More distinct food intake patterns among women than men in northern Sweden: a population-based survey

Predicting Sensitivity to Adverse Lifestyle Risk Factors for Cardiometabolic Morbidity and Mortality

People appear to vary in their susceptibility to lifestyle risk factors for cardiometabolic disease; determining a priori who is most sensitive may help optimize the timing, design, and delivery of preventative interventions. We aimed to ascertain a person’s degree of resilience or sensitivity to adverse lifestyle exposures and determine whether these classifications help predict cardiometabolic disease later in life; we pooled data from two population-based Swedish prospective cohort studies (n = 53,507), and we contrasted an individual’s cardiometabolic biomarker profile with the profile predicted for them given their lifestyle exposure characteristics using a quantile random forest approach. People who were classed as ‘sensitive’ to hypertension- and dyslipidemia-related lifestyle exposures were at higher risk of developing cardiovascular disease (CVD, hazards ratio 1.6 (95% CI: 1.3, 1.91)), compared with the general population. No differences were observed for type 2 diabetes (T2D) risk. Here, we report a novel approach to identify individuals who are especially sensitive to adverse lifestyle exposures and who are at higher risk of subsequent cardiovascular events. Early preventive interventions may be needed in this subgroup.

Clustering Analysis and Machine Learning algorithms in the prediction of dietary patterns: Cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND

Machine learning investigates how computers can automatically learn. This study aimed to predict dietary patterns and compare algorithm performance in making predictions of dietary patterns.

METHODS

We analyzed the data of public employees (n=12,667) participating in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The K-means clustering algorithm and six other classifiers (support vector machines, naïve Bayes, K-nearest neighbors, decision tree, random forest, and xgboost) were used to predict the dietary patterns.

RESULTS

K-means clustering identified two dietary patterns. Cluster 1, labeled the Western pattern, was characterized by a higher energy intake and consumption of refined cereals, beans and other legumes, tubers, pasta, processed and red meats, high-fat milk and dairy products, and sugary beverages; Cluster 2, labeled the Prudent pattern, was characterized by higher intakes of fruit, vegetables, whole cereals, white meats, and milk and reduced-fat milk derivatives. The most important predictors were age, sex, per capita income, education level, and physical activity. The accuracy of the models varied from moderate to good (69-72%).

CONCLUSIONS

The algorithms' performance in dietary pattern prediction was similar, and the models presented may provide support in screener tasks and guide health professionals in the analysis of dietary data. This article is protected by copyright. All rights reserved.

The effect of different methods to identify, and scenarios used to address energy intake misestimation on dietary patterns derived by cluster analysis

Background

All self-reported dietary intake data are characterized by measurement error, and validation studies indicate that the estimation of energy intake (EI) is particularly affected.

Methods

Using self-reported food frequency and physical activity data from Alberta’s Tomorrow Project participants (n = 9847 men 16,241 women), we compared the revised-Goldberg and the predicted total energy expenditure methods in their ability to identify misreporters of EI. We also compared dietary patterns derived by k-means clustering under different scenarios where misreporters are included in the cluster analysis (Inclusion); excluded prior to completing the cluster analysis (ExBefore); excluded after completing the cluster analysis (ExAfter); and finally, excluded before the cluster analysis but added to the ExBefore cluster solution using the nearest neighbor method (InclusionNN).

Results

The predicted total energy expenditure method identified a significantly higher proportion of participants as EI misreporters compared to the revised-Goldberg method (50% vs. 47%, p < 0.0001). k-means cluster analysis identified 3 dietary patterns: Healthy, Meats/Pizza and Sweets/Dairy. Among both men and women, participants assigned to dietary patterns changed substantially between ExBefore and ExAfter and also between the Inclusion and InclusionNN scenarios (Hubert and Arabie’s adjusted Rand Index, Kappa and Cramer’s V statistics < 0.8).

Conclusions

Different scenarios used to account for EI misreporters influenced cluster analysis and hence the composition of the dietary patterns. Continued efforts are needed to explore and validate methods and their ability to identify and mitigate the impact of EI misestimation in nutritional epidemiology.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00696-3.

Diets benefiting health and climate relate to longevity in northern Sweden

BACKGROUND

Diets combining adequate nutritional quality and low climate impact are highly needed for human and planet health.

OBJECTIVES

We aimed to 1) evaluate nutrient density indexes' ability to predict mortality, and 2) assess the effects of diets varying in nutrient density and climate impact on total mortality.

METHODS

Dietary data from 49,124 women and 47,651 men aged 35-65 y in the population-based prospective study Västerbotten Intervention Programme (Sweden) were used. Greenhouse gas emissions (GHGEs) were estimated using data from life cycle assessments. Fifteen variants of nutrient density indexes were evaluated and the index that best predicted mortality was used to estimate participants' nutrient density. GHGEs and nutrient density were adjusted for energy intakes. Total mortality risk was estimated by Cox proportional hazards models for 4 groups of women and men, respectively, i.e., higher nutrient density, lower climate impact (HNutr/LClim); higher nutrient density, higher climate impact (HNutr/HClim); lower nutrient density, lower climate impact (LNutr/LClim); and lower nutrient density, higher climate impact (LNutr/HClim-reference group).

RESULTS

NRF11.3, a Sweden-adapted variant of the Nutrient Rich Foods index, was identified to have the best ability to predict mortality in the study population. Median follow-up times for women and men were 16.0 and 14.7 y, respectively. For women a significantly lower mortality risk was found for HNutr/LClim (HR: 0.87; 95% CI: 0.79, 0.96; P = 0.008) and HNutr/HClim (HR: 0.87; 95% CI: 0.78, 0.97; P = 0.011) than for LNutr/HClim. Among men LNutr/LClim had a significantly higher mortality risk (HR: 1.10; 95% CI: 1.01, 1.21; P = 0.033) than LNutr/HClim.

CONCLUSIONS

Diets beneficial for both health and climate are feasible and associated with lower mortality risk in women. Further studies are needed to understand how men may transition into diets that are more sustainable from a combined health and climate perspective.

Changes in food intake patterns during 2000-2007 and 2008-2016 in the population-based Northern Sweden Diet Database

Background

Food intake patterns provide a summary of dietary intake. Few studies have examined trends in food intake patterns over time in large, population-based studies. We examined food intake patterns and related sociodemographic and individual characteristics in the large Northern Sweden Diet Database during the two time windows 2000–2007 and 2008–2016.

Methods

In total, 100 507 participants (51% women) who had filled in a 64-item food frequency questionnaire and provided background and sociodemographic data between 2000 and 2016 were included. Food intake patterns were evaluated for women and men separately for the two time windows 2000–2007 and 2008–2016, respectively. Latent class analysis was used to identify distinct, latent clusters based on 40 food groups.

Results

Among both women and men, a greater proportion of participants were classified into food intake patterns characterized by high-fat spread and high-fat dairy during 2008–2016 compared to 2000–2007. In the earlier time window, these high-fat clusters were related to lower educational level and smoking. Simultaneously, the proportion of women and men classified into a cluster characterized by high intake of fruit, vegetables, and fibre decreased from the earlier to the later time window.

Conclusion

From a public health perspective, the increase in clusters with a high conditional mean for high-fat spread and high-fat dairy and decrease in clusters with a high conditional mean for fruit and vegetables, during the time period 2008–2016 compared to 2000–2007, is worrisome as it indicates a shift away from the recommended food habits. Subgroups of women and men with less healthy dietary patterns in the time window 2008–2016 with lower education, lower age, higher body mass index, lower levels of physical activity and more smoking were identified and future interventions may be targeted towards these groups.

Electronic supplementary material

The online version of this article (10.1186/s12937-019-0464-0) contains supplementary material, which is available to authorized users.

Dairy Products and Cancer Risk in a Northern Sweden Population

The role of dairy products in cancer is unclear. We assessed consumption of fermented milk, non-fermented milk, cheese, and butter, estimated from semi-quantitative food frequency questionnaires, in relation to prospective risk of breast, prostate, colorectal, smoking-, and obesity-related cancers in 101,235 subjects, including 12,552 cancer cases, in the population-based Northern Sweden Health and Disease Study. Most analyses (n = 20) rendered null results. In men, we observed an increased prostate cancer risk among high-consumers of cheese (hazard ratio (HR) for highest vs. lowest quintile (Q5-Q1), 1.11; 95% CI, 0.97-1.27; P^trend = 0.013). In women, high-consumers of cheese had a decreased risk of overall cancer (HR Q5-Q1, 0.95; 95% CI, 0.88-1.04; P^trend = 0.039), smoking-related (HR Q5-Q1, 0.84; 95% CI, 0.72-0.97; P^trend ≤ 0.001), and colorectal cancers (HR Q5-Q1, 0.82; 95% CI, 0.63-1.07; P^trend = 0.048). Butter yielded a weak decreased obesity-related cancer risk in women (HR Q5-Q1, 0.91; 95% CI, 0.81-1.02; P^trend = 0.049). Fermented milk yielded HRs below zero in women, but with no clear linear associations. In conclusion, this study does not support any major adverse or beneficial effects of fermented milk, non-fermented milk, cheese, and butter in the diet from a cancer risk perspective.

Potato consumption and risk of pancreatic cancer in the HELGA cohort

Potatoes have been a staple food in many countries throughout the years. Potatoes have a high glycaemic index (GI) score, and high GI has been associated with several chronic diseases and cancers. Still, the research on potatoes and health is scarce and contradictive, and we identified no prospective studies that had investigated the association between potatoes as a single food and the risk of pancreatic cancer. The aim of this study was to prospectively investigate the association between potato consumption and pancreatic cancer among 114 240 men and women in the prospective HELGA cohort, using Cox proportional hazard models. Information on diet (validated FFQ’s), lifestyle and health was collected by means of a questionnaire, and 221 pancreatic cancer cases were identified through cancer registries. The mean follow-up time was 11·4 (95 % CI 0·3, 16·9) years. High consumption of potatoes showed a non-significantly higher risk of pancreatic cancer in the adjusted model (hazard ratio (HR) 1·44; 95 % CI 0·93, 2·22, P_{for trend} 0·030) when comparing the highest v. the lowest quartile of potato consumption. In the sex-specific analyses, significant associations were found for females (HR 2·00; 95 % CI 1·07, 3·72, P_{for trend} 0·020), but not for males (HR 1·01; 95 % CI 0·56, 1·84, P_{for trend} 0·34). In addition, we explored the associations by spline regression, and the absence of dose–response effects was confirmed. In this study, high potato consumption was not consistently associated with a higher risk of pancreatic cancer. Further studies with larger populations are needed to explore the possible sex difference.

Dairy Product Intake and Cardiometabolic Diseases in Northern Sweden: A 33-Year Prospective Cohort Study

Dairy products are important constituents of most diets, and their association with adverse health outcomes remains a focus. We characterized dairy food intake and examined associations with the incidence of type 2 diabetes (T2D), myocardial infarction (MI) or stroke among 108,065 Swedish men and women. Hazard ratios (HRs) and 95% CIs were estimated using the multivariable Cox proportional hazards models in a population characterized by high milk tolerance. During a mean follow-up of 14.2 years, 11,641 first-time events occurred. Non-fermented milk intake decreased, whereas butter intake increased over the period. For high intake of non-fermented milk, the HR (95% CI) for developing T2D and MI was 1.17 (1.03, 1.34) and 1.23 (1.10, 1.37), respectively, in men. A greater intake of butter, fermented milk, and cheese tended to be associated with a reduced risk of T2D and/or MI. Non-consumers and those who chose low-fat variants of the targeted dairy products had increased risk for T2D, MI, or stroke compared to those in the non-case group. Generally, effect-sizes were small. This prospective study found that non-fermented milk was associated with an increased risk for developing T2D and MI and that subjects abstaining from dairy products or choosing low-fat variants were at greater risk. However, the overall cardiometabolic risk of non-fermented milk intake was judged as low, since the effect sizes were small.

Beverage consumption patterns and energy contribution from beverages per meal type: results from a national dietary survey in Sweden

OBJECTIVE

Many studies of food intake have been performed and published in Sweden, but to our knowledge no studies have extensively explored the beverage consumption of the Swedish adult population. The present study aimed to describe the beverage consumption and the contribution of beverage energy (including alcohol energy) to total energy intake according to gender, region of living, meal type and day for a Swedish adult population.

DESIGN

National dietary survey Riksmaten (2010-2011), collected by the Swedish National Food Agency.

SETTING

Sweden.

SUBJECTS

A total of 1682 participants (57 % women) reported dietary intake data during four consecutive days, specified by portion size, meal, time point, day of the week and venue. Meals were categorized as breakfast, lunch, dinner and 'other'.ResultThe beverage reported to be consumed the most was water (ml/d), followed by coffee. Men had a higher consumption of juice, soft drinks, beer, spirits and low-alcohol beer, while the consumption of tea and water was higher for women. For both genders, milk contributed the most to beverage energy intake. Energy percentage from beverages was higher at lunch and dinner during weekends for both genders. Participants from the biggest cities in Sweden had a higher consumption of wine for both genders and tea for men than participants from other regions.

CONCLUSIONS

A considerable part of total energy intake was contributed by beverages, especially for men. Beverages can contribute to a more enjoyable diet, but at the same time provide energy, sugar and alcohol in amounts that do not promote optimal health.

The effect of under-reporting of energy intake on dietary patterns and on the associations between dietary patterns and self-reported chronic disease in women aged 50–69 years

The aim of this cross-sectional study was to investigate whether under-reporting of energy intake affects derived dietary patterns and the association between dietary patterns and self-reported chronic disease. Diets of 6204 women aged 50–69 years participating in the Norwegian Breast Cancer Screening Program were assessed using a 253-item FFQ. We identified dietary patterns using principal component analysis. According to the revised Goldberg cut-off method, women with a ratio of reported energy intake:estimated BMR<1·10 were classified as low energy reporters (n 1133, 18 %). We examined the associations between dietary patterns and self-reported chronic diseases by log-binomial regression, and the results are presented as prevalence ratios (PR) and CI. ‘Prudent’, ‘Western’ and ‘Continental’ dietary patterns were identified among all reporters and plausible reporters. The PR expressing the associations between the ‘Western’ and ‘Prudent’ dietary pattern scores and self-reported chronic diseases were consistently highest among plausible reporters except for joint/muscle/skeletal disorders. The largest difference in PR among plausible v. all reporters was found for the association between the ‘Prudent’ pattern and diabetes (PR for highest v. lowest tertile: PRall reporters 2·16; 95 % CI 1·50, 3·13; Ptrend<0·001; PRplausible reporters 2·86; 95 % CI 1·81, 4·51; Ptrend<0·001). In conclusion, our results suggest that under-reporting can result in systematic error that can affect the association between dietary pattern and disease. In studies of dietary patterns, investigators ought to consider reporting effect estimates both for all individuals and for plausible reporters.

Dietary intake, leisure time activities and obesity among adolescents in Western Sweden: a cross-sectional study

BACKGROUND

Overweight and obesity among adolescents are increasing worldwide. Risk factors include dietary intake characteristics and high levels of physical inactivity. In Sweden, few large comprehensive population-based surveys of dietary intake and lifestyle among adolescents have been carried out. Thus, the purpose of the current study was to describe dietary intake and food choices as well as leisure time activities in relation to overweight and obesity in a total sample of all schoolchildren aged 15 years in Western Sweden.

METHODS

In 2008, a questionnaire was sent to all 21,651 adolescents born in 1992 in Västra Götaland Region, Sweden. Participation rate was 54.3 % (50.7 % girls/49.3 % boys). The questionnaire included a 73-item semi-quantitative food frequency questionnaire and questions on lifestyle. Results were evaluated against the Nordic Nutrition Recommendations and Swedish indicators of healthy diet and exercise habits. Associations with concurrent overweight and obesity were evaluated in multiple linear regression analysis.

RESULTS

Among girls, 49.5 % reached the goal of consuming fruit and vegetables at least daily, whereas for boys the figure was 34.4 %. Among both sexes, 15 % reached the goal of consuming fish at least twice weekly. Two-thirds of both sexes reached the goal of regular moderate or vigorous physical activity weekly. In total, 12.4 % were overweight and 2.4 % were obese. More girls than boys were underweight, whereas more boys than girls were overweight or obese (p < 0.001). Boys exhibited a more frequent intake of sodas and concentrated fruit juices, milk 3 % fat, bread and potatoes and fast food (p < 0.001). Frequent intake of candies and chocolate was reported by both sexes. Among girls and boys, living in rural areas, living in apartments and reporting no frequent leisure time physical activity were significant risk factors for being overweight or obese, also when adjusted for other risk factors.

CONCLUSIONS

Dietary habits of adolescents in Western Sweden warrant improvements. Public health actions should be taken to increase consumption of fruit, vegetables and fish, and decrease consumption of sodas and candies and also to increase frequency of physical activity. These actions may be helpful in reducing risks for overweight and obesity.

A Lebanese dietary pattern promotes better diet quality among older adults: findings from a national cross-sectional study

Background

Proper nutrition is critical for healthy aging and maintaining functional independence. Limited research has been done on the assessment of dietary patterns of older adults and their association with diet quality indices. This study was conducted to identify, characterize, and evaluate the dietary patterns and diet quality of older adults in Lebanon, a middle-income country undergoing nutrition transition.

Methods

A cross-sectional population-based study was conducted on a nationally representative sample of community-dwelling older adults aged >50 years (n = 525). Socio-demographic, anthropometric, and lifestyle variables were collected through interviews, and dietary intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Five commonly used diet quality indices (DQIs) were calculated, including the Alternative Healthy Eating Index (AHEI), the alternate Mediterranean diet score (aMed), the Dietary Approach to Stop Hypertension (DASH) style diet score, and the Lebanese Mediterranean Diet index. Dietary patterns (DPs) were derived using exploratory factor analysis. Associations of identified DPs with energy, energy-adjusted nutrients, and DQIs were evaluated by Pearson’s correlations. Multiple linear regression analyses were used to examine correlates of DPs.

Results

Three DPs were derived: Lebanese, Western, and High Protein/Alcohol patterns. The Lebanese pattern had highest correlations with fiber, folate, vitamin C, and all five DQIs. The Western was positively associated with energy and sodium and was inversely correlated with fiber, most vitamins, and a number of DQIs, namely AHEI, aMED, and DASH-style diet score. Highest correlations with intakes of proteins and fat were observed for the High Protein/Alcohol pattern. The Lebanese pattern was associated with female gender, education, nonsmoking and physical activity, whereas the Western pattern was associated with adverse health behaviors, including smoking, skipping breakfast, and physical inactivity.

Conclusions

Of the three identified patterns, the Lebanese DP was associated with better diet quality and healthier lifestyle behaviors while the Western pattern implicated a lower quality diet. Public health programs promoting prudent diets, including the Mediterranean and Lebanese DPs, are needed to improve the diet quality of middle-aged and older adults in an attempt to improve their functionality and quality of life.

Dietary patterns in Swedish adults; results from a national dietary survey

Dietary patterns derived by statistical procedures is a way to identify overall dietary habits in specific populations. The aim of this study was to identify and characterise dietary patterns in Swedish adults using data from the national dietary survey Riksmaten adults 2010-11 (952 women, 788 men). Principal component analyses were used and two patterns were identified in both sexes: a healthy pattern loading positively on vegetables, fruits, fish and seafood, and vegetable oils, and negatively on refined bread and fast food, and a Swedish traditional pattern loading positively on potatoes, meat and processed meat, full-fat milk products, sweet bakery products, sweet condiments and margarine. In addition, a light-meal pattern was identified in women with positive loadings on fibre-rich bread, cheese, rice, pasta and food grain dishes, substitute products for meat and dairy products, candies and tea. The healthy pattern was positively correlated to dietary fibre (r 0·51-0·58) and n-3 (r 0·25-0·31) (all P<0·0001), and had a higher nutrient density of folate, vitamin D and Se. The Swedish traditional and the light-meal pattern were positively correlated to added sugar (r 0·20-0·25) and the Swedish traditional also to SFA (r 0·13-0·21) (all P<0·0001); both patterns were in general negatively correlated to micronutrients. Dietary pattern scores were associated with, for example, age, physical activity, education and income. In conclusion, we identified three major dietary patterns among Swedish adults. The patterns can be further used for examining the association between whole diet and health outcomes.

Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort

No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992–8, included 120 010 cohort members aged 30–64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v. lowest quartile of intake of total WG products was 0·68 (95 % CI 0·62, 0·75, Ptrend over quartiles< 0·0001) for women and 0·75 (95 % CI 0·68, 0·81, Ptrend over quartiles< 0·0001) for men. The MRR for highest v. lowest quartile of intake of total WG types was 0·74 (95 % CI 0·67, 0·81, Ptrend over quartiles< 0·0001) for women and 0·75 (95 % CI 0·68, 0·82, Ptrend over quartiles< 0·0001) for men. Despite lower statistical power, the analyses of cause-specific mortality according to quartiles of WG intake supported these results. In conclusion, higher intake of WG products and WG types was associated with lower mortality among participants in the HELGA cohort. The study indicates that intake of WG is an important aspect of diet in preventing early death in Scandinavia.

Use of Scandinavian moist smokeless tobacco (snus) and the risk of atrial fibrillation

BACKGROUND

Snus is a smokeless tobacco product, widely used among Swedish men and increasingly so elsewhere. There is debate as to whether snus is an acceptable "harm-reduction" tobacco product. Since snus use delivers a dose of nicotine equivalent to cigarettes, and has been implicated in cardiac arrhythmia because of associations with sudden cardiovascular death, a relation with atrial fibrillation is plausible and important to investigate.

METHODS

To assess the relation between use of snus and risk of atrial fibrillation, we carried out a pooled analysis of 7 prospective Swedish cohort studies. In total, 274,882 men, recruited between 1978 and 2004, were followed via the National Patient Register for atrial fibrillation. Primary analyses were restricted to 127,907 never-smokers. Relative risks were estimated using Cox proportional hazard regression.

RESULTS

The prevalence of snus use was 25% among never-smokers. During follow-up, 3,069 cases of atrial fibrillation were identified. The pooled relative risk of atrial fibrillation was 1.07 (95% confidence interval = 0.97-1.19) in current snus users, compared with nonusers.

CONCLUSION

Findings from this large national pooling project indicate that snus use is unlikely to confer any important increase in risk of atrial fibrillation.

Effect of energy under-reporting on secular trends of dietary patterns in a mediterranean population

BACKGROUND

Diet is an important factor in the prevention of chronic diseases. Analysis of secular trends of dietary patterns can be biased by energy under-reporting. Therefore, the objective of the present study was to analyse the impact of energy under-reporting on dietary patterns and secular trends in dietary patterns defined by cluster analysis.

DESIGN AND METHODS

Two cross-sectional population-based surveys were conducted in Spain, in 2000 and 2005, with 3058 and 6352 participants, respectively, aged 25 to 74 years. Validated questionnaire was used to collect dietary data. Cluster analysis was run separately for all participants, plausible energy reporters (PER), and energy under-reporters (EUR) to define dietary patterns.

RESULTS

Three clusters, "healthy", "mixed" and "western", were identified for both surveys. The "mixed" cluster was the predominant cluster in both surveys. Excluding EUR reduced the proportion of the "mixed" cluster up to 6.40% in the 2000 survey; this caused secular trend increase in the prevalence of the "mixed" pattern. Cross-classification analysis of all participants and PER' data showed substantial agreement in cluster assignments: 68.7% in 2000 and 84.4% in 2005. Excluding EUR did not cause meaningful (≥ 15%) changes in the "healthy" pattern. It provoked changes in consumption of some food groups in the "mixed" and "western" patterns: mainly decreases of unhealthy foods within the 2000 and increases of unhealthy foods within the 2005 surveys. Secular trend effects of EUR were similar to those within the 2005 survey. Excluding EUR reversed the direction of secular trends in consumption of several food groups in PER in the "mixed" and "western" patterns.

CONCLUSIONS

EUR affected distribution of participants between dietary patterns within and between surveys, secular trends in food group consumption and amount of food consumed in all, but not in the "healthy" pattern. Our findings emphasize threats from energy under-reporting in dietary data analysis.

Reported dietary intake in early pregnant compared to non-pregnant women - a cross-sectional study

Background

A woman’s nutritional status before conception and during pregnancy is important for maternal health and the health of the foetus. The aim of the study was to compare diet intake in early pregnant women with non-pregnant women.

Methods

Between September 2006 and March 2009, 226 women in early pregnancy were consecutively recruited at five antenatal clinics in Northern Sweden. Referent women (n = 211) were randomly selected from a current health screening project running in the same region (the Västerbotten Intervention Program; VIP). We collected diet data with a self-reported validated food frequency questionnaire with 66 food items/food aggregates, and information on portion size, alcohol consumption, and supplement intake. Data were analysed using descriptive, comparative statistics and multivariate partial least square modelling.

Results

Intake of folate and vitamin D from foods was generally low for both groups. Intake of folate and vitamin D supplements was generally high in the pregnant group and led to significantly higher total estimated intake of vitamin D and folate in the pregnant group. Iron intake from foods tended to be lower in pregnant women although iron supplement intake evened out the difference with respect to iron intake from foods only. Energy intake was slightly lower in pregnant women but not significant, a reflection of that they reported consuming significantly less of potatoes/rice/pasta, meat/fish, and vegetables (grams/day) than the women in the referent group.

Conclusions

In the present study, women in early pregnancy reported less intake of vegetables, potatoes, meat, and alcohol than non-pregnant women. As they also had a low intake (below the Nordic Nutritional Recommendations) of folate, vitamin D, and iron from foods, some of these women and their unborn children are possibly at risk for adverse effects on the pregnancy and birth outcome.

Association between the intake of α-linolenic acid and the risk of CHD

The intake of the mainly plant-derived n-3 PUFA α-linolenic acid (ALA) has been reported to be associated with a lower risk of CHD. However, the results have been inconsistent. Therefore, the objective of the present study was to examine the association between the intake of ALA and the risk of CHD. Potential effect modification by the intake of long-chain n-3 PUFA (n-3 LCPUFA) was also investigated. Data from eight American and European prospective cohort studies including 148 675 women and 80 368 men were used. The outcome measure was incident CHD (CHD event and death). During 4-10 years of follow-up, 4493 CHD events and 1751 CHD deaths occurred. Among men, an inverse association (not significant) between the intake of ALA and the risk of CHD events and deaths was observed. For each additional gram of ALA consumed, a 15 % lower risk of CHD events (hazard ratios (HR) 0·85, 95 % CI 0·72, 1·01) and a 23 % lower risk of CHD deaths (HR 0·77, 95 % CI 0·58, 1·01) were observed. No consistent association was observed among women. No effect modification by the intake of n-3 LCPUFA was observed.

Dietary patterns and whole grain cereals in the Scandinavian countries – differences and similarities. The HELGA project

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 Västerbotten 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.

Dietary intake assessment in women with different weight and pregnancy status using a short questionnaire

OBJECTIVE

First, to evaluate the ability of a short dietary questionnaire (SDQ) to estimate energy intake (EI) on group and individual levels compared with total energy expenditure (TEE) measured by the doubly labelled water method. Second, to compare the SDQ's performance in estimating energy, nutrient and food intakes with a sixty-six-item FFQ used in large-scale Swedish epidemiological research.

DESIGN

Cross-sectional.

SETTING

Umeå, Sweden.

SUBJECTS

In total, sixty-five non-pregnant women, of whom thirty-one were overweight or obese, and twenty-five pregnant, normal-weight women completed the protocol.

RESULTS

On average, the SDQ captured 78 % and 79 % of absolute TEE in the non-pregnant and pregnant normal-weight women, respectively. Furthermore, the SDQ captured an average of 57 % of TEE in the overweight/obese non-pregnant women. The Spearman correlation of EI and TEE was significant in the overweight and obese women only (ρ = 0·37, 95 % CI 0·02, 0·64). There was no significant difference between the SDQ and the more extensive FFQ in the ability to assess EI when compared with TEE. Intakes of most nutrients and foods were significantly higher when assessed with the SDQ compared with the FFQ.

CONCLUSIONS

A new short dietary questionnaire with an alternative design underestimated EI of non-pregnant and pregnant, overweight and obese women on a group level but was able to rank the overweight/obese women according to EI. Furthermore, the short questionnaire captured as much or more of the energy, nutrient and food intakes of non-pregnant normal-weight and overweight/obese women on the group level as a traditional, more extensive FFQ.

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.

Low-carbohydrate, high-protein diet score and risk of incident cancer; a prospective cohort study

BACKGROUND

Although carbohydrate reduction of varying degrees is a popular and controversial dietary trend, potential long-term effects for health, and cancer in specific, are largely unknown.

METHODS

We studied a previously established low-carbohydrate, high-protein (LCHP) score in relation to the incidence of cancer and specific cancer types in a population-based cohort in northern Sweden. Participants were 62,582 men and women with up to 17.8 years of follow-up (median 9.7), including 3,059 prospective cancer cases. Cox regression analyses were performed for a LCHP score based on the sum of energy-adjusted deciles of carbohydrate (descending) and protein (ascending) intake labeled 1 to 10, with higher scores representing a diet lower in carbohydrates and higher in protein. Important potential confounders were accounted for, and the role of metabolic risk profile, macronutrient quality including saturated fat intake, and adequacy of energy intake reporting was explored.

RESULTS

For the lowest to highest LCHP scores, 2 to 20, carbohydrate intakes ranged from median 60.9 to 38.9% of total energy intake. Both protein (primarily animal sources) and particularly fat (both saturated and unsaturated) intakes increased with increasing LCHP scores. LCHP score was not related to cancer risk, except for a non-dose-dependent, positive association for respiratory tract cancer that was statistically significant in men. The multivariate hazard ratio for medium (9-13) versus low (2-8) LCHP scores was 1.84 (95% confidence interval: 1.05-3.23; p-trend = 0.38). Other analyses were largely consistent with the main results, although LCHP score was associated with colorectal cancer risk inversely in women with high saturated fat intakes, and positively in men with higher LCHP scores based on vegetable protein.

CONCLUSION

These largely null results provide important information concerning the long-term safety of moderate carbohydrate reduction and consequent increases in protein and, in this cohort, especially fat intakes. In order to determine the effects of stricter carbohydrate restriction, further studies encompassing a wider range of macronutrient intakes are warranted.

Dietary patterns of Pakistani adults and their associations with sociodemographic, anthropometric and life-style factors

Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by prawns, fish, potatoes and yogurt. The fat and sweet pattern scores were low among older subjects, those with high BMI and waist circumference but high among females and physically active participants. The fruit and vegetable pattern was associated with younger age, high BMI, education and non-tobacco use. The seafood and yogurt pattern was associated with high BMI, increased physical activity and non-tobacco use. In conclusion, distinct dietary patterns exist for the Pakistani population that may be related to some of the population characteristics and thus may have importance in suggesting dietary and life-style interventions in the prevention of chronic diseases.

Diet and lifestyle factors associated with fish consumption in men and women: a study of whether gender differences can result in gender-specific confounding

Background

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

Methods

Lifestyle information on 32,782 men and 34,866 women (aged 30–60 years) was collected between 1992 and 2006 within the Västerbotten Intervention Programme (a health intervention in northern Sweden). Spearman correlations coefficients (R_s) were calculated between self-reported consumption of fish and other food items. Lifestyle variables were compared between fish consumption categories.

Results

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

Conclusions

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

The use of cluster analysis to derive dietary patterns: methodological considerations, reproducibility, validity and the effect of energy mis-reporting

Over the last three decades, dietary pattern analysis has come to the forefront of nutritional epidemiology, where the combined effects of total diet on health can be examined. Two analytical approaches are commonly used: a priori and a posteriori. Cluster analysis is a commonly used a posteriori approach, where dietary patterns are derived based on differences in mean dietary intake separating individuals into mutually exclusive, non-overlapping groups. This review examines the literature on dietary patterns derived by cluster analysis in adult population groups, focusing, in particular, on methodological considerations, reproducibility, validity and the effect of energy mis-reporting. There is a wealth of research suggesting that the human diet can be described in terms of a limited number of eating patterns in healthy population groups using cluster analysis, where studies have accounted for differences in sex, age, socio-economic status, geographical area and weight status. Furthermore, patterns have been used to explore relationships with health and chronic diseases and more recently with nutritional biomarkers, suggesting that these patterns are biologically meaningful. Overall, it is apparent that consistent trends emerge when using cluster analysis to derive dietary patterns; however, future studies should focus on the inconsistencies in methodology and the effect of energy mis-reporting.

The Mediterranean diet score and mortality are inversely associated in adults living in the subarctic region

The Mediterranean diet has been widely promoted and may be associated with chronic disease prevention and a better overall health status. The aim of this study was to evaluate whether the Mediterranean diet score inversely predicted total or cause-specific mortality in a prospective population study in Northern Sweden (Västerbotten Intervention Program). The analyses were performed in 77,151 participants (whose diet was measured by means of a validated FFQ) by Cox proportional hazard models adjusted for several potential confounders. The Mediterranean diet score was inversely associated with all-cause mortality in men [HR = 0.96 (95% CI = 0.93, 0.99)] and women [HR = 0.95 (95% CI = 0.91, 0.99)], although not in obese men. In men, but not in women, the score was inversely associated with total cancer mortality [HR = 0.92 (95% CI = 0.87, 0.98)], particularly for pancreas cancer [HR = 0.82 (95% CI = 0.68, 0.99)]. Cardiovascular mortality was inversely associated with diet only in women [HR = 0.90 (95% CI = 0.82, 0.99)]. Except for alcohol [HR = 0.83 (95% CI = 0.76, 0.90)] and fruit intake [HR = 0.90 (95% CI = 0.83, 0.98)], no food item of the Mediterranean diet score independently predicted mortality. Higher scores were associated with increasing age, education, and physical activity. Moreover, healthful dietary and lifestyle-related factors additively decreased the mortality likelihood. Even in a subarctic region, increasing Mediterranean diet scores were associated with a longer life, although the protective effect of diet was of small magnitude compared with other healthful dietary and lifestyle-related factors examined.

Exploring dietary patterns, obesity and sources of bias: the Västerbotten Intervention Programme (VIP)

Objective

Dietary patterns capture the overall diet and thereby provide information on how nutrients are consumed in combinations, and have been suggested to be a better method than studying single nutrients. The present study explored the relationship between dietary patterns at baseline and incidence of obesity at 10-year follow-up in women.

Design

A longitudinal study using baseline measurements from 1992–1996, including food intake, medication, heredity, socio-economic status, lifestyle and measured body composition, and follow-up data collected in 2002–2006 including measured body composition.

Setting

Data from the Västerbotten Intervention Programme (VIP) in Sweden.

Subjects

A total of 6545 initially non-obese women aged 30–50 years.

Results

Among women reporting plausible energy intakes, the ‘Fruit and vegetables cluster’ predicted the highest incidence of obesity (OR = 1·76, 95 % CI 1·11, 2·76; P = 0·015) compared with women in the other food pattern groups combined. When adjusting for metabolic factors and BMI at baseline, the risk for obesity in the ‘Fruit and vegetables cluster’ was attenuated to non-significance. In contrast, high intake of fruit per se was associated with a decreased risk of developing obesity (OR = 0·69, 95 % CI 0·51, 0·91; P = 0·010).

Conclusions

Dietary pattern groups identified by cluster analysis are likely to reflect characteristics in addition to diet, including lifestyle, previous and current health status and risk factors for future disease, whereas intake of fruit per se was a stable indicator and less affected by baseline characteristics. These results underscore the need for complementary methods in understanding diet–disease relationships.

A traditional Sami diet score as a determinant of mortality in a general northern Swedish population

OBJECTIVES

To examine the relationship between "traditional Sami" dietary pattern and mortality in a general northern Swedish population.

STUDY DESIGN

Population-based cohort study.

METHODS

We examined 77,319 subjects from the Västerbotten Intervention Program (VIP) cohort. A traditional Sami diet score was constructed by adding 1 point for intake above the median level of red meat, fatty fish, total fat, berries and boiled coffee, and 1 point for intake below the median of vegetables, bread and fibre. Hazard ratios (HR) for mortality were calculated by Cox regression.

RESULTS

Increasing traditional Sami diet scores were associated with slightly elevated all-cause mortality in men [Multivariate HR per 1-point increase in score 1.04 (95% CI 1.01-1.07), p=0.018], but not for women [Multivariate HR 1.03 (95% CI 0.99-1.07), p=0.130]. This increased risk was approximately equally attributable to cardiovascular disease and cancer, though somewhat more apparent for cardiovascular disease mortality in men free from diabetes, hypertension and obesity at baseline [Multivariate HR 1.10 (95% CI 1.01-1.20), p=0.023].

CONCLUSIONS

A weak increased all-cause mortality was observed in men with higher traditional Sami diet scores. However, due to the complexity in defining a "traditional Sami" diet, and the limitations of our questionnaire for this purpose, the study should be considered exploratory, a first attempt to relate a "traditional Sami" dietary pattern to health endpoints. Further investigation of cohorts with more detailed information on dietary and lifestyle items relevant for traditional Sami culture is warranted.

Evaluation of dietary intake in Danish adults by means of an index based on food-based dietary guidelines

BACKGROUND

Data on dietary intake and physical activity has been collected from a representative sample of the Danish population from 2003-2008.

OBJECTIVES

The aim of the present study was to describe the habitual diet in Denmark and to evaluate the overall diet quality using a diet quality index based on the National Food-Based Dietary Guidelines (FBDG), which consists of seven guidelines regarding diet and one regarding physical activity.

DESIGN

Data from the Danish National Survey of Diet and Physical Activity 2003-2008 (n=3354) were included. The diet quality index was constructed based on five of the seven dietary guidelines. Individuals were categorised according to quartiles of the diet quality index, and food and nutrient intakes were estimated in each of the groups.

RESULTS

Macronutrient distribution did not meet recommendations in any of the groups, as energy from total fat and especially saturated fat was too high. A high intake of high-fat milk products, fat on bread and processed meat contributed to a high intake of total fat and saturated fat, and sugar-sweetened soft drinks contributed to a high intake of added sugars in the group below the lowest quartile of the diet quality index. Individuals above in the highest quartile had higher intakes of 'healthy foods' such as fish, fruit and vegetables, rye bread, and also a higher consumption of water and wine. Overall, intakes of micronutrients were sufficient in all groups.

CONCLUSIONS

The diet quality index is a useful tool in assessing food and nutrient intake in individuals with high vs. low degree of compliance towards the dietary guidelines, and provides a valuable tool in future studies investigating variations in dietary intakes with respect to lifestyle, demographic and regional differences in Denmark.

Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort

BACKGROUND/OBJECTIVE

Long-term effects of carbohydrate-restricted diets are unclear. We examined a low-carbohydrate, high-protein (LCHP) score in relation to mortality.

SUBJECTS/METHODS

This is a population-based cohort study on adults in the northern Swedish county of Västerbotten. In 37,639 men (1460 deaths) and 39,680 women (923 deaths) from the population-based Västerbotten Intervention Program, deciles of energy-adjusted carbohydrate (descending) and protein (ascending) intake were added to create an LCHP score (2-20 points). Sex-specific hazard ratios (HR) were calculated by Cox regression.

RESULTS

Median intakes of carbohydrates, protein and fat in subjects with LCHP scores 2-20 ranged from 61.0% to 38.6%, 11.3% to 19.2% and 26.6% to 41.5% of total energy intake, respectively. High LCHP score (14-20 points) did not predict all-cause mortality compared with low LCHP score (2-8 points), after accounting for saturated fat intake and established risk factors (men: HR for high vs low 1.03 (95% confidence interval (CI) 0.88-1.20), P for continuous = 0.721; women: HR for high vs low 1.10 (95% CI 0.91-1.32), P for continuous = 0.229). For cancer and cardiovascular disease, no clear associations were found. Carbohydrate intake was inversely associated with all-cause mortality, though only statistically significant in women (multivariate HR per decile increase 0.95 (95% CI 0.91-0.99), P = 0.010).

CONCLUSION

Our results do not support a clear, general association between LCHP score and mortality. Studies encompassing a wider range of macronutrient consumption may be necessary to detect such an association.

Diet and lifestyle of the Sami of southern Lapland in the 1930s--1950s and today

OBJECTIVES

To describe the lifestyle of the Sami of southern Lapland 50 to 70 years ago in relation to the present-day Sami and non-Sami populations and, thereby, to provide a basis for future studies of culturally related determinants of health and illness.

STUDY DESIGN

A qualitative analysis, and a quantitative comparison of Sami and non-Sami groups.

METHODS

Semi-structured interviews were conducted with 20 elderly Sami concerning their parents' lifestyle and diet 50 to 70 years ago. Questionnaire data from 81 reindeer-herding Sami, 226 non-reindeer-herding Sami and 1,842 sex-, age- and geographically matched non-Sami from the population-based Västerbotten Intervention Project were analysed by non-parametric tests and partial least squares methodology.

RESULTS

Surprisingly, fatty fish may have been more important than reindeer meat for the Sami of southern Lapland in the 1930s to 1950s, and it is still consumed more frequently by reindeer-herding Sami than nonreindeer-herding Sami and non-Sami. Other dietary characteristics of the historical Sami and present-day reindeer-herding Sami were higher intakes of fat, blood and boiled coffee, and lower intakes of bread, fibre and cultivated vegetables, compared with present-day non-Sami. Physical activity was also a part of the daily life of the Sami to a greater extent in the 1930s to 1950s than today. Sami men often worked far from home, while the women were responsible for fishing, farming, gardening (which was introduced in the 1930-1950 period), as well as housework and childcare.

CONCLUSIONS

For studies investigating characteristic lifestyle elements of specific ethnic groups, the elements of greatest acknowledged cultural importance today (in this case reindeer meat) may not be of the most objective importance traditionally.

The implications of nutrition services within the health care system on the quality of life and longevity, in developed countries: a re-analysis of 38 studies

BACKGROUND

The United Nations' Global Population Pyramid is undertaking a shift from pyramid to cube. The concomitant decline in fertility and mortality rates produces a higher portion of older people, and, thus, an increased number of deaths due to cancer and cardiovascular disease (CVD). Limited studies have investigated the effect of health care services on longevity. In this work, findings from studies throughout the world are presented and re-analysed in order to evaluate the effect of health care services on population's health status.

METHODS

Studies that have assessed the associations of nutritional and other health care services (i.e., physicians supply, technical support, inter-collaboration) on longevity and health status were retrieved (searches in PubMed, EMBASE, Scopus, up to January 2010), and summarized here.

RESULTS

Few studies, mostly located in the US and the UK, have evaluated the role of health care services on population's health status. The majority of the studies reported a beneficial association between the frequency of physicians and mortality, while some other studies reported weak or no associations between physician's supply and longevity. Also nutritional services (screening) seem to promote better clinical outcome.

CONCLUSION

Although very few data are available, it seems that there is a positive correlation between the quality and quantity of health care services and longevity. Strong primary health care seems to be effective on the population's health outcome. Active health policy and enhancement of health and nutritional services within the health care system may contribute to improved population's health and their overall quality of life.

Mis-reporting, previous health status and health status of family may seriously bias the association between food patterns and disease

Background

Food pattern analyses are popular tools in the study of associations between diet and health. However, there is a need for further evaluation of this methodology. The aim of the present cross-sectional study was to evaluate the relationship between food pattern groups (FPG) and existing health, and to identify factors influencing this relationship.

Methods

The inhabitants of Västerbotten County in northern Sweden are invited to health check-ups when they turn 30, 40, 50, and 60 years of age. The present study includes data collected from almost 60,000 individuals between 1992 and 2005. Associations between FPG (established using K-means cluster analyses) and health were analyzed separately in men and women.

Results

The health status of the participants and their close family and reporting accuracy differed significantly between men and women and among FPG. Crude regression analyses, with the high fat FPG as reference, showed increased risks for several health outcomes for all other FPGs in both sexes. However, when limiting analysis to individuals without previous ill-health and with adequate energy intake reports, most of the risks instead showed a trend towards protective effects.

Conclusions

Food pattern classifications reflect both eating habits and other own and family health related factors, a finding important to remember and to adjust for before singling out the diet as a primary cause for present and future health problems. Appropriate exclusions are suggested to avoid biases and attenuated associations in nutrition epidemiology.

Consumption of filtered and boiled coffee and the risk of first acute myocardial infarction; a nested case/referent study

BACKGROUND AND AIM

In northern Sweden, consumption of both filtered and boiled coffee is common. Boiled coffee, especially popular in rural areas, is known to raise blood lipids, a risk factor for acute myocardial infarction (MI). To our knowledge, only one epidemiological study, a case-control study from Sweden, has investigated boiled coffee in MI, noting an increased risk at high consumption levels in men, and no association in women. The aim of the present nested case-referent study was to relate consumption of filtered and boiled coffee to the risk of first MI.

METHODS AND RESULTS

The study subjects were 375 cases (303 men, 72 women) and 1293 matched referents from the population-based Northern Sweden Health and Disease Study. Coffee consumption was assessed by food frequency questionnaire. Risk estimates were calculated by conditional logistic regression. A statistically significant positive association was found between consumption of filtered coffee and MI risk in men [odds ratio for consumption > or = 4 times/day versus < or = 1 time/day 1.73 (95% CI 1.05-2.84)]. In women, a similar association was observed, but for boiled coffee [odds ratio 2.51 (95% CI 1.08-5.86)]. After adjustment for current smoking, postsecondary education, hypertension, and sedentary lifestyle, the results for women were no longer statistically significant.

CONCLUSION

Consumption of filtered coffee was positively associated with the risk of a first MI in men. A similar tendency was observed for boiled coffee in women, but the result was not statistically significant in multivariate analysis. Further investigation in a larger study is warranted.