Early-life diet and risk of inflammatory bowel disease: a pooled study in two Scandinavian birth cohorts.

OBJECTIVE: We assessed whether early-life diet quality and food intake frequencies were associated with subsequent IBD. DESIGN: Prospectively recorded 1-year and 3-year questionnaires in children from the All Babies in Southeast Sweden and The Norwegian Mother, Father and Child Cohort Study were used to assess diet quality using a Healthy Eating Index and intake frequency of food groups. IBD was defined as >2 diagnoses in national patient registers. Cox regression yielded HRs adjusted (aHRs) for child's sex, parental IBD, origin, education level and maternal comorbidities. Cohort-specific results were pooled using a random-effects model. RESULTS: During 1 304 433 person-years of follow-up, we followed 81 280 participants from birth through childhood and adolescence, whereof 307 were diagnosed with IBD. Compared with low diet quality, medium and high diet quality at 1 year of age were associated with a reduced risk of IBD (pooled aHR 0.75 (95% CI=0.58 to 0.98) and 0.75 (95% CI=0.56 to 1.00)). The pooled aHR per increase of category was 0.86 (0.74 to 0.99). Pooled aHR for children 1 year old with high versus low fish intake was 0.70 (95% CI=0.49 to 1.00) for IBD, and showed association with reduced risk of UC (pooled aHR=0.46; 95% CI=0.21, 0.99). Higher vegetable intake at 1 year was associated with a risk reduction in IBD. Intake of sugar-sweetened beverages was associated with an increased risk of IBD. Diet quality at 3 years was not associated with IBD. CONCLUSION: In this Scandinavian birth cohort, high diet quality and fish intake in early life were associated with a reduced risk of IBD.

Loss of height predicts total and cardiovascular mortality: a cohort study of northern European women.

OBJECTIVE: To examine height changes in middle-aged northern European women in relation to overall and cardiovascular mortality. DESIGN: Population-based cohort studies with longitudinally measured heights and register-based mortality. SETTING: Sweden and Denmark. PARTICIPANTS: Population-based samples of 2406 Swedish and Danish women born on selected years in 1908-1952, recruited to baseline examinations at ages 30-60, and re-examined 10-13 years later. MAIN OUTCOME MEASURE: Total and cardiovascular disease (CVD) specific mortality during 17-19 years of follow-up after last height measure. RESULTS: For each 1 cm height loss during 10-13 years, the HR (95% CI) for total mortality was 1.14 (1.05 to 1.23) in Swedish women and 1.21 (1.09 to 1.35) in Danish women, independent of key covariates. Low height and high leisure time physical activity at baseline were protective of height loss, independent of age. Considering total mortality, the HR for major height loss, defined as height loss greater than 2 cm, were 1.74 (1.32 to 2.29) in Swedish women and 1.80 (1.27 to 2.54) in Danish women. Pooled analyses indicated that height loss was monotonically associated with an increased mortality, confirming a significant effect above 2 cm height loss. For cause-specific mortality, major height loss was associated with a HR of 2.31 (1.09 to 4.87) for stroke mortality, 2.14 (1.47 to 3.12) for total CVD mortality and 1.71 (1.28 to 2.29) for mortality due to causes other than CVD. CONCLUSION: Height loss is a marker for excess mortality in northern European women. Specifically the hazard of CVD mortality is increased in women with height loss during middle age, and the results suggest that the strongest cause-specific endpoint may be stroke mortality. The present findings suggest attention to height loss in early and mid-adulthood to identify women at high risk of CVD, and that regular physical activity may prevent early onset height loss.

The food diary as a pedagogical strategy in undergraduate nursing nutrition education: A student evaluation.

BACKGROUND: Few studies have evaluated educational nutrition activities in undergraduate nursing, and none have published how the established food assessment method, the food diary, can be used as a pedagogical method in this context. OBJECTIVE: To describe undergraduate nursing students' learning outcomes of basic nutrition and important elements for their learning after conducting a one-day food record with a subsequent seminar (henceforth: "the food diary method"). DESIGN: Cross-sectional. SETTING: Undergraduate nursing program in Sweden. PARTICIPANTS: 161 students. METHODS: Participants conducted a one-day food record by documenting their food intake and calculating the nutritional values. After completion, students participated in a seminar, and an evaluative questionnaire was distributed at the end. The questionnaires contained both numerical and free-text questions. RESULTS: Of 162 students attending the seminar, all but one completed the questionnaire (response rate: 99%). The highest rated learning outcome, on the 5-point Likert scale, was an increased understanding for the nutritional recommendations (Median, M = 5). The highest rated educational aspects were that they compared their records with the nutritional recommendations (M = 5), and the calculations of nutritional values of their records (M = 5). Participants also indicated that they gained information that would be useful for them as practicing nurses (M = 5). CONCLUSIONS: Overall, the food diary method appeared to be a feasible method in educating and engaging undergraduate nursing students in the field of basic nutrition. These findings support results from previous studies in this area, such that educational nutrition activities that utilize active, experiential, and social learning strategies were appreciated by the students.

Secular trends in diet-related greenhouse gas emission estimates since 2000 - a shift towards sustainable diets in Sweden.

OBJECTIVE: This study examines secular changes in diet-related greenhouse gas emissions (GHGE) in younger and older Swedish adults, since the turn of this century. DESIGN: Two cross-sectional health examination surveys were conducted in 2001-2004 (T1) and 2014-2018 (T2). At both times, an eighty-six-item FFQ was embedded in the survey. From the food frequencies and age-standardised portion sizes, GHGE estimates (kg CO2e/year) were calculated. GHGE was modelled as a function of time period and covariates, for five distinct age groups. SETTING: The municipality of Gothenburg, in western Sweden. PARTICIPANTS: Women and men aged 25-34, 35-44, 45-54, 55-64 and 65-75 years were randomly selected from the population registry and recruited for examinations. After exclusion of participants with incomplete dietary data, the analytic sample consisted of 2569 individuals at T1 and 2119 at T2. RESULTS: Lower dietary GHGE scores were observed at T2 compared with T1, in each age group, adjusting for sex, BMI and education. The largest differences in GHGE were observed in the youngest age group (approximately 30 % reduction). Decreasing trends in GHGE from animal-based foods were observed at all ages and were accompanied by smaller increases from plant-based sources in younger groups only. At all ages, GHGE from discretionary foods decreased, and prevalence of overweight remained stable. CONCLUSIONS: Optimal dietary trends should support both human health and planetary health. Our results suggest that Swedish adults have moved in this direction, e.g. through less intake of red meat products and stable weight status.

Fatty fish intake in mothers during pregnancy and in their children in relation to the development of obesity and overweight in childhood: The prospective ABIS study.

BACKGROUND: Although controversial, lower maternal intake of n-3 polyunsaturated fatty acid (PUFA) during pregnancy and lower levels of omega-3 PUFA in serum phospholipids during childhood have been related to obesity. The main source of omega-3 PUFA is fatty fish in the diet. OBJECTIVES: To assess the relationship between overweight/obesity and the intake of fatty fish in maternal diet during pregnancy and in children up to 8 years of age. METHODS: The prospective cohort All Children in South-East Sweden (ABIS) followed babies from birth to 8 years of age. A total of 6749 children at 5 years of age (boys 52.6%) and 3017 children at 8 years (boys 52.3%) participated. A "fatty-fish index" was constructed on the basis of self-reports of nutritional habits. RESULTS: The prevalence of overweight and obesity in children at 5 years were 12.9% and 4.2%, respectively. At 8 years, 12.2% of the children presented overweight and 2.3% obesity. Girls were more affected than boys by overweight/obesity. A higher fish index during pregnancy was not related to overweight/obesity in the children, whereas a higher fish index in the children during the first years of life was related to obesity at 5 and 8 years of age. This relationship disappeared in a multivariable analysis. Maternal body mass index (BMI), maternal education, maternal smoking during pregnancy, birth weight, and physical activity all remained related to overweight/obesity at both 5 and 8 years of age. CONCLUSION: No relationships were found between a lower intake of fatty fish in the diet, neither in mothers during pregnancy nor in early childhood, and increased risk of overweight/obesity.

Introduction of fish and other foods during infancy and risk of asthma in the All Babies In Southeast Sweden cohort study.

The etiology of asthma includes lifestyle factors. Breastfeeding and introduction of complementary foods have been suggested to affect asthma risk, but the scientific foundation is not solid. Children from the birth cohort All Babies In Southeast Sweden study were included (n = 9727). Breastfeeding duration and timing of introduction of infant formula and food were collected prospectively during the first year. Through linkage to the Swedish Patient Register, 948 children were identified with any asthma until age 15-17 years, of which 450 cases were atopic. Breastfeeding duration was not associated to risk of asthma. Introduction of infant formula earlier than at 14 weeks of age was associated with higher risk of non-atopic asthma. Introduction of fish before 43 weeks of age, as compared to later, was associated with a lower risk of asthma, irrespective of atopic classification. Reverse causation was accounted for but did not explain the results.Conclusion: Introduction of infant formula and timing of introduction of fish seem to impact the long-term risk of doctor-diagnosed asthma. Emphasis on the growing body of evidence that early introduction of allergens offers protection against atopic disease should be considered in future recommendations. What is Known: • Breastfeeding and introduction of complementary foods might influence the risk of atopic diseases. Recently, a review stated that more studies are needed to clarify the role for asthma development. What is New: • Introduction of infant formula earlier than at 14 weeks of age was associated with a higher risk of developing non-atopic asthma. The risk was pronounced in children introduced to infant formula before 4 weeks of age while being breastfed less than 4 weeks. • Early fish introduction, before 43 weeks of age, was associated with a lower risk of asthma, independent of atopic classification of asthma.

Occupational stress is associated with major long-term weight gain in a Swedish population-based cohort.

PURPOSE: Occupational stress and obesity are both increasing in prevalence, but prospective findings relating these conditions are inconsistent. We investigated if baseline as well as prolonged exposure to high job demands and low decision latitude were associated with major weight gain (≥ 10% of baseline weight) in 3872 Swedish women and men examined three times over 20 years in the population-based Västerbotten Intervention Program. METHODS: Anthropometry was measured and participants completed questionnaires on job strain, diet, and other lifestyle factors. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI), adjusting for confounders. RESULTS: Adjusting for age, baseline low decision latitude was associated with major weight gain over 10- and 20-year OR (95% CI) 1.16 (1.00-1.33) and 1.29 (1.13-1.47), respectively (both sexes combined). After adjustment for diet quality and other confounders, the effect over 20 years remained 1.30 (1.13-1.50). Sex modified the effect of prolonged exposure to high job demands over at least 10 years (interaction p = 0.02), showing that high job demands was a risk factor of major weight gain over 20 years in women [1.54 (1.14-2.07)], but not in men [0.87 (0.63-1.19)]. Neither diet nor other lifestyle factors explained these associations. CONCLUSIONS: In conclusion, low decision latitude predicted major weight gain in women and men. In women, the results suggest an additional contribution to major weight gain from high job demands.

Longitudinal 10-year changes in dietary intake and associations with cardio-metabolic risk factors in the Northern Sweden Health and Disease Study.

BACKGROUND: Dietary risks today constitute the largest proportion of disability-adjusted life years (DALYs) globally and in Sweden. An increasing number of people today consume highly processed foods high in saturated fat, refined sugar and salt and low in dietary fiber, vitamins and minerals. It is important that dietary trends over time are monitored to predict changes in disease risk. METHODS: In total, 15,995 individuals with two visits 10 (±1) years apart in the population-based Västerbotten Intervention Programme 1996-2014 were included. Dietary intake was captured with a 64-item food frequency questionnaire. Percent changes in intake of dietary components, Healthy Diet Score and Dietary Inflammatory Index were calculated and related to body mass index (BMI), serum cholesterol and triglyceride levels and blood pressure at the second visit in multivariable regression analyses. RESULTS: For both sexes, on group level, proportion of energy intake (E%) from carbohydrates and sucrose decreased (largest carbohydrate decrease among 40 year-olds) and E% protein and total fat as well as saturated and poly-unsaturated fatty acids (PUFA) increased (highest protein increase among 30 year-olds and highest fat increase among 60 year-olds) over the 10-year period. Also, E% trans-fatty acids decreased. On individual basis, for both sexes decreases in intake of cholesterol and trans-fatty acids were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). For men, increases in intake of whole grain and Healthy Diet Score were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). Also for men, decreases in intake of trans-fatty acids and increases in Healthy Diet Score were associated with lower systolic blood pressure at second visit (P = 0.002 and P < 0.000). For women, increases in intake of PUFA and Healthy Diet Score were associated with lower BMI at second visit (P = 0.01 and P < 0.05). Surprisingly, increases in intake of sucrose among women were associated with lower BMI at second visit (P = 0.02). CONCLUSIONS: In this large population-based sample, dietary changes over 10 years towards less carbohydrates and more protein and fat were noted. Individual changes towards the Nordic dietary recommendations were associated with healthier cardio-metabolic risk factor profile at second visit.

Parity, weight change, and maternal risk of cardiovascular events.

BACKGROUND: High parity has been suggested to increase risk of maternal cardiovascular disease independent of body mass index measured after childbearing. Pregnancy is, however, associated with persistent weight gain and metabolic changes that, independent of parity, increase the risk of cardiovascular disease. It could therefore be questioned if high parity independently increases the risk of cardiovascular disease or if this association may be confounded, mediated, or modified by other parity-related factors. OBJECTIVE: We sought to investigate the association between parity and risk of cardiovascular disease, and secondary outcomes in terms of myocardial infarction and cerebral infarction, with particular focus on potential mediation by anthropometric measures and effect modification by lactation. STUDY DESIGN: We used data from 16,515 female participants (age 44.5-73.6 years) of the population-based Malmö Diet and Cancer Study with baseline examination from 1991 through 1996. The Malmö Diet and Cancer Study was followed up throughout 2010, with a median follow-up of 15.8 years. We used Cox proportional hazards model to examine the association between parity and cardiovascular disease. RESULTS: Adjusted for age and other potential confounders, grand multiparous women (≥5 children) had an increased risk of cardiovascular disease (hazard ratio, 1.60; 95% confidence interval, 1.20-2.14), myocardial infarction (hazard ratio, 1.68; 95% confidence interval, 1.15-2.45), and cerebral infarction (hazard ratio, 1.74; 95% confidence interval, 1.18-2.58) compared to women with 2 children. Additional adjustment for baseline body mass index and weight change since age 20 years attenuated the risk, but the increased risk for cardiovascular disease (hazard ratio, 1.38; 95% confidence interval, 1.02-1.87) and myocardial infarction (hazard ratio, 1.53; 95% confidence interval, 1.04-2.26) in grand multiparous women remained significant. Models stratified by lactation time showed that risk was only raised in grand multiparous women who had a mean lactation time of <4 mo/child. In sensitivity analyses excluding women with a history of diabetes at baseline, risk estimates for grand multiparous women became nonsignificant in the full model. CONCLUSION: Part of the increased risk of cardiovascular disease and myocardial infarction in grand multiparous women seems to be mediated by weight gain and potentially by higher likelihood of type 2 diabetes mellitus. Lactation may modify the increased risk of grand multiparity in that longer duration might offset the cardiovascular disease risk.

Introduction of complementary foods in Sweden and impact of maternal education on feeding practices.

OBJECTIVE: To describe the introduction of complementary foods in a population-based cohort in relation to recommendations and explore the possible impact of maternal education on infant feeding practices. DESIGN: Prospective data from the All Babies in Southeast Sweden (ABIS) cohort study were used. The ABIS study invited all infants born in south-east Sweden during October 1997-October 1999 (n 21 700) to participate. A questionnaire was completed for 16 022 infants. During the infants' first year parents continuously filed in a diary covering introduction of foods. SETTING: Sweden. SUBJECTS: Infants (n 9727) with completed food diaries. RESULTS: Potatoes, vegetables, fruits/berries and porridge were the foods first introduced, with a median introduction between 19 and 22 weeks, followed by introduction of meat, cow's milk, follow-on formula and sour milk/yoghurt between 24 and 27 weeks. Early introduction of any food, before 16 weeks, occurred for 27 % of the infants and was more common in infants of mothers with low education. Overall, potatoes (14·7 %), vegetables (11·1 %), fruits/berries (8·5 %), porridge (7·4 %) and follow-on formula (2·7 %) were the foods most frequently introduced early. The majority of infants (≥70 %) were introduced to potatoes, vegetables, fruits/berries and porridge during concurrent breast-feeding, but introduction during concurrent breast-feeding was less common in infants of mothers with low education. CONCLUSIONS: Most infants were introduced to complementary foods timely in relation to recommendations. Low maternal education was associated with earlier introduction of complementary foods and less introduction during concurrent breast-feeding. Still, the results indicated exposure to fewer foods at 12 months in infants of mothers with low education.

Increase in waist circumference over 6 years predicts subsequent cardiovascular disease and total mortality in nordic women.

OBJECTIVE: Despite solid evidence of an association between centralized body fatness and subsequent disease risk, little is known about the consequences of changes in body fat distribution. Recently it was shown that large hip circumference (HC), measured once, was protective against total and cardiovascular disease (CVD) mortality in women but that gain or loss in HC was unrelated to these outcomes. This study examines whether a 6-year change in waist circumference (WC) predicts mortality and CVD in the same study sample. METHODS: Baseline WC and 6-year change in WC as predictors of mortality and CVD were analyzed in 2,492 women from the Danish MONICA study and the Prospective Population Study of Women in Gothenburg, Sweden. RESULTS: Increase in WC was significantly associated with increased subsequent mortality and CVD adjusting for BMI and other covariates, with some evidence of a J-shaped association. Associations between increase in WC and outcomes were restricted to women with normal weight at baseline and to ever-smokers. CONCLUSIONS: In contrast to changes in HC which did not predict mortality and CVD, a 6-year increase in WC is strongly predictive, particularly among initially lean women and ever-smokers. This implies the importance of developing strategies to prevent central fat deposition.

Dietary intake of naturally occurring plant sterols is related to a lower risk of a first myocardial infarction in men but not in women in northern Sweden.

Dietary intake of naturally occurring plant sterols is inversely related to serum cholesterol concentrations. Elevated serum cholesterol increases the risk of myocardial infarction (MI), but it is unknown if this can be reduced by dietary intake of naturally occurring plant sterols. Our aim was to investigate if a high intake of naturally occurring plant sterols is related to a lower risk of contracting a first MI. The analysis included 1005 prospective cases (219 women, 786 men) and 3148 matched referents (723 women, 2425 men), aged 29-73 y at baseline, from the population-based Northern Sweden Health and Disease Study. A food frequency questionnaire (FFQ) was completed at baseline. Absolute plant sterol intake was inversely related to the risk of a first MI in men (OR highest vs. lowest quartile = 0.70; 95% CI: 0.53, 0.85; P-trend = 0.006) but not in women. After adjustment for confounders, the estimated risk was somewhat attenuated (OR highest vs. lowest quartile = 0.71; 95% CI: 0.55, 0.92; P-trend = 0.067), suggesting that increasing sterol intake from 150 to 340 mg/d reduces the risk of a first MI by 29%. Energy-adjusted plant sterol intake was not related to the risk of a first MI in either men or women. In conclusion, the findings of this observational study show that a high absolute intake of naturally occurring plant sterols is significantly related to a lower risk of a first MI in men in northern Sweden, whereas no significant relation was seen for energy-adjusted plant sterol intake. In women, no significant associations were found. The results from this study show that intake of plant sterols may be important in prevention of MI.

Evaluation of plant sterol intake estimated with the Northern Sweden FFQ.

OBJECTIVE: To evaluate plant sterol intake estimated with the eighty-four-item Northern Sweden FFQ against repeated 24 h dietary recalls (24-HDR) as the reference method. DESIGN: Randomly recruited participants from the Västerbotten Intervention Programme (VIP) responded to an FFQ (FFQ1). Over the subsequent 12 months, ten repeated 24-HDR were carried out. After this, a second FFQ (FFQ2) was completed. SETTING: Västerbotten county, northern Sweden. SUBJECTS: Ninety-six men and ninety-nine women. RESULTS: The Pearson correlation coefficient for absolute total plant sterol intake estimated with FFQ1 and 24-HDR was 0.58 and 0.55 for the men and women, respectively. Cross-classification of participants into quartiles of absolute plant sterol intake estimated with FFQ1 and 24-HDR showed that 90% of the men and 83% of the women were classified into the same or an adjacent quartile. For energy-adjusted plant sterol intake, 71% of the men and 74% of the women were classified into the same or an adjacent quartile. The agreement for cross-classification of participants into quartiles between FFQ1 and FFQ2 was good for both absolute and energy-adjusted plant sterol intake. CONCLUSIONS: The FFQ is able to capture absolute plant sterol intake to the same extent as other nutrients, and to rank individuals according to both their absolute and energy-adjusted plant sterol intake. The reproducibility of the FFQ was good, suggesting that the method is reliable. This makes it possible to use plant sterol data from the FFQ in large-scale studies of the association between plant sterol intake and disease.

Inverse relation between dietary intake of naturally occurring plant sterols and serum cholesterol in northern Sweden.

BACKGROUND: Plant sterols are bioactive compounds, found in all vegetable foods, which inhibit cholesterol absorption. Little is known about the effect of habitual natural dietary intake of plant sterols. OBJECTIVE: We investigated the relation between plant sterol density (in mg/MJ) and serum concentrations of cholesterol in men and women in northern Sweden. DESIGN: The analysis included 37 150 men and 40 502 women aged 29-61 y, all participants in the Västerbotten Intervention Program. RESULTS: Higher plant sterol density was associated with lower serum total cholesterol in both sexes and with lower LDL cholesterol in women. After adjustment for age, body mass index (in kg/m(2)), and (in women) menopausal status, men with high plant sterol density (quintile 5) had 0.15 mmol/L (2.6%) lower total serum cholesterol (P for trend = 0.001) and 0.13 mmol/L (3.1%) lower LDL cholesterol (P = 0.062) than did men with low plant sterol density (quintile 1). The corresponding figures for women were 0.20 mmol/L (3.5%) lower total serum cholesterol (P for trend < 0.001) and 0.13 mmol/L (3.2%) lower LDL cholesterol (P for trend = 0.001). CONCLUSIONS: The present study is the second epidemiologic study to show a significant inverse relation between naturally occurring dietary plant sterols and serum cholesterol. To the extent that the associations found truly mirror plant sterol intake and not merely a diet high in vegetable fat and fiber, it highlights the importance of considering the plant sterol content of foods both in primary prevention of cardiovascular disease and in the dietary advice incorporated into nutritional treatment of patients with hyperlipidemia.

Body composition in male elite athletes, comparison of bioelectrical impedance spectroscopy with dual energy X-ray absorptiometry.

BACKGROUND: The aim of this study was to compare body composition results from bioelectrical spectroscopy (BIS) with results from dual energy X-ray absorptiometry (DXA) in a population of male elite athletes. Body composition was assessed using DXA (Lunar Prodigy, GE Lunar Corp., Madison, USA) and BIS (Hydra 4200, Xitron Technologies Inc, San Diego, California, USA) at the same occasion. Agreement between methods was assessed using paired t-tests and agreement-plots. RESULTS: Thirty-three male elite athletes (soccer and ice hockey) were included in the study. The results showed that BIS underestimates the proportion of fat mass by 4.6% points in the ice hockey players. In soccer players the BIS resulted in a lower mean fat mass by 1.1% points. Agreement between the methods at the individual level was highly variable. CONCLUSION: Body composition results assessed by BIS in elite athletes should be interpreted with caution, especially in individual subjects. BIS may present values of fat mass that is either higher or lower than fat mass assessed by DXA, independent of true fat content of the individual.