (RA), osteoarthritis (OA), and Kashin-Beck disease (KBD), together with the effect of Se supplement (chondroitin sulfate [CS] nano-Se [SeCS]) on CS structure-modifying sulfotransferases in KBD chondrocyte. Fifty serum samples from each group with aged-matched (40-60 years), normal control (N), RA, OA, and KBD (25 males and females, respectively) were collected to determine Se concentrations. Furthermore, the KBD chondrocytes were divided into two groups following the intervention for 24 h: (a) non-treated KBD group and (b) SeCS-treated KBD group (100 ng/mL SeCS). The ultrastructural changes in chondrocytes were observed by transmission electron microscopy (TEM). Live/dead staining was used to observe cell viability. The expression of CS-modifying sulfotransferases including carbohydrate sulfotransferase 12, 13, and 15 (CHST-12, CHST-13, and CHST-15, respectively), and uronyl 2-O-sulfotransferase (UST) were examined by quantitative real-time polymerase chain reaction and western blotting analysis after SeCS intervention. The Se concentrations in serum of KBD, OA, and RA patients were lower than those in control. In OA, RA, and control, Se concentrations were higher in male than in female, while it is opposite in KBD. In the cell experiment, cell survival rate and mitochondrial density were increased in SeCS-treated KBD groups. Expressions of CHST-15, or CHST-12, and CHST-15 on the mRNA or protein level were significantly increased. Expression of UST slightly increased on the mRNA level, but no change was visible on the protein level. Se deficiency in serum of RA, OA, and KBD was observed. SeCS supplemented in KBD chondrocytes improved their survival rate, ameliorated their ultrastructure, and increased the expression of CS structure-modifying sulfotransferases.

  • 1357. Ward, Heather A
    et al.
    Norat, Teresa
    Overvad, Kim
    Dahm, Christina C
    Bueno-de-Mesquita, H Bas
    Jenab, Mazda
    Fedirko, Veronika
    van Duijnhoven, Fränzel J B
    Skeie, Guri
    Romaguera-Bosch, Dora
    Tjønneland, Anne
    Olsen, Anja
    Carbonnel, Franck
    Affret, Aurélie
    Boutron-Ruault, Marie-Christine
    Katzke, Verena
    Kühn, Tilman
    Aleksandrova, Krassimira
    Boeing, Heiner
    Trichopoulou, Antonia
    Lagiou, Pagona
    Bamia, Christina
    Palli, Domenico
    Sieri, Sabina
    Tumino, Rosario
    Naccarati, Alessio
    Mattiello, Amalia
    Peeters, Petra H
    Weiderpass, Elisabete
    Åsli, Lene Angell
    Jakszyn, Paula
    Ramón Quirós, J
    Sánchez, María-José
    Dorronsoro, Miren
    Huerta, José-María
    Barricarte, Aurelio
    Jirström, Karin
    Ericson, Ulrika
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Gylling, Björn
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Bradbury, Kathryn E
    Khaw, Kay-Tee
    Wareham, Nicholas J
    Stepien, Magdalena
    Freisling, Heinz
    Murphy, Neil
    Cross, Amanda J
    Riboli, Elio
    Pre-diagnostic meat and fibre intakes in relation to colorectal cancer survival in the European Prospective Investigation into Cancer and Nutrition2016In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 116, no 2, p. 316-325Article in journal (Refereed)
    Abstract [en]

    Improvements in colorectal cancer (CRC) detection and treatment have led to greater numbers of CRC survivors, for whom there is limited evidence on which to provide dietary guidelines to improve survival outcomes. Higher intake of red and processed meat and lower intake of fibre are associated with greater risk of developing CRC, but there is limited evidence regarding associations with survival after CRC diagnosis. Among 3789 CRC cases in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, pre-diagnostic consumption of red meat, processed meat, poultry and dietary fibre was examined in relation to CRC-specific mortality (n 1008) and all-cause mortality (n 1262) using multivariable Cox regression models, adjusted for CRC risk factors. Pre-diagnostic red meat, processed meat or fibre intakes (defined as quartiles and continuous grams per day) were not associated with CRC-specific or all-cause mortality among CRC survivors; however, a marginal trend across quartiles of processed meat in relation to CRC mortality was detected (P 0·053). Pre-diagnostic poultry intake was inversely associated with all-cause mortality among women (hazard ratio (HR)/20 g/d 0·92; 95 % CI 0·84, 1·00), but not among men (HR 1·00; 95 % CI 0·91, 1·09) (Pfor heterogeneity=0·10). Pre-diagnostic intake of red meat or fibre is not associated with CRC survival in the EPIC cohort. There is suggestive evidence of an association between poultry intake and all-cause mortality among female CRC survivors and between processed meat intake and CRC-specific mortality; however, further research using post-diagnostic dietary data is required to confirm this relationship.

  • 1358. Ward, Heather A.
    et al.
    Whitman, Julia
    Muller, David C.
    Johansson, Mattias
    Jakszyn, Paula
    Weiderpass, Elisabete
    Palli, Domenico
    Fanidi, Anouar
    Vermeulen, Roel
    Tjonneland, Anne
    Hansen, Louise
    Dahm, Christina C.
    Overvad, Kim
    Severi, Gianluca
    Boutron-Ruault, Marie-Christine
    Affret, Aurelie
    Kaaks, Rudolf
    Fortner, Renee
    Boeing, Heiner
    Trichopoulou, Antonia
    La Vecchia, Carlo
    Kotanidou, Anastasia
    Berrino, Franco
    Krogh, Vittorio
    Tumino, Rosario
    Ricceri, Fulvio
    Panico, Salvatore
    Bueno-de-Mesquita, H. Bas
    Peeters, Petra H.
    Nost, Therese Haugdahl
    Sandanger, Torkjel M.
    Ramon Quiros, Jose
    Agudo, Antonio
    Rodriguez-Barranco, Miguel
    Larranaga, Nerea
    Maria Huerta, Jose
    Ardanaz, Eva
    Drake, Isabel
    Brunnstrom, Hans
    Johansson, Mikael
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Grankvist, Kjell
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Travis, Ruth C.
    Freisling, Heinz
    Stepien, Magdalena
    Merritt, Melissa A.
    Riboli, Elio
    Cross, Amanda J.
    Haem iron intake and risk of lung cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort2019In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 73, no 8, p. 1122-1132Article in journal (Refereed)
    Abstract [en]

    Background: Epidemiological studies suggest that haem iron, which is found predominantly in red meat and increases endogenous formation of carcinogenic N-nitroso compounds, may be positively associated with lung cancer. The objective was to examine the relationship between haem iron intake and lung cancer risk using detailed smoking history data and serum cotinine to control for potential confounding.  

    Methods: In the European Prospective Investigation into Cancer and Nutrition (EPIC), 416,746 individuals from 10 countries completed demographic and dietary questionnaires at recruitment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident lung cancer (n = 3731) risk relative to haem iron, non-haem iron, and total dietary iron intake. A corresponding analysis was conducted among a nested subset of 800 lung cancer cases and 1489 matched controls for whom serum cotinine was available.

    Results: Haem iron was associated with lung cancer risk, including after adjustment for details of smoking history (time since quitting, number of cigarettes per day): as a continuous variable (HR per 0.3 mg/1000 kcal 1.03, 95% CI 1.00-1.07), and in the highest versus lowest quintile (HR 1.16, 95% CI 1.02-1.32; trend across quintiles: P = 0.035). In contrast, non-haem iron intake was related inversely with lung cancer risk; however, this association attenuated after adjustment for smoking history. Additional adjustment for serum cotinine did not considerably alter the associations detected in the nested case-control subset.

    Conclusions: Greater haem iron intake may be modestly associated with lung cancer risk.

  • 1359.
    Warensjö Lemming, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Liisa, Byberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Wolk, Alicja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Institute of Environmental Medicine (IMM), C6, Nutritional Epidemiology, Stockholm, Sweden.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    A comparison between two healthy diet scores, the modified Mediterranean diet score and the Healthy Nordic Food Index, in relation to all-cause and cause-specific mortality2018In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 119, no 7, p. 836-846Article in journal (Refereed)
    Abstract [en]

    High adherence to healthy diets has the potential to prevent disease and prolong life span, and healthy dietary pattern scores have each been associated with disease and mortality. We studied two commonly promoted healthy diet scores (modified Mediterranean diet score (mMED) and the Healthy Nordic Food Index (HNFI)) and the combined effect of the two scores in association with all-cause and cause-specific mortality (cancer, CVD and ischaemic heart disease). The study included 38 428 women (median age of 61 years) from the Swedish Mammography Cohort. Diet and covariate data were collected in a questionnaire. mMED and HNFI were generated and categorised into low-, medium- and high-adherence groups, and in nine combinations of these. Multivariable-adjusted hazard ratios (HR) of register-ascertained mortality and 95 % CI were calculated in Cox proportional hazards regression analysis. During follow-up (median: 17 years), 10 478 women died. In the high-adherence categories compared with low-adherence categories, the HR for all-cause mortality was 0·76 (95 % CI 0·70, 0·81) for mMED and 0·89 (95 % CI 0·83, 0·96) for HNFI. Higher adherence to mMED was associated with lower mortality in each stratum of HNFI in the combined analysis. In general, mMED, compared with HNFI, was more strongly associated with a lower cause-specific mortality. In Swedish women, both mMED and HNFI were inversely associated with all-cause and cardiovascular mortality. The combined analysis, however, indicated an advantage to be adherent to the mMED. The present version of HNFI did not associate with mortality independent of mMED score.

  • 1360. Webb, Charlotta
    et al.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Hammarroth, Solveig
    Högberg, Lotta
    Lagerqvist, Carina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rosén, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stenhammar, Lars
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Carlsson, Annelie
    High adherence to a gluten-free diet in adolescents with screening-detected celiac disease2015In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 60, no 1, p. 54-59Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate the gluten-free diet (GFD) adherenceafter one year of follow-up in children with screening-detected celiac disease (CD) in a general population. METHODS: A total of 18,325 12 year olds were invited to participate in apopulation-based CD screening (ETICS- Exploring the Iceberg of Celiacs in Sweden), of whom 13,279 participated. In 240 children, CD was detected through elevated anti-tissue transglutaminase antibodies 2 (TG2-IgA) and verified by a small-intestinal biopsy. This sub-study included the 210 children with TG2-IgAevaluated both at the initialbiopsy occasion and at the one-year follow-up. GFD adherence was evaluated by a combination of TG2-IgA measurements and self-reported adherence (n = 193). RESULTS: After one year, 83% (179/210) had normalizedTG2-IgA levels (<5U/mL). Among those who had >50 U/mL at diagnosis,25% (16/63) still had elevated TG2-IgA but for the majority their initial values were more than halved. Most reported a high level ofGFD adherence ('always' 75%(158/193) and 'often' 14%(30/193)), and 75% (145/193) reported always adhereingcombined with normalized TG2-IgA. Although reporting that they were always adherent, 13 (6.7%) had not yet normalized their TG2-IgA levels completely, however, a majority of these initially had the highestTG2-IgA levels. CONCLUSIONS: GFD adherence is high in adolescents with CD detected by screening of the general population of Swedish 12yearolds. Almost all had normalized serology and reported GFD adherenceat the one-year follow-up. However, a few adolescents whoreported GFD adherence still had elevated TG2-IgA levelssuggesting more severe disease and/or non-adherence.

  • 1361. Webb, Charlotta
    et al.
    Norström, Fredrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Myléus, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Ivarsson, Anneli
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Halvarsson, Britta
    Högberg, Lotta
    Lagerqvist, Carina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rosén, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Sandström, Olof
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Stenhammar, Lars
    Carlsson, Annelie
    Celiac disease can be predicted by high levels of anti-tissue transglutaminase antibodies in population-based screening2015In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 60, no 6, p. 787-791Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate any potential correlation between anti-tissue transglutaminase antibodies of type immunoglobulin A (tTG-IgA) and the degree of gluten induced enteropathy in children participating in a screening study for celiac disease (CD) and to assess to what extent the revised ESPGHAN (European Society for Paediatric Gastroenterology, Hepatology and Nutrition) guidelines cover this group of patients.

    METHODS: This is a sub-study of a cross-sectional CD screening study, ETICS (Exploring the Iceberg of Celiacs in Sweden), a two-phased study performed during 2005-2006 and 2009-2010. The 13,279 participating children had a blood test obtained and those with positive tTG-IgA were recommended a small intestinal biopsy. The tTG-IgA levels at the time of biopsy were compared with the assessment of the biopsy.

    RESULTS: There were 267 children included, of whom 230 were diagnosed with CD. Out of all children, 67 children had low tTG-IgA levels (<5 U/mL), whereof 55% had Marsh 3 lesions. All children with tTG-IgA levels exceeding 10 times the upper limit of normal values of 5 U/mL, i.e. 50 U/mL, were diagnosed with CD. Lowering the cut-off to 3 U/mL, all but one child with 30 U/mL got CD diagnosis.

    CONCLUSION: By adapting the revised ESPGHAN criteria, biopsies could have been omitted in a fourth of all cases. Our results indicate, that the criteria might be useful even on screened children. Further studies are needed to confirm whether the 2012 ESPGHAN guidelines should be revised to also apply to the populations being screened.

  • 1362.
    Weghuber, Daniel
    et al.
    Paracelsus Med Univ, Dept Pediat, Mullner Hauptstr 48, AT-5020 Salzburg, Austria.
    Boyland, Emma
    Univ Liverpool, Dept Psychol Sci, Appetite & Obes Res Grp, Liverpool, Merseyside, England.
    Caroli, Margherita
    Erhardt, Eva
    Univ Pecs, Dept Paediat, Pecs, Hungary.
    Frelut, Marie-Laure
    Forslund, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
    Mazur, Artur
    Univ Rzeszow, Fac Med, Rzeszow, Poland.
    Ring-Dimitriou, Susanne
    Paris Lodron Univ, Dept Sport Sci & Kinesiol, Salzburg, Austria.
    Vlachopapadopoulou, Elpis A.
    Childrens Hosp P&A Kyriakou, Dept Endocrinol, Athens, Greece.
    Thivel, David
    Clermont Auvergne Univ, Lab Metab Adaptat Exercise Physiol & Pathol Condi, Clermont Ferrand, France.
    Childhood Obesity: The Need to Translate Research into Daily Practice: Announcing the Annals of Nutrition and Metabolism as the Official Journal of the European Childhood Obesity Group2019In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 74, no 1, p. 80-82Article in journal (Other academic)
  • 1363.
    Weimann, Arved
    et al.
    Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Germany.
    Braga, Marco
    San Raffaele Hospital, Milan, Italy.
    Carli, Franco
    Department of Anesthesia, School of Nutrition, Montreal General Hospital, McGill University, Montreal, Canada.
    Higashiguchi, Takashi
    Department of Surgery & Palliative Medicine, Fujita Health University School of Medicine, Toyoake, Japan.
    Huebner, Martin
    Service de chirurgie visc erale, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
    Klek, Stanislaw
    General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Krakau, Poland.
    Laviano, Alessandro
    Dipartimento di Medicina Clinica, UOD Coordinamento Attività Nutrizione Clinica, Università di Roma La Sapienza, Roma, Italy.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Lobo, Dileep N.
    Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK.
    Martindale, Robert
    Oregon Health & Science University, Portland OR, USA.
    Waitzberg, Dan L.
    Department of Gastroenterology, School of Medicine, LIM-35, Ganep e Human Nutrition, University of Sao Paulo, Sao Paulo, Brazil.
    Bischoff, Stephan C.
    Institut für Ernährungsmedizin (180), Universität Hohenheim, Stuttgart, Germany.
    Singer, Pierre
    Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
    ESPEN guideline: Clinical nutrition in surgery2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 3, p. 623-650Article in journal (Refereed)
    Abstract [en]

    Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidanc'e of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include:

    integration of nutrition into the overall management of the patient

    avoidance of long periods of preoperative fasting

    re-establishment of oral feeding as early as possible after surgery

    start of nutritional therapy early, as soon as a nutritional risk becomes apparent

    metabolic control e.g. of blood glucose

    reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function

    minimized time on paralytic agents for ventilator management in the postoperative period

    early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.

  • 1364.
    Wendin, Karin
    et al.
    Uppsala University, Department of Domestic Sciences.
    Aaby, K
    Edris, A
    Ellekjaer, M R
    Albin, R
    Bergenstahl, B
    Johansson, L
    Willers, E P
    Solheim, R
    Low-fat mayonnaise: Influences of fat content, aroma compounds and thickeners1997In: Food Hydrocolloids, ISSN 0268-005X, E-ISSN 1873-7137, Vol. 11, no 1, p. 87-99Article in journal (Refereed)
    Abstract [en]

    The effects of fat content and thickeners, propylene glycol alginate (PGA; 1.40%) and guar gum (1.55%), on sensory and instrumental quality descriptors on reduced fat mayonnaises (15 and 30% fat) with and without added aroma compounds, citral (semi-polar) and pyroligneous acid (polar), were investigated. One mayonnaise, 82% fat, without added thickener or aroma compounds was used as reference. Sensory evaluation (quantitative descriptive analysis; QDA), rheological analysis (yield stress, maximum viscosity, G' and G''), measurements of particle size and headspace CC-MS analyses were carried out. Correlations between the results were developed Perceived and instrumental texture, and perceived smell and flavour, changed differently in magnitude and direction due to fat content and type of thickener.

  • 1365.
    Wendin, Karin
    et al.
    Department of Food Science, Faculty of Life Sciences, University of Copenhagen.
    Allesen-Holm, Bodil H.
    Bredie, Wender L. P.
    Do facial reactions add new dimensions to measuring sensory responses to basic tastes?2011In: Food Quality and Preference, ISSN 0950-3293, E-ISSN 1873-6343, Vol. 22, no 4, p. 346-354Article in journal (Refereed)
    Abstract [en]

    Basic taste solutions induce sensory perceptions via taste receptors and give rise to specific facial reactions. Many of these have been shown to be innate. The aim of this study was to explore relationships between the sensory perception of basic taste solutions at different concentrations and facial reactions. Basic taste solutions each at three levels plus water were served to a panel. The assessors individually identified quality, intensity and pleasantness. They were recorded during tasting and their facial reactions (based on FACS) were coded and analysed. Facial reactions indicated both quality and concentration of the stimuli. The intensity of most facial reactions increased with increasing stimulus concentration, most pronounced for sourness (lips) and bitterness (eyes and forehead). Pleasantness ratings decreased with increasing concentrations of all basic tastes. Water and the lowest sucrose concentration were perceived as the most pleasant samples and gave rise to the lowest intensity of facial reactions. The study showed that a combination of sensory analyses and facial expressions was successful in adding further insight to the knowledge of perception of basic tastes.

  • 1366.
    Wendin, Karin
    et al.
    Kristianstad University, Faculty of Natural Science, Research Environment Food and Meals in Everyday Life (MEAL). Kristianstad University, Faculty of Natural Science, Avdelningen för mat- och måltidsvetenskap.
    Blucher, AnnaLinnéuniversitetet.
    Mat och måltidsteknik för ett hälsosamt och oberoende åldrande2018Collection (editor) (Other academic)
    Abstract [sv]

    Att äta är något som för många är en självklar och till stora delar oreflekterad aktivitet. Mat är inte sällan en källa till glädje och samvaro, till gemenskapoch samhörighet. För andra är ätandet en daglig kamp, en kamp som inte bara innebär att få maten och drycken i munnen, att tugga och svälja, utan som också innebär en ständig strävan att försöka uppträda på ett sätt som överensstämmer med de kulturella och normativa aspekterna kring måltiden. En måltid handlar inte bara om maten på tallriken, utan också om matens sociala,fysiska och tidsmässiga inramning.

  • 1367.
    Wendin, Karin
    et al.
    SIK Swedish Inst. Food & Biotechnol, Gothenburg, Sweden.
    Ekman, Susanne
    Bülow, Margareta
    Ekberg, Olle
    Johansson, Daniel
    Rothenberg, Elisabet
    Department of Clinical Nutrition, Sahlgrenska University Hospital, Go ¨ teborg, Sweden.
    Stading, Mats
    Objective and quantitative definitions of modified food textures based on sensory and rheological methodology.2010In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 54Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Patients who suffer from chewing and swallowing disorders, i.e. dysphagia, may have difficulties ingesting normal food and liquids. In these patients a texture modified diet may enable that the patient maintain adequate nutrition. However, there is no generally accepted definition of 'texture' that includes measurements describing different food textures.

    OBJECTIVE: Objectively define and quantify categories of texture-modified food by conducting rheological measurements and sensory analyses. A further objective was to facilitate the communication and recommendations of appropriate food textures for patients with dysphagia.

    DESIGN: About 15 food samples varying in texture qualities were characterized by descriptive sensory and rheological measurements.

    RESULTS: Soups were perceived as homogenous; thickened soups were perceived as being easier to swallow, more melting and creamy compared with soups without thickener. Viscosity differed between the two types of soups. Texture descriptors for pâtés were characterized by high chewing resistance, firmness, and having larger particles compared with timbales and jellied products. Jellied products were perceived as wobbly, creamy, and easier to swallow. Concerning the rheological measurements, all solid products were more elastic than viscous (G'>G''), belonging to different G' intervals: jellied products (low G') and timbales together with pâtés (higher G').

    CONCLUSION: By combining sensory and rheological measurements, a system of objective, quantitative, and well-defined food textures was developed that characterizes the different texture categories.

  • 1368.
    Wendin, Karin
    et al.
    Uppsala University, Dept of Domestic Sciences.
    Ellekjaer, M R
    Solheim, R
    Fat content and homogenization effects on flavour and texture of mayonnaise with added aroma1999In: Lebensmittel-Wissenschaft + Technologie, ISSN 0023-6438, E-ISSN 1096-1127, Vol. 32, no 6, p. 377-383Article in journal (Refereed)
    Abstract [en]

    The influence of fat content (700 and 820 g/kg) and homogenization on the texture and flavour of mayonnaise with added citral (semi-polar) or pyroligneous acid (polar) was investigated. The quality of mayonnaise was described by sensory descriptive profiling. Mayonnaise containing 820 g fat/kg had the highest intensity of sour smell, sour taste, thickness and fattiness. Increased fat content, from 700 to 820 g/kg, did not significantly affect the perception of smoke flavour due to pyroligneous acid, or lemon flavour due to citral. Homogenization increased sweetness and whiteness, and depressed thickness and fattiness in mayonnaises with added pyroligneous acid.

  • 1369.
    Wendin, Karin
    et al.
    SIK, The Swedish Institute for Food and Biotechnology AB.
    Hall, G
    Influences of fat, thickener and emulsifier contents on salad dressing: Static and dynamic sensory and rheological analyses2001In: Lebensmittel-Wissenschaft + Technologie, ISSN 0023-6438, E-ISSN 1096-1127, Vol. 34, no 4, p. 222-233Article in journal (Refereed)
    Abstract [en]

    The effects of contents of fat, thickener and emulsifier in salad dressing were investigated. Twelve types of dressings were produced according to a full factorial design, whereby the fat content was set at three levels, the thickener and the emulsifier contents at vivo levels. The dressings were analysed by a sensory panel, using both quantitative descriptive profiling and time-intensity (TI) evaluation, and by instrumental/rheological measurements. The two sensory methods were related to each other and the instrumental results were related to tire sensory results. All design parameters had a significant influence on the properties of salad dressing, mainly on texture and mouthfeel. Fat content was the most influencing parameter. Inter-action effects were found and it can he concluded that the content of the emulsifier was less critical when the fat and thickener contents increased Dynamic and descriptive sensory analyses,ere mainly related to each other in the fattiness attribute. There were strong relations between instrumental and sensory analysis according to rheological and texture attributes, /r/ greater than or equal to 0.7 (Pearson correlation coefficient)for most texture attributes.

  • 1370.
    Wendin, Karin
    et al.
    Kristianstad University, School of Education and Environment, Avdelningen för Humanvetenskap.
    Höjier, Karin
    Kristianstad University, School of Education and Environment, Avdelningen för Humanvetenskap.
    Sepp, Hanna
    Kristianstad University, School of Education and Environment, Avdelningen för Humanvetenskap.
    Rothenberg, Elisabet
    Kristianstad University, Forskningsmiljön Mat, måltid, hälsa i 24-timmarsperspektivet. Kristianstad University, School of Education and Environment, Avdelningen för Praktisk-estetiska ämnen. Kristianstad University, Resrarch environment Food and Meals in Everyday Life (MEAL).
    Barns smakpreferenser och matvanor2014In: Nordisk Nutrition, ISSN 1654-8337, no 3, p. 19-22Article in journal (Other academic)
  • 1371.
    Wendin, Karin
    et al.
    SIK, The Swedish Institute for Food and Biotechnology AB.
    Janestad, H
    Hall, G
    Modelling and analysis of dynamic sensory data2003In: Food Quality and Preference, ISSN 0950-3293, E-ISSN 1873-6343, Vol. 14, no 8, p. 663-671Article in journal (Refereed)
    Abstract [en]

    Time intensity (TI) data from earlier reported studies on cream cheese and salad dressing were used to develop models based on both polynomials and ordinary differential equations (ODE) that can be used to describe and interpret TI-data. Polynomials were thus fitted to experimental data. By taking the first and second derivatives of the polynomials one gets new polynomials that express how the perceived intensity changes with time. By integrating the original polynomial one gets a new polynomial that expresses how the classical TI-parameter "Area Under the Curve" is accumulated with time. Graphical display of all these types of polynomials gives an immediate and easily interpretable impression of the influence of different experimental factors on the time dependent perception. In the ODE models experimental factors, both formula and process conditions, were taken into account. Thus it was possible to develop equations that can be used for prediction of TI-curves for intermediate experimental settings.

  • 1372.
    Wendin, Karin
    et al.
    SIK, The Swedish Institute for Food and Biotechnology AB.
    Langton, M
    Caous, L
    Hall, C
    Dynamic analyses of sensory and microstructural properties of cream cheese2000In: Food Chemistry, ISSN 0308-8146, E-ISSN 1873-7072, Vol. 71, no 3, p. 363-378Article in journal (Refereed)
    Abstract [en]

    Flavour and texture in cream cheese depend on the microstructure. The objective of this work was to study the influence of fat content, salt content and homogenisation pressure on the microstructure and sensory properties of cream cheese. Twelve types of cream cheese were produced according to a full-factorial design, whereby the fat content was set at three levels, the salt content at two levels and the homogenisation pressure at two levels. The cheeses were analysed by a sensory panel, using both quantitative descriptive profiling and time intensity (T1) evaluation, and by using a confocal laser scanning microscope, CLSM, whereby the microstructure of the cheeses was analysed. All the design parameters had a significant influence on the flavour and texture, although fat had the largest effect. Interaction effects between the design parameters were also found to influence the character of cream cheese. The results showed that it is possible to create a cream cheese with lower fat content and with sensory attributes similar to the attributes in cream cheese with high fat content, by modification of production parameters.

  • 1373.
    Wendin, Karin
    et al.
    Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL). Kristianstad University, Faculty of Natural Science, Avdelningen för mat- och måltidsvetenskap.
    Olshov, Anders
    Äter vi ihjäl oss?: mattrender på tvärs mot hälsa och hållbarhet2018Report (Other academic)
    Abstract [sv]

    Idag äter vi så mycket att fler dör av fetma och övervikt än av undernäring. Konsekvenserna av människans växande aptit är enorma, inte bara för de individer som drabbas av fetma och dess följdsjukdomar som typ 2-diabetes och hjärt-kärlsjukdomar, utan också för växter, djur och klimat. Vi får i oss för mycket energi, vilket gör oss feta, och vi äter mer kött och fisk, vilket tär på jordens resurser. I Sverige har andelen överviktiga och feta ökat från 46 till 51 procent i åldersgruppen 16-84 år under tioårsperioden 2006-2016. De direkta och indirekta samhällskostnaderna för fetma och övervikt beräknas till 70 miljarder kronor av Folkhälsomyndigheten. Fortsätter fetman att öka i samma takt som under det senaste decenniet når kostnaderna 95 miljarder kronor om tio år, enligt myndigheten. Det skulle motsvara statens utgifter för rättsväsendet, försvar och samhällets krisberedskap. De globala årliga utgifterna relaterat till fetmaepidemin ligger på 18 000 miljarder kronor, runt 2,8 procent av hela världens samlade bruttonationalprodukt. Omkring fem procent av alla dödsfall globalt kan relateras till fetma. Fetma är även den enskilt största riskfaktorn för diabetes. Görs inget kan 1,4 miljarder vuxna (22 procent av alla vuxna) leva med fetma 2045 och 736 miljoner med diabetes (12 procent). Diabetesrelaterade hälsoutgifter skulle då stiga till över 8 000 miljarder kronor och orsaka stort individuellt lidande. I Sverige har köttkonsumtionen fördubblats sedan 1990 från 27 till 53 kilo per person och år och den totala konsumtionen från 230 till 527 miljoner kilo. Det följer en internationell trend där ekonomisk tillväxt och ökade disponibelinkomster ökar efterfrågan på kött och mejeriprodukter. Som följd tas allt större landarealer i anspråk och skövlas skog på andra håll i världen, minskar biodiversiteten och ökar utsläppen i form av växthusgaser från djur. Globalt ger utsläppen från matdjuren (kor, får, getter, grisar och kyckling) 6 miljarder ton växthusgaser per år, vilket motsvarar knappt en femtedel av det totala utsläppet av växthusgaser. Nästan hälften av all skog som en gång täckte jordens yta är borta. Grundvattenkällorna minskar då jordbruken använder stora vattenmängder. Cirka en tredjedel av fiskbestånden är överfiskade. Då jordens befolkning förväntas öka från dagens 7,6 miljarder till knappt 10 miljarder invånare år 2050 och livsmedels- och köttkonsumtionen samtidigt ökar skulle livsmedelsproduktionen, enligt FAO, behöva öka med 70 procent om maten ska räcka till alla. Det är svårt eftersom de areella resurserna och vattenresurserna är begränsade. Det är inte heller hållbart mot bakgrund av den globala uppvärmningen och andra hållbarhetsmål. Åtgärder för att skapa en hållbar livsmedelskonsumtion brådskar. Sänkningarna av matmomsen 1992 och 1996, EU-medlemskapet och den globala konkurrensen inom livsmedel har gjort mat billigare relativt andra varor. I kombination med ökade inkomster gör det att konsumenter lägger en allt mindre andel av hushållsbudgeten på matinköp och att de har råd att äta skadligt mycket. Höjd matmoms samt införande av kött-, fett- och sockerskatter är ekonomiska styrmedel som kan användas för att minska matkonsumtionen och valet av mat samtidigt som skatteintäkterna kan används till riktade satsningar för bättre skolmat, bättre måltider inom äldreomsorgen och till ekonomiskt svaga grupper.För att få till stånd en strukturell beteendeförändring måste samhället även på andra sätt ge medborgare och verksamheter incitament att agera i mer hälsosamma och miljövänliga riktningar. Det kan röra sig om informations- och utbildninginsatser, allmänna folkhälsoundersökningar, mer vegetariskt och mindre kött  i skolorna, införandet av ett licenssystem för att att få bort godis och läskförsäljningen från livsmedelsbutikerna, åtgärder för att minska matsvinnet och främjande av cykling och idrott. En rimlig ambition är att Sverige verkar för att bli en internationell förebild med världens friskaste folk.  

  • 1374.
    Wendin, Karin
    et al.
    Uppsala University, Department of Domestic Sciences.
    Solheim, R
    Allmere, T
    Johansson, L
    Flavour and texture in sourmilk affected by thickeners and fat content1997In: Food Quality and Preference, ISSN 0950-3293, E-ISSN 1873-6343, Vol. 8, no 4, p. 281-291Article in journal (Refereed)
    Abstract [en]

    When reducing fat content or replacing fat with thickener in reduced fat foods, flavour and texture may change. The objective of this study was to investigate effects of thickener and fat content on flavour and texture in low-fat foods. We used sourmilk with 0.1% or 4.2% fat where odour compounds with differing polarity, maltol or ethyl 2-methylbutyrate, were added. Sourmilk with: O.1 g 100 ml(-1) or 0.5 g 100 ml(-1) gelatine; 0.05 g 100 ml(-1) or 1.O g 100 ml(-1) pectin; or 0.65 g 100 ml(-1) or 0.9 g 100 ml(-1) xanthan added, and sourmilk without any thickener added, for each of the two odour compounds were manufactured. Sensory evaluation by descriptive profiling and viscosity measurements by Bohlin VOR were made. Perceived thickness increased with higher fat content and with increased concentration of thickener. Viscosity (measured by a Bohlin rheometer) did also increase with higher fat content and with increased concentration of thickener. Smell and flavour of maltol increased with higher fat content, while smell and flavour of ethyl 2-methylbutyrate were unaffected. Smell and flavour of the maltol were unaffected by all the thickeners, while smell and flavour of the ester were affected. Sourness was masked by all the thickeners.

  • 1375.
    Wendin, Karin
    et al.
    Kristianstad University, Faculty of Natural Science, Research Environment Food and Meals in Everyday Life (MEAL). Kristianstad University, Faculty of Natural Science, Avdelningen för mat- och måltidsvetenskap.
    Westergren, Albert
    Kristianstad University, Faculty of Health Science, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, Research Platform for Collaboration for Health. Kristianstad University, Faculty of Health Science, Avdelningen för sjuksköterskeutbildningarna och integrerad hälsovetenskap.
    Undernäring hos äldre med neurologisk sjukdom2019In: Neurologi i Sverige, ISSN 2000-8538, Vol. 2, no 19, p. 28-31Article in journal (Other academic)
    Abstract [sv]

    Maten och måltiderna är viktiga delar av våra liv. Det handlar om allt från hälsa och överlevnadtill social samvaro och kulturella aktiviteter. Vid sjukdom eller plötsliga förändringari livet ställs mycket på ända som kan ha en stor inverkan på vårt ätande och därmed på vårhälsa, vilket i sin tur kan leda till undernäring. Neurologiska sjuk domar och åldrande är vanligaorsaker till undernäring. I denna artikel ger professorerna Karin Wendin och AlbertWestergren, båda vid Högskolan Kristianstad, en översiktlig beskrivning av undernäring,vad det innebär att vara drabbad och vad man kan göra för att motverka undernäring.”Både åldrandet i sigoch neurologisk sjukdombidrar till minskadaktivitet och sannoliktminskad aptit.”

  • 1376.
    Wendin, Karin
    et al.
    Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL). Kristianstad University, School of Education and Environment, Avdelningen för Humanvetenskap.
    Westergren, Albert
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Platform for Collaboration for Health.
    Blücher, Anna
    Linnéuniversitetet.
    Andersson, Håkan
    Linnéuniversitetet.
    Lindén, Maria
    Mälardalens högskola.
    Nyberg, Maria
    Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL). Kristianstad University, School of Education and Environment, Avdelningen för Humanvetenskap.
    Pajalic, Zada
    Norge.
    Olsson, Viktoria
    Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL). Kristianstad University, School of Education and Environment, Avdelningen för Humanvetenskap.
    Örtman, Gerd
    Linnéuniversitetet.
    Högberg, Ann-Marie
    Anhörigas Riksförbund.
    Borgstierna, Catharina
    Bestic AB.
    Stuhr Olsson, Gunnel
    Findus AB.
    Toll, Birgitta
    Borås stad.
    Mer krävs för att undvika svält bland äldre2015In: Svenska Dagbladet, ISSN 1101-2412, no 23 decemberArticle in journal (Other (popular science, discussion, etc.))
  • 1377.
    Wennberg, Maria
    et al.
    Umeå universitet, Allmänmedicin.
    Gustafsson, Per E
    Umeå universitet, Allmänmedicin.
    Wennberg, Patrik
    Umeå universitet, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Allmänmedicin.
    Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 1, p. 122-129Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse whether poor breakfast habits in adolescence predict the metabolic syndrome and its components in adulthood. Previous studies suggest that regular breakfast consumption improves metabolic parameters. Design: Prospective. Breakfast habits and other lifestyle variables at age 16 years were assessed from questionnaires. Poor breakfast habits were defined as skipping breakfast or only drinking or eating something sweet. At age 43 years, the effective sample consisted of 889 participants defined as having the metabolic syndrome or not, using the International Diabetes Federation criteria. Logistic regression was used to calculate odds ratios and confidence intervals. Setting: The Northern Swedish Cohort, a longitudinal population-based cohort with 27-year follow-up. Subjects: Adolescents (age 16 years). Results: Prevalence of the metabolic syndrome at age 43 years was 27.0%. Of the participants, 9.9% were classified with poor breakfast habits at age 16 years. Adjusted odds for the metabolic syndrome at age 43 years was OR = 1.68 (95% CI 1.01, 2.78) for those with poor breakfast habits at age 16 years compared with breakfast eaters. Looking at the metabolic syndrome components, poor breakfast habits at age 16 years were associated with central obesity (OR = 1.71; 95% CI 1.00, 2.92) and high fasting glucose (OR = 1.75; 95% CI 1.01, 3.02) at age 43 years, even after multivariate adjustments. Conclusions: Poor breakfast habits in adolescence predicted the metabolic syndrome in adulthood. Of the metabolic syndrome components, poor breakfast habits in adolescence predicted central obesity and high fasting glucose in adulthood. Further research is needed to fully understand the relationship between early breakfast habits and adult metabolic syndrome.

  • 1378.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Gustafsson, Per E
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Poor breakfast habits in adolescence predict the metabolic syndrome in adulthood2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 1, p. 122-129Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse whether poor breakfast habits in adolescence predict the metabolic syndrome and its components in adulthood. Previous studies suggest that regular breakfast consumption improves metabolic parameters. Design: Prospective. Breakfast habits and other lifestyle variables at age 16 years were assessed from questionnaires. Poor breakfast habits were defined as skipping breakfast or only drinking or eating something sweet. At age 43 years, the effective sample consisted of 889 participants defined as having the metabolic syndrome or not, using the International Diabetes Federation criteria. Logistic regression was used to calculate odds ratios and confidence intervals. Setting: The Northern Swedish Cohort, a longitudinal population-based cohort with 27-year follow-up. Subjects: Adolescents (age 16 years). Results: Prevalence of the metabolic syndrome at age 43 years was 27.0%. Of the participants, 9.9% were classified with poor breakfast habits at age 16 years. Adjusted odds for the metabolic syndrome at age 43 years was OR = 1.68 (95% CI 1.01, 2.78) for those with poor breakfast habits at age 16 years compared with breakfast eaters. Looking at the metabolic syndrome components, poor breakfast habits at age 16 years were associated with central obesity (OR = 1.71; 95% CI 1.00, 2.92) and high fasting glucose (OR = 1.75; 95% CI 1.01, 3.02) at age 43 years, even after multivariate adjustments. Conclusions: Poor breakfast habits in adolescence predicted the metabolic syndrome in adulthood. Of the metabolic syndrome components, poor breakfast habits in adolescence predicted central obesity and high fasting glucose in adulthood. Further research is needed to fully understand the relationship between early breakfast habits and adult metabolic syndrome.

  • 1379.
    Wennberg, Maria
    et al.
    Umeå universitet, Socialmedicin.
    Gustafsson, Per
    Umeå universitet, Socialmedicin.
    Wennberg, Patrik
    Umeå universitet, Allmänmedicin.
    Hammarström, Anne
    Umeå universitet, Socialmedicin.
    Irregular eating of meals in adolescence and the metabolic syndrome in adulthood: results from a 27-year prospective cohort2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 3, p. 667-673Article in journal (Refereed)
    Abstract [en]

    Objective: The objective was to investigate whether irregular eating of meals in adolescence predicts the metabolic syndrome and its components in adulthood, and if any specific meal is of particular importance. Design: Prospective cohort study with 27 years of follow-up. Information on meals (breakfast, school lunch and dinner with family), lifestyle (alcohol consumption, smoking habits, physical activity, consumption of sweets and pastries) at age 16 years was assessed from questionnaires, and presence or not of the metabolic syndrome and its components were defined at age 43 years in 889 participants (82.1 % of total cohort). Logistic regression was used to calculate odds ratios and confidence intervals. Setting: The Northern Swedish Cohort; all school-leavers of the 9th grade in the town Lulea in 1981. Subjects: Adolescents (age 16 years). Results: Irregular eating of meals at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years (OR=1.74; 95 % CI 1.12, 2.71), but this was explained by concurrent unhealthy lifestyle at age 16 years. Poor breakfast at age 16 years was the only meal associated with the metabolic syndrome at age 43 years, independent of other meals, BMI (kg/m2) and lifestyle at age 16 years (OR = 1.67; 95 % CI 1.00, 2.80). Conclusions: Irregular eating of meals in adolescence predicted the metabolic syndrome in adulthood, but not independently of BMI and lifestyle in adolescence. Poor breakfast in adolescence was the only specific meal associated with future metabolic syndrome, even after adjustments. Breakfast eating should be encouraged in adolescence.

  • 1380.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Gustafsson, Per
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Wennberg, Patrik
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Hammarström, Anne
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Irregular eating of meals in adolescence and the metabolic syndrome in adulthood: results from a 27-year prospective cohort2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 3, p. 667-673Article in journal (Refereed)
    Abstract [en]

    Objective: The objective was to investigate whether irregular eating of meals in adolescence predicts the metabolic syndrome and its components in adulthood, and if any specific meal is of particular importance. Design: Prospective cohort study with 27 years of follow-up. Information on meals (breakfast, school lunch and dinner with family), lifestyle (alcohol consumption, smoking habits, physical activity, consumption of sweets and pastries) at age 16 years was assessed from questionnaires, and presence or not of the metabolic syndrome and its components were defined at age 43 years in 889 participants (82.1 % of total cohort). Logistic regression was used to calculate odds ratios and confidence intervals. Setting: The Northern Swedish Cohort; all school-leavers of the 9th grade in the town Lulea in 1981. Subjects: Adolescents (age 16 years). Results: Irregular eating of meals at age 16 years was associated with higher prevalence of the metabolic syndrome at age 43 years (OR=1.74; 95 % CI 1.12, 2.71), but this was explained by concurrent unhealthy lifestyle at age 16 years. Poor breakfast at age 16 years was the only meal associated with the metabolic syndrome at age 43 years, independent of other meals, BMI (kg/m2) and lifestyle at age 16 years (OR = 1.67; 95 % CI 1.00, 2.80). Conclusions: Irregular eating of meals in adolescence predicted the metabolic syndrome in adulthood, but not independently of BMI and lifestyle in adolescence. Poor breakfast in adolescence was the only specific meal associated with future metabolic syndrome, even after adjustments. Breakfast eating should be encouraged in adolescence.

  • 1381.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. The Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. The Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
    Uusitalo, U
    Tuomilehto, J
    Shaw, J E
    Zimmet, P Z
    Kowlessur, S
    Pauvaday, V
    Magliano, D J
    High consumption of pulses is associated with lower risk of abnormal glucose metabolism in women in Mauritius2015In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 32, no 4, p. 513-520Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate if consumption of pulses was associated with a reduced risk of developing abnormal glucose metabolism, increases in body weight and increases in waist circumference in a multi-ethnic cohort in Mauritius.

    METHODS: Population-based surveys were performed in Mauritius in 1992 and in 1998. Pulse consumption was estimated from a food frequency questionnaire in 1992 and outcomes were measured in 1998. At both time points, anthropometry was undertaken and an oral glucose tolerance test was performed.

    RESULTS: Mauritian women with the highest consumption of pulses (highest tertile) had a reduced risk of developing abnormal glucose metabolism [odds ratio 0.52; 95% CI 0.27, 0.99) compared with those with the lowest consumption, and also after multivariable adjustments. In women, a high consumption of pulses was associated with a smaller increase in BMI.

    CONCLUSIONS: High consumption of pulses was associated with a reduced risk of abnormal glucose metabolism and a smaller increase in BMI in Mauritian women. Promotion of pulse consumption could be an important dietary intervention for the prevention of Type 2 diabetes and obesity in Mauritius and should be examined in other populations and in clinical trials.

  • 1382.
    Wennberg, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Tornevi, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Centre for Population Studies (CPS).
    Bergdahl, Ingvar A
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Diet and lifestyle factors associated with fish consumption in men and women: a study of whether gender differences can result in gender-specific confounding2012In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 11, p. 101-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Fish consumption and intake of omega-3 fatty acids from fish are associated with a lower risk of cardiovascular disease. However, a prospective study from northern Sweden showed that high consumption of fish is associated with an increased risk of stroke in men, but not in women. The current study aimed to determine if fish consumption is differently related to lifestyle in men compared with women in northern Sweden.

    METHODS: Lifestyle information on 32,782 men and 34,866 women (aged 30--60 years) was collected between 1992 and 2006 within the Vasterbotten Intervention Programme (a health intervention in northern Sweden). Spearman correlation coefficients (Rs) were calculated for associations between self-reported consumption of fish and other food items or lifestyle variables.

    RESULTS: Fish consumption was positively associated with other foods considered healthy (e.g., root vegetables, lettuce/cabbage/spinach/broccoli, chicken, and berries; Rs = 0.21-0.30), as well as with other healthy lifestyle factors (e.g., exercise and not smoking) and a higher educational level, in both men and women. The only gender difference found, concerned the association between fish consumption and alcohol consumption. Men who were high consumers of fish had a higher intake of all types of alcohol compared with low to moderate fish consumers. For women, this was true only for wine.

    CONCLUSIONS: Except for alcohol, the association between fish consumption and healthy lifestyle did not differ between men and women in northern Sweden. It is important to adjust for other lifestyle variables and socioeconomic variables in studies concerning the effect of fish consumption on disease outcome.

  • 1383.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Hospital Luleå.
    Weight or shape: finding your way to diet and exercise2017Book (Refereed)
  • 1384.
    West, Christina E.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Jenmalm, Maria C.
    Transfer of Probiotic Bacteria From Mother to Child: A Matter of Strain Specificity?2015In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 61, no 2, p. 157-158Article in journal (Other academic)
  • 1385.
    Westergren, Albert
    Kristianstad University College, Department of Health Sciences.
    Nutrition and its relation to mealtime preparation, eating, fatigue and mood among stroke survivors after discharge from hospital: a pilot study2008In: The Open Nursing Journal, ISSN 1874-4346, Vol. 2, p. 15-20Article in journal (Refereed)
    Abstract [en]

    Eating difficulties and nutritional deficits are common among persons with acute stroke and during rehabilitation. Little is known about such problems after discharge from hospital. In addition the relationship between fatigue and nutritional status among stroke survivors living in the community remains to be explored. The aim of this pilot study was to describe mealtime preparation, eating, fatigue, mood and nutritional status among persons with stroke six months after discharge from hospital and to explore associations between these factors. Patients were interviewed six months poststroke. Standardised questions and methods were used. The mean age of the 89 respondents was 77.2 (SD 6.6) years, 44 were women and 45 men. Difficulties with swallowing, ingestion and energy to eat occurred among 27%, 20% and 7% respectively. Difficulties with cooking and buying food occurred among 57% and 56% respectively and 41% were at nutritional risk. Feeling full of energy less than some of the time was experienced by 61% while 15% had felt gloomy and sad at least some of the time during the previous four weeks. Considering activities of daily living (ADL), having a less favourable nutritional status was significantly predicted by difficulties with buying food, difficulties with ingestion and being a woman. Considering psychological state (mood and energy), having a less favourable nutritional status was significantly predicted by a lack of energy and high age. This study supports the occurrence of a nutritionally related fatigue by means of “lack of energy”. The associations between poor nutritional status and fatigue can work in both directions. Thus persons with fatigue are more prone to have poor nutritional status and those with poor nutritional status are at greater risk of fatigue. Besides fatigue also difficulties with buying food and ingestion are associated with nutritional risk. As nutritional deficits occur a long time after stroke onset it is important to assess aspects of mealtime preparation and the eating process and when necessary provide food delivery service and eating assistance in order to prevent a vicious circle of undernourishment and fatigue to develop.

  • 1386.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Blomqvist, Kerstin
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Edberg, Anna-Karin
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Petersson, Pia
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap.
    Sätt måltidsupplevelsen i centrum2012In: Kristianstadsbladet, ISSN 1103-9523, no 16/6, p. B4-Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Måltidsupplevelsen påverkas av så mycket; ljuset i lokalen, ljud, dukning, servering, bemötande, maten, smakerna, doften och sällskapet. Men hur kan den kunskapen omsättas på sjukhus och äldreboenden? Det skriver Albert Westergren, professor i omvårdnad, Kerstin Blomqvist, biträdande professor i klinisk omvårdnad, Anna-Karin Edberg, professor i omvårdnad, och Pia Petersson, ansvarig för sjuksköterskeprogrammet, samtliga på Högskolan Kristianstad.

  • 1387.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Screening for nutritional risk among home dwelling elderly people without service from the municipality2011In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 6, no Suppl. 1, p. 87-Article in journal (Refereed)
    Abstract [en]

    Risk factors for malnutrition were frequent mamong elderly persons and calls for preventive actions through information about how to eat healthy. This information can be provided during preventive home visits.

  • 1388.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society.
    Hedin, Gita
    Kristianstad University, School of Health and Society.
    Do study circles and a nutritional care policy improve nutritional care in a short- and long-term perspective in special accommodations?2010In: Food & nutrition research, ISSN 1654-661X, Vol. 54, p. 5402-Article in journal (Refereed)
    Abstract [en]

    Study circles give positive short-term effects and a NCP gives positive short- and long-term effects on NC. Whether a combination of study circles and the implementation of a NCP can give even better results is an area for future studies.

  • 1389.
    Westergren, Albert
    et al.
    Kristianstad University College, Department of Health Sciences.
    Lindholm, Christina
    Kristianstad University College, Department of Health Sciences.
    Axelsson, Carolina
    Kristianstad University College, Department of Health Sciences.
    Ulander, Kerstin
    Kristianstad University College, Department of Health Sciences.
    Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations2008In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 12, no 1, p. 39-43Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to explore the prevalence of eating difficulties and malnutrition among persons in hospital care and in special accommodations. DESIGN: The cross-sectional observational study was performed in Nov. 2005. SETTING: Hospitals and special accommodations. PARTICIPANTS: Out of 2,945 persons, 2,600 (88%) agreed to participate (1,726 from special accommodations and 874 from hospitals). In total all special accommodations in six municipalities and six hospitals were involved. MEASUREMENTS: Risk of undernutrition was estimated as at least two of: body mass index below recommendation, weight loss and/or eating difficulties. Overweight was graded based on body mass index (if 69 years or younger: 25 or above: if 70 years or older: 27 or above). RESULTS: The mean age of those living in hospitals was 69 years and 53% were women, while the corresponding figures for those in special accommodations were 85 years and 69% women. In hospitals and special accommodations, eating difficulties were common (49% and 56% respectively) and about one quarter had a body mass index (BMI) below the limits (20% and 30% respectively) and one-third above the limit (39% and 30% respectively) thus only about 40% had a BMI within the limits. Both in hospitals and in special accommodations 27% were considered to have a moderate or high risk of undernutrition. CONCLUSION: Only about 40% in special accommodations and hospital care have a BMI within the recommended limits. As both low and high BMI are frequent in both settings, the focus of care should not only be on undernutrition but also on overweight. Using the Swedish criteria for defining risk of undernutrition seems to give a slightly lower prevalence than has been shown in previous Swedish studies, but this can be due to an underestimation of the occurrence of eating difficulties.

  • 1390.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society.
    Lindholm, Christina
    Kristianstad University, School of Health and Society.
    Matsson, Anna
    Stroke Unit, Central Hospital Kristianstad.
    Ulander, Kerstin
    Kristianstad University, School of Health and Society.
    Minimal Eating Observation Form: reliability and validity2009In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 13, no 1, p. 6-12Article in journal (Refereed)
    Abstract [en]

    Objectives: Eating difficulties are common for patients in hospitals (82% have one or more). Eating difficulties predict undernourishment, need for assistance when eating, length of hospital stay and level of care after hospital stay. Eating difficulties have through factor analysis (FA) been found to belong to three dimensions (ingestion, deglutition and energy). The present study investigates inter-observer reliability. Other questions at issue are if the findings from the previous FA can be confirmed, if adjustments need to be done and if the Minimal Eating Form (MEOF) can serve as an assessment model for identification of eating difficulties. Previously found associations between eating difficulties and outcomes as well as measures taken to improve oral intake were also investigated. Design: Inter-observer study and cross-sectional observational study. Settings: Hospitals and special accommodations (SAs). Participants and measurements: Inter-observer study: Observers made standardized assessments of eating, independently and at the same time, on a sample of 50 patients with stroke. Survey study: 2600 (88%) out of 2945 persons agreed to participate in a survey of eating and nutrition. All SAs within six municipalities and six hospitals were involved. Nursing students, clinical tutors and staff performed the assessments, supported by the researchers. Results: The average agreement between observers of eating difficulties was 89% (Kappa coefficient 0.70). In the survey study, the mean age of persons (n=1726) living in SAs was 85 years (SD 8) and 69% were women, while the corresponding figures for patients (n=874) in hospitals were 69 years (SD 18) and 53% women. Low Body Mass Index (BMI) was found in 27%, unintentional weight loss in 23% and need of eating assistance in 38% of the persons. Protein- and energy- (PE-) enriched food was given to 4%, adapted consistency of food to 23% and food supplements to 16% of the persons. The new FA confirmed the previous one and minor adjustments of the model were made. Having ingestion difficulties was the strongest predictor of need for eating assistance (OR 14.5). Deglutition difficulties strongly predicted serving of adapted consistency of food (OR 7.3). Poor energy levels and reduced appetite predicted weight loss (OR 6.0), BMI below limits (OR 2.5), supplements (OR 5.3) and PE-enriched food (OR 3.4). Conclusions: The MEOF has satisfying validity and reliability. The earlier model of eating difficulties was confirmed (MEOF-I), and the model was slightly adjusted to a new model, MEOF-II. Providing eating assistance seems effective in preventing malnutrition (weight loss and BMI below limits), and is mainly provided to persons with ingestion difficulties. Difficulties with energy intake and appetite are not associated with eating assistance; indicating that those persons might need support of some other kind. This support can include providing PE-enriched food and supplements, but seems however insufficiently or inadequately delivered, as low energy and appetite problems are also associated with both weight loss and low BMI. Findings from other studies are confirmed.

  • 1391.
    Westergren, Albert
    et al.
    Kristianstad University College, School of Health and Society.
    Lindholm, Christina
    Kristianstad University College, School of Health and Society.
    Ulander, Kerstin
    Kristianstad University College, School of Health and Society.
    Eating difficulties among elderly persons predict support and outcome2007In: 29th ESPEN Congress, 8-11 sept. 2007. Prag, 2007Conference paper (Refereed)
    Abstract [en]

    Rationale: Difficulties regarding ingestion, deglutition and/or energy predicts malnutrition, assistance when eating, length of hospital stay and level of care after in-hospital rehabilitation. In this study, previously found associations between eating difficulties and outcome as well as actions taken to improve oral intake were investigated.Methods: All special accommodations (SAs) within six municipalities and six hospitals were involved. Out of 2945 persons 2600 (88%) agreed to participate. Students, clinical tutors and staff collected the data. Logistic regression analyses explored associations between eating difficulties (independent variables), support and outcome (dependent variables).Results: Mean age of persons (n=2600) was 79.7 years (SD 14.4) and 63% were women. Low BMI (<20 if /=70 yrs) was found in 27%, unintentional weight loss 23%, eating assistance 38%, protein- and energy (PE-) enriched food 4%, adapted consistency of food 23% and food supplements 16%. Ingestion difficulties was the strongest predictor of eating assistance (OR 14.6). Deglutition difficulties predicted adapted consistency of food (OR 7.4). Energy and appetite predicted BMI below limits (OR 2.5), weight loss (OR 6.0), PE-enriched food (OR 3.4) and supplements (OR 5.3).Conclusions: Eating assistance to elderly persons seems effective in preventing malnutrition (weight loss and low BMI) and is mainly provided to those with ingestion difficulties. Difficulties with energy and appetite are not associated with eating assistance indicating that support of some other kind is needed such as providing PE-enriched food and supplements. This support seems however insufficiently or inadequately delivered as energy and appetite problems are associated with weight loss and low BMI. Findings from other studies are confirmed. Studies comparing “optimised nutritional support” to persons with energy and appetite problems versus “regular support” are needed.

  • 1392.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Nilsson, M.
    Edfors, Ellinor
    Kristianstad University, School of Health and Society.
    Lindskov, Susanne
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Adaptation of "Seniors in the community: risk evaluation for eating and nutrition , version ll" (SCREEN ll) for use in  Sweden: report on the translation process and field test2010Conference paper (Refereed)
  • 1393.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Nilsson, Maria
    Lund University.
    Hagell, Peter
    Lund University.
    Adaptation of "Seniors in the community risk evaluation for eating and nutrition, Version II" (SCREEN II) for use in Sweden: report on the translation process2010Report (Other academic)
    Abstract [en]

    This report describes the initial stages of the Swedish adaptation of "Seniors in the community: Risk evaluation for eating and nutrition, Version II" (SCREEN II) that has been developed by Heather Keller.

  • 1394.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Norberg, Erika
    Central Hospital, Kristianstad.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Diagnostic performance of the Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients – a cross-sectional study2011In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 10, p. 24-Article in journal (Refereed)
    Abstract [en]

    Background: The usefulness of the nutritional screening tool Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) relative to Nutritional Risk Screening 2002 (NRS 2002) remains untested. Here we attempted to fill this gap by testing the diagnostic performance and user-friendliness of the MEONF-II and the NRS 2002 in relation to the Mini Nutritional Assessment (MNA) among hospital inpatients. Methods: Eighty seven hospital inpatients were assessed for nutritional status with the 18- item MNA (considered as the gold standard), and screened with the NRS 2002 and the MEONF-II. Results: The MEONF-II sensitivity (0.61), specificity (0.79), and accuracy (0.68) were acceptable. The corresponding figures for NRS 2002 were 0.37, 0.82 and 0.55, respectively. MEONF-II and NRS 2002 took five minutes each to complete. Assessors considered MEONF-II instructions and items to be easy to understand and complete (96- 99%), and the items to be relevant (87%). For NRS 2002, the corresponding figures were 75-93% and 79%, respectively. Conclusions: The MEONF-II is an easy to use, relatively quick and sensitive screening tool to assess risk of undernutrition among hospital inpatients. With respect to user-friendliness and sensitivity the MEONF-II seems to perform better than the NRS 2002, although larger studies are needed for firm conclusions. The different scoring systems for undernutrition appear to identify overlapping but not identical patient groups. A potential limitation with the study is that the MNA was used as gold standard among patients younger than 65 years.

  • 1395.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Norberg, Erika
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Vallén, Christina
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Cut-off scores for the Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) among hospital inpatients2011In: Journal of Food and Nutrition Research, ISSN 1336-8672, E-ISSN 1338-4260, Vol. 55, p. 7289-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    The newly developed Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) has shown promising sensitivity and specificity in relation to the Mini Nutritional Assessment (MNA). However, the suggested MEONF-II cut-off scores for deciding low/moderate and high risk for undernutrition (UN) (>2 and >4, respectively) have not been decided based on statistical criteria but on clinical reasoning. The objective of this study was to identify the optimal cut-off scores for the MEONF-II in relation to the well-established MNA based on statistical criteria.

    DESIGN:

    Cross-sectional study.

    METHODS:

    The study included 187 patients (mean age, 77.5 years) assessed for nutritional status with the MNA (full version), and screened with the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, Body Mass Index (BMI) (or calf circumference), eating difficulties, and presence of clinical signs ofUN. MEONF-II data were analysed by Receiver Operating Characteristics (ROC) curves and the area under the curve (AUC); optimal cut-offs were identified by the Youden index (J=sensitivity+specificity-1).

    RESULTS:

    According to the MEONF-II, 41% were at moderate or high UN risk and according to the MNA, 50% were at risk or already undernourished. The suggested cut-off scores were supported by the Youden indices. The lower cut-off for MEONF-II, used to identify any level of risk for UN (>2; J=0.52) gave an overall accuracy of 76% and the AUC was 80%. The higher cut-off for identifying those with high risk for UN (>4; J=0.33) had an accuracy of 63% and the AUC was 70%.

    CONCLUSIONS:

    The suggested MEONF-II cut-off scores were statistically supported. This improves the confidence of its clinical use.

  • 1396.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Norberg, Erika
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Vallén, Christina
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Cut-off scores for the Minimal Eating Observation and Nutrition Form - Version ll (MEONF ll) among hospital inpatients2011Conference paper (Refereed)
  • 1397.
    Westergren, Albert
    et al.
    Kristianstad University College, School of Health and Society.
    Petersson, K.
    Lindholm, Christina
    Kristianstad University College, School of Health and Society.
    Axelsson, Carolina
    Kristianstad University College, School of Health and Society.
    Ulander, Kerstin
    Kristianstad University College, School of Health and Society.
    "Study circles" improves nutritional care and body mass index2008In: Clinical nutrition supplements, Volume 3, Supplement 1, 2008, page 61: 30th ESPEN Congress, 13-16 sept, 2008. Florence, Italy, 2008, p. 61-Conference paper (Refereed)
    Abstract [en]

    The staffs’ knowledge, experiences and motivation are likely to be important and so is an adaptation to each unit’s context to achieve positive changes in nutritional practice. How do study circles (SCs) and policy documents (PD) affect nutritional interventions for persons with moderate or high risk for undernutrition (UN-risk) in special accommodations (SAs)?

     

    All SAs within six municipalities were involved. UN-risk was defined as the occurrence of at least two of; involuntary weight loss, Body Mass Index below limit (<20 if /=70 yrs) and/or presence of eating difficulties. In year 2005 and 2007 it was 361 (27%) out of 1337 and 322 (35%) out of 920 persons respectively that were at UN-risk and included in this study. Interventions: In 18 of the departments 39 SCs were implemented, involving 8 staff each, in total 315 persons. Each group met for 3 occasions (3 hours each time) to discuss eating and nutrition based on a manual (www.vardalinstitutet.net/scn). The SCs did not focus on the above definition of UN-risk. In four other SAs a PD was politically anchored. No intervention was implemented in the other SAs.

     

    SCs and PD increased the precision in provided nutritional actions significantly for persons at UN-risk.

     

    The precision (percent) in the provision of nutritional actions.

    Intervention

    Year 2005

    Year 2007

    P-value

    No intervention

    n=229, 86 y

    n=202, 87 y

     

      E-food

    10

    11

    .875

      Food supplement

    31

    29

    .751

      Eating assistance

    65

    67

    .611

     

     

     

     

    Study circles

    n=92, 87 y

    n=82, 87 y

     

      E-food

    16

    32

    .012 *

      Food supplement

    24

    39

    .045 *

      Eating assistance

    67

    69

    .870

     

     

     

     

    Policy document

    n=40, 86 y

    n=38, 85 y

     

      E-food

    5

    24

    .023 *

      Food supplement

    52

    53

    .999

      Eating assistance

    72

    68

    .805

    y = mean age in years, * = significant increase in provision (p<0.05), E-food = Energy Enriched

     

    Both study circles and policy documents improves the precision in the provision of correct nutritional actions for those at moderate or high risk for undernutrition. It is likely that a combination of study circles and policy documents can improve the precision of provision of nutritional actions even more.

  • 1398.
    Westergren, Albert
    et al.
    Kristianstad University College, School of Health and Society.
    Petersson, Karin
    Lindholm, Christina
    Kristianstad University College, School of Health and Society.
    Axelsson, Carolina
    Kristianstad University College, School of Health and Society.
    Ulander, Kerstin
    Kristianstad University College, School of Health and Society.
    Overweight and risk for undernutrition among persons within special accommodations and hospital care – Year 2005 and 20072008In: Clinical nutrition supplements, Volume 3, Supplement 1, 2008, page 160-161.: 30th ESPEN Congress, 13-16 sept, 2008. Florence, Italy, 2008, p. 160-161Conference paper (Refereed)
    Abstract [en]

    Rationale: Both undernutrition and overweight have major impacts on morbidity and mortality and are thus important to prevent. This study explores the prevalence of undernutrition and overweight among persons in special accommodations (SAs) and hospital care in the year of 2005 and 2007. Methods: Six hospitals and all of the SAs within six municipalities were involved. In the year of 2005, 2600 (88%) out of 2945 persons agreed to participate in the study, and in 2007 there were 2255 (81%) out of 2784 persons participating. Risk for undernutrition was defined as the occurrence of at least two of the following; involuntary weight loss, Body Mass Index (BMI) below limit (<20 if /=70 yrs) and/or presence of eating difficulties. Overweight was defined based on BMI (if /=25: if >/=70 yrs: BMI >/=27)[1]. Nursing students, clinical tutors and staff collected the data. Results: The mean age and the risk for undernutrition increased significantly in SAs between the two years. The prevalence of overweight increased with three percent in hospitals as well as in SAs although this increase was not statistically significant. Table:

    Percent of persons at risk for undernutrition and with overweight

     

    SAs2005 (n=1726)

    SAs2007 (n=1526)

    P-value

    Hospitals2005 (n=874)

    Hospitals2007 (n=728)

    P-value

     

    Agemean (SD)

    85 (8)

    86 (8)

    <0.001

    69 (18)

    69 (16)

    0.987

    At risk forundernutrition

    27

    35

    <0.001

    27

    28

    0.947

    Overweight

    30

    33

    0.089

    39

    42

    0.182

     

    SAs = Special Accommodations

    Conclusion: The society in general and health care professionals in specific needs to consider not only prevention for persons at risk for undernutrition, but also the prevention for persons becoming overweight. Reference(s) Only 3 Lines maximum: 1. Westergren A, Lindholm C, Axelsson C & Ulander K. Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations. The Journal of Nutrition Health and Aging 2008, Vol 12, Number 1, Page 39-43.

  • 1399.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Stuhr Olsson, Gunnel
    Findus Sverige AB.
    Kost och näring borde ta en större del av diskussionen om äldres livskvalitet2017In: Landskronaposten, ISSN 2001-7162, no 12 oktober, p. A3-Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Fokus på motion och läkemedel är givetvis bra för att förebygga fallolyckor bland äldre. Tyvärr har kost- och näringsaspekten fallit bort ur diskussionen. Det skriver Albert Westergren, professor vid Högskolan Kristianstad och Gunnel Stuhr Olsson, Findus Sverige AB.

  • 1400.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    Torfadóttir, Ólina
    Akureyri University Hospital.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Malnutrition and nutritional care in an Icelandic teaching hospital2014In: Research, ISSN 2334-1009, no 1, p. 1270-Article in journal (Refereed)
    Abstract [en]

    Background: About 30% of hospital inpatients are at undernutrition (UN) risk and it is important that sufficient nutritional treatment and care is provided in order to avoid a decline in health. Aim: To explore the prevalence of UN risk, the associations between UN-risk and other factors, and describe the nutritional treatment/care towards those at UN-risk at an Icelandic teaching hospital. An additional aim was to evaluate the user friendliness of a nutritional screening tool. Methods: Inpatients (n=56; median age 69 years; 29 women) were assessed by eight nurses using the Minimal Eating Observation and Nutrition form – version II (MEONF-II), a recently developed nursing nutritional screening tool. Results: In total 23% (n=13) were at moderate/high UN-risk. The prevalence of overweight/obesity was 57%. Among patients at UN-risk, 61% received energy dense food, oral nutritional supplements, and/or artificial nutrition; this figure was 35% among those at no/low risk. MEONF-II total scores correlated with dependency in activities of daily living (rs, 0.350), and UN-risk categories correlated with tiredness (rs, 0.426). The MEONF-II was regarded as easy to use and relevant. Conclusion: There is a need for interventions connecting the nutritional screening with individualised nutritional treatment and care in order to narrow the gap between screening and intervention. The Icelandic version of the MEONF-II is perceived as user-friendly.

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