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  • 301.
    Dernini, S.
    et al.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Forum on Mediterranean Food Cultures, Rome, Italy; Food and Agriculture Organization of the United Nations, Rome, Italy.
    Berry, E. M.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Department of Human Nutrition and Metabolism, Braun School of Public Health, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
    Serra-Majem, L.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; University of Las Palmas of Gran Canaria, Las Palmas, Spain; Inter-University International Centre of Mediterranean Food Cultures Studies (CIISCAM), Rome, Italy.
    La Vecchia, C.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
    Capone, R.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; International Centre for Advanced Mediterranean Agronomic Studies (CIHEAM), Bari, Italy.
    Medina, F. X.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Universitat Oberta de Catalunya/Open University of Catalonia, Barcelona, Spain.
    Aranceta-Bartrina, J.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; University of Navarra, Navarra, Spain.
    Belahsen, R.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Chouaib Doukkali University, El Jadida, Morocco.
    Burlingame, B.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Massey University, Palmerston North, New Zealand.
    Calabrese, G.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; University of Turin, Turin, Italy.
    Corella, D.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Department of Preventive Medicine, University of Valencia, Valencia, Spain; CIBER Fisiopatologia de la Obesidad y Nutricion, Valencia, Spain.
    Donini, L. M.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Inter-University International Centre of Mediterranean Food Cultures Studies (CIISCAM), Rome, Italy; INRA, INSERM, NORT/Aix-Marseille University, Marseille, France.
    Lairon, D.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Sapienza University of Rome, Rome, Italy.
    Meybeck, A.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Food and Agriculture Organization of the United Nations, Rome, Italy.
    Pekcan, A. G.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Department of Nutrition and Dietetic, Hacettepe University, Ankara, Turkey.
    Piscopo, S.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Inter-University International Centre of Mediterranean Food Cultures Studies (CIISCAM), Rome, Italy.
    Yngve, Agneta
    Örebro University, School of Hospitality, Culinary Arts & Meal Science. International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom.
    Trichopoulou, A.
    International Foundation of Mediterranean Diet (IFMeD), London, United Kingdom; Hellenic Health Foundation, Athens, Greece.
    Med Diet 4.0: the Mediterranean diet with four sustainable benefits2017In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 20, no 7, p. 1322-1330Article, review/survey (Refereed)
    Abstract [en]

    Objective: To characterize the multiple dimensions and benefits of the Mediterranean diet as a sustainable diet, in order to revitalize this intangible food heritage at the country level; and to develop a multidimensional framework - the Med Diet 4.0 - in which four sustainability benefits of the Mediterranean diet are presented in parallel: major health and nutrition benefits, low environmental impacts and richness in biodiversity, high sociocultural food values, and positive local economic returns.

    Design: A narrative review was applied at the country level to highlight the multiple sustainable benefits of the Mediterranean diet into a single multidimensional framework: the Med Diet 4.0.

    Setting/subjects: We included studies published in English in peer-reviewed journals that contained data on the characterization of sustainable diets and of the Mediterranean diet. The methodological framework approach was finalized through a series of meetings, workshops and conferences where the framework was presented, discussed and ultimately refined.

    Results: The Med Diet 4.0 provides a conceptual multidimensional framework to characterize the Mediterranean diet as a sustainable diet model, by applying principles of sustainability to the Mediterranean diet.

    Conclusions: By providing a broader understanding of the many sustainable benefits of the Mediterranean diet, the Med Diet 4.0 can contribute to the revitalization of the Mediterranean diet by improving its current perception not only as a healthy diet but also a sustainable lifestyle model, with country-specific and culturally appropriate variations. It also takes into account the identity and diversity of food cultures and systems, expressed within the notion of the Mediterranean diet, across the Mediterranean region and in other parts of the world. Further multidisciplinary studies are needed for the assessment of the sustainability of the Mediterranean diet to include these new dimensions.

  • 302. Deschasaux, Melanie
    et al.
    Huybrechts, Inge
    Murphy, Neil
    Julia, Chantal
    Hercberg, Serge
    Srour, Bernard
    Kesse-Guyot, Emmanuelle
    Latino-Martel, Paule
    Biessy, Carine
    Casagrande, Corinne
    Jenab, Mazda
    Ward, Heather
    Weiderpass, Elisabete
    Dahm, Christina C.
    Overvad, Kim
    Kyro, Cecilie
    Olsen, Anja
    Affret, Aurelie
    Boutron-Ruault, Marie-Christine
    Mahamat-Saleh, Yahya
    Kaaks, Rudolf
    Kuehn, Tilman
    Boeing, Heiner
    Schwingshackl, Lukas
    Bamia, Christina
    Peppa, Eleni
    Trichopoulou, Antonia
    Masala, Giovanna
    Krogh, Vittorio
    Panico, Salvatore
    Tumino, Rosario
    Sacerdote, Carlotta
    Buen-de-Mesquita, Bas
    Peeters, Petra H.
    Hjartåker, Anette
    Rylander, Charlotta
    Skeie, Guri
    Ramon Quiros, J.
    Jakszyn, Paula
    Salamanca-Fernandez, Elena
    Maria Huerta, Jose
    Ardanaz, Eva
    Amiano, Pilar
    Ericson, Ulrika
    Sonestedt, Emily
    Huseinovic, Ena
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Khaw, Kay-Tee
    Wareham, Nick
    Bradbury, Kathryn E.
    Perez-Cornago, Aurora
    Tsilidis, Konstantinos K.
    Ferrari, Pietro
    Riboli, Elio
    Gunter, Marc J.
    Touvier, Mathilde
    Nutritional quality of food as represented by the FSAm-NPS nutrient profiling system underlying the Nutri-Score label and cancer risk in Europe: results from the EPIC prospective cohort study2018In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, no 9, article id e1002651Article in journal (Refereed)
    Abstract [en]

    Background

    Helping consumers make healthier food choices is a key issue for the prevention of cancer and other diseases. In many countries, political authorities are considering the implementation of a simplified labelling system to reflect the nutritional quality of food products. The Nutri-Score, a five-colour nutrition label, is derived from the Nutrient Profiling System of the British Food Standards Agency (modified version) (FSAm-NPS). How the consumption of foods with high/low FSAm-NPS relates to cancer risk has been studied in national/regional cohorts but has not been characterized in diverse European populations.

    Methods and findings

    This prospective analysis included 471,495 adults from the European Prospective Investigation into Cancer and Nutrition (EPIC, 1992-2014, median follow-up: 15.3 y), among whom there were 49,794 incident cancer cases (main locations: breast, n = 12,063; prostate, n = 6,745; colon-rectum, n = 5,806). Usual food intakes were assessed with standardized country-specific diet assessment methods. The FSAm-NPS was calculated for each food/beverage using their 100-g content in energy, sugar, saturated fatty acid, sodium, fibres, proteins, and fruits/vegetables/legumes/nuts. The FSAm-NPS scores of all food items usually consumed by a participant were averaged to obtain the individual FSAm-NPS Dietary Index (DI) scores. Multi-adjusted Cox proportional hazards models were computed. A higher FSAm-NPS DI score, reflecting a lower nutritional quality of the food consumed, was associated with a higher risk of total cancer (HRQ5 versus (Q1) = 1.07; 95% CI 1.03-1.10, P-trend < 0.001). Absolute cancer rates in those with high and low (quintiles 5 and 1) FSAm-NPS DI scores were 81.4 and 69.5 cases/10,000 person-years, respectively. Higher FSAm-NPS DI scores were specifically associated with higher risks of cancers of the colon-rectum, upper aerodigestive tract and stomach, lung for men, and liver and postmenopausal breast for women (all P < 0.05). The main study limitation is that it was based on an observational cohort using self-reported dietary data obtained through a single baseline food frequency questionnaire; thus, exposure misclassification and residual confounding cannot be ruled out.

    Conclusions

    In this large multinational European cohort, the consumption of food products with a higher FSAm-NPS score (lower nutritional quality) was associated with a higher risk of cancer. This supports the relevance of the FSAm-NPS as underlying nutrient profiling system for front-of-pack nutrition labels, as well as for other public health nutritional measures.

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  • 303. Dimova, Lidiya G.
    et al.
    Zlatkov, Nikola
    Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS). Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine).
    Verkade, Henkjan J.
    Uhlin, Bernt Eric
    Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS). Umeå University, Faculty of Medicine, Department of Molecular Biology (Faculty of Medicine).
    Tietge, Uwe J. F.
    High- cholesterol diet does not alter gut microbiota composition in mice2017In: Nutrition & Metabolism, ISSN 1743-7075, E-ISSN 1743-7075, Vol. 14, article id 15Article in journal (Refereed)
    Abstract [en]

    Introduction: Western diet containing both saturated fat and cholesterol impairs cardio- metabolic health partly by modulating diversity and function of the microbiota. While diet containing only high fat has comparable effects, it is unclear how diets only enriched in cholesterol impact the microbiota. Therefore, we aimed to characterize the response of host and microbiota to a high cholesterol ( HC) diet in mice susceptible to cardio- metabolic disease. Methods: LDLR knockout mice received either 1.25% HC or no cholesterol containing control diet ( NC) for 12 weeks before characterizing host cholesterol metabolism and intestinal microbiota composition ( next generation sequencing). Results: HC diet substantially increased plasma ( 1.6- fold) and liver cholesterol levels ( 21- fold), biliary cholesterol secretion ( 4.5- fold) and fecal neutral sterol excretion ( 68- fold, each p < 0.001) but not fecal bile acid excretion. Interestingly, despite the profound changes in intestinal cholesterol homeostasis no differences in microbial composition between control and HC- fed mice were detected. In both groups the main phyla were Bacteroidetes ( 55%), Firmicutes ( 27%) and Verrucomicrobia ( 14%). Conclusion: Our results demonstrate that in mice HC diet alone does not alter the microbiota composition despite inducing substantial adaptive changes in whole body cholesterol homeostasis. The impact of Western diet on intestinal microbiota thus appears to be mediated exclusively by its high fat content.

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  • 304. Ding, Ming
    et al.
    Huang, Tao
    Bergholdt, Helle K. M.
    Nordestgaard, Borge G.
    Ellervik, Christina
    Qi, Lu
    Frazier-Wood, Alexis C.
    Aslibekyan, Stella
    North, Kari E.
    Voortman, Trudy
    Graff, Mariaelisa
    Smith, Caren E.
    Lai, Chao-Qiang
    Varbo, Anette
    Lemaitre, Rozenn N.
    de Jonge, Ester A. L.
    Fumeron, Frederic
    Corella, Dolores
    Wang, Carol A.
    Tjonneland, Anne
    Overvad, Kim
    Sorensen, Thorkild I. A.
    Feitosa, Mary F.
    Wojczynski, Mary K.
    Kahonen, Mika
    Ahmad, Shafqat
    Renström, Frida
    Umeå University, Faculty of Medicine, Department of Biobank Research. Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Psaty, Bruce M.
    Siscovick, David S.
    Barroso, Ines
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Biobank Research.
    Hernandez, Dena
    Ferrucci, Luigi
    Bandinelli, Stefania
    Linneberg, Allan
    Sandholt, Camilla Helene
    Pedersen, Oluf
    Hansen, Torben
    Schulz, Christina-Alexandra
    Sonestedt, Emily
    Orho-Melander, Marju
    Chen, Tzu-An
    Rotter, Jerome I.
    Allison, Mathew A.
    Rich, Stephen S.
    Sorli, Jose V.
    Coltell, Oscar
    Pennell, Craig E.
    Eastwood, Peter R.
    Hofman, Albert
    Uitterlinden, Andre G.
    Zillikens, MCarola
    van Rooij, Frank J. A.
    Chu, Audrey Y.
    Rose, Lynda M.
    Ridker, Paul M.
    Viikari, Jorma
    Raitakari, Olli
    Lehtimaki, Terho
    Mikkila, Vera
    Willett, Walter C.
    Wang, Yujie
    Tucker, Katherine L.
    Ordovas, Jose M.
    Kilpelainen, Tuomas O.
    Province, Michael A.
    Franks, Paul W.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA; Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Arnett, Donna K.
    Tanaka, Toshiko
    Toft, Ulla
    Ericso, Ulrika
    Franco, Oscar H.
    Mozaffarian, Dariush
    Hu, Frank B.
    Chasman, Daniel I.
    Dairy consumption, systolic blood pressure, and risk of hypertension: Mendelian randomization study2017In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 356, article id j1000Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE To examine whether previous observed inverse associations of dairy intake with systolic blood pressure and risk of hypertension were causal. DESIGN Mendelian randomization study using the single nucleotide polymorphism rs4988235 related to lactase persistence as an instrumental variable. SETTING CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) Consortium. PARTICIPANTS Data from 22 studies with 171 213 participants, and an additional 10 published prospective studies with 26 119 participants included in the observational analysis. MAIN OUTCOME MEASURES The instrumental variable estimation was conducted using the ratio of coefficients approach. Using metaanalysis, an additional eight published randomized clinical trials on the association of dairy consumption with systolic blood pressure were summarized. RESULTS Compared with the CC genotype (CC is associated with complete lactase deficiency), the CT/TT genotype (TT is associated with lactose persistence, and CT is associated with certain lactase deficiency) of LCT-13910 (lactase persistence gene) rs4988235 was associated with higher dairy consumption (0.23 (about 55 g/day), 95% confidence interval 0.17 to 0.29) serving/day; P<0.001) and was not associated with systolic blood pressure (0.31, 95% confidence interval -0.05 to 0.68 mm Hg; P=0.09) or risk of hypertension (odds ratio 1.01, 95% confidence interval 0.97 to 1.05; P=0.27). Using LCT-13910 rs4988235 as the instrumental variable, genetically determined dairy consumption was not associated with systolic blood pressure (beta=1.35, 95% confidence interval -0.28 to 2.97 mm Hg for each serving/day) or risk of hypertension (odds ratio 1.04, 0.88 to 1.24). Moreover, meta-analysis of the published clinical trials showed that higher dairy intake has no significant effect on change in systolic blood pressure for interventions over one month to 12 months (intervention compared with control groups: beta=-0.21, 95% confidence interval -0.98 to 0.57 mm Hg). In observational analysis, each serving/day increase in dairy consumption was associated with -0.11 (95% confidence interval -0.20 to -0.02 mm Hg; P=0.02) lower systolic blood pressure but not risk of hypertension (odds ratio 0.98, 0.97 to 1.00; P=0.11). CONCLUSION The weak inverse association between dairy intake and systolic blood pressure in observational studies was not supported by a comprehensive instrumental variable analysis and systematic review of existing clinical trials.

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  • 305. Dixen, Karen
    et al.
    Basse, Astrid L.
    Murholm, Maria
    Isidor, Marie S.
    Hansen, Lillian H. L.
    Petersen, M. Christine H.
    Madsen, Lise
    Petrovic, Natasa
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Nedergaard, Jan
    Stockholm University, Faculty of Science, Department of Molecular Biosciences, The Wenner-Gren Institute.
    Quistorff, Bjorn
    Hansen, Jacob B.
    ERR gamma Enhances UCP1 Expression and Fatty Acid Oxidation in Brown Adipocytes2013In: Obesity, ISSN 1930-7381, E-ISSN 1930-739X, Vol. 21, no 3, p. 516-524Article in journal (Refereed)
    Abstract [en]

    Objective: Estrogen-related receptors (ERRs) are important regulators of energy metabolism. Here we investigated the hypothesis that ERR gamma impacts on differentiation and function of brown adipocytes. Design and Methods: We characterize the expression of ERR gamma in adipose tissues and cell models and investigate the effects of modulating ERR? activity on UCP1 gene expression and metabolic features of brown and white adipocytes. Results: ERR gamma was preferentially expressed in brown compared to white fat depots, and ERR gamma was induced during cold-induced browning of subcutaneous white adipose tissue and brown adipogenesis. Overexpression of ERR gamma positively regulated uncoupling protein 1 (UCP1) expression levels during brown adipogenesis. This ERR gamma-induced augmentation of UCP1 expression was independent of the presence of peroxisome proliferator-activated receptor coactivator-1 (PGC-1 alpha) but was associated with increased rates of fatty acid oxidation in adrenergically stimulated cells. ERR? did not influence mitochondrial biogenesis, and its reduced expression in white adipocytes could not explain their low expression level of UCP1. Conclusions: Through its augmenting effect on expression of UCP1, ERR gamma may physiologically be involved in increasing the potential for energy expenditure in brown adipocytes, a function that is becoming of therapeutic interest.

  • 306.
    Doi, Mariko
    et al.
    Department of Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
    Sultana Rekha, Rokeya
    Laboratory Science Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).
    Ahmed, Sultan
    Laboratory Science Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).
    Okada, Masafumi
    Department of Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
    Kumar Roy, Anjan
    Laboratory Science Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).
    El Arifeen, Shams
    Child Health Unit, Public Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Raqib, Rubhana
    Laboratory Science Division, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B).
    Wagatsuma, Yukiko
    Department of Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
    Association between calcium in cord blood and newborn size in Bangladesh2011In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 106, no 9, p. 1398-1407Article in journal (Refereed)
    Abstract [en]

    Ca status in the uterus during pregnancy has been suggested to affect fetal growth and size at birth. In Bangladesh, low Ca levels in pregnant women and low birth weight in infants are common. The present study explored the association between Ca levels in cord blood and newborn size at birth (birth weight and birth length) in Bangladesh. Samples and data included 223 women with live-born singleton deliveries in rural Bangladesh. Newborn weight and length were measured at birth. From cord blood obtained at delivery, Ca, 25-hydroxy vitamin D, bone-specific alkaline phosphatase and intact parathyroid hormone levels were determined. An association between size at birth and Ca levels in cord blood was found (birth weight, P = 0·022; birth length, P = 0·001). Associations between Ca and newborn size were further analysed using multivariate regression analyses. After adjusting for several covariates of characteristics in mothers and newborns (gestational weeks at birth, sex of newborn, socio-economic status, maternal height, BMI, age and season at birth), birth length still exhibited a significant relationship with Ca levels in cord blood (birth length, P = 0·030). The present study indicates that Ca status in cord blood might be associated with the birth length of newborns. Ca levels during gestation may affect fetal growth.

  • 307.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Iron and Other Micronutrient Deficiencies in Low-Birthweight Infants2013In: Maternal and child nutrition: the first 1,000 days / [ed] Jatinder Bhatia, Zulfiqar A. Bhutta, Satish C. Kalhan, 2013, p. 197-206Conference paper (Refereed)
    Abstract [en]

    Low birthweight (LBW), defined as birthweight <2,500 g, is a major global public health problem and is associated with lifelong cognitive and behavioral problems. Very LBW (VLBW) infants (<1,500 g) are at high risk of multiple macro- and micronutrient deficiencies, but most LBW infants are larger (1,500-2,500 g), and the most common nutritional problem of those infants is iron deficiency (ID). Globally, about 25% of pre-school children have ID anemia (IDA), the most severe form of ID, and there is good evidence that ID is associated with impaired brain development. However, adverse effects of excessive iron supplementation have been observed. Delayed umbilical cord clamping, which increases infant iron stores, should be recommended for all newborns. There is good evidence that intakes of 2 mg of dietary iron per kg daily prevents IDA in LBW infants without causing adverse effects. A recent study shows that this dose of iron supplementation also reduces the risk of behavioral problems at 3 years in infants with birthweights 2,000-2,500 g.VLBW infants need 2-3 mg/kg per day. To achieve these intakes, breastfed LBW infants should receive iron supplements, and formula-fed LBW infants should receive an iron-fortified infant formula.

  • 308.
    Domellöf, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Braegger, Christian
    Campoy, Cristina
    Colomb, Virginie
    Decsi, Tamas
    Fewtrell, Mary
    Hojsak, Iva
    Mihatsch, Walter
    Molgaard, Christian
    Shamir, Raanan
    Turck, Dominique
    van Goudoever, Johannes
    Iron Requirements of Infants and Toddlers2014In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 58, no 1, p. 119-129Article in journal (Refereed)
    Abstract [en]

    Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group because their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of ID anemia (IDA) include low birth weight, high cow's-milk intake, low intake of iron-rich complementary foods, low socioeconomic status, and immigrant status. The aim of this position paper was to review the field and provide recommendations regarding iron requirements in infants and toddlers, including those of moderately or marginally low birth weight. There is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting. Delayed cord clamping reduces the risk of ID. There is insufficient evidence to support general iron supplementation of healthy European infants and toddlers of normal birth weight. Formula-fed infants up to 6 months of age should receive iron-fortified infant formula, with an iron content of 4 to 8 mg/L (0.6-1.2 mg <bold></bold> kg(-1) <bold></bold> day(-1)). Marginally low-birth-weight infants (2000-2500 g) should receive iron supplements of 1-2 mg <bold></bold> kg(-1) <bold></bold> day(-1). Follow-on formulas should be iron-fortified; however, there is not enough evidence to determine the optimal iron concentration in follow-on formula. From the age of 6 months, all infants and toddlers should receive iron-rich (complementary) foods, including meat products and/or iron-fortified foods. Unmodified cow's milk should not be fed as the main milk drink to infants before the age of 12 months and intake should be limited to <500 mL/day in toddlers. It is important to ensure that this dietary advice reaches high-risk groups such as socioeconomically disadvantaged families and immigrant families.

  • 309.
    Domellöf, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Szitanyi, P
    Simchowitz, V
    Franz, A
    Mimouni, F
    ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Iron and trace minerals2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2354-2359Article in journal (Refereed)
  • 310.
    Domellöf, Magnus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Thorsdottir, Inga
    Thorstensen, Ketil
    Health effects of different dietary iron intakes: a systematic literature review for the 5th Nordic Nutrition Recommendations2013In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 57, no 21667Article, review/survey (Refereed)
    Abstract [en]

    Background: The present literature review is part of the NNR5 project with the aim of reviewing and updating the scientific basis of the 4th edition of the Nordic Nutrition Recommendations (NNR) issued in 2004. Objective: The objective of this systematic literature review was to assess the health effects of different intakes of iron, at different life stages (infants, children, adolescents, adults, elderly, and during pregnancy and lactation), in order to estimate the requirement for adequate growth, development, and maintenance of health.

    Methods: The initial literature search resulted in 1,076 abstracts. Out of those, 276 papers were identified as potentially relevant. Of those, 49 were considered relevant and were quality assessed (A, B, or C). An additional search on iron and diabetes yielded six articles that were quality assessed. Thus, a total of 55 articles were evaluated. The grade of evidence was classified as convincing (grade 1), probable (grade 2), suggestive (grade 3), and inconclusive (grade 4).

    Results: There is suggestive evidence that prevention or treatment of iron deficiency (ID) and iron deficiency anemia (IDA) improves cognitive, motoric, and behavioral development in young children, and that treatment of IDA improves attention and concentration in school children and adult women. There is insufficient evidence to show negative health effects of iron intakes in doses suggested by the NNR 4. There is insufficient evidence to suggest that normal birth weight, healthy, exclusively breast-fed infants need additional dietary iron before 6 months of life in the Nordic countries. An iron concentration of 4-8 mg/L in infant formulas seems to be safe and effective for normal birth weight infants. There is probable evidence that iron supplements (1-2 mg/kg/day) given up to 6 months of age to infants with low birth weight (<2,500 g) prevents IDA and possibly reduce the risk of behavioral problems later on. There is probable evidence that ID and IDA in pregnant women can be effectively prevented by iron supplementation at a dose of 40 mg/day from week 18-20 of gestation. There is probable evidence that a high intake of heme iron, but not total dietary, non-heme or supplemental iron, is associated with increased risk of type 2 diabetes (T2D) and gestational diabetes.

    Conclusions: Overall, the evidence does not support a change of the iron intakes recommended in the NNR 4. However, one could consider adding recommendations for infants below 6 months of age, low birth weight infants and pregnant women.

  • 311. Domingo, Jose L.
    et al.
    Ericson Jogsten, Ingrid
    Örebro University, School of Science and Technology.
    Eriksson, Ulrika
    Örebro University, School of Science and Technology.
    Martorell, Isabel
    Perello, Gemma
    Nadal, Marti
    van Bavel, Bert
    Örebro University, School of Science and Technology.
    Human dietary exposure to perfluoroalkyl substances in Catalonia, Spain: temporal trend2012In: Food Chemistry, ISSN 0308-8146, E-ISSN 1873-7072, Vol. 135, no 3, p. 1575-1582Article in journal (Refereed)
    Abstract [en]

    In this study, we assessed the levels of 18 perfluoroalkyl substances (PFASs) in the most widely consumed foodstuffs in Catalonia, Spain, as well as the total dietary intake of these compounds. Forty food items were analysed. Only perfluoropentanoic acid (PFPeA), perfluorohexadecanoic acid (PFHxDA) and perfluorooctanoicdecanoic acid (PFOcDA) were not detected in any sample. Perfluorooctane sulfonate (PFOS) was the compound found in the highest number of samples (33 out of 80), followed by perfluorooctanoic acid (PFOA), perfluoroheptanoic acid (PFHpA), perfluorohexane sulfonic acid (PFHxS), perfluorodecanoic acid (PFDA) and perfluorodecane sulfonic acid (PFDS). Fish and shellfish was the food group in which more PFASs were detected and where the highest PFAS concentrations were found. The highest dietary intakes corresponded to children, followed by male seniors, with values of 1787 and 1466 ng/day, respectively. For any of the age/gender groups of the population, the Tolerable Daily Intakes (TDIs) recommended by the EFSA were not exceeded. In general terms, PFAS levels found in the current study are lower than the concentrations recently reported in other countries.

  • 312.
    Dragsted, L.
    et al.
    Univ Copenhagen, Dept Nutr Exercise & Sports, DK-1168 Copenhagen, Denmark..
    Acar, E.
    Univ Copenhagen, Dept Food Sci, DK-1168 Copenhagen, Denmark..
    Gurdeniz, G.
    Univ Copenhagen, Dept Nutr Exercise & Sports, DK-1168 Copenhagen, Denmark..
    Andersen, M-B
    Univ Copenhagen, Dept Nutr Exercise & Sports, DK-1168 Copenhagen, Denmark..
    Poulsen, S.
    Univ Copenhagen, Dept Nutr Exercise & Sports, DK-1168 Copenhagen, Denmark..
    Astrup, A.
    Univ Copenhagen, Dept Nutr Exercise & Sports, DK-1168 Copenhagen, Denmark..
    Bro, R.
    Univ Copenhagen, Dept Food Sci, DK-1168 Copenhagen, Denmark..
    Engelsen, S. B.
    Univ Copenhagen, Dept Food Sci, DK-1168 Copenhagen, Denmark..
    Savorani, F.
    Univ Copenhagen, Dept Food Sci, DK-1168 Copenhagen, Denmark..
    Brader, L.
    Aarhus Univ Hosp, Dept Med & Endocrinol MEA, Aarhus, Denmark..
    Hermansen, K.
    Aarhus Univ Hosp, Dept Med & Endocrinol MEA, Aarhus, Denmark..
    Schwab, U.
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland..
    Kolehmainen, M.
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland..
    Paananen, J.
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland..
    Poutanen, K. S.
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland..
    Cloetens, L.
    Lund Univ, Biomed Nutr Pure & Appl Biochem, S-22100 Lund, Sweden..
    Akesson, B.
    Lund Univ, Biomed Nutr Pure & Appl Biochem, S-22100 Lund, Sweden..
    Siloaho, M.
    Univ Oulu, Dept Internal Med, Inst Clin Med, SF-90100 Oulu, Finland..
    Savolainen, M. J.
    Univ Oulu, Dept Internal Med, Inst Clin Med, SF-90100 Oulu, Finland..
    Gunnarsdottir, I
    Univ Iceland, IS-101 Reykjavik, Iceland.;Natl Univ Hosp Iceland, Landspitali, Reykjavik, Iceland..
    Thorsdottir, I
    Univ Iceland, IS-101 Reykjavik, Iceland.;Natl Univ Hosp Iceland, Landspitali, Reykjavik, Iceland..
    Ulven, S. M.
    Oslo & Akershus Univ Coll Appl Sci, Fac Hlth Sci, Dept Hlth Nutr & Management, Oslo, Norway..
    Rosqvist, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Uusitupa, M.
    Univ Eastern Finland, Inst Publ Hlth & Clin Nutr, Joensuu, Finland..
    Larsen, T. M.
    Univ Copenhagen, Dept Nutr Exercise & Sports, DK-1168 Copenhagen, Denmark..
    Metabolomic response to Nordic foods2015In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 67, p. 55-55Article in journal (Other academic)
  • 313. Draper, Catherine E.
    et al.
    Tomaz, Simone A.
    Jones, Rachel A.
    Hinkley, Trina
    Twine, Rhian
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
    Norris, Shane A.
    Cross-sectional associations of physical activity and gross motor proficiency with adiposity in South African children of pre-school age2019In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 22, no 4, p. 614-623Article in journal (Refereed)
    Abstract [en]

    Objective: The study aimed to investigate the relationship between physical activity, gross motor skills and adiposity in South African children of pm-school age.

    Design: Cross-sectional study.

    Setting: High-income urban, and low-income urban and rural settings in South Africa.

    Participants: Children (3-6 years old, n 268) were recruited from urban high-income (n 46), urban low-income (n 91) and rural low-income (n 122) settings. Height and weight were measured to calculate the main outcome variables: BMI and BMI-for-age Z-score (BAZ). Height-for-age and weight-for-age Z-scores were also calculated. Actigraph GT3X+ accelerometers were used to objectively measure physical activity; the Test of Gross Motor Development (Version 2) was used to assess gross motor skills.

    Results: More children were overweight/obese and had a higher BAZ from urban low-income settings compared with urban high-income settings and rural low-income settings. Being less physically active was associated with thinness, but not overweight/obesity. Time spent in physical activity at moderate and vigorous intensities was positively associated with BMI and BAZ. Gross motor proficiency was not associated with adiposity in this sample.

    Conclusions: The findings of this research highlight the need for obesity prevention particularly in urban low-income settings, as well as the need to take into consideration the complexity of the relationship between adiposity, physical activity and gross motor skills in South African pre-school children.

  • 314. Dratva, Julia
    et al.
    Bertelsen, Randi
    Janson, Christer
    Johannessen, Ane
    Benediktsdóttir, Bryndis
    Bråbäck, Lennart
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dharmage, Shyamali C
    Forsberg, Bertil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Gislason, Thorarinn
    Jarvis, Debbie
    Jogi, Rain
    Lindberg, Eva
    Norback, Dan
    Omenaas, Ernst
    Skorge, Trude D
    Sigsgaard, Torben
    Toren, Kjell
    Waatevik, Marie
    Wieslander, Gundula
    Schlünssen, Vivi
    Svanes, Cecilie
    Real, Francisco Gomez
    Validation of self-reported figural drawing scales against anthropometric measurements in adults2016In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 19, no 11, p. 1944-1951Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the present study was to validate figural drawing scales depicting extremely lean to extremely obese subjects to obtain proxies for BMI and waist circumference in postal surveys.

    DESIGN: Reported figural scales and anthropometric data from a large population-based postal survey were validated with measured anthropometric data from the same individuals by means of receiver-operating characteristic curves and a BMI prediction model.

    SETTING: Adult participants in a Scandinavian cohort study first recruited in 1990 and followed up twice since.

    SUBJECTS: Individuals aged 38-66 years with complete data for BMI (n 1580) and waist circumference (n 1017).

    RESULTS: Median BMI and waist circumference increased exponentially with increasing figural scales. Receiver-operating characteristic curve analyses showed a high predictive ability to identify individuals with BMI > 25·0 kg/m2 in both sexes. The optimal figural scales for identifying overweight or obese individuals with a correct detection rate were 4 and 5 in women, and 5 and 6 in men, respectively. The prediction model explained 74 % of the variance among women and 62 % among men. Predicted BMI differed only marginally from objectively measured BMI.

    CONCLUSIONS: Figural drawing scales explained a large part of the anthropometric variance in this population and showed a high predictive ability for identifying overweight/obese subjects. These figural scales can be used with confidence as proxies of BMI and waist circumference in settings where objective measures are not feasible.

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  • 315. Duarte-Salles, Talita
    et al.
    Fedirko, Veronika
    Stepien, Magdalena
    Aleksandrova, Krasimira
    Bamia, Christina
    Lagiou, Pagona
    Laursen, Anne Sofie Dam
    Hansen, Louise
    Overvad, Kim
    Tjønneland, Anne
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    His, Mathilde
    Boeing, Heiner
    Katzke, Verena
    Kühn, Tilman
    Trichopoulou, Antonia
    Valanou, Elissavet
    Kritikou, Maria
    Masala, Giovanna
    Panico, Salvatore
    Sieri, Sabina
    Ricceri, Fulvio
    Tumino, Rosario
    Bueno-de-Mesquita, H B As
    Peeters, Petra H
    Hjartåker, Anette
    Skeie, Guri
    Weiderpass, Elisabete
    Ardanaz, Eva
    Bonet, Catalina
    Chirlaque, Maria-Dolores
    Dorronsoro, Miren
    Quirós, J Ramón
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Ohlsson, Bodil
    Sjöberg, Klas
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Khaw, Kay-Tee
    Travis, Ruth C
    Wareham, Nick
    Ferrari, Pietro
    Freisling, Heinz
    Romieu, Isabelle
    Cross, Amanda J
    Gunter, Marc
    Lu, Yunxia
    Jenab, Mazda
    Dietary fat, fat subtypes and hepatocellular carcinoma in a large European cohort2015In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 137, no 11, p. 2715-2728Article in journal (Refereed)
    Abstract [en]

    The role of amount and type of dietary fat consumption in the etiology of hepatocellular carcinoma (HCC) is poorly understood, despite suggestive biological plausibility. The associations of total fat, fat subtypes and fat sources with HCC incidence were investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which includes 191 incident HCC cases diagnosed between 1992 and 2010. Diet was assessed by country-specific, validated dietary questionnaires. A single 24-hr diet recall from a cohort subsample was used for measurement error calibration. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated from Cox proportional hazard models. Hepatitis B and C viruses (HBV/HCV) status and biomarkers of liver function were assessed separately in a nested case-control subset with available blood samples (HCC = 122). In multivariable calibrated models, there was a statistically significant inverse association between total fat intake and risk of HCC (per 10 g/day, HR = 0.80, 95% CI: 0.65-0.99), which was mainly driven by monounsaturated fats (per 5 g/day, HR = 0.71, 95% CI: 0.55-0.92) rather than polyunsaturated fats (per 5 g/day, HR = 0.92, 95% CI: 0.68-1.25). There was no association between saturated fats (HR = 1.08, 95% CI: 0.88-1.34) and HCC risk. The ratio of polyunsaturated/monounsaturated fats to saturated fats was not significantly associated with HCC risk (per 0.2 point, HR = 0.86, 95% CI: 0.73-1.01). Restriction of analyses to HBV/HCV free participants or adjustment for liver function did not substantially alter the findings. In this large prospective European cohort, higher consumption of monounsaturated fats is associated with lower HCC risk.

  • 316. Duarte-Salles, Talita
    et al.
    Fedirko, Veronika
    Stepien, Magdalena
    Trichopoulou, Antonia
    Bamia, Christina
    Lagiou, Pagona
    Lukanova, Annekatrin
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Trepo, Elisabeth
    Overvad, Kim
    Tjønneland, Anne
    Halkjaer, Jytte
    Boutron-Ruault, Marie-Christine
    Racine, Antoine
    Cadeau, Claire
    Kühn, Tilman
    Aleksandrova, Krasimira
    Trichopoulos, Dimitrios
    Tsiotas, Konstantinos
    Boffetta, Paolo
    Palli, Domenico
    Pala, Valeria
    Tumino, Rosario
    Sacerdote, Carlotta
    Panico, Salvatore
    Bueno-de-Mesquita, H B as
    Dik, Vincent K
    Peeters, Petra H
    Weiderpass, Elisabete
    Torhild Gram, Inger
    Hjartåker, Anette
    Ramón Quirós, Jose
    Fonseca-Nunes, Ana
    Molina-Montes, Esther
    Dorronsoro, Miren
    Navarro Sanchez, Carmen
    Barricarte, Aurelio
    Lindkvist, Björn
    Sonestedt, Emily
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Khaw, Kay-Tee
    Wareham, Nick
    Travis, Ruth C
    Romieu, Isabelle
    Riboli, Elio
    Jenab, Mazda
    Dairy products and risk of hepatocellular carcinoma: the European Prospective Investigation into Cancer and Nutrition2014In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 135, no 7, p. 1662-1672Article in journal (Refereed)
    Abstract [en]

    Intake of dairy products has been associated with risk of some cancers, but findings are often inconsistent and information on hepatocellular carcinoma (HCC) risk is limited, particularly from prospective settings. The aim of our study was to investigate the association between consumption of total and specific dairy products (milk/cheese/yogurt) and their components (calcium/vitamin D/fats/protein), with first incident HCC (N(cases) = 191) in the European Prospective Investigation into Cancer and Nutrition cohort, including a nested case-control subset (N(cases) = 122) with the assessment of hepatitis B virus/hepatitis C virus infections status, liver damage and circulating insulin-like growth factor (IGF)-I levels. For cohort analyses, multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI). For nested case-control analyses, conditional logistic regression was used to calculate odds ratios and 95% CI. A total of 477,206 participants were followed-up for an average of 11 years (person-years follow-up = 5,415,385). In the cohort study, a significant positive HCC risk association was observed for total dairy products (highest vs. lowest tertile, HR = 1.66, 95% CI: 1.13-2.43; p(trend) = 0.012), milk (HR = 1.51, 95% CI: 1.02-2.24; p(trend) = 0.049), and cheese (HR = 1.56, 95% CI: 1.02-2.38; p(trend) = 0.101), but not yogurt (HR = 0.94, 95% CI: 0.65-1.35). Dietary calcium, vitamin D, fat and protein from dairy sources were associated with increased HCC risk, whereas the same nutrients from nondairy sources showed inverse or null associations. In the nested case-control study, similar results were observed among hepatitis-free individuals. Results from this large prospective cohort study suggest that higher consumption of dairy products, particularly milk and cheese, may be associated with increased HCC risk. Validation of these findings in other populations is necessary. Potential biologic mechanisms require further exploration.

  • 317. Duell, Eric J
    et al.
    Lujan-Barroso, Leila
    Llivina, Claudia
    Muñoz, Xavier
    Jenab, Mazda
    Boutron-Ruault, Marie-Christine
    Clavel-Chapelon, Françoise
    Racine, Antoine
    Boeing, Heiner
    Buijsse, Brian
    Canzian, Federico
    Johnson, Theron
    Dalgård, Christine
    Overvad, Kim
    Tjønneland, Anne
    Olsen, Anja
    Sánchez, Soledad C
    Sánchez-Cantalejo, Emilio
    Huerta, José-María
    Ardanaz, Eva
    Dorronsoro, Miren
    Khaw, Kay-Tee
    Travis, Ruth C
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Rafnsson, Snorri
    Palli, Domenico
    Sacerdote, Carlotta
    Tumino, Rosario
    Panico, Salvatore
    Grioni, Sara
    Bueno-de-Mesquita, H Bas
    Ros, Martine M
    Numans, Mattijs E
    Peeters, Petra H
    Johansen, Dorthe
    Lindkvist, Björn
    Johansson, Mattias
    Umeå University, Faculty of Medicine, Department of Biobank Research. Genetic Epidemiology Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Skeie, Guri
    Weiderpass, Elisabete
    Duarte-Salles, Talita
    Stenling, Roger
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Riboli, Elio
    Sala, Núria
    González, Carlos A
    Vitamin C transporter gene (SLC23A1 and SLC23A2) polymorphisms, plasma vitamin C levels, and gastric cancer risk in the EPIC cohort2013In: Genes & Nutrition, ISSN 1555-8932, E-ISSN 1865-3499, Vol. 8, no 6, p. 549-560Article in journal (Refereed)
    Abstract [en]

    Vitamin C is known to protect mucosal tissues from oxidative stress and inhibit nitrosamine formation in the stomach. High consumption of fruits, particularly citrus, and higher circulating vitamin C concentrations may be inversely associated with gastric cancer (GC) risk. We investigated 20 polymorphisms in vitamin C transporter genes SCL23A1 and SCL23A2 and GC risk in 365 cases and 1,284 controls nested within the European Prospective Investigation into Cancer and Nutrition cohort. We also evaluated the association between these polymorphisms and baseline plasma vitamin C levels in a subset of participants. Four SNPs were predictors of plasma vitamin C levels (SLC23A1 rs11950646 and rs33972313; SLC23A2 rs6053005 and rs6133175) in multivariable linear regression models. One SNP (SLC23A2 rs6116569) was associated with GC risk, in particular non-cardia GC (OR = 1.63, 95 % CI = 1.11-2.39, based on 178 non-cardia cases), but this association was attenuated when plasma vitamin C was included in the logistic regression model. Haplotype analysis of SLC23A1 yielded no associations with GC. In SLC23A2, one haplotype was associated with both overall and non-cardia GC, another haplotype was associated with GC overall, and a third was associated with intestinal-type GC. Common variants in SLC23A1 and SLC23A2 may influence plasma vitamin C concentration independent of dietary intake, and variation in SLC23A2 may influence GC risk. Additional prospective studies in large populations and consortia are recommended. Investigation of variation in vitamin C transporter genes may shed light on the preventative properties of vitamin C in gastric carcinogenesis.

  • 318. Duell, Eric J
    et al.
    Travier, Noémie
    Lujan-Barroso, Leila
    Clavel-Chapelon, Françoise
    Boutron-Ruault, Marie-Christine
    Morois, Sophie
    Palli, Domenico
    Krogh, Vittorio
    Panico, Salvatore
    Tumino, Rosario
    Sacerdote, Carlotta
    Quirós, J Ramón
    Sánchez-Cantalejo, Emilio
    Navarro, Carmen
    Gurrea, Aurelio Barricarte
    Dorronsoro, Miren
    Khaw, Kay-Tee
    Allen, Naomi E
    Key, Timothy J
    Bueno-de-Mesquita, H Bas
    Ros, Martine M
    Numans, Mattijs E
    Peeters, Petra Hm
    Trichopoulou, Antonia
    Naska, Androniki
    Dilis, Vardis
    Teucher, Birgit
    Kaaks, Rudolf
    Boeing, Heiner
    Schütze, Madlen
    Regner, Sara
    Lindkvist, Björn
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Overvad, Kim
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Egeberg, Rikke
    Tjønneland, Anne
    Lund, Eiliv
    Weiderpass, Elisabete
    Braaten, Tonje
    Romieu, Isabelle
    Ferrari, Pietro
    Jenab, Mazda
    Stenling, Roger
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Aune, Dagfinn
    Norat, Teresa
    Riboli, Elio
    González, Carlos A
    Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.2011In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 94, no 5, p. 1266-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Gastric cancer (GC) is the second leading cause of cancer death worldwide. The association between alcohol consumption and GC has been investigated in numerous epidemiologic studies with inconsistent results.

    OBJECTIVE: We evaluated the association between alcohol consumption and GC risk.

    DESIGN: We conducted a prospective analysis in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, which included 444 cases of first primary gastric adenocarcinoma. HRs and 95% CIs for GC were estimated by using multivariable Cox proportional hazards regression for consumption of pure ethanol in grams per day, with stratification by smoking status, anatomic subsite (cardia, noncardia), and histologic subtype (diffuse, intestinal). In a subset of participants, results were further adjusted for baseline Helicobacter pylori serostatus.

    RESULTS: Heavy (compared with very light) alcohol consumption (≥60 compared with 0.1-4.9 g/d) at baseline was positively associated with GC risk (HR: 1.65; 95% CI: 1.06, 2.58), whereas lower consumption amounts (<60 g/d) were not. When we analyzed GC risk by type of alcoholic beverage, there was a positive association for beer (≥30 g/d; HR: 1.75; 95% CI: 1.13, 2.73) but not for wine or liquor. Associations were primarily observed at the highest amounts of drinking in men and limited to noncardia subsite and intestinal histology; no statistically significant linear dose-response trends with GC risk were observed.

    CONCLUSION: Heavy (but not light or moderate) consumption of alcohol at baseline (mainly from beer) is associated with intestinal-type noncardia GC risk in men from the EPIC cohort.

  • 319. Dullemeijer, Carla
    et al.
    Zock, Peter L.
    Coronel, Ruben
    Den Ruijter, Hester M.
    Katan, Martijn B.
    Brummer, Robert
    Örebro University, School of Health and Medical Sciences.
    Kok, Frans J.
    Beekman, Jet
    Brouwer, Ingeborg A.
    Differences in fatty acid composition between cerebral brain lobes in juvenile pigs after fish oil feeding2008In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 100, no 4, p. 794-800Article in journal (Refereed)
    Abstract [en]

    Very long-chain n-3 PUFA from fish are suggested to play a role in the development of the brain. Fish oil feeding results in higher proportions of n-3 PUFA in the brains of newborn piglets. However, the effect of fish oil on the fatty acid composition of specific cerebral brain lobes in juvenile pigs is largely uninvestigated. This study examined the effect of a fish oil diet on the fatty acid composition of the frontal, parietal, temporal and occipital brain lobes in juvenile pigs (7 weeks old). Pigs were randomly allocated to a semipurified pig diet containing either 4% (w/w) fish oil (n 19) or 4% (w/w) high-oleic acid sunflower oil (HOSF diet, n 18) for a period of 8 weeks. The fish oil diet resulted in significantly higher proportions (%) of DHA in the frontal (10.6 (SD1.2)), parietal (10.2 (SD1.5)) and occipital brain lobes (9.9 (SD 1.3)), but not in the temporal lobe (7.7 (SD1.6)), compared with pigs fed the HOSF diet (frontal lobe, 7.5 (SD1.0); parietal lobe, 8.1 (SD 1.3); occipital lobe, 7.3 (SD1.2), temporal lobe, 6.6 (SD1.2). Moreover, the proportion of DHA was significantly lower in the temporal lobe compared with the frontal, parietal and occipital brain lobes in pigs fed a fish oil diet. In conclusion, the brains of juvenile pigs appear to be responsive to dietary fish oil, although the temporal brain lobe is less responsive compared with the other three brain lobes. The functional consequences of these differences are a challenging focus for future investigation.

  • 320.
    Edfors, Ellinor
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Forskningsmiljön PRO-CARE.
    Westergren, Albert
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Forskningsmiljön PRO-CARE.
    Home-living elderly people’s views on food and meals2012In: Journal of Aging Research, ISSN 2090-2204, p. 761291-Article in journal (Refereed)
    Abstract [en]

    Background.

    The aim of the study was to describe home-living elderly people’s views on the importance of food andmeals. Methods. Semistructured interviews with twelve elderly people. The interviews were analysed using qualitative content analysis.

    Results.

    Respondents described how their past influenced their present experiences and views on food and meals. Increased reliance on and need of support with food and meals frequently arose in connection with major changes in their life situations. Sudden events meant a breaking point with a transition from independence to dependence and a need for assistance from relatives and/or the community. With the perspective from the past and in the context of dependency, respondents described meals during the day, quality of food, buying, transporting, cooking, and eating food.

    Conclusions.

    Meeting the need for optimal nutritional status for older people living at home requires knowledge of individual preferences and habits, from both their earlier and current lives. It is important to pay attention to risk factors that could compromise an individual’s ability to independently manage their diet, such as major life events and hospitalisation. Individual needs for self-determination and involvement should be considered in planning and development efforts for elderly people related to food and meals.

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  • 321.
    Edfors, Ellinor
    et al.
    Kristianstad University, School of Health and Society.
    Westergren, Albert
    Kristianstad University, School of Health and Society.
    "Om man ska ha mat, ska det vara god mat": äldre personers upplevelser av mat och måltider i ordinärt boende2010Report (Other academic)
    Abstract [en]

    The aim of the study was to capture the older persons' experiences in relation to foodand meals in ordinary housing.

    Method:Semi-structured interviews, with twelve older persons, on the basis of the instrument

    "Seniors in the community: Risk Evaluation for Eating and Nutrition, Version II" (SCREEN II). The interviews were analyzed with manifest and latent content analysis.

    Results:Respondents described how past life largely influenced their current experiences and views on food and meals. Increased reliance and need for support arose frequently in connection with a major change in the life situation. The results showed that the SCREEN II is useful for measuring the risk of malnutrition under Swedish conditions.

    Conclusions: Older people's knowledge about good and nutritious food as well as individual needs for self-determination and feeling involved should be considered in planning and development efforts related to food and meals in ordinary housing. SCREEN II can be considered as an appropriate instrument to use in the context of preventive home visits, in order to identify risk factors that can cause malnutrition. Further research in larger samples is needed.

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  • 322.
    Edfors, Ellinor
    et al.
    Kristianstad University, School of Health and Society.
    Westergren, Albert
    Kristianstad University, School of Health and Society.
    "Om man ska ha mat, ska det vara god mat": äldres upplevelser av mat och måltid i ordinärt boende2010Conference paper (Refereed)
    Abstract [sv]

    Bakgrund: Malnutrition, vilket inkluderar både undernäring och övervikt/fetma, är ett vanligt problem bland äldre personer, som kan leda till fysiska och psykiska funktionsnedsättningar. Flertal äldre personer i ordinärt boende som lever ensamma har svårigheter med att införskaffa, tillaga och äta sin mat. Genom förebyggande åtgärder kan uppkomst och försämring av malnutrition, ökat beroende, behov av institutionell vård och försämrad livskvalitet förebyggas.

    Syfte: Syfte med studien var att utifrån äldre personers upplevelser och erfarenheter undersöka och kartlägga mat och måltider i ordinärt boende.

    Metod: Semistrukturerade intervjuer, med tolv äldre personer, utifrån instrumentet ”Seniors in the community: Risk evaluation for eating and nutrition, version II” (SCREEN II). Intervjuerna analyserades med manifest och latent innehållsanalys.

    Resultat: Analysen av intervjuerna visade att respondenternas tidigare liv i hög grad påverkade nuvarande upplevelser av och syn på mat och måltider. Ökat beroende och behov av stöd uppkom inte sällan i samband med en större förändring i livssituationen. Resultatet visar att SCREEN II är ett användbart instrument för att mäta risk för malnutrition under svenska förhållanden.

    Slutsats: Äldre personers kunskaper kring god och näringsriktig mat samt individuella behov av självbestämmande och delaktighet bör beaktas i planering och utveckling av insatser kopplade till mat och måltider i ordinärt boende. För att uppmärksamma riskfaktorer som kan leda till malnutrition kan SCREEN II vara ett lämpligt instrument att använda i samband med förebyggande hembesök. Det finns ett behov av mer omfattande forskning inom området.

  • 323. Eiben, G
    et al.
    Andersson, C S
    Rothenberg, Elisabet
    Göteborgs universitet.
    Sundh, V
    Steen, B
    Lissner, L
    Secular trends in diet among elderly Swedes: cohort comparisons over three decades2004In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 7, no 5, p. 637-644Article in journal (Refereed)
    Abstract [en]

    Objective: The purpose of this study was to compare dietary practices among different birth cohorts of 70-year-old Swedes, who were examined between 1971 and 2000.

    Setting: Göteborg, Sweden.

    Design: Four population-based samples of 1360 70-year-olds, born in 1901, 1911, 1922 and 1930, have undergone health examinations and dietary assessments over a period of almost three decades. One-hour diet history (DH) interviews were conducted in 1971, 1981, 1992 and 2000 with a total of 758 women and 602 women. The formats and contents of the dietary examinations were similar over the years. Statistical analysis of linear trends was conducted, using year of examination as the independent variable, to detect secular trends in food and nutrient intakes across cohorts.

    Results: At the 2000 examination, the majority of 70-year-olds consumed nutritionally adequate diets. Later-born cohorts consumed more yoghurt, breakfast cereals, fruit, vegetables, chicken, rice and pasta than earlier-born cohorts. Consumption of low-fat spread and milk also increased, along with that of wine, light beer and candy. In contrast, potatoes, cakes and sugar were consumed less in 2000 than in 1971. The ratio of reported energy intake to estimated basal metabolic rate did not show any systematic trend over time in women, but showed a significant upward trend in men.

    Conclusions: The diet history method has captured changes in food selections in the elderly without changing in general format over three decades. Dietary quality has improved in a number of ways, and these findings in the elderly are consistent with national food consumption trends in the general population.

  • 324.
    Eiffener, Elodie
    et al.
    Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
    Eli, Karin
    Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK ; Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
    Ek, Anna
    Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Sandvik, Pernilla
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics.
    Somaraki, Maria
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics.
    Kremers, Stef
    Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
    Sleddens, Ester
    Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, the Netherlands.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of food studies, nutrition and dietetics. Unit of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial2019In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 14, no 11, article id e12556Article in journal (Refereed)
    Abstract [en]

    Background: Few studies have explored the influence of preschoolers' behavioural problems on obesity treatment.

    Objectives: To assess emotional and behavioural problems before and after an obesity intervention and examine relationships between changes in child behaviour and changes in weight status.

    Method: The study included 77 children (4‐6 years old, 53% girls, mean body mass index [BMI] z‐score of 3.0 [SD 0.6]) who participated in the More and Less Study, a randomized controlled trial. Families were randomized to a parenting program or to standard treatment. The children's heights and weights (BMI z‐score, primary outcome) were measured at baseline and 12 months post baseline. Parents rated their children's behaviours (secondary outcome) on the Child Behavior Checklist (CBCL) for ages 1.5 to 5 years, a questionnaire that measures psychosocial health and functioning, encompassing emotional and behavioural problems. Changes in child behaviour during treatment were examined through paired samples t tests; the influence of child behaviour on treatment effects was examined through linear regressions.

    Results: Child emotional and behavioural problems significantly improved after obesity treatment. Lower scores were found for Emotional Reactivity, Sleep Problems, Affective Problems, Aggressive Behaviour, Externalizing Behaviours, Oppositional Defiant Problems, and Total Problems. Child behaviour significantly affected obesity treatment results: Attention Problems and attention deficit hyperactivity disorder (ADHD) at baseline contributed to increasing BMI z‐scores, whereas Oppositional Defiant Problems, Externalizing Behaviours, and a higher number of behavioural problems predicted decreasing BMI z‐scores.

    Conclusions: Child behaviours at baseline influenced treatment results. Child emotional and behavioural problems improved post treatment. The results suggest that obesity treatment may help in reducing emotional distress among preschoolers.

  • 325.
    Einarsson, Sandra
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Laurell, Göran
    Tiblom Ehrsson, Ylva
    An explorative study on energy balance in patients with head and neck cancer2019In: Nutrition and Cancer, ISSN 0163-5581, E-ISSN 1532-7914Article in journal (Refereed)
    Abstract [en]

    Background: Involuntary body weight loss in head and neck cancer is common. Fundamental for weight loss is an energy imbalance where total energy expenditure exceeds energy intake.

    Aim: To map energy intake and parameters of energy expenditure at the start of and after radiotherapy, and their relation to weight change, body mass index, and immune markers in patients with head and neck cancer.

    Materials and Methods: Data from 20 patients on energy intake (24-hour dietary intake recalls), total energy expenditure (SenseWear Armband Pro3), resting energy expenditure (indirect calorimetry), body weight, body mass index, and immune markers in serum (C-reactive protein and Interleukin-6) were collected at the start of and after radiotherapy (median 8 mo, range 5–13).

    Results: No statistical significance was shown between the two measurement points for energy intake or for the different parameters of energy expenditure. Median values for energy balance were 0.93 and 0.96 for the start of treatment and follow-up, respectively. Twelve and 13 patients had a negative energy balance at the start of radiotherapy and at follow-up, respectively.

    Conclusion: A negative energy balance was seen for the majority of patients, which stresses the importance of nutritional treatment at the start of and after radiotherapy.

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  • 326.
    Einarsson, Sandra
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food, Nutrition and Culinary Science.
    Laurell, Göran
    Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University.
    Tiblom Ehrsson, Ylva
    Department of Surgical Sciences, Section of Otorhinolaryngology and Head & Neck Surgery, Uppsala University.
    Mapping the frequency of malnutrition in patients with head and neck cancer using the GLIM Criteria for the Diagnosis of Malnutrition2020In: Clinical Nutrition ESPEN, ISSN 2405-4577Article in journal (Refereed)
    Abstract [en]

    Background & aims: Patients with head and neck cancer are defined as high-risk patients for malnutrition, but the inconsistent practice of diagnosing malnutrition is a barrier in comparing studies and in assessing patients in clinical practice. The aim of the study was to describe the frequency of malnutrition over time in patients treated for head and neck cancer using the GLIM Criteria for the Diagnosis of Malnutrition.

    Methods: Data from a prospective observational study on patients with head and neck cancer were used (n = 210). Patients were assessed for malnutrition using the combination of one phenotypic and one etiologic criterion. The following phenotypic criteria for malnutrition were used: body weight loss (either >5% within the past six months or >10% beyond six months), body mass index (<20 kg/m2 if <70 years or <22 kg/m2 if ≥70 years), and fat free mass index measured by bioelectrical impedance analysis (<17 FFM/m2 for males and <15 FFM/m2 for females). The following etiologic criteria for malnutrition were used: reduced food intake (partial or no food intake with the need for artificial nutrition) and C-reactive protein (>5 mg/L).

    Results: For all eight possible combinations of GLIM, the frequency of malnutrition reached its highest point at seven weeks after the start of treatment. A total of 32% of the patients fulfilled the criteria for malnutrition using weight loss >5% within the past six months (phenotypic) in combination with C-reactive protein >5 mg/L (etiologic).

    Conclusions: GLIM Criteria for the Diagnosis of Malnutrition can be used to assess malnutrition in patients with head and neck cancer during treatment. Using the same criteria to define malnutrition in nutritional research will make it possible to produce multiple lines of evidence on malnutrition in head and neck cancer and its adverse effects on treatment, prognosis, and survival.

  • 327.
    Ejlertsson, Göran
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Forskningsmiljön Människa - Hälsa - Samhälle (MHS).
    Gott liv tarvar god mat2009In: Livskvalitet öster om leden: om att steka ål, äta socker och bygga hus men också om frukten, supen, bakterien, hälsan & döden, Tomelilla: ÖsterlenAkademien , 2009, p. 55-64Chapter in book (Other (popular science, discussion, etc.))
  • 328. Ek, Anna
    et al.
    Sorjonen, Kimmo
    Eli, Karin
    Lindberg, Louise
    Nyman, Jonna
    Marcus, Claude
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Karolinska Inst, Div Pediat, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.
    Associations between Parental Concerns about Preschoolers' Weight and Eating and Parental Feeding Practices: Results from Analyses of the Child Eating Behavior Questionnaire, the Child Feeding Questionnaire, and the Lifestyle Behavior Checklist2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, article id e0147257Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Insight into parents' perceptions of their children's eating behaviors is crucial for the development of successful childhood obesity programs. However, links between children's eating behaviors and parental feeding practices and concerns have yet to be established. This study aims to examine associations between parental perceptions of preschoolers' eating behaviors and parental feeding practices. First, it tests the original 8-factor structure of the Child Eating Behavior Questionnaire (CEBQ). Second, it examines the associations with parental feeding practices, measured with the Child Feeding Questionnaire (CFQ).

    MATERIALS AND METHODS: Questionnaires were sent to parents from 25 schools/preschools in Stockholm, Sweden and to parents starting a childhood obesity intervention. The CEBQ factor structure was tested with confirmatory factor analysis (CFA). Associations between CEBQ subscales Food approach and Food avoidance and CFQ factors Restriction, Pressure to eat and Monitoring were examined with structural equation modelling (SEM), adjusting for child and parental characteristics, and parental confidence, measured with the Lifestyle Behavior Checklist (LBC). CFQ Concern for child weight and Perceived responsibility for child eating were used as mediators.

    RESULTS: 478 parents completed the questionnaires (children: 52% girls, mean age 5.5 years, 20% overweight/obese). A modified 8-factor structure showed an acceptable fit (TLI = 0.91, CFI = 0.92, RMSEA = 0.05 and SRMR = 0.06) after dropping one item and allowing three pairs of error terms to correlate. The SEM model demonstrated that Food approach had a weak direct effect on Restriction, but a moderate (β = 0.30) indirect effect via Concern, resulting in a substantial total effect (β = 0.37). Food avoidance had a strong positive effect on Pressure to eat (β = 0.71).

    DISCUSSION: The CEBQ is a valid instrument for assessing parental perceptions of preschoolers' eating behaviors. Parental pressure to eat was strongly associated with children's food avoidance. Parental restriction, however, was more strongly associated with parents' concerns about their children's weights than with children's food approach. This suggests that childhood obesity interventions should address parents' perceptions of healthy weight alongside perceptions of healthy eating.

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  • 329. Ek, Weronica E.
    et al.
    Reznichenko, Anna
    Ripke, Stephan
    Niesler, Beate
    Zucchelli, Marco
    Rivera, Natalia V.
    Schmidt, Peter T.
    Pedersen, Nancy L.
    Magnusson, Patrik
    Talley, Nicholas J.
    Holliday, Elizabeth G.
    Houghton, Lesley
    Gazouli, Maria
    Karamanolis, George
    Rappold, Gudrun
    Burwinkel, Barbara
    Surowy, Harald
    Rafter, Joseph
    Assadi, Ghazaleh
    Li, Ling
    Papadaki, Evangelia
    Gambaccini, Dario
    Marchi, Santino
    Colucci, Rocchina
    Blandizzi, Corrado
    Barbaro, Raffaella
    Karling, Pontus
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Walter, Susanna
    Ohlsson, Bodil
    Tornblom, Hans
    Bresso, Francesca
    Andreasson, Anna
    Dlugosz, Aldona
    Simren, Magnus
    Agreus, Lars
    Lindberg, Greger
    Boeckxstaens, Guy
    Bellini, Massimo
    Stanghellini, Vincenzo
    Barbara, Giovanni
    Daly, Mark J.
    Camilleri, Michael
    Wouters, Mira M.
    D'Amato, Mauro
    Exploring the genetics of irritable bowel syndrome: a GWA study in the general population and replication in multinational case-control cohorts2015In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 64, no 11, p. 1774-1782Article in journal (Refereed)
    Abstract [en]

    Objective IBS shows genetic predisposition, but adequately powered gene-hunting efforts have been scarce so far. We sought to identify true IBS genetic risk factors by means of genome-wide association (GWA) and independent replication studies. Design We conducted a GWA study (GWAS) of IBS in a general population sample of 11 326 Swedish twins. IBS cases (N=534) and asymptomatic controls (N=4932) were identified based on questionnaire data. Suggestive association signals were followed-up in 3511 individuals from six case-control cohorts. We sought genotype-gene expression correlations through single nucleotide polymorphism (SNP)-expression quantitative trait loci interactions testing, and performed in silico prediction of gene function. We compared candidate gene expression by real-time qPCR in rectal mucosal biopsies of patients with IBS and controls. Results One locus at 7p22.1, which includes the genes KDELR2 (KDEL endoplasmic reticulum protein retention receptor 2) and GRID2IP (glutamate receptor, ionotropic, delta 2 (Grid2) interacting protein), showed consistent IBS risk effects in the index GWAS and all replication cohorts and reached p=9.31 x 10(-6) in a meta-analysis of all datasets. Several SNPs in this region are associated with cis effects on KDELR2 expression, and a trend for increased mucosal KDLER2 mRNA expression was observed in IBS cases compared with controls. Conclusions Our results demonstrate that general population-based studies combined with analyses of patient cohorts provide good opportunities for gene discovery in IBS. The 7p22.1 and other risk signals detected in this study constitute a good starting platform for hypothesis testing in future functional investigations.

  • 330.
    Ekelund, Ulf
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Nilsson, Andreas
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Total daily energy expenditure and pattern of physical activity measured by minute-by-minute heart rate monitoring in 14-15 year old Swedish adolescents2000In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 54, no 3, p. 195-202Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess total daily energy expenditure (TDEE) and patterns of physical activity among Swedish male and female adolescents and to relate the amount and intensity of physical activity to existing recommendations (energy expenditure equal to or above 12.4 kJ/kg/day or accumulation of 30 min/day in moderate physical activity equal to 4.5 times sedentary energy expenditure or more).

    DESIGN: TDEE, physical activity level (PAL=TDEE/BMR), energy expenditure (EE) and time spent in different intensities of physical activity were assessed by using minute-by-minute heart rate monitoring in combination with laboratory measured sedentary energy expenditure (SEE) and peak oxygen uptake.

    SETTING: Department of Physical Education and Health, Orebro University, and Department of Clinical Physiology, Orebro Medical Centre Hospital, Sweden.

    SUBJECTS: Eighty-two 14-15 y old adolescents (42 boys, 40 girls) from the city of Orebro, randomly selected through a two-stage sampling procedure.

    RESULTS: TDEE was 12.8 MJ/day and 10.0 MJ/day for boys and girls respectively (P<0.001) and PAL was 1.74 and 1.67 (NS). Forty-four percent and 47%, respectively, of TDEE referred to EE in physical activity, of which 70% for both genders referred to light physical activity (corresponding to <4.5 times SEE). Eleven boys and 14 girls had an EE lower than 12.4 kJ/kg/day and/or did not accumulate 30 min/day in physical activity >/=4.5 SEE. Those (n=20) with the highest PAL values (>2.01 and 1.81, respectively) spent 149 min/day at a >/=4.5 SEE intensity level compared to 40 min/day for those (n=30) with the lowest PAL values (<1.55 and 1.45, respectively).

    CONCLUSIONS: Swedish adolescent boys and girls are similarly physically active. The major amount of time devoted to physical activity refers to light physical activity. At least thirty percent of adolescents seem not to achieve appropriate levels of physical activity considered to be beneficial for health.

  • 331.
    Ekelund, Ulf
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden.
    Sjöström, Michael
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Yngve, Agneta
    Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Nilsson, Andreas
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Unit for Preventive Nutrition, Department of Medical Nutrition, Karolinska Institutet, Stockholm, Sweden;.
    Total daily energy expenditure and pattern of physical activity measured by minute-by-minute heart rate monitoring in 14-15 year old Swedish adolescents2000In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 54, no 3, p. 195-202Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess total daily energy expenditure (TDEE) and patterns of physical activity among Swedish male and female adolescents and to relate the amount and intensity of physical activity to existing recommendations (energy expenditure equal to or above 12.4 kJ/kg/day or accumulation of 30 min/day in moderate physical activity equal to 4.5 times sedentary energy expenditure or more).

    DESIGN: TDEE, physical activity level (PAL=TDEE/BMR), energy expenditure (EE) and time spent in different intensities of physical activity were assessed by using minute-by-minute heart rate monitoring in combination with laboratory measured sedentary energy expenditure (SEE) and peak oxygen uptake.

    SETTING: Department of Physical Education and Health, Orebro University, and Department of Clinical Physiology, Orebro Medical Centre Hospital, Sweden.

    SUBJECTS: Eighty-two 14-15 y old adolescents (42 boys, 40 girls) from the city of Orebro, randomly selected through a two-stage sampling procedure.

    RESULTS: TDEE was 12.8 MJ/day and 10.0 MJ/day for boys and girls respectively (P<0.001) and PAL was 1.74 and 1.67 (NS). Forty-four percent and 47%, respectively, of TDEE referred to EE in physical activity, of which 70% for both genders referred to light physical activity (corresponding to <4.5 times SEE). Eleven boys and 14 girls had an EE lower than 12.4 kJ/kg/day and/or did not accumulate 30 min/day in physical activity >/=4.5 SEE. Those (n=20) with the highest PAL values (>2.01 and 1.81, respectively) spent 149 min/day at a >/=4.5 SEE intensity level compared to 40 min/day for those (n=30) with the lowest PAL values (<1.55 and 1.45, respectively).

    CONCLUSIONS: Swedish adolescent boys and girls are similarly physically active. The major amount of time devoted to physical activity refers to light physical activity. At least thirty percent of adolescents seem not to achieve appropriate levels of physical activity considered to be beneficial for health.

  • 332. Ekelund, Ulf
    et al.
    Ward, Heather A.
    Norat, Teresa
    Luan, Jian'an
    May, Anne M.
    Weiderpass, Elisabete
    Sharp, Stephen J.
    Overvad, Kim
    Ostergaard, Jane Nautrup
    TjOnneland, Anne
    Johnsen, Nina Fons
    Mesrine, Sylvie
    Foamier, Agnes
    Fagherazzi, Guy
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Li, Kuanrong
    Kaaks, Rudolf
    Ferrari, Pietro
    Licaj, Idlir
    Jenab, Mazda
    Bergmann, Manuela
    Boeing, Heiner
    Palli, Domenico
    Sieri, Sabina
    Panico, Salvatore
    Tumino, Rosario
    Vineis, Paolo
    Peeters, Petra H.
    Monnikhof, Evelyn
    Bueno-de-Mesquita, H. Bas
    Ramon Quiros, J.
    Agudo, Antonio
    Sanchez, Maria-Jose
    Maria Huerta, Jose
    Ardanaz, Eva
    Arriola, Larraitz
    Hedblad, Bo
    Wirfalt, Elisabet
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Johansson, Mattias
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine. International Agency for Research on Cancer (IARC), Lyon, France.
    Key, Timothy J.
    Travis, Ruth C.
    Khaw, Kay-Tee
    Brage, Soren
    Wareham, Nicholas J.
    Riboli, Elio
    Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)2015In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 101, no 3, p. 613-621Article in journal (Refereed)
    Abstract [en]

    Background: The higher risk of death resulting from excess adiposity may be attenuated by physical activity (PA). However, the theoretical number of deaths reduced by eliminating physical inactivity compared with overall and abdominal obesity remains unclear.

    Objective: We examined whether overall and abdominal adiposity modified the association between PA and all-cause mortality and estimated the population attributable fraction (PAF) and the years of life gained for these exposures.

    Design: This was a cohort study in 334,161 European men and women. The mean follow-up time was 12.4 y, corresponding to 4,154,915 person-years. Height, weight, and waist circumference (WC) were measured in the clinic. PA was assessed with a validated self-report instrument. The combined associations between PA, BMI, and WC with mortality were examined with Cox proportional hazards models, stratified by center and age group, and adjusted for sex, education, smoking, and alcohol intake. Center-specific PAF associated with inactivity, body mass index (BMI; in kg/m(2)) (>30), and WC (>= 102 cm for men, >= 88 cm for women) were calculated and combined in random-effects meta-analysis. Life-tables analyses were used to estimate gains in life expectancy for the exposures.

    Results: Significant interactions (PA x BMI and PA x WC) were observed, so HRs were estimated within BMI and WC strata. The hazards of all-cause mortality were reduced by 16-30% in moderately inactive individuals compared with those categorized as inactive in different strata of BMI and WC. Avoiding all inactivity would theoretically reduce all-cause mortality by 7.35% (95% CI: 5.88%, 8.83%). Corresponding estimates for avoiding obesity (BMI >30) were 3.66% (95% CI: 2.30%, 5.01%). The estimates for avoiding high WC were similar to those for physical inactivity.

    Conclusion: The greatest reductions in mortality risk were observed between the 2 lowest activity groups across levels of general and abdominal adiposity, which suggests that efforts to encourage even small increases in activity in inactive individuals may be beneficial to public health.

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  • 333. Ekstedt, Mirjam
    et al.
    Nyberg, Gisela
    Ingre, Michael
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Ekblom, Örjan
    Marcus, Claude
    Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: a cross-sectional study2013In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 10, p. 82-Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described. Method: We conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary (<1.5 METS), light (1.5 to 3 METS) and moderate-to-vigorous (> 3 METS); and Body Mass Index standard deviations score, BMIsds. Results: Total sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -. 23, P < .01). A negative association between BMIsds and sleep duration was found (-. 10, p < .01). Conclusions: Short sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.

  • 334.
    Ekstedt, Mirjam
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Systems Safety and Management.
    Nyberg, Gisela
    Karolinska Institutet.
    Ingre, Michael
    Stockholm University.
    Ekblom, Örjan
    Karolinska Institutet.
    Marcus, Claude
    Karolinska Institutet.
    Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: a cross-sectional study2013In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 10, no 82Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described. Method: We conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary (<1.5 METS), light (1.5 to 3 METS) and moderate-to-vigorous (> 3 METS); and Body Mass Index standard deviations score, BMIsds. Results: Total sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -. 23, P < .01). A negative association between BMIsds and sleep duration was found (-. 10, p < .01). Conclusions: Short sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.

  • 335.
    El Ansari, Walid
    et al.
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Surgery, Hamad General Hospital, Doha, Qatar / College of Medicine, Qatar University, Doha, Qatar / Faculty of Applied Sciences, University of Gloucestershire, Gloucester, United Kingdom.
    Berg-Beckhoff, Gabriele
    Unit for Health Promotion Research, Institute of Public Health, University of Southern Denmark, Esbjerg, Denmark.
    Association of health status and health behaviors with weight satisfaction vs. Body image concern: Analysis of 5888 undergraduates in Egypt, Palestine, and Finland2019In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 12, article id 2860Article in journal (Refereed)
    Abstract [en]

    Little is known about the relationships between weight satisfaction, body image concern, healthy nutrition, health awareness, and physical activity among college students across culturally different countries. We assessed country and sex-specific associations between health status (self-rated health, depression, BMI), healthy behavior (healthy nutrition, physical activity, health awareness), weight satisfaction, and body image concern via a cross-sectional survey (5888 undergraduates) in Egypt, Palestine, and Finland. This health and wellbeing survey employed identical self-administered paper questionnaires administered at several Universities in two Eastern Mediterranean countries (Egypt, Palestine—Gaza Strip), and an online-survey comprising the same questions in Finland. Regression analyses were employed. Health status variables exhibited the strongest associations; high BMI and more depressive symptoms were more often among students satisfied with their weight (except in Palestine), but they were positively associated with body image concern irrespective of country or gender. Self-rated health was not associated with body image concern or weight satisfaction. Healthy behaviors were not associated with body image concern or weight satisfaction. Depressive symptoms and BMI were the most prominent predictors for body image concern. There were country-specific consistent results when using the body image concern score. Further research is necessary to compare body image across different cultures and countries. 

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  • 336.
    Elhassan, Mohammed
    et al.
    Swedish University of Agricultural Sciences.
    Wendin, Karin
    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. University of Copenhagen.
    Olsson, Viktoria
    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.
    Langton, Maud
    Swedish University of Agricultural Sciences.
    Quality aspects of insects as food: nutritional, sensory, and related concepts2019In: Foods, E-ISSN 2304-8158, Vol. 8, no 3Article in journal (Refereed)
    Abstract [en]

    n the search for another appealing source of future food to cover the increasing need for nutrients of a growing global population, this study reviewed the potential of insects as human food. Most previous reviews have dealt with insects as a group, making it difficult to evaluate each individual insect species as food because of the generalized data. This study assessed some common edible insects, but concentrated on mealworms. Insects, especially mealworms, have a similar or higher nutritional value than many conventional food sources. For example, the protein content of mealworm larvae is reported to be almost 50% of dry weight, while the fat content is about 30% of larval dry weight. Mealworms can be cooked by different methods, such as hot air drying, oven broiling, roasting, pan frying, deep frying, boiling, steaming, and microwaving. Oven broiling in particular gives a desirable aroma of steamed corn for consumers. Changes in the flavor, taste, and texture of mealworm products during storage have not been studied, but must be determined before mealworms can be used as a commercial food source. Factors controlling the shelf-life of mealworms, such as their packaging and storage, should be identified and considered with respect to the feasibility of using mealworms on a commercial scale.

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  • 337.
    Eli, Karin
    et al.
    Unit for Biocultural Variation and Obesity, Institute of Social and Cultural Anthropology, University of Oxford, 51/53 Banbury Road, Oxford, OX2 6PE, UK.
    Hörnell, Agneta
    Department of Food and Nutrition, Umeå University, 901 87 Umeå, Sweden.
    Etminan Malek, Mahnoush
    Astrid Lindgren Children's Hospital, Department of Clinical Nutrition, Karolinska University Hospital Huddinge, 171 76 Stockholm, Sweden.
    Nowicka, Paulina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics. Division of Pediatrics, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, 141 57 Huddinge, Sweden.
    Water, juice, or soda?: Mothers and grandmothers of preschoolers discuss the acceptability and accessibility of beverages2017In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 112, p. 133-142Article in journal (Refereed)
    Abstract [en]

    Intake of sugary beverages is strongly associated with weight gain and obesity among children; however, differences between mothers' and grandmothers' attitudes and practices concerning young children's beverage consumption remain unclear. This is notable since about a quarter of families in the US and the UK rely on grandparents as the main providers of informal childcare. The aim of this study is to examine mothers' and maternal grandmothers' attitudes, knowledge, and practices regarding preschool-age children's beverage consumption. The analysis focuses on identifying intergenerational similarities and differences, given the potential impact that such differences might have on young children's beverage consumption habits. Twenty-two semi-structured interviews, representing eleven families, were analyzed using thematic analysis. The sample included all mother-maternal grandmother dyads from The Grandparents Study, which took place in Eugene, Oregon, USA. More than half of mothers and grandmothers met overweight/obesity criteria. Among the children (mean age 4.7 years; five girls and six boys), seven met overweight/obesity criteria. Most mothers and grandmothers were unemployed, and reported an annual household income below 30,000 USD. The analysis identified three thematic categories: 1) mothers and grandmothers agree about the hierarchy of healthiness between and within beverages, though juice occupies an ambivalent position; 2) mothers and grandmothers cite role modeling and the home environment as important in regulating preschoolers' beverage intake; 3) mothers and grandmothers balance between restricting sugar-sweetened beverages and using these beverages as treats. The results suggest that when mothers and grandmothers use soda, juice, and juice-drinks as treats, they do so within a wider dynamic of balancing practices, and within two intersecting domains: the hierarchy of beverages, including the still ambivalent status of juice as healthy or unhealthy, and the definition of ‘special occasion’.

  • 338. Eli, Karin
    et al.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Malek, Mahnoush Etminan
    Nowicka, Paulina
    Water, juice, or soda?: Mothers and grandmothers of preschoolers discuss the acceptability and accessibility of beverages2017In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 112, p. 133-142Article in journal (Refereed)
    Abstract [en]

    Intake of sugary beverages is strongly associated with weight gain and obesity among children; however, differences between mothers' and grandmothers' attitudes and practices concerning young children's beverage consumption remain unclear. This is notable since about a quarter of families in the US and the UK rely on grandparents as the main providers of informal childcare. The aim of this study is to examine mothers' and maternal grandmothers' attitudes, knowledge, and practices regarding preschool aged children's beverage consumption. The analysis focuses on identifying intergenerational similarities and differences, given the potential impact that such differences might have on young children's beverage consumption habits. Twenty-two semi-structured interviews, representing eleven families, were analyzed using thematic analysis. The sample included all mother – maternal grandmother dyads from The Grandparents Study, which took place in Eugene, Oregon, USA. More than half of mothers and grandmothers met overweight/obesity criteria. Among the children (mean age 4.7 years; five girls and six boys), seven met overweight/obesity criteria. Most mothers and grandmothers were unemployed, and most reported an annual household income below 30,000 USD. The analysis identified three thematic categories: 1) mothers and grandmothers agree about the hierarchy of healthiness between and within beverages, though juice occupies an ambivalent position; 2) mothers and grandmothers cite role modeling and the home environment as important in regulating preschoolers' beverage intake; 3) mothers and grandmothers balance between restricting sugary beverages and using these beverages as treats. The results suggest that when mothers and grandmothers use soda, juice, and juice-drinks as treats, they do so within a wider dynamic of balancing practices, and within two intersecting domains: the hierarchy of beverages, including the still ambivalent status of juice as healthy or unhealthy, and the definition of 'special occasion'.

  • 339. El-Khoury, Antoine E
    et al.
    Forslund, Anders
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Olsson, Roger
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Branth, Stefan
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Sjödin, Anders
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Andersson, Agneta
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Atkinson, Alan
    Selvaraj, Amalini
    Hambraeus, Leif
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
    Young, Vernon R
    Moderate exercise at energy balance does not affect 24-h leucine oxidation or nitrogen retention in healthy men1997In: American Journal of Physiology, ISSN 0002-9513, E-ISSN 2163-5773, Vol. 273, no 2, p. E394-E407Article in journal (Refereed)
    Abstract [en]

    Short-term metabolic experiments have revealed that physical exercise increases the oxidation of leucine, which has been interpreted to indicate an increased requirement for dietary protein in physically active subjects. Because it may be inaccurate to extrapolate measurements of amino acid oxidation made over a few hours to the entire day, we have carried out a continuous 24-h intravenous [1-13C]leucine/[15N]urea tracer study in eight healthy adult men. Their diet supplied 1 g protein.kg-1.day-1, and exercise (mean maximal O2 consumption 46%) was for 90 min during the 12-h fast and 12-h fed periods of the day. Subjects were adapted to the diet and exercise regimen for 6 days. Then, on day 7, they were dressed in the University of Uppsala energy metabolic unit's direct calorimeter suit, were connected to an open-hood indirect calorimeter, and received the tracers. Exercise increased leucine oxidation by approximately 50 and 30% over preexercise rates for fast and fed periods, respectively. This increase amounted to approximately 4-7% of daily leucine oxidation. Subjects remained in body leucine equilibrium (balance -4.6 +/- 10.5 mg.kg-1.day-1; -3.6 +/- 8.3% of intake; P = not significant from zero balance). Therefore, moderate exercise did not cause a significant deterioration in leucine homeostasis at a protein intake of 1 g.kg-1.day-1. These findings underscore the importance of carrying out precise, continuous, 24-h measurements of whole body leucine kinetics; this model should be of value in studies concerning the quantitative interactions among physical exercise, energy/protein metabolism, and diet in humans.

  • 340.
    Ellegård, L.
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Aldenbratt, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Svensson, Maria K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Lindberg, C.
    Sahlgrens Univ Hosp, Neuromuscular Ctr, Dept Neurol, Gothenburg, Sweden.
    Body composition in patients with primary neuromuscular disease assessed by dual energy X-ray absorptiometry (DXA) and three different bioimpedance devices2019In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 29, p. 142-148Article in journal (Refereed)
    Abstract [en]

    Background: Patients with primary neuromuscular disease have reduced muscle mass, and use of body mass index to assess nutritional status and body composition can therefore be questioned. Dual emission X-ray absorptiometry (DXA) can estimate muscle mass, but is not always readily available. Bioimpedance is a simple, portable and "easy to use" method for the assessment of body composition.

    Objectives: To assess muscle mass by DXA in 143 patients with primary neuromuscular disease and validate three bioimpedance devices; Impedimed SFB7, (BISIMPEDIMED), Xitron4200 (BISXITRON) and Tanita MC180MA (MFBIATANITA).

    Methods: Body composition was assessed by DXA in 143, by BISIMPEDIMED in 116, by MFBIATANITA in 104 and by BISXITRON in 35 patients.

    Results: Muscle mass assessed by DXA, and phase angle (PhA) were below reference values in all female and 96% of male patients. BISIMPEDIMED underestimated muscle mass by 6.5±14.2 kg (p < 0.001), but this could be corrected after exclusion of resistance (Ri) values > 3500 Ohm (p = 0.84). MFBIATANITA over-estimated muscle mass by 30.8±9.1 kg (p < 0.001) with systematic bias, whereas BISXITRON was in agreement with DXA, and without systematic bias. Muscle mass was strongly correlated to PhA (rPEARSON = 0.75, p < 0.01).

    Conclusion: Patients with primary neuromuscular disease have proportionally more fat and less muscle mass than the population in general, despite normal BMI. Muscle mass can be assessed by bioimpedance in these patients, but performance and bias depends on device. Phase angle by bioimpedance correlates to muscle mass, and could therefore potentially be used a surrogate measure of muscle mass during follow up.

  • 341.
    Elmsjö, Albert
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry.
    Rosqvist, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Engskog, Mikael K R
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry.
    Haglöf, Jakob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry.
    Kullberg, Joel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Iggman, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Johansson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Ahlström, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Arvidsson, Torbjörn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry.
    Risérus, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Pettersson, Curt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry, Analytical Pharmaceutical Chemistry.
    NMR-based metabolic profiling in healthy individuals overfed different types of fat: links to changes in liver fat accumulation and lean tissue mass.2015In: Nutrition & Diabetes, ISSN 2044-4052, E-ISSN 2044-4052, Vol. 5, no 19, p. e182-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Overeating different dietary fatty acids influence the amount of liver fat stored during weight gain, however, the mechanisms responsible are unclear. We aimed to identify non-lipid metabolites that may differentiate between saturated (SFA) and polyunsaturated fatty acid (PUFA) overfeeding using a non-targeted metabolomic approach. We also investigated the possible relationships between plasma metabolites and body fat accumulation.

    METHODS: In a randomized study (LIPOGAIN study), n=39 healthy individuals were overfed with muffins containing SFA or PUFA. Plasma samples were precipitated with cold acetonitrile and analyzed by nuclear magnetic resonance (NMR) spectroscopy. Pattern recognition techniques were used to overview the data, identify variables contributing to group classification and to correlate metabolites with fat accumulation.

    RESULTS: We previously reported that SFA causes a greater accumulation of liver fat, visceral fat and total body fat, whereas lean tissue levels increases less compared with PUFA, despite comparable weight gain. In this study, lactate and acetate were identified as important contributors to group classification between SFA and PUFA (P<0.05). Furthermore, the fat depots (total body fat, visceral adipose tissue and liver fat) and lean tissue correlated (P(corr)>0.5) all with two or more metabolites (for example, branched amino acids, alanine, acetate and lactate). The metabolite composition differed in a manner that may indicate higher insulin sensitivity after a diet with PUFA compared with SFA, but this needs to be confirmed in future studies.

    CONCLUSION: A non-lipid metabolic profiling approach only identified a few metabolites that differentiated between SFA and PUFA overfeeding. Whether these metabolite changes are involved in depot-specific fat storage and increased lean tissue mass during overeating needs further investigation.

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  • 342.
    Elshorbagy, Amany K.
    et al.
    Univ Alexandria, Dept Physiol, Fac Med, Alexandria, Egypt.
    Samocha-Bonet, Dorit
    Garvan Inst Med Res, Diabet & Metab Div, Sydney, NSW, Australia;Univ New South Wales, Fac Med, Sydney, NSW, Australia.
    Jernerén, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. Univ Oxford, Dept Pharmacol, Oxford, England.
    Turner, Cheryl
    Univ Oxford, Dept Pharmacol, Oxford, England.
    Refsum, Helga
    Univ Oslo, Inst Basic Med Sci, Dept Nutr, Oslo, Norway;Univ Oxford, Dept Pharmacol, Oxford, England.
    Heilbronn, Leonie K.
    Univ Adelaide, Discipline Med, Adelaide, SA, Australia;Garvan Inst Med Res, Diabet & Metab Div, Sydney, NSW, Australia.
    Food Overconsumption in Healthy Adults Triggers Early and Sustained Increases in Serum Branched-Chain Amino Acids and Changes in Cysteine Linked to Fat Gain2018In: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 148, no 7, p. 1073-1080Article in journal (Refereed)
    Abstract [en]

    Background: Plasma concentrations of branched-chain amino acids (BCAAs) and the sulfur-containing amino acid cysteine are associated with obesity and insulin resistance. BCAAs predict future diabetes. Objective: We investigated amino acid changes during food overconsumption. Methods: Forty healthy men and women with a body mass index (mean +/- SEM) of 25.6 +/- 0.6 were overfed by 1250 kcal/d for 28 d, increasing consumption of all macronutrients. Insulin sensitivity and body composition were assessed at baseline (day 0) and day 28. Fasting serum amino acids were measured at days 0, 3, and 28. Linear mixed-effects models evaluated the effect of time in the total group and separately in those with low and high body fat gain (below compared with at or above median fat gain, 1.95 kg). At days 0 and 28, insulin-induced suppression of serum amino acids during a hyperinsulinemic-euglycemic clamp test and, in a subset (n = 20), adipose tissue mRNA expression of selected amino acid metabolizing enzymes were assessed. Results: Weight increased by 2.8 kg. High fat gainers gained 2.6 kg fat mass compared with 1.1 kg in low fat gainers. Valine and isoleucine increased at day 3 (+17% and +22%, respectively; P <= 0.002) and remained elevated at day 28, despite a decline in valine (P = 0.019) from day 3 values. Methionine, cystathionine, and taurine were unaffected. Serum total cysteine (tCys) transiently increased at day 3 (+11%; P = 0.022) only in high fat gainers (P-interaction = 0.043), in whom the cysteine catabolic enzyme cysteine dioxygenase (CDO1) was induced (+26%; P = 0.025) in adipose tissue (P-interaction = 0.045). Overconsumption did not alter adipose tissue mRNA expression of the BCAA-metabolizing enzymes branched-chain keto acid dehydrogenase E1 alpha polypeptide (BCKDHA) or branched-chain amino transferase 1 (BCAT1). In the total population at day 0, insulin infusion decreased all serum amino acids (-11% to -47%; P < 0.01), except for homocysteine and tCys, which were unchanged, and glutathione, which was increased by 54%. At day 28, insulin increased tCys (+8%), and the insulin-induced suppression of taurine and phenylalanine observed at day 0, but not that of BCAAs, was significantly impaired. Conclusions: These findings highlight the role of nutrient oversupply in increasing fasting BCAA concentrations in healthy adults. The link between cysteine availability, CDO1 expression, and fat gain deserves investigation.

  • 343. Emaus, Marleen J.
    et al.
    Peeters, Petra H. M.
    Bakker, Marije F.
    Overvad, Kim
    Tjonneland, Anne
    Olsen, Anja
    Romieu, Isabelle
    Ferrari, Pietro
    Dossus, Laure
    Boutron-Ruault, Marie Christine
    Baglietto, Laura
    Fortner, Renee T.
    Kaaks, Rudolf
    Boeing, Heiner
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Masala, Giovanna
    Pala, Valeria
    Panico, Salvatore
    Tumino, Rosario
    Polidoro, Silvia
    Skeie, Guri
    Lund, Eiliv
    Weiderpass, Elisabete
    Ramon Quiros, J.
    Travier, Noemie
    Sanchez, Maria-Jose
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Dorronsoro, Miren
    Winkvist, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Bueno-de-Mesquita, H. Bas
    Khaw, Kay-Tee
    Travis, Ruth C.
    Key, Timothy J.
    Aune, Dagfinn
    Gunter, Marc
    Riboli, Elio
    van Gils, Carla H.
    Vegetable and fruit consumption and the risk of hormone receptor-defined breast cancer in the EPIC cohort2016In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 103, no 1, p. 168-177Article in journal (Refereed)
    Abstract [en]

    Background: The recent literature indicates that a high vegetable intake and not a high fruit intake could be associated with decreased steroid hormone receptor–negative breast cancer risk.

    Objective: This study aimed to investigate the association between vegetable and fruit intake and steroid hormone receptor–defined breast cancer risk.

    Design: A total of 335,054 female participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort were included in this study (mean ± SD age: 50.8 ± 9.8 y). Vegetable and fruit intake was measured by country-specific questionnaires filled out at recruitment between 1992 and 2000 with the use of standardized procedures. Cox proportional hazards models were stratified by age at recruitment and study center and were adjusted for breast cancer risk factors.

    Results: After a median follow-up of 11.5 y (IQR: 10.1–12.3 y), 10,197 incident invasive breast cancers were diagnosed [3479 estrogen and progesterone receptor positive (ER+PR+); 1021 ER and PR negative (ER−PR−)]. Compared with the lowest quintile, the highest quintile of vegetable intake was associated with a lower risk of overall breast cancer (HRquintile 5–quintile 1: 0.87; 95% CI: 0.80, 0.94). Although the inverse association was most apparent for ER−PR− breast cancer (ER−PR−: HRquintile 5–quintile 1: 0.74; 95% CI: 0.57, 0.96; P-trend = 0.03; ER+PR+: HRquintile 5–quintile 1: 0.91; 95% CI: 0.79, 1.05; P-trend = 0.14), the test for heterogeneity by hormone receptor status was not significant (P-heterogeneity = 0.09). Fruit intake was not significantly associated with total and hormone receptor–defined breast cancer risk.

    Conclusion: This study supports evidence that a high vegetable intake is associated with lower (mainly hormone receptor–negative) breast cancer risk.

  • 344. Eneroth, Hanna
    et al.
    Wallin, Stina
    Leander, Karin
    Nilsson Sommar, Johan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Åkesson, Agneta
    Risks and Benefits of Increased Nut Consumption: Cardiovascular Health Benefits Outweigh the Burden of Carcinogenic Effects Attributed to Aflatoxin B1 Exposure2017In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 9, no 12, article id 1355Article in journal (Refereed)
    Abstract [en]

    Nuts are rich in nutrients and mounting evidence shows that consumption reduces cardiovascular disease (CVD) incidence. Nuts may also be a major source of aflatoxin B₁, a potent liver carcinogen and the risk/benefit balance is unknown. Based on national statistics and data from the PREDIMED intervention trial, we estimated the potential CVD-reduction if Swedes aged 55-79 consumed 30 g nuts/day, instead of the current national average of five grams per day. We also assessed the reduction in disability-adjusted life years (DALYs) due to myocardial infarction (MI) and stroke. We estimated the aflatoxin B₁ exposure from nuts and calculated the margin of exposure. The approximation that one nanogram aflatoxin B₁/kg body weight/day results in one additional liver cancer case/10 million person-years was used to estimate the number of liver cancer cases. The increased nut consumption scenario prevented more than 7000 CVDs in 2013 (306/100,000 person-years) and contributed to about 55,000 saved DALYs for stroke and 22,000 for MI. The concomitant increase in aflatoxin B₁ exposure caused an estimated zero to three additional cases of liver cancer, corresponding to 159 DALYs spent, emphasizing the associated risks. Increased nut consumption, as part of a varied healthy diet, is warranted even when aflatoxin B₁ exposure is taken into account. However, efforts to reduce aflatoxin exposure from food are essential.

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  • 345.
    Engelheart, Stina
    et al.
    Örebro University, School of Medical Sciences.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences.
    Assessment of nutritional status in the elderly: a proposed function-driven model2018In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 62, article id 1366Article in journal (Refereed)
    Abstract [en]

    Background: There is no accepted or standardized definition of 'malnutrition'. Hence, there is also no definition of what constitutes an adequate nutritional status. In elderly people, assessment of nutritional status is complex and is complicated by multi-morbidity and disabilities combined with nutrition-related problems, such as dysphagia, decreased appetite, fatigue, and muscle weakness.

    Objective: We propose a nutritional status model that presents nutritional status from a comprehensive functional perspective. This model visualizes the complexity of the nutritional status in elderly people.

    Design and results: The presented model could be interpreted as the nutritional status is conditional to a person's optimal function or situation. Another way of looking at it might be that a person's nutritional status affects his or her optimal situation. The proposed model includes four domains: (1) physical function and capacity; (2) health and somatic disorders; (3) food and nutrition; and (4) cognitive, affective, and sensory function. Each domain has a major impact on nutritional status, which in turn has a major impact on the outcome of each domain.

    Conclusions: Nutritional status is a multifaceted concept and there exist several knowledge gaps in the diagnosis, prevention, and optimization of treatment of inadequate nutritional status in elderly people. The nutritional status model may be useful in nutritional assessment research, as well as in the clinical setting.

  • 346.
    Engelheart, Stina
    et al.
    Örebro University, School of Medical Sciences.
    Brummer, Robert Jan
    Örebro University, School of Medical Sciences.
    Forslund, Helene Berteus
    Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Meal patterns in relation to energy and protein intake in older adults in home health care2020In: Clinical Nutrition ESPEN, ISSN 2405-4577, Vol. 35, p. 180-187Article in journal (Refereed)
    Abstract [en]

    Background & aims: Inadequate dietary intake is common in frail elderly people, however knowledge of meal patters and their relation to dietary intake is scarce, but is important for planning meals and nutritional prevention and interventions. The aim of this study was to describe meal patterns and the relation to energy and protein intake in elderly people in home health care.

    Methods: In this cross-sectional study, 69 men and women >= 65 years old with a lasting need for home health care were included. A 24-hour recall was used to analyse meal patterns as well as intake of energy and protein. Meal patterns were analysed in terms of number of eating occasions, time of the first, and the last meal each day, length of the overnight fast, timing of the energy and protein intake, energy content and time for the largest meal of the day, and classification as an early or late eater.

    Results: In this population, 77% had four or five eating occasions per day. The median length of the overnight fast was 13 h and 87% of participants had an overnight fast of >11 h. Regarding the timing of the energy and protein intake, there were three peaks: in the morning, mid-day and in the evening. The mid-day meal was the most important eating occasion regarding total energy intake; mid-day was also the time of the day when most participants had a protein intake >20 g. The majority (60%) of participants were categorized as early eaters. Neither the number of eating occasions nor the length of the overnight fast was correlated with energy or protein intake; however, a large energy intake from the largest meal of the day was significantly correlated with an increased total energy and protein intake, indicating that daily energy intake is stimulated by at least one large meal per day.

    Conclusions: This study showed that one large meal a day had more impact on daily energy and protein intake than did several eating occasions or a short overnight fast in elderly people in home health care. Further research is needed to elucidate how to stimulate large energy intake at main meals to stimulate daily energy and protein intake. (c) 2019 European Society for Clinical Nutrition and Metabolism.

  • 347. Engeset, D.
    et al.
    Skeie, G.
    Olsen, A.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Dietary patterns and whole grain in Scandinavia. The HELGA project2013In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 63, no Supplement 1, p. 341-341Article in journal (Other academic)
    Abstract [en]

    Background and objectives: In the recent years a trendwithin nutrition epidemiology has been to assess overall dietaryquality, often by identifying dietary patterns. The HELGAstudy population is based on samples of existing cohorts fromthe three Scandinavian countries. All three cohorts are part ofthe EPIC study. The aim of this study is to find a typical wholegrain pattern in Scandinavia and see if the pattern is similar inthe three countries.Methods: The associations among the variables were investigatedby factor analysis.Results: Both Norway and Sweden had two breakfast patternsand one dinner pattern. Both the countries had a healthybreakfast pattern including food items commonly consideredhealthy, such as fruit, yoghurt and breakfast cereals. However,coarse bread was the main item in a more traditional pattern for Norway, while it was a part of the healthy pattern inSweden. The second breakfast pattern in Sweden included unhealthyitems like white bread, cakes, sweets, soft drinks andalcohol. The dinner pattern was almost equal in Sweden andNorway. Denmark differed from the other Scandinavian countriesconcerning dietary patterns. Only one breakfast patternwas found. This pattern had some similarities with the traditionalNorwegian pattern, but scored high on all whole grainitems while in Norway only wheat had a high score. Two dinnerpatterns are seen for Denmark, the healthier one includesfruit and vegetables, fish and poultry, the second includes meatand meat products, ice cream and alcohol.Conclusions: When comparing dietary patterns from thethree Scandinavian countries, we find both differences andsimilarities. The main whole grain item used in Norway andSweden seems to be wheat, while rye is more dominant in Denmark.

  • 348. Engeset, Dagrun
    et al.
    Braaten, Tonje
    Teucher, Birgit
    Kühn, Tilman
    Bueno-de-Mesquita, H B
    Leenders, Max
    Agudo, Antonio
    Bergmann, Manuela M
    Valanou, Elisavet
    Naska, Androniki
    Trichopoulou, Antonia
    Key, Timothy J
    Crowe, Francesca L
    Overvad, Kim
    Sonestedt, Emily
    Mattiello, Amalia
    Peeters, Petra H
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Jansson, Jan Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Boutron-Ruault, Marie-Christine
    Dossus, Laure
    Dartois, Laureen
    Li, Kuanrong
    Barricarte, Aurelio
    Ward, Heather
    Riboli, Elio
    Agnoli, Claudia
    Huerta, José María
    Sánchez, María-José
    Tumino, Rosario
    Altzibar, Jone M
    Vineis, Paolo
    Masala, Giovanna
    Ferrari, Pietro
    Muller, David C
    Johansson, Mattias
    Luisa Redondo, M
    Tjønneland, Anne
    Olsen, Anja
    Olsen, Karina Standahl
    Brustad, Magritt
    Skeie, Guri
    Lund, Eiliv
    Fish consumption and mortality in the European Prospective Investigation into Cancer and Nutrition cohort2015In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 30, no 1, p. 57-70Article in journal (Refereed)
    Abstract [en]

    Fish is a source of important nutrients and may play a role in preventing heart diseases and other health outcomes. However, studies of overall mortality and cause-specific mortality related to fish consumption are inconclusive. We examined the rate of overall mortality, as well as mortality from ischaemic heart disease and cancer in relation to the intake of total fish, lean fish, and fatty fish in a large prospective cohort including ten European countries. More than 500,000 men and women completed a dietary questionnaire in 1992-1999 and were followed up for mortality until the end of 2010. 32,587 persons were reported dead since enrolment. Hazard ratios and their 99 % confidence interval were estimated using Cox proportional hazard regression models. Fish consumption was examined using quintiles based on reported consumption, using moderate fish consumption (third quintile) as reference, and as continuous variables, using increments of 10 g/day. All analyses were adjusted for possible confounders. No association was seen for fish consumption and overall or cause-specific mortality for both the categorical and the continuous analyses, but there seemed to be a U-shaped trend (p < 0.000) with fatty fish consumption and total mortality and with total fish consumption and cancer mortality (p = 0.046).

  • 349. Engeset, Dagrun
    et al.
    Hofoss, Dag
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Olsen, Anja
    Tjønneland, Anne
    Skeie, Guri
    Dietary patterns and whole grain cereals in the Scandinavian countries: differences and similarities. The HELGA project2015In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 18, no 5, p. 905-915Article in journal (Refereed)
    Abstract [en]

    Objective: To identify dietary patterns with whole grains as a main focus to see if there is a similar whole grain pattern in the three Scandinavian countries; Denmark, Sweden and Norway. Another objective is to see if items suggested for a Nordic Food Index will form a typical Nordic pattern when using factor analysis. Setting: The HELGA study population is based on samples of existing cohorts: the Norwegian Women and Cancer Study, the Swedish Vasterbotten cohort and the Danish Diet, Cancer and Health study. The HELGA study aims to generate knowledge about the health effects of whole grain foods. Subjects: The study included a total of 119 913 participants. Design: The associations among food variables from FFQ were investigated by principal component analysis. Only food groups common for all three cohorts were included. High factor loading of a food item shows high correlation of the item to the specific diet pattern. Results: The main whole grain for Denmark and Sweden was rye, while Norway had highest consumption of wheat. Three similar patterns were found: a cereal pattern, a meat pattern and a bread pattern. However, even if the patterns look similar, the food items belonging to the patterns differ between countries. Conclusions: High loadings on breakfast cereals and whole grain oat were common in the cereal patterns for all three countries. Thus, the cereal pattern may be considered a common Scandinavian whole grain pattern. Food items belonging to a Nordic Food Index were distributed between different patterns.

  • 350.
    Englund, Davis A.
    et al.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    Kirn, Dylan R.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Zhu, Hao
    Hebrew SeniorLife, Inst Aging Res, Boston, USA.
    Travison, Thomas G.
    Hebrew SeniorLife, Inst Aging Res, Boston, USA; Harvard Med Sch, Boston, USA.
    Reid, Kieran F.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    von Berens, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Melin, Michael
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Gustafsson, Thomas
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
    Fielding, Roger A.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    Nutritional Supplementation With Physical Activity Improves Muscle Composition in Mobility-Limited Older Adults, The VIVE2 Study: A Randomized, Double-Blind, Placebo-Controlled Trial2018In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 73, no 1, p. 95-101Article in journal (Refereed)
    Abstract [en]

    Background: Nutritional supplementation and physical activity have been shown to positively influence muscle mass and strength in older adults. The efficacy of long-term nutritional supplementation in combination with physical activity in older adults remains unclear.

    Methods: Mobility-limited (short physical performance battery [SPPB] ≤9) and vitamin D insufficient (serum 25(OH) D 9–24 ng/mL) older adults were recruited for this study. All subjects participated in a physical activity program. Subjects were randomized to consume a daily nutritional supplement (150 kcal, 20 g whey protein, 800 IU vitamin D, 119 mL beverage) or placebo (30 kcal, nonnutritive, 119 mL). In a prespecified secondary analysis, we examined total-body composition (dual energy X-ray absorptiometry), thigh composition (computed tomography), and muscle strength, power, and quality before and after the 6-month intervention.

    Results: One hundred and forty-nine subjects were randomized into the study [mean (standard deviation, SD) age 78.5 (5.4) years; 46.3% female; mean (SD) short physical performance battery 7.9 (1.2); mean (SD) vitamin D 18.7 (6.4) ng/mL]. After the intervention period both groups demonstrated improvements in muscle strength, body composition, and thigh composition. Nutritional supplementation lead to further losses of intermuscular fat (p = .049) and increased normal muscle density (p = .018).

    Conclusions: Six months of physical activity resulted in improvements in body composition, subcutaneous fat, intermuscular fat, and strength measures. The addition of nutritional supplementation resulted in further declines in intermuscular fat and improved muscle density compared to placebo. These results suggest nutritional supplementation provides additional benefits to mobility-limited older adults undergoing exercise training.

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