Physical activity and screen time in Swedish children and adolescents: The generation pep study 2018-2021.

AIM: To analyse physical activity and screen time trends annually between 2018 and 2021 in large population-based samples of Swedish children and adolescents. METHODS: This is a repeated cross-sectional study using data collected over 4 years (2018-2021) using simple probability sampling of Swedish children and adolescents aged 4-17 years. The web-based questionnaire, including questions on physical activity and screen time, was filled out by a parent if the child was <12 years of age and by the adolescents themselves if they were ≥ 12 years. Sociodemographic data was collected from the parents. RESULTS: No significant difference in physical activity was observed in 2020 and 2021 compared to 2019. However, older children/adolescents and girls have higher odds to be in a lower physical activity category (p-values<0.001). With regards to screen time, there was a significant increase in reported screen time from 2018 to 2021 for children and adolescents, with screen time peaking in 2020 (p-values<0.001). CONCLUSION: This is the first study in Sweden evaluating trends in physical activity and screen time in large population-based samples spanning from pre-school to adolescence. Interventions to promote physical activity, especially in the older age groups and to reduce screen time in a Swedish context are warranted.

Generation Pep Study: A population-based survey on diet and physical activity in 12,000 Swedish children and adolescents.

AIM: This study presents dietary intake and physical activity in a large nationally representative sample of children and adolescents in Sweden. It also reports the study protocol for the Generation Pep Study that will be used for yearly repeated measurements. METHODS: A random sample of children and adolescents aged 4-17 years living in Sweden was invited to fill in a Web-based questionnaire on dietary intake and physical activity. For participants aged <12 years, the parents were asked to fill in the questionnaire together with their child. Information on socio-economic background was collected from the parents. RESULTS: A total number of 12,441 children and adolescents participated in the study (participation rate 43%). The results indicate that 13- to 17-year-olds have notably less healthy dietary intake and lower physical activity compared with younger age groups. In general, the dietary intake was most healthy among 4- to 6-year-olds. A socio-economic gradient was seen for many of the studied variables. CONCLUSION: Participants of a high socio-economic status and younger age generally had healthier dietary intake and higher physical activity. The study provides novel national data as it includes a wide age of children and adolescents (4-17 years).

Vegetables, fruits, and berries - a scoping review for Nordic Nutrition Recommendations 2023.

Vegetables, fruits, and berries comprise a large variety of foods and are recognised to play an important role in preventing chronic diseases. Many observational studies have been published during the last decade, and the aim of this scoping review is to describe the overall evidence for the role of vegetables, fruits, and berries for health-related outcomes as a basis for setting and updating food-based dietary guidelines. A scoping review was conducted according to the protocol developed within the Nordic Nutrition Recommendations 2023 project. Current available evidence strengthens the role of consuming vegetables, fruits, and berries in preventing chronic diseases. The most robust evidence is found for cancer in the gastric system and lung cancer, cardiovascular disease, and all-cause mortality. Steeper risk reductions are generally seen at the lower intake ranges, but further reductions have been seen for higher intakes for cardiovascular disease. Weaker associations are seen for type 2 diabetes. There is evidence that suggests a beneficial role also for outcomes such as osteoporosis, depression, cognitive disorders, and frailty in the elderly. The observed associations are supported by several mechanisms, indicting causal effects. Some subgroups of vegetables, fruits, and berries may have greater benefits than other subgroups, supporting a recommendation to consume a variety of these foods.

Potatoes - a scoping review for Nordic Nutrition Recommendations 2023.

Potatoes comprise a common staple food in the Nordic and Baltic countries and contribute to the diet with vitamins, minerals, dietary fibre and phytochemicals. However, potatoes may also be consumed in processed forms with added fat and salt, which raises concerns about possible adverse health effects. The aim of this scoping review is to describe the overall evidence for the role of potatoes as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023. PubMed was searched for systematic reviews and meta-analyses, and evidence was extracted on relevant health outcomes. Current available evidence indicates that moderate consumption of potatoes is not associated with a substantial risk of chronic diseases, and that they may be part of a healthy diet. However, the health effects vary greatly depending on cooking methods, and studies indicate that the intake of French fries/fried potatoes should be limited. Overall, the evidence regarding health effects of potatoes is very limited, and possible associations need to be further investigated.

Fruit juice - a scoping review for Nordic Nutrition Recommendations 2023.

Fruit juice has a similar nutrient content as whole fruit and may in this respect be part of a healthy diet. However, a lower amount or lack of fibre and a higher concentration of sugars and energy could also contribute to less satiation and increase the risk of excess energy intake. The aim of this scoping review is to describe the overall evidence for the role of fruit juice as a basis for setting and updating food-based dietary guidelines in the Nordic Nutrition Recommendations 2023. PubMed was searched for systematic reviews and meta-analyses and evidence was extracted on relevant health outcomes. Current available evidence indicates that low to moderate consumption of fruit juice is not associated with an apparent risk of chronic diseases and may have protective effects on cardiovascular disease. The association between the intake of fruit juice and weight gain remains unclear and might be of concern for some groups of people. Overall, the evidence regarding health effects of fruit juice is limited.

Construction and validation of a scoring system for the selection of high-quality data in a Spanish population primary care database (SIDIAP).

BACKGROUND: Computerised databases of primary care clinical records are widely used for epidemiological research. In Catalonia, the Information System for the Development of Research in Primary Care (SIDIAP) aims to promote the development of research based on high-quality validated data from primary care electronic medical records. OBJECTIVE: The purpose of this study is to create and validate a scoring system (Registry Quality Score, RQS) that will enable all primary care practices (PCPs) to be selected as providers of researchusable data based on the completeness of their registers. METHODS: Diseases that were likely to be representative of common diagnoses seen in primary care were selected for RQS calculations. The observed/expected cases ratio was calculated for each disease. Once we had obtained an estimated value for this ratio for each of the selected conditions we added up the ratios calculated for each condition to obtain a final RQS. Rate comparisons between observed and published prevalences of diseases not included in the RQS calculations (atrial fibrillation, diabetes, obesity, schizophrenia, stroke, urinary incontinence and Crohn's disease) were used to set the RQS cutoff which will enable researchers to select PCPs with research-usable data. RESULTS: Apart from Crohn's disease, all prevalences were the same as those published from the RQS fourth quintile (60th percentile) onwards. This RQS cut-off provided a total population of 1 936 443 (39.6% of the total SIDIAP population). CONCLUSIONS: SIDIAP is highly representative of the population of Catalonia in terms of geographical, age and sex distributions. We report the usefulness of rate comparison as a valid method to establish research-usable data within primary care electronic medical records.

The Need for an Evidence-Based Program in Sweden to Support Parents to Create Healthy Lifestyle Behaviors from the Start of Life-Parental Perceptions.

In Sweden, there have been no interventions promoting the development of healthy lifestyle behaviors starting in infancy. Thus this paper aims to: (i) investigate Swedish parents' experiences regarding feeding of solid foods, screen time, and physical activity in healthy infants; (ii) investigate parents' needs and perceptions regarding information/support provided in primary child healthcare (CHC) and (iii) explore whether a parenting program focused on child diet and active play would be relevant and utilized. Semi-structured interviews were conducted with 20 parents. These were recorded, transcribed verbatim and analyzed using thematic analysis. Seven themes emerged: Feeling excited to enter a new phase; Parents' responsibility of doing it "right" can be stressful; Motivated to learn during specific time windows; Information to trust; The importance of social support from peers; Experiences of support received from CHC; and the Infant, Feeding, Activity, and Nutrition Trial (INFANT) for a Swedish context. Parents were excited to enter new phases in their child's development. However, this came with worry they were doing things "right", leading parents to want more information/support. Overall, Swedish parents were very positive about the prospects of engaging in a primary CHC delivered program to support them to promote healthy lifestyle behaviors from birth and felt this could complement the care currently provided.

Body mass index and gestational weight gain in migrant women by birth regions compared with Swedish-born women: A registry linkage study of 0.5 million pregnancies.

INTRODUCTION: Women migrating to high-income countries may have increased risks of adverse pregnancy outcomes as compared with native-born women. However, little is known whether migrant women are more likely to have unhealthy body mass index (BMI) or gestational weight gain (GWG), which is of importance considering the well-established links between unhealthy BMI and GWG with adverse pregnancy outcomes. Hence, the aim of the study was to examine the prevalence and estimate odds ratios (ORs) of underweight and obesity in the first trimester as well as inadequate and excessive GWG across birth regions in migrant (first-generation) and Swedish-born women in a population-based sample of pregnant women in Sweden. METHODS: This population-based study included 535 609 pregnancies from the Swedish Pregnancy Register between the years 2010-2018. This register has a coverage of approximately 90% and includes data on body weight, height, birth country and educational attainment. BMI in the first trimester of pregnancy was classified as underweight, normal weight, overweight and obesity whereas GWG was classified as inadequate, adequate and excessive according to the recommendations from the National Academy of Medicine, USA. BMI and GWG were examined according to 7 birth regions and the 100 individual birth countries. Adjusted ORs of underweight, obesity as well as inadequate or excessive GWG by birth regions were estimated using multinomial logistic regression. RESULTS: There were large disparities in unhealthy BMI and GWG across birth regions. For instance, women born in North Africa and Middle East and Sub-Saharan Africa had 1.40 (95% CI 1.35-1.44) and 2.13 (95% CI 2.03-2.23) higher odds of obesity compared with women born in Sweden. However, women born in Sub-Saharan Africa had also considerably higher odds of underweight (OR, 2.93 [95% CI 2.70-3.18]) and inadequate GWG (OR, 1.97 [95% CI 1.87-2.07]). The limitations of the study include the lack of a validated measure of acculturation and that the study only had data on first-generation migration. CONCLUSIONS: The large differences across the 7 regions and 100 countries highlights the importance of considering birth region and country-specific risks of unhealthy BMI and GWG in first-generation migrant women. Furthermore, inadequate GWG was common among pregnant first-generation migrant women, especially in women born in Sub-Saharan Africa, which demonstrates the need to promote adequate GWG, not only the avoidance of excessive GWG. Thus, our findings also indicate that additional support and interventions may be needed for first-generation migrant women from certain birth regions and countries in order to tackle the observed disparities in unhealthy BMI and GWG. Although further studies are needed, our results are useful for identifying groups of women at increased risk of unhealthy BMI and weight gain during pregnancy.

Dietary fish and fish oil and the risk of rheumatoid arthritis.

BACKGROUND: Intake of fish oil and oily fish has been reported to improve clinical symptoms in people who have rheumatoid arthritis. Whether the intake of oily fish and fish oil might also protect against the development of rheumatoid arthritis is not known. OBJECTIVE: We investigated the association between intake of oily fish and fish oil supplements and the risk of rheumatoid arthritis in a population-based case-control study. METHODS: The study comprised 1889 incident cases of rheumatoid arthritis and 2145 randomly selected controls recruited from a geographically defined area of Sweden during 1996-2005. Data on the consumption of oily fish and fish oil supplements 5 years preceding enrollment had been obtained through a questionnaire. We calculated odds ratios (ORs) for the development of rheumatoid arthritis, using logistic regression to adjust for age, residential area, body mass index, smoking, and alcohol consumption. RESULTS: Compared with subjects who never or seldom consumed oily fish, the OR for developing rheumatoid arthritis was 0.8 (95% confidence interval = 0.6-1.0) for subjects who consumed oily fish 1-7 times a week. The results did not change notably when stratifying the cases for rheumatoid factor or for antibodies to citrullinated peptide antigens. Similar results were seen for subjects consuming oily fish 1-3 times a month. Cases and controls did not differ in their consumption of fish oil supplements. CONCLUSION: Intake of oily fish was associated with a modestly decreased risk of developing rheumatoid arthritis.

Associations between estimated fatty acid desaturase activities in serum lipids and adipose tissue in humans: links to obesity and insulin resistance.

Fatty acid composition of serum lipids and adipose tissue triacylglycerols (AT-TAG) partly reflect dietary fatty acid intake. The fatty acid composition is, besides the diet, also influenced by desaturating enzymes that can be estimated using product-to-precursor fatty acid ratios. The interrelationships between desaturase indices derived from different serum lipid fractions and adipose tissue are unclear, as well as their associations with obesity and insulin resistance. We aimed to investigate cross-sectional correlations between desaturase indices as measured in serum lipid fractions (phospholipids; PL and free fatty acids; FFA) and in adipose tissue (AT-TAG). In a population-based sample of 301 healthy 60-year-old men various desaturase indices were assessed: stearoyl-CoA-desaturase (16:1n-7/16:0; SCD-16 and 18:1n-9/18:0; SCD-18, respectively), delta-6-desaturase (20:3n-6/18:2n-6; D6D) and delta-5-desaturase (20:4n-6/20:3n-6; D5D). Correlations with BMI and insulin resistance (HOMA-IR) were also examined. SCD-16 and D5D were significantly correlated between fractions and tissues (all r > 0.30), whereas SCD-18 and D6D were not. Desaturase indices in serum FFA and AT-TAG were significantly correlated; SCD-16 (r = 0.63), SCD-18 (r = 0.37), and D5D (r = 0.43). In phospholipids, SCD-16 was positively correlated to BMI (r = 0.15), while D5D negatively to both BMI (r = -0.30) and HOMA-IR (r = -0.31), all p < 0.01. D6D in both phospholipids and AT-TAG was positively correlated to HOMA-IR and BMI (all p < 0.01). In conclusion, SCD-1 and D5D activity indices showed overall strong correlations between lipid pools. SCD-1 activity index in adipose tissue is best reflected by 16:1/16:0-ratio in serum FFA, but associations with obesity and insulin resistance differ between these pools. D5D in PL was inversely related to obesity and insulin resistance, whereas D6D index showed positive associations.

Autoantibodies against modified apolipoprotein B-100 in relation to low-density lipoprotein size and the metabolic syndrome in otherwise healthy men.

The role of inflammation in atherosclerotic disease is well established, but the role of autoantibodies against modified apolipoprotein (apo) B-100 remains unclear. The metabolic syndrome is associated with a proinflammatory state, a predominance of small dense low-density lipoprotein (LDL) particles, and an increased risk for atherosclerotic diseases. Previous studies have shown specific autoantibodies against modified apo B-100 (within LDL) to be related to human atherosclerotic disease. The objective of the present study was to investigate whether autoantibodies against modified apo B-100 are related to parameters of the metabolic syndrome, such as small dense LDL. Two hundred ninety-one healthy men were investigated for different metabolic, anthropometric, and inflammatory variables; LDL peak particle size; and distribution of LDL in 4 subfractions. Subjects were grouped according to LDL peak size > or = 23.5 nm (pattern A, n = 230) or <23.5 nm (pattern B, n = 61). Immunoglobulin (Ig) G and IgM antibodies against 2 aldehyde-modified peptide sequences, denoted as 45 and 210, within apo B-100 were quantified. Levels of IgG(45), but not the other autoantibodies, were significantly higher in pattern B individuals (with a predominance of small dense LDL particles) compared with pattern A (P < .01). Relationships for both IgG(45) and IgG(210) with parameters typically associated with the metabolic syndrome were found. Only IgG(45) tended to be higher in individuals with the metabolic syndrome compared with those without (P = .07). We conclude that subjects with a predominance of small dense LDL particles have elevated concentrations of IgG(45) in the circulation, which reflect an activated immune response to a specific epitope of modified apo B-100.

Association between dairy food consumption and weight change over 9 y in 19,352 perimenopausal women.

BACKGROUND: Dairy foods may play a role in the regulation of body weight. OBJECTIVE: We examined the association between changes in dairy product consumption and weight change over 9 y. DESIGN: The study was conducted in 19 352 Swedish women aged 40-55 y at baseline. Data on dietary intake, body weight, height, age, education, and parity were collected in 1987-1990 and 1997. The intake frequencies of whole milk and sour milk (3% fat), medium-fat milk (1.5% fat), low-fat milk and sour milk (or=1 serving/d; 3) constant, >or=1 serving/d; and 4) decreased from >or=1 serving/d to <1 serving/d. Odds ratios (ORs) with 95% CIs for an average weight gain of >or=1 kg/y were calculated by using multivariable logistic regression analyses, with group 1 as the reference. RESULTS: Mean (+/-SD) body mass index (in kg/m2) at baseline was 23.7 +/- 3.5. The constant (>or=1 serving/d) intakes of whole milk and sour milk and of cheese were inversely associated with weight gain; ORs for group 3 were 0.85 (95% CI: 0.73, 0.99) and 0.70 (95% CI: 0.59, 0.84) respectively. No significant associations were seen for the other 3 intake groups. When stratified by BMI, the findings remained significant for cheese and, for normal-weight women only, for whole milk and sour milk. CONCLUSION: The association between the intake of dairy products and weight change differed according to type of dairy product and body mass status. The mechanism behind these findings warrants further investigation.

Measures of oxidized low-density lipoprotein and oxidative stress are not related and not elevated in otherwise healthy men with the metabolic syndrome.

OBJECTIVE: The metabolic syndrome predisposes to the development of cardiovascular diseases. Oxidative stress and elevated circulating oxidized low-density lipoprotein (LDL) concentrations are related to cardiovascular disease and proposed to be features of the metabolic syndrome. F2-isoprostanes are lipid peroxidation products and considered the most reliable biomarkers of oxidative stress. METHODS AND RESULTS: Plasma oxidized LDL (oxLDL) and urinary 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha; the major F2-isoprostane) were analyzed in a cross-sectional study of 289 healthy men (62 to 64 years of age). Individuals completed a 7-day dietary record, and fasting plasma insulin, lipid, and lipoprotein concentrations, LDL particle size, and inflammatory markers were determined. National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATPIII) criteria were used to define the metabolic syndrome and individuals were grouped according to the number of risk factors for the metabolic syndrome (0, [n=88; 30%]; > or =1, [n=179; 62%], metabolic syndrome [n=22; 8%]). Group comparisons revealed no differences for oxLDL, 8-iso-PGF2alpha, or reported intake of macronutrients, whereas C-reactive protein and interleukin-6 were increased in the metabolic syndrome. LDL cholesterol strongly determined oxLDL in univariate and multivariate analysis, but no relationship to 8-iso-PGF2alpha was found. In turn, 8-iso-PGF2alpha was related to reported intake of fat, fatty acids, and dietary antioxidants. CONCLUSIONS: There were no increases in plasma oxLDL or measures of oxidative stress (urinary 8-iso-PGF2alpha) in these otherwise healthy 63-year-old men with the metabolic syndrome. Furthermore, no relationship between oxLDL and 8-iso-PGF2alpha was found, but our results suggest a role for dietary factors in oxidative stress.

Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men.

BACKGROUND: Plasma concentrations of long-chain n-3 polyunsaturated fatty acids are lower in vegetarians and in vegans than in omnivores. No data are available on whether these concentrations differ between long- and short-term vegetarians and vegans. OBJECTIVES: We compared plasma fatty acid composition in meat-eaters, vegetarians, and vegans and examined whether the proportions of eicosapentaenoic acid (20:5n-3; EPA), docosapentaenoic acid (22:5n-3; DPA), and docosahexaenoic acid (22:6n-3; DHA) were related to the subjects' duration of adherence to their diets or to the proportions of plasma linoleic acid (18:2n-6; LA) and alpha-linolenic acid (18:3n-3; ALA). DESIGN: The present cross-sectional study included 196 meat-eating, 231 vegetarian, and 232 vegan men in the United Kingdom. Information on anthropometry, diet, and smoking habits was obtained through a questionnaire. Total fatty acid composition in plasma was measured. RESULTS: The proportions of plasma EPA and DHA were lower in the vegetarians and in the vegans than in the meat-eaters, whereas only small differences were seen for DPA. Plasma EPA, DPA, and DHA proportions were not significantly associated with the duration of time since the subjects became vegetarian or vegan, which ranged from <1 y to >20 y. In the vegetarians and the vegans, plasma DHA was inversely correlated with plasma LA. CONCLUSIONS: The proportions of plasma long-chain n-3 fatty acids were not significantly affected by the duration of adherence to a vegetarian or vegan diet. This finding suggests that when animal foods are wholly excluded from the diet, the endogenous production of EPA and DHA results in low but stable plasma concentrations of these fatty acids.

Soy intake and blood cholesterol concentrations: a cross-sectional study of 1033 pre- and postmenopausal women in the Oxford arm of the European Prospective Investigation into Cancer and Nutrition.

BACKGROUND: Clinical trials have suggested that the intake of soy protein reduces blood cholesterol. Few studies have explored this relation in subjects who consume soy as part of their regular diet. OBJECTIVE: In this study, we investigated whether blood cholesterol concentrations are related to the intake of soyfoods in a cohort comprising subjects with a wide variation in soy intake. DESIGN: This cross-sectional study included 1033 pre- and postmenopausal women selected from the Oxford arm of the European Prospective Investigation into Cancer and Nutrition. The sample included 361 nonvegetarians, 570 vegetarians, and 102 vegans. Their dietary intake was assessed by using a food-frequency questionnaire. Anthropometric data, medical history, and lifestyle information were obtained with the use of a questionnaire, blood samples were obtained, and plasma total, LDL-, and HDL-cholesterol concentrations were measured. RESULTS: Soy-protein intake was inversely associated with total and LDL-cholesterol concentrations and with the ratio of total to HDL cholesterol but not with HDL-cholesterol concentrations. Mean plasma LDL-cholesterol concentrations in women with a soy-protein intake >/=6 g/d was 12.4% lower than that in women who consumed <0.5 g/d (P < 0.001). CONCLUSION: Moderate intakes of soyfoods as part of a regular diet are associated with favorable blood cholesterol concentrations.

Associations between diet and the metabolic syndrome vary with the validity of dietary intake data.

BACKGROUND: Underreporting is a common problem in dietary surveys. Few studies have shown the implication of this when investigating diet-disease relations. OBJECTIVE: We investigated how underreporting affects the associations between dietary factors and the metabolic syndrome. DESIGN: Dietary intake measured with a 7-d food record, fasting insulin concentrations, and other variables of the metabolic syndrome were assessed in a cross-sectional study of 301 healthy men aged 63 y. Biological markers for intakes of protein, sodium, and potassium were measured in 24-h urine samples. Underreporters (URs, n = 88) were identified by Goldberg's equation, which compares energy intake with energy expenditure, both expressed as multiples of the basal metabolic rate. Physical activity level was estimated, and individual cutoffs were calculated. RESULTS: The URs had higher nutrient and food densities in their diet than did the non-URs, which suggested that they followed a healthier diet. The URs had a higher prevalence of the metabolic syndrome than did the non-URs (18% and 9%, respectively; P = 0.029). The biological markers confirmed a low validity of the dietary data in the URs. The correlations between fasting insulin concentrations, a central component of the metabolic syndrome, and the intakes of polyunsaturated fats, n-6 fats, and fat from milk products were stronger in the URs than in the non-URs, which indicates that inaccurate data can introduce spurious associations. CONCLUSION: The association between diet and fasting insulin differed between URs and non-URs in this study of 301 healthy men aged 63 y. If URs are not identified and excluded or treated separately in studies in nutritional epidemiology, spurious diet-disease relations may be reported.

Control of glycemia and cardiovascular risk factors in patients with type 2 diabetes in primary care in Catalonia (Spain).

OBJECTIVE: The objective of this study was to analyze the clinical characteristics and levels of glycemic and cardiovascular risk factor control in patients with type 2 diabetes that are in primary health care centers in Catalonia (Spain). RESEARCH DESIGN AND METHODS: This was a cross-sectional study of a total population of 3,755,038 individuals aged 31-90 years at the end of 2009. Clinical data were obtained retrospectively from electronic clinical records. RESULTS: A total of 286,791 patients with type 2 diabetes were identified (7.6%). Fifty-four percent were men, mean (SD) age was 68.2 (11.4) years, and mean duration of disease was 6.5 (5.1) years. The mean (SD) A1C value was 7.15 (1.5)%, and 56% of the patients had A1C values ≤7%. The mean (SD) blood pressure (BP) values were 137.2 (13.8)/76.4 (8.3) mmHg, mean total cholesterol concentration was 192 (38.6) mg/dL, mean HDL cholesterol concentration was 49.3 (13.2) mg/dL, mean LDL cholesterol (LDL-C) concentration was 112.5 (32.4) mg/dL, and mean BMI was 29.6 (5) kg/m(2). Thirty-one percent of the patients had BP values ≤130/80 mmHg, 37.9% had LDL-C values ≤100 mg/dL, and 45.4% had BMI values ≤30 kg/m(2). Twenty-two percent were managed exclusively with lifestyle changes. Regarding medicated diabetic patients, 46.9, 22.9, and 2.8% were prescribed one, two, or three antidiabetic drugs, respectively, and 23.4% received insulin therapy. CONCLUSIONS: The results from this study indicate a similar or improved control of glycemia, lipids, and BP in patients with type 2 diabetes when compared with previous studies performed in Spain and elsewhere.

Validity for use in research on vascular diseases of the SIDIAP (Information System for the Development of Research in Primary Care): the EMMA study.

INTRODUCTION AND OBJECTIVES: Information in primary care databases can be useful in research, but the validity of these data needs to be evaluated. We sought to analyze the validity of the data used in the EMMA study based on data from the Information System for the Development of Research in Primary Care. METHODS: We compared the prevalence of cardiovascular risk factors observed in EMMA-hypertension, diabetes, hypercholesterolemia (and its treatments), obesity, and smoking-with equivalent data from the Registre Gironí del Cor (REGICOR), a population-based study that uses standardized methodology, in 2000. We also compared the incidence rates of vascular diseases and its association with these risk factors in a 5-year follow-up. RESULTS: We analyzed data from 34 823 participants included in EMMA and 2540 REGICOR2000 study participants aged 35 to 74. The prevalence of risk factors did not differ significantly between the 2 studies, except for the prevalence of former smokers in men, which was higher in REGICOR2000 (24.7% [95% confidence interval, 23.9%-25.5%] vs 30.1% [95% confidence interval, 27.1%-33.1%]), and the proportion of patients with lipid-lowering and antihypertensive therapy, which was higher in EMMA (46.9% vs 32.7% and 8.7% vs 6.3%, respectively). There were no differences between the 2 studies when comparing the incidence of vascular diseases (2.1% in both studies in men and 1.18% [95% confidence interval, 0.7%-1.7%] in REGICOR2000 vs 0.75% [95% confidence interval, 0.64%-0.87%] in EMMA in women) and its association with risk factors. CONCLUSIONS: The prevalence of cardiovascular risk factors and their association with the incidence of vascular disease observed in the EMMA study are consistent with those observed in an epidemiological population-based study with a standardized methodology.

Eating meals irregularly: a novel environmental risk factor for the metabolic syndrome.

BACKGROUND: Skipping meals is a common practice in our current society; however, it is not clear whether eating meals regularly is associated with the metabolic syndrome. OBJECTIVE: Our aim was to assess the association of eating meals regularly with parameters of the metabolic syndrome and insulin resistance in a representative population-based cohort of 60-year-old men and women. METHODS AND PROCEDURES: A population-based cross-sectional study of 3,607 individuals (1,686 men and 1,921 women), aged 60 years, was conducted in Stockholm County, Sweden. Medical history, socioeconomic factors, and lifestyle data were collected by a questionnaire and a medical examination, which included laboratory tests. RESULTS: Of the subjects who were regular eaters, 20% fulfilled the criteria for the metabolic syndrome vs. 27% of subjects who were irregular eaters (P < 0.0001). The adjusted odds ratio (OR) for having the greatest number of components of the metabolic syndrome in subjects who were regular eaters was 0.27 (95% confidence interval (CI), 0.13-0.54) using subjects who did not fulfill any criteria for the metabolic syndrome as a reference group. Eating meals regularly was also inversely related to insulin resistance (OR, 0.68 (95% CI, 0.48-0.97)) and to gamma-glutamyl transferase (OR, 0.52 (95% CI, 0.33-83)) after full adjustment. DISCUSSION: Eating meals regularly is inversely associated to the metabolic syndrome, insulin resistance and (high) serum concentrations of gamma-glutamyl transferase. These findings suggest that eating meals irregularly may be part of several potential environmental risk factors that are associated with the metabolic syndrome and may have future implications in giving dietary advice to prevent and/or treat the syndrome.

Markers of endothelial activity are related to components of the metabolic syndrome, but not to circulating concentrations of the advanced glycation end-product N epsilon-carboxymethyl-lysine in healthy Swedish men.

Endothelial function is considered important in the development of cardiovascular diseases and type 2 diabetes. Circulating advanced glycation end-products (AGEs) and dietary components have been shown to affect endothelial function in type 2 diabetics, but determinants of endothelial function in a non-diabetic population are more poorly investigated. Therefore, we investigated relationships between dietary habits, AGEs and endothelial activation in men with isolated metabolic disturbances. Circulating markers of endothelial activation (soluble forms of vascular cell adhesion molecule-1, intercellular adhesion molecule-1, E-selectin and von Willebrand factor) and plasma N epsilon-carboxymethyl-lysine (CML, the predominant AGE in human plasma) were analyzed in a cross-sectional study of 294 healthy men. Individuals completed a 7-day dietary record, and metabolic and inflammatory parameters were determined. NCEP/ATPIII-criteria were used to define the metabolic syndrome. Endothelial activation was higher in individuals with the metabolic syndrome, and was positively related to certain features of the syndrome (insulin, glucose, inflammation and obesity), but not to others (triacylglycerol and blood pressure). Dietary factors were related to endothelial activation, but CML was not. Multivariate analysis revealed energy and alcohol intake, along with insulin and markers of oxidative stress and inflammation, to be positive predictors of endothelial activation. In this cohort of otherwise healthy men, endothelial activation was increased in individuals with the full metabolic syndrome, but not in those with only some of the components of the metabolic syndrome. Insulin resistance, inflammation, oxidative stress, the dietary intake of energy and alcohol, but not plasma CML, predicted endothelial activation in these men.