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Du Y, Qi L, Borné Y, Sonestedt E. Adulthood weight changes, body mass index in youth, genetic susceptibility and risk of atrial fibrillation: a population-based cohort study. BMC Med 2024; 22:345. [PMID: 39183287 PMCID: PMC11346199 DOI: 10.1186/s12916-024-03565-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/15/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND Epidemiological evidence on weight change and atrial fibrillation (AF) remains limited and inconsistent. Previous studies on body mass index (BMI) in youth and AF rarely considered subsequent BMI. This study aimed to assess the associations of AF with weight change and BMI in youth, as well as modified effect by genetic susceptibility of AF. METHODS The study included 21,761 individuals (mean age 57.8 years) from the Malmö Diet and Cancer cohort. Weight information was obtained at three time points, including recalled weight at age 20 years, measured weight at baseline (middle adulthood), and reported weight at 5-year follow-up examination (late middle adulthood). A weighted genetic risk score of AF was created using 134 variants. RESULTS During a median follow-up of 23.2 years, a total of 4038 participants developed AF. The association between weight change from early to middle adulthood and AF risk was modified by sex (Pinteraction = 0.004); weight loss was associated with a lower AF risk in females, but not in males. Conversely, weight gain was positively associated with AF risk in a linear manner in females, whereas increased AF risk appeared only when weight gain exceeded a threshold in males. Participants with weight gain of > 5 kg from middle to late middle adulthood had a 19% higher risk of AF relative to those with stable weight, whereas weight loss showed a null association. Compared to individuals with a lower BMI at age 20 years, those with a BMI above 25 kg/m2 had an increased risk of AF (HR = 1.14; 95% CI: 1.02-1.28), after controlling for baseline BMI; this association was more pronounced in males or those with a lower genetic risk of AF. CONCLUSIONS Weight gain in middle adulthood was associated with higher AF risk. Weight loss from early to middle adulthood, but not from middle to late middle adulthood, was associated with a lower risk of AF only in females. Higher BMI in youth was associated with an increased risk of AF, particularly among males or those with a lower genetic risk of AF.
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Affiliation(s)
- Yufeng Du
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yan Borné
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
- Department of Food and Meal Science and the Research Environment MEAL, Faculty of Natural Science, Kristianstad University, Kristianstad, Sweden.
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Rydhög B, Carrera-Bastos P, Granfeldt Y, Sundquist K, Sonestedt E, Nilsson PM, Jönsson T. Inverse association between Paleolithic Diet Fraction and mortality and incidence of cardiometabolic disease in the prospective Malmö Diet and Cancer Study. Eur J Nutr 2024; 63:501-512. [PMID: 38078965 PMCID: PMC10899283 DOI: 10.1007/s00394-023-03279-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 11/08/2023] [Indexed: 02/28/2024]
Abstract
PURPOSE Paleolithic Diet Fraction (PDF) estimates how large a portion of the absolute dietary intake stems from food groups included in the Paleolithic diet. In randomized controlled trials higher PDFs have been associated with healthier levels of cardiometabolic risk markers. Our aim was to build upon these findings by examining associations between PDF and mortality and incidence of cardiometabolic disease in the prospective Malmö Diet and Cancer Study. METHODS PDF was calculated from an interview-based, modified diet history method, and associations were estimated by using multivariable Cox proportional hazards regression. The examined cohort consisted of 24,104 individuals (44-74 years, 63% women) without previous coronary events, diabetes, or stroke at baseline (1992-1996). A total of 10,092 individuals died during a median follow-up of 18 years. RESULTS Median PDF was 40% (0-90%). The adjusted hazard ratios (HR) for PDF as a continuous variable (from 0 to 100%) were for risk of death from all causes 0.55 [95% CI 0.45, 0.66], tumor 0.68 [95% CI 0.49, 0.93], cardiovascular 0.55 [95% CI 0.39, 0.78], respiratory 0.44 [95% CI 0.21, 0.90], neurological 0.26 [95% CI 0.11, 0.60], digestive, 0.10 [95% CI 0.03, 0.30], and other diseases 0.64 [95% CI 0.41, 1.00]. The corresponding HR for risk of coronary event was 0.61 [95% 0.43, 0.86], for ischemic stroke it was 0.73 [95% 0.48, 1.09] and for type 2 diabetes it was 0.82 [95% 0.61, 1.10]. CONCLUSION Observational data suggest an inverse association between PDF and all-cause as well as cause-specific mortality and incidence of cardiometabolic disease.
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Affiliation(s)
- Björn Rydhög
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Jan Waldenströms Gata 35, CRC, Hus 28 Plan 11, 205 02, Malmö, Sweden.
| | - Pedro Carrera-Bastos
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Jan Waldenströms Gata 35, CRC, Hus 28 Plan 11, 205 02, Malmö, Sweden
| | - Yvonne Granfeldt
- Department of Food Technology, Engineering and Nutrition, Lund University, Lund, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Jan Waldenströms Gata 35, CRC, Hus 28 Plan 11, 205 02, Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Peter M Nilsson
- Internal Medicine-Epidemiology, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Tommy Jönsson
- Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Skåne University Hospital, Lund University, Jan Waldenströms Gata 35, CRC, Hus 28 Plan 11, 205 02, Malmö, Sweden
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Li H, Wang Y, Sonestedt E, Borné Y. Associations of ultra-processed food consumption, circulating protein biomarkers, and risk of cardiovascular disease. BMC Med 2023; 21:415. [PMID: 37919714 PMCID: PMC10623817 DOI: 10.1186/s12916-023-03111-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND We aim to examine the association between ultra-processed foods (UPF) consumption and cardiovascular disease (CVD) risk and to identify plasma proteins associated with UPF. METHODS This prospective cohort study included 26,369 participants from the Swedish Malmö Diet and Cancer Study, established in 1991-1996. Dietary intake was assessed using a modified diet history method, and UPF consumption was estimated using the NOVA classification system. A total of 88 selected CVD-related proteins were measured among 4475 subjects. Incident CVD (coronary heart disease and ischemic stroke) was defined as a hospital admission or death through registers. Cox proportional hazards regression models were performed to analyze the associations of UPF intake with risks of CVD. Linear regression models were used to identify the plasma proteins associated with UPF intake. RESULTS During 24.6 years of median follow-up, 6236 participants developed CVD, of whom 3566 developed coronary heart disease and 3272 developed ischemic stroke. The adjusted hazard ratio (95% confidence interval) in the 4th versus 1st quartile of UPF was 1.18 (1.08, 1.29) for CVD, 1.20 (1.07, 1.35) for coronary heart disease, and 1.17 (1.03, 1.32) for ischemic stroke. Plasma proteins interleukin 18, tumor necrosis factor receptor 2, macrophage colony-stimulating factor 1, thrombomodulin, tumor necrosis factor receptor 1, hepatocyte growth factor, stem cell factor, resistin, C-C motif chemokine 3, and endothelial cell-specific molecule 1 were positively associated with UPF after correcting for multiple testing. CONCLUSIONS Our study showed that high UPF intake increased the risk of CVD and was associated with several protein biomarkers. Future studies are warranted to validate these findings and assess the potential pathways between UPF intake and CVD.
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Affiliation(s)
- Huiping Li
- School of Medicine, Northwest University, Taibai North Road, Beilin District, Xi'an, 710069, China.
- School of Public Health, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, 300070, China.
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 21428, Malmö, Sweden.
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 21428, Malmö, Sweden
| | - Yan Borné
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 21428, Malmö, Sweden.
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Strid A, Hallström E, Lindroos AK, Lindahl B, Johansson I, Winkvist A. Adherence to the Swedish dietary guidelines and the impact on mortality and climate in a population-based cohort study. Public Health Nutr 2023; 26:2333-2342. [PMID: 37395057 DOI: 10.1017/s1368980023001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To assess the associations between adherence to the Swedish dietary guidelines and all-cause mortality (i.e. assessing the index' ability to predict health outcomes), as well as levels of dietary greenhouse gas emissions (GHGEs). DESIGN A longitudinal study 1990-2016 within the population-based cohort Västerbotten Intervention Programme. Dietary data were based on FFQs. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15), based on the 2015 Swedish dietary guidelines. Dietary GHGEs were estimated from life cycle assessment data including emissions from farm to industry gate. Hazard ratios (HR) and 95 % CI of all-cause mortality were evaluated with Cox proportional hazards regression, and differences in median GHGEs were tested between quintiles of SHEIA15 score using the Kruskal-Wallis one-way ANOVA test. SETTING Northern Sweden. PARTICIPANTS In total, 49 124 women and 47 651 men, aged 35-65 years. RESULTS Median follow-up times were 16·0 years for women and 14·7 years for men, during which time 3074 women and 4212 men died. A consistent trend of lower all-cause mortality HR for both sexes with higher SHEIA15 scores was demonstrated. For women, the all-cause mortality HR was 0·81 ((95 % CI 0·71, 0·92); P = 0·001) and for men 0·90 ((95 % CI 0·81, 0·996); P = 0·041) between the quintile with the highest SHEIA15 score compared with the quintile with the lowest SHEIA15 score. A consistent trend of lower estimated dietary GHGEs among both sexes with higher SHEIA15 scores was also found. CONCLUSIONS Adherence to Swedish dietary guidelines, estimated by SHEIA15, seems to promote longevity and reduce dietary climate impact.
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Affiliation(s)
- Anna Strid
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, SE-405 30Gothenburg, Sweden
| | - Elinor Hallström
- Department of Agriculture and Food, Research Institutes of Sweden (RISE), Lund, Sweden
| | - Anna Karin Lindroos
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, SE-405 30Gothenburg, Sweden
- Department of Risk and Benefit Assessment, Swedish Food Agency, Uppsala, Sweden
| | - Bernt Lindahl
- Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, The Sahlgrenska Academy, University of Gothenburg, SE-405 30Gothenburg, Sweden
- Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Zhang S, Li H, Engström G, Niu K, Qi L, Borné Y, Sonestedt E. Milk intake, lactase persistence genotype, plasma proteins and risks of cardiovascular events in the Swedish general population. Eur J Epidemiol 2023; 38:211-224. [PMID: 36604367 PMCID: PMC9905175 DOI: 10.1007/s10654-022-00937-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/16/2022] [Indexed: 01/07/2023]
Abstract
To investigate the associations of milk intake (non-fermented and fermented milk), lactase persistence (LCT-13910 C/T) genotype (a proxy for long-term non-fermented milk intake), and gene-milk interaction with risks of cardiovascular disease (CVD) and CVD mortality. Also, to identify the CVD-related plasma proteins and lipoprotein subfractions associated with milk intake and LCT-13910 C/T genotype. The prospective cohort study included 20,499 participants who were followed up for a mean of 21 years. Dietary intake was assessed using a modified diet history method. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). After adjusting for sociodemographic and lifestyle factors, higher non-fermented milk intake was significantly associated with higher risks of coronary heart disease (CHD) and CVD mortality, whereas higher fermented milk intake was significantly associated with lower risks of CVD and CVD mortality. The genotype associated with higher milk (mainly non-fermented) intake was positively associated with CHD (CT/TT vs. CC HR = 1.27; 95% CI: 1.03, 1.55) and CVD (HR = 1.22; 95% CI: 1.05, 1.42). The association between rs4988235 genotype and CVD mortality was stronger in participants with higher milk intake than among participants with lower intake (P for interaction < 0.05). Furthermore, leptin, HDL, and large HDL were associated with non-fermented milk intake, while no plasma proteins or lipoprotein subfractions associated with fermented milk intake and LCT-13910 C/T genotype were identified. In conclusion, non-fermented milk intake was associated with higher risks of CHD and CVD mortality, as well as leptin and HDL, whereas fermented milk intake was associated with lower risks of CVD and CVD mortality.
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Affiliation(s)
- Shunming Zhang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 21428, Malmö, Sweden.
| | - Huiping Li
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 21428, Malmö, Sweden
- Nutritional Epidemiology Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Gunnar Engström
- Cardiovascular Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Kaijun Niu
- Nutritional Epidemiology Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yan Borné
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 21428, Malmö, Sweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms Gata 35, 21428, Malmö, Sweden
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Li H, Borné Y, Wang Y, Sonestedt E. Starch intake, amylase gene copy number variation, plasma proteins, and risk of cardiovascular disease and mortality. BMC Med 2023; 21:27. [PMID: 36691017 PMCID: PMC9872432 DOI: 10.1186/s12916-022-02706-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Salivary amylase, encoded by the AMY1 gene, initiate the digestion of starch. Whether starch intake or AMY1 copy number is related to disease risk is currently rather unknown. The aim was to investigate the association between starch intake and AMY1 copy number and risk of cardiovascular disease (CVD) and mortality and whether there is an interaction. In addition, we aim to identify CVD-related plasma proteins associated with starch intake and AMY1 copy number. METHODS This prospective cohort study used data from 21,268 participants from the Malmö Diet and Cancer Study. Dietary data were collected through a modified diet history method and incident CVD and mortality were ascertained through registers. AMY1 gene copy number was determined by droplet digital polymerase chain reaction, a risk score of 10 genetic variants in AMY1 was measured, and a total of 88 selected CVD-related proteins were measured. Cox proportional hazards regression was used to analyze the associations of starch intake and AMY1 copy number with disease risk. Linear regression was used to identify plasma proteins associated with starch intake and AMY1 copy number. RESULTS Over a median of 23 years' follow-up, 4443 individuals developed CVD event and 8125 died. After adjusting for potential confounders, a U-shape association between starch intake and risk of CVD (P-nonlinearity = 0.001) and all-cause mortality (P-nonlinearity = 0.03) was observed. No significant association was found between AMY1 copy number and risk of CVD and mortality, and there were no interactions between starch intake and AMY1 copy number (P interaction > 0.23). Among the 88 plasma proteins, adrenomedullin, interleukin-1 receptor antagonist protein, fatty acid-binding protein, leptin, and C-C motif chemokine 20 were associated with starch intake after adjusting for multiple testing. CONCLUSIONS In this large prospective study among Swedish adults, a U-shaped association between starch intake and risk of CVD and all-cause mortality was found. Several plasma proteins were identified which might provide information on potential pathways for such association. AMY1 copy number was not associated with CVD risk or any of the plasma proteins, and there was no interaction between starch intake and AMY1 copy number on disease risk.
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Affiliation(s)
- Huiping Li
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, China.
- Nutritional Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
| | - Yan Borné
- Nutritional Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden.
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